by Nancy Kress
The father handed Jesse the laminated printout, with the deeply embossed seal in the upper corner. Jesse scanned it quickly. The necessary RB antioncogene on the eleventh chromosome was present. The girl was not potentially allergic to scaramine. Her name was Rosamund.
“Okay, Rose,” Jesse said gently. “I’m going to help you. In just a little while you’re going to feel so much better…” He slipped the needle with anesthetic into her arm. She jumped and screamed, but within a minute she was out.
Jesse stripped away the bedclothes, despite the cold, and told the men how to boil them. He spread betadine over her distended abdomen and poised the laser knife to cut.
The hallmark of his parents’ life had been caution. Don’t fall, now! Drive carefully! Don’t talk to strangers! Born during the Depression—the other one—they invested only in Treasury bonds and their own one-sixth acre of suburban real estate. When the marching in Selma and Washington had turned to killing in Detroit and Kent State, they shook their heads sagely: See? We said so. No good comes of getting involved in things that don’t concern you. Jesse’s father had held the same job for thirty years; his mother considered it immoral to buy anything not on sale. They waited until she was over 40 to have Jesse, their only child.
At 16, Jesse had despised them; at 24, pitied them; at 28, his present age, loved them with a despairing gratitude not completely free of contempt. They had missed so much, dared so little. They lived now in Florida, retired and happy and smug. “The pension”—they called it that, as if it were a famous diamond or a well-loved estate—was inflated by Collapse prices into providing a one-bedroom bungalow with beige carpets and a pool. In the pool’s placid, artificially blue waters, the Randalls beheld chlorined visions of triumph. “Even after we retired,” Jesse’s mother told him proudly, “we didn’t have to go backwards.”
“That’s what comes from thrift, son,” his father always added. “And hard work. No reason these deadbeats today couldn’t do the same thing.”
Jesse looked around their tiny yard at the plastic ducks lined up like headstones, the fanatically trimmed hedge, the blue-and-white striped awning, and his arms made curious beating motions, as if they were lashed to his side. “Nice, Mom. Nice.”
“You know it,” she said, and winked roguishly. Jesse had looked away before she could see his embarrassment. Boston had loomed large in his mind, compelling and vivid and hectic as an exotic disease.
There was no peritonitis. Jesse sliced free the spoiled bit of tissue that had been Rosamund’s appendix. As he closed with quick, sure movements, he heard a click. A camera. He couldn’t look away, but out of a sudden rush of euphoria he said to whoever was taking the picture, “Not one for the gallery this time. This one’s going to live.”
When the incision was closed, Jesse administered a massive dose of scaramine. Carefully he instructed Kenny and the girl’s father about the medication, the little girl’s diet, the procedures to maintain asepsis which, since they were bound to be inadequate, made the scaramine so necessary. “I’m on duty the next thirty-six hours at the hospital. I’ll return Wednesday night, you’ll either have to come get me or give me the address, I’ll take a taxi and—”
The father drew in a quick, shaky breath like a sob. Jesse turned to him. “She’s got a strong fighting chance, this procedure isn’t—” A woman exploded from a back room, shrieking.
“No, no, noooooo…” She tried to throw herself on the patient. Jesse lunged for her, but Kenny was quicker. He grabbed her around the waist, pinning her arms to her sides. She fought him, wailing and screaming, as he dragged her back through the door. “Murderer, baby killer, nooooooo—”
“My wife,” the father finally said. “She doesn’t…doesn’t understand.”
Probably doctors were devils to her, Jesse thought. Gods who denied people the healing they could have offered. Poor bastards. He felt a surge of quiet pride that he could teach them different.
The father went on looking at Rosamund, now sleeping peacefully. Jesse couldn’t see the other man’s eyes.
Back home at the apartment, he popped open a beer. He felt fine. Was it too late to call Anne? It was—the computer clock said 2:00 a.m. She’d already be sacked out. In seven more hours his own 36-hour rotation started, but he couldn’t sleep.
He sat down at the computer. The machine hadn’t moved to surround his empty square after all. It must have something else in mind. Smiling, sipping at his beer, Jesse sat down to match wits with the Korean computer in the ancient Japanese game in the waning Boston night.
Two days later, he went back to check on Rosamund. The row house was deserted, boards nailed diagonally across the window. Jesse’s heart began to pound. He was afraid to ask information of the neighbors; men in dark clothes kept going in and out of the house next door, their eyes cold. Jesse went back to the hospital and waited. He couldn’t think what else to do.
Four rotations later the deputy sheriff waited for him outside the building, unable to pass the security monitors until Jesse came home.
COMMONWEALTH OF MASSACHUSETTS
SUFFOLK COUNTY SUPERIOR COURT
To Jesse Robert Randall of Morningside Security Enclave, Building 16, Apartment 3C, Boston , within our county of Suffolk. Whereas Steven & Rose Gocek of Boston within our County of Suffolk has begun an action of Tort against you returnable in the Superior Court holden at Boston within our County of Suffolk on October 18, 2004 , in which action damages are claimed in the sum of $2,000,000 —as follows:
TORT AND/OR CONTRACT FOR MALPRACTICE
as will more fully appear from the declaration to be filed in said Court when and if said action is entered therein:
WE COMMAND YOU, if you intend to make any defense of said action, that on said date or within such further time as the law allows you cause your written appearance to be entered and your written answer or other lawful pleadings to be filed in the office of the Clerk of the Court to which said writ is returnable, and that you defend against said action according to law.
Hereof fail not at your peril, as otherwise said judgment may be entered against you in said action without further notice.
Witness, Lawrence F. Monastersky, Esquire , at Boston, the fourth day of March in the year of our Lord two thousand four .
Alice P. McCarren
Clerk
Jesse looked up from the paper. The deputy sheriff, a soft-bodied man with small, light eyes, looked steadily back.
“But what…what happened?”
The deputy looked out over Jesse’s left shoulder, a gesture meaning he wasn’t officially saying what he was saying. “The kid died. The one they say you treated.”
“Died? Of what? But I went back…” He stopped, filled with sudden sickening uncertainty about how much he was admitting.
The deputy went on staring over his shoulder. “You want my advice, doc? Get yourself a lawyer.”
Doctor, lawyer, Indian chief, Jesse thought suddenly, inanely. The inanity somehow brought it all home. He was being sued. For malpractice. By an uninsurable. Now. Here. Him, Jesse Randall. Who had been trying only to help.
“Cold for this time of year,” the deputy remarked. “They’re dying of cold and malnutrition down there, in Roxbury and Dorchester and Southie. Even the goddamn weather can’t give us a break.”
Jesse couldn’t answer. A wind off the harbor fluttered the paper in his hand.
“These are the facts,” the lawyer said. He looked tired, a small man in a dusty office lined with second-hand law books. “The hospital purchased malpractice coverage for its staff, including residents. In doing so, it entered into a contract with certain obligations and exclusions for each side. If a specific incident falls under these exclusions, the contract is not in force with regard to that incident. One such exclusion is that residents will not be covered if they treat uninsured persons unless such treatment occurs within the hospital setting or the resident has reasonable grounds to assume that such a person is insured. Those a
re not the circumstances you described to me.”
“No,” Jesse said. He had the sensation that the law books were falling off the top shelves, slowly but inexorably, like small green and brown glaciers. Outside, he had the same sensation about the tops of buildings.
“Therefore, you are not covered by any malpractice insurance. Another set of facts: Over the last five years jury decisions in malpractice cases have averaged 85 percent in favor of plaintiffs. Insurance companies and legislatures are made up of insurables, Dr. Randall. However, juries are still drawn by lot from the general citizenry. Most of the educated general citizenry finds ways to get out of jury duty. They always did. Juries are likely to be 65 percent or more uninsurables. It’s the last place the have-nots still wield much real power, and they use it.”
“You’re saying I’m dead,” Jesse said numbly. “They’ll find me guilty.”
The little lawyer looked pained. “Not ‘dead,’ Doctor. Convicted—most probably. But conviction isn’t death. Not even professional death. The hospital may or may not dismiss you—they have that right—but you can still finish your training elsewhere. And malpractice suits, however they go, are not of themselves grounds for denial of a medical license. You can still be a doctor.”
“Treating who?” Jesse cried. He threw up his hands. The books fell slightly faster. “If I’m convicted I’ll have to declare bankruptcy—there’s no way I could pay a jury settlement like that! And even if I found another residency at some third-rate hospital in Podunk, no decent practitioner would ever accept me as a partner. I’d have to practice alone, without money to set up more than a hole-in-the-corner office among God-knows-who…and even that’s assuming I can find a hospital that will let me finish. All because I wanted to help people who are getting shit on!”
The lawyer took off his glasses and rubbed the lenses thoughtfully with a tissue. “Maybe,” he said, “they’re shitting back.”
“What?”
“You haven’t asked about the specific charges, Doctor.”
“Malpractice! The brat died!”
The lawyer said, “Of massive scaramine allergic reaction.”
The anger leeched out of Jesse. He went very quiet.
“She was allergic to scaramine,” the lawyer said. “You failed to ascertain that. A basic medical question.”
“I—” The words wouldn’t come out. He saw again the laminated genescan chart, the detailed analysis of chromosome 11. A camera clicking, recording that he was there. The hysterical woman, the mother, exploding from the back room: noooooooooo…The father standing frozen, his eyes downcast.
It wasn’t possible.
Nobody would kill their own child. Not to discredit one of the fortunate ones, the haves, the insurables, the employables…No one would do that.
The lawyer was watching him carefully, glasses in hand.
Jesse said, “Dr. Michael Cassidy—” and stopped.
“Dr. Cassidy what?” the lawyer said.
But all Jesse could see, suddenly, was the row of plastic ducks in his parents’ Florida yard, lined up as precisely as headstones, garish hideous yellow as they marched undeviatingly wherever it was they were going.
“No,” Mike Cassidy said. “I didn’t send him.”
They stood in the hospital parking lot. Snow blew from the east. Cassidy wrapped both arms around himself and rocked back and forth. “He didn’t come from us.”
“He said he did!”
“I know. But he didn’t. His group must have heard we were helping illegally, gotten your name from somebody—”
“But why?” Jesse shouted. “Why frame me? Why kill a child just to frame me? I’m nothing!”
Cassidy’s face spasmed. Jesse saw that his horror at Jesse’s position was real, his sympathy genuine, and both useless. There was nothing Cassidy could do.
“I don’t know,” Cassidy whispered. And then, “Are you going to name me at your malpractice trial?”
Jesse turned away without answering, into the wind.
Chief of Surgery Jonathan Eberhart called him into his office just before Jesse started his rotation. Before, not after. That was enough to tell him everything. He was getting very good at discovering the whole from a single clue.
“Sit down, Doctor,” Eberhart said. His voice, normally austere, held unwilling compassion. Jesse heard it, and forced himself not to shudder.
“I’ll stand.”
“This is very difficult,” Eberhart said, “but I think you already see our position. It’s not one any of us would have chosen, but it’s what we have. This hospital operates at a staggering deficit. Most patients cannot begin to cover the costs of modern technological health care. State and federal governments are both strapped with enormous debt. Without insurance companies and the private philanthropical support of a few rich families, we would not be able to open our doors to anyone at all. If we lose our insurance rating we—”
“I’m out on my ass,” Jesse said. “Right?”
Eberhart looked out the window. It was snowing. Once Jesse, driving through Oceanview Security Enclave to pick up a date, had seen Eberhart building a snowman with two small children, probably his grandchildren. Even rolling lopsided globes of cold, Eberhart had had dignity.
“Yes, Doctor. I’m sorry. As I understand it, the facts of your case are not in legal dispute. Your residency here is terminated.”
“Thank you,” Jesse said, an odd formality suddenly replacing his crudeness. “For everything.”
Eberhart neither answered nor turned around. His shoulders, framed in the grey window, slumped forward. He might, Jesse thought, have had a sudden advanced case of osteoporosis. For which, of course, he would be fully insured.
He packed the computer last, fitting each piece carefully into its original packing. Maybe that would raise the price that Second Thoughts was willing to give him: Look, almost new, still in the original box. At the last minute he decided to keep the playing pieces for go, shoving them into the suitcase with his clothes and medical equipment. Only this suitcase would go with him.
When the packing was done, he walked up two flights and rang Anne’s bell. Her rotation ended a half hour ago. Maybe she wouldn’t be asleep yet.
She answered the door in a loose blue robe, toothbrush in hand. “Jesse, hi, I’m afraid I’m really beat—”
He no longer believed in indirection. “Would you have dinner with me tomorrow night?”
“Oh, I’m sorry, I can’t,” Anne said. She shifted her weight so one bare foot stood on top of the other, a gesture so childish it had to be embarrassment. Her toenails were shiny and smooth.
“After your next rotation?” Jesse said. He didn’t smile.
“I don’t know when I—”
“The one after that?”
Anne was silent. She looked down at her toothbrush. A thin pristine line of toothpaste snaked over the bristles.
“Okay,” Jesse said, without expression. “I just wanted to be sure.”
“Jesse—” Anne called after him, but he didn’t turn around. He could already tell from her voice that she didn’t really have anything more to say. If he had turned it would have been only for the sake of a last look at her toes, polished and shiny as go stones, and there really didn’t seem to be any point in looking.
He moved into a cheap hotel on Boylston Street, into a room the size of a supply closet with triple locks on the door and bars on the window, where his money would go far. Every morning he took the subway to the Copley Square library, rented a computer cubicle, and wrote letters to hospitals across the country. He also answered classified ads in the New England Journal of Medicine, those that offered practice out-of-country where a license was not crucial, or low-paying medical research positions not too many people might want, or supervised assistantships. In the afternoons he walked the grubby streets of Dorchester, looking for Kenny. The lawyer representing Mr. and Mrs. Steven Gocek, parents of the dead Rosamund, would give him no addresses. Neither would his
own lawyer, he of the collapsing books and desperate clientele, in whom Jesse had already lost all faith.
He never saw Kenny on the cold streets.
The last week of March, an unseasonable warm wind blew from the south, and kept up. Crocuses and daffodils pushed up between the sagging buildings. Children appeared, chasing each other across the garbage-laden streets, crying raucously. Rejections came from hospitals, employers. Jesse had still not told his parents what had happened. Twice in April he picked up a public phone, and twice he saw again the plastic ducks marching across the artificial lawn, and something inside him slammed shut so hard not even the phone number could escape.
One sunny day in May he walked in the Public Garden. The city still maintained it fairly well; foreign tourist traffic made it profitable. Jesse counted the number of well-dressed foreigners versus the number of ragged street Bostonians. The ratio equaled the survival rate for uninsured diabetics.
“Hey, mister, help me! Please!”
A terrified boy, ten or eleven, grabbed Jesse’s hand and pointed. At the bottom of a grassy knoll an elderly man lay crumpled on the ground, his face twisted.
“My Grandpa! He just grabbed his chest and fell down! Do something! Please!”
Jesse could smell the boy’s fear, a stink like rich loam. He walked over to the old man. Breathing stopped, no pulse, color still pink…
No.
This man was an uninsured. Like Kenny, like Steven Gocek. Like Rosamund.
“Grandpa!” the child wailed. “Grandpa!”
Jesse knelt. He started mouth-to-mouth. The old man smelled of sweat, of fish, of old flesh. No blood moved through the body. “Breathe, dammit, breathe,” Jesse heard someone say, and then realized it was him. “Breathe, you old fart, you uninsured deadbeat, you stinking ingrate, breathe—”