Slumrat Rising

Vol. 4 Chap. 37 Medical Necessity

Truth moved through the emergency room with surprising (to him) efficiency. It seemed that this specific job, a sort of phase two of an intake, did not actually require much medical knowledge. What it required was someone recognized as a doctor, looking at the patient.

That was it. You looked at them, listened to them, and told them they would be looked after. Maybe gave them a little preview of what would happen next. Because what was actually happening wasn’t medicine. It was management.

“Alright, Junior-Bro, who do we have next?”

“Male, 78, presenting with advanced chlamydia. The disease has been confirmed by lab work, his symptoms are consistent with the disease.” The resident was barely hanging in there, but he had been “barely hanging in there” for hours now, and quite possibly days. Even weeks. “Barely hanging in there” was the ground state for junior doctors, Truth learned, and not something unique to the specimen in front of him.

“If Pathology-Bro has diagnosed him, Nurse-Bro can run the charms, clean him up and get him home. What’s the problem?”

“I don’t know.”

“You don’t know? Bro, you have his chart literally in your hands.”

“Yeah. But it doesn’t say.”

Truth took the chart out of his hands. He didn’t know how to read medical records, but he did know how to cheat. He started flipping through at speed, slapped it shut, gave the resident a particularly filthy look, then went into the little curtained off cubicle.

“Mr. Bumint. On behalf of the shareholders here at the Evergreen Hospital Network, and those of us with their stocks in our pension funds, thank you for your repeat business. You have been a real Bro for our bottom line. However, we would be failing as doctors if we didn’t at least remind you that prevention is a whole lot cheaper than the cure.”

“Eeeeh heheh! Well, you know how it is…”

“Senior-Bro, I’m a bone doctor. I know exactly how it is. Which is why I’m telling you, nobody, but nobody, gets eight STD’s in a year without doing a whole lot of bone-ing without doing much thinking. At this point I should report Sunny Acres Retirement Community as a VD epicenter!”

“Now now, let's not get too exaggerated.”

“Senior-Bro, I’m not joking. Haven’t you seen the posters up on the walls? VD is considered a threat to military readiness. Right now, the reporting requirements are just “suggestions,” but every doctor in this hospital knows it’s going to get mandatory any day now.”

“No, really?”

Truth nodded strongly. “Hey Junior-Bro, I think I saw some VD brochures by the nurse station. Grab one for Blumint-Bro.”

“Yes Doctor.” The resident staggered off at commendable speed.

“And now that the kid is gone looking for something that isn’t there- C’mon, Bro. What’s going on?”

“Well, just cause we are a bit older, it ain’t like we died. Man’s got needs. Thankfully, women do too.”

Truth rolled his eyes. “Senior-Bro, who are you talking to? Where are you? I know. We all know. You guys make teens look like they took a vow of chastity. But eight in a year. Are you deliberately trying to get infected or what?”

“What? No, never!” There was a pause. Then a longer pause. The old man shifted around, looking everywhere but at Truth. Eventually he broke down.

“You get lonely.” His voice was soft. Roughened by age, and withered. A Level One, and one that had lived a hard life. No fancy life extension spells or potions for him. Cultivation might take him to a hundred. Maybe only to ninety. Well. Normally. Truth wouldn’t bet on him seeing his seventy-ninth birthday under the circumstances.

Truth nodded, encouraging him to talk.

“Lots of lonely people. Sometimes it’s about romance, or friendship, just trying to feel like you aren’t outliving everyone you knew and cared about. “Never too late to make new friends” and all that stuff. But for me, it’s about not waking up alone. Just… hate that. I don’t even really care who I sleep with. Don’t even care that much if we have sex, though we usually do. I just… I don't want to wake up alone.”

“So you find whoever’s lonely-”

“A few drinks, maybe a lot of drinks-” The old man continued.

“My place or yours?” Truth finished.

“Yeah. And by that point, I’m not really thinking about much of anything.”

“Tried keeping condoms on the night stand? Maybe a few charms?”

“Yeah, but we are all in our seventies and eighties, you know? Nobody’s getting pregnant. Even with the alchemist's help, you don't want to waste time.”

“It isn’t wasted time, Bro. It’s how you make sure you get invited back to bed a second time. As I think you know by now. Bro, you can literally get a handful, two handfuls, of condoms, for free, from the nursing station. Literally the only free things in the hospital. Get ‘em. Use ‘em. Or in a month or two, your whole apartment building is quarantined by the Army, and then you really will be lonely.”

The old man sighed and seemed to shrink in on himself. “Well. I’ll try.”

Truth left the old man and had a nurse page the resident. The announcement over the loudspeakers was an impressively malicious touch, Truth thought. He hadn’t even asked the nurse to do that.

A case of literary theft: this tale is not rightfully on Amazon; if you see it, report the violation.

Truth was visibly irritated and tapping his foot by the time the resident scrambled around the corner. “Doctor, I am so sorry! I just couldn’t-”

“Junior-Bro, every second we spend with a patient costs money. Costs the hospital money, costs the patients money. Or their insurance. Every. Second. If I can put a brochure in his hands, I don’t have to explain things in person, right? So why can’t you get a brochure, Bro? What school did you go to?”

“I. I attended Bosan-”

“Alright, third tier school, I should lower my expectations. Disappointing! Come on, Junior-Bro, let’s see if there is anything worth salvaging in you.”

Truth strode off, trailing the praying-for-death resident behind him.

“Who’s next?”

“Male, 50, hit by a wagon. Out of surgery for the moment.”

“Someone cast ANCEF?”

“Yes, Doctor. As well as a complete Demon Eye workup, bloodwork, bilework, phlegm work, everything, really. It… would probably be faster to list the things that aren’t wrong with him than list the things that are.”

“Who’s doing his bones?”

“I don’t think a bonesetter has been called for yet. They are still trying to repair his internal organs and keep his brain from swelling more than it already is.”

Truth frowned. “That’s not very bone like.”

“Err. No, doctor.”

“Shame. What’s his insurance like?”

“Starbrite.”

That got a raised eyebrow from Truth. “What’s he doing here, then?”

“We were the closest available hospital, and he wouldn’t have survived the ambulance ride to Eternal Polestar Partners Hospital.”

“Alright, write this down- patient-bro is to be given the most expensive care possible to get him prepped and stabilized for transport. I want ANCEF charms, I want blood replenishment charms, Golden Body Charms-” Truth rattled off everything the System remembered as being both a medical charm and vaguely relevant to the condition at hand. “And don’t forget to include that he had lunch here, used a full day in an ER private suite, can’t forget the room materials, have to bill for those too. Top notch full time attending nurse care. Eeeh… four nurses. Oh, and put down every doctor on the floor for a consultation.”

“Should I bill the Ambulance as a Class 1A Ambulance? That’s what we usually do for Starbrite cases.”

“Naturally. Both ways. Even if Polestar sends their own.”

“Yes Doctor. Standard Starbrite package coming up.”

“Now that’s good thinking.” Truth nodded approvingly. Management. It was all management. How could you spend the least and bill the most while still pretending to serve the public? That was the game. What was maddening was that there was almost no opportunity to actually cast Cup and Knife!

It was management, again. You were doing customer management by letting the patient think they were being seen by the big, important doctor, time management in the form of minimizing the thought you spent on each patient, resource management by getting them in and out with a maximum of expense (for them) and a minimum of expenditure (for you), and even reputation management in the form of looking professional and decisive.

Healing the patient was, at best, an incidental byproduct of the system.

Truth was alarmed to discover he was good at it. There were shades of the Prince in there, but it wasn’t just that. Something about walking through the halls, declaring that if people would just shut up and listen, he could cure what ails them. Something calling from the depths of his blood.

The methodology was quite straightforward. He would ask what the next patient’s problem was, quiz the resident about how the problem was supposed to be addressed, sigh dramatically, then go do exactly what the resident suggested, just with liters upon liters of confidence and Bro-itude. Throw in a heavy dose of social engineering and cynicism, and the patients and the resident alike thought he was God’s gift to Orthopedics. Possibly to medicine generally.

Follow it up with a deceptively casual “Junior-Bro will handle the paperwork for you,” to tidy up the loose ends. Move on to the next patient. The resident wouldn’t be sleeping any time in the next calendar week, but that, too, was normal.

Where things got sticky were the psychiatric cases. He ran them through a quick checklist (conveniently provided by the hospital, who knew damn well no non-specialist was going to adequately identify a mental condition) and once their billing category had been determined, parked them in a room to wait for whatever psychiatrist was on call to make their way to them.

Occasionally a sedative would be prescribed. More often, nothing was prescribed, despite the patient’s repeated requests. Screening out the addicts was a depressingly necessary step in the process. He had ejected four from the hospital already, and was quite certain more would follow.

“Alright, next patient?”

“Fifteen year old male, suicide attempt.”

“Fifteen? Nasty. History?”

“Clean, from what we can tell. No history of abuse, disease, substance abuse, if he’s bullied at school it hasn’t escalated to the point where someone’s made a note of it. Mom’s a dental hygienist, dad manages a Happy Happy Mart. Attends-”

“Point is that he’s a normal kid from an upper D Tier family?”

“Yes, Doctor.”

“With no obvious reason to self harm?”

“Yes, Doctor.”

“How?”

“Mixed up household cleansers in the bathtub, didn’t properly seal the door and a neighbor called the fire department when she thought a fire was breaking out in their unit.”

Truth nodded.

“How did he respond to the questionnaire?”

“He didn’t.”

“We haven't run it yet?” Truth raised an eyebrow, strongly suggesting that some Bro was very doomed.

“We ran it, Doctor, it’s just that he didn’t respond to questions.”

“Non-responsive, non-verbal, what?”

“He understands what he is told and can speak, he just doesn’t. It doesn’t appear to be autism, or at least there is no indication of it in his record.”

Truth looked in on the kid. He just sat on the bed, staring at the floor. Not moving, not calling out, not looking particularly happy or sad. He still had some charms taped to his check and neck, a monitoring sigil stuck to the inside of his wrist. But all in all, he appeared to be an almost sickeningly average Jeon teenager.

“Parents were called?”

“Yes, and they are trying to get off shift, but…”

Truth nodded.

Truth walked into the little cloth covered cubicle. Gently touching on Incisive, he said- “Talk to me.”

The kid shrugged. Truth let the silence drag on. Eventually, the kid spoke.

“I thought it through. I just… thought everything through. I can’t make friends. Don’t see the point. I can’t see a reason to study. Can’t see a reason to play sports, or games, or read. Can’t see the future. It’s all going wrong, and it’s only getting worse. Nobody was mean to me, or not more than usual. I don’t think I’m crazy. It’s just… there isn’t anything good coming, and being alive hurts. So… why live?”