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Clay went straight for a shower when he got home, then to bed, gently shifting the cat from a central position on the wide bed. 'Move over, Victoria,' he said.

On the answering machine beside his bed he played back his messages.

'I'm so disappointed you're not there, Clay—' Dawn's seductive voice filled the silence of the room '—because I want to see you. Give me a call when you get in.'

'Not tonight, baby,' he said aloud, clicking off the machine, then the light.

An annoying image of a woman in a red dress superimposed itself on the more recent mental image of Dawn Renton, together with the sadness of her story. Sophie's thoughtful face, oddly vulnerable, her expressive eyes and full, beautifully shaped mouth seemed to haunt him as he hovered on the brink of sleep.

He turned on his side, reaching out to touch the soft fur of the purring cat. Firmly he pushed the thoughts of Sophie Dunhill from his mind.

Clay
was at the hospital by
7
a.m. on the following Monday. His operating list was due to start at 8 a.m. sharp, so he wanted to be in the operating room by a quarter to eight. That would give him fifteen minutes to change into a scrub suit, have a few words with his waiting patient—the first on the list, who would be lying on a stretcher in the OR corridor outside his designated operating room—and scrub for the required
number of minutes before
putting on a sterile gown and
gloves.

Clay tried to have his life at the hospital organized almost down to each minute of the ten-hour day that he expected to put in there. That was just a routine day. Being a surgeon, it did not exactly allow for everything to be cut and dried—that was not in the nature of the job—yet he made the effort as though it were so. A surgeon had to be proactive, rather than reactive, ready to go at a moment's notice, ready to meet whatever challenge might present itself, knowledgeable and experienced enough to make the right decision at once. Most of those decisions were made under pressure. There were emergencies and unexpected happenings.

That challenge was what he loved about the job, that was what kept him going. The adrenaline high was like a drug addiction—he never got tired of it, he always wanted more. Even when he knew that he had to pace himself, shouldn't push himself beyond a certain point to take on more and more work, he knew how difficult it was to say no, to admit that he had reached his limit, that it was time to refer to someone else or to another hospital.

He also saw the burn-out, the physical and mental breakdowns in some of his colleagues who treated themselves as though they were super-human, not governed by the same laws of nature and common sense that directed the lives of other breeds of people—least of all those of their patients.

Before his operating list began, on Mondays, Wednesdays, and Fridays he would routinely arrive early and run up to the surgical floor, on level two of the wing, the same level as the operating rooms, to see those patients he would be operating on that day. Although he didn't spend long with each patient, they were reassured by his presence, by his willingness to listen to any last-minute questions or concerns.

Most of the time he made a very deliberate effort to be accessible, available and non-threatening to his patients. After all, the medical facilities and the staff were there for the patients, not the other way round, although to witness the arrogant shenanigans of some of his medical colleagues, it wasn't a universally evident assumption. Such arrogance often left him appalled and angry—which was one of the reasons he wanted to be the next chief of surgery. Jerry Claiboume was a great guy who had done a lot to ensure that the department of surgery was patient-centred, yet there was still work to be done in that direction, a change from lingering paternalism and, he had to admit, sexism.

When he had seen his patients and changed into a green scrub suit in the surgeons' locker room, he made his way through the automatic double glass doors to the operating suite. Even after years of being a surgeon, he always experienced a heightened sense of anticipation—a thrill, he supposed he could call it—of the work ahead of him. He was, he acknowledged, one of those fortunate—rather rare—individuals who loved their work.

'Morning, Rick.' He passed his senior surgical resident going in the opposite direction down the main OR corridor from which the individual operating rooms led off. 'Are we all set?'

'Morning, Dr Sotheby,' Rick said, coming to a brief halt. 'Yep, it's all systems go. Just going to get a quick mouthful of coffee before we start.'

'Sure. See you in there.'

Rick Sommers was a tall, gangly young man, going prematurely bald, which made him look wise beyond his years. In the green surgical scrub suit that flapped around his skinny body he looked undernourished, even though he ate voraciously whenever he got a chance.

Although they were on a first-name basis, Rick was formal in the OR—they found it worked best that way when others were around. They also got along very well together, Clay reflected yet again as he watched the younger man stride off down the corridor. That was mainly because they had compatible personalities, were good at their jobs and shared the same subtle sense of humour which was an invaluable attribute in the often tense atmosphere of the OR. Clay was well aware that he himself could be mildly sarcastic at times, in spite of good intentions to the contrary, while Rick was never that way—not yet. Maybe that was something that came with power.

'Good morning, Dr Sotheby,' a nurse greeted him as he neared his own operating room, number four.

'Morning,' he said, smiling. Before going into his own room, he popped into room three for a quick word with the anaesthetist, Claude Moreau, who would be working there for the day. Claude was involved with a patient of his who was in the intensive care unit.

'Morning, Claude,' he said to Dr Moreau, who was checking his anaesthetic machine and equipment. 'How's Annie Lewowski? I didn't get a chance to see her this morning.'

'Hi, Clay.' The tall, calm French-Canadian turned his startling blue eyes on Clay. Of all the anaesthetists in the hospital, he was one of the best. 'I saw her briefly this morning and there's a definite improvement since yesterday. She's breathing all right on her own.'

Annie Lewowski, in her late sixties, had suffered a stroke, a blood clot in the brain, following major surgery the previous week for a bowel obstruction. 'That's great to hear,' he said. 'I'll see her later.'

Taking a short cut through the clean prep room which connected two rooms, where some instruments were sterilized in the autoclave and the large sterile packs of linen were kept for the day's cases, he heard two nurses talking in room four.

'I was hoping that I wouldn't have to scrub for Clay Sotheby today, now that I've been put back in this service,' one was saying, a remark that brought him to a halt. 'He did sort of embarrass me that time. I'd like my colleagues to get a chance to forget about it.'

The speaker had a pleasant, well-modulated voice, one he recognized instantly as belonging to Sophie Dunhill, RN.

'Oh, don't worry about him, Sophie. He's a pussycat really.' That was the voice of Rhona May, the head nurse of rooms three and four. 'I should know, I've worked with him for a long time.'

Sophie laughed rather shortly. 'That's not how I would describe him, unless you mean a pussycat with extra big teeth and claws—and to me that's a tiger!'

Both women laughed together softly, at his expense, while he hovered. Then the door of the prep room came swinging open suddenly and Sophie came hurrying through, almost crashing into him.

'Oh...' She came to a halt inches from him. Dressed in a pale blue jumpsuit, which was the uniform for the registered nurses in the operating room, plus the blue paper hat which enclosed the hair and the tie-on face mask, she had taken on the usual anonymity that such gait) provided. He much preferred her in the red dress. Yet she looked slim and trim, he noted with appreciation as his eyes went over her swiftly.

'Oh...' she said again, flustered, 'it's you, Dr Sotheby.'

'So, I'm a tiger, am I, Ms Dunhill?' he said, shifting his weight nonchalantly onto one leg so that he could stand with one hand on his hip, blocking her way with an extended elbow. He was gratified to see that her large, expressive eyes had widened, the pupils large. So he had got some sort of reaction from the cool Sophie.

Although she flushed, she recovered quickly. 'Well, definitely not a pussycat,' she said.

'I can be,' Clay said. 'You just have to give me a chance.'

'You've had plenty of chances, Dr Sotheby,' she said. 'And, anyway, eavesdroppers seldom hear good of themselves.' Their eyes met and he thought he could detect a glimmer of humour in hers.

Pressing his advantage, he added, 'I definitely want you to scrub for my first case Ms Dunhill,' he said in a tone which he hoped brooked no refusal, 'for which you should be scrubbing right now if you're going to be ready on time. I know you're familiar with a gut resection, more so than with a Whipple.'

'Yes, of course I am,' she snapped back. 'I'm quite familiar with a Whipple, too. It was just a bad day for me.'

'I see,' he said, narrowing his eyes, trying to divine her mood. He decided to let that past lapse drop for good. 'We'll forget about that. I think you would be interested in this case, a young man who has to have a gut resection because of Crohn's disease. It's always sad at that age.'

'Yes,' Sophie said, her interest captured. 'I was wondering why he would need a resection. At least it's better than having cancer, I think. Will he need a permanent colostomy or ileostomy?'

'I'm hoping not,' he said, 'although I expect I'll give him a temporary one—an ileostomy—until the inflammation has settled down.' An ileostomy or colostomy, the opening of the small bowel or the large bowel, respectively, onto the surface of the abdominal skin, was difficult for a patient to live with at any age. It was even more so for a young person, for someone as yet unmarried. 'His rectum and the colon seem unaffected by the disease at the present time,' Clay added, 'so there's a good chance that we can leave those parts intact, and I can reconnect the cut ends of the gut again in a later operation when all the inflammation has died down...although that can take months.'

'That would be good,' Sophie said. 'Crohn's is an awful thing to have, isn't it? All that chronic inflam
mation, with no known cause. Imagine the pain of it, and how it must affect your life.'

'Yes. It's been pretty debilitating for him,' Clay agreed. 'I'll see what his gut looks like when we do the laparotomy, although I have a pretty good idea of what I'll find.'

'They get all sorts of adhesions and fistulas, don't they?' she asked.

'Yes,' he said. Loops of the inflamed bowel of a patient with Crohn's disease often adhered to each other, and sometimes fistulas, or small channels, opened up between the loops. Clay could visualize it readily, having seen it many times. 'All those loops can form a solid mass...a real mess. The temporary ileostomy will rest the bowel.'

'I don't envy him,' she said feelingly.

Rhona May poked her head round the prep room door. 'Time to get scrubbed, Sophie,' she said.

'I'll give you a few extra minutes to prepare, Ms Dunhill,' he offered to her retreating back as she silently left the room. 'Good morning, Rhona,' he added cheerfully. 'How are you today?'

'Morning, Dr Sotheby. I'm just fine,' the nurse greeted him warmly.

'I've promised Sophie not to be too much of a tiger,' he told Rhona. Gratified by the nurse's startled expression, he walked into the operating room, then out to the corridor where his patient, a young man of twenty-eight, lay on a stretcher waiting to be wheeled into room four. Alex White MD, who was another of the anaesthetists, was with him.

'Morning, Clay,' Dr White said quietly when Clay came to stand beside him as he was putting a second intravenous line into their patient. 'How goes it?'

'Pretty good,' he said, and found that he meant it. Monday mornings were not always good, particularly after a weekend on call. Chronic fatigue was par for the course. Right now he felt rather buoyant.

'Good morning, Mike,' he greeted his patient, whose illness he had chronicled for months before finally deciding on surgery. Inflammatory bowel disease, of which there were two types—ulcerative colitis and Crohn's disease—weren't easy to diagnose initially, he reflected, as the early symptoms could be somewhat vague, similar to a number of other diseases and infections.

Chronic fatigue, some weight loss and abdominal pain had brought Mike Dolby to his general practitioner. That doctor had made the referral to University Hospital, specifically to him. Already Clay was thinking ahead to the details of what he would have to do, what he would most likely find when he had Mike Dolby's abdominal cavity opened. They had already done various procedures in order to make the diagnosis. The pathologist had made the final diagnosis from biopsies of the gut.

'Morning, Dr Sotheby,' Mike Dolby said. 'I feel at a disadvantage like this, flat on my back.' He tried to joke to hide his apprehension. He looked pale and ill, a slight young man who looked younger than his twenty-eight years. The disease had played havoc with his life.

Clay placed a hand on his patient's shoulder. 'I'm pretty sure that this will be a routine procedure,' he said, repeating what he had said before. They had already gone over, several times, all the ramifications of the operation, as well as the implications for the future. In particular he had explained that a ileostomy would
almost certainly be a temporary measure. 'Just keep in mind that you're going to feel much better in every way when this is over.'

Mike nodded, trying to relax. Clay had ordered a pre-op sedative for him, in consultation with Alex White, which had already been given. That, no doubt, was taking the edge off his understandable anxiety.

'I'll leave you in the capable hands of Dr White,' he said with a smile, 'then I'll see you inside the room in a few minutes.'