“Bypass surgery,” said Pamela. Rose had brought down the chart and Pamela flipped it open. “He’s four days postop. He’s been doing well.”

“Was doing well,” corrected Jerry. Bruce’s color looked almost normal but the pupils stayed widely dilated and the EKG ran out a flat line.

“Must have had a massive heart attack,” said Jerry. “Maybe a pulmonary embolus. Did you say he was blue when you found him?”

“Dark blue,” Pamela affirmed.

Jerry shook his head. Neither diagnosis should have produced deep cyanosis. His thoughts were interrupted by the arrival of a surgical resident, groggy with sleep.

Jerry outlined what he was doing. As he spoke, he held up a syringe of epinephrine to get rid of the air bubbles, then pushed it into Bruce’s chest, perpendicular to the skin. There was an audible snap as the needle broke through some fascia. The only other sound was the EKG machine spewing out paper with the straight line. When Jerry pulled back on the plunger, blood entered the syringe. Confident he was in the heart, Jerry injected. He motioned for Peter to recommence compressing the chest and for Rose to reinflate the lungs.

Still there was no cardiac activity. As Jerry opened the outer cover of the sterile packaging holding a transvenous pacemaker electrode, he wished he had never begun the charade. Intuitively he knew the patient was too far gone. But now he had started, he had to finish.

“I’m going to need a fourteen-gauge intercath,” said Jerry. With betadine on a cotton sponge, he began to prepare the entry site on the left side of Bruce’s neck.

“Would you like me to do that?” asked the surgical resident, speaking for the first time.

“I think we have it under control,” said Jerry, trying to project more confidence than he felt.

Pamela began helping him on with a pair of surgical gloves. They were just about to drape the patient when a figure appeared at the doorway and pushed past the medical student. Jerry’s attention was drawn by the surgical resident’s response: the ass-kisser did everything but salute. Even the nurses had perceptively straightened up as Thomas Kingsley, the hospital’s most noted cardiac surgeon, strode into the room.