Michael Palmer: Natural Causes

"Hardly." Truscott's sardonic laugh was unconvincing. "I'm angry about having my all-too-meager paycheck signed by a man who raffles off elective plastic surgical procedures, sends his residents on well-publicized house calls, and has closed-circuit TV put in delivery rooms."

"He's raised thousands of dollars with those raffles and contests-probably hundreds of thousands. And most families love the chance to be part of a birth. We've become the second busiest OB service in the city."

Before Truscott could respond, Glenn Paris stepped forward and tapped on the microphone. Immediately 120 staff physicians, residents, nurses, and trustees fell silent.

Glenn McD. Paris, the president of Medical Center of Boston, exuded confidence and success. He was only five feet eight, but many described him as tall. His jaw was as square as any Boston Brahmin's, and the intensity in his gaze was arresting. He had been described by one supporter as a mix of equal parts Vince Lombardi, Albert Schweitzer, and P.T. Barnum, with a dash of Donald Trump thrown in. Axel Devlin, on the other hand, had once called him the most distasteful and dangerous affliction to descend on Boston since the British.

Six years before, a desperate board of trustees had lured Paris away from a major hospital in San Diego that he had turned around in a remarkably short time. The deal they struck with him included the promise of a free hand in fund-raising and all hospital affairs, generous financial incentives, bonuses tied to any hospital profit, and the rent-free use of a Back Bay penthouse, donated to the institution some years before by a grateful patient. Paris had responded with a vigorous campaign to give the hospital a positive, easily definable image and to turn its red ink to black at all costs.

In some ways, the man had succeeded. The hospital's staggering debt had leveled off, if not lessened. At the same time, its increasing emphasis on whole-body medicine and personalized treatment had led to a growing reputation as a caring medical center.

But there was still a lack of respect for the institution in many quarters, both public and academic, and the feeling among some trustees that before long, the hospital would simply have to move in other directions.

"Good morning, troops," Paris began. "I want to welcome you to the official beginning of MCB's ninetieth year. The purpose of this annual kickoff is to introduce our new house staff and to help them feel at home." He motioned for the new residents to stand and led a round of applause. "You should know," he said to them, "that your group represents the best MCB has ever been matched up with in the national resident matching program."

Again applause. Several of the residents shifted uncomfortably, obviously wishing they could sit down. Paris, beaming as if he were showing off his children, kept them standing. The news of the high match-hospitals make their preferential list, prospective residents make theirs, and a computer does the rest-had been well publicized. But he was not one to miss the chance to milk such a success for all it was worth.

Truscott leaned over toward Sarah. "Note how carefully fearless leader neglects to add that although the match is the highest in MCB history, it still ranks below any of the other Boston teaching hospitals."

"For true?"

"Blankenship let that one slip out at lunch last week."

Dr. Eli Blankenship, the chief of staff, was also the head of the MCB resident training program. It was his impressive knowledge of alternative healing and his enlightened attitude toward Sarah's desire to blend her techniques that had convinced her to rank MCB number one on her match list. At the time, largely because of her unique background and high scores on the National Medical Boards, several more prestigious hospitals had already expressed interest in her.

"Please sit down," Paris said finally.

"In 1951, at age fifty…" Truscott murmured.

"Before going any further," the CEO continued, "I want to address the heightened security to which you were all subjected this morning. Over the past year, too much of this hospital's business has been finding its way to certain reporters and other special interests, who have gone out of their way to paint an unfavorable and damaging picture of the Medical Center of Boston. Some of these leaks involve the minor day-to-day errors-no, most are too trivial to be called errors-I should say problems in patient care which plague any hospital, and which are never shared with the public. Others involve exchanges at our staff meetings and conferences."

Sarah's beeper went off, the readout summoning her to an outside call. Wishing she could have crawled to the end of the row rather than stand up directly in front of Paris, she made her way to the nearest auditorium phone.

"All hospitals," Paris continued, "are in competition to maintain their allotment of beds and to keep a reasonable percentage of those beds filled. And as you know, that competition is often intense. Hospitals as large and prestigious as White Memorial now advertise in the yellow pages. Negative publicity for MCB, especially groundless negative publicity, hurts every one of us. From now on, no unauthorized personnel will be allowed in our medical rounds or staff meetings. Further, anyone other than our public relations office who speaks about hospital business with the press will be asked to leave our employ…"

Sarah listened for a minute to her call, gave some instructions, and returned to her seat.

"One of my home birth patients is in active labor," she whispered. "She's still got a ways to go, but her bp's a little low. I hope this program doesn't run over."

"You're doing home births yourself?" Truscott looked at her incredulously.

"No, Andrew. I assure you, I only look dumb. Dr. Snyder will be coming out with me. This will be our second one."

Randall Snyder, the OB/Gyn chief, was one of those seated on the stage behind Glenn Paris. As Sarah nodded up toward him, she realized that Paris had stopped speaking and was glowering down at her.

"Sorry," she mouthed, color rushing to her cheeks.

"Thank you," Paris mouthed in return.

He cleared his throat and took a sip of water. The silence in the hall was dramatic.

"Believe me," he went on finally, "this subversion from within is serious, serious business. As you know, outside interests and some more financially secure institutions have been just waiting for us to go under. Ours is an attractive facility with a wonderful location. But those folks are in for a rude awakening, my friends. A rude awakening. For some time now, I have been negotiating with a very well-endowed philanthropic group whose primary aim is the improvement of health care. We are currently on the home stretch of an extensive grant application. If that grant comes through-and at present all the signs are right-MCB will have financial stability and a vast capability to grow. That was the goal I set with you six years ago, and today I am pleased to state that it is a goal well within our reach."

There was a smattering of applause, which gradually spread until all in the auditorium-including Andrew-had joined in.

"That's the spirit," Sarah said to him.

"My hands were getting cold," Truscott replied.

Behind the podium, Glenn Paris again was beaming.

"Please don't stop on my account," he said as the response died down.

"He's a crafty one," Truscott whispered beneath the laughter that followed Paris's comment. "I'll say that for him."

"He's working a miracle."

"He's hyping himself."

"Before I introduce those seated behind me," Paris went on, "and while we are on the subject of outside interference in hospital business, I want to say just a few words about the gauntlet of demonstrators some of you were forced to traverse to get here this morning. Some on our maintenance staff are currently conducting an illegal job action which we have good reason to believe has been instigated and is being abetted by one of those operations committed to our demise. Mark me well. We shall not allow them to interfere one iota with patient care or any other business of this institution." He pounded his fist on the podium for emphasis. "And that you can take to the bank!"