They hear her long before they can see her, the sharp, staccato clicks of her polished black heels sounding from the hallway. The motley group glances nervously around the board room table and a look of anxiety shadows the faces of doctors in lab coats and suit-wearing business execs alike. The spotless glass doors to the room open inward and the waiting professionals draw their faces back into masks of expressionless solemnity. As she crosses the threshold, she glances quickly at the clock before taking her seat at the head of the shining wooden table. Wearing slim black dress pants and a light blue blouse, dark brown hair pulled into a sleek ponytail, she exudes an air of authoritative confidence that commands the attention of those in the room. The stark white lab coat she wears on top of her polished business attire provides a sharp contrast and combines the two halves of the room surrounding her. Dr. Anna Colier is stitched above the pocket on the left side of her coat, embroidered in red cursive typeface. She clears her throat, and begins the dreaded meeting that looms on the board members’ calendars every six months. As unavoidable as a flower yielding to the chill of winter, this meeting is a necessary evil. Unlike their usually brief board meetings over budgeting and supplies, this meeting faces an evolving threat. Much like the viruses that the hospital faces every day, growing and adapting along with their antidotal counterparts, the hospital is constantly embroiled in war with insurance companies. Pitting medicine against money, patient improvement versus financial gain, there are no winners. There are, however, casualties. Patients whose insurance can no longer cover their medical treatments, either due to time constraints or cost, are in the cross hairs of the negotiations. Dr. Anna Colier stands on the front lines of that war.
Hours pass, tempers running high and patience wearing thin, as the board of the hospital’s top doctors and financial advisors nears an agreement. They face an inevitable truth. Helpless to avoid the miles of red tape that stretch taut around the hospital walls, the board must agree to concessions within their policies that will ultimately force them to send people home from the hospital before they are ready. Without insurance, the financial advisors stress, the hospital will be unable to financially account for those who run out of coverage. The medical experts on the panel drag their feet, reluctant to accept the policy changes at the cost of desperately needed medical care. Under the scrutinizing gaze of Dr. Colier, the board eventually reaches an agreement. Ever the pragmatist, she is solely intent on reaching a concrete agreement and having things return to equilibrium, without opposing views and dissent clouding the waters.
As disgruntled board members file out, Anna remains in the boardroom alone, gathering her thoughts.  She gazes at the neatly stacked documents in front of her, letting her mind wander to a past that seems like another lifetime.  Someone else’s lifetime.
Medical school had been grueling for young Anna Colier and memories of those days bring an uncharacteristic grimace to her usually collected demeanor. Relentless exams, dense textbooks, and indifferent professors had left Anna desperate to escape and get a taste of the real-world that she had missed out on during her isolated time in med school. Anna’s grimace turns to a nostalgic smile as she recalls her rebellious decision to enlist in the Army after graduation, much to her parents’ distress.  Anna mindlessly taps her sleek, silver pen on the stack of papers as images play across her mind like scenes from an old movie:  a young, ambitious girl who wanted to see the world, an eager military doctor boarding a plane with the pride that comes answering some higher call to action.  Then the images change.  Intense and vivid they crowd into her mind—pictures of injuries so brutal, chaos so uncontrollable, and men so damaged, so utterly broken, that the young doctor feels helpless, useless, and purposeless.  Images, too, of other doctors sobbing, cracking under the relentless pressure, going home…
Abruptly, Dr. Anna Colier forces herself back to the present, taking deep breaths to stabilize her pounding heart.  Tapping the stack on the tabletop, she evens out the corners until they are completely in order.  Just like her hospital.  No gray areas, no chaos.
As Anna rises to leave, a group of nurses emerges from the meeting room across the hall, fresh from their briefing on the hospital’s new “Duration of Stay” policies.  Susan Driscoll, R.N., slams her empty coffee cup into the blue recycling can and shakes her head angrily as Anna watches from the dim conference room.  “I’d like to see the Ice Princess look into the eyes of the people she’s kicking out and tell them herself,” Susan scoffs.  “Bet that woman hasn’t ever been within two feet of an actual patient.”  Voices echo in the corridor as the pack of nurses makes its way to the elevator bay, but Anna Colier has heard enough.  Scarlet-faced and determined, Anna rises from the table and resolves to go on rounds for the first time in years. “Lead by example,” she calmly tells herself, setting off to find Nurse Driscoll’s floor.
For two hours, Dr. Colier and Nurse Driscoll’s paths never cross.  By chance, both start at opposite ends of the stroke unit, making their way from room to room.  As her shift draws to a close, Susan pauses outside of Michael Sartelli’s door.  If Susan were allowed to have a favorite patient, which she isn’t, Michael would be it.  Mr. Sartelli, the patient in question, is a slender Italian man in his early 60’s.  He suffered a stroke nearly two weeks ago and Susan has quickly gotten to know Michael and his tight-knit Italian family, who drop by at all hours bearing homemade cookies for the nurses and brightly colored homemade cards from Michael’s grandkids.  Even in his extremely fragile state, and with few of the mental and physical capacities he had prior to the stroke, there is a twinkle in Michael’s eyes that hints at his true personality.  Ever since he regained consciousness and became stable enough for visitors, there is never a time of day when at least one family member isn’t there.
Susan straightens her teal scrubs and fiddles with her ID badge as she attempts to gather her strength for this visit, noticing that the fluorescent lights of the hall seem especially harsh today.  Carrying nothing but the terse script that she’s been told to stick to, which she has nonetheless modified to soften the impact throughout her rounds, Susan contemplates what this new policy will mean for Michael.  Surely it will force him to leave the stroke wing within the week, even though Susan and all of his doctors know he is far from ready.  It will also cut short his stay in the rehab step down unit, which will ultimately mean that Michael will be back at home, in a house that is probably unsuitable for his new mobility needs, with little to no assistance from nurses or therapists.  Snapping out of her reverie, Susan sighs and enters the room, dreading what is to come next. She is shocked by the sight that greets her. Standing off to the side of the small room, far from the patient’s bed, Dr. Colier is grimly addressing the patient’s family members whom Susan recognizes as one of Michael’s daughters and his son. Hiding her shock, so as not to further upset the already visibly distraught young adults, Susan puts on a calm façade and walks to stand next to Dr. Colier.  She occasionally interjects, putting a more reassuring spin on Dr. Colier’s robotic explanation as the family is briefed on the situation. With a growing heaviness, Susan’s watches sadly as Michael’s children break the news of the hospital stay being cut short to Michael himself. This sadness turns to a complete feeling of despair as Susan watches Michael light up when he hears he is going to rehab sooner than expected. Her heart is in her throat as she realizes that he thinks his early dismissal from the hospital is because he is getting better faster than usual, when in fact he has such a tremendously long way to go and is really in no condition to be leaving. Unable to watch any longer, she quickly mutters something about coming back in a few minutes to no one in particular and hurriedly strides out into the hallway. Unable to stop her tears, Susan feels them begin to cloud her eyes as she rapidly moves through the hallway. She has not yet made it to the end of the hall when she hears a door open and quickly shut, and turns to locate the noise’s source. Susan’s tearful gaze meets the eyes of none other than Dr. Colier and for a brief moment their eyes lock before Susan angrily wipes her tears and turns on her heel to round the corner at the end of the hall.
*********
After a particularly long week of work at the hospital, Dr. Colier stops at the grocery market on her way home to pick up a quick meal to heat up. She is headed home with no plans, no one waiting for her, and for that reason she decides she has no need to buy anything too elaborate to make. She heads towards the aisle of canned soup, walking at her characteristically fast pace, hurriedly passing customer after customer. She appreciates the layout of the grocery store. Not unlike a hospital, she thinks to herself. Stark lighting, everyone and everything has a precise place. Lost in her thoughts, Dr. Colier almost fails to recognize the familiar face she passes as she turns into the canned foods aisle. Dr. Colier wracks her brain trying to place the person among the hundreds she sees at work during the course of a week, but is interrupted in her process. Behind her Dr. Colier hears the familiar woman answer her phone, and quickly grow upset. “What do you mean it’s happening again? He’s just not ready to be home yet,” she pleads, “How are we going to take care of him on our own?” Upon hearing these words, Dr. Colier quickly recognizes the woman as the young daughter of Michael Sartelli, the very woman to whom she had delivered the news of the hospital’s new “Duration of Stay” policy. The daughter seems only in her early thirties, but Anna Colier can tell that the situation is taking quite a toll on her. It is evident in the appearance of the young woman. Dark bags have formed under her eyes.  Dressed in her work clothes, despite it being past 7 o’clock, it is apparent that she hasn’t been home all day and her face seems far too sullen for such a young person. Once the young woman hangs up, sighing in frustration, Anna Colier turns and approaches her. A flash of recognition crosses Michael’s daughter’s face, which quickly turns to anger. Sensing the woman’s anger, Anna Colier decides to nip things in the bud. “Your father left our hospital 4 or 5 weeks ago, right?” she asks cordially, “How has he been doing?”
“Funny thing for you to be asking,” Michael’s daughter snaps, “as a matter of fact, he has really regressed since he left the hospital. He wasn’t ready. He’s having an increasingly difficult time with his physical therapy and is about to be removed from the rehab facility even though everyone involved knows it is going to have devastating effects.”  Taken aback, Anna Colier stutters in an attempt to find her voice. Her mind is reeling to find a form a coherent sentence but she can’t formulate an answer; there’s no pre-scripted response, no black and white clear-cut explanation to provide. “Our house,” the young woman continues with desperation edging into her voice, “is not equipped to handle the physical and medical needs of my father. And that’s only if the financial burden alone doesn’t put us all out of the home before he even gets there.” 
“You know what,” Michael’s daughter scoffs, “forget about it. Not like you care about the individual patients anyway, even if he is so much more than that to his family. You don’t really care about saving lives, all you and your board execs care about is saving money.” With that, the young woman turns, tears threatening to spill out of her angry eyes, and pushes her cart quickly out of the aisle. Stunned, Anna Colier is unable to regain her composure for the first time in ages. She mindlessly paces towards the freezer aisle, grabs the first thing she sees, and hurries through checkout.
*********
Anna Colier’s dinner remains untouched until she relents and shoves the tasteless microwave pasta dish into the trash bin. Pacing about her pristinely kept kitchen, she is unable to shake the pit in her stomach. She snatches her work bag from its position by the room’s entryway and yanks out her favorite silver pen. Haphazardly shuffling through her usually immaculately organized desk, she grabs the first notepad her restless hands come across. Sitting down, her guilty agitation is replaced by an overwhelming swell of adrenaline. Tapping her pen methodically against the paper she allows her head to be flooded with the realities she had turned a blind eye to for so long. Her mind is a battlefield once more, flashing through image after image of her past decisions and every argument that she has been forced to mediate. But this time it is not images of literal war, rather the war that she has been caught between every day of the last eight years. “It’s time to choose a side,” she thinks, “No more standing by and letting the rest of the world deal with the consequences of my actions without taking any heat for them myself.” Scribbling on her notepad she pens the title: Money vs. Medicine: What Are the True Costs and Who Really Pays the Price? Adrenaline in her veins at last, she outlines the counterargument to the practical dogma that has guided her every policy decision in years past. This time she is ready to compromise. Ready to face an issue separated along lines of clear black and white, Anna Colier takes a deep breath and prepares herself to entire the gray area of uncertainty. The no-man’s land between two sides of the war, the place where she knows the solution lies if she only searches hard enough for it.