Robin Cook - Fatal Cure

"What are you talking about?" David asked.

"Just yesterday I spoke with you about utilization," Kelley said. "I thought it was pretty clear and that you understood. Then today you irresponsibly ordered two non-CMV consults to see a hopelessly terminal patient. That kind of behavior suggests that you have no comprehension of the major problem facing medicine today: unnecessary and wasteful expense."

With his emotions raw, David struggled to keep himself under control. "Just a minute. I'd like you to tell me how you know the consults were unnecessary."

"Oh, brother!" Kelley said with a supercilious wave of his head. "It's obvious. The patient's course wasn't altered. She was dying and she proceeded to die. Everyone must die at some time or another. Money and other resources should not be thrown away for the sake of hopeless heroics."

David stared into Kelley's blue eyes. He didn't know what to say. He was dumbfounded.

Hoping to avoid Wadley, Angela sought out Dr. Paul Darnell in his windowless cubicle on the other side of the lab. His desk was piled high with bacterial culture dishes. Microbiology was his particular area of interest.

"Can I speak to you for a moment," Angela called from Paul's doorway.

He waved her in and leaned back in his swivel chair.

"What's the autopsy protocol around here?" she asked. "I haven't seen any done since I got here."

"That's an issue you'll have to discuss with Wadley," Paul said. "It's a policy problem. Sorry."

Reluctantly, Angela went to Wadley's office.

"What can I do for you, honey?" Wadley said. He smiled a kind of smile Angela had previously seen as paternal but now saw as lewd.

Wincing at being addressed as "honey," Angela swallowed her pride and asked about the procedure for arranging an autopsy.

"We don't do autopsies," Wadley said. "If it's a medical examiner case, the body goes to Burlington. It costs too much to do autopsies, and the contract with CMV doesn't include them."

"What if the family requests it?" Angela asked, knowing this wasn't precisely true in the Kleber case.

"If they want to shell out eighteen hundred and ninety dollars, then we'll accommodate them," Wadley said. "Otherwise, we don't do it."

Angela nodded, then left. Instead of getting back to her own work, she walked over to the professional building and went into David's office. She was appalled by the number of patients waiting to be seen. Every chair in the waiting room was occupied; a few people were even standing in the hall. She caught David as he shuttled between examining rooms. He was clearly frazzled.

"I can't do an autopsy on Marjorie Kleber."

"Why not?" David asked.

Angela told him what Wadley had said.

David shook his head with frustration and blew out between pursed lips. "My opinion of this place is going downhill fast," he said. He then told Angela about Kelley's opinion of his handling of the Kleber case.

"That's ridiculous," Angela said. She was incensed. "You mean he suggested that the consults were unnecessary because the patient died. That's crazy."

"What can I tell you?" David said with a shake of his head.

Angela didn't know what to say. Kelley was beginning to sound dangerously uninformed. Angela would have liked to talk more, but she knew David didn't have the time. She motioned over her shoulder. "You've got an office full of patients out there," she said. "When do you think you'll be done?"

"I haven't the slightest idea."

"How about I take Nikki home and you give me a call when you're ready to leave. I'll come back and pick you up."

"Sounds good," David said.

"Hang in there, dear," Angela said. "We'll talk later."

Angela went back to the lab, finishing up for the day, collected Nikki, and drove home. Nikki was ecstatic to get out of the hospital. She and Rusty had an exuberant reunion.

David called at seven-fifteen. With Nikki comfortably ensconced in front of the TV, Angela returned to the hospital. She drove slowly. It was raining so hard the wipers had to struggle to keep the windshield clear.

"What a night," David said as he jumped into the car.

"What a day," Angela said as she started down the hill toward town. "Especially for you. How are you holding up?"

"I'm managing," David said. "It was a help to be so busy. I was grateful for the diversion. But now I have to face reality; what am I going to tell Nikki?"

"You'll just have to tell her the truth," Angela said.

"That's easier said than done," David said. "What if she asks me why she died? The trouble is I don't know, neither physiologically nor metaphysically."

"I've thought more about what Kelley said," Angela said. "It seems to me he has a fundamental misunderstanding about the basics of patient care."

"That's an understatement," David said with a short, sarcastic laugh. "The scary part is that he's in a supervisory position. Bureaucrats like Kelley are intruding into the practice of medicine under the guise of health-care reform. Unfortunately the public has no idea."

"I had another minor run-in with Wadley today," Angela said.

"That bastard!" David said. "What did he do now?"

"He called me 'honey' a few times," Angela said. "And he brushed his hand across my backside."

"God! What an insensitive jerk," David said.

"I really have to do something. I just wish I knew what."

"I think you should talk to Cantor," David said. "I've given it some thought. At least Cantor is a physician, not just a health-care bureaucrat."

"His comment about 'the girls,' as he called them, in his medical school class was not inspiring," Angela said.

They pulled into their driveway. Angela came to a stop as close as possible to the door to the mud room. They both prepared to run for shelter.

"When is this rain going to stop?" David complained. "It's been raining for three days straight."

Once they were inside, David decided to make a fire to cheer up the house while Angela reheated the food she'd made earlier for herself and Nikki. Descending into the basement, David noticed that moisture was seeping through the grout between the granite foundation blocks. Along with the moisture was the damp, musty odor he'd occasionally smelled before. As he collected the wood, he comforted himself with the thought of the earthen floor. If a significant amount of water were to come into the basement, it would just soak in and eventually disappear.

After eating, David joined Nikki in front of the TV. Whenever she was ill they were lenient about how much time she was allowed to watch. David feigned interest in the show in progress, while he built up the courage to tell Nikki about Marjorie. Finally, during a commercial break, David put his arm around his daughter.

"I have to tell you something," he said gently.

"What?" Nikki asked. She was contentedly petting Rusty who was curled up on the couch next to her.

"Your teacher, Marjorie Kleber, died today," David said gently.

Nikki didn't say anything for a few moments. She looked down at Rusty, pretending to be concerned about a knot behind his ear.

"It makes me very sad," David continued, "especially since I was her doctor. I'm sure it upsets you, too."

"No, it doesn't," Nikki said quickly with a shake of her head. She brushed a strand of hair away from her eyes. Then she looked at the television as if she were interested in the commercial.

"It's okay to be sad," David said. He started to talk about missing people you cared about when Nikki suddenly threw herself at him, enveloping him in a flood of tears. She hugged him tighter than he could ever remember her having hugged him.

David patted her on the back and continued to reassure her.

Angela appeared at the doorway. Seeing David holding their sobbing child, she came over. Gently pushing Rusty aside, she sat down and put her arms around both David and Nikki. Together the three held onto each other, rocking gently as the rain beat against the windows.