"There are two tragedies in life, One is not to get your heart's desire, the other is to get it." And of course, "The Omnicenter, Complete patient care with complete caring patience." There were several others, most of which Kate had heard or read before. One, however, she could not recall having seen. Done in black Benedictine calligraphy, with a wonderfully ornate arabesque border, it said, "Monkey Work for the Monkeys."
Zimmermann followed her line of sight to the saying. "A gift from Carl,
" he explained. "His belief is that the energy of physicians and nurses should be directed as much as possible to areas utilizing their five senses and those properties unique to human beings-empathy, caring, and intuitiveness. The mechanics of our job, the paperwork, setting up of appointments, filling of prescriptions, and such, he calls 'monkey work.
His machines can do those jobs faster and more accurately than any of us ever could, and it seems Carl teaches them more almost every day."
"So, " said Kate, "he's named his computers… the Monkevs." Zimmermann said the last two words in unison with her. Kate sensed a letup in the uneasiness she had developed toward Carl Horner and began looking forward to meeting the man. "Now, " Zimmermann asked, "can you brief me on what you have found in these two patients of ours? I have reviewed their records and found little that might be of help to you."
In the concise, stylized method of case presentation ingrained in physicians from their earliest days in medical school, Kate gave a one minute capsule of each woman's history, physical exam, laboratory data, and hospital course. "I've brought sections from the ovaries of both patients. I think there's a decent microscope in the lab downstairs," she concluded. Zimmermann whistled softly. "And the only link to this point is that both were patients here? " Kate nodded. "Well, I can't add much. Miss Rittenhouse had been an Omnicenter patient since nineteen seventynine. Nothing but routine checkups since then, except that she was within one missed appointment of being asked to go elsewhere for her gynecologic care. The contract we have our patients sign gives us that option."
"I know. I signed one, " Kate said. The contract was another example of the patient-oriented philosophy of the Omnicenter. Fees were on a yearly basis, adjusted to a patient's income. There was no profit to be made from insisting on compliance with periodic routine visits, yet insist they did. "What about Beverly Vitale?"
Zimmermann shrugged. "Six years a patient. Abortion here five years ago by suction. Had a diaphragm. Never on birth control pills or hormones of any kind. Always somewhat anemic, hematocrits in the thirty-four to thirty-six range."
"She was on iron."
"Yes. Dr. Bartholomew has had her on daily supplements since the day of her first exam."
"Who was Ginger Rittenhouse's doctor? " Kate was grasping for any connection, however remote. "Actually, she was cared for by the residents, with the help of a faculty advisor. In this woman's case, it was me. However, there was never any need for me to be consulted. She became a patient just after I arrived. I saw her once, and she has had no trouble since." He grimaced at what he considered an inappropriate remark. "Excluding the obvious, " he added. DEAD END. Kate's mind's eye saw the words as she had written them. She glanced at her watch. There would be a surgical specimen processed as a frozen section in half an hour. Her reading would determine whether the patient underwent a limited or extensive procedure. Still, she felt reluctant to let go of the one common factor she had found. "I'm due back for a frozen in a short while, Bill. Do you think Voll could take me by to meet Carl Horner and his trained Monkeys?
"Certainly, " Zimmermann said. "He's expecting us. By the way, I understand congratulations are in order."
"For what?"
"Well, word has it that you are to be the next chief of pathology."
Kate laughed ruefully. "Welcome to the new game show, I've Got No Secrets. Actually, I don't even think my name has formally been presented for consideration yet, so you can hold the congrattllations.
Besides, with the financial mess the department is in, I'm not sure condolences wouldn't be a better response. You don't suppose that Ashburton Foundation of yours has a few extra hundred thousand lying around, do you?"
"I have no idea, Kate. Norton Reese handles that end of things. I am just one of the barge toters and bale lifters. You might talk to him, though. The foundation certainly has taken good care of us."
Kate stepped into the carpeted, brightly lit corridor. "I'll say they have, " she said. The chance that Norton Reese would put himself out on behalf of her department was less than none. "Monkey Work for the Monkeys." The message was displayed throughout Carl Horner's computer facility, which occupied an area at the rear of the first floor several times the size of Marco Sebastian's unit. Ensconced in the midst of millions of dollars in sophisticated electronics, Carl Horner looked to be something of an anachronism.
Beneath his knee-length lab coat, he was wearing a plaid work shirt and a pair of farmer's overalls. His battered work boots might just as well have received their breaking in on a rock pile as in the climate-controlled, ultramodern suite. Horner greeted Kate with an energetic handshake, thotlgh she could feel the bulbous changes of arthritis in every joint. Still the man, stoop shouldered and silver haired, had an ageless quality about him. It emanated, she decided, not only from his dress, but also from his eyes, which were a remarkably luminescent blue. "Dr. Bennett, I owe you my deepest apology. The error regarding the Rittenhouse file was nothing more-nor less-than a spelling mistake on my part."
Kate smiled. "Apology accepted. Incident forgotten."
"Have you found the explanations you were looking for?"
"No. No, we haven't. Mr. Horner, could you show me around a bit?
I'm especially interested in how the machines work in the pharmacy."
"Carl, " Zimmermann said, "if you and Dr. Bennett don't mind, I'm going to get back to work. Kate, I plan to review those slides later tonight and to do some reading. Together, I promise that we shall get to the bottom of all this. Meanwhile, enjoy your tour. We're certainly proud of Carl and his Monkeys."
Patiently, the old man took Kate through the filling of a prescription.
"These cards are preprinted with the patient's name and code number and included with the patient's chart when she has her appointment.
The doctors tear em up if they're not needed. As you can see, there are twenty-five separate medications already listed here, along with the codes for dosage, amount, and instructions. The machines dispense only these medications, and then only in the form of a generic — as good as any brand-name pharmaceutical, but only a fraction of the cost. The machines automatically review the patient's record for allergies to the medication prescribed, as well as any interaction with medications she might already be taking." Horner's presentation had all the pride of a grandmother holding court at a bridge party. "If there's any problem at all, the prescription is not filled and the patient is referred to our pharmacist, who handles the matter personally."
"What if the physician wants to prescribe a medication other than the twenty-five on the card? " Kate asked. "Our pharmacy is fully stocked.
However, because of the Monkeys, we need only one pharmacist on duty, and he or she has more time to deal with problems such as drug interaction and side effects."