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  “You okay?” he asked.

  “Good enough. You?”

  With friends, Patty often referred to herself as the son my father wishes he had had. Her wonderful older brother, Tom, a wilderness guide and expert fly-fisherman, was often unemployed but always busy advocating for various environmental causes. He was also openly gay and exceedingly happy—except for those infrequent times he spent with their father.

  “Soon,” Patty’s brother would say every time he ventured east from Oregon. “Soon the guy’s going to figure it all out. What a force he’ll be then.”

  Moriarity scuffed at the ground with the toe of his spit-polished shoe.

  “I’m doing all right. I miss your mother, that’s for sure.”

  It had been two years since Ruth Moriarity lost a heroic battle with ovarian cancer—two years during which Tommy seemed to have aged a dozen.

  “Yeah,” Patty said, risking a squeeze of her colonel’s hand. “I miss her, too.”

  Moriarity seemed to sag for a moment, then just as quickly pulled himself up ramrod straight.

  “So, how are you doing on these cases?” he asked.

  Patty shook her head.

  “We’re working like hell on them, but nothing so far. My bet is it’s either a disillusioned, disgruntled physician or the relative of someone who died because of managed-care negligence. Our hope is that sometime soon the killer will feel the need to get his message across to the public more stridently, and move closer and closer to being out in the open. Then maybe we can get a hook into him.”

  “You still upset about Brasco taking your place in charge of this case?”

  “Nope. I’m fine, Dad.”

  “Good. I’m glad you understand why the change was made. Brasco’s been around a good while. I imagine you’ll learn a lot from him.”

  “I’ve learned a lot already.”

  “I heard he’s got a cryptographer and a psychologist on the case.”

  “That he does.”

  Patty narrowly avoided choking on the words. Even before the murder of Marcia Rising, she was concerned that the letters found beside Ben Morales’s body might be the start of something and had both the code-breaker and profiler at work. In one of his first acts after taking over as head of the investigations, Brasco had sent out a memo to all the higher-ups summing up the department’s efforts to date on the two managed-care killings. In it, he unabashedly took full credit for bringing both specialists on board.

  If Tommy Moriarity picked up on the venom in his daughter’s voice, he hid it well.

  “So,” he said, “you’re still happy you became a cop?”

  Tommy’s dream for his daughter centered around at least law school, and at most the Presidency. He didn’t speak to her for two months after learning she had taken the state police exam without consulting him.

  He’s the perfect father, she often said to friends, so long as you do what he wants. “I’m very happy being a cop,” she said now.

  “I hear good things about you from Lieutenant Court.”

  He can’t stand me, Dad, or any other woman detective, for that matter. He and his pal Brasco are absolute Neanderthals. If a male version of me had handled this case exactly the same way I had, believe me, he’d still be running it.

  “I’m pleased to hear that,” she said.

  Tommy shifted uncomfortably. This wasn’t going to be the moment he suddenly blurted out how proud he was of her and what she had become, or how sorry he was for not insisting she be left in charge of the managed-care murders. If anything, Patty suspected he was embarrassed at how much pressure had been brought to bear on him to not protest her demotion to Brasco’s second fiddle. At some level, she thought, he had to be proud that she had chosen to follow in his footsteps. But then again, maybe not.

  “So,” he said, “we’re still on for our dinner a week from Friday?”

  Without ever really discussing it, they had gone from eating together twice a week following the death of Ruth Moriarity to every other.

  “My place, same time,” Patty said with forced cheer.

  “Well . . . good luck with this case. Call me if I can be of any help.”

  He gave her a wooden hug, turned, and headed off across the lawn, stepping to his left to avoid what looked like a piece of Cyrill Davenport.

  CHAPTER 5

  The Boston chapter of the Hippocrates Society had been meeting on the third Thursday of each month since its inception fourteen years ago. Initially, the three founders of the chapter met at the home of one or another of them. Soon, driven by a steady increase in membership, they moved to a conference room at Harvard Medical School. Now, for nearly four years, meetings had been held in the amphitheater of the Massachusetts Medical Society—a spectacular modern structure located in a Waltham office park, featuring a massive four-story glass atrium at the main entrance, which opened onto terraced gardens and a bamboo forest.

  The avowed goal of the Hippocrates Society was to recapture the practice of medicine from the capricious and viselike grip of the managed-care industry. Begun originally in San Francisco, the Society now had chapters in Chicago, Philadelphia, New York, and Houston, as well as its most rapidly expanding member, Boston. It was named for the fourth-century BC Greek physician, who was now widely recognized as the father of medicine. Hippocrates held the then-heretical belief that illness had a physical and rational explanation and did not represent possession of the body by evil spirits. He also preached the natural healing properties of rest, a good diet, fresh air, and cleanliness, and wrote the Oath of Medical Ethics taken today at most medical-school graduations.

  Will arrived at the medical society with fifteen minutes to spare before the seven P.M. start. He had spent the last hour with John Doe, who had, over the past forty-eight hours, made the transition from near-hopeless physical disaster to medical miracle. Following his remarkable surgery there had been a rocky period during which his coma remained dense, his temperature once reached 106 degrees, and his systolic blood pressure persisted below 80 despite the most vigorous treatment.

  To make matters worse, the shock and hypothermia had caused his kidneys to shut down, producing no urine output at all. Will brought in specialists from cardiology, neurology, and nephrology—the kidney experts. He and his residents delicately monitored dozens of body chemicals, working under the dangling sword of nonfunctioning kidneys, which meant that toxins couldn’t be cleared from John Doe’s body. In addition, without kidneys, the blood level of administered medications was a challenge to control and could, in fact, have easily become a source of lethal complications.

  Hour after hour, the man’s life hung by the thinnest of threads. Suddenly, twenty hours after Will had stepped back from the operating table and stripped off his gloves signaling the end of the surgery, a single magnificent drop of urine appeared in John Doe’s catheter . . . then, a minute later, there was another. Kidney function was returning, and from a treatment standpoint, anything was now possible. Will, the nurses, the residents, and the nephrologist toasted the event in the nurses’ lounge with coffee and stale doughnuts.

  Just three hours ago, nearly two days after he was left for dead in an alley, the man remarkably and progressively regained consciousness. All at once John Doe had a real name—Jack Langley—and a life. He was a salesman from Des Moines, lowa, and father of three, and had been incapacitated by sudden, severe abdominal pain. He was down on one knee when he was attacked by three men. Fortunately, it appeared that Langley wasn’t conscious for most of the ensuing beating. Now, hardly out of the woods but certainly improving, Langley was filling the nurses in on the details of his life even as they were bringing him up to speed on his close brush with mortality.

  Will was pleased to find that most of the medical society amphitheater’s 140 state-of-the-art conference seats were occupied. As he stepped into the hall, he was immediately surrounded by colleagues wanting some sort of update on the latest in the managed-care killings. As head of publici
ty and public relations for the Boston chapter for the past two years, Will had expected to be contacted by the press if not the police, but so far nothing.

  An eager OB named Runyon, clearly more interested in what he had to say than in any grisly headlines, captured the conversation.

  “So, get this one, Will. Twenty-three-year-old woman develops severe abdominal cramping. It’s the holiday weekend, so she gets called by the HMO on-call doc, who phones in a scrip for indigestion. The office is closed for the weekend, so no arrangements are made for follow-up. She is worse by morning and calls again and gets another doc who calls in a different prescription, insinuating that last night’s doc doesn’t know what in the hell he’s doing.”

  “Tubal pregnancy,” Will said, anxious to speak with Tom Lemm, the Society president.

  Runyon looked crestfallen at having the tag line of his tale preempted.

  “Exactly,” he said, speaking to those nearby, as Will had headed off. “She bled out on the way to an ER—as in died. Can you believe it?”

  Will spotted Lemm, a family practitioner in his fifties, on the far side of the hall. By the time he reached the man, he had been regaled by a surgeon, whose name he didn’t know, with the story of a woman whose HMO told her to wait awhile to have her thyroid biopsy repeated because the evidence of cancer from the first set of seven painful needle biopsies was inconclusive. Three months later, her husband was transferred to another state and assigned coverage with a different HMO. When the woman’s cancer suddenly began rapidly growing, the new HMO refused to pay for treatment, claiming it was a preexisting condition.

  “Hey, Will,” Lemm called out as he approached, “this may be our largest gathering yet.”

  He motioned to the crowd, and Will noticed as he followed the gesture that his partner, Susan Hollister, had just entered and was casting about for a seat.

  Thanks for showing up, Suze. I owe you one.

  “I’ve got a couple of cases, Tom. Do you think they’re appropriate given this latest murder?”

  “Are they funny?”

  “That depends.”

  “On what?”

  “On whether you mean funny, ha ha, or funny, all of a sudden I can’t see out of my right eye.”

  “Which are these?”

  “A little of both.”

  “Well, you’re on the agenda. There’s more tension than usual from what’s going on, but I don’t see any reason to withhold an anecdote or two. Tonight it’ll be right after we finish discussing the status of the class-action suit. After your report, we’ll decide what we’re going to do about the big debate against Boyd Halliday next week.”

  “What do you mean?”

  “I spoke to him an hour ago. He says it would send the wrong message to the public and the killer if he called off the debate.”

  The debate, billed as a forum, had been organized by the Wellness Project, a respected independent consumer health-care coalition, and was scheduled for venerable Faneuil Hall in downtown Boston. Halliday, the powerful and dynamic CEO of Excelsius Health, was to be matched up against Jeremy Purcell, a world-renowned surgeon, Harvard professor, philosopher, and former president of the Hippocrates Society. Thanks in large measure to Will’s efforts, publicity for the forum, which was titled Managed Care: Boon or Boondoggle, had been extensive, and a sellout was anticipated. Of course, the managed-care murders had only heightened interest in the event.

  “How does Jeremy feel about it?” Will asked.

  “I’m surprised you haven’t heard,” Lemm said. “Jeremy’s had a fairly large coronary. He had emergency bypass surgery at White Memorial.”

  “And?”

  “He’s reasonably stable now, but he won’t be ready for next week. We have to decide what we’re going to do.”

  “Halliday’s a force,” Will said, in what he knew was something of an understatement.

  “He is that. Listen, I’ve got to get this show on the road. Don’t worry about your stories. If people want to laugh they’ll laugh. I think one of the big reasons we’re getting more members at every meeting is you and your stories.”

  “I don’t make them up, I just read them.”

  “That’s the point. They’re real.”

  “Okay, I’ll do my best.”

  “Will, you’re doing great things for this organization, and don’t think we don’t appreciate it.”

  “Well, garsh, thanks, Mickey,” Will said in his highly tuned Goofy imitation—the only one in his repertoire.

  Lemm, a lean six-footer, shambled up to the podium and silenced the crowd with a few taps on the microphone.

  “Three nurses die in an accident and are spirited up to the pearly gates,” he began, without any introductory remarks. “Saint Peter is there and asks each one, ‘Who are you, and why should you be allowed to walk through these gates?’ ‘I was a nurse in a private doctor’s office for forty-five years,’ the first responds. ‘I instructed patients on how to take their medicines; I gave out lollipops to the children—sugar-free, of course.’ ‘Go right in,’ Saint Pete says.

  “The second nurse walks up. Same question from Saint Pete. ‘I was a nurse in a hospice,’ she says, ‘and for many years I soothed dying people’s fears of crossing over to the other side, and made the transition a peaceful and enlightening one.’ ‘Please go right in,’ Pete says again. ‘Milk and cookies are on the right.’ The third nurse comes forward. Again, Pete asks about her qualifications for admission. ‘I did case reviews for a managed-care company,’ she says. Pete checks his massive golden book. ‘Ah yes,’ he says, ‘I have you right here.’ He swings open the gate, and as she starts in, he adds, ‘But we’ve only got you scheduled for a three-day stay.’ ”

  Laughter from the assembled was enthusiastic, even though Will suspected that most had heard the joke before. Lemm was right. These men and women needed to laugh. Their profession, in many cases their dream, was under constant attack, and the AMA, the organization they had counted on to man the battlements, had mounted a feeble defense. The well-oiled machine of the managed-care industry had cut through the various medical specialties like a thresher.

  It probably wasn’t totally fair to draw the analogy between the way managed care overwhelmed the practice of medicine one specialty at a time (giving concessions to the ophthalmologists at the expense of the GPs, then suddenly regulating the ophthalmologists) and the way Hitler swept through Europe a country at a time, but Will was hardly the first physician to see it that way. There was a remarkable, intensely moving Holocaust memorial near Quincy Market in Boston. At the entrance was a quote from a Lutheran pastor named Martin Niemöller.

  In Germany they came first for the Communists, and I didn’t speak up—because I wasn’t a Communist.

  Then they came for the Jews, and I didn’t speak up—because I wasn’t a Jew.

  Then they came for the trade unionists, and I didn’t speak up—because I wasn’t a trade unionist.

  Then they came for the Catholics, and I didn’t speak up—because I was a Protestant.

  Then they came for me—and by this time there was no one left to speak up.

  “Let’s begin this meeting as we do all our meetings with a reading of the roll—physicians who have notified us they are leaving patient care or retiring from medicine prematurely. Their specific reasons vary, but the themes behind them do not. These physicians can no longer handle the paperwork, frustration, and inconvenience to their patients, if not actual danger, of corporate medicine.”

  The reading of the roll, consisting of as many as twenty names each month, was, as always, painful. Along with most of the names was a short statement of the reasons this fifty-one-year-old family practitioner or that forty-eight-year-old obstetrician decided to look elsewhere for the emotionally fulfilling, economically rewarding life that they at one time felt was worth the years of sacrifice, exhaustion, and escalating financial outlay demanded by medical school and residency.

  This month, three of the nine names on th
e roll were well known to Will. One of them had been a clinical instructor of his in med school. Half of all physicians recently polled, he was thinking glumly and angrily, had said that given the chance, they would not do it over. . . .

  After the reading of the roll, Lemm called on the Society’s legal committee, which reviewed in detail the status of a class-action suit being brought against several of the largest HMOs by the Hippocrates Society in conjunction with a number of state medical associations and some individual physicians. The case, which had been plodding forward for almost five years but was now gaining some momentum, charged the HMOs with extortion and with violating the federal Racketeer Influenced and Corrupt Organizations Act.

  Other legal actions from around the country were also reviewed, including a lawsuit in California accusing the health plans of interfering with physicians’ ability to make independent medical decisions. The plans threatened physicians with economic loss, the suit was charging, in an effort to deter them from fulfilling their duty owed their patients and encourage them to place unreasonable and often unsafe restrictions on the level of medical services that might be delivered to their patients.

  The legal team’s presentation was interrupted a number of times by applause. In the analogies to the Nazi takeover of Europe, the lawyers and physicians of the legal team were the resistance—sniping at the enemy, disrupting them wherever possible. When they had finished their presentation, there was an almost palpable drop in energy throughout the hall.

  “So,” Lemm announced, perhaps sensing the same thing, “before we do new business, let’s hear from our illustrious publicity and public relations chairman, Will Grant. What do you have for us tonight, Will?”

  There was a smattering of applause as Will took over the microphone. He had been painfully shy as a child, and as an adult had never been that comfortable speaking in public. But over time he had managed to convince himself that looking or sounding like a fool wasn’t that big a deal. After two years, reporting to the Society each month held no great stress—especially when he had material such as he did tonight.