by LaGreca, Gen
“With CareFree, instead of deciding what pill is best to prescribe, I have to ask: What pill am I allowed to prescribe? My judgment is superseded by an arbitrary third party. If you multiply this kind of humiliation by thousands of cases, and by the chronic fear doctors have of punishment if they break the rules, you’ll know why the best ones are quitting medicine, and you’ll also know why the American standard of care, once the finest in the world, is deteriorating. The doctors who survive, the ones who play by the rules, give up the thing that makes them good healers: their free, inquiring minds.
“CareFree’s rules don’t represent any judgment superior to mine—just the opposite. They represent political decisions and statistical averages that have nothing to do with your case. If you can’t get the tests or the surgery you need for your condition, it means that your tax money went to buy something else for someone else. The state tells you it’s giving you something for nothing, but there’s no such thing. What CareFree really does is tax your money, which you can’t spend as you choose, so the state can spend it—or not spend it—as it chooses. Not only are you still paying through taxes for your medical care, which is now grossly inflated by the cost of running a huge bureaucracy, but you’re also paying a hidden and deadly price—the price of giving up your right to make your own medical decisions. He who pays the bill sets the terms; therefore, there’s no method of improving CareFree so that you and I can be autonomous. Any variant of CareFree would be and always has been the same. So do you really want medicine to be ‘free’ of charge?
“No airline would ever have a clerk in an office miles away telling your pilot how to fly your plane. No hospital or doctor would ever give you cookbook medicine. None of us would give you a distant administrator to decide your treatment on the basis of a statistical average or on the basis of who’s trading favors with whom among the politicians. Medicine and politics don’t mix. Everyone in medicine knows this. CareFree is like an elephant in the house of medicine. We pretend it’s not there, we walk around it, and we try not to get trampled.
“You, the public, seized medicine from the doctors and gave it to the politicians because you wanted your treatment to be free. It’s not free. You want the providers to shun material rewards and to work primarily for your benefit. I reject that. I practice medicine because I love it. I help others, which gives me great satisfaction, but it’s not the thing that can fuel a life’s dedication to a grueling profession. I didn’t endure the poverty and grind of med school and residency so that I could do a good turn for you without personal gain for me, and that includes material rewards beyond what I could achieve in a job not requiring ten post-college years of training.
“Besides controlling the material rewards that I obtain for my work, CareFree also controls something else that is vital to me and my patients. Nicole Hudson’s case demonstrates the issue clearly. It’s not about bogus research. I showed that I have grounds for the action I took. It’s not about costs. Her surgery can be paid for without taxpayers’ money. It’s not about the patient’s safety. The patient is doing fine. It’s about one issue only: my judgment or CareFree’s power?
“What’s really on trial here? If you want to save not only my patient and me but also medicine itself, you must recognize that you can’t straitjacket the doctors; you can’t force us to serve you. If you build houses for a living, I don’t have a right to march the state in to control your business so that you can provide me with a house for free. That would amount to holding you as my slave. You can’t do that to the doctors. It’s a fact that in the days when insurance was not controlled by the state, private policies—the good kind that didn’t interfere with treatment decisions—were affordable. It’s a fact that before the passage of licensing laws, lobbied for by the medical profession, there was a greater supply of doctors and auxiliary personnel, which kept fees low. And it’s a fact that before the state’s meddling, private charity abounded for those who couldn’t pay. The freer, happier, and more prosperous the doctors were, the more generosity they showed to the needy. You tell me whether you’d be in a mood to give private charity after you performed twelve hours of surgery but got paid for only six.
“I tried to give charity to Nicole Hudson, but her treatment was prohibited by law, even though I charged no fee. You tell me the motives of your so-called benefactors who claim they want to help the unfortunate yet condemn a young woman at the pinnacle of her life to a future of misery. I say CareFree is on trial here, and I urge you to give it the sentence it deserves. Your own life may depend on your decision.”
When he finished, David was looking at Warren.
“Thank you, Dr. Lang,” said his attorney. Then Green nodded to Harkness, signaling that it was his turn.
“Dr. Lang,” said Harkness, rising from his seat, “your dedication to medicine is admirable, I’m sure. However, from the information I have, it also seems as if you’re dedicated to other things, as well. Is it true, Dr. Lang, that before CareFree, your office pulled in several million dollars in billings each year?”
“Yes.”
“So you admit you made a lot of money before CareFree pulled the plug on that?” roared Harkness accusingly.
“I did.”
“Excuse me, Mr. Harkness,” said Green, rising from his seat, “but why don’t you also ask how many ball players, rock singers, company executives, and, yes, even lawyers, made more money than my client did? And how many lives did they save?”
“Mr. Secretary, this interruption is out of line!” Harkness cried indignantly.
“We’re not bound by legal protocol here. I think Mr. Green can finish his point,” said Warren.
Harkness looked astonished. Green, who was about to sit down, also seemed surprised at being permitted to proceed.
“And what about the years of schooling and residency in which Dr. Lang made little or no income?” Green continued. “And the overhead expenses for his loans, malpractice insurance, office rent, staff salaries—”
David contradicted his attorney. “Well, no, Russ. Even after I paid all the overhead, I still made a pretty good living.”
David ignored the angry look his attorney flashed at him. Harkness beamed. With Green silenced by his own client, Harkness continued his questioning.
“And isn’t it true, Dr. Lang, that you and your brother talked to private investors about creating a research center with venture capital, where you would test your ideas about nerve repair, ideas that the body of reputable scientists say are impossible?” Harkness’s condemning tone made the deed sound terrible.
“That’s right.”
“And you talked to a pharmaceutical company about producing the drugs you discovered for nerve repair?”
“I did.”
David had discussed the matter with his friend, pharmaceutical president Phil Morgan, whose company had several of its drugs removed from CareFree’s formulary when Morgan defended David’s surgery on Nicole.
“And if a company manufactured those drugs, you, as the discoverer, would collect royalties, would you not, Dr. Lang?”
“I would hope so; that was my intention.”
“And if you could launch your research center and get your new drugs manufactured, you could make a great deal of money, couldn’t you, Doctor?” Harkness bellowed reproachfully.
“Perhaps.”
“And it would please you to make a lot of money, wouldn’t it?”
“It would.”
“Ah ha! So, in your overzealous drive to market your new products and to get as rich as you possibly could, you cut a few corners and ignored a few rules, didn’t you? With wild dreams of fame and fortune whirling in your mind to cloud your medical judgment, you pushed a barely developed procedure and untested drugs on a helpless patient to serve as your personal guinea pig, didn’t you?”
“That’s absurd,” said David quietly.
David’s attorney raised his hand to object again, but Harkness prevailed for the final, biting word: “We’
ll let the jury decide how proper it is for a healer to be wheeling and dealing with drug company executives and venture capitalists and to be recklessly endangering his patients. I don’t think I need to ask you any more questions, Dr. Lang, because your actions speak for themselves about your character! Thank you.”
Looking pale and distraught, Warren called for the closing statements from both attorneys, and then dismissed the twelve advisors for deliberation. He adjourned the proceeding for two hours. Although it was one o’clock and he had skipped breakfast, he had no appetite for lunch. He retired to his office, staring vacantly out the window for two hours.
When he returned to the courtroom, it was filled. His advisors were already seated in the jury box, and David was staring at him from the defendant’s table. Warren turned to the spokeswoman of the panel, who rose to face him.
“What have the advisors decided, Ms. Farley?”
“I’m afraid we’re deadlocked, Mr. Secretary. Six of us strongly believe that you should lift Dr. Lang’s suspension and allow Ms. Hudson’s second operation. The other six of us feel just as strongly that Dr. Lang should receive the maximum suspension and fine for subjecting Ms. Hudson to an unauthorized procedure. Those six further believe that Dr. Lang should be barred from doing any nerve-repair surgery on humans until the animal experimentation is completed and the proper authorities have reviewed the findings and found the procedure safe. We think it would be useless to deliberate further. We have no dispute about the facts of the case, but we have a profound philosophical disagreement about the role of the state in medicine, and it doesn’t appear likely that any of us will have a change of heart.”
The spokeswoman looked timidly at the secretary, as he had a reputation for demanding that others fulfill their obligations. He had asked for a decision and the advisors had given him none. Would he order them to deliver a verdict that they found impossible to render? Surprisingly, Warren, looking tired and weak, only nodded.
“Thank you, Ms. Farley.” Although his next words were addressed to the entire courtroom, he looked directly at David: “We’ll adjourn until ten o’clock tomorrow morning. At that time I will give you my decision.”
Chapter 22
Trapped
An evening breeze stirred through the shade trees and flowed into the open windows. The warm air was like the last gasp of summer, thought David, sitting next to Nicole in her living room. In two days autumn would arrive, a time when the leaves would reach maturity, then die with grace and beauty. His eyes traced the svelte lines of his dainty companion, who wore silk slacks and a sweater. The short puffed sleeves of her outfit accentuated the thinness of her arms. Nicole was in the summer of her life, and he would permit nothing to cause her decline.
Mrs. Trimbell had retired to her room, exhausted from the trial that day. Nicole, resisting her own fatigue, turned on the television to scan the news stations, despite David’s protest. The trial was the major story of the day, and the likely topic of discussion on the evening talk shows and news broadcasts.
“We proved our case today,” Nicole said with radiant innocence. “Surly everyone will agree.”
“Don’t count on it.”
She located a channel announcing the stories in the headlines: “Tomorrow Secretary of Medicine Warren Lang is expected to issue a decision in the case involving his son’s experimental surgery on dancer Nicole Hudson,” said the newscaster. “Sources in the Burrow Administration believe the verdict will affect the secretary’s credibility as head of the BOM and his chances of running on the governor’s ticket. We also have word that Governor Burrow will announce his running mate tomorrow. For more on this story, let’s go to his campaign headquarters in Albany.”
Nicole switched the channel to another news station. David felt as if he and his patient were about to be swallowed by a large shadow cast by a small man named Mack Burrow.
“Should CareFree be canned, as David Lang and Nicole Hudson suggested at their hearing today?” the host of a talk show asked a political analyst.
“We must respect the law and achieve social change within the system,” said the analyst. “If we don’t enforce CareFree’s rules, we run the risk of anarchy.”
“Doctors like David Lang should be reducing the spiraling costs of health care, not devising ways to spend more,” said another analyst. “That’s why the government must step in.”
“But David Lang says that government interference caused the soaring demand and spiraling costs of health care in the first place,” interjected the host.
“How we got where we are is irrelevant. What’s important now is to prevent the problem from worsening, and only the government can do that.”
Nicole once again changed the channel.
“Dr. David Lang and his patient Nicole Hudson today complained that CareFree is too restrictive. How do you respond to that?” a reporter asked Assistant Secretary of Medicine Dr. Henrietta Richards.
“CareFree is an outstanding program with a distinguished record of helping people,” replied Dr. Richards authoritatively.
“Then why have doctors left New York State in record numbers since the start of CareFree?”
“Oh, that’s not the fault of CareFree but just the normal human reaction to change. Studies show that people don’t accept change well at first.” Dr. Richards smiled pleasantly. “But their resistance passes after an adjustment period.”
“How about Dr. Lang’s charge that the doctors can’t decide for themselves how to handle cases?” asked the reporter.
“Our administrators always listen to the doctors’ requests. A healthy exchange of opinions occurs constantly. CareFree shouldn’t be viewed as imposing its views on the medical community but rather as collaborating with it.”
With an angry snap of her finger on the remote, Nicole searched for a better channel.
“Should society allow its doctors to make a pile of money off the sick?” asked Miriam Bell, a talk-show hostess who had just signed a four-million-dollar contract with her television station.
“I believe that the profit motive is incompatible with the life of a healer,” replied guest Ronald Wells, a lawyer whose recent defense of a football player in a rape trial brought him a fee of two million dollars.
“And bending the rules for family members is definitely a no-no for a public official,” interjected another guest. “CareFree will have to punish David Lang, or else Warren Lang can kiss his political career good-bye.”
David took the remote from Nicole’s hand and muted the sound. She rubbed her eyes wearily.
“Let’s not dwell on the news, Nicole.”
She nodded.
“Mrs. Trimbell tells me you’re sleeping fitfully and crying out in the night.”
She sighed.
“What’s wrong? Tell me.”
“It’s a nightmare I used to have as a child, at times when I felt . . . trapped. I was free of it for years . . . until recently.”
“What’s it about?” He took her hand.
Her face grew intense, as if troubled by an inner vision. “I dream that I’m in a big church and men are taking me away. I scream and try to break loose because I want to stay with a nun called Sister Luke, but they won’t let me. It’s the way I was carried off from a neighborhood parish as a child and placed in foster care.”
“I see.” David left her side to get a glass of water from the kitchen. He gave it to her, along with tablets from a bottle that he took from his pocket.
“Mrs. Trimbell called me this morning, concerned about you. So I brought these pills to help you sleep.”
He sat on the couch next to her.
“I suppose I should take them. Thank you.”
“Tonight I want you to forget about the trial and to think only about something that’s pure pleasure.”
She threw her head back wistfully. “I’ll dream of the Phantom . . . naked.”
His mind burned with wild thoughts of lifting the dainty bundle, carrying her into the b
edroom, and making her dream a reality. She would have no nightmares then! Instead, he stood up abruptly, distancing himself from his temptation.
“Take the pills, will you, so I can get going?”
She swallowed the medicine, curious at the sudden brusqueness in his voice.
“I’ll see you tomor—” he stopped, catching an image on the television screen.
“What is it?”
“It’s the commissioner for the blind. Remember the guy you decorated with your milkshake at the hospital? He’s on TV with the governor,” said David, engaging the sound. “He looks different now that he’s dry.”
“Today Wellington Ames, the commissioner of New York City’s Department of Disabilities, was promoted by Governor Burrow to one of the most coveted posts in state government, director of the Department of Human Services,” a reporter explained.
“During a lengthy search to fill the vacancy in Human Services, Commissioner Ames’s fine work in New York City came to my attention,” said Malcolm Burrow from a hotel podium. “It gives me great pleasure to award the director’s post to a distinguished official who has an outstanding record of public service.”
“It’s a great honor to be appointed to this position,” said Ames, standing next to Burrow. “I’ll be working closely with the governor on important matters for the people of New York . . .”
Nicole recognized the voice of the official who had wanted to place her in a home for the blind. He was the man who had visited her in the hospital on the day that she had received the Phantom’s roses, which was also the day that she had lost the Phantom’s letter.
* * * * *
In a quiet neighborhood on Manhattan’s East Side, a man sat alone on the balcony of his penthouse. He glanced up at a misty sky and down at a deserted street. Dinner from a local restaurant lay untouched on a table. The evening was unusually quiet for the restless figure because it did not include a party, a banquet, a speaking engagement, a meeting, or a television appearance. Although he rarely thought of his wife, who had died several years ago, he missed her that night. He had canceled two engagements that evening—a trip to a shelter for the homeless and dinner at a posh restaurant. The conflict of opposites. For the first time that day, sitting alone in the darkness, he had no attendant to open his mail, to clear his food, to take his messages, or to keep his schedule. He felt revulsion at the thought of being around people and anxiety at the prospect of being alone. The conflict of opposites.