by Gen LaGreca
“Mr. Secretary, would you like to move the conference indoors?” an aide asked.
“Why, no. We shouldn’t let a few dark clouds scare us.”
The secretary reassured New Yorkers that CareFree would triumph because it was a noble plan. His thick white hair brightened the darkening scene like a beacon atop a lighthouse. His impassioned voice sparked hope.
After his introductory remarks, the secretary delivered his message: “Fees paid to hospitals and doctors will be reduced by fifteen percent in order to meet CareFree’s temporary financial challenges, which the providers themselves have caused with actions that were self-serving rather than public-spirited.”
He felt a sudden jolt at the sight of a young man joining the crowd that had gathered. The man, who was a wearing a doctor’s white coat, had probably wandered over from a nearby hospital. A disturbing image of himself as a young doctor under siege flashed through the secretary’s mind. Was he now the Bob Martin and Charles Fox in the life of the physician before him, making unfair accusations that everyone would believe and that the doctor would be helpless to combat? His mind slammed a door on the unwelcome thought before it could gain a foothold. Another, more comforting idea hurried to replace it: He reminded himself that he was working for a noble cause—the good of the people. Thus, his actions were justified.
He continued his speech with added vigor. “CareFree guarantees everyone the right to medical care. The doctors have a duty to provide that care, and I have an obligation to see that they do. If any doctor flagrantly and willfully violates the law, I will personally impose stringent consequences. We cannot permit lawlessness. I will uphold the rules so that the public can receive all the benefits of CareFree.”
Lightning flashed in the distance. It was soon to strike closer.
* * * * *
The same dismal sky blanketed Manhattan that afternoon, subduing its glorious cityscape to a cluster of black shadows in gray space. Inside the executive offices of Riverview Hospital, the board of directors was meeting to elect a chief of neurosurgery. The group had invited David Lang to address them prior to their private deliberations and vote. In their pinstriped suits, they sat on swivel chairs around a glass-topped conference table, listening to hospital administrator Randall Lang enumerate David’s credentials. To the board, the surgeon, who sat beside his brother, appeared calm. Only Randy could detect the troubled look in David’s eyes, which made him decide that it would be better if his brother spoke as little as possible.
David reminded himself of how close he was to unveiling the secret of healing that the nervous system had so cleverly hidden. In time, he would heal, too. He warned himself that if he gave his word, he would have to honor it. For as long as he could remember, he had viewed a promise as a sacred commandment never to be broken. He reassured himself that there was no reason to feel uneasy. Hadn’t he already taken the necessary steps to keep his vow? He had begun to curtail his practice. He had hired an additional secretary whose sole job was to ensure his compliance with CareFree. He had resolved to enter and leave his office from a back door that bypassed the waiting room, to avoid contact with unauthorized patients attempting to see him. And he had cleared his desk! He had taken steps to bring himself closer to CareFree and to distance himself from the growing number of desperate patients who somehow managed to find him.
He wished the meeting were over. His head was beginning to ache. He wanted to be happy at the prospect of completing his research, but he could feel nothing. The vision of a young dancer swept across his memory, and with it the special joy of a free spirit. But he must not think of that particular image—of a free spirit—at this meeting. He forced his mind to concentrate on the simple task at hand. He would be asked to give his word, and he would do so. Then he would steadfastly stick to his plan and keep his promise. By virtue of this one vow, he could complete his years of research and resolve questions left unanswered through the centuries.
The sound of Randy’s notes dropping onto the table forced David’s attention back to the meeting.
“Now that I’ve enumerated David Lang’s qualifications for the director’s post, I’ll pause for your comments and questions,” said Randy.
“David’s clinical qualifications are unquestionable,” said the chief of staff, an aging man with tired eyes. “But Randall, you haven’t mentioned his research, which I understand would be supported in the chief’s post.” He turned to David. “We know you’re working on a new surgical treatment for nerve repair. What are the chances you’ll succeed?”
As David opened his mouth, about to indicate the great promise of his work, Randy jumped in, faster and louder. “Don’t worry, Sam. When you consider the scientists who’ve tried over the years, and they had unlimited access to animals, what could possibly come of David’s paltry efforts? He’ll putter around the lab with the research fellows, but what can we expect from a few modest studies of such a massive problem?”
David flashed Randy an angry look too subtle for anyone else to detect, and Randy sent David an apologetic shoulder shrug. Randy had neglected to tell David that the board was expecting him to fail.
“So let me allay your fears,” Randy continued, the undertone of bitterness detectable only by his brother, “and assure you that the prospect of trail-blazing a cure to one of medicine’s greatest problems is unlikely.”
The treasurer, a big man with sagging shoulders, turned to David. “In the old days when we operated like a corner grocery, being inundated with customers wanting a new product would have shot profits through the roof. Oh, yes! Your new treatment would’ve been like finding a mother lode—back then. But times have changed.” He shrugged his shoulders indifferently. “Whether that’s good or bad isn’t for me to say. As a businessman, my job is to adapt to changing conditions, not question them. So, I emphasize, Dr. Lang, that today an onslaught of additional patients needing costly procedures could trigger a financial catastrophe for the hospital. If CareFree accepted your new treatment and paid us enough to perform it here, fine. But that’s a big if. What if CareFree accepted your procedure but assigned too low a fee to the hospital for your patients? What if CareFree set our fee so low that we had to provide your treatment at a loss?” The others nodded in agreement. “We must avoid that risk at all costs!”
“Dr. Lang’s new procedure would treat very sick patients,” commented another board member. “There could be expensive complications that CareFree would never have anticipated in fixing our fee. And, of course, once they put on their price tag, we’d be stuck with it for everybody who had the treatment. Where would we be then?”
“I understand,” said David.
“I’m sure you wouldn’t want to cause the financial ruin of this hospital, Dr. Lang,” said the vice chairman.
“I wouldn’t,” David replied.
Charles Hodgeman, the chairman of the board, cleared his throat thunderously. He was a husky man with thinning hair and an intimidating voice. “Aside from the research angle, I’m concerned about Dr. Lang’s shaky compliance record with CareFree.”
The others quickly nodded their agreement.
“Let me be blunt, Dr. Lang,” Hodgeman continued. “CareFree is here to stay, like it or not. I’m a realist, so I accept the conditions of doing business in this age. I want to know whether you’re a realist, too. Because if you should get in hot water with CareFree, you could pull Riverview down with you. If unlawful practices were performed here, we could lose our accreditation. The BOM could close us down in a heartbeat, and they’d be damn glad to do it, too—it’d help their budget. That’s why I want your personal guarantee that you won’t act like a loose cannon.”
David rose, his proud bearing and steady eyes evoking confidence, despite the board’s skepticism.
“Ladies and gentlemen, what you’re saying about me is true, and you’re justified in being concerned. I have resisted CareFree because I believe that medicine is a private matter between a doctor and patient, and none of th
e state’s business. However, I realize that I can no longer survive in medicine with this viewpoint. For the sake of my career, I have resolved to comply with the rules fully. I am determined to be a . . . model . . . CareFree . . . doctor. I give you my . . . promise.”
Because the only response was a conspicuous silence and a few eyebrows raised skeptically, Randy thought it prudent to provide an additional incentive: “You know that other hospitals in the city have closed because they couldn’t survive the rising costs of compliance, coupled with the reduction in their fees by CareFree. Riverview Hospital has survived, and many of you have personally thanked me for that. If Riverview is to remain viable, I need to work even harder in the future. Having key people in important positions helps me sleep at night, and my sleeping habits should be of concern to the board, if Riverview is not to fall the way of Memorial, Columbus, East River Medical—”
“All right, Randall, you’ve made your point,” said the chairman. “But we must avoid at all costs any misguided idealism. We want realists who know how to play the ga—”
He paused at the sudden entrance of an aide.
“Excuse me,” said the man, handing papers to Randy and the chairman. “A message from CareFree just came for Mr. Hodgeman and Dr. Randall Lang for their immediate attention.”
The chairman frowned as he read the correspondence. “This is pretty bad,” he declared to the others. “CareFree has just announced a fifteen-percent cut in our fees . . .”
The others gasped.
“. . . and they’re warning the medical profession that there will be hell to pay for those who don’t comply with the rules.”
“The bastards! This isn’t fair!” Randy blurted out involuntarily, his eyes burning with indignation.
The chairman shrugged his shoulders, his eyes as dull as the ashes of a fire long extinguished. “Fairness is irrelevant. It’s a policy we’ll have to live with somehow, so there’s no use getting angry,” he said flatly, turning to Randy. “I want you to inform our clinicians immediately of CareFree’s statement. Then I want you to devise ways to monitor their activities more closely. We need stricter controls. We need to look at the way these doctors get access to radiology, to imaging, to surgery, to anything they want. We need more internal forms, procedures, approvals, and protocols. We need to hire more administrative staff to curtail the doctors’ activities. We have to show CareFree that we can police ourselves, so they’ll let us remain a free enterprise.”
“I’ll take care of it, Charles,” Randy replied, pocketing the notice. “Now what about the matter at hand?”
“Oh, yes, the matter of catapulting medicine into the next century,” the chairman said, snickering.
“The matter of providing me with peace of mind, so I can figure out how we can take a hit for fifteen percent and still not go belly-up,” Randy replied.
The chairman stared at the inflexible face of his administrator and the unreadable face of the surgeon. “Dr. Lang, reassure us again, please. Do we have your solemn promise that you will do nothing in the OR that hasn’t been approved, certified, permitted, authorized, and endorsed by CareFree?”
David saw pages he could not tear from his memory. He saw seven years of careful experiments, painstaking records, tedious analyses. He saw a dream that kept him alive more than the air he breathed.
“Mr. Hodgeman, you have my word of honor. I promise to do only what is permitted. I swear I will obey the rules.”
Chapter 10
On Shaky Ground
“Am I interrupting?” The blond head of Randall Lang appeared at the door of David Lang’s office.
“Come in,” said David.
The surgeon was at his desk, dutifully tending to the day’s crop of documents, which had sprouted like new weeds just when he thought that he had cleared them all.
“You made it, David! You’re our new chief of neurosurgery. The announcement will come tomorrow.”
“Thank you,” David said, standing up.
The two men of the same height and features, one in a business suit and the other in a doctor’s coat, shook hands across the desk.
“Now that CareFree is tightening the torture rack for the heretics, you didn’t reform a minute too soon.”
“I suppose,” said David, walking around the desk toward his brother.
“The day you see a sign over the entrance to a building that reads ‘Institute for Neurological Research and Surgery,’ you’ll know you did the right thing.”
“I hope so.”
“Picture the staff, the laboratories, the surgical suites,” Randy said excitedly, his face raised and his arms outstretched, as if standing before a temple. “Picture yourself as the medical director and me as the administrator! We opened the first door to that goal today. Once everybody sees what a failure CareFree is, nothing will stand in our way.”
“I don’t know,” said David, his gaze drifting out the window, the gray sky reflecting in his eyes. “I sometimes wonder what makes CareFree possible. It doesn’t seem to be a concern with success or failure.”
“If the system doesn’t collapse, I’ll get that institute anyway. I’ll find a way, so help me!”
“How? By selling our souls?”
“Don’t think that.”
“Haven’t we already?”
“We’re doing what we must. What recourse do we have?”
David had no reply.
“Hi, guys!” His wife appeared at the door, a swirl of auburn hair swinging above her white doctor’s coat, a narrow border of brown skirt showing beneath it. “What happened at the board meeting today? I’m dying to know!”
“The board has approved your husband as our chief of neurosurgery.”
“Wonderful!”
Marie flung her arms around David’s shoulders and kissed him. His arms remained at rest, his face expressionless.
“Don’t look so glum, honey. You’d think you were voted chief of funerals.” She turned to Randy. “It might take David time to get used to respectability. But I think he’ll like it. I think we’re about to see a new David.”
“Yes, a new David, a brilliant surgeon who conducts medical experiments and makes revolutionary discoveries,” Randy replied.
“A new David who’s finally accepted among the city’s top doctors. I’m so proud to be the director’s wife!”
David said nothing.
“I knew you’d make it. I already made dinner arrangements to celebrate,” Marie continued.
David was planning to work late that evening, but felt he owed Marie her celebration. “Okay,” he said, forcing a smile.
“By the way, David, I invited someone to join us tonight.”
“Oh, who?”
“It’s a surprise, but I think you’ll be pleased,” she smiled gaily, her arm around his shoulder. “The new David will be pleased.”
Her smile froze at a sudden tension in his body. He heard before the others the staccato footsteps approaching his office and recognized their urgent tempo. He turned to the door a moment before his secretary appeared there.
“Dr. Lang, you’re wanted in the ER. There was an explosion nearby that damaged several buildings. The police think it was caused by a gas leak. About two hundred people are injured. The ambulances are arriving!”
“Oh, dear!” Marie’s words hit the back of the man who was already out the door.
* * * * *
The healers and the wounded crammed the ER. Doctors and nurses came from wherever they were when they heard the news. They arrived in white coats, in hospital scrubs, in business clothes, in tennis shorts, in sundresses. They came to tend to the bundles of bloody clothing and burnt flesh arriving on stretchers.
Beyond the swinging doors of the ER, David heard sirens wailing and glimpsed ambulances gridlocked on the ramp. Beyond the swinging doors on the opposite side, he saw the waiting room being transformed into a makeshift ward by the infusion of white clinical uniforms, linen, and bandages. His wife and others were gat
hering there to assist the injured.
Under the glaring fluorescent lights of the ER, at a command post of work spaces behind high counters, nurses were making a flurry of phone calls—to search for more stretchers, to locate rooms for new admissions, to alert Surgery to impending cases. Phones rang plaintively, computer screens flashed, pagers buzzed, monitors beeped, respirators whooshed, and all the time, the wounded moaned.
White-coated doctors flew to meet blue-clad rescue workers bringing in the victims. Doctors examined the wounded while keeping stride with the rolling stretchers. Staff members in hospital scrubs questioned the victims, jabbed them with needles, wiped blood from their faces, and held their hands. When all of the beds were occupied, rescuers left the injured on stretchers, on chairs, or on the floor, so they could return to the ramp for a new load. Hospital workers stepped over an obstacle course of wounded flesh.
Glass-enclosed rooms with life-support equipment received the most serious cases:
“He’s unconscious.”
“Her pressure’s crashing.”
“He’s bleeding out on us.”
The steady hands and sure voices of the healers brought calm to chaos:
“Let’s get a chest film.”
“Start a second IV.”
“Sir, can you hear me? Where does it hurt?”
“He needs a chest tube.”
“Call the OR. Tell them we’re on our way up with a ruptured spleen.”
“This woman’s in labor. Call OB.”
“This guy just stopped breathing. Call Respiratory.”
And, as a sheet was pulled over a victim’s face, “Call the morgue.”
