Bitter Medicine

by Sara Paretsky

  “You want Civics One-oh-one? No, they’re appointed by the governor and approved by the legislature.”

  “I see.” I studied the rest of the fruit. I had an inkling of an idea. It would mean going back to Friendship tonight to check out… unless… let your fingers do the walking.

  “You still there?” Murray demanded.

  “Yeah, and the unit charges are ticking away. Look, someone recommends these people, right? I mean, does Big Jim call the state medical society and say, tell me who your ten best people in public health are and I’ll pick one to be king of Human Resources?”

  “Get real, Warshawski. This here is Illinois. Some hack down in Springfield who’s on the public-health committee, or whatever legislative name they give it, has a pal who wants a job and he—” He broke off, suddenly. “I see. The lumbering Swede catches up finally with the nimble-brained Polack. I’ll try to see you tonight at Dortmunder’s.”

  He hung up without another word. I smiled sardonically and dialed the Sixth Area Headquarters. Rawlings came on the line immediately.

  “Where in hell are you, Warshawski? I thought I told you not to leave the jurisdiction.”

  “Sorry—I went to the burbs last night and stayed up too late to drive home. Didn’t want one of your pals in traffic patrol prying my body away from a lamppost on the Kennedy. What’s up?”

  “Just thought you’d like to know, Ms. Warshawski, that since your gun hasn’t been fired lately we don’t think you used it to kill Fabiano Hernandez.”

  “What a relief. It’s been keeping me up nights. Anything on Sergio?”

  He made a disgusted noise. “He’s got an airtight alibi. Not that that means anything. But we took his little place on Washtenaw apart. Found enough crack to maybe get a judge to agree he ain’t a model citizen, but no Smith and Wesson.”

  I remembered the little place on Washtenaw all too clearly. I wished I’d been able to help strip it and said as much to Rawlings.

  “I didn’t realize I had anything to be thankful for until just now. Anyway, come by the division and pick up your gun if you want it. And in the future, if you’re spending a night away from Chicago, I want to know about it.”

  “You mean, forever and ever? Like if I go to England in the spring, you want to know about—” The receiver slammed in my ear before I could finish the sentence. Some people, nothing you do can please them.

  I smelled the shirt I’d been wearing yesterday. If I put it back on again I wasn’t sure I’d be able to stand the drive home. Marriott’s little guide to hotel services listed a “Galleria of shops.” I chose a sportswear store and explained my predicament.

  “Could you send someone up with two or three tops—medium, or size twelve? Red, yellow, white—anything in those colors?”

  They were happy to help out. Half an hour later, dressed in a white ribbed T-shirt and black jeans, with my smelly business clothes stuffed into a laundry bag, I settled the bill and headed back to the city. My night’s rest and all the little extras came to over two hundred dollars. Thank goodness for the box factory in Downers Grove—something was going to have to come in before the American Express bill arrived.

  My first stop in town was to pick up my gun at the police station. Rawlings wasn’t in, but he’d left word with the desk sergeant. I had to show three pieces of identification and sign a couple of receipts, which suited me fine. I didn’t want anyone and his dog Rover able to pick up a handgun at whim. Especially my handgun. Although someone apparently had—or at least its twin brother.

  I was still wearing high heels and panty hose under my new jeans, so I stopped at home to change into running shoes. I took a few extra minutes to arrange for a cleaning service to come straighten out my place, then headed downtown—I couldn’t concentrate on my work in the middle of such squalor.

  My office faces east. It was relatively cool in the mid-afternoon heat. Instead of turning on the air conditioner, I opened a window to let in the city air and smells. The clattering roar of the Wabash L underneath made a pleasant backdrop for my work. Before getting started, I dialed the number I’d copied from Alan Humphries’s file on Consuelo. No answer.

  I pulled the papers from the portfolio briefcase and divided them into neat piles: the medical material for Lotty, the financial and administrative documents for me. As I sorted, I sang snatches of “Whistle While You Work,” which filled me with the happy industry of Snow White and her pals.

  I went through Peter’s employment agreement first, since that was only a few pages long. A base salary of $150,000 a year to join Friendship as their top obstetrics man. Plus two percent of all profits accruing from the hospital’s obstetrics service. Plus profit sharing from the Schaumburg facility as a whole—at a rate to vary based on his own contributions to the hospital and the total number of staff. And, as a sweetener, a little chunk of change from the national franchise. Nice work if you could get it.

  The letter was signed by Garth Hollingshead, chairman of the national company. In a concluding paragraph, Hollingshead commented:

  “Your recommendations from Northwestern tell us you were the top man to graduate in your year. They offer similar comments on the skill you showed in three years of obstetrical residency. We at Friendship can all understand your desire to spend additional time training in perinatology, but believe the facilities we can offer you to do your training on the job, as it were, will not be equaled anywhere in the country.”

  Well, gosh. If someone wrote me a letter like that, offering me that kind of money, with profit sharing thrown in, I’d have a hard time turning it down. Ms. Warshawski, as an unparalleled thorn in the side of the police, with deductive capabilities well above the average, we would like you to be a private detective for twenty or thirty thousand a year, plus no health insurance, plus getting your face cut open and your apartment burglarized every now and then.

  I turned to the material I’d taken from Humphries’s office. These documented the formal organization of the hospital. Humphries was head of Friendship V, with a salary and bonus guaranteed to equal two hundred thousand in any given year in which the hospital met its profit targets. Profit sharing kicked in for any amounts above plan. I pursed my lips in a silent whistle.

  Friendship was a closely held corporation. Most of its hospitals were in Sunbelt states where certificates of need were not required. In the Northeast and Midwest, most states required their approval before anyone—town, corporation, or anyone else—could start a new hospital or add a major new facility to an existing hospital. As a result, Friendship’s Schaumburg facility was its first in the Great Lakes area.

  As the afternoon wore on, I picked up a miscellany of useful knowledge. Friendship V, the chain’s eighteenth hospital, was the fifth it had built from scratch. When it acquired an existing facility it apparently kept the original name.

  Every hospital department had separate sales and profit goals set by an administrative committee made up of Humphries and the department heads. The national parent set overall goals for each facility. It was hard to keep reminding myself that sales in this context referred to patient care.

  Humphries sent out periodic administrative memos to the departments telling them how to work within federal guidelines, which set average lengths of stay and care for different conditions. Where Medicare or Medicaid reimbursement was involved, it was important that they not exceed the guidelines, since the hospital paid the difference.

  I wouldn’t have thought there’d be too much in the way of government-insured patients in the affluent northwest, but they apparently treated a fair number of older people. Humphries had detailed month-by-month statistics on who ran over and under the maximum reimbursed stay, with a note to one offender, heavily underscored, to “Please remember we are a for-profit institution.”

  By the end of the afternoon I had made my laborious way through the stack of files and reports I’d brought with me. I’d marked a few questions for Lotty, acronyms and special jargon, but for the mos
t part the documents were comprehensible corporate reports. They presented an approach to the practice of medicine that I personally found unappetizing, since it seemed to place the health of patients second to that of the organization. But Friendship didn’t seem involved in any direct malpractice, or any overt illegal finances—such as billing the government for more expensive procedures than it was performing.

  So Friendship was honest. That should please me in a world filled with corruption. Why wasn’t I happy? I’d gone on a fishing trip. I’d found Consuelo’s record for Lotty, even if it wasn’t a copy that could be used in court. What else had I expected? Blackmail by IckPiff that would make the hospital pay my ex-husband’s bill? Or did I just want a scapegoat for the frustrations and disasters of the last month?

  I tried to shrug away a faint sense of depression, but it stayed with me as I packed up the papers and headed north to the Dortmunder.

  28

  Falling to the Bottom Line

  Lotty brought Max Loewenthal, executive director of Beth Israel, to the Dortmunder with her. A short, sturdy man of sixty or so with curly white hair, he had been a widower for a number of years. He was in love with Lotty, whom he’d met after the war in London—he, too, was an Austrian refugee. He had asked her several times to marry him, but she always replied that she wasn’t the marrying type. Still, they shared season tickets to the opera and the symphony every year and she had traveled around England with him more than once.

  He stood up at my entrance, smiling at me with shrewd gray eyes. Murray hadn’t arrived yet. I told them we might expect him.

  “I thought Max could answer administrative questions if any arose,” Lotty explained.

  Lotty rarely drinks, but Max was knowledgeable about wines and pleased to have someone to share a bottle with. He picked out a ’75 Clos d’Estournel from the bins along the walls and had it opened. Max waved away the waitress, who knew Lotty and me well and was disposed to talk. None of us wanted to eat until we’d been through my cache.

  “I have Friendship’s file on Consuelo, although if you’re going to have it admitted in court you’ll have to order a copy through proper channels.” I pulled the two records on Consuelo from my briefcase and handed them to Lotty. “The typed one was the one locked in Humphries’s office and the handwritten one was in Peter Burgoyne’s desk file.”

  Lotty put on her black-rimmed glasses and studied the reports. She first read the typed copy, then went through Peter’s handwritten notes. Her heavy brows drew together and deep lines etched themselves around her mouth.

  I found I was holding my breath and reached for the wine. Max, equally intent, didn’t try to stop me from pouring before it had breathed properly.

  “Who is Dr. Abercrombie?” Lotty asked.

  “I don’t know. He’s the person in the report Peter says he tried calling?” I thought of the brochures I’d picked up in Peter’s office and fished them from my portfolio. They might list hospital staff.

  “Friendship: Your Full-Care Obstetrics Service” proclaimed a slickly printed piece. They had spent a lot of money on it—four-color, letterpress with photographs. The cover showed a woman nestling a newborn infant, a look of ineffable joy on her face. Inside, the copy proclaimed: “Giving birth: the most important experience of your life. Let us help you make it your most joyful experience as well.” I skimmed through the copy. “Most women give birth without complications of any kind. But if you need extra help before or during birth, our perinatologist is on call twenty-four hours a day.”

  At the bottom of the page, a serious but confident man held what looked like an electric blanket control against the abdomen of a pregnant woman. She gazed up at him trustingly. The caption read: “Keith Abercrombie, M.D., board-certified perinatologist, administers ultrasound to one of his patients.”

  I handed it over to Lotty, indicating the picture with my finger. “Translate, please?”

  She read the caption. “He’s using sound waves to make sure the baby is still moving, checking the heart-beat to make sure it’s normal. You can also estimate height and weight with these gadgets. Late in pregnancy you can usually tell sex as well.

  “The perinatologist is an obstetrician with a specialty in treating the complications of pregnancy. If your baby is born with problems, you’d get a specialist pediatrician in, a neonatologist. Consuelo needed a perinatologist. If he’d shown up, then little Victoria Charlotte might have made it long enough to get to the neonatologist, who also didn’t seem to be there.”

  She took off her glasses and laid them on the table beside the papers. “Dr. Burgoyne’s problem is obvious. Why he didn’t want me to see his case notes. What I don’t understand is why he didn’t throw them out—the typed report is explanatory without revealing overt negligence.”

  “Lotty. It may be obvious to you, but it isn’t to us. What are you talking about?” Max demanded. Unlike her, he still spoke with a pronounced Viennese accent. He reached for the reports and started looking through them.

  “In the typed report, they explain that Consuelo showed up as a nonambulatory emergency. She was beginning labor and she was comatose. They administered dextrose to try to restore her blood sugar and raise her blood pressure. They say in the typed report that they used ritodrine to try to retard labor. Then it became a trade-off on whether they could stop labor without killing her, so they went ahead and took the baby. Then she died, of complications of pregnancy. But Burgoyne’s handwritten notes tell a much different story.”

  “Yes, I see.” Loewenthal looked up from perusing Peter’s handwritten notes. “He spells the whole thing out, doesn’t he?”

  I thought I might scream with impatience. “Spell it out for me!”

  “What time did you get to the hospital?” Lotty asked me instead.

  I shook my head. “I can’t remember—it’s been almost a month.”

  “You’re a detective, a trained observer. Think.”

  I shut my eyes, recalling the hot day, the paint factory. “We got to the plant just at one. Fabiano’s appointment was at one and I had an eye on the dashboard clock—we were cutting it close. It might have been a quarter hour later that Consuelo started in labor. Say I spent fifteen minutes in the plant getting instructions on what hospital to use and how to find it. Another fifteen to drive there. So it must have been around one-forty-five when we got to Friendship.”

  “And yet at three o’clock they were just calling Abercrombie,” Max said. “So a good hour went by in which they didn’t do anything for her.”

  “So when I talked to that impossible woman in admissions, they weren’t treating her,” I said. “Goddamn it, I should have made a bigger stink at the time. They must have kept her waiting on that gurney for an hour while they debated treating her.”

  Lotty ignored that. “The point is, they say they gave her ritodrine. That’s the drug of choice today, and certainly what this Abercrombie should have done, if he’d been there. But Burgoyne’s notes say he gave her magnesium sulfate. That can cause heart failure; it did in Consuelo’s case. He notes that her heart stopped, they took the baby and revived Consuelo, but all the shocks her system had had that day were too much—her heart stopped again in the night and they couldn’t revive her.”

  Her brows furrowed together. “When Malcolm got there, he must have known what the problem was. But maybe he didn’t know right off that they weren’t using ritodrine. If the IV bag wasn’t clearly labeled…”

  Her voice trailed off as she tried to visualize the scene. The bins of wine bottles rotated around me and the floor seemed to swoop up toward me. I clutched the edge of the table. “No,” I said aloud. “That’s just not possible.”

  “What is it, Vic?” Max’s sharp eyes were alert.

  “Malcolm. They wouldn’t have killed him to stop him reporting what he’d seen. Surely not.”

  “What!” Lotty demanded. “This isn’t a time for jokes, Vic. Yes, they’d made a serious mistake. But to kill a man, and so brutally? An
yway, when he talked to me, he told me they were using the right drug. So maybe he didn’t know. Or maybe he questioned the nurses later. Maybe that’s what he told me he wanted to check on that night—before he wrote his report. What I don’t understand is where this Abercrombie was. Burgoyne says he tried calling him, more than once, but he never showed up.”

  “I guess I could try to find Abercrombie’s office,” I said unenthusiastically. “See if he left any telltale case notes lying around.”

  “I don’t think that will prove necessary.” Max had been studying the brochure. “We can use logic. They just say he’s on call twenty-four hours a day. They don’t say he’s part of the hospital staff.”

  “So?”

  He grinned. “Here’s where my specialized knowledge becomes important. You wonder why Lotty brought me. You say to yourself, why is this senile old man interrupting my great detection—”

  “Knock it off,” I said. “Get to the point.”

  He became serious. “In the last ten years, there’s been a shift in the age at which educated women give birth—they’re having their first babies much later than they used to. Because they’re educated, they know about the risks, right? And they want to go to a hospital where they know an expert will be on hand to treat them if they have complications.”

  I nodded. I have a number of friends agonizing over the various stages of conception, pregnancy, and delivery. The modern pregnancy—gone through with the care we used to reserve for buying a car.

  “So by now enough people are worrying about these issues that hospitals that want to be competitive in obstetrics have to have a perinatologist on hand. And they have to have a full complement of fetal monitors and neonatal intensive-care unit and so on.

  “But to make something like that pay, you need to be delivering at least twenty-five hundred to three thousand infants a year.” He grinned wolfishly. “You know. Bottom line. We can’t offer unprofitable services.”

  “I see.” I did. I saw the whole picture with amazing clarity. Except for a few little pieces. Like Fabiano. Dick and Dieter Monkfish. But I had an idea about them, too.