“She was born with it,” Donald had said. “The diagnosis was originally made when she was nine months old and the patient has been on various antibiotics and medications since then. According to her medical records, her original pediatrician diagnosed acute asthma that would worsen when she entered her early teens. Mary went through her early teens fine, but the condition did worsen when she reached her twenties. Surgery was recommended at that time, but her insurance company instead opted for a high-level antibiotic therapy which she underwent with minimal success.” Donald had paused, taking a quick survey of the room, making sure his point was well made. “The nodes in her bronchial tubes have only gotten worse, forming bronchitis and heavy scarring in her lungs. Ms. Hess is highly susceptible to pneumonia. The slightest cold can lead to the condition and, left untreated, could kill her. She is now at the point where the condition will steadily worsen, filling her lungs with fluids and effectively drowning her. The antibiotics have had no effect on her now for the past three weeks and a ventilator is only prolonging the condition. Without surgery to excise the nodes and extract the fluid from her lungs, she will eventually require the assistance of a breathing machine, which will require permanent in-house care. This could lead to a number of conditions that could hasten her demise or prolong it; complete respiratory failure, being the chief one. That in turn will lead to a coma and my God, consider how much money that will cost if that were to happen?”
Eddie later told him that despite his obvious sarcasm at that last remark, his little speech had worked. It had helped that Bernie was filling in for the droid Red Rose had on their payroll who posed as a physician. Bernie had said a few words to the executive on his left and, judging by the man’s face, it was serious enough to merit his attention. The executive relayed Bernie’s message down to his colleagues and the verdict was rendered immediately. Mary Hess’s surgery would be paid in full, including all post-op care. Prolonging the life of their “member” wasn’t their primary focus; preserving their financial bottom line by paying the fifteen thousand dollars necessary for her surgery, as well as the five thousand dollars that would be required for the post-op work, was more attractive than millions of dollars paid out over the possibility of her lifespan, should she live that long after succumbing to complete failure of her respiratory system. That didn’t include the lawsuits that would no doubt be filed against Red Rose on her behalf by her family.
Donald remembered that incident quickly and smiled at Michael. He hoped his confidence would convey itself to the young man. “I’ve reduced the executives at Red Rose Insurance to cowering puppies, Michael. Don’t worry about them. You’re in my care and I’ll go to bat for you if we run into any trouble with them.”
“How much will the surgery cost?” Michael asked, his eyes wide, his features still bearing his nervousness.
“That’s not for you to worry about,” Donald said, putting his arm around Michael and leading him to the door of the examination room. “In fact, I don’t want you to worry about this. Doctor’s orders. You’re going to be fine.”
Michael paused at the door and turned to Donald. “This surgery...how...is it necessary even if it does turn out to be cancer? I mean...don’t they treat cancer with radiation or something?”
“If the blood work comes back showing the white and T cell activity that suggests cancer, then a surgical procedure called a radical inguinal orchiectomy is performed where an incision is made in the groin and the testicle is removed through it.”
“So you don’t, like, cut through the ball sac?”
“The scrotum? No, Michael.”
“You have to actually take it out?”
Donald continued with the condensed medical lesson. “It has to be removed to be examined in the lab to see what kind of cancer it is. If a tumor called seminoma is found and it is verified that we caught it early in the first stage, treatment will be the surgery itself and a mild dose of radiation therapy to the abdomen where the abdominal lymph nodes are. If the tumor is nonseminoma, then the lymph nodes in your abdomen will be removed following the radical inguinal orchiectomy, to be followed again by either radiation or chemotherapy. It’s difficult to tell you now what the treatment options are without knowing exactly what we’re dealing with, but it’s important that you get those tests done today.” Donald made his order clear with a direct look into Michael’s eyes. “Do you understand?”
Michael nodded, rubbing his face with a shaky hand. “Yeah. I understand.”
“Good.” Donald clapped his hand on Michael’s shoulder. “Get those tests done and I’ll call you tomorrow. And don’t worry...everything will be fine.”
“Will this...surgery...will it affect my sex life or my ability to have kids?” Michael’s voice was low, barely a whisper.
“Not at all,” Donald said. “You will be able to function normally within a few weeks after the surgery, and it won’t affect your fertility rate at all. In fact, I’ve had several patients who later became fathers after having undergone treatment for testicular cancer.” Donald smiled again. “You’ll be fine, Michael. I understand that the mere thought that you might have cancer is scary, but trust me when I say testicular cancer is highly curable. In fact, if you’d like, I can send a couple of pamphlets home with you that explain things further. Okay?”
Michael nodded. “Yeah.” He looked a little better. “That would be great.”
“I’ll get them and leave them with the front desk for you to pick up when you check out.” Donald checked the clock. He was three minutes late for his next appointment. “I’ll call you tomorrow with those test results,” he said.
“Okay. Thanks, doc.” Michael held out his hand and Donald shook it.
“No problem, Michael.”
As Donald headed back down the hall for his next appointment he made a mental note to confer with Dr. Schellenger at Lancaster Urological Medical Group regarding his probable diagnosis of testicular cancer for Michael Brennan. He would recommend Dr. Schellenger to perform the radical inguinal orchiectomy if his schedule permitted it, and he would let Dr. Schellenger’s Medical Assistant know that Red Rose was the insurance carrier just in case the two had to face the panel of men who thought they were doctors.
Just another day, Donald thought as he put on his best friendly physician’s face and entered Examination Room #4 to greet his next patient for the afternoon.
CHAPTER TWO
MICHELLE WAS SITTING in the cubicle that had been assigned to her for her latest gig—creating a data warehouse for a manufacturing firm—when her cell phone rang. She pulled it off her belt clip and answered. “Hello.”
“Michelle?” It sounded like Sam Greenberg.
“Speaking.”
“Sam Greenberg, Michelle.” She felt her hopes rise. “I’m calling to formally offer you the position. Is April 3 still a good start date for you?”
“Absolutely!” Michelle felt giddy with excitement. “I’ll be there bright and early.”
Sam laughed. “Wonderful. Let me be the first to welcome you to our team. I’m very glad to have you on board.”
“I’m glad to be a part of your team, Mr. Greenberg,” Michelle said. “Thank you.”
When she hung up she paused briefly, ignoring the flickering screen of the laptop in front of her. It was Friday, her last day on this assignment. She’d have a week off to relax and get things in order at home which she’d been wanting to do, then she’d start the new job bright and early the following Monday morning. It was the perfect transition. All that was left was to inform the consultant group she was working for now that she’d be unavailable for a while. Common par with contractors.
The rest of the afternoon flew by for Michelle Dowling.
SHE TOLD HER fiancé, Donald, the news when he arrived home from work.
“That’s great!” Donald said, sweeping her up in his arms. She hugged him, felt his sandpapery face rubbing against hers as he kissed her. “We’ll have to celebrate.” He headed toward the win
e rack in the kitchen. He was still wearing his white lab coat, which he thought made him look more doctorly; she thought it made him look like a mad scientist. “Do we still have that bottle of Chablis?”
“Yep,” Michelle said. She’d arrived home from work an hour before and had already gotten dinner started—a casserole in the crock pot. “It’ll go with this casserole I have.”
“Good.” Donald found the bottle and was rummaging for the opener in the junk drawer. He found it and began fumbling with the cork, tongue sticking out of the corner of his mouth in concentration. “So you really got it then. This is great news. And the pay is what they offered you in the first interview?”
“Yep,” Michelle began setting the table. “Seventy thousand to start, plus bonuses.”
“Wow!”
With this new salary she’d now be making as much as what Donald made at Crossroads Medical Group. They had talked about the possibility of her quitting her job and returning to her avocation—music and art—if Donald landed a position with a larger, private medical group. Such a position would push his earnings over the six figure mark and would be enough to sustain them for the life they wanted—a modest house in the country, enough money to not only pay the bills and mortgage but have fun with, and then, as they’d been discussing recently, getting married and having children.
The thought excited Michelle for reasons she couldn’t dwell on now. Things had to be taken one step at a time, and with this new job they were already halfway there. The house they were in was in a nice development in Lititz that had recently appreciated in value. Donald had bought it four years ago; it could easily be sold and, with the money from both their jobs, buy them that ranch house in the country they’d always dreamed of. Getting married would be a cinch—neither of them wanted to go through with a formal ceremony. There were few people in her family she’d want to throw a formal wedding party for anyway, and Donald’s parents were open-minded enough to accept whatever their son wanted. They could get married this summer, get the house shortly after and then maybe by fall—
“—it’s what you want?”
“Huh?” Donald’s voice shook her out of her thoughts. She realized she had already set the table. “I’m sorry, hon, I didn’t hear you.”
“I said, are you sure this is what you want?” Donald was leaning against the kitchen counter, his tie loosened around his collar, regarding her with those soft blue eyes. He had a neatly trimmed beard and his wavy hair was cut short and thinning a little along the top. He also kept himself in relatively good shape, too; they both did. Of course, Michelle thought she could lose thirty pounds, but Donald thought her weight was fine. Besides, as he jokingly told her whenever she complained about her figure to him, he liked her just the way she was, which just made her love him more even if she knew he probably silently agreed with her that she could lose weight.
“I do,” Michelle said. “It’s pretty much everything I’ve been looking for in a job.”
“Is it just computer graphics?”
“It’s that, along with some technical writing, designing and laying out technical documentation for both online and print publications, and creating financial reports.”
“So it’s pretty close then,” Donald said. Michelle knew what he was getting at now. Another reason she loved him fiercely. Donald was her biggest supporter when it came to encouraging her to leave the corporate world and strike out on her own with her computer graphics, at least on a part-time basis. She could then devote the rest of her time to her art. He brought the subject up every time they talked about their jobs. Correction: every time Michelle complained about hers. “You wouldn’t be bitching like this if you were doing what you really love to do for a living,” he’d told her one evening after a particularly bad day at one of her consulting jobs. “Granted, even I have bad days sometimes, but not to the extent that you do. If you were making your living with your art, the occasional headaches that arise would not be as big a deal.” She knew what he was talking about and wished she could be brave enough again to go out on a limb to try carving a niche for herself in her chosen vocation, but she did have to pay the bills.
“Pretty close,” she said, smiling. “Close enough that the Crystal Report stuff will be only a minor annoyance. I’m hoping to use the technical writing and design portions of the job to bolster my resume, maybe use them as a springboard to start my own business.”
Donald smiled back. “That’s what I like hearing!”
“I don’t know how it will help me in getting back into art again,” Michelle said.
“You could design CD covers, create advertising for magazines, write press-releases. The possibilities are endless.”
“Yeah, but – “
“Do enough work locally and let people know about your background, it might be enough to get you a couple of jobs,” Donald continued. “You know...some work for a cartoon or a commercial, maybe getting into teaching.”
Michelle laughed. “I need a degree for that!”
“Did you need a degree to produce commercial art for the Wynn Agency?”
“No, but—” Ten years ago, Michelle had become a client of the Wynn Agency, which represented commercial artists of all kinds—photographers, painters, graphic artists. One of their clients saw her portfolio and commissioned her for a series of portraits that now hung in all their corporate buildings around the world. It had been a good paying gig.
“There you go. Excuses, excuses. No buts, Michelle. You set up too many roadblocks for yourself without even trying things. If you put as much effort at directing your energy towards the things you really like to do, that you know you’re good at, instead of working at all these god-awful corporate financial firms, you’d be —”
Michelle felt herself growing a little angry with Donald and tried not to let it show. He was right of course, but he also knew she had no choice in the matter. She had to make a living, dammit! And making forty dollars an hour as a Business Intelligence Analyst paid the bills far better than an art teacher pulling in fifteen dollars an hour at some community center teaching retirees how to use watercolors. “I know, I know,” she said, heading to the refrigerator to finish getting the table set for dinner. “Swim with sharks long enough, you become one.”
Donald stepped up to her and put his arms around her mid-section. “Hey, I’m sorry, honey.” He kissed the back of her neck. “I didn’t mean to push you that hard. I know you hate working in the whole corporate environment thing, and I know you don’t need me to be constantly reminding you that your talents will be better used elsewhere.”
Michelle sighed. How many times have they—had she—gone through this? She knew he was right; knew that the corporate world was unsuited for her, but it was all she knew. Donald was smart enough to recognize it, and he cared enough to encourage and support her through his little pep talks. She also knew that if they were in the right financial situation she’d be able to leave the corporate world and pursue her avocation—art. She turned around and hugged him. “Thanks,” she said. She kissed his cheek. “I know you’re just looking out for me.”
“So stop it!” He finished for her. They laughed.
Donald helped her finish with the table setting, and when she began dishing out the casserole he joined her at the table. “I guess I wouldn’t have been so gung-ho about this if it hadn’t been what I went through today,” he said.
“Oh?” The change in direction of the conversation startled her. They’d started talking about what they were going to do this weekend and Michelle had completely forgotten Donald’s foray into pushing her to leave the corporate world. “Why’s that?”
“I met with Red Rose today,” Donald said. They were eating supper, the night outside was chilly and Michelle heard the heater kick on. “Remember that patient I told you about a few days ago who I diagnosed with testicular cancer?”
Michelle nodded.
“His blood tests came back showing that cancer was a possibility,” Donald
said. “I started getting the ball rolling, contacted a Urologist I know at Lancaster Urological who specializes in this sort of thing, and started getting the paperwork going. Then this morning Red Rose informs us they want more tests because they want to rule out testicular cancer.”
“Rule it out?”
“Yeah.” Donald paused between forkfuls of food. “Bastards would rather pay smaller lab fees to run multiple tests rather than the surgical and biopsy fees that will not only make the diagnosis, but will determine the type of cancer. And in the meantime, letting Michael wait for surgery is just prolonging things.”
“It’ll spread, right?” Michelle asked. She’d listened to enough of Donald’s stories about Red Rose Medical Insurance to know they were run by the most incompetent morons in the universe.
“Sure. Let testicular cancer go long enough and even a seminoma type will spread through the lymph nodes and affect other parts of the body. Lymphoma could develop, certain lung and bone cancers. That’s what’ll eventually kill a patient.”
“And their rationale for wanting more tests is?” Michelle already knew the answer to this, but for some reason she had to hear it in order to grasp the absurdity of it.
“You and I both know that,” Donald said, continuing his supper. “They just don’t want to pay for the surgery. If we go ahead with the surgery anyway, they’ll deny the claim. But if they get Michael to jump through all their hoops in the name of their excuse for ‘determining the best level of care for their member’”, he emphasized the quotations with his fingers, “then they’ll eventually come around. In the meantime we’ll have wasted a few weeks, even a few months, and Michael’s condition could very well get worse.”
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