The Protocol: A Prescription to Die (7 page)

Chapter 11

Carl had always held a fascination with death. He preferred watching people
anticipate
the event rather than dealing with its aftermath as he had to now. Watching death had always provided him with an almost sexual release. Working where he did now, death had already taken place, and the corpses didn’t even put a bump in his heart rate.

Where was the fun in that?

The dead were already dead. They didn’t react. Watching the surprise in a person’s eyes when he realized that death was mere moments away? That was an adrenaline rush beyond words, and was something that could still make his heart beat faster.

He started with his mother’s cats when he was ten. To her dying day, his mother never knew why all of her cats ran away so frequently.

“Running away” was such a broad term.

Carl enjoyed himself growing up.

His mother’s cats didn’t.

Carl looked down at his arm and ran his finger against the long scar that travelled from his wrist to the pit of his elbow. He’d never known a cat’s back claws were as strong as that tom’s had been. It hurt like a bitch for a week after he was scratched, and it even became infected, but what he did to the cat, he was sure, hurt just as much, perhaps more, but definitely not as long.

He started off slowly and experimentally. He’d take the latest cat from his mother’s bed, say the appropriate soothing words, stroke its fur, and then bring it outside. When the feline was purring, he quickly threw it into a white plastic garbage bag, then a pillow case, and then another garbage bag. He’d time himself. From initial insertion, until the struggling stopped. His record was six minutes, thirty-three seconds.

Five cats went that way: two Maine coons, a tabby, and two calicos.

His mother began to wonder why her stash of spare pillowcases was disappearing.

“Dryer eats them. With my fucking socks.”

“Watch your language, young man,” she’d always say.

Carl enjoyed saying, “fuck” within earshot of her.

It wasn’t that his mother had millions of cats at his ready. She didn’t. There was always a lag between his experiments: time to allow her to realize one cat was gone, time to grieve, and then time to have his latest step-father go to the Humane Society and adopt another. Carl always thought that the name was rather ironic: the Humane Society.

If they only knew how humane he was being.

At least he enjoyed himself, and that’s what mattered.

Carl’s mother was a diabetic. It’s no wonder. All she did, after all, was sit on her ass all day, watch soap operas, and eat.

Constantly eat.

Carl often wondered if she’d end up being one of those fat women who became melded to her chair. That would have been cool to watch.

After he became bored with the cat-in-the-trash-bag trick, he decided to try experimenting using one of his mother’s insulin needles. She used three new ones each and every day, he just needed one. Dirty or not. It didn’t matter to a cat.

First he tried Liquid Plumber in a cat’s back leg. Then he dissolved mouse poison in water, and injected the solution into the cat. That proved interesting. If not a bit disgusting as he watched the cat develop blistering ulcers in a matter of hours, collapse, puke its guts out, and ultimately dissolve.

The experiment he carried out on the old tom was the best though. He was the cat who gave him the arm-length scratch. The cat deserved what it got. Carl would never forget the sound the lawnmower made as it ran over the cat buried up to its neck.

Thhhhhhunk.

Instead of grass clippings shooting out, it was a gory combination of black and gray fur, blood, and chips of bone. Carl later found a chunk of cat skull under his mother’s lilac bushes.

*

Carl was a teenager when he finally graduated.

Not from high school, which he did.

Barely.

But graduate from cats to humans.

He started slowly with his mother. First, he injected her bottles of insulin with small amounts of interesting concoctions from around the house, some of which he’d already used on the cats: antifreeze, the mouse poison solution, vinegar, Tabasco sauce, fabric softener, and bleach. He never added enough to change the color of the insulin too much but his mother was so fat she couldn’t really see the bottle clearly anyway. Most of the time she had Carl fill the syringes, and perform the injection anyway. None of the solutions did much to make it the least bit titillating. It definitely didn’t get him to the point of wanting to play the single handed salute. Occasionally she’d complain about being sore or that it burned as he pressed the plunger.

Nothing cool happened. At least nothing visible.

Carl was disappointed.

For all he knew though, she could have been slowly dissolving from inside out. She was just too fat to notice anything, and there was an immense bulk to contend with.

It wasn’t until Carl acquired a job as a janitor at the nursing home that he finally found an improved, larger, and more elaborate chemistry set available to him and an even greater pool of living experiments with which to have a bit of fun.

Chapter 12

Eat followed Joey into his fifth-floor office.

“She’s looking good today, isn’t she?” Joey asked.

Joey had been his mother’s nurse since she moved in, and he was the one who suffered her wrath when he tried to give her a bath. But that was two years ago. Now it seemed that she knew him better than Eat. He was very good to her; and good
for
her. Eat never directly asked, but based on the date on the nursing school diploma hanging on his office wall, he was probably only a few years younger than Eat. He had surrendered the battle of his hair line several years ago and now when he shaved his face he just continued onto his head. It wasn’t a shiny pate by any means, but one of those that had a constant, lurking five o’clock shadow.

“Eh,” Eat shrugged. He had trouble trying to be positive with the situation. “She thought I was dad today, and that I was dating Sophia from the dining room.”

“You could do worse,” said Joey.

“Playing matchmaker now, Joey?”

“I know, it’s not easy. It’s a terrible disease. Sit. Make yourself comfortable. You’re making me nervous. She is doing better though. The kidney infection has cleared up, and she’s back to being her old social self again. For a while, she wasn’t coming out of her room. Not even to play pinochle. That’s when I figured something was up.”

“I think it’s amazing that she can’t remember I’m her son, but she can remember the nuances of playing card games. Pinochle isn’t easy.”

“I know it’s odd, but it’s a totally different part of the brain being used.” Joey walked back to his desk, opened a manila folder that was on the top of a pile of other folders, and sat down. “She had a quick physical last week. Just received the results.”

“They’re giving ad hoc physicals now?”

“Yup. They’re required once a month now. You heard that we were just acquired by Aequalis?”

“Yes. The woman at the reception desk,” Eat looked up at the ceiling trying to grasp her name that he’d forgotten within seconds of walking away from the front desk. It came to him, “Rachel. She told me she was here for training. Some pretty snazzy technology you have here now. Great technology but now the menu is bologna, coleslaw, and Ensure?”

Joey shook his head.

“Lots of changes. The menu is only part of it.
Everything
is automated now. We have to enter all data into the Aequalis system, and it gets stored in some database. In DC I think. Aequalis then analyzes what we enter, and sends back instructions. It even has the pharmacy automated.”

“It recommends the diagnosis?”

“Not really. I don’t know if the system makes the diagnosis, or if the panel interprets the data. However, they make the actual diagnosis and treatment. Of course the doctor here can override, but we’ve been told that for that to happen, it would require a load of paperwork whose sign-off and approval would need to go to whoever God reports to. Someone in DC from what I understand.”

“Rachel was able to see exactly where mom was sitting. It even showed her a video of her waiting at the table.”

“That’s one of the new tools Aequalis has brought in. Each resident is wearing a necklace, wrist bracelet, and an ankle bracelet. They’re nothing a fashion critic would endorse, but they’re very functional. They continuously transmit their location within the confines of the property. If the signal from two of the three devices is not received for more than thirty seconds, an alarm is sent to the front desk. We then go on a hunt.”

“Proximity detection,” Eat confirmed. “I’ve done a lot of work with that. On a much larger scale though, not the geriatric set.”

Joey nodded. “But there’s more. If a necklace or wrist bracelet transmission is picked up by one of the floor monitors for more than thirty seconds, a fall alarm is sent to the front desk.”

“It detects if the resident has fallen down using vertical proximity analysis then.”

“Exactly. You have done work, haven’t you?”

“Just a little,” Eat confirmed. In fact, Eat had done a lot with proximity detection and some of his software was in use by the NSA and NORAD.

He just couldn’t say anything.

“It is also constantly sending us the vitals on every resident once every five minutes. There’s also an alarm for non-movement during the day. The time window for that alarm is set higher though. I think it’s set at ten minutes.”

“I’m amazed they just don’t have a chip implant.”

Joey laughed at that.

“Don’t laugh. It’s out there. They do it for dogs. No stretch to get that for humans. I’m sure someone is experimenting with it.”

“The monitors are the cool part; it’s been a big help. The other half of the pie though is taking a bit longer to accept. Three doctors and four nurses have already left since Aequalis took over. Aequalis wanted them to retire anyway. It used to be one nurse per floor. I had the fifth. But now I have the third, fourth, and fifth.”

“What’s this about a panel in DC?” asked Eat.

“It’s part of the new law. IPAB. Independent Payment Advisory Board, or something like that. It’s some group that reviews everything we do, and either denies or approves it. I haven’t had too much interaction with it yet. I’ve just heard about it.”

Joey was visibly uncomfortable.

“Enough of that though. We’re here to talk about Betty Lou, not to commiserate on how my job has been hijacked by some bureaucrat,” Joey laughed uncomfortably then looked up at the ceiling. “If someone is listening, I didn’t say that.”

“Too late. You’re screwed,” Eat said. He was half joking but knew what kind of technology really existed. If they were monitoring as much as it sounded, they heard everything the two men had said.

Eat just didn’t know who “they” were.

Yet.

Joey returned his attention to the manila folder, and started reading the report bound to the right cover flap.

“I’m surprised you don’t have that on a laptop or something. Paper is so,” Eat paused for effect, grimaced, and rolled his eyes. “Twentieth century.”

“I know. I know,” said Joey as he rolled his eyes. “Technically, we’re not supposed to print anything out. But I don’t have a way to view things up here yet. I’ve been told that each of us will have a laptop assigned sometime next week. Until then,” he rustled the paper, “It’s old world technology and tree eradication.”

“So, how’s she doing?”

“Well, according to this report, she’s doing fine. There’s some new data here that I’ve never seen before but I’ll figure it out, and let you know what it means. Let’s see. Hemoglobin, iron, lipids, oxygen saturation are well within the norm for a woman her age. Red blood cell count looks good. White blood cell count is still a bit high.”

“Still a bit high? Why would that be?”

“Kidney infection, remember?”

Eat nodded. “Forgot about that.”

“It typically takes a bit of time to get back to normal after an infection. The body likes to keep a contingent army of white blood cells out there just in case those little bacteria buggers think they can regroup and re-attack.”

Joey looked up at Eat seemingly to see if he was following along. Eat nodded back.

“Now here’s the new piece of data that I’ve never seen before. Telomere. It says she’s a 10 and the range is 1 to 10. It also indicates that Aequalis considers that high for her neurological condition. I’m going to have to do some research. Like I said, I’m not sure what that means. It’s new.”

“What was she taking for the infection?”

“Pen VK.”

“Penicillin. Ok.”

“But that regimen has expired. I don’t think Aequalis has approved anything else for her.”

“Why would they have any say? Don’t you and the doctor control that?”

“Not really. Not any more, at least. We can recommend. They now approve and redefine all of the treatment protocols. The medicine is dispensed in the pharmacy with the patient’s name on it along with the dosage instructions. We know what we’re providing, but no longer have complete control. Now we just follow the instructions given to us.”

Eat shook his head in disbelief. “You really have no input on anyone’s care?”

“Very little,” Joey confirmed. “It’s all a matter of costs now. Minimizing them, to be more precise. Pharmaceuticals are dispensed three day’s worth at a time now. It used to be a thirty-day supply. All blood and urine specimens are sent off to Aequalis for analysis. The results are then entered and stored in the database. It becomes part of the medical record that we can see here,” he said as he waved the piece of paper. “This report tells us the results of the latest labs and physical.”

“So what happens if she has a headache?”

“If she tells me, I enter it into the system along with her temp and blood pressure. I can dispense things like aspirin, ibuprofen, or acetaminophen on my own but that’s it. Anything else has to be approved by Aequalis, and the IPAB.”

“What if she falls and breaks her leg?”

“The system would alert us that she has fallen, first of all. Then after a quick triage, we’d probably have to send her off to the ER at Eastside Medical. That’s the only Aequalis hospital in the area right now.”

“But that’s all of the way across town. There are at least two others that are closer.”

“Yes. But that’s the only way the government is going to pay for any claims. It will not cover any expense not approved by Aequalis and the IPAB. Word has it that all hospitals will be administered by Aequalis within the next year. They just haven’t had time to make the transition yet. Private hospitals and insurance are a thing of the past.”

This was sounding way too Big Brother to Eat and he was actually starting to get concerned. He’d heard about the new health care law but hadn’t paid much attention to it. “You said there was more on the report that you were not familiar with?”

“Yes. It mentions a protocol for your mother. Protocol U. I have no idea what that means. But I can find out and let you know. But overall, I think she’s doing fine. Nothing out of the ordinary for a woman of her age with Stage 6b Alzheimer’s.”

“I know you are doing what you can. What about….”

Eat was about to bring up what he perceived as a faster than normal deterioration of her memory, when a woman walked into Joey’s office.