It’s Mardi Gras season in post-Katrina New Orleans. With only one week until the big day, thousands of tourists have flocked to the city, paralyzing traffic and jamming the French Quarter with drunken crowds and garbage. City officials are hoping for record crowds and record revenues to generate the biggest boost to the Crescent City since the “big storm.”

Alexander Lee Destephano, legal counsel for Crescent City Medical Center, a world-class hospital, is excitedly anticipating her third Mardi Gras Season and most of all, her date with dashing art historian Mitch Landry. The couple has tickets to the Endymion Extravaganza, the biggest Mardi Gras Ball in New Orleans at the Super Dome on Saturday evening. After many months, life is good again and Alex is determined to experience and appreciate everything it has to offer. She can hardly wait until Saturday evening.

But, things change. Alex is stat-paged to the Medical Center at 6:00 am on Monday morning only to learn from her boss, Don Montgomery and her former husband, Dr. Robert Bonnet that Grace Raccine, a cancer patient at CCMC and the first lady of Louisiana has been found unconscious in her room covered with blood with no visible injury. To compound matters, patients are leaving CCMC against medical advice and staff are refusing to work creating crisis and chaos in the Obamacare hospital environment. By the end of the day, the night with Mitch at the Endymion Ball is the last thing on Alex’s mind…

5-star praise from Amazon readers:

“[The author] combines…her knowledge…with complex characters and a few plot twists to create a real winner!”

“Involved plot, well woven, exciting pace. A very good mystery thriller.”

“Great story line…adds new knowledge and lore of…New Orleans.”

an excerpt from

Chaos at Crescent City Medical Center

by Judith Townsend Rocchiccioli

Chapter 1

The pungent smell of Cajun spices permeated the February New Orleans air. With only one week before Carnival, the French Quarter was blazing with activity. Ornate iron balconies bowed under the weight of dozens of people, pressed together tightly for a better look at the street below. Being “up” on a balcony during Mardi Gras was prestigious, giving one an immense sense of power and control over the crowd below. You could get people in the streets to do just about anything for a Mardi Gras “throw” — a string of plastic beads or an aluminum doubloon.

Raoul Dupree, a waiter at Tujague’s Restaurant, was smoking outside the door of the European-styled bistro. His eyes were riveted on a gorgeous man hanging over a balcony a few doors down. The man was teasing a lovely but drunk young woman in the street. The man fingered a string of gold beads in front of her and repeated “show your tits” continuously. Others on the balcony picked up the chant, and it became louder and louder, almost deafening. The young woman kept reaching for the gold beads, just to have them snatched from her grasp each time. She looked around and smiled drunkenly and benignly at the large crowds gathered nearby and above on the balconies. The man was smiling at her, taunting her and luring her to grab the beads. The chant had become louder and frenzied. Crowds on the street and adjoining balconies were wildly excited and picked up the rhythm, hollering, clapping and stamping their feet. Finally, in the flick of an instant, the young woman pulled up her white T-shirt exposing her perfectly shaped breasts. The crowd went wild, clapping and shouting with approval. The woman grabbed her beads held them up for the crowd and quickly disappeared into an alley.

Raoul smiled to himself, shaking his head. Mardi Gras still amazed him. After a lifetime of Carnival seasons, he still wasn’t used to the heavy partying, drunken and lewd behavior so common during the season. People would do anything for a Mardi Gras trinket. He shook his head and shrugged his frail shoulders as his eyes again located the handsome man just as a hand reached out and roughly grabbed his blonde hair and shoulder. Raoul startled and looked around quickly and saw the flushed face of the frowning Tujague’s maitre d’/bouncer.

“Your boys in the private booth are getting anxious, Raoul. Better get your skinny ass up there and keep ‘em happy. We don’t want any of those sons of bitches on our bad side,” said the burly maitre d’ said as he gestured toward the door.

Raoul stamped out his cigarette butt, grimaced and ran up two flights of steps to a private dining room where three men sat smoking after a long lunch. Tujague’s, the oldest restaurant in the French Quarter, had a reputation for privacy and discretion and was a meeting place for prominent New Orleanians engaged in all sorts of business legal and illegal. Privacy, circumspect service and seven-course prix fixe dinners made the restaurant a favorite.

The men were talking quietly as Raoul loitered outside the dining room.  One glance at the group convinced him not to interrupt. He recognized one man, but he’d never seen the others and wondered how they were connected. From what he’d observed, he didn’t think they knew each other well and doubted if they’d ever been together before. They didn’t seem to mix. After cocktails and several bottles of wine, the tone of their conversation had moved from strained politeness to menacing. The maitre d’ had wasted no words when he’d told Raoul to stay out of the room except to serve. Each time he’d entered the private booth conversation stopped.

The man Raoul recognized was Frederico Petrelli, better known as “Rico”, reputedly a mob boss from Chicago who’d recently moved to New Orleans to oversee the “Dixie Mafia’s” activities in the Riverboat and land gambling operations. Raoul knew Rico because he often dined at Tujague’s and usually had his special waiter, Matthew. Unfortunately, Matthew was off today due to injuries he’d received last week.

Raoul kept his distance as he eyed the group and decided he never wanted to run up against Frederico. He was in his mid-fifties, balding and at least 40 pounds overweight. He had a long irregular scar on his right forearm, and dark beady eyes. He glared at his companions with distrust and impatience. His thick pursed lips moved back and forth over a wet cigar in his mouth. Frederico was a classic picture of a vicious Chicago mafia boss.

The second man was also distinctive but in a different manner than the gangster. This man was tall, with a swarthy complexion. His dark oiled hair was pulled back into a ponytail. He had a long face with an aquiline nose and thin lips that seemed to curl in a permanent smirk. His eyes were strange, the color somewhere between a blackish-yellow, and they gave the man a sinister appearance. It was impossible to tell his age. He could be anywhere between 30 and 60. His body was big, well-proportioned and in perfect shape. Raoul was pretty sure about this because he spent most of his time visually undressing men and he could easily imagine the man’s six pack abs. His clothes were expensive, as was the gold medallion hanging around his neck. He wore dark trousers and a custom-designed dark shirt opened at the neck. He caressed a leather strap in his lap as if it were his lover as he alternately tapped his well-manicured nails against the hand-rubbed walnut table. His dark eyes moved side to side as he followed the conversation between the other two men. His eyes were unreadable and gave him a menacing and evil appearance. Raoul’s attention was drawn again to the leather strap in the ponytailed man’s lap as he continued to stroke the strap. The ponytailed stranger said little, instead following the conversation between Frederico and the third man. The ponytailed man gave Raoul the creeps, and Raoul rubbed away the chill bumps that had appeared on his arms. Raoul shuddered, thinking the man looked like the devil with those yellow-black eyes and dubbed him “the evil one”.

The third man was less distinctive. Raoul wouldn’t have paid much attention to him had his companions not been so macabre. The third man was about 40 years old with brown hair and an honest face. He spoke with a Midwest accent and seemed ordinary. The ordinary man was speaking when Frederico summoned Raoul into the dining room. Frederico rudely interrupted him.

“Give us sambukas all the way around. Also, a pot of  espresso, and get the fuck out of here,” Frederico barked at Raoul.

Raoul left quickly but heard the ordinary man say, don’t care what you do. I want Robert Bonnet ruined and dead. I don’t know what your interests are in the Bonnets and the medical center, but I want the man dead. He killed my wife and baby three years ago. Kill him. He had a wild look in his eyes, and was shaking. He appeared unstable.

Raoul’s ears picked up at the mention of Robert Bonnet. He knew Dr. Bonnet from the medical center where he worked as a volunteer on the AIDS floor. Dr. Bonnet had operated on his lover last year when no other surgeon had been willing to. Dr. Bonnet hadn’t cared that Josh had AIDS and would probably die anyway but had pulled strings to give Josh a chance to get a new liver and live longer. He’d given Josh a lot of comfort before he had died. Hearing threats against Dr. Bonnet encouraged Raoul to take a risk, and he paused for a moment, eavesdropping outside the room.

Frederico glared at the third man with a bored expression and said harshly, “Shut up, choir boy. No time for emotions. They get in the way of business and cause mistakes. No mistakes, you hear?” The gangster’s voice had become low and threatening as he glared at the ordinary man. “You make a mistake, you pay.”

The ordinary man, frantic, stared at him. The evil one with the ponytail simply nodded his head, said “Salute” and raised his cup in a toast.

Rico continued to glare at the ordinary man and said “Get it choir boy, no mistakes. You know what to do.”

The ordinary man nodded.

Raoul returned to the serving area, his heart thudding heavily in his chest.

                                   Chapter 2

“You’ve got to handle this, dammit, Alex. You do treat Robert Bonnet differently from the other staff physicians. This is the third complaint we’ve received against him in less than six months. Something must be done. That, as lawyer for this medical center, is your responsibility.”

Alexandra Lee Destephano sat on the edge of the sofa as she listened to her boss rant and rage. Don Montgomery was the chief executive officer at Crescent City Medical Center. Dissociating herself from his tirade, she glanced around the executive office. The office was stiff, formal, and uncomfortable and the décor mirrored the pretentious nature of Crescent City Medical Center’s haughty CEO. If fact, there was a likeness between the man and the office. Don Montgomery was tall and stiff in his Versace suit and Louis Vuitton watch. His thinning brown hair framed his cold unsmiling, face.

Alex likened her boss to a fish, but she was brought back to reality as he closed the distance between them and entered her personal space. Alex rose from the sofa and backed away from him. Overlooking the sarcasm in her boss’s voice, she prayed for patience and remembered the advice of her maternal grandmother, Kathryn Rosseau Lee of Virginia. Alex struggled for control and responded, “Why don’t we take a few minutes to review these claims and see if we do have anything serious against the hospital?  I am not convinced that we do.” Alex watched the frown flicker across Don’s impassive face.

The CEO stood up, walked to his office door, and opened it. “I don’t have time and that is not my job. I’m up to my ass in Obama Care bull shit regulations that are going to cost us millions, absolute millions, and I don’t have time to discuss your ex-husband’s inability to practice safe medicine. If you’re going to play ball with the big boys, you’ll just have to figure out how or get out.”

Alex could feel anger seeping through her brain and tried hard not to roll her eyes as Don continued his self-aggrandizing, “Don’t forget that I run this hospital. The financial success, image and future of this place are my responsibility. I have to second guess our competition and keep our market edge. No one here has any of the skills needed to assist me. Weren’t for my leadership, the board of trustees would have voted for that Health Trust merger six months ago.”

Alex was sick to death of Don’s proclaimed “Savior Behavior” and wondered if he lived in a vacuum. She doubted he realized the efforts of the physicians, staff, and volunteers were part of the success of the world-class and prestigious Crescent City Medical Center. Don consistently took credit for all accomplishments at CCMC and cast blame on others when things went wrong. She sighed as the CEO continued eulogizing himself.

“If I didn’t have a handle on internal and external sabotage we encounter daily, we’d be history. Only strong hospitals and medical centers with strong leadership will survive these times, but I can’t do it all.” Don paused his sermon for a moment and then shook his finger in her face.

“Now, take care of this problem immediately, dammit. I expect a report from you within twenty-four hours about how you’re going to handle the malpractice claims against Robert Bonnet.”

Alex was angry at the CEO’s disrespect and patronizing superiority but held her temper. “I’ll meet with Dr. Bonnet and the staff involved this week.”

As she left the office, her self-control barely intact, Alex wondered how many executives she was going to have to train. Don Montgomery was already the second CEO in her two-year tenure as in-house legal counsel for Crescent City Medical Center. She was beginning to wonder if she’d be able to stand it for another two years. Alex constantly wondered if she’d made the right decision in moving to New Orleans to practice hospital law. In all honesty, she wondered did she treat Robert Bonnet, her ex-husband, differently from other CCMC physicians. Sometimes feelings of uncertainty and guilt clouded her mind; she hoped it didn’t cloud her professional judgment as well. Alex’s thoughts returned to Robert as she left the executive offices and headed toward her own, continuing to think about Robert along the way.

Robert Henri Bonnet, M.D., was the chief of surgery at CCMC and a favored son of New Orleans. Alex knew that Robert was a skillful physician. They’d met over ten years ago at the University of Virginia in Charlottesville, when Robert was a resident in general surgery, and she was a doctoral student in clinical nursing. They dated less than a year before they married in a very small but circumspect ceremony at the UVA Chapel on the Lawn. Their union melded two of the most powerful families in the South — the aristocratic Bonnets’ of Louisiana and the powerful Lees’ of Virginia.

Her musings led her through the opulent atrium of the world-famous hospital into the Hospital Café where she ordered a Latte and continued to think about her failed marriage. The marriage to Robert had been perfect in the early years, and she still wondered when things had gone wrong. In truth, Alex rarely saw Robert at CCMC and knew little about his personal life. She was curious about Don’s angst towards Robert. Her intuition suggested that something was involved but she wasn’t sure what it was.

Alex reflected on her meeting with Don as she slowly sipped her coffee. Other physicians at CCMC presented greater legal risks than Robert. For instance, her greatest concern was the hospital’s internationally famous vascular surgeon who allowed his physician’s assistant to perform complex aspects of cardiac surgery. Another concern centered on CCMC’s nationally known cancer physician whom Alex suspected of practicing active euthanasia. She considered these physicians much more dangerous than a few complaints about Robert.

Alex had considered her former relationship with Robert prior to accepting employment at CCMC. Their divorce had been final for four years, and their parting had been amicable. Much of their difficulty had centered on Alex’s decision to go to law school and postpone having children until she established a law practice. Robert, a product of a traditional home, didn’t like the idea of a professional wife who worked outside the home. Over the duration of their marriage, their individual lives took separate paths — Robert’s in medicine and Alex’s in law.  The decision to end the marriage was mutual although Alex believed two miscarriages, during her third year of law school, were the major reason Robert divorced her. Robert had wanted her to quit school at the onset of the second pregnancy, but Alex had refused, noting that she was healthy and too close to graduation. Robert had become extremely depressed at the loss of the second child and declared they’d grown too far apart to continue their marriage. He had moved out of their home shortly afterward and filed for divorce.

She’d been hurt by the separation and divorce but knew it would have been difficult to build a life with Robert. After the divorce and her graduation from UVA law school, she’d accepted an offer from a chain of Catholic hospitals in Houston.

Alex’s tenure with the Catholic hospital group had provided her with experience and practice. Her nursing background added considerable depth to her ability to determine high risk and analyze potential malpractice cases.

Alex continued to mull over Don’s curious request as she looked around the glass atrium. Why did Montgomery want her to fix Robert? Her intuition nagged at her and suggested there was more than was apparent in the CEO’s behavior. She made a mental note to call Robert and speak with him soon.

As Alex entered her office suite, she noted that her secretary was late. Just as she finished checking email, her striking blonde-headed bomb shell Cajun secretary, Bridgett, almost six feet tall in red spiked heels, knocked on her door and came in.

“Happy Monday, Alex,” Bridgett sang. “We’ve got a new unbelievable complaint for the book. You’re gonna love it.”

Alex looked up and smiled as she waited patiently waited for Bridgett to continue her story.

Bridgett combed her long blonde hair back with her fingers and grinned. “Well, patient’s probably a nut bunny, but then what’s new?? Anyway, for the purposes of our book, she’s got a great story.”

Bridgett was dancing with excitement, dying to tell Alex about the new patient complaint. Her blue eyes sparked with the anticipation of her newest adventure in the legal advisor’s office. Bridgett loved her job, and she was good at it. She could sell ice to Eskimos in December and had prevented many lawsuits at CCMC simply by listening and being supportive of families in crises.

Alex laughed. “Is it better than the guy who came in for the penile enlargement but refused to wear his weights?”

Bridgett burst into renewed laughter again. “Unbelievable. Yeah, that thing never did work, did it? The surgery would’ve worked if he’d worn his weights, right? I mean, you gotta pull that old thing up and out to make it larger, right?” Bridge dissolved once again into laughter.

Alex shrugged her shoulders and grinned, “Who knows? To be honest, I don’t know much about penile implants, don’t really want to but I do believe that obeying laws of physics would have made the surgery successful.”

Bridgett, still laughing, thumbed through the book as she contemplated her answer. The Crescent City Medical Center book of The Craziest Patients Ever was a compilation of the most colorful, unusual and creative patient complaints known to the medical center. The addition of a new entry to the coveted notebook was a spectacular event made known only to a few individuals. Favorite entries to date included complaints from the penis man, another man who’d forgotten he’d agreed to have his foot amputated and complained later when he found it was missing, and the woman who had committed her husband to The Pavilion, CCMC’s psychiatric facility, and later sued the hospital for negligence after she signed him out against medical advice. And of course, there was the New Orleans Voodoo Queen who swore that the hospital had “taken” her magical powers after surgery. The suit had still not been dismissed and was being handled in the city court.

Bridgett continued to string Alex along, not telling her the new story until Alex erupted into a fix of impatience. “Tell me. Don’t keep me waiting.”

Bridgett hesitated a few more seconds. Finally she began,

”Well this one is straight out of the Emergency Department…”

“Yeah and….hurry up! You never know when we’re gonna be interrupted around here,” Alex said, as she scanned the outer office furtively.

“Well,” Bridgett continued, “This man came into the ED and told the admitting clerk that he had to see a doctor right away because he couldn’t talk…”

“Who was taking for him?”

“He was talking for himself.”

Alex stared at Bridgett uncomprehending. “I don’t get this. What am I missing? How could he not talk if he was talking?”

“That’s probably a good question. Well, I guess the clerk didn’t even pick up on it and sent him back him to see a doctor. Then they called in a throat specialist.”

“Terrific,” Alex said sarcastically, shaking her head and smiling. “We really have a bunch of rocket scientist clerks over there, don’t we?”

“Yep,” Bridgett replied, “but there is no new news there.”

Alex nodded agreement, “Then what?”

“He saw a doctor, some new guy to the CCMC ED who kept insisting to the patient that he could talk until the patient just sort of went bonkers, screaming and yelling and holding his head.”

“And then..?”

“The doctor left him alone and went out front, raging at the ED admitting clerks and then went to order a psych consult. About that time, the new throat surgeon came in and not knowing, saw the patient. Then a short time later the nurses heard a bunch of screaming and the sounds of stuff breaking coming from the guy’s room. When they went to check, the patient had broken all the IV bottles and equipment he could find, pulled all of the equipment out of the wall and jumped up on the wall-mounted TV and swung back and forth on the TV while it was still on the wall. The Price is Right was on.”

Alex looked at Bridgett, dumbfounded at the new story and at people in general. “What’d did the nurses do?”

“Called security but before they could get there, the man jumped down from swinging on the TV and ran out of the ED into the lobby where he turned all of the green plants over on the new oriental carpeting. If that wasn’t enough, he turned the water fountain machine upside down on the carpet making an enormous mud slide.”

Alex covered her mouth with her hand, “OMG, Don’s gonna have a shit fit. He just had those carpets installed…”

“You haven’t heard the end of it yet, Alex.”

Alex stared at her secretary, her eyes huge, “What else?”

Bridgett was now reporting at full capacity, her long red nails clicking against the desk. “Well, he pulled down all of the framed art in the foyer too and smashed all of the glass all over the marble floor.” Once again Bridgett dissolved into peals of laughter. “I heard Don almost had a heart attack when they called him.”

“Wow. I bet he just about pooped his pants,” thinking this must have occurred just after she had met with him.

“Probably. Anyway, the guy was apparently acting pretty crazy and people were afraid of him and ran away. When the area was clear, he ran over to the coffee kiosk and turned all of that over too. The newly opened marble foyer now looks like a black, gritty hell.”

“And the art collection is smashed to smithereens. Good Lord, how long did it take CCMC security to get there?”

“All of this happened very quickly, probably 3 or 4 minutes at tops. The guy was fast! The staff is calling him the “Monkey Man” based on his ability to swing from the TV in the ED. He’s also pretty good at slinging coffee and art.” Bridgett was laughing so hard her big blonde curls were dancing and tears and mascara were streaming from her eyes. “We’ve got some great pictures from cell phones and digitals. Don is going to have a shit-fit.”

“You got that right, if he hasn’t already.” The look of disbelief on Alex’s face was mingled with humor. “Pretty incredible. He spent millions on that renovation.”

Bridgett looked at Alex sideways. “Well, serves him right. Maybe he should spend that money on his staff and patients.”

Alex nodded and asked, “Does Monkey Man have a regular doctor?”

Bridgett looked at Alex sheepishly, “Yep, Dr. Bonnet.”

Alex raised her eyebrows and said sarcastically, “Huh, oh great. But why? Robert’s a surgeon. Why would he have a medical patient? Well, I need to see him anyway.”

“I think the guy is a charity case, from the clinic where Dr. Bonnet volunteers. Al,” Bridgett began and then hesitated for a moment, “There are a lot of rumors about Dr. Bonnet among the nurses and the administrators. I know people aren’t comfortable talking with you about him since he’s your ex and all….”

“What kind of rumors?” Alex’s voice was sharp, her former good mood gone. She knew Bridgett had good connections on the grapevine, particularly from her twin sister, Angela, a nurse in the operating room.

“Just that he’s been irritable and unpredictable lately, and some of the nurses think he’s been drinking when he makes rounds.” Bridgett looked at Alex’s face and was instantly sorry for repeating the rumor.

Alex’s face darkened. “That’s news to me. Keep me posted about our new complaint. Alex jerked her head toward the door, “I guess I better get to this pile of work.” She tried to sound noncommittal, but Bridge could tell she was concerned.

Bridgett walked towards the outpatient surgery department and thought about the ongoing battles between Alex and Don Montgomery. Bridgett couldn’t understand how someone couldn’t get along with Alex. Alex was great, a regular person. She was patient and kind and a bunch of fun.  Part of Alex’s beauty was she didn’t know she was beautiful. Besides that, she was really nice, a real down to earth person. Not snotty like that uppity female lawyer before her.

She hoped she hadn’t upset Alex. She felt a pang of guilt for talking to Alex about Dr. B. She doubted Alex even thought of herself as exceptional. She never seemed to notice how people looked at her when she walked into a room. If anything, Bridgett thought, her boss seemed a little shy and unsure of herself. Guess it takes a long time to get over a bad marriage.

Besides, losing Dr. Bonnet would be hard. He was so good-looking and kind, a real hunk. Her cousin told her he ran a free surgery clinic in the bayou. A couple months ago her cousin told her he’d saved the arm of a little boy who had been bitten by an alligator. He didn’t even charge the family. He was really good to the Cajun community. Bridgett flipped her blonde hair back and decided she didn’t believe the rumors about the handsome Dr. Bonnet.

After Bridgett left, Alex sat at her desk and pondered her secretary’s remarks about Robert. She valued her rapport with the nursing staff and was pleased that they, in spite of her law degree, still perceived her as one of them. Her relationship with them had come in handy more than once.

Alex reflected back to the times Robert had drunk more than she thought he should. She’d attributed it to the pressures of hospital life and hard work, although there were a few times when their own personal difficulties had seemed to cause bouts of heavy drinking, particularly after the miscarriages. She specifically recalled an episode concerning her refusal to quit school. It depressed her a bit to hear the rumors. Hope they’re just rumors, she said to herself. I don’t need this.

Several hours later Alex was immersed in a slip and fall case, when Bridgett buzzed her to say that Dr. Bonnet wanted to see her. Within moments Robert was in her office.

“Alex, how good to see you. How are things going?”

Alex looked up as she felt a blush creeping up her neck. At 42, Robert was an astonishingly attractive man. He was tall with sandy blonde hair and had the slight build of the New Orleans French population. His voice was deep and soft with a subtle Creole accent. His eyes were brown and expressive, kind eyes, she had always thought. Alex immediately stood and offered her hand. “Robert, how good to see you. It’s been a while.” Alex was stunned by her formality.

Robert’s eyes appraised Alex critically. “It has. This hospital is so big; months go by before I see many of my colleagues. Alex, you look beautiful! New Orleans agrees with you. Tell me about your family. How are Grand and the Congressman? I read in the morning paper that he’s here in New Orleans. Business?”

Alex felt a flush come over her again and she could feel the warmth as it moved all the way up and down her body. I can’t believe that I’m feeling like this about seeing him. I must look like a teeny bopper to him. She was breathless and a little nervous as she responded. “Yes, Granddad’s here. Some big political pow-wow, coalition building thing with Governor Raccine. Grandmother’s doing fine. She broke her hip last September, riding her horse. Fortunately, her fall didn’t slow her down much. Still rides every day. She’s still managing the family, the Washington house, and the horse farm.”

In truth, Alex’s grandmother, Kathryn Lee, was the strongest force in her life. Unlike her shy, reclusive daughter, she had an interminable strength, yet she was gracious and pragmatic. She had the patience of a saint and the soul of an angel. Grand had served as a role model for Alex all of her life and much of Alex’s strength of character and integrity had been inherited from Kathryn. Her grandfather often joked that Alex had inherited her grandmother’s bad points as well. Congressman Lee insisted that both women were the most stubborn and willful women on earth.

Robert smiled and said, “I miss seeing her. She’s quite the lady. How’s the Congressman?”

“The same. You know him — still serving the conservative people of Virginia. He’s actively drafting crime, drug, and immigration legislation. He’s totally opposed to Obama Care and voted against it. He’s convinced that it is going to ruin healthcare as we know it in this country. And, of course, he has his own ideas about health reform — and they don’t, as I’m sure you can imagine, complement those of the present administration.”

“I can imagine,” Robert replied wryly. “I’d think our views probably wouldn’t match but would serve for some lively conversation. I miss seeing them. You seen your grandfather yet?”

“No. He’s busy tonight. We’re planning to get together tomorrow afternoon. He’s taking the red-eye back to Virginia tomorrow night.”

“Give him my best. Get to the farm much?”

Alex nodded as her blue eyes took on a faraway look as she visualized her grandparents’ farm, “Wyndley,” located half-way between Richmond and Washington D.C. in Hanover County, Virginia. After her parents had divorced when she was three years old, Alex had spent most of her childhood at Wyndley with her grandparents and her reclusive mother.

“No, I’m hoping to get up for a long weekend in April or May. Virginia’s beautiful in the spring and Grand just purchased a new Arabian brood mare. Wyndley’s becoming a well-known thoroughbred farm. I need to get back there more often. It grounds me and helps me sort through things and get them into perspective.”

Robert nodded in understanding. “Yeah, I understand that. That’s why I often go over to my summer home in Gulf Shores. I went last weekend and, as a matter of fact, I’m going this weekend for that very reason to escape Mardi Gras. The ocean, sun, and a few nights at the Floribama bar will allow me to relax.”

Alex’s thoughts immediately returned to the rumors of Robert’s drinking. They’d spent many evenings “wasting away “in Gulf Shores, Alabama at the coveted Floribama Lounge, the legendary home of Jimmy Buffet where very few people left alert. Of course, the Floribama was gone now, washed away by Hurricane Katrina. “Be careful.”

“Will do. By the way, Don Montgomery said you wanted to see me. What’s up?”

Alex looked at him sharply, her paranoia kicking in. “That why you’re here? When did you see Don?” Alex was suspicious.

“Last week at a medical staff meeting.  He mentioned on the way out you wanted to see me. You never called, and today my morning OR schedule got canceled, so I just came by on the chance you’d be in.

Alex tingled with anger, and then suspicion set in. She felt ambushed.

“Did Don give you any idea about why we needed to meet?” Alex’s voice was distrustful.

Robert picked up on the suspicious edge to Alex’s voice. “No. Why? What’s going on?”

Noting the flush in her check, his voice raised, “What! Alex, no games. We go back too far to play games with each other.” His voice had a ring of concern in it.

Alex’s intent was to be professional, and she chose her words carefully. “Don’s concerned because we’ve received three complaints about you in less than six months. One will end up as a malpractice action. He thinks three complaints are too many for that period of time. Besides, Don really likes to micro-manage,” she added quickly, shrugging her shoulders.

Robert ignored Alex’s dig at Don Montgomery. He scowled at her and replied, his voice was reserved and formal. “I want to be clear here. I assume the action you’re speaking of is the one where the elderly gentlemen with cancer developed a post-operative infection and died following colon surgery.”

Alex nodded and Robert continued, “I warned the patient, the family, and the oncologist of this risk. He was a poor candidate because of his battered immune system; he was a sitting duck for a massive infection.” Robert stopped for a moment and reflected. He shook his head sadly as he thought about the man’s prolonged and painful death. “I’m not the only physician named. You should be able to defend that claim. After all, you are a UVA lawyer! What else?”

Alex flinched at Robert’s sarcasm, and her own stress began to increase as she felt her heartbeat pick up. “Let me pull the files. I can’t recall the other two off the top of my head.” As she left her office, her gut tightened and the nausea began to mount. She had a sick feeling. Something’s going on, she thought. What the hell is going on? He’s freaked. This isn’t the confidant, brilliant and self-assured surgeon I used to know. Alex took several minutes to compose herself and review the files before returning to her office.

Robert paced in Alex’s office. As he waited for her to return, he could feel his own anxiety rising. He couldn’t understand Montgomery’s behavior towards him either, and, combined with the other things that were happening, he was feeling unnerved. He was constantly getting bumped from the OR schedule for no good reason. Several people he’d worked with for years were acting strangely, some were actually avoiding him, and he’d been greeted frostily this morning by another surgeon. Something was definitely stewing. But what? Robert shook his head but continued to think as he felt a darkness descend upon him.

Alex found Robert deep in thought when she returned. He looked at her expectantly, his voice reserved as he addressed her, “Well, what are they?”

Alex turned papers in the file. “In November you did an abdominalplasty and a breast augmentation on Elaine Morial Logan. Now she’s complained that her new belly button’s disfigured, and her breasts are too large. She’s also complained that you were short-tempered and angry with her when she came in for her follow-up visit. Several weeks ago her lawyer called and threatened a malpractice action because his client maintains she never knew that her ‘new’ breasts were silicon and could possibly cause cancer.”

Robert face flushed with anger. “That’s a pile of crap. What bullshit.  We discussed the silicon controversy in great detail. Elaine Logan will never be satisfied with herself or her body. I didn’t want to do the surgery anyway because I knew there’d be trouble, and her psychiatrist, Dr. Demonde, agreed with me. All of this is noted in the medical record.” Robert gestured angrily towards the file on Alex’s desk.

“Why’d you do the surgery, Robert?” Alex gave him a curious look. She saw another flash of impatience as he responded, his voice disgusted and terse.

“It was political. I got a bunch of pressure from the hospital diversity committee. Apparently, she complained to some of the black physicians that I refused to operate on her because she was black. Of course that’s BS as well. Consequently, the committee and Don insisted, pressured me to do the surgery. They wanted to avoid any negative publicity from the Morial Logan family.”

Alex rolled her eyes, but she believed Robert’s story. She continued, “Well, according to Don, Elaine Morial Logan is causing us considerable negative publicity in the black community. I don’t need to remind you of her social standing or her network in New Orleans.”

“Hell yes, I know their standing. I am from here, remember?”

Alex grimaced at his response. “Robert, be careful what you say. This woman and her family are potentially dangerous to us, both politically and economically. Her husband represents St. Bernard’s Parish in the legislature. We’ve trying to get approval to build a new facility there. If her brother succeeds in his bid for mayor, CCMC will need him as a friend. We don’t need the Morial and Logan families as enemies.”

Robert shrugged it off, resigned, “Okay, Alex. Sorry. I still think you should be able to defend this. Where’s the complaint now?”

“Well, it comes before the hospital risk and medical malpractice committee in two weeks. If Logan files, we’ll settle out of court.”

“That’s bull-shit. You can’t be serious. I’ve done nothing wrong.” Robert, clearly angry, stopped for a moment. “If anything, I exercised extreme prudence by not even wanting to operate on this lady. I knew she was a problem. As far as I’m concerned, administration got me into this. They can damn well get me out. It’s a set-up, and I’m furious about it. That’s the last time I’ll be their damn patsy. What else?” Anger was clear in Robert’s voice as he slammed his fist on the table.

“The other complaint is an internal one lodged by several operating room nurses and techs who, at this point, must remain anonymous. They complained your behavior in the operating room is erratic and unsafe and that you are always short-tempered.”

“This is preposterous.  I have great rapport and working relationships with the OR staff. Who filed this? I don’t believe it.” Robert’s face was suffused with anger.

“Robert, you know I can’t tell you.”

“Tell me what you can, please.” He gave her his pitiful look she remembered from way back. She relented some.

“Well, mainly they complained of emotional and profane outbursts when you couldn’t schedule your surgeries to meet your time constraints. You exhibited some, and I quote, ‘acting out’ behaviors. They also report that you yelled at them when a sterile field was set up incorrectly.”

“Hell, yes, I was angry when they set the sterile field incorrectly the third time. That idiot, Bette Farve, keeps hiring these incompetent OR techs instead of RNs. Setting up the sterile field incorrectly delayed the surgery for forty-five minutes. Has anybody calculated what that cost the hospital in lost time and money? Besides, the patient had an additional forty-five minutes of anesthesia he didn’t need — that could have caused problems for him and us.” Robert shook his head disgustedly. “What’s the unsafe practice complaint?”

“It’s unclear. Apparently one of your patients died during surgery and one OR staff member maintains the reason he died was because you incorrectly hooked him up to the heart-lung pump.” Alex set the file down and looked hard at Robert.

His mouth flopped open. He was shocked. “That’s absurd. I don’t even do that, the cardiac techs do.”

“This OR staffer says you rarely, if ever, check the settings on the pump. That’s the unsafe practice complaint.”

“Dammit, that’s their job. They’re licensed to do it.” Robert stood and began pacing around Alex’s office. “Something’s wrong here. This is a witch hunt. Has to be. I don’t understand it. I need to go, Alex, and think these things over. I’ll talk to you later.”

As Robert left her office, all his attention was focused on the barrage of complaints against him. He didn’t see the tall dark-haired man with the swarthy complexion outside of Alex’s office.

Alex decided to pack it in. It had been a really long day.

Chapter 3

Alex walked home from the medical center. She lived in the Riverbend area of the city, less than a mile from the hospital. Crescent City Medical Center was located on Prytania, between St. Charles Avenue and the river, in the shadow of Interstate 10. The location allowed easy access to its hundreds of patrons. Alex’s home was a few blocks off St. Charles and she could, weather permitting, easily walk back and forth. The horrendous New Orleans traffic made walking preferable to driving and the exercise benefits were another boost.

As Alex reached home, she smiled at how well the restoration of her house had turned out. She’d decided to live in the Riverbend area of New Orleans because the neighborhood was convenient to work, and she loved the architecture. She’d purchased a large town house shortly after arriving in New Orleans, and divided it into two apartments, renting the lower flat. The house was built in 1875 and could be easily hailed as “Old New Orleans.” Many of her favorite restaurants and shops were within walking distance.

As Alex reached her front courtyard, she was jarred out of her daydreaming as her cell phone began ringing. Searching for it in her purse, she opened the front door only to note the obviously loud ringing of her house phone. She immediately felt a pang of guilt as she heard the deep voice of Mitch Landry on the other end. She answered the phone and smiled as she heard Mitch’s anxious voice on the other end of the line.

“Alex, you haven’t forgotten our dinner plans have you? I’ve been calling and calling for an hour.”

Alex smiled into the phone. “No, of course not. I’m sorry, I should have called you. I just walked in. It’s been a long day, and, to be completely honest, I’ve been tied up all day. But, I’m starving, ready and willing. What’s the plan?” Her voice was light-hearted.

Mitch checked his watch. “Well, it’s now about six-thirty. Pick you up at eight? I’ve reservations at the Cafe Degas for eight-thirty.”

“Sounds great. See you then.”

As Alex hung up the phone, she felt guilty about forgetting her date with Mitch. Most people would die for a male companion like him. He was handsome, intelligent and well-connected. As an architectural historian and preservation consultant, he’d never be wealthy, but money seemed unimportant to him. Mitch was a pleasant escape from her day-to-day grind at the hospital and offered refreshing company. Besides, Alex smiled to herself, Mitch was very sexy, and she really liked him.

Her spirits brightened as she showered, dressed for her dinner date, and found herself mentally comparing Mitch with Robert. They were entirely different, she thought, in appearance and personality. Mitch was tall and dark with a muscular build. Robert was of slighter stature with much lighter coloring. Both men had a fervent passion for their work and both men were self-absorbed in their careers.

This is ridiculous, she chided herself. Why should I compare these two? My marriage to Robert has been over for years. It’s crazy for me to even be thinking this way. Robert’s completely out of my life. But, in all honesty, Alex had to wonder about her reaction to him today in her office.  She heard the door bell ringing and saw Mitch standing between the two Grecian Columns in her courtyard. She answered the door, her heart beating rapidly.

Mitch looked devastatingly handsome as he stood in the door frame. He was perfect, too perfect Alex sometimes thought. He had on dark trousers and a white shirt open at the neck. He was in excellent physical shape and Alex knew he worked out most days. His wavy dark hair was combed back from his face. He was tall, dark, handsome and exciting.

Alex’s heart began beating a little faster at the sight of him. Once again she wondered why Mitch, whom she’d been seeing exclusively for over four months, was reticent to start a physical relationship with her. At first, Alex had been relieved that Mitch hadn’t pressured her into intimacy. Yet, several times she’d found she feeling vulnerable and rejected at the end of the evening. It was probably residual feelings that stemmed from her father’s and Robert’s rejections of her.  More recently, Mitch seemed to be moving towards intimacy again, although his usually warm and inviting conversation often became stilted and aloof at the close of the evening.

Mitch’s eyes lit up at the sight of Alex, and he appraised her admiringly. “You look great… That teal color of your dress sets off your eyes, and I like your hair down. You look so carefree and comfortable.” Mitch groped for the proper words.

“I know, relaxed and casual. Bridgett tells me the same thing. I guess I must look like an old maid at the hospital. To quote my idiotic boss, ‘I have to dance with the big boys, so appearance is important.'” Alex paused for a moment and inhaled the fragrance of the spring flowers. “These flowers are beautiful. How about a glass of wine?”

“Sure. I told Andre at the Cafe we may be a little late.  Do you have any of that Virginia Chardonnay we enjoy so much? I’m pretty impressed with Virginia wine.”

“The Chardonnay is from Barboursville Vineyards, near my grandparents’ farm. Help yourself. I also have some Brie, heated with honey and almonds, on the coffee table in the living room. I’ll be in as soon as I arrange these flowers.”

Mitch poured two glasses of the Chardonnay in Alex’s wine glasses and gazed appreciably around her living room. The furnishings were impeccably beautiful, simple, and elegant, just like Alex. It’s funny how people reflect their homes, Mitch mused, as he studied the lovely walnut library cabinet on the wall opposite the sofa. As his eyes continued to survey the room, Mitch again noted the architectural design of the flat. The heavily carved mantels and decorative woodwork in the living and dining rooms were left natural, and pale blue silk wallpaper pulled together the pastels in the living room.

Alex returned with the fresh flowers in a cut-glass vase which she placed on the dining room table. She seated herself on the sofa next to Mitch.  After reaching for her wine and taking a sip, she asked, “How’s your newest project going? Did you get your historical foundation funding for the Acadia Village Project?”

Mitch’s face showed the animation he felt for his newest project. He’d been chosen to plan the preservation and restoration of a small settlement of historical structures in southwest Louisiana. He was delighted at the opportunity to finally pursue rural preservation. Since most of his work had been done in the French Quarter and in the Garden District, the opportunity to work on rural preservation would showcase his knowledge and ability in the areas of Creole and Arcadian architecture.

Mitch smiled and answered her question. “Yes. It’s great. Next week I begin the Arcadian Village in Lafayette. Would you like to visit the project? It’s a nineteenth-century Cajun settlement and it represents rural Louisiana.” He continued, “Let’s plan a weekend soon so you see the work as it unfolds.” He looked at his watch.

Alex warmed at the possibility of a field trip to Mitch’s architectural projects. “So I can have a full appreciation of your talents,” Alex teased. “I would love to. When can we go?”

“Soon, but I haven’t done anything yet.” Mitch glanced again at his watch and said, “We had better get going. We don’t want to keep Andre waiting too long. I’d hate to lose our table.”

As they left her apartment and walked toward Mitch’s car, Alex again savored the New Orleans night, and the fragrance of lilac and wisteria created an aura of romance. As Alex slipped her hand into Mitch’s, she felt him stiffen slightly. She felt rebuffed and wondered why he continued to see her. He doesn’t seem to have any sexual interest in me, so what’s this all about, she thought to herself. She didn’t understand his reticence. They seemed to go well together and had similar interests. He did seem to care for her and was warm and generous with his time and his gifts.  Besides, she liked him better than any male companion she’d had since her divorce. That made it even harder to accept.

The ambiance at the Cafe Degas was perfect. Like many fine restaurants in New Orleans, it had an eclectic decor. There were no side walls, only louvered shutters in case of extreme cold or rain. The evening was almost warm enough for al fresco dining, but Mitch, fearing the night would turn cool, ushered Alex to a table in the corner.

The cuisine at the cafe was excellent. After listening to the specials, Alex choose beef and Mitch selected crepes.

Their dinner conversation revolved around various topics.

“Your grandfather’s in town. Read about it this morning in the paper. How’s he doing?”

“Great. I talked with him earlier. He has a meeting tonight and he’s leaving late tomorrow. We’re having drinks tomorrow afternoon.”

“Are he and your grandmother staying with you?”

“My grandmother isn’t here. He’s alone and staying at Palm Court. It’s a quick trip. Some political brouhaha, I’m sure. He’s especially good at those.” Alex smiled, thinking of Adam Lee’s particular talent of making people see things his way. “My grandmother swears the Congressman could make a leopard change his spots if given enough time.”

Mitch picked up on her smile. “You’re close to them, aren’t you? Any chance I’ll ever get to meet him?”

Alex, surprised, was taken back. “Umm,no. I doubt it, at least not this visit. He’s tight for time. I’ll introduce you to both of them later. They’ll be here in June for another meeting.” She could feel a warm flush come over her face. She felt a little guilty about denying him the chance to meet her grandfather. She hoped Mitch wasn’t put off by her response.

Recognizing her embarrassment, Mitch reached for her hand. “Sounds good to me. You ready for the Extravaganza Saturday night?”

Mitch had invited her to the costumed ball sponsored by the Krewe of Endymion. The Endymion Extravaganza was this weekend and was the largest and most lavish ball in New Orleans.

Alex had been anticipating the ball for weeks. She’d gone overboard in having Yvonne LaFleur design a sumptuous gown for her, justifying the purchase with the idea she could wear it again in a few years. Alex was hoping the Endymion Extravaganza would be the beginning of an intimate relationship between her and Mitch. They’d decided to stay overnight at the Fairmount Hotel, the night of the ball, and had plans to spend the weekend in the Quarter. She smiled in anticipation.

“Alex, am I boring you? What are you smiling about? You’re in another world.” Mitch’s eyes were warm over the candlelight.

Alex was immediately apologetic. “Sorry. I was thinking about the Extravaganza and how much fun we’re going to have. I’m looking forward to it. What were you saying, Mitch?”

“Nothing important. How about some cafe au lait and cheese cake? Buy the whole thing and you can take it home. I know how much you love it. It’ll be the perfect ending to our meal.” Alex nodded in agreement.

“How are things going at the hospital? You seem a little distracted tonight?”

“Busy. Health care’s changing everywhere, and we are trying to prepare for Obama Care, which none of us truly understands. Nobody understands the health care bill. Not even Obama. The legislation is over 1,000 pages! There are all kinds of fears and concerns over health reform and the whole health care environment is fiercely competitive and focused on cheap care but good results.  I know it’s going to cost us millions and we will see significant job losses in health care providers, especially nurses, because reimbursement will decline. Most small to medium size hospitals are estimated to lose at least a million dollars a year in Medicare reimbursements.”

    Alex noticed that Mitch was paying rapt attention and continued, “Obama Care includes $575 billion in cuts to Medicare to pay for a Medicaid expansion to provide health care for the poor, but these cuts are going to hurt those of us in acute care. The elderly are our most expensive and costly patient population. It’s real competitive here, more than in most places, or at least that’s what I hear from my colleagues. Look what’s happened here in the past few weeks. American Hospital Corporation bought 80 percent of Tulane for $180 million. Then, they immediately merged with Health Quest and formed another huge conglomerate. Health Trust, as it’s known, now owns twenty-five hospitals in Louisiana. It’s going to be difficult for smaller hospitals to compete with these big boys.”

     Alex paused for a second, thinking to herself and continued, “Health Trust even has international holdings, and, when you factor national health insurance programs into it, the times will be dangerous at best and the outcomes and quality of care uncertain, mostly like substandard to outcomes now. These huge conglomerates are buying up hospitals in Europe, specifically in England and Switzerland, and I understand they’re even negotiating with hospitals in South America.  Makes you wonder who’ll still be in business in a few years with the fierce competition. It’s a turbulent time for healthcare.”

Mitch was listening closely and responded, “How many hospitals can they buy without it being a monopoly?”

Alex looked speculative. “All but one, I suppose. I’m not as worried about monopolies as I am about legal risks and cost-cutting to save money on patient care. Hospitals are struggling to survive.  These mergers and buy-outs affect a hospital’s credibility and image. Obama Care is going to make things even harder and more expensive. Look what’s happened recently in Florida and in Boston, especially the hospital that gave 10 times the amount of chemotherapy drugs and killed the patient. These errors are tragic and have long term consequences. It’ll take those hospitals years to recover from the negative publicity.”

“Yeah. You would think a cancer center would know how to calculate the correct chemotherapy medicine. Those patients’ families were really angry and the press had a field day with it.  People pick hospitals because of their doctors, don’t they?”

“Used to, but now they have to go where their insurance company will pay. Big business and insurance companies run health care now. They control health care and who gets it. Obama Care will only make it worse and more costly.  Remember when hospitals first started advertising and using slogans like, ‘the best care in town’ or ‘caring made visible’ or ‘the finest doctors in the country?'” Mitch nodded, and Alex continued.

“These slogans have come back to haunt us, becoming the basis for malpractice suits. Sometimes patients don’t believe they got the best care or the finest doctors.”

“Are these claims defensible?”

“Many are, some aren’t, depending on the facts of the case. Information systems make it possible for patients to search data bases kept on health care practitioners. For instance, a patient can find out whether a practitioner has ever been sued.”

“Sounds like the medical information explosion to me. Pretty scary for doctors and nurses, I would imagine.”

“It is. Patients can even learn how much money the physician earns. That adds even more fuel to the fires of malpractice actions. It’s all part of the consumer rights movement.” Alex was pensive as she stared into her water glass.

“You mean that if patients experience bad results from surgery or medical treatment, they can do their own research to build a malpractice claim?” Mitch looked surprised.

“Sure. Even more disturbing than the actual malpractice actions is the amount of publicity they receive, and how that publicity impacts the image and reputation of a hospital. I predict those hospitals in Boston and Florida will lose millions in revenues in the next couple of years. Times are tough. Many smaller and less powerful hospitals will be bought and closed by big corporations to decrease competition and costs. Others’ll be forced out of business.  We’re already seeing that in New Orleans.”

Mitch set his coffee cup down and pondered her remarks. “Many people think physicians make too much money anyway.” He looked at Alex sheepishly. “Of course, people say the same thing about lawyers. You think the Obama Care will remedy any of these problems?”

Alex was quick to reply. “Nope. It will make it worse. CCMC is currently in pretty good shape financially because of our large international population. They represent a significant portion of our revenues.”

“How do you think CCMC will do in the long run? You think anyone will buy them?”  Mitch looked at her intently.

“Don’t know. Someone tried a few months ago, but our board of trustees voted it down. They’re adamant we remain independent.  I know we’re in for a long haul.” Alex sighed, “I can’t even predict what’ll happen tomorrow. Another huge problem is the loss of Charity Hospital during Katrina. The city and hospital community has been struggling with how to care for Louisiana’s poor, and disenfranchised population. It’s gonna be a bumpy ride, no question about it.”

Mitch stifled a yawn and looked as his watch. “It’s getting late. Best be getting home. I don’t want to keep you out too late.” Mitch stood and helped her with her chair. Then the handsome couple walked hand-in-hand through the balmy New Orleans night.

At her door Mitch tentatively kissed Alex good night. “Call you soon. Sweet dreams.”

“Thanks, Mitch. It was a lovely evening.”  Alex entered her flat and returned to the living room to clear away the wine glasses and cheese tray. After straightening the kitchen, she returned to the living room to close the French doors leading to the roofed balcony. She stepped outside again to enjoy the fragrant New Orleans night.

Once outside, she was surprised when she noticed Mitch on the opposite side of the street talking to a short stocky man with a cigar in him mouth. Strange, she thought to herself. It’s after midnight. I’ll have to ask him who that was. She watched the pair several minutes. After a few minutes the men parted ways, and Mitch headed towards his car.

***

Congressman Adam Patrick Lee sat impatiently in his room at the Palm Court Hotel. For the tenth time, he dialed Alex’s number. No answer. Where in the hell is she, he thought to himself. It’s almost midnight. Damn, I wish she didn’t live here. This city’s full of creeps and perverts. He had hated New Orleans for years, and was convinced that the city had robbed Alex’s mother of her youth and her sanity. He still blamed New Orleans for her final, anguished mental break and the silence she had lived in for over 30 years.

Fucking nasty city, he thought as he impatiently redialed Alex’s home phone. His hand still stung from where he’d cold-cocked some kid trying to pick his pocket