“I don’t want you to—”
“Don’t you?” That wasn’t my inside voice. But it felt good, damn it. “Isn’t that what you want? What everyone expects of me? To just bury it so we can get to the business at hand and make you feel comfortable? Well, I’m not. Not this time. You know why? Because my whole fucking life is about doing the right thing. So other people can be happy and okay. And it’s not working out too well for me. For once, just once, I’m not doing it. I’m doing what I really want to do. I’m being true to me. Go find a monk, a priest, whoever fits your belief system. Get forgiveness there. You’re not going to make a fool of me, exploit me, and make a profit all at the same time.”
His head bowed, hands curling at his sides. “I’m not asking you to do anything, Zora. I just want you to hear this apology. I didn’t see how I could make my leaving easier on you, there really was no other way. And for that, I felt ashamed. I always have. Still do, to this day.”
I realized I was holding myself, arms crossed around my body. Each of my hands clutched the opposite shoulder. My chest rose and fell under the bands of my arms, each breath slow. Labored. Watching the cords of his neck tighten, seeing the wash of color drain from his now tightly clenched fists, I held myself even tighter. It seemed we were both somehow adrift, undone, fighting to hold ourselves together. Outside the door, the women’s laughter and murmurs from passersby were just audible. Somehow the rest of the world was carrying on as usual, while inside this tiny room time stood still.
“Did you really think I was dead?” His brows pulled together.
His question revived the same inexplicable grief I’d felt yesterday after turning to see him in my doorway. Of course, I hadn’t wanted him to have been dead. But I’d never found a trace of him after I sent back his ring, after finding him in that coffee shop, wrapped in a redhead, not even when searching online. The only alternative was a truth somehow just as heartbreaking: That it had been easy for him to walk out of my life without a backward glance, without any attempts at communication. That he’d had so little regard for me that it never occurred to him that he’d gutted me.
Even after knowing how much I’d loved him.
I looked away, fighting to suppress the emotion choking my airway.
Nope. No crying.
Why was this so hard, after all these years?
“I’m not mad that you left, Nick. I’m mad you never came back and didn’t have the decency to send as much as a flare in my direction before you moved on.”
That was far more honest and vulnerable than I’d intended to be.
My ringtone sounded from the depths of my purse. Grateful for the interruption, I fished in my handbag, wondering who was psychic enough to grant this reprieve. Glancing up, I thought I might have glimpsed relief on Nick’s face.
I fished for the phone in my purse. “I just need to make sure it’s not an emergency.”
He nodded, signaling he’d wait.
So great was my agitation, I was hardly surprised when the phone jumped out of my nervous hands and clattered to the floor.
Nick’s height folded, his head brushing my shoulder as he bent to retrieve the phone. I jerked away from the accidental touch and backed into the table. His gaze slid over the display of my phone before he placed it in my outstretched hand. His expression soured.
“Jackson James.” He managed to make Jackson’s name sound like the plague.
I turned the phone around. It was a text from Jackson, his delayed response to our previous conversation about meeting up that next evening. It was typical Jackson James: direct and heavy on innuendo.
I’ll pick up dinner from the Front Porch after my shift. You just bring that sugar to Daddy.
I barely suppressed an eye roll, noting Nick’s gaze was fastened to my face.
He didn’t appear to be breathing. “You call Jackson James ‘Daddy’?”
Thank you, Jackson, for saving me in this moment.
I managed to arch one brow. “I don’t see how that’s any of your concern.” I shoved my purse back up my arm. “Is there anything else you wanted to say?”
Nick looked away. His Adam’s apple bobbed. “Jackson James. You call little, pimply Jackson James, ‘Daddy.’”
My spine stiffened. “I care about Jackson. You have no idea who he is now and what he means to our community.”
“Is that right?”
“It is.”
He took a step closer to me, lowering his voice. “Zora. You and I both grew up with Jackson James. You know—”
I knew the argument currently gathering force wasn’t really about Jackson. Not really. It was an opportunity for us both to vent and thrash about something else, something that didn’t pick at the scab of our past. Half of me wanted to pursue my line of questioning, wanted to drain Nick of the answers I’d craved for so many years. The other half wanted to avoid it, to walk away from him, forever. To escape before something ugly or cruel was unmasked.
“You, thinking you’re the only one who’s changed after all these years? It’s the absolute height of arrogance.”
His head snapped up. “What does that mean?”
A ragged breath escaped me. “It doesn’t matter, Nick. If you leave here with only one takeaway, let it be this: Be consistent. You left all those years ago without a single word. If you really want to show me how sorry you are, leave. Again.”
I watched his face as I said it. There was a moment, a tiny one, when his expression was unguarded. The hurt I glimpsed countered any triumph I might have felt for finally speaking my truth. I only felt ashamed. I had to fight the age-old instinct to gather him to me, to comfort him.
“I’m going,” I told him, suddenly feeling tired. I successfully moved around him without touching him and made my way to the door on unsteady legs, grasping the doorknob before I turned back.
Nick still faced the spot I’d just vacated. “I missed you, Z. Miss you.”
“Goodbye, Nick.”
He straightened and turned to me. “I just want you to know. I loved you, with everything I had. I’ve never loved anyone that way. And I never would have left you if I’d had the choice. I’m sorry I disappointed us both.”
I turned and walked out, before I embarrassed either of us by letting the hot rush of tears blurring my vision spill onto my cheeks.
Carly met me in the hallway, having just left a patient’s room. She offered an uncharacteristic smile, brandishing her clipboard. “Got another one!”
“That’s great.” I attempted a smile, nodding at what I assumed was a signed consent form. “Can you do me a favor, Carly? Mr. Rossi is in the capture station. Can you make sure he makes it out all right and finds his way back to the lobby?”
Her face lit up. “Oh, of course. I’d be happy to.”
“Great. I’ll see you at the staff meeting this afternoon.”
“You sure you’re all right, Dr. L.?”
I paused in my tracks and turned back. This time I didn’t feel the same strain of artifice in my smile.
“I will be.”
Chapter Seven
Zora
When the email arrived in my inbox early the next day, I realized I’d been expecting it, holding my breath in anticipation of its arrival.
Because you could never really escape the malignant works of fate.
Sitting in my now-partly rehabbed office, I took a deep breath and marshaled all my strength before opening the bold, unread item in my email inbox.
It was short, perfunctory. The invite requested my presence that very afternoon with Dean Peter Gould and several other names I’d never seen before. It was sent on behalf of an administrative assistant outside of the School of Medicine. Dread pooled in my gut with each search performed on the unknown invitee names.
They’d brought in the big guns. They wanted me in attendance.
Shit.
By the time I strolled into the fancy conference room in one of the hospital’s administrative suites, I’d almos
t accepted my fate.
Almost.
But I sure as hell wasn’t about to go down without a fight.
Peter was already seated at the highly-shined wood table, nattily attired in one of the obnoxious bow ties in the university colors he seemed to favor, with matching suspenders. He attempted a smile when I entered. It looked like a grimace.
I tacked the corners of my mouth up and made nervous small talk with the other attendees. The Vice President of Patient Experience, Allie Nevers, was there. I’d worked with her extensively in the past and always enjoyed her brash sense of humor and commentary. She made things interesting, at least, and we’d gotten pretty good at teaming up to control the flow of discourse so that it worked in our favor. Our strategic support of each other had helped turn the tide of hospital administrator’s sentiments over communication training and led to the implementation of our wildly successful program. She was a strong support and ally, and I hoped she could throw me a rope.
I could already tell I was badly in need of an escape.
As the meeting started and introductions went around the room, I couldn’t help but wonder what merited the attendance of high-ranking hospital administrators. Curiouser and curiouser . . .
“As you all know,” Peter began, “our visitor from this last week, Nick Rossi, has presented a solution to integrate new innovation into our patient interactions. This application, and the advent of telemedicine, represent an exciting opportunity to reach patients who might otherwise struggle with access to health care and this hospital. This allows us to extend our reach.”
I frowned, wondering when he’d started using commercial-speak. This guy spent most of his time scaring the hell out of medical students. Now he was excited over an app?
“We are by no means suggesting this application will replace face-to-face interactions. I can’t imagine a world in which that would ever be possible. But it does allow us to specifically target patients in surrounding towns who are, for example, less likely to come back for post-surgical visits because of transportation constraints. Our preference will always be for patients to return to the hospital, and we will continue to advocate for that and offer supportive services that accommodate those who require greater assistance. But this application offers the opportunity for earlier, more frequent check-ins. And we can easily identify other applications outside of surgical contexts, say in primary care.”
My phone vibrated. I snuck a glance and read a text message from Allie. She sat across from me, nodding along with whatever Gould was saying, her face placid.
I should be back in my office, having my usual fantasy of Idris Elba bending me over my desk. Watch, this meeting will be email-worthy.
I suppressed a snort.
“So, it’s FaceTime for patients,” Allie said, face deadpan. “It’s an app connecting patients with their doctors via video. Sounds like old news to me.”
Peter’s brows pulled low. “Telemedicine itself is not new, but this application allows for seamless integration with our own medical records. The application and related software would be branded with the hospital’s name. The record of the call, any prescribed medications? All indexed on our end, allowing our clinicians access to what transpired while managing that patient’s ongoing care.”
I heard a few murmurs from the suits at the other end of the table.
Peter nodded. “We’re opting for twenty-four-hour support. In the event one of our clinicians is unable to respond to a patient within the specified time frame, someone from Mr. Rossi’s pool of highly qualified clinicians will take the case.”
His gaze shifted to me. “Mr. Rossi said you were very helpful, and for that we thank you.”
Of course he did.
“Your work has really helped the hospital turn the tide of declining patient satisfaction scores. We all certainly credit you with that.”
He gave a decisive nod, then began clapping. His effort was slow to catch on as others belatedly realized his intention.
I didn’t react but did brace myself. I’d been in academia long enough to know that flattery came right before being voluntold, and ladies and gentlemen, I was just about to be voluntolded.
“As we talked to Mr. Rossi, we realized that, while we were familiar with the nature and quality of training our clinicians receive, we have no idea what communication training his pool of clinicians have undergone.” His voice lowered as he aimed a sidelong glance at Allie. “After working so hard to bring up our scores, the last thing any of us want is to have our survey scores go down because of unsatisfactory interactions with pool clinicians.”
Allie sat up straight. I watched as any last trace of Idris-borne lust vanished from her eyes.
Shit. Shit shit shit.
Peter had known just how to hit his mark, just what button to push.
Allie and her team in Patient Experience were responsible for ensuring patient satisfaction scores for doctor and nurse communication remained high. HCAHPS, or Hospital Consumer Assessment of Healthcare Providers and Systems, held far more sway than an average Yelp review. The survey measured patient satisfaction among a number of categories, including patients’ communication about medicine and their overall communication with doctors and nurses. The scores were public and easily accessible to the discerning consumer. And the results were tied to the hospital’s funding from Medicare. Better scores equaled better reimbursement, and that was only one of the many metrics we were concerned about when it came to patient satisfaction.
“We all know,” Gould said, “that the hospital is in a precarious position right now. We’re a community hospital that prides itself on our outreach. With increasing costs and the record losses we’re facing now because of unpaid balances, the hospital is struggling to stay afloat. Offering an incentive like this makes us a more attractive option, but we can’t take the risk of lowering our patient satisfaction scores or our funding.”
“Okay, wait,” I said, fighting panic as I watched Allie’s face grow more and more stiff. I saw where this was headed, and if Allie threw her weight behind Peter Gould’s not-yet-spoken mandate, with his convincing argument in play, I was done for. I’d have no time to apply for more grants. I’d have no time for my own research. I’d be stuck in training hell. And then what would happen to my staff? To my research team? “HCAHPS are administered to recently discharged patients. Inpatient,” I said firmly. “The interactions on the app would not take place on an inpatient basis. This would not affect our patient satisfaction scores.”
Allie shook her head. “It doesn’t matter, Zora. I hear all the time from our docs and nurses about how patients see a number of different clinicians during a hospital stay, and despite the survey emphasizing who should be rated, if they’re upset about something, they might ding the wrong person. If we’re agreeing to let other docs treat our patients, whether it’s impatient or not, they need to receive the same communication training our docs received in-house. In our patient’s minds, it’ll all be the same system. And in a sense, they’d be right. If a doc interacts with our patients on behalf of Knoxville Community Hospital, they’re representing us.” She shook her head again. “They have to be trained.”
“I’m so glad you agree,” Gould said smoothly. Mentally, I threw my pen at the smug smile he aimed my way. “I think we’re all in agreement here.”
More murmurs from the other side of the table.
My phone vibrated again. Allie’s newest text featured a meme of a stick figure being chased and eventually run over by a school bus, its guts smeared around the broken lines. I’m sorry, her text read.
I ignored whatever she was now mouthing to me from across the table.
“We want this done before we close the deal,” Gould said, and inwardly, I screamed. “Which means soon.”
“How soon?” I couldn’t pretend I didn’t know where this was going, but I wanted specifics.
“We’re prepared to give you whatever resources you may need. Mr. Rossi has generously agreed to
pay you, and anyone who assists, a consulting fee.”
I shook my head. This was an instance where I didn’t care how much cash was being dangled about. It was Nick’s money. I didn’t want it. And besides, I doubted Nick Rossi would agree to pay the salaries of my entire research staff.
“How long?”
He let out a breath. “Let’s see how it goes. I know today is already Thursday, but we’d need you to take an immediate trip to New York starting next Monday to train their clinicians with our curriculum. Mondays aren’t slow clinic days, but Mr. Rossi has somehow corralled the folks on his end with hardly any notice, God knows how.” I bit back my frustration at the admiration in his voice. “He’s prepared to take on any and all costs. But we need you there to ensure their trainers grasp the material and are prepared to train others the right way.”
Seven faces all turned toward me. The room grew deathly quiet.
Gould and I eyed each other.
I’d taught others how to use silence strategically. There was no way he was winning this game.
He broke the silence first. “Whatever you need,” he repeated. “I don’t think I need to tell you how important this is for the hospital.”
“We should talk in private,” I said, finally. I sat back to signal an end to the conversation. “I’m afraid I can’t make a commitment at this moment.”
Out of the corner of my eye, Allie’s eyes grew huge in her head.
Gould didn’t break eye contact with me when he addressed the room at large. “Thanks, everyone, for coming today. I think we’ve all got a good sense of the matter at hand. I’d appreciate it if you gave us the room.”
I listened as chairs pushed back from the table, scraped along the hardwood floors. Oooh. You in trouble, Allie mouthed to me behind Peter before disappearing. Discreet, parting murmurs reached us as everyone else silently filed out of the door.
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