A Tale of Two Men

Pablo walked quickly past the Taco Bell as the smell of food assailed his nostrils. His stomach begged for food as he left this morning, but that would have meant Maria and the baby would have gone without. The 20-year-old man felt the cold, damp pavement through the thin soles of his shoes as he trudged on, knowing what he had to do. For days he had walked these streets, asking every prospective employer for work, always with the same reply: "Not today – try tomorrow."

Too many tomorrows had come and gone for Pablo and his girlfriend; now there was another mouth to feed. Where would the money come from? With no skills and minimal education, only youth and daring were in his favor.

With determination borne of need, his fingers gripped the cold, hard steel in the pocket of his shabby jacket. His lips trembled. Could he do it? He had to do it. There was no choice. He jerked open the door of the 7-11 store and entered.

The clerk behind the counter was middle-aged. A family man with three young boys, he had worked at this store for little over a year with no trouble… that is until now. Perhaps it was the way the young man’s eyes shifted rapidly around the store, taking in the lack of other customers. Something alerted the clerk to danger, and he slowly pulled a baseball bat out from under the counter.

From the corner of his eye, Pablo saw the slight movement. Was the clerk reaching for a gun? He couldn’t take the chance. In a flash, his gun was out. Shots were fired. The clerk was hit; the bullet entered his left arm. The clerk heard the thud of his own bat as he fell to the floor. Blood spurted from his artery as he collapsed. The pool became bigger … and bigger … as his eyes closed.

Pablo was caught a short distance away as he fled from the store, a few paltry dollars in his fist. As he later sat on Death Row, he saw his life as a series of miseries. Telling the 7-11 clerk’s family how sorry he was had not stopped his own self-loathing.

The years go by slowly and Pablo’s 15-year-old, fatherless son grows up to face a harsh world. Momentarily, he escapes with a shot of heroin. At the age of 19,he sees a car – a fast, sleek job – the epitome of all he can never have. The temptation is too great; he must have it. After all, he’s stolen plenty of them in the past, what’s one more or less? On the license plate there is a strange symbol; he notices it, but the curving serpent called the caduceus means nothing to him. The car starts easily enough, once the wires are crossed, and the young man roars away. What he doesn’t see is that his fast getaway has alerted a cruising police car just down the block.

* * *

Meanwhile, a few blocks away, fifty-five-year-old physician, Dr. John Engles, leaves for work at the Health Maintenance Organization hospital. His title is Chief Physician. He is well known for his ability to maintain a smiling, benevolent countenance even when confronted with agonizing patient complaints. Some wonder openly if this man’s lofty position was achieved by ruthless, benefit cost cutting which caused anguish and suffering for so many patients.

The Chief Physician begins his day addressing a group of hospital-based doctors in a conference room: "Only about one percent of our patients with major strokes need ever be admitted to the hospital," he states. "We must cut costs in every way possible. Our urban, HMO units have done this quite successfully. Therefore, I suggest we do the same at this hospital." He neglected to explain that the real reason for the cost difference was that the urban patient population was much on the average younger.

Dr. Engles chose not to tell the group that only a week ago, a sixty-year-old woman had died shortly after leaving the emergency room. The woman had been sent home despite being diagnosed with a profound stroke. While at home, the stroke caused a seizure -- a known potential complication -- and during the seizure she vomited and choked to death before the paramedics could reach her. Had she been in the hospital, a physician would have been there to quickly clear her airway and save her life. The death certificate, which was signed by the patient’s regular HMO physician, simply stated she had an untreatable extension of the stroke.

Later that same day, an twenty-two week pregnant woman arrived at the hospital in shock. She had just been in an automobile accident and had massive bleeding from a placental separation, which occurred about an hour after the accident. Ordinarily, the obstetrics physician would have responded immediately to this life-threatening event in other hospitals. But earlier in the day at another staff meeting, the Chief Physician had made a point of telling the obstetrics physicians that they need not concern themselves with the care of women whose pregnancy was less than 23 weeks, and stressed that this was particularly true if the patient had also been involved in a trauma incident. "After all," Dr. Engles pointed out, "the baby is not viable. You can treat this situation as if the fetus were a benign abdominal tumor. Let the general surgeons handle it," he added dismissively. Already overburdened with a heavy work schedule, the obstetrics staff, while somewhat surprised at this statement, appeared to relax a little: one less trauma to worry about.

Unfortunately for the young mother, the OB physicians were thus not called to respond. The surgeon on duty was not familiar with the hidden bleeding that could occur within the womb but outside the baby from this type of injury. Sadly for the young woman, she used up all of her clotting factors as her body tried to stem the bleeding in the womb. The same bleeding dislodged the placenta causing her baby to die. The mother’s blood was soon so thin from this excessive bleeding – so empty of crucial clotting factors – that she bled instantaneously at every site where attempts were made to give her fluid and blood intravenously. Finally, she bled into her brain and died.

The hospital, of course, was not blamed. Had they not done everything possible to save her life and that of the baby? Didn’t she have a surgeon by her side? The insurance claims would show that it was the fault of the auto accident.

The Chief Physician could of course rest easy, for no notes were kept at these policy meetings. Therefore, any problems that arose from this new approach would become the responsibility of either the surgeon on duty or the obstetritionan, if one had ever been notified. Since the Chief Physician is not really practicing medicine but rather only "coaching" his staff, the medical licensing board cannot touch him.

After a busy day, the Chief Physician, our Dr. Engles, left the hospital to return to his country club estate. As he headed for his car, he suddenly noticed something was wrong. "What! Where’s my car?" If there was one thing of which he was proud, it was his beautiful, sleek Corvette. His added income - from many cost-cutting bonuses - had bought him the best. And he had put considerable money into a new, anti-theft system for it. "It’s impossible!" he thought as he scanned the spot where his car had been. "All morality seems to be gone these days – it’s hard to know who to trust!"

* * *