had it not been for the sudden death of Louis Han and the subsequent entry into her life of Peter Ettinger.
'So you use this herbal mix instead of prenatal vitamins?'
'Ever since I found a herbalist in town who could put it together, I have. I give every woman I see in the OB clinic the choice of taking whatever vitamin samples we happen to have on hand or the tea. Some pick one, some pick the other. I've been keeping some notes on birthweights and infant health, but the numbers are still too small to see any difference.'
'Fascinating. What sort of herbs and roots are we talking about here?'
'Do you know about herbal medicine?'
'Not unless you consider having an assortment of Celestial Seasonings teas as being knowledgeable. I am interested in being enlightened, though.'
'In that case, here's the handout I give to all the women I see in the clinic. It lists the nine ingredients in the supplement, and what each does.'
'Angelica, dong quai, comfrey,' Andrew said, scanning the list. 'This is exotic-sounding stuff.'
'Not really. If we were in Beijing, folic acid, beta-carotene, cupric oxide, and many of the other components of our standard prenatal vitamins would be considered just as far out.'
'Point taken. This hospital is certainly tailor-made for you, isn't it.'
'I know you have some misgivings, but I think we deliver the best patient care of any hospital in the city.'
'Maybe so. We're certainly becoming the leading hospital for treating active labor complicated by DIC, I'll say that much for us.'
Sarah's beeper sounded, ordering her to call extension 2350.
'That's the birthing room,' she said. 'I've got to go.'
'Don't worry about your trash. I'll take care of it.'
'Thanks. Andrew, do you think we should form some sort of committee to begin investigating these cases?'
'I think that's a splendid idea. If there's one thing this hospital could use more of, it's committees.'
'I'm serious. I mean, it's not like an epidemic or anything. But two such similar and unusual cases. It certainly makes you wonder. Well, as they say in the postal service, I've got a delivery to make. We'll talk about all this more later, won't we?'
'You bet,' Andrew said.
He watched until Sarah had left the cafeteria. Then he took an envelope from his lab coat pocket and tapped it thoughtfully against his palm.
'Not two cases, m'dear,' he muttered. 'Make that three.'
CHAPTER 8
The surgical senior residents' office was an eight-foot square, windowless box that had once served the Suffolk State Hospital as a storage closet. To Andrew Truscott, occupying the office at all, let alone sharing it with two others, was an indignity quite in keeping with those he already had to endure for being associated with the Medical Center of Boston. This should have been his year. He should have been chief resident and after that a staff surgeon on a tenure track. There was no justification for the flake who had been chosen over him. At any normal hospital it just wouldn't have happened.
After a year of postgraduate medical training in western Australia, he had met and married an American tourist and elected to move to the States. He expected the research and practice opportunities for a surgeon-and the income-would be much greater there. The Medical Center of Boston was not his first choice for a residency, but he was not disappointed to accept Eli Blankenship's offer of a position. After all, he reasoned, it was still a Boston teaching hospital.
Three months into his first year of surgical training at MCB, Truscott began discreetly searching for vacancies in the residency programs at other hospitals. But the only available slots were at borderline facilities with even less prestige than MCB. So he stayed.
He detested Glenn Paris and the carnival-like atmosphere that surrounded the place. He disliked working at a hospital that so deemphasized clinical research that it was considered by many academicians to be something of a joke. And most of all, after investing five years of his life, he resented being passed over because he was, in the words of his department head, 'too inflexible and intolerant.' He was then informed that there was neither the money nor the research/office space to keep him on staff when his residency was over. Cut loose by Crunchy Granola General: the final ignominy.
Now Andrew Truscott sat in the tiny office, sipping orange juice from a Styrofoam cup and rereading a letter that had been routed to him by the head of the surgical service. Dated June 23, the letter was from the medical examiner's office in New York City. It was the department head's request that Andrew, as chairman of the surgical morbidity/mortality committee, look into the matter and recommend what departmental action, if any, was indicated.
DEAR DOCTOR:
First, let me apologize for the delay in getting this letter off to you. Budget cutbacks have hit our agency and greatly slowed the laboratory, cytologic, and clerical work necessary to complete a case. And unfortunately, our caseload continues to grow.
The case I write you about is a twenty-four-year-old woman, Constanza Hidalgo, who was killed when the car she was driving was struck by a bus in November of last year. The details surrounding this case, and the findings of my department, are presented in the enclosed documents. As you will note, the woman appears to have been in active labor at the time of her death. Our laboratory and microscopic studies also indicate that she was suffering from an acute hemorrhagic disorder, most likely disseminated intravascular coagulopathy.
A couple of months ago, one of my staff pathologists was attending a national meeting at which he heard another pathologist mention a case of fatal DIC complicating active labor. Quite incidentally, he returned to work and mentioned the case to me. The hospital at which that woman died was yours. I have been able to learn from contacting her family that Miss Hidalgo was also from Boston and was being followed in your outpatient department. Whether this is coincidence or not, I do not know.
Please use the enclosed information in any way you wish, and do keep me posted of any developments. Certainly DIC occurs in some pregnancies, but in my experience not without a very obvious cause.
Best regards,
MARVIN SILVERMAN, M.D.
Associate Medical Examiner
Andrew opened the copy of Constanza Hidalgo's MCB chart. The record dated back to the woman's childhood, but contained no medical history of particular interest. Her prenatal appointments were kept without exception, and nothing in the clinic notes gave a hint as to the disaster awaiting her and her fetus.
Truscott had already reviewed the chart several times since receiving Silverman's letter. Now, though, he read even more carefully, running his finger down each page until he found a brief outpatient note dated August 10. The note read:
Patient doing well and continuing part-time work as a waitress. Some complaints of fatigue, but no ankle edema, abdominal pain, urinary frequency, headaches, blurred vision, or unusual bleeding.
P.E.-normal vital signs, unremarkable cardiac exam, no edema, 22 wk. uterine fundus. Fetal heart heard easily at 140/min.
Impression: 22-week intrauterine pregnancy
Plan: Ptnt. elects to switch from prenatal multivits to herbal supplements. Three month supply and instructions given.
