Chapter 1

Sitting at his kitchen table sipping on his second cup of coffee this morning Doctor Steven Brandle was satisfied with his life. Looking at the view out of his large picture window on to Lake Lancer for some reason always caused him to reminisce about things that had happened in his life.

It was just over two years ago his hand had started shaking when he was doing a cosmetic procedure. Eventually he was diagnosed with having a form of dystonia. He was fortunate in that he had a minor form of dystonia which was an involuntary muscle spasm that so far had not progressed. While it had caused him to give up doing cosmetic surgery and become a GP here, he was receiving a high degree of personnel satisfaction in practicing this form of medicine that he didn’t receive from doing cosmetic surgery.

The pace of life here was slower here than it was in Los Angeles and that made life for him more enjoyable. He had also discovered that the women here were just like women everywhere with the same wants, needs and desires. He was fortunate to have met a number of women and because of that his love life hadn’t suffered. Presently he was seeing two women, Doris Connelly who was a writer of romance novels and Nancy Hodges who owned four fast food restaurants. He had feelings for these ladies but he wasn’t sure if he wanted to commit to a permanent relationship with either lady.

Steve practiced medicine at a clinic founded and funded by internet billionaire John Wilkinsing. John’s mother lived in the area which was the reason John’s foundation established this clinic. The patients Steve treated had the normal illnesses that would be found at any clinic. There had been a few illnesses that were markedly different but they had been properly diagnosed and handled.

One thing which was starting to concern Steve was that he was seeing a number of patients that were from the town of North Rivers. This town was over an hour’s drive from Lake Lancer going in the opposite direction from the University’s hospital. Why there was this increase was something he wondered about.

He did ask the patients from North Rivers why they had come to the clinic. As a group they responded that it was the closest place they could go for medical treatment. Steve continued to have concerns about this influx of patients and after work on Saturday decided to take a drive to visit this town.

In approaching the town he observed the sign with the town’s name and saw the population listed as eleven hundred and twenty five. This was about a quarter the size of Lake Lancer. The main section of the town consisted of a gas station and a few stores to include a food store and a small church.

After filling up his car with gasoline he asked the cashier as to whom if anyone was in-charge of the town. Steve was told a Jim Hardy was the part time mayor. Steve asked for and was given directions on where to find Jim.

Steve found Jim in one of the stores which was a combination of a hardware store and what once was referred to as a five and ten. Jim was about Steve’s age and height but weighed about fifty pounds more.

After introducing himself Steve said, “I am starting to see a number of your townspeople at the clinic in Lake Lancer and I was wondering why?”

“The simple answer Doc is we have no Doctor here and your clinic is the closest place they can go to receive medical treatment.”

“Did you ever have a Doctor here?”

“No we never did. There was a Doctor in a town east of us but he died. A town our size cannot support a full-time Doctor or a medical facility. It’s just a question of simple economics as to the funds needed for those things.”

Steve was quiet for a while but then he said, “I think your problem of not having medical services available for your townspeople could be solved if you had a physician assistant periodically stopping by. Unfortunately the present rules as to how a PA is supervised are restrictive and I think prohibits me from sending my PA out here. Let me think about the problem and see if I can come up with a solution.”

Jim thanked Steve and said anything he could do would be welcomed.

That evening Steve took Nancy out to dinner. She looked exceptionally well in the black sheath dress she was wearing with the tantalizing V neckline. He just couldn’t help but think about how she looked when she wasn’t wearing anything. That was something he already knew which caused him to further think about how the evening would end.

The dinner and Nancy’s companionship were nice. There was somewhat of a damper put on Steve’s anticipation of what would be happening later when Nancy said she was going to be going to the Las Vegas area to visit with her parents for an unknown length of time.

“My mother is not in the best of health and my father has had a minor stroke. I am going to see what the situation is there. My brother who is single and I discussed it and I knew I would be the one going there. My parents moved there because of my dad who is frugal was tired of paying the high California State income tax. He said he could put up with the high temperatures during the summers there if he didn’t need to pay state income tax. Mother just puts up with him and didn’t resist going there. I just don’t know now how long I will be there.”

Hearing Nancy saying that was a bummer for Steve. The activities later at Nancy’s home were anything but that. It seemed like she wanted this to be a night to remember and that this love making was going to need to last her till she was with Steve again. She didn’t know when that would be.

Steve didn’t know the number of orgasms she had that night but he knew it was a considerable number. For him he had two which was his norm for the evening and another one in the morning. He was one satisfied man when he left Nancy that morning. He was a little proud of himself as he looked at Nancy who was somewhat disheveled and saw that freshly fucked look on her face. As she gave him one last kiss at her door she sheepishly told him that she had never enjoyed making love as much as she did last night.

Monday at the clinic, Steve reviewed the current rules on the supervision of PA’s just to make sure nothing had changed. Seeing that PA supervision was acceptable if “immediate electronic communication was available” he phoned the PA Board in Sacramento for clarification.

Steve spoke with a nice lady at the Board who said, “The subject of Skype supervision has been discussed. The Board decided that supervising by Skype is permissible but the present law of a physician supervising no more than four PA’s still applies. There is consideration now being given to an exception to that number if the supervising Physician will only supervise and not be involved with any other patients while he is supervising the PA’s. That exception has not yet been approved.”

Steve thanked her and then placed a call to Jim Hardy at North Rivers.

“Jim, I would like to send a physician assistant out to your town on Thursday and every Thursday thereafter if there is a need.”

“That sounds great.”

“For me to do that however it will require a place where he can see the patients which means an office with table and chairs along with a receptionist. It goes without saying that the PA needs a private place for him to conduct the examination. More importantly he must have access to wi-fi which is a must. Without wi-fi available I can’t send a PA out there.”

“We can provide all you require. The office next door to me is available and there will be wi-fi there. My wife will be the receptionist.”

“You can spread the word that a PA will be there Thursday at nine am.”

“The word will spread like wildfire.”

The next morning Steve told his PA Todd what he had arranged for him to do on Thursday at North Rivers. Todd was told that besides his medical equipment and supplies to also bring sufficient forms for the patients to fill out which would be inputted along with the billing for what was done when he brought the forms back for Steve’s review and approval. Further he was to take a notebook computer with a separate video camera to use Skype and to contact Steve if he had any questions about treating any of the patients. Also the video camera should be always on and show the patient so Steve can watch and listen in to what is going on occasionally.

With Nancy now gone Steve was somewhat counting the days till Doris came back to the area. Doris alternated between living here and living in Las Vegas because of the tax situation. He knew that she was scheduled to return here in about a month and a half. It was only two days since Nancy had left but Steve was already wondering what he was going to do for female companionship. Granted it wasn’t only about six weeks till Doris was back in the area but when you were having intimate relations at least once and sometimes twice a week, six weeks was a long time.

As luck would have it on Wednesday Steve received a phone call from Amber Sullivan. Amber was a redheaded drug representative with a gangbuster body that Steve had bedded once. He often thought about her but thought that it was a one-time thing in him being with her. He hadn’t had any contact with her in over a year.

“I am going to be in the University hospital area Friday touting our new blood thinner drug. If you have no plans I thought we could get together after I was done working” said Amber.

Her remark of them getting together cause Steve to have a big smile on his face as he responded, “I certainly would like to see you again. I am at the clinic till five and maybe longer. If you don’t mind why don’t you pick up some carryout and we can have it at my home. I do have an extra bedroom that you can use.”

“A pizza sounds good but there is no reason I will need to use the extra bedroom. I am sure your bed is big enough for two.”

She came right to the point thought Steve and said she would be at the clinic a little after five. In ending the call he didn’t rub his hands together but when he put the phone down he said, “YES!”

Thursday at the clinic Todd checked in with Steve on Skype and said he was ready to go. He said he had a nice private area to meet with the patients and the Mayor’s wife Karen seemed to be very efficient. Todd said there were fourteen people already there waiting to see him.

Steve told him to start treating the people and not to hesitate to ask him if he needed some advice. Throughout the day Steve looked in how Todd was doing and didn’t hear or see any problems.

The next morning Todd presented Steve with the records from yesterday for him to approve and sign. Steve asked Todd how he thought it went and if there were any problems.

“Nothing that I couldn’t handle. The usual assortment of colds, flu, some rashes and minor infections. I did write a number of prescriptions as you can see and also renewed a number of them. After you are done reviewing and approving give the forms back for entering into the computer and for the billing to be done. There were some patients that I told needed to come to the clinic here and have some blood work done and two that needed a cat scan. I will say the people were very appreciative that I did come there and told me to thank you for doing that. They were nice people and it gave me a good feeling that I was able to help them.”

“I am glad it worked out. You can now plan on where you will be spending your Thursdays” and Steve laughed as he said that.

“Along that line there are a few things I would like to suggest. It would be nice if there was a nurse with me who could draw some blood when required. Maybe we could set it up for her to go there Friday and do that at one time for those people who needed it done. She wouldn’t need to spend a full day there. Also there were some supplies I wish I had there. I am going to keep a checklist on what supplies I need to bring with me and will probably add to the list as time goes on.”

“On anther note, our twin boys will be going to various camps and then to elementary school this fall. Carol my wife was hoping that when they are at camps or in school she could work part time at the clinic while I work full time. The money for doing that she would be saving for the boys as college is expensive.”

“The checklist is a good idea and something other PA’s could use if they are sent to outlying areas. I see no problem in Carol working but that is something I will need to check with Troy at the foundation first and will let you know.”

Later that day, Steve phone Troy Kane who was a Senior Director of the John Wilkinsing foundation and asked about PA Carol working part-time while her husband Todd worked full time.

“I don’t see a problem in doing that. Tell her she can start when she wants to.”

“How are things going at the foundation? Any problems in dispensing all those funds” asked Steve.

“Sometimes yes and sometimes no. At times I wonder if what we give is getting as much bang for the buck that it should be getting.”

“What do you mean?”

“You should see what some of the research grant requests we get are. It’s ridiculous on what they propose they want to study.”

“Let me ask you a question first before I tell you about what I am doing. What is the bottom line on what this clinic’s operational costs are?”

“I have that info on my computer so give me a minute to pull it up. Okay I have it, here it is. After deducting what we received back from patient reimbursement, insurance, Medicare, Medicaid, the bottom line is that the clinic has a substantial operating loss. It is still a large loss even if I take out the ambulance, the EMT’s and the costs for those two airplane charters.”

When Steve was told the amount he just whistled and said, “That has to be the main reason why small towns or small population centers do not have good medical care as they can’t afford it. Let me tell you what I am doing in utilizing Todd our physician’s assistant and why.”

Steve relayed what he was doing in sending Todd out to North Rivers once a week. He told of the reception Todd had received.

He continued saying, “You know the arrangement you made with Don and Dana as to paying for their living and medical schooling expense in return for them committing to work here for a number of years I think is money well invested and will pay dividends in the long run. I do think you should consider expanding something like that into a formal program. A program that will give grants to students going to medical school to become doctors and to include those studying to be physician assistants.”

“With a large number of our medical schools graduates wanting to do research or specialize we just aren’t producing enough doctors who want to be internists. Those Doctors are the first line of defense in providing medical care and a solid well run physician assistant program would go a long way to solve the shortage of that type of Doctor. I could see in the future an experience Doctor sitting in a room with many large screen LCD monitors on the wall supervising a large number of PA’s.”

“There however are some changes that need to be made to the present law as it pertains to PA’s if that is going to happen. Right now a Doctor is limited to supervising no more than four PA’s. I can see the original thinking of why it was that number but things have changed. I don’t think it was ever thought of a Doctor sitting in a room with many monitors solely supervising PA’s. The original thought must have been that the Doctor was somewhere in the building and could be summoned if needed. That number needs to be increased.”

“What you are saying sounds interesting but you need to stop right there. I understand some of what you said and it seems like something we should look into doing but that is something that is beyond me.”