by Robin Cook
“Don’t begrudge Morgan Stanley’s take. They are the ones assuming the most risk here, and from what you are saying, it’s even more than they think.”
“Go back to your clients! Offer them whatever you need to. I tried the bank, and I pleaded with Rodger, but it’s a no go.”
“I can’t go back to my client,” Michael said, decisively suggesting that there was no room for discussion.
“‘Client’? I thought it was clients?” Angela said. She was confused. He’d always said clients and used the word syndicate. She was certain.
“It’s really one client,” Michael said reluctantly.
“Why can’t you go back to him? Surely he doesn’t want to risk his generous payoff, with as much stock and options as he controls.”
“That’s what I said when I went back for the quarter of a million.”
“Tell him again. I assume he’s a smart man. Tell him exactly what I told you, that the ORs are open.”
“He is a smart man, especially about money. If I go back to him at this point, he’ll know we are desperate.”
“We are desperate.”
“Whether it is true or not, it is a bad negotiating position. He might demand to take controlling interest.”
It was now Angela’s turn to stare out the window at the river. The idea of losing control of her company was anathema after all her effort. Yet what other options did she have? For a brief moment, she thought about going back to the practice of medicine and giving up the entrepreneurial lifestyle. But the thought was short-lived. She was realistic enough to know that the freedom her current lifestyle afforded her, at least prior to the current cash-flow problem, had become addictive. She couldn’t help but recall her disastrous experience with her primary-care practice and the realities of the current healthcare reimbursement, which was totally out of her control. Also, she reminded herself that if nothing else, she was persistent. She wasn’t going to give up now that she was fifty yards from the finish line after a ten-mile race.
“Let me talk to your client directly,” Angela said, breaking the silence. She had suddenly redirected her attention to Michael, who’d sat back in his chair. A few dots of perspiration had appeared along his hairline.
“Oh, yeah, sure!” Michael mocked, as if it was the most ridiculous suggestion she could possibly make.
“Why not? If he has any questions, he can ask them directly instead of through you. I can reassure him. With all the experience I’ve been having, I’m getting good at convincing investors.”
“My client has made it abundantly clear he only wants to talk to me about investment issues.”
“Oh, come on, Michael. I’m not going to steal your client. Don’t be so paranoid.”
“It’s not me who is paranoid, it’s him. Just so you understand the situation, there’s several shell companies between him and his position in Angels Healthcare, as well as with several other pending deals.”
“Why so much secrecy? Is there something here you’re not telling me?”
“I’m only following his orders.”
“Is he your major client in most of your placement deals?”
“Let’s just say he’s a big player. I can’t be more specific.”
Angela eyed her ex. This need for secrecy added to her general unease. Although she truly didn’t know why, it was apparent that Michael had no intention of enlightening her further. Instead of pressing him, she said, “Why don’t you raise the money from someone else? Make it a sweet deal to one of your other clients.”
“It’s too short a time frame for that. There’s no one I know whom I could approach.”
“Then what about yourself? I’ve already maxed out all my equity.”
“Me, too.”
“What about your jet?”
“It’s pledged to the hilt. Hell, it’s been on one hundred percent charter as well.”
Angela threw up her hands and stood. “Well, there’s not much more I can say or do. I’m afraid all our fates are in your hands, Michael. You are our placement agent, for better or worse.”
Michael breathed out noisily. “Maybe I can come up with fifty grand,” he said reluctantly. After everything he’d all but promised people, if this IPO stalled, he knew he’d be in deep trouble, and not just financially.
“That’s a start,” Angela said. “I can’t say it will guarantee success, but it will be much appreciated. What do you want as compensation?”
“Twelve percent as a loan, but convertible at my discretion to one hundred thousand dollars of preferred stock.”
“Jesus Christ!” Angela murmured, then, in a normal voice, added, “I’ll have Bob Frampton call you as soon as I get back to the office. When can we expect to have access to the cash?”
“In a day or so,” Michael said distractedly. He was already trying to think of how he’d manage to cobble together the funds. He had not been joking when he told Angela he was maxed out, although he did have some gold futures he’d kept out of the mix for a disaster. He reasoned that this might be the disaster.
“I’ll be at the office putting out fires if you have any bright ideas,” Angela said as she got her coat and briefcase. She looked back at Michael before leaving. He’d gone back to staring out the window.
As she walked to the elevator, she vaguely thought that Michael was his own worst enemy. She also thought of the proverb that you can take the boy out of the country, or in this case his old neighborhood, but often you could not take the country out of the boy, especially since Michael had moved back to his old neighborhood after the divorce. To Angela, Michael’s story smacked of a Greek tragedy. Michael was a smart, well-educated, handsome, and often charming individual who had the potential to be successful on many fronts, yet he had a tragic flaw: He was a prisoner of his past, when he had unknowingly absorbed indelible and ultimately harmful allegiances, attitudes, and values.
Thinking in this vein about Michael, Angela couldn’t help but reflect for a moment about herself. As a realist, she knew that she too carried some emotional baggage from her past, and her current life was far from serene. As she boarded the elevator, she wondered if she too had a tragic flaw that could explain how she had gone from a very idealistic first-year medical student to where she currently was: begging for money from a man she despised to prop up a nascent financial empire.
4
APRIL 3, 2007
11:25 A.M.
Laurie couldn’t remember the last time she had been so keyed up. Moving quickly, she left Paul Plodget’s office after speaking with him and Edward Gonzales. She’d again hit pay dirt. The first time had been a half-hour earlier with George Fontworth, an ME who’d been with the OCME for almost as long as Arnold and Kevin. He’d provided her with four MRSA cases he’d had over the last three months. And now she’d learned Paul had also seen four MRSA cases over the same time period, and Edward one. Although one of Paul’s cases was from Manhattan General, a tragic case of a previously well five-year-old girl who’d developed rapidly fatal necrotizing pneumonia from a boil-like lesion obtained at a local playground, all the others were from an Angels Healthcare hospital. First, there was a Jonathan Wilkinson, who’d died of necrotizing pneumonia after a triple coronary bypass; second was Judith Astor, who died of toxic shock–like syndrome after a facelift; and third was Gordon Stanek, who died of necrotizing pneumonia after a rotator-cuff repair. Edward’s case was Leroy Robinson, who passed away from necrotizing pneumonia after the repair of an open wrist fracture.
Walking quickly enough to briefly skid on the highly waxed vinyl floor, Laurie stormed into her office. After sitting down, she pulled herself toward her desk and reached for her rapidly expanding matrix to add Paul’s and Edward’s cases.
“Remind me, if asked, never to do another case with our beloved chief,” Riva said, turning around toward Laurie. It was a common joke around the OCME to express such sentiments after working with Bingham. Riva had come up to the office between cases to make a few work-related ca
lls. For a moment, she watched Laurie diligently work, wondering why her office mate hadn’t even greeted her. It was so unlike Laurie.
“Hey!” Riva called out after several minutes had ticked by. “What are you doing?”
Laurie’s head bobbed up. She apologized, belatedly realizing her rudeness. “I’ve stumbled onto something quite extraordinary.”
“Like what?” Riva asked dubiously. She knew Laurie to be a passionate woman who loved her work and who frequently became excited over problematic cases. Sometimes it was appropriate, and sometimes not.
“There has been a mini-epidemic of nosocomial MRSA that’s gone essentially unnoticed.”
“I wouldn’t say it’s gone unnoticed,” Riva said. “It’s been happening for a decade or more, not only in this country but internationally as well. Didn’t it start in Britain?”
“Let me phrase it differently. Within the last three and a half months or so, there’s been a number of very severe MRSA inpatient infections resulting in rapid death, all occurring at three hospitals owned by Angels Healthcare.”
“Just those three hospitals?”
“That’s it! Except for one I uncovered five minutes ago that happened at Manhattan General, all the others have been at the three hospitals.”
“How many cases are you talking about?”
Laurie looked back to her ballooning matrix and silently counted what she had recorded. “I’ve got twenty-one so far, but I have yet to talk with Chet, our deputy chief, or Jack, for that matter.”
“Are these cases of necrotizing pneumonia involving this newer, community-acquired MRSA?”
“Most of them,” Laurie said. “A few of the others are described as toxic shock syndrome. In those cases, there is extensive lung inflammatory damage from the bacterial toxins and from the overproduction of cytokines by the deceased, but the infection itself is elsewhere. As for the involved strain, it’s been the community-acquired MRSA in those cases where I’ve seen the case files. The problem is I have yet to see too many case files.”
“Then you have twenty-three, not twenty-one.”
“How so?” Laurie asked. She looked back at her matrix and started to recount.
“Because I have had two,” Riva explained. “It was three months ago and maybe a week or two apart.” Swiveling around in her chair, Riva took down a small, bound notebook from her bookshelf above her desk. Unlike any of the other medical examiners, Riva kept a longhand chronological journal of all her cases. On several occasions Laurie wished she had thought of doing the same. In it, Riva added personal observations and feelings that were inappropriate for the official report. It was more like a diary than a mere case-by-case compendium. After rapidly flipping the pages, Riva came to the respective entries. She quickly read them before raising her eyes to meet Laurie’s. “You definitely have twenty-three: One of mine was from Angels Orthopedic Hospital, and the other from Angels Cosmetic Surgery and Eye Hospital.”
“Can I see?” Laurie asked eagerly.
Riva handed over the journal and pointed to the two entries.
Laurie read rapidly. As an exceptionally thorough pathologist, Riva had recorded the name of the hospital and even the specific strain of MRSA involved in both cases. She had written it as: CA-MRSA, USA400, MW2, SCCmecIV, PVL.
Laurie looked at Riva. “In the few case files I’ve seen, the bacteria wasn’t so specifically typed. Was there some reason it was in your cases?”
“I had it subtyped,” Riva explained. “Like you, I was impressed with the pathology in the lung. More for general interest, I sent an isolate of each case to the CDC because I’d read they were looking to obtain MRSA samples for their MRSA library.”
“Do you have any idea what all the alphanumeric acronyms mean?”
“Not a clue,” Riva admitted. “If you read further, you’d see I’d promised myself I’d look it up, but unfortunately, like a lot of good intentions, I never did it.”
“Was the CDC surprised that the strains were the same despite coming from different hospitals?”
“I don’t believe I mentioned there were two hospitals involved.”
Laurie nodded, but the fact that the two strains were exactly the same bothered her, considering what Agnes had told her about how easily staphylococcus exchanged genetic material. She felt pleased that she’d asked Cheryl to get an appropriate contact with someone involved with MRSA at the CDC, as it would give her an opportunity to ask the question directly to someone particularly competent.
“You wrote in your journal that you obtained hospital records,” Laurie said. “Do you still have them?”
“Probably,” Riva said. “They came in as e-mail attachments. I usually save those just for this kind of situation.”
Riva turned to her computer keyboard and began typing.
Laurie picked up her own phone and called down to Cheryl Myers. Luckily, she was still at her desk rather than out on a site visit. Laurie apologized in advance before telling her she needed quite a number of additional hospital records from the Angels Healthcare hospitals.
“Not a problem,” Cheryl said. “Just e-mail me the names.”
“I did save the hospital records,” Riva said when Laurie hung up her phone.
Laurie got up and looked over Riva’s shoulder. “Fantastic!” Laurie said. “I guess I can access that from my computer. What’s the file name?”
Within a few minutes, Laurie had Longstrome and Lucente’s hospital medical records on her screen. Of all the MRSA cases that had come in to be autopsied over the last four months, these were the first hospital records she had. Arnold Besserman had provided her with several of the OCME case files he still had in his office, but he couldn’t put his finger on the hospital records.
“Well, I’ve got to get downstairs and do my next case,” Riva said.
Laurie waved over her shoulder, preoccupied by printing out the documents.
“Don’t you have another case as well?” Riva asked.
“Oh! Shit!” Laurie said. With her burgeoning interest in the MRSA cases, she’d forgotten. It was embarrassing to think that Marvin was patiently waiting.
“You’re preoccupied,” Riva said. “I’m sure I can get someone else to do it.”
“I’ll do it,” Laurie said. While she didn’t want to take time away from her current project, she felt guilty about not doing her share. “If you see Marvin down there, tell him I’ll be calling him shortly.”
With a final nod, Riva disappeared, leaving the door ajar.
Laurie went back to her computer and made the final click to load the second document into the printer queue. Knowing she’d have to wait five or ten minutes for the two documents, she went back to her matrix, adding Riva’s cases. When she was finished, she leaned back. It was a sizable list, certainly bigger than the two matrixes she’d made in the past. Now she had to decide how to label the columns. Some of the information she thought appropriate was intuitive, such as: age, sex, race, doctor, date, hospital, diagnosis, type of surgery, predisposing factors, anesthesia, and staph type. Laurie then drew more vertical lines next to the ones she’d already drawn. She knew she needed little space for things like age and sex, and more for predisposing factors and diagnosis. When she was finished, she made sure there was room for more columns. And it was for that reason she was pleased to have the hospital records. She knew that by going over them, she’d come up with more categories.
Satisfied with her progress, Laurie leaped up from her desk with the intention of dashing to the computer room, only to collide into Jack as he appeared in the doorway. Both were surprised, but more so for Laurie, who let out an involuntary yelp. In the process of grabbing Laurie’s upper arms, Jacked dropped the case files he was carrying, as well as his crutches.
“My God!” Jack joked. “What is there, a fire in here?”
Laurie pressed a hand to her chest. It took a few breaths before she could talk. “I’m sorry,” she managed. “I guess I’m preoccupied and in a hurry.”
>
“I heard as much about the preoccupied part,” Jack said. “I ran into Riva getting off the elevator. She said you’d come across something that you found particularly interesting but didn’t elaborate. What’s up?”
“Have you had any MRSA cases in the last three months or so with pulmonary involvement?”
“You have to give me more of a clue what you are asking. You know I’m not good with acronyms.”
“Methicillin-resistant staphylococcus aureus,” Laurie said.
“Uh-oh. Is this a setup? Isn’t MRSA what your ACL case had this morning?”
“It is,” Laurie admitted. She started to bend down to retrieve Jack’s case files and crutches.
Jack, who was still holding onto Laurie’s upper arms, restrained her and then bent down to gather his belongings. “I can’t recall having any MRSA ever,” he said, while straightening up.
“How about Chet?”
“Now, he might have. It seems to me I heard him talking on the phone about staph with Miss Smiles, Agnes Finn. Whether it was MRSA or not, I have no idea.”
“Thanks for the tip. I’ll have to ask him.”
“So it’s obviously MRSA that has you so preoccupied and in a hurry.”
“It’s certainly the preoccupied part, but the reason I’m in a hurry is because I forgot I’ve got another case to post. Poor Marvin’s been waiting for several hours.”
“Riva mentioned the case as well. She said she offered to have someone else do it. She said you didn’t take her up on the offer, although she sensed that you wanted to.”
Laurie let out a small laugh. “That’s sensitive enough on her part to be almost scary.”
“Then let me do it,” Jack said. “I’m done with all my cases, and from what Riva said, the post itself should be straightforward. I mean, it’s going to be plain blunt trauma with the poor guy falling ten stories onto concrete.”
“You don’t mind?” Laurie questioned. “Maybe you should give it another thought. Riva mentioned to me earlier that there are three stakeholders who are very interested in the case. All three want a different manner of death. No matter what you come up with, two other people are going to be disappointed. That’s not your favorite kind of case.”
