Robin Cook - Fatal Cure

"You think CMV gave us fraudulent numbers?" Traynor asked.

"No," Beaton said. "But like all HMOs when they are dealing with their own hospitals, CMV has an economic incentive for their doctors to limit hospitalization, something the public has no idea about."

"You mean like actual payments to the doctors?" Traynor asked.

"Exactly," Beaton said. "It's a bonus bribe. The more each doctor cuts his hospitalization rates the bigger the bonus. It's very effective. Caldwell and I believe we can fashion a similar economic incentive here at Bartlet Community Hospital. The only problem is that we will have to fund it with some start-up capital. Once it's operational, it will pay for itself by reducing hospitalization."

"Sounds great," Traynor said with enthusiasm. "Let's pursue it. Maybe this kind of program, combined with DUM, will eliminate the red ink."

"I'll arrange a meeting with Charles Kelley to discuss it," Beaton said as she got her coat.

"While we're on the topic of utilization," Beaton said as they started down the long hall toward the exit, "I hope to heaven that we're not going to get the Certificate of Need for open-heart surgery. It's crucial we don't. We have to keep CMV sending their bypass patients to Boston."

"I agree wholeheartedly," Traynor said as he held the door open for Beaton. They passed out of the hospital into the lower parking area. "That was one of the reasons I was in Montpelier today. I've started some behind-the-scenes negative lobbying."

"If we get that CON we'll be looking at a lot more red ink," Beaton warned.

They arrived at their respective cars which were parked side by side. Before he climbed behind the wheel, Traynor glanced around the dark parking area, particularly up toward the copse of trees that separated the lower lot from the upper.

"It's darker out here than I remembered," he called over to Beaton. "It's like asking for trouble. We need those lights."

"I'll get right on it," she promised.

"What a pain!" Traynor said. "With everything else we have to worry about, we've got to worry about a damn rapist. What are the details about last night's episode?"

"It occurred about midnight," Beaton said. "And this time it wasn't a nurse. It was one of the volunteers, Marjorie Kleber."

"The teacher?" Traynor asked.

"That's right," Beaton said. "Ever since she got sick herself she's been doing a lot of volunteering on weekends."

"How about the rapist?" Traynor asked.

"Same description: about six feet, wearing a ski mask. Ms. Kleber said he had handcuffs."

"That's a nice touch," Traynor said. "How'd she get away?"

"It was just lucky," Beaton said. "The night watchman just happened along while making his rounds."

"Maybe we should beef up security," Traynor suggested.

"That's money we don't have," Beaton reminded him.

"Maybe I should talk to Wayne Robertson and see if the police can do any more," Traynor said.

"I've already done that," Beaton said. "But Robertson doesn't have the manpower to have someone up here every night."

"I wonder if Hodges really did know the rapist's identity?"

"Do you think his disappearance could have had anything to do with his suspicions?" Beaton asked.

Traynor shrugged. "I hadn't thought of that. I suppose it's possible. He wasn't one to keep his opinion to himself."

"It's a scary thought," Beaton said.

"Indeed," Traynor said. "Regardless, I want to be informed about any such assaults immediately. They can have disastrous consequences for the hospital. I especially don't want any surprises at an executive board meeting. It makes me look bad."

"I apologize," Beaton said, "but I did try to call. From now on I'll make sure you are informed."

"See you down at the Iron Horse," Traynor said as he got into his car and started the engine.

"I've got to leave to pick up my child from her after-school program," Angela said to one of her fellow residents, Mark Danforth.

"What are you going to do about all these slides?" Mark asked.

"What can I do?" Angela snapped. "I've got to get my daughter."

"Okay," Mark said. "Don't jump on me. I was only asking. I thought maybe I could help."

"I'm sorry," Angela said. "I'm just strung out. If you could just see these few I'd be forever in your debt." She picked five slides from the rack.

"No problem," Mark said. He added Angela's to his own stack.

Angela covered her microscope, grabbed her things, and ran out of the hospital. No sooner had she pulled out of the lot than she was bogged down in rush-hour Boston traffic.

When Angela finally pulled up to the school, Nikki was sitting forlornly on the front steps. It was not a pretty area. The school was awash with graffiti and surrounded by a sea of concrete. Except for a group of sixth- and seventh-graders shooting baskets beyond a high chain-link fence, there were no grammar-school-aged children in sight. A group of listless teenagers in ridiculously oversized clothing loitered alongside the building. Directly across the street was the cardboard shanty of a homeless person.

"I'm sorry I was late," Angela said as Nikki climbed into the car and plugged in her seat belt.

"It's all right," Nikki said, "but I was a little scared. There was a big problem in school today. The police were here and everything."

"What happened?"

"One of the sixth-grade boys had a gun in the playground," Nikki said calmly. "He shot it and got arrested."

"Was anybody hurt?"

"Nope," Nikki said with a shake of her head.

"Why did he have a gun?" Angela asked.

"He's been selling drugs," Nikki replied.

"I see," Angela said, trying to maintain her composure as well as her daughter could. "How did you hear about this? From the other kids?"

"No, I was there," Nikki said, suppressing a yawn.

Angela's grip on the steering wheel involuntarily tightened. Public school had been David's idea. The two of them had gone to considerable effort in choosing the one that Nikki attended. Up until this episode, Angela had been reasonably satisfied. But now she was appalled, partly because Nikki was able to talk about the incident so matter-of-factly. It was frightening to realize that Nikki viewed this as an ordinary event.

"We had a substitute again today," Nikki said. "And she wouldn't let me do my postural lung drainage after lunch."

"I'm sorry, dear," Angela said. "Do you feel congested?"

"Some," Nikki said. "I was wheezing a little after being outside, but it went away."

"We'll do it as soon as we get home," Angela said. "And I'll call the school office again, too. I don't know what their problem is."

Angela did know what the problem was: too many kids and not enough staff, and what staff they had was always changing. Every few months Angela had to call to tell them about Nikki's need for respiratory therapy.

While Nikki waited in the car, Angela double-parked and dashed into the local grocery store for something to make for dinner. When she came out there was a parking ticket under the windshield wiper.

"I told the lady you'd be right out," Nikki explained, "but she said 'Tough' and gave it to us anyway."

Angela cursed under her breath.

For the next half hour they cruised around their immediate neighborhood looking for a parking space. Just when Angela was about ready to give up they found a spot.

After putting cold groceries in the refrigerator, Angela and Nikki attended to Nikki's respiratory physiotherapy. Usually they only did it in the morning. But on certain days, usually those with heavy pollution, they had to do it more often.

The routine they had established started with Angela listening with her stethoscope to make sure Nikki didn't need a bronchodilating drug. Then, by using a large beanbag chair that they'd bought at a garage sale, Nikki would assume nine different positions that utilized gravity to help drain specific areas of her lungs. While Nikki held each position, Angela percussed over the lung area with a cupped hand. Each position took two or three minutes. In twenty minutes they were finished.