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.
"Not to mention the fact that the ER provides sixty percent of all admissions, plus lab and other spin-offs," Monks said. "Which makes it possible for this hospital to survive, no matter what your bean-counter computer programs say."
"If they come in electively, they pay for what they get." Baird's forefinger jabbed at Monks's chest, an imaginary skewer. "But in the ER, we've got to take them whether they pay or not. So a lot of the time, they don't."
"We should start letting them die in the streets? Have the feds and the state close us down?"
There was a pause. Monks realized that they had both almost been shouting.
Baird pushed his chair back and stood up. "Let's cool off. This isn't doing either of us any good."
Several responses flashed through Monks's mind, but they all rang of adolescent bluster. Baird was right – this was not doing any good.
He left without speaking, went outside, and leaned against the building in the shade. It occurred to him that a red beer would taste just fine. He heaved himself off the wall and started walking to a bar called Charley's, just two short blocks away.
Charley's was an old-fashioned tavern, a long narrow room with a scarred bar, a burger grill, and worn vinyl booths. It was quiet, dark, inviting, the kind of place where you could easily spend a day or three.
But by the time he was inside, Monks had calmed down. There was too much going on. He could not afford a dull mind. He got a club soda and took it to a booth at the back.
He tried to decide which was justified – his anger at being sold down the river, the queasy feeling that he might, in fact, have mishandled the incident – or the even queasier one that a slick attorney could make it look like he had. He started assessing potential targets of liability.
First, chronologically, came D'Anton. But Roman had ruled out a surgical infection. The possibility of some other condition that D' Anton had not checked for, or had ignored, was not likely.
D' Anton had given Eden the Valium. It had probably factored in, by keeping her sedated – she might have called for help earlier, otherwise. But there was no direct connection to the death. His prescription was within reasonable limits, and it was not his responsibility to see that the drugs were used properly after she left the clinic.
Unless something damning turned up in the records or the autopsy, D' Anton was in the clear.
Next came Ray Dreyer, the fiancé. He had agreed to care for her for twenty-four hours after the surgery. But he was not a professional, not operating under any license or bonding. He might be liable to some degree, but on a personal level.
Then there was Monks.
For lawyers, the issue was clear. When someone undergoing medical treatment was injured or died, someone else was to blame. The simple rule for malpractice went: there had to be negligence, there had to be injury, and the negligence had to have caused or contributed to the injury.
Assuming that the DIC was, in fact, the cause of death, Monks was also in the clear legally. Nothing he'd done had contributed to that.
But if a procedure was seen as questionable or simply unnecessary – such as administering the heparin – that was still sufficient grounds for an attorney to file a deep-pockets lawsuit, in the hopes that the hospital would settle out, for a hefty sum.
And Monks's name would be entered in a national registry of physicians who had tacitly admitted to negligence – tarred forever by that brush.
He walked back inside to a house phone and put out a page for Dick Speidel, the chairman of the Emergency Room's Quality Assurance committee.
Monks was in luck – Dick Speidel answered the page. Speidel was also an ER doc, so he didn't keep regular hours, and he wasn't on shift today. But he acted as liaison between the emergency group – a self-contained corporation that contracted with Mercy Hospital – and the hospital's administration, so he tended to be around quite a bit on business.