COLUMBIA UNIVERSITY MEDICAL CENTER
NEW YORK CITY
MARCH 24, 2011, 6:30 A.M.

Pia staggered down Fort Washington Avenue like a drunk, clutching her stomach. Thinking she was about to throw up, she stopped by a garbage can, but she was only able to bend over the rim and dry-heave a couple of times. Pia stood up and breathed deeply in and out. She had to get a grip on herself, but what was she going to do? There was an immediate issue to contend with, and she was almost grateful for the distraction: She remembered that she and George had to see the dean of students at seven, so she went to the dorm to find George.

George had set his alarm for 6:15. He was accustomed to sleeping soundly, even if the rigors of medical school meant it might be for only three or four hours at a time. But last night he’d been unable to sleep save for brief snippets, constantly turning over the events of the evening in his mind. At one point he’d given up and sat for almost an hour in the semi-comfortable armchair by the window and nursed a glass of Jack Daniel’s from a bottle that had lasted through his whole medical school career. Through the window he could see a portion of the George Washington Bridge and a bit of the New Jersey Hudson River waterfront. He was totally confused and humiliated about his motivations.

Last night, Pia had come desperately close to wrecking all of George’s plans. George stopped himself; it really wasn’t Pia’s doing that he had tagged along with her. He had to take some responsibility. The problem was that he cared about her too much to let her blindly charge into these predicaments by herself, and whether she acknowledged it or not, she needed his help. Still, he knew there was a point where he’d have to stop and put his own interests first. He just didn’t know where that point would be.

He’d been asleep for only a little more than an hour when the alarm went off, and George unknowingly swept his hand over the snooze button. Nine minutes later he did it again, and he would have done it a third time if Pia’s knocking hadn’t woken him up. He was pleased to see her until he saw the look on her face and realized there was something wrong.

“What happened . . . ? Wait, what time is it? We’ve got the dean . . .”

Pia walked into the room like a reanimated zombie and fell full-length on George’s bed. She mumbled something into George’s pillow.

“What’s wrong?” George saw what time it was and started to get dressed. After a few seconds, he went over to the bed and sat on the edge and moved a few strands of hair from Pia’s cheek. She was a basket case.

“Tell me,” he said quietly.