Crisis (23 page)

"What are we talking about?"

"There'll be the vault company and backhoe charge, as well as cemetery fees. On top of that will be our charges for obtaining the permits, supervision, and use of the embalming room."

"Can you give me a ballpark idea?"

"At least several thousand dollars."

Jack whistled softly as if he thought the figure high, whereas in actuality he thought it was cheap with all that was involved. He stood up. "Do you have an off-hours phone number?"

"I'll give you my cell phone number."

"Terrific," Jack said. "One other thing. Do you know the address of the Stanhope home?"

"Of course. Everybody knows the Stanhope house. It's a landmark in Brighton."

A few minutes later, Jack was back in the rent-a-car again, drumming the steering wheel while he thought of what he should do next. It was now after two p.m. Returning to the courtroom didn't thrill him. He'd always been more of a performer than a spectator. Instead of going back into Boston, he reached for the Hertz map. It took him a few minutes, but he located the Newton Memorial Hospital and oriented himself, and eventually arrived at his destination.

Newton Memorial Hospital resembled almost every suburban hospital Jack had been in. It was built in a confusing hodgepodge of various wings added over the years. The oldest section had period details like decoration on a cake, mostly Greek Revival, but the new structures were progressively plainer. The most recent addition was just brick and bronze-tinted glass with no embellishments whatsoever.

Jack parked in the visitors' area, in a lot that backed onto a wetland with a small pond. A flock of Canada geese were floating motionless on the surface like a bunch of wooden decoys. Consulting the fat case file, Jack memorized the names of the people he wanted to speak with: the emergency-room doctor, Matt Gilbert; the emergency-room nurse, Georgina O'Keefe; and the staff cardiologist, Noelle Everette. All three were on the plaintiff's witness list, and all three had been deposed by the defense. What was troubling Jack was the cyanosis issue.

Instead of going to the front entrance of the hospital, Jack went to the emergency area. The ambulance bay was empty. To the side was an automatic sliding glass door. Jack walked in and headed directly to the admitting desk.

It seemed like a good time to visit. There were only three people in the waiting area; none of them appeared sick or injured. The nurse at the desk looked up as Jack approached. She was dressed in scrubs and had the usual stethoscope slung around her neck. She was reading
The Boston Globe.

"Calm before the storm," Jack joked.

"Something like that. What can we do for you?"

Jack went through his usual spiel, including the ME badge flash. He asked for Matt and Georgina, purposefully using their first names to suggest familiarity.

"They're not here yet," the duty nurse said. "They work the evening shift."

"When does that start?"

"At three."

Jack looked at his watch. It was going on three. "So they will be here shortly."

"They better be!" the duty nurse said sternly but with a smile to show she was being humorous.

"What about Dr. Noelle Everette?"

"I'm sure she's here someplace. Want me to page her?"

"That would be helpful."

Jack retreated to the waiting area with the other three people. He tried to make eye contact, but no one was willing. He eyed an old
National Geographic
magazine but didn't pick it up. Instead, he marveled about Stanislaw Jordan Jaruzelski transforming himself into Jordan Stanhope, and then he brooded about how he was going to get Jordan Stanhope to sign an exhumation permit. It seemed impossible, like climbing Mount Everest not only without oxygen but also without clothes. He smiled briefly at the thought of a couple of bare-assed climbers standing triumphantly on the rocky summit.
Nothing is impossible,
he reminded himself. He heard Dr. Noelle Everette's name over an old-fashioned page system. Such a page system seemed like an anachronism in the information age, with grammar-school kids text-messaging.

Five minutes later the ER duty nurse called him back to the admitting desk. She told him that Dr. Everette was up in radiology and would be happy to talk with him. The nurse then gave him directions.

The cardiologist was busy reading and dictating cardioangiograms. She was sitting in a small viewing room with an entire wall filled with X-ray films on a movable conveyor belt. The only light came from behind the films and washed her with its fluorescent blue-whiteness, similar to moonlight but brighter. It made the cardiologist appear ghostlike, particularly in her white coat. Jack assumed he looked equally washed-out. Jack was completely forthright. He explained who he was and why he was associated with the case.

"I am to be an expert witness for the plaintiff," Noelle said, wishing to be equally forthright. "I'm going to testify that by the time the patient arrived here at the emergency room, we really had no chance to resuscitate her, and I was indignant to learn there had been an avoidable delay. Some of us old-fashioned physicians who treat all comers and not just those who pay us up front are angry about these concierge doctors. We're convinced they are self-serving rather than acting in the patients' best interests as they claim and which true professionalism dictates."

"So you are testifying because Dr. Bowman is practicing concierge medicine?" Jack asked. He was taken aback by Noelle's emotional response.

"Absolutely not," Noelle said. "I'm testifying because there had been a delay getting the patient to the hospital. Everyone knows that after a myocardial infarction, it is critical to start fibrinolytic and reperfusion treatment absolutely as soon as possible. If that opinion secondarily says something about my feelings vis-a-vis concierge medicine, so be it!"

"Listen, I respect your position, Dr. Everette, and I'm not here to try to convince you otherwise. Believe me! I'm here to ask you about the degree of cyanosis the patient apparently had. Is that something you remember particularly?"

Noelle relaxed to a degree. "I can't say particularly, since cyanosis is a frequent sign seen with severe cardiac illness."

"The ER nurse wrote in the notes the patient had central cyanosis. I mean, she specifically said 'central' cyanosis."

"Listen, when the patient got here, she was close to death, with dilated pupils, completely flaccid body, and a pronounced brachycardia with total AV black. Her heart could not be externally paced. She was on death's door. Cyanosis was just part of the whole picture."

"Well, thanks for talking with me," Jack said. He stood.

"You're welcome," Noelle responded.

As Jack made his way back down to the emergency room, he was even more pessimistic about the outcome of the case than he'd been earlier. Dr. Noelle Everette was going to be a powerful expert witness for the plaintiff, not only because of her expert status as a cardiologist but also because she was articulate and a dedicated physician, and because she had been directly involved in the case. "Times have changed," Jack murmured out loud, thinking that it used to be hard to find a doctor to testify against another doctor. It seemed to him that Noelle was looking forward to testifying, and despite what she'd said, part of her motivation was antipathy toward concierge medicine.

By the time Jack got back to the ER, the shift had changed. Although the ER was still peaceful, Jack had to wait to talk with the nurse and the doctor while they got themselves updated on the patients present who were waiting for test results or for the arrival of their personal physicians. It was close to three thirty when Jack finally was able to sit down with them in a small staff lounge area directly behind the admitting desk. Both were young. Jack guessed early thirties.

Jack said essentially the same thing he'd said to Noelle at the outset, but the emergency-room staff's response was much less emotional or censorious. In fact, Georgina, in her bubbly style, professed to have been greatly impressed by Craig.

"I mean, how many doctors arrive at the ER riding with the patient in the ambulance? I can tell you: not many. The fact that he's being sued is a travesty. It shows how far out of whack the system is when doctors like Dr. Bowman are ambushed by the likes of the ambulance-chaser lawyer on the case. I can't remember his name."

"Tony Fasano," Jack offered. He was enjoying hearing someone who shared his thoughts, although he wondered if Georgina had heard the social side of Craig's tale, especially since Leona had come to the ER that fatal night.

"That was it: Tony Fasano. When he first came snooping around here, I thought he was an extra in one of those gangster movies. I really did. I mean, I couldn't imagine he was for real. Did he really go to law school?"

Jack shrugged his shoulders.

"Well, it wasn't Harvard, I can tell you that. Anyway, I can't imagine him calling me as a witness. I told him exactly what I

thought of Dr. Bowman. I think he did a great job. He even had a portable ECG machine and had already tested for biomarkers before they arrived here at the ER."

Jack nodded as Georgina spoke. He'd read all this in her deposition in which she'd fulsomely praised Craig.

When she fell silent, Jack said, "What I wanted to talk to you people about was the cyanosis."

"What about the cyanosis?" Dr. Matt Gilbert asked. It was the first time he'd spoken. His laid-back personality was overwhelmed by Georgina's vivacity.

"You remember the cyanosis, silly," Georgina said, giving Matt a playful slap on the shoulder before Jack could speak. "She was as blue as a blue moon when they brought her in here."

"I don't think that expression has anything to do with color," Matt said.

"It doesn't?" Georgina questioned. "Well, it should."

"Do you not remember the cyanosis?" Jack asked Matt.

"Vaguely, I suppose, but her general condition trumped everything else."

"You described it as 'central cyanosis' in your notes," Jack said to Georgina. "Was there some specific reason for that?"

"Well, of course! She was blue all over, not just her fingers or legs. Her whole body was blue until they got her on oxygen with the respirator and started doing cardiac massage."

"What do you think might have been the cause?" Jack asked. "Do you think it could have been a right-to-left shunt or maybe severe pulmonary edema?"

"I don't know about a shunt," Matt said. "But she didn't have any pulmonary edema at all. Her lungs were clear."

"One thing I remember," Georgina said suddenly. "She was completely flaccid. When I started another IV line, her arm was like a rag doll's."

"Is that unique, in your experience?" Jack asked.

"Yeah," Georgina said. She looked at Matt for confirmation. "There's usually some resistance. I guess it varies with the degree of consciousness."

"Did either of you see any petechial hemorrhages in her eyes, any strange marks on her face or neck?"

Georgina shook her head. "I didn't." She looked at Matt.

"I was worrying too much about the big picture to see any such details," Matt said.

"Why do you ask?" Georgina questioned.

"I'm a medical examiner," Jack explained. "I'm trained to be cynical. Smothering or strangulation has to be at least considered in any sudden death with cyanosis."

"Now that's a new angle," Georgina said.

"A biomarker assay confirmed a heart attack," Matt said.

"I'm not questioning there was a myocardial infarction," Jack said. "But I'd be interested if something other than a natural process brought it on. Let me give you an example. I once had a case of a woman, arguably a few years older than Mrs. Stanhope, who had a heart attack immediately after being robbed at gunpoint. It was easy to prove a temporal connection, and the perpetrator is sitting on death row to this day."

"My word!" Georgina said.

After giving both individuals a business card that included his cell phone number, Jack headed back to his car. By the time he unlocked the door and climbed in, it was after four o'clock. He sat for a moment, looking out at the small pond. He thought about his conversation with the hospital staff, thinking it was a wash in regard to Craig's cause between Noelle and Georgina, with one avidly for and one avidly against. The trouble was that Noelle was surely going to testify, whereas Georgina, as she expected, probably would not since she wasn't on the defense list. Other than that, he hadn't learned much, or if he had, he was too dumb to recognize it. One thing was for certain: He'd liked and was impressed by all these people, and if he got into an accident and was brought in there, he'd feel he was in good hands.

Jack thought about his next move. What he would have liked to do was drive back to the Bowman house, suit up in his basketball gear, and have a run with David Thomas, Warren's friend, over on Memorial Drive. But realistically speaking, Jack knew that if there were any chance of his contributing to the case by doing an autopsy on Patience Stanhope's earthly remains, he had to force himself to face Jordan Stanhope with the idea of getting him to sign the exhumation permit. The problem was how to get him to do it short of procuring a pistol and holding it to his temple. Jack could not think of a single reasonable stratagem and ultimately resigned himself to ad-libbing while trying to appeal to the man's sense of justice and fairness.