“I’m going to give you a breathing treatment to open up your lungs and then I’ll get you some medications to use at home. I’ll see if we have any samples of inhalers in the back,” Tobi said.
“No! I can’t afford anything more than the fee I already paid, please! That’s why I haven’t come in sooner,” she said. “The kids need boots and gloves, and I can’t waste money like that.”
Tobi was floored. “I think it’s only twenty-five bucks, let me check.”
“Twenty-five dollars is grocery money, you don’t understand. I already paid $110 to be seen and I have no more. But if you have some samples, I would very much appreciate that.”
Tobi stood frozen for a moment. Jenna’s oxygen saturation was only ninety-four percent. She was compensating for now based on her general good health, but that wouldn’t last.
“You know what? Just take the breathing treatment. I’ll ask the manager to waive the fee; if they won’t, I’ll pay for it myself.” She walked out of the office before Jenna could even respond.
Travis looked at her when she asked Esther to set up the nebulizer. “Will you get in trouble for that? She will get billed, you know.”
“Then I will pay for it. Geez, it’s twenty-five bucks. I spent more than that on dinner last Friday night. I can’t let her walk out of here like that. You know, it wasn’t that long ago that physicians routinely treated a certain percentage of patients as charity. We expected to. It’s only now that we have to answer to some corporate money monger who needs to pad his pockets with every possible dollar that we can’t make compassionate decisions on our own anymore.”
It took a half hour, but ultimately, Tobi got permission to waive the fee as a “one time courtesy.” It felt like a warning not to try this again, but at least she got that. Maybe she had shamed corporate by saying she had already started the treatment and would pay for it herself if need be. Geez, the medication in the nebulizer had to cost all of four or five dollars, maybe less, and the nebulizer itself had been paid for a hundred times over. It was less than $100 brand new.
Not to say that they should treat patients for free. Even before she worked in corporate medicine, Tobi had found that some people tended to think they were entitled to free care even at a private facility. Even when they had just dropped seventy-five bucks on a manicure, they’d come in complaining about their fifteen dollar copay. They did not recognize that there was significant overhead in running a practice. Staff salaries were the biggest payouts, and the reason B. Healthy operated so lean, and there was also the price of rent, utilities, medications, equipment, and supplies, not even mentioning malpractice insurance. All the costs of operating a business of any kind. Still, she should be able to make exceptions for hardship cases without feeling like she had just committed a crime. As Tobi had told the on-call manager she texted for permission, she had to be able to look at herself in the mirror at night. Even the manager did not have the authority to render a decision, although she was in favor, and had to run it by corporate first.
Jenna’s lungs were clear when she left, her oxygen saturation was up to one hundred percent, and Tobi had found a sample inhaler in the back closet to give her. Jenna was extremely grateful, and Tobi was sure the positive recommendations and repeat business she had just “produced” for B. Healthy would more than make up for the couple of bucks they’d lost. She congratulated herself for having gone over Evelyn’s head from the get-go. Tobi was sure she would have gotten a flat out no; Evelyn was so deep in corporate’s pocket, it was ridiculous.
Samantha had signed in at 2:00 p.m. and waited about forty-five minutes before Tobi got in to see her. She was a kind looking woman in her late forties, and she walked into the exam room in a jerky fashion, leaning heavily on her cane and dragging her left leg.
“Hi, I’m Dr. Lister, how are you? I’m sorry about the wait.”
“I’m very well, thank you,” Samantha said. “No worries, I saw the ambulance. This is nothing, really. I just cut my finger on the cat food can this morning. It bled a lot, so I thought it might need a stitch.”
Tobi confirmed her medical history. Samantha was forty-six years old with multiple sclerosis. Her cane was balanced next to her where she sat on the exam table. Samantha saw Tobi looking at it.
“Yes, I haven’t been able to walk without my ‘buddy’ here for years; sometimes I can’t walk with it, either, but luckily that’s not too often.” She smiled. “I’ve also been hospitalized a few times for asthma, but happily, I’m not allergic to cats, since I’ve taken up their cause.” She fiddled with the cane. “I started feeding a few of the neighborhood strays, and pretty soon, I guess the word got out. They all come to my back door now, and meow like crazy. I feel so bad for them, it’s so cold out. But I can’t take any more inside. I’ve already got three. I just took in little Mozart last week, he’s only a kitten. This,” she raised her bloody finger, “is from his food can.”
Tobi came alongside the exam table to remove the bandage. “How many cats do you have?”
“Outside? Must be fifteen or twenty. I had a bunch of them spayed or neutered, and last week, I put a little heated cat house on the porch, now that the temperatures are below freezing. I don’t know, I guess I’m a little crazy. I just can’t stand to watch poor helpless little creatures suffer.”
“The world needs more people like you,” Tobi smiled.
“I don’t really understand people who abandon them. The kitties are so appreciative too. Especially when I put the heater out there … I find when I do something to help a little creature or a person in need, it makes me feel so much better. It gets me out of my pity-pot, you know? I could go crazy, if all I thought about were the things I can’t do anymore. So maybe, in a way, I’m actually being selfish.”
“Not at all,” Tobi said. “When you help someone, you always help yourself too. Kindness is its own reward. If you use one candle to light another, you don’t diminish the light of the first, but you end up with double the light. So you’re just spreading light in the world, and it’s lighting up your own life in the process.” Tobi thought of how much better she felt because she had gotten Jenna her nebulizer treatment.
“As for your finger,” Tobi continued, “I think we can just glue it and spare you the stitches. It will hold just as well.”
After she had cleaned, repaired, and dressed the wound, Tobi said again, “Thank you for being so patient with our wait time today, Samantha. I think it’s wonderful how you take care of the little ones.”
“Thank you for fixing my finger, this was a very pleasant visit.” Samantha shook her head. “The wait was no bother, I’m sure your other patients were in much worse shape than me.”
Esther gazed after Samantha as she left. “That patient was so sweet. I wish all our patients could be that way. And she doesn’t have it easy; did you see her hobble out with that cane?”
“Her ‘buddy,’ she called it,” Tobi said. “Yeah, people who know what it really means to suffer seem to be way more tolerant and caring than people who have it easy. Sometimes we need to get bashed over the head to notice we are all human and all just trying to make our way in the world.”
Twenty minutes later, there were again numerous people waiting to be seen. The next man called up to the front desk held his hand over his eyes and spoke slowly and softly. “My name is Bartholomew. Please, help me. I was cleanin’ … I think I splashed the bleach in my eyes. They burn something very fierce.” He wore an old brown plaid work shirt and had a thick Haitian accent. His hands were dry and cracked.
Esther took him straight to the back, and started irrigating his eyes, while Patty got his information. Tobi did a corneal stain and found chemical burns to both eyes, thirty and fifty percent. She had numbed his eyes with tetracaine, but he needed an ophthalmologist as soon as possible.
Tobi explained to Bartholomew, “Alkaline burns like this are the worst kind. The b
urn continues to do damage even after the bleach has been washed away. You need to see an ophthalmologist, but none are open on Sunday afternoon, and only a few hospitals out here actually have ophtho departments. How did you get here? Is there someone who can drive you?”
Bartholomew nodded slowly. “The boss drove me here, but my sister is comin’. She’s goin’ to take me back to the Bronx, where I live.”
“Bartholomew, you need to go straight to the hospital emergency room, okay? Even though your eyes feel better right now, that pain killer I put in them will wear off in about an hour.” Tobi poked her head out the door, for once appreciative of the circular layout of her office that allowed her to glance up front. “Patty, would you call Montefiore Hospital and make sure they have ophthalmology available?”
“I’m on it, Dr. L.”
Bartholomew was on his way with his sister when Tobi walked into Mrs. Jensen’s exam room. The patient was pacing back and forth in front of her rapid strep test. “I’m sorry for the delay,” Tobi said, “we had an emergency.”
Mrs. Jensen snapped at her. “Yes, I know. I saw that guy come in—he took my seat! And then you took him first. Why didn’t he just go to the emergency room? If he had an emergency, he should have gone there! Why didn’t you just send him there? Why did you have to waste time seeing him here, when he had to leave anyway?”
Tobi just stared at her for a second, trying to keep her jaw in it’s appropriate position in her face. “You’re right,” she finally said. “He should have gone straight to the hospital, but once he comes in to my office, I’m responsible. I don’t turn away people in need.”
“Well, I need to know if I have strep or not. Just tell me if my test is positive or negative. It’s like a pregnancy test, right? Can you just read it for me? I don’t need to be examined, I told them I didn’t want my blood pressure taken. Why did she waste time taking my blood pressure? What has that got to do with anything? I need to get out of here; I have things to do!”
Tobi felt her own blood pressure rising. The strep test was negative.
She went back up front, knowing she had just gotten another zero that would paint her as a horrible physician and found a text message from Ellie.
Hey, I’m in the south shore office and Rufini is here. He just took Monica’s tablet again. WTF. He went in to the back with it. Monica is pissed!
Tobi wrote back.
Why doesn’t she call him out on it?
And she should email Steve.
What are you doing in that office, anyway?
Ellie replied.
They shorted me a shift, so this is make up.
Tobi went back to work. She was too busy to get involved in the drama, but what was Ismar’s deal with stealing tablets?
Morgan had been pacing in his room and stuck his head out for the fifth time to ask how long it would be. “I checked an hour before I came in, and this office had no wait, but there were five people in front of me when I got here, and now I’ve been waiting over an hour. You even took someone before me who came after I did. How does this happen? Look, I just need some drops for my eye, I’m sure it’s just a sty.”
“She’ll be with you very soon,” Travis told him.
When Tobi got in the room, he looked like he might boil over. “Yes, sir, we did have about a ten-minute period earlier where there was no one in the waiting room, although the exam rooms were still full. We had two very urgent matters that set us back a bit. In this setting, we can never tell how many patients may come in before you get here, and I still have to take care of the emergencies first. I would do the same for you if, God forbid, you needed immediate attention.”
He quieted but stayed angry for the remainder of the visit. He did indeed have a sty, and she treated him with an ophthalmic antibiotic ointment and he left.
Later, Patty reported that Dr. Milton had called and told them that Morgan had told his housekeeper—who was also Dr. Milton’s babysitter—to tell Dr. Milton, to tell Dr. Lister, that he hadn’t realized there was only one doctor on, and he felt bad for having been so difficult.
“That Dr. Milton,” Esther said, “she’s connected to the whole neighborhood!”
Chapter 34
They were packed up and headed for the door when Rufini showed up. The four of them glanced at each other and Travis let him in.
“Hello, you are all done for the night? See you tomorrow, then.” He nodded to Travis, Patty and Esther, then looked pointedly at Tobi. “I can speak to you for a moment?”
Tobi searched desperately for a reason to say no, but she wasn’t fast enough. He walked in and put his case down on the counter. Esther looked at her apologetically, but Travis didn’t move. Tobi knew he sensed her dread.
“We can wait with you guys, it’s no bother,” he said.
Rufini shook his head. “No, I don’t want to keep you. Don’t worry, I will walk Dr. Lister to her car. She will be fine.”
Travis looked at her for a long minute. He must be completely psychic, Tobi thought, or else I wear my feelings on my scrubs. When he couldn’t come up with a good reason to stay, he nodded at her and glanced toward the parking lot for a brief second before he left.
Locked in an empty office with Ismar was the very last place she wanted to be.
“What’s up, Ismar?”
“Yes, so, Tobiii.” He paused, and abruptly, Tobi saw him. Despite the below freezing weather, there was a thin layer of perspiration on his upper lip, his left brow twitched, and she could smell his sweat. His left hand trembled ever so slightly, holding a package of pastry and his right was resting on something she could not see inside his briefcase.
“I know we have not been, like, social, but I think this is not good. We should be friendly more, don’t you think? Here, I brought you some baklava. Peace offering. You like sweets?”
“Now isn’t a good time, Ismar. It’s been a long day and I need to get home.”
Ismar put the baklava nearly under her nose. “Who do you live with, Tobi? Do you live alone?”
Fire alarms went off in her head, and she brushed the pastries away. He always gave her the creeps, but this was ridiculous.
“Ah, I don’t think my living situation is really company business, Ismar. Why do you want to know?”
“I told you, Tobiii, I want us to be, like, friends. You started to tell me about your family. You have a brother, right?”
“No.”
“I’m sure you said you have a brother.”
“I said I had a brother. He died nineteen years ago.”
“That’s terrible. How did he die?”
“Why do you care, Ismar? It’s not something I discuss with people. It was many years ago.”
“Why not?”
“Because it’s painful! And irrelevant. Look, I—I appreciate the overture, but I really need to get home. Have a good night.” Tobi spun on her sneaker and nearly ran for the door, leaving Ismar to close up. It was all she could do not to look behind her as she practically sprinted into her car and locked the doors. She looked to her left and saw Travis sitting in his CRV with the motor running. He smiled at her and nodded, and she blew him a kiss. He waited until she pulled out of the parking lot and turned onto the road before leaving, but Tobi still didn’t feel safe as she drove down the turnpike, and it was an effort to stay within ten miles-per-hour of the speed limit.
Why was she so freaked out? She tried to analyze her reaction as she put distance between herself and the office. It made no sense to her, she had been compelled purely by some gut instinct, to get the hell out of there. She replayed the scene in her head and kept dwelling on his hand in the briefcase, like he was holding onto something.
This is mad, she thought. I’m losing my mind. He’s an ass, but he wouldn’t do anything to hurt me physically. And he was just seen with me by Esther, Patty, and Travis, so how stupid
would that be? He’d be caught in an instant.
She thought about calling Steve Chagall, but what would she say? It was inappropriate for Ismar to have come to the office to see her when everyone was gone. And then to offer her food … ugh. She would never eat anything he gave her. Ever.
She had to stop for gas on the way home, she was almost on empty, but she chose a more expensive station that was full service, so she didn’t have to get out of her car. She kept the doors locked and only cracked the passenger window two inches to hand off her credit card.
Christmas decorations lined the strip mall across the street, and it reminded her that Hanukkah was around the corner. Troy used to contend that while every Jewish holiday was a celebration of a major miracle, we often walked sightless every day among unacknowledged miracles that were equally mind blowing, failing to acknowledge the improbable phenomenon that we are mobile, intelligent, breathing human beings who can feel love and appreciate beauty in a universe ruled by entropy. Troy saw God in the blazing colors of a sunset, the first blossoming of a delicate flower, and the chirping of newborn baby birds. It was one of the things she loved most about him .... Geez, why was she thinking of him now? Still, she knew he was the reason she often listed the gifts of each day, and the strokes of “highly-coincidental good fortune”––otherwise known as miracles. Like the tree that had fallen during the storm last winter and missed her car by eight inches, and her homeowners association had it cleared away in less than three hours. Today she counted Travis’s just happening to be there to give her a sense of security, making a clean escape from Ismar and the office tonight, and the woman with chest pain who had made it safely to the hospital.
For years, she had prayed every day for the miracle that Reuben was still alive somewhere out there, and that she might find him.
She arrived at her little community and smiled at the guard at the gatehouse who let her in. But when she finally pulled into her driveway, she had another flash of irrational fear when she noticed someone in her rear view mirror who she did not recognize, strolling leisurely down the street. Why would anyone go walking in this frigid weather? Then she saw the dog and understood, but she stayed locked in her car for a full minute, telling herself she was nuts. They couldn’t get in if they didn’t belong here, she told herself. Finally, she called Chloe, but it went to voicemail.
Code Blue Page 16