He explained: "In a democracy, the people are in charge. Theoretically. In an autocracy, it's a despot. In a theocracy, the church rules. So, in a mediocracy..." He left it open, pa.s.sing it to her.

"Society is ruled by that which is mediocre," she finished, feeling a click within, a reversal of roles. He had become the lecturer and she the pupil.

She had wanted to learn from him? Of course. She had just thought she would remain in charge the whole time, and in a small way hated to lose the moment when she saw him turn again, back to the window, to stare. Hated world, intolerable world, world that rejects and is rejected.

"I'm awake," he whispered, "but all it does is hurt."

She thought of ruts over the next couple of days. How easy to fall into them, how difficult to recognize them from inside. Was she living in one as of late?

She worked, she treated patients. She came home, she slept. Books, always there to be read, nonfiction mostly, biographies and psychology texts, the occasional mystery. Her parents had retired two years ago to Prince Edward Island and she faithfully wrote them every other week. Now and again, a drive into the desert to watch the dawn, and feel the warming embrace as the newborn sun scorched the purity of land, to remember why she had come down here. Anything else? No, not much of note.

And she had to admit that, were it not for Sarah, it might sound dreadfully sterile. Sarah was a live-in safeguard against things becoming too routine. Sarah who prodded, "See this? Let's go here," and, "Look, look who's playing, you're coming with me, aren't you?" Sarah never had to prod very hard. Adrienne wanted a social life, but the world was geared to those whose nights were free. It was her schedule - how the h.e.l.l was she supposed to have a real social life when she didn't clock in until four in the afternoon?

Re-evaluation often came out of unlikely inspirations: this time a patient who had brought her back face-to-face with the reasons she had gone into psychology in the first place.

Ruts meant no new purpose, no fresh goals. And so, that night after work, following the session with Clay, she stayed up until four completing her initial letter of proposal for a possible grant to study male aggression. She had already been to the university psychology department to see what was available, found herself drawn to one involving correlations between violence and authoritarian backgrounds. Perfect.

Of course, with the pace of funding agencies, both state and federal, she stood almost no chance of getting approval in time to take advantage of Clay's presence in Tempe. He would be long gone, discharged. There was no reason to expect Ferris Mendenhall to approve his stay for that long, a.s.suming Clay would even want to stay.

Still, it didn't mean that, were a grant approved, she might not be able to make later contact.

Without exaggeration, Clay Palmer was unlike any other patient she had ever treated. She'd had ample contact with sociopaths and schizophrenics, and with patients whose maladaptation to the world had turned them into dysfunctional wretches. In their company Clay would fit, but he was the first of them to speak so rationally as a theoretician.

The mediocracy. Would Friedrich Nietzsche have spoken similarly, in this day and age, had he found himself in the asylum at the age of twenty-five?

Note to herself: See if there was anything available on the treatment Nietzsche had been receiving at the end of his life. It had been, after all, during the dawn of the psychoa.n.a.lytic method.

Now, if she could just get the results of the karyotype so they could put that behind them.

Adrienne had been expecting it to arrive without ceremony, by courier perhaps, finding it in with her mail some afternoon when reporting for her shift.

The last thing she had expected was the Friday phone call from Arizona a.s.sociated Labs, ten minutes after her arrival. The voice on the other end was bewildered and excited in the same breath.

The results were nothing Adrienne had heard of before.

Worse, they were nothing the caller had ever seen.

Eight.

She tried to banish the word from her mind. Such an ugly word, rife with connotations unfair to a victim of biology's whims and nature's pa.s.sion for variety. Still, the word lingered, applicable, technically correct.

Mutation.

No wonder she had detected such a thrill in the voice of the geneticist who had called with the news. He had been looking at something so unusual its implications weren't even understood.

That weekend, Adrienne spent every free moment poring over genetics texts to give her at least some working knowledge of the subject, conversational footing in a science where even most M.D.'s were lacking. She burned both midnight and noonday oil, barely needing sleep. Sarah did not resent this in and of itself, only that for once Adrienne refused to share that which was consuming her. Tough. Sarah miffed was only a temporary condition, and this business of chromosomal mutation was just a bit beyond the usual pale of lives gone astray.

The core of the human animal, Adrienne knew, was written out in a seemingly endless sequence of protein codes, three billion base pairs in all, linked into the twining dual strands of a double helix, one of nature's most elegant structures. Three billion links in the chain of DNA, an identical text found in the nucleus of nearly every cell in the body. She found mind-boggling the sheer numbers and the infinitesimal scale on which they existed. Scaled-up a.n.a.logies were the only thing that helped her grasp the enormity of the miracle. One she found especially vivid: It was as if a rope with a diameter of two inches and a length of 32,000 miles was neatly arranged within an organic vessel the size of a domed stadium. Behold, a single nucleus.

The rope, however, was not of continuous length. Human DNA was apportioned among forty-six chromosomes, two of which, the X and the Y, determined gender, the remainder existing in twenty-two matched pairs. Every trait of structure and function and bearing that characterized one as a human being - as well as an individual among the world's billions - was encoded in the 50- to 100,000 genes found along the chromosomes. Most of the time, when anything went wrong on a genetic level, what and where was a mystery, although the number of genes a.s.sociated with specific diseases and defects was increasing all the time.

Of genetic disorders, she learned there were around 3500. Among those, a mere twelve were so obvious they could be sighted off a karyotype at a glance.

Among them were conditions such as Klinefelter's syndrome and Turner's syndrome and others afflicting normal gender designation. Too many X chromosomes, or not enough. Then there was the XYY male genotype that had provoked such hotly contested debate.

Down's syndrome was also among this dozen, whose mentally r.e.t.a.r.ded and physically impaired progeny carried a third copy of chromosome twenty-one, instead of the normal pair.

Twelve abnormalities, all unique.

But then there was Clay Palmer, who exhibited a thirteenth not even in any book she consulted: a triple set of chromosome twelve.

This was most unexpected.

And very, very new.

"How does this manifest itself in my patient?" she had asked.

"That's the wrong question. It's premature," she was told by a geneticist named Ryker. "Inasmuch as I can't even tell you what this means."

In the physical nature of the defect, it was most obviously closest to Down's syndrome, an identical glitch but involving a different pair of chromosomes. Clearly, Clay Palmer exhibited none of the symptoms characteristic of Down's. He was highly intelligent, physically healthy, with no skull deformation or slanted eyes, no indication of heart disorder.

Chromosome twelve. Here too were located genes a.s.sociated with hemolytic anemia, lipoma, myxoid liposarcoma, type-one vitamin D dependency, and - Acute alcohol intolerance.

This could be a find. Clay had been hospitalized more than once for alcohol poisoning.

Her weekend was lost in a density of specialization and the vast interior landscape, never without a book, reading wherever opportunity presented itself: kitchen, office, bathroom, behind the wheel while stopped at traffic lights, on the sofa while failing to realize that for the past ten minutes Sarah's feet had been in her lap. In learning there was safety, for to set the books aside was to remove the diversion and nakedly confront the fact that she was absolutely petrified.

Because what does it mean? What does this mean in terms of his body and his mind?

In her hospital sat a young man who by turns sought to tear himself and other people to pieces, the worst of his impulses held in check by a fragile grasp on the hope that he might learn to become something better. Whether a n.o.ble quest or a fool's errand, Clay Palmer had seemingly yet to decide, but the outcome was largely up to her. If she was correct, Clay might only be months away from committing the ultimate irrevocable crime, after which intervention would become a moot point. His future would consist of prison, or death.

He had looked to her for help. And she was going to have to look him in the eye and tell him the truth, along with the words she hated most of all: I'm sorry ... I don't know.

And how inadequate these words sounded to her ears. Who, though, among healers of body and mind, felt adequately trained in dealing out disappointment? Who felt comfortable admitting there were syndromes beyond their expertise, beyond even their knowledge? What pompous pretenders they all were at times. Their understanding of the totality of human life was barbarously crude, not far beyond using leeches and trephining holes into the skull to release evil spirits.

When Clay looked at her, it was with the same lost melancholy another's face might have worn after being told a parent had died, or a sibling, a favorite grandparent ... someone who had always been there, now gone. It was the face of downward spirals, and Adrienne pictured Clay sliding helplessly along a coil of double helix.

Thirty-two thousand miles. He might never hit bottom.

"It's me, then." His whisper was as soft as the sound of a knife on a throat.

His room felt cold for no good reason, or was she the only one who noticed? It was Monday afternoon, h.e.l.l of a way to start the week - you seem to be coming along nicely in our sessions, and by the way, did you know you're a freak of nature?

"I thought it was something I could work on, try to beat," he said, "but it's me..."

"Clay, please listen, there's no reason to believe that. It's too early to conclude what effect this might have on you, or even if it has one at all."

"It's me, it's me," and his voice curled into a low chant of loathing, "it's me," weighted forearms beginning to clash against each other, the casts striking as hammer and anvil, each blow harder than the last. Eyes wide, an acute madness brought on by knowledge - he had looked into deformity and found himself staring back. Black hair in tangles that fell into his eyes, he burned upon a pyre of his own fears, and she had no way to a.s.suage them.

"It's me and it's in every f.u.c.king cell in my body!" Clay screamed.

He was off the bed before she realized what he was doing, lurching across the room to the far wall, throwing himself whole-bodied into a murderous swing at the chain link over the window. The cast - his right - rebounded with an atonal tw.a.n.g of metal, and he battered away at it again as she went for the door, holding it open, nodding into the hall while in they came, the enforcers of the asylum she'd had waiting just in case. He was code blue all over again, and succeeded in impacting the chain link with enough force to drive it into the window behind. Gla.s.s shattered, but if he wanted shards he was out of luck, nothing had fallen inside, so he sagged down the wall while turning on himself. Reddened fingertips hooked just beyond the ends of the casts, ragged nails in need of tr.i.m.m.i.n.g. Clay seemed to regard his body as something hideous beyond tolerance, head straining on neck as if to distance itself from torso. With those heavy, clawed hands he ripped at the T-shirt under his robe, shredded through to the skin beneath.

He tore.

He tore.

The orderlies were on him before he knew they had entered the room. Arms seized, he was dragged away from the wall, sobbing. His last recourse at venting the corrosive rage was to snap, and try to bite.

Convulsing and nailed to the floor by other hands, enforced cruciform pose and raw bleeding stomach and raked chest and old ribbed scars from older hatreds turned inward, he met her eyes just once...

Then followed the needle all the way to his arm.

As many times as it took.

It was the curse of the evening shift: One could never get off at midnight and have enough time to drown workday sorrows in a long night of binge drinking. She'd be lucky to get in three rounds before last call.

Home, then, home and a bottle. n.o.body could run her out of home before she was good and ready.

Adrienne turned on the stereo before pouring the first drink, volume low because Sarah was already asleep upstairs. Music had its charms, a companion that never judged failures. She could listen to the enchantment of Celtic song and believe in the magic of beautiful dark-haired women with the throats of angels.

She found the note in the kitchen, taped to the freezer door, where she wouldn't miss it. Sarah's expansive, loopy hand: I invented a new drink tonight: the peanut b.u.t.ter daiquiri. It sticks to the roof of your liver.

Are you smiling?

I love you and I think you're working too hard.

Adrienne peeled it away from the door - smiling, yes - and brushed it with her fingertips, some new kind of Braille, seeking love, any connection. Such mementos she kept in a small box upstairs, always meaning to get around to sorting them and giving them a proper sc.r.a.pbook home, but never finding the time.

Her drink of choice tonight was gin over ice with a squeeze of lime. She carried it to the sofa and sank into both.

And what of Clay, this late hour? Calmed out of his senses, strapped into his bed in case he was feigning stupor, or woke up cranky. Three and a half weeks of lithium might as well have been breath mints, for all the good it had done him. Given enough of a trigger, he could have exploded at any time.

Still...

He had not.

So which had been the greater force within him: self-control, or medication? Her every a.s.sumption about him was now in a tenuous new light. Oh, she could talk, all right, could spin textbook rea.s.surances in accordance with proper methodology: no reason to believe his genetic condition had anything to do with behavioral affect, cognitive defect, emotional maladaptation, nothing to indicate any connection at all...

And it would have been miraculous if this had rea.s.sured him. She wasn't even fooling herself. This was simply beyond all understanding.

Adrienne got a second drink and returned to the sofa with the rainstick kept propped in one corner. It had been made in the shadow of the Andes, a meter of thin Normata cactus. While dead and drying, its spines had been pressed into the hollow body, which some peasant artisan had then filled with pebbles and fragments of bone, before sealing the end.

She upended it slowly, like an hourgla.s.s, and listened to the cascade of pebbles and bone over delicate spines, a rippling sound like a sweet July shower. Sarah had bought this for her for their first month's anniversary, after Adrienne's pa.s.sing remark that she missed the rains of San Francisco.

Prayers for rain; the Diaguitas of Chile used rainsticks to serenade their G.o.ds. In more superst.i.tious moments, she fancied she could do likewise: serenade elder G.o.ds of the mind, summoning the spirits of Jung and Fromm; prayers for a deluge of insight.

"Paper didn't say anything about rain."

Sarah slouched in the doorway to the hall, frowzy-headed and squinting against the light. She wore rumpled socks and a T-shirt that fell to mid-thigh, promoting some den called Club Cannibal, on the Ivory Coast. She braved the light and came on in.

"I woke you, I'm sorry."

Sarah, waving it off, half-asleep and squinty, shuffled around the sofa to lean over and wrap her arms around Adrienne's shoulders. Their heads knocked lightly together, black hair on blond. She felt the tender press of lips to her neck.

"You look whipped," Sarah murmured.

Adrienne fought it, finally shut her eyes and nodded. "I'm sitting here second-guessing myself. It takes some effort."

Sarah kissed her again and came around to join her. Adrienne set aside the rainstick, listened to its final trickling.

"Are you ready to talk to me?"

Here again was that breach of ethics, that forbidden sharing of privileged information. She had often compared her profession with religious vocations and their inevitable crises: priests who doubted, nuns who l.u.s.ted, vice versa. Encouraged to seek guidance only from others in the same fold, they would get such a narrow perspective in return, wouldn't they? Such myopia had never made sense to her. Sometimes you needed a confessor from beyond your own circle, if only to remember there was another world out there, with other ways of thinking.

So she told: Clay and the test, the results and his reaction. Feeling no better, but less alone, and less alone can be a lot.

"You had an obligation to tell him," Sarah said. "There's no way around that."

"I know that" - Adrienne was gesturing more emphatically than she realized - "but it's the timing, I thought he was strong enough to deal with it, I really did. I completely misjudged it, the chance he'd revert back to an earlier state where he'd try mutilating himself."

"But look at the kind of news it was. Do you think there's a good time to hit somebody with something like that?"

Point well made. Perhaps the true measure of her progress with Clay would be how well he acclimatized himself to the test results over the next several days - not his immediate devastation.

"And consider this: You'd have to tell him eventually. If you told him it came back normal and then admitted you'd been lying, no matter how well-intentioned the reason, how do you think he'd feel then?"

"Betrayed. Maybe manipulated."

"You're d.a.m.n right he would. I would."

You would, wouldn't you? And you'd be furious about it, too. A part of Sarah was like Clay, on some rudimentary level. Odd how it had never occurred to Adrienne before. Impulsive, a bit untamed, now and again given to fanciful rumination, Clay was like Sarah would be with all the restraints chipped away, leaving only a core of desperation, confused hungers, and panic-stricken rage.

"So isn't all you can do, really," Sarah said, "is help him come to terms with that news?"