The Chairmen

by Robert I. Katz

  Weisberg shrugged. “That was then. This is now. Amazon is a big company. Big companies can’t grow as fast as small companies. Amazon’s best days are behind it. Sooner or later, Amazon is going to crash. It’s inevitable.”

  Over the years, Amazon had already crashed more than once, but the stock had always, sooner or later, stabilized and moved back up, fueled by rosy projections and steadily increasing revenues, if not always a profitable bottom line. About two years ago, Kurtz had put a few thousand into Amazon. Amazon had gone up. Kurtz had sold out with a 40% gain and considered himself lucky. Weisberg, he thought, made sense, but then so did Norris. In Kurtz’ opinion, the stock market was inherently unpredictable. Putting money into the stock market was not so different from betting it on the horses. This didn’t bother Kurtz. Kurtz liked to gamble, now and then, but he tried not to confuse good luck with genius.

  He yawned. He hadn’t slept well last night. Somewhere, a lunatic was stalking his next victim. Somewhere, a new atrocity was about to take place. He yawned again, slowly finished the last few bites of his sandwich and rose to his feet. “See you later,” he said. Norris looked at him. Weisberg absently nodded. The others ignored him.

  Half an hour later, he was operating on a hernia. The hernia was a tough one, the patient fat, the wound deep. Loops of bowel intermittently popped up into the incision. After stuffing bowel back into the abdomen for the third time, Kurtz turned to the head of the table and said, “Can’t you keep him relaxed?”

  The anesthesiologist poked her head up over the drapes. “He is relaxed,” she said. “He’s just fat.”

  Kurtz restrained himself from saying anything he might later regret and decided to ignore her. He knew the patient was fat. He also knew that he was having a hard time with what should have been a routine case.

  Calm, he told himself. Stay calm. He placed a new retractor and continued. An hour later, bowel tucked neatly into the abdomen, abdominal wall sutured nice and tight, they dropped the still sleeping patient off in the recovery room. Kurtz dictated his operative note, changed into a jacket and tie and took the elevator up to the Fifteenth Floor. Night had already fallen. He shook his head sadly. He had hoped to be home before sundown and he still had to make rounds, maybe another hour of work to do.

  His first patient was a woman named Cloris Right. Kurtz had removed her diseased gallbladder the day before. She lay in bed, watching television. “How are you today, Mrs. Right?” Kurtz asked.

  “Fine,” she said. She gave him a half-hearted smile. “When can I go home? It’s impossible to sleep here. The nurses are yakking away all night long.”

  Kurtz looked at the chart. No temperature, vital signs stable. “Let me see your incision,” he said. The incision was white, the edges tightly closed. From the looks of the bandage, the drainage had stopped. “How about tomorrow morning?”

  Her smile grew wider. “Thanks,” she said.

  “I’ll see you in my office in a week. Okay?”

  “You bet.”

  Kurtz had barely walked out of the room when there came a shriek from down the hall and an alarm began to blare. A nurse poked her head out of a patient’s room, yelled, “Call a Code!” at the secretary sitting at the nursing station. The nurse’s head vanished back into the room.

  Jesus, what now? Kurtz thought. Then he ran.

  A withered old man lay on the bed. An intern stood at the head, squeezing an Ambu bag, while the nurse pumped rhythmically on the patient’s chest. Two other nurses rolled in a code cart. “Give me some scissors,” Kurtz said. A nurse handed him the scissors and he slit the patient’s gown off his chest, slapped some ECG leads on and looked up at the monitor. Nothing. “Epinephrine,” he said. A nurse handed him an amp and he injected it into the IV, then turned the drip up as fast as it would go. The flat line began to waver slightly. Fine v-fib. Not good but better than nothing. “Give me the paddles,” he said.

  “Ready,” the nurse said.

  Kurtz touched the two metal paddles onto either side of the patient’s chest, said, “Everybody off.” The intern looked up, realized what was about to happen and scrambled off the bed. Kurtz pressed the button. A snapping sound came from the machine and the patient’s body jumped into the air, then fell heavily back. The ECG showed the same fine, quivering line. “Again,” Kurtz said. The patient jumped again.

  The body, Kurtz noticed, wasn’t stiff but was completely unresponsive, the skin waxen and cool, the eyes fixed and dilated. This was not going to work. The old guy must have been dead for a half an hour at least when the nurse happened to notice him. But you had to give it an honest try, even when you knew it was hopeless.

  “Give me another epi,” Kurtz said. “And an amp of bicarb.” Bicarb was no longer part of the advanced life support algorithm, but this guy was cold and undoubtedly acidotic. Epinephrine doesn’t work if there’s too much acid in the system.

  They worked on him for another twenty minutes before Kurtz finally said, “That’s enough, people. Let’s call it.”

  The intern looked at him uncertainly. “Isn’t there anything else we can do?”

  “No,” Kurtz said. “He’s dead. He’s going to stay dead.”

  “Oh,” the intern said. He sat down in a chair, staring at the body, his face white.

  “Your patient?” Kurtz asked.

  “Yeah.”

  “I’m sorry,” Kurtz said.

  The intern drew a deep breath. “What am I going to tell his family?” he asked.

  Kurtz scratched his head. They gave the new interns lectures in how to break such news to the family but they somehow weren’t much help when you had to do it for real. “Tell them we did everything we could. It’s the truth.”

  “I suppose.” The intern looked up at Kurtz with bewildered eyes. “I’ve never lost a patient before.”

  It won’t be the last, Kurtz thought, but looking at the intern’s pale face and trembling lips, he knew better than to say it. “I’m sorry,” he said again.

  Chapter 13

  “I wanted you to know that I’ve accepted a position at Stanford,” Dennis Cole said. His tone was casual, almost bored, as if his chairman’s reaction was a matter of no concern to him at all, which was probably the case.

  “I’m sorry to hear that.” Peter Reinhardt was sorry, but not at all surprised. The institution had calculated the pros and the cons and had made a deliberate decision not to give Dennis Cole what he wanted.

  Dennis Cole was big and beefy. He looked more like a truck driver than a surgeon and he tended to loom over the people he was talking to, which he realized and used to his advantage. He had come here, years ago, with certain goals and expectations. Those goals and expectations had largely been fulfilled. His research was respected, even cutting edge, his clinical acumen beyond dispute. It was time for him to go on to the next level, if not here, then somewhere else. It was too bad, but inevitable. Academics in all fields tended to be transient, following the next opportunity to a new university, a new town, sometimes a new state or even a new country.

  “When will you be leaving?” Reinhardt asked.

  “Four months. That will give me time to wind down my current projects and get my new lab set up.”

  “I’m sorry it’s worked out this way,” Reinhardt said.

  “So am I,” Cole said, “but that’s life.”

  The Executive Committee of the Department of Anesthesiology met twice monthly. Two weeks prior, Vinnie Steinberg had been stuck with a difficult case and had not been able to make it to what would have been his first such meeting after being appointed Clinical Director at Easton.

  Sitting around the table were the Clinical Directors at Staunton and St. Agnes, as well as all of the various Division Directors: Cardiac, Regional, Neuro, General, Pediatric and Obstetrical Anesthesia, Intensive Care and Pain Management. Steinberg had met all of them before but the only one he had ever exchanged more than a few words with was Jerry Hernandez, big, overweight and balding, who was both the Di
rector of Neuro and the Clinical Director at Staunton. Steinberg settled back in his seat, happy to finally be one of the movers and shakers of the Department of Anesthesiology but his happy feeling faded quickly as he soon discovered that nothing was moving and nothing was shaking. Serkin talked for over an hour, giving an update on various departmental initiatives, research projects and institutional imperatives. He spent about half this time pointing out the various ways in which Staunton was superior to Columbia, Cornell and NYU, ways that struck Steinberg as at least mildly delusional, such as a higher state rating on cardiac surgery mortality. Steinberg happened to know that Peter Reinhardt, who naturally took the lion’s share of credit for this particular statistic, referred out his most difficult cases to Mount Sinai. Finally, at the end of the monologue, Serkin looked around the room. “Anything else?” he asked.

  Everybody smiled. Nobody spoke. Finally, tentatively, Steinberg raised his hand.

  Serkin frowned at him. “Yes?” he said.

  “What about the Discharge Policy?”

  Serkin nodded. “I’ve appointed a sub-committee to come up with a unified policy. It will be headed by Susan Greene.”

  Susan Greene was the Director of Pediatric Anesthesia. She had recently been recruited (if that was the right word) from Virginia, where she had kept a low profile and had no accomplishments of any sort to her credit. Susan looked at Serkin, pursed her lips and said nothing.

  “Oh,” Steinberg said. “Well, then, so long as it’s being taken care of.” Objectively, Steinberg knew that the whole discharge policy issue was not exactly Earth shaking. What was more important, from Steinberg’s point of view, was that the Departmental decision-making body quite obviously was not allowed to make any decisions.

  “See you in two weeks,” Serkin said.

  “Right,” Steinberg said. They all filed out. None of them said a word as they trooped down the hallway and into the elevator but as they went their separate ways in the lobby, Jerry Hernandez, who had no doubt been through this many times before, gave him a sad, knowing smile and a sympathetic shake of his head.

  Go home, Steinberg thought, put his feet up, have a nice drink…on second thought, maybe a double. Eat dinner, then boot up the old computer and make sure his CV was up to date. The thought cheered him. He left the building with a little bounce to his step.

  “Sure, we have surveillance cameras,” Patrick O’Brien said.

  Kurtz looked at him, surprised. He had asked the question as a matter of routine but had expected a different answer. “Where are they?” Kurtz asked.

  “No cameras allowed in any of the patient areas,” Patrick O’Brien said. “That would be a HIPAA violation. The entrances to the building are pretty well covered, including the ER. Also, the parking lots.”

  “How long do you keep the data?”

  Patrick shrugged. “We keep it for a year.”

  “Okay,” Kurtz said, “I’ve got an idea…”

  Over the next week, two messages were received on the obstetrics floor, one obscene phone call was made to Christina Pirelli’s home and one other to the Dean’s secretary, Mrs. Kaplan. The messages on obstetrics came, as most of the messages had, by interoffice mail. Both, as most of them had, threatened nameless destruction for unspecified sins. One was addressed to the head nurse during the morning shift, the other to the unit secretary. Both women called Security when they arrived and then put the messages from their minds. By now, obscene messages had become part of the background noise of their jobs.

  All together, this made over thirty messages (so far as they knew) that had been mailed in the hospital. Interoffice mail was picked up and delivered twice each day. All of the messages had been received in the morning, which meant that most, perhaps all, had been mailed the prior afternoon.

  Staunton offered three weeks of vacation to all of its non-medical employees, four weeks to the physicians. By correlating vacation schedules and recorded sick days with the known times of letter delivery and cases of sabotage, and by correlating surveillance data with the vacation schedules, they were able to confirm that the majority of possible suspects did not enter the hospital on at least one day when a message would have been delivered. Within a week, they had narrowed down their suspect list to eight men who fit the demographic criteria and who could be seen coming to work on all thirty or so days when one of the messages could have been mailed, and also on the evening when the dead fetus had been stolen from the pathology lab.

  Kurtz neither knew nor had ever heard of any of them. One was a pediatrician, one was a PhD in biomechanics who worked for the department of orthopedics, designing prosthetic joints, one was a technician in the Pathology Lab, two were housekeepers, one was an ex-marine who worked for Security, one was an OR tech and the last worked in the cafeteria. Some possibilities seemed more likely than others. The guy in pathology would have ready access to the dead infant. The OR tech would have had some familiarity with surgical packs. Security had ready access to keys, could easily get into locked rooms and could presumably nose around the whole institution without exciting suspicion, though people do tend to remember a uniform. If it was the Security guy, he was probably wearing plainclothes, Kurtz reflected. The others seemed less likely. The cafeteria worker’s job was relatively restricted and the housekeepers were assigned to the tenth and eleventh floors. On the surface, at least, these three would have less freedom to roam.

  “This isn’t bad,” Lew Barent said.

  Barent had been on vacation in Los Angeles for a week, visiting his oldest daughter and her new baby. He had arrived back home two days earlier and had already spoken with Harry Moran. This was the first time he and Kurtz had gotten together since his return. He looked tanned and well-rested. They were sitting in a booth at the diner a few blocks from Easton. Kurtz was eating a turkey club and Barent had a bowl of chili with a side order of potato salad. Patrick O’Brien nursed a cup of coffee. Moran, sitting next to Barent, smiled down at his sandwich, a chicken cutlet with Swiss cheese and sauerkraut on rye bread, slathered with mayonnaise.

  “I thought you were eating healthy,” Kurtz said.

  Moran smiled wider. “It’s chicken. Chicken is healthy.”

  “Ah,” Kurtz said. “Of course. I knew that.” He turned toward Barent. “So, any chance of getting search warrants?”

  Barent looked briefly amused. “What, are you kidding?”

  Kurtz shrugged. He was kidding, actually. No judge in America was going to issue a search warrant on data as speculative and flimsy as this.

  Moran glanced at O’Brien. “You have enough people to keep an eye on these guys?”

  “None of their offices are in patient care areas.” O’Brien grinned. “We’re going to put a few cameras where they’ll be useful.”

  “Excellent.”

  Kurtz sat back in his chair. This was good, he thought. Very good. Finally, they seemed to be getting somewhere.

  James Rosen and Mary Lustig were the two faculty members whose non-clinical time had been reduced by Christina Pirelli. Kurtz spoke to both of them and found out nothing useful. Rosen had a wife who liked expensive furniture and wanted a “cottage” in the country. The hand writing was already on the wall where Rosen was concerned.

  “Yeah, my CV is out.” Rosen smiled apologetically. “Teaching is okay but research leaves me cold. I like taking care of patients. Might as well take care of patients and get paid for it.”

  “What do you think of Christina?” Kurtz asked.

  “Christina is okay. She’s an academic. She wants an academic department.” He shrugged. “I don’t fit in. It’s nobody’s fault. Good that I discovered it.”

  Mary Lustig’s story was just as unhelpful. Her husband was an investment banker. He brought in far more money than either of them could ever spend. Unlike James Rosen, Mary Lustig was not interested in more money. “I’m going part time,” she said. She patted her abdomen, which was noticeably rounded. Kurtz estimated about five months along. “When I was a
resident, one of my attendings once said to me that he would like his job a lot more if he could do it a little less.” Mary Lustig looked around her office and smiled. “I’m lucky. I can afford to do what I want.”

  A week later, it was apparent that they had gotten nowhere. All eight men arrived at work on time and spent their days doing exactly what they were supposed to do. Nothing suspicious was picked up by any of the cameras. Five of the eight placed memos in the outbox in their departmental offices. All five memos were examined in the mailroom before being delivered to their intended recipients. They were all innocuous. During that week, two more messages were received, one by the Dean and one by a secretary in the Department of Obstetrics and Gynecology. Both were written in crayon. Both threatened nameless destruction. Both came by interoffice mail.

  On Wednesday morning, a veterinary technician in the medical school arrived at work to find that all of the cages in the animal lab had been opened during the night. Rats, mice and four dogs looked up as the door opened, then scattered.

  “Shit!” The technician had enough presence of mind to immediately close the door behind him, then, cursing under his breath, he picked up the phone and called, first his immediate supervisor, then Security.

  In the end, none of the animals escaped (so far as they could tell) but ten mice and four rats were never found. The dogs, presumably, had eaten them. And since one mouse looks much like another, all of the ongoing experiments were ruined.

  On a table in the center of the room was a note.

  You can’t stop me. You can’t find me.

  “We don’t have cameras on the entrances to the school,” O’Brien said. “Just the hospital.”

  “The only previous incident of actual sabotage was in the hospital,” Kurtz said. “The stolen fetus.”

  O’Brien frowned, looked out the window and across the street to where the medical school and the research pavilion seemed to be jeering at them. “And the school connects to the hospital by a tunnel under the street, which, somehow, we didn’t think significant.”