Despite my “handicap” and the “well-meaning advice” that medicine was a stretch for me, I graduated from St. Georges University School of Medicine on the island of Grenada with honors, aced the foreign medical graduate exam, and completed my training in family medicine at UC Medical Center in San Francisco. I received high praise for my skills and dedication, but I couldn’t escape the stigma of having attended a foreign medical school—permanent, second-class citizenship.
Beverly Ramirez, my office nurse, dropped a large bundle of mail into my inbox. “Good morning, Arnie.”
Beverly was a second-generation US citizen born to Mexican parents. They had been among the first to benefit from the illegal alien amnesty program in 1985. Her dark hair and eyes reflected the family’s indigenous background. The entire family had worked hard. They owned three cars, their own homes, and all were U.S. citizens. Two brothers were doctors, three were nurses, and one was a professor of computer science at Cal State, Hayward.
Beverly had been with me from day one. With Lois, she helped create and grow the practice. She was smart, reliable, and had a wonderful sense of humor that made our days in the office enjoyable, even in the face of all the annoying problems that came with running a medical practice. Her personality and her fluent Spanish attracted many Spanish-speaking patients.
I suggested early on that she speak with me only in Spanish, as part of my latest attempt to conquer the language. When she remembered to whom she was talking, we communicated well, and my Spanish improved dramatically. When she forgot that I was, after all, a gringo, and flooded my ears with lightning Spanish, I shook my head in frustration.
Although I was far from fluent, Beverly and many of our Spanish-speaking patients appreciated the attempt and the respect for them my attempts implied.
I eyed the stack in my inbox. “Anything interesting?”
“The usual, laboratory and x-ray reports, discharge summaries, and consultation notes. I got rid of the insurance and investment offers, and the free drug company trips to Paris. I know you’d never leave us for Paris.”
“Paris. You know I’d sell my soul for Paris.”
She smiled and pointed to the phone. “That flashing line is for you.”
“Your smile is making me nervous, Bev. Who is it?”
“It’s your favorite HMO medical director, Charles Kingston.”
“Terrific. What does he want this time?”
Beverly shrugged her shoulders and left.
Charlie’s voice boomed. “You did it again. Why in hell send Ernie Clark to Stanford when we have our own cancer specialists.”
“Good morning to you, Charlie. I love hearing your voice.”
“I’m sorry, Arnie. This is one part of my job I hate.”
“Find another job.”
“Once they replace me, you’ll be telling everyone that working with Charlie Kingston… those were the good-ole-days.”
“If you were my patient, Charlie and you had Ernie Clark’s problem, I’d send you to Stanford where they’ve treated hundreds of malignancies like yours and have access to experimental treatments not available elsewhere.”
“Wellcare can’t afford it, and as you know, we don’t have a contract with Stanford.”
“So you wouldn’t go?”
“Sure I’d go, but I’d pay for it myself.”
“You can afford it, Charlie, but what about the poor schmuck who can’t?”
“Life’s unfair, Arnie. Don’t blame me or Wellcare for that, too.”
“We’re never going to agree. I can read the financial pages and I don’t think we need to take up a collection for Wellcare or its overpaid executives.”
“Will you at least try to stay in the Wellcare system?”
“Of course, Charlie. You can count on me when it’s best for my patients.”
“Another thing, Arnie.”
“Yes.”
“Come and do my job for a month.”
“No insult intended, Charlie, but I wouldn’t do your job.”
After Lois and I finished dinner, I helped clear the table and loaded the dishwasher. I stretched out on the great room sofa and patted my forty-inch waist. “I’m heading out for the gym. I’ll be back at nine. I’ll be nice and sweaty, just the way you like me.”
“Right. Why don’t you see me after your shower, Big Boy. Maybe you’ll get lucky, that is if you have enough energy left.”
Practicing medicine doesn’t offer much physical activity. Since I hated exercise per se, I played over-thirty basketball one or two evenings each week when possible. My father’s premature death had affected me my entire life. If I had the money, the time, and the necessary narcissism, I might spend years on an analyst’s couch to understand the effects of his death on me. His massive heart attack at thirty-six was a mind-numbing shock. Afterward, my every twinge and ache was the harbinger of ‘The Big One’.
Studying medicine was the perfect prep school for the incipient hypochondriac who caught each disease as it appeared in the medical syllabus. That’s understandable, but I concluded long ago that a headache was just a headache, and not a brain tumor. In addition, I learned after heart screening and sophisticated testing of my blood fats and cholesterol, that my risk for coronary heart disease was low. Still, since we only understand about 50 percent of the risk factors for this disease, I played all the odds.
I’d been athletic since childhood when I grew early in height and bulk to six feet four inches tall. I played power forward in college at two hundred forty pounds, but today at a mere two hundred pounds, I was less muscle and more fat. I enjoyed the game and was athletic enough to do well, but I lacked—as my coach freely expressed it—the killer instinct essential to that position. Knocking a player down was okay. Taking someone out deliberately wasn’t in me.
Lois found me bear-like, and in private called me her Teddy Bear. We kept terms of endearment to ourselves, but neither of us made excuses for these small intimacies. They simply said that we were still, after all these years of marriage and two kids, crazy about each other and confident enough to let it show. Overt affection was as natural for us as breathing. It was a proud legacy to leave for our daughters.
Chapter Three
Henry Fischer, the President of Horizon Drugs, scanned the red-inked spreadsheet for the third time and shook his head in disgust. He’d worked the numbers repeatedly, but the bottom line remained the same; they were losing money. His desk at corporate headquarters in Emeryville was an enormous cherrywood custom creation. The offices sat before the fourth floor window with a spectacular view. Henry looked out over the San Francisco Bay with a panorama of the Golden Gate Bridge and the San Francisco skyline. He’d had his first good look at the view when he purchased the building and thought how it would impress visitors.
Horizon Drugs had opened its doors thirty years ago as Horizon Pharmacy, a neighborhood drugstore in El Cerrito Plaza, a small East Bay mall. Henry came from a long line of pharmacists, and although he had dreams of going to medical school, his family, especially Theodore (Teddy) Fischer, his father, and tradition, prevailed over ambition. Teddy raised five children with upper-middle-class advantages and conservative Germanic values.
“We’re pharmacists,” Teddy said, “My father, and his father were pharmacists in Munich. By 1935 with the rise of the Nazis, I decided to leave the country before it was too late.”
Although Teddy had considered Henry capable, he remained concerned with his son’s extravagance. When Henry took over Horizon Pharmacy, Teddy haunted the place. He still counted each pill, checked daily receipts, and studied the books, fearing that Henry’s stewardship would destroy his life’s work.
Henry shook his head as Teddy studied the books. “What’s the matter, Pop? Don’t you trust me?”
Teddy smiled. “Of course I trust you, Henny. If I can’t trust family, whom can I trust? It’s hard for an old man to break lifelong habits.”
“Please, Pop, don’t call me Henny, it’s Henry.�
�
“Of course. Excuse me,” he said smiling as he embraced his son.
Henry Fischer had been one of those kids born with absolute confidence. While most children of his generation were shy and spoke only when spoken to, Henry was outgoing, charming, and completely comfortable with children and adults alike. Friends and relatives would blink with surprise and smile as this precocious child extended his hand to greet them with a warm hello, and engaged them in near-adult conversation.
Henry charmed his way through school. With a bright mind, Henry became each teacher’s favorite and won every elective office he sought. He graduated with honors from Berkeley High as class president. He continued to UC Berkeley, and graduated from UC San Francisco School of Pharmacy.
Henry made up for his short stature with elevated shoes and hair combed high. People called him a spark plug for his high energy level and rapid speech pattern. Built like a gymnast, he worked out feverishly especially when his scale drifted above 140 lbs. Henry wore Yves Saint Laurent and Valentino suits. He’d paid over $2000 for a few and drove the tailors crazy until each fit perfectly. He went weekly to the unisex hair salon for a trim.
Only his sister, Joanie knew the real Henry Fischer as a man living a charmed life. She tried to tell Teddy. “Henry lies with such conviction that no one recognizes it. He gives his word and breaks it without giving a shit about the people he hurts and he still sleeps like a baby.”
Teddy smiled. “You’re jealous of Henry.”
Joanie shook her head and left the room.
When Henry heard that Highland Pharmacy was in trouble, he arranged a meeting with Morey Sherman, its owner, and a collegial competitor.
Morey was Teddy’s contemporary, but looked much older as the stress of his failing business had taken its toll.
Henry studied the older man. “I’m sorry to hear about your troubles, Morey. Teddy has a special affection for you. Can we do anything to help?”
Morey’s eyes filled. “It’s my fault. I should have changed with the times. Now it’s too late. I’m going to lose everything.”
“I’ve talked it over with Teddy,” Henry lied. “We’ll buy your entire inventory, but we have our own problems and can only pay you a fraction of its value.”
“What choice do I have? Where do I sign?”
“We’ll seal this deal with a handshake, like your deals with Teddy.”
Three weeks later, a desperate and disheveled Morey Sherman approached Henry. “You haven’t paid me yet. I need the money right away.”
“Take it easy, Morey. We have problems, too. I’ll pay you when I can.”
“You promised me half by last week. I need the money. I have obligations and can’t pay my bills. Please Henry, this has never happened to me before. My honor is at stake.”
“I’d like to give you the money right now, but we have cash flow problems. I’ll get it to you when I have it.”
Henry kept up the delaying strategy for months, until one morning Morey’s wife found him dead in the garage with his car’s motor running.
Teddy was livid. “What’s the matter with you, Henry? Morey was my friend for twenty-six years. We were amiable competitors and often helped each other. How could you treat him that way?”
Joanie smirked. “Don’t say I didn’t warn you. You don’t know your son, Teddy. Henry will stop at nothing to get his way.”
Henry smiled at his father and sister. “Don’t blame me. I would have paid, if he’d told me how important it was to him. He should have told me.”
Henry married Ruth Carlin, a petite and athletic woman. She was the only daughter of Bertram Carlin, the CEO of Lathrup industries, a major supplier of after-market auto parts.
Bert Carlin was a tough and ruthless businessman, but he left that persona at work. At home, he doted on Ruth, indulging her every whim including dance, piano, art lessons, and gymnastics. She went to the finest summer camps learning to ride, surf, and write fiction and poetry. Her closets bulged with the finest clothes and shoes, many she’d never worn. In Bert’s eyes, she could do no wrong. Miraculously, Ruth resisted these corrupting influences and grew into an unpretentious and generous woman. Bert encouraged her into the business administration program at UC Berkeley, hoping that she’d join him in running Lathrup Industries. When she declined, preferring to teach, he embraced her choice at once.
Ruth taught fourth grade in the upscale Lafayette school district in Contra Costa County east of the Oakland-Berkeley hills. She loved teaching, but loved Henry more. After the birth of the first of their three kids, she retired to be a stay at home mom.
Henry was generous with his wife and children, so Ruth overlooked his character flaws, as part of what it took to be successful in business. She’d grown up with her father’s small ethical lapses.
One evening as they were preparing for bed, Ruth turned to Henry. “Now that we have our youngest in first grade, I’d love to go back to teaching.”
“I don’t think that would be such a good idea.”
“Why? I loved my work, and with all the kids in school, I can restart my career.”
“I don’t see what the big deal is all about,” he said jerking the bedspread off the bed in anger. “You have everything a wife could want. Moreover, the kids still depend on you.”
Ruth sat at her dressing table, head down.
Henry joined her on the cushioned bench and rubbed her shoulders. “Now don’t go getting upset. We agreed before we had children that we wanted them to have a full-time mother, not a nanny or tossed into childcare. It’s best for them.”
“How about what’s best for me? I can’t be a mother forever. One day they’ll be gone and then what do I do?”
“You can do anything you want. Go back to school, work, volunteer, or whatever. Only your energy and imagination limit you.”
I’ve lived my life to support him, Ruth thought. Nobody coerced me, and I enjoyed pleasing him. When is it my time?
“I’ve talked with the school district. They need me for either third or fifth grade. My hours will coincide with the children’s.”
Henry reddened. “You’ve accepted their offer?”
“I told them that I’d let them know in a few days. I want to do this, Henry. Try to understand.”
“Do what you please. I don’t give a damn!” he said as he stomped from the room.
Chapter Four
I looked up as my office manager, Beverly Ramirez, stuck her head into my office. “Can you speak with Wellcare, Arnie?”
“Tell them I died.”
As I worked through my busy morning, the image of Samantha Goldstein crept into my mind.
“How many more?” I asked Beverly as the clock approached 10:30.
“Seven.”
“Seven more before lunch! I don’t believe it. I have a noon meeting at the hospital.”
“Relax, Arnie. You’ll make it. Most of them will take you minutes, and,” she retreated defensively toward the door, “and, we had to squeeze Missy Cabot in this morning.”
“Shit! Anyone but her. That woman will take most of the morning. I thought I was off the hook with her for at least three months.”
Missy Cabot, age fifty-seven, was a pain in my ass. A bitterly unhappy woman with an uncaring husband and ungrateful kids, Missy chose hypochondriasis for two purposes, one to relieve her largely imagined symptoms, and two, to torture me. When she first came to my office many years ago, I ignored my first impression that the woman was a kook, and put her through an extensive evaluation. The negative test results did little to ease her symptoms, and forced me to do what I hated the most, ignore them.
Beverly handed me Missy’s chart. “I tried to hold her off, but she’s too good. She knows exactly what to say. When she went to that terrible chest pain moving down her left arm, we were dead meat. You need to examine her. I’d have sent her to the ER, but Wellcare would have refused to allow the ER to see her. She’s on our dime, Arnie.”
“Do another EKG an
d let me know when she’s ready.”
After seeing my sixth patient, I looked for an escape route as only Missy remained. Beverly attached the useless EKG tracing to Missy’s three-inch thick office file. I compared it with her most recent cardiogram, one of twenty plus that decorated her chart, and that I’d committed to memory (it’s a bad sign when you remember a patient’s EKG). It didn’t surprise me to find her cardiograms unchanged.
I entered the examination room trying to smile. “How’s it going, Missy?”
She was a thin woman with straw-like, shoulder length bleached-blonde hair. Her face showed the coarse wrinkles of a heavy cigarette smoker and ruby-red lipstick feathered her vertically fissured lips.
She rubbed her chest with her palm. “It my ticker. Maybe I got too excited this morning when I had it out with my pain-in-the-ass daughter.”
“Is this pain the same as you had before?”
“Yes, Doctor Roth. It’s like someone’s sticking sharp needles into my chest, and it hurts to breathe,” she stabbed her chest with a crimson acrylic fingernail.
“What about the arm pain?”
She rotated her arm. “I think I pulled a muscle yesterday when I tried to clean my windows.”
I examined her carefully, and then showed her the EKG. “Missy, your heart tracing is normal. This is nerves or maybe you pulled a muscle.”
I reassured her for the umpteenth time, and made my usual fatal error. “Call me if you have more chest pain.”
“What about my dizziness, nervousness, headaches, and itchy scalp, Doctor?”
My head swam. “We’ve been over all this before, Missy. It’s nothing.”
“Thank you, Doctor,” She said and reached into her huge purse to grab a notebook. She thumbed through three pages. “I have a few other things I need to discuss with you, Dr. Roth.”
I shook my head and checked my watch. “No time now, Missy, let’s keep them for your next visit.”
Ignoring symptoms even when they came from a neurotic patient was a potentially deadly game. With my luck, one of these days she’d really have something life-threatening.
The Sixth Sense (Brier Hospital Series Book 3) Page 2