V.I. Warshawski 04 - Bitter Medicine (33 page)

Lotty brought Max Loewenthal, executive director of Beth Israel, to the Dortmunder with her. A short, sturdy man of sixty or so with curly white hair, he had been a widower for a number of years. He was in love with Lotty, whom he’d met after the war in London-he, too, was an Austrian refugee. He had asked her several times to marry him, but she always replied that she wasn’t the marrying type. Still, they shared season tickets to the opera and the symphony every year and she had traveled around England with him more than once.

He stood up at my entrance, smiling at me with shrewd gray eyes. Murray hadn’t arrived yet. I told them we might expect him.

“I thought Max could answer administrative questions if any arose,” Lotty explained.

Lotty rarely drinks, but Max was knowledgeable about wines and pleased to have someone to share a bottle with. He picked out a ‘75 Cos d’Estournel from the bins along the walls and had it opened. Max waved away the waitress, who knew Lotty and me well and was disposed to talk.

None of us wanted to eat until we’d been through my cache.

“I have Friendship’s file on Consuelo, although if you’re going to have it admitted in court you’ll have to order a copy through proper channels.” I pulled the two records on Consuelo from my briefcase and handed them to Lotty. “The typed one was the one locked in Humphries’s office and the handwritten one was in Peter Burgoyne’s desk file.”

Lotty put on her black-rimmed glasses and studied the reports. She first read the typed copy, then went through Peter’s handwritten notes. Her heavy brows drew together and deep lines etched themselves around her mouth.

I found I was holding my breath and reached for the wine. Max, equally intent, didn’t try to stop me from pouring before it had breathed properly.

“Who is Dr. Abercrombie?” Lotty asked.

“I don’t know. He’s the person in the report Peter says he tried calling?” I thought of the brochures I’d picked up in Peter’s office and fished them from my portfolio. They might list hospital staff.

“Friendship: Your Full-Care Obstetrics Service” proclaimed a slickly printed piece. They had spent a lot of money on it-four-color, letterpress with photographs. The cover showed a woman nestling a newborn infant, a look of ineffable joy on her face. Inside, the copy proclaimed: “Giving birth: the most important experience of your life. Let us help you make it your most joyful experience as well.” I skimmed through the copy. “Most women give birth without complications of any kind. But if you need extra help before or during birth, our perinatologist is on call twenty-four hours a day.”

At the bottom of the page, a serious but confident man held what looked like an electric blanket control against the abdomen of a pregnant woman. She gazed up at him trust-ingly. The caption read: “Keith Abercrombie, M.D., board-certified perinatologist, administers ultrasound to one of his patients.”

I handed it over to Lotty, indicating the picture with my finger. Translate, please?“

She read the caption. “He’s using sound waves to make sure the baby is still moving, checking the heartbeat to make sure it’s normal. You can also estimate height and weight with these gadgets. Late in pregnancy you can usually tell sex as well.

“The perinatologist is an obstetrician with a specialty in treating the complications of pregnancy. If your baby is born with problems, you’d get a specialist pediatrician in, a neonatologist. Consuelo needed a perinatologist. If he’d shown up, then little Victoria Charlotte might have made it long enough to get to the neonatologist, who also didn’t seem to be there.”

She took off her glasses and laid them on the table beside the papers. “Dr. Burgoyne’s problem is obvious. Why he didn’t want me to see his case notes. What I don’t understand is why he didn’t throw them out-the typed report is explanatory without revealing overt negligence.”

“Lotty. It may be obvious to you, but it isn’t to us. What are you talking about?” Max demanded. Unlike her, he still spoke with a pronounced Viennese accent. He reached for the reports and started looking through them.

“In the typed report, they explain that Consuelo showed up as a non-ambulatory emergency. She was beginning labor and she was comatose. They administered dextrose to try to restore her blood sugar and raise her blood pressure. They say in the typed report that they used ritodrine to try to retard labor. Then it became a trade-off on whether they could stop labor without killing her, so they went ahead and took the baby. Then she died, of complications of pregnancy. But Burgyonc’s handwritten notes tell a much different story.”

“Yes, I sec.” Loewenthal looked up from perusing Peter’s handwritten notes. “He spells the whole thing out, doesn’t he?”

I thought I might scream with impatience. “Spell it out for me!”

“What time did you get to the hospital?” Lotty asked me instead.

I shook my head. “I can’t remember-it’s been almost a month.”

“You’re a detective, a trained observer. Think.”

I shut my eyes, recalling the hot day, the paint factory. “We got to the plant just at one. Fabiano’s appointment was at one and I had an eye on the dashboard clock-we were cutting it close. It might have been a quarter hour later that Consuelo started in labor. Say I spent fifteen minutes in the plant getting instructions on what hospital to use and how to find it. Another fifteen to drive there. So it must have been around one-forty-five when we got to Friendship.”

“And yet at three o’clock they were just calling Abercrombie,” Max said. “So a good hour went by in which they didn’t do anything for her.”

“So when I talked to that impossible woman in admissions, they weren’t treating her,” I said. “God damn it, I should have made a bigger stink at the time. They must have kept her waiting on that gurney for an hour while they debated treating her.”

Lotty ignored that. “The point is, they say they gave her ritodrine. That’s the drug of choice today, and certainly what this Abercrombie should have done, if he’d been there. But Burgoyne’s notes say he gave her magnesium sulfate. That can cause heart failure; it did in Consuelo’s case. He notes that her heart stopped, they took the baby and revived Consuelo, but all the shocks her system had had that day were too much-her heart stopped again in the night and they couldn’t revive her.”

Her brows furrowed together. “When Malcolm got there, he must have known what the problem was. But maybe he didn’t know right off that they weren’t using ritodrine. If the IV bag wasn’t clearly labeled…”

Her voice trailed off as she tried to visualize the scene. The bins of wine bottles rotated around me and the floor seemed to swoop up toward me. I clutched the edge of the table. “No,” I said aloud. “That’s just not possible.”

“What is it, Vic?” Max’s sharp eyes were alert.

“Malcolm. They wouldn’t have killed him to stop him reporting what he’d seen. Surely not.”

“What!” Lotty demanded. “This isn’t a time for jokes, Vic. Yes, they’d made a serious mistake. But to kill a man, and so brutally? Anyway, when he talked to me, he told me they were using the right drug. So maybe he didn’t know. Or maybe he questioned the nurses later. Maybe that’s what he told me he wanted to check on that night-before he wrote his report. What I don’t understand is where this Abercrombie was. Burgoyne says he tried calling him, more than once, but he never showed up.”

“I guess I could try to find Abercrombie’s office,” I said unenthusiastically. “See if he left any telltale case notes lying around.”

“I don’t think that will prove necessary.” Max had been studying the brochure. “We can use logic. They just say he’s on call twenty-four hours a day. They don’t say he’s part of the hospital staff.”

“So?”

He grinned. “Here’s where my specialized knowledge be-comes important. You wonder why Lotty brought me. You say to yourself, why is this senile old man interrupting my great detection-”

“Knock it off,” I said. “Get to the point.”

He became serious. “In the last ten years, there’s been a shift in the age at which educated women give birth-they’re having their first babies much later than they used to. Because they’re educated, they know about the risks, right? And they want to go to a hospital where they know an expert will be on hand to treat them if they have complications.”

I nodded. I have a number of friends agonizing over the various stages of conception, pregnancy, and delivery. The modern pregnancy-gone through with the care we used to reserve for buying a car.

“So by now enough people are worrying about these issues that hospitals that want to be competitive in obstetrics have to have a perinatologist on hand. And they have to have a full complement of fetal monitors and neonatal intensive-care unit and so on.

“But to make something like that pay, you need to be delivering at least twenty-five hundred to three thousand infants a year.” He grinned wolfishly. “You know. Bottom line. We can’t offer unprofitable services.”

“I see.” I did. I saw the whole picture with amazing clarity. Except for a few little pieces. Like Fabiano. Dick and Dieter Monkfish. But I had an idea about them, too.

“So is Dr. Abercrombie a chimera?” I asked. “They just hire an actor to pose with a fetal-monitor machine?”

“No.” Max spoke judiciously. “I’m sure he’s real. But is he really attached to the hospital? Friendship Five is in an upscale neighborhood, correct? They do not typically treat high-risk pregnancies-the type of patient that Consuelo was-young, bad diet, and so on. If one of your Dr. Burgoyne’s patients seemed to be prone to complications, he’d get Abercrombie over to see her. But why pay a quarter of a million dollars a year for someone whose work you need only once a month at best?”

He poured more wine into my glass and tasted his own. He nodded absentmindedly, a fraction of his attention on the wine.

Lotty frowned. “But, Max. They’re advertising a full-service obstetrics service. Level Three care, you know. That’s why we told Vic to take Consuelo there. Carol spoke with Sid Hatcher, asked him where they should go in that part of the suburbs. Sid had seen the advertisements, had heard their service discussed at some meeting he’d been to. That’s why he recommended Friendship.”

“So if they didn’t have this Abercrombie really on staff they couldn’t advertise?” I asked skeptically. Truth in advertising is the law, sure, but only if you get caught.

Lotty leaned forward in her intensity. “The state comes in and certifies you. I know this, because I was the perinatologist at Beth Israel when we got our original certification. Before I went into family medicine and opened my clinic. They came in and put us through a major review-equipment and everything.”

I emptied my glass. I hadn’t eaten since the virtuous fruit and yogurt I’d had for breakfast. The rich, heavy wine went straight from my stomach to my brain, warming me. I needed a little warmth to deal with what I was learning.

“If Murray shows up I think he’ll have the answer to that.” I held out my right hand and rubbed my first two fingers against my thumb, the Chicago city symbol.

Lotty shook her head. “I don’t understand.”

“Payoffs,” Max explained to her kindly.

“Payoffs?” she echoed. “No. It wouldn’t happen. Not with Philippa. You remember her, don’t you, Max? She’s with the state these days.”

“Well, she’s not the only person with the state,” I said. “She has a boss who’s in charge of health regulation. She’s got an obnoxious young prick of a colleague who’s on the make. The two of them are good drinking buddies. Now all we need to find out is what state rep they drink with, and we’ll be all set.”