Critical

1

At age thirty-seven, Angela Dawson was no stranger to adversity and anguish, despite having grown up in an upper-middle-class family in the affluent suburb of Englewood, New Jersey, where she had enjoyed all the associated material advantages, including the benefit of an extensive Ivy League education. Armed with both M.D. and MBA degrees as well as excellent health, her life on this early April night in the middle of New York City should have been relatively carefree, especially considering that she had every advantage of a wealthy lifestyle at her fingertips, including a fabulous city apartment and a stunning seaside house on Martha's Vineyard. But such was not the case. Instead, Angela was facing the biggest challenge of her life and suffering significant anxiety and distress in the process. Angels Healthcare LLC, which she had founded and nurtured during the previous five years, was teetering on the edge of either mind-numbing success or utter failure, and its outcome was to be decided in the next few weeks. The outcome rested squarely on her shoulders.

As if such an enormous challenge was not enough, Angela's ten-year-old daughter, Michelle Calabrese, was having a crisis of her own. And while Angela's CFO and COO, the presidents of Angels Healthcare's three hospitals, and the recently hired infection-control specialist waited impatiently in the boardroom down the hall, Angela had to deal with Michelle, with whom she'd been talking on the phone for more than fifteen minutes.

"I'm sorry, honey," Angela said, struggling to keep her voice calm yet firm. "The answer is no! We have discussed it, I've thought about it, but the answer is no. That's spelled n-o."

"But Mom," Michelle whined. "All the girls have them."

"That's hard to believe. You and your friends are only ten years old and in the fifth grade. I'm sure many parents feel the same as I do."

"Dad said I could. You are so mean. Maybe I should go live with him."

Angela gritted her teeth and resisted the temptation to respond to her daughter's hurtful comment. Instead, she swiveled in her chair and glanced out the window of her corner office. Angels Healthcare was located on the twenty-second floor of the Trump Tower on Fifth Avenue. Her private office faced both south and west, with her desk oriented to the north. At the moment she was looking south, down the length of Fifth Avenue, chockablock with traffic. The receding red taillights appeared like a thousand radiant rubies. She knew her daughter was responding to her own anger about life with divorced parents and was trying to use Angela to get her way. Unfortunately, such hurtful comments about her ex-husband had worked several times in the past and had gotten Angela furious, but Angela was determined to try to keep it from happening. Especially under the strain she was, she had to keep herself calm for her upcoming meeting. Parenting and running a multimillion-dollar business were often at odds, and she had to keep them separate.

"Mom, are you still there?" Michelle questioned. She knew she'd crossed the line and already regretted her comment. There was no way she wanted to live with her father and all his crazy girlfriends.

"I'm still here," Angela said. She swung back around to face her sparsely furnished, modern office. "But I did not like your last comment one bit."

"But you are being unfair. I mean, you let me pierce my ears."

"Ears are one thing, but belly-button rings are something else entirely. But I don't want to talk about it anymore, at least at the moment. Have you had supper?"

"Yeah," Michelle said dejectedly. "Haydee made paella."

Thank God for Haydee, Angela thought. Haydee Figueredo was a gracious Colombian woman Angela had hired as a live-in nanny right after Angela had separated from her husband, Michael Calabrese. Michelle was only three at the time, and Angela was six months away from finishing her internal medicine residency. Haydee had been like a gift from heaven.

"When are you coming home?" Michelle asked.

"Not for a couple of hours," Angela said. "I'm going into an important meeting."

"You always say that about meetings."

"Maybe I do, but this one is more important than most. Do you have homework?"

"Is the sky blue?" Michelle said superciliously.

Angela wasn't happy about the disrespect Michelle's comment and tone suggested, but she let it go.

"If you need any help with any of your subjects, I'll help you when I get home."

"I think I'll be asleep."

"Really! Why so early?"

"I have to get up early for the field trip to the Cloisters."

"Oh, yes, I forgot," Angela said with an exaggerated grimace. She hated to forget events that were important to her daughter. "If you are asleep when I get home, I'll sneak in, give you a kiss, and then I'll see you in the morning."

"Okay, Mom."

Despite the conversation's earlier tone, mother and daughter exchanged heartfelt endearments before disconnecting. For a few moments, Angela sat at her desk. But the phone conversation with her daughter had reminded her of a time and an episode that had been equally as challenging and distressing as the current situation. It had been when she had to deal with both divorce proceedings and the bankruptcy of her inner-city primary-care practice, and the fact that she had survived them gave her confidence in her current circumstance.

With slightly more optimism than she had had earlier that afternoon, Angela pushed back from her desk, picked up her notes, and emerged from her office. She was surprised to see her secretary, Loren Stasin, sitting dutifully at her desk. Angela had not given the woman a thought over the previous three hours.

"Why are you still here?" Angela questioned with a touch of guilt.

Loren shrugged her narrow shoulders. "I thought you might need me."

"Heavens, no. Go on home! I'll see you in the morning."

"Do I need to remind you of your meeting tomorrow morning at the Manhattan Bank and Trust, followed by your meeting with Mr. Calabrese at his office?"

"Hardly," Angela said. "But thank you anyway. Now, you get out of here!"

"Thank you, Dr. Dawson," Loren said while surreptitiously putting away a novel.

Angela continued down the stark interior hallway. For a multitude of reasons, she wasn't looking forward to tomorrow's meetings. She always found it somewhat demeaning to try to raise money, and now, in such a desperate situation, it would be that much more humiliating. Even worse was that one of the people she would be asking for money was her ex-husband. Whenever she met with him, regardless of the reason, it almost never failed to evoke all the emotional turmoil of the divorce, not to mention the vexation she felt toward herself for having married him in the first place. She should have known better. There had been too many subtle suggestions that he would turn out like her father, challenged by her success to the point of encouraging bad behavior.

At the closed door to the boardroom, Angela paused, took a fortifying breath, then entered. Similar to her private office, the interior was aseptically modern, and dominated by a striking central table composed of a two-inch-thick piece of glass placed on the top of a white marble Ionic capital. The floor was white marble tile. Each of the side walls to the right and left had imbedded flat-screen television monitors for PowerPoint presentations. The far wall was glass, overlooking Fifth Avenue. The gilded and illuminated top of the landmark Crown Building immediately across the street filled the starkly modern room with a reflected warm glow.

The round table had been Angela's idea. Her management style emphasized teamwork rather than hierarchy, and the round table was more egalitarian than the usual boardroom fare. Although there were chairs for sixteen people, only six were occupied at the moment. The CFO was by himself at the opposite end, his back to the window. The three hospital presidents were to Angela's left. The COO was a few chairs away from the CFO, to Angela's right. The infection-control professional was next to the COO.

Purposefully, none of the department heads of Angels Healthcare, such as those from supply, laundry, engineering, housekeeping, public relations, personnel, laboratory services, and nursing, medical staff, or outside members of the board, were present. In fact, none had even been notified that the meeting was scheduled, much less invited.

Angela smiled cordially as she quickly glanced around at individual faces and acknowledged each person. The expressions were mildly apprehensive, except for CFO Bob Frampton, whose fleshy face had an ever-present sleep-deprived appearance, and for COO Carl Palanco, who looked to be in a state of continual surprise.

"Good evening, everyone," Angela said as she sat down. She again glanced around the room. "First, let me apologize for keeping you waiting. I know it is late and you are eager to get home to your families, so we will make this short. The good news is that we are still in business." Angela glanced at the three presidents, all of whom nodded in a restrained fashion. "The bad news is that our cash-flow problem has gone from concerning to critical. Of course, we felt the situation was critical a month ago, but it has gotten worse."

Angela gestured toward Bob Frampton, who shook his head slightly as if to wake himself. He leaned forward, putting his elbows on the table with his beefy hands together and fingers interlocked.

"We are rapidly approaching, if not violating, our eighty percent margin on our loans with the Manhattan Bank and Trust. We had to sell some bonds to make a payment to our cardiac stent provider. They were threatening to cut off our supply."

"Considering how tight finances are, I want to personally thank you for doing that," Dr. Niesha Patrick said. She was a young African-American woman with light skin and a scattering of freckles in a butterfly pattern across her nose and cheeks. Like Angela, she had an MBA in addition to an M.D. Angela had recruited her from a large West Coast managed-care company to run Angels Heart Hospital. "With our ORs intermittently closed, our only dependable source of income has been from invasive angiography and cardioplasty. Without stents, even that revenue would be severely impacted."

"Invasive angiography and Lasik have probably been responsible for keeping us afloat," Angela said. She nodded in appreciation toward both Niesha and Dr. Stewart Sullivan. Stewart was the president of Angels Cosmetic Surgery and Eye Hospital.

"We are all doing what we can," Stewart said.

"As much of a gold mine specialty hospitals are in the current reimbursement milieu," Angela said, "they are at a particular disadvantage when their operating rooms close."

"But the operating rooms are now all open," Dr. Cynthia Sarpoulus said defensively. Cynthia was a medical-school classmate of Angela's who'd gone on to specialize in infectious disease and epidemiology. Angela had hired her when the current nosocomial infection problem started three and a half months previously. Cynthia was a dark-complected, raven-haired woman with a bit of a temper. Angela had been willing to put up with her thin-skinned and often caustic style because of her training, dedication, intelligence, and reputation. She'd been the reputed savior of several institutions with infection-control problems.

"They might be open, but they aren't being utilized except by a fraction of our medical staff," Dr. Herman Straus said. Angela had recruited Herman from a Boston community hospital, where he'd been a well-respected assistant administrator. A big, athletic man with an outgoing personality, he had a particular affinity for dealing with orthopedic surgeons. That quality combined with his Cornell Hospital administration training made him an ideal president of Angels Orthopedic Hospital, and his record was proof of it.

"And why is that?" Angela asked. "Surely they know we have been on top of this problem right from the beginning. Cynthia, remind everyone what has been done."

"Just about everything possible," Cynthia snapped, as if she was being challenged. "Every OR has been cleaned with sodium hypochlorite and fumigated at least once with a product called NAV-CO2. It's a nonflammable alcohol vapor in carbon dioxide."

"And not without considerable expense," Bob interjected.

"And why that particular agent?" Carl questioned.

"Because methicillin-resistant staphylococcus aureus, or its more common designation, MRSA, is highly sensitive to that particular preparation," Cynthia shot back, as if it were a fact everyone should know.

"Let's not get testy," Angela said. She wanted to keep the meeting friendly and, she hoped, productive. "We are all on the same page here. No one is casting aspersions. What else has been done?"

"Every hospital room that has seen an infection has also been similarly treated," Cynthia said. "More important, perhaps, as you all know, every member of the medical staff and every employee of the hospitals are cultured on a recurrent basis, and those who test positive as a carrier are treated with mupirocin until they test negative."

"Also at great expense," Bob added.

"Please, Bob," Angela said. "We are all aware of the expense side to this disaster. Cynthia, continue! Do you think culturing and treating the staff and employees is critical?"

"Absolutely," Cynthia said. "And we might consider the same for patients as a prelude to admission. Both Holland and Finland had a particularly bad problem with MRSA, and the way that they brought their problem under control was by treating both staff and patients: anyone who tested positive as a carrier. I'm beginning to wonder if we might have to do the same thing. Yet my real concern is that the MRSA is occurring at all three of our hospitals. What does that say? It says that if a carrier is responsible, then that carrier must routinely visit all three hospitals. Consequently, I have as of today ordered the testing and treating of all employees from even here at the home office who regularly visit all three hospitals, whether they have actual patient contact or not."

"Anything else?" Angela asked.

"We have mandated aggressive hand-washing after each patient contact," Cynthia said, "particularly with the medical staff and nursing personnel. We've also instituted strict isolation for all MRSA patients, and more frequent changing of medical staff clothing, such as white coats and scrub outfits. We also require more alcohol cleaning after each use of routine equipment, like blood pressure cuffs. We've even cultured all the condensate pans of all the HVAC air handlers in all three hospitals. All have tested negative for pathogens, especially the strain of staph that has been plaguing us. In short, we are doing everything possible."

"Then why haven't the doctors been admitting patients?" Bob questioned. "As they are all owners, they have to be aware they are taking money from their own pockets by not doing so, especially if we go bankrupt."

"I don't want to hear that word," Angela said, having already been through that demeaning experience.

"It's clear why they are not admitting," Stewart said. "They are terrified of their patients getting a postoperative infection despite all the infection-control strategies. With reimbursement solely based on DRGs, or diagnostically related groups, patients getting a postoperative infection directly cuts down on their productivity, and it is productivity that determines their income. Besides, there's the malpractice worry. Several of our plastic surgeons and even two of our ophthalmologists are being sued over these recent staph infections. So it's pretty simple. Despite being equity owners, it makes economic sense for them to go back to University or the Manhattan General, at least in the short run."

"But all hospitals are having trouble with staph," Carl said, "particularly methicillin-resistant staph. And that includes both the University and the General."

"Yeah, but not over the last three months, nor at the rate we have been seeing it," Herman said. "And despite all these efforts that Dr. Sarpoulus has been spearheading, the problem has not run its course, given that we at Angels Orthopedic had another case late today. It's a patient by the name of David Jeffries."

"Oh, no!" Angela lamented. "I hadn't heard. I'm crushed. We'd been spared for more than a week."

"Like all the previous cases, we're trying to keep it quiet," Herman said. "As I said, it unfolded late this afternoon." For a few moments, silence reigned.

All eyes switched to Cynthia. The expressions ranged from anger to dismay to inquisitiveness: How could this happen after all that Cynthia had just told them was being done, with considerable funds that they did not have?

"It hasn't been confirmed it was methicillin-resistant staph," Cynthia snapped defensively. She'd been called by the hospital's infection-control committee chair and briefed on the case just prior to coming to the current meeting.

"If you mean it hasn't been cultured, you're right," Herman said. "But it was positive by our VITEK system, and my lab supervisor says she's never had a false positive: false negatives yes, but not false positives."

"Good Lord," Angela said, trying to keep her composure. "Was the patient operated on today?"

"This morning," Herman said. "Anterior cruciate ligament repair."

"How is he doing, or shouldn't I ask?"

"He died while being transferred to the University Hospital. For obvious reasons, once it was clear he had septic shock, he would have been far better treated over there."

"Good Lord," Angela repeated. She was devastated. "I hope you realize that was a bad decision. Sending two patients in as many days to a regular, full-service hospital raises the risk the media might get ahold of the story. I can just see the headlines: Specialty Hospital Outsources Critical Patient. That would be a PR nightmare for us and do what we are trying desperately to avoid: negatively affect the IPO."

Herman shrugged. "It wasn't my decision. It was a medical decision. It was out of my hands."

"How has the Jeffries family taken it?" Angela asked.

"About the way you would expect," Herman responded.

"Have you spoken with them personally?"

"I have."

"What is your sense; are they going to sue?" Angela asked. At this point, damage control had to be a priority.

"It's too early to tell, but I did what I was supposed to do. I took responsibility on behalf of the hospital, apologized profusely, and told all the things we have been doing and will do to avoid a similar tragedy."

"Okay, that's all you can do," Angela said, more to reassure herself than Herman. She made a quick note. "I'll inform our general counsel. The sooner they get on it, the better."

Bob spoke up: "If there had to be another postoperative infection, as tragic for everyone as it is, it's best the patient passed quickly. The cost to us is considerably less, which could be critical under the circumstances."

Angela turned to Cynthia. "Find out if the procedure was in one of the operating rooms that had just been cleaned. In any case, see that it is again taken care of, but don't shut the whole OR. And find out when all the involved personnel had been cultured and if any of them had been a carrier."

Cynthia nodded.

"Isn't there some way we can get our physician owners to up the census?" Bob asked. "It would be enormously helpful. We have to have revenue. I don't mind billing Medicare in advance if it is only for a couple of weeks."

The three hospital presidents looked at one another to see who would speak. It was Herman who spoke up: "I don't think there's any way to increase census, especially with this new MRSA case today. I don't know how my colleagues feel, but orthopods are very infection-adverse, because bone and joint infections have a tendency to stay around for a long time and eat up a lot of the surgeon's time, even in the best of circumstances. I've spoken about this issue with my chief of the medical staff. He's the one who clued me in."

"I've spoken with my chief of the medical staff," Niesha said. "I got essentially the same response."

"Ditto for me," Stewart added. "All surgeons are risk-averse when it comes to infections."

"It's probably too late, in any case," Angela said, trying to recover from this new blast of bad news. "But Bob's question gets to the heart of the reason I called this meeting. First, I wanted you all to hear about everything Dr. Sarpoulus has done concerning our MRSA problem. Of course, I wasn't aware there had been a new case. I'd truly hoped we were in the clear. Be that as it may, we have to somehow weather the next few weeks."

Angela then turned to Cynthia. "Angels Healthcare thanks you for your continued efforts, today's events notwithstanding. Now, would you mind leaving us for our boring financial discussion?"

Cynthia didn't respond at first. Her coal-dark eyes regarded Angela briefly, then swept around at the others. Without a word, she pushed back from the table and left the room. The door closed with a definitive thump.

For a moment, no one spoke.

"Rather headstrong," Bob commented finally, breaking the silence.

"Headstrong but dedicated," Carl said. "She's taken this whole problem and its persistence personally. I bet she thinks we are going to talk about her negatively especially with this new case."

"I'll assure her tomorrow,"Angela said. "But now let's get to the crux of the matter. As you all know, the closing of our IPO is two weeks away. The trick is how we are going to get there without any would-be investor or SEC official finding out about our ongoing cash-flow disaster. We've been lucky so far, despite the malpractice suits. We're also lucky that the problem with the staph occurred after the external audit, so its impact is not reflected in our IPO prospectus. I know you have all made enormous personal sacrifices. No one in the top echelon has taken any salary over the last two months, and that includes me. We've all maxed out our personal credit. I thank you for that. I can assure you we have begged and borrowed from all our investors to the maximum, including a quarter of a million from our lead angel investor syndicate.

"The irony of this desperate situation is that if the IPO goes as planned, the underwriters have recently guaranteed us five hundred million dollars, meaning we all will be rich and the company will be swimming in cash. Equally as important, our three hospitals proposed for Miami and our three hospitals proposed for Los Angeles will start construction. We are poised to be the first specialty hospital company to go public after the lifting of the United States Senate moratorium on specialty hospital construction, and we are involved in all the most lucrative specialties. The timing could not be more perfect. The sky is the limit. We just have to get there."

Angela paused and engaged the eyes of each of the people in the room to make sure there was no dissent. No one moved or spoke. Angela briefly glanced down at her notes.

"There is no blame in this situation," Angela asserted. "None of our spreadsheets that we used for forecasting even worst-case scenarios predicted such a catastrophe, where all our ORs would shut down essentially simultaneously. With revenue at near zero and fixed costs high, the burn rate on our emergency capital was enough to leave us here in the home office breathless. But you know all this, and with your help, we have survived. We've limped along, withholding payment to our suppliers until it was critical. We're continuing to do that, but still, it might not be enough. Bob, tell everyone how much capital we would need to get us through the IPO."

"I'd be very confident with two hundred thousand dollars," Bob said. "As the amount drops to zero, so does my confidence."

"Two hundred thousand," Angela repeated with a sigh. "Unfortunately, that's a lot of money, and I'm fresh out of ideas. What it comes down to is whether any of you smart people have any suggestions. From your perspective, the main problem, of course, is that all of you will have to meet payroll, and with a negative cash flow continuing, that is getting more and more difficult unless we help you. The trouble is, all our cash accounts are drawn down."

"What about withholding paying taxes?" Stewart suggested. "It's just two weeks."

"Bad idea," Bob said with hesitation. "Payroll tax and withholding tax are paid by wire transfer. If any of you or we hold it up, the bank will know, because we would have to instruct them to do so. Instructing the bank to not pay taxes would be an enormous red flag."

"What about going back to our lead angel investor?" Niesha suggested.

"I'm going to try tomorrow," Angela said. "I'm not optimistic.

Our placement agent, who found the angel investor initially, has already squeezed out a quarter of a million a month ago, and at the time led me to believe that well was dry. Yet I'm still going to try."

"What about a bridge loan from the bank?" Stewart said. "They know about the IPO. Hell, it will only be two weeks. With the interest we've been paying on our loans, they've been making a fortune from us."

"You are forgetting what I said at the outset," Bob said. "I got a call Friday from our healthcare relationship manager at the bank. He was disturbed that we'd drawn down on facility by selling the bonds to pay our stent provider. They are not all that happy with us at the moment. If he called even part of our loan, the game would be over."

Angela looked from one person to another at that point. Everybody was looking down at their feet through the glass table. "All right," she said, when it was apparent no one had any other ideas. "I'm off to the bank and then our placement agent tomorrow. I'll do my best. If anyone has any additional ideas, I'll have my cell phone at all times. Thank you all for coming."

There was a scraping sound as all the chairs save for Angela's were pushed back on their Teflon-tipped legs. Everyone filed out, with most giving Angela's shoulder a reassuring squeeze in the process. For a few moments she stayed where she was, staring out at the gilded conical roof of the Crown Building across the street, while thinking about her company's predicament. It didn't seem fair that after all her work and anxiety, she and her nascent Angels Healthcare empire might be brought down by some lowly bacteria. At the same time, she wasn't surprised. In the financial world, whether it involved manufacturing lightbulbs or delivering healthcare, fairness was at best an afterthought. Money was king, and she'd learned that lesson the hard way, vainly trying to keep afloat her primary-care practice, which saw more than its share of Medicaid patients. It was that wrenching experience of bankruptcy more than anything else that had driven her to business school, where she had excelled as a kind of revenge and where she came to realize that medical care, if approached correctly, could make one not just financially comfortable but truly rich.

With a renewed sense of resolve, Angela pushed back her own chair and stood up. She retrieved her coat and umbrella from her office but purposefully left the notes she was holding and her briefcase on her desk. She planned to retrieve them in the morning before heading over to her first meeting of the day at the Manhattan Bank and Trust. She knew that in order to get a good night's sleep and be in top form on the morrow when she'd need all her wits, she had to make an active effort to clear her mind. By doing so under similar stressful circumstances in the past, she not only felt better the following day but often viewed problems from a different perspective and had new ideas. It was as if her subconscious was an active participant in her decision-making.

On the corner of Fifth Avenue and 56th Street, Angela stood a step away from the curb and raised her hand in an attempt to hail a cab, well aware that cabs were hard to come by at eight-twenty-five in the evening, especially on a drizzly early-April night. Since many of the city's taxi drivers were ending their shift, most of the cabs she saw had their off-duty lights on. The others were occupied. Until the previous month, Angela had regularly used a car service, but with the account seriously in arrears, she'd been reduced to taking cabs. Just when she was about to start walking to her 70th Street apartment, a taxi pulled up to discharge a passenger. The moment the man paid and jumped out, Angela climbed in.

As the cab sped toward Angela's destination, she took a deep breath and let it out with a huff. It was only then that she became conscious of her tenseness. With her arms crossed in front of her, she massaged the tips of her shoulders, then did the same with her temples. Slowly, she could feel her abdominal muscles and thigh muscles relax. Opening her eyes, she took in the lights of the city reflected in the slick, wet streets. There were plenty of pedestrians out, many arm in arm, sharing umbrellas. It was at such moments, between the demands of the workday and the domestic concerns involving her daughter, that Angela was aware of the fact that she had no social life, specifically with members of the opposite sex. Interacting with men was restricted to work-related encounters, the rare parents' night at her daughter's school, or, sadly enough, with someone in the checkout line at the grocery store. The fact that it was her choice, both as a driven woman and as a woman whose experiences with men caused her to question their monogamous ability, didn't lessen the occasional desire.

Refusing to give the issue more thought, she pulled out her cell phone and pressed the speed-dial button for home. Expecting to hear her daughter's voice since she usually answered before the completion of the first ring, Angela found herself talking with Haydee, the nanny-cum-majordomo. As busy as Angela's life was, she allowed Haydee to fill multiple roles.

"Where's the terror?" Angela questioned. The appellation "the terror" was the way Angela and Haydee humorously referred to Michelle behind the girl's back. It was humorous because it was the opposite of what they felt. Both women thought Michelle mildly and age-appropriately willful and occasionally argumentative, as evidenced by the belly-button-piercing issue, but otherwise near perfect.

"She's in bed, and I believe already asleep. Should I wake her?"

"Heavens, no!" Angela said, feeling a mild pang of loneliness. "Surely not."

After a short conversation about various domestic issues, Angela made an impromptu decision. She concluded the conversation by telling Haydee not to wait up for her, as she wouldn't be home for several more hours.

Sliding forward on the seat, Angela spoke to the driver through the Plexiglas partition. Instead of going home to a sleeping daughter, she'd decided to go to her health club. With all that was going on, she'd not been there for months and certainly could use a workout for mental as much as physical reasons. Besides, she reasoned, there would be people around, and on top of that, she could get a bite to eat in the club's surprisingly good restaurant/bar.

Angela's athletic club was close to her apartment, a block over and a few blocks down Columbus Avenue. She found her underused membership card without much difficulty in her overstuffed wallet. In short order, she changed into her workout clothes and took a turn on one of the stationary bikes while watching CNN. She was dismayed at how out of shape she was. Within five minutes, she was out of breath. After ten minutes, she was sweating to the extent that she feared she looked like a glass of iced tea in the tropics. Yet she persisted on sheer willpower until she had reached her twenty-minute goal.

Dismounting from the bike, Angela put her hands on her hips and stood with her chest heaving, trying to catch her breath. For a moment, it took all her concentration. On top of that, she was drenched. Her hairband, which in the past had been more of an affectation than a necessity, was completely soaked. She imagined she looked like a wreck with her face flushed, her workout gear clinging to her body, and her hair a veritable mop. What was so embarrassing was that the people on the neighboring bikes were all riding with such apparent ease. No one seemed to be perspiring, and many were able to concentrate on reading as they pedaled. Angela knew there was no way she could have read anything during her workout, especially toward the end.

She picked up her towel and dried her face. Feeling self-conscious about her lack of endurance and bedraggled appearance, she quickly scanned the faces of the other riders as she set off toward the weight room. Luckily for her self-esteem, no one paid her any heed until she briefly locked eyes with a blond man who was pedaling furiously yet hadn't broken a sweat. The rapidity with which he looked away confirmed Angela's concerns about her appearance. As she passed behind him, she had to smile at her paranoia; in point of fact, she didn't care what the stranger thought.

Angela wandered around the weight room with no particular plan, using the machines randomly. She was careful not to use too much weight or do too many repetitions. The last thing she wanted to do was pull a muscle or sprain a joint. Despite the hour, the room was reasonably crowded. She noticed how a number of the men were checking out the women while pretending they weren't, reminding her how shallow some men could be.

Taking a pair of very light free weights, she positioned herself in front of a mirror and began stretching more than exercising the muscles of her upper body. While she continued, she appraised herself and tried to be objective. Her figure was still quite good and hadn't significantly changed from how it had looked in her mid-twenties. Obviously, that was due far more to genes than to effort, considering how seldom she'd made it to the gym while she'd nurtured Angels Healthcare. Her belly was flat, despite her pregnancy. Her legs had good definition, and her tush was firmer than she deserved. All in all, she was content with her appearance, except for her hair.

Angels Healthcare had been embroiled in the current MRSA-induced catastrophe only a month when she found a few stray gray hairs. Her mother had gone gray early so she shouldn't have been so surprised, but it had bothered her to the extent that she'd secretly gotten a rinse at the local pharmacy and used it several times. Although the gray had disappeared, she'd worried that some of her natural sheen had gone with it. And now, as she looked at it in the health-club weight room mirror, she was convinced.

Angela suddenly made a brief but exaggerated expression of utter horror in the mirror as a way of mocking herself. In the final analysis, she was not a vain person. Accomplishment was what interested her, not appearances.

"Are you all right?" a voice asked.

Angela turned and looked up into the face of the blond man with whom she'd briefly locked eyes in the room with the stationary bikes. He was somewhere in his mid-forties, reasonably handsome, and probably equivalently intelligent. He had bright blue eyes, cropped hair, and an insouciant, engaging smile. He was wearing a T-shirt that said Make my day.

"I'm quite okay," Angela said after her brief assessment of the stranger. "Why do you ask?"

"I thought there for a minute you were about to cry."

Angela laughed heartily. When she'd made her mocking expression in the mirror, she'd momentarily forgotten she was in a room with a bunch of secretly attentive males.

"Why are you laughing? Really! A minute ago, while you were doing your curls, you looked like you were about to break down in tears."

"It would take too long to explain."

"Time is not a problem for me. How about a drink after we finish our workouts and you can explain? After that, who knows?"

With a wry smile, Angela regarded the man standing next to her. It had been a while since she had experienced such a rapid, unabashed come-on. Under normal circumstances, she would have merely smiled and walked away. In her current mood, some repartee and companionship had an uncharacteristic appeal, at least for an hour or so. After all, she was trying to clear her mind.

"I don't know your name," Angela said, knowing full well she was opening the proverbial door.

"Chet McGovern. And yours?"

"Angela Dawson. Tell me, do you pick up women frequently here at the club?"

"All the time," Chet said. "Actually, it is the reason I come as often as I do. The exercise itself is too much like work."

Angela laughed again. She appreciated both honesty and a sense of humor. It seemed that Chet McGovern had both.

"You can drink while I eat," Angela said. "I'm famished."

"You've got a deal, lady."

Forty minutes later, after the two had showered, they sat across from each other in the combination bar/restaurant. The bar was packed. Behind the bar was a flat-screen TV televising a baseball game that everyone ignored. The level of the background chatter was like a bunch of feeding seabirds. Angela was sensitive to the noise, since she hadn't been in such an environment for years. She had to lean forward over her grilled salmon salad to hear.

"I asked what kind of work you do," Chet repeated. "You look like a model."

"Oh, sure," Angela scoffed. With comments like that, she knew for certain she was with an individual who thought of himself as a pickup specialist.

"Really!" Chet persisted. "What are you, twenty-four or twenty-five?"

"Thirty-seven, actually," Angela said, resisting the temptation to be sarcastic.

"Never would have guessed it. Not with a figure like you have."

Angela merely smiled. Such comments were fun to hear, even if less than sincere.

"If not a model, what kind of work do you do?"

"I'm a businesswoman," Angela said without elaborating, and to turn the conversation away from herself, she quickly added, "And how about you? Movie star?"

It was Chet's turn to laugh. Then he leaned forward and said, "I'm a doctor." Then he sat back. From Angela's perspective, he'd assumed a decidedly self-satisfied smile, as if she was supposed to be impressed.

"What kind of a doctor?" Angela asked after a pause. "M.D. or Ph.D.?"

"M.D. and board-certified."

Whoop-de-do! Angela thought sarcastically but didn't communicate.

"As a businesswoman, what do you actually do?"

"I suppose I'd have to admit I mostly spend my time trying to raise money as unpleasant as that is. Start-up companies are like plants: They constantly need water, and sometimes it takes a lot of water before they bear fruit."

"That's quite poetic. How close is the company you work for away from bearing fruit?"

"Very close, actually. We're two weeks away from going public."

"Two weeks! That must be very exciting."

"Right now, it's more anxiety-producing than exciting. I need to raise about two hundred thousand dollars to shore up our liquidity to get to the IPO."

Chet whistled through his teeth. He was impressed, and gathered that Angela had to be a rather high-level executive. "Is the company going to be able to do it?"

"I try to be optimistic, especially since the investment-banking gurus promise the IPO will be a sellout. Maybe you, as a board-certified physician, would like to invest. We can certainly make it worth your while with interest or equity or both. We do have a lot of physician investors: more than five hundred, to be exact."

"Really?" Chet questioned. "What kind of company is it?"

"It's called Angels Healthcare. We build and run specialty hospitals."

"I suppose that means you know something about doctors."

"You could say that," Angela agreed.

"Sadly, I'm not as liquid as I'd like at the moment," Chet said. "Sorry."

"No problem. If you change your mind, give us a call."

"Well," Chet voiced, obviously wanting to change the subject. "Are you single or married, or somewhere in between?"

Back to the come-on, Angela thought. All at once, she didn't care to keep up her side of the conversation. She'd been amused, but suddenly she felt tired, which had been the goal. She wanted to go home. "Divorced," she said, and then added what she thought would be a turn-off. "I'm divorced, and I live with my ten-year-old daughter, who is home sleeping."

"I guess that rules out your apartment," Chet said. "I'm single – very single, actually – and I have a terrific apartment just around the corner. How about a nightcap?"

"And see your etchings, I suppose. Sorry. I've got both my daughter and the two hundred thousand dollars to think about." Angela waved to one of the waiters and motioned for the check.

"I'll take care of the check," Chet said magnanimously.

"No, you won't!" Angela said with a voice that brooked no disagreement. "I'm afraid I used you, in a way. As penance I insist."

"Used me?" Chet questioned with a confused expression. "What do you mean?"

"It would take much too long to explain, and I've got to get home."

Chet acted a tad desperate as Angela signed the check to her house account. "How about dinner tomorrow night?" he suggested when she'd finished.

"That's very generous of you, but I'm afraid I can't take the time. I'm not sure what to expect at the office tomorrow."

"But it would give you a chance to explain how you, quote, 'used me,'" Chet said. "I certainly don't feel used, and I've truly enjoyed meeting you. If I've offended you, I apologize. I promise I won't be so flippant. It's just an act."

Mildly surprised at Chet's willingness to reveal what seemed to be vulnerability, Angela stuck out her hand as she got to her feet.

While shaking hands, she said, "I've enjoyed your company. I mean that. Maybe after the IPO we can have another drink or even a dinner."

"I'd like that," Chet said, regaining his aplomb. "And it will be my treat."

"It's a deal," Angela said, knowing that now it was her turn to be the one less sincere.