“Maybe,” Tobi said. “It should only happen. Not a buy out, but they’re talking about a merger with Hospitals for Health. B. Healthy wants to use their name to back our services. Maybe things will improve if that happens. H for H is a monstrosity, but so far, anyway, it’s owned and run by physicians, and they still hold quality of care as a priority.”
“Hey,” Esther said, “have you worked with Dr. Rufini lately? I filled in last week in the south shore office, and everyone is talking about him.”
“He hasn’t been here much, thankfully, and definitely not to see patients,” Tobi said. “What are they saying?”
“That he’s been acting peculiar. He hangs out in that office a lot, usually behind a closed door, and sometimes they hear him on the phone, yelling. Friday, he took Monica’s tablet and said he’d made a mistake, but he wouldn’t give it back. He told her to get another one and he would log her out.”
“Was Monica okay with that?”
“She was ticked off, but she said she hadn’t opened her email, so she didn’t care.”
“What about EveryScripts?” Tobi asked.
“Probably already timed her out.”
The doors unlocked, and several patients walked in.
Byron was the first patient of the day.
“Good morning, my name is Dr. Lister. I hope you don’t mind the mask. I’m wearing it with everyone now.”
“No,” Byron said, “not at all. You should wear it. I’m at death’s door!”
“Oh, I’m so sorry. What’s wrong?”
“It’s this sinus infection. It started yesterday and is just getting steadily worse. I took Nyquil last night, and I’m a little better, but it won’t go away. No, no fever. And I’m not achy; I don’t think I have the flu.”
She ended up treating him with just a nasal spray, and he seemed satisfied with that. I hope he never gets seriously ill, she thought. How would he manage?
There was a steady stream all day. Lunch was discussed, but never actually happened. By one-thirty, they were all getting hungry and a little irritable.
The office manager called. “Hi, Evelyn,” Esther said. “I’m fine, how are you?” A long minute passed, and Esther’s face darkened. “Well, I don’t know. We’re pretty busy here. We have three new patients who just arrived, and it’s been very steady. We’re up to twenty-three and it’s not even two o’clock. Can’t you find anyone else?” Another silence. “Well, Travis just brought back a fifty-three year old with chest pain, and she doesn’t look good. We need to do an EKG, and who knows what else. And then we have two more who need x-rays, so that takes Travis off the floor. It’s really not fair to leave us short-staffed, and it’s not safe for the patients! And then you want us to get people in and out quickly, right? That can’t happen if you’re always pulling staff away. How can you expect ….”
Esther stared at the phone, and then slammed it down. Tobi was shocked, Esther was always polite and soft-spoken.
“Evelyn wants me to go to the south shore office to help out. They’re even busier than we are, and she doesn’t have anyone else to send. Instead of hiring more staff, they just spread us around like peanut butter on toast.”
“Haven’t they been telling you guys for the last eight months that the shortage of staff problem is getting fixed?” Travis asked. “I’m glad this isn’t my main bread and butter.”
“Yeah, any week now.” Tobi looked at Esther. “It doesn’t matter, it’s not happening. I can’t spare you right now. Let’s get our chest pain patient into the cardiac room and taken care of first, and later I will call Evelyn and have a word. Would you get an EKG set up while I’m getting her history and doing an exam? Then Patty can call EMS while we start an IV. She’ll need oxygen, aspirin, and nitro spray.”
Tobi had lived the evolution of urgent care. When it had started thirty years ago, it was with sincere, caring physicians, who opened stand-alone minor emergency centers as an alternative to a standard private practice. In those days, they were staffed by doctors and nurses, receptionists, x-ray techs, and billers, much as one would expect, and there were very few around. Over time, and as insurance reimbursements across the field of medicine dropped, RNs gave way to LPNs and then finally to medical assistants, because they were cheaper, and the rad techs were given the dual role of either receptionist or medical assistant, because not every patient needed an x-ray so they had a lot of down time. Billing had mostly moved off site.
In many companies now, it was one provider (who could be a doctor, physician assistant, or nurse practitioner), a medical assistant, a rad tech, and a receptionist. Some models had a rad tech and an MA, with either of them doubling as receptionist, and in some ridiculous cases, it was just the provider and one other staff member. Some companies had started employing scribes to help the providers work faster, as it was certainly cheaper than hiring more clinicians. Most other companies added more support staff when their offices got busy, but B. Healthy couldn’t even staff the minimum, and would not schedule a regular second provider unless a site was averaging fifty-five or more patients per day.
Having limited support on such busy days was torture for the staff and annoying to the patients—to say nothing of being unsafe when there was an emergency. It was the more ironic, because Urgent Care was finally being recognized as a specialty of sorts, and the insurance companies had actually paid more in the last few years for urgent care visits than they had for primary care visits. Yet they operated with less than half the staff of a primary care office. It was getting harder and harder to find the human connection. Even the patients were left feeling swindled.
The woman with chest pain felt better after the nitro spray, and Tobi sent her out by ambulance on aspirin, oxygen, and an IV. Then she called Evelyn.
“Hi, Dr. Lister. How are you?”
“Hi, Evelyn. Esther has to stay here today. We are much too busy for you to leave me with just Travis and Patty. We just sent out a cardiac patient, and we have a full waiting room. You can’t leave us understaffed like that. It’s not fair to us and it’s not safe for the patients. I told her not to go.”
“Oh, isn’t Suleman with you today too?”
“No, Evelyn, he isn’t. And if he were, it would be more appropriate to utilize him as a scribe, not an MA.”
“Oh, I’m sorry. I thought you had him there. That’s fine then, she should stay.”
Tobi hung up and told Esther.
“But Dr. L., she makes the schedule! How does she not know?”
Patty came over. “She knew. She was just hoping no one would challenge her.”
Chapter 32
When Troy went back into Bent’s office, he was told the inspector was out of town for the next couple of days. He felt like he would burst with frustration. Bent did not seem to need him for any further questioning, so why had he asked him to stay? Although, it had hardly seemed like a request. He felt an enormous pressure to leave, despite his reticence to confront Tobi.
Troy resolved that as soon as Bent returned, he would ask if there was any new information, and state that he was taking his leave of Queensland. If Bent wanted to keep him, he would have to arrest him, and Troy knew there were no grounds for that; it would have happened already if there were. He went for his three-mile run on the beach, and then dipped into the crisp water to cool off and sat down on the sand to meditate. It had been a while, but it was a discipline he would never forget.
Troy had trained years ago on how to silence his thoughts and transcend his physicality, but he had not invoked this mind exercise at all in the last few weeks. It was like he had regressed to the time before he had learned to master himself, but he was ready to recover and prepare to leave.
Troy’s family roots were somewhat unusual. He was from an ancient line of Sephardic Jews who had fled to Italy during the Spanish Inquisition, and they were unique in that they had maintained the
Ladino language and culture while living alongside their Italian neighbors. Even after escaping to the United States at the onset of the Second World War, his parents had still spoken Ladino at home the way many Ashkenazi Jews spoke Yiddish, and Troy had never quite felt like he fit into American Jewish culture. His family customs differed from common Sephardi, as most Spanish Jews had emigrated further to the Middle East or south to Morocco centuries earlier, and the Ashkenazi from eastern Europe did not know what to do with him at all. Although he felt a deep connection to the God of Israel, he avoided synagogues and the conventional practice of religion.
Both of Troy’s parents had died during his junior year in college, in the Chicago Loop derailment in February of 1977. He had been an only child and always a bit of a loner. At the age of twenty, he had felt completely lost. He had one uncle, a successful attorney who had been struggling with lung cancer, and wasn’t expected to make it more than another few months. Uncle Franklin had told Troy to stay in school and that he would cover Troy’s tuition at Cornell University. While Troy studied geology and meteorology, Franklin sued the Chicago Transit Authority on Troy’s behalf, and eleven months later, Troy was awarded $3.1 million dollars. It was the day Franklin died.
Troy had graduated on paper, but skipped the ceremony. There was no one to come anyway. For a couple of years afterward, he traveled the world looking for—whatever he was looking for. He didn’t even know what that was. Eventually, he found himself in India and studied for sixteen months with the Dalai Lama, and finally he found peace.
In Tibet, Troy had connected with the Earth and the creatures upon her, and he found solace in his solitude. He was befriended by a stray, deaf, nine-year-old Rajapalayam dog that he named Raj. They were both lonely and aimless, adrift in a world that made no sense to them, but they learned to love and trust each other. Troy began to look at the world through the dog’s eyes, through a mind that could see, smell, taste, and feel but could not hear anything at all. He imagined what that must be like and experimented with how different the world seemed without sound. He plugged his ears with beeswax and looked at body language, and found it was often at odds with spoken words. He saw the butcher’s menacing movements toward the chicken, which were otherwise clouded by the man’s gentle, reassuring voice. Troy reached out with his other senses to connect with the essence of his environment and felt the vibration of the surf with his skin instead of hearing the waves with his ears, translating his surroundings without the audial cues that influenced how he would have otherwise interpreted what he saw.
There were definitely fewer distractions when he could not hear, and it had heightened his other sensibilities. He felt like he was able to grasp a truer nature of things. He began to fathom many lies in life, unpleasant truths that were obscured by clever discourse, and to see things as they really were.
When Raj died a year later, a part of Troy had wanted to die with him, but he felt he owed it to the dog to go on. Raj had had so little but had given him so much, that he wanted to help vulnerable animals everywhere. He was no longer satisfied living in his own head, and he left his inward search and turned outward to find ways to rescue defenseless, tortured creatures, and also to heal the Earth that sustained them all.
He started his foundation, Executors for Our Earth, and it had grown from an organization committed to animal rescue and protesting the deforestation of rain forests to a global agency that sponsored promising initiatives, like using compost such as orange peels to regenerate soil in burned out regions of the Amazon. Recently, they were examining unique rocks that absorbed carbon dioxide directly from the air, and the transplantation of alternative breeds of algae to revitalize coral reefs, like the Great Barrier Reef. The foundation had taken on its own life, and had many affluent contributors, under which it had prospered.
Troy was pleased with the pace of his accomplishments, recognizing the task he had undertaken was monumental, but he had grown restless with the paperwork, however digitized it had become. He was not a man to stay behind a desk, so after a couple of years, he had given over daily management responsibilities of the foundation to his oldest and most trusted friend, Mack Elberg. Mack had studied environmental science and later earned his MBA, so Troy felt free to travel and investigate novel ways to replenish the forests and the atmosphere that was being ravaged by greedy profiteers. It also allowed him to wander and enjoy firsthand the Earth that he loved so much.
It had been on one of those trips in August, 1996, that he met Tobi and Benny. Orcas were common sightings in Puget Sound, and when his travels landed him in the San Juan Islands, instead of taking the private charter he had been offered for free by a benefactor, he decided to join a small boat tour leaving from Washington State’s Friday Harbor on the Western Prince II, with no one he knew. He had recently ended yet another relationship and he wanted to be invisible. Just a guy, not the CEO of a huge save the Earth foundation. He could not seem to find anyone who understood him and his need for God and nature. Women seemed mostly interested in his checkbook.
He remembered the boat anchoring in the sound at the location of the last whale sightings, and the smell of brine and motor oil as the engine cut. He felt the cool breeze in the bright sunshine as he walked around the side of the boat, and that’s when he saw little Benny. The boy was barely three feet high and bursting with excitement.
“Look, Mommy, another one! And another one! And another one! Look, Mommy! Another BIG ONE! They are spy hopping, Mommy, all of them are coming to look at us!” Benny collided with Troy as he jumped up and down pointing at the whales.
“Benjamin! Be careful!” Tobi had said.
“It’s fine, no worries.” Troy smiled and turned to little Benjamin. “Pretty cool, huh?”
“Yes! The orca whales are talking and they tell each other where to find the humans. They come to see us!”
Tobi had laughed and said “it does indeed appear that way,” as more whales seemed to surface every few minutes. “Sorry about your foot,” she turned to look at Troy and their eyes met for the first time, and locked.
In retrospect, Troy had fallen in love with them both right then. The woman was kind, solitary, and sublime, and the boy was full of life and joy and newness. He chattered away to Troy ceaselessly for the whole trip.
“That is an orca whale,” Benjamin pointed. “They are also called killer whales. Did you know there are two kinds of whales? There are baleen whales that have no teeth and there are whales that do have teeth. Now, the orca whale has teeth and so does the sperm whale, but the humpback whale doesn’t have any teeth, and neither does the right whale.” He shook his head vehemently for emphasis. “And all the whales are mammals like us, none of them are fish, and the mommies take care of the babies.”
Troy was startled. “How old are you?”
“I am five years old.” He pushed his palm straight out in front of him with all five digits hyperextended.
The tour had gone by quickly with his little narrator, and Troy forgot all about his own loneliness. He was very aware of Tobi watching them together with amusement. She kept a distance and allowed her son to enjoy his adventure and his new audience, but was clearly ready to pounce if he were threatened in any way. When they got off the boat, he asked if he could buy them dinner. Tobi had stiffened immediately and started to decline, but she was no match for her son’s exuberant acceptance.
They talked for two hours over dinner in a little outdoor café about animals, endangered species, and the forces of nature, and by the time the check came, Troy knew he’d found two kindred spirits and his soulmate. Tobi insisted on paying for herself and Benny, and he let her—that time. He knew instinctively that if he pressed the issue, it would push her away. That in itself, separated her from the other women he had known.
He had almost stopped believing he would ever find another person who respected the vast energy of the universe, connected in some small way to the holy forc
es of nature as he did, and was open to novel ways of seeing the world. It felt like the three of them had been a family since the beginning of Time.
After dinner, Benny had quieted down and started to fade, looking like he had worn himself out, suddenly the five year old he professed to be. Until the waiter tripped over a napkin on the floor and the hot coffee he was carrying fell from his tray. The cup cracked and the coffee splashed onto Benny’s wrist. He wailed and ran into his mother’s arms.
Troy felt terrible and immediately offered to take them to the hospital. Tobi looked carefully at the small burn on her son’s wrist, and said it was okay, she’d take care of it, and asked the waiter for some ice. Troy protested he might need a doctor, but Tobi firmly declined. “I am a doctor,” she’d said.
She ultimately did give him her phone number, but Troy knew it was at least partly because she did not ever expect to hear from him. Three thousand miles was far away in her world, but for Troy, the distance had been nothing.
Troy settled into the Port Douglas sand, the memory of that day hovering behind his eyes. He let his muscles relax completely, feeling the pull of the Earth below and the surge of the surf beyond, and allowed himself to dissolve into the pulsations of the Coral Sea. He became one with the wind and the tide and let himself—whatever made him Troy—expand. He tapped the energy he felt and fed off it, welcoming in the raw power, emptying his mind and feeling the life force of the planet.
Why was it that he could attain such transcendence best when he was suffering and in pain? It seemed that only when his soul was broken, did life feel truly authentic.
Chapter 33
After EMS left, Tobi went in to see Jenna in room two, a self-pay patient who had been out of work for the last several months after a bicycle accident. She was a single parent and was unable to afford COBRA insurance anymore, so her kids were now covered on Healthy New York, but she had nothing for herself. She was there for bronchitis and was wheezing with every breath.
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