An American Airline flight from Cancun, Mexico, landed at Detroit Metropolitan Airport on Sunday afternoon. Ray Tamayo, his wife, and his two teenage daughters exited the plane. They were all tanned and happy. Dr.Tamayo, in particular, was pleased with his appearance; his dark suntan contrasting nicely with the silver hair at his temples. He arranged a limousine ride to take his family to their home in Toledo. Detroit Metro is located on the south side of Detroit, a mere forty-five miles from Toledo. The limo ride would take just under an hour.

The doctor’s home was mammoth; a ten thousand square foot mansion built in a Spanish motif with white stucco exterior and a bright orange terracotta roof. Entering the home, they were greeted by the scent of fresh flowers, a welcome prepared by their maid, Annalina. She had cleaned the entire house during the family’s absence, and placed bouquets of fresh flowers in the foyer, kitchen, living area and master bedroom. Annalina, an illegal immigrant from Mexico, had separate living quarters in Tamayo's home.

Ray Tamayo felt invigorated and alive after his vacation, but didn’t look forward to returning to work--especially knowing he would be greeted by stacks of charts in need of dictation, along with piles of unanswered telephone messages. The next day, as usual, he arrived at the office early, never later than seven a.m. The doctor knew that time was money, and for him, money was life.

                                                  * * *

On Monday morning Carlo Conti drove his new Lincoln Continental to St. Christopher’s Cemetery in Beverly Hills, Michigan. It was exactly ten days from the night of Michael’s death, and ten days since he had rammed his car into the hospital's Emergency Room entrance. He'd driven directly into a thick, concrete column, one of two supporting a concrete slab roof.  His intent to kill himself was foiled by an airbag. Something he had forgotten about. He sustained nothing more than bruised knees and walked away from the crash with naer a scratch. He was not cited by the police, who assumed the distraught old man had either passed out or was disoriented. In either case, they felt he was not responsible for his actions.

He stood at his son’s grave, which was covered with freshly laid sod. His entire family was there, Michael, Cassie, and Marie. Next to Marie’s gravesite was one remaining, unused plot. Carlo placed flowers in front of each headstone. He knelt and prayed—praying for the souls of his children and wife. He spoke to God, apologizing for his life of anger, his pursuit of weatlh and the horrible way he had treated his son. Since the funeral, Carlo had resumed attending Mass every day, praying for forgiveness, doing his best to redeem himself and make reparation for what he perceived as a life of unconscionable behavior. After twenty minutes of solemn prayer, he drove back to his empty home.

                                                       * * *

As expected, Tamayo found a large pile of charts on his desk, along with numerous messages and test results. A death certificate, lying on top of a stack, caught his eye. He reviewed the certificate: Michael Conti, age thirty-nine. The name didn’t ring a bell. He couldn’t recall who Michael Conti was, and wondered if the certificate had been delivered to the wrong office. A copy of the emergency room memo regarding Michael’s treatment was paper clipped to the death certificate.

As Tamayo read the memo, he felt a rush of anxiety. Michael Conti suddenly came back to him. What the hell happened? he thought. Leafing through the emergency room notes, he discovered that David Barnett had been called in as a consulting cardiologist. Tamayo knew Barnett well enough to know of his capabilities; he held him in high regard. Ray felt some relief in knowing that Mr.Conti had most likely received good care from Barnett, and realized that he, having been on vacation, had no obligation to sign the certificate. Death certificates are a serious matter, and generally have to be signed within forty-eight hours of a patient’s demise. This certificate was already a week late. He took it out to his secretary and asked her to send it immediately, via courier, to Dr. Barnett’s office.

Tamayo returned to his office and fingered through various medical charts on his desk. He located Michael Conti’s chart from his visit two weeks ago. Inside were numerous test results awaiting his review. As with most of his patients, he had tested Michael to the hilt. The chart contained results from an EKG, a Doppler of the carotids and lower extremities, an echocardiogram, an ultrasound of the abdominal aorta, a forty-eight hour Holter monitor, a nuclear stress test and blood work including a complete metabolic profile, complete blood count, cholesterol fractionation, and some esoteric labs, a homocysteine level and C-reactive protein.

Since Michael Conti was dead, and would never be returning to the office, Tamayo decided there was no need to assess the test findings. He would be too busy with his remaining backlog to waste time on a dead man. He had more important things to attend to. Ray threw Conti's chart in the lower drawer of his desk.

                                                                                                                                      * * *

Time had become Carlo Conti’s enemy. Minutes passed at an excruciatingly slow pace. Three weeks after Michael’s funeral, Carlo had not yet returned to work. He no longer cared about his business, his wealth or his life. He was painfully alone and living in misery; he prayed to God frequently throughout the day, begging for relief from his dire agony—none came.

Carlo tried to escape reality with sleep, but suffered through relentless nightmares that forced him to take short naps during the day--remaining awake all night. He went a month or more without leaving his home, becoming disheveled and unkempt. He wore the same clothes for days on end, never showered and refused to answer phone calls, even those from his office. Carlo Conti, the CEO and President of Conti Manufacturing, had become a destitute, abject recluse.

A major change in Carlo's attitude came just in the nick of time; as he was nearing his breaking point, and seriously considering suicide, an emotional transformation came to his defense. Intense, malevolent anger and a craving for revenge became his salvation. The joy of vengence consumed him, giving him something to live for. His depression was surplanted by a thirst for restitution from those who had destroyed his family. For the first time in many weeks, Carlo Conti was happy. 

Characteristicly for Carlo, with his past dedication to rhythm birth control when never wanting another child, he remained oblivious to the contradiction between his hunger for vengence and his desire to please God.

Carlo's new found anger, snapped him out of his catatonic state. He began to venture outside and soon returned to work. At his office, he became preoccupied with planning his attack. By any means possible, he would obtain recompense. Any means included assistance from the one person he knew could help. Carlo had to call his cousin Vico. 

“Hello.”

“Vico, it’s Carlo.”

“Carlo, I’m really glad to hear from you. Me and Angela have been worried sick about ya since Mikey and all.” 

“I appreciate that, Vico.”  

"I felt bad about not talkin’ to you at the funeral. You know how it was--so crowded, and we really didn’t know what to say. It was terrible, Carlo.”

“I understand. Give my best to Angela. Listen, I'm callin’ ya for a favor.”

“Anything, you name it.”

“I wanna hire a P.I., an investigator to do some snoopin'  for me--to look into someone’s background.”

“No problem. I know a lot of guys like that. Hope you don’t mind me askin’—why do you need a PI?”

“I’m angry, Vico, real angry. It’s the doctors. I know they screwed up. Michael shouldn’t have died. Marie never should have died.” He hesitated, deciding not to mention Cassandra. 

“I know how you feel. Those fuckin’ bastards. Fuckin’ doctors are worse than the goddamn attorneys. Mikey and Marie both gone. It’s your whole family.”

Carlo thought, Vico didn’ t mention Cassie. I’m not surpised. She’s a distant memory for everyone but me.

Vico continued.” You’ve lost your whole goddamn family. I feel for ya.”

Carlo was no stranger to curse words; however, when talking to Vico, four letter words seemed to fly out of his mouth, as if they were mandatory. “You’re right, Vico. Those bastards are all a bunch of greedy assholes. They’ve killed my family and I’m gonna make ‘em pay!”

“Son-of-a-bitch. I know exactly what you mean. I’m so angry I could go after those pricks myself. I don’t know how you sleep at night.”

“I don’t.”

“Fuckin’eh. I’m not surprised, Carlo”  

“Vico, I appreciate your help. If you could give me the name of someone who can investigate these crooks it would mean a lot to me.”

“Listen, I’m not gonna give you a name now. I have to think about this. I wanna decide who’s the best man for your job. You’ll get a phone call in a couple a days. I guarantee it.”

“Thanks. Remember to tell Angela I said hello. I appreciate her thoughts.”

“I won’t forget. Like I said, we’re both pretty tore up about this. It’s a fuckin’ bad deal. The big guy upstairs really fucked you over.”

Carlo felt an emotional jolt, stunned by hearing the suggestion that it was God’s doing. Since Cassie’s death, he had been consumed by guilt—religious guilt, Catholic guilt. He struggled with it for decades. He thought, Am I to blame. Is God punishing me for my sins?

"Vico why do you say that? What’s God have to do with this?”

“Come on, Carlo. It’s just an expression. How the hell would I know what God thinks? I was only talkin’ ‘bout all the shit you been through. I know you go to church every day. I know you gotta be prayin’. What good has it done ya? Fuckin’ God. I don’t believe in him.”

“Vico, I’m not blaming God for this. I love God. He’s on my side. Without my prayers I’d have been dead long ago.”

“Okay, I’m sorry for what I said. You hang in there buddy.  Remember, you’re gonna get a phone call in a couple a days.”

Exactly as promised, a call came two days later. It wasn’t Vico. It was an investigator named Frankie Belletti. Carlo explained that he wanted background information on all of the physicians involved in Michael’s care: Tamayo, Goetsh, and most importantly, Barnett. The PI said it would be a piece of cake. The majority of the information needed was on the internet in the National Physician’s Data Bank. He promised to get all of the dirt he could find—figured it would take no more than a week of poking around. Frankie would report back soon.

A return call came sooner than anticipated,only four days later. The investigator had already dug up some pertinent information. 

“Mr. Conti, it’s Frankie Bell. We spoke the other day.”

“I thought your name was Belletti?”

“Yeah, it is. But everybody calls me Frankie Bell. You know how it is with us Italians."

Feeling disappointed, Carlo thought, I hope Vico hasn’t sent me some low life. “Okay, Frankie Bell, I’m surprised you called back so soon.”

“Yeah, me too. I got some good dope on one a your doctors. Didn’t wanna wait to tell ya ‘bout it."

“Great, what did you find?”

“This David Barnett guy.”

“Yeah, what about him?”

“Fuckin’ guy’s a lush. He’s a boozer. The state board suspended his license. They made him  go to treatment, some place down south. He was down there forever, then they let the son-of-a-bitch go back to work.”

Carlo wasn’t impressed with the news. It was interesting information, but likely wouldn’t amount to much. “I’m not sure that’s gonna help. I was with Barnett at the hospital. He certainly didn’t seem to be drunk. Is that all you’ve found?”

“Is that all? I was pretty excited about it myself. But if that ain’t enough, I’ll just  keep on diggin’.”

“I’d appreciate it, Frankie. I’d like you to do that. This alcohol stuff may be useful, but I’m hoping for more.” Carlo reinforced his point. “Listen Belletti, check out all of those fuckin’ doctors, not just Barnett. Understand?”

“Okay, okay, I will. I’m on it, Mr. Conti. Call ya again in a few days.”

“I’ll be waiting.”

Three days later he received his return call. “Mr. Conti, it’s Frankie Bell.”

"I hope you have more news for me.”

“I don’t think we’re gonna do any better. I been lookin' around in the background of the docs: Goetsh, Tamayo, Barnett, even the emergency room nurses. Everybody seems clean. This boozer Barnett is the only thing I got for you.”

“I’m disappointed. Tamayo, you sure looked hard at Tamayo?”

“Yea, I looked real hard. Everybody I talked to said the guy’s an arrogant asshole, but that’s about it. He’s squeaky clean. Never been successfully sued, no drugs, no booze, no sex issues, no nothin’. He’s a real greedy bastard, but that’s it.”

“So, you think this is all you’re gonna get?”

“I’m afraid so. I’ll keep my ears open and keep lookin’ a little more, but I don’t think we’re gonna get more than we got.”

Carlo was frustrated. “How much do I owe you?”

“Mr. Conti, I know I told you ten grand when we first talked, but since I feel like I’m lettin’ you down a bit, let’s call it an even eight big ones. That sound alright?”

The money was of little concern for Carlo. He was more interested in the results.  “Frankie, tell you what, I’m going to give you the full ten thousand, but I want you to keep your eyes and ears open. Any other information provided will be greatly appreciated and financially rewarding.”

“I understand. And thanks for the ten grand. I don’t feel like I deserve it, but I ain’t gonna turn it down. I’ll be talkin’ to you later, sir.”

“Good bye, Mr. Bell.  Keep looking.”

Carlo spent the following week ruminating over his situation. His anger and desire for revenge were as strong as ever. Frankie Balletti had called back without new information. All Carlo had to go on was Barnett’s history of alcoholism. After thinking long and hard about it, he decided he would have to make that work. Now he needed an attorney. Another call to cousin Vico was in order. 
                                                                                                                                      * * *

Ray Tamayo, having been home from Cancun for over a month, had long ago finished his backlog of dictations. He said goodbye to his last patient of the day and walked to his office to dictate a note. He pulled his stethoscope from his neck to store it in the bottom drawer of his desk. Opening the drawer, he noticed one last chart needing dictation—Michael Conti’s chart. Shit, I forgot that was in there. Might as well get it over with now. He sat to review its contents.

Conti's chart was jammed with test results waiting for Tamayo's review. Ray started dictating.

The first test in the pile, a normal resting electrocardiogram, was followed by a Doppler study to review the carotid arteries for evidence of plaque. The Doppler was mildly abnormal and was dictated as such. The following test, an echocardiogram, done to review cardiac muscle and valve function, was normal. Michael’s lower extremity Doppler study showed minimal narrowing in the vessels to his legs—nothing serious. An ultrasound of Michael’s abdominal aorta revealed extensive atherosclerosis, unusually advanced for a thirty-nine-year-old, but not life threatening. Since none of these studies had any serious abnormalities, Tamayo dictated them accurately.

The three remaining tests in the pile really caught his attention. He perused the Holter recording’s numerous pages of EKG rhythym strips, stopping short on page five. The EKG  showed a short burst of a life threatening arrhythmia--ventricular tachycardia. The doctor quickly leafed through the accompanying diary of symptoms to see what Michael was doing when the V-Tach occurred. He had been jogging, and reported a sensation of skipped heart beats at the exact time of the arrhythmia. Tamayo was in a jam. The serious nature of this arrhythmia would have warranted rapid follow up. Since a Holter requires forty-eight hours of recording, Tamayo could not have reviewed it prior to leaving on vacation.

Furthermore, Michael’s nuclear cardiac stress was markedly abnormal with severe electrocardiograph changes during exercise, indicating that he indeed had significant coronary artery disease. While reviewing the stress nuclear, Tamayo felt a sinking feeling in his chest and a brief wave of guilt—both quickly passed. No need to cry over split milk, he thought. His major concern was the possibility of this test getting into the hands of an attorney. Certainly, Michael should have received urgent attention on that Monday, two days after Tamayo’s departure. It was the doctor’s responsibility to have adequate coverage by another professional, a cardiologist, not merely his medical assistant.

The last test in the pile was a sheet of laboratory results. Most of the results were normal with one major exception When the doctor saw Michael’s cholesterol level his eyes shot open wide as he uttered, Dios Mio! Michael Conti’s cholesterol was a staggering twelve-hundred-eighty-six. Tamayo was stupified; he had never seen a cholesterol level any where near that level

Had Michael’s tests been reviewed in a timely manner, Tamayo could have saved his life—he was sure of it. An angioplasty or coronary bypass would have saved him. However, at this point the test results were moot; the patient was dead. Tamayo's neglect of Michael Conti's cardiac work-up was blatant, egregious negligence that Ray Tamayo could never face publicly. The doctor decided there was no need for further dictation, further thought or further  remorse. It was time to move on to more pleasant things. 

Tamayo placed Conti’s chart in a special cabinet containing his collection of past mistakes--a secret, padlocked cabinet. The doctor removed the tape from the dictation machine and tossed it in the trash. It’s been more than a month and I haven’t heard a word from Conti’s widow or relatives. Things should be fine--things will be fine, I'll see to it. I’m not gonna worry about attorneys and law suits. Besides, I’ve never been sued in over thirty years of practice. I’m charmed!

                                                                                                                                   * * *

 “Hello.”

 “Vico, it's Carlo.”

“Hey, Carlo. Did my man call you?”

“Yep. He came up with something I can use.”

“I'm not surprised.  Frankie’s a good guy.”

Carlo bit his tongue, thinking Frankie was a louse. “Yeah, he’s alright.”

“What can I do for you now?”

“Vico, I need an attorney. Someone experienced in malpractice. Someone who’s really good.”

“I know just the guy. He’s a fuckin’ bulldog. This guy eats doctors for lunch. But Carlo, he’s a bit pricey.”

“Money’s not an issue. He sounds like the right kinda guy—an aggressive blood sucker?”

“You got it, Carlo. Like I said, he’s a Goddamn bulldog. And this guy’s experienced. I’ve known him for a long time, and from what I hear, he never loses. He's even done some work for me. As you can imagine, if he takes care of my shit, he ain’t no stickler about the law—breaks a few rules now and then, but get’s the job done. Know what I mean?” 

Carlo hated attorneys almost as much as he hated doctors, but in this case, the right attorney could be his salvation. “He sounds perfect. However, there’s a potential problem. This case is gonna be in Ohio, in Toledo. I need a guy that’s licensed outside of Michigan.”

“I don’t know ‘bout that. I’ll give him a call and find out if he can work in Ohio, I’ll have him call you directly. I think those guys can get temporoay privelidges outta state. If not, I’ll call ya back and come up with some more names. I know a lotta councelors, Carlo. Like the consiglieres of the old days. They were the best. Most of these new guys are asshole-- greedy bastards, just like the doctors, but some of ‘em are good guys; there willing to give ya an honest day’s work for a few bucks.”

“Sounds like a plan, Vico. I appreciate it. “

“Hey, Carlo. It’s the least I can do. Like I said, me and Angela, we’re really shook up about this whole thing. You deserve some gratification, a little sweet revenge for Christ’s sake, Carlo, you’ve earned it.”

“Vico, what’s this attorney’s name.”

“His name? It’s John Gallagher.”  

"He's not Italian?

"Fuck no. Guy's Irish or a Scot--I don't know. But I can tell ya, I know some world history. I study that shit. Those people are fuckin' barbarians, especially the Scots. Gallagher takes no prisoners. He'll do the job for ya, Carlo."