Status permanently inactive was a long narrow room lined with metal floor-to-ceiling shelves and human-width aisles. The shelves were filled with medical charts. Each chart bore a black tab. Hundreds of consecutive tabs created wavy, inch-thick black lines that seemed to cut the files in half.
Access was blocked by a waist-high counter. Behind it sat an Asian woman in her forties, reading a tabloid-sized Asian-language newspaper. Rounded characters—Thai or Laotian, I guessed. When she saw me she put it down and smiled as if I were delivering good news.
I asked to see the chart for Charles Lyman Jones IV. The name didn’t appear to mean anything to her. She reached under the counter and produced a three-by-five card titled SPI REQUISITION. I filled it out, she took it, said “Jones,” smiled again, and went into the files.
She looked for a while, walking up and down the aisles, pulling out charts, lifting tabs, consulting the slip. When she returned she was empty-handed.
“Not here, Doctor.”
She shrugged. “Someone take.”
“Someone’s already checked it out?”
“Must be, Doctor.”
“Hmm,” I said, wondering who’d be interested in a two-year-old death file. “This is pretty important—for research. Is there any way I could talk to that someone?”
She thought for a moment, smiled, and pulled something else out from under the counter. El Producto cigar box. Inside were stacks of SPI requisition forms held together with spring clasps. Five stacks. She spread them on the counter. The top slips all bore the signature of pathologists. I read the patients’ names, saw no evidence of alphabetization or any other system of classification.
She smiled again, said “Please,” and returned to her newspaper.
I removed the clasp from the first pile and sifted through the forms. It soon became obvious that a system did exist. The slips had been classified by date of request, each stack representing a month, each piece of paper placed in daily chronological order. Five stacks because this was May.
No shortcuts—every slip had to be examined. And if Chad Jones’s chart had been checked out before January 1, the form wouldn’t be here at all.
I began reading the names of dead children. Pretending they were just random assemblages of letters.
A moment later I found what I was looking for, in the February stack. A slip dated February 14 and signed by someone with very poor penmanship. I studied the cramped scrawl, finally deciphered the last name as Herbert. D. Kent Herbert, or maybe it was Dr. Kent Herbert.
Other than the signature, the date, and a hospital phone extension, the slip was blank; POSITION/TITLE, DEPARTMENT, REASON FOR REQUEST hadn’t been filled out. I copied the extension and thanked the woman behind the counter.
“Do you have any idea who this is?”
She came over and peered at the form.
“Habert … no. I just work here one month.” Another smile. “Good hospital,” she said cheerfully.
I began to wonder if she had any idea what she was filing.
“Do you have a hospital directory?”
She looked confused.
“A hospital phone book—the little orange ones?”
“Ah.” She bent and produced one from under the counter.
No Herberts in the medical roster. In the following section, listing nonmedical staff, I found a Ronald Herbert, tagged as Assistant Food Services Manager. But the extension didn’t match the one on the slip and I couldn’t see a catering specialist having an interest in sudden infant death.
I thanked her and left. Just before the door closed, I heard her say, “Come again, Doctor.”
I retraced my steps through the sub-basement, passing Laurence Ashmore’s office again. The door was still closed and when I stopped to listen, I thought I heard movement on the other side.
I kept going, looking for a phone, finally spotted a pay unit just past the elevators. Before I got to it the elevator door opened and Presley Huenengarth stood there, looking at me. He hesitated, then walked out of the lift. Standing with his back to me, he removed a pack of Winstons from his suit pocket and took a long time cracking the seal.
The elevator door started to shut. I checked it with the heel of my hand and got on. The last thing I saw before it closed was the security man’s placid stare behind a rising cloud of smoke.
After riding up to the first floor I used an in-house phone near Radiation Therapy to dial D. Kent Herbert’s extension. The hospital’s main switchboard answered.
“Western Pediatrics.”
“I was dialing extension two-five-oh-six.”
“One moment and I’ll connect you, sir.” A series of clicks and mechanical burps, then: “Sorry, sir, that extension’s been disconnected.”
“Since when?”
“I don’t know, sir.”
“Any idea whose extension it was?”
“No, sir. Who were you trying to reach?”
“D. Kent Herbert.”
“Is that a doctor?”
“I don’t know.”
Pause. “One moment … The only Herbert I have listed is Ronald, in Food Services. Would you like me to connect you?”
“Why not?”
Five rings.
“Ron Herbert.” Crisp voice.
“Mr. Herbert, this is Medical Records, calling about the chart you requisitioned?”
“Come again?”
“The medical chart you checked out in February? From SPI?”
“You must have the wrong guy, pal. This is the cafeteria.”
“You never requested an SPI chart on February 14 of this year?”
Laughter. “Now why the heck would I do that?”
“Thank you, sir.”
“No prob. Hope you find what you’re after.”
I hung up, took the stairs to the ground floor and entered the throng in the lobby. Easing my way through hard-packed bodies, I made it to the Information counter and, after spotting a hospital directory near the clerk’s hand, slid it toward me.
The clerk, a dyed-blond black woman, was answering a Spanish-speaking man’s question in English. Both of them looked tired and the acid of strife embittered the air. The clerk noticed the book in my hand and looked down her nose at me. The man’s gaze followed. The queue behind him swayed and rumbled like a giant serpent.
“You can’t have that,” said the clerk.
I smiled, pointed at my badge, and said, “Just want to borrow it for a minute.”
The clerk rolled her eyes and said, “Just for a minute, that’s all.”
I moved to the far end of the counter and flipped the book open to the first page, running my eyes and my index finger down the numbers column on the right side of each page, prepared to scan hundreds of extensions until I found 2506. But I hit the jackpot after only a couple of dozen.
ASHMORE, L.W. (TOX.) 2506
I replaced the book and thanked the clerk. She glared again, snatched it, and placed it out of reach.
“Half a minute,” I said. “Do I get a refund?”
Then I saw the faces of the people waiting in line and regretted being a wise-ass.
I went up to see Cassie, but there was a DO NOT DISTURB sign on her door and the nurse on duty told me both she and Cindy were sleeping.
On my way out of the hospital, my thoughts were intruded upon by someone calling my name. Looking up, I saw a tall, mustachioed man approaching from the main entrance. Late thirties, white coat, rimless glasses, Ivy League clothes. The mustache was an extravagant waxed black handlebar. The rest of him seemed arranged around it.
He waved.
I reached into the past and drew out a name.
Dan Kornblatt. Cardiologist. Former UC San Francisco chief resident. His first year at the hospital had been my last. Our relationship had been limited to case conferences and casual chats about the Bay Area—I’d done a fellowship at Langley Porter and Kornblatt delighted in pushing the proposition that no civilization existed south of Carmel. I remembered him as long on brains and short on tact with peers and parents, but tender with his young patients. Four other doctors were walking with him, two women, two men, all young. The five of them moved rapidly, accompanied by swinging arms—physical fitness or a strong sense of purpose. As they got closer I saw that Kornblatt’s hair had grayed at the temples and his hawk face had taken on a few seams.
“Alex Delaware. My, my.”
“Hi, Dan.”
“To what do we owe the honor?”
“Here on a consult.”
“Really? Gone private?”
“A few years ago.”
“Where?”
“The West Side.”
“But of course. Been back up to the real city lately?”
“Not lately.”
“Me neither. Not since two Christmases ago. Miss that Tadich Grill, all that real-city culture.”
He made introductions all around. Two of the other doctors were residents, one was a Cardiology fellow and one of the women—a short, dark, Mideastern woman—was an attending physician. Obligatory smiles and handshakes all around. Four names that passed right through me.
Kornblatt said, “Alex, here, was one of our star psychologists. Back when we had them.” To me: “Speaking of which, I thought you guys were verboten around here. Has something changed in that regard?”
I shook my head. “It’s just an isolated consult.”
“Ah. So where you heading? Out?”
“If you’re not crunched for time, why don’t you come with us? Emergency staff meeting. Are you still on staff? Yeah, you must be if you’re doing a consult.” His brows creased. “How’d you manage to avoid the Psychiatry bloodbath?”
“Through a technicality. My affiliation was in Pediatrics, not Psychiatry.”
“Pediatrics—that’s interesting. Good loophole.” To the others: “You see, there’s always a loophole.”
Four knowing looks. None of them was over thirty.
Kornblatt said, “So, you wanna hang with us? The meeting’s an important one—that is, if you’re still feeling sufficiently affiliated to care what goes on around here.”
“Sure,” I said, and fell in alongside him. “What’s the topic?”
“The decline and fall of the Western Peds Empire. As evidenced by the murder of Larry Ashmore. Actually, it’s a memorial for him.” He frowned. “You heard about what happened, didn’t you?”
I nodded. “Terrible.”
“Symptomatic, Alex.”
“Of what?”
“What’s happened to this place. Look at the way the whole thing’s been handled by the administration. A physician gets murdered and no one even bothers to send around a memo. Not that they’re paper-shy when it comes to disseminating their directives.”
“I know,” I said. “I happened to read one. On the door of the library.”
He scowled and his mustache flared. “What library?”
“I saw that too.”
“Sucks,” he said. “Every time I have research to do I’ve got to drive over to the med school.”
We walked across the lobby and came up against the queues. One of the doctors noticed a patient waiting in line, said “I’ll join you in a moment,” and left the group to greet the child.
“Don’t miss the meeting,” Kornblatt called after her, without breaking step. When we were clear of the crowd, he said, “No library, no Psych department, no overhead for grants, total hiring freeze. Now, there’s talk about more cutbacks in all departments—straight across the board. Entropy. The bastards probably plan to tear the place down and sell the real estate.”
“Not in this market.”
“No, I’m serious, Alex. We don’t make money and these are bottom-line people. Pave it over, put in lots of parking lots.”
“Well,” I said, “they might start by paving the ones across the street.”
“Don’t hold your breath. We are peons to these guys. Just another form of service staff.”
“How’d they get control?”
“Jones—the new chairman—was managing the hospital’s investments. Supposedly did a really good job, so when hard times got harder the board claimed they needed a financial pro and voted him in. He, in turn, fired all the old administration and brought in his own army.”
Another crowd milled near the doors. Lots of tapping feet, weary head shakes, and needless punches of the buttons. Two of the lifts were stuck on upper floors. An OUT OF ORDER sign was taped across the door of the third.
“Onward, troops,” said Kornblatt, pointing to the stairwell and increasing his pace to a near-run. All of them vaulted the first flight with the zest of triathlon junkies. When we got to the top, Kornblatt was bouncing like a boxer.
“Go, team!” he said, pushing the door open.
The auditorium was a few paces down. A couple of doctors were lounging near the entrance, which was topped by a handwritten banner that said ASHMORE MEMORIAL.
I said, “Whatever happened to Kent Herbert?”
Kornblatt said, “Who?”
“Herbert. The toxicologist. Didn’t he work with Ashmore?”
“I didn’t know anyone worked with Ashmore. The guy was a loner, a real—” He stopped himself. “Herbert? No, can’t say I remember him.”
We entered the big fan-shaped lecture hall; rows of gray cloth seats sloped sharply to a wooden lecture pit. A dusty green board on wheels stood at the rear of the pit. The upholstery on the seats was dingy and some of the cushions were tattered. The light, fluctuating hum of occasional conversation filled the room.
The auditorium held at least five hundred chairs but no more than seventy were occupied. The spotty attendance gave it the look of a pass-fail class. Kornblatt and his entourage headed down toward the front of the room, shaking hands and trading a few high-fives along the way. I hung back and sat by myself in the uppermost row.
Lots of white coats—full-time staffers. But where were the private practitioners? Unable to attend on short notice or choosing to stay away? Western Peds had always suffered from town-gown tension, but the full-timers and the physicians out in “the real world” had always managed to achieve a grudging symbiosis.
As I looked around some more, I was struck by another scarcity: gray heads. Where were all the senior people I’d known?
Before I could mull that, a man holding a cordless microphone stepped into the pit and called for quiet. Thirty-five; soft, pale baby face under a big blond Afro. His white coat was slightly yellowed and too big for him. Under it he wore a black shirt, and a brown knit tie.
He said, “Please,” and the hum died. A few beepers went off, then silence.
“Thanks to all of you for coming. Could someone get the door?”
Faces turned. I realized I was closest to the exit, got up and shut the door.
“Okay,” said Afro. “The first order of business is a moment of silence for our colleague Dr. Laurence Ashmore, so if you could all please rise.…”
Everyone stood. Heads drooped. A long minute passed.
Afro said, “Okay, please be seated.” Walking to the board, he picked up a piece of chalk and wrote:
AGENDA
1. ASHMORE MEMORIAL
2.
3.
4. …?
Stepping away from the board, he said, “Is there someone who wants to say a few words about Dr. Ashmore?”
Silence.
“Let me say, then, that I know I speak for all of us in condemning the brutality of what happened to Larry. And in offering our deepest sympathy to his family. In lieu of flowers, I propose we get together a fund and donate it to an organization of the family’s choice. Or our choice, if it would be too disruptive to ask the family at this point. We can decide now, or at a later date, depending on what people feel. Anyone care to comment?”
A short-haired woman in the third row said, “How about the Poison Control Center? He was a toxicologist.”
“Poison Control Center sounds good,” said Afro. “Anyone second that?”
A hand rose in the middle of the room.
“Thanks, Barb. So moved. Anyone know the family? To inform them of our plan?”
No response.
He looked at the woman who’d made the suggestion. “Barb, would you be in charge of collecting the funds?”
She nodded.
“All right, people, bring your donations to Barb Loman’s office in Rheumatology and we’ll see that the Poison Control Center gets the money, posthaste. Anything more along those lines?”
“Data,” said someone. “As in, we don’t have any.”
“Could you stand and clarify, Greg?” said Afro.
A stocky, bearded man in a checked shirt and wide, floral, retro tie rose. I thought I remembered him, as a resident, without the beard. An Italian name …
“… I’m saying, John, is that security stinks around here. What happened to him could have happened to any of us, and since it’s our lives on the line we deserve to have full access to information. Exactly what happened, the progress of the police’s investigation, as well as any measures we can take to assure our safety.”
“There aren’t any!” a bespectacled black man across the room called out. “Not unless the administration makes a real commitment to genuine security—twenty-four-hour guards at every entrance to the lot and at each and every stairwell.”
“That means money, Hank,” said the bearded man. “Good luck.”
A ponytailed woman with dishwater hair got up.
“The money would be available, Greg,” she said, “if they got their priorities straight. What we don’t need are more paramilitary types obstructing our patients in the halls. What we do need is exactly what you and Hank just said: genuine security, including self-defense classes, karate, Mace, personal training, whatever. Especially for female staff. The nurses deal with this kind of threat every single day, coming from across the street. Especially the night shift—you know how a couple of them were beat up, and—”
“I know tha—”
“… the open lots have no security at all. As all of us are learning, from direct experience. I drove in at five this morning on an emergency call, and let me tell you, it felt scary, people. I also have to say I think it was a serious mistake to limit this meeting to physicians. This is no time for elitism. There are nurses and ancillary staff out there suffering just like we are, working for the same goals. We should be getting together, empowering each other, not fractionating.”
No one spoke.
The ponytailed woman looked around the auditorium and sat down.
Afro said, “Thank you, Elaine, your point is well taken. Though I certainly don’t think any deliberate attempt was made to be exclusionary.”
“Well,” said the ponytailed woman, standing again, “was anyone else other than physicians informed?”
Afro smiled. “This was an ad hoc medical staff meeting, Elaine, so it’s only natural that physicians would—”
“Don’t you think the rest of the staff cares, John?”
“Of course,” said Afro. “I—”
“Western Peds women are terrified! Wake up, people! Everyone needs to be empowered. If you recall, the last two assault victims were women and—”
“Yes, I do recall, Elaine. We all do. And I assure you that in the event other meetings are scheduled—and it’s certainly clear to me that they need to be—a definite effort will be made to reach out.”
Elaine contemplated debate, then shook her head and sat.
Afro returned to the board, chalk poised. “I suppose we’ve moved on to another item, de facto, haven’t we. Staff security?”
Scattered nods. The lack of group coherence was almost tangible. It reminded me of so many other meetings, years ago. Endless discussions, little or no resolution …
Afro placed a check next to ASHMORE MEMORIAL, wrote STF SECURITY on the next line, and faced the assembly.
“Okay. Any suggestions beyond guards and karate?”
“Yeah,” said a balding, swarthy, thick-shouldered man. “Guns.”
A few chuckles.
Afro gave a tight smile. “Thank you, Al. Was that the way things were handled in Houston?”
“You bet, John. S and W in every black bag. That’s Smith and Wesson, for all you pacifist types.”
Afro made a gun with his thumb and forefinger, pointed it at Bald, and winked. “Anything else, Al, short of turning the hospital into an armed camp?”
Dan Kornblatt stood. “I hate to say it but I think we’re lapsing into tunnel vision here. What we need to do is address the larger issues.”
“In what sense, Dan?”
“In the sense of our purpose—the institution’s purpose.”
Afro looked puzzled. “Are we through, then, with item two?”
Kornblatt said, “I certainly am. Security is just a symptom of the greater malaise.”
Afro waited a moment, then checked off STF SECURITY.
“What malaise is that, Dan?”
“Chronic, end-stage apathy—institutionally sanctioned apathy. Just look around. How many private physicians are there on staff, John? Two hundred? Just take a look what percentage cared enough to brown-bag it today and make a statement with their presence.”
“Dan—”
“Wait, let me finish. There’s a reason so few private people are here. And it’s the same reason they avoid sending their paying patients here if they can find semi-decent local facilities. Same reason so many of our top people have gone elsewhere. We’ve been tagged as a stepchild—an institutional loser. And the community’s bought into that because the board itself and the administration hold this institution in low regard. And so do we. I’m sure we’ve all had enough psych to know what happens to the self-image of a kid who keeps being told he’s a loser. He starts believing it. Same thing applies to—”
The door opened wide. Heads turned. George Plumb entered and straightened his tie, a blood-red paisley against a white shirt and light-gray raw silk suit. His shoes clicked as he descended to the pit. When he got to the bottom he stood next to Afro, as if assuming his rightful position.
“Afternoon, ladies and gentlemen,” he said.
Kornblatt said, “We were just talking about institutional apathy, George.”
Plumb gave a thoughtful look and placed one fist under his chin. “I was under the impression this was a memorial for Dr. Ashmore.”
Afro said, “It was, but we’ve covered some additional ground.”
Plumb turned and studied the writing on the board. “Quite a chunk of ground, it seems. Might I backtrack and talk a bit about Dr. Ashmore?”
Silence. Then nods. Looking disgusted, Kornblatt sat down.
“First of all,” said Plumb, “I want to communicate the sympathy of the board of directors and the administration for the loss of Dr. Laurence Ashmore. Dr. Ashmore was a noted researcher and his absence will be profoundly felt. In lieu of flowers, Mrs. Ashmore has requested that funds be sent to UNICEF. My office will be pleased to handle all donations. Second, I want to assure you that progress has been made fabricating new parking cards. The cards are ready and can be picked up from Security between three and five, today and tomorrow. We regret any inconvenience. However, I’m sure all of you recognize the necessity of changing the keys. Any questions?”
The stocky bearded man named Greg said, “What about real security—guards at each stairwell?”
Plumb smiled. “I was just getting to that, Dr. Spironi. Yes, both the police and our own security staff inform us that the stairwells are a problem, and though the cost will be considerable, we are prepared to implement twenty-four-hour guards, one man per shift, for each level of the physicians’ lot, as well as one guard per shift for each of the three open lots across the boulevard. That adds up to a total parking staff of fifteen guards, meaning a net hire of eleven guards added to the four already on staff. The cost, including benefits and insurance, should amount to slightly under four hundred thousand dollars.”
“Four hundred!” said Kornblatt, springing to his feet. “Almost forty thousand a cop?”
“Guards, not cops, Dr. Kornblatt. Cops would cost much, much more. As I said, the figure includes benefits, insurance, workman’s compensation, supplies and equipment, and site-specific ancillary costs such as orientation and in-house training. The company with which we’ve contracted has an excellent track record and their proposal includes self-defense and crime-prevention education for the entire staff. The administration didn’t feel it was appropriate to bargain-hunt in this matter, Dr. Kornblatt. However, if you’d like to shop around for a more competitive price, be our guest. Bear in mind, however, that time is an issue—we want to restore a sense of security and well-being for everyone, with maximal haste.”
Lacing his hands across his abdomen, he looked at Kornblatt.
The cardiologist said, “Last time I checked, my job was treating kids, George.”
“Precisely,” said Plumb. Turning his back on Kornblatt, he said, “Any additional questions?”
There was a moment of silence, as long as the one honoring Ashmore’s memory.
Kornblatt stood and said, “I don’t know about the rest of you but I’m feeling co-opted.”
Plumb said, “Co-opted? In what sense, Dr. Kornblatt?”
“In the sense, George, that this was supposed to be a physicians’ meeting and you’ve just walked in and taken over.”
Plumb rubbed his jaw. Looked at the doctors. Smiled. Shook his head.
“Well,” he said, “that certainly wasn’t my intent.”
“Maybe not, George, but it’s sure coming out that way.”
Plumb stepped forward, toward the front row. Lowering one leg to the cushion of an empty seat, he rested his elbow on the bent knee. Chin on hand again, and he was Rodin’s “Thinker.”
“Co-opting,” he said. “All I can say is that was not my intention.”
Afro said, “George, what Dan—”
“No need to explain, Dr. Runge. The tragic incident with Dr. Ashmore has left all of us on edge.”
Maintaining the thinker’s pose, he turned back to Kornblatt: “I must say, Doctor, that I’m surprised to be hearing that kind of sectarian talk from you in particular. If I recall correctly, you drafted a memorandum last month calling for greater communication between the administration and the professional staff. I believe the term you used was cross-pollination?”
“I was talking about decision-making, George.”
“And that’s exactly what I’m attempting to do, Dr. Kornblatt. Cross-pollinate vis-à-vis security decisions. In that spirit I reiterate my offer to you—to any of you. Come up with your own security proposals. If you can develop one as comprehensive as ours, at equal or lower cost, the administration and the board will be more than happy to entertain it seriously. I mean that. I’m sure I don’t need to remind you of the institution’s financial situation. That four hundred thousand will have to come from somewhere.”
“Patient care, no doubt,” said Kornblatt.
Plumb gave a sad smile. “As I’ve stressed in the past, patient-care reduction is always the court of last resort,” he said. “But each month strips us closer and closer to the bone. No one’s fault—it’s just present-day reality. In fact, perhaps it’s good we’ve wandered afield of the issue of Dr. Ashmore’s murder and are talking about it in open forum. To some extent, fiscal and security issues dovetail—both stem from demographic issues outside of anyone’s control.”
“There goes the neighborhood?” said Spironi.
“Unfortunately, Doctor, the neighborhood has already gone.”
“So what do you suggest?” said Elaine, the ponytailed woman. “Closing down?”
Plumb shifted his gaze to her sharply. Lifting his foot from the chair, he straightened and sighed.
“What I suggest, Dr. Eubanks, is that we all remain painfully aware of the realities that, for all intents and purposes, imprison us. Institution-specific problems that augment the already difficult state of health care in this city, county, state, and to some extent, the entire country. I suggest that all of us work within a realistic framework in order to keep this institution going at some level.”
“Some level?” said Kornblatt. “That sounds like more cuts a-comin’, George. What’s next, another pogrom, like Psychiatry? Or radical surgery on every division, like the rumors we’ve been hearing?”
“I really don’t think,” said Plumb, “that this is the right time to get into that kind of detail.”
“Why not? It’s an open forum.”
“Because the facts simply aren’t available at present.”
“So you’re not denying there will be cuts, soon?”
“No, Daniel,” said Plumb, straightening and placing his hands behind his back. “I couldn’t be honest and deny it. I’m neither denying nor confirming, because to do either would be to perform a disservice to you as well as to the institution. My reason for attending this meeting was to pay respect to Dr. Ashmore and to express solidarity—personal and institutional—with your well-intentioned memorial for him. The political nature of the meeting was never made clear to me and had I known I was intruding, I would have steered clear. So please excuse that intrusion, right now—though if I’m not mistaken, I do spot a few other Ph.D.’s out there.” He looked at me briefly. “Good day.”
He gave a small wave and headed up the stairs.
Afro said, “George—Dr. Plumb?”
Plumb stopped and turned. “Yes, Dr. Runge?”
“We do—I’m sure I speak for all of us in saying this—we do appreciate your presence.”
“Thank you, John.”
“Perhaps if this leads to greater communication between administration and the professional staff, Dr. Ashmore’s death will have acquired a tiny bit of meaning.”
“God willing, John,” said Plumb. “God willing.”