Showing posts with label The First to Say No. Show all posts
Showing posts with label The First to Say No. Show all posts

Thursday, August 9, 2012

Sharing Another Chapter - The First To Say No...by Charles C. Anderson

The emergency room entrance of Parkview Hospit...
The emergency room entrance of Parkview Hospital in Fort Wayne, Indiana. (Photo credit: Wikipedia)
BRH is spreading the word...but...YOU can help! To the right, you'll see Dr. Anderson's picture! Click on that picture and "start following" Dr. Anderson's blog and comment on one or more of his articles...Please leave contact info because 20 randomly selected individuals will receive a copy of one of his books! If you have a preference, ask for it! Don't forget he'll need an address where the book should be sent! 
8.
 Dr. Kate Taylor watched the clock all through her shift Wednesday night.  Would Elita be there at seven in the morning?  She had not heard a word since leaving her next to her car in the parking deck three nights before.
At six o’clock Thursday morning she retreated to her office with a few charts.  She sat on the couch and thought of her best friend.

Dr. Elita Romanov had immigrated from Chechnya in 2002 and subsequently attended medical school at Emory University in Atlanta.  Her Chechen name had been Elita Ramazanov, but she had shortened it upon her arrival in America.  She completed her internship and residency in emergency medicine at George Washington University Medical Center in Washington, D.C., and met Kate there.  Kate was doing a fellowship year in critical care medicine, having completed her own training in emergency medicine at Eastern Virginia Medical School in Norfolk, Virginia.

Kate loved working with Elita, who had a knack for getting along with even the grouchiest of colleagues and attending physicians.  Because they spent time together outside the ED, playing tennis and jogging, and both were single, Kate sometimes felt that other people in the hospital thought they were a gay couple. 

Their emergency department was unusual in its physician staffing.  A man was usually head of such a large and busy department.  There were six ED physicians at Parkview Hospital ED.  The four men were competent and friendly, but the hassles of being an ED physician at Parkview made them very possessive of their time away from work.  The men didn't live in Parkview.  They would work at Parkview Hospital until a better job came along.  Elita and Kate lived within a few blocks of each other in the neighborhood. 

The door opened and Elita walked in.  She closed the door behind her. Kate jumped to embrace her.  They held each other for several seconds before Elita backed away and reached for Kate’s hands.

“I’m fine.  And my scalp swelling has gone down.” She lightly touched the back of her head. “My hair is just long enough to cover up the bruise.”

They sat down on the couch and faced each other.

“The newspaper said the police think it was part of a gang hit by the Crips on the Plagues,” Kate said, “a reprisal for interfering with their businesses in Watertown.”

“I’ve been staking out my condo for the past two days,” Elita said. “Nobody has been near my door.  Nothing suspicious.”

“I’m so relieved.”

“I read about Jennifer in the newspaper,” Elita said. “How is she?”

"I saw her at six-thirty last night in the ICU," Kate said. "She has a tracheostomy and a nasogastric feeding tube.  Her jaws are wired.  She's scared to death.  All I could tell her was that a man hit her.  She looked so incredulous.  Can you imagine waking up, unable to talk, unable to open your mouth, your face swollen like a pumpkin, able to feel the suture lines in your face but afraid to look in a mirror?"

“No trouble imagining that at all,” Elita said. “And what explanation did you give her for why Jack Hopkins hit her?" she asked.

"I just shook my head," Kate said, "like I didn't know and it was my fault."

Elita leaned over and hugged her again. “You know it isn’t your fault. I'll go up and talk to her later today."

"We’re going to have to stop pretending that there is something noble about helping junkies, and drunks, and criminals in a gang abuse innocent people,” Kate said.

"In my native country, we do not have these problems," Elita said.  "The government gives people incentives to change.  The U.S. government gives people incentives not to change."

"I don't have any faith in rehab for sociopaths," Kate said. “I will have to tell you later about my experience with Jack Hopkins in the park and the death of Cassandra Smith.”

Elita raised her eyebrows. “I look forward to that.”

There was a knock at the door. "Good morning," Dr. Baker said, appearing in the doorway. Kate picked up her coat. 

Dr. Romanov said, "Good morning, Jim. I’ll finish your charts, Kate.  Run along.”

Once outside the building, Dr. Baker asked, "Have you talked to the police about Jennifer?"

Before answering, Kate looked around. It was a clear fall day, with a light breeze. She took a step ahead of Dr. Baker and started walking home.

"The hospital told me not to,” Kate said as he jumped to catch up.  "I've called the police four times in the past about Jack’s assaults.  He has plenty of money for a good lawyer.  Jack pleads diminished capacity due to his seizure disorder, and the judge says that he doesn't know that he's hurting people.  It's not true.  Jack told me he knew exactly what he was doing.”

"I don't blame you for being angry.  We all feel responsible when something happens on our watch. But it wasn't your fault.  I heard that you didn't even know he was in the ED."

They walked in silence for a few minutes along the sidewalk closest to the park. "I can hardly believe what has happened to my neighborhood," Kate said.  "Many of Watertown's finest restaurants and cafes were once located on this street." 

"I read somewhere that Parkview had one of the largest intact neighborhoods of Victorian architecture in the United States," he said. “Most every house has columns or double porches.”
 
"All that elaborate molding in the front of the houses was hand carved,” she said, pointing toward a house.

"I like the way the canopy of trees grows over the sides of the streets," he said. "These trees look 150 years old."

"Most of the houses in Parkview were built between the Civil War and the 1920s,” she said.  “The twelve-acre park was supposed to be common ground. Up until the last decade, this was one of the most prestigious places to live in all of Watertown."

"I don't know anyone who would walk through the park today," he said, "not without a big dog, or pepper spray, or a pistol in their pocket.”

“Look around you at the empty houses,” Kate said.  “Each one represents a family that has given up.  Civilization has been at war with the Plagues here in Parkview for ten years now, and civilization is losing.  I don't want to give up.  I'm losing my job, my neighborhood, and my hospital.  And I don't know what to do."

"I guess you know all about the threat to close the hospital," Jim said.

"I met with Chris McMahan last week."

"What did he say?"

"Parkview Hospital's parent company, New Century Health, has given us one more year to improve our bottom line.  If we can't, we're history.  They're already building a new hospital in Harman County.  They've applied for a certificate of public need (COPN) to build this hospital without closing Parkview, but the decision about closure won't be made for about a year."

"We might be happier in Harman County."

Kate smiled at his use of the word “we.” The November wind freshened.  She turned her collar up.
"I've asked Mr. McMahan to spend a night shift with me in the ED," Kate said. "I want him to see how our hospital is making things worse.  Sometimes he just looks too content for a guy whose hospital is about to be closed." 

She stopped on the sidewalk and looked toward the park.

"Thank you for walking with me today," she said, reaching for his hand. "When I was a child my real father took me to this park every day.  He worked nights, on the docks.  Every afternoon we would go to the fountain.  He would pick me up and hold my right hand while I walked around the marble rim of the fountain.  I felt safe because I could look down at the pennies on the bottom without fear of falling in.  Sometimes he would put his arms around me from behind and hold me while I leaned out and threw pennies into the water.  I remember watching those pennies turn over and over as they reflected the sunlight on their way to the bottom."

"Did you make a wish?" he asked.

"Not for myself.  I wished that every child in the world could have a daddy like mine."

"That's beautiful."

"After we played at the fountain he pushed me on a swing set nearby, one of those with a leather seat.  They're gone now.  He kept asking me if he pushed too hard, or if I was going too high."

"He sounds like a loving father."

"He was.  He gave me a bicycle for my seventh birthday and taught me how to ride it in this park.  He would run along beside me to catch me if I lost my balance."

"What happened to your father?"

"He died of a cerebral aneurysm when I was eight.  My mother remarried when I was nine."

"What was your step-father like?" he asked
.
She started to walk again, then stopped, turned toward him, and lowered her forehead to his chest.  Her arms fell limp to her sides.  He held her while she cried silently.

She whispered, "He raped me from age ten until age thirteen, when my mother poisoned him."

He grasped the shoulders of her coat and guided her backward. "Sit down with me under this tree, Kate."

"I'm so sorry," he said, settling in beside her with his right arm around her shoulders.  "Now I understand so much more about you.  Thank you for telling me."

She sniffed and looked away from his face.  "You mean now you know why I'm damaged goods?"

He reached into his pocket and handed her his navy handkerchief. "I'm going to hug you, Kate, and you’re going to have to fight me if you try to stop me," he said, pulling her close. "You are not damaged goods to me.  I have waited so long for you to trust me with anything important about yourself."

The hug began to feel better and better to Kate.  She was uncertain what to do. She pulled backward and looked toward the fountain in the park.

"I never even talked to my mom about what my step-father did to me until this week.  Something happened that brought it all back.”

“Tell me about it,” he said.

“Can I ask you a question?"

He reached for her chin and forced eye contact.
The words came out slowly. "Can you understand why this park and that fountain are too important for me to move to Harman County?"

"Of course.  They are your connection to your real father."

She wiped her eyes with his handkerchief.  "They are my only clear recollections of interaction with my father.  After he died I came to the fountain and thought about him a lot.  I talked to him and prayed about him.  I felt so close to him there."

"It must have been comforting."

"It was, but not for long."

"What happened?"

"Until yesterday, I haven't gone to the park since I was thirteen.  I've been too afraid," she said.

"Go on."

"When I was thirteen, a man chased me around the fountain.  He tore off my shirt and bra."

He waited patiently for her to continue. "It's all right," he said. “I’m here.  I won't let anyone hurt you."

"I jumped into the fountain and he came in after me.  It was only two feet deep, but he got hold of my foot.  I kicked him and he lost his balance.  I jumped out while he was choking on the water and ran home."

"What a horrible experience," he said. "But he can't hurt you now.  That was more than twenty years ago."

She looked up into his eyes.  Two steady streams poured down her cheeks. "No, Jim, that man is still at the fountain.  He was there yesterday and he plans to stay."

"Why did you go into the park?”

"I needed to remember how my dad comforted me.  I was thinking of Jennifer.  That man who hit her almost got me yesterday.  It's Jack Hopkins."

She looked up at him.  As he turned his head slowly toward her, she saw his pupils dilate. His eyebrows approached each other and his forehead developed deep furrows of concern. His lips and jaw tightened. "How long have you known that Jack Hopkins was the same man who tried to rape you when you were thirteen?"

"Since yesterday," she said. "He bragged about it.  He also admitted that he beat up on people to make them afraid of him, and it had nothing to do with his seizures."

"What else do I need to know?”

"He knows that my mom poisoned his dad.”

“Give me some time to think about this,” he said. “I don’t want you walking by this park alone.  Promise me you won’t do that again.”

She nodded.

Jim stood up and pulled Kate to her feet.  They walked in silence, hand in hand.  When they arrived at Kate's house, he put both arms around her and squared her body to his. It was the first time she had wanted to hold a man face-to-face since her father died.  It felt good.

He said, "I want you to know that you are important to me.  Anything or anyone that threatens you is my enemy. I can make Mr. Hopkins disappear.”

I want to do that myself.

"Thank you, Jim.  Don’t do anything now.  He’s only one of many Plagues who prey on our hospital staff.  We need a larger solution and answers to some basic questions. But thanks for offering.”

“Then what can I do?”

“The administrator and the board no longer listen to me,” she said.  “They might listen to you.  I need to understand why Parkview Hospital is on a mission to subsidize self-destructive behavior. I need to know how a successful hospital that made money could turn into a nightmare that loses money in only five or six years.  Maybe you could shed some light.”

He kissed her on the forehead and quickly jumped into his car. “I’ll get on it right away.”

She stood in her bay window and watched him drive back to Parkview Hospital. How could he make Jack Hopkins disappear? 


Enhanced by Zemanta

Tuesday, July 31, 2012

Read First Chapter of The First To Say No


The First to Say No

Charles C. Anderson

The author has authorized BRH to
give free, limited  PDF copies of either 
of his books by just commenting and 
providing an EMail...First Come,
First... 
.


Dr. Elita Romanov’s first thought as she fought her way into consciousness was of her boyfriend in Chechnya. But he had been killed in the second war with the Russians. Her next thought was the screaming pain in the back of her head. She rolled her head to the right nd discovered a tender lump in her scalp. She wished she could reach up and touch it.Was her hair matted with blood from a laceration in this lump? She wiggled her nose. She opened and closed her eyes and mouth. She turned her head from side to side and felt her earrings
touch a table.The rest of her head seemed okay. She wondered if she had other injuries. Someone had knocked her out. She could think of no other explanation.Why was her body moving back and forth?

She looked down and identified the bobbing head of a man. He was grunting. He was lying on top of her. He was inside her. She registered the odors of bourbon, cigarettes, decayed teeth, and sex. A scream would feel good, but she knew better. She recognized the taste in her mouth and wanted to spit. She knew better than to struggle.After all,  this was the third time she had been raped, including two gang bangs by the Russians. She willed herself to be flaccid, and swallowed.

This man on top of her appeared to be Puerto Rican. He had a red bandana cap on top of his head. He was looking down at her naked chest and belly, as if her face was not attached. She was being raped by a member of the Plagues, the local gang that ruled the neighborhood of Parkview.

She searched for more information. The ceiling had chipped blue paint. She felt wood against her bare back. Her legs dangled from the knees. She could touch the floor with her toes. Her arms were tied over her head by cloth, probably to the legs of the table she was lying on.

She smelled wood smoke. She heard the voices of men in the next room and the steady rhythm of some kind of music. A door over his left shoulder was closed, or almost closed. This Plague was naked so far as she could see. She scanned the room for his knife or gun. No. She smelled wood smoke.  No plague ventured very far from his personal weapon. On the couch to her right she saw his pistol and a bottle of Vaseline. She noted her
work scrubs strewn between the couch and the table she was lying on.

She studied her rapist. He was becoming more excited. His palms were positioned on the table on each side of her pelvis. He abruptly moved them to her breasts, which he gripped like handles. Sweat dripped from his head onto her chest and abdomen as the pace of his thrusts quickened. The wood of the table gnawed at her back as he pulled her back and forth by her breasts.

He had failed to secure her feet. Slowly she lifted her right knee and extended her foot. He didn’t notice. She lifted her left knee. If he was aware of her leg movements, he didn’t care.

Not tying her legs was a critical mistake on her rapist’s part.Tying her slender hands at the wrists with cloth was also a mistake. She relaxed her right hand and steadily pulled it through the cloth restraint. As her left hand slid from its restraint, her rapist began to grunt loudly.

Elita gradually squeezed her thighs together to limit his penetration. He responded by removing his hands from her breasts, inserting the palms of his hands under her buttocks and lifting her pelvis off the table. He spread her thighs with his forearms as he leaned into her. At that moment, this man was her predator. In a few heartbeats, he would be her prey.

The man’s jaw fell open. His chin jutted toward her. He closed his eyes and began to tremble. Like a crouching lioness in the savannah, Elita sprang to life, elevated her pelvis and clamped the rapist’s neck between her thighs. She locked her ankles together and squeezed with the powerful muscles in her thighs.

At five feet ten inches tall, she was a finely tuned thirty-four year old athlete with honed skills at both taking lives and saving them. Elita wore her brunette hair short, combed behind her ears, and liked earrings.
Her hands were delicate and very steady for a young physician.She was a rare combination, a lioness who was as graceful as her prey, the gazelle, and as deadly as a black mamba. Not many emergency physicians had her level of experience treating the wounds of war. Only the U.S. State Department knew the details of her most remarkable skill.

Her rapist was already short-winded when Elita interrupted most of the blood flow to his head. She could feel his carotid pulses against the inside of her thighs. His heart rate accelerated. She rested her forearms on the table as he struggled to get his feet under himself. He lifted her pelvis another foot off the table, but stumbled back to his knees. She watched his face turn ashen.

He abandoned his efforts to stand. Flailing his arms around her thighs, he knocked the red scarf off his head. His chin collapsed to her pubic bone. He tried to wiggle his hands between her thighs and his neck, but he did not have the strength to pry his head out.

Elita knew that his brain could only last a few seconds without blood flow and oxygen. His efforts to free himself were already panicky and uncoordinated. He appeared to be getting some air through his mouth and nose, however, and she did not want him to cry out. Squeezing his neck from the sides had effectively cut off most of his brain’s blood supply, but his airway, in the midline of his head and neck, was still at least partially open.

Without releasing her leg grip on his neck, Elita sat up and wrapped her hands around the back of his head. She guided his nose and mouth to her vagina and pulled his face to her to make a tight seal. She watched his breastbone being sucked in with each respiratory effort. She felt the suction tug on the soft tissues of her perineum.

She concentrated on his carotid pulses against her thighs. His heart rate was now decelerating. She estimated about forty beats per minute.His head color was now blue. She looked toward the door. No one entered.
She held him as his heart rate became slower and slower, showing no more emotion than a lioness suffocating a gazelle.

Once his heartbeat disappeared, she gradually relaxed the muscles in her thighs and sat completely upright. Holding his hair in her fists, she guided his head to the floor between her feet.

She bounded toward the couch, but slipped on his semen in the floor. She caught herself on her knees with her face against the couch. The pistol was six inches from her nose.

The feel of the pistol grip in her hand brought out her first emotion, a faint smile in the corner of her mouth. She examined it carefully. It was a Glock .45 semiautomatic. She released the clip in the hand grip and counted fourteen rounds in the magazine. She pulled back on the slide of the gun enough to confirm a round already in the chamber. Gently she let the slide move back to its ready position. She inserted the magazine into the hand grip and stepped to the right of the door.

Elita gently grasped the door knob with her left hand and leaned her naked back against the doorframe.The Glock was resting against the right side of her face as she cracked the door and leaned forward.

The first thing she saw was a wood stove. It was mid-November. She recalled that the weather had been especially cold and windy recently. She felt the heat from the stove on her forehead. She scanned the room
by direct vision and by reflections from glass surfaces in the room.

There were two men in the room that she could see, a black male and a white male, both seated on a couch.They appeared to be counting money on a small table. She noted the front door and a full window
on each side of this door. It was an old house, not unlike the many Victorian houses in Parkview. She wondered where she was.

On the far side of the couch in the floor of the room where she had been raped was her own purse and overcoat.The work scrubs on the floor meant that she had been abducted on her way to or from work
in the emergency department, where she was an attending physician.She guessed that it had happened in the parking deck as she was leaving, although she had no recollection of this.

Walking to and from the car in the parking deck was the most vulnerable time for any female employee at Parkview Hospital. The Plagues specialized in preying on nurses and other female employees coming and going for the night shift.They were smart enough to disable the security cameras before acting. She recalled that an emergency department nurse named Janice Green had been abducted from the second level of the parking deck and raped about six months earlier.

Elita weighed her options. She could open the door and start shooting. But what if there were more than two Plagues in the room? What if she walked into a cross-fire? It would be better to draw everybody
in the room to the door.

She walked back to the table, sat down and spread her legs. Reaching down, she picked the dead man’s head up by the hair and positioned it between her legs, where she held it again with her thigh muscles. She arched her back and extended her arms over her head and underneath the table.The Glock was in her right hand. She began to moan rhythmically, increasing the volume quickly.

She heard the door creak open, followed by laughter.The two men at the door were still laughing when Elita sat up and shot them both in the chest.They crumpled in the doorway. She held the gun extended toward the door as she stood up. The dead man’s head between her legs fell back to the floor. No one else came to the door or ran out the front door.

Elita entered the front room with the gun out in front.There were stairs to her left and a kitchen to her right. The kitchen was empty. She leaped up the stairs and methodically moved from room to room with the gun until she was satisfied that she was alone. She looked out of an upstairs window and saw the line of tall trees that encircled River Park. She had been abducted and raped within a mile of her own home.

She moved like a cat down the stairs, three steps at a time.This waslikely one of the Plagues’ regular hangouts. Any number of Plagues could return without warning. She stepped over the two dead men in the doorway and walked toward her clothes. Everything was there except her panties. She dressed hurriedly and looked for her shoes.

She moved like a cat down the stairs, three steps at a time.This was likely one of the Plagues’ regular hangouts. Any number of Plagues could return without warning. She stepped over the two dead men
in the doorway and walked toward her clothes. Everything was there except her panties. She dressed hurriedly and looked for her shoes.

She found the second shoe underneath the couch and sat down on the table to tie the laces. She disliked having to let go of the Glock to tie her shoes. On the table were stacks of twenty dollar bills wrapped in zip lock bags.The briefcase on the table held two packages of white powder, which she suspected to be cocaine. She looked around the house for something large enough to hold the money. The briefcase would be hard to run with.

A dirty brown pillowcase from the floor of the bedroom fit the bill. The money went into the pillowcase, which she dropped at the front door. She had no use for the drugs. She put her overcoat on and felt in her pockets. Her cell phone was still there. She stuffed the Glock into the other pocket of the overcoat.

In the closet of the kitchen Elita found a five gallon kerosene can, but it was empty.The only other thing that might be useful was a tire iron. She recalled the kerosene stove she had seen upstairs. It had not been warm.

She searched the closet and cabinets for any kind of accelerant, liquid or powder—anything that was flammable. Apparently, no one cooked or cleaned much in this house.

If there were three Plagues inside, there was bound to be a vehicle or two outside. Visitors and employees at the hospital often complained that gas was removed from their cars in the parking deck. It was worth a try.

There were two vehicles outside, a yellow HUMVEE and a blue sedan. The moon was three-quarters. The streets were quiet. Not by accident, she thought, the street lamps near the house were not functional.
She looked at her watch. It was 3:30 AM. 

Elita used the tire iron to pop the trunk of the sedan, being careful not to leave fingerprints on the car.Among the clutter in the trunk her hands ran into what she was looking for—an eight foot length of clear PVC tubing, approximately three-fourths inch diameter.

She took the hose and left it next to the sedan’s rear wheel at the curb. Returning to the house she retrieved her purse, the pillowcase, and the five gallon empty kerosene can. She smashed the light fixture overhead in the front room with the kerosene can on her way out and stuffed her purse into her overcoat pocket with the cell phone.

People in America thought that country girls were resourceful. But American country girls never had to survive on their own in a war zone, where being a woman was not usually an asset.

On her knees, she fed the clear hose into the tank of the sedan until she felt resistance. She held the other end of the hose between her thumb and forefinger, gripping it as close to the end as she could.The three-quarters
moon provided the only light. She would have to be careful sucking on the end of the PVC tube. Once the gas started coming, it would come fast. She positioned herself where she could see all of the hose outside the
tank in the moonlight and began to suck. In between breaths, she moved her thumb over the end of the hose to maintain the suction.

It helped to know how long it usually took and how many breaths. When the gas was four or five inches from her mouth she moved her thumb quickly over the end of the hose and then directed the tube into the kerosene can. Gravity did the rest. She watched the gas flow steadily from the tank of the sedan into the can.

The can would weigh about forty pounds when full. But by the time it was three-quarters full, she saw headlights approaching. She pulled the hose out and dropped it behind the rear wheel.

Four Plagues piled out of the vehicle, each carrying a bag from McDonald’s.They approached the house. She wondered how many of these four had already taken their turn at her. 

She crouched in the darkness until they had all entered the door. While the four were trying to digest what they were seeing in the dim light from the stove, Elita moved to the porch with the kerosene can.

Holding the handle of the can with both hands, she turned her body counterclockwise like a hammer thrower in the Olympics. As she pirouetted, the velocity of the can increased. After two turns the can was horizontal to the wooden porch floor. After three full turns she released the can through the window in front of the wood stove.

She dived off the porch as the front room exploded in a fireball. From her crouched position in front of the house she watched two burning men stagger out the door. Resting the Glock on her left knee, she fired twice. In a few seconds it was clear that no other Plagues would be leaving alive.

She grabbed the pillowcase and the PVC hose and ran down the street fifty yards to her left before cutting between houses into an alley. She followed the alley until she emerged onto Robbins Street. She
recognized her position.

The night was suddenly filled with sirens, blue lights, and red lights. She had no doubt she would make it back to her own home unseen. No one was even shooting at her.

Back home, Elita called Dr. Katherine Taylor, her best friend and colleague in the emergency department. “I need you to come over here now. Dress for work.We’ll talk when you get here.”

“Are you all right?” Kate asked at the door.

They embraced.

“I’m okay,” she said, “but the war with the Plagues has heated up.”

Kate listened intently as Elita told her story.

“My guess is that my car is still in the parking deck,” Elita said. “We need to remove it before morning.”

Elita looked at her watch. "Let's give it another thirty minutes. The cameras in the parking deck will likely be disabled. I can probably leave without being seen.

Kate asked, “Why aren’t you trembling and crying?”

“I used up my trembling and crying years ago,” Elita said. “You should know now that this is a war to the death with the Plagues.We must kill every last one in order to stop the violence against healthcare workers at Parkview Hospital.”

“Doctors killing people,” Kate murmured. “It’s a lot to swallow, but I’ve had enough time to justify it in my own mind. I’m tired of being a victim. I just don’t know how to do it yet.”

“In war you cannot consider your enemy a person,” Elita said. “The Plagues are not people.They are wild animals. No one is going to protect us from them. But we must delay further plans until we know the consequences of killing seven Plagues in one night,” Elita said.

“Why do you care about getting your car now?” Kate asked.

“You can never tell what will survive a fire,” Elita said. “Something could point to me. Somebody out there has my panties, or at least he did at one time. Someone could connect my car left in the parking deck to the Plagues. Maybe someone saw my abduction. I don’t want my car found and searched by the police. I don’t want to be targeted again by the Plagues in retaliation.”

“What’s that smell?” Kate asked, looking into Elita’s fireplace.

“It’s all the clothes I had on, a pillowcase, some PVC tubing, and my overcoat.The smell is PVC.As you know, it gives off toxic fumes, so let’s go into the kitchen.”

“Let me fix you some coffee,” Kate said as she entered the kitchen.

“What I really need is some antibiotics,” Elita said. “I’m glad I’ve had my hepatitis vaccines. I need a morning-after pill and some shells.”

“Some shells?”

“It’s okay. I’m going to lay low for a few days.Tell everybody I have the stomach flu.We have no idea how many Plagues know whom they abducted tonight.The seven I killed may be the only ones who know. On the other hand, the Plagues may come looking for me in force in the morning.There’s about forty-five left out there. I’ve packed a few things to take with me.You just need to drop me off at the parking deck.”

“I’ll have my cell phone. If nothing happens to my house by day

"Where will you be?"

"I'll have my cell phone. If nothing happens to my house by day after tomorrow, I’ll be at work Thursday morning.”

“You need any money?”

“I have plenty of cash. In fact, we need to put the money I recovered tonight to work. I took a few dollars.The rest is in the refrigerator in a brown bag. Hide it in a safety deposit box.We can talk more strategy
if I’m still alive in two days.”

~~~







This is a work of fiction. The events and characters described herein are imaginary and are not
intended to refer to specific places or living persons. The opinions expressed in this manuscript are
solely the opinions of the author and do not represent the opinions or thoughts of the publisher. The
author has represented and warranted full ownership and/or legal right to publish all the materials in
this book.

Friday, July 27, 2012

Charles C. Anderson Shares--Safety Vs. Money...with Offer for Free Copy...

"On the far side of the couch on the floor of the room where
 she had been raped was her own purse and overcoat.
The work scrubs on the floor meant that she
 had been abducted on her way to or from work
in the emergency department, where she was
an attending physician. She guessed that it 
had happened in the parking deck as she was leaving,
although she had no recollection of this. 
"Walking to and from the car in the parking deck was 
the most vulnerable time for any female employee
 at Parkview Hospital. The Plagues specialized in preying
 on nurses and other female employees coming and going 
for the night shift.They were smart enough to disable
the security cameras before acting. She recalled that an 
emergency department nurse named Janice Green had
 been abducted from the second level of the
 parking deck and raped about six months earlier." 
Want to learn more, BRH has been authorized to give a PDF copy of The First to Say No...just leave a comment that you are interested. You can comment each day an article runs at BRH.
If you have already read The First to Say No, ask for The Farm...both by Charles C. Anderson. Let us know what you think about this issue!

The Reality Behind the Book...

HOW HOSPITAL ADMINISTRATORS 
CONTRIBUTE TO E.D. VIOLENCE



I have had a close working relationship with six hospital administrators, close enough to figure out some of the things that make them tick. The easiest administrator to deal with is not the CEO of a hospital that is part of a large hospital corporation. The corporate administrator is a puppet. He wants only two things from the ED– happy patients and getting paid. After all, this is a big part of how he is judged by his corporation.

The administrator in an independent hospital is more likely to care about his employees, to institute policies that protect them, and stand behind the ED staff. He is accountable only to a local board, to which he can justify measures to protect employees. Let’s examine a couple of examples where administrators undermine their own ED.

Corporate CEOs in hospital chains are competing with their colleagues in other hospitals. In their race to keep their Press Ganey scores up, increase revenue, and capture as much market share as possible, the corporate administrator often makes promises to the public that the staff in their ED cannot keep. Have you noticed the battle of the billboards, where each hospital administrator tries to outdo his competitors by promising that a patient will be seen in his ED even before he take his clothes off. They have reduced themselves to competing over the number of minutes before a patient is greeted by a physician. Somebody forgot that our mission is to provide the best care possible for each patient and to concentrate on the sickest people first.

The ED is not a cattle drive or a theme park. Its purpose is not to entertain you or make you happy. Its purpose is not to leave you satisfied. Its purpose is to deliver the most appropriate care to each patient, as quickly as possible given the overall requirements of the sickest patients. When patients are given impossible promises and told that they are entitled to satisfaction they frequently become angry when they find that the waiting room is packed and they have to wait a half hour. The average ED patient is not known for his patience. He is noted for being demanding. Guess who is teaching him this? So the administrator sets up a confrontation between the ED staff, who are working as fast as they can, and the patient and family, who actually believe the billboards.

The best solutions to most ED problems have been known for decades. They are just trampled by the desire to make more money. One good answer to diffusing potential violence is a dedicated concierge whose only job is to advise patients and families about the progress of their relative or how long it will be until they are seen and why. Hospital administrators do not want to waste money on concierges any more than they do on adequate security. It’s always about money.

I was so happy when Virginia developed the first prescription monitoring program. At last doctors could track drug seekers from pharmacy to pharmacy. We did not have to make an educated guess who was a drug seeker. We could have the data in front of us before we confronted the patient. Guess what? Administrators have no interest whatsoever in the fight against prescription drug abuse, even though more people kill themselves from prescription drugs than heroin and cocaine combined. Remember, they want happy patients who pay their bills. The administrator does not care if you give the drug seeker 40 tablets of Dilaudid as long as he leaves happy with a smile on his face. He will be given a survey as he leaves and a follow up call later to make sure he was satisfied with the service from his pusher. Press Ganey calls this measuring quality of care.

I always take a nurse into the room with me when I talk to someone about their overuse of drugs, usually narcotics. I want double documentation that the patient was properly informed, that he was referred to a pain management specialist, or to his private doctor, or to drug rehab. It doesn’t matter where he is referred. He will be angry. He was promised a happy visit to the theme park and now he has to leave without the prescription he came for. He is not satisfied.

Again, the administrator has promised a service that I cannot deliver. I have a moral obligation to do the right thing for each patient, even if he doesn’t like my treatment. Thus, the ED physician has a difficult choice. He can generate great Press Ganey scores and turn out happy patients with no personal concern for the harm he is doing, or he can stand his ground, be branded as a trouble maker by the administrator, and generate confrontations where he is the most at risk. Are you beginning to understand why we are not making any progress in the prescription drug epidemic? Ideally, the uniformed police officer should accompany the ED physician into the room and escort the patient off of the premises. When a patient is in withdrawal and wants only one thing, he can turn violent in a heartbeat. The officer by your side is an effective tool. But the real culprit is the administrator. He is the one who is inviting the drug seeker to keep coming and to expect to go away happy. If these drug seekers were disappointed regularly, and the administrator stood behind you and what you were trying to do, they would not come back.

I have some more bad news for those of you who thought the administrator cared about best practices for common diseases. You know, all that stuff you spend hours learning in CME courses. If you have a determined mom who wants antibiotics for her kid’s cold, it is not in your best interest to try to educate the mother. Mom’s own doctor and other ED physicians have so thoroughly indoctrinated her that all URIs require a visit to the doctor and an antibiotic that your attempts at education will only produce another unhappy patient. And, of course, producing happy paying patients is the administrator’s priority, not providing care based on best practices.

Press Ganey scores have proven that doctors who pass out more drugs get higher scores. The administrator and the patient want you to order as many tests and X-rays as possible. It doesn’t matter that the patient doesn’t need them. Press Ganey measures satisfaction, not quality of care. If mom thinks junior needs an X-ray, and that is why she came, then you, the physician, are trapped. The hospital makes money on the tests you order. This is why it does not bother the administrator that the same alcoholic gets 25 head CTs per month for evaluation of altered mental status. Each physician is judged by the amount of money he can generate per patient and the number of patients he can satisfy. What does this have to do with quality of care?

Many of the basic safety measures that are unavailable in many EDs are missing simply because they cost money. Three uniformed off-duty cops per day cost money. Metal detectors cost money. Your safety as an ED employee is not as important to Mr. Administrator as saving that money. Having officers interferes with the administrator’s view of the ED as a theme park. So do metal detectors. One of the problems with the average administrator is that he has never experienced the emotional trauma of a sudden, unexpected shooting or stabbing of a real person, someone he cared about, right in front of him. He is under the same illusion as the administration at Virginia Tech—“That couldn’t happen here.”

I have been in the ED or trauma center on six occasions when bullets were flying. I have seen five people killed in the ED with guns and two shot in their beds on floors upstairs. I have seen a nurse stabbed in the parking lot and a physician’s brain turned to hamburger with a baseball bat just outside the ambulance entrance. Let me tell you what I have learned. If your uniformed officer is not in the ED when these events start, he is useless. If he is not armed, in some fashion, he is useless. Having a team that responds to “Code Atlas” is too little, too late for the type of patients that EMTALA has herded into our EDs. The pen on all those policies for response to violence has not been mightier than the sword in my 38 years of experience. You can write all of the policies you want, but if you do not have a weapon that you can access in a few seconds, you have no chance to prevent further tragedy.

Think about it. The average fight is over in less than 30 seconds, usually in half that time. It doesn’t take long to pull a knife or shoot a gun. If you believe that no one in your waiting room has a loaded gun or a knife, you are a fool. Sociopaths and deranged schizophrenics do not care about policies. They can clear out your waiting room for no other reason than they are tired of waiting. I guarantee that you will never forget it.

I spent the greater part of my career working the night shift in large hospitals. That is one of the reasons that I am more attuned to the potential for sudden violence. Most of the very worst tragedies I have seen occurred at night. The only good thing about nights is that the administrator is not around to babble on about satisfaction surveys from a group of patients who are intoxicated, psychotic, drug seeking, and drug abusing. I have never figured out how those comatose, septic nursing home patients filled out their surveys, but I appreciated them.

What is the point of having uniformed guards, or any security guards, or any action team, if no one is allowed to touch the patient? In a subsequent post, I will discuss the effect of fear of litigation on violence in the ED and how this constant over-concern with being sued prevents us from giving any useful guidelines to our own employees. Many employees feel that anything they do to help a colleague who is under attack will result in being fired. They are often right.

I just finished reading the position statement of the Emergency Nurses Association on violence in the emergency setting. I was shocked at the list of generic recommendations. Even the ENA does not demand uniformed, armed (in some fashion) officers. They do not specify concierges. They do not ask for relief from charges of assault if they are forced to come to the aid of a colleague. They do not ask to be able to defend themselves without fear of being charged with a crime. They do not provide the specifics that are necessary to take to the legislature.

I still contend that it is better to prevent an assault than respond to one. Preventing assaults requires a constant show of credible force. Administrators are standing in the way of this with their emphasis on satisfaction, speed, and theme park environments.

In summary, hospital administrators are one of the chief barriers to having a safe workplace in the ED. They put their money into television sets, security cameras, lights, and policies. Happy patients and paying patients. These are some of the reasons you are being assaulted. I pray that no nurse ever has to look down at her dead colleague in the floor of the ED before insisting on protection in specific terms.
Enhanced by Zemanta