“Color me impressed.” Roy Burke rubbed his beefy hands together as if summoning a genie from a lamp. “Your Patient Stratification Program has saved us millions.”

Mara O’Leary stood in the vestibule of Skylands Hospital with the Chairman of the Board; sunlight from the floor-to-ceiling windows warmed her nearly as much the compliment. An audience with the Chairman was virtually unheard of, but Mara’s cost containment strategies had become legendary. She was on the cusp of something big: win over Burke, and she was sure to become the hospital’s first female CEO.

“Reserving brand-name drugs for the One Percent was only the first step.” Mara wiped moist palms over her skirt, battling the tremble in her voice. Her role as Vice President of Population Health required her to look past individual patients and toward the faceless masses, whom she segmented based on their healthcare expenditures. Her job wasn’t easy, but it was important.  “Our new pilot program focuses on mitigating the cost of childbirth among the uninsured. It brings stratification to a whole new level.”

A door opened down the hall and a woman motioned toward them. “They’re ready.”  Mara led the way, scurrying two steps for each of Burke’s long strides.

She paused to catch her breath. “The program’s childbirth classes may seem a bit far-fetched. But they’re effective.”

Burke froze as he stepped over the threshold. Mara watched his eyes widen, then narrow. The thin line of his lips hardened, then twisted into a smirk.

“Dogs?” Burke turned toward Mara, eyebrows raised, his forehead wrinkled in question.

“Labradors. Or, labordors, technically speaking.”

Ten yellow labordors fulfilled various tasks at stations positioned around the large windowless room. A few lay next to a trainer wearing a pregnancy suit; they whimpered as she writhed on the floor in simulation of deep labor. Others tugged at neatly stacked towels and placed them next to a baby doll that wailed a tinny electronic cry. The dog closest to the door nosed at three large buttons on a console and was rewarded with a dog treat, a pat on the head, and the affirmation of “Good dog!” with each successful push.

“What is this?”

“Welcome to the Canine Childbirth Training Institute.” Mara grinned. “The home birth solution for the uninsured.”

Mara led Burke to a chair in the corner, connected a laptop to a large screen, and called up a PowerPoint slide. “It costs about $32,000, on average, for a hospital-based birth, not accounting for complications. Fine for our insured population; our managed care contracts are rock solid. But for the uninsured, we eat those costs,” she said, gesturing toward the graph with a laser pointer.

Burke leaned back and looped his fingers behind his head. “Damn illegals devour our profits like ravenous Rottweilers. Tell me something I don’t know.”

Mara giggled nervously, uncertain of how to respond. She paused and took a breath, shifting focus back to the presentation. “Legally, we can’t deny care to anyone. Nor should we.” She moved to the next slide. “Our program satisfies all requirements, but at a fraction of the cost of traditional care.”

“I like the sound of that.”

“I thought you would.” Mara tucked her hair behind her ear, pleased. “The labordors are trained as doulas to assist through all aspects of a normal labor and delivery.”

“Doulas?”

“Human doulas provide emotional and physical comfort measures during labor. Through our childbirth classes, these dogs will become trained birthing support animals – certified Dogoulas.”

She tapped at the keyboard again, bringing up a photo of a labordor wearing a white service vest; above it, the text: Su doula se ayudará.

“Would’ve been better to use Pit Bulls,” Burke muttered.

Mara pretended not to hear his comment and advanced to a montage depicting a woman in labor with her dog assisting: laying its head on her swollen belly, placing a washcloth on her forehead, licking her palm as she pushed.

“What’s the liability?” Burke asked.

“Minimal. The program has safeguards.” Mara gestured toward a dog nosing at a baby doll. “If the dog senses any danger, it presses a button that signals a nurse to check on the mother at home. Same thing happens once the baby is born.”

“They never set foot in the hospital?”

“Theoretically. It’s low risk clinically and financially.”

Burke scowled. “Uninsured illegals who choose to breed are always a risk.”

As Mara opened her mouth to respond, a labordor abandoned its position and barreled toward her, tongue flailing and tail swinging. She knelt to block the force of its exuberance and embraced the dog to contain its wiggle.

Burke tapped his fingers into a steeple, pensive. “What if we could take this program one step further? Turn a profit?”

Mara stroked the dog’s head; it reached its nose up, sniffing out her racing pulse. Before meeting with Burke, she’d explored all prospects for revenue generation and had come up with nothing. What had she missed?

“And also…” he continued, leaning in, “do our patriotic duty as Americans?”

Mara shook her head. “I’m sorry, I’m not seeing the connection…”

“If the dog signals the birth to a nurse, couldn’t it also trigger a call to ICE? I’m sure our current administration would reward us handsomely for every illegal we send packing.”

In Burke’s cold eyes, Mara saw the anguished face of each mother who would be separated from her newborn child. But she also saw the certainty of her own future locked in, if she was willing to take this next step. As she stood, the dog shifted at her feet, emitting a low whine. Mara swallowed hard.

“Yes,” she said. “An agreement with the government could be lucrative.”

“Color me impressed.” Burke chuckled. “I didn’t think you had it in you.”

Neither did Mara. But as CEO, she must. She would.

Burke extended his hand. “Make it happen.”

Nodding, Mara reached out. Her palm tingled as her fate, and the fate of the faceless masses, was sealed.