The Protocol: A Prescription to Die (3 page)

Dying required a million signatures.

He wasn’t really looking at his father’s
cremated
remains. He was looking at the
pulverized
remains of his bones that didn’t disintegrate during the cremation process: femur, tibia, fibula, skull, ribs, radius, ulna, humerus, and pelvis. And probably a few teeth for good measure. Everything else that was him had bubbled, erupted, melted, and broiled away to finally be blown through an exhaust pipe masked with a plethora of filters and ultimately released into the fresh, Minnesotan air.

Eat thought it ironic that before the box was delivered, one of the last things his father had come in contact with was an enormous food processor.

Eat didn’t really know what to expect when he first gazed at the contents within the bag. If he didn’t know any better, he would have guessed that the bag was filled with two scoops of the $7.99 concrete mix that anyone could buy at a hardware store.

He wasn’t trying to be disrespectful, but Eat stuck his right index finger into the ashes, and stirred it around. It wasn’t at all what he was expecting, the ashes where relatively soft to the touch.

He was holding a bag of grey baby powder in his lap.

As he was stirring, his finger brushed against something larger within the ashes. He reversed his finger’s path and hooked it to bring whatever it had come in contact with to the top. It looked like a long dumpling floating at the top of a bowl of gray stew, but when he flipped it over with his fingernail, it became clear what it was.

A chunk of bone.

It was about as wide as his pinky finger, and almost half as long. It wasn’t a full, rounded, piece as he could see the latticework and center channel that once held the marrow. His stomach flipped and he had to swallow to keep down the contents of his stomach, however empty it was at the moment. He wasn’t expecting to see anything of real substance remaining of his father.

Ash was one thing.

Bone fragments were another.

He pulled his finger out of the ashes and used his thumb to press the bone fragment down as far as possible.

He didn’t want to see it.

He wanted to pretend that his spelunking in his father’s ashes never happened.

But Eat had a job to do.

Eat decided to take small steps, and work his way up to emptying the entire box. Using his thumb and forefinger, he withdrew a pinch of ashes out of the box. He placed the box on the ground, stood up, and walked closer to the flowing St. Croix.

“Here’s to you, Dad. I’m at the Flanding. Miss you,” he said as he released the pinch of ashes.

Nature was weird.

It seemed to have a sense of humor, and a plan of its own. Eat wanted the ashes fall straight down onto the water, but they were so light, they just twirled in the slight breeze, wafted back towards Eat, and stuck to his pants as if attracted to a magnet.

He remembered swearing, and subsequently apologizing to his father. Four letter words should not be used when trying to spread your father’s ashes, even just a pinch. Eat patted his pants, but it just made things worse as the remnants on his finger and thumb smeared his pants even more. His black Chinos now had streaks and uneven whitish-gray blotches on the left leg that made it look like he’d just lost a fight with a bag of flour.

*

Eat came so close that day; closer than he’d had ever come before to actually doing it. But the gust of wind that twirled around where he stood had re-planted the roots of the indecision that he hoped were successfully weeded out. Later, Eat truly believed it was his father telling him to chill. There was more for him to know before he did anything with his ashes.

Eat re-tied the bag, slowly closed the lid, and re-secured the golden clasps, effectively re-imprisoning his father in his wooden coffin. As he stood up, he folded the director’s chair, and leaned it against his legs. He zipped his jacket up, and returned to his car with the box of ashes secure in his hands, and the chair tucked into his armpit.

Eat surrendered to Mother Nature.

Another Saturday was only six days away and he’d surely spend another week building the courage to try again.

At least that was his intent.

That’s not how things turned out.

Chapter 2

Barbara Nordstrom sat in her office overlooking the Mississippi River. It was Saturday morning and it felt as if she’d never left the office on Friday; that she’d been stranded here all night. She quickly and quietly sniffed her armpits to make sure that she had, in fact, remembered to shower this morning.

She was born and raised in Los Angeles, and thought that being relegated to the bowels of Minnesota was the worst kind of punishment conceivable. She hated it here, and for good reason.

The locals were too nice.

If she dared venture beyond the city limits where the land was extraordinarily flat, and consisted of oceans of corn, wheat, or sunflowers instead of civilization, everyone drove a pickup instead of a real car, like her Mercedes. Many even went to church on Sundays. Most had some sort of gun, although she had to admit that she carried one too. The one she owned just wasn’t on a rack in a beat up Chevy pickup, or strategically placed within the antlers of some unlucky deer.

Barbara stayed within the city confines.

At least there was a hint of culture here.

The weather was another story. There was the snow and frigid temps from Halloween to St. Patrick’s Day. Sometimes to Easter or even Memorial Day. As an additional benefit, when the snow finally started to melt, there was no way in hell to keep her car clean. When the snow and mud finally vanished, summer moved in with humidity, mosquitoes, and ticks.

Wood ticks.

She hated those things.

She could not fathom how some people could call this boil on a pig’s ass paradise, but evidently they did. Some people called this place home, and never left to discover the true paradise on the Pacific coast.

Nonetheless, she was here for a reason. She would try to make the best of it knowing that there was an end in sight. Barbara was the author of America’s new healthcare guidelines, and the chair of the IPAB, the Independent Payment Advisory Board, that administered her healthcare guidelines. The President specifically appointed her to be its first chairperson. If she did her job well, which she fully intended to do, the possibility of a cabinet position was likely in her future. It was a carrot on a stick she could not lose sight of.

Socialized medicine was a dream come true for her. Finally, after decades of battles, retreats, and political subversion, there was finally someone in the White House who had the testicular fortitude to enact socialized medicine, and move the United States into the twenty-first century. The seeds of the concept had been planted more than sixty years ago. The powerbase in DC knew it would take years and many political battles for the seeds to germinate, many of the battles would be lost. The key to political success, however, was persistence and sleight of hand.

The cornerstone of her guidelines was the concept of protocol definitions. Protocols outlined what an individual claimant was allowed to receive based on several factors and rules. These factors gave each citizen a score based on age, health, and a newly discovered measurement of natural life span called the telomere. Telomeres were found at the end of DNA strands. Telomeres were best described as a shoelace aglet that bound the ends of each strand of DNA. The longer the telomere, the longer the subject was statistically able to live. Shorter telomeres indicated a more concise lifespan.

Barbara preferred concise for most people.

Barbara was a pioneer in using telomeres to advocate distributive healthcare policies. Based on a mathematical score, telomere length, and cost/benefit analysis, the claimant was assigned a protocol that dictated the amount of medical attention to be provided.

Or denied.

But she never used those words.

Barbara had spent years debating and advocating distributive health care polices before finally being brought into the administration’s inner circle. It was her opinion that only those who were providing a measureable benefit to society, be allowed to have high-end medical care. Someone who was seventy-five, diabetic, had Alzheimer’s, had just suffered a heart attack, and had longer than average telomeres, should not be provided the same extensive medical services as a thirty-five year-old CEO with similar telomeres, who was unfortunate to also have a coronary. The seventy-five year old should be preparing for end-of-life, whereas the executive statistically had decades of remaining productivity.

The CEO could continue to add to the collective tax base.

The seventy-five year old was a drain.

Numbers were the battle axes, crossbows, and chainmail she used to beat her opponents into submission. No one could repudiate her logic based on facts. When an opponent introduced emotion into the equation, she knew she had won the argument. The politicians played the game in front of the television cameras, but behind the scenes they signed on to her way of thinking. Most were amazed when Barbara outlined the facts before their respective committees. When she itemized just the costs of Alzheimer’s, autism, Down syndrome, and terminal cancer, the federal money handlers usually turned green. That’s when she knew she had them between her cross hairs, and was able to pull her trigger. She never directly outlined her protocol dictum; she was successful in skirting the precise language. “The federal government needs to intervene and manage this national dilemma,” was her final argument. They finally agreed, with much fanfare and media coverage, and put her in charge. A two thousand page document that no one had read became the law of the land.

The science was not available to eradicate the afflictions like Alzheimer’s, Downs, or autism, but the ability to cull the population of those who suffered from these afflictions was. Eugenics was taboo for many. It was the bible to Barbara. It was sacred to her argument, and to her, the logic of her argument was solid, unquestionable.

If you don’t die, you live. When you live, you get old and sick. Being old and sick costs money. The key to cost control is to shrink the population of the old and sick.

Quite simple, really.

She considered having it tattooed on each and every one of her employees.

Just to prove her point.

*

The resulting political child was baptized Aequalis Health. It was the nation’s first healthcare exchange, and the tri-state region of Minnesota, North Dakota, and South Dakota was deemed to be the program’s pilot. The federal government acquired, restructured, and streamlined all of the regional insurance providers under the single Aequalis umbrella. Private insurance was essentially illegal in these states. Her next step was implementing the guidelines. It would be intensive hands-on management by her for a limited time, but the dream of a big office in DC with a direct line to the President of the United States, was worth getting her hands dirty.

And bloody if needed.

Nothing and no one was going to stop her.

She even found herself involved with some of gritty marketing tasks, and approved all of the content for the exchange’s website:
www.aequalishealth.com
.

A spreadsheet of data stared back at her from her laptop. Until some of the daily tasks could be offloaded to someone else, someone completely trustworthy, she found herself having to manage them herself. Each day she reviewed the data and assessed the protocol assigned to each person on the docket. The software made the first attempt, Barbara provided a spot check. She was one of a handful of people who had the authority to assign a protocol as it meant continued life or a scheduled euthanization, financial neutrality, or financial loss. Her job was to assign protocols to minimize costs to Aequalis Health, and ultimately to the Treasury. The software she helped design did most of the work; she just pressed the buttons and made sure the numbers appeared reasonable. The decision making process was very objective and unemotional. If the numbers indicated a particular protocol be assigned to a person, it was done.

No fanfare.

No pomp.

No circumstance.

A simple, quick injection and Joe American was no longer a drain to society.

The consequences of each protocol were known only to Barbara, the Secretary of HHS, and certain members of congress who helped author the law. She did not believe the President was fully aware of the protocol definitions, as his ignorance provided a means of plausible deniability. Occasionally, Barbara would be asked override a particular protocol assignment when a claimant, or his family, made a substantial political donation, but that did not happen too often.

Barbara relished the pharaonic power she possessed.

She reviewed assignments on a weekly basis, and today there were ten claimants given the highest assignment, Protocol U. This was her favorite of all designations because it was the most impactful to the ultimate goals of Aequalis, to thin the herd.

She spent hours at Aequalis-managed centers throughout the city. This provided additional insight not provided by the data, and she was able to see some of the Protocol U candidates. Thus far, she had not disagreed with any of the software’s assignments. There had been times, albeit few and far between, when the application appeared too lenient with the assignments it doled out, and she chose to intervene and assign the higher protocol. The members of the herd already assigned Protocol U were the people whose costs to the system could no longer be justified, as they no longer provided measurable societal benefit. They were part of the two percent of the population that accounted for more than forty percent of healthcare costs. It was Barbara’s job to decrease the pool of “two-percenters.” This group required an extra push to deliver them to where nature would eventually take them. Barbara was more than happy to provide all of them access to Heaven’s car pool lane.

It was her job, after all.

*

Barbara turned her attention to another tab on her spreadsheet, and kicked her desk drawer. The numbers from Claims and Accounts were not remotely close to what they were supposed to be. Too many claims were being approved. Not enough were being denied or delayed and therefore too much money was being paid. Output was exceeding input. How could she go in front of Congress and tout the success of Aequalis, when costs were not going down as quickly as she had projected?

She was not about to look bad in front of that group because of a gaggle of the Minnesotan ass-wipes who worked alongside her in this God-forsaken office building.

Barbara dialed the number for the Claims and Accounts supervisor who worked in a five-by-five cube on the fourth floor, two floors below. Even though it was Saturday, the claims department was manned seven days a week, and the person she needed to talk to was on duty.

“Claims and Accounts, this is Natalie,” came the sweeter-than-sugar, almost sing-songy voice on the speakerphone. Barbara almost gagged.

“Natalie. Barbara Nordstrom. Please come to my office.”

She didn’t say please.

She didn’t wait for a response.

She just hung up.