When Ryan complimented her on the beauty of the locket, the nurse said, “It’s a phoenix. Early nineteenth century. Dr. Hobb gave it to me for my third anniversary.” She registered his surprise, and her fair cheeks pinked as she quickly corrected the impression that she had given him. “The doctor is my father-in-law. And Andrea-Mrs. Barnett, the receptionist-she’s his sister.”

“You don’t think of a medical practice as a family business,” Ryan said.

“They’re a close family,” she said, “and quite wonderful. Blake, my husband, graduated Harvard Medical.”

“Cardiology?”

“Cardiovascular surgery. When he finishes his residency, he’ll join Dougal-Dr. Hobb-in the practice.”

Given the indifference to the idea of family and tradition that characterized both of Ryan’s parents, he envied the Hobb clan.

Instead of taking Ryan directly to an examination room, Laura led him first to Dougal Hobb’s study. “He’ll be with you in just a minute, Mr. Perry.”

Again, he felt as if he were in a private home rather than in a medical office, even though on one wall were displayed the surgeon’s medical degrees and numerous honors.

Because Wilson Mott had provided a thorough file on the surgeon, Ryan did not bother to review the framed items on the wall.

Instead, when Dr. Hobb entered, Ryan stood admiring the cherry-veneer Biedermeier desk with ebony inlays.

Under six feet tall, fit and trim but not pumped, dressed in black loafers, gray wool slacks, a cranberry-red cardigan, and a white shirt without tie, Hobb did not cultivate a power look, yet Ryan felt that a force of nature had entered the study.

Although he had a clear baritone voice, Hobb spoke softly, with the trace of an ingratiating accent that might have been Carolinian. He had a full head of salt-and-pepper hair, but not a leonine silver mane; his brown eyes were direct, though not striking; his features were pleasant, though not handsome. Yet he seemed to fill the room with his presence.

They sat in armchairs that faced each other across a Biedermeier pedestal table with magnificently figured walnut veneer, in order to, as Dr. Hobb put it, “get to know each other.”

Within a few minutes, Ryan understood that Dr. Hobb made such a powerful impression because he seemed, from the first encounter, to be self-effacing, even humble, although his great surgical skills and his success prepared you to expect a fulsome pride if not arrogance, and because he seemed genuinely to care about you, to be motivated by compassion that he could convey without ever sounding either as if he were selling himself or coddling his patient.

“These past three months,” Ryan said, “have been frightening, of course, and dispiriting, but it’s not just the fear and the bouts of depression that leave me increasingly unable to cope. It’s the strangeness of these months, the downright weirdness, the sense that something’s terribly wrong in my life other than just my illness. I keep thinking that someone’s manipulating me, that I’m not in control of my own life anymore, that the medical care I’m being given isn’t the care I should have. I understand that for a guy my age, it’s easy to succumb to paranoia when you’re hit with a diagnosis like this, because it’s so unexpected. I mean, I’m just thirty-four years old, and I can’t get my head around the idea that I’m going to die.”

“We won’t let that happen,” said Dr. Hobb, leaning forward in his chair. “We simply will not let it happen.”

Considering how the odds were stacked against Ryan, he did not think such a confident declaration as the one Hobb had made could be taken seriously, yet that was how he took it. He believed that Dougal Hobb would not let him die, and he was filled with such relief and overcome with such gratitude that his vision blurred, and for a moment he could not speak.

TWENTY-EIGHT

That day, devoting himself almost exclusively to Ryan, Dr. Hobb conducted numerous tests, though he did not put his patient through another myocardial biopsy. He made the reasonable assumption that the lab had properly analyzed the tissue samples that Dr. Gupta submitted.

As a backup procedure, he ordered a recently devised high-tech analysis of Ryan’s blood, looking for the expression of key genes that would confirm abnormal cardiac-muscle function consistent with inherited cardiomyopathy. He found them.

Ryan had no illusions that Dr. Gupta’s diagnosis would be overturned. What he wanted from Dougal Hobb was the hope that came with knowing he was in the care of a brilliant physician who was as committed to the aggressive practice of his specialty as Ryan had been committed to aggressively building Be2Do.

Dr. Hobb prescribed two of the four medications that were part of Ryan’s current drug regimen, dropped two others, and added three.

At seven o’clock in the evening, in his study once more, before sending Ryan back to Newport Coast, the surgeon provided him with a slim medic-alert phone. By pressing only a single button, twice, Ryan would be connected by satellite uplink with an emergency service.

“Keep it on you at all times,” Hobb advised. “Make a habit of charging it on your nightstand every night. But take it out of the charger and with you when you go to the bathroom, in case anything incapacitating should happen to you there.”

He gave Ryan a list of physiological crises-such as the episode of breathing difficulty-in the event of which the medic-alert phone should be used without hesitation.

“And if I’m notified that your waiting is over, that a match has been found for you,” Hobb said, “I’ll contact you through the same medic-alert service. Time is of the essence in these matters. I don’t like to trust to ordinary phones. Unthinkingly, patients turn them off, set them to voice mail. As long as this device is charged, it’s in service. There’s no OFF switch. So keep it charged and keep it with you. The day may come.”

After a two-hour ride in the chartered limousine with Naraka silent and solemn behind the wheel, Ryan returned home.

He had been served a light boxed lunch at Dr. Hobb’s facility, but he’d had no dinner. He searched the refrigerator and put together a meal of sorts.

Lee and Kay Ting were off duty now, and were in their private quarters-doing what, he did not care. He didn’t suspect them of conspiracy any longer.

Or if he did suspect them just a little, he did not worry that they could harm him further. He had taken control of his fate, and no one in his usual circles knew that he had done so.

Although Dr. Hobb might think his new patient eccentric or worse, he had agreed to honor a request not to inform Samar Gupta that Ryan was now under the care of a new cardiologist.

For seven years, Ryan had self-insured because he loathed the insurance-company and government bureaucracies, as well as the endless paperwork, of the health-care system. A $100,000 check, written as a retainer to Dougal Hobb against all future costs, had bought some relaxation of the usual protocols between physicians.

He intended to continue to keep his periodic appointments with Dr. Gupta, though he would not follow any advice given or take any medications provided by that physician.

Although Ryan didn’t suspect Gupta any more than he did Lee and Kay Ting, if Gupta knew of Hobb’s involvement, he would pass the news along to Forry Stafford, and Forry-or his wife, Jane-would tell Sam.

He believed that Forry was a friend. But friendships failed all the time. Brother turned against brother, since the time of Cain and Abel, and even more frequently, more savagely, in this barbarous age.

Although his heart had reached the unshakable conclusion that Samantha was faithful to him and could never betray him, and though his mind was largely in agreement with his heart, he remembered well what she had said so recently at dinner.

If you knew me as completely as I know you, you might not love me.

He loved her as he had never loved another, and he trusted her as he had allowed himself to trust no one else. But by the nature of the world, those who loved and trusted were uniquely vulnerable.

Human beings are such knotted, desperate pieces of work-it’s a rare thing to know one completely, to the core, and still love him.

Perhaps that had been the most honest, the most self-revealing, and the most loving thing that anyone had ever said to him.

But in his present distress, which so easily could spiral into despair, he could not entirely dismiss the possibility that her words might have constituted a consummate act of manipulation.

He didn’t like himself much right now. He might not like himself much for a long time. But he liked himself enough to want to live.

Sitting on a stool at the smaller of the two kitchen islands, preferring to dine by only the light in the cooktop hood, he ate halloumi cheese on zaatar crackers, black olives, slices of soujouk, and cold asparagus. He finished with a fresh pear and a handful of shelled pistachios.

He suspected that in the weeks and months ahead, he would be taking more meals alone than he might wish.

After consulting the labels on each of the five bottles of drugs supplied by Dr. Hobb, he took the medications as prescribed.

Upstairs, in his bedroom, he inserted the medic-alert phone in the charger and stood the charger on his nightstand, so close to his bed that he should be able to reach it regardless of his condition. As he had done the past few nights, he would go to sleep comforted by the light of a lamp. Recently, waking in darkness had felt like coming awake in a sealed casket after being prematurely buried, with too little air to long sustain him.

Lying in bed, with the TV tuned to an old Western-John Wayne in The Searchers-Ryan reviewed the decisions he had made this day, and he felt good about them.

He had tremendous confidence in his new cardiologist, although even Hobb had been stumped by one thing. The doctor had not been able to explain adequately the soft insistent knocking that now and then rose within Ryan, although the physician firmly ruled out the notion that it could be some kind of blood-and-muscle problem related to the cardiomyopathy.

Hobb suggested that the sound instead might indicate a hearing problem, a malady of one ear or the other. Eventually, Ryan pretended to consider that possibility, but remained certain that the rapping had originated not in the nautilus turns of either ear, but within his chest.

Less than half his attention was with John Wayne in the post-Civil War West, because he lay waiting for the rap-rap-rapping to resume.

Eventually, as the movie drew toward an end, as wave after wave of weariness washed Ryan toward needed sleep, he thought that perhaps the knocking would not come again because he had already answered it, had opened the door.

He did not know what he meant by that. It was the kind of muddy thought that eddied through a mind half submerged in sleep’s river.

And so he slept.

During the night, a landscape materialized around him, and for the first time in months, a dream returned him to one of the places that had disturbed his sleep in September.

In the beginning there was only an impression of depth. Waste and void, bottomless and terrifying.

Then the void became water, invisible without light, silent without currents, neither warm nor cold, sensed rather than felt.

A wind blew across the water, a mystic wind murmuring without melody, and in the wind was light, the pale luminosity of the moon carried like dust, which silvered every ripple, although the body of the lake remained black.

The wind breathed once, then perished, and the earth formed around the perimeter of the lake, not fertile soil but bleak rocks, and out of the rocks grew trees as colorless as shadows.

He found himself standing on the rocks, as before, but one thing had changed. He was no longer the sole visitor to the lake.

On the farther shore stood a figure. Although dark, this Other could be discerned because the landscape behind it was so much darker that contrast was achieved.

As the Other began slowly to navigate the rocks, coming around the lake, Ryan knew that it must be Samantha, though he could see nothing of her face and little of her form.

She would have called to him, as he would have called to her. But this place had no air to carry their voices.

He began to move to meet her as she circled toward him, but he took only a few steps across the treacherous rocks before a hand on his shoulder halted him. Even in the gloom, he recognized William Holden at his side.

The long-dead actor-star of Sabrina and The Bridge on the River Kwai and so many more films, winner of the Oscar for his performance in Stalag 17-said, “It isn’t her, pal.”

Ryan was not surprised that Holden could speak in this airless realm. The rules by which others lived never applied to movie stars.

Suffering lined the actor’s handsome face, as had been the case by the time that he starred in The Wild Bunch and Network.

“Listen, pal, I had a drinking problem. In Europe once, I was driving drunk, had an accident, killed a bystander.”

Even if there had been air to allow speech, Ryan would not have known how to reply to the actor’s non sequitur.

Still at a distance, the Other nevertheless steadily approached along the shore.

“Don’t be a dope, Dotcom. That isn’t her. You come with me.”

Ryan followed Holden away from the relentless Other. Through the long and exhausting night, they circled the black lake together, as in movies they might have sought to avoid Indian warriors or German soldiers, and Ryan thought he should compliment the actor on his performance in Sunset Boulevard or ask for an autograph, but he said nothing, and Holden never spoke again.

TWENTY-NINE

With the holidays approaching, and then with the holidays upon them, Ryan found reasons to minimize the number of evenings he spent with Samantha, passing just enough time in her company to avoid raising in her the suspicion that avoidance was his intention.

Loving her more passionately than he had once thought he could love anyone, he wanted to be with her. Because she could read him so well, however, he worried that she would infer accurately from his most innocent statement or expression that he had secretly changed physicians from Gupta to Hobb.

He did not want to argue with her, but the prospect of argument dismayed him less than did the certainty of her disappointment in him if she learned what he had done. He needed her approval as the rose needs the rain.

In light of his condition, Ryan could take refuge in not only the usual seasonal excuse of prior obligations but also in complaints about reactions to his medications-nausea, headaches, insomnia, mood swings-that were even occasionally real.

And when they were together, he tried to charm, to engage, to entertain, to be Winky less than Dotcom, always with no hint of the effort behind his performance. With her, he found this easier than he would have with anyone else, because by her nature she always drew from him the best of who he was and of what he had to offer. He had always wanted to please her even before he had anything to hide from her.