My Favorite Midlife Crisis (Yet)

by Toby Devens

  I’d been playing with a gel pen. Its extra-fine point glided perilously close to my wrist.

  “That’s got to be a mistake,” I said. “There’s no other hospital in a ten mile radius. They can’t shut Covenant down.”

  “Everything turns on the bottom line these days.” He shrugged. “Covenant’s been hemorrhaging dollars for years. So maybe UltaMed is amputating. Seems like a logical move to me. You have a gangrenous foot—you cut it off.”

  I sent him a shocked look. “These are human beings we’re talking about, Neil, not mixed metaphors. If Covenant shuts down, where are these people going to go?”

  “Not here,” Neil said much too quickly, his sharp amber eyes finally settling on me. “Bethany’s dragging her feet on getting out the final report, but I’ve seen her preliminary draft on our pro bono numbers. We can’t afford to absorb these uninsured patients. Not anymore. Not even a few. And you should know Seymour backs me up on this.”

  “Sonofabitch,” I muttered after he closed the door. Then I phoned Dan Rosetti’s office. My father’s doctor was chief of gerontology at Covenant. If anyone could separate truth from scuttlebutt, Dan could. His receptionist said he’d been called to a 3 p.m. meeting of department heads. It was 3:15. Those hatchet meetings never lasted more than a half hour. If I hustled, I might be able to tag him on the way out.

  I drove through West Baltimore under a steady drumbeat of rain. The famous white marble stoops fronting the formstone row houses were stained gray by the gloom, and a soggy mulch of early October leaves clogged the gutters. Everything looked as raw as I felt.

  This neighborhood was a west side version of the one I’d grown up in across town. Working class. A tavern on every corner. A laundromat and a check cashing service flanked the storefront that used to house my women’s clinic. It was now the Beulahland Tabernacle of Joyous Prayer. Covenant loomed like Old Mother Hubbard over the neighborhood, its red brick skirts spread across two city blocks, its bonnet, a smaller silver replica of Johns Hopkins Hospital’s gold dome, washed dull in the dreary light. Just as my mother had hauled Rolfe and me to Hopkins for earaches and poison ivy, the folks around here used Covenant as their doctor’s office.

  No more.

  When I hit Dan Rosetti’s reception area in Covenant’s physicians tower, his appointments secretary said, “He’s still in the meeting, Dr. Berke. You’ve heard the latest?” She slashed two fingers across her throat.

  I nodded. “Is it official?”

  “Just came across on WBAL news.” She glanced at her desk radio. “I’ve been working here twenty-one years. As my kids would say, this really sucks. Not for me so much. I just keep thinking, what’s going to happen to our patients? All these poor seniors don’t take change easily. Especially the Alzheimer ones.”

  I hadn’t thought about that. My dad took the same green chair on every visit. Picked up but didn’t read, couldn’t read anymore, one of the large-print magazines stacked on the side table. He’d be lost in a new place.

  “Gwyneth?” Dan Rosetti’s voice rose behind me. I felt his hand light on my shoulder and turned to see a grim smile.

  “Oh, Dan,” I said, emotion flooding, surprising me. “What the hell is going on?”

  “My office.” He hitched his neck in that direction. “I’ll tell you everything I know.”

  ***

  What he knew was my worst nightmare realized. UltaMed had filed the legal papers to sell Covenant. More official in this day of media power, they’d already released the news to the press.

  “Covenant’s a lost cause,” Dan said. He’d been with the hospital since his residency there, which added up to three decades.

  “And what happens to you?” I asked.

  “Oh, I’ll be fine. Union Memorial has been after me for years. They’ve got a first-rate gerontology department. The problem is Covenant has been eating the charges for a few patients of mine. Don’t ask me what’s in store for those folks now. Unless.” He pressed fingers to his forehead. “I was thinking about you in there. About your clinic.”

  “My clinic,” I sighed. “There is no clinic and it doesn’t look like there ever will be. I’ve hit every foundation that sounded even remotely promising. I’m at a dead end, Dan.”

  “Maybe not,” he said.

  The phone rang. Dan peered at the caller ID. “One of my patients. Probably saw the bad news on TV. This shouldn’t take long.”

  I took the moment to glance around his office. Awards from the Knights of Columbus, Polish Home Club, and Sons of Italy thanking him for his volunteer service shared the wall with his diplomas from Yale and Penn Medical School.

  Sitting on his bookshelf was a mug painted with “#1 Dad” that had all the pixie charm of a kid’s summer camp crafts project. And beside the mug, the inevitable clutch of family photos. In one, a younger Dan with pure black hair stood straight and proud as a Roman soldier beaming down on his captured Saxon bride. The wife was fair and pretty. In her lap perched a child of six or so, hair as flaxen as the mother’s but bearing her father’s generous smile. A more recent portrait of Mrs. Rosetti revealed how well she’d aged into what I guessed were her early forties.

  By the time Dan hung up the phone, I’d already shifted my stare from the photos. There was not going to be a repeat of the debacle with Hank Fischman, the plastic surgeon, and the photos of his trophy family. Knowing too much about my colleague’s private lives, their younger wives, was a passport to depression.

  “So, you’re having problems getting funding,” Dan said, eyebrows knit pensively. “But I think with Covenant closing, you may have a better chance. Especially if you expand your vision somewhat. Now don’t jump on me until you’ve heard me out. It’s a women’s clinic. No question. But now the need is even greater.”

  I chewed a knuckle, listening.

  “One day a week, you add a pediatric component. Many of the women who come to see you have children. So this is a natural. We bring in some volunteer docs.” He mentioned two of Baltimore’s best pediatricians. “I guarantee you, if these guys don’t sign on, I can find people who will. Or maybe we just do an open clinic one day a week. See whomever. Male. Female. All ages. Hell, I’m trained in internal medicine. I’ll give up a morning. Maybe a day.”

  I shook my head, astounded at his offer. When the Clinic was operating, it was tough for me to squeeze one afternoon out of the practice. I’d added two nights a week on my own time and for the rest hired a couple of young physicians eager to moonlight. “This is very generous of you,” I said. “You really think you can give up a day?”

  “Why not? I’m fifty-seven years old. I’ll be negotiating a new contract and I figure I can write my own ticket. I like to think I got into medicine to treat people, not their wallets. The Clinic will give me the opportunity to prove that.”

  What an amazing man! For a moment, in the gloom that was both outside and inside, hope flickered.

  Still, every silver lining has its cloud. I found mine. “What makes you think we can bring this off?” I asked. “A full-service clinic even for one or two days a week is going to take serious money for staff, equipment, insurance. If I couldn’t get backing for my little storefront…”

  “Aha. But with a broader patient base, we might have a better shot at landing some grants,” he countered. “If you like, I’ll help you write the proposal. Anyway, think about it.”

  I promised I would.

  And I did. I even sketched out a revised mission statement. But then something came up and for the next few weeks I found myself preoccupied with a situation that was even more urgent and much, much closer to home. Kat was in trouble.

  Chapter 23

  No call from her in nearly a week and then when she surfaced, I wished she hadn’t. Not that way.

  I was checking on my patient after a four-hour procedure Friday morning.
My arches hurt, but I was still on my surgical high in the recovery room when my pager went off.

  I located an empty cubicle and returned Kat’s call. I thought maybe she wanted to talk about her gallery show, which was scheduled to open in a few weeks. Or that she needed to vent about Summer or Lee. I forgot she never called during the workday except in an emergency. She’d phoned when her sister was diagnosed with cancer and when the police called about Ethan. Now, I heard her voice and it was hollow as bamboo.

  “Gwyn, I’ve found a lump in my breast.”

  Friday midday isn’t a good time to discover a lump. Many of our docs start their weekend early. When Kat called, Neil Potak, her gynecologist, was on the far nine at the Woodholme Country Club. At the hospital, the Breast Imaging Center wound down by midafternoon and the odds of getting someone to take a look or a feel were dicey.

  Unless you had connections. I had connections.

  I told Kat to sit tight and give me five minutes. I called Radiology four floors down and snagged the chief tech Renee Carson on her way out and turned her around. She tagged Leah Abramovitz, my favorite radiologist, and within a half hour we pulled a team together for an unscheduled mammogram.

  I caught Ibrahim Sukkar having a late lunch at his desk. He was the doctor I saw for my own breast check and he had the discerning fingers of a blind man. “Abe, I would consider it a personal favor if you’d take a look at my friend.” I explained the situation.

  “Of course,” he said.Twenty minutes later, Kat reeled into the radiology waiting room looking as if she hadn’t slept in days. Ashy complexioned and tangle haired, she’d thrown on one of Ethan’s salvaged windbreakers over jeans and a T-shirt. Watching her remove it with jerky preoccupied movements, seeing those frantic eyes, I was glad I’d rallied the troops.

  I hugged her, then held her hand while she rattled on nervously, “I’m so glad you’re here. I can’t believe you rounded up someone to see me. God, I can’t even talk my mouth is so dry. I want a cigarette. I haven’t smoked for fifteen years and I would kill for a Salem. That’s how crazy I feel. Logically, I know it’s probably nothing; 80 percent of lumps are benign, right? It’s not like this torture is something brand-new.” Kat had moderate fibrocystic disease. “I’ve been carrying around these two bags of jelly beans since I was thirteen and I’ve felt lumps before, but this is different. This feels like a piece of peanut brittle, but with one peanut in the center and no sharp edges.”

  I didn’t like the sound of it, but I was saved from having to dissemble by Renee Carson flashing us her broadest smile.

  “Hi, Dr. Berke. You’re looking good. You can come in now, Mrs. Greenfield.” Renee read her face and added tenderly, “It’s okay, baby. We’ve kept the machine warm for you.”

  “Oh, God, I hate this.”

  We all hate it. For whom the bell tolls and each year you figure you’ve run out of time and it’s about to toll for you. During my own mammograms, I’m bathed in agita, just another terrified woman. The precious MD, all the education, counts for nothing when it’s your breasts in the vise. And I say the same prayer every year: “Forgive me for everything and protect me against wildly multiplying cells in the name of the Father, the Son, and the Holy Ghost, amen.” I can’t remember the last time I attended church except as a wedding guest, but I always promise that if I get through this mammogram with a passing grade, I’ll start again. I never keep the promise.

  I sent Kat off with another promise, one a friend could make but a physician couldn’t. “Whatever it is, we’ll take care of it. You’ll be fine.”

  Fifteen minutes later, she shambled back to the cubby, teeth chattering, ties undone. “Oh, sweet Jesus, I’m glad that’s over. She’s a nice lady, that Renee. She says you operated on her years ago. She thinks you hung the moon. She says it shouldn’t take long. Dr. Abramovitz doesn’t have anyone ahead of me.”

  Renee drew back the curtain. “I hate to do this to you, but we need to reshoot. Now I don’t want you to jump to any conclusions, sweetheart. This makes us all crazy, so I know what you’re thinking, but I just want to position you a little differently. Here, let me help you with your gown.”

  As Kat slid by her, Renee widened her eyes at me.

  ***

  The film of Kat’s breast looked dicey and Abe Sukkar persuaded her to let him do a core needle biopsy that same afternoon. At four thirty, he delivered Kat back to me gulping breaths, but by the time we reached the hospital garage, her brain had already made its initial adjustment to the shock of dreadful possibility. Such a pliable organ, the brain. You’d think it would explode with some of the thoughts it has to process. But no, it just reconfigures its cells and moves on. Unless it goes nuts.

  “We won’t know until the lab work comes back. For now, it’s inconclusive. Dr. Sukkar’s words. Which means it could be...” She couldn’t go on.

  “It means what Abe said. Until the pathologist examines the cells under a microscope, it’s just a questionable mass.”

  “Mass. That reminds me. I want to go to Mass on Sunday. Time to up the bidding in my bargaining with God.” Kat twisted an ironic smile. “The agnostic in the foxhole. I’m such a cliché.” She inhaled tremulously. “Four days of not knowing. It’s like some medieval torture. By Tuesday, I’ll be a total wreck.”

  “It’s going to be a long weekend. Can Summer stay with you?”

  “Summer’s in New York with Tim, visiting his parents. I’m not going to screw up her outing.”

  “Lee?”

  “No, not Lee. That’s over. I haven’t seen him in a week. We…all right I decided this was better for everyone concerned. Before it got too serious. Don’t look at me like that.”

  “He’s a great guy, Kat.”

  “There are other great guys. Let’s just hope I’m around to enjoy them.”

  “Oh, Kat, you will be.”

  When we got to her car, she insisted on driving herself home. I didn’t argue because medically she was in shape to drive and emotionally it wasn’t a bad idea. Steering through rush hour traffic was an acceptable metaphor for what she was going to be doing over the next few days. Let her have the illusion, at least, of control.

  “It will do me good. I’ll put on QSR, blast out the Golden Oldies, and pretend I’m sixteen again. When life was simple and you didn’t have crap like this to worry about.” Her history. Not mine.

  “Well, take it easy. I’m going to stop at home for a few things and then I hope you have fresh sheets on the guest room bed because I’m staying with you this weekend,” I said.

  “No. Really. It’s okay, you don’t need to. I’ll be sleeping most of the time anyway.”

  “Maybe. But when you wake up and need a shoulder to cry on or you have any questions, I want to be there.”

  Surprisingly, she didn’t protest further. “I really got lucky when I drew you in the dorm lottery, lo those many years ago. Don’t think I don’t know it.” She squeezed my hand.

  “Yeah, I could have been Brenda Cofee with the b.o. or Susie Lemberg who dried her diaphragm on the radiator, remember?”

  That teased a smile. “I mean it. You and Fleur, I don’t know what I’d do without you.”

  “That reminds me, I should call Fleur. If it’s okay with you.”

  “Yes, it’s okay, I guess. Sure. She’ll be royally pissed if she’s out of the loop.”

  “Knowing Fleur, she’ll probably want to stay over, too.”

  “Hey, we’re keeping a vigil here, not having a pajama party.” But she looked pleased. Then in a quick turn into her subconscious, she said, “I don’t care about the breast, you know. They can take it. They can take both of them. I’ve never fixated on my breasts anyway. Italians are ass people. A nice round ass, now there’s a real symbol of womanhood. I’d fight like hell against an assectomy, but they can have my boobs. I just don’t wa
nt to die. Not that way. I watched my sister die of breast cancer and I don’t want to go down that road.” She shivered.

  “That was fifteen years ago. There are all kinds of new roads to go down that don’t end in the place your sister did.”

  She slid behind the wheel of the trusty old Volvo she’d owned for a decade. I crouched by the open door. “You sure you’re okay?”

  “Yeah, I’m just scared shitless. I feel like such a coward. I’m trying not to catastrophize. That’s what Ethan used to say I did. Always expect the worst. Well, maybe he can serve as my intermediary with God. Head death off at the pass.”

  “Ahh, Kat.”

  “You’re right, you’re right. For once, I’m going to visualize a happy ending. The biopsy comes back negative, no bad cells. It could come back negative, right, Gwyn? It could be nothing, couldn’t it?”

  I gave her the only right answer. “It certainly could be nothing.” The “could” was the truth. But it was the “nothing” that became the weekend’s mantra.

  Chapter 24

  Nature sent Kat a mockingly beautiful weekend to anguish through. The October sun shone, the temperature soared, and the warmth turned up the souvenir scent of summer flowers and the misplaced loamy aroma of spring. Stretched out in a patio chair, she spent the daylight hours overlooking her garden as the wind chimes tinkled and endless cups of chamomile tea cooled on the tray table next to her. Fleur and I observed a respectful silence and checked on her every few hours.

  On Saturday, Harry Galligan tracked me down on my cell phone. He knew it was last minute but did I have any interest in catching a movie that night?

  “Ah, Harry, what a nice idea,” I said, “but I’m staying over with a friend for the weekend. She had a medical scare and now she’s waiting for some test results. It’s tough marking time by yourself. I’m here to lend moral support.”

  “You’re doing the right thing.” Pause. “The person with the medical problem, it’s not that lady we met in your lobby, is it?”