Crisis

10

The morning routine was as chaotic as it had been the previous morning, including another disagreement between Meghan and Christina over an article of apparel. Jack never knew what it was, but the tables had been turned. Now it was Meghan denying Christina, resulting in Christina rushing back upstairs in tears.

Alexis was the only one acting normally. It was as if she were the glue holding the family together. Craig was somnolent and spoke little, apparently still feeling the effects of his sleeping medication on top of his scotch.

After the kids had left for school, Alexis turned to Jack. "What do you want to do about transportation? Do you want to come with us or drive yourself?"

"I've got to drive myself. My first stop is the Langley-Peerson Funeral Home. I've got to get the signed papers over there to start the exhumation process." What he didn't say was that he hoped to get in a little basketball in the late afternoon.

"Then we'll see you in the courtroom?"

"That's my intention," Jack said, although he harbored a hope that Harold Langley could work miracles and get Patience Stanhope out of her eternal resting place that very morning. If that could happen, then Jack could do the autopsy, have the gross results by that afternoon, present them to Craig and Alexis, and be on the shuttle back to New York. That would give him Thursday to wrap things up in his office prior to the honeymoon that was to begin on Saturday morning. It would also give him the opportunity to pick up the tickets and hotel vouchers.

Jack left before Alexis and Craig. He got into his rent-a-car and headed for the Massachusetts Turnpike. He had assumed that having already visited the Langley-Peerson Funeral Home, it would be easy to find it again. Unfortunately, he was wrong. It took him almost forty minutes of highly aggravating driving to cover approximately five miles as the crow flew.

Muttering obscenities to himself over the stressful experience, Jack finally pulled into the funeral home's parking lot. It was more crowded that the previous day, forcing Jack to park at the very back. When he got around to the front of the building, there were people milling about on the porch. It was at that point that he guessed a service was about to get under way. His suspicions were confirmed when he entered the foyer. In the viewing room to the right, people were scurrying about, arranging flowers and unfolding additional chairs. On the catafalque was an open coffin with its occupant comfortably resting. The same pious soundtrack as the day before inundated the scene.

"Would you care to sign the book?" a man asked in a quiet, sympathetic voice. In many respects, he was a significantly heavier version of Harold Langley.

"I'm looking for the funeral director."

"I am the funeral director. Mr. Locke Peerson at your service."

Jack mentioned he was looking for Mr. Langley and was directed back to Harold's office. He found the man at his desk.

"The current Mr. Stanhope has signed the authorization," Jack said, wasting no time with small talk. He handed over the form. "Now it's a matter of utmost urgency to get the body back here to your embalming room."

"We have a service this morning," Harold said. "After that, I'll get on it."

"Do you see any chance of it happening today? We're really up against a strict deadline."

"Dr. Stapleton, do you not remember that the city, the vault company, a backhoe operator, and the cemetery are all involved in this endeavor? Under normal conditions, we're talking about a week at least."

"It cannot be a week," Jack said emphatically. "It's got to be today or tomorrow at the very latest." Jack shuddered at the implication of having to wait until Thursday and wondered what he could tell Laurie.

"That's an impossibility."

"Perhaps an extra five hundred dollars on top of your usual fee is in order to make up for the inconvenience." Jack watched Harold's expression. He had an almost parkinsonian lack of mobility and a pair of narrow lips that recalled Randolph 's.

"All I can say is that I will give the affair my utmost effort. There can be no promises."

"I can't ask for anything more," Jack said while giving Harold one of his business cards. "By the way, do you have any idea of what condition we can expect the body to be in?"

"Absolutely," Harold said emphatically. "The body should be in pristine condition. It was embalmed with our usual care, and the coffin is a top-of-the-line Perpetual Repose mated with a premier cement vault."

"What about the grave site: much water?"

"None. It's on the crest of the hill. The original Mr. Stanhope had picked it out himself for the family."

"Call me as soon as you know something."

"I most certainly will."

As Jack left the funeral home, the people on the porch had begun somberly filing in. Jack got into his car and consulted his map, which had been significantly upgraded by Alexis, who had laughed when she'd heard he'd been trying to navigate around the city with the rent-a-car map. Jack's next destination was back to the medical examiner's office. Thanks to significantly less traffic, Jack was able to make the journey in comparatively short time.

The receptionist remembered him. She told him that Dr. Wylie was definitely in the autopsy room on this occasion, and she took it upon herself without being asked to call down and talk with her. The result was that a mortuary tech came up to reception and escorted Jack down to the autopsy anteroom. Two men in mufti were milling about; one was African-American, the other Caucasian. The Caucasian was a big, red-faced Irishman. Everyone else was in Tyvek protective gear. Jack was to learn a few minutes later that the men were detectives interested in the case Latasha Wylie was doing.

Jack was given gear, and after suiting up he pushed into the room. Like the rest of the facility, the autopsy room was state-of-the-art and made the New York room look like an anachronism in comparison. There were five tables, three of which were in operation. Latasha's was the farthest away, and she waved for him to come over.

"I'm almost finished," Latasha said behind her plastic face mask. "I thought you might like to take a look."

"What do you have?" Jack asked. He was always interested.

"It's a fifty-nine-year-old female found dead in her bedroom after having been visited by a man she met on the Internet. The bedroom was in disarray suggesting a struggle, with the bedside table upended and the bedside lamp broken. The two detectives waiting out in the dressing area are thinking homicide. The woman had a gash on her forehead at her hairline."

Latasha pulled the woman's scalp down from where it had been reflected over the face to gain access to the brain.

Jack bent down to look at the laceration. It was round and punched in, as if delivered by a hammer.

Latasha went on to describe how she had been able to reconstruct what turned out to be an accident and not a homicide. The woman had slipped on a small throw rug on the polished wood flooring and had collided with the bedside table, hitting her forehead on the lamp's finial with the full force of her body weight. The case turned out to be an example of how important knowledge of the scene was. It seemed that the lamp's finial was a rather tall spire ending in a flat disc that resembled a hammerhead.

Jack was impressed and told Latasha so.

"All in a day's work," she said. "What can I do for you?"

"I want to take you up on your offer of autopsy supplies. It appears that it is a go, provided they can be expeditious getting the body out of the ground. I'm going to do it at the Langley-Peerson Funeral Home."

"If you end up doing it after hours, I'd be willing to help, and I could bring a bone saw."

"Really?" Jack questioned. He'd not expected such generosity. "I'd be happy to have your help."

"Sounds like a challenging case. Let me introduce you to our chief, Dr. Kevin Carson."

The chief, who was doing a case on table number one, turned out to be a tall, lanky, pleasant individual with a southern accent who mentioned he was on a first-name basis with Jack's chief, Dr. Harold Bingham. He said Latasha had told him about what Jack was trying to do, and he supported her offer to process specimens and help with toxicology if needed. He said they did not yet do their own toxicology but had access to a superb twenty-four-seven facility at the university.

"You tell Harold hello from Boston," Kevin said before going back to his case.

"I certainly will," Jack responded, although the man was already bent over the body in front of him. "And thanks for your assistance."

"He seems like a pleasant chief," Jack said as he and Latasha went out into the anteroom.

"He's very personable," Latasha agreed.

Fifteen minutes later, Jack stashed a box of autopsy supplies in the trunk of his Accent, moving his basketball gear out of the way in the process. He also slipped Latasha's card with cell phone number into his wallet before climbing in behind the steering wheel.

Although Alexis had suggested another parking facility near Faneuil Hall, Jack was content to return to the one beneath the Boston Common, since it was easier for him to find. He also enjoyed the walk skirting the Massachusetts State House.

Pushing into the courtroom, Jack tried to let the door close as silently as possible behind him. At that moment, the court clerk was swearing in a witness. Jack had heard the name; it was Dr. Herman Brown.

As he stood by the door, Jack's eyes scanned the room. He saw the backs of Craig's and Jordan's heads along with those of their attorneys and the attorneys' associates. The jury seemed as bored as they had the day before, while the judge appeared preoccupied.

He was shuffling papers, glancing at them, and reorganizing them as if he were alone in the room.

Jack's eyes scanned the spectators and immediately locked onto Franco's. From the distance, Franco's eye sockets appeared like featureless black holes beneath his Neanderthal-like brow.

Against his better judgment, Jack smiled and waved. He knew it was foolish, since he was taunting the man, but Jack was unable to stop himself. It was a re-emergence of the risk-taking mentality that he had glommed on to for a number of years as a juvenile coping mechanism for his guilt about surviving his family. Jack thought he saw the man tense, but he could not be certain. Franco continued to scowl at him for several beats longer but then shifted his gaze when his boss scraped his chair back from the plaintiff's table and headed toward the podium.

Berating himself for deliberately provoking the man, Jack thought about finding a hardware store and buying some pepper spray. If there was to be a second confrontation, Jack had no intention of trading blows again. Their difference in size made that an unfair exchange.

Jack returned to scanning the spectators. Once again, he was taken by the number. He wondered how many were the proverbial courtroom junkies, vicariously thrilled by people receiving their comeuppance, particularly the wealthy and powerful. As a successful doctor, Craig was fair game.

Finally, Jack found Alexis. She was sitting in the first row over against the wall, close to the jury box. Next to her seemed to be one of the few empty seats. Jack walked down to the bar, and then by excusing himself, he stepped into the aisle. Alexis saw him coming and moved her belongings to make room. Jack gave her shoulder a squeeze before sitting down.

"Any luck?" Alexis whispered.

"Progress, I hope, but it's now out of my hands. What's been happening here?"

"More of the same, I'm afraid. It was a slow start, since the judge had to deal with some arcane legal stuff. The first witness was Dr. Noelle Everette."

"That couldn't have been good."

"It wasn't. She came across as a superbly trained, thoughtful, and sensitive professional with the added benefit that she's from the community and was involved in the resuscitation attempt. Tony handled it well, I'm sorry to say. The way he questioned her and the way she answered kept the jurors' attention. I even saw the three homemakers nodding at one point – not a good sign. Her testimony was essentially the same as Dr. William Tardoff's, but to me more effective. She comes off like the doctor everyone wishes they had."

"How was Randolph on cross?"

"Not as effective as he was with Dr. Tardoff but, personally, I couldn't see how he could be, considering how well Dr. Everette came across. I had the feeling he just wanted to get her off the stand."

"That might have been the best stratagem," Jack said. "Did the issue of concierge medicine come up?"

"Oh, yeah. Randolph tried to object, but Judge Davidson is letting it all in."

"Did the issue of cyanosis come up?"

"No. Why do you ask?"

"It continues to be a nettle in my brain. It will be one of the prime things on my mind when and if I do the autopsy."

A sixth sense made Jack turn around and look across the room at Franco. The man was again glaring at Jack with an expression that hovered between a grimace and a cruel smile. On a positive note, from the angle in which Jack was looking, he could see that the left hand side of Franco's face was as red as Jack's. So far, things were apparently equal.

Settling back on the rock-hard oak pew, Jack directed his attention to the proceedings. Tony was at the podium, while Dr. Herman Brown was in the witness box. In front of the bench, the court reporter's fingers were playing incessantly on her small machine to create a verbatim record. Tony was having the witness testify to his impressive academic and clinical credentials, and it had been going on for a quarter of an hour. As chief of cardiology at the Boston Memorial Hospital, he also occupied the chair of the Department of Cardiology at Harvard Medical School.

Randolph had stood on several occasions and offered to stipulate as to the witness's qualifications as an expert to save the court's time, but Tony had persisted. He was trying to impress the jury, and it was working. It became increasingly apparent to everyone that it would be hard to find a witness more qualified in cardiology, or even equivalently qualified. The man's appearance and bearing added to his image. There was a Boston Brahmin aura that was similar to Randolph 's but without the hint of disdain and condescension. Instead of cold and distant, he appeared kind and gentle: the sort of person who would go out of his way to put a baby bird back into its nest. His hair was grandfatherly white and well groomed, his posture straight. His clothes were neat but not overly elegant, and they had a comfortable, lived-in look. He wore a paisley bow tie. There was even a hint of self-deprecation, as Tony had to work to get the man to admit reluctantly to his awards and accomplishments.

"Why is this medical Olympian testifying for the plaintiff in a malpractice trial?" Jack whispered to Alexis, but it was more of a rhetorical question, and he didn't expect an answer. He began to wonder if the reason had something to do with Noelle Everette's unexpected comment about concierge medicine when she had said, "Some of us old-fashioned physicians are angry about concierge doctors." Maybe Dr. Brown was one of that group because the concept of concierge medicine flew in the face of the new professionalism that academia was trying to espouse, and more than anyone else at the trial, Dr. Herman Brown was representing academia.

"Dr. Brown," Tony Fasano said, gripping the sides of the lectern with his short, thick fingers. "Before we get to Patience Stanhope's unfortunate and avoidable death -"

"Objection," Randolph said emphatically. "There has been no establishment that Mrs. Stanhope's death was avoidable."

"Sustained!" Judge Davidson declared. "Rephrase!"

"Before we get to Patience Stanhope's unfortunate death, I'd like to ask you if you've had previous contact with the defendant, Dr. Craig Bowman."

"I have."

"Can you explain the nature of your contact to the jury?"

"Objection, Your Honor," Randolph said with exasperation. "Immaterial. Or if it is material in some unfathomable way, then I object to Dr. Brown as an expert witness for bias."

"Counsels approach the bench, please," Judge Davidson said.

Tony and Randolph dutifully grouped at the side of the judge's bench.

"I'm going to be very upset if we have a repeat of Monday," Judge Davidson said. "You're both experienced lawyers. Behave as such! You both know the rules. As to the current line of questioning: Mr. Fasano! Am I to assume you have a relevant rationale for your current line of questioning?"

"Absolutely, Your Honor! The core of the plaintiff's case revolves about Dr. Bowman's attitude toward his patients in general and Patience Stanhope in particular. I call to the court's attention the deprecatory 'PP' classification. Dr. Brown has the ability to provide some insight into the development of these traits during Dr. Bowman's critical third year in medical school and during his residency training. Subsequent testimony will relate them directly to the case of Patience Stanhope."

"Okay, I will allow this line of questioning," Judge Davidson said. "But I want it related quickly to establish its relevance. Am I clear about that?"

"Perfectly clear, Your Honor," Tony said, unable to suppress a slight smile of satisfaction.

"Don't look so goddamned pained," Judge Davidson said to Randolph. "Your objection has been recorded. My judgment, provided Mr. Fasano is being totally honest about relevancy, is that the probative value will outweigh the prejudicial. I admit it is a judgment call, but that's why I'm here. In return I will grant the defense wide leniency on cross-examination. As for the question of bias, there's been ample opportunity to determine that during discovery, and it wasn't. But the issue can be examined on cross.

"And I want the pace to pick up," Judge Davidson said. "I've allocated this week for this trial, and here it is Wednesday already. For the sake of the jurors and my schedule, I want it to conclude on Friday unless there are some particularly extenuating circumstances."

Both lawyers nodded. Randolph repaired to his seat at the defense table while Tony returned to the podium.

"Objection overruled," Judge Davidson called out. "Proceed."

"Dr. Brown," Tony said after clearing his throat. "Would you tell the jury the nature of your contact with Dr. Craig Bowman?"

"My first contact was as his preceptor at Boston Memorial Hospital on his internal-medicine rotation during his third year of medical school."

"Could you explain what this means, since no one in this wonderful jury went to medical school?" Tony made a sweeping gesture down the line of jurors, some of whom nodded in agreement. Everyone was paying rapt attention, except for the plumber's assistant, who was focusing on his nails.

"Internal medicine is the most important rotation and the most demanding during the third year, and perhaps for the entire four years. It is the first time the students have prolonged contact with the patients from the patient's admission to their discharge, and they participate in the diagnosis and therapy under strict observation and supervision by the resident house staff and by the preceptor."

"Was this preceptor group that included Dr. Bowman a large group or a small group?"

"A small group: six students, to be exact. The teaching is intense."

"So you as the preceptor see the students on a regular basis."

"Every day."

"So you can observe the overall performance of each student."

"Very much so. It is a critical time in the student's life, and it marks the beginning of the individual's transformation from a student to a physician."

"So that attitudes that are observed or develop are important."

"Exceedingly so."

"And how do you rate your responsibility as a preceptor vis-a-vis attitudes?"

"Again, exceedingly important. As a preceptor, we have to balance the explicit attitudes toward patients as promulgated by the medical school versus the implicit attitudes often exhibited by the overworked and -stressed house staff."

"There's a difference?" Tony questioned with exaggerated disbelief. "Can you explain the difference?"

"The amount of knowledge medical trainees must assimilate and have immediate recall of is staggering and increasing every year. As pressed as residents are, they can sometimes lose sight of the ultimate humanistic aspects of what they are doing and which form the basis of professionalism. There are also defensive coping mechanisms in the face of suffering, dying, and death that are not healthy."

Tony shook his head in bewilderment. "Let me ask you if I have this correct. In simplified terms, there can be a tendency on the part of medical trainees to devalue individual people, like losing sight of the trees by paying too much attention to the forest."

"I suppose," Dr. Brown said. "But it is important not to trivialize this issue."

"We'll all try," Tony said with a short chuckle, which brought a few tentative smiles from the jurors. "Now, let's get back to the defendant, Dr. Craig Bowman. How did he do during his rotation in third-year internal medicine?"

"Generally excellent. In the group of six students, he was far and away the most knowledgeable and the most prepared. I was often astonished at his recall. I remember one episode of asking what a patient's BUN was."

"The BUN is a laboratory test?" Tony asked.

"Yes. I asked it more as a rhetorical question, to emphasize that knowledge of kidney function was key in the treatment of the patient's condition. Dr. Bowman rattled if off without hesitation, making me wonder if he had made it up, a frequent medical student ploy to cover unpreparedness. Later, I looked it up. It was exactly right."

"So Dr. Bowman got a good grade for the course."

"He got an A."

"Yet you qualified excellent by saying 'generally excellent.'"

"I did."

"Can you tell us why?"

"I had a nagging feeling, which I again got while supervising Dr. Bowman when he was a resident at the Boston Memorial Hospital."

"And what was this feeling?"

"I had the impression that his personality -"

"Objection!" Randolph called out. "Foundation: The witness is neither a psychiatrist or psychologist."

"Overruled," Judge Davidson said. "As a physician, the witness has had exposure to those fields, the amount of which can be challenged on cross. The witness may proceed."

"It was my impression that Dr. Bowman's desire to succeed and his lionization of our then chief resident made him view patients as a means to compete. He actively sought out the most difficult patients so his presentations were intellectually the most interesting and achieved the widest acclaim."

"In other words, it was your impression Dr. Bowman saw patients as a way to further his career?"

"Essentially, yes."

"And that kind of attitude is not consistent with the current concept of professionalism?"

"That's correct."

"Thank you, doctor," Tony said. He paused and looked from one juror to another, making eye contact with each, allowing the testimony to sink in.

Jack leaned over toward Alexis and whispered, "Now I understand what you said about Tony Fasano; this guy is good. Now he's putting academic medicine and its inherent competitiveness on trial along with concierge medicine."

"What's bothering me is that he's changing Craig's successes into a liability in anticipation of Randolph trying to do the opposite."

When Tony recommenced his questioning, he zeroed in on the Patience Stanhope episode with a vengeance. In short order, he got Dr. Brown to testify how important it was to begin treatment for victims of a heart attack absolutely as soon as possible and that from reviewing the records that Patience's chances of survival had substantially diminished due to Craig's delay in confirming the diagnosis.

"Just a few more questions, Dr. Brown," Tony said. "Are you acquainted with Dr. William Tardoff?"

"Yes, I am."

"Are you aware he trained at Boston University?"

"I am."

"And likewise are you acquainted with Dr. Noelle Everette, and are you aware that she trained at Tufts?"

"I am, on both accounts."

"Does it surprise you that three cardiology experts from our area's three prestigious medical schools all concur that Dr. Craig Bowman did not meet the standard of care in relation to Patience Stanhope?"

"It does not. It merely shows unanimity on the issue of the need for rapid treatment of heart attack victims."

"Thank you, doctor. No more questions." Tony picked up his papers from the lectern and walked back to the plaintiff's table. Both his assistant and Jordan acknowledged his performance with pats on the arm.

Randolph slowly stood to his commanding height and approached the podium. He adjusted his jacket and put one of his heavy, thick-soled, wingtip lawyer shoes on the rail.

"Dr. Brown," Randolph began, "I agree that there is unanimity on the need of treating heart attack victims as soon as possible in an appropriately equipped facility. However, that is not the issue before the court. The issue involves whether or not Dr. Bowman met the standard of care."

"Insisting on going to the Stanhope residence rather than meeting the victim at the hospital caused a delay."

"But prior to Dr. Bowman's arrival at the Stanhope residence, there was not a definitive diagnosis."

"According to the plaintiff's testimony at deposition, Dr. Bowman told him his wife was having a heart attack."

"That was the plaintiff's testimony," Randolph said, "but it was the defendant's testimony that he specifically said a heart attack must be ruled out. He did not categorically say Patience Stanhope was having what you doctors call a myocardial infarction, or MI. If there had not been a heart attack, there would not have been a delay. Is that not true?"

"That is true, but she had a heart attack. That's been documented. It was also in the record she had a questionable stress test."

"But my point is that Dr. Bowman did not know for certain Patience had had an MI," Randolph said. "And he will testify to that in this court. But let us turn our attention to your earlier testimony about medical school. Let me ask you if you got an A in your third-year rotation on internal medicine?"

"I did."

"Did all your fellow students in your preceptor group get As?"

"No, they did not."

"Did they all want to get As?"

"I suppose."

"How do you get into medical school? Must you routinely get A's in your premedical curriculum?"

"Of course."

"And how do you get the most coveted residencies, like at the Boston Memorial Hospital?"

"By getting A's."

"Is it not hypocritical for academicians to decry competition as anti-humanistic and yet base the whole system upon it?"

"They do not have to be mutually exclusive."

"Perhaps in the best of worlds, but reality is something different. Competition does not breed compassion in any field. As you eloquently testified, medical students must absorb a staggering amount of information, which is what they are graded on. And one further question in this regard. In your experience both as a student and as a preceptor, is there competition for the, quote, 'most interesting patients' rather than the routine degenerative afflictions?"

"I guess there is."

"And that's because their presentations gather the most acclaim."

"I suppose.

"Which suggests that all of the students, but particularly the top students, to a degree use the patients both to learn from and advance their careers."

"Perhaps."

"Thank you, doctor," Randolph said. "Now, let's turn to the issue of medical house calls. What is your professional impression of house calls?"

"They are of limited value. One doesn't have access to the tools that are necessary to practice twenty-first-century medicine."

"So doctors generally are not in favor of house calls. Would you agree?"

"I would. Besides the lack of equipment, it represents an inappropriate utilization of resources, since there is too much downtime traveling to and from the home. In the same time frame, many more patients could be seen."

"So it is inefficient."

"Yes, you could say that."

"What is the opinion of patients about house calls?"

"Objection!" Tony called out, semi-rising from his chair.

"Hearsay."

Judge Davidson snapped off his reading glasses and glared down at Tony with irritable disbelief.

"Overruled!" he snapped. "As a patient, which we all are at some point, Dr. Brown would be talking from experience. Proceed."

"Would you like me to repeat my question?" Randolph asked.

"No," Dr. Brown said. He hesitated. "Patients generally like house calls."

"How do you think Patience Stanhope felt about house calls?"

"Objection!" Tony said, rising again. "Supposition. There's no way the witness would know how the deceased felt about house calls."

"Sustained," Judge Davidson said with a sigh.

"I assume you read the medical records supplied to the plaintiff."

"Yes, I read them."

"So you are aware that Dr. Bowman made many house calls to tend to Patience Stanhope prior to the evening in question, often in the middle of the night. From reading these records, what was the usual diagnosis on these visits?"

"Anxiety reaction manifesting itself mostly in gastrointestinal complaints."

"And the treatment?"

"Symptomatic and placebo."

"Was pain ever involved?"

"Yes."

"Where was the pain?"

"Mostly low abdominal but occasionally midepigastric."

"Pain in the latter location is occasionally reported as chest pain. Is that correct?"

"Yes, that's correct."

"From your reading of the record, would you say that Patience Stanhope exhibited at least some evidence of hypochondriasis?"

"Objection!" Tony called out but stayed in his chair. "Hypochondriasis is never mentioned in the record."

"Overruled," Judge Davidson said. "The court would like to remind the plaintiff's attorney that the witness is his medical expert."

"From reading the record, I believe it would be a safe assumption that some element of hypochondriasis was involved."

"Does the fact that Dr. Bowman made repeated house calls, which you have said most doctors do not favor, often in the mid-die of the night to a woman with avowed hypochondriasis, say something to you as a physician about Dr. Bowman's attitude and compassion for his patients?"

"No, it does not."

Randolph stiffened with surprise, and his eyebrows rose. "Your response defies rationality. Can you explain?"

"It is my understanding that house calls are one of the perquisites that patients expect when they pay high retainer fees, sometimes as high as twenty thousand dollars a year, to be part of a concierge medical practice. Under such a circumstance, one cannot say Dr. Bowman's making house calls necessarily reflects beneficence or altruism."

"But it might."

"Yes, it might."

"Tell me, Dr. Brown, are you biased against concierge medicine?"

"Of course I'm biased against concierge medicine," Dr. Brown sputtered. Up until that moment, he had maintained a detached coolness, not too dissimilar to Randolph 's. It was clear that Randolph 's questions had challenged him.

"Can you tell the court why you feel so strongly?"

Dr. Brown took a breath to calm himself. "Concierge medicine flies in the face of one of the three basic principles of medical professionalism."

"Perhaps you could elaborate."

"Of course," Dr. Brown said, lapsing into his familiar professional role. "Besides patient welfare and patient autonomy, the principle of social justice is a key underpinning of twenty-first-century medical professionalism. The practice of concierge medicine is the absolute opposite of trying to eliminate discrimination in health care, which is the key issue of social justice."

"Do you believe that your strong feelings in this regard might compromise your ability to be impartial concerning Dr. Bowman?"

"I do not."

"Perhaps you could tell us why since, to use your words, it 'flies in the face' of rationality."

"As a well-informed internist, Dr. Bowman knows that the symptoms women experience with myocardial infarction do not follow the classic symptoms experienced by men. As soon as an internist thinks about a heart attack in a female, particularly a postmenopausal female, he should act as if it were a heart attack until proven otherwise. There's a parallel in pediatrics: If the thought of meningitis occurs to a physician with a pediatric patient, the physician is obligated to proceed as if it is and do a spinal tap. Same with a female and a possible heart attack. Dr. Bowman suspected a heart attack, and he should have acted accordingly."

"Dr. Brown," Randolph said. "It is often said that medicine is more of an art than a science. Can you tell us what that means?"

"It means that factual information is not enough. A doctor must use his judgment as well, and since this is not an objective arena that can be studied, it is labeled an art."

"So scientific medical knowledge has its limits."

"Exactly. No two humans are exactly the same, even identical twins."

"Would you say that the situation Dr. Bowman faced on the evening of September eighth, 2005, when he was called to see for the second time in the same day a woman whom he knew was hypochondriacal called for a large measure of judgment?"

"All medical situations call for judgment."

"I'm asking specifically about the evening in question."

"Yes. It would have called for a large measure of judgment."

"Thank you, doctor," Randolph said, gathering up his notes. "No more questions."

"The witness may be excused," Judge Davidson said. Then, turning to the jurors, he added, "It is nearing the noon hour, and it looks to me as if you could all use some sustenance. I know I could. Remember not to discuss the case with anyone or among yourselves." He cracked the gavel. "Court's adjourned until one thirty."

"All rise," the court officer called out as the judge stepped down from the bench and disappeared into his chambers.