Contents
Title Page
Dedication
Acknowledgments
Prologue
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
Chapter 35
Epilogue
About the Author
Also by Michael Palmer
Copyright Page
To my sister, Susan Palmer Terry, and all those others who have battled against breast cancer
ACKNOWLEDGMENTS
In preparing to write The Society, I used my mailing list and web site to hold a contest in which I asked my readers to share accounts of both their misadventures and gratifying experiences with managed care. There were many, many entries. In the course of reading this novel you will encounter a number of these stories. In fact, I did not find it necessary to make up any! So, special thanks to all those who submitted their tales, especially finalists Dr. Louis Borgenicht, Fay McEleney, Lisa Reagan, Vicki Kozlowski, Martha Ficklin, Dr. Jack Langley, John Lynch, Dr. Lamont Weide, Bev Spellman, Judy Converse, Dr. Mark Dahl, Jill Adams, Laurie Peterson, Geoffrey Kent, Dina Mason, Doug Ansell, Melissa Smith, and Jodi VanMeter.
I feel so fortunate to have the friends and experts in my writing life that I do.
Jane Berkey, Don Cleary, and Peggy Gordijn at the Jane Rotrosen Agency continue to be there for me at every turn.
Bill Massey and Andie Nicolay at Bantam have shepherded this book through each step.
Susan Terry, Daniel Palmer, Robin Guilfoyle, and Mimi Santini-Ritt have been my special readers.
Lt. Cole Cordray, Eve Oyer, Officer Matthew MacDonald, and Dr. Bud Waisbren have given me technical help.
Paul Fiore has helped keep me in shape for the rigors of novel writing.
Bill Wilson and Dr. Bob Smith have taught me patience and given me the ability to write 500 pages one page at a time.
Luke remains the enduring constant and life force behind everything I do.
PROLOGUE
4,013,864.
Marcia Rising tilted back in her chair just enough so that neither her chief financial officer Leonard Smith, seated to her right, nor Executive VP Dan Elder to her left could see what she was writing on her legal pad. She was expected to take some notes at these meetings, anyhow. After all, she was the boss. Smiling inwardly, she added an ornate dollar sign in front of the 4. At the far end of the broad mahogany table, Vice President Joe Levinson droned on. Levinson was the cost-containment officer for Eastern Quality Health, and as such was responsible more than anyone except Marcia, herself, for the managed-care company’s strong financial picture. But as a speaker, he was as animated and vibrant as drying paint.
“. . . We took last quarter’s slumping numbers as a strident warning—a shot across our financial bow, if you will—that we had to renew incentives among our employees and physicians in the area of cost containment. The in-house contest we ran was most successful in this regard. Almost immediately there was a twenty-one percent increase in claims rejected outright, and a thirteen percent increase in those surgical claims that were bundled for payment together with at least one other claim. There were some complaints from doctors, but nothing Bill’s physician-relations people couldn’t handle. . . .”
Four million . . . thirteen thousand . . . eight hundred . . . sixty-four.
Marcia wrote the numbers out longhand, then she added touches of calligraphy to the figure, which was her salary for the preceding twelve months. Factor in her eight million in unexercised stock options, and she was well into the upper echelons of female executives in the country. The numbers had a delightful rhythm to them, she mused, perhaps a conga. She imagined a kick line of her nineteen hundred employees, snaking its way through the building.
Four mill-ion thir-teen kick! . . .
Marcia was more than pleased with the way her officers had responded to the recent dip in corporate profits. Her philosophy of one set of premiums and coverages for companies with younger, healthier employees and another for those who might have a more risky, older crew was infallible.
“If they don’t get sick, they can’t cost us,” she had preached over and over again to her minions.
Let some other company cover those who are running out of time or won’t take care of themselves. Every dollar spent researching the demographic makeup of a company (blacks get more hypertension, diabetes, and kidney failure; Asians are ridiculous hypochondriacs; Hispanics have too much alcoholism, drug addiction, and mental illness; thirty-somethings are okay, forty-somethings are not) would return hundreds in the form of payouts that Eastern Quality Health wouldn’t have to make.
Eight hun-dred sixty-four kick! . . .
“. . . And so, as I see it, our company has weathered a passing financial squall,” Levinson was saying, “but there are major storm clouds on the horizon for the entire industry. Still, our ship will remain seaworthy so long as we never lose sight of the fact that our business is all about health—that is, the health of Eastern Quality.”
To laughter at his rare humor, and a smattering of applause, Levinson bowed slightly and took his seat. The meeting was, to all intents, over. Marcia stood and encouraged her officers to maintain their vigilance, to bring problems and ideas to her attention sooner rather than later, and never to lose sight of the goals of Eastern Quality Health—not to be the biggest HMO, but rather to be the most efficient. Then she crossed to the door of her suite and shook the hand of each of them as they left. Finally, she settled in behind her desk and gazed out at the reflecting basin and double fountain that graced EQH’s fifteen-acre campus on Route 128, eighteen miles north and west of Boston. The setting sun had already dipped below the tree line, yielding to a still, cloudless evening. Arranged neatly in labeled wire bins on her desk was two or three hours of work she expected to complete before going home. Seldom was she not the last EQH employee out of the building.
Marcia brushed a minuscule crumb from her Armani jacket and started with a review of reports from the team of attorneys handling one of several suits pending against the company—this one centered on confusion over whether or not a particular policyholder had the coverage for a bone marrow transplant. EQH’s position was, of course, that she did not, although, as of the woman’s death six months ago, the question had become moot. Still, her annoying husband’s unwillingness to accept the truth was prolonging a resolution. Marcia dictated a carefully worded letter demanding that the lawyers stand firm at a settlement of $50,000 with no admission of culpability. It was to be that, or nothing.
Outside her third-floor window night settled in as she reached for the next set of reports. Finally, at nine, she gathered her things in the Moschino briefcase her husband had given her, straightened her desk, then her skirt, and headed out to the elevator. Floor two of the garage, the so-called officer’s parking lot, was accessed only via the elevator, and only with the aid of a pass card. Marcia pulled her overcoat tightly about her and stepped
out into the raw March night. She knew what vehicle each of her upper-management officers drove, and took pains to encourage them to choose automobiles reflecting their personal success and, through that, the success of EQH. Besides her Mercedes SL500 Silver Arrow convertible, there were still two cars in the lot—utilization management director Sarah Brett’s Infiniti, and chief of physician relations Bill Donoho’s Lexus. Marcia made a mental note to reward them both for their diligence.
She was nearing her car when she felt more than heard the presence of someone else in the lot. She whirled at the sound of footsteps. A man, fedora brim pulled down to the bridge of his nose, hands in his trench-coat pockets, had left the shadows and was approaching her.
How in the hell had he gotten out here? she wondered angrily. This was absolutely the last screwup for Joe O’Donnell. If you couldn’t trust your security chief, who in the hell could you trust? First thing in the morning, O’Donnell was history, and none of his whining about five children was going to save him this time.
Marcia’s pulse shot up at the sight of the man, then slowed as she took in the situation with the quick, analytical thinking that had become her trademark. There was a security camera sweeping the lot from just above the doors to the elevator foyer, so maybe one of the two guards on duty would spot the stranger. Managed care was at times a controversial and emotional business. Her executive officers were encouraged to have a legally registered handgun. Hers was locked in the glove compartment of the Silver Arrow, but if this was trouble, there was no way she could reach the car in time. She peered through the gloom trying to get a fix on the man’s eyes.
Dammit, O’Donnell!
Less than ten feet away, the intruder stopped. By now, Marcia was certain that this was no one associated with EQH.
“Who are you?” she demanded. “How did you get out here?”
“Mrs. Rising, I have something for you.”
A woman! Marcia felt her pulse surge once more.
“Who are you?” she said again, her voice breaking.
The woman—slender with a narrow face and eyes still shielded by her hat—withdrew her left hand and passed over an envelope. Her calmness and the coldness in her voice tied a knot of fear in Marcia’s chest. She stared down at the envelope, which she now held.
“Go ahead,” the woman urged. “Open it.”
Marcia fumbled the envelope open and withdrew two cards, each three inches square. On one, carefully printed with some sort of marker, was the unadorned block letter R. On the other was a T.
“What is this? What’s this all about?”
She stumbled backward toward the Mercedes, the letters and envelope still reflexively clutched in her hand.
Before her, the woman calmly withdrew a pistol from her coat pocket, its muzzle covered by what looked like a rubber nipple.
“My God, no!” Marcia cried. “Don’t do this! I have money. Lots of money. I’ll give you whatever you want.”
“This won’t hurt as much as it should,” the woman said, firing from four feet away into the center of Marcia’s chest.
The CEO was reeling backward when a second shot, fired almost from the hip, caught her squarely in the throat.
The woman slid the silenced pistol back into her trench-coat pocket and turned toward the door.
“Sleep tight,” she whispered.
CHAPTER 1
“Drained.”
“Wiped.”
“Fried.”
“Burnt.”
“Oh, that’s a good one.”
“Okay, whose turn is it?”
“Dr. Cameron’s.”
“Hell no, lass. Not me. I just did tuckered out.”
“Then it’s Dr. Grant’s turn.”
From his position across the operating table from his partner, Will Grant surveyed the three nurses and, finally, the anesthesiologist.
“You sure?” he asked.
“It’s you, all right,” the scrub nurse said.
“I can’t think of any more.”
“Well you damn well better, laddie,” Cameron said, his Highlands brogue as dense as it had been when he moved to the States a decade and a half ago. “Give me a sponge on a stick please, would you, Mary? Thank ye. Now, Will, today’s word was your idea. T’would be a travesty for you to lose the whole shibickie and end up buyin’ the beers for this motley crew.”
Before he could reply, Will yawned widely enough to displace his paper surgical mask off his nose.
“Seems like I should have picked some word other than exhausted,” he said as the laughter died down. He turned his head to allow the circulating nurse to reposition his mask. “But it was the only one I could think of.”
“No surprise there,” Cameron said. “We should allow ‘Dr. Will Grant’ as a legal answer to this one because, laddie, you define the term. I couldn’t believe it when I heard you were covering again tonight.”
“Four days of alimony.”
“What?”
“Every extra call night I take from you guys translates into four days of alimony paid—more if I get a case.”
“Which you almost always do. Well, we’re getting ready to close. Sir Will, my trusty assistant, do you have any reasons why we shouldn’t go ahead and sew up this lucky bugger?”
“Stomachs R Us,” Will said. “You did a really nice job getting that tumor out, Gordo.”
“You forgot to add ‘as always.’ ”
“As always. How about prostrate?”
“Debbie did that already,” the circulating nurse said. “I’ve been keeping track. Fatigued, winded, frazzled, run down, wilted, sagging, flagging, weary, sucking wind, tired, overtired, dog tired, dead tired, worn out, prostrate, whipped, spent, leaden, run down, pooped, too pooped to pop, baked, toasted, enfeebled, haggard, tuckered out, plumb tuckered out, drained, wiped, fried, and burnt. You only have until Dr. C. gets the last clip in.”
Will flexed his neck muscles, which, after a three-and-a-half-hour case, felt as if someone had injected them with Krazy Glue. It was only a slight exaggeration to say that the last time he hadn’t been some form of exhausted was eighteen years ago when, at twenty-three, he started medical school. Med school, internship, surgical residency, vascular fellowship—he often wondered if he had known, really known, about the call schedules; and the interminable hours in the OR; and the early morning emergencies; and the office practice; and the continuing-education responsibilities; and the staff meetings; and the mushrooming malpractice premiums; and the ambulance chasers, and the diminishing financial returns brought about by managed care; and ultimately the divorce and supplementary nights on duty to make ends meet, would he do it all again the same way. The answer, as always, was yes—except, of course for the managed-care part.
“Last clip coming down, laddie,” Cameron announced, lowering the final surgical clip dramatically toward the incision.
“Petered out,” Will blurted at the last possible second.
Silence held sway as those in OR 3 polled one another.
“We’ll give it to you, Will-boy,” Cameron said finally, “as long as you assure us your answer isn’t merely a description of your sex life.”
Fredrickston Surgical Associates was a four-person group, headquartered in the Medical Arts Building, a block away from Fredrickston General Hospital, a fully designated trauma center thirty miles southwest of Boston. The four surgeons rotated call with three others, although in any given seven-day stretch, Will would take on one or even two nights in addition to his own. Today, Tuesday, he finished seeing patients in the office, then trudged back to the hospital through the raw, gray afternoon. James Katz and Susan Hollister met him for sign-out rounds outside the surgical intensive-care unit. Katz, now in his late sixties, was the patriarch of the practice, if not the entire hospital. He was as stiff in his manner and speech as he was in his posture, and to the best of Will’s knowledge, no one had ever mentioned him telling a joke. Still, the man was universally beloved and respected for his digni
ty, his skill in the operating room, and his ability to teach residents and other physicians.
“Weren’t you just on call, Will?” he asked.
“That was two nights ago, and it was incredibly quiet. Steve Schwaitzberg wants to chaperone some sort of overnight with one of his kids’ classes.”
“Is he going to pay you back with a night?” Katz pressed.
Whether it was his liberal politics and interests, his relaxed dress and manner with the patients, or his inability to keep his marriage together, Will sensed he had, for some time, been Katz’s least favorite of the three younger associates. Still, the two of them had always been on decent terms, although there was invariably some tension when the subject of Will’s extra call nights came up.
“He probably will pay me back,” Will said, knowing—as doubtless did his senior partner—that the truth was being stretched.
“Don’t you see the twins on Tuesdays?” Susan asked.
As reserved and conservative as Gordon Cameron was flamboyant, Susan had preceded Will into the practice by two years. A competent surgeon, she was quite slender and attractive in a bookish way, but to the best of Will’s knowledge had never been married. For several years, she had been dating a businessman—at least according to her she was. Will had never met the man, nor had Gordo. And from time to time, Cameron would speculate that Susan’s businessman was, in fact, a businesswoman. Regardless, Susan had gone from being reserved and somewhat distant from Will before his divorce to being a concerned friend, worrying about his health, his children, and even his social life. One of the rare times Will had allowed himself to be fixed up was with a former Wellesley College roommate of Susan’s. Had he taken years of acting lessons, he couldn’t possibly have been less himself than he was that night.
I’m just not ready, he reported to Susan after the spiritless evening. We didn’t have anything in common. She was a human being.
“I do have the kids, yes,” he said, “but tonight’s our regular night at the soup kitchen, so I’ll just take call from there until I bring them home. Speaking of the Open Hearth,” he added, determined to divert the subject from his taking too much call, “we’re always looking for volunteers to serve.”
The Society Page 1
