"Is there some reason you should know?" Cynthia questioned, with an edge to her voice.
"Well, no, I suppose not," Loraine responded. She switched her attention to the other woman, whose nametag read: Mrs. Fran Gonzales, OR Supervisor. "Fran, I have a guest here who wanted to take a peek at our OR." Loraine motioned for Laurie to step up to the counter, and Loraine introduced her as a New York City medical examiner.
Before Fran could respond, Cynthia's head popped back up. She'd returned to studying the OR scheduling log, which she and Fran had been busily doing before Laurie and Loraine had appeared. "You are a medical examiner?" she questioned, with even more edge to her voice than when she'd spoken with Loraine.
"I am," Laurie confirmed.
"What the hell are you doing here?"
"I'm ah…" Laurie began, but hesitated. She was taken aback by Cynthia's tone and challenging glare. Laurie couldn't help but remember Arnold's description of the woman as not being terribly cooperative, as well as defensive, and essentially telling him to butt out. The last thing Laurie wanted was some sort of a confrontation, knowing she was, to a certain extent, overstepping her bounds by making the site visit. Steve Mariott, the evening PA, had visited the hospital the night before, after Jeffries's death had been called into the OCME.
"Well?" Cynthia questioned impatiently.
"I autopsied a case this morning of a patient who'd been operated on yesterday here at Angels Orthopedic Hospital and who had died of an exceptionally aggressive MRSA infection."
"We are well aware of that, thank you very much," Cynthia snapped.
Laurie glanced briefly at Loraine, who appeared as surprised as Laurie. "When I canvassed my colleagues, I discovered you'd had a number of similar cases. I thought it was appropriate to come over here, and see if I could help."
Cynthia laughed cynically. "And just how did you think you could help? Have you been trained in epidemiology, infection control, or even in infectious diseases?"
"My training is in forensic pathology," Laurie said defensively. "My exposure to epidemiology has not been extensive, but my understanding is that in an outbreak of this sort, one of the first things that should be done is to accurately subtype the organisms."
"I'm board-certified in internal medicine with a subspecialty in infectious diseases and have a Ph.D. in epidemiology. As far as your comment about subtyping, you are correct but only if such information is needed to decide on a targeted method of control. In our situation, it wasn't needed, since our CEO insisted that we use a global control strategy. Our interest was not in saving money by restricting ourselves to a target approach. I spoke with one of your colleagues a number of weeks ago after he'd autopsied one of our MRSA cases. I assured him we were well aware of the problem and aggressively engaged in solving it, and thanked him for the call."
"That's all well and good," Laurie said, with her own dander rising. "Having had the dubious honor to autopsy the unfortunate individual this morning, I can say with some conviction that you have been unsuccessful in your control efforts."
"That might be the case, but we surely don't need interference. Your job is to tell us cause of death and anything else we might not know pathologically. The fact of the matter is that we are well aware of both the cause and mechanism of death, and we are doing everything humanly possible to control this unfortunate outbreak. What is it you wish to accomplish by visiting the operating room? What do you want to see?"
"To be totally honest, I don't know," Laurie said. "But I can assure you that there have been thousands of times that site visits have either helped or been crucial in a forensic investigation. Mr. Jeffries is officially a medical examiner's case, and I am duty-bound to investigate it fully, which in this case means viewing the scene of his proximate cause of death. Odds are, he was exposed to the bacteria that led to his demise in the operating room where he'd had his surgery."
"We'll see about that," Cynthia said, getting to her feet. "I'll have you talk with someone with considerably more authority than I. I insist you wait outside in the surgical lounge. I will be right back."
Without another word or even a glance over her shoulder, Cynthia walked quickly to the double doors and departed.
Laurie and Loraine exchanged another surprised and confused glance.
"I'm sorry," Loraine said. "I don't know what's come over her."
"It's certainly not your fault."
"She is under a lot of pressure," Fran, the OR supervisor, said. "She's been intense from the first, and it's only gotten worse. She's taking the whole problem very personally, so try not to do so yourself, Dr. Montgomery. She's even been at my throat on occasion."
"Who is she going to fetch?" Loraine questioned. "Mr. Straus, the hospital president?"
"I have no idea," Fran said.
"Let's go back to the lounge," Loraine suggested to Laurie.
"I think that might be a good idea," Laurie said. She felt anxious from an adrenaline surge engendered by the unexpected confrontation and its potential consequences.
As they walked, Loraine added, "Dr. Sarpoulus has always been uptight, as Fran suggested. Are you sure you want to stay? She was very rude."
"I'll stay," Laurie said, with some misgivings. What motivated her was the hope of being able to smooth things over with someone more rational than Cynthia Sarpoulus. Leaving on an unpleasant note certainly would not be helpful if she had additional questions, and there might even be a complaint made about her visit. Laurie specifically wanted to avoid such a possibility.
Back in the surgical lounge, Laurie accepted some coffee and crackers from Loraine. As busy as she'd been, she'd skipped lunch and was famished.
"So it was the CEO's decision not to characterize more fully the staph strains involved in the outbreak?"
"I guess," Loraine said. "I thought it had been Cynthia's decision, but I guess not."
Laurie had more questions, but her thoughts were interrupted by Cynthia's reappearance. By her expression, her mood had not mollified. Her sharply defined, full lips were pressed firmly together, and she walked with obvious determination. Behind her came a man and a woman. The woman was of medium height, with blemish-free pale skin, aristocratic features, and a helmet of short, thick hair. She was dressed in an elegant business suit and walked with a decidedly commanding resoluteness while still managing to exude classic femininity.
The man was her antithesis, not only in gender but in his general appearance and the way he moved. He wore a rumpled plaid wool jacket with leather elbows, the kind that Laurie had always associated with academia. Instead of resoluteness, he projected an air of wariness, with his pale eyes constantly on the move as if he were in a potentially hostile environment.
"Dr. Montgomery," Cynthia said triumphantly. "May I present Dr. Angela Dawson, the CEO of Angels Healthcare, and Dr. Walter Osgood, department head of clinical pathology. I believe you should direct your comments to them."
"What seems to be the trouble?" Angela demanded. From her tone, it was obvious Laurie's presence was not to her liking.
"I'm afraid I have no idea," Laurie said, as she got to her feet. Since they were nearly the same height, she and Angela literally saw eye to eye.
Loraine scrambled to her feet. "If there is any fault concerning Dr. Montgomery's presence, surely it is mine," she said. "Dr. Montgomery called me after she had autopsied Mr. David Jeffries. She asked to come to the hospital for a visit as part of her investigation. I invited her. She only asked to see our OR HVAC system in the engineering spaces, a typical patient room, and the OR itself. I didn't see any problem in that. I suppose I should have run it by Mr. Straus beforehand."