“Hello, Lisa. You’re up early.”
“Are you on the toilet?”
“Uh…”
“George, what were you thinking?”
“You’re not going to say,
Hello, how are you? Thanks for sending the checks, so I can keep my five-thousand-square-foot monstrosity toasty warm and my Range Rover filled with gas and my toes painted a glossy hue of harlot
?”
“You’ve always got a joke. George. This is not a joke.”
“Okay, I’ll bite. What’s got your designer thongs in a wad?”
“You could have gotten yourself killed. In front of your son! This is your idea of parenting?”
“What?” As soon as Villanueva asked the question, he remembered the confrontation. “Oh, that.”
“Yes, that. What were you thinking?”
“You know me, Lisa. I’m all about peace and love. Just had to straighten out some jag-off.”
“Jesus, George. Why you? That’s why we have police. Nick was terrified.”
“Terrified?”
“Yes, George.”
Villanueva checked his watch. The thought of enduring another ten minutes or so of this harangue was not something he welcomed. It was 5:55
AM
. Saved by the bell.
“Lisa, I’d love to chat. I’ve got M and M.”
“Well, that’s just wonderful. Listen, if you want to commit suicide, do it on your own time and not in front of your highly impressionable son!”
“Roger that. Suicide. Own time.” His ex hung up before he had finished.
By the time Villanueva reached Room 311, Buck Tierney was standing at the front of the room before the assembled surgeons. Tierney stood ramrod-straight at parade rest, his hands behind his back and legs spread shoulder width. Even though he had never gone beyond ROTC as an undergrad, Tierney liked to give off a military bearing. He gave the impression he was a general readying his troops for a great battle. From his perspective, that wasn’t too far off. Life was about winning other people over to your point of view.
“Good to see all of you this morning. Wish I could serve you up some eggs and home fries.” The assembled surgeons were used to Buck’s down-home shtick and didn’t respond. Tierney rocked on his heels and continued. “I wanted to answer something Dr. Saxena proposed the last time we were here. You may recall she suggested we not let instrument reps in the OR. Now, first of all, let me be clear, this conversation isn’t about Dr. Saxena, whom I have no doubt is an outstanding doctor.”
Sitting next to Hooten, Sydney Saxena bristled.
“And don’t get me wrong, I’m all for maintaining the sanctity of our decision-making abilities as doctors, but facts are facts. And whether or not Dr. Saxena likes to admit it, the truth of the matter is a rep may know more about the stent or graft or hip than many surgeons do. He might know more about the latest heart valve than even you do, Dr. Saxena.”
Sydney stood and held up her hands as though he were an errant motorist about to run a stop sign. “Dr. Tierney—”
Buck barreled ahead. “The reps—they’ve been around ’em more. They’ve seen more operations using ’em. If they want to spend a couple hours in the OR while we use their device, I say more power to ’em. More power to us, really.”
“Dr. Tierney, if I may,” Saxena said as politely as possible. “As medical professionals, we are the ultimate arbiters of what care our patients receive.”
“No one says we have to listen to ’em.”
“Buck, whether or not you want to admit it, those reps are influencing sacred medical decisions, and they are doing it to benefit their own pocketbook. Look, we had a case in here a year or so ago where the rep during a TKA said one of our surgeons needed to shave a little more bone off the tibia, so his own prosthetic would fit. Now, that advice happened to be wrong, but our surgeon listened to him. The outcome was less than desirable.”
There were a few murmurs of assent among the surgeons. The orthopedist who had performed the surgery, Dr. Joseph Polanski, stared straight ahead and said nothing.
“I do remember that case. The woman was left with a limp,” a doctor a few rows behind him called out.
Buck held up his hands.
“Dr. Saxena, you’re just cherry-pickin’ examples here. I could give you ten other examples where the rep gave advice that was not only medically sound, but prevented a bad outcome.”
There were murmurs of assent to Tierney’s argument. One surgeon called from the back, “Some of those guys are good, no question. You know Troy Richardson, with Bravo Devices? I had an improper alignment of the calcaneus for the screw, and he pointed it out.”
Tierney looked at Saxena and held a hand out toward the surgeon, as though he were presenting evidence in court. Saxena ignored him and turned to the large cadre of doctors surrounding her.
“I know we’re all busy,” she said. “But do we want to be relying on ex-football-players and sorority presidents to be telling us what we should or should not be doing in the OR?”
“They know their stuff,” Tierney said.
“They know
their
stuff. They’re going to spend that hour or two in the OR convincing you that
their
stuff is the only way to go. What if you want to use some other company’s stuff?”
“I don’t know about you, Dr. Saxena, but I am not going to let one of these reps push me around,” Tierney said. His tone was clear: The only reason Sydney wanted to ban the reps was that she was a patsy.
“Would you let a detailer in the examination room while you considered what drug might be appropriate for your patient?” Saxena asked.
“Now you’re talking about Medicine. We all know those worms in Medicine are pushovers and need all the protection they can get.”
A wave of laughter went through the room.
“We,” Tierney said with gusto. “We are surgeons!” The mostly male crowd roared their approval.
“Now you’re talking!” one surgeon called.
Sydney shook her head. She could see she had been badly beaten by Tierney’s demagoguery. The experience was deflating.
Villanueva, his enormous mass immobile for most of the debate, stood up. Sydney’s hopes rose.
“Buck. I don’t suppose your argument is any way colored by Bravo Devices’ ten-million-dollar pledge for a ‘Bravo Ambulatory Care’ center for your new heart wing, is it?”
Tierney reddened.
“Dr. Villanueva, I resent the insinuation. You are impugning my honor, and I will not stand here and allow you or anyone else to impugn my honor.”
“What are you, the prince of England? Who talks like that?”
Buck took a step toward Villanueva. Hooten stood.
“Gentlemen, enough!”
Hooten turned toward Chelsea General’s surgical staff. “By a show of hands, let me know how many of you are in favor of barring representatives of medical device companies from the OR?”
The hands of half a dozen doctors went up, Sydney, Tina, and Villanueva among them.
“How many are opposed and would like to keep the status quo?”
The remaining forty or so hands went up.
“All right then. It is settled,” Hooten said authoritatively.
E
arly that afternoon, Park’s wife came to pick him up at his office. Park didn’t mind relinquishing the driving to her. He looked forward to Pat’s arrival each afternoon.
Sung had worried the surgery and radiation would affect what he prized most of all—his hard-won knowledge. So far, he felt sharp as ever. He’d be starting a monthly course of chemo pills soon, though, and that could also scramble his brain.
“One step at a time,” Pat told him. Or, “One day at a time.”
He’d tried to take her advice. He hadn’t reviewed the latest medical literature on his scheduled chemo or calibrated his life expectancy based on the latest data and the success of his treatment thus far.
Something else: Park appreciated each day at the teaching hospital. Instead of sizing up his own abilities against his colleagues’, he’d begun to value their talents. Instead of viewing patients as abstract medical problems, he started seeing them as people.
Park noticed how fellow staffers at Chelsea General now treated him differently. No longer did they deal with him as an unpleasant necessity in their lives. They approached him with kindness. They took the time to quiz him about his family. They asked if there was anything they could do for him. Each night, the radiation oncologist, a Dr. Eduardo Hernandez, clasped Park’s hands in his own and wished him well before stepping out of the room so the radiation machine could perform its task. With his life on the line, he was finally welcomed into Chelsea General. Always an outsider, Park the patient had somehow become one of them. Park treasured it, and also noted this as yet another example of the odd behavior of Americans.
Pat put an arm around his waist, a public gesture of affection that was new since his diagnosis. Before, he had made it clear that she should stay away from the hospital, and he would have scolded her for showing affection there—or anywhere in public, for that matter. Now he was enjoying having Pat at his side. Her slim arm around his soft midsection was comforting.
“Let’s get you home for a nap.”
“Yes.”
They began making their way to the parking garage.
“And then maybe we can go out for dinner,” Sung said. “The two of us.”
“A date?” They had not gone on a date in years. Park saw that he had surprised her and he saw that she was smiling. It was the expression of a little girl. Park said nothing, but he experienced a deep joy seeing her so happy.
They took a few more steps. “Do we know any babysitters?” Park asked. They had never left their children with anyone who was not family. Park’s father was in Korea and Pat’s family—a mother, father, and brother—lived in New Jersey and rarely visited. So the kids went everywhere with them. Even when they appeared at colleagues’ parties, they would arrive early with the children in tow. If it was a formal event or a hospital function, Sung Park would go alone.
“I think there are some older girls in the neighborhood.”
“Good,” Park said.
“Tonight may be difficult.”
“I see.” Doubt entered Park’s voice.
“But we will go on a date as soon as we can find a babysitter. Soon. Okay?” Still with her arm around his waist, she pulled her husband tight.
“A date!” Park said.
I
nstead of boarding the flight that would bring him home in time for Monday Morning and Room 311, Ty booked a flight the following morning from Miami to Houston and on to Phoenix. Once he landed at Sky Harbor International, he rented a car and headed north on 87 until he reached the turnoff for Fountain Hills.
He had never missed a Monday Morning meeting during his time at the hospital. Part of that was chance. They weren’t held every week, and when he’d vacationed in Italy three years earlier and Southern California the previous year, he’d planned it around a break in the M&M schedule. When he rented a cabin on the Upper Peninsula for a couple of weeks one summer, Ty had come back for M&M and then resumed his vacation. Once, he’d driven his motorcycle all night to return from a college friend’s wedding in Philadelphia. Another time, he had walked in after operating all night on a patient whose skull fractured when she was launched through a windshield.
Ty turned into a condominium development set into a hillside and pulled up in front of an adobe-colored, stucco home with a living room window made of glass bricks and a small deck over a two-door garage. The deck offered up a view of rooftops stretching across the valley and low mountains in the distance. Even though it was late autumn, the temperature was pushing ninety. He didn’t see his sister’s car, but he assumed it was in the garage. He’d heard stories about cars getting so hot people used potholders on the steering wheel. He was pretty sure that was an urban legend, but you never knew.
Ty parked his rental and knocked on the door. His sister Kate answered so quickly, Ty was left knocking in thin air. Brother and sister spent a moment just looking at each other, and then exchanged an affectionate hug.
Everything was in order. The house was so meticulously maintained you’d never guess she had two preschool-aged children—unless you noticed the foam corners neatly affixed to the coffee table or the childproof outlet covers. Kate watched Ty as he walked to the couch and sat down. She wore a look of concern. It was as though she was trying to determine if this visitor was really her older brother. Kate pulled up a chair and sat facing him.
“Ty, what’s going on?”
“I wouldn’t have asked if you could see me if it wasn’t important.”
“Of course. I can take a day off for big brother. So what’s happening? I’m worried about you.”
“I gave you the gist of it in my text. Just having a hard time shaking this,” Ty said. He found it difficult to continue. Kate took his hand. The move seemed to flip a switch. This was the one person in the world who really knew him, who could understand him, who loved him always without hesitation.
Ty began sobbing. The grief welled up from deep inside. It was as though her touch had released whatever was holding it back. Kate leaned forward and put her hands on Ty’s shoulder. Ty’s sobs came in waves: grief not only for Quinn McDaniel and Allison McDaniel, but his brother, Ted, and his sister Christine. Whatever stopper had held those feelings in check was released. It was as though he was vomiting grief.
“Ty, it’s okay. Whatever it is, it’s okay. You’re a good doctor. A great doctor.”
“But this wasn’t supposed to happen,” Ty said through his tears. “It wasn’t supposed to happen.” He looked down at her Navajo-patterned rug as he spoke.
“It’s okay, Ty.”
“After Ted died. And Christine was shot. I told myself I was going to be the one,
the
doctor. The doctor who could save people like Ted, like Christine, when no one else could. And then this kid. Quinn McDaniel. Kate, I was supposed to be the one who could save him. I was created…evolved, somehow designed to do…
this
.” He paused. “Ridiculous, right?” Ty let out a long sigh.
“You know what?” Kate said. “You’re right.” Ty looked up at her. “It
is
ridiculous,” she continued.