Respected as one of the most successful malpractice defense attorneys in the National Capital Region, forty-one-year-old Bridget Larsen balks at defending Dr. Zack Winston against her arch-rival, nefarious plaintiff’s attorney Roger Meadows. “No more ER docs,” she says. “The odds against them are too damned high.”
Bridget’s rise to the top of her profession followed a twisting trajectory. A broken engagement in her second year of medical school disrupted her life. She turned away from medicine and found her true calling in the law. After graduation from Harvard Law, she married a classmate who later became US Attorney for Southeastern Virginia. She built her own career in DC as a stalwart defender of physicians facing malpractice suits.
“It all works,” she says.
Does it, Bridge?
Despite her enviable personal and professional status, Bridget is restless within herself but can’t fathom why. She accepts Zack Winston as a client against her better judgment, drawn to his charming vulnerability and convinced that he’s victimized by her nemesis, Roger Meadows. Bridget and Zack form a unique, sometimes contentious partnership; a relationship that will threaten both their careers—and their lives.
EXCERPT from DEAD ALREADY. © Reprinted by permission. All rights reserved.
Bridget Larsen fought a too-familiar battle in District of Columbia Superior Court. The judge, a tired-looking man in his early sixties, massaged his temples and spoke in a detached tone. “Ms. Larsen.”
“Thank you, Your Honor.” Bridget pushed back from the defense table, stood, buttoned her navy-blue suit jacket, and flipped her wavy blond hair over her shoulders. Seated next to her, Dr. Julie Dawson, a thirty-two-year-old emergency physician from George Washington University Hospital, gazed at her with anxious eyes.
In a stately walk toward the witness stand, Bridget smiled at Roger Meadows retaking the seat next to his client at the plaintiff’s table. “Just a few questions for the good doctor there,” she said as she made deliberate eye contact with as many jurors as possible. She paused in front of the jury box and faced the plaintiff’s expert-physician witness waiting to parry her cross-examination. Her eyes scanned his well-groomed appearance: salt-and-pepper hair with no errant strands, manicured fingernails, custom-fit charcoal suit with red silk tie, monogrammed shirt-cuff kissing a gold Rolex on his left wrist. She had observed his rich Italian footwear when he took the stand earlier. Quintessential peacock doc.
Confident of everyone’s attention, she addressed the witness. “Dr. Sanders, I’m Bridget Larsen, and I represent the defendant.” She gestured toward Dr. Dawson, pleased by the young physician’s demure pose in an off-the-rack half-size-large dark-gray suit, pale blue cotton blouse, absence of make-up, and dishwater brown hair drawn into a modest chignon—just as Bridget had coached her. Unpretentious as a sparrow.
“To summarize, in your opinion Dr. Dawson here missed classic EKG signs of ST elevation myocardial infarction, or ‘STEMI’ as it is called. Is that right?”
“As I stated to Mr. Meadows a few minutes ago.”
Bridget glanced at the jury. “In layman’s terms, you believe she missed a heart attack, right?”
The physician sneered. “She missed a heart attack.”
Bridget tugged on an ear lobe and turned toward the jury. “You further opined that George Watkins, the late husband of Mr. Meadows’ client, suffered wrongful death as the result of Dr. Dawson’s alleged misdiagnosis, right?”
The doctor scoffed. “As the result of her negligence, yes. She sent him home to die.”
Bridget wheeled toward the judge. “Move to strike that as speculative and prejudicial.”
“Sustained. The jury will disregard the witness’ response. Just answer the questions, Doctor.”
The physician turned to the judge. “Sorry, your honor. May I hear the question again?”
The court reporter repeated Bridget’s question.
The doctor harrumphed. “Yes.”
Bridget smirked. “Thank you for finally answering a question without your personal embellishment.”
Behind her, Roger Meadows, all sixty-four doughy inches of him, bounced to his feet. “Object!”
Bridget waved him off. “I’ll withdraw that.” She moved closer to the witness. “To be explicit, Doctor, you’ve rendered an opinion about the cause of Mr. Watkins’ death. You did not state an absolute fact, correct?”
The doctor folded his arms. “I have given my expert opinion based on training and years of experience, yes.”
“Could another emergency physician with similar training and experience have a different opinion?”
Meadows objected. “Calls for speculation.” He shot Bridget a sinister look.
Bridget shrugged. “Okay, then. Let’s review the relevant EKG together, to be sure I have it right.” She stepped to a large video monitor next to the witness stand, on the screen a magnified computerized EKG tracing. “Earlier, under questioning from Mr. Meadows, you pointed out details in this EKG that, in your opinion, confirm the diagnosis of STEMI.” She used a laser pointer to identify a segment of the tracing. “These elevated lines between the S and T waves, right?” She pointed to areas on the EKG representing single heartbeats.
“In a normal EKG, you would expect those lines to stay even with the baseline, am I right?”
She pointed to verbiage printed near the top of the EKG. “What’s this, Doctor?”
His voice spat impatience. “That’s the computer’s interpretation of the tracing.”
“Not an official reading by a trained cardiologist, right?”
“Correct. It’s an AI thing. They can be pretty accurate.”
Bridget furrowed her eyebrows. “AI thing? I don’t understand.”
The doctor huffed. “Artificial intelligence. The computer analyzes the tracing against programmed algorithms and comes up with a preliminary interpretation.”
“Got it. Thanks.” She looked at the jury. “Can you read that interpretation from your seat?”
“Sure. ‘Abnormal EKG. Unconfirmed. Cannot rule out anterior infarct.’”
Bridget nodded. “So, this artificial intelligence thing could not validate a STEMI, or heart attack, on this EKG?”
He waved a dismissive hand. “It’s a machine. EKG interpretation is an art. There are nuances, often esoteric and not relevant to this case.”
Bridget smiled toward the jury. “Too esoteric for us lawyers and laymen, eh?”
Roger Meadows jumped up. “Object. Badgering.”
Bridget cast a skeptical eye at the judge. She looked back at the jury. “I’ll restate it. To generalize for our slower minds, Dr. Sanders, sometimes a ‘normal’ EKG can have an elevated ST segment for reasons other than a heart attack, correct?”
The doctor crossed his arms. “Can have subtle nuances, yes.”
“Might other physicians reach different conclusions based on those subtle nuances, regardless of the computer’s analysis?”
The doctor stared at her. “Again, not applicable to this case, which is a straightforward misinterpretation of a pathological EKG.”
Bridget cocked her head. “No doubt about your interpretation?”
She turned back to the EKG. “Okay. I’d like to ask you about some other features on this tracing.” She led the doctor through several technical aspects of the EKG tracing, then pointed to a small wave on the EKG. “This little bump at the beginning of the elevated ST segment, what’s that called?”
The physician stared at her for a few seconds before answering. “J wave.”
“What other condition, besides STEMI, might demonstrate a J wave like this one?”
The man flushed. “Early repolarization, but this patient had STEMI.”
Bridget smiled, patronizing. “Early repol, as you ER docs call it, is a benign condition that can mimic STEMI, right?”
“It’s not the same as a heart attack, right? No one dies from early repol, do they?”
She paused for a few seconds, walked back toward the witness. “Dr. Sanders, do you know an academic emergency physician, Dr. Evan Reed?”
“I’ve heard of him.”
“He’s famous in your specialty, is he not?”
“He has a solid reputation.”
“Are you familiar with Dr. Reed’s study, published in the ANNALS OF EMERGENCY MEDICINE in 2013, wherein he describes a formula for differentiating early repolarization from STEMI?”
Bridget squinted at him. “You do read medical journals, don’t you, Doctor?”
The man scowled. “Of course.”
Bridget smiled. “What if I tell you that the formula Dr. Reed derived in that study establishes, as independent predictor of early repol over STEMI, the same findings we just reviewed on this EKG; that a competent emergency physician, such as Dr. Dawson here, might correctly interpret that EKG as benign, non-life-threatening early repolarization, not STEMI. Not a heart attack?”
Meadows roared. “Objection. She’s testifying, and badgering.”
“Sustained. That’s enough, Ms. Larsen.”
Bridget raised her hands. “Sorry. Let’s move on.” She walked toward the jury. “Dr. Sanders, when did you last treat a patient in an ER?”
The man bristled. “I don’t work ER shifts anymore. I’m a consultant.”
Bridget lifted her eyebrows. “You don’t see patients? Since when?” Roger Meadows fidgeted behind her, but no objection came.
“Roughly five years.”
“Wow. How do you stay current in your profession? A lot could change in that time, right?”
“I read—” He stopped, catching himself.
Shoulders slumped. “Yes.”
“Just not the ANNALS OF EMERGENCY MEDICINE.”
Roger Meadows yelled from his seat. “Objection.”
“Sustained.” The judge scowled at Bridget. “Wrap this up, Ms. Larsen.”
“Yes, your honor.” She stepped away from the doctor, turned to the jury. “What consulting do you do, Dr. Sanders?”
“Various projects, on request.”
“Expert legal testimony?”
“I am in demand for that.”
Bridget spun away from the jury and faced the witness. “Isn’t it the only ‘consulting’ you do?”
The man looked away. “I support both plaintiff and defense attorneys.”
“No other consulting beyond expert testimony?”
“No. I mean, yes, that’s all I do.”
She moved within two feet of him. “You get paid for your testimony, Doctor?”
“I receive remuneration for my time.”
Bridget inched closer. “How expensive is your time, Doctor?”
“I devote many hours to researching the cases and preparing my testimony.”
“But not—” She made a pretense of catching herself in mid-sentence. “Whoops. Almost mentioned ANNALS again.”
She felt the judge’s glare and turned to him.
“Thank you for your patience, Your Honor.” She swung back to the jury. “And for yours, ladies and gentlemen. One final question for the ‘expert’ here.”
She inspected him from head to toe. When she spoke, her voice rose in a steady crescendo. “That’s an Armani suit, right? Custom-tailored shirt? Rolex watch? Gucci shoes? All paid for by remuneration for your precious time, Doctor?”
Meadows nearly toppled the table in front of him. “Objection!”