THE OATH
by Richard C. Katz

I thought Todd would apologize for keeping me waiting almost 20 minutes, but instead he started with a warning. “Dr. Hill,” he said, standing behind his desk speaking down to his papers and me. “I am running late for a meeting with the Director so we will have to cut this short.”

“I’ve asked you before to call me, Karen. This’ll only take a minute.” I played poker a lot in Vietnam and knew a bluff when I saw one. Todd bullshitted often and what clinched it this time was I knew the Director was off-station at the University. I sat down, his desk between us, and smoothed out my oversized white lab coat. I pushed a strand of hair behind my ear with my little finger. “I’ve been emailing you for three weeks asking about the status of my construction project, but I haven’t heard – ”

“Ask Rodriguez,” he interrupted. “He is in charge of –”

“I’m asking you.” My voice was calm, but the chair creaked as I leaned forward. Mike Rodriquez, a friendly guy I’ve known for years, hated working for Todd, who treated information like a weapon and everyone like the enemy. Todd’s engineering skills were limited and he lacked the esprit de corps that would win him support from others. I took a breath and sat up in the chair, speaking carefully and smiling like women do when haggling with self-important men. “I’m asking you because you’re the man in charge, not Mike.” He looked up from his paper, but didn’t sit down. “If there’s a good reason for delaying construction on a critically needed outpatient clinic, tell me and we can discuss it. I learned a long time ago not to waste time negotiating with someone who doesn’t make the decisions.”

His eyes narrowed at me like he was taking aim. He picked up a folder off the desk without looking down. “Sorry, Dr. Hill, but as I said, ask Rodriguez about the status of your project. He keeps the schedules. I do not.” Todd took a step around the desk. “Now, I have to update the Director on the current –”

“Just tell me this.” I shot out of my chair, blocking his path, more lab coat than me. “When you finish refurbishing the Director’s suite, repaving his parking spaces, hanging his new artwork, what’s next?”

He sniffed, then said, “What?”

“You started the ground work almost a year ago. Why not finish it and build my clinic?  My staff works in a maze built almost 60 years ago with bad air and poor lighting built to accommodate half the number of patients we see.”

He looked down at me like I was a bug and said, “Everyone needs space. We need more space, too. Look at this place.” He gestured with the folder. His office was large and crowded with file cabinets, two computers, and a small round table with four chairs. Blueprints were tacked to the walls. In a corner, I noticed a small fridge and two chairs, a guitar in one. He probably used the second chair to prop up his feet when he played.  

“Nice office. Looks comfortable and functional. Good lighting, too.”

“Too small. Regulations specify 350 square feet for the chief engineer, 135 square foot offices for my staff, and a basement. Our offices are only –”

“A basement?” I snorted. “Todd, this is Phoenix. No one has a basement.”

His eyes lost focus. “Regs say we have to have a basement in case there’s a tornado.” He was bluffing again.

I tried logic. “We never have tornados in Phoenix.”

“Regulations say Engineering has to have a basement.” He stared at me. “In case there is a tornado.”

I tried bureaucracy. “OK, show me the policy that says you have to have a basement in case of a tornado.” He started around me. I touched his shoulder with a fingertip. He shook off my touch and glared at me. I went on talking. “Policy Directive 07-71 says medical staff should have two 135 square foot exam rooms per physician, 60 square foot cubicle space for each health tech, a panic button and sink in each exam room, and 11 handicapped parking spaces within 100 feet of the entrance. I have none of those things and patients wait. I’m just asking you when –”

Todd took a half-step toward me and I flinched. He smiled. “Listen, Doc. I am going to go to my meeting with the Director.” I opened my mouth to interrupt, but he held up a hand to stop me. “I will fill him in on my progress completing his area’s renovations, then tell him that the next project in the pipeline per my committee’s recommendation is,” his eyes got big like he was enjoying himself but the smile went away, “not yours. Anything but your building. Got it?” He turned to go, then spun back and stabbed the air in front of my face with the folder. I blinked, but stood my ground. “Negotiate with you? I’d be stuck here in this dead-end hospital forever if I needed something from people like you.” Again he gave me the bug look, but this time his eyes narrowed as if he were deciding whether to spray or just step on me. “You doctors get the big bucks and everybody treats you like gods. And you lady doctors think you are so special. I know you tried to get around me by going to Central Office, tried to circumvent my authority, but they blew you off. Am I right?  We all talk. The Director, Fiscal, Human Resources, Engineering.” He grabbed a breath. “We take care of business and each other so we can take care of this hospital. You just work here. We keep the lights on, the heat and air going. You’d be working in a fucking cave if –”

“Christ!  It’s about taking care of patients, not buildings!”

“Then go take care of your patients. I’ve got real work to do.” He brushed the folder passed my eyes, a symbolic slap, and then pointed it at the door. “Now get the fuck out of my office and I don’t ever want to hear you whine about your fucking building again.” He turned his back on me and stomped out the door. It was quite a performance. Exit, stage right.

My pulse was pounding in my ears. I felt that feeling again, the pressure around my eyes and the back of my throat, but I said nothing. I did nothing. I just watched the bastard head out the door into the waiting room and out of the building. I thought about running after him, then running away from him, then about smashing things, but a moment later, I was outside and he was just a tiny speck up ahead, closing in on the main hospital building. I took a deep breath and the air felt good. I turned in the opposite direction and started walking. After awhile, I was outside the field where my outpatient clinic was to be built, will be built.     

It was a remote corner of the hospital campus and had been a beautiful grassy meadow with a row of trees sheltering it from the adjacent parking lot. Now the area was surrounded by a cyclone fence and used to drain water from the improperly resurfaced parking lot which flooded whenever it rained, another miscalculation from Todd, who apparently skipped class the day they covered the incline required for proper drainage of flat surfaces. Todd had turned my oasis into a toxic dump, littered with trash, the ground permanently soggy and black from the gas and oil leached from the parking lot surface. The odor from decay and petro products hung in the air, stinging my eyes and nose. The site reminded me of the La Brea Tar Pits and I wondered what future archeologists might think when they excavated artifacts buried beneath the surface. I slipped through a hole hacked in the fence, maybe by some kids from one of the poor neighborhoods that surround the hospital, and climbed up onto a berm of dirt bordering a trench cut at least 30 feet down into the ground for sewage. The pipes had already been laid and connected, the only part of the project completed. I looked down into the trench. It was too deep and dark to see the pipes, but I looked anyway. What I saw was the ditch I hid in 40 years ago.

*   *   *   *

It started with an explosion. It always starts that way. Sally looks up from her cards and asks “Incoming?” but we’re nurses and not soldiers so I can’t tell. Kate looks out the window behind me. She opens her mouth wide and I think calmly, We’re done playing tonight. I lay my cards on the bed and turn my head to look out the window expecting to see only dark. A great bonfire of twisted metal stands about 50 yards away where one of our Surgical Intensive Care Units– just a Quonset hut, really – was supposed to be.

“God Almighty,” comes from someone’s lips, maybe mine, as a second hut, closer this time, turns into a red fireball, the sound reaching us a split second later. No one says anything. We jump into our scrubs and head for the exit when the window closest to me breaks and four sticks of dynamite and a sparkling fuse bounce onto the floor, rolling over itself three or four times. I tell myself, Go! Go! but I just stare at the fuse, which no longer sparkles, but smokes instead, crushed out when the dynamite tumbled onto the floor. There’s another explosion, close, and we all jump at the same time as the walls of our hut shutter and creak. “Go,” I yell and the three of us run out of our hut towards SICU #14, the hut where our patients are. I hear pistol and automatic fire echoing all around, a scream and shouting in Vietnamese, and then there’s another explosion, farther away.

Everywhere there is fire and smoke and heat and the stinging smell of dynamite. “Where is everybody?” asks Kate. Just then, an unarmed soldier runs past us without stopping.

“Wait!” I scream after him. “Wait!  What’s happening?” But he keeps running. I relax a little when we find #14 intact. Most of the patients are already out of bed and help Sally, Kate, and me carry and drag five of the most severely wounded out the back of the hut into a ditch we use to dump refuse and trash, material we aren’t supposed to throw into the latrine. Just as the three of us start back to get the remaining two patients, a wall of heat and wind knocks me onto my back. When I sit up, I see the hut is a ball of flame, but I don’t hear anything. My scrubs are scorched, and my face and arms feel like they are sun burnt. Medical equipment, now just smoking bits of metal and glass, is scattered all around me. I turn to my right and see Kate screaming, but I can barely hear her. She points past me and I turn to my left. Sally is lying on her side, bent over part of an iron bed frame that penetrated her chest and neck and I know she is dead. I tug at Kate’s arm and we crawl back and tumble into the ditch. I cover the patients and ourselves with trash and tell everyone to be still, but Kate’s eyes are wild and she shakes badly. A young Corporal named Wallace cradles her in his arms. He says something in her ear while stroking her hair. She puts her head on his shoulder and closes her eyes. She becomes still and, after awhile, she looks like she is sleeping. We lay under the trash for what seems like hours but is less than ten minutes. Little by little, I hear shouts and screams, and then sounds of whistles and guns and explosions. Then there’s quiet and all I hear are American voices.

We three received Bronze Stars, Sally posthumously, for saving eleven patients. My Star and Commendation are framed on my office wall and remind me every day why I am here. When I returned to the States, only two years had past, but everything was different. I needed a new start so I went to med school on the GI Bill. Through the kindness of others, blind luck and hard work, I graduate the University of Washington. During my residency in Internal Medicine, I rotated through the VA hospital in Seattle and connected with other vets. I was home. Since then I worked at five different VA hospitals – not good for either of my marriages – and eleven years ago moved alone to Phoenix to become Chief of Medicine at this VA.

*   *   *   *

“I could kill that motherfucker,” Sam said, pushing her glasses back up her nose. It was morning, half-way between the breakfast and lunch crowds, so the hospital cafeteria was pretty empty. I was squeezed into a booth with Samantha Collier, Mike Rodriquez, and Donny Fitzgerald, drinking coffee and catching up on nothing in particular. I just finished telling them about my meeting with Todd.

Sam was the administrator in charge of Ambulatory Care. She was also a Gulf War veteran and the pitcher on our hospital softball team. Although I was currently batting over .700, I rarely got a decent hit off her during practice.  

“Tsk-tsk, Sam,” said Donny. “Such language.”  Donny was our Chief of Surgery and a Lieutenant in the Navy Reserves who recently had returned from Iraq. He was a deeply religious man who volunteered with Doctors Without Borders.

“I could stand to hear more,” Mike said. He was sitting next to me, just on the edge of the bench, and grinned when I glanced sideways at him. Tall, dark, and good-looking, he was a quiet guy in his early 30s who always wore a white shirt and tie, shiny black shoes, and black slacks with that crisp crease he learned to make in the Navy where he earned his degree in engineering. Engineering Service had a string of ineffective chiefs who left our hospital in quick succession. Mike was on staff and had been appointed Acting Chief until Todd’s arrival. Now he was Todd’s assistant because Todd had a bogus degree from an online Florida diploma mill that handed out degrees to anyone with tuition and a laptop.

Donny looked at Mike. “You don’t kill people because they frustrate you. People murder people for money or power.”

“Or revenge,” said Mike.

“Or sex,” said Sam.

Donny looked quickly from Mike to Sam and continued. “I know you’re joking, but it’s not healthy to talk like this. You’ve got to find the good in people. Everybody has some good in them, although I’ll admit Todd would test Jesus himself.” Donny looked at Mike. “Todd finally installed the new MRI. He’s certainly better than your predecessors. Remember Jacobs?  Worthless. Nothing got done. It’s a blessing he’s gone. And Briggs?  The last thing on his mind was work. No wonder he ran off with that exotic dancer and moved to Mexico.”

“I heard she was only seventeen,” I said.

“I heard that, too,” said Sam.

“Good riddance to them both,” Donny said.

“Exotic dancer,” said Mike, savoring each syllable. Sam and I laughed.

Donny grimaced and shook his head. Then he smiled and turned to me. “Still seeing that pediatric neurologist, what’s his name?” Donny wanted me to get married again. He and his wife had five kids, three still in school, and he wanted everyone to live the wholesome life.  

“Marty, yeah. This Friday. He’s taking me out for dinner.” He was staying the weekend, but I didn’t feel like sharing at the moment.

“Good, so you’re not cooking,” said Mike. “Hate for you to scare this one away, too.” That earned him another look.

“What’s with Todd’s hair?” Sam wagged a finger at her head. “How can his wife let him leave the house with that mess on his head every morning?”

“Divorced,” said Mike. “Even his fish walked out on him.”

“I’m taking up a collection to have Todd topped,” I offered. “Anyone interested?”

“I’m in for fifty,” Sam deadpanned.

“Lord!” Donny shook his head, not finding anything funny about decapitation.

“Lighten up, Donny,” said Mike. “You know they’re just kidding, letting off some steam.” I knew why Donny was upset. At the heart of every joke lies some truth. I also knew that none of my friends at the table were capable of murder.

“Forget our Hippocratic Oath, not to do any harm?” Donny asked me, sounding like a dad.

I finished my coffee. The cafeteria was filling up and I had to get back to the ward. “You’re paraphrasing. The translation is, ‘for the good of my patients.’”

“Damned if you do, damned if you don’t,” said Mike, not particularly making sense.

Donny looked straight at me. “Seriously, you don’t see the conflict between being a doctor and talking that way?” He sounded offended.

“Oh, Donny,” said Sam, trying to lower the tension.

I motioned to Mike I had to get up and he slid off the bench to make way. “What about the greater good?” I asked. “Which rules do we follow?  What about ‘Thou shall not kill?’  A lot of those Marines and Sailors you patched up went right back into combat and did some serious harm to sons and fathers and daughters, and to themselves, don’t you think?” I slid out of the booth, holding the empty coffee cup.

“What they did after they recovered was necessary. You know that.” He looked up at me, a little defiant.

“God, Donny, I’m not criticizing –” I started.

“They sacrifice their lives for us!”

“— you for doing your job or them for doing theirs, but you have to admit, there’s some sort of linkage, cause and effect.”
“Sounds like a choice between the lesser of two evils,” said Sam. “But what never changes is you have to do what’s best for your patient.”

I nodded my head. “I’m just saying you can’t let anything or anybody get in your way of doing what you believe is right for the patients, especially, these patients.” Mike and Sam were with me. So was Donny, in his fashion.

“For the good of the patients,” Donny said, raising his coffee cup. We touched cups like we were toasting the regiment in a corny old movie.

*   *   *   *

I was walking at a fast clip down the main corridor back to the ward, lost in my thoughts, when I almost plowed into Officer Forest, who was heading in the opposite direction toward the cafeteria. He raised a palm in greeting and stopped to talk. “Slow down, Doc!  How you doing?”

“Fine and dandy, Officer. How are you?” We were day and night. He was a tall African-American in a dark blue uniform accented with the usual police bling, including a black Sig Sauer 9mm. The holster, cuffs, gas, and other gadgets hung from a utility belt that would make Batman jealous.

“Any more problems with your car?” Yesterday, I lied about my alarm going off, and asked if he could tell from the security cameras in the parking lot if anyone messed with my car. He explained that, unless someone reported an incident, the recordings in the parking lot were preserved for only 24-hours, after which the new video feed records over the old one. That was good to know.

I shook my head. “Good,” he said. “Maybe it was just a truck driving by.”

“Maybe,” I said. “Sorry, but I got to run.”

“I can see that, Doc. You have a good day. And watch your step!” He smiled and I waved and resumed walking. A few seconds later, I glanced back and he was still watching me.

*   *   *   *

I planned it for the Friday before the next three-day weekend, which happened to be Presidents Day. This was the Friday. I waited until the day shift ended and the night shift began. This way, I figured, everybody else would be either in their cars driving home or inside the hospital starting their shifts. I was wearing my black oversized nylon hoodie with the kangaroo pockets over my white lab coat. The desert air get’s cold at night and the hoodie would help me blend in. I tied my hair back with a scrunchie while I watched the parking lot from a stairwell window.  Once I was sure the lot was deserted, I left the building, walked through the parking lot, past the trees, and entered the field. Todd was waiting when I got there. “You’re late!” he barked. “It’s getting dark already.”

“Sorry. I really appreciate you coming here at the last minute before you head home. I thought it was important enough to need your personal attention.” I was all respect.

“What is this emergency you wanted to show me?” His concern seemed authentic and that surprised me. I quickly pointed to the far end of the lot.

“Over there, on the other side of that hill, there, by the trench. Looks like there’re some pipes or something sticking up through the ground.  Gas pipes, maybe?  Looks dangerous.”

“That’s impossible,” Todd said, but he marched off in the direction of the hill. I looked around in the fading sunlight and seeing no one, followed him. When I caught up, he was standing on the berm, staring down into the trench, his penlight pointed down into the void. Birds sang from the nearby trees. The sound of traffic was far off in the distance. The oil soaked ground was darker than the sky.

“What’s the matter?” I asked, slipping on a pair of latex gloves I brought from the ward.

“I don’t see anything, but somebody was digging.” His attention was on the trench. “There is a shovel over here.” He pointed without looking at a shovel I left nearby. The handle was wooden and worn, and three-and-a-half feet long, the same length as a baseball bat. The blade was ten inches and square, sharp along the edges. I picked it up as though I was going to inspect it. He glanced my way, then looked back toward the trench. I stepped behind him, close, and tightened my grip on the handle. I took a deep breath.

“I don’t see anything,” Todd said. “Maybe, in the daylight–” He started to turn around to his left.

I planted my feet and swung the shovel overhand like an axe and hit him hard, feeling the impact in both my shoulders. The edge of the blade struck his lambdoidal suture, the soft spot about 45-degrees behind his left ear, and I heard his skull crack a little. He exhaled audibly and staggered, but kept turning toward me. The second time I hit him square in the middle of his forehead and blood poured out of the wound. His skull cracked louder this time, and he let out a short cry as he realized what was happening. He started to crumple, but then looked right at me and didn’t collapse. It must have taken a lot of effort and I admired him then, a little. The third time I swung sideways like a batter swinging for the fences and connected with his left temporal bone, widening both cracks and collapsing the left half his skull. There was a sucking sound and blood spurted out laterally to my right. It was messy, but Todd was silent as he crashed on his face into the dirt. The sky quickly got darker and I could see headlights in the distance. The birds stopped singing as the traffic noise grew louder. Muffled, ugly gasps and bubbles of blood suddenly came out from the dirt under his nose and mouth, and then stopped just as abruptly. I reached down and felt his neck to check the pulse in his carotid. It was erratic, weak and fading. I took his car keys from his right pants pocket, but resisted taking his wallet. That would be stealing. I kicked Todd’s legs straight and rolled him into the trench. Then I shoveled enough dirt down the trench to cover his body, just like I had with the other two. Jacobs and Briggs had company.

I wiped the handle with my handkerchief just to be safe and tossed the shovel into a different section of the trench on my way back to the parking lot. As I passed through the trees, I pulled the hood over my head to cover my hair and face in case anyone was still around. The gloves looked like they didn’t tear so I kept them on, but put my hands in my pockets and kept my head down until I got to Todd’s red BMW Z3. I knew I didn’t have to worry about the cameras in the parking lot, but why take unnecessary chances?  I drove the Beemer three blocks and parked on a deserted side street by the graffitied wall of an abandoned building, a former community center. I left the keys in the ignition, lights on and the engine running. It was a crappy downtown neighborhood and the car would be gone within five minutes, either headed for Mexico or sold by the piece within a week. I pocketed the gloves and, still wearing the hood over my head, walked back to the hospital, entering a stairwell through a side door usually propped open by smokers. No one was there so I removed the hoodie, rolling it up and tucking it under an arm beneath my lab coat. I let my hair back down and stood quietly for ten seconds to control my breathing. Then I slowly climbed the stairs. Halfway up, I heard a door open and shut at a landing above, so I rushed up the remaining steps to the third floor, opened the door and slipped onto the ward.

I dropped the gloves in a red biohazard container on my way to the Nurses’ Station. Toni Flowers, the head nurse, was whispering on the phone, a personal call, I was sure. I leaned down against the counter, waiting and listening, until she put the receiver down. She looked up with her “what do you want” expression.

“Everything under control?” I asked, smiling like we were best friends.

“Quiet as a nun’s mouse on the dark side of the moon,” she said making full eye contact as though she could get rid of me with the sheer force of her stare. I let her think it worked.

“I’m going to enter progress notes and call it a day,” I said, rising. “Have a good weekend.” She didn’t reply as I walked away. Once in my office, I stuffed the hoodie into my tote bag, planning to throw it in the washer when I got home. I sat at my computer and entered notes on patients I saw earlier that day into the Computerized Patient Records System. CPRS time-stamps every entry, so I was documenting not only the visits but also that I was still in the building. I took off my lab coat, slipped on my brown lambskin leather coat, and grabbed my tote. On the way off the ward, I dropped the lab coat in a laundry hamper where it would be cleaned before I returned to work on Tuesday.

I was walking fast toward the exit to the parking lot, going over the details of the last 47-minutes to make sure I didn’t forget anything. “Hey, Doc!” I jumped and turned. It was Officer Forest. “Didn’t mean to scare you.”

“No, no,” I smiled. “It’s just, I was just thinking about a patient.” Then, “I’m sorry, Jason, but I’m in a–”

“That’s okay. You walked right passed me. I’m sure you’ve got a lot on your mind. Here, let me walk you to your car,” he said, pushing the door open to the parking lot. “Part of my job.” He looked concern so I nodded to reassure him. We walked into the dark and the cool. There were no stars. I thanked him at the car and we wished each other a good night. On the drive home, I picked up The Seven Samurai. It’s a long movie and Marty hates reading subtitles so I knew the evening wouldn’t be wasted. By the time I got home, I had an hour to get washed up and dressed. I hoped he’d bring Italian. I like Italian.

That Tuesday, after the long weekend, the Director noted that Todd wasn’t at Morning Report, but it wasn’t all that unusual for anyone to miss the meeting every now and then. Later, when he wasn’t at a meeting with the architects, Pam, the Director’s secretary, called Todd’s secretary, Anita, who said he wasn’t on leave and didn’t call in so she assumed he was somewhere on the grounds seeing to some emergency. She dialed his pager. He didn’t respond. A couple of hours later, when he didn’t show up for his own staff meeting, Mike tried his cell. When I heard about that, I wondered if anyone wandering in the area could hear Todd’s pager beeping or phone ringing from under a couple of feet of dirt.   In all likelihood, no one was around to hear anything.  Anita called Todd at home before lunch. There was no answer, so Mike drove out to Todd’s apartment and finding it empty, reported him missing to VA Police and Security. They contacted the City Police who did nothing but submit a missing persons report and wait for something to happen. Nothing did. No one else inquired about his whereabouts and by the end of the week, Mike was again appointed Acting Chief of Engineering.

*   *   *   *

I was on my way to the Research Building when I heard diesel engines from the direction of the field. I hadn’t visited the site in weeks, since Todd went missing, so I walked past the trees and slipped through the hole in the fence. A large yellow backhoe was knocking down the berm and pushing dirt into the sewerage trench. Mike was there wearing a white hard hat. He saw me and waved. As I walked toward him, someone handed him a green hard hat, which Mike held out to me, gesturing to put it on, which I did.

“Matches your eyes. Anyone ever tell you how hot you look in a hard hat, Doctor Hill?”

“As a matter of fact, no,” I said. “But thanks anyway.” I looked around. “Is this what I think it is?”

He pointed around the site at different spots and equipment. “We’re filling in the trenches dug for water, electricity, communication, and sewerage,” he said, “and scraping the ground before pouring the foundation. Once all this is covered with cement,” his hands swept over the section where Todd and the others were now buried under tons of dirt, “we put up the structure and the walls. It will go faster than you think. You’ll see.”

I was choking up. “Thank you, Mike.” After all this time, that’s all I could say.

He ah-shucked me. “Hey, for the good of the patients, right?”

*   *   *   *

The prevailing rumor was that Todd left suddenly because he was tipped off that the Inspector General’s Office was investigating allegations of misappropriation of funds. It might even have been true. Bureaucracies are fertile ground for planting gossip and many employees welcome the distraction. This time, however, I didn’t have to initiate the rumor, but I did what I could to help it along. After about three months, Human Resources finally announced the vacancy for head of Engineering at our hospital. I volunteered to chair the search committee and select the best candidate to act for the good of the patients. Mike applied for the job and, so far, he is our most promising candidate.

THE END

BIO: I currently live in Scottsdale, Arizona.  I have published nonfiction articles for years.  A longer version of “The Oath” was published as an audio file (no text) on CrimeWav.com.  This text version has been shortened and reedited.