Under The Knife

Patrick kept shaking his head. “She was our only girl, Mr. Ransom. Our only child. She was always so good, you know? Never complained. Even when she was a baby. She’d just lie there in her crib and smile. Like a little angel. Just like a darling little—” He suddenly stopped, his face crumpling.

“Mr. O’Brien,” David said gently, “I know it’s not much of a comfort to you now, but I promise you, I’ll do everything I can.”

Patrick shook his head. “It’s not the money we’re after. Sure, I can’t work. My back, you know. But Ellie, she had a life insurance policy, and—”

“How much was the policy?”

“Fifty thousand,” answered Mary. “That’s the kind of girl she was. Always thinking of us.” Her profile, caught in the window’s light, had an edge of steel. Unlike her husband, Mary O’Brien was done with her crying. She sat very straight, her whole body a rigid testament to grief. David knew exactly what she was feeling. The pain. The anger. Especially the anger. It was there, burning coldly in her eyes.

Patrick was sniffling.

David took a box of tissues from his drawer and quietly placed it in front of his client. “Perhaps we should discuss the case some other time,” he suggested. “When you both feel ready….”

Mary’s chin lifted sharply. “We’re ready, Mr. Ransom. Ask your questions.”

David glanced at Patrick, who managed a feeble nod. “I’m afraid this may strike you as…cold-blooded, the things I have to ask. I’m sorry.”

“Go on,” prompted Mary.

“I’ll proceed immediately to filing suit. But I’ll need more information before we can make an estimate of damages. Part of that is lost wages—what your daughter would have earned had she lived. You say she was a nurse?”

“In obstetrics. Labor and delivery.”

“Do you know her salary?”

“I’ll have to check her pay stubs.”

“What about dependants? Did she have any?”

“None.”

“She was never married?”

Mary shook her head and sighed. “She was the perfect daughter, Mr. Ransom, in almost every way. Beautiful. And brilliant. But when it came to men, she made… mistakes.”

He frowned. “Mistakes?”

Mary shrugged. “Oh, I suppose it’s just the way things are these days. And when a woman gets to be a—a certain age, she feels, well, lucky to have any man at all….” She looked down at her tightly knotted hands and fell silent.

David sensed they’d strayed into hazardous waters. He wasn’t interested in Ellen O’Brien’s love life, anyway. It was irrelevant to the case.

“Let’s turn to your daughter’s medical history,” he said smoothly, opening the medical chart. “The record states she was forty-one years old and in excellent health. To your knowledge, did she ever have any problems with her heart?”

“Never.”

“She never complained of chest pain? Shortness of breath?”

“Ellie was a long-distance swimmer, Mr. Ransom. She could go all day and never get out of breath. That’s why I don’t believe this story about a—a heart attack.”

“But the EKG was strongly diagnostic, Mrs. O’Brien. If there’d been an autopsy, we could have proved it. But I guess it’s a bit late for that.”

Mary glanced at her husband. “It’s Patrick. He just couldn’t stand the idea—”

“Haven’t they cut her up enough already?” Patrick blurted out.

There was a long silence. Mary said softly, “We’ll be taking her ashes out to sea. She loved the sea. Ever since she was a baby…”

It was a solemn parting. A few last words of condolence, and then the handshakes, the sealing of a pact. The O’Briens turned to leave. But in the doorway, Mary stopped.

“I want you to know it’s not the money,” she declared. “The truth is, I don’t care if we see a dime. But they’ve ruined our lives, Mr. Ransom. They’ve taken our only baby away. And I hope to God they never forget it.”

David nodded. “I’ll see they never do.”

After his clients had left, David turned to the window. He took a deep breath and slowly let it out, willing the emotions to drain from his body. But a hard knot seemed to linger in his stomach. All that sadness, all that rage; it clouded his thinking.

Six days ago, a doctor had made a terrible mistake. Now, at the age of forty-one, Ellen O’Brien was dead.

She was only three years older than me.

He sat down at his desk and opened the O’Brien file. Skipping past the hospital record, he turned to the curricula vitae of the two physicians.

Dr. Guy Santini’s record was outstanding. Forty-eight years old, a Harvard-trained surgeon, he was at the peak of his career. His list of publications went on for five pages. Most of his research dealt with hepatic physiology. He’d been sued once, eight years ago; he’d won. Bully for him. Santini wasn’t the target anyway. David had his crosshairs on the anesthesiologist.

He flipped to the three-page summary of Dr. Katharine Chesne’s career.

Her background was impressive. A B.Sc in chemistry from U.C., Berkeley, an M.D. from Johns Hopkins, anesthesia residency and intensive-care fellowship at U.C., San Francisco. Now only thirty years old, she’d already compiled a respectable list of published articles. She’d joined Mid Pac Hospital as a staff anesthesiologist less than a year ago. There was no photograph, but he had no trouble conjuring up a mental picture of the stereotypical female physician: frumpy hair, no figure, and a face like a horse— albeit an extremely intelligent horse.

David sat back, frowning. This was too good a record; it didn’t match the profile of an incompetent physician. How could she have made such an elementary mistake?

He closed the file. Whatever her excuses, the facts were indisputable: Dr. Katharine Chesne had condemned her patient to die under the surgeon’s knife. Now she’d have to face the consequences.

He’d make damn sure she did.

* * *

GEORGE BETTENCOURT DESPISED doctors. It was a personal opinion that made his job as CEO of Mid Pac Hospital all the more difficult, since he had to work so closely with the medical staff. He had both an M.B.A. and a Masters in public health. In his ten years as CEO, he’d achieved what the old doctor-led administration had been unable to do: he’d turned Mid Pac from a comatose institution into a profitable business. Yet all he ever heard from those stupid little surrogate gods in their white coats was criticism. They turned their superior noses up at the very idea that their saintly work could be dictated by profit-and-loss graphs. The cold reality was that saving lives, like selling linoleum, was a business. Bettencourt knew it. The doctors didn’t. They were fools, and fools gave him headaches.

And the two sitting across from him now were giving him a migraine headache the likes of which he hadn’t felt in years.

Dr. Clarence Avery, the white-haired chief of anesthesia, wasn’t the problem. The old man was too timid to stand up to his own shadow, much less to a controversial issue. Ever since his wife’s stroke, Avery had shuffled through his duties like a sleepwalker. Yes, he could be persuaded to cooperate. Especially when the hospital’s reputation was at stake.

No, it was the other one who worried Bettencourt: the woman. She was new to the staff and he didn’t know her very well. But the minute she’d walked into his office, he’d smelled trouble. She had that look in her eye, that crusader’s set of the jaw. She was a pretty enough woman, though her brown hair was in a wild state of anarchy and she probably hadn’t held a tube of lipstick in months. But those intense green eyes of hers were enough to make a man overlook all the flaws of that face. She was, in fact, quite attractive.

Too bad she’d blown it. Now she was a liability. He hoped she wouldn’t make things worse by being a bitch, as well.

* * *

KATE FLINCHED AS BETTENCOURT dropped the papers on the desk in front of her. “The letter arrived in our attorney’s office this morning, Dr. Chesne,” he said. “Hand delivered by personal messenger. I think you’d better read it.”

She took one look at the letterhead and felt her stomach drop away: Uehara and Ransom, Attorneys at Law.

“One of the best firms in town,” explained Bettencourt. Seeing her stunned expression, he went on impatiently, “You and the hospital are being sued, Dr. Chesne. For malpractice. And David Ransom is personally taking on the case.”

Her throat had gone dry. Slowly she looked up. “But how—how can they—”

“All it takes is a lawyer. And a dead patient.”

“I’ve explained what happened!” She turned to Avery. “Remember last week—I told you—”

“Clarence has gone over it with me,” cut in Bettencourt. “That isn’t the issue we’re discussing here.”

“What is the issue?”

He seemed startled by her directness. He let out a sharp breath. “The issue is this: we have what looks like a million-dollar lawsuit on our hands. As your employer, we’re responsible for the damages. But it’s not just the money that concerns us.” He paused. “There’s our reputation.”

The tone of his voice struck her as ominous. She knew what was coming and found herself utterly voiceless. She could only sit there, her stomach roiling, her hands clenched in her lap, and wait for the blow to fall.

“This lawsuit reflects badly on the whole hospital,” he said. “If the case goes to trial, there’ll be publicity. People—patients—will read those newspapers and it’ll scare them.” He looked down at his desk. “I realize your record up till now has been acceptable—”

Her chin shot up. “Acceptable?” she repeated incredulously. She glanced at Avery. The chief of anesthesia knew her record. And it was flawless.

Avery squirmed in his chair, his watery blue eyes avoiding hers. “Well, actually,” he mumbled, “Dr. Chesne’s record has been—up till now, anyway—uh, more than acceptable. That is…”

For God’s sake, man! she wanted to scream. Stand up for me!

“There’ve never been any complaints,” Avery finished lamely.

“Nevertheless,” continued Bettencourt, “you’ve put us in a touchy situation, Dr. Chesne. That’s why we think it’d be best if your name was no longer associated with the hospital.”

There was a long silence, punctuated only by the sound of Dr. Avery’s nervous cough.

“We’re asking for your resignation,” stated Bettencourt.

So there it was. The blow. It washed over her like a giant wave, leaving her limp and exhausted. Quietly she asked, “And if I refuse to resign?”

“Believe me, Doctor, a resignation will look a lot better on your record than a—”

“Dismissal?”

He cocked his head. “We understand each other.”

“No.” She raised her head. Something about his eyes, their cold self-assurance, made her stiffen. She’d never liked Bettencourt. She liked him even less now. “You don’t understand me at all.”

“You’re a bright woman. You can see the options. In any event, we can’t let you back in the O.R.”

“It’s not right,” Avery objected.

“Excuse me?” Bettencourt frowned at the old man.

“You can’t just fire her. She’s a physician. There are channels you have to go through. Committees—”

“I’m well acquainted with the proper channels, Clarence! I was hoping Dr. Chesne would grasp the situation and act appropriately.” He looked at her. “It really is easier, you know. There’d be no blot on your record. Just a notation that you resigned. I can have a letter typed up within the hour. All it takes is your…” His voice trailed off as he saw the look in her eyes.

Kate seldom got angry. She usually managed to keep her emotions under tight control. So the fury she now felt churning to the surface was something new and unfamiliar and almost frightening. With deadly calm she said, “Save yourself the paper, Mr. Bettencourt.”

His jaw clicked shut. “If that’s your decision…” He glanced at Avery. “When is the next Quality Assurance meeting?”

“It’s—uh, next Tuesday, but—”

“Put the O’Brien case on the agenda. We’ll let Dr. Chesne present her record to committee.” He looked at Kate. “A judgment by your peers. I’d say that’s fair. Wouldn’t you?”

She managed to swallow her retort. If she said anything else, if she let fly what she really thought of George Bettencourt, she’d ruin her chances of ever again working at Mid Pac. Or anywhere else, for that matter. All he had to do was slap her with the label Troublemaker; it would blacken her record for the rest of her life.

They parted civilly. For a woman who’d just had her career ripped to shreds, she managed a grand performance. She gave Bettencourt a level look, a cool handshake. She kept her composure all the way out the door and on the long walk down the carpeted hall. But as she rode the elevator down, something inside her seemed to snap. By the time the doors slid open again, she was shaking violently. As she walked blindly through the noise and bustle of the lobby, the realization hit her full force.

Dear God, I’m being sued. Less than a year in practice and I’m being sued….

She’d always thought that lawsuits, like all life’s catastrophes, happened to other people. She’d never dreamed she’d be the one charged with incompetence. Incompetence.

Suddenly feeling sick, she swayed against the lobby telephones. As she struggled to calm her stomach, her gaze fell on the local directory, hanging by a chain from the shelf. If only they knew the facts, she thought. If I could explain to them…

It took only seconds to find the listing: Uehara and Ransom, Attorneys at Law. Their office was on Bishop Street.

She wrenched out the page. Then, driven by a new and desperate hope, she hurried out the door.

CHAPTER TWO

“MR. RANSOM IS unavailable.”

The gray-haired receptionist had eyes of pure cast iron and a face straight out of American Gothic. All she needed was the pitchfork. Crossing her arms, she silently dared the intruder to try—just try—to talk her way in.

“But I have to see him!” Kate insisted. “It’s about the case—”

“Of course it is,” the woman said dryly.

“I only want to explain to him—”

“I’ve just told you, Doctor. He’s in a meeting with the associates. He can’t see you.”

Kate’s impatience was simmering close to the danger point. She leaned forward on the woman’s desk and managed to say with polite fury, “Meetings don’t last forever.”

The receptionist smiled. “This one will.”

Kate smiled back. “Then so can I.”

“Doctor, you’re wasting your time! Mr. Ransom never meets with defendants. Now, if you need an escort to find your way out, I’ll be happy to—” She glanced around in annoyance as the telephone rang. Grabbing the receiver, she snapped, “Uehara and Ransom! Yes? Oh, yes, Mr. Matheson!” She pointedly turned her back on Kate. “Let’s see, I have those files right here…”

In frustration, Kate glanced around at the waiting room, noting the leather couch, the Ikebana of willow and proteus, the Murashige print hanging on the wall. All exquisitely tasteful and undoubtedly expensive. Obviously, Uehara and Ransom was doing a booming business. All off the blood and sweat of doctors, she thought in disgust.

The sound of voices suddenly drew Kate’s attention. She turned and saw, just down the hall, a small army of young men and women emerging from a conference room. Which one was Ransom? She scanned the faces but none of the men looked old enough to be a senior partner in the firm. She glanced back at the desk and saw that the receptionist still had her back turned. It was now or never.

It took Kate only a split-second to make her decision. Swiftly, deliberately, she moved toward the conference room. But in the doorway she came to a halt, her eyes suddenly dazzled by the light.

A long teak table stretched out before her. Along either side, a row of leather chairs stood like soldiers at attention. Blinding sunshine poured in through the southerly windows, spilling across the head and shoulders of a lone man seated at the far end of the table. The light streaked his fair hair with gold. He didn’t notice her; all his attention was focused on a sheaf of papers lying in front of him. Except for the rustle of a page being turned, the room was absolutely silent.

Kate swallowed hard and drew herself up straight. “Mr. Ransom?”

The man looked up and regarded her with a neutral expression. “Yes? Who are you?”

“I’m—”

“I’m so sorry, Mr. Ransom!” cut in the receptionist’s outraged voice. Hauling Kate by the arm, the woman muttered through her teeth, “I told you he was unavailable. Now if you’ll come with me—”

“I only want to talk to him!”

“Do you want me to call security and have you thrown out?”

Kate wrenched her arm free. “Go ahead.”

“Don’t tempt me, you—”

“What the hell is going on here?” The roar of Ransom’s voice echoed in the vast room, shocking both women into silence. He aimed a long and withering look at Kate. “Just who are you?”

“Kate—” She paused and dropped her voice to what she hoped was a more dignified tone. “Doctor Kate Chesne.”

A pause. “I see.” He looked right back down at his papers and said flatly, “Show her out, Mrs. Pierce.”

“I just want to tell you the facts!” Kate persisted. She tried to hold her ground but the receptionist herded her toward the door with all the skill of a sheepdog. “Or would you rather not hear the facts, is that it? Is that how you lawyers operate?” He studiously ignored her. “You don’t give a damn about the truth, do you? You don’t want to hear what really happened to Ellen O’Brien!”

That made him look up sharply. His gaze fastened long and hard on her face. “Hold on, Mrs. Pierce. I’ve just changed my mind. Let Dr. Chesne stay.”

Mrs. Pierce was incredulous. “But—she could be violent!”

David’s gaze lingered a moment longer on Kate’s flushed face. “I think I can handle her. You can leave us, Mrs. Pierce.”

Mrs. Pierce muttered as she walked out. The door closed behind her. There was a very long silence.

“Well, Dr. Chesne,” David said. “Now that you’ve managed the rather miraculous feat of getting past Mrs. Pierce, are you just going to stand there?” He gestured to a chair. “Have a seat. Unless you’d rather scream at me from across the room.”

His cold flippancy, rather than easing her tension, made him seem all the more unapproachable. She forced herself to move toward him, feeling his gaze every step of the way. For a man with his highly regarded reputation, he was younger than she’d expected, not yet in his forties. Establishment was stamped all over his clothes, from his gray pinstripe suit to his Yale tie clip. But a tan that deep and hair that sun-streaked didn’t go along with an Ivy League type. He’s just a surfer boy, grown up, she thought derisively. He certainly had a surfer’s build, with those long, ropy limbs and shoulders that were just broad enough to be called impressive. A slab of a nose and a blunt chin saved him from being pretty. But it was his eyes she found herself focusing on. They were a frigid, penetrating blue; the sort of eyes that missed absolutely nothing. Right now those eyes were boring straight through her and she felt an almost irresistible urge to cross her arms protectively across her chest.

“I’m here to tell you the facts, Mr. Ransom,” she said.

“The facts as you see them?”

“The facts as they are.”

“Don’t bother.” Reaching into his briefcase, he pulled out Ellen O’Brien’s file and slapped it down conclusively on the table. “I have all the facts right here. Everything I need.” Everything I need to hang you, was what he meant.

“Not everything.”

“And now you’re going to supply me with the missing details. Right?” He smiled and she recognized immediately the unmistakable threat in his expression. He had such perfect, sharp white teeth. She had the distinct feeling she was staring into the jaws of a shark.

She leaned forward, planting her hands squarely on the table. “What I’m going to supply you with is the truth.”

“Oh, naturally.” He slouched back in his chair and regarded her with a look of terminal boredom. “Tell me something,” he asked offhandedly. “Does your attorney know you’re here?”

“Attorney? I—I haven’t talked to any attorney—”

“Then you’d better get one on the phone. Fast. Because, Doctor, you’re damn well going to need one.”

“Not necessarily. This is nothing but a big misunderstanding, Mr. Ransom. If you’ll just listen to the facts, I’m sure—”

“Hold on.” He reached into his briefcase and pulled out a cassette recorder.

“Just what do you think you’re doing?” she demanded.

He turned on the recorder and slid it in front of her. “I wouldn’t want to miss some vital detail. Go on with your story. I’m all ears.”

Furious, she reached over and flicked the Off button. “This isn’t a deposition! Put the damn thing away!”

For a few tense seconds they sized each other up. She felt a distinct sense of triumph when he put the recorder back in his briefcase.

“Now, where were we?” he asked with extravagant politeness. “Oh, yes. You were about to tell me what really happened.” He settled back, obviously expecting some grand entertainment.

She hesitated. Now that she finally had his full attention, she didn’t know quite how to start.

“I’m a very…careful person, Mr. Ransom,” she said at last. “I take my time with things. I may not be brilliant, but I’m thorough. And I don’t make stupid mistakes.”

His raised eyebrow told her exactly what he thought of that statement. She ignored his look and went on.

“The night Ellen O’Brien came into the hospital, Guy Santini admitted her. But I wrote the anesthesia orders. I checked the lab results. And I read her EKG. It was a Sunday night and the technician was busy somewhere so I even ran the strip myself. I wasn’t rushed. I took all the time I needed. In fact, more than I needed, because Ellen was a member of our staff. She was one of us. She was also a friend. I remember sitting in her room, going over her lab tests. She wanted to know if everything was normal.”

“And you told her everything was.”

“Yes. Including the EKG.”

“Then you obviously made a mistake.”

“I just told you, Mr. Ransom. I don’t make stupid mistakes. And I didn’t make one that night.”

“But the record shows—”

“The record’s wrong.”

“I have the tracing right here in black and white. And it plainly shows a heart attack.”

“That’s not the EKG I saw!”

He looked as if he hadn’t heard her quite right.

“The EKG I saw that night was normal,” she insisted.

“Then how did this abnormal one pop into the chart?”

“Someone put it there, of course.”

“Who?”

“I don’t know.”

“I see.” Turning away, he said under his breath: “I can’t wait to see how this plays in court.”

“Mr. Ransom, if I made a mistake, I’d be the first to admit it!”

“Then you’d be amazingly honest.”

“Do you really think I’d make up a story as—as stupid as this?”

His response was an immediate burst of laughter that left her cheeks burning. “No,” he answered. “I’m sure you’d come up with something much more believable.” He gave her an inviting nod. In a voice thick with sarcasm, he jeered, “Please, I’m dying to know how this extraordinary mix-up happened. How did the wrong EKG get in the chart?”

“How should I know?”

“You must have a theory.”

“I don’t.”

“Come on, Doctor, don’t disappoint me.”

“I said I don’t.”

“Then make a guess!”

“Maybe someone beamed it there from the Starship Enterprise!” she yelled in frustration.

“Nice theory,” he said, deadpan. “But let’s get back to reality. Which, in this case, happens to be a particular sheet of wood by-product, otherwise known as paper.” He flipped the chart open to the damning EKG. “Explain that away.”