Both wore white coats over professional-looking outfits. Not all the docs here were dressed the same. A recent trend sought to do away with lab coats and neckties, because some studies cited them as culprits in the spread of infectious diseases.
Julie thought that was rubbish. The real villain was lack of basic hygiene. If all physicians took the time to wash their hands properly, those coats and ties would be as clean as any article of clothing.
Nevertheless, a movement had sprung up among the younger set to shun traditional attire altogether. Two camps had formed, those with coats and those without, and each wore their allegiance like Sneetches vying to be the coolest on the beaches. Julie and Lucy were old school. Roman Janowski was old school as well; he should have been opposed to dressing down, but he was shrewd when it came to recruiting talent. He made White Memorial a hip place to work.
Doctors dealt with life-and-death issues, and clothing choice had no relationship to patient outcome. But it represented a subtle shift in attitude that seemed to mirror a not-so-subtle shift in the business of medicine.
White Memorial was just another hospital in a long chain of health-care providers to migrate from a traditional HMO structure to become an accountable care organization. Julie did not expend much of her energy on the business side of medicine. She had enough to manage in the ICU, and the MBAs were best suited to make sure that more cash came in than went out. But Julie did not live with her head lodged under a rock, either. She had read up on ACOs in an attempt to ascertain if it was just HMO-style managed care disguised by another name. After some serious contemplation, Julie concluded that ACOs were an evolution to a better way of doing medicine.
There was reasonable concern that the ACO model would lead to an increase in hospital mergers, greater consolidation of market powers, and higher prices. So far Julie had not noticed much of a change since White Memorial adopted the model. ACO or HMO, Julie still had plenty of sick people who needed her care.
Michelle showed up later than expected, introductions were made, and it was not long before the three women were drinking their respective beverages and chatting like old friends.
Julie caught them up on her contentious conversation with Dr. Coffey.
“He said what?” Michelle asked.
“He said that I’m chasing unicorns,” Julie repeated.
Lucy was incredulous. “After he insulted her med school training. What an ass. You showed him the echo and EKG, I assume.”
“Of course I did. But he’s not at all convinced they mean anything.”
“Well, Sam had a clean heart,” Lucy said. “That should mean something to him.”
“It’s a Twinkie thing,” Julie said.
Lucy appeared perplexed. “A Twinkie thing?”
Julie spent some time going over what Dr. Coffey had explained to her about the vanishing sponge cake.
“So what, then? Abandon the search?”
Michelle’s question hit Julie hard. It was a reasonable one to ask, although the idea of accepting Dr. Coffey’s explanation did not sit well. If it had just been Sam’s case, Julie might have dropped the matter entirely. There was, however, this business with Brandon Stahl and his secret admirer to consider. The trio discussed this in detail as well.
“Who do you think gave Brandon Colchester’s file?”
Julie shrugged. “That’s a good question, Lucy. Nobody knows. It was someone who not only had access to the medical records system, but had a lot of knowledge as well.”
Lucy pondered that. “You know, I have a thought there.”
“Yeah?”
“I think this secret admirer of Brandon’s may have paid me a visit as well.”
“How so?” Julie was quite curious.
“Something to do with a cobalt poisoning case. I got results from a mysterious lab test that just happened to lead us to a correct diagnosis. I think I have an idea who might have sent me those test results, too. I’ll do some digging and let you know.”
“That’s wonderful. Thank you, Lucy.”
“Do you believe Brandon?” Michelle asked.
“He was very convincing. I guess I want to believe him.”
Michelle reflected on this. “If he’s telling the truth, then he has the worst luck imaginable.”
“How so?” Julie asked again.
“Well, he gets caught on tape offering to kill Colchester, which honestly I find deplorable, but that’s beside the point. Then Colchester dies of heart failure, but has the whole vanishing Twinkie thing, and Brandon gets sent away for murder. If that’s how it went down, it’s a shocking injustice.”
“You’re forgetting they found morphine in Brandon’s apartment,” Lucy said. “That taints him more than just a little in my mind.”
“Mine too, I guess,” Julie said.
Lucy said, “Let’s agree Brandon didn’t inject Colchester with a fatal dose of morphine, like he says. Then we’re still talking a very significant medical anomaly here. Two fatal cases in one hospital is more than just a unicorn, it’s a damn Pegasus.”
“Explain,” Julie said.
“Sam had a clean heart, and Brandon’s echo, from what you told me, was clear of any blockages. This Twinkie thing is ten percent of heart failure cases at most. Isn’t that what you said?”
“Well, that’s what Coffey told me.”
“Ten percent chance of it happening twice in the same hospital is an anomaly in my book. I’d love to get a look at that echo.”
Julie made a tsk sound and grimaced. “I can’t believe I let Dr. Coffey take those printouts,” she said. “He had me so rattled.”
“No worries. We can get it later.”
“Maybe getting you rattled was his intention.” Michelle tossed this out in a very matter-of-fact way.
It struck a chord with Julie. She took a long drink of tea and gave it some thought. “You think Coffey’s covering something up?”
“I’m just saying his behavior sounds odd to me. But I’m not a doctor.”
“You’re married to one,” Julie said. “That counts.”
Michelle gave a laugh. “I suppose there’s an osmosis factor I can claim. So I stand by my statement. Not only was Coffey being a jerk, he was being an odd jerk.”
“But why?”
“You said it yourself. He’s protecting his reputation.”
“And an innocent man goes to jail for it?” Julie looked dubious.
“The morphine,” Lucy reminded them.
“Hmmm… hard to explain away, isn’t it?” Michelle said. “So where do you go from here?”
Julie shook her head. “Honestly, I’m not sure. Dr. Coffey made another good point. What could have produced such a scare or sudden stress event that it caused two rare heart-stunning conditions?”
“Fatal stunning at that, which makes it even more unusual,” Lucy said. “It wasn’t like Donald and Sam got a lot of varied experiences in their days.”
Before anyone could answer, Julie spotted someone in line at the cafeteria-someone she had never met before, but wished to speak with urgently.
“Excuse me for a moment,” Julie said, getting up from the table. “I’ll be right back.”
Julie caught up with the willowy blonde as she was refilling a cup of coffee. Her tray held an apple and a blueberry Greek yogurt. Big meals in the cafeteria were a rarity-nobody had much time to eat.
Julie would not even have known about this woman had it not been for Brandon Stahl. After the prison meeting, Julie did some Googling and even a stint on the corporate intranet. She wanted to know more about Sherri Platt, the young nurse who essentially put Brandon Stahl away for life. According to her bio, Sherri had left her career in long-term acute care to work as an oncology staff nurse at White. It was a fairly significant career change, but jumping jobs in nursing was a common practice.