Code Blue

by Debra E Blaine

  In his thoughts, Troy still heard Marcus telling him about “this guy” who wanted to help him find Robain’s family, even though the guy seemed like an unlikely sort to be obliging. And then Marcus had been killed. So, what did that mean? Had the guy found out that Robain was Reuben? Had he found Tobi too?

  Troy was beside himself by the time the inspector came back, but Bent just nodded to him. “Your story checks out. But there’s one more thing, Mr. DeJacob.”

  “Yes?”

  Bent still had Troy’s cell in his hand, and he raised it emphatically. “We haven’t been able to find a thing on Robain Sacks prior to seventeen years ago. How long did you know him?”

  CHAPTER 19

  Tobi called Ellie on the way home. “Did you know we’re losing Jorge?” she asked.

  “Oh, yeah, I kinda did, but I didn’t know it was for sure yet. When is he going? I heard the Queens position is opening up next week. Another rad tech quit.”

  “Another one? Geez … well, Jorge’s not taking it. Crystal Clear Radiology got him instead.” Tobi wondered why she always seemed to be the last to know these things. “You could’ve told me. Esther apparently knew too. I’m happy for him, but I’m really sad for us.”

  “I know, he’s so good, right? And if Janie quits, we’ll have no regular RT. Hey, I heard a rumor we will be merging with Hospitals for Health. That’s where Dr. Comet went, isn’t it? Do you know anything about that?” Ellie asked.

  “Yes, he mentioned it, but nothing is certain yet. B. Healthy would have to relinquish some control, but then they’d get the backing of a huge hospital system.” Tobi was gratified that she actually knew something Ellie didn’t.

  “Yeah, well maybe they’ll start considering the patients instead of only their wallets.” Ellie suddenly lowered her voice to a whisper. “Hey, did you hear about Dr. Meloncamp, from the Manhattan region? I heard he tried to kill himself! His wife found him with a bullet in his head, and he’s at Mount Sinai Hospital. Looks like he’s going to survive, but they don’t know what the residual effects will be.”

  “What?” Tobi felt her stomach flip over. Medicine was becoming a profession with one of the highest suicide rates in the country, and it was pretty scary, but this was the closest it had ever come to her own sphere.

  “Yeah, I overheard Dr. Richmond, the lead physician for the Manhattan region, talking about it. They’re trying to keep it quiet right now.”

  “Who is he? Did you ever meet him?”

  “No, but I heard he’s a really nice guy. Super smart, and very sweet. His site was known for patients complaining about stupid things. Rocco, the rad tech, used to work with him, and Dr. Meloncamp would get terrible scores from people because they didn’t think they should have to wait for their flu shot no matter how busy the office was, or they’d ask for levofloxacin for colds and he wouldn’t give it to them.”

  “Ugh, Levaquin?”

  “Yup, totally inappropriate. He’d say no, because it wasn’t the right thing to do, but then he would sulk over the scores. And his office was so busy, he couldn’t possibly get people in and out in forty-five minutes, they’d come in six or seven at a time. You know how it gets. And they give us such a skeleton staff. Half the offices don’t even have receptionists anymore.”

  “You think he tried to off himself because of his scores?” Tobi asked. “That’s so sad. Nothing like that is worth taking your life over. Does he have kids? Why are they trying to cover it up?”

  “I don’t know about kids. Dr. Richmond is a good guy; I don’t think he’s trying to cover it up, but maybe he wants to get all the facts first and I heard him talking about wanting to be able to offer some kind of counseling for the rest of us before making the news public.”

  Tobi whistled softly. “Yikes. We’re such a setup for depression, Ellie. Our population is in the top ten percent in intelligence––because how else could we get into med school? We were all motivated from the outset by compassion and altruism, to sacrifice seven to ten years of our lives after college to train to heal others … often starting our earning careers with a half a million dollars in debt … and for what? You know, I got screamed at last month for not forcibly repeating a rapid strep test on an eight-year-old kid who’d had a culture pending from the day before! The kid almost bit the mother’s hand off and broke the tongue depressor in his mouth. He could have choked on it, but the mother wrote it up on Facebook and sent an email to the company president, insisting I should have tried a third time––she couldn’t wait two days for the culture results that were cooking at the lab.”

  “Wow, I didn’t hear about that. What did Dr. Chagall say?”

  “He backed me up,” Tobi said, “agreed that someone was bound to have gotten hurt and it was ridiculous, since the results would be back in two days anyway. It still went all the way to our CEO and the legal team got involved. Ultimately, they dropped the case, but it took three weeks.

  “You know,” Tobi continued, “all our education and arduous training is now just so some vulture capitalist can tell us we have to become sycophants to the demands of entitled people who insist they know exactly what they need and that we must give it to them instantly—or they send nasty reviews and try to ruin us. Then they come back a few weeks later to be seen for something else! But B. Healthy is so afraid the bad press might lose them a ‘customer’ or two. Geez, those same patients will sue us if their inappropriate but desired treatment causes a bad outcome—like if the mother or kid had been injured.”

  “Of course, in a heartbeat,” Ellie agreed. “Your son is so lucky too, that you’re paying his tuition. I feel like I’ll be in debt until I’m fifty. And—don’t get me wrong—I love and respect most of our PAs, but it’s like even the hospitals don’t need physicians anymore. Our job can be done by ‘mid-levels’ who studied for one quarter of the time we did and have a fraction of the debt we have. Why did we even bother?”

  “That’s exactly why I’m committed to paying Ben’s way. So that if he decides when he’s forty years old that medicine is no longer worth practicing, he won’t be looking at a pile of debt and feel trapped into staying in something that’s toxic. There are more and more physicians looking for nonclinical careers now. I wonder if Dr. Meloncamp has looked at other options?”

  “If he hasn’t, he should,” Ellie said. “Monica and I were talking about getting together to do something nice for him and his wife. I don’t know what, just something to support them and tell them it’s okay, we understand and we love them.”

  “Please count me in. It could be we’re all just a shade away from throwing in the towel at times.”

  They hung up and Tobi came into the house, shaken and exhausted.

  Maybe it was time to rethink her own life. Was she close to doing something stupid and just not being honest with herself? She didn’t think so; right now, she was on a mission to get Ben through school without loans so he could start his life with a clean slate. But she was so tired when she got home, especially if it were after a few back to back twelve-hour shifts, that with the exception of her frequent chats with Ellie or Chloe, her life had become about going to work and going to sleep, and nothing more, and that first day off after a several-day run was mostly about recovery. She did make sure to always be off on Fridays to get to Shabbat services. It grounded her again and reminded her of what was really important in life, and she got to catch up with her synagogue friends. But otherwise, she often just felt like a hamster on a wheel.

  I really have to find time for me, she thought. Time just got away from her, and of late, it felt like she had lost touch with much of herself. The old Tobi would never have put up with this lack of authenticity in her life. She’d have been looking for another place to work long ago, even if that meant leaving medicine entirely. She just seemed to have gotten into a rut at B. Healthy.

  Reuben’s sudden death should have taught her it was best
to enjoy the moments at least, if not the days, because putting life off for later could be a big mistake. It was so challenging to put that into practice, though.

  Pantelaymin pushed her knitted green and purple ball over to Tobi and looked up with impish eyes. The cat really was such a gentle soul. Tobi had rescued her from the North Shore Animal League, a large no-kill shelter. So many of their animals had been through hell before they arrived there and were exceedingly grateful to go home to warm and loving families. PanniKat had only been there for twenty-four hours when Tobi found her, and the tiny kitten had been only five weeks old. Panni had no memory of hardship, so she was distinctly ungrateful, but she was still one of the least destructive or spiteful cats Tobi had ever met.

  Tobi had named her Pantelaymin after Lyra’s daemon familiar from Philip Pullman’s His Dark Materials. She loved the idea of a person’s inner self reflected externally as an ever-changing animal until puberty set in, and their personality was declared. She was pretty sure that if she had an extrinsic daemon, it would be a cat. And Panni really did seem to understand exactly what Tobi needed, and when.

  Tonight, they played ball until Tobi seemed to be the only one chasing it. She made herself a tomato, basil, and mozzarella sandwich on multigrain bread, and hit the bed fairly early, hoping for a better day tomorrow.

  Chapter 20

  Tobi was standing on a beach. There was a gentle breeze in the summer air and the sand, almost white, was soft and warm between her toes. The water was cool, a pure peacock blue, with white foam where the waves broke, and the air smelled like the sea. She felt motion, like she was being sucked into the sand and then onto the ocean, and for a moment she was sliding on top of the water, surfing without a surfboard.

  Waves began to crash behind her and she found herself under the bubbling water, its blue turning into blue-green with a hint of brown, hazel colored, deep and mysterious, alive and transcendent, warm and soft and fathomless. Like Troy’s eyes … and then it was Troy, in front of her, and she was drowning. Drowning in those eyes and drowning in love, and then drowning in pain and in loneliness.

  Tobi needed to surface to breathe, but everything was a blur and she didn’t know which way to swim. She felt the vertigo of being upside down and pain in her ears because she hadn’t equalized pressure, and she was being carried away in the flow of the ocean. Suddenly there was a gun in her hand and she found herself trying to buck the current and point it at herself, but she did not know why. Troy grabbed her hand and the gun fell away, sinking into the depths of the water. He leaned over to kiss her, and as his lips touched hers, she inhaled his breath and found a regulator in her mouth, which hissed as she breathed. She extended her head back and it hit the top of a scuba tank, which was strapped on too loosely, as if by afterthought.

  She heard Troy whisper in her ear, and it was clear as crystal under the water. “Don’t worry, I’m right here. I’ll always be here with you.”

  He showed her the depth gauge from behind her back, and it read forty-three feet. He wasn’t wearing any gear, his long, golden hair was undulating in waves above his head, he breathed easily in the water without a mask or a tank, and he hung suspended in front of her without any effort or equipment. Troy’s body had not aged in nineteen years, and she was mesmerized by him, recalling every line and angle of his silhouette. Like a magnet, she was drawn to touch him. He was so intensely familiar, so full of confidence, tranquility, and passion all at once. And then, suddenly, he was gone, Tobi’s regulator dissolved into sand, and she was gasping for breath and thrashing in her panic, trying to figure out which way was up.

  Tobi grasped behind her for the back-up regulator, vaguely wondering why she was not wearing a buoyancy compensator at this depth, and managed to blow the water out first with the last of her strength. She sucked in a long, wheezy breath, and then another. She reached out with both hands for Troy, her teeth clamped too hard on the rubber bite plate so that her jaws hurt, feeling her continued descent by the searing pain in her ears—she must have ruptured her ear drums—and the water darkened around her until all color and light were lost and nothing was discernible.

  Too late, she realized she was wearing a weight belt. The belt would not release, and she gave up, stretching her arms out in all directions, twisting her body and searching everywhere for Troy’s eyes again, but all she saw was the blackness of the water as she sank further into the murk. “No!” she tried to scream, “come back!” The bubbles traveled sideways toward the surface and she knew abruptly which way to go, but her legs were tangled in reeds and she could not kick.

  Tobi woke with a start to Pantelaymin sniffing at her face. She was drenched in sweat and shivering, and her heart was racing. Her eyes burned and were swollen nearly shut from crying. It was easier to keep them closed, but she was afraid the dream would return. Panni put a soft paw on Tobi’s cheek and licked the tears from her face.

  Chapter 21

  Ismar sat in his study and stared at the encrypted message, sweat beading on his brow. Jennie had sent a couple of gyros upstairs with his favorite tzatziki sauce, but reading the memo had made him too nauseated to eat for once. These people are crazy, he thought. He had agreed to do one simple job, to use their program to sift through charts and give them information on patients with specific diagnoses. It was tricky enough even with the software they’d provided, since he had to hide his tracks while breaking HIPAA policy, but now they wanted him to get dirt on the doctors too? Whatever were they doing with all this, anyway, and why did they care if Lister had a brother? And when would his debt be paid?

  Maybe he had focused overmuch on Lister since she wrote comprehensive notes and was fertile ground for his phishing, but now they wanted him to get her personal history as well? Her thoroughness could be costing B. Healthy money in lower volume and turnover, but the Project wouldn’t care at all about that. Molly Baker had been riding Ismar because his sector did not produce as much revenue as some of the others, so he was making it a habit to criticize any of the providers who were slow, but it was a constant juggling act. He needed them to be slow and comprehensive for the Project, but he also needed them to be fast and efficient for B. Healthy. There were ten sites in his region, and he was having trouble living up to B. Healthy standards for speed, though he was collecting good fodder for the Russians to use. Why were they so fixated on Lister? She happened to have a very high percentage of repeat customers, which was good for business but bad for the Project. The better she knew a patient, the less she wrote in the chart, because it was already in her head.

  He supposed he could try to engage her in conversation about both her family and the patients she knew, but he doubted she would give him any specifics. And at the end of the day, Ismar put his trust in the whip over the sugar cube. Whipping Lister to make her faster seemed to be exactly what his American employers found productive, so what would she think if he was suddenly nice to her? But now his Russian “friends” were coming to New York? This could not be good for him.

  He groaned and turned his attention to his gyros. He guessed he could eat after all.

  CHAPTER 22

  I hate Mondays, Tobi thought, as she pulled into the parking lot at ten to eight. The flu was at its height, and their average this month was forty-five patients a day, for both eight- and twelve-hour shifts.

  Her phone pinged with a notification from her work email. Her Press Ganey score was being reported. She glanced at it with foreboding and saw the zero from a patient who claimed Tobi “needed more training because she upset her five-year-old daughter and could not get a simple throat culture.” That would be the exorcist girl, Jillian. That was the only little girl with issues she’d seen in the last couple of weeks. Perfect. There was also an unhappy patient who was not feeling better after forty-eight hours and angry he was not given an antibiotic “like he knew he needed.” Tobi always made it a point to tell her patients that colds last about a week, but it seemed t
o fall mostly on deaf ears. Was this the kind of thing that got to Meloncamp, she wondered? You work your butt off at an insane pace and then the Press Ganey comes up with a seventy.

  Doctors are, by definition, overachievers. Giving them a consistent seventy percent is like someone whispering in their ears on a regular basis, “You are a failure.” And B. Healthy insisted on eighty-five and above, or the quarterly incentive checks would shrink. Maybe it was just an excuse not to bonus their employees, but some were bound to break under the incessant criticism. Tobi was starting to think that anyone who was getting a consistent ninety and above on their scores was probably not practicing good evidence-based medicine.

  Her crew today was Marta and Connor. Connor was full-time on the south shore and he was filling in for Jorge. Patty had taken off, and apparently, since Connor knew how to register patients himself, someone figured the clinic could do without a receptionist for the day. He also had the unfortunate reputation for being rather lazy, either not wanting to get up from the front desk except to shoot films, or hanging out in the x-ray room for extended periods of time, even after the studies were long completed. The schedule was patchy for a lot of sites now; many of Tobi’s shifts this month were not covered with x-ray techs, even though Jorge had given three weeks’ notice. She was going to miss him dearly.

  Of course, lack of proper coverage impacted their customer satisfaction scores too. She wondered if corporate would stop pressuring the providers for a while since Meloncamp was still in the hospital. There had been an email that went out from Steve Chagall and Joshua Richmond, offering support to anyone who needed to talk, so perhaps they’d have a week or two of respite, but it wouldn’t last. How could it? They had to pay the board and their corporate salaries. Neither Tobi nor Ellie could figure out how they were supposed to manage high speed and high Press Ganey scores when they were shorted staff. It felt like the Egyptians telling the Hebrews to make brick without straw.