Critical

by Robin Cook

  “I think I can handle it.”

  “Well, then I’ll take you up on the offer. But there’s one important fact that didn’t get in the PA’s report, which I got from Cheryl, and which might be important. It was the distance from the building that the body landed. It was twenty-one feet.”

  “Sounds like I might have to dust off my high-school physics,” Jack said. “Now that we have that settled, why are you preoccupied about MRSA? It’s not that it is new; it’s been a big problem in hospitals for some time. Or shouldn’t I ask?”

  “You shouldn’t ask!” Laurie agreed. “Not until I get more information. Then I’ll sit you down for a convincing PowerPoint presentation.”

  “Why do I have a bad feeling about the goal of this supposed presentation?”

  “Because you are worried I’m going to change your mind.”

  “Fat chance, Laurie, I’m having my knee fixed come Thursday.”

  “We’ll see,” Laurie said confidently. “Come on! I’ll ride down in the elevator with you. I need to pick up some material I just had printed.”

  As they walked down the hall toward the elevator, Laurie asked Jack about his previous case, the last of the three homicides Lou was interested in. She’d heard Lou’s description that morning about the detective sergeant’s daughter and the baseball bat.

  “It’s a good one,” Jack said, manipulating the crutches like a pro. “It was another opportunity for our PAs to shine. Steve Mariott noticed there were no footprints in the copious amount of blood on the floor. I mean, in and of itself, it doesn’t mean a whole lot, but it made him look at the scene a little closer than he might have otherwise, which turned out to be key. The victim’s forehead was bashed in, with even a bit of brain tissue extruding, but the overall shape of the wound wasn’t concave like you’d expect a bat to cause. I made a mold of the injury, and its tramline.”

  “You mean it’s more like having been caused by a sharp edge?” Laurie questioned as they boarded the elevator.

  “Exactly,” Jack said, grabbing both crutches in one hand so he could press the button for the basement. Laurie leaned over and hit the button for the first floor. The OCME printer was in the computer room, which was part of the administration area.

  “Steve had noticed a bit of blood on the cast-iron edge of a granite coffee table. He’d even taken a picture of it, as well as the bat. I think Satan Thomas, in a drunken, drug-addled stupor, fell while trashing the apartment and hit his forehead on the edge of the coffee table. To prove it, I’ve sent one of the daytime PAs back to the scene to get a mold of the table’s edge.”

  “That’s terrific,” Laurie said. “Lou is going to be pleased.”

  “I think the girlfriend is going to be the most pleased.”

  The door to the elevator opened. Laurie gave Jack a quick hug and thanked him for volunteering to do her case.

  “I’ll think of a way you can pay me back,” Jack said with a wink and a smile.

  After the elevator door closed, Laurie hustled down the main corridor toward the office printer in the computer room. She was determined to take advantage of this unexpected free time. With the hospital records of Riva’s two cases, she planned on working more on her matrix by creating more categories and filling in the boxes she could. What Laurie was interested in was finding some hidden commonality among the cases, which could explain the sudden cluster.

  Laurie also wanted to get in touch with Cheryl Myers, if Cheryl hadn’t called her already, and get the phone contacts Laurie had asked for. She wanted to call the CDC and the joint commission, but mostly she wanted to call Loraine Newman. In the back of her mind, Laurie had begun to believe that a visit to the Angels Orthopedic Hospital and perhaps even Angels Healthcare was in order, even though such excursions were discouraged by the chief. Ten years earlier, Laurie had been called into the chief’s office and chastised for making a similar site visit; Bingham felt strongly that visiting scenes was the province of the PAs, not the MEs. But under the circumstances she felt justified, even impelled, and not just to bolster her argument against Jack’s surgery. Her intuition was telling her that there was something vaguely unsettling about this series of MRSA cases that went beyond the Typhoid Mary theory.

  Adding to her unease were the results of Jack’s two cases that morning, the manners of death of which turned out to be the opposite of what was expected—accidental rather than homicidal. Such surprises reminded her that it was always important to keep an open mind about the manner of death. Even the most talented forensic pathologist could be fooled.

  Laurie now began to question if the current series of MRSA cases involved something more sinister than the assumed manner of death, therapeutic complication, a relatively new death designation championed by Bingham to replace “accidental” in a hospital setting. Keeping in mind her two previous series, one fifteen years ago and the second two years ago, whose manners of death had been assumed to be accidental and natural, respectively, but whose ultimate determination shockingly turned out to be homicidal, Laurie could not dismiss the possibility that the current series could be the same. Knowing that she’d be ridiculed if she gave voice to her intuitions, Laurie was aware that she had to see if there was any real evidence to bolster her suspicions, and she had to do it quickly.

  5

  APRIL 3, 2007

  11:55 A.M.

  Angela removed her coat and draped it over her arm as she exited the elevator on the twenty-second floor of the Trump Tower and briskly walked down toward Angels Healthcare. During the ride uptown from Michael’s office, she’d been able to use her BlackBerry to respond to all her e-mails and was reasonably confident she wouldn’t be overwhelmed when she got to her office. She wondered how people had functioned pre-Internet.

  She acknowledged her secretary, Loren, who was on the phone as Angela passed by. Inside her office, she was about to hang up her coat when she stopped, doing a double take. There was a large clear-glass vase of luxurious red roses perched on the corner of her desk. They stood out in bold relief in the sparse, white décor. After finishing with her coat, and curious who could have sent the flowers and why, she looked for a note. There was none to be found. Now even more curious about the flowers, she leaned out her doorway. She had to wave to get Loren’s attention.

  “What’s with the flowers?” Angela mouthed silently. Loren was still on the phone. From overhearing bits and pieces of the conversation, Angela could tell it was the union representative who’d been persistently trying to organize the Angels Healthcare hospitals. There was no way Angela wanted unionization, but with everything else going on, she didn’t have the time or the patience to deal with him, so it fell to Loren to hold him off.

  Loren put her hand over the receiver. “I’m sorry. They came with a card. It’s here on the corner of my desk.” She nodded toward the envelope.

  Angela picked up the envelope and got a finger under the flap. Once it was open, she slid out the card. It said simply: Regards from the used one.

  “What the hell?” Angela murmured. She turned the card over, but the back was blank. Curious but overwhelmed with all she had to do, she simply slid the card back into the envelope. She’d think about it later.

  Tapping Loren’s shoulder, Angela motioned for her to again cover the receiver with her hand, and then said, “Tell him I’ll meet with him in three weeks. Go ahead and schedule an actual appointment. That should satisfy him. Then call Bob Frampton and Carl Palanco. Tell them to come into my office ASAP. And where’s the afternoon schedule?”

  Loren pulled out the schedule for the afternoon meetings and handed it over.

  Angela retreated back into her office, closing her door. Seated at her desk, she looked at the schedule. Most of the everyday issues of running each of the hospitals was delegated to the department supervisors, but they reported to their respective hospital presidents as well as to a department head in the Angels Healthcare home office, and those individuals in turn reported to Carl Palanco as the COO
, and ultimately to Angela as the CEO. By perusing the schedule, Angela could gauge what the rest of the day would be like. She’d been booked to see the general counsel, most likely about the previous day’s MRSA death and how to stave off a lawsuit; the risk-management committee chair for the same reason; and the patient safety committee chair. After that, she was to travel over to the Angels Orthopedic Hospital to attend the hospital medical staff meeting. The final scheduled meeting would be back at her office with Cynthia Sarpoulus, so that the infectious-disease professional could give Angela a briefing of what she had learned and what she had planned to do about the previous day’s MRSA death.

  Of all the meetings, the medical staff meeting was the most important. It would afford Angela a chance, at least at the orthopedic hospital, to impress on the doctors the vital importance of upping their patient census, despite the minor setback the Jeffries case represented. The only way the revenue stream would turn around is if the surgeons did surgery. Angela was aware more than anyone that the success of the specialty hospital depended exclusively on the doctor owners admitting their paying patients, meaning those patients with insurance, either private or Medicare, or those patients with adequate wealth. The specialty-hospital business as per Angela’s business plan was not interested in Medicaid or charity cases, or, for that matter, any cases where cost might exceed revenue.

  Angela’s phone jangled under her arm. It was Loren, informing the boss that the CFO and COO had arrived.

  “Send them in,” Angela said, putting aside the afternoon schedule.

  The two men, dramatic opposites in outward appearance and mannerism, came into the room. Carl Palanco bounded in, snatched one of the four modern straight-backed chairs from where it stood against the far wall, positioned it in front of Angela’s desk, and sat himself down. His expression and constant motion suggested he’d had eight cups of coffee. In contrast, Bob Frampton moved as if in oil, and everything about his face suggested a desperate need for a good night’s sleep. Yet despite their contrasting miens, Laurie knew them both to be equivalently clever and resourceful, which was why she had strenuously recruited them at the outset to be her key employees.

  It took Bob long enough to move a chair next to Carl’s that Angela had been tempted to leap up and do it for him. But she stayed in her seat, and the thought gave her insight into her own hyper state. She wondered if she appeared as high-strung as Carl.

  “Anything happen this morning that I should know about, apart from the e-mails you men have sent me?” Angela asked, to start things off.

  Carl looked at Bob. Both men shook their heads.

  “I’ve met with the heads of supply, nursing, laundry, engineering, housekeeping, and laboratory services to talk about a deeper cut in expenses over the next few weeks,” Carl said. “I’ve gotten some creative ideas.”

  “I applaud the initiative,” Bob said, “but at this point, any efforts in that regard are too little too late, as far as the IPO is concerned.”

  “I’m afraid Bob is right,” Angela said.

  “I had to do something,” Carl explained. “I couldn’t just sit in my office and do nothing. And come what may, an emphasis on cost-consciousness is a good mind-set for our central department heads to have for the future. I mean, it’s hardly wasted effort.”

  Angela nodded. Keeping a rein on expenses was particularly key for hospital profitability, as holding companies of hospital chains had learned to great advantage over the last few decades. A large part of Angels Healthcare’s profitability, at least prior to the MRSA problem, was due to Angela’s business plan of building three specialty hospitals at the same time and centralizing things like laundry, supplies, housekeeping, engineering, laboratory services, and even anesthesia. Each hospital had a head, or chief, of these various services, but they all answered to the department head in the company’s home office.

  “How about your morning?” Bob asked Angela. “Any luck?”

  “Marginal,” Angela admitted. “As you mentioned last night, we’re seriously drawn down on our credit at the bank after selling the bonds. The good news is that Rodger Naughton assured me he was not going to call any of our loans. The bad news is that he cannot authorize a loan without collateral, which I expected. On the other hand, he’s sent the additional loan request up the ladder, but from his attitude, I think we have to assume it’s a lost cause.”

  “What about your ex-husband?” Bob asked. As was the case with all the key employees, Bob was aware that their placement agent had been married to Angela but divorced a year before she founded Angels Healthcare. Although initially hesitant about the relationship, Bob had accepted it. He’d expressed a preference for a more direct relationship with a blue-ribbon investment bank, but had been won over by Michael Calabrese’s ability to come up with an outstanding angel investor during their mezzanine round of raising capital.

  “I was able to get him to commit another fifty thousand of his own money,” Angela said. She did not mention how demeaning the meeting was.

  “Bravo!” Carl said.

  “It’s a bit short of what I would feel comfortable with,” Bob said.

  “I did my best. Getting him to put in the extra money was like squeezing water from a rock.”

  “Did you discuss the terms?” Bob asked.

  “Oh, yeah! You don’t think Michael Calabrese would offer that kind of money without rewarding himself.”

  “What did you offer?”

  “I didn’t offer; he told me,” Angela said, and went on to explain the terms.

  “Whoa!” Bob commented. “He’s being rather generous with himself.”

  “It can’t be helped under the circumstances,” Angela said. “Call him and draw up the documents. I want that money in our account before he changes his mind. I happen to know how fickle he can be.”

  “Will do,” Bob said, typing himself a note on his BlackBerry.

  “Okay, that’s it,” Angela said, placing her palms on her desk as if she were about to stand up. “Except I want to make sure everyone who knows about the MRSA death yesterday understands that the less said about it, the better. I’d like to keep it away from the medical staff as much as possible.”

  “I’ve reminded all the hospital CEOs,” Carl said. “I also spoke to Pamela Carson in public relations.”

  “Good,” Angela said. “Anything else?”

  “There is one thing I just remembered,” Bob said. He straightened himself in his chair. “Paul Yang hasn’t come into the office today.”

  “Has he called in sick?” Angela asked. She felt her general anxiety rise another notch.

  “No. I left a message on his cell and also e-mailed him, but he hasn’t gotten back to me. I don’t know where he is.”

  “Is that odd for him?” Angela asked, while she debated mentioning Michael’s possible role.

  “Of course it’s odd! He’s usually so methodical. I even called his wife. She said he didn’t come home last night or even call.”

  “Good God!” Angela said. “Has she called the police?”

  “No, she hasn’t. He’s done this before, although not for a number of years. He’d had a drinking problem, which had led to some odd behavior. His wife told me he’d been out of sorts of late and had gone back to having a cocktail or two on his way home.”

  “I never knew he had a drinking problem,” Angela said. She did not like to be blindsided about any Angels Healthcare employees, particularly key employees.

  “I kept it out of his record,” Bob said. “I should have told you when I recruited him, but he and I had worked together for something like six years, and he’d been clean.”

  “Good God!” Angela repeated, raising her eyes to the ceiling for a moment. “Now we have to worry about a drunken binge by our accountant, who’s been threatening us all with filing an eight-K. What else can go wrong?” She took a deep breath before looking back at Bob.

  “I know he was struggling with his conscience,” Bob said. “That’s why I call
ed you about him yesterday, to keep you in the loop. Up until then, he hadn’t mentioned the problem for over a week. I’d thought it was a nonissue. Apparently, he’d read an article about the sentencing of the Enron and WorldCom people. I told him what I’d told him before, namely that our not filing the eight-K is justifiable. We’re not trying to perpetrate a fraud by bilking people out of their savings or retirement funds, which is what the SEC rule is about. In fact, just the opposite! We’re creating capital for people.”

  “After you called me yesterday about him, I called Michael because when you had originally brought the issue to my attention, I had discussed it with him. I thought with his IPO experience he would have a suggestion of how to handle the problem, and he did. He said he knew someone who could talk to him and put his mind at ease by convincing him that filing the eight-K wasn’t necessary in our situation.”

  “Was it a corporate attorney?”

  “I have no idea. I didn’t ask, but I find myself wondering if talking with Michael’s acquaintance could have had anything to do with Paul’s not coming to work today.”

  “It’s possible, but I bet the reason for his being incommunicado is more prosaic, like he got himself blotto and is currently sleeping it off in a fleabag hotel.”

  “Is there any way we could find out if he filed the eight-K?” Angela asked hesitantly.

  “Not that I know of,” Bob responded. “We’ll just have to wait and see if the shit hits the fan.” He laughed humorlessly.

  “If you think of a way, let me know,” Angela said. “It would be best if we know sooner rather than later, so we can prep our general counsel. We’ll be forced to come up with a rational explanation of why we didn’t file earlier. Maybe you should start giving it some thought, Bob.”

  Bob nodded.

  “What about Paul’s secretary?” Carl asked. “Has she heard from him?”