He hated to travel. He felt strangely disconnected when he was away from his practice and his home, as if someone had pulled the plug on him and he’d ceased to exist. He shook himself. He didn’t like the feeling.
He opened his suitcase and pulled out a bottle of Bushmills. He poured a couple of fingers’ worth, then settled back onto the double bed and watched the TV without seeing it.
No sense in kidding himself: He was nervous about tomorrow. He had never testified before a committee of any sort, let alone one being run by the ferocious Senator James McCready. Why on earth had he agreed to do it? Why would anyone set himself up for a grilling by a bunch of politicians? Crazy!
It was all Mike—pardon: Congressman—Switzer’s fault. If he hadn’t sweet-talked Alan into this, he’d be home safe and sound in his own bed before his own TV.
No, that wasn’t true. Alan knew he really had no one to blame but himself for being here. He had wanted a chance to say something against the Medical Guidelines bill, and Mike had given it to him.
But would it matter?
He had begun to wonder if maybe he wasn’t a vanishing breed…a dinosaur…a solo physician practicing a personal brand of medicine, developing one-to-one relationships with his patients, gaining their trust, dealing with them person to person, becoming someone they came to with their problems, someone they called when their children were sick, someone they placed high on their Christmas card list.
The coming thing seemed to be the patient-as-number, served by the doctor-as-employee who worked for a government or corporate clinic, seeing X number of patients per hour for Y hours per day, then signing off and going home like every other wage slave.
Alan was not totally immune to the allure of the 9-to-5 setup: normal hours, guaranteed income and benefits, no calls in the middle of the night or on Sunday afternoons in the middle of the Jets game. Enticing…
Great for robots, maybe, but not for dinosaurs.
Switzer was styling himself as the champion of the American doctor, but how much was real and how much was a role, Alan couldn’t say. He and Mike went back to their undergraduate days at NYU where they’d been fairly good friends until their postgraduate paths parted: Mike to law school and Alan on to medicine. Mike had always struck Alan as a decent sort, but the fact remained that he now held—and intended to continue to hold—an elected office; and that meant he had to keep an eye on which way the wind was blowing.
Switzer certainly seemed to know how to keep his name in the paper, what with his feud with the City MTA on the home front and his butting heads with Senator McCready on the national level. But how much of his opposition to McCready’s Medical Guidelines bill was real commitment and how much was because McCready and the MTA’s Cunningham were members of the other party?
Not knowing for sure made Alan slightly queasy. For the moment, however, he would have to trust Switzer. He had no choice.
And tomorrow I put my head on the block.
The hearings started at the unheard-of hour of 7:00 a.m., so he turned off the TV, undressed, poured himself another drink, and lay in the dark. He tried to find an oldies channel on the radio but the reception was poor, so he resigned himself to waiting for sleep in silence. He knew he’d have to be patient, because he could tell already it was going to be one of those nights.
Here we go, he thought as he lay there.
It never failed. Whenever he left town he spent the first night running through his own peculiar variation on A Christmas Carol.
He wrestled with the covers on the unfamiliar mattress, plagued by the ghosts of Patients Present: the sick ones he had left behind. They were in good hands, but he was out of town and they were out of reach. He wondered if he’d made any diagnostic blunders or therapeutic errors that wouldn’t be found in time. The same worries nagged him every night, but never with the intensity as when he was out of town.
He wondered if other doctors lay awake nights worrying about patients. He never mentioned it to anyone because it sounded phony, like cheap PR, like dime-store Marcus Welbyism.
The worries about current patients flowed naturally into the ghosts of Patients Yet to Be, products of Alan’s chronic anxiety over keeping current in all the fields his practice touched on. A virtually impossible task, he knew, but he fretted about not knowing of a new diagnostic tool or a new therapy that could change the course of a patient’s disease.
And last—his subconscious always saved the worst for last—the ghosts of Patients Past. He feared them the most. Like a silent crowd around an accident, all the failures of his medical career ringed the bed, crouched on the covers, and hovered overhead as he slipped toward sleep. The failures…the ones who had slipped through his fingers, the lacerated lives that got away.
Caroline Wendell was first tonight, appearing at the foot of the bed, baring her shoulders and legs to show him all those utterly gross bruises that kept popping out and threatening to, like, simply ruin her prom because her gown was, like, you know, off the shoulders. She hadn’t known then that her bone marrow had gone wild, destroying her along with itself. Alan hadn’t known immediately, either; but now he relived the weak, sick feeling that came over him when he’d spun down a hematocrit and saw the much-too-thick buffy coat of white cells in the capillary tube. Eventually she faded away, just as she had in real life from the acute lymphocytic leukemia that had kept her from seeing the end of her senior year.
Little Bobby Greavy crawled up on the bed to demonstrate that what a wild bone marrow did to a young girl’s body was nothing compared to what people did to each other. Bobby was a visitor from Alan’s training years, and now he gracefully turned to show off the red, blistered second-degree burn in the skin of his back—a perfect triangular imprint of his mother’s steam iron.
Bobby almost always brought along Tabatha, the little seven-month-old who had been clouted on the head so many times she was blind. Despite Alan’s pleas and demands and strident protests, both had been returned to their respective parents by the court and he never saw them again.
Bobby and Tabatha dissolved into Maria Cardoza. She was a frequent visitor. Slim, beautiful, nineteen-year-old Maria. As usual, she floated in on her ICU bed, naked, bleeding from her nose, her mouth, her abdominal incisions, her rectum and her vagina. That was how he had last seen her, and the image was branded on his subconscious. Four years ago he had been passing through the ER when the EMTs brought her in from a two-car head-on accident on 107. He had seen her only once before in his office for a minor respiratory infection. Since no one else was available, he had assisted the surgeon on call in removing her ruptured spleen and sewing up her lacerated liver. The procedure had been effective, but all the clotting factors in her blood had been chewed up and she simply would not stop bleeding. Alan had dragged a hematologist out of bed but nothing he did would make Maria’s blood clot. Once again, fresh as that very night, he felt the grim, almost hysterical frustration of his impotence, of the futility of every effort to save her as he stayed by her bed until dawn, watching liter after liter of the various solutions and plasma fractions that poured into her veins run out the drains in her abdominal cavity. She went into renal shutdown, then congestive heart failure, then she went away.
But not for good.
Maria and her touring company lived on, visiting Alan on a regular basis.
Almost time.
Mike Switzer, all eyes behind his horn-rimmed glasses, wavy brown hair falling over his angular face, had hovered at Alan’s side all morning.
“Just stay cool, Alan,” he kept saying. “Don’t let them rattle you.”
Alan kept nodding. “Sure. Don’t worry. I’m fine.”
But he wasn’t fine. He felt as if he were about to be fed to the lions. His stomach kept twitching and his bladder urged him to the men’s room again despite three visits already.
He’d heard about McCready and how he could cut you up and eat you alive before you even knew he was talking to you.
The hearing r
oom was just like the ones he’d see now and then on cable TV: oak paneled, with the politicos and their aides sitting up behind their desks on the raised platform like Caesars in the Coliseum, and the testifiers below like Christians waiting for their turn in the ring. Bored-looking reporters strolled in and out of the room or slouched about in chairs at the rear until The Man Himself limped in and sat behind the nameplate that said:
SEN. JAMES A. MCCREADY (D-NY).
Then they were all attention.
Alan studied McCready from his vantage point among the plebeians. With his stooped frame and sagging jowls, he looked older than his reputed fifty-six years. The impenetrable dark glasses that had become his trademark over the past few years were in place, shutting him off from everyone around him, masking what ever hints his eyes might let slip about what was going on in his mind. No matter what was said, Senator McCready remained expressionless and insectoid behind his shades.
Some confusing chatter went back and forth among those on the podium, followed by someone finishing testimony that had begun yesterday, then it was Alan’s turn to sit before the microphones.
The Senator
James McCready let his mind wander as the latest doctor—what was his name? Bulmer?—began to speak. He had heard all he wanted to hear on this subject long ago.
Besides, he didn’t want to be here. He felt tired and weak. He felt old.
Fifty-six and he felt like a hundred. Thank God he could sit now and regain the strength he had spent just walking here from his office…and sitting down. If they only knew what it cost him to seat himself slowly when every muscle in his body screamed to allow him to flop into his chair.
And mornings were his best times. That was why he scheduled these hearings for the crack of dawn. By the afternoon he could barely fake it. Good thing he’d been wounded in Vietnam. That old, nearly forgotten injury had finally served some useful purpose. Keeping his head still and moving only his eyes behind his dark glasses, McCready scanned the committee room. He’d started wearing the heavily tinted lenses when his upper lids had begun to droop. He’d feared at first that people would think he was trying to look like a movie star. Instead, they said it made him look like General Douglas MacArthur. Well, if he had to look like somebody, he could certainly do worse than MacArthur.
His gaze came to rest on Congressman Switzer.
Now there’s a man to watch out for. He smells the weakness in me and he’s readying himself for the kill. The first time I stumble, he’ll be on me. Look at him there, the little weasel bastard! Hanging on his pet doctor’s shoulder, egging him on. Probably coached him for weeks. These doctors can’t think on their own unless it’s about medicine, and even then they screw up plenty!
McCready, above all else, knew about medical screw-ups. But he chided himself for begrudging Switzer a pet doctor. After all, he had plenty of his own.
He focused in on the doctor. What was his name again? He looked at the list. Oh, yes—Bulmer. He couldn’t resist a smile. Poor Dr. Bulmer…probably thinks he has a real ally in Switzer. Wonder if he realizes that his buddy will drop him the instant he’s no longer needed?
He heard Dr. Bulmer say the magic words, “In closing…” and decided he’d better tune in. It had been a brief address and he was ending it while he still had everyone’s attention. Maybe this doc wasn’t so dumb.
“…that these so-called guidelines are cookbook medicine of the lowest sort. It allows a doctor no leeway in tailoring therapy to a particular patient under particular conditions. It reduces doctors to robot mechanics and reduces their patients to assembly-line cars. It is the most dehumanizing piece of legislation I have ever had the misfortune to read. It will drive out the kind of doctor who shapes his therapeutic approach to the individual patient, and will encourage the rise of the physician-bureaucrat who does everything unswervingly by The Book. Medicine will become as personal as welfare, as efficient as the Post Office, and as successful as the Middle East peace process.
“Only one party will suffer in the long run: the patient.” From somewhere in the room there came the sound of one pair of hands clapping, then two, and then many.
Obviously ringers, McCready told himself. But then more and more hands joined in until the whole room—some committee members included!—was clapping. What had this Bulmer character said? He’d brought no graphs or charts, and he couldn’t have gone over too many facts and figures because McCready would have noticed lots of glazed eyes. Which meant that he’d probably done a “Dr. Sincerity” number on the room. He clenched a fist. He should have listened.
Well, no matter. He’d have a little fun with him, then cut him down to size. He cleared his throat and the room silenced.
“So tell me, Dr. Bulmer,” he said, noting the per sis tent rasp in his voice. “If American medicine doesn’t need guidelines, how do you explain the healthcare crisis in this country?”
Bulmer nodded toward him. He seemed ready for the question.
“Besides you, Senator, who says there’s a crisis? A recent nationwide study showed that only ten percent of the people polled were dissatisfied with their personal healthcare, yet fully eighty percent were under the impression that there was a healthcare crisis in America. So I have to ask myself: If ninety percent of the people are satisfied with their own health care, and have not personally experienced a ‘healthcare crisis’ of any sort, where do they get the idea that there’s a crisis? The answer is obvious: They have been told so often about a healthcare crisis in America that, despite their personal satisfaction, they believe it exists. As inheritor of a chain of newspapers, Senator, I figure you’re in a better position than I to explain how this perceived crisis in healthcare might have been manufactured.”
The bastard! McCready thought as a smattering of applause died out before it really got started. The doctor was trying to put him on the defensive. He debated mentioning that the McCready newspaper chain was being held in trust and run by a board of directors while he was in office, but decided against it. Better to ignore the remark—not even dignify it with an answer. He waited until the silence bordered on the uncomfortable. When he finally spoke he treated Bulmer’s last remark as if it had never been uttered.
“So everything’s just hunky-dory with American medicine, eh?”
The doctor shook his head. “No, Senator. Everything’s far from ‘hunky-dory’ in American medicine. Doctors in general aren’t doing their job as well as they should or could. I’m not talking about competence—anyone graduated from a U.S. school can be assumed to be competent. I’m talking about the void growing between doctors and their patients. The structure and strictures of managed care have already been addressed here. But new technologies that allow us to diagnose and treat illness as never before are building a wall between patient and physician.”
McCready wasn’t too sure he liked the way this was going. He had expected some bromides about how doctors were only human and were doing the best they could. He didn’t know what Bulmer was leading up to.
The doctor paused, then continued. “I really hate to bring it up before a committee such as this, but here goes: As doctors, we must—we need to—keep touching people, and by that I mean an actual laying on of hands, even when it’s not necessary. It’s letting that person know that there’s another human being among all this hardware.
“A simple example: A doctor can listen to a heart by standing to the patient’s right, grasping the head of the stethoscope with the fingers of his right hand, reaching over, and pressing it against the patient’s chest wall—only the diaphragm of the stethoscope touches the patient. Or he can lean close and steady the patient by placing his left hand on the patient’s bare back. He’s not hearing any better, but he’s in contact. It’s a very simple but very personal thing. And there are diagnostic bonuses that come with touching. You can often pick up little cues from the feel of the skin and tissues beneath. It’s not something you can get from a textbook, it’s something you can learn only by doing
. It’s hands-on medicine, but too few doctors are doing it today. And those who are will be driven out by the Medical Guidelines bill.”
The committee room was silent. Even the reporters had stopped their chatter.
They like him. The senator decided he’d do better being gentle with Bulmer than trying to cut him up.
“Very well put, Dr. Bulmer. But why did you say you hesitated to bring it up before this committee?”
“Well…” Bulmer said slowly, obviously measuring his words. “The operating premise of this committee seems to be that you can actually lay out guidelines for good medical care. So I wouldn’t be surprised if my comments inspired a new federal guideline requiring every doctor to touch each patient for a predetermined number of minutes during each examination.”
A few titters, then a couple of guffaws, then the room erupted into laughter. Even some committee members broke into sheepish grins.
McCready was furious. He didn’t know if he had been set up or if Bulmer’s remark had been genuinely off the cuff. Either way, this pipsqueak doctor was ridiculing him and the committee. His words had been carefully padded with humor, but the sting was still there. McCready glanced at the other committee members. The looks on their faces sounded an alarm in him.
Until this moment he had harbored not the slightest doubt about his bill’s inclusion in the latest Medicare appropriations. These hearings had been mere formality. Now he experienced his first twinge of uncertainty. Bulmer had struck a nerve and the committee members were twitching.
Damn him!
This bill had to pass. The country needed it! He needed it! He had to put an end to the kind of medical oversights that had left him undiagnosed for so long. And if the medical establishment couldn’t or wouldn’t do it, then he’d goddamn well do it for them! But right now he had to act. Top priority was to get this doctor away from the microphone and off the floor immediately.
The Complete Adversary Cycle: The Keep, the Tomb, the Touch, Reborn, Reprisal, Nightworld (Adversary Cycle/Repairman Jack) Page 88