The paperwork took only a minute, and by the time we were done, the news crews had finished setting up. One look at them clustered together expectantly and I had to fight the urge to bolt, but Mother fixed her most winning smile on her face and prepared to face her inquisitors. Even I had to admit that she was nothing short of amazing.
Coached by Denise, Mother distilled our reasons for wanting to block the sale of Prescott Memorial Hospital into snappy sound bites, which she dispensed with the poise of a professional. Without any sense of irony, Denise had convinced Mother to sell our legal challenge as a David versus Goliath story with the small and determined Prescotts and Millhollands pitting themselves against an unfeeling and monolithic corporation. This struck me as so preposterous that I was worried about keeping a straight face, but just as Denise had predicted, the reporters ate it up.
When her PR handlers signaled that it was time for Mother to move on to her schedule of print interviews, I was grateful. Even the horror show of a day that I was facing seemed preferable to a daylong grin fest with the press—and that was even taking into account the fact that my first call of the day was at the hospital.
It always amazes me how quickly the prosperity of the business district gives way to something else. Five blocks from where the young Turks of the financial markets juggle buy and sell orders from Japan and worry about making the payments on their Ferraris, families live from welfare check to welfare check from one generation to the next. There were no Starbucks on these street corners, no Armani-clad strivers, just empty bottles and swirling trash and the hard, cold reality of the street.
Traffic thinned out as soon as I shook clear of the Loop. Everybody who had someplace to go was heading in the other direction, trying to get to work on time. I turned west on Sixteenth Street, heading over the railroad yards toward Canal. In the daytime the neighborhood surrounding Prescott Memorial looked even shabbier than at night. Fast-food wrappers blew through the streets carried by the breeze while the asphalt glittered with shards of broken glass.
I parked in the lot closest to the main building and said a silent prayer for my car. My grandfather had always envisioned his hospital as an oasis, a place of beauty as well as healing. Now the eaves sagged on the stately red brick buildings, the lawn was trampled, and the sidewalks were cracked. Still, compared to what lay around it, the hospital campus looked like Lourdes.
I decided to see Bill Delius first. I was also hoping that I might bump into Claudia. Something about the hang-up calls was still nagging at me, and I wanted to ask her about her weekend schedule. I also wanted to wish her luck in today’s morbidity and mortality conference.
But when I arrived on the postsurgical floor, there was another doctor sitting at the nurses’ station. When I asked, he told me that a construction worker had just been helicoptered in from the work site where he’d fallen, impaling himself on a ten-foot length of steel pipe. My roommate would be in the operating room for the foreseeable future.
I found Bill Delius easily enough. He may have been only a semi-impoverished college professor, but by the standards of Prescott Memorial, the fact that he had health insurance made him a wealthy man. He had one of the private rooms reserved for paying patients down at the end of the hall. I knocked softly, not wanting to disturb him if he was resting. Receiving no reply, I stuck my head in cautiously for a peek.
He looked terrible, though I don’t know what else I expected. After all, they’d opened him up from stem to stern and even harvested veins from his legs to graft onto the vessels leading to his heart. According to Claudia, even though the procedure is common, it’s one of the most invasive—and for the surgeon, exhausting—in the medical repertoire. When they’re done, they still have to connect the two sides of the breastbone with steel wires, and just sewing everything back up can take two surgeons working together for hours.
Looking closely, I thought Delius seemed more out of it than asleep. The drugs that poured in through the IV line to control his blood pressure, his heart rate, and his pain also caused a backlash of interactions and side effects. As I eased myself into the visitor’s chair it occurred to me just how vulnerable he was lying there unconscious and alone. I thought of Mrs. Estrada and the other patients who had died, and wondered if they had been on this floor.
Bill Delius wasn’t dying—at least not while I was in the room—but unfortunately he wasn’t doing anything else either. Seeing him hooked to monitors and with tubes running in and out of his body, I felt all my Monday-morning bravado drain away. I’d known what Bill Delius had wanted before his heart attack, but everything had changed in those terrible seconds on the sidewalk outside of McCormack Place. Did I have any idea of what he would want now? And who the hell did I think I was, going to bat in his place with Mark Millman and whatever graduate student he managed to get ahold of?
I looked down at Bill Delius’s sallow face, the oxygen cannula taped to his nose, but as hard as I looked, I saw no answers there.
I found Kyle Massius in his corner office in the hospital’s administrative wing. He did not look at all happy to see me.
“I really should call security and have you thrown out,” said the man I’d dunked in the pool every summer when we were still kids.
“I’d love to see you try,” I countered easily, settling into a chair. After all, it’s hard to be intimidated by somebody once you’ve seen them with French fries stuck up their nose. In an earlier generation Kyle would have been considered the classic second son. Clever and ambitious, he’d been raised to privilege and then pushed out to make a living when his father left his mother and squandered all his money on a twenty-two-year-old soap opera star. With an interest in science but a talent for business, he’d gotten his degree in hospital administration and used his family connections to land his job at Prescott Memorial.
“Do you have any idea how much trouble your mother is going to end up causing for herself with this crusade of hers?” he demanded, running his hand through what was left of his hair and giving me what I’m sure he thought of as a very pointed look over the top of his glasses.
“Trouble for herself or for you?” I countered. “What did you really think would happen when you decided to sell out this hospital? You know my mother. Did you really think that the family would just genteelly step aside while you dismantled everything that they’ve spent four generations working to build?”
“That’s got to be the first time the Prescott family has found its name associated with that ugly four-letter word work,” Massius observed dryly.
“I don’t know of many people who are putting in their forty hours a week who have enough left over to endow a place like this,” I pointed out.
“For your information, nobody has what it takes to endow a place like this anymore. When Everett Prescott decided to dazzle his friends by founding a hospital, all he needed to do was put up a big building and fill it with beds. Now we have MRIs and joint-replacement surgery, operating rooms that are filled with enough specialized equipment to launch a space shuttle. Nobody can write a check for all of that.”
“Maybe no one person can,” I countered, “but many people pooling their resources can.”
“But for how much longer? Do you have any idea how deeply in debt we are already? Do you know how hard it is for this hospital to keep constantly raising money? It’s not just the Founders Ball, you know, it’s the constant begging for people to remember us in their wills, the perpetual scraping to corporations, the competition with more trendy charities—AIDS, breast cancer, the homeless—everyone clawing for the same charitable dollar.”
“You make it all sound so noble,” I observed dryly.
“Oh, for Christ’s sake, Kate. Will you get off your high horse? I’ve spent the last three years fighting a losing battle. Do you know how many patients we turn away for every one that we admit? Every year it just gets harder.”
“And you honestly think that it will get easier once HCC takes over?”
�
�The community will be better served,” declared Massius sanctimoniously. “Differently perhaps, but better.“
“So who put you in charge of deciding what’s in the best interest of the community?”
“Your mother, the woman who’s so terribly in touch with the people. She did when she put me in charge of this hospital. Don’t get me wrong, Kate. I understand that your family feels a certain proprietary interest, but a hospital is an institution that has to change and grow with the times. Just because you paid for it doesn’t mean you can control it.”
“We’ll have to see about that,” I said.
“Is that what you came here to tell me?”
“No. I came to get copies of all the correspondence between HCC and the hospital, as well as copies of the budgets for the last five years, and a copy of the charter.“
“You don’t want much, do you? What makes you think that you can just waltz in here and ask for all of that?”
“The fact that you’re going to have to turn it over to me anyway during discovery, so you might as well get it over with,” I replied, pulling a copy of the lawsuit we’d just filed out of my briefcase and sliding it across his desk. “Consider yourself served.”
“Well, isn’t this just my lucky day,” he declared bitterly, showing no sign of picking it up. “Two lawsuits in one day. It’s too bad we had to close down our psychiatric unit because we didn’t have the money. But who knows, maybe there’s still a padded cell somewhere for me.”
“Two lawsuits?” I inquired. “What’s the other one?“
“Oh, you’ll love this. The family of a woman who died last week from a botched appendectomy filed suit against the hospital this morning.”
“When did she die?” I asked, fearing the worst.
“This past Friday.”
“The family didn’t spend much time thinking about it,” I observed. Poor Claudia. I remembered her once telling me that emergency room docs get sued an average of once every four years, but to end up with a malpractice suit on your first patient was enough to drive a doctor into dermatology.
“They didn’t need much time.”
“Why is that?”
“She was perfectly healthy except for her appendix.“
“How can you be so sure?” I demanded, remembering what Claudia had said about her having been scheduled for surgery to remove her gallbladder.
“I’m sure because I hired her. The woman’s name was Camille Estrada, and she was a professional patient.“
“What?”
“She was what they call an undercover patient, an employee of the consulting firm we use to evaluate our patient care. We’ve been having some problems on our surgical unit, so we had her admitted through the OBGYN service for some kind of vague abdominal problems, and Farah Davies dummied up a diagnosis that would require surgery.”
“You mean she would have actually gone ahead and had an unnecessary operation?” I inquired incredulously.
“No, of course not. We wouldn’t have let it go that far.”
“So what about her appendicitis? Was that real?”
“Yes. It was just coincidence that it ruptured while she was working.”
“So what happens now? I assume that whoever operated on her carried malpractice insurance.”
“Unfortunately it’s more complicated than that. It appears that it was a member of the house staff who actually performed the procedure. It’s only a matter of time before the family finds out. They’ll subpoena the records, or they’ll depose the nurses. I’m telling you, Kate, our exposure on this is huge.”
“I know you’ve been experiencing an unusual number of patient deaths,” I said. “How can you be so sure that this isn’t one of them?”
“Who told you that we were experiencing a high rate of anomalous deaths?” demanded Massius sharply. “Gerald Packman,” I replied. It was the truth.
“You listen to me, Kate,” replied Massius with a note of real menace in his voice. “There is no way the hospital can survive the lawsuit and the publicity it would generate if a story like that gets out. The hospital’s official position is that the attending surgeon behaved understandably but irresponsibly in leaving Mrs. Estrada in the care of an inexperienced resident in order to assist in what he perceived was a greater emergency. He had absolutely no way of knowing the fellow was incompetent and would botch the operation.”
“So let me get this straight,” I said. “You’re saying that no matter what other problems the hospital might have been experiencing on the surgical unit, problems that you deemed serious enough to justify hiring Mrs. Estrada to investigate, it was still the fellow’s fault that the patient died?”
“What I’m saying, Kate, is that when you look at it from the point of view of the greater good of the hospital, the fellow is the only variable in the entire equation that’s completely expendable.”
CHAPTER 13
The telephone is the lawyer’s scalpel and as I drove back to my office I wielded it as best I could to try and extricate my roommate from her perilous predicament. My first call was to the hospital operator to try and warn Claudia. She told me that Claudia was in surgery and unable to be paged. Suppressing my frustration, I asked her to connect me to Carl Laffer. I understood Claudia’s reluctance to have her connection with me made public, but under the circumstances I felt justified in using any ammunition that came to hand, and there was no doubt that this was my best weapon. Unfortunately, not just Laffer but also McDermott were in the operating room and unavailable. I left messages for each of them before pushing the END button on my cell phone in disgust. The truth is I was not used to having so much of what was happening being completely outside of my control, and I didn’t like it.
As I parked the car I found myself wondering when they were going to do the autopsy on Mrs. Estrada and what they were going to find. Had Claudia somehow actually made a mistake? Even the premier surgeons are just people doing the best job they can on any given day. Over the course of a career every surgeon makes mistakes. But even if Claudia had made a mistake, the hospital and McDermott stood to take the blame in all but the most blatant cases of negligence. I remembered what Farah Davies had said about prima donnas like McDermott feeling the need to rush in and save the day. If all she’d needed was another pair of hands, then McDermott should have sent Claudia in to help Davies and done the appendectomy himself. Once again I found myself thinking about the strange chemistry between Davies and McDermott and wondered if there was something else that had prompted him to come rushing to her aid.
And what about the other deaths? How were they related to Mrs. Estrada? Claudia and I had talked long into the night about how someone could go about killing off patients, but we hadn’t talked about why. Most cases that Claudia had heard about involved deranged individuals whose motives were beyond understanding. But would someone who was mentally unstable go about systematically killing off the patients of only one particular surgeon? Claudia had mentioned a well-known case where a surgeon had murdered the patients of a rival surgeon in order to drive him from the hospital. But there was no competition for patients at Prescott Memorial. Physicians there worked for the prestige of affiliation and a token salary. The whole thing made no sense.
When I arrived upstairs at Callahan Ross the receptionist informed me gravely that Skip Tillman, the firm’s managing partner, wanted to see me right away. I supressed a groan.
This wasn’t exactly good news. Tillman’s wife and my mother are best friends, which means that ever since my first day at Callahan Ross I have found myself with a bad case of in loco parentis. The worst part is that my peers routinely misconstrue his concern for interest, mistakenly assuming that he is my mentor. For some reason they think that what he doles out behind closed doors is guidance, whereas its much more likely to be disapproval.
I stopped by my own office only long enough to hand my briefcase to my secretary, who reiterated that Tillman wanted to see me.
“Why do you always have
to make him mad?” Cheryl demanded rhetorically.
“I didn’t make Skip mad,” I pointed out, ramming loose bobby pins back into my hair. “I happen to know on good authority that he was born that way. Listen, I need you to do something for me while I’m upstairs visiting the spanking machine.”
“You speak and I obey. Isn’t that how it’s supposed to work?”
“Page Claudia at Prescott Memorial every five minutes.” I rattled off her pager number. “As soon as you get her on the phone, come and get me. I don’t care if I’m still in with Tillman. I don’t care if you have to break the door down. I absolutely, positively have to speak to her as soon as possible.”
“Why? What’s up?”
“I’ll explain it all later. But it’s really important. Call her every five minutes.”
“Consider it done,” replied my secretary. As I turned the corner and headed down the hall toward the stairs, she called out after me. “Do me a favor and try not to get fired. I still haven’t finished paying off my last semester’s tuition.”
When I arrived at the double mahogany doors that led to Tillman’s office, Doris, his secretary told me to go right in. She didn’t smile, and the fact that he didn’t keep me waiting boded no good. Tillman was very much a lawyer of the old school, a product of the time when men were men, women were scarce, and cocktails were lunch. His office was a shrine to that golden era, with its massive mahogany desk, beaded paneling, and antique globe depicting the vast borders of the British Empire. On the wall behind him hung his three Harvard diplomas—known within the firm as the holy trinity—B.A., M.Div., J.D.
“What on earth do you think you’re doing?” Tillman demanded before I’d even crossed the threshold. He was a patrician prototype, white haired and perennially annoyed.
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