by G. H. Ephron
“It doesn’t look good when we can’t fulfill our study enrollment,” Kwan huffed. “And that doesn’t do squat for the hospital’s reputation as a leading research institution.”
He marched off, fuming.
“He can be such an asshole,” Gloria muttered.
“I heard that,” Kwan shot back over his shoulder.
I sighed. I hoped the old Kwan, the one with a sense of perspective, wasn’t on permanent leave.
I started down the hall, intending to go up to my office. Protecting the hospital’s reputation—it was the same excuse Liam Jensen trotted out to keep Channing from airing something in public. A death. I wondered whose. Perhaps an adverse event that Jensen was all too willing to overlook?
I paused outside an oversize closet we use as a shared office for the half-dozen or so temporary and part-time staff on the unit. Jess was sitting there, staring at a blank computer screen.
“His bark is worse than his bite,” I said. I entered the room and sat down.
She lifted a trembling hand to her face. “He’s right. I haven’t been doing my job. I’ve been letting my personal feelings interfere.”
“Grief is a legitimate emotion, even for a psychiatrist. Don’t be so hard on yourself.”
“I can’t believe she’s dead,” Jess said, her voice raspy and quiet. She was weeping. Tears flowed freely down her face. “I can’t eat. I can’t sleep. I can’t focus on my patients. I haven’t been able to think about anything else.”
“Channing was more than a mentor to you.”
Jess stared at the windowless wall. “Channing has been my anchor, my safe haven, all through my mother’s illness.”
“Your mother’s been ill?” I asked.
“Early onset Alzheimer’s. She was only fifty years old. A psychologist. She diagnosed herself, a year ago Thanksgiving, long before her doctors even admitted that she was sick.”
I’d seen too many families try to cope with the incomprehensible brutality of Alzheimer’s, watching a soul slip away while the body remained vital and strong. “I’m sorry,” I said. “A terrible waste.”
“I remember when she stopped practicing. It was the day she came home with a black eye. Blamed it on her own poor judgment. She’d gone in to evaluate an agitated patient and sat down with him between her and the door. When he exploded, she couldn’t get out.
“My father and I tried to keep her home.” Jess swiped the heel of her hand across one cheek, then the other. “But she was deteriorating fast. We hired caregivers during the day, but I never knew when there was going to be a crisis and I’d have to rush home. Seemed like every other minute I was dealing with someone flipping out.
“I could talk to Channing about how angry it made me, having to stretch myself thin, sacrifice any personal life, and at the same time how much I loved my mother. Putting her into an institution was one of the hardest things I’ve ever done.”
Jess touched the old-fashioned gold locket she was wearing on a chain around her neck. She rubbed the engraved surface between her thumb and forefinger. “Channing helped me get past the guilt. She was a friend, and more.”
Jess’s bond with Channing sounded intense and personal. Jess idolized her. I wondered, what was Jess to Channing? A fledgling to be helped along? A daughter to be nurtured?
“I guess that’s why this is hitting you so hard,” I said. “You’re grieving for a friend, but you’re already emotionally raw from your mother’s illness. It must feel like you’re reliving that loss as well.”
Jess put her hand over her eyes. “I keep wanting to pick up the phone”—her voice broke—“call her.”
I touched her arm. “Do you feel up to working with patients?” I asked.
“I’m a psychiatrist,” Jess said, her voice ragged. She put her head back and ran her hands through her hair, intertwining the fingers behind her neck. “I’m supposed to know how to control my emotions. That’s one of the things I’ve learned from my mother and from Channing. How to behave like a professional.” She straightened. “I need to work.”
“That’s good. Because we need you to work.”
Jess gave me a weak smile.
I was on my way back to my office when Gloria and Kwan intercepted me. “Destler just called,” Gloria said. “He wants to see the three of us in his office. Now.”
“Shit,” I said. I’d heard about unit heads and their staffs getting the Summons. It was never good news. Had punching holes in our conference-room walls been a prelude to something worse? I looked at my colleagues. I’d resign before I’d let them decimate our staff.
“His underground must be working overtime,” Gloria said. “He’s probably heard we’re under census.”
Kwan expanded his chest and tugged on the ends of his jacket. “It appears the barbarians are at the gates again. Time to rally the troops.” That was the Kwan I knew and cherished.
The three of us trudged across the campus to the Administration Building, through the massive double doors and up the wide marble staircase to Destler’s office. Virginia Hedgewick sat at her desk. She glanced up and pushed her wire-rimmed glasses to the bridge of her small, pointy nose. A fireplug of a woman who wore boxy suits and sturdy shoes, Virginia had been at the Pearce for more years than anyone could remember, though she hadn’t aged a day since I’d first met her ten years ago. She was affectionately known as The Hedgehog, in part because she looked like one, and in part because she’d rolled herself into a ball, figuratively speaking, while the institution changed around her. How she’d ended up as administrative assistant to the CFO of the hospital was a source of wide speculation.
“Sorry about the last-minute summons,” she said, glancing up at the wall clock. “I congratulate us all. You’re practically on time. He’s here, of course, but that’s because he pulled another all-nighter. I know you folks always say that it’s not healthy to be a workaholic, but if you ask me, Dr. Destler thrives on it.”
She opened the door to the inner sanctum. Destler was standing as we trooped in, his hands behind his back. He reminded me of a fat, round white peach with his pale pink skin and blue eyes rimmed by reddish eyelids. The room was thick with his sweetish odor, as though he carried a pocketful of aging apple cores.
From a Sargent portrait hanging behind Destler’s massive mahogany desk, Miss Wilhelmina Pearce, granddaughter of Silas Pearce, the benefactor of the institute, stared down at us. Long strands of pearls cascaded over her ample bosom.
We sat. Destler remained on his feet. He had a chart on a metal easel alongside his desk. “This is excellent,” Destler enthused, not wasting a moment to acknowledge the tragedy that had occurred less than forty-eight hours earlier. “I’m glad you’re all here. Sorry about the last-minute notice.”
“Good news?” I said, hoping to smoke whatever it was out into the open.
“As you know, over the last four years we’ve come through a difficult period.” That was an understatement. The average stay at the hospital had shrunk from a year to twenty days. Managed-care patients had replaced most of our wealthy clientele. “We’re constantly fine-tuning.”
He turned to his chart. The last column was labeled COST EFFECTIVENESS, and it had red and black checks all the way down. I scanned quickly to find our unit. We were at the bottom with a red check-minus. I didn’t need his M.B.A. to know that wasn’t good.
Destler tapped an anemic-looking green bar on his chart. “I’m afraid throughput on the Neuropsychiatric Unit is lower than anywhere else in the hospital.”
Throughput was The Number at senior staff meetings. It represented how many patients you could push through, given your resources, in a standard amount of time. If patients were the lifeblood of the unit—a turn of phrase popular with administrators like Destler—then improving throughput meant higher blood pressure for the unit as an organism. We could handle that only up to a point before the staff had a collective stroke.
“That doesn’t surprise me,” I said. “After all, our patie
nts are neurologically impaired. You can’t just pump a couple of pills into them and send them on their way.”
“All patients need special care, Peter,” Destler said, giving me his benign Buddha smile.
“And they need specially trained staff,” Gloria added, rising partway out of her chair. “Remember what happened to Carol Tillingham.” We all remembered the nurse who’d been floated onto our unit one day and tendered her resignation the next. “It wasn’t her fault. Regular psych nurses get eaten alive with patients like ours.
“I know how you feel, Nurse Alspag,” Destler said. I could feel Gloria twitching. She reacts to patronizing the way the rest of us do to poison ivy. Destler didn’t notice. “That’s why I asked you here to brainstorm with me. Better to stay ahead of the curve and avoid the kind of unpleasantness you all experienced before I came aboard.”
That shut us up. When Destler had arrived at the Pearce, the place had been a war zone. Cost cutting hadn’t kept pace as reimbursements shrank. There were ominous rumblings of impending bankruptcy, layoffs, mergers. The surrounding community was in a tizzy as the board considered selling off land to housing developers. It had been everything I could do to keep Gloria from accepting one of the job offers she had.
“And with all three of you,” he beamed, “we should be able to come up with an excellent solution. So let’s think on it.”
There wasn’t much to think on. To make his little bar creep up, we’d need to increase the number of beds, decrease the number of staff, or shorten the length of stay—preferably, all of the above.
Destler suggested, “We could broaden your mission, combine the Neuropsychiatric Unit with Geriatrics and—”
Kwan cut him off. “Just because many of our patients are older, that doesn’t mean you can mix them in with the general geriatric patient.” He was talking real slowly and leaving spaces between his words, the way he does when he tries to explain the fine points of men’s fashions to me or baseball to Gloria. “Patients who have dementia don’t mix with patients who don’t.”
Destler pursed his lips. “I can see your concern.” Kwan started to say something, but Destler held up his hands. “Just for a moment, let’s consider the benefits. With a larger, more diverse core population, we can probably eliminate a psychiatrist, maybe even two.” There went Kwan’s job. “Bring in a clinical nursing supervisor.” So much for Gloria’s. “And then, what role does a neuropsychologist play in all of this now, really?” He raised an eyebrow at me. “More and more, psychiatric hospitals are about medicine these days.”
As opposed to what, I wondered.
Destler chuckled. “The one bright spot is the research you have going on.”
Kwan shot me a triumphant look.
“I’m encouraging more units to get involved in clinical trials. That gives us additional resources to work with. And the pharmaceutical companies are excellent partners. Just this morning, in fact, I got a call from one of the VPs at Pharmacom. He was calling to say how pleased they are with the Zerenidine trial.” He paused. I waited for the shoe to drop. “They did have one concern.”
“I’m quite sure we’ll fill our patient quota,” Kwan said. “There’s plenty of time yet.”
“Actually, it was something else. Do you really think Pharmacom should be made to suffer because security on your unit fails to control a patient’s access to liquor? The whole incident is quite embarrassing, to say the least.”
They’d heard about Mr. Fleegle. Of course, they’d have been copied on the Adverse Event report. The three of us sat there dumbfounded.
“You categorized the event as ‘severe,’” Destler went on. Here was the real point. “Since when is inebriation life threatening? The patient would have had to be in immediate risk of death from the reaction as it occurred—”
Kwan broke in, “If Mr. Fleegle had been driving. If he’d gotten himself a bigger bottle of booze. Yes, I’d say the reaction could have been life threatening.”
“Could have been,” Destler said, massaging his chin. “All I’m asking you to do is think about it.” He gazed over at his chart. “Of course, I’d never suggest anything that goes against your clinical judgment. But I did need to pass along their concerns.”
We stood on the steps of the Administration Building after the meeting. I was stunned. I couldn’t see any other way of interpreting Destler’s message—he wanted the report of Mr. Fleegle’s drug reaction downgraded or suppressed entirely.
“Did what I think just happened happen?” Kwan asked.
“We just got hit by a bus,” Gloria said.
“That’s the good news,” Kwan said. “The bad news is, we survived.”
Gloria gazed up at the second-floor windows. “He wouldn’t dare.” She didn’t sound at all sure of herself.
“That was no mild adverse event,” Kwan sputtered. “If he thinks I’m going to change my report, Destler can take a flying …”
“Absolutely,” I said.
When I got back to my office, Annie had left me a message. “Hey, Peter. I’ve got that information.” I was relieved. She didn’t sound as if she was going to stay pissed off, though she’d have had every right to be. “Let me know how you want it.”
How I wanted it … . I smiled, imagining a few ways that would be nice. But I called back and left a tamer message: “How about over ice cream? Meet me at Toscanini’s at nine? And Annie, thanks for the call … really.”
When I hadn’t heard back from her by eight-thirty, I went over anyway to the ice cream lovers’ Mecca. I took over a corner table up against the plate-glass window and settled in to wait. Annie rolled in, literally, at twenty past.
“Waiting long?” she asked, all innocence, as she sat down and took off her sleek black helmet. She was wearing dark leggings, a T-shirt, a down vest with a sweatshirt tied at the waist, and in-line skates. Her cheeks were bright pink. “Took a little longer to get over here than I expected. I wasn’t sure you’d wait.”
She slipped off her wrist, knee, and elbow guards, and tucked them away in her backpack.
“Listen,” I said, hoping my voice sounded sufficiently contrite, “I’m truly sorry about …”
She held up her hands. “No need to apologize. No offense taken.”
Like hell. Then why wasn’t she looking me in the eye?
“What would you like?” I asked. “Coffee?”
Annie eyed the four-foot-high brass Italian espresso machine with its spigots, valves, and pipes—whenever they turned it on, I half expected to hear an organ playing the Hallelujah Chorus.
“Ice cream?” I suggested.
She scanned the handwritten list of flavors. “Green-tea ice cream? Saffron? Khulfee? What’s that?”
“It’s good. Chocolate Sluggo’s good too. So’s the Belgian chocolate. Mandarin chocolate. White chocolate.”
“I get the picture.” Annie laughed. “A mochaccino, I think.”
“No ice cream?”
“No thanks.”
I brought back a frothy mochaccino for Annie; an espresso and a dish of burnt-caramel ice cream with hot fudge for me. I licked the hot fudge off the back of my spoon. “Want a taste?” I asked.
“Maybe later.” She pulled a folder out of her backpack. “Preliminary autopsy results.”
“Preliminary?” Let it go, asshole, I told myself, and hurried to add, “Thanks.”
I took the folder and set it aside. I’d read it when I was alone.
“How’s the mochaccino?” I asked.
“Delicious. Want a taste?”
“Actually, I do,” I said.
She started to offer me her cup, but I put my hand on her arm. I leaned in and kissed her on the mouth, this time a gentle, lingering kiss. For a few moments, the noise of the ice cream parlor faded to nothing, leaving only the heady, sweet smell of vanilla and malt in the back of my nose, to mix with the bittersweet taste of the mochacchino and a little saltiness from Annie’s skin.
“You’re right,” I said. “D
elicious.”
Annie leaned back against the brick wall, appraising me. “So, when are you going blading with me?”
I choked and put up my hands. “I don’t think so. I’m not into broken bones.”
“Come on. You’ll love it.”
“I hated ice-skating, the two times I tried it.”
“It’s not the same.”
“I’ve got weak ankles.”
“Not an issue. The boots support your ankles.”
“What if I fall down?”
“You will. The first thing I’ll teach you is how to fall. It’s easy. Getting up is Lesson Two. That’s harder.”
Swell. The last thing I wanted to do was compete with MacRae, sprawled on the pavement like an overturned turtle. I mounted a counterattack. “Have you ever rowed?”
Annie screwed up her nose. “I hate boats. I get seasick, just looking at one.”
“It’s a little boat. And there aren’t any waves.”
“The water’s so dirty in the Charles. A person could get dysentery. Body parts could dissolve. And it’s too cold.”
“It’ll be warm enough in a couple of weeks.”
“You can go blading now.”
We sat there, grinning at each other. I suspected I was forgiven, but just to be certain, I asked, “Sure you don’t want a taste of this?”
Annie didn’t answer at once, knowing full well that she was torturing me. Then she wrinkled her nose and said, “Well, maybe just a taste.”
I loaded up the spoon with the bittersweet ice cream and a dollop of hot fudge and fed it to her. She closed her eyes. “Mmm,” she said. “You’re right. That’s delicious.” She looked at me thoughtfully. “Some things are worth waiting for. Problem is, you never know for sure which ones.”
Just then, a boisterous group of in-line skaters piled into the ice cream parlor. In the lead was a young black man with dreadlocks to his shoulders and a red, black, and green knit cap. He bellowed, “Yo, Annie!” Several others waved, including the petite redhead who held her back straight and head high like a ballet dancer. They were about as diverse a crowd as you’d ever see in Boston. From teen to middle-aged, male, female, all shades of skin color from blue-black to freckled Irish.
