Dr. Sack shrugged. “There would not necessarily have been pain. She had old, brittle bones that would have broken easily. The odontoid process is just a little thing, a bony prominence of the second cervical vertebra. Her son reported that last night she was feeling very well, had eaten with good appetite, in fact, just an hour before her death. She was confined in bed, with three pillows behind her for support. Having slipped down, she threw herself back on the pillows rather petulantly. I would guess that the jarring, plus a partial turning of her head on the neck bones, drove the loose fragment into the spinal cord, making death almost instantaneous.”

He performed the laminectomy, cutting into the back of the neck to expose the knobs of the cervical spine, slicing expertly through the red muscle and the whitish ligaments. “Notice the spinal dura, Dr. Robinson?”

Spurgeon nodded.

“Exactly like the membrane that wraps the brain.” With his gloved fingertip and the scalpel he held the incision wide so they could see the area of hemorrhage and the cord crushed by the fragment of bone, the death-dealer.

“There it is,” he said cheerfully. “You didn’t order neck x-rays, Dr. Robinson?”

“No.”

Dr. Sack pursed his lips and grinned. “I predict that you will next time.”

“Yes, sir,” Spurgeon said.

“Turn her again,” Dr. Sack said. He looked at Silverstone. “Let’s see how well old Jerry taught you,” he said. “Finish it up for me.”

Without hesitation Adam accepted the scalpel from him and made the broad, deep Y-incision over the sternum.

When he looked up a few minutes later he saw satisfaction in Dr. Sack’s eyes. But he glanced over at Spurgeon and his feeling of pleasure died. The intern’s eyes were on Adam’s knife but his features were rigid and wracked with misery.

Whatever he was seeing was a long way from the little group around the table.

Adam sympathized with Spurgeon. But the numbing knowledge that he had been solely responsible for not preventing death was an occupational Gorgon that sooner or later confronted every physician, and he knew instinctively that the intern had to be allowed to face it in his own way.

He had problems of his own in the animal lab.

The German shepherd named Wilhelm, the first dog he had given a large dose of Imuran, had developed a clinical pattern almost exactly like the one that had killed Susan Garland. Within three days Wilhelm was dead of an infection.

The mongrel bitch named Harriet, to whom he had given a minimum dose of the immunosuppressive drug, rejected the transplanted kidney the day before Wilhelm died.