EDWARD TEAK WANTS OUT. He is the CEO of a failing hospital in a dying town. When he learns that a for-profit mega-chain is interested in acquiring the hospital if its finances can be improved, Teak hatches an outlandish plan to eliminate the five most costly patients imperiling the system. While itâs nothing heâs proud of, it just might work, putting some miserable souls out of their misery, making the hospital someone elseâs headache, and saving himself in the process. Heâs so close; he can almost feel the cords of the promised golden parachute in his sweaty palms. But it is all unraveling. Fast. Teakâs no mastermind killer. Frankly, heâs lucky he made it this far.
Little Falls follows Teakâs darkly funny path, one marked by missteps and double-crosses. Along the way, Little Falls reveals the misplaced incentives and hypocrisies that distort American healthcare, ultimately asking how much a life is worth in a world where the bottom line always wins.
EDWARD TEAK WANTS OUT. He is the CEO of a failing hospital in a dying town. When he learns that a for-profit mega-chain is interested in acquiring the hospital if its finances can be improved, Teak hatches an outlandish plan to eliminate the five most costly patients imperiling the system. While itâs nothing heâs proud of, it just might work, putting some miserable souls out of their misery, making the hospital someone elseâs headache, and saving himself in the process. Heâs so close; he can almost feel the cords of the promised golden parachute in his sweaty palms. But it is all unraveling. Fast. Teakâs no mastermind killer. Frankly, heâs lucky he made it this far.
Little Falls follows Teakâs darkly funny path, one marked by missteps and double-crosses. Along the way, Little Falls reveals the misplaced incentives and hypocrisies that distort American healthcare, ultimately asking how much a life is worth in a world where the bottom line always wins.
Today could be the day. I could be fired. Frankly, it would be a blessing.
I slip into my Subaru Outback and make the quick trip to
Little Falls Hospital. It is a ride that takes me past the boarded-up stores, cracked sidewalks, and vacant buildings of Little Falls. The town looks deserted, but I know better. After all, the inhabitants keep arriving at the hospital day after day, night after night. Behind the drawn curtains and locked doors, I sense their presence. They are hidden at home, shadows staring bleary eyed into mirrors, coughing up phlegm, spitting into sinks. I am reminded that they exist by the lam- inated signs that have popped up overnight on the small patches of grass in front of the row houses on 16th street: âVote âNoâ to New Middle School,â as if the population had finally given up.
Pretty bleak, I know. Good thing I am on Prozac. A decent dose, too. I pop it in private (even the wife is in the dark). Dr. Wills, one of the old-school internists still wandering the halls of the hospital, prescribes it to me. He was friendly with my
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late, great father, and after his death, Dr. Wills assumed the unsolicited role of surrogate father figure. By âfather figureâ I mean that like my actual father he treats me with contempt tinged with disappointment. My father, John Teak, M.D., PhD, M.H.S., was a legend at Little Falls Hospital. He was the longest serving president of the medical staff who, through the decades, amassed a bevy of adoring patients and comparable reverence from his fellow medical professionals. There is even a Teak Pavilion within the outpatient oncology center. It has a bubbling water fixture set in the center of an expansive atrium, New Age music piped in through hidden speak- ers, and an oversized oil-painting of my father in a starched white coat with one hand in his pocket and the other gripping a stethoscope like a talisman. I try to avoid that pavilion.
My father really wanted me to become a doctor. Unfortunately, I had a fatal flaw: a visceral aversion to the sight of blood (or pretty much any bodily fluid, for that matter). I would faint during blood draws, turn ashen during slasher flicks, and reflexively vomit at the sound or sight of someone doing likewise. By the time I was in college, my father resigned himself to this unfortunate reality and instead pushed me into the world of healthcare administration. He was quick to lecture me about how the golden age of medicine had passed as if he were talking about ancient Rome. The era in which doctors walked as giants amongst men had come to an end, and power had shifted to the âsuits.â I can still remember how his face contorted painfully when he reflected on this change, spitting out the word âsuitâ with disgust. Fast forward, Iâm the âsuit.â Not only am I âthe suit,â but I am also the âchief suitâ running this shit-show. Iâm the CEO of Little Falls Hospital and, truth be told, all I ever wanted to do in college was major in English.
How I ended up the Chief Executive Officer of the hospital by my early forties is a mystery to me. After finishing college, I reluctantly got a Masters in Public Health and worked for
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several years in administration at one of the big-shot academic hospitals in the city. My claim to fame came as a result of an assignment to expand a service line for the institution. There were several options to select from, and I chose to implement a stroke program. I didnât know the first thing about strokes, but as long as they did not involve blood and guts, I figured this was the right project for me. This decision was fortuitous. The roll out was a fabulous success, infusing a tremendous amount of cash into the healthcare system and providing invaluable prestige for the institution. I went from a nobody pencil pusher to the darling of the administration overnight.
I met Sam during those halcyon years. She was several years younger than me â vivacious, good-looking, fantastic body. Sam was a graduate student in journalism, and although I was certainly out of her league, I suspect that my spectacular rise at work made up for any shortcomings in the charisma department. The courtship was brief as I was acutely aware that any deal with such a woman would need to be sealed quickly. I got her a ring, a shiny, expensive one. There was an elaborate wedding that could be best described as a weeklong event and a honeymoon in Kauai at the Four Seasons. Days after returning from Hawaii, Sam dropped out of journalism school and began to wear yoga pants 24/7. It wasnât long before our first child, Cole, was born. He came into this world pissed off, wailing as if he had an immense beef with everyoneâa mindset he has yet to grow out of. Three years later came his sister, Olive, a quiet, simple soul, perpetually agreeable to a fault.
In the midst of this period, my father died suddenlyâa heart attack on the eleventh greenâa doctorâs death if ever there was one. Several months after the funeral, a phone call came out of the blue, which I have since come to see as some- thing akin to a karmic enema. The CEO of Little Falls Hospital had retired, and the Hospital Board was conducting a search
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for his replacement. They had heard tales of my success in the big city. Furthermore, my fatherâs sudden death was a blow to the institution, and the subsequent months did little to heal this raw wound. I imagine that the Board must have thought that if only a smidgen of my fatherâs brilliance had rubbed off on his only child, I would be a capable steward. It was either that or they were desperate. Little Falls Hospital, after all, had already seen better days.
I wasnât certain how Sam would respond to this offer. She had grown accustomed to her fast-paced urban lifestyle. But when I told her about the phone call, Samâs eyes widened like she had won a stuffed animal at the carnival. Sure, she would miss the city, but the lure of being a CEOâs wife was simply too intoxicating. She came to see relocation to the suburbs as a Peace Corp volunteer might think of a stint in the Congoâshe was to be a missionary delivering coolness to the backward natives of the âburbs. This fit nicely into the narrative she was creating about herself. After dropping out of graduate school she had reinvented herself as a full-time mommy blogger specializing in parenting adviceâan interesting development considering we were doing a terrible job of raising our own.
I came at this opportunity from a different vantage. Although it was something I chose not to discuss with Sam, city living had become unaffordable. It was tough enough with Samâs proclivity for shopping, but add two kids into the equation and there was no way to make this lifestyle financially sustainable. Another pressing issue was my mother. She had been diagnosed with early-onset dementia years before my fatherâs death, and this unexpected loss seemed to have accelerated her decline. Her deteriorating health suddenly became my responsibility. I never wanted to return to the town of my youth. Who really does?
I sit at the intersection near Alâs Donut Shop for several min-
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utes staring vacantly at the traffic light stuck on red before reluctantly driving through it. I take the first turn off Hutchins Avenue, swinging the car onto Main Street before passing by an unhealthy number of seedy bars, a flower shop, and a convenience store run by a Somali family. I am in no rush to reach the end of the street where the last indignity resides. The legal offices of bottom-feeding malpractice attorneys line the terminus like a gauntlet. Although the other storefronts on Main Street are weathered, the signs outside the law offices are meticulously maintained as if there is a painter on retainer: McBride, Schoner, and Biddle followed by Tuscan, Dalton, and OâLeary, and finally Thompson, Thompson, and Thomas. Each morning these vultures peer through blinds sipping coffee made from their Keurig machines as ambulances whizz by, praying that some poor patient has fallen out of a hospital bed or, even better, that a wrong-sided surgery has been performed. It takes all my strength to resist lowering the window and giving these scumbags the middle finger that they so richly deserve. I take the turn off Main Street with some speed. The car kicks up gravel and emits a satisfying screech as I swing onto Hospital Boulevard and pass the dilapidated welcome sign.
Perched atop a hill overlooking its namesake town, Little Falls Hospital stretches across an eighty-acre plot of land. The original hospital building, with its white portico exterior and granite façade, known simply as âThe Rotunda,â dates to the years after the Civil War when George Little, the son of a prominent banker, returned from the battlefield with a baffling case of acute lead poisoning from a rebelâs bullet lodged in his right calf and an even more debilitating case of an unnamed venereal disease. Funded by the elder Abraham Little, âThe Rotundaâ was the jewel of the town, a magnificent domed edifice sporting an Italian marble floor and an iron statue at its entrance that depicts a pioneer stepping over the lifeless body of a Native American in full headdress. At its inception,
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the hospital was a state-of-the-art facility that provided care for soldiers returning from the war, proudly dispensing ether to the clientele while hacking off their limbs.
As the fortunes of the town rose, so did the hospitalâs footprint and reputation. In the early days, industry was humming, leading to a rapid growth of Little Fallâs downtown. There was a steel mill in the center of the town and two shoe factories along the outskirts. The hospital expanded to meet the demands of the ballooning population with a new inpatient building, maternity unit, and Tuberculosis sanatorium. Over the years, some buildings were torn down or renovated and others built in their place. As medicine modernized, so did the hospital complex. Far from a single building, Little Falls Hospital would be unrecognizable to its founder. There is now a large emergency department, expanded inpatient facilities, outpatient medical office buildings, an oncology center, and several parking garages. Interspersed with the patient facilities are eerie industrial buildings sprouting cylindrical chimneys that belch black smoke and house the enormous boilers and generators that keep the hospital running and open for the patients. And the patients keep coming.
They come to the hospital with their problems.
They have chest pain. They fall off ladders and crash cars. They get cancer. A lot seem to get cancer. They shoot each other and sometimes they shoot themselves. They get pregnant and lose pregnancies. They have headaches, toothaches, stomach cramps, hacking coughs, rashes, and fevers. They hammer their thumbs, trip down stairs, have dizzy spells. They come to the hospital depressed and lonely, at the worst moments of their lives, slipping into thin hospital gowns with resignation and fear. They want to be fixed. They demand to be fixed. And I suppose this was what the hospital is there for: to fix them. But who is there to fix the hospital?
No doubt the Board hoped I was that person. Yet two days into my tenure as CEO it was clear to me that saving
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this place was a foolâs errand. This is not to say I did not try. I cut costs, battled unions, merged nursing units, slashed payrolls, and fought insurance companies. None of it made a difference. Now, years later, the hospital is on life-support, and Iâm the sucker stuck giving endless chest compressions.
I have a designated parking space close to the back entrance to the hospital. When Sam heard about this perk, she seemed genuinely impressed. I am ambivalent about having the parking space. Sure, it is convenient, particularly when the weather is rotten, but there is a price to be paid. Nearly every time there is a contract negotiation or worse, a strike, my car becomes a target for vandals. Iâve been keyed more times than I can remember (no doubt this is the primary rea- son I have come to detest the color tungsten metallic). Most of the time itâs pretty innocuous stuff, such as a hastily created squiggle along the carâs doors. Once âPRIKâ was carved into the hood of the vehicleânot sure if it was an acronym for something or if the perpetrator simply forgot the âC.â Other times, I arrive to discover my tires flat. I have learned to take nothing for granted, making it a habit to check my brakes before I depart each evening.
I pull into the parking space beside the warped âReserved for CEOâ sign, shut off the engine, and stare at the steering wheel for a full minute. Having resigned myself to the inevitability that I must leave the vehicle, I grab my leather briefcase and exit the car just as a cold, stiff breeze smacks me in the face. I scurry to the door, swipe my ID badge across the sensor, and slip into the hospital. The lobby is quiet at this hour. It is the chief reason I come to work earlier than I need to. There are those who see it as a sign of dedication to my job. I do not correct them. I take in the stillness of the lobby for a moment. Then I remember, this is not an ordinary day. Kearns said to expect an early phone call. The way things have been going I suspect that this is the end of the road for me. What else could it mean?
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My office is on the first floor of the main hospital building, a hulking facility connected to the Rotunda by a walkway. I like that my office is located on the first floor. The truth is that I rarely leave this floor to visit the higher levels where the patients reside. I am terrified of catching an illness, especially the colitis that has been spreading like wildfire on the floors. I particularly avoid the intensive care units up on the fifth floor, if at all possible. The thought of critically ill patients with intravenous lines in their arms and tubes in every orifice makes me queasy. I hedge my bets by liberally dousing my hands with hand sanitizer throughout the day and surreptitiously cleaning door knobs with the antiseptic wipes I hide in a plastic bag in my suit pocket.
I barely make it ten feet into the hospital before I spot my Prozac dealer Dr. Wills loitering at the far end of the main lobby.Â
Doesnât that fucker ever leave the hospital? He makes eye contact with me and shoots me a look that I have become accustomed to through the years. It is the expression of a physician who realizes that his airplaneâs pilot looks awfully familiarâdeducing with incremental dread that the pilot is a patient of his who he has been treating for sui- cidal ideation. I nod to Dr. Wills, pivot abruptly, and make a beeline for an adjacent hallway before he can intercept me, even though this means I will now need to take a circuitous route to my office. I walk down the corridor, passing the shuttered pharmacy and a vending machine humming violently as if it is in the final throes of death. I make two more quick turns and I am back on track. As I near my office, I can see the stocky form of Dr. Vance Gorn sitting on a bench outside my office. When he spots me approaching, he springs to his feet, nearly causing me to recoil and flee.
âHey, Ed,â he cheerfully announces. His sudden advancement prompts me to take a few steps backward. âI know I donât have an appointment, but I had a little time free before I have to round on my patients and I thought we could chat, if that is ok.â
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âSure, Vance,â I answer as politely as possible, resisting the urge to clench my teeth. âLet me just open up my office. Claire doesnât get in this early.â With my possible impending lay-off looming, I should just tell Gorn to pound sand, but before I can even think about it, I reflexively flip into my role as chief appeasement officer. Habits are hard to break.
One of the things I have gotten used to as CEO is the common tactic by members of the staff to ambush me in the hopes of snagging an impromptu face-to-face meeting. As the hospitalâs future has grown more uncertain, these curbside encounters have become increasingly frequent to the point that I spend much of my day darting around the grounds like Iâm stuck behind enemy lines. I begrudgingly have to admire the tenacity of Gorn to park himself in front of my office this early.
As I swipe my ID across the card reader and push open the door, I make small talk about the weather and the local sports teams, eliciting grunts from the doctor. I hold open the door and flick on the lights. There is a small sitting area outside my inner office where Claire, my secretary, has a desk. Against the wall are several wooden chairs that look like they date to the Revolutionary War that I purposefully selected for their extraordinary lack of comfort. Hanging on the walls are framed accolades bestowed upon the institution during its golden years, honors long since past. I swing open the door to my office, turn on the lights, and motion for Gorn to follow. As I enter the room, he reaches back and slowly closes the door behind him with a sinister click. Oh shit. I can feel my heart skip several beats. The last time someone elected to close the door to my office without asking permission was when I found out that one of the internists, Dr. Himes, was just arrested for boning patients in exchange for oxycodone. It was a PR nightmare for the hospital. What the hell is this about? I sink into the plush chair behind my enormous mahogany desk and brace myself.
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I force myself to remain calm as Gorn takes his time finding a seat in front of my desk. He leans towards me, clasping his hands together as if in prayer. Gorn is by all accounts a physically unattractive man. He has a simian, missing link quality about him, flat nose, sloped forehead, retracted chin as if some Neanderthal genes remained buried deep within his DNA. He has a propensity to blink rapidly, his long, black, shiny eyelashes flickering back and forth like the wings of a hummingbird. It is unnerving. His looks are matched by his notorious bad temper in the cardiac catheterization laboratory. A week does not go by without some incident report surfacing complaining about his demeaning and patronizing conduct. That said, the doctorâs deeply unpleasant appearance and offensive behavior are happily excused, as the man is a virtual cash machine for the hospital, performing a staggering number of well-paying cardiac procedures. As one of the few shining stars at the hospital, Gorn is someone I can ill-afford to ignore or piss off.
I continue to stare at the doctor with a goofy smile and wait until he speaks. I have learned through my tenure as CEO to make every effort to listen to those around me before I speak. It makes me appear thoughtful, deliberate, and in control, even when I am most certainly none of these things.
âEd, I know these are tough times,â Gorn begins. âFinances are not exactly stellar for the institution. I get it. That said, we could really use updated equipment in the lab. Itâs an embarrassment, Ed. What we need is...â
I listen as complaint after complaint rains down and I am...I am...elated. I want to jump out of my chair and dance. I want to leap across the desk and plant my lips on the manâs enormous forehead. I am utterly relieved to discover that this is what Gorn felt was so important to surprise me with first thing in the morning. Alternative disaster scenarios such as his imminent departure to a competing medical system, a gigantic malpractice or worse, harassment suitâsexual or
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otherwiseâdissolve. It is simply a case of the âSanta List.â If Kearns wants to lower the axe today, at least I will be able to end on a high note.
The thing is, I get this all the time. The doctors are constantly approaching me like it is Christmas Eve and they are itching to deliver their wish lists before it is too late. But here is the deal. Sure, Iâm Santa Claus, but Iâm that Santa Claus reeking of whiskey, cigarettes, and week-old urine holding court at that crappy mall with the low-end department store as an anchor, Arbyâs, and clothing stores catering to over- sized women and tall men. The best they can hope for is a gift card from one of those dollar type shops selling shit from China. The most depressing part of this reality is that several miles away there is a much nicer mall with a considerably more generous Santa Claus. It is called Apex Healthcare and it is flush with cash. Throughout the neighboring well-to-do communities, Apex Healthcare has built gleaming new medical offices and hospitals with soaring, vaulted glass ceilings, valet parking, and spacious, private patient rooms. They even have exercise facilities with Olympic size pools and med spas where you can get your skin peeled and thighs contoured before grabbing a kale smoothie. They invest heavily in marketing, planting their billboards up and down the expressways, promoting not just healthcare but lifecareâa way to live that is laughingly unattainable but undeniably attractive. Take, for example, the two billboards I have driven by for the past two months: one with an amputee with a prosthetic limb climbing Mount Everest, the other with an octogenarian woman limberly fencing. Apex Healthcare had managed to capture the unicorn of medicineâthe âgood payer mixââpatients who actually have jobs, would be mortified not to pay what they owe, and generally are cross-fit healthy. Apex Healthcareâs well-to-do patient population is a far cry from ours here at Little Falls Hospitalâa population who at the first sign of a doctorâs bill would ball it up and wipe their asses with the
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paper. So ask away.
As Gorn spews his requests my mind drifts. What should
I have for lunch? My eyes settle on the framed portrait of George Little hanging on the wall behind the doctor. Iâve stared at his visage for hours over the years until it has become seared onto my brain. In the painting, George Little leans against a wooden table, clothed in the blue uniform of the Union army. He is baby-faced, wearing a cap pulled snug over his head and a far-away look. I have often wondered what was going through his mind when the painting was created. I like to imagine he could impart some wisdom to me through time, but Iâm pretty sure that the reality behind his expression has something to do with the burning he felt every time he urinated.
âWell, I donât want to take up all your time,â Gorn trails. I sense an exit as I emerge from my daydream. We stare blankly at each other, and I figure that I should probably break the silence.
âVance, I think you make some good points.â I open the top drawer of my desk and pull out a pen and small notepad that I keep there for just such an occasion. I begin to write feverishly as if Gornâs words have led to an epiphany that I must put to paper before it vanishes. I periodically glance up at Gorn and nod as if to indicate that he delivered some good stuff. When I am done writing, I make sure I run the tip of the pen back and forth on the page dramatically until it nearly shreds the paper and rise to my feet with zest. Gorn responds in kind. Before he can say another word, I am by his side directing him out with the palm of my hand against the small of his back all the while muttering: âAll excellent points, Vance. We are lucky to have you here. You are a treasure. I will be certain to work on this right away.â As he leaves the office I shake his hand, give him a good-natured pat on the back, and thank him again for bringing this important issue to my attention. The doctor departs with a smug look on his
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face, an expression that indicates he is itching to recount to his compatriots how he tore the CEO a new one. I consider this encounter a resounding success.
When he is finally out of sight, I emit a long sigh and retreat to the sanctuary that is my office, pausing a moment to dispense a hefty glob of translucent sanitizer into the palm of my hand and vigorously rub it across both sides (Iâve seen the internal reports of hand washing rates among the physicians at the hospital). I plop into my leather chair and swivel it back and forth for a while before locating the pen I had tossed aside during the impromptu meeting with Gorn. I embark on a jam session, tapping the tip of the pen against the surface of the desk like a teenage drummer at Battle of the Bands until the satisfaction of this diversion fades. My eyes desperately search the room for anything I can do while I wait for Kearnsâ phone call. They settle on the notepad I had left on the desk. I pull it closer to me and smirk at the doodles I had created: a smiley face, a house, a stick figure on a bi- cycle, and a poorly composed depiction of a dog whose tail looks like a fifth leg. I rip off the top sheet, open the lowest desk drawer, and toss it in, watching as it floats down and lands face up on a pile of similar doodle-filled pieces of paper before I slide the drawer shut with my foot. I look over at the clock. Ken Kearns, the chairman of the Board of Trustees, should be calling any moment.
The Board of Trustees oversees the hospital system and is drawn from members of the community who volunteer their time. Why anyone would do so is beyond me but I gather it ranges from a sense of civic duty to an inflated sense of self. Most of the members are attorneys, financial advisors, or retired physicians; however, there is a smattering of random people on the Board, including the director of the local aquarium and a vicar. Kearns is two years into a four-year stint as chairman. He made a fortune selling paper products when that was still a profitable enterprise and now lives in
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an impressive estate sporting a horse farm and a lake on the edge of Ashbridge, the town I also call home. You can often spot him driving through Ashbridge on nice summer afternoons in a refurbished antique car from the 1930s wearing driving goggles and periodically honking a horn that sounds like a goose being strangled. Kearns is a nice enough guy, a God-fearing do-gooder who never misses the opportunity to reference Scripture or talk about some church mission to South America. Not surprisingly, he takes his charge as chairman with an oppressive sobriety, as if Jesus himself had ordered him to do so. This only adds to my burden to turn this hospital around. Itâs bad enough when the government and social ills are conspiring to see you fail. Now I have to impress Jesus as well.
The phone on my desk rings. Kearnsâ cellphone number is displayed on the screen.
I guess this is it. I resign myself. Time to be fired. I wouldnât blame him. If this place was flailing when I came on board, it is exponentially worse off now.
It would devastate Sam, of course, being married to a complete loser. The news would spread like wildfire amongst her friends who would feign sympathy but gloat in private. Did you hear that Edward Teak got fired? Sam must be beside herself. What would his father think?
But it might be a relief. I could start over. Possibilities pop into my mind...a new life...one without Sam or the kids. I could be alone, grow out a beard, and live in a wooden shack like the Unabomber. After souring on a life as a celibate hermit, I imagine an alternative life with a dirty blond-haired wife whose perpetual smile uplifts my spirits. She is sitting in the passenger seat of my car, a kayak fastened to a rack on the roof. We park along the side of the road and hike into a densely forested mountain, Patagonia jackets flapping in the breeze, Yeti thermoses in tow, heading towards the summit. The image fades and I realize Iâve seen this fantasy before
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on an Apex Healthcare billboard off route 210 near the Taco Shack. Reality comes crashing down. I am back in my office staring at a dead man from over one hundred and fifty years ago who has nothing at all to say to me. The phone continues to ring.
I pick up the receiver and place it against my ear.
âKen?â
âHey, Ed.â The voice on the other end sounds hoarse. âSorry, Ed. I have a terrible cold. It must be the change in weather. Howâs the family?â
âNot so bad. Yours?â Typical Kearns. You have to go through idle banter until you get to the meat.
âThe usual. Kids never call enough.â Kearns chuckles and subsequently launches into a long bout of coughing. âThe wife has a bad case of tennis elbow. Had to skip her tournament.â
âSorry to hear that.â I couldnât give two shits about Marge Kearnsâ tennis disability. It takes all my restraint to keep from throwing the phone against the wall.
âSheâll be OK. Sheâs seeing Paul Preston from Ortho. He wants her to first try some Advil, but it upsets her stomach...â Kearnsâ voice trails off and there is silence for about ten seconds. âSheâs been icing it.â
The rage arrives with little notice. One moment my fists are clenched tightly upon the desktop, fingernails digging into the soft flesh of my palms and the next I can feel heat spreading up my neck and into my head. My heartbeat thumps in my ears and my vision darkens. I open the top right desk drawer and frantically search for a stray Xanax that might have been lost amongst the paperclips. After an unsuccessful hunt, I slam the drawer shut.
Kearns drones on. âThe last time she took Advil she nearly developed an ulcer. It was terrible...she moaned all night.â
Unable to tolerate any more small talk, I decide that Kearns desperately needs hard redirection or I might explode.
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âKen, whatâs up? Sorry about the wife but your message sounded like you had something important to talk about.â
âOh, yes. Sorry, Ed,â Kearns apologizes. âI know you are a busy guy and you need to get back to helping the blessed folk of Little Falls. Look, I got a call from the mayor of Little Falls and he is worried about the current financial outlook for the hospital. As you know, the hospital is the largest employer in town, and it would be devastating for the community if the hospital had to shut down. Not to mention the loss of a venerable institution with such a storied history and commit- ment to taking care of Godâs children. On top of that, I just learned that our bond rating has been downgraded again. Iâm a businessman, Ed. Iâm sorry to say that this canât go on. The hospital is on life-support. Itâs dying. Ed, youâre hearing what I am saying?â He pauses and I respond with a pathetic grunt. Kearns continues. âYou know what this means?â
Deliverance. I look up hopefully at George Little with only a tinge of embarrassment at my failings.
The fingernails of my left hand scratch at the surface of my desk as I cradle the receiver closer to my mouth. âKen, I totally understand. If I were in your shoes...â I let the words hang.
âEd, you know what this means?â Kearns repeats before delivering a junky sounding cough that forces me to pull the receiver from my ear. I wonder if the man heard me. Get on with it already. I grunt again to prod Kearns forward with the announcement, keeping my eyes on George Little.
âIt means that you have to work even harder. You are a Teak, man! A Teak!â Kearnsâ voice rises as if he is behind the pulpit. âYour father, may he rest in peace, was exceptional. He was a legend. He was my doctor for thirty-five years. Your father saved my life. I donât tell this story often but I think you need to hear it. One day when I came to see him for a muscle sprain he saw a little dot on my arm and insisted I have it biopsied. Believing myself to be immortal in those
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days, I waved the recommendation off. It was just a dot! But the man wouldnât let it go until I said, âshucks, alright already, you win. Iâll get it biopsied. Came back as melanoma. M-e- l-a-n-o-m-a. The pathologist said that he had never in his entire career seen a case of melanoma diagnosed so early. Said something to the effect that there were only one or two abnormal cells. He even went on to publish an article about it somewhere. Look it up! Your father diagnosed the cancer so early that I was cured. Your father saved my life. He was a great man, and you have his blood coursing through your veins, son. That means that you, too, are great.â
I feel nauseated. I can hear Kearns breathing heavily on the line. For such a reserved man, he has worked himself into a frenzy.
âYou there, Ed?â Kearns inquires.
I emit a confirmatory sound that comes out like a squeak from one of Oliveâs rubber ducks.
Kearns is not done. âLook, I can remember in the eighties when Kearns Paper was getting clobbered by one of our competitors, McAddles. I thought that it was the end of the road for the company. I mean, Ed, we were on the ropes. Just when everything appeared hopeless, thatâs when I came up with the Urbano pocket organizer with the mini-calculator sewn into the inside cover. It was a huge success and helped turn around the company. That and the fact that Kevin McAddles was stealing money from the business and spending it on hookers and drugs. I guess what I am saying is: things are looking pretty dire, but they donât have to be.â
âSo Iâm not fired?â I sputter.
âFired? Son, Iâm calling to tell you that though times are tough, the Board is behind you to the very end. Remember that the good savior doesnât give us anything we cannot handle. You are the captain, my boy. You either get this ship seaworthy or you go down with it.â
I feel adrift, uncertain what I should be feeling at this
25
WILL WERNER
moment. I should be fired. That would make sense. I deserve to be fired for fuckâs-sake. I donât have a clue how to turn this âshipâ around. I am way over my head. I just want to walk away from this mess.
âYou can do this, Ed. You owe it to your father. He loved this hospital. He would turn in his grave if he knew a Teak let his beloved institution down. Teaks donât fail and they donât quit. You...can...do...it. You have to.â
There is a chink in the blackness and I see a surge of optimism break through. Maybe Kearns is right. Maybe I can do this. He believes in me. Maybe I am man enough to figure a way out of this slow motion disaster.
âOk,â I reply meekly.
âOk, then, Champ. Keep me updated.â The line goes silent. I hold onto the receiver, cradling it against my shoulder before hanging it up. I glance at George Little, feeling my momentary positivity ebb and then poof...it is gone. I have no idea how to clean up this mess.
Dear Lord, I am trapped.
26
âFrankly, heâs lucky he made it this farâ is quite the understatement of Ed Teakâs series of incredulously fortunate events. Doing away with Little Falls Hospitalâs five costliest patients is no easy task, after all. But now that the ball is rolling anyway, Ed might as well clear its path to his salvationâŚ
The reading experience that Werner crafts is fantastic. Itâs both entertaining and nerve-wracking to analyze Edâs every move and count the cracks that could unravel his plan. As you read with bated breath, until the very end, you wonder whether youâre hoping he succeeds or gets caught for his crimes.
The conflict is developed well, from the many inequities and inefficiencies of small-town healthcare to everything else that isnât going well in Edâs life. Ed himself is observant, well-meaning, and generally not unkind. His desperation to get out of Little Falls and the way his thoughts and actions progress are laid out with skillful narration. Dry humor is injected at good moments, and Werner writes in a way that keeps the story light, despite its dark undertones.
Little Falls has great writing overall, although there are a few areas that needed more thorough proofreading (including a few inconsistent names in one particular chapter). Some middle chapters also felt a tad slow, but the build-up of tension leading to the end of the novel more than made up for that. As the end approaches, there is a clear shift in mood from darkly funny to concerningly ominous, and the conclusion of the novel leaves one feeling unsettled at the turn of events. The fact, however, that the ending isnât unsatisfying and is actually quite inevitable further reveals the subtle brilliance of Wernerâs storytelling.Â
Leading with this impressive debut novel, Werner is definitely an author to keep an eye out for.