“It was a dark and stormy night,” ...yeah, right…just like the opening line of a bad fiction novel. Looking outside at the rain pelting the breakroom window, I was more worried about what was going on inside. More like inside my patient’s belly. Problem was that the situation was a little more complicated than just the weather.
As the trauma surgeon on call, I had a twenty-nine-year-old white male with a suspected torn liver from a motor vehicle accident. All I wanted was to get this case going and explore this nice gentleman’s belly to make sure he would not bleed to death. My employer Columbus HealthCare System was doing their best to keep me from doing just that.
I ambled up to the Operating Room desk and asked the night nurse supervisor, “Hey, Lilly. When are we going to start this little night-crew shindig?”
“We’ve already opened everything for you in room #10, but we’re waiting on Dr. Campbell to finish his three-level back surgery case in room #23, Dr. Chandler,” she said in her best sarcastic tone. “You know, his case is listed as a level one priority.”
That meant big bucks for hospital charges, for hardware, and OR time for CHS.
“So what?” I replied.
“Unless your patient’s vital signs have suddenly changed, Dr. Campbell still gets priority. You do know the new rules, don’t you, Doctor?”
Did I ever. Since the big CHS buyout last year, money made the rules. All high paying cases now got top priority. Patient care now took a backseat.
So there I waited, anxious to pull my patient out of danger and across the finish line, but still stuck at the starting gate.
Meanwhile, waiting to go in OR #10 was my patient. A nice guy on his way home from work on a typical Friday evening, driving through the rain, probably trying to remember what kind of pizza his wife told him to pick up for the kids. His problem started when a semi-truck changed lanes without looking and turned the end of his workweek into a nightmare deluxe.
His vital signs were shaky at best when he hit the trauma room door. The patient’s ER workup—which I sometimes think stands for extra resistance—and his abdominal CT scan both indicated a torn liver. Despite the trauma team getting his tank filled with several units of blood before heading to the OR, I felt leery about him crashing and burning in a hurry.
To make matters worse, this delay of an urgent surgery made me more paranoid than usual. The last few months it seemed like I got the shuffle and stall every time I scheduled an emergency. I couldn’t quite put a finger on it, but I’d noticed a lot of subtle things coming my way. It had gotten so bad in recent weeks that even when I had an emergency case like tonight, I had to wait eons for their managed care representative to approve it.
Since the takeover of St. Jude Hospital by CHS, some clueless rep. who didn’t know the first thing about surgery, medicine, and life in general, now determined if and when it was necessary for surgeons to operate on patients. Unbelievable.
“Do you have a faxed approval to go ahead from the CHS quality assurance representative yet?” Lily raised one eyebrow, almost daring me to produce a stupid piece of paper.
“Of course, dearest Lilly,” I said in my most Southern accent, trying to hide the anger seething through the back of my voice. “I called it in over an hour ago. It should be on your desk as soon as the poor overworked rep. has a chance to fax it to you.”
Most of my present resentment had been caused by trying to reach this CHS rep., finally getting past the ever-present busy signal on their toll-free, anxiety-building number.
“Hello, this is Columbus HealthCare System, provider relations department,” the representative had answered in a monotone voice.
“Yes, this is Dr. Kyle Chandler at St. Jude Hospital in Kansas City. Someone placed a call for me over half an hour ago to get approval to take my patient to the operating room for abdominal trauma. The operating room here still hasn’t received approval confirmation. What’s the holdup?”
“What did you say your name was?” the representative replied.
“Chandler. Dr. Kyle Chandler. And what is your name, please?” trying to hide the razor tone of my voice.
“I’m sorry. We are not allowed to give out personal information concerning representatives. Now what was your question?”
“Look Ms. What-Ever-Your-Name-Is, I have a twenty-nine-year-old unfortunate man with two young children at home. He happened to be on the wrong end of a semi-truck this evening. If he doesn’t get to the operating room soon, there’s a good chance he will likely bleed out from multiple internal injuries. He has CHS insurance like everyone else these days, so what more do I have to do to help this guy stay alive?”
“It is not necessary to be so abrupt,” she replied. “If you will once again give me the basic insurance information, I will check to make sure this accident recipient is a valid company policyholder.”
Accident recipient. Valid company policyholder. What happened to real people with their real families and real feelings?
I gave her all the inane, nonmedical information that she desired, making me wonder why I went to medical school in the first place. She assured me that it sounded like this case would probably be approved. Probably, she stressed. I half expected a lecture from her on the expensive costs of surgery these days, but I guess she was too busy to finish her speech.
I hung up and waited for what seemed like an eternity. Finally, I got the go ahead to explore this nice guy’s abdomen. Thank goodness I only found small-sized tears of the left lobe of the liver that were easily repaired. Disaster averted. Chalk up another run for the good guys of patient care.
After putting the dressing on his incision, I shed my gloves and gown and headed for the surgery waiting room. I found the patient’s wife half asleep. I explained that I was very happy that her husband’s internal injuries were much smaller that we suspected before surgery and that things went very well. I told her that I felt confident that he’d likely make a full recovery. Her smile and a brief squeeze of my hand showed her huge sense of relief. That moment is what made the insanity of this place still worth my while.
When I finished speaking with the patient’s wife, I got out of my wrinkled scrubs, dressed, and headed for the recovery room to check my patient’s vital signs once more. He was doing well, all things considered, so it was time for me to head home.
As I hurried toward the parking lot, I slammed my fist into my other hand, realizing that I left my car keys back in my white coat hanging in my OR locker. Man, I hated when I did bonehead things like that.
I turned around and trotted back to the surgeon’s lounge. As I entered the dressing room, I thought it strange that at that very moment, the door on the other end closed.
Then, I saw the upper compartment to my OR locker was open. I never left that open.
I slowly opened the door wider, half expecting a pit bull to jump out at me. Instead, nothing was out of place. I checked the latch to the upper locker door. It worked perfect.
Who would be in the dressing room at this late hour other than the cleaning people? And they wouldn’t leave in a rush, even if the building was on fire. The surgery locker room was an inner sanctum that only the warriors of the OR could visit.
Maybe it was another surgeon getting ready for an urgent surgery case. The problem with that was that when my case was through, I glanced at the surgery schedule board on my way out, and there were no other cases pending. Don’t over think this. Just blow it off, Chandler.
I looked for my keys in the pocket of my white lab coat hanging in my locker. Not there. My anxiety went up a notch. I searched the rest of my locker and found them on the floor of the locker in my OR shoes. I never would have put them there.
I found there were six keys on the ring instead of seven. The missing key was a small numbered key that went to a storage locker I rented. The key was definitely gone. What in world was going on?
As I tried to calm myself, I shut my locker door and trudged back to my car in the doctor’s parking lot now so conveniently located in what seemed like another zip code. Another CHS award winning idea.
This whole situation was really beginning to bug me now. Who would have gone in there? And how would they get access to the combination to my locker? Why were they looking for a certain key? Too many questions.
I got in my old gray Volvo sedan and drove home, hopeful for some serious shut-eye. When I arrived, I realized that some things in life were not meant to be.
The minute I opened my condo door, I knew that I should have listened to the news on the radio on my way home to see if Pearl Harbor had been bombed again. Via my kitchen. Make that my previous kitchen.
Whoever came through there left no stone unturned. Pots and pans out, cabinet drawers open. Cereal, flour, sugar on the counters, you name it. Everything was scattered everywhere. Next, I went from room to room. More of the same. Furniture turned over, pictures off the walls, drawers left open. Really not too much serious damage, but for what?
After a quick check, I discovered nothing was missing. Should I call the police? Probably yes, but what good would that do since nothing was taken? I was worried although I wasn’t really scared. To be a successful trauma surgeon, you had to be fearless and take whatever pitches they throw at you. An older surgery professor once taught me to fight stress with sarcasm. So no, I was not calling the police. But two incidents on the same night in two different places? Better yet, why?
/ / / / /
"Anything pressing I need to know about?" I asked my secretary Janice the following Tuesday lunch hour as I stopped at her cubicle. I had been on trauma-call on both Friday and Sunday. Because I was on call two days over the weekend, I was off call today, Tuesday.
“Well, you’ve got two new inpatient consults to see, and you’ve got to code last Wednesday’s exploratory laparotomy case for me, because the OP report isn’t back yet. Also a bunch of phone messages on your desk,” she replied, in her usual unexcitable tone.
Janice had been with me since I joined the group seven years ago. She had previously been the secretary for an older OB/GYN physician, famous for always forgetting his glasses and doing surgery by Braille. She said he finally had to retire when the group found out that his eyesight was actually fine, but it was really Jack Daniels that caused his perpetual blurred perception.
“You weren’t on call for someone else last night, were you?” she asked. “I saw another awful car wreck that made the ten o’clock news.”
“No, that case must have gone elsewhere. As you know, I was on call Friday evening and had an MVA case that turned out a lot smaller than expected. All of my elective Monday cases went fine. This morning I spoke with Dr. Anders as I was passing through the ER on the way to my surgery cases. He mentioned that it was a quiet night last night. That one you saw on the news must have involved one of the last surviving people in the Midwest that did not have Columbus HealthCare as their insurance,” I quipped as I flipped through the mail she handed me.
Since their takeover of St. Jude Hospital last year, things had definitely changed for the worse. I must have been one of the only people that felt CHS was inept since they were the current rage on Wall Street. The company had originally started as a small, efficient managed care system of hospitals in the Northeast; until a little over two years ago it unexpectedly had quadrupled in size, consuming hospitals faster than a starved linebacker at a free all-you-can-eat buffet.
“You know that remarks like that about CHS are eventually going to get you in trouble,” she replied.
“Not likely. Unless the hidden cameras they originally put in this place got new audio hook-ups.”
“Funny,” she murmured. “By the way, how’s your trauma patient from the weekend, the one that got hit by the semi-truck you left me a note about?”
“He’s going to do okay,” I replied. “Should go home any day now.”
Janice was fairly efficient, wasn’t long on humor, but all the same, was a group employee with seniority. More important, she really knew her limits of what she didn’t have to do. She was good at working the system to make my life tolerable, but was also an expert of not doing one thing beyond her required job description. Not a great situation, but it could be worse.
“Oh…Sydney called,” she added. “Left a message to have you call him on his mobile phone this morning or try him at his club downtown around lunchtime.
“Thanks. I’ll try to reach him later.” Work areas with no doors made easy eavesdropping for all to hear within a thirty-foot radius.
I made my way back to the cubicle that my multispecialty group called my office. Personal offices were inefficient use of space they said, as determined by our group’s Efficiency Management Committee. Therefore, everyone got a small, semi-open desk with two side panels. They were placed like a hundred miles from the patient exam rooms on purpose so you wouldn’t hang out at your desk. Another perk for all those years of medical training.
I sat down, going through the rest of my mail when a certain letter caught my eye. It was from my investment firm, which handled my banking transactions and what little investments I had. What was strange was that anything concerning my personal and financial matters was always sent to my home, not to my office.
I opened the letter. It was from the financial advisor who handled my account, a somewhat aggressive middle-aged manager who thought he was much more on the cutting financial edge than he really was. Along with the letter was a printout showing that there recently had been an unusual number of inquiries on the status of my account by an unlisted computer source. There were also a number of inquiries from some outside credit rating agencies about my current credit status.
The short note from my account advisor inquired if I had recently bought some hugely expensive antique that might have triggered this new interest in my account. He knew of my growing interest in buying and selling antiques. It was a hobby I had taken up a few years back to balance my life with something completely different from my career in medicine. I gave him a call to see what the deal was.
“Good morning, James Galloway’s office. How may I help you?” his efficient secretary answered.
“Hello, this is Dr. Kyle Chandler. May I speak with James?”
“I’m sorry, Dr. Chandler. He’s in a meeting right now, may I take a message?”
“Please have him call me at my office when he gets out of his meeting.” I hung up knowing darn well that we would probably play phone tag for the next several days.
I ambled back up to Janice’s cubicle.
“Page me if James Galloway calls, will you Janice?” I left her cubicle heading for the hallway. “I’m going to make rounds next door and then see these two new consults before afternoon office hours start.” I didn’t tell her that I had to make a brief stop along the way.
The offices of our multispecialty group, Client Interaction Areas, as redefined by CHS—was in a large modern office complex joined by an underground passageway to the main building of the hospital. St. Jude Hospital, the Catholic institution where I practiced. It was the bastion that I trusted to fight the good fight for proper patient care against the slash-and-burn companies of drive-through managed care, but it had finally given in last year. They abruptly sold out to Columbus HealthCare System, the growing mammoth for-profit health care system.
Halfway down “the underway,” as the connecting passageway was referred to by those sprinting up and down its carpeted path, I veered sharply left to the hospital’s medical records department. This was an area of the hospital bordering somewhere between precise organization and utter confusion.
Because of the multiple cubicles with four-foot high stacks of medical charts everywhere, the medical records department was really a refuge of privacy. I darted into a booth in the back, away from the nosey front office clerks, and dialed Sydney’s cell phone number. The rings were obviously forwarded to his club downtown when the maître d’ picked up the receiver.
“The Downtown Club,” the man answered in an effectively snobbish voice.
“Mr. Sydney Alfred, please.”
“May I ask who is calling, please?”
“Dr. Kyle Chandler.”
I hated using the “Doctor” title, but I used it more often than not. Usually it was the only way to get past the instant barriers people threw up to isolate themselves.
“One moment, please. I will see if he is available,” the maître d’ replied.
After a brief pause, a familiar voice came over the line.
“Kyle, my boy. Glad you called,” Sydney blurted in his usual upbeat tone. He always called me “my boy.”
“I hope I’m not interrupting anything, Sydney.”
“Nonsense. Jefferson here was just telling what was fresh today on the menu. The snapper looks good. Why don’t you head on down here and join me for a bite?”
Jefferson was one of the veteran waiters at Sydney’s club that had worked there for what seemed like forever. He always took care of Sydney personally, not to mention pocketing a handsome Christmas bonus every year.
“I’d love to, but duty calls. My secretary left a message that you called,” I replied.
“Ah, yes. Seems I was speaking to a friend of mine over a rubber or two of bridge at my golf club yesterday. Nice fellow, but way too lucky if you ask me. He had two slams in less than hour. I don’t mind losing, but I can’t stand someone that gloats.”
“Anyway,” he continued, “He was telling me about an upcoming auction later this week with some very distinctive pieces. The whole thing was put together in a hurry according to him. Strict invitation only. I could get you on the list if you like.”
“Well, Sydney, I’m pretty busy this week. And besides, I haven’t had a chance to check on that outrageously expensive French buffet you convinced me to purchase.”
“Which one was that?”
“You know, the one I bought in St. Louis at the auction we went to a couple of months ago. I just got it out of storage and over to my refinisher only a few weeks ago. I’ve got to get that one squared away and unload it before thinking about buying something else,” I explained.
“Hogwash,” he snorted. “How in the world are you going to get ahead in this world if you keep thinking in such small terms? My goodness son, you need to start looking at the big picture. Don’t let money be such a limiting factor. If it’s capital you need…”
“Sydney, you know that in my case money is the limiting factor. You even know to the penny how much I make a year. And we’ve been through this before, especially since you’re the one who got me hooked on buying and selling antiques. So I appreciate the offer, but…”
“Well, at least you can go and see what they have up for bidding. You never know what you may run across. Besides, someday soon you’ll realize that that buffet was one huge bargain when you see how much it will fetch after a little refinishing. Especially after scooping the bid on it at the last minute from that Russian guy.”
“What?” I asked somewhat puzzled.
“The Russian guy. Don’t you remember how mad he got when some messenger interrupted him during the bidding on that buffet, and you won the bid out from under him? Seeing his face fall to the ground after the auctioneer banged the gavel to end the bidding was worth the price of admission.”
“Oh, yeah. That was kind of strange.”
“So, what about the auction? You must go. I insist,” Sydney persisted.
“Okay. Okay. I give in. When is it?”
“Friday evening at 7:00 p.m. I’ll have my office deliver the invitation to your home later this week with directions once I get them.”
“One more thing, I almost forgot. A good friend of mine called me this morning. His name is Ian Griffin. Runs a private investigation firm. I’ve known him for years. He told me to have you call him as soon as possible.”
A private investigator? “Why does he want to talk to me?”
“I don’t know. Maybe he needs a good surgeon. Come to think of it, he did mention something about some kind of shipment being broken into but didn’t explain any details. I’ve got his number here on a card in my pocket. One second…ah, here it is. His number is 298-4389. Give him a call.”
“If you say so, but it’ll have to be later this afternoon. I don’t know anything about any kind of shipment, though. Speaking of broken into, you just reminded me. Did I tell you that somebody broke into my condo the other night?”
“Really? You’re kidding, right?”
“No. Messed up the furniture and such but didn’t take a thing as far as I can tell. Really strange.”
“That’s odd. Who would do such a thing?”
“You tell me. Well, got to go. Talk to you later this week.”
“Right,” he said as he hung up.
I headed out of the medical records department, down the underway, and on to the hospital to see a few post-op patients, as well as the two new consults. I discharged two patients home, because they were doing surprising well ahead of schedule. That always made families as well as me even happier. All my other patients were slowly coming around to normalcy. All in all a good start to the afternoon.
After a quick bite of food from my sack lunch, I attended to my afternoon office patients. I had just finished dictations around 5:45 p.m. when I got a page that James Galloway was on the line. I was somewhat astounded that he was still at his office at this hour. I figured him for one that headed for the business cocktail circuit when the stock market closed in New York.
“Hello, James. Kyle Chandler here.”
“Glad I could track you down.” James always sounded a little too enthusiastic. “Did you get my note in the mail?”
“Sure did. What’s this computer inquiry jazz all about?”
“I thought you might be able to tell me. It seems that some computer source that we can’t get a listing for has been making an unusual number of inquiries on the financial status of your accounts just in the last day or two. Also, there have been a ton of inquiries from all kinds of legit outside credit rating agencies asking about your credit status. You have any reason as to why, such as a new expensive purchase of some sort, that I don’t yet know about?”
“Not that I know of.”
“Well, we’ll keep trying to track down who’s making all these inquires, but it’s not been an easy task. I got one of our computer jocks to finally trace one inquiry down to an e-mail address in London of some nonexistent corporation. It doesn’t add up. Somebody is going to a lot of trouble to find out everything they can about your financial status, and they are doing a first-rate job of covering their tracks.”
Yet another strange occurrence to add to the pot. “I wish I could clue you in James, but I don’t have enough investments or cash to interest even me, much less somebody else.”
“Yes, I’ve been meaning to talk to you about that. There are these great new web-based technology stocks that I just heard about this morning that would be perfect to beef up your portfolio. Why don’t I…”
“Some other time, James. I’ve got to go. Keep me informed on any new inquiries on my accounts. Goodbye,” I said as I hung up before any more of his sales pitches could reach my end of the line.
Great. Just great. First my OR locker, then my condo, and now this? Somebody was looking for something I had, but what? What in the world did I have—a single guy who didn’t hang out with high rollers or the country club set? Why was someone systematically trying to plow through every corner of my life?
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