“Thank you. You've been very kind."
“Actually, I like teaching skills,” Jack replied as he climbed into the driver's seat and rolled down his window. “I suppose that's why I stayed in an academic center. Originally I'd planned to set up a private practice in Milwaukee or Chicago."
“You certainly have the patience for it. I'm afraid my store of patience is much smaller."
He turned to look at me for a long moment. “But you have perseverance, obviously. Probably a much more valuable quality than patience."
Was it? I doubted that very much. Nigel was patient, and I was persevering. Even the combination didn't seem to have moved us to the right place. “I'm starved,” I said. “Let's get back and see what Sherri's created for her buffet."
Chapter Five
On Monday I was admitted to Dr. Lavinia Hager's office by an administrative assistant who appeared unusually flustered by my arrival. Since I was on time and dressed with my usual care, this struck me as odd. Dr. Hager herself, an attractive woman in her late fifties, regarded me with a certain coolness. Though she shook my hand, there was little warmth in her greeting.
The chair she waved me to was a totally inappropriate item with more the appearance of a narrow wheelchair than a comfortable seat. This might have been the height of modern design, but it was difficult to wedge myself into its skimpy confines. I grimaced; so did Dr. Hager.
Because we had spoken on the phone several times, when Dr. Hager had been more cordial, I was puzzled by her attitude. She immediately asked for a detailed description of my training and practice, something which I would have thought quite unnecessary under the circumstances.
It occurred to me that Doug's recent fax to her from his hospital bed might have been less than flattering. Perhaps he had mentioned how alert I was to allowing even high risk labors to continue at their own pace, without undue monitoring or rush to intervene. Like Doug, Dr. Hager was reputed to be a high-tech practitioner. Give them a new toy and they would find a way to use it.
Dr. Hager's attitude disturbed me. Her contention that I would have much to learn, that the American practice of obstetrics was far in advance of England's, was nicely calculated to rouse my defensiveness. Nigel has taught me well in this regard, however. All Dr. Hager was able to elicit from me was a passive nod and smile—and the occasional recitation of the figures which indicated England was far and away a less dangerous place for a child to be born.
“That's only because you give every pregnant woman prenatal care,” she remarked, rather carelessly.
“But that's necessary for a good outcome,” I reminded her. “It only makes good medical and financial sense."
The National Health has its faults, heaven knows, but it does provide health care to everyone. Americans are apparently convinced that government administration of health care is inefficient and wasteful. But their private insurance companies add a very expensive layer between doctors and patients, which seems totally unnecessary to me.
Dr. Hager took me on a brief tour through her department, introducing me to the OB attending doctors, but with a half-hearted instruction to them to see that I be given any assistance I needed in my research. When she deposited me at the office I'd been assigned (quite a nice one, obviously meant for Doug's comfort), she flashed the briefest of smiles.
“I'll take under consideration your desire to do clinical work, Dr. Potter,” she said.
“It's in my contract,” I reminded her.
“You have to be included under the department's insurance. That's a matter I have to approve.” And without further explanation, she turned on her stylish high heels and left me.
* * * *
My purpose in coming to Madison had been not only to engage in the agreed-upon comparisons of Effective Care in Pregnancy and Childbirth (ECPC), but to actively participate in obstetrical care. Since I had a valid medical license to practice in the U.S., this was not a matter for debate, so far as I was concerned. But I couldn't practice if I wasn't covered under the department's insurance.
If Doug had planned to be only an observer, there was no reason why I had to be, so I set about establishing a foundation for myself in the department. I managed to woo two of her attendings to my side of this debate. Both Dr. Sarah Jamison and Dr. Willard Kyle seemed to appreciate my frustration with the idea of being prevented from participation in clinical work.
Sarah, who was a new member of the staff, probably had a great deal to lose by championing my cause, but that didn't seem to deter her. On the Wednesday after I started, Sarah took me along to the weekly morbidity and mortality conference. (Dr. Hager hadn't mentioned it to me.) The conference met in a small, attractive auditorium with facilities which would have made Doug Lattimore's eyes pop out.
Referring to the case under discussion, Sarah said, “Dr. Potter mentioned that she's had experience with this kind of cultural problem in handling high risk deliveries in England. Apparently some ethnic groups view at least an attempt at labor as highly desirable, even when the likelihood of a caesarean is high. There have been men in these groups who have spurned their wives for not attempting to deliver vaginally."
Dr. Kyle called on me to give an example, and I succinctly described a not-uncommon situation in London of a Bengali couple I'd dealt with the preceding week. Dr. Hager thanked me for my participation and turned the discussion to other matters. After the meeting, both Sarah and Willard helped me corner her.
“I would very much like to have Dr. Potter work with me, as we'd planned,” Sarah urged. “I've arranged for her to have access to our ECPC data, but I feel I have a great deal to learn from her about clinical practice as well. Not only is the cultural set-up different there, but the English experience of what's successful high-tech-wise may be different. Even more than that, Dr. Hager, I want to learn about their system of midwifery care."
Dr. Hager waved aside Sarah's arguments. “Dr. Lattimore felt the ECPC research would occupy him quite sufficiently for the duration of the fellowship. Dr. Potter would be diluting her efforts by maintaining a clinical practice as well."
Willard Kyle, who was an older attending, merely raised his brows at this. “If Dr. Potter feels she can manage both areas, I think we have an obligation to let her try. She's obviously familiar with our American system, Lavinia. After all, she trained at Duke."
“Many years ago.” Dr. Hager smiled kindly to show that this wasn't meant as an insult. She was, after all, perhaps fifteen years older than I, though a striking-looking woman with silver hair and intelligent eyes. “A lot has changed in our practice of obstetrics since those days."
“I assure you I'm abreast of the literature,” I said, trying to keep a sardonic edge from my voice. “Doug Lattimore must have given you some idea of my competence. We've worked together for many years."
She was unrelenting. “Dr. Lattimore has no way in which to judge your performance by our standards."
“Dr. Hager, I'm qualified to do clinical work in the United States. We agreed that I would on the phone last week."
“Perhaps that was rash on my part,” Dr. Hager said, but there was no trace of apology in her melodious voice.
“Not at all,” I assured her. “I wouldn't have come if the only inducement had been the ECPC work. Statistics are all well and good; I've produced most of the studies from my hospital. But the real pleasure and learning experience is seeing first-hand what is being done, especially in a first-class university environment."
Flattery obviously was going to get me nowhere. Dr. Hager responded flatly, “Our patients expect cutting edge knowledge and experience here, Dr. Potter. We're not familiar with either your knowledge or your experience. You can appreciate the dilemma that produces."
Dr. Kyle snorted. “It's no worse a dilemma than any resident produces, Lavinia. And Dr. Potter's licensing automatically makes her eligible for our hospital insurance.” He offered me a good-natured smile and said, “I think we should welcome her into the fold."
&
nbsp; When Dr. Hager didn't accept his suggestion, Sarah grew impatient. “Lavinia, you promised me access to Dr. Potter's English experience. I've made all my arrangements for the next few months based on that. Why don't you stand in on a couple of procedures to see for yourself how she does?"
Though I could see it was a necessary ploy, I found this suggestion somewhat demeaning. After all, I'd practiced obstetrics in a university setting for so many years it seemed absurd anyone would question my credentials. When Dr. Hager said she didn't have the time to do that, Sarah said, “Well, I do and Dr. Kyle does, so we'll handle the matter."
Dr. Hager did not flat out veto this arrangement, and our meeting disbanded. I couldn't help believing Doug had somehow sabotaged me, which made me madder than hell. As if I hadn't put up with enough from him over the years, now he was crippling the one opportunity I had for a stint away from his irritating authority.
While awaiting opportunities to prove my capabilities, I spent a fair amount of time questioning my new colleagues and exploring the hospital floors and patient charts. One of the fellowship stipulations had been that the records for the past few years would be made available so that I could study how patients were indeed being handled, and what I could make of the outcomes.
My understanding was that American insurance companies currently were trying to shorten patient stays (to save money, of course) and that their method for determining when to do this consisted of going through patient charts to ascertain if morbidity or mortality issues entered the picture during the patient's hospital stay. If they didn't, obviously—in the corporate mind—there was no sense wasting money keeping the poor sods in hospital, despite their potentially vulnerable physical and psychological states.
A few years ago determining length of stay would have been considered in vast, monitored studies of the issues. Today it was being plotted out of wishful thinking by people intent on that bottom line. They were doing outpatient mastectomies in the United States, for God's sake! Greed is a nasty motivator.
In any case, the whole matter of effective care in obstetrics was a passion with me. From everything I'd seen at the University, Dr. Hager had a similar concern. Though she was far more geared to high-tech practice than I was, her department was run for the benefit of the patient rather than the practitioner. And Lavinia knew her department would ultimately benefit from my research, which was why no doubt why she'd allowed someone to take Doug's place when he was unable to come. So her animosity toward me was both confusing and distressing.
Though I spent hours working on the ECPC data, it was the sort of thing which required regular breaks in order to give it my best concentration. With no clinical practice to distract me, I used the bike riding as a diversion, but I was not very successful for a while. Actually mounting the purple monster and getting started without Jack's supporting hand on the seat proved harder than I'd expected.
But I persevered. I had no intention of asking the neurosurgeon's assistance again and made sure that I worked with the bike when he would not be around. Sherri frequently came to cheer me on. I learned to prop the bike steady against the garage and she'd give me a shove off. With this start I managed to stay astride for quite some time, often making it up and down the block. When I didn't, I pretty much had to walk the bike back to start again.
After watching for a few days, Sherri made a suggestion. “Let's try you on a pogo stick. It requires a similar kind of balance and getting started."
Pogo sticks must not have been around when I was a child, because it was something I'd seen only in movies. To me it looked just as complicated as the bike. “Not at all,” she protested and showed me how to hop on and keep hopping.
Imagine me hopping around on a pogo stick. Nigel would have been stunned, if for no other reason than that it looked totally undignified, even when Sherri did it—and she did it well. Still, it turned out to be a good idea because once I got the idea of the balance of the pogo stick, I was able to transfer the knowledge to the bike, concentrating on the pedals instead of keeping my seat.
Just before dinner Thursday, after an hour of working on it alone while Sherri got dinner, I managed to mount without the assistance of the garage siding. I rode off steadily around the block, merrily forgetting that Americans drove on the other side of the street than English folks.
Cliff was not expecting someone to try to enter the driveway at the same time he was, and we nearly collided. When he recognized that it was me, he merely shook his head in mock despair and said, “You're going to have to remember where you are, Amanda."
“How true! And all week long being at the University has felt just like being at home,” I remarked rather tartly.
“Dr. Hager giving you a hard time?” he asked, his ferocious eyebrows raised.
“She's making things difficult."
“She's usually rather accommodating, from what I've heard. She's had the position for at least half a dozen years, so she's got a solid hold on it. Angel said she was widowed two or three years ago. Maybe that's changed her. Is this going to make a problem for you?” he asked, climbing out of the car he'd pulled off to the side.
“I hope not. I seem to have two champions on her staff. They'll help me bypass her where they can, but it's a bit of a nuisance."
Cliff frowned and pursed his lips. “Let me know if I can help. Though I'm not beloved of everyone here either, coming from the outside. There were several people who apparently expected to get my job.” He shrugged and added, “And they probably should have. Sometimes you lose perspective when you're at a place like Fielding. You think no other medical center in the country has the same kind of talent, and you're wrong. At least partially,” he couldn't help adding with a twinkle in his eyes.
“God, and think where that puts people at universities in England,” I said as I rolled the bike toward the garage. “No wonder Dr. Hager doesn't trust me."
He frowned as he followed me. “Doesn't trust you? But you couldn't have done anything wrong yet."
“No, and she's not about to let me. Maybe my boss wrote a less than flattering synopsis of my career. Not to worry.” I leaned the bike against the wall and dusted off my hands. “Doug and I are old antagonists and I've learned a lot about working with someone who doesn't appreciate your strengths and overestimates your weaknesses."
We started to walk toward the house, Cliff easily outpacing me with his long legs and energetic stride. When he came out of a brief abstraction he slowed his pace to mine and asked, “Are you still thinking of trying to find another place? Or haven't you had time to consider that yet?"
Surprisingly, it had completely slipped my mind. “I'll stay,” I decided instantly. “Mayfield House is working out perfectly."
“Great. Angel hopes to get you out to our house one of these days, too, for a meal.” He paused on the back steps and turned to me with a worried look. “Sometimes I think it's too much for her, you know, the medicine and the child and me not being available to help much. I'm useless at arranging childcare."
How many fathers had I heard say that over the years? But I held my tongue, saying only, “Could you give her a break, Cliff? Could you stay with your son and let her take off alone sometimes?"
“I don't think she wants time alone."
I frowned. “Really? She'd be the only mother I know who didn't. Maybe just a few hours now and then. You'd get to know your son better that way."
His expression turned almost comically dismayed. “I'm not good alone with Roger. I hate changing his diaper and I don't really know how to bathe him."
“Those skills are easily acquired,” I said, trying to sound patient. “If you spend time with him, you'll learn. Mothers have to learn, too, Cliff. They don't come with built-in knowledge."
“But it's not the same,” he objected, holding the door for me to enter in front of him. “It will be better when he's older and I can actually do something with him."
Remembering my own days when Cass was a baby, experiencing bo
th the overwhelming love and the trapped frustration, I couldn't help but ask, “Yes, but can you wait that long to do something for your wife?"
Before he could figure out how to answer, I hastened up the stairs. I've met a thousand fathers like Cliff—well-meaning, loving even—who allowed their wives to shoulder an unfair share of the household work and childcare. If these husbands and fathers felt they were being asked to do too much, how about their wives? Life was even less of a picnic for them.
My concern for my patients, and in this case for Angel, often led me to voice my strong feelings on the subject. I wasn't blessed, or cursed, with the usual English reserve, and it was a tenet with me that it was better to speak up than regret not taking the opportunity to right a wrong. If Cliff was miffed with me, so be it. At least my words might give him pause, I thought as I brushed my hair in preparation for returning downstairs to dinner.
* * * *
There were only five of us at the table. Jack wasn't there, and the sculptor, Rob Sharpe, seemed to be away for the week, so I had yet to meet him. Sophia Granger was as contentious as ever, and if Cliff had intended to continue our discussion, he stood little chance. Ms. Granger complained about the food, the facilities and the other guests.
For the sake of peace at the dining table, which we English value rather highly, finding it conducive to digestion, I set myself the task of finding something that would make a difference in Sophia Granger's life. When I questioned her about her daily activities, they turned out to be few. She wrote letters to old friends ("But half of them come back because they've died,” she complained) or read books of an uplifting nature which could not have failed to irritate her.
“With your experience, I should think one of the literacy projects would need you,” I said. “Haven't they been beating down your door?"
“What literacy projects? No one has mentioned literacy projects to me."
“Surely you must have them here in the U.S. They're a very active function of libraries in my country. Wiping out adult illiteracy is a pressing goal for us, because it's something of a scandal. We have an impressive education system, especially during those years when children learn to read."
An Abundant Woman Page 5