Four of a Kind (36 page)

“Come in, Carla,” said the spider to the fly.

Tentatively, Carla entered the office of Dr. James Clifton, the hospital director at LICH, her top boss. The boss of bosses. She’d met with this man and his two associates, both seated at the conference table with him, only a few times before, including the day she was hired fifteen years ago.

Also at the conference room table, her direct boss, Dr. William
Abernathy, the head of LICH outpatient clinic services. She had weekly meetings with him about budget, agenda, staff, budget, services, supplies, budget, special cases, and, just to make sure she absolutely understood the importance of it, budget.

Confronted by four men in suits, Carla felt an immediate self-consciousness that she was fat. Ridiculous, given the context. This meeting was about the health of the hospital. She knew that LICH, like every city hospital, was ailing. Her girth couldn’t be less relevant to the dire subject at hand, and yet, Carla felt the fear of being judged by these men on her attractiveness. As she often told her teenage eating-disorder patients (although it rarely penetrated their obsessed minds), anxiety about weight was a convenient distraction for life’s real problems. When you were having trouble at school, or at home, or wherever, and couldn’t deal with the pressure of the problem, it was a relief for anorexics and bulimics to instead fixate on food. Extra weight was, after all, a “problem” they had some control over.

“Please have a seat, Carla,” said the director.

“Thank you, Dr. Clifton,” she said, keenly aware of the fact that he called her by her first name while she used his degree and surname. It was a show, on his part, of familiarity. On her part? She would show respect, regardless.

All the men looked worn out. Carla’s was one of the last meetings of the day. They’d already seen dozens of staff members. Probably a third had been fired. Carla could smell the lingering stress and sadness in the room.

She sat opposite the men in suits. They smiled at her anxiously. They were not her enemies. They were the bearers of bad news. She tried not to hate them reflectively. “How bad is it?” she asked.

“Twenty percent cuts hospital-wide,” said Dr Clifton. “Select departments will have deeper cuts.”

“Including the pediatric clinic?” she asked.

He paused, checked his laptop notes.

It’s worse than I thought
, Carla realized.

“Eighty percent of pediatric clinic patients at city hospitals present with nonemergent health concerns. Many of the illnesses can be cured with a simple prescription. Maintaining the clinic is one of our biggest costs,” he read the on-screen missive. “The problem isn’t just uninsured patients and expense. The cost is high for parents taking time off work and for kids who have to miss school.” He paused, drew breath. “In cooperation with the new Secretary of Health and Human Services, Mayor Bloomberg has decided to try an experimental program in certain parts of New York City to treat nonemergent pediatric concerns. A quarter of funding for city pediatric facilities will be redirected to implement this program.”

“The program is?” asked Carla, dying to hear this one.

Dr. Clifton cleared his throat. “If I may continue.”

“By all means,” she said.

“The program is to have pediatricians hold clinic hours in public school nurses’ offices,” he said. “Doctors go to the students, instead of the other way around. In counties where this program in under way, minor problems like ear infections, lice infestations, rashes, etc., are caught earlier, before they become severe. Contagions are isolated. Lower incidents of STDs, flu, and a dozen other communicable diseases have been dramatically reduced in the student population. Kids stay in school, parents don’t miss work. Hospitals can free up space and money for other departments. Each student’s medical insurance information will be logged into the school’s records. Those without insurance will be registered, at school, for Child Health Plus. It’s a combined effort by the Departments of Education and Health and Human Services. The goal is that, by 2012, every kid enrolled in a public elementary, middle, or high school in New York City will be registered and covered.”

Carla nodded. Send the doctor to the kids. It was a brilliant idea that addressed all of her many complaints about the pediatric clinic system. The crowding and long waits. Kids missing a whole day of school just to get an antibiotic prescription. The pissed-off parents
who postponed bringing in their child, allowing a minor condition to blow up, for fear of missing work.

“What about the twenty percent of kids who don’t have minor complaints?” she asked, picturing the ever-widening crack in the system.

“We’ll be redirecting clinic funds for a pediatric specialist in the emergency room,” he said. “And more triage nurses for faster intake.”

Again, made sense. Often, Carla would take one look at a patient, and have to send him or her out the door to another doctor. She flashed to a few nightmares during her tenure at the hospital, when a child was brought to the emergency room and she had to leave the clinic to tend to that child, creating a huge logjam at the clinic, and insufficient attention to the emergent-care kid. A full-time pediatrician working the emergency room was a great idea.

Send the doctor to the patients. Have schools liaison with insurance providers
. It seemed so obvious, a classic case of, “Why hadn’t someone thought of this sooner?” The restructuring was outside-the-box thinking—exactly what the nation and the borough of Brooklyn needed desperately. Old think: Wait for things to get better on their own. New think: If a system isn’t working, try something completely different.

As the nation goes, so do I
, thought Carla. She had no choice but to walk directly into the paradigm shift. It was time for her to try something different, whether she was ready for it or not.

Dr. Clifton cleared his throat. And now, she thought, here comes the big finish. “At LICH, we believe this program represents the future of pediatric health care. We’re honored that the mayor has selected our clinic for restructuring.” He looked up from his computer screen. “Carla, I’m offering the same choice to all four of our clinic pediatricians. This is a broad-stroke job description, of course. If you are interested in being a rover, you’ll be assigned to six public schools in the borough, two elementary, two middle, and two high schools.
Your hours will be determined by need, but you can expect a workweek of around fifty hours. Some doctors keep the school nurse’s office open until six o’clock. Your salary would be exactly what you’re making now, minus a percentage cut we have yet to vote on. It’ll be around ten percent.”

More patients, exhaustive travel, longer hours, less money. Carla said, “What are the other options?”

Dr. Clifton clicked them off mechanically, early retirement, part-time this, part-time that, etc., none of them appealing. She must have looked discouraged. He said, “I know it’s a lot to think about.”

“What about my support staff?” she asked.

“Some will be absorbed by the hospital,” he said. “Some will be let go.”

“Last question: What about preschool-aged children? Babies and toddlers.”

“We’re going to combine maternity and early-childhood health care on one floor,” he said. “Vern Summers and Kal Vali have already accepted their reassignments.”

Meaning, she thought, two of her colleagues grabbed the on-site jobs. And she was left in the cold. Carla knew her reprimands would wind up hurting her, but she had no idea how badly.

“When will you need my decision?” she asked.

“By June fifteenth,” he said.

“Why then?”

“On July first, we shut down the clinic.”

Tears shot out of Carla’s eyes. Literally burst forth, without warning. She’d been in complete control of her emotions until that moment.

Life as she knew it was changing. Although she had “options,” she had no choice, really. Carla was forty-five years old. And she would have to start over.

Claude was adamant. “You have to take the rover job,” he said. Another “kitchen table” conversation in the freshly painted dining room. “Forget part-time. We can’t make it on one and a half salaries.”

He’d had some incredible luck this week, accepting an offer to go to work for his former employer’s competition—at a twenty percent drop in pay. Unlike Tim Fandine, who hadn’t had a job in years, Claude bounced back after six weeks of unemployment. But even with his new job, money was still impossibly tight.

So tight, in fact, that they’d already made the decision about Brownstone. Neither Manny nor Zeke would attend next year. With diminished incomes, they couldn’t swing one tuition. Incredibly, they were still earning too much for aid. Carla had already accepted the new reality. She’d fought against it for months, and was now willing to admit defeat—about private school. But Carla still had some fight in her.

Carla said, “The rover job is one option. There is another possibility.”

“I’m listening,” said Claude.

“Do you remember Dr. Stevens? You met him at a couple hospital benefits. He’s a pediatrician in private practice in the Heights.”

“Drawing a blank,” he said.

“He’s a very nice man,” she said, trying to warm Claude up to the man, and the plan. “I ran into him a week ago and he asked me to call him to talk about his practice.”

“Partnership?” asked Claude, perking up. A partnership in a private practice could mean big money.

She shook her head. “Not exactly.”

“What, then?”

“I spent a lunch hour today at his office on Remsen Street. It’s the bottom floor of a lovely brownstone building. Very clean, nice, three exam rooms,” she said. “His staff seems great. He invited me to shadow him for a while, get a feel for how he runs the place. Then we talked for a few minutes on his stoop.”

“Waiting,” said Claude, moving her along.

She took a deep breath. “He’s dying. Non-Hodgkin’s lymphoma. He wants to sell his practice to a doctor he trusts to give his patients a high level of care.”

“And he’s offered it to you,” said Claude. “How much?”

“A pittance, considering,” she said.

He laughed. “I know what that means. We can’t afford it.”

“We could cash out our IRAs and 401Ks, and get a small business loan for the rest.”

“Ransack our retirement for a risky business venture, and go in way over our heads in debt? This is the kind of thinking that got us into the recession.”

“Don’t blame the recession on me,” she shouted, getting angry. “This is how people make money, Claude. They take risks. We’ve been playing it safe our whole lives. Every decision I’ve made has been about doing the responsible thing, the right thing. Well, look where that’s got us.”

“You still haven’t told me how much,” he said.

“It really is hardly anything,” she said. “Half a million.”

He laughed, holding his stomach, wiping at his eyes. “Oh, Carla. You
are
funny. Take the rover job. We’ll get by.”

“I’m too old for that job,” she said.

“I won’t let you put us half a million dollars in debt,” he said. “We don’t even have the thousands it would take in fees to get a loan.
If
we could get a loan.”

That rattle she just heard deep in her chest? It was the last gasp of a dream, of running her own practice and being a family doctor, making an impact on people’s health and happiness for their whole lives. She would settle, as Claude wanted her to, for the sake of her own family. Making an impact on her sons’ health and happiness would have to be enough.

Claude crossed to her side of the table, and rubbed his wife’s broad shoulders. Leaning down, he kissed her sweetly on the neck,
and said, “I’m sorry, baby. I know you’re upset. But you must have known that buying a private practice was never going to happen.”

She let him kiss and comfort her. They made love that night. The unspoken offer had been made and accepted: in exchange for Claude’s affection and protection, Carla would comply. As she lay awake, long after Claude fell asleep, she could count backward in time, the generation upon generation of American women—of color, or otherwise—who’d traded their dreams for their family. Carla was sure Bess’s mother, Simone Gertrude, the old-school feminist, would have contempt for Carla’s acquiescence. What Carla would have preferred, from any woman of any generation, was understanding. Wives and mothers had to make sacrifices. The number one sacrifice on the list? The chance to reach their full potential.