“Dr. Forester wants to start his own residency program and become the chair,” Scales said. “That’s the unspoken agenda.”
“Of course, I want to start a training program,” Jack retorted, whirling on him. “We’re a teaching hospital. I don’t care who runs it.”
“We don’t need reminding what we are,” snapped Scales. “The question is, do we need a new program that may have detrimental effects on our existing ones?”
“Would somebody mind telling me what’s wrong with the status quo?” persisted Kingston.
“Dr. Kingston has a valid question, Dr. Forester,” Witner said. “You’ve been the ER director for five years now. I was under the impression you had made major improvements down there already.”
Shoulders growing tenser by the second, Jack inhaled and looked straight into Witner’s eyes.
“We’re doing the best we can with what we’ve got, but we’re bursting at the seams and working our staff to death. We need a new ED, we need modern equipment, and we need to fulfill our teaching mission by training emergency doctors.”
“If you’re short-staffed, why not use more moonlighters?” said Bergman. “There’s plenty of residents who’d like to earn a few extra dollars.”
“Because emergency medicine is more than just the acute-care side of the other fields. After med school here, I left and did four years of training in it, and I should know. You have to handle urgent medical or traumatic situations with patients of any age in a chaotic environment—days, nights, weekends and holidays. You’ve got to intubate, put in chest tubes, stabilize fractures, do spinal taps on infants and ninety-year-olds, recognize child abuse, deliver babies, defuse violent patients and much more. Only special training or years of experience can prepare you for it.”
“Sounds like a GP on steroids,” said Allen Capistro, the head of the Division of Hand Surgery.
This brought a fresh wave of laughter, and Jack’s frustration deepened.
“Allen, if a member of your family comes to the ED, who do you want taking care of them—a trained emergency doctor or a moonlighting resident?”
Norman Scales leaned forward and smiled.
“I wouldn’t be so hard on moonlighters, Dr. Forester. For one thing, the moonlighting resident doesn’t think he or she knows it all. They are more likely to call for help when they need it.”
“Dr. Scales,” Jack said, “you make my case. A training program teaches the emergency physician what his or her limitations are.”
“Jack.” Scale’s tone was patronizing. “There are only so many patients. If we add more trainees down there, what happens to our existing internal medicine and surgery residents? I’ll tell you what’ll happen. The quality of their educational experience will be diluted.”
He turned then to Jacob Hansen, the salt-and-pepper-bearded Chairman of Surgery. “Jacob, you’re a major stakeholder in this, and we haven’t heard from you yet. What are your thoughts? Do you not see this as diminishing the training of your residents in the emergency room?”
Hansen appeared to study the backs of his hands for a moment, his face solemn. The room quieted, and he looked up and down the table.
“For one thing, the major issue here is building a new ED. The training program would come later. But, in general, when faced with the prospect of change, we should consider foremost how it would affect patient care. So, the question is this. If we vote to fund a new emergency department, and we then create an emergency medicine residency program, would the result be better care for our patients?” He paused. “I think the answer is yes.”
“Definitely,” Jack assured him, feeling hope rise in his breast.
“Your surgery residents would be pushed aside, Jacob,” Scales said. “What about their future patients?”
Hansen turned to him. “I grant you they would probably see fewer patients—not that they’d complain about that.” A few chuckles greeted this. “But I suspect they’d be better taught and supervised in the context of a program like Dr. Forester envisions, and they’d certainly benefit from working in a modern environment with state-of-the-art equipment. The net tradeoff should be positive.”
Scales frowned. “There’s no guarantee it wouldn’t be the reverse—and I, for one, don’t want to tamper with the hard-earned reputation we have for training internists.”
Several other people began speaking simultaneously, and in a few seconds, the entire table was in a hubbub.
“Ladies and gentlemen,” Witner shouted. “Please! We must move on if we’re going to finish the agenda this morning. I’m going to call for a motion. Are we ready to take this step, or not?”
“I move we drop it,” said Bergman.
“I second that motion,” Scales said.
The hubbub rose again.
“Silence, please,” Witner ordered. “There’s a motion on the floor to drop the proposal for a new emergency department. Any more discussion?”
“Yes.” Gavin rose to his feet. “Colleagues, would you mind if I weighed in with a few words, ex officio?”
Witner stared at him and cleared his throat. “Certainly, absolutely, we were hoping you would,” he said, his voice neutral. “The chair recognizes Dr. Gavin, ex officio.”
Gavin approached the table.
“I’ll get right to the point. Before stepping down last May and passing the deanship to poor Bob McCarthy, I was a firm supporter of Dr. Forester’s vision. I remain so. I’m personally convinced we need a new emergency department, along modern designs, and I believe we can find a way to fund it.”
“Thank you, Dr. Gavin,” Witner said, his voice rising. “Your input is appreciated. Now—”
“I’m not finished, Dr. Witner. Furthermore, I believe emergency medicine would be a good addition to the list of our fine training programs. There are not enough good emergency doctors—able clinicians like Dr. Forester here—to go around. There’s no reason I can see why we shouldn’t train our own, and it will be a blessing to the entire region.
“This isn’t revolution, as the adage goes, it’s just evolution. In light of the additional revenue this Medical Media program will generate, I think it makes sense to proceed. If we want to continue attracting the best students, this is an investment we need to make, and the sooner the better. That’s all I have to say, thank you.”
A murmur spread around the table as Gavin sat back down.
“With all due respect,” Scales said, “this may be putting the cart before the horse.”
“Thank you again, Dr. Gavin,” said Witner. “To view this proposal as evolutionary seems reasonable, and New Canterbury has always stood for progress. The problem here is one of finances. I agree with Dr. Gavin that funding this project is an essential step, but one which will, unfortunately, take a great deal of study. Is there any further discussion?”
The second hand swept around the clock. Chairs shuffled and throats were cleared, but no one else spoke.
Witner nodded. “Then, we have a motion to table this proposal pending further study, and it has already been seconded. All in favor—a show of hands, please.”
Gradually, the hands rose—some hesitantly, some boldly. But more and more rose until all Jack could see was a clear majority against him.
VI
Back Stage
His anger rising with each step, Jack trudged down a seldom-used stairwell near the Flexner Room. Though not the most direct route to the emergency department, it was the least used, and he did not want to run into anyone.
Yanking open the door at the bottom, he found the basement corridor empty. A growl escaped his throat, and he flung his briefcase at the old cinderblock wall, which was smooth from countless layers of paint applied over the past century.
The case bounced and slapped onto the floor, the sound echoing down the corridor. Not only would he like to have it out with Witner, he’d also love to have a personal discussion with Norman Scales, who was obviously power-hungry.
Until Witner entered the pictu
re as interim dean, Scales had gotten used to the idea that change in the emergency department was inevitable. But Witner had rekindled his opposition—nurtured it and fed it. What Witner stood to gain, Jack had no idea. Maybe he was just doing Scales a favor so Scales would support him for the permanent deanship. These political games were making him sick at heart. He was sure finances weren’t at the core of the matter.
Aiming a kick at the old briefcase, he watched it flip and bang against the wall again. Panting, pinpoints of light flashing before his eyes, he heard the sound of rapid footfalls approaching. He didn’t come this way often and had forgotten that the main security office wasn’t far away.
The footsteps grew louder, and a tall, portly man wearing the green pants and white shirt of a security guard appeared around the corner. He halted ten feet away and looked at Jack in surprise. Then he glared at the briefcase, which miraculously was still closed.
Tim Bonadonna, assistant chief of security for the medical center, had been a close friend of Jack’s since they met in the fourth grade at New Canterbury Elementary School, where Jack had been the taller of the two. At six-foot-four, Tim now loomed over him.
“It sounded like someone was being murdered down here. You okay there, partner?”
They approached and shook hands.
“Howdy, Tim. Me and the case just had a little tiff.”
“Well, I’m glad to see you’re the one still standing. Those little buggers are tough.” He pointed at the case. “You want me to arrest the son of a bitch?”
“No, we’ve already made up.”
“What the hell’s going on?”
Jack released a breath and looked away.
“Things didn’t go so hot at the meeting this morning, Tim. I can’t believe it. They shot it down.”
“Your proposal? I don’t believe it, either.”
“The whole damn thing. Tabled.”
Tim shook his head.
“That really sucks, buddy. I know how long you’ve been working on this.”
“I can sum up the problem in two words—Bryson Witner.”
“I never liked that bastard, Jack. He floats around this place like King Tut on a golden barge.”
“Only two people spoke up in favor of the proposal—Jacob Hansen and Dr. Gavin. He’d gotten to everybody else.”
“Dr. Gavin? He’s back from Brazil?”
“You bet. Got in last night.”
“Well, there you go.” Tim thrust out his jaw. “Maybe he’ll throw that arrogant dude out on his arse.”
“We can hope.”
“And we’ll throw a party when it happens,” Tim added. “Speaking of entertainment, when are you going to come catch a performance?”
Tim Bonadonna was an actor, and a very good one. He was currently playing Falstaff in a University Players production of Henry IV, Part 2.
“Soon, man, soon.”
“You keep saying that.”
“I mean it.”
“You’d better. Hey, watch this.”
The large man drew himself up, arched an eyebrow and pointed at the briefcase.
“Be this some novel sport, Doctor—abuse of the attaché? Or did the undoing of your scheme at the morning’s assemblage of swineherds also undo your wits? But, yes, a plague upon me—your visage bespeaks it all! By the nonce, I shall help to scourge thine enemies. I will lift Witner on a pike!
“But what is this change I see in your eyes? Can it be that if I continue these silken words you might grow vexed and strike me? Ah, but now I recall me how once you did bloody the nose of Harry Lee, bully foul, when I was but a runt and he did push me into a nettle bush, and because of this, I will this cajolement cease, and—”
“Please, you’ve cheered me up. Jesus Christ, I’ll come. I promise.”
“How’d you like it?”
“Not bad. In fact, that’s pretty good.”
“Excellent. Let me buy you a coffee.”
“Raincheck, Tim, I’ve got to work. But glad I ran into you.”
“Likewise. How’s your brother doing with this change in weather?”
Tim Bonadonna was one of the few people who seemed to enjoy the one-sided nature of conversations with Jack’s reclusive brother Tony.
“Fine. He moved into the barn last night.”
“Good. Listen, don’t forget dinner at our place next Friday. Sonia asked me to remind you, being familiar with the way you neglect your friends.”
“Thanks, and give her my love.”
Jack watched the bulky figure disappear around a corner, then examined the briefcase for damage—nothing major—and headed down the corridor toward the emergency department, which was on the far side of the complex. He strode rapidly, despite his fatigue, past the tunnel that led to the old nurses’ residence, by a row of teaching labs that were only storerooms now, by the pathology department offices and the morgue. Finally, he arrived at one of several back entrances to the ED, his heart pounding as if he’d just run a mile. He set his jaw and stepped in.
The noise, action and brightness hit him like a refreshing wave. He had never liked the term “emergency room.” It was true this had once been a single room, but that was long before his time, back when that single room was staffed by just a nurse and maybe an intern, and there’d been a portico outside for horse-drawn ambulances. That had long since given way to a bustling warren of corridors and thirty-five separate rooms, though most of them were just tiny cubicles separated by curtains. Some were set aside for special purposes, like the eye-nose-and-throat room, and the two gyn rooms with stirrup stretchers for pelvic exams; and there was the large suite that contained all the necessary equipment to deal with several major trauma cases. There was a cardiac arrest room and three psychiatric rooms with padded walls, and a room near the lobby with wallpaper, soft lighting and a couch where loved ones could grieve. When all the rooms were full and people kept arriving, as happened almost every day, patients were simply put on stretchers up and down the hallways.
Though the New Canterbury emergency department was a cobbled-together, noisy, bustling, congested warren, it was still his. Jack gazed around almost fondly.
Just to his right, here in the very back of the department, was an area that had once belonged to the pathology department. Walls were moved, and it was now called Suite X, an observation area that predated Jack’s tenure here; it could hold three stretchers, separated by curtains. It was space the ED needed, but it was less than ideal for two reasons.
For one thing, it was remote. For another, it was right next to the main autopsy room, separated only by a sheet of drywall, meaning patients lying in there could hear the sound of necropsies being performed—the plop of organs tossed into the weighing bucket, the whine of a bone saw removing the top of a skull.
Not long before Jack arrived five years before, an elderly woman had died in Suite X, unattended and forgotten by the staff, discovered dead by a family member the next morning. So, one of his first actions as the medical director had been to install a video camera connected to a monitor in the central station.
However, the only real solution to this ED’s problems—of which this was just one of dozens—was new construction, period.
He stepped around a stretcher in the hallway, dodged a sprinting RN and entered Suite X. Over by the back wall, near a door that, for some reason, still gave access to the autopsy room, lay an elderly man reading a magazine. He had a bandage on his head. Next to his stretcher sat an old woman, knitting. The autopsy room was quiet.
“Everything okay, folks?”
“Yes, thank you, Doctor,” said the woman. “They told us he could have something to eat, but they haven’t brought anything in yet.”
“I’ll check,” he said, going back into the corridor.
At the California hospital where he’d taken his emergency medicine residency training, Jack had worked in an ultramodern ED. It was designed in six semicircular “pods”—one for acute medical cases, one for minor cases, one
for pediatrics, one for trauma, a psych pod and, lastly, a dedicated and well-monitored observation area. Each region had a raised central station around which the rooms were arrayed, so that every patient was visible. No one got stuck in a corner and left alone. That’s what the proposal had been all about, a variation on this paradigm.
He stopped a technician and asked her to check on a meal for the patient in Suite X then went by the central station toward his office.
The central station sat roughly in the middle of the department and measured about twenty-by-fifty feet. It was bordered by a waist-high counter, and it served as a work area for nurses, medical students, residents and physicians. Two secretaries occupied alcoves on either wing to answer phones, take care of pages and operate the pneumatic tube system that sent specimens of body fluids to the laboratory. His office lay at the front end of the central station next to Gail Scippino’s; she was the new ED nursing supervisor.
Several nurses and residents and the secretaries greeted him as he passed. He nodded and smiled, careful to hide his disappointment. It was the people who mattered—the staff and the students and the patients—not the politics. He knew most of them believed he was going to make things better; he had never been shy about sharing his vision and hopes. Now what could he tell them?
Wally Deutch was bent over a chart at the far counter and hadn’t seen him. Jack slipped by. The time to tell him would arrive soon enough. God willing, Wally wouldn’t really just quit. At some point soon, he’d have to break the news to all the others, too—all the colleagues who’d looked to him for leadership and believed in his vision. But not now.
VII
Travelers Meet
The Amtrak swayed, and Zellie Andersen felt the clicking become fainter and less frequent. Leaning close to the cool glass, she watched the superstructure of a bridge flash by. Down below, she made out the dark band of a river. Having studied the map, she knew it was the Seneca River. They would reach New Canterbury in a matter of minutes, and sure enough, buildings began to flash past.
Out on the platform, a gust of frigid air took her breath away—it had to be twenty degrees colder here than in Manhattan. She strode into the little station, taking note of the junk food wrappers and ticket stubs littering the floor. The windows were thick with grime, and the air was stale. A rolled-up disposable diaper lay on one of the orange plastic chairs. Hopefully, the rest of the town wasn’t like this. If it were, she wasn’t going to linger. Do the article and go home. No, just take notes and bolt.
Final Mercy Page 4
