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on."
    "Head exam, as I mentioned, revealed both depressed and compound skull fractures of the left parietal and temporal bones. Severe swelling and lacerations of the face made it difficult to evaluate facial fractures. Her pupils were midposition and unreactive. Her nose and throat--' "Oculocephalic
    "reflexes?"
    "I didn't test them."
    "You didn't?"
    "No, sir. I didn't want to manipulate the neck. I was concerned about possible spinal dislocation."
    She saw, by his slight nod, that her answer had been acceptable.
    She described the physical findings. The normal breath sounds. The unremarkable heart. The benign abdomen. Dr. Wettig did not interrupt. By the time she'd finished describing the neurologic findings, she was feeling more self-assured. Almost cocky. And why shouldn't she? She knew what the hell she'd been doing.
    "So what was your impression?" asked Dr. Wettig. "Before you saw any x-ray results?"
    "Based on the midposition and unreactive pupils," said Abby, "I felt there was probable midbrain compression. Most likely from an acute subdural or epidural haematoma." She paused, and added with a quiet note of confidence, "The CT scan confirmed it. A large left-sided subdural with severe midline shift. Neurosurgery was called in. They performed an emergency evacuation of the clot."
    "So you're saying your initial impression was absolutely correct, Dr. DiMatteo?"
    Abby nodded.
    "Let's take a look at how things are this morning," said Dr. Wettig, moving to the bedside. He shone a penlight into the patient's eyes. "Pupils unresponsive," he said. He pressed a knuckle, hard, against the breastbone. She remained flaccid, unmoving. "No response to pain. Extensor or otherwise."
    All the other residents had edged forward, but Abby remained at the foot of the bed, her gaze focused on the patient's bandaged head. WhileWettig continued his exam, tapping on tendons with a rubber hammer, flexing elbows and knees, Abby felt her attention drift away on a tide of fatigue. She kept staring at the woman's head, recently shorn of hair. The hair had been a thick brown, she remembered, clotted with blood and glass. There had been glass ground into the clothes as well. In the ER, Abby had helped cut away the blouse. It was a blue and white silk with a Donna Karan label. That last detail was what seemed to linger inAbby's memory. Not the blood nor the broken bones nor the shattered face. It was that label. Donna Karan. A brand she herself had once purchased. She thought of how, sometime, somewhere, this woman must once have stood in a shop, flipping through blouses, listening to the hangers squeak as they slid across the rack...
    Dr. Wetrig straightened and looked at the SICU nurse. "When was the haematoma drained?"
    "She came out of Recovery about 4 a.m."
    "Six hours ago?"
    "Yes, that would make it six hours."
    Wetrig turned to Abby. "Then why has nothing changed?" Abby stirred from her daze and saw that everyone was watching her. She looked down at the patient. Watched the chest rise and fall, rise and fall with every wheeze of the ventilator bellows.
    "There... may be some post-op swelling," she said, and glanced at the monitor. "The intracranial pressure is slightly elevated at twenty millimetres."
    "Do you think that's high enough to cause pupillary changes?"
    "No. But--'
    "Did you examine her immediately post-op?"
    "No, sir. Her care was transferred to Neurosurgery service. I spoke to their resident after surgery, and he told me--'
    "I'm not asking the neurosurgery resident. I'm asking you, Dr. DiMatteo. You diagnosed a subdural haematoma. It's been evacuated. So why are her pupils still midposition and unreactive six hours post-op?"
    Abby hesitated. The General watched her. So did everyone else. The humiliating silence was punctuated only by the whoosh of the ventilator.
    Dr. Wettig glanced imperiously at the circle of residents. "Is there anyone here who can help Dr. DiMatteo answer the question?"
    Abby's spine straightened. '! "I can