The Mask of Sanity Page 5

  If he’d harbored any doubts—which he didn’t—his confrontation with Sugarman the next morning would easily have banished them. The disagreement erupted at the monthly heart-transplant summit, a seven A.M. session during which senior clinicians from various disciplines reviewed which patients should be eligible for organs. When Balint arrived, exhausted after only four hours of sleep, he found his colleague already seated in the conference room. Sugarman raised his Styrofoam coffee cup to acknowledge his arrival. “How are you, Balint?”

  “Almost awake.”

  He retrieved an agenda from the stack at the door. In twos and threes, the representatives of the various departments and services dallied in: anesthesia, nursing, psychiatry. Balint waited for Chester Pastarnack to arrive—but then, to his surprise, Sugarman called the meeting to order. The baton, it appeared, already had been passed. No longer would Pastarnack’s bald crown with its enormous brow make final determinations of life and death. They had entered the Sugarman era. Balint’s nemesis was now to play God, at least for the short time on earth still allotted to him.

  “I saw your patient Navare this morning, Balint,” began Sugarman. “You can’t seriously want to list him?”

  “But I do. Why not? He’s under sixty-five. He’s got strong family support.”

  Sugarman shook his head. “Pardon my French, Jeremy, but he’s a fucking nightmare. The guy’s a poorly controlled diabetic on the brink of renal failure. He could be Dickgoddamn-Cheney and I wouldn’t cut open his chest.”

  An awkward silence settled over the conference room. These transplant summits were usually harmonious affairs, a collaborative effort. Chester Pastarnack rarely spoke until every participant had received an opportunity to offer his ten cents—and he certainly never used profanity. On occasion, Pastarnack had even been known to solicit an opinion from one of the medical students or nursing trainees who observed the meeting from the folding chairs along the rear wall.

  “Am I crazy, people?” asked Sugarman. “Or am I missing something?”

  Balint’s eyes wandered from face to face. He could have kissed the consult-liaison psychiatrist—a dour German woman old enough to be his grandmother—when she offered a tepid word of support. “That man possesses a will to live,” she said. “I met with him for two hours last week. Psychologically, he’s an excellent candidate.”

  “Anybody else?” asked Sugarman.

  “The daughter is a nursing student,” observed one of the nursing coordinators. “I’m just throwing that out there.”

  Sugarman raised his eyebrows. “Okay, she’s a nursing student. Good for her. But what am I supposed to do with that information?”

  “She’ll be able to look after him,” ventured the psychiatrist.

  Sugarman grinned—an ugly grin. “If I have to play the bad guy, then I have to play the bad guy. Say we give your friend a heart, Balint, he’s got a one-in-three chance of dying on the table. Even money, he’s dead in a month. And do you really want to tell the parents of some twenty-year-old athlete with cardiomyopathy who doesn’t get that heart that we had to kill their kid—which is, in essence, what we’d be doing—so the chief of cardiology could try to buck the odds?”

  That was the final verdict. They passed over Delilah’s father and moved on to the next candidate. Balint didn’t absorb another word that was said all morning. When the meeting ended, he hardly noticed. Only after Sugarman approached him and placed his hand on Balint’s shoulder did he register that it was time to leave.

  “It’s not personal, Jeremy. He’s a lousy candidate. If we had more organs, it would be different. You know how it is . . .”

  “Of course, it’s personal,” snapped Balint. “Maybe not for you. But for Norman Navare and his daughter, you bet your ass it’s damn personal. Where do you get off playing God all of a sudden, Sugarman? Are you even an organ donor?”

  “Whoa, cowboy. What’s gotten into you?”

  Balint realized he was on the brink of ruining everything. If word got around that bad blood had brewed between him and Sugarman before the murder, it would only be a matter of time before the authorities discovered Amanda’s affair—and then all would be lost. His only option was to swallow his pride and apologize.

  “I’m sorry, Warren. I shouldn’t have said that. I was way out of line,” he said.

  “Don’t think twice. We all have our moments.” He flashed Balint a benevolent smile. “No harm, no foul.”

  Balint placed his hand atop of the surgeon’s. It was the only way. “Navare is a family friend . . .”

  “I had no idea. I’m sorry,” said Sugarman. Balint hated the man now more than ever—despised him for his sympathy above all else. “If I thought he had a remote chance, you understand, I’d bend over backward . . .”

  Balint stood up and Sugarman gave him a hug—the sort of macho half embrace exchanged by clergymen and mobsters. Perfect. At least a dozen witnesses had seen them make up. But to Balint, his rival’s embrace was more than hypocrisy. The arms locked around his torso were already the icy limbs of a cadaver.

  CHAPTER FOUR

  He had decided upon the how. His next step was to determine the where.

  Balint bought himself a Rand McNally Road Atlas at a service station. He might have searched for promising locations on the Internet, but he did not want to leave behind an electronic trail. Circumstantial evidence had sent nearly as many men to prison as eyewitness accounts. A similar calculus shaped his choice to center the spree in New York City, using Manhattan as his hub and the Tri-State suburbs for spokes. The distances were longer than he would have preferred—it was a two-and-a-half-hour drive from Laurendale to Westchester and Long Island, nearly three to Fairfield County in Connecticut—but they were tolerable. Suburban Philadelphia had been his other option, but he’d grown up in nearby Bucks County, and he sought to avoid even the remotest ties to the crime scenes. Of course, choosing the suburbs of either New York or Philadelphia put him way ahead of the average killer. A less-intelligent perpetrator would have concentrated the crimes around Laurendale itself, murdering once in North Jersey and then in the Trenton area and on another day down by Atlantic City—until the police required only a protractor and a piece of string to home in upon their suspect. Balint’s research confirmed what he’d already suspected: most criminals were indeed not very bright. If you marked the sites of a serial killer’s crimes on a map, nine times out of ten you could then predict the murderer’s address within half a mile.

  The first rule Balint settled upon, in regard to choosing his targets, was not to be governed by sentiment. He resolved against shying away from potential victims because they cared for young children or elderly parents. If he were to succeed, he had to be willing to strangle nuns and kindergarten teachers and firefighters, disabled veterans and elderly widows, even pregnant women and adolescents, all with equal voracity. He planned to avoid younger children, but for a practical reason: he feared strangling elementary school kids might impact the psychological profile of the killer that the police inevitably would generate. He hoped to have the authorities searching for a disaffected dropout or derelict—often the perpetrators of serial killings. In contrast, he’d read, methodical child butchers lurked in all segments of society. Balint’s first priority had to be to murder Sugarman without getting caught. Inevitably, avoiding detection meant selecting additional targets. Vulnerable targets. The alternative was to assume greater risks, and while he might have been willing to take such chances where only his own welfare was concerned, he refused to play Russian roulette with the futures of his daughters.

  After several days of reflection, he concluded that New York’s Westchester County offered as good a place to start as any. But where in Westchester? He proceeded by process of elimination—avoiding large municipalities, which might already possess street cameras, such as Yonkers, and those like Mount Vernon, where a violent crime would not draw much attention. At the opposite end of the spectrum, he feared homes in the tiny suburbs of
Scarsdale and Chappaqua could confound him with high-tech security systems. Above all else, he avoided towns to which he could claim even the remotest connection: he had a second cousin in Ardsley and a former girlfriend in Mamaroneck, so he scratched these communities from his list. Ultimately he settled upon the village of Cobb’s Crossing, because it contained both a small college and a planned retirement community, each of which might afford easy targets, and because, in a pinch, its position at the intersection of four major highways promised access to numerous escape routes.

  Balint circled the hamlet on the Westchester County map in his atlas. Then he thought the better of leaving behind any vestige of his planning, so he tore the page from the Rand McNally and ignited it on the gas range. As he watched the flame burning toward his fingers, his spirits surged on a wave of power, a glorious wave that carried him aloft like a phoenix rising from ash.

  NORMAN NAVARE returned home from the hospital three days later, as Balint had anticipated, and he scheduled a follow-up appointment for early the next week. This time, he booked a full-hour block with his priority patient. All weekend long, he found himself looking forward to the encounter, and when the time finally arrived, he actually suffered a mild case of the jitters. Adding to his anxiety, Navare ran late—Delilah later explained that she’d accidentally locked her keys inside her car—and Balint was on the brink of giving up hope when the old man and his daughter stepped through the office door. Navare’s complexion had assumed the blue-gray tinge of an ice floe.

  “I’m so sorry,” apologized Delilah. “But I come bearing gifts.”

  She handed Balint a colorfully striped paper bag.

  “A little something to say thank you . . .”

  Her offering was more than a little something. She’d baked him cookies, literally hundreds of cookies, shaped like hearts with red and blue sprinkles. These weren’t valentine-style hearts; they actually looked like human organs. Upon closer inspection, Balint realized the red and blue sprinkles had not been randomly distributed: the red patches marked the oxygenated blood of arteries, while the blue area indicated the relatively deoxygenated blood of veins.

  “Anatomically correct,” observed Balint. “Very impressive.”

  “You’ve been so kind to us,” she replied. “To me . . .”

  Usually Balint replied to this sort of remark with the observation that he was merely doing his job. To Delilah, he answered, “Don’t be foolish. It’s the least I could do for my favorite patient.” Of course, what he actually meant was that she was his favorite patient, so to speak, and they both knew it. Her father was merely some debilitated housepainter with heart disease—not a person Balint had any reason to favor over countless other critically ill men and women.

  Balint examined Navare and ordered several diagnostic tests. “Your father could use another echocardiogram,” he explained. “To make sure that his ejection fraction is holding steady.”

  “Any news on the heart?” asked Delilah.

  He hadn’t yet told her about Sugarman’s decision.

  “I’m still working on getting him listed. We’ve hit a minor snag regarding your father’s eligibility, but nothing we shouldn’t be able to overcome . . .”

  “Are you sure?”

  “I thought you trusted me. I am going to get your father a heart, even if it means poisoning all the other candidates on the list.”

  Navare shook his head. “Don’t worry too much about me, doc. You should give your hearts to the most deserving people . . .”

  Delilah patted his knee. “You’re as deserving as anyone, Papa . . .”

  “I am an old man,” said Navare. “If it comes down to me or someone younger . . . a father of small children . . .”

  Balint closed the man’s chart. “I understand your concerns, Mr. Navare. But we do give the hearts to the most deserving candidates. In this case, I’m optimistic that there will be enough to go around . . .”

  He completed Navare’s physical exam and asked him to step into the lavatory to provide a urine sample. Urinalysis was entirely unnecessary, but it afforded Balint a moment alone with Delilah. The nursing student looked radiant with her onyx hair braided into cornrows and her breasts snug under a cotton halter. He guessed that she’d done herself up for the appointment.

  “I hope I’m not out of line,” Balint said, trying to mask his own confidence, “but I was wondering—I swear to you I’ve never asked this of a patient’s family member before, and I could probably get in big trouble for doing it—but I was wondering if you might want to have dinner with me sometime?”

  “Do you mean go on a date?”

  He looked away. “I shouldn’t have asked.”

  From the next room, they heard the rhythm of Norman Navare’s urine hitting a specimen cup.

  “Now who’s being foolish?” asked Delilah. “And yes, Jeremy, I would be very happy to have dinner with you.”

  At that moment, the bathroom door opened and Navare shuffled back into the examination suite. He was still tucking his undershirt into his trousers with one hand and he held the cup of urine in the other. His fly wasn’t zipped. Balint took the specimen from him to label it, while his daughter assisted with his clothes.

  “I should see you in another three weeks, Mr. Navare. After the echo results come back. But I’ll obviously call you sooner if we uncover anything alarming.”

  He opened the door for the old man and his daughter.

  In a softer voice, he asked, “And I’ll see you . . . ?”

  “Name your day.”

  “Tomorrow?”

  She smiled. “Sure. Tomorrow.”

  “My last patient is scheduled for five thirty. Do you want to meet downstairs in the lobby at six fifteen tomorrow night?”

  She agreed.

  Balint watched the beauty as she helped her father past the receptionist’s desk and across the packed waiting room. He regretted for a moment that he hadn’t thanked her one final time for the cookies. Then he returned to his desk, opened Navare’s electronic chart, and recorded that he’d discussed the man’s present ineligibility for cardiac transplantation with both the patient and his daughter.

  BALINT AWOKE so giddy the next morning that he considered canceling all of his patients and taking the day off to relax. He might have done so—except that his alibi with Amanda depended upon a long day at the office. As far as his wife was concerned, he’d be delivering a dinner lecture on anticholesterol medications for a drug company that evening, a lucrative gig of the sort that fell into his lap on occasion; this time, Balint told her that he’d be filling in at the last minute for a colleague whose child had become seriously ill. Unfortunately Amanda managed their finances, so he ran the risk that she might eventually notice that he’d never been reimbursed for this nonexistent presentation, but he was hoping that as months passed, the matter would slide through the cracks. Of course, if he didn’t go to work at all, she’d notice something amiss.

  Skipping out on the hospital without staying home wasn’t an option either, as it might have been most days, when he could have split his time between the gym and the library. But this was also the afternoon Balint was slated to speak with Rabbi Steinhoff. Amanda had arranged the meeting—and if he postponed, she was bound to go through the roof. After all, his wife served on the synagogue committee that had hired the handsome young Israeli, a decorated veteran of his nation’s air force.

  The incongruity was not lost on Balint that the very same day he planned to cheat on his wife for the first time, after nine years of marriage, he was also consulting with a clergyman about charitable work. If this were a film, he imagined, Steinhoff would gain his confidence, ultimately causing his conscience to get the better of him, and he’d end up revealing the murder scheme to the rabbi. But this was not a movie and he had no intention of divulging anything.

  Balint met Steinhoff on the elevator as he was returning from lunch; the pair shared an awkward ride in the crowded car. They exchanged handshakes in the co
rridor, then strolled in silence until they reached Balint’s office. The rabbi stood a head taller than he did, but was far too thin for his frame, and Balint found himself reminded of the line from Shakespeare’s Julius Caesar about Cassius boasting a “lean and hungry” look. He’d seen the play with Amanda one summer in the Berkshires—and this was among the few passages that had lodged inside his nonpoetic skull. Since this wasn’t a medical visit, Balint seated himself opposite the rabbi in one of the upholstered patient chairs, rather than behind his own imposing mahogany desk.

  “Thank you for your time, Dr. Balint.” The rabbi spoke rapidly—with no trace of a Hebrew accent. “I realize you’re busy. I’m busy. Everyone is busy these days. My wife likes to say that she’s too busy to be busy . . .” Obviously Steinhoff thought this remark rather witty, so Balint resisted the urge to insinuate that the man’s wife might be busy sampling merchandise elsewhere. “So I am grateful that you’ve made the time for me, and I will try to be as brief as possible . . .”

  “No rush,” said Balint. “It’s a quiet afternoon.”

  Steinhoff raised his eyebrows in surprise, as though the notion of a quiet afternoon was a first perilous step toward adultery and murder. Balint missed the late Rabbi Felder, an irreverent, hearing-impaired clergyman who had probably never been busy for a single day of his life.

  “I’ve come to propose a joint venture,” pitched Steinhoff. “Are you familiar with Project Cain?”

  “Amanda told me something about it. You try to keep Jewish kids from committing crimes.”

  “Not only Jewish kids. Kids of all backgrounds.” Steinhoff leaned forward, dropping his voice nearly to a whisper—even though they sat alone in the office with the door shut. “We operate in Newark. Mostly in the black community. My guess is that none of the children we assist are actually Jewish.”