Natural Causes

by Michael Palmer

  “Annalee, I’m so excited for you.”

  “Yeah. Peter’s really come through this time. So, what’s this urgent stuff? And who’s Rosa Suarez?”

  “There really is a Dr. Suarez. In fact, she’s right here. She’s—she’s been studying weight loss programs for the government. I told her about Peter’s program and about Dr. Singh.”

  “Those two are really raking it in,” Annalee said. “Peter’s added a whole new shipping area to this place. Twenty or so employees just packing it up an’ shipping it out. It seems half of America is overweight and watching late-night TV. And every one of them is looking to walk the high road to slimness, as Peter puts it.”

  “Annalee, do you have any idea how we can get in touch with Dr. Singh?”

  “None. He comes by every few weeks with a new supply of the vitamin caps that go with each order. But I almost never see him. I can try asking Peter without telling him it’s for you. He’s furious that your lawyer has subpoenaed him to testify.”

  “Tough,” Sarah murmured. “Listen, Annalee. Don’t get yourself in any trouble over this. But it would be a huge help to us to speak with Dr. Singh.”

  “I’ll see what I can do. Is that it?”

  “Could you send me out some of that powder?”

  “You mean you don’t want to pay forty-nine ninety-five by check or major credit card, and allow three to six weeks for delivery, sorry no CODs? Well, I think I can handle that.”

  Sarah gave Annalee Rosa’s address, thanked her, and again begged her not to get into any conflict with her father. Then she sat staring out at the rich autumn afternoon.

  “Rosa, you really believe this weight loss powder might be connected with the DIC cases?” she asked.

  “Assuming the facts as we have them are true,” Rosa replied, “it is certainly as likely a cause as your prenatal supplement.”

  “It makes no sense.”

  “That’s because the facts as we have them are clearly not all the facts. I’d like to see one of those infomercials you told me about.”

  “I’ll get to work on that. My lawyer has some connections in TV. I’ll see if he can get hold of a tape of one for tomorrow night’s progress meeting. By the way, are you coming?”

  “I wasn’t planning on it. But now that I’m officially off the case, I think I will. Especially if one of the feature attractions is that tape. Besides, with what you told me, and what I heard over the phone just now, I think the stakes might have just been raised.”

  “I don’t understand.”

  “Your friend Annalee took that diet powder, yes?”

  “Yes.”

  “And she’s due to go into labor in just a few weeks, yes?”

  “I didn’t even think of that.”

  “With all you’ve had to process this past hour, that’s understandable. Besides, there’s time. Not a whole lot of time, but some. I’ll see you tomorrow evening at your lawyer’s office.”

  Sarah hugged Rosa long and lovingly, and promised not to share what they had learned with anyone. Then she hurried down the stairs and back to MCB. The roller coaster was cranking upward again. And she was feeling more excited and energized than at any time in weeks.

  Alone in her room, seated cross-legged on her bed, Rosa Suarez tried to incorporate the new information with what she already knew. Sarah was right. Blaming the DIC cases on the short-term ingestion of an herbal powder years before made no real sense … yet. It also did not connect in any obvious way with the missing hospital chart pages. Scratching lines and drawing arrows on her pad, Rosa strained to put all of the facts in order until she felt her concentration begin to evaporate. Exhausted, she sank down onto the pillow. Nothing was solid. Nothing. It was like trying to link up puzzle pieces made of Jell-O. She wanted desperately just to close it all off and go to sleep. Instead, she called Ken Mulholland in the CDC lab.

  “Hey, Rosa, how’s your back?” he asked.

  Just hearing his voice brought a smile. Of all those at work, only Ken knew where she was and how she had gotten the time off.

  “Worse every day, thank goodness,” she said. “Have you got anything for me?”

  “Yes and no. I don’t know what it is with you and your boss, but a memo has come down that your investigation is officially closed. No one in our department is to be devoting time to it. My section chief followed up the notice with a visit to me. He knows I’ve been helping you. I … um … I’ve been firmly instructed.”

  “You mean warned. My chief really wants to be sure I fail this one. I’m sorry, Ken. Listen, don’t take any chances. But I really need your help.”

  “And you’ve got it. You aren’t the only person around here with sick time coming, you know. If I have to, I’ll just get the flu and work with you up there. You did say you had access to equipment.”

  “Not like yours, but yes. A whole lab, complete with technician. Now, what have you got?”

  “We’ve got enough to say your girl had some sort of DNA virus in her blood at the time it was drawn last July. But we don’t have enough growth to classify or type it. And we’re not going to, either. Our last specimen burned out yesterday. If you want us to go further, we’re going to need more serum.”

  “Then we’ll just have to find a way to get you some.”

  “And I’ll need the name and number of your technician up there. I may have to have him do the cultures.”

  “Anything you want that’s within my power, you get.”

  “That important, huh?”

  “I’m sitting on Vesuvius here, Ken. I swear I am. And soon, very soon, I think it’s going to blow.”

  CHAPTER 28

  October 10

  THIS IS JOHNNY NORMAN SPEAKING TO YOU FROM Television City, asking you, our live studio audience, and you, our millions of home viewers: Are you ready to change your lives for the better?” “Yes!”

  “Are you ready to catch the brass ring and finally hold on to it?”

  “Yes!”

  “Are you ready to walk the High Road to Slimness and Health?”

  “Yes!”

  “A little louder, please. I didn’t quite hear you.”

  “YES!”

  “Well, all right, then. You’ve come to the right place, so let’s get started. It’s time once again to say hello to your guide on the High Road—the man who coached his club to two Super Bowls but couldn’t quite coach himself away from the ice cream bowl. Let’s have a big, Herbal Weight Loss greeting for Coach Tom ‘Bear’ Griswold!”

  Tall, granite jawed, and slender as a sapling, Coach Tom Griswold bounded onto the stage, clapping his hands the way he might have following one of his fabled half-time harangues. Packed into the waiting room of Matt’s office, the viewers watched the taped infomercial in almost morbid fascination as Griswold recited his life story, accompanied by startling pictures of his expanding career, reputation, and waistline.

  “I had more money in the bank than I’d ever want to spend, a family that loved me, a great career in broadcasting, and at almost three hundred pounds, a life expectancy that my doctors were measuring in months! At first they calmly advised me to lose weight. Then they got more threatening. They told me that unless I did lose that weight, I might as well stop buying green bananas.…” Burst of laughter. “Well, look at me now!”

  He spun around in a graceless pirouette, to the accompaniment of screaming cheers from the adoring studio audience.

  “Amazing,” Glenn Paris murmured in awe.

  “No, America,” Eli Blankenship said. “The country where you can’t be too rich or too thin.”

  “And now, Johnny,” the coach went on, “before we meet the man responsible for bringing this remarkable discovery to America, give us the grand total to date.”

  A huge, garishly lit tote board filled the screen, its blank spaces awaiting Johnny Norman’s grand announcement.

  “Okay, Coach. Here we go. To date, the number of people around the country and around the world who have joined us
on the High Road to Slimness and Health is: FIVE HUNDRED AND SEVENTY-ONE THOUSAND, SIX HUNDRED AND NINETEEN!” Exuberant applause.

  “At forty-nine ninety-five apiece,” attorney Arnold Hayden added. “Most incredible. And how long have they been marketing this stuff?”

  “About six months,” Matt said.

  “But don’t forget, Arnold,” Colin Smith reminded. “From all indications, this stuff really works. Truthfully, now. Wouldn’t you pay fifty bucks to get rid of that Michelin of yours—especially if you didn’t have to knock yourself out dieting?”

  “Thank you, Johnny Norman,” Coach Griswold was saying. “Now I want to introduce you all to the man who has put years back into my life, to say nothing of what he has done for my tennis game and—my beautiful wife Sherry will be quick to tell you—for my love life as well.” A few titillated oohs followed. “But first, let’s hear a song from one of the true daughters of the Ayurvedic Herbal Weight Loss System. Betty Wilson was a Broadway star at two hundred and thirty pounds. But she’ll be the first to tell you how much she hated looking in the mirror. Today she’s still a star. But just look at what she sees in that mirror now.” Whistles and cheers for the singer, whose blue-sequined gown seemed painted on her perfectly proportioned, size-six body. “Ladies and gentlemen, singing the title song from her new Broadway show, Miss Betty Wilson.”

  Matt fast-forwarded through the song while the others in the waiting room muttered phrases of disbelief or of grudging admiration. Then the coach, after a syrupy ninety-second introduction, brought Peter Ettinger onstage to a standing ovation from the studio audience. At the sight of him, Sarah felt the muscles of her jaws harden. But even she had to admit that the man, who looked and seemed larger than life in most circumstances, was even more imposing on TV.

  Striding from one side of the sound stage to the other with the graceful elegance of a giraffe, Peter recited the meticulously documented tale of his discovery of Dr. Pramod Singh of New Delhi, India, and the man’s remarkable Herbal Weight Loss System. Next came a series of testimonials from various carefully selected clients, all of whom were failures on other programs. Their moving tributes were interwoven with a step-by-step introduction to Ayurvedic medicine, tracing its development over thousands of years, from the earliest recorded history, through various periods of abandonment and acceptance, to an incredible resurgence in the 1980s and ’90s.

  And finally, against a backdrop that was clearly India, came a taped message from Pramod Singh himself. The secret herbs included in the Ayurvedic Herbal Weight Loss System were only part of the story, he stated. Although to be sure, a most major part.

  “Use our powder properly, eat in moderation, avoid the five forbidden foods,” he advised in a musical accent, “and you will lose the weight you wish no matter what else you do. Meditate five minutes each day, and follow the other basic principles of Ayurveda explained in your manual, and you will know many new freedoms beyond simply being thin. You will know freedom of the spirit. I am sorry I cannot be with you all in person, but I am here supervising the harvesting of the twelve crucial, natural components of our powder. I look forward to seeing you all in a few weeks. And now, back to Dr. Peter Ettinger.”

  “Doctor of what?” Matt asked, switching off the tape.

  “Peter Ettinger has a number of degrees from a number of institutes,” Sarah said. “But I honestly don’t know if any of them is a Ph.D. from a traditional university.”

  “You don’t sound as if you like the man much,” Colin Smith said.

  “He’s a pompous ass if you ask me,” Glenn Paris said.

  Sarah smiled inwardly at the notion that almost certainly Peter would have chosen the exact same words to describe the hospital CEO.

  “Well,” Matt said, “I think we ought to get started. I’ve already said my piece by reasserting that the account of the nightmarish night Sarah and I survived in Chinatown is quite factual, and that rumors or no rumors, body or no body, Andrew Truscott is quite dead. The police have turned up nothing new. Neither did a private detective I hired—a very good one. We haven’t given up trying to prove our story, but we’re also at a loss about where to go from here. Any suggestions?… Well, then, unless there are any questions, I propose we move on.

  “So far in this business, Jeremy Mallon’s been scoring all the points, and we have been very much on the defensive. Tomorrow, with the formal deposition of Peter Ettinger, I hope that status will change. Before I ran the video, Mrs. Suarez gave you all some idea of what sort of things we’ll be trying to pin him down on. I hope she’ll go into more detail in just a bit. First, though, I’d like to hear from Dr. Snyder and Dr. Blankenship. Any order will be fine.”

  Sarah caught Matt’s eye for the briefest moment. He was self-assured and very much in control of the meeting. How far he had come since that first session in the Milsap Room at MCB. Silently she longed for the day when she could be with him openly as his friend and lover—the day when Willis Grayson, his anger and his lawyers, would be a thing of their past.

  “Suppose I go first, Eli,” Randall Snyder offered. “What I have to say won’t take very long.” He cleared his throat. “I’ve had the American College of OB/Gyn send letters of inquiry to the heads of every obstetrics department in the country, looking for any unexplained cases of DIC in pregnancy or labor. So far there hasn’t been one where there wasn’t at least some predisposing thing going on—abruptio placentae, infection, toxemia, sickle cell disease, in utero fetal demise. Not one. I must say, Sarah, having sent the letters and made the dozens of follow-up calls, the lack of any DIC patient who did not take your prenatal supplement remains most disturbing and, if I may say so, most incriminating.”

  “Thank you,” Matt said coolly. “You may say anything you wish. Someone has gone to a great deal of trouble, and caused a great deal of pain, to make Sarah’s prenatal supplement appear responsible for those cases. That fact, more than any other, suggests to me that it is not. Dr. Blankenship?”

  The chief of medicine tapped a pencil thoughtfully against his palm before picking up the sheaf of notes he had set on the floor beside his seat.

  “Well,” he said finally, “my assignment was to become one of the world’s leading experts on disseminated intravascular coagulopathy. It turns out that this was not nearly the humbling task it first seemed it would be. I have discovered that everyone in the clotting world knows when DIC occurs but absolutely nobody knows why. The more common name for this condition is consumptive coagulopathy, because while it is going on, all of the body’s coagulation factors get consumed—used up in those tiny, abnormal clots. In its worst form, DIC is almost universally fatal. This fact makes the accomplishment of Defendant Sarah in saving the life of Plaintiff Lisa all the more remarkable. People who have DIC as badly as the plaintiff simply don’t make it.

  “Would I testify to that on the witness stand, Mr. Daniels? You betcha I would.” His manner and tone, which had been quite matter-of-fact, intensified dramatically. “I would do anything I honestly could to help. I am quite disturbed about this case and the lack of overwhelming support Sarah has received from our institution. We made a promise to her and to ourselves months ago when we first met that we would present a unified front, and that Sarah would be considered innocent until proven—proven—otherwise. Randall, Glenn, I’ve spoken with Rob McCormick about this letter he sent out requesting Sarah’s replacement as chief OB resident next year. He says he’ll be happy to retract it for the time being if you two are in agreement to do so.”

  “Eli,” Paris said, “this is hardly the place or time to—”

  “Glenn, please. I don’t want to start a war here or embarrass Sarah. But if we’re going to present the unified front we agreed to, then we’ve got to get McCormick to back off. Yes?”

  Paris’s annoyance was apparent. Whether or not he agreed with Blankenship’s request, he was uncomfortable with being told what to do.

  Finally, after a long pause during which he regained his compo
sure, he grinned and nodded.

  “Right you are, Eli. I don’t know where Rob got the idea to do what he did, but I’ll call him tomorrow and set him straight.”

  “Excellent. Randall?”

  “No problem,” Snyder responded unenthusiastically.

  “In that case, on with the show,” Blankenship said. “There’s one last category of causes of DIC I thought I might mention, and that’s poisons. The injection of the naturally occurring clotting agent, thrombin, can cause a DIC-type picture, as can certain snake venoms. The toxin found in at least five different species of crotalids can cause lethal DIC.”

  “Crotalids?” Matt asked.

  “Sorry, Matt. Rattlesnakes.”

  “But I don’t believe the poisons you describe are effective by mouth,” Sarah said. “And Lisa was at home when her DIC began. I can’t imagine she could have received an injection of any sort.”

  “Or been bitten by a diamondback.” Arnold Hayden guffawed.

  No one else laughed.

  “As I said,” Blankenship replied, “I only included the poison possibility for completeness. There may be an oral toxin we don’t know about that can cause DIC. Maybe someone has such a substance and is on a vendetta against our hospital or the obstetrics department. At this point, who knows?”

  “That’s all we need,” Glenn Paris groaned. “A psycho.”

  “Any questions for Eli?” Matt asked. “Okay, then. Rosa, you’ve kindly shared some significant developments in your work. Can you sum up what your conclusions are at this point?”

  Earlier in the day, Sarah had spoken with Rosa for over an hour. The epidemiologist felt torn between the desperate need for all concerned to share information and ideas and her deep-seated bias against disclosing research still in progress. Until her results were checked, double-checked, and locked away, she felt uncomfortable trusting anyone with the details of her work. In the end, nothing was really resolved between them except that Rosa would attend the meeting and disclose as much data and theory as she felt comfortable in doing. No more.