To the Bone (9 page)

He tried to decide which was justified—his anger at being sold down the river, the queasy feeling that he might, in fact, have mishandled the incident—or the even queasier one that a slick attorney could make it
look
like he had. He started assessing potential targets of liability.

First, chronologically, came D'Anton. But Roman had ruled out a surgical infection. The possibility of some other condition that D'Anton had not checked for, or had ignored, was not likely.

D'Anton had given Eden the Valium. It had probably factored in, by keeping her sedated—she might have called for help earlier, otherwise. But there was no direct connection to the death. His prescription was within reasonable limits, and it was not his responsibility to see that the drugs were used properly after she left the clinic.

Unless something damning turned up in the records or the autopsy, D'Anton was in the clear.

Next came Ray Dreyer, the fiancé. He had agreed to care for her for twenty-four hours after the surgery. But he was not a professional, not operating under any license or bonding. He might be liable to some degree, but on a personal level.

Then there was Monks.

For lawyers, the issue was clear. When someone undergoing medical treatment was injured or died, someone else was to blame. The simple rule for malpractice went: there had to be negligence, there had to be injury, and the negligence had to have caused or contributed to the injury.

Assuming that the DIC was, in fact, the cause of death, Monks was also in the clear legally. Nothing he'd done had contributed to that.

But if a procedure was seen as questionable or simply unnecessary—such as administering the heparin—that was still sufficient grounds for an attorney to file a deep-pockets lawsuit, in the hopes that the hospital would settle out, for a hefty sum.

And Monks's name would be entered in a national registry of physicians who had tacitly admitted to negligence—tarred forever by that brush.

He walked back inside to a house phone and put out a page for Dick Speidel, the chairman of the Emergency Room's Quality Assurance committee.

 

Monks was in luck—Dick Speidel answered the page. Speidel was also an ER doc, so he didn't keep regular hours, and he wasn't on shift today. But he acted as liaison between the emergency group—a self-contained corporation that contracted with Mercy Hospital—and the hospital's administration, so he tended to be around quite a bit on business.

Monks met him in front of the ER's main entrance. Speidel was about Monks's age, a big bearlike man with thick dark hair and kind, cynical eyes. Like most longtime emergency personnel, he was under no illusions about textbook situations versus bloody, desperate, real ones.

“I need to make it clear, I'm speaking to you in your capacity as QA chair,” Monks said. This made the conversation official business: the information exchanged was not available to any outsider, except by subpoena.

Speidel's eyebrows rose. “Nuclear secrets? Terrorist attacks?”

“I've got a Death Review coming up.”

Speidel nodded. Word had already gotten around.

The hospital's Quality Assurance system, QA for short, reviewed all internal mishaps and mistakes, from medical errors to people slipping and falling. Everything that happened under its auspices was undiscoverable by the courts—its privacy was protected, including, especially, from lawyers. All personnel, from the chief of staff on down through janitorial, were under a strict injunction of confidentiality. Bribery and ratting did happen, but not often. This maintained rigorous honesty without vulnerability; it was the hospital's method of self-policing and self-educating. Like all systems, it had its flaws, but in Monks's experience, it worked remarkably well.

Eden Hale's Death Review was going through the QA system's standard channels. It was clearly the Emergency Room's case, and up to the ER committee's chair, Speidel, to assign another, nontreating ER physician—not Monks—to review it. The Medical Records department would provide all pertinent information. That physician would then fill out a form, answering three questions: Given the circumstances, was the outcome predictable? Was the treatment within the standard of care? Does this case need review by the full QA committee?

Monks wanted to know what his peers thought—what they would have done in his place; whether he was justified or damned.

“I'd like you to expedite the review, Dick,” Monks said. “If it does go to committee, to do it this month instead of next.”

Speidel frowned. “That's next Monday, Carroll.”

“I know it's a lot to ask.”

“Are you kidding? Most guys would put it off indefinitely and hope it went away. I just meant I'm not sure if I have time. I haven't even assigned it yet.”

“If I screwed up, I want to know it,” Monks said. “The hospital ought to know it, too. There are rumblings about litigation.”

Speidel gazed off at the ocean. Monks knew that as liaison and QA chair, he would be acutely concerned about any situation that might reflect badly on the ER.

“All right,” Speidel said. “If you don't have any objections, I'll do the initial review myself.”

“That's more than fine with me.”

“I'll let you know tomorrow morning.”

Speidel went back inside. Monks stayed there for a minute, deciding what to do next. A distant fog bank was forming on the horizon, like a mirage. It offered a teasing promise of cooler air. That would be a blessing.

 

Ray Dreyer's phone number wasn't listed. But he had logged in at the ER desk yesterday. Monks coaxed the charge nurse into looking up his address and phone.

It was almost nine
A.M.
now, but he was reasonably sure that Dreyer was not an eight-to-fiver. If anything, the call might wake him up.

After four rings, a digital voice answered. “
The person you are calling is not available right now—
” It seemed that Dreyer wanted to stay anonymous.

Monks waited for the beep, then said, “Mr. Dreyer, this is Dr. Monks. I attended Eden Hale—”

The phone clicked, and a male voice said, “Yeah, I remember.”

So Dreyer was screening calls, too. His tone made it clear that he was not feeling any friendlier. Monks decided to forget about social graces and get right to it.

“It turns out that Eden had salmonella in her bloodstream. Food poisoning. Any ideas how she might have gotten that?”

“Hey, I don't know what she ate,” Dreyer said. “She had stuff in the refrigerator.”

“You didn't stop anyplace after the clinic? A deli, takeout?”

“Uh-uh. We went straight back to her apartment.”

“Did Eden keep anything around, like chemicals?”

Dreyer's tone turned wary, probably from worry about recreational drugs. “What kind of chemicals?”

“Insecticides?” Monks said. “Photography equipment, heavy-duty cleaning fluids?”

Dreyer laughed thinly. “She never cleaned anything in her life, except when she took a bath. There's about five tons of makeup, if that counts.”

It was a tender sentiment for a lost love.

“What about drugs?” Monks said. “This is just between us. Did she take anything besides the Valium the doctor gave her?”

“No way, man. All she wanted to do was crash.”

And so she had, Monks thought.

“Okay, thanks,” he said. “We're still working on this.”

“So am I,” Dreyer said mysteriously.

Monks hung up, walked back out to his battered Bronco, and drove to D'Anton's clinic.

T
he clinic's parking lot was almost empty this morning, but the front door was unlocked. When Monks pushed it open, Gwen Bricknell was busy at her desk—exactly as he had last seen her yesterday, except that she was wearing an eggshell-colored dress of light, fine cotton. Monks was not much of a judge of women's clothing, or men's for that matter, but he had a feeling that it was the kind of simple attire that was very expensive. The room was otherwise deserted. When he walked to the desk he caught the scent of her perfume, very faint, musky rather than sweet.

He did not expect her to be friendly, and he was surprised when she smiled and said, “Good morning, Dr. Monks.”

He murmured hello, struck again by her sheer beauty. If there was any flaw, it was flawlessness—as if, when D'Anton had sculpted her face, he had razored off the imperfections that lent humanness.

But her eyes, dark like olives, were alive—wary, but not hard with hostility. If anything, she seemed a little frightened. The shock of Eden Hale's death had had time to sink in, he thought. This was not the ER; losing a patient was not something that happened with inevitable regularity.

“We're closed, officially,” she said. “I'm just rescheduling appointments.”

“Dr. D'Anton was going to leave some records for me. Sorry if this is bad timing.”

“No, no, it's fine. Welles—Dr. D'Anton—is taking a couple of days off. He asked me to make you at home. He apologizes for being abrasive yesterday. He was very upset.”

“Understandable, of course,” Monks said.

“I know this is awkward, Doctor,” she said, surprising him again. “I don't mean for it to be.”

“I appreciate that, Ms. Bricknell,” he said. “I don't like it either. But I need to find out what happened to that young woman.”

For the next couple of seconds, Monks had the eerie sensation that whoever was behind Gwen Bricknell's eyes had gone—that he was looking at an absolutely still body whose owner was someplace else. By the time he was aware of it, she was back.

“I'll get the records,” she said. She stood and opened the door into the rear office, started to step through, and stopped abruptly.

Monks realized that the nurse, Phyllis, was walking past, just on the other side of the door.

Gwen's shoulders sagged in exasperation. “Phyllis, you are everywhere I
turn
.”

“I cover a lot of ground,” Phyllis said crisply. “Somebody has to.”

“There's really no need for you to be here today.”

“There's always a need for me to be here.” Phyllis marched swifty on, a squarish, formidable presence. Gwen glanced back at Monks, rolling her eyes.

“She surprised me, too, yesterday,” he said.

“She's incredibly competent. She does most of the low-level procedures. It's almost like having another doctor. But sometimes she decides she's in charge, especially when Welles isn't around.”

Gwen went on into the office, leaving the door open. Monks glimpsed another figure, down the hallway that opened onto the procedure rooms. It was the maintenance man, Todd, apparently still at work on the air-conditioning. He raised a hand in cheerful greeting. Monks returned it.

Gwen came back a minute later, with a manila folder clasped in her hands. Her fingers were long and slender, tipped by crimson ovals. She did not wear a wedding ring.

“I wish I had such devoted staff,” Monks said. “Coming to work when the clinic's closed.”

“Todd's a gem,” she said. “He can fix anything. That's how we found him. He was working at Bayview Hospital, and Welles came out one day and his Jaguar wouldn't start. Todd just happened to be there and got it going. Now we can't do without him. He's like that character on
M*A*S*H
, what's his name? Who always knows what everybody needs ahead of time?”

“Radar,” Monks said.

“Well, that's Todd.”

She walked ahead of him to one of the screened-off waiting rooms. Her dress was almost translucent, clearly outlining her body. It was an odd sensation, following her past the nude photos of herself on the wall. They had obviously been taken years ago, but she did not seem to have changed much. Eden Hale must have coveted those breasts, Monks thought. They were peach-sized, high and firm. No doubt, they, too, had been enhanced by D'Anton's touch.

At the waiting room's door, Gwen turned to him and offered him the folder. But she held on to it for just a second, so that there was a curious little tug of war between them before she let go.

Monks was reevaluating fast. Apparently, she did not hold grudges.

He sat in one of the comfortable chairs and opened the folder. It contained a standard sheaf of medical records. He paged through Eden Hale's history. It was clean, as they tended to be with young affluent patients; even things like chickenpox and measles rarely appeared these days. She had had persistent ear infections, requiring occasional draining and antibiotic treatment, until age eleven. There were no allergies or adverse reactions to drugs, no operations or broken bones. Her blood work showed her to be O positive, with no diseases, and white cell count well within the normal range.

A copy of D'Anton's chart from the breast procedure confirmed that it was an augmentation, using saline-filled implants, inserted through endoscopic incisions in the armpits. Most of the chart was a checklist, in technical jargon and abbreviations. Monks was not familiar with all the terms, but D'Anton's terse, handwritten notes at the bottom confirmed that the procedure had been routine and had gone smoothly. All in all, the records were thorough and excellent, the work of a top-notch professional.

There was a copy of her discharge form, the same form that the paramedics had found in her purse. It contained postoperative instructions—no strenuous activity, sponge baths only for five to seven days, sexual relations permitted to resume after that time provided the breasts were treated gently—and it stipulated that the patient must be cared for by a competent adult for at least twenty-four hours afterward. This was signed underneath with a scrawl that Monks was able to read only because he already knew the name: Raymond L. Dreyer.

Finally, there were photographs—several of her face, both full on and in profile, others of her nude upper body, and a few close-ups of her breasts. Another set of images, computer-generated, appeared to be the projected results. These showed the breasts enlarged, shapely, prominent. They also showed a modified face, with nose and cheekbones sculpted into graceful lines—eliminating the hint of coarseness Monks had noticed.

It seemed that the planned makeover on Eden Hale had only started.

He looked again at the discharge form, under method of payment. It was checked CASH.

Monks stacked the sheets and put them back into the folder. There was no suggestion of anything other than that Eden had left here healthy. He hadn't really expected there to be. Any possibility that the records had been altered was extremely unlikely.

He walked back to the desk and gave Gwen the file.

“I'm sure you get told this a lot,” he said. “I've seen your face many times. TV, magazines.”

She raised a hand and pointed, with a
voilà
gesture, at the room's photo display of nudes.

“Yes?” she said, with just a hint of a smile now—a model advertising something intimate. “It seems like you've gotten a pretty good look at the rest of me, too.”

“I'm an admirer of beauty,” Monks said.

Her expression changed subtly, with a flicker of pleasure passing across her eyes before they lowered. It was a shameless thing to say, Monks knew. But, even calculated, it gave him a pleasant shot of electricity.

He'd spent a fair amount of time last night, during those sleepless hours, remembering his clear sense that Julia D'Anton had known Eden Hale, and that Gwen had wanted to hide it.

He did not want to confront her. It was probably nothing, and he would probably never see her again. But just in case there turned out to be some little scratch on D'Anton's Teflon surface after all, Monks wanted to keep Gwen Bricknell friendly, willing to talk.

“I'm glad we were able to help you, Dr. Monks,” she said, her gaze returning to meet his own. “If there's anything more I can do, let me know.”