"I hate medicine," Dr. Bannerjee said to her husband that night.

"What's wrong, sweetie?"

She explained about Miranda Amorelli. But he couldn't understand the details. He wasn't a physician.

"Maybe I should just quit. Just be a housewife." But she knew she couldn't. Julian did not earn very much at Willamette's small private college. They depended on her earnings, or, rather, the promise of earnings to come. So far, overhead, uncompensated patients, and Medicare rejections had prevented her from collecting very much.

"Don't worry about it," Julian said. "You're not on for the weekend. Let the call guy take care of it."

That was easy for him to say. He wasn't responsible for Miranda Amorelli, who was one of those unlovable patients who seemed to be coming through the ER with more frequency these days. Miranda was a heroin addict. She was HIV positive. She had no useful veins. She was a noncompliant diabetic. She was belligerent and abusive. She had no family. Nobody cared whether she lived or died.

So, Dr. Bannerjee asked herself, why should she care? Especially since she and Julian had the long weekend off and were treating themselves to an expensive mini-vacation, skiing over at Bend. She didn't even know this fat woman patient who had been thrust upon her. She wondered if the transfer to her service would have been so urgent had it been Monday instead of Friday.

Nevertheless, Dr. Bannerjee lay sleepless all night beside her husband, worrying about her new patient. Two hundred and ninety pounds, demanding, noncompliant, and foul-mouthed to boot. But sick. Very sick. And it couldn't be clinical AIDS. Not yet. There had not been the usual premonitory things, the candidiasis, diarrhea, feeling lousy. Just an explosive onset of severe infection. Miranda Amorelli had come in with a white count of 30000 and a fever and despite 4 days on antibiotics was no better. As the Americans put it, she was "bad vibes." Finally, at four a.m., Dr. Bannerjee quietly got up and went to the phone in the kitchen.

At the hospital the night shift was winding down. Selma and Annette were standing at Miranda Amorelli's bedside where the patient was thrashing violently in what seemed to be delirium tremens. She had just pulled out the intravenous line placed with such difficulty on admission. She had punched the lab technician who had tried to draw blood and refused to have her blood pressure or temperature taken, striking out wildly whenever she was touched, however soothingly.

"She's Dr. Bannerjee's patient," Selma said. "We ought to call her."

"It's the weekend," Annette reminded her, "Dr. Bannerjee isn't on. Dr. Repscott is and you know what you'll get from him. Especially a combative patient he's never seen before. He'll just order a sedative and speed up her IV"

"He'll have to restart it then."

At that moment the telephone rang.

"Dr. Bannerjee must have a sixth sense," Annette said. "She's coming right over."

"Great. Let's talk her into putting in a central line."

Julian Benstetter, Mita Bannerjee's husband, was 20 years older than she and a sociologist who had met her while on a field trip in Kuala Lumpur. It was his third marriage and the first in which his wife was not a financial burden. Even now he had so much child support to pay that he was lucky to have found someone like Mita who could pay her own way and part of his. He was determined to be a good husband and never demand, never complain. Mita was already beginning to sound burnt out, so he knew he mustn't do anything to make her even more unhappy with her profession. But it wasn't easy to be a doctor's husband. He had sensed immediately when Mita left the bed and he knew why she had gone. It had happened before. Not terribly often, it was true, but more commonly than it should have and always, it seemed, on her afternoons off, when they usually scheduled their lovemaking. It was a good thing he wasn't young any more and could put up with that. Still, he resented it. Any patient, it seemed, meant more to a doctor than any husband. He was glad he was not a doctor himself, his mind constantly filled with someone else's problems. He wondered how young American physicians married to each other managed.

"It's all right," Dr. Bannerjee crooned. "It's all right. I'm here. I'm here. We're going to get you well. These ladies are going to help. You're going to be fine. You're going to be fine." She held Miranda Amorelli's huge paw in both of her own fine-fingered little hands. The paw was heavily bruised where one after another IV attempts had failed. Dr. Bannerjee had been crooning for half an hour and finally Miranda was beginning to quiet down.

"We need to get you well," she said finally, coming close to the patients flushed and puffy ear, her voice gentle as though sharing secrets. "I'm going to start your IV, OK? You'll be a good girl. Hold still for me?"

Miranda responded by tearing her hand from Dr. Bannerjee's, grasping the bedrails, hauling herself erect and screaming. Lost in the scream were half-comprehensible words, most of them obscene.

"I won't! I won't! Let me go, let me go!"

"We can get some muscle in here," Selma said. "Security day shift's about to come on."

"A patient has a right to refuse any intervention," Annette recited primly. "It's in their bill of rights."

"She's delirious," Selma retorted. "She's not in her right mind. She can't make that kind of decision for herself."

Dr. Bannerjee sighed. These Americans with their odd preoccupation over non-essentials. "She is infected. She is dehydrated. She must have her IV."

"She'll just pull it out again," Selma pointed out.

"We'll do a subclavian."

The procedure was very difficult. Miranda Amorelli's obesity was such that it defied even the longest of needles, the thinnest of tubing. It had taken the IM Valium way too long to make her tractable and Dr. Bannerjee knew that at home Julian would be getting up. He never said anything when she slipped away like this, but she knew how he felt. And they were supposed to be on their way to Bend by now.

She would give it up, she swore to herself. Stop practicing medicine, do her best to be the good wife she knew Julian deserved. But then she remembered her brother's contempt when she had left Kuala Lumpur with her new husband. "Just another woman," he had said. "All that education for nothing."

None of her family had accepted Julian. She had already shamed them by marrying a red-faced, goat-bearded foreigner after rejecting all the more suitable matches found for her. She would shame them more if she gave up her status as a doctor, status earned with such difficulty. What was more, she would shame herself.

Mita Bannerjee sat with Miranda Amorelli while 2 liters of saline ran quickly in. She watched the yellow bubbles in the catheter, checked the bag as it slowly filled, pumped the blood pressure cuff every 5 minutes. The nurses could have done that, of course, but they were busy now with morning report and there were other patients who were more tractable. And more attractive. Dr. Bannerjee could hardly blame them for taking Miranda Amorelli at her word and leaving her alone. Especially when they didn't really know what was wrong. Especially when she wasn't getting any better. Especially when there were no relatives around to make a fuss. Well, she didn't like Miranda Amorelli either, but it was her duty to care for her. She knew how guilty she would feel if, as the Americans put it, she "left any stone unturned." She decided to enrich the antibiotic mixture, put in additional coverage for anaerobes. Then her thoughts turned to Julian.

She was grateful to her husband. He had always been kind. Sometimes she wondered why he had sought her out, ignored the fact that she had already turned down so many men, almost forcibly taken her away, brought her here to the United States, improved her English, coached her through the difficult board exams. She hoped he loved her, but she could never be sure. He made much of giving up his career so she could have one. But she knew he had been denied tenure at the University before he went to Kuala Lumpur and that Lane College was probably the best he could do. Perhaps Julian had only married her because he knew how much money a doctor could make in America.

In any event, she was grateful. A woman should be married, even though she had been nauseated by her parents' choices for her, and although it was probably too late to have children. She was sorry about her family, now alienated, but she did not feel guilty about them, guilty the way she felt about this patient, Miranda Amorelli. For there was still something missing in her care. Miranda was failing fast. She must have something that could be treated. Bad-bug sepsis, pus under pressure?

"She's probably going to die," Mita muttered, half to herself.

"I know," Annette agreed as she made her last round of the shift.

And then it was seven a.m. and Annette was not there any longer.

Mita shook herself awake. It was past eight o'clock. She had automatically curled into the high-backed convalescent's chair made for someone much larger and taken a doctor's catnap.

She called to the nurses.

"Give me a hand! It's time to turn her." The day crew hurried over to assist. They shifted the sedated bulk to its side. "Oh, my God!" said one of them, hand reflexively moving to lips. On Miranda Amorelli's backside the moist, black stench of gangrene assaulted eye and nose. Quickly, Mita pulled on gloves and probed the tissues around the evil patch. Fluctuance? She couldn't tell. The patient was too fat. But the superficial tissue was dead. And deep there must be something. An abscess almost certainly. With that white count, with the fever, with the uncontrolled diabetes, the thick, unresisting, relatively avascular fat, there could be any mix of organisms. It was obvious she would have to be drained and debrided. And quickly. "How soon can we get the OR?" she asked.

"There isn't a permit," the OR supervisor said. "We'll have to get a family member to sign."

"There isn't any family."

"Oh my! And it's an emergency? I'd better call administration."

More delays. Americans were obsessed with paperwork, so much of it unnecessary. Dr. Bannerjee and the surgeon waited with the newspaper in the Doctor's Lounge. She thought of calling her husband to explain, then decided against it. He would have to understand. And what could he say? If he said it didn't matter she wouldn't believe him for, of course, it did matter. The condo in Bend had been reserved for months. If he said it did matter and blew up at her she would cry and feel guilty. He probably wouldn't blow up, of course. He wasn't violent like so many husbands, both at home and here, but he could project a silence. Oh, how well the Americans used silence! It would be just too terrible if her marriage should fail because of someone as intrinsically worthless as Miranda Amorelli.

"Uck!" The scrub tech could not restrain her disgust. The abscess was truly dreadful. The necrotic surface skin was undermined by foul-smelling cavities from which thin brown purulence poured.

"Kocher," the surgeon replied. He opened and debrided. There would be nothing left of this woman's buttock. Already the fascia was in sight. And anaerobes. Yes, certainly anaerobes. Behind her mask Mita began to grow angry. Why hadn't the ward picked this up before? Why hadn't she been called sooner? But then, how could one feel fluctuance in such a buttock, know what was the source of infection in so poorly controlled a diabetic? She couldn't blame the ward people. She would probably have temporized with antibiotics, too, if she had been the first one to see the patient. Still, she felt guilty about it. She shouldn't have waited this long before making the diagnosis. She should never have gone into infectious disease. She didn't have the temperament for it. Why not anesthesia where the hours were predictable and you didn't have to become involved? Well, she knew why. Infectious disease was the only fellowship available to her with her foreign credentials. So the personal demands of patient care were too much for her. That was just too bad.

Several hours later she finally returned home. Julian had long since made the bed and finished the funnies. She could see he was determined not to be unpleasant and sighed with relief.

"How did it go?" he asked.

"All right. She'll probably die anyway."

"But you did all you could?"

"Yes, I think so."

"Well, then," he said, giving her a hug as she slumped beside him on the sofa. "That's all that matters."

She kissed him gratefully. "I'm glad you think so," she whispered. "But it was an abscess. We should have known about it sooner. If ..."

"Life is nothing but ‘ifs,’" Julian said. She began to cry. Julian extended the hug and took her into his lap. He was not a big man but she was so much smaller he seemed huge. He was shelter, protection from the world, even from the demands of medicine.

"I'm sorry about the skiing," she murmured.

"Skiing's not all that important," he said. "And I'll bet your patient will live. You'll see. Did you get any breakfast?"

She shook her head.

"Waffles, then. It isn't morning, but what the hell."

She returned the hug. Why, she wondered, was he being so good? She hoped it was because he really loved her. But would he love her if she were to quit, if they had to live in near-poverty on his pitiful salary? She didn't know and she didn't dare ask.