The Oath (2 page)

A
t the beginning of this effort, my knowledge of medicine and the medical establishment was limited, to say the least. I’d especially like to thank Marcy St. John, senior counsel with Blue Shield of California, and Pat Fry, chief operating officer of Sutter Health, for the insights and information that helped somewhat bridge this gap in my education and knowledge. Also, thanks to two nurses for their help: my sister Pat Barile, and Cheri Van Hoover.

In the legal realm, as always I depend most heavily on the expertise of my great friend and collaborator Alfred F. Giannini of the San Francisco District Attorney’s office. Inspector Joe Toomey of the San Francisco Police Department has also been most generous with his time and expertise.

My day-to-day life is enhanced considerably by the competency and wonderful personality of my phenomenal assistant, Anita Boone. She is a treasure to work with and a joy to know.

No less heartfelt thanks—for a variety of other reasons—go to Tom Hedtke; Poppy Gilman; Carolyn Giannini; Jesse Tepper, president and founder of the San Francisco Little League; Peter J. Diedrich; and Dee Scocos. Richard Herman is a terrific author himself—go read him—and he supplied an important epiphany.

The names of three characters in this novel were supplied by the winners in charitable auctions; I would like to acknowledge the generous contributions of Margie Krystofiak to Serra High School of San Mateo, California; Frank Husic to
Imagine
; and Catherine Treinen to Cal-State Fullerton.

I am deeply indebted to all the people at Dutton for their tremendous support and commitment; in particular, I would like to single out Glenn Timony, Lisa Johnson, Kathleen Matthews-Schmidt, Susan Schwartz, and Kim Hadney for their yeoman efforts. Carole Baron has been and continues to be a terrific publisher, cheerleader, and friend; our regular discussions on book and other matters are a source of great pleasure, and have helped to sharply focus and improve the narrative of this novel. Mitch Hoffman is a great guy and superb editor; the book’s final shape owes much to his suggestions and good taste.

Barney Karpfinger remains the best agent an author could ever have, and a true friend as well. His artistic encouragement, level head, business acumen, and sense of humor are each as important as they are rare. Barney, you’re a true mensch, and I can’t thank you enough for everything.

Closer to home, perennial best man Don Matheson just keeps those good times coming; and Frank Seidl remains the king of wine and laughter. Finally, my two children, Justine and Jack, continue to enrich my life on a daily basis. My borrowings of their concerns and life events continue to inform and hopefully enrich these novels and my life, both of which would be empty without them.

H
er stupid, old American car wasn’t working again. So now Luz Lopez was sitting on the bus with her sick son, Ramiro, dozing beside her. This time of day, midmorning, the streetcar wasn’t crowded, and she was glad of that. Ramiro, small for eleven years old, had room to curl up with his head on her lap. She stroked his cheek gently with the back of her hand. He opened his eyes and smiled at her weakly.

His skin was warm to her touch, but not really burning. She was more concerned about the cut on his lip than the sore throat. There was something about the look of it that bothered her. He’d banged it on some playground bars on Monday and today, Thursday, it was swollen, puffy, yellowish at the edges. But when the sore throat had come on yesterday, Ramiro had complained not about the cut lip, but the throat. Luz knew her boy wouldn’t make a fuss unless there was real pain. He was up half the night with gargling and Tylenol. But this morning, he told her it wasn’t any better.

She had to take the day off so he could see a doctor. Time off was always a risk. Though she’d been halfway to her business degree when she’d left home, now she worked as a maid at the Osaka Hotel in Japantown, and they were strict about attendance. Even if the reason was good, Luz knew
that every day she missed work counted against her. The clinic said they could see him before noon—a miracle—so maybe she could get his prescription and have Ramiro back at school by lunchtime; then she could still put in a half day back at the Osaka.

She had lived in San Francisco for over ten years now, though she would never call the place home. After the opponents of land reform in El Salvador had killed her father, a newspaper publisher, and then her brother Alberto, a doctor who had never cared about politics, she had fled north with her baby inside her. It had taken her husband, Jose´, almost three years to follow her here, and then last year La Migra had sent him back. Now, unable to find work back home, he lived with her mother.

She shifted on her seat on her way to the Judah Clinic, which was not on Judah Street at all, but two blocks before Judah began, where the same street was called Parnassus. Why did they not call it the Parnassus Clinic, then? She shook her head, these small things keeping her mind from what it wanted to settle on, which was the health of her son.

And of course the money. Always money.

Ramiro’s tiny hand lay like a dead bird in hers as they walked from the streetcar stop to the clinic, a converted two-story Victorian house. When she opened the front door, she abandoned all hope that they’d get to her quickly. Folding chairs lined the walls of the waiting room. More were scattered randomly in the open space in the middle, and every seat was taken. On the floor itself, a half dozen kids played with ancient plastic blocks, or little metal cars and trucks that didn’t have all the wheels on them.

Behind the reception window, four women sat at computer terminals. Luz waited, then cleared her throat. One of the women looked up. “Be just a minute,” she said, and went back to whatever she was doing. There was a bell on the counter, with instructions to ring it for service, but the computer woman already had told Luz she’d just be a minute (although now it had been more like five), and Luz didn’t
want to risk getting anyone mad at her. They would just go more slowly. But she was angry, and sorely tempted.

At last the woman sighed and came to the window. She fixed Luz with an expression of perfect boredom and held out her hand. “Health card, please.” She entered some information into her computer, didn’t look up. “Ten dollars,” she said. After she’d taken it and put it in a drawer, the woman continued. “Your son’s primary care doctor is Dr. Whitson, but he’s unavailable today. Do you have another preference?”

Luz wanted to ask why Dr. Whitson was unavailable, but knew that there would be no point in complaining. If Dr. Whitson wasn’t here, he wasn’t here. Asking about him wouldn’t bring him back. “No.” She smiled, trying to establish some connection. “Sooner would be better, though.”

The woman consulted her computer screen, punched a few more keys. “Dr. Jadra can see Ramiro in twenty-five minutes. Just have a seat and we’ll call you.”

The words just popped out. “But there are no seats.”

The woman flicked a look to the waiting room over Luz’s shoulder. “One’ll turn up any second.” She looked past her. “Next.”

While Ramiro dozed fitfully, Luz picked up a copy of the latest edition of
San Francisco
magazine. There were many of them in the room, all with the same cover photo of a strong Anglo businessman’s face. Luz read English well and soon realized the reason for the multiple copies. The story was about the director of Parnassus Health—her insurance company. The man’s name was Tim Markham. He had a pretty wife, three nice-looking children, and a dog. He lived in a big house in Seacliff and in all the pictures they took, he was smiling.

Luz cast a glance around the waiting room. No one was smiling here.

She stared at the face for another minute, then looked down at her sick boy, then up at the wall clock. She went
back to Mr. Markham’s smiling face, then read some more. Things were good in his life. His company was experiencing some growing pains, yes, but Markham was on top of them. And in the meantime, his patients continued to receive excellent medical care, and that was the most important thing. That was what he really cared about. It was his lifelong passion.

Finally, finally, a nurse called Ramiro’s name. Luz folded the magazine over and put it in her purse. Then they walked down a long hallway to a tiny windowless room with a paper-covered examining table, a sink and counter, a small bookcase and shelves. Posters of California mountain and beach scenes, perhaps once vibrantly colored, now hung faded and peeling from the walls.

Ramiro laid himself down on the table and told his mom he was cold, so she covered him with her coat. Luz sat in an orange plastic molded chair, took out her magazine, and waited again.

At 12:22, Jadra knocked once on the door, then opened it and came in. Small and precise, completely bald, the doctor introduced himself as he perused the chart. “Busy day today,” he said by way of apology. “I hope you haven’t had to wait too long.”

Luz put on a pleasant expression. “Not too bad.”

“We’re a little shorthanded today. Twenty doctors and something like eight have this virus going around.” He shook his head wearily. “And you’re Ramiro?”

“Samp2;´.”
Her boy had opened his eyes again and gotten himself upright.

“How are you feeling?”

“Not so good. My throat…”

Jadra pulled a wooden stick from a container on the counter. “Well, let’s take a look at it. Can you stick out your tongue as far as you can and say ‘ahh’?”

That examination took about ten seconds. When it was over, Jadra placed a hand on the boy’s neck and prodded around gently. “Does that hurt? How about that?”

“Just when I swallow.”

Five minutes later, Luz and Ramiro were back outside. They’d been at the clinic for over two hours. It had cost Luz ten dollars, more than she made in an hour, plus a full day’s wages. Dr. Jadra had examined Ramiro for less than one minute and had diagnosed his sore throat as a virus. He should take Children’s Tylenol and an over-the-counter throat medication. He explained that the way viruses work, symptoms go away by themselves within about fourteen days or two weeks, whichever came first.

A joke, Luz supposed, though it didn’t make her laugh.

Two days later, Ramiro was worse, but Luz had to go to work. Last time they’d warned her about her absences. There were a lot of others who would be happy to take her job if she didn’t want to work at the hotel anymore. So she had to take Ramiro into urgent care at night, after she got off.

On the bus, she gathered him in next to her, wrapped her own coat over his shivering little body. He curled up and immediately fell asleep. His breathing sounded like someone crinkling a paper bag inside his lungs. His cough was the bark of a seal.

This night, the clinic was less crowded. Luz paid her ten dollars and within a half hour, full dark outside now, she heard Ramiro’s name called. She woke her boy and followed a stout man back into another tiny office, similar to Dr. Jadra’s except there was no art, even faded.

Ramiro didn’t notice. He climbed onto the paper-covered examining table, curled his knees up to his chest, and closed his eyes. Again she covered him with her jacket, and again she waited. Until she was startled awake by a knock at the door.

“I could use a nap myself,” the woman said gently in good Spanish. She wore a badge that said
DR. JUDITH COHN
. She studied the folder, then brought her attention back to Luz. “So. Tell me about Ramiro. Where did he get this cut?”

“At school. He fell down. But he complains of his throat.”

The doctor frowned deeply, reached for a tongue depressor. After a longer look than Dr. Jadra had taken, Dr.
Cohn turned to Luz. “The throat doesn’t look good, but I really don’t like the look of this cut,” she said in Spanish. “I’d like to take a culture. Meanwhile, in case it isn’t a virus, I’ll prescribe an antibiotic.”

“But the other doctor…”

“Yes?” She reached out a hand reassuringly. “It’s okay. What’s your question?”

“The other doctor said it was a virus. Now it might not be. I don’t understand.”

Dr. Cohn, about the same age as Luz, was sympathetic. “Sometimes a virus will bring on a secondary infection that will respond to antibiotics. The cut looks infected to me.”

“And the drug will take care of that?”

The doctor, nodding, already had the prescription pad out. “Does Ramiro have any allergies? Good, then. Now, if for some reason the cut doesn’t clear up, I might want to prescribe a stronger antibiotic, but I’ll let you know when I get the results of the test.”

“When will that be? The results?”

“Usually two to three days.”

“Three more days? Couldn’t we just start with the stronger antibiotic now? Then I would not have to come back for another appointment.”

The doctor shook her head. “You won’t have to come here again. I can call in the other prescription if we need it.”

Luz waited, then whispered, “There is also the expense, the two prescriptions.”

Dr. Cohn clucked sadly. “I’m sorry about that, but we really don’t want to prescribe a stronger antibiotic than Ramiro needs.” She touched Luz on the forearm. “He’ll be fine. You don’t need to worry.”

Luz tried to smile. She couldn’t help but worry. Ramiro was no better. In fact, she knew that he was worse. Despite her resolve, a tear broke and rolled over her cheek. She quickly, angrily, wiped it away, but the doctor had seen it. “Are you really so worried?”

A mute nod. Then, “I’m afraid…”

The doctor sat down slowly and leaned in toward her. She
spoke in an urgent whisper. “Everything will be all right. Really. He’s got an infection, that’s all. The antibiotics will clear it up in a few days.”

“But I feel…in my heart…” She stopped.

Dr. Cohn straightened up, but still spoke gently. “You’re both very tired. The best thing you can do now is go home and get some sleep. Things will look better after that.”

Luz felt she had no choice but to accept this. She met the doctor’s eyes for a long moment, then nodded mechanically and thanked her. Then she and her bundled-up and shivering son were back out in the cold and terrible night.