Natural Causes (3 page)

“You mean Everwell?”

Sarah shrugged. “Possibly. But they’re not the only candidate. Thanks to Axel Devlin, there are more than a few people who have the wrong impression about the way we do things here.”

Devlin, a
Herald
columnist with an unabashedly conservative slant, had dubbed MCB Crunchy Granola General. He made it a frequent target of “Axel’s Axe” in his popular Take It or Leave It column. As an M.D. with extensive training and expertise in acupuncture and herbal therapy, Sarah herself had been mentioned in the column on two occasions, not at all flatteringly. She never had figured out how Devlin learned of her.

“Who knows?” Andrew responded with no great interest. He nodded toward the dozen or so picketers. “They are a gnarly group, I’ll say that for them. Not a tattooless deltoid in the bunch.” He paused at the door marked
Staff Only
and turned to her. “Well, Dr. Baldwin, are you ready to pop up a level?”

Sarah stroked her chin thoughtfully, then took Truscott’s arm.

“What options exist for me are either unacceptable or illegal, Dr. Truscott,” she said. “Let’s do it.”

•  •  •

Fifty feet above the pristine mountain pool, Lisa Summer poised on the cliff’s edge. But for the garlands of white lilies around her neck and her head, she was naked. The sun glinted off her long, perfect body and sparkled in her straw-gold hair. All around her, wildflowers billowed, blanketing the cliffs and cascading down the rocks beside the shimmering falls. High overhead a solitary hawk glided effortlessly against the cloudless, azure sky
.

Lisa tilted her head back and let the sun warm her face. She closed her eyes and listened to the churning water below. Then, arms spread, she tightened her toes over the edge, took a final, deep breath, and pushed off. Wind and spray caressed her face as she floated more than fell past the falls, twisting and tumbling through the crystal air … downward … downward … downward …

“Hang in there, Lisa. Beautiful. Hang in there. The contraction’s almost over. A minute ten … a minute twenty. That’s it. That’s it. Oh, you did great. You did just great.”

Slowly Lisa opened her eyes. She was propped on the futon in her cluttered room, bathed in the rays of the early-morning sun. Heidi Glassman, her housemate, friend, and birthing coach, sat beside her, stroking her hand. Across from her, waiting, were the crib and changing table she had found at Goodwill and meticulously refinished.

The weeks of practice in class and at home were paying off. Lisa was now in her third hour of active labor, but thanks to the series of sensual images she had developed, the pain of every contraction so far had been easily subverted.

Dr. Baldwin called the process internal and external visualization. It was, she had told Lisa, a modest form of self-hypnosis—a technique that, if practiced diligently, would enable Lisa to make it through even difficult labor and delivery without any anesthesia or other drugs. For some contractions, Lisa used external visualization
to send herself soaring off her mountain cliff or for a wondrous undersea ride on the back of a dolphin. For others, she used internal visualization to see the actual muscles of her womb and the baby boy within, and to mentally buffer them both with thick cotton batting.

“How’re you doing?” Heidi asked.

“Fine. Just fine,” Lisa said dreamily.

“You look very peaceful.”

“I feel wonderful.”

Unaware she was doing so, Lisa slowly opened and closed her hands.

“Five minutes apart for nearly an hour. I think it may be time to call.”

“There’s time,” Lisa said. She closed her eyes for a few seconds. “I don’t think I’ve even started to dilate yet.”

Her mind’s eye saw her cervix clearly. It was just beginning to open.

“Want me to check?” Heidi asked.

Heidi was a nurse who had spent several years on an OB floor. Now she was poised to assist Dr. Baldwin with the home birth.

“I don’t think there’s any need,” Lisa said, rubbing her fingers now.

“Something the matter?”

“No. My hands feel a little stiff, that’s all—”

“Might be retained water. Let me check your blood pressure.”

Heidi slipped a blood pressure cuff around Lisa’s arm and set her stethoscope over Lisa’s brachial artery. The pressure, ninety over sixty-five, was a bit lower than it had been, although still in the normal range for early labor. Heidi mulled over the change, then decided it was of no significance. She wrote the pressure down in her notebook and made a mental note to check it again in ten or fifteen minutes.

“Who’s going to win the pool?” Lisa asked.

“Assuming it’s today?”

“Oh, it’s going to be today. You can count on it.”

“In that case, Kevin will be thirty dollars richer.”

Kevin Dow, a painter, was another of the residents of 313 Knowlton Street. There were ten of them in all. Most were artists or writers, and none of them made much money. They called their living arrangement a commune, and in that light shared almost everything. Lisa, who sold her pottery and occasionally refinished old furniture, had lived in the massive, gabled house for almost three years. And although she had twice slept with one of the men in the commune, she felt certain the child within her was not his and had made that clear to him from the outset, much to his relief.

In fact, who the father was, or was not, did not matter to Lisa one bit. The baby would be raised by her and her alone. He would be raised in simplicity, with love and patience and understanding, and without the pressure of expectations.

With Heidi’s assistance, she stood and walked over to the window. Her right arm felt tired and heavy.

“Can I get you anything?” Heidi asked.

Lisa absently rubbed at her shoulder as she stared out at a squirrel that was leaping deftly along a series of branches that seemed far too pliant to hold it.

“Maybe some cocoa,” she said.

“Coming up.… Lisa, are you okay?”

“I—I’m fine. I think another one’s about to hit. How long has it been?”

“Five minutes, three seconds.”

“I think I’ll do this one standing.”

Lisa leaned forward and braced herself against the sill. Then she breathed deeply, closed her eyes, and tried to send her mind inside her body. But nothing happened—no images, no sense of peace, nothing—nothing except pain. She was trying too hard, she thought. She had to be centered—that’s what Dr. Baldwin had taught her—centered and prepared for each contraction. For the first time she felt a nugget of fear. Maybe she didn’t know
how bad it was going to get. Maybe she didn’t have what it takes.

She gritted her teeth and stretched her arms and legs tightly.

“How long?” she asked.

“Forty seconds … fifty … a minute … a minute ten.…”

The intensity of the contraction began to lessen.

“A minute twenty. You okay?”

“I am now,” Lisa said, backing away from the window and settling down on the futon. Her forehead was dotted with sweat. “That one was a bear. I wasn’t ready.”

Lisa swallowed and tasted blood. She probed with her tongue and found the small rent she had made by accidentally biting down on the inside of her cheek. The pain of the contraction was now completely gone, but the weird ache in her arm and shoulder persisted.

Heidi left the room and returned just in time for the next contraction. With Heidi’s help and better preparation, Lisa found this contraction was much more manageable. Heidi slipped on the blood pressure cuff and once again took a reading. Eighty-eight over fifty, and even harder to hear than before.

“I think we should call,” she said.

“Is everything okay?”

“Everything is fine. Your pressure’s fine. I just think it’s time.”

“I want this to be perfect.”

“It will be, Lisa. It will be.”

Heidi stroked Lisa’s forehead and then went to the phone in the hall. The drop in pressure was minimal, but if it was the start of a trend, she wanted Dr. Baldwin on hand.

Across the street, in front of 316 Knowlton, Richard Pulasky crouched behind his car as he disengaged the high-powered telephoto lens from his Nikon. He had
gotten at least two good face shots of the girl, he felt certain. Maybe more. He pulled the frayed photo of Lisa Grayson from his pocket. The girl in the picture didn’t look exactly like the woman in the window, but close enough. It was her, and that was that. Six months of work had just paid off big-time. Half the private dicks in town had taken a crack at finding the girl, but Dickie Pulasky had actually pulled it off.

Grinning to himself, Pulasky slid into his car through the passenger-side door. With any luck, he would be pocketing a fifteen-grand payoff within the week.

S
ARAH SECURED HER BIKE TO THE METAL-FRAME BED IN
the obstetrics on-call room. Over her first two years of residency she had spent nearly as many nights in the narrow cubicle as she had in her own apartment—and none of them very restfully.

After changing from her Spandex into the maroon scrubs favored by her department, she paused by the chipped bureau mirror. She rarely wore makeup of any kind, but in honor of Changeover Day, she smoothed on a bit of pale-pink lipstick. Then, as she often did just before starting her workday, she studied herself for a few quiet moments. Using sun block religiously during her years in Thailand had been worth the effort. Her skin still had good tone, and just a few freckles at the tops of her cheeks. There were some faint creases at the corners of her eyes, but nothing drastic. Her dark hair—mid-back length for most of her life—was short now, and sprinkled ever so lightly with gray. On balance, she decided—especially considering two years of low-paying, hundred-hour work weeks, with no financial or emotional support from the outside
world—the woman in the mirror was holding up pretty damn well.

As in past years, the kickoff for Changeover Day at MCB was a continental breakfast and a presentation to the staff and residents by hospital president Glenn Paris, several department heads, and a member or two from the board of trustees. What made this year’s kickoff different were the security guards checking photo IDs at each entrance to the auditorium. Sarah caught up with Andrew Truscott just as he was being cleared.

“Planning to watch the show from the last row?” she asked. For years Truscott had staked himself a seat there at most conferences.

“Having seen ol’ Paris’s slides from that vantage for four years running, I thought I might try something a bit closer.”

“Fine by me,” she said as they made their way down the steeply banked aisle of the amphitheater to the second row. “At our age we might as well begin learning how to deal with presbyopia and otosclerosis anyhow. Do you happen to know why the security check?”

Truscott thought for a moment.

“I’ll bet they’re searching for lunatics,” he said.

“Lunatics?”

“Anyone who would come to this affair who didn’t absolutely have to.”

“Very funny.”

“Thank you. I have no doubt our fearless leader will address the heightened security—either before or after his yearly recounting of the history of our august institution.” He thrust his jaw out in a caricature of Glenn Paris. “ ‘In 1951, at age fifty, Medical Center of Boston moved from the midcity to the outskirts in order to occupy the nine buildings which once comprised the Suffolk State Hospital, better known as the nut house. And although that transition was completed decades ago, it is still rumored that late at night, the ghost of
Freddy Krueger scrubs up and stalks our operating rooms.…’ ”

“Andrew, what is with you today? Is it the chief residency? Are you just angry at not getting it?”

“Hardly.” Truscott’s sardonic laugh was unconvincing. “I’m angry about having my all-too-meager paycheck signed by a man who raffles off elective plastic surgical procedures, sends his residents on well-publicized house calls, and has closed-circuit TV put in delivery rooms.”

“He’s raised thousands of dollars with those raffles and contests—probably hundreds of thousands. And most families love the chance to be part of a birth. We’ve become the second busiest OB service in the city.”

Before Truscott could respond, Glenn Paris stepped forward and tapped on the microphone. Immediately 120 staff physicians, residents, nurses, and trustees fell silent.

Glenn McD. Paris, the president of Medical Center of Boston, exuded confidence and success. He was only five feet eight, but many described him as tall. His jaw was as square as any Boston Brahmin’s, and the intensity in his gaze was arresting. He had been described by one supporter as a mix of equal parts Vince Lombardi, Albert Schweitzer, and P.T. Barnum, with a dash of Donald Trump thrown in. Axel Devlin, on the other hand, had once called him the most distasteful and dangerous affliction to descend on Boston since the British.

Six years before, a desperate board of trustees had lured Paris away from a major hospital in San Diego that he had turned around in a remarkably short time. The deal they struck with him included the promise of a free hand in fund-raising and all hospital affairs, generous financial incentives, bonuses tied to any hospital profit, and the rent-free use of a Back Bay penthouse, donated to the institution some years before by a grateful patient. Paris had responded with a vigorous campaign to give
the hospital a positive, easily definable image and to turn its red ink to black at all costs.

In some ways, the man had succeeded. The hospital’s staggering debt had leveled off, if not lessened. At the same time, its increasing emphasis on whole-body medicine and personalized treatment had led to a growing reputation as a caring medical center.

But there was still a lack of respect for the institution in many quarters, both public and academic, and the feeling among some trustees that before long, the hospital would simply have to move in other directions.

“Good morning, troops,” Paris began. “I want to welcome you to the official beginning of MCB’s ninetieth year. The purpose of this annual kickoff is to introduce our new house staff and to help them feel at home.” He motioned for the new residents to stand and led a round of applause. “You should know,” he said to them, “that your group represents the best MCB has ever been matched up with in the national resident matching program.”