A Second Opinion, Chapter Seven: The More You Know…

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This is chapter 7 of a serialized novella appearing on Ars Gratia Libertatis every two weeks.  Read from the beginning here.

Chapter Seven: The More You Know…

Quis custodiet ipsos custodes? –Juvenal

The surveillance van was state of the art. No expense had been spared in equipping it with all the newest bells and whistles of the professional voyeur’s trade. Declaring that the van would be “fighting terrorism” the Health Board had kitted it out with full video and auditory sensing and recording equipment (including night and thermal filtering), a veritable hacker’s wet dream of phone and internet taps and signal boosters, and even some more exotic technology still in the experimental phase. Though budgets for life-saving drugs and new beds for hospitals lagged, for this, it seemed, there was always enough money.

A Second Opinion, Chapter Six: Thomas King

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This is chapter 6 of a serialized novella appearing on Ars Gratia Libertatis every two weeks.  Read from the beginning here.

Chapter Six: Thomas King

Never doubt what small men will do for great power. –Paolo Bacigalupi

Thomas King had been ten the moment he first decided he wanted to be a bureaucrat. It had not been a conscious decision; he still said he wanted to be an astronaut, but deep down, where it counts, he didn’t. The young boy with the mousy brown hair, his midsection always a little too doughy, wanted to be a bureaucrat when he grew up.

It had happened the day Thomas was awarded the title of Recess Monitor for going a whole month without being tardy once. That recess was one of the least fun half hours the children at Oliver Wendell Holmes Elementary School would ever have to endure. But for Thomas King, it was a blast.

A Second Opinion, Chapter Five: Shelly Reyes

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This is chapter 5 of a serialized novella appearing on Ars Gratia Libertatis every two weeks.  Read from the beginning here.

Chapter Five: Shelly Reyes

“The human race divides politically into those who want people to be controlled and those who have no such desire. The former are idealists acting from highest motives for the greatest good of the greatest number. The latter are surly curmudgeons, suspicious and lacking in altruism. But they are more comfortable neighbors than the other sort.” –Robert Heinlein

Shelly Reyes was a good person. That’s what everyone who met her said about her. She devoted countless hours outside her job (as a selfless public servant in the Office of Energy Regulation) to community service and social work. Naturally bubbly, she could carry on a conversation about absolutely nothing with just about absolutely anyone.

A Second Opinion, Chapter Four: The Devil You Know

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This is chapter 4 of a serialized novella appearing on Ars Gratia Libertatis every two weeks.  Read from the beginning here.

Chapter Four: The Devil You Know

A light dusting of snow, freshly fallen, lay across the earth outside John Morales’ window. Like an accent it highlighted the objects it covered. Edges became sharper and more visible in the stark, white landscape, as if a lens had clicked into place to bring everything into focus.

Original Poetry: The Public Good

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In the Name of the Public Good

The judges were old, the judges were cold.
They defended the Public Good.
Their mandate was clear, today they would hear
Who rejected the Public Good.

The verdict from them: ten men they’d condemn
For ignoring the Public Good.
There is no reprieve, if you don’t believe
In restoring the Public Good.

The men were famous, their actions shameless:
They’d reviled the Public Good.
Salesmen and bankers, merchants and traders
Were on trial for the Public Good.

Their crimes were excess, achievement, success
For themselves, not the Public Good.
The judges intoned, “You’ll be publicly stoned;
Selfish pride hurts the Public Good.”

“Thus our law decrees: you’ll die on your knees
In the name of the Public Good.
For profits you’ve lusted, your freedom has rusted
The chains called the Public Good.

Our god called the Public Good.
The Tyrant, the Public Good.”

Cannibals, an Original Poem

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Cannibals (or: “Eating Atlas, a tale of bailouts”)

Cannibals chew no human meat
In our enlightened age.
Instead they loot the balance sheet,
Destroying page by page.

They gather round the boiling pot
To cook away our rights.
They sit and stir and while they plot,
They chant throughout the nights:

“If you are sick you’ll need our aid;
We’ll take from those who work.
We’ll ‘eat the rich’ to get you paid,
We worship those who shirk.

We need our fix, we want much more.
Producers we will gut!
For every tax from rich to poor
We’ll take most of the cut.”

The CEOs, the head honchos
Now hear the tolling bell.
The parasites; their mortal foes,
Are leading us to hell.

“You’ll work for free, you’ll work for fun,
You’ll give us what you owe.
No profit now, so says our gun!”

Drooling cannibals crow.

They are so quick,
To praise the sick
And damn those who have health.
But who will feed
Their reckless greed
When they’ve ate up all the wealth?

A Second Opinion, Chapter Two: The Man From the Health Resources Allocation Board

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This is chapter 2 of a serialized novella appearing on Ars Gratia Libertatis every two weeks.  Read from the beginning here.

Chapter Two: The Man from the Health Resources Allocation Board

 

“Bureaucracy is a giant mechanism operated by pygmies.”

–Honore de Balzac (1850)

That night John drove home through the gusting snow.  He arrived distracted and preoccupied.  His girlfriend, Shelly, hardly noticed during a short dinner as she went on about her day.  After dinner, while Shelly sat down to watch TV, he excused himself and went out to the garage.  He began pulling boxes down from their positions on the storage shelves in the back.  After a short while he found what he was looking for, a beat up plastic storage container, marked on the side with worn-out marker, “Personal.” He carefully lowered it to the ground and sat down on the cold concrete beside it.

Inside was a diverse collection of papers, pictures and trinkets: things that, at one point or another, had been significant enough to him to merit being set-aside and saved.  There were tickets from the play he had seen with Shelly on their first date (Les Miserables), a Mother’s Day card he had made when he was three, some school projects and papers he’d been unusually proud of, some certificates of achievement, a picture of him at graduation.  He paged through all of these, carefully setting them aside on the dusty garage floor, until he came to a single, battered blue folder.

He didn’t know why he felt compelled tonight to revisit this piece of his past.  The box hadn’t been opened since his mother’s death a few years ago.  He nevertheless peeled the aging cover back and sat, absorbed, reading the words of his 22 year old self.  Behind the blue folder cover was an essay, written towards the end of his pre-med undergraduate career at Harvard.  The essay was titled, “The Purpose of Medicine” and had been written in a philosophy class he’d had to take to fulfill a liberal arts requirement.  His professor, while disagreeing with the conclusion, had liked it so much she’d submitted the essay and it had been published in an obscure academic journal right after he’d graduated.

“The purpose of medicine” (it began) “is not solely to heal the body and soothe the mind.  Doctors are not robots, merely performing maintenance on biological machines.  They are guardians of health, and for this phrase to have any meaning a holistic interpretation of it is required.  That is, for a doctor to be more than just a biological repair expert, he must concern himself with more than simply the causes and treatments of human maladies.  For a doctor to truly be a doctor he must take a keen and special interest in the world around him; in the way his society is ordered, in how his health care system works and in the underlying philosophy that guides decisions made by politicians and patients alike.”  Morales read all 15 pages, not realizing how uncomfortable he was on the hard ground until he had finished.

He went to bed that night feeling bitter for a reason he couldn’t explain.

****************************************************************

It took Morales two hours the next morning to drive the 5 miles from his house on Arapaho Road to the hospital.  The roads were largely unplowed, city budgets having been cut again. By the time he arrived at the hospital the man from the Health Resources Allocation Board was already there.  He’d asked to be picked up by the hospital’s Flight For Life helicopter “only if it happened to be in the area of the State Capitol building around, say, 9:30am.”  Unsurprisingly, for this man signed off on every pill, needle and paperclip the hospital was allowed to have, the helicopter had been there.

He was a short man, shorter than John, and his balding hair was slicked back from his forehead with a liberally applied amount of gel.  He was a bit too plump, and he smiled a bit too much.  His suit was immaculate.

He was sitting in John’s chair, behind John’s desk, when Morales walked into his office.  He looked up from his work scrutinizing the forms John had filled out last night when the doctor, impatient, coughed quietly.  “John!” he smiled broadly, his eyes dull.  “Glad you made it in, I heard about the roads; god what a mess.  But I guess ‘essential personnel’ like us have to come in to work anyway, huh?”  He chuckled a little too quickly at his own joke.

Morales tried to smile back, it came out as a grimace, “Hi Thomas.”

“Don’t worry, because you were so late I’ve got through most of it.  I’ll only be another 45 minutes or so while I check the nurses’ records for the CAT scans and MRI uses.”

Thomas made no move to rise from John’s chair.  An errant voice popped into Morales’ head, “How much of your time is spent filling out paperwork for bureaucrats who’ve never once set foot in a medical classroom?” He shook his head to clear the thought and smile-grimaced again, “Sure, no problem Thomas.  I’ll do the rounds while you finish up.  Page me if you have any questions.”

Thomas didn’t respond except to focus again on the papers on the desk.  After a short pause, Morales turned and left his office.

His rounds were uneventful; he spoke briefly with haggard nurses who offered him anemic smiles.  As he passed the door to the security office a thought occurred to him and he stopped, did an about-face and knocked lightly on the frosted glass pane labeled “Hospital Security.”

“Yeah? Come in!” a gruff voice greeted him.  He pushed in the door and the mustached man behind the desk smiled up at him, “Hi Doc, what can I do you for?”

“Hey Gerry, think I may have filed a CAT scan under the wrong patient name, could I check your citizen database real quick?”  John adopted a concerned frown.

“Sure thing Doc, just don’t tell the big brass I let you poke around on government computers.”  Gerry winked.  He called every person in a white coat ‘Doc.’  One of his private jokes that only he seemed to find funny.

“No problem Gerry; mum’s the word.”

Gerry gestured to an empty desk with a computer and said, “The password’s ‘Aspen.’”

Lysandra Fremont….No Records Found

Lisandra Freemont…No Records Found

Lisa Freemond……..No Records Found

John tried every possible permutation of Lysandra and Alyssa’s names and every time the government database responded that they did not exist.  He frowned.  Odd.

“Paging Doctor Morales.  Paging Doctor Morales.  Doctor Morales please report to surgical wing room 104.”

“Thanks Gerry, gotta go” said John as he hastily erased his search history and got up from the desk.

“No problem Doc, hey, quick question—”

“Sorry, could be urgent.” And Morales was gone, not bothering to close the door behind him, his brisk footsteps echoing like machinegun fire down the hallway.

When he arrived at 104, his office, Thomas was there waiting for him.  “Well John, looks like everything checks out but ah, there’s one thing…”

John knew what was coming next; he’d done this dance enough with the various bureaucrats and government personages that oversaw his practice to be able to read the signs.  The hesitant manner, the ‘oh-too-casual’ voice (belied by a conspiratorial lean-in of the head) and the raised, questioning eyebrows.

“Listen,” Thomas went on, “I have a friend” (it’s always a ‘friend’ or an aunt or a girlfriend or a big campaign donor) “who’s had some trouble getting an appointment to see a specialist.  I know you have some pull around here, so I was hoping you could look into it.  All of his papers are in order, so it would be nothing illegal,” the bureaucrat assured Morales, “but if you could just look into it, I’d really appreciate it.”

Thomas finished, waiting expectantly.  Next was to come Morales’ role in this little stage production.  He had his lines memorized perfectly, knew his cues and, at any other time, would have played his part like a master thespian.

But instead, he went off-book, upsetting the carefully orchestrated little drama.

“I uh—I’m not sure that’s a good idea Thomas.”

There was a slight pause as if Thomas was doing a mental double take.  “But John, you have my assurances it’s nothing illegal, I just want you to check up on my friend…”

“I’m just not comfortable with it, ok?  There’s a lot of rules about waiting lists and what doctors can and can’t do and I’d rather not risk it.”

Thomas looked like he’d bitten into something incredibly sour.  “I control this entire hospital’s finances John.”

Morales didn’t reply, letting the words hang in the air, looking directly into Thomas’ eyes until the peeved bureaucrat turned on his heels and left without so much as a goodbye.

He was slightly surprised at his own actions.  Normally he would have simply done as the government agent had asked.  After all, there were plenty of people in the country like Thomas.  Nothing Morales could do about it, it was just the way the world worked; people would always try to play the system to their own advantage.

That the system actively encouraged it was a thought that had not occurred to John Morales until today.  Or, more precisely, until last night.

The rest of the day proved (relatively) uneventful.  John had just finished scrubbing down after a surgery and was settled into his office to complete the additional paperwork that Thomas’ visit had made necessary when Gerry knocked on his open door.

“Oh, hey Gerry. ‘What can I do yah for?’” said Morales, adopting the security chief’s slow drawl with a slight grin.

“John, you were here after hours yesterday, did you notice anything fishy last night?” Gerry seemed preoccupied.

“No,” Morales lied, his heart caught slightly, “why?”

“Huh, something funny happened to all the cameras on your side of the building, they recorded nothing but static for about 20 minutes, starting around 7:30.”

A Second Opinion, Chapter One: “Blow, blow, thou winter wind”

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This is chapter one of a serialized novella which will appear on Ars Gratia Libertatis bi-weekly.

Chapter One: “Blow, blow, thou winter wind”

Now winter nights enlarge
The number of their hours,
And clouds their storms discharge
Upon the airy towers.

–Thomas Campion (1617)

The first few flakes of the coming storm drifted lazily past the window.  John Morales watched them fall.  They descended slowly, occasionally collecting in the window sill or meeting their doom against the warm glass. The streetlamps in the parking lot, like spotlights, caught them in a yellow-orange glare and lit them up as if on a stage. Their downward spiral became a spectacle of theatre.  But the lethargy of the flakes’ descent unsettled John.  Normally he loved watching the beauty of snowfall from a safe, warm shelter, but not tonight.  Tonight he suspected malice in the easy path the snow traced to the earth.  It lingered, as if to say “there’s no need to hurry, time is on our side.”  The snow knew it was only going to get colder, and it could be deliberate in its wintry conquest of the frozen ground.  Its reign was inevitable.

He glanced at his watch, only 5:30, and already it was dark outside.  It was going to be a cold December.  He allowed himself a wry smile to think the snow was right; the National Office of Weather Prediction had issued a “severe winter weather” alert for Denver and Jefferson Counties.  He’d have to leave soon to beat the storm or risk sleeping at the hospital, again.  He sighed and ran his hand through his hair, looked once more out the window and, pushing morose thoughts from his mind, focused again on the paper in front of him.

It was a requisition and compliance form and it had to be done by tomorrow when the agent from the health board came for his weekly inspection.  In bold black letters, next to the eagle and Rod of Asclepius seal of the National Office of Health Services, it read, “Form 111-3a for the Administration of Health Care Services Relating to Treatment of Central, Peripheral Nervous System and Spinal Column Diseases.”  He filled out his clinic’s identification number at the top, and his own personal physician number, next to his federal ID number and Social Security Number below it.  Next came the tedious process of checking off procedures, patients, uses of equipment, and requests for more supplies.

He was lucky his clinic enjoyed such a good reputation and that he was the only certified neurosurgeon on the whole Front Range.  Other clinics and hospitals routinely had to deal with shortages of equipment and medicine.  He had heard rumors (vehemently denied by the Health Department) of some doctors giving cancer patients sugar pills, because the necessary drugs couldn’t be obtained from the Health Services Distribution Office.  It was all only temporary, of course, until the Health Department was able to finish the reorganization of the health care industry.  Still, things were going to get worse before they got better, if the increasing volume of paperwork was any indication.

John Morales was 32 years old, but already he had national acclaim as one of the best neurosurgeons in the country.  He’d graduated with honors from Harvard Medical School and moved back to Denver, Colorado, where his father was mayor and could pull some strings with the Health Department Physician Allocation Board, to do his internship and residency.  He had become somewhat famous when he removed a potentially fatal blood clot from the brain of the governor’s son, who had been brought in after a skiing accident.  In gratitude the governor had overridden the decision of the Health Department and allowed Morales to open his own neurosurgery practice at the Sky Ridge Medical Center in south Denver.

John’s thin frame made him appear taller than his five foot ten, and his jet black hair accentuated his dark, unnerving eyes.  Visitors to his office often noticed that his movements were slow, they would seem almost lazy but for their quiet efficiency.  All this lassitude disappeared when he was performing surgery.  In the operating room he moved with an energy even he couldn’t explain, barking orders and focusing with an intensity that seemed like it could melt through steel.  These days though, that was the only time he seemed to have any energy.  He didn’t know why he felt constantly drained when he returned every night to the small house he shared with his girlfriend.  It had become a chore, waking up in the morning to a career that had, at one time in his life, been the only thing that could excite him.  He didn’t know why the thought of saving lives no longer provided the inspiration it had before.

The next time John glanced up from his desk it was 7:30, and a few inches of snow had accumulated on the asphalt beyond his window.  He re-read the form one more time, signed his name on the last page, and stood up with a sigh.  Reaching for his jacket he took a last look out the window at the snow in the parking lot.  He paused and looked closer: what had before been an unsullied blanket of white was now marked with two sets of footprints, both leading to his door.

He heard the knock and tensed; surely no one out this late, in this storm, could be up to any good.  Moving slowly to the front of the office, past the receptionist desk, he strained to see his guests out the windows.  He glimpsed two slight figures, one shorter than the other, taking cover against the wall as they waited for their knock to be answered.  He reached the door and opened it cautiously.  “Hello?  Can I help you?”

“Are you Dr. John Morales?” The voice came from the taller of the two figures, both still in the shadow of the doorjamb.  Despite the voice’s obvious femininity, it carried a hint of command.

“Yes, why?”

“Dr. Morales, my daughter and I need your help.” The woman moved into the light as she spoke, guiding her daughter forward as well.  The woman’s face was grim, angular, with short, ash blonde hair and cold, grey eyes.  These now looked at John beseechingly, her eyebrows drawn together in concern.  Her daughter, about 11 or 12 years old, peered up at him placidly, her green eyes seeming to calmly register everything, a few bright blonde strands of hair were visible from the hood of her parka and her slightly crooked nose glowed red with the cold.  “May we come in?” her mother asked.

“You know being here this late is against the Patient Care Laws, right?”  Morales reminded her.

“Yes, I know.”

There was every reason to turn her away.  He needed to leave soon before the falling snow made the highway impassable, and the Patient Care Laws forbade meeting with a specialist outside the approved appointment process, punishable by fines and jail time.  There was, of course, good reason for such laws and Morales had had many experiences with desperate or cunning patients trying to game the system and bypass the waiting times illegally.  Such laws merely made sure everyone got equal treatment and access to an increasingly shrinking pool of specialist doctors and surgeons.  Morales knew they were necessary, despite how bad he always felt when turning away a frantic mother or pleading husband.  But the quiet intensity of the woman’s gaze, the fact that she had asked for him by name, her honest admission of her guilt in coming to see him after hours and, though he wouldn’t admit it, his own simple curiosity, made John Morales relent.  “I’ll see what I can do.  Come in, come out of the cold.”  He opened the door wide and motioned the pair inside with his arm.

The woman ushered her daughter through the door and spoke as she removed her scarf, “Thank you doctor.  I apologize; we wouldn’t have come here except it’s absolutely urgent.  I know our being here is illegal, but we have no one else to turn to and Alyssa’s situation is…unique.”  John Morales raised an eyebrow in curiosity and she continued, “My name is Lysandra Fremont, and this is Alyssa, my daughter.  Alyssa has started to get seizures, vision loss and numbness in her feet, among other symptoms.  We went to a primary care doctor, but he couldn’t even make a diagnosis.  Her symptoms match no known illness, neurological or otherwise.  He said we’d have to talk with a neurological expert to find out what she has.  Unfortunately, Alyssa’s symptoms are getting worse.  Even under normal circumstances the wait to see a neurologist is 8 months, which I don’t think she has, and ours are hardly normal circumstances.”

“See, Dr. Morales, because of a clerical error in the Department of Health’s Patient Database, Alyssa and I aren’t allowed to receive specialist care.  We’re trying to get it resolved but it’s already been two years, and you know how fast bureaucracies are at fixing their mistakes.”  She smiled wearily.  “We tried everything we could to get Alyssa an appointment with someone who could help her, but nobody would let us.  Coming to you like this is an act of desperation.  Aly’s not getting any better and I—we—have no-one else to turn to.  You’re the only one who can help us.”  The last sentence was spoken softly, but her eyes looked steadily into John’s face.

Morales hated this part, “I’ll talk to someone, see what I can do to fix your situation, but I can’t treat your daughter until I have all the right permissions.”

“We’ve already tried working within the system Doctor, talking with someone won’t work.  You must believe me, this is the only way Alyssa will get treated.”

“The health agents wouldn’t just deny a request like that, there’s got to be something you’re not telling me—“

“There isn’t.”

“But there’s got to be some reason—“

“Reason has nothing to do with it Doctor.  Procedure does.  The secretaries, and bureaucrats that all denied Aly treatment were merely following the guidelines they were given.”

“Look, even if I wanted to help you I couldn’t, not without getting caught.  I have to account for every nickel I spend and report all expenditures on equipment and medicine” sighed the surgeon.

Lysandra smiled, “That’s an easy enough problem to solve. I’ll simply pay you out of pocket for all the expenses you incur, that way you don’t have to report any of it to the Health Department.”

“I don’t think you understand how expensive this can get Ms. Fremont.  These procedures can cost hundreds of thousands of dollars; that’s why only the government can afford to pay for them.”

“I’ll admit I can’t pay you with government credit Dr. Morales; truth be told the Revenue Department rejected our application for access to my husband’s bank account after he died.  But I’m no beggar; my family had several physical assets left after Mark’s death, and I can pay you, in these.”  She pulled a small gold coin, no bigger than a dime, from her pocket and pressed it into Morales’ hand.  He held it up wonderingly, turning it over in the light to study its detail.  On one side were two letters, a capital U and a capital S, one overlaid on the other, and the phrase “Life, Liberty, Property” above the number 10.  The opposite side bore a painstaking rendition of a distinguished man in a periwig, with the name “Patrick Henry” inscribed beneath it. “It’s real.” Lysandra said.

“Where did you get this?” John asked.

“You wouldn’t understand.  But I can assure you I have enough of them to pay you for whatever treatment Alyssa needs.”

John lowered the coin slowly, and held it out for her, “Mrs. Fremont, as much as I want to help you I can’t, this is illegal and—“

“But is it wrong?” the little girl interrupted him.

“What?”

“Is it wrong, or right?” Alyssa repeated, her green eyes looking directly at him.

There was a moment of silence as Morales considered the simple question.  Finally he replied, “It’s not a question of wrong and right, when you get older you’ll realize there are other things you need to take into account, like the effect on other people and on society.  What would happen if we let just anyone come in off the street without an appointment and ask for care?  Hospitals would be swamped and overworked and then no one would get medicine.  See, not everything’s as black and white as it seems to be when you’re young.”

“Maybe, maybe not.” Lysandra replied with an amused smile.  “And we wouldn’t want you to treat Alyssa over the objections of your conscience.  May I ask you a question, Doctor?”

“Sure…” was John’s cautious reply.

“Why did you decide to enter medicine?  It’s a very difficult profession, isn’t it?  Especially the field of neurology.”

Again Morales paused.  Why was he even entertaining the idea of not turning these people over to the authorities?  And why did he feel compelled to be honest with the pair?  Both mother and daughter seemed to have an air of frank sincerity; he would almost have called it naiveté but for the steel he saw in Lysandra’s eyes and the silent perspicacity he saw behind her daughter’s.  Their directness and openness unsettled him.  He wasn’t used to people speaking so candidly about their position or their needs.  Neither had mentioned any high ranking political connections (fictitious or otherwise) to pressure him into aiding them, and neither had presented forged Health Claims documents.

At a loss, he gave her the rote answer, “Because I wanted to help people.”

“But that’s not all, is it?  If it were you could have joined a government soup kitchen and endured far less.  Instead you chose 12 grueling years of medical school, internships and residency.  Did you really just want to help people?”

“I wanted to save lives.”

“And is that what you’re doing?”  Lysandra didn’t glance at her daughter to make her point but Morales looked at the little girl nonetheless.  “How much of your time is spent filling out paperwork for bureaucrats who’ve never once set foot in a medical classroom and how much is devoted to actually saving lives doctor?”

“I-”

“And whose lives are you saving?” she interjected rapidly.  “48 of the last 50 patients you treated were either friends or relatives of people with political power.  I know, I checked.”

“That’s enough!” he yelled, and caught himself, surprised by his own outburst.  He went on, more quietly, “The system works; yes it has flaws, but without it even fewer people would have access to the small amount of medical specialists out there.”

Lysandra smiled, opened her mouth to ask a question, seemed to think better of it and instead looked at her daughter.  Her next words were spoken softly, “And if the system has flaws, John Morales, shouldn’t you at least try to correct them?  Whatever risk to your professional career that entails?”

The Fremont woman turned her grey eyes once more on Morales, “We won’t ask you to make this decision right now Doctor. I don’t want you to feel pressured and we’d prefer you have some time to think it over.  I’ll bring Alyssa back in a week, and you can decide then.”

John Morales nodded quietly.  Lysandra and Alyssa put their coats on and left the office without another word, just a shy wave from the little girl as the door swung shut.  The doctor stood looking at the closed door with eyes narrowed in thought, a small gold coin clenched in his hand.