A Second Opinion, Chapter Seven: The More You Know…
This is chapter 7 of a serialized novella appearing on Ars Gratia Libertatis every two weeks. Â Read from the beginning here.
Chapter Seven: The More You Know…
Quis custodiet ipsos custodes? –Juvenal
The surveillance van was state of the art. No expense had been spared in equipping it with all the newest bells and whistles of the professional voyeur’s trade. Declaring that the van would be “fighting terrorism” the Health Board had kitted it out with full video and auditory sensing and recording equipment (including night and thermal filtering), a veritable hacker’s wet dream of phone and internet taps and signal boosters, and even some more exotic technology still in the experimental phase. Though budgets for life-saving drugs and new beds for hospitals lagged, for this, it seemed, there was always enough money.
The Sky Ridge Medical Center was a large hospital complex, with sprawling, concrete parking lots that enveloped and extended, as construction is wont to in the wide open West, in every direction. The van had been parked on the edge of one of these for most of the day without arousing the slightest suspicion in passerby. An extralegal dump of the hospital’s security records had turned up only one item of note. The hospital’s security coordinator, Gerald Clarke, had put in a recent request for new CCTV cameras to replace some that were malfunctioning on the north side of the complex. He had written in the comments section of the online requisition form that the cameras had been recording spottily, showing nothing but static for brief intervals, usually in the evenings.
At 3:00 an unusually observant person would have noticed the van moving from one parking lot to another, more northern one. The van’s inhabitants spent the rest of the day waiting.
By 7:00 most of the windows marking doctor’s offices were dark, only a few stubborn holdouts remained lit. Of these only one was on the ground floor of the hospital. At about 7:30 the van’s occupants, patched into the hospital’s security network, noted a malicious subroutine, cleverly concealed as a recurring calendar appointment, shut down the optics and audio of all the cameras on the north side of the building. Before they could repair the intrusion into the hospital’s computer network, two people came walking through the parking lot from the direction of nearby I-25.
Both people wore heavy jackets and scarves, and the agent manning the front seat of the van noticed a wisp of blond underneath the smaller figure’s winter hat. He quietly signaled his comrades, still puzzling over the hospital computer infection, and they reluctantly joined him at the front where they could see the pair as they made their way through the windblown parking lot to the north entrance. The door soon opened, spilling sterile light onto the coal black pavement, and the van’s occupants could, by zooming their camera lenses, make out a surgeon in a white coat with short, dark hair holding the door open and smiling broadly. The smile froze in time on the screens inside the van, as the image was captured for analysis against a citizen database. The door closed, and the van’s occupants scrambled to get audio within the facility.
But the computer hack had taken down the internal recording devices on this side of the hospital as well. For almost an hour the frustrated would-be spies tried every workaround and digital trick to undermine the crafty electronic interloper, but to no avail. The van’s occupants were interrupted in their frantic coding by the hospital’s north door, as it once again cast a clean shaft of light onto the pavement. The doctor reappeared, this time clad in a winter jacket, and still smiling. Behind him came the other two, likewise armed for the cold.
The trio made their way to a solitary car, a decade old model, and waited patiently as the doctor fumbled for the unlock button on his keys. All three piled in and a moment later the car was rolling towards the parking lot exit. Shortly afterwords the van, too, began to move.
Morales had agreed to drive the Fremonts home with some reluctance. Though Lysandra had convinced him that the recent transportation strike had cut the bus service they needed to get back, John couldn’t help but think something else was behind her unprecedented request. He had agreed because he couldn’t bear to imagine mother and daughter walking for miles through the winter ice in the dark, but also to satisfy his own curiosity and maybe learn something new about the mysterious pair.
The ride to the Fremonts home was animated, with Lysandra continuing the discussion she’d begun in the hospital, Alyssa adding insights incredibly trenchant for a 10 year old, and Morales challenging and asking questions as he drove. The Fremonts lived in a small apartment complex just east of downtown Denver. John, following Lysandra’s directions, took Colfax Avenue through the city, past the state Capitol building and south of the financial district with its soaring arias of steel and glass.
During a brief lull in the conversation Alyssa began picking at the upholstery. “I wouldn’t want to be a doctor here, you drive a crappy car.”
“Aly! That’s impolite.” Her mother was stern, but not because she disagreed with her impudent offspring.
Morales chuckled, “It’s ok, I get paid the standard approved surgeon’s salary.” Lyse could tell Morales was thinking about something else even as he said it.
She probed, “Is that salary enough for someone with a family? Or parents to support?”
“The Health Board calculates it based on an average cost of life index. If surgeons are paid too much then the price of healthcare rises beyond what many people can afford, and the government would have to raise taxes.”
Lysandra directed Morales to turn into a parking lot on the left as she replied. “John, ten years ago there were neurosurgery clinics in every major hospital in the region. Neurosurgeons were one of the highest paid, most respected positions in medicine and somehow even people without tons of money got treated. But nobody studies neurosurgery anymore, it’s just not worth the extra years of schooling. You’re the last neurosurgeon in the whole state. Do you know what that means? Why do you think we have such a shortage of doctors and nurses?” She said her next words slowly, to stress their importance, “Incentives matter, John. If there are no more neurosurgeons it doesn’t matter what they get paid, no one will get treated.”
Morales didn’t answer, just put the car in park. Finally, he responded, “I had a friend who left his job as a heart surgeon for a fundraising role on the governor’s last campaign. He told me in private it paid better. I heard his wife had just got pregnant.”
Lysandra opened the passenger side door and turned to John, “I think you should come inside for some hot chocolate. I’d like to share something with you.”
He hesitated for a moment, Alyssa, her winter hat already on, looked at him unnervingly from the back seat, and the open passenger door let in cold air. Morales turned off the engine and unbuckled his seatbelt.
Across the street a white van pulled into an empty parking space.
The Fremonts’ apartment was modest. It had no art on the walls, and its small living room, leading off to a tiny kitchen around the corner, was tidily put together. The only thing that gave it any unique character, in fact, was the fully stocked bookshelf on the far wall. It was large to the point of being ostentatious, and completely at odds with the more unassuming furniture that made up the balance of the room.
Morales could make out a few of the larger titles from the doorway; their spines loudly proclaimed dissertations on and defenses of “liberty,” “economics,” and “rights.” Some of the authors he recognized, others were more obscure. There were some German sounding names, and, how would you even pronounce that? Anne? he guessed while tilting his head sideways at one of the more ponderous looking tomes on the top shelf. Something about Greek mythology. He smiled. Well, you certainly couldn’t say the Fremonts were unread.
Lysandra returned from the kitchen with two steaming mugs. “You can sit if you like.” Morales, thanking her, took one of the mugs and lowered himself onto the couch. Alyssa had retreated to her bedroom to do homework, leaving the two adults to discuss the type of boring things adults are concerned with. Lysandra sat across from John and set her mug on the coffee table.
“John, what’s your opinion on the country?”
He smiled helplessly at the overly broad question, one of Lyse’s hallmarks, before he realized she expected an answer. “I…” his first flippant response died as he took in the earnestness of her gaze. Morales paused, and gave the issue some serious thought as he took a hesitant sip of the still scalding hot chocolate. “I don’t know that I have much of an opinion on it, I mean, I certainly didn’t up until a few weeks ago.” He went on as Lysandra suppressed a smile behind her cocoa mug, “It’s definitely got issues, it’s not perfect.” Morales paused again, reflecting, “I suppose I’m unhappy with it, on the whole.”
“And do you think it’s headed in the right direction, on the whole?”
“What do you mean?”
“Do you see things getting better or worse if the country continues in the direction it is going?”
“Well, all these shortages and the economic crisis and emergency powers are only supposed to be temporary…” his voice trailed off in an audible ellipses. The “but” was left unsaid.
“No one really believes they will be.” Lysandra finished for him.
John Morales nodded.
“And what about the healthcare system?”
“I think you know I agree that it’s broken, and I’d like to help you fix it.”
Her eyebrows shot up, “Oh? And how do you propose to do that?”
Morales was, once again, caught off guard. “Well, I thought–I mean, you’re always talking about it; haven’t you got some ideas? Isn’t that why you brought me up here?”
Lyse smiled chimerically, “What are your ideas John?”
“Honestly? I hadn’t–” he saw the look on her face and concluded, deflatedly, “I thought about maybe starting a political advocacy group; I could raise some money for a mailing and advertising campaign and then try some lobbying at the federal level.” Isn’t that how things get done?
“Several such groups already exist. Why would you succeed where they have failed?”
The surgeon felt a flicker of annoyance. “Are you trying to tell me it’s not possible? To just give up?”
The woman across the coffee table seemed not to hear the question. “John, as a doctor, would you try to treat post-surgical epileptic seizures by prescribing ephedrine?”
Morales gave her a quizzical glance before replying, “No, that wouldn’t help at all, it might even cause harm. I would prescribe phenytoin sodium instead.”
Lysandra continued, “What if it wasn’t that easy, and you didn’t know that phenytoin was the most effective anticonvulsant? Would you continue prescribing ephedrine, knowing it wasn’t effective?”
He leaned back into the couch, and took another sip of hot chocolate. “No, that’d be against the medical code of ethics. I’d have to turn to research and evidence to find an effective medicine like phenytoin.”
“So tell me,” the woman across the coffee table concluded, “what evidence do you have that a strategy of political advocacy will bring about positive, structural change to the healthcare system? What evidence do you have that working within the system works?”
Morales was taken aback, then chuckled at an errant thought; at its very implausibility, “Are you suggesting violent revolution, then?”
Lyse shook her head earnestly, “Not violent, no, those rarely work out. I’m talking about a different kind of revolution. It’s still dangerous, but-” she paused, as if remembering something.
For the first time since he’d met her 2 months before, John sensed that Lysandra was nervous. She had been fidgeting unconsciously throughout the conversation, her fingers tapping the side of the mug she held in her hands. She bit her lip. Morales was, now more than ever, exceedingly curious.
Lysandra finally set her mug down and stood up. “John, can I tell you a story?” The doctor nodded. She stepped to the other end of the little room, then turned to regard him with an odd expression, one corner of her mouth drawn upwards and her eyebrows downwards, as if not quite sure what to do with this neurosurgeon in her living room. The look passed and she spoke. “I told you my husband, Mark, died several years ago, but I never told you how.”
The angular woman seemed, for a split second, almost vulnerable, and she reached her hand out half-unconsciously to rest it against the bookshelf. She went on, her voice even, “Mark didn’t die in some accident, or of an incurable disease, or anything like that; he was murdered.”
Morales sat up a little straighter.
“He only wanted to help people, and for that, he was killed.” The words didn’t sound as bitter as they could have; it had been a while. “John, how familiar are you with private doctors’ cooperatives?”
“I know they’re illegal, and highly dangerous.”
Lysandra smiled sadly, “Only to those who run them.” Morales raised an eyebrow and she explained, “10 years ago, when the government really started tightening controls on medicine, my husband started the first doctors’ cooperative.
“It was a very low-key thing at first. He started simply by doing some pro-bono diagnoses for a couple close friends and family, really more consulting work than healthcare. Once the Patient Care Laws went into effect many people could no longer get appointments for the type of minor diagnoses, and prescriptions that Mark had been doing, and that were no longer covered under government health insurance. So friends of friends also started stopping by. And some of these started paying him for the favor. Sometimes in gift cards, or home-brewed beer, or even silver coins, before those were all bought up by the Treasury.
“Pretty soon Mark had more ‘patients’ than he could handle outside of work hours. He couldn’t simply turn them away, as the hospitals and big medical practices were doing; these were people he knew and cared about, and I couldn’t help him as much as he needed since I was still completing my residency.” Morales started slightly at this. Lysandra continued, “So he brought on a partner.”
“Mark had a close friend in his practice who shared his, uh, political ideals, and managed to convince him to start doing the same under the table work. Together, they managed to help all the people that had been overwhelming Mark. But then the law changed again.
“The Patient Care Laws weren’t doing what they were supposed to; the cost to the government of the universally guaranteed medical care kept going up. They had to do something or risk insolvency of the whole system. That’s when they passed the pay caps. I think they called it the Medical Pay Rationalization Act. It was supposed to happen gradually, but many states implemented it within the year, to try and prop up their failing budgets.
“A lot of doctors we knew just quit. A lot of others were stuck with student debt and mortgages they suddenly couldn’t afford, and kids they couldn’t put through college. More than a few turned to outside work to supplement their income.
“Mark mentioned his little side project to a couple of them; he didn’t make much from it, but it did help. Several joined him, bringing their own patients and networks. Eventually there were dozens of doctors working in this ad-hoc organization treating people under the table. It got so big they rented a temporary office space to handle some of the patients during the daytime hours.
“But at that size it was unwieldy, and it was no longer just close friends and relatives stopping by. Now we had friends of friends, and friends of friends of relatives being referred, and it was bound to get out sometime that there was a secret underground doctor’s co-op treating people who couldn’t get care in the official government system.
“And it did get out. But we didn’t think-” Here she paused, and seemed to lean more heavily on the bookshelf at her side. She swallowed and continued, “We just didn’t know how the government would react.
“There was a raid. We still don’t know who reported the co-op to the Health Board, but we know the result. They came in the evening; Mark was just starting his shift at the rented office after finishing up at his day job clinic. The Health Board sent two full SWAT teams, blew down the door and charged in guns drawn, as if they were dealing with hardened, dangerous criminals.
“Mark was sitting at the front desk, doing some accounting paperwork before his first client. When the door blew open he stood up; instinctively, or out of fear, I don’t know, and some government agent thought that was threatening behavior and shot him 3 times in the chest.” There was no hint of stress in her voice at the last, and her eyes calmly met John’s. It was as if, having already made the decision to share it, relating the moment of her husband’s death was no more taxing than commenting on the weather to a recent acquaintance. But her hand never left the bookshelf.
“A lot of things happened after that. Many of the doctors were arrested and fined, there was an official investigation into the shooting that found the agent’s ‘use of force was justified,’ and,” she took a breath, “the idea of an escape was first discussed.
“Mark’s friend, the one he first brought into the co-op, had some pretty radical ideas. He wanted to kill the man who’d shot Mark, he wanted to sue the federal government, he wanted to convince the state to secede. One of his ideas was to start our own hidden society, so something like this could never happen again. It was a crazy idea, but he was passionate about it, and argued it eloquently. He began to win over some other doctors. And me.
“We later found the reason for his persuasive eloquence was that he’d been visited, not long after the…raid, by someone who was already living in such a place, and who wanted us to join them. When we learned that this secret group already existed to a degree, it didn’t take much more convincing for a lot of us to sign on.
“And that’s where we went and helped to create. What you jokingly called a ‘Shangri La’ the other night actually exists.”
Morales was not convinced, and his skepticism was plain in the downturn of his eyebrows.
“John, I want to take you to Shangri La” she added.
“But that’s…” he couldn’t think of a better word for it, “a bit extreme.”
Lysandra frowned, “This country is falling apart, can’t you see that? We have ‘Patient Care Laws’ that were created to prevent patients from getting care. We’ve been in an ‘economic crisis’ for over a decade. There are fewer doctors, fewer entrepreneurs, and fewer jobs. The only thing there’s more of is government bureaucrats. And that’s just not sustainable. I mean, the snow doesn’t even get shoveled anymore!” Lysandra was unusually animated, waving her arms to the streets outside the window to make her point. She calmed down. “And things are getting worse.”
Her voice was hushed, but insistent, “The government has power over almost every aspect of our lives, and it’s been growing for years. The government can now control our medical procedures, for our own good, censor the Internet, for our own good, confiscate our property, for our own good, regulate food prices, for our own good, limit where we work, for our own good, track our every movement, for our own good. How far away do you think we are, really, from political dissidents and undesirables being arrested and ‘disappeared,’ all in the name of some common good?”
Morales was still doubtful, “Don’t you think you’re being a little dramatic? People predict apocalypse and tyranny all the time but it never actually happens.”
“Except when it does,” Lysandra was quick to counter. “People who predict doom and gloom are pariahs, until they’re right. And there are numerous times through history when they’ve been right. Just look at Wiemar Germany or the Roman Republic. John, there is plenty of evidence that this society is on a quickly accelerating path to government control and terror, even if you won’t admit it.”
Morales felt a bit of color flush to his cheeks, and he stood up from the couch, bringing his gaze level with hers. “Oh? Then why me? Why come out here to try and ‘save’ me? Was I just the most crucial domino? Will my loss hasten the demise of this society you hate so much? ‘The last neurosurgeon in the whole state?’ ” He repeated her earlier words, making air quotes with his fingers.
Instead of responding she turned to her bookshelf and, after a quick search, pulled something from it. Crossing the small room she presented it to John for inspection. It was battered and fairly old, dated, in fact, the year of his graduation from Harvard undergrad, but he recognized it immediately. The byline on the red and gray cover of The American Journal of Ethics in Medicine (which had since ceased publication) in the top right corner read, â€œThe Purpose of Medicine, by John Morales.â€
His eyes widened slightly in surprise. Belatedly, he noticed the smattering of medical textbooks among the more numerous philosophical and economic volumes on her bookshelf. Lyse answered, â€œBecause I read this.â€
She paged through it, came at last to the place she wanted, and held it up so John could see. There, underlined in a thick, blue pen, was the conclusion of his piece. “A doctor’s position necessitates a special focus on the politics and, more importantly, the underlying philosophy of the healthcare system he labors in. If that system becomes inimical to individual rights, if it encroaches upon the freedom of the patient to choose the level of care he thinks best for him, and the liberty of the medical professional to practice according to the dictates of his conscience, and to be compensated fairly for his efforts and expertise, then a doctor must, if he truly wishes to be a guardian of health, seek to alter and reform that system. Of course, this means the doctor must also take a stand; he cannot sit on the fence regarding his ethical and philosophical beliefs. But then again, who can?”
John was suddenly uncomfortably aware of how close Lysandra stood to him, of her measured breathing as she searched his face, and of the curved line of her hair, as it framed her eyes. He broke her gaze with difficulty.
“You studied medicine?”
“So what are you now? Some glorified headhunter? Instead of trying to recruit people for a job you’re recruiting them for a whole society?”
Some mirth returned to her eyes. “Yes.” She carefully returned the old copy of the Journal to its place on her bookshelf. “We thought it made sense for each of us to be responsible for people in our unique areas of expertise.”
“Surely you don’t think a whole society has only one headhunter?”
John was, if not yet convinced, beginning to consider the barest hint of a possibility that everything Lysandra Fremont had said was true. A secret, hidden civilization? It would seem laughable but for the stubborn peculiarities that he still could not explain away: the mother and daughter’s complete invisibility to a wide array of government databases, their belief in things that nobody articulated in public anymore, and the single, hard gold coin he still had from their first visit. Suddenly he was full of questions, “And just where is this society? How big is it? What kind of governm-”
Lyse held up her hand and interrupted, “John, I realize the importance of an informed decision when it comes to something like this, but you have to understand, for safety’s sake there are just some things I can’t share with you yet.”
Finally, one last question bubbled to the surface of John Morales’ brain, one of supreme importance, “But what about Alyssa? Does your ‘Shangri La’ have the necessary equipment for me to continue my tests on her?”
Lysandra froze. Her eyes darted to Alyssa’s bedroom door, and she seemed to move them back to John’s face only with a supreme effort. She took a deep breath, â€œJohn, I was never trying to save her; I was trying to save you.â€
He felt a sudden, tickling sense of foreboding. â€œWhat do you mean?â€ His eyes were narrowed in suspicion.
The admission, when it came, was blunt and matter-of-fact, â€œAlyssa has no neurological illness, but up until recently you did.â€
The anger filled his stomach with warmth, he could feel his jaw involuntarily clenching. His knuckles, protruding roughly from the fists at his side, were blanched white. â€œYou lied to me.â€ It wasn’t a question.
The hurt in her eyes perfectly mirrored the rage in his. â€œPlease understand John, I had to for-â€
â€œFor my own good?â€ His sarcasm cut her off. â€œHow dare you lecture me on morality.â€ His voice was under control, but just barely, as he backed away from her. He opened the door, turning around just long enough for a final, bitter broadside, “Oh, and that essay of mine? Where everything is clear, and black and white, and easy? I grew out of that stuff after college, maybe you should, too!” The door slammed behind him, strong enough to shake the books across the room.
John drove aimlessly, angrily. He found himself downtown, amid tall skyscrapers still bravely proclaiming their neon devotion to holy Commerce. He stopped at a red light and looked dully through his window. The news ticker on one of the financial buildings scrolled ponderously; the crimson light from its updates spilled across the snow on the sidewalks, even this late in the evening. “…’Gang of Five’ senators indicted in sex scandal, forced to resign…Major news networks to see third government bailout…President orders state automobile firms to increase hiring…Prescription drug shortage ‘only temporary’ says Health Board Director…” Morales looked away.
He didn’t notice the white van stopped 2 cars behind him in traffic.