Adam’s sympathy dissipated. “We really lost him during that first six-minute cardiac arrest, wouldn’t you say, sir?”

Kender looked at him. “No,” he said. “No, I wouldn’t say that.” He got up and went to the window. “See that big red-brick mausoleum across the street?”

“The animal lab?”

“It was built a hell of a long time ago, before the Civil War. Oliver Wendell Holmes once dissected cats in that building.”

Adam waited, unimpressed.

“Well, you and I and Oliver Wendell Holmes aren’t the only ones who have worked there. For a long time now Dr. Longwood and Dr. Sack and some other people around here have been taking dogs dying of gangrene in their vitals, and by doing to them what we did to that fellow we had in our OR, they’ve been able to save some of those dogs.”

“This was a man,” Adam said. “Not a dog.”

“During the last two years we’ve had sixteen such patients. Each of them has died, but each has lived longer than the last. This man lived for forty-eight hours. The experimental procedures worked for him. They turned an inoperable gangrenous condition into one we could handle through surgery. Who knows—the next patient, if we’re lucky, may not go into cardiac arrest.”

Adam looked at the older surgeon. He felt a number of things, all at once. “But when do you say to yourself, ‘This man is gone, we can never bring him back, let him die peacefully and with dignity?’”

“Every physician makes up his own mind about that. I never say it.”

“Never?”

“Goddamit, my young friend,” Kender said. “Just take a glance at what’s happened within a stone’s throw of this hospital, within the memory of people who are working here. In 1925 a young physician named Paul Dudley White began treating a 15-year-old girl from Brockton. Three years later she was dying because her heart was being choked by a leatherlike pericardial covering. He had had her admitted to the Massachusetts General Hospital eight or nine times, and everybody had looked at her and treated her, and nobody could do anything. So he had her sent home knowing she must die unless in some way the pericardium could be removed. As he pondered on this he had Katherine admitted to the M.G.H. just once more, hoping that in some way surgery might prove possible. By a stroke of luck—call it serendipity—right about that time a young surgeon named Edward Delos Churchill had returned to the Massachusetts General from Europe, fresh from a year or two of advanced training in thoracic surgery, including a period under the great Ferdinand Sauerbruch in Berlin. Churchill later was to become Chief of Surgery at the Massachusetts General Hospital, of course.

“Well, Dr. White met him in the old brick corridor and persuaded him to come up to the ward to see Katherine. Nobody in the United States had ever succeeded in doing anything about constrictive pericarditis with a knife or with medicines. But Dr. White asked Dr. Churchill if he would try, and—” Kender shrugged—“the girl was slowly dying.