Natural Causes

CHAPTER 28

October 10

THIS IS JOHNNY NORMAN SPEAKING TO YOU FROM Television City, asking you, our live studio audience, and you, our millions of home viewers: Are you ready to change your lives for the better?" "Yes!"

"Are you ready to catch the brass ring and finally hold on to it?"

"Yes!"

"Are you ready to walk the High Road to Slimness and Health?"

"Yes!"

"A little louder, please. I didn't quite hear you."

"Well, all right, then. You've come to the right place, so let's get started. It's time once again to say hello to your guide on the High Road-the man who coached his club to two Super Bowls but couldn't quite coach himself away from the ice cream bowl. Let's have a big, Herbal Weight Loss greeting for Coach Tom 'Bear' Griswold!"

Tall, granite jawed, and slender as a sapling, Coach Tom Griswold bounded onto the stage, clapping his hands the way he might have following one of his fabled half-time harangues. Packed into the waiting room of Matt's office, the viewers watched the taped infomercial in almost morbid fascination as Griswold recited his life story, accompanied by startling pictures of his expanding career, reputation, and waistline.

"I had more money in the bank than I'd ever want to spend, a family that loved me, a great career in broadcasting, and at almost three hundred pounds, a life expectancy that my doctors were measuring in months! At first they calmly advised me to lose weight. Then they got more threatening. They told me that unless I did lose that weight, I might as well stop buying green bananas…" Burst of laughter. "Well, look at me now!"

He spun around in a graceless pirouette, to the accompaniment of screaming cheers from the adoring studio audience.

"Amazing," Glenn Paris murmured in awe.

"No, America," Eli Blankenship said. "The country where you can't be too rich or too thin."

"And now, Johnny," the coach went on, "before we meet the man responsible for bringing this remarkable discovery to America, give us the grand total to date."

A huge, garishly lit tote board filled the screen, its blank spaces awaiting Johnny Norman's grand announcement.

"Okay, Coach. Here we go. To date, the number of people around the country and around the world who have joined us on the High Road to Slimness and Health is: FIVE HUNDRED AND SEVENTY-ONE THOUSAND, SIX HUNDRED AND NINETEEN!" Exuberant applause.

"At forty-nine ninety-five apiece," attorney Arnold Hayden added. "Most incredible. And how long have they been marketing this stuff?"

"About six months," Matt said.

"But don't forget, Arnold," Colin Smith reminded. "From all indications, this stuff really works. Truthfully, now. Wouldn't you pay fifty bucks to get rid of that Michelin of yours-especially if you didn't have to knock yourself out dieting?"

"Thank you, Johnny Norman," Coach Griswold was saying. "Now I want to introduce you all to the man who has put years back into my life, to say nothing of what he has done for my tennis game and-my beautiful wife Sherry will be quick to tell you-for my love life as well." A few titillated oohs followed. "But first, let's hear a song from one of the true daughters of the Ayurvedic Herbal Weight Loss System. Betty Wilson was a Broadway star at two hundred and thirty pounds. But she'll be the first to tell you how much she hated looking in the mirror. Today she's still a star. But just look at what she sees in that mirror now." Whistles and cheers for the singer, whose blue-sequined gown seemed painted on her perfectly proportioned, size-six body. "Ladies and gentlemen, singing the title song from her new Broadway show, Miss Betty Wilson."

Matt fast-forwarded through the song while the others in the waiting room muttered phrases of disbelief or of grudging admiration. Then the coach, after a syrupy ninety-second introduction, brought Peter Ettinger onstage to a standing ovation from the studio audience. At the sight of him, Sarah felt the muscles of her jaws harden. But even she had to admit that the man, who looked and seemed larger than life in most circumstances, was even more imposing on TV.

Striding from one side of the sound stage to the other with the graceful elegance of a giraffe, Peter recited the meticulously documented tale of his discovery of Dr. Pramod Singh of New Delhi, India, and the man's remarkable Herbal Weight Loss System. Next came a series of testimonials from various carefully selected clients, all of whom were failures on other programs. Their moving tributes were interwoven with a step-by-step introduction to Ayurvedic medicine, tracing its development over thousands of years, from the earliest recorded history, through various periods of abandonment and acceptance, to an incredible resurgence in the 1980s and '90s.

And finally, against a backdrop that was clearly India, came a taped message from Pramod Singh himself. The secret herbs included in the Ayurvedic Herbal Weight Loss System were only part of the story, he stated. Although to be sure, a most major part.

"Use our powder properly, eat in moderation, avoid the five forbidden foods," he advised in a musical accent, "and you will lose the weight you wish no matter what else you do. Meditate five minutes each day, and follow the other basic principles of Ayurveda explained in your manual, and you will know many new freedoms beyond simply being thin. You will know freedom of the spirit. I am sorry I cannot be with you all in person, but I am here supervising the harvesting of the twelve crucial, natural components of our powder. I look forward to seeing you all in a few weeks. And now, back to Dr. Peter Ettinger."

"Doctor of what?" Matt asked, switching off the tape.

"Peter Ettinger has a number of degrees from a number of institutes," Sarah said. "But I honestly don't know if any of them is a Ph.D. from a traditional university."

"You don't sound as if you like the man much," Colin Smith said.

"He's a pompous ass if you ask me," Glenn Paris said.

Sarah smiled inwardly at the notion that almost certainly Peter would have chosen the exact same words to describe the hospital CEO.

"Well," Matt said, "I think we ought to get started. I've already said my piece by reasserting that the account of the nightmarish night Sarah and I survived in Chinatown is quite factual, and that rumors or no rumors, body or no body, Andrew Truscott is quite dead. The police have turned up nothing new. Neither did a private detective I hired-a very good one. We haven't given up trying to prove our story, but we're also at a loss about where to go from here. Any suggestions?… Well, then, unless there are any questions, I propose we move on.

"So far in this business, Jeremy Mallon's been scoring all the points, and we have been very much on the defensive. Tomorrow, with the formal deposition of Peter Ettinger, I hope that status will change. Before I ran the video, Mrs. Suarez gave you all some idea of what sort of things we'll be trying to pin him down on. I hope she'll go into more detail in just a bit. First, though, I'd like to hear from Dr. Snyder and Dr. Blankenship. Any order will be fine."

Sarah caught Matt's eye for the briefest moment. He was self-assured and very much in control of the meeting. How far he had come since that first session in the Milsap Room at MCB. Silently she longed for the day when she could be with him openly as his friend and lover-the day when Willis Grayson, his anger and his lawyers, would be a thing of their past.

"Suppose I go first, Eli," Randall Snyder offered. "What I have to say won't take very long." He cleared his throat. "I've had the American College of OB/Gyn send letters of inquiry to the heads of every obstetrics department in the country, looking for any unexplained cases of DIC in pregnancy or labor. So far there hasn't been one where there wasn't at least some predisposing thing going on-abruptio placentae, infection, toxemia, sickle cell disease, in utero fetal demise. Not one. I must say, Sarah, having sent the letters and made the dozens of follow-up calls, the lack of any DIC patient who did not take your prenatal supplement remains most disturbing and, if I may say so, most incriminating."

"Thank you," Matt said coolly. "You may say anything you wish. Someone has gone to a great deal of trouble, and caused a great deal of pain, to make Sarah's prenatal supplement appear responsible for those cases. That fact, more than any other, suggests to me that it is not. Dr. Blankenship?"

The chief of medicine tapped a pencil thoughtfully against his palm before picking up the sheaf of notes he had set on the floor beside his seat.

"Well," he said finally, "my assignment was to become one of the world's leading experts on disseminated intravascular coagulopathy. It turns out that this was not nearly the humbling task it first seemed it would be. I have discovered that everyone in the clotting world knows when DIC occurs but absolutely nobody knows why. The more common name for this condition is consumptive coagulopathy, because while it is going on, all of the body's coagulation factors get consumed-used up in those tiny, abnormal clots. In its worst form, DIC is almost universally fatal. This fact makes the accomplishment of Defendant Sarah in saving the life of Plaintiff Lisa all the more remarkable. People who have DIC as badly as the plaintiff simply don't make it.

"Would I testify to that on the witness stand, Mr. Daniels? You betcha I would." His manner and tone, which had been quite matter-of-fact, intensified dramatically. "I would do anything I honestly could to help. I am quite disturbed about this case and the lack of overwhelming support Sarah has received from our institution. We made a promise to her and to ourselves months ago when we first met that we would present a unified front, and that Sarah would be considered innocent until proven-proven-otherwise. Randall, Glenn, I've spoken with Rob McCormick about this letter he sent out requesting Sarah's replacement as chief OB resident next year. He says he'll be happy to retract it for the time being if you two are in agreement to do so."

"Eli," Paris said, "this is hardly the place or time to-"

"Glenn, please. I don't want to start a war here or embarrass Sarah. But if we're going to present the unified front we agreed to, then we've got to get McCormick to back off. Yes?"

Paris's annoyance was apparent. Whether or not he agreed with Blankenship's request, he was uncomfortable with being told what to do.

Finally, after a long pause during which he regained his composure, he grinned and nodded.

"Right you are, Eli. I don't know where Rob got the idea to do what he did, but I'll call him tomorrow and set him straight."

"Excellent. Randall?"

"No problem," Snyder responded unenthusiastically.

"In that case, on with the show," Blankenship said. "There's one last category of causes of DIC I thought I might mention, and that's poisons. The injection of the naturally occurring clotting agent, thrombin, can cause a DIC-type picture, as can certain snake venoms. The toxin found in at least five different species of crotalids can cause lethal DIC."

"Crotalids?" Matt asked.

"Sorry, Matt. Rattlesnakes."

"But I don't believe the poisons you describe are effective by mouth," Sarah said. "And Lisa was at home when her DIC began. I can't imagine she could have received an injection of any sort."

"Or been bitten by a diamondback." Arnold Hayden guffawed.

No one else laughed.

"As I said," Blankenship replied, "I only included the poison possibility for completeness. There may be an oral toxin we don't know about that can cause DIC. Maybe someone has such a substance and is on a vendetta against our hospital or the obstetrics department. At this point, who knows?"

"That's all we need," Glenn Paris groaned. "A psycho."

"Any questions for Eli?" Matt asked. "Okay, then. Rosa, you've kindly shared some significant developments in your work. Can you sum up what your conclusions are at this point?"

Earlier in the day, Sarah had spoken with Rosa for over an hour. The epidemiologist felt torn between the desperate need for all concerned to share information and ideas and her deep-seated bias against disclosing research still in progress. Until her results were checked, double-checked, and locked away, she felt uncomfortable trusting anyone with the details of her work. In the end, nothing was really resolved between them except that Rosa would attend the meeting and disclose as much data and theory as she felt comfortable in doing. No more.

"I must first stress what Dr. Snyder has already brought up," Rosa began. "The connection, whether significant or not, between the three DIC cases and the ingestion of Sarah's prenatal supplement is quite firmly established. I should add, however, that my laboratory work and research does not suggest a direct toxic relationship between DIC and the ingestion of any herb. An allergy of some sort to one of the components, or perhaps contamination with a toxin, would be much better bets. But I have serious doubts about either of those possibilities as well. As has also been mentioned, discovery of a labor patient with DIC who has never taken herbal prenatal vitamins would effectively absolve Dr. Baldwin of any responsibility."

"What do you make of this Herbal Weight Loss product?" Paris asked.

"I was hoping you'd be able to help us there, Mr. Paris," Rosa said. "This Pramod Singh, what can you tell us about him?"

"Not very much, really. Six years ago, when I came to MCB, I made the decision to incorporate various aspects of what is called holistic medicine into our hospital. I was looking for an identity for MCB-something that would make the public want to come to us.

"Pramod Singh was a highly respected Ayurvedic physician who heard about what we were trying to do and contacted me. I put him on salary, and he worked in our outpatient department for almost two years. Then he just quit. No notice. Not even a letter of explanation. Just a one-sentence note. The next time I heard about him was when I saw him on one of these dumb programs.

"I had originally hoped Singh might be part of a larger holistic department at the hospital. But until our McGrath Foundation grant, we've been on such thin financial ice that I couldn't guarantee anything. By the way, as long as I'm on the subject, I hope you'll all be my guests at the demolition of the Chilton Building the end of the month. It will kick off the largest construction project in MCB history. We'll be having a champagne reception just before the big bang. I also hope some of you will buy chances in the raffle we're running to be the one to actually push the button. A once-in-a-lifetime opportunity, if I do say so myself."

"Did any of you know Dr. Singh was using this weight loss powder when he was at MCB?" Rosa asked, pointedly ignoring Paris's bombast. "Well, you might ask around."

"Do you really think this product and the DIC cases are connected?" Snyder asked.

"Remember, Dr. Snyder," Rosa said. "My stock in trade is probabilities. The more times a connection happens, the more likely it is to be significant. Now, to the many other commonalities I have uncovered among our three cases, we can most probably add the exposure four or five years ago to Dr. Singh and his product. But remember, as Mr. Paris just explained, he purposely established a unique facility where products like Singh's powder or Sarah's prenatal supplement might exist. So in the end, our three women's choosing to be cared for at the Medical Center of Boston may prove to be the most significant commonality of all."

"God, that's all we need!" Paris exclaimed. "Rosa, you're not planning to speak to the press about this, are you?"

Rosa smiled at the notion.

"It was like pulling teeth for Dr. Baldwin just to get me to speak to you at all," she said. "I'm not inclined to trust any wider audience with my findings, at least not yet."

"Okay, everyone," Matt said. "If there's no other business, we'll call it quits and I'll finish preparing for our first offensive. Arnold, the Ettinger deposition's going to be taken at eleven at Mallon's office. You're welcome to attend."

"I just might," the lawyer responded.

"Give 'em hell, Daniels," Paris said.

One by one the MCB group filed out, until only Matt, Sarah, and Rosa remained.

"I thought the session went very well, Matt," Sarah said.

"Come on. We got almost no place, and you know it." He paced to the window, his fists clenched in frustration. "Parts of hospital charts missing; Chinese tongs getting paid to frame you and a helpless old man; some nervous, little, stuttering weirdo following you. Somebody, someplace knows what in the hell is going on around here. And I'm getting sick and tired of it not being me."

"I might be able to help a little bit," Rosa said softly.

"What are you saying?" Matt stopped pacing.

"There's something I know that I haven't spoken about at all. I've decided to share it with you two but, for now at least, with no one else. Please don't speak of this to anyone."

Matt glanced over at Sarah.

"You have our word," he said.

"Okay. Lisa Grayson had some sort of DNA virus in her bloodstream at the time she had her crisis. My lab person doesn't know exactly what it is, but he does know it's not usual. He wants some more serum from Lisa."

"Even though she has no DIC symptoms?" Sarah asked.

"He'll take what he can get. If nothing grows, he'll look for antibodies and see if he can back his way into an identification. He's very good at what he does. One of the best. But I'm afraid we can't get to Lisa without going through this attorney of hers."

"In that case, maybe we should ask him before we begin to dissect Ettinger," Matt said.

"It's very important," Rosa said. "I don't believe either the herbal weight loss powder or Sarah's vitamins are solely responsible for what's happened. They may both be playing a role, but an infection of some sort makes more sense. I have a terrible, terrible feeling that unless we get to the bottom of things soon, more women are going to die."

Fifty miles to the west, Annalee Ettinger lay on her canopied bed, nestled in the arms of her fiance, Taylor.

"Tay," she said. "It's happening again. Here, feel right here. I swear I'm having some contractions."