Natural Causes

CHAPTER 27

October 9

SCALPEL… SPONGE, PLEASE… SCOPE READY, please… How're you doing, Kristen? Are you feeling any of this?… Excellent, that's excellent… Do you still want to watch this procedure on the monitor?… All right then. Here we go…"

The young woman on the operating table, a mother of three, had begged for local rather than general anesthesia. Although general was the norm, Sarah had agreed. She had done her first tubal ligation by laparoscopy late in her first year of residency. That procedure had gone without a hitch, as had the twenty or twenty-five she had done since then, three of them utilizing a local anesthetic with heavy sedation. She was a damn good surgeon. Technically and clinically one of the best, if not the best, her training program had ever had. Why then had her life in the hospital become such hell?

"Okay, Kristen. What you're looking at are your in-sides. There's a small but very powerful light at the tip of this laparoscope. Right next to the light source is a fiber optic pickup that can take light and actually make it bend around corners. The fiber optics carry the images back to this eyepiece and also to the television monitor. As of this moment, your left ovary-that little pink thing in the middle of the screen-is a star! Amazing, huh?"

Fiber optics. Sarah found herself momentarily wondering about the scientist responsible for the remarkable, revolutionary discovery. Worldwide communications forever changed. The frontiers of surgery pushed farther back perhaps than with any other single discovery since anesthesia. Had life rewarded the inventor? Was he rich? Was he at peace? Or had controversy, illness, or the machinations of others made things hard for him?

Sarah had inserted a bipolar cautery instrument through a small incision just over Kristen's pubis. Now, watching through the laparoscope, she guided the tips of the cautery unit around the narrow fallopian tube. Next she traced along the tube from where it entered the uterus to its fimbriated tip-the fringed end next to the ovary.

"Okay, Kristen, your tube's completely freed up. I'm going to grasp it with the little pincher on the cautery unit and burn it closed. If you still want to watch, you might actually see the fat cells in the tissue sizzle and pop. Then, just to be sure there are no little surprise tax deductions in your future, I'm going to repeat the procedure in a second spot as well, a bit closer to your uterus. The burns we're going to make will deaden the sensory nerves along with the tubal tissue, so there won't be much pain from that area after we're all done-if there's any pain at all…"

We're going to make… after we're all done… The phrases, used reflexively, now sounded as awkward as Sarah was feeling. She glanced over at the nurses. They used to love working with her; they'd talk and joke with her during cases. Now, whether they intended it or not, there was distance.

She and Matt had reported Andrew's murder to the police. But the one detective assigned to the case had failed to find Andrew's body or any evidence at all of foul play. He couldn't locate Tommy Sze-to or even turn up a witness willing to corroborate any part of their story. The malpractice case against her was proceeding along and, fueled by her unsubstantiated account of the night in Chinatown, was still receiving a goodly amount of media attention. There were any number of rumors circulating around the hospital grapevine. One of them had Andrew leaving his wife for Sarah, and then leaving for Australia when Sarah jilted him for another man. Another had Sarah killing Andrew after a lovers' quarrel and then making up the Chinese gang tale in case his body was ever found. It was terribly frustrating to know that without concrete proof of some sort, she was powerless to convince any doubter of the truth.

In the press, the publicity about Sarah and the Medical Center of Boston had ranged from disruptive to brutal. A nasty letter from the president of the Chinatown Neighborhood Association had been published in the Globe, calling her allegations about tongs and violence damaging to his community. In various publications and broadcasts, her motives had been questioned, as well as her morality, and even her sanity. Worst of all, nothing had changed. Absolutely nothing.

Desperate to clear Sarah's name, and his own suddenly shaky reputation, Matt had hired a private detective. After nearly three weeks and more than $2,000, the man had come up with essentially no more information than that Tommy Sze-to was no longer in Boston and possibly no longer in the country. Nobody in Chinatown to whom he spoke knew anything about Dr. Andrew Truscott.

"That's it, Kristen. A couple of Band-Aids and you're off to recovery," Sarah said. "Thank you all. Thank you very much."

There were a few mumbled replies, but no praise for a job that was, in fact, exceptionally well done. Sarah stripped off her gloves and rushed into the nurses' locker room, feeling quite alone and perilously close to tears. She still felt committed to staying at work and to seeing things through-more so than ever since Andrew's death. But it was doubtful she would ever again feel comfortable at MCB. Being up on pedestals the way most M.D.s were made them easy targets. She would never have believed how fragile a physician's reputation and professional respect could be. It was incredibly painful to realize that more than two years of consistently good work-of always staying the extra hour, of always helping out when help was needed-were no real match for baseless rumor and innuendo.

She changed into fresh scrubs and her clinic coat, and stopped by the mail room to check her cubby. Among the pathology reports and copies of operative dictations, there was a note from Rosa Suarez, dated that morning, asking Sarah to get in touch with her. There was also a letter from the chairman of the hospital board of trustees, sent out via a computer-generated mailing sticker. The envelope was indistinguishable from those she frequently received announcing a staff/trustee tea, or requesting an update on her continuing education activities. The contents of the envelope, however, were hardly routine. The letter, signed by some typist in lieu of the board chairman, politely informed Sarah that due to the confusion and uncertainty surrounding her and her future, the professional conduct subcommittee of the board had requested OB/Gyn department head Dr. Randall Snyder to submit an alternate recommendation for the position of next year's chief resident.

"Damn!" Sarah shoved the letter in her clinic coat pocket and pounded her fist on the counter.

"Damn what?"

Eli Blankenship, his massive pate gleaming beneath the fluorescent light, smiled down at her. The sight of him immediately softened Sarah's anger. Throughout her ordeal, the medical chief had been one of the few constants at the hospital-always upbeat and encouraging; always applying his incredible intellect to her problems. There was no doubt, he had told her, that the story she and Matt told about Tommy Sze-to and Andrew Truscott was perfectly true. Any real student of mysteries would have known that, he said. Their account was simply too far out, too rough around the edges, to be anything other than fact.

"Mornin', Dr. Blankenship," the mail clerk said, handing over a huge stack of announcements, lab reports, journals, and magazines.

"G'morning to you, Tate. How's the Mrs.?"

"Still doin' great, thanks to you."

Blankenship smiled his pleasure and led Sarah away from the window.

"What's going on?" he asked.

She pulled out the letter from the hospital trustees and passed it over.

Blankenship read it in seconds.

"This is ridiculous," he exclaimed. "Rob McCormick and the rest of those fops on the board of trustees spend so much time worrying about appearances that they forget about accomplishments. Ergo, they have none. Idiots. Sarah, don't we have a meeting scheduled with you and your lawyer?"

"Yes, sir. Tomorrow evening."

"Well, I promise you I shall have spoken with McCormick by then. I can't guarantee you a reversal of his position, but I can be very persuasive when I must be. I also promise you a lengthy dissertation on DIC. I've become quite an expert on the condition. I feel strongly that some force other than or in addition to your prenatal supplements is at work. And I swear, we're going to find out what it is." He studied the anger and frustration in her eyes. "Sarah, you must keep your chin up through all this. You have a good deal more support around this hospital than you might think, including, as far as I can tell, Dr. Snyder. I'd be surprised if he had anything to do with this letter."

"How could he not?" Sarah asked. "Just a few months ago he was offering me a partnership. Now he's as chilly and formal as can be. I get the feeling that most folks around here, including Dr. Snyder, would be happy if I would just dry up and blow away."

"But you're not going to, right?"

"No, Dr. Blankenship, I'm not. I'm not because regardless of what most people seem to be thinking, I don't believe I've done anything wrong-not to those three women, and not to Andrew."

Blankenship put a reassuring arm around her shoulders.

"We are going to get to the bottom of all this," he said with firm conviction. "We are going to find out what afflicted those women, and we are going to find out who was responsible for Andrew Truscott's death. Something is going to break for us soon, Sarah. I sense it in my gut." He patted his sumo wrestler's midsection. "Which, incidentally, is hardly the most sensitive part of me. And meanwhile, I intend to do what I can to ensure that no one in this hospital takes action against you because of what they believe might be true."

"Thank you," Sarah said. "Thank you for everything."

"Okay, then," Blankenship said. "I'll see you tomorrow evening-hopefully with some good news from that damn board of trustees. Where are you headed now?"

"To give Rosa Suarez a call. Apparently she's got something she wants to talk to me about."

"Well, you can report on whatever it is tomorrow night," Blankenship said. "Or better still, perhaps you can talk our secretive epidemiologist into coming and reporting to us herself."

"Perhaps I can," Sarah mused, feeling more centered and determined than she had in weeks. "Perhaps I can at that."

• • •

"Rosa, what do you mean you've been taken off the investigation?"

Seated on a maple rocker by the foot of the bed in Rosa Suarez's room, Sarah stared at the older woman incredulously.

"I told you before that my supervisor and I don't see eye to eye much of the time."

"That study you did in San Francisco."

"Precisely."

"But your data were altered."

"He doesn't believe that. Anyhow, he's cited my lack of progress and the absence of any further cases of DIG, and he's sent me back to the library until my retirement in four months. For the time being, I will not be replaced on the project."

"That's terrible." Sarah felt a knot of panic in her chest. She had hoped, believed, that the impressive, diligent little woman would somehow solve the mystery that was threatening her career. "After the things you told me, I really had high hopes for some sort of breakthrough. Now you're leaving. I just-"

Rosa Suarez stopped her with a raised hand. She then sat down on the edge of the bed, her gaze leveled at Sarah.

"There has been a breakthrough, Sarah," she said. "And I am most assuredly not leaving."

"But-"

"I had about six weeks' worth of unused sick time. So as of today, I am on medical leave, recuperating from a slipped disk. An orthopedic friend of ours who owed me a favor has kindly supplied the official documentation of my plight."

Sarah's emotional roller coaster began another upward swing.

"Thank you," she said hoarsely. "Thank you for not giving up. But I don't understand. How can your department head stop the investigation if there's been a breakthrough?"

"Because," Rosa said grinning, "he doesn't know about it. And he won't know about it until it is airtight and backed up twice over. I sense that while the U.S. military doesn't seem to be involved here as it was in San Francisco, some very powerful and resourceful folks might be."

"Tell me."

"The problem you have faced is two-pronged. First, there have been no DIC cases found that are unrelated to you. And second, the three DIC cases from your hospital have no major risk factors in common other than your herbal supplement."

"Yes, I understand that."

"Well, after many dead ends, I have unearthed another, most significant factor that our three DIC cases had in common."

"Namely?" Sarah asked excitedly.

"Namely, their weight."

It took no more than fifteen minutes for Rosa to describe the efforts that culminated with her discovery of Constanza Hidalgo's diary and the revelation of the girl's incredible weight loss, achieved with some sort of powder from a "foreign" MCB doctor, referred to in the diary only as "Dr. S."

"Armed with that information," she explained, "I retraced my steps through Alethea Worthington's past and finally through Lisa Summer's. It has taken a lot more time than I would have liked, because Alethea's family is just about nonexistent. And Lisa and her father have been out of the country for much of the past month. But what I've learned is more than intriguing. Alethea once had a horrific weight problem. Two hundred and forty pounds, one of her neighbors told me. Here are a couple of photocopies I made from her high school yearbook. This is Alethea, here. As you can see, she was quite large."

"Do we know if she took the same diet powder as Connie Hidalgo?" Sarah asked.

"Not exactly. But I have been able to ascertain that her weight loss occurred about four and one-half years ago-the same approximate time as Connie's. And the pages covering that time have been torn from her MCB chart as well."

"And you haven't told anyone about this?"

Rosa shook her head.

"After what happened in San Francisco, it's not even easy for me to share this information with you," she said. "But I know how much you've suffered. And although I hardly consider myself an expert on the subject of who to trust, I do trust you."

"Thank you," Sarah said. "Oh, God, thank you so much."

Blankenship was right. A break was imminent.

"There's more," Rosa said as if reading her thoughts. "Much more."

"Lisa?"

"Exactly. I haven't spoken to her directly, but I did make several visits to her Boston home. Her housemates were most suspicious of me, especially in view of the lawsuit against you. But finally they came around. Here are some pictures they gave me of her. The top few are from when she first moved into the group house. The last couple are more recent."

"She must be fifty pounds lighter in these later photos!"

"Seventy, actually," Rosa said. "Only one of the people in the house was there four and a half years ago when she lost the weight, but he's sure she did it with a powder of some sort. The same time, probably the same powder. Sarah, we are not dealing with coincidence here. I promise you we're not."

"Did you check Lisa's hospital record for missing pages?"

"There's no physical evidence that pages were removed, but that means nothing. There are no pages from that whole year."

"Rosa, this is a breakthrough. Do you have any idea who this Dr. S. might be?"

"Some. The clues provided in Constanza Hidalgo's diary suggested a male, possibly foreign. I added to that equation the time frame over which this fascinating powder was dispensed, and the initial 'S.' Then I checked through the records at personnel." She searched through her portfolio and withdrew a spiral bound notebook. "Assuming the parameters I chose are all correct, there are three good candidates. I wasn't quite certain what to do with her impression that the man was foreign. She did not seem that sure. The first name of the three is still on the staff at MCB. The other two haven't been for several years."

She passed the notebook over to Sarah.

"Gilberto Santiago, M.D… Sun Soon, M.D., Ph.D… Pramod Singh, D.Med. (Ayurv.)," Sarah read. "No bells for any of them. Not even Santiago."

"What does that mean?" Rosa asked. "That last man's degree?"

"Probably Doctor of Ayurvedic Medicine. It's an ancient Indian healing system-" Her voice fell away.

"What is it, Sarah? You look like you've just seen a ghost."

Slowly Sarah's eyes came up to meet hers. "What I may have just seen, Rosa, is the truth. I need to make a call."

"Use that phone right there. If the call is long distance, just use this credit card. I'll be long retired before anyone realizes that a woman on sick leave in Atlanta made this call from Boston."

The best Sarah could do to reach Annalee Ettinger was to leave an urgent message with the operator at Xanadu. She gave Rosa's name rather than her own and stressed several times the importance of the situation.

"Now," Rosa said after Sarah had hung up, "it seems that it is your turn for explanations."

Sarah shared what little she knew of Pramod Singh and the Ayurvedic Herbal Weight Loss System. She had sketched Peter Ettinger as fairly as she could, but Rosa quickly picked up on the tension the man brought to her voice.

"He sounds to me like a textbook megalomaniac," Rosa observed.

"I always knew he was prideful. But I considered him very much a visionary."

"My experience is that both are often stepping-stones on the road to megalomania."

When the phone rang Sarah reached instantly for the receiver.

"Dr. Rosa Suarez, please?"

Sarah recognized Annalee's rich alto. "Annalee, it's Sarah. How are you doing?"

"Hey, what a nice surprise. We are doing beautifully, thank you. The baby's getting cranked up for the big plunge."

"How much longer?"

"Six, seven weeks. For my money, tomorrow would be fine. Peter's got two midwives from Mali hovering around me all the time. Since I've had no problems whatsoever, they spend all their time cooking and cleaning and bumping into one another."

"Annalee, I'm so excited for you."

"Yeah. Peter's really come through this time. So, what's this urgent stuff? And who's Rosa Suarez?"

"There really is a Dr. Suarez. In fact, she's right here. She's-she's been studying weight loss programs for the government. I told her about Peter's program and about Dr. Singh."

"Those two are really raking it in," Annalee said. "Peter's added a whole new shipping area to this place. Twenty or so employees just packing it up an' shipping it out. It seems half of America is overweight and watching late-night TV. And every one of them is looking to walk the high road to slimness, as Peter puts it."

"Annalee, do you have any idea how we can get in touch with Dr. Singh?"

"None. He comes by every few weeks with a new supply of the vitamin caps that go with each order. But I almost never see him. I can try asking Peter without telling him it's for you. He's furious that your lawyer has subpoenaed him to testify."

"Tough," Sarah murmured. "Listen, Annalee. Don't get yourself in any trouble over this. But it would be a huge help to us to speak with Dr. Singh."

"I'll see what I can do. Is that it?"

"Could you send me out some of that powder?"

"You mean you don't want to pay forty-nine ninety-five by check or major credit card, and allow three to six weeks for delivery, sorry no CODs? Well, I think I can handle that."

Sarah gave Annalee Rosa's address, thanked her, and again begged her not to get into any conflict with her father. Then she sat staring out at the rich autumn afternoon.

"Rosa, you really believe this weight loss powder might be connected with the DIC cases?" she asked.

"Assuming the facts as we have them are true," Rosa replied, "it is certainly as likely a cause as your prenatal supplement."

"It makes no sense."

"That's because the facts as we have them are clearly not all the facts. I'd like to see one of those infomercials you told me about."

"I'll get to work on that. My lawyer has some connections in TV. I'll see if he can get hold of a tape of one for tomorrow night's progress meeting. By the way, are you coming?"

"I wasn't planning on it. But now that I'm officially off the case, I think I will. Especially if one of the feature attractions is that tape. Besides, with what you told me, and what I heard over the phone just now, I think the stakes might have just been raised."

"I don't understand."

"Your friend Annalee took that diet powder, yes?"

"Yes."

"And she's due to go into labor in just a few weeks, yes?"

"I didn't even think of that."

"With all you've had to process this past hour, that's understandable. Besides, there's time. Not a whole lot of time, but some. I'll see you tomorrow evening at your lawyer's office."

Sarah hugged Rosa long and lovingly, and promised not to share what they had learned with anyone. Then she hurried down the stairs and back to MCB. The roller coaster was cranking upward again. And she was feeling more excited and energized than at any time in weeks.

Alone in her room, seated cross-legged on her bed, Rosa Suarez tried to incorporate the new information with what she already knew. Sarah was right. Blaming the DIC cases on the short-term ingestion of an herbal powder years before made no real sense… yet. It also did not connect in any obvious way with the missing hospital chart pages. Scratching lines and drawing arrows on her pad, Rosa strained to put all of the facts in order until she felt her concentration begin to evaporate. Exhausted, she sank down onto the pillow. Nothing was solid. Nothing. It was like trying to link up puzzle pieces made of Jell-O. She wanted desperately just to close it all off and go to sleep. Instead, she called Ken Mulholland in the CDC lab.

"Hey, Rosa, how's your back?" he asked.

Just hearing his voice brought a smile. Of all those at work, only Ken knew where she was and how she had gotten the time off.

"Worse every day, thank goodness," she said. "Have you got anything for me?"

"Yes and no. I don't know what it is with you and your boss, but a memo has come down that your investigation is officially closed. No one in our department is to be devoting time to it. My section chief followed up the notice with a visit to me. He knows I've been helping you. I… um… I've been firmly instructed."

"You mean warned. My chief really wants to be sure I fail this one. I'm sorry, Ken. Listen, don't take any chances. But I really need your help."

"And you've got it. You aren't the only person around here with sick time coming, you know. If I have to, I'll just get the flu and work with you up there. You did say you had access to equipment."

"Not like yours, but yes. A whole lab, complete with technician. Now, what have you got?"

"We've got enough to say your girl had some sort of DNA virus in her blood at the time it was drawn last July. But we don't have enough growth to classify or type it. And we're not going to, either. Our last specimen burned out yesterday. If you want us to go further, we're going to need more serum."

"Then we'll just have to find a way to get you some."

"And I'll need the name and number of your technician up there. I may have to have him do the cultures."

"Anything you want that's within my power, you get."

"That important, huh?"

"I'm sitting on Vesuvius here, Ken. I swear I am. And soon, very soon, I think it's going to blow."