Mark was asleep when she arrived home but lifted his head and looked over at her as she slid between the sheets. He looked at her vacantly, his eyes flat.
“Sorry,” Tina said. “I had a case.” Mark didn’t respond. He looked at her for a moment more, his mask-like expression unnerving her. The spark in the marriage had fizzled sometime earlier, maybe a year, maybe more. They both knew it, though neither mentioned how their relationship had devolved from intimacy into a series of bloodless interactions, flat discussions of who would pick up one of the girls at ballet or go to the store or call the plumber. Neither acknowledged out loud that their marriage was dying. Saying it aloud would somehow make it real, and they would have to do something about it. Up until that point, neither had the inclination or energy to do that.
Now, as Tina looked at Mark’s expressionless face, his almost dead eyes, a frisson of fear caused her to shiver. She worried he would raise the issue now, when she was tired and feeling guilty. When she
was
guilty. Mark rolled over and went back to sleep, his breathing slow and rhythmic.
Tina remained wide awake, despite fatigue so deep her limbs felt like alien appendages. She replayed Mark’s look. Was that suspicion? Could he see she was suffused with the afterglow of sex? It had been a while since Mark had seen her like that. If Tina had to guess, she would say it was before their second child was born. The conception of child number three was a fluke, the product of too much wine at, ironically enough, a hospital party.
As Tina repositioned herself on the pillow as softly as possibly, as though she might literally make waves with any hasty or clumsy motion, she thought about that article Ty had mentioned detailing the more than two hundred reasons people had sex. Most involved permutations of power and self-esteem. She wondered if that was also the category her night with Ty would fit into. True, she had always connected with him. Lately, however, when she saw Ty at the hospital, there was something unusual in his expression, a vulnerability.
The hours with Ty had been like a dream, and she had craved the intimacy. Now, as the predawn thrum of traffic became audible from the highway a mile or so away, Tina wondered what she had been thinking. What was she hoping to accomplish? Also, she experienced shame. She had broken her vows again. Even though she considered them largely empty, Ridgeways did not break their vows. They did not go against their word. The betrayal gave her a sick feeling in her gut.
As a teenager, before she had gone on a date, her father would always call after her, “Remember who you are.” She took this seriously. She stayed clear when her summer friends in Edgartown met some prep cook in a walk-in refrigerator to buy pot, or when they used fake IDs to buy six-packs, vodka, tequila, and more from the package store. She wasn’t a total nerd. She went to the parties on South Beach, but she left before hormones and alcohol-fueled thinking made skinny-dipping, tipping lifeguard stands, and unprotected sex seem like good ideas. Her father’s admonition was in her head when she grabbed her boyfriend’s wrist as he tried to slide a hand down her pants in the cramped backseat of his parents’ BMW. Another of her father’s sayings: “Don’t do anything you wouldn’t want printed in the newspaper.”
Tina rolled over and faced away from her husband, but despite her fatigue she could not find sleep. She thought about the headline from that night’s transgression: “Respected Doctor Guilty of Adultery.” Or, “Married Mother of Three Seduces Doctor.” She lay there for a few more minutes stewing in her thoughts. Finally unwilling to lie there another minute longer, she got out of bed, went to the kitchen, and started the coffee machine. A hint of purple was visible behind the trees at the far end of their small backyard.
As the coffee gurgled, Tina thought of the time when she was five or six. She, her brother, and her parents had gone to the Dukes County Agricultural Fair, the highlight of the summer on Martha’s Vineyard. Wandering among the quilts and pies and artwork inside the old Grange Hall, she had become separated from her family. She went outside, thinking maybe they were ahead of her. In growing panic, she walked aimlessly among the dirt and straw and the fast-moving swirl of the crowd, a churning maelstrom of legs and feet from her vantage point. Day was giving way to night, and Tina watched a girl her own age getting lemonade squeezed from lemons and shaken with sugar and water. She walked some more, her panic growing. She walked down a corridor of carnival games and food and was distracted by the blinking lights around a booth in which you threw darts and tried to pop balloons to win stuffed animals. Darts were arranged in threes on the counter in front of the game, and enormous stuffed animals were tacked to the wall on either side of the bright balloons. The carnie running the game had leaned over the counter, his weathered, tanned face close, blocking her path. “Are you lost?” he leered.
Tina had backed away from the cigarette breath, her heart pounding, and bumped into a teenage boy.
“Watch it.”
She spun around. It was now dark, the lights from the Tilt-A-Whirl spinning around in front of her. Kids screaming. The fairgoers were silhouettes among the brightly lighted rides and games. At that moment, she was certain she would never see her family again. Tears came to her eyes. She was terrified. She stopped moving and stood as people walked past.
That’s when she heard her father’s distinctive whistle, an up-and-down, almost whimsical sound he used at the beach when he wanted them to come. She found him and wrapped her arms around his legs.
“Daddy!”
“Heya, monkey.”
Tina could always count on her father to rescue her when she was lost. Tina adored her father. She picked up the phone and called. He answered on the first ring.
“Hi, Dad.”
“Hi, Tina. Kind of early for you academic docs, isn’t it?” Tina’s father liked to chide her about her life in a teaching hospital, though his ribbing was filled with pride. He acted as though he himself had not spent most of his career in academic medicine before taking over his father’s practice in Vermont in his sixties.
“Just wanted to see how it’s going up there.”
“Got our first big snow. You know what that means. Big business. Broken ribs. Heart attacks. Sprained knees. But it is beautiful. What are you doing calling so early?”
“Just wanted to see how you’re doing.”
“Anytime you want to help out the old man, we’ll stick your name on the shingle. Ridgeway and Ridgeway, Practitioners of the Ancient Healing Arts.”
“Sounds good.”
“I’m serious, monkey. Anytime.”
“Thanks, Dad.”
Tina said good-bye and imagined herself for a moment in rural Vermont, bringing patients into the world and seeing them out. Serving as ob-gyn, family practitioner, urologist, oncologist, and every other stripe of medicine. The image seemed attractive. For all the professional prestige that came with working at a large teaching hospital, Tina admired the country doctors who often had only themselves and their medical knowledge to rely on in an emergency.
She wondered for a moment what her father would think about her scrapping her career at Chelsea General. She was angry with herself for even raising the question. Her father had always been a towering figure. She admired him, but at the same time she was growing to realize just how much control he had exerted on her path through life. Once her brother had strayed from the expectation he would become a doctor, it had been a foregone conclusion that Tina would become an MD and go into academic medicine. No doubt, she chose her own specialty, but the rest was preordained. Tina was thinking about this when she heard the rest of the family begin to stir.
A
t that moment, Harding Hooten stood on his back deck and listened. Nothing thrilled him like the dawn chorus. He heard cardinals, a mourning dove, the rapid-fire knocking of a woodpecker. Was that a bluebird he heard? Hooten enjoyed a deep satisfaction from birding, though he had little time for it. This quiet moment before dawn was about all he could count on, and that meant listening, not watching.
Hooten’s fascination with birds began as a medical student, when a fellow first-year at Columbia had approached him and asked if he was “a birder.” Hooten paused for a moment trying to grasp the man’s name from his memory. The fellow had looked somewhat like a stork himself. What was his damn name? Hooten dug hard. He was doing this more often lately, trying to remember a name, an address, a fact from his life. He had taken to stopping what he was doing until he found the neuronal pathway that gave him his answer, but it was getting harder.
Hooten pictured his former classmate, six-foot-six, spindly, bushy eyebrows. He even remembered what he was wearing that morning: blue work pants and a denim shirt. Same thing he wore every day they went out. Hooten saw him leaning close to patients, listening with his head cocked to the side, not missing a word as he took histories. His expressive eyes always seemed damp, as though from tears or glee. He was empathy personified. Amazing bedside manner. The switch flipped for Hooten.
Scott. That was his name: Clinton Scott. Hooten breathed a sigh of relief. Maybe he wasn’t senile just yet. They called him Great Scott because patients would confess all sorts of dark secrets—drinking problems, domestic violence, even sexual troubles decades before erectile dysfunction became an acronym tossed around by athletic men on television commercials. Hooten breathed a sigh of relief. Clinton Scott. He dreaded the continuing march of age-related memory loss.
That fall morning in Upper Manhattan almost fifty years earlier, Scott had asked him if he was a birder.
“You mean a bird-watcher?” Hooten replied. Growing up in Camden, Maine, he had never given birds a second thought, other than to note that seagulls would eat almost anything they could choke down their gullets. A friend of his had worked at a doughnut shop and would lob unsold crullers at the birds, which would catch them and swallow them in stages like a sword swallower at a traveling carnival.
“I’ll take that as a no,” Scott said and handed him a pair of binoculars. “Let’s go.”
“But this is New York.”
“Central Park is a wonderful place, but we want to be there when the sun comes up.”
Hooten was tired. He had been up memorizing the bones of the hand, but Scott’s enthusiasm was infectious. From that morning on, Hooten was a birder. On mornings he wasn’t at the hospital, he went out with Scott. The outings were a reminder there was a world outside the hospital. Hooten found the serenity of watching and listening relaxing, even amid the long, long hours of residency.
Scott had gone on to become an endocrinologist and eventually head the Universidad de Ciencias Médicas in Costa Rica, no doubt attracted to the job because of the incredible diversity of bird life in that small Central American country. There were more species there than in all of the United States. At the last reunion, he’d heard Scott, one of his only true friends, had been killed in a car accident.
Hooten closed his eyes, listening, separating the cacophony of birdsongs into the different species. Even in the dark, the birds could communicate. It was a natural marvel, but on this morning, the ornithological orchestra did not soothe him. The peace he usually felt from the birdsongs did not last long. He was thinking of the upcoming M&M. An appalling lack of communication had almost resulted in the death of a child, and Hooten had decided he was not going to let this sort of benign neglect pass without making a few of his junior colleagues sweat. A patient who dies in the OR despite a surgeon’s best efforts was one thing, but passing the buck while a child’s condition deteriorated was something he was not going to tolerate as long he was chief of surgery.
There was something else troubling Hooten this morning. He knew Martha wanted him to retire, to spend more time with her, with the children and grandchildren, to spend time at the place on Mackinac Island. But at the end of the day, what was his legacy? How could his stamp on Chelsea General be made lasting? The hospital might commission a portrait and hang his likeness in some corridor, or name a teaching service after him, but day to day how could his time at Chelsea General be measured?
Hooten had worked hard during his thirty-odd years at Chelsea General. As chief of surgery, he had routinely put in fourteen- or sixteen-hour days as chief of surgery. He had done his best to make sure Chelsea General adopted the latest surgical techniques, that every surgeon under him paid attention to details, and that residents received the best training possible. Maybe most important, he ran M&M in a way designed to make every surgeon 100 percent accountable, and as a result had transformed the very way surgeons learned and benefited from one another’s mistakes. Hooten had added a level of transparency to surgery rarely seen anywhere in the world. Still, his eyes clouded. The girl’s case showed that despite the best practices, medicine fell to individuals, who too often were inclined to push their work on to the next physician or the next shift as a result of laziness, or fatigue, or lack of confidence, or dinner plans. Even on his watch, the patient sometimes got shortchanged. The doctors, nurses, lab techs, pharmacists, therapists, social workers, orderlies inside the hospital who turned the institution from a large hodgepodge of buildings to a living, breathing organism were too often prone to the second law of thermodynamics: entropy—the tendency of disorder to increase over time.
Between the motion and the act falls the shadow
. Hooten’s job was to prevent the shadow, to reverse the natural trend toward disorder, slothfulness, fuzzy thinking, shortcuts, and sloppy assumptions. He did not want his tenure at Chelsea General to end with a whimper. How was it possible to have his exacting standards last longer at the hospital than he did?
In the early glow of the day, Hooten watched a female cardinal perched on a branch, its coloring just starting to show tan-green. If Chelsea General was the sum total of the individuals, Hooten thought, then the only way the hospital maintained its high standards was to make sure the individual who took his place held the same standards he did. His replacement couldn’t worry about being popular and had to be equally immune to flattery and intimidation.