He straggled back to Reuben’s now empty flat. The bed and furniture were still there and the electric was still running, which he had intended to shut off just before he left. But the walls were bare, and the stereo and TV were gone, and his footsteps echoed unnervingly. He collapsed on the bed, with Tobi’s face hovering in front of him. The coffee rush was gone and he was crashing. He pulled out his phone again and opened Messenger. No answer. Of course, she wasn’t going to make this easy.
Tobi,
Please.
I need to talk to you. It’s urgent.
T
He plugged the phone in to charge at the bedside and succumbed to a deep but troubled sleep.
Chapter 26
The long shift was almost over. Rikard was in room four, a pleasant gentleman with a French accent who looked absolutely miserable. His face was drawn, his hair was squashed flat on his head, and his skin was clammy. The flu test was on the counter where Marta had run it, and the small red “positive” line was visible across the room. Both Suleman and Tobi went in with their face masks on, and Tobi introduced them both as they walked in.
“When did you start to feel sick?” she asked the patient.
“Four days ago, but it got much worse on the plane. I just came back from Vancouver. My wife wanted me to get checked when I land, and if I have the flu, she told me not to come home. I can stay in a hotel. She doesn’t want me to get her or our kids sick.”
“How old are your children?”
“Ten and eight,” he answered. “It’s okay, I don’t mind. How long do you think I’ll be contagious? Do I need to burn my clothes, or leave them outside, or anything like that?”
“That’s pretty harsh,” Tobi chuckled. “Are your children healthy?”
“Oh, yes,” Rikard answered, “thank God.”
“The teachers have been coming in telling me half their classes are out with flu, so your kids can pick it up at school, even if you don’t go near them. At this stage, this could run another five or six days.”
Tobi hesitated. “I don’t want to get involved in your marriage, but a hotel sounds pretty drastic. It’s flu, not plague. Is there a room in your house where you can just sort of quarantine yourself? If your family gets sick, they can come in immediately for the flu antiviral, and you can just throw your clothes in the wash.”
“I have an office downstairs, with a couch.”
“Perfect. Just wash your hands frequently, clean the surfaces with disinfectant, like Lysol, and cover your mouth when you cough. It’s airborne, so take a mask with you, if you want.”
Tobi asked Suleman to send a nasal spray and a cough medicine for the patient. As he was getting ready to go, Rikard brought up a question.
“So, I am curious. What is your personal position on who to vaccinate? In France, we say the young, the old, and the sick, but here in America, it seems everyone is supposed to get the flu shot—even though it doesn’t seem to be working. Should my children get this vaccine that is not working? Did you get the vaccine? Please, tell me honestly, what do you think?”
Tobi shifted uncomfortably on her feet. “Ah, umm … you’re right. It hasn’t been very effective again this year, so I understand why people are reluctant to get it. And I think that makes the whole practice of immunization confusing to the public. Because people don’t understand that the influenza vaccine is unique; they assume other inoculations will have the same potential lack of effectiveness. But the flu vaccine is fundamentally different from most others, and is much harder to produce, because there are so many different strains of flu. It has to be reinvented every year by guessing which strain will be most prevalent by the time it’s ready for distribution. We don’t have a universal influenza vaccine.”
Tobi did not add that the vaccine had seemed to be more effective in the years before it was made mandatory for health care workers and teachers, and the pharmaceutical companies had a guaranteed market. This was one reason she thought the public was becoming increasingly resistant to immunization in general. The flu shot was now obligatory in so many environments, and when people saw it wasn’t working, they assumed the MMR, (measles, mumps, rubella), would be ineffective as well.
“You have vaccinated your kids for measles, tetanus, and polio, right?” Tobi asked him.
“I think so,” Rikard said. “My wife takes care of most of that stuff.”
“Good, because not getting those vaccines is dangerous and constitutes neglect. Seriously. Those viruses are stable organisms for which we have had excellent vaccines with close to a hundred percent effectiveness for decades, and with virtually no risks. But if you’re not vaccinated and you contract them, they’ll make you much sicker and are more likely to be fatal or leave permanent defects. We are seeing a huge resurgence of measles now, which is killing people unnecessarily, when we had essentially eliminated it entirely from the United States. I hope we don’t start seeing polio and tetanus too, although a couple of years ago, there was a tragic case of tetanus in a little boy who spent months in the hospital; his parents still didn’t immunize him after that. I believe in individual autonomy, but I feel like that was a case for social services to step in. It’s like we’re going back to the Dark Ages.”
“I thought you could get autism from vaccines.”
“Many, many studies have been done, and there is no link between vaccinations and autism,” Tobi said.
“Not even from the flu vaccine? Can my children get autism from that one?” Rikard asked.
“No, not autism—or any other horrible disease,” Tobi said. “But as for still getting the flu, I’ve certainly seen a large number of pretty sick flu patients who were vaccinated. But I’m not going to advise anyone who wants the influenza vaccine not to get it.” She raised her hands helplessly.
He laughed. “Right, this is America, after all. You have to be careful what you say. In France, we don’t sue each other like you people do. I understand.” He was smiling for the first time during the visit.
“I’m going to France,” Tobi said under her breath.
“You are going to France? When are you going?” Rikard became suddenly animated.
“No, no,” she laughed, “I’d like to, though.” How wonderful it would be to practice medicine without litigation worries, and in a place where pharmaceutical companies were not allowed to advertise and manipulate the public with terror tactics. Rikard’s wife, however, was obviously already indoctrinated into the American way.
Randall was the last patient. He complained of having a sinus infection for the last three days and said he got them five or six times a year. He usually went to his primary doctor, who always gave him prednisone and clindamycin, a steroid and a powerful antibiotic, but his doctor hadn’t been in today. He had chills and sweats, sinus pressure and a slight cough. His temperature was 101. His nose was dripping and he looked tired. He adamantly refused the flu test.
“I have never had the flu, and I will never get the flu,” Randall told Tobi. “I have a sinus infection, like I always get. I came here for my antibiotics and my steroids. That’s what I want.”
“The flu does cause a miserable infection in your sinuses,” Tobi said, “but antibiotics don’t treat this kind of sinus infection, they only treat those caused by bacteria. I can give you some medicine to help you feel better,” Tobi said.
“I know what I have, I am thirty-six years old and I know my body. I want my clindamycin and prednisone. Now.”
Tobi was not in the mood to argue, but giving him those two medications could cause harm. “Randall,” she tried again, “all of your symptoms are classic signs of influenza, and we are in the middle of huge epidemic. Antibiotics do nothing against the flu virus, and the steroids can actually weaken your immune system right now and make you worse. I would only use them if you were wheezing or having trouble breathing.”
“I realize that is y
our opinion,” Randall said condescendingly. “But I didn’t come here for your opinion, I came here for my medicine. Now, please send it to the pharmacy for me. I need clindamycin, 300 milligrams four times a day for ten days, and prednisone three times a day for three days.”
“I’m sorry?” Tobi was speechless for a minute. “Actually, Randall, my opinion is exactly what you get when you come here. That’s kind of assumed when you register. I’m sorry, we aren’t a retail store, I have to do what I believe is the right thing. Those are the terms of my medical license.”
“Well, I can see you aren’t going to help me here.” Randall marched out of the office.
“Wow!” Marta said. “What a jerk! Proper medical care is what we ‘sell’ here, Bozo.”
They closed up the office and Tobi went out into the cold night to her car. Another zero. And if Randall complained, she’d be called to task by Ismar for not keeping him “happy,” but she was too weary to care. Her breath was frosty in front of her as she walked, and the hairs on the back of her neck stood up. She felt a chill that was distinctly different from the wintery air, almost like she was being watched, and she wondered if the angry Randall were hovering about somewhere. She jumped at the sound of an engine starting across the parking lot and peered into the darkness, glancing behind her constantly until she was locked safely inside in her car. She wasn’t usually one to spook easily, but it felt like something was just wrong, and she couldn’t put her finger on it. Well, she thought, I felt that way for years after Reuben died and it was just me being ridiculous.
Chapter 27
It was only a fifteen minute drive home, which was one reason Tobi had stayed at B. Healthy, but on the way, she called the medical director, Dr. Chagall. She needed to start sticking up for herself.
“Hi, Steve. Do you have a couple of minutes?”
“Actually, I was going to call you. You first.”
“Okay. I had a meeting with Rufini and Molly today. Should I be looking for another job?”
“No, why would you ask that?”
“Rufini comes in frequently to tell me I’m the slowest provider in the region, and today the two of them came in and berated me for not seeing patients fast enough and not giving antibiotics for viral infections. And, he asked me if I’m ‘happy’ here at B. Healthy. You yourself sent out the blurbs citing the CDC recommendations for the use of antibiotics. And I’m not leaving the side of a critical patient to see a case of strep exposure, no symptoms. I’ll quit first.”
“Tobi, your medical practice is par excellence, no one wants you to change that, don’t worry. They just want to see faster turnover, but not if it puts someone at risk.”
“Steve, you know we never get staffed appropriately, and even if it’s on the schedule, Evelyn changes the schedule last minute, not generally for our benefit, and doesn’t update it. So, what would you think if someone told you they wanted to make sure you were feeling ‘happy’ in your life and maybe this place wasn’t doing it for you?”
“I think I would feel exactly the same way. I haven’t heard anything about this, but I assure you, I want you to continue here for as long as you choose. I’ll speak to Rufini about it. Are you doing okay with the news of Tim Meloncamp?”
“And that’s the other thing—they avoided that topic completely. Pretty callous of them, I think.” Tobi sighed. “I heard about him from Ellie Milton, and it was kind of a shock. I mean, I didn’t know him, but it kind of shakes the ground a little. I hope he didn’t do it because of the corporate working conditions. I mean, I get it, but—quit, don’t kill yourself. Does he have family?”
“He’s married, no kids. Lots of loans. He’s a sensitive sort. There had to be more going on, but the B. Healthy environment didn’t help, I’m sure. He’ll be in rehab for months. He has a right-sided hemiparesis and a slight aphasia.”
“Poor guy. Guess he’s left-handed,” Tobi said.
“Yeah, guess so. If you’re feeling like you need to talk, you know you can call me. We’re working on setting up a buddy chat, maybe five providers to a group, so it’s a little more personal. Just so people can vent. We’re getting some push back from corporate on it, though.”
“Of course, they won’t want us bonding over poor working conditions, but it’s a great idea. You know, it gets lonely in the office without another colleague to bounce things off of.”
“That’s the idea,” Steve said. “Clinicians need more community. And hopefully, we’ll pass out some material on things to look for and what to do if you think someone is heading for a break.”
“Thanks, Steve. Is that what you wanted to talk to me about?”
“In part, but there’s something else. You know we have alerts that go off when you access someone’s chart that you have no direct business in, and lately, you’ve been snooping in a love of charts of patients who aren’t yours.”
“Oh, yeah, sorry. I sent some Tamiflu over for Ellie a couple of weeks ago. You know, we can’t do it over the phone in New York State anymore, it all has to be electronic.”
“I’m not talking about that,” Steve said. “You’ve been peeking in a slew of charts over the last couple of months.”
“I don’t know what you’re talking about. My current patient load is quite enough for me,” Tobi laughed.
“Tobi, this is serious, it’s a breach of privacy and a huge HIPAA violation. Everything you do on your login traces back to you, you know.”
Tobi was floored. “Steve, I haven’t been snooping. Really. I have no idea what you’re talking about. I mean, sometimes I’ll look in a chart if a PA calls with a question about a patient, but other than that, no, I never do that.”
“Okay, maybe that’s it. But you and a few other docs have been lighting up frequently. I’ll check it out with IT.”
“But, you know ...” Tobi hedged. “I think Ismar took my tablet last week while I was still signed in.”
“Why would he do that?”
“I have no idea. I didn’t actually see him do it, but Jorge did. I do know that my tablet was switched.”
“That doesn’t make any sense, Tobi, why would he use your login? Listen it’s nothing official yet, but it looks like we’ve been given the go ahead to affiliate with Hospitals for Health. We’re just cinching up the contract, and this kind of thing will never fly with them. They’re very scrupulous.”
“Is that why we’ve been getting so many phishing warnings and the security on the tablets has been upgraded? It times out, like, every three minutes.”
“Four minutes, and yes, so we have changed our whole firewall. There were too many holes for H for H’s comfort. We actually started that a couple of months ago in anticipation.”
“That’s fabulous news. Maybe they will be more focused on good medicine and healthy outcomes than on profit and popularity.”
“That’s the hope. Keep the faith, Tobi.”
The guard at the gatehouse smiled and waved her through, and Tobi pulled into her driveway. But as she got out of her car, she instantly felt the foreboding again. She told herself she was crazy, but stared up and down her street, nevertheless, trying to probe through the darkness behind every tree. She suddenly wished Pantelaymin were a German shepherd. She walked into her house and turned the deadbolt as Facebook Messenger pinged again on her phone.
Tobi,
Please.
I need to talk to you. It’s urgent.
T
Like hell, Tobi thought. I needed to talk to you, you bastard. When Reuben died, when mom died, when Ben cried for weeks over losing you, and then when he graduated high school, and college … I needed to talk to you when the sunset was gorgeous and sparkled perfectly on the surf on Fire Island, and I needed to talk to you when I was at Zion National Park and when I stood on top of the mountain at the Canyons in Park City, and I needed to talk to you when my boss was being a dick … y
eah, I needed to talk to you too, Troy. Go fly.
Ellie called as soon as Tobi was inside.
“Hey, so I worked on the south shore today with Monica, and she told me something very interesting. Rufini locked himself in the breakroom for a half an hour the other day, and they could hear him arguing on the phone. When he came out, they said he was sweating like crazy and wouldn’t even look at anyone; he just left.”
“Ismar always sweats, he’s fat. What was the argument about?” Tobi asked.
“Not sure, the first time it was in another language no one could figure out, so probably Turkish.” Tobi had an image of the south clinic’s staff lined up against a closed door trying to listen, like an old Jackie Gleason episode.
“But then, he was speaking English and it sounded like he was talking to a bank or something,” Ellie continued. “Is he being foreclosed on? He’s got that huge house up on Centre Island. It’s gotta be over a couple mil, how does he pay for that? She heard him saying, like, ‘I’ll get it to you by next week’ and ‘please don’t do that,’ and stuff like that, and she said he sounded desperate. And Monica also heard he was mixed up with some very bad people in Turkey and came here to get away from them. He might even have had a different family that he abandoned when he came here.”
“Where do you hear these things, Ellie?” Tobi wasn’t in the mood for made-up drama, she had enough of her own right then. And she hated drama.
“Monica knows Rufini’s wife’s cousin, who’s good friends with Monica’s brother. Rufini got into it with his wife last week and I guess something slipped out in the argument. Now she’s pissed that he was already married in another country and didn’t tell her, and she thinks he only married her for citizenship.”
“Well, that wouldn’t surprise me. But this is a case of ‘he said-she said’ and mostly in another language that nobody who was listening can speak, so it’s hard to take it too seriously.”
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