Foreign Body (41 page)

"It's Sachin," an equally gruff voice responded.

"Ah, yes, Mr. Gupta," Cal said with a more businesslike tone.

"You called last night."

"I did. We have another job. Are you available?"

"It depends on the job and on the compensation."

"The compensation will be more than the last time."

"Give me an idea of the scope of the job."

"It's an American. A young woman. We'd like to entertain her here for perhaps twenty-four hours, and then we would like her to leave."

"For good?"

"Yes, for good."

"Do you know where she is, or is that part of the job?"

"We know where she is."

"It will be double last time's charge."

"How about one and a half times?" Cal suggested. Even though he didn't care about the cost, he had an irrepressible urge to bargain.

"Double," Sachin said.

"Alright, double," Cal responded. He wanted to get out for his run. "But I want it to happen today, if possible."

"I'll be by for half the compensation now and for the rest tonight."

"I'm going out for a run. Give me a half-hour."

"What is the name, and where do I find her?"

"Her name is Jennifer Hernandez, and she's staying at the Amal Palace Hotel. Is that a problem?"

"No. It shouldn't be. We have friends who work in maintenance. We'll let you know. I'll give you a call before we bring your guest over for her visit."

"It's nice doing business with you."

"Likewise," Sachin said before disconnecting.

"That was easy," Cal said to himself, hanging up the receiver.

"of coursee I can see them," Jack said. He was bending over Laurie, who was semi-recumbent on the examination table. Dr. Arun Ram was standing between her legs, which were draped with an examination sheet, directing the ultrasound probe with one hand and pointing at the screen with the other. He was a short man with honey-colored skin and remarkably dark, thick, medium-length, carefully groomed hair. He was also young: Jack guessed early thirties. What Jack noticed most was the singular gentleness and serenity he projected.

"I'm amazed I can see them so well," Jack added with excitement. "Laurie, can you see them?"

"If you stop hogging the screen I can."

"Oh, sorry," Jack said. He backed up a foot or so. Using his index finger, he counted four in the left ovary alone.

"It's a wonderful crop," Arun agreed. His voice matched his composure.

"How much longer with the injections?" Jack asked.

"Let's measure," Arun said. Then, to Jack, he added, "Could you hold the probe while I get a ruler?"

"I guess," Jack said, not sure he wanted to play doctor with his own wife. But he took the handoff of the probe from Arun, and he took it blindly. The image rapidly distorted.

"Careful!" Laurie complained.

"Sorry," Jack said contritely. Watching the screen, he managed to reposition the probe where it had been. He felt nervous.

Arun opened the exam-table drawer and pulled out a ruler. Placing it directly on the screen, he read out the diameters of the follicles: "Seventeen millimeters, eighteen millimeters, sixteen millimeters, and seventeen millimeters. That's terrific!" He put the ruler away. "I think we can substitute the gonadotropin trigger injection for your injection shot today." He took the probe from Jack and removed it. He gave Laurie a reassuring pat on the top of her knee. "We're done. You can get up, and we'll meet in my office." He waved for Jack to follow.

"The trigger will be today?" Laurie asked. "I'm thrilled."

"We don't need for them to be much bigger than they are," Arun said from the doorway, gesturing for Jack to precede him. Inside his office, he moved a couple of chairs over to his desk. Jack took one. Arun sat down and recorded his finds in the chart he'd started for Laurie. "This looks like a very auspicious cycle, with four such healthy-looking follicles poised over the functioning oviduct. Dr. Schoener will be pleased. If the trigger shot is done today, which I'm going to recommend, then the fertilization should be tomorrow. Are we going to utilize intrauterine insemination, or what is your preference?"

"I think we should wait for Laurie," Jack said.

"Fine," Arun commented, finishing up and tossing the chart aside. "Did your wife happen to mention that there was a time I aspired to be a forensic pathologist here in India?"

"I don't believe she did."

"It's not important. The reason I didn't is because the facilities for forensic pathology have been traditionally very bad, for bureaucratic reasons."

"I notice even a hospital like this one lacks any mortuary facility."

"That's true," Arun said. "There's little need. Hindu and Muslim families claim their departed immediately for religious reasons."

"Here I am," Laurie said brightly, coming into the room. "I'm so excited about reaching the trigger injection. I can't tell you how much I hate taking hormones."

"I asked your husband about IUI," Arun said to Laurie. "He wanted to wait for you."

Laurie glanced at Jack. "Why did you want to wait for me?"

Jack shrugged. "He asked what our preference was."

"Well, natural is much nicer. There's no doubt. But intrauterine gets all those little guys where they need to be. With this much effort, we cannot take any chances. I'm afraid we have to do IUI."

"Fine," Jack said, waving his hands in the air.

"Then let's make an appointment for tomorrow. How about around noon?"

Laurie and Jack looked at each other and nodded. "That's fine," Laurie said.

"Noon it is," Arun said. "We'll do all we can to see that your little one is conceived here in India. Now that that is out of the way, what is your business here at Queen Victoria Hospital? Is it something I can help you with? I am free. Today is my research day."

"Do you have any friends who are forensic pathologists?" Laurie asked.

"I do. A very good friend, in fact: Dr. Vijay Singh. He and I have been friends since childhood. We both wanted to go into forensics. He actually did. He teaches at one of the private medical colleges here in New Delhi."

"Do they have pathology facilities at this medical school?" Jack asked. He was encouraged.

"Absolutely. It's a medical school and a small hospital."

"How about autopsy facilities?" Laurie asked.

"Of course. As I said, it is a medical school. They do quite a few academic autopsies."

Jack and Laurie regarded each other, then both nodded. They knew each other well enough that a significant amount of nonverbal communication occurred between them.

"Arun-do you mind if we call you Arun?" Jack asked.

"I prefer it," Arun said.

"Do you think your friend Vijay might be willing to allow us to use his facilities? We'd like to do an autopsy."

"You have to have permission to do an autopsy here in India."

"This is a special case," Jack said. "It is not an Indian but rather an American, and the immediate next of kin is here and gives her consent."

"That is a unique request," Arun said. "To be honest, I don't know the legal situation."

"Doing the autopsy, we believe, is very important."

"It could put a halt to a possible serial killer," Laurie said. "What we are concerned about is the existence of an Indian angel-of-death healthcare worker flying under the radar here in Delhi, targeting American medical tourism patients. Now, we were going to go to the involved hospital administrations, but we have learned since getting here that the administrations are, for some ill-advised reason, totally against investigating this problem."

"How have you heard about it?" Arun asked.

"By happenstance a young woman whom I have known for many years is here because her grandmother was the ostensible first victim."

"I think you'd better tell me the whole story," Arun said.

Between the two of them, Laurie and Jack told Arun everything they'd heard the night before from Jennifer and Neil, including the probable attempt on Jennifer's life. Arun was captivated by the story and listened intently, hardly blinking. "And that's it," Jack concluded, and Laurie nodded. "If any cases needed an autopsy, it's Maria Hernandez's and the two others," Jack added. "Our thinking is, we're dealing with a probable poisoning, which an autopsy can often ascertain, and even suggest the likely agent. Of course, then it has to be confirmed by toxicology. One way or the other, we definitely need to do an autopsy on at least one case, and all three if possible."

"The only toxicology labs here in India are at the public hospitals, like the All India Institute of Medical Sciences, where I am an alumnus, but you wouldn't be able to do an autopsy there. That's for certain. Vijay's facility would be the best bet, and he could arrange for the toxicology to be done. You know, I heard of these two cases here at the Queen Victoria. There is not much chatter about them, but what there is, I did hear. You see, there are very few adverse outcomes in India with medical tourism cases, and when there is, it's almost always a very high-risk case."

"Usually in healthcare serial-killer circumstances," Laurie said, "there's an element of rationality perverted involved, such as a misconstrued desire to prevent suffering, or putting people in jeopardy to get the credit for saving them. Can you think of what could be the rationale here, killing American medical tourists? We certainly can't."

"I can right away," Arun said. "Not everyone in healthcare in India is thrilled with this sudden explosion of the private sector, creating these islands of excellence, like the Queen Victoria Hospital. It's fostering a startlingly divergent two-tiered system. Right now more than eighty percent of healthcare spending is in this relatively small sector, starving the much larger public health system, particularly in arenas like communicable diseases in rural areas. I know a number of academic types who are passionately opposed to the Indian government's subsidy of medical tourism, even if ultimately it is for India's good in relation to foreign exchange. To understand, all you'd have to do is travel from this hospital to a public hospital. It is the equivalent of moving from medical nirvana to a medical underworld."

"That's fascinating," Laurie said. "It never entered my mind to think of it as a zero-sum situation."

"Nor I," said Jack. "That means there are probably radical medical students who are against it as well."

"Without doubt. It's a complicated issue, just like every other issue in a country with a billion people."

"But why would the hospital administration want to block any investigation?" Laurie asked.

"I can't help you there. If I had to guess, it's probably some misguided bureaucrat's decision. That's the usual explanation for irrational behavior in India."

"And why just Americans? You get medical tourists from other countries, right?"

"Absolutely. In fact, it's my belief most come from the rest of Asia, the Middle East, Europe, and South America. Still, it is the USA that has been specifically targeted of late. I believe the government's department of medical tourism is specifically looking to the U.S. as a major source of growth to push it beyond thirty percent per year. We have the capacity. The existing private hospitals are currently underutilized."

"What is your personal feeling about medical tourism?" Laurie asked.

"Personally, I'm against it, unless the profits went for public health. But that's not the case and will never be the case. The profits are being skimmed off by the new megabusinessmen, of which we have more than our share. Plus, in my view the two-tiered system that's being created is ethically untenable."

"Yet you are utilizing the private hospitals," Laurie pointed out.

"I am. I fully admit, but I'm also doing my part for the public hospitals, too. I split my time, working pro bono at the public hospital as an ob-gyn while supporting myself and my family with my private infertility patients. Since there are not too many of us, I've made it a point to join the staff of most private hospitals for my patients' convenience, although I have offices only at two."

"Are you on the staff at the Aesculapian Medical Center?"

"I am. Why do you ask?"

"There was a third death at that hospital related to the two here. We believe whoever is involved must have an association at both institutions. It's what makes us believe we might be dealing with a physician."

"That's a good point," Arun said.

"Since you are not for medical tourism, perhaps you might not be willing to help us solve a mystery that seems to be giving the medical tourism a black eye. It could even be one of your fellow academics or one of your radical students who is at the bottom of it."

"I don't condone this methodology," Arun said categorically. "I'm more than happy to help. In fact, with my interest in forensics, I'll find it intriguing. What's first?"

"The autopsy, without a doubt," Jack said.

"Let me call Vijay," Arun said, picking up his phone.

Chapter 31

OCTOBER 19, 2007

FRIDAY, 9:45 A.M.

NEW DELHI, INDIA

Inspector Naresh Prasad was bored and uncomfortable. He'd had his tea, and he'd read the newspaper cover to cover. He had been sitting in the driver's seat of his Ambassador for almost three hours, with no sign of Jennifer Hernandez and no word from the concierge desk. Although he was certain he'd probably bump into her the moment he left the car, he did it anyway, leaving his door ajar.

Standing outside, he stretched, then bent over and almost touched his toes. It was the best he could do. The Sikh doorman waved and smiled. Naresh waved back. Still no Miss Hernandez. He looked back in the car. Although he knew he should show appropriate patience and get back in the car, he couldn't get himself to do it. It was too hot in the car with the sun beating down.

He glanced back at the hotel. What was she doing? Why hadn't she come down? But then he realized he was just assuming she'd not come down, and he was assuming that if she had, then Sumit would have notified him as per his offer to keep him informed. All at once, Naresh decided it was time to find out if she'd been spotted.