Michael Palmer: Natural Causes

DOWN WITH GLENN PARIS… MCB = MORE COCK AND BULL… BETTER MANAGEMENT, NOT BETTER PROMISES… MCB NAY HMO YEA…

The placards were, in the main, professionally done. The messages on them ranged from snide to malicious.

Is PARIS BURNING? WELL WHY NOT?… PAY US OR FIX IT YOURSELF… YOU TRUST THIS PLACE WITH YOUR LIFE?!!!

Whatever their beef with MCB, Sarah noted, the maintenance workers had some money behind them.

"Nice day for a demonstration, eh?"

Andrew Truscott, a senior resident in vascular surgery as of today, fell into step beside her. Originally from Australia, Truscott had an acerbic wit, made even deadlier by an outback accent he could fine-tune from trace to dense. Now thirty-six, he was the only other resident Sarah's age. He was a difficult person to warm up to-rigidly traditional, opinionated, and too often facetious. But he was also a damn fine surgeon. The two of them had met the day she arrived at MCB and had quickly connected. At first Sarah expected that rapport-that sense of comrades-in-arms-to grow into a true friendship. But comrade-in-arms turned out to be as close as Andrew ever allowed anyone at MCB to get.

Still, Sarah enjoyed her contacts with the man, and had certainly benefited from his teaching. She also acknowledged to herself that had Andrew Truscott not been married, she would gladly have dusted off her feminine wiles to try and break down his reserve. As things stood, she was still without the solution to the nagging problem of how she was to become a competent surgeon herself without totally suppressing the need for love, companionship, sex, and whatever else of merit went with life beyond the hospital.

"What would Changeover Day at MCB be like without a few pickets, Andrew?" she said.

"Ah, yes. Changeover Day at the Medical Center of Boston. At the east wing we have a lineup of professional drug-seekers, duping the new residents with textbook performances of the passing of a kidney stone or the slipping of a lumbar disk. At the west wing, we have a lineup of disgruntled maintenance workers, looking to squeeze a few more bucks from this stone of a hospital. Ain't medicine grand?"

"MCB nay, HMO yea," Sarah said. "Since when are the maintenance workers into hospital politics?"

"Probably since someone told them they might actually get those bucks if Everwell took the place over."

"It's not going to happen."

Truscott smiled. "Try telling them."

For several years, the ambitious-some said avaricious-Everwell Health Maintenance Organization had been waiting and watching like a predatory cat as MCB staggered beneath a crippling weight of fiscal problems, labor unrest, and the controversy surrounding its emphasis on blending nontraditional healing with traditional medicine and surgery. By charter, a vote of the hospital trustees, if approved by the state Public Health Commission, would turn the hospital over to the definitely for-profit operation. And each job action, each piece of negative publicity, brought the unique institution closer to its knees.

"It's not going to happen, Andrew," Sarah said again. "Things have gotten better every year since Paris took over. You know that as well as I do. MCB has become one of a kind. People from all over the world come here for care because of the way we do things. We can't let Everwell or anyone else ruin that."

"Look, mate," Truscott said, his accent deepening, "if you're going to become impassioned about anything, you've got to turn in your surgeon's merit badge. That's the rule."

"You get just as impassioned about things as I do," Sarah said. "You're just too macho to let it show." She glanced past the demonstrators at the bicycle rack, which was empty save two rusted three-speeds, whose tires appeared to have been slashed. "I think the nurse's aides were a bit less physical during their strike," she observed. "It looks like my bike gets chained to the bed in the on-call room. Andrew, don't you have the feeling that someone other than the maintenance men has helped organize all this?"

"You mean Everwell?"

Sarah shrugged. "Possibly. But they're not the only candidate. Thanks to Axel Devlin, there are more than a few people who have the wrong impression about the way we do things here."

Devlin, a Herald columnist with an unabashedly conservative slant, had dubbed MCB Crunchy Granola General. He made it a frequent target of "Axel's Axe" in his popular Take It or Leave It column. As an M.D. with extensive training and expertise in acupuncture and herbal therapy, Sarah herself had been mentioned in the column on two occasions, not at all flatteringly. She never had figured out how Devlin learned of her.

"Who knows?" Andrew responded with no great interest. He nodded toward the dozen or so picketers. "They are a gnarly group, I'll say that for them. Not a tattooless deltoid in the bunch." He paused at the door marked Staff Only and turned to her. "Well, Dr. Baldwin, are you ready to pop up a level?"

Sarah stroked her chin thoughtfully, then took Truscott's arm.

"What options exist for me are either unacceptable or illegal, Dr. Truscott," she said. "Let's do it."

Fifty feet above the pristine mountain pool, Lisa Summer poised on the cliff's edge. But for the garlands of white lilies around her neck and her head, she was naked. The sun glinted off her long, perfect body and sparkled in her straw-gold hair. All around her, wildflowers billowed, blanketing the cliffs and cascading down the rocks beside the shimmering falls. High overhead a solitary hawk glided effortlessly against the cloudless, azure sky.

Lisa tilted her head back and let the sun warm her face. She closed her eyes and listened to the churning water below. Then, arms spread, she tightened her toes over the edge, took a final, deep breath, and pushed off. Wind and spray caressed her face as she floated more than fell past the falls, twisting and tumbling through the crystal air… downward… downward… downward…

"Hang in there, Lisa. Beautiful. Hang in there. The contraction's almost over. A minute ten… a minute twenty. That's it. That's it. Oh, you did great. You did just great."

Slowly Lisa opened her eyes. She was propped on the futon in her cluttered room, bathed in the rays of the early-morning sun. Heidi Glassman, her housemate, friend, and birthing coach, sat beside her, stroking her hand. Across from her, waiting, were the crib and changing table she had found at Goodwill and meticulously refinished.

The weeks of practice in class and at home were paying off. Lisa was now in her third hour of active labor, but thanks to the series of sensual images she had developed, the pain of every contraction so far had been easily subverted.

Dr. Baldwin called the process internal and external visualization. It was, she had told Lisa, a modest form of self-hypnosis-a technique that, if practiced diligently, would enable Lisa to make it through even difficult labor and delivery without any anesthesia or other drugs. For some contractions, Lisa used external visualization to send herself soaring off her mountain cliff or for a wondrous undersea ride on the back of a dolphin. For others, she used internal visualization to see the actual muscles of her womb and the baby boy within, and to mentally buffer them both with thick cotton batting.

"How're you doing?" Heidi asked.

"Fine. Just fine," Lisa said dreamily.

"You look very peaceful."

"I feel wonderful."

Unaware she was doing so, Lisa slowly opened and closed her hands.

"Five minutes apart for nearly an hour. I think it may be time to call."

"There's time," Lisa said. She closed her eyes for a few seconds. "I don't think I've even started to dilate yet."

Her mind's eye saw her cervix clearly. It was just beginning to open.

"Want me to check?" Heidi asked.