Natural Causes

CHAPTER 14

AT ONE-FIFTEEN IN THE AFTERNOON, FOR THE FIRST time in her professional life, Sarah asked to be replaced in the operating room. The case, a tubal ligation by laparoscope, was straightforward enough, and one she had looked forward to doing. But the morning had been a blur of conferences, explanations, phone calls and more phone calls. And no matter how she tried, she simply could not get focused enough to feel at ease in the operating room.

For a physician with distracting problems-personal or professional-there is no more difficult or dangerous place to be than in a hospital. Sarah had heard that statement more than once in required courses on risk management and liability. But she had never experienced it personally. Under the best of circumstances, one lecturer had warned, the possibility of committing a serious error was like a raven, perched constantly on the shoulder of every doctor, feeding on fatigue, time constraints, routine, and loss of concentration. A collapsing marriage, financial strain, alcohol, drugs, or accusations of any sort of impropriety only heightened already disconcerting odds.

A momentary distraction, the omission of a decimal point in a medication order, the failure to notice a change in one of dozens of laboratory test results-the possibilities for disaster in an acute care facility were endless, and frequently well camouflaged.

Make the physician in question a surgeon, Sarah thought now, and add the pressure of having her problems become public knowledge, and the lecturer's spectral raven turns into a vulture. She took a cup of tea to an empty room in the residents' sleeping quarters and lay down, trying to will her dull headache into submission.

The 5:30 A.M. call from the AP stringer had been quickly followed by three others, all reporters, all wanting her thoughts on Axel Devlin's column. After her tenth "No comment" and her fourth "Please don't call me again," she unplugged her phone.

A brief try at returning to her meditation was fruitless. Finally she pulled her yellow slicker over her Spandex and walked her bike through the soft rain to the small market at the end of her street. There were three other people in the store. Sarah felt conspicuous and ill at ease as she paid for a coffee and muffin and then, as casually as she could, a copy of the Herald. Huddled in a deserted shop doorway down the street from the market, she first scanned, then carefully picked through Axel Devlin's prose.

The column did disturb her greatly, but more for its bald-faced bias and obvious intent to harm than for its content. What Devlin had written was, in essence, factual. All three of the DIC victims had seen Sarah in the outpatient department. And all three had opted to take the herbal supplement over the synthetic. But whatever had caused their bleeding problem had nothing to do with that choice. The herbs she prescribed were the precise mix that a scientifically designed study had proven superior to synthetics. She had reprints of the article, published in English in one of the most prestigious medical journals in Asia, and would have provided a copy had she only been asked.

The content and purity of her herbal mix was the province of Kwong Tian-Wen, one of the oldest, most experienced, and most respected herbalists in the Northeast. The purity of his products, she could easily argue, rivaled or exceeded that of most pharmaceuticals, especially the generics. Time and again since government regulations had begun requiring the use of generic substitution wherever possible, one or another of the many fly-by-night manufacturing companies had been cited for peddling substandard medicine. And many times the drugs involved had life-or-death potential. Still, the punishment meted out to the companies was, more often than not, an admonition and a slap-on-the-wrist fine.

It would have been a pleasure, Sarah felt, to air such issues. If only Devlin had done his job fairly. If only he had asked for her side. Now she was faced with the prospect of having to hold a press conference of her own, just to be certain her responses to his allegations were laid out clearly and completely.

Throughout the morning just past, the atmosphere surrounding her had been a striking contrast to the cheers and back-slapping that had followed her treatment of Lisa Summer. By the time she arrived on the OB/Gyn floor for rounds, copies of the Herald were everywhere-at the nurses' station, on the bedstands in patients' rooms, even in the bathroom of the staff lounge.

There was an almost palpable coolness from many of the nurses, along with whispers behind her back and gestures she caught out of the corner of her eye. But virtually no one mentioned the column to her-no one except her department chief, the chief of staff, the CEO of the hospital, and the head of public relations.

At noon she managed to break away from the madness to visit Lisa. If anyone deserved a personal rebuttal of Devlin's implications, it was she. The empty room, scrubbed and waiting for its next patient, was unsettling, but no more so than the news that Lisa had left the hospital with her father not fifteen minutes before with no attempt made to call Sarah. No message left. Just a discharge order from Randall Snyder, and she was gone. An hour later Sarah had asked someone to take over for her in her laparoscopy case.

By two-thirty, a brief nap and three aspirins had eased the pressure in Sarah's head. She set her copy of the Herald on the small metal desk and pulled a pad of lined progress note sheets from the drawer. She had always been a fighter. But twice in the past she had decided not to dignify Axel Devlin's jibes at her with a response. This time there was no way she was going to turn her back on his bullying. She would state and restate her position and qualifications. And she would not stop until his destructive, irresponsible reporting techniques were exposed.

At Wellesley, her anthropology honors thesis had been highly praised, both for its content and for her writing style. There was no reason she could not draft a press release that would put Devlin in his place and make strong points for certain herbal therapies as well.

Carefully she read through the column again, this time underlining key words and phrases. Although it was not essential, it would help to know the source of Devlin's information. Glenn Paris had spoken of the constant, damaging leaks of hospital goings-on and had even threatened termination for anyone found responsible. Was this particular column the result of just another in that series of leaks, or was someone specifically trying to bring her down?

Herbal Prenatal Supplement… nine different roots and herbs… elephant sleeper… moondragon…

Was there any chance a patient of hers had gone to Devlin with the clinic handout? That made no sense. She had never kept secret the supplement or its contents. And no one-not even Devlin-had shown any particular interest in it. Not until now.

Now two of those… patients are dead and a third is maimed…

Sarah scratched her pen absently along one edge of the pad. Who knew that she had at one time or another seen all three victims in the clinic? Who would have had access to their records? Would Devlin have trusted a source other than a doctor?

Where do these herbs and roots come from? Who checks them for contamination?… For composition?…

Even the tone of Devlin's questions sounded professional. Someone had fed him the words. Furthermore, that someone almost certainly had to have been a physician. For a few suspended minutes, Sarah closed her eyes, searching her memory, sorting through the facts and possibilities.

"No," she whispered suddenly. "Oh, no."

She hurled her pen against the wall. Then she snatched up her clinic coat and stormed from the room.

"Why, Andrew?" she cried as she raced down the stairs. "For God's sake, why?"

"Money, of course," Truscott said simply.

Sarah slammed her fist down on the Herald, landing dead center on Axel Devlin's sketched likeness. "Andrew, I know you don't like Glenn, and you don't like this place. But we've been friends for over two years. You would do this to me for money?"

"Not for money, luv. For lots of money. And as for our being friends-the last friend I remember having stole my bike in the fourth grade and gave it to a girl he liked."

"Oh, Andrew."

"You can handle it, kid. You are possibly the most competent woman I know. And just remember, there's no such thing as bad publicity. There is only publicity. The article will raise public awareness of your cause."

"That's bullshit, and you know it. Who paid you? Devlin? Everwell?" Sarah glared across the desk at the surgeon.

"It's really none of your business who paid me," Truscott said. "You know, Sarah, I didn't make up any lies-about this place or about you. You did see all three of those women, and you did give them your little potion."

"Andrew, before turning bits and pieces of information over to a person like Devlin, you could at least have taken the time to speak with me, or to read the studies on the supplement. You know what you did-the way you did it-was wrong. Can't you at least admit that?"

"I'll tell you what," Truscott said with sudden vehemence, "I'll admit that what I did was wrong as soon as you admit that ever since you arrived at this place, you've annoyed people with your holier-than-thou attitude regarding the inadequacies and callousness of the way we poor, limited M.D.'s do things. You walk around with this smug if-only-you-all-knew-the-great-secrets-I-know, if-only-you-all-were-as-complete-a-doctor-as-I-am attitude that just about everyone in this place finds threatening."

"But-"

"Let me finish! You may think you're helping to make all of us more complete doctors. But even in this place, even in Crunchy Granola General where almost anything goes, you're looked on as a kook. The women on the staff think you're not professional enough, and the men are so intimidated by you that they avoid you like sea captains avoid icebergs. So before you start attacking me, you might take a look at yourself."

Sarah felt perilously close to tears. She had been wronged, clearly wronged by this man. Yet here he was, putting her on the defensive. Over her years at MCB, she had felt almost universal respect and acceptance from the staff, male and female. Many, like Alma Young, had gone out of their way to tell her so. Her performance evaluations were consistently among the highest of the residents. After two decades of solo practice, Randall Snyder was considering her for a partnership. Why was she letting this, this clone of Peter Ettinger, get to her so?

She bit at the inside of her lip until she felt certain her tears were contained. Then she snatched up the Herald and turned toward the door.

"Where are you going?" Truscott demanded.

"I'm going back to work."

"What are you going to do about all this?"

"If you mean am I going to Glenn, the answer is I don't know yet."

"They won't fire me. Not without hard proof."

"Andrew," she said without turning back, "right now, thanks to what you've done, I have more important things to worry about than whether or not they fire you."