by Gen LaGreca
Warren emitted the sigh of a father long resigned to having strong-willed children. “All right, Randall Lang, say your piece.”
While David protested in vain to his father, Randy was sworn in. Declining the witness chair offered by the attendant, Randy remained standing before Warren and the courtroom. David had no choice but to return to the defendant’s table.
“As the president of Riverview, I represent the owners of the hospital where Dr. David Lang performed the surgery in question. We’re the owners, but we weren’t invited to this little gathering that will determine what transpires in our hospital.” He glanced derisively at Warren. “That’s okay. We’re not offended. We’re used to being owners but not being able to buy bedsheets without clearing it through a regulator. We’re not like the doctor and patient before you, who think they have rights. We know we have none. The public told us so when it elected Malcolm Burrow.
“We accept that. Why? Because we feel guilty. Why? Because we want to make a profit from treating the sick. Can you imagine? We go to school, learn a profession, get a job, take on the immense liability of running a hospital and overseeing complex, risky procedures performed on countless numbers of you, the public, to restore your health and save your lives—and we’re supposed to lay this at your feet without an eye on our lifestyles, our families, our homes, our children’s education, or our retirement. We’re supposed to put forth gut-wrenching effort through decades of our lives without an eye on personal gain—only on unselfish devotion to you. Do you want to make money, as much as you can, from your chosen work?
“The people who now run medicine claim that they don’t want to make money; they just want to take care of you. How touching! Let’s examine what’s happened to medicine since it was taken over by an institution without a financial motive. Look back, those of you who are old enough, to a time before Mack Burrow and his precursors trampled over medicine. Did profit keep you waiting for vital tests? Did profit keep beds out of service while you fainted in the ER? Did profit deny you needed surgeries? Did profit give you antiquated buildings, broken equipment, and lousy service? Did profit price you out of insurance when the actuaries, not the politicians, dictated how policies were written? Profit wouldn’t dare treat you that way, because you’d take your business to competitors smart enough to serve you better.
“What is it they want, your benefactors who put us in the backseat and told you that our drive for money would crash the car? Are you, the patients, really in the driver’s seat, as you’ve been told? We don’t dare ask who’s steering the car or where it’s headed. We just do what we’re told, and in exchange, we get to take the financial risk of owning an enterprise that we have no control over.
“If making health care a business is wrong, then why do you keep us around at all? Many Mack Burrows of the world took over the hospitals outright. So why is the mother of all relics, the private hospital, still here? Because we take the punches. Here’s how it works. The state, your great savior, promises you free vaccines, free checkups, ten-dollar brain scans, or what have you. Then why not take Johnny to the doctor every time he gets the sniffles? Everyone loves a bargain, so the demand for health care skyrockets, and the state spends more than it ever imagined. What do our great leaders do now? Do they admit they made a mistake and cut their programs? Never! They blame us, the selfish profiteers, of course; and they cut our budgets, which only intensifies the crisis.
“And you, the magnificently clueless general public, don’t see this. All you know is that no one answers our phones anymore, no nurses are available when you need a pill, and no doctor is around to set your broken leg. You see us treat you badly, and your knee-jerk response is: ‘Those greedy hospitals. They’re only out for money. What do they care if we die in their hallways.’ Do you stop and ask yourselves why we would let you die in our hallways if we were out for money? If we manufactured shoes, would it be a wise decision to let our customers roam barefoot? But we’re not permitted to make decisions anymore.
“Do you realize any of this? No. Do we tell you? No. Do you know that the only people who can treat you poorly and get away with it are those who don’t make money from treating you? Frankly, they make more money from not treating you. When they collect the same taxes regardless, the way to make ends meet is to curtail service, not to render it. And you keep swimming into the current, clamoring for your Mack Burrows to pass more laws to tip our boat deeper into the water, while we’re trying to haul you in.”
Randy paced, throwing occasional, insolent glances at Warren. “You know, there’s money and there’s money, but your leaders paint it all black, regardless of how it’s acquired. Someone who spends ten years after college learning to be a neurosurgeon, or someone like me, who runs a hospital, is a different sort of person than a bank robber. Our money is earned, not robbed. It comes from giving something, not stealing it, from giving you the supreme value of your health and life. What are the motives of those who tell you that a director of cardiology is as shady a character as a bank robber—because they both want money? Do you know what it does to the cardiologist to have you believe this? Why do you believe it?”
Randy threw his hands up, stopped his pacing, and turned to his father. “Every drowning creature has its swan song, so here’s mine. Let’s compromise. You keep your rulebooks, your inspectors, and all of medicine; only leave one small aspect free, an aspect that hasn’t been born yet and that will never be born within CareFree. Lift the regulations concerning nerve repair, and a newly formed, privately funded Institute for Neurological Research and Surgery will be opened, ready to admit its first patient, Nicole Hudson, in time for her next surgery, and ready to allow David Lang to complete his research. We don’t want a penny from the state! We know that he who pays the bills calls all the shots. We only want to be left alone, unencumbered by CareFree’s rules. Do you think we need your inspectors to tell us to sterilize our needles? If we were negligent, we’d have the real law courts to answer to, as we should, and that’s the patient’s true protection. I’m asking you, Mr. Secretary, to stand aside and let a terrible thing called profit bring forth a glorious thing called a medical breakthrough.”
Randy looked at his father, waiting for a reply.
“Mr. Secretary,” said CareFree’s attorney, Brian Harkness, “I don’t think we can waste any more time on such an extraneous issue as the establishment of some kind of institution.”
Warren nodded.
Randy grinned insolently. “It’s my institution that’s extraneous?”
“You’ve been heard, Dr. Lang,” said Warren. “Now leave us to continue.”
“Have I really been heard, Mr. Secretary?” For an unguarded moment, the mockery vanished from Randy’s face. He looked more open and vulnerable, and his mouth seemed to tighten with the hidden pain of an old wound. “Have you ever really heard me?” he asked quietly. “Have you ever really known me?”
“Thank you, Dr. Lang, for sharing your thoughts with us,” said Warren. “Now, Mr. Green will continue presenting his case.”
Randy’s eyes, still blazing from the passion of his plea, cooled when he saw only blank stares around him. An advisor in the jury box swatted a fly. Harkness read his notes. Warren evaded his eyes, looking down. Randy thought of a pile of ashes from which a phoenix would never rise. He turned to his brother to find the only eyes that met his squarely in silent salute. His glance lingered on David, acknowledging a bond that had always been theirs. Then Randy left the courtroom.
“I call the patient, Nicole Hudson,” said David’s lawyer, Russell Green.
Aided by Mrs. Trimbell, Nicole took the witness stand. Her clothes and makeup were tastefully understated, yet all eyes followed the arresting beauty that was a complete statement of its own. The boyishly cropped hair, the majestically high cheekbones, and the perfectly aligned features suggested a fashion model, whereas the tailored red suit, the tiny diamond earrings, and the small leather purse suggested a young executive. The midthigh le
ngth of the skirt defined the boundary where refinement bows to glamour.
Her face possessing a child’s openness and a woman’s self-assurance, Nicole addressed the gathering: “Everything good that ever happened to me stemmed from my own choice, not from others choosing for me. When I was six, I decided to become a dancer, and everything I’ve done since then has been geared to achieving that end. People tried to discourage me, but I listened to my own voice. As a result, I developed something precious in my life that has given me the greatest fulfillment I could ever imagine. All of that came from my own decisions about my own life.
“When I was eight, I was abandoned. I lived as a ward of the state, shuffled from one foster family to another until I ran away at thirteen. I had to run away because I was being completely controlled by others, hampering me to the point of desperation. When I left, I rescued my life and my future career. Running away was the best decision I ever made.
“I thought that this dreadful condition of total dependence was something to be endured because I was a child. The hope of one day being in charge of my own life sustained me through the worst moments of my childhood.
“Just when I achieved my goal and was certain that my days of helplessness were over, I received this terrible injury. Dr. Lang told me about his experimental procedure—that there were risks, that my chances were slim, that his animal research wasn’t completed, that the procedure had never been tried on a human. He explained that the surgery was illegal and asked if the state’s edict mattered to me. Lying in the hospital feeling half dead, I remember wondering how some alien thing called ‘the state’s edict’ could presume to make a crucial decision about my life. I told Dr. Lang that I would want his surgery even if my chances of dying from it were ninety-five percent. I made my own choice, knowing everything I needed to know.
“Now, with Dr. Lang being suspended and with us pleading for permission to complete my treatment, I . . . feel as if I’m a . . . ward of the state . . . again.” Her eyes grew more intense. Her voice, superbly steady until then, threatened to crack. Years of experience in fighting for herself made Nicole take a pause that restored her control. “This nightmare existence of having no choice, no will, no way to act has now come back to torture me. I must decide this issue for myself, and I must have the second surgery. I don’t want other people to pay for my medical bills, nor do I want to pay for theirs. I want to stand alone, as a single person, to rise or fall at my own hand. I don’t want decisions about my life made by others. I want out of this haunted house called CareFree that turns adults into helpless, frightened children.”
Her voice rose to fill the room with an anger she could not contain. “And you must stop punishing my doctor for helping me. If you don’t, I’ll go on every talk show and speak to every newspaper. I’ll tell the world how vicious you are. If you destroy me and my doctor, I’m going to make CareFree crumble at my feet!”
Nicole had disobeyed the instructions of David’s attorney to be calm and respectful. David tried to dismiss the thoughts he was having about his patient, because his urgent desire to grab the little red suit and to rip it off her body had no place in a civilized meeting.
Harkness sprang up when his turn came. “Ms. Hudson, let me first say how extremely sorry I am about your injury.”
He paused for Nicole to thank him for his concern, but she did not.
“I think it’s understandable that you would be distraught, Ms. Hudson,” he continued soothingly. “Wouldn’t you say that under these trying circumstances, you are upset and perhaps not yourself?”
“I’d say I’m very much myself.”
Harkness picked up a file from his table and skimmed through the documents inside. “You have quite a history, don’t you, Ms. Hudson, of running away as a child and of being returned to the child welfare authorities by foster families? They tried to reach out to you, these records say, but you rebuked their attempts. You were described as being antisocial, uncommunicative, headstrong, disobedient, and maladjusted. This is your history, isn’t it?”
“Yes, but how is that relevant to what we’re discussing?”
“And when you ran away at the age of thirteen, with the blush of childhood on your cheeks, didn’t you work illegally under an assumed name as, shall we say, an entertainer in a gentleman’s club?”
“I was a stripper in a strip joint. But how is that relevant?”
“You were a problem child. You ran away from families that tried to give you a home. You became a stripper at the tender age of thirteen. Could one say that these decisions you boast about having made for yourself are of dubious distinction?”
Nicole smiled wryly. “Does that mean you can force better decisions on me? Better because they’re made by you?”
“And through some iron-willed obsession that you had throughout your life, you studied, you succeeded, you became a star. Wouldn’t you say that you now have the money, personally, to pay for these nerve-repair surgeries ten times over?”
“And if I didn’t have the money, do you think I’d want you to decide for me? If I had no money, do you think I’d want to have no brain, too?”
“Answer the question, please.”
“Yes, I have the money.”
“You sit here and tell us you want no part of CareFree. That’s fine for you to say, isn’t it, Ms. Hudson, when you can buy the services of a personal heart transplant team if you wanted to? What about the people who can’t afford medical treatment? If CareFree crumbled at your feet, as you’d like it to, what would you suggest we do with the people who depend on this program because they’re disadvantaged?”
“More disadvantaged than I was?”
“But you rose above that, Ms. Hudson. You were one of the very few who beat the odds. What about the others who won’t ever reach your level?”
“How do you think I rose? How do you think they would rise? I’m telling you from personal experience, the worst thing you can do for the disadvantaged is to keep feeding them like a mother bird that won’t let her babies fledge. My blindness is . . . devastating . . . because it makes me dependent on others. Why would anyone want a self-imposed blindness? Basically, there’s only you and the world, and you take your chances. That’s the challenge—and the glory—of life, isn’t it?”
“If I may remind you, the people of this state elected Governor Burrow democratically. The people want CareFree, Ms. Hudson. As a citizen, don’t you feel an obligation to respect society’s laws?”
“No, Mr. Harkness, I can’t say that I feel an obligation to respect a law that’s destroying me.”
“All right, Ms. Hudson.” Years of practice raised Harkness’s voice to a high pitch of moral condemnation. “It’s understandable, granted your history of antisocial behavior and fugitive activities, that you are rebellious and arrogant toward the law!” As David’s attorney rose to object, Harkness sat down. “I have no more questions. Thank you, Ms. Hudson.”
Nicole felt lost in a dark tunnel echoing with the shouts of Brian Harkness. She lowered her head and sighed as two familiar warm hands covered her cold ones.
“It’s over, Nicole. No one’s going to ask you any more questions,” said the hushed voice that she needed to hear.
“David, I don’t know how to talk to these people,” she whispered. “They don’t speak my language.”
“The language you spoke was beautiful.” She felt the familiar squeeze of hands telling her this moment was important. “Don’t be afraid of them. Here, I’ll help you down.”
Attuned to the subtle movements of her guide, Nicole needed no verbal cues as David escorted her to the gallery. They looked not like a blind patient and a doctor but more like a young couple, arm in arm, strolling through a park.
When Nicole was seated, Warren nodded to David’s attorney to continue.
“I call Dr. David Lang,” said Green.
The man taking the witness stand did not look like an outlaw. The clean lines of the starched white shirt, silk tie, and dee
p green suit had an elegant simplicity. The suntanned face formed a bronze backdrop for the light green eyes that glowed like gemstones. The tall, trim form with the subtle waves of hair cropped closely around the face was serenely classic. The hands with the long, sensitive fingers looked exquisitely carved by a master sculptor. David leaned back in the chair and related his story.
“I broke the law because I can’t work with CareFree in the OR with me. To diagnose an illness, to interpret a brain scan, to decide when to operate, to remove a tumor—all require that I analyze the case at hand and apply the sum of my medical knowledge to make a decision. It is profoundly important that I be able to think unencumbered, because a patient’s life can rest on my actions.
“To treat a patient, I must examine the person, diagnose the problem, and determine how to fix it. Because the human body is complex, there are no pat answers—only countless combinations of symptoms, conditions, and treatment options. Medicine is not a connect-the-dots puzzle.
“With CareFree, the scientific inquiry I have to make stops. Instead of deciding what are the best tests to run in a particular case, I have to ask: What tests am I allowed to run? Someone behind a desk miles away who never met my patient will make that decision.
“Instead of asking what treatment is best in a given situation, with CareFree I have to ask: What treatment am I allowed to use? A clerk in an office and a book of regulations can override my judgment. That’s what CareFree is—the incompetent ruling the competent, the faceless bureaucracy superseding the individual doctor and patient.
“If it takes an average of six hours to remove a certain kind of tumor, that’s what CareFree bases my fee on. Because the human body doesn’t confine itself to CareFree’s surveys, you may have a tumor that will take me twelve hours to remove, but I’ll get paid for only six. What do I do? Remove it completely and work for nothing? Or follow an utterly arbitrary ruling, quit after six hours, and leave you with a vestige of tumor that will regrow in ten years? CareFree rewards the short-term, the mediocre, the shoddy, the unconscientious and penalizes the doctors who are above average.