by Donna Leon
‘Did your sister tell you this?’
‘Of course not,’ Signorina Elettra said. ‘All she told me was the nickname. I started having a look when I came in this morning.’ Her face hardened and she said, ‘The health system never stops surprising me with the extent of its inattention: its data bank is protected by a system that is an invitation to steal.’
‘“Having a look?”‘ Brunetti asked, choosing to ignore her indignation.
She gave the side of the keyboard an affectionate pat and said, ‘I did the same as I did for Dottor Donato, Commissario. I found her patient list and saw what she’s prescribing.’ She shook her head in feigned disapproval. ‘Much of the medicine is new.’
‘“New” as in “expensive?”‘ Brunetti asked.
‘Yes, and in some cases, very.’
‘How does she get away with it?’ he asked. ‘I thought the health service would at least keep an eye on what doctors prescribe.’
‘They do,’ she answered. ‘But her patient list is enormous, more than a thousand, so what she prescribes for other patients probably makes it balance out to some average cost per patient that the calculations of the health service will accept.’ Her voice veered towards indignation again. ‘They’re very careless. It would take no time at all to flag something as conspicuous as what she’s doing.’
Before she went on to explain the details of this perfect system to him, Brunetti asked, ‘Could you make me charts like the ones you made for the pharmacy?’
‘Of course, Dottore,’ she answered. ‘I’ve got a program that …’ she began but, anticipating his lack of interest, let it drop. She reached for a piece of paper and asked, ‘What would you like me to list?’
‘I’d like one with the people who are taking medicine for psychological problems and one with the people with any form of dementia. Names, addresses, ages, what she’s prescribed for them and its cost. In the cases where she’s prescribed an expensive new drug, give the cost of the generic or the standard medicine she chose not to prescribe.’
She looked up for long enough to smile. ‘Of course, Commissario.’ She bent her head to continue writing.
‘Could you find out, as well, where the prescriptions were filled?’
She nodded quickly to show the ease of this.
The faintest memory of something he had read in the Gazzettino some time – perhaps years – ago flitted through his mind. ‘Could you check to see if she’s ever written prescriptions for people who were already dead?’
She pulled her hand back so quickly that her pen left a black trail across the sheet of paper. ‘What?’
‘It happens,’ he said calmly. ‘At least the Gazzettino told me it happens. If people don’t die in a hospital, the Ufficio Anagrafe sometimes isn’t informed. Or the health service. It can take months, even longer, before they’re officially declared dead.’
Signorina Elettra stared off into space, her face rapt in the consideration of possibilities. ‘So they go to Limbo and stay there, getting their pensions and having prescriptions written for them?’ She shook her head a few times in a gesture that could as easily be admiration as astonishment. ‘Very tempting,’ she whispered.
‘I’m particularly interested in which pharmacy fills their prescriptions,’ Brunetti said.
She gave a smile utterly deprived of mirth. ‘So am I.’ She turned to face her computer, and it was evident that her attention had pulled up stakes and was moving off in the direction he had indicated.
Realizing there was no further need for him to stay, Brunetti went back to his office.
He had bought a copy of that day’s Gazzettino on the way to the Questura, and he could think of no better way to while away the time waiting for Signorina Elettra to call: he knew she would think of nothing else until she had let herself into the information bank of the health system and helped herself to whatever she pleased. He set the newspaper on his desk and looked at the front page, which held a photo of the mayor, smiling broadly, posed in front of a map of the Canale Vittorio Emanuele, the city’s latest attempt to keep the cruise ships coming at whatever cost to the citizens. Brunetti looked upon his works and despaired.
At the bottom right was a small headline about the Carabinieri’s dismantling of a drug ring in the city. See page 27. Page 27 told him that the Carabinieri, after a yearlong investigation, yesterday had arrested six suspected dealers in an operation called ‘Iron Fist’.
The sellers, it was revealed, had worked virtually unobserved near three of the city’s schools, even in the face of complaints from nearby residents and the parents of the students in these schools. Finally, however, ‘the dealers’ time ran out’, and an early morning raid by the Carabinieri led to the sequestration of thirteen kilos of hashish, marijuana, and synthetic drugs and pills. All of the men arrested were in the country illegally; all were taken to the Carabinieri station, questioned, and released with an order to leave the country within 48 hours.
Questions of jurisdiction neither concerned nor much interested Brunetti. Nor did he understand why people took drugs; it might be nothing more complex than that they were there for the having. Brunetti was pragmatic enough to approve of anything that interrupted the flow of drugs into young bodies; beyond that, he took the short view. Maybe the pause in supply would help Sandro Gasparini; maybe his father’s situation would function as a slap on the back of the head and turn his mind to more serious things. Maybe not.
Brunetti saw that there was a pile of new files in his in-tray but ignored them and returned to the front page of the Gazzettino. As usual, he skipped over every article dealing with national politics, sighed at the international news, and ignored sports. That left him precious little, and he was quickly done with it. The options open to him seemed either to hurl himself from the window of his office or accept his responsibilities and read the files.
He slid the newspaper to his left, then turned it over to hide the photo of the mayor and pulled the stack of files towards him. Noon was ringing from the bells of San Giorgio dei Greci when Signorina Elettra appeared at his door and knocked lightly on the jamb. ‘May I come in, Commissario?’
Looking up from the file he was reading, Brunetti observed, ‘Either I hear your news, Signorina, or I continue to read the discussion of how – in the absence of a city law regarding bicycles – to classify riding a bicycle in the city, whether as a crime or an infraction.’
‘I’ve read those directives carefully, Signore,’ she said with every semblance of seriousness. ‘I think it’s better to consider it an infraction.’
Brunetti closed the file and placed it on top of the others that had already migrated to the left. ‘Thank you, Signorina,’ he said. ‘And what do you bring me?’
‘The charts, Signore.’
‘Ah, good,’ he said. ‘Is there anything I should pay special attention to?’
‘No, Commissario. I think the numbers make it clear enough what’s going on.’ That said, she came across and set the papers in front of him then left his office.
Signorina Elettra had commented on how many patients Dottoressa Ruberti had, yet when he looked at the list headed ‘Dementia’, he was still surprised to see that it consisted of four pages of patient names listed single-spaced, each name followed by the name and price of the medicines Dottoressa Ruberti had prescribed. There followed the name and price of similar, often generic, medicines that were also available. In some cases the difference in price was triple, though it was usually a bit less than double. More than half of the prescriptions had been filled by the Farmacia della Fontana.
In the second chart, Dottoressa Ruberti’s patients with ‘Diseases of the Psyche’ – also running to four pages – the same pattern was repeated, as was the name of the pharmacy. The medicines she prescribed for her patients were always much more expensive than the generic products listed beside them.
The third chart – I Morti – introduced a bit of variety. The name of the patient was followed by the date of death re
gistered in the Ufficio Anagrafe and then by dates when each prescription had been filled posthumously. In some cases, there were more than two years between the first date and the last. All but six of these prescriptions were still being filled by the Farmacia della Fontana.
Brunetti found himself thinking of the chicken and the egg. Which would have come first, the suggestion from the doctor that the pharmacist pass on to the health service the cost of the prescription for the more expensive medicine and thus claim the higher refund? Or was it the pharmacist who went in search of accommodating doctors who would write the prescriptions the pharmacist could most profitably process? And which of them would offer, and which of them accept, whatever financial inducement was made?
Brunetti realized he would have to speak to both of them to see what their truths were, but he had better begin with the temptee and not the tempter, if only because this weaker person would be more likely to tell the truth. It seemed to him more likely that the pharmacist would be the tempter.
He turned on his computer and searched for Dottoressa Ruberti’s address and office hours. She would be there today, he learned, in Campo Santa Margherita, not far from Signora Gasparini’s home, until one-thirty, which meant he could easily make his way there, take a seat in her waiting room, and then allow himself to become the last patient of the morning.
For a moment, he considered asking either Vianello or Griffoni to go with him, but he still felt sufficiently embarrassed about his complete misjudgement of Gasparini that he preferred to go alone.
He got off the Number One at Ca’ Rezzonico and walked through Campo San Barnaba, past the fruit vendor’s two boats, covered during lunchtime with green tarpaulins, over the bridge and down towards the Campo. It was already after one when he got there; it took him a few minutes to find the address, just next to the estate agent. The sign gave her name and the hours of opening and asked that the patient ring and enter. He did the first, heard the door click open, and did the second.
He climbed to the first floor and saw another sign, with her name and an arrow pointing to the back of the building. At the end of the corridor was a door with her name on a brass plaque. He went in.
Three people sat in the room, two women and a man. Four chairs were empty. Six eyes observed him as he entered and chose the chair farthest from them. Before he sat, he nodded at them and, at their failure to respond, reached forward and took the magazine on the top of the pile on the table.
The women, he had noted, were both very fat, and the man very thin. He had remarked nothing else about them, nor did he glance up to study them. Instead, he read six reasons to become a vegan and waited. A door opened to the left of the three waiting people, and a woman’s voice said, ‘Signora Tassetto’.
One of the women pushed herself to her feet and, not without difficulty, walked to the door and inside. Brunetti observed the pale-skinned woman standing at the door: she was easily as tall as he was, wore a white lab coat; she turned away to follow the woman before Brunetti had time to study her. Fifteen minutes later, the woman emerged and made for the door, and the doctor called for ‘Signor Catucci’. This time, Brunetti noticed that the doctor wore no makeup and had light brown hair pinned back on both sides of her face. His eye caught hers; it was evident that she was surprised by the presence of an unknown man in her waiting room. She followed the patient into her office.
Only five minutes passed before she came to the door again and allowed the man to leave: he walked slowly, as though he had just heard news he didn’t like. There was no need to summon the woman, who had got to her feet as the door opened and passed in front of the doctor. Again, her eyes went to Brunetti before she turned away from the room.
It seemed a long time before the woman emerged, although it couldn’t have been more than ten minutes. When she had left, the woman in the white coat walked over to Brunetti and asked, ‘May I help you, Signore?’ Her voice was tentative, as though she were the person seeking help. She was in her forties, he’d guess.
Brunetti stood and set the magazine back on the pile. ‘I’d like to talk to you, Dottoressa,’ he said.
‘And you are?’
‘Guido Brunetti,’ he said and paused. But then, still penitent over his treatment of Professoressa Crosera, he added, ‘I’m a Commissario of Police.
She relaxed but did not smile. ‘Ah, yes,’ she said, stepping back from him. ‘Come into my office. We can talk there.’ She started to turn towards the other room but stopped and said, ‘I’ve been expecting you,’ then continued towards the door.
Brunetti followed her inside. She closed the door and went to sit behind her desk, moving with an easy grace often seen in tall women.
Her office was vastly different from that of Dottor Stampini at the hospital: neat, orderly, with a comfortable chair for the patient at the end of the doctor’s desk and an examining bed, covered with the usual sheet of paper, against the far wall, in which there were two windows with a view to the building on the other side of the calle. A glass-fronted cabinet was filled with packages of medicine. Her desk had a computer on the right side; on the surface were two piles of what must be patient files and nothing else.
The usual medical diplomas were interspersed with photos of single flowers enlarged to unrecognizability as anything other than exercises in construction. Brunetti sat in the single chair and looked at Dottoressa Ruberti. Her face was long, as was her body; her thinness made her seem taller. Her glance was level and did not shy away from his, her eyes light brown, the sort of colour that admirers would call ‘amber’ and detractors ‘muddy’.
Brunetti had often felt uncomfortable in social situations with doctors: he wondered if they were always assessing a person’s health when they looked them in the eye or took their hand or asked them if they’d like more wine. She, instead, looked at him as though wondering if there were anything she could do to help him.
‘You said you’d like to talk to me, Commissario. Could you tell me about what?’
‘Tullio Gasparini,’ Brunetti said.
‘Ah, yes,’ she said neutrally. ‘Signora Gasparini’s nephew.’
‘How is it that you know him, Dottoressa? He’s not a patient of yours, is he?’
Her glance was suddenly disapproving. ‘Commissario Brunetti,’ she said with what seemed an exercise of patience, ‘may I suggest some courtesies we might observe during this conversation?’
‘Of course,’ Brunetti said.
She returned his glance without smiling. ‘Good.’ She nodded a few times, as though finishing a conversation with herself, then said, ‘I’ll tell you the truth: you don’t have to trick me into saying something I should not.’ Before he could feign innocence, she went on. ‘Is this acceptable to you?’
‘Yes,’ Brunetti said. ‘But all the people I talk to say that they’re telling the truth.’
‘So do my patients,’ she said tiredly. ‘That they drink only so much or smoke only so much or never eat more than six grains of rice a day.’ She looked at him directly. ‘It’s one of the reasons why I can’t stand dishonesty any more. Do you understand?’
‘Yes,’ Brunetti answered, then was forced to remark, ‘But I’m not sure I should believe you.’
He had hoped to provoke her with the remark, but he failed. ‘I don’t lie, Commissario, even though I’d like to. It would be so convenient at times.’
‘If that’s true,’ Brunetti said, already following the new rules and telling her what he thought, ‘it’s very rare.’
Her face softened as she said, ‘Unfortunately, Tullio Gasparini is another person who cannot lie or be dishonest. He came to me and told me what he knew and what he was going to do.’
It was too early for Brunetti to ask about that, so he asked, ‘How did you know he wasn’t lying?’
‘Experience. Many people, especially those who are going to die and know it, stop lying or lose the taste for it, or the necessity for it. So, over the years, I’ve come to recognize the symptoms of trut
h, as well as of disease.’
‘And Signor Gasparini?’ he asked.
‘Unfortunately, he never learned to recognize other people who are like him, so he refused to believe me when I tried to talk to him.’ She rubbed at her right cheek as though it were a habit that helped her think. ‘Or perhaps it’s because he’s worked all his life with numbers and so doesn’t know how to read people.’
‘What did he tell you, Dottoressa?’ Brunetti asked.
‘Before answering, Commissario,’ she said, ‘could I ask you how you found me?’
Brunetti saw no reason to play games with her by saying he’d googled her and found the address. Instead, he said, ‘I learned of your connection with Dottor Donato and decided I should talk to you.’
‘Connection?’ she repeated, face softening at his word. ‘What a delicate way you have with language, Commissario.’ She smiled for the first time, and he saw that she must once have been lovely before life thinned her down with trouble she’d not had the skill to lie her way out of.
‘Could you tell me how it happened that you met him?’ Brunetti asked.
‘I met him years ago because I’d occasionally go into his pharmacy to speak to him about some of my patients. I wanted to be sure he’d give them a written explanation of when and in what sequence to take their medicines and remind them to consult it every day.’
‘Isn’t that on the prescription?’ Brunetti asked.
Her look was level and cooler than it had been. ‘Please, Commissario,’ she said. ‘If a patient is taking six, or ten, medicines a day, it becomes difficult to remember when to take them. I asked him to write out a schedule for each of them. That’s all.’
‘Did he agree to do it?’
She thought about how to answer this for some time and finally said, ‘I persuaded him. I told him I had many patients who were so old and confused that they needed this help.’
‘And he did it?’
‘Yes.’
‘And your connection?’ Brunetti asked, giving no special emphasis to this final word.
‘That came some years later.’ She paused like a driver at a fork in the road, considering which way to turn.
