Critical (28 page)
"No matter," Jack said, regaining the excitement with which he had arrived. "I wanted to tell you what I've been doing for the last couple of hours."
"I'd like to hear," Laurie said. "But you see all these case files and these printouts of hospital records on my desk?"
"Of course I see them," Jack interrupted. "It's hard to see your desk underneath them. But first let me tell you about the case you passed up."
"I think we should talk about these cases on my desk," Laurie said.
"In a minute!" Jack snapped. Then, in a more normal tone, he said, "God, you've got such a one-track mind."
You're the one to talk about a one-track mind,
Laurie thought but did not say. Sometimes Jack could be a lesson in patience control.
"I'm the visitor. I'm the one who came to you, so my story goes first. Okay?"
"Fine," Laurie intoned in frustration.
"Anyway, thanks for passing up the Rodriguez case."
"You're welcome," Laurie said insincerely.
"The cause of death was straightforward, as I'm sure you assumed it would be. I mean, the victim, a construction worker, fell ten stories onto concrete from a building under construction."
"Can you get to the point!" Laurie complained.
Jack stared at Laurie for a beat. "You're in a crummy mood."
"No, I'm just a little impatient to talk about something which, with due respect, I think is more important."
"Okay, okay," Jack said. "So as not to hear about this for a week, tell your story!"
"No, I agreed for you to talk first, so finish! Just pick up the pace."
Jack smiled wryly before continuing. "The internal exam showed all sorts of blunt-trauma injury, including detached heart, ruptured liver, and bilateral compound fractures of the femurs. But I knew that wasn't going to help with the manner of death, so I visited the scene."
"I hope you didn't cause your own
scene,
" Laurie quipped. "Because I did a site visit myself and inadvertently caused a
scene,
which has Bingham spitting bullets."
"Not diplomatic me!" Jack said. "Actually, everyone had a ball. What I did was fill a plastic body bag with sand courtesy of the contractor so that it was the same weight as the victim. Then, up on the tenth floor ..."
"I hope you didn't climb ten stories on your injured knee," Laurie interjected.
"No!" Jack said as it if was totally out of the question. "They took me up in the construction elevator. Up there, I checked where the guy was working when he fell. Ironically enough, he was putting up temporary guardrails. With a guy down on the ground with a stopwatch, we first rolled the bag off the ledge like what would happen if Mr. Rodriguez had accidentally fallen. And do you know how far away from the building the bag ended up?"
"I can't imagine."
"Six feet, and it took two and a half seconds. When we heaved the body bag off as if he were pushed or leaped on his own accord, guess where it landed in two-point-six seconds?"
"Please, just tell me your story?"
"Twenty-one feet on the nose. Pretty cool, huh? It proves it wasn't an accident."
"What if he stood at the edge of the building, closed his eyes, and took a baby step?"
"Wouldn't happen. He wouldn't want to hurt himself by hitting the building on the way down."
"You're sure of that?"
"I am. I thought about it myself once, a few months after the plane crash."
"Oh," Laurie merely said. It was an area she didn't want to revisit at the moment. Jack still struggled with depression on occasion.
"I'm going to sign the case out as suicide. Do you know why?"
"I can't guess," Laurie said. "Why?" Despite her initial pique, she was interested. "Why not homicide? He could have been pushed or thrown."
"Because on external exam, he had healed scars across both wrists. He'd attempted suicide before. This time, he used a more efficacious and guaranteed method."
"Very interesting," Laurie said with questionable sincerity. "Now, can I speak?"
"Of course," Jack responded. "But I think I know what you are going to say."
"Do you?" Laurie questioned, with a touch of superciliousness.
"You are going to tell me by the looks of all these case files that there has been a surge at Angels Orthopedic of MRSA postoperative infections, and that I have to cancel my surgery or at least reschedule it for some indeterminate later date. Am I close?"
"You are right on the nose," Laurie said, "but, smarty pants, I think you should hear the details."
"Can't we do it over a bite to eat somewhere along Columbus Avenue?"
"I want to tell you now," Laurie insisted. "These MRSA cases are truly a mystery. In my opinion, what is happening actually cannot be happening, either naturally or intentionally."
Jack's eyebrows raised when Laurie mentioned the idea that the MRSA was being spread intentionally. He asked her if she truly thought it was possible. When she said yes, he didn't dismiss the idea out of hand. Laurie had a track record of ferreting out several equally bizarre situations some years earlier that everyone else had dismissed.
"Okay. Let's hear the unexpurgated version, and I promise not to interrupt."
First, Laurie handed over her unfinished matrix and then went on to tell Jack everything she did that day, and everything she'd learned and everything that was pending. She finished up with:
"There shouldn't even be a discussion whether or not you should proceed with your operation. You shouldn't, plain and simple."
"Well, I'm sorry that Blowhard Bingham gave you a hard time. I think your visit to the Angels Orthopedic Hospital should be a source of commendation, certainly not the opposite. I'm intrigued myself by all you have told me, except for your final conclusion. Now, don't argue with me!"
Laurie had tried to complain.
"I let you speak without interruption, so let me have the same courtesy. I have been proactive today anticipating your attempting to change my mind, so I've learned some things as well. First off, these MRSA infections in your series are not technically nosocomial, since they are not within the time period of forty-eight hours."
"That's true," Laurie agreed, "but that definition is more for statistical purposes."
"The forty-eight-hour limit is because infections within that time very often are from organisms carried in by the patient. And that will undoubtedly turn out to be the case with your series, and my reason for believing that is twofold: One is because of what you have learned in your investigation -- namely, that the contamination cannot be occurring naturally or by intention, ergo, it is being brought in by the patients; secondly, the cases all seem to be community-acquired MRSA, which by definition comes from the community, or in other words from outside the hospital."
"Can I say something now?" Laurie questioned.
"If you must."
"The CA-MRSA, or community-acquired, has definitely shown up as a problem in hospitals, and that's been over a number of years at an ever-increasing rate."
"That may be so, but I believe the fact that the bug is the CA-MRSA exclusively lends more credence to my theory. But be that as it may, I also called Dr. Wendell Anderson's office and spoke to his scheduling nurse. Thinking of you, I asked her whether it would be possible, if I put off the surgery, to again be scheduled at the seven-thirty slot. She said it would be up to the doctor, because he always starts at eight-thirty or nine and that he was doing me a favor by coming in early on Thursday."
"Well then let's delay it," Laurie said.
"I don't want to delay it. That's the point. Yet I wanted to ask in case I changed my mind, but I didn't."
"Why not?" Laurie demanded with obvious irritation at Jack's intransigence.
"Because the sooner it gets done," Jack growled, "the sooner I'll be on the bike and on the b-ball court."
"Jesus Christ!" Laurie exclaimed, throwing up her hands in frustration. "How can you be so foolishly stubborn?"
"I'll tell you how," Jack snapped back. "Before I hung up with Anderson's secretary, I asked her to have Anderson call me back, which he did within the hour. I put the questions to him very directly. First, I asked him if he knew about the MRSA in the Angels hospitals. He said he did, and he admitted there was a significant mystery to it, because he told me all the infection-control mechanisms that the hospital had instituted at great expense. He said infections had decreased but were still occurring at a much-reduced rate. He also told me that he had himself instituted some control measures above and beyond what the hospital was doing."
"What were they?"
"On his own cases he insists the anesthesiologist give supplemental oxygen, maintain the patient's body temperature, and even monitor and maintain glucose levels."
"Has he had any recent postoperative infection?" Laurie asked incisively.
"I'm glad you asked that question," Jack said smugly. "Although I know it's an egotistical sore point with surgeons, I asked him directly if he had. Surprisingly enough, he said he's only had three postoperative infections in all his career, and all three had been open compound fracture repairs, meaning the cases were dirty to begin with. Also, all three were at University Hospital, not Angels Orthopedic."
"So he's not had an MRSA case."
"Well, I don't know what the bacteria was involving his cases at University, but the point is, he's had no infection problem at Angels."
Laurie stared off. She could sense she was losing the argument.
"I even went a step further," Jack said. "I asked him from one doctor to another if he would go ahead and have the surgery as scheduled given the timing in relation to my injury and the fact that Angels is struggling with an MRSA problem." Jack paused for maximum impact.
"And?" Laurie was forced to say. She wanted to know.
"He said in a heartbeat he would do it. And furthermore, he said he wouldn't operate at Angels if he didn't feel that confident. He said the only thing he would personally do was use an antibiotic soap for several days before the procedure. When I admitted to already doing that, he said I'd be fine. He also said that when I go in for my pre-op bloodwork tomorrow, that he would arrange that I be screened for MRSA, and that if I turned out to be a carrier, he would insist I be treated and that the operation would be delayed. The last thing he said was that he'd see me Thursday morning at seven-thirty a.m., and I'd be back on my bike in three months and playing b-ball in six."
Laurie looked over at her pile of cases and hospital records. She felt a mixture of frustration, anger, and despondency. Jack had certainly made some cogent points, especially talking directly to his surgeon, who was highly regarded and rather famous for operating on celebrity athletes. Yet still, Laurie could not help but feel it was a wrong decision to proceed with the surgery under the circumstances. It would be okay if it were an emergency, but as elective surgery, it still seemed crazy to her.
"Come on!" Jack said, standing up and touching her shoulder in the process.
As if she were in molasses, Laurie got to her feet.
Jack handed her matrix back to her. "I still think you should proceed with investigating this series. There has to be an explanation, and I for one would certainly like to hear it."
Laurie nodded, took the matrix, and tossed it casually onto the rest of the debris on her desk.
Jack wrapped his arms about her and hugged her. "Thanks for caring," he said.
Laurie hugged back.
"I love you," Jack said.
"I love you, too." Laurie said.
11
APRIL 3, 2007 5:25 P.M.
"So, how are we going to work this?" Angelo asked Franco.
He and Franco were in Franco's car, having pulled over to the left side of Fifth Avenue between 56th and 57th streets. There was a row of massive concrete urns sitting on the sidewalk, presumably for protection of the Trump Tower from wayward vehicles. The commercial entrance to the building was behind them, forcing one of them at any given time to be looking back over his shoulder to keep the area under observation.
"That's a good question," Franco answered. "This isn't the easiest assignment I've ever had. Where's that description again?" Angelo handed over the sheet of paper.
"Your turn to watch the entrance," Franco said. Facing forward, he quickly reread the description. "I guess we will have to rely on the hair. I can't even imagine what blond with lime-green highlights will look like. It sounds almost scary."
"I think the size issue will tip us off, at least initially," Angelo said. It was easier for him to look back while sitting in the front passenger seat. "It's hard to see the hair color with the angle of the sun, and there's a lot more people coming out. I guess it's quitting time."
"If we don't see her soon, I'm going to start worrying we've missed her."