“I know where it is. You treat outpatients there. You even have outpatient surgery.”
“Right. It’s also where we have some of our more pressing ethics problems.”
“Oh?”
“Normally, they’re not problems for most doctors. Certainly they’re not problems for other hospitals. But they’re very definitely problems for Catholic hospitals.”
“Let me guess: family planning.”
“Right.”
Koesler looked slightly puzzled. “Well, as far as the ‘official’ Catholic teaching goes, there are only two approved means of family planning. One is complete abstinence from sexual activity, and the other, under set circumstances, is the rhythm method.” Absolutely nothing had changed in the Church’s attitude toward family planning in the thirty-odd years Koesler had been a priest. Church approval of the rhythm system had occurred shortly before he had been ordained in 1954. “But very few pay much attention to that view any longer. Just the bishops, some priests, and a few very conservative lay Catholics.”
“But you see, Father, the bishops like to exercise a good measure of control over Catholic hospitals.”
“That makes sense. They’d exercise complete control across the board if they could. But family planning is a private matter between each couple. At most it might enter the confessional as a question or as a matter for some discussion. But I can see where in a hospital you’re in the external forum and the bishops might be able to control—or try to control—the hospital’s teaching and practices.”
“Exactly. And that’s where a place like St. Vincent’s is in a lot of trouble. If we don’t dispense information and devices for all medically approved methods of birth control, we lose government funding. That, in itself, I think, would not discourage Sister Eileen. But she knows our patients have a right to this information and service. And she is determined to make it available to them. The peculiar twist in all this is that most of our poor patients couldn’t care less about birth control. They figure the more babies the better.”
“So,” Koesler clarified for himself, “St. Vincent’s provides the information and means of artificial birth control under the threat of losing government financing—but against the bishops’ directives—and because the CEO believes it’s the medically and ethically correct thing to do, even though most patients don’t want the information in the first place.”
“That’s about it.”
“A dilemma. A real dilemma. But where does Dr. Kim fit into this?”
“As usual, Dr. Kim is involved in shortcuts. But, in this instance, they are rather significant shortcuts.”
“Oh?”
“I don’t have this firsthand, but from some of the clinic personnel I trust. Dr. Kim, when faced with any sort of problem pregnancy, will routinely perform a D & C—at least he will call it a D & C.”
“D&C?” Koesler asked.
“Dilatation and curettage. You dilate the cervix and scrape the womb’s lining. It’s standard treatment for any number of gynecological problems. But not for a problem pregnancy. Then it’s a euphemism for abortion. And that’s where St. Vincent’s draws the line. Our policy permits teaching methods of contraception, the implantation of IUDs, prescribing birth control pills, even sterilization . . . but not abortion. Not abortion.”
“I see.”
“It would be lots harder to prove, but according to some, Dr. Kim also schedules hysterectomies with some abandon.”
“He does?”
“Yes. Even when the woman’s condition does not warrant it, a hysterectomy is sometimes the easiest and at the same time the most lucrative therapy.”
“What a crime to perform such radical surgery if a woman doesn’t really need it!”
“Indeed. But it is convenient. However, if these charges can be proven, Dr. Kim will be out on his ear.”
“Oh, my. But”—Koesler’s brow furrowed—“there’s still a shortage of doctors. Wouldn’t he be able to tie in with another hospital?”
“Perhaps. But remember where St. Vincent’s is on the desirability list. It’s something like a baseball player being unconditionally released from a last-place team. And remember where Dr. Kim wants to go. Very definitely up from St. Vincent’s. Not down. Not even a lateral arabesque.”
“So,” Koesler concluded, “I would guess that would be motivation enough for Dr. Kim to clean up his act.”
“Maybe. Maybe. Unless he had an alternative.”
“An alternative?”
“He might try to hurry the closing of St. Vincent’s. If the hospital closed shop before he was dismissed . . .” Scott’s gesture signified a satisfactory conclusion, at least by Dr. Kim’s lights.
They picked up their trays and headed for the counter area. En route to the conveyor belt that would carry their trays to the dishwasher, they encountered a man who had just settled with the cashier and was scanning the cafeteria preliminary to selecting his dining place.
“Hello there, John,” Scott greeted him. “Have you met our substitute chaplain yet?”
“I haven’t had the pleasure.”
Scott introduced John Haroldson, chief operating officer of St. Vincent’s. Haroldson, of medium height, appeared to be in his mid-sixties. His heavily lined face was framed by wispy, wavy white hair. His eyes were a very light blue and when he smiled, as he was doing now, all the lines of his face moved in an upward direction. Koesler’s impression was of a rather nice-looking, friendly gentleman.
“So you’re going to be with us until Father Thompson returns, eh?” Haroldson observed.
“That’s right. This was my first day on the job and I must admit I’ve learned a lot, with a lot more to learn.”
“Don’t worry, Father, the hospital won’t jump up and bite you. You’ll get along fine. If there’s anything I can do to help, don’t hesitate to call on me.”
Haroldson headed for a table. Scott and Koesler deposited their dinner trays on the conveyor. They stopped together just outside the cafeteria. For the moment, they were alone in the corridor.
“That’s another one,” Scott said.
“Another one what?”
“Another problem area.”
“Oh?”
“Haroldson goes back in this hospital almost as long as Eileen.”
“That’s a problem?”
“Not in itself. It’s just that John has a bit of a persecution complex. He’s always moved up a notch behind Eileen, until, of course, her final appointment. When she became a supervisor, he was named assistant comptroller. She moved into a vice-presidency; he became a supervisor. Then he became COO with the likelihood of eventually becoming CEO. But Eileen leapfrogged him into the top job.
“It doesn’t show, but John Haroldson is a bitter man, and the principal target of his bitterness is Eileen. It’s really manifested when they’re together, especially in a meeting.”
“I’ve been here only a day, “ Koesler said, “and I’ve just met Sister Eileen this once, but it does seem to me she’d be able to handle someone’s bitterness. I mean, she’s already juggling any number of problems—most of them far more serious than envy.”
“It’s not that she can’t handle any sort of frontal attack that Haroldson might launch. It’s that the longer he stays here, the more he covets Eileen’s position. It’s a need, as he sees it, to balance the scales of justice. But he hasn’t long to go till mandatory retirement—a few months at most. And I get the feeling he wants to set matters straight before he has to leave here. “
“How could he do that?”
“I’m not sure. I just think that might be his aim.”
They began walking toward the elevators.
Almost facetiously, Koesler commented, “Well, there’s Dr. Kim and now Mr. Haroldson. Anyone else to be concerned about?”
“Sure. But once you know what’s at stake here and the lay of the land, you’ll be able to figure things out for yourself with no additional help from me.”
“I doubt
that.”
“There is one more person you ought to be aware of who just might slip by.”
“Who’s that?”
“Sister Rosamunda.”
“Sister Rosamunda!” Koesler exclaimed. “Why, she’s the embodiment of the grandmother most people would want if they were able to invent their own!”
“No argument. It’s just that Rosey should have been retired years ago. But her ultimate fear is being put on the shelf. And Eileen is simply too kind to insist on her retirement. On the contrary, each year that it comes up—and it does come up each and every year—Eileen goes to bat with the corporation on behalf of Rosey. And in deference to Eileen, they allow Rosamunda to stay.”
“That sounds sort of nice. Very considerate of Sister Eileen.”
“Except that Rosey is left dependent on Eileen’s continued good will. As long as Eileen is in charge, the corporation will continue to defer to her on this. But eventually, inevitably, Eileen will be forced to pull the active plug on Rosey. And that will be the end of Rosey’s professional life.
“Add to which, Rosey—although officially she is listed as the sacristan and still has access to the patients—is getting senile. And on top of all that, she’s got a bit of a drinking problem. Not much, mind you, but enough to upset the applecart.”
“A drinking problem! You’ve got to be kidding!”
“I don’t kid. Not about that kind of thing. Now, Father, you know that’s not unheard-of. Although most Catholics—and I suppose that includes priests—like to think that someone like the aged and venerable Sister Rosamunda is above every human failing, above every human condition. But that’s just not realistic. With Rosey, it began years ago when arthritis joined her long list of medical problems. There was a lot of pain and a reluctance to depend on medication. Which, with an accumulation of ills like those that hit Rosey, wouldn’t have done all that much to relieve the suffering. Like many elderly people in pain, she turned to alcohol for some relief. She’s still on it.”
“Okay, suppose she is . . . what has that got to do with anything else?”
“Only this: that while there are some people—like the two I’ve mentioned—who might deliberately plan to undermine Eileen in running this hospital, somebody like Rosey could deep-six Eileen’s operation very effectively, if unintentionally. Or, she could even be used by someone who wanted to get at Eileen.”
A small bell sounded and the “up” button lit. Up was their only option. They were in the basement. They entered the elevator, silent during the one-story ride.
The lobby was vacant, with the exception of the receptionist, who was busy at her switchboard. The two men paused again.
“Let’s sit down for a moment,” Scott said.
Since no one else was in the lobby, the two men had a wide selection. They chose a two-person couch against the wall near the elevator.
“A group of us here at St. Vincent’s happen to appreciate what Eileen is trying to do,” Scott commenced. “We try as best we can to make it work—because of the way we feel about her. You’re going to be here only a few weeks. But in that time God knows what might happen.
“I used to read your stuff in the Detroit Catholic when you were editor. You struck me as the kind of person who would understand what Eileen is trying to do—that is, if you knew about it—as well as recognize some of the roadblocks along the way. So, for the duration of your stay in Father Thompson’s absence, and on behalf of those who are backing Sister Eileen—including Father Thompson—I guess I’m asking for your support.”
“Well, you have it. Very definitely. Just one question: How long do you think you all can hold things together?”
Scott ran a hand through his beard for a few moments. “Not long enough, I fear. Like all hospitals, the bottom line on St. Vincent’s is a deficit budget. The ledger for this hospital looks like a gigantic nosebleed. But for Eileen’s sake, we want it to last as long as it possibly can.
“Eileen is dedicated to serving the poor. And, inspired by her sacrifice, we join her. So we stay here as some sort of sign to whoever wants to recognize what we’re doing.
“Almost everyone else in the health care business is in it to make a living, if not a damn good profit, while we watch the money trickle away. It would be nice if someone bailed us out. But, then, there’s almost no way anyone could do that. Our deficit is a bottomless pit. So we say, ‘what the hell,’ and dive into the folly that is Christianity.” Scott paused and looked significantly at Koesler. “With all of that, are you still with us?”
“Gladly. But you have given me lots to think about.” He smiled. “I’ll see you tomorrow.”
They parted. After hanging his chaplain’s uniform in the closet of the pastoral care department, Koesler made his way to his car in the nearby parking lot. All the way back to his parish, St. Anselm’s in Dearborn Heights, he continued to ponder all that Dr. Scott had told him.
Without doubt, there was more to St. Vincent’s Hospital than met the casual eye. He would have to be alert to every nuance, especially those that affected Sister Eileen or her program.
At St. Anselm’s, he checked the desk in his office. There were only a few phone calls to be returned. He could do that in the morning.
* * *
I wonder what it will be like to kill a nun. Why should it be any different from killing anyone else? Is there some circle in hell reserved for murderers of nuns?
The whole business is ludicrous. I would laugh if I could. But I cannot. The pain—the pain in my head is killing me. It feels as if the top of my head is about to blow apart.
It is not as though death is foreign to this place. A hospital almost 150 years old! Thousands of people have died here. What is one more!
The good nun’s soul would be assumed into heaven. Why not? She probably is not aware that she is torturing me. That she is twisting a band of stress ever tighter until my head is ready to explode! The hounds of hell are screaming in my brain!
Will no one rid me of this troublesome nun? No one? No one! Then I must do it myself.
She must die. And I must do it. At the right moment. But soon—it must be soon!
* * *
The expression “As different as the night the day” could not find a truer embodiment than in a hospital. St. Vincent’s was no exception. Nor was there any doubt that schedules were established for the convenience of hospital personnel.
Day began when the day staff arrived at approximately 6:00 a.m. Day began slowly. Both staff and patients were trying to wake up. Patients’ conditions were checked. Cheery words spoken. Grunts returned. Sponge baths given. Medications administered. The action and commotion intensified as the day progressed.
Some patients did nothing; some were healing, some dying. Some were wheeled down to surgery. Some to therapy. Some to postoperative intensive care. Some returned to their rooms. Some received visitors. Some, if they could afford the rental, watched the mindless games and soaps of daytime commercial TV. Some who could not afford it watched one of the two “free” channels. One of these showed ancient slapstick movies. The other was the chapel channel, which, most of the time, showed a large, empty ornate chapel. Patients were fed three meals a day plus an evening snack, according to doctors’ orders.
A kind of climax was reached in late afternoon. After which came a gradual decrescendo.
Dinner was followed by prime-time TV and/or visitors. At 8:00 p.m., visiting hours ended and night prayers were broadcast.
Most employees had gone home, thus the hospital tempo slowed. There was a last-ditch effort to supply patient needs. After 10:00 p.m., in effect, the patients would not be needed until morning.
It was now just a few minutes after ten. All corridor overhead lights were off. Floor-level night-lights gave only scant illumination to hallways.
George Snell, a burly security guard, was on duty.
There was no reason anyone should have rested easily on that account. Though widely recognized for his prowess as
a ladies’ man, George was by no means the most reliable member of a security force that was hardly topflight. It was, when all was said and done, the best security service St. Vincent’s could afford.
George, supported by both arms, was leaning against a wall on floor 3-D. Between him and the wall was a nurse’s aide, also theoretically, on duty, but who George knew could be talked into a short break.
“How about it, baby? How’s about a little?”
“I’ll say this for you, George,” replied the virtually imprisoned aide, “you sure have a way about you.”
“Yeah.”
“Why, you could charm a girl right out of her better judgment.”
“That’s the idea.”
“I know what the idea is, George. But we are on duty.”
“Duty, rootie. Everybody’s asleep.”
“No, they’re not, George. And if one of them rings that little bell at the nurses’ station, the charge nurse is gonna start wonderin’ where I am.”
“Don’t worry, baby, I’ll cover for you.” He winked elaborately.
“And you’re supposed to be on duty, too. What if something happens?”
“What’s gonna happen at old St. Vinnie’s? The hospital’s asleep and this end of downtown’s deserted. We’re the only ones awake.” He leaned closer.
“Well . . .” she vacillated, “where can we go?”
“I got that all figured out, baby. Room 3009 is a single and it’s vacant.”
“A single! For you? And me, too?”
“We will be as one.”
“A pretty big one.”
“Baby, we can stand here and talk about it all night. Or we can get it on.”
“Okay. But I got a hunch we’re gonna be sorry.”
“Baby, one thing I can promise you, you ain’t gonna be sorry.”
They made their way, she leading, down the hall to 3009. As she entered the room, she heard a dull plop behind her. She couldn’t believe her eyes. His clothing was in a heap on the floor. He must’ve been loosening everything on their way down the hall. If it were an Olympic event, George would win a gold medal for disrobing.
So there it was.
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