Pennsylvania's Finest, page 11
Five minutes later Phil Drummer left the PGH having finished another overnight call shift. He did not stop down at the Polk Lounge to say goodnight. He needed fresh air. The quick exit outside the hospital confines felt good as he began the walk westward. His mind was trying to register what had just occurred over the past work shift. A collision of emotions swelled up inside him. He recalled the happy smile of Willie Brown calling Knight his “Messiah.” He felt the crunch of Mr. Brown’s ribs beneath his hands during the chaos of the code blue. Lastly he recoiled at the visual recall of the autopsy and subsequent dismemberment of a human body. He picked up his pace wanting to get away from the hospital quickly that evening.
Then, one block away from the hospital a strange thing occurred. Phil’s olfactory senses appreciated a faint but acrid odor. He inhaled again appreciating the scent, now with a briny quality. He soon recognized this to be the vented exhaust smell of William Brown’s cremated body. To the unsuspecting students amidst the campus the stench was imperceptible. To Dr. Drummer it was not. Phil appreciated the aroma for the next two blocks. During that time he felt a chill to the bone while reciting a prayer for the repose of William Brown’s soul.
CHAPTER 11 The Chronicle
Nearly three weeks after Mr. Brown’s autopsy, a meeting occurred between the Philadelphia General Hospital and the Philadelphia Chronicle. The venue for the gathering was the classy Three Fives Restaurant. Located on 555 Locust Street the restaurant represented the avant-garde of North Italian cuisine. Originally owned by a chef with an inheritance from a Lusitania victim, it graciously served the well to do in Philadelphia for generations.
It was a warm September night as the parties involved each made their way to the quaint South Philadelphia lane. First to arrive was Doctor Michael Barnes. Doctor Barnes had completed his Wednesday office hours at 5 PM that evening. He then took advantage of the weather conditions and slowly walked downtown to the restaurant. His genetic make up compelled him to arrive twenty minutes early. As a host to many meetings at the eatery he was well known to the staff, who escorted him to a quiet private room on the second floor overlooking the historic street. Per routine they poured him a glass of room temperature spring water.
Ten minutes later marked the arrival of Howard Rineman. Mr. Rineman was the esteemed CEO of the Philadelphia General Hospital system, having held that position for the past six years. It was a position that he coveted. He was raised in New York City attending the finest prep schools his family could afford. He then attended the University of Pennsylvania as an undergraduate. He completed his training with an MBA from Penn’s Wharton School of Business. He relished his job as the kingpin of the largest employer in the Delaware Valley. A true socialite, he excelled in the public arena. His calendar of events featured a community get together nearly every night of the week.
Rineman was also well known at the Three Fives. He was politely greeted and escorted to the upstairs room where Barnes was waiting
“Howard, good to see you,” said Barnes extending his hand and standing as Rineman entered. Barnes respected Rineman, always believing his decisions kept the welfare of the hospital staff in mind.
“Good evening Michael,” responded Rineman as he shook hands. The two gentlemen then sat down. Without having to ask a young female waitress brought Rineman a glass of Bokma gin.
“Hard to believe it has been two years since the last review article,” said Barnes while looking out the window at the historic street below.
“Time flies,” said Rineman taking a sip of the gin. “Let’s just hope the numbers are favorable again.”
“I really don’t approve of the emphasis placed on these mortality numbers,” said Barnes. “The care of a cardiac patient is complex in nature and cannot be completed represented by a mortality percentage.”
“I know,” said Rineman. “However accountability and complete disclosure is the standard now. With the Cold War over the government has a surplus of workers sitting around and doing nothing on the taxpayer’s dollar.” Rineman paused to glance at an oil painting on the wall and then continued, “To justify paying these public servants, attention has focused on the nation’s health care system. Once the government gets involved an avalanche of numbers, paperwork and standards follow.”
Barnes continued to look out the window as he spoke, “Not like the good old days when a surgeon was a surgeon.” He paused then spoke again while shaking his head, “Not a nervous Nellie worrying about his standard of care rankings.”
“Ah the good old days,” said Rineman. “The days when you and Dr. Knight could knock off a patient and tell the family their loved one just didn’t make it,” Rineman paused as he finished the gin. “We all miss the good old days.”
“There was accountability back in the day,” said Barnes turning his gaze back to Rineman. “But it was an internal accountability, within the department, among a surgeon’s peers.”
“Those days are long gone,” said the CEO. “Every external force now demands data available for public consumption.” Rineman paused as the waitress brought a tray of cheese. “Like it our not, standards of care must be documented, met or exceeded, and made available to all.” He paused to sample some Gouda cheese before saying with a smile, “Hopefully to our advantage.”
“It is going to be close this year,” said Barnes. “Richard just had a peri-operative death. Per his calculations one or two more will tip the scales in the wrong direction.”
“He says that every two years,” said Rineman.
“I know, I know,” replied Barnes. “Its probably a good idea we didn’t invite him this year. He actually took it well.”
“After our last meeting with the Chronicle it was a no brainer to leave him off the guest list,” said Rineman with an agitated tone. “I mean the guy got drunk right at this very table and a bit ornery with the reporter.”
“He is old school,” said Barnes. “But a heck of a surgeon.”
Rineman smiled in agreement and then asked, “Does he still have that young blonde filly in his stable of women?”
Barnes was impressed by the street lingo from the CEO. However, before he could respond, escorting steps were heard approaching the room. The maître d’ was then heard giving a short history on the Three Fives. He soon entered the room with a somewhat disheveled looking middle-aged man. Upon their arrival both Dr. Barnes and Mr. Rineman arose.
Harold Rineman quickly stepped forward extending his hand to the final guest saying, “Mr. Russo, welcome, welcome.”
Mr. Anthony Russo was old school. Old school South Philadelphia. He was 59 years of age and a product of first generation Italian immigrants. Italian was the only language spoken in his home growing up. Raised in South Philly he worked in the family bakery as a child. The bakery was located in the heart of the Italian Market on Ninth Street. He attended South Philadelphia High School where he developed a passion for ice hockey. Slight in stature, he used speed and determination to excel at the sport. He relished a good fight in the schoolyard or on the ice. He adored the Philadelphia Flyers and the Broad Street Bully teams of the 1970s. In 1976 his uncle, who happened to be politically connected, secured him a job with the Chronicle as a beat reporter. Since then he rose steadily up the ladder at the Chronicle despite its turbulent relationship with the city’s political machine. In 2002 he was awarded an associate editor position, which he held ever since.
Mr. Russo never presented himself well. His hair was thick and wavy and never brushed in any direction. He abhorred fine clothing and physical fitness. He smoked cheap cigars and ate unhealthy foods. He enjoyed strip bars and the clientele that gathered there. He was out of context at the Three Fives when he approached his dinner mates.
“Harold,” was the gritty response from the Philadelphia Chronicle’s chief medical reporter. “Good to see you again, please, just call me Tony.”
Rineman then reacquainted Anthony Russo with Dr. Barnes and the three gentlemen sat down. Niceties were exchanged as Tony Russo then began to run up a bar tab on the health care system’s expense. Scotch was his poison. As dinner progressed the reason for their get together became the main topic.
“I can assure you gentlemen, that the report will be fair to all physicians and institutions involved,” said Russo. He was enjoying a potato gnocchi entrée.
“Of course, of course,” said Rineman. “We have always found your wording to be favorable to PGH.” Rineman then paused while dabbing his lips with a napkin. He continued, “That’s why we graciously contribute each year to your newspaper’s charitable program for intercity kids. We consider it an honor.”
Russo understood the comment. His chief editor informed him that the PGH Health Care System was the major contributor to their “Off the Street Program” for underprivileged Philadelphia youth. The medical system was also the top monetary provider to the paper for medical advertisements.
Barnes then spoke, “As usual we need to let the public be aware of the complexity of the cases at PGH. When the community hospitals in the suburbs run into trouble, they immediately ship their critically ill patient to PGH. We are the last stop.”
“Of course, of course,” said Russo with some pesto sauce on his chin. “But you have to understand that the other major medical centers in town also claim their cases are the most complex.” He paused to digest and spoke again, “I met with the Temple boys last week and they said the same thing.”
“We understand,” said Rineman taking control of the conversation. “As the largest employer in the region we have a commitment to medical excellence. This commitment has been the gold standard for the area and we are confident the numbers will reflect that.”
“Any idea how the numbers are looking?” said Russo in a matter of fact fashion.
“No,” said Barnes. “We don’t worry about them. They are what they are.”
“How about Dr. Knight?” said Russo, now starting to stir the conversational pot.
“Dr. Knight is the premier cardiothoracic surgeon not only in Philadelphia, but on the eastern seaboard,” said Rineman. “His only concern is each patient’s well being, beyond that these numbers don’t affect his actions.” Rineman paused for credibility sake and then continued, “I can assure you of that.”
“They say he is the best,” replied Russo. “Always one of Philadelphia’s Top Doctors mentioned in that rag of a magazine each year.” Russo then finished off his dinner and rubbed his stomach while looking around the room. He then said, “Where is the good Dr. Knight this evening?”
Dr. Barnes went to speak but Rineman cut him off saying, “Prior commitment, but he does send his regards.” The three men then smiled at each other.
“His regards,” said Russo. “Two years ago at this very table he almost threw me out that window.”
“A passionate man,” replied Rineman quickly. “A very passionate man.”
“That’s what makes him so successful,” said Barnes. “His passion for life and for the medical profession.”
Russo shook his head to try and bring the nonsense to an end saying, “Listen men, this data I publish is available to the public on the internet. They are just too lazy to look it up. The Chronicle just pulls this public information together and publishes it in a fashion that the common man can read while taking his daily constitutional on the toilet. That’s it. Its not rocket science, I’m not going to win a Pulitzer for this series.”
“The usual timing for the article?” asked Rineman.
“Yep, early January,” said Russo. “Possibly New Year’s Day. Slow time of the year for news.”
“Well we look forward to a well balanced article that accurately tells the region and nation who we are,” said Barnes.
“Yes indeed,” said Rineman. “An article that will allow both the Chronicle and PGH to continually benefit from the rewards of positive press.”
Russo nodded back assuring his hosts of a fair worded report. He then ordered dessert and an expensive bottle of port wine for the group. Anthony Russo then enjoyed a premier cigar offered by the maître d’ complements of the house. The group broke up at 9:30 PM. Russo then slowly walked south to a well-known Gentlemen’s Club for additional entertainment. Rineman and Barnes headed towards Rittenhouse Square and public transportation.
“That went well,” said Barnes as the couple walked through the square.
“Yea, but I don’t trust the guy,” replied Rineman. “I don’t like our system’s reputation riding on the wording of a cheesy alcoholic.”
“It will be fine,” said the trusting Barnes. “And the numbers do speak for themselves.”
“Yea, its not like we can control them,” replied Rineman while hailing a cab that transported them away from center city.
At that moment, approximately seventeen stories above Barnes and Rineman, sat Dr. Knight. He was visiting the apartment of Jennifer Ranier. It was of course the premier penthouse overlooking the park with a commanding view towards center city. Knight was sitting out on the patio sipping some vodka. Music of Alexander Borodin played softly overhead. It was a peaceful evening with a sky full of bright stars. A warm gentle breeze drifted across the spacious balcony.
Knight had bought the penthouse as a newlywed many years ago. He had strong emotional attachments to it. Ten years ago he and his wife moved several blocks away to Washington Square West. There they lived in a pricey federalist home with an adjacent garden. Mrs. Knight was claustrophobic and hated elevators. She required a home that offered her street access in a posh neighborhood.
Knight kept the penthouse as an investment, for years renting it out to foreign businessmen who appreciated excellence. Then, as his marriage turned into a working relationship, it served as an enticing perk to a string of bedmates. Jenna Ranier was the current concubine residing in the penthouse. She was the holder of the apartments longevity record, having resided there for four years.
Knight was brooding that evening. He was still recovering from the sudden death of his patient. He also was awaiting the final autopsy report from Dr. Falcon. Lastly, he was acutely aware of the fact that Rineman and Barnes were meeting the Chronicle representatives that evening. The fact that he was excluded from the gathering disturbed his psyche. Knight always wanted to be in control of the situation, whether in the O.R. or in his personal life.
He slowly sipped the vodka listening to the city hustle and bustle below. As a rule he only imbibed in spirits on an evening that preceded a nonsurgical day. Tomorrow’s schedule did not involve any planned surgery. He sat in a comfortable oversized outdoor ottoman chair. It belonged to a set of furniture he and his wife bought specifically for the veranda. Surrounding the chair was a series of sofas and tables casually placed around a center coffee table. The area was lit by a series of LCD lights running along the floorboards. Some overhead lamps added to the soft ambience of the setting.
Knight was ruminating on the upcoming Chronicle article. Every two years he would become obsessed with his quality control numbers. He understood his place as the self-proclaimed premier cardiothoracic surgeon in the Philadelphia area. Hard work, surgical skills and self-promotion garnered the top spot. The importance placed on the upcoming article was paramount in his mind. An average, or above average ranking would keep him in the top spot. A below average mortality ranking would damage his practice. More importantly it would harm his reputation and ego.
Subconsciously the Chronicle article impacted his medical decisions and patient care. His medical staff micromanaged every patient with the specific goal of discharging a living human being. This was the only criteria for a successful outcome. Other complications such as a blood clot, infection or reoperation did not concern him. Dr. Knight’s only conscious concern at the end of a calendar year was his mortality rate. If it was good, then he was a success.
That evening he and Ranier enjoyed a catered meal from a fine French restaurant on Rittenhouse Square. As a rule Jennifer Ranier was an incompetent chef. She fortunately made up for this culinary deficiency with a feminine prowess that captivated Knight. That evening she was mentally and physically prepared to pay her dues to the landlord. She wore her recently highlighted hair straight to the shoulder level with a soft part down the middle. Her skin was lightly tanned from the warm September sun. Sterling silver adorned her neck, wrists and right ankle. She wore a black pullover strap dress that accentuated her toned figure. High heels finished the package that was ready to be unwrapped. The couple had already enjoyed a full bottle of wine with dinner.
As Knight sat in his chair, Ms. Ranier slowly walked out to the balcony in a sultry fashion. She held a glass of wine in one hand as she sat on the sofa next to Knight. She had sensed his uneasiness over the past two weeks, which continued that evening.
“I love September nights,” said Ranier. She slowly swept her hair back over one shoulder looking at Knight. Her eyes were welcoming and her lipstick sassy spice red.
Knight just stared forward over the balcony rail saying, “I wonder what those idiots talked about this evening.” He was referring to the Rineman and Barnes meeting.
“I’m sure they discussed exactly what they told you,” replied Ranier.
“I’m not sure,” replied Knight still with a fixed gaze. “I know Barnes well, but I can’t completely trust Rineman.” He paused to sip the vodka and continued, “He is just a puppet for that Board of Trustees. I know they hate me.”
“No they don’t,” said Ranier quickly. “You are the main bread winner for the whole health system. The Trustees are only interested in the bottom line.”
“I guess so,” said Knight. “You know I just worry about this darn article coming out soon.” Knight let out a sigh slowly shaking his head side to side. He looked down on the near empty glass of vodka. He slowly twirled the liquid in the glass. He let out another slow exhale.
