Insuring Death

By Charley Fish

Did someone murder four elderly women patients in room 204 of a hospital one night or did they suddenly decide to commit suicide? A young doctors search for answers takes him from a hospital in rural Ohio to Washington D.C., where he finds not only legislative bills but also people are being killed.

• Language: English
• Publisher: AuthorHouse
• Release date: May 22, 2015
• ISBN: 9781504900669

Charley Fish

Charley Fish discovered writing, fishing, horses and girls at the same time. He spends his days writing and riding except when he goes fishing for a day or two in a secluded area. He now is trying to focus on one girl, and promises to let the world know when that happens. He credits his freedom to his parents, who blessed him with a large trust fund and who gave him every possible means of support and encouragement. He says the trust fund also helped him quite a bit with the girls.

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© 2015 Charley Fish. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

Published by AuthorHouse 05/20/2015

ISBN: 978-1-5049-0067-6 (sc)

ISBN: 978-1-5049-0066-9 (e)

The book is a work of fiction. Any similarity to any living person, buildings, or hospital, is purely coincidental. The characters and their behaviors are also fictional creations.

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and such images are being used for illustrative purposes only.

Certain stock imagery © Thinkstock.

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

CONTENTS

Chapter One Cold Help

Chapter Two Sleeping on the Job

Chapter Three The Doctor Saves

Chapter Four Confrontation

Chapter Five Cost-Saving at Work

Chapter Six Memory

Chapter Seven A Living Nightmare

Chapter Eight The Wedding

Chapter Nine Care Planning

Chapter Ten Thirty-Six Hours under Cover

Chapter Eleven One More Mouth to Feed

Chapter Twelve Another World

Chapter Thirteen Lee

Chapter Fourteen Lobbying

Chapter Fifteen The Real Washington

Chapter Sixteen Suits on the Wall

Chapter Seventeen Ducks Run the Hospital

Chapter Eighteen First-Class Medicine

Chapter Nineteen Deluxe Health Care for Sale

Chapter Twenty The Real Way to Pass Legislation, or Wink, Wink

Chapter Twenty-One Georgetown

Chapter Twenty-Two Bring on the Interviews!

Chapter Twenty-Three A Real Job?

Chapter Twenty-Four Fine Work If You Can Get it, and You Can Get it If You Try

Chapter Twenty-Five A Business Lunch with Friends

Chapter Twenty-Six Beauty Is as Beauty Does

Chapter Twenty-Seven A Drink to the Future

Chapter Twenty-Eight Georgetown Again

Chapter Twenty-Nine Sometimes Home Ain’t So Sweet

Chapter Thirty Memories

Chapter Thirty-One Awake at Last

Chapter Thirty-Two Death Stalks

Chapter Thirty-Three Trouble?

Chapter Thirty-Four DC, the Heart of It All

Chapter Thirty-Five More Visitors

Chapter Thirty-Six More Guests to N Street

Chapter Thirty-Seven Help!

Chapter Thirty-Eight Cats

Chapter Thirty-Nine The News

Chapter Forty A Spy’s Restaurant, or a Shoe in Time

Chapter Forty-One My Friend the Reporter

Chapter Forty-Two The Dogs

Chapter Forty-Three A Friend in Deed

Chapter Forty-Four The Pool

Chapter Forty-Five Tennis Anyone?

Chapter Forty-Six The Smoke Clears

Conclusion

Dedication

To my parents, Lou and Ida, who taught me values as well as the need to mix reality and dreams; to Ann J, who taught me courage; to Edith S, who exemplifies a combination of elegance and intelligence; to Eileen C, who introduced me to books and opera; to Cheri P, Cookie A, and Sandy S, my lifetime friends; to Mark G, my best friend and my lover who taught me to believe in myself, and to all the people who believed in me and encouraged me throughout the years. Thanks to all of you.

The beast is dying, he crowed, raising his tea cup toward an American flag. "A new world will be born …"

CHAPTER ONE

Cold Help

Cold. Help me. I’m cold. Please help me. Dear God, how it hurts. Help me. Someone, can you hear me? A petite, grayish-haired woman looked up from her bed at the doctor towering over her like a god.

Shh. You’re okay. A small prick. A short hurt, and then you’ll feel better.

You can help me? Thank you.

In just a minute, you’ll feel better. I promise. The doctor smiled and patted his patient gently on her arm.

It hurts. So cold. I am so cold, she repeated, her eyes begging but hopeful.

It’s going to feel cold for just a little longer. Just a small pain, and then there will be no pain. I promise. The doctor touched her gently, lifting her arm while he spoke. Now, I am taking your arm. A pinch and that’s all. You’ll be finished with this soon. The doctor spoke with a calm, soothing tone as he placed the needle on the inner side of her elbow.

The woman, relaxed by the sound of his voice and the warmth of his eyes, still winced as the needle went into her arm.

Ouch, she said. The needle is thick. It hurts.

The doctor put the used needle in a sharps box. He stuck the box in a pocket of his white jacket. He placed his fingers together so they resembled the steeple of a church.

Shh. Sweetie, you’re going to be fine, he said softly. Here, I’ll pray with you while the shot starts to work. The Lord is my shepherd …

It feels like a snake, she cried, panic in her voice. A snake is crawling up my legs. They’re numb, and the snake is climbing higher. I’m scared. She gasped and whispered, Help me. It hurts to breathe. I can’t breathe … She became silent, her eyes fearful.

You will feel better in a moment. I shall not want …, continued the doctor.

The snake—my neck—help. Choking meeeee … She wheezed out the words, her panicked, scared eyes begging the doctor for help. She became silent, staring forward, eyes seeing nothing, her breathing slowing down more and more every second.

Relax, you are going to be fine, the doctor said, stroking her arm above the shot site while he talked. Close your eyes. I’m here. He leadeth me … Maggie. Maggie? Maggie? Can you hear me? The doctor searched for the emergency button, found it and pushed it. No one came. He turned toward his patient, She had stopped breathing.

He screamed loudly, pushing the button again and again as he called out to the hospital staff.

Nurse, intern! Get in here immediately, quick, emergency, he screamed.

A nurse ran into the room. The doctor closed the eyes of his patient as the nurse approached the hospital bed. The doctor sighed deeply.

Maggie Williams. Nice lady. About seventy-two or seventy-three. Dead. Why? Don’t know. Heart, it looks like. Stopped breathing. A ‘do not resuscitate’ order on her chart. Can’t do anything more for her.

The nurse looked from the doctor to the patient. She reached for the woman’s arm and felt no pulse. She spoke slowly and deliberately to the doctor.

So, doctor, another sudden death of an older woman? What really caused her death?

Damn, nurse. He bowed his head and wiped his eyes using the back of the sleeve on his right arm. I’m supposed to be smart. How can they say I am smart when I couldn’t prevent this? A nice woman. She wanted so much to live. We talked just yesterday when I did my rounds.

I hate to say this, but I think you need to have an autopsy performed to determine what happened to her, the nurse said. When the doctor didn’t respond, the nurse continued, Her chart says she came in with a high temperature, pains, a flu with complications. She should have made it. I don’t quite understand this."

Heart. It looks like her heart stopped at 6:55, the doctor snapped. Write that as the cause of death. The nurse did not move. Question my judgment, and you question your right to a job, he said softly, glaring at her, his eyes totally dry.

The nurse stared at him for several minutes. Then she wrote as directed.

Okay. Family? she asked.

None, nurse. Would you please call someone to have the body removed?

I still think we should have an autopsy to verify the cause of death. She stammered out the words, looking down at her feet as she spoke. She gulped twice and faced the doctor.

No, he said sternly. It was her heart. Sometimes they just break, you know.

CHAPTER TWO

Sleeping on the Job

Aaaaah!

What the hell is that? Dr. Peter Manglaz, a young intern at Mt. Morgan County Clinic Hospital, a small, rural hospital in Mt. Morgan, Ohio, snapped awake.

The vent grate rattled.

Help me! Please, someone help me! I need help, please. The voice began sobbing.

Another painful wail followed.

The bars on the vent rattled again.

Then silence. A shudder passed through the whole hospital.

Peter Manglaz twisted himself upright, in the process almost falling off the short, red, uncomfortable couch on which he had been dozing. He had been napping in a second floor room when he should have been working. He didn’t want to wake up. He had been dreaming that a beautiful blonde-haired woman suddenly plopped into his bed on top of him, like manna falling on the Israelites in the desert. He sighed and looked with half-shut eyes around the green-painted room. No tall, long-legged, blue-eyed, perfectly proportioned, exquisitely dressed blonde woman on the red couch with him.

For a few seconds, he reflected on the greenish color on the walls of the room. Green like an operating smock, green like half-dead grass, overly clean, boring, sterile green-colored walls. A small, cheaply cast, gold-colored icon of Jesus nailed to the cross hung on the wall over the couch. His eyes fixed on the cross. He wished he could pray. But nothing happened. No words to or thoughts of the Almighty came from his head or heart.

Dr. Manglaz’s body ached. Tired. Too tired to think. Too many very long days as an intern. No life, no rest for the weary. Next year, interns will only work twelve hours a day. Now it’s long hours—long, tiring hours, he muttered softly to himself.

To his long work day, Peter Manglaz had added travel, a flight from Washington DC and a drive of several hours from the Columbus airport to his home near Mt. Morgan in northwest Ohio. He had stopped at home for an hour to feed his cat, check his mail, shower, and change before reporting to the hospital. Then he put in sixteen hours of work caring for patients, being cheerful every second, and constantly fighting to be alert to every nuance of each patient’s health issues. When late evening settled over the hospital and quiet reigned, he had sneaked into the green room for a few hours of rest on its ugly red couch.

Again, the scream of a woman echoed through the ventilation system, rattling its bars. The cross on the wall shook and threatened to fall.

Not a dream, he thought. Damn.

Help me, please help me, please help me now. A voice screamed then audibly sobbed. The vent rattled again. A pained moan blew through the grates, along with the wind from the HVAC.

Oh damn, what is that? He spoke to himself. Tired. His eyes now wide open, his body twisted upright in an unnatural position on the old red couch, he listened.

Aaaaah! Help me!

Dr. Manglaz jumped up. Why is this woman screaming? Am I the only one who heard the loud cry? How could that be possible?

He stretched his long, somewhat awkward arms toward the ceiling and looked longingly at the couch for one brief second as he tore out the door.

Manglaz ran down the hall in search of the source of the scream. He brushed the wrinkles out of his jacket and pants as he ran.

Sleep deprived and a rattling vent system caused by someone, somewhere screaming, he thought somewhat incoherently as he tried to move faster. If only interns could get more sleep, moving wouldn’t be so difficult. And why am I the only one running? He had no answers. He just ran.

Another three minutes passed. No nurses appeared. No one else seemed concerned. The hospital slept.

He stopped to catch his breath at an empty nurse’s station. He sucked air in rapidly.

One light on a panel blinked. Someone was buzzing for help.

Where are those damn nurses? he thought. Why are they not here?

He looked at the light. It blinked above the number 204. He could find room 204 and maybe find the source of the wail. He set off rapidly.

This is against the hospital code, he thought as he rushed toward the room. No nurse, no one to answer the blinking light, just me, a lowly intern, and a suffering patient.

Manglaz’s long legs stretched as he ran, pulling his awkward, tall frame and smallish face down the hall toward room 204. His arms dangled from sleeves too short for their length.

What kind of medicine are we practicing here where women are left to scream into vents? he muttered to himself as he pushed himself to move faster. He was huffing, pushing his out-of-shape body as fast as he could. What happens if I complain about the lack of nurses? Would the board of this hospital applaud me for finding out something they should know? Or would they condemn me for revealing a secret hospital policy of neglecting people on purpose? He couldn’t think, couldn’t weigh what would happen.

He snapped back to reality. Who cares about recommendations in the future? Someone needs help now.

His glasses, almost too big for his smallish, horse-shaped head, slid down his nose as he moved through the halls toward the room. He pushed his glasses back into place.

Room 204 looked like any of the other four-bed rooms in the hospital. A small, withered woman, who appeared to be in her early eighties, thrashed on her bed, screaming and calling loudly for help. She writhed in pain, tears flowing down her face.

Three other women, themselves tethered to IVs, tried to calm her from their own beds. One kept pushing her emergency button again and again. When Dr. Manglaz burst into the room, she stopped and sighed, muttering, Thank God.

The first woman stopped screaming and started to shake.

Help me, she gasped. Help me. Help me. She waived mitten-covered hands toward the doctor, indicating he should take them off.

Dr. Manglaz touched her gently on the arm.

I’m here, he said.

She tried to smile but couldn’t. Her shivering continued, and she moved her arms toward the IV—as if to shake it and pull it out. Then she pleaded with her eyes and hands for Dr. Manglaz to free her hands from the thick mittens so she could pull it out.

He walked around to the back of her bed, where her medical chart hung. He read it carefully to see her diagnosis, to see what he could safely do to help her. Morphine was permitted, but he noted that none had been given to her. In fact, almost nothing—including food or water—had been given to her in days.

What the hell? he thought. For some reason, no one has done a damn thing about her broken hip, and she has been here two days. Some strange test has been given to her that I have never heard of. The results seem to be listed as a mark—even stranger.

A needle in her arm was attached to a bag, but the prescription pasted on the bag suggested that nothing but saline with a little added sugar was coursing through her system. Dr. Manglaz thought that he should add a painkiller to the mix.

No food for two days, because maybe hip surgery, the woman whispered between groans. No doctor, no pain medicine, just nurses who tell me the doctor will be here soon. But the doctor never comes. Thank you for coming. Help me, she pleaded in a whisper. Help me.

Dr. Manglaz rushed back to the still-empty nursing station and found a box of sterile syringes. He punched in a code on the locked safe behind the counter and took out a bottle of morphine. He filled the syringe, secured the bottle in the safe, and hurried back to the room.

The woman’s face was wet from tears. She was curling into a tight ball to try to stop the pain, her mittened hands still trying to tug at the IV. Her breath came and went in quick gasps.

He picked up part of the tube flowing between the needle in the woman’s arm and the saline solution. Then he found the spot where her IV joined the tube and inserted the morphine-filled syringe there so she wouldn’t have to feel another needle prick.

When the syringe had emptied, he sat in a chair by her side, patting her arm until the morphine took hold. She looked at him with tired, pain-filled eyes and grabbed his arm.

Thank you, she whispered. Finally, her eyes closed and she slept.

He wrote the dosage of morphine he had given her on her chart. He still couldn’t understand why the chart had a strange mark and why, according to the chart, nothing had been done to help her or even to ease her pain.

One of the other women in the room called out to Dr. Manglaz: She moaned for such a long time. Then she started those horrid screams. No one came to help her. We kept pushing the nurse button. No one came to help her, or for that matter, us.

Have you had food recently? he asked.

None of us have had anything since we were moved into this room yesterday afternoon. Nothing. The woman spoke almost in a whisper, enunciating each word clearly.

Dr. Manglaz walked around the room to look at all the charts. More strange charts, he noted, and more tests with the same results. He wondered why all the women had been given the same tests. All were attached to intravenous units, and all were receiving nothing but saline solution. No matter what the chart indicated as the illness, not one of them seemed to be receiving the proper medical care.

He turned. In the next bed, a woman stared at him, her large brown eyes surrounded by long brown eyelashes. He walked over and sat next to her.

How long have you been ill? he asked gently.

A week. More. I came down with this terrible cough. I went to the doctor—not my family doctor, but the one assigned to me in the clinic. She looked at him for a minute, then resumed talking. I have a medical mess, she said softly. I can’t use the family doctor anymore. My Medicare insurance was cut. I don’t qualify for Medicaid. I can’t afford Obamacare insurance premiums. Plus my doctor sent me elsewhere. Why, I don’t know. My new doctor seems very kind, she rambled on, happy to have found an audience. He told me I would get better care in the hospital than if I stayed at home. I live alone and can’t afford to hire someone to help me. He said that my care would be covered if I came here, but not if I stayed home. So here I am.

She reached out her hand, a well-cared-for hand, her nails neatly manicured. She grabbed the doctor by his arm gently, as a mother would lovingly take hold of a son who was ready to leave the dinner table before the meal had finished.

Don’t leave me, she said.

Dr. Manglaz looked at her hand, noticing a scar on one finger, probably from years of wearing a wedding ring, the size of which probably had remained the same as the fingers had grown stouter with age. Her arm had large blue veins, loose skin, and a light sprinkling of hair covering its bones. From the bone structure of her face, he could see that she had been a beautiful woman. Her grayish-brown hair had the remains of a modern cut still visible, although the hospital stay had done its best to eliminate all sense of style. Her brown eyes stared intently at him.

My husband is dead, my brothers and sisters are dead, my parents have been dead for a long time, and my daughter died in a car crash three weeks before she was to be married, many years ago, the woman softly whispered, never letting go of Dr. Manglaz’s arm.

"My husband and I had a small home. He got ill. We needed money to pay for his health care. We did this reverse mortgage to get enough money to pay for his care. It didn’t help. He died. I lost money selling the home and moved to a small apartment to save what was left. Now I have only the pictures of him to remind me of our past happiness.

At first, I felt so alone and so unwanted. I thought of driving the car into a tree or the ocean or just jumping into deep water somewhere, but then I found out how precious is my life. I also found my beloved cat. I helped others with their animals. I visited the old. And, I learned to say ‘thanks’ for each new day I was given.

Dr. Manglaz listened to her, gently patting her hand, which clung to his arm as she spoke.

I did want to stay home with my cat, but I had no care there, she repeated with a sigh. I want to be home, surrounded by his pictures and my cat. I am afraid, she added plaintively. If I don’t go home, who would take care of my cat, Smokey? My beautiful, Russian blue baby. He follows me everywhere. He jumps into my lap whenever I sit down. Tears flowed from her eyes. She wiped her sleeve across her face and sniffed to hold back the water that seemed to pour down her cheeks onto her gown.

Where is Smokey now? Dr. Manglaz asked her gently.

My neighbor promised to feed him until I return. I made no other arrangements. I thought I would get better fast if I came here, but, she added sadly, it’s not happening.

Dr. Manglaz looked at her chart, which listed minimum care, and said nothing. She seemed to have bronchitis progressing toward pneumonia. She had been prescribed only codeine cough medicine and a few aspirin, nothing to kill the bronchitis itself. He thought for a moment, and then with his hand free from her clutching, touched her gently on her arm.

She smiled at him, grateful for the kindness, grateful that someone had heard her. He looked into her eyes, smiled softly, and told her he had to leave. She released her grip on his arm, and her eyelids slowly lowered. She was asleep.

Manglaz stood up. He quietly walked around the room, looking for signs that any care had been given to the women. He was puzzled by the charts but said nothing about that to the women in the room. Instead, he walked out of the room toward the nursing station on his way back to the sterile green room reserved for interns.

At the station, a big-boned woman who seemed to have been stuffed into the white nursing uniform she wore, sipped coffee. She turned toward Manglaz as he approached. The woman’s large, grayish-black eyes glared at him from under well-made-up eyelids. She thumped her large hand with long, red, professionally manicured nails on the table.

Where were you twenty minutes ago? he asked her angrily. The emergency bell was ringing loudly. I ran past here because a patient was crying out for help. I saw not one person at this desk to answer the bell. How could you leave the desk unattended?

Smarty, she answered slowly, if the bell rings and I go answer it, the desk is empty. Then, if the bell rings again, no one is available. Just me here, see. She glared at him.

Know what? Every now and then, I need a break for coffee to keep awake. Sometimes I even need to use the restroom. I may be large, but I can’t be getting coffee, in the restroom, and answering one or more bells all at the same time, she said in a strong, confident voice.

How could you leave this station unattended? he repeated.

Listen, big important doctor, she sneered, I am as close to a nurse as shows up at night here. I get a break every now and then. I need the bathroom occasionally. Don’t you do the same—snooze in the green room against regulations, maybe?

Dr. Manglaz blushed. He thought no one had noticed his occasional naps. Obviously, at least one person knew.

She continued. There used to be four registered nurses manning this station at night, but now there is one, a nurse assistant, me, alone most of the night. The four nurses had college degrees. Two specialized in elderly and the problems of elderly. I had some training, not in anything special, but I come for a lot less money. They could give each other breaks. I am not a machine to stay here all night with no break. I lift them, wash them, feed them, medicate they, whatever. They don’t want no high-priced trained nurses on at night. They ain’t doing much to care for these folks day or night. They gotta cost save these days, on me and on them.

She shrugged her shoulders. Doc, she continued in a sarcastic voice, how come you are just noticing that only one person is here at night? Where you been? Hospital thinks it’s too expensive to have four registered nurses anymore. Especially for these old ones, who gonna die anyhow.

Dr. Manglaz stared angrily at her. The patient’s green light was on, and no one came. She was screaming in pain, and no one came—until I heard the wail. That is inexcusable.

The woman stuck her chunky finger under his nose and waved it angrily. You may be a hot shit MD, but you don’t know nothing about how medicine is practiced today or what goes on in this hospital.

With that she turned away and began writing on a file on top of a pile of files on the desk next to the phone and the emergency lights.

Dr. Manglaz tried to ask her about the medical histories of the other patients and the woman he had just seen, but the nurse ignored him, managing to keep her rather large back to him no matter from which side he attempted to address her.

A light went on, and buzzing started, loud and insistent. She left for the room, glaring at him as she waddled with great anger and purpose away from the station.

Only one of me here all night, she muttered, loud enough for the doctor to hear.

Manglaz went back to the green room for interns and thought about curling up and taking a nap. He sat on the couch, but sleep seemed far away. He looked to the right, and his eyes fell on the crucifix hanging on the wall over the couch. He stared at one particular piece of gold paint flaking off the icon’s leg. In his mind, the icon of Jesus became the old woman, blue-veined arms that then melted into puffy young, flesh-filled arms, hanging on the cross.

He tried to pray but couldn’t. He could only see the women looking desperately at him.

Jesus and prayer didn’t erase the vision of care needed but not given. No treatment. Why? The gold-flaking paint merged with blue veins and circled round and round in his mind.

He sat on the couch and tried to close his eyes. He wanted the dream of the blonde jumping naked into his arms. But the beautiful blonde had vanished, and in her place were four old faces staring at him from beds, their eyes pleading for help. One fat nurse sneered at his attempt to rest on the couch while patients begged for service. Still, being exhausted during the quiet hours of the night and hidden away in the green room with Jesus on the wall, he tried to rest.

CHAPTER THREE

The Doctor Saves

Hello, who are you? I keep waiting for my doctor to come—or for any doctor.

Yes. I am your doctor.

You’re a doctor? Great. You look too young to be a doctor. You look young enough to be my grandson. Where did you go to school? Are you still a student?

Not for a few years now.

At your age, I went to the ballet and opera all the time, but now one ticket costs more than the whole season used to. I just can’t afford it anymore. It’s so hard. I just stay home with my beautiful gray cat and watch videos—not even DVDs, just old videotapes of ballets and operas. Shows you what happens when old age comes along with low income.

The doctor pulled out a syringe and a vial of medicine. He filled the syringe from the vial and smiled at the older lady.

Oh yes, I talk too much. But there has been almost no one to talk to, except the other sick women in the room. I have a good cough. The doctor I saw said I have bronchitis. He said you could treat it faster and better here at the hospital.

I’ll give you shot, a little prick in the arm, and it should help you. First, you forgot to sign this paper when you came in. Here is a pen.

A shot to cure it? Sure, I’ll take anything to cure it and to get home. I forgot to sign a paper? No problem, give it to me with a pen. It’s about my care here, you say. Okay, it’s signed. Here, use this arm. The veins in the other one are gone.

Nice, Doctor. I didn’t even feel the prick. What’s next? Hey Doctor, it feels like a snake has started to crawl up my legs. I am very tingly and numb. Please tell me I am okay. Am I okay? Am I … She gasped once more. Then she was silent.

The door slammed shut after the doctor left the room. No one still inside it could say anything.

Dawn snuck in through the closed window shades. The bustle of the morning started up outside the door of the sterile green room. Carts squeaked as they were wheeled down the hall. The sound of a cheerful voice saying Good morning carried clearly into the green room, where Manglaz had curled up once again for an illegal snooze.

Manglaz jumped up. He was less than rested, and a few muscles ached from his cramped position on the couch, but with the help of some rather stale, cold coffee, he was at least alert. He walked into the adjoining washroom, poured water into the sink, and splashed it on his face.

Will have to do, he whispered to himself. He took off his shirt, splashed water under his arms, and dried off with a paper towel.

He shook his shirt several times, as if waving it around would remove the wrinkles. He put his shirt back on, found his glasses, and slid them onto the bridge of his nose, hooking them behind his ears. He looked in the mirror, ran his fingers through his hair, and smiled, pleased that the rims of his glasses just perfectly covered the circles under his eyes. He stretched his arms toward the heavens. His muscles creaked.

Dr. Manglaz began morning rounds on what would be another long day. A small, rural hospital, his facility combined many different departments on one floor.

His first patient, a young woman about eighteen years old with huge freckles and a sunny smile, had been admitted to the hospital to get her newly diagnosed diabetes under control. Dr. Manglaz watched as a nurse deftly bound the upper part of her arm, stuck a needle into the large vein in the middle, and after just one stick, drew blood. Then it was his turn. He listened to her heart, felt her pulse, and studied her eyes, ears, and nails. She was doing quite well. Her system was adjusting to the medicine and new diet. They talked a little, and he asked her if she had any questions or concerns. She answered, grateful for the attention. Dr. Manglaz shook her hand, smiled, and left the room.

In the next room, he checked the progress of an elderly man suffering from congestive heart failure. The man greeted the young doctor warmly, thrusting a poem he had written during the night into Dr. Manglaz’s hand. The doctor grinned broadly as he read the poem, praised it, and then handed it back to its author. He listened to the man’s heart and examined his eyes and ears. The man wrinkled his forehead, swept his hand through his full head of gray hair, and smiled. Dr. Manglaz told him he had made great strides toward health, shook his hand, and moved on to the next patient, a woman he had never met.

When he entered her room, he found her sitting up on her bed, shrunken and scared, the opposite of the friendly, gray-haired older man. Dr. Manglaz had to take out stitches from her neck. He pretended to be experienced. While he worked, the patient kept her eyes closed as if in prayer. Clip, clip, clip. He finished by cleaning the area.

Didn’t feel it, Doc, she said and smiled. Dr. Manglaz breathed a sigh of relief.

He focused on caring for the patients to whom he had been assigned. But every few minutes, a thought about the women he had seen the night before would pop into his mind. He worried about them. For some reason, the women were not receiving proper medical treatment. He also had no use for the nurse’s assistant, who seemed more interested in her coffee than in the women’s welfare. But they had not been assigned to him, and he was just an intern. He tried to think through the steps he would need to take to get them the care they needed.

When he had finished his morning rounds and was once again free from his official work, he went to check on the four women. He opened the door to the room and saw four empty beds with fresh, clean sheets ready for patients.

He went back to the nurses’ desk to check on the room and the patients he had seen during the night. He couldn’t understand what had happened. He was certain that he had gone to the correct room. This morning, three attractive women nurses worked at the desk.

Excuse me, he began politely, were there not four women in room 204 down the hall last night?

One nurse looked at him through tired eyes and answered quietly, They’re gone.

Where are they? he asked.

Gone.

Where?

It was time. And they made the decision, according to the records. That’s all.

For what?

It was time. She turned away.

It was time for what? he screamed, but no one answered. Two of the nurses walked away as if they had to see patients immediately. They set off quickly in different directions.

Where are they? he said. He pushed his open hands insistently on the desk. Tell me now, he hissed. Now.

The remaining nurse turned away from him too and busied herself at the desk. Like her ruder counterpart the night before, she managed to keep her back to him no matter how hard he tried to look her in the face.

CHAPTER FOUR

Confrontation

Dr. Manglaz had to find out what had happened to the four women patients. He rushed away from the desk and tore swiftly down the hall, throwing doors open in a mad frenzy as he moved along.

He pushed his way into the book-filled office of Dr. Jonathan T. Engel III, Director of Medical Care. The secretary in the office allegedly guarding the director from intrusions tried to stop Dr. Manglaz, but he walked past her desk. She quickly dialed the director as Manglaz sped by. When she couldn’t get the director, she rushed to his office door, listening closely to see if she needed to call hospital security.

Dr. Engel specialized in diseases of the elderly and was recognized internationally for his research and his writings. He had been invited to the small rural hospital to assume its top medical position. Dr. Engel, a short man, built a large power base quickly in his new location. No one really cared why he had left more prestigious hospitals in large cities and landed in Mt. Morgan, Ohio. Having someone with his reputation and number of published papers working and living in town was enough.

Excuse me, said Dr. Manglaz. I must ask you a very important question about four patients. Now. That is, right this very minute.

Dr. Engel sat behind a large plush chair with his back turned to the door and his feet comfortably placed on a stool. When Dr. Manglaz started to speak, he turned and seemed surprised to see someone else in his office. He glared at Dr. Manglaz.

Engel stood up as he greeted Manglaz. He pointed Manglaz to a chair. Engel returned to his desk.

Sit down. What can I do for you? Engel said, his mouth smiling, his eyes stern and cold.

Scattered on the floor in various piles were papers from his last book and papers from the next book comingled with other papers that could soon be articles. Dr. Engel knew exactly where every document was located in the many piles surrounding his desk. The alleged sterility of his white jacket seemed out of place among the clutter and filth of his office. He worked in organized chaos. Dr. Engel kept a small chair, somewhat lower than his own, for visitors. When Engel sat behind his desk in his large chair, few people sitting in the smaller chair across from him could stare him directly in the eyes. He liked it that way.

He ran his well-manicured hand through what had once been a full head of hair and said impatiently, Well, what do you want?

While Dr. Engel stared intensely at him, Dr. Manglaz began to speak. Last night, I heard a scream through the vent system. Manglaz spoke quickly, his voice shaking. No nurses were at the nursing station, but someone had pushed a button calling for a nurse in room 204. I went to room 204 to see why one of our patients felt a need to make such noise. I found four women whose care, according to the charts, had been minimal. I made them more comfortable. When I went to look at them today to make sure their care had improved, the women had vanished. The nurses would not tell me where they went, only that the women had made some kind of choice.

The head doctor looked at him for a long time and said nothing. Manglaz fidgeted as he waited for the answer. He squeezed his hands together nervously while he looked Dr. Engel in the eye, something he as a tall person could do, even while sitting in the very low chair.

Finally Dr. Engel spoke in a quiet but authoritarian tone. Dr. Manglaz, the women made a choice—the correct choice for the circumstances.

Dr. Manglaz listened, nervously squeezing his fingers into a fist and releasing them.

Please explain, he said, his voice shaking. He stared at his nails, only glancing at Dr. Engel every now and then.

Dr. Engel lectured him. "This hospital is located in an area where the majority of people struggle to make far less than the national average salary. Even with mandatory insurance, we still get those people who can’t afford medical insurance, don’t qualify for Medicaid, and as a consequence don’t seek medical care until they are very ill. These people have no personal doctor, and the cost of their medical care we have to deduct as a bad debt. Some of them come here with merely a bad cold, others with advanced cancer that was never treated. Maybe one day, this hospital will be able to give loans to some of them to allow them to pay off their medical care expenses, but right now caring for them costs the hospital quite