"What the jury thinks is all that matters," said the lawyer. "The inflammatory language impresses juries and may get you angry enough so you won't think clearly on the stand. It's a money game, remember. Think of it that way, just a money game. Slattery wants a big settlement, of which he gets a third. A third of a million dollars will make Slattery call you anything he has to. If he can paint you to look like a clone of Richard Speck, he will. Relax. Be thankful you're facing Slattery and not Iggie Lavinsky. As trial lawyers go, Slattery rates a "C". He keeps falling down in a straight line, but he does fall down. We'll beat him. Lavinsky, on the other hand, is scum, a street fighter. None of us like him. He'll do anything to win, anything: perjury, bribery, witness tampering, falsifying evidence, anything. If I have a line I won't cross and let's say it's here ... ," the lawyer placed a knife in the center of the table. "And if it's Slattery's line it's here ... ," he placed another knife 6 inches away from the first. "Then Lavinsky's line is here ... ," he held a fork far away from the two knives, then let it drop to the floor with a clatter.

The doctor, accustomed to the sterility of hospitals, was fascinated by the darkness hinted at in this other world. He leaned forward across the table toward his attorney as the latter dropped his voice into a nocuous tone.

"You read about the murder case in Buxton?" asked the lawyer. "Coke dealer shoots a part-time cop in the head—gangland-style execution. Tells a barfly the whole story. Barfly shoots her mouth off and the dealer winds up arrested for murder? Remember that one?"

"Yeah, 6 months ago or so," said the doctor. "The drug dealer got off, didn't he?" He sipped his wine and waited for the story.

"Lavinsky got him off. I mean, it's an impossible case to win, but Lavinsky pulled it out. Here you have a witnessed confession and the witness tells the world, and still Lavinsky beat it".

"You said you wanted my advice about something?" the doctor asked between bites of his lobster roll. He took another sip of wine and looked at the attorney, who was scanning the tables for anyone he might know.

"Yeah, different kind of case. Wanted to run it by you. Nothing to do with medical malpractice. Well, it does and it doesn't". He picked up a potato chip, turned it this way and that for inspection, and popped it into his mouth. He looked at the doctor, paused, and then began.

"I have a client—just a kid really—involved in a civil suit surrounding an alleged murder. Kid's from a good family. There's money. They are being sued by the family of the deceased for losses in excess of two million-five. The deceased was some kind of engineer". The lawyer ate a handful of chips, sipped his wine, and continued.

"Here's the story. The engineer was out with his wife for a night on the town. They're walking down the Western Promenade, you know, in the park where the stone wall runs along the coast. My client, the kid, is sitting on the wall with his buddies and the engineer doesn't like the way this bunch of kids are looking at his wife. He gets hot under the collar. Has a big mouth. You know the type. My client's friends, three of them, will testify that the engineer threw the first punch. My client breaks the engineer's jaw with one punch. Just a lucky punch, really. The engineer winds up at the medical center for a wiring job. He's in the hospital for 5 days. He calls his doctor a few days after discharge, complaining of chest pain and shortness of breath. His doctor puts him off. The wife called a couple of more times, I guess. Put off each time. Two days later he's back in the emergency room in shock. In a couple of hours he's dead. Autopsy shows he died of blood clots to his lungs".

"Pulmonary emboli," said the doctor.

"That's the term," said the lawyer. "Pulmonary emboli. Well, the engineer's wife has hired Prudhomme's firm and they're suing the kid's family for damages like I said. Now if the wife had Iggie Lavinsky in this case, they'd be suing the town, the hospital, and the family for damages. But so far just the family has been named". The lawyer caught the eye of someone at a far table, nodded a greeting, and dropped his voice, leaning toward the doctor. "My question to you is this: even if my client had thrown the first punch, which three witnesses are in any case prepared to deny, but just suppose he had ... hypothetically ... would he be guilty of murder? I mean, medically speaking, do you think he killed the guy?"

The doctor, finished with his lobster roll, had ordered another glass of cabernet and was now swirling it under his nose. He looked out the window at the harbor and the gulls wheeling in the bay, seeing nothing.

"No, he isn't," the doctor answered after some thought. "No, I don't think he's directly responsible for the engineer's death. He didn't die of a fractured mandible. He died of pulmonary emboli".

"But," interrupted the lawyer, "the fractured jaw was a proximate cause ...".

"It sounds to me," said the doctor, hesitating over a line of thought for which he had been burned once before, "it sounds to me that the engineer's doctor is more responsible for the guy's death".

The lawyer nodded encouragingly, saying nothing.

"I mean," continued the doctor, "chest pain and shortness of breath are classic symptoms of pulmonary emboli. Any doctor with a recently hospitalized patient who had been lying in bed for 5 days should know that's a perfect set-up for pulmonary emboli. It seems to me that the engineer's doctor missed the diagnosis. The deceased in all likelihood otherwise would have been saved. Your client can't be blamed for a missed diagnosis". The doctor shrugged and went back to his wine.

The lawyer leaned forward across the table, keeping his voice low. "That's my fallback position. I'm glad you agree with me on that point".

"You've lost me," said the doctor.

"The way I am going to develop the case is this. Our defense will be self-defense, to say the engineer threw the first punch. And we have our witnesses on that point. But we'll be ready with medical experts to testify that pulmonary emboli caused the man's death, that a missed diagnosis is where the jury should point the finger. Just in case. Anything that points the finger away from my client".

"But you'd be exposing the man's physician to a possible lawsuit, as well as the medical center," said the doctor.

"Yeah, that's the hard part. Our firm is also retained by the doctor and the medical center," answered the lawyer. "We may well expose them. We'd have to be careful. But Prudhomme isn't naming them right now and we have 2 more years until the statute of limitations runs out—this assault happened a year ago. We can set up enough smoke screens and spin this process out long enough so that any finger pointing will occur past the statutory period. You see, any good lawyer ... well, I should say, any smart lawyer, because I'd have to include Iggie Lavinsky here ... would name everybody in the initial suit and get it on the books, a matter of court record. Then you're not pushed by the statute, you develop the case at your leisure, drop from the case any defendants without exposure, and proceed."

"That's why," continued the lawyer, pointing a stick of celery at his companion, "that's why in a medical malpractice suit you name every doc who signed the patient's record".

The doctor remained silent, mulling this over, thinking about the guilty chiropractor in his case and about why he hadn't been named. His attorney, as if reading his mind, added: "Except those without a deep pocket. Developing a case is hard work enough without going after bit players with paltry insurance policy coverage".

In the weeks following his deposition, the doctor returned to his practice, attempting to lose himself there, denying the lawsuit that would never quite go away. It began to color his every waking moment. If he talked with colleagues, privately he noted that it was not they who were being sued, and privately he wished it would happen to them. Whereas his anger initially had been directed at his patient's husband, this anger had now taken on a life of its own, swelling, growing, metastasizing, engulfing anything in its path. Lawyers, judges, bureaucracies, and The System became obvious targets for it. But also his associates, for their happiness in the face of his misery, and the hospital, as the scene of his misfortune, Medicine itself, for having cheated him, his home and possessions for trapping him in a life he no longer wanted to live, and his wife, for not understanding. More than this, his patients caught his anger and this anger the doctor had for them was a deep, rotting anger, the burning anger of eternal fire, the vindictive anger of revenge and sought-for vindication. The doctor saw his patients differently in these days. Whereas previously his old patients had been as old friends whose visits he enjoyed, now their demands upon him he saw as prelude to litigation. He became short with them, and abrupt. He gave them what they needed but no longer what they wanted from him. He became conscious of that distinction, relished the taste of revenge it afforded him, and sensed their discontent as evidence he had successfully wounded them, the enemy. New patients he avoided wherever possible. Whereas in years past they had represented for him the challenge of medicine, the hunt for diagnosis, now they were a band of greedy litigants. He had no history with them; they didn't know him at all and would eagerly jump at the first excuse, embroiling him in another suit, which, he had concluded in the darkest of hours, would be the last for him.

Instead of caring about his patients, and caring for them, the doctor became careful of their records. It was not what he had said or done, whom he held and comforted in moments of awful grief, nor whom he called and consoled for long hours on the phone, after hours. It was not the lengthy list of diagnoses he could summon up in times of crisis, nor the sudden inspired decision that would save a life. It was not his discerning ear, his practiced eye, the touch of his palm, the keenness of his fingers, the perceptions of his soul. It was not his wisdom.

It was the medical record. What was written down, recorded (for the court), became paramount. No parade of grateful patients, no litany of lives saved could ever provide testimony for the doctor. But the medical record and what it contained would be his salvation. If he spent 5 minutes with a patient, he would spend the next 10 completing a record of the encounter. If he admitted a sick patient to the hospital, he might spend 20 minutes examining the patient, and then, carefully dodging the concerned family, write orders, dictate notes, arrange a detailed summary, and package carefully this medical record that was, he was constantly reminded, a legal document after all.

The doctor became of two minds. On the one hand, he was both beating the system and exacting retribution for his suffering. Quality was judged by the written word after all, and he was recording to perfection. Secretly he prided himself on this game of words the system had forced him to play. He reaped praise from the quality board, praise from the utilization committees, and praise from the peer review organizations. He became the darling of the medical records department. He tried to believe that was the measure of all things, that it meant he was a good doctor.

Yet he knew that he was not. Patients needed him, and wanted his caring. They wanted his love. He would not deliver. They had hurt him. They had to suffer, as he suffered. He became half a doctor, and none at all. And his misery was compounded a millionfold.

The weeks passed, as the doctor railed against this private prison, the bonds of which he had forged. One afternoon, late on a Friday, his office nurse, now distanced from him as well, dropped a chart on the desk in front of him.

"New patient," she said, and hurried off.

The doctor read the complaint the nurse had written on a slip—chest pain—and saw the patient's age, 35. Hypochondriasis was his immediate diagnosis. He sat at his desk ruminating, dreading the encounter. Why, he thought, does a 35-year-old woman have to see a doctor about chest pain? Doesn't she read Time like the rest of us? Doesn't she know how impossible it is for premenopausal women to have heart disease? Can't she live with the aches and pains the rest of us suffer? What is the matter with people these days that they must always run to the doctor? Christ, no insurance yet! I won't even get paid for this.

Thus he stalled, brooded, and finally dragged himself kicking and screaming to the examining room.

"I'm Dr. Simpson. What can I do for you?" He avoided looking at the patient, as was his manner these days. It lessened the contact, and his commitment. He could remain disengaged. He thumbed through her patient questionnaire, waiting for her answer.

"I don't know ... I have chest pain," answered the patient.

They never know, Simpson thought. It's always you tell me, Doc, ha, ha, ha or that's why I'm here, Doc, ha, ha, ha or if I knew I wouldn't be here, ha, ha, ha. He caught the quiver in her voice, its restraint. God, more social problems, he thought. No, not again. I haven't time for any more sob stories.

"What is the pain like, ah ... Mrs. Heath?" asked Simpson, glancing again at the chart. "Do you get it with exertion or can it occur at any time? How long has it been going on?"

"I've had it for about 6 months. It can come on any time. Usually when I'm in bed," said Mrs. Heath. "I'm worried it's my heart".

Simpson looked at her. Her hair had been pushed into place without brushing. She was thin, her clothes hanging from her. Her turtleneck, a dark green, was unironed. She wore no make-up. She looked immensely tired, worn out at 35.

"You're under stress," Simpson said matter-of-factly. "You going through a divorce? Financial problems? Husband abusing you?" He gave her a list. Yet he was softening. For reasons known only to the doctor, he could most closely identify with this manner of suffering.

"My husband was murdered ... about ... a little over a year ago," said the patient. At this, she broke down, sobbing softly.

"Murdered?" was all the doctor could manage. He felt instantly guilty for his callousness and entirely out of his element with this turn in the story. The woman merely nodded her head, saying nothing. She picked at the lint on her slacks, then self-consciously smoothed the fabric with her palms. She swallowed, tried to speak, looked up at Simpson, then down at the floor, the tears rolling down her cheeks.

"What happened? How did ... what happened to your husband?"

Mrs. Heath looked up, tried again to answer the doctor, and, when she couldn't find the words, shook her head and covered her face with her hands.

"I'm sorry," he said, meaning it, he realized with surprise. "I am so very sorry".

And with this, the words came.

"We ... I have four little ones. My husband was an engineer. Very talented. He had a good job at the paper mill ... they loved him there ... ," her voice cracked, but she continued. "We had no life insurance. Who has life insurance at 35? I don't know what I'm going to do. We're going to lose the house. I can't work. Jennie is only 2. Any money I could earn I would have to pay in child care. My parents haven't any money. They can't help us. And Allen's parents won't ... ," she stopped, biting her lower lip, and looked up at the ceiling trying to gain control.

The doctor had lost all track of time. He wanted to write her out a check to cover the next 10 years. He wanted to hold her and tell her everything would work out. He wanted to fix this, and could not.

"Allen ... your husband ... tell me about that. Tell me about him".

"We were in love. I mean really in love. This was a second marriage for both of us. Jennie is all I have of him". She broke down, wracked with sobs, crying uncontrollably. Her doctor waited. "We always went for walks. We were walking along the coast that night ... the night it happened. Some men ... three or four men were sitting on a rock wall. They started whistling at me and yelling obscenities. Allen stepped in front of me and told them to keep their mouths shut. One of the men jumped off the wall and punched Allen in the face, knocked him out. He fell and the man kept punching him and punching him and punching him ...". She swallowed hard, trying not to cry. "His jaw was broken. He died of complications".

"Wait," said Simpson. "Just a minute. Didn't I read about this, or ... ? Did ... I'm sorry, Mrs. Heath, but did Allen start the fight? I mean, did he punch first?"

"No!" she said, shaking her head violently. "No! He had pushed me behind him, to protect me, and still had his hands on me. He never fought at all. Afterwards the men all laughed and walked away".

"What are you doing about all this now?" asked Simpson, already knowing the answer.

"There is a criminal case against the man ... for murder, or manslaughter. I don't know which. And my lawyer ... I have a lawyer ... said that if he is convicted, we can file a civil suit and attempt to collect damages. But it's their word against mine, he said. He's not too optimistic. Well, I don't know. I haven't talked to him in a couple of months".

The patient was cried out now. She sat quietly waiting for the doctor's next move. He sat, legs crossed, elbow on the back of the chair, looking off at a point on the far wall, deep in thought. Funny, he thought, funny how truth can be a Rorschach to some people. With nuance, suggestion, a few points shaved here and there, a little gloss to highlight here, and with liberal use of money, the truth, he thought, can be anything you want it to be.

He looked at his patient. She saw the "facts" so simply, as they had been presented to her, and she trusted that they were so. A thug had killed her husband (he had died of complications, she believed) and would be tried (and acquitted, no doubt), and she would be forgotten, with barely an apology. She and her four children. Trusting lawyers, trusting the law and its judges and juries, she would be the ultimate victim. The brute, the "kid from the nice family," would be wiser for the experience. Maybe. Free, certainly, his family having purchased that for him.

Simpson considered his options. He could tell her what he knew to be the truth, explaining to her the husband's hospitalization and the nature of the "complications". He could suggest she call her lawyer with this new information and maybe, if he ever called her back, maybe he would initiate another suit, and maybe something more would be gained. But even if her lawyer took the reins, he would no doubt call Dr. Simpson, dragging him into the case, forcing him into the role of whistle-blower.

Carefully, he listened to her heart. Its strong, steady sounds confirmed his thoughts. He knew what he should do. She needed a specialist. He would refer her to a specialist. He grabbed the phone book, leafing through the Yellow Pages, found the address and number, and jotted it down on a prescription blank.

"Your chest pain is nothing," he said. "It isn't your heart ... it sounds perfect. It's just all this stress that is causing your chest pain. When your stress is relieved, the pain will go away".

Handing her the slip of paper, he looked her steadily in the eye. "I want you to see this man," Simpson said. "Call him up—his number is right there—make an appointment, and go talk to him. Tell him your whole story: how you saw the fight, all the details, what happened at the hospital, what they told you, how you kept calling the doctors back when Allen wasn't doing well at home ...".

"How did you know about that? How did you know we kept calling? I don't remember my telling you that".

"I guessed. Families do that. Never mind," said Simpson. "Just see this guy. He'll help you".

Mrs. Heath fingered the prescription blank. "Isadore Lavinsky," she said. "Is he a psychiatrist, or one of those counselors? Do I need a psychiatrist?"

"No," said Simpson. "He's a lawyer. Iggie, they call him ... Iggie Lavinsky. He's a specialist. And you need him. He'll help you. More than I can".