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  Medical Options

  What the Doctor Knows Could Kill You

  A Novel

  Marcus Steele

  iUniverse, Inc.

  New York Lincoln Shanghai

  Medical Options

  What the Doctor Knows Could Kill You

  Copyright © 2006 by Marcus M. Steele

  All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the publisher except in the case of brief quotations embodied in critical articles and reviews.

  iUniverse

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  Lincoln, NE 68512

  www.iuniverse.com

  1-800-Authors (1-800-288-4677)

  This is a work of fiction. All of the characters, names, incidents, organizations, and dialogue in this novel are either the products of the author’s imagination or are used fictitiously.

  ISBN-13: 978-0-595-41005-7 (pbk)

  ISBN-13: 978-0-595-85359-5 (ebk)

  ISBN-10: 0-595-41005-7 (pbk)

  ISBN-10: 0-595-85359-5 (ebk)

  Contents

  C H A P T E R 1

  C H A P T E R 2

  C H A P T E R 3

  C H A P T E R 4

  C H A P T E R 5

  C H A P T E R 6

  C H A P T E R 7

  C H A P T E R 8

  C H A P T E R 9

  C H A P T E R 11

  C H A P T E R 12

  C H A P T E R 13

  C H A P T E R 14

  C H A P T E R 15

  EPILOGUE

  C H A P T E R 1

  THE GREAT WHITE NORTH

  Michael Hawke anticipated his new job as the movers were getting everything from his old condo. It had a worn look to it but he was definitely excited about the new job. From his old job in downstate Michigan to Northern Michigan were he would be developing a research program.

  They packed everything and his flight to Northern Michigan went without event. When he did arrive however he was greeted at the airport with news of a death of one of the research assistants he was working with.

  “This is great, we are moving up here to get away from crime downstate and now this!” His wife Maria stated. She was reluctant to move as they had a nice life downstate and a circle of friends. The crime did bother her though. The Detroit area had changed so much in the last forty years.

  Now there were thriving suburbs but a crime ridden core. The week before they left there was news of an ophthalmologist that was killed by some people that followed her to her atm that night. She was tall with dark hair and exquisitely beautiful features.

  “Hey, I don’t know anything about this „.it looks like she committed suicide by jumping off a building but the cops can’t rule out foul play”.

  “Why do they say foul play, don’t they just feel someone killed her?” She asked.

  “You never know, I also wasn’t sure why they always did that.” Hawke answered back.

  “Do they know anything about her?” Maria was curious, where was this place she was moving.

  “Gosh it looks like her name was Betty Kool, well she’s Kool alright, on ice I would say!”

  “That’s not funny, well do they know anything else about her?” Maria was somewhat curious at this point.

  The paper hadn’t given much detail. Hawke perused it as they drove his Mercedes back from the airport. It was a gold kind of yellowish C240 … very zippy and something he bought after a few years of practice. In retrospect he probably wouldn’t have bought one immediately after training but all those years of subjugating himself in training was something he needed to get out of his system. He was a practicing cardiologist now for almost ten years. He did coronary angioplasty which is using a balloon to open up the arteries when people have heart attacks and the like. True a lot if not most of the people could avoid having a heart attack if they lost some weight or stopped smoking or did some regular exercise. Of course family history does play a role in this as well. Hawke was lucky that his own grandparents lived to their 80’s. His father was a family doctor and his brother a plastic surgeon. Both his sisters were nurses and medicine was the family business for them. He enjoyed his work in Detroit but as with any commodity the more of something there is the less valuable it is. There was a shortage of doctors and more specifically cardiologists. However there are three very different areas of practice. There are physicians that have their green card; physicians that practice in a city or suburbs or rural physicians. Now the opportunities to be more independent and have a wider scope of practice are more with doctors in rural settings by virtue of the fact there just are not the same number of people there. By moving to Northern Michigan he had hoped to develop a research program.

  It was tough not being in academics. All the good studies would go through the universities and it was tough for the guys in private practice really to get access to the good studies. He thought that with setting up his own program he might be able to develop some high quality research. Beth seemed to be a good candidate. She was originally from the Petoskey area and wanted to move closer to see her folks. She had adopted an Asian girl when she was doing research in Boston. She mainly worked on cardiology trials while there.

  The coronary arteries are an interesting group. They are relatively small but not so small that they can’t cause problems. The brachial arteries which are large and have relatively little problems with atherosclerosis. In fact most heart attacks occur on arteries that only have about a 50-70% blockages instead of narrowing reaching 95% and totally occluding. This represented a real change in scientific thought.

  Stents are metal cages that prop open the arteries to keep them open and prevent heart attacks from occurring. They have been around since the 1980’s and now represents billions of dollars in revenue. Yes healthcare and heart care is a money maker. There were about 4 major companies Smith and Smith, Morey, New York Products and Arrow. Smith and Smith was a family company started four generations ago. Like most companies like this the great grandfather built it and the grandfather worked hard on it. By the time it gets to the great grand kids they have the money but no drive to do anything with their money but waste it.

  This was an interesting phenomenon of American wealth. In fact I heard the Smith and Smith heirs say “There is no American dream for me „I have an eight figure trust fund and can or have anything on earth I want. My grandfather was the American dream … coming from nothing to something. I came from something and am something.” He had a point. Even if he totally squandered everything he had he couldn’t manage a thing he would still die wealthy.

  As Warren Buffet said “It is very Un-American for me people to start out with a head start on other people”. He feels people should work their way up to achieve and not be handed anything to us. He does have a point. That is why Smith and Smith was a decent company but really wasn’t leading the way anymore with coronary products. Morey was started by an engineer from Canada about 40 years ago. It was a solid company and did good research. In fact all the companies did good work. With universities loosing funding someone had to pick up the funding issues. Sure doctors have been accused of being on the gravy train … taking favors from companies in exchange for using certain products.

  All other fields do it; for example lawyers are able to take their clients out to nice restaurants and nobody seems to mind. I guess because doctors have to be part saints, part businessmen that it is under suc
h scrutiny.

  I guess it is all perception in terms of the public and what they think of doctors. Look at stock brokers; they have all these laws governing their performance and selling on insider information and the like.

  Hawke like the idea of doing trials with the companies. They had enough money to finance them and paid their doctors well. They earned good money and weren’t stressed with issues of patient care. Beth was working on one of these trials. Hawke was wondering why and intelligent nurse doing research with a family and seemingly a perfect life would commit suicide.

  “She could have had some history of depression you never know” Maria piped

  in.

  “Yeah, I guess, though I’m just bothered by it. She was supposed to be doing work with me on the new Mark 5 stent that had so much promise. It was a stent that had a drug coating on it.”

  “What does drug coating mean …” Maria whose background was history

  quipped.

  Sometimes Hawke found it hard to explain scientific things to her but he always enjoyed her perspective on things.

  “Several years doctors found that they could prevent arteries from restenosing by putting a coating on the stent. They used an anticancer coating to prevent proliferation of the tissue. When an angioplasty is done there is injury to the vessel wall. It has worked well … patients benefited. Cardiologists have noticed a decline in business as there have not been as many patients referred for angiogra-phy. That is to say because they don’t renarrow they don’t need another angio-gram. Coronary angiograms were something that used to pay a lot of money but now they pay only a few hundred dollars. Hawke didn’t go into into medicine for the money . it was nice though. Doctors used to be paid a lot but not any more. Essentially they are good smart people that want to help humanity. Unlike their colleagues as engineers, mbas and lawyers doctors have a sense of altruism. Most are happy with their money and some are even further motivated by the “Mother Theresa” complex.

  “Yeah these new drug coated stents with Prevental are pretty good for prevention of the renarrowing. They had one problem though, they would tend to give heart attacks in some people. The data though says they are pretty safe. There is a new compound out there though called RU 786 that is being tested.” He said enthusiastically.

  She nodded in agreement. “Is that the new drug you were testing out?”

  “Yes, in Detroit we had worked on it. We had some pretty good results although just last week there was one death?

  “Did you record it?”

  “Well, I left it up to Zane to do.” Zane Paulson was a colleague of Mike’s that worked with him in Detroit on the project.

  The Mercedes made the meandering pathway up to their condominium. It was large, 3000 square feet with orange exterior. They had bought it on the internet and the inside was spacious with a good view of the golf course. He unloaded the car with their suitcases and all his medicals stuff. Setting up at a new practice and moving always was a hassle. You had to get all your things together and hope nothing gets lost in the move. Then there were the issues people had in terms of their kids as well. So many of his colleagues could not move or work in a different city because their wives and the kids don’t want to move. Well, he thought it would be a good move; little does he know what lay ahead .

  C H A P T E R 2

  WELCOME

  “Hey how are you doing Mike, it’s great to have you aboard!” said Carry Marsh the electrophysiologist. These were an interesting group. The EP guys as they were called in cardiology were responsible for putting in pacemakers and defibril-lators. Defibrillators were devices that were put in to prevent the heart from dying suddenly of a shock. These were basically structured like pacemakers but a little larger and costing twenty thousand dollars to boot! They paid well and that is why a lot of interventional cardiologists; which is what Hawke is liked putting them in. Plus they were a lot of fun to do as well. Hawke loved anything to do with his hands and he felt that he was truly blessed in his ability to help his fellow man. He believed in the definition of success once coined.” You are not a success

  unless you do something for someone everyday for which they could never repay “

  you.

  Marsh was an interesting man. Very brilliant indeed he had a penchant for fine wines and the better things in life. The other electrophysiologist was Michael Castone. Castone’s family came to this area as did a lot of Italians at the turn of the century. The mining companies up here would go ahead and offer the job of mining in this territory of the country to the oldest boy with the idea that he would send money back home to Italy to his family. Castone was skilled with his hands; a little slimy though.

  “Hey Carry, great to see you again! How is the pacing business? You still putting in those ‘shock boxes?’”

  “Everyone that you interventional guys don’t take from me!” he scorned jokingly.

  “How was your trip Mike? Any problems with the snow? Up here it takes a little getting used to you know.”

  “Oh sure if you someone is not used to it. Remember we came from Detroit downstate and we certainly are used to the snow. It’s too bad what happened to Beth.”

  Before he could finish Dr. Marsh injected “Yeah, it was real surprise to all of us. Especially since she is from the area and we thought she was pretty happy ya know?”

  “Did she have some previous history or anything?”

  “Not really we looked at her file prior to hiring her and she seemed pretty rock solid and all.”

  “Boy with her having a kid and all being a single parent it will be tough”

  “The daughter, Yee, will live with Beth’s parents. They are good people and I don’t think they will mind a second parent hood”.

  “How are they taking the whole thing?” Hawke asked.

  “I guess how would anyone take it when their only daughter dies . suicide or not?”

  “Or not?”

  “I just meant this was a suicide or other times people could die at someone else’s hands”

  “It was just over there Mike, the window by the wall. That is where she fell”

  The office was large and well decorated. It had sections for the nuclear cameras, treadmills and echo machines. There were about one hundred employees in the group which had fifteen cardiologists. There was the usual group of folks who were in the area because that is where there family is from. Then there are a couple of transplants who thought they would leave the high call low salary environment of the city behind. Whether it was Detroit, Chicago or Cleveland for some people the hassle of commuting, the headache of being a fish in a huge pond with other sharks just wasn’t enjoyable.

  Hawke ambled over to his office. There was a beautiful credenza and a very expensive desk. This is where he was going to spend a lot of time. Most of his time would be spent at the hospital of course.

  “Where was Beth’s desk?”

  “Uh just over here behind Dr. Lock’s desk. Lock isn’t here. He probably just went skiing with his kids”. John Lock was a big guy. Standing six three and two twenty five he was lean and in good health. He married his high school sweetheart and had six kids. They were from the Chicago area but the commute and the politics of academia was really too much for him.

  John was brilliant and fair minded for sure. “So did John say anything about Beth as their desks were pretty close?”

  “No he was shocked like anyone else.”

  “Could I see her desk?” Hawke was always inquisitive and something didn’t sit right about this. He is moving up here to continue work on a new research project and suddenly his main researcher commits suicide? What was she working on? Why now? Was she really suicidal or was someone else involved and why?

  “Uh yeah you could see the desk but it was cleaned out?

  “By whom?” His spider sense was
tingling now.

  “I don’t know for sure but the rep from Morey, John Westinghouse was by to gather some of her stuff up. He was working very closely on the project with her.

  Hawke examined the desk and it looked indeed like it was “cleaned out”. His eyes just caught the edge of something and he looked at it. The penholder had just one pen. That was odd. Every nurse or doctor or nurse keeps a ready supply; they are lifted often and quite inadvertently.

  Hawke walked with Carry back to the echocardiogram reading room.

  “Mike you gotta excuse me; I gotta ton of echoes to get caught up on. There are just so many and then I need to go to the lab to do an electrophysiology study.”

  “Sure Carry. Listen nice to see you again and thanks for showing me around.” Hawke picked up the boxes of books and pens and charts and the like and carted them over to his desk.

  “Oh Hi Dr. Hawke!” a lady piped from the room. This was he thought Theresa who sort of ran the office nurse wise. With that many women under one roof sometimes you needed a mother hen to keep everyone in line.

  “Hey Theresa, good to see you again.” Hawke waived over. It was hard to remember everyone’s names in the office but he really made an effort. Everyone was working together on a team and it was important to remember people’s names he thought anyway. A lot of doctors were not like that; particularly a lot of the old school guys who came from a different era. Hawke recently remembered some comments made

  He remembered some comments made previously about how easily he remembered names.

  It came easily to him and it frankly helped him. His sister who was a nurse told him that would really help in practice. Everybody loved to feel important and this brought people together as a team. Hawke also felt he had somewhat ofa six sense about people. He would meet someone and get a first impression that was usually right. The book “Blink” talked about his phenomenon and he felt it was for sure true. That first inkling you get about somebody; yes it was the most correct. It didn’t matter how much you rationalized or how much you knew something was intellectually correct. So many times he had a bad or good feeling about a patient and he was right most of the time.