The Oath Read online

  "That's a lot more than ten."

  "Yes it is, and you'd think that once we educate people, tell them all the facts, everybody would stop using it and go for the cheap stuff, wouldn't you?"

  "They don't?"

  "Never. Or statistically never. Given the choice, the patients almost always choose Nokance. It's the brand name people recognize. There's confidence in the product."

  "Like Bayer aspirin."

  "Exactly!" Ross silently brought his hands together, as though he was applauding. "So—and here's the point—although it costs us forty dollars more per scrip to supply the Nokance, if we approve it and keep it on the formulary, it costs the patients the same amount it always has, which is ten bucks, the drug copay. So we delist it."

  "The Nokance?"

  "Right."

  "But—this is still hypothetical now—you're saying it's good stuff and you don't let your patients get it."

  "They can get it, but we won't pay for it. If we did, it would wipe us out. We're dealing with extremely small margins for the survival of the company here. You've got to understand that. The point is that Nokance isn't the only stuff that works. That's what I'm trying to get through to you. The generics do the job."

  Elliot had his own very strongly developed ideas about drug formularies. He had been suffering from multiple sclerosis for over twenty years, and on the advice of his doctors, he sometimes thought that he'd tried all the various generics in the world for his different and changing symptoms. Not invariably, but several times—at least enough to have let him develop a healthy skepticism—he'd experienced side effects or discomfort with the generics. When he'd gone back to the brand name, the problems vanished. So Ross would never sell him on the universal benefit of generic drugs.

  "So just to be clear on your position," Elliot said, "your view is that this gatekeeping and cost cutting, from managed care to generic drugs, is essentially consistent with your Hippocratic oath, for example. Where the emphasis is first to do no harm, then to heal."

  "Basically, yes." Ross seemed pleased with this take on it, but Elliot knew he wouldn't be for long. "We're in medicine, Mr. Elliot," he continued. "The goal is maximum wellness for the most people."

  "And there's no conflict between your business interests and the needs of your patients?"

  "Of course there is." Ross was leaning back in his chair comfortably, his legs crossed. "But we try to minimize it. It's all a matter of degree. The company needs to sustain itself so it can continue doing its work."

  "And also make a profit, let's not forget. You've got to show earnings, though—right?—to please your investors?"

  Ross smiled and spread his hands in a self-deprecating way. "Well, we're not doing too well at that lately."

  "So I hear." Elliot came forward in his wheelchair, spoke in a friendly tone. "Do your investors ever express displeasure with the salaries of your officers and directors?"

  Ross blinked a few times, but if the question bothered him, he covered it quickly. "Not often. Our board members are skilled businesspeople. If the pay weren't competitive, they'd go elsewhere. Good help is hard to find, and when you find it, you pay top dollar for it."

  "And this good help, what does it do exactly? Run the company?"

  "That's right."

  "And yet you're close to bankruptcy." It wasn't a question, but Elliot let it hang for a beat. "Which makes one wonder if lesser-paid help could do any worse, doesn't it?"

  * * *

  Fisk and Bracco may have come across as a matched pair to their fellow homicide inspectors, but they really couldn't have been much more different from each other as human beings. And this meant they were different kinds of cops, too.

  When it got to be five o'clock, Harlen Fisk asked his partner if he'd drop him off at Tadich's, the city's oldest restaurant. In spite of his pregnant wife and baby boy waiting at home, he'd be meeting his aunt Kathy and several of her supporters for dinner and schmoozing well into the night. He didn't invite Bracco to join them, and there were no hard feelings either way. The fact was, Fisk was a political animal with his eye someday in the distant future on political rewards.

  By contrast, Bracco was the son of a cop, but even so, until he got the promotion to homicide, he hadn't clearly understood how much his father's connection to the mayor was affecting his career, how much the regular guys resented him. And he'd never asked for special treatment—it had simply come with the territory. Political people in the department thought they could make the mayor happy by being nice to the Bracco boy, and they weren't all wrong.

  But when Fisk had told him that he was thinking about going to his aunt, the city supervisor, to complain about their continued ill-treatment on the fourth floor, Bracco had talked his partner out of it. One thing he'd learned from his father was that cops didn't whine. Ever. The thing to do was talk to Glitsky, he'd said. Ask straight and deal with the answer, which was that there was probably no intentional homicide here with the hit and run, and hence nothing to look into.

  Bracco believed that this was the truth. But what else was he doing with his time?

  So after he dropped Harlen off downtown, he spent a few hours checking leads that they'd picked up on the car during the course of the day. He didn't expect any results, but you never knew. His experience in hit and run had taught him that most of the time, the drivers would wait until they thought nobody was looking for their car anymore. They'd park it out of sight, keep the garage door closed. After a month, they would take it to a car wash or body shop. And that would be the end of it.

  But maybe this time—long odds, but possible—it would be different. They'd gotten eleven patrol call-ins during the day. These were vehicles fitting the description that were parked at the curb or in driveways around the city, reported by patrolling cops. Fisk hated this kind of legwork. Bracco, on the other hand, put in a couple of hours checking out each and every one. The impact that had thrown Markham would have left a sign even on an old, thick-skinned American car, and a quick walk around with a flashlight would tell him if he would need to come back with a warrant. But none of the cars had anything close.

  Not exactly knowing why, he killed another half hour walking through the parking garage at Portola Hospital, but there wasn't one old green car. So, feeling like an idiot, he sat in his car and wrote some notes to jog his memory tomorrow—check the Rent-A-Wrecks, don't forget the call-ins to H&R from citizens interested in the reward from the supervisor's fund (ten thousand dollars for information leading to the arrest and conviction, et cetera).

  Finally, on his way home after a piroshki gut-bomb he bought at a place on Nineteenth Avenue, he decided to head back up to Seacliff, to Markham's house. Start, as Glitsky said, with the family. Look at the cars parked outside. After all, he reminded himself wryly, he was the car police.

  * * *

  "Can I help you?"

  Bracco straightened up abruptly and shone his flashlight across the hood of the white Toyota he was examining. It was the last one of what had been twenty-three cars parked on Markham's block. The beam revealed a man of above-average height, who brought a hand up against the glare, and spoke again in a harsh, strained voice. "What the hell are you doing?"

  Bracco noted with alarm that he was reaching into his jacket pocket with his free hand. "Freeze. Police." It was all he could think to say. "Don't move." Bracco didn't know whether he ought to flash his badge or draw the gun from his shoulder holster. He decided on the latter and leveled it at the figure. "I'm coming around this car." His blood was racing. "Don't move one muscle," he repeated.

  "I'm not moving."

  "Okay, now slowly, the hand in your jacket, take it out where I can see it."

  "This is ridiculous." But the man complied.

  Bracco patted the jacket, reached inside and removed a cell phone, then backed away a step.

  "Look, I'm a doctor," the man said. "A patient of mine who lives here died today. So I come out after paying my condolences and somebody's at my car with
a flashlight. I was just going to use the cell to call the police myself."

  After a moment, Bracco handed the phone back to the doctor, and put his gun back where it belonged. If he'd felt like an idiot before walking the parking lot at the hospital, now he was mortified, although he wasn't going to show it. "Could I see some identification, please?"

  The man turned to look toward the house for a moment, then came back to the inspector. "I don't see " he began. "I'm " Finally he sighed and reached for his wallet. "My name is Dr. Eric Kensing," he said. "I was the ICU supervisor today at Portola Hospital."

  "Where Mr. Markham died?"

  "Right. He was my boss, I guess. Why are the police out here now?"

  Bracco found himself coming out with the truth. "I'm looking for the hit-and-run vehicle."

  Kensing blew out impatiently. "Could I please have my wallet back?" He slipped it into his pocket, then suddenly asked, "You're not saying you really think somebody Tim knew hit him on purpose, then came here to visit the family?"

  "No. But we'd be pretty stupid not to look, wouldn't we?"

  "It sounds a little far-fetched to me, but if that's what you guys do " He let the thought go unfinished. "Listen, are we done? I'd like to go now. My car didn't hit him. You see any sign that I hit him? You want to check again and make sure? I interrupted you in the middle of it."

  Something about the man's tone—a mixture of arrogance and impatience—struck Bracco. He knew that people reacted to cops in all kinds of different ways. Every once in a while, though, he believed that the reaction revealed something unusual, perhaps a consciousness of guilt. Kensing was reaching for the door handle, but Bracco suddenly and instinctively wanted to keep him for a few more words.

  "You say Mr. Markham was your boss? I didn't realize he was a doctor."

  Kensing straightened up at the car door and sighed again. "He wasn't. He ran the company I work for. Parnassus Health."

  "So you knew him well, did you?"

  A pause. "Not really." He shifted his gaze back over Bracco's shoulder again. "Now if we're done here "

  "What's in the house?" Bracco asked.

  "What do you mean? Nothing."

  "You keep looking back at it."

  "Do I?" He shrugged. "I wasn't aware of it. I suppose I'm worried about them. It's been a real tragedy. They're devastated in there."

  Bracco was picking up an off note that might have been fatigue but might be something else. He could turn his questions into an interrogation of sorts if he could manage to keep the right tone. "I thought you said you didn't know him well."

  "I didn't."

  "Yet you're worried about his family?"

  "Do you have some problem with that? Last time I checked, it wasn't a crime to care about a victim's family." Kensing swiped a hand across his forehead, cast a quick look up and down the street. "Look, Officer, are we going somewhere with this that I'm missing?"

  Bracco didn't answer. Instead, he asked a question of his own. "So, you didn't have any strong feelings about him?"

  The doctor cocked his head to one side. "What do you mean? As a boss?"

  "Any way."

  This time, the doctor paused for a long moment. "What's your name, Officer, if you don't mind? I like to know who I'm speaking with."

  "Bracco. Sergeant Inspector Darrel Bracco. Homicide."

  As soon as Bracco said it, he knew it was a mistake. Kensing nearly jumped at the word. "Homicide?"

  "Yes, sir."

  "And you're investigating Tim's death? Why? Does somebody think he was murdered?"

  "Not necessarily. A hit and run that results in death is a homicide. This is just routine."

  "Routine. Checking the cars coming to his house?"

  "Right. And you just called him Tim."

  "Does that mean something? His name was Tim."

  "You didn't know him very well, and yet you called him by his first name?"

  Kensing was silent, shaking his head. Finally, he let out a long breath. "Look, Inspector, I don't know what I'm supposed to say. The man died in my unit today, while he was under my care. I've known him for fifteen years, and I came by here to pay further condolences to his wife and family. It's almost ten o'clock and I've been up since six this morning and I'm the walking dead right now. I don't see where calling the man by his first name has any meaning, and if you don't mind, I've got an early call again tomorrow. I'd be happy to talk to you at the hospital if you want to make an appointment."

  Bracco realized that maybe he'd pushed his spontaneous interrogation too far. Everything Kensing said, tone or no tone, made perfect sense. There was no real point in harassing this probably decent doctor who had, in fact, voluntarily opened the door to another interview tomorrow. The inspector knew he'd overreached.

  "You're right. But I may call you in the next few days."

  "That'd be fine," Kensing said. "I'm not going anywhere."

  They both stood in the street for another beat; then Bracco told him good night and turned for the house. Glitsky had told him it started with the family, and maybe he'd find something inside, get some valuable first impressions. But he hadn't gone two steps when he heard Kensing's voice again. "You're not thinking about going up to the house, are you?"

  He stopped and turned. "I thought I might."

  The doctor hesitated, seemed to be considering whether to say anything. Finally, he spoke up. "Well, you'll do what you're going to do, Inspector, but you might want to consider giving them a break tonight and coming back tomorrow. They've had a bad day. They're wrung out. I guarantee none of them drove your hit-and-run car. What are you going to ask them that can't wait?"

  Bracco had had a long day himself. He looked back at the house, still lit up. It struck him that his need to find something, anything, to do with Tim Markham's death, and thereby prove his worth to Glitsky, was pushing him too far too fast. He'd invented phantoms and made some interrogation mistakes here with Kensing, just now.

  And he was about to do it again with the family when he had no plan and there was really nothing to ask. He should leave them to their exhaustion and grief. Tomorrow was another day.

  Bracco nodded. "That's a good call, but you and I might be talking again soon."

  "I'll look forward to it," Kensing said, and opened the door to his car.

  8

  Glitsky had lived in the same upper duplex for twenty years and now, between the blessing of rent control and the latest surge in San Francisco real estate, he knew he would be living there when he died. Even if the owner sold it, a new owner could never make him leave unless he wanted to move in himself, and that would take forever and cost a fortune. Glitsky's rent could never go up beyond a piddling percentage. And with converted condo one-bedroom fixer-uppers now going for half a million dollars anywhere in the city, he knew he could never afford to buy something else. As it was, he paid rent of less than a thousand dollars a month for the place, which was on a quiet dead end, a really beautiful tree-lined block north of Lake. His backyard opened onto a greenbelt and running path at the border of the Presidio, so he often woke up to birds chirping rather than sirens wailing. Deer and raccoon sightings were common. He didn't kid himself—he knew he was one of the very fortunate.

  Still, it wasn't as though he lived in ducal splendor. Ducal splendor, he felt, was hard to come by in thirteen hundred square feet, especially when that area was subdivided into three bedrooms, a kitchen, and a living room. Still, with Flo he'd raised his three boys here; the lack of room had never really been an issue then, and it wasn't now. For the past several years, a housekeeper named Rita Schultz had lived with him and Orel, and she had slept behind a screen in the living room. Rita was gone now, which made the living room seem gigantic. Treya's sixteen-year-old daughter, Raney, had taken over what had for a short while been the television room down the hallway behind the kitchen. They had plenty of room.

  It was now 7:30 and both kids had gone off to school. Glitsky and Treya were both drinking tea, reading th
e newspaper at the kitchen table, which wasn't big enough to spread out the sections, so they played a quiet game, covering a portion of each other's pages whenever they turned their next one. When Treya had done this for the fourth time, covering the lengthy article Glitsky was reading about the latest news on the ancient water flows on Mars and what they all might mean, he put down his mug, reached over and, quite gently, ripped the offending page down the middle. He then dropped it on the floor.

  "You are such a fun person," she said. "I don't care what everybody says."

  "Are there people who don't think I'm fun?"