During one of our walks, I asked Eileen how she got through the long Nantucket winters. We talked about the books she read and her other diversions, and then she said, "I like to watch the way the sun sets over my meadow every afternoon, how it moves north and south as the seasons change." Close observation of the natural world-the direction of the wind, the rise and fall of the tides, the night sky in different seasons, gave her great satisfaction.

Eileen's first extended time away from Nantucket was to attend Radcliffe on an academic scholarship. When her class held its 50th reunion last summer, she was chosen to give the keynote address, a tribute to the esteem in which her classmates hold her and to her eidetic memory for the characters and events of her college days. Perhaps she was chosen, too, because of her enduring gratitude, oft expressed, for having had the chance to attend such a fine school. Coming as she did from a small town, a working-class background, Eileen was intoxicated by the atmosphere in Boston and Cambridge-all those bright people pursuing excellence in so many fields. Including medicine. There had never been any doubt in her mind that Boston deserved its reputation as the world's premier medical city.

Eileen has a physician on Nantucket, but when she developed angina several years ago, she was quick to seek consultation from a cardiologist in Boston. Every year, she would go for an evaluation and stay for a few days with her Radcliffe room-mate, Joan, a high-minded Irish Catholic spinster like herself.

Eileen came back from these annual consultations reassured that her condition was stable and, after a celebratory ice cream cone with us on her birthday, she would resume her diet and exercise regimen, a small price to pay, she often said, for the blessings of a long and happy life. "Ah, me, aren't we lucky," she liked to say, marveling at the perfection of those shared high summer days on Nantucket.

But last winter, Eileen's angina became unstable, and early one cloudless winter night she was medevaced by helicopter to a Boston hospital. Despite her pain, she was excited at the prospect of her first helicopter ride; she asked to be allowed to sit up so that she could look out of the chopper during the trip. "Nothing doing," the medic told her, so she obediently lay down on a stretcher and was borne west with the night.

Supine and restrained, Eileen could still see a patch of sky through the helicopter canopy. When she got to the hospital, her friend Joan was there to meet her. "How are you?" Joan asked.

"Oh, I still hurt a little, but I'm fine," chirped Eileen. "I had Venus on my right the whole way across."

She wasn't fine, of course. She had critical narrowing of one of her coronary arteries and was hustled off the next morning for percutanous transluminal coronary angioplasty and stent placement. The procedure went well, and an exercise test afterward confirmed a positive outcome. That was the good part.

Three days after the procedure, Eileen was discharged, according to the hospital's "standard protocol." The trouble was, Eileen's was not exactly a "standard" case. It snowed more than a foot that day in Boston, so returning to Nantucket was out of the question. Joan was happy to have Eileen come and stay with her but could not drive to get her because of the snow. As the storm intensified, Eileen's departure was delayed several hours until arrangements could be made to pay for and have delivered $400 worth of low-molecular-weight heparin (not part of the hospital's formulary) from an outside pharmacy-a transaction that caused Eileen considerable agitation because she had left Nantucket without her checkbook or credit card and had to make several telephone calls to arrange payment.

Heparin in hand, Eileen climbed into the back of a cab and was dispatched into the teeth of the blizzard with no star to navigate by. But she left the hospital without protest, secure in the knowledge that so fine a Boston hospital would not compromise her safety or the quality of her care just to avoid the expense of extending her stay another day because of the weather.

After half an hour of slipping and sliding through Boston's deserted streets, the cab delivered its exhausted fare to Joan's apartment. Eileen was so weak that she required help getting into the elevator, and when she got inside the apartment, she began to have chest pain again. Refusing Joan's offer of food and drink, she said, "I just want to lie down." Forty-five minutes later, despite three nitroglycerin pills, her pain was worse. Joan called 911, and an ambulance came and took Eileen back through the snow to the hospital's eerily empty emergency department. Soon after arrival, Eileen had a cardiac arrest, was resuscitated, and underwent urgent cardiac catheterization, which confirmed a thrombosed stent and a myocardial infarction. With good care and good fortune, she survived.

After several days of convalescence, Eileen was once again ready for discharge. Good weather made for a less arduous second trip to Joan's apartment, where she stayed for 2 weeks before going home to Nantucket.

Joan was so concerned about the way Eileen had been treated the day of the storm that she wrote the hospital. Why, she asked, had Eileen been sent out into a blizzard so soon after undergoing a major cardiac procedure? Would it not have been safer, less anxiety-provoking, to keep her in the hospital until the storm had passed? Might not such a strategy have prevented the stent thrombosis?

Three weeks later, a response came from the president of the hospital and the attending physician. After acknowledging the facts of the discharge and its aftermath, the attending physician concluded, without apology or warmth:

"She had stent thrombosis within 1 hour of arriving at (her friend's) home in Cambridge. This is ... an unfortunate outcome but one which was not predictable. On every regimen, there are a few patients who develop acute stent thrombosis. The current regimen, which this patient received, is the regimen which we believe gives the lowest chance of stent thrombosis."

The president added,

"I hope this [the attending physician's letter] will convince you that appropriate attention was paid to her medical care, and that the unfortunate consequence of stent thrombosis which developed shortly after her discharge and arrival at your home in Cambridge was one of those events that occasionally occur despite the best of treatment [italics added]. I am glad that on subsequent readmission, we were able to be of some help, and I hope that she is continuing to do well."

Yes, thank you, she is continuing to do well. But I wonder what she thinks now about the quality of medical care in Boston. Does it still deserve unqualified gratitude and respect, the way everything else in Boston does, in her scheme of things? Is she "lucky" to have been treated the way she was? Does she wonder if any hospital, anywhere, uses Venus as a navigational aid? Or does she share the nagging suspicion that whatever their histories and reputations, hospitals everywhere seem to be more influenced by the bottom line than by the taillights of a taxi receding into the blinding snow?