Jack bit his tongue to keep from making an appropriate comment about the difference between someone’s life and someone’s stats. Instead, he said, “I thought you might be interested to hear that the heart looked fantastic. It was situated perfectly, and all the anastomoses were completely healed and fully patent. But I do have a question: I have been told it was a targeted donation. How common is that?”
“It’s not common with the heart,” Chris said. “Kidney and liver, yes, but heart, no. Yet it does happen.”
“How was it that it happened in this case?” Jack asked. He decided to go for broke.
“To tell you the truth, I don’t know the details,” Chris said. “The patient and the heart came in together. I was just the plumber and hooked the thing up. It was a perfect donor heart and a good match, or so we were told. All the preparation in terms of matching and physiological testing was done at a sister institution.”
“Any idea of where the heart came from?” Jack asked.
“I was told by the surgeon who came in with the heart, who happens to be a friend, that a motorcyclist with severe head trauma had arrived in the hospital’s emergency room the same day the patient presented in cardiac extremis. Obviously, serendipity played a major role, because apart from the coincidental timing, both patients had the rare blood type of AB-negative.”
“That is serendipitous,” Jack agreed. “So this targeted donation occurred outside of UNOS.”
“Of course,” Chris said. “That’s what a targeted donation is. It’s from one person to another person. I don’t know for sure, but I would imagine the families knew each other, or if they didn’t, they do now. It was a gracious thing for the grieving family to do. A life was lost, but a life was saved. Well, at least for a few months.”
“How does UNOS feel about such an arrangement?” Jack asked. Despite what he was hearing, his intuition was still ringing alarm bells. He couldn’t help but feel there was something decidedly improper about this story. It was too coincidental, too pat. Besides, AmeriCare was somehow complicit.
“In this particular situation, UNOS had no jurisdiction,” Chris explained. “But in all fairness, I was also told that the patient had been on UNOS’s waiting list for a heart for over a year. AB-negative hearts are rarer than hen’s teeth.” He chuckled at his own joke.
“What about the other HLA antigens that should match between a donor organ and the recipient?” Jack questioned. “Were they a good match in this case?”
“Very good,” Chris said. “I was told all twelve human leukocyte antigens matched, which is rare. I suppose that is why the patient did so well post-op. She was air-lifted out of here the day she got out of the cardiac surgery recovery room to continue her recovery at our sister institution. I couldn’t have been more pleased with her course. I felt like a million bucks.”
I’m sure you did,Jack thought but didn’t say. Instead, he said, “Our Toxicology Department determined on a screen that the patient had no immunosuppressants on board. Does that surprise you?”
“It more than surprises me,” Chris said. “In medicine, when you get an unexpected lab result, you do it again. I’d advise you to have your toxicologists do it a second time. The patient had to have immunosuppressants in her system. I know for certain, because we started them in surgery, kept them up while she was in the cardiac surgery recovery room, and sent them with her as part of her discharge packet.”
Although Jack had more questions for the surgeon, another knock on the open office door caught his attention. Turning in its direction by reflex, he was in for a big shock. In walked the embodiment of everything Jack hated about AmeriCare, Charles Kelley, the hospital CEO and president. When Jack had entered medicine the previous century, the heads of hospitals were called administrators and were often doctors whohad been willing to take MBA courses. The benefit was that the hospital continued to be oriented around their original, basic altruistic function of taking care of the sick. Now, at MGH, the chief was not a doctor but rather a trained businessman. It had been a necessary transition, because the main goal had changed from patient care to providing a handsome return on investment for faceless investors.
Charles Kelley was a striking figure. At six-eight, he towered over most everyone. Sandy-haired, continually tanned, impeccably dressed in silk suits, and commanding a multimillion-dollar salary, he seemed to have come directly from central casting. “Well, well,” he said in a condescendingly acerbic tone, “if it isn’t our favorite medical examiner.”
Biting back equivalent sarcasm, Jack struggled to control himself. Previously, when he had first investigated and eventually outed the MGH microbiology terrorist who had been trying to start the epidemic for his advertising executive sister’s benefit, Jack had had multiple run-ins with Charles. Charles had seen Jack as trouble from the wordgoand made significant attempts to have him fired. As Charles was politically connected, with close personal and professional ties to the mayor, he nearly succeeded. And now, since he was just as close with the new mayor and for the same reason—namely, significant campaign contributions—Jack knew he was on very thin ice. It was Laurie who would be in the crosshairs now.
“I’ve heard you’re here to bring us bad news,” Charles continued.
“As a city employee I’m always striving to be of service,” Jack said, and then inwardly lambasted himself for being unnecessarily provocative with such obvious sarcasm.
“I’ve got to do afternoon rounds,” Chris said, interrupting the exchange between Jack and Charles. “So I’ll be running along. Thanks for the info.” He touched his forehead in a kind of half-assed salute. Jack watched him go with regret. He would have liked to ask more questions.
As Chris departed, Katherine spoke up: “It has been confirmed witha photograph that Dr. Stapleton brought that the person he autopsied is the individual we operated on for the Dover Valley Hospital.”
“That’s unfortunate,” Charles commented. He stared daggers at Jack. “You certainly are a conveyer of distressing news. Tell me, do you rub everyone you meet the wrong way?”
“Just those people I don’t respect,” Jack said, and inwardly groaned at his lack of self-control. He was hopeless.
“I’ll pretend I didn’t hear that,” Charles said. “Let’s cut to the chase. I understand that you’re looking to identify this unfortunate individual.”
“It could be critical if it is determined she died of a potentially contagious disease,” Jack said, hoping to move away from ad hominem retorts.
“I have spoken with our counsel. We cannot give you any medical details of our service without a proper subpoena. What I am willing to give you is her name.”
“That’s a start,” Jack said. “I don’t think details of her recent surgery will be critical. The name and permanent address and anything else you have will suffice for now.”
“We don’t have the permanent address,” Charles admitted.
“Then the billing information will be adequate,” Jack said.
“We don’t have any billing information,” Charles said. “The entire admission, including the surgery, was completely covered by our sister hospital, Dover Valley Hospital, whose heart center is associated with our heart center. It was their show. We were just being supportive to save a life.”
