A Second Opinion, Chapter One: “Blow, blow, thou winter wind”
This is chapter one of a serialized novella which will appear on Ars Gratia Libertatis bi-weekly.
Chapter One: â€œBlow, blow, thou winter windâ€
Now winter nights enlarge
The number of their hours,
And clouds their storms discharge
Upon the airy towers.
–Thomas Campion (1617)
The first few flakes of the coming storm drifted lazily past the window.Â John Morales watched them fall.Â They descended slowly, occasionally collecting in the window sill or meeting their doom against the warm glass. The streetlamps in the parking lot, like spotlights, caught them in a yellow-orange glare and lit them up as if on a stage. Their downward spiral became a spectacle of theatre.Â But the lethargy of the flakesâ€™ descent unsettled John.Â Normally he loved watching the beauty of snowfall from a safe, warm shelter, but not tonight.Â Tonight he suspected malice in the easy path the snow traced to the earth.Â It lingered, as if to say â€œthereâ€™s no need to hurry, time is on our side.â€Â The snow knew it was only going to get colder, and it could be deliberate in its wintry conquest of the frozen ground.Â Its reign was inevitable.
He glanced at his watch, only 5:30, and already it was dark outside.Â It was going to be a cold December.Â He allowed himself a wry smile to think the snow was right; the National Office of Weather Prediction had issued a â€œsevere winter weatherâ€ alert for Denver and Jefferson Counties.Â Heâ€™d have to leave soon to beat the storm or risk sleeping at the hospital, again.Â He sighed and ran his hand through his hair, looked once more out the window and, pushing morose thoughts from his mind, focused again on the paper in front of him.
It was a requisition and compliance form and it had to be done by tomorrow when the agent from the health board came for his weekly inspection.Â In bold black letters, next to the eagle and Rod of Asclepius seal of the National Office of Health Services, it read, â€œForm 111-3a for the Administration of Health Care Services Relating to Treatment of Central, Peripheral Nervous System and Spinal Column Diseases.â€Â He filled out his clinicâ€™s identification number at the top, and his own personal physician number, next to his federal ID number and Social Security Number below it.Â Next came the tedious process of checking off procedures, patients, uses of equipment, and requests for more supplies.
He was lucky his clinic enjoyed such a good reputation and that he was the only certified neurosurgeon on the whole Front Range.Â Other clinics and hospitals routinely had to deal with shortages of equipment and medicine. Â He had heard rumors (vehemently denied by the Health Department) of some doctors giving cancer patients sugar pills, because the necessary drugs couldnâ€™t be obtained from the Health Services Distribution Office.Â It was all only temporary, of course, until the Health Department was able to finish the reorganization of the health care industry.Â Still, things were going to get worse before they got better, if the increasing volume of paperwork was any indication.
John Morales was 32 years old, but already he had national acclaim as one of the best neurosurgeons in the country.Â Heâ€™d graduated with honors from Harvard Medical School and moved back to Denver, Colorado, where his father was mayor and could pull some strings with the Health Department Physician Allocation Board, to do his internship and residency.Â He had become somewhat famous when he removed a potentially fatal blood clot from the brain of the governorâ€™s son, who had been brought in after a skiing accident.Â In gratitude the governor had overridden the decision of the Health Department and allowed Morales to open his own neurosurgery practice at the Sky Ridge Medical Center in south Denver.
Johnâ€™s thin frame made him appear taller than his five foot ten, and his jet black hair accentuated his dark, unnerving eyes.Â Visitors to his office often noticed that his movements were slow, they would seem almost lazy but for their quiet efficiency.Â All this lassitude disappeared when he was performing surgery.Â In the operating room he moved with an energy even he couldnâ€™t explain, barking orders and focusing with an intensity that seemed like it could melt through steel.Â These days though, that was the only time he seemed to have any energy.Â He didnâ€™t know why he felt constantly drained when he returned every night to the small house he shared with his girlfriend.Â It had become a chore, waking up in the morning to a career that had, at one time in his life, been the only thing that could excite him.Â He didnâ€™t know why the thought of saving lives no longer provided the inspiration it had before.
The next time John glanced up from his desk it was 7:30, and a few inches of snow had accumulated on the asphalt beyond his window.Â He re-read the form one more time, signed his name on the last page, and stood up with a sigh.Â Reaching for his jacket he took a last look out the window at the snow in the parking lot.Â He paused and looked closer: what had before been an unsullied blanket of white was now marked with two sets of footprints, both leading to his door.
He heard the knock and tensed; surely no one out this late, in this storm, could be up to any good.Â Moving slowly to the front of the office, past the receptionist desk, he strained to see his guests out the windows.Â He glimpsed two slight figures, one shorter than the other, taking cover against the wall as they waited for their knock to be answered.Â He reached the door and opened it cautiously.Â â€œHello?Â Can I help you?â€
â€œAre you Dr. John Morales?â€ The voice came from the taller of the two figures, both still in the shadow of the doorjamb.Â Despite the voiceâ€™s obvious femininity, it carried a hint of command.
â€œDr. Morales, my daughter and I need your help.â€ The woman moved into the light as she spoke, guiding her daughter forward as well.Â The womanâ€™s face was grim, angular, with short, ash blonde hair and cold, grey eyes. Â These now looked at John beseechingly, her eyebrows drawn together in concern.Â Her daughter, about 11 or 12 years old, peered up at him placidly, her green eyes seeming to calmly register everything, a few bright blonde strands of hair were visible from the hood of her parka and her slightly crooked nose glowed red with the cold.Â â€œMay we come in?â€ her mother asked.
â€œYou know being here this late is against the Patient Care Laws, right?â€Â Morales reminded her.
â€œYes, I know.â€
There was every reason to turn her away.Â He needed to leave soon before the falling snow made the highway impassable, and the Patient Care Laws forbade meeting with a specialist outside the approved appointment process, punishable by fines and jail time.Â There was, of course, good reason for such laws and Morales had had many experiences with desperate or cunning patients trying to game the system and bypass the waiting times illegally.Â Such laws merely made sure everyone got equal treatment and access to an increasingly shrinking pool of specialist doctors and surgeons.Â Morales knew they were necessary, despite how bad he always felt when turning away a frantic mother or pleading husband. Â But the quiet intensity of the womanâ€™s gaze, the fact that she had asked for him by name, her honest admission of her guilt in coming to see him after hours and, though he wouldnâ€™t admit it, his own simple curiosity, made John Morales relent.Â â€œIâ€™ll see what I can do. Â Come in, come out of the cold.â€Â He opened the door wide and motioned the pair inside with his arm.
The woman ushered her daughter through the door and spoke as she removed her scarf, â€œThank you doctor.Â I apologize; we wouldnâ€™t have come here except itâ€™s absolutely urgent.Â I know our being here is illegal, but we have no one else to turn to and Alyssaâ€™s situation isâ€¦unique.â€Â John Morales raised an eyebrow in curiosity and she continued, â€œMy name is Lysandra Fremont, and this is Alyssa, my daughter.Â Alyssa has started to get seizures, vision loss and numbness in her feet, among other symptoms.Â We went to a primary care doctor, but he couldnâ€™t even make a diagnosis.Â Her symptoms match no known illness, neurological or otherwise.Â He said weâ€™d have to talk with a neurological expert to find out what she has.Â Unfortunately, Alyssaâ€™s symptoms are getting worse.Â Even under normal circumstances the wait to see a neurologist is 8 months, which I donâ€™t think she has, and ours are hardly normal circumstances.â€
â€œSee, Dr. Morales, because of a clerical error in the Department of Healthâ€™s Patient Database, Alyssa and I arenâ€™t allowed to receive specialist care.Â Weâ€™re trying to get it resolved but itâ€™s already been two years, and you know how fast bureaucracies are at fixing their mistakes.â€Â She smiled wearily.Â â€œWe tried everything we could to get Alyssa an appointment with someone who could help her, but nobody would let us.Â Coming to you like this is an act of desperation.Â Alyâ€™s not getting any better and Iâ€”weâ€”have no-one else to turn to.Â Youâ€™re the only one who can help us.â€Â The last sentence was spoken softly, but her eyes looked steadily into Johnâ€™s face.
Morales hated this part, â€œIâ€™ll talk to someone, see what I can do to fix your situation, but I canâ€™t treat your daughter until I have all the right permissions.â€
â€œWeâ€™ve already tried working within the system Doctor, talking with someone wonâ€™t work.Â You must believe me, this is the only way Alyssa will get treated.â€
â€œThe health agents wouldnâ€™t just deny a request like that, thereâ€™s got to be something youâ€™re not telling meâ€”â€œ
â€œBut thereâ€™s got to be some reasonâ€”â€œ
â€œReason has nothing to do with it Doctor.Â Procedure does.Â The secretaries, and bureaucrats that all denied Aly treatment were merely following the guidelines they were given.â€
â€œLook, even if I wanted to help you I couldnâ€™t, not without getting caught.Â I have to account for every nickel I spend and report all expenditures on equipment and medicineâ€ sighed the surgeon.
Lysandra smiled, â€œThatâ€™s an easy enough problem to solve. Iâ€™ll simply pay you out of pocket for all the expenses you incur, that way you donâ€™t have to report any of it to the Health Department.â€
â€œI donâ€™t think you understand how expensive this can get Ms. Fremont.Â These procedures can cost hundreds of thousands of dollars; thatâ€™s why only the government can afford to pay for them.â€
â€œIâ€™ll admit I canâ€™t pay you with government credit Dr. Morales; truth be told the Revenue Department rejected our application for access to my husbandâ€™s bank account after he died.Â But Iâ€™m no beggar; my family had several physical assets left after Markâ€™s death, and I can pay you, in these.â€Â She pulled a small gold coin, no bigger than a dime, from her pocket and pressed it into Moralesâ€™ hand.Â He held it up wonderingly, turning it over in the light to study its detail. Â On one side were two letters, a capital U and a capital S, one overlaid on the other, and the phrase â€œLife, Liberty, Propertyâ€ above the number 10. Â The opposite side bore a painstaking rendition of a distinguished man in a periwig, with the name â€œPatrick Henryâ€ inscribed beneath it. â€œItâ€™s real.â€ Lysandra said.
â€œWhere did you get this?â€ John asked.
â€œYou wouldnâ€™t understand.Â But I can assure you I have enough of them to pay you for whatever treatment Alyssa needs.â€
John lowered the coin slowly, and held it out for her, â€œMrs. Fremont, as much as I want to help you I canâ€™t, this is illegal andâ€”â€œ
â€œBut is it wrong?â€ the little girl interrupted him.
â€œIs it wrong, or right?â€ Alyssa repeated, her green eyes looking directly at him.
There was a moment of silence as Morales considered the simple question.Â Finally he replied, â€œItâ€™s not a question of wrong and right, when you get older youâ€™ll realize there are other things you need to take into account, like the effect on other people and on society.Â What would happen if we let just anyone come in off the street without an appointment and ask for care?Â Hospitals would be swamped and overworked and then no one would get medicine.Â See, not everythingâ€™s as black and white as it seems to be when youâ€™re young.â€
â€œMaybe, maybe not.â€ Lysandra replied with an amused smile.Â â€œAnd we wouldnâ€™t want you to treat Alyssa over the objections of your conscience.Â May I ask you a question, Doctor?â€
â€œSureâ€¦â€ was Johnâ€™s cautious reply.
â€œWhy did you decide to enter medicine?Â Itâ€™s a very difficult profession, isnâ€™t it?Â Especially the field of neurology.â€
Again Morales paused.Â Why was he even entertaining the idea of not turning these people over to the authorities?Â And why did he feel compelled to be honest with the pair?Â Both mother and daughter seemed to have an air of frank sincerity; he would almost have called it naivetÃ© but for the steel he saw in Lysandraâ€™s eyes and the silent perspicacity he saw behind her daughterâ€™s.Â Their directness and openness unsettled him.Â He wasnâ€™t used to people speaking so candidly about their position or their needs.Â Neither had mentioned any high ranking political connections (fictitious or otherwise) to pressure him into aiding them, and neither had presented forged Health Claims documents.
At a loss, he gave her the rote answer, “Because I wanted to help people.”
“But that’s not all, is it? Â If it were you could have joined a government soup kitchen and endured far less. Â Instead you chose 12 grueling years of medical school, internships and residency. Â Did you really just want to help people?”
“I wanted to save lives.”
“And is that what you’re doing?” Â Lysandra didn’t glance at her daughter to make her point but Morales looked at the little girl nonetheless. Â “How much of your time is spent filling out paperwork for bureaucrats who’ve never once set foot in a medical classroom and how much is devoted to actually saving lives doctor?”
“And whose lives are you saving?” she interjected rapidly. Â “48 of the last 50 patients you treated were either friends or relatives of people with political power. Â I know, I checked.”
“That’s enough!” he yelled, and caught himself, surprised by his own outburst. Â He went on, more quietly, “The system works; yes it has flaws, but without it even fewer people would have access to the small amount of medical specialists out there.”
Lysandra smiled, opened her mouth to ask a question, seemed to think better of it and instead looked at her daughter. Â Her next words were spoken softly, “And if the system has flaws, John Morales, shouldn’t you at least try to correct them? Â Whatever risk to your professional career that entails?”
The Fremont woman turned her grey eyes once more on Morales, â€œWe wonâ€™t ask you to make this decision right now Doctor. I don’t want you to feel pressured and we’d prefer you have some time to think it over.Â Iâ€™ll bring Alyssa back in a week, and you can decide then.â€
John Morales nodded quietly.Â Lysandra and Alyssa put their coats on and left the office without another word, just a shy wave from the little girl as the door swung shut.Â The doctor stood looking at the closed door with eyes narrowed in thought, a small gold coin clenched in his hand.