Brian’s title as chief financial officer far exceeded his actual responsibilities. His education and interest in business administration made him a wizard with the books, and he knew how to evaluate the many business profit and loss sheets that came the way of Horizon in its expansion.
“We’re getting killed, Henry,” came Brian’s opening salvo.
“You’re not telling me something that I don’t know. We’re making greater than 16 percent margin, pretty damn good for the industry, but it’s not enough.”
“You can read the P&L statements as well as anyone. Our capital expenditures, the delay in opening new pharmacies, and the rising prices of drugs are making this a tougher business every day. Walgreen, Rite-Aid, CVS, and that tiny competitor, Wal-Mart, are mounting aggressive marketing initiatives. They’re killing off five percent of local pharmacies every year.”
“We’ve done well over the last few years with our agreements to supply Brier Hospital, local clinics, and physicians’ offices with drugs and medical supplies. We made a fortune with our contracts for chemotherapy medications, EPO for dialysis, cancer, and AIDS patients, and a whole range of hospital supplies, but now…”
Brian’s deal with Henry was to share the profits from Horizon Pharmacy over a certain dollar amount per month. In the last three months, they’d exceeded that target once and only by a hair. Brian, extravagant by nature, aspired to a fat income and he was having difficulty in meeting his own strongly held professional targets, and his family’s material needs.
Brian placed the P and L sheets on Henry’s desk. “How badly do you want to turn this around, Henry?”
“What kind of question is that?”
“It’s a simple question when you face losing everything you’ve worked years to create.”
“I wouldn’t murder anyone, if that’s what you mean.”
“Nobody’s talking about murder, but many drugs are far too potent…I’ll show you the published studies. We could dilute them while maintaining their effectiveness, and by the way, greatly increase our margins.”
“Maintain their effectiveness?”
“The drugs I’m talking about don’t have absolute doses,” Brian said with a thin smile. “We titrate them, that is physicians adjust their doses to obtain a specific effect. The only thing that the users could notice is that they are using more medication to obtain an effect.”
“I don’t know if we can get away with that. They’d catch on eventually.”
“Not if we’re smart, and by smart, I mean not too greedy.”
“We could go to jail!”
“Choose your poison, Henry.” He paused for a thoughtful moment. “You wouldn’t need to know.”
“I’ll think about it. Outline the details for me to review, and then we’ll talk again.”
Henry decided to go along with Brian’s suggestion before he left—after all, what choice did he have? Everyone makes compromises, he thought. I’m no different. Even Teddy had to deal with the devil in Germany, at least until he could get his family out.
Bankruptcy loomed over the horizon. Teddy’s business, bankrupt?
Henry needed to rationalize his decision. His investors, people who held him in high regard, people who trusted him would lose everything. More than one hundred employees, many who have been with Horizon for over twenty years, would lose their jobs. He couldn’t imagine the humiliation. Worse of all, he would hear from Bert Carlin, Ruth’s father.
He would love this—rubbing my nose in it.
Pharmacists substitute cheaper drugs or supplies to increase their profit margins, and nobody gets hurt. This is no different.
The next morning, Brian and Henry sat over coffee. “I’m turning day-to-day operational control to you, Brian. I expect that you’ll do your best to boost our margins in a totally ethical way. That’s the tradition of Horizon Drugs.”
“Of course,” said Brian. “I’d never do anything to compromise our sterling reputation.”
“I’m going to make this work,” said Julie Kramer as Debbie Wallace returned to the office for her third visit. “That should do it,” she said as she injected more saline to expand the small bag in Debbie’s breast. “The scaring from your radiation made immediate reconstruction difficult, but I think we have enough space now.”
“I’m so nervous Julie,” said Debbie, “what will it look like?”
“I’m not going to tell you that it will look exactly like your normal breast. It won’t. At first, it will look a little unnatural, but as it heals, as gravity exerts its effects, and your new breast fills into your bra, it will look nearly normal. We might need to do a little nip here or a tuck there, but you’ll look fine.”
The surgery went well, but Debbie’s postoperative pain was severe especially when she moved her arm. After six days in the hospital, she returned home to begin chemotherapy. She stood naked before her mirror and grimaced at the oddness of her chest. Her new right breast, black and blue from the surgery, sat an inch higher than her left, and compared with the smooth graceful curve of the left breast, the right was lumpy and irregular. The puffy pinkish healing fresh incisions looked uneven. Julie promised this would recede over time.
Each time Matt tried to look at her breast, Debbie turned away.
“I love you,” he said. “Don’t shut me out.”
“I love you too, but I’m not ready.”
It surprised Debbie how quickly she recovered from the surgery. She needed to adjust to Arnie’s absence.
Jordan Goodman, Brier’s busiest cancer specialist, agreed to administer her chemotherapy as outlined by UC’s Stanley Becker. The Brier oncology-hematology program used a converted supermarket, a large outpatient facility, three blocks from the hospital.
The huge parking lot was half-full when Matt drove Debbie in for her first chemotherapy treatment. As they walked toward the East Bay Comprehensive Cancer Center, the traffic on nearby highway twenty-four rumbled in the background. They grasped each other’s hand, turning Debbie’s fingers white with the pressure. The chemotherapy, like her mastectomy, was life affirming and while it came with an array of emotions, one stood out—fear.
“I’m frightened,” she said.
“Me too, Baby.”
“I can’t stand the dread, the hopelessness, and the loss of control over our lives…it’s unbearable.”
“I have the irresistible urge to get back in the car, pack our bags, and get the hell out of town,” said Matt, “but hope’s distant voice of keeps me going.”
“Everything that’s happened in our lives changes us, the good and the bad,” said Debbie. “I recognize for the first time, something that only the neurotic obsesses about when they focus on all those who take our lives in their hands every day. You know them, the airline pilot, the taxi driver, the operator of the thrill ride, and those who control what we eat, drink and breathe.”
“And our physicians,” said Matt, opening the door to the clinic.
“I trust them, just as I trust you, baby, it’s as simple as that. They want me to get better. That’s enough.”
They approached the receptionist, identified themselves, and gave her their insurance information. Katy Howard, a nurse in her late twenties, introduced herself, brought them into a small examining room. Katy took Debbie’s vital signs, and had her sign a six-page Authorization to Perform Chemotherapy form. Most of the document contained a long list of possible side effects ranging from trivial to, as the clinic’s attorneys insisted, death. She wasn’t sure if they fostered informed consent to help her or protect the clinic…well, yes she was sure.
Debbie could see that Katy was a caring nurse, so she downplayed her reaction to the clinic’s questions. As if she were giving a Miranda warning, Katy read from the card. “Are you sure you understand the risks of this treatment, the side effects, and that you have a right to another opinion or a more detailed explanation of these medications…if so, please check this box, and sign here,” she said pointing to the form.
“You’re kidding, of course,” said Debbie, with a broad smile as she held up the document.
“I’m sorry, Mrs. Wallace. They make us do this, or we can’t give you the treatment.”
“I know,” she paused, “and please call me Debbie. I’m sure you understand I’m not all that glad to be here, and this scares the hell out of me.”
Katy took Debbie’s hand, nodded. “Come with me.”
They walked together into a room the size of a small theater at a multiplex cinema. A circular nursing station stood in the center of the room while at its periphery, against the walls, were leather recliners fully occupied but for one. Fluids in glass bottles or in plastic bags ran through clear plastic tubes and into veins.
Katy tied a print blue floral patient gown around Debbie’s neck. “This is to protect your pretty clothes, I love that dress, it’s so cute, and it goes with your blue eyes.”
Debbie looked around the pale yellow room. They’d decorated the walls with photo reproductions of Ansel Adams and Edward Weston. Most patients slept, maybe that was the best way to deal with chemotherapy.
As she sat with her right arm extended, Katy cleaned it with disinfectant and inserted a small plastic catheter into a vein. She hung a bag of salt solution and ran a small amount in to assure the correct placement of the catheter.
“We’ve got to make sure that the catheter is securely inside the vein because if chemotherapy drugs escape, they can be extremely damaging to the tissues.”
“Damaging to the tissues,” she said, “and you’re pumping it into me. That’s encouraging.”
“I understand how you feel, but we’re after cancer cells.”
Katy injected two medications into Debbie’s IV. “The doctors have designed these to prevent side effects.” Next, she hung a glass IV bottle with a hazy fluid. “We’ll run this in over three hours and then you’re out of here.”
“How will I feel?”
“Most of the time, patients feel well, but if you feel sick, push the call button and I’ll give you something. Try to relax if you can. Sleep, read, watch TV or listen to music.”
Debbie somehow managed to fall asleep during the third hour of treatment, waking only when Katy removed her IV. “We’ll see you in three weeks.”
Katy gave Debbie three vials of medication to counteract the predictable side effects of the chemo and a five-page list of complications and treatment advice. “It’s going to get rough, but I know you can handle it.”
Chapter Seventeen
“Arnie, take it easy,” Lois said.
After three days assuring Jack that I was stable, he had moved me into the skilled nursing facility for aggressive rehabilitation.
I had no idea how difficult it would be. I could barely sit upright, and when I did, dizziness and weakness overwhelmed me. At first, I blamed this on the effects of prolonged bed rest, even as they’d used electrical simulators to maintain my muscle tone.
It’s a joke to think that technology can mimic the effects of gravity by stimulating a few muscle bundles.
I noticed that weakness wasn’t my only problem. I had difficulty coordinating my muscles, an aftereffect of encephalitis. I wouldn’t be returning to work for a while.
To prove my mind was intact, I worked the San Francisco Chronicle’s daily crossword puzzle, which I completed easily. I tackled the New York Time’s puzzle, which left me in my usual state of frustration. Lois and I spent time reminiscing about our past. My memory, it seems, was better than hers was, or less selective. Women remembered a few things better than men did, especially any insult, perceived or real, even if it happened eons before.
I wanted to go home, but my limited mobility and the physical therapy I needed made it necessary for me to stay in rehabilitation. Although Lois and the kids came every day, it wasn’t home.
Sandy Katz, my physical therapist, came from the Marquis De Sade school of Rehabilitation. This was odd since when we first met, she looked like a shy high school student with auburn hair in pigtails. Her awe at caring for a respected physician lasted thirty seconds.
At our first session, she shook her head in disappointment. “Don’t be such a pussy, Arnie. Let me see you sweat.”
I sweated and wobbled between the parallel bars, unable to support my weight for more than twenty seconds. In retrospect, Sandy Katz was just what I needed. I’d been an athlete with natural gifts, so I never worked as hard as others did. In my weakened condition, PT with Sandy was more difficult physically and more challenging emotionally than anything I’d done before. Over time, I got rid of the wobble, and my rubber legs were replaced by saplings, and finally by tree limbs. Among my life’s accomplishments, walking again, unassisted, was my proudest achievement.
On the day of discharge, Lois and the kids came to drive me home. Sandy marched into my room pushing a wheelchair. “Have a seat, Doc. It’s time to make room for someone who needs our help.”
I hugged Sandy goodbye. “I can never thank you enough, but if you think you’re going to get me in that chair again, you’d better get someone a little bigger to do it.”
“Don’t be a pain in the ass, Doc, you know it’s hospital regulation.”
I kissed her on her rosy cheek, turned, and walked out. “Tell them to sue me.”
As I walked into the bright sunshine, all my senses were fine-tuned. The air was rich with Jasmine and roses, more distinct than I’d ever noticed before. Maybe this was another benefit of my newfound freedom.
“Let me drive,” I said as we approached our Toyota Sienna minivan.
Lois slid quickly into the driver’s seat. “I don’t think I’m ready for that.”
I sensed a musky aroma. “What’s that smell in here?”
“That’s ‘new car smell’. Becky chose it when we went to the car wash to get the van ready for the big day.”
Becky pouted. “Don’t you like it, Daddy? I picked it out myself.”
“I love it, sweetie. Daddy’s nose must be really sensitive today.”
Lois turned and gave me one of her looks.
The powerful tang made me uncomfortable. “That’s pretty potent, Lois.”
“I think they make that stuff up in a New Jersey lab along with thousands of scents and flavors in our soaps, perfumes, toiletries, beverages, and food.”
I enjoyed the ride home and felt my eyes fill as we pulled up to our tri-level redwood house and parked in the garage. When I walked through the kitchen, I breathed in a strong pine scent. My mind flashed to my childhood home, and my mother scrubbing with Pine Sol, her favorite. “You cleaned the house for my homecoming.”
“You’re surprised. Let me introduce myself, Lois Roth, your wife.”
“I guess that shouldn’t surprise me. You’re the one who straightens up for the cleaning lady.”
Amy grabbed my hand and dragged me down the hall. “Come Daddy, I even cleaned my room for you.”
When we entered her room, it looked uncharacteristically neat. She made the bed herself I saw by the uneven cover and the sheet dangling from one side.
“Whose room is this?”
“Oh, Daddy.”
I picked up the scent of Windex. “You cleaned the windows, too, I see.”
“How could you tell?”
“I haven’t seen those windows so clean since you were six.”
“Oh Daddy, you know I’m only five,” she laughed still holding my hand and now hugging my thigh.
When we returned to the kitchen, our eight-year-old, Becky, stood quietly studying her feet.
“Can I see your room too, Becky?”
“Sure Daddy.”
I followed her to a similarly neat room. I detected the smell of fresh paint. Somebody had hung two pictures on her wall; one was a pencil still life of our back yard with the flowers and trees beautifully rendered while the second was a watercolor of a little girl standing alone in a field of grain, dark clouds overhead. Becky’s message was clear, fear and loneliness. I forgot how talente
d she was and vowed to sign her up for more art classes.
I scanned the room. “You did a terrific job.”
“Daddy,” she hesitated, and then began to cry. “I was so afraid...” she rushed into my arms.
“It’s okay, Becky. I’m fine. Please don’t worry. I’ll never leave my little girl.”
When I returned to the kitchen, I grasped Lois’s hand. “Do you want me to see your room, too?”
Lois grinned. “Oh, don’t worry, you’ll be seeing a good bit of that room. We’ve got a lot of catching up to do.”
“I may not be the man you’re used to right now, Baby. Give the old man some slack.”
“Don’t worry,” she smiled sensually. “I’ll do all the work. You relax and enjoy.”
I went into the great room and collapsed into my recliner, savoring the strong leather aroma as the seat cushion whooshed under my weight.
I turned and adjusted my pillow, struggling for sleep. The flashing 12:00 on the alarm clock said we’d been through a power outage. I flipped on the nightstand light, examined my wristwatch, and reset the clock to 2:15 a.m. Lois’s snore was soft and regular—white noise. I was almost asleep when the first scent molecule reached my consciousness—the acrid odor of fire. For ten seconds my mind ignored the message, and then I sat up, alarmed. I shook Lois, “Wake up—wake up!”
She groaned. “What is it, sweetie?”
“Can’t you smell it?”
“Smell what?”
I stood, glanced around the room. “Something’s burning.”
“I didn’t smell a thing—go back to sleep.”
I returned to bed fully awake now, sampling the air…the faintest trace of smoke then moments later, the undeniable fumes of fire. I turned on the bedside lamp again and when I gazed at the closed door to our room, traces of smoke seeped in from beyond. Now sirens sounded in the distance as I touched the door handle and retracted my hand immediately from the searing hot knob. “Daddy…Daddy…,” came the plaintive distant wail. “Lois…Lois…” I screamed. “Get up!”
The Sixth Sense (Brier Hospital Series Book 3) Page 8
