Critical (2 page)

As a computer programmer for a high-flying Manhattan-based software company, David had spent, as he put it, a lot of hours on his butt, shackled to his monitor. Being an athletically inclined individual from as early as he could remember, he needed competitive exercise, and tennis was his thing. Up until his injury a month prior to his surgery, he'd played at least four times a week. He'd even vainly tried to interest his two preteen sons in the game.

As for his injury he had no idea how it had happened. He'd always kept himself in good shape. All he had remembered about the event was charging the net after making what he thought had been a good lead shot. Unfortunately his shot had not been as good as he had hoped, and his opponent had followed up with a well-placed return to David's left. On the run, David had planted his leading foot and twisted left to try to get to the ball. But he never got near it. Instead, he had found himself on the ground, clutching a painful knee that had immediately begun to swell dramatically.

Considering David's fulminant postoperative course, one certainly could say that he should have been more respectful of bacteria. Within hours of his surgery, relatively small numbers of staphylococci, which had found their way into David's knee and the distal bronchioles of his lungs, began their molecular magic.

Staphylococcus is a common type of bacterium. At any given time, two billion people, a third of the world's population, have them commensally residing inside their nares and/or in moist locations on their skin. Indeed, David was so colonized. But the species that had gotten inside David's body was not from his flora, but was rather a particular strain of staphylococcus aureus that had taken advantage of the ease with which staphylococci exchange genetic information to enhance their virulence and hence competitive advantage. Not only did this particular subspecies resist penicillin-like antibiotics, it also carried the genes for a host of nasty molecules, some of which helped the invading bacteria adhere to the cells that lined David's smallest capillaries while others actually destroyed the defensive cells that David's body sent to deal with the developing infection. With David's cellular defenses crippled, the invading bacteria's growth rapidly became exponential, reaching in hours a secretory stage. At this point, a group of other genes in this particular staphylococcus genome switched on, allowing the microorganisms to spew out a library of even more vicious molecules called toxins. These toxins began to wreak havoc inside David's body, including causing what is commonly referred to as the "flesh-eating effect," as well as the symptoms and signs referred to as toxic shock syndrome.

David was first made aware of the gathering storm by a slight fever, which developed six hours after his surgery, well before the invading bacteria reached the secretory stage. David didn't give the rise in temperature much thought, nor did the nurse's aide, who duly recorded it in his digital record. Next, he noticed what he described as tightness in his chest. With his narcotic pain medicine onboard, the administration of which he was able to adjust himself, he didn't complain. He thought these early symptoms were par for the course until his breathing became labored and he coughed up blood-tinged mucus. Suddenly, it was as if he couldn't quite catch his breath. At that point, he became truly concerned. His anxieties ratcheted up when he called attention to his worsening condition and the nurses responded by erupting in a flurry of anxious activity. As blood cultures were drawn, antibiotics were added to his IV, and frantic calls were made about a possible emergency transfer to the University Hospital, David hesitantly questioned if he was going to be all right.

"You'll be fine," one of the nurses said reflexively But that reassurance notwithstanding, David died several hours later of overwhelming sepsis and multiorgan failure while en route to a full-service general hospital.

LIKE MOST PEOPLE, Paul Yang never truly worried about his ultimate fate, yet he should have, particularly around the time that David Jeffries was losing his molecular battle with bacteria. Similar to other fellow human beings cursed by the knowledge of their mortality, Paul didn't dwell on the harsh reality of death, even with the nagging reminder of progressively aging at a gradually quickening pace. At age fifty-one, he had too many more immediate concerns, such as his family, which included a spendthrift wife who was never materially satisfied, two children in college and another soon to follow, and a large suburban house with a commensurate mortgage and the constant need of major repair. As if all that wasn't enough, over the last three months his job had been driving him to distraction.

Five years previously, Paul had given up a comfortable yet predictable and somewhat boring job at an established Fortune 500 firm to be the chief and only accountant for a promising new startup company proposing to build and run private, for-profit specialty hospitals. He had been aggressively recruited by his former boss, who had earlier been recruited to be the start-up's CFO by a brilliant woman doctor named Angela Dawson, who was just finishing her MBA at Columbia University. The decision to switch jobs had been agonizing for Paul, since he was not a gambler by nature, but his growing need for disposable income and the chance to make it big in the rapidly growing, trillion-dollar healthcare industry trumped the uncertainties and the associated risks.

Remarkably, everything had gone according to plan for Angels Healthcare LCC, thanks to Dr. Angela Dawson's innate business acumen. With the stock, warrants, and options Paul controlled, he was within weeks of becoming rich along with the other founders, the angel investors, and to a lesser extent the more than five hundred physician equity owners. The closing of an IPO was just around the corner, and due to a terrifically successful recent road show that had institutional investors drooling, the stock price was just about set at the upper limits of everyone's expectations.

With an anticipated five hundred million dollars to be raised on the first go-round, Paul should have been on cloud nine. But he wasn't. He was more anxious than he'd been in his entire life, because he was ensnared in an epic ethical dilemma exacerbated by the series of recent corporate accounting scandals, including that at Enron, which had rocked the financial world during the previous six or seven years. The fact that he had not cooked the books was not a consolation. He religiously adhered to GAAP -- Generally Accepted Accounting Procedures -- and was confident that his books were accurate to the penny. The problem was that he didn't want anyone outside of the founders to see the books, specifically because they were accurate and therefore clearly reflected a major negative-cash-flow situation. The problem had started three and a half months previously, just after the independent audit had been completed for the IPO prospectus. It began as a mere trickle but rapidly mushroomed into a torrent. Paul's dilemma was that he was supposed to report the shortfall, not just to his CFO, which he certainly did, but also to the Securities and Exchange Commission. The trouble was, as the CFO quickly pointed out, such reporting would undoubtedly kill the IPO, which would mean that all their strenuous effort over almost a year would go down the drain, perhaps along with the future of the company. The CFO and even Dr. Dawson herself had reminded Paul that the unexpected burn rate was a mere quirk and obviously temporary since the cause was being adequately redressed.

Although Paul acknowledged that everything he was being told was probably true, he knew his not reporting definitely violated the law. Forced to choose between his innate sense of ethics and a combination of personal ambition and his family's insatiable need for cash, the conflict was driving him crazy. In fact, it had driven him back to drink, a problem he'd overcome years ago but that the current situation had reawakened. Yet he was confident the drinking wasn't completely out of control since it was restricted to having several cocktails prior to boarding the commuter train on his way home to New Jersey. There had been no all-night binges and partying with ladies of the night, which had been a problem in the past.

On the evening of April 2, 2007, he stopped into his designated watering hole en route to the train station, and while sipping his third vodka martini and staring at himself in the smoky mirror behind the bar, he suddenly decided he would file the required report the following day. He'd been flip-flopping for days, but all at once he thought maybe he could have his cake and eat it too. In his mildly inebriated state, he reasoned that it was now so close to the IPO closing that maybe the report would sit around at the bureaucratic SEC and not get to the investors in time. That way, he'd have assuaged his conscience and, he hoped, not killed the IPO. Feeling a sudden euphoria at having made a decision even if he would change his mind overnight, Paul rewarded himself with a fourth cocktail.

Paul's final vodka seemed more pleasurable than the previous, but it might have been the reason he did something an hour later that he normally would not have done. Weaving slightly while walking home from the train station, he allowed himself to be approached a few doors away from his house and to be engaged in conversation with two nattily dressed yet vaguely unnerving men who had emerged from a large, vintage black Cadillac.

"Mr. Paul Yang?" one of the men had questioned in a raspy voice.

Paul stopped, which was his first mistake. "Yes," he responded, which was his second mistake. He should have just kept walking. Coming to such a sudden halt, he had to sway slightly to maintain his balance, and he blinked a few times to try to sharpen his mildly blurry vision. The two men appeared about the same age and height, with hatchet-like faces, deeply set eyes, and dark hair carefully slicked back from their foreheads. One of the men had considerable facial scarring. It was the other man who spoke.

"Would you be so kind as to afford us a moment of your time?" the man asked.

"I suppose," Paul responded, surprised by the disconnect between the gracious syntax of the request and the heavy New York accent.

"Sorry to delay you," the man continued. "I'm certain you are eager to get home."

Paul turned his head and glanced at his front door. He was mildly discomfited that the strangers knew where he lived.

"My name is Franco Ponti," the man added, "and this gentleman's name is Angelo Facciolo."

Paul looked briefly at the man with the unfortunate scarring. It appeared as if he didn't have eyebrows, which gave him an otherworldly appearance in the half-light.

"We work for Mr. Vinnie Dominick. I don't believe you are acquainted with this individual."

Paul nodded. He had never met a Mr. Vinnie Dominick, as far as he knew.

"I have been given permission by Mr. Dominick to tell you something financially significant about Angels Healthcare that no one at the company knows," Franco continued. "In return for this information, which Mr. Dominick is certain will be interesting to you, he only asks that you respect his privacy and not tell anyone else. Is that a deal?"

Paul tried to think, but under the circumstances it was difficult. Yet as Angels Healthcare's chief accountant, he was curious about any so-called significant financial information. "Okay," Paul said finally.

"Now, I have to warn you that Mr. Dominick takes people at their word, and it would be serious if you don't honor your pledge. Do you understand?"

"I suppose," Paul said. He had to take a sudden step back to maintain his balance.

"Mr. Vinnie Dominick is Angels Healthcare's angel investor."

"Wow!" Paul said. In his position as accountant, he knew that there was an angel investor to the tune of fifteen million dollars, whose name no one knew. On top of that, the same individual recently provided a quarter-of-a-million-dollar bridge loan to cover the current shortfall. From the company's perspective, and Paul's, Mr. Dominick was a hero.

"Now, Mr. Dominick has a favor to ask. He would like to meet with you for a few moments without the knowledge of the principals of Angels Healthcare. He told me to say that he is concerned the principals of the company are not following the letter of the law. Now, I'm not sure what that means, but he said you would."

Paul nodded again as he tried to clear his alcohol-addled brain.

Here was the issue he'd been struggling with solo for weeks, and suddenly he was being offered unexpected support. He cleared his throat and asked, "When would he like to meet?" Paul bent down to try to see into the interior of the black sedan, but he couldn't.

"Right now," Franco said. "Mr. Dominick has a yacht moored in Hoboken. We can have you there in fifteen minutes, you can have your talk, and then we'll bring you back to your door. It will be an hour at most."

"Hoboken?" Paul questioned, wishing he had skipped the cocktails. It seemed to be getting harder and harder to think. For a second, he couldn't even remember where Hoboken was.

"We'll be there in fifteen minutes," Franco repeated.

Paul wasn't wild about the idea, and hated being put on the spot. He was a bean counter who liked to deal with numbers, not hasty value judgments, particularly when suffering a buzz. Under normal circumstances, Paul would have never gotten into a car at night with total strangers for an evening meeting on a yacht with a man he'd never met. But in his current muddle and with the prospect of being abetted in his business decision-making by such an important player as Vinnie Dominick, he couldn't resist. With a final nod, he took a wobbly step toward the open car door. Angelo helped by taking Paul's laptop and handing it back to him when Paul was settled.

There was no conversation as they drove back in the direction of New York. Franco and Angelo sat in the front seat, and from Paul's vantage point in the back, their heads were dark, motionless, two-dimensional cutouts against the glare of the oncoming traffic. Paul glanced out the side window and wondered if he should have at least gone into his house to let his wife know what he was doing. He sighed and tried to look on the bright side. Although the interior of the car reeked of cigarettes, neither Franco nor Angelo lit up. Paul was at least thankful for that.