Of the eleven recent photographs in the new album, the oldest appeared to be of a man in his seventies. The youngest showed a fair-haired boy with delicate features, his blue eyes taped open, no older than seven or eight.

A windowpane rattled softly and rising wind soughed in the eaves. Something fluttered in the attic, perhaps a roosting bird.

Eleven assisted deaths in sixteen months. This ferrier had poled across the Styx with some regularity.

Ryan returned the album to the bookshelf, retrieved the original two ring binders, and carried them to the desk.

Having gone directly to the shelves on entering the room, he had not noticed the familiar book on the desk. A copy of Samantha’s novel lay facedown.

Staring at Sam’s jacket photo, Ryan settled in the office chair. He hesitated to inspect the book.

When finally he picked it up, he turned to the half-title page, then to the full-title. He was relieved to find no inscription from the author, no signature.

Paging through, he discovered notations in the margins, petty criticisms, some of them vulgar enough to sicken him. He read only a few before closing the book in disgust.

Understandably, Spencer Barghest would have been interested enough in the novel to buy a copy. He’d been in a relationship with Sam’s mother for at least six years. And he had in some way assisted her twin sister, Teresa, out of this world, which was either a noble act of compassion or cold-blooded murder, depending on your point of view.

The point of view that mattered most was Teresa’s, but given the shortage of reliable mediums these days, the authorities were not likely to obtain a deposition from her.

Putting the book aside, Ryan turned next to the first ring binder. Sixteen months earlier, none of these faces in this album had meant anything to him. He was curious to see if that would be the case again or if he might have overlooked something the first time.

Perhaps his personal journey over the past year had sharpened his sensitivity to suffering, because these faces affected him more profoundly than before. They remained death portraits, but on this second viewing, he was more poignantly aware that they were people, even in death each of their faces alive with character.

If he had missed anything important the first time through the binder, he missed it again-and did not have the courage to review it a third time.

The second album was the one from which he had extracted the photo of Teresa that had obsessed him. He had sat here, mesmerized by the reflections in her eyes-until Cathy Sienna had stepped in from the hall to say the house was giving her the creeps.

Ryan had agreed and, assuming that the discovery of Teresa’s death portrait was the lodestone that had drawn him here, he had closed the ring binder and returned it to the shelf.

Now he found the third plastic sleeve still empty. Perhaps Barghest had not discovered that Teresa’s photo was missing.

Twelve sleeves farther into the album, he came across someone he knew. He closed his eyes in disbelief.

If it belonged in this sick collection at all, surely this face should be in the third ring binder, the new one, among the portraits of the people to whom Barghest had evidently ministered since Ryan’s previous visit. Impossible that it belonged with the faces of those who had been unfortunate enough to come under his care years ago.

Heart knocking harder than it had when Lily’s sister had cut him in the parking lot, Ryan opened his eyes and found that he had not mistakenly identified the woman in the photograph.

I’m here. I’m watchin’ over you. You’ll be just fine.

The smooth dark skin.

Don’t hold your breath, honey.

The emerald-green eyes.

You hear him, don’t you, child?

Twelve sleeves after Teresa, who had been dead six years, was Ismay Clemm, one of the two cardiology nurses who had assisted Dr. Gupta with the myocardial biopsy.

FORTY-FIVE

The rising wind choked and wheezed in the eaves, as if words were caught in its throat, and in frustration thrashed the branches of the melaleucas beyond the study window.

Sixteen months ago, sitting in this room, Ryan had been certain he stood at the threshold of a discovery that would strip bare the lurid details of the conspiracy against him. Now the same conviction gripped him.

The first time around, upon finding Teresa’s photo, he thought he had before him the essential piece of the puzzle. Already half obsessed with the perfection of Samantha’s face, he was at once riveted by its perfect duplicate. Seeing the six-year-old death portrait mere hours after having risen from the bed of a lover whose countenance, as she slept, matched the dead face detail for detail, Ryan had been struck by an intense awareness of the eternal presence of death in life that at first disoriented him and then led him to focus on Teresa as the hub from which all the recent weirdness had radiated.

Teresa Reach, however, could neither complete the puzzle nor even contribute to its solution. She was not part of the web that unknown others seemed to be spinning around Ryan.

He couldn’t properly call her a red herring, because no one had planted her photograph in the ring binder with the intention of misdirecting him. In his eagerness to seize the moment, to act, he had raced to the conclusion that her presence in this collection of faces was the illuminating thing he had come to Las Vegas to discover.

But here, sixteen months and twelve pages later in the album, a greater astonishment and the true key lay before him: Ismay Clemm, the fiftysomething cardiology nurse, who had not only assisted with the myocardial biopsy but also had checked on him repeatedly, after the procedure, when he had been on the bed in the prep room, sleeping off the lingering effects of the sedative.

There, he had for the first time experienced the dreams that for a while plagued him: the black lake, the haunted palace, the city in the sea. As much as anything, those repetitive nightmares-and the paranoia that they reinforced, the suspicion of being drugged or poisoned that they enflamed-had motivated him to make that first trip to Vegas while waiting for Dr. Gupta to report the results of the biopsy.

Although Ryan now knew beyond doubt that Ismay Clemm was the pivot point on which he could turn from confusion to clarity, he paged through the rest of the ring binder, studying faces. He needed to be certain he did not make the same mistake now that he had made when he leaped to the conclusion that Teresa would be the key to the door of truth.

The remaining faces were those of strangers. He returned to the nurse. Not Ismay, surely. Ismay’s other.

If these events had a theme, it was identical twins. Samantha and Teresa. Lily and her deranged sister with the switchblade.

Ryan heard a rapping, but it was Zane or Sienna in another room, sounding out a wall for indications of a hidden cache.

He had no idea in what town Ismay Clemm lived. Because her name was unusual, Ryan used his cell to avail himself of a new information service that searched for listings not by city but by area code. He could find no number for Ismay in either the 949 or 714 areas, which might only mean that her phone was unlisted.

At four o’clock on a Sunday afternoon, reaching Dr. Gupta to ask after Nurse Clemm would be difficult. Getting to him on a week-day would be no easier.

A year ago, after discovering that his patient had been under the care of Dr. Dougal Hobb for more than a month, Dr. Gupta had sent Ryan’s records to Hobb, and a curt note to Ryan expressing dismay that he had not been informed sooner of this decision. He was not likely to take or return a call.

As a consequence of all this, Ryan had changed internists, as well. He moved from Forry Stafford to Dr. Larry Kleinman, who offered a concierge medical practice.

He considered calling Kleinman’s 24/7 contact number to ask if the doctor would be willing to seek from the hospital the name of the other cardiology nurse who had assisted Gupta in the biopsy that day. But as he stared at the death portrait of Ismay’s twin, he remembered the lean nurse whose body fat was less than a cricket’s. Whippit. No. Whipset. First name Kara or Karla.

Of the Whipsets that he found in the 949 area code, one had a first name similar to what he recalled. He recognized it at once: Kyra.

He placed the call, and she answered on the third ring.

After he identified himself and apologized for intruding on her privacy and on her Sunday, Ryan said, “I’m hoping you might know how I can get in touch with Ismay Clemm.”

“I’m sorry. Who?”

“The other nurse who assisted in the procedure that day.”

“Other nurse?” Kyra Whipset said.

“Ismay Clemm. I very much need to talk to her.”

“I don’t know anyone by that name.”

“But she assisted during the biopsy.”

“I was the only nurse on the procedure, Mr. Perry.”

“A black woman. Very pleasant face. Unusual dark-green eyes.”

“I don’t know anyone like that.”

“Could she have been…assisting unofficially?”

“I think I would remember. Anyway, it’s not done.”

“But she was there,” he insisted.

His conviction made Nurse Whipset uncertain. “But how did she assist, what did she do?”

“When the first tissue sample was taken, she told me not to hold my breath.”

“That’s it? That’s the extent of it?”

“No. She also…she monitored my pulse.”

“How do you mean?”

“Well, she stood beside the examination table, holding my wrist, checking on my pulse.”

With a note of bewilderment, Kyra Whipset said, “But throughout the procedure, you were hooked up to an electrocardiograph.”

He tried to recall. The memory wouldn’t clarify.

Nurse Whipset said, “An electrocardiograph with a video display. A machine monitored your heart activity, Mr. Perry.”

Ryan remembered the fluoroscope on which he had watched the tedious progress of the catheter as it followed his jugular vein into his heart.

He could not recall an electrocardiograph. He could not say for certain that she was wrong, and he had no reason to suspect that she might lie to him. But what he remembered instead of the ECG was Ismay Clemm.

“After the procedure, I had to lie down on the bed in the prep room, to let the sedative wear off. She checked in on me a few times. She was very kind.”

“I looked in on you a few times, Mr. Perry. You were dozing.”

Staring at the death portrait in the ring binder, he said, “But I remember her clearly. Ismay Clemm. I can see her face now.”

“Can you spell the name for me?” Nurse Whipset asked.

After he spelled it, she spelled it back to him to make sure she had gotten it right.

“Listen,” she said, “I suppose it’s possible for some reason she briefly visited the diagnostics lab during the procedure, and I was too busy to pay much attention to her, but she made an impression on you.”

“She made an impression,” he assured Kyra Whipset.

“Because of the sedative, you might not recall it clearly. Your memory might have exaggerated her time in the room, the level of her involvement.”

He did not disagree with her, but he knew it had not been that way, not that way at all.

“So,” she said, “give me a number where I can reach you. I’ll make a couple of calls to people at the hospital, see who knows this woman. Maybe I can get contact information for you.”

“I’d appreciate that. Very kind of you,” he said, and gave her his cell number.

Rap-rap-rapping: George Zane and Cathy Sienna testing walls, testing cabinets.

Ryan removed Ismay Clemm’s death portrait from the plastic sleeve in the ring binder and put it on the desk.

The sharpening wind was a scalpel now, stripping the skin off every tract of bare land it found. Beyond the window, trees shuddered in clouds of yellow dust, in the acid-yellow light of late afternoon.

From the manila envelope that he had brought with him, Ryan took the photos of Teresa Reach and Lily X. He lined them up with the death portrait of the woman who looked like Ismay Clemm.

He knew now a disquiet that was different in character from any he had known before.

This journey had taken him from dead-center in the realm of reason, where he had lived his entire life, to the outer precincts, where the air was thinner and the light less revealing. He stood on the borderline between everything he had been and a new way of being that he dared not contemplate.

He had half a mind to return two photos to the ring binders and leave at once with just the picture of Lily.

The problem with that was-he had nowhere to go except home, where sooner or later he would be slit open and have his heart cut out of him again, this time without anesthetics.

After a while, the air acquired a faint alkaline taste from the dust-choked wind that relentlessly groaned and snuffled at the windows.

When eventually Ryan’s cell phone rang, the caller was not Kyra Whipset, but a woman named Wanda June Siedel, who said that she was calling on Nurse Whipset’s behalf.

“She says you want to know about Ismay Clemm.”

“Yes,” Ryan said. “She was…very kind to me at a difficult time in my life.”

“That sounds like Ismay, all right. Sure does. She and me were eight years best friends, and I don’t expect ever to know somebody sweeter.”

“Ms. Siedel, I’d very much like to talk with Nurse Clemm.”

“You call me Wanda June, son. I would sure like to talk to Ismay myself, but I’m sorry to tell you, she’s passed on.”

Gazing at the nurse’s photo on the desk, Ryan avoided for the moment his most important question. Instead he said, “What happened?”

“To be blunt, she married wrong. Her first husband, Reggie, he was a saint to hear Ismay tell it, and I expect he must have been if half her stories about him were true. But Reggie, he died when Ismay was forty. She married again seven years later, that was to Alvin, which is why she came here and I ever met her. She loved Alvin in spite of himself, but he never set well with me. They made it eight and a half years, then she fell backwards off a convenient stepladder and smashed the back of her skull bad on some convenient concrete.”

When Wanda June did not continue, Ryan said, “Convenient, huh?”

“Son, don’t take me wrong on this. I’m making no accusations, have no intention to smirch anyone’s reputation. Lord knows, I’m no policeman, never even watched them CSI shows, and there was plenty of policemen on Ismay’s case, so it’s got to be that they knew what they were doing when they called it an accident. Can’t be but crazed with grief and loneliness why Alvin took up with another woman just a month after Ismay’s gone. Crazed with grief and loneliness, crazed by the estate money and the insurance money, poor crazed and lonely Alvin.”