The Killing Vote

by Bette Golden Lamb

  He arrived at the hospital at 7:00 a.m., an hour earlier than his usual time. After touring every satellite at least twice, upsetting the nursing staff with his repeated drop-ins, he knew the time had come to get out of their way. Leave. No one wanted administration watching their every move, and asking inconsequential questions. Even the doctors were beginning to toss hostile glances. No one said a word, but body language told him it was time to disappear.

  He returned to his office to wait for Garrett Rudge’s arrival.

  While he sat staring at his office door, his thoughts returned to the woman who was destined to become a prototype for Desisto.

  His stomach wrenched and his hands started to shake violently.

  No! No! I can’t vote against her! I can’t!

  He was on the bitter edge of breaking down, of breaking a long-standing rule: Do not drink at work.

  One experience of almost getting caught nipping Scotch had ended that habit. He swore he would never take that risk again. But the bottle still remained in the locked bottom drawer of his desk.

  He moved to his office window, still thinking about whisky, how it would burn its way down his throat. Then Rudge’s Mercedes pulled into the parking lot.

  Holt glanced back at the desk drawer where the liquor was hidden, shook his head. He slipped into his suit coat, gathered the papers he would need, and squared his shoulders as he left his office. Holt and Rudge walked into the conference room at the same time. They nodded their usual unenthusiastic greetings to one another, and took their seats. The other members of the committee were already seated.

  The Administrator could feel the CEO’s eyes probing him, but Holt refused to make further eye contact. While the nervous tension started to invade the room, an iciness that started at his ankles and rose to his neck made him shiver; yet his palms were wet with perspiration.

  Holt did a quick visual roll call—Silver, Wolfe, Bradberry, Michaels, Rudge, and himself, plus a woman from the Medical Secretaries department, who would be responsible for the minutes of the meeting. When he turned back to his notebook, he could sense Rudge continuing to study him as he opened the proceedings.

  After Holt turned the meeting over to Rudge, the CEO stood to speak but was instantly interrupted by Rev. John Bradberry

  “Yes, John?” Rudge said. “You have something urgent to put before the committee?”

  “Yes!” Bradberry said sharply. “We must postpone this meeting.”

  “Your request is out of order.”

  “And that’s an inappropriate response.”

  Rudge’s face reddened. But before he could respond, Bradberry continued.

  “Advocates for the elderly have been noticeable absent from these proceedings. Neither CORPS nor anyone else, has been informed about these deliberations, let alone invited to—”

  “Come, now, Reverend, Galen’s had a standing ethics committee since the mid-eighties.”

  “This is not the same kind of committee. In fact, that long standing hospital group continues to function on a regular basis.” He looked around the table. “Our panel is not part of the Galen Ethics Committee. Our existence has never been made public, nor have we invited other community members to attend.”

  “And your point is?” Rudge asked.

  “I think Bob should adjourn today’s meeting until we can notify relevant community leaders about our agenda and request their input.”

  “That’s totally unacceptable,” Rudge said.

  “Reverend,” Zach said, “I understand your concern, but we’ve been struggling with this for six difficult months. Personally, I think we should get on with it.”

  “Exactly my point,” Bradberry said. “Getting on with it? Is that the kind of atmosphere we want for something like this—”

  “I don’t think additional time and input,” Clifford Michaels said, “is going to make our decision any easier.”

  “This is not supposed to be easy.” Bradberry shuffled papers in front of him. “We’re dealing with complexities here that far outweigh anything—”

  “We’re all aware of that, Reverend,” Rudge said.

  “Who represents Della Paoli?”

  “We all represent her!” Rudge snapped.

  “Do any of you even know what the woman looks like?”

  “She would be the person who cannot move any part of her body.” Rudge said. “Is that the answer you want?”

  Bradberry pointed at Rudge. “That’s a cheap shot.”

  “You’re being obtuse, Reverend. This is a community problem; the people on this committee represent the community.”

  Bradberry looked around the table again. “Far as I can see, Clifford and I are the only so-called community members. And you’ve spent six months bombarding us with a bunch of corporate PR.” He glared at Rudge. “All the other members of this committee have a biased connection to Galen and Hygea.”

  “Reverend, you’re not the only one concerned about patient needs. I’m just as concerned as you are, so is the hospital staff,” Sarah Silver said.

  “Then why have these meetings been kept under wraps?”

  “Because we can’t allow the public to dictate hospital policy,” Rudge said.

  “I think you’re giving the public short shrift.”

  “Really? How many people do you think would appear if we ran a newspaper ad announcing an open meeting of the Galen Ethical Review Committee?”

  “I have no idea,” Bradberry said. “But if you mentioned selective euthanasia, you’d probably have to hire an auditorium to handle the turnout.”

  Rudge looked around the room for support. Everyone avoided his eyes. “I think people are as well informed as they want to be!” He turned to Holt. “However, if Reverend Bradberry wants to put the question of postponement to a vote, then we should call for a second.”

  “I see nothing wrong with that,” Holt said, still refusing to look in Rudge’s direction.

  “I second the motion” Michaels said.

  “May I have a show of hands opposed to Reverend Bradberry’s motion?”

  At first, only Wolfe held up his hand. Then Michaels did the same.

  “All right,” Holt said, holding his breath, “those in favor?”

  Bradberry’s hand shot up immediately. Holt followed with a tentative half-raised hand, eliciting a stony stare from Rudge. “Sarah?” Rudge said. “Apparently it’s up to you to break the tie.”

  She rearranged herself in her chair, glanced quickly at the other committee members, and said quietly, “I abstain.”

  Rudge, unable to contain a smile, said, “It appears we have a tie.”

  Reverend Bradberry snapped his pencil in two, tossed it down on the table, and leaned back in his chair, eyes closed.

  * * *

  “Moving on,” Rudge said, fully in charge again, “we’re going to hear from Patricia Evans, one of Galen’s social workers. She’s been investigating the designated case of Della Paoli.” He nodded stiffly toward Bob, who used the intercom to call in the case worker.

  Patricia Evans entered with a determined step, took a chair, and opened a slim file in a poised manner.

  Rudge wished Holt had selected someone who projected more warmth. He cursed himself for not having taken care of it himself.

  The case worker glanced at the committee members, then began to read unemotionally from her report:

  “I’m Patricia Evans, senior staff social worker with Galen Hospital. I was assigned to the Paoli case two days ago.

  “The nature of my investigation was to look into the woman’s background; find and communicate with any relatives and friends; report on any findings that would be relevant to her treatment and ultimate disposition.

  “Unfortunately, I was unable to obtain any useful information from the patient herself. And the only other data available was on her driver’s license.

  “Using that as a source, I went to her apartment and spoke to her landlord and neighbors. No one seemed to know much about the
patient.

  She lives alone; her husband died approximately six months ago from a heart attack. She apparently has no children, nor other close relatives; and she’s lived at her present address about five months.”

  As she stopped to turn a page, Bradberry interrupted. “Are you saying that after five months in one place, no one knew anything about this woman beyond what you’ve told us?”

  Evans looked up from her reading. “One neighbor did seem to have a little more background than the rest, but—”

  “Is this information in your report?” Bradberry said.

  “No! I wasn’t able to confirm her statement.”

  “I’d like to hear it anyway,” Michaels said.

  Rudge waved a hand for Evans to continue.

  “Essentially, Mrs. Paoli told her neighbor that she’d spent most of her life moving from place to place. Apparently, her husband was a traveling musician.”

  “Did Mrs. Paoli work?” Silver asked.

  “She supposedly worked as a waitress at various times, and also took occasional house cleaning jobs.” Evans paused, then added with an edge of impatience, “I think we could save some time here if I read the statistical data.”

  Rudge winced at her tone of voice but Evans looked down at her file and continued:

  Della Paoli. White. Sixty-six. Born August 2, 1947.

  Widowed approximately six months.

  No known children. No known blood relatives.

  Occupation: Flower vendor

  Resides in a one-room furnished apartment, rent $500 per month, plus utilities.

  Owns an eight-year-old station wagon.

  Checking account: $23.14; savings pass book showing $502.34. No evidence of any insurance —supplemental medical, life, or automobile beyond PL & PD.

  Evans flipped her folder shut with a heavy sense of finality.

  “She has no one at all?” Silver said, her voice dropping almost to a whisper. “Not even a close friend?

  “That’s what my investigation indicates.”

  “I thought you said something about her working as a waitress and house cleaner,” Wolfe said. “Yet, you list her occupation as ‘flower vendor.’ I don’t understand.”

  Evans cleared her throat. “According to her neighbor, Mr. Paoli had a five-thousand-dollar life insurance policy. The proceeds apparently were used to cover funeral expenses, and open a flower stall.”

  “Sounds like she was doing fairly well on her own,” Wolfe said.

  “Not necessarily. She didn’t own the flower stall, she merely rented the space at an exceedingly low rate. This, I discovered, is not unusual—surrounding businesses like the color and atmosphere of a flower vendor, so they make it financially attractive for a person to operate one. All that was required was the first month’s rent and enough money to purchase her first inventory. After that, it should have paid for itself.”

  “Did you question the surrounding merchants?” Bradberry asked. “Perhaps they might be willing to help her.”

  “Of course I spoke to them. They didn’t know her very well, and they didn’t seem to be interested in her situation.”

  “But you said she did have automobile insurance?” Holt said, his fingers drumming rapidly on the table.

  “Property damage and personal liability only. The only insurance of any benefit to Mrs. Paoli is her Medicare.”

  “I wonder what prompted her to sell flowers?” Silver said.

  “I have no way of knowing that. I’ve told you everything I was able to learn.”

  Wolfe asked Rudge, “Do you have copies of Miss Evans’ report for us?”

  Rudge nodded. He picked up the copies and passed them around the table. “Now, if there are no other questions—”

  “Just a moment,” Wolfe interrupted. “I’m really uncomfortable with the sparseness of the information on this woman.”

  “Miss Evans can’t be held responsible for obtaining what isn’t there,” Rudge said.

  “True,” Wolfe said. “But it might help if she could provide us with her professional insight.”

  Evans looked at Rudge who nodded his permission.

  “As I reported, the woman’s life is a virtual blank.” Evans stopped and thought for a moment. “Considering her physical condition, she has very little to sustain her—no family, no friends, no support group.”

  Most of the committee members were visibly uneasy. After a long interval, Rudge said, “Thank you, Miss Evans.”

  The social worker nodded, picked up her folder, and left the room.

  * * *

  Clifford Michaels interrupted his detailed note-taking, looked up at Rudge. “Garrett, after listening to Ms. Evans’ report, I realized that there must be thousands, or millions of Della Paolis out there.”

  “No doubt. And your point?”

  “I’m thinking about those who work hard for every penny they get,” Michaels said, “yet never have much of anything—the kind of people who are never going to own a home, be able to buy a new car, or ever have more than two or three outfits of clothing. How many of them will face the same fate as Della Paoli when they’re terminally ill or physically and mentally helpless?”

  “We’ve covered that, and quite thoroughly, Clifford,” Rudge said. “Some people will simply have more choices than others.”

  Michaels stared at the ceiling. “There is a huge difference between have some choices and having none.”

  “Don’t you think you’re overreacting?” Rudge said

  “Overreacting?” Bradberry interjected before Michaels could respond. “Not if you add in old people, poor people, handicapped people, street people, black people, brown people, yellow people, red people, you have staggering numbers of those who will find themselves in the same hopeless situation as Della Paoli. Do we simply say, ‘Sorry, there’s no more space, no more money for you’?”

  Rudge’s face turned a bright red. “You’ve gone far off track, Reverend. Our only concern here is with one person, Della Paoli. She’s alone, she’s very ill, she’s helpless—probably terminal—and without financial resources.”

  “Society may not be doing much for people like Della Paoli,” Bradberry said, “but as Ms. Evans pointed out, she does have Medicare. She doesn’t have to be tossed out into the street.”

  “No one’s talking about tossing her into the street,” Rudge said, his voice getting louder. “But let me be blunt about this, Reverend: her only real prospect is to rot in some extended care facility, at great expense to the taxpayers. This committee has the unique opportunity to set a precedent which will allow patients like her to die with dignity.”

  “I’ve had it up to here with that ‘death with dignity’ crap,” Michaels said, raising his hand to eye-level. “We’ve each seen all kinds of people die, under all kinds of circumstances. There’s never anything dignified about it. It’s a dirty, messy business.”

  “But everyone has to cross that threshold,” Bradberry said. “At least it deserves as much dignity as we can provide.”

  “John, that’s a nice bit of philosophy,” Holt said, “but the truth is that we don’t want to see others dying, slowly or in any other way. It reminds us of our own mortality.”

  “Don’t you think we should have the right to determine the time and place of our own death, if at all possible?” Silver said.

  “Yes, I do,” Holt said. “But in Della Paoli’s case, we don’t know what she wants, or if it’s possible to know what she wants.”

  “Bob,” Wolfe said, “I know what she wants. So do you. It’s what any of us would want.”

  “I certainly don’t want someone standing over me, deciding whether I should live or die, not have any say in the decision?” Holt said.

  Rudge’s eyes bored into him.

  “Wait a minute,” Silver said. “Considering Mrs. Paoli’s condition, you really don’t know what she wants?”

  “No, I don’t”

  “She’s paralyzed, man,” Silver said. “She’s completely he
lpless. For me, being trapped like that, with a functioning mind, would be the most terrifying existence.”

  “That’s your opinion, Sarah,” Bradberry said, “but that still doesn’t tell us how Della Paoli feels, does it?”

  “And she’ll never have that ability,” Rudge said.

  “Who the hell made you God?” Michaels said. “I understand, she can communicate in a rudimentary manner.”

  Rudge could see that Holt wanted to support Michaels. Twice he cleared his throat, ready to speak again, but one glance from Rudge stopped him.

  “No one is trying to play God, Clifford.” Our goal is to find a way to help Della Paoli.”

  “True, she may be the woman of the hour,” Bradberry said, “but that’s by no means the extent of it. Not by a long shot.”

  “I’m not sure I understand your meaning,” Rudge said.

  “I mean, would you and Hygea have needed this committee and six months of meetings if Della Paoli was your sole concern?”

  “Right now,” Rudge said, “all any of us need to be concerned about is Mrs. Paoli.”

  “You’re a liar, Garrett Rudge,” Bradberry said, pushing back from the table. “How can you sit there and deliberately lie. This is supposed to be a medical ethics committee. What we decide will have an effect on all of society, not just the patients of Galen Hospital.”

  “Reverend, you’ve made a lot of noise here this morning,” Rudge said. “You’ve pounded us with your ‘the sky is falling’ negativity. But you’ve yet to come up with any constructive counter proposals.”

  “Garrett, I don’t have to prove you’re wrong. What you’re doing here is unethical, short-sighted, and flat out deceptive.

  * * *

  Bob Holt sat with notebook open, pen in hand, playing the role of dedicated administrator to the hilt. But his entire body was damp and clammy, clothes soaked with sweat.

  He believed the Reverend, knew he spoke the truth. But his inner voice was more of a whisper than a shout. And he was frightened.