Hospitals are run by nurses. Margaret Spencer, the chief nurse, had worked at Embarcadero County Hospital for twenty years and knew where all the bodies-literally and figuratively -- were buried. Nurse Spencer was in charge of the hospital, and doctors who did not recognize it were in trouble. She knew which doctors were on drugs or addicted to alcohol, which doctors were incompetent, and which doctors deserved her support. In her charge were all the student nurses, registered nurses, and operating room nurses. It was Margaret Spencer who decided which of them would be assigned to the various surgeries, and since the nurses ranged from indispensable to incompetent, it paid the doctors to get along with her. She had the power to assign an inept scrub nurse to assist on a complicated kidney removal, or, if she liked the doctor, to send her most competent nurse to help him with a simple tonsillectomy. Among Margaret Spencer's many prejudices was an antipathy to women doctors and to blacks.

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