Although Jack should have expected Christina to…

Although Jack should have expected Christina to return to the sensitive issue after his inadequate response, such a direct, personal question snapped him back to that disturbing sequence when he'd said good-bye to his wife and daughters at the Chicago airport. It had been fifteen years ago almost to the day that he'd driven his family to the airport to take a commuter flight back to Champaign while a band of rogue thunderstorms and tornadoes were approaching through the vast midwestern plains. He'd been in Chicago, retraining in forensic pathology after a health-care giant had gobbled up his ophthalmology practice back in the heyday of managed care's expansion. Jack had been trying to get Marilyn to agree to move to Chicago, but she had rightfully refused for the children's sake.

The passage of time had not numbed Jack's memory of the last good-bye.

As if it had been yesterday, he could see in his mind's eye, watching through the glass partition, Marilyn, Tamara, and Lydia descend the ramp behind the departure gate. As they reached the maw of the Jetway only Marilyn turned to wave. Tamara and Lydia, with their youthful enthusiasm, had just disappeared.

As Jack was to learn later than night, only fifteen or twenty minutes after takeoff the small prop plane had plowed full-speed into the fertile black earth of the prairie. It had been struck by lightning and caught in a profound wind shear. All aboard had been killed in the blink of an eye.

"Are you okay, Uncle Jack?" Christina asked. For several beats, Jack had been motionless as if caught in a freeze-frame.

"I'm fine," Jack said with palpable relief. He'd just relived the moment in his life that he strenuously avoided thinking about, and yet the episode concluded without the usual visceral sequelae. He didn't feel as if his stomach had flip-flopped, his heart had skipped a beat, or as if a heavy, smothering blanket had descended over him. It was a sad story, but he felt enough distance that it could have involved someone else. Perhaps Alexis was right. As she'd said on the phone: Perhaps he'd processed his grief and moved on.

"How old were they?"

"The same as you and Meghan."

"That's awful."

"It was," Jack agreed.

Back up in the kitchen/great room, Alexis had Jack sit at the family table while she finished boiling the pasta. The girls had all retreated upstairs to get ready for bed. It was a school night. Jack's eyes ranged around the room.

It was an expansive yet cozy room befitting the house's external appearance. The walls were a light, sunburst yellow. A deep, comfortable sofa upholstered in a bright green floral fabric and covered with cushions faced a fireplace surmounted by the largest flat-screen television Craig had ever seen. The curtains were the same print as the sofa and framed a bow window looking out on a terrace. Beyond the terrace was a swimming pool.

Beyond that was lawn with what looked like a gazebo in the gloom.

"It's a beautiful house," Jack commented. In his mind it was more than beautiful. Compared to how he had been living over the last ten years, it was the epitome of luxury.

"Craig has been a wonderful provider, as I said on the phone," Alexis said as she poured the pasta into a colander.

"Where is he?" Jack questioned. No one had mentioned his name. Jack assumed he was out, perhaps on an emergency medical call or possibly conferring with his attorney.

"He's asleep in the upstairs guest room," Alexis said. "As I implied, we're not sleeping together and haven't been since he left to live in town."

"I thought maybe he was out on a medical call."

"No, he's free of that for the week. He's hired someone to cover his practice during the trial. His attorney recommended it. I think it's a good thing. As

dedicated a doctor as he is, I wouldn't want him for my doctor right now.

He's too preoccupied."

"I'm impressed he's asleep. If it were me, I'd be up, pacing the house."

"He's had a little help," Alexis admitted. She brought the pasta and salad over to the table and put it in front of Jack. "It was a hard day with the opening of the trial, and he's understandably depressed. I'm afraid he's been self-prescribing sleeping pills to deal with insomnia. There's also been some alcohol: scotch, to be exact, but not enough to worry about, I don't think. At least not yet."

Jack nodded but didn't say anything.

"What would you like to drink? I'm going to have a glass of wine."

"A little wine would be nice," Jack said. He knew more than he wanted to about depression. After the plane crash, he'd fought it for years.

Alexis brought over an opened bottle of white wine and two glasses.

"Did Craig know I was coming?" Jack asked. It was a question he should have asked before he'd agreed to come.

"Of course he knew," Alexis said while pouring the wine. "In fact, I discussed the idea with him before I called you."

"And he was okay with it?"

"He questioned the rationale but said he'd leave the decision up to me. To be truthful, he wasn't excited about it when we discussed it, and he said something that surprised me. He said he thought you disliked him. You never said anything like that, did you?"

"Absolutely not," Jack said. As he began to eat, he wondered how far to take the conversation. The truth of the matter was that back when Alexis and Craig had gotten engaged, he didn't think Craig was appropriate for

Alexis. But Jack had never said anything, mainly because he thought, without knowing exactly why, that doctors in general were a poor risk, marriagewise. It was only relatively recently that Jack's tortured road to recovery had given him the insight to explain his earlier gut reaction —

namely, that the whole medical training process either selected narcissistic people or created them, or some combination of the two. In Jack's estimation, Craig was the poster boy in this regard. His single-minded dedication to medicine almost guaranteed that his own personal relationships would be correspondingly shallow, a kind of psychological zero-sum game.

"I told him you didn't feel that way," Alexis continued. "In fact, I said you admired him because you told me that once. Am I remembering correctly?"

"I told you I admired him as a consummate physician," Jack said, aware that he was being mildly evasive.

"I did qualify it by saying you were envious of his accomplishments. You did say something to that effect, didn't you?"

"Undoubtedly. I have always been awed by his ability to do real, publishable basic science research while handling a large, successful clinical practice. That is the romantic goal of a number of physicians who never even come close. I made a stab at it back when I was an ophthalmologist, but in retrospect, my supposed research was a joke."

"I can't imagine that's true, knowing what I do about you."

"Getting back to the critical issue, how does Craig feel about me actually being here? You really didn't answer that."

Alexis took a sip of her wine. It was apparent she was considering the answer, and the longer she paused while doing so, the more uneasy Jack became. After all, he was a guest in the man's house.

"I suppose my not answering it was deliberate," she admitted. "He's embarrassed to be asking for help, as you suggested he might be on the

phone. There's no doubt he sees dependency as a weakness, and this whole affair had made him feel totally dependent."

"But I have a feeling he's not the one asking for help," Jack said. He finished his pasta and started in on his salad.

Alexis put her wineglass down. "You are right," she said reluctantly. "I'm the one who's asking for help on his behalf. He's not all that happy about you being here because he's embarrassed. But I'm ecstatic you are here."

Alexis reached across the table and took Jack's hand. She squeezed it with unexpected ferocity. "Thank you for caring, Jack. I've missed you. I know it's not the best time for you to be away, and that makes it even more special. Thank you, thank you, thank you."

A sudden flash of emotion washed over Jack, and he felt his face flush. At the same time, the avoidant nature of his personality kicked in and asserted itself. He detached his hand from Alexis's, took a gulp of wine, than changed the subject. "So, tell me about the opening day of the trial."

Alexis's slight smile turned up the corners of her mouth. "You are smooth, just like the old days! That was an impressively quick U-turn from an emotionally charged arena. Did you think I might not notice?"

"I keep forgetting you're a psychologist," Jack said with a laugh. "It was an instinctual reaction for self-preservation."

"At least you admit to your emotional side. Anyway about this trial, all that's happened so far are the two opening statements by the opposing attorneys and the testimony of the first witness."

"Who was the first witness?" Jack finished the salad and picked up the wineglass.

"Craig's accountant. As Randolph Bingham explained later, the whole reason he was included was merely to establish that Craig owed a duty to the deceased, which was easy, since the deceased had paid the retainer fee, and Craig had been seeing her on a regular basis."

"What do you mean 'retainer fee'?" Jack asked with surprise.

"Craig switched from a traditional fee-for-service practice to a concierge practice almost two years ago."

"Really?" Jack questioned. He'd had no idea. "Why? I thought Craig's practice was booming, and he loved it."

"I'll tell you the main reason even if he won't," Alexis said, moving herself in closer to the table as if she was about to reveal a secret. "Over the last number of years, Craig has felt he has been progressively losing control of patient decisions. I'm sure you know all this, but with more and more involvement of insurance companies and various health plans with cost containment, there's been more and more intrusion into the doctor-patient relationship, essentially telling doctors what they can and cannot do. For someone like Craig, it has been a progressive, ongoing nightmare."

"If I were to ask him why he made the change, what reason would he give?"

Jack questioned. He was fascinated. He'd heard of concierge medicine, but he thought it was a small fringe group or a mere trendy quirk in the system.

He'd never talked with a doctor who practiced in such a setting.

"He wouldn't admit he'd ever compromised a patient decision because of outside influence, but he'd be fooling himself. Just to keep his practice solvent, he has had to see progressively more patients in any given day. The reason he gives for switching to concierge medicine is that it affords him the opportunity to practice medicine the way he was taught in medical school, where he could spend as much time as needed with each patient."

"Well, it's the same thing."

"No, there's a subtle difference, although there's an aspect of rationalization on his part. The difference is between a negative push and a positive pull.

His explanation emphasizes the patient."

"Is the style of his practice playing a role in the malpractice case?"

"Yes, at least according to the plaintiff's attorney, who I have to say is performing better than anticipated."

"How do you mean?"

"To look at him, and you'll see for yourself if you come to the courtroom, you'd not imagine on first glance he'd be effective. How should I say this: He's a composite stereotype of the tawdry, ambulance-chasing personal-injury lawyer and the mafioso defense attorney, about half Craig's defense attorney's age. But he's relating to the jury in a surprisingly effective manner."

"How is Craig's practice style supposed to play into the case? Did the plaintiff's attorney address it in his opening statement?"

"Absolutely, and very effectively. The whole concept of concierge medicine is predicated on being able to satisfy patient needs, like a concierge at a hotel."

"I get the association."

"To that end, each patient has access to the doctor through cell phone and/or e-mail so that they can contact the doctor at all hours and be seen if necessary."

"Sounds like an invitation to abuse on the part of the patient."

"I suppose with some patients. But it didn't bother Craig. In fact, he seemed to like it because he started making house calls at off-hours. I think to him there was something retro and nostalgic about it."

"House calls?" Jack questioned. "Making house calls is usually a waste of time. As a modern-age doctor you're so limited in what you can do."

"Nonetheless, some of the patients love it, including the deceased. Craig had seen her often after hours. In fact, he had seen her at her home the

morning of the very day the malpractice was supposed to have occurred.

That evening she took a turn for the worse, and Craig made a house call."

"It seems to me it would be hard to find fault with that."

"One would assume so, but according to the plaintiff's attorney, it was Craig's making the house call rather than sending the patient to the hospital that caused the malpractice, since it delayed the diagnosis and emergency treatment of a heart attack."

"That seems absurd," Jack said indignantly.

"Not when you hear it coming from the plaintiff's attorney during his opening statement. You see, there are other circumstances surrounding the episode that are important. It happened when Craig and I were officially separated. At the time, he was living in an apartment in Boston with one of his nubile secretary-cum-file clerks named Leona."

"Good God!" Jack exclaimed. "I don't know how many stories I've heard of married physicians having affairs with their office help. I don't know what it is about male medical doctors. In this day and age, most men in other endeavors know not to date their employees. It's asking for legal troubles."

"My sense is you are being too generous to the middle-aged married males who find themselves locked in a reality that didn't live up to their romantic expectations. I think Craig falls into such a group, but it wasn't Leona's twenty-three-year-old body that was the initial lure. It was, ironically enough, the change to the concierge practice, which provided something he'd never had: free time. Free time can be a dangerous thing for someone who'd spent half of his life as single-minded as Craig. It was like he woke up and looked at himself in the mirror and didn't like what he saw. All of a sudden he had this manic interest in culture. He wanted to make up for lost time and become overnight his image of a well-rounded person. But it wasn't enough for him to do it alone like a hobby. Just as he did with medicine, he wanted to indulge it with one hundred percent effort, and he insisted I go along with it. But obviously I couldn't, not with my job and the

responsibility of the girls. That's what drove him out, at least as far as I know. Leona came later, as he realized he was lonely."

"If you're trying to make me feel sorry for him, it's not going to work."

"I just want you to know what we're up against. The plaintiff's attorney knows that Craig and Leona had tickets for the symphony on the night the plaintiff's wife died. He says witnesses will prove that Craig made the house call even though he suspected the patient had a heart attack on the outside chance it wasn't. If he had found that to be the case, he would have been able to make the concert. Symphony Hall is closer to the plaintiff's house than Newton Memorial Hospital."

"Let me guess — this Leona is scheduled to be a witness."

"Of course! She's now the spurned lover. To make matters worse, she is still working in Craig's office and he can't fire her for fear of another lawsuit."

"So the plaintiff's attorney is contending that Craig put the patient at risk by playing the odds against the possible diagnosis."

"That's essentially it. They're saying that it's not up to the standard of care in terms of making a timely diagnosis, which for a heart attack is critical, as events have shown. They don't even have to prove that the woman would have survived had she been taken to the hospital immediately, just that she might have. Of course, the cruel irony is that the allegation is diametric to Craig's practice style. As we've said, he's always put patients first, even before his own family."

Jack ran a hand through his hair in frustration. "This is more complicated than I thought it would be. I assumed the question revolved around some specific medical issue. This kind of case means there is even less chance of my being any help than I thought."

"Who knows?" Alexis said fatalistically. She pushed back from the table, went over to the service desk, and hefted a sizable manila envelope stuffed with papers. She brought it back to the table and plopped it down. It made a

resounding thump. "Here's a copy of the case I put together. It's pretty much everything, from interrogatories to depositions to medical records. The only thing that's not included is a transcript of today's proceeding, but I've given you a good idea of what was said. There's even a couple of Craig's recent research papers he suggested I include. I don't know why: maybe to save face, imagining you'll be impressed."

"I probably will be if I can understand them. Anyway, it looks like I have my work cut out for me."

"I don't know where you want to work. You have a lot of choices. Can I show you a few alternatives besides your room downstairs?"

Alexis led Jack on a tour of the first floor of the house. The living room was huge but appeared uncomfortably pristine, as if no one had ever stridden across its deep pile carpet. Jack nixed that. Off the living room was a mahogany-paneled library with a wet bar, but it was dark and funereal with poor lighting. No thanks! Down the hall was a media room with a ceiling-mounted projector and several rows of lazy-boy chairs. Inappropriate, and worse lighting than the library. At the end of the hall was a sizable study with matching his-and-hers desks on opposing walls. His desk was neat with each pencil in a pencil cup sharpened to a needle-like point. Her desk was the opposite, with haphazard stacks of books, journals, and reprints.

There were several reading chairs and hassocks. A bow window similar to the one in the great room looked out onto a flower bed with a small fountain. Directly opposite the window was floor-to-ceiling shelving on either side of the entrance door. Among a mixture of medical and psychology texts was Craig's old-fashioned leather doctor's bag and a portable ECG machine. As far as being a work area, the best thing about the room was the lighting setup, with recessed ceiling fixtures, individual desk lamps, and floor lamps by each club chair.

"This is a terrific space," Jack said. "But are you sure you don't mind me in your personal study?" He switched on one of the floor lamps. It cast a wide, warm glow.

"Not in the slightest."

"What about Craig, since it's his space, too?"

"He wouldn't mind. One thing I can assure you about Craig. He's not territorial."

"Okay, then, here's where I'll be. I have a feeling it will take me quite a few hours." He put the bulging manila envelope down on the table between the two reading chairs.

"As the saying goes, knock yourself out. I'm off to bed. With the need to get the kids off to school, tomorrow comes early around here. There are plenty of drinks in the kitchen refrigerator and more in the wet bar, so help yourself."

"Terrific! I'm all set."

Alexis let her eyes wander down Jack's frame, then back to his face. "I have to tell you, brother, you look good. When I visited you out in Illinois, and you had your ophthalmology practice, you looked like a different person."

"I was a different person."

"I was afraid you were going to become overweight."

"I was overweight."

"Now you look hale, hungry, and hollow-cheeked, like an actor in a spaghetti western."

Jack laughed. "That's a creative description. Where did that come from?"

"The girls and I recently watched some old Sergio Leone movies. It was an assignment for a film class Tracy's taking at her school. Seriously, you look like you're in good shape. What's your secret?"

"Street basketball and bike riding. I treat them like second careers."

"Maybe I should give them a try," Alexis said with a wry smile. Then she added: "Good night, brother. See you in the morning. As you might expect, it's always a bit chaotic with three girls."

Craig watched Alexis walk down the hall and then with a final wave disappear up the stairs. He turned around and scanned the room again. A sudden silence descended like a blanket. The place looked and smelled so different from his own surroundings, it could have been on a different planet.

Somewhat self-conscious about being in someone else's space, Jack sat down in the easy chair illuminated by the floor lamp. The first thing he did was take out his cell phone and turn it on. There was a message, and it was from Warren, with the promised name and phone number of his friend in Boston. The name was David Thomas, and Jack called immediately, thinking he might be in need of exercise if the morrow turned out to be as stressful as he feared. Alexis's evasiveness about Craig's response to Jack's visit was enough to make anyone feel less than welcome.

Warren must have been full of praise about Jack when he talked to David, because David was overly enthusiastic about Jack coming for a run.

"This time of year we play every night starting about five o'clock, man!"

David had said. "Get your honky ass over there and we'll see what you got."

He gave Jack directions to the court on Memorial Drive near Harvard. Jack said he'd try to get there in the late afternoon.

Next, Jack called Laurie to report that he was settled as best as could be expected so far.

"What do you mean?" she asked warily.

"I have yet to see Craig Bowman. The story is, he's not all that happy I'm here."

"That's not very nice, all things considered, particularly the timing."

Jack then described what he thought was the positive news about his response to Alexis's daughters. He told Laurie that one of the girls had even brought up the crash right off the bat, but that he had taken it in stride, to his pleasant surprise.

"I'm amazed and pleased," Laurie said. "I think it's terrific, and I'm relieved."

Jack went on to say that the only bad news was that the malpractice didn't involve a technical medical issue, but rather something far more convoluted such that there was even less chance that he could help them than he'd thought.

"I hope that means you'll be on your way back here straight away," Laurie said.

"I'm about to read the file," Jack said. "I imagine I'll know more at that point."

"Good luck."

"Thanks. I'll need it."

Jack ended the call and put his phone away. For a moment, he strained to hear any noise in the vast house. It was as silent as a tomb. Picking up the manila envelope, he dumped the contents onto the side table. The first thing he picked up was a research paper Craig had coauthored with a renowned Harvard cell biologist and had published in the prestigious New England Journal of Medicine. It was about the function of sodium channels in cell membranes responsible for nerve and muscular action potentials. There were even some diagrams and electron micrographs of subcellular molecular structure. He glanced at the materials-and-methods section. It was amazing to him that someone could conceive of such arcane concepts, much less study them. Seeing as it was all beyond his current

comprehension, he tossed the paper aside and picked up a deposition instead. It was the deposition of Leona Rattner.

7

BOSTON, MASSACHUSETTS

TUESDAY, JUNE 6, 2006

6:48 A.M.

Contents - Prev | Next

The first thing Jack was aware of was a distant verbal disagreement followed by the concussive force of a door slamming. For a brief moment, he tried to incorporate the sounds into his dream, but it didn't make any sense. Instead, he opened his eyes only to have not a clue where he was.

After checking out the fountain bathed in bright sunlight outside the bow window as well as the interior of the study, it all came back to him in a flash. In his hand was a deposition of a nurse named Georgina O'Keefe from the Newton Memorial Hospital, which he had been in the process of rereading when he'd fallen fast asleep.

Gathering up all the papers from the Stanhope vs. Bowman malpractice case, Jack slipped them into the manila envelope. It took some doing to get them all in. Then he got to his feet. A wave of momentary dizziness made him pause briefly.

He had no idea what time he'd fallen asleep. He'd read through the entire collection of papers and had been in the process of going back over those parts he thought most interesting when his eyes closed involuntarily. To his

surprise, he'd been captivated by the material from the start. If the story didn't indirectly involve his sister, he would have thought it an entertaining script for a soap opera, since the colorful characters' personalities leapt off the pages. There was the gifted and dedicated but arrogant and adulterous doctor; the nubile, spurned, and angry lover; the precise and rather laconic bereaved spouse; the knowledgeable but contentious experts; the parade of other witnesses; and finally the apparently hypochondriacal victim. It was a comedy of human foibles, except for the unfortunate fatal outcome and the fact that it had ended up as a malpractice suit. As far as the probable outcome of the suit was concerned, at least from reading the material, Jack thought Alexis's concern and pessimism were well founded. With his grandiosity and arrogance, which came out in the latter stages of his deposition, Craig did not help his cause. The plaintiff's attorney had succeeded in making Craig sound as if he believed it was an outrage that his clinical judgment was being questioned. That wouldn't play well with any jury. And on top of that, Craig had implied that it was his wife's fault he'd had an affair with his secretary.

Whenever Jack was pressed to describe the goal of his job as a medical examiner, his usual response, depending to a degree on the inquirer and the occasion, was to say he "spoke for the dead." As he read over Stanhope vs.

Bowman, he found himself ultimately thinking mostly about the victim and the unfortunate but obvious circumstance that she could not be deposed or serve as a witness. Playing a game in his mind, he considered how it would influence the case if she were able to participate, and thinking along those lines made him believe that she was the key to a successful resolution of the case. It seemed to him that if the jury believed she was the hypochondriac Craig said she was, they'd have to find for the defense, despite her final symptoms being all too real and despite Craig's narcissistic personality.

Thinking in this vein emphasized the unfortunate reality that there had been no autopsy and, accordingly, there was no medical examiner on the defense's witness list to speak for the deceased.

With the manila envelope under his arm, Jack snuck down the hallway toward the basement stairs beneath the main staircase. As scruffy as he was,

he preferred not to run into anybody. As he started down the stairs, he heard more yelling above by one of the girls and another door slam.

Down in his quarters, Jack shaved, showered, and dressed as quickly as he could. When he got back upstairs, the entire Bowman clan was in the great room. The atmosphere was strained. The three girls were at the table behind cereal boxes. Craig was on the sofa hidden behind the The New York Times with a mug of coffee on the coffee table in front of him. Alexis was at the counter, busily making sandwiches for the girls' lunches. The TV above the fireplace was tuned to the local news, but the sound was barely on. Sun streamed in through the bow windows. It was almost blinding.

"Good morning, Jack," Alexis said lightly when she noticed him standing in the doorway. "I hope you slept okay downstairs."

"It was very comfortable," Jack said.

"Say good morning to your uncle," Alexis advised the girls, but only Christina did so.

"I don't know why I can't wear the red top," Meghan whined.

"Because it belongs to Christina, and she says she prefers you don't," Alexis said.

"Did the plane burn with your daughters in it?" Christina asked.

"Christina, that's enough!" Alexis said. She rolled her eyes for Jack's benefit. "There's fresh juice in the fridge and fresh coffee in the maker.

What do you usually have for breakfast?"

"Just fruit and cereal."

"We have both. Help yourself."

Jack went over to the coffeemaker. As his eyes began to search for a cup, a mug came sliding down the granite countertop, thanks to Alexis. He filled it

with coffee and plopped in a spoonful of sugar and a dollop of cream. As he stirred, he again took in the room. Christina and Alexis were now embroiled in a conversation about after-school plans. The two other girls seemed silent and sulky. Craig had not emerged from behind his newspaper, which to Jack seemed an obvious slight.

Refusing to be cowed and believing a good offense was the best defense, Jack walked over to the mantel. He was now looking directly at Craig's newspaper, which Craig was holding up to its full extent like a barrier wall.

"Anything interesting in the news?" Jack asked while taking a sip of his steaming coffee.

The top edge of the paper came down slowly, progressively revealing Craig's puffy, slack face. His eyes were like bull's-eyes with dark surrounding rings, while his sclerae were webbed with minute red capillaries, giving him the visage of a man who'd been out on an all-night binge. In contrast to his weary face, he was dressed in a freshly pressed white shirt and conservative tie, while his sandy-colored hair was neatly brushed with a slight sheen suggesting a dab of gel.

"I'm hardly in the mood for small talk," Craig said morosely.

"Nor am I," Jack responded. "At least we agree right out of the starting gate.

Craig, let's clear the air! I'm here on my sister's behest. I'm not here to help you. I'm here to help her. If I help you, it's fallout. But let me tell you something; I think it stinks that you've been sued for malpractice. In my estimation from what I know of you professionally, you're the last one who should be sued for malpractice. Now, there are some other social areas in which you don't shine from my perspective, but that's another story entirely.

As far as the case is concerned, I've read the material and I have some thoughts. You can hear them or not, that's your call. As far as my staying in your house, that's also your call, since I demand unanimity on the part of couples when I'm a guest. I can easily move to a hotel."

Except for the muted sounds of the local news and some twittering of birds outside, the room went silent and still. No one moved until Craig noisily collapsed his papers, folded them haphazardly, and tossed them aside. A moment later came the renewed clink of flatware against cereal bowls from the table. From the sink came the sound of the faucet being turned on.

Sound and action had returned.

"I have no problem being up-front," Craig said. His voice now sounded more tired and sad than morose. "When I heard you were coming, I was irritated. With everything that's going on, I didn't think it was an appropriate time for company, especially since you'd never bothered previously to come for a visit. Frankly, it irked me that you might harbor the mistaken illusion you were the cavalry riding in at the nick of time to save the party in peril.

Having you tell me right off that that's not the case makes me feel differently. You're welcome to stay, but I'm sorry I'm not up to being much of a host. As far as your thoughts about the case are concerned, I'd like to hear them."

"I don't expect you to be a host at all, considering what you are going through," Jack said. He sat on the corner of the coffee table diagonally across from Craig. The conversation was going better than he'd anticipated.

He had in mind to further the cause by paying Craig a compliment. "Along with all the court-related material, there were a couple of your most recent research papers. I was impressed. Of course, I'd be more impressed if I understood them."

"My attorney has in mind to introduce them as evidence of the extent of my commitment to medicine. The plaintiff's attorney according to his opening statement is going to try to prove the opposite."

"Certainly can't hurt. I can't imagine how he's going to present them, but I'm no lawyer. If he does, I have to give you credit, Craig. You are amazing.

Most every doctor I know thinks they would like to do a combination of clinical work and research. It's the ultimate ideal absorbed in medical school, but you're one of the few that actually does it. What's so surprising,

it's real research and not those 'reports of an interesting case' type papers that try to masquerade as research."

"There's no doubt it is real research," Craig said, perking up a tad as he warmed to the subject. "We are learning more and more about voltage-gated sodium channels in nerve and muscle cells, and it has immediate clinical application."

"In your last paper in NEJM, you talked about two different sodium channels, one for heart muscle and one for nerves. How are they different?"

"They are structurally different, which we are now determining at a molecular level. How we knew they were different was because of their marked difference in their response to tetrodotoxin. There's a thousandfold difference, which is extraordinary."

"Tetrodotoxin?" Jack questioned. "That's the toxin that kills people in Japan who eat the wrong sushi."

Craig laughed in spite of himself. "You're right. It's sushi made by an inexperienced sushi chef from puffer fish at a particular time of their reproductive cycle."

"Remarkable," Jack commented. Having accomplished getting Craig to perk up, he was eager to move on. Craig's research, although interesting, was far too esoteric for his liking. Jumping directly from one subject to another, Jack brought up his feelings about how the victim, Patience Stanhope, was the key element to win his malpractice case. "If your attorney can indisputably establish the fact in the jurors' minds that this woman was the kind of hypochondriac she was, the jury will have to find against the plaintiff."

For a few seconds, Craig merely stared back at Jack. It was as if the conversational transition had been so abrupt that his brain had to reboot itself. "Well," he said at length. "It's interesting you say that, because I already said as much to Randolph Bingham."

"Well, there you go. We're thinking on the same plane, which lends more credibility to the idea. What did your attorney say?"

"Not much, as I recall."

"I think you should bring it up again," Jack said. "And while we're on the subject of the deceased, I didn't see an autopsy report. I'm assuming there was none. Am I correct?"

"Unfortunately, there wasn't an autopsy," Craig said. "The diagnosis was confirmed by the biomarker assay." He shrugged. "No one expected a malpractice suit. I'm sure if they had, the medical examiners would have opted for a postmortem and I would have requested one."

"There was one other small point in the record I thought was curious," Jack said. "An ER nurse by the name of Georgina O'Keefe, who was the admitting nurse at Newton Memorial Hospital. She wrote in her notes that the patient had marked central cyanosis. The reason it jumped out was because she didn't mention it in her deposition. I went back and checked. Of course, the reason I was sensitive to the issue was because in your deposition, you said you were shocked at the degree of cyanosis when you saw the patient. In fact, this issue was a point of disagreement between you and Mr. Stanhope."

"It certainly was a disagreement," Craig said defensively. Some of the original sullenness returned to his voice. "Mr. Stanhope had said on the phone, and I quote, 'She looked rather blue', whereas when I got to the house, she was floridly cyanotic."

"Would you have labeled it central cyanosis like Ms. O'Keefe?"

"Central or peripheral, what's the difference in this kind of case? Her heart wasn't pumping her blood fast enough through her lungs. There was a lot of deoxygenated blood in her system. That's what generally causes cyanosis."

"The issue is the amount of cyanosis. I agree the deep cyanosis certainly suggests not enough blood was going through her lungs or that not enough

air was getting into her lungs. If it were peripheral cyanosis, meaning blood just pooling in her extremities, it wouldn't have been so conspicuous or even."

"What are you implying?" Craig asked aggressively.

"To be honest, I don't know. As a medical examiner, I try to keep an open mind. Let me ask you this: What kind of relationship did the deceased have with her surviving husband?"

"Somewhat strange, I suppose. They certainly weren't affectionate in public.

I doubt they were close, since he did commiserate with me about her hypochondriasis."

"You see, we medical examiners from experience are naturally suspicious.

If I were doing this autopsy and considering the cyanosis, I would look for any signs of smothering or strangulation just to rule out homicide."

"That's absurd," Craig snapped. "This wasn't a homicide. Good grief, man!"

"I'm not suggesting it was. I'm just thinking about it as a possibility.

Another possibility could be the woman had an undiagnosed right-to-left cardiac shunt."

Craig impatiently ran his fingers through his hair, which changed his appearance from looking tired but neat to tired and mildly disheveled. "She didn't have a right-to-left shunt!"

"How do you know? She didn't let you do any non-invasive cardiac imagery like you wanted after her questionable stress test, which, by the way I couldn't find."

"We haven't been able to locate the tracing yet at the office, but we have the results. But you're right. She refused any cardiac studies."

"So she could have had a congenital right-to-left shunt that was undiagnosed."

"What difference would it make if she had?"

"She could have had a serious structural problem with her heart or major vessels, which raises the issue of contributing negligence, since she refused follow-up studies to your stress test. More importantly, if she had a serious structural defect, then one might argue the outcome would have been the same even if she had been taken to the hospital immediately. If that had been the case, then the jury would have to find for you and you'd prevail."

"Those are interesting arguments, but unfortunately for me, it is all academic. An autopsy was not done, so it will never be known if she had a structural abnormality."

"Not necessarily," Jack said. "An autopsy wasn't done, but that doesn't mean one couldn't still be done."

"You mean exhume the body?" Alexis asked from the kitchen area. She'd obviously been listening.

"Provided it wasn't cremated," Jack added.

"It wasn't cremated," Craig said. "It was buried in Park Meadow Cemetery.

I know because I was invited to the funeral by Jordan Stanhope."

"I guess that was before he sued you for malpractice."

"Obviously. It was another reason I was so taken aback when I was served with the summons and the complaint. Why would the man invite me to the service and then sue me? Like everything else, it doesn't make sense."

"Did you go?"

"I did. I felt obligated. I mean, I was upset I'd not been able to resuscitate the woman."

"Is it difficult doing an autopsy after being buried for almost a year?"

Alexis asked. She'd come over and taken a seat on the couch. "It sounds so

ghoulish."

"You never know," Jack said. "Two factors are the most important. First: how well the body was embalmed. Second: whether the grave stayed dry or if the seal on the casket remained intact. The reality is you never know until you open up the grave. But regardless of the situation, a lot of information can be gleaned."

"What are you guys talking about?" Christina yelled from the table. The two other girls had disappeared upstairs.

"Nothing, sweetie," Alexis said. "Run up and get your things. The school bus is going to be here any minute."

"This could be my contribution to the case," Jack said. "I could find out the procedure for exhumation here in Massachusetts and do an autopsy. Short of my providing mere moral support, it's probably the only way I could offer to help in this affair. But it's up to you guys. You tell me."

Alexis looked at Craig. "What do you think?" she asked.

Craig shook his head. "To be honest, I don't know what to think. I mean, if an autopsy were to prove she had some major congenital cardiovascular problem such that any delay getting her to a hospital had no significance, I'd be all for it. But what are the chances? I'd have to guess rather small. On the flip side, if an autopsy were to show her myocardial infarction was even more extensive than one might expect, maybe the autopsy would make things worse. It seems to me to be a wash."

"I'll tell you what," Jack said. "I'll look into it. I'll find out all the details, and I'll let you know. Meanwhile, both of you can give it some thought.

What do you say?"

"I say it's a plan," Alexis responded. She looked at Craig.

"Why not?" Craig said with a shrug. "I've always said more information is better than less."

8

BOSTON, MASSACHUSETTS

TUESDAY, JUNE 6, 2006

9:28 A.M.

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"All rise!" the court officer called as Judge Marvin Davidson emerged from his chambers and mounted the stairs to the bench. The black robes shielded his feet, so he seemed to glide like an apparition. "Be seated," the court officer called out after the judge had done so.

Jack looked behind himself so he could lower his posterior onto the seat without knocking over his Starbucks coffee. After the fact, he'd noted that no one else had brought any refreshments into the courtroom, so he'd guiltily stashed his coffee beside him on the bench.

He was sitting next to Alexis in the crowded spectators' section. He'd asked her why there were so many observers, but she'd told him she had no idea whatsoever. Almost all the spectator seats were taken.

The morning at the Bowman residence had gone better than Jack had imagined. Although Craig had flip-flopped to a degree from being conversational to brooding, they'd at least had a mutually honest talk, and Jack felt infinitely better being a guest in their home. After the girls had left

for school, there'd been more conversation, but then it was mostly between Alexis and Jack. Craig had reverted to his sullen, preoccupied state.

There'd been a long discussion about transportation to and from town, but ultimately Jack had firmly insisted he'd drive. He wanted to come to the courtroom to get a feel for the principals, particularly the lawyers, but then around midmorning, he wanted to drive to the Boston medical examiner's office, where he'd start his investigation about Massachusetts's rules regarding exhumation. After that, he didn't know what he'd do. He'd told them he might come back to the courtroom, but if he didn't, he'd meet them at the Newton house in the late afternoon.

As the court took its time getting ready to begin by handling the usual housekeeping motions, Jack studied the principal actors. The African-American judge looked like a former college football player gone to seed, yet the sense of authority he radiated through the confident deliberativeness with which he handled the paperwork on his desk and conversed sotto voce with his clerk gave Jack the reassuring feeling he knew what he was doing.

The two lawyers were exactly as Alexis had described. Randolph Bingham was the picture of the elegant, polished, big-firm attorney in the way he dressed, moved, and spoke. In sharp contrast, Tony Fasano was the brazen, flashy young lawyer who flaunted his trendy clothes and clunky gold accessories. Yet the characteristic of Tony that Jack noticed right off and which Alexis had not mentioned was that Tony appeared to be enjoying himself. Although the bereaved plaintiff sat rigidly, Tony and his assistant were carrying on an animated conversation with smiles and suppressed laughter, which was a far cry from the defense table, which sat in either frozen propriety or defiant despair.

Jack's eyes moved staccato down the line of jurors as they filed into the jury box. It was obviously a diverse group, which he thought appropriate. It struck him that if he ducked out of the court and strolled down the street, the first twelve people he'd confront would be an equivalent group.

While Jack was studying the jurors, Tony Fasano called the first witness of the day. It was Marlene Richardt, Craig's matronly secretary-cum-

receptionist, and she was duly sworn and seated in the witness box.

Jack turned his attention to the woman. To him, she looked like the strong-willed Frau that her German name suggested. She was of sizable proportions and built square, not too dissimilar from Tony. Her hair was up in a tight bun. Her mouth was set bulldog-style, and her eyes sparkled with defiance. It wasn't hard to sense she was a reluctant witness, whom Tony had the judge declare a hostile witness.

From the podium, Tony started out slowly, trying to joke with the woman, but he was unsuccessful, at least that's what Jack thought until he switched his attention to the jurors. In contrast to the witness, most of them smiled at Tony's attempts at humor. All at once, Jack could see what Alexis had implied, namely that Tony Fasano had a flair for connecting with the jury.

Jack had read Marlene's deposition, which had very little connection to the case, since the day of Patience Stanhope's demise she'd not been in contact with the patient, because the patient had not come into the office. The two times Craig had seen the patient had been at her home. So Jack was surprised that Tony was taking as long as he was with Marlene, painstakingly charting her association with Craig and her own troubled personal life. Since she and Craig had worked together for fifteen years, there was a lot to talk about.

Tony maintained his humorous style. Marlene ignored it at first, but after about an hour of what was starting to smack of a filibuster on Tony's part, she began to get angry, and as she did so she started to respond emotionally.

It was at that point that Jack correctly sensed that the jokey style was a deliberate ploy on Tony's part. Tony wanted her off-balance and angry. As if sensing something unexpected was coming, Randolph tried to object that the testimony was endless and immaterial. The judge seemed to agree, but after a short sidebar conversation, which Jack could not hear, the questioning resumed and quickly hit pay dirt for the plaintiff's cause.

"Your Honor, may I approach the witness?" Tony asked. He was holding a folder in the air.

"You may," Judge Davidson said.

Tony stepped up to the witness box and handed the folder to Marlene.

"Could you tell the jury what you are holding?"

"A patient file from the office."

"And whose file is it?"

"Patience Stanhope."

"Now there is a file number on the file."

"Of course there's a file number!" Marlene snapped. "How would we find it otherwise?"

"Could you read it aloud for the jury," Tony said, ignoring Marlene's mini-outburst.

"PP eight."

"Thank you," Tony said. He retrieved the file and returned to the podium.

Expectantly, several of the jurors leaned forward.

"Mrs. Richardt, would you explain to the jury what the initials PP stand for."

Like a cornered cat, Marlene's eyes darted around the room before settling for a moment on Craig.

"Mrs. Richardt," Tony prodded. "Hello! Anybody home?"

"They are letters," Marlene snapped.

"Well, thank you," Tony said sarcastically. "I believe most of the jurors recognized them as letters. What I'm asking is what they stand for. And

permit me to remind you that you are sworn, and giving false testimony is perjury, which carries a severe penalty."

Marlene's face, which had become progressively red during her testimony, got redder still. Even her cheeks swelled as if she were straining.

"If it will help you remember, later testimony will suggest that you and Dr.

Craig Bowman came up with this filing designation, which is not typical in your office. In fact, I have two other patient file numbers from your office."