Natural Causes

CHAPTER 12

WILLIS GRAYSON, CRADLING A $150 BUNDLE OF exotic flowers, trotted up the stairs to the fifth floor of the Surgical Building. A slight cold had kept him out of his pool since his return from the coast, and even this bit of exercise was welcome.

He had left the hospital that morning ecstatic over Lisa's decision to talk with him. Later he and Ben Harris had spent an hour with Dr. Randall Snyder. The obstetrician seemed a decent enough sort, though certainly no intellectual giant. Still, Ben was impressed with him, and that was sufficient to soften much of Willis's knee-jerk anger toward the physicians who had cared for his daughter. It also alleviated some of his misgivings about the Medical Center of Boston. The care Lisa had received seemed to have been adequate, especially considering that Snyder and the hospital had believed all along that she was without any means to pay for it.

It was disappointing to learn that Snyder and the others on the medical team had no clue as to what might have caused Lisa's blood problem. Still, it did appear that an effort was being made to get to the bottom of things. Grayson charged Ben Harris with obtaining the names of the leading experts in the field so that they could be put on the case.

Next on Grayson's agenda would be a visit later that afternoon to the head of physical therapy and rehabilitation. He would tactfully inform her that, while he appreciated the efforts of her department, the people at the Rusk Rehabilitation Institute in New York would be overseeing the selection and implementation of Lisa's prosthesis. And then finally, perhaps in the morning, he would try to meet with the obstetrics resident who was said to have done more than anyone else to save Lisa's life. If, in fact, Sarah Baldwin had played such a role, his people would be instructed to learn about the woman and her needs, and to come up with an appropriate reward.

Energized at regaining the control that had eluded him for nearly five years, Grayson strode down the corridor to room 515. Both of the slide-ins on the door were empty. He knocked once and then eased the door open. Both beds were newly made, and the room unoccupied.

"What in the hell?"

Battling anxiety, confusion, and anger, Grayson checked the two metal armoires and then the bathroom. All were clean and empty. After leaving Lisa that morning, he had tried to get her transferred to a single room. When informed that every room on the floor was a double, he had left strict instructions with the head nurse on the floor to notify admissions that he would pay whatever was necessary to keep the other bed in room 515 empty. What in the hell could have happened?

He threw the flowers onto one of the beds and raced to the nurses' station. Janine Curtis, the nurse to whom he had spoken earlier, appeared prepared for a confrontation.

"Miss Curtis," he demanded, "what's become of my daughter?"

She held his gaze evenly.

"Nothing's become of her, sir," she said with exaggerated patience. "She's doing fine. She's been moved to another room."

"But we agreed this morning she would stay where she was, and that no one would be moved in."

"I know what you requested, sir. But Lisa asked to be moved to another room, and we obliged her."

"Well then, where is she now?" he snapped.

"I'm afraid I can't tell you that, sir," the nurse said.

"Miss Curtis, I'm not in the mood for games."

"It's Mrs. Curtis, and this is no game. Your daughter told us quite emphatically that she does not wish to see you."

"What?"

"She said that if you want to speak with her, you might try coming back tomorrow morning. She'll see how she feels then."

"Dammit, she told me just a few hours ago to come back at three this afternoon. Now where is she?"

"Mr. Grayson, please keep your voice down. Our patient has given us a clear and specific order, and we fully intend to honor it. I would suggest you do as she asks and return tomorrow."

"And I would suggest you be very careful whom you talk to like that."

"Mr. Grayson, you made it perfectly clear who you were this morning. In all honesty, it makes no difference to me. Lisa is an adult with control over the decisions involving her life. She is also my patient. She's been through a great deal, and I intend to do whatever I can to honor any wishes she might have."

She smiled at him coolly and then returned to her work.

Glowering at her, Grayson gave brief thought to searching every room on the floor. Then he stormed off.

• • •

The initial meeting between Andrew Truscott and attorney Jeremy Mallon, some two and a half years before, had actually taken place at a Red Sox-Yankees game. Before Glenn Paris canceled the Everwell HMO's contract with MCB, the organization had used the hospital for a modest percentage of its inpatient cases. Each year, as a "thank you" to the residents, the HMO would rent a bus, load it with beer, and take the entire house staff to a clambake and then to Fenway Park.

Having heard rumors of Andrew Truscott's profound disenchantment with MCB, Mallon had carefully arranged the seating so that he was next to Truscott. By the end of the third inning, they had evolved makeshift code words for the hospital and key personnel, and had established their mutual distaste for Glenn Paris and his offbeat antics. By the bottom of the fifth, Truscott had made it clear that he was not unwilling to provide inside information on hospital goings-on in exchange for certain considerations. And by the seventh-inning stretch, they had exchanged numbers and agreed to meet again in the near future.

Now, some $30,000 later, Andrew scribbled a fictitious name in the log book of the office building at One Hundred Federal Plaza and rode the elevator to the twenty-ninth-floor law offices of Wasserman and Mallon. His relationship with the attorney was a shaky one. Andrew neither trusted nor liked the man, and although Mallon was too slick to get a decent handle on, Andrew suspected those feelings were reciprocated. However, there was no denying that each had profited from the other. And with the information he had tucked in his briefcase tonight, their collaboration seemed destined to continue.

The brass plaques on the mahogany doors to the firm's suite listed four partners and about twenty associates. Jeremy Mallon was the only one with an M.D. in addition to his law degree. The spacious interior, with its glass-enclosed library and multiple secretary's desks, had an array of original oils on the walls that included a Sargent, an O'Keeffe, and a small Wyeth. Truscott wondered in passing how many physicians' malpractice victories and settlements it had taken to develop such a collection.

As soon as he entered the reception area, Andrew caught the aroma of Chinese food. And after brief stops before the Sargent and a striking piece by the contemporary realist Scott Pryor, he followed the scent down the hall to Mallon's office. Although the number of white cartons spread across the teak table suggested a small banquet, only Mallon was there.

"Come in, Andy. Come in." Mallon motioned Andrew to a seat with his chopsticks. "I didn't know what you liked, so I ordered a little of everything."

Andrew winced at the use of his nickname, which he had never liked. Andy. Despite the hefty payments, he felt wary around Mallon, a gladhander who always seemed to have a hidden agenda. If it served his purposes, Andrew suspected, the attorney would devour him with the same dispassionate enthusiasm he exhibited toward the Peking duck.

"There's beer, wine, or whatever else you want in the fridge beneath the wet bar," Mallon said. "Forgive me if I seem to be rushing, but Axel's holding up writing his column until he hears from me, and there's a reception at my club that my wife has made mandatory."

"No problem."

My club. Although Andrew was uncomfortable with the man personally, he did admire his power and style. More than once in their dealings, thoughts of what a law career would be like crossed his mind. Somewhere down the road, a brass plaque might read Wasserman, Truscott, and Mallon.

"Did you watch the news tonight?" Mallon asked.

"No, I just got out of work."

"Goddamn Paris made it onto all three stations. I'm really sick of seeing that Bozo's face on TV."

"What goes around comes around," Andrew said, tapping his briefcase.

"Well, I hope whatever it is you have is good, because we are running out of time."

"What do you mean?"

"Just that. Competition in the managed health care business is getting more intense every day. It's already big fish eats little fish. No one is safe, and everyone is justifiably paranoid. Right now, Everwell's in a pretty decent position. But they're so strapped for beds and office space that they've decided they can't wait much longer for MCB to go up on the block. They're looking at other options, the best of which will cost millions more than it would to make a fire-sale buy of MCB. Millions. And ultimately, anything else they acquire will deliver much less in terms of space and equipment. We need that hospital."

"I've heard rumors of massive layoffs pending at MCB. Doesn't that suggest the financial problems are getting worse?"

"There's a big difference between rumors and done deeds, Andy. People may be talking about layoffs, but my sources say that MCB has actually begun some hiring. And there's more. For several years now I've had a pipeline into some of the really big creditors of the hospital, including the bank that holds one of its mortgages. They tell me that recently Paris and his financial advisor, Colin Smith, have stopped scrambling for money. They've even started paying off some bills. I think it's got to be that foundation Paris talked about in the speech you recorded."

"That was the first time I ever heard him mention it," Truscott said.

"And you're sure he never gave the name?"

"You heard the tape."

"I want that name, Andy, and quickly. If we know what we're up against, chances are we can come up with some sort of countermeasure. If Paris and Smith manage to get that place out of the hole, we'll probably never get another shot at it. Remember how much I said is at stake for us."

"Assuming I get you the name," Andrew heard himself say, "I expect a small portion of those millions will find its way in my direction."

Mallon's eyes flashed.

"Do yourself a favor, Andy," he said with chilling calm, "and don't try and put the screws to me. Okay? Just come up with that name. Let me choose the reward. We both know you have no future at Crunchy Granola General. Zip. And need I remind you that except for a few hospitals way out in the boonies, the market is already glutted with general surgeons? It's a safe bet that those few who are getting hired for decent jobs were chief residents in their training programs. That's something you're never going to be putting on your resume. Your future is with us, Andy. You know it, and we know it. So just help us out where you can, and get me that name."

Truscott reddened. Clearly he was out of his league. Mallon was a pro at manipulation and control. All Andrew could do was hang in there and learn from the man. His own day would come.

"Point made," he said.

"Excellent. Now, what have you got for me in that briefcase?"

Andrew handed over the sheet Sarah had given him, along with Xeroxes of the three hospital records and also some notes he had made.

"This involves Sarah Baldwin," he said.

"Ah, yes. Another major thorn in our side. The woman has certainly become a media darling."

Andrew remembered Sarah, the next chief resident in obstetrics, seated across from him in the cafeteria, smugly lecturing him on the power of alternative healing.

"Well, your friend Devlin may be in a position to change that," he said.

Mallon scanned Sarah's prenatal information sheet. "Bloodroot… moondragon leaves… elephant sleeper. These are all herbs of some sort?"

"They are. They're boiled and drunk as some sort of tea. As you can see, each item has several names. Baldwin recommends them over the standard supplements pregnant women are required to take. She claims a study done in the jungle somewhere proved the herbs are superior to what she calls 'processed vitamins.' "

"Fascinating. Go on, Andy."

"Well, most everyone at MCB thought the Summer girl was the second DIC case at our hospital. She wasn't. She was the third." He slid across the letter from the New York medical examiner. "As you will see from studying the hospital records I've copied, all three women who got DIC-the two who died, and the one who is still in the hospital-have one definite thing in common besides the fact that they all were MCB patients. All three opted to take Baldwin's herbal porridge."

It was clear from Mallon's expression that no further explanation was necessary.

"Does any other obstetrician prescribe these?" he asked.

"No."

"Where does she get them?"

"From some herbalist in Chinatown. Do you want me to find out who?"

"Absolutely. There's no time tonight, though. As soon as we're done, I'm going to fax these over to Devlin. And don't worry. No one else will lay hands on those records. Tell me, do you think taking these herbs could have caused that blood problem?"

"Not by themselves, I don't. But there are examples-many examples, actually-of an allergy to one substance sensitizing patients to the action of something else."

"Give me an example," Mallon said, scratching notes on a pad.

"Well, let's see. A number of antibiotics-tetracycline is probably the best known-cause extreme sensitivity to sunlight in certain patients. The reaction is not completely understood and can be very, very severe. We have no idea which tetracycline users are going to get it. Many don't. So we just tell everyone who gets put on the drug to stay covered up."

"Yes, I remember that now. Have you had a chance to study this list?"

"I've looked it over. None of it makes much sense to me. I tried looking up some of the herbs."

"And?"

"It's going to take someone with more time than I have, and access to a better library. The various names-scientific, western, Asian-make the whole thing pretty complicated."

"The more complicated the better," Mallon said. "There are potential problems of miscommunication all over the place. Language problems, fouled-up shipping orders…"

"Lack of consistent dosage control," Andrew added. "Contamination with other herbs or pesticides."

"Scary stuff-especially if any of these herbs has potential effects on blood clotting." Mallon spent half a minute absently tapping his eraser on the table. "Well, the whole thing would pack more punch if we knew more of the biology," he said finally. "But until we do, I suspect Devlin will be able to get a few miles out of what we have here. This material has potential, Andy. Big potential."

"I agree."

"Tell me. What's your relationship with this Sarah Baldwin?"

Truscott thought a bit, then said simply, "I don't have one."

"Well, then, do what you can to dig up anything else on her, Andy. Anything at all." Mallon took two envelopes from his desk. "A reward for your loyalty and for this information," he said, passing one of them over. "And here's the letter you requested from the medical director at Everwell. The position it promises assumes that Everwell will be taking over MCB. No takeover, no position. Clear?"

"Clear."

"Good. I like clear. You're doing fine, Andy. Just fine." Mallon slipped the material into his briefcase and snapped it shut. "Rather than try to fax all this to Devlin, I'm going to drop it off myself. Sorry to seem as though I'm rushing you out, but my wife is waiting for me."

"No problem," Truscott said as they headed out. "I'm about a week behind in sleep, and I ought to try to get at least a little caught up-especially seeing as how I'm scheduled to meet with Willis Grayson tomorrow morning."

"The Willis Grayson?"

"Yes. Didn't I mention that? God, that was dumb of me. I meant to tell you about that when I got here, and I got so involved with-"

"Tell me about what?" Mallon had stopped walking.

"The girl who survived the DIC, the one who's still in the hospital-"

"Yes?"

"She turns out to be Grayson's daughter."

"What?"

"I don't know the whole story, but apparently she's been living this hippie existence for years as Lisa Summer. Grayson showed up by helicopter this morning. He's made appointments with every doc who had anything to do with her case."

"Why?"

"I don't really know. I guess he wants to find out exactly what happened. I'm scheduled to meet with him at eleven."

Mallon rubbed at his chin.

"Do you know where he's staying?" he asked.

"Grayson? Nope. No idea."

"It doesn't matter. I can find that out. What kind of shape is his daughter in?"

"She's depressed as hell. But medically she's doing pretty well. Her arm-what's left of it-is healing nicely."

"And she lost her baby?"

"That's right."

"Willis Grayson's grandchild…"

"Pardon?"

"Nothing. Nothing." Suddenly oblivious to Andrew, Mallon snatched up the phone from a nearby desk, called Axel Devlin, and alerted him that a messenger would be by shortly with a special package for him. Then he dialed another number. "Who's this, Brigitte?… Oh, Luanne, how're you doing? This is Jeremy Mallon speaking… Fine, I'm just fine, thank you. Listen, you know the reception?… Yes, well, Mrs. Mallon is there right now, and she's expecting me. Would you find her please and tell her I'm going to be late. In fact, tell her that if I'm not there by ten I won't be there at all. Do you have that?… Thank you, Luanne. Thanks very much. I'll catch up with you later in the week." He set the receiver down. "I don't think Mary Ellen would trash seventeen years of marriage over one missed reception," he said as much to himself as to Truscott. "Listen, Andy, I'm going to stay here and make some calls. You know the way out, yes?"

"Sure. Are you going to try to contact Grayson?"

"The man's got a ton of lawyers, I'm sure. But I doubt any of them are M.D.'s. Men like Grayson want the best. I've just got to find a way of educating him as to who, in this type of legal business, the best is. You take care now."

Without waiting for Truscott to leave, he hurried back into his office.