Olaf Kroneman
Insectology
When I was young, I had an ant farm. Sugar white sand was sandwiched between two layers of clear plastic. The sand had to be properly prepared, and once this task was completed, you sent for your ants. It took two weeks, but it felt like years until a package came in the mail with your ant population.
I slid them through a paper funnel into the farm. The pilgrims organized and soon built tunnels that snaked around the plastic. They worked incessantly and heroically for nothing
but my amusement and admiration.
I watched them labor, like family. They took care of each other, and when there was a death, they buried the fallen in an isolated section of the ant farm.
I thought the creatures wonderful, respectful, and dignified.
It was against the law to send a queen, and without a queen the colony was doomed to extinction.
The last surviving ant had to bury the second to the last surviving ant. It made me heartsick.
After an appropriate amount of time, I would get a new farm and start over.
In high school I took honors courses in science and went to the university and received a bachelor's in zoology, then a PhD in entomology.
My parents called it insectology and thought it was a useless pursuit. They were correct. The only job I could get was working in pest control, which meant I would have to kill those that I admired. I declined.
A graduate research position was impossible to obtain, so I went to medical school. The study of insects was much more difficult than that of humans. There were so many species of insects with many different needs, quirks, and habits. I studied insect by insect.
I discovered that there were only two species of humans, nice ones and mean ones.
Getting a PhD was tough, medical school, a cinch.
I enjoyed studying to be a doctor and entering the profession. Endeavoring to help people get better and comforting those who were beyond my help gave me meaning. I tried to emulate insect-like behavior and looked after the welfare of my patients. Doctors could learn a great deal of commitment, purpose, civility, and empathy from the study of insects, particularly ants or bees.
I returned to my hometown and practiced family medicine in the old neighborhood community hospital. The hospital was designed by a famous architect over one hundred years ago. They don't build them like that anymore. The terra-cotta stonework was ornate, like a castle. Some of the rooms contained a fireplace, though plugged for decades. Sculptures of angels, carved in marble, perched on the roof and watched over the community.
At its inception the hospital served all, including newly arrived immigrants. In the early twentieth century, my grandparents arrived on a boat from Poland confused and lost, but the hospital and the parish church met their needs. My mother was born there and died there at the age of ninety.
The hospital served an African American population who moved in the neighborhood with the open housing of the 1960s. More immigrants came, Vietnamese, Muslims, and Catholics fleeing the Middle East.
Soon we would serve those coming from Mexico.
We cared for the huddled masses.
The parish church was the king; the hospital was the queen.
Like Bellevue or St. Jude's, we were equity and equality before it was cool. There was no concern for payment.
The study of insects remained a fascination and a needed diversion from patient responsibility and a reminder of the inchoate civility of insects. I recalled a novel about a guy who woke up one day and found he was a bug. In undergraduate school I wrote an essay and opined that becoming a bug made him a better person. I got an "F."
If you had to tell them, they'd never get it.
In my basement I had terrariums containing different insect specimens collected from the hospital.
I had ants, bedbugs, cockroaches, fruit flies, and maggots.
My ant farm was now made of glass and covered an entire wall of the basement. I even had a queen, which took the credentials of an entomologist to obtain. With a queen my colony could survive for thirty years and produce a million offspring.
Ants were very sociable. They communicated through scents, called pheromones. If an ant was stressed, sick, or hungry, it would give off a unique pheromone alerting healthier ants of its needs. Others received the signal and fed the compromised ant or secreted antibiotic saliva on its distressed exoskeleton. Other scents could lead the forager ants to sites of picnics or other sources of food. Workers, drones, warriors all labored as one for the betterment of the colony. One for all and all for one.
All controlled by a swirl of pheromones.
The most dominating pheromone was that produced by the queen. Provided she was healthy, her powerful pheromone kept the colony thriving and united.
Ants developed the perfect male of the species. The male ant lived solely to copulate with the future queen, and once the act was completed, he could not return to the colony and so, being unable to care for himself, died. They didn't last a day after copulation. I hoped it was worth it.
Domestic violence was not an issue in the ant world.
I had a colony of bedbugs. I didn't like them; I studied them. I didn't know why they existed. I thought of them as "America's Guest." They were just blobs of tiny bloodsucking insects. Surprisingly they didn't transmit disease. They'd bite and leave itchy marks but were harmless. My theory was they had antibiotics in their bite that prevented disease. I attempted to isolate this antibiotic property.
I was still a scientist, an entomologist, but so far, no luck discovering a novel antibiotic secreted by the bedbugs.
Maggots were great to clean wounds, and I had a supply that I used to clean wounds in my office. They did an admirable job and could clean a wound and leave the viable tissue undisturbed, better than a wound care specialist.
The hospital halted the use of maggots. We could no longer use them for hospitalized patients.
They also outlawed the use of leeches. Leeches applied to injured tissues improved blood supply and saved patients' legs and arms from amputation, also noses. When a nose job went bad, a leech applied to the nose in the privacy of one's home saved young women from horrible disfigurement.
I never was big on medical leeches, but they had their champions.
Getting rid of the maggots and leaches was a sign for what was to come. The hospital was becoming sanitized for some reason, and so the useful, time-tested creatures were out.
I never thought I would use my PhD, but would sign my consults MD, PhD. There were lots of MDs who had a PhD, not in entomology or the humanities but in business or hospital administration. The functionary doctors turned administrators wanted to get away from the bedside and make serious money legitimizing the business side.
Osler, Halstead, Cushing, and others would be spinning in their graves.
A colleague approached me. He was obviously distressed.
"They're going to sell us to a hospital chain," Dr. Samuel Kline told me. "We will no longer be a community hospital. They are going to change our name."
"We will no longer be St. Catherine's?" I asked.
"No, we will be Serenity Health Number Twenty-Three. We will be one of a chain of twenty-three hospitals, that is if they don't tear us down. They don't like to stay invested in poor communities. They buy them so they can shut them down."
I figured it was coming, though we were like butterflies that dreamed the summer had no end.
"It's the way of the future, hospital consolidation. All the signs were there, I guess," I said. "I tried to miss the obvious."
"That means higher prices, inferior care, no community input, just corporate. They already did it to the dialysis centers and destroyed the kidney doctors. It ruined an entire branch of medicine. They'll come for the heart doctors, cancer specialists and surgeons next."
"Don't cause waves, Sammy. You're lucky you're still on staff after you tried to prevent the sale of the dialysis clinics to the monopolies. The hospital made a ton of money when they sold them."
"Do you know the company that is going to buy us is from out East?" Dr. Kline said. "They enter a community with the promise of giving great care and access. But they exploit. They destroy the competition and suck all the money they can out of the patients. Ten percent of the residents in the communities they've invaded have been turned over to a collection agency. They're taking their homes."
"Sammy, stay under the radar. You can't beat them."
"I can go down fighting. I can determine how I'm going to lose."
I shook my head. "No."
At the next medical business meeting, our future was revealed.
The representative from the hospital chain presented their plans and intentions at a general staff meeting. Three hundred doctors were in attendance to learn of the fait accompli.
The out-of-town doctor who was fronting for the consortium addressed us. He told us that hospitals across the country merged, and this was to create large health-care systems for the betterment of the community. Costs would come down, and the quality would go up. He wanted us to speciously call him "Dr. Rick."
It was about economies of scale.
One of the doctors spoke.
"What is the problem with the quality we have now?"
"You have served the community admirably, but we can do so much more as a national hospital chain."
Dr. Kline stood, held the microphone.
"What you're telling us is a crock and you know it."
"Keep this civil," Dr. Rick said.
"Civility only for the civilized," Dr. Kline said.
"I beg your pardon," Dr. Rick said.
"When hospitals consolidate, all competition is lost. As a result, health-care costs rise, and quality goes down. When hospitals compete, the quality goes up, and prices come down. The last hospital you merged was like ours, and you bulldozed it. It was in a poor area. That's another thing--the hospital mergers aren't attracted to underserved areas. You're a bigger threat to minorities than something like climate change. I suspect you will knock our hospital down and sell the real estate. The rumor is that the board members have already purchased the land after the demolition of the hospital. Those crooks always get the inside scoop and launder Medicare money.”
There was a lot of grumbling.
"Leave us alone," a doctor said.
"Carpetbagger."
Damn, I thought. He's done it again. Spoke truth to power; now he's finished. You can't do that in a hospital.
The meeting ended early. It was a disaster for the administrators. Dr. Rick's face was a vengeful blood red. The target went on Dr. Kline's back.
Within weeks Dr. Kline got harassed by medical administration. He was labeled "a disruptive physician." Dr. Rick threatened to report him to the national data bank; once reported a doctor could never work in a hospital again.
"Can't you fight them?" I asked Dr. Kline.
"I don't have enough money. If I agree not to renew my hospital privileges, they won't report me."
"That's blackmail."
"Yes, but I can still work in another hospital. I have a family. I must cut my losses."
Dr. Kline was finished. It was to be a lesson for the rest of us.
Dr. Rick called several of us into the boardroom.
I took notice of the boardroom. It was carpeted, unlike the hospital floors. Insects preferred carpeting and liked to hide in the fibers.
Dr. Rick spoke.
"I want to warn you all about behavior like Dr. Kline's. He is a disruptive physician."
"He cares about the hospital and his patients," I said.
"He is like those bugs that splat against your car windshield, and you hit the wipers and wash them away."
Now I was angry. Rick insulted my friend Dr. Kline, but also my noble insects. This meant war.
My insects would never behave like "Dr. Rick." Insects have regard for one another. If the doctors had behaved like my steadfast insects, they would not have allowed an outsider to enter the colony and destroy it. The warrior ants would have quickly dispatched the bastard.
Evidently, doctors were not ants, but sheep being led to the slaughter.
I returned home to continue my experiment on the bedbugs. I ground them into a paste and used gel electrophoresis to separate potential antibiotics. Then it hit me. I was wasting them.
I would use my bedbugs and give them purpose. They were no longer "America's Guest," but the potential savior of our hospital.
Prior to the merger a state inspection was scheduled. Dr. Rick was to lead the officials on a tour. Our senior leaders and top management would be in tow. Approval meant huge bonus money for the bureaucrats.
I had to stop them.
Bedbugs were attracted by the carbon dioxide given off by human exhalation. Patients with lung disease gave off large quantities of carbon dioxide. The day before the inspection, I placed several colonies in the pulmonary ward. The crusaders would beeline it to the source of CO2.
I placed other bedbugs in the intensive care units, another rich source of carbon dioxide. In twenty-four hours, they should settle in. Would they be noticed? It all depended on the amount of carbon dioxide in the environment.
I crossed my fingers.
The day of inspection arrived.
The parade of inspectors wore blue suits or skirts and sensible shoes and followed Dr. Rick.
They toured the maternity ward, the pediatric floor, and entered the intensive care unit. The door opened, and the group entered.
"This is the ICU. As you can see, it needs updating," Dr. Rick said.
Then the cry, "Bedbugs."
A nurse drew back a sheet.
A dozen brown bugs swirled around the foot of a bed.
Dr. Rick looked worried.
One of the inspectors said, "It happens all the time. Hospitals can't get rid of all of them. It comes with the territory. Your hospital is not the first."
They walked to the other side of the ICU and another cry of "bedbugs."
"This is most unusual," Dr. Rick said. "I can't explain it."
"It is nothing we haven't seen before. It won't stop our merger.”
The inspectors tried to ignore the bugs. But I noticed they were scratching.
This was working better than I could have hoped.
Now a trip to the pulmonary unit, where the carbon dioxide concentration was even higher than that of the ICU.
The nursing supervisor of the pulmonary unit met the entourage and told them not to come in --there was an outbreak of bedbugs.
"Let's go to the boardroom," Dr. Rick said.
I couldn't follow them to the administrative offices, but the waitstaff and custodial staff told me what happened next.
The officials were sitting around the table. They had Krispy Kremes, bagels, fruit, and all sorts of edibles. Dr. Rick began his talk, and people started scratching. First hardly noticeable. They scratched behind their ears, then their chests. They moved around in their chairs like they had hemorrhoids. They couldn't get settled. Dr. Rick stopped talking. He started scratching.
Then a swarm of ants converged on the Krispy Kremes.
Somebody shouted, "Ants."
I used very small, almost colorless ants. I put them in the refrigerator and didn't feed them for several days before I let them loose in the boardroom. As they warmed up, they became active, started to motivate on their fast-moving, tiny little feet. They were hungry.
"It looked like a big dance party," a waitperson said. 'They were moving and shaking. It was like 'Rocking New Year's Eve.' They did the twine, the jerk, the bird, the tighten up, and the cha cha cha. It was too bad they didn't pipe music into the boardroom and put it on YouTube."
One of the custodians said, "I recorded it. I called it 'jock itch.' The video is on YouTube, and I put it to music, the Isley Brothers' 'Shout.' Take a look."
"You know you make me want to shout, throw my hands up and shout..."
The bureaucrats were jumping around trying to stop an itch. I never thought a bunch of stiff administrators could move and shake like Alvin Ailey dancers.
Dr. Rick started doing the hustle.
The meeting ended. They shuffled out of the boardroom in what looked like a conga line.
I watched it again and again. It got funnier every time I played it.
It went viral.
I smiled. "Insectology" came in handy. It was not worthless.
This merger was stopped cold. But there would be more. Our hospital, the queen, continued to give off pheromones, but I felt they were weakening. We couldn't hold out forever.
Medicine and hospitals had become about money, and money attracted scum just like carbon dioxide attracted bedbugs. The carpetbaggers would come back, but so would my bedbugs.
I also had the nuclear option--fire ants.
©2023 by Olaf Kroneman
Olaf Kroneman has been in the practice of medicine since 1983, where
his patients and colleagues inspire his writing and suggest its themes.
His writing has appeared in many literary magazines, and his story "The Recidivist," won the Writer's Digest short story contest.
