by Andy Siegel
“Excellent. I love having a renegade doctor in my corner screening my malpractice cases for free. What do you think?”
“It’s not a garden variety case.”
“Yeah, I’ve come to the same conclusion. But I’m just a lawyer, you’re the doc. Let me hear it.”
Before he can continue, the house lights dim. “Now, for your viewing pleasure, on center stage, Jingles Dance Bonanza is proud to present, making her New York debut, all the way from Paris—L-O-L-A, Lolaaaaa … LaRue!” A few pairs of hands clap. It’s a reception like this one that highlights how well-loved Cookie is.
The spotlight frames her. She’s wearing a French cancan dress, petticoat, black stockings, and a large feathered hat. As the music starts, she does a Frisbee toss with her hat, sending it flying stage right. Then she pulls off her dress and tosses it left. Nice choreography. What can I say? I’m a dance dad, but, like I said, no pole for my Little Munch, Penelope. At this moment, I come to a distressing realization. Pole is spelled backward right in the middle of the very name I gave my daughter. Shit.
Mick and I turn back to each other after this brief distraction.
“So … Cookie’s case,” he restates. “I have my opinions, but why don’t you tell me how you see it?” Always testing me.
“It’s not what I see that’s bothering me, it’s what I don’t see.”
“Go on.”
“Cookie’s prior attorney, Chris Charles, claimed an injury compromising the flow of cerebral spinal fluid, requiring repeated spinal taps to keep her brain from bursting.”
“Yes, I saw that in the legal document you sent me but not in any of the medicals. I’ve been meaning to ask.”
“Yeah, well, that’s what I meant when I said what was bothering me is what I don’t see—which is any medical documentation of tapping. But I’ve got to tell you, I had them in my office, and I witnessed for myself our friend, Major, performing an emergency tap. He actually hit a nerve that triggered a kick that sent him flying. Cookie didn’t even know she’d done it; it was involuntary.” I couldn’t help shaking my head as I remembered the scene.
“Anyway, it’s why I called them in, trying to get this lack of documentation straightened out. Major explained it’s not in the medical records because he’s the one who diagnosed it and has been the one taking care of the procedure. Says he has complete records, which should be on the way to me.
“But here’s what makes it more interesting. Dr. McElroy didn’t document any injury to the structures responsible for the flow of CSF in his operative report, which is not uncommon when a surgeon wants to cover up something. Yet, at his oral deposition, he came right out admitting he did cause a penetrating injury into the subarachnoid space with a resultant CSF leak.”
“Get out of here!” Mick says, disbelievingly. “We both know doctors never do that.”
“Yeah, well, he also testified that it was self-limiting.”
“Why didn’t you send me a copy of his deposition transcript?”
“’Cause I wanted your opinion only based on the medical records.”
“Unfair.”
“You’ll get over it. Anyway, given that any confession of error in the medical-legal game is unheard of, McElroy just rolled over and came out with it. And the way he did it was a bit odd.”
“How?” Mick’s definitely paying close attention.
“I’ll tell you how. Cookie’s former lawyer, Charles, asked, ‘Doctor, did anything occur during the surgery that was not documented in your operative report?’ Like a staged question—and then McElroy confessed, just like that.”
“That’s unusual.”
“Yeah, I thought so, too. But maybe it’s not as strange as it might seem on the surface. The guy knew he had a witness against him.”
“A witness? In an operative case? What are you talking about?”
“I saw an unsigned statement by a nurse named Molina in the file, which laid the guy out for dead. They obviously had some difference in the OR regarding the handling of a ‘leak’ he caused. The statement indicates that Molina sought out Cookie before she was discharged and explained to her and Major what happened, knowing McElroy intentionally omitted the injury from his operative report.”
“That’s crazy. A member of the medical profession coming out against one of their own. It just never happens.”
“Yeah, well, it happened—and didn’t happen. Like I said, the Molina statement was unsigned. Maybe someone from the hospital’s Risk Management Department got to her after Chris Charles did and created this draft copy.”
“Maybe,” Mick responds. “Anyway, McElroy did admit, against his interest, to the mechanism of injury necessitating the tapping, in the absence of medical records that would show whether Cookie had ever even received a tap. So what did you see in the medicals?”
“So,” I say, “the medicals. The first post-op MRI taken of Cookie’s neck the day before her discharge showed a moderate-sized fluid collection in the area where McElroy admitted to injury. But there was no definite fluid invasion into the space where you’d expect to see a CSF leak. The radiologist said the differential diagnosis included a post-op blood collection, an infection or a CSF leak. He further stated at the end of his report, ‘consider spinal tap if clinically indicated.’”
“Go on.”
I gulp the last of my drink. “Now, the second post-op MRI was taken two weeks later and was read by the same radiologist. He did an interval comparison of the two and stated the fluid collection seen on the prior study had spontaneously reabsorbed, consistent with it having been a post-op blood collection. I have to agree with the guy because, if the fluid was a CSF leak rather than blood, you’d expect it to keep collecting, and there would have to have been a spinal tap within a week of McElroy’s surgery. But that never happened.”
“Keep going,” Mick says, his expression resembling that of proud father. He swigs the last of his brew, then looks around for our server, holding up two fingers.
“Okay. Now, according to Major, he tapped Cookie for the first time six months after McElroy’s operation—which seems too remote to connect to the surgery, despite the confession of injury.”
Mick gives me a curious look. “I agree a temporal component seems to be missing,” he says, “but nothing’s black and white in medicine. Let’s consider the big picture. Before the op, she’d never had a tap. Then, during it, she has a CSF leak from an injury to the structures that could compromise CSF flow, and the post-op MRI confirmed the presence of some kind of fluid in the area at question. And the radiologist raises the possibility of a tap. Six months later, she needs the first of many taps. That seems to work for me.”
“Then how do you explain the absence of a fluid collection on the second post-op MRI?” I demand.
Mick’s ready for this. And I know I’m about to play the pupil. But I like to learn.
“Here’s the thing about MRIs; they show what they show on the date they were taken. The day before and the day after each could reveal different findings when you’re talking about the ebb and flow of tiny fluid collections. Something as simple as the patient ingesting a vast quantity of water on the day of the MRI, coupled with her continued IV hydration, can influence the results because all an MRI is showing is the fluid in and around soft tissues.” He takes a breath.
“Also, the injury that caused the CSF to leak could have been self-limiting at one point in time, just like McElroy testified. Then, it could have spontaneously begun to leak again at a later point. Remember, we’re talking about an injury to a membrane here that has a very limited capacity to repair itself. So don’t let that one finding throw you off. Besides, if there really was a tear bad enough to leak CSF, McElroy could’ve patched it up like a hole in an inner tube, with it reopening at a later date. ”
“Well, we’ll never know that because Charles never pursued that line
of questioning with McElroy. He just accepted the self-limiting testimony. And I’d be crazy to ask him anything I don’t know the answer to at the time of trial. Now, can we talk about the subsequent surgeries?”
“Sure.”
I love my man, Mick. Just as I’m about to start, two drinks hit the table.
“This is a good place to conduct business,” I tell him lifting mine up. He nods in agreement.
“Okay,” I continue, “not one op report mentions an injury into the subarachnoid space, nor did the surgeon dictate a repair to the structures that involve the circulation of cerebral spinal fluid. The first subsequent surgery was aimed at removing the surgical hardware McElroy’d improperly screwed into the joint space. The other was aimed at Cookie’s healing insufficiencies; meaning the nonunion of bone, and then the donation of new bone to effect restabilizing the fusion that never took.”
Mick shakes his head. “Yeah, now that you mention it, the surgeon never addressed the CSF issue other than making note of repeated taps by way of patient history. It’s definitely mysterious. You’re going to have to speak to the subsequent surgeon and get an explanation.”
“I will.”
“You’re on top of it, Tug. Or should I say, on tap of it.”
You can’t be serious all the time, even when discussing leaking spinal fluids.
Just at that moment, scattered unenthusiastic clapping begins and ends just as fast. Lola from Paris is taking her bow. Now she’s coming down the side steps of the stage. With dress and feathered hat in hand, she heads right for us in a determined manner. I take a sip of my Stoli O, wondering what’s going on. She pulls up close to me and stops.
I lean back and look up. “Bonjour, Mademoiselle Lola from France,” I welcome her. “I hope you’re enjoying our wonderful city.” Smooth, huh?
“I’m from Paris,” she barks in an accent more Tommy’s Trailer Park than Arc de Triomphe. “Paris, New York.” She looks at Mick, then back at me. She puts her hands on her hips. “You two didn’t catch one minute of my show. Yapping the whole time. That was rude.”
Before I get a chance to respond—which is good, because I don’t have a response—Mick takes charge.
“Lola, I can tell you are a lovely girl. And, yes, it is true. Mr. Wyler over here and I were quite rude to you during your solo by carrying on with our business instead of giving you the undivided admiration you deserved.”
Her expression softens a bit. Funny that I’m paying attention to her face.
“For that, we apologize. Could I make it up to you in a bit? I’d be honored if you’d grace me with a private dance.”
She smirks, jutting her thumb at Mick. “I like this guy. He’s got class,” Lola tells me.
“Sure, honey,” she replies to Mick, “I’d love to give you a dance. I’ll be around later when you two close up shop.”
Mick smiles. They’ve got a deal. She puts her hat on, taps it down, and struts off with dress in hand, seemingly satisfied.
“You defused that pretty well, Mick. And to your advantage. But, listen, I’ve got to hop.”
“You know what you need to do, right?”
“Yeah,” I answer. “Have Pusska get all the MRI studies.”
“Right. All of them. Not just the first two post-op ones from the McElroy surgery. And …” Mick adds, cuing me to end his sentence.
“Get them Ray-diated.”
“That’s right, get them Ray-diated.”
TOO OBVIOUS
I walk out of the club straight into Minotero. This is far from coincidence. He’s leaning against a Lincoln Town Car. The government-issued type with a searchlight attached just in front of the driver’s side mirror. He’s wearing that stupid trench coat again and seems even shorter than I remember.
Anyway, I’m glad to see him since I have something to tell him. I approach purposefully. “Do me a favor, Minnow,” I say. “Never come to my office again, and don’t involve yourself with my clients. You hear me?”
“Do you mean Cookie? Or maybe Robert Killroy? Which one?” What’s going on here? How would he even know about Robert? I’ve only started his representation.
“Where are you getting the names of my clients?”
“That’s what I do, know stuff. Seeeee.”
I take a second to assess and collect myself. The names of my new clients are not public knowledge, so he’s got some real source that, at the moment, I can’t figure out. I realize I need to tone things down in an effort to appeal to his sensible side. If he has one. I mean, he did give me his name.
“I don’t know who you are,” I say kindly, “or why you’re involving yourself in my business, and also in the business of my clients, but you’re stepping over the line. I can’t imagine what interest you have here. Don’t you think it’s time to explain?”
“You want explanations, I’ll give you explanations, seeeee. I warned you off Cookie’s case, and you didn’t heed it. I investigate insurance fraud claims, and her case is one of my assignments, seeeee.”
“What are you talking about? She has a solid malpractice case. Besides which, it’s clear she’s not the type of person who perpetuates insurance fraud.”
“It’s not Cookie we’re investigating.”
“What do you mean? Who else would be in the position to commit the fraud?”
“The doctor and the lawyer. It happens all the time, usually with medical facilities. But we’ve seen it like this, too, seeeee.”
“Dr. McElroy and Chris Charles? No. I don’t seeeee,” I respond. “What fraud could they possibly be involved in?”
“McElroy commits the surgical error and Charles brings the lawsuit. Just like in the movies. Then they split the insurance payout.”
“Wait a second. The money here isn’t so large that any doctor would be enticed to co-conspire in such a plan with so little return. But something else makes the whole thing utterly farfetched …”
“Oh yeah, what’s that?”
“If we accept that they’re co-conspirators in this scheme, then it must have been set up beforehand. Meaning, they could only effectuate their plan if it was known that Cookie would retain Chris Charles. How do you explain that?”
“Easy, seeeee.”
As frustrating as all this is, at least I got the guy talking. “No, I don’t. Her boyfriend, Major, was the one who referred her to Charles and, come to think of it, to McElroy as well. Hmm, so are you saying Major’s involved, too?”
“I’m not saying anything. We’ve been on this assignment a long time, and the end is just around the corner. You’re interfering with an ongoing investigation, seeeee. So now that you know, get off the case. I got a job to do here, and you’re getting in the way.”
“Not so fast. I’m going to represent my client zealously to the end. Cookie did nothing wrong, based on what you’ve said, and in handling her action, I’ll be doing nothing wrong. You know it and I know it. If she was injured she’s entitled to fair and reasonable compensation.” I shake my head reproachfully. “You’re the only one with something to lose here, if this story of yours is true.” I mean, how can it be? Major seemed to be in support of Cookie switching attorneys. No way is he involved.
Minnow takes a threatening step forward. This guy loves intimidating gestures.
“You don’t believe me?” he shouts. “What do you know? You don’t even know these people! How do you explain McElroy testifying about the injury when it wasn’t in his operative report? That’s proof of his participation in this scheme, seeeee.”
I will say this, Minnow knows his facts. He’s definitely on the inside, somehow. But I’ve had enough of him and his annoying ‘seeeees.’
“Listen to me. In fact, I view things just the other way.” I pause, letting that sink in. “If this was the situation, then McElroy would’ve come straight out and documented his surgical error in
his operative report. How do you explain that?”
“I’ll tell you how,” he quickly responds. “Too obvious.”
“Too obvious?”
“Yeah, too obvious. These guys are smart. They’re litigating the claim, making it real, seeeee.”
“No, I still don’t see. We’re getting nowhere. I’m out of here.”
I turn but not before taking in three numbers and three letters, and begin walking away. There’s a remote possibility it all might be true, only because he’s in possession of such detailed facts. Plus, I saw the movie Minnow was referring to with that plot—Malice with Alec Baldwin and Nicole Kidman. But it was the operating surgeon who co-conspired with his patient to commit the insurance fraud.
I feel his eyes on my back. He’s pissed off.
I pull out my phone and start an e-mail. To: Pusska. Subject: Various. Please come to my office at nine a.m. with the findings on your assignment. I also have something else for you. I send her the make, model, and license plate of Minnow’s car, stating, I hope this helps. Thanks.
Before I even have the chance to put the phone away, it vibrates in my hand. It’s Pusska’s reply.
“You know you vant to fuck me.”
Chapter Eleven
“Let me know when Pusska gets here,” I say as I pass Lily.
“No ‘hello,’ no ‘good morning Lily, how are you today?’ Just a command. That’s a little disrespectful, don’t you think?”
“Yes, you’re right, it was. Good morning, Lily. How are you today? Could you buzz me when Pusska gets here, please?”
“I’m fine, and no. Why don’t you get yourself a real investigator? And you’re way too comfortable with me,” she cautions.
I nod, continuing on. I think we don’t have a normal lawyer-paralegal relationship. And she’s right.
I enter my office and stop in my tracks. There’s a surprise. Pusska. She’s sitting at my desk with her feet up. There’s an open bottle of red, and she’s sipping from one of the wine glasses I keep stowed away in my private cabinet next to my mini wine fridge. To my further surprise, she’s wearing a skirt suit, a first. However, her blouse is unbuttoned awfully low, lower than your normal suit-wearing woman.
