Natural Causes

by Michael Palmer

  Natural Causes

  Palmer, Michael

  Random House, Inc. (1994)

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  * * *

  SUMMARY:

  ldwin races to a Boston hospital with a young woman whose normal labor has suddenly become a matter of life and death. As she struggles to save both mother and baby, she doesn't know that two other women have already died under horrifying identical circumstances. And so begins Sarah's own nightmare, as she learns that the prenatal herbal vitamins she prescribed are the only thing these women have in common. Soon Sarah is fighting to save her career, her reputation--her life. For she's certain there must be some unknown factor linking these women, and as she gets closer to the truth, it becomes clear that someone will do anything--even murder--to keep a devastating secret.

  Praise for Michael Palmer

  EXTREME MEASURES

  “Spellbinding … A chillingly sinister novel made all the more frightening by [Palmer’s] medical authority.

  —The Denver Post

  “Sustains high speed … A welcome new storyteller.”

  —Los Angeles Times Book Review

  THE SISTERHOOD

  “A suspenseful page-turner … jolts and entertains the reader.”

  —Mary Higgins Clark

  SIDE EFFECTS

  “Has everything—a terrifying plot … breakneck pace … vividly drawn characters.”

  —John Saul

  FLASHBACK

  “The most gripping medical thriller I’ve read in many years.”

  —David Morrell

  SILENT TREATMENT

  “Guaranteed to terrify anyone who … has reason to step inside the doors of a hospital … Dynamite plot.”

  —The Washington Post

  ALSO BY MICHAEL PALMER

  From Bantam Books

  The Sisterhood

  Side Effects

  Flashback

  Extreme Measures

  Silent Treatment

  Miracle Cure

  Critical Judgment

  The Patient

  Fatal

  The Society

  NATURAL CAUSES

  All rights reserved.

  Copyright © 1994 by Michael Palmer.

  Library of Congress Catalog Card Number: 93-26832.

  No part of this book may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without permission in writing from the publisher.

  For information address: Bantam Books.

  eISBN: 978-0-307-78122-2

  Bantam Books are published by Bantam Books, a division of Random House, Inc. Its trademark, consisting of the words “Bantam Books” and the portrayal of a rooster, is Registered in U.S. Patent and Trademark Office and in other countries. Marca Registrada. Bantam Books, New York, New York.

  v3.1

  Dedicated to

  Luke Harrison Palmer

  Welcome, big guy

  Contents

  Cover

  Other Books by This Author

  Title Page

  Copyright

  Dedication

  Acknowledgments

  Prologue

  Chapter 1

  Chapter 2

  Chapter 3

  Chapter 4

  Chapter 5

  Chapter 6

  Chapter 7

  Chapter 8

  Chapter 9

  Chapter 10

  Chapter 11

  Chapter 12

  Chapter 13

  Chapter 14

  Chapter 15

  Chapter 16

  Chapter 17

  Chapter 18

  Chapter 19

  Chapter 20

  Chapter 21

  Chapter 22

  Chapter 23

  Chapter 24

  Chapter 25

  Chapter 26

  Chapter 27

  Chapter 28

  Chapter 29

  Chapter 30

  Chapter 31

  Chapter 32

  Chapter 33

  Chapter 34

  Chapter 35

  Chapter 36

  Chapter 37

  Chapter 38

  Chapter 39

  Chapter 40

  Chapter 41

  Chapter 42

  Chapter 43

  Chapter 44

  Epilogue

  About the Author

  Preview of Michael Palmer’s medical thriller Fatal

  ACKNOWLEDGMENTS

  If you read the “About the Author” page, please read this page as well. The people listed below are very much about the author, and share my deepest thanks.

  Beverly Lewis, my editor and friend, defines the word Godsend.

  Linda Grey and Irwyn Applebaum, my publishers at Bantam, have been supportive, insightful, and encouraging.

  Jane Rotrosen, Don Cleary, Stephanie Laidman, Meg Ruley, and Andrea Cirillo of the Rotrosen Agency have been major influences on each of my books and on my career as a writer.

  Dr. Rick Abisla of Falmouth, Massachusetts, and Dr. Dolores Emspak of Swampscott, Massachusetts, gave me invaluable technical advice in their specialty.

  Attorneys Marcia Divoll and Joanne Colombani Smith of Boston, and Ms. Ginni Ward did the same for me in their areas of the law.

  Nurses Jeanne Jackson and Carolyn Moulton of Falmouth gave me books to read and helped me appreciate the power and potential of alternative healing. Dr. Bud Waisbren of Ipswich, Massachusetts, provided information and encouragement that nudged me through a particularly resistant block.

  Dr. Richard Dugas dragged me off to play bridge from time to time, and so may have preserved my sanity. John Saul and Michael Sack had just the right words at just the right times.

  And finally, my love and thanks to my wife, who once again bore the brunt of my writing maelstrom with remarkable class and an understanding patience.

  M.S.P.

  Swampscott, Massachusetts

  PROLOGUE

  CONNIE HIDALGO’S CONTRACTIONS HAD BEEN LITTLE more than twinges for the first two hours of the drive; but as she and her fiancé passed the New London exits on I-95, the tightening within her began to intensify.

  “Billy, I think something’s happening,” she said.

  “Gimme a break. You been sayin’ that for a goddamn month, and you still got a month to go.”

  “I should have stayed home.”

  “You should have done exactly what you’re doin’, which is to make this trip to New York and help me make this buy.”

  “Well, at least you couldda taken the Mercedes. This seat is killing me.”

  Connie knew that taking the slick 500SL had been out of the question. The last thing Billy Molinaro wanted was to attract attention—or car thieves. Besides, he never was one to change his routine, especially when things were going well. The battered Ford wagon had always been their way into and out of Manhattan. There wasn’t a chance in the world he would have agreed to doing anything differently this night. He hadn’t told her how much money they were carrying in the two gym bags stuffed in the tire well, but she knew it was plenty—more than ever before.

  She squirmed as another contraction built and stared out the window, trying to lose herself in the lights and signs as they flashed past. She was a slight woman—all belly, Billy kept saying—with wide, dark eyes and a fine, smooth face that she had learned made most men want her. At fourteen, she had delivered a baby girl and had given it away without so much as looking at it. Now, ten years later, God had blessed her with a second chance. And nothing was going to go wrong. Nothing.

  “Billy, I love you,” she said softly.

  “In that case, light this for me.”


  He slipped a fat joint from beneath his seat, licked it expertly, and leaned toward her.

  “Billy, no. It’s bad for the baby.”

  “Crack is bad for the baby,” he corrected. “That’s why I haven’t let you do any since we found out you were pregnant. But no one has ever shown nothing wrong with weed. Trust me on that one.”

  “Well, at least open the window.”

  Connie lit the joint and, in spite of herself, breathed in deeply as he exhaled. As always, Billy was right. She had smoked daily during her first pregnancy—cigarettes and marijuana—and the baby had been born plump and perfect.

  “Now listen,” Billy said. “Manny Diaz is a slime, but after all the deals him and me’ve done together, I pretty much trust him—especially with you around to translate when he won’t talk English. But this is bigger than any of those other deals, so we gotta take extra precautions. I’m gonna have you stay out in front with the motor running. You keep the doors locked until I come out and tell you it’s okay. If anything doesn’t seem right—anything at all—just get the hell away and call my cousin Richie in Newark. Got that?”

  “I got it. I got it.”

  Another contraction hit. Connie clenched her teeth and pressed her slender fingers against her womb. She had had two bouts of false labor in the past two weeks, and felt more certain than not that this was the same deal. She checked Billy’s watch. If the contractions continued to be this bad, she would begin to time them.

  But as she worked at convincing herself that there was nothing happening for her to worry about, Connie began to experience another kind of pain—this one in the tips of her fingers. At first she couldn’t really call it a pain. It was more of a numbness—an unpleasant lack of feeling. By Stamford, the numbness had given way to a persistent, electric discomfort—worse when she pressed down, but not completely gone when she didn’t. Huddled in the darkness, she tested her fingertips one by one. All of them ached.

  It was nerves, just nerves, she thought. Billy had relit the joint. One toke wouldn’t hurt, and it would probably help a great deal. Connie pulled his hand over, pressed her lips to the moist paper, and breathed in until she couldn’t hold any more. It had been nearly six months since she had been even a little bit stoned. Surely one toke wasn’t going to hurt the baby. In fact, she reasoned, with what it had in store, the little thing probably needed a buzz even more than she did.

  By New Rochelle, Connie had smoked all of one joint herself. The pain in her fingers was no less, and the contractions were still coming every five minutes or so, but neither bothered her as much.

  “Billy, I feel better,” she said.

  “I knew you would, Sugar.”

  Within just a few miles, though, she sensed the buzzing pain beginning in her toes. Frightened, she tried another joint.

  “Hey, back off that stuff,” Billy said.

  “I think the baby’s coming.”

  “Well, I hope he knows enough to stay put until we get this deal done. I need you behind this wheel to do it right. Besides, if we blow it, the kid’d be better off not coming out at all.”

  “Billy, I’m serious.”

  “And what do you think I am—the Good Humor man?” He glanced nervously at his watch. “Right on schedule. We pull this buy off, Sugar, and we’re in the big leagues. Believe me. This is the test Dominic has been waiting to give me. And nothing’s gonna fuck it up.”

  Connie heard the intensity in her lover’s voice and clenched her teeth against the throbbing in her hands and feet. Billy was right. It wasn’t just their money at stake, it was their future. When she was younger and fat and unattractive, the only thing men ever wanted from her was sex. When she changed and became beautiful, the men who hit on her had more going for them—took her nicer places. But what they wanted was still the same. Only Billy had been different. He had made her his girl. And from the very beginning he had treated her with respect. Now they were about to have a child. And as soon as this deal was done, he had promised they would be married.

  Whatever she had to do to help Billy Molinaro tonight, she would do. If only the aching would let up … just a little.

  With a discomfort that nearly brought tears, she reached up and flicked on the overhead light.

  “Hey, what’re you doing?” Billy asked.

  “Just … just looking for a tape to play.”

  She glanced at her hands, and then quickly switched off the light and pulled them from his line of sight. Her fingers and thumbs from the first knuckle to the tip had turned almost black. The rest of her hands was a dusky gray.

  “Well?”

  “Well what?”

  “Well, what tape did you pick?”

  “Oh, I—I decided I’d rather rest.”

  Please, God, she thought, just let me get through one more hour. Just one.

  It was after midnight when they rolled down the Harlem River Drive and turned off onto 116th Street. The fierce contractions in Connie’s womb no longer concerned her as much as the fear that when they reached the meeting place, she would be unable to grasp the wheel, much less drive. Her left hand, now fixed in a semiclaw, was nearly useless. And although she could work her right hand and fingers, even slight movements of them sent intense pain shooting up her arm.

  Please, God.…

  “Well, this is it, Sugar,” Billy said, stopping beneath a streetlight in front of a dilapidated tenement. “These guys are scared shitless of Dominic, so I don’t expect any problems. It never hurts to cut the cards, though, especially with this size deal. So you stay here, doors locked, motor running. I’ll go up and check their shit. If it’s okay, we’ll make the exchange right here on the street. Okay? Connie, I said ‘Okay?’ ”

  Connie Hidalgo, her hands and feet throbbing, bit at the inside of her lip while the pain from a particularly fierce contraction lanced through her. As the tightening subsided, she felt warmth begin to pool between her legs. Her water was breaking.

  “P-please hurry,” she managed. “The baby’s going to come soon. I—I think we need to go to a hospital.”

  Billy snatched up his test kit and adjusted the holster beneath his left arm.

  “You just goddamn keep it together until we’re done,” he snapped. “Understand?” He noticed the pain in her face, and his expression softened. “Connie, honey, everything will be all right. I promise. I’ll finish this business with Diaz as quick as I can. And then if you want, I’ll get you the best damn doctor in New York.”

  “But …”

  “Remember, now, keep your door locked, and keep your eye out for trouble. I love you.”

  “I love you, too,” Connie said. But he was already gone.

  With great effort, she slid behind the wheel and locked the driver’s side door. Having your water break was no great cause for alarm, she thought desperately. The birthing class nurse had stressed that over and over again. Five minutes passed. Then five more. The contractions were hell.

  Anxious to distract herself, to check her fingers, Connie again turned on the interior light. The gray, cold hands with their blackened fingertips looked like some sort of Halloween prop. She glanced at herself in the rearview mirror. Something was wrong with her face. It took several seconds for her mind to understand the dark ribbons of blood that had begun winding down from her nostrils, across the top of her lip, and alongside the corners of her mouth.

  “Please, Billy. Please hurry,” she whimpered.

  She was clumsily searching her purse for a tissue when she noticed the deep crimson stain expanding over the groin and legs of her beige maternity slacks. This wasn’t the clear or slightly tinged fluid the nurse had spoken of. It was blood! Connie felt dizzy, confused. She tried to dab at the flow from her nose, which now was entering her mouth and spattering down onto her blouse. Her left arm felt leaden.

  “Please! Please someone help me,” she cried. Then she realized that the words were in her mind, but she could not speak them. Her vision seemed blurred, the left side of her
body paralyzed. Terror beyond any she had ever known took hold.

  At that moment, the windshield of the Ford exploded inward, showering her with glass. Instantly, from across her brow, blood cascaded into her eyes. She pawed at it with the back of her right hand, managing to clear her vision briefly. Billy’s body was stretched across the hood of the car, his shattered head and one arm dangling lifelessly over the passenger seat beside her. Soundlessly Connie screamed and screamed again.

  Through the shattered windshield, she could see several men approaching. With no conscious purpose other than to get away, she dropped her hand onto the gear shift, knocking it from park to drive. The Ford shot forward, striking at least one of the men and glancing off several parked cars. As the wagon careened onto Third Avenue, Billy’s body fell away. Connie, now more dead than alive, looked to her left in time to see the headlights and grillwork of a bus.

  For one brief instant, there was a horrible, grinding noise, accompanied by pain unlike any Connie had ever known. Then, just as suddenly, there was blackness … and peace.

  CHAPTER 1

  July 1, Changeover Day

  IT WAS EXACTLY SEVEN POINT TWO MILES FROM SARAH Baldwin’s North End apartment to the Medical Center of Boston. Today—a Monday—the roads were dry, the humidity low, and at six A.M., the traffic virtually nonexistent.

  Sarah squinted up at the early-morning glare, getting a sense of the day. “Nineteen minutes forty-five seconds,” she predicted.

  She straddled her Fuji twelve-speedy, adjusted her safety helmet, and set her stopwatch to zero. Just fifteen seconds either way had become the allowable margin in the contest. More often than not, she won. Over the two years she had been commuting by bike to MCB, she had honed her accuracy by factoring into her average time as many arcane variables as she could remember on any given day. Tuesday or Thursday? … Add thirty seconds. Regular coffee at breakfast instead of decaf?… Deduct forty-five. Two nights in a row off call? … A full minute or more to the good. Today she also factored in the need to pedal hard enough to feel she had exercised, but not so hard as to break much of a sweat.