by Robin Cook
When Jack had arrived home the previous evening, he’d been disappointed to find both Laurie and JJ fast asleep and a note on the console table by the front door: “Bad day, lots of tears, no sleep but asleep now. I have to get mine when I can. Soup on the stove. Love, L.”
The note had made Jack feel guilty and lonely. He’d not called all day for fear he’d wake them, which had happened in the past. Although he always encouraged Laurie to call him when she could, she never did. He hoped the reason wasn’t out of resentment that he got to go to work while she remained at home, but even if it was, he knew she wouldn’t have it any other way.
But his guilt wasn’t just about not calling—it was because he actually didn’t want to know what was going on at home. Sometimes, he didn’t even want to go home. Being in the apartment made the tragedy of his son’s illness and Jack’s inability to affect it unavoidable. Although he’d never admitted it to Laurie, just holding the suffering infant was a strain on his emotions, and he hated himself for it. At the same time he understood what was behind his feelings: He was vainly trying not to get too attached to the child. The unspeakable reality lurking in the recesses of his mind was that JJ was not going to survive.
Jack took advantage of the house’s peacefulness by diving into Trick or Treatment. When Laurie awoke four hours later, she found him so completely absorbed that he’d forgotten to eat.
Jack listened while Laurie recounted her day. Just like every other day, the more he heard, the more he felt she was a saint and he the opposite, but he let her get it all out. When she’d finished, they’d gone into the kitchen, where she insisted on heating up some soup for the two of them.
“It’s ironic that you brought up trying alternative medicine this morning,” he’d said as they’d eaten. “I can tell you one thing, we might be desperate, but we are never going to use alternative medicine.” He told her about Keara Abelard and his decision to look seriously into the alternative-medicine issue. As physically and mentally exhausted as she was, she listened to his impassioned lecture with only half an ear until he got to the fatal case of the three-month-old dying from chiropractic cervical manipulation. From that point on, Jack had had her full attention. He described how Trick or Treatment was opening his eyes to all the mainstream alternative-medicine fields, including homeopathy, acupuncture, and herbal medicine, in addition to chiropractic.
When Jack had finished his mini-lecture, Laurie’s response was to congratulate him on finding a worthy subject to occupy his mind while the family was treading water regarding JJ’s treatment. She even confessed to some jealousy, but that was as far as it went. When Jack again brought up the subject of getting her back to work with the aid of round-the-clock nurses, she’d again refused, saying she was doing what she needed to do. She then went on to mention three cases of alternative-medicine fatalities that she’d had herself. One was a case of an acupuncture victim who’d died when the acupuncturist inadvertently impaled the victim’s heart with an acupuncture needle right in the area of the sinoventricular node. Two others died from heavy-metal poisoning from contaminated Chinese herbs.
Jack was pleased to get Laurie’s cases and had admitted he’d sent out an e-mail to all their M.D. colleagues, asking for similar cases, to try to estimate the incidence of alternative medicine- induced deaths in New York City.
“Hey!” Chet called out while giving Jack’s arm a forceful nudge. “What are you having, a psychomotor seizure?”
“Sorry,” Jack said, shaking his head as if waking from a trance. “My mind was someplace else.”
“What did you want to ask me about my VAD case?” Chet asked. He had been waiting for Jack to finish his question.
“Could you possibly get the name or accession number of that case so I can get the details?” Jack said, but he didn’t listen for Chet’s response. His mind was back, remembering that morning when he’d awakened at five-thirty, still in his clothes, still sitting on the living-room couch. On his lap was Trick or Treatment, open midway through the appendix.
The book had solidified his negative feelings about alternative medicine and boosted his interest in the issue. Although there were certain sections of the book that he’d skimmed, for the most part he’d read the entire volume, even underlining certain key passages. Its message surely meshed with his own stance on the subject, and he felt the arguments the authors used to justify their conclusions were clear and unbiased. In fact, Jack felt they had bent over backward to try to make a case for alternative medicine, but in their summary all they could say was that homeopathy provided only a placebo effect; acupuncture, besides placebo, might have an effect on some types of pain and nausea, but it was minor and short-lived; chiropractic, besides placebo, showed some evidence of efficacy in relation to back pain, but conventional treatments were usually equally beneficial and far less expensive; and herbal medicine was mostly placebo, with products of little or no quality control, and for those products with a pharmacological effect, drugs that contained just the active ingredient were decidedly more safe and more efficacious.
Having slept just a couple of hours, Jack thought he’d be exhausted. But, at least initially, that hadn’t been the case. After an exhilarating cold shower and a bite to eat, Jack had cycled to the OCME in near-record time.
As keyed up as he was with newfound knowledge about alternative medicine, Jack immersed himself in his work, signing out several pending cases before grabbing an unwilling Vinnie to start work in the autopsy room. By the time Jack had come by Chet’s office he’d finished three autopsies, which included a shooting at a bar in the East Village and two suicides, one of which Jack found definitely suspicious and about which he’d already put in a call to his buddy, Lieutenant Detective Lou Soldano.
“Hey,” Chet called out again. “Anybody home? This is ridiculous. It’s like having a conversation with a zombie. I just told you the name of that VAD case of mine, and you look like you’re back having another petit mal seizure. Didn’t you sleep last night?”
“I’m sorry,” Jack said, squeezing his eyes together and then blinking rapidly. “You’re right about me not getting much sleep last night, and I’m running on nervous energy. Tell me again the name!”
“Why so interested?” Chet questioned, writing the name on a piece of notepaper and handing it to Jack.
“I’m looking into alternative medicine in general, and chiropractic VAD in particular. What did you find when you looked into VAD back then?”
“You mean above and beyond the fact that no one wanted to hear about it?”
“You mean besides your chief?”
“When I presented the case on grand rounds, it ignited a kind of debate, with half the audience for and half against chiropractic, and those who were for it were really for it. It was an emotional issue that took me by surprise, especially that my boss was such a fan.”
“You said you’d gathered four or five cases. Do you think you could find their names as well? It would be interesting to unofficially compare the incidence of VAD between New York City and L.A.”
“Finding the name of my own case was relatively easy; finding the others is asking for a miracle. But I’ll check. How are you going to look into it around here?”
“Have you checked your e-mail lately?”
“Can’t say I have.”
“When you do, there’s one from me. I sent an e-mail to all the city MEs, looking for cases. Later this afternoon I’m going to go over to records and see if I can find any there as well.”
Suddenly, Jack’s BlackBerry buzzed. Always concerned it might be Laurie and a crisis at home, he snatched it out of its holster and glanced at the LCD screen. “Uh-oh!” he said. It wasn’t Laurie. It was the chief, Harold Bingham, calling from the front office downstairs.
“What’s up?” Chet asked, noticing Jack’s reaction.
“It’s the chief,” Jack said.
“Is that a problem?”
“I made a site visit yesterday,” Jack confessed.
“It was to the chiropractor involved in my case. I wasn’t my usual diplomatic self. In fact, we almost came to blows.”
Chet, who knew Jack better than anyone else in the office, grimaced. “Good luck!”
Jack nodded thanks and clicked to accept the call. Bingham’s no-nonsense secretary, Mrs. Sanford, was on the line. “The chief wants you in his office, now!”
“I heard that,” Chet said, making the sign of the cross. The meaning was simple: Chet was convinced Jack’s situation needed prayer.
Jack pushed away from Chet’s desk. “Thanks for the vote of confidence,” he said sarcastically.
As he walked to the elevator, Jack thought the summons had to be about good old Newhouse, the chiropractor. Jack had fully expected to have to answer for the episode but didn’t think it would happen so quickly. This probably wasn’t due to just a phone call from the irate chiropractor but rather a call from a lawyer. Consequences could be a slap on the wrist—or a drawn-out civil suit.
Stepping out of the elevator, Jack thought that instead of defending himself in front of Bingham, which he knew would be difficult if not impossible, perhaps he should go on the offense.
“You are to go right in,” Mrs. Sanford said, without looking up from her computer. Since she’d done the same thing the last time he’d been called on the carpet ten years previously, he was once again mystified how she’d known it was him.
“Close the door!” Bingham demanded from behind his mammoth wooden desk. The desk was set back below high windows covered with ancient venetian blinds. Calvin Washington, the deputy chief, was sitting at the large library table, with the glass-fronted bookcases behind him. Both men stared at Jack unblinkingly.
“Thanks for calling me down here,” Jack said earnestly, walking directly up to Bingham’s desk and giving it a thump with the bottom of his fist for added emphasis. “The OCME must take a responsible stand on alternative medicine, particularly chiropractic. Yesterday we had a death by bilateral vertebral artery dissection caused by unnecessary cervical manipulation.”
Bingham looked confused by the way Jack took the wind out of his sails. “I’ve taken the lead,” Jack continued, “by forcing myself yesterday to take the time and effort to conduct a site visit to the offending chiropractor to confirm that he performed the cervical manipulation. As you might gather, this was not the easiest task, and I needed to be forceful to get the information.”
Bingham’s blotchy face paled slightly, and his rheumy eyes narrowed while he stared at Jack. Then he removed his glasses to clean them—and to buy himself time. Snappy repartee had never been one of his strengths.
“Sit down!” Calvin boomed from the back of the room.
Jack sat in one of the chairs in front of Bingham’s desk. He didn’t look back. As he expected and feared, Calvin was not taken in by his tactics the way Bingham was.
Calvin’s imposing bulk appeared out of the corner of Jack’s line of vision. Slowly Jack raised his eyes to look at him. Calvin had his hands on his hips, his face drawn, his eyes blazing. He towered over Jack. “Cut the bullshit, Stapleton!” he thundered. “You know damn well you’re not supposed to be out there running around the city, flashing your badge around like a renegade TV cop.”
“Looking back, I realize I didn’t handle it well,” Jack admitted.
“Was this some kind of personal vendetta against chiropractic?” Bingham demanded.
“Yes, it was personal.”
“Do you care to explain?” Bingham demanded.
“You mean other than chiropractic has no business treating illnesses that have nothing to do with the spine? Or that chiropractic bases its rationale for such treatment on an idiotic outdated mystical concept of innate intelligence that has never been found or measured or explained? Or that such treatment often involves cervical manipulations that can cause death, like in my twenty-seven-year-old patient?”
Bingham and Washington exchanged a dismayed glance at Jack’s emotional outburst.
“That all may or may not be true,” Bingham said, “but what makes it personal?”
“I’d rather not get into that,” Jack said, forcing himself to calm down. He knew he was letting his emotions get the better of him, just as he had at the chiropractor’s office. “It’s a long story and the association is what you would call rather indirect.”
“You’d rather not get into that,” Bingham repeated scornfully, “but we might feel it is necessary, and that if you don’t do it, it might be at your peril. Since you might not have been served with a subpoena yet, it’s my unpleasant responsibility to inform you that you and the OCME are being sued by a Dr. Ronald Newhouse. . . .”
“He’s not a doctor, for chrissake,” Jack blurted. “He’s a goddamn chiropractor.”
Bingham and Washington exchanged another quick glance. Bingham was clearly frustrated, like a parent with a recalcitrant teenager. Calvin was less generous. He was just plain furious and finding it difficult to hold his tongue.
“For the moment, your opinion of chiropractic doesn’t matter,” Bingham said. “It was your actions that are in question here, and the gentleman in question is most likely a doctor of chiropractic. You and the OCME are being sued for slander, defamation of character, assault—”
“I never touched the guy,” Jack interrupted. He was finding it difficult to follow his own advice in regard to his emotions.
“You do not have to touch someone to be sued for assault. The plaintiff only has to believe you are about to injure him in some way. Were you in his office yelling at him?”
“I suppose,” Jack admitted.
“Did you threaten to have him arrested for killing his patient?”
“I suppose,” Jack said sheepishly.
“You suppose!” Bingham echoed with heightened scorn, momentarily throwing up his arms toward the ceiling in exasperation. Then, raising his voice, he yelled, “I’ll tell you what I think it is: It’s an egregious misuse of official authority. I have the mind to kick your ass outta here and put you on unpaid administrative leave until this mess is sorted out.”
A chill went down Jack’s spine. If he was put on leave, his lifeline to emotional sanity would be cut. He’d have to stay home, and Laurie would have to come to work instead. He’d have to assume responsibility for taking care of JJ. Oh my God! Jack voiced inwardly. He suddenly felt desperate, even more than he’d been feeling up until then. The last time he’d been in a similar circumstance facing Bingham’s wrath, he didn’t care about himself. But now he couldn’t afford to be self-destructive. His family needed him. He couldn’t get depressed. Bingham was right; it was a mess.
Bingham noisily took in a deep breath and blew it out through pursed lips. He looked up at Calvin, who still glared down at Jack. “What do you think, Calvin?” Bingham asked. His voice had calmed to near normal.
“What do I think about what?” Calvin demanded. “Whether we put this asshole on administrative leave or beat him to a bloody pulp?”
“You met with the general counsel, not I,” Bingham said. “What was her opinion about the indemnity issue? Is she confident our insurance will cover this episode whether the suit settles or goes to trial?”
“She thought it should. After all, it’s not a criminal suit.”
“What about the possibility of Stapleton’s actions being considered purposefully malicious?”
“She was less sure about that possibility.”
Jack looked from Bingham to Calvin and back. For the moment they were ignoring him, as if he wasn’t even there. After several more exchanges between the two men, Bingham switched his attention to Jack. “What we’re talking about here is whether you’re going to be covered by insurance. According to your contract, the OCME indemnifies you for malpractice, except if the malpractice involves criminality or is considered malicious, meaning you were doing it on purpose instead of by accident.”
“I didn’t go to the chiropractor’s office to injure anybody, if that’s what you mean,” Jack sa
id contritely. He had the sense that the situation was spiraling out of control.
“That’s reassuring,” Bingham said. “We have to decide if we are going to defend you or not. Of course, it has some bearing whether or not our insurance will cover a judgment against you. If it won’t, then you’ll probably have to defend yourself, which could be expensive, I’m afraid.”
“My motives were definitely not malicious,” Jack said, as his heart skipped a beat at the prospect of having to defend himself. With Laurie on leave and the extra expenses of JJ’s illness, he didn’t have money for a lawyer. “I didn’t go to the chiropractor’s office with any other intent except to find out if he had seen my patient professionally, and whether or not he had manipulated her cervical spine.”
“What was the cause of death again?” Bingham asked.
“Bilateral vertebral artery dissection,” Jack said.
“Really!” Bingham commented, as if he’d heard it for the first time. Immediately, his eyes glazed over. It was a physiological reflex for him whenever his brain sifted through the thousands of forensic cases in which he’d been involved over his extensive career.
Although Bingham could struggle at times with remembering recent events, like the cause of death of Keara Abelard, which Jack had mentioned only moments earlier, his distant recall was encyclopedic. A moment later he blinked and roused himself, as if waking from a trance. “I’ve had three cases of VAC,” he reported.
“Were they caused by chiropractic manipulation?” Jack asked hopefully. Still, it was becoming clear to him that he wasn’t going to be able to keep his private life separate from his professional life if he wanted to avoid being put on administrative leave or worse. He was going to have to admit to JJ’s illness and his difficulty dealing with it. Only then might Bingham and Calvin excuse his unthinking behavior the day before.
