“Your job is critically important,” my father intoned as my brother threw up bricks. “Go to work on time, get more patients, and secure your job.” His advice was essentially the opposite of what I had been planning. Instead of quitting, he thought I should work even harder and ask for a raise.
“I need more money now,” I said. I felt pathetic talking about my financial troubles in front of my brother—and at his palatial home, no less—but part of me wanted him to feel sorry for me, too.
“All he does is talk about money!” my father shouted.
“I have bills to pay!”
“So send Mohan to public school!”
“That is not an option. It’s one of the worst in the city.”
My father shook his head in disgust. “As far as I am concerned, you can come home from work and start worrying. Worry the whole night if you want to, but in the morning go to work and do your job. If you lose your job, then it’s over. It’s over for you; it’s over for us. Apart from the financial problem, won’t you feel embarrassed? Your colleagues, your in-laws, everybody will know you were fired!”
Rajiv dribbled in for a layup.
“This is a utilitarian society,” my father said. “If they need you, they will beg you. If they don’t need you, they will kick you. At my job, they keep track of when I come and go.”
“It’s a government job! You have to clock in and out.”
“Well, yes, I have to swipe my ID badge, but that is not the point. If you lose your job, we are finished. I will be the first to have a heart attack!” He hollered to a phantom audience, “He is my son! I cannot see him out on the street.”
I couldn’t help faintly smiling. My father was nothing if not persistent. “I’m—I don’t know…”
“What? Tell me.”
“I’m depressed.”
“If you lose your job, you’ll be more depressed! Things are going well—”
“Things are never going well!”
“Things are going well, and if they aren’t, so what? Worrying won’t help.”
He was right, of course. I had made my own choices, yet I was wallowing in self-pity. What I wanted most of all was for my father to simply commiserate. But Dad never gave you what you wanted, only what he thought you needed.
“I don’t enjoy—”
“If you get busy, you will enjoy. What’s not to enjoy? You are a doctor!” he hollered. “You have the respect of the world!”
We walked back to the house. Head bowed, my father was deep in thought. I couldn’t help thinking of the way he looked when I was ten years old, similarly stooped over his desk in our garage in Riverside, California, reeking of rubber cement, painstakingly preparing a table for one of his research papers while exhorting me to become a doctor and never take the purely academic path he had taken. At the university, he explained, people were jealous. They stabbed you in the back. There was no job security. You might not get rewarded for your hard work. In medicine, he promised, I would have respect, wealth, and influence—all things that had eluded my talented father.
At the pool, my niece and nephew were splashing around in the water. We sat down with my sister-in-law, Vandana, who was watching them. “Why don’t you and Rajiv come up with a plan?” my father implored.
“I told him I could set him up with my friend Amir Chaudhry,” Rajiv said suddenly. “He is a cardiologist in private practice. Sandeep could moonlight at his office on weekends. [Many academic physicians he knew were moonlighting in private practice to supplement their salaries.] Amir told me he talked to Sandeep, but he didn’t show any interest.”
“Well, that seems like a good idea!” my father said, his face brightening. “Try out private practice and see if you like it.”
“He will hate it,” Rajiv said dismissively. “He doesn’t have the mind-set for private practice.”
Rajiv’s operating philosophy was that doctors didn’t really care how competent you were, or at least that wasn’t the overriding concern when they referred patients to you. It was all about personal relationships. Rajiv understood this as well as anyone. When Dr. Singh’s sister was hospitalized, Rajiv went to the CCU at 2:00 a.m. to put in a basic IV line that could have been inserted by an intern. When Dr. Kohli’s father had chest pain after stepping off a plane from India, Rajiv left his family at the movie theater watching Shrek and went to meet him in the emergency room. “You have to learn how to play the game,” Rajiv said. “Every doctor I know says I’m his best friend.”
I glanced at Vandana, who was sunbathing on a recliner. “He invests a lot in these relationships, Sandeep,” she said, forcing a smile. “It takes a lot of sacrifice.”
“Your brother is the king of Long Island, and people still don’t even know who you are!” Rajiv said disdainfully. “You’ve got to take these doctors out to dinner, buy them a bottle of wine, come to some of the Indian parties.”
I groaned loudly.
“See, Dad,” Rajiv said, as though I had just made his point. “He thinks he is better than everyone.”
“Why don’t you mix with people?” my father demanded angrily. “Rajiv was telling me you keep your door shut the whole day!”
“So do you,” I replied lamely.
“Ha! He’s comparing himself to me. I’m a scientist!”
“You’re in a service profession now,” Rajiv reminded me.
My brother was right. In times of stress I often regressed into the habits of my previous academic life.
“So why don’t you work with this guy Chaudhry?” my father said. “He could be very helpful to you, even though he is a Pakistani—”
Now it was Rajiv’s turn to groan. Dad’s antipathy for Pakistan always eventually came out. His family had been caught up in brutal sectarian violence during the partition of India in 1947, when he was eight years old. He had witnessed horrific bloodshed, which left psychic wounds that bled at inopportune times.
“I have lived among Muslims, so I know what they are,” my father declared. “Look at Sunnis and Shias in Iraq. Muslims killing Muslims. Only slight differences between them—they have only slightly different interpretations of Islam—but they have no hesitation to kill each other. Read the paper! A Hindu will think twenty times before killing anybody. It is the biggest tragedy for India that we have Pakistan as our neighbor. The worst neighbor one could have.”
“Dad, you’re not helping,” Rajiv said.
“What am I saying?” my father said defensively. “Keep good relations with Chaudhry because you need the work. But I would not expect too much from him. I cannot generalize, but Pakistanis are not as broad-minded as we are. He’ll be stingy and mean and…” He started losing momentum. “Anyway, it’s okay, you need him, you need another source of income. And Sonia was telling me she is going to work, too.”
“That’s what she says,” I said skeptically. She’d been promising to find a job for several months now. “We’ll see.”
“I know, Bubboo, but remember your job at LIJ is critically important. You cannot work for Dr. Chaudhry at the cost of that job.” His face softened. He looked tired. “Life is not a bed of roses, my son. You have so much going for you. I meet people all the time who say, ‘Oh, you are Jauhar, you write for The New York Times.’ I say, ‘No, that is my son,’ but I feel so proud. Don’t burn your blood. Life is too short.”
In the early evening, my parents and my brother walked me to the circular drive. The sun was starting to set. Mosquitoes were buzzing rapaciously around me, and violet impatiens were blooming brightly on the stoop. My parents were supposed to fly out the following day. I felt a vague longing for them to stay. My heart ached when I remembered how Dad used to return from research conferences with a bag of airplane peanuts or a couple of Brach’s candies for his kids.
When he hugged me, my lips trembled. I cleared my throat. Then, before I could get into the car, I started sobbing. My mother started crying, too.
“What is it? What’s the matter?” my father said, fe
igning alarm. Then he started laughing. His reaction was the exact inverse of mine. The more I bawled, the more he laughed, as though he could assuage my melancholy with his fake jolliness. “What is it, Bubboo?” he said affectionately, patting my head as though I were eight years old again. I thought of how he would be dead one day, and it made me cry even harder.
Between sobs, my mother said in Hindi, “Just looking at him makes me so sad.”
I wasn’t sure why I was crying. In human physiology there is the concept of referred pain, in which a painful sensation is perceived to be in a different place from where the injury actually has occurred, and so it is with emotions, too. It wasn’t just about my job or financial frustrations but something else: my relationship with my father, how he was with me—or perhaps just how he was. He had been so detached while I was growing up. I had always been desperate for his approval. Once, in sixth grade, after I’d done something to annoy him, he complained to my mother: “He used to be such a good kid. He used to listen, eat fruits.” Tearfully, I had told him that I did still eat fruit, that sometimes I stopped in the grove after school and picked an orange. That upset him even more. “You’re eating the fruit from that orchard! It has pesticide on it. You could die if you eat that fruit!” My mother got on my case, too: “It is poison, son. You’ll get sick!” My pathetic attempts at regaining my father’s good graces usually failed miserably.
Before I drove away, my father offered some more advice: “Now that we have come up with a plan, don’t rehash everything. Keep yourself busy. An idle brain is the devil’s workshop, so keep as busy as possible. And when you go to work, work! The job has to be your first priority. And move to Long Island to be closer to your job.”
The advice had a familiar ring, and I felt comforted. I started to back out of the driveway, but he stopped me.
“Take care of your health, too. Eat fruits. Exercise regularly. If you are healthy, you can face problems much better. Save money, too, as much as you possibly can. You will need money for good times and for bad. And make some friends, Sandeep. You have no friends. I was thinking, Neeta’s husband, what’s his name, Jeff?”
“Fred.”
“Yes. Why don’t you invite him over for a drink? Make him your friend. He is a doctor, too. The problem is, you are not tactful like Rajiv.”
I nodded. Salty mucus ran over my upper lip.
“If you need to talk, you can call me anytime,” my father said. “Midnight, three o’clock, one o’clock, anytime. I am there for you. Always keep busy. It is not falling in water but staying there that drowns a man. An idle brain—”
“I heard it, Dad, I heard it,” I said, raising the window. I started to drive away.
My father raised his hand in salute. On his face was an expression I had never seen before, somewhere between smile and scorn—or perhaps disgust. “Don’t worry,” I heard him say as I drove off. “Worrying doesn’t help. And please call us because we will constantly be worried.”
Rajiv called Dr. Chaudhry on my behalf that night. We made an appointment to meet the following week.
EIGHT
Pact
Go after exactly what you want, not what you want. For you never get anything but the things that you exactly wanted.
—Alan Gregg, twentieth-century physician
Amir Chaudhry’s main office was in a gray building standing on concrete pillars in a leafy middle-class suburb on Long Island with narrow streets and old clapboard houses that had a certain weatherworn charm. Just down the road were a strip mall and, beyond it, the local high school, where a sign out front announced the weekend’s sporting events. My appointment was at one o’clock, but Chaudhry had called me that morning to ask me to come a bit early. He had a full roster of outpatients, and once he was done at the office he had to make rounds at two hospitals.
The waiting room on the second floor was packed. I checked in at the front desk and took a seat among the throng of mostly Indian and Pakistani patients talking on cell phones or tending to their infants. His assistant soon called me in. She led me down a narrow corridor to Chaudhry’s chamber. Manila folders were stacked in tall piles on an elegant cherrywood desk. On the walls were framed certificates from hospitals in Karachi and Queens. On the far side of the room was a poster of an illuminated lighthouse that read “Success doesn’t come to you. You go to it.”
After about five minutes, Chaudhry entered. He greeted me warmly and asked me to sit down. A short, balding Pakistani in his mid-forties, he had huge red ears, gold wire-framed glasses, and a white coat embroidered with the words “We Care.” He sank into a leather chair behind his desk, swiveling sideways to face a bureau with pictures of his four children. The piles of folders hid most of his body, save for his head and shoes, expensive Hugo Boss loafers. We made small talk for a couple of minutes—when was I going to move to Long Island?—but I could tell he was eager to get to the matter at hand.
He started off by saying that he had discussed my situation with Rajiv, whom he considered like a brother, and that he was glad to help. But first he wanted to tell me a little about his practice.
I nodded, feeling abashed at being so exposed.
He had been working as a cardiologist for five years, mostly as a solo practitioner. About a year prior he had tried partnering with another cardiologist, but that relationship had not worked out.
“I needed a second office,” he explained. “I was losing patients from the hospital who did not want to come to the South Shore, so I thought if I had an office in Queens, patients would follow me and my days would be totally busy.”
“Your days weren’t busy enough already?” I asked. It came out like a challenge, which I had not intended.
Chaudhry smiled wanly. “A year ago I was not as busy as I am now,” he replied. “Just look at my eyes.” They were bloodshot. “This week I have slept only about six hours a night. See these piles?” He pointed to the folders on his desk. “These are echos”—heart ultrasounds—“I still have to finish.”
There must have been hundreds. Chaudhry told me the discs were provided by a mobile imaging company, which had arrangements with local internists to perform echocardiograms in their offices. Insurers that covered the imaging paid the company, and the company paid rent to the internists to station their own employees on the premises. “I don’t know what the exact setup is,” he said quickly. “I am just collecting a fee to read the study.”
I shifted in my chair. The phone rang. He picked it up. “Patient is here? Okay, two minutes.”
He turned back to me. “I wanted to talk to you before we make a schedule so you will understand about private practice. See, Sandeep, you are in a different world at LIJ. You don’t think about the business side of things.” I nodded agreeably. “But don’t worry,” he quickly added. “You will soon get the hang of it.”
The arrangement he had in mind was the following: He wanted me to take over his emergency room calls at LIJ (so-called doc-of-the-day), which meant that once a week I would be admitting ER patients who required cardiac monitoring but did not already have a cardiologist. Chaudhry would collect the insurance payments for my admissions and pay me a flat fee (which would be in addition to my regular LIJ income). He said he was trying to transition out of hospital work altogether. “You don’t make much money in the hospital,” he said dismissively. “If I see ten inpatients, that’s about six hundred dollars. But if I sit in the office, I can stay in one place, get the echo done—that’s three hundred and fifty dollars—get a stress test—that’s eight hundred dollars. Plus, what is the liability in the office? Office patients are stable. They are not going to crash on you.”
It all seemed pretty mercenary, but from what I’d heard about Chaudhry and his practice, I wasn’t surprised. At that point I viewed working with Chaudhry as a necessary but short-term evil. I simply nodded and allowed him to proceed.
In addition to his inpatient work, Chaudhry wanted me to do weekend shifts in various satellite offices he had
set up. I would supervise nuclear stress tests, see patients, and maybe read a few echos. He predicted the shift would run until midafternoon.
“Ali, my physician’s assistant, will be with you,” he said. “He will see patients, too, but you must stick your head in and say hello. Patients want to see you, not a PA. If they are unhappy, they go back and complain to their primary care physician.”
He did not have to explain that that would be a bad thing.
“The whole thing is screwed up because we are dependent on primary care doctors,” he went on. “They are jealous that why should cardiologists make all the money. They see a patient for fifty dollars, so they are not happy that you or I can get eight hundred dollars for a stress test. So instead of referring their patients to us for echos, they rent out their offices to echo companies, or they hire cardiologists to work directly with them and pay them a fixed fee. That is how the whole thing gets corrupted. Some people are just too greedy about these things.”
I glanced at the piles of echos but didn’t say anything. He seemed unaware of the irony, that he was complaining about the greed and corruptibility of other physicians.
He mentioned an internist who had been referring patients to him. “Last month he sent me only one patient. And this month only one patient.”
Unsure of what he was driving at, I nodded hesitantly.
“So I understand something must have happened,” he said.
“Like what?” I asked.
He threw up his hands, exasperated by my obliviousness. “He met someone else! He developed a relationship with another cardiologist.”
I couldn’t help but smile at the overwrought response, with its connotations of a romantic breakup. Again the phone was ringing, but this time he ignored it. “I tell you, these primary care doctors are crooks. They will tell you that you are good, you are the best, but then they make a deal with somebody else. Top Medical Group—you know them? Singh, Doshi, Lieberman—they were sending me one hundred percent of their patients. Now for last one year I have not seen a single patient from them. Even patients who want to see me, they do not get a referral.”
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