Miss Julia Takes the Wheel

by Ann B. Ross

  I turned to look at him as another thought occurred to me. “Do you think those big pharmaceutical companies have special divisions just to think up what to call all those new drugs?”

  “I wouldn’t doubt it,” Sam said, folding the paper to a front-page article. “They have special divisions for everything else.”

  “I can just see it,” I said, letting my imagination roam through the possibilities. “A group of very smart young people who’ve never had a pang of any kind in their lives, sitting around throwing out suggestions for naming the next wonder drug. They’d want something catchy and easy to remember so patients can tell their doctors what they want. Except,” I went on, “they’re just about scraping the bottom of the barrel by now. Have you heard some of the names they’ve come up with? And, Sam, you know how things catch on and become part of the culture. I wouldn’t be a bit surprised to be introduced some day to Ms. Otezla Jones or Miss Lyrica Smith. Maybe even to Miss Repatha Wright.”

  Sam laughed. “You may be right.”

  I knew I was, and I’d not even mentioned the possibility of twin sisters named the Misses Tena and Kyleena Brown.

  Chapter 3

  *

  “You know,” Sam said, putting aside the newspaper, “we really should be grateful that Bob Hargrove is bringing in a locum tenens. He could’ve just as easily—maybe more so—turned his practice over to the hospital during the time he’s gone.”

  “Really? How could the hospital run a private practice?”

  “That question,” Sam said with a quick glance at me, “just shows how healthy you are, and thank goodness for it. You’re out of touch with what’s been going on in medicine in the last ten years or so. You ever wonder why I gave up my seat on the hospital board?”

  “Well, not really. I just thought you’d had enough. I mean, you’ve been on every board in town at one time or another, anyway.”

  “That was part of it,” Sam said, nodding. “But it was mostly because I could see the way the wind was blowing—and I didn’t like it.” Sam shifted in his seat beside me, an indication that he was troubled. “Honey, medicine is not practiced the way it once was. Used to be that one of the reasons young men—and women—put in all the years to become doctors was the opportunity to be on their own, to have their own practices that included personal relationships with their patients. Many of the general practitioners prided themselves on cradle-to-grave care of their patients.”

  “That’s exactly what I expect from Dr. Hargrove,” I said with firm approval. “My only concern is that he’ll predecease me, and I’ll have to look for another doctor. That’s why I’m not too upset at his taking so much time off. I want him to get the rest he needs so he’ll stay healthy.”

  “Well, I’m sorry to tell you that it doesn’t work that way anymore. See,” Sam said, crossing one leg over the other, “it used to be that most of the ones who went to medical school were definitely not the corporate types—they had no desire to work for somebody else. They were independent souls—some, I admit, independent jackasses, but you’ll find that kind in any field. Except for a very few—like Hargrove—who’re holding on to the old ways, they’ve now bought into the new way of practicing medicine.”

  Frowning at the thought of changing something that had worked well for years, I said, “But what’s new about it? They still see patients, don’t they? And diagnose and treat whatever they have, don’t they? I don’t understand how else medicine could be practiced.”

  “Well, it’s like this. Somehow or another—and it beats me how quickly and easily it’s come about—hospital administrations have jumped into the catbird seat, and with that, you get the whole corporate setup—CEOs, CFOs, business plans, financial projections, and you name it. The practice of medicine as a business—because, honey,” Sam said, sitting up straight to make sure that I understood the problem, “private equity companies are buying up small hospitals, which means, in turn, that those hospitals are run to make a profit.”

  “What’s a private equity company?”

  “One that’s owned by stockholders who expect a return on their investment. So, doctors now work for the hospitals—hired by them, sent patients by them, and drawing a salary from them. And not only that, they’re often given quotas as to the number of patients they’re expected to see per day, and the worst thing is—” Sam stopped, drew a deep breath as if to calm himself “—the worst thing,” he went on, “is that when they admit a patient to the hospital, they have to turn the care of that patient over to another group of salaried doctors—hospitalists, they’re called.”

  “What?” I asked, staring at him. “You mean your own doctor doesn’t take care of you?”

  “That’s right. Your own doctor won’t even make rounds. They work nine to five in their offices, and the hospitalists are in charge during the hospital stay.”

  “Well, that doesn’t make sense. If your own doctor thinks you need to be admitted, he ought to be the one in charge. How can these hospitalists know your history? Or anything else about you?”

  “Beats me, honey,” Sam said with a sigh. “And it beats me how those independent-minded doctors could just fold and give in to it. Of course, they get weekends off, and they don’t get phone calls at night, and they get regular vacations, as well as regular incomes, and, perhaps the biggest attraction, they don’t have all the clerical problems. I mean, the hospitals keep the medical records, apply for insurance, Medicare, and Medicaid payments, do all the billing and collecting, and keep the government happy with tax reports and so on. I can see how appealing that would be. Very few doctors are businessmen, but I can’t help but think that they’ve made a poor bargain—sold their souls, even.

  “But,” he went on, “I understand some of it. A lot of ’em come out with huge student loans, so to work for a hospital saves them from having to borrow more to set up an office. And with the increase of highly specialized practices that require unbelievably expensive technology, only hospitals can afford them. Still, it seems to me that the changes benefit everybody but the patient. Physicians used to be taught to treat the patient, not the disease. But now hospitalists treat the disease, and the patient is apt to get lost in the process.”

  “Well,” I said, verging on outrage, “just who came up with those bright ideas?”

  “I wish I knew, although I can guess. The ones who’ve come out on top are the hospital administrators who are answerable only to stockholders. They’re now the top dogs. After years and years of deferring to their medical staffs, doctors now work for them, rather than the other way around.”

  “I don’t think it ought to be that way, Sam. Why hasn’t Dr. Hargrove told us about this?”

  “He has, but he’s made no changes, so you probably didn’t notice. He’s one of the few in town who’ve refused to contract with the hospital.” Sam stopped, thought a minute, then said, “I don’t think Dr. Harry Holcomb did, either.”

  “No wonder. He’s as old as the hills. Besides,” I went on, “I’ve heard things about him.”

  Sam smiled without comment, as he often did when I referred to gossip. “Well, anyway, if any of the holdouts admit you to the hospital, they’ll continue to care for you while you’re there.”

  “Well, thank goodness for that. I don’t want one of those hospitalists around me at all. Why, the very name gives me cold chills. They ought to call them substitute doctors since—” I stopped, suddenly thinking of Dr. Hargrove’s replacement.

  Sam, who could follow my thinking better than I could most of the time, said, “Not the same, honey. A locum tenens isn’t a hospitalist. He’ll follow Dr. Hargrove’s lead, not the hospital’s, in the way he runs the practice. I’m sure Bob wouldn’t have hired him otherwise. That’s one thing you don’t have to worry about. Of course,” Sam went on with an indulgent smile, “just stay well and neither of us will have to worry about any of it.”

  “
I certainly intend to, especially since I’ve now learned how the practice of medicine has been turned upside down and inside out.

  “But you know, Sam,” I went on, recalling something that Mildred Allen had complained about quite recently. “Maybe that explains those computers that all the doctors haul around with them. Mildred went in not long ago to have a stress test and she had to see a string of doctors. Every one of them, she said, came in pushing a little table on wheels with a computer on it—like it was an appendage or something. And to make it worse, during the whole time the doctors spoke to her, they kept their eyes on the computer screen, tap-tap-tapping away. She said it was disconcerting to have what was supposed to be a one-on-one conversation with one’s physician while his eyes stayed glued to that screen.”

  “Yes,” Sam said, nodding, “they have to keep records of everything to send to a central computer in the hospital.”

  “Sounds like big government to me—keeping tabs on everybody.”

  Sam smiled. “Pretty close to it, I guess. But of course, doctors have always kept records—handwritten, but later transcribed by a typist. They kept them not only to chart a patient’s progress, but also for legal purposes. You know, in case they were sued sometime in the future.”

  “Yes, Dr. Hargrove always comes in with a pen and a pad, and scribbles down anything I complain of. But Mildred said having that computer between them was like having a robot listening in and taking notes on everything that was said. She didn’t like it.

  “And furthermore,” I went on, “she said the screen was always turned away from her so she couldn’t see what was being entered.” I stopped and thought for a few minutes, then said, “And, you know, Sam, computers are taking over our whole lives. There’s no telling what the things are doing, nosing into our private lives, keeping records until Doomsday—it makes me ill to think of it. And another thing, every child in school has to have a computer nowadays. I’m not sure they even learn what it means to write. All they ever do is ENTER.”

  “Well, we went through the Industrial Age when everything changed.”

  “Not me,” I said to lighten things up. “I’m not that old.”

  Sam laughed. “Me, either, but we’re certainly going through the Electronic Age. And we’d better get used to it, because everything is changing.”

  “I can ignore whatever else changes,” I said, reaching for his hand, “just as long as you don’t.”

  Chapter 4

  *

  We both turned as we heard the kitchen door open and close, then Lloyd’s greeting to Lillian. After a short conversation with her, he left the kitchen, crossed the hall, and came into the library.

  “Hey, Miss Julia, Mr. Sam,” he said, walking to the fireplace and warming his hands. “Boy, it’s cold out there.”

  “It sure is,” Sam said, smiling at him.

  “I hope your coat’s warm enough,” I said. “I’ve just come in myself and can testify to how bitter it is. And that reminds me. Has your father gotten home yet?” J. D. Pickens was a private investigator under contract to a major insurance company to investigate suspected fraud and other illegal activities. He was often away from home for days at a time.

  “No’m, I think he’ll be home this weekend.” Lloyd, finally warmed up, began divesting himself of his heavy jacket. “At least I hope he will.”

  “Well, then,” I said, “be sure to remind your mother to let the faucets drip tonight. They’re calling for a hard freeze, maybe even dropping into the teens, which could mean frozen water pipes. To say nothing of downed trees and broken power lines.”

  “Yes’m, I will. But mama says the best money she and J.D. ever spent was buying that self-starting generator. She says that worrying about losing power is a thing of the past now.”

  “I know what she means,” I said, thinking of the comfort of having one ourselves.

  “How’s school these days?” Sam said, having had enough, I suspected, of weather talk. Lillian and I could discuss it for hours, which we often did.

  “Pretty good,” he said, sitting on the opposite sofa facing us. “I guess.”

  “Just pretty good?” Sam asked. “What’s going on? You sound a little jaded.”

  Lloyd shrugged his shoulders. “I don’t know about that. I’ll have to look up jaded before I say either way.”

  Sam grinned—he often pulled out a word that Lloyd and I had to look up. “World weary,” he said.

  “Then no, I don’t think it’s that,” Lloyd said, leaning back. “It’s more of trying to figure how to get out of doing something I don’t want to do without hurting anybody’s feelings. It’s a dicey situation.”

  Immediately visions of bullying, cheating, or gang-related problems popped into my head. “Are you in trouble, Lloyd?”

  He grimaced. “I’m gonna be if I’m not careful. See, I heard—I mean, somebody told me—that Andrea Mason is going to ask me to the dance the school’s having for Sadie Hawkins Day.”

  “Mason?” I asked, going over the name in my mind to place her family. “If it’s the Masons I know, they’re very nice.”

  “Oh, she’s nice, but she’s tall, too. And I’m not.”

  Sam frowned. “I thought it was usually the girl who worried about height differences.”

  “Ordinarily, I don’t worry about it—we’re pretty good friends. But if they play a lot of slow dances, I have to worry about where my eyes come up to.”

  Sam immediately got it, but it took me a minute. He tried not to laugh, holding himself in as he nodded in acknowledgment of a truly dicey situation.

  “To make it worse,” Lloyd went on, “somebody else told me that Janice McDonough is going to ask me, and maybe Leigh Swanson, too, and they’re both kinda short. So, see?” He shrugged his shoulders as if having a plethora of dates in the offing was a burden to be borne. “It’s not the height that worries me, it’s the number of them, and how I’ll have to choose which one I go with.”

  “Well, Lloyd,” I said with a smidgeon of pride, “it sounds as if you’re a popular boy.”

  “No’m, I don’t think so. It’s mainly because I’m a good dancer so—”

  “You are?” I asked, surprised.

  “Yes’m. J.D. showed me how, and he’s real good. He said I’m a natural when it comes to moves, so now all the girls want to go with me.”

  “Well, I declare,” I said, at a loss for anything else to say.

  Lloyd frowned, twisted his mouth, then said, “I don’t even know why we have to have a Sadie Hawkins Day dance, anyway. I mean, who is Sadie Hawkins, anyway?”

  “Why, Lloyd,” I said, surprised that he had to ask, “Sadie Hawkins was a character in the Li’l Abner comic strip. She was, unfortunately, the homeliest girl in Dogpatch and had no suitors for her hand. In desperation to marry her off, her father declared an official Sadie Hawkins Day on which a footrace was held when the women chased the men. Whoever got caught had to marry the girl who caught him.”

  “Good grief!” Lloyd said. “And here I’ve been worried about having to dance with somebody.”

  “Well,” I said to ease his consternation, “I could have it wrong. It’s been a long time since I’ve seen that comic strip.”

  “I think it’s been discontinued,” Sam said. “Al Capp died some while ago. But he created some memorable characters. Remember Senator Jack S. Phogbound? And Jubilation T. Cornpone?”

  “And Joe What’s-His-Name?” I said, smiling. “I never could pronounce his name, but the one with a black rain cloud over his head.”

  “Nobody could,” Sam said. “That comic strip became a social commentary during a time of protests, riots, and general unrest, especially on campuses. The genius of Capp could make you laugh and at the same time blow your head off. One thing he came up with could still be used today. Remember S.W.I.N.E.?”

  “No, what was that?”


  “Students Wildly Indignant about Nearly Everything,” Sam said, laughing even as he shook his head. “Just watch the news and see if I’m right.”

  “Well,” Lloyd said, clearly having had enough of our reminiscing, “I guess it’s no wonder that the county high school has what they call a Turnaround dance. It’s the same as ours—the girls ask the boys—but they don’t have to wonder who Sadie Hawkins is.

  “Or,” he went on, dolefully, “if the boys know what’s supposed to happen if they get caught. And I’ve got three girls chasing me.”

  Sam, who was still trying to keep a straight face, said, “Oh, I don’t think you need to worry about anything permanent. In fact, it seems to me that you’re already caught. Now it’s just a matter of which one you want to end up with at the dance.”

  “It’s worse even than that,” Lloyd went on, rolling his eyes. “’Cause, see, the word’s gotten around that I’m getting a car. The girls like that, too.”

  “A car!” I said, sitting up straight. “Why, Lloyd, you aren’t old enough to drive. Who’s getting you a car?”

  “J.D. is, and, yes ma’am, I am. I’m fifteen, and I’ve taken driver’s ed, so I have my beginner’s permit. I have to have a licensed driver with me until I’m sixteen, but, see, all the girls like J.D., too, and he’ll be with me when I drive.”

  “They Lord!” I said, wondering what Hazel Marie’s swashbuckling husband would think of next and wondering what I could do to nip Mr. Pickens’s too-much-too-soon idea in the bud as well.

  “But that’s a problem, too,” Lloyd went on, frowning. “Because, see, the licensed driver has to ride in the front seat, so J.D. will have to sit by me while I drive, and my date, whichever one I take, will have to sit in the backseat by herself. None of ’em would like that, and the whole evening would be shot before we even got there. And the other two’ll have their feelings hurt and probably won’t ever speak to me again.”

  “Lloyd,” Sam said, pontifically, “I am going to issue a Solomonic solution for you. Tell those young ladies that you couldn’t possibly choose one over the others, so you’ll take all three of them, or—how about this? They could draw straws to narrow it down. Either way, it would be out of your hands.”