by Robin Cook
“You might be right,” Brian said, getting to his feet and starting for the kitchen. Instead of following, Aimée headed toward the foyer. “Aren’t you coming, too?” he asked.
“I think I should go and give Hannah a hand, and I think Juliette needs your undivided attention.”
He nodded and continued into the kitchen. To his surprise Juliette wasn’t there, just Camila rinsing the dishes and putting them in the dishwasher.
“Where’s Juliette?” he asked.
“She’s upstairs in her room,” she said. “She suddenly said she wasn’t feeling well and wanted to go to bed. To tell you the truth, although I wasn’t happy to hear her say she wasn’t feeling well, I was glad to hear her say something. It was the first time she has spoken since she woke up.”
“That’s not good,” Brian said, recalling Jeanne’s warning about regression.
“She did look a little flushed to me and I thought I saw her have a chill, so I took her temperature. It was 101.”
“Uh-oh,” Brian voiced. “Why would she have a fever? But wait! Is 101 a fever for a four-year-old?” He knew temperatures varied considerably during the day, even in adults but more so in children.
“Interesting you asked,” Camila said. “I questioned it myself, so I googled it. I got the impression that anything over 100.4 could be considered a fever, but it’s sort of borderline. But combined with her saying she doesn’t feel well the last few days, it makes me nervous.”
Remembering also that Jeanne mentioned Juliette might develop psychosomatic symptoms, he wondered if that could include a fever. He truly didn’t know, and despite his EMT medical knowledge, he’d not had much pediatrics experience. Although he was mildly reluctant to call Jeanne the same day he’d met her for fear of taking advantage of her generosity, he thought the potential fever issue serious enough to overcome his hesitation. Sitting down on the banquette, he took out his phone and Jeanne’s old business card. After giving Camila a brief description of Jeanne’s professional qualifications, he placed the call, hoping Jeanne wouldn’t think he was being too pushy by calling so soon. It had to ring a number of times, and just when he thought her voicemail message was about to start, she answered. He could tell she was out of breath. After he gave his name, he asked if he was calling at an inopportune moment and if she was still at Megan Doyle’s.
“Heavens no, on both accounts. I’m glad to hear from you. I’m on my bike in Inwood Hill Park not too far from the Indian Caves. It just took me a minute to get my phone out of my back pocket.”
“I’m sorry to interrupt what must be a fun ride,” Brian said. “But I have a specific question, if you have a moment. You mentioned that my daughter might have psychosomatic symptoms in response to my wife’s death. Can a fever be a psychosomatic symptom?”
“Good question! If I remember correctly, fever can definitely be a psychosomatic symptom. But I think it has only been seen in children considerably older than your daughter. You said she is four, correct?”
“Yes, she’s four, but also like you suggested, just today she seems to be behaving as if she is much younger. She’s stopped talking for the most part.”
“Oh, dear,” Jeanne said. “That doesn’t sound so good. Listen, I can stop by if you would like and see if I can talk with her. I’m generally pretty good with kids. If you are concerned about Covid, I can also reassure you that I had a test just last week that was negative, and I abide by the pandemic rules to the letter.”
“I would appreciate that very much,” Brian said, and gave his house number. He then added that he’d had a relatively recent negative test as well, and as a family they’d been careful about following all the recommended precautions.
“Sounds good! We should be okay in that regard, and I’m on my way.”
After he disconnected the call, he sat at the banquette for a few minutes, thinking how lucky he’d been by striking up a conversation with Jeanne. Even though he’d been fully engaged in the process of raising Juliette, Emma had been most definitely in the driver’s seat. Now on his own, he felt like a fish out of water. “Well, that couldn’t have gone any better,” he said to Camila, who had sat down across from him. “She’s coming over.”
“I hope she can help,” she said.
“I’m going to go up to Juliette’s room and see if she’ll talk. Do you want to come with me, or do you need a break?”
“I’ll come. There’s nothing for me to do in the office.”
On the way up the back stairs, Brian gave Camila a thumbnail sketch of meeting Jeanne similar to what he’d told his mother.
“What a lucky encounter,” she said as they headed along the upstairs hallway and entered Juliette’s room. “She could be a big help.”
Still in her pajamas, Juliette was lying on her side on the bed, facing away. As Brian came around the end of her bed, he could see that her eyes were open and unblinking, yet she didn’t move. She was also sucking her thumb, which she hadn’t done for years. It seemed to him further evidence that she was regressing. Her other hand was clutching Bunny to her chest.
“Hello, Pumpkin,” Brian said, using one of his many endearing nicknames for her. She didn’t respond or even move. “Camila said you weren’t feeling well. Can you tell me what’s wrong? Do you have a sore throat or is your stomach upset?” There was no response. “Camila said you had a chill, is that right?” Still no response.
Brian put his palm on Juliette’s forehead, and she felt warm to him. “How about coming back to the kitchen and we’ll watch something, whatever you want? We’ll watch it together. What do you think? Is that a good idea?” Juliette didn’t move or answer. He looked back at Camila, who shrugged her shoulders as if to say “I told you so.” Redirecting his attention back to Juliette, Brian said: “I want to take your temperature again. Should we do it here or in the kitchen?”
“I want my mommy,” Juliette whispered just loud enough for him to hear, and it melted his heart.
“I know you do, Pumpkin,” Brian whispered back. “I miss her, too, but Mommy is in heaven. I’m here and someone else is coming who wants to meet you. Are you okay with that?”
When Juliette didn’t respond or move, he gave her shoulder a squeeze just to make contact. “Okay, I’ll get the thermometer, and I’ll be right back.”
CHAPTER 21
September 1
Jeanne, Camila, and Brian stepped out of Juliette’s room, and all three hesitated at the top of the main staircase. Both Brian and Camila had been impressed with the creative way that Jeanne had managed to interact with Juliette and gotten her to talk. What she’d done was first engage Bunny as if Bunny was the one suffering, telling Bunny that as a little girl, she had a very similar rabbit friend who was so important to her that she’d brought her to America. Jeanne had then asked Juliette if she could hold Bunny, and to Brian’s and Camila’s surprise, Juliette had handed her the floppy stuffed rabbit.
“Oh, poor Bunny,” she had said, stroking its head. “No wonder she’s not feeling well. She’s missing one of her eyes.”
“But she can see fine,” Juliette responded. With that little exchange Jeanne had started a conversation and had been able to switch the topic to Juliette’s symptoms. Within a relatively short time she was able to get the child to admit to a sore throat, a headache, and an upset stomach.
“You certainly have a way with children,” Camila observed.
“Thank you,” she said. “I had a lot of practice being a school psychologist.”
“So, what do you think?” Brian asked.
“I do think Juliette is experiencing psychosomatic symptoms, but I’m a little concerned she might also actually be sick,” Jeanne said. “The fever issue is what bothers me. You say you confirmed her temperature is elevated?”
“I did,” he said. “I took it again just before you got here. It’s 100.8, which I guess is just over borderline.
She has a fever, but not much of one.”
“Whether it’s a fever is beyond my expertise. I’m hardly a doctor, but tell me this: Is there any chance she might have been exposed to the coronavirus? I hate to say it, but there is a very slight chance she could have Covid.”
“Not while I’ve been with her,” Brian said. “And not here in the house.” He looked at Camila questioningly.
“Certainly not here in the house,” Camila said. “We haven’t had any visitors, aside from the medical personnel yesterday, and they were in full protective gear. And I can’t imagine when she could have been exposed on the few times she and I have gone out since Emma was hospitalized. On those occasions we only went to Emerson Playground or Isham Park, and she didn’t socialize and wore her mask. But you know, thinking about how she has been acting makes me think she hasn’t been feeling well for some time.”
“I agree,” Brian said. “Ever since my wife got sick, and Juliette saw her have a seizure, she hasn’t been herself.”
“Well, if we have learned anything over the last eight months, coronavirus spreads remarkably easily in certain situations,” Jeanne remarked. “My advice is that she should at least be seen by her pediatrician. Does she have one?”
“Of course,” he said. “Dr. Rajiv Bhatt on Broadway. Let’s go down to the office, and I’ll give him a call.”
Brian led while the others followed. As they filed in, he turned on the light.
“A nice touch,” Jeanne said as she glanced around. “I haven’t been in too many offices with a crystal chandelier.”
“It was a formal dining room that my wife and I turned into an office for our security business,” Brian explained as he gestured for Jeanne to take one of several side chairs.
“I’m going to get some coffee and then check on Juliette to make sure she is still sleeping,” Camila said. “Does anyone want anything from the kitchen?”
“I’m good,” Brian called out as he searched his contacts for Dr. Bhatt’s office number.
“Thank you, but I’m fine, too,” Jeanne said with a wave.
As the call went through, he looked over at his visitor, who was still dressed in her biking clothes. “You look like you are an avid biker,” he said. “My wife and I were, too.”
“It was the one sport my husband and I did together.”
Brian raised his hand to indicate his call had connected. He listened but didn’t speak, then quickly disconnected and put the phone down. “Busy,” he said.
“Camila seems very committed to your daughter,” Jeanne said.
“She is. Unbelievably so. I am so lucky to have her. We hired her because of her business background, but she ended up moving in with us because of the pandemic. Since then she’s become family in a very real way. I truly don’t know what I’d do if she were to decide to leave.”
“I hope you aren’t offended by my asking,” she said, “and you don’t have to answer if you don’t want to, but I’m intrigued by you saying that you and your wife had a security business. What’s your background to have that kind of expertise?”
“We were both New York City policemen,” Brian explained. “But more importantly we both were graduates of the Emergency Service Unit Academy and then served as ESU officers for a combined total of ten years, which is an extraordinary amount of law enforcement experience between the two of us.”
“Excuse my ignorance, but I’m not familiar with ESU,” Jeanne said.
“It stands for Emergency Service Unit. It’s like special forces with the military. Whenever the NYPD are confronted with someone dangling off a skyscraper or a bridge, an active shooter, a hostage situation, a mass casualty event like 9/11, or even serving a high-risk warrant, we were the ones who were called to take care of it.”
“You mean you were a member of a SWAT team?”
“Special Weapons and Tactics was just one small aspect of our role,” he said. “ESU training was really extensive and intense. We were cross-trained in multiple disciplines and immersed in SCUBA, negotiation tactics, jumping out of helicopters, EMT requirements, you name it. My wife, Emma, was one of very few women who took the training. It was very physical to say the least.”
“My word. It sounds to me like you are overtrained to do mere personal security.”
“That was the idea. We thought we’d be in high demand with our backgrounds. It’s just that the timing turned out to be problematic thanks to Covid-19.” He raised his phone. “Let me try the pediatrician again.”
Brian redialed and listened. He listened for longer than Jeanne expected without speaking and then let out a sigh of frustration before disconnecting. “Damn, he’s on vacation!”
“Did the recording give the name and number of a covering doctor?”
“No,” he said. “I’m not surprised. There aren’t too many pediatricians in the immediate area. What’s suggested in his outgoing message is for anything that can’t wait until he gets back this coming Monday should be seen at the MMH Inwood Emergency Department. He’s made arrangements that the MMH ED doctors have online access to his records if it’s needed for the continuity of care.”
“Might continuity of care be important in Juliette’s case?” she asked.
“It could be,” Brian said reluctantly. “I don’t know for sure, but Juliette was a premature baby and spent her first couple of months in the Children’s Hospital at Columbia-Presbyterian Hospital. That was where we originally met Dr. Bhatt.”
“Okay, that solves it. Let’s have her be seen at MMH Inwood. It might even be easier since they can go ahead and do a Covid-19 test straightaway.”
“I don’t know!” Brian said with a questioning expression. “In the middle of being in for nearly two hundred thousand dollars, the MMH Inwood ED might be the last place I want to take her. Hell, they might even refuse to see her for all I know.”
“They aren’t going to refuse to see her,” Jeanne scoffed. “By law I don’t think they can refuse.”
“Maybe so, but they sure as hell might be less than accommodating or even rude to us.”
“I can’t imagine,” Jeanne said. “The MMH Inwood might be predatory and overly profit centered, but I’ve come to understand there is a definite divide between their clinical side and their billing and collections shenanigans. Not once did I have the impression the doctors doing the day-to-day care had any idea of what was going on on the business side. Of course, whether they should have is an entirely different question.”
“I disagree,” he countered. “With my wife, it was the chief medical officer who saw fit to discharge her, and I’ve been worried it might have been because the hospital wasn’t being paid.”
“Hmmm,” she voiced. “You might be right. Do you know that the position of chief medical officer is a relatively new position in hospitals?”
“I didn’t,” Brian said.
“During my lawsuit and because of my budding interest in business issues when I changed from being a school psychologist to running an alarm company, I’ve spent many hours researching modern-day hospital business practices. It’s eye-opening, to say the least, or maybe horrifying is a better term. One of the things I came to understand was that the chief medical officer, or CMO in hospital jargon, is really an administrator hired by the hospital CEO. Although originally trained as a doctor, the CMO usually has some subsequent business background like an MBA, so their main interests revolve more around hospital costs than clinical outcomes. Although it sounds similar, the chief medical officer isn’t the same as chief of surgery or chief of internal medicine, whose orientation is just the opposite.”
“I had no idea,” Brian said. “I thought the CMO might have been a combined position representing both surgery and internal medicine and still more attuned to what’s best for the patient.”
“No, it’s definitely administrative and mostly geared toward keeping costs down
to maximize profits,” Jeanne said. “I hope I’m not boring you with all this economic minutia.”
“Quite the contrary, but you are making me more concerned my wife was discharged prematurely. I feel so naïve about this current medical world.”
“You and a lot of other people. Unfortunately, it’s all about money. The sheer amount of money involved in healthcare attracted private equity because of the sky-high potential profits. It’s the private equity investors who have forced hospitals to hire a bevy of compensation consultants.”
“What the hell are compensation consultants?”
“They are highly trained businesspeople whose sole goal is to maximize revenue,” Jeanne explained. “They don’t care if the company is a hospital or trucking firm. Their shenanigans and advice have contributed significantly to a major uptick in hospital prices and thereby profit.”
“I thought a lot of hospitals were now struggling financially,” he said, realizing he’d been getting mixed information from Roger Dalton.
“That’s true,” she said. “But that’s just since the coronavirus has forced them to cut back on lucrative elective surgery like joint replacements. Otherwise, hospitals, particularly chain hospitals, have been virtual gold mines thanks in large part to their teams of compensation consultants. It’s the community hospitals and rural hospitals, which are still primarily oriented toward patient care and the neighborhoods they serve, that are hurting. They are either going out of business or being snapped up by hospital chains backed by private equity, which quickly turn them into money-making machines. And it’s happening across the country, thanks to all their compensation consultants and CEOs like Charles Kelley. Welcome to the twenty-first century.”
“It all infuriates me,” Brian snapped. “With what you are saying, I’m even more convinced my wife was discharged because of economics. What a disaster!”
“It’s possible,” Jeanne said. “I give you that. But the point I want to make is that the MMH Inwood CMO and the compensation consultants have nothing to do clinically with what happens on a day-to-day basis in the Emergency Department. No one there will have any idea you owe the hospital money or that the hospital is suing you. And to get back to Juliette, I really think she should be seen and seen at MMH with her medical records available if needed and get a Covid test. Actually, what I think will be more of a problem is that she’s going to refuse to go, but I’ll be happy to help convince her if you would like.”
