Resulting in Death

by Lynn Fulton

Now more than ever seems it rich to die . . . 

Prologue 

One year—to the day—before Dr. Dolan called me, the body of Frederick Layton was floating face down, suspended halfway between the dimpled water’s surface and the tiled pool bottom at the Gold Mountain Athletic Club. I used to picture him bent slightly at the waist, arms held out in front of him as if to receive an embrace. His legs would hang behind, slightly apart, with knees bent and feet turned up, showing the creases in the thick white skin on his soles. His blonde hair would spread out in an aureole about his head, moving slightly with the languid motion of the water like kelp that spreads and floats on the surface of the sea.  

After Layton vs. Dolan was all over and the file was closed and sent off to storage, I used to think about fate, or the convergence of the twain, as Hardy put it. It made a nice conceit to imagine Layton floating there, while I sat with clammy palms in a stuffy room at Georgetown, defending my doctoral thesis on Keats and wholly unaware of a dead man I didn’t know three thousand miles away. And yet all the time there he was, my iceberg, waiting to be discovered and set in motion the whole deadly sequence of events . . . 

Chapter 1 

“So I’ve got this heart I can’t get out because it’s basically stuck down in bloody scar tissue,” said the surgeon, looking up from the thick medical chart on his desk. “I’ve also got this thin, flimsy aorta that’s calcified to boot. The stuff is like eggshell; you put a cross-clamp on the aorta sometimes, you can hear it go crunch. That’s the second problem. And then the third problem was I couldn’t cannulate that aorta; it would just tear apart like wet toilet paper, and then where would I be? So we had to go in through the femoral artery, which means you’ve got retrograde flow, which means if any of that calcified material does get into the bloodstream, it’ll just go right up to his brain. And maybe that’s what happened.”  

He meant maybe that was why the patient, a fifty-eight year-old advertising executive, ended up after open heart surgery with the mental capacity of a carrot: neligent aortic valve replacement, resulting in cerebrovascular accident/brain damage, was how I’d entered the allegation in the computer record. I took a half second to look up at him from my page of notes.  

“If I can get you to go back for a minute . . . I’m losing track of the first problem. The adhesions?”  

He leaned forward in his chair, making the springs squeak. He was a small man with fine-boned hands and narrow arms that seemed lost in the loose sleeves of his surgical scrubs. He held his hands together in front of him, cupped as if he were holding a heart there over the desk for me to see. 

“Well, that’s the other thing that could have happened. See, if I can’t mobilize the heart entirely—dissect it all the way out—then when we’re all done, I can’t do the usual air removal maneuvers. Usually, you tip it upside down, move it back and forth and make sure you’ve squeezed all the air out before you take him off bypass. But I couldn’t, because of those highly vascularized adhesions. I had a choice: do I risk letting him bleed to death on the table as I cut through all that mess? Or do I risk him getting an air embolism because I didn’t mobilize the heart?” He sighed. “It was a judgment call; maybe it was wrong. But unfortunately, medicine isn’t an exact science.”  

I nodded, writing furiously.  “How come you guys don’t use a tape recorder?” he asked. “That’s what my car insurance company does.”  

I smiled. “We like to do things the hard way. Can you explain to me what you did do to remove the air from the heart?” 

He could, and did. For weeks I couldn’t get out of my head the image of those small hands holding a heart, tipping and rocking it back and forth, squeezing out all the air. 

That was one kind of case I handled as a claims investigator for California Physician’s Mutual, premiere provider of malpractice insurance to doctors and hospitals all over the state. On the opposite end of the spectrum was a case like the one Dr. Rudy Amato had reported a few days before. He told me about a former patient who’d written him a letter saying she’d lost her job and started hearing voices because he’d had sex with her. Now, patients accuse their doctors of all kinds of crazy things, and most of them really are untrue. So when I asked Dr. Amato if there were any validity to these allegations of sexual misconduct, I used a somewhat bemused tone of voice, politely conveying to him that I was on his side and didn’t for a minute believe what the patient was saying. But there was only the merest pause before Dr. Amato answered: 

“Yup.”  

Shit, I thought, and said in my best insurance gal chirp, “Okay. Can you tell me the date when the relationship began?”  

Give me a good, meaty surgical case any day. 

A year before, California Physician’s had swooped down, like Superman, and rescued me from the abyss. I’d left Georgetown with a suitcase and a pile of student loan debt, and ended up in San Francisco, staying with friends while I pounded the pavement month after month, hoping prospective employers would overlook that disfiguring hump of a Ph.D. on my back. Because what I’d finally learned after six years of graduate school—and I’ll admit I’m a very slow learner—was that pursuing an academic career was probably the last thing I wanted to do with my life. So once my thesis was duly signed, bound in black, and sent to moulder in the basement of the library, it was time to leave.  

Going from doctoral defense to the defense of doctors, then, seemed like a real step in the right direction. My new employers promised to pay me every two weeks, give me health insurance, a retirement plan, vacation time, and—something I never could have gotten in academia—weekends off. At first I couldn’t believe my good fortune: not only had I escaped the hopeless grind of academia, but I had actually found an interesting job that paid well in a fun place to live. One year later, of course, the novelty had worn off, but the job still had its moments. On the day I interviewed the surgeon about the heart valve case, though, I had no idea how very interesting it was going to become.  

He was my last meeting in a long day of driving around talking to doctors, and it was deep twilight when I finally came out of the building that housed his office. I took a long breath of cool air and flexed my note-taking fingers while I headed across the parking lot towards my glamorous company car, a baby-blue Ford Tempo. The light in the sky had drained to a faint blue-green glow over the horizon: it was that time of day when all good citizens should be at home with their loved ones—in my case, a really comfy couch. Be patient, couch, I thought while I tossed my briefcase in the trunk; soon we will be together.  

Then I heard a ragged voice behind me. 

“Were you in to see the doctor?” A tall woman with hunched shoulders and long gray hair had appeared at my elbow. The skin on her face hung like the mantle of melted wax on a candle; purple shadows pooled under her eyes and her lower lip drooped like a sullen child’s. She wore a dirty pink quilted coat with a flowered skirt peeking out from underneath it, and her legs were bare to the shins, which disappered into red socks and what I realized after a half second were not shoes, but a man’s leather slippers. Maybe that explained why I hadn’t heard her come up behind me—  

“Did you go see the doctor?” she demanded again. “You don’t look like you’ve been to the doctor.” 

She leaned forward and peered into my face; her breath smelled sour. I couldn’t help moving back, but I tried to remain polite. “No, I haven’t seen the doctor.” I turned toward the car, hoping to get away, but she moved with me. 

“I thought so.” There was an unpleasant satisfaction in her voice. “I knew you weren’t sick enough; not yet anyway. But you will be.” She grabbed the sleeve of my coat. “And then you need to watch out, be careful because he’s always watching, looking out for his chance, because I didn’t give it to him, and now he’s mad—he’ll get me for that, he said he’d get me for that—” 

“Excuse me!” I pulled my arm away with a jerk and twisted around her to put my key in the lock. Jeez, I thought, why me? I ducked into the car and pulled the door shut while she just stood there, seeming astonished at my effrontery. Then when I started the engine she leaned close to the window and put her hand against it, pressing hard so that her palm was white and bloodless against the glass. 

“I’m telling you, he’ll get me for it; he’ll get you too! You watch out. You just watch out, Miss!”  

“Go away!” I shouted back at her through the glass while I revved the engine. She opened her mouth very wide and laughed, letting her tongue rise up over her lip.  

“You won’t give him much trouble! He won’t have any trouble with you!”  

Then she frowned at me with a look of contempt, shaking her head slowly; I could only stare back at her. Finally she turned and edged away between the parked cars, still shaking her head and muttering. I let out my breath while I put the Tempo in reverse. Cripes, I thought, remembering Dr. Amato and his lover who heard voices.  

Where do all the poor crazy ladies come from?

Chapter 2 

That was on Friday.  

On that Sunday night, before the Monday when Dr. Dolan called me at work, Trace called me at home, just when I was starting to think about getting to bed, which meant it was really late back East. Trace has always kept late hours, though, but not because he’s a partying kind of guy: he just worries too much. He worries about where he’s going in life, and he worries about me, and he worries about us, too, I guess. I, of course, had been trying to avoid the whole question of whether there was an “us” to worry about ever since I left Georgetown. But we’d remained friends, and it wasn’t unusual for him to call, full of worries, on Sunday nights, when the only thing I had to worry about was whether or not I had something clean to wear on Monday morning. I no longer spent my weekends grading papers, planning lessons, revising chapters—or feeling guilty about not working—so whenever he called steeped in those Sunday night blues, I suppose I couldn’t help rubbing it in a little. 

“Did you have a fun weekend?” I’d ask. 

“Well, I guess so,” he’d say. “I frittered most of it away. I’ve been trying to prep for my discussion section tonight; that’s the one thing I absolutely have to get done. How about you?” 

“Oh,” I’d say, “I really wanted to finish reading the Sunday paper, but it’s just about bedtime and I haven’t even cracked the magazines yet, so I might have to save them for tomorrow night.”  

Then he’d sigh and say “Must be nice, Petra,” as if I’d done some really unethical thing in order to lead a life of sinful leisure.  

On this particular Sunday, the Modern Language Association job list had just come out, and he was trying to lure me back into the academic fold. 

“Here’s one, Petra. They need a generalist at Grinnell; emphasis on undergraduate teaching ” 

“Trace, I don’t want to go to Iowa.” 

“It’s a one-year contract to start, but it could lead to a permanent position.” 

“Great; then I could be permanently in Iowa. You apply for it, Trace, and if you get it, I promise to come visit you, but I think I’m set here in S.F. for now.” 

“I know; I just thought I’d tell you what’s out there. And speaking of visiting . . . Do you have room for me next month? Did I tell you M.L.A. is in San Francisco this year?”  

He had in fact told me awhile ago, but I hadn’t chosen to hear him because I thought I was on the verge of getting involved with someone and didn’t want to promise Trace a place to stay for the convention. But the involvement I’d hoped for never materialized—it finally turned out the guy was probably the last one out of the closet in all of San Francisco. We stayed friends, though—in fact, I happened to introduce him to his current boyfriend. Story of my life, I thought at the time. But the upshot was that now I had no objection to Trace staying with me during the convention, which is essentially a huge job fair for college teaching positions. The experience is grueling if you have interviews, and depressing if you don’t, so I figured either way, he would need a friend. And personally, I thought it might do him a world of good if the friend—that is, me—were someone who’d discovered life outside of academia. 

“Sure you can stay with me,” I said. “I’d love to have you out here; it’d be fun.” And I meant it: there were times, in fact, when I missed him a lot. In San Francisco people were such connoisseurs of worldly pleasure that I’d actually begun to long for the asceticism I used to laugh at in Trace. He’d grown up as a faculty brat at Cornell and had always been much more at home in the academic world than I. While I daydreamed during those interminable evening seminars, telling myself stories about my classmates or making up a history for the professor’s moth-eaten sweater, Trace would actually take part in the discussion, sometimes even interrupting and raising his voice in intellectual passion. And it was passion—that was what made him different from everyone else I knew at Georgetown. He had no thought of impressing anyone; if he used “hegemony” in a sentence, it was because he honestly felt no other word would do.  

On this Sunday night, then, he went on to tell me he’d submitted a paper for the convention, and I told him I’d find a way to be there if it was accepted. Then he talked some more about how his research was going, and a new tack he was starting to develop that could lead to the next big project after his dissertation. He was pretty excited about it, and as he talked I started feeling wistful for the intellectual life. I could picture him on the phone in the tiny kitchen of the basement apartment we used to share: he would lean his long body over the counter, sometimes even putting a foot up on the edge while he talked, and then he’d become all elbows and knees, like a big bug.  

Unlike him, I was talking on the phone stretched out on my bed, where I’d been reading a mindless paperback mystery before going to sleep. It was a real bed with an expensive cushy mattress—I’d bought it just a few months ago when I suddenly realized I was making enough money that I didn’t have to sleep on a damn futon anymore. But that night while I was talking to Trace, all at once my nice soft bed, my mindless paperback, and the airy apartment I had all to myself seemed like gains ill-gotten from the prostitution of my intellect. I basically went from feeling smug about having escaped the anguish Trace was still going through, to feeling sorry for myself because my brain was going to mush in the service of the insurance industry. And after I got off the phone, I simply couldn’t shake the feeling that I was just plain bored with my job. Sure, it’s an interesting job as jobs go—but it’s still just a job, with phones to answer, in-stacks to clear, letters to write, and forms to fill out. Plus, there’s no way to escape the fact that you work in insurance, which I always thought was a scam. And finally, I had a tough boss, who was afraid too much positive feedback would go to my head.  

All these things, combined with some deceptively rose-colored memories of my student days, and the fact that I am just an ungrateful and dissatisfied person by nature, meant that when I got to work on Monday morning, I was in a thorough funk and did not expect to be amused or interested by anything that could happen there. 

Which just shows to go you. Because that was the day Dr. Dolan called and told me about the floating lawyer. 

After talking to Trace that night I’d fallen asleep over my paperback mystery, which chronicled the adventures of a tough but sensitive ex-policewoman private eye who moved at ease through the seamy underworld of L.A. As I walked down 19th Avenue to my Muni stop the next morning, I thought idly about how ill-equipped I was to be the heroine of a mystery. No violent circumstances clouded my past: I had never witnessed the murder of any friends or relations; I did not hang out with cheerful prostitutes; I was not on a first-name basis with ruthless mobsters. I was never on a police force, had never been in jail, and didn’t even know anyone who had. Except for my cousin Ralph, who was once caught pissing on a city councilman’s lawn after a party and had to spend the night in the tank—I don’t think that counts.  

And my biggest disqualification, I told myself as I got off the bus with everyone else on the other side of town, was that I earned a regular paycheck and worked—when I wasn’t out interviewing doctors—in an office. Another day, another dollar. I went through the revolving doors at 545 Sansome and took the elevator to the thirteenth floor.  

Monday morning began with a meeting, which didn’t improve my mood; sitting through meetings was another thing detectives in books never had to do. Actually there were two meetings. The first was one of the all-employee assemblies that had been started by the new CEO to facilitate cross-departmental communication. That’s how he talked; my buddy Angie and I sat in the back and tried to play buzzword bingo. We had compiled a list—evolving, pro-active, dynamic, paradigm—but our squat, red-faced leader was off form and didn’t say any of our words.  

Then we had the claims department meeting. This was a little less deadly, as a note of levity was injected by Russ Scanlon, a regional manager who’d been appointed our Fraud Prevention Coordinator after Cal-Phys got in trouble with the state for not reporting enough suspected insurance fraud. The fact that there is essentially no such thing in the field of professional liability did not deter the earnest fraudbusters of the Department of Insurance, who insisted that we start an anti-fraud program with quarterly “fraud education” meetings. So four times a year, Russ donned a gold star he’d gotten out of a cereal box and told us some irrelevant but amusing story about fraudulent schemes carried out against auto, worker’s comp, and homeowner’s carriers. This would kill fifteen or twenty minutes pleasantly enough and provide a relief from the usual topics of runaway defense costs, pesky coverage questions, and the impending overhaul of our outdated computer system. But the problem with meetings, I’ve always found, is that no matter how boring they are, eventually they end and you have to go back to work, which is worse. On the way out I was grabbing another donut to console myself when Angie paused next to me and asked, “What did Sherry say about Dr. Amato?”  

“I haven’t had a chance to tell her yet,” I said. “I’m sure she’ll tell me what I should have told him and how I ought to handle it next time.”  

“She’ll tell Dr. Amato how to handle it next time, that’s for sure!” she said.  

Back in my cube, I shuffled some papers and started to write a brief preliminary report on the Dr. Amato business. For awhile I mused about just how to put this episode into staid business language. The patient’s name was Cathy Mendel; date of birth, 5/16/46; occupation, none known, though apparently she’d mentioned to Dr. Amato something about losing her job. Allegation: Sexual misconduct resulting in emotional distress and economic damages. Have sex would have to become initiate a sexual relationship—except he said she started it. And Dr. Amato, naturally, did not simply say yup, but answered in the affirmative.  I was just beginning to notice how some of the allegation codes were taking on a whole new meaning—like #0325, Early Discharge, or #0489, Negligent Positioning—when my phone rang.  

“Petra, I have Dr. Dolan on the line for you,” said Tricia. 

“Okay, thanks.” I wondered what he could be calling about. We’d settled a nuisance thing for him about six months ago: he’d recently lost his wife to breast cancer and didn’t want to deal with a lawsuit. He and I had struck up a kind of rapport when I went out to talk to him about the case, and he even sent me a nice note when the whole thing was over. Doctors generally never do this.  

“Hi, Dr. Dolan,” I said now. “How are you? I haven’t heard from you for awhile.” “I’m fine, Petra, thanks. At least, I was fine until this morning.” 

“Uh-oh.” I reached for a new incident form. “What happened this morning?” 

“I’m afraid I was served with a subpoena,” he said apologetically.  

“I’m sorry to hear that.” Usually when I say that I mean I’m sorry the doctor is calling up to add to my caseload, but I really was sorry for Dr. Dolan. He’d cut back his practice right after the last case and was getting ready to retire. From what he told me, he just wanted to relax, spend time with his grandkids, and mourn for his wife. He didn’t need a new lawsuit to deal with. And I really felt he was a good doctor who cared a lot about his patients; he was just a little old-fashioned and too trusting, which meant he didn’t always document things as carefully as he should.  

“The background on this is a little unusual,” he began. “The patient was a pretty well-known attorney out here. His wife is the district attorney, Alice Layton; you may have heard of her . . .” 

“No, but that doesn’t mean anything. You said was—is the patient deceased?’ 

“Yes; he died young. Late forties, forty-eight maybe. I can’t remember now.”  

“And what happened to him?”  

“Well,” Dr. Dolan said, “That’s what I’m not so sure of. He died last year in the pool at his athletic club, and I guess the coroner felt it was sudden cardiac death. It made a bit of a stir at the time; in the middle of Alice’s campaign and all.” He cleared his throat. “Anyway, he’d been a patient of mine for many years, and he’d had a fainting spell about two years before he died. I got him a cardiac workup then, and it turned out he did have mitral valve prolapse, and some isolated arrhythmias on the EKG, but nothing much. I recommended he take beta blockers, but he quit after a couple of months. He said they interfered with his ability to work out, and decreased his sex drive, that kind of thing.” 

“Did you counsel him about staying on them?” I asked, thinking pessimistically that if he had, he probably hadn’t written it down. 

“I did, but I didn’t push him. I figured, he’s an intelligent person; he can make his own decisions. And I didn’t really feel he had a serious heart problem. Because—here’s where it gets sticky—I thought I knew the underlying cause for that fainting spell, and maybe the arrhythmias too. When he told me he wanted to quit the beta blockers, he also told me that the night before his collapse, he’d been partying and taking cocaine.” 

“Aha,” I said. 

“Right. I mean, apparently he did this pretty frequently, so naturally I figured that was the contributing factor. And he’d always been such an athletic guy, too, running and swimming and playing tennis and all, and he’d never had any problems before. So I just let it go. The problem is, because it was kind of a sensitive issue, I didn’t document it in my records.”  

“The fact that he told you he was using cocaine, you mean?” I was beginning to see why he thought the case was unusual. 

“Right.” He sighed. “Of course, now I really wish I had. But I guess, with his wife being district attorney, I just didn’t want to put something so potentially inflammatory in my records. I also knew his firm did a lot of defense work for you folks; I guess I just didn’t want to rock any boats.” 

Defense work for Cal-Phys? I’d never heard the patient’s name before, so I asked which firm he was with.  

“Hulburt, Meyer & Ryan.” Indeed, I thought. They get a good number of our cases in C.C. County. “Joe Ryan was my attorney on the last case,” Dr. Dolan went on, “And he and I work well together, but . . .” 

“No, I don’t think we want to give this one to Ryan. We’ll have one of the San Francisco firms handle it.”  

“That’s probably a good idea. Fred was pretty well-known out here; I wouldn’t want anything about this to get into the papers.” 

“Of course not.” While we were talking, I was scrolling through his old files on the computer screen: Jones vs. Dolan, Cray vs. Dolan, Fiorella vs. Dolan, and so on back to Leveridge vs. Dolan in 1979. It was a fairly typical claims history for any doc who’s been practicing that long. The majority of these were cases he’d reported on a precautionary basis—less than optimal outcomes, patients who failed to pay their bills—and were never litigated, though one or two had gone to trial or been settled.  

“I can’t think why Alice is doing this,” Dr. Dolan said finally. He’d been pretty matter-of-fact up to this point, but now the distress of being sued was starting to hit him. “We were all shocked by Fred’s death, but God knows, it was one of those terrible tragedies that just happen sometimes. And I know what people say about lawyers, but . . .” 

“I’m getting the idea you were socially acquainted with the patient.”  

“Yes; ‘socially acquainted’ is about right. We’d see each other now and then at the same functions, fundraisers and so on. And I never heard any rumors about him using cocaine. I got the feeling he quit using it after that time he told me about.” 

“Do you know if his wife knew about this . . . habit of his?”  

“I have no idea; we never really discussed it, of course.” Of course, I thought. Stupid question—I was getting too interested in the scandalous side of the case. That was always my problem in the job: I never found the intricacies of the medicine as compelling as the stories behind the records. Well, I thought, maybe this is one case where my prurient interest will actually be an advantage. But for the moment I forced myself back to the boring details, and asked him for the filing date and docket number on his subpoena. 

Later I knocked on the door of Sherry’s office and put my ear close to the wood to listen for her impatient “Yes?” Most of the other supervisors never keep their doors closed unless they’re doing something that really can’t be interrupted, like chewing out an investigator or changing into their workout clothes, but Sherry, as I’d learned early on, was a little different. 

“Hi, Sherry,” I said as I opened the door. “Do you have a minute?” 

“Of course,” she said without looking up.  

“I got kind of a weird case in this morning; I wanted to ask you about the referral.” I gave her a quick sketch of what Dr. Dolan had told me. She didn’t appear all that interested, and only made a snorting noise when I told her the decedent had been a partner at Hulburt, Meyer & Ryan. 

“Give him to Sevrenson,” she said, and started to turn back to her computer. “Okay; there was one other thing I thought you should know about. I got a call from a Dr. Rudy Amato on Thursday—” 

“Oh no.” She turned around again and frowned at me, making the skin pull taut at the corners of her mouth. “Not Dr. Rudy Amato. Didn’t we cancel him?” 

“Doesn’t look like it; I checked.”  

“Damn.” She relaxed a little, and flashed me what passed, for her, as a wry smile. “I should have known that would be too good to be true. Well, what’s Dr. Amato been up to now?” 

“Fornication, apparently. It seems he had an affair with a patient.” I told her what else he’d told me. 

“At least he admitted it this time.” She pushed her thin blonde hair behind her ears and scowled down at her desk. “Send him a letter that quotes all the exclusions: defense only, no indemnity, blah blah blah. Let me see it before you send it.” 

“I take it he’s been in this kind of trouble before?”  

“Various kinds. Not this exactly. Dr. Rudy is just a scumbag, that’s all there is to it.” She turned back to her computer as I was leaving. “Tell Angie to come by when she gets the chance, will you?” 

I nodded, closing the door behind me, and went back to my cube, where I finished entering Dr. Dolan’s new claim into the database:  Negligent failure to treat mitral valve prolapse, resulting in death.  

End of sample

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