A Second Opinion, Chapter Two: The Man From the Health Resources Allocation Board

This is chapter 2 of a serialized novella appearing on Ars Gratia Libertatis every two weeks.  Read from the beginning here.

Chapter Two: The Man from the Health Resources Allocation Board

 

“Bureaucracy is a giant mechanism operated by pygmies.”

–Honore de Balzac (1850)

That night John drove home through the gusting snow.  He arrived distracted and preoccupied.  His girlfriend, Shelly, hardly noticed during a short dinner as she went on about her day.  After dinner, while Shelly sat down to watch TV, he excused himself and went out to the garage.  He began pulling boxes down from their positions on the storage shelves in the back.  After a short while he found what he was looking for, a beat up plastic storage container, marked on the side with worn-out marker, “Personal.” He carefully lowered it to the ground and sat down on the cold concrete beside it.

Inside was a diverse collection of papers, pictures and trinkets: things that, at one point or another, had been significant enough to him to merit being set-aside and saved.  There were tickets from the play he had seen with Shelly on their first date (Les Miserables), a Mother’s Day card he had made when he was three, some school projects and papers he’d been unusually proud of, some certificates of achievement, a picture of him at graduation.  He paged through all of these, carefully setting them aside on the dusty garage floor, until he came to a single, battered blue folder.

He didn’t know why he felt compelled tonight to revisit this piece of his past.  The box hadn’t been opened since his mother’s death a few years ago.  He nevertheless peeled the aging cover back and sat, absorbed, reading the words of his 22 year old self.  Behind the blue folder cover was an essay, written towards the end of his pre-med undergraduate career at Harvard.  The essay was titled, “The Purpose of Medicine” and had been written in a philosophy class he’d had to take to fulfill a liberal arts requirement.  His professor, while disagreeing with the conclusion, had liked it so much she’d submitted the essay and it had been published in an obscure academic journal right after he’d graduated.

“The purpose of medicine” (it began) “is not solely to heal the body and soothe the mind.  Doctors are not robots, merely performing maintenance on biological machines.  They are guardians of health, and for this phrase to have any meaning a holistic interpretation of it is required.  That is, for a doctor to be more than just a biological repair expert, he must concern himself with more than simply the causes and treatments of human maladies.  For a doctor to truly be a doctor he must take a keen and special interest in the world around him; in the way his society is ordered, in how his health care system works and in the underlying philosophy that guides decisions made by politicians and patients alike.”  Morales read all 15 pages, not realizing how uncomfortable he was on the hard ground until he had finished.

He went to bed that night feeling bitter for a reason he couldn’t explain.

****************************************************************

It took Morales two hours the next morning to drive the 5 miles from his house on Arapaho Road to the hospital.  The roads were largely unplowed, city budgets having been cut again. By the time he arrived at the hospital the man from the Health Resources Allocation Board was already there.  He’d asked to be picked up by the hospital’s Flight For Life helicopter “only if it happened to be in the area of the State Capitol building around, say, 9:30am.”  Unsurprisingly, for this man signed off on every pill, needle and paperclip the hospital was allowed to have, the helicopter had been there.

He was a short man, shorter than John, and his balding hair was slicked back from his forehead with a liberally applied amount of gel.  He was a bit too plump, and he smiled a bit too much.  His suit was immaculate.

He was sitting in John’s chair, behind John’s desk, when Morales walked into his office.  He looked up from his work scrutinizing the forms John had filled out last night when the doctor, impatient, coughed quietly.  “John!” he smiled broadly, his eyes dull.  “Glad you made it in, I heard about the roads; god what a mess.  But I guess ‘essential personnel’ like us have to come in to work anyway, huh?”  He chuckled a little too quickly at his own joke.

Morales tried to smile back, it came out as a grimace, “Hi Thomas.”

“Don’t worry, because you were so late I’ve got through most of it.  I’ll only be another 45 minutes or so while I check the nurses’ records for the CAT scans and MRI uses.”

Thomas made no move to rise from John’s chair.  An errant voice popped into Morales’ head, “How much of your time is spent filling out paperwork for bureaucrats who’ve never once set foot in a medical classroom?” He shook his head to clear the thought and smile-grimaced again, “Sure, no problem Thomas.  I’ll do the rounds while you finish up.  Page me if you have any questions.”

Thomas didn’t respond except to focus again on the papers on the desk.  After a short pause, Morales turned and left his office.

His rounds were uneventful; he spoke briefly with haggard nurses who offered him anemic smiles.  As he passed the door to the security office a thought occurred to him and he stopped, did an about-face and knocked lightly on the frosted glass pane labeled “Hospital Security.”

“Yeah? Come in!” a gruff voice greeted him.  He pushed in the door and the mustached man behind the desk smiled up at him, “Hi Doc, what can I do you for?”

“Hey Gerry, think I may have filed a CAT scan under the wrong patient name, could I check your citizen database real quick?”  John adopted a concerned frown.

“Sure thing Doc, just don’t tell the big brass I let you poke around on government computers.”  Gerry winked.  He called every person in a white coat ‘Doc.’  One of his private jokes that only he seemed to find funny.

“No problem Gerry; mum’s the word.”

Gerry gestured to an empty desk with a computer and said, “The password’s ‘Aspen.’”

Lysandra Fremont….No Records Found

Lisandra Freemont…No Records Found

Lisa Freemond……..No Records Found

John tried every possible permutation of Lysandra and Alyssa’s names and every time the government database responded that they did not exist.  He frowned.  Odd.

“Paging Doctor Morales.  Paging Doctor Morales.  Doctor Morales please report to surgical wing room 104.”

“Thanks Gerry, gotta go” said John as he hastily erased his search history and got up from the desk.

“No problem Doc, hey, quick question—”

“Sorry, could be urgent.” And Morales was gone, not bothering to close the door behind him, his brisk footsteps echoing like machinegun fire down the hallway.

When he arrived at 104, his office, Thomas was there waiting for him.  “Well John, looks like everything checks out but ah, there’s one thing…”

John knew what was coming next; he’d done this dance enough with the various bureaucrats and government personages that oversaw his practice to be able to read the signs.  The hesitant manner, the ‘oh-too-casual’ voice (belied by a conspiratorial lean-in of the head) and the raised, questioning eyebrows.

“Listen,” Thomas went on, “I have a friend” (it’s always a ‘friend’ or an aunt or a girlfriend or a big campaign donor) “who’s had some trouble getting an appointment to see a specialist.  I know you have some pull around here, so I was hoping you could look into it.  All of his papers are in order, so it would be nothing illegal,” the bureaucrat assured Morales, “but if you could just look into it, I’d really appreciate it.”

Thomas finished, waiting expectantly.  Next was to come Morales’ role in this little stage production.  He had his lines memorized perfectly, knew his cues and, at any other time, would have played his part like a master thespian.

But instead, he went off-book, upsetting the carefully orchestrated little drama.

“I uh—I’m not sure that’s a good idea Thomas.”

There was a slight pause as if Thomas was doing a mental double take.  “But John, you have my assurances it’s nothing illegal, I just want you to check up on my friend…”

“I’m just not comfortable with it, ok?  There’s a lot of rules about waiting lists and what doctors can and can’t do and I’d rather not risk it.”

Thomas looked like he’d bitten into something incredibly sour.  “I control this entire hospital’s finances John.”

Morales didn’t reply, letting the words hang in the air, looking directly into Thomas’ eyes until the peeved bureaucrat turned on his heels and left without so much as a goodbye.

He was slightly surprised at his own actions.  Normally he would have simply done as the government agent had asked.  After all, there were plenty of people in the country like Thomas.  Nothing Morales could do about it, it was just the way the world worked; people would always try to play the system to their own advantage.

That the system actively encouraged it was a thought that had not occurred to John Morales until today.  Or, more precisely, until last night.

The rest of the day proved (relatively) uneventful.  John had just finished scrubbing down after a surgery and was settled into his office to complete the additional paperwork that Thomas’ visit had made necessary when Gerry knocked on his open door.

“Oh, hey Gerry. ‘What can I do yah for?’” said Morales, adopting the security chief’s slow drawl with a slight grin.

“John, you were here after hours yesterday, did you notice anything fishy last night?” Gerry seemed preoccupied.

“No,” Morales lied, his heart caught slightly, “why?”

“Huh, something funny happened to all the cameras on your side of the building, they recorded nothing but static for about 20 minutes, starting around 7:30.”

Aducknamedjoe

"I need no warrant for being, and no word of sanction upon my being. I am the warrant and the sanction."

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