Robin Cook - Fatal Cure

"The statistics are in for your first quarter," Kelley said in a somber tone. "And they are not good."

David looked back and forth between the two men, feeling increasingly anxious.

"Your productivity is not satisfactory," Kelley continued. "You are in the lowest percentile in the whole CMV organization according to the number of patient visits per hour. Obviously you are spending entirely too much time with each patient. To make matters worse, you are in the highest percentile in ordering laboratory tests per patient from the CMV lab. As far as ordering consults from outside the CMV community, you're completely off the graph."

"I didn't know these statistics were gathered," David said lamely.

"And that's not all," Kelley said. "Too many of your patients have been seen in the Bartlet Community Hospital emergency room rather than in your office."

"That's understandable," David said. "I'm fully booked out for two weeks plus. When someone calls with an obviously acute problem needing immediate attention, I send them to the ER."

"Wrong!" Kelley snapped. "You don't send patients to the ER. You see them in your office provided they're not about to croak."

"But such disruptions throw my schedule into a turmoil," David said. "If I take time out to deal with emergencies, I can't see my scheduled patients."

"Then so be it," Kelley said. "Or make the so-called emergency patients wait until you've seen the people with appointments. It's your call, but whatever you decide, don't use the ER."

"Then what's the ER for?" David asked.

"Don't try to be a wiseass with me, Dr. Wilson," Kelley said. "You know damn well what the ER is for. It's for life-and-death emergencies. And that reminds me. Don't suggest that your patients call an ambulance. CMV will not pay for an ambulance unless there is pre-approval and pre-approval is only granted in cases that are truly life-threatening."

"Some of my patients live alone," David said. "If they're ill…"

"Let's not make this more difficult than it need be," Kelley interrupted. "CMV doesn't operate a bus service. All this is pretty simple. Let me spell it out for you. You must seriously increase your productivity, you must lower your use of laboratory tests drastically, you must reduce, or better yet stop, using consults outside the CMV family, and you must keep your patients out of the ER. That's all there is to it. Understand?"

David stumbled out of the CMV office. He was flabbergasted. He'd never considered himself extravagant in the use of medical resources. He'd prided himself on always keeping the patient's needs to the fore. Kelley's tirade was unnerving to say the least.

Reaching his office suite, David limped inside. He caught sight of Kevin disappearing behind a closed door with a patient and remembered his prophecy about the utilization evaluation. Kevin had been right on target; it had been devastating. What also bothered David was that Kelley had not made a single reference to quality or patient approval.

"You'd better get hopping," Susan said the instant she saw him. "You're getting behind again."

Midmorning Angela ducked out of the lab and went to check on Nikki. She was pleased to find her doing as well as she was. The fact that she wasn't running a fever was particularly encouraging. There was also a definite subjective decrease in Nikki's congestion following a prolonged visit by the respiratory therapist. Angela used a nurse's stethoscope to listen to Nikki's chest. There were still sounds of excessive mucus, but not nearly as much as there had been that morning.

"When can I go home?" Nikki asked.

"You just got here," Angela said, giving Nikki's hair a tousle. "But if you continue to improve the way you've been going, I'm sure Dr. Pilsner won't want to keep you long."

Returning to the lab, Angela went to the microbiology section to check on Nikki's sputum swab; she wanted to make certain it had been plated. It was crucial to determine the mix of bacteria in Nikki's respiratory tract. The technician assured her it had been done.

Returning to her office, Angela hung up her white coat in preparation to read a series of hematology slides. Just before she sat down she noticed the connecting door between her office and Wadley's was ajar.

Angela went over to the door and peeked in. Wadley was sitting at a double-headed teaching microscope. He caught sight of her and waved for her to come over.

"This is something I want you to see," Wadley said.

Angela stepped over to the 'scope and sat opposite her mentor. Their knees almost touched beneath the table. She put her eyes to the eyepiece and peered in. Immediately she recognized the specimen as a sample of breast tissue.

"This is a tricky case," Wadley said. "The patient is only twenty-two years old. We have to make a diagnosis, and we have to be right. So take your time." To make his point, he reached under the table and grasped Angela's thigh just above the knee. "Don't be too impulsive about your impression. Look carefully at all the ducts."

Angela's trained eye began to scan the slide in an orderly fashion, but her concentration faltered. Wadley's hand had remained on her thigh. He continued talking, explaining what he thought were the key points for making the diagnosis. Angela had trouble listening. The weight of his hand made her feel acutely uncomfortable.

Wadley had touched her often in the past, and she had had occasion to touch him as well. But it had always been within acceptable social bounds, such as contact on an arm, or a pat on the back, or an exuberant hug. They had even done several "high fives" during the softball game at the Labor Day picnic. There had never been any implication of intimacy until now, when his hand remained rooted to her leg with his thumb on the inside of her thigh.

Angela wanted to move away or remove his hand, but she did neither. She kept hoping that Wadley would suddenly realize how uncomfortable she felt and withdraw. But it didn't happen. His hand stayed on her thigh throughout a long explanation about why the biopsy had to be considered positive for cancer.

Finally Angela got up. She knew she was trembling. She bit her tongue and turned back toward her office.

"I'll be ready to review those hematology slides as soon as you are through with them," Wadley called after her.

Closing the connecting door between the offices, Angela went over to her desk and sank into her chair. Near tears, she cradled her face in her hands as a flood of thoughts cascaded through her mind. Going over the course of events of the previous months, she recalled all the episodes when Wadley offered to stay late to go over slides, and all the times he appeared when she had a few free moments. If she ever went to the coffee shop he appeared and always took the seat next to her. And as far as touching was concerned, now that she thought about it, he never passed up an opportunity.

All at once the mentor-like effort and demonstrative affection Wadley had been expending had a different, less generous, more unpleasant connotation. Even the recent talk of attending a pathology meeting in Miami during the next month made her feel uneasy.

Lowering her hands Angela stared ahead. She wondered if she was overreacting. Maybe she was blowing this episode way out of proportion, getting herself all worked up. After all, David was forever accusing her of being overly dramatic. Maybe Wadley hadn't been aware. Maybe he'd been so engrossed in his didactic role, he didn't realize what he was doing.

She angrily shook her head. Deep down she knew she wasn't overreacting. She was still grateful for Wadley's time and effort, but she could not forget how it felt to have his hand on her thigh. It was so inappropriate. He had to have known. It had to have been deliberate. The question was what she could do to put an end to his unwanted familiarity. After all, he was her boss.