"Go on."

"Head exam, as I mentioned, revealed both depressed and compound skull fractures of the left parietal and temporal bones. Severe swelling and lacerations of the face made it difficult to evaluate facial fractures. Her pupils were midposition and unreactive. Her nose and throat-' "Oculocephalic

"reflexes?"

"I didn't test them."

"You didn't?"

"No, sir. I didn't want to manipulate the neck. I was concerned about possible spinal dislocation."

She saw, by his slight nod, that her answer had been acceptable.

She described the physical findings. The normal breath sounds. The unremarkable heart. The benign abdomen. Dr. Wettig did not interrupt. By the time she'd finished describing the neurologic findings, she was feeling more self-assured. Almost cocky. And why shouldn't she? She knew what the hell she'd been doing.

"So what was your impression?" asked Dr. Wettig. "Before you saw any x-ray results?"

"Based on the midposition and unreactive pupils," said Abby, "I felt there was probable midbrain compression. Most likely from an acute subdural or epidural haematoma." She paused, and added with a quiet note of confidence, "The CT scan confirmed it. A large left-sided subdural with severe midline shift. Neurosurgery was called in. They performed an emergency evacuation of the clot."

"So you're saying your initial impression was absolutely correct, Dr. DiMatteo?"

Abby nodded.

"Let's take a look at how things are this morning," said Dr. Wettig, moving to the bedside. He shone a penlight into the patient's eyes. "Pupils unresponsive," he said. He pressed a knuckle, hard, against the breastbone. She remained flaccid, unmoving. "No response to pain. Extensor or otherwise."

All the other residents had edged forward, but Abby remained at the foot of the bed, her gaze focused on the patient's bandaged head.