In a whisper she said, “Where is Dr. Savard?”

“She has left the hospital staff and is moving to Europe. Can you tell me what you’ve done?”

The woman shook her head fiercely and turned her face away.

“Mrs. Campbell,” Anna said. “Your situation is dire. You must realize that. I will do everything in my power to help you, but you must prepare yourself. Do you have a message for me to pass on?”

Again the violent shake of the head. Her voice was broken and hoarse, but Anna heard her clearly.

“I want nothing now but an end to it all.”

Anna said, “Nurse Mitchard, please put the patient under as quickly as possible. There is not one second to waste.”

•   •   •

NO TIME TO waste, and still hygiene could not be forgotten. Anna stood at the sink scrubbing her hands and lower arms furiously, counting out the seconds to herself. Beside her the ambulance doctor held his hands and shirtsleeves both under running water and was watching the blood wash away.

He introduced himself as Neill Graham, an intern from Bellevue.

“What can you tell me?” she asked him.

“She admitted nothing. Profuse hemorrhaging, guarding, pain on rebound, in and out of delirium. I couldn’t examine her properly in the ambulance but by the smell, she’s septic.”

“The husband?”

“Neighbor sent word, I’m guessing he’s on his way.”

“Dr. Savard,” one of the nurses called, a note of panic in her voice. “We’ve got a prolapsed umbilical cord already presenting.”

To Neill Graham Anna said, “Anything else?”

“Just that she wanted to see Dr. Savard.”

“Thank you,” Anna said. “I’ll take it from here.”

“Could I observe?”

Anna paused. He was young, but his demeanor was professional and his interest seemed sincere. “I may need another pair of hands,” she said. “But you’ll have to get rid of that shirt and scrub in properly, nails especially. Don’t spare on the carbolic. Nurse Walker is circulating, she’ll find you a tunic.”

•   •   •

WHEN ANNA CAME to the operating table, her hands still damp and stinging from the carbolic acid, Mrs. Campbell had already been calmed by the ether. She was strapped to the extended stirrups in the lithotomy position, her knees flexed and canted outward, her legs and torso draped. Instruments newly out of the autoclave were arranged neatly on sterile trays. The nursing staff stood waiting for Anna to begin.

Helen Mitchard sat at Mrs. Campbell’s head monitoring anesthesia. She had already started to give the patient saline injections by means of a cannula, which might make some small difference.

“Status?”

She gave a sharp shake of her head, reaffirming what Anna already knew: it would take a miracle to turn this around.

Anna folded back the draping to reveal fresh dressings that were already soaked with blood and discharge. The effluvia was enough to make her head snap back. Septicemia had an unmistakable smell, but there was also a strong odor of feces. Whoever had operated on this woman had perforated her bowel.

Anna glanced at the nurse beside her. “Nurse—”

“Hawkins,” the young woman supplied.

“I’m going to need a good three gallons of saline to irrigate. And when we’re done here today, I’ll want to talk to you about your grasp of human anatomy.” She picked up a uterine sound that would give her an idea of the extent of the damage. “This is not an umbilical cord, Nurse Hawkins. It’s a loop of lower intestine.”

•   •   •

JACK STOPPED BY Verhoeven’s house to tell Sophie and Cap that the family party had boarded the ferry and departed as scheduled to cruise the East River. Without Anna.

“Or you,” said Sophie. “There will be some very disappointed cousins.”

They sat him down to eat lunch and talk through changes to the day’s plans.

Cap said, “Bring her back here when she’s free. We’re planning on eating on the terrace in the evening. We have a good view of the new bridge from there.”

Sophie walked Jack to the door. She put her hand on his lower arm, lowering her voice.

“Cap’s been pushing himself far too hard,” Sophie said. “But I really would like you to bring Anna and we’ll eat together. Cap and I will both retire quite early given—”

“Tomorrow.”

She nodded, a little flustered. “So you two will have the terrace to yourselves.” Her expression was completely innocent, but Jack had begun to figure Sophie out, and he saw something like quiet amusement in her eyes. He leaned over and kissed her cheek, felt her start and then relax.

“It’s good that you and Anna found each other,” she said. “I would worry about her while I’m gone, if she didn’t have you.”

•   •   •

IT WAS PAST three by the time Jack got back to the New Amsterdam, where he found Anna waiting for him in her office. To his gently raised brow she said, “Her blood loss was too severe and the infection too far advanced. She began to convulse and I lost her. Someday when blood transfusions are safe, cases like this one will take a better end.”

Jack sat down across from her, rested his elbow on the arm of the chair and his chin on his palm, and regarded Anna. Her demeanor was resigned, as it must be, he understood, for anyone who practiced medicine.

He said, “Her husband passed me on my way out, earlier.”

Anna closed her eyes. “Yes, I know.”

“Very distraught?”

“Angry, I would say. Confrontational. When I told him she had asked for Dr. Savard by name, he looked at me as if I had been caught in a lie. He said, ‘She has a proper doctor at Women’s Hospital, she has no business in a place like this.’ As if the New Amsterdam were a brothel. I was glad he didn’t ask me about a cause of death. I don’t think he would have liked hearing about an abortion.”

“Has the coroner been notified?”

She stood and stretched. “Yes, Mr. Abernathy took care of it. There will be an autopsy and an inquest, and I’ll have to testify. But not until Monday. Shall we go?”

•   •   •

IN THE END Anna was glad to have missed the family party on the river. Once Cap and Sophie had sailed, they would spend the afternoon together in the garden with the visitors; for now it suited her to sit on Cap’s terrace in the late afternoon sun with the people she loved best in the world.

Then Sophie surprised her. As soon as Anna started to describe the emergency surgery that had caused the change in plans, her cousin went very still.

“Don’t you remember, Anna? I told you about Mrs. Campbell, you must remember. It was the day you went to Hoboken in my place.”

Jack sat forward, his attention suddenly focused.

Sophie was saying, “Her fourth boy, the oldest barely five, and she was terribly afraid of another pregnancy.”

Anna did recall. “The woman married to the postal inspector.”

“Ah,” Jack said. “I crossed paths with the man when he got to the New Amsterdam.”

There was a small, fraught silence in which Anna knew she and Sophie were thinking the same thing: Mrs. Campbell had asked about contraceptives, and Sophie had sent her a pamphlet, anonymously.

Sophie asked, “How was he with you?”

Anna would have liked to forget Archer Campbell, who had raged at her like a man dressing down a groom responsible for the loss of a valuable mare. She had held on to her temper and swallowed her irritation, and most of all she had subdued her own feelings about losing a patient. Campbell was condescending and insulting, but he was also newly bereaved and must be shown both patience and compassion. Nothing she said had satisfied him, and in the end he went off to see what was keeping the coroner.

“He didn’t know she was pregnant,” Anna said to Sophie.

Sophie inclined her head to one side as if she had something to say, but then thought better of it. Instead she hummed, a low rough sound.

“He’ll never accept that she had an abortion. I can only imagine what he’s telling the coroner.”

Jack rubbed her shoulder. “They’ll do an autopsy, won’t they?”

Anna made that same soft sound, neither yes or no.

“Get used to that sound,” Cap told Jack. He sat a little apart from them, wrapped in blankets even in the warmth of the sun. To Anna he seemed content and agitated all at once, as though he had just come back from a long and strenuous hike and was determined to leave on another in short order.

“Used to what sound?” Jack asked.

“That rough humming in the back of the throat. They both do it. Ask any medical question that has to do with an actual human being and their voices drop a register and all you get is that noncommittal throat clearing. I think they’re taught how to do it in medical school, like a secret handshake.”

Sophie gave him a half smile. “Oh dear. Who told you about the secret handshake?”