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  “Pammy sure doesn’t see it that way, Mom. I always get the feeling she’s lording it over me because she got the looks.”

  “She’s not that shallow, Karen. Pammy may be a little defensive because she’s jealous of your career. Remember how your dad stepped on her Hollywood dreams? She gets a part at the community playhouse now and then, but I don’t think it gives her much satisfaction.”

  “She doesn’t seem jealous. The way she’s always bragging about her kids to me.”

  “Naturally. What’s she supposed to brag about? You’re the one with a good marriage—while she has Brett.” She said “Brett” with undisguised disdain. “Of course she has to focus on the kids.”

  Elizabeth sipped her wine, while Karen used her fork to sort through the contents of her taco. Eventually, Karen asked her mother why she had suggested lunch.

  “Your father has been diagnosed with prostate cancer,” she said bluntly. “He needs your help, Karen. He would value your advice.”

  Karen was concerned. She agreed to call her father, but displayed skepticism that her father would listen to her advice.

  “Dad doesn’t think much of my ideas, Mom. He even blames me for your divorce.”

  “Ha!” blurted Elizabeth. “Pammy told me about that one. The idea that your feminist politics caused me to rebel. That’s a hot one! Well, you can put it out of your head. Boredom and menopause were better guesses. Just so you don’t blame yourself, I’ll tell you something else I shouldn’t. And don’t you ever repeat it to anyone. Not your father, not your sister, not even Jake. I left Daddy because I got interested in another man. You girls were all grown up, and I took a gamble on something that seemed promising. He was handsome and very successful. It didn’t work out, but there was no going back. As you know, Gene is not the best forgiver in the world. But I don’t cry over spilt milk. That’s just the way it is.” Karen’s mother finished her wine and looked Karen in the eye. “When you gamble, sometimes you lose.”

  Karen slowly lowered a forkful of refried beans to her plate. Her appetite was gone. Whether this was caused by the dark ring of grease congealing around the beans on her plate or by something her mother had said, she was not certain.

  When she returned to the office, Karen called the Office of the Inspector General in Washington, D.C. She got the name and telephone number of a deputy prosecutor who handled Medicare billing fraud. Then, she sat and thought. She could not turn Larry’s files over to the feds until she found file number 3, the file Larry’s note said contained information about a hospital billing conspiracy related to the clinic’s fraud. She needed to know what was in that file. She could not risk betraying her client to federal prosecutors. But the hospital’s possible involvement in the fraud was not the only thing that held Karen back. She had no independent confirmation of the matters described in Larry’s files. She then realized that her indiscreet comment to Dr. Bernard at the Ethics Committee meeting, in which she had revealed her suspicions about the clinic’s fraudulent billing practices, was actually liberating. There was no longer any reason to conceal her suspicions from the clinic doctors. Bernard had talked to Grimes about Karen’s outburst at the Ethics Committee meeting. Bernard had undoubtedly also alerted the doctors involved. Karen rifled through Larry’s files, selected a couple of claim forms and a newspaper clipping, picked up her telephone receiver and dialed. A receptionist answered.

  “Jefferson Clinic.”

  “Dr. Norman Caswell, please.” Dr. Caswell was the oncologist whose outlandishly excessive income had triggered Larry’s investigation, the cancer specialist who billed for chemotherapy he never gave, and overprescribed chemotherapy to boost his earnings. And a dead ringer for Bela Lugosi. The receptionist informed Karen that the doctor was “with patients.” She took Karen’s name and extension. Dr. Caswell called back almost immediately.

  “Karen,” he said warmly. Karen started. Dr. Caswell had never called her by her first name before. Word must have gotten around that Karen was to be appeased. “How are you? I saw your father in the Oncology Center last week. How’s he doing?”

  Karen started again. God, she thought, keep this guy away from my father.

  “Dr. Caswell, you really shouldn’t discuss patients out of their presence. For all you know, my father hasn’t even told me about his prostate cancer.”

  “Oh, you lawyers. What can I do for you?”

  “Doctor, we have a payment dispute with an insurance company,” Karen lied. “Could you tell me what your records show as the last two dates of treatment for William S. Dragos, patient number 176605?”

  “Hold on a minute, I’ll have my gal punch it up on the computer.” Karen waited. “Here it is,” said Dr. Caswell. “August 18 and September 5 of this year.”

  “And you remember Mr. Dragos coming for treatment on those dates?”

  “Absolutely. Melanoma patient. Pleasant fellow.”

  “Thank you, Dr. Caswell.”

  Karen sat back and looked at the newspaper clipping she had removed from Larry’s file number 4. It was an obituary for William S. Dragos, dated July 29.

  CHAPTER

  18

  It was 5:00 P.M. Karen felt weary as she donned her down coat and wool hat, grabbed her briefcase with a mittened hand, and headed for the door of her office. The phone rang, and she hesitated before returning to her desk to answer. It was Anne Delaney.

  “Got another medical staff problem for you, Karen.”

  “I don’t need another one, Annie. My plate is full. I’m going home right now.”

  “It’s another anesthesiologist imbibing his own anesthesia. You like those.”

  “Not tonight. I’m going home right now.”

  “It’s Dr. Futterlieb.”

  A member of the Medical Executive Committee was in trouble. Futterlieb was the affable “frat boy” Karen suspected of having a drinking problem. She had to deal with it and silently cursed herself for answering the phone. She sat down, pulled off one mitten, and took notes.

  “I just saw him yesterday,” said Karen. “He’s on the Medical Executive Committee. Who reported him?”

  Anne relayed the report she had received from the head nurse in surgery. Late that morning a nurse had walked into an operating room and found Dr. Futterlieb passed out on the floor with an anesthesia mask strapped to his face. She removed the mask and called the emergency room. Futterlieb recovered, but when interviewed by the Chief of Surgery, the anesthesiologist admitted he used anesthetic agents habitually, Dr. Futterlieb had developed the knack of self-administering the precise amount of gas necessary to keep himself suspended just this side of unconsciousness, an effect he found pleasurable and addictive. Over time, he needed to increase the dosage to achieve the same result. That day, he had given himself a bit too much gas and had gone under. He was lucky the nurse walked in. In another ten minutes he would have sustained permanent brain damage. In twenty minutes he would have been dead.

  “I thought you’d better be involved right away,” said Anne. “This is obviously a matter for the Medical Executive Committee, but I don’t know what we do when the doctor in question is a member of the committee. If Futterlieb doesn’t participate, which obviously he oughtn’t, how do we determine what’s a quorum, what’s a majority? Do we count him or not?”

  Karen said it did not make much difference. She was sure that all the committee would do was put him in an impaired professionals program.

  “They can’t do that,” said Anne.

  Karen, who assumed Anne was merely expressing surprise and disbelief, rhetorically asked, “Why not?”

  “He’s already in one,” said Anne.

  After waiting out a brief tirade from Karen, Anne added, “You’re going to like this next part even better. The Chief of Surgery said we had to understand Dr. Futterlieb was not himself today. He had a very upsetting experience early this morning, in obstetrics.”

  “Judas priest, Annie! What the hell is an impaired anesthesiologist doing in obstet
rics? Why would we allow that?”

  Anne explained that Dr. Futterlieb had lobbied hard and successfully to stay on the “On Call” schedule for obstetrics. Deliveries of babies were lucrative for anesthesiologists, because the hospital paid them a stipend to ensure round-the-clock availability of anesthesia services to women in labor. Consequently, all of the anesthesiologists fought for slots on the O.B. “On Call” schedule.

  “So what was Futterlieb upset about?”

  Anne explained that Dr. Futterlieb had made a serious mistake during a labor and delivery, one that was inexcusable. He had placed an epidural—a type of anesthesia injected between the mother’s vertebrae to relieve labor pain—too high. As a result, the mother had convulsed, but had been successfully resuscitated.

  “What about the baby?” asked Karen.

  “The baby died,” Anne replied quietly.

  “I’m going home right now,” said Karen.

  Karen did not go home right then. Her car would not start. The same was not true of the rusted-out, unmuffled pickup truck driven by the overweight, bearded man who had given Karen the finger the night before. It roared past as Karen stood shivering in the dark parking garage, waiting for Jake to arrive with the jumper cables, again assailing her eyes and throat with noxious fumes. By the time Jake showed up and determined that jump-starting the Volvo would be ineffective since the battery had been stolen, Karen was fuming.

  “I can’t stand this place anymore! This hospital is an abomination, a hellhole, a …”

  “A bête noire?” proffered Jake as he started the Mustang.

  Karen laughed involuntarily. “Don’t interrupt my dudgeon. I mean it, Jake. It’s beyond the pale. It’s not enough that the cabal at the Jefferson Clinic is treating people who aren’t sick and billing Medicare for treating people who are dead, while Joe Grimes cooks up ever more Byzantine ways of dispensing payola. No. Now we have murderers sneaking around and rapists assaulting patients in their beds. What kind of a place is this?”

  “Pretty normal place, I’d say,” said Jake, lighting his first cigarette of the day. Karen waved the smoke away, scowling. Jake opened his window a crack and continued. “You’ve got about a hundred doctors on your medical staff. If a dozen of them are real miscreants, that’s still only twelve percent. Not so bad. Half of the musicians I know are felons of some sort. Folks are flawed.”

  “Yeah,” said Karen, “some even smoke cigarettes when they’re supposed to be quitting. But rotten musicians don’t hurt anybody.”

  “I’ve listened to some vocalists damn near killed me,” retorted Jake.

  Karen fished her parking card out of her purse and handed it to Jake. Jake inserted it into the automatic card reader and the wooden arm rose to permit their exodus from the garage. Karen glanced resentfully at the prime parking spaces reserved for the physicians.

  The two rode in silence for several minutes through the neighborhood surrounding the hospital. It was composed mostly of older residential buildings—frame duplexes, dirty brick apartments such as the Traymont, where Larry had kept an apartment, and frumpy bungalows. One newer fast food restaurant served refugees from the hospital cafeteria and the employees of the small, grimy factory planted in the middle of the neighborhood before the city adopted a decent zoning ordinance. Other than the new wing of the hospital and the hamburger franchise, the only contemporary building Karen and Jake passed on the way home was the gleaming postmodern edifice of the Jefferson Clinic. Just past the clinic, they drove through an old industrial area, where a dozen haphazard smokestacks sprouted cloudlike plumes that glowed red and purple from the remnants of the sunset. Sandwiched between the timeworn factories were rows of narrow, clapboard Victorian-style houses, their open front porches bespeaking a more congenial era, before decks and patios were concealed in the rear. Nearly every other street corner maintained a tavern, the kind that offered shots and tap beers. Karen had heard Jake perform in at least half of these bars and had learned never to order a martini in one.

  Looking at the sooty, rusting factories where they made machine parts, tools, paper goods, and farm implements, it occurred to Karen that the only thriving businesses in Jefferson were hooch, hamburgers, and health care. No high-tech startups in Jefferson, no entertainment industry, no home offices for multinational conglomerates. Still, Karen realized that although they had little glamour and got little media attention, places like Jefferson were where most of the work of the country got done.

  As they neared home, she spoke. “You know, Jake, it’s not just the miscreants, as you call them, that drive me nuts. Granted, those are a small minority. It’s the incompetents.”

  “Out of a hundred docs,” observed Jake, “forty-nine are going to be below average.”

  “But they all have years of medical school, years of residency training.”

  “Sure,” replied Jake, “and I know guys who’ve had twenty years of instrumental lessons who can’t blow a line to save their asses. Not everything can be taught. Does four years of college and three years of law school guarantee you a lawyer knows his torts from his tuchas?”

  Karen conceded the point, but she still sulked. “People trust hospitals. They expect us to take care of them.”

  Jake extinguished his cigarette. “Maybe they expect too much. They don’t want to think that the doctors are just imperfect human beings out to score some jack like everybody else. The thought that a doctor might be crooked or incompetent is too scary. Same way people don’t want to think cops are subject to the usual human frailties. It makes people feel too helpless.”

  “And the doctors make it worse,” Karen declared, “by using jargon that laypeople can’t understand.”

  “Yeah, like lawyers don’t do that,” quipped Jake. “If your doctor or lawyer says something you don’t dig, you should make them explain it until you do. It’s your nickel, and it’s your neck.”

  “I know. You’re saying the patient is responsible for his own care. I agree. But it still infuriates me that the good physicians don’t do anything about the quacks.”

  Jake pulled his rusted-out Mustang into their driveway. “Understandable, though. It’s like a fraternity. Makes them all more secure if they stick together. It’s another way they’re like the cops.”

  Jake turned off the engine. He touched the tips of his missing fingers. Karen knew he was remembering terror and blood, his father carrying him on foot to the doctor’s house. “Another way doctors are like cops. If you ever really need one, you never forget it if one comes through for you. Speaking of cops, do you want to report the ripped-off battery?”

  “No. They’ll just make out a report and tell us to file a claim with our insurer. I’ll talk to Max about it.”

  “Did you tell Max about the guy who rammed your car and gave you the finger?”

  Karen squirmed in her seat. “I forgot.”

  Jake gave her a skeptical look.

  I’m embarrassed to talk to Max,” said Karen, “since you had your dude-to-dude talk with him.”

  “You’re gonna have to get over that,” said Jake.

  “I know,” said Karen. “I’ll tell him tomorrow.”

  “Are you sure you’re okay?” said Jake.

  Karen nodded, but her face still was troubled. Jake studied her expression, and picked up her left hand. “What is it? Spill.”

  “We killed a baby today,” she said. Tears rolled down her cheeks. Her infertility seemed to have intensified her response to such misfortunes.

  “I’m sorry, sweetheart,” Jake said gently. “I really am.”

  The phone was ringing when Karen and Jake opened the front door. Karen tracked slush across the beige carpeting and dropped her briefcase to the floor. She picked up the receiver with her mittened hand.

  “Hello? Hello?…” She listened briefly and then banged the receiver down.

  “Who was that?” asked Jake.

  “Just some Good Samaritan calling to tell me not to do anything stupid.”

&
nbsp; CHAPTER

  19

  Her neck accented with pearls since she had discarded the cervical collar, Karen sat at her computer terminal Thursday morning composing a letter to Charles Packard, Deputy Attorney, Office of the Inspector General She intended to summarize the contents of Larry’s files and her own conclusions-Karen was a slow, hunt-and-peck typist, but the alternative would have been to have Margaret type the letter, which would have been the equivalent of reading it over the hospital PA system. Karen was not yet sure if she would ever send the letter.

  The previous night, she and Jake had talked at length about personal responsibility. Karen had described the snarl of conflicting duties in which her job had ensnared her. Her ethical duty as an attorney, her duty as a hospital employee and Joe’s subordinate, her duty as the friend to whom Larry had entrusted his secret, and her duty as a health care professional appeared irreconcilable. Viewed from one perspective, she had no choice but to report the clinic to the Inspector General From another, she was absolutely prohibited from reporting. Jake, who was usually helpful, failed to come up with any answers. Instead, he exhorted Karen to remember that it was “just a gig.” He also referred to an element of the “Eightfold Path of Buddhism” which pertained to occupational duties: “Right Livelihood.”

  “It means you have to try to make a living without hurting anybody or anything,” Jake had explained. “It’s harder than it sounds.”

  Karen had awakened too early Thursday morning, feeling annoyed with her husband.

  She decided to keep her options open for the time being. She would draft the letter to the Inspector General, keep looking for file number 3, and continue to investigate Larry’s death. At 9:00 A.M. Joe Grimes called. He asked Karen to meet with him at 10:00 A.M. about the MRI project.

  As soon as Karen hung up, her telephone chirped again. It was sleazy Lou Chambers, the attorney for Dietrich Heiden, the patient who said Carson Weber assaulted him on Thanksgiving night. Chambers reminded Karen of his demand for medical records and incident reports. “You can pick up the medical records during regular business hours,” she told Chambers. He could try to subpoena the incident reports, but Karen advised him that the hospital would bring a motion to have the subpoena quashed.