6
Eric Kensing still wore his blood-spattered green scrubs. He was slumped nearly horizontal in a chair in the doctors' lounge on the ground floor, his long legs stretched straight out before him, his feet crossed at the ankles. The room was otherwise empty. A lock of gray-specked black hair hung over his forehead, which he seemed to be holding up with the heel of his right hand.
He heard the door open and someone flicked on the overhead lights. He opened his eyes. It was his soon-to-be ex-wife Ann. "They said I'd find you here." Her voice at whisper pitch, under tight control.
"Looks like they were right."
She started right in. "At least you could have called me, Eric. That's what I don't understand. Instead I find it out on the goddamn radio. And with the kids in tow," she added, "thank you very much."
He got to his feet quickly, not wanting to give her the edge. "Where are they now? Are they okay?"
"Of course they're okay. What do you think? I left them at Janey's. They're fine."
"Well, good." He waited, forcing her.
"So why didn't you call me?"
He backed up a step, crossed his arms. He had an open, almost boyish face in spite of the worry lines, the bags under his eyes, a puffiness at his once-proud jawline. But around his wife he'd learned, especially in the past year or two, to suppress any animation in his face. Not that he felt any conscious need to do that now anyway, but he was resolved to give Ann nothing. He might have been molded from wax, and could easily have passed for someone in his early fifties, though he was fifteen years short of that. "Why would I call you? His wife was here, his family. Besides, the last I heard you'd broken up again. For good."
She set her mouth, drew a determined breath. "I want to see him," she said.
"Help yourself. As long as Carla and his kids are gone. I'd ask you to try and be sensitive if they're still around."
"Oh, yes. Mr. Sensitive. That's your role, isn't it? Bedside manner, comforting the bereaved?"
"Sometimes." He shrugged. "I don't care. You do what you want. You will anyway."
"That's right. I intend to." Her nostrils flared. "How did he die here? How could that happen?"
"He got smashed up, Ann. Badly."
"People get smashed up all the time. They don't die."
"Well, Tim did."
"And you don't care, do you?"
"What does that mean? I don't like to lose a patient, but he wasn't"
Her voice took on a hysterical edge. "He wasn't just a patient, Eric." She glared at him. "Don't give me that doctorspeak. I know what you really think."
"Oh, you do? What's that?"
"You're glad he's dead, aren't you? You wanted him to be dead for a long time."
He had no ready response. Finally, he shook his head in resignation and disgust. "Well, it's been nice talking to you. Now excuse me" He started to walk by her.
But she moved in front of him. "Where are you going?"
"Back to work. I've got nothing more to say to you. You came here to see Tim? You found me easy enough. You won't have any problem. Now please get out of my way. I've got work to do."
She held her ground. "Oh yes, the busy doctor." Then, taking another tack. "They said you were on the floor."
"What floor?"
"You know what one."
He backed up a step. "What are you talking about?"
"When he died."
"That's right," he said warily. "What about it?"
He'd had long experience with her when her emotions took over, with the sometimes astounding leaps of logic of which she was capable. Now he saw something familiar in her eyes, a kind of wild lucidity that he found deeply unsettling. "I should tell somebody," she said. "I'll bet I know what really happened up there."
"I don't know what you're talking about."
"Yes you do, Eric. I'm the only one who knows what you're really capable of. How unfeeling you can be. How you are."
"Oh please, Ann, don't start."
"I will start. You killed him, didn't you?"
He thought she'd been going there, and now that she had, the depth of his rage allowed for nothing but pure reaction. Summoning all of his control, he turned to make sure no one else was within earshot, then leaned in toward her, inches from her face. He forced a brutal smile. "Absolutely," he said with all the cold conviction he could muster. "I pumped his IV full of shit as soon as I could get away with it."
She backed away and froze.
He had her. Her delicious panic impelled him to continue striking. "I kill people here all the time. It's one of the unsung perks of the job."
She stared at him with real fear for a long moment. But he'd shocked her back to herself. Her shoulders relaxed; she gulped a few breaths. "You think that's funny?" she asked. "You think it's something to joke about?"
"You think I'm joking? Were you joking when you asked me?" But then, suddenly, it had gone far enough. "Get a grip, Ann. Did I kill him? Jesus."
"You were there and you hated him."
"So what? Maybe you didn't understand the message. He got run over."
"And brought here."
"It was the closest ER, Ann. I didn't somehow arrange it."
"You should have taken yourself off his case."
"And why is that? So I wouldn't have a chance to kill him? Maybe you don't get ithow about if I wanted to kill him? How about that?" He stared at the total stranger with whom he'd lived a dozen years, who'd borne him three children. For an instant, he wanted to get another rise out of her.
But that gambit had played itself out. She shook her head finally. "You didn't kill him," she said. "You don't have the guts."
"You said it, not me. But whether I did or not, he's gone, isn't he? That's going to be tough on little Annie, isn't it?"
He'd hit her again where it hurt. She set her jaw, then suddenly reached out and pulled violently at a sleeve of his scrubs. "You son of a bitch. What am I supposed to do now, Eric? Tell me that. What am I supposed to do?"
"Whatever you were going to do, Ann. I don't really care. He wasn't coming back anyway." Then, a last thrust. "Don't tell me you don't have a fallback boyfriend?"
She came forward now in a wild fury, her fists flailing at him. "You bastard!" She kept coming, pounding at him, spewing obscenities, until finally he'd gotten ahold of both of her wrists. He gripped them tightly in front of him.
"Ow! Let me go. You're hurting me."
"Good."
"Let me go, damn you!"
"Don't you dare swing at me again. You hear me?" He held on for one more moment, squeezing with all of his strength. She continued to struggle against him, making little inhuman cries with the exertion, trying to pull her arms away, to twist her body, but he had her and wasn't letting her go. Finally, he pulled her close in to him and locked her in his gaze. She wasn't ready to give it up, not yet, but he kept her in an iron grip, until at last he felt the fight go out of her. "Do you hear me, goddamnit?" he whispered.
"Yes. Let me go."
He stepped back and pushed her away as he released her. "I'm leaving," he said. "Get out of my way."
She was rubbing her arms, then holding them out. "Look what you've done," she said. "You've hurt me."
"You'll live," he said.
She stepped in front of him, all but daring him to go another round.
But leached out of the hurt and rage, he had no more stomach for fighting her. "Why don't you go home, Ann? Back to the kids. You don't belong here."
But she stared obstinately up at him. "I need to see him. Where is he now?"
He knew what she meant. She wanted to view Markham's body. But fuck that, he thought. "Best guess right this minute," he said. "Somewhere close to the center of hell."
Then he pushed past her and made it out of the room.
* * *
Little League was playing havoc with the Hardys' schedule. Vincent practiced on Mondays and Wednesdays, and Hardy was coaching. So he and Frannie had had to change thei
r sacred date night to Tuesdays for the duration of the season. Tonight, at a little after 7:00, Hardy pushed open the door of the Little Shamrock where they were supposed to rendezvous, but she hadn't yet arrived.
Her brother, Moses McGuire, though, was behind the rail, talking to a young couple who were decked out in a lot of black leather. In one of his manic phases, McGuire's voice boomed enough to drown out Sting on the jukebox, who wasn't exactly whispering himself.
Hardy pulled up a stool by the front window, half turned so he could watch the cypresses bend in the stiff wind at the edge of Golden Gate Park across the street. Moses glanced at him and began to pull his Guinnessan automatic call for Hardy nine times out of ten. The foam in the stout would take several minutes to fall out, and this way Moses could keep talking until it had. No point in breaking up a good story.
Which continued. " so the guy'd had a stomachache for like nine months, they'd already taken out first his appendixwrongthen his gall bladderwhoops, wrong again. Nothing helps. And they don't find anything and finally send him on his way, telling him he's stressed out. Well, no shit. So he starts doing acupuncture, seeing a chiropractor, taking herbs, getting massagesnothing helps. And meanwhile"here McGuire turned to Hardy, pointed at his pint, almost ready"meanwhile, the guy's trying to go on with his life, he's supposed to be getting married in a few months."
The couple asked almost in unison, "So what happened?"
"So two weeks ago, he wakes up doubled over. Can't even get out of bed. They cut him open again, but this time close him back up and say they're sorry. He's got a month. They must have missed it."
"A month to live?" the girl asked. "Is that what they meant?"
"Yeah, but it wasn't a month, either," Moses concluded. "Turns out, it was five days."
The guy was staring through his drink, shaking his head. "Five days?"
McGuire nodded in disgust. "I served him a drink in here three weeks ago and went to his funeral on Monday." He grabbed Hardy's pint and walked it down the bar.
Hardy drank off a mouthful. "That was a fun story. Who were you talking about?"
"Shane Mackey. You didn't know?"
From his own days as a bartender, Hardy had known Mackey when he'd played on the Shamrock's softball team for a couple of years. He couldn't have been much beyond forty years old. Hardy remembered buying him and his fiance´e a drink at the New Year's party here, four months ago. He carefully put his glass on the bar and swirled it. "Was that a true story?"
"The good parts, anyway. The wedding was going to be next month. Susan and I had already bought them some dishes."
7
At 9:30, Malachi Ross was in his office, in his leather Eames chair, a cup of coffee grown cold on the glass table in front of him. Across from him, in his wheelchair, a yellow notepad on his lap and a tape recorder next to Ross's coffee, sat Jeff Elliot. Through the vertical blinds, Ross was looking past the reporter, out over downtown from the seventeenth floor. But he noticed neither the lights of North Beach dancing below him nor the stars clear in the wind-swept sky above. He hadn't eaten since breakfast, yet felt no hunger.
They'd been at it for almost a half hour, and Ross had brought the discussion around to himself, his background. How he'd joined the Parnassus board as a doctor whose original job was to provide medical legitimacy for the company's profit-driven business decisions. This was back in the first days of aggressive managed care, and Ross told Elliot that he had come on as the standard-bearer for designating a primary care physician, or PCP, for each patient as the gatekeeper of the medical fortress, a concept which by now had pretty much become the standard for HMOs everywhere in the country.
"But not a popular idea," Elliot observed.
Ross came forward in his chair and met the reporter's eyes. "Give me a better road and I'm on it tomorrow," he said. "But basically it works."
"Although patients don't like it?"
A resigned shrug. "Let's face it, Mr. Elliot, people are hard to please. I think most patients appreciate the efficiency, and that translates to satisfaction." He wanted to add that in his opinion, people were overly concerned with all the touchy-feely junk. The body was a machine, and mechanics existed who knew how to fix it when it broke. The so-called human element was vastly overrated. But he couldn't say that to Elliot. "It's really better for the vast majority of patients."
"And why is that?" the reporter asked. "Doesn't it just remove them from any kind of decision loop?"
"Okay, that's a reasonable question, I suppose. But I've got one for you, although you won't like the sound of it. Why should they be in it?" Again, he held up his hand, stopping Elliot's response. "It's hard enough to keep this ship afloat with professionals who know the business. If patients had the final say, they'd sink it financially. Now I'm not saying we shouldn't keep patients informed and involved, but"
"But people would demand all kinds of expensive tests they don't really need."
Ross smiled with apparent sincerity. "There you are. Healing takes time, Mr. Elliot, and you'd be surprised at how many health problems go away by themselves."
He stood up and went over to the small refrigerator at the corner of the room and got out a couple of bottled waters. He gave one to the reporter and sat back down.
"Look," he said, leaning forward and speaking, ostensibly, from the heart. "I know this must all sound pretty callous, but nobody's opposed to losing the money on tests if they're necessary. Hell, that's what insurance is all about, after all. But if fifty guys show up month after month, and each one gets his test when only five really need it, then instead of Parnassus losing twenty-five grand, which is covered by premiums, we lose a quarter mil. To cover that, we'd have to increase premiums and copays by a factor of ten, which nobody can afford. So the whole system falls apart, and no one gets any health care."
Elliot drank some water. "But let's say out of the fifty guys who want their tests, ten in fact need them. Not five. What happens to them?"
"They get identified, Mr. Elliot. Maybe a little late, which is regrettable. Nobody denies that. They're tough choices, I admit. I personally wish nobody had to go through any pain ever, honest to God. That's why I became a doctor to begin with. But it's my job now to keep this ship afloat, and if we tested every patient for everything they wanted as opposed to everything they truly needed, we'd sink like a stone, and that's the cold, hard truth. Then nobody would get any tests because nobody could afford them. You think that would be better?"
"Let me ask you one," Elliot replied. "I've heard a rumor you haven't paid some of your doctors. Would you care to comment on that?"
Ross kept on his poker face, but Elliot's awareness of this fact startled and worried him. He also thought he knew the source of itthe always difficult Eric Kensing, who'd admitted Baby Emily and then, he suspected, been Elliot's source on the breaking story. But he only said, "I don't know where you would have heard that. It's not accurate."
This evidently amused the reporter. "Is that the same as not true?"
Ross sat back in an effort to appear casual. "What we did was ask our doctor group to loan a sum to the company, with interest, that would come out of the payroll reserve. It was entirely voluntary and we've paid back everyone who's asked."
* * *
Jeff Elliot had been sitting listening to Malachi Ross's apologies and explanations for over an hour. Now the chief medical director was talking, lecturing really, about the rationale for the Parnassus drug formulary, maybe hoping that Jeff would spin the self-serving chaff into gold in his column, get some PR points for the group in Ross's coming war with the city.
"Look," Ross said, "let's say the Genesis Corporation invented a cancer-curing drug called Nokance. The budget to research and develop the drug and then shepherd it through the zillions of clinical trials until it got FDA approval comes in at a billion dollars. But suddenly, it's curing cancer and everybody wants it. Sufferers are willing to pay almost anything, and Genesis needs to recoup its inve
stment if it's going to stay in business and invent other miracle drugs, so it charges a hundred bucks per prescription. And for a couple of years, while it's the only show in town, Nokance gets all the business.
"But eventually the other drug companies come out with their versions of Nokance, perhaps with minute variations to avoid patent disputes"
"But some of which might cause side effects?"
A pained expression brought Ross's eyelids to half-mast. "Rarely, Mr. Elliot. Really. Very rarely. So look where we are. These drugs also cure cancer, but to get market share, they're priced at ten bucks. In response, Nokance lowers its price to, say, fifty dollars."
The Oath Page 6
