Monday, July 30, 2012

The Hawks Are Circling

     This morning as I hurried down the Tennessee flagstone walkway from the front door to my car I saw twelve hawks and nine vultures making circles overhead.  It seemed as though they were aiming for me, ready to yank off my head, pick the flesh from my bones, claw my liver, and slurp out my eye sockets.  They are ruthless, gory creatures.
     Then I saw the poor chicken, my defenseless friend, who produced eggs for my son's giant chocolate birthday cake yesterday.  It was torn to pieces and bleeding on the ground a few yards away.  The predators were very close--just above the tree line--so I knew they couldn't be frightened by me, an unarmed, soft-hearted human whose trek to the car to make it to work on time was a minor annoyance that delayed their carnivorous gratification.
     I wasn't surprised, then, upon arrival at the office, to be told that three of my staff had been contacted by the FBI over the weekend.  One was a student who worked for the clinic part-time through high school as a file clerk and nursing assistant.  She had just started college courses in Tallahassee:  the FBI agent said he'd meet her on campus for questioning.  She doesn't have to talk to him--but she doesn't see what harm it could do.  She told us she'd been honored to work at Colasante Clinic, and she cried when she left for college. 
     Perhaps she and I are both as naively innocent as my chickens, pecking dirt with characteristic American industriousness to meet the basic requirements of life, not realizing people can be after you.  She may not be aware of what many lawyers have told me, that federal agents pick and choose from among the elements of their interviews in order to splice together a story they want to tell.  The story elevates them:  they have caught a criminal red-handed, the FBI is heroic, Americans can be glad their tax dollars (all $8.1 billion of them, in 2012) are being spent to defend the public in a mighty way.
     The FBI agent drove to the home of one of my nurses over the weekend--and his IRS cohort blocked the driveway with a second vehicle.  They questioned the nurse for twenty minutes on the back porch, while a catahoola-leopard-hound-pitbull-mix barked wildly in the background.  "I could have let the dog loose any time," the nurse said, "and he'd have torn them up."
     "Why does Dr. C. do aortic ultrasounds?" the agents demanded to know.
     "If one in a hundred has an impending dissection," the employee answered, "think of what we've saved?  You've got to understand:  aortic aneurysms are silent--patients don't have a single symptom.  How are you going to find one, if not with an ultrasound?"
     A dissecting aortic aneurysm is an excruciating but quick death in one out of three cases.  The aorta ruptures like an overblown balloon.  Blood explodes into the abdominal cavity--and that's it.  But before the patient dies, emergency surgery and hospital costs can wrack up charges of $100,000.
    What will Medicare pay a doctor to perform for an ultrasound to prevent such a catastrophe, in patients with multiple risks?  $81.
     Are the FBI agents upset about that $81?  Are they upset that my clinic posted profits in the years before their raid ?  Do they think I shouldn't have spent $70,000 on ultrasound units?  Should I have left tests like that to the hospital?  Should we solo docs turn everything over to hospitals?
     The hawks are circling.  They're picking the brains of everyone in my vicinity.
     Does the FBI know anything about medicine?  Or are its agents just playing the numbers?
     No matter...they need a victim.
     Will I be next?
     There had better be a good reason, because I am not a chicken.

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