Cry From The Grave
Chapter 2
Ten minutes after Daryl Goodspeed and Helen Smith returned to the interior warmth of St. Matthew's Grove, a quartet of individuals gathered around a window table at Robust Wine Bar, some distance west of the hospice. An award-winning establishment in the heart of old Webster Groves, Robust countered its relatively plain yet stately brick exterior with a contemporary interior flair. Walls painted in varying shades of browns, tans, and creams accentuated the sand-and-black colored granite tables and bar. A small but growing number of connoisseurs placed their orders and waited patiently at their tables. Many were stopping for a social drink, a late afternoon snack, or an after-hours chat with a friend. The evening crowd would be more inclined toward music and entertainment, to be provided that night by a modern acoustic group known as the Six Napoleons. For now, an excited buzz ran through the establishment, as if the cooler weather had enlivened their souls toward increasing gregariousness.
The only solemnity in the restaurant came from four people seated near the window. Exchanging pleasantries and initial small talk, they sipped their drinks and picked at the food they agreed to share. The most frail and venerable among them had just taken a minimal swallow of his Hopler Pinot Blanc. Rory Giles, part-time chaplain at St. Matthew's Grove, was exhausted both by a lack of sleep and the worry this gathering would produce. The eldest of the group, he both looked and felt older than his sixty-four years, his gray hair thinning and his slight frame more stooped as the days passed. Watching him with much concern was the Reverend Nicholas Fisher, rector of Emmanuel Episcopal Church and diocesan liaison to the hospice. Many assumed Fisher to be aloof in conversation, but in truth, there was little that escaped his sharp ears and sky-blue eyes. He lifted a glass of 2010 Pierre Chermette Gamay to his lips and passed a bowl of red pepper hummus to Dr. Dean Hibbler. Absent-mindedly, Hibbler's fingers played with the neck of his Smithwick's Irish Ale as he scooped some hummus on a pita chip and thrust it into his mouth. The one person refusing Hibbler's culinary order was Isabel Andrews, the nursing director at St. Matthew's Grove. She had selected a goat cheese tartlette to share with the men, but she had eaten much of it while finishing most of her glass of Catana Malbee.
Fisher set his wine glass on the table and sat erect in his chair. What he had to say could wait no longer.
"Thank you all for coming," he began, souring at his forced decency. "I know this is not very convenient, but I felt the need to have us discuss things away from the hospice. I promise I won't keep you very long. I know you, Isabel and Dean, need to get back soon.
"However, it is critical that you be apprised of some matters that have been in the works for some time but which will affect the operation of St. Matthew's Grove in the future. As the diocese has considered how best to be responsible with our budget, it falls to me to deliver these matters to you. Above all else, I hope you take what I say in the spirit it is given. What we discuss today is intended to make St. Matthew's better."
Isabel Andrews was wiping her glasses while Fisher spoke. As the rector paused, she looked at him apprehensively. "Nick, that sounds like the sort of monologue given when pink slips are going out."
Fisher put up his hand in a cautionary gesture. "No one is saying that, but I do want us to be aware of a few things. No one can deny that in today's economy, everyone needs to tighten the belt. The Diocese of Missouri knows it can't operate according to financial dreams but rather by facing monetary realities. We've had to cut programs and measures across the board. One of those hard choices happens to be St. Matthew's. Not in the sense that we have to unload it, but rather that we need to reshape how the hospice operates."
"As if we're not operating on a tight budget as it is?" the nursing director implored.
"This is about confronting a few realities, Isabel," replied Fisher, irked by the interruptions. We are faced with either closure or radical change. St. Matthew's has a quality reputation, no doubt, for personal attention. But it gives that function because it is small, too small to function as a viable alternative in the hospice market. We have too much competition just in St. Louis alone. And let's face it--it is incredibly difficult to draw nurses and staff to hospice care anyway. The problem is more abject when our average daily census remains at historic lows. With the changes coming to health care nationally, we can't be sure of how our billing and revenue stream will change. We operate on a shoestring, but it is still not enough. Competitive hospice care demands we have a larger staff than we do now, and for that, we need more room and more patients. St. Matthew's Grove is too small and has too few resources.
"But we can fix things as they stand. It will just require changes. Thanks to some groundwork laid by Dean, we have had conversations with several hospice corporations interested in taking St. Matthew's Grove on as a participating center. One of these groups that seems to have genuine possibilities is Dignity Care. Now, this might require some other things. We might remain as we are in the same facility, but that doesn't seem likely. We could be linked as a satellite campus in Dignity's orbit. But the most plausible scenario is that St. Matthew's Grove would dissolve and the diocese would receive a settlement from the sale of the grounds. Additionally, what would then happen is that our patients and staff would matriculate to another center in the area under Dignity's banner."
"Locally, you mean?" It was the first time Rory Giles spoke.
"That is the intention," Fisher nodded, understanding Giles' trepidation. Nearing retirement, the chaplain was likely not high on the priority list in the tailwinds of a corporate takeover. "There are obviously several matters to be dealt with. Going forward will be extremely difficult for all of us, the patients especially. But staying where we are is not cost-effective, either for the hospice or the diocese. And we have no room to grow. We occupy a tiny space on the seminary grounds, one that isn't even Episcopalian, so as it is Eden is being extraordinarily generous! We hardly have the option for expansion or modernization."
"I disagree," Isabel blurted out, confirming her position as the primary nonconformist. "If there is a matter of cost, then of course we must deal with it. But Nick, even you have to admit this is a bit sleight-of-hand. We had a written promise from the diocese last year that you would continue the financial support and oversight for two more years. The diocese told us nothing would be touched, no re-arrangement at all, until September of next year. That gives us almost eleven months to consider what austerity looks like. You act as if the decision to cut loose has already been made."
"Nick, if I may?" asked Hibbler, and Fisher wearily nodded his assent. "Isabel, no one doubts our desire to make this work, but the reality is we have to prepare for change. And it is coming. We are a small staff and we can provide only so much care. We have to face the likely reality of closure now and the transition next year will be much smoother if that must be one of our options."
"What's to become of us?" asked Giles, his normally timid eyes exploding with fresh boldness.
"What do you mean?" Hibbler inquired.
"The staff. The nurses. Isabel. The cafeteria workers. The janitors. You seriously don't expect a corporate entity to take everyone on as one big happy family."
"We have no reason to believe..."
"That they won't consider all the options," Giles interrupted dourly. "Of course, but we all know that staffing decisions in health care, especially with outside agencies, are done with the bottom line in view. My point is that obviously Dignity Care--if that's who St. Matthew's Grove goes with--will keep an executive director and a nursing director, but I doubt a chaplain is high on their list of priorities."
"And," said Isabel firmly, piercing the air with a thick yet beautifully manicured index finger, "we can pretty well guarantee that a doctor would be welcome on staff, but the odds of my keeping the same position is minimal at best."
Her words hung in the air. Hibbler glared at her over the top of his glass as he drained the remainder of his wine.
Isabel returned the burning stare. "You've set it all in motion, Dean. You've manipulated this whole effort so you'd have a job in exchange, the rest of us be damned!"
"That," replied Hibbler sharply, "is your conjecture. It might help to root a few of your assertions in reality."
"Dean!" snapped Fisher, more loudly than he intended, as several patrons turned toward the brewing clash.
"If this was to be a potential event, then we should have been moving toward consensus this whole time!" Isabel grumbled, picking up her purse and grabbing her jacket. "This is on your hands, Nick, Dean! The diocese shouldn't have gone back on its word, and Dean had no business taking part in isolated negotiations without our knowledge!"
"You're upset because it has to do with your job, Isabel," Fisher said soothingly, like a mother comforting her sick child.
"I'm upset because it has to do with a lot of people, loyal people who have been at St. Matthew's for some time. Not just me, but Rory here. Anna and Beverly and Billy and the other nurses. And Melba is only part-time, but what about her? And the patients, for heaven's sake! I doubt any of them make a difference to you."
She turned and stormed out, nearly knocking over a young urbanite who was nursing a beer. The three men watched her go, Hibbler with a smirking insouciance, Fisher looking grim, and Giles shaking his head in morose fashion. The chaplain wearily got to his feet and checked his pocket watch.
"Nick, I'll need to talk to you," he said. "Some time tomorrow morning? Your office?"
Fisher painfully smiled his assent and watched Giles head toward the door. With a heavy heart, he glimpsed his friend's bowed head as he turned down Lockwood Avenue toward his parking space. He's a good man, thought the rector. This can't be easy for him and it's the end of everything he knows.
Fisher set his wine glass on the table and sat erect in his chair. What he had to say could wait no longer.
"Thank you all for coming," he began, souring at his forced decency. "I know this is not very convenient, but I felt the need to have us discuss things away from the hospice. I promise I won't keep you very long. I know you, Isabel and Dean, need to get back soon.
"However, it is critical that you be apprised of some matters that have been in the works for some time but which will affect the operation of St. Matthew's Grove in the future. As the diocese has considered how best to be responsible with our budget, it falls to me to deliver these matters to you. Above all else, I hope you take what I say in the spirit it is given. What we discuss today is intended to make St. Matthew's better."
Isabel Andrews was wiping her glasses while Fisher spoke. As the rector paused, she looked at him apprehensively. "Nick, that sounds like the sort of monologue given when pink slips are going out."
Fisher put up his hand in a cautionary gesture. "No one is saying that, but I do want us to be aware of a few things. No one can deny that in today's economy, everyone needs to tighten the belt. The Diocese of Missouri knows it can't operate according to financial dreams but rather by facing monetary realities. We've had to cut programs and measures across the board. One of those hard choices happens to be St. Matthew's. Not in the sense that we have to unload it, but rather that we need to reshape how the hospice operates."
"As if we're not operating on a tight budget as it is?" the nursing director implored.
"This is about confronting a few realities, Isabel," replied Fisher, irked by the interruptions. We are faced with either closure or radical change. St. Matthew's has a quality reputation, no doubt, for personal attention. But it gives that function because it is small, too small to function as a viable alternative in the hospice market. We have too much competition just in St. Louis alone. And let's face it--it is incredibly difficult to draw nurses and staff to hospice care anyway. The problem is more abject when our average daily census remains at historic lows. With the changes coming to health care nationally, we can't be sure of how our billing and revenue stream will change. We operate on a shoestring, but it is still not enough. Competitive hospice care demands we have a larger staff than we do now, and for that, we need more room and more patients. St. Matthew's Grove is too small and has too few resources.
"But we can fix things as they stand. It will just require changes. Thanks to some groundwork laid by Dean, we have had conversations with several hospice corporations interested in taking St. Matthew's Grove on as a participating center. One of these groups that seems to have genuine possibilities is Dignity Care. Now, this might require some other things. We might remain as we are in the same facility, but that doesn't seem likely. We could be linked as a satellite campus in Dignity's orbit. But the most plausible scenario is that St. Matthew's Grove would dissolve and the diocese would receive a settlement from the sale of the grounds. Additionally, what would then happen is that our patients and staff would matriculate to another center in the area under Dignity's banner."
"Locally, you mean?" It was the first time Rory Giles spoke.
"That is the intention," Fisher nodded, understanding Giles' trepidation. Nearing retirement, the chaplain was likely not high on the priority list in the tailwinds of a corporate takeover. "There are obviously several matters to be dealt with. Going forward will be extremely difficult for all of us, the patients especially. But staying where we are is not cost-effective, either for the hospice or the diocese. And we have no room to grow. We occupy a tiny space on the seminary grounds, one that isn't even Episcopalian, so as it is Eden is being extraordinarily generous! We hardly have the option for expansion or modernization."
"I disagree," Isabel blurted out, confirming her position as the primary nonconformist. "If there is a matter of cost, then of course we must deal with it. But Nick, even you have to admit this is a bit sleight-of-hand. We had a written promise from the diocese last year that you would continue the financial support and oversight for two more years. The diocese told us nothing would be touched, no re-arrangement at all, until September of next year. That gives us almost eleven months to consider what austerity looks like. You act as if the decision to cut loose has already been made."
"Nick, if I may?" asked Hibbler, and Fisher wearily nodded his assent. "Isabel, no one doubts our desire to make this work, but the reality is we have to prepare for change. And it is coming. We are a small staff and we can provide only so much care. We have to face the likely reality of closure now and the transition next year will be much smoother if that must be one of our options."
"What's to become of us?" asked Giles, his normally timid eyes exploding with fresh boldness.
"What do you mean?" Hibbler inquired.
"The staff. The nurses. Isabel. The cafeteria workers. The janitors. You seriously don't expect a corporate entity to take everyone on as one big happy family."
"We have no reason to believe..."
"That they won't consider all the options," Giles interrupted dourly. "Of course, but we all know that staffing decisions in health care, especially with outside agencies, are done with the bottom line in view. My point is that obviously Dignity Care--if that's who St. Matthew's Grove goes with--will keep an executive director and a nursing director, but I doubt a chaplain is high on their list of priorities."
"And," said Isabel firmly, piercing the air with a thick yet beautifully manicured index finger, "we can pretty well guarantee that a doctor would be welcome on staff, but the odds of my keeping the same position is minimal at best."
Her words hung in the air. Hibbler glared at her over the top of his glass as he drained the remainder of his wine.
Isabel returned the burning stare. "You've set it all in motion, Dean. You've manipulated this whole effort so you'd have a job in exchange, the rest of us be damned!"
"That," replied Hibbler sharply, "is your conjecture. It might help to root a few of your assertions in reality."
"Dean!" snapped Fisher, more loudly than he intended, as several patrons turned toward the brewing clash.
"If this was to be a potential event, then we should have been moving toward consensus this whole time!" Isabel grumbled, picking up her purse and grabbing her jacket. "This is on your hands, Nick, Dean! The diocese shouldn't have gone back on its word, and Dean had no business taking part in isolated negotiations without our knowledge!"
"You're upset because it has to do with your job, Isabel," Fisher said soothingly, like a mother comforting her sick child.
"I'm upset because it has to do with a lot of people, loyal people who have been at St. Matthew's for some time. Not just me, but Rory here. Anna and Beverly and Billy and the other nurses. And Melba is only part-time, but what about her? And the patients, for heaven's sake! I doubt any of them make a difference to you."
She turned and stormed out, nearly knocking over a young urbanite who was nursing a beer. The three men watched her go, Hibbler with a smirking insouciance, Fisher looking grim, and Giles shaking his head in morose fashion. The chaplain wearily got to his feet and checked his pocket watch.
"Nick, I'll need to talk to you," he said. "Some time tomorrow morning? Your office?"
Fisher painfully smiled his assent and watched Giles head toward the door. With a heavy heart, he glimpsed his friend's bowed head as he turned down Lockwood Avenue toward his parking space. He's a good man, thought the rector. This can't be easy for him and it's the end of everything he knows.
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