The year after the insertion of the renal stent, he had surgery for another major obstruction, this one in his left carotid artery, one of the two main arteries that stretch from the aorta to the base of the skull and supply blood to the brain and that if left obstructed could cause a disabling stroke or even sudden death. The incision was made in the neck, then the artery feeding the brain was clamped shut to stop the blood flowing through it. Then it was slit open and the plaque that was causing the blockage scraped out and removed. It would have been a help not to have to face this delicate an operation alone, but Nancy was swamped by her job and the demands of caring for the children without a mate, and as yet he'd met no one at Starfish Beach whom he could ask for assistance. Nor did he want to disrupt his brother's hectic schedule to tell him about the surgery and cause him to be concerned, especially as he would be out of the hospital the following morning, providing there were no complications. This wasn't the peritonitis crisis or the quintuple bypass surgery — from a medical point of view it was nothing extraordinary, or so he was led to believe by the agreeable surgeon, who assured him that a carotid endarterectomy was a common vascular surgical procedure and he would be back at his easel within a day or two.

So he drove off alone in the early morning to the hospital and waited in a glassed-in anteroom on the surgical floor along with another ten or twelve men in hospital gowns scheduled for the first round of operations that day. The room would probably be full like this until as late as four in the afternoon. Most of the patients would come out the other end, and, too, over the course of the weeks, a few might not; nonetheless, they passed the time reading the morning papers, and when the name of one of them was called and he got up to leave for the operating room, he gave his sections of the paper to whoever requested them. You would have thought from the calm in the room that they were going off to get their hair cut, rather than, say, to get the artery leading to the brain sliced open.

At one point, the man to his side, having handed him that day's sports section, quietly began talking to him. He was probably only in his late forties or early fifties, but his skin was pasty and his voice was not strong or assured. "First my mother died," he said, "six months later my father died, eight months after that my only sister died, a year later my marriage broke down and my wife took everything I had. And that's when I began to ............