THE SURGICAL SENIOR RESIDENTS' OFFICE WAS AN eight-foot square, windowless box that had once served the Suffolk State Hospital as a storage closet. To Andrew Truscott, occupying the office at all, let alone sharing it with two others, was an indignity quite in keeping with those he already had to endure for being associated with the Medical Center of Boston. This should have been his year. He should have been chief resident and after that a staff surgeon on a tenure track. There was no justification for the flake who had been chosen over him. At any normal hospital it just wouldn't have happened.
After a year of postgraduate medical training in western Australia, he had met and married an American tourist and elected to move to the States. He expected the research and practice opportunities for a surgeon-and the income-would be much greater there. The Medical Center of Boston was not his first choice for a residency, but he was not disappointed to accept Eli Blankenship's offer of a position. After all, he reasoned, it was still a Boston teaching hospital.
Three months into his first year of surgical training at MCB, Truscott began discreetly searching for vacancies in the residency programs at other hospitals. But the only available slots were at borderline facilities with even less prestige than MCB. So he stayed.
He detested Glenn Paris and the carnival-like atmosphere that surrounded the place. He disliked working at a hospital that so deemphasized clinical research that it was considered by many academicians to be something of a joke. And most of all, after investing five years of his life, he resented being passed over because he was, in the words of his department head, "too inflexible and intolerant." He was then informed that there was neither the money nor the research/office space to keep him on staff when his residency was over. Cut loose by Crunchy Granola General: the final ignominy.
Now Andrew Truscott sat in the tiny office, sipping orange juice from a Styrofoam cup and rereading a letter that had been routed to him by the head of the surgical service. Dated June 23, the letter was from the medical examiner's office in New York City. It was the department head's request that Andrew, as chairman of the surgical morbidity/mortality committee, look into the matter and recommend what departmental action, if any, was indicated.
DEAR DOCTOR:
First, let me apologize for the delay in getting this letter off to you. Budget cutbacks have hit our agency and greatly slowed the laboratory, cytologic, and clerical work necessary to complete a case. And unfortunately, our caseload continues to grow.
The case I write you about is a twenty-four-year-old woman, Constanza Hidalgo, who was killed when the car she was driving was struck by a bus in November of last year. The details surrounding this case, and the findings of my department, are presented in the enclosed documents. As you will note, the woman appears to have been in active labor at the time of her death. Our laboratory and microscopic studies also indicate that she was suffering from an acute hemorrhagic disorder, most likely disseminated intravascular coagulopathy.
A couple of months ago, one of my staff pathologists was attending a national meeting at which he heard another pathologist mention a case of fatal DIC complicating active labor. Quite incidentally, he returned to work and mentioned the case to me. The hospital at which that woman died was yours. I have been able to learn from contacting her family that Miss Hidalgo was also from Boston and was being followed in your outpatient department. Whether this is coincidence or not, I do not know.
Please use the enclosed information in any way you wish, and do keep me posted of any developments. Certainly DIC occurs in some pregnancies, but in my experience not without a very obvious cause.
Best regards,