Chapter 2 Violated
Even though she loved being in the mountains in Taos, and seeing Gran and Chris and Andrew, Claire had slept restlessly and woke early while they were there. Tonight, if things worked out, she could take care of some work so she could devote time to replacing Sandra. If things went her way, she’d be back home before the kids went to bed.
She drove the one-block-long alley behind the clinic. Even though it wasn’t quite dark, the sun’s rays sliced low across the building, casting a long shadow. Without leaving her vehicle, she saw the back door was closed. At the end of the block, she turned right and then right again onto Jackson’s Pond’s main street, passing the empty corner storefront where a faded sign, “Hardware,” hovered above its awning. Next, her clinic waited, in the middle of the block.
She parked head-in against the curb, and noticed the white door and the long windows that usually added a bit of sparkle to the line of fading storefronts. But this evening, shadows emphasized the empty sidewalk. No sparkle anywhere. And here she was, alone in an empty town with a single stoplight two blocks away. She watched its steady blink in her side mirror.
Seeing the clinic’s bright sign—red and black letters on white—Jackson’s Pond Wellness Clinic—always prompted her to smile, as if a patient might be watching from inside. Not tonight. She had too much to do. Finding a replacement for Sandra wouldn’t be a simple chore. Recruiting to a small town, for the salary they could pay was tough. Finding Sandra had taken months. At the time she had hired Sandra, Claire had wondered if she and Susan, the other nurse practitioner who staffed Calverton, had settled because they were feeling desperate. But she’d plunged ahead, and now Sandra had quit. That gave Claire two weeks, beginning tomorrow morning, to find a way to keep both clinics running. Tonight she’d take care of all the catching up—review charts of patients seen while she’d been in Taos, identify any billing problems, inventory medication supplies. She told herself to stop thinking about J.D. and his bull sale, and to get inside and take care of her own business.
But she didn’t move. As if it happened yesterday, the night she’d decided, definitely, she’d open the second clinic pushed aside her already jumbled thoughts. Two years ago last July, wiping the kitchen counter after supper, she’d said to J.D. “I’m thinking of opening another clinic. The two docs in Calverton have closed their practices to new Medicare and Medicaid patients. People end up in Emergency because they can’t pay. There’s a real need.”
He shook his head and said, “I don’t see how you can do any more. You always take on too much, plus there’s the kids and all you do here at home.”
She’d wanted to tell him that if he helped at all, the kids and things at home wouldn’t be a problem. But she knew what he’d say—that it didn’t have to be all or none. He’d say that and then they’d be off the subject again. Instead, she said, “I’m just going to be supervising. I’ll hire another NP.”
His only response was a long silent stare.
Not waiting for him to speak, she said, “You know I can handle it. Remember I managed graduate school and being pregnant with Jay Frank and Amy a toddler and I’ve never failed to do everything both of them need and take care of you, not then or since I started the Jackson’s Pond Clinic.”
He interrupted, “Yes, and you won’t let me or anyone help with any of it, even if I offer. You don’t have to prove a thing to me. And just so you know, I’d be happy if you hired a housekeeper, or if you never took care of another patient again.” Turning to leave the room, he said, “I’ll say it again, you take on too much. But you’re going to do whatever you want to, so I might as well save my breath.”
After he left the room, she scrubbed at a cast iron skillet, muttering, “I’ll be damned if I hire a housekeeper.” The next day she started searching for a clinic site in Calverton.
She’d felt then as if she’d made an important beginning. Tonight she wondered . . . but she didn’t have time for wondering. There was work to do.
She got out, pulled her tote bag across the seat and hoisted it on her shoulder, closed her door, and pressed the lock button on her key fob, focusing on each action as if it were critical. It was the way she’d taught herself to avoid making dosage errors prescribing meds for children. Now the step-at-a-time sharp focus had become habit.
Three years ago when she and her dad renovated the building, he had wired switches, one just inside the front door and another inside the back, to operate all the lights at once. He’d said, “Anyone who comes in here when it’s dark should be able to light the entire place, for safety.”
She had agreed just to please him. Since then there had been several nights and early mornings she’d been glad he’d thought of the precaution. Not that anyone had ever bothered her when she was here alone.
“Is anyone here?” she shouted into the dim space, knowing it would do about as much good as whistling in the dark.
Locking the front door behind her, she left the reception area and quickly checked each of the four exam rooms, the restrooms, and the storage room, then opened the door wide on the other office and hers. Everything looked right, like Friday had ended in a rush. On the counter in reception, billing sheets and charts in neat stacks showed there had been several patients that day.
She pulled on the handle of the cash drawer. It slid open; it shouldn’t have. Claire pushed aside the reception desk chair and pulled the drawer out its full length—no metal organizing tray, nothing. She shot a look toward the front door. Still locked. She sat, not sure her legs would hold her, dizzy, her heart rate rapid. A deep breath, held for twenty seconds, then exhaled slowly settled the tachycardia. It didn’t stop the question that thundered in her mind—what else might be missing?
Most patients wrote checks for their co-pays, but occasionally one paid cash. Clinic procedure stated there would be one hundred dollars in small bills for change placed in the drawer each morning. At closing time, any excess would be taken to the after-hours deposit near the bank’s ATM, and the hundred would stay locked in Claire’s office in her desk drawer. Anyone planning to steal, who might have watched Laverne working, would see the empty organizer and presume there was no money left in the building overnight. At least that was their thinking when they came up with the procedure.
Laverne, the receptionist, had taken care of that money as if it were her own, each day since the clinic opened. And she never took out the drawer organizer. She called it “our decoy.” And she never left that drawer in reception unlocked, not even after she put away the change in Claire’s desk at night.
They had posted a small sign on the front window, No Narcotics Kept In This Clinic. But anyone who’d ever been handed a packet of samples knew there were other drugs.
She had to focus. Slumped, head in hands, Claire tried to form a list. The first thought—call the Sheriff—made her shake her head. No, first get more information. She had been gone. Friday had been the only day clinic had been open without her. Surely Laverne could explain, or had left a note.
The med room and her office were the only places Claire hadn’t checked closely. She stood and pushed the drawer closed with her knee, realizing as she did she’d already smeared any fingerprints. Whatever made her want to operate a clinic, much less two? She hurried toward the back to her office.
On her desk, in the center, lay an envelope with her name on the front. Unable to find the letter opener that belonged next to the telephone, Claire ripped an end off the envelope and shook out the single sheet of paper. She scanned the page. It said the change was locked in her desk. After reading the second of the two brief paragraphs, she dropped the paper and exhaled, air rushing through her nostrils with the hiss of a tire deflating. The nurse practitioner who’d turned in her resignation had left and said she would not return. Said she had a family emergency and had to leave town, couldn’t work out her two weeks’ notice. A male, Laverne didn’t know who he was, hung around inside the clinic and outside in an old pickup, from noon until Sandra left with him at a quarter of four.
On the back of the envelope, Claire started a list, each item headed by a heavy dot of the pen, inserting equally heavy, dark question marks for missing information:
• Cash organizer missing or out of place.
• Sandra Berry, NP left without working out her notice
• Berry left clinic before close of business. A patient arrived after she left and was turned away due to her absence. Not an emergency patient.
• ? Charts completed for patients seen
• ? If charts complete, any errors in care/charting
• ? Took only her own possessions when leaving?
Claire’s ballpoint ground a hole in the envelope as she made the last question mark. She stopped writing and fit the key into her desk drawer’s lock. She turned and pulled on the handle. It wouldn’t open. She rotated the key and the drawer slid open. It had been unlocked. There lay the one hundred dollars in small bills, wrapped in a wide red rubber band. She exhaled and sat back.
Because the volume of patients at the Jackson’s Pond location was low, but steady, averaging around fourteen daily, only two people were on duty each day. The nurse practitioner was with the patients from the time they left the reception area until they returned there to check out. Laverne did reception, record keeping, and insurance billing—and everything else. The practitioner cleaned the exam table and equipment after each patient. A woman from town came in each morning at 7:30 and did all other cleaning, supervised by Laverne, who worked from 7:30 until 5:30. The day’s last appointment or walk-in patient was taken no later than 4:45. Laverne locked up after Claire or the other NP left, no later than 5:30.
At least that’s what their written procedure said. Claire sometimes stayed after the door was locked, to audit charts from the days the other practitioner was on duty, or to finish up her own charting. Sometimes, recently, she’d just sat in her office, waiting for the whirling in her head to stop.
In the med room, the samples left by pharmaceutical reps, plus stock drugs were organized by category—antihistamines, cough remedies, bronchodilators, SSRIs, antibiotics, statins, drugs for hypertension, for diabetes, miscellaneous—in locked cabinets above the counter that occupied all of one side of the eight by ten foot room. Vaccines and some other injectables were refrigerated. The sign in the front window told the truth. Anyone in pain acute enough to require an injectable pain med, even something non-narcotic like Tramadol, they sent to Emergency at the hospital in Calverton.
A ring binder on the cabinet top held an inventory sheet for each drug, stock or sample, with spaces for each item dispensed, patient name, and stock remaining, plus initials of the nurse completing the entry. Reminding herself, again, to breathe, Claire inhaled. An odor of sweat and grease gouged at her as she rifled through the categorized, alphabetized pages. She lifted the notebook near her face and sniffed—definitely something there. Thinking of fingerprints, she pulled on exam gloves and turned to the first page of antihistamine/decongestants—Allegra D.
Purchases of pseudoephedrine, either alone or in combination meds, such as Allegra D, were documented in pharmacies. Anyone stupid enough to try cooking methamphetamine from those drugs would also probably be dumb enough to steal them to avoid the control process in a pharmacy. Cooking the meth required only a secluded spot, some rudimentary knowledge of the process, equipment scavenged or stolen from junk piles, and a view of right and wrong Claire couldn’t comprehend. She leaned toward the pages and sniffed again. Grease and something else, she couldn’t quite place.
According to the Allegra D page, there should be twelve boxes of samples containing four tablets each. Her initials showed on the last entry, five days ago, dispensing two boxes to Amos Gutierrez—14-2=12 in stock. As soon as she unlocked and opened the cabinet, she saw too many empty spaces. Every speck of pseudoephedrine, no matter what brand or combination, was gone. She slammed the cabinet door, locked it. This wouldn’t keep until tomorrow morning.
I HOPE YOU ENJOYED THIS SLICE OF CHAPTER 2!