Robin Cook: Critical

With slightly more optimism than she had had earlier that afternoon, Angela pushed back from her desk, picked up her notes, and emerged from her office. She was surprised to see her secretary, Loren Stasin, sitting dutifully at her desk. Angela had not given the woman a thought over the previous three hours.

"Why are you still here?" Angela questioned with a touch of guilt.

Loren shrugged her narrow shoulders. "I thought you might need me."

"Heavens, no. Go on home! I'll see you in the morning."

"Do I need to remind you of your meeting tomorrow morning at the Manhattan Bank and Trust, followed by your meeting with Mr. Calabrese at his office?"

"Hardly," Angela said. "But thank you anyway. Now, you get out of here!"

"Thank you, Dr. Dawson," Loren said while surreptitiously putting away a novel.

Angela continued down the stark interior hallway. For a multitude of reasons, she wasn't looking forward to tomorrow's meetings. She always found it somewhat demeaning to try to raise money, and now, in such a desperate situation, it would be that much more humiliating. Even worse was that one of the people she would be asking for money was her ex-husband. Whenever she met with him, regardless of the reason, it almost never failed to evoke all the emotional turmoil of the divorce, not to mention the vexation she felt toward herself for having married him in the first place. She should have known better. There had been too many subtle suggestions that he would turn out like her father, challenged by her success to the point of encouraging bad behavior.

At the closed door to the boardroom, Angela paused, took a fortifying breath, then entered. Similar to her private office, the interior was aseptically modern, and dominated by a striking central table composed of a two-inch-thick piece of glass placed on the top of a white marble Ionic capital. The floor was white marble tile. Each of the side walls to the right and left had imbedded flat-screen television monitors for PowerPoint presentations. The far wall was glass, overlooking Fifth Avenue. The gilded and illuminated top of the landmark Crown Building immediately across the street filled the starkly modern room with a reflected warm glow.

The round table had been Angela's idea. Her management style emphasized teamwork rather than hierarchy, and the round table was more egalitarian than the usual boardroom fare. Although there were chairs for sixteen people, only six were occupied at the moment. The CFO was by himself at the opposite end, his back to the window. The three hospital presidents were to Angela's left. The COO was a few chairs away from the CFO, to Angela's right. The infection-control professional was next to the COO.

Purposefully, none of the department heads of Angels Healthcare, such as those from supply, laundry, engineering, housekeeping, public relations, personnel, laboratory services, and nursing, medical staff, or outside members of the board, were present. In fact, none had even been notified that the meeting was scheduled, much less invited.

Angela smiled cordially as she quickly glanced around at individual faces and acknowledged each person. The expressions were mildly apprehensive, except for CFO Bob Frampton, whose fleshy face had an ever-present sleep-deprived appearance, and for COO Carl Palanco, who looked to be in a state of continual surprise.

"Good evening, everyone," Angela said as she sat down. She again glanced around the room. "First, let me apologize for keeping you waiting. I know it is late and you are eager to get home to your families, so we will make this short. The good news is that we are still in business." Angela glanced at the three presidents, all of whom nodded in a restrained fashion. "The bad news is that our cash-flow problem has gone from concerning to critical. Of course, we felt the situation was critical a month ago, but it has gotten worse."

Angela gestured toward Bob Frampton, who shook his head slightly as if to wake himself. He leaned forward, putting his elbows on the table with his beefy hands together and fingers interlocked.

"We are rapidly approaching, if not violating, our eighty percent margin on our loans with the Manhattan Bank and Trust. We had to sell some bonds to make a payment to our cardiac stent provider. They were threatening to cut off our supply."

"Considering how tight finances are, I want to personally thank you for doing that," Dr. Niesha Patrick said. She was a young African-American woman with light skin and a scattering of freckles in a butterfly pattern across her nose and cheeks. Like Angela, she had an MBA in addition to an M.D. Angela had recruited her from a large West Coast managed-care company to run Angels Heart Hospital. "With our ORs intermittently closed, our only dependable source of income has been from invasive angiography and cardioplasty. Without stents, even that revenue would be severely impacted."

"Invasive angiography and Lasik have probably been responsible for keeping us afloat," Angela said. She nodded in appreciation toward both Niesha and Dr. Stewart Sullivan. Stewart was the president of Angels Cosmetic Surgery and Eye Hospital.

"We are all doing what we can," Stewart said.

"As much of a gold mine specialty hospitals are in the current reimbursement milieu," Angela said, "they are at a particular disadvantage when their operating rooms close."

"But the operating rooms are now all open," Dr. Cynthia Sarpoulus said defensively. Cynthia was a medical-school classmate of Angela's who'd gone on to specialize in infectious disease and epidemiology. Angela had hired her when the current nosocomial infection problem started three and a half months previously. Cynthia was a dark-complected, raven-haired woman with a bit of a temper. Angela had been willing to put up with her thin-skinned and often caustic style because of her training, dedication, intelligence, and reputation. She'd been the reputed savior of several institutions with infection-control problems.

"They might be open, but they aren't being utilized except by a fraction of our medical staff," Dr. Herman Straus said. Angela had recruited Herman from a Boston community hospital, where he'd been a well-respected assistant administrator. A big, athletic man with an outgoing personality, he had a particular affinity for dealing with orthopedic surgeons. That quality combined with his Cornell Hospital administration training made him an ideal president of Angels Orthopedic Hospital, and his record was proof of it.

"And why is that?" Angela asked. "Surely they know we have been on top of this problem right from the beginning. Cynthia, remind everyone what has been done."

"Just about everything possible," Cynthia snapped, as if she was being challenged. "Every OR has been cleaned with sodium hypochlorite and fumigated at least once with a product called NAV-CO2. It's a nonflammable alcohol vapor in carbon dioxide."

"And not without considerable expense," Bob interjected.

"And why that particular agent?" Carl questioned.

"Because methicillin-resistant staphylococcus aureus, or its more common designation, MRSA, is highly sensitive to that particular preparation," Cynthia shot back, as if it were a fact everyone should know.

"Let's not get testy," Angela said. She wanted to keep the meeting friendly and, she hoped, productive. "We are all on the same page here. No one is casting aspersions. What else has been done?"

"Every hospital room that has seen an infection has also been similarly treated," Cynthia said. "More important, perhaps, as you all know, every member of the medical staff and every employee of the hospitals are cultured on a recurrent basis, and those who test positive as a carrier are treated with mupirocin until they test negative."

"Also at great expense," Bob added.

"Please, Bob," Angela said. "We are all aware of the expense side to this disaster. Cynthia, continue! Do you think culturing and treating the staff and employees is critical?"