Preferential Treatment, page 6
“Who said anything about craniot… whatever it was that you said?” asked a confused and anxious Mary.
“I’m sorry, Mrs. Gunther. A craniotomy just means any surgery on the cranium or the skull. We use the term to refer to any surgery that involves opening the cranium, including intracerebral aneurysm surgery.”
“Well,” Samantha began, “aren’t there any other neurosurgeons in this town?”
“Yes, there’s another group, Neurological and Neurosurgical Associates, but unfortunately, they don’t do HMO cases. You could use one of them, but you may have problems with your HMO. You could have to pay the surgeon’s bill and that will probably run into the thousands.”
“I really can’t afford to pay for an expensive neurosurgeon, Dr. Bloomburg,” said Joe.
“What the hell is insurance for, then?” shouted Samantha. “Dad pays all this goddamned money to the HMO, then they can’t provide him with a doctor, and he has to pay more to get a surgery to save his life?”
“I understand your concern, Folks. But I think that if the HMO isn’t able to provide you with someone, you’ll probably have a good argument that it will have to pay someone out of the plan to do the surgery.”
“Well, if that’s the case and Goldstein’s gone and Hall won’t operate, then let’s get dad some place good like Ohio State or WVU,” said an exasperated Samantha. “Maybe the University of Pittsburgh. They’ve got to have good surgeons at one of those places. With all due respect, Doctor, if no one can take care of dad in this HMO, then I’d rather have him go someplace where they know what they’re doing rather than have some local yokel operating on him.”
“I really don’t blame you,” said Bloomburg. The doctor turned toward Joe. “Please don’t repeat this, but I’ve been not only your doctor but also a friend to you, Joe, and you, Mary, for a long time. I have to speak frankly.”
Bloomburg looked over her shoulder toward the door. It was shut. “I’d go to a major medical center or a university affiliated medical facility if I were facing this surgery,” she said in barely a whisper. “There are just not that many of these surgeries performed here at St. Johns, and I’d rather see Joe have a surgical team that does them regularly. Studies have shown that there’s a much better success rate in aneurysm surgeries when they’re done by surgical teams with the most experience performing them.”
“I appreciate your candor, Doctor,” said Samantha. “How do we find such a team?”
“Here’s what I’ll do for you, Joe. I know a well-trained neurosurgeon at Johns-Hopkins in Baltimore. We went to medical school together at the University of Kentucky. I’m sure either he or one of his colleagues can do the surgery for you—as long as we get the HMO to agree to pay for it. I know that if I had a problem like yours, he’d be the first one I’d call. I still keep in contact with him, and we get together about once a year for dinner. If I ask him to take you on as a patient, I think he’ll do me that favor. At the very least, if he can’t do it, he’ll find somebody that can.”
“That sounds wonderful, Doctor. We’d really appreciate it if you could arrange that,” a grateful Samantha exclaimed. “What do you think, Dad?”
Joe, who had been listening intently, propped himself up on his elbows. “How much will this cost us?” Joe inquired.
“Nothing if I can convince the HMO to send you up there. Now, if it’s okay with y’all, I’ve got some phone calling and convincing to do. I’ll let you know as soon as I hear something. I won’t leave you hanging. I promise. Joe, is it okay with you if I proceed this way?”
“Sure, doc. You go ahead. I trust you. Always have, always will.”
Bloomburg returned to her office. She dreaded the call she was about to make. She intensely disliked having to deal with Gunther’s HMO, Center Health Management System, with whom she had had many past unpleasant encounters. Even though she felt she had a reasonable, if not a compelling, argument for sending Joe to a neurosurgeon out of the region and out of his HMO system, she predicted that she was in for a hassle. It seemed to Bloomburg that the powers-that-be at the HMO dedicated their careers to make her life and the lives of her patients miserable. She participated as a physician in the plan, not because she wanted to, but because she had many patients who were members. On more than one occasion she entertained serious thoughts of withdrawing. She was not afraid of losing her patient base if she withdrew—she didn’t need the money. Rather she continued as an affiliated doctor because she felt an allegiance to those folks and their families whom she had treated for so many years and who had become HMO patients.
A virtual stampede of patients into the HMO had taken place over the past several decades. With the advent of managed care and the genesis of the health maintenance organization system in the area, many patients sought this type of system for their health care needs. This was primarily, if not solely, because of its relatively low cost. By controlling what doctors could charge and by maintaining an iron grip upon what could and could not be ordered by doctors in caring for their patients, the HMO kept costs low. As a result, the HMO was able to charge a premium with which very few traditional fee-for-services insurance plans could compete.
While the HMO was attractive to the healthy person shopping the market for relatively low-cost health insurance, it often had a downside when a sick patient needed help the most. Such was the case of Joe Gunther. An HMO insured, Gunther was stuck with a limited number of neurosurgeons from whom to choose to render care in his hour of need. Now it was up to Bloomburg to go to bat for him.
In the past, the doctor had lost many battles with the HMO; however, she was optimistic that she could win this one. She reached for the telephone and pressed the speed dialer button—one that she had pressed thousands of times before.
“Good evening, Center Health Management. How may I direct you call?”
“Dr. Bloomburg, here,” she said. “I need to talk to the medical director or someone in authority about an out-of-plan referral.”
“Dr. Sanchez is in. I’ll put you through.”
Bloomburg waited patiently, mentally preparing for what she knew was to be the third degree.
“Dr. Sanchez.”
“Doctor, this is Gretchen Bloomburg over at the Family Practice Clinic.”
“Yes, Dr. Bloomburg. What can I do for you this evening?”
“Well, we’ve got a little situation over at St. John’s with a patient of mine, Joseph Gunther, one of your HMO subscribers.” Bloomburg cleared her throat. “Mr. Gunther has been diagnosed with a subarachnoid hemorrhage that may have been caused by an intracranial aneurysm. We need a neurosurgical consult and will probably need an angiogram and eventual surgery.” Bloomburg paused.
“And you need approval for a consult?”
“Yes, and probable surgery.”
“That’s no problem. Sounds pretty straightforward. That can be authorized,” Sanchez stated.
“But there’s one problem, Doctor—I believe that there are no neurosurgeons available to do the work. Dr. Goldstein is out of the country and Dr. Hall quit doing craniotomies. While not emergent, my patient needs to be seen very soon and may need surgery in the next few days. Otherwise, his life is potentially in danger. So . . .”
“But Dr. Bloomburg,” Sanchez interjected. “We . . .”
“So,” Bloomburg interrupted, “as I was saying, we need to refer him to an out-of-plan neurosurgeon. I know one that I highly recommend.”
“Dr. Bloomburg, you are mistaken, or perhaps you are unaware.”
“Mistaken or unaware of what?” a miffed Bloomburg retorted.
“There is, in fact, a neurosurgeon available to treat your patient.”
“I’m sorry; I don’t think I understand what you’re saying. I’ve already contacted the only available HMO neurosurgeon in the area and his office tells me he isn’t treating aneurysms anymore.”
“Well, I have a wonderful surprise for you and your Mr. Gunther,” Sanchez bragged. “Perhaps you haven’t heard of our brand new neurosurgeon in town, Dr. Ancil Montgomery.”
There was a stunned silence on Bloomburg’s end of the line. She knew there had been a recruitment effort to bring another neurosurgeon to town, but she hadn’t heard even a whisper about one actually agreeing to set up practice in the city or anywhere in the surrounding area.
I need to get out more. “Uh—no. Haven’t heard of him. When did he come to town?”
“Started last week. He participates with our HMO. So, Doctor, I suggest you call Dr. Montgomery and let him know he has a new patient. The request for the consult is granted. Of course, we’ll need to know your patient’s presumptive diagnosis and the specifics of his recommendation for treatment before it will be authorized.”
“Of course,” said Bloomburg, still shocked by the revelation.
“By the way, Doctor, do you know Dr. Montgomery’s background?” Bloomburg asked.
“No. I just know he’s a neurosurgeon, has been granted provisional privileges at St. John’s, and participates with the HMO. Guess that makes him your guy. Gotta go. Have a call on the other line. Bye.”
Bloomburg pulled the reading glasses from her face and slowly rubbed her tired, sore eyes. It had been a long day, and it looked like it wasn’t close to being over. She had begun to see patients in her office at 8:00 a.m. The stream seemed endless. It was the flu season in West Virginia, and this, along with the other usual problems of her patients, recently made every day tough. Along with the fifty office visits she attended to, she had another fifteen patients in the hospital. Joe Gunther now made sixteen.
The fatigued doctor desperately wanted to turn the lights off, go home, pet her cat, and have a glass of wine with her husband, but she needed to fulfill her promise to her long-time patient. She slowly lifted the telephone receiver and dialed Directory Assistance. Once the doctor’s information was located, Bloomburg jotted down the number on a blank rolodex card then dialed. At this hour she knew his answering service would be as close as she could get to him. As expected, Montgomery’s answering service responded.
“Just leave a message for him that Dr. Gretchen Bloomburg called. My phone number at the office is (304) 555-2020 and home is 555-4589—same area code. Please tell him I have a referral for him involving a subarachnoid hemorrhage and a suspected intracranial aneurysm. Thanks.”
Bloomburg riffled through the pink message slips left for her by her receptionist. Nothing looked so important that it couldn’t wait until the next day. She pushed back from her desk and turned off her light.
As Bloomburg walked down the corridor past the examination rooms, the receptionist’s telephone rang, startling her. Momentarily, she debated whether she should answer it or not. She looked at her wristwatch—6:55. The doctor hurried into the receptionist’s office and grabbed the receiver. She expected it was some kind of emergency.
“This is Dr. Bloomburg.”
“Dr. Bloomburg, glad I caught you. Ancil Montgomery, returning your call,” a youthful-sounding voice said.
“Yes, Dr. Montgomery. Thank you for returning my call so promptly.”
“No problem, and please call me Ancil.”
“Fine, Ancil. I guess you received my message that I have an HMO patient at St. John’s with a subarachnoid hemorrhage and a probable aneurysm?”
“Yes, Ma’am, I did.”
“Ancil, if I’m going to call you Ancil, you can’t call me Ma’am. Gretchen will be fine.”
“Okay, Gretchen. What’s your patient’s name?”
“His name is Joe Gunther. He’s in Room, I think it’s 428, if my memory serves me correctly. Anyway, he’s on Four South at St. John’s. Dr. Jacobson had ordered a CT scan, and it confirmed subarachnoid hemorrhage. Mr. Gunther needs a neurosurgeon, and I understand you are now affiliated with the HMO and are accepting neurosurgical referrals.”
“That’s correct, as of late last week. Have you talked to the HMO about pre-cert for me to see him?”
“Yes. I did that earlier. They gave me your name and have given the go-ahead for you to examine him. As you know, if you plan any procedures on him or any surgeries, you’ll have to go back and get approval, otherwise, the HMO probably won’t pay for them.”
“Yeah. I’ve been told the drill. I’d like to go over soon to see Mr. Gunther and introduce myself. I don’t want to wait too long. If it’s an aneurysm, we’ll probably have to take care of it in the next few days,” Montgomery said.
“That’s good. I hope you can help him. He’s been a long-time patient of mine. I think you’ll find him delightful.”
“Thanks, Gretchen. I look forward to meeting you in person soon.”
“Likewise. Bye.”
The sound of Montgomery’s young voice piqued Bloomburg’s curiosity about this doctor in whose hands Joe Gunther’s fate had just been placed. She clicked the Internet icon on the desktop computer and typed “Ancil Montgomery, M.D., neurological surgery” in the search box.
The computer ground through the Internet’s billions of bits of information as it performed its search. After several seconds, a menu appeared on which was listed a website for an Ancil Joseph Montgomery, M.D. Bloomburg raced the cursor to the link, pointed, and clicked the mouse.
Instantly, the web page appeared. On the right side of the screen was the photographic image of the head and upper torso of a young, Caucasian male sporting a red bow tie and a white lab coat. Under the photo was the name “Ancil Joseph Montgomery, M.D.—Neurological Surgeon.”
Bloomburg pushed her reading glassed up the slope of her nose. She scrolled down the page and wondered if this were the same Ancil Montgomery, M.D. to whom she had just referred Joe.
She found the address listed on the web page. It matched the address given to her by directory assistance—822 Medical Circle Drive. Bloomburg scrolled down the page and found Montgomery’s curriculum vitae:
Ancil Joseph Montgomery, M.D.
822 Medical Circle Drive,
Abbington, West Virginia 25999
Neurological Surgeon
Date/Place of Birth: April 10, 1972—Reynoldsburg, Ohio
Married: Jo Beth Lawson-Montgomery
Children: Ancil Joseph Montgomery, Jr.
Susan Elizabeth Montgomery
Education: B. S., Dormont College (summa cum laude), 1993.
Medical Education: M. D., The Ohio State University (with honors), 1997.
General internship – St. Louis General Hospital, St. Louis, MO, 1997-1998.
General Surgery Residency – St. Louis General Hospital, St. Louis, MO, 1998-1999.
Neurological Surgery Residency – St. Louis General Hospital, St. Louis, MO, 1999-2004.
Bloomburg looked in amazement at Montgomery’s resume.
Christ! He’s just out of residency, and Sanchez wants to stick my patient with this rookie? Maybe a lumbar disc surgery or a peripheral nerve repair, but an aneurysm? What was he thinking?
Bloomburg inhaled and attempted to calm herself. She reached for the telephone to call Joe to tell him the news but hesitated.
I’ll call him tomorrow. I can’t deal with this tonight.
CHAPTER 5
Later that evening, unbeknownst to Bloomburg, an energetic Ancil Montgomery charged down the corridor of Four South of St. John’s Hospital. The door to Room 428 stood slightly ajar. A dim flickering light from the television shown through the crack between the door and its frame. Inside the darkened room, a few muffled voices could be heard over the drone of the TV.
Montgomery rapped three times on the door. The door opened, and Mary peered at a handsome young man who stood smiling in the doorway. He wore gray dress slacks, a navy blue buttoned-down collar shirt, and a white lab coat which framed a yellow and black silk tie. He took one step toward Mary and extended his right hand. His fingers were long and thin, his nails impeccably manicured. His hair was blond, almost platinum, fine and wispy.
“Hi, I’m Dr. Montgomery.”
Mary looked puzzled. “Hello, Doctor. May I help you?”
“I’m looking for Mr. Joseph Gunther. Do I have the right room?”
“Yes. I’m Mary Gunther. Joe’s over there in the bed.”
Montgomery peered past Mary, eager to see his new patient. Mary stood in the doorway as if to prevent Montgomery’s entry.
“May I come in?” asked Montgomery.
“Sure,” said Mary slowly stepping aside. “Please. Joe, there’s a doctor here to see you.”
Montgomery headed toward Joe’s bedside. Joe, lifted his head and looked at Montgomery through half-closed eyes. The sleeping pill the nurse had given him had begun to take effect.
“Hello, Mr. Gunther. Dr. Montgomery. I’m a neurosurgeon. Dr. Bloomburg asked me to see you for a consultation.” Montgomery extended his hand.
Joe looked with suspicion at the young Montgomery and slowly extended his hand. “Hello,” said Joe. “You’re the brain surgeon?”
“Yes, I’m a neurosurgeon,” Montgomery corrected Joe. “How are you feeling?” Montgomery could sense Joe’s uneasiness.
“You’re the one that’s supposed to operate on me?”
“Well, Mr. Gunther, that’s looking ahead. First, I need to find out exactly what’s wrong with you. I have gotten your history and have looked over your chart, but in order to know whether there will be any surgery recommended, I’ll have to conduct some more testing.”
“But if there’s going to be an operation on my head, you’re the one that’s going to be doing it? Because you don’t look old enough to be out of high school,” Joe exaggerated. “And I don’t want no highschooler cuttin’ on my head.”
Mary looked surprised. She had never seen her husband act so unfriendly or blunt toward a stranger. She was more surprised that Joe would be so bold with a doctor. Both of the Gunthers held physicians in the highest esteem.
Montgomery had seen this type of patient before during his residency. He smiled at Joe and pulled up a chair, sitting on it backwards with his hands perched on the top of the chair back.
“I’m sorry, Mrs. Gunther. A craniotomy just means any surgery on the cranium or the skull. We use the term to refer to any surgery that involves opening the cranium, including intracerebral aneurysm surgery.”
“Well,” Samantha began, “aren’t there any other neurosurgeons in this town?”
“Yes, there’s another group, Neurological and Neurosurgical Associates, but unfortunately, they don’t do HMO cases. You could use one of them, but you may have problems with your HMO. You could have to pay the surgeon’s bill and that will probably run into the thousands.”
“I really can’t afford to pay for an expensive neurosurgeon, Dr. Bloomburg,” said Joe.
“What the hell is insurance for, then?” shouted Samantha. “Dad pays all this goddamned money to the HMO, then they can’t provide him with a doctor, and he has to pay more to get a surgery to save his life?”
“I understand your concern, Folks. But I think that if the HMO isn’t able to provide you with someone, you’ll probably have a good argument that it will have to pay someone out of the plan to do the surgery.”
“Well, if that’s the case and Goldstein’s gone and Hall won’t operate, then let’s get dad some place good like Ohio State or WVU,” said an exasperated Samantha. “Maybe the University of Pittsburgh. They’ve got to have good surgeons at one of those places. With all due respect, Doctor, if no one can take care of dad in this HMO, then I’d rather have him go someplace where they know what they’re doing rather than have some local yokel operating on him.”
“I really don’t blame you,” said Bloomburg. The doctor turned toward Joe. “Please don’t repeat this, but I’ve been not only your doctor but also a friend to you, Joe, and you, Mary, for a long time. I have to speak frankly.”
Bloomburg looked over her shoulder toward the door. It was shut. “I’d go to a major medical center or a university affiliated medical facility if I were facing this surgery,” she said in barely a whisper. “There are just not that many of these surgeries performed here at St. Johns, and I’d rather see Joe have a surgical team that does them regularly. Studies have shown that there’s a much better success rate in aneurysm surgeries when they’re done by surgical teams with the most experience performing them.”
“I appreciate your candor, Doctor,” said Samantha. “How do we find such a team?”
“Here’s what I’ll do for you, Joe. I know a well-trained neurosurgeon at Johns-Hopkins in Baltimore. We went to medical school together at the University of Kentucky. I’m sure either he or one of his colleagues can do the surgery for you—as long as we get the HMO to agree to pay for it. I know that if I had a problem like yours, he’d be the first one I’d call. I still keep in contact with him, and we get together about once a year for dinner. If I ask him to take you on as a patient, I think he’ll do me that favor. At the very least, if he can’t do it, he’ll find somebody that can.”
“That sounds wonderful, Doctor. We’d really appreciate it if you could arrange that,” a grateful Samantha exclaimed. “What do you think, Dad?”
Joe, who had been listening intently, propped himself up on his elbows. “How much will this cost us?” Joe inquired.
“Nothing if I can convince the HMO to send you up there. Now, if it’s okay with y’all, I’ve got some phone calling and convincing to do. I’ll let you know as soon as I hear something. I won’t leave you hanging. I promise. Joe, is it okay with you if I proceed this way?”
“Sure, doc. You go ahead. I trust you. Always have, always will.”
Bloomburg returned to her office. She dreaded the call she was about to make. She intensely disliked having to deal with Gunther’s HMO, Center Health Management System, with whom she had had many past unpleasant encounters. Even though she felt she had a reasonable, if not a compelling, argument for sending Joe to a neurosurgeon out of the region and out of his HMO system, she predicted that she was in for a hassle. It seemed to Bloomburg that the powers-that-be at the HMO dedicated their careers to make her life and the lives of her patients miserable. She participated as a physician in the plan, not because she wanted to, but because she had many patients who were members. On more than one occasion she entertained serious thoughts of withdrawing. She was not afraid of losing her patient base if she withdrew—she didn’t need the money. Rather she continued as an affiliated doctor because she felt an allegiance to those folks and their families whom she had treated for so many years and who had become HMO patients.
A virtual stampede of patients into the HMO had taken place over the past several decades. With the advent of managed care and the genesis of the health maintenance organization system in the area, many patients sought this type of system for their health care needs. This was primarily, if not solely, because of its relatively low cost. By controlling what doctors could charge and by maintaining an iron grip upon what could and could not be ordered by doctors in caring for their patients, the HMO kept costs low. As a result, the HMO was able to charge a premium with which very few traditional fee-for-services insurance plans could compete.
While the HMO was attractive to the healthy person shopping the market for relatively low-cost health insurance, it often had a downside when a sick patient needed help the most. Such was the case of Joe Gunther. An HMO insured, Gunther was stuck with a limited number of neurosurgeons from whom to choose to render care in his hour of need. Now it was up to Bloomburg to go to bat for him.
In the past, the doctor had lost many battles with the HMO; however, she was optimistic that she could win this one. She reached for the telephone and pressed the speed dialer button—one that she had pressed thousands of times before.
“Good evening, Center Health Management. How may I direct you call?”
“Dr. Bloomburg, here,” she said. “I need to talk to the medical director or someone in authority about an out-of-plan referral.”
“Dr. Sanchez is in. I’ll put you through.”
Bloomburg waited patiently, mentally preparing for what she knew was to be the third degree.
“Dr. Sanchez.”
“Doctor, this is Gretchen Bloomburg over at the Family Practice Clinic.”
“Yes, Dr. Bloomburg. What can I do for you this evening?”
“Well, we’ve got a little situation over at St. John’s with a patient of mine, Joseph Gunther, one of your HMO subscribers.” Bloomburg cleared her throat. “Mr. Gunther has been diagnosed with a subarachnoid hemorrhage that may have been caused by an intracranial aneurysm. We need a neurosurgical consult and will probably need an angiogram and eventual surgery.” Bloomburg paused.
“And you need approval for a consult?”
“Yes, and probable surgery.”
“That’s no problem. Sounds pretty straightforward. That can be authorized,” Sanchez stated.
“But there’s one problem, Doctor—I believe that there are no neurosurgeons available to do the work. Dr. Goldstein is out of the country and Dr. Hall quit doing craniotomies. While not emergent, my patient needs to be seen very soon and may need surgery in the next few days. Otherwise, his life is potentially in danger. So . . .”
“But Dr. Bloomburg,” Sanchez interjected. “We . . .”
“So,” Bloomburg interrupted, “as I was saying, we need to refer him to an out-of-plan neurosurgeon. I know one that I highly recommend.”
“Dr. Bloomburg, you are mistaken, or perhaps you are unaware.”
“Mistaken or unaware of what?” a miffed Bloomburg retorted.
“There is, in fact, a neurosurgeon available to treat your patient.”
“I’m sorry; I don’t think I understand what you’re saying. I’ve already contacted the only available HMO neurosurgeon in the area and his office tells me he isn’t treating aneurysms anymore.”
“Well, I have a wonderful surprise for you and your Mr. Gunther,” Sanchez bragged. “Perhaps you haven’t heard of our brand new neurosurgeon in town, Dr. Ancil Montgomery.”
There was a stunned silence on Bloomburg’s end of the line. She knew there had been a recruitment effort to bring another neurosurgeon to town, but she hadn’t heard even a whisper about one actually agreeing to set up practice in the city or anywhere in the surrounding area.
I need to get out more. “Uh—no. Haven’t heard of him. When did he come to town?”
“Started last week. He participates with our HMO. So, Doctor, I suggest you call Dr. Montgomery and let him know he has a new patient. The request for the consult is granted. Of course, we’ll need to know your patient’s presumptive diagnosis and the specifics of his recommendation for treatment before it will be authorized.”
“Of course,” said Bloomburg, still shocked by the revelation.
“By the way, Doctor, do you know Dr. Montgomery’s background?” Bloomburg asked.
“No. I just know he’s a neurosurgeon, has been granted provisional privileges at St. John’s, and participates with the HMO. Guess that makes him your guy. Gotta go. Have a call on the other line. Bye.”
Bloomburg pulled the reading glasses from her face and slowly rubbed her tired, sore eyes. It had been a long day, and it looked like it wasn’t close to being over. She had begun to see patients in her office at 8:00 a.m. The stream seemed endless. It was the flu season in West Virginia, and this, along with the other usual problems of her patients, recently made every day tough. Along with the fifty office visits she attended to, she had another fifteen patients in the hospital. Joe Gunther now made sixteen.
The fatigued doctor desperately wanted to turn the lights off, go home, pet her cat, and have a glass of wine with her husband, but she needed to fulfill her promise to her long-time patient. She slowly lifted the telephone receiver and dialed Directory Assistance. Once the doctor’s information was located, Bloomburg jotted down the number on a blank rolodex card then dialed. At this hour she knew his answering service would be as close as she could get to him. As expected, Montgomery’s answering service responded.
“Just leave a message for him that Dr. Gretchen Bloomburg called. My phone number at the office is (304) 555-2020 and home is 555-4589—same area code. Please tell him I have a referral for him involving a subarachnoid hemorrhage and a suspected intracranial aneurysm. Thanks.”
Bloomburg riffled through the pink message slips left for her by her receptionist. Nothing looked so important that it couldn’t wait until the next day. She pushed back from her desk and turned off her light.
As Bloomburg walked down the corridor past the examination rooms, the receptionist’s telephone rang, startling her. Momentarily, she debated whether she should answer it or not. She looked at her wristwatch—6:55. The doctor hurried into the receptionist’s office and grabbed the receiver. She expected it was some kind of emergency.
“This is Dr. Bloomburg.”
“Dr. Bloomburg, glad I caught you. Ancil Montgomery, returning your call,” a youthful-sounding voice said.
“Yes, Dr. Montgomery. Thank you for returning my call so promptly.”
“No problem, and please call me Ancil.”
“Fine, Ancil. I guess you received my message that I have an HMO patient at St. John’s with a subarachnoid hemorrhage and a probable aneurysm?”
“Yes, Ma’am, I did.”
“Ancil, if I’m going to call you Ancil, you can’t call me Ma’am. Gretchen will be fine.”
“Okay, Gretchen. What’s your patient’s name?”
“His name is Joe Gunther. He’s in Room, I think it’s 428, if my memory serves me correctly. Anyway, he’s on Four South at St. John’s. Dr. Jacobson had ordered a CT scan, and it confirmed subarachnoid hemorrhage. Mr. Gunther needs a neurosurgeon, and I understand you are now affiliated with the HMO and are accepting neurosurgical referrals.”
“That’s correct, as of late last week. Have you talked to the HMO about pre-cert for me to see him?”
“Yes. I did that earlier. They gave me your name and have given the go-ahead for you to examine him. As you know, if you plan any procedures on him or any surgeries, you’ll have to go back and get approval, otherwise, the HMO probably won’t pay for them.”
“Yeah. I’ve been told the drill. I’d like to go over soon to see Mr. Gunther and introduce myself. I don’t want to wait too long. If it’s an aneurysm, we’ll probably have to take care of it in the next few days,” Montgomery said.
“That’s good. I hope you can help him. He’s been a long-time patient of mine. I think you’ll find him delightful.”
“Thanks, Gretchen. I look forward to meeting you in person soon.”
“Likewise. Bye.”
The sound of Montgomery’s young voice piqued Bloomburg’s curiosity about this doctor in whose hands Joe Gunther’s fate had just been placed. She clicked the Internet icon on the desktop computer and typed “Ancil Montgomery, M.D., neurological surgery” in the search box.
The computer ground through the Internet’s billions of bits of information as it performed its search. After several seconds, a menu appeared on which was listed a website for an Ancil Joseph Montgomery, M.D. Bloomburg raced the cursor to the link, pointed, and clicked the mouse.
Instantly, the web page appeared. On the right side of the screen was the photographic image of the head and upper torso of a young, Caucasian male sporting a red bow tie and a white lab coat. Under the photo was the name “Ancil Joseph Montgomery, M.D.—Neurological Surgeon.”
Bloomburg pushed her reading glassed up the slope of her nose. She scrolled down the page and wondered if this were the same Ancil Montgomery, M.D. to whom she had just referred Joe.
She found the address listed on the web page. It matched the address given to her by directory assistance—822 Medical Circle Drive. Bloomburg scrolled down the page and found Montgomery’s curriculum vitae:
Ancil Joseph Montgomery, M.D.
822 Medical Circle Drive,
Abbington, West Virginia 25999
Neurological Surgeon
Date/Place of Birth: April 10, 1972—Reynoldsburg, Ohio
Married: Jo Beth Lawson-Montgomery
Children: Ancil Joseph Montgomery, Jr.
Susan Elizabeth Montgomery
Education: B. S., Dormont College (summa cum laude), 1993.
Medical Education: M. D., The Ohio State University (with honors), 1997.
General internship – St. Louis General Hospital, St. Louis, MO, 1997-1998.
General Surgery Residency – St. Louis General Hospital, St. Louis, MO, 1998-1999.
Neurological Surgery Residency – St. Louis General Hospital, St. Louis, MO, 1999-2004.
Bloomburg looked in amazement at Montgomery’s resume.
Christ! He’s just out of residency, and Sanchez wants to stick my patient with this rookie? Maybe a lumbar disc surgery or a peripheral nerve repair, but an aneurysm? What was he thinking?
Bloomburg inhaled and attempted to calm herself. She reached for the telephone to call Joe to tell him the news but hesitated.
I’ll call him tomorrow. I can’t deal with this tonight.
CHAPTER 5
Later that evening, unbeknownst to Bloomburg, an energetic Ancil Montgomery charged down the corridor of Four South of St. John’s Hospital. The door to Room 428 stood slightly ajar. A dim flickering light from the television shown through the crack between the door and its frame. Inside the darkened room, a few muffled voices could be heard over the drone of the TV.
Montgomery rapped three times on the door. The door opened, and Mary peered at a handsome young man who stood smiling in the doorway. He wore gray dress slacks, a navy blue buttoned-down collar shirt, and a white lab coat which framed a yellow and black silk tie. He took one step toward Mary and extended his right hand. His fingers were long and thin, his nails impeccably manicured. His hair was blond, almost platinum, fine and wispy.
“Hi, I’m Dr. Montgomery.”
Mary looked puzzled. “Hello, Doctor. May I help you?”
“I’m looking for Mr. Joseph Gunther. Do I have the right room?”
“Yes. I’m Mary Gunther. Joe’s over there in the bed.”
Montgomery peered past Mary, eager to see his new patient. Mary stood in the doorway as if to prevent Montgomery’s entry.
“May I come in?” asked Montgomery.
“Sure,” said Mary slowly stepping aside. “Please. Joe, there’s a doctor here to see you.”
Montgomery headed toward Joe’s bedside. Joe, lifted his head and looked at Montgomery through half-closed eyes. The sleeping pill the nurse had given him had begun to take effect.
“Hello, Mr. Gunther. Dr. Montgomery. I’m a neurosurgeon. Dr. Bloomburg asked me to see you for a consultation.” Montgomery extended his hand.
Joe looked with suspicion at the young Montgomery and slowly extended his hand. “Hello,” said Joe. “You’re the brain surgeon?”
“Yes, I’m a neurosurgeon,” Montgomery corrected Joe. “How are you feeling?” Montgomery could sense Joe’s uneasiness.
“You’re the one that’s supposed to operate on me?”
“Well, Mr. Gunther, that’s looking ahead. First, I need to find out exactly what’s wrong with you. I have gotten your history and have looked over your chart, but in order to know whether there will be any surgery recommended, I’ll have to conduct some more testing.”
“But if there’s going to be an operation on my head, you’re the one that’s going to be doing it? Because you don’t look old enough to be out of high school,” Joe exaggerated. “And I don’t want no highschooler cuttin’ on my head.”
Mary looked surprised. She had never seen her husband act so unfriendly or blunt toward a stranger. She was more surprised that Joe would be so bold with a doctor. Both of the Gunthers held physicians in the highest esteem.
Montgomery had seen this type of patient before during his residency. He smiled at Joe and pulled up a chair, sitting on it backwards with his hands perched on the top of the chair back.
