Natural Causes (34 page)

“Thank you,” Matt said coolly. “You may say anything you wish. Someone has gone to a great deal of trouble, and caused a great deal of pain, to make Sarah’s prenatal supplement appear responsible for those cases.
That fact, more than any other, suggests to me that it is not. Dr. Blankenship?”

The chief of medicine tapped a pencil thoughtfully against his palm before picking up the sheaf of notes he had set on the floor beside his seat.

“Well,” he said finally, “my assignment was to become one of the world’s leading experts on disseminated intravascular coagulopathy. It turns out that this was not nearly the humbling task it first seemed it would be. I have discovered that everyone in the clotting world knows
when
DIC occurs but absolutely nobody knows
why
. The more common name for this condition is consumptive coagulopathy, because while it is going on, all of the body’s coagulation factors get
consumed
—used up in those tiny, abnormal clots. In its worst form, DIC is almost universally fatal. This fact makes the accomplishment of Defendant Sarah in saving the life of Plaintiff Lisa all the more remarkable. People who have DIC as badly as the plaintiff simply don’t make it.

“Would I testify to that on the witness stand, Mr. Daniels? You betcha I would.” His manner and tone, which had been quite matter-of-fact, intensified dramatically. “I would do anything I honestly could to help. I am quite disturbed about this case and the lack of overwhelming support Sarah has received from our institution. We made a promise to her and to ourselves months ago when we first met that we would present a unified front, and that Sarah would be considered innocent until proven—
proven
—otherwise. Randall, Glenn, I’ve spoken with Rob McCormick about this letter he sent out requesting Sarah’s replacement as chief OB resident next year. He says he’ll be happy to retract it for the time being if you two are in agreement to do so.”

“Eli,” Paris said, “this is hardly the place or time to—”

“Glenn, please. I don’t want to start a war here or embarrass Sarah. But if we’re going to present the unified
front we agreed to, then we’ve got to get McCormick to back off. Yes?”

Paris’s annoyance was apparent. Whether or not he agreed with Blankenship’s request, he was uncomfortable with being told what to do.

Finally, after a long pause during which he regained his composure, he grinned and nodded.

“Right you are, Eli. I don’t know where Rob got the idea to do what he did, but I’ll call him tomorrow and set him straight.”

“Excellent. Randall?”

“No problem,” Snyder responded unenthusiastically.

“In that case, on with the show,” Blankenship said. “There’s one last category of causes of DIC I thought I might mention, and that’s poisons. The injection of the naturally occurring clotting agent, thrombin, can cause a DIC-type picture, as can certain snake venoms. The toxin found in at least five different species of crotalids can cause lethal DIC.”

“Crotalids?” Matt asked.

“Sorry, Matt. Rattlesnakes.”

“But I don’t believe the poisons you describe are effective by mouth,” Sarah said. “And Lisa was at home when her DIC began. I can’t imagine she could have received an injection of any sort.”

“Or been bitten by a diamondback.” Arnold Hayden guffawed.

No one else laughed.

“As I said,” Blankenship replied, “I only included the poison possibility for completeness. There may be an oral toxin we don’t know about that can cause DIC. Maybe someone has such a substance and is on a vendetta against our hospital or the obstetrics department. At this point, who knows?”

“That’s all we need,” Glenn Paris groaned. “A psycho.”

“Any questions for Eli?” Matt asked. “Okay, then. Rosa, you’ve kindly shared some significant developments
in your work. Can you sum up what your conclusions are at this point?”

Earlier in the day, Sarah had spoken with Rosa for over an hour. The epidemiologist felt torn between the desperate need for all concerned to share information and ideas and her deep-seated bias against disclosing research still in progress. Until her results were checked, double-checked, and locked away, she felt uncomfortable trusting anyone with the details of her work. In the end, nothing was really resolved between them except that Rosa would attend the meeting and disclose as much data and theory as she felt comfortable in doing. No more.

“I must first stress what Dr. Snyder has already brought up,” Rosa began. “The connection, whether significant or not, between the three DIC cases and the ingestion of Sarah’s prenatal supplement is quite firmly established. I should add, however, that my laboratory work and research does not suggest a direct toxic relationship between DIC and the ingestion of any herb. An allergy of some sort to one of the components, or perhaps contamination with a toxin, would be much better bets. But I have serious doubts about either of those possibilities as well. As has also been mentioned, discovery of a labor patient with DIC who has never taken herbal prenatal vitamins would effectively absolve Dr. Baldwin of any responsibility.”

“What do you make of this Herbal Weight Loss product?” Paris asked.

“I was hoping you’d be able to help us there, Mr. Paris,” Rosa said. “This Pramod Singh, what can you tell us about him?”

“Not very much, really. Six years ago, when I came to MCB, I made the decision to incorporate various aspects of what is called holistic medicine into our hospital. I was looking for an identity for MCB—something that would make the public want to come to us.

“Pramod Singh was a highly respected Ayurvedic
physician who heard about what we were trying to do and contacted me. I put him on salary, and he worked in our outpatient department for almost two years. Then he just quit. No notice. Not even a letter of explanation. Just a one-sentence note. The next time I heard about him was when I saw him on one of these dumb programs.

“I had originally hoped Singh might be part of a larger holistic department at the hospital. But until our McGrath Foundation grant, we’ve been on such thin financial ice that I couldn’t guarantee anything. By the way, as long as I’m on the subject, I hope you’ll all be my guests at the demolition of the Chilton Building the end of the month. It will kick off the largest construction project in MCB history. We’ll be having a champagne reception just before the big bang. I also hope some of you will buy chances in the raffle we’re running to be the one to actually push the button. A once-in-a-lifetime opportunity, if I do say so myself.”

“Did any of you know Dr. Singh was using this weight loss powder when he was at MCB?” Rosa asked, pointedly ignoring Paris’s bombast. “Well, you might ask around.”

“Do you really think this product and the DIC cases are connected?” Snyder asked.

“Remember, Dr. Snyder,” Rosa said. “My stock in trade is probabilities. The more times a connection happens, the more likely it is to be significant. Now, to the many other commonalities I have uncovered among our three cases, we can most probably add the exposure four or five years ago to Dr. Singh and his product. But remember, as Mr. Paris just explained, he purposely established a unique facility where products like Singh’s powder or Sarah’s prenatal supplement might exist. So in the end, our three women’s choosing to be cared for at the Medical Center of Boston may prove to be the most significant commonality of all.”

“God, that’s all we need!” Paris exclaimed. “Rosa,
you’re not planning to speak to the press about this, are you?”

Rosa smiled at the notion.

“It was like pulling teeth for Dr. Baldwin just to get me to speak to you at all,” she said. “I’m not inclined to trust any wider audience with my findings, at least not yet.”

“Okay, everyone,” Matt said. “If there’s no other business, we’ll call it quits and I’ll finish preparing for our first offensive. Arnold, the Ettinger deposition’s going to be taken at eleven at Mallon’s office. You’re welcome to attend.”

“I just might,” the lawyer responded.

“Give ’em hell, Daniels,” Paris said.

One by one the MCB group filed out, until only Matt, Sarah, and Rosa remained.

“I thought the session went very well, Matt,” Sarah said.

“Come on. We got almost no place, and you know it.” He paced to the window, his fists clenched in frustration. “Parts of hospital charts missing; Chinese tongs getting paid to frame you and a helpless old man; some nervous, little, stuttering weirdo following you. Somebody, someplace knows what in the hell is going on around here. And I’m getting sick and tired of it not being me.”

“I might be able to help a little bit,” Rosa said softly.

“What are you saying?” Matt stopped pacing.

“There’s something I know that I haven’t spoken about at all. I’ve decided to share it with you two but, for now at least, with no one else. Please don’t speak of this to anyone.”

Matt glanced over at Sarah.

“You have our word,” he said.

“Okay. Lisa Grayson had some sort of DNA virus in her bloodstream at the time she had her crisis. My lab person doesn’t know exactly what it is, but he does
know it’s not usual. He wants some more serum from Lisa.”

“Even though she has no DIC symptoms?” Sarah asked.

“He’ll take what he can get. If nothing grows, he’ll look for antibodies and see if he can back his way into an identification. He’s very good at what he does. One of the best. But I’m afraid we can’t get to Lisa without going through this attorney of hers.”

“In that case, maybe we should ask him before we begin to dissect Ettinger,” Matt said.

“It’s very important,” Rosa said. “I don’t believe either the herbal weight loss powder or Sarah’s vitamins are solely responsible for what’s happened. They may both be playing a role, but an infection of some sort makes more sense. I have a terrible, terrible feeling that unless we get to the bottom of things soon, more women are going to die.”

Fifty miles to the west, Annalee Ettinger lay on her canopied bed, nestled in the arms of her fiancé, Taylor.

“Tay,” she said. “It’s happening again. Here, feel right here. I swear I’m having some contractions.”

T
HERE WERE NO POLITE INTRODUCTIONS; NO CIVIL
shaking of hands. Once the combatants were present and seated at the massive conference table in Jeremy Mallon’s law firm library, once the stenographer had readied her machine and loosened her fingers, the battle simply began. With no judge present, Sarah wondered just how ugly it might get.

“State your full name please,” Matt said, after dictating the time, date, location, list of those present, and the purpose of the session.

“Peter David Ettinger.”

“Your occupation?”

“I am an anthropologist and a healer.”

“Your education?”

“I have a bachelor’s degree from Reed College and a master’s from the University of Michigan, both in anthropology, and both with honors.”

“On the television ads for your weight loss product, you are often referred to as ‘Doctor.’ Have you a degree at that level?”

“I hold an honorary doctorate in herbal sciences from
the Holbrook College of Chiropractic, and several other honorary doctorates as well.”

“Do you have a Ph.D.?”

“No.”

“An M.D.?”

“Certainly not.”

“And what is your current occupation?”

“I am the executive director of the Xanadu Holistic Health Community and president of the Xanadu Corporation.”

“And exactly what does the Xanadu Corporation do?”

“We formulate and distribute the Ayurvedic Herbal Weight Loss System.”

The key to a successful deposition, Matt had explained to Sarah, was the same as that for a successful courtroom cross-examination—never ask a question to which you do not already know the answer. Unfortunately, he was quick to add, the only significant questions he would be asking Peter Ettinger today
were
those to which they had no answer.

Sarah stared down at her hands, folded tightly on the table in front of her. She hoped Peter could not tell
how
tightly. When she had first returned to Boston, she had actually entertained notions of reestablishing some sort of professional or platonic relationship with the man. Now she could barely stand to look at him. She had never done anything more virulent than to move her life along in directions that did not include him. No public condemnations; no nasty letters; no tell-all articles; no demands for palimony. Yet here he was, helping to orchestrate a legal case against her that could well put her in professional purgatory, if not in prison.

“You mentioned you were a healer, Mr. Ettinger—oh, excuse me, do you prefer to be addressed as
Mister
or
Doctor?”

“Either way. Mister will be fine.”

“Don’t badger this man, counselor,” Jeremy Mallon
warned matter-of-factly. “Either in your words or your tone. You do, and this deposition may be over a lot sooner than you expect.”

“Mr. Mallon, please don’t threaten me,” Matt countered. It seemed to Sarah he was purposely exaggerating his Mississippi drawl. “You saddled this mule months ago in the shop of a sick old man. Now you and your stable of experts had better be ready to ride it yourselves.”

In the corner of the room, the stenographer dispassionately whispered into the hooded microphone of a tape recorder at the same time she was tapping out the exchange on her machine. Arnold Hayden, seated to Matt’s right, nodded that Matt’s response was appropriate and necessary. Across from Hayden, Jeremy Mallon’s associate countered by whispering something in Mallon’s ear. Sarah managed a furtive glance across at Peter, but saw only an emotionless mask. Circles within circles within circles. The whole affair would have been incredibly fascinating to her, had not her livelihood and way of life been at stake.

The morning had begun contentiously an hour before the actual deposition. Mallon flatly refused to allow his client, Lisa Grayson, to have her blood drawn or, in fact, to be contacted by Matt, Sarah, Rosa Suarez, or anyone else who did not clear such contact with him. Matt had kept his cool and had stopped short of indicting the Ayurvedic Herbal Weight Loss System. But it was clear to Sarah that before this session was through, Peter’s remarkable gold mine would come under attack.