“Let’s say around eight.”
“Eight it is,” Jason said, heading for the door. As he left, Shirley called after him.
“I’m really sorry about your patient.”
The staff meeting was better attended than Jason had expected, given such short notice. Fourteen of the sixteen internists were there, and several had brought along their nurses. It seemed obvious they all recognized they were facing a serious problem.
Jason started with the statistics that he’d extracted from the computer printout listing all patients who’d died within a month of a complete physical. He pointed out that the number of deaths had increased in the last three months, and said he was trying to check up on all GHP clients who’d had executive physicals in the last sixty days.,
“Were the physicals evenly distributed among us?” Roger Wanamaker asked.
Jason nodded.
A number of the doctors spoke out, making it clear they feared the start of a nationwide epidemic. No one could understand the connection with the physicals, and why the deaths were not being anticipated. The acting chief of cardiology, Dr. Judith Rolander, tried to take much of the blame on herself, admitting that in most of the cases she’d reviewed, the EKG done during the physical did not predict the imminent problems, even when she was armed with hindsight.
The conversation then switched to stress testing as the main key to predicting catastrophic cardiac events. There were many opinions on this issue; all were duly discussed. Upon recommendation from the floor, an ad hoc committee was formed to look into specific ways to alter their stress testing in hopes of increasing its prognostic value.
Jerome Washington then took the floor. Getting heavily on his feet, he said, “I think we’re overlooking the significance of unhealthy lifestyles. That’s one factor that all these patients seem to share.”
There were a few joking references to Jerome’s weight and his affection for cigars. “All right, you guys,” he said. “You know patients should do what we say and not what we do.” Everyone laughed. “Seriously,” he continued. “We all know the dangers of poor diet, heavy smoking, excess alcohol and lack of exercise. Such social factors have far more predictive value than a mild EKG abnormality.”
“Jerome is right,” Jason said. “The poor risk-factor profile was the only negative commonality I could find.”
By a vote, it was decided to form a second committee to investigate risk-factor contribution to the current problem and come up with specific recommendations.
Harry Sarnoff, the current month’s consulting cardiologist, raised his hand, and Jason recognized him. When he got to his feet, he began to talk about noticing an increase in morbidity and mortality for his inpatients. Jason interrupted him.
“Excuse me, Harry,” Jason said. “I can appreciate your concern, and frankly I’ve had experience apparently similar to yours. However, this current meeting involves the problem with the outpatient executive physicals. We can schedule a second meeting if the staff desires to discuss any potential inpatient problem. They very well may be related.”
Harry threw up his hands, and reluctantly sat back down.
Jason then encouraged the staff to be sure to autopsy any patients who met unexpected deaths if the medical examiner didn’t take them. Jason then told the audience that the results from the medical examiner’s office on his patients suggested that the people were suffering multisystem disease including extensive cardiovascular problems. Of course, that fact only undermined the concern that their conditions had not been picked up on either resting or exercise EKGs. Jason added that Pathology thought there was an autoimmune component.
After the meeting broke up, the doctors gravitated to smaller groups to discuss the problem. Jason collected his printout and searched for Roger Wanamaker. He was in an animated conversation with Jerome.
“May I interrupt?” Jason asked. The two men separated to allow Jason to join them. “I’m about to leave town for a few days.”
Roger and Jerome exchanged glances. Roger spoke: “Seems like a poor time to be leaving.”
“I need it,” Jason said without elaborating. “But I have five patients in house. Would either of you gentlemen be willing to cover? I’ll admit right up front that they’re all pretty sick.”
“Wouldn’t much matter,” Roger said. “I’ve been in here night and day trying to keep my own half dozen alive. I’ll be happy to cover.”
With that problem solved, Jason went into his office and called Carol Donner, thinking late afternoon would be a good time to catch her. The phone rang a long time and he was about to give up when she answered, out of breath. She told him she’d been in the bath.
“I want to see you tonight,” Jason said.
“Oh,” Carol said noncommittally. She hesitated. “That might be difficult.” Then she added angrily, “Why didn’t you tell me about Helene Brennquivist last night? I read in the paper that you were the one who found the bodies.”
“I’m sorry,” Jason said defensively. “To be perfectly honest, you woke me last night and all I could think about was the package.”
“Did you get it?” Carol asked, her voice softening.
“I did,” Jason said. “Thank you.”
“And…?”
“The material wasn’t as enlightening as I’d hoped.”
“I’m surprised,” said Carol. “The ledgers must have been important or Alvin wouldn’t have asked me to keep them. But that’s beside the point. What an awful thing about Helene. My boss is so distressed he won’t let me go anywhere without one of the club bouncers. He’s outside the building at this very moment.”
“It’s important that I see you alone,” Jason said.
“I don’t know if I can. This behemoth takes orders from my boss, not me. And I don’t want any trouble.”
“Well, call me the minute you get home,” Jason said. “Promise! We’ll think of something.”
“It’ll be late again,” Carol warned.
“That doesn’t matter. It’s important.”
“All right,” Carol agreed before hanging up. Jason made one more call, to United Airlines, and checked on service from Boston to Seattle. He learned there was a daily flight at four P.M.
Gathering his stethoscope, Jason left his office and headed for the hospital to make rounds. He knew he needed to thoroughly update his charts if Roger was going to cover. None of his patients was doing very well, and Jason was disturbed to find that another patient had developed advanced cataracts. Troubled, he arranged an ophthalmology consult. This time he was certain he hadn’t noticed the problem on admission. How could the cataracts have progressed so far so fast?
At home, he changed into jogging clothes and ran a good hour, trying to sort out his thoughts. By the time he showered, changed, and drove over to Shirley’s, he was in a better mood.
Shirley outdid herself with the dinner, and Jason began to think she’d fit into the Superwoman category. She’d worked all day running a multimilliondollar company and conducting crucial union negotiations, yet somehow she’d gotten home, put together a fabulous feast of roast duck with fresh pasta and artichoke. And on top of that she’d dressed herself in a black silk chemise that would have been appropriate for the opera. Jason felt embarrassed that he’d put on jeans and a rugby shirt over a turtleneck after his shower.
“You wore what you wanted and so did I,” Shirley said with a laugh. She gave him a Kir Royale and told him to wash the radicchio and the arugula for their salad. She checked the duck and said it was about done. To Jason, it smelled heavenly.
They, ate in the dining room, sitting at opposite ends of a long table with six empty chairs on either side. Every time Jason poured more wine. he had to get up and walk several steps. Shirley thought it was amusing.