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Vicki managed to work up another dirt-eating smile. “Degree or not, what’s the difference?”

“Well,” said Chip, “it might make quite a difference to someone like Dr. Delaware here, who genuinely earned his.”

“I’m sure it does.

He heard the acid in her voice and gave her a quizzical look. She got flustered and looked away.

He noticed the gift box. “Vicki. Again?”

“It’s just a little something.”

“That’s very sweet of you, Vicki, but totally unnecessary.”

“I wanted to, Dr. Jones. She’s such an angel.”

“That she is, Vicki.” He smiled. “Another bunny?”

“Well, she likes them, Dr. Jones.”

Mister, Vicki — if you insist on using a title, how about Herr Professor? It has a nice classical ring to it, wouldn’t you agree, Dr. Delaware?”

“Absolutely.”

He said, “I’m prattling — this place addles me. Thank you again, Vicki. You’re very sweet.”

Bottomley went scarlet.

Chip turned to me. “Ready if you are, Doctor.”

We walked through the teak doors into the hustle of Five East. A child being wheeled somewhere was crying, a little boy hooked to an I.V. and turbaned with bandages. Chip took it in, frowning but not talking.

As we approached the elevators he shook his head and said, “Good old Vicki. What a shameless brownnoser. But she got kind of uppity with you back there, didn’t she?”

“I’m not her favorite person.”

“Why?”

“I don’t know.”

“Ever have any hassles with her before?”

“Nope. Never met her before.”

He shook his head. “Well, I’m sorry for you, but she seems to be taking really good care of Cassie. And Cindy likes her. I think she reminds Cindy of her aunt — she had an aunt who raised her. Also a nurse, real tough egg.”

After we passed a gaggle of dazed-looking medical students, he said, “It’s probably territorial — Vicki’s reaction to you. Some kind of turf battle, wouldn’t you say?”

“Could be.”

“I notice a lot of that kind of thing around here. Possessiveness over patients. As if they’re commodities.”

“Have you experienced that personally?”

“Oh, sure. Plus, our situation heightens the tension. People think that we’re worth kissing up to, because we’ve got some sort of direct line to the power structure. I assume you know who my dad is.”

I nodded.

He said, “It rubs me the wrong way, being treated differently. I worry about it leading to substandard care for Cassie.”

“In what way?”

“I don’t know, nothing specific — I guess I’m just not comfortable with being an exception. I don’t want anyone missing something important because they hung back or broke routine out of fear of offending our family. Not that Dr. Eves isn’t great — I have nothing but respect for her. It’s more the whole system — a feeling I get when I’m here.”

He slowed his pace. “Maybe I’m just talking through my hat. The frustration. Cassie’s been sick with one thing or another for virtually her whole life and no one’s figured out what’s wrong yet, and we also... What I’m saying is that this hospital’s a highly formalized structure and whenever the rules change in a formalized structure, you run the risk of structural cracks. That’s my field of interest: Formal Org — Formal Organizations. And let me tell you, this is some organization.”

We reached the elevators. He punched the button and said, “I hope you can help Cassie with the shots — she’s gone through an absolute nightmare. Cindy, too. She’s a fantastic mother, but with this kind of thing, self-doubts are inevitable.”

“Is she blaming herself?” I said.

“Sometimes. Even though it’s totally unjustified. I try to tell her, but...”

He shook his head and put his hands together. The knuckles were white. Reaching up, he rotated his earring.

“The strain on her’s been incredible.”

“Must be rough on you, too,” I said.

“It hasn’t been fun, that’s for sure. But the worst of it falls on Cindy. To be honest, we’ve got your basic, traditional, sex role-stereotyped marriage — I work; she takes care of things at home. It’s by mutual choice — what Cindy really wanted. I’m involved at home to some extent — probably not as much as I should be — but child rearing’s really Cindy’s domain. God knows she’s a hell of a lot better at it than I am. So when something goes wrong in that sphere, she takes all the responsibility on her shoulders.”

He stroked his beard and shook his head. “Now, that was an impressive bit of defensive pedantry, wasn’t it? Yes, sure, it’s been damned rough on me. Seeing someone you love... I assume you know about Chad — our first baby?”

I nodded.

“We hit bottom with that, Dr. Delaware. There’s just no way to...” Closing his eyes, he shook his head again. Hard, as if trying to dislodge mental burrs.

“Let’s just say it wasn’t anything I’d wish on my worst enemy.”

He jabbed the elevator button, glanced at his watch. “Looks like we caught the local, Doctor. Anyway, we were just coming out of it — Cindy and I. Pulling ourselves together and starting to enjoy Cassie when this mess hit the fan... Unbelievable.”

The elevator arrived. Two candy-stripers and a doctor exited, and we stepped in. Chip pushed the ground-floor button and settled with his back against the compartment’s rear wall.

“You just never know what life’s going to throw you,” he said. “I’ve always been stubborn. Probably to a fault — an obnoxious individualist. Probably because a lot of conformity was shoved down my throat at an early age. But I’ve come to realize I’m pretty conservative. Buying into the basic values: Live your life according to the rules and things will eventually work out. Hopelessly naïve, of course. But you get into a certain mode of thinking and it feels right, so you keep doing it. That’s as good a definition of faith as any, I guess. But I’m fast losing mine.”

The elevator stopped at four. A Hispanic woman in her fifties and a boy of around ten got on. The boy was short, stocky, bespectacled. His blunt face bore the unmistakable cast of Down’s syndrome. Chip smiled at them. The boy didn’t appear to notice him. The woman looked very tired. No one talked. The two of them got off at three.

When the door closed, Chip kept staring at it. As we resumed our descent he said, “Take that poor woman. She didn’t expect that — child of her old age and now she has to take care of him forever. Something like that’ll shake up your entire worldview. That’s what’s happened to me — the whole child-rearing thing. No more assumptions about happy endings.”

He turned to me. The slate eyes were fierce. “I really hope you can help Cassandra. As long as she has to go through this shit, let her be spared some of the pain.”

The elevator landed. The moment the door opened, he was out and gone.

When I got back to the General Peds clinic, Stephanie was in one of the exam rooms. I waited outside until she came out a few minutes later, followed by a huge black woman and a girl of around five. The girl wore a red polka-dot dress and had coal-black skin, cornrows, and beautiful African features. One of her hands gripped Stephanie’s; the other held a lollipop. A tear stream striped her cheek, lacquer on ebony. A round pink Band-Aid dotted the crook of one arm.

Stephanie was saying, “You did great, Tonya.” She saw me and mouthed, “My office,” before returning her attention to the girl.