They will say, ‘Of course, do everything.’ At that point, Dr. Kim will put in an order to plug in the life-support systems, and leave the patient to vegetate.”
“I see.” Koesler thought he did. “But what does conduct like that have to do with the hospital—or Sister Eileen?”
“For one thing, it drives costs up, most of the time needlessly. Instead of spending a lot of money on systems that keep essential body functions going, the patient should be allowed to die with some dignity. But doctors like Kim never quite give dignity a chance. So it’s that much more difficult to balance a budget.”
“I see.”
“Now, Dr. Kim is by no means alone in his approach to terminal patients. Where he could have a problem, that could cause the rest of us to have a concomitant problem, is in the clinic. Has anyone told you much about the clinic?”
“I know where it is. You treat outpatients there. You even have outpatient surgery.”
“Right. It’s also where we have some of our more pressing ethics problems.”
“Oh?”
“Normally, they’re not problems for most doctors. Certainly they’re not problems for other hospitals. But they’re very definitely problems for Catholic hospitals.”
“Let me guess: family planning.”
“Right.”
Koesler looked slightly puzzled. “Well, as far as the ‘official’ Catholic teaching goes, there are only two approved means of family planning. One is complete abstinence from sexual activity, and the other, under set circumstances, is the rhythm method.” Absolutely nothing had changed in the Church’s attitude toward family planning in the thirty-odd years Koesler had been a priest. Church approval of the rhythm system had occurred shortly before he had been ordained in 1954. “But very few pay much attention to that view any longer. Just the bishops, some priests, and a few very conservative lay Catholics.”
“But you see, Father, the bishops like to exercise a good measure of control over Catholic hospitals.”
“That makes sense. They’d exercise complete control across the board if they could. But family planning is a private matter between each couple. At most it might enter the confessional as a question or as a matter for some discussion. But I can see where in a hospital you’re in the external forum and the bishops might be able to control —or try to control—the hospital’s teaching and practices.”
“Exactly. And that’s where a place like St. Vincent’s is in a lot of trouble. If we don’t dispense information and devices for all medically approved methods of birth control, we lose government funding. That, in itself, I think, would not discourage Sister Eileen. But she knows our patients have a right to this information and service. And she is determined to make it available to them. The peculiar twist in all this is that most of our poor patients couldn’t care less about birth control. They figure the more babies the better.”
“So,” Koesler clarified for himself, “St. Vincent’s provides the information and means of artificial birth control under the threat of losing government financing—but against the bishops’ directives—and because the CEO believes it’s the medically and ethically correct thing to do, even though most patients don’t want the information in the first place.”
“That’s about it.”
“A dilemma. A real dilemma. But where does Dr. Kim fit into this?”
“As usual, Dr. Kim is involved in shortcuts. But, in this instance, they are rather significant shortcuts.”
“Oh?”
“I don’t have this firsthand, but from some of the clinic personnel I trust. Dr. Kim, when faced with any sort of problem pregnancy, will routinely perform a D & C—at least he will call it a D & C.”
“D&C?” Koesler asked.
“Dilatation and curettage. You dilate the cervix and scrape the womb’s lining. It’s standard treatment for any number of gynecological problems. But not for a problem pregnancy. Then it’s a euphemism for abortion. And that’s where St. Vincent’s draws the line. Our policy permits teaching methods of contraception, the implantation of IUDs, prescribing birth control pills, even sterilization . . . but not abortion. Not abortion.”
“I see.”
“It would be lots harder to prove, but according to some, Dr. Kim also schedules hysterectomies with some abandon.”
“He does?”
“Yes. Even when the woman’s condition does not warrant it, a hysterectomy is sometimes the easiest and at the same time the most lucrative therapy.”
“What a crime to perform such radical surgery if a woman doesn’t really need it!”
“Indeed. But it is convenient. However, if these charges can be proven, Dr. Kim will be out on his ear.”
“Oh, my. But”—Koesler’s brow furrowed—“there’s still a shortage of doctors. Wouldn’t he be able to tie in with another hospital?”
“Perhaps. But remember where St. Vincent’s is on the desirability list. It’s something like a baseball player being unconditionally released from a last-place team. And remember where Dr. Kim wants to go. Very definitely up from St. Vincent’s. Not down. Not even a lateral arabesque.”
“So,” Koesler concluded, “I would guess that would be motivation enough for Dr. Kim to clean up his act.”
“Maybe. Maybe. Unless he had an alternative.”
“An alternative?”
“He might try to hurry the closing of St. Vincent’s. If the hospital closed shop before he was dismissed . . .” Scott’s gesture signified a satisfactory conclusion, at least by Dr. Kim’s lights.
They picked up their trays and headed for the counter area. En route to the conveyor belt that would carry their trays to the dishwasher, they encountered a man who had just settled with the cashier and was scanning the cafeteria preliminary to selecting his dining place.
“Hello there, John,” Scott greeted him. “Have you met our substitute chaplain yet?”
“I haven’t had the pleasure.”
Scott introduced John Haroldson, chief operating officer of St. Vincent’s. Haroldson, of medium height, appeared to be in his mid-sixties. His heavily lined face was framed by wispy, wavy white hair. His eyes were a very light blue and when he smiled, as he was doing now, all the lines of his face moved in an upward direction. Koesler’s impression was of a rather nice-looking, friendly gentleman.
“So you’re going to be with us until Father Thompson returns, eh?” Haroldson observed.
“That’s right. This was my first day on the job and I must admit I’ve learned a lot, with a lot more to learn.”
“Don’t worry, Father, the hospital won’t jump up and bite you. You’ll get along fine. If there’s anything I can do to help, don’t hesitate to call on me.”
Haroldson headed for a table. Scott and Koesler deposited their dinner trays on the conveyor. They stopped together just outside the cafeteria. For the moment, they were alone in the corridor.
“That’s another one,” Scott said.
“Another one what?”
“Another problem area.”
“Oh?”
“Haroldson goes back in this hospital almost as long as Eileen.”
“That’s a problem?”
“Not in itself. It’s just that John has a bit of a persecution complex. He’s always moved up a notch behind Eileen, until, of course, her final appointment. When she became a supervisor, he was named assistant comptroller. She moved into a vice-presidency; he became a supervisor. Then he became COO with the likelihood of eventually becoming CEO. But Eileen leapfrogged him into the top job.
“It doesn’t show, but John Haroldson is a bitter man, and the principal target of his bitterness is Eileen. It’s really manifested when they’re together, especially in a meeting.”
“I’ve been here only a day, “ Koesler said, “and I’ve just met Sister Eileen this once, but it does seem to me she’d be able to handle someone’s bitterness. I mean, she’s already juggling any number of problems—most of them far more serious than envy.”
