"What else?" Monks said.
"Not something you'd find around the house. I'd recognize anything from cleaning fluids to rat poison. Maybe in agriculture, or industry. She wasn't involved in anything like that, was she?"
Monks felt the insane urge to laugh. "Industry, but not that kind."
"What do you mean?"
"She was an adult film actress. Look, she was recovering from surgery. She'd have gone straight home from the clinic. She wouldn't have been out wandering around."
"Any indications that she was suicidal?"
Monks had never spoken with Eden Hale, never seen her really alive. There might have been a dark, despairing side to her. But it didn't jibe with what he knew, and it didn't seem to follow that a woman who had just gone through an expensive, painful treatment to become more beautiful would want to kill herself immediately afterward. Particularly in a protracted, agonizing way.
"No," he said. "Not yet, anyway."
"Well, I'm afraid that's not much help," Roman said. "I can run more tests or request the city coroner to. But it's tough when I don't know what I'm looking for."
"You think anything will turn up on the autopsy?"
"It'll bear out the DIC, Carroll. But I wouldn't hang too much on anything more." Roman hesitated, then said, "Just on the off chance it did turn out to be some particularly virulent strain of salmonella, was your treatment consistent with that?"
Monks pushed his plate away and leaned his elbows on the table, pressing the heels of his hands into his eyes.
'The initial phase was," he said. "Somebody comes in dehydrated and bleeding in an unknown location, you start by replacing fluid volume, then blood. Next step is to locate the source of the bleeding and treat that – if you can. That's where I diverged."
"Diverged how?"
"There was no way to treat it, except to try to break up the clotting. I gave her heparin."
"Seems reasonable to me," Roman said.
"If you look at it that way, yes. But going by the book – about the last thing you want to do with something like salmonella is thin the blood."
Monks took the elevator up to Baird Necker's office. This time he was uninvited.
His mind was stepping up its analysis, reviewing what he knew, eliminating some possibilities and considering others further. It was a little more satisfying with the new information, although still frustrating as hell.
Salmonella was a bacteria, a prime cause of what was generically called food poisoning. There were several exotic strains and modes of infection, but by far the most common cases seen in the States came from ingesting tainted food. Poultry was a major carrier.
Salmonella didn't cause clotting, but the opposite – if it was advanced enough, there was copious intestinal bleeding, discharged via characteristic bouts of bloody diarrhea. Usually there wasn't much that could be done, beyond replacing fluids and blood, and keeping the patient stable until the attack ran its course. With proper treatment, the disease was rarely fatal.
In short, if he had not given Eden Hale the heparin, he would be safely off the hook now. She would have died anyway, and the cause of the DIC might remain forever a mystery. But no one would be able to point a finger at Monks and accuse him of doing the wrong thing.
It was futile to think about whether he could have stood there and let her go, without trying something. That way lay madness.
But he had seen plenty of salmonella, and whether this was some new super mutant or the plain old garden variety, he still couldn't believe it was responsible. Something else, some terrible unseen pump inside her, had driven all her bloodstream's clotting factors into the smaller vessels, leaving the larger ones to bleed unchecked.
He thought about what Roman had said. His mind turned the word toxin over and over. But how the hell would she have gotten into something that virulent, and rare enough that it wouldn't show up on the tox screen, or be recognized by a highly experienced pathologist?
He had to admit: if he was looking at himself objectively, he would have seen a man clutching at straws.
"There's a new wrinkle," Monks said to Baird, and told him about the conversation with Roman.
"Salmonella, huh?" Baird said. "I wouldn't think she'd have been hungry, that soon after surgery."
"It only takes a taste. She probably wasn't thinking too clearly, with the Valium. Maybe she nibbled at something, chicken salad from a deli that she'd kept too long. Maybe her boyfriend will know. Did you know he was supposed to stay with her at least twenty-four hours, but he left her alone?"
"He seems like a putz, no argument there. But that doesn't have anything to do with us. This is escalating, Carroll. The young lady's mother and father were here yesterday. They're stunned. They didn't even know she was having the breast surgery."
Monks felt another heavy brick settle onto the load. He had a troubled son of his own, last heard of living on the streets of Seattle. But so far, no one had called on Monks to tell him that his child had died in a hospital far from home and family.
"I got the pretty clear sense that they're not going to make things easy," Baird said. "I told them there were complications that haven't been identified yet. Her father got seriously pissed off. They more or less walked out."
"I could explain it to them more clearly."
"I don't think that would do any good. By the way, one of your nurses has also commented that she didn't think the heparin was appropriate. She says she questioned it at the time."
"With all due respect to Mary Helfert," Monks said, "she's not a physician, and she's certainly not qualified to provide an emergency diagnosis. She didn't know what DIC was."
"It's another thing that doesn't help," Baird said. "I'm starting to look at damage control. If it comes to that, I hope you'll cooperate."
"Meaning, stand still and take the blame?"
"Nobody said anything about blame. But if we had to settle out."
"Before we start convicting, Baird, let's wait till the jury's in. Autopsy, final lab, and tox screen. Her history, any preexisting conditions. And there's still a possibility that this is related to the surgery."
Baird looked away, drumming his fingers on his desk. "D'Anton called me again – told me you went by his clinic. I wish you hadn't done that."
"Why the hell not? Physicians consult with each other when they're treating the same patient. Besides which, the surgery's going to be examined in the postmortem. It's not like there's any secret involved."
"I don't want to bring him into this."
A sour taste rose in Monks's mouth. "An ER doc is expendable," he said. "But not your golden boy – cash cow plastic surgeon?"
"I've got to think of the hospital, Carroll. He's world famous."
'There doesn't seem to be any doubt in anybody's mind about that. Especially his."
"He's bringing in millions of dollars' worth of business to this place. Which helps cover what the ER loses."
Monks's eyes widened in outrage. "The ER's in the business of healing the sick. Not scheduled elective surgery."
"Knock off the self-righteous bullshit. Are you telling me reconstructive surgery's not important?"
"I have all the respect in the world for reconstructive surgeons," Monks said. "But D'Anton caters to rich women's vanity. Period."
"People are entitled to any kind of health care that makes them feel good."
"As long as they can pay for it?"
"This hospital cannot operate as a charity," Baird said, speaking the words one angry syllable at a time. It was a line Monks had heard him say many times.