Michael Palmer - The Society

The laughter this time was heartfelt, but also a bit edgy. Having medicine practiced over the telephone by HMO MDs or, even worse, non-MDs was a constant sore point for most of the Hippocrates Society members.

“That’s it until next month,” Will said. “Back to you, Tom.”

Lemm returned to the podium and silenced those who were still buzzing over Will’s cases.

“One last piece of business,” he said. “As many of you know, Jeremy Purcell, who was to champion our cause at next week’s forum, has had emergency bypass surgery. He’s reasonably stable at White Memorial but has been absolutely forbidden to participate in the debate. We can’t back out of the deal, so we need to select someone who can face up to Boyd Halliday. Jeremy has promised to make his notes and slides available and to spend time coaching whomever we choose. As a last resort, I will do this, but you all know as well as I do that I am a plodder-a behind-the-scene type of guy. I’ll help, and even sit beside our champion, but we really need someone with more panache than I have, someone with just the right balance of intellect, passion, and humor.”

Will, focused approvingly on Lemm’s words more than on the man himself, suddenly realized that the Society’s president was staring directly over at him. Before he could react, an internist from Springfield had waved his hand and shouted out, “I nominate Will Grant!”

“Second!” a dozen voices rang out.

“Third!” someone yelled.

“Fourth!”

Lemm waved the members to quiet down.

“Will,” he said earnestly, “I know you must be feeling like you’ve been set up. Well, I am here to assure you that you have.” Laughter. “Calm down! Hush up, please, all of you. I’m sorry, Will. I apologize for making light of this. And seriously, it was Jeremy who suggested you as his replacement just yesterday, and the executive committee agreed. I know there’s not much time for preparation, but we will help you in any way we can, and if you want me, I’ll be right up there on the stage beside you as your aide-de-camp.”

There was absolute silence throughout the auditorium.

Will sighed. He knew he desperately did not want to publicly debate the flamboyant president of Excelsius Health. He also knew that he couldn’t say no to the Society.

“I’ve been humiliated and utterly degraded before,” he said without leaving his seat. “I suppose that means I’m well prepared for an encounter with Boyd Halliday.”

“Will. . Will. . Will. . Will,” someone began chanting, as if they were ringside at a prizefight. One hundred and forty joined in.

“Will. . Will. . Will. . Will.”

“There being no further business,” Lemm shouted out over the din, “I’ll see you all at Faneuil Hall. Nice job, all. Meeting adjourned.”

Of all the dumb things , Will thought, as he drove out through the largely deserted parking lot. You are no more equipped to match up with Boyd Halliday than you are to bat against Pedro Martinez . He pulled off to the side of the road, set his palm pilot on the wheel, and called up Tom Lemm’s cell phone number. Lemm would just have to do it. Before he could dial, his own cell began ringing.

“Dr. Grant?” a woman’s voice asked.

“Yes.”

“This is Ellie Newell. I work in the comptroller’s office at the hospital. Mr. Davidson is my boss. I called him about this, and he called Mr. Brodsky. Apparently, Mr. Brodsky told him you would want to hear what’s just happened.”

Seth Brodsky was the longtime CFO of Fredrickston General.

“What’s this about?” Will asked.

“It’s about your patient, John Doe, in the ICU.”

“He’s not John Doe anymore. He just woke up and told us his name. It’s Langley, Jack Langley from Des Moines, Iowa.”

“Yes, I know,” Ellie said. “I just spoke to his wife.”

“You did?” Will had called Marybeth Langley just a few hours before.

“I also spoke with an officer at Midwest Industrial Care, the HMO that covers the Langley family.”

“And?”

“Dr. Grant, correct me if I’m wrong, but it seems Mr. Langley is still facing a long hospitalization.”

“If there are no serious setbacks, he is. The man was essentially dead when he was brought in. It’s a miracle he’s alive at all. I would guess ten more days. Maybe even two weeks.”

“His bill already-counting, among other factors, the cost of the ER, the OR, the surgical team, the recovery room, the ICU, and a number of consultants-is in excess of forty-five thousand dollars.”

“I’m not surprised.”

“Well, Midwest Industrial has flatly refused to pay anything and will not pay for any subsequent care.”

“That’s ridiculous. What reason did they give?”

Ellie Newell hesitated.

“Well,” she said, “the insurance company has a strict policy regarding all surgery. No coverage unless the procedure is preapproved by them or approved within twenty-four hours.”

“But the man was in a coma!”

“I know.”

“How can they do this?”

“Mr. Davidson told me that you of all doctors wouldn’t even bother asking that question-that you’d already know the answer.”

Will felt himself deflate.

“You know, Mr. Davidson is absolutely right,” he said. “He’s absolutely right. Thanks for calling me.”

Will ended the call, then called Tom Lemm.

“Tom, it’s Will.”

“Hey, I hope you’re not upset with me for the way I railroaded you back there. Desperate situations call for desperate measures.”

“No problem,” Will replied. “I was just calling to see if we could get together tomorrow. We’ve got a lot to do before next week.”

Marybeth Langley was a petite, energetic woman with a sweet face and manner. For the week since Will’s call, she had been spending nights in a small B amp;B in downtown Fredrickston and days at the bedside of her husband, Jack. Despite the persistent refusal of their HMO to pay for any of Jack’s surgery, consultations, or hospitalization, she and her husband had decided to remain at FGH and under Will’s care until it was medically appropriate for him to return to lowa. Finally, that time had arrived.

It was mid-afternoon on a chilly, gray Thursday, the day of the Faneuil Hall managed-care forum. Will had repaired an electrician’s painful hernia in the morning, then worked his way through a reduced office schedule. He wanted to leave at least an hour for a final review of the mass of notes and articles he had accumulated regarding the shortcomings of managed care-especially Jeremy Purcell’s insights and strategies. Throughout college and medical school, Will never took an exam that he felt truly ready for, but never had he felt as ill-prepared for anything as he did for this debate. Saying yes to Tom Lemm and the Hippocrates Society was certainly noble enough, but it was evolving into one of the dumbest, most impetuous things he had ever done. He reminded himself for the hundredth time that he could only do what he could do, and then turned his attention to discharging his prize patient. The titanic struggle the two of them had endured together had forged a friendship that went well beyond the usual doctor-patient relationship.

“So, Jack,” Will said, “it looks like this is it.”

“Looks like.”

Langley had proven to be a bright, well-read man-a laconic Midwesterner with a subtle sense of humor, who listened to country-western music almost around the clock and loved his job selling heavy machinery, although his life’s dream had once been to become a veterinarian. The pictures of and by Langley’s kids had been taken down and packed. Nurse’s discharge instructions had been checked over by Will, then given. Langley, dressed in chinos and a loose-fitting Kansas City Royals sweatshirt, was seated in a wheelchair, the required mode of transportation for discharge.