Lethal Practice (4 page)

She had smiled, walked over to where I was sitting, and straddled my lap. “You balance me,” she’d said while taking off my glasses. Then we’d made love, and the subject never came up again.

Back in the kitchen I wiped Muffy’s paws, filled her bowls, and listened to Janet put on her Dr. Graceton voice and phone the OR at her hospital—we deliberately worked at different institutions. She was halfway through setting up her operating schedule when I finished with the dog and blew her a kiss on my way out the door. She promptly indicated on which part of her anatomy I could place my affection. This was one of the reasons we worked separately.

The road back to the hospital wasn’t quite as deserted as it had been on my trip home a few hours earlier, but the sound of the tires and my opinion of the wet hadn’t altered. It was usually about this time of year when I considered a career change.

The meeting Hurst had refused to cancel was our annual slugfest to divide up the budget for hospital equipment. I could understand why he wanted us to carry on as normally as possible, but his rather fierce insistence that only
he
would announce Kingsly’s death was a little odd. Hell, everyone would know soon anyway. I didn’t even think it would take long for word to get out that it had been murder, no matter what Detective Bufort might want. Our gossip network was one of the fastest east of the Mississippi.

My walk across the parking lot did little to lift my spirits. Over me towered the lights and windows of St. Paul’s. Eight hundred beds, and from each of them I could imagine a plea by its occupant that this not be the final stop. I shivered as I felt these entreaties add their weight to the morning chill.

Normally a seven o’clock meeting would sputter to a start at seven-thirty. This morning the brightly lit boardroom was positively cheery with the smells of fresh coffee and hot danish. The usual cast of departmental chiefs was already into second servings and exuding a gaiety more befitting a cruise ship than our yearly squabble over money. Obviously, they hadn’t heard about Kingsly.

Hurst and the director of finance, Thomas Laverty, came in, slammed their Dickensian-size ledgers bulging with computer printouts onto the table, and sat down. The air changed. An odor of stale flesh and out-of-date thinking wafted through the room as they assumed their places.

“Gentlemen,” Hurst said, “the meeting will come to order.”

People coughed, scraped their chairs, and settled into the glazed trances they normally needed to endure these sessions. I noticed that Watts was absent. He was probably downstairs, already starting the postmortem on Kingsly. I wondered how the rest of the chiefs would react when Hurst announced his death.

“Okay,” Hurst said. “The first order of business is the hospital deficit. Mr. Laverty?”

Son of a bitch! He wasn’t going to tell them. Incredulous, I stared at Hurst, who caught my eye but looked pointedly at Laverty. Business as usual? That was obscene. Why was he waiting? And from the calm way Laverty started off his remarks, I could only presume Hurst hadn’t told him either.

I sat there stunned by Hurst’s callousness. I caught snippets about “services provided,” “managed care plans,” and “rates below what we’ve traditionally charged” as Laverty droned on about deficits and abandoning fee-for-service remuneration. I couldn’t tune in to a review of issues that were standard for most hospitals in the country. Whatever all of us thought of Kingsly, he had been a colleague, and nothing justified pushing on with a meeting like this within hours of his murder. My outrage grew as Laverty started showing pie charts and announcing figures while Hurst carefully fixed his baggy eyes on first one chief, then the next—his usual maneuver whenever he wanted to intimidate and stifle criticism. Most hadn’t the balls to challenge the numbers anyway, and “a two-point-five-million deficit” slipped by without pause for questions.

Laverty started a familiar review of how bigger hospitals had bought and closed smaller indebted hospitals to increase patient volume, but I had stopped even trying to pay attention, and his voice rumbled into the distance. Instead, I sank into a fugue of exhaustion and gave way to feeling sick at heart over the murder and Hurst’s brutal indifference to it. Finally, some of Laverty’s words again penetrated my fatigue.

“Therefore,” I heard him say, “we have no choice but to close a hundred beds immediately—and indefinitely.”

My first reaction was that I’d heard wrong, that I’d missed something by not keeping track of his little lecture. I knew immediately what the impact would be. Previous closures of other hospitals had overloaded the remaining emergency departments, and beds everywhere in the county were scarce. As it was, we had patients waiting one or two days in the ER before they finally got admitted. Now no one would have rapid access to beds, and we could expect the corridors of emergency to be littered with rows of stretchers.

But I hadn’t heard wrong—the uneasy look on Laverty’s face told me that. He kept glancing nervously at Hurst, but Hurst’s expression remained hard, cold.

Murmurs of alarm started coming from the others around the table.

“What about electives?”

“We’ll never get our cancer patients in.”

“Christ, our gallbladders’ll have gangrene by the time—”

“Are you out of your little minds?” Sean Carrington, seated next to me, boomed. His muscular physique and red, bushy eyebrows made him look more like a Highland chieftain than the chief of surgery.

“Oh, of course I’ll accept any reasonable alternative,” replied Hurst as he made a pyramid of his fingers in front of his mouth.

Sean went red at Hurst’s sarcasm, and I had to catch his arm while he took a few gulps of air to tame his well-known temper. Hurst just stared back at him as if Sean were a besotted fool to care about our patients.

Hector Saswald, chief of anesthesia and our leading opportunist, picked this awkward pause to test where he would be politically safe. “Uh, Mr. Laverty, you estimated a deficit of two point five million. Are you able to say how much we will save by closing a hundred beds?”

“Not exactly.”

“Not
exactly?”

“Well,” Laverty said, “we can’t fire anyone because of the unions, so we won’t save in salaries, but we
will
use less power and linen, and of course laundry and food costs will fall. We just haven’t broken out these costs per bed yet. Haven’t had a chance to get to it. However, I can assure you the savings will be significant.”

We were speechless.

Saswald quickly made his political choice. “Well, that explains any questions that I had. I commend senior management for its initiative and leadership in solving this problem for us, and I wish to have it recorded in the minutes that I give my full support for any additional budget-trimming measures of these kinds they come up with.”

Beaming at Hurst, he sat back in his chair.

Hurst still didn’t seem to care.

The rest of us needed a few seconds to realize the jerk was serious. I felt Sean start to tense again beside me, but I leaped to my feet before he throttled someone.

“Mr. Laverty, let me make sure I understand what has so thrilled Saswald here. Basically, you have no idea how much money will be saved by closing a hundred beds, and you don’t have any idea how long they will be closed. Is that right?”

Laverty stared at me as if it would have been obvious to a half-wit the first time. “So?” was his only reply.

“So since the savings are to come from the laundry, linen, and food normally used by the patients in these beds, you must be planning to keep them in emergency unfed, unclothed, and sheetless.”

“Dr. Garnet, I object!” shouted Laverty, flapping his hands at Hurst for help.

Hurst responded by slamming his hand on the table as if it were a gavel. “You’re out of order. Garnet!”

“Like hell I am. There hasn’t been an elective admission in medicine for a decade—they’re all emergencies—and we’ve twice as many of them since those other hospitals were shut down. Closing a hundred of our own beds now and letting even more patients pile up in the ER is nuts.”

I looked around for help. There were mutterings of approval and nods in unison from less than half of those around the table. The rest of the chiefs, the scared little political shits in the room, wouldn’t even look at me. They watched the extent of Hurst’s indifference, then accepted the inevitable and stayed silent. I felt the fight going out of me as their inertia and my own fatigue weighed me down ... until I saw Hurst start to smirk.

I slammed
my
fist down.

Now Sean put his hand on my arm. Everyone else shrank back. Except Hurst.

“Really, Dr. Garnet—”

“Days and nights in emergency corridors, sir, are not funny, with the noise and stink of overcrowding, on top of the pain and fear that patients come to us with. That’s the
reasonable alternative
that you and your cost cutting have gotten us.”

“That’s not fair!” Hurst snarled.

“When you and the mighty minds that run health care in this county got together two years ago, we ended up with the bright idea of closing hospitals. Except the boys with the calculators—the experts who assured us we could absorb the increased load and not let care suffer— goofed! You’ve done a lot of talking since, but not much has changed. Hell, some days we’re so jammed, we’ve had to refuse ambulances and hope nobody died trying to make it to the next ER.”

I stopped myself then. The litany of screw-ups was endless, and heaping it on Hurst wasn’t entirely fair. In giving vent to my fury and attacking him personally, I’d succeeded only in making an ass of myself. Everyone at the table except Sean started easing away from me, even my few allies from minutes earlier, their eyes shifting or hooding over with embarrassment. Yet as I fought to control my rage, I could have sworn Hurst looked pleased by my outburst. I couldn’t reconcile the devastated man from last night with the cold cynic who seemed to be gloating at me now. And still not a word about Kingsly. Why was he waiting?

“Gentlemen!” The soothing tones of Dr. Gil Fernandez, chief of psychiatry, poured onto our troubled waters.

Standing by the doorway, he must have slipped in unnoticed before I’d started my rant. He was tall and impeccably dressed in his trademark dark suit with a scarlet handkerchief elaborately puffed up in his breast pocket. He wore his black hair swept back from a high, balding forehead. A thin, carefully trimmed mustache seemed to give him three lips.

When every eye was on him, he completed his entrance by stepping to a vacant chair beside Hurst. “For the record,” he declared pompously, distracting everyone from my hysterics by his own strangeness, “as I have pointed out many times, psychiatry returns funds to the hospital from our pool to cover our own operating expenses, and therefore I feel we can in no way be held responsible for the deficit and must be excluded from any bed cuts. I assure you I’ve briefed Mr. Kingsly fully on our unique situation.”

I almost blurted out
Kingsly’s dead, you pompous prick,
but I made myself keep quiet. I wanted to see if Fernandez’s use of the dead man’s name would force Hurst to finally tell everyone. It didn’t. Hurst simply gazed benignly at Fernandez, then said, “Of course. Dr. Fernandez, your situation is unique. Our calculations suggest the new measures in your department will be limited to a few beds at most.”

The smug look between the two curdled what was left of the milk in the few sips of coffee I’d gotten down.

“Speaking of Kingsly, where
is
our chief executive officer?” Sean asked. “Has he permanently withdrawn from these meetings?”

This wasn’t an innocent inquiry. At every meeting over the last couple of years, one of us had made a point of asking where Kingsly was. We hadn’t wanted him present; we’d wanted him fired. So we’d taken turns putting his absences on the record. But Hurst basically ran the hospital the way he wanted in Kingsly’s absence and had no interest in getting him fired. He was fully aware of our impotent little game but dutifully excused Kingsly each time to keep his absences off the record. For this crap, we’d become doctors.

But that was over now.

Despite my orders from Hurst, I had to let Sean know. I leaned toward his ear and quietly warned, “Stop it! Not anymore.”

He gave me a puzzled look. “Wait a minute,” he protested. ‘The guy should be here! If he can’t cut it, get him replaced! We decided—”

“He’s dead!” I whispered, trying to get him to shut up. “They found him last night in his office.” But it was too late.

Hurst leaped to his feet. “How dare you speak ill of the dead!” he roared. He didn’t even wait for a collective gasp before adding, “For years I’ve put up with your snide remarks and outright insults about the poor man, but this morning, it’s too much!”

Sean and I were frozen. The others kept darting their eyes to us and back to Hurst. For a moment I thought he’d snapped. His cheeks were violently red and his body shook. Then he stiffly drew himself straighter, just as I’d seen him do in Kingsly’s office earlier that morning. But now, unlike then, his eyes were hard and focused. This was an act, and I realized what he’d been up to all along.

“It is my extremely sad duty,” he began, in a low tone now, with just the right tremble in his voice, “to announce the untimely passing of Mr. Kingsly. He was found dead in his office last night.”

No lies there. The expected “Oh, no,” “That’s awful,” “How sad” broke out around the table, but no one asked a single question about cause of death. I guessed everyone simply assumed it was related to his drinking.

“And I am doubly shaken,” Hurst continued, his voice again rising, filling with a carefully honed anger, “by the insulting words of Drs. Garnet and Carrington regarding our poor friend and leader.”

He gazed slowly around at his audience so none would miss the look of hurt he wore because of Sean and me. “I tried to carry on business as usual in the way I know the man would have wanted us to, but now simple dignity demands that we adjourn this meeting.” He wearily sat back in his chair and covered his eyes.

The better to hide his triumph, I thought.