Natural Causes

by Michael Palmer

  “But he did. Denying responsibility doesn’t alter reality. Matt, I’ve smoked opium. A number of times when I was in Thailand. I know what it can do. And it’s quite possible that because of carelessness, or old age, or opium, or some combination of the three, Tian-Wen screwed up. And because of his errors—his mistakes in preparing my supplement—people have died.”

  “I don’t buy it.”

  “Well, I certainly hope not. You’re my lawyer. But until you can prove someone set him up, including who, and why, I’ve got to believe that he might have been responsible for what happened to those women. And that makes me just as responsible for using him.”

  They rounded the corner of the concrete and granite mall that fronted the Superior Court Building. Ahead of them, a small group of demonstrators—perhaps twenty—milled about. A single, uniformed policeman kept them back from the steps. Off to one side, a camera crew from Channel 7 was interviewing one of the demonstrators, a gaunt, bearded man who was wearing a full-length, hooded, crimson robe.

  “I don’t like the looks of this,” Matt muttered, stopping some distance away to assess the situation.

  “What’s it all about?”

  “Unless I miss my guess, it’s about you. Did you see the Herald this morning?”

  Sarah shook her head. “I was in the clinic working at seven. I barely had time for a cup of coffee. Don’t tell me I made it again.”

  “You and your hospital, actually. On page four there’s an article about some grant that MCB has just received to build a huge new center to scientifically study certain areas of alternative healing. Is there a Charlton Building?”

  “It’s the Chilton Building,” Sarah said. “It’s deserted and boarded up now. In a few months they’re going to demolish it to begin work on the center. But that’s old hat. Everyone at MCB’s known about that for weeks.”

  “Well, it’s news to the Herald. And right across from that item, on page five, is the announcement that you’re going before a malpractice tribunal today. Axel Devlin mentioned it as well. ‘The beginning of the end for Dr. Flake’ is the way I think he put it. Something like that. My office got several calls wanting to know details. I didn’t speak to anyone, but Ruth told me it sounded like somebody was organizing a demonstration on your behalf. And I think this must be it.”

  “Oh, no,” she moaned.

  “There’s no back way into this place unless prior arrangements are made. I don’t think we have any choice but to run the gauntlet. So, as your attorney, I’m suggesting you limit your vocabulary for the next minute to four words: ‘Thank you’ and ‘No comment.’ Okay?”

  “No comment … thank you,” Sarah said.

  The small demonstration was made up primarily of practitioners of various forms of alternative healing. Sarah recognized some of them, including a very talented chiropractor and an acupuncturist who was once a full professor in Beijing. There were also three women who had taken Sarah’s supplement, had normal labor, and delivered without incident. Two of them carried their infants with them in backpacks.

  As Sarah and Matt approached, the group fell back and applauded.

  “Hang in there,” one called out.

  “Good luck, Doctor,” a woman said. “We’re behind you.”

  She carried a handmade sign that read:

  ALTERNATIVE HEALERS REALLY CARE

  The specter in the red robe broke off his interview with Channel 7 and rushed over, extending a bony hand.

  “Dr. Misha Korkopovitch, energy healing and shamanism,” he said. “We’re with you all the way, Dr. Baldwin. You’re bringing us all together like nothing else ever has.”

  “Thank you,” Sarah managed, as Matt whisked her up the stairs. “Matt, this is very strange and a little hard to take. Some of those people I revere as healers. Some, like that Misha, are probably kooks.”

  Matt glanced back as they entered the building. “Not much different than if they were a group of M.D.’s, right?” he said.

  “… Let’s look at what we have here, and how we intend to prove our case.…”

  Jeremy Mallon consulted his notes briefly and then began a slow strut before the tribunal. He was closely observed from the plaintiff’s table by two other attorneys, one about his age and one quite a bit older.

  “Grayson’s lawyers,” Matt whispered.

  He nodded toward the courtroom, which had been nearly empty when they arrived. Several of the demonstrators had taken seats. And now Willis Grayson and an entourage of four were making their way down a row. Before Sarah could look away, Grayson’s cool gray eyes found hers. The power and anger in them made her shudder. As she returned her attention to Mallon, she wondered about Lisa—how she was doing, and whether she had been given the option of attending today.

  The physician on the tribunal, an obstetrician from Harvard named Rita Dunleavy, and the attorney, a balding, rumpled man named Keefe, were squeezed in behind the bench beside Judge Judah Land, according to Matt an implacable veteran of twenty-five years or more on the bench.

  Mallon’s opening remarks had included the words dangerous, reckless, irresponsible, negligent, arrogant, substandard, flawed, and fatal. Sarah, he alleged, had prescribed a potentially powerful set of drugs to patients who were at their most sensitive and vulnerable—those readying their bodies to give birth.

  “Given the lack of control over herbal medicines,” Mallon went on, “there are any number of points between the soil in Southeast Asia and the bloodstream of a woman in Boston where something can go awry. Our offer of proof today consists of letters from an obstetrician, Dr. Raymond Gorfinkle, and from a non-M.D. specialist in herbal medicine, Mr. Harold Ling. The letters from these two experts make it clear that Dr. Baldwin acted outside of standard medical practice in prescribing an herbal supplement for her patients in place of prenatal vitamins, and outside of standard holistic practice in the manner in which her supplement was prepared and dispensed. Specifically, Mr. Ling’s letter questions the competence of the herbal pharmacist who ordered the herbs and then compounded the medicinals prescribed by Dr. Baldwin.”

  Mallon then proceeded to read the two condemning letters out loud. Gorfinkle, an obstetrician operating out of West Roxbury, stressed that in thirty plus years of practice, he had seen all manner of rites and rituals used by his patients. Some of those he felt were unhealthy, some innocuous. But never had he seen any broad deviation from the norm at the request of a physician. In his opinion, in Boston, Massachusetts, in the 1990s, substituting herbs of any kind for FDA-approved prenatal vitamins constituted substandard medicine.

  Ling, an herbalist from New York’s Chinatown, was no less damning. Herbal supplements had their place in maintaining health, he wrote, but only in small amounts, and only when provided by an established, responsible herbal pharmacist. It was his opinion that Kwong Tian-Wen, a well-known chronic opium abuser, was neither established nor responsible. He further felt that noni, the herb in the jar that Kwong believed contained chamomile, could well cause problems with blood clotting.

  “Ling is one of Peter’s oldest friends,” Sarah whispered. “And Gorfinkle is just a hired gun. He makes a fortune testifying against other doctors.”

  “I’m not surprised,” Matt said. “I’m sure my ex-wife would love the chance to do to me what Ettinger is doing to you.”

  “Mr. Daniels,” Judge Land said, with a weariness in his voice that suggested Matt might as well remain mute, “you have about five minutes to present your arguments. You know that no letters from experts or other evidence will be considered from your side at this time.”

  “I do know that, your Honor, yes. Thank you.… Sarah, listen,” he whispered. “I don’t want to say anything now that will give Mallon a clue as to what part of his case we intend to home in on. As, things stand, I can’t see how we can win here. So we can only hurt ourselves.”

  “I understand.” But Sarah wasn’t at all certain she did.

  “Your Honor, Dr. Dunleavy, Mr. Keefe,” Matt sa
id, eschewing the pacing tactics of his opponent and allowing just a hint of drawl into his speech. “What we’re all looking for today is the presentation of a prima facie case from my colleague, Mr. Mallon. But what we have gotten instead is a very impressive smoke screen. What’s missing? What void is Mr. Mallon trying to hide behind all that smoke? Well, I suspect you see the answer to those questions as well as I do. He’s trying to hide the fact that he has nothing that connects action taken or not taken by Dr. Sarah Baldwin with the development of DIC in Lisa Grayson.

  “Frankly, with what little substantive material he has produced today, I’m surprised Mr. Mallon has the gumption even to bring this case before a tribunal. We’ve heard a shouldn’t have from Dr. Gorfinkle and a could possibly have from Mr. Ling, but those are the weakest speculations. There’s no science here, no expert saying that what this caring, dedicated physician did was wrong, and that because—because—of her alleged actions, an infant was stillborn and her mother gravely injured. Without such an expert, Mr. Mallon has failed to prove his prima facie case. On that basis, I request a dismissal of the charges against my client.”

  “Bravo,” Sarah whispered after Matt sat down. “Bravo.”

  “Bullshit,” he whispered back.

  “What?”

  “I’m the one whipping up a smoke screen. And you can see by the faces on our panel up there that they know it. Mallon’s done more than he had to to win here.”

  The judge thanked the participants, promised to have a decision within the hour, and dismissed the tribunal.

  Matt spoke not at all as they left the courthouse and headed back toward his office.

  “Well?” Sarah asked finally.

  “Well, what?”

  “Well, what do you think?”

  “Think about what?” He seemed distracted and perplexed.

  “About what just went on in there, of course,” she said irritably.

  “I think we lost.”

  “So what? You told me that was going to happen before we even went in.”

  “That doesn’t make me feel any better about it. We were pretty much hammered in there. And Mallon did it without even working up a sweat.” He sank down on a curbside bench. “Sarah, listen,” he went on. “Dead babies and maimed young women make juries angry. Sometimes very angry. I don’t know how solid a link Mallon’s going to be able to forge between Mr. Kwong’s herbs and Lisa Grayson’s DIC, or even if a judge is going to allow him to introduce the two other DIC cases. But my sense is that with Kwong’s drug arrest, and frail, pretty, one-armed Lisa coming forward to testify, he’ll be able to pluck enough emotional chords to make a jury stick the burden of proof on us. And that’s a position the defense never wants to be in.”

  There was a nervousness about him, a tension in his eyes and the set of his jaw, that Sarah had never seen before.

  “Maybe you should go right to the bottom line,” she said.

  He looked up, startled that she had read him so quickly and so accurately. “Well, the bottom line is that there’s an option available to us that I haven’t discussed with you, but that I think we ought to seriously consider.”

  “Namely.”

  Black Cat Daniels chewed at his lower lip and scuffed at a cigarette butt with the toe of his shoe.

  “Namely, to quit,” he said.

  CHAPTER 23

  THE THREE-FAMILY CLAPBOARD TENEMENT WAS ON A dead-end street in a decaying section of Dorchester. It was badly in need of new shingles, gutters, and a coat of paint. Lugging a heavy briefcase, Rosa Suarez trudged up the front walk. Her data-gathering was well along now, but nothing had yet emerged to explain the three DIC patients at the Medical Center of Boston.

  At her urging, the CDC had sent out requests to hundreds of hospitals searching for other, similar cases. But those that had been reported so far all had logical, well-established explanations such as abruptio placentae, toxemia, or overwhelming infection.

  Now, in hopes of stirring up something that she might have overlooked, Rosa was retracing some steps. She was starting with follow-up interviews with the families of the two deceased victims and later in the week with Lisa Grayson. At the same time, she planned to check and recheck the massive number of cultures she was running.

  Although her supervisor had said little to her directly, the first signs of his impatience had already surfaced in the form of a brief memo. Dr. Wayne Werner, senior field epidemiologist, would be finished with his current project and would be available for reassignment in three to four weeks, it read. Anyone in the department needing Werner’s help with an ongoing investigation should submit a request in writing within the next two weeks. Rosa knew that the memo was at least a demand for some sort of likely hypothesis from her, and at worst a threat that she was soon to be replaced.

  The name crudely painted just above the mail slot of the first-floor flat was BARAHONA. Fredy Barahona, a laborer, was home all day, every day, drawing disability for a back problem. His wife, Maria, was working the night shift in a sneaker factory. Maria’s daughter by her previous marriage, and the only child she would ever conceive, was Constanza Hidalgo.

  Rosa was feeling the strain of her intensive investigation, now nearly seven weeks along. She had lost weight, quarreled with her husband for the first time in several years, and developed an annoying tic at the corner of one eye. But she was frightened enough and determined enough to keep pushing herself to the limit. She desperately wanted to leave her profession a winner. More important, she wanted to head off what she firmly believed was impending disaster.

  Someone had deliberately torn pages from the hospital records of at least two of the three DIC cases she was investigating. Sarah Baldwin was being followed and had been accosted once. And the meticulous research techniques that had served Rosa so faithfully over the years were not delivering. She felt as if she were tiptoeing around a ticking bomb, with no clear idea how to disarm it. The only thing that seemed certain to her at this point was that unless answers were found, and soon, more women and their unborn infants were going to die.

  Maria Barahona was a plump, work-weary woman who had almost surely been quite attractive at one time in her life. She kept up a cheery front, but the pain of losing her only child showed in her eyes. Once, during Rosa’s initial interview with her, she had begun to weep. But just as quickly she composed herself, apologized, and went on answering questions. Now, with her husband across the room, dozing on a tattered recliner, she served Rosa tea and talked once again of Connie. Although her English was decent enough, she seemed relieved to be conversing in Spanish.

  “There were drugs in the car, you know,” she said. “They told us Connie had marijuana in her blood, but I don’t believe it. She was a happy girl. A good girl, too. And so, so beautiful. Her only crime was falling in love with that bastard, Billy Molinaro. Please, Mrs. Suarez, please. Forgive me for swearing.”

  “Mrs. Barahona, there is no need for you to apologize.”

  “She was so beautiful. You should have seen her, Mrs. Suarez. Men would just stop what they were doing and stare when she walked by. We had already picked out her boy’s name. Guillermo. Even though he would have been called Billy, Connie was going to spell it the Spanish way.”

  As she had during their first interview, Maria Barahona was rambling. She was once again nearing tears. Rosa broke in somewhat desperately.

  “Mrs. Barahona,” she said, “somewhere between three and five years ago your daughter was treated for something at the Medical Center of Boston. Would you have any idea at all what that was?”

  Some of the anguish left the woman’s face as she focused on Rosa’s question.

  “I—I don’t remember anything. She had some headaches and some stomach trouble—especially with, you know, her monthly. But nothing that didn’t get better when she took medicine. She always had great faith in the doctors at the Medical Center. If they said take this pill at three minutes after four, my Constanza sat looking at her watch until three minutes a
fter four.”

  Another dead end. Rosa stared at the floor, trying to imagine Connie Hidalgo’s mounting terror during those last nightmarish hours of her life. Was there anything else? Anything at all she could try?

  “Mrs. Barahona, Maria, I know that Connie was living with Billy Molinaro,” she said finally. “When did she leave home for good?”

  “They were planning a wedding,” Maria said, obviously embarrassed. “And she still spent many nights here. Many nights.”

  “Please, Maria. I’m sorry. I didn’t mean to imply anything at all. I just wondered if her room still had her things in it. That’s all. If it does, with your permission I’d like to check it over.”

  “Oh. Well, if you think it might help, certainly you can look at anything you want. It’s the room back there on the right. I haven’t changed anything. If you don’t mind, though, I’d like to get dinner started. I work the night shift, you know.”

  “I know,” Rosa said, glancing over at Fredy Barahona, who was in need of a shave and hadn’t so much as stirred since her arrival. She wondered if he had ever prepared a meal on his own, and reflected momentarily on how lucky she was to have spent forty years married to Alberto Suarez. “Thank you, Maria. I’ll be fine.”

  Connie Hidalgo’s bedroom spoke, of a woman who had never really stopped being a little girl. The bureau and bed, possibly painted by Connie herself, were white with pink accents. The pillow cases, also pink, were frilly, with hand-painted teddy bears and balloons. And there were stuffed animals everywhere—a hundred or more. Zebras and elephants; bears and orangutans; kittens and all manner of dogs. The walls were covered with posters of romantic island getaways and neon-lit cities. Rosa swallowed against the sadness in her throat. Despite the marijuana reported in Connie’s bloodstream, Rosa sensed she would have developed into a loving, devoted parent.