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The screaming from the fifth-floor ward got louder. The patients sensed that something terrible had happened.

Adelaide heard rapid, purposeful footsteps crossing the tile floor, coming toward the office. She gripped the containers of chemicals and waited, aware that the only thing protecting her now was the noise from the inmates down below. The shrieks and cries would make it difficult if not impossible for the killer to hear the sound of her breathing.

The intruder stopped directly in front of the desk. A flashlight came on briefly. Adelaide prepared to fight for her life.

But the intruder turned and hurried quickly out of the office. A few seconds later, footsteps sounded on the stairs.

The keening of the agitated patients rose and fell, but there were more shouts now. They came from the courtyard below the broken window. Someone had found Ormsby’s body and was sounding the alarm.

Adelaide waited a few heartbeats and then got to her feet. She was shaking so badly she had a hard time keeping her balance. She thought briefly of trying once again to find the key to the file cabinet, but common sense prevailed. Escape from the sanitarium was the first priority.

She reached up to adjust the nurse’s cap pinned to her tightly knotted hair. When she glanced down at the desk, she saw that the black velvet box containing the perfume bottles was gone. The intruder had taken it.

She selected one of the two open jars of chemicals to use as a weapon and left the other one behind on the desk. She picked her way through the moonlit lab. When she got to the staircase, she descended cautiously.

At the foot of the stairs, she paused in the stairwell and looked around the edge of the door.

The inmates continued to howl and scream through the grills set into the locked doors, but the hallway was empty. There was no sign of the intruder.

Her room was located at the far end of an intersecting hallway. There were no other patients in that corridor. Earlier she had arranged the pillows and blankets on her bed in an attempt to approximate the outline of a sleeping figure, but it looked as if the ruse had been unnecessary. The agitation of the other inmates and the commotion in the courtyard were sufficient to conceal her movements. The white cap and the long blue cloak, familiar elements of a nurse’s uniform, would do the rest. With luck, anyone who chanced to see her from a distance would assume she was a member of the hospital staff.

The entrance to the old servants’ stairs was in a storage closet on the opposite side of the hall. She was edging out of the stairwell doorway, preparing to make a dash for the closet, when the patients’ screamsrose in another hellish crescendo. It was all the warning she got. It was just barely enough to save her.

She retreated to the shadows of the stairwell and waited. When the screams faded a little, she risked a peek around the doorway.

A man dressed in a doctor’s coat, a white cap, and a surgical mask emerged from the hallway that led to her room. The black velvet box was in his left hand. In his right he gripped a syringe.

The only thing that saved her from being seen was that the masked doctor was intent on rushing down the hall in the opposite direction. He disappeared through the locked doors just beyond the nurses’ station.

She did not think it was possible to be any more terrified, but the sight of the masked doctor leaving the corridor that led to her room sent another shock of horror across her nerves. Maybe he had intended to kill her, too.

With an effort of will, she pulled herself together. She certainly could not continue to dither in the stairwell indefinitely. She had to act or all was lost.

She took a deep breath, clutched the jar in one hand, and rushed across the hallway. She opened the door of the storage closet.

A bearded face appeared at the steel grill set into a nearby door. The insane man stared at her with wild, otherworldly eyes.

“You’re a ghost now, aren’t you?” he said in a voice that was hoarse from endless keening and wailing. “It was just a matter of time before they killed you, just like they did the other one.”

“Good-bye, Mr. Hawkins,” she said gently.

“You’re lucky to be dead. You’re better off now because you can leave this place.”

“Yes, I know.”

She slipped into the storage closet, closed the door, and turned on the overhead fixture. The door to the service stairs was at the back. It was locked. To her overwhelming relief, one of the keys she had been given worked.

By the time she made it downstairs to the darkened kitchen on the ground floor, she could hear sirens in the distance. Someone had telephoned the local authorities. The sanitarium was located a couple of miles outside the small town of Rushbrook. It would take the police and the ambulance several minutes to arrive on the scene.

There was no one around to see her when she slipped out of the kitchen. She inserted another key into the lock on the massive wrought iron gate that the delivery vehicles used.

And then she was free, hurrying down a rutted lane with only the light of the moon to guide her.

She was not at all sorry that Ormsby was dead, but his death could complicate her already desperate situation. It would be so easy for the authorities to conclude that the patient who had escaped the secure grounds of the Rushbrook Sanitarium on the night of the doctor’s mysterious demise was, in fact, a crazed killer.

She had to get as far away as possible from the asylum before the orderlies realized she was gone.

It occurred to her that one person already knew she had disappeared—the doctor in the surgical mask who had gone to her room with the syringe.