by Robin Cook
“Could you hear enough from my side of the conversation to guess what Ms. Hernandez said?” Kashmira questioned. She was sitting in the hospital CEO’s office at a library table. He was seated across from her. In contrast to her elegant ethnic costume, Rajish Bhurgava, the rounded, mildly overweight CEO, was attired cowboy-style with ill-fitting jeans and a plaid flannel shirt that snapped rather than buttoned. He had his legs crossed and his cowboy boots precariously balanced on the corner of the table.
“I could tell you were not able to get permission to embalm or cremate, which was the major goal of the call. That’s unfortunate.”
“I tried my best,” Kashmira said, in her defense. “But the granddaughter is distinctively pertinacious in comparison with the son. Maybe we should have just gone ahead and cremated without asking her.”
“I don’t think we could have taken that risk. Ramesh Srivastava was very clear when he called me that he wanted this case to disappear. He specifically said he did not want any possible continued cause for media attention, and if the granddaughter is bullheaded, as you suspect, cremating the body without permission could have caused a blowup.”
“You mentioned Ramesh Srivastava earlier when you called me about Hernandez’s death and told me we had to deal with it tonight. Who is he? I’ve never heard the name.”
“I’m sorry. I thought you knew. He’s a top-level administrator who’s been placed in charge of the department of medical tourism in the health ministry.”
“Is he the one who called you about the death?”
“He is, which was shocking. I’ve never met the man, but he’s an important individual. His appointment shows how vital the government thinks medical tourism is becoming.”
“How did he hear about the death before we did?”
“That is a good question. One of his subordinates saw it on CNN International and felt it serious enough, considering its possible effect on the PR campaign the Ministry of Tourism and the Indian Healthcare Federation have been co-sponsoring, to inform Srivastava immediately despite the hour. What impressed me was that Srivastava then called me directly instead of delegating it to one of his underlings. It shows how serious he thinks it is, which is why he wants the case to disappear, which, of course, is why he wants rapid disposition of the body. To help, he said he’d call to have the death certificate signed without delay, which he did. He also ordered that no one from the hospital staff on any pretext should talk to the media. He said that on the air there was a hint of some kind of investigation. He does not want an investigation of any sort.”
“I got that message loud and clear, as did everyone else.”
“So,” Rajish said, letting his legs fall to the floor and slapping the table for emphasis, “let’s get the body cleared for cremation or embalming and out of here.”
Kashmira pushed back her chair, the legs of which screeched against the floor in protest. “I will get the process started immediately by making the travel arrangements for Ms. Hernandez. Are you planning on talking to Mr. Srivastava again tonight?”
“He asked me to call his home with an update. So, yes, I will be calling.”
“Mention to him we might need his support to get an emergency M visa for Ms. Hernandez.”
“Will do,” Rajish said, jotting down a quick note to himself. He watched Kashmira walk out the door. Returning his attention to the phone Kashmira had used to call Jennifer and taking out Joint Secretary Srivastava’s phone number, which Rajish had written on a piece of scratch paper, he made the call. It made him feel proud to be calling someone so high in the health bureaucracy, especially at such an unorthodox hour.
After answering on the first ring, suggesting he was waiting by the phone, Ramesh Srivastava wasted no time with small talk. He asked if the body had been taken care of as he’d requested. “Not quite,” Rajish had to admit. He went on to describe how they’d asked the son but that the son had designated the granddaughter but the granddaughter had demurred. “The good part,” Rajish explained, “is that the granddaughter will be on her way to Delhi within a few hours and that as soon as she arrives they will press her for a decision.”
“What about the media?” Ramesh questioned. “Has there been any media patrolling around the hospital?”
“None whatsoever.”
“I’m surprised and encouraged. It also brings me to the issue of how the media got news of the death in the first place. In the context the piece was presented on the air, it seems to us that it had to have been a left-wing student who is against the rapid increase in private hospitals in India. Are you aware of any such person or persons at Queen Victoria Hospital?”
“Absolutely not. I’m certain we in the administration would be aware of such a person.”
“Keep it in mind. With public hospital budgets stagnant, particularly for infectious disease control, there are people who feel quite emotional about the issue.”
“I will certainly keep it in mind,” Rajish said. The idea that one of their medical staff could be a traitor was troubling, and the first thing he was going to do in the morning was raise the issue with the chief of the medical staff.
Chapter 5
OCTOBER 15, 2007
MONDAY, 10:45 A.M.
LOS ANGELES, USA
(SIMULTANEOUS WITH RAJISH BHURGAVA’S LEAVING
THE QUEEN VICTORIA HOSPITAL)
Jennifer was in the process of making her way from the medical school back to the main building of the UCLA Medical Center and felt amazed at what she’d been able to accomplish despite her emotional fog. From the moment she terminated the conversation with the Queen Victoria Hospital case manager a little over an hour ago, she’d dealt with her new preceptor, dashed home, called back to India to give her passport number, made her way to the med school, got the blessing of the dean for a week off, arranged a replacement for her gainful-employment blood-bank job, and was now hoping to solve her emotional fears, economic concerns, and the problem of malaria prophylaxis. Although she’d taken out the almost four hundred dollars she had in savings, she was worried it might not be enough even with her credit card and Foreign Medical Solutions of Chicago paying her major expenses. Jennifer had certainly never been to India, much less on a mission dealing with a dead body. The possibility she would need a significant amount of cash was hardly far-fetched, especially if cremation or embalming was not something that could be charged.
Being as busy as she’d been over the hour-plus had had the secondary benefit of keeping her from obsessing about the reality of her grandmother’s passing. Even the weather helped, since it was as glorious as the dawn had predicted. She could still see the mountains in the distance, although not with quite the same startling clarity. But now that she was almost finished with her errands, reality began to reassert itself.
Jennifer was going to miss Maria terribly. She was the person with whom Jennifer was the closest, and had been since Jennifer was three years old. Besides her two brothers, neither of whom she spoke with for months on end, her only relatives that she knew were in Colombia, and she’d met them only once back when her grandmother had taken her there for that expressed purpose. Relatives on her mother’s side were a complete mystery. As far as Jennifer was concerned, her father, Juan, didn’t count.
Just as Jennifer had passed through the revolving entrance of the main redbrick hospital building, her cell phone sounded. Checking the screen, she could see it was India calling back. She answered the phone and in the process stepped back outside into the sunlight.
“I have good news,” Kashmira said. “I’ve been able to make all the arrangements. Do you have a pencil and paper?”
“I do,” Jennifer responded. Getting a small, stiff-backed notebook from her shoulder bag and tucking her phone into the crook of her neck, she was able to write down the flight information. When she learned she’d be leaving that afternoon but not arriving until almost the wee hours of Wednesday, she was appalled. “I had no idea it would take so long.”
“It is a long flight,” Kashmira admitted. “But we are halfway around the world. Now, when you land here in New Delhi and reach passport control, go to the diplomatic corps line. Your visa will be waiting there. Then once you have your baggage and come out of customs, there will be a representative from the Amal Palace Hotel holding a sign. He will handle your luggage and get you to your driver.”
“Sounds simple enough,” Jennifer said, while she was trying to figure out from the departure times and the arrival times just how many hours she would be in the air. She quickly realized she couldn’t do it without knowing all the time zones. In addition, she found herself confused by having to cross the international date line.
“Wednesday morning we will arrange a car to pick you up from the hotel at eight. Will that be alright with you?”
“I guess,” Jennifer said, wondering how human she would be feeling after being on a plane for nine years and having no idea how much sleep she would be able to get.
“We look forward to meeting you.”
“Thank you.”
“Now I’d like to ask you once again if you have made up your mind between cremation and embalming?”
A wave of irritation washed over Jennifer just when she was beginning to like the case manager. Didn’t she have any intuition? Jenifer wondered with amazement. “Now why would I change the way I thought just a couple of hours ago,” she questioned irritably.
“The administration made it clear to me they believe it would be best for everyone, even best for your grandmother’s body, if we got on with it.”
“Well, I’m sorry. My feelings have not changed, especially since I have been so busy that I haven’t had time to think about anything. Furthermore, I don’t want to feel like you are pushing me. I’m coming just as soon as I can.”
“We certainly are not pushing you. We are just recommending what is best for everyone.”
“I don’t consider it the best for me. I hope you people understand, because if I get there and my grandmother’s body has been violated without my consent, I’m going to make a big stink. I’m serious about this, because I can’t believe your laws are that much different than ours in this kind of situation. The body belongs to me as the responsible next of kin.”
“We certainly would not do anything without your expressed approval.”
“Good,” Jennifer said, recovering to a degree yet surprised about the vehemence of her response. It wasn’t lost on her that she was probably experiencing a significant amount of transference with her emotions, blaming the hospital and even Maria. Not only was she sad about her grandmother, she was also mad. It hardly seemed fair that Maria had not confided in her about running off to India, having major surgery, and then getting herself killed.
After terminating the call, Jennifer stood where she was, recognizing it was probably going to take her some time and effort to sort through her psychological issues. But then she realized what time it was and that she had to catch a flight whose departure was not that many hours away. With that in mind, she hustled back through the revolving door and headed for the emergency department.
As per usual, the emergency room was bedlam. Jennifer was looking for Dr. Neil McCulgan, who had risen in rapid fashion from chief emergency-medicine resident to his current position as an assistant emergency-room director in charge of scheduling. Jennifer had met him during her first year, when he was still a resident. As a character unknown on the East Coast, he was entirely unique to her, and she found him intriguing. Neil was a stereotypical Southern California “surfer dude” sans blond hair, which, in his case, was nondescript brown. What Jennifer found so distinctive was his openly friendly laid-back attitude that was in total contrast to his being a closet intellectual and a compulsive studier with a near photographic memory. When she’d first met him she truly couldn’t believe he’d been attracted to a tense, highly demanding medical specialty like emergency medicine.
Although Jennifer was well aware she didn’t share his social graces, she did share his general interest in knowledge for knowledge’s sake and his study habits, and found him a fertile source of all sorts of information. Over a period of a year Neil became the first man with whom she felt she could truly converse, and not only about medicine. As a consequence, they became best friends. Actually, Neil had become her first real boyfriend. She thought she’d had boyfriends before, but after meeting Neil she realized that was not exactly true. Neil had been the first person to whom Jennifer had been willing to confide her most private secrets.
“Excuse me!” Jennifer called out to one of the harried nurses at the chaotic central station. The nurse had just shouted something to a colleague who was leaning out a doorway several rooms down the main corridor. “Can you tell me where Dr. McCulgan is?”
“I haven’t the faintest,” the man said. For some reason he had two, not one, stethoscopes draped around his neck. “Did you try his office?”
Taking that suggestion, Jennifer hurried over to the triage area, where the office was located. Glancing in, she felt lucky. He was sitting at his desk with his back to her, dressed in a starched white coat over green scrubs. Jennifer plopped herself down in the chair squeezed between the desk and the wall. Startled, he looked up momentarily.
“Busy?” Jennifer managed, with a catch in her voice. Her question only elicited a scoffing chuckle from the man, whose attention had returned to the massive ER schedule for the month of November that he was poring over.
Neil had pleasant features, intelligent eyes, and a slight dusting of premature gray along his temples. He also had the broad shoulders and exceptionally narrow waist of a surfer. On his feet he wore white-leather wood-soled clogs. “Can I talk to you for a moment?” she questioned. As she spoke she had to choke back tears.
“If you can make it quick,” he said, but with a smile. “I have to have this schedule ready for the printer in one hour.” He looked up again and only then became aware that she was struggling with her emotions. “What’s wrong?” he said with sudden concern. He put down his pen and leaned toward her.
“I had awful news this morning.”
“I’m so sorry,” he said, reaching out and gripping her arm. He didn’t ask what the news was about. He knew her well enough to know that she would tell him if she was inclined but wouldn’t tell him if she wasn’t, despite any amount of cajoling on his part.
“Thank you. It was about my grandmother.” Jennifer pulled her arm free and reached across Neil’s desk to grab a tissue.
“I remember. Maria, right?”
“Yes. She died just a few hours ago. It was even announced, believe it or not, on CNN.”
“Oh, no! Gosh, I’m truly sorry. I know what she meant to you. What happened?”
“I’m told a heart attack, which definitely surprises me.”
“I can understand why. Didn’t the medical department here recently give her a remarkably clean bill of health?”
“They absolutely did. They even gave her a stress test.”
“Are you going to head home, or is that a problem? I mean, didn’t you start your new surgery rotation today?”
“No and yes,” Jennifer said cryptically. “The situation is a bit more complicated.” She then went on to tell Neil the whole story about India, about being needled concerning cremation or embalming, about getting the dean to grant a week’s leave, about a medical-service company paying her expenses, and about leaving in just a few hours.
“Wow,” Neil said. “You’ve had quite a morning. I’m sorry you are going to India for such a sad reason. As I told you last May when I came back, it’s a fascinating country, full of unbelievable contrasts. But I guess this won’t be a pleasure trip.” Neil had been to India five months before to speak at a medical conference in New Delhi.
“I can’t imagine anything about this trip being pleasurable, which brings me to the issue of malaria. What do you think I should do?”
“Ouch,” Neil said, wincing. “I’m sorry to say you should hav
e started something a week ago.”
“Well, there’s no way I could have anticipated this. I’m okay on everything else, even typhoid, from the scare last year with my patient in internal medicine.”
Neil grabbed a prescription pad from his drawer and rapidly wrote one out. He handed it to Jennifer, who looked it over.
“Doxycycline?” Jennifer read out loud.
“It’s not the number-one choice, but the coverage starts immediately. The best part is you probably don’t need it. It’s the south of India where malaria is a true problem.”
Jennifer nodded and put the scrip into her shoulder bag.
“Why did your grandmother go to India for her surgery?”
“Purely cost, I assume. She didn’t have health insurance. And I’m sure my bastard of a father encouraged it big-time.”
“I’ve read about medical tourism to India, but I’ve never known someone who actually did it.”
“I wasn’t even aware of it.”
“Where are they putting you up?”
“A hotel called the Amal Palace.”
“Wow!” Neil said. “That’s supposed to be five-star.” He chuckled, then added, “You’d better be careful; they must be trying to buy you off. Of course I’m kidding. They don’t need to buy you off. One of the negatives about medical tourism is you have no recourse. There’s no such thing as malpractice. Even if they screw up big-time, like taking out the wrong eye or killing someone by mistake or incompetence, there’s not a thing you can do.”
“It’s my guess they’ve negotiated some kind of deal with the Amal Palace. It’s just where they put people up. I mean, it’s not like I’m getting a special deal. Apparently, they pay airfare and hotel for one relative. That’s why I’m getting the trip. My lazy father claimed he couldn’t go.”
