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Raymond got to his feet, pressed his napkin to his chest, and gave me a hearty welcome. He was the sort of person who smiled with blatant insincerity from one side of his mouth while addressing you as “Mr. So-and-So,” sometimes preceding that with “Well, if it isn’t old—” I think he was trying to be funny but I’m not sure. I hugged Adrienne as she stood, running the end of my forefinger up the small of her back to feel her shiver. Very responsive, that Adrienne, and she rewarded me with a twinkle. The three of us sat down together. They both beamed at me with the intense curiosity which we save for people we suspect might not be stable. I do think I was viewed as not quite under control, but some women liked that. Adrienne had once said of her husband, “I wanted him so badly, I can’t believe I’m sick of him now.” I thought she was either being provocative or just covering her tracks.

Quite inadvertently as my hand rested in my lap our fingers touched, and as she didn’t withdraw hers, I let them intertwine. Raymond did notice this. “A little wine?” he asked sarcastically. “Some candles, perhaps?”

“Raymond, be a sport and let me at him.” Expressed like this, we had to laugh. “Really, all of my antics are just for Raymond’s entertainment.” Good one, that, and it took Raymond in, as his returning complacency attested.

“In English class,” Raymond said, “we once had to write an essay on one of Dante’s circles of hell, and we could pick whichever circle we wanted. I picked ‘the Sea of Excrement’ and it really has stayed with me.”

When Adrienne and Raymond came with me one afternoon for a visit to my father, Raymond kept saying about his meager house, “It’s all you need!” He seemed antic and uncomfortable. Afterward, my father remarked, “I wouldn’t piss on him if he was on fire.”

I knew Raymond didn’t like me. My cherished friend Jinx said he hated me, but I thought that was a bit much. As a single woman, Jinx gets around more than I do, invited here and there: she had a very sharp ear and a sharper memory.

I had by now acknowledged my solipsism, my slow winding inward. I also noticed that Kavanagh left without a word. I supposed I had impolitely abandoned him, but after all, he had farted in my glove. Still, I’d been discomfited by the cold stare I had caught from Raymond Wilmot before he realized I’d seen him.

“You can make Adrienne very happy if you’ll come for dinner.”

“I’d love to,” I intoned.

“And in the interest of appearances, I’ll join you.”

I told Raymond that that was entirely up to him. I knew how unsatisfactory that was, since he undoubtedly knew there had been more to Adrienne’s and my flirtation than met the eye. I just didn’t think he cared. I was wrong about that: he cared. It would later seem that it was all he cared about.

The December night that I was celebrating my fortieth birthday with a small cake in the emergency room, they brought Tessa in: into her abdomen she had plunged a serrated bread knife, an item she continued to clutch while on the gurney. I took it from her hand, and feeling the heat of her gaze, I quickly moved to dealing with her wound. I knew that if she were admitted to the clinic itself she would be subjected to what I viewed as diagnostic imprudence — laparotomy and various explorations, which experience had caused me to associate with increased morbidity. Though I would later have a chance to review these judgments, I honestly felt that they didn’t alter the way things turned out. In effect, I was keeping Tessa to myself. I had hoped that this was a cry-for-help injury — the timing, during my shift, aroused my suspicions — but the knife, it turned out, had pierced the skin, the subcutaneous layer, the linea alba, and the peritoneum, and I could only hope that it had gone no farther, that is, into the viscera. Over the next four days, attending Tessa round the clock while she stared at me without speaking, I failed to contain the major leakage, the uncontrolled granulosis of the peritoneum, the necrosis, and an infection that laughed off antibiotics in a general cascade. She was looking right through me when she slipped away.

Aren’t there things that your parents should tell you? After my mother’s death, I had found her reading glasses. I’d sat down on our old sofa in front of the window, with its view of a stunted row of odorless rugosa roses, still knowing, after all those years, which part I could sit on without feeling the springs. I put my mother’s glasses on. The earpieces were too short for me, and I had to press them down on my nose uncomfortably. It didn’t matter: I could barely see through them.

I only felt that something quite terrible had happened to me. My first instinct was flight: I would just leave town, leave the area, try to leave myself; but that soon struck me as irrational and no more than a conversion of this terrible feeling into weakness that would open up into something worse. And something happened that was quite meaningless, however unsettling: driving home from the hospital, I saw children standing alongside the road holding tombstones; at closer range the tombstones turned out to be skateboards, but the first impression endured.

The death of Tessa gave rise to some misunderstandings in town, and at first the doctors stood by me. But we began having trouble with our board of directors, and the clinic went half speed as a kind of protest or strike. Raymond Wilmot was now chairman of the board.

But I wanted to work. I had to work. It was the only balm I had for the several kinds of mental pain that had beset me. I may have taken the whole thing too seriously. I had a classmate at medical school who was now marketing a homeopathic cure for jet lag; when I saw him at our reunion and asked if it actually worked, he said blandly, “There’s no fucking way.” He pointed out another classmate who had invented a universal stool softener. “He’s making a fortune.” It seemed that believing we were surrounded by people who enjoyed being fooled is what united all Americans. I had begun in the emergency room. Trauma was different: we knew exactly what to blame, and the literal qualities of the obvious thing that caused the injury was but a poor object to resent. The beauty of trauma lay in its peculiarly genuine qualities.

We kept having meetings, most among ourselves, and sometimes with the board, an altogether tiresome exercise, since the board really didn’t understand what we did and seemed to regard doctors as a necessary evil. Wilmot preached fiscal responsibility and local control. He saluted himself for “giving back to the community” which had been so good to him by taking it in the shorts on every Wilmot transaction. He never failed to thwart us on equipment and facility enhancements and would blow up if challenged. Any doctor raising questions about the finances of the clinic was urged to stick to his knitting. We also had an obsequious clinic manager, Darryl Coutts, a native of Tennessee whose genial Southern ways masked his spineless inability to grasp the essentials of the job. We ignored him too.

It seemed that we had barely recovered from one of Wilmot’s board meeting pep talks when it was time for another, with fresh rants about “emerging challenges” and “opportunities for greatness.” It didn’t help that Alan Hirsch made a cylinder with his right hand and raised and lowered it over his crotch while rolling his eyes. If the roof leaked, Wilmot assured us that a “capital infusion” was on the horizon and that our only obligation was to close ranks and provide better care for our patients. Hirsch whispered to me, “An absolute dribbling fuckwit.” As Wilmot was looking my way, I nodded gravely, hoping to give the appearance of having just absorbed some insight supportive of his bottomless inanities. “He loves you,” whispered Hirsch.