Robin Cook - Critical

"I think we should talk about these cases on my desk," Laurie said.

"In a minute!" Jack snapped. Then, in a more normal tone, he said, "God, you've got such a one-track mind."

You're the one to talk about a one-track mind, Laurie thought but did not say. Sometimes Jack could be a lesson in patience control.

"I'm the visitor. I'm the one who came to you, so my story goes first. Okay?"

"Fine," Laurie intoned in frustration.

"Anyway, thanks for passing up the Rodriguez case."

"You're welcome," Laurie said insincerely.

"The cause of death was straightforward, as I'm sure you assumed it would be. I mean, the victim, a construction worker, fell ten stories onto concrete from a building under construction."

"Can you get to the point!" Laurie complained.

Jack stared at Laurie for a beat. "You're in a crummy mood."

"No, I'm just a little impatient to talk about something which, with due respect, I think is more important."

"Okay, okay," Jack said. "So as not to hear about this for a week, tell your story!"

"No, I agreed for you to talk first, so finish! Just pick up the pace."

Jack smiled wryly before continuing. "The internal exam showed all sorts of blunt-trauma injury, including detached heart, ruptured liver, and bilateral compound fractures of the femurs. But I knew that wasn't going to help with the manner of death, so I visited the scene."

"I hope you didn't cause your own scene, " Laurie quipped. "Because I did a site visit myself and inadvertently caused a scene, which has Bingham spitting bullets."

"Not diplomatic me!" Jack said. "Actually, everyone had a ball. What I did was fill a plastic body bag with sand courtesy of the contractor so that it was the same weight as the victim. Then, up on the tenth floor…"

"I hope you didn't climb ten stories on your injured knee," Laurie interjected.

"No!" Jack said as it if was totally out of the question. "They took me up in the construction elevator. Up there, I checked where the guy was working when he fell. Ironically enough, he was putting up temporary guardrails. With a guy down on the ground with a stopwatch, we first rolled the bag off the ledge like what would happen if Mr. Rodriguez had accidentally fallen. And do you know how far away from the building the bag ended up?"

"I can't imagine."

"Six feet, and it took two and a half seconds. When we heaved the body bag off as if he were pushed or leaped on his own accord, guess where it landed in two-point-six seconds?"

"Please, just tell me your story?"

"Twenty-one feet on the nose. Pretty cool, huh? It proves it wasn't an accident."

"What if he stood at the edge of the building, closed his eyes, and took a baby step?"

"Wouldn't happen. He wouldn't want to hurt himself by hitting the building on the way down."

"You're sure of that?"

"I am. I thought about it myself once, a few months after the plane crash."

"Oh," Laurie merely said. It was an area she didn't want to revisit at the moment. Jack still struggled with depression on occasion.

"I'm going to sign the case out as suicide. Do you know why?"

"I can't guess," Laurie said. "Why?" Despite her initial pique, she was interested. "Why not homicide? He could have been pushed or thrown."

"Because on external exam, he had healed scars across both wrists. He'd attempted suicide before. This time, he used a more efficacious and guaranteed method."

"Very interesting," Laurie said with questionable sincerity. "Now, can I speak?"

"Of course," Jack responded. "But I think I know what you are going to say."

"Do you?" Laurie questioned, with a touch of superciliousness.

"You are going to tell me by the looks of all these case files that there has been a surge at Angels Orthopedic of MRSA postoperative infections, and that I have to cancel my surgery or at least reschedule it for some indeterminate later date. Am I close?"

"You are right on the nose," Laurie said, "but, smarty pants, I think you should hear the details."

"Can't we do it over a bite to eat somewhere along Columbus Avenue?"

"I want to tell you now," Laurie insisted. "These MRSA cases are truly a mystery. In my opinion, what is happening actually cannot be happening, either naturally or intentionally."

Jack's eyebrows raised when Laurie mentioned the idea that the MRSA was being spread intentionally. He asked her if she truly thought it was possible. When she said yes, he didn't dismiss the idea out of hand. Laurie had a track record of ferreting out several equally bizarre situations some years earlier that everyone else had dismissed.

"Okay. Let's hear the unexpurgated version, and I promise not to interrupt."

First, Laurie handed over her unfinished matrix and then went on to tell Jack everything she did that day, and everything she'd learned and everything that was pending. She finished up with:

"There shouldn't even be a discussion whether or not you should proceed with your operation. You shouldn't, plain and simple."

"Well, I'm sorry that Blowhard Bingham gave you a hard time. I think your visit to the Angels Orthopedic Hospital should be a source of commendation, certainly not the opposite. I'm intrigued myself by all you have told me, except for your final conclusion. Now, don't argue with me!"

Laurie had tried to complain.

"I let you speak without interruption, so let me have the same courtesy. I have been proactive today anticipating your attempting to change my mind, so I've learned some things as well. First off, these MRSA infections in your series are not technically nosocomial, since they are not within the time period of forty-eight hours."

"That's true," Laurie agreed, "but that definition is more for statistical purposes."

"The forty-eight-hour limit is because infections within that time very often are from organisms carried in by the patient. And that will undoubtedly turn out to be the case with your series, and my reason for believing that is twofold: One is because of what you have learned in your investigation – namely, that the contamination cannot be occurring naturally or by intention, ergo, it is being brought in by the patients; secondly, the cases all seem to be community-acquired MRSA, which by definition comes from the community, or in other words from outside the hospital."

"Can I say something now?" Laurie questioned.

"If you must."

"The CA-MRSA, or community-acquired, has definitely shown up as a problem in hospitals, and that's been over a number of years at an ever-increasing rate."

"That may be so, but I believe the fact that the bug is the CA-MRSA exclusively lends more credence to my theory. But be that as it may, I also called Dr. Wendell Anderson's office and spoke to his scheduling nurse. Thinking of you, I asked her whether it would be possible, if I put off the surgery, to again be scheduled at the seven-thirty slot. She said it would be up to the doctor, because he always starts at eight-thirty or nine and that he was doing me a favor by coming in early on Thursday."

"Well then let's delay it," Laurie said.

"I don't want to delay it. That's the point. Yet I wanted to ask in case I changed my mind, but I didn't."

"Why not?" Laurie demanded with obvious irritation at Jack's intransigence.

"Because the sooner it gets done," Jack growled, "the sooner I'll be on the bike and on the b-ball court."

"Jesus Christ!" Laurie exclaimed, throwing up her hands in frustration. "How can you be so foolishly stubborn?"

"I'll tell you how," Jack snapped back. "Before I hung up with Anderson's secretary, I asked her to have Anderson call me back, which he did within the hour. I put the questions to him very directly. First, I asked him if he knew about the MRSA in the Angels hospitals. He said he did, and he admitted there was a significant mystery to it, because he told me all the infection-control mechanisms that the hospital had instituted at great expense. He said infections had decreased but were still occurring at a much-reduced rate. He also told me that he had himself instituted some control measures above and beyond what the hospital was doing."