Critical (22 page)

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 confusing. 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.”

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.

With both her emotional and her rational brain in turmoil, Laurie bypassed her office for Jack's. She needed a little reassurance from having been abused by Bingham and the powerful and politically connected Angela Dawson. But Jack's desk chair was disappointingly empty.

“Where's Jack?” Laurie asked Chet, whose eyes were glued to his microscope. He hadn't heard her come in.

“He's out on one of his field trips,” Chet said, looking up from his work.

“Meaning?”

“You know Jack: The more controversy, the better! He posted a case where the three involved stakeholders are at each other's throats over the manner of death. It was a construction worker at a high-rise site who fell ten stories onto concrete.”

“I know the case,” Laurie said. “What's he up to?” As irritated as Laurie had made Bingham, she hoped Jack would be discreet, a virtue he often ignored.

“How should I know. He said something about reenacting the crime, but short of his jumping off the building himself, I have no idea what he meant.”

“When he comes back, tell him I was looking for him.”

“Will do,” Chet said agreeably