She’d need to put together a local construction team to look at the hospital blueprints and draw up plans for conversion. SunView had done this all over the country, and once preliminaries went back to the design department, she’d have something to work with within a month. On that kind of accelerated schedule, she had a bit of time before she’d need to close the ER to admissions and redirect the staff to discharge or transfer in-house patients. But in one month she had to be sure.

An hour and a half later when she’d done as much as she could, she shut down the computer. Harper hadn’t called. She didn’t want to leave without finding out how Jimmy was doing, and she didn’t want to leave without seeing Harper. She already knew the family, so stopping in the ER wasn’t going to be intrusive. She packed her laptop and walked through the empty halls of the administrative wing into the clinical area. Unlike her office building at home where she was often the only one working late at night, the hospital was somnolent, but not asleep. Maintenance engineers pushed big machines with giant rotating brushes back and forth, polishing the worn tiled floors. Transport personnel pushed patients on litters and in wheelchairs toward X-ray and the elevators. Doctors and nurses talked in low voices as they passed. The lights in most of the hallways had been turned down, leaving the corners in shadow. Her footsteps seemed an intrusion on the solemn quiet.

The bright lights of the ER entrance signaled a return to activity. A middle-aged woman in sweatpants and a wrinkled checked shirt sat in the waiting area adjacent to the treatment area with a teenage boy who was holding his left arm against his chest, a grimace on his face. Just as Presley went to press the red button on the wall to open the automatic ER doors, they swung toward her. She stepped aside as a husky blond in a scrub shirt and jeans strode out.

“Jason Smith?” he called.

The boy and his mother stood up. Presley walked into the ER behind the trio as the man said, “Hi. I’m Will Eddy, a PA. You flipped your ATV, huh?”

“Yeah,” the boy said. “I think maybe I broke my arm.”

“Lucky he didn’t break his fool neck,” the woman muttered, stroking the boy’s hair as they walked.

The PA led the mother and son down the hall toward the treatment areas. “We’ll get an X-ray of your arm and see what’s going on.”

Presley checked the whiteboard. Three patients’ names were printed in precise black letters. Jimmy Reynolds was listed in room nine. No one was in sight, so she waited by the long counter opposite the board until someone turned up and she could ask about Jimmy. A minute passed and Harper came around the corner carrying a clipboard. She checked her watch when she saw Presley.

“Sorry, the time got away from me,” Harper said.

“That’s all right. I’ve been working. How are things going?”

“His labs should be done by now. I was just about to pull them up on the computer.” Harper gestured to a row of black-vinyl-topped stools on the far side of the counter where several monitors and bins of loose papers stood in a line. “Have a look.”

Presley followed Harper around the counter and sat next to her. Harper typed in her name and a password, then some other identifying data for Jimmy, and lab work appeared on the screen. Presley looked over the numbers, and she didn’t need to be a doctor to see the string of asterisks marking the abnormal values. WBC: 65,000. Blasts: 80%. She caught her breath.

“We’ll need a bone marrow biopsy in the morning,” Harper muttered, “but it looks like AML.”

“AML?”

“Acute myeloblastic leukemia. He’s in crisis.” Her voice was flat and hard.

“Meaning what?”

Harper pushed back and rolled her shoulders. “Meaning he needs chemo right away, and maybe a stem cell transplant. That will be the hematologist’s call.”

“Can you handle that here?” Presley thought of St. Joseph’s and Banner Good Sam and the other huge medical centers in Phoenix. The shiny glass-and-steel complexes, so different than this centuries-old stone-and-timber edifice, were cold and impersonal, but their very imposing size inspired confidence. But was newer always better?

“It depends on what the heme guy says,” Harper replied. “Chemotherapy is chemotherapy, and if Jimmy stays here, he’ll be closer to home. His parents have a seven-year-old at home, crops in the field, and animals to tend. They’ll want to be with him as much as they can, but they can’t leave everything behind, either.”

“Where’s the hematologist?”

“About thirty minutes away in Saratoga. They’ve got a satellite office near here and admit patients now and then. They’ll also see consults.”

“Can you get one of them here tonight?”

“For this, you bet.”

“I’m going to wait.”

Harper said, “It might be morning before we get this sorted.”

“Are you going to be able to get any sleep?”

“Probably not.”

“Then we’ll have an early breakfast.”

Harper studied her for a long moment. “I’m cooking, then.”

“We’ll discuss it.”

“Deal.” Harper rose. “There’s a staff lounge down the hall if you get tired of working. Bad TV and decent coffee, usually.”

“Thanks, I’ll find it.”

“I’m going to go tell his parents.”

Presley grasped her arm. “Harper?”

Harper stopped, a question in her eyes.

“It’s good that it’s you. They trust you.”

Harper blew out a breath. “Yeah.”

*

Presley contemplated going back to her office, but for once, the appeal of dry facts and figures eluded her. Her stomach was jittery with agitation, but she headed for the cafeteria for a cup of coffee anyhow. Compared to the rest of the first floor, the cafeteria was a beehive of activity. Not many tables were occupied, but cafeteria workers were slotting big aluminum trays of food into the wells in the long steam tables. The coffeemaker was perking away. Hospital personnel were straggling in, in pairs and small groups. Presley paused at the head of the food line, contemplating whether she was actually hungry or not. The pizza she’d shared had been hours ago, but she finally decided coffee was all her stomach could handle.

“Passing on late-night supper?”

Presley spun around. “Flannery. What in the world—” She caught herself, taking in Flannery’s scrubs. The last time she’d seen her had been after the practice, in a ratty T-shirt and gym shorts. “Saturday night. An accident?”

Flann shook her head. “For once, something better. A delivery.”

Presley could feel her brows climb. “You’re here delivering a baby?”

“Right now, I’m just babysitting. Valerie Simpson, the OB, was up at Lake George with her husband and twins when one of her patients decided to deliver early. She called and asked me if I could cover for her until she could get here.”

Presley immediately thought of the liability issues. OB was one of the specialties with the highest malpractice insurance rates and the largest number of suits brought against practitioners, primarily because anything involving either the mother or the child for years to come could potentially result in a suit. Flannery was no doubt capable, but she wasn’t a board-certified OB/GYN physician. There had been a time, not that many years before, when a general surgeon like Flannery would routinely provide care in many of the areas that were now relegated to subspecialists. General surgeons used to set fractures, deliver babies, treat trauma, and operate on every part of the body. Now some surgical specialty existed for almost everything—the eyes, the ears, the chest, the abdomen, the vascular system, the soft tissues, the female reproductive organs, the male urinary system, and of course, the world of the fetus before and after birth. “Does this happen often?”

“Not too often—I’ve assisted on a few tough deliveries when I’ve been handy. Every once in a while I’ll scrub in on a hysterectomy if Valerie needs help.”

“I’m beginning to see why you and Harper like this kind of practice. The things you do are almost unheard of in other places.”

Flannery’s gaze was direct and unwavering. “That’s a shame, don’t you think?”

“For doctors like the two of you, yes, it probably is. There are those, though, who would argue that you can’t possibly be good at all of those things, and specialization is the best way to provide the most effective care.”

Flannery didn’t appear offended. She made a face as if to say, so what. “I know my limits. So does Harper. That counts for more than anything.” She grinned, and the devil was back in her eyes. “I know what I’m good at too, so that helps.”

Presley laughed. “It’s in the genes, that surgical arrogance, isn’t it?”

“Might be in my blue jeans.”

“God, I walked into that one, didn’t I?”

“Pretty much.” Flannery picked up her tray and tilted her chin toward the hot table behind her. “You sure you don’t want something to eat? It’s free.”

“Really? Every night?”

“Yes, for the night staff and whoever else might be here working.”

“That’s got to be pricey.” Presley followed as Flannery walked toward a table.

“That’s it for you, isn’t it, the bottom line?” Flannery sat down, her comment not delivered critically, but simply matter-of-factly.

Presley took no offense. Why should she? “Yes, it has to be. That’s my job. Don’t you think being profitable is important?”

“It’s one thing that’s important.” Flannery picked up half of a huge triple-decker sandwich and took a healthy bite. She chewed for a few moments and sipped some coffee. “It’s not everything, though. Sometimes sacrificing a little of the bottom line for quality is worth the trade-off.”

“One hopes not to sacrifice either.”

“Let me ask you something. SunView—big hospitals, little hospitals, everything in between?”