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  RE: ANALYSIS OF FOUR INCHES OF PLASTIC CATHETER.

  WE TESTED SUBJECT CATHETER MATERIAL FORWARDED BY MS. ANNE DELANEY, RISK MANAGER, SHOREVIEW MEMORIAL HOSPITAL. TESTS WERE PERFORMED FOR TENSILE STRENGTH, PUNCTURE RESISTANCE, BENDING AND COMPRESSION. PIECES OF THE SUBJECT CATHETER WERE EXAMINED USING INFRARED SPECTROSCOPY AND DIFFERENTIAL SCANNING CALORIMETRY. THE SAMPLE MATERIAL WAS COMPARED TO NEW MATERIAL FURNISHED BY THE CUSTOMER. WE FOUND THE MATERIAL TO BE BRITTLE AND LACKING ELASTICITY COMPARED TO THE NEW SAMPLE. OUR CONCLUSION IS THAT THE SAMPLE MATERIAL HAS BEEN SUBJECTED TO HIGH TEMPERATURES RESULTING IN A BREAKDOWN OF POLYMERS.

  An invoice for $550 was enclosed.

  It certainly looked as if someone had resterilized the catheter, in violation of the manufacturer’s warning. Thus her defense of the malpractice case was in jeopardy, along with the survival of Shoreview Memorial and, therefore, her job. But something else bothered Karen about the report, something she couldn’t put her finger on, that made her feel frightened and somber. She reread it. No question about it, she felt fear. It was the way the conclusion was phrased that bothered her. Could there possibly be something more to the Larry Conkel incident than an inappropriate but otherwise innocent resterilization of the catheter?

  That night, Karen sat ringside at the Caledonia Club listening to Jake’s band, which was named Code Blue. Karen had given Jake the idea for the name of his band. “Code Blue” was jargon used at many hospitals, including Shoreview Memorial, that when announced over the hospital’s public address system generated a coordinated response by the staff. The codes were designated by various colors—blue, red, pink, gray—that in many instances suggested the condition for which they were used. For example, a “Code Red” advised the staff that there was a fire at the designated location, “Code Gray” indicated that a tornado or severe storm was in the area, and “Code Pink” was used to activate the plan for handling an infant abduction. “Code Blue,” the most commonly used, meant that a patient had suffered a cardio-respiratory arrest, that is, had no heartbeat and was not breathing. A split-second response from physicians, nurses, respiratory therapists, pharmacists and other technical staff, as well as a certain amount of good luck, was needed to save the life of the patient.

  Jake said Code Blue was a good name for a blues band. Grim, black-humor names for bands were in vogue. Plus, Jake thought it an apt description of the dire condition of live blues music in the midwest and most of the rest of the country. With blues in one of its periodic downswings, Karen knew Jake and the other members of Code Blue considered themselves lucky to have a regular engagement at a place like the Caledonia Club. Most blues acts were relegated to shot-and-a-beer taverns that paid peanuts. The Caledonia Club was one of the classier places in Jefferson, clean, trendy and well decorated. It served a relatively upscale clientele and paid its live acts pretty well.

  Karen watched Code Blue perform, Jake down on one knee, head bowed, playing a melancholy solo from “Blues with a Feeling.” It was Jake and Karen’s “song.” Karen remembered the first time she heard the song. It was the night she had discovered the right half of her own brain.

  CHAPTER

  6

  The first time Jake asked Karen for a date she wasn’t quite sure that he had. As she was leaving the college infirmary after her bout with food poisoning, he nonchalantly remarked, “Okay if I swing by Friday, we can catch some dinner, maybe some music after?”

  When Friday evening came, Karen was annoyed. Dinner and music. Could be a French restaurant and the symphony. Could be the salmonella diner and LPs in a dorm room. What to wear? Maybe Jake wasn’t so wonderful. Carl would have given her more information. Having observed Jake’s lumberjack wardrobe, she figured gray slacks and a white sweater covered the possibilities. It turned out not to matter. Nothing she owned would have fit with Jake’s outfit.

  At 7:00 P.M. the housemother informed Karen that she had a visitor in the common room. When she entered, Jake was seated at an old upright piano, a cigarette dangling from his mouth, playing an atonal modern jazz piece, full of incredibly rapid scales and angular arpeggios that seemed all but random to Karen. Jake was dressed entirely in black and was wearing a beret. On the front and back of his long-sleeved black jersey were gaudy silkscreens of eight-armed Hindu gods sitting in lotus position. He looked like a ’50s beatnik who had been exiled to Woodstock. Karen walked over to the piano.

  “Know any classical?” she asked. Jake put his cigarette in an ashtray on top of the piano and launched into a Beethoven sonata. While Jake, were he asked, would have said his interpretation was tasteless and unoriginal, to Karen it sounded like Horowitz. When he finished, she applauded vigorously, as did a small audience that had been drawn into the common room. Jake stood and draped Karen’s down jacket over her shoulders, offered her his arm, and the two strolled out.

  Sitting in Jake’s Volkswagen, Karen had been enthusiastic. “You play beautifully. No wonder you’re a music major. Are you preparing for a career as a pianist? You should, you know.”

  “I’ll never be a jazz or classical concert pianist,” Jake said matter-of-factly. “I don’t have what it takes.”

  “What do you mean? You never make a single mistake. You play with feeling and sensitivity. You’ve obviously worked hard at it. What don’t you have?”

  Jake looked at her apologetically, his eyebrows cocked out like quotation marks around his brown eyes. He raised his left hand in front of his face. Karen felt a small shock in her throat and a twinge of nausea. Jake was missing most of the little finger on his left hand and the tip of his fourth finger.

  “Dad left his saber saw plugged in,” said Jake. “My concert piano career was over when I was five years old. Guitar, too.” Karen was astonished she had not noticed the disfigurement before. In retrospect, his piano playing seemed impossible. “On the plus side,” said Jake, “you just might be in the presence of the world’s best eight-fingered Canadian sitar player. Now, if you’ve still got an appetite, what say we chow down?”

  He took her to a small Jamaican restaurant that served spicy pumpkin soup, fried plantains, yucca, and broiled grouper with root vegetables. Karen tried ginger beer for the first time. The Rastafarian waiter flirted with Karen, who found the whole experience exciting, but a little frightening. Carl Gellhorn’s idea of an exotic restaurant was Hong’s Chinese Palace.

  Adding to her nervousness, in the VW after dinner Jake lit a joint and offered it to her. She politely and somewhat reluctantly tried a couple of tokes and was feeling disoriented and anxious when Jake parked the car in an unlit parking lot in a run-down neighborhood, in front of a place called “The Mineshaft.”

  Inside The Mineshaft, it was noisy, warm, smoky, and smelled of stale beer. The walls and ceilings were painted black, and the dirty wood floor was littered with cigarette butts. Large black and white photos of black men Karen assumed were musicians of some kind hung haphazardly around the main room, which was jammed with small battered tables and chairs. Jake led Karen by the arm through the boisterous crowd, which was near capacity and mixed racially. The audience, for the most part, was noticeably older than Karen—not a student crowd. Karen felt out of place and apprehensive.

  Jake led her to a table with a piece of paper folded like a pup tent sitting in the middle of it, on which someone had printed “Reserved” in pencil. He helped her off with her coat and held her chair. Karen excused herself to go to the restroom, which was the size of a broom closet, smelly and stifling. Her claustrophobia, combined with the marijuana, made her heart pound so intensely she was afraid it would fibrillate. She decided to risk bladder injury instead and returned immediately to the table.

  “Would you care for a drink?” Jake asked. “I recommend a Stinger.” Karen did not know what a Stinger was, but she said “Okay” and Jake headed for the bar.

  Alone at the table, her apprehension intensified. She held her purse on her lap, her knees tight together, and squeezed the handles. “What am I doing here?” she s
aid to herself. “This is too weird. I don’t know this guy that well, why would I trust his judgment? If I’d gone out with Carl, I’d be in a safe suburban movie theater right now. Instead, I’m in some seedy dive where people probably get stabbed. For all I know, he lost his fingers in a knife fight. Why is he taking so long?” She felt short of breath, panicky.

  The crowd got suddenly quiet and eyes turned toward a small stage on which two scruffy-looking men with guitars and an even scruffier guy with a set of drums had set up. A thin, bald man with a gray beard and several garish tattoos stood at a microphone in the middle of the stage. He spoke in a gravelly, alcohol-soaked voice.

  “Good evening, and welcome to The Mineshaft. I want to remind you cats to tip the waitresses generously because I don’t pay ’em for shit. And now, let’s get it together for the best blues in the middle west. Ladies and gents, The Mineshaft is proud to present Buddha and the Lowdown Polecats!”

  The man disappeared behind a shabby velvet curtain. Karen thought she heard four gunshots, and she jumped in her chair, but it was just the snare drum setting the quick tempo. The bass guitar kicked in at such a volume she could feel the vibrations on her skin. The lead guitar started playing a bright, effervescent solo and voices in the crowd began to shout out encouragement. In the back of Karen’s anxiety-gripped mind, something said: “Hey. These guys are good.”

  A waitress came up from behind and put a drink on the table. Karen opened her purse.

  “It’s taken care of,” shouted the waitress. Karen spun around and scanned the bar. No Jake. Great. He goes to the men’s room and misses the start of the show.

  Next, a vocalist joined in, exhorting the audience:

  “Aw, mercy! You know it ain’t no crime,

  C’mon now, get down y’all

  And have a good time.

  Gonna rock this joint

  Yeah, gonna rock this joint

  Now I know we can do it,

  So let’s get down to it!”

  The singer leapt from behind the curtain. It was Jake. He slid sideways across the stage to the microphone, cupped a small rectangular piece of metal to his mouth, and suddenly the room was filled with a wailing, soaring sound and a blast of applause. Jake spun on his heels and dropped into the splits. The audience whooped.

  Oh my, thought Karen. I was worried he’d miss the show. Jake’s in the show. Jake is the show. She began to get angry with him for tricking her. “Show-off,” she said out loud. “Bastard.” But something remote in her mind said, “I’m having fun.” By the end of the opening number, she was on her feet with the rest, whistling through her teeth.

  Without patter, the band went right into the next number, a slow one, “Blues with a Feeling.” Karen relaxed and savored the conviction in Jake’s soulful rendition of the ballad. As she watched and listened, she felt herself sexually lubricating. Her limbs and face were suffused with a warm, sweet feeling. Jake closed his eyes tightly as he played, absorbed in the sound of the harp, as if in a trance. Karen said softly, “This guy is insane.” But that small voice in the back of her mind said, “This guy is the one.”

  Karen still retained some of that feeling twenty years later as she sat listening to Code Blue at the Caledonia Club. Jake’s hair was shorter now and his waist a tad thicker. His mustache was neatly trimmed and starting to show some gray. He wore a plain black jersey, without psychedelic adornment. But he still appeared to be transported to another world when he was deep into a song, especially a slow one. Over the years, his playing had acquired the simplicity and elegance of a mature virtuoso. A patron at the next table, a regular who knew who Karen was, leaned over and shouted to her, “He sure plays the hell out of this one, don’t he? He write it?” About half of the songs Jake’s band played were original, the other half were covers of songs performed by pioneers of the genre.

  “No,” replied Karen. “This is a classic. By Little Walter.”

  At her own mention of the name, Karen felt a tingling sensation at the back of her neck. The expression dropped from her face. She grabbed her jacket and hurried across the small dance floor to the stage. With a nod of his head, Jake passed the solo to the guitarist. “What’s up?”

  Karen shouted, “I’ve gotta go look in on Walter.” She raised her fist to her mouth, thumb up, and pantomimed drinking. She looked at Jake out of the corner of her eye, eyebrows raised as if to say, “Get it?” Jake watched as Karen snaked her way toward the door, a smile of admiration and gratitude spreading across his broad face.

  CHAPTER

  7

  Just after midnight Karen slipped into Larry Conkel’s office on the second floor in the old section of Shoreview Memorial. Larry’s office was approximately the same size as hers, but that was where the similarity ended, she thought. Whereas her office was sparely furnished and orderly, with just one neat pile of work papers on the desk under the heavy cut-crystal paperweight, Larry’s office was chaos in bloom. Deep, crooked piles of documents, letters, computer printouts, junk mail and trade publications covered every square inch of his desk and file cabinet, as well as the top of the radiator and much of the floor. His tables and wall shelves were full of knickknacks, travel souvenirs, houseplants, empty soda cans and opened packages of breath mints and hard candy. While Karen had two steel-framed modern art prints of clean, geometric shapes on the walls of her office, Larry had dozens of variously sized, framed photos of himself with friends, family members, medical staff members, local politicians, and a plethora of scaly game fish.

  On one huge bookcase, he had nothing but mugs. Karen knew people who collected stamps, coins, matchbooks, anything having to do with owls, and one who collected antique eggbeaters. Larry collected beer mugs. He had pewter mugs, glass-bottomed mugs, ceramic mugs with the logos of imported beers and ales from Europe, Latin America and the Far East, and mugs in the shapes of faces, with little hats that tipped up when you pressed a thumb lever. He had huge three-liter steins and tiny little steins that would hold only an ounce of beer. And on the top shelf he had a souvenir mug from the Chicago Blues Festival with the theme of that year’s festival, “Blues with a Feeling,” hand-painted in script over a caricature of the originator of the modern style of blues harp, Walter Jacobs, also known as Little Walter. “My new favorite,” Larry had told Karen when she presented him with the mug as a fortieth birthday present.

  Karen cleared a box of papers from a guest chair and pulled the chair over to the bookcase. Standing on the chair, she still needed to rise on tiptoe to reach the mug. She got it down and looked in the mug. Inside were a small brass key and a larger, steel key. She took the keys out, replaced the mug, stepped down from the chair, and looked around the office. Larry’s desk had a lock in the center drawer, but it was unlocked. Opposite the desk was a two-drawer oak wall unit with magazines and potted cacti on top of it. The bottom drawer had a lock in it. She tested the drawer and found it locked. She inserted the small brass key and turned. It opened.

  Inside were three fat reddish-brown accordion files labeled “J.C.—Fraud Investigation”. Together the files were over two feet thick. The labels were numbered 1, 2 and 4. Each file contained several manila folders. She removed the file numbered 1, sat down in the guest chair and pulled out the first folder. She set the folder on her lap and opened it. She scanned a few pages of the contents. When Karen realized what she was looking at, she decided to move all the files to her own office.

  It was half past midnight when she finished moving the files. Jake would be home from the gig around 3:00 A.M. She could review the documents for two hours and still be home to greet him.

  In front of her was the record of an extensive investigation Larry Conkel had conducted into massive billing fraud at the Jefferson Clinic, a local medical group that supplied Shoreview many of its doctors. Much of the record was handwritten. Larry apparently did not trust even his secretary with the information contained in the file. Karen understood why.

  The file revealed that three years earlie
r, Larry had collected data for a physician recruitment contract with the clinic. Such contracts were common: a hospital collected data showing a need for a physician in a certain specialty. A medical group, such as the Jefferson Clinic, could recruit a physician in that specialty to relocate to the hospital’s service area and join the medical group. The hospital guaranteed the group that the cost of hiring the specialist, including salary, would not exceed the fees that the specialist would collect for treating patients. If it did, the hospital would make up the difference. Growth without risk for the medical group, a new source of patient admissions for the hospital. The additional patients the newly recruited physician admitted to the hospital would inevitably make the hospital much more money than it paid out to the medical group on the guarantee.

  Karen knew a lot about the simple facts of hospital economics: the filling of empty beds meant more money for the hospital without much more cost. Hospital billings for the patients brought in by the new doctor were almost pure profit, so it was worth it to the hospital to guarantee the recruit a generous salary to get another big admitter on the hospital’s medical staff. This sort of arrangement was only legal under federal law, however, if the hospital could prove there was a need in the community for a new doctor in a particular specialty. Without a documented need, the scheme might be viewed as just a way to increase the number of expensive treatments and therefore jack up the cost to federal programs like Medicaid and Medicare.

  In the case of the Shoreview Memorial physician-recruitment contract three years earlier, the recruited doctor was a medical oncologist, a type of specialist who treated cancer with chemotherapy, named Norman Caswell. Dr. Caswell had always given Karen the creeps. He was gaunt and sallow and usually wore a patently insincere smile that made her think of an undertaker. Shoreview Memorial had guaranteed the Jefferson Clinic that it could hire Dr. Caswell at a salary of $300,000 per year, plus bonus, without risk if his patient revenues fell short. Because the hospital had agreed to pay any shortfall, the clinic was required to open its books to Shoreview concerning Dr. Caswell’s income.