The Oath

by John Lescroart

  "Which it doesn't," Marlene Ash repeated. "Owe, I mean."

  "Can you prove that?" Glitsky the cop wanted to see the evidence.

  "I intend to," Ash said. "Go back to the original invoices."

  "Grand jury." Hardy cracked a fortune cookie.

  Ash nodded grimly. "That's what I'm thinking."

  "How can they say they'd run up thirteen million extra dollars and never saw it coming?" Roake asked. "That's what I'd like to know."

  Jackman turned to her. "Actually, that was fairly clever. They say their contract with the city covers outpatient AIDS treatment, mental health and drug abuse counseling, and physical therapy, and they've been providing it all along without being reimbursed. The key word is 'outpatient.' They're out the money, they've already provided the service, we owe it to them." He shrugged. "They distort the hell out of the contract to get to that position, but all the unions want to read their contracts to cover those services, so Parnassus has some political support."

  "So it's a contract language dispute," Freeman said. "Tell them to sue you in civil court."

  "We would," Jackman said, "except that we're starting to think—"

  "We know," Ash interrupted.

  "We're starting to think," Jackman repeated, giving his ADA a reproachful glare, "that they didn't provide the care they allege. It was all outpatient stuff, after all. The record keeping appears to be uneven, to say the least."

  "Grand jury," Hardy repeated.

  Jackman broke a professional smile. "I heard you the first time, Diz. Maybe. But I'm also thinking about freezing their accounts and appointing a receiver to keep 'em running, which is the last thing Parnassus wants, but if they think it might get them paid and they do need the money."

  "You're sure of that?" Freeman asked.

  Jackman nodded. "They're not paying their doctors. I'm taking that as a clue. We've received a couple of dozen complaints in the last six months. So finally we wrote a letter, told them to straighten up, pay their people or maybe we'd need to get involved, and sent a copy to each of their board members, still being paid, by the way, at an average of three hundred fifty thousand dollars a year."

  "A year?" Glitsky asked. "Every year?"

  "A little more, I think," Jeff Elliot said.

  "Every year?" The lieutenant couldn't get over it. "I'm definitely in the wrong business."

  "No you're not, dear," Treya told him. "You're perfect where you are."

  Hardy blew Glitsky a kiss across the table.

  "Anyway," Jackman forged ahead, "the threat got their attention. In fact, if you want my opinion, that was the proximate cause of this demand for the thirteen mil."

  "So what happens if we let them go bankrupt?" Glitsky asked. "How bad could it be?"

  Freeman chuckled. "May I, Clarence?" he asked the DA, then proceeded without waiting for any response. "Let me count the ways, Lieutenant. The first thing that happens is that every city employee, and that includes you, loses their health insurance. So instead of paying ten dollars to see your doctor, now you're paying sixty, eighty, a hundred and fifty. That's per office visit. Full price for prescriptions. So every union in town sues the city because you're guaranteed insurance as part of your employment contract. Then the city sues Parnassus for not providing the service; then Parnassus countersues the city for not paying for the service. So now everybody in town has to go to County General for everything and there's no room for anyone this side of multiple gunshot wounds. If you only have cancer, take two aspirin and call me in the morning. Bottom line is, if it turns out to be a bad year for the flu or AIDS or earthquakes, letting Parnassus go bankrupt could bring the city right along with it." Freeman smiled around the table. Bad news always seemed to stoke him up. "Did I leave anything out?"

  "That was pretty succinct, David, thank you." Jackman pushed the remains of his fortune cookie around on the table. "In any event, Parnassus must be close to broke if it's resorting to this."

  "We've got to charge them with something," Ash said.

  Freeman had another idea. "I like bringing an action to freeze their accounts and appoint a receiver to investigate their books and keep the business going." The old man gave the impression he wouldn't mind taking on the job himself.

  Jackman shook his head. "We'd have to go a long way to proving the fraud, David. We can't just walk in and take over."

  "Even if they haven't paid their doctors?" Roake asked. "I'd call that a triggering event."

  "It might be," Jackman agreed. From his expression, he found the idea potentially interesting. "Well," he said, "thanks to you all for the discussion. I'm sure I'll come to some decision. Jeff," he said across the table, "you've been unusually quiet today. I seem to remember you've written Parnassus up for a few items recently. Don't you have some advice you'd like to offer on this topic?"

  The reporter broke a cynical smile under his thick beard. "You've already heard it, sir. Don't get sick."

  4

  Though he was nearly fifty years old, Rajan Bhutan had only been a nurse for about ten years. He'd arrived with his wife in the United States in his mid-twenties. For some time, he had made do with a succession of retail jobs, selling women's shoes and men's clothes in chain stores. This was the same type of work he'd done in Calcutta, although it didn't suit his personality very well. Small of stature, moody, and somewhat introspective by nature, he had to force himself to smile and be pleasant to customers. But he was efficient, honest, intelligent. He showed up for work every day and would stay late or come in early without complaint, so while he wasn't much of a salesman, he tended to keep his jobs—his first one at Macy's Herald Square, where he stayed six years. Then at Nordstrom for five more.

  His wife had augmented their income by giving piano lessons and for about ten years they had been reasonably happy in their little apartment in the Haight, the only major disappointment in their lives the fact that Chatterjee was unable to get pregnant. Then, finally, when they were both thirty-five, she thought that the miracle had occurred, but it turned out that the something growing in her womb was not a baby, but a tumor.

  After Chatterjee died, Rajan no longer found smiling, or sales, to be tolerable. During the months he'd nursed his wife, though, he'd discovered that giving physical care appealed to him in some important way. Over the next four years, he used up most of his savings going to nursing school full-time, until he finally received his RN from St. Mary's, and took a full-time job at Portola.

  And true to form, he stayed. The doctors and administration liked him for the same reasons his bosses in retail had always kept him on. But he had few if any friends among the nurses. Dark and brooding now to an even greater degree than he'd been before when he'd worked in sales, he made little effort to be personable. But he was good at giving care. Over time, to his shift partners he became almost invisible—competent and polite, albeit distant and with his hooded demeanor, somewhat ominous.

  Now he stood over the bed of James Lector. After checking the connections on all the monitors, he smoothed the blanket over the old man's chest, and turned to look behind him, across the room, where Dr. Kensing was with his partner today, Nurse Rowe, adjusting the IV drip on Mr. Markham, who'd only just been wheeled in from post-op.

  Rajan looked back down at Lector, on life support now for these past couple of weeks. He had recently stabilized but who knew for how long? Looking at the old man's gray, inanimate face, he wondered again—as he often did—about the so-called wonder of modern medicine. The memory came back fresh again—in the last days, they had kept Chatterjee alive and supposedly free from pain with life support and narcotics. But as the years had passed, he'd come to believe that this had really been a needless cruelty—both to him for the false hope and to her for the denial of peace.

  He believed in helping the sick, in easing pain. This was his mission, after all, after Chatterjee. But the needless prolongation of life, this was what bothered him now, as it always did when he worked the ICU.

  He looked d
own again at Mr. Lector's face, then back over to Dr. Kensing and Nurse Rowe, working to save another person who might be permanently brain-damaged at best, should he survive at all.

  Folly, he thought, so much of it was folly.

  Shaking his head with regret, he sighed deeply and went to the next bed.

  * * *

  Dr. Malachi Ross stopped at the door to the intensive care unit and took a last look to make sure everything was as it should be. The large, circular room had seven individual bed stations for critical cases, and all of them were filled, as they were at all times every day of the year. The odds said that five of the patients in them, and possibly all seven, would not live. Ross knew that this was not for lack of expertise or expense; indeed, the expense factor had become the dominating element of his life over the past years. He was the chief medical director and CFO of the Parnassus Medical Group and keeping costs under control while still providing adequate care (which he defined as the minimum necessary to avoid malpractice lawsuits) was his ever more impossible job.

  Which was, he knew, about to enter another period of crisis. In the short term at least. For occupying one of the beds here today was his colleague and chief executive officer, Tim Markham, struck down on his morning run, an exercise he practiced with religious zeal in an effort to stay vigorous and healthy to a ripe old age. Ross supposed there was irony in this, but he had lost his taste for irony years ago.

  The monitors beeped with regularity and the other machines hummed. All around the room, white shades had been pulled over the windows against the feeble spring sun.

  Markham was in the first bed on the left, all hooked up. He'd been up here for three hours already, the fact that he'd lived this long with such serious injuries some kind of a miracle. Ross took a step back toward the bed, then stopped himself. He was a doctor, yes, but hadn't practiced in ten years. He did know that the bag for the next transfusion hung from its steel hook next to the bed, where it ought to be. The other IV was still half-full. He had to assume everything was in order.

  Exhausted, he rubbed his hands over his face, then found himself looking down at them. His surgeon's hands, his mother used to say. His face felt hot, yet his hands told him he wasn't sweating.

  Drawing a deep breath, he turned and opened the door to get out.

  He stepped out into the hallway where three more ICU candidates, postsurgery or post-ER, lay on their own gurneys attached to monitors and drips. They'd arrived since Markham had been admitted; now, as the beds in the ICU became available, these patients would be transferred inside for theoretically "better" intensive care.

  Dr. Eric Kensing was supervising the unit this morning, and now he stood over one of the beds in the hallway, giving orders to a male nurse. Ross had no desire to speak to Kensing, so he crossed to the far side of the hall and continued unmolested the short way down to the ICU's special waiting room. Distinguished by its amenities from the other spaces that served the same basic purpose, the intensive care waiting room featured comfortable couches and chairs, reasonably pleasant art, tasteful wallpaper, shuttered windows, and noise-killing rugs. This was because a vast majority of the people waiting here were going to hear bad news, and the original architects had obviously thought the surroundings would help. Ross didn't think they did.

  It was just another waste of money.

  At the entrance, he looked in, noting with some satisfaction that at least Brendan Driscoll had left the immediate area for the time being and he wouldn't have to endure his reactions and listen to his accusations anymore. Driscoll was Markham's executive assistant and sometimes seemed to be under the impression that he, not his boss, was the actual CEO of Parnassus. He gave orders, even to Ross, as though he were. As soon as he'd heard about the accident, Driscoll had evidently left the corporate offices at the Embarcadero to come and keep the vigil at Markham's side. He'd even beaten Ross himself down here. But now, thankfully, he was gone, banished by an enraged Dr. Kensing for entering the ICU for God knew what reason, probably just because he wanted to and thought he could.

  But, disturbing though he could be, Driscoll was nowhere near as serious a problem to Ross as Carla Markham, Tim's wife. Sitting at one end of the deep couch as though in a trance, she looked up at him and her mouth formed a gash of hostility and sorrow, both instantly extinguished into a mask of feigned neutrality.

  "He's all right," Ross said. Then, quickly amending it. "The same."

  She took the news without so much as a nod.

  He remained immobile, but his eyes kept coming back to her. She sat stiffly, her knees pressed together, her body in profile. Suddenly, she looked straight at him as though she'd only then become aware of his presence. "The same is not all right. The same means he is near death, and that is not all right. And if he does die "

  Ross stepped into the waiting room and put up a hand as though physically to stop her. "He's not going to die," he said.

  "You'd better hope that's true, Malachi."

  "We don't have to talk about that. I've heard what you said and you're right, there were troubles. But no crisis. When Tim comes out of this, we'll talk it out, make some adjustments, like we have with a thousand other issues."

  "This is not like any of them."

  His mouth began to form a knowing smile. She was so wrong. Instead he cocked his head and spoke with all the conviction of his heart. "Don't kid yourself," he said. "They've all been like this." He stared down at her, watching for any sign of capitulation.

  But she wouldn't hold his gaze. Instead, shaking her head once quickly from side to side, she reached some conclusion. "He wasn't going to make adjustments this time. The adjustments were what kept tearing him apart. If he doesn't live, I won't, either."

  He couldn't be sure if she was referring to living herself—she'd threatened suicide the last time Markham had left her—or to making the kind of adjustments her husband had learned to live with. "Carla," he began softly, "don't be—"

  But she wasn't listening. Suddenly, she was standing up in front of him, the semblance of neutrality dropped for now. "I can't talk to you anymore. Don't you understand that? Not here, maybe never. There's nothing to say until we know about Tim. Now excuse me, I've got to call the children." She walked by without glancing at him on her way out of the room.

  Ross sat in one of the leather settees and pushed himself back into the chair. He gripped the edges of the armrests to keep his surgeon's hands from shaking.

  * * *

  Ross heard first the monitor alarm, then the code blue for the ICU. For twenty minutes, the commotion nearly reached the level of bedlam even out in the hallway, when almost as abruptly as it had begun all the activity and noise came to a halt.

  And then, suddenly, Tim Markham was dead.

  Ross had gotten up out of his chair and was waiting outside the ICU, standing there when Doctor Kensing appeared from inside, his handsome face stricken and drawn. He met Ross's eye for a moment, finally looking down and away. "I don't know what happened," he said. "I thought we might have got him out of the woods, but " The words trailed off and the doctor shook his head in defeat and misery.

  If he was looking for commiseration, Ross thought, he was barking up the wrong tree. In fact, Ross found himself fighting the urge to say something spiteful, even accusatory. The time would come for that. Kensing had been Ross's particular nemesis for a couple of years, questioning his medical and business decisions, defying his edicts, crusading against his policies with the rest of the medical staff. Kensing's presence on the floor now, in the ICU directing Markham's ultimately failed care, was from Ross's perspective a bitter but not unwelcome act of fate that he would exploit if he could after the initial impact of the tragedy had passed. But it would have to wait.

  Now, Ross had business to which he must attend. He didn't wait for Kensing to reappear in the hallway with his no doubt self-serving postmortem analysis of what had gone wrong, as if he could know by now. He had no stomach for the condolences, hand-holding and-
wringing that he knew would attend the next hours at the hospital. Instead, he left the floor by elevator and got out in the basement parking garage, where he got in his Lexus and contacted his secretary, Joanne, on his cell phone. "Tim didn't make it," he said simply. "I'll be there in ten minutes."

  5

  David Freeman and Gina Roake, straight-faced, told Dismas Hardy that they were going to continue their walk from Lou's up to Freeman's apartment on Mason to look over some documents. Freeman would be back in the office later, if Hardy would be so kind as to tell Phyllis.

  "I'd be delighted, David. Any excuse just to hear her sweet voice."

  So, coming into the lobby alone, Hardy was congratulating himself for his restraint in not commenting on David and Gina's lame document-perusal excuse, when the dulcettoned Phyllis stopped him. "Mr. Elliot from the Chronicle would like you to call him as soon as you can."