Robin Cook - Critical

Adding to her unease were the results of Jack's two cases that morning, the manners of death of which turned out to be the opposite of what was expected – accidental rather than homicidal. Such surprises reminded her that it was always important to keep an open mind about the manner of death. Even the most talented forensic pathologist could be fooled.

Laurie now began to question if the current series of MRSA cases involved something more sinister than the assumed manner of death, therapeutic complication, a relatively new death designation championed by Bingham to replace "accidental" in a hospital setting. Keeping in mind her two previous series, one fifteen years ago and the second two years ago, whose manners of death had been assumed to be accidental and natural, respectively, but whose ultimate determination shockingly turned out to be homicidal, Laurie could not dismiss the possibility that the current series could be the same. Knowing that she'd be ridiculed if she gave voice to her intuitions, Laurie was aware that she had to see if there was any real evidence to bolster her suspicions, and she had to do it quickly.

Angela removed her coat and draped it over her arm as she exited the elevator on the twenty-second floor of the Trump Tower and briskly walked down toward Angels Healthcare. During the ride uptown from Michael's office, she'd been able to use her BlackBerry to respond to all her e-mails and was reasonably confident she wouldn't be overwhelmed when she got to her office. She wondered how people had functioned pre-Internet.

She acknowledged her secretary, Loren, who was on the phone as Angela passed by. Inside her office, she was about to hang up her coat when she stopped, doing a double take. There was a large clear-glass vase of luxurious red roses perched on the corner of her desk. They stood out in bold relief in the sparse, white decor. After finishing with her coat, and curious who could have sent the flowers and why, she looked for a note. There was none to be found. Now even more curious about the flowers, she leaned out her doorway. She had to wave to get Loren's attention.

"What's with the flowers?" Angela mouthed silently. Loren was still on the phone. From overhearing bits and pieces of the conversation, Angela could tell it was the union representative who'd been persistently trying to organize the Angels Healthcare hospitals. There was no way Angela wanted unionization, but with everything else going on, she didn't have the time or the patience to deal with him, so it fell to Loren to hold him off.

Loren put her hand over the receiver. "I'm sorry. They came with a card. It's here on the corner of my desk." She nodded toward the envelope.

Angela picked up the envelope and got a finger under the flap. Once it was open, she slid out the card. It said simply: Regards from the used one.

"What the hell?" Angela murmured. She turned the card over, but the back was blank. Curious but overwhelmed with all she had to do, she simply slid the card back into the envelope. She'd think about it later.

Tapping Loren's shoulder, Angela motioned for her to again cover the receiver with her hand, and then said, "Tell him I'll meet with him in three weeks. Go ahead and schedule an actual appointment. That should satisfy him. Then call Bob Frampton and Carl Palanco. Tell them to come into my office ASAP. And where's the afternoon schedule?"

Loren pulled out the schedule for the afternoon meetings and handed it over.

Angela retreated back into her office, closing her door. Seated at her desk, she looked at the schedule. Most of the everyday issues of running each of the hospitals was delegated to the department supervisors, but they reported to their respective hospital presidents as well as to a department head in the Angels Healthcare home office, and those individuals in turn reported to Carl Palanco as the COO, and ultimately to Angela as the CEO. By perusing the schedule, Angela could gauge what the rest of the day would be like. She'd been booked to see the general counsel, most likely about the previous day's MRSA death and how to stave off a lawsuit; the risk-management committee chair for the same reason; and the patient safety committee chair. After that, she was to travel over to the Angels Orthopedic Hospital to attend the hospital medical staff meeting. The final scheduled meeting would be back at her office with Cynthia Sarpoulus, so that the infectious-disease professional could give Angela a briefing of what she had learned and what she had planned to do about the previous day's MRSA death.

Of all the meetings, the medical staff meeting was the most important. It would afford Angela a chance, at least at the orthopedic hospital, to impress on the doctors the vital importance of upping their patient census, despite the minor setback the Jeffries case represented. The only way the revenue stream would turn around is if the surgeons did surgery. Angela was aware more than anyone that the success of the specialty hospital depended exclusively on the doctor owners admitting their paying patients, meaning those patients with insurance, either private or Medicare, or those patients with adequate wealth. The specialty-hospital business as per Angela's business plan was not interested in Medicaid or charity cases, or, for that matter, any cases where cost might exceed revenue.

Angela's phone jangled under her arm. It was Loren, informing the boss that the CFO and COO had arrived.

"Send them in," Angela said, putting aside the afternoon schedule.

The two men, dramatic opposites in outward appearance and mannerism, came into the room. Carl Palanco bounded in, snatched one of the four modern straight-backed chairs from where it stood against the far wall, positioned it in front of Angela's desk, and sat himself down. His expression and constant motion suggested he'd had eight cups of coffee. In contrast, Bob Frampton moved as if in oil, and everything about his face suggested a desperate need for a good night's sleep. Yet despite their contrasting miens, Laurie knew them both to be equivalently clever and resourceful, which was why she had strenuously recruited them at the outset to be her key employees.

It took Bob long enough to move a chair next to Carl's that Angela had been tempted to leap up and do it for him. But she stayed in her seat, and the thought gave her insight into her own hyper state. She wondered if she appeared as high-strung as Carl.

"Anything happen this morning that I should know about, apart from the e-mails you men have sent me?" Angela asked, to start things off.

Carl looked at Bob. Both men shook their heads.

"I've met with the heads of supply, nursing, laundry, engineering, housekeeping, and laboratory services to talk about a deeper cut in expenses over the next few weeks," Carl said. "I've gotten some creative ideas."

"I applaud the initiative," Bob said, "but at this point, any efforts in that regard are too little too late, as far as the IPO is concerned."

"I'm afraid Bob is right," Angela said.

"I had to do something," Carl explained. "I couldn't just sit in my office and do nothing. And come what may, an emphasis on cost-consciousness is a good mind-set for our central department heads to have for the future. I mean, it's hardly wasted effort."

Angela nodded. Keeping a rein on expenses was particularly key for hospital profitability as holding companies of hospital chains had learned to great advantage over the last few decades. A large part of Angels Healthcare's profitability at least prior to the MRSA problem, was due to Angela's business plan of building three specialty hospitals at the same time and centralizing things like laundry supplies, housekeeping, engineering, laboratory services, and even anesthesia. Each hospital had a head, or chief, of these various services, but they all answered to the department head in the company's home office.