by Ayad Akhtar
3 I suspect, if you’re still reading this book, you’re the sort of person who’s already aware of the mind-boggling municipal boondoggle that, in 2012, corroded the city’s pipes and had the children of Flint drinking water from what one official would call a lead-coated straw—a tale that, if it wasn’t real, would read like the kind of tragic farce I used to associate with Gogol’s Russia or some Third World banana republic concocted by Naipaul.
VIII.
Langford v. Reliant; or, How My Father’s American Story Ends
1.
In October of 2012, my father saw a patient by the name of Christine Langford, a fair-haired, newly pregnant twenty-six-year-old woman with a long-standing heart problem known as long QT syndrome. Christine had been diagnosed in childhood with the condition, which, triggered by exercise, emotional excitement, or sleep, can lead to a particularly serious form of irregular heartbeat. Specifically—and crucially to this story—“long QT” refers to a longer-than-normal interval between two beats of the heart, an elongation that can provoke a chaotic heart flutter that, if it goes on for any extended period of time, often results in sudden death.
Long QT syndrome appeared to run in Christine’s family. Her mother, Corinne, had it, and long QT caused the death of Christine’s sister, Kayleigh, when Kayleigh was nine. The girl’s heart stopped beating as she napped one Sunday afternoon after helping her grandfather tend to the cows on the family farm in Kendall, Wisconsin, a small community in the far western reaches of the state. After Kayleigh’s death, extensive tests on the girl’s tissues and on the rest of the family would reveal that Kayleigh, Christine, and her mother were all carriers of the gene for long QT syndrome.
For years, Christine and her mother took beta-blockers, medications that slowed and regulated the heart’s beating, and neither of them experienced any significant heart symptoms from that point forward. But then Christine got pregnant. While surfing the internet one night, she came across an article that warned of potential prenatal risks to the fetus from some beta-blockers. The medication she’d been on since she was a young girl was at the top of the list. She called her doctor the next morning. He referred her to my father—then considered to be the state’s leading specialist in all manner of arcane heart-rhythm problems.
By 2012, Father was nearing the end of his career. He’d been through two and a half boom-and-bust cycles: his first cardiology practice—as you’ll recall—going fully out of business in the early ’90s, his second practice only barely averting collapse in the aftermath of the World Trade Center attacks. Across the country, brown doctors saw their patient load decline after 9/11, and my father’s cardiology group—staffed almost entirely with South Asian physicians—was no exception. He lost 40 percent of his business within three months; most of those patients never came back.
To compensate for lost capacity, Father came up with a counterintuitive strategy: expand into the farther rural reaches of the state. People out there had heart problems, too, of course, and they usually traveled hours to be seen, often needing to stay overnight in big-city hotels when they were scheduled for tests. Father believed—and convinced the doctors in his group—that shorter drives and the prospect of sleeping at home the night before a procedure would outweigh any conscious or unconscious bias a patient might have.
As my father tells it, it was a full five years before his group saw results, but by 2007 they were seeing more patients than any other cardiology practice in the state. It wasn’t long before their startling growth drew the notice of a corporate health-care network I will call Reliant Health for the purposes of this narrative. In 2010, my father’s cardiology group would get bought out by Reliant, and the resulting clash of administrative cultures—one driven by doctors, the other by MBAs—forms an important backdrop to the story I’ll be telling here.
Christine saw my father at a clinic in La Crosse, a small city along Wisconsin’s western border with Minnesota, a place known to most, now, for having lent an archaic Old French version of its name to America’s most popular brand of flavored sparkling water, La Croix, a drink concocted there in the early ’80s and eventually sold to a publicly traded holding company based, for the tax purposes of its owner, in Fort Lauderdale, Florida. Christine lived an hour southeast of La Crosse, in a small town called Westby, where she worked as an elementary school music teacher and taught private piano lessons to pupils on Saturdays. Father remembered this detail about her in particular, as it came up during her examination, how she gave piano lessons and how his son—I—used to take them. Something else Father recalled about that exam was the argument it provoked with Thom Powell, the administrator at Reliant overseeing the group’s business. Ever on the lookout for new ways to increase revenues, Powell had recently ordered his doctors to shorten their visits and delegate more of their duties to the group’s nurse practitioners; this was cheaper and created more room in the schedule for the lucrative billable appointments with MDs. When Powell discovered from an end-of-week report that Father had spent forty-two minutes with Christine—the average was ten minutes per patient—he went ballistic.
The reason for Christine’s considerably longer-than-usual exam was a series of EKG scans in her case file that Father worried had never been read properly. They showed the expected elongated QT intervals, but not only that. Father thought he saw further irregularities in the scripts, irregularities that suggested another potential problem: Brugada syndrome, the ailment that brought Father and Trump into contact in the mid-’90s. Father was particularly concerned by the hints of Brugada he was seeing on Christine’s EKGs, as the beta-blocker she was taking, propranolol, was dangerous for Brugada patients, quite apart from its prenatal risks. After spending the extra time to take Christine’s complete medical history, Father told her that nothing he’d heard convinced him she didn’t have Brugada, and the only way to know for certain was a gene test that typically took six weeks, even when expedited. Considering that propranolol was potentially harmful to her fetus, he advised her to think seriously about discontinuing it until they were able to run the necessary test, and perhaps for the full term of her pregnancy, no matter the result. His advice was offered with the usual disquieting medical equivocations: as a specialist only just familiar with the details of her case, he could give her the information; the decision was for her to make with her cardiologist. Father recalled that she pressed him for a more definitive answer. “Do you mind, Doctor, if I ask—do you have a daughter?” she asked.
“I don’t,” he said after a moment’s hesitation.
“If you did, and if she had my medical history—what would you tell her to do?”
As I’ve imagined the moment—with Christine on the examining table, looking over her shoulder at him; Father already at the door, his hand on the knob—I see Father register something that moves him to stop. Against his better judgment, he entertains the thought experiment. Then he finally says: “I would tell her to stop taking the propranolol.”
Christine took his advice.
Two weeks later, she and her unborn child were dead.
2.
The first I heard about any of this was on the morning after the night I drove up from Chicago to fish my father out of jail. It was late October in 2017, and I was in the final week of rehearsals for the opening of my newest play. I’d been in the rehearsal room with my phone on silent until late that evening, which is why I initially missed his call from the police station. He’d left a slurred, reluctant message in a pebbly bass that sounded nothing like his usual voice: “Beta. I’m in the Elm Brook jail. You can call Benji. He said you can come and get me if you can.”
Benji was not his lawyer but the deputy police chief of the village of Elm Brook, the small, mostly affluent suburban community where I’d grown up and where my father still lived in 2017. Benji and I had been in school together since the third grade; part of the same summer swimming-lesson cohort and Dungeons & Dragons group; we’d been backfield defenders on the JV soccer team toge
ther and served as members of the student council our senior year in high school. I knew his parents; he knew mine. He was the only one of my high school friends to personally pay his respects after my mother’s obituary was printed in the local paper. His own mother’s long terminal illness is what had brought him home after college upstate; when she died, he ended up staying in Elm Brook, marrying a fellow high school classmate of ours named Jess, and joining the local police department.
Outside the theater, it was a nippy, overcast night. The sounds of traffic and the passing El echoed against the brick-and-glass facades rising everywhere in this corner of the Loop. From a nearby kitchen, the smell of seared meat wafted along the sidewalk on which I paced, phone to my face, waiting for someone at the Elm Brook police station to pick up.
“Police department,” a woman’s voice finally answered. “Can I help you?”
“Deputy Fitzsimmons, please.”
“What’s your business?”
“I got a call from my father. Who I think is being held there…”
“Right,” she said, clearly apprised.
“He left a message for me to call Benji.”
“Hold, please,” she said as she left the line and dropped me into the middle of a Viennese waltz. In the storefront windows across the street, I saw the reflection of the theater’s marquee directly above me. The title of my new play had just gone up. MERCHANT OF DEBT, it read in bloodred block letters. Underneath it was a harmless but irritating indignity: my name was misspelled, a wayward letter misplaced from my last name into my first. The receptionist’s voice interrupted the music. “Hold, please, sir,” she said. After a long silence, I heard his voice, that distinctive nasal growl that—along with so much else about him: the broad freckled face, the strawberry curls, the patient, unassuming solidity—had remained mostly unchanged since high school.
“Hey, buddy.”
“Benji, hi. How are you?”
“Can’t complain, can’t complain. I mean, all things considered—you’re down in Chicago right now, right? If I’ve got that straight? Got something going up?”
“I am. Opens Monday.”
“Yeah. Saw it on Facebook. I keep up with you.”
“That’s nice to hear.”
“Yeah, no. It’s amazing.”
His enthusiasm was touching, but I wasn’t sure how to respond to it. “Benji, what’s going on with my dad?”
“Right,” he said, not quite dropping the bright tone. “You know there’s that new casino just past where that middle school used to be…”
“Sure.”
“So Jess has been working as a dealer there. Last few months, our shifts have been matching up. I’ve been picking her up after work. Don’t know if you’re aware, but your dad spends a lot of time there—”
“I have some idea.”
“Anyway, he was pretty lit tonight, making a stink. Security showed up, and he just sorta walked out in a huff. I followed him out into the parking lot, and I see him getting into his car. I mean, he’s tripping over himself, I doubt he can see straight, but he’s gonna drive? I stopped him before he got out on the road. It was messy, but I got the cuffs on him and brought him back here.”
“Wait: So did you arrest him?”
“I was off duty. So I just kinda brought him in. Didn’t book him. He’s sleeping now.”
“In the cell?”
“Yeah. I just, I don’t know—I thought it might send a message. It’s not the first time we’ve seen him like that at the casino. Jess was saying it’s been getting worse. Your dad’s a good guy. What he did for my dad when he was sick I’ll never forget. So I figured maybe a little wake-up couldn’t hurt. I’ll admit, I knew you were in Chicago. I know it’s an inconvenience, but if you could come get him yourself—I don’t know, it would make things a lot easier…”
“Of course. I’ll come up right now. I can probably be there by eleven thirty?”
“Cool. I’m gonna get home and get the kids to bed. I’ll text you my cell. Give me a shout when you get close, and I’ll come back to meet you.”
“Thanks, Benji. This is all very thoughtful of you.”
“Like I said, buddy. Your dad’s a good guy.”
* * *
The drive home was a straight shot up the interstate, ninety-four minutes without traffic, according to my iPhone—on which I also spent most of that drive on a conference call with the production’s creative team. We were three days out from our first performance, and the lead actor still didn’t know his lines. The evening run had been mostly a disaster, and the director was convinced the issue was psychological. She thought the actor in question had yet to get over his initial misgivings about playing the role. Before taking it on, he’d expressed his worries that the character—more than partly inspired by Riaz—was too ambiguously drawn when it came to the central moral matter. He wasn’t sure, he complained, if he was being asked to play a hero or a villain. “How about neither?” I’d responded when our agents arranged for us to meet for dinner in New York.
“How about both?” he countered coyly, biting on a bread stick. I’d been there before, glad-handing a star over a drink or meal, trading compliments as we sniffed out each other’s vanities. I’d done it before and never well. What’s the harm in playing along this time? I wondered. I conceded the counter—and did so by way of needlessly flattering his intelligence—but I would regret it. He would take my encouragement for permission to create a version of the character entirely too buoyant and one-dimensional, too indifferent to the murkier tonal range that was the essence of the play’s dramatic plight. His cloying take hadn’t worked in the rehearsal room and was working even less now that we’d moved onto the set. The director wanted me to give in and let him keep some stage business I’d hated since he introduced it early in rehearsal—in which he needlessly gave out money to a character who worked for him in the opening scene. The gesture was gratuitous and unjustified dramatically, but he’d gone to great lengths to build it into the physical action. When I asked him to explain why he was doing it, he lectured us on the importance of a save-the-cat moment—his name for any early story point where the hero does something the audience will find appealing (like Sigourney Weaver—he explained—saving Jonesy the cat in that first scene where we meet her in Alien). “Your play doesn’t have a save-the-cat moment; I’m doing you a favor,” he said. I responded by laughing out loud. From that point forward, things only got worse between us. Every time I saw him do his save-the-cat nonsense, I told him to stop. He wouldn’t. And then he told the director he didn’t want the writer talking to him anymore. The day before, on set, he’d done it again, and I stormed out. We were at a standstill, and the director believed the tension between us was the real reason he couldn’t remember his lines. She counseled me over the phone to give in: “Just let him have it. It doesn’t hurt the play. If he sees you soften on this, he’ll feel like he’s won something. It’ll be the boost he needs. I won’t be shocked if he shows up the next day line-perfect.”
I was skeptical this was all it would take, but I told her I was game to try.
Our call ended as the exit for Elm Brook approached. A steady light rain had been falling since I’d crossed the border into Wisconsin, and here, where the off-ramp and road into town were paved with a speckled beige-gray concrete, the wet surface sparkled beneath the streetlamps. The town center was two miles down a sloping road, and the police station sat just past a raised set of train tracks in the building that also housed the local library. I pulled up into an empty spot alongside the only squad car parked in front and got out just as an approaching freight train sounded its horn.
Inside, the passing rattle of train wheels on rail joints sounded surprisingly close, floating in through the open barred window in the cell where my father snored on his side, a Green Bay Packers blanket covering much of his torso. The cell was large and clean, with a single bench of dark varnished wood on which my father slept. Benji unlocked the jail door, pull
ed it open, and stepped inside. He got to his knees and gently prodded Father awake. Father roused, grumbling, then turned and lifted his head. His sleepy eyes narrowed with suspicion as he registered Benji, then widened with sudden alarm as they found me standing beyond the bars. He looked like a frightened child, I thought, a forlorn runaway. “Hi, Dad,” I said gently, hoping to soothe him, but he only sighed, his head dropping back against the bench.
“Can I go now?” he demanded with a petulant bray. Benji didn’t reply. Father sat up, glowering. “Hmm? Can I go?”
“You’re free to go. You always were—as long as there was someone to drive you home.”
“Where’s my car?”
“At the casino.”
“You separated me from my veeehicle?” I would have laughed at the question if I hadn’t heard the earnest outrage in it. He was clearly still drunk and confused.
“Just trying to make sure you don’t hurt yourself or someone else, Doctor.”
“Good Samaritan. Yeah, yeah,” Father groused.
“Dad. You might want to thank Benji for helping you. It could have been a bad situation if—”
“What do you know? Hmm? Were you there? I didn’t see you. I never see you anymore.”
“Doc—” Benji interjected gently.
“Okay, look. Fine. Thank you, Benji. Thank you for humiliating me in front of my boy. Who thinks he’s better than everyone now that he’s famous. But you know I was not nobody, either.”