Justine Rendal, better known by her pen name, Olivia Goldsmith, was never late. Early on Wednesday, January 7, she walked into Manhattan Eye Ear and Throat Hospital, the cosmetic-surgery hub of New York City. As almost everyone knows by now, the author of the best-selling book that inspired the movie The First Wives Club did not walk out. It shouldn't have happened. After all, Manhattan Eye and Ear is a renowned teaching hospital where Hollywood and European royalty, politicians, and First and Second Ladies have had their faces nipped and bodies tucked. Goldsmith's anesthesia was administered by a certified anesthesiologist. Her surgeon, respected ear, nose, and throat specialist Norman Pastorek, had operated on her before in his office, liposuctioning her chin, lifting her eyelids, and injecting her forehead with Botox, according to someone who saw her there frequently. This time, Goldsmith had told friends she was having excess skin under her chin removed. In plain English, she was having a face-lift.

When Sylvie, the 40-year-old wife in Goldsmith's 1998 novel Switcheroo, discovers that her husband has fallen for a woman who is a younger version of herself, she examines her aging face in the mirror. "When had those bags under her eyes filled in with fat? And when had the the sides of her jaw...begun to hang like that?" Goldsmith could articulate women's grief over their fading beauty and the attendant loss of power—while making them laugh at the same time. "She could take the good, bad, and sad and make it funny," says Steven Mintz, her personal attorney.

In Switcheroo, Sylvie and her husband's mistress, Marla, decide to trade places for two weeks. Marla darkens her hair and puts on weight; Sylvie goes blonde, loses weight, and gets a face-lift. Two lines in Switcheroo reveal, chillingly, that Goldsmith knew the risks of dying from plastic surgery: "Sylvie woke up choking and realized. She hadn't died under the knife." Goldsmith didn't wake up. While receiving the anesthetic, she suffered a heart arrack and slipped into a coma. Mintz says, "I don't know whether it was when she was given the IV sedation"—which suppresses discomfort during the insertion of the breathing tube-"or when she was intubated, but surgery had not commenced." (Another source says that one incision had been made.) The procedure, performed tens of thousands of times a year without mishap, rapidly became grave.

"Allergic reactions to anesthetics are extremely rare," says Douglas Blake, assistant clinical professor of anesthesia after Brown Medical School In Providence, Rhode Island. For a healthy person, he says, the risk of death from anesthetic is 1 in 200,000 to 400,000, but smokers, drinkers, and overweight people have more complications. Some drugs, including certain antidepressants and stimulants, can cause adverse reactions when taken before anesthesia. (A source says that Goldsmith was taking an anti-seizure drug that is often prescribed for mood regulation, but it is not normally considered a risk factor.) Anesthesia can also exacerbate any cardiac or respiratory problems that were undetected before surgery.

A spokeswoman for the hospital, Ann Silverman, says that "regulations on patient confidentiality preclude us from discussing the case," but she comments that the surgeon "has an exemplary professional record, and, naturally, the hospital is reviewing the case."

After Goldsmith's heart attack, she could not be resuscitated. She was transferred to Lenox Hill Hospital and died seven days later. She was 54 years old.

As for her continual refinements to her own looks, Goldsmith "paid attention to her appearance, especially when she was going on a book tour," says comedy writer Gail Parent, her friend and collaborator on one screenplay project. Goldsmith's tenth novel, Dumping Billy, was scheduled for publication in May. In preparation for publicity for her book Marrying Mom in 1996, she tore through Saks, bemoaning, "Nothing fits, nothing fits," remembers John Yunis, an interior designer who was then working at the store's Zoran boutique. "She said she was going on a book tour and needed to look thin. It was very emotional for her." She eventually bought $40,000 worth of Zoran clothes in several colors and thanked Yunis in the book's acknowledgments.

That same year, Goldsmith displayed a sharp sense of humor about the pressure to be thin and beautiful as she gave a talk at Manhattan's upscale Harmonie Club. She told the crowd she had made several million dollars on the film sale of The First Wives Club, but she was 40 pounds overweight. How many of the women in this room, she wondered aloud, would want to trade places with her? Those present don't remember any volunteers.

As a beginning novelist, Goldsmith wore a fake-looking blonde wig and oversize glasses in her photos to mock the image of a glamorous author. Later, says Rachel Hore, Goldsmith's editor at HarperCollins in England, she "dropped it—maybe because she was a success in her own right.... She didn't need to act out anymore."

On a promotional photo shoot for The First Wives Club, Goldsmith showed up at the studio "with three or four blonde wigs, things you would find on Canal Street," says Sigrid Estrada, who photographed her four times for book jackets between 1991 and 1995. "She didn't want professional hair and makeup. She dragged the wig over her hair"—sometimes chopping at it with a pair of scissors—"and splashed on the makeup fast. She'd say, 'Let's not take time on this.' She was always in a rush."

But like Marlene Dietrich, who was always lit in the same flattering way by director Josef Von Sternberg, Goldsmith appreciated being shown to her best advantage. "I lit her the way she liked," Estrada says, "with a 45 degree light. It brought out her cheekbones." To camouflage the fullness under her chin, "I overexposed the pictures and retouched them by hand," Estrada says. "Still, she was not happy with herself. She was always looking at magazines saying, 'I want to have that chin, that nose.' She was researching plastic surgeons and wound up with someone she had confidence in." She offered to give Estrada his name if she ever needed it. As one character says in Switcheroo; "If a person is going to look that good, even for one night, I think it's really mean not to share how you did it with a friend."

For most people, The First Wives Club conjures Goldie Hawn's outrageously inflated lips ("If you have any more collagen," a doctor warns Hawn's character, "you'll look like your lips got caught in a pool drain"), but in the 1992 book there was no mention of lip injections or surgery. Goldsmith didn't focus on surgery until Flavor of the Month, published in 1993. ln this morality tale, a Hollywood actress "who is too plain and too past her prime" invests $67,000 in an extreme makeover.

To write the surgery scenes depicted in the book, "Olivia really did her homework," says New York City plastic surgeon Michael Evan Sachs. He never operated on her, he says, but "she called me after seeing me on Oprah and said, 'I'd like to follow you around for three months." She didn't flinch at watching operations, and she applied the lessons not only to Flavor but also to later books, wringing humor out of a sometimes gruesome subject. Describing a face peel to her car-dealer husband, the wife in Switcheroo explains it's "sort of like refinishing an antique car—first you coat it with some chemical that pops off its top layer of paint, then you sand it down gently and hope it looks better."

A theme that recurs in Goldsmith's books is rage at beauty standards that make aging women invisible and replaceable by trophy wives. ("I make my living writing cheery little comedies about women who get shafted by men," Goldsmith once wrote.) And though First Wives Club gave roles to middle-aged women—Hawn, Bette Midler, and Diane Keaton—Hollywood has barely changed since Hawn spoke the infamous line in the film: "The only three ages for women in Hollywood are babes, district attorneys, and Driving Miss Daisy." Judith Ehrlich, a literary agent (but not Goldsmith's), remembers the author getting upset years ago because a producer who had optioned one of her books wanted to make the lead character ten years younger. Jennifer Perini—a Hollywood executive whom Goldsmith described as "the only young, tall, thin blonde I truly like"—observes that Goldsmith often made "cracks about younger women. It was a powerful theme."

As much as Goldsmith railed against the beauty system, "I think she became intoxicated with the Hollywood thing," Estrada says. "She met all these people who had plastic surgery, She thought it should be done, and she was not scared about it." Estrada remembers Goldsmith calling her in 1995, saying excitedly, "You have to see my new chin!" But not long after the chin-tightening operation, "she started to be unhappy again," Estrada says, Five years later, Goldsmith made fun of her age by declaring on the jacket of her latest book, Young Wives: "Olivia Goldsmith... is no longer young or a wife."

It probably wasn't a coincidence that Goldsmith named one fictitious cad of a husband "Reid"—an inside joke to the handful of people who knew that it was the last name of her ex-husband, John T. Reid, a handsome fashion executive whom she never publicly identified. Their divorce, after six years together, was the fuel for Goldsmith's prolific writing engine. No matter how many millions she earned later, she never got over the fact—as she told innumerable interviewers—that her ex kept the house in the Hamptons, the Manhattan apartment, and the jaguar. She retained $300,000 (which she earned by selling a small management-consulting firm she was running at the time); that dwindled to less than $40,000 by the time she finished The First Wives Club.

Two decades later, at the time of her death, she was involved in "a new romance, and she was very happy," says Jamie Raab, publisher of Warner Books, which is releasing Dumping Billy. Like the characters in her books, Goldsmith also had intense relationships with female friends, Parent says, "Olivia showed her friends how much she loved them. She gave generous gifts, and you responded in kind."

Kelly Lange, a mystery writer and former NBC news anchor in Los Angeles. received one such gift years ago on Valentine's Day. "There was no man in my life. Everyone in the newsroom had roses on their desks. I didn't have any," Lange says. That night, after she shared this lament with Goldsmith over dinner at a restaurant, her friend excused herself briefly, a little later, a delivery man walked in with a large vase of flowers for Lange. The attached note read, "Kelly, Last night was wonderful—Denzel."

It was another example of Goldsmith's talent at turning pathos into comedy. "If it weren't so tragic," says Lange of Goldsmith's death, "Olivia would have thought it was funny."