Michael Palmer - Natural Causes

And finally, against a backdrop that was clearly India, came a taped message from Pramod Singh himself. The secret herbs included in the Ayurvedic Herbal Weight Loss System were only part of the story, he stated. Although to be sure, a most major part.

"Use our powder properly, eat in moderation, avoid the five forbidden foods," he advised in a musical accent, "and you will lose the weight you wish no matter what else you do. Meditate five minutes each day, and follow the other basic principles of Ayurveda explained in your manual, and you will know many new freedoms beyond simply being thin. You will know freedom of the spirit. I am sorry I cannot be with you all in person, but I am here supervising the harvesting of the twelve crucial, natural components of our powder. I look forward to seeing you all in a few weeks. And now, back to Dr. Peter Ettinger."

"Doctor of what?" Matt asked, switching off the tape.

"Peter Ettinger has a number of degrees from a number of institutes," Sarah said. "But I honestly don't know if any of them is a Ph.D. from a traditional university."

"You don't sound as if you like the man much," Colin Smith said.

"He's a pompous ass if you ask me," Glenn Paris said.

Sarah smiled inwardly at the notion that almost certainly Peter would have chosen the exact same words to describe the hospital CEO.

"Well," Matt said, "I think we ought to get started. I've already said my piece by reasserting that the account of the nightmarish night Sarah and I survived in Chinatown is quite factual, and that rumors or no rumors, body or no body, Andrew Truscott is quite dead. The police have turned up nothing new. Neither did a private detective I hired-a very good one. We haven't given up trying to prove our story, but we're also at a loss about where to go from here. Any suggestions?… Well, then, unless there are any questions, I propose we move on.

"So far in this business, Jeremy Mallon's been scoring all the points, and we have been very much on the defensive. Tomorrow, with the formal deposition of Peter Ettinger, I hope that status will change. Before I ran the video, Mrs. Suarez gave you all some idea of what sort of things we'll be trying to pin him down on. I hope she'll go into more detail in just a bit. First, though, I'd like to hear from Dr. Snyder and Dr. Blankenship. Any order will be fine."

Sarah caught Matt's eye for the briefest moment. He was self-assured and very much in control of the meeting. How far he had come since that first session in the Milsap Room at MCB. Silently she longed for the day when she could be with him openly as his friend and lover-the day when Willis Grayson, his anger and his lawyers, would be a thing of their past.

"Suppose I go first, Eli," Randall Snyder offered. "What I have to say won't take very long." He cleared his throat. "I've had the American College of OB/Gyn send letters of inquiry to the heads of every obstetrics department in the country, looking for any unexplained cases of DIC in pregnancy or labor. So far there hasn't been one where there wasn't at least some predisposing thing going on-abruptio placentae, infection, toxemia, sickle cell disease, in utero fetal demise. Not one. I must say, Sarah, having sent the letters and made the dozens of follow-up calls, the lack of any DIC patient who did not take your prenatal supplement remains most disturbing and, if I may say so, most incriminating."

"Thank you," Matt said coolly. "You may say anything you wish. Someone has gone to a great deal of trouble, and caused a great deal of pain, to make Sarah's prenatal supplement appear responsible for those cases. That fact, more than any other, suggests to me that it is not. Dr. Blankenship?"

The chief of medicine tapped a pencil thoughtfully against his palm before picking up the sheaf of notes he had set on the floor beside his seat.

"Well," he said finally, "my assignment was to become one of the world's leading experts on disseminated intravascular coagulopathy. It turns out that this was not nearly the humbling task it first seemed it would be. I have discovered that everyone in the clotting world knows when DIC occurs but absolutely nobody knows why. The more common name for this condition is consumptive coagulopathy, because while it is going on, all of the body's coagulation factors get consumed-used up in those tiny, abnormal clots. In its worst form, DIC is almost universally fatal. This fact makes the accomplishment of Defendant Sarah in saving the life of Plaintiff Lisa all the more remarkable. People who have DIC as badly as the plaintiff simply don't make it.

"Would I testify to that on the witness stand, Mr. Daniels? You betcha I would." His manner and tone, which had been quite matter-of-fact, intensified dramatically. "I would do anything I honestly could to help. I am quite disturbed about this case and the lack of overwhelming support Sarah has received from our institution. We made a promise to her and to ourselves months ago when we first met that we would present a unified front, and that Sarah would be considered innocent until proven-proven-otherwise. Randall, Glenn, I've spoken with Rob McCormick about this letter he sent out requesting Sarah's replacement as chief OB resident next year. He says he'll be happy to retract it for the time being if you two are in agreement to do so."

"Eli," Paris said, "this is hardly the place or time to-"

"Glenn, please. I don't want to start a war here or embarrass Sarah. But if we're going to present the unified front we agreed to, then we've got to get McCormick to back off. Yes?"

Paris's annoyance was apparent. Whether or not he agreed with Blankenship's request, he was uncomfortable with being told what to do.

Finally, after a long pause during which he regained his composure, he grinned and nodded.

"Right you are, Eli. I don't know where Rob got the idea to do what he did, but I'll call him tomorrow and set him straight."

"Excellent. Randall?"

"No problem," Snyder responded unenthusiastically.

"In that case, on with the show," Blankenship said. "There's one last category of causes of DIC I thought I might mention, and that's poisons. The injection of the naturally occurring clotting agent, thrombin, can cause a DIC-type picture, as can certain snake venoms. The toxin found in at least five different species of crotalids can cause lethal DIC."

"Crotalids?" Matt asked.

"Sorry, Matt. Rattlesnakes."

"But I don't believe the poisons you describe are effective by mouth," Sarah said. "And Lisa was at home when her DIC began. I can't imagine she could have received an injection of any sort."

"Or been bitten by a diamondback." Arnold Hayden guffawed.

No one else laughed.

"As I said," Blankenship replied, "I only included the poison possibility for completeness. There may be an oral toxin we don't know about that can cause DIC. Maybe someone has such a substance and is on a vendetta against our hospital or the obstetrics department. At this point, who knows?"

"That's all we need," Glenn Paris groaned. "A psycho."

"Any questions for Eli?" Matt asked. "Okay, then. Rosa, you've kindly shared some significant developments in your work. Can you sum up what your conclusions are at this point?"

Earlier in the day, Sarah had spoken with Rosa for over an hour. The epidemiologist felt torn between the desperate need for all concerned to share information and ideas and her deep-seated bias against disclosing research still in progress. Until her results were checked, double-checked, and locked away, she felt uncomfortable trusting anyone with the details of her work. In the end, nothing was really resolved between them except that Rosa would attend the meeting and disclose as much data and theory as she felt comfortable in doing. No more.

"I must first stress what Dr. Snyder has already brought up," Rosa began. "The connection, whether significant or not, between the three DIC cases and the ingestion of Sarah's prenatal supplement is quite firmly established. I should add, however, that my laboratory work and research does not suggest a direct toxic relationship between DIC and the ingestion of any herb. An allergy of some sort to one of the components, or perhaps contamination with a toxin, would be much better bets. But I have serious doubts about either of those possibilities as well. As has also been mentioned, discovery of a labor patient with DIC who has never taken herbal prenatal vitamins would effectively absolve Dr. Baldwin of any responsibility."