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  “What if he is Lex Rittenour?” Stephanie said. “With that IPO about to happen? There’s a huge story here.”

  “That’s not our concern.”

  “It’s everybody’s concern,” she said heatedly. “It’s a scam. They’re going to screw people big-time and make a fortune doing it.”

  More severely, Monks said, “Whether or not that’s true, Stephanie, that’s not the issue here. The issue here is a patient’s confidentiality being foremost. I’d advise you to keep your speculation to yourself.”

  She let out a sound of exasperation, a sort of uh, and spun away, a gesture so reminiscent of her mother that it startled him. She looked like Gail at that age too—athletic, taffy hair cut short for swimming, not so much pretty as brightly energetic. He had not spent much time with her over the past years, and there came the bittersweet sense that she was grown, becoming lost to him.

  “I’d also advise you to sign your chart,” he called, and stepped away with mock alacrity from her withering gaze.

  Monks was somewhat familiar, from news accounts, with the issue Stephanie was talking about. At its center was a software program that worked off the recently mapped human genome, offering a sweeping diagnostic test for potential diseases and birth defects.

  The genius behind this was none other than Lex Rittenour, stepping again into the news. Within the next few days, an initial public stock-offering was scheduled to open, estimated at upward of a billion dollars.

  But criticism was furious and bitter. At the controversy’s center was a fear that tore deep into the human heart—that this was an attempt to identify and even engineer a genetically superior race, which would have privileged status and dominate its inferiors.

  Monks walked to the nurses’ station, where Leah Horvitz, the charge nurse, was working at her computer.

  “Are those Asian folks still around?” Monks asked. “The ones who brought the guy in Cubicle Seven?”

  “They disappeared.”

  Monks was not surprised. “Let’s go ahead and enter him.”

  Leah typed something with machine-gun speed. “Name?”

  “He gave it as John Smith.”

  There was an infinitesimal pause, while Leah registered what that probably meant: several hundred dollars minimum for the hospital, plus at least one unpaid physician, namely, Monks.

  “Middle initial Q by any chance?” she asked acerbically.

  “Probably.”

  She typed in the name, adding it to the other thousands of John and Jane Does in the accounts receivable files.

  “Any other information?”

  “Not yet,” Monks said. “I’ll let you know.”

  Whoever John Smith was, there remained the question of what had happened to him. A suicide attempt was possible, with him lying to cover it—but injected narcotics were not usually suicide drugs of choice. It seemed more likely that he had been trying a new kick and miscalculated his dose. Had fallen, causing the lacerations to his face. He would have stopped breathing within a minute or two—but the Asians had had the skill to keep him alive, the presence of mind to bring him here.

  However it had gone, John Smith was a lucky man.

  Monks walked back into Cubicle Seven. “Breathing okay?” he said.

  “I’ve got someone coming to get me,” John said, sounding a little smug.

  Monks gripped John’s wrist, feeling the pulse through his fingertips. It was much better, firm and steady. He released it and stepped back, folding his arms.

  “Physically, you’re coming along fine,” Monks said. “It’s my professional advice that you get a psychiatric evaluation. I can arrange one if you’ll agree.”

  “I like my head the size it is.” John’s tone was sharp.

  “It seems plenty big enough,” Monks agreed.

  John stared combatively. But then he deflated, rolling wearily to the side, knees rising into a fetal position. One hand rose to touch his own skull.

  “You see this brain? This brain founded an empire.”

  “Very impressive. Maybe it’ll break a record when the pathologist weighs it.”

  “I feel like shit.” This time the words came out in a dead, miserable tone. Monks found himself liking John a little better. “This wouldn’t have happened, except I was trying to do the right thing,” John said. “You probably don’t believe me.”

  “I don’t get how ‘doing the right thing’ involves shooting narcotics,” Monks said, but felt a touch of shame for being judgmental. He had spent more than his own share of time wrapped in the inflamed insulation of alcohol, shielding himself against his failings and rage.

  “I’m Frankenstein, man,” said John Smith. “I created a monster.”

  “Monster?”

  “A perfect monster.” John made a cackling sound, which Monks interpreted as the bleak amusement that stemmed from despair. “Worst kind. Now I want to lock it up, but—” His hands turned palm up in a gesture of futility. “It’s gotten huge.”

  “Try to get comfortable,” Monks said. “We’ll leave the IV in, in case you need more of the reversal medicine. There’s a buzzer if you have trouble.”

  “Doctor?”

  Monks paused on his way out. John had not moved, his gaze still on the wall.

  “Yes?”

  “What did you say your name was?”

  “Monks.”

  “Is that German?”

  “Irish. From gaelic manachan, a monk.”

  “What, they shortened it when they got to this country?”

  “Yeah,” Monks said. “They tried ‘Smith’ first, but nobody bought it.”

  Monks saw John’s lips curve in a smile before his eyes closed again.

  2

  Less than fifteen minutes later, Monks was in another cubicle, examining an elderly woman who complained of intestinal discomfort, when a tap came at the door. It was a nurse, looking nervous.

  “You’d better come out here, Doctor.”

  Monks could hear a voice now, across the room. It was not loud, but had an intense abrasive tone that overrode the ER’s other sounds. Its owner was a man leaning over the main desk, gripping the counter as if he were about to vault it, talking to—or more accurately at—Leah Horvitz. He was in his mid thirties, trim, wearing the young executive look: dark moussed hair, expensive suit with tie loose at the collar, tasseled shoes, Burberry overcoat. Two other men, similarly dressed, stood in the waiting room with the air of guards: one just inside the door to the ER, the other at the main entrance, talking on a cell phone. Both had the broad-shouldered look of ex-football players.

  Monks gave the worried old lady in the cubicle’s bed his best reassuring smile, which he secretly feared made him look crocodilian.

  “You’re going to be fine,” he said, patting her hand. “I’ll be right back.”

  “I’m not sure I’m getting through to you, miss,” the man at the desk was saying as Monks approached. His voice was edged with contained menace. “Your lack of cooperation could have very serious consequences for this hospital.”

  Leah, true professional that she was, ignored him with icy calm, her gaze on her work. “Why don’t you try getting through to Dr. Monks?” she said, without looking up.

  “Where do I find this Dr. Monks?”

  “Right behind you.”

  The man swung around to face Monks, thrusting his jaw forward like a boxer rising to the bell. “Are you in charge here?” he demanded.

  “I’m the senior physician on duty.”

  “You have a patient named John Smith? Where is he?”

  “He’s being cared for.”

  “He told me you’re refusing to release him. I strongly advise you to do so, now.”

  “Mind if I ask, by what authority?” Monks said.

  Impatiently, the man pulled an embossed business card from his wallet and held it up for Monks’s inspection. It identified him as Ronald Tygard, attorney, with an office in the Bank of America Building. It was a prestigious addre
ss, and Tygard obviously knew it.

  “I’ll take care of the bill right now,” Tygard said.

  Monks said, “That would be nice. But I’m afraid you can’t have John Smith just yet. There’s a question of competence.”

  “Are you suggesting I’m not competent?” Tygard said, bristling.

  “I’m telling you he’s not, in the medical and legal sense. Not in full control of himself. He could still go down again.”

  “We won’t let him out of our sight.”

  “The keyword is medical, friend,” Monks said again. “He needs full-time medical attention, until he’s out of danger.”

  “You have no idea of the league you’re dealing with.” Tygard spoke quietly, with narrowed eyes.

  “This is not my personal preference, Mr. Tygard. I’m talking about liability exposure.” Monks could not resist adding, “Surely, you understand. As an attorney.”

  “This is bullshit,” Tygard said disgustedly, and signaled to his crony standing guard inside the ER door. “Andrew, go find him.” Andrew took a striding step into the room, as if to start yanking open cubicle doors.

  Monks threw the rope around his temper again, but not by much. “Mr. Tygard, if your man’s not here because he needs emergency medical attention, he’s interfering with people who do. So are you. Kindly leave, both of you.”

  Tygard ignored him.

  Monks was abruptly aware that the ER seemed still, hushed. Personnel were paused in their movements as in a tableau, none watching openly but everyone tuned in to see how this was going to work out.

  He said to Leah, “Call Security. Let’s get the SFPD here too.”

  “Hold on, now.” Tygard spun toward Leah with palm outstretched. She watched Monks, phone receiver in one hand, finger poised over the button.

  Tygard bowed his head—a somewhat theatrical gesture of being overwrought by circumstances, struggling manfully for control. Then he inhaled deeply and extended his hand to Monks.

  “I’m sorry, I’m under a lot of pressure,” he said. “Let’s start over.”

  “I’m likely to have touched something contagious,” Monks said. “Nothing personal.”

  Tygard’s hand dropped, rubbing unobtrusively against his slacks. “It doesn’t have to be your medical attention,” he said.

  “That’s true,” Monks conceded. “We could have an ambulance take him to another hospital. Of course, there’d be several more people involved, another check-in procedure, all that.” He waited, letting the point sink in; it would not help the cause of John Smith’s anonymity.

  “His own doctor, then,” Tygard said.

  Monks considered. To be safe, in terms of covering his and the hospital’s ass, he knew he should insist on keeping John Smith the full four hours. But John was stable, and by the time a physician could arrive and sign him out, the acute danger period would have passed. Most important, Monks’s sum total of training, experience, intuition—feel—satisfied him.

  “If that doctor’s willing to come here, I’ll release John into his care, AMA,” Monks said.

  “What’s AMA?”

  “Against medical advice.”

  Tygard smiled thinly. “We can handle that.” He snapped his fingers at Andrew, who was hovering nearby, a powerful physical force waiting to be directed. “Call Dr. Rostanov,” Tygard said. “Get her here, now, I don’t care what she’s doing.” Andrew produced a cell phone and cupped it to his ear.

  Monks said, “If you’d ask your friends to move outside.”

  “It will only be for a short time, Doctor,” Tygard said. “We just want to make sure nobody comes in who doesn’t belong.”

  “Mr. Tygard, this is a hospital emergency room, not an executive suite. I decide who belongs. This has already taken up a lot of time, and my patience is wearing thin.”

  Tygard gave him another cold, measuring look, then issued the order. Andrew threw Monks a similar look, making it clear that he was tolerating this only because he had to, then walked stiffly out. He and his partner took up positions flanking the main door.

  Eyes widened mockingly, Tygard said, “Satisfied?”

  Monks would have let it go except for what he saw in Tygard’s face. It was young, unstamped by hardship or real adversity, living smugly on the surface of a glossy world and untroubled by concern for the great weight of those who struggled below. Monks did not like bullies under any circumstances, but especially bullies who had not paid dues.

  “When I run into people like you, Ron,” Monks said wearily, “I always want to tell them, ‘You don’t have to flaunt your inner child so much. It’s real obvious.’ “

  Tygard’s gaze narrowed. “What the hell’s that supposed to mean?”

  “You could save yourself a lot of work.”

  There was a longish moment of eye contact. Monks got the unsettling sense that it was not about menace or even dislike, but about two different species that did not comprehend each other. And neither wanted to share the planet.

  “I’d like to see John now,” Tygard said.

  Monks pointed toward Cubicle Seven. “It’s my opinion he should have a psychiatric evaluation. I offered to give him one here, but he refused. I’d urge you to make him reconsider. If not here, then Dr. Rostanov should arrange one.”

  Tygard walked to the cubicle, shutting the door hard behind him.

  Monks stood where he was for a minute, aware that he was breathing deeply, his body catching up; that he was shaking a little. He was angrier than he had thought. Taking care of the ER was trouble enough, without having to put up with this. At least it looked like the hospital stood to get paid after all.

  Best of all, this goddamned mess was soon to be somebody else’s problem.

  He made a visual inspection of the ER, an automatic move before returning to the elderly lady with the bowel trouble. Stephanie, helping one of the nurses, caught his gaze and mimed an exaggerated I-told-you-so look.

  Whether John Smith was, in fact, Lex Rittenour, Monks did not much care; but he admitted that, judging from the drama, John was indeed a man of some consequence.

  Found dying on a San Francisco sidewalk, with a needle barely out of his arm.

  When Tygard had referred to John Smith’s personal physician as “she,” and added the name Rostanov, Monks had formed an unconscious image of a tall, imperious Valkyrie type of hardy northern stock, sweeping in from the steppes wearing furs and boots.

  He did not realize this until he was called to the desk to meet her, and his mental picture shifted abruptly. Martine Rostanov was a small, waifish woman of about forty, with a short thick mop of dark hair, slender, veined hands—and a stirrup brace, just visible on her left foot beneath the cuff of her slacks. She swung the leg a little from the hip as she walked. She was dressed casually—heavy Shetland wool cardigan over a soft white turtleneck, with a simple gold bracelet that seemed to flow like mercury with its own fire. Monks was no judge of women’s clothing, but the ensemble was tasteful and, he was sure, expensive.

  The introductions this time were civil. Her eyes were dark and anxious, but Monks imagined something else in the way she watched him: as if they had met in the past, and she was waiting to see if he would remember. He did not, and he was pretty sure he would have.

  He stepped into the hall with her and gave her a quick rundown of the situation.

  “This is horrible,” she said. “It never should have happened.”

  It was not clear whether she meant the overdose, the emergency room treatment, or something else entirely.

  “Are you sure you want him?” Monks said.

  “Is he going to go down again?”

  “Realistically, it’s not likely.”

  “Then, yes. I have Narcan with me. I’ll get him into treatment immediately.”

  The door from the ER opened into the hallway. It was Stephanie. Monks waited for her to pass by on whatever errand. But she lingered, with a tentative smile. Monks was surprised. It was not like Stef to be forward wit
h strangers.

  “Dr. Rostanov, my daughter Stephanie,” he said. “First year med at UCSF.”

  Martine Rostanov’s eyebrows arched: appraising, sensuous, even suggesting a potential for cruelty. Monks feared that she would say something cutting, impatient with the introduction in what was hardly a social situation.

  But she said, “You must be very proud.”

  Stephanie stammered thanks. “Any advice?” Monks’s surprise deepened: His daughter was blushing.

  “You have to be better than the men,” Dr. Rostanov said. “Keep being better.”

  Then, in a gesture that was odd but just right, she touched Stef’s cheek lightly with her fingers: a gracious dismissal. Stephanie hurried away, leaving him bemused at his daughter’s boldness, and at the powerful presence he had glimpsed beneath Martine Rostanov’s slight exterior.

  “That was kind of you,” he said.

  “I know who you are.” She spoke the words quietly, even timidly. Her eyes seemed to suggest sympathy.

  Monks was puzzled. “I’m sorry. Have we—”

  “No. From the newspapers, a couple of years ago.”

  Comprehension hit him with an abrupt tingle of adrenaline, a stark instantaneous flashback to a moment when he lay bleeding from knife slashes on the stone floor of a wine cave, while a psychopath’s psychopath knelt on his back, about to hamstring him. With a clarity laced with nausea, he felt the shock of his cheek hitting the cold stone, the knife’s sharp point piercing the flesh of his leg with practiced confidence, and he tasted the metallic but strangely sweet flavor of his own blood in his mouth. The events of that same night had spilled over into Mercy Hospital, most notably when another physician had had his heart removed on an autopsy table—while still alive at the time.

  The hospital had done its best to downplay publicity, and like most news, it had blown quickly through the public’s memory. Monks was left with a certain notoriety among coworkers, a sort of two-edged awe; in the eyes of some he was heroic, while others feared that he was like a man prone to being struck by lightning—bad luck and a danger to be near.