He paused, surveyed his incredulous audience, and seemed to particularly savor his next revelation. “There is a single account in all the hospital’s bank records and cost centers that routinely holds money. We noticed it because, in contrast, all the other cost centers are continually in deficit. This center, with no designated function, is numbered 0067.”
The absurdity exposed. An account rendered peculiar in our madhouse by the simple deviance of actually having some money in it.
He no longer needed a dramatic pause to get our attention. In fact, he seemed taken aback as, one by one, we reacted to the enormity of what he’d told us. We’d endured shortages year after year. Suggesting we had an embezzler in our midst was a flashpoint. Every person at the table seemed to be getting angry. By now some were standing, leaning in on him. Others remained seated, staring at him, their expressions changing from disbelief into disgust and their hands curling into fists. Riley and his two cops occasionally made a note. Names? Reactions? A lack of reaction?
It was Sean who found his voice first. “Do you mean that creep was siphoning off hospital funds?” he asked, barely controlling the rage in his voice.
Bufort clearly hadn’t expected this level of fury and still seemed astonished by what he’d unleashed. “We don’t know much yet,” he said cautiously, “but I’m asking anyone who does to come forward. We’re especially interested at the moment to hear from anyone with any information on cost center 0067.”
I got my own brain functioning again. “How much do you figure went through this center?” I asked.
“More than a million a year,” Bufort said carefully, as if each word were nitro.
I swung on Hurst. “That’s the cost of closing fifty beds. Were you aware of this?”
He had a lock on the table’s edge that turned his knuckles as white as his face. “Of course not!”
I didn’t believe him.
“Is this why you were so hell-bent on attacking the deficit and ordering such excessive bed cuts? Were you planning to use the extra savings to cover some embezzled shortfall of Kingsly’s?
At my accusation his lips trembled so violently that I was sure he’d have attacked me if we’d been alone.
“Well, get this. Hurst,” I said before he calmed down enough to speak. “Patients in emergency aren’t going to play victim to cover Kingsly’s dead ass, incompetent, crooked, or both. Your court order’s dead in the water as of now.”
I hadn’t planned to use that fact this morning. I pulled a rolled fax of legal-size text from my lab coat pocket. It was confirmation that our malpractice insurance group in Albany would assign a legal team to quash Hurst’s court order. But I unscrolled to an even more pertinent section. Against the sounds of Hurst’s sputters and the counter-protests of Carrington and Watts telling him to “stuff it,” I started reading aloud. “ ‘Specifically forbidden is any action on the part of the county, hospital, or any individual representing the hospital who attempts to coerce a physician to work in conditions unsafe for patients or contributing to patients being subjected to substandard care. Our company deems the long waiting times for emergency patients to get beds as unduly dangerous to their well-being and, as such, a breach in the standards of acceptable hospital practices. Adherence to such standards is the basic tenet under which we grant malpractice policies, and any failure to adhere to them automatically renders our contracts null and void. The probability of costly lawsuits is too great, and we refuse to underwrite in such a high-risk situation.’ “
Everyone was looking at me now with very confused expressions on their faces. Even the cops.
Sean asked, “What’s that mean?”
“It means if a hospital doesn’t have the integrity to shut down emergency services that can’t supply timely care, then the insurance company can withdraw malpractice coverage. Without coverage, it’s against our own hospital bylaws for a physician to work.”
“Wow!”
“Finally!”
“Great!”
Lost in this chorus. Hurst went an even paler shade of his usual white. “It’ll never stand!” he snarled at me.
“Then try this,” I said, and handed him another document.
All the side conversations stopped. Every pair of eyes gazed at Hurst as he skimmed my latest offering. Probably, I thought, he was going to say we should meet privately later and discuss the matter, try to bury the ruling without the other department heads finding out. I blew that option off the table.
Not letting my eyes off Hurst, I raised my voice. “Gentlemen, what I’ve shown Dr. Hurst is a letter of intent from our protective agency to defend free of charge any physician subjected to legal action for his or her part in shutting down an unsafe ER. They figure it’s cheaper to prevent the inevitable litigation than to pay for it later. And whatever our own financial woes might be, Dr. Hurst and his bean counters aren’t likely to go into a court of law to argue their right to force doctors into unsafe practices just to balance their books.”
Now I looked at my colleagues. Four days ago they had been cool, outright hostile to any action on our part against the bed closures. A few had probably welcomed the injunction.
Arnold Pinter hesitatingly tried to rekindle their opposition. “Uh, Earl, surely this is completely inappropriate at this meeting, don’t you think? I suggest you forget this ridiculous idea of shutting down emergency. Why, the—”
“Shut up, Arnold!” Sean Carrington shouted. “And I’ll be raising this same principle of standards with the department of surgery.”
The other chiefs came to Carrington’s and my support.
“Right.”
“Agreed.”
“Bravo!”
A few even gave me a slap of congratulations on the back. Their smiles lightened the mood, but only for some.
Fernandez was staring into space. He gave no sign of following what was going on around him. Instead, as white as Hurst, he got to his feet and made for the door. I was startled to see his hand shake as he reached for the handle. I don’t think anyone else in the room noticed him leave. Except the policewoman. I saw her watching his departure and making a note on her pad.
I turned back to the table.
Saswald was desperately oiling his sensors to gauge the political swing unfolding too fast for his usual self-serving calculations.
I enjoyed putting him on the spot. “Where are you now, Sas?”
He started weaving the air with his hands. “Well, I... of course, I must raise any such serious matters for careful study within my anesthesia department, and I’ll make a motion—”
“Forget it, Sas.” Gotcha! I knew I was being petty, but it felt good.
In my mind I fancied a perversion of one of those righteous bumper stickers: I DON’T BRAKE FOR POLITICIANS, EVEN IF THEY PRETEND TO BE PHYSICIANS. LET ‘EM BE SMEARS ON THE ROAD. Then I remembered that I’d nearly been dispatched to that status myself and sobered up. I turned from the stillblustering Saswald and faced Hurst.
“Forty-eight hours. Hurst, or we shut down. Open the goddamn beds!”
He glared at me but said nothing. I glared right back at him. I was pretty certain now that he’d gone as far as crippling the hospital to cover up a scandal over Kingsly. Was he also capable of killing for it? I still didn’t know, but clearly we were now on a different footing about the beds.
Arnold sank morosely into his chair.
Riley broke my second of triumph with a quiet cough, then deferred to Bufort and thus duly returned us to the business at hand. We all sat back down and stopped muttering to one another. Riley and the two uniformed police resumed watch on their respective sections of the table. I don’t think anyone else noticed we were being observed so systematically.
“We are questioning the director of finance.”
That explained Laverty’s absence.
“We are not sure yet of me extent of his involvement. Nor do we know how these events led to your former executive director’s murder. But we’re very
sure there is a connection.”
I saw the policewoman look at Hurst and make yet another note. I wondered if because of my outburst he’d be questioned now about covering up the embezzlement.
Bufort made his next disclosure very quietly. ‘Two days ago, as I mentioned, we had to completely change our thinking and the scope of our investigation. That’s when we learned from Dr. Watts that there may have been a second murder with a cardiac needle.”
While everyone else at the table gasped in surprise, Watts grimaced at this belated acknowledgment of the inconvenient find and leaned back with his arms folded.
Bufort gave him a wary look, then said, “A derelict DOA in your emergency had evidence of an unexplained intracardiac needle stab. We are looking into other explanations, but given how Mr. Kingsly died, we have to keep the possibility of a connection open, though what the connection could be, we’ve no idea.”
More silence—until he added what I wished he’d left out. “Yesterday morning both Dr. Garnet’s house and his office here in the hospital were broken into, and he was the target of a hit-and-run attempt.”
It was my turn to stare at the center of the table. I heard horrified exclamations of shock from all around me. “Oh my God!” “How awful!” “Good Lord!” Beside me, I sensed Watts tense up.
“The attack,” Bufort explained, “was vicious, and barely failed. Again we haven’t the slightest idea how the attempt might be tied in with Kingsly’s killing. Not even Dr. Garnet has a clue as to what has made him so vulnerable.”
Arnold and Saswald nodded readily—probably in agreement to the judgment that I was “clueless.”
“For the moment,” continued Bufort, “we must assume these extraordinary events are linked somehow. Please contact me if you think of anything that might help us. In the meantime, I would like all of you to be careful.”
As the meeting broke up, I got some more patronizing looks from Arnold and Saswald. They made me feel I could have avoided my own misfortune had I just paid attention. They were obviously not going to make the same mistakes I’d made—whatever the hell those mistakes were. What pompous asses.
Sean stood up and gave my shoulder a hearty squeeze as he went by me on his way to the door. A few of the others mumbled words of sympathy while they pushed away from the table, but I got the distinct impression the danger I was in made them feel uncomfortable. I felt a flash of impatience and almost blurted out that it wasn’t catching, but I had to admit they had a point. I probably wasn’t the healthiest guy to be around right now.
Out of the corner of my eye I saw Watts frowning at me. When he caught me looking, he quickly turned away. Of all of them, his was the opinion I most cared about, but if something was troubling him, he didn’t let me in on it.
Chapter 12
It was the type of day when the afternoon light starts fading at one o’clock. Fog and low clouds slid over the city like rolls of steel wool. Even photo sensors on the street lamps had declared most of the sun’s effort invalid and left a ragtag pattern of some off, some on, and some flickering feebly in limbo—vital signs of a dying neighborhood on a monitor, part of a city weakening and shutting down.
The daylight filtering through the mist was little more than a dim glow, the kind that emanates from a TV set left on after sign-off. The houses, modest boxes set back from the street, were blurred. The few cars that were out hissed their approach before I could see them emerge and then vanished quietly in the white haze. Each time I heard the sounds I stiffened and hugged the inner sidewalk, then relaxed and tried to shake the previous morning’s attack.
But that wasn’t why I was out walking, at least not entirely. A bit of it was frustration at trying to dodge a faceless menace. But the real reason was a deeper niggling that had kept interfering with my attempts to work. I’d tried several routines throughout the morning to distract myself. In the end I felt like an actor, restlessly putting on one costume after another and none of them being right for the part.
I’d checked emerge. It was a mess. Did they need help? No, they needed beds. I called Janet. She was busy in the OR. At least she was safe, if operating on AIDS patients was safe. Her partner had just had his hand sliced by a resident’s slip with a scalpel while in the open abdomen of an HIV-positive woman. The risk depended on the amount of the patient’s blood that had contaminated his wound, but even if it was minimal, and even if his tests in three months and six months were negative, there would be lingering doubts for years each time he made love to his wife.
My feet made crunching sounds on the remains of a broken beer bottle. I sidestepped the jagged end piece and thought of our wallpaper. I scuffed the smaller glass bits off my wet soles and trudged on, but I couldn’t shake off my black thoughts.
I’d called the vet. No change. This was the gray time, hope soiled with dread. On many occasions I’d cast that same sentence over human life.
I’d tried working on the quality assurance study in my office. When Carole had placed all the material on the disks now in the trunk of my car, she had done the work on the hard disk of the computer she locked away each night. With her help—I was hopeless wading through her computer files myself—I had been able to work on the numbers, but the data was frustrating in its monotony. Any answer it held slid beyond my grasp. There were highs and lows, wins and losses, but mostly draws, and all within the norm. I could find nothing to kill for. At least, nothing I could see. But the image of a baby’s room slashed and coated with feces suggested madness, not logic.
I’d managed to make the record of my actions and conversations over the last few days for Bufort. The net result was, as he had so eloquently put it, I hadn’t a clue who I’d threatened or why anyone thought it necessary for me to die.
I felt a little satisfaction though. By taping the report instead of laboriously writing it out, I’d foiled Janet and Bufort’s plan to keep me busy for days. When I’d finished, I had asked Carole to type it up and send it to Bufort.
Then I’d ended up pacing the office, driving her insane. She suggested I go bother Mrs. O’Hara, but no patients were booked that day. Still, I’d shuffled over through the parking lot and found Mrs. 0 filing lab reports. After having me check a few abnormals and arrange follow-up tests or repeat examinations, she wasn’t putting up with me either.
So here I was, walking in the fog, trying to get past the debris of what I knew and tease out what was bothering me. Cushioned by the mist and braced by cold, I kept thinking I had missed something. I reran the morning meeting, and the fuzziness slid into a single focused image: Fernandez. But this time it wasn’t his fear and agitation that struck me. I’d just discovered what I’d overlooked. In fact, it was something that was missing from the events at the meeting that was incongruous. I’d missed it because it was a negative find—not there when it should have been. As I told my residents over and over, unless you go after negative signs, you’ll miss them every time. I had to talk to Fernandez. It didn’t make sense, but what wasn’t there that should have been was all I had.
I wheeled around and headed back toward the hospital through the fog. It was growing darker now, and the hospital’s lights loomed up over me like an onrushing ship.
I left my raincoat in the doctors’ coatroom, dripping alongside other bedraggled wet wear. The place smelled like the inside of a running shoe. Plaster fell out in chunks, pushed by fuzzy green and blue mold that bulged from inside the walls. Maybe Hurst’s cost cuts could lead to a new source of income—growing our own penicillin.
Hurrying down the hallway toward psychiatry, I had little idea of how to confront Fernandez other than surprise him into leveling with me. But as I got closer to his office, I remembered him screaming at me in the parking lot the day before and began to rethink the likelihood of startling the truth out of him.
My second thoughts brought me to a stop in front of the coffee shop. After the gloom outside, it looked like a sanctuary of warm light and delicious aromas. Hot soup and a bagel with lox s
uddenly seemed far more important than ambushing a frazzled shrink.
I slipped into line and caught the attention of the woman behind the counter. She mouthed over the other waiting heads, “The usual?”
I nodded thanks, stayed in line to prepay the order, and tried to think of a better way to question Fernandez.
At the cash register, my musings were interrupted by Bessie. Eighty-one now, and a regular volunteer for the auxiliary, she had been head nurse in emergency when I first came on staff. Trained and seasoned in World War II, she was at ease in a crisis and ever ready for a drink or a poker game after the work. “That’ll be six-fifty, Doc. When are you and that other doc of yours going to finally learn how to make kids?”
Janet was her doctor. She’d taken an ovarian cancer out of Bessie two years ago, and Bessie had been back on her stool three weeks later.
“Hey, lady,” I said, “shows you haven’t kept your appointment with Janet. We finally figured it out. Must’ve missed the lecture. Looked it up in one of her books. Our first will be here in April.”
Her smile and surprise were genuine. “I’m so glad for you.” She gave my hand a squeeze after handing back my change. “And my best to Janet. Tell her I’ll be in.”
“You’d better, Bessie. Skip one appointment and see what you miss?”
Another smile and she was on to the next in line.
I headed for a free table and passed a foursome of retired surgeons. They gathered each afternoon to relive old battles and rehash cases long since dust. Twenty years ago they were my teachers and in their prime. When I took over as chief eight years ago, one of them, Jack Graham, was still working emergency, hopelessly unable to keep up with the increasing pace and standards. He’d become outright dangerous. My first task was to tell him it was time to leave. It was like telling him he had cancer, but for him it was even worse: He was sentenced to go on living without his work.
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