Natural Causes

MARVIN SILVERMAN, M.D.

Associate Medical Examiner

Andrew opened the copy of Constanza Hidalgo's MCB chart. The record dated back to the woman's childhood, but contained no medical history of particular interest. Her prenatal appointments were kept without exception, and nothing in the clinic notes gave a hint as to the disaster awaiting her and her fetus.

Truscott had already reviewed the chart several times since receiving Silverman's letter. Now, though, he read even more carefully, running his finger down each page until he found a brief outpatient note dated August 10. The note read:

Patient doing well and continuing part-time work as a waitress. Some complaints of fatigue, but no ankle edema, abdominal pain, urinary frequency, headaches, blurred vision, or unusual bleeding.

P.E.-normal vital signs, unremarkable cardiac exam, no edema, 22 wk. uterine fundus. Fetal heart heard easily at 140/min.

Impression: 22-week intrauterine pregnancy

Plan: Ptnt. elects to switch from prenatal multivits to herbal supplements. Three month supply and instructions given.

Return to Clinic: 4 wks.

The note was signed: S. Baldwin, M.D.

Truscott opened his briefcase and withdrew copies of the outpatient records of Lisa Summer and Alethea Worthington, the twenty-two-year-old woman who had gone into labor on the morning of April 4, had developed horrible DIC, and had essentially bled to death in the delivery room. Like Constanza Hidalgo, Alethea Worthington had been seen once in the obstetrics clinic by Sarah. And like both Lisa and Constanza Hidalgo, she had elected to take Sarah's herbal prenatal supplements.

Setting his feet on the corner of his desk, Truscott mulled over the situation. No doubt, the fact that each of the three DIC victims had taken Sarah's herbal supplement was coincidence. She had seen dozens of patients-possibly hundreds-in the clinic during her two years at MCB, and most of them had gone on to perfectly normal deliveries.

Still, he thought, until the actual cause of the DIC could be determined, the possibility of using the coincidence to further undermine the public confidence in MCB was most intriguing-especially in the hands of Jeremy Mallon. Truscott had almost not even bothered telling Mallon about the lights going out on Glenn Paris. But he had, and through Mallon, the attorney who represented the Everwell HMO, the information had found its way to Axel Devlin. The acid-penned reporter had done the rest.

Truscott opened the Herald. He did not know how much Mallon would be paying him for the Changeover Day story, but the equivalent of two weeks' salary was a decent guess. The money was certainly welcome. But more important was the matter of a letter from Everwell guaranteeing Andrew a surgical staff position should the HMO acquire the Medical Center of Boston. Mallon had been generous enough with his payments, but he had yet to deliver on that promise. Perhaps this DIC business was just the lever Andrew needed to pry that letter loose.

Truscott slid a Gaulois from the sterling cigarette case a former lover had given him, lit up, and then dialed Jeremy Mallon's private line.

"Greetings, Mallon, Truscott here," he said. "I'm glad to see you made such quick use of the Changeover Day tape. Listen though. I have something more for you. Something quite good, actually… No, I don't want to discuss it over the phone… That will be fine. Just fine. Oh, one more thing. A letter that was promised me… Yes, precisely that letter. Have it with you when we meet, will you?… That's splendid. Just splendid."

Truscott hung up, gathered the Xeroxed records together, and locked them in his briefcase. Of all the payoffs from Mallon, this promised to be the sweetest. That his disclosures might cause problems for Sarah Baldwin troubled him very little. As a surgeon, she was as capable and self-assured as any woman he had known in medicine. But she also represented everything he found distasteful about the Medical Center of Boston. And now, with this Lisa Summer thing, there would be no living with her or the rest of the oddball element at the hospital. She and her cronies were basking in the sunlight of her success like a herd of overfed sheep. The timing was perfect to seed the clouds for a little rain.

Besides, Sarah's ego had survived the other tidbits about her he had fed to Mallon. It would survive this batch as well. The real prizes at stake were Glenn Paris and his hospital sideshow. Already wounded and weakened, their survival was not nearly so certain.

As he headed out to check on his service, Andrew Truscott was singing softly to himself "Oh, MCB is falling down, my fair lady…"