Corruption in the Or

by Barbara Ebel

  Viktoria stepped behind the cluttered desk and ran her eyes over the top at anesthesia journals, pain journals, cords for electronic devices, and three framed pictures. Other pictures graced the only open side wall. Lots of them. Many were photos of Dr. Huff with other anesthesiologists, most likely at conferences and meetings. She got the impression he was politically active in the field.

  She pulled her eyes away from the extraneous items and scanned the spines of the texts in the first bookcase. To her surprise, the stash of books had a method to their madness. Major specialties like OB/GYN were all together, whether anesthesia related or not. Especially since the group practice did OB anesthesia, she liked that.

  Quickly, she figured out the medical specialties in the next bookcase. The patient’s subject matter of a rare epilepsy should be written up in internal medicine and/or neurology, she thought. She came to Harrison’s two volume set of the Principals of Internal Medicine right behind Jay’s chair where a paper tray sidled next to it. It was the same type of tray holding the anesthesia records in the anesthesia office, the records of cases done and then submitted to Jeffrey Appleton so the hospital could submit them to insurance companies for reimbursement to them.

  She locked her hand around the seven-pound Harrison’s first volume and jimmied it forward, but it jostled the tray next to it and the pamphlets lying on top fell to the floor. They were only anesthesia related information for patients, and she grabbed them from the carpet and started to put them back.

  But as she stood straight, she realized their absence revealed the true contents underneath, fitting squarely into the plastic tray. Like from the anesthesia office, the paperwork she saw were also anesthesia charge slips and time records of cases done.

  She grabbed the stack and slumped into Jay’s chair. The paperwork qualified as originals, not copies. She thumbed through them and one fact stuck out. The cases appeared to be from the last week or two and all of them had a designated “E” which meant they all qualified as emergencies. If it had anything to do with it, that meant they never showed up on the official day’s surgery schedules that Jeffrey Appleton would see. And since these were originals, that meant he wasn’t getting them either.

  Which meant he also was not getting reimbursed for them!

  Which meant that, although the anesthesiologists got paid a salary by the hospital, maybe they were double-dipping and also getting reimbursed for cases over and above what they were submitting to the hospital and for cases the hospital didn’t know about.

  -----

  Viktoria stared at the pile on her lap for a full five minutes. The idea that the department might be embezzling money disgusted her, and she sat motionless thinking it over. Then she realized it was not so much the department that was crooked, but Jay Huff, the President of the group. No wonder he walked around with a furrowed brow all the time, she thought. He could be worrying about getting caught!

  She yanked her iPhone out of her pocket, opened up “notes,” and entered a few abbreviated case descriptions, the date and time, and other succinct information from the pile on her lap. Was her train of thought flawed? she thought. The possibility of pulling something like this off, because of case load checks and balances of OR information sent to Jeffrey Appleton, was probably slim. Then she snapped a picture of one of the charge slips.

  Finally, she took a deep breath, and slipped the paperwork back into Jay Huff’s plastic tray. She covered it up with the pamphlets and reorganized her thinking. Her purpose had been to research “Idiopathic Photosensitive Occipital Epilepsy.”

  With a heavy heart at how despicable some, or most, human beings can be, she lugged the heavy medical book to her lap and dove into the index.

  -----

  When Viktoria arrived in the recovery room, Bobby Wright was perched on the long nurse’s counter talking with the second nurse on duty. The other RN scrambled from one side of the stretcher to the other, adjusting the bed sheet and pulse oximeter of the young male patient all finished with his surgery. The patient dozed and no signs of pain flashed across his expression.

  As Dr. Thorsdottir gripped the railing, she read her patient’s vital signs, watched his chest rise with a normal respiratory rate, and nodded her approval to the nurse.

  She turned and leaned over the counter. “Nice job, Bobby. Many of the patients whom I’ve seen arrive in this recovery room are not as comfortable as yours.”

  “Funny you say that. I notice that myself.” He smiled, flashing bright white teeth, a harsh contrast between the hint of a mustache and beard growing in black as his hair. He raised his arm and patted himself behind his own shoulder.

  “Bobby’s a proficient nurse anesthetist,” the RN added. “If I need surgery, I’m requesting him. Better yet, I’d request who I don’t want.”

  “I hear you,” Bobby said. “So, are you going to the wedding tomorrow?”

  “Of course! Wouldn’t miss it for the world.”

  “Then I’ll see you, unless for some reason Dr. Thorsdottir here calls me back for most of the night, and we have cases to do. I do need to get my masculine beauty sleep before duding up for a wedding.” He turned to Viktoria. “Do you need me anymore?”

  Viktoria was stuck on the previous conversation and Bobby needed to tap her arm.

  “Sorry, Bobby. Sure, thank you. You’re free to go. Just check at the front desk to make sure there are no cases in the ER that may be coming our way.”

  Bobby waved and strutted away. Viktoria went straight to the anesthesia office and took a seat. Their case had qualified as an after-hours emergency, and she wanted to trace the anesthesia charge ticket. In a few minutes, the nurse anesthetist walked in and put the sheet straight into the reimbursement records in their plastic tray.

  “Bye again,” he said.

  “Have a wonderful time tomorrow. I will do my best to not call you back in.”

  Viktoria absentmindedly brewed over the practice while she popped chocolates in her mouth. It did seem strange. Some nurse anesthetists in the group did not keep their patients’ pain under control like others. Patients arriving in the recovery room immediately needed the standing pain orders to be implemented and others were satisfied and content, and they reported a low pain score when asked. Of course, many factors come into play with patient’s surgeries and background, but if she dived deeper, kept tabs, and figured it out, she bet that the two CRNAs getting married tomorrow fell short as adequate pain providers.

  -----

  After Viktoria’s young patient was discharged from the recovery room, she felt comfortable enough to forage in the doctor’s lounge for something substantial enough to call dinner. The room was empty and quiet except for the minimal drone of the television which was tuned to the weather channel. “After a possible shower or two overnight, tomorrow should bring sunny skies and temperatures in the sixties,” the meteorologist reported for the local area.

  Viktoria stepped up to the counter to find it bare except for a bowl of fruit and a basket of crackers and cheese. She opened the compact refrigerator below and luckily found a plastic tray with left over sandwiches, a tray of picked-over fruit, and a variety of drinks. The ham and cheese sandwiches looked the most appealing and, to her delight, she uncovered a small cheesecake as well.

  She placed her assorted dinner on one of the tables. After eating, she realized, she needed to go upstairs and pick out a call room. She hoped the hospital catered to doctors’ needs while they stayed on call in-house and not at home, and that the rooms were comfortable and stocked with a few essentials.

  Viktoria felt grateful and relaxed while chomping on the croissant sandwich and even intermittently closed her eyes and thought about Buddy. He was such a find. He was meant to come into my life, she thought.

  In the next moment, the wooden door to the lounge whooshed open, an RN barged in, and Viktoria startled. She jerked her head up as the RN surveyed the room and stopped short. “Have you seen Dr. Winter?” she asked with a hurried speech. />
  “Not at all.”

  “He’s the obstetrician on call tonight. I can’t find him anywhere, and he’s not answering his pages.” She turned and began fleeing out the door.

  “Can I help you with anything?” Viktoria called after her.

  “Only if you can deliver a baby!”

  CHAPTER 16

  Viktoria pushed back and jumped up. The nurse had disappeared, but there was no way she could finish her dinner sandwich after being told Dr. Winter was not responding to the nurses’ calls and a delivery on the obstetrics floor was imminent.

  She dodged into the hallway. “I don’t know your name, but I’m right behind you.”

  “I’m Linda,” the RN shouted over her shoulder. “Who are you?”

  “Dr. Thorsdottir.” She hurried her steps behind the short woman in tight scrubs and loose hair flying down her back. “With anesthesia.”

  They both bounded up the stairwell and flung the door open on the obstetrics ward. “Any luck?” Linda shouted towards the desk.

  “Nope. Still can’t reach Dr. Winter,” someone yelled back.

  Linda’s eyes snapped open wider as she nailed her focus on Viktoria.

  “I’ll do my best,” Viktoria said, “but it’s been years since I delivered a baby. What can you tell me?”

  “Gravida 2, Para 1. She’s at full-term and I believe she suffered no complications during the last nine months. Her ‘significant’ other is in the room with her, or at least that’s my guess who he is. These days, the guys sometimes aren’t significant at all.”

  Linda moved towards a closed door and grabbed the handle.

  “Fetal heart rate monitoring been normal?” Viktoria asked.

  “Yes, no fetal distress.”

  Viktoria allowed herself a sigh of relief. The situation could be a lot worse.

  The two women flung into the patient’s delivery room. Viktoria allowed her eyes to take an instantaneous snapshot of the scene before her as she bounded to the patient’s bed set up in the lithotomy position. The patient’s legs were spread apart and the fetus’s head was crowning. The woman’s face contorted as her teeth gritted down so hard, Viktoria thought that, any second, she would hear her back molars crack.

  Alongside the bed, a thirties-looking man stood wearing a frightened expression. He took a step back towards the window. “Finally, someone who knows what they’re doing!”

  Viktoria ignored his remark. She was no obstetrician. Without time to gown up, she reached towards the tray table to grab a pair of gloves from the cardboard box. But she didn’t make it. The grimace on the woman’s face ramped up as she pushed with all her might. A slippery, moist male infant slithered out into Viktoria’s forearms.

  Two thoughts imploded in Viktoria’s brain. The baby was alive and kicking, and full of vitality. And secondly, thank God he hadn’t been a breech presentation!

  -----

  Mother, father, and baby weren’t the only ones who needed to simmer down their heart rates. Viktoria gulped a big breath of air and let it out with relief. She shot a glance at the male whom she assumed was the dad. “Want to cut the cord?”

  The man slowly came out of his frightened state and nodded with assurance that he was up to it. Linda handed Viktoria the tools she needed from a delivery tray and soon put the infant in the bassinet to dry him off and swaddle him in a blanket. Doctor and nurse decided on an Apgar score of eight and nine, a healthy index of the newborn’s status.

  The commotion in the room settled into a peaceful state as Viktoria prepared to leave. She needed to write a note in the chart exactly what happened as best she could. She certainly couldn’t write it as good as an obstetrician, but decided to be very thorough. It would be better if the real obstetrician and pediatrician came and checked on mother and baby.

  Viktoria penned the delivery information needed and then called the pediatrician on call, explaining the situation. “I can’t take much credit for bringing this baby into the world. Mom pretty much did it all.”

  “Nevertheless,” he said, “your presence and know-how was invaluable.” Close by in the pediatric NICU, he promised to zoom over to evaluate the infant.

  Viktoria scanned the hallway where Dr. Winter still did not appear. Since he was the obstetrician on call for the night, she didn’t want to be delivering any more babies at Masonville General Hospital. Time to track down Jessy Winter, she thought.

  -----

  Jessy Winter’s office and case load on Friday was a tad lighter than usual. But today that did not translate into something positive. It gave him a little more leg room to dive deeper into the abyss of his mind and concentrate on the horrid situations that had taken over his life.

  After holding back anger most of the morning and early afternoon, by 4 p.m. his troubles demarcated themselves into segregated punishments in his brain. For one hour straight, his brain rattled with thoughts of his divorce. Sure, he knew, the “results” had been pending before this week, but he’d been in denial about just how bad the outcome could be.

  Although he and his wife had been married for nineteen years, they had gone through their ups and downs and had waxed and waned with their arguments and differences. Before their daughter Lucy had been born, they had tried for several years to conceive. The fertility expert claimed there was nothing wrong with either of them and if they would quit trying so hard, nature would take its course.

  Sure enough, their baby girl was conceived, and nine months later he spilled over with joy to see his own baby be born. And how she’d grown! Overnight, she’d jumped from the crib to a spot on the girls’ soccer team in grammar school. Lucy became the joy of his life.

  But now? He would be lucky to get little, ridiculous “visits” with her. It would surely qualify as less time than her soccer coach spends with her, whoever that might be. After all, how would he know her coaches when he would be working like a dog paying all the bills?

  His little girl was being torn away from him and that was as good as tearing out his own heart.

  This deep thinking rumbled these thoughts around like marbles in a satin pouch. How could he tolerate this through her years in grammar school, through her high school, and through whatever she would negatively think of him during college and as an adult?

  He exhausted himself with the divorce thoughts and the knowledge that he would be a slave to working and paying the bills without so much as a respite from the oppressiveness of it all. As it was, he had been living in the hospital to make ends meet and to allow his wife and daughter to have their home.

  Which brought him to 5 p.m., at which time he avoided the doctor’s lounge and isolated himself in a corner of the cafeteria. He scarcely bit into a slice of meatloaf. When he finally left it uneaten, he took the elevator up to his call room.

  Jessy pushed open the door and frowned at the mess. Apparently, the housekeeping service had cut him off, which made sense. Jeffrey Appleton may have handed down the message to him of his hospital privileges being revoked, but to be crispy clear about it, he’d been “fired.”

  Yes, fired from the hospital. This was the second humongous problem for him, which tied in severely to the first. Picking up and procuring someplace else to live could be done, he thought, even if it meant getting a cheap option at the Stay Long Hotel place where the outlander anesthesiologist stayed.

  But what for? He could not work at Masonville General Hospital and no other hospital in the vicinity, or anywhere else, would be trusting enough of him to allow him on their staff. He was in deep shit.

  And wait until his colleagues learned all this. He’d be segregated to only see patients on their return visit after they delivered their babies. But that was thinking positively. By next week, he would be as good as canned from his office practice. All those years of studying biology and chemistry in college with the intent of being accepted to medical school, four hard years of medical school, and four grueling years of residency. For what? For nothing.

  Jessy stood lik
e a mummy staring in the room. Finally, he cleared a spot off the bed and sat down. Only to stare at the floor.

  He leaned forward and buried his head in his hands. There was no escape. Trying to resolve these problems was impossible. They were set in stone and could not be undone. Thinking about them highlighted the hopelessness and helplessness of his situation. He was doomed.

  For the last two days, his cloud of despair had ramped up so much that he wanted nothing to do with living the continuance of this imperiled fate. He wanted to be dead right now, so how would that change when the morning came? When the morning hours rolled around, he’d be technically ousted from being an MD in the hospital where he had delivered umpteen infants by vaginal and Cesarean sections, tied women’s tubes, did D&Cs, and performed a multitude of other procedures. And tomorrow he didn’t even have what he considered “visitation” with his own daughter.

  No, life would not go on like normal. That is, life would not go on for him. Period. At least being a physician gave him choices, options in how to go about killing himself. He could immediately march down to the pharmacy store, fill a prescription, and pop a handful of drugs which would send him off from Mother Earth in a deep, nonarousable sleep. But, hell, he felt too lazy and too impatient to do that.

  On his computer the night before, he had googled people well-known to have committed suicide via hanging, and learned a lot about the atrocity of the gallows and that the first known account of execution by hanging was in Homer's Odyssey. Which, of course, he had never read.

  As far as he could tell, the method started to be used in medieval times for capital punishment, but he suspected humans were doing it a lot further back than that. Humans were nasty, so they must have been tying nooses around peoples’ necks for criminal and trivial reasons. If, in more modern days, they were doing it because of the color of people’s skin, then any reason must have sufficed.

  He wanted to go out dramatically. Let the medical system, which only caters to the patients and not the doctors; the damn ex-wife; and the lawyers and the judges, think about what they made him do.