by Todd Cohen
Other “Roto-Rooter” type devices were developed, using mechanical or diamond-cutting techniques and even lasers to break up hardened blockages. But no real large-scale breakthrough came with heart blockage-treating medical devices until the invention of the stent. That tiny little expandable piece of metal that would revolutionize my business and expand my practice and the Cath Lab at Mount Sinai. “Hey, I thought I was supposed to get my mind off of work!” I screamed in my head as I slammed my palm against my temple.
We then mopped the bathroom floor. We haven’t had this much togetherness in a long time. Bridget, Jason, and their cousins all helped clean the floor and we all washed up. Then sat in our living room and relaxed to some Seinfeld reruns on our fifty-inch HDTV. A fifty-inch TV that hung like a painting above the fireplace.
Hanging out on our L-shaped sofa, munching on popcorn and laughing to a Seinfeld classic, “Junior Mint!”
Chapter 13
The sun gleamed through the window, awakening me at seven a.m. the next morning. Normally I might pull out a pedal kayak and go out on the bay towards Quogue. Or head out on my trek over the Ponquogue Bridge to Southampton and back. But now I was on a mission.
In order to relieve my mind of the pressures of my job, I headed back to Fred at True Value. Fred was the most sympathetic man I knew, and I was forever grateful for his help last night. Unlike most owners of hardware stores, he was always the consummate gentleman. “Must have been a disgruntled attorney or a former Wall Street guy,” I said sarcastically to myself. But now he was truly interested in helping his customers. I brought him two bottles of Pindar Winter White wine from the North Fork and gave them to him to show my appreciation.
“Fred, what do I need to repair my washer drain? Do you have three 100-foot hosing sections? How about a Kohler showerhead? How do I remove the existing old head and put the new one on, etc. etc.?” I asked.
Fred always had the answer. “You need this roll of plumber’s tape!” “Don’t forget a 12-mm wrench.” “Oh, and by the way, if you have any problems you can call me at 631-288-7777. And don’t hesitate to buzz me after hours if you need anything. You know where I live.”
With my summer vacation at hand, I switched into a more productive mode to get my mind off medicine and our financial struggles. First, I fixed the washer drain, then attached a string of hoses from our house all the way out onto the “T” end of our dock, and finally, I installed a new showerhead in our master bathroom.
With each and every task I felt a new sense of accomplishment!
Chapter 14
Solitude. That’s why I got the place out east in the first place. I seldom see any life in the neighborhood. Most of my neighbors are rarely there, even during the peak summer season. One of the neighbors is a famous African American TV personality whose name I am not at liberty to disclose. “Oh,” but a little hint—she lives in Chicago. I have only seen her house vibrant with life once in the past two years other than with the maintenance crew.
I had just completed my hose hook-up, at the end of my dock, and set up the kayak rack and jumped off the end into the bay to cool off. As I mounted my ladder I looked back at my place and glanced around the bay.
To my right was a six-foot-tall, balding, somewhat-overweight man waving and shouting, “Hey, Doc, can you give me a hand?” It was Charley Weisberg, senior partner at Goldman Sachs. The same guy I’d seen in appearances on Fast Money, Squawk Box, and Morning Joe. But instead of a dark suit and tie, he was wearing Bermuda shorts and a Yale T-shirt, with an orange juice in one hand and a cigar in the other.
I had met Mr. Weisberg a total of four times, including this morning’s encounter. All except one was out back, shouting dock to dock or from my kayak to his dock.
One evening last summer, I had to deliver an errant package to their front door. I walked from my humble abode a short distance down the road, past their front-hedged property and though their driveway’s gate, up their elegant, lit driveway, and rang the door. The door opened, but it was not Mr. Weisberg. No! It was a stylishly dressed woman reminiscent of Princess Grace Kelly, or Audrey Hepburn in the movie Breakfast at Tiffany’s. She had voluptuous blond hair and was wearing a luxurious black evening gown, a pearl necklace, and Christian Louboutin black pumps, with their characteristic red soles.
“Thank you,” she said. “What is your name?”
“Dawson, Matthew Dawson. We moved here a year ago.”
“Sorry, Mr. Dawson, but I have to get back to Charley. Thanks again.” She closed the door without much ado.
She didn’t tell me her name, and I was unsure who she was and what her exact relationship was to Mr. Weisberg. I didn’t even get an invite inside their grand palace! There was no introduction, no “get to know your neighbors,” and especially no “why don’t you and the missus come over for cocktails or wine and cheese?”
Mr. Weisberg was a world traveler for Goldman, working on M&A: that’s mergers and acquisitions, he told me. When Google bought YouTube, I thought that must have been Charley. When Facebook bought Instagram, I also thought of Charley. But I really didn’t know for sure. M&A biz was always so secretive.
And there he was, belly hanging out, in flip-flops and a T-shirt! Waving me down from his immense waterside deck on the back of his massive white-shingled estate.
“Shaw thing,” I replied, while giggling internally from my Alexiev humor. Like a southern accent or an OCD compulsion. “What do you need?”
“I’ve tried my contractor, but I didn’t get a response. I have to get our pool heater started, leaks fixed from the spa as well as the faucet out on the deck—the list is endless! I see you’re having fun out there on your dock, and I thought you might want to give it a try over here?”
“That’s what happens when you only use a place three times a year,” I thought. He had lots of things to fix. I guess that big old maintenance crew he had out there just made the place look well kept. Their estate seemed to be falling apart. That’s at least how he made it seem.
Next thing you know Charley had me helping him out back with all sorts of projects. And boy did I enjoy it. The best distraction ever! Got my mind off medicine. Not a thought of my medical practice or TCT presentation. I was able to mend his Vanderbilt-style Hampton Estate’s backyard woes the same way I used to fix my cardiac patients. After a week of this, I start to wonder:
“Do I return to a dying practice in Manhattan?”
Chapter 15
Back from vacation, I returned to that Mecca of a hospital that towers over Central Park on the Upper East Side of Manhattan in New York City—Mount Sinai Hospital. Typically, I feel refreshed after going to the local beach or kayaking on Quantuck Bay out in the Hamptons. But not this time! My recent break was not a vacation in the usual sense. I wasn’t at all tired from the hard work, lifting, hauling, fixing, and plumbing. I was invigorated. Not my typical vacation, more a retreat for a Home Improvement aficionado. In other words, a boot camp for the home handyman, or maybe perhaps a plumber’s apprentice. But even though I did not do the usual lounging out on our dock or read the latest New York Times best seller, I felt re-energized. I had regained that giddy-up in my step—something that had been missing for quite some time.
I went down to the doctor’s lounge and grabbed a pod of Tully’s French Roast and ran it through the hospital’s Keurig coffee maker. With coffee in hand, I raced up to the Cath Lab to check the schedule. I’ve been the lab director for the past twelve years, during which time I turned a dying program into a bustling cath lab. Not just any cath lab but the biggest and busiest in all New York City. A cath lab is where we “interventionalists” get to unclog blocked arteries and keep them open with those stents that I described earlier. And “stenting” has been a way of life for me, taking care of patients from all over the city and beyond. At least, that was the way it was up until the time hospitals starting buying doctors’ practices.
Let me explain. As a specialized interventiona
l cardiologist, I get my patients, or as we say, referrals, from other more general cardiologists. At least, that is the way it was until my referring-doctor medical practices were acquired by the other competing hospitals—Columbia Presbyterian and NYU. First, it was the Goldberg group, then, the Sachs practice, followed by Terry Waxman’s entire heart center, and almost all the rest went elsewhere. “Business, just business,” I thought.
Chapter 16
Mount Sinai’s Cath Lab consisted of six procedural rooms where all the stenting and complicated heart plumbing procedures took place. There were two additional electrophysiology (EP) rooms where our electrician counterparts implanted their pacemakers and defibrillators. A large, twenty-bed recovery room handled the patients prior to and after their procedures. The lab was staffed with a unique cast of characters. Characters that ran the place, and ran it like a finely tuned machine. Each of the characters had a nickname.
Our coordinator was a tall, stern, somewhat muscular, black-haired Russian nurse named Nina. Her real name was Ninotchka Sangamore. Ninotchka, she told me, was an old Greta Garbo comedy from the late ’30s that was later, in the mid-’50s, made into a Broadway musical called Silk Stockings. Nina was the name of the main character. Neither the film nor the play I had ever heard of. But then Nina proceeded to belt out the show’s hit song: “I love the look of you, the lure of you . . . I’d love to gain complete control of you.”
Ironically, Nina had a surprisingly good voice and was not bashful in showing it off. Had she not been the coordinator of our lab, she might have had a shot at Broadway.
“All of you?” I said back to Nina.
“Yes,” she replied. “Cole Porter and Ella Fitzgerald.”
“I know it from Ol’ Blue Eyes,” I said.
“Sinatra did it well after the show,” she agreed.
As the coordinator, she organized and supervised all the patients’ scheduling, including each and every one of the Mount Sinai Cath Lab nurses. Patient safety was her motto!
“Every patient, every procedure,” Nina would say firmly.
She went from procedural room to procedural room, all inside our complex, repeating this often, each and every day, as she inspected procedural time-outs in which the correct patient and procedure were identified prior to any cath lab procedure. This was a hospital Joint Commission requirement, like a pilot’s checklist before flying an airplane. The transporters were Gabe and Senior. Senior’s son Junior worked in the operating room upstairs. Senior, or “Senior Moment,” was the “real” Jamaican, who always called me the “real Ja-Fakin.” But I thought “Senior” was quite a cruel name because Senior was near retirement age!
Our cardiovascular techs, or CVTs, were the guys and gals who operated our lab’s equipment, including the X-ray equipment used to photograph blockages. The CVTs were headed by none other than Cath Lab Gene. His name was stolen from his sister “EP Jean,” who worked over in a busy EP Lab out on the Island. Cath Lab Gene used to joke about his sister having almost the same name. I thought it humorous when he recounted that her boss used to say, “We worked hard to finally isolate ‘the EP Jean.’” But true to Cath Lab Gene’s name, he was definitely part of the DNA of our lab, if you know what I mean. He was a well-built, former New York City police officer, who had created law and order in midtown Manhattan—the Grand Central Terminal area precinct, to be precise. And for almost the past decade, he has created the same “law and order” in our Cath Lab, along with Nina. His job was also organizing lab staff and equipment, and assuring rapid lab turnover.
The list of name parodies went on and on and on. Fifty folks to run six cath rooms, and all were cranking—stent procedures in two labs, TAVRs (transcutaneous valve replacements) in two, a garden-variety cath procedure in one, and a LARIAT procedure in another. The LARIAT was the lab’s latest procedure. The doctor would tie off a part of the heart where clots can form. The procedure was alleged to prevent strokes. At least, that’s what the manufacturer purported.
As you would have guessed, NONE of these procedures were mine! I couldn’t imagine losing each and every cardiology-referring group to the competition, but that’s the way it went. Yes, Mount Sinai bought some other practices, but their patients went to other large Mount Sinai cardiology groups. Not to me! But I still was the Cath Lab Director, at least for the foreseen future. But how long could I survive with a dwindling patient base? A year, maybe two, tops?
I used to have seven-to-twelve “cath procedures” scheduled daily. Now I was down to one or two a day, max. On my clinic day I used to see up to fifty patients, but now I rarely see as many as fifteen. Talk about depressing. I’m holding on to Mr. Jones, who comes just to tell me about his place in the Heights on Shelter Island, and Mrs. Windsor, who just likes to talk about her cats up in Rye! I am more a psychologist than an invasive cardiologist. How depressing! Was that what I was destined to do? With a Johns Hopkins medical degree and cardiology training at Stanford? I’m playing Freud to a bunch of psychos, not fixing broken hearts as I was trained to.
At least I have my research, I thought. A thought that gave me solace!
Chapter 17
It was October 22, and my presentation was complete. At last, TCT 2012 was here! Just a reminder, TCT stands for “Transcatheter Cardiovascular Therapeutics,” the annual interventional cardiology conference. I grabbed a cab from my home in Port Washington and headed to LaGuardia for a three-hour flight to Miami. I’ve been totally self-absorbed with work leading up to this meeting. I guess it is this perseverance that made me what I am today. But it is not without a cost. At times I’ve lost touch with my family life. This is one of my major flaws. When I get like this, it’s as if they are totally out of my life.
Many years ago, before things totally deteriorated in our marriage, we saw Mary Ann Hanley, the local marriage therapist. Shari put it this way to Mary Ann:
“There can be all this chaos going on at home, and you are totally oblivious to it. MD, I am at my wit’s end and you are so self-absorbed. I was left to deal with the kids, the home, and all our problems. And you would get annoyed if I tried to interrupt your train of thought or your work! I was so irritated with you!”
There has been a cost to my prosperity. In the cab, I pulled myself out of MD-ville and pressed the speed dial on my cell. The phone rang, followed by our answering machine message and a beep.
“Hey guys, just leaving for my meeting. Thinking of you. Love you guys!”
LaGuardia was a bit of a pit, at least compared to Miami International. When I hit Miami, I folded my sport jacket and threw it into my briefcase alongside my MacBook Air. I walked out of the airport through baggage claim towards ground transportation. There was a middle-aged man of medium build with curly grey hair sporting a captain’s hat, holding a sign that read, “Dawson.”
As I walked toward him, we locked eyes.
“Dr. Dawson?” he said in a slightly high-pitched voice with a Spanish accent.
“Yes,” I responded.
“I am Eli from South Beach Livery. Dr. Smillar arranged for me to take you to the convention.”
“Eli, very nice to meet you.”
The conference organizer was kind enough to arrange a car service to pick me up and take me over to the Miami Convention Center. Unlike New York, which was grey and cloudy and 48 degrees Fahrenheit, Miami was sunny, without a cloud in the sky, and 72 degrees.
“Dr. Dawson, where’s your home?”
“Near New York City. On Long Island.” I was still perplexed by his accent. Central or South America perhaps?
“Where, Doc?” Now with his high-pitched voice, he sounded a little like Mel Blanc’s Bugs Bunny. Especially with adding the Doc!
“A little town called Port Washington,” I retorted.
“You’re kidding.” Eli chuckled.
“What do you mean?” I inquired.
“My family still lives in Port; wife and kids, that is. I relocated to Florida while my wife is trying to sell my house in Salem.
”
Salem was a nice, quiet area in Port Washington. Modest homes, but a great place to raise a family.
“Port’s just too expensive, Doc. Hard to get by even with two incomes with those property taxes. I had to find a place down here. Much cheaper real estate and no property taxes.
“I agree.” Eli was right on the money, so to speak. Long Island in general was much more expensive than the rest of the country.
“Maybe you know my wife? She is a schoolteacher in Schreiber? Vicky Sephardic. She teaches English.”
“My daughter had an English teacher named Vicky. Loved her!” Must have been the one, I thought.
Eli took my briefcase and threw it in the back of his black Lincoln Town Car. I hopped in the back and then we proceeded to drive due eastward.
“Hey, by the way, where are you from originally?” I just had to ask.
“Venezuela. Though I spent some time in Israel as well. Perhaps you hear some of that in my voice as well? Been driving in this great country for many years.”
“You have a unique twang. I just couldn’t piece it together. Where are you from precisely? Caracas?” That was the only place I knew in Venezuala. Closest I’ve ever been was Aruba, where I fished off the Venezuelan coast and felt their strong trade winds. I knew it was the capital, but did not know any place else in that Commie country. Also knew it was a third world place. Poor as hell!