Ramesh Srivastava did all he could to keep his composure. Here it was after ten at night and he was getting yet another call. To him it has seemed like he’d been on the phone all evening. First it had been his deputy of the department of medical tourism calling to say that his immediate subordinate deputy had called him only minutes earlier with the disappointing news that there’d been a report on CNN of yet another American patient death in a private Indian hospital. It was the third in three days, this time at the Aesculapian Medical Center. What made it particularly newsworthy was that the patient, David Lucas, was only in his forties. No sooner had Ramesh finished that unsettling call than he got a call from Khajan Chawdhry, the CEO of the involved hospital, with all the details as he knew them. Now here was the phone ringing yet again.

“What is it?” Ramesh demanded, with no attempt at sociability. As a high-ranking Indian civil servant, he didn’t expect to be working this hard.

“It is Khajan Chawdhry again, sir,” the CEO said. “I’m sorry to bother you, but a slight problem has developed in relation to one of your specific orders—namely, your insistence there should be no autopsy.”

“How can there be a problem?” Ramesh demanded. “It’s a very simple order.”

Earlier, Khajan had explained the bizarre sequence of events involving David Lucas’s demise, starting with the incipient cyanosis with no airway obstruction, followed by the changes in the heart’s conduction system and a sudden rise in the patient’s temperature and potassium level. As a nonphysician, Ramesh had asked for a translation of the irritating doctor gobbledygook and had been told the man had died of some sort of heart attack/stroke combination as a best-guess hypothesis. Ramesh’s response had been for the attending surgeon to sign the death certificate as exactly that, and under no circumstances ask for an autopsy to be authorized.

“The problem is the wife,” Khajan said sheepishly. “She said she may want an autopsy.”

“People generally do not want autopsies,” Ramesh said irritably. “Did the surgeon talk her into requesting one after I specifically ordered him not to do so?”

“No, the surgeon is well aware of the general negative feeling about autopsies in the private sector, and specifically aware of your feelings in this case. It wasn’t he who has spoken to the wife about an autopsy, but rather another American, by the name of Jennifer Hernandez, who had called her prior to the wife’s even hearing about her husband’s death. It was this Hernandez woman who raised the issue of a possible autopsy by saying several American forensic pathologists were on their way to look at her grandmother, and could look at her husband as well, provided the husband’s body was not cremated or embalmed.”