Natural Causes

CHAPTER 23

THE THREE-FAMILY CLAPBOARD TENEMENT WAS ON A dead-end street in a decaying section of Dorchester. It was badly in need of new shingles, gutters, and a coat of paint. Lugging a heavy briefcase, Rosa Suarez trudged up the front walk. Her data-gathering was well along now, but nothing had yet emerged to explain the three DIC patients at the Medical Center of Boston.

At her urging, the CDC had sent out requests to hundreds of hospitals searching for other, similar cases. But those that had been reported so far all had logical, well-established explanations such as abruptio placentae, toxemia, or overwhelming infection.

Now, in hopes of stirring up something that she might have overlooked, Rosa was retracing some steps. She was starting with follow-up interviews with the families of the two deceased victims and later in the week with Lisa Grayson. At the same time, she planned to check and recheck the massive number of cultures she was running.

Although her supervisor had said little to her directly, the first signs of his impatience had already surfaced in the form of a brief memo. Dr. Wayne Werner, senior field epidemiologist, would be finished with his current project and would be available for reassignment in three to four weeks, it read. Anyone in the department needing Werner's help with an ongoing investigation should submit a request in writing within the next two weeks. Rosa knew that the memo was at least a demand for some sort of likely hypothesis from her, and at worst a threat that she was soon to be replaced.

The name crudely painted just above the mail slot of the first-floor flat was BARAHONA. Fredy Barahona, a laborer, was home all day, every day, drawing disability for a back problem. His wife, Maria, was working the night shift in a sneaker factory. Maria's daughter by her previous marriage, and the only child she would ever conceive, was Constanza Hidalgo.

Rosa was feeling the strain of her intensive investigation, now nearly seven weeks along. She had lost weight, quarreled with her husband for the first time in several years, and developed an annoying tic at the corner of one eye. But she was frightened enough and determined enough to keep pushing herself to the limit. She desperately wanted to leave her profession a winner. More important, she wanted to head off what she firmly believed was impending disaster.

Someone had deliberately torn pages from the hospital records of at least two of the three DIC cases she was investigating. Sarah Baldwin was being followed and had been accosted once. And the meticulous research techniques that had served Rosa so faithfully over the years were not delivering. She felt as if she were tiptoeing around a ticking bomb, with no clear idea how to disarm it. The only thing that seemed certain to her at this point was that unless answers were found, and soon, more women and their unborn infants were going to die.

Maria Barahona was a plump, work-weary woman who had almost surely been quite attractive at one time in her life. She kept up a cheery front, but the pain of losing her only child showed in her eyes. Once, during Rosa's initial interview with her, she had begun to weep. But just as quickly she composed herself, apologized, and went on answering questions. Now, with her husband across the room, dozing on a tattered recliner, she served Rosa tea and talked once again of Connie. Although her English was decent enough, she seemed relieved to be conversing in Spanish.

"There were drugs in the car, you know," she said. "They told us Connie had marijuana in her blood, but I don't believe it. She was a happy girl. A good girl, too. And so, so beautiful. Her only crime was falling in love with that bastard, Billy Molinaro. Please, Mrs. Suarez, please. Forgive me for swearing."

"Mrs. Barahona, there is no need for you to apologize."

"She was so beautiful. You should have seen her, Mrs. Suarez. Men would just stop what they were doing and stare when she walked by. We had already picked out her boy's name. Guillermo. Even though he would have been called Billy, Connie was going to spell it the Spanish way."

As she had during their first interview, Maria Barahona was rambling. She was once again nearing tears. Rosa broke in somewhat desperately.

"Mrs. Barahona," she said, "somewhere between three and five years ago your daughter was treated for something at the Medical Center of Boston. Would you have any idea at all what that was?"

Some of the anguish left the woman's face as she focused on Rosa's question.

"I-I don't remember anything. She had some headaches and some stomach trouble-especially with, you know, her monthly. But nothing that didn't get better when she took medicine. She always had great faith in the doctors at the Medical Center. If they said take this pill at three minutes after four, my Constanza sat looking at her watch until three minutes after four."

Another dead end. Rosa stared at the floor, trying to imagine Connie Hidalgo's mounting terror during those last nightmarish hours of her life. Was there anything else? Anything at all she could try?

"Mrs. Barahona, Maria, I know that Connie was living with Billy Molinaro," she said finally. "When did she leave home for good?"

"They were planning a wedding," Maria said, obviously embarrassed. "And she still spent many nights here. Many nights."

"Please, Maria. I'm sorry. I didn't mean to imply anything at all. I just wondered if her room still had her things in it. That's all. If it does, with your permission I'd like to check it over."

"Oh. Well, if you think it might help, certainly you can look at anything you want. It's the room back there on the right. I haven't changed anything. If you don't mind, though, I'd like to get dinner started. I work the night shift, you know."

"I know," Rosa said, glancing over at Fredy Barahona, who was in need of a shave and hadn't so much as stirred since her arrival. She wondered if he had ever prepared a meal on his own, and reflected momentarily on how lucky she was to have spent forty years married to Alberto Suarez. "Thank you, Maria. I'll be fine."

Connie Hidalgo's bedroom spoke, of a woman who had never really stopped being a little girl. The bureau and bed, possibly painted by Connie herself, were white with pink accents. The pillow cases, also pink, were frilly, with hand-painted teddy bears and balloons. And there were stuffed animals everywhere-a hundred or more. Zebras and elephants; bears and orangutans; kittens and all manner of dogs. The walls were covered with posters of romantic island getaways and neon-lit cities. Rosa swallowed against the sadness in her throat. Despite the marijuana reported in Connie's bloodstream, Rosa sensed she would have developed into a loving, devoted parent.

Rosa took a framed five-by-seven snapshot from the bureau and raised the window shade to view it in better light. Connie, looking even more vibrant than in the newspaper photo Rosa had in her files, stood arm in arm with a swarthy, handsome, confidently grinning young man, whom Rosa was certain was Billy Molinaro. The snapshot was taken on board a boat of some sort, possibly the sightseeing kind. Behind them was the distinctive skyline of Manhattan. Connie, copper skinned, slender, and full breasted, was absolutely lovely.

Uncertain of what she was after, Rosa first checked the bureau drawers and then the contents of the small bookcase. The books were mostly paperback romances and library books that had never been returned. There were no photo albums or scrapbooks, but there was a yearbook-The Sword and Rose-from St. Cecilia's High School. The yearbook was clearly low budget-a far cry from the glossy, full-color productions Rosa had seen from other high schools, including the one her daughters had attended.

She skimmed through the pages of black-and-white photos, searching for some that included Connie. There were, at least on first perusal, none. Nor were there many messages from classmates. The few she read were hardly passionate: All the best to a terrific kid… We didn't know each other well, but I hope you have a wonderful life… Good luck from your friend in Latin 213… Rosa glanced again at the radiant, sensuous woman sharing a harbor cruise with the dashing young man who was to become her husband. The tepid comments from Connie's schoolmates did not jibe at all with that woman.

Rosa flipped to the class photos at the back of the book. Where her daughters' yearbooks had four good-sized color portraits per page, The Sword and Rose had ten-all black-and-white. Printed in minute type beside each photograph was a summary of that student's activities during her years at St. Cecilia's. Constanza Hidalgo had been a cafeteria aide and a member of the culinary arts club. Nothing else. No music, no drama, no sports. Rosa stared at Connie's photograph. Even allowing for the fact that the portrait was slightly out of focus, Rosa doubted she would have been able to identify its subject without being told.

Once again she held up the framed snapshot. The girl in the yearbook was most certainly the woman with Billy Molinaro… yet she wasn't. The mouth was the same, and the eyes, too, although they held none of the spark that Rosa saw in the more recent picture. But the face in the yearbook was much rounder and very much less interesting. It was as if someone had taken a paring knife and carved away the younger Connie's plainness.

Rosa set the yearbook on the bed and completed her inspection of the room. There was nothing else of interest in the bookcase or on the floor. She opened the small closet. Along with two maternity dresses, there were a number of fairly chic outfits and dresses, all size six, and a dozen or more pairs of shoes. If what Rosa was seeing were the clothes Connie had chosen not to move to Billy Molinaro's place, the former cafeteria aide and cooking club member had become a legitimate candidate for any best-dressed list.

The floor of the closet, like much of the room, was covered with stuffed animals. Rosa would never know what caught her eye, or what instinct made her bend down and move part of the pile aside. But there beneath the bears, snow leopards, and toucans was a shoe box, bound with rubber bands.

And inside the shoe box was a diary.

• • •

Matt delighted his secretary by sending her home for the remainder of the afternoon. Then Sarah and he split the corned beef sandwich and fries they had picked up at Gold's and talked for a time about absolutely nothing of any importance.

"Do you have to be back at the hospital soon?" he asked, as he poured coffee for them from the carafe of a well-used Mr. Coffee.

"I have some patients to sign out to the on-call doc, some dictation I need to do, and I have to get my bike. But I'm okay for a little longer."

"Good. There are some things we ought to go over."

"Like quitting?"

"Like understanding what we're up against here, and how malpractice underwriters like the MMPO operate."

The tension that Sarah had seen develop in her lawyer over the course of the past six weeks seemed indelibly etched across his brow. When they had met initially, her innocence-their case-had seemed so clear-cut, so straightforward. Now? She sipped at her coffee and asked him to continue.

"First of all," he said, "I want you to know that I think something's screwy with this whole business. I know you're not convinced, but I believe someone set Kwong Tian-Wen up to make him-and you-appear responsible for those three DIC women."

"But as things stand, we have no proof that he and I are not responsible. Only Tian-Wen's word."

"And his family's. We can put together a defense based on the presumption that someone's out to make you look guilty. But without who and why, it won't hold up."

"Meaning, if we pursue this into court, we'll lose."

"Sarah, we're really up against it." His voice drifted away. His fist was clenched.

"But, hey," she said, "aren't you the one who told me that more often than not, the legal system manages to sort out what's truth and what isn't?"

" 'More often than not' is still not always. Things aren't that simple in this case. Tian-Wen's frail. He gets confused a lot. I might be able to get a doctor's excuse to keep him off the stand. But that's a long shot because he's not that bad off anymore. And even if we succeed, Mallon will just depose him at home, maybe use closed circuit TV. One way or another, the jury will get to meet him up close and personal, as they say."

"But how will Mallon explain why so many women who took my supplement had no problem?"

"I suspect you know the answer to that."

"You mean he'll just claim that Tian-Wen messed up with some batches and not with others."

"Or else that the incorrect herb or herbs reacted with some women and, for whatever reason, not with others. In this situation, he just has to have a response that works. It doesn't necessarily have to be right. With Lisa Grayson on their side, and Kwong Tian-Wen on ours, and the penchant of juries to think they're settling claims against megabucks insurance companies, not flesh-and-blood people, I'm afraid it's going to boil down to our having to prove in court that we're not at fault. I can just see Mallon now."

He picked up his baseball and mitt, and began pacing, popping the ball into the pocket as he spoke.

" 'This lovely young artist, with two good, strong arms and a healthy fetus, puts her faith and trust in Dr. Sarah Baldwin. Dr. Baldwin does something unusual and irregular to the lovely, pregnant young artist with two good strong arms-something well beyond the accepted norm for her medical community. And suddenly, the lovely young artist loses her baby and her right arm. Since nothing else happened during our lovely young artist's pregnancy, Dr. Baldwin must prove to this court that she was not the cause of this tragedy.' "

"That sounds gruesome."

"In legal terms, that little twist at the end is called res ipse loquitor-the thing, or deed, speaks for itself. It's a legal gun barrel that no defense lawyer ever wants to find himself staring down. But it happens-especially, from what I've been able to read, in medical malpractice trials."

"I thought I was supposed to be innocent until proven guilty."

"If Mallon gets a judge to accept res ipse loquitor, and we can't prove that you are not responsible, we're cooked. What's more, if we lose here, two more families are almost certain to go after what insurance you have left, and whatever else you own or may ever own." He stopped pacing and sank back into his chair.

"What do you think we should do?" she asked.

"Well, before I answer that, there's one more thing you ought to know. It has to do with Willis Grayson. It's been troubling me almost since the beginning of this case. Finally, today, seeing him and his legal army in that hearing room, I think I know what it is. Sarah, he doesn't want just to see you lose this case. He wants to bury you."

"I-I don't understand," she said, feeling suddenly chilly.

"The way I see it, Grayson's got more money than God, right?"

"I suppose."

"I'm sure he's not adverse to winning sixty percent of a huge jury award. But my guess is it still wouldn't equal the interest he earns on his personal checking account. The way I put it together, Mallon's in it for the money and to stick it to your hospital. But Grayson wants you, or whoever is responsible for Lisa's tragedy, to be put away for a long, long time."

"I can't believe this. Willis Grayson out to destroy me. It's crazy, absolutely crazy. But do you want to know what's even crazier, Matt? The absolute craziest thing of all? I don't even know whether he's justified or not."

"I told you how I feel about that."

"I know. What do you think we should do?"

"Well, we can try for some sort of settlement without admission of guilt. I'm not sure I can get the MMPO, Mallon, or Grayson to buy it, but you never know. It's sort of a Mexican standoff. Our side says we would have won at trial, but the legal fees would have been higher than the settlement. The other side says that even though there's, no admission of guilt, the fact that the MMPO paid up implies that they were right to sue. Then the rhetoric dies down and everybody goes back to his life. Before you know it, the ripples go away and the big pond is still again."

"We can do that?"

"We can try."

"And you think we should."

Matt pressed his fingertips into a steeple and stared out the window. The creases traversing his brow deepened.

"If they'd accept, the answer is yes," he said finally. "Yes, I think we should."

"I need to think about it. How long do I have?"

"A week, maybe. A little longer if you need it."

"Thanks."

She felt distracted, ill at ease, and suddenly very tired. Kwong Tian-Wen… Mallon… Lisa… Willis Grayson… the hospital… goddamn Peter… criminal charges… further lawsuits… How could the case once have seemed so simple? She set her cup down and turned to go.

"I'll drive you back to the hospital," Matt said.

"That's okay."

"No. I-I want to. I want to very much."

Sarah turned back to him, but he quickly looked away and began loading papers into his briefcase.

I want to. I want to very much. Had he really just said that?

"Offer accepted," she replied.

Matt fixed his gaze on the rear end of the car ahead of them as he inched his red Legacy away from the city. Sarah would never have imagined a situation in which she was grateful for heavy traffic, but she was this afternoon. The ride from Matt's downtown office to MCB, which should have taken fifteen minutes, was going to take closer to forty. Except for some small talk unrelated to the case, they rode in silence. She looked at him directly when she was speaking, but continued to study his face out of the corner of her eye when she wasn't. The timing couldn't have been much worse, she told herself. Falling for the attorney representing her in a malpractice case was hardly the wisest thing in the world. But it was happening. And there really wasn't a damn thing she could do about it.

Though he hadn't actually said so, she sensed Matt was attracted to her as well. But there were ethical issues that would be pressuring him neither to act on those feelings nor even to voice them. Perhaps if they could settle her case, those considerations could be set to rest, and they could get on with the business of really getting to know one another and possibly even falling in love.

But before she agreed to try and settle, there was something she had to know. "Matt, tell me. If you could script this whole legal thing exactly the way you wanted-the way that would benefit you the most-how would it go?"

He looked at her strangely. "What a funny question. What do you mean the way that would benefit me the most?"

"Financially, career-wise. You know."

She debated, then rejected, the notion of sharing with him what Ruth had told her. The woman was too gabby, and probably a professional liability to him, but it seemed premature to make trouble.

For a moment, she was afraid Matt was about to guess that she knew more about his situation than he had shared with her.

"Well," he said finally, "I suppose if the hypothetical options were placed in order, the number-one most desirable would be a knock-down, drag-out court battle against Jeremy Mallon that generated a ton of publicity and fees for me, followed by a jury verdict of no negligence for you."

"And the number-one least desirable?"

"The same exact scenario, I suppose, except that we lose. That would pretty much finish me as far as malpractice cases go, to say nothing of referrals. In this game, everybody knows who wins and who doesn't. And nobody likes to put their life on the line with an established loser."

"Is that why you recommend that we try to settle?"

He slammed on the brakes and glared at her, oblivious to the blaring horn behind him.

"Is that what you think?" he asked.

"I-I'm sorry. No, that's not what I think, and it's not what I meant. Dammit, Matt, I'm not putting things together too clearly. I just want this whole business to be over."

His expression quickly softened. He reached over and squeezed her hand. Then he pulled over to the curb. "Sarah, I'd let someone put bamboo splinters under my fingernails if I thought it would help us win in court. But I've been working like hell on every angle I can think of, and I keep running into dead ends. If I'm pushing too hard to settle, it's probably because today just gave me a firsthand feel for what it's going to be like.

"Still, if it's what you want, or if they refuse our offer, I'm ready to dig in and do battle. You probably don't know much about relief pitchers, but we're notoriously lacking in the part of the brain that tells a person there is legitimate reason to be frightened of something. Suggesting we settle is what I think is best for you. It may be best for me, too, but believe me, that's incidental. Think about it, though. This case has already generated more publicity than most, and it hasn't really even started. If we go to trial, you're going to be the featured performer in a three-ring circus like you couldn't imagine. Axel Devlin will be just one of your problems."

"I understand. Matt, I'm sorry for what I said before. I'll let you know as soon as I decide."

He nodded and pulled back into the traffic.

"Don't worry," he said. "One way or the other, things will work out. And no matter what happens…"

"Yes?" Go ahead, Matt, say it, she urged silently. Tell me that no matter what happens, we'll face it together. Tell me how happy you are that we've met.

"I-um-I just want you to know I'm behind you one hundred percent."

Two silent minutes later, he pulled to a stop by the main entrance to MCB. Sarah thanked him and momentarily considered sharing her own feelings. Finally she turned away. He had enough pressure on him as it was. If she was reading him wrong, she would just be adding to it.

She entered the campus through the security gate and headed toward the surgical building where she had left her bicycle. A short ride through the arboretum would be just the ticket before her long-overdue session in the dictation carrel. To settle or to fight? Her thoughts were racing. Distracted, she was just a few yards from the surgical building before she realized what had happened.

A bucket of paint-bright red enamel-had been poured over her bike. Tied onto the seat was a rag doll, also drenched in glistening scarlet. One of its arms had been ripped off and dropped on the ground. Its abdomen had been slashed open. Pinned to its chest was a crudely written sign that read