Patient X

Patient X

The siren floated just above the whispers and groans of patients waiting to be treated. It was just a flutter and based upon the cycles Milton knew he had time to message his latest crush before it arrived. Maybe move from virtual sex to something that might leave a mark.

Busy day,” he wrote. “But it’s how I save  lives. Meet tonight?”

He pushed aside the files of unprocessed claims and admissions and wiped a bare forearm across the surface of his desk. He opened a new file on his computer screen, set the cursor to Line One, Question One, “Payment type,” and waited.

A medical team stood on the driveway outside the ER. They rolled an empty gurney back and forth between them as if tossing a ball. A doctor, dressed in blue scrubs and standing nearby was talking into his phone.

“October 4^th, 4:10 pm, male patient, 35-40 years old, head trauma, lacerations resulting from car collision. Full ER team with trauma kit standing by.”

Mrs. Schoenhauer, Milton’s boss, was there as well. She was wearing a pink cotton dress fitted with mid-length pleated sleeves and wide lapels. A double string of milk-glass pearls hung between her breasts. At her waist she bounced a leather portfolio. Milton knew the process, knew who was in charge and he could see in the pinched faces of the trauma team when she looked at them, that they did too.  

Everything hung in suspense until the siren and the ambulance merged at the end of the driveway. Tires squealed and the van ricocheted to a stop, one of the attendants pulled open the rear doors and an EMT jumped out holding a chart. He handed it to Mrs. Schoenhauer. Two members of the trauma team reached into the van, grabbed the ambulance gurney while two others rolled the unoccupied gurney alongside it and then all four, on cue, lifted the patient from one to the other. Mrs. Schoenhauer looked down at the chart, then nodded to the doctor. The team steered the patient through admissions and into one of the treatment rooms. Mrs. Schoenhauer, unimpressed, remained outside.

Milton watched from his desk. It was one of many in a row aligned along a side wall of the ER. Between each of the desks were panels of opaque glass, one on each side, forming a turret behind which staff sat and conducted their business.  The panel in front of Milton’s desk read “Duty Payments.”

Milton saw Mrs. Schoenhauer escorting a young woman with short-cut blonde hair towards him.

“This is Milton,” she said, pulling out a chair in front of his desk. “He will take care of you.”

Milton set his fingers, ready to begin typing. The woman let out a few sobs and, when she caught her breath, said, “We were just married.” Sob, sob. “Now this. Will he die?” Milton could see tears dangling from her chin and he forgot his lines, momentarily. Mrs. Schoenhauer, who had started to walk away, stopped . “Is it Ms. or Mrs. Popper?” she asked, trying to prompt Milton.

“Yes,” Milton said, quickly. “As you know, the state will pay for your husband’s care. But, you have the option, as you know, to make sure he gets the best care, the care that he needs to fully recover. That, of course, takes a little more. We have it all worked out. Now, how would like to pay?”

The payment of a charge on top of a charge, something now called a duty, was standard practice in all commercial exchanges. It was how the world did business. Milton assumed it was how the world had always done business, but his grandfather remembered a different time, when only gangsters and thieves charged above a fixed rate for things people needed. He called it a bribe and he blamed immigrants for bringing it here, people who came from places where graft and corruption were a way of life. But it might just as well have been the rich. They controlled the goods people needed after all. Things like food and medical care. And they were smart enough to manipulate the market, to create demand so that people would be willing to pay just about anything to survive. Once that becomes the status quo, the difference between a bribe and supply and demand is moot.

Milton’s job in the ER was to collect duties. Payments that ensured patients got the care they required. Sure, the state provided insurance, but that didn’t go very far. You’d be lucky to come out of the hospital at all. The people still sitting in the ER hadn’t or couldn’t pay the duty. They would sit there until the state insurance said it was okay to treat them.

Milton wasn’t just a clerk, he provided a service. He was a mediator. If you wanted a trained heart surgeon to do your by-pass, you paid a duty. If wanted stitches instead of a Band-Aid, you paid a duty. Milton knew how much. His recovery rate—how much he was able to collect compared to the state’s coverage—earned him the “Golden Duty” trophy three out of the last five years. He was helping people, making sure they got the care they needed. He thought of himself as the guy who got people into the pre-flight lounge, even those with economy class tickets.

The night before it all started, Milton went out with two casual acquaintances. Thirty minutes into the evening, he was ready to leave. They weren’t as amusing as they thought themselves to be and he was tired of being called OG even though they were maybe 2-, 3-years younger, at most. When they disappeared into the bathroom he was able to check his messages and reach out to his virtual crush.

“I’m missing someone,” he teased.

The response came quickly. “So, Mr. Big-Wad, what happened the other day? Sounded dramatic.”

“It was. Lots of blood. But I saved him,” he said, showing off.

“You’re so full of shit.”

“Ok, I didn’t save him, but I got him to the doctor that did,” Milton insisted.

“That’s not what I’m talking about.”

“Then. What?” he asked.

“I know who you really are. I see you with those two sex toys.”

“R U here?”

“Not anymore. I didn’t want to make a scene.”

Milton scanned the crowd, not sure what he was looking for. After all, he’d never seen him in clothes.

“I don’t care about them,” he typed quickly.

“How could you. You only care about yourself.”

He was silenced.

“Don’t message me again,” popped up on his screen with an emoji that said the same thing.

Milton tried to get the bartender’s attention. He would buy a drink if he could and pay a sizeable duty to get some information, a name or phone number or better yet, an address. But the bartender had better things to do and didn’t seem to know anything anyways. He sent a dozen more messages. But the line had gone dead.

The next morning, the rejection felt like a hangover. He was lethargic and getting dressed was just unfulfilling: Carhart chinos and short-sleeved polo. The ER was quiet and Mrs. Schoenhauer was on the 2^nd floor in a meeting. It gave him time to beat himself up for his foolishness, his neediness. Still thinking about himself, but now, back at his desk, an attendant rolled a swollen-faced woman in a wheelchair to his window. She was covered in a shawl, newly knitted with frilled edging, only her head exposed. Her face was twisted in alternating grains of anguish and relief. Even with the shawl, Milton could see that she was pregnant, full to the brim and straining not to have the baby where she sat.  

Milton didn’t care. Her condition was her condition. He started off, “As you know, the state will pay for your care. But, of course, there are limits. Limits that even I don’t fully understand. You have the option to make sure you get the best care, the care that you need to deliver a healthy baby.” At that word, “baby,” her legs and arms shot forward as if she were reaching for someone just in front of her, but invisible to Milton.

He continued. “Now, how would like to pay?” At the word, “pay,” she let out a scream. Was that an answer or a question, he wondered. Then she followed that with a series of short gasps, almost the reverse of a scream, sucking air into her mouth through two vibrating lips. One, two, three. Then a pause, then a squeak, as unexpected as it sounded, like something had leaked out of hole. Then silence.

Milton started over. “Ma’am , as you know, the state will pay for the delivery of your baby. Limits, limits that even I don’t even understand are in place, however. But you can make sure you get the best care, the care that you need to deliver a healthy baby. Now, how would like to pay?”

Scream…gasp…gasp…gasp…squeak. All of it louder this time and more deliberate—but for the squeak, which was apparently outside of her control.

There would be no third time, Milton decided. He was getting worried and didn’t want to be the cause of a spontaneous delivery—whatever that was. He looked for Mrs. Schoenhauer. Maybe she would know the procedure for this scenario. But she was still in her meeting. So he tried to problem solve. Did she not understand the process? Was she from out of town? Out of the country? Somewhere where duties didn’t exist? Was it her first time in a hospital? All of this was too much for him. He was only supposed to collect the duty. He didn’t want to know anything more about the patient. Didn’t want to know why they couldn’t pay. Didn’t want to know what happened to them if they didn’t.

The woman’s aerobics got worse. She snapped and recoiled and bounced and jostled, arms and legs extending again and again. Finally, she started shaking, as if a jolt of energy were traveling through her body. Milton, sitting across from her, felt something strike him just below the left nipple and then he too tensed, leaned backwards in his chair and felt something hot travel through his body and out his fingertips as arcs of light. Then nothing. He went blank.

Slowly, he rebooted. One process at a time. Vision, then feeling, then voice. He heard himself say, “I think we need to get that baby thing taken care of. You are going to get the best care, top of the line and were going to move you along right now. Get you somewhere that can help you. Get you the best care and attention. No problem.” He waved to a nurse who had been standing against the wall. She came and pushed the woman into a delivery room, where she, Milton later learned, delivered a healthy baby girl named Azalea.

At home that evening, Milton had not forgotten his broken heart, but there was something else, something balancing that emptiness. It was a feeling of having done something extraordinary. He muddled about in his own emotions for a while until he stumbled on the image of the baby Azalea. He had lied, cheated, deceived and corrupted the process of collecting a duty, but somehow he felt richer for doing it. Soon he was bounding about the apartment singing: “Azalea, Azalea.”

Milton slept soundly that night. The next morning the buzz of failing to follow procedure was still in his head. The satisfaction of going against Mrs. Schoenhauer was like a love note he’d found on his car. He had a purpose, an inner sense of meaning. Yes, it was criminal. Yes, it might lead to the decline of capitalism and society and he would have to relinquish the Golden Duty award, but it felt good.

His first admission that morning was a small boy, gingerly balancing his right arm with his left hand. He was crying and his mother tried to comfort him by rubbing his head. “It hurts, doesn’t it?” she said. “Maybe its broken.” To which the boy cried louder, “No, not broken.”

Milton looked down the row of desks for Mrs. Schoenhauer. She was standing, as managers do, looking as if she wasn’t looking, but he knew she saw everything everyone did. He thought about the feeling he had when he let the pregnant woman pass without paying a duty. But he feared what would happen if Mrs. Schoenhauer caught him. He knew that he should follow procedure, charge the duty, and push the little boy and his mother along. But he didn’t. He looked at the boy, snot running down his lip, and he did precisely what he wanted to do, and he did it for himself. He was a thief, a punk, a gangster and he was going to get out of the deal whatever he wanted and let the boy and his mom bear the cost.

“Probably not broken,” Milton said to the boy, with barely a smile, “but it’s good to know, don’t you think?” Then he looked up at his mother, “We’ll take care of him. He’ll get the best care here.” He slipped a receipt for full payment into her purse without her knowing and he waved to the nurse to take him to get treated.

Milton handled other cases that day, accident victims, a guy who lost the fight, the mechanic who forgot to set the brake on a car before crawling under it, and he didn’t ask for a duty from a single one of them. He had his own selfish reasons. Testing the system, taking from it what he could, getting his piece of the pie from every exchange. But it made him feel good, in a bad way. He knew he’d get caught eventually. That’s what happens to all criminals.