Hektoen International

A Journal of Medical Humanities

Business as usual

David Blitzer
New York, New York, United States


An empty hospital room
Inauguración del Hospital Municipal de Chiconcuac. 2016. Photo by Presidencia de la República Mexicana. Via Flickr. CC BY 2.0.

Clarissa Myers arrived at the hospital at the usual time on Monday morning. She walked past her assistant, strode into her office, and sat at her desk, just as she had for the past three years. She took a moment to study the view and then turned back to her desk, settling her mind for what the day would require from her. Her schedule for the day was fairly typical for the start of a week. She had the usual meetings with other chief officers of the hospital system. She had led the hospital system, for which she was the chief executive officer, into what was proving to be the most productive and profitable period in its history. This, of course, is exactly what she had been hired to do. Indeed, her entire career had been geared towards this type of work. After several years in consulting, an MBA from an elite business school, and plenty of experience with leadership in other sectors, she had moved into medicine expecting the same success for herself. Thus far, she had certainly delivered, and she did not expect anything to change on that front. There was, however, the CMO (chief medical officer) report.

Late last week, while on the phone discussing branding opportunities with a new regional satellite partner, her assistant had walked into her office and left the most recent report from the chief medical officer. On the report was a single post-it saying “!?!” Clarissa knew exactly what this meant. She had been receiving these reports every week since she took over at the helm of the hospital system. For the past few months, she could not remember exactly how long, the CMO had been adding exclamatory notes just like this one. The reports themselves had also been relatively unchanged. They all reported essentially the same thing, namely that the hospital did not have any patients. Not that visit numbers were down or that trends were ominous, but rather that the hospital was in fact empty.

An empty operating room in a hospital
Inauguración del Hospital Municipal de Chiconcuac. 2016. Photo by Presidencia de la República Mexicana. Via Flickr. CC BY 2.0.

It was the strangest thing, and yet, ever since reports like this started coming to her, she had not been able to figure out what to do with the information. She was sure they were accurate, indeed she had verified it with her own eyes. Yet from discussions with her chief financial officer, she knew that revenues in that period were just as high as they had been. Her chief operations officers told her that all systems were running at, or near, full capacity and that they were continuing to build in more efficiencies to improve their margins. The chief marketing officer assured her that the hospital brand had never been stronger. Every chief officer had similarly positive news to report. Everyone save the CMO. In fact, just recently the annual hospital rankings had been released and her system was once again #1 in the region and had broken into the top five nationally. This was a new high for the system, and earned Clarissa a performance bonus. By any of the metrics that Clarissa had spent her career chasing, the hospital had never been in a stronger position. She knew this and she knew simultaneously that the hospital was not serving patients, but she could not explain the disconnect.

Since this little problem had arisen, they had held several meetings of the chief officers, and no one was able to figure it out. Finally, they had presented the problem to the board of trustees. Clarissa had been nervous about that meeting. While she had a relatively strong relationship with the board, she had expected this to be her first major conflict with them since taking over as CEO. She had not expected their actual reaction, which had been a collective shoulder shrug and then a hearty congratulations on the most recent financial report.

If Clarissa was being honest with herself, this little issue had been nagging at her for all of these months. She kept coming back to it, yet she could not figure out what it really meant and what to do about it. Shaking her head, she decided to once again table these thoughts for a later moment. She returned to the meetings and phone calls that lay ahead of her for the day. She just did not have the time or head space to waste on philosophical thoughts about her empty hospital. There was, after all, bigger business to attend to.



DAVID BLITZER obtained his MD and Master’s in Bioethics from the University of Pennsylvania. He is currently a 4th year resident in the cardiothoracic surgery training program at Columbia University.


Summer 2021  |  Sections  |  Fiction

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