There is no Jonathan left to defend was what she told herself. This did not make her feel any better.
“I didn’t want to hire him. You can imagine the caliber of applicants we see.”
“Of course,” Grace said.
“I wanted to overrule the chief resident. The chief resident wanted him. The guy was just swept away.”
Grace frowned. “Okay,” she finally said.
“And I got that. I really did. You met Sachs, you just thought: Wow, this guy’s got a personality and a half. And let me tell you something. You can’t be any kind of doctor and not have the most profound respect for the power of placebo. Lots of things can be the placebo. Personality can be the placebo. I was trained by a surgeon. This was in Austin, where I was a resident. He specialized in a very, very difficult operation, on a kind of tumor that lodges in the aorta. You know the aorta?”
Then he looked at her, more or less for the first time since he’d sat down. This point, evidently, was important enough for that.
“Yes, sure.”
“Right. So people are coming to Austin, Texas, from all over the world to have this particular surgeon operate on them, and they’re right to do it, because he’s one of the best surgeons on the planet for this particular operation. And here’s my point. This surgeon is missing two fingers on his left hand. Crushed by a stone when he was a kid. Climbing accident.”
“Okay,” Grace said. She was trying to follow, trying to connect what he was saying to what she imagined they were here to discuss, but also wondering if she could stop him now. She didn’t really care about a surgeon in Austin, Texas.
“Now. How many people you think ever looked at their surgeon’s hand and thought: You know what? I think I prefer the hand that’s going inside my heart to remove a tumor to have all its fingers and went and got another surgeon?”
Grace waited. Then she realized he was actually waiting for her.
“I don’t know. None?” She sighed.
“Not one. Not one patient, or family member. He had that personality. He had so much personality it was like a drug of its own. Placebo! You see my point? I never had that.”
No shit, thought Grace.
“Not that that means anything about whether the science is there, the diagnostic insights. Those were the only things we thought about a generation ago. But your husband happens to come along at a very particular time. The patients have been trying to say something to us about it for years and years, and now, for the first time, we’re trying to listen to them. I mean”— he laughed, mainly to himself—“we’re trying to listen. We’re trying to think patient care, not just disease care, if that makes sense to you.”
Did it? Grace wondered. But he wasn’t looking at her, so she didn’t have to say.
“In the eighties, early nineties, we’re doing all this navel-gazing about what makes a good doctor and a great hospital. You know, the patient or the patient’s family member shouldn’t have to go running down the hallway after the doctor to ask him what he’s talking about, or what it means for the patient. And for pediatrics it’s like that times a thousand. They don’t have just themselves to worry about, they’re worried about how the child’s going to react to what the doctor’s saying, or his body language. And we heard it forever from parents, and we were trying to think about it in a new way. And then here’s Jonathan Sachs from Harvard.”
He was looking, of course, not at her as he said this, but across the room at the waiter, who was approaching with identical platters. He never took his eyes off the waiter and leaned back as the plate approached. Grace said thank you.
“So I let the chief resident talk me into it. And big surprise, Sachs is hugely popular with the patients. They love him. We get these devoted letters. ‘He was the only doctor who took the time to really connect with our child and us.’ ‘The others didn’t even know our names after four months in the ward.’ One guy told how Sachs bought his son a stuffed animal on his birthday. So okay, I’m fine with being wrong. I don’t need to be the authority on every single thing. There’s more to being a great doctor than just knowing what to do,” he said. He was chewing his dill pickle with less than dainty bites. “When you have a sick child it’s very comforting to feel there’s a strong personality in charge. I’ve known a number of very brilliant diagnosticians, very, very adept at formulating a treatment plan. They didn’t communicate very well, not with the parents and especially not with the children.” He looked actually thoughtful when he said this, and Grace marveled at his imperviousness to his own deficiencies. That in itself was something of a survival strategy, she thought. “You give a parent of a sick child a choice between the doctor who maybe won’t look at them and the one who sits them down and says, ‘Mr. and Mrs. Jones, I am here to make your child’s life better.’ What do you think they’re going to pick? You’ve got kids, right?”
Now he was looking at her. Now she was the one who would have loved to look away.
“Yes. We have a son. Henry.”
“Right.” He plunged on, one hand holding his sandwich aloft, just to the left of his mouth. “So, say Henry’s in the hospital. He’s got…let’s say, a tumor. Brain tumor, let’s say.”
Grace, feeling weak, just stared at him.
“What kind of doctor would you want? You want a doctor who connects, right?”
She would have said: The one who will heal him, fuck the personality. But she was quaking just from the briefest idea of Henry with a brain tumor on a ward in Memorial, and livid that Sharp—Sharp-the-Turd indeed—had so wantonly put her through it.
“Well…,” she said, playing for time.
“But the truth is, if you’re thinking in terms of the overall performance of the hospital team, which is a sum of everyone bringing their individual talents together to serve the patient, then we’re better off if we have a Sachs as well as somebody like a Stu Rosenfeld or Ross Waycaster. He came in the same year. Stu did, too. He was Jonathan’s supervisor.”
“I remember,” Grace said, trying to breathe through it. She took an experimental bite of her sandwich. It was heavy on the mayonnaise, but she’d expected that. “So you’re saying Jonathan had some sort of…deficiency. Like being short some fingers. But he had such a big personality people overlooked it?”
“He had a big deficiency,” Sharp said, sounding affronted. “Much bigger than a couple of missing fingers. I’m not telling you anything you don’t know. This is your field now. Yes?”
No, Grace thought. But she nodded anyway. “How did you make up your mind about him?”
“Oh…” He shrugged, as if this were the least important part. “By the end of the second or third year, I’m hearing stuff. Not from the patients, or the family members. They’re crazy about him, like I said. But I’m not the only one who’s on edge around this guy. The nurses don’t like him. A couple came to me right before he started his residency, but it wasn’t anything you could base an action on. I didn’t think I could even put it in the file. I just wrote myself an e-mail about it and hoped I’d never have to come back to it.”
“What—,” she said sharply, and then stopped until he had to look at her. “What was the complaint?”
“Oh, nothing earth-shattering. He was arrogant, blah blah. This is not the first time I’ve heard that about a doctor, from a nurse.”
Grace surprised herself by laughing. “No, I suppose not.”
“Flirtatious with some of the women. They didn’t like it. Well, I think some of them didn’t like it, and maybe some of them did.”
Even at this, she noted, he didn’t bother looking at her.
“But nothing concrete to my way of thinking, so I just let it go. And look, I’ve got other big personalities on my service. You know, shrinking violets don’t become oncologists, at least not here. We have whole generations who never got the God complex memo, they’re just grandfathered in, all over the hospital. The field!” he insisted, as if she’d challenged him.
But then, witho
ut being able to help herself, she did just that.
“I don’t think Jonathan had a God complex. Is that what you’re saying?”
“No, no…” He shook his head. “Well, I might have thought so at the beginning, but I watched him for a long time. Mainly because I had to, because he was a hot spot—he was someone my attention kept being drawn to. And I started to realize, here was a guy who didn’t just behave differently to different people, he was a different person depending who he was with. Stu Rosenfeld never had a bad word to say. He covered your husband’s patients for years.”
“They covered each other,” Grace corrected.
“No. Somebody else covered Rosenfeld. Different people—Sachs got out of it somehow. He wasn’t covering anyone, not for years, but I never heard about it from Rosenfeld. He had a massive blind spot about your husband, like a lot of the others. I’m telling you, I got to be fascinated with the guy. I almost got to like him.”
It wasn’t mutual, Grace thought. She picked up one of the potato chips on her plate, looked at it, and put it back down.
“But you know what made me finally make up my mind was that story in New York magazine, for the Best Doctors. You know what he said?”
Of course Grace knew what he’d said. She’d read the short piece many times. But that didn’t seem relevant.
“He said it was a privilege to be allowed into someone’s life at the worst moment, when they wish they could tell everybody to go away. But they can’t do that, because these are people who might be able to save their child’s life. And how he’s honored and humbled. And I read that and I said: Hah! That was it. Except he wasn’t humbled, I knew that much. He was something, but he wasn’t humbled.”
Grace just looked at him. “I don’t know what you mean,” she finally said.
“I mean, he fed off that situation, of being at the center of intense emotions. He got a big charge from it. Even if he couldn’t help the patient. Even if he couldn’t save the patient, you know what I’m saying? He didn’t care about that part. It was all the emotion coming at him. I think emotion fascinated him. Well,” he said with real nonchalance, “you’re the shrink. You know all about it.”
She was finding it hard to concentrate. She made herself look hard at Robertson Sharp III. She found herself looking at the space between his eyebrows, which was sort of an eyebrow of its own. It was not a thing of beauty, but it was very interesting to look at.
“I don’t know why people think you can’t have a psychopath in a hospital setting. Why should we be immune? Doctors are such saints?” He laughed. “I don’t think so.” He wasn’t looking at her. It wasn’t an important point in the way that the aorta had been an important point, she supposed. And he was hardly the type to notice that she was having some difficulty. For one thing, she could not breathe properly. The word, so blithely spoken, had pierced her like a spike. And then he used it again. “A psychopath is a person. A physician is a person. Presto!” Sharp said. He was trying to signal the waiter. He wanted something, apparently.
“We’re supposedly healers. That’s supposed to make us great humanitarians—just one assumption on top of another, and it all adds up to complete bullshit. Anybody’s spent time in a hospital you know it’s full of the biggest sons of bitches you’ll ever meet in your life!” He laughed a little. Apparently this nugget of wisdom never got old. “Maybe they happen to be very adept at making a sick body better, but they’re still sons of bitches. I once had a colleague—I won’t say who. He’s not at Memorial now. Actually, he might not be a physician anymore, which isn’t a bad thing, probably. We were in a meeting once with the director of volunteers in pediatrics, long meeting about setting policy for the playrooms and entertainers. Afterwards I said something to him about what a long meeting it was. You know what he says? ‘Oh, I love do-gooders because they always do me so much good.’ That’s all he says.”
For the first time since she’d sat down, it occurred to Grace that she could actually go. Anytime she wanted, she could leave.
“I think…Jonathan cared about his patients,” she said carefully, though why she bothered she didn’t have the faintest idea.
“Well, maybe yes, maybe no. Maybe we don’t get to understand what ‘cared about’ means to somebody like Sachs.” He took another monster bite of his sandwich and chewed like a ruminant. “I’ll tell you one thing. He didn’t care about his colleagues, by any definition. He moved them around like chess pieces. He liked a lot of drama. If he got bored, he’d tell somebody about something another person had said, or who was getting it on with somebody else. Whether any of it was true, who knows? He couldn’t be part of any team, anything with a common object. Especially if there was somebody involved who he didn’t like, and he didn’t like a lot of people. He put energy into his patient care, because he got something from that. He put a lot of energy into the family members. A lot. And some of the people he worked with, if they made his life easier. But he never paid much attention to other people if he couldn’t use them, even if it was someone he saw every day. No return on the investment. So there were a lot of folks he didn’t really notice, but they still noticed him. They found him very interesting, watching him operate. And you know, it takes a lot of effort to hold up the mask he had.” He seemed to consider. “Mask would not be the scientific term, I guess.”
It wasn’t. But she got the idea.
“And those people saw a lot. All the nasty bits. The comments he made, the way he just froze you out. If he was supposed to be in a meeting and he didn’t think he should have to be there, he seemed to find a way to disrupt it somehow, so it would all end up taking even more time, which never made any sense to me. And all those co-workers he was ignoring, if they hadn’t felt so dissed by him, they might not have been paying such close attention. I think that’s what did him in, actually.”
Sharp paused to dig his fork into the now soggy paper cup of coleslaw. It dripped as it rose to his mouth.
“It was an attending in radiology who came to me about it the first time. I had Sachs come in for a meeting. He was extraordinarily good-natured the whole time. He said he was going through a difficult period at home, and it wasn’t something he’d like to see get around the hospital. He told me he and the woman had already decided to stop seeing each other.” He had set down his fork. His fingers, all ten of them, were on the tabletop. Grace saw that they were moving, as if he were playing, silently and only in his mind, a fairly complicated piano piece. “But then it happened again, with somebody on the nursing staff. I said, ‘Look, trust me, I have no interest in intruding into your life. This is none of my business. But you’ve got to keep it out of the hospital.’ I mean, you can’t object to that, right? And he always apologized and gave me some reason why it had happened and he was taking care of it. Once I had to call him in and he claimed he was being stalked by somebody. He wanted my advice on how to handle it. We spent the whole meeting going over hospital protocol and whether he ought to be making a formal complaint, after which he tells me what a great role model I am and if he’s ever a chief he hopes he can provide the kind of leadership I do, blah blah. Utter crap, but then again, when he said it something in me sort of sat still and listened. So again, he took care of it, or at least I didn’t hear anything else about it. But then he had something with Rena Chang. Dr. Chang. And I had to pay attention to that, because her supervisor came to me about it. But then she left. I never had to meet with him about that one. She went somewhere in the Southwest. Santa Fe, maybe?”
Sedona, thought Grace, shuddering.
“I heard she had a baby,” said Robertson Sharp III.
“Excuse me,” Grace said politely. If she hadn’t heard her own voice, she might not have noticed that she’d spoken. Then she was on her feet, staggering across the room. Then she was in the bathroom, on the toilet, with her head between her knees.
Oh God, she thought. Oh God, oh God, oh God. Why had she asked for this? Why, why, had she wanted to know? Her mouth was full
of the awful taste of tuna. Her head was pounding and pounding.
Rena Chang. She of the smudge stick. She of the “parallel healing strategies.” Jonathan had laughed about her. They both had laughed about her. How long ago had that been? She tried to concentrate. She tried. But it wouldn’t come. Before Henry? No, it had to be after. Had Henry been a baby? Had he been in school? She couldn’t even get her mind around why this should matter. She had no idea how long it took her to get out of the bathroom.
When she got back, the waiter had removed both their plates. Grace slid back into the booth and sipped her now chilly tea. His phone was now on the tabletop. He had perhaps done a bit of business while he was waiting.
“Dr. Sharp,” said Grace, “I know Jonathan had a disciplinary hearing in 2013. I’d like to know more about that.”
“He had a few disciplinary hearings,” Sharp said a little gruffly. It was rather late in the day for him to start getting gruff with her, thought Grace. “One for accepting a monetary gift from a patient’s father. Allegedly accepting,” he modified. “The father declined to speak to the hospital attorney. It had to be dropped. Then we had another one about the incident with Waycaster. In the stairwell.”
Where he had tripped, in other words. He had tripped in the stairwell, chipping his tooth, which had had to be repaired and was still, wherever it was at this very moment, a slightly different color from the teeth on either side. She assumed. Except that he had not tripped, she knew that now.
You Should Have Known Page 36