Lethal Remedies

by M. Louisa Locke

  As Annie took the keys, Dr. Brown continued. “Mrs. McClellan had the foresight to ask Mrs. Branting for their return on Tuesday afternoon when she told her that she was resigning.”

  Looking around the small office, Annie’s heart sank. There was a file cabinet in the corner, its top drawer half open, apparently because the folders in it were askew. In addition, she saw a box in the corner that appeared to hold a jumble of clothing, books, and toys; she supposed these might be donations. If so, they would need to be assessed in value for her audit. Maybe this was something she could ask Miss Keene to do. Most disturbing of all, the desk looked like someone had simply dumped a trash can of different-sized pieces of paper onto it.

  She turned to Dr. Brown and said, “Can I assume that pile of papers on the desk represents Mrs. Branting’s files for the past year?”

  “I’m afraid so. I had no idea until I came in this morning how she had left things. Simply unconscionable, although maybe it was better that I didn’t know, or I would never have been brave enough to ask you to help us out.”

  “I must say, taking me on the tour first was an excellent strategy,” Annie replied, charmed by the doctor’s candor. “Of course, after seeing what good work you all are doing, I can’t possibly refuse to go forward. If it is any help to assuage your conscience, I have seen worse.”

  Annie was telling the truth. Unless a firm, or in this case a charity, hired a trained accountant, their financial records were often in terrible shape. Even in offices where everything looked all neat and organized, she often discovered that there were crucial documents missing or misfiled. And the actual account books could be in awful shape. It was amazing how few people were able to understand basic bookkeeping and the importance of using the double-entry system.

  Then there were the problems a couple of simple math errors could cause, which were in turn compounded when the error got passed on from year to year. Of course, there was always the possibility that what seemed like human error or unfamiliarity with bookkeeping were really the result of someone in the firm stealing and using the account books to hide that fact.

  Dr. Brown touched the stack on the desk, hurriedly catching an envelope that began to slide to the floor as she said, “Oh, Mrs. Dawson, I have difficulty believing you’ve seen worse. I sincerely hope I haven’t given you an impossible task.”

  “If you give me an hour, I will try to discover the extent of the problem,” Annie said. “You did say you don’t have to leave until eleven, didn’t you? I should leave then as well.”

  “Normally, either Dr. Wanzer or I try to be here until a little after noon to check on the patients in the hospital section and see if Dr. Blair needs to consult with us about a particular case she has seen downstairs in the dispensary. Mornings are also the time we work with the nurses on their training. Occasionally, we will go out into the neighborhood if there is a patient that is too ill to make it to the dispensary. But today, I would like to leave early because I have a few more private patients I need to see back at my office before I leave town. So, yes, I will come back to see you in an hour.”

  “Good, now I will let you get back to your work,” Annie said. “And I will start mine.”

  What she didn’t say was that she hoped that an hour didn’t just reveal problems that were so severe that they couldn’t be solved by putting neat figures in an account book.

  Annie leaned back in the wooden desk chair and shrugged her stiff shoulders. Then she checked the clock on the fireplace mantel as she rubbed her hands together, trying to regain some warmth. Dr. Brown had asked if she wanted a servant to light a fire in the room’s fireplace, but she had declined. From experience, she was more likely to stay alert if she didn’t get too warm. However, the room was chilly enough so that she had gotten up at some point and fetched her coat from the foyer. That had kept her body warm, but not her hands.

  She had ten minutes to go before she could expect Dr. Brown to reappear, and she had only one small stack of papers left to go through. The rest she had put into four separate piles. Receipts for purchases, bills (some marked paid), checks (some cashed, some uncashed), and general correspondence. She had also found a cash box in the bottom of the desk drawer—but she hadn’t had the heart to do more than take out some uncashed checks she found in the box, not count the cash itself, which didn’t look to be more than a few dollars and some change.

  What she didn’t have time to do was look in the file drawers, where she hoped to find at least the previous year’s financial documents and reports. These would give her a good clue as to what she should be looking for in terms of income and disbursement for this year. She also thought she might find some of the documents related to this year’s finances in these drawers since she had noticed that most of the bills and receipts on the desk were from just the last couple of months. Looking at the state of the top file drawer, however, she didn’t have much expectation of these documents being any more organized.

  Picking up the first letter on the small pile of correspondence she had yet to go through, she saw it was a request for payment by a pharmacist, and she put this on the bills pile. The second piece of paper appeared to be a copy of a letter that had been sent out under Argenta Branting’s signature, directed to Mr. Richard Truscott. Annie’s interest quickening at the name of the patient who had not paid her bills, she carefully read through the letter. Frowning at the former treasurer’s fussy handwriting, she noted that this letter had been sent the first week of January and referenced an operation called an ovariotomy and aftercare that had been done in November. The letter was polite, mentioning that the bill was one month in arrears. Putting this letter aside, she continued to go through the pile and found copies of two more letters addressed to Richard Truscott. One letter was dated two weeks after the first, again asking for payment. In this one, Mrs. Branting expressed concern that she hadn’t gotten a reply to her first letter, suggesting that perhaps it had gone astray. Nevertheless, the wording was very polite.

  A third letter from Mrs. Branting was dated the first of February and referenced a letter she had received from Mr. Truscott where he had written that he had no intention of paying the bill because of the unsatisfactory results of the operation. In her reply, the former treasurer stated that the dispensary would be looking into taking legal action against the Truscotts if the bill wasn’t paid by the first of March. Short, to the point, but still very restrained.

  Annie looked for a copy of this letter from Truscott that Mrs. Branting referenced, but instead she found a letter dated this past Monday morning. She assumed this was the letter that had offended Mrs. Branting so much that she felt compelled to resign as treasurer and hand the problem over to Dr. Brown.

  In this letter, Mr. Truscott sounded quite angry, his language quite unrestrained for a business letter, and she had a little more sympathy for Mrs. Branting’s reaction. In Annie’s experience, most men of business used a very cold, precise, and formal language to convey their dissatisfaction in writing, much along the lines of the letter from Mrs. Branting to Truscott that had threatened legal action.

  As she reread this letter from Richard Truscott, she began to sense that behind the anger was an element of fear, fear that his wife was seriously, if not mortally, ill. Truscott said that his wife’s illness was the result of the actions taken by the Pacific Dispensary and that—instead of curing his wife, Phoebe—the operation she had undergone had made her condition worse. He concluded by writing that he was considering suing them for malpractice, or worse, if his wife did not recover.

  Suddenly, the problems of unpaid bills seemed like the least of the dispensary’s problems, and Annie got up to find Dr. Brown to tell her the bad news.

  Chapter 7

  “Malpractice!” Dr. Brown, clearly shocked, put down the letter, her hand pressed against her chest.

  Annie said, “I’ve heard the term used in the newspapers…usually hinting that the doctor had performed an illegal…I mean…”

  �
��No need to mince words. It usually means an abortion,” Dr Brown said, frowning angrily.

  “But that can’t possibly be what he means, could it?” Annie replied quickly, not wanting to have offended the doctor.

  “Of course not. The dispensary would be closed down in a second if there were the slightest hint we were engaged in that sort of illegal act. The poor woman had ovarian cysts that were retaining so much fluid that she did look as if she were in a gravid state, but Phoebe Truscott was certainly not pregnant, and we did not perform an abortion.”

  “Could her husband have actually thought this is what occurred?”

  “Good heavens, no! I went over the diagnosis and why we recommended surgery in great detail with both Phoebe and her husband. As did Dr. Harry Granger, Phoebe Truscott’s regular physician. We had been very conservative in our treatment prior to that recommendation. We had her come in multiple times over the previous year so we could express the fluid from the cysts multiple times. But the cysts were growing so aggressively at the end that surgery was the only remaining option. I ended up having to take out the left ovary, it was so diseased.”

  “You did the surgery?”

  “Yes, although Dr. Granger and several other of our consulting physicians were present.”

  “And Mr. Truscott couldn’t have misunderstood what you were doing?” Annie picked up the letter, looking at the exact wording he had used.

  Dr. Brown frowned and said, “I can’t believe he could. Although patients, and their loved ones, often only hear what they want to hear when you are explaining something to them. But Mr. Truscott appeared to be an intelligent and rational man. In addition, when his wife left the dispensary, he was effusive in his thanks to us for the care we had taken with her.”

  “So this operation wasn’t done without his agreement?”

  Annie could imagine a case where a wife might make a decision about her health that went against her husband’s wishes and the husband subsequently lashing out at the doctors and refusing to pay the bill.

  “No, no, he was completely behind the decision,” Dr. Brown said with conviction. “He came with Phoebe for each of the initial procedures and appeared to support his wife when she begged for us to do the surgery and not just do another expression.”

  “Is there any way of proving that they both understood exactly what was going to happen in the surgery?”

  “Absolutely. When we opened the Pacific Dispensary for Women and Children, I insisted that we have a document that a patient—and a relative if appropriate—needed to sign before admission. In the case of a surgical procedure, the document lists the reasons for the operation, the kind of steps we have taken leading up to surgery, the steps we expect to take during the surgery, and our estimation of what kind of aftercare will be required. This document spells out the possible risks that are always associated with this kind of surgery and includes a statement that the dispensary and attending staff will not be liable for any problems that might occur from the operation or aftercare. We also include an estimate of the costs of the procedure and aftercare.”

  Annie felt enormous relief hearing this. She said, “And the Truscotts…both of them…signed this document?”

  “Oh, yes. I wouldn’t have gone forward with the operation if they hadn’t. The document will be in our medical files, downstairs, and I can assure you those files are in good shape, not like the files in this office. In medical school, my professor of surgery not only encouraged us to follow this practice, but gave us a sample document that I have used as well in my own practice. You would have signed one before I took you on as an obstetric patient. I have insisted that any doctor affiliated with the dispensary use it as well if they perform operations here.”

  “I am impressed. No wonder you didn’t hesitate to sign the documents I showed you this morning,” Annie said.

  At Nate’s urging, Annie had made a practice of having a similar document prepared for clients to sign that covered her for any liability connected with her auditing or financial advisory activities. In addition, she’d brought a similar document that covered Nate’s legal services, since she had anticipated that the dispensary might need him to compose letters for Annie to send out to people regarding their bills. She now understood why Dr. Brown had needed little explanation before signing both of these documents this morning.

  Picking up Truscott’s letter again and rereading the final sentences, Annie said, “So, if Mr. Truscott isn’t referencing an abortion, what do you think he meant by saying that he would sue the dispensary for malpractice?”

  “I can’t say without examining Mrs. Truscott. I am concerned that his wife might be experiencing some sort of infection.”

  “Would this be likely to be associated with the effects of the surgery?” Annie asked.

  “Unfortunately, it might,” the doctor replied. “Any time you cut into a person’s body, there is the possibility of infection. I’m sure you’ve read some of the recent newspaper articles that have reported that the death of poor President Garfield was not due to the assassin’s bullet, but to the system-wide infection he developed from the multiple attempts to probe his wound to remove that bullet.”

  Like most Americans, Annie had followed the sad story of how the president’s body had become riddled with infection over the seventy-nine days between the assassination attempt and his ultimate death. And she had personal experience with the ravages an internal infection could cause, as well. Soon after her first husband died, she had helped take care of one of his relatives, who was suffering a painful infection she had contracted in childbirth.

  Thinking of this experience, she said, “I hope that infection from the surgery was one of those risks mentioned in the document you had the Truscotts sign.”

  Dr. Brown said, decisively, “Yes, yes, in some detail. In fact, there had been some signs of infection immediately after surgery, which is not at all unusual. However, we were successful in combating the infection and only sent her home after she showed all the signs of a complete recovery.”

  “But the infection could return?” Annie asked.

  “Yes, unfortunately, it could. I personally told Mrs. Truscott that she should let us know immediately if she experienced any sort of abdominal pain or fever, because it’s not unknown for there to be a recurrence of infection up to as much as twelve months after this sort of surgery. It’s also possible Mrs. Truscott could be developing some new cysts. We didn’t see any problems with the right ovary, so we left it in. However, that doesn’t mean conditions haven’t changed since November when we operated. I don’t know why we weren’t alerted as soon as she began to have difficulties.”

  Annie really needed to have Nate go over the document the Truscotts had signed, make sure the dispensary really was covered, legally. She didn’t know if he had ever dealt with a malpractice suit, so she didn’t know how much work this would entail. When she had volunteered his services, she didn’t think he would need to do anything more complicated than write a letter to get someone to pay their bill.

  Annie asked, “Is it possible that Richard Truscott is in financial difficulty?”

  Dr. Brown shook her head slowly, saying, “I have trouble believing that’s what is happening. First of all, it was my impression that Phoebe Truscott is the one with the money, and it was my understanding that she was quite wealthy. The operation and aftercare were costly, but neither of them ever expressed any hesitation about the fees.”

  Dr. Brown got up and began to pace around the small office. “If she is indeed ill, why didn’t she notify us?”

  Annie said, “Sometimes a person’s finances aren’t exactly what they seem, so we do need to keep in mind that this might be a possibility. Perhaps Richard Truscott thinks if he threatens the dispensary he can get some money out of you or maybe free medical care for his wife in compensation? In the letter, Truscott doesn’t say he will take legal action but that he might have to take action. That sounds suspiciously like he wants something from y
ou in return for not going through with the threatened suit.”

  “Why would he feel he had to extort help from us? Even if for some reason they couldn’t pay for our services, we would still take care of her and find some way for them to pay the bills off over time. Wouldn’t be the first time we have made some financial accommodations for patients. And if Mrs. Truscott contacted Dr. Granger, the doctor who referred her to us, I can’t believe he wouldn’t have told me if he knew she was in difficulty. It’s so very strange.”

  Dr. Brown came and sat back down, again looking at the letter as if it held some explanation.

  “And this Dr. Granger hasn’t mentioned anything?” Annie said.

  “No. He is our chief consulting physician, and he was here checking on a patient just last week,” the doctor replied. “Oh, Mrs. Dawson, I really don’t know if I should still go tomorrow. Lucy Wanzer could make the trip without me.”

  “What exactly could you do if you stayed?” Annie said. “Seems to me if Mrs. Truscott is suffering from some sort of infection, whether caused by the operation you conducted here or not, she has probably turned to someone else for follow-up treatment, don’t you imagine?”

  “Yes, yes, you’re probably right. That does happen quite often when a patient is dissatisfied with how they are feeling—hoping that a different doctor will come up with a more effective cure. But we should at least make sure that whoever is treating her now has her full medical history,” Dr. Brown said.

  “Can’t Dr. Granger or your resident physician, Dr. Blair, handle that?” Annie said.

  “Oh, yes, either of them could.”

  “If by some chance Mrs. Truscott did want to come to the dispensary for treatment, would it be a problem that you are out of town?”