“Off the record,” Fredericks said, “You know very well that we can’t keep pumping up psychiatric crocks like Lundeen. He’s making my VA look like a turnstile for geriatric has-beens. Nothing personal, Vic, but Grumpy or Frumpy or Lumpy or whatever you call him, belongs in a domiciliary where he can peacefully finish his days making poppies for Veterans Day.”
McGinnis jerked the phone away from his ear and wished that there were a convenient sewer outlet to flush it down. Taking a deep breath to calm himself, he struggled to control his voice. “These vets have earned their stripes and deserve continuing treatment, and Lieutenant Lundeen is at the front of the list.”
The rumblings in Fredericks’ stomach growled back over the phone. The man was pissed. “Lieutenant Grumpy Lundeen. Where have I heard that name before? Probably at the Veterans Appeal Office where he was pissing and moaning about trying to get his disability payments increased. They’re all alike. Off the record, of course.” Fredericks’ voice shifted into an attack mode. “And how effective is your treatment, for Lundeen or any of those burned-out cases? Nobody seems to be getting discharged.”
McGinnis grabbed another deep breath and tried again. “Be fair, Carlton. Discharge is a poor way of measuring progress. It’s a political gauge, not a medical one.”
“Well, politics determine your budget, Dr. McGinnis, and right now you are at the wrong end of the food chain. Get those chronic patients in your group ready for discharge or a one-way trip to an old soldiers’ home and do it within the next 30 days. That’s the directive.”
“Your directive or the VA’s?”
“You’re bordering on insubordination, Doctor.”
“Then help me understand how we can clinically and ethically justify discharging patients who still need treatment. I don’t have a quick fix for severe trauma.” A pause, punctuated by more stomach rumbling, echoed over the phone. McGinnis knew he was on the ropes, or, more precisely, his patients were on the ropes and he needed to convince, no, sell, a hostile Fredericks on the idea of further treatment. He could feel Fredericks’ disgust dripping from the other end of the line, but he pressed his argument anyway.
“You know as well as I do, Carlton, that current research is clear in demonstrating that post-traumatic stress is a neurological as well as a psychological event. PTSD changes a patient’s brain, for God’s sake. It takes time to change the neurological substrate created by the physical and personal hells these men have endured. Traumatic injuries can occur in seconds; rerouting their impaired neurosynapses, emotions and relationships can take years. These vets put their lives on the line. They deserve more than to be pushed out the door.”
The silence at the other end hung like a guillotine ready to drop. Then Fredericks began to speak, in slow, deliberate, biting tones. “Doctor, have you finished your tired lecture?” Another pause, but McGinnis could hear the steam in Fredericks’ voice building again. “I’ve had it with your attitude. Don’t play the Stars and Stripes for me. I’ve served my time in Nam and know the damn drill. Sure, some good guys got banged up, but most got on with their lives.”
“Like you, for instance,” shot back McGinnis.
“Yeah, like me. And by the way, McGinnis, I didn’t see you there. Where the hell did you get your battle stripes?” Fredericks let the silence linger briefly and then continued. “You don’t have to reply to my question. I already know the answer. I’ve read between the lines in your records. You were undoubtedly smoking marijuana, paying off the Draft Board and screwing co-eds in graduate school, while real men were slugging it out in the goddamn jungles and rice paddies thousands of miles away. Then there’s that counseling you received at the Student Health Service for getting anxious in tight places. Well, buster, you’re in a damn tight place right now, you—”
“You’re out of line, Fredericks,” McGinnis sputtered.
“Don’t talk about being out of line to me. You’re the one who’s draining our budget by pampering antique has-beens, and not showing one damn bit of progress with any of them.”
“That’s unfair and you know it. Treatment takes time.”
“Don’t try to con me, McGinnis. Don’t hide behind excuses for not getting the job done. If you don’t know how to effectively treat patients, say so. Then I’ll help you.”
“Meaning what?”
“Meaning that I understand your group meets every Friday morning at 10:00 a.m. I plan to review your patients’ charts and observe your group with Dr. Shellenberger this Friday. Our recommendations for effective treatment, transfers or discharges will promptly follow. I’ll not let therapeutic bungling, incompetence and mismanagement undercut the financing of this hospital. As for you, my bleeding heart and claustrophobic friend, get used to the drive to the state pen and its cozy cellblocks. Remember to take deep breaths when the smoke gets too bad and the walls start closing in. ”
Then the phone went dead.
McGinnis stared at the phone in disbelief. He knew Fredericks was a cold, calculating bureaucrat who made golden calves out of budgets. Still, he’d never heard such vile, venomous comments spew from his mouth. Although short on social skills, Fredericks seldom showed his contempt in such a base fashion. He prided himself in being politically correct, rarely revealing any information that might come back to bite him. He kept his dark side cloaked in secrecy. “Cover your backside” was his constant mantra. Something must be going on that was creating fire in his shorts.
Fredericks’ threats and methods were draconian, but his comments today well-exceeded his usual insults and political maneuverings: His character assassination of Lumpy, his attack on Vic’s professional competence, his reading medical records without authorization, his threatening to turn McGinnis’ psychological vulnerabilities against him, his transferring McGinnis “into the lion’s mouth” at the State Penitentiary . . . Fredericks’ behavior was over the top. No one with any guts should stand by and watch this stream of disasters continue. What Vic could or would do about it was another matter. Vic thought about the times he had been bullied—being pushed around in the grade school locker room by older kids who teased him about being a “momma’s boy;” letting his high school girlfriend tell off the jock who called her a slut while pinching her butt and Vic pretended he didn’t notice; watching a class bully in college wrestle a small, gay student to the ground and then cut off his long blond hair while Vic stood by and did nothing; listening to cutting comments at cocktail parties about the “nigger in the White House” while Vic remained disgusted but silent. How long are you going to tolerate this crap? he thought. How bad does it have to get before you do something? How bad, Vic? How bad?