Cassi had never intended to get married while in medical school. But Thomas Kingsley was the kind of man that she had not even allowed herself to dream about. She might never meet anyone like him, and since Thomas was in medicine himself, she was confident it would not hinder her work. Cassi said yes and Thomas was ecstatic.
They were married on the lawn in front of Thomas’s house in view of the sea. Most of the hospital staff had attended and afterward referred to it as the social event of the year. Cassi could remember every moment of that glorious spring day. The sky had been a faraway blue, not unlike Thomas’s eyes. The sea had been relatively calm, with small white caps licked by the westerly breeze.
The reception was sumptuously catered, the lawn dotted with medieval-looking tents from the top of which heraldic flags snapped in the wind. Cassi had never been so happy, and Thomas appeared proud, ever mindful of the smallest details.
When everyone had left, Thomas and Cassi walked the beach, mindless of the icy surf grabbing at their ankles.
Cassi had never felt quite so happy nor quite so secure. They spent the night at the Ritz-Carlton in Boston before leaving for Europe.
After they had returned from their honeymoon, Cassi went back to her studies but ever mindful of her powerful mentor. In every conceivable way, Thomas helped Cassi. She’d always been a good student, but with Thomas’s help and encouragement, she excelled beyond her wildest expectations. He continued to encourage her to come frequently to the OR to see particularly interesting cases and, while she rotated on surgery, to have her assist, experiences which other medical students could only dream about. Two years later, when it came to graduate study, it was the pathology department that recruited Cassi, not vice versa.
Perhaps the memory that warmed Cassi’s heart more than any other was the weekend she graduated from medical school. Thomas had acted subdued from the moment they’d awakened that morning, which Cassi had attributed to a complicated surgical case Thomas was expecting. During dinner the night before, he’d told Cassi about a patient who was scheduled to be flown in from out of state. He’d apologized for not being able to take her to the celebration dinner the evening after the commencement, and although she was disappointed, Cassi had assured Thomas that she understood.
During the ceremony, Thomas had made a fool of himself and embarrassed Cassi by following her to the podium and taking hundreds of flash pictures with his Pentax. Afterward, when Cassi expected him to disappear abruptly to surgery, he led her across the lawn to an awaiting limousine. Confused, Cassi climbed into the long black Cadillac. Inside were two long-stemmed glasses and a chilled bottle of Dom Perignon.
As if in a fantasy, Cassi was whisked out to Logan Airport and hurried aboard a commuter flight to Nantucket. She tried to protest that she had no clothes and could not possibly go without first returning home, but Thomas had assured her that every detail had been attended to and indeed it had. He showed her a bag, packed with all her makeup and medicine, as well as some new clothes, including the sexiest pink silk Ted Lapidus dress Cassi had ever seen.
They only stayed for a single night, but what a night. Their room was the master suite of an old sea captain’s mansion that had been converted to a charming country inn. The decor was early Victorian with a huge canopy bed and period wallpaper. There was no television and more importantly, no telephone. Cassi had the delicious sensation of total isolation and privacy.
Never had she felt so in love nor had Thomas ever been so attentive. They spent the afternoon bicycling along country lanes and running in the icy surf on the beach. Dinner was at a nearby French restaurant. Their candlelit table was set within the shelter of a dormer whose window looked out over Nantucket Harbor. The lights from the anchored sailboats flickered across the water like the sparkle of gemstones. Capping the dinner was Cassi’s graduation present. To her utter astonishment, she gingerly lifted from a small, velvet-lined box the most beautiful three-strand pearl choker she’d ever seen. It was secured in front by a large emerald surrounded by diamonds. As Thomas helped her put the necklace on, he explained that the clasp was a family heirloom, brought from Europe by his great-grandmother. Later that night, they discovered that the imposing canopied bed in their room had one unexpected flaw. It squeaked mercilessly whenever they moved. This discovery brought on fits of uncontrolled laughter but did nothing to diminish their enjoyment. If anything, it gave Cassi another wonderful memory of the weekend.
Cassi’s reverie was broken by the jerk with which Thomas brought his Porsche to a stop in front of their garage. He reached across and pressed the automatic door button inside the glove compartment.
The garage, also weathered shingle, was completely separate from the house. There was an apartment on the second floor, originally designed for servants, where Thomas’s widowed mother, Patricia Kingsley, resided. She’d moved from the main house when Cassi and Thomas married.
The Porsche thundered into the garage, then with a final roar, died. Cassi got out, careful that the door did not hit her own Chevy Nova that was parked alongside. Thomas loved his car as much as his own right arm. She also closed the door without too much force. She was accustomed to slamming car doors, something which had been a necessity with the old family Ford sedan. On several occasions Thomas had become livid when she’d reverted back to her old habit despite his lectures on the careful engineering of the Porsche.
“It’s about time,” said Harriet Summer, their housekeeper, when Thomas and Cassi entered the hall. To emphasize her displeasure, she made sure they saw her check her wristwatch. Harriet Summer had worked for the Kingsleys since before Thomas was born. She was very much the old family retainer and had to be treated as such. Cassi had learned that very quickly.
“Dinner will be on the table in a half hour. If you’re not there, it will get cold. Tonight’s my favorite TV show, Thomas, so I’m leaving here at eight-thirty come what may.”
“We’ll be down,” said Thomas, removing his coat.
“And hang up that coat,” said Harriet. “I’m not going to be picking them up all the time.”
Thomas did as he was told.
“What about Mother?” asked Thomas.
“She’s as she always is,” said Harriet. “She lunched well and she’s expecting a call for dinner, so get cracking.”
As Thomas and Cassi started upstairs, Cassi marveled at the change in her husband. At the hospital he was so aggressive and commanding, but the minute Harriet or his mother asked him to do something, he obeyed. At the top of the stairs, Thomas turned into his second-floor study, saying that he’d see Cassi in a few moments. He didn’t wait for her to reply. Cassi wasn’t surprised, and she continued down the hall toward their bedroom. She knew he liked his study, which was something of a mirror image of his office at the hospital except that it had a wonderful view of the picturesque garage and the salt marshes beyond. The problem was that over the last few months Thomas had begun to spend more and more time there, occasionally even sleeping on the couch. Cassi had not commented, knowing that he was troubled with insonmia, but as the number of nights he spent away from her increased, it had begun to distress her more and more. The master bedroom was at the very end of the hall, on the northeast side of the house. It had French doors giving out onto a balcony that had a commanding view of the lawn down to the sea. Next to the bedroom was a morning room facing east. On nice days the sun would stream through the windows. Between the two rooms was the master bath.
The only part of the house Cassi had redecorated was the bedroom suite. She’d salvaged and repaired the white wicker porch furniture that she had found ignominiously abandoned in the garage. She had chosen bright chintz fabrics for matching comforter, drapes, and seat cushions. The bedroom had been papered with a Victorian-style vertical print; the morning room painted a pale yellow. The combination was bright and cheerful, in sharp contrast with the dark and heavy tones of the rest of the house. Cassi had essentially taken over the morning room as her study since Thomas had shown no inclination to share it. She’d found an old country-style desk in the basement, which she’d painted white, and had bought several simple pine bookcases, which she’d painted to match. One of the bookcases had a second role; it served to conceal a small refrigerator that contained Cassi’s medicines.
After testing her urine again, Cassi went to the refrigerator and removed a package of regular insulin and one of Lente insulin. Using the same syringe, she drew up a half cc of the U 100 regular and then one-tenth cc of the U100 Lente. Knowing she had injected herself in her left thigh that morning, she chose a site on her right thigh. The whole procedure took less than five minutes.
After a quick shower, Cassi knocked on the door to Thomas’s study. When she entered she sensed that Thomas was more relaxed. He’d just finished buttoning a fresh shirt and ended up with more buttons than buttonholes when he got to the top.
“Some surgeon you must be,” teased Cassi, rapidly fixing the problem. “I met a medical resident whom you impressed last night. I’m glad he didn’t see you buttoning your shirt.” Cassi was eager for light conversation.
“Who was that?” asked Thomas.
“You helped him on a resuscitation attempt.”
“It wasn’t a very impressive effort. The man died.”
“I know,” said Cassi. “I watched the autopsy this morning.” Thomas sat down on the sectional sofa, pulling on his loafers.
“Why on earth were you watching an autopsy?” he asked.
“Because it was a post-cardiac-surgical case where the cause of death was unclear.”
Thomas stood up and began to brush his wet hair. “Did the entire department of psychiatry go up to watch this event?” asked Thomas.
“Of course not,” said Cassi. “Robert called me and ..." Cassi paused. It wasn’t until she’d mentioned Robert’s name that she remembered the talk they had had in the car. Fortunately Thomas kept brushing his hair.
“He said that he thought there was another case for the SSD series. You remember. I’ve spoken to you about that before.”
“Sudden surgical death,” said Thomas as if he were reciting a lesson in school.
“And he was right,” said Cassi. “There was no obvious cause of death. The man had had a bypass operation by Dr. Ballantine ...”
“I’d say that was a sufficient cause,” interrupted Thomas. “The old man probably put a suture right through the Bundle of His. It knocks out the heart’s conduction system, and it’s happened before.”
“Was that your impression when you tried to resuscitate him?” asked Cassi.
“It occurred to me,” said Thomas. “I assumed it was some sort of acute arrhythmia.”
“The nurses reported the patient was very cyanotic when they found him,” she said.
Thomas finished his hair and indicated he was ready for dinner. He gestured toward the hall while he spoke: “That doesn’t surprise me. The patient probably aspirated.”
Cassi preceded Thomas out into the hall. From the autopsy she already knew the patient’s lungs and bronchial tubes had been clear, meaning he had not aspirated anything. But she didn’t tell that to Thomas. His tone suggested he’d had enough of the subject.
“I would have thought that beginning a new residency would keep you busy,” said Thomas, starting down the stairs. “Even a residency in psychiatry. Aren’t they giving you enough work to do?”
“More than enough,” said Cassi. “I’ve never felt quite so incompetent. But Robert and I have been following this SSD series for a year. We were eventually going to publish our findings. Then, of course, I left pathology, but I truly think Robert is onto something. Anyway, when he called me this morning I took the time to go up and watch.”
“Surgery is serious business,” said Thomas. “Particularly cardiac surgery.”
“I know,” said Cassi, “but Robert has seventeen of these cases now, maybe eighteen if this new one checks out. Ten years ago SSD only seemed to occur in patients who were in coma. But lately there’s been a change. Patients who have come through surgery with flying colors are seemingly dying postop without cause.”
“When you consider the number of cardiac cases done at the Memorial,” said Thomas, “you must realize how insignificant a percentage you’re talking about. The Memorial’s death rate is not only well below the average, it’s equal to the best.”
“I also know that,” said Cassi. “But still it’s fascinating when you consider the trend.”
Thomas suddenly took Cassi’s arm. “Listen, it’s bad enough that you chose psychiatry as a specialty, but don’t try embarrassing the surgical department about our failures. We are aware of our mistakes. That’s why we have a death conference.”
“I never intended to cause you embarrassment,” said Cassi. “Besides, the SSD study is Robert’s. I told him today that he was going to have to carry on without me. I just think it’s fascinating.”
“The competitive climate of medicine always makes other people’s mistakes fascinating,” said Thomas, gently propelling Cassi through the archway into the dining room, “whether they are legitimate mistakes or acts of God.”
Cassi felt a pang of guilt as she thought about the truth of Thomas’s last statement. She never considered it that way, but it was true.
As they entered the dining room, Harriet gave them a petulant glance and said that they were late.