Foreign Body

Chapter 6

October 16, 2007

Tuesday 6:30 a.m.

New Delhi, India

Cal Morgan was a deep sleeper and needed a powerful alarm to wake up. What he employed was a clock radio with a CD player, and the CD he used was martial music. At three-quarter volume the player was capable of vibrating the night table enough to move itself and other objects on its crowded surface. Even Petra in the neighboring master suite could hear it as if it were in her room. So when it sounded, Cal made an effort to turn it off the moment he became adequately conscious. Even so, he occasionally fell back into deep sleep.

But that was not going to happen this morning. He was much too keyed up about the previous night’s activities for more sleep. He stared up at the high ceiling and thought about what had transpired the evening before.

What bothered him was how close Veena’s suicide attempt had come to bringing his whole project down. If he hadn’t gone in to check on her when he did, she would have died, and there was little doubt that her death would have resulted in an inquest, and an inquest would have been a disaster. It would certainly have closed Nurses International, and in the process, at the very least, slowed his progress toward his ultimate goal of becoming truly wealthy as the CEO of SuperiorCare Hospital Corporation.

Cal hadn’t been interested in healthcare initially, and he still wasn’t interested in taking care of patients or nurses, for that matter. He just liked the money involved, two trillion per year in the United States alone, and the field’s record of sustained growth. Back when he was in high school, advertising had been his first career choice, and he had gone through UCLA and the Rhode Island School of Design in preparation. But briefly working in the field caused him to recognize its limitations, especially financially. Giving up on advertising, but not its principles of deception, he sailed through Harvard Business School, where he was introduced to the mind-boggling money involved in healthcare. When he finished business school he sought and got an entry-level job at the SuperiorCare Hospital Corporation, which was one of the biggest players in the field. The company owned hospitals, feeder clinics, and healthcare plans in almost every state and major city in the United States.

To best utilize his creative bent, Cal entered the company via the public relations department, where he saw the best opportunity to make a name for himself and thereby attract the attention of the company’s officers. On his first day he boasted he would lead the company in ten years, and after two it appeared as if his prophecy might have merit. Along with a striking woman five years his senior and an inch taller than his six feet named Petra Danderoff, who’d been part of PR when he joined, he found himself co-running the entire department thanks to a series of extremely successful ad campaigns the two had contrived that had nearly doubled the enrollment in several of the company’s healthcare plans.

Some people had been surprised at his meteoric rise, but not Cal. He was accustomed to success from an early age, partly as a self-fulfilling prophecy of the confidence and competitiveness that was part of his genetic makeup, and which had been honed to an obsession by his equally competitive father. From early childhood he’d wanted to win at everything, especially in competition with his two older brothers. From board games like Monopoly to school grades, from athletics to the presents he gave his parents at Christmas, Cal insisted on being number one with a kind of single-mindedness few could match. And success only reinforced his appetite for more success, to the extent that over the years he lost all vestiges of the need for moral principles. In his mind cheating, which he didn’t refer to as such, and ignoring ethics, which he considered mere limitations for the faint of heart, were simply tools to advance one’s agenda.

SuperiorCare Hospital Corporation officers were not aware of these details of Cal’s background and personality. But they were very aware of his contributions to the company and were eager to reward him, particularly the CEO, Raymond Housman. By coincidence this recognition had materialized more or less at the same time a mounting financial problem had been brought to the CEO’s attention by his CFO, Clyde English. To their collective horror, accounting had determined that the company had lost, in 2006, about twenty-seven million dollars from its bottom line because India’s growing medical tourism industry had caused a disturbing number of American patients to shun SuperiorCare hospitals and wing off to the Asian subcontinent for their surgeries.

Linking the two issues, Raymond Housman had invited Cal to a secret meeting in his office. He’d explained the medical tourism issue and the need to somehow turn it around. He’d then offered Cal an unparalleled opportunity. He said SuperiorCare was looking to lavishly fund through a secretive bank in Lugano, Switzerland, a company with the express purpose of seriously diminishing demand for patients to go to India for surgery, if he would agree to form it. Raymond was very clear that SuperiorCare Hospital Corporation wanted no ostensible connection with such a company and would strenuously deny there was a connection if asked, nor did they want to know how the company accomplished its goal. What Raymond didn’t say but what Cal definitely heard was that his termination at SuperiorCare Hospital Corporation was temporary and that his success in the current venture would be a cause for him to be welcomed back into the corporate fold with open arms at an extremely high level, essentially leapfrogging the corporate ladder.

Despite having no idea how he was going to engineer the new company’s objective, Cal had accepted immediately with the proviso that Petra Danderoff, then his co-director of the public relations department, would be included in the deal. At first Housman had balked with no one to run SuperiorCare’s PR, but after being reminded of the seriousness of the medical tourism problem, he relented.

Two weeks later, Cal and Petra were back in Cal’s hometown of Los Angeles, brainstorming their company-to-be’s modus operandi. To help, each had hired a gifted friend: Cal had chosen Durell Williams, an African-American whom he had befriended at UCLA and who had gone on to specialize in computer security; and Petra had asked Santana Ramos, a Ph.D. in psychology who had joined CNN after she’d worked in private practice for a half-dozen years.

Most important, all four people were equally competitive, equally dismissive of ethics as a limiting weakness, and equally convinced that their current challenge of curtailing medical tourism for a Fortune 500 company was an opportunity of a lifetime, and each vowed that they would do whatever it took to denigrate medical tourism. Quite expeditiously, the group had settled on a company plan of promoting patients’ fears as the best way to lower demand. Until patients were subjected to propaganda to the contrary, everyone facing surgery had strong reflex reservations about going to India or another developing country for an easily understandable complex of reasons. First was the concern of the country’s general lack of cleanliness, raising the specter of wound infection and catching any one of a number of dreaded infectious diseases. Next there was an obvious question of the skill of the surgeons and the other personnel, including nurses. In addition, there was the question of the quality of the hospitals and whether the necessary high-tech equipment was available. And finally there was the question of whether the operations that were performed were generally successful.

When the group looked into the propaganda the India Tourist Office was actively putting out, they discovered the office was clearly addressing these specific issues. Consequently, it was decided that Cal’s new company would create ad campaigns to do the opposite and take advantage of people’s fears. Everyone was certain this plan would be successful, since ad campaigns are always easier when the goal is the support of people’s existing beliefs and prejudices.

Unfortunately, no sooner had they settled on a strategy and begun trading ideas when they ran into a serious problem. They had realized that with India spending serious money and effort promoting their medical tourism, the Indian government would surely investigate if someone started doing the opposite, and an investigation of any sort would invariably cause significant problems if ad campaign claims could not be substantiated.

What had been quickly recognized was that real data were needed involving private Indian hospitals, particularly in relation to outcomes, mortality, and complications, which included such statistics as infection rates. Yet the data were not available. The group had checked the Internet, medical journals, and even the Indian health ministry, which they soon discovered was dead set against releasing any such information, even refusing to admit if it existed. In their own ads they used no data whatsoever, merely claiming their outcomes were as good as or better than outcomes in the West.

Stymied for a time, the group had suddenly realized they needed a fifth column inside the private Indian hospitals participating in the highly profitable and growing medical tourism industry. What would have been best were accountants, but the efficacy of that idea seemed questionable at best. Instead, they had hit on the idea of using nurses, mainly because Santana knew something the others didn’t — namely, that there existed a worldwide business in nurses. In the West there was a shortage. In the East, particularly in the Philippines and India, there was a surplus, with many young nurses desperately wanting to emigrate to the United States for economic and cultural reasons but facing significant, almost insurmountable, hurdles.

After extensive research and much discussion, Cal et al. had decided to go into the nurse business by founding a company called Nurses International. Their plan, as was accomplished, was to hire a dozen young and vulnerable, attractive, impressionable, newly graduated Indian nurses, pay them U.S. nurses’ wages, and bring them to the States on tourist visas, specifically to California, for a monthlong training session with the idea of turning them into a team of beholden and therefore easily manipulated spies. In California they had been purposefully spoiled to maximize their manipulability and to take advantage of their wish to emigrate. At the same time, they had been trained in computers during the morning hours, particularly in regard to computer-hacking techniques. In the afternoons they had worked for a few hours as nurses in a SuperiorCare hospital to improve their American English as well as acquaint them with American patient expectations, both of which, it had been assumed, would make it easier to hire them out to private Indian hospitals.

Everything had gone miraculously according to plan, with teams of two nurses currently in six private Indian medical tourism hospitals. For housing, all had been required to live together in a mansion rented by Nurses International in the diplomatic area of New Delhi, to the initial chagrin of the nurses’ families. Since the money the nurses were providing continued, however, family complaints vanished.

After they had been working for a week, with all of them complaining they wanted to go back to California sooner than the six months they were required to remain in India, they had been instructed to begin extracting patient-outcome data from the computers in their respective hospitals. The goal was to be able to begin to calculate infection rates, adverse outcome rates, and death rates for their future ad campaigns. To Cal and the others’ surprise, none of the nurses questioned this activity, and they were wonderfully successful. But then disaster had struck. Something had happened that no one had anticipated. The stats had turned out to be quite good, even strikingly excellent in several of the institutions.

For a few days Cal and Petra had been depressed and unsure of what to do. After all the money they’d gone through to set up the elaborate spy system, they had begun to feel pressure for results. Raymond Housman had even sent a secret representative a week earlier for an update on when they could expect something to happen. It seemed that the bottom-line losses from medical tourism were continuing, and ticking upward at an alarming rate. Cal had promised results would soon be forthcoming, since at the time of the envoy’s visit, the outcome data were just beginning to flow in.

But then, by tapping into his creativity and urge to win, Cal had come up with a second idea. If there were no bad statistics to be found for the basis of a negative ad campaign, why not create their own bad-outcome, hard-luck stories with the help of their installed fifth column and feed the stories to the media in real time. With the unsuspecting help of an anesthesiologist and pathologist whom he’d gotten to know in Charlotte, North Carolina, while he’d worked at SuperiorCare’s corporate office, Cal had settled on succinylcholine as his drug of choice to cause sudden death. The idea was to find patients who’d had a history of some sort of heart disease and who’d had succinylcholine as part of their anesthesia, and inject them with an additional bolus of the muscle-paralyzing drug the evening following their operations. Cal had been assured the drug would be undetectable, and if it was detected, it would be assumed to be from the patient’s anesthesia. Best of all, there’d be an immediate diagnosis of a fatal heart attack because of the cardiac history.

As soon as Cal and Petra had polished the scheme, they presented it to Durell and Santana. Although Durell had taken the plan in stride, Santana had initially been hesitant. For her, stealing privileged data was one thing, but killing people was something else entirely. Still, she had eventually given in, partly as a function of the others’ enthusiasm; partly because of everyone’s commitment to success, including her own; partly because she’d become convinced the scheme could not be discovered; and partly because there was going to be a limited number of victims; but mostly because she and the others believed it to be the only way to salvage Nurses International, which, as it turned out, they were all counting on to be a key step in their careers and in obtaining the wealth they thought they deserved. A lesser reason for her change of heart was the intense study of Hinduism she’d undertaken since she’d arrived in the country. She’d found herself attracted intellectually to the concept of punarjamma, or the Hindu belief in rebirth, meaning death was not the end but merely the door to a new life, and a better one if the individual had adhered to his dharmic responsibilities. And finally was the fact that she, along with the others, had vowed to do whatever it took to denigrate medical tourism.

Once the new strategy had been accepted, the problem had then switched to the nurses’ reactions and the question of their cooperation. Although the group had become so acculturated to American culture from their month in Los Angeles, so addicted to the money they were being paid for the benefit of their families, and were so looking forward to emigrating that they would most likely do whatever was asked of them, Cal, Petra, and Durell were unsure. Santana, on the other hand, thought the nurses would have no problem, as they would be aided by their belief in samsara and particularly their belief in the importance of the organization and the group over the individual. Santana had then said the key was Veena and getting her to accept that it was her dharma to “put to sleep” an American patient. The idea was that if she was willing to do it, as the de facto leader, the rest would unquestioningly follow suit.

But Veena’s cooperation was not a given. While everyone agreed she was the most committed to the team and the most desirous of emigrating, everyone had sensed a disconnect of her obvious keen intelligence, her inborn leadership ability, and her exceptional beauty, with her equally apparent poor self-image and lack of self-esteem. With such a thought in mind, Santana had gone on to explain it was her professional opinion that Veena was burdened with serious psychological baggage of some sort on top of a strongly ingrained attachment to traditional Indian culture and religiosity. She also had suggested that learning the issue and offering to help her with it, whatever it was, might be key in obtaining Veena’s cooperation.

At that point all had looked to Durell. It was common knowledge he was intimate with one of the nurses, Samira Patel. Although this affair had been looked upon with disapproval by Petra and Santana, suddenly it became useful. Since Samira had been Veena’s roommate as well as her best friend, they believed that if Veena had confided in anyone, it would have been Samira. Consequently Durell had been tasked to find out, which he did by convincing Samira that Nurses International needed to help Veena, and if they weren’t able to do so out of ignorance of what was troubling her, the whole program, including helping the nurses to emigrate to the United States, would be in peril.

Samira clearly believed every word and, despite having been sworn to secrecy, related Veena’s painful family history. Armed with this information, Cal had approached Veena the previous afternoon with his offer to stop the abuse once and for all in return for her cooperation and leadership in regard to the new strategy. Veena had initially demurred but then had changed her mind, because of the promise of eliminating the threats to her sisters and mother. That had always been the biggest concern standing in the way of her being able to emigrate.

Cal Morgan Sighed. Having rehashed this history, he realized the whole program of discouraging Americans to come to India for surgery had hardly been the walk in the park that he’d initially assumed it would be. He shook his head and wondered what else was going to happen. Recognizing there was no way to anticipate the unexpected, he decided he needed an exit strategy. If worse came to worse, he needed to have a plan and resources to get out of India, at least for himself and the other three principals. He promised himself he’d bring it up that morning at the eight-o’clock meeting he’d scheduled.

Rolling over, Cal looked at the face of his alarm clock. At six-forty-five it was time to get up if he wanted to get in a run before breakfast, and he could check on Veena to make sure she was up and planning to go to work. Although the doctors had cleaned her out the night before in the emergency department and thought she’d absorbed a minimum of the Ambien because of Cal’s rapid efforts, he had to be certain. Her not showing up for work the very next day after Mrs. Hernandez’s passing might attract some attention if there was any reason for someone to doubt the patient’s death was natural. There was also the concern that Veena had been noticed at the hospital well after her shift had been over.

With his jogging gear on, Cal headed in the direction of the guest wing. Rounding the last turn, he saw Veena’s door was ajar, which he thought encouraging. Once at the entrance he knocked on the jamb, said hello, and leaned into the room all at the same time. Veena was sitting on her bed in a robe. Except for the slight reddish color of the whites of her eyes, she appeared normal and as gorgeous as ever. She wasn’t alone. Santana was sitting on Samira’s bed opposite Veena.

“I’m glad to say the patient feels fine,” Santana said. Santana was five years Cal’s senior. Like Cal, she was dressed in a jogging outfit, but unlike Cal’s, the outfit was stylish, with black, shiny, skintight pants and an equally tight, black short-sleeved shirt made of synthetic fabric. Her dark, thick hair was in a ponytail pinned up against the back of her head.

“Terrific!” Cal said, and meant it. “You are going to work, I presume?” he asked Veena.

“Of course,” Veena said. The voice reflected the mildly drugged feeling she was experiencing.

“We’ve been talking about what happened last night,” Santana said forthrightly.

“Terrific,” Cal repeated, but without the same enthusiasm. He couldn’t help but feel reluctant discussing an issue he’d be uncomfortable talking about if he’d been the one involved.

“She has assured me that she will not try it again.”

“That’s nice,” Cal responded, while thinking She’d damn well better not.

“She said she did it because she felt the gods would look kindly on her: sorta a life for a life. But now, because the gods saved her, she feels they want her to stay alive. In actuality, she believes the whole episode is her karma.”

Like hell they saved her, Cal thought but didn’t vocalize. In its place, he said, “I couldn’t be happier, because we certainly need her.” Cal studied Veena’s face and wondered if she’d told Santana about the aggressive lovemaking episode or about the patient’s disturbing agonal death throes, but her face appeared as inscrutably serene as usual. When Cal had spoken with the other principals the night before after returning from the ER, he hadn’t mentioned it either — exactly why, he didn’t know. His best guess was that he was embarrassed at having been so clearly taken advantage of by Veena’s sexual aggression. Cal was accustomed to manipulating women, not vice versa. In regard to the kind of death the succinylcholine had apparently caused, which was far different from the peaceful paralysis that had been described to him and he’d relayed to the others, he was afraid any discussion might dampen general enthusiasm for the scheme.

Cal had then excused himself and left, despite being mildly concerned the women might take the opportunity to discuss him. But he didn’t worry about it for long. Exiting the bungalow and running out through the front gate, he began his jog. Chanakyapuri was one of the few areas of the city other than the coastal ridge reserved forest where running was enjoyable. Unfortunately, he was later than usual, and the traffic was already heavy and increasing with every passing minute. The dust and pollution were already almost to midday levels. In response, he exited the main road in favor of backstreets. There the air was better, but not far from the clogged main road he ran into a large group of monkeys, which always scared him. Delhi monkeys were remarkably bold, at least from Cal’s experience. It wasn’t that he thought they would attack him en masse, but more because he worried they carried some exotic diseases that he might catch, especially if one bit him. That morning, as if sensing this unease, the animals chased after him, baring their yellow teeth, chattering, and screeching as if they were crazed.

Deciding that monkeys and pollution were more than enough reason to consider the jog that morning a bust, Cal abruptly switched directions, causing the monkeys to flee in panic. Like a horse intent on returning to the barn, Cal rapidly retraced his route back to the mansion. After being outside for less than a half-hour, he was happy to be inside and particularly happy to step into his shower. While he lathered and shaved, and despite the disappointing jogging experience, he thought of the morning in a positive light. The short conversation with Santana had significantly relieved a concern about Veena. The suicide gesture had scared him, and until Santana’s reassurance to the contrary, he’d been worried she might try it again. Now he was confident that wouldn’t happen, and by involving the concept of karma, Veena apparently now thought of what she’d done to Mrs. Hernandez as part of her fate, which boded well for the cooperation of the other nurses.

After enjoying a breakfast of ham and eggs prepared by the bungalow’s chef, Cal headed toward the glass-enclosed conservatory at the back of the house. When they had moved into the house, the room had only chairs, but they had added a round table and used the space as their morning conference room.

When Cal walked in, the other three were already seated and their lively conversation trailed off. Cal took his usual chair, facing directly out into the garden with his back to the mansion’s interior. The others had taken their usual chairs as well, suggesting all four to be creatures of habit. Santana was to Cal’s right, Petra to his left, and Durell directly across. Each of their postures reflected to a degree their personality. With quiet confidence, Durell was slouching, cradling his chin in his hand with his elbow on the arm of the chair. He was a powerful-appearing, heavily muscled man with mahogany-colored skin and a dark pencil-line goatee and mustache. Petra was sitting bolt upright on the edge of her chair as if in grammar school with the need to impress the teacher with the degree of her attention. She was a remarkably tall, handsome woman, high-colored and high-spirited. Santana was sitting back comfortably in her chair with her hands folded in her lap like the professional psychologist she was, waiting for the patient to begin speaking. She always appeared calm, with her emotions under strict control.

Cal opened the meeting with Veena’s suicide attempt to be certain everyone was well informed. He had Santana relate what she had learned that morning when talking with Veena, particularly about Veena insisting she would not try it again and why. Cal admitted the episode had frightened him to the point he believed they needed a rapid exit strategy in place in case it was needed. “If she had succeeded in killing herself,” Cal continued, “there would have been an investigation and an inquest, and any sort of investigation would have spelled big trouble for Nurses International.”

“What exactly do you mean by exit strategy?” Petra questioned.

“Exactly what the phrase implies,” Cal said. “I’m not talking about something philosophical here. I’m talking literally. In a worst-case scenario, such that if we have to get out of India at a moment’s notice, all the details should be prearranged. There shouldn’t be any need for improvisation, for there might not be time.”

Petra and Santana nodded in agreement. Durell merely raised his eyebrows questioningly. “By land, sea, or air?” he asked.

“I’m open to suggestions,” Cal responded. He looked at each in turn, settling on Petra, who was a stickler for this kind of detail.

“By air would be too difficult,” she said. “Passport control at Gandhi International is too experienced. We’d have to pay off too many people, since we wouldn’t know what time of day it might end up being. If we were trying to secretly escape, it would have to be by land.”

“I agree,” Durell said. He leaned forward, elbows on the table, hands working at each other. “I think we should plan to go northeast with a car or SUV that we buy expressly for this purpose and keep it gassed, packed with necessities, and ready to go. We could plan to cross the border into Nepal at a place we decide beforehand that is the best, although there really isn’t a lot of choice. And finally, we should also put in the car an appropriate amount of cash for bribes. That’s key.”

“You mean buy a vehicle, prepare it, and then keep it out of sight?” Cal asked.

“Exactly,” Durell responded. “Start it up once in a while but put it into that big garage on the grounds and leave it there.”

Cal shrugged. He looked at each woman in turn to sense their reactions. No one spoke. Cal turned back to Durell. “Can I put you in charge of arranging what you are suggesting?”

“No problem,” Durell said.

“Now let’s turn to our new strategy. Have we gotten any feedback at all?”

“We most certainly have,” Santana said. “I heard back from my contact at CNN in only a couple of hours. They had gone ahead and put the story on the air right after they got it just as I’d hoped. The response was terrific and apparently much more than they had expected, with a flood of e-mail from the word go. It was more than they’ve had on any story other than presidential primary politics for a week. They are dying for more.”

Sitting back, Cal let a slight smile spread across his face. What he was hearing was the first good news their collective efforts had generated for the whole project.

“When I woke up this morning, there was another message from Rosalyn Beekman, my CNN contact. She said that all three networks’ news shows expropriated the story to put together pieces on medical tourism in general. At the end of all three segments, the anchors left the question of the safety of surgery in India very much in question.”

“Terrific,” Cal exclaimed, lightly punching the surface of the table with his fist several times for emphasis. “It’s music to my ears. It also brings up the question of when we should do it again. If CNN is, as Santana says, dying for more material, it seems to me we shouldn’t deny them.”

“I agree,” Durell said. “No question. If the fish are biting, it’s time to fish. And I have to tell you guys, Samira is ready. It hurt her feelings that Veena had been selected to be the first over her. She says she has a patient with some kind of heart history having surgery this morning who would be perfect.”

Cal gave a quick chuckle. “And I was worried we’d have trouble getting the nurses to cooperate, and here they are spontaneously volunteering.”

Turning from Durell, Cal glanced at Petra and Santana in turn. “What about you women? What are your thoughts about doing another? Last night when I found Veena had ODed, I never guessed I’d be asking whether we should do another tonight, but here I am.”

“Rosalyn was emphatic about wanting more material,” Santana said, looking across at Petra. “Since we know the news will be guaranteed to go right on the air, I’d have to vote yes.”

“What’s the chance Samira will have an overreaction like Veena?” Petra asked, staring back at Santana. “We don’t want another suicide attempt.”

“Certainly not Samira,” Durell said. He was emphatic. “She might be Veena’s age, her roommate, and her best friend, but personality-wise, they are two completely different people, which in some respects might be why they are tight, or at least used to be tight. Yesterday afternoon before Veena left to do her thing, she reamed Samira out for sharing her family secrets.”

“Do you agree, Santana?” Petra asked.

“I do,” Santana said. “Samira is very competitive, but she’s not a leader. More important, she’s more self-centered, and not so bottled up.”

“Then I’ll agree to it,” Petra said.

“What about the event being in the same hospital two days in a row?” Durell asked. “Does anybody see that as a problem?”

“That’s a good question,” Petra said.

All eyes switched to Cal. He shrugged. “I don’t think it matters. I was assured it would not be discoverable for a bunch of reasons. Second of all, the hospital authorities and their business backers are going to want to bury these deaths ASAP, excuse the pun, to avoid negative publicity as much as possible. India doesn’t have a medical examiner system, but even if by some astronomically thin chance someone suspected foul play, and for another astronomically thin chance even thought of succinylcholine, the drug would be long gone and any residuals, or whatever they call it, would be explained away as coming from the anesthesia they’d had from surgery.”

“Actually,” Santana said, “two deaths in two days is an even bigger story. I think it helps our cause.”

Nodding his head in agreement, Cal looked at both Petra and Durell. Both nodded. “Wonderful,” Cal said with a smile, placing both hands on the table. “It’s wonderful to have unanimity. Let’s make it happen.” Then, looking at Durell, he added, “Then you’ll give Samira the good news when she returns from work.”

“It will be my pleasure,” Durell responded.