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  Prologue

  WHEN I WAS a little girl, I often tried to run away from my shadow. I didn’t like being followed. My father thought that was very funny, but I didn’t laugh or smile along with him. My mother looked worried about it and tried to get my father to worry about it, too, but he never did.

  My shadow wasn’t there when I looked in the mirror, and when I awoke in the morning, I turned quickly to see if my shadow had gone to sleep with me.

  “Where does your shadow go at night?” I asked my father once.

  He looked at my mother and thought and thought about it.

  “Good question,” he said.

  “No, it’s not,” she said. “It’s spooky.”

  He shrugged. “Well,” he said after a few moments. “If you look outside at night, you often see bigger and longer shadows, right? That’s where your shadow and my shadow and your mother’s shadow go at night. They go to join their shadow family.”

  “Stop it,” my mother said.

  My father leaned toward me when she turned away.

  “When you lose your shadow,” he whispered, “you lose the best friend you’ll ever have.”

  Pru

  SOMETIMES I ANTICIPATE an ominous dark gray mist in a patient’s room before I enter it. The mist would be billowing in from the walls and ceiling as if there was a fire just outside the windows, but unlike smoke, it would have no odor, and it wouldn’t burn my or the patient’s eyes. For these patients, seconds that passed would be more like years rushing by. The earth would spin faster on its axis. They would sense time was slipping through their fingers. It was easier to hold a cup of water in your hand. Troubling thoughts would seep through their minds, staining every hope with the inky reality of a curtain persistently closing.

  I didn’t need to take a blood pressure or use a stethoscope to hear heartbeats slowing and ponderously pounding with desperation. Whenever I did and saw and heard the results, I feared my forced smile would speak volumes and put the patient into a panic, which would only make things worse. But I never let that happen. I was good at being soothing, being hopeful, and even trickling in laughter that lifted my spirits, too. To be a truly dedicated nurse, especially a cardiac nurse, I’d always have to help my patients believe there was room for hope. Pessimists in a hospital are like nonswimmers in a lifeboat. They are a constant reminder to the others of just how desperate the situation is.

  When my father first heard me say I wanted to be a nurse, he nodded and said, “You’re a good enough actress to pull it off, Pru.”

  “Why is it important for a nurse to be an actress?” I asked him.

  “Oh, it’s especially important for a nurse. Even if you dislike someone intensely, you can still make him or her feel welcome, comfortable, and you can give optimism even to the terminally ill, even if it’s only getting them to believe they will live longer than their doctor has predicted. So much of life requires us to pretend to be someone we’re not and say things we don’t truly believe. That’s a discovery you’ll make daily, Pru. Don’t fault yourself for it. For good or for bad, that’s what it means to be an adult.”

  “A bit of a phony?”

  “A bit of a phony,” he said, smiling. “We all can’t be a Sagittarius like your mother was and always say what we believe regardless of the consequences. For her, a friend was a potential victim.”

  I didn’t laugh. My father rarely joked about something that he thought would impact on my future. He was intent on delivering his wisdom to me as I grew older, especially after my mother passed away. At one point, I sensed his panic, his fearing that I was nearing the age when I wouldn’t value what he had to say as much as I had when I was younger and vulnerable. I know he felt that being a single parent to a girl on the cusp of becoming a woman made everything he said to me more important, almost desperate. He was afraid I’d become just another teenager full of herself, with an unseen umbilical cord tying me to my smartphone. My eyes would be stuffed with text messages. I’d make easily avoidable errors. I should have listened would be tattooed on my forehead and visible in every selfie.

  But in the end, he would blame himself.

  However, today I had no need to assume a false face and play a role in a tragedy. I saw no dark gray mist. If anything, the room I was entering was brighter than the sunshine splashing down from a nearly cloudless California spring sky. The ceiling seemed to have a halo. Unseen angels were holding hands in a circle, their feet gleaming with toes of diamonds as they danced with joy above us.

  Douglas Thomas’s life had been saved. He was well into his recuperation, and now his parole had come through. That was the way most patients saw their discharge from the hospital, a release from a different kind of prison. Illnesses prescribed the length of their sentences. I was the gentle jail keeper whose dainty hands wove tubes and wires, changed IV bags, and dispensed medicines with unpronounceable names. Some looked at me as if I was performing magic.

  I stopped in the doorway to watch Belinda Spoon, one of my nurse’s aides, help Mr. Thomas into the wheelchair, not that he needed much help now. She squatted to adjust the footrests.

  Maybe more intentionally than everyone assumed, Belinda had a tendency to leave two, even three buttons of her blouse undone, revealing a cleavage that would easily swallow all of Douglas Thomas’s long fingers right up to his palm. It was like dipping into chocolate pudding to find the rich dark cherries submerged like secret promises of pleasure. I had overheard her proudly refer to her ample breasts with that image herself. Right now, Mr. Thomas looked so mesmerized by the fantasy that he didn’t see or hear me enter.

  His cardiac surgeon, Dr. Simon, would probably tell me it was a healthy sign when a recovering bypass patient showed interest in sex. For Dr. Simon, interest in it was an indication of anyone’s recovery from anything. Using that as a standard, the doctor himself was in perpetual recuperation. It was a wonder that he could get his mind off sex long enough to operate successfully.

  Douglas Thomas had so wanted to walk out on his own steam. For any patient, being able to do that was the reaffirmation that he or she was nearly completely healed, but I had explained that hospital policy and insurance concerns dictated that he be escorted in a wheelchair to his waiting taxi at Cedars-Sinai in Los Angeles. He was disappointed, but I rarely had a better patient when it came to following my orders like a child obeying his parent.

  I didn’t especially like to think of myself that way, but nurses do take on something of a motherly image, and patients, regardless of their ages, are often more like children. Men especially become little boys, and when they are past danger and discomfort, they want you to know they are back to being men. That twinkle in their eyes and the lust in their smiles reappear. At minimum, an attractive woman is sexually harassed in their thoughts.

  “Cleared for takeoff,” I said, holding up and waving his discharge papers.

  He turned to me and with his long, spidery thin fingers brushed back his gray-spattered, dark brown hair, smiled, and straightened up in his chair. He had unremarkable walnut-brown eyes, so dull that I imagined they were on some weak backup battery most of the time he was here. Just recently, they had begun to pull up some more energetic light. He was close to six feet tall, but only one hundred six
ty pounds. From his chart, I noticed that he had lost a little more than six pounds during his stay. That wasn’t much, but I asked him if he had been doing any dieting before he had been diagnosed. He said no, so I assumed he was always a slim man, with a narrow, tight face exaggerating his jawline. All the clothes he was wearing looked a size too large, but they had looked that way when he was admitted.

  “Maybe I’ll start eating more sensibly now,” he told me on the first day he was out of intensive care and I had remarked about his weight. “My mother was always after me to put on some pounds. You’d be pleased if I did, too, wouldn’t you, Nurse Dunning?”

  “I rarely have the opportunity to tell a patient to gain weight. It’s usually the other way around,” I said, and he laughed.

  “Maybe the first time you see me on the outside, you’ll advise me to go on a diet.”

  Why would I see him on the outside? We lived on the opposite sides of one of the world’s biggest cities. Accidentally running into each other at Starbucks or the grocery store was unlikely. He was obviously flirting, even in his relatively still weakened condition, but I tried to do nothing to encourage it. Too often, young women unintentionally send the wrong messages and get blamed for anything that happens. In this culture, it seems innocence is reserved only for men.

  Right now, I nodded at Belinda and squeezed my own blouse closed at the collar. Message was delivered. She stood and buttoned hers, but not without a smirk, the expression clearly accusing me of being a prude and embarrassing her.

  “Nurse Dunning,” Mr. Thomas said, flashing a wider, healthier smile of delight, the sort of smile that makes a man look more like a little boy full of anticipation on Christmas morning, “I was afraid you wouldn’t be here for the launching. I left something for you.”

  He nodded at the table beside the bed. There was a small gift-wrapped box on it.

  “What is it?” I asked, well knowing.

  “A token of my sincere appreciation,” he said, looking more impish.

  “That wasn’t necessary, Mr. Thomas.”

  “I think by now you can call me Douglas, Nurse Dunning.” He turned to Belinda and pointed at me. “This is the woman who saved my life.”

  I looked at Belinda, who wore that habitual tight frown on her face that she had whenever she was in my company. Her dislike for me was obvious. We were about the same age, Belinda twenty-four and I twenty-five. There was no question in my mind that if Belinda had enjoyed the opportunities I had, she would have become a fine nurse. She was practically one now, educating herself on the job.

  But it wasn’t jealousy that motivated her to be even more disapproving at the moment. Six days ago, just before I had begun my rotation, I had stopped in Douglas Thomas’s room impulsively, like someone with a premonition. He was asleep, and Annie Sanders, the nurse I was relieving, a nurse who had been at Cedars four years longer than I had, had not woken him to take his medication, thinking she would return after she had tended to her remaining three patients. I had almost missed it, but the color of the pill caught my attention, and I pounced, waking Mr. Thomas in the process.

  “What’s going on?” he asked when I had scooped it up. He was in his second day out of intensive care. Bypass patients usually remained in the hospital for a week, some a bit longer. He saw the way I was looking at the cup with the pill.

  “I think this is a mistake,” I said. “I’ll check on it, Mr. Thomas.”

  “What mistake?”

  “Just relax, Mr. Thomas,” I said, and started to turn. He reached for my arm. I was surprised at the strength of his grip around my elbow, the tips of his long fingers and thumb nearly touching each other.

  “What is that pill?” he demanded.

  “It’s for enhancing blood clotting. You’re on a small dosage of blood thinner,” I said, and immediately regretted the revelation.

  His eyes widened. “That might have killed me.”

  “I doubt this one dose would, Mr. Thomas,” I said, giving him my best reassuring smile, “but let me see what happened.”

  He took his hand away, and I hurried out to the nurses’ station.

  My informing the patient didn’t go over well with other members of the staff. They thought I had spoken too quickly, maybe deliberately. As it was pointed out, all I had to say at the time was that there was a patient medication mix-up and not identify the pill and introduce the idea that we might have killed him. A recent estimate of death caused by medical errors in hospitals was at 210,000 a year. Some of the patients admitted were almost as anxious about that as they were about their illnesses as it was.

  I regretted what I had told Mr. Thomas, but as my father often said, “You can’t put the toothpaste back in the tube.” Disapproving glances still floated my way in the hallways. Where was the loyalty to my associates? Cops don’t expose other cops, and doctors dislike testifying against other doctors for malpractice. Why shouldn’t nurses behave in a similar manner?

  Belinda had pushed Douglas Thomas a little forward and was turning to wheel him out the door, but Mr. Thomas put up his hand to tell her to stop.

  “I want to see her face when she opens that,” he said, nodding at the small box.

  “I got other patients to look in on,” Belinda muttered. “You ain’t the only one bein’ released today, Mr. Thomas. They’re anxious, too.”

  “Just one more minute, please,” he pleaded.

  Reluctantly, she waited for me to go to the table and pick up the gift, the corner of her mouth so deeply tucked in that it looked like she had a finger hooked there and was pulling it open wider for a dentist to examine a molar.

  “Go on. Open it before I’m shoved out of here,” he said, giving Belinda a stern look.

  I tore away the gift wrapping. There was no clue by looking at the plain white box, but I anticipated jewelry and not the usual box of chocolates.

  That it was, an akoya pearl necklace. Thanks to my mother, I knew jewelry. This was no small gift and far from a token.

  “Oh, I can’t take this, Mr. Thomas. It’s way too expensive.”

  “Hey, if I’m gone, what good is my money?”

  “But you’re not gone. You’re going to live a long life.” I sounded more like a gypsy fortune-teller than a nurse.

  But he was only in his mid-forties with a good prognosis. I liked to know the basics about my patients, more than only their medical history. Douglas Thomas was a bachelor, never married. From the very small number of guests and the one relative who had signed papers, I thought he was quite a loner. I knew he was an accountant at a firm in Sherman Oaks. By his own admission, his interaction with people during his workday was limited, and from what I could tell, he had no romantic affair going at the moment, if ever.

  I didn’t pry with questions. However, he had been quite talkative here, mostly with me after the pill incident. I quickly learned that his father was in assisted living, suffering from early dementia, and he had lost his mother to heart failure three years ago. Like me, he was an only child. He was keen on finding similarities between us, which was not unusual for a man who looked past my uniform or maybe through it. Something in common was always a good launching pad for longer conversations. I tried not to have too many.

  There was always such a fine line between being personable and being too personal when it came to how we nurses interacted with our patients, whether they were male or female. Sometimes I felt like I was on tiptoe, weaving constantly through a maze of mother-daughter, mother-son, and husband-wife relationships, because they were so emotionally naked when one of them was on a sickbed, possibly waiting for life-or-death decisions. I could see the panic in their eyes and smiles of hopeful expectation when I entered the room.

  I dreamed of having the power that came from the laying on of hands. I might have saved my mother. That was a dream I cherished.

  “Those pearls were my mother’s,” he said. “She’d want you to have them. It will make me happy and speed up my recovery just knowing you’ll be w
earing them, and when you do, I hope you’ll think of me,” he said.

  “But, Mr. Thomas, a string of pearls like this? I don’t know. Surely there is someone in your family, someone else who . . .”

  “No one in my family saved my life.”

  “That’s a little of an exaggeration, Mr. Thomas,” I said, glancing at Belinda, who was shaking her head with disapproval icing her eyes.

  “Not to me. Now, you listen. You were here when Dr. Simon advised me to avoid stress,” he said, scowling. “If you don’t take it, you’ll be guilty of murder. Belinda is a witness. Right, Belinda?”

  She looked at the ceiling, the impatience washing over her hefty body.

  I sighed. There was no giving this back, I thought, and why prolong this? He looked like he would continue to argue about it and literally wouldn’t leave the room or really would have another near heart attack if I refused to take it.

  “Thank you, Mr. Thomas,” I said.

  He smiled like my father smiled, starting on the right side and then completing it with the spread of his lips. He put his hand over his heart.

  “I’m happy you’re pleased. Home, please, James,” he told Belinda. She didn’t laugh. He looked back at me as they were going through the doorway. “I’m not through thanking you, Nurse Dunning. Get used to it,” he said.

  Strangely, that sounded more like a warning than a promise of something nice.

  With the box in my hands, I felt obligated to walk behind them to the elevator and say good-bye to him there. Every employee stopped to watch us go by, their conversations put on pause. I pressed the box of pearls close to my breasts, not that I didn’t expect everyone to learn about them as soon as Belinda had returned from delivering Douglas Thomas to his taxi. With the speed I knew she’d spread it, she might as well put it on the bulletin board at the nurses’ station or do a PA announcement.

  The smallest things could have great consequences, especially in hospitals perhaps. I had no idea at the time, but it was early days on the road to a far more serious, nearly tragic mistake than a single dose of the wrong medicine.