Herbert S. Heineman, M.D.

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PART I: 1970

Chapter 1: The Warrior

Frank Frazier knew he’d lost. He should never have taken the case. It was almost four o’clock, he was tired, and his head ached. Soon the jurors would go home shaking their heads over his mean-spirited cross-examination. In the morning they’d lean back in their chairs, legs crossed, arms folded, their verdict written on their faces. The vision made him squeeze his head. Either he performed a miracle right now or he might as well quit, because time had all but run out.

“Ms. Morales,” he said, in a desperate last attempt to forestall the inevitable, “isn’t it true that you were once arrested for shoplifting?”

“I never, ever shoplifted. The charge was dis—”

“Ob-jection.” Bruce MacAdoo too was tired and the nurse’s answer was part way out before he could lift his 280-pound frame from the chair. “This case is about a vitamin injection, Your Honor, not shoplifting.”

The judge leaned forward on the bench and addressed the witness: “How old were you when this alleged event took place, Ms. Morales?”

“Fifteen, and anyway it was my boyfriend, not me. . . .” Her voice broke and no more words would come.

Judge O’Hara closed his eyes and inhaled deeply through his nose. “Mr. Frazier,” he drawled, “I think we can all agree that this is past history and irrelevant today. Objection sustained.”

“No more questions.” Frazier sank into his chair.

Strictly speaking, Morales’s extraordinary beauty should have been irrelevant too. But both attorneys knew better. As she was flinching under the barrage of questions that afternoon, flinging her glossy black mane this way and that and looking hurt, not a single juror’s attention wandered. MacAdoo suppressed a smile, intuiting their sympathy for the lovely victim of Frazier’s inquisition. As she stepped down she cast a smile of gratitude toward the judge. Admiring eyes and deep inhalations followed her out of the courtroom. So much for that all-important last impression of the day, so much for changing the jurors’ minds, so much for the miracle. Still, Frazier tried to console himself, the effort might not have been wasted. Subconsciously, His Honor’s ruling notwithstanding, some jurors might now be wondering about the witness’s veracity. Then again, they might be angry at him, Frazier, for a perceived low blow. He dared not speculate on the net effect.

The law office was only a half dozen short blocks from the courtroom in City Hall. Frazier walked slowly down Fifteenth Street and turned right on Walnut, willing himself to savor the crisp November air, to banish his headache, to make a game of zigzagging untouched through the rush-hour crowd — anything to take the edge off his mood — while his associate maintained a respectful silence. At Sixteenth Street they were stopped by a red light.

“Damned liar!” He laughed bitterly as he said it. “And she gets away with it because she does a shampoo commercial and wiggles her luscious ass at the jury — and the judge. Nobody walks like that without trying. I swear that one guy was drooling right into his beard. And did you get a whiff of that perfume? Did you see the judge sucking it in? Jesus, you’d think it was his last breath before going off the plank.” A pause. “Not that I blame him. I’m no youngster, but let me tell you, I was glad I had my . . . well, never mind.”

Karen sighed. She, too, had found the display repugnant, but she didn’t think that flirting in court per se discredited the nurse’s testimony. “Nurses do disinfect the skin before sticking the needle in,” she said. “It’s not that complicated. Alan couldn’t believe she hadn’t. If the jurors believe her, it could be because they’ve had injections and know the routine. Haven’t you?” Since he said nothing, she went on, “She probably couldn’t help the way she walked either. Nurses don’t wear spike heels on the job; she’s not used to them.”

“Then MacAdoo’s been calling the shots on footwear as well as sloshing herself with ‘My Desperation,’ or whatever’s hot this month, and flinging her hair around. I wouldn’t put it beyond him.”

Karen tried to think constructively. From the outset — bolstered by Alan’s reaction — she had thought their case was weak, and tomorrow the jury would recess to go through the motions of reaching their predictable verdict. Unless — and a big unless it was — the defense’s one remaining witness, their medical expert, gave Frazier an opening. Karen tried to think what such an opening could be, but she knew the cross exam would be limited to topics covered in the direct.

“Go home,” Frank said as they reached their office building, “I’ve got some thinking to do. Be in by seven, so we can talk strategy.”

Over dinner, Alan listened without comment as she recounted the day’s events. She assumed he too had had a hard day and she didn’t press for more interest on his part. Things would be better once both were established and secure in their professions. For now, she was depressed and she slept poorly.

She didn’t expect the night’s respite to be any kinder to Frank than to her, considering he bore responsibility for the case, but she was wrong. When she entered the office of Frazier & Drummond next morning, she found a man transformed, as one who has just learned that the mean-looking shadow on his chest x-ray was an artifact.

He looked her over approvingly. “Great.”

Karen followed his gaze with a puzzled expression. “What do you mean? Aren’t we going to court?”

Oh yes, we are.” She found his enthusiasm exasperating and totally out of place, and came close to stamping her foot. But before she had to deal with that impulse, he laid his plan before her. “You’re going to cross-examine Abrams.” There it was, her future in one sentence.

Her jaw dropped. She was barely sixteen months out of law school, fifteen months with the firm, less than six months past her bar examination. She considered herself lucky to be in court at all instead of shuffling papers in the office. But Frank, good lawyer that he was, had to have a better motive than altruism, and it took her only seconds to suspect what it was.

“OK,” she said unemotionally. “It’s a lost case, so it doesn’t matter if I screw up. That’s how a young female lawyer gets her feet wet, right?”

Frank grinned again. “Lost case, eh? That’s exactly what I want that bastard to think. But I’m sending you in there to win. Understand? To win.”

Obviously she did not understand.

“Do you honestly think I can do a better job than you? Or is this a matter of meeting fire with fire?”

The suggestion of sarcasm was not lost on Frank but, far from being offended, he silently congratulated himself for having hired this quick wit. A true courtroom warrior she’d be. He leaned forward and looked earnestly into her eyes. “Don’t be insulted. We don’t have many cards left to play; you know that as well as I. Morales had the jurors lapping out of her hand. I need you to blunt the effect.”

“You want me to out-bimbo her?” Karen looked at him incredulously. “I couldn’t perfect that body language in the next hour if my life depended on it. Not to mention that I don’t have her hair or her behind.”

Frank suppressed an instinctive denial. “On the contrary, I want you to be Karen Avery, the opposite of Nora Morales. Show them the dignified side of femininity. Don’t flout your looks. Don’t put on any airs at all. Don’t even think about her.”

Karen made a wry face, resisting an impulse to object to what she perceived as condescension. “So they’ll be more impressed by my variant of womanhood than hers? Is that the idea? And what’s the strategy for the cross exam? I assume there is one?”

Frank was unruffled. “Wait and see what MacAdoo does, then undo it. Something tells me he’s getting complacent. That self-satisfied smirk. He’ll give us an opening. I’ll make notes as we go. Have you had breakfast?”

“Just coffee. Poor Alan, he’ll have to eat at the hospital again.”

Frank walked slowly round the desk. “I hope Alan has the stomach for this. Lucky he’s a doctor. Maybe he won’t feel outdone by a successful lawyer wife — or resent the hours.”

Karen shrugged off a slight frown. “I don’t think it’ll be a problem, once he has his boards and a faculty position. As long as he’s a resident in training . . . . Anyway, it’s only a matter of time.”

They took the elevator down without speaking, walked a block, and turned into The Buttered Bagel. Before the hostess had a chance to seat them they saw Bruce MacAdoo seated at another table with a slight man in a light gray suit, starched white shirt, and dark blue bow tie. The lawyers exchanged tepid nods of recognition and looked away. Frank asked for a table on the opposite side of the little coffee shop.

“Is that Doctor Abrams?” Karen whispered when they had given their order to the server.

“I hope so,” Frank answered, idly sipping water. “Look at that bow tie – probably another MacAdoo touch. To me he looks like a pompous ass, a miniature pompous ass.”

That was not the way Karen had seen him, but looking again after Frank’s appraisal she thought, maybe he is a pompous ass. Frank’s mental process brought a smile to her face; he could be infuriating one moment, endearing the next, but always sharp.

Over French toast and bacon she also began to see the shrewdness of his ploy. She pictured the jurors in deliberation, the six men replaying yesterday’s visuals and the women reminding them of what they were there for. She forgot her earlier displeasure. By the time they reached City Hall, she was looking forward to her day in court. What a shame that her only audience, other than the litigants and members of the court, would likely be the plaintiff’s mother.

“Please rise,” intoned the bailiff, at the same time motioning Dwayne Williams to stay in his wheelchair. Everyone else rose as the judge mounted the bench.

“The court is in session in the trial of Williams versus Prentiss, The Honorable Judge Liam J. O’Hara presiding. All private conversation will cease. Please be seated.”

MacAdoo rose from his chair at defendant’s table. “Your Honor, the defense calls Doctor Marvin Abrams.”

It did not take MacAdoo long to convince the judge that Abrams qualified as an expert on the subject of injections. Abrams was medical director of a clinic at which the city health department provided immunizations against influenza and childhood infections. During his eighteen-year tenure he had supervised, by his estimate, more than fifty thousand such procedures. “I lost count after the first twenty thousand,” he said in a tone that placed his primacy beyond challenge.

“How many of those injections became infected?” asked MacAdoo.

“None. Not a one.”

“Do your nurses disinfect the skin before injecting?”

Abrams winced as if hurt. “They most certainly do. As public servants we owe it to the taxpayers to follow protocol to the letter. Safety’s our major concern.”

Frazier put his hand over his mouth and pretended to gag. The judge looked at him expressionless save for a twinkle in his eyes. Frazier began to write on his yellow pad.

“What do they use for disinfection?” MacAdoo asked.

“Isopropyl alcohol, seventy percent.” Not sixty-nine, not seventy-one, Frazier growled under his breath.

“Doctor, in your opinion, how likely is it that Mr. Williams’s infection — with its tragic consequences — was caused by the vitamin injection that Nurse Nora Morales gave him in Doctor Prentiss’s office?”

Doctor Abrams straightened his bow tie, sat up straight, and said solemnly: “Vanishingly unlikely.”

“Could you put that in terms of probability — say, one chance in a thousand, perhaps?”

“More like one in a million.”

“And why is that?”

“Because the nurses prep the injection site by killing the bacteria. Ergo, nothing left to cause an infection. That’s the whole purpose.” Abrams sat back, his point made.

“And you say this with reasonable medical certainty?”

“With absolute certainty.”

“Is this the standard practice of nurses in private physicians’ offices as well?”

Frank, as aggressive now as he had been beaten down the day before, rose. “Objection. This witness is not qualified to describe nursing practices in private offices.”

“That’s OK, Your Honor, I withdraw the question,” MacAdoo said before the judge could sustain the objection. “I have no further questions.” One point for MacAdoo, Frank conceded silently, but not a major one.

O’Hara turned to plaintiff’s table. “Your witness, Mr. Frazier.” Frank passed the pad on which he’d been writing. Karen studied it a few seconds and nodded slightly.

“If it please Your Honor, Attorney Avery will cross-examine.”

“Very well, proceed, Ms. Avery.”

Eyebrows arched as Karen rose from her chair. Even the alternate jurors leaned forward expectantly. Karen stood five feet nine in her flats. Her brown suit, yellow blouse, and modest amber earrings coordinated perfectly with her hair, which was pinned up in back to reveal a graceful neckline. She wore no fragrance and no makeup other than pale lipstick. MacAdoo took in the scene through narrowed eyes, diagnosing Frazier’s strategy instantly. With her left hand Karen slowly picked up the notepad from the table, allowing the jurors to see her engagement and wedding rings. She nodded briefly in their direction, a thoughtful expression on her face, then approached the witness.

“Doctor Abrams,” she said softly, “I’m Karen Avery, associate in the firm of Frazier & Drummond. We represent Dwayne Williams, whom you see over there in the wheelchair.”

Abrams sat motionless, looking defiantly into her face.

“Are you aware, Doctor, that Mr. Williams is — at least, was — a star athlete on the Penn track team?”

McAdoo was on his feet. “Objection! This is about an injection. Plaintiff’s athletic prowess may be commendable, but it’s irrelevant.”

“Your Honor,” Karen countered, “Mr. Williams’s status as an athlete representing the University of Pennsylvania in intercollegiate sports is very much relevant. It speaks to the damages we are seeking.”

“I agree, Ms. Avery. Objection overruled.”

“Doctor, Mr. Williams is handicapped due to complications of an infection following an injection into his right buttock—”

“But not because of it,” Abrams interjected.

“Your Honor, I request that remark be stricken. It was not responsive to any question.” Her tone was respectful but firm.

“Doctor, please confine your testimony to answering counsel’s questions,” Judge O’Hara instructed the witness.

Yessir,” Abrams answered with a smirk. Karen continued.

“Doctor, you testified that in your clinic you have never seen an infection following an immunization shot. Is that right?”

“That is right.”

“And your nurses always disinfect the skin in accordance with protocol, right?”

“They follow the rules. I see to that. I have a mandate.”

After pausing long enough to allow the doctor to elaborate further if he wished, she asked, “In your opinion, doctor, is it absolutely impossible to get an infection as the result of a shot?”

“Shot? You mean a bullet, from a gun?”

“No, doctor, I mean an injection with a needle,” Karen answered in a level tone, as if the point needed clarification.

“Oh, it’s possible, I guess.”

“Under what circumstances would it happen?”

“Naturally, if the needle or the material being injected is contaminated. That doesn’t happen in a properly run facility.”

“How about if the skin is dirty?”

“Maybe if it’s covered with feces.” He grinned at the jury. Karen turned to Williams with a look of sympathy, long enough to draw some of the jurors’ eyes in the same direction. Williams’s eyes were flashing in anger. Karen turned back to Abrams.

“Nobody’s claiming that Mr. Williams’s skin was covered in feces. Besides, his infection turned out to be staphylococcal, didn’t it?”

Abrams took a moment to answer. “Yes.”

“Would you expect feces to cause a staph infection?”

“They could. More commonly intestinal bacteria, like E. coli.”

“Where do staph infections usually come from?”

“Staph are all over the place. Infections can come from anywhere.”

“Doctor Abrams,” Karen said slowly, “I’d like you to consider a hypothetical situation: Say a nurse uses a sterile, disposable needle, draws fluid from a brand-new vial after swabbing the rubber diaphragm with alcohol — isopropyl alcohol, 70% — and gives an injection. Next day the area of the injection is painful and swollen, and it turns out to be infected. Would you agree that the infection was likely caused by the shot?”

Abrams closed his eyes and shook his head in disbelief. “Well, you said hypothetical, so OK, maybe it was. In real life it’s rarer than hens’ teeth. I’ve already said that. At least not if the nurse cleans the skin before inserting the needle. You didn’t say she did. Did you leave that out deliberately?”

Karen didn’t need to object. “Doctor,” Judge O’Hara said with a sigh, “you’ll have to leave the questions to counsel. Just answer as best you can.” This time there was no smirk and no yessir, only a straightening of the tie.

Karen took a few steps away from the witness box, looking blankly at the jurors as she turned. She noted she still had their attention. Then she faced Abrams again.

“In the scenario you just considered, Doctor Abrams,” she resumed, “if the infection was staphylococcal, where would those bacteria most likely have come from?”

“I’ve already told you,” he answered irritably, “they can come from anywhere.”

“Could you give me some examples?” she asked quietly.

“The floor, the ceiling, the table — who knows?” He pointed derisively to the objects he named. Turning to the jury box, he added with a smile, “Even in a clean facility like Doctor Prentiss’s office there would be occasional staph here and there.” The jurors sat impassive. MacAdoo’s head hung.

Karen took a step back. “Are staphylococci also found on the skin?”

“Of course they are. Everybody knows that.”

“Even clean skin?”

“Sure, unless it’s been disinfected.”

Karen took another step back. “Unless it’s been disinfected,” she repeated, looking out the window, and paused for a few seconds before going on. “Now, Doctor Abrams, I’ll ask your opinion as a medical expert. Given a choice among the floor, the ceiling, the table, and the skin,” she listed them without pointing, “which is the most likely source of an infection at the point where a clean, sterile needle has penetrated the skin?”

“Now just a minute—”

“Please answer, doctor. You’re here as an expert, and your expert opinion is all I’m asking for.”

Abrams drew a breath. “The skin, I guess. But that’s only because—”

“Thank you, doctor, that’s all.” She didn’t care whether or not he finished his sentence. Turning to the judge, she said, “I’m done, Your Honor.”

The attorneys’ summations predictably reiterated the points they’d tried to establish during questioning. Neither Frazier nor MacAdoo was outstanding for his eloquence.

It took the jury a little over two hours to reach a 10 to 2 verdict for the plaintiff, with two of the six men dissenting. Karen and Frank, interviewing the foreman on the way out, learned that Doctor Abrams’s demeanor had done substantial damage to defendant’s case; as for Nurse Morales, the juror merely smiled and shrugged his shoulders. The lawyers walked to the office along the same route as the day before, but Frank couldn’t have cared less about the weather or the sounds of city life. Gone was the anger, replaced by such generosity of spirit that he willingly shared the misgivings he’d had from the outset.

“Let me tell you,” he said, “if I’d had my wits about me, I wouldn’t have taken the case. Nancy Olson refused to support me. Sure, she agreed that the staph probably entered through the skin somewhere, but she said it could just as easily have been a minor cut someplace else, or from picking his nose — people carry staph in their noses, did you know that? An injection carries very little risk. So she begged off. I have great respect for Nancy’s judgment, but there was something about Dwayne Williams that got to me. Here’s a young, handsome, straight A student and track star at Penn, and on top of that a really nice guy; I just wanted him to win. It’s all emotional, I know. Les Drummond didn’t like the idea either.”

“Do you think the jury saw it that way? I mean, the kind of guy he was.”

“Could be. You can’t predict how jurors will think. But you learn to avoid certain pitfalls. MacAdoo couldn’t have picked a worse expert. Arrogant little sonofabitch. You heard what they thought about him, and it made all the difference. MacAdoo knew it too. Did you see his expression? I can’t understand that he didn’t see it coming. They must have gone over his testimony before the trial.” He stopped walking and turned to her. “And you, Karen, you were brilliant. Keep that up and you’ll go places.”

Karen nodded. “Maybe Morales helped us too! Made it easier for me, perhaps?”

“You’re catching on, counselor.”

“But why did John Barker agree to testify for us after Nancy refused?”

“He almost didn’t,” Frank answered. “He was sort of on the fence, but he had his own reason for helping us. Just so happens that Prentiss had an affair with the wife of one of Barker’s friends. Led to a nasty divorce.”

Karen stared. “But he testified that he didn’t know anyone connected with the case. Was he lying?”

“No. He never met Prentiss, only heard about the affair.” Ah, bless those technicalities, Karen thought, seeing the sly look on Frank’s face.

Back in the office, she sat at her desk and relaxed. No way could Alan help being interested now. And she’d call her father in Washington, of course. Already she could hear him brag that his daughter had beaten one of the city’s best defense lawyers and shown once again that women are every bit as smart as men. No male chauvinist he; in social awareness he was years ahead of his colleagues at the State Department. And no doubt some nickname such as Daddy’s Darling Dragon Slayer would enter the family lexicon. Friends of the family would applaud while she dutifully acknowledged his support in her climb.

The depth of his support had first become manifest in a conversation they’d had during her senior year in high school. That was when she told him she wanted to be a lawyer. “Ah, that’s a man’s job, not for you, little Carrybags,” he’d said, putting an affectionate arm round her shoulder. She still cringed at the touch. “Go to college, meet a man. With your looks and your wit you can have the best. And if he wants to go to graduate school — law, or medicine, or international relations, whatever — I’m ready to help out with money. It’s the least I can do for my son-in-law.”

Twice more she brought up the subject and twice more she found him resolved to protect her against the world. When her younger brother Jeremy, whose intellectual prowess was not discussed outside parent-teacher conferences, professed an interest in political science, dad cheered him right on. She turned to her mother for help, but mom, who’d never worked outside the home, said dad knows what it’s like out there. In the end he relented enough to let her choose whatever college she could get into. When she chose Oberlin, he gladly gave his blessing — high standards, coeducational, just the place for a girl from a good family to make connections.

Karen did make connections. Along with history and literature, she learned that gender alone need be no impediment to ambition, that she could hold her own against the brightest of both sexes at any level, and that she had the right of self-determination. She had no illusions that dad’s education had kept pace with hers, or that mom had the strength to stand up for her, so she waited till she had her acceptance in hand before revealing that she would study law at the University of Pennsylvania — and, by the way, leave Oberlin without a husband in tow. Dad swallowed hard and came up with the tuition money he had earmarked for his son-in-law. Soon he was graciously acknowledging the kudos of friends and colleagues for encouraging his daughter to challenge the sex barrier.

Now, five years later, and married in her own good time to a doctor, Karen saw her career stretching before her like a highway without speed limit. And who could tell what lay beyond the horizon? Her own practice? Academia? A judgeship? Political office? At the very least, partnership at F & D. And incidentally, a worthy peer to her husband, whom even dad approved of.

She predicted Alan’s reaction correctly. Her court victory brought out unabashed pride. He arranged for coverage at the hospital and took his wife to Bookbinder’s for a dinner of lobster tail followed by strawberry shortcake. Wine at the restaurant was followed by brandy at home and, recovering an intimacy that stress had denied them too long, they celebrated into the night.

When her period was two weeks late she ascribed the delay to excitement over the trial. It took another month before the fearful possibility of pregnancy forced itself on her. Without telling her husband, she visited Rosetta Brand. An hour later she left Rosetta’s office in a cold sweat. But her distress was short-lived; a firebrand in the courtroom was not going to be a wimp at home. By the time she arrived there she was calm.