The Society

by Michael Palmer

  “When I resign from the symphony board, I just might take you up on your invitation,” Katz replied sincerely.

  “Me, too,” Susan added with more sparkle.

  “I didn’t know you were on the symphony board,” Will said.

  “I’m planning on being on it someday.”

  “All right,” Katz said, “let’s get on with this. Will, it’s a good thing you enjoy your work, because you certainly do a heck of a lot of it.”

  Jim Katz had seven patients in the hospital, Susan and Will three apiece, and Gordon Cameron, who had already gone home, two, including the case he and Will had done earlier in the day. The trio of surgeons that included Steve Schwaitzberg had another five. Schwaitzberg had signed his three out over the lunch hour, and the other two would do so by phone. Twenty patients in all—a load by modern standards. Insurance restrictions had seen to it that most of them had received their pre-op evaluations as outpatients, and had been operated on before they had even seen their rooms or met the nurses who were going to be their caregivers. The moment after their surgery was completed, they were being primed for discharge. Actuarial tables compiled by the managed-care and insurance industries had demonstrated that such policies saved money without causing a significant rise in post-op complications. Will’s experience with his own and many other practices had shown that a good number of patients would gladly beg to differ with those statistics.

  At Susan’s urging, they saw Jim Katz’s group first. He would never complain about his workload or diminishing physical capabilities, but the three younger members of the group had each seen evidence that layers were peeling off his stamina and abilities in the OR, and they sought to protect him in any way they could. All went well until the last of Katz’s patients, a sixty-three-year-old diabetic man whose gallbladder Katz had removed the morning before.

  “So, Mr. Garfield,” Katz said, checking the four small incisions he had made into the man’s abdominal cavity, and nodding approval of the way they looked, “is your wife on her way here to get you?”

  “She just called from the parking garage, I shouldn’t worry,” Garfield said.

  “Good, good. And the nurses have given you my discharge instructions? Good.”

  Will didn’t like anything about what he was seeing and hearing. Stuart Garfield was doing his very best to mask it, and maybe he didn’t even realize it was happening, but he was experiencing some shortness of breath. Susan nodded minutely that she had noticed the same thing. The managed-care companies decreed that a night in the hospital or even less was to be the standard of care for the laparoscopic removal of a gallbladder. Katz did not consider that the man’s diabetes was reason to argue for more, and it wouldn’t have been except for the distension of the veins alongside the man’s neck and the slight bluish cast to his lips—both subtle signs of evolving trouble.

  Nonchalantly, Will sidled over to the bedside, slipped his stethoscope into his ears, and listened through the man’s back to the base of his lungs. Rales, the crackling sounds made by fluid filling the small air sacs, were most definitely present. Stuart Garfield was in early heart failure—a potentially serious condition in any patient, but even more so in a diabetic who, with little warning, perhaps by the time he and his wife had reached the highway, could be in full-blown pulmonary edema—a terrifying, life-threatening emergency. Will motioned Katz over to the doorway. There was no easy way to present the findings, and with a physician as forthright and honorable as Katz, it wasn’t smart to try.

  “Jim, he’s in some congestive heart failure,” Will whispered. “Neck veins distended, rales at both bases, a little blue around the gills.”

  Katz sagged visibly, crossed to the bedside to listen, then returned to the doorway.

  “I knew I shouldn’t have been rushing him out,” he said, shaking his head in dismay.

  “Listen, don’t be hard on yourself. We’re making rounds together as a team. This sort of thing is why we do it. Thanks to our friendly neighborhood insurance companies, the pressure’s on all of us now all the time. They tell you that the average surgeon gets his gallbladder patients out of the hospital on the first post-op day, or even the day of the procedure. You know darn well that if you keep yours in an extra day or two, you’re going to be right down on the HMOs’ list. They don’t ignore these things.”

  “Just the same,” Katz said wearily, “thanks for saving my bacon.” He returned to his patient. “Mr. Garfield, I’m going to wait for your wife to get up here, then we have to talk.”

  “I’ve never seen him so glum,” Susan said, as they headed off to see the first of her patients.

  As the sole woman in the group, Susan had proclaimed herself the mother hen, dedicated to keeping Gordo’s weight under control, seeing that Will got enough sleep and met someone special, and insisting that Jim Katz cut back on his many obligations.

  “We more or less grew up with the problems of managed care,” Will said. “Jim’s had to adapt to them. He gets sort of wistful when he talks about the time when you simply diagnosed a surgical problem in a patient, cut it out, and cared for the person until they were ready to go home.”

  “Ah, yes, the good old days before one-size-fits-all medicine. My mom is embroiled in a battle with her HMO right now. She’s got huge fibroids, complete with pain and vaginal bleeding, and her GYN wants to do a hysterectomy.”

  “Makes sense to me.”

  “Me, too, but the evaluators at her HMO say the procedure is unnecessary. What’s more, they performed their magnificent evaluation of her over the phone. No one from her HMO has ever laid eyes or hands on her, but they’re the ones making the decision.”

  Will hoisted himself up haughtily and adopted a dense British accent.

  “I’m not a doctor, but I play one on the phone.”

  “Exactly. So Mom has pain every time she takes a step, and her doctor says the fibroids would make it impossible for him to feel a malignancy if one were there.”

  “Goodness. She still in Idaho?”

  “Forever.”

  “And you never had any desire to go back there to practice?”

  “How can I know I exist if I can’t see myself in store windows when I walk down the street?” Susan’s dark eyes smiled. “Besides, what do I have in common with Demi Moore and all of those other big-name transplants from Hollywood?”

  “You should bring your mom’s case up at the Society meeting Thursday night.”

  “Um . . . the truth is, I hadn’t decided if I was going to go. Will, I appreciate your enthusiasm for the Hippocrates Society, really I do, but after almost a year of going every month, I just haven’t gotten caught up in it. I’m definitely upset with managed-care companies’ policies and regulations and all they’re doing to the way we practice, but I just haven’t been able to get as . . . as fired up as the rest of you, even with my mom’s recent problems. You know me. I’m pretty reserved about most things—not shy like some people think, but not that outspoken, either. And excuse me for saying so, but you people are fanatics.”

  Will laughed.

  “Hey, now, I wouldn’t go that far. How about committed?”

  “If that makes you more comfortable.”

  “Listen, Suze, we need every body we can get at these meetings. There were over a hundred docs there last time. A hundred! The papers are really starting to take notice.”

  “Will, I’m on two committees in the hospital and a couple at church. The people on the desk at my gym don’t know who I am, and I’m afraid my boyfriend may be headed there, too.”

  “I understand. Just do your best. I may tell your mom’s story anyway.”

  “You have my permission.”

  “These companies have ripped the heart out of medicine, Susan. They have to be stopped.”

  “You just be careful not to rile them up too much. You wouldn’t be the first doctor they’ve squashed.”

  “I’d like to see them try,” Will said.

  CHAPTER 2

&nbs
p; Ashford was a bedroom community located almost midway between Fredrickston and Worcester. Beeper and cell phone at the ready, Will checked out with the ER and surgical residents and headed west through modest late-afternoon traffic. He knew that he was hardly the only divorced dad forced to drive to the house that had once been his to take his children out for dinner, but that knowledge did nothing to assuage the weirdness he invariably felt in the situation—especially when the doorbell was answered, as it was tonight, by Mark Mueller, once a friend and financial adviser to him and Maxine, and now, for more than a year, her live-in.

  “Hey, how’s it going?” Mueller said, knowing better than to attempt a handshake.

  Mueller, though about Will’s height and build, had a full scalp of curly hair, which invariably made Will reflect on the modest but relentless recession at the corners of his own. Max had explained that she and Mueller were too much in love not to live together but that the cost of marriage, in terms of lost alimony, made nuptials a fiscal impossibility.

  Will stepped into his former foyer.

  “Kids ready?”

  “Danny’s just finishing up his homework. Jess is ready, though.”

  Will smiled to himself. Could any pair of twins ever be more different from each other—or more wonderful in those differences? Jess always ready, Danny last minute or beyond; one meticulous, one scattered; one serious and intense, one flaky and wildly imaginative; one (Jess) an athlete, the other already credited with several community-theater productions.

  Damn you, Max.

  “Hey, Dad, who loves you?”

  Jess, in jeans and a bulky sweater, came racing around the corner and dove into his midsection.

  “Who loves you, baby. Everything okay?”

  “Fine. Tammy got sent home today for throwing spitballs. Cody Block said he likes me. I got an ‘A’ on my Morocco project. Are we going to the Hearth or your place or a restaurant?”

  “Hearth.”

  “Great!”

  “Danny, let’s get—”

  The shoulder-first assault from behind, with more force than any ten-year-old should be able to generate, nearly knocked both Will and Jess over.

  “Open Hearth night, right?” Danny asked.

  “Right on.”

  “Um . . . Max wants them home by nine,” Mueller said uncomfortably.

  Will’s eyes flashed. His thin smile said many things.

  “Nine it will be, Mark. She at the gym?”

  “Office. She should be back soon.”

  “Nine. Come on, guys.”

  “I keep telling you, I’m not a guy.”

  “All right, come on, girls.”

  “Daddy!”

  Will, two classmates, and a saintly psychiatrist had started the Open Hearth Kitchen during Will’s sophomore year in med school. The idea was to survive two intense years of basic science studies by involving themselves in a project centering on real live humans. Almost immediately, the other students and faculty joined in, helping to make their efforts a success. A dynamic, visionary young director and a committed board saw to it that the merchants, schools, churches, and residents of Fredrickston and the surrounding towns understood the place and embraced it. Now, after sixteen years, there were times when volunteers had to be turned away, although none of the thousands of diners who had patronized the kitchen ever were. Three hundred and ten was the record for dinners served on one night, but with the economy continuing to nosedive, that record seemed likely to fall before long.

  No matter how hard it had been to take time off from work, Will seldom missed the monthly board meetings, and almost never his serving obligation—the first and third Tuesdays of every month.

  The rugged, three-story clapboard structure occupied a corner lot in the most run-down part of town. Maxine had tried insisting that the area was too dangerous to keep “dragging” the twins to, but in this debate, unlike most of the rest, Will had prevailed.

  “Okay,” he said, easing his four-year-old Wagoneer into the small parking area, “you guys know the drill.”

  “I’m doing dessert,” Danny called as the two raced up to the kitchen door.

  “You did it last time!”

  As he often did, Will paused to survey the building and to reflect on the years since the project’s inception. In the beginning, a nearby Episcopal church had rented the first floor to them for next to nothing. Now, the Open Hearth Kitchen, a tax-exempt corporation, owned the whole thing. Belief, perseverance, fearlessness—over the intervening years, the Open Hearth had come to mean so many things to him. Now his involvement was limited to board of directors’ meetings and those two nights a month as a server. His energy—what there was left of it—had instead been channeled into the Hippocrates Society and its quixotic mission of reclaiming medicine from the HMOs and insurance companies.

  Belief . . . perseverance . . . fearlessness.

  By the time Will entered the kitchen, the kids were each involved in animated discussions as they worked. He smiled at the ease with which they had made themselves part of the gang, and the genuineness with which they had been accepted. In all, this night there were sixteen volunteers and five staff. No army had ever functioned with more efficiency and esprit.

  “Hey, Will, wassapnin’.”

  “Same old, same old, Beano. How about you?”

  “Can’t complain. Your kids are really something. Two minutes and they’re already up to their elbows in whatever needs doing.”

  Benois Beane, forty-something, had been the Hearth’s director for going on five years, during which he had continued to expand the agency’s programs, instituting a Meals on Wheels service and an employment counselor. He had also taken it on himself, following an offhand remark by Will, to ensure that no one called Will “Doc.” Many knew he was a physician, but there was no reason at all to advertise the fact. The last thing he wanted was to dilute the dual pleasures of serving food to those who needed it and introducing his children to people who were light-years from the tree-lined privilege of Ashford.

  “Beano, the place is looking great.”

  “Yeah. Thank God for all those churches and synagogues.”

  “I suppose that would be appropriate,” Will said.

  Beane took a moment to find the humor, then his ebony face crinkled in a broad grin.

  “Good one,” he said. “I almost missed it. Forgive me for saying this, Will, but you look as if you’ve been working too much.”

  “Hell no. By my standards I’m exceedingly well rested. See me tomorrow morning. By then I’ll be looking as if I’m working too much. What you’re viewing now is totally fresh Grant.”

  “Fresh Grant,” Beane echoed. “Sounds like something we should have on the menu.”

  By five-thirty when the doors opened, at least fifty were lined up to be served, a number of them with young children in tow. A goodly percentage of the patrons still had a roof over their heads, but for them, food and heat were getting more and more difficult to manage. The twins had settled their conflict in house and were working side by side at the dessert section. Will, an apron tied around his waist, strolled among the tables with a soapy-water spray and a towel, chatting with the diners and cleaning up after they had left. At one table, where a particularly grizzled down-and-outer sat alone, picking at his beef stew and rice, Will stopped.

  “How’re you doin’?” he asked.

  The man, with metallic-blue eyes and a nose that had been broken probably more than once, forced a weak smile.

  “Can’t complain,” he said.

  “Name’s Will.”

  “John. John Cooper.”

  “I haven’t seen you here before.”

  “Haven’t been.”

  “Well, you picked a good night to start. Beef stew is about the best thing we do.”

  “It’s very tasty.”

  “Listen, John, I don’t go around advertising the fact, but I’m a doctor. I work at the hospital. Stop me if you think I’m out of line, but I’m co
ncerned about those lumps on the side of your neck.”

  Cooper didn’t bother reaching up to touch them.

  “What about ’em?”

  The lumps, markedly swollen lymph glands, were trouble. Will’s quick differential diagnosis included several types of cancer, as well as scrofula—a form of tuberculosis.

  “Has any doctor checked them out?”

  “Can’t afford no doctor.”

  “You have Mass Health? Any kind of insurance?”

  Cooper shook his head.

  “Will you come see me and let me check those over, maybe run a few tests? It won’t cost you a thing.”

  “Maybe.”

  “I promise I’ll take good care of you.”

  “That’s nice of you.”

  Seldom more than a couple of tables behind, Will could see enough from where he stood to know he would be hard-pressed now to catch up with the influx.

  “Listen, John,” he said, “I’m going to send Ben Beane over to talk with you. He runs this place. He’ll help you fill out the forms to get some state insurance, okay?”

  “You mean welfare?”

  “Insurance—the sort everyone in this country deserves to have. I don’t like to put labels on things, but what I’m talking about isn’t welfare. Wait here. I’ll get Ben. He’ll explain everything, and he’ll also give you my address. Okay?”

  “If you say so.”

  On the way over to find Beane, Will paused briefly to wipe down two tables. Most of the patrons of the Open Hearth Kitchen were respectful of the place and quick to do whatever they could to keep the tables ready for others. But some weren’t.

  “Beano, I need your help with a new guy.”

  “The one you were talking to?”

  “He needs to come see me about some big lumps in his neck. Can you give him my address and have your people start him on the bumpy road to Mass Health coverage so we can get some tests done?”