Dan’s heels clattered like ball bearings against the linoleum, echoing down the hall. He spotted James twenty feet away.

“Dr. Deeeeeetaaaaan! I need you now!”

James had just entered his office and closed the door when it swung open again.

“James, it’s November. You were scheduled to be on hematopathology with Haas this month, but we need to juggle the schedule. You’re going to ULS with Nomura.”

“Lots of juggling going on recently. Thanks.”

“Don’t thank me—you’ll probably be cursing me before the month is out. You’ll be pushing glass 24/7.”

“I can push glass.”

“Yeah, right. Nomura’s expecting you. Drive’s ten minutes. You know where the lab is, right?”

James nodded, though he was hoping to stay at Memorial, even if it meant enduring Haas. He also hadn’t cleared the air with Deanna after the awkward encounter with Wilma and the chicory coffee.

He headed straight to the morgue. Located in the basement, near the kitchen and dining room, the autopsy suite was hidden from the public eye. The sharp odor of formalin mingled with the smell of frying bacon. Deanna sat in the resident cubicle, reviewing charts.

“Hey.”

“Hey.”

“Deanna, everything okay?”

She closed the folder. “Yes…no, not really.”

“What’s wrong?”

“This patient—she died of cancer, so young. I was thinking about her family, the life she never had. You know, in med school I got so attached to patients it clouded my judgment. I thought pathology would buffer me from that. But I’ll never be completely removed. I grieve like any doctor does.”

James sat beside her. “I wish I could do this autopsy for you. Take away the pain, just for a little bit.”

She smiled faintly. “You’re sweet, James. Usually I don’t mind autopsies—just this one. Thanks for listening.”

“Always. I’ve got your back.”

“That means a lot. Why are you here—were you looking for me?”

“Dan just reassigned me to ULS. Starting today. I wanted you to know—especially since you offered to help me with heme.”

“Condolences. Not sure which is worse—Haas or ULS. At least you’ll be with Nomura.”

“My thoughts exactly.”

“Call me. Or stop by. It’s a different world there.” She winked. The jasmine of her perfume lingered as James walked out.

ULS was a sprawling one-story complex in a warehouse park. The sliding glass doors bore bold white letters: United Laboratory Services.

Behind the reception desk sat a young man with spiked blond hair and tattoos. “Sign in and drop your lab order in the box.”

“I’m Dr. James Deetan, pathologist. Dr. Nomura is expecting me.”

“Hang on.” He punched the intercom.

“Yes?” Nomura’s voice answered.

“There’s a James Deetan here to see you.”

“Send him in.”

“Third door on the left,” Spiky-hair instructed, giving James a curious once-over.

Relieved, James entered Nomura’s office, nearly buried behind towers of slides and paperwork.

“Welcome to ULS,” Nomura said.

“Bit different than Memorial,” James replied.

“Big business. Pathology is a commodity here. Look at this—” Nomura gestured at the piles. “They expect us to do a day’s worth of work in half the time, with half the reimbursement. Everything is capitated. Better get used to it.”

“I’m ready to start.”

“Good. No time for previewing. We’ll double-head cold.”

They signed out dozens of cases, Nomura dictating nonstop as James frantically matched paperwork to slides.

“Dr. Nomura—I think we have a mismatch. Slide says ‘Smith, Jake,’ requisition says ‘Smith, Jack.’ Looks like they were filed wrong.”

Nomura checked. “Good catch. Distractions happen all the time here.” He sighed. “Let’s grab coffee.”

They passed rows of maroon cubicles, the clatter of keyboards echoing. “Transcriptionists,” Nomura explained. “I’ll introduce you later.”

Before they reached the pot of coffee, a booming voice stopped them.

“Well, a new pathologist?”

A short, round man with thinning hair approached.

“Gene, this is one of our residents, James Deetan,” Nomura said.

“Pleased to meet you, James. Eugene Carlisle—president of ULS.”

Carlisle beamed. “Can I borrow him for a bit?”

“Be my guest,” Nomura said.

Carlisle’s office was spacious, lined with shelves of books, framed photos of horses and family, and an open folder of multicolored graphs.

“Masao’s dermpath, right? Someone told me dermpath’s easy—99% of cases are five diseases.”

James hesitated, searching for a safe answer. “I don’t think it’s that easy. Even if it were, it’s the 1% that bounce back—the ones that lead to lawsuits. That’s why you need Dr. Nomura.”

Carlisle grinned. “I like you. Let me show you something.” He pointed to the revenue graphs. “Red line—St. Louis. Our top performer. Do you know why?”

James shook his head.

“You. Pathologists at Memorial. Haas, Nomura—best in the business. Easy to sell our services with names like that. We’ve doubled volume in a year, cut costs 40%. Memorial followed suit—laid off 30% of their lab staff after seeing our numbers.”

James thought of Carter’s lab, and the whispers of cuts.

Carlisle pulled another chart. “It’s us and Birkman now. We’ve swallowed every small lab in the Midwest. They’ve got the West Coast. East is up for grabs. Managed care—it’s war. And we’re winning.”

“Like Cain and Abel,” James muttered.

Carlisle chuckled. “Which one are we?”

“I wouldn’t guess.”

“I like you even more. Welcome to ULS, James.”

Leaving Carlisle’s office, James followed glowing red letters down a hall to a massive call center, buzzing like a telethon.

“Yes, Doctor, sorry we missed the pickup—yes, we’ll send someone right away—”

A tall woman with tousled hair and octagonal glasses approached. Her badge read: DORIS STANLEY, Supervisor Client Services.

“Can I help you?” she asked warmly.

“Just looking. Dr. James Deetan—new resident.”

“First day? I’m Doris. We handle all the complaints. It’s… entertaining.” She smiled, then sighed. “Though with half the staff gone, it’s more grueling than fun.”

James nodded. “I hope I’ll see you again.”

“You will,” she said, smiling knowingly.

Back with Nomura, James recounted the encounter.

“So you got the sermon from Carlisle.”

“This isn’t Memorial. I feel sorry for all those who lost their jobs.”

“Bottom line rules here. When I first came to St. Louis, there were dozens of little labs. Now it’s just the two blood brothers, ULS and Birkman.”

“Like Cain and Abel?”

Nomura chuckled. “Maybe. Let’s break for lunch—the roach coach should be here.”

James thought of the Philippines, where families stayed with sick relatives, bringing food instead of dealing with insurance and managed care. Here, efficiency had replaced compassion.

As they passed the front desk, Spiky-hair called, “Hey James! Don’t forget—HR for your badge!”

Nomura lifted his hand. “And remember—don’t forget to have fun.”

Next Chapter: Chapter 18-No Bias