by LaGreca, Gen
“So what’s your point, Dr. Lutz?”
“I mean that I couldn’t abandon my patients in the middle of treatment because CareFree changed its rules, could I? No matter what we want to call it, depression or marriage counseling, it’s the same case.”
“But it’s a different diagnosis. You switched the diagnosis.”
“But the pain is the same!”
“Excuse me?” Warren asked threateningly.
Dr. Lutz looked down timidly, and a subtle satisfaction glimmered on Warren’s face, as if he had won some kind of battle.
“But Mr. Secretary, if I had dropped the case when marriage counseling was no longer covered, then couldn’t I be charged with patient abandonment? That’s an infraction, too, isn’t it?”
“So instead you decided to be charged with fraud?”
The comely psychologist did not protest, which seemed to permit the secretary to soften his tone.
“Next time,” he added kindly, “call our office if you have questions about diagnoses and changes in our coverage. After all, we’re here to help you.”
“Well, I . . . uh . . .”
“I think the fine is justified. Now do you have any other questions?”
“I guess not,” Dr. Lutz said disappointedly.
The secretary looked pleased with the dispatching of Dr. Lutz and signaled to his assistant for the next case. His aide approached, but this time without a new file, whispering something in Warren’s ear, as a distinguished gray-haired man approached the podium.
“Good afternoon,” said Warren to the tall man in a business suit.
“Good afternoon, Dr. Lang. I’m Kenneth Viceroy, the director of cardiology at Pace Memorial Hospital.”
“I understand that we have no case against you, Dr. Viceroy.”
“That’s right, and CareFree has never had a case against me or any member of my department. We pride ourselves on following the law.” The surgeon raised his right hand to his heart as if taking an oath.
“So what brings you here today?”
“An urgent request. We’ve applied for CareFree’s approval to perform heart transplants at Pace Memorial, and we’re told it will take thirty days more to obtain authorization. Yesterday a patient was admitted who is an excellent candidate for a transplant. With Whittier Medical Center having closed last month, the nearest hospital that can perform this procedure is fifty miles away, and the patient is too unstable to be moved. I came to ask your permission to perform this surgery immediately, or the patient could die. You see, we’ll be using the same transplant team that worked at Whittier before it closed.”
“Dr. Viceroy, your group may perform the surgery—”
“Wonderful!”
“—when you have met your regulatory burden.”
“Dr. Lang, really!”
“We have a responsibility to ensure public safety.”
“I recognize that, of course. But everyone on our team has experience performing transplants safely. Isn’t there anything you can do?”
“There are reasons for the laws we have. If we could take on face value everyone who stands here and says he’s okay, then we wouldn’t need any regulations, would we? We’ll just let anyone who says he’s okay loose on the public. Is that what you’re advocating?”
“Of course not. But can’t you expedite the approvals?”
“We can’t cut corners with public safety.”
“But if we don’t operate, the patient could die!”
“But if we make an exception for you, then others who have pending applications will want us to do the same for them. This undermines our system, Dr. Viceroy. We have the lives of millions of patients to consider. That’s why we must focus on a wider context than one individual patient, and we must follow the proper procedures.”
“I respect those procedures, of course.”
“Yet you want me to disregard them?”
“But in this case—”
“Especially in the case of a complex, risky operation such as yours, it’s even more important to ensure that society is protected. I’m confident the public can count on you, Dr. Viceroy, to continue your commendable record of regulatory compliance.”
The cardiologist bristled, about to disagree, when Warren dismissed him by calling the next case.
* * * * *
Later that afternoon Warren’s chauffeur drove him up the winding hill to the fragrant front garden of the governor’s mansion. Disturbing thoughts of his last encounter with David lingered, marring the secretary’s usual rush of excitement on visiting his ardently wished-for future home. On his way to Burrow’s office, he walked through the picture gallery of governors, reaching the empty place on the wall beyond Burrow’s portrait where the next governor’s picture would hang. As was his habit, he visualized his own likeness in the spot. But instead of feeling his usual thrill, the aftertaste of his bitter meeting with David intruded to evoke a pervasive, unnamed guilt. His son’s acrid words seemed to echo ominously through the hall: Before this matter is over, one of us will be finished.
Warren recalled the people he had encountered that day who gave his life legitimacy: the patients who revered him as their only hope; the restaurant staff members who treated him like royalty; the doctors who, despite their frustrations with the system, respectfully accepted his authority. With the endorsement of all these people, how could one man make him avert his eyes from the portraits like an impostor undeserving of greatness?
In the opulent Victorian parlor outside the governor’s office, an aide offered Warren a seat. While waiting for his appointment, the secretary observed the Burrow administration in action. The governor’s personal secretary was telephoning a candy shop in Glens Falls to order a specific kind of truffle that Burrow craved. A writer composing Burrow’s memoirs worked at a computer. One advisor left the inner office and another entered it, while many others waited. Warren had never known the governor to be alone. Like favorite pets, Burrow’s aides followed him everywhere—in his bedroom while he dressed, in his bathroom while he shaved. Burrow constantly called meetings with aides, then wasted hours of their time by making them wait to see him. The governor was never punctual, Warren thought irritably, feeling like a boy at the dentist’s office. Burrow seemed to take a peculiar pleasure in having a throng of people queuing to see him.
Before being appointed to his current post and establishing a home in Albany, Warren was an advisor to the governor and a frequent overnight guest at the mansion. Burrow, an early riser, had an odd fear of being alone and a reputation for waking anyone available for companionship. Warren remembered the governor’s early morning wanderings into his room to talk. The pajama-clad, aging, somewhat helpless looking Burrow jarred with the persona of the commanding politician, masterful at playing special-interest groups against each other. Burrow could persuade the unions to back a bill and big business not to oppose it, all the while creating a universe of obligations, favors, and fears that he used to run the state. Warren wondered why such a man could not bear loneliness.
“These are my real friends,” Burrow once said, pointing to a wall of twenty monitors installed in his office. The electronic array glowed with television news broadcasts and public-opinion surveys. The first time Warren had seen the massive display, the governor had laughed at his surprise. “The media and the polls,” Burrow said reverently of his wall of videos, as leaders from another age might have uttered the words truth and justice.
Burrow employed a giant remote control to navigate the wall, muting the sound until his picture appeared on a particular screen, at which time he would engage the volume on it. On particularly stressful days, he was known to unleash the sound on all monitors simultaneously, creating a cacophony to rival a department store’s television showroom. “These screens are the secret to running the state,” the governor would say. Another menagerie of monitors existed in his bedroom. When the governor traveled, a team of technicians installed screens in his hotel rooms. He could no
t live without them.
Mack Burrow needed people, thought Warren, yet encounters with the state’s most powerful politician invariably ended in a soliloquy. At Burrow’s frequent dinner parties, he was always the center of attention. Warren, who held the seat beside the governor at the table, once declined an invitation in order to attend his grandson’s piano recital. At Burrow’s next dinner, Warren was relegated to a seat farthest from the governor. The secretary never declined an invitation from Burrow again.
If another person ventured to make conversation at the dinner table, it would invariably remind Burrow of a story that he liked to tell—of his ancestors, his childhood, his military service. He related to Warren how the first Burrow to reach America died fighting alongside George Washington in the Revolutionary War. Later Warren learned that the Burrow clan had not emigrated to America until a century after the War of Independence. Warren could understand, if not condone, the governor’s mendacity to gain political advantage. But why would Burrow lie when no practical result could be achieved?
“Political oratory is like storytelling,” Burrow once told Warren. “More important than truth is the response of the audience.” Burrow often omitted major sections of his prepared speeches to spend time shaking hands with the audience. “No idea is as powerful as a handshake,” he would say.
Burrow kept what he called his “stable of consultants,” the Ivy League professors who counseled him. Their presence provoked the cruder aspects of his nature—the swearing, the lewd jokes, and the biting nicknames that he coined for them, delivered in jest and expected to be taken as such. Professor Samuel Klink, who held the economics chair at a prestigious university, was called “Klunk.” Professor Tournkey was “Turkey.” Warren bristled at the thought of these academicians grinning obsequiously at Burrow’s nicknames. What did they need from him, and what did he want from them? Warren wondered.
Burrow read newspapers voraciously and devoured biographies of powerful men. Warren recalled the governor’s rage at reading a news story about a popular department store laying off fifty workers in a candy-making operation that it decided to farm out of state. “They call every day to check on the status of the permits they want for their new store,” Burrow pouted, “but when they fire fifty workers, you think they’d have the decency to let me know first!” Burrow looked personally offended, the way he did when someone declined his dinner invitation.
Warren glanced at his watch. Burrow’s secretary, catching his eye, gestured that he would be next. On her desk Warren saw the customary stack of presents kept within Burrow’s reach. In prior administrations, gift-giving had been relegated to a staff member. However, Burrow elevated this function to one rivaling the greeting of foreign dignitaries. The governor took a personal interest in giving gifts to the people he encountered. His favorite memento was a framed, autographed picture of himself. Such photos, like religious icons, decorated homes and offices throughout the state, where they seemed to beg for a candle to be lit before them.
Burrow also loved giving electric toothbrushes with his name inscribed on them. “Why toothbrushes?” Warren once had the temerity to ask. “I want people to think of me first thing in the morning and last thing at night,” Burrow replied. He would give a person the same gift repeatedly, each time expecting the receiver to display surprise and delight. Warren himself had received nine toothbrushes and a dozen photos.
The ritual of the gifts, Warren thought, went beyond mere generosity or even eccentricity to place people in a state of obligation and dependence. Was Warren himself in such a state? And was he, as David accused, placing millions of others in a state of dependence through the gifts bestowed by Carefree? A momentary fear gripped him, but he resisted its pull. The idea is ridiculous, he told himself. No one but David would think so. A shake of Warren’s great white hair dismissed the matter.
Warren disapproved of Burrow’s displays of power, ardently believing that Governor Warren Lang would rule better. He would be perfectly positioned to run for the state’s highest post after serving a term as lieutenant governor. But that would entail Burrow’s choosing him for a running mate. What price would Burrow demand for this greatest of gifts?
* * * * *
In the inner office beyond the closed mahogany door that Warren faced, the governor was having a meeting with his campaign manager, Casey Clark. The two watched a demonstration taking place outside the window. Several hundred victims of spinal cord injury held placards reading Cure, Not Care; More Research on Nerve Repair; CareFree Must Cure Us.
“This could spell trouble,” said the governor, peering through the transparent curtain.
“The publicity could hurt us,” replied Clark, standing beside him. The double-breasted suit with padded shoulders that the tall, well-built young campaign manager wore gave him an almost military authority beyond his years.
“Since this David Lang thing began, my office has gotten calls from one hospital after another wanting us to approve a new scanner, a new pavilion, new beds, a remodeling,” the governor moaned, pacing nervously. “A heart surgeon called, asking to perform his experimental procedure. A cancer research group wants permission for its new treatment. And I received a petition from doctors trying to unionize.”
“This thing could blow up,” said Casey Clark, taking a seat on the arm of a sofa. “And the election is only thirteen weeks away.”
“Some of these groups don’t just want our funding for their pet causes,” said the governor. “They’re more brazen. They want to act outside of CareFree, collecting private fees from private patients, putting us back where we started! I thought this divisiveness was behind us. Now some hotshot reopens a can of worms that could harm CareFree!”
“And without CareFree, you have no big hook to reel in the voters in November, Governor.”
“And no platform for Washington in two years—or whenever I decide to make my bid.”
Because critics accused Burrow of seeking reelection in New York only as a springboard for the presidency in two years, the governor was promising to complete a full four-year term in Albany. His fervent ambitions for the next presidential race had to be kept secret, so inadvertent references to his running in two years were always amended.
“To compete on a national scale, Governor, you need a big new program to distinguish yourself,” said the authoritative Clark, who was seven years out of college. His impassioned support of Burrow in the latter’s first campaign for governor had landed the young devotee the job as campaign manager for the reelection.
“I have a program: CareFree National. We’re going nationwide with CareFree in two years—or whenever I run.”
“You’ll solve a problem that’s gripped the nation for decades. You’ll accomplish what other great presidents only dreamed of. Every time they tried to launch full-scale national health care, they got knocked down. You’ll be the one who succeeds. You’ll have the accomplishment of CareFree in New York to ride on. What a brilliant platform, Governor! That’s the ticket for our bid in two years—or whenever you decide to secure your rightful place in history.” An almost religious zeal flickered on Clark’s face.
“But the divisiveness has to stop. A dangerous anti-big-government sentiment gained ground with the kickback scandal. It could intensify with the case of Warren Lang’s son and rock the boat at the wrong time. What am I going to do, Case?” The loose skin on Burrow’s face was like wet concrete waiting to be shaped by a passing footprint.
“Let’s look at the opinion polls,” replied Clark.
Both men pulled chairs close to the oracle that they trusted to answer all questions: the wall. They sat before four rows of monitors that gave the quaint colonial office the look of an airport control tower.
“I had the opinion meters set up on screen sixteen,” Clark said, clicking buttons on the remote to produce the desired program.
Clark’s staff polled public opinion by playing videos of people in the news to a sampling of voters and measuring their
reactions. The first video segment showed the lieutenant governor. The dial of the opinion meter, displayed below the speaker, swung into the red zone, indicating strong disapproval of the voters.
“That’s a no-brainer,” quipped the governor. “That’s why he’s history.”
The next video segment showed the secretary of medicine giving a speech. The dial swung into the green zone of the meter, indicating strong approval.
“Everybody likes Uncle Warren,” said Clark.
The governor nodded.
The next video segment showed the governor responding to a reporter’s question about David Lang’s surgery: “We support research as an initiative of CareFree. We have plans to fund medical research projects, which you’ll see unfolding in the weeks and months to come.”
“What plans?” interjected Clark.
“I don’t know,” said the governor, his eyes following the fickle little dial on the screen.
“Regarding David Lang’s unauthorized treatment,” the governor continued on the video, “we need to hear from all sides. There are dangers in listening only to one disgruntled doctor. Our first and foremost concern is with ensuring the patient’s safety.”
The dial settled in the middle of the meter, registering neither approval nor disapproval.
“They don’t know what to think,” said the governor.
Clark echoed his sentiment. “The people are sitting on the fence on this.”
In the next segment David Lang was talking to the press, his head high, his eyes guiltless and insolent: “It’s none of the governor’s business what I do in the OR. The only permission I need is from my patient.”
The dial swung into the green zone, indicating approval.
“The ingrates!” cried the governor. “After all I did for them, the people like the hotshot over me!”
“But he doesn’t know that, so let’s not tell him. Besides, there’s more.” Clark fast-forwarded the video. “We polled another test group on the same topic. Watch this.”