Homeless, Inc.

By A F Johnson

Wealthy transplant surgeon Dr. Bernard Angotti dedicated his life so that no person would be refused medical treatment, like his small brother who passed away. His free clinic in Portland, Oregon, dubbed “Homeless, Inc.” was the center of his life, until an investigation uncovered the clinic as the source for body parts taken from homeless patients illegally for sale on the black market. When his best friend on whom he performed a liver transplant dies, and he is sued for malpractice, Angotti is jailed as head of the black market ring harvesting body parts and his medical license is revoked. Then Dr. Angotti realizes the fight he has to preserve his marriage, his reputation, and Homeless, Inc.

• Language: English
• Publisher: A F Johnson
• Release date: Oct 23, 2011
• ISBN: 9781465724274

A F Johnson

A. F. Johnson grew up in the Boston Area. He served in the U. S. Army during the Korean conflict. He received his B.A. in Business Administration from Northeastern University. He and his wife and 5 children moved to Alaska where he became a commercial fisherman, bush pilot, renowned hunter and entrepreneur. After the passing of his wife, he turned down the nomination for Governor of Alaska to pursue a career in writing in Oregon.

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Prologue

I was named after my grandfather, Bernardo Angotti. I was nine years old on that winter day in 1960 when my parents and three month old brother, Petro, boarded the subway for the long trip to the emergency room. Something bad was happening. Peter must be really sick. Mother always took care of him at home, holding the baby over a steaming pan of water so he could breathe better when he had a hard time. This time we were taking Peter to the hospital, she said.

Winter in Brooklyn can be cold and heartless, like the people who sat unconcerned while my mother, standing, held my little brother in her arms. She cooed quietly in her native Italian to the baby as she clung to my father to keep from falling each time the train jerked to a stop, or swayed around a curve. She was young, but I didn’t know it then. She was not more than thirty years and her black stockings were rolled up to just below her knees, a carryover from the old days. She wore a faded print dress covered by an oversized wool coat and her black knit shawl made her look like an old woman. Her dark eyes peered out from olive skin, looked first to me, and then to my father. I wished I could help.

Give me the bambino, he said. He took Petro, or Peter as I called him, into his huge hands and held him next to his chest under his wool coat. The baby wiggled in his blankets and protested. He must have been very cold; his lips were so blue.

They had come to New York before I was born. My father was a hod carrier for a mason in the summertime, but there was little or no work in the winter. It was like that in my neighborhood. Plenty of food in the summer, neighbors laughing and us boys playing stick ball in the streets, but winter descended like a recession. People kept indoors, hoarding their meager food supply and running up debt at the local grocers.

* * *

The train stopped and the doors opened with a whoosh. My father bumped his way through the mass of people to the Grand Street exit. I followed, limping to keep up with his long strides. Peter must be really sick.

The blue hospital sign twisted in the blowing snow and we bent against the wind towards it. I grabbed my father’s arm and pointed to the glowing red Emergency sign through the frigid snow stinging my eyes. We trotted up the long ramp, slipping on ice toward the double doors. Automatically, they opened at our approach.

My father rushed up to a nurse at the desk. Help me, please. My bambino—he’s sick.

She looked up and backed away from the smell of garlic. Please step to the end of the line, sir.

My father held Peter out to her. But…

A burly male dressed in stained whites took my father by the elbow and guided us to the back of the line. Yah gotta wait yah turn, he said.

* * *

The warmth of the waiting room felt good and snow from our clothing began to melt and puddle around our feet. An orderly came by with a mop and wiped up the water. He stopped once and looked at me, then turned and shook his head as he walked away. He made me feel afraid.

We inched our way up to the desk. Name and address? the nurse asked.

My father removed his hat. Frederico Angotti. One ah two ah four Mulberry Street.

Insurance?

My father squirmed. No. I no have the insurance.

The nurse looked sternly at us. How will you pay?

A little ever week. I come to the hospital ever week and give you five dollar.

I heard the nurse mumble, No insurance, as she bade a note. She attached a safety pin onto a tag and handed it to my father. Here, she said. Pin this on the baby’s blanket. The starched white cap in her hair had come undone and sat crooked on her head, and her white dress was all wrinkled, like she had been standing there for a long time. Pointing, she said, Take a seat over there on the bench. Someone will call you.

My father again held out the baby to her. But, my little one…

My mother tugged on his sleeve and led us to the bench. I watched the nurses circulating around the crowded room and focused on the tired nurse at the station mechanically sorting out patients and directing them to special places in the room.

Hours later, a well dressed woman came in through the sliding doors towing a toddler and took her place in line. Soon she was sitting with the child on her lap on a chair near the doors that led to a treatment area.

A nurse with a clipboard appeared and motioned for the woman and the child to follow her.

My father held Peter out to me and spoke to me in Italian. Here, Bernardo, Hold your brother.

I balanced Peter on my knee and listened to his ragged breathing.

My father approached another nurse on the floor. Scusa, please. My bambino’s sick. We wait a long time.

The nurse walked over to me and picked up the tag pinned to Petro’s blanket. N I it read. Sorry, you must wait your turn. What was special about us? Why did that lady go before us? Her child must be really sick.

My father sat down and took my brother from my arms and handed him to my mother. She smiled as she stuck her finger into the blankets covering his face. I could see his little legs kicking at the blankets confining him. My mother’s face suddenly took on a look of grave concern when the baby started to cough again.

I looked down at my feet. I took the yo-yo out of my pocket and played with it, all the while studying my new special shoe. The one that made my club foot fit to the ground. The foot was skewed inward and the leather sole of the shoe was so heavy I dreaded lacing it on every morning. Maybe if I didn’t need the special shoe, we would have enough to pay for Peter's treatment. I thought about school—how my classmates used to taunt me because I couldn’t join in their games and I was a freak to them. They didn’t mock me any more—not since they found out that I was the smartest in the class. Instead, they asked me to help them with their homework and to coach them on the multiplication tables.

There were fewer patients in the waiting room and the noise level had dropped. Only occasionally did someone sniffle, or a youngster cry out. The overhead fluorescent lights seemed to burn brighter and I felt like we were grouped in special places in the waiting room. Across from us people were dressed better, and they seemed to be getting treatment sooner, while we waited. The baby had quieted as my mother looked at his face, praying while she worked the rosary between her fingers. A nurse walked up to us and consulted her clipboard. My father stood and took Peter from my mother’s arms and gave him to the nurse. She pulled the blanket away from the baby’s blue face. She put a stethoscope on Peter’s chest and listened. I tried to read her face, but she gave no clue as to his condition. She pulled it from her ears and she rocked the baby in her arms and her face softened, just for a moment before she said, Sorry, sir. Your baby’s dead.

I watched my father look at the nurse, the unasked question distorting his face.

The nurse reached out for Peter. Here, give me the baby. We’ll take care of it.

My father turned and pulled Peter away from her hands. No. I take care of my son.

My mother didn’t understand. She looked at the nurse for a long time and then at my father. She shoved her coat sleeve into her mouth and muffled a sob. I knew that something bad had happened. Suddenly, I felt lonely. I felt like I would never have Peter to play with again. It was obvious to me that people who could afford to pay for services were given priority.

I watched the Doctors and the nurses in their clean white coats. They moved as if in a dream, uncaring. I fixed my gaze on the severe old nurse at the desk. Something moved inside my chest. I stood taller then. I took my parents hands and said, Come. We walked slowly together out of the sliding doors into a dark, cold winter night.

Chapter 1

Good Samaritan Hospital, Portland, Oregon

Spring, 2000

The intercom clicked on and a firm male voice said, Code blue, room 316, code blue, room 316. The hallway on the third floor of the surgical recovery ward filled with a team of doctors and nurses organized around a crash cart headed for room 316. Doctor Angotti dropped the chart he was reading onto the nurse’s desk.

Dammit, that’s Charlie Masterson, my patient. Don’t tell me he’s coded, Angotti said as he jerked his way down the hall toward Charlie’s room. His heavily booted right foot made a clunking noise with each step.

Only three days ago he was talking to Charlie and his wife, Brenda, while she held their one year old in her lap. Charlie had been afraid and didn’t want to go through the kidney transplant. The dialysis treatment was good enough, Charlie said. Angotti explained to him and Brenda that with his history of high blood pressure, smoking and Type II diabetes, Charlie would not see his four children celebrate their next Christmas. He explained the surgery in detail, how Charlie would be able to go home within the week, and the first day after surgery he would feel like a new man. Now he was dying. Maybe Angotti should have kept him on dialysis for just a while longer.

Angotti reviewed the operation in his mind. His surgical nurse, Alicia Jordan, had the O.R. well organized and the patient ready and draped. The nephrologist was on standby as well as two assistant nurses, two anesthesiologists, and Doctor Harold Frost, an assistant renal transplant surgeon who would assist him by removing the two diseased kidneys laparoscopically after Angotti implanted the donor kidney. The new kidney had pinked up and started working immediately after Angotti attached the iliac artery and vein. It even began putting out urine before he could connect the ureter to the bladder.

There weren’t any hitches in the surgery, except one, when Frost mistakenly nicked an adrenal gland and Angotti had to go in and sew it up after suctioning out the blood.

Charlie had his surgery just three days ago and was healing nicely. He was up and walking the first day. His color was good and he was infused with energy. Getting all of those poisons out of his system probably was the reason. But now, Angotti was faced with the possibility that Charlie may not make it.

Angotti rounded the corner and stopped at the doorway of room 316. He had to push his way through the crash team. I’m here. Give me the paddles.

A nurse already had bagged Charlie and was squeezing oxygen into his lungs while another pulled down his gown and exposed his chest.

Two hundred, Angotti ordered as he pressed the paddles to Charlie’s chest. Clear, he said.

The patient jumped with the shock and settled back onto the bed. The line on the heart monitor remained flat, its steady sound like a death warrant took command of the room as everyone held their breath and watched.

Three hundred, Angotti said. The nurse operating the defibrillating equipment nodded. The machine began to whine, increasing in pitch as it reached the charge called for.

Clear. He pressed the paddles again to the chest.

Again the lifeless body jumped to their bidding and settled back down on the sheets. The line remained steady and flat while the monitor registered a steady, metallic alarm.

Dammit. Four hundred, Angotti said. The nurse at the console nodded. Again he pressed the paddles to the chest, and again Charlie jumped. The line remained flat. Some people at the doorway turned to leave. It was all over.

Angotti threw down the paddles and pounded his fist into his patient’s chest. Dr. Moreno, chief of cardiology, walked up to the patient and put a hand on Angotti’s shoulder. I’m calling it, he said. Time of death, 3:22 p.m.

* * *

Perspiration made Angotti’s shirt stick to his armpits. What could have gone wrong? An hour ago, his patient was recuperating as planned. Vital signs were perfect and recent blood tests indicated the patient was not in rejection.

Angotti returned to his office. He buried his head in his hands. It was always a disappointment when he lost a patient. A disappointment, hell. It was downright heart wrenching. He picked up the phone and called for Alicia to come to his office. He also called for the Charlie’s chart, but it was not available at the moment.

Alicia arrived a few minutes later. Bad luck, she said.

Luck had nothing to do with it. What the hell went wrong? We’ve done hundreds of these transplants together, and I’ve never had one go bad as quickly as this one did.

Alicia took a seat in front of his desk and concentrated on a spot on the wall behind him and shook her head. The only thing that went wrong is when Doctor Frost screwed up and nicked that gland. We had to rush a supply of blood up to replace what the patient lost. I’m double checking it now to be sure it was the right type, although, I know it was correct. I checked it myself before we administered it. Think Charlie was leaking a little?

I don’t know. Only an autopsy would tell, and I don’t want to order one if I can help it. Think I’ll wait until I review the chart.

Alicia stood to leave. If I think of anything, I'll call immediately. I know what Charlie and his family meant to you.

Brenda Masterson is on her way over now. I’ve got to give her the news. God, I hope she doesn’t bring her four kids.

His office door swished quietly behind Alicia as she left his office. He shook his head, confused by the turn of events. He wouldn’t be satisfied until he found the answer.

Chapter 2

Angotti stared out of his office window, watching the black clouds boil and blow in over the city. He hoped they would continue on and the storm would pass them by, but a few splatters of rain were already hitting the window.

He picked up Charlie Masterson’s chart and quickly thumbed through it looking for the donor information. The chart held the donor form that contained only the name of the hospital and harvesting doctor. He picked up the phone and called the nursing supervisor.

When she answered, he said, This is Doctor Angotti. Can you please arrange to get me Charlie Masterson’s donor chart?

Certainly, Doctor. I was just on my way to the transplant coordinator’s office. I’ll have it sent up to you immediately.

He then called for Alicia Jordan. While waiting for the chief O.R. nurse, Angotti reviewed the donor form that accompanied the kidney from Adventist Hospital. A list of lab screens for infections and blood type were noted, but no donor’s name.

There was a single knock on the door and Alicia Jordan stepped in. You wanted to see me?

Yes, thanks for being so prompt. He picked up the chart. I’ve been reviewing Charlie Masterson’s chart. It doesn’t give the donors name. Do you know anything about who the donor was?

Sorry, Doctor, no, I don’t.

A half hour passed without any word about the donor file. Angotti picked up the phone and called the nursing supervisor. Have you found the donor file for Charlie Masterson yet?

No, doctor. I've looked everywhere and can find no file.

If I had the donor’s name, it could help, but I don’t, Angotti said.

We don’t file under donor’s name, only under the recipient's name. It isn’t here. Have you checked in Surgery?

No, but I will. I’ll call down there right now.

The clerk in the surgery department spent nearly an hour, but found no files relating to Charlie Masterson, or his ghost of a donor.

Angotti wondered what his next move would be. He had to find out what was going wrong. He had never been in a situation like this before, and he felt it was a stain on his surgical accomplishments. He was tinkering with the idea just to go over to Adventist Hospital and try to find out the information himself when his phone rang.

Angotti? This is Doctor Abraham, chief of surgery. How are you feeling today?

About what you’d expect after losing a patient.

Yes, I’m sorry about that. It happens to all of us now and then.

The chief cleared his throat. A question has come up about Charlie Masterson’s unfortunate death. I’m afraid we’re going to have an autopsy done.

Isn’t that a bit unusual? We know why he died—he rejected the kidney.

Yes, but the question is why?

Angotti thought a moment. Who’s question?"

Okay, here it is. Mrs. Masterson has been asking questions and asked to speak to our legal department. I’ve talked to the administrator. He is in agreement with me, as well as is legal. They think we should protect our ass and try to find out cause of death, particularly since there is the problem of missing donor information.

I've been working on that. I’ve toyed with the idea of going over to Adventist to find out what I can.

Now, listen, Doctor. Keep away from Adventist. In fact, keep away from the whole case. Just let us handle it.

But, I want to find out what went wrong.

You will. I’ll send you a copy of the report, after all, you’re paying for it.

What do you mean? I’m paying for it?

Well, your office. We'll bill it there.

Why?

Why? Why, it’s obvious, Doctor Angotti. You’re the one who caused this problem. The line went dead and Angotti looked at the telephone in his hand. He wasn't sure he heard the words right.

* * *

Two days later. Angotti received the autopsy report, along with a bill from Northwest Autopsy Service in the amount of two thousand fifty-two dollars and ninety-eight cents. He picked up the phone and called Doctor Abraham. When the chief of surgery came on the line, Angotti said, Have you seen this bill? It’s outrageous. Who is Northwest Autopsy?

Calm down, Doctor. One question at time. Yes, I've seen the bill. Northwest Autopsy is out of Washington State. We use them for all of our work. We’ve found it to be much cheaper than staffing our own facility.

But, the price is outrageous. I could have done it for under five hundred.

No you couldn't—we wouldn’t let you.

Angotti let an impatient breath escape into the phone. What's the next step?

Have you read the report?

I’ll get to it tonight when I get home. Can you give me a one sentence synopsis?

Sure. Your patient died because of an infection.

Patients die from infections.

Yes, but something happened. Didn’t your assistant knick a gland? Was it treated correctly?

It was an accident. Things happen. And yes, I treated it correctly.

The surgery chief sighed into the phone. Read the report. Then prepare to answer to a board of inquiry tomorrow. We convene at 1:00 p.m.

Angotti stared at the dead phone. Did he hear right? He was to be investigated?

* * *

He was five minutes late for the hearing. Angotti spent his lunch time looking for the missing file. The administrator frowned as he took his seat. Angotti mumbled an apology. He noticed the hospital’s attorney sitting at the right of the Timothy Dick, the administrator. Dick cleared his throat and began.

Doctor Angotti, can you tell us about the mistake that took place during your surgery on Charlie Masterson?

Angotti didn’t like being on the defensive, and started twisting his wedding ring round and round on his finger.

There was no mistake. My assistant nicked an adrenal gland, or maybe a vein leading to it. I corrected the situation.

Why didn’t you call in a thoracic surgeon to repair the damage?

Angotti sat back in his chair. The damage wasn’t that bad. There was no thoracic surgeon on the team. I’m a surgeon. I went in and made the repair.

Doctor Abraham, chief of surgery leaned forward. That’s not your call, Doctor. Protocol is that a thoracic surgeon be called immediately when an artery is severed.

It wasn’t an artery. I put a clamp on it, and sewed it up. A first year surgical student could do the same.

Dick took over. That’s why we have rules, Doctor, to prevent errors like this.

There was no error. This was surgery for chrissakes. You don’t waste time when a patient is open on the table.

Abraham said, Well, it resulted in an infection, that probably caused the death of your patient.

Angotti almost stood, his face a beet red. The autopsy didn’t show any infection in the area. It was clean.

Probably from the antibiotics administered, Abraham said. There was infection in his blood.

Like I said, infections happen all the time. Your hospital kills more people from infections after a skilled surgeon has saved the life of your patients.

The administrator’s face showed a frown. He leaned over as the attorney whispered into his ear. He picked up a legal pad and consulted it. Did you review the donor chart?

Uh, the chart is missing. It's nowhere in the hospital.

How did you confirm the typing? the surgical chief said.

There was paperwork with the kidney. I confirmed the typing.

Where is that paperwork now?

A vein in Angotti’s neck stood out. I don’t know.

The other doctors around the table sat in silence. Angotti couldn’t