When he next went to the hospital for the annual checkup on his carotids, the sonogram revealed that the second carotid was now seriously obstructed and required surgery. This would make the seventh year in a row that he would have been hospitalized. The news gave him a jolt — particularly as he'd heard by phone that morning of Ezra Pollock's death — but at least he would have the same vascular surgeon and the operation in the same hospital, and this time he would know enough not to put up with a local anesthetic and instead to ask to be unconscious throughout. He tried so hard to convince himself from the experience of the first carotid surgery that there was nothing to worry about, he did not bother to tell Nancy about the pending operation, especially while she still had her mother to tend to. He did, however, make a determined effort to locate Maureen Mrazek, though within only hours he had exhausted any clues he might have had to her whereabouts.

That left Howie, whom by then he hadn't phoned in some time. It was as though once their parents were long dead all sorts of impulses previously proscribed or just nonexistent had been loosed in him, and his giving vent to them, in a sick man's rage — in the rage and despair of a joyless sick man unable to steer clear of prolonged illness's deadliest trap, the contortion of one's character — had destroyed the last link to the dearest people he'd known. His first love affair had been with his brother. The one solid thing throughout his life had been his admiration for this very good man. He'd made a mess of all his marriages, but throughout their adult lives he and his brother had been truly constant. Howie never had to be asked for anything. And now he'd lost him, and in the same way he'd lost Phoebe — by doing it to himself. As if there weren't already fewer and fewer people present who meant anything to him, he had completed the decomposition of the original family. But decomposing families was his specialty. Hadn't he robbed three children of a coherent childhood and the continuous loving protection of a father such as he himself had cherished, who had belonged exclusively to him and Howie, a father they and no one else had owned?

At the realization of all he'd wiped out, on his own and for seemingly no good reason, and what was still worse, against his every intention, against his will — of his harshness toward a brother who had never once been harsh to him, who'd never failed to soothe him and come to his aid, of the effect hi............