Critical (23 page)

Before Fran could respond, Cynthia's head popped back up. She'd returned to studying the OR scheduling log, which she and Fran had been busily doing before Laurie and Loraine had appeared. "You are a medical examiner?" she questioned, with even more edge to her voice than when she'd spoken with Loraine.

"I am," Laurie confirmed.

"What the hell are you doing here?"

"I'm ah ..." Laurie began, but hesitated. She was taken aback by Cynthia's tone and challenging glare. Laurie couldn't help but remember Arnold's description of the woman as not being terribly cooperative, as well as defensive, and essentially telling him to butt out. The last thing Laurie wanted was some sort of a confrontation, knowing she was, to a certain extent, overstepping her bounds by making the site visit. Steve Mariott, the evening PA, had visited the hospital the night before, after Jeffries's death had been called into the OCME.

"Well?" Cynthia questioned impatiently.

"I autopsied a case this morning of a patient who'd been operated on yesterday here at Angels Orthopedic Hospital and who had died of an exceptionally aggressive MRSA infection."

"We are well aware of that, thank you very much," Cynthia snapped.

Laurie glanced briefly at Loraine, who appeared as surprised as Laurie. "When I canvassed my colleagues, I discovered you'd had a number of similar cases. I thought it was appropriate to come over here, and see if I could help."

Cynthia laughed cynically. "And just how did you think you could help? Have you been trained in epidemiology, infection control, or even in infectious diseases?"

"My training is in forensic pathology," Laurie said defensively. "My exposure to epidemiology has not been extensive, but my understanding is that in an outbreak of this sort, one of the first things that should be done is to accurately subtype the organisms."

"I'm board-certified in internal medicine with a subspecialty in infectious diseases and have a Ph.D. in epidemiology. As far as your comment about subtyping, you are correct but only if such information is needed to decide on a targeted method of control. In our situation, it wasn't needed, since our CEO insisted that we use a global control strategy. Our interest was not in saving money by restricting ourselves to a target approach. I spoke with one of your colleagues a number of weeks ago after he'd autopsied one of our MRSA cases. I assured him we were well aware of the problem and aggressively engaged in solving it, and thanked him for the call."

"That's all well and good," Laurie said, with her own dander rising. "Having had the dubious honor to autopsy the unfortunate individual this morning, I can say with some conviction that you have been unsuccessful in your control efforts."

"That might be the case, but we surely don't need interference. Your job is to tell us cause of death and anything else we might not know pathologically. The fact of the matter is that we are well aware of both the cause and mechanism of death, and we are doing everything humanly possible to control this unfortunate outbreak. What is it you wish to accomplish by visiting the operating room? What do you want to see?"

"To be totally honest, I don't know," Laurie said. "But I can assure you that there have been thousands of times that site visits have either helped or been crucial in a forensic investigation. Mr. Jeffries is officially a medical examiner's case, and I am duty-bound to investigate it fully, which in this case means viewing the scene of his proximate cause of death. Odds are, he was exposed to the bacteria that led to his demise in the operating room where he'd had his surgery."

"We'll see about that," Cynthia said, getting to her feet. "I'll have you talk with someone with considerably more authority than I. I insist you wait outside in the surgical lounge. I will be right back."

Without another word or even a glance over her shoulder, Cynthia walked quickly to the double doors and departed.

Laurie and Loraine exchanged another surprised and confused glance.

"I'm sorry," Loraine said. "I don't know what's come over her."

"It's certainly not your fault."

"She is under a lot of pressure," Fran, the OR supervisor, said. "She's been intense from the first, and it's only gotten worse. She's taking the whole problem very personally, so try not to do so yourself, Dr. Montgomery. She's even been at my throat on occasion."

"Who is she going to fetch?" Loraine questioned. "Mr. Straus, the hospital president?"

"I have no idea," Fran said.

"Let's go back to the lounge," Loraine suggested to Laurie.

"I think that might be a good idea," Laurie said. She felt anxious from an adrenaline surge engendered by the unexpected confrontation and its potential consequences.

As they walked, Loraine added, "Dr. Sarpoulus has always been uptight, as Fran suggested. Are you sure you want to stay? She was very rude."

"I'll stay," Laurie said, with some misgivings. What motivated her was the hope of being able to smooth things over with someone more rational than Cynthia Sarpoulus. Leaving on an unpleasant note certainly would not be helpful if she had additional questions, and there might even be a complaint made about her visit. Laurie specifically wanted to avoid such a possibility.

Back in the surgical lounge, Laurie accepted some coffee and crackers from Loraine. As busy as she'd been, she'd skipped lunch and was famished.

"So it was the CEO's decision not to characterize more fully the staph strains involved in the outbreak?"

"I guess," Loraine said. "I thought it had been Cynthia's decision, but I guess not."

Laurie had more questions, but her thoughts were interrupted by Cynthia's reappearance. By her expression, her mood had not mollified. Her sharply defined, full lips were pressed firmly together, and she walked with obvious determination. Behind her came a man and a woman. The woman was of medium height, with blemish-free pale skin, aristocratic features, and a helmet of short, thick hair. She was dressed in an elegant business suit and walked with a decidedly commanding resoluteness while still managing to exude classic femininity.

The man was her antithesis, not only in gender but in his general appearance and the way he moved. He wore a rumpled plaid wool jacket with leather elbows, the kind that Laurie had always associated with academia. Instead of resoluteness, he projected an air of wariness, with his pale eyes constantly on the move as if he were in a potentially hostile environment.

"Dr. Montgomery," Cynthia said triumphantly. "May I present Dr. Angela Dawson, the CEO of Angels Healthcare, and Dr. Walter Osgood, department head of clinical pathology. I believe you should direct your comments to them."

"What seems to be the trouble?" Angela demanded. From her tone, it was obvious Laurie's presence was not to her liking.

"I'm afraid I have no idea," Laurie said, as she got to her feet. Since they were nearly the same height, she and Angela literally saw eye to eye.

Loraine scrambled to her feet. "If there is any fault concerning Dr. Montgomery's presence, surely it is mine," she said. "Dr. Montgomery called me after she had autopsied Mr. David Jeffries. She asked to come to the hospital for a visit as part of her investigation. I invited her. She only asked to see our OR HVAC system in the engineering spaces, a typical patient room, and the OR itself. I didn't see any problem in that. I suppose I should have run it by Mr. Straus beforehand."

"As president of the hospital, that would have been wise," Angela agreed. "It would have saved us this embarrassment." Then, turning to Laurie, she said, "You do understand that this is private property."

"I understand," Laurie said. "But David Jeffries is a medical examiner case, and by law, I have subpoena power for documents and whatnot, and to visit the scene in order to investigate fully the cause and manner of death."

"There is no doubt legal recourse for you to carry out your duty, but barging in here is not one of them. Someone has already visited us from your office the previous evening and was shown appropriate hospitality. I will be very happy to discuss this with the chief of the OCME, Dr. Harold Bingham, whom I have had the pleasure of meeting on several occasions."

Laurie felt a chill descending her spine. Despite knowing she ultimately had the legal right to make the visit, the very last thing she wanted was for Bingham to be dragged into this ridiculous brouhaha over nothing, especially since she knew from past experience he'd probably side with the hospital.

"Thank you for your industriousness," Angela continued. "I'm sure your motivation was to help us, but as you can imagine, this problem has taken a terrible toll not only on some of our patients but on our institution, and, frankly, we are inordinately sensitive to the crisis. When I call Dr. Bingham, I will mention that we are not averse to you or anyone from the OCME visiting our OR, but we will require a warrant and that whoever is designated be tested as a carrier for MRSA. As part of our attempt to deal with this horrible problem, we insist that everyone entering the OR suite be clean."

"I had not thought of that," Laurie said, with a touch of guilt. Never once did it cross her mind that she could be a carrier herself, especially from having autopsied an individual just that morning who was chock-full of the bacteria.

"We, on the other hand, are extremely aware of it. But the point is we are not trying to limit your investigation. At the same time, we are certain your visiting our OR would not be enlightening in the slightest. The epidemiologist for the New York City Board of Health, Dr. Clint Abelard, who is a public servant like yourself, has inspected our OR on two occasions and found nothing. Of course, he wasn't allowed in until it was assured that he was not an MRSA carrier."

"I wasn't aware an epidemiologist had been involved until I got here," Laurie said. "Obviously, he's much more qualified than I. I'm sorry to have caused any misunderstanding. I hope I haven't inconvenienced you too much."

"You haven't. Dr. Sarpoulus, Dr. Osgood, and I were here attending the monthly medical staff meeting. It's not as if we had to come all the way from our home office."

"I'm pleased."

"There's one other point I wanted to make. You have questioned our decision not to accurately subtype the particular strains of the involved MRSA causing us such havoc. To explain, I've asked Dr. Osgood to accompany me to meet you. I know Dr. Sarpoulus has alluded to the reasons, but Dr. Osgood can explain it better, as he is boarded in both clinical pathology and microbiology. It's important for you to understand we have done every possible thing in our power to rid ourselves of this problem. Anything else would be irresponsible."

FIFTEEN MINUTES LATER, Angela and Cynthia were in a cab heading south on Fifth Avenue. Walter had stayed behind to meet with the orthopedic hospital's laboratory supervisor. Angela and Cynthia had ridden in silence, with Angela staring out the side window of the taxi and noticing that the trees of Central Park had the very first suggestion that spring was around the corner.

But Angela was thinking less about nature and more about her problems with Angels Healthcare, which seemed to grow with each passing day. The last thing she expected at this late date was a problem with the medical examiner's office. The concern was publicity, which had been a worry from the start. Back when the MRSA cases first occurred, she'd made it a point to contact the chief medical examiner, to convince him that they were on top of the problem to the extent of having reported it to the New York City Department of Health and encouraging the epidemiologist to come to the hospital.

Angela turned to Cynthia. "What was your take on that medical examiner? Did she strike you as an independent sort?"

"Absolutely. Why else would she come out and visit our hospital when there was no mystery about the cause of death. I didn't like her there while we're trying to keep a lid on this affair. That's why I came down to get you. I thought it was something you should handle."

"I'm glad you did. I considered her a threat the moment I laid eyes on her. I don't know exactly why, but she struck me as very focused and driven, and, to compound it, very intelligent. Did you see how she made eye contact? Most people caught in a similar circumstance would have been cowed to some degree."

"She did the same to me," Cynthia said. "I definitely challenged her the moment I heard she was a medical examiner."

"She worries me," Angela admitted. "If she manages to get any of this MRSA problem into the press, it will certainly come to the attention of institutional investors as part of their due diligence. If that happens, more than likely the IPO will have to be postponed, or if it's not, it certainly won't be successful."

"I think you did a terrific job talking to her."

"You think so? Really?"

"I do. First, you mixed just enough condemnation and commendation, threat and praise, to put her off balance. Second, your warning about calling her boss definitely affected her negatively; I don't think she will be making any more visits, whether announced or not. And finally you made her understand that there are a number of people working on solving the problem who have much more epidemiological training than she has. I'm sure she feels she'd fulfilled her responsibility."

"I hope you are right," Angela said, not fully convinced.

"I'm sure I am. I was impressed. You were brilliant. You really played her like a violin."