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  Shoreview never paid out a cent on the guarantee, Karen saw in the file, which was good. Dr. Caswell and the clinic did even better. The profits on Dr. Caswell’s services to patients were nearly four times the guarantee.

  A physician making over a million dollars a year was not unheard of in Jefferson, but Larry had personally collected and analyzed extensive data on the need for chemotherapy in the region. There was simply no way there were enough cancer patients in town to support that volume.

  Larry had checked Dr. Caswell’s billing records against his medical records. They matched up. Then Larry had talked to one of Dr. Caswell’s patients. He told the patient he was calling to see if she was satisfied with the courtesy of the staff and the convenience of the facility when she received her chemotherapy treatments.

  The patient had said, “What chemotherapy? I never had any chemotherapy.”

  Reading on in Larry’s meticulous notes, Karen learned he had discovered dozens of cases of billing for services that had not been provided, and yet were documented in the medical records. He looked at the records more closely and discovered Dr. Caswell was up to something even worse: he had given chemotherapy to people who were not candidates for it under accepted guidelines. Patients who were legitimate chemotherapy patients had their dosages increased beyond appropriate levels, because Dr. Caswell could bill more for higher dosages. Maximizing reimbursement was the exclusive criterion on which treatment decisions had been made. That was how Norman Caswell was able to make $1.2 million a year.

  Larry widened his investigation. At least four other doctors at the clinic were engaged in similar practices on just as large a scale. One of the perpetrators was Edward Bernard, the cardiologist. He had his share of documented nonexistent office visits, but much worse was his performance of cardiac catheterizations on patients with perfectly healthy hearts. Their angiograms were normal. Their medical records stated, “Patient reports chest pain.” When Larry questioned them, the patients had said, “What chest pain? I never had any chest pain.” On several of Dr. Bernard’s cases, Larry had concluded, “The only indication for catheterization appears to have been that the patient had health insurance.”

  Karen could scarcely believe Larry’s files. He had documented billing fraud running into the tens of millions. This was nothing compared to the unnecessary pain, anxiety, discomfort, and inconvenience scores of trusting patients had suffered. Worst of all, Larry had written, was the unnecessary risk to which they had been exposed. One recipient of an unneeded cardiac catheterization had had an adverse reaction to the radiopaque dye, gone into anaphylactic shock, and died.

  Dozens of patients had been subjected to dangerous, painful, invasive procedures with horrendous side effects, for no good medical reason. Millions of dollars paid for unneeded treatments or medical care that was never even given. At least one very wrongful death.

  If what she was reading ever saw the light of day, Karen knew it would destroy the Jefferson Clinic and end the medical careers of several prominent physicians.

  The chirp of her telephone startled her. Feeling suddenly furtive and paranoid, she answered without giving her name.

  “Legal Department.”

  “Legal Department? I need a lawyer. I think my wife’s deserted me.”

  “Jake?” asked Karen.

  “Y-y-y-ello,” said Jake.

  “What time is it?” asked Karen.

  “Quarter past three. I’m home. Just checking to make sure you’re okay. How’s Walter?”

  “Long story. I’ll tell you when I get home.”

  “Tell me tomorrow. I’m done in.”

  “Busy day tomorrow. Thanksgiving.”

  “Gee,” said Jake, “I can hardly wait.”

  CHAPTER

  8

  A winter storm slammed into the city of Jefferson on Thanksgiving Day. The shoulders of the two-lane highway that led to Karen’s mother’s apartment were littered with the cars of impatient drivers. Visibility was no more than thirty feet, and the wind made the wet snow look like it was falling horizontally across the flat midwestern landscape.

  Karen’s mother and father had divorced twelve years earlier. Ever since, Thanksgiving had been a ten-hour ordeal, with time allotted equally between mother and father to avoid offending either parent. The location of the turkey and stuffing phase of the meal, versus the pumpkin pie and coffee phase, were alternated annually like the World Series designated-hitter rule.

  As Karen and Jake’s eleven-year-old Volvo chugged and fish-tailed through the driving snow, Karen sat in uncharacteristic silence, coiling and uncoiling a tress of her dark hair with her index finger, staring blankly at the cornfields, which were quickly turning from brown to white. She barely noticed that Jake was white-knuckled and hunched forward in his seat, struggling to keep the rear-wheel-drive car from sliding off the slick, slushy road.

  “Can’t believe this thing was made in Sweden,” said Jake.

  “What?” said Karen.

  “Sweden. They make Volvos in Sweden.”

  “Uh-huh.”

  “This heap is terrible in snow. No traction at all.”

  “Uh-huh.”

  “But they have lots of snow in Sweden. It snows all the time in Sweden. With all that snow, and with cars like this, it’s no wonder all the guys in Bergman movies are so dour.”

  “I guess.”

  Jake took his eyes off the road for a brief moment and glanced at Karen. “What is it?” he said.

  “What is what?”

  “What is ’dis trouble in mind, ’dat got you in its sway?”

  “What?”

  Jake looked at Karen again, more intently. “Spill it,” he said.

  Karen sighed. “What I found in Larry’s office last night is just so awful, I don’t believe it.”

  “What’d you find?”

  “I found enough smoking guns to fill an armory. I found a malignancy growing on Shoreview. I found proof of the banality of evil.”

  “Could you be a little more specific?”

  Karen told Jake the story—about the keys she found in the “Little Walter” mug, and how one of them unlocked the files from Larry’s investigation into the Jefferson Clinic’s fraudulent practices, how Larry’s records showed that some of the clinic physicians routinely billed Medicare for services they never performed.

  “So they’re ripping off Uncle Sam,” said Jake. “Shame on them. But it could be a whole lot worse. Like if they actually went ahead and operated on the old folks, when they didn’t need surgery, just to get the dough.”

  “They did a lot of that, too,” said Karen. “They did invasive diagnostic procedures like cardiac catheterizations. One of them, that creep Caswell, gave cancer patients chemotherapy they didn’t need just to get the fees.”

  “Bummer,” said Jake. He risked removing his right hand from the steering wheel and reached over to massage the back of Karen’s neck. “Whoa,” he said. “Lotta tension there. You’re wound tighter than a four-dollar watch. That’s more than just a hard day’s night at your gig.”

  “I dread going to my mom’s for Thanksgiving. You know that. And my dad’s is worse. It’s always the same thing. This family stuff. I hate all Pilgrims.”

  “Yeah, holidays can be a drag, but hey, maybe we can sort of get into the Norman Rockwell spirit. To grandmother’s house we go, and all that jazz.”

  “That’s just it,” said Karen. “It’s not grandmother’s house if you have no grandchild to take there. Of course, Pamela will be at Mom’s, exhibiting her little darlings. I hate Norman Rockwell.”

  Jake smiled. “Remember the true meaning of the day,” he said with facetious piety. “And think of something you are thankful for.”

  Karen turned and stared out the car window at the blowing snow. “I’m thankful,” she said, “that it comes but once a year.”

  The turkey was excellent, but nothing else was at Elizabeth Decker’s apartment. Karen’s older sister, Pamela, and her two children ha
d flown in from Cleveland to be with their mother for Thanksgiving. Pamela’s husband, Brett, an executive with a women’s wear mall chain, had stayed behind. Pamela relayed her husband’s excuse, the press of business on the Friday after Thanksgiving, traditionally the biggest shopping day of the year. Karen knew that Brett’s absences from Decker family gatherings, which were more the rule than the exception, had long been a source of irritation to her mother. Karen wondered whether her mother suspected, as she did, that the “business” Brett was attending to was of the monkey variety.

  Karen Hayes was a pretty woman, but her sister Pamela was beautiful in a wholesome, all-American way. She had high cheekbones, a small upturned nose, and mounds of artificially blonde hair. During a brief career as a fashion model she had met her husband. Both women had their mother’s slender figure, but Pamela had her father’s height and straight posture as well She also had something else her sister lacked.

  Fertility.

  Pamela’s children had been the focal point of the early afternoon, at best a dull proposition for Karen and Jake, and an unwelcome one for both children. Pamela’s daughter Suzanne, an introverted adolescent, aloof and listless, acted both embarrassed and bored when her aunt, uncle or grandmother attempted to make conversation with her. Suzanne was as tall as her mother, but by slouching she managed to make her height appear to be an affliction. Karen thought she could see Pamela’s good looks waiting to emerge from beneath Suzanne’s glum expression and mild case of acne, and she detected in her niece’s refusal to wear makeup or style her hair a callow but healthy assertion of independence. Suzanne’s brother, Dante, a stocky kindergartener with black hair in a pudding-bowl cut, had difficulty sitting still for long, but had an endless capacity for orchestrating battles with his grandmother’s ceramic Nativity figurines.

  At dinner Elizabeth turned the conversation to Karen’s children. The nonexistent ones. Karen had tried again to explain to her mother the medical possibilities, the numerous tests she and Jake had been through, the medications she had tried, the reasons for their decision not to attempt risky surgical treatment for endometriosis, which would have involved major abdominal surgery to remove fragments of endometrium, tissue growing abnormally outside of the uterus. This condition was commonly suspected as a cause of infertility in women who had postponed having children until they were in their thirties.

  And once more Karen tried to convince her mother that it was extremely unlikely that her infertility was the result of anything she or Jake had done in college, such as smoking marijuana, using birth control devices, or skinny-dipping in the campus pond. Pamela, as usual, offered suggestions such as doing headstands after intercourse, eating more fruit, or her favored prescription: “You’re just trying too hard. Relax!” All this discussion was carried on in the presence of a sullen fourteen-year-old girl and a curious five-year-old boy.

  Before Elizabeth could ask to speak with Karen privately, so she could inquire for the fourth time in as many years whether Karen had ever had an abortion, Karen leapt up. “Gotta go!” she exclaimed, and blamed their early departure on road conditions.

  As it turned out, their departure was not early enough. With six inches of snow on the highway, their old Volvo did not make it above twenty miles per hour for the entire drive to Karen’s father’s house. The long, exhausting drive took them through the city and over the bridge below the dam on the Weyawega Flowage. Despite her tense mood, Karen couldn’t help but notice that the city of Jefferson, old and tired as it was, had an undeniable charm in the winter. The dam creating the flowage was originally built for a mill. The mill had been converted into retail space for shops that sold candles, greeting cards, and antiques. A huge wooden wheel still turned on the millrace, although it was not connected to anything. The spill from the dam looked like a waterfall and caused the lights reflected on the surface of the river below the dam to shimmer in zigzag patterns.

  The facades of the commercial buildings lining the main street on both sides of the bridge looked, Karen imagined, just as they must have in the nineteenth century, when the city was built. Karen appreciated the individuality of each storefront and the countless man-hours it must have taken to create the carved lintels, gargoyle gutters, and intricate brickwork with hand tools. The ornate buildings seemed to impart additional beauty to the falling snow. The generic warehouse superstores on the outskirts of town and the snow, on the other hand, seemed only to make each other uglier.

  As they crossed the Weyawega bridge, Karen smiled once again at its unintentionally humorous architecture. Squat Greek-style columns embellished with carved garlands and bas-relief figures supported the massive guardrails, and the roadway was lined with rococo wrought-iron lampposts topped by flickering gaslights. At each end of the bridge sat a pair of larger-than-life concrete lions, their toothy mouths open in silent roars, apparently anticipating a grand future for Jefferson. Karen had always thought that, in the context of the city’s languid pace, the lions were really yawning.

  “Don’t let my father bait you,” she said.

  “No problema,” replied Jake.

  “He puts you down as an indirect way of expressing his disappointment with me.”

  “I don’t think he’s disappointed with you. I think he’s disappointed with me, directly.”

  “Nothing I ever did was good enough,” said Karen.

  “Oh? I remember him busting his buttons at graduation. Looking at your diploma and booming ‘magna cum laude’ over and over again, magna cum loudness.”

  Karen smiled. “Yeah, but it’s been downhill ever since.”

  “You mean,” said Jake, “ever since I came on the scene.”

  Karen reflected. “No, not really. I think his attitude toward us changed after Mom split. It’s like he started resenting us or something. Plus, since then he’s become so judgmental. He has no idea how much criticism from a father can sting.”

  “You ever tell him?”

  “No. You don’t talk about personal stuff with my dad, at least not since the divorce. He’s still bitter and brittle. I don’t think he’ll ever get over it.”

  “You never told me why your parents split up.”

  “I never knew. My mom moved out one day. Only she knows why. All I ever got from either one of them on the subject was a lot of evasion and blather.”

  “Blather?”

  “You know, like, ‘It just didn’t work out.’ I’m supposed to believe two people can be together twenty-six years and raise two children, and then it just doesn’t work out.”

  Karen reached over to the dashboard and turned up the heat.

  “It’s about ninety in here already,” said Jake.

  “I’m cold.”

  “That’s because we’re here.”

  Karen and Jake arrived at Gene Decker’s red brick colonial forty-five minutes behind schedule, receiving a cool reception from their host. Karen’s father, a stern-looking man in his tortoiseshell bifocals, wore a dark suit and a necktie and eyed with disapproval the sweaters and jeans worn by his daughter and son-in-law. Karen had known her father would look askance at their casual attire, but she figured she was asking enough of Jake to show up at these annual events without making him dress uncomfortably. Jake didn’t even own a suit. And weren’t they old enough to decide for themselves how to dress in their free time?

  Of course, it wouldn’t help that their attire would suffer even further by comparison to Pamela’s. She would arrive looking chic as always in a cashmere sweater with coordinated silk pants, an ensemble by Michael Kors that Karen knew went for just under two grand at Neiman Marcus in Chicago. Pamela never failed to make Karen feel a bit down in the heels, even though she suspected that the designer creations Pamela sported had previously been worn by mannequins in Brett’s stores. Still, she had to give Pamela credit for fitting into mannequin sizes after two children.

  “We’d better go right to the dining room, since the evening’s half shot already,” Gene grumbled as his daughter
and son-in-law stomped the snow off their shoes and removed their jackets. “Help yourself to the liquor cabinet, Jake. Make yourself at home, Tootsie Roll.” Her father’s pet name for her, which he had used since she was a child, always set Karen’s teeth on edge.

  Jake mixed bourbon manhattans for himself, Karen and her father, while Gene turned down the volume on the televised football game and placed platters of food on the long, formal dining room table, covered with a starched white tablecloth. Karen surveyed the decor of her childhood home, which had not changed in years. The dark wood stain, flocked brocade wallpaper and stodgy plush carpeting that had been fashionable when Elizabeth Decker picked it all out now seemed stale, tired and sad. At least the place was clean. Although he regularly used only three of the ten rooms, Gene had his cleaning service do the entire house every week, including the rooms that had been Karen’s and Pamela’s, still done up as girls’ bedrooms.

  Karen was appalled that her father had a catered turkey dinner prepared, in spite of the plans that his family come “for dessert.” All that food wasted just so his grandchildren would not get something at Grandma’s house that was not available at his. The three sat down in the dining room and talked about football and the weather while they waited for Pamela and the kids.

  Two rounds of manhattans later, the adults drank coffee while Karen’s niece and nephew dug into seconds on the pumpkin pie. Mr. Decker dug into his son-in-law.

  “So, Jake, at some point do you think you might be getting a job?”