Finally she’d had enough. She decided to resign as medical director and return to the admitting ward, but not to Dr. Jeffers, Dr. Fintner, and Dr. S. She would start over. She would find a new, fresh, untouched physician, one who was willing to work with her full-time on the admitting ward. She sent out feelers, and Dr. Dan came over for his tour and his interview. She liked him right away.
He was tanned and brown, with a 1950s flattop and sideburns, and he was beautifully dressed, from his Armani jacket to his Gucci shoes. Also, he was meticulously groomed, with his nails manicured and his thick brown eyebrows trimmed. Although not a handsome man, being too tall and too thin with a head just a little small for his body, he had done a lot with what nature had given him. Dr. Romero thought he would make a good medical director and that she would groom him for the position. So she offered him the job, and by the time I came back from Switzerland, he was on the admitting ward with the Welcome! sign up and the doors closed.
Consequently, I was never properly introduced to Dr. Dan. I knew him by sight on the evenings when I passed him in my car, as he loped down the hill to the streetcar. I knew him by rumor, which had it that the doctors’ part-time schedules drove him crazy and that he monitored our comings and goings with janitorial spies. But I knew him best by his workups, which were neatly printed backhand, clear, readable, and short.
Dr. Dan liked his patients, and they liked him, but he did not delve into their problems, I saw by his workups. He did not call their former physicians, review all their records, or do a detailed physical examination. He prized efficiency above all and had not found that an extensive workup added much to his patients’ care. Instead, he transferred into his own workup the diagnoses and medications his patients arrived with, which was why he could see a patient faster than any physician I’ve ever known and couldn’t fathom what took the rest of us so much time. What Dr. Dan did think worth his while were procedures. He could put in a needle just about anywhere—spinal canal, lung, abdomen, veins, arteries—quickly and efficiently. For procedures, Dr. Dan was the man to call.
For several years he stayed behind the closed doors of the admitting ward. He did become co-medical director. He never was able to replace the part-time doctors with full-timers as he had planned, nor persuade a quorum of doctors to attend his early-morning meetings, but he did install cameras in the doctors’ parking lot and was about to put in a time clock when … he disappeared. We came in one day, and he was gone. He’d taken a more lucrative position in Hawaii, and sold his house, packed up his clothes, and taken ship for the Big Island, all in two weeks’ time.
We didn’t hear from him again until two years later, when Mr. Conley telephoned to persuade him to return. He could have his old job back as co-medical director, Mr. Conley offered, and his office on the admitting ward. He would assist Mr. Conley with implementing Chambers; he would respond to the medical concerns of the Department of Justice; he would help organize the move to the new Laguna Honda after the facility was finished; and he would keep the doctors in tow. Particularly Dr. Kay and Dr. Romero, who were infuriating Dr. Stein by their persistent questioning about the hospital, the County, and the budget. Mr. Conley could guarantee Dr. Dan carte blanche because the medical director was now Dr. Sonnen, who mostly stayed in his office upstairs.
Dr. Dan was interested. He did make more money in Hawaii, and it was a more prestigious position, but he missed Laguna Honda. The thing was, he told Mr. Conley, he wouldn’t work with Dr. Romero. They’d had a falling-out. He wouldn’t go into the details.
What about working with Dr. S.? Mr. Conley asked. She was back on the admitting ward.
Maybe. He would see.
And so when I heard Dr. Dan striding down the hallway on the day he came back, it was with some trepidation.
His stride did not break until it came to the open door of our doctors’ office. Then it stopped. I was reading a chart at my desk and turned my head. Soft brown shoes, gray silk socks, creased linen pants, dark green, open-collared shirt, cream-colored Armani jacket—Dr. Dan was, I saw, just as well-dressed as ever. And even more perfectly tanned. He stood in the doorway and looked around. Then he walked in, pulled the chair out from the counter desk, sat down, spread his long arms along the desk, and put his head down.
“It’s still here!” he murmured.
“So you love this place, too,” I said.
Then he sat up and turned his chair partly around. He had a remarkable profile. It was the profile of a French knight in the Bayeux Tapestry—high forehead sloping back, strong nose that started at his eyebrows—perfectly shaped to wear a medieval Norman helmet.
“Oh, I missed it so much when I was in Hawaii!”
“How was it? What did you do there? What didn’t you like?”
“Well, it was a great job, on paper. I was head of subacute care for the Kaiser system on the whole island. Paid well, almost twice as much as here. The beaches were great, and James was pretty happy. But it was a mess. There were hardly any beds for the subacute patients—the ones ready to leave the acute hospital but not ready to go home; you know—they needed IV antibiotics, wound care, or just time to recover from the intensive care unit. But the utilization review managers were always on our case to discharge them as soon as possible, even when there was no place to send them, and at the same time the hospitals were sending us their sickest patients, with tubes, trachs, vents—you name it.”
Dr. Dan stood up and walked out. I followed him. He meandered down the corridor and looked at each of the metal brackets, now empty of the plants he’d abandoned two years before. Then he went into the nursing station, took the ring of keys from above the file cabinet, and walked through the ward almost to the solarium. There was a door I’d never noticed, and he unlocked it. I saw a narrow room, five or six feet wide, with a steel counter along the wall and a dirty window at its end.
Dr. Dan smiled.
“What’s this for?” I asked.
“I don’t know what it was for originally. But I use it for my plants and my flowers. It’s perfect. When the plants aren’t looking well, I bring them in here and mist them. And I use it to arrange bouquets for the ward. Looks like I’m going to have to run out later today and bring in a whole new set of plants and a lot of flowers.”
Which he did. In the mid-afternoon, he asked me to watch his new patients, and he walked down the hill and took the J trolley to his favorite florist.
Before I left that day, I saw Dr. Dan’s Armani jacket hanging in the office, and I walked over to the little room he’d shown me that morning. Its door was open, and so was its window, now clean. The counter was crowded with green plants in pots, and in the sink were dozens of irises, roses, and gerbera, and various greenery. Dr. Dan, wearing an apron and with scissors in hand, was clipping and cutting and arranging them all into vases he’d found, only he knew where.
When I came in the next morning, the metal brackets were once again filled with green plants, and there were bouquets in the solarium and on the ward. But the doctors’ office was empty and so was the nursing station; the chart rack was gone and the door of the lounge was closed. It was Wednesday, and the team meeting for the patients had started.
I needed a patient’s chart, though, so I knocked on the door and then walked in. There was Dr. Dan, lounging in a peeling deck chair, legs straddled out in front of him, open chart on his lap. He was flipping through it, scanning the notes, and talking about when the patient might be discharged and what medications he would need. After a bit, I realized he was talking about one of my patients.
“What are you doing?” I interrupted.
Dr. Dan did not look up. “I’m discussing Mr. Eks.”
“Mr. Eks is my patient.”
“I know. You weren’t here.”
“Why didn’t you start with your own patients then? You don’t know anything about Mr. Eks.”
“You weren’t here.”
The room got very quiet. Dr. Dan did look up from the chart then,
and we looked right at each other. His eyes, I saw for the first time, were narrow and a flat gray-green. They were cold. Then he turned back to the chart and continued to present Mr. Eks.
I left.
About an hour later he came into our office, but he didn’t sit down.
“Do not present my patients when you know I’m in the hospital,” I told him.
“If you aren’t around, I will present your patients, and if you raise your voice to me, we won’t be able to work together,” he retorted.
I looked up at him—his flat face and flat eyes, and felt his flat, determined will. I took in a deep breath and let it out slowly. Working with Dr. Dan was going to be quite different from working with Dr. Chang, Dr. Fintner, or Dr. Jeffers.
Dr. Dan was one of the few doctors at Laguna Honda—perhaps the only doctor—who was ambitious about a career in health care. As an old almshouse, the hospital was not mainstream, and the ambitious who came to it were ambitious in other areas—in physics, surfing, history—but not in health care. Except for Dr. Dan. And his ambition was limited; he just wanted to be medical director.
He was a farm boy from upstate New York, and though you could take the farm boy out of the farm, you couldn’t take the farm out of the farm boy. Although he dressed with exquisite taste, his time was farm time; his view, a farm view.
He woke at dawn and took the streetcar to the foot of the hospital, then walked up the hill. He left late in the evening, walking down the hill and taking the streetcar home. He didn’t drink or smoke or play around with women or men. On winter evenings at home, he went over hospital reports and went to bed early, and on his days off he came in anyway, strolling in his long-legged way through the wards, reading other doctors’ charts, talking to the nurses. Or he took long walks through the city, over the bridge and out into the country, many miles. And yet, with all his Franklinsonian living, Dr. Dan wasn’t even boring. He told a good story. He had an eye for detail, especially vestimentary, an ear for the ridiculous, and a taste for mockery, which extended to the patients, doctors, and administrators, though not, by and large, to the nurses.
Dr. Dan came from a long line of nurses and probably should have been a nurse himself but, tall and the only son, he went to medical school. Still the stories he told me were of visiting his mother, Head Nurse Stanislaus, in her hospital on Sundays when he was just a little boy, and feeling the romance of her white uniform and cap, her rigorous schedule, and the nursing camaraderie. And though I never met his mother, I couldn’t help but imagine her as cousin to Miss Lester and descendant of those fierce nuns of the Hôtel-Dieu in Paris. He himself was the closest thing we’d had to Miss Lester since Miss Lester.
Dr. Dan loved the nurses and the Way of Nursing, although he didn’t nurse much, not in the way that Dr. Bart did, who, before she was a doctor, had been a nurse—plumping pillows, helping a patient drink through a straw. Dr. Dan didn’t sit on beds, shake hands, or touch patients all that much, but, then, neither did Miss Lester.
And he had the nurse’s attitude toward the doctor: the nurse’s impatience with the doctor’s attention to such small details as a certain pulse and blood pressure, a slightly elevated copper level, or the particular shape of a red blood cell. Dr. Dan, too, suspicioned that medicine was overblown; its careful histories and physicals pretentious and unnecessary.
After a while I began to realize that Dr. Dan was an amazing guy—a whirlwind—and what is that about sowing the wind and reaping the whirlwind?
He was everywhere at once, quick and confident, but also hasty and hotheaded. If he saw his patients, it was in the early morning. He wrote his notes while listening to nursing rounds, and by eight AM had moved on to his duties as co-medical director, conducted at his counter desk.
Hence, for the first time in my years at the hospital, I was privy to its politics—its meetings and secret plans, its backbiting and incompetence. All day long, while I was seeing patients, people showed up at the door of our office with complaints and concerns. Dr. Dan would listen for a minute or two and then prescribe. He didn’t mull over or investigate, but he did cut Gordian knots, order babies partitioned in two, deny, approve, and legislate.
He did not give up his duties as physician on the admitting ward either. He piled up televisions and headphones under his counter desk, and now and then he could be found fitting a patient with a headset. Every Wednesday afternoon he left the hospital to buy flowers, and in the early evening he arranged new bouquets. He ordered furniture for the TV room and solarium, and had the lounge repainted. He spent quite a while with the furniture swatches and paint samples, sitting first in the lounge, then in the TV room, then in the solarium. He wanted to get the colors just right.
He loved the hospital even more than I did and knew it better. It was Dr. Dan who showed me the priest’s flat in the turret, with its heavy wooden door and barred window. It was Dr. Dan who, at Christmas, gave each staff member on the admitting ward, including Rose, our gentle janitor, a hundred-dollar gift certificate and a thank-you note from him. He was never sick; he was devoted and engaged.
It took us a while, but gradually he and I got to know and use each other’s strengths and weaknesses. He covered for me on my days off; I covered for him while he was in his administrative role. Slowly he began to appreciate that my way could be useful and even efficient, and, with the case of Janice Gilroy, he changed his mind about the value of the Way of Medicine.
Somewhat.
Dr. Dan was not the first doctor at Laguna Honda to take care of Janice Gilroy.
At fifty, Ms. Gilroy had come and gone and come back to us many times. She was of the rare breed of Bad Girl and had been saved by modern medicine from the worst consequence of her badness—namely death—but preserved for quite a bit of suffering, as she resided just this side of death. Laguna Honda had always had a few patients like her, but now it had many more, as medicine became more and more amazing, bringing patients back—but just a little back—from the brink.
Ms. Gilroy was a drug abuser, and she would use anything, especially cocaine, marijuana, heroin, and alcohol. Cocaine is especially hard on the body, and Ms. Gilroy had the high blood pressure, kidney disease, and poor circulation to show for it. She had the poor memory of the chronic marijuana user, the bad liver of the heroin user, and the weak heart of the alcoholic. This was in general.
But in particular, she’d had a stroke in the right side of her brain. Now, a stroke on the right side of the brain is both easier and harder than a stroke on the left side of the brain. It is easier because a stroke on the right side of the brain does not injure the left side of the brain, with its capacity for speech. Also, because the brain is cross-wired, a stroke on the right side of the brain does not paralyze the right side of the body, with its usually more dexterous abilities, but the left side, and so is usually less disabling.
But a stroke on the right side of the brain is harder than one on the left because the right side of the brain has something special about it, indefinable and unnamed—a kind of centered cheerfulness—and with a stroke on the right side of the brain, a patient often becomes depressed. So that in addition to being paralyzed on her left side, and in addition to her other disabilities, Ms. Gilroy was also despondent. As an antidote to her depression, she used drugs whenever she could get them, which would upset the delicate balance among her many medications and diseases, and put her right back in the hospital.
When she wasn’t in the hospital, she lived with her daughter, who did not quite understand her mother’s disabilities nor the imperative of keeping her away from drugs. So Ms. Gilroy would stabilize at Laguna Honda, and then her daughter would take her home on a pass or even against medical advice, where she would eat, drink, and be merry, and end up back in the intensive care unit and then back with us. I’d admitted her myself in the past.
But this time it was Dr. Dan who admitted her, and he’d done a good job. He had told her daughter off—there’s no other way to say it—and she’d ma
de herself scarce. Hence, Ms. Gilroy had no access to drugs; she wasn’t eating food that threw her system off; nor was she being taken home clandestinely, though with the best intentions in the world. And she’d improved. Everything about her was just a little bit better—heart, liver, kidneys.
Until this afternoon, Dr. Dan told me, when she’d deteriorated. Actually, it had started three days earlier. At morning nursing rounds he’d heard that Ms. Gilroy was different somehow—moaning, confused, and complaining of pain. So he’d ordered pain medications. But the next day she was worse—agitated and still complaining of pain. So he’d ordered more pain medications and added something for restlessness.
Did he examine her? I asked him.
Not exactly. But he had checked her blood and urine and didn’t find any infection or illicit drugs. Then he asked the psychiatrist to see her, because perhaps the change in her mental status was psychiatric. The psychiatrist did see her and he increased her antipsychotic medications, but still she was no better. She was worse—more restless, agitated, and confused. Dr. Dan had a meeting to attend; would I take a look and try to figure out what was wrong with her?
Wow.
Trying to find the cause for the change in mental status that Dr. Dan described was daunting. Especially in someone as ill as Ms. Gilroy. There were endless possibilities. She would need a brain scan and a bone scan, a spinal tap, perhaps biopsies, and even after those, the complexity of her medical problems would doubtless require another prolonged hospitalization at the country. But Ms. Gilroy came after Steve Harp. So instead of first going through her records, talking to her family and the nurses, and then examining her, I went over to see her for myself. I’d learned from Steve that seeing the real patient was worth a thousand words.
God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine Page 30