Critical

by Robin Cook

  But Angela was thinking less about nature and more about her problems with Angels Healthcare, which seemed to grow with each passing day. The last thing she expected at this late date was a problem with the medical examiner’s office. The concern was publicity, which had been a worry from the start. Back when the MRSA cases first occurred, she’d made it a point to contact the chief medical examiner, to convince him that they were on top of the problem to the extent of having reported it to the New York City Department of Health and encouraging the epidemiologist to come to the hospital.

  Angela turned to Cynthia. “What was your take on that medical examiner? Did she strike you as an independent sort?”

  “Absolutely. Why else would she come out and visit our hospital when there was no mystery about the cause of death. I didn’t like her there while we’re trying to keep a lid on this affair. That’s why I came down to get you. I thought it was something you should handle.”

  “I’m glad you did. I considered her a threat the moment I laid eyes on her. I don’t know exactly why, but she struck me as very focused and driven, and, to compound it, very intelligent. Did you see how she made eye contact? Most people caught in a similar circumstance would have been cowed to some degree.”

  “She did the same to me,” Cynthia said. “I definitely challenged her the moment I heard she was a medical examiner.”

  “She worries me,” Angela admitted. “If she manages to get any of this MRSA problem into the press, it will certainly come to the attention of institutional investors as part of their due diligence. If that happens, more than likely the IPO will have to be postponed, or if it’s not, it certainly won’t be successful.”

  “I think you did a terrific job talking to her.”

  “You think so? Really?”

  “I do. First, you mixed just enough condemnation and commendation, threat and praise, to put her off balance. Second, your warning about calling her boss definitely affected her negatively; I don’t think she will be making any more visits, whether announced or not. And finally you made her understand that there are a number of people working on solving the problem who have much more epidemiological training than she has. I’m sure she feels she’d fulfilled her responsibility.”

  “I hope you are right,” Angela said, not fully convinced.

  “I’m sure I am. I was impressed. You were brilliant. You really played her like a violin.”

  Angela shrugged. She wasn’t so sure. Her intuition was telling her the opposite, and that Dr. Laurie Montgomery was going to be a problem. Angela wondered if she should talk to Michael about her. But then, after another short session staring out the taxi’s window, Angela suddenly pulled her cell phone from her Louis Vuitton bag, slipped it open, and speed-dialed her secretary.

  “Loren? Get me Dr. Harold Bingham’s number.”

  To Cynthia, she said, “I want to be totally certain Dr. Laurie Montgomery behaves.”

  DR. WALTER OSGOOD was nervous. The whole time he’d been talking with his supervisor of the Angels Orthopedic Hospital’s clinical laboratory, Simon Friedlander, he kept thinking about the surprise visit from the woman medical examiner. He’d explained to her why he’d advised not to bother testing the MRSA to determine their explicit subtype. The woman had nodded repeatedly as if she’d understood, yet he sensed she hadn’t agreed. It was subtle but definite, and it worried him.

  When he’d finished the meeting with Simon, which had been stressful because of his nervous preoccupation with Dr. Laurie Montgomery’s visit, Walter asked if he could use Simon’s office to make a private phone call. Sitting at the man’s desk, he noticed a family photo. One of Simon’s sons was the same age as Walter’s only child. Before making his call, Walter picked up the framed photo so he could see the boy’s image more clearly. He was an obviously healthy child, with a shock of unruly blond hair and a purposefully silly but happy expression. Walter fought off a sudden surge of sadness, anger, and envy. He put the photo back down, closed his eyes, and took a deep breath to rein in his emotions involving the unfairness of life. At the moment, his son was far from healthy, having been diagnosed with a rare, severe form of Hodgkin’s disease requiring what his health insurer deemed “experimental” treatment. At the moment, Walter’s son had no hair and had lost a quarter of his former weight.

  Opening his eyes, Walter took out his wallet and extracted a small piece of paper with a single phone number with a Washington, D.C., area code. It was supposed to be for emergencies only, and he debated if this qualified. Making a sudden decision, he picked up the receiver and dialed.

  On the other end, the phone rang a number of times, and Walter wondered what he’d say if he got voice mail. Just when he thought the phone wouldn’t be answered, it was. A deep, wary voice said, “What is it?” There was no hello.

  “This is Walter Osgood,” Walter began, but he was immediately cut off.

  “Are you on a landline?”

  “I am.”

  “Hang up and call this number,” the voice said. He rattled off a phone number and hung up.

  Walter rapidly wrote the number on the edge of an envelope addressed to Simon. He then dialed the number. The same voice immediately answered. “You were not supposed to call me unless there is an emergency. Is that the case?”

  “How do I know what constitutes an emergency?” Walter snapped. “As far as I’m concerned, if it isn’t now, it will be.”

  “What is it?”

  “A New York City medical examiner by the name of Laurie Montgomery came to the Angels Orthopedic Hospital asking questions.”

  “Why is that an emergency?”

  “She’d autopsied a patient who’d died yesterday from MRSA. She wanted to go into the OR, and had even been up in the engineering spaces.”

  “So what?”

  “That’s easy for you to say. I don’t like it. The next thing, it could be in the papers.”

  “What’s her name again?”

  “Dr. Laurie Montgomery from the Office of the Chief Medical Examiner. What are you going to do?”

  “I don’t know. But I’ll keep you informed, and you do the same.”

  The line disconnected. Walter glanced at the receiver as if it could answer his question. Then he lowered it into its cradle. The strangest part was that he didn’t even know the man’s name.

  Walter carefully erased the phone number he’d written on the envelope on Simon’s desk before walking out into the lab.

  LAURIE’S TAXI WAS now speeding south on Second Avenue toward the OCME and running the lights. But instead of concern about her safety, other than being certain her seat belt was secure, Laurie was obsessed with her surprising visit to Angels Orthopedic Hospital. Nothing had been as she’d expected.

  The edifice was far more luxurious than she’d imagined. And the cast of characters had run the gamut from congenial to rude, and the CEO of Angels Healthcare, whom she never expected to meet, was definitely in the latter category. Laurie wondered if the woman would act on her thinly disguised threat to call Bingham. Under New York City law, a medical examiner definitely has the right, while investigating a case, to do what is needed to protect the public, and visiting an OR where there had been eleven infectious deaths over three months would certainly fall into that category.

  If anything, the visit had only intensified her urge to talk Jack out of his surgery, at least until the MRSA mystery had been solved. Although Angela Dawson had expressed a remorse for the toll the outbreak had taken on their patients, she seemed just as concerned about the institution itself. It was as if the two were equivalent, which shocked Laurie. She could not believe that under the circumstances, the hospital was continuing to do surgery, that the reduced revenues were on a par with lost lives. The CEO had been introduced to Laurie as a doctor, which Laurie had assumed to be medical doctor, but now she thought it must be Ph.D., not M.D. It just didn’t seem possible for her to be otherwise.

  She tried to focus on the outbreak, but the contradictions were c
onfusing. Although she knew the airborne spread of staphylococcus was possible, it wasn’t common, mainly because staph cannot be aerosolized like anthrax or other airborne bacterial threats. Staphylococcus remains viable for a very short time outside a warm, moist, nutrient-rich environment, and when a few errant molecules did land within someone’s nose or mouth, it behaved itself admirably and almost never caused problems. Yet in her series of mostly primary pneumonia, it had to have been airborne, and it had to have been a large dose. But that meant the patients had to have been exposed in the operating room to a relatively large amount of the pathogen. The trouble with that scenario was that the HVAC system was outfitted with HEPA filters that caught viruses a hundred times smaller than bacteria, and even if a few got through, the air in the OR changed every six minutes. On top of that, the patients undergoing general anesthesia never breathed the ambient air. In short, Laurie told herself it was impossible. Her series could not happen either naturally or purposefully.

  “We are here at your destination, ma’am,” the cabbie said through the Plexiglas divider.

  Laurie paid the fare and, still in a semi-trance from the staphylococcus conundrum, climbed from the cab and mounted the steps of the OCME. Once inside, she was surprised to see Marlene, still at her post.

  “Aren’t you supposed to be off duty at three?” Laurie questioned.

  “My relief called in to say she was going to be a few minutes late,” Marlene said in her soft southern accent.

  Laurie nodded and headed toward the ID room door.

  “Excuse me, Dr. Montgomery. I’m supposed to tell you when you come in that Dr. Bingham wants to see you in his office ASAP.”

  Laurie felt her face flush. Intuitively, she knew that Angela Dawson had to have already called and complained about her visit. With Laurie’s long-standing aversion to confrontations with superiors, she was not looking forward to being called on the carpet, if that was what was about to happen. It wasn’t that she felt guilty in any way, it was her fear of losing control of her emotions. Such a reflex response had started when she was a preteen and had never entirely gone away. At that time, she had suffered a horrific confrontation with her autocratic father, who had unjustly blamed her for her older brother’s death from a drug overdose. Since that awful episode, it was as if her response to confrontation was hardwired and beyond her control. As she approached Bingham’s secretary, Mrs. Sanford, she could feel the involved synapses firing and setting herself up for the fall.

  “You are to go right in,” Mrs. Sanford said.

  Laurie glimpsed the secretary’s face as she passed by the woman’s desk in hopes of getting a hint of what to expect, but Mrs. Sanford seemed to avoid eye contact.

  “Shut the door, Dr. Montgomery!” Bingham bellowed from behind his massive and cluttered desk. Laurie did as she was told. The chief’s use of such formality suggested the worst.

  “Sit down!” he said, equally forcibly.

  Laurie sat. She could tell her face was flushed, but she had no idea how obvious it was. She hoped it wasn’t. What bothered her the most about her reflex emotionalism was the concern that people would interpret it as a sign of weakness. Laurie knew she was not a weak person. It had taken a while for her to be sure of it, but now that she was sure, it rankled her that she couldn’t control behavior that suggested otherwise.

  “I’m disappointed in you, Laurie,” Bingham said, with a slightly more mellow tone.

  “I’m sorry to hear that,” Laurie said. Although there was a slight quaver to her voice, she felt encouraged. She’d managed to hold back any embarrassing tears.

  “You have been so dependable of late. What’s happened?”

  “I’m not sure I understand your question.”

  “I just got off the phone with a Dr. Angela Dawson. She was furious that you showed up unannounced at one of her private hospitals, demanding entry into unauthorized areas. She even threatened to call the mayor’s office.”

  Having overcome her emotions for the time being, Laurie allowed a more appropriate irritation to emerge. In her mind, Bingham should have been commending her resourcefulness and supporting her rather than siding with a businessperson who was obviously more concerned about her institution than her patients.

  “Well?” Bingham demanded impatiently.

  Understanding that it was as important to control her anger as her tears, Laurie calmly explained why she had gone to the hospital and what she had learned about the MRSA deaths that were occurring at Angels Healthcare hospitals despite commendable infection-control efforts. She told Bingham that she hadn’t arrived unannounced but had been invited by the chairperson of the infection-control committee, who had been hospitable and happy to give Laurie a tour.

  Bingham harrumphed into a partially closed fist. He studied Laurie with his rheumy eyes. He was, Laurie thought, partially mollified by hearing the other side of the story.

  “How many times have I or Dr. Washington told you that it is OCME policy that the PAs do the footwork and that you, as a medical examiner, stay here and do the cases?”

  “Several times,” Laurie admitted.

  “Ha!” Bingham barked. “Without exaggeration, it has to be more like a half a dozen times. We have world-class forensic investigators. You are to utilize them! Let them slog through city hospitals and crime scenes. We need you here. If you are not busy enough, I can rectify that.”

  “I’m busy enough,” Laurie averred, thinking about all the cases she had outstanding, waiting for additional information to come in.

  “Then get back to work and get more cases signed out!” Bingham said, with a ring of finality. “And stay away from Angels Healthcare hospitals.” With the matter taken care of, he reached into his in box and pulled out a handful of letters that needed his signature.

  Laurie stayed in her seat. Bingham ignored her as he began to read the first letter.

  “Sir,” Laurie began. “May I ask you a few questions?”

  Bingham looked up. His face registered surprise that Laurie was still seated in front of him. “Make it fast!”

  “I couldn’t help but be surprised you weren’t more taken by the number of these MRSA cases that I mentioned and the fact that the how and the why have not been determined. Frankly, I am mystified and concerned.”

  “They are obviously therapeutic complications,” Bingham said. “The how I have no idea, although I know several epidemiologists are working on it. And the number: Well, I knew there were quite a few, but I was not aware it had reached the twenties.”

  “How did you hear about them?”

  “From two sources, first from Dr. Dawson, several months ago. She wanted me to know that she’d contacted the Department of Health and had the city epidemiologist on the case. Then from a surgeon friend of mine. He’s one of the investors in the company as well as on the Angels Orthopedic staff. In fact, he had been doing most of his affluent-patient cases there before this MRSA problem started. He’s been keeping me abreast of the situation because a year or so ago he’d talked me and Calvin into picking up some of the founders’ stock.”

  “What?” Laurie demanded. “You are an investor in Angels Healthcare?”

  “Certainly not a heavy investor,” Bingham said. “When my friend Jason recommended it because he had learned it was going to go public, I had my broker check it out. He thought it looked promising. He actually took a larger stake than I.”

  Laurie’s jaw slowly dropped open. She stared at Bingham with astonishment.

  “What’s got into you?” Bingham questioned. “Why are you acting so surprised? Specialty hospitals are serving a need.”

  “I’m shocked,” Laurie admitted. “Do you know this Dr. Angela Dawson?”

  “I can’t say I know her. I’d spoken with her, as I just mentioned, and even met her at a mayoral function. She’s very impressive. Why do you ask?”

  “Is she an M.D. or Ph.D.?”

  “She’s an M.D. She has her boards in internal medicine.”

&
nbsp; Laurie was even more taken aback.

  “You have a strange expression, Laurie. What are you thinking?”

  “I’m thinking it is a little weird for you to be essentially ordering me to stay away from Angels Healthcare hospitals when you are an investor and there is a problem going on.”

  The web of capillaries on Bingham’s nose dilated. “I resent the implication,” he boomed out.

  “I don’t mean to sound insubordinate,” Laurie added quickly. “I’m actually thinking of your best interests. It might be best for you to recuse yourself.”

  “You better be careful, young lady,” Bingham snapped patronizingly while pointing one of his thick fingers at Laurie. “Let’s get this straight. I’m not in any form or fashion restricting your investigation of your case, especially not for my investment. I’m just telling you not to go to those hospitals yourself, angering politically connected people, and putting me in a difficult situation. All I’m saying is to use the forensic investigators to do your legwork, as I’ve been telling you for years. Are we clear on this?”

  “Quite clear,” Laurie said. “But I’d like you to know that my intuition is telling me there is something decidedly odd going on.”

  “Maybe so,” Bingham reluctantly agreed. He was clearly more irritated now than when Laurie had first arrived. “Now get out of here and get back to work so that I can get back to mine.”

  Laurie did as she was told, but before she could open the door, Bingham called out, “Actually, it’s my recollection your intuition has always been right, so keep me informed and, for God’s sake, stay away from the press.”

  “I’ll do that,” Laurie promised. There had been a few times in the past when she had unknowingly leaked confidential information to the media.

  In the elevator on the way up to the fifth floor, Laurie couldn’t decide if she was pleased with herself for holding back her tears or disgusted with herself for provoking Bingham. She was leaning in the direction of the latter. It had served no purpose whatsoever to accuse him of impropriety; she didn’t believe it herself. Her response had been from shock that her own chief was supporting an organization whose ethics seemed questionable at best.