Dispensing with the Truth: The Victims, the Drug Companies, and the Dramatic Story Behind the Battle over Fen-Phen

INTRODUCTION

You probably would never have heard of Mary Linnen if she hadn’t wanted to lose twenty-five pounds for her wedding dress. On Memorial Day 1996, she was just another bride-to-be, coming home to her parents’ house to celebrate her engagement. She was bursting with plans for her wedding and for a family full of children, just like her own parents’ Irish clan.

The surprise baby who came along late in her parents’ lives, Mary, the family’s peacemaker and pacifier, had been the last to leave the nest. At twenty-nine, she was still unmarried, despite a pretty freckled face, a mane of dark hair, and a high-pitched laugh. Her folks worried that she’d end up one of those unhappy single women making a life out of the parish Altar Guild.

But now she was hugging Mary Jo and Tom Linnen on their front porch in Orchard Park, New York, as her fiancé, Tom Caruso, stood nearby smiling. Mary began babbling about the details she’d pinned down. It would be a Roman Catholic mass, of course, in Hingham, Massachusetts, where she lived. She’d picked a little place on the water for the reception—her sister Nancy’s house. Mary, a graphic artist, would probably do the invitations herself.

As for the dress, nothing too frilly. Something that would show off her five-foot seven-inch frame and minimize her big-boned Irish stock. She promised her mom, We’ll go shopping for the dress real soon. I’ve been to see a doctor. I’ve started losing weight. About ten days earlier, her doctor had prescribed a popular combination of diet drugs called Fen-Phen. Mary started taking them mid-May, and the results were already showing. She’d been on the drugs eleven days.

But that weekend, as Mary, Tom, and her parents were going up Heartbreak Hill at the nearby golf course, Mary signaled to the rest of the foursome to slow down. I can’t breathe, she said. I think I’m going to faint.

Until that spring, weight had never been a problem for Mary. She was an athlete, a high school champion swimmer, a hiker, and a member of the tennis team at Colby-Sawyer College in New Hampshire. Always on the move, friends would say. She’d bragged about being able to drag a sofa up three flights of stairs into her apartment in Quincy, near Boston.

That was the apartment she shared in the early 1990s with Connie Lovejoy, a lonely girl she’d met at Colby. Mary had been a dorm counselor, clucking over freshmen like a mother hen; Connie was one of her little chicks.

There was nothing spectacular for good or bad about Mary during her college years. She partied on weekends. She smoked with the crowd or when she was studying. Her weight bobbed up a little during exams when she became a sedentary snacker, but it always came off as soon as she got back to her normal state of motion.

Mary dropped out of Colby, looking for independence. She and Connie moved in together in a Boston suburb, and Mary began learning design and graphics. She had a bright red VW Fox; a closetful of Talbots and fuzzy sweaters—safe clothes; and a dog called Dustin, named in a fit of laughter after the song Dust in the Wind. Mary became almost too serious for her age in her mid-twenties. She developed career plans, sketching out for Connie her idea for her own business in graphic design. She set up exercise and cleaning routines for herself and Connie. On her Friday-night pub crawls she began substituting Diet Coke for beer. She quit smoking and began giving Connie stern looks when she caught her roommate lighting up. She stopped indulging in the occasional joint. She and Connie made a pact not to date guys who did drugs.

Mary also began attending St. Paul’s Catholic Church. She often visited her oldest sister, Nancy, who had helped raise her. She ritually called her mother and father every week. The only time the creative Mary would emerge was later at night, when she penned emotional poems or pecked away at her secret work-in-progress, a steamy romance novel.

In psychobabble, Mary might have been called a fixer. She attracted the luckless in life—stray dogs, stray roommates. She didn’t need things to be perfect, she needed to be needed. That was how she came to fall in love with Tom Caruso. She’d been waiting at work for an elevator when its doors opened, revealing the bluest eyes she’d ever seen. They belonged to Tom Caruso, who was repairing the lift. He flashed a huge, white smile at her. Mary was carried away—at least for a couple of floors. As she drifted off that night in her apartment, all she could talk about were Tom’s eyes and his smile, as Connie listened.

Over the next two years, Mary would tell Connie and her sister Nancy the rest about Tom. About his alcoholism, his attempts at recovery, his juvenile record. Tom had confided to Connie that he was scared to tell Mary about his past, she was so straight. But he told Connie that Mary was going to save him. When Tom and Mary finally moved in together, they would pray together over the kitchen table at night, asking God to keep Tom sober.

When Tom proposed, he took her on a walk through the woods and promised that he would never stop trying to live up to her hopes for him. It was after this that Mary called ecstatically to tell her parents she was officially engaged.

However, she wasn’t quite wedding-ready. She had gained thirty pounds over the winter, cooking for Tom. She was pushing 180, a high-water mark for her. And, annoyingly, this time she couldn’t shed the weight just by exercising and cutting out snacks. There was a history of thyroid problems in Mary’s family. So in April, Mary made an appointment with a Boston endocrinologist, Dr. Abby Landzberg.

No thyroid problems, said her medical tests. But Landzberg had heard of the Fen-Phen combo from one of her patients, and she thought it might get Mary down to her regular weight in time to buy the dress.

In early June, about a week after the incident on the golf course, Mary stopped in to see the nutritionist attached to Landzberg’s office and mentioned the shortness of breath. The nutritionist popped out to see the doctor and came back with the order that she stop the pills. But Abby Landzberg didn’t come over to examine Mary or send her off for tests. When Mary quit taking Fen-Phen she’d only been on them twenty-three days.

Almost immediately, she seemed to get better: no dizziness, no shortness of breath. But by the end of summer, the symptoms returned worse than before. Mary was so exhausted that she postponed the wedding; she had no energy for it. A mere flight of stairs would wipe her out. When Labor Day came, Mary had to forgo the customary last-blast-of-summer trip to the beach. Too tired for TV, she didn’t notice the news reports about a study in The New England Journal of Medicine, which said the diet drugs Pondimin and its chemical sister Redux were causing a terrible lung disease among women in Europe.

During these months, Mary cried to Nancy that she was in agony. Abby Landzberg sent Mary to a couple of specialists, including a gynecologist. Mary was frustrated, collapsing at her job, her legs and stomach swelling strangely from water retention. She begged Landzberg to put her in a hospital and check out her breathing problems, but neither Mary nor Nancy could get Landzberg to admit her.

On a chilly day in October Mary called her parents. She’d just gotten home, said her mother, Mary Jo. She said she’d gotten so tired she’d had to leave work. She added that Mary was crying and quite scared. She said she’d barely been able to drive home. I told her to get to a doctor.

Finally, in November, Mary landed in the emergency room of South Shore Hospital. After a quick, and cheap, EKG, doctors tested her heart using a catheter, and then said that it appeared she had pulmonary hypertension. Now Abby Landzberg needed to get Mary under the care of a pulmonary specialist, and she chose the best one she knew: her husband, Michael.

He put Mary into Brigham & Women’s Hospital in Boston. After a battery of tests and a flurry of respiratory crises that had left Mary gasping for air, he reached his conclusion. On November 14, he told her and her assembled family members that she had primary pulmonary hypertension.

The mechanics of PPH were complicated to explain. But the condition it caused was simple: death by slow suffocation.

The capillaries sending oxygen to Mary’s lungs had thickened and were closing. Mary’s condition was so bad that her only options were either a combination heart/lung transplant, with a 50 percent rate of success, or the implantation of a tube directly into her chest that would pump a drug called Flolan around her heart to make it pump harder.

Nancy, Mary, her parents, and Mary’s other siblings huddled in a hospital conference room watching a video about what the Flolan option entailed. It was how she’d spend the rest of her life, said Nancy. We watched it, and just burst into tears.

For the rest of her life, Mary would be hooked up to a portable machine. She would have to make up her solution daily, fill her tube, clean all the equipment. Infection would always haunt her. The machine was equipped with an alarm. If it malfunctioned, she had only two minutes to fix it or call an ambulance, because she would probably go into cardiac arrest. She would always have to worry about dislodging the pump—whether by bumping into people, turning in bed, playing with Dustin, or making love.

Worse news for Mary was that she would never be able to bear children. Mary wept bitterly over that; she and Tom already had some names chosen for babies. But what really frightened Mary was death. She was so scared, Nancy said. She was terrified of dying. She was living in hell.

Before she went into surgery in early December 1996, Mary made her parents promise that if anything happened to her, they would get the truth out—tell her story, and work to get the diet drugs off the market so other women wouldn’t be hurt.

Then, she tearily released Tom from his vow to marry her. You were engaged to someone who was well. I’m not. You don’t have to stay. When she awoke from the heart surgery with the catheter in her chest, Tom was standing next to the bed with a tiny box he’d bought that day. In it was a wedding ring.

Mary’s father, Tom, had heard about medical problems with Fen-Phen. A former CIA employee, he had a background in research and quickly absorbed everything he could in medical literature on the diet drugs. By the end of November, he had also found an attorney, Alex MacDonald of Robinson & Cole in Boston. Now unemployed, Mary had just been told that her Flolan could cost $200,000 a year. She would need to go on disability. Tom and Mary Jo were retired, living on a pension. Since Mary’s doctors had now agreed that diet drugs were the culprits, Tom Linnen hoped that Alex would be able to get a settlement from the pharmaceuticals that would cover the cost of Flolan and further hospitalization for her remaining years.

MacDonald anticipated eventually filing suit against Wyeth-Ayerst, the makers of Pondimin, and against Fisons, the distributors of Phentermine. He and Mary would talk for hours about her situation. One afternoon she phoned him at his office. I don’t know what my parents will do if anything happens to me, she told him. You’ll watch out for them for me, won’t you? I’m trying not to let them know how scared I am, she said, as Alex heard her sniffling.

Of course, Alex said, but you’ll be okay.

For a while at least, Mary said to herself; the outside survival rate for her disease was four years.

Except around Nancy, Mary tried to maintain her sense of humor. She sent her sister Michelle into hysterics making bizarre jokes about some of the stranger aspects of her medicine, such as the unwieldy purse-sized pump.

Meanwhile, Tom Caruso was devastated by Mary’s illness. He was terrified he’d crush her at night. The tube contraption was a mess, and Mary was always just one infection away from another trip to the hospital. Now when the two of them sat holding hands at the kitchen table, they were praying for Mary to live.

One morning Nancy got a phone call from Mary—The tube’s come out! Mary screamed. There’s blood everywhere! Nancy jumped in the car and tore over to Mary’s. When she arrived, the med techs from Mary’s emergency 911 call were just leaving. They had secured Mary’s tubing back into the hole in her chest. When Nancy entered the apartment, she found Mary with a sponge washing the floor and walls. I didn’t want you to see all the blood, Mary sobbed.

By January, Mary’s eyesight had begun failing, and she eventually lost it completely in one eye. She cried to Nancy, What will happen to me if I can’t see to do my medicine? How will I check it to see if it’s right? I don’t want to go into a home.

To cheer her up, Nancy took Mary to a movie matinee. They chose a daytime show because, as Nancy explained, It wasn’t as crowded during that time and we didn’t have to worry about anyone pushing into Mary or knocking into her [machine].

The film had been running a short time when the beeping alarm on Mary’s pump went off in the darkened theater. We panicked, said Nancy. We knew we only had a two-minute period in which we could find out what was wrong and fix it [or] she would go into heart failure. They rushed to the lobby where they stood under the brightest lights they could find, adjusted the machine and tubing, and turned off the alarm. It was so terrible, said Nancy. The two cried and went home.

Problems with the pump and Mary’s shortness of breath continued. On February 20, she landed back in the hospital. Two days later, she was released. Tom picked her up and drove her to her apartment, where guest lists for the postponed wedding invitations and business cards for the company she wanted to start littered the tables. He carried her up the stairs and placed her on the bed. That’s when she gasped, Something’s wrong, I can’t breathe.

By the time paramedics came and took Mary out on a stretcher, Mary’s eyes had rolled up in her head and she had stopped breathing. The EMS tech who responded to Tom’s 911 call said later that after they had resuscitated her temporarily in the ambulance, Mary cried and grabbed him. She told him how scared she was of dying and begged them to save her. She was pronounced dead at the hospital. She was thirty years old.

Afterwards, Connie said, Mary had such a big heart. I never thought it could break.

By the time Alex MacDonald stood before the jury three years later, he was part of one of the largest mass tort lawsuits in American legal history. Around 45,000 women—an epidemic by any person’s standards—were believed to have developed one of two different diseases linked to their lungs or to their heart from taking the drugs. Another 300,000 women were prepared to sue Wyeth and American Home Products in order to get expensive tests to determine whether they also had heart disease.

As it turned out, Mary Linnen was very close to the profile of most of those who took the drugs—a woman who was neither truly obese nor old but the perfect target of a carefully orchestrated diet drug fad aimed specifically at women and that made the companies hundreds of millions of dollars. Mary’s was just one lawsuit, the first wrongful death suit over the drugs in America. But thanks to the refusal of her lawyers to allow the drug companies to bury the details of her story along with her, Mary Linnen’s case would become the most important single suit the company would face.

However, it wasn’t Mary’s case that led to the drugs’ ultimate withdrawal in 1997. It was another deadly side effect, heart valve damage, that would embarrass both the drug company and the U.S. Food and Drug Administration. Ironically, heart valve damage wasn’t pinpointed by American Home Products’ million-dollar computerized worldwide surveillance system of its drugs’ safety; or by the Food and Drug Administration, with its international database on drugs and their side effects. It was a couple of hands-on medical personnel in two out-of-the-way places—Fargo, North Dakota, and Belgium—who identified the deadly side effect that had been present all along. They merely treated their patients, noticed a pattern, added two plus two, and got the answer.

The FDA washed its hands of the issue and let the tort lawyers take over. The company began a nearly $100 million public relations spin campaign that would put presidential consultants to shame. Using several PR firms, American Home Products stage-managed a tableau involving the FDA, Washington lobbyists, politicians, medical journals, and some of America’s most celebrated medical schools and hospitals, in order, apparently, to ward off paying damages and risking punishment by the government. Meanwhile, a mismatched, warring band of barristers began battling in federal and state courts, trying to outmaneuver a corporate giant.

CHAPTER 1

Crusaders, Cowboys, and Cannibals

Can I look forward to my waning years signing checks for fat people who are a little afraid of some silly lung problem … ?

—E-mail from a Wyeth-Ayerst administrator, Kay Anderson, to Dr. Patty

Acri, product labeling director, October 3, 1996

1

Alex MacDonald had just escaped from the crowded parking lot at the Garden in Boston, where several thousand children had been screaming happily at Disney on Ice, when his cell phone rang. He wasn’t going to answer it.

At that moment, he and his youngest daughter, Emma, were doing Daddy Time, giggling over the spectacle of Mickey and Goofy and Beauty and the Beast on skates, twirling to canned music under a hundred pounds of sequins. Alex was searching the night for snowflakes for Emma. Alex’s wife, Maureen, had their oldest girl, Nora, back at the house waiting with hot chocolate. This’ll just take a minute, he promised solemnly as he pressed the answer button.

It was his partner, Steve Rotman. Mary Linnen just died.

What? Alex briefly lost control of his Toyota Celica.

She died this afternoon, Rotman explained. Her father wants you to call him.

Wait, wait, said Alex, steering the car toward the Cambridge exit. You must have heard him wrong. She just got out of the hospital today, he sputtered. I just talked with her two days ago. And then he remembered what she told him when she called, nearly hysterical. She had foreseen her own death.

As Alex turned into the driveway of his yellow clapboard home off Storrow Drive, one of Cambridge’s tony addresses, it hit him. He had never lost a client like Mary Linnen. He did divorces—calamitous, horrible ones where people certainly were injured, but nobody ever died in them. This was so, well, unfathomable. Doctors lose clients—lawyers don’t lose clients.

Dialing into his office phone, Alex heard the broken voice of Thomas Linnen on his voice mail. Alex, Mary died today.

Maureen poured Alex a drink after she put the girls to bed. He was in shock. I thought she was getting better, he said, starting to cry. They said she was stabilizing.

Maureen sighed. You know, she explained quietly, this is what I was trying to warn you about. Doctors can only do so much with this. Mary was in bad shape.

Maureen Strafford was a well-known cardiology anesthesiologist specializing in pediatric cases. A former med student at Boston U., she had worked alongside prominent doctors from Harvard and Yale. She’d been Alex’s sounding board on Mary’s case from the first day.

When Alex was initially visited by Mary Linnen’s father, he told his wife that night about the new client with pulmonary something.

Pulmonary hypertension? Maureen asked. Oh, my God, did she take those diet drugs? Alex, she’s going to die.

But no matter how many times Maureen had said, "Alex, with severe pulmonary hypertension, they all die," he hadn’t believed her.

Maureen was well versed in lung disease problems and Fen-Phen. In fact, she had interned at Columbia with a woman who was now a leading cardiologist, Dr. Robyn Barst. Maureen had warned Alex: Once they’re on the pump—the Flolan contraption—it’s usually just a matter of when.

After calling Mary’s distraught mother and angry father, numbly expressing sympathy, Alex sat down on the sofa and just looked at Maureen. She was so scared of dying, he said. Maureen nodded, You told me.

2

Lawyers always say, like some cheap cliché, that some particular client or case changed their life. After the Linnen case, Alex didn’t hesitate to say it to anyone who asked, remembering the oddity of the Disney’s sequined Alice in Wonderland skating that night, and the rabbit hole he fell down hours later. The Linnen lawsuit that followed thrust him into the strange, warring world of tort litigation on a scale neither he—nor, for that matter, anyone else—had ever seen.

Not that he hadn’t yet tasted blood in massive corporate cases. As a rising star, Alex MacDonald was already the label on a file at the Boston Globe. He’d nailed five doctors at a local hospital—a major coup in Boston—in a malpractice case, at the time the largest wrongful death settlement in Massachusetts history.

Not bad for a kid from Boston’s backwater. In fact, Alex was just a couple of miles short of being a Southie, like the kid in Good Will Hunting. He was working class, a blue-collar boy from Dorchester, an immigrant division that hadn’t seen much action since Moby Dick was a guppie. His father, a farmer from Nova Scotia, and his mother, an immigrant from Prince Edward Island, had met and married in Boston in 1940. His dad became a union organizer, his mom a domestic, and between them, there were only five years of formal elementary education. Their hopes that Alex would become the first in the family ever to get to college wavered when they saw him spending so much time as a teenager playing guitar in a recroom rock band that called themselves, appropriately, The Poor Boys. They didn’t comprehend fully the allure that performing had on their son.

But talk was really Alex’s forte, and the young debater won a scholarship to Boston University. It was a joyous day in the MacDonald household when Alex was accepted at Harvard Law School; it was also a terrifying one, since nobody knew how he’d pay for it. A restricted scholarship footed part of his bill, and he worked after classes at a local mental hospital. It looked like he’d have to stretch out his last year—maybe drop out and come back, when a teacher pointed him to the book of bequests at Widner Library. It was a huge tome, dedicated mostly to the scions of Yale, Harvard, and Beacon Hill, and took hours to check. But there, on the second-to-last page, Alex found the William Stoughton Bequest, a 250-year-old grant solely for students from the towns of Dorchester or Milton.

It was 1976, the Bicentennial Year, when he graduated, and then almost blew his chance for a job. I wanted to do public defense work, he said, unintentionally evoking the tradition of the Catholic guilt career choice. You’ve made it, now go save the world.

The group of Harvard grads willing to go into legal services was quite short. Harvard may have been a hotbed of idealism in the ’60s, but these students weren’t stupid. While he watched his classmates land at swank firms in Boston, New York, Philadelphia, and Chicago, Alex was pushing for a $10,000-per-year cubicle in a public defenders’ office. Philadelphia Legal Services finally came through, about the moment that Alex’s instinct for survival kicked in. It was all well and good to want to do good. But if he couldn’t make a living, he’d never get that chance. He was about to leave for Philly when he recalled, I looked in the mirror and said, ‘What the hell am I doing?’

He rushed to the placement office and grabbed one of the few jobs left, a firm of old blue bloods, Hemenway & Barnes. Old Alfred Hemenway had been a pal of President William McKinley.

For the next five years, Alex was doing stale corporate litigation and divorce work for the rich and regrettable when he was called by a senior partner who asked him to clean up a minor matter involving their clients the Cabots, one of Boston’s First Families. Alex had been weaned on tales of the local leftovers from the Mayflower, the Lodges and the Cabots. The saying goes: The Lodges speak only to Cabots, and the Cabots speak only to God.

The young caretaker on the Cabot estate, living in the carriage house, had gone to check the hot water heater, which exploded in his face. At the sound of the blast, his wife, eight months pregnant, rushed to the top of the stairs to the basement just in time to see her husband engulfed in flames. The Cabots wanted a personal injury lawyer to sue the hot-water-heater maker. Perhaps young Alex, a member of the old family retainer firm, could suggest a PI attorney to whom to refer the case.

In 1981 in Boston, personal injury law was considered the proctology of the profession. Alex would be doing his firm a favor by disposing of the matter and keeping Hemenway & Barnes away from the sordid nonsense. But after interviewing the fire marshal, Alex was intrigued—the fireman indicated that the heater was definitely the culprit. Divorce and real estate work were leaving Alex stale, and this sounded different. It sounded like a real case where there were two sides and they fought each other, instead of gently negotiating into paralysis. He asked the senior partner to let him do the job.

The heater, Alex learned, had been the subject of an ad in Parade magazine from the Consumer Product Safety Commission and had been involved in more than ninety other accidents. Conveniently for Alex, its maker had deep pockets.

Alex went to visit the caretaker, who was holding down a bed in one wing of a local hospital while his wife, in labor, was a patient in another. In his mid-twenties, the caretaker, like Alex, had a sideline in a local rock group, and Alex told him: I’m gonna make two predictions: You’re gonna be wealthier than you’ve ever dreamed. And your band will play at my wedding.

From his earliest days, Alex had been bulging with braggadocio. It was one of his methods to shore up confidence in himself—by backing himself into a corner, he had to deliver. He made it part of his game in major cases, bragging up front to the other side to screw with their minds.

But in this case, he was trying to reassure the young caretaker, who was certain he’d die right there in the hospital, a pauper with a new baby. Fortunately for both men, both boasts came true. The large firm representing the heater’s manufacturers found itself besieged by weekly requests for documents and depositions; in August 1983 they paid a settlement almost twice what Alex had originally anticipated.

Alex had been dating Maureen Strafford, a young doctor in New York with a wild laugh whom he’d met at a local wedding on Memorial Day weekend in 1980. He’d promised to call, and he did—a full twelve months later, on Memorial Day weekend. Maureen had just joined the staff at Columbia-Presbyterian Hospital as a new pediatric cardiologist and was not returning to Boston anytime soon. Come visit New York, she suggested. Alex shivered. New York? That’s like going to the moon.

But he went anyway, unable to resist (he would tell their children later) her bold red hair, her brazen humor, her watered-blue eyes, and her sexiest organ—her brain. Two months after the Cabot caretaker case settled, the huge bonus for Alex provided a lavish wedding for 250 guests. The caretaker and his band, and a DJ, were joined onstage by Alex during the evening. It was the only time in its 150-year history that the elitist Harvard Club on Commonwealth Avenue received complaints from its Back Bay neighbors about the insufferable noise.

Alex had switched firms in 1983 to Harrison & Maguire, which handled mostly large real estate litigation. But he couldn’t stay away from medical suits, and he’d soon taken on a client, Vincent Napolitano, who was president of Gould’s Pump Company, a New York corporation on the Fortune 500. It would become the largest wrongful death recovery case in Massachusetts.

Napolitano—had Alex had a chance to know him—was Alex’s kind of guy. A blue-collar baby from New York’s backside, he’d gone to the top but never forgot being on the bottom. The multimillionaire was loved in the community and among his workers—once he sent an employee’s little boy on his corporate jet down south for leukemia treatments.

One night in August 1984, at a restaurant, Napolitano got indigestion and became the victim of ambulance roulette. The emergency med techs would not take patients through the Sumner Tunnel to the closest major hospital, and instead took him to a local clinic in Winthrop. Napolitano suffered an allergic reaction to the anesthesia administered during a minor procedure to open up his breathing tube. He died on the operating table, one day short of his fifty-fourth birthday.

It was during the Napolitano case that Alex discovered the most important member of his legal team: his wife. Alex brought the medical records home one night and Maureen grabbed them—anesthesiology was her residency specialty, and she told Alex, I know what he died from. Maureen’s own mentor reviewed the files and told Alex, Congratulations. This is the worst case of medical malpractice I’ve ever seen. Over the next five years, Maureen was Alex’s medical tutor before all his depositions. Once, a defense attorney took Alex aside and confided his firm’s amazement at Alex’s ability to ask and understand a lengthy series of complicated medical questions. Alex told the lawyer, The secret is, I’m Howdy Doody. He explained that Maureen, his doctor wife, was like Buffalo Bob, pulling all the strings. No one sees her lips move when I talk.

Napolitano, Alex figured, was the kind of man who deserved all the drama Alex could provide. All trial attorneys are frustrated actors, Alex conceded, and he was Shakespearean in his frustration. But he was also an ersatz director. Preparing for one deposition, Alex had a camera crew film the operating room as it was set up when Napolitano died. There was only silence as the camera slowly panned around to the doors, and then up an adjoining wall where hung two hundred vials of the antidote that could have saved Napolitano, if only the doctor had known what he was doing. The case settled in 1989, before the jury was impaneled, for roughly $4.6 million—a first, and an unheard-of award within Boston’s temple of medicine.

In 1993, Harrison & Maguire merged with Robinson & Cole, one of the most prominent legal organizations in New England, the firm that Samuel Clemens—Mark Twain had used for literary and legal issues. With almost two hundred lawyers and offices in Connecticut and New York, it was the epitome of a staid, upper-crust firm to which Harvard students aspire. The new firm’s Massachusetts offices took up the twenty-fifth and twenty-sixth floors at One Boston Place, around the corner from the Revolutionary-era Old Christ Church, where they can be glimpsed in B shots of The Practice and Ally McBeal. Once again, a band of blue bloods found themselves harboring a closet medical malpractice maven, wandering incognito in the fields of the Lord.

It was the perfect life. Alex and Maureen moved into a historical Adams colonial house in Cambridge that had been the home of Helen Keller and her teacher Annie Sullivan when Keller attended Radcliffe. They bought a place on the Vineyard, in Chilmark, where the elite turn summer into a verb. His neighbors in Cambridge and on the Vineyard included Nobel scientists, the literati, actors, politicians, and the demigod of the law, Alan Dershowitz. Alex had taken a course once from the master—now he and Dershowitz were drinking buddies; well, if drinking includes Cabernet tastings. Dershowitz had even accepted suggestions from Alex for one of his novels, and afterwards, readers of The Advocate’s Devil found a character named Alex O’Donnell from the mean streets of Dorchester.

Mornings were father-daughter time, as Alex fed and dressed their two blond little girls while Maureen was in surgery at the hospital. Maureen’s practice grew and she continued teaching, her favorite aspect of the job. Alex spent off hours toying with an unfinished novel. I’m gonna overtake Alan [Dershowitz], he joked. If he can sell fiction, so can I.

Alex enjoyed tweaking his Brooks Brothers colleagues and the opposition by continuing to sport the lengthy locks he had cultivated in college. Blondish brown and parted in the middle, with his thick mustache and long goatee trimmed to a point, they made Alex resemble one of those portraits of Jesus seen on the living-room walls of the rough Catholic neighborhood where he’d grown up. Hairstyle as statement, one way of saying that despite his current plush lifestyle, the idealist had not sold out.

You could look down on the Charles River from Alex’s expansive office windows. His walls were cluttered with photos of himself with Dershowitz in Paris and with famous politicians, including Bill Clinton. There was a separate photo of him with Hillary Clinton, obviously lecturing her on the fine points of the law. He’d become moderately famous, and his ego had grown along with his girth, though the ego, it should be noted, was definitely in the lead. One of the photos showed him singing into a mike with a Vineyard neighbor—Carly Simon. The caption read, You’re So Vain.

It fell to Maureen to let the air out of Alex’s balloon occasionally. She was, Dershowitz laughed, Alex’s perfect foil. When his ego ran rampant, she would put up a speed bump. If he got too pedantic at cocktail parties, she’d come up behind him, prod his side, and tweak him verbally. And she would not let him forget why he had become a lawyer.

Alex loves the fight, the good guys against the bad guys, she explained, adding that she blamed too many Saturdays with his brother at the movies watching westerns. Alex just wanted a fast horse, a big gun, and a white hat. He loves being on the ‘right’ side in a case, she said. The Napolitano case—he was frenzied, she said. He was so upset that these people had done something so wrong. He has to have that kind of case to keep going, she laughed, and then you can’t stop him.

But he hadn’t had that kind of case in several years, and he was edging perilously close to complacency, which Catholic guilt abjures.

Then the Linnens walked into his office in November 1996.

At the time, they thought all they needed was someone to help get Mary on worker’s comp to defray her medical costs. Mary signed the contract with Robinson & Cole and introduced herself to Alex by phone. But about a week later, Mary was back in the hospital and scheduled for surgery and the insertion of the heart catheter. She was much sicker than they had realized. In a call to Alex, Mary whispered urgently, Do everything you can to get these drugs off the market. That might be a little difficult, Alex thought, with hundreds of millions of dollars at stake for the pharmaceuticals. But what the hell. Yes, I will, he promised.

But before he faced the pharmaceuticals, he’d have to face his own partners. The case would need fronting, big money to support any litigation before the verdict. In the Cabot caretaker case, the old-line firm found it distasteful to write a check for $5,000 to cover costs. Alex wondered what Robinson & Cole was going to do when he asked for $450,000 up front for experts and depositions for the Linnen case.

Luckily, Robinson & Cole was flush with capital. It gave Alex what he had always wanted—the power of an old-line law firm with the resources of a megalithic corporation—enough to go toe-to-toe with any major defendant and its phalanx of retainer lawyers. This is what I can give you, Alex said to the Linnens. Of course, he didn’t anticipate that he’d need to call on those resources so soon.

3

There was much to do the morning after Mary’s death, and after a sleepless night, Alex could not focus. But after calling his partners, he zeroed in on the most urgent need: an autopsy. He hadn’t planned for one, but Maureen had several suggestions for the pathologist. An autopsy would be one of the key pieces of evidence in a wrongful death suit, and this one had to be perfect—he’d known Mary, laughed with her, let her cry to him. An autopsy would show how she died, suffocating, and might indicate why.

He was kicking himself. Instead of showing how she died, he should have taped Mary herself, showing how she lived. He should have brought in the camcorder and done a day in the life tape, following her as she washed her tube, measured medicine with her failing eyesight, tried to insert a tube without spurting blood on herself and the furniture, and how she had to rest constantly, her hands and feet bloated up to the size of giant pillows. That’s what he should have done, dammit. Now it was too late.

Mary Linnen’s cardiologist had said that PPH survival rates were about four years and Mary had developed the disease the previous summer. Alex assumed that meant she had two or three years left. He shouldn’t have assumed anything, he swore silently.

But he’d make it up to her. Luck, in such short supply in Mary’s life, came through after Mary’s death. The family, which recognized the importance of an autopsy, had been prepared to pay for one that they could use in court. Still, a contracted autopsy would carry some bias—like a paid expert.

The night Mary died, because of local medical interest in rising numbers of PPH cases, the Massachusetts coroner’s office became involved. They arranged the postmortem, and they drew on one of the most prominent medical examiners in the field. In essence, they were giving their stamp to a critical review that determined Mary Linnen had died of pulmonary hypertension—caused by the ingestion of diet