Foreign Body

by Robin Cook

  “That’s it,” Jennifer said, nodding. “Well done.”

  “And you didn’t go to the police?” Jack asked.

  Jennifer nodded. “Neil, who’s been here before, to a medical meeting, pretty much talked me out of it.”

  “The local police are often corrupt,” Neil explained. “And besides, something I did not mention to you today, Jennifer, and another reason I didn’t want you going back to talk to the police, is that I think they are somehow actively involved.”

  “How so?” Jennifer asked. She was taken aback by the idea.

  “I can’t imagine it was by chance the plainclothes policeman was behind you. It’s too much of a coincidence. My sense is that he was either following you or following the victim. If I had to guess, I’d put my money on you.”

  “Really?” Jennifer intoned. “If that were the case, then I’d be willing to bet the policeman was following us when we were leaving.”

  “Who knows. The point is that the police might not be innocent bystanders in all this, which isn’t reassuring, since, as I said, corruption is not unknown.”

  “Well,” Jack said. “A threat to Jennifer’s life certainly does change the complexion of her granny’s case and what we are going to have to do.”

  “You think the threat is related?” Laurie asked.

  “You have to assume so,” Jack said, “and, as Neil says, a threat that involves possibly corrupt police is very disturbing.”

  “Let me tell you the main thing that has made me suspicious about this whole situation,” Jennifer said. “This threat, or whatever it was today, is just the icing on the cake. What really caught my attention, not only with Granny but with the other two deaths as well, is the disconnect between the time of the victims’ deaths as reported on their death certificates and the time that the death was a centerpiece of a CNN segment about medical tourism. Take Granny! I saw the piece on television at approximately seven-forty-five in the morning in L.A., which is about eight-fifteen the same night here in India. When I got to see the death certificate, I found out it said she died at ten-thirty-five, two hours and twenty minutes later.”

  “The death certificate is just the time a doctor declares the person dead,” Laurie said. “It doesn’t aspire to be the actual time the person died.”

  “I understand that,” Jennifer said. “But think about it. It’s a two-hour, twenty-minute separation, but you have to add to that the time for someone to put the story together, call CNN, and report it. Also, you have to add the time it takes CNN to do whatever authentication they are going to do, write the story, and then schedule it. We’re talking about a lot of time. In fact, I’d probably guess more like two hours.”

  “I see her point,” Jack said. “Did this happen with the other two deaths as well?”

  “Exactly the same with the second one, Benfatti. The earliest I had it being on TV in New York was eleven a.m., which is eight-thirty p.m. in India. The time on the death certificate is ten-thirty-one p.m. Again, that’s two hours’ difference. It almost seems like someone is reporting these deaths to CNN before they even happened. On top of that, consider the similar time frames. Could that be a coincidence, or something else?”

  “What about the third death?” Laurie asked.

  “The third death was somewhat different than the other two, and the reason why was, the victim wasn’t discovered essentially cold and blue like the first two. But in other ways the same, including the time frame. The third patient was discovered still alive by his surgeon, and a full resuscitation was attempted that unfortunately was not successful. I happened to catch the CNN segment a little after nine p.m., and the anchors reported that the death had been sometime earlier. This afternoon I talked to the wife. The death certificate has nine-thirty-one p.m.”

  “It does seem as if someone has been tipping off CNN way before anyone else seems to even know about the deaths, especially on the first two cases,” Jack said. “Now, that’s odd.”

  “All three of us—myself, Lucinda Benfatti, and Rita Lucas—learned of our loved ones’ death from CNN after the network had known about it long enough to make it into a story and schedule it to be on the air and seemingly before the hospital knew about it. If it hadn’t been for this very strange timeline situation, I might have already had my granny’s body treated. But as it is, I cannot help but think these deaths are not natural. They’re purposeful. Someone is doing this and then is very eager to proclaim it around the world.”

  When Jennifer stopped speaking, no one spoke for several minutes.

  “I’m afraid to have to agree with Jennifer,” Laurie said, breaking the silence. “It’s starting to sound to me like an Indian version of an angel of death. We’ve had a few of those in the U.S.: healthcare workers who go on a murdering spree. This has to be an inside job. But usually the victims have some consistent association with one another. From what you’ve said, that doesn’t appear to be the case here.”

  “That’s right,” Jennifer said. “They range in age from Granny at sixty-four down to David Lucas, who was in his forties. Although two were at the same hospital, the third was at another institution. Two were orthopedic procedures, the third was obesity surgery. The only constant is that they are all Americans.”

  “It does seem that the time of death is approximately the same,” Laurie added. “And presumably the mechanism, with slight individual variations.”

  “Is there any relationship between the two hospitals?” Jack asked.

  “They are both the same kind of hospital,” Jennifer said. “There are essentially two types of hospitals in India: the run-down public hospitals and these new, impressively equipped private hospitals that are being built for the medical tourism industry and secondarily for the newly emergent Indian middle class.”

  “How big is the Indian medical tourism movement?” Jack asked.

  “It’s going to be very big,” Jennifer said. “The little I’ve been able to look into it has suggested some people think it might eventually challenge information technology for foreign exchange. By 2010 it’s supposed to produce two-point-two billion. It was growing somewhere around thirty percent per year last time accurate figures had been obtained. It’s interesting to speculate if these recent deaths will impact such an impressive growth. There have been a number of cancellations reported.”

  “Maybe that’s why there’s such eagerness on the part of the powers that be to sweep these cases under the proverbial rug,” Jack suggested.

  “Jack asked if there was any relationship between the two hospitals,” Laurie said. “You didn’t quite answer the question.”

  “Sorry,” Jennifer said. “I got sidetracked. Yes. I found out on the Internet that they both belong to the same sizable holding company. There are big profits to be made in Indian healthcare, especially with the government providing strong incentives, like various kinds of tax breaks. Big business is becoming more and more involved as a consequence of the high profits yet high start-up costs.”

  “Jennifer,” Jack said, “when you started to tell us about the timeline discrepancy, you said that it was the main source of your suspicion the deaths weren’t natural. That suggests there were other sources. What were they?”

  “Well, first it was that they were pushing me too hard to make a decision about cremation or embalming right from the word go. Since I’m aware that autopsies either can’t be done or are significantly less useful after either procedure, their dogged persistence eventually raised a red flag. Next was the pat and all-too-convenient diagnosis of heart attack after I’d just had Granny evaluated by the UCLA Medical Center, and she’d been given a blue-ribbon report, especially in relation to her heart.”

  “They didn’t do any angiography or anything like that, did they?” Jack asked.

  “No angiography, but they gave her a stress test.”

  “Anything else that has made you suspicious?” Jack asked.

  “The cyanosis that was reported on both Granny and Benfatti when t
hey were found.”

  “This is interesting,” Laurie said, nodding her head.

  “Not the third patient?” Jack asked.

  “Him, too,” Jennifer said. “I asked Rita Lucas, the wife, to ask. There was cyanosis, but it was only when they first found him, and he was still alive but in extremis. When they started resuscitation, the cyanosis cleared rapidly, giving them a false impression that the resuscitation was going to be more effective than it was.”

  “How long did the resuscitation go on?”

  “I don’t know exactly, but my impression was not that long. The patient started getting rigor mortis while they were still trying to revive him.”

  “Rigor mortis?” Laurie questioned. She looked at Jack. Both were surprised. Normally rigor mortis didn’t set in for hours.

  “The wife said that the surgeon told her that so she wouldn’t think they’d stopped too soon. She said he attributed it to the hyperthermia.”

  “What hyperthermia?” Jack asked.

  “It was a very difficult resuscitation attempt. The patient’s temperature shot up sky-high, and so did his potassium. They tried to treat both without much result.”

  “Good grief,” Jack said. “What a nightmare.”

  “So it turns out that all three had generalized cyanosis, which didn’t make a lot a sense to me with the diagnosis of a generic heart attack.”

  “That doesn’t make any sense to me, either,” Neil said, speaking up for the first time. “That’s got to be a respiratory problem more than a cardiac problem.”

  “Or a right-to-left shunt,” Laurie said.

  “Or a poisoning,” Jack said. “It’s not going to be a right-to-left shunt: not with three patients. One, maybe. But not three. I think we’re looking at a toxicology problem here.”

  “I agree,” Laurie said. “And I thought I was coming merely to be supportive.”

  “You are being supportive,” Jennifer added.

  Jack looked at Laurie. “You know what this means, don’t you?”

  “Of course,” Laurie responded. “It means there definitely needs to be an autopsy.”

  “They are not going to do one,” Jennifer interjected. “I’m telling you. And let me tell you something else, which is what I was talking to Mrs. Benfatti about. This afternoon I got a call from my favorite case manager, Kashmira Varini, and she had a new offer that she and the hospital administration thought would entice me to give cremation a green light. She said that the hospital CEO pulled some strings and had gotten permission for Granny, along with Benfatti and Lucas, to be taken to Varanasi to be cremated and her ashes placed in the Ganges.”

  “Why Varanasi?” Jack asked.

  “I looked it up in my guidebook,” Jennifer said. “It is interesting. It’s the holiest Hindu city; it’s also the oldest. It’s been occupied for over three thousand years. If you are cremated there, you get extra karma for your next life. When I didn’t jump up and down and agree instantly to the Varanasi offer, she then threatened me just like she threatened Mrs. Benfatti. She said the hospital intends to seek a magistrate’s writ to deal with Granny’s body as they see fit and have the writ in hand by noon tomorrow.”

  “That means somehow we have to manage to do an autopsy in the morning,” Laurie said. She looked at Jack.

  “I agree,” Jack said. “Looks as if tomorrow might be a full day.”

  “I’m telling you they won’t authorize one,” Jennifer insisted. “I told this to Laurie on the phone. The Indian autopsy situation is horrid. It’s a kind of bad legacy system with no independence for the forensic pathologists. The police and the magistrates are in control of deciding if and when an autopsy is to be done, not the doctors.”

  “It’s an extension of the British inquest system,” Laurie said. “It’s very much behind the times. It’s hard for medical examiners to provide the necessary oversight they are supposed to provide without freedom from law enforcement and the judiciary, especially if the police and the magistrates are in cahoots.”

  “We’ll have to do the best we can,” Jack said. “You mentioned a death certificate. Is there a signed death certificate for your grandmother?”

  “Yes, there is,” Jennifer said. “The surgeon was apparently only too happy to sign it out as a heart attack.”

  “It probably was, ultimately,” Jack said. “What about the other two cases?”

  “As I said, there are death certificates on all three,” Jennifer added. “It’s part of the reason I feel the ministry of health just wants these cases to disappear.”

  “That’s confusing if it is true,” Laurie said to Jack. “What we are thinking about here is an Indian healthcare angel of death. Why would the hospitals, and even the ministry of health, want to help cover it up, which it is doing by avoiding an autopsy. It doesn’t make much sense.”

  “I don’t think we’re going to be able to answer too many questions until we are reasonably sure our hypothesis about these deaths being murders is confirmed,” Jack said. “So let’s talk about tomorrow.”

  They all glanced at their watches.

  “Oh my goodness,” Jennifer said. “It’s already tomorrow. It’s after one. You guys better get some sleep.”

  “I have an infertility appointment at eight a.m.,” Laurie said, agreeing.

  “That’s at the Queen Victoria Hospital,” Jack said. “That’s going to get us there early.”

  “I made it there so we’d have an in of sorts.”

  “That was a great idea,” Jennifer said.

  “I understand your grandmother’s body is in a basement cooler,” Jack said to Jennifer.

  “That’s correct. Very close to the staff cafeteria.”

  Jack nodded, deep in thought.

  “What time should we meet up in the morning before heading out?” Jennifer asked. “And where? Should we breakfast together?”

  “You, young lady,” Jack said with authority, “are going to stay here at the hotel. After what you experienced today, it is too dangerous for you to be running around outside. You really shouldn’t have come to meet us at the airport.”

  “What!” Jennifer demanded. She leaped to her feet, arms akimbo, challenging Jack.

  “I have to give you credit,” Jack said calmly. “It seems that your suspicions and persistence have opened a can of worms here in New Delhi, but in so doing you have put yourself in jeopardy. I think Laurie will agree with me.”

  “I do, Jennifer.”

  “You have to let us try to prove what you’ve managed to uncover,” Jack continued. “I can’t participate unless you are willing to step back. I refuse to have your life on my conscience for this possible conspiracy.”

  “But I’ve put—” Jennifer tried to complain, but she knew Jack was right.

  “No buts!” Jack said. “We can’t even be sure we’ll be able to do much. Is that worth risking your life?”

  Jennifer shook her head, then slowly sat back down. She glanced at Neil, but Neil nodded that he agreed with Jack.

  “Okay,” Jennifer said with resignation.

  “That’s it, then,” Jack said while slapping his thighs. “We’ll keep you guys informed. I’d prefer you stay in your room, but I know that’s asking a bit much, and it’s probably not necessary. Just stay within the hotel.”

  “Can I help?” Neil asked.

  “We’ll let you know,” Jack said. “Let me have your mobile number! Meanwhile, you can keep Jennifer entertained so she won’t be tempted to leave the premises.”

  “Don’t be patronizing,” Jennifer complained.

  “You’re right. I’m sorry,” Jack said. “That did sound condescending. I truly didn’t mean it that way. Sarcasm is my reflex style of humor. As I already said, I do give you a lot of credit for getting this investigation to this point, in spite of your grief. I doubt I could have done it.”

  After saying good night to one another, Jack and Laurie got up and left the other two to finish their beers. As they walked out into the lobby, Jack s
aid he wanted to stop at the concierge desk to reserve a van for the morning if it was possible.

  “What do you want with a van?” Laurie asked.

  “If we want to take a body from point A to point B, I want us to be prepared.”

  “Good thinking,” Laurie said with a smile, guessing what Jack had in mind.

  A few minutes later, as they were rising up to the seventh floor in the elevator, Laurie said, “I learned something tonight I didn’t know before. Jennifer’s father apparently abused her as a child.”

  “That’s a tragedy,” Jack said, “but she’s certainly high-functioning.”

  “At least ostensibly.”

  “Did she tell you?”

  “No, he did. It was by accident. At least I think it was by accident. He had convinced himself that from my mentoring position, I would have known, but I didn’t. So don’t say anything to anyone.”

  Jack made an exaggerated questioning expression. “Who would I tell?”

  “Are you done?” Neil asked, after Jennifer had taken the last pull on her beer. She nodded as she placed the empty bottle back on the table. She stood up and offered him a hand. They started for the elevators.

  “I don’t like the idea of being confined to the hotel.”

  “But it is the smartest thing to do. Why take a chance at this point. I thought about it but hesitated to suggest it.”

  Jennifer gave Neil a quick testy glance.

  They boarded the elevator. “Floor, please,” the operator intoned.

  Jennifer and Neil exchanged a glance, unsure who was going to speak.

  “Nine,” Jennifer said, when Neil failed to respond.

  They didn’t talk as they rode up, nor when they walked down to Jennifer’s room. At her door, they stopped.

  “I hope you are not expecting to come in,” Jennifer said. “Not at one-thirty in the morning.”

  “When it comes to you, Jen, I don’t allow myself to expect anything. There are always surprises.”

  “Good. I got pretty angry at you back in L.A. I had expected a different response.”

  “I realized that after the fact. At the same time, there could have been a bit more discussion.”