SOMETIME AFTER MIDNIGHT Michael Knowles wakes to the sound of his beeper and picks up the phone. “You want Finney,” he tells the page operator. “I’m not on call tonight.”

“You are now, Dr. Knowles,” the operator says officiously, and puts him through to the ER. A nurse comes on and brings him up to speed in a voice shrill with hysteria. The patient, she explains, a thirteen-year-old girl from Arbor Hill, is in labor, four months premature. “Boyfriend dropped her off about an hour ago and split. No prenatal care, no insurance. Now she’s bleeding all over the place and I can’t get anyone to give me a consult. Your partner’s puking his guts out in the men’s room. I’m told it’s food poisoning.”

“Give me twenty minutes,” Michael mutters, and like a man called to the service of war he grabs his coat. He had fallen asleep on the couch in the study. He climbs the stairs quietly, feeling strangely like a guest in his own home, wary of the light that burns on his wife’s bedside table. He enters the room uneasily, dreading a strained encounter, but Annie is asleep and all the lines of discord have vanished from her face. For a moment he marvels at her beauty, her glorious brown hair, the fleshy protrusion of her upper lip, her T-shirt twisted appealingly across her breasts. His heart begins to pound. She has squandered her beauty, he thinks. He does not know what will happen between them now. But no matter how much he rationalizes what she did, and he does rationalize it, no matter how much he tries to talk himself into hating her, he finds himself loving her more. His love for her is ripe in his mouth. The fruit has rotted perhaps, but he refuses to spit it out. With routine compassion he picks up the book at her side and sets it on the nightstand. For a moment he stands there, half-expecting her to wake, almost hoping that she will. Not to fight anymore, but to find each other inside a single, wordless moment. To find each other and remember what brought them both there in the first place, and why neither has left. But it’s too late for that, and she doesn’t wake, and they’re paging him again. He writes her a note, GOT PAGED, and leans it against the base of the lamp, where she will find it in the morning. Then he switches off the light and steps into the hall, listening to the yearning silence of the big house. It makes him think of his kids and he looks in on them now before he goes. First comes Henry, his ten-year-old son, sprawled across the mattress amid blankets and toys and forgotten stuffed animals. The boy’s hamster, Harpo, spins obsessively in its cage and for a moment Michael just stands there, contemplating the creature’s useless exertion. In the room next door, Rosie, who is six, sleeps with perfect stillness, maintaining the meticulous hierarchical positioning of her dolls at the end of her bed. Michael can’t imagine loving anything more than his children and feels a pang of guilt because he rarely sees them. Quality time, that’s what he’s resorted to. All part of the failed equation, he thinks, heading down the crooked stairs of the old house and out into the cold night, where it has begun to snow again. The flakes are thick and white like the feathers of birds. He takes a moment to zipper his jacket, to pull on his hood. The night is quiet, the sound of snowfall a comfort somehow, and he pushes himself on, cursing himself for wasting time.

The Saab starts with a lusty roar that makes him grateful that he owns a good car, even though he does not consider himself a man of attachments or possessions. The car smells of leather and promise and his own pathetic gratitude and it comes to him that he’s been a fool in his marriage, that what came between him and Annie is his own goddamn fault. It’s about him, not her, he realizes. It’s about everything he’s not.

Angry now, he pulls out of the driveway and speeds down the road, blowing past the squad car parked on the corner. Ever since he delivered the sheriff’s babies none of the cops pull him over for speeding. They know people are waiting for him, people in pain, and they respect that. One of the benefits of living in a small town like High Meadow, he thinks, gunning the engine, winding down the hill past Slattery’s cow farm, the fields dark and dense and silent, veiled in a dusting of fresh snow. Too early in the season for snow, he thinks, just a couple of weeks shy of Thanksgiving, but the weather is always unpredictable in upstate New York, and after all these years he’s no stranger to it. Ordinarily in weather like this he’d take Route 17 down to Bunker Hill, but he’s worried about the girl in the ER and decides to take Valley Road instead to save time. Under ideal circumstances the shortcut is dangerous, complicated with tight, snakelike turns, but it takes fifteen minutes off the trip. Tonight Valley Road shimmers with ice. The naked trees seem to tremble in his headlights. The sleet comes out of the dark like millions of pins and he is forced to decelerate, taking the curves slowly, methodically. The suffering girl will have to wait, he tells himself; nothing he can do about it now. At the end of Valley Road he turns onto Route 20, streaming into a line of traffic behind a behemoth snowplow, then onto the interstate, the city of Albany like a white blur before him.

Downtown, the streets are deserted except for a few homeless stragglers. The green neon cross on St. Vincent’s Hospital blinks and buzzes like some divine Morse code. Only now, as he pulls through the mammoth jaws of the doctors’ parking garage and climbs the labyrinth of concrete to his spot on level four, does it occur to him that something may be amiss. That perhaps the phone call had been a hoax: the bleeding girl, Finney being sick. Now that he thinks about it, he hadn’t recognized the nurse’s voice and he knows all the nurses at St. Vincent’s. The garage is deserted. The hanging fluorescent lights move in the wind, squealing slightly on their hinges. He knows he’s paranoid-Comes with the territory, they’d told him when he’d first started at the clinic, and he’d been more than willing to accept that, but now, tonight, he senses danger and he hesitates getting out of the car at all. He looks up at the glass doors a hundred feet away, where a nurse passes by in her pink scrubs, and the sense of routine comforts him. His beeper sounds again-I’m coming, hold your fucking horses-and he grabs his bag and opens the door and they’re on him, three or four or even five men, dragging him across the concrete into the dark. Cursing him, shoving him, laughing a little with their raised fists, taking turns splitting open his face, pushing him from one man’s arms into another’s. A greasy terror sloshes through his head. And then he’s down on his knees, someone throttling him, wrapping a cord around his neck, and as the air leaves his body like a pierced balloon he wonders if they are finally going to kill him. The fat one speaks in a cold, even voice, sweat splashing off his lips: “We’ve had enough, Dr. Knowles, we’ve had enough of your bullshit,” and then a shock of pain in his balls, excruciating and dense, and he doubles over and pukes-and he is glad for a moment, puking, because he thinks they will leave him alone, but they don’t, they kick him again, and again, and he is down on all fours like a dog amid chewing-gum wrappers and cigarette butts and shattered glass and his own puke and he suddenly begins to cry. Where is the guard, he wonders now-why hasn’t anyone seen them, some nurse, some technician, some doctor? Why isn’t someone calling the police?

“Let’s medicate the poor bastard.” Someone yanks back his head and pries open his mouth, dropping in pills. He doesn’t swallow, but then he gags and chokes and the bitter powder burns his throat. Water comes next, and more pills, and he can’t breathe. Surrender, he tells himself, you have no choice! His body lax as butter, everything blurred and slow and jangling with silence. I can’t fucking hear you! he thinks dully. Their big hands, quivering faces, mouths open in laughter. I can’t hear anything.

They put him in the trunk. The road vibrates under his head like a jackhammer. For the moment he is relieved to be left alone; he is relieved to be alive. And then it comes to him, suddenly, vividly, that he is going to die.

For months he has waited for this moment, feared it, and now that it is here, finally, now that it is happening to him, yes, to him, it is all the terror he imagined and worse.

Snowflakes on his face. The sky is kissing you, Daddy, he hears his daughter whispering. The men are talking but he cannot make out a word of it. He feels the prick of a needle, the warm drug rushing through him, bringing a taste into his mouth, cotton candy, and a feeling throughout his limbs that is not entirely unpleasant. The men smell of whiskey and triumph as they grip his body and pull him out of the dark place. Staggering with his weight, they bring him in their arms to a car and they put him into it, behind the wheel. Even in his dementia he knows it’s his own car, he recognizes the smell, Rosie’s paddock boots in the back, Henry’s chocolate bars for Cub Scouts, and they strap him in and turn the key and the engine screams. He wants to tell them that he can’t see, he’s in no shape to drive, but his mouth won’t work, his tongue is too big, and now the car is moving, it floats for a moment in midair, then tumbles through the dark like a clumsy animal. Suddenly he understands what they have done and he doesn’t care, really, it doesn’t matter anymore, and he forgets it, he forgives them all their stupidity, and he can only remember her face, her beautiful mouth. Annie! He screams inside his head. He is screaming and screaming. Annie!

But it is too late. And his wife can’t hear him.