Room 312. Pre-Op Eval. Urgent.
"Saved by the bell," Jax murmurs. He checks his own pager. "Same patient. Mr. Henderson. Isn't he the guy the police brought in last night?"
"I believe so," I say, standing up and buttoning my white coat. I need armor. "Infective Endocarditis. He needs a valve replacement."
"Let’s go," Jax says. "Maybe we can find another closet on the way."
"Dr. O'Connell," I say, opening the door. "Go to hell."
"After you, Dr. York."
Room 312 smells of stale alcohol and sickness.
The patient, Mr. Henderson, is a man in his sixties who looks eighty. He is thin, his skin grey and papery. He is wearing a hospital gown that hangs off his skeletal frame. His chart lists him as "No Fixed Address."
He is also an Army veteran. I know this because Jax noticed the faded tattoo on the man’s forearm the moment we walked in.
"Hey there, Sarge," Jax says, his voice shifting instantly fromannoying colleaguetogentle healer. He pulls up a chair and sits close to the bed, ignoring the smell. "How’s the breathing?"
"Heavy, Doc," Henderson wheezes. "Feel like I got an elephant sitting on my chest."
I pick up the chart. It’s grim. The bacteria from IV drug use has colonized his tricuspid valve. It’s a vegetation the size of a grape. Every time his heart beats, it risks throwing a clot to his lungs.
"Mr. Henderson," I say, keeping my distance at the foot of the bed. "The infection has destroyed one of the valves in your heart. Without surgery to replace it, your heart will fail. Likely within days."
The man looks at me with watery, resigned eyes. "Surgery sounds expensive, fancy Doc."
"We treat the patient, not the wallet," Jax says firmly. "We’ll get you fixed up."
"Actually," a voice says from the doorway, "we need to discuss that."
I turn.
Dr. Anthony Sterling is standing there.
The Chief of Surgery is wearing a suit that cost more than my car. He is smiling, but it is the smile of a shark sensing blood in the water.
"Dr. York, Dr. O'Connell," Sterling says smoothly. "Can I see you in the hallway for a moment?"
Jax stiffens. I see the muscles in his jaw bunch.
We step out into the corridor. Sterling closes the door gently, sealing the dying man inside.
"We have a problem," Sterling says, checking his watch. "Mr. Henderson has no insurance. He has a history of non-compliance. This would be his second valve replacement. He blew the first one five years ago with continued drug use."
"He has an addiction," Jax says, his voice low. "That’s a disease, Anthony. Not a crime."
"It’s a liability," Sterling corrects him. "The Board has issued new guidelines for pro bono cases. The likelihood of recidivism is too high. We can't waste a hundred-thousand-dollar procedure and a bed in the ICU for a patient who is going to be back on the street injecting heroin next week."
I look at the chart in my hands. Sterling is, strictly speaking, following the ethical guidelines for resource allocation. It is logical. It is efficient.
But then I look at Jax.
He is vibrating.
It’s not the fun, flirtatious energy from the office.This is dangerous. His hands are clenched into fists at his sides. He is staring at Sterling with a look of pure, unadulterated hatred.
"He served two tours in Vietnam," Jax says. His voice is shaking. "He took shrapnel for this country. And you’re telling me he’s too expensive to save?"
