OFFICE HOURS
She moved from Cambridge on a hot morning in late June, under high, dark rain clouds that promised thunder and lightning. She had thought she would be happy to leave the house on Brattle Street; but in the last days, as some of the furnishings were sold and some went to storage and some went to Tom—as piece by piece was carried out until her high heels made echoes in the empty rooms—she looked at the house with the forgiving eyes of a former owner and saw that Tom had been right about its dignity and splendor. She was reluctant to leave it; despite her failed marriage, it had been her nest. Then she remembered that it was like a large hole in the ground into which they had poured their money, and she was content to lock the door and drive out of the driveway, past the brick wall with sections that still needed work, her responsibility no longer.
She was aware that she was driving into the unknown. All the way to Woodfield, her mind grappled with medical economics, fearful lest she was making a disastrous mistake.
For several days she had toyed with a fantasy. Suppose she were to operate a practice on a cash basis only—able completely to ignore the insurance companies, whence came most of the bad stuff that on occasion made doctoring unpleasant? If she were to drop her fee for an office visit steeply—say, down to twenty dollars—would enough patients come to keep her afloat financially? Some would come, she knew, sick people who weren’t covered by medical insurance. But would anybody covered by Blue Cross/Blue Shield forget about the fact that he or she owned a paid-up insurance policy and volunteer to pay cash at Dr. Cole’s office?
She realized regretfully that most people wouldn’t.
She decided to try to establish an unofficial fee of twenty dollars for those who were uninsured. Insurance companies would pay their usual forty dollars to sixty-five dollars for an office visit by one of their clients, depending on the complexity of the problem, with an additional charge for house calls. Full physical examinations would be billed at ninety-five dollars, and all lab work would be done at the medical center in Greenfield.
She put Toby to work two weeks before the office officially opened, programming all the insurance company documents into the computer. She would do most of her business with the five largest insurance companies, but there were fifteen other companies from which many patients bought insurance, and about thirty-five smaller, marginal companies. All of them had to be in the computer, multiple forms from each firm. The exhausting programming was a one-time job, but R.J. knew from experience that it would have to be updated constantly as companies discontinued some forms, revised others, and added new ones.
It was a major expense, one with which her great-grandfather had not had to contend.
A Monday morning.
She arrived at the office early, her hurried breakfast of toast and tea turned into a cold ball of nervousness in her stomach. The place smelled of paint and varnish. Toby already was at work, and Peg arrived two minutes later. The three of them grinned at one another foolishly.
The waiting room was small, but suddenly it looked enormous to R.J., deserted and empty.
Only thirteen people had made appointments. People who had been twenty-two years without a local doctor must have grown accustomed to the fact that they had to go out of town, she told herself. And once people had forged a relationship with a physician, why should they go to somebody new?
Suppose no one showed up? she asked herself in what she recognized as unreasonable panic.
Her first patient was there fifteen minutes before his appointment, George Palmer, seventy-two years old, a retired lumber miller with a painful hip and three stubs where fingers should have been.
“Morning, Mr. Palmer,” Toby Smith said calmly, as though she had been greeting patients for years as they came through the door.
“Mornin’, Toby.”
“Morning, George.”
“Mornin’, Peg.”
Peg Weiler knew just what to do, ushered him into an examining room, filled in the top of his chart, took a set of vitals and recorded his data.
R.J. enjoyed taking a very relaxed history of George Palmer. In the beginning, each of the office visits would require a lot of time because every patient was new to her and would require a full workup.
In Boston she would have sent Mr. Palmer and his bursitis to an orthopod for a shot of cortisone. Here she gave the injection herself and asked him to make another appointment to see her.
When she stuck her head into the waiting room, Toby showed her a bouquet of summer flowers, sent by her father, and a huge ficus plant sent by David Markus. There were six people in the waiting room, and three of them didn’t have appointments. She told Toby to practice triage; anyone in pain or severely ill should be worked in quickly. Others should be given the first available appointment. She realized suddenly, with a strange mixture of relief and regret, that she didn’t have time to spare, after all. She asked Toby to bring her a cheese sandwich on a kaiser roll from the general store, and a large decaf. “I’ll work through my lunch hour.”
Sally Howland was coming through the front door. “I have an appointment,” she said, as if she expected to be challenged, and R.J. had to restrain herself from kissing her crabby landlady.
Both Peg and Toby said they would work through the lunch hour too, and that they had better order sandwiches of their own. “I’ll pay,” R.J. told Toby happily.