by Judith Lucci
"Yeah. You would think a cancer center would know how to calculate the correct dosage of chemotherapy medicine. Those patients' families were angry and the press had a field day with it. People pick hospitals because of their doctors, don't they?"
"Used to, but now they have to go where their insurance company will pay. Big business and insurance companies run healthcare now. They control healthcare and who gets it. Obamacare will only make it worse and more costly. Remember when hospitals first started advertising and using slogans like, 'the best care in town' or 'caring made visible' or 'the finest doctors in the country'?" Mitch nodded, and Alex continued.
"These slogans have come back to haunt us, becoming the basis for malpractice suits. Sometimes patients don't believe they got the best care or the finest doctors."
"Are these claims defensible?"
"Many are, some aren't, depending on the facts of the case. Information systems make it possible for patients to search data bases kept on healthcare practitioners. For instance, a patient can find out whether a practitioner has ever been sued."
"Sounds like the medical information explosion to me. Pretty scary for doctors and nurses, I would imagine."
"It is. Patients can even learn how much money the physician earns. That adds even more fuel to the fires of malpractice actions. It's all part of the consumer rights movement." Alex was pensive as she stared into her water glass.
"You mean that if patients experience bad results from surgery or medical treatment, they can do their own research to build a malpractice claim?" Mitch looked surprised.
"Sure. Even more disturbing than the actual malpractice actions is the amount of publicity they receive, and how that publicity affects the image and reputation of a hospital. I predict those hospitals in Boston and Florida will lose millions in revenues in the next couple of years. Times are tough. Smaller and less powerful hospitals will be bought and closed by big corporations to decrease competition and costs. Others'll be forced out of business. We're already seeing that in New Orleans."
Mitch set his coffee cup down and pondered her remarks. "Many people think physicians make too much money anyway." He looked at Alex sheepishly. "Of course, people say the same thing about lawyers. You think that Obamacare will remedy any of these problems?"
Alex was quick to reply. "Nope. It will make it worse. CCMC is currently in good shape financially because of our large international population. They represent a significant portion of our revenues."
"How do you think CCMC will do in the long run? You think anyone will buy them?" Mitch looked at her intently.
"Don't know. Someone tried a few months ago, but our board of trustees voted it down. They're adamant that we remain independent. I know we're in for a long haul." Alex sighed, "I can't even predict what'll happen tomorrow. Another huge problem is the loss of Charity Hospital during Katrina. The city and hospital community has been struggling with how to care for Louisiana’s poor, and disenfranchised population. It is gonna be a bumpy ride, no question about it.”
Mitch stifled a yawn and looked as his watch. "It's getting late. Best be getting home. I don't want to keep you out too late." Mitch stood and helped her with her chair. At her door, Mitch tentatively kissed Alex good night. "Call you soon. Sweet dreams."
"Thanks, Mitch. It was a lovely evening," Alex said as she bid him goodnight. After straightening the kitchen, she returned to the living room to close the French doors leading to the roofed balcony. She stepped outside again to enjoy the fragrant New Orleans night.
As she stood on her balcony, she was surprised when she saw Mitch on the opposite side of the street talking to a short stocky man with a cigar in him mouth. Strange, she thought. It's after midnight. I'll have to ask him who that was. She watched the pair. After a few minutes, the men parted ways, and Mitch headed towards his car.
***
Congressman Adam Patrick Lee sat impatiently in his room at the Palm Court Hotel. For the tenth time, he dialed Alex's number. No answer. Where in the hell is she, he thought. It's almost midnight. Damn, I wish she didn't live here. This city's full of creeps and perverts. Adam Lee hated New Orleans and was convinced that the city had robbed Alex’s mother of her youth and final bit of sanity. He still blamed New Orleans for her anguished mental break and the silence she had lived in for over 30 years.
Fucking nasty city, he thought as he impatiently redialed Alex’s home phone. His hand still stung from where he'd cold-cocked some kid trying to pick his pocket several hours earlier. He'd been right outside his hotel, for God's sake. The most expensive hotel in New Orleans, and it was worse than Washington DC. It was even worse than the pickpockets in Rome and Sicily, and they were supposed to be the worst on the planet. Was nothing sacred in this underwater swamp town? Congressman Lee had not been in favor of rebuilding the city after Katrina but had kept his thoughts to himself. Screw the levies. No amount of patching and reengineering could ever guarantee what could happen in a Category 5 hurricane. He shook his head as he remembered the horrors that had occurred in the Super Dome following the storm. Rape, violent assault, crack-cocaine, and drug dealing had been the order of the day, as well as a blatant disregard for the weak and elderly.
His mind continued to wander and he reviewed the events of the day and his many visits to the Crescent City. Things had gone pretty well in most of his meetings, but something wasn't quite right in the Governor's office. Several of the Governor's aides had been short, practically rude, to him. Well, maybe not rude, maybe more embarrassed and uninformed. Didn't know a damn thing about how Governor Raccine was planning to use his influence with the Southern Governors to win the crime vote. Raccine had to have a plan. The Southern Governors were meeting next week.
What was up with Governor Raccine himself? Why was he unavailable for the Congressman? For God’s sake, Adam Lee was one of the highest-ranking Congressmen in DC. For years, Raccine had been a wily, perceptive politician, always in control of his issues and platforms. When Adam had finally met with him, Raccine was unsure of himself, sort of floundering all around the issues. Not even four bourbons had calmed him down, although he was slurring his words when he left. The governor had kept looking over his shoulder as if he expected someone to be there. Of course, his wife was sick with terminal cancer. However, Adam thought it was more than that. Something was wrong. He could smell it. Of course, if Kathryn were that ill, he'd be screwed up too. He smiled when he thought of his wife back in Virginia. He missed her. He'd never tell her, of course. However, he knew she knew. He'd been a lucky man to find such a fine woman to stand by him. She was the best political wife a man could have, and she put up with his tangents, moods, idiosyncrasies, bouts of drinking and depression. He'd never make it without her. She was and had been his rudder in stormy seas for over 40 years. He knew that and suspected she did too.
He continued to muse about George Raccine. He'd known him for years. George was a real political machine. He'd brought respect and dignity to a state long famous for corrupt politics. Raccine had done a superb job working with Senator Bonnet and, for the first time in years, the economy of the state was growing.
Adam felt his impatience increasing and he dialed Alex's number for the umpteenth time. She answered in a sleepy voice on the second ring.
"Where the hell have you been, young lady? It's after midnight," he said, his voice gruff, but in a teasing tone.
Alex laughed at his tone. "Adam, need I remind you that I'm over thirty years old, educated, employed, and living on my own? I have no keeper?"
"Need I remind you that anytime I'm anywhere close you have a keeper? Where've you been?"
"Boy, you’re bossy. For your information, I had a date with a most attractive man."
"Humph, who is he and what does he do. I'll check him out."
"That's precisely why I'm not telling. When and if it becomes important, you'll know." Alex detected the playfulness in her grandfather's voice. She continued, "Okay, Granddad. What's up? You didn't call to
keep tabs on me."
"Hell I didn't. What's the story on Grace Raccine? Is she worse, doing badly?"
Alex tried to remember if she'd heard anything recently about the first lady. "Not that I know of. She's still at CCMC, getting chemo, but is doing all right. Robert did her surgery a few months ago. Why?"
Adam hesitated. "Don't know. Nothing really. George seemed distracted. Not on the ball or something. He seems screwed up, unprepared, I guess. His aides don't know a damn thing about his plans for the Governor’s conference. From what I picked up, the administration's going soft, sort of backing down on the most important issues. This is a huge change in strategy. I need George’s support to get my legislation passed. You know if anything is coming down politically in Louisiana?"
"Nope. Not really. Hardly keep up with local politics here. CCMCs politics are all I can handle. I'll check around and let you know. Anything else, Adam?"
"Nope. We still on for tomorrow?"
"You bet. See you at five."
"Love you, Alex. Nighty-night.
"Love you too, Granddad. Go to bed you impossible, irascible, crotchety old fool and don’t call me back!"
Alex felt her heart swell with love for her grandfather as she hung up the phone. A teddy bear in a lion's coat, she thought. Of course, others would describe him as a wolf in sheep’s clothing.
***
Mrs. Grace Raccine, the wife of the Governor of Louisiana, was resting comfortably in her VIP suite at CCMC when Kathy Smithson, the evening charge nurse, came in on rounds. Mrs. Raccine looked up from her book. "Hello, Dear, isn't it about time for you to go home?" She smiled gently at Kathy.
"I just wanted to see if there was anything else you needed before I left. Did you get your sleeping pill?"
"The nurse offered it to me, but I didn't take it. To tell you the truth, I think that's what is causing the nightmares I've had the past few nights. I could've gone home earlier if I'd had been resting better. Sleep always makes a difference in how you feel."
Kathy nodded in agreement. "You're still going home in pretty good time. It takes a long time to recover from abdominal surgery, and then, considering you had that terrible infection, you've done very well. I'll miss you when you leave." Kathy smiled.
Mrs. Raccine smiled back, touched Kathy's hand, and said, "I'll miss you too, dear. You and all the other nurses have been good to me. In addition, Dr. Bonnet's excellent. You know, Dr. Bonnet’s father and my husband were childhood friends. I've known Robert since he was a tyke growing up on St. Charles. He and my late son were school chums, the best of friends." Mrs. Raccine paused for a moment, reminiscing, and she continued, "You know, I've never been to CCMC before. Our family usually goes to Jefferson." She lay back against the pillows, tired and weak. "I don't think I've ever had better nursing care.” She sighed and continued, "I'm really tired. I know Dr. Bonnet said it would take time, but I need to feel better before they start the radiation."
Kathy smiled again at Mrs. Raccine and said, "You will. You'll start feeling better sooner than you think. Chemo is tough on you and makes you feel tired. However, your blood work is looking better tonight. Get a good night's sleep to get a head start before you go home."
"Thanks, Kathy. I'll try. Have a good evening, at least what's left of it. See you tomorrow."
Mrs. Raccine was exhausted by the short conversation. She was worried about her health, of course, but she was more worried about her husband. Something was up with George. He was not quite right these days. He'd been acting strangely for several months. She’d noticed secretive phone calls, cancelled meetings with trusted advisors, men hanging around the Governor’s Mansion in Baton Rouge she didn’t know, as well as a lot of late night meetings in New Orleans. He was spending less and less time in Baton Rouge and more time here. Grace continued to consider things. George seemed to be pushing Andre Renou, his chief aide, aside and that was unusual. Those two had been joined at the hip for years and George never made decisions without getting Andre's take on the issue. She couldn't pinpoint anything specific, but she knew something was bothering her husband. She continued to consider the strange happenings, but it just made her wearier. Finally, she fell asleep.
Kathy frowned as she left the room. Gastric cancer was bad enough as it was, but Mrs. Raccine's cancer had spread to her liver. She also had metastasis to her lungs which made her more tired and short of breath. It seemed so unfair for such a wonderful woman and community leader to be so cruelly ill. Kathy wondered if Mrs. Raccine's dreams were related to her diagnosis. She'd mentioned her dreams had snakes and evil things in them but Mrs. Raccine couldn't seem to remember much else. Mrs. Raccine was Creole and Creoles traditionally believed all dreams have meaning. Kathy wouldn’t be surprised if Grace had brought a gris gris with her to the hospital to help her heal. Kathy left the hospital with a heavy heart for Grace Raccine.
At one-fifteen in the morning, the gentlemen in Room 626 had a heart attack, and the nurses were busy with him until after two-thirty. A nursing assistant documented at two o'clock that Mrs. Raccine was sleeping soundly with her side rails up. That was just an hour before all hell broke loose.
Chapter 4
Alex approached CCMC at seven-thirty on Tuesday morning and was dismayed to see TV trucks, camera crews, and reporters. A sinking feeling came over her, and she immediately felt her stomach knot. Nausea prevailed as she wondered what was wrong. What could have happened? It must be bad. Of course, she admonished herself, it could be something positive. Many great things happen at CCMC, but somehow she wasn't able to convince herself that something good had happened. Her gut told her the opposite. It was bad. Reporters never came out this early in New Orleans for anything, except to photograph the trash after Mardi Gras, or for something bad. Anything good could have waited until noon. She walked towards the administration offices with an overwhelming sense of dread.
The administration suite was in chaos. Two of the secretaries were trying to keep the press out of the suite, and the other two were on the phone. Alex wondered why everyone was in so early. One of the secretaries motioned her towards the conference room. As she entered, she noted Don Montgomery, Dr. John Ashley, the chief of medicine, Bette Farve, chief of nursing, and Elizabeth Tippett, the director of hospital-media relations sitting around the conference table. Don was speaking as she entered the room.
His voice was loud, blaming, and arrogant. "Where the hell's Alex Destephano? This is when we need her. Where in the hell is she?" Don's face was red, his eyes blazing.
Elizabeth, a pretty young brunette, spoke calmly. "Don, we called her around six and didn't get an answer. It's only seven-thirty. I'm sure she'll be here soon. Relax a little. We need to focus on a press release. What are you going to say?"
The CEO glared at her. “I’m not saying a damn thing. That is your job. What is it about you people that you don’t understand that I cannot do everything around here?"
Alex stood frozen at the door. Her voice was quiet. "I'm here. I was probably in the shower at six. What's going on?"
Her colleagues looked at her strangely, speechless, but obviously glad to see her.
Elizabeth was the first to speak. "We're not really sure what happened. At five this morning, the charge nurse on Six North was making final rounds on her patients. When she entered Mrs. Raccine's room, the room was in a shambles, destroyed. Blood was all over the place."
"What! What about Mrs. Raccine?" Alex interrupted, fearing the worst.
Elizabeth continued, "Mrs. Raccine's alive, but in shock. She has no injury. Physically, she's stable, at least for now."
"What?” Alex looked dumbly at Elizabeth. “What about the blood? Where was she injured?"
"The blood's not Mrs. Raccine's."
"What?" Alex barked at Elizabeth. "I don't understand - whose blood is it? How did the blood get into the room?" Alex's voice was demanding.
Elizabeth held her arms up in a back-off gesture. "Alex, chill out and please let me finish. I'll tell you
what we know, which isn't much. We think the blood belongs to a rooster found in the room with her. We also found a dead snake, cut in three pieces under her bed. We don't know the meaning." Elizabeth paused for a breath.
Alex could hardly believe what she was hearing. She was stunned and could feel the hair stand up on her arms. The hospital leaders started talking at once, shouting over each other in an effort to be heard, except for Alex, who was speechless. She watched as an administrative aide closed the conference room door from the peering eyes of news reporters.
"Quiet, quiet," Alex said firmly. "One at a time, please."
Finally, the noise died down.
"Help me understand. What does this mean? What else have you done?" She looked around the room. "Have the police been notified? Does Governor Raccine know? How'd the press find out?"
Dr. Ashley, a fifty-something year old, silver-headed, gentle-faced general practitioner who seemed a little calmer than the other administrators, attempted to answer Alex's barrage of questions. "Alex, please keep in mind we don't know much. Yes, the police have been called. Captain Francoise of the NOPD is currently questioning the staff on Six North."
Alex looked at her nemesis, Bette Farve, and asked her sharply, "Have you spoken to the nurses about what happened? Have you interviewed and prepared them for the police questioning? Did you impound the chart from the unit?"
Bette Farve, an angry, thin-faced stick of a woman, bristled at Alex's questions and responded sarcastically, "I talked with the night nurse briefly, but she was so traumatized that she didn't make much sense. It was a waste of my time." Bette hesitated for a moment and continued arrogantly, "If we'd been able to reach you, Ms. Destephano, perhaps we could've been more prepared for this." Bette's voice was cold and had a caustic edge to it.
