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circled her forefinger around a clump of shoulder-length blond hair, around and around, pulling the hairs harder each time, as if yanking her skin away from her skull would create an escape route for her misjudgments. She stared at the empty examination room in her Las Vegas clinic. She no longer noticed the soft ambers and greens of the desert prints she had chosen to be every bit as nice as those in the clinic across town that supported this one in the barrio. Just a month ago the surprised smiles on her patients’ faces when they entered her welcoming office had made the cost worthwhile. And she wouldn’t have wasted half a month on some distant beach anyway, not when her patients needed her and she had a practice to build. And a community to make her mark in.
    After med school a public health guy had talked up applying to a research project in Boston . “Vital, important work,” he had insisted. “A lot of driven types get into it. But they could really use a woman like you, near the top of your class, but also diplomatic. You, Louisa, you sweep people off their feet”—she couldn’t help smiling at that— “and right into your pocket where you wanted them all along.” She had turned him down flat, said You Bet Your Life was not a game she chose to play. But the truth was the guy had made her feel as if he’d cracked her skull open and exposed her mind to the world. She was not about to go to work somewhere where people labeled what she did—focusing on her work and getting everyone else enthusiastic about it—manipulation. She’d worked her tail off in med school. She had no life outside her career. All those years had given her a good view of the failures of medicine, and she damn well planned to be in a position to make changes. You can climb to the top in spite of your competitors, but it’s so much quicker if you can make them see the sense in giving you a leg up. If the research recruiter called that manipulation, then it was no wonder his establishment needed a woman everyone liked.
    Manipulation was what Grady Hummacher had done to her. She had never meant him to be more than a diversion. With Grady all the doors were open and there w-as a prize behind every one. So what if it was all mirage; she didn’t have time for more than that. A delicious diversion, to be dipped into totally, then shaken off, was exactly what she needed.
    And then he’d shown up with the boys. “They’re tabulae rasae,” he’d said as if he’d known the perfect bait. “They’ve never heard a sound. They don’t even have a concept of what language is. They’d be ‘backroom boys,’ if their tribe had lived in more than one-room huts.” Grady had stood right here in this examining room, his wiry hair bleached almost white against his tanned face, his elbows barely bent to rest his hands on the boys’ shoulders. Next to Grady’s tough body, his let’s-try-it expression, the boys looked like third-graders, scared, fascinated, exhausted, amazed. Carlos and Juan, Grady called them, though, of course, he could have called them anything. What he did know, Grady insisted, was that Juan and Carlos had no future in the Panamanian rain forest. Their only chance was with her help in the United States . With her standing in the medical community—everyone liked her—she could get the boys the best diagnosticians, surgeons, specialists, therapists. She could change their lives. She could give them lives.
    She was intrigued by the challenge, the unlimited possibilities. She was hooked. What she hadn’t factored in was coming to care about them. But it was impossible not to.
    Juan was such a sparkler. His eyes were never still, always watching. Was he thinking like we do, she had wondered. Without words was there a mechanism to classify, speculate on experiences, on what other people did? When she got him a sign-language tutor, she would ask him. Could he really go from no concept of words as symbols of things, movements,