Hospitals are run by nurses. Margaret Spencer, the chief nurse, had worked at Embarcadero County Hospital for twenty years and knew where all the bodies - literally and figuratively - were buried. Nurse Spencer was in charge of the hospital, and doctors who did not recognize it were in trouble. She knew which doctors were on drugs or addicted to alcohol, which doctors were incompetent, and which doctors deserved her support. In her charge were all the student nurses, registered nurses, and operating room nurses. It was Margaret Spencer who decided which of them would be assigned to the various surgeries, and since the nurses ranged from indispensable to incompetent, it paid the doctors to get along with her. She had the power to assign an inept scrub nurse to assist on a complicated kidney removal, or, if she liked the doctor, to send her most competent nurse to help him with a simple tonsillectomy. Among Margaret Spencer's many prejudices was an antipathy to women doctors and to blacks. Kat Hunter was a black woman doctor.

Kat was having a hard time. Nothing was overtly said or done, and yet prejudice was at work in ways too subtle to pin down. The nurses she asked for were unavailable, those assigned to her were close to incompetent. Kat found herself frequently being sent to examine male clinic patients with venereal diseases. She accepted the first few cases as routine, but when she was given half a dozen to examine in one day, she became suspicious.

At a lunch break she said to Paige, "Have you examined many men with venereal disease?"

Paige thought for a moment. "One last week. An orderly."

I'm going to have to do something about this, Kat thought.

Nurse Spencer had planned to get rid of Dr. Hunter by making her life so miserable that she would be forced to quit, but she had not counted on Kat's dedication or her ability. Little by little, Kat was winning over the people she worked with. She had a natural skill that impressed her fellow workers as well as her patients. But the real breakthrough happened because of what came to be known around the hospital as the famous pig blood caper.

On morning rounds one day, Kat was working with a senior resident named Dundas. They were at the bedside of a patient who was unconscious.

"Mr. Levy was in an automobile accident," Dundas informed the younger residents. "He's lost a great deal of blood, and he needs an immediate transfusion. The hospital is short of blood right now. This man has a family, and they refuse to donate any blood to him. It's infuriating."

Kat asked, "Where is his family?" "In the visitors' waiting room," Dr. Dundas said. "Do you mind if I talk to them?" Kat asked. "It won't do any good. I've already spoken to them. They've made up their minds."

When the rounds were over, Kat went into the visitors' waiting room. The man's wife and grown son and daughter were there. The son wore a yarmulke and ritual tallis.

"Mrs. Levy?" Kat asked the woman. She stood up. "How is my husband? Is the doctor going to operate?" "Yes," Kat said.

"Well, don't ask us to give any of our blood. It's much too dangerous these days, with AIDS and all." "Mrs. Levy," Kat said, "you can't get AIDS by donating blood. It's not poss - "

"Don't tell me! I read the papers. I know what's what."

Kat studied her a moment. "I can see that. Well, it's all right, Mrs. Levy. The hospital is short of blood right now, but we've solved the problem."

"Good."

"We're going to give your husband pig's blood."

The mother and son were staring at Kat, shocked.

"What?"

"Pig's blood," Kat said cheerfully. "It probably won't do him any harm." She turned to leave.

"Wait a minute!" Mrs. Levy cried.

Kat stopped. "Yes?"

"I, uh ... just give us a minute, will you?"

"Certainly."

Fifteen minutes later, Kat went up to Dr. Dundas. "You don't have to worry about Mr. Levy's family anymore. They're all happy to make a blood donation."

The story became an instant legend around the hospital. Doctors and nurses who had ignored Kat before made a point of speaking to her.

A few days later, Kat went into the private room of Tom Leonard, an ulcer patient. He was eating an enormous lunch that he had had brought in from a nearby delicatessen.

Kat walked up to his bed. "What are you doing?"

He looked up and smiled. "Having a decent lunch for a change. Want to join me? There's plenty here."

Kat rang for a nurse.

"Yes, doctor?"

"Get this food out of here. Mr. Leonard is on a strict hospital diet. Didn't you read his chart?"

"Yes, but he insisted on - "

"Remove it, please."

"Hey! Wait a minute!" Leonard protested. "I can't eat the pap this hospital is giving me!"

"You'll eat it if you want to get rid of your ulcer." Kat looked at the nurse. "Take it out."

Thirty minutes later, Kat was summoned to the office of the administrator.

"You wanted to see me, Dr. Wallace?"

"Yes. Sit down. Tom Leonard is one of your patients, isn't he?"

' "That's right. I found him eating a hot pastrami sandwich with pickles and potato salad for lunch today, full of spices and - "

"And you took it away from him."

"Of course."

Wallace leaned forward in his chair. "Doctor, you probably were not aware that Tom Leonard is on the hospital's supervisory board. We want to keep him happy. Do you get my meaning?"

Kat looked at him and said stubbornly, "No, sir."

He blinked. "What?"

"It seems to me that the way to keep Tom Leonard happy is to get him healthy. He's not going to be cured if he tears his stomach apart."

Benjamin Wallace forced a smile. "Why don't we let him make that decision?"

Kat stood up. "Because I'm his doctor. Is there anything else?"

"I ... er ... no. That's all."

Kat walked out of the office.

Benjamin Wallace sat there stunned. Women doctors.

Kat was on night duty when she received a call. "Dr. Hunter, I think you had better come up to 320."

"Right away."

The patient in Room 320 was Mrs. Molloy, a cancer patient in her eighties, with a poor prognosis. As Kat neared the door she heard voices inside, raised in argument. Kat stepped inside the room.

Mrs. Molloy was in bed, heavily sedated, but conscious. Her son and two daughters were in the room.

The son was saying, "I say we split the estate up three ways."

"No!" one of the daughters said. "Laurie and I are the ones who have been taking care of Mama. Who's been doing the cooking and cleaning for her? We have! Well, we're entitled to her money and - "

"I'm as much her flesh and blood as you are!" the man yelled.

Mrs. Molloy lay in bed, helpless, listening.

Kat was furious. "Excuse me," she said.

One of the women glanced at her. "Come back later, nurse. We're busy."

Kat said angrily, "This is my patient. I'm giving you all ten seconds to get out of this room. You can wait in the visitors' waiting room. Now get out before I call security and have you thrown out."

The man started to say something, but the look in Kat's eyes stopped him. He turned to his sisters and shrugged. "We can talk outside."

Kat watched the three of them leave the room. She turned to Mrs. Molloy in bed and stroked her head. "They didn't mean anything by it," Kat said softly. She sat at the bedside, holding the old woman's hand, and watched her drop off to sleep.

We're all dying, Kat thought. Forget what Dylan Thomas said. The real trick is to go gentle into that good night.

Kat was in the middle of treating a patient when an orderly came into the ward. "There's an urgent call for you at the desk, doctor."

Kat frowned. "Thank you." She turned to the patient, who was in a full body cast, with his legs suspended on a pulley. "I'll be right back."

In the corridor, at the nurses' station, Kat picked up the desk telephone. "Hello?"

"Hi, sis."

"Mike!" She was excited to hear from him, but her excitement immediately turned to concern. "Mike, I told you never to call me here. You have the number at the apartment if - "

"Hey, I'm sorry. This couldn't wait. I have a little problem."

Kat knew what was coming.

"I borrowed some money from a fellow to invest in a business ..."

Kat didn't bother asking what kind of business. "And it failed."

"Yeah. And now he wants his money."

"How much, Mike?"

"Well, if you could send five thousand ..."

"What?"

The desk nurse was looking at Kat curiously.

Five thousand dollars. Kat lowered her voice. "I don't have that much. I ... I can send you half and the rest in a few weeks. Will that be all right?"

"I guess so. I hate to bother you, sis, but you how it is."

Kat knew exactly how it was. Her brother was twenty two years old and was always involved in mysterious deals. He ran with gangs, and God only knew what they were up to, but Kat felt a deep responsibility toward him. It's all my fault, Kat thought. If I hadn't run away from home and deserted him ... "Stay out of trouble, Mike. I love you."

"Love you, too, Kat."

I'll have to get him that money, somehow, Kat thought. Mike's all I have in the world.

Dr. Isler had been looking forward to working with Honey Taft again. He had forgiven her inept performance and, in fact, was flattered that she was in such awe of him. But now, on rounds with her once more, Honey stayed behind the other residents and never volunteered an answer to his questions.

Thirty minutes after rounds, Dr. Isler was seated in Benjamin Wallace's office.

"What's the problem?" Wallace asked.

"It's Dr. Taft."

Wallace looked at him in genuine surprise, "Dr. Taft? She has the best recommendations I've ever seen."

"That's what puzzles me," Dr. Isler said. "I've been getting reports from some of the other residents. She's misdiagnosing cases and making serious mistakes. I'd like to know what the hell is going on."

"I don't understand. She went to a fine medical school."

"Maybe you should give the dean of the school a call," Dr. Isler suggested.

"That's Jim Pearson. He's a good man. I'll call him."

A few minutes later, Wallace had Jim Pearson on the telephone. They exchanged pleasantries, and then Wallace said, "I'm calling about Betty Lou Taft."

There was a brief silence. "Yes?"

"We seem to be having a few problems with her, Jim. She was admitted here with your wonderful recommendation."

"Right."

"In fact, I have your report in front of me. It says she was one of the brightest students you ever had."

"That's right."

"And that she was going to be a credit to the medical profession."

"Yes."

"Was there any doubt about ...?"

"None," Dr. Pearson said firmly. "None at all. She's probably a little nervous. She's high-strung, but if you just give her a chance, I'm sure she'll be fine."

"Well, I appreciate your telling me. We'll certainly give her every chance. Thank you."

"Not at all." The line went dead.

Jim Pearson sat there, hating himself for what he had done.

But my wife and children come first.