Julie gazed out the window at the standstill traffic.
“I can relate,” she said.
“Wish I could write queries against the database, but I can’t. If I could, I might be able to pull up records for myocardial infarctions that also have a record delete transaction type in the transaction logs. That’s the pattern we’re looking for.”
“I thought you were a superuser,” Julie said.
“The superuser access is for viewing, adding, and editing records. The database stuff is with IT.”
“But you said you got one. How?”
“I was looking at names and remembered a guy I wheeled to the morgue, Tommy Grasso. He used White Memorial like a Comfort Inn. So I checked it out.”
“And?”
“And he didn’t have an echo on file, but his EKG looked a lot like our two other cases. ST-T abnormalities, QT prolongation with large negative T waves occurring in succession. So I checked the transaction log and there it was-a record of a deletion logged postmortem.”
“Any history of heart disease?”
“No. It’s the lungs that were killing him, not the heart.”
“The EKG is telling, but not telling enough. We need an echo to definitively show takotsubo type ballooning.”
“That’s gonna be tough to find.”
Julie did not disagree. Protocols for chest pain always involved an EKG. The twelve-lead setup, six on chest and four on the arms and legs, could be done in a few minutes, and computer algorithms gave interpretations immediately. Echocardiograms, by contrast, were not routine. White did not offer a twenty-four-hour echo service like some hospitals with cardiology fellowship programs staffed night and day.
“I’ll keep looking,” Jordan said. “There’s something to this, Dr. Devereux. Especially with those deleted records. It’s a pattern.”
“No, it’s a start. Look up Colchester’s file for me. Let’s compare his EKG with Tommy’s.”
“Hang on a second.”
Jordan’s second was more like a couple of minutes, in which time Julie inched her car forward maybe forty feet. She drummed her fingers restlessly on the steering wheel while waiting.
“Hey Doc, check this. That record is gone.”
Julie’s vision went white and cleared in time for her to hit the brakes before finding the bumper of the car in front.
“What do you mean gone?”
“As in, the record doesn’t exist in the EMR system anymore.”
One name came to Julie’s mind.
Dr. Coffey.
Coffey had made it clear Julie’s investigation was unwelcome, and now he was making sure it was impossible. Maybe Dr. Coffey had discovered something on his own to make him and the department look bad, or perhaps something that would make it hard to keep Colchester’s killer behind bars. A cold chill spread across the nape of Julie’s neck. Just how far was William Colchester’s reach?
Jordan checked the database and found Sam’s record was still in the system. But with Colchester’s EMR gone, Julie no longer had definitive evidence of two cases of takotsubo at White. What she had was smoke, but no fire.
“What are you thinking?” Jordan asked.
“I’m thinking I can’t get to Sherri Platt’s place soon enough.”
CHAPTER 34
Roman Janowski walked alongside Allyson Brock as they headed from the main entrance of Suburban West to the rehabilitation unit. Her strides equaled two of his, and he had a feeling Allyson hurried to make it as uncomfortable for him as possible.
White Memorial had gobbled up Suburban West like a great white shark snatching a meal in a single bite. The biggest obstacle to the takeover had always been the board of directors, but the numbers Romey put forward were so favorable his negotiation skill could have been second-rate and would have still closed the deal. Romey’s lawyers had the papers drafted and the details ironed out well in advance of that meeting. Based on projections, West’s chairman of the board, Vince Hanke, was doing everything in his power to speed up the process.
Brilliant.
The full transition would take time, but there already were some tangible benefits in bringing Suburban West into White’s accountable care organization. The benefits could be even greater, but Romey had heard from the other CEO that Allyson kept her foot too heavy on the brake. Romey had come here to force that foot over to the gas.
ACOs were the media darlings of the moment, with almost daily news reports of savings to Medicare projected in the billions. With ACOs, the average spending per patient was expected to plunge forty to fifty dollars per month in the coming years. Multiply that by millions of patients, and the trend was worth some attention.
The media could write whatever stories they saw fit, but Romey’s accountability was to his board, which mandated he deliver profits and patients. Before Romey took over White Memorial, those were thought to be mutually exclusive objectives. Allyson would learn the hard way they were not.
The looming takeover left Romey little time for exercise, or for screwing around with either of his two mistresses. It had been all work and no play, and indeed that made Romey a dull boy. His suit pants did not fit as well, and his notoriously slow metabolism probably had something to do with how snug his blazer felt across his chest.
The stress of the merger did not seem to bother Allyson any. Her weight had not fluctuated one iota. She still looked fine in her business suit, her rear end filling out her black slacks to perfection. Who said walking golf courses wasn’t exercise? Romey lamented not getting a chance to bed her. It could have happened, too, but Romey always put business before pleasure.
“How are things with Knox Singer going?” Romey asked.
Allyson’s counterpart had come from Boston Community Health, better known as BCH. Knox had already given Romey an earful on how things were going.
“I think we’re making progress,” Allyson said in a voice too sweet, too saccharine.
“Any trouble spots?” Romey was much better at lying.
“Nothing we can’t handle,” Allyson said.
“Good,” Romey said. “I read the report from Dr. Lucy Abruzzo. It seems you two had a good meeting.”
“We did. She’s a very directed person, not much small talk with her. It was an extremely productive working session, and I’m sure there are efficiencies we can gain by leveraging the resources of her pathology department.”
“Dr. Abruzzo may have a certain way about her, but she’s supremely competent. I’m sure whatever ideas she’s come up with will benefit our respective hospitals and our patients.”
When they reached the rehab unit Romey walked the floor, checking in on the rooms.
“No available beds,” he noted.
“We’ve been busy,” Allyson said. “It’s good for the hospital and the patients. They have to go somewhere.”
“Shouldn’t some of them have gone to White? You’ve seen the numbers, or have you forgotten?”
Romey led Allyson beyond the nurses station, out of earshot of the staff. A few patients were out on guided walks around the floor. Most got around with the aid of a walker.
“I hadn’t forgotten, Romey,” Allyson said. “But it’s a lot easier to move these patients on paper than it is in real life. They have families nearby and don’t see the benefit of going to White.”
“Because you haven’t made them see the benefit.”
“I thought my job was to run this hospital,” Allyson said with some bite.
Romey returned a half smile.
“The staff is a reflection of their leadership, is all I’m saying. If the staff believes it’s better for their care, the patients will believe it, too.”
Romey put his hands behind his back and walked with an exaggerated tilt from side to side, like he was out on a leisurely stroll. He popped into a unit where a frail, thin man could barely be seen beneath all the tubing connected to his body. Romey went to the patient’s bedside after Allyson introduced him to the nurse.