Primitive Secrets

by Deborah Turrell Atkinson

  On Friday, two days before his death, notes covered the page. On the 7:30 a.m. line, he had written Bitsy, Aloha #272, Hilo. Flights ran to the outer islands like the downtown buses went to the O’ahu suburbs, only a little more reliably.

  Maybe he’d taken Bitsy to the airport early that morning. That was the morning Storm had picked him up at eight to drop his car off and take him into the office. He probably would have mentioned having already been to the airport and back, but he hadn’t said a word. Okay, David or Michelle could have taken Bitsy. Storm tapped the page with her finger. Wonder when that phone call, the argument Lorraine had told her about, had taken place? Bitsy must have called from the Big Island.

  Lorraine probably had made a note of the phone call on the list she’d handed Storm. But the list was in her duffel in the overhead compartment. Storm sneaked a look next to her. The toddler had dozed off. His gluey graham cracker was crumbling against Storm’s shorts and the mother was reading Cosmopolitan with a look of grim satisfaction on her face. Probably looking over the article on multiple orgasms. Storm decided not to disturb her. She trailed her finger down Hamasaki’s Friday schedule. A couple of court dates, lunch with Roy Tam, and a note to call Sherwood Overton. Oh, yeah, that was Wang’s and Cunningham’s new client. He was a big wheel; she remembered Hamasaki introducing her to him a week or so ago. As the CFO of the big local health management organization, he was an important customer. For Saturday, there was a memo to tell Meredith something that Storm couldn’t decipher, some reminders to phone people, and a note to pick up the dry cleaning.

  The Sunday page was empty except for one note. On the six-thirty p.m. line, Hamasaki had written S.O. Storm sat back in her seat. Sherwood Overton?

  She would have to wait to get back to O’ahu to check if Overton had met with Uncle Miles. Since Lorraine hadn’t mentioned it, she might have to call Overton’s office and finesse some information from his secretary.

  She turned the page to Monday and frowned. Uncle Miles had written Bitsy, Aloha #23, arr. 10:15 on the morning schedule. Storm remembered Sergeant Fujita checking to see when she was expected to arrive, since he was reluctant to give her the news of her husband’s death over the phone. Fujita had mentioned that Michelle was planning to pick her mother up that afternoon.

  Which didn’t jibe with Hamasaki’s notebook. It was possible that Aunt Bitsy had arranged to stay longer and have a more leisurely morning with her sister. With more careful questions, Storm could probably find out.

  The rest of the notes in the planner were routine appointments with familiar names, though Uncle Miles had root canal!#* scheduled for Monday afternoon. Poor Uncle Miles. Storm flipped through the rest of the book. Nothing else rang any bells.

  She put the calendar book back in the satchel and pulled out the first two files her fingers grasped. She flipped open the one on top and found some info on Roy Tam’s highway project. Great, she could look that over this weekend and be prepared for the meeting on Monday. The second file had the name Tom Sakai typed neatly on a tab that did not match the ones Storm usually saw in the office. When she opened it, she read a letter from Sidney O’Toole, M.D. that addressed the board of directors of Unimed. Storm knew that name; it was Sherwood Overton’s company and the ER where the assembly line doctor had checked her nose. It was also the new employer of Rick, the philandering asshole.

  The letter was cc’ed to the Utilization Review Committee. In it, he pleaded the case of Tom Sakai, a local plumber and a charter member of the health management organization. Sakai had multiple myeloma, a virulent cancer of the bone marrow. His only hope of recovery lay in having a bone marrow transplant. Storm blinked with surprise. This had to be the guy who came to see Hamasaki.

  O’Toole appeared to be responding to a previous rejection of Sakai’s request for the transplant by the utilization review managers. He pointed out the long-term financial benefits for the HMO in terms of public relations in a community where word travels faster than radio waves. Storm appreciated O’Toole’s reference to the coconut wireless as a stab at levity, but she knew his plea was completely serious.

  He proposed that the HMO cover the cost of Sakai’s therapy, which with plane fare to Seattle and his treatment at a private hospital would add up to a couple hundred thousand dollars. People would hear about the organization’s caring efforts toward their patients and their subscribers would increase. Even if Sakai died, which was possible in spite of the transplant, O’Toole promised that large establishments, like law firms and state offices, would know of the organization’s heroic efforts to save this man’s life and enlist their employees in their health system. Especially since the HMO planned to develop its own high-tech oncology center and cancer clinic.

  Storm sat back and reflected on what she knew about the operation of health management organizations. They were hierarchies run by business people who watched the bottom line and made sure the company turned a profit. An internist like O’Toole was called a capitated doctor, which meant that he practiced in a group of doctors that was paid a set monthly fee by the HMO to examine patients. One of his jobs was to decide which patients needed to see specialists or to be admitted to the hospital.

  O’Toole’s group held back part of this fee every month to cover their own operating costs. What was left went to specialists (like oncologists) and to the group’s own physicians as monthly salary, or capitation fee.

  Specialists and extra treatments for a patient came out of this set-aside fee. Consequently, when O’Toole referred to a specialist or asked for special treatments, he cut into not only his own income, but also that of his colleagues. In addition, like all capitated doctors, O’Toole had signed an agreement called a “gag order,” which meant he wasn’t allowed to inform Sakai or any other patient that he had any options other than what the HMO offered him.

  The organization had both O’Toole and Sakai by the short and curlies. O’Toole was stuck between being a bouncer, maintaining his income and reputation, and being the patient advocate the Hippocratic oath commanded. Sakai fought for his life and depended on O’Toole, as his primary physician, to refer him for the treatments he needed.

  Storm let her head flop back on the seat and tried to read between the lines in the letters she held. O’Toole had approached Hamasaki because he trusted Hamasaki’s confidence, but probably also because O’Toole needed some muscle behind his words. Hamasaki had enough clout with local law firms and state organizations to influence the employee health plans that would be chosen.

  O’Toole’s request for more extensive therapy for his patient had been rejected once already. The letter Storm held was a second try. Storm imagined that O’Toole had come to Hamasaki before he mailed the second letter. In his favor, he just couldn’t stand to stay silent and watch the young man die. But Unimed could ruin O’Toole. They could curtail his pay, fire him, sue him, or smear his reputation if he spoke outside of the HMO. As for Sakai, no other health insurance establishment would take him on. The HMO could hold him to the treatment they wanted. Storm shuddered. Poor Tom Sakai.

  She wasn’t sure if O’Toole or Sakai legally had a chance. Sakai, when he joined the HMO as a healthy thirty-year-old, had signed a contract with them for the medical care they offered. Even if he had read the small print, he probably wouldn’t have cared that the HMO didn’t offer bone marrow transplants. What thirty-year-old believes that he’ll need one? What sixty-year-old does?

  Storm swallowed hard. Still, tens of millions of dollars would be at stake if Sakai started a lawsuit. Juries like to side with people like Sakai. Sadly, if Sakai died in the middle of the proceedings while being refused treatment by the HMO, the family could get even more for the anguish they’d endured.

  If they knew about it, the executive board had to be very nervous. Storm had a bad feeling that they did.

  She looked again at the letter. O’Toole wrote that the palliative treatments, the methotrexate for chemotherapy and r
odding of the bone fractures, were not working. Sakai was in pain and growing weaker.

  The next couple pages in the file were photocopies of Sakai’s medical history. He was thirty-five. Storm’s stomach flip-flopped; he was so young. He had gone to see a general practitioner at the HMO, the one running the clinic that day, because he had recurrent pains in his thighs. It had grown so bad that he couldn’t continue to throw a ball with his seven-year-old son. The GP punted Sakai to O’Toole, who was the next level up in terms of specialists. O’Toole called in the oncologist.

  O’Toole and the oncologist supervised a round of chemotherapy for a year with decent results. Then Sakai relapsed. His wife was three months pregnant.

  Storm checked the date on that note. Eight months ago, so she’d had the baby. O’Toole’s last written comments were that the patient was seeking traditional Hawaiian therapies. O’Toole was encouraging it, as long as Sakai also continued his chemotherapy.

  The final paper in the file was a confidential letter from the HMO board to O’Toole. He was reminded not to discuss the possibility of treatments not offered by the organization with Sakai or his wife. The bone marrow transplant was out of the question. The last sentence said that perhaps when the HMO underwent their planned expansion and had their own cancer treatment center, they would be in a position to help Sakai.

  Storm shook her head sadly. Except that Sakai would be dead. A bunch of MBAs had handed down a death sentence to a thirty-five-year-old father. The file drooped in her grip while questions stampeded her mind. O’Toole had to have informed Sakai before he’d copied his chart and shown it to Hamasaki. If he hadn’t, O’Toole would be betraying his patient-physician confidentiality, and that didn’t sound like old Dr. O’Toole. O’Toole must have gone ahead and told Sakai about getting treatment not covered by the HMO, too, or Sakai would never have gone to see Hamasaki. Perhaps the doctor had suggested the visit, perhaps not. O’Toole was certainly walking a minefield of personal, moral, and legal uncertainties.

  Just whom had Hamasaki contacted on Sakai’s or O’Toole’s behalf? Where had he asked his questions? The theft of Hamasaki’s file from her living room floor stuck in Storm’s mind like a raspberry seed in a molar. O’Toole’s name had been scribbled in it, but nothing else, she was sure.

  The announcement came for passengers to prepare for landing. Storm rubbed her burning eyes, then slipped the file back into the briefcase. She wrestled it under the seat, raised her seat back, and gazed out the window at Hilo Harbor. The fragility of life was particularly apparent to her at that moment. Usually, takeoffs and landings were nail-biters for her. Storm watched the ground approach with a thrum of anxiety that, this time, had nothing to do with the aircraft.

  She wondered again about the incidents of the last few days. The letter in the briefcase might be what the thief was after, and this person was someone with enough clout to hire thugs to do the dirty work. There was a chance that Hamasaki had stroked out over the stress of keeping the secret, but Storm didn’t think so. The man thrived on secrets. So had he been killed for threatening to reveal the details of Tom Sakai’s sad story?

  Storm yawned to pop her ears and clear her mind. None of this made sense. The HMO treated thousands of people; Sakai wouldn’t be alone in this struggle. Health maintenance organizations would have their legal eagles lined up to defend the company against many of these lawsuits. And Hamasaki would have known this.

  She stared out the window. She was still missing a large chunk of information. Information that someone might have killed to find.

  Chapter 13

  When the plane banked to make its approach, the sun on the water sparkled like rare jewels on blue velvet, a reminder of beauty in the world. Storm tried to dispel the cold breath of eternity prickling her neck with a wish for dry weather on the serpentine two-lane highway that ran from Hilo to Pa’auilo.

  That particular drive demanded a person’s full attention. There are wetter places in the Hawaiian Islands than the northeast coast of the Big Island, but Storm hadn’t seen many. Weeks could pass when one didn’t see the sun peek through the clouds and mist. But when the sun shone, the emerald green of the tropical foliage against the matte black of ancient lava flows startled with its splendor.

  Hilo was surrounded by waterfalls, plants with leaves the size of her VW that bore flowers as big as her head, and orchid farms whose exotic blooms were extolled worldwide. If one were to wander from the well-traveled paths, the silence and aroma of jungle were omnipresent. Decomposing leaves, fragrant blossoms, and lushness so thick that walls of plant growth confronted the explorer. It was not hard to believe in menehane, or the Hawaiian version of leprechauns.

  Hilo itself was a city of about forty thousand people, populated with families who had been there for generations. In the past, many had worked in the sugar cane industry. The last several years, people switched to farming various products like macadamia nuts and coffee. Because of its rainy climate, tourists came through Hilo on the way to Volcano National Park, ate a fast lunch, then hightailed it back to Kona on the sunny side of the island.

  Storm, however, found Hilo’s water-blurred edges more conducive to tranquility than the blades of sunlight reflected from the white sands of Maui or O’ahu. Standing at the covered, open-air luggage claim, she took a deep breath of the humidity. Water dripped from the eaves of the building onto blooming anthurium plants. Men in rubber slippers slapped one another’s backs and women hugged each other. All around her, people smiled. Storm relaxed; this was the Big Island, where everyone knew someone who knew you or your parents. She could unwind now.

  Becky rushed by. “I’ll meet you here in fifteen minutes. I’ve got to check out.”

  Storm had time to pick up a car at the rental booth, then call Fujita to tell him that she’d found the appointment book with its entries about Hamasaki’s activities the days before his death. She struggled with whether to tell the detective about the briefcase, but then realized she’d have to reveal Sakai’s medical issues and O’Toole’s conflict of interest. She decided not to mention it yet, because of the potential damage to both Sakai and O’Toole. She’d talk to O’Toole first.

  Sure enough, Fujita wanted to see Hamasaki’s appointment book. An officer would meet Storm at the airport, package it, and send it back on the next flight. “Don’t leave, now. He’ll be there in ten minutes,” Fujita said.

  Storm looked at her watch. Nearly seven-thirty. He couldn’t be too late; the last plane to O’ahu left in an hour. The small, outer-island airports tucked in early, just like the rest of the businesses, except for the bars. She and Becky would have no trouble finding a cozy place to have a bite, especially if it had good beer on tap. Local folks liked their happy hour.

  The police officer, who turned out to be a no-nonsense woman, showed up before Becky arrived. Hilo is not a big town, but she must have been only a few blocks away. She pulled her squad car to the curb, got out, walked to Storm as if she were the only person standing around, and gave Storm a receipt for the notebook with an efficient thank-you.

  “Tell Fujita that I’d like it back, eventually. Please?” Storm called after her.

  The officer turned with a half salute and a nod. “Will do.” And she disappeared into the terminal area.

  Storm phoned Aunt Maile to tell her that she’d be late, threw her bag and Hamasaki’s briefcase into the trunk of the car, then leaned against the door to wait for Becky. She wondered if Becky had access to passenger lists. Storm knew from experience that airline personnel wouldn’t usually release passenger information to the general public. She felt a pang of guilt at wanting to check up on Aunt Bitsy. Did it matter if the flight time Hamasaki had written didn’t jibe with when she had arrived? Storm wasn’t sure, and the loose end bothered her.

  She caught sight of Becky, who had changed into jeans and was dragging a small bag on wheels.

  “Oh, good,” Becky said when she saw Storm’s c
ar. “I was hoping I could bum a ride from you. My fiance can pick me up at Haunani’s Grill.”

  “Sure. I have a favor to ask.” A story spun out of Storm’s mouth before she could reconsider. “My aunt lost her trifocals on a plane from Hilo last Wednesday. I thought we could look for them.”

  “What flight was she on?”

  “I’m not sure. Can you find out?”

  “I think so.” Becky led Storm into the terminal. Except for helping a straggler trying to make the last plane, the attendants were beginning to close up. Becky asked a clerk whose computer terminal was still lit to check the passenger lists for Elizabeth Hamasaki.

  He typed, then waited a few moments. “She was on flight twenty-eight, the two-forty. Let’s see…lost glasses.” He looked at Storm. “What color were they? We’ve got two pairs.”

  “Two in the afternoon? From Hilo? Uh, they’re blue.”

  “No, twenty-eight leaves from Kona. Hmm…One’s gold-rimmed and the other pair’s green, it says. Kona sent them over. Wanna see ‘em? Green and blue could be mixed up. Heck, some of the baggage guys wouldn’t know the difference.”

  Storm had to force her mouth closed. “Er, no thanks.” She showed her teeth in what she hoped looked like a grateful smile. “I’ll call her first. They’re probably in the bottom of this huge purse she carries. She loses them twice a week in there.” Storm hoped she didn’t look as flabbergasted as she felt. Her mind whirled. Why Kona? Bitsy’s sister lived in Hilo. It was a winding, arduous drive of at least two hours from one town to the other.

  The clerk returned her smile, and Storm backed away before he could notice her lips quiver.

  Chapter 14

  Storm tried to focus her attention on Becky’s happy chatter. Fortunately, Becky rambled on about her fiance and Storm could savor the chicken long rice and spicy tako, a raw octopus dish, without having to do much more than nod and grunt in the right places. The food was great and Storm was ravenous despite her preoccupation with the Hamasakis.