Natural Causes

by Michael Palmer

  IATROGENIC: ILLNESS OR INJURY CAUSED BY THE WORDS OR ACTIONS OF A PHYSICIAN.

  Sarah flashed on the sign that once hung over Peter Ettinger’s desk. There was every reason to believe that the patient’s striking turn for the worse was due to his treatment, not his disease—to the diuretics, not the aneurysm. She reached the operating suite doors just as the litter was being wheeled into one of the ORs.

  “Andrew, wait!” she cried out.

  It took less than half an hour for the old man to respond to his magnesium infusion and wake up. Until his retirement a year before, Terence Cooper had been a boatbuilder of some note. He had a cackling laugh and a wonderful, toothless smile. And upon meeting Sarah, he immediately asked her out on a date, assuring her that his wife wouldn’t mind all that much.

  “Mrs. Cooper keeps telling me to try out new things,” he said.

  Sarah let him squeeze her hand and then turned to leave. Until that moment, Andrew had said very little to her. Now he stepped between her and the door.

  “I can explain about room four twenty-one,” he said softly.

  “I couldn’t care less,” she responded. “Except that you should have been more alert after you got down here. If you hadn’t been … sleeping, I suspect you would have checked those chems before you took him to the OR.”

  “I suspect you’re right.”

  “Good,” Sarah said, easing past him and into the hallway. “I love being right.”

  “Thanks for saving my bacon,” he called out after her. “You’re a hell of a doctor.”

  Sarah considered some sort of response, then just shook her head and continued on. Her pager sounded just as she reached the OB/Gyn floor. She responded, expecting to hear Andrew, anxious to continue mending fences. Instead, the voice on the line was Annalee Ettinger’s.

  • • •

  Sarah sat on the edge of the bed in the small resident’s call room, listening sadly to Annalee’s account of what had transpired with her father.

  “I couldn’t tell what upset him more,” Annalee said, “my going to see any M.D. at all, or my going to see you in particular.”

  “I’m the least important factor in this equation. I know an obstetrician in Worcester who would be happy to do a home birth for you.”

  “Peter’s insisting on no M.D.s. Midwives only. He’s even talking about flying some in from Mali.”

  “How do you feel about all this?”

  “I feel sorry for you for what’s being written in the papers. But that stuff hasn’t influenced me one way or the other.”

  “Good.”

  “And even the things Peter promised—the money, and the recording chance for Taylor and all. But no matter how hard I try, I can’t get past all the things Peter’s done for me—from the very beginning.”

  “I understand.”

  “I know he’s not perfect, but—”

  “Annalee, you don’t have to explain. I understand. Besides, you’re a healthy young woman in great shape. I have no reason to think there’ll be any problems. I’ll send you the name of the obstetrician in Worcester, just in case you want his help in any way.”

  “Thanks for not making this any harder for me, Sarah.”

  “Nonsense.”

  There was a prolonged, uncomfortable silence.

  “Sarah, there’s something else,” Annalee said finally. “Peter insisted I sit in on part of a meeting in his office.”

  “Go on.”

  “Four men and Peter. They want to hire him to check into the composition of that herbal supplement of yours and to check up on someone named Kwang or Kwok or something. Do you know who that is?”

  Sarah was beginning to feel queasy.

  “Yes, I know who that is,” she said. “Who were the men?”

  “Two were suits from New York—lawyers. They were there with this guy, Willis Grayson, the father of the girl you saved. The dude must be big stuff, because Peter was like a puppy around him. He acted as if I was supposed to know who he was, too, but I didn’t.”

  “Who was the other man?” Sarah asked. Her hands felt like ice around the receiver.

  “Another lawyer. Oilier than the others, if you know what I mean. His name’s Mallon.”

  “Unfortunately, I know him, too.”

  “Sarah, Peter said some pretty unkind things about you. I think that’s what he wanted me to hear. He said you were never as good an herbalist or acupuncturist as you liked to believe. I was on the edge of telling him to stop, or just walking out, but I just couldn’t do either one. I’m—I’m sorry.”

  “Annalee, don’t be sorry,” Sarah said. “Just do what feels right, and don’t lose touch with me. I appreciate your calling me like this.”

  “I’m sorry,” Annalee said again.

  Sarah hung up without another reply. She felt there was a chance that if she tried to speak, she would begin to cry. And Annalee did not deserve that sort of additional stress. How crazy. When they were together—at work and as lovers—Peter had told her and anyone else who would listen that she was one of the finest American herbal therapists and acupuncturists he had ever known. Now, suddenly, she was an inept fraud.

  Sarah bunched the pillow beneath her head and stared wearily at the ceiling. The truth was that in becoming an M.D., in trying to blend the best of eastern and western medicine, she had become a threat to practitioners on both sides. That Andrew and Peter, the two practitioners attacking her now, both happened to be male may or may not have had significance. But she suspected it did.

  For a time, blanketed by a pall of loneliness and isolation, she wept. Soon, though, she felt her spirit begin to regroup within a nidus of anger. Beyond tweaking two bulbous egos, she had done nothing wrong. If it was a fight they wanted, it was a fight they would get. She picked up the phone and paged Eli Blankenship. Within a minute he returned her call.

  “Dr. Blankenship,” she said. “I don’t know exactly who I’m supposed to talk to, or what I’m supposed to do, but I’d like to meet with you as soon as possible. I think I’m about to be sued.”

  CHAPTER 17

  July 20

  SARAH WAS CERTAIN THAT AT TIMES IN HER LIFE SHE must have felt as conspicuous and ill-at-ease as she did tonight, but she could not remember when. The Milsap Board Room at MCB was long and fairly narrow, with a plush Oriental carpet, floor-to-ceiling windows that overlooked the city, and a massive walnut table surrounded by twenty high-backed oxblood leather chairs. Although Sarah had never actually seen the room before, she had heard about it, mostly through doctors’ litanies of the medical equipment that Glenn Paris elected not to purchase so that it might be built.

  Five men—Paris, Drs. Snyder and Blankenship, chief financial officer Colin Smith, and a prissy attorney named Arnold Hayden—sat at one end of the table, sipping drinks from a mirrored wet bar and chatting amicably. Sarah paced at the other end, alternately gazing out at the sheets of windblown rain and checking her watch.

  Several days before, a letter from attorney Jeremy Mallon to Sarah’s insurance carrier, the Mutual Medical Protective Organization, had made it official. Sarah was being sued for malpractice by Lisa Grayson. Two days after that, the claims adjuster at the MMPO assigned an attorney named Matthew Daniels to her case. The meeting tonight had been requested by him.

  Sarah had spoken with her new attorney by phone for almost an hour, but had come away from that conversation with little sense of the man other than that he was southern and most economical with his words. The hazy image she had formed of him sprang more, she suspected, from the balding, potbellied, perspiring Hollywood stereotype than from anything Daniels actually said.

  “Sarah,” Paris called out, “come on down here and have a glass of this Chablis. We’re all getting nervous just watching you stalk around over there.”

  Sarah hesitated, then took the path of least resistance and accepted the offer. Paris, like the two department heads, had been cordial enough toward her since the news of her suit, but she could tell that
each of them had doubts.

  “I wonder why this Daniels wanted us to get together here at the hospital and not at his office,” Arnold Hayden blustered. “Irregular. Highly irregular.”

  “Arnold, have you ever heard of him?” Smith asked.

  “No. I started doing some checking, but I haven’t gotten too far. He’s an Essex Law grad.”

  “Not exactly Harvard.”

  “Not exactly law school,” Hayden corrected snidely. “His firm is Daniels, Hannigan and Goldstein. I’ve never heard of them, but I have someone making inquiries.”

  “I’m certain the insurance company wouldn’t assign someone to my case who wasn’t good,” Sarah said. “It’s their money. Besides, I don’t think it will take any Clarence Darrow to prove that I’m not guilty of malpractice. All Mallon has to base his case on is that the three women happened to have taken my supplement. We can produce many others who also took it and had perfectly normal deliveries.”

  “True,” Blankenship said. “What we really need to close the circle, though, is a case of DIC like the others, but in a woman who never took anything other than standard prenatal vitamins.”

  “Of rather be found guilty than have another woman go through that,” Sarah said.

  “Of course. Of course. It goes without saying that we all feel that way. But if such a case does occur—or has occurred somewhere—it would certainly take you and your mixture right out of the loop, as it were.”

  Sarah checked the time and began pacing again. Matthew Daniels was already five minutes late. His arrival would bring the group to two attorneys, two medical professors, two hospital executives, and her. Being the only woman in the group was more or less neutralized by her status as an M.D. But nothing offset her dismay at being the accused. In truth, she couldn’t have been more out of place had she accidentally crashed an exclusive fraternity induction ceremony. The whole evening would have been significantly easier to handle had Rosa Suarez agreed to come. But the epidemiologist had begged off, stating that it would be best for her to stay removed from hospital politics and personalities.

  Since her arrival on the scene, Suarez seemed to have been living at MCB. Sarah had seen her at all hours, measuring off corridors with blueprints in her hand, lost behind a wall of tomes in the library, making notes in the record room, or talking to staff. She had interviewed Sarah at length early in her investigation and briefly a number of times since. Although Suarez was reluctant to speak of anything not germane to her mission, she did share that she had a husband, Alberto, back in Georgia, and that she had no family or friends in Boston. Sarah had responded with an invitation to dinner, but the woman politely declined. Her manner was soft-spoken and certainly not aggressive, but Sarah had no difficulty discerning her intelligence and determination.

  “Sarah,” Paris said, “did you put together this list of the ingredients in your vitamins?”

  “The list yes, the explanation of each component, no. Rosa Suarez did that. She plans to expand on the information when she has a chance to do the research.”

  “Does she now. What a little beaver that woman is. I only wish she would keep me better informed about what’s going on. I have the feeling she doesn’t like me very much, although I’ll be damned if I know why. I gave her essentially free run of the hospital. Do we know if she’s gotten anywhere?”

  “She’s borrowed one of my technicians and is setting up a spare lab of mine to do some cultures,” Blankenship said. “Sarah, I agree with Glenn. Mrs. Suarez is exceedingly capable. But she’s also very secretive. I do suspect, though, that somehow or other she is going to get to the bottom of all this.”

  “Which would make both this meeting and your tardy attorney moot,” Paris added.

  “Late to his own meeting.” Arnold Hayden clucked. “Irregular. Highly irreg—”

  As if on cue, the door to the Milsap Room opened and Matt Daniels backed in, shaking off his umbrella and his trench coat in the hallway. The moment he turned around, Sarah was pleased to acknowledge that her projection of him could not have been much farther off target. He was tall and well built, with a rugged, weathered face. He was also soaked.

  “Daniels, Matt Daniels,” he said, pawing at his forehead and dark hair with a handkerchief even more sodden than he was. “Sorry I’m late. I had a flat. My own damn fault, too. I did enough dumb things today to bring a curse on the Pope.”

  His drawl was unmistakable, though not nearly as pronounced as Sarah remembered. The initial vibrations she was receiving were all positive, especially those that were telling her he was ingenuous enough to be almost as out of place in this gathering as she was. He moved to shake hands with the man closest to him, who happened to be Randall Snyder. But then, when it was apparent that the OB chief preferred to stay dry, he backed off and simply nodded.

  Irregular, Sarah thought, pleased. Highly irregular.

  Daniels circled to an empty seat, slid his briefcase onto the table, and wiped it dry with the sleeve of his sport coat. If he was aware of the expressions of amusement and disbelief on the faces of the other five men, he certainly did not show it.

  “Mr. Daniels, I’m Sarah Baldwin,” she said, extending her hand, which felt lost in his.

  “Matt,” he said. “Matt’ll do fine.”

  She introduced the five to him, but blanked out on Arnold Hayden’s name.

  “Well, I’d like to apologize again, and thank you all for coming out on such a night,” Daniels began, after Hayden had somewhat irritably filled in Sarah’s blank. “Our adversary in this case is a lawyer named Jeremy Mallon. I decided to set up this meeting after I spoke with him earlier today. As you’ll hear, he certainly seems intent on moving things along.”

  No comment at all on his opponent. Sarah noted the MCB men exchanging glances and had no trouble reading their thoughts. In malpractice circles, according to what she had been told by Glenn Paris, Mallon was something of a legend.

  “Mr. Daniels, do you know who Jeremy Mallon is?” asked Arnold Hayden.

  Uh-oh, Sarah thought. Here we go.

  “Well, actually sir, I don’t.”

  “Well, Mr. Daniels,” the attorney went on, clearing his throat, “I—um—I think before we begin, it might help us some if we knew a little of your background in the area of medical malpractice. The hospital hasn’t been sued yet, but there’s every reason to believe we will be if it looks like Sarah’s going to lose—and not just by the Graysons, but by the families of those other women as well. Even worse, we stand to take a pounding in the press. So I hope you won’t think it presumptuous of me to ask.”

  “Not at all, Mr. Hayden,” Daniels said evenly. “Why, you hardly seem like the presumptuous type. Let’s see, the answer to your question is: I’ve only defended one doctor for malpractice. He was a dentist, actually. A woman claimed her headaches were caused by his pulling out an extra molar and messing up her bite. For what it’s worth, we did go to trial, and I did win the case.”

  “That’s very reassuring,” Hayden said not kindly. “Do you have any idea how the MMPO came to choose you for this case?”

  “To tell you the truth, I’ve kind of wondered some about that myself, although I’m very pleased they did. I’ve been on their roll of available attorneys for a couple of years now, and this is the first time they’ve sent me a case.”

  “Well, that’s great, just great!” Paris erupted. “Mr. Daniels, I don’t mean to sound rude, but you must understand that there is a great deal at stake here. Your adversary, as you call Jeremy Mallon, is totally dedicated to bringing this hospital to its knees. And he is damn good at what he does, which in the main is to sue doctors. Don’t you think we ought to call the MMPO and have them assign some other firm to the case?”

  Sarah studied Daniels as he thought over the question. If he was disturbed by the two-pronged attack from Hayden and now Paris, it did not show in his face, which at that moment reminded her of Fess Parker as Davy Crockett, debating whether or not to stay on and defend the
Alamo. His expression was severe enough, but there was a spark in his azure eyes—a defiance—that Sarah felt certain only she was appreciating.

  “Well,” he said finally, “for any number of reasons, I’d sure hate to see that happen. But since you’ve brought it up, I guess we ought to consider it.”

  “Good,” Paris said.

  “However,” Matt went on, “there are a couple of points I’d like to make. For one, Dr. Baldwin here is my client. Whether I stay or go is really up to her. For another, since speaking with her the other day, I’ve done some reading and some talking to people. Mallon or no Mallon, I think I can do a good job representing her.”

  “How can you say that, with almost no experience in this area?” Hayden demanded.

  “Because the law’s the law, Mr. Hayden. And I’m still just naive enough to equate the legal process with getting at the truth. And getting at the truth is something I always liked doing.”

  Glenn Paris turned to Sarah. “Sarah, it is our opinion that you can get better counsel and a better defense from someone more, how should I say, experienced than Mr. Daniels here. But he is right. You are his client. And it is for you to decide.”

  Sarah looked over at Daniels, who held her gaze coolly. Bring on Santa Ana, Mr. Travis. I ain’t plannin’ on goin’ nowhere.

  “Well, Mr. Paris,” she said, “provided my job isn’t on the line over this, I guess I feel that if Mr. Daniels handles himself in court the way he has here, I’m in pretty good hands. Mr. Daniels—Matt—I’m sure that if you needed to involve Mr. Hayden or any of the other MCB lawyers, you’d do it, wouldn’t you?”

  “Anytime.”

  “In that case, Mr. Paris,” Sarah said, “I’m comfortable being represented by this man.”

  “Good Lord,” Eli Blankenship suddenly exclaimed, “I think I just figured out who our Mr. Daniels is. Let’s see if I get this right, Matt. Bottom of the ninth, no outs, bases loaded, three and nothing on the Toronto batter—”