The Book of Mimi, Chapter One

My having crawled into Glory, Arizona, where I met Henry on Day One, was a consequence of having known slightly too long and unquestionably too well, Miriam M. Lyle, M.D., Associate Professor of Surgery, Division of Neurosurgery, University of Arizona, Maricopa Medical Branch, Phoenix, Arizona. She was a brain surgeon. What I eventually tripped over was that Mimi Lyle, professionally speaking, was, if not actually incompetent, less than Sterling at the operating table, despite being well regarded at the academic level.

Such a conclusion comes, however, only through pain and suffering; all the early impressions were far more favorable. We cub residents were given to believe she had a reputation as a bright young academic tigress in the stultified world of professors of neurosurgery. It was said this was based on some esoteric research she had published prior to moving to the desert. The move itself was poorly understood. It was said she left a plum fellowship without finishing the course. No one expected a rising Eastern or even Midwestern star to relocate to the land of golf courses and tennis courts. That usually happened as a prelude to retirement. The rumors around Professor Lyle generally invoked themes of sexual intrigues or inordinate salary offers. Neither was true.

No one had to tell us she was tall, classically beautiful and, from my testosterone hardened viewpoint, undeniably sexy. I had seen her in the Hospital, striding down the long corridors of linoleum and buzzing, garish lights. In silk blouses, all types of skirts, open white coat and pumps, she was - visually at least - the lone Rose amidst the bands of wandering and grubby Gypsy doctors.

She eschewed the low-maintenance short-cropped hair considered mandatory for any woman in a surgical specialty. Hers was long and a deep auburn. It didn't flounce and bounce like a TV model; she generally had it braided and wound up on top of her head, but with her perfectly sculpted neck it looked elegant. She had a long thin nose, thinly arched eyebrows and pale blue eyes. She usually wore fitted clothes, so there was ample evidence to believe that her body was everything a woman's body, in the tightly closed eyes of a 27-year-old, often lonely male, should be. Despite her being at least a dozen years older, my Y-chromosome went on alert whenever she was near. Call it a schoolboy crush.

My distinctly mixed fortunes with La Profesora began in the Spring of my second year of general surgical residency. I drew a rotation on Neurosurgery while she was the Attending assigned to the teaching service - my immediate boss. Though no one would expect a general surgeon, even one, say, stranded in the Nebraska Outback, to operate on brains and spinal cords, we were expected to have at least a rudimentary understanding of the field.

I'd been warned of her operating room deficits, sort of. Among medical underlings the right kind of story about our superiors easily becomes mythic, retold often enough that senior residents will correct details in their juniors' versions of the story just as they would an incorrect medication order. Oral history is a healthy tradition in teaching hospitals.

18.p.

The neo-campfire for us Maricopans was The Longhorn, a Tex-Mex restaurant a block from the hospital. A maze of sprawling cinder-block rooms growing like mushrooms from a decrepit old adobe house, it had been the residents' bad habit for as long as anyone could remember, loved and hated in equal parts: the meals were cheap, yet big enough to fuel the average mortal for days. The secret of their success was grease.

The center of the action was a certain large, oval table - forever ennobled among the brethren as 'The Oval Table: Where Everyone's More Equal Than an Intern.' There, I got my first Tales of Mimi, over chips, salsa and cerveza. Maybe when the crunch came I was carrying along the opinions and judgements of my residency peers instead of forming my own based on first-hand observation. Not very doctor-like.

But the stories were scary.

A talkative resident two years my senior had told me she was once scrubbed in with Mimi for six hours to do a one-level laminectomy, an extraordinarily long time for a routine operation on a herniated spinal disc. Reason: They couldn't find the offending piece of disc. "No wonder," I was told, "she was two levels off."

"But couldn't that happen to anyone?" I asked.

"One level, maybe. Two? Rarely. Anyway, you're supposed to get films."

"Films. Looking for…?" A pause. I was obviously not in on this.

"X-ray comes in and shoots a cross-table lateral, after the surgeon has marked the level she's at with something that will show up on the film, like a 22-gauge spinal needle. It's standard. Then anybody who can count backwards from five can see that the needle is at L 2-3, not L 4-5, and you move down."

"She never got films," I said.

"Refused to. The nurse asked twice if she should call X-ray. Dreamy Mimi was humming to herself and didn't answer the first time. So the nurse repeated it. She had the needle up on the field, ready to go. Like I said, it's considered standard.

"Meems didn't like it," she went on, "she said, 'Listen honey' - kinda sing-song-y, like it was supposed to be a joke - 'at the Mayo Clinic only wimps need radiologists looking over their shoulders. Do you know what they charge to review an intra-op film, two days after we've finished the surgery?

"The nurses here have a lot of guts," my resident went on, "I guess they have to. This nurse is about older than God and BIG. She says to Mimi, 'I've heard Dr. Hebert ask what the three most over-rated things in America are.'"

Dr. Hebert was the Chair of General Surgery at Maricopa, my ultimate boss.

She went on: "There's a real painful silence because everyone there - probably Mimi included - has heard Dickie Hebert's pat line about the Mayo Clinic. She finishes, 'Home cooking, home fucking, and the Mayo Clinic.' There's a longer silence, except from the anesthesiologist, who's doing a very bad job of trying not to laugh - he must have heard that line 20 times. My guess is he's just enjoying seeing someone throw it in Mimi's face. She's so full of herself and that Mayo Clinic shit."

19.p.

"And...," I prompted.

She leaned slightly toward me. "I've heard Mimi Lyle has a pretty good vindictive streak. They say she does target practice at a shooting range every few months. Like a cop. I wish I knew this nurse's name. She might die a mysterious death someday. Say a thirty-eight to the thalamus or scalpel to the medulla oblongata. Mimi hasn't said a thing, so the nurse says, `I don't know about the home fuckin' part. I never really thought of it as being that highly rated to begin with.'

"Mimi is, I guess, not up for this repartee. She can only drop names. `Ian McWhorten is one of the finest neurosurgeons on the planet, and he could operate circles around anybody in Phoenix,' and blahbedy blahbedy."

"Who's Ian McWhorten?" I asked.

"Her mentor at Mayo's. Supposedly a great neurosurgeon, so he probably could operate circles around anybody in Phoenix, but he apparently didn't let Dr. Lyle in on any of his secrets." She paused. "Like I said, she was two vertebrae off. Spent two hours inside that guy's L-spine before she'd get a film."

"And when she did?"

"Spent a long time looking at the CT and then the film, then the CT, then the film. Finally she extended the incision, did the lam, pulled out a chunk of disc the size of a goddamn almond, closed up and went home. "

"Never said a word," I guessed.

"Said, 'These things happen,' to me. Never said a word to the nurses."

"Anything happen after that?"

"Are you on drugs? What would happen? The nurses maybe write up an incident report, which goes into a confidential file and rots. I imagine Joe Kellogg, the Chief of Neurosurgery, heard about it all, eventually, though it's not like an official report. I was the only other doctor scrubbed and I'm not writing it up. I suppose the anesthesiologist or nurses dropped a few hints around the OR for Kellogg. But face it, the only thing Dr. Kellogg is going to do is tell her to get a film. It's not like she's the first neurosurgeon to open at the wrong level."

"What about when she opens the wrong side of the skull?" I asked. This wasn't the first story I'd heard about Dr. Lyle.

"I wasn't there for that one," she said. "In fact I don't know anyone who was. I heard the story, though: car-wreck-coma, CT shows a big clot on the brain, rush to the OR at midnight, turn a really neat flap, but it's on the wrong side. Close up, turn the head, do it again. This time find a big ugly clot, suck it out, close up, go home. Patient dies. Probably would have died anyway. Most do."

20.p.

"I heard he ended up in long-term care."

"Well, same thing."

"And nothing came of that."

"Sheesh. You don't get it. She's hot shit around here. She was the first female neurosurgeon west of St. Louis and not in California, and Joe Kellogg landed her here. She was considered a hot little go-getter and something of a plum for a shithole like this. She's smart - she knows the science. And she gets grant money. She does a little research and goes to all the meetings and flounces around like a princess among the good-old-boy brain surgeons. They like her. They publish her papers. She gets more grant money."

"But she can't operate."

"Say what you will, doctor," she opened her hands up like a crocus, "I'd call that operating."

"Does she get films now during lams?"

"I try not to be around when she's in surgery."

As a "PGY-2" (Post-Graduate Year-2) resident my standing on the clinical totem pole was just on top of the interns ("PGY-1's") who were only on top of the medical students (baggage.) In this continuous initiation process one is regularly moved from place to place and service to service, and therefore continuously ignorant. Ignorance is vulnerability, and rather than worrying over her operative skills I was more interested in the stories of her occasional meanness and caprice. She was said to have thrown an intern out of the operating room for not knowing some fact of neuroanatomy that she thought was supposed to be basic knowledge. About all I remembered of neuroanatomy, beyond the names of the big lobes, was that studying it was like trying to memorize a huge computer circuit board you couldn't see and none of it seemed like basic knowledge.

She was known to have stationed interns with her post-op patients for 48 straight hours in the ICU's, calling in at odd hours, supposedly a little tipsy after late-night trysts, more to see that the hapless trainees were there and awake than how the patient was doing. The patients often as not did poorly, but that wasn't unusual in neurosurgery. The problem, I was told, was that she would have mucked around in their brains for eight or ten or twelve hours, pressing retractors on their memories or motor abilities or coordination until they disappeared into oblivion as the underlying brain slowly turned to yogurt. Another surgeon might have taken a fourth that long, and the parts of the patient's brain that were in the way would have seen less physical abuse and more blood flow and had a better chance of hanging around.

The Book of Mimi has its genesis, appropriately, in an Intensive Care Unit.

21.p.

Just as I did to start every rotation, I showed up on the designated patient unit - this time it was the Surgical ICU - at 6:30 am on the appointed Monday to see the patients with the interns in preparation for rounds with the professor. That day, though, I was alone. Maricopa Medical Branch is the Junior Varsity of the UA Centers for Health; the smaller specialty services like neurosurgery often don't get both an intern and a resident. Though a resident is usually better off sans intern in terms of efficiency, it meant I was alone in the gunsights. On top of that, my particular "Month with Meems," through a quirk in the academic calendar, was to be six weeks. Six weeks at the foot of the mistress, seeing patients only in her clinic, rounding just with her, reading up on literature germane to her research projects, sharing the meals on the fly, and, in my case at least, getting highly personal.

With the stories I had collected around the Medical Center of Mimi the Witch, no one had told me she was charming. Nor would our introduction suggest it.

That first morning I asked the ICU charge nurse, a woman who had sheltered me a few times during the storms of internship, if Dr. Lyle had any patients there. She smiled wryly and nodded. "Mrs. Gottshok. Bed five." I turned but she went on. "You and Mimi, huh?

"Yes."

"This'll be good."

I shot her a look. I assumed she meant I was going to be another case of medical-training mincemeat. She was smiling. I said, "You'll be sure I get a decent burial, won't you?"

"Whatever you need, Doctor."

I gave her back a look of surrender.

I found the patient's chart. She was a 71-year-old woman with a leaky mitral valve, prone to congestive heart failure. The Friday prior, Dr. Lyle had taken an irritating rub off a major nerve to her left arm by fusing two of the woman's cervical vertebrae. They put the woman in the Unit supposedly for overnight monitoring only, but she became short of breath post-op. The resident on the cardiology team put a catheter in her pulmonary artery to diagnose what he already knew, namely that water was backed up in her lungs. He gave her diuretics and her heart failure resolved. She was still in the ICU because, in poking the huge needle under her collar bone to get the catheter in, he had also punctured her lung, giving her a small pneumothorax - a collapsed lung. The morning chest film had already been done, so I compared it to the ones from the days before; the lung was again up and working.

Mrs. Gottshok was sitting up flicking through the television channels with the old-fashioned hard-wired remote control unique to hospitals. I introduced myself and asked how she was feeling.

"Bored," she said, nearly shouting. "I want to go home. You people are all boring."

I smiled. "You're an astute observer," I said. "How's your breathing this morning?"

"I'm here, aren't I? My breathing is just peachy. Now are you going to let me out of here?"

22.p.

"I sure hope so. Your chest X-ray looks like you're headed in that direction. But better let me have a listen, first."

I had the bell of my stethoscope on the woman's back when Dr. Lyle came into the room. I nodded a hello. Dr. Lyle asked Mrs. Gottshok something like, "How are you this morning." With my ears full of stethoscope, trying to sort out normal wind tunnel sounds from a few stray whistles and a whooshing heart murmur, all I heard was mumbo-jumbo. Mrs. Gottshok began a long answer at high decibel volumes, nearly deafening me. I held up my hand to cut her off, and again asked her to just take a nice deep breath. It never occurred to me that I was cutting off Dr. Lyle's interview of the patient, only that I could not complete my physical exam if they were going to talk. Auscultation of the patient's chest is relatively sacrosanct, even when done by a trainee.

After we left the bedside, Dr. Lyle asked me what I thought. "Her lung's back up. She's surgically stable. We should get her out of the Unit today, maybe even home tomorrow." Mimi nodded, her arms folded. I said, "I'll write for it. When do you want to see her in clinic?"

"Seven to ten days. Resident clinic."

"Sure."

"Your name Malcolm?" She was reading my nametag.

"Yes it is, Malcolm Ishmail."

"Dr. Ishmail, please don't ever again cut me off as I'm talking to a patient."

I tensed. "I'm - oh, uh - sorry, Dr. Lyle." Twenty minutes into the rotation and I was already a bumbling nincompoop. "I guess it was just, you know, a reflex. I was concentrating on her breath sounds. You know, trying to..."

"You can do that on your time. Not when I'm making rounds."

"Yes. I'm sorry." I knew the para-military drill: Short answers invite the least reprisal.

I spent the next few days being brief and to the point, and trying to do what a good medical resident is supposed to do: Know at any given instant precisely what the professor is thinking despite the absence of discernable clues. I saw all the patients in Clinic and in the Hospital ahead of her and then presented the history and physical findings with my own speculative assessment and treatment plan. She would nod or frown, prod, ask leading "guess-what-I'm-thinking" kinds of questions, and correct or sometimes completely ignore, probably out of sympathy, my diagnoses and plans. Sometimes she was curt and sometimes generous, offering impromptu explanations of the pertinent physiology, pathology or pharmacology involved in the particular case. Her didactic base was as advertised - extensive. She asked for daily lectures from me - schoolboy-style - on various neurosurgical topics, to be certain I was reading my texts at night. Things like, "Tomorrow give me five minutes on the choice of diuretics for cerebral edema."

In the second week, though, our rigid professionalism cracked.

23.p.

In afternoon clinic I got an urgent page from the operator. She had on hold a patient I had known almost a year, Karen Booker. The operator told me she sounded 'bad.' I took the call alone in Mimi's office.

Karen was a good-looking blonde, 19 and round as a beach ball when she showed up on Labor and Delivery with contractions every three minutes. As the intern on Obstetrics I delivered the baby. Her boyfriend, Enrico, the child's father, was a thick and surly Hispanic who, I came to find out, regularly beat Karen. He also kept her away from any money - even her own - and from talking to her family. This came out during a post-partum encounter when I asked her about some bruises and refused to accept the usual lies.

Before letting her take the baby home I made sure the hospital social worker had Karen in touch with the police in her neighborhood and a shelter. The social worker and I had a long talk with her. Very pragmatic stuff like accumulating a few dollars in change, memorizing phone numbers and the bus route to the shelter.

Eight weeks after going home with Enrico, in the face of a fresh assault, she put the plan into effect, slipping away as he slept off a drunk. She phoned me two days later to share her moment of pride.

True to the course of the disease, she eventually went back to Enrico. And got beaten. She called me in tears one night, speech impaired by her thick lips. I called the police. Enrico, no virgin to the county jail, went away for a while on a parole violation.

Karen's call that afternoon was a kindly warning: Enrico was out. He had roared over to her mother's house, where she was staying, to tell her he would be coming for her when he got an apartment and not to bother to call me, he was going to "dust" me soon. He said he knew my car and where I lived. She was going to take a bus to her sister's in Reno. She thought I would do well to leave town, too. She assured me he meant it.

Mimi came into her office as I was telling hospital security that there was a faint possibility of a row on campus and would they mind keeping an eye on my Datsun. Naturally she asked what that was all about. After hearing my tale she gave me an odd smile and said, "Does she call you often?"

"Oh, maybe once every three months. It's no big deal. I give her pep talks. She sent me a picture of the kid she had done at Sears. He's really cute."

"Are you afraid of this Enrico?"

"I don't think so. He just wants her to believe he's her only resource. Keep his place as sole source of everything. If he can make her think I'm as good as dead that's all he needs."

"He could be genuinely angry with you."

"Maybe. But I imagine I'm not worth a lot of jail time to him."

"You hope so."

"Yeah, I guess that's it."

24.p.

She stared at me, smiled and nodded. "How did you know what to do? Most doctors are in the dark about domestic abuse."

"We studied it in a criminal psyche course in college. I guess it carried over."

"Well you should be proud of yourself. Seriously. I know a bit about it."

"What do you mean?"

She looked at me. "I mean I've been there. My husband - I was very young - 17 - I wanted away from my father. I'd dated Tony off and on for three years. He was a sailor, home on leave. The whole thing struck me as awfully romantic. I could live away from my father's obsessive control and have a love 'lost at sea.' Then every few months a week of passion."

"But it didn't work out," I said.

"Well, partly. I got away from Daddy. But the first week home on leave the passion went wrong. On the fourth night together we quarreled. He started hitting me."

"Oh God."

"I was frightened enough to just take it. I knew if I fought back it would only be worse. So I got him more whiskey. When he passed out I took all the money from his wallet and drove to my brother's. I was half-hoping he would come after me. My brother would have made him regret ever having met me."

"But he didn't come?"

"No."

"Well, Karen doesn't have a brother. She needed a little help. It was the right thing to do." She was looking at me. I shrugged. "Maybe the guy just pissed me off. The worm."

"Still, you watch yourself."

"Yeah." I got a wry grin. "I'll know if he's behind me. She said he's driving his cousin's big silver pickup. It rides low but it's real loud." She nodded a smile.

The next morning, our rounds had us crossing paths with Doug Goodbout, one of the general surgery professors. He was a perverse legend among us underlings for always using the longest possible phrase for anything medical and an amusing breathiness in his voice. He was often imitated, though we were definitely laughing at him, not with him.

As we passed in a hallway he suddenly stopped to ask Dr. Lyle to see a patient of his who might have a nerve entrapment. As he waxed aerobic about this 'septuagenarian female with abdominal distension and pain,' the possibility of 'an incompletely obstructing colonic carcinoma,' and his plans for 'radionuclide scintillography, and a chest Roentgenogram,' Mimi caught me rolling my eyes behind Dr. Goodbout.

25.p.

When they had gone she asked, "You find Dr. Goodbout amusing?"

"I'm sorry, Dr. Lyle."

"No. That's normal, I'm sure. Many of us find him amusing."

"Well, you could call a Roentgenogram an x-ray." I was suddenly feeling less cowed. "Once, after Dr. Goodbout gave a Grand Rounds last year, one of the students on my team started imitating him on rounds: 'Um, Dr. Ishmail, did you happen to notice on that last gentleman the particularly noteworthy examples of the dermatologic manifestations of the stigmata of hepatic degeneration resulting from excessive ethanol intake?' I broke up. The resident thought we were laughing at the poor alcoholic and just about busted our heads."

She laughed. I smiled at her. She said, "I saw on the surgery schedule once a case booked as 'difficult repair of large, recurrent, incisional, ventral hernia with Marlex mesh.'"

"Isn't that kind of redundant?"

"It positively defines redundancy! I didn't have to look to know who the surgeon was."

Now I was laughing. "Were you at the Grand Rounds last year? When he spoke?" She shook her head. "He was lecturing in his normal style, about something esoteric like vasoactive peptide of the gut, using a lot of ," - I again imitated his breathiness - "excess verbiage, when, right in the middle some guy near me in one of the back rows, maybe about 75 himself, well dressed, I'd guess a retired surgeon, stands up to leave, clattering chairs, and says to no one in particular but loud enough for half the audience to hear," - I deepened my voice and slowed it way down -" 'I've always said he was a pompous son of a bitch! Can't say what's on his mind. Has to use a bunch of half-dollar words!' and climbs out of the lecture hall. Everyone in the back was busting up, giggling but trying to be quiet."

She was laughing. "Burt Lorenzen," she said. "Gravelly voice. Thick silver hair?"

"Yeah, I think so."

"He's a great man, one of my favorites. Never shy about what's on his mind. He's nearly deaf, though, so he tends to be loud. Not retired either. Keeps busy with general surgery out in Sun City. He's sent me a couple of patients. He's a dear man."

"Well we figured he had nailed Dr. Goodbout."

She was still laughing. "Don't the students call him Grand-Uncle Doug?"

"Uh-huh."

"Where did that come from?"

"I've never heard."

26.p.

"Probably Dickens. Or just one of those names that gets passed down from class to class until its roots are lost," she said.

"It just fits because you can't take him 100 percent seriously."

"And what do you call me these days?" Her eyes were dancing.

"You?" I was caught off guard.

"Dreamy Mimi?"

I grinned. "Well, I have heard that one."

"Any new ones? That one's from junior high."

" 'Fraid not."

"No 'Grand Aunt Meems?' No 'Wicked Witch of the East?' 'Mimi Lyle the Crocodile?'"

" 'Fraid not."

"When I was in medical school," she said, "our Chief of Medicine, Hanna Johnston, was a very large woman, maybe five foot ten, 220, but not so much fat as just big - big shoulders, big bones - who lived with a very strange little person. Not her husband, it was said. In fact there was some speculation about the person's gender. Everyone said Dr. Johnston smoked cigars though no one could ever claim to have seen her in the act.

"Anyway, she terrorized the students. She would have sit-down rounds in a conference room once a week with all the third years on Medicine and grill them endlessly on obscure diseases. So, the story goes, one day she was puffing down the corridor in her long white coat, with a white blouse underneath. She passed a bunch of students and housestaff and one of the third years said, 'Who was that?' The resident said grandly, 'that was Hanna Johnston.' and the student said, 'That was Hanna Johnston? I thought it was a refrigerator.' "

I was laughing again. She went on.

"Supposedly Dr. Johnston heard the comment, because she stopped suddenly, but never turned around. She just started up again and never said anything. Naturally the story spread and Hanna Johnston has forever been 'The Refrigerator' to the otherwise terrified junior students."

"It's their only defense," I said.

"Well I've always been afraid of acquiring a name like 'The Refrigerator.' One might as well be 'The She-Bitch from Hell.' The medical sense of humor can be cruel." We smiled at each other. She looked at her watch. "Let's get some lunch, " she said.

Against a back wall in the Doctor's Dining Room, over some soupy lasagna, she went on reminiscing with a story from her class skit at the end of medical school. "Will you be involved in your Resident Class graduation skit?"

"Is there one?" I answered. "Over three years away."

27.p.

"Well, I'll give you a song you might find useful. But you have to promise to keep my name out of the skit. Can you do that?"

"I guess I could try, but I don't even know if we'll have one, much less who'll be writing it."

"Oh, of course you'll have one. Every surgical residency class does. And you'll have to be involved. You're quicker than most and it seems much funnier, too. Anyway, I'll take that as a promise. The song is to the tune of 'Love is Blue.' Do you know it?"

"Sure."

"We started to write it for our skit but never found a place to use it, so it just hangs out there, waiting." She sang, "Blue, blue, the baby's blue. One ventricle, there should have been two…"

I broke up laughing. She smiled at me, all of her scariness gone, vanished with a smile. I smiled back.

During afternoon clinic I asked her what the rest of the song was. She said that was all they'd written.

An hour later I passed her in the hallway, each of us nose down in a patient's chart, and I softly whistled the melody to "Love is Blue." She grinned over her shoulder and disappeared into an examining room.

Around 4:30 I had just finished helping our last patient - a paraplegic in an electric wheel chair souped-up with motorcycle accessories - down the hall to the waiting room. When I turned back Mimi was staring at me from her office door. She turned slowly inside. I went in and was about to say 'good-bye, see you at morning rounds,' when she again made me bumble. Very quickly and without looking up, she asked, "Would you consider having dinner with me?"

I'm sure I stopped breathing. She may not have been scary anymore as an Attending but she was still very much in charge, still the boss, still Teacher, now dangerous at a whole new level.

I might have said No, if I'd wanted to, but I didn't.

"What time? I mean, yes. Umm, what time?"

"Any time, really. Nothing formal. Do you have evening plans?"

"Well, a basketball game. A bunch of us have a team in a city league. For any game about half of us can get there. It's a five-thirty game, though, if that wouldn't be too late."

"In my younger days I would have come to the game to watch a bunch of hulking, hormonally overloaded young men sweat all over themselves and each other. And enjoyed it quite a bit. In my situation these days I'll just have to enjoy it in my mind. But, I will wait for your game. Give me your address and I'll pick you up at, say, 7:00?" I nodded. "You live alone, don't you. I have to be fastidiously discreet. You understand."

28.p.

"My housemate is on call tonight. Neonatal ICU service. I won't actually see her during daylight for six weeks."

"Her?"

"Lab partner and best friend from medical school. Purely platonic."

She eyed me.

"We keep secrets from each other," I lied.

"Seven o'clock then."

At the end of the game I declined the usual "Let's go get a beer" invitations with no explanation to my friends. The game ran long, but my house was near the gym so I was home right at seven. A Mercedes convertible was in my driveway, and Mimi was waiting on the porch.

"Uh, Dr. Lyle," I said, "I'm sorry. Still have to shower."

"Don't be sorry," she said. "I came early on purpose. I told you I like sweating young men." Judging from the way she smiled I guess my face flushed. She had on a sleeveless satin blouse, a long skirt of something light and filmy, and sandals. The evening was warm, even for Phoenix in spring. The light was fading and the western sky looked like a rainbow ribbon on fire. The townhouse I rented was in a typically nondescript development patch with streets that curve around nothing in particular. The grounds were post-bulldozer chic: clumps of boulders and pampas grasses with a lot of cheap little cacti and one stunted or mangled saguaro per acre. The townhouse units were staggered along a curve so the adjacent patios were offset from one another. Each unit had a peekaboo view of the big red dog-turd rocks that pass for mountains there, but the back patios were invisible to the neighbors.

There was enough breeze that it would be cool on the patio, so I led her there and brought her a glass of wine for the wait while I showered. When I stepped away to go inside she turned and grabbed my wrist, staring into my eyes.

"Stay a minute," she said.

I felt my heart detonate in my throat. I could only stare, thinking of nothing to say. Apparently this was going to be educational.

She changed her expression to something like a gentle knowing smile and pulled herself closer to me. She took a long slow sip of the wine and gave it to me. I gulped a longer one. She turned and set it on the armrest of my garage-sale wooden chaise. She turned back and ran both hands up my chest. Her perfume was an expensive-smelling cross between rose petals and come-fuck-me musk.

"I told you I like sweaty men," she said and pulled my shirt out of my gym shorts, then up over my head. Keeping her hands on my pecs, she lifted her head back to kiss me. Her lips were like water after a mountain hike, cool, wet, delicious and not altogether satisfying. It was a slow, relaxed, nibbling. I didn't know what the protocol response was so I stood there like an eighth grader, hard as rock in my jock strap, which I'm sure she felt, pressed against her belly. She teased her tongue into my mouth and ran her hands lightly all around my hips and groin. She slid her fingers inside the waistband of my gym shorts and peeled them down, exposing my arousal poking above the elastic of the jock. Still in my high-tops and two pairs of socks, I tried to think of high school gym class to slow the flutter in my groin.

29.p.

"It seems you like older women," she said, eyeing the tumescence, and began unbuttoning her blouse. When she was bare to the waist she stopped to fix me with her stare, then lifted her neck very straight to hold her breasts at their most perfect posture and took another slow sip of the wine. My mouth was dry. I took a drink, too, but missed the armrest, shattering the glass on a rock among the cacti.

I fell to my knees and she pulled my head to her breasts. They had the slightly deflated look of a woman who had once nursed, but she was sighing and lightly glowing with perspiration. I found her beautifully perfect.

She sat and pushed herself backward up the chaise, drew up her skirt, and shimmied out of her panties. She pulled me out of the jock and squeezed me into her. She locked her legs around mine, scrunched her eyes closed, and rocked. I may have been on top but there was no doubt who was laying whom. Embarrassed, I came.

Obviously she had not participated in that particular climactic moment. Though it was tempting to verbally gush inquiries, apologies and puppy-dog prattle I was awed into a better choice - keeping my mouth shut. I think she got exactly what she wanted: proof that despite my relative youth and strength I was absolutely susceptible to her. After about three minutes of nothing but mutual heavy breathing I pulled out and off of her. "Shower," I grunted.

Her reply was only, "Bring me a towel."

We went to a barbecue restaurant far away on the west side of Phoenix, away from the money side of town. She said it had great food and was sure to have no one in it who would recognize us. There wasn't much talk over dinner, but she did warn me not to get too full because I would need to show some energy before the night was over.

When we left she handed me the keys to her Mercedes and went to the passenger side. As I started the car she leaned onto my shoulder and began whispering into my ear wonderfully explicit observations about my anatomy, what she especially liked about it, her own post-coital state and how much she enjoyed a certain reminder issuing from her during dinner. Perhaps the single most remarkable thing about my time with Professor Lyle was that I did not crash the car during that excruciating drive to her Scottsdale condo. Naturally her anticipatory pillow talk had the desired effect, and by the time we got there I was a juvenile ball of testosterone, painfully erect but otherwise completely malleable to her whims.

Our encore session was unquestionably more satisfying for her, in the usual sense, and for that matter, for me. She conducted us through an extensive repertoire of postures and points of contact, punctuated by two rather vocal peaks from her, followed by brief rest periods and finally a grunting orgasm from me. I ended it with the sleep of the dead.

30.p.

Her clock radio at 5 am seemed as painful as any hangover I'd ever had. She called a cab for me and gave me a twenty to pay for it. Mimi was explicit: I was to try my very goddamnedest to get to rounds at a normal hour and make not the slightest comment nor facial expression nor untimely erection for that matter to let any of the Hospital snoops have even a faint glimmering of a hint of what had happened, and if I had a poker face and any luck at all, would happen again very soon indeed.

I replied softly, "Yes, ma'am."