“As you know,” said Marshall, “Mercy is engaged in merger negotiations with Osteo and General.” Doug knew Lancaster Osteopathic Hospital and Lancaster General Hospital were Mercy’s chief competitors in the area. “The nuns are running scared. Sister believes that with the increasing market penetration of managed care in Central Pennsylvania, she needs to align or merge with someone to obtain sufficient bargaining clout.”
Doug was always irritated by the flip manner Marshall and his sidekick, Joe Raskin, would refer to the nuns. By Sister, Marshall meant the head administrator of Our Lady of Mercy Hospital where Keystone Anesthesia was based. She ran the Catholic hospital with the help of a cadre of nuns from the special order, the Sisters of Christian Benevolence.
Marshall continued. “She’s afraid that as a single entity, the large HMO’s and managed care corporations will dictate her fees and low ball her right out of business. She might be right.” He paused to clear his throat.
“Those fuckers!” exclaimed Raskin, who smacked his flattened palm on the wooden table. Doug turned and gave Raskin a hard stare. He had never cared much for Raskin. From the day they had met twelve years ago, Doug had quickly put Raskin in the major pain-in-the-butt category. Raskin was a contemporary of Marshall; the two of them had founded the anesthesia department at Mercy back in 1969. Doug knew Raskin could always be counted on to support Marshall’s point of view. However, Raskin rarely added anything of substance. Raskin caught Doug’s stare and returned it, eyes glowering. He then added sourly without dropping his eyes from Doug, “Pardon my French.”
“General’s better than Osteo,” said Omar Ayash in his Middle-Eastern accent. Ayash was also a member of the old guard. He had emigrated from Lebanon in the late sixties, and after bouncing around New York and Pennsylvania, wound up at Mercy in 1972. Doug was surprised to hear from Ayash; he was usually silent during these meetings.
“Not nearly so many AIDS cases or Lancaster knife and gun club members,” Ayash continued, referring to Osteo’s inner city location and the patient population this entailed. “Besides, half of Osteo’s patients are medical assistance. No money there.”
“Bryan,” said Doug, “a lot of the surgeons seem to think we’re going with General.”
“That’s what I heard as well,” added Mike. Doug turned to look at Mike. Something about him, his tone or expression wasn’t quite right, but he couldn’t put a finger on it. To the rest of the group, Mike probably appeared to be fully engaged in the discussion, but Doug sensed a preoccupation or a faraway look in his friend.
Bryan Marshall cleared his throat loudly in an effort to silence further interruptions. “Sister called me up to her office for a meeting this afternoon. That’s why this emergency session was necessary. I can shed some light on the merger talks but there’s been some, uh, new developments.” Marshall enunciated the word “developments” peculiarly, imparting an ominous tone. He paused for further emphasis, and a hushed silence fell over the room.
I can’t wait to hear this, thought Doug. These merger talks were unsettling enough. What now? Everyone leaned forward slightly in their seats.
“You’re right, Doug,” Marshall said. “Sister is favoring General. She likes the administrator over there. He’s willing to make concessions so she can preserve her autonomy at Mercy and keep her precious Catholic mission intact. And you all know bloody well what that means—no abortions or tubals.” Marshall hammered his fist down on the table as he said the word abortions.
“She’d flush this place down the fucking toilet,” said Raskin angrily, “and us with it before she’d back down on abortions!” His face turned red and Doug couldn’t help but wonder what his blood pressure was.
Doug fired another look of disgust at Raskin, but Raskin had his eyes on Marshall. Doug realized this was not the main point. He knew Sister’s feelings on abortion were non-negotiable, but it really didn’t matter. Assuming a merger did take place, all the abortions could easily be performed at the original institution. What else did Marshall have on his mind?
“Apparently,” Marshall continued, “Thompson’s been engaged in talks with Pinnacle.” He delivered the word “Pinnacle” as if he had lobbed a grenade into their midst. He stopped abruptly, as if he had no more to say—as if what he said was enough.
The silence was broken by a loud snort as Ken Danowski sneezed. Ken was one of the younger members of the group, seated to Mike’s left. “Sorry,” he said, although it came out muffled through his handkerchief.
“Oh shit! Pinnacle—that’s just great,” said Mike.
“The turd’s in the punch bowl now,” added Raskin profoundly, eyes sparkling.
Doug grimaced and figured this was what the emergency meeting was really all about—Pinnacle. The door opened, and Kim Burrows entered the room. She quickly headed for the empty chair next to Ken Danowski. Doug saw Kim and Ken exchanged meaningful glances. Doug knew they were the neophytes of the group and looked to each other for support.
“Nice of you to join us, Doctor Burrows,” Marshall growled sarcastically as he took a lingering look at his watch. “Even you might find this meeting important. We were just talking about Pinnacle Anesthesia.”
Kim took off her parka and slid into her seat. Her cheeks were bright red from the cold and almost matched the color of her lipstick. Doug thought she was an attractive woman, small and slim with fine features and short blond hair. She’d recently celebrated her thirty-second birthday and had been with Keystone for two years. “What’s Pinnacle Anesthesia?” she asked in a weak voice.
“You’ve never heard of Pinnacle?” Raskin asked, as if he couldn’t comprehend the fact that there was actually one person on the planet in the dark on this matter.
“No, should I have?” Kim answered defensively, her voice taking on a strident tone. She was unable to hold Raskin’s stare; she dropped her gaze and busied herself with her pen.
“They’re the bastards that come into a hospital and take over the anesthesia department,” Raskin explained with rancor. “They clean house and bring in their own people to run the fuckin’ place. Right, Bryan?” Raskin paused momentarily to get a confirmatory nod from his superior, and continued with renewed vigor. “They contract directly with the hospital to run the department for a fixed fee, and turn the billing over to the hospital. Administration goes ape-shit over that. They get the docs on salary, where they’ve always wanted ‘em, and have a chance to make a profit from the billing, too.”
“Joe’s right, Kim,” Doug said. “This is serious bad news for us.”
“But,” Kim said, “Joe mentioned profit. What does—how can they run this place any more efficiently than we do? We work sixty-plus hours per week!” Doug knew Kim despised their present work schedule. This time she gave Raskin a burning glare, which she didn’t drop.
“They bring in newly trained docs or docs with questionable histories who are willing to work for half of what we do,” Doug responded. “Remember Kim, the job situation out there is tight.”
“That’s the catch, Kim,” Mike went on. “The people they bring in are usually inferior or downright dangerous.”
“None of them are board-certified,” noted Raskin with pride. All of the Keystone group were board-certified except for Omar Ayash—three failed attempts at the written exam, and Kim Burrows—who had passed her writtens and would sit for her first oral exam in July.
“Don’t you think the surgeons would be outraged and rally behind us?” Kim asked.
Marshall’s head swiveled with surprising speed to lock his gaze on Kim. He cocked his head slightly, like a hawk evaluating his prey. A cruel smile materialized on his face. “Unlikely my dear girl. Do you really think so?” He wielded his vast experience like a mace and bludgeoned people for their naiveté. Of course, Doug knew, naiveté was defined as any opinion contrary to Marshall’s own. “The surgeons wouldn’t care if chimpanzees were providing the anesthesia, so long as their cases didn’t get held up!” Marshall didn’t bother to a
dd “You stupid bitch”, as it was clearly implied by his tone.
Doug hated when Marshall did this, and sadly it wasn’t all that rare. Doug occupied a strange place in the group. He knew he was sort of the middleman between the junior and senior partners. People on both sides came to him with their various gripes, and he took it on himself to be a kind of peacemaker—the glue that bound the group together. He didn’t particularly care for the role, especially when Marshall or Raskin started to run roughshod over the younger members.
Doug knew Kim was stung by Marshall’s response; he could see it in her face. He wanted to help her, but it was no fun sticking his head on the chopping block either. What was she thinking!? She knew the surgeons weren’t known for their loyalty to the anesthesiologists. Doug sighed and said, “However Bryan, the hospital does have a credentials committee that might make it tough to bring in poorly qualified people.”
“You’re missing the point, Landry!” Marshall boomed with exasperation, his head swiveling once again. “For Godsakes man, the credentials committee is made up mostly of surgeons. Plus, if the nuns smell money, they can bloody well railroad anyone through that blasted committee. You know that!”
Doug groaned inwardly. Nice job, Doug. He had succeeded in deflecting Marshall’s anger away from Kim all right, right onto himself. “Yeah, I guess so,” he said weakly. Doug decided to retreat a bit, lick his wounds, and consider the situation. Now was not the time to challenge Marshall directly. He needed to gather more information, plan his course of action.
Although Doug was not thrilled with the prospect of Pinnacle Anesthesia, he realized panicking was premature. Many factors would need to be decided before this was a done deal. The merger could collapse at any point. Pinnacle might well not be able to come to a suitable fee agreement with Mercy. Kim was right when she said that Keystone ran the place efficiently.
Second, even if Pinnacle did come in, they usually didn’t clean house as Raskin had suggested. Doug knew from several of his friends in other parts of the state that Pinnacle usually retained about half of the existing department, expelling the less desirables. However, the chief frequently got the axe, as they liked to bring in their own man to head the new group.
One reason Pinnacle kept on several former partners was specifically to address Kim’s concern. They didn’t want to stir up surgeon outrage; this was bad for business. They needed these people to provide continuity and smooth over the transition period. With passing time, however, the old members often found themselves becoming excess baggage as their usefulness faded and newer, cheaper labor became available.
The meeting droned on for another hour with the typical bickering, back-biting, and ass-kissing that Doug figured exemplified corporate meetings across the country; from the small town school board meetings held in cafeterias, to the elegant polished teak enclaves of General Motors, human nature remains remarkably constant, he thought. Nothing was really agreed upon or resolved, as was usually the case in these emergency sessions.
Doug believed this latest development could easily have been discussed next week at their regularly scheduled corporate meeting. But he knew Marshall liked to call these emergency meetings to demonstrate the central importance of work in one’s life. Besides, Doug thought, Marshall had little else to do. His children were all grown up, and his wife was frequently out of town on extended vacations. Marshall didn’t have any soccer teams to coach, baths to give, or homework to help with. He wouldn’t have the faintest concern for these anyway.
By the time the meeting broke up at 9:15, Doug was tired and anxious to go home. It had been a long day, and he knew he’d have to be in here bright and early the next day. He walked out of the building together with Mike Carlucci. The two men stopped at Mike’s Suburban.
“Well, what’d you think?” Doug asked. He spoke in a hushed tone as they both noticed Bryan Marshall and Joe Raskin engaged in a similar post-meeting chat at the far end of the parking lot.
“I dunno Doug—I wish we coulda waited ’til next week to discuss it. I mean he really doesn’t know anything yet.”
“Yeah, you’re right,” Doug said, shivering in the December wind. “Hey, wanna grab some coffee or dessert? It’s too cold to stand out here and talk.” Frequently, the two of them would stop somewhere after corporate meetings to conduct the post-mortem analysis.
“Not tonight, Doug. I gotta go home.”
Doug, for the second time in the evening, sensed a slight distance in Mike. “You OK Mike? You know, with your case and all?”
“Yeah, sure. I’m dealing with it.” Mike paused as a gust of wind roared by, rendering speech impossible. “Wonder how long it’ll take ’em to sue?”
“Not sure, Mike—you don’t know they will,” Doug offered limply. The two men stared past each other. There was an awkward silence as Doug struggled to find other words of comfort. He couldn’t.
“I’ll see you tomorrow, Doug,” Mike finally said with a pained expression. “Take care.”
“Yeah, you too.” They each headed for their vehicle. Doug realized that a lawsuit was virtually guaranteed and that they both knew it.
Doug paused at his truck, turned, and gazed up at the hospital. The wind bit into him, urging him to seek cover inside his truck, but he stood his ground. The hospital loomed dark and massive in front of him, blotting out half the night sky. The building, cloaked partly in shadows, was a Frankenstein patchwork of ill-fitting additions, and clashing architecture. Its jagged roofline was littered with microwave antennae, ductwork, and chimneys. A monstrous concrete parking garage, newly constructed, attached to the body proper via two enclosed aboveground walkways.
Doug wondered about the future of Mercy’s anesthesia department. Was it about to undergo radical surgery? Was the answer somehow linked to the department’s murky past? He realized he knew precious little about the department’s early years, and for the first time, it bothered him. Discussions of the past were conspicuously absent. Details about it were glossed over; direct questions rebuffed.
What were Marshall and Raskin talking about?
CHAPTER THREE
Bryan Marshall walked back into the building from the cold parking lot and headed to his office. He thought the meeting had gone about as well as could be expected, although he noted Carlucci wasn’t holding up well with the strain of his case.
He unlocked his office and stepped in. He knew it was late and he should be getting home but figured he had time for a quick look. He sat down at his desk and unlocked the bottom drawer. Toward the back, behind some files, was a metal box with another lock. Using the small key hung on the chain around his neck, he unlocked the box. Marshall pulled out a stack of photographs and riffled through them until he found the one he was looking for. The chosen photo was faded somewhat and looking a little worn, but he didn’t care.
“Karen, Karen,” he muttered to himself. He closed his eyes and leaned back in his chair, coaxing the old memory to life; it wasn’t the first time. He could see and hear her as plainly as if she were in the room.
“Stop that! What are you doing?” Karen McCarthy squirmed out of his embrace.
Marshall nodded slightly at her shrill tone; it definitely pleased him. “I’m just trying to gauge your interest in your current position, Miss McCarthy,” he said.
“What do you mean?” she asked flustered, as she backed toward the wall of the cramped office. Her elbow collided with one of the many framed diplomas covering the wall and sent it seesawing crazily on its mounting. Her face registered mostly surprise, but he believed he could detect a delicious hint of fear.
She eyed the door, as if calculating the distance, and then edged a few steps to her left toward it. Marshall didn’t pursue her, but was content to study her, aware vaguely of the heaviness of his breathing. She was such a small thing, and so young. Not much older than his daughter. He knew he could easily overpower her. He debated his course of action for a moment, but something about her eyes got to him. She had the lo
ok of a cornered animal; he thought she might scream at any moment. He realized he was going about this all wrong—this was virgin territory after all. Time for a new tack, he thought.
With effort, Marshall manufactured a gentle smile and slowed his breathing. “Look, Miss McCarthy. I’m sorry about the—ah, hug. It’s just my Old World upbringing.” He searched her delicate face and dazzling, light-green eyes. He thought he could see the panic recede a notch. He retreated behind the oak desk that consumed half the room and settled down in the leather chair, its wooden frame groaning beneath the load. The casters on his chair squealed as he rolled closer to the desk. He shuffled some papers, cleared his throat, and said, “Have a seat.” He gestured to the only other chair in the room.
“I’d prefer to stand,” she said, her face trying to manage defiance, but her voice wavering and barely audible.
“As you wish,” he said. “The reason I called you in early for this meeting is so we could discuss several things. You’ve been a student here six months now and it’s come to my attention that you’ve had some problems.” He looked up at her. She remained standing, staring at the newly carpeted floor. He cleared his throat again and continued. “The Department of Anesthesia is like a big family. The school of Nurse Anesthesia is part of that family. Your problems are our problems and vice versa.” He maintained his smile, trying hard to add warmth to it.
After slipping on his reading glasses, Marshall opened a folder on his desk and began leafing through papers slowly as if performing a distasteful task. “Hmmm, let’s see here,” he said sadly. “Failure to intubate the trachea, unrecognized esophageal intubation.” He paused and looked over his glasses at her. She didn’t meet his gaze. He continued, “Poor manual dexterity, technical skills below average, D on the pharmacology final.” He leaned back in his chair, shook his head wearily and sighed. “Karen, Karen—your evaluations say it all. What am I going to do with you?”
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