He took a handful of crackers, settled himself in the front row and nodded to Meomartino. “You may begin, Doctor.”

As the Surgical Fellow read the details it was apparent that the first case was routine, a 59-year-old male with advanced liver carcinoma who had not sought help until too late.

“Preventable or unavoidable?” Dr. Longwood asked, brushing crumbs. Each senior man voted unavoidable, and the Chief concurred. “Long past the time of no return,” he said. “Points up the need for early diagnosis.”

The second case was that of a woman who had died of heart failure while being treated medically in the ward for gastric lesions. There had been no previous heart disease history, and the autopsy had revealed that the lesions had in fact been non-malignant. Again each of the surgeons declared the death unavoidable.

“I agree,” Dr. Longwood said, “but I must remark that if she had not died of coronary disease we would have been treating her wrongly. She should have been opened and explored. An interesting article in Lancet two months ago emphasized that the five-year survival rate for medically treated gastric tumors—undetermined whether benign or malignant—is ten per cent. When the patient is explored to find out just what’s happening in there, the five-year survival rate rises until it becomes fifty-to-seventy percent.”

This is a class room, Spurgeon thought, relaxing and beginning to enjoy himself; only a class room.

Dr. Longwood introduced Dr. Elizabeth Hawkins and Dr. Louis Solomon. Spurgeon felt the small change in the atmosphere, noticed Dr. Kender, the kidney transplant man, lean forward, nervously jiggling something is his ham-like hand.

“We are happy that Dr. Hawkins and Dr. Solomon have accepted our invitation to meet with us today,” Dr. Longwood said. “They are residents in the Pediatric Service, where they were nearing the end of the internship at the time of occurrence of the next death to be discussed.”

Adam Silverstone read of five-year-old Beth-Ann Meyer, who had suffered thirty percent body burns when scalded by boiling water. Two skin grafts later in the hospital’s pediatric ward she had vomited one night at three o’clock, and cast-up foodstuffs had occluded her windpipe. It had taken a resident in anesthesiology sixteen minutes to respond. When he got there the small patient was dead.

“There was no excuse for the amount of time taken by the anesthesiologist in responding, of course,” Dr. Longwood said. “But tell me . . .” the cool eyes traveled from Dr. Hawkins to Dr. Solomon, “. . . why didn’t you do a tracheotomy?”

“It happened so fast,” the girl said.

“There was no tracheotomy kit,” Dr. Solomon said.

Dr. Kender held up, between his thumb and forefinger, the object he had been shaking in his fist. “Do you know what this is?”

Dr. Solomon cleared his throat. “A pen knife.”

“I’m never without it,” the kidney surgeon said quietly. “I could open a windpipe with it on a trolley car.”

Neither of the pediatric residents answered. Spurgeon could not take his eyes from the pale face of the girl. They are handing it to these people cold turkey, he thought. They are saying to them: You—you—killed this child.