Doctored (28 page)

I closed the door to my office so the conversation would not carry into the hallway. “I can give you some money back,” I said quietly, even though I knew it had already been spent. “I don't want to keep your money if it isn't being earned.”

“Any investor will invest if the revenue is coming in,” Chaudhry said, ignoring the offer. “The problem is when the revenue is not coming. You know how much I am now getting for stress tests after expenses, Sandeep? Two hundred dollars. You know how much Oxford is paying me for a new consult? Ninety-eight dollars, and only twenty-two for a follow-up! I am taking home just enough money to pay my bills.”

I was dubious, but I kept quiet. I needed to keep the moonlighting going for as long as possible, and I was afraid of saying something that could make Chaudhry terminate the deal. Nonetheless, I didn't know how much longer I could go on denying the unseemly reality of it all.

“The problem, Sandeep, is that your hospital patients are not following up in my office for tests,” he said. I told him that I had been handing out his business card and offering the patients timely appointments to see me on Saturdays when I came to the office. I did not understand why they weren't coming.

“Hospital patients have their own doctors,” Chaudhry explained in the pedantic tone he had increasingly been using with me. “When they go back to their internists and ask for a referral for Chaudhry or Jauhar, the internist will say, ‘Why are you going there? Go to this other cardiologist. I know him.' So the chance of those patients coming to us is maybe five or ten percent. What you are doing is not wrong. This is just the dynamic of private practice.”

In order to capture more of my doc-of-the-day admissions, Chaudhry told me that in addition to passing out his card, he wanted me to call Samantha, his office manager, with every patient's demographic information, as well as to fax her the insurance information. Though I was offended at having to do such scut work, I said I would.

“If you want to increase your revenue, Sandeep, you have to get into the practice,” he urged. “We must figure out why more doctors are not sending us patients. What is the reason?” He mentioned that even Dr. Oni, the Nigerian internist, had stopped referring patients to the office.

Oni had been one of Chaudhry's most loyal referral sources, supporting him from the time Chaudhry opened his practice in 2002. When I started taking ER calls, Chaudhry had instructed me to refer my patients to Oni for general medicine consults to give him some extra business. I had done this for a while, but in recent months I'd stopped.

“If you send one or two extra patients to Oni, it will help us in the long run,” Chaudhry lectured. “See, this is called connection. At the end of the day everybody should be happy. I'm not saying send every single patient to Oni—you don't want people to think it is automatic—but keep him in the loop. How did I get a connection with Dr. Mazer? If I have a GI issue, I use him. If he has a cardiac issue, he uses me. This is called channeling.”

Chaudhry proposed a new plan. He wanted me to start seeing patients at various internists' offices where he was paying rent (essentially a fee to sit on their premises and see their patients), referring those patients back to his main office if they needed cardiac procedures. “Right now I am giving you a piece of my pie, but we have to make the pie bigger if we want this to work.”

I told him I would try.

“You will be a great asset to me if you can go to Ozone Park,” he said; it was about an hour's drive from my apartment. “I also have a connection in the Bronx. Just give me a few months the way I am explaining, and you will see a huge difference in your revenue.”

“What about stress tests and echos?” I asked. By now I had learned the real money was in testing.

“I can give you some studies,” he said. “But then you have to come to the office to read them. The problem, Sandeep, is that you don't want to come. See, everybody wants to spend time with their family, but you have to make some sacrifice, too. Until you invest time and energy, how do you expect to make more money?”

I could tell he felt obligated to give me another chance, and for a moment I actually felt sorry for him. I felt undeserving of his patience and saddened that he felt coerced by his friendship with Rajiv to continue to work with me.

“You have to be a little lovey-dovey with patients, Sandeep. Private practice is lovey-dovey. Let's say I adjust the antihypertensive. I will tell the patient to come back in a few days to check the blood pressure. If I am ordering a test, I will tell them to come back to discuss the results.”

“Sure, boss,” I said, just wanting to get off the phone.

“Look, I am very fair,” he said. “You and me should promote together. Let's take out an hour from our busy schedules and meet some physicians in Queens. Once they see us together, maybe some of your brother's friends will start sending us a few patients. If you could get one or two internists who are not sending me patients to start sending you patients—if I can get four or five new patients a month through you who are getting everything done in the office—then it is a plus point. That is all I am asking. I am not asking for a hundred percent of their business.”

I told him that I would try to make this happen. When I got off the phone, I felt nauseated. I took a deep breath, and a dry heave welled up in my chest. Water filled my eyes. It was all I could do to keep from vomiting.

 

THIRTEEN

Deluge

Midway on our life's journey, I found myself

In dark woods, the right road lost. To tell

About those woods is hard—so tangled and rough …

—Dante,
The Inferno
, Canto 1, translated by Robert Pinsky

To his credit, Chaudhry did try to make it work. We experimented with different arrangements—seeing patients in Valley Stream, reading echos in Richmond Hill, even doing stress tests on weeknights after I left the hospital—but nothing gelled. For a few months I even went to an office in Harlem, not far from where I lived, where Chaudhry rented space from a jowly, phlegmatic Bangladeshi internist who seemed to think the world of himself. On my first day he gave me a tour of the facility, which occupied the entire second floor of an industrial office building next door to a McDonald's. “You are from India?” he asked with a strong accent.

I nodded, surveying the space, feigning awe. I asked him how long he had been working there.

“You want to know if I am renting?” he said coyly. “That is what you want to know?”

“Yes,” I lied.

He took his time answering. “So let us just say we own the whole operation,” he said proudly.

It was a huge practice with nearly a dozen employees and a plenitude of patients, mostly Dominican immigrants, who were shuffled through a dense maze of exam rooms. The waiting area always had a loud buzz, a communal conviviality, even at nine o'clock on Saturday morning. Spanish-speaking assistants were available, but they had many duties besides translation, so patients would sometimes wait hours to be seen. There was a podiatrist down the hall who was also renting space. He had an alert, shiny face and a streetwise, almost sinister aura. He would periodically come over, hinting that he wanted referrals, forcing small talk, slowing me down. He kept promising to refer his diabetics to me—as if I needed more patients—but he never did. We set up an echo machine next to my exam room so patients could be scanned while waiting for an interpreter. As soon as one became available, I'd take advantage and quickly go through two or three examinations without a break, slightly decanting the crowded waiting area. If I ordered a stress test, the patient would be offered car service to Chaudhry's office on Long Island, along with a voucher for lunch.

By the end, Chaudhry was treating me like a naive younger brother whom he was merely tolerating. He was clearly dissatisfied with my performance, though technically I was doing everything he was asking of me. Maybe he knew how I felt about his practice—or about private practice in general. At one point he drew up a contract giving me a small portion of the echo and stress fees as an incentive to work harder, but when payday arrived, I was reimbursed according to the old flat-fee formula.

When he finally let me go in the spring of 2008, it was over the phone. “What I am saying, Sandeep, is, you have a shop, you open up a shop, anybody who walks in, you have to have a smiley face, right? These are small things that I hate to tell you, but these things are missing.”

I had that sad, strange feeling of being jilted by someone I'd never wanted to be with.

“If the money comes in, I don't mind paying you, but right now you are living on my pie. What I have been trying to do for the last two years is create a separate pie for you, but somehow we have failed.”

Unsure of how to respond, I stared at the speakerphone in my office. My leg was jumping up and down like a jackhammer.

“I don't see anybody referring patients to you, Sandeep. Sameer Chawla was sending in January, February, March—and then zero. I want to help you, but in this tight situation at least one patient should be referred to you through some connection. But not a single patient is coming.”

“I don't know why Sameer stopped referring,” I said. Sameer Chawla was a good friend of Rajiv's. In January, Chaudhry and I had gone to his ramshackle office in Queens Village with a platter of Indian sweets and a few referral pads printed with Chaudhry's contact information and a list of the insurance plans we accepted. We waited cravenly in our white coats among quiet turbaned patients until we were called in to see him. When we finally sat down with him, he seemed friendly enough, and he pledged to lend his support; but the goodwill had lasted only a few months.

“Sandeep, you have to understand, running a big show costs a lot of money,” Chaudhry said. “I have two thousand square feet to cover, plus staff, plus nuclear machine, plus echo tech, plus Malik, plus Denis, plus certifications. I am no longer even doing stress tests every Saturday because if only five patients are coming, I still have to give full payment to Denis, full payment for the staff, full day to Malik. If I am not doing ten-plus nuclears on a given day, I am losing money.”

My throat was dry. The other line rang, but I ignored it.

“Last Thursday I canceled my office,” he went on. “I was sitting down like a CEO and thinking, Hey, Amir, what is going on? Why your revenue is so scanty? Do you know that now I only get thirty dollars for a follow-up and a hundred dollars for a new consult? If we don't order a test—echo, carotid, arterial Doppler, nuclear, or stress echo—well, seeing patients is just garbage.”

“But I order those tests,” I said weakly.

“I am not talking about you, Sandeep! What I am saying is that in private practice the overhead is so high. And then on top of it I have to pay my biller. I'm telling you honestly, last year I was in debt.”

I didn't believe him, but at this point it didn't matter.

“So we can meet with Dr. Richards, like you wanted,” I said, trying not to sound desperate. “We can invite Dr. Kapoor out to lunch again.”

But it was too late. “Sandeep, I respect you and I love you, but dollar has to come to pay you. If I get nada, then rather we both sit at home on the weekend. I have a family, four kids; living that lifestyle is expensive. If money is not coming, Amir cannot pay you. You have to understand, I am not a hospital.”

After hanging up, I felt woozy, so I went outside for some air. I sat down on a bench near the parking lot. In the distance, tulips were shooting out of tiny plots on the sidewalk, like hands coming out of a grave. Chaudhry's admonitions kept echoing through my head. “In private practice, you have to stay busy. If you don't stay busy, you can't make it work.” Now what to do? What did this mean? Were we going to default on our apartment? Were we going to have to switch Mohan to the shitty local school? Was I going to have to go back to taking Sonia's father's handouts? Or perhaps worst of all, was I going to have to quit my job and go into private practice full-time? I resolved not to tell Sonia anything, at least not immediately. I was hoping to find more work before we spent down the little savings we'd accrued.

Shortly afterward, Sonia and I went on a long-planned trip with Mohan to Block Island, our first vacation in over a year. I hadn't wanted to go, but I couldn't bring myself to cancel at the last minute. We packed a cooler and a couple of suitcases and drove up to Point Judith, Rhode Island, to catch the ferry. The dock was brimming with summery excitement. Pretty girls in clingy summer dresses were clutching their boyfriends and sipping beer. We were the picture of happiness: a successful Manhattan doctor couple on an exclusive weekend getaway with their four-year-old son. But the picture lied.

The ferry ride was choppy. Halfway across Block Island Sound I was wiping vomit off Mohan's seat. When we arrived on the island, the sky was like a jar of dirty cotton balls. Stormy winds had started to blow. We hailed a cab to our inn. When we pulled up on the gravelly drive, it was already dusk. Whitewashed wood recliners were arrayed randomly on the sloping front lawn. A flock of blackbirds were zigzagging in the distance like one collective organism, apart from a lone straggler trying to merge with the group. Transfixed, I watched them fly overhead.

That night, after unpacking, I went for a run. The rain had stopped, though the trees were still dripping noisily. The path through the field was muddy. The tall grass scraped against my green Gap pants. Because I had stupidly forgotten to bring my sneakers, I was wearing old leather dress shoes that were coming apart at the soles. I sprinted in near pitch darkness, feeling the pasty wetness in my toes. The shadows of trees sliced across the path. The air smelled of manure. My feet were splashing into puddles and crunching on fallen branches. I tripped on a reed, but I kept on going.