by Robin Cook
“It’s a beautiful house,” Jack commented. In his mind it was more than beautiful. Compared to how he had been living over the last ten years, it was the epitome of luxury.
“Craig has been a wonderful provider, as I said on the phone,” Alexis said as she poured the pasta into a colander.
“Where is he?” Jack questioned. No one had mentioned his name. Jack assumed he was out, perhaps on an emergency medical call or possibly conferring with his attorney.
“He’s asleep in the upstairs guest room,” Alexis said. “As I implied, we’re not sleeping together and haven’t been since he left to live in town.”
“I thought maybe he was out on a medical call.”
“No, he’s free of that for the week. He’s hired someone to cover his practice during the trial. His attorney recommended it. I think it’s a good thing. As dedicated a doctor as he is, I wouldn’t want him for my doctor right now. He’s too preoccupied.”
“I’m impressed he’s asleep. If it were me, I’d be up, pacing the house.”
“He’s had a little help,” Alexis admitted. She brought the pasta and salad over to the table and put it in front of Jack. “It was a hard day with the opening of the trial, and he’s understandably depressed. I’m afraid he’s been self-prescribing sleeping pills to deal with insomnia. There’s also been some alcohol: scotch, to be exact, but not enough to worry about, I don’t think. At least not yet.”
Jack nodded but didn’t say anything.
“What would you like to drink? I’m going to have a glass of wine.”
“A little wine would be nice,” Jack said. He knew more than he wanted to about depression. After the plane crash, he’d fought it for years.
Alexis brought over an opened bottle of white wine and two glasses.
“Did Craig know I was coming?” Jack asked. It was a question he should have asked before he’d agreed to come.
“Of course he knew,” Alexis said while pouring the wine. “In fact, I discussed the idea with him before I called you.”
“And he was okay with it?”
“He questioned the rationale but said he’d leave the decision up to me. To be truthful, he wasn’t excited about it when we discussed it, and he said something that surprised me. He said he thought you disliked him. You never said anything like that, did you?”
“Absolutely not,” Jack said. As he began to eat, he wondered how far to take the conversation. The truth of the matter was that back when Alexis and Craig had gotten engaged, he didn’t think Craig was appropriate for Alexis. But Jack had never said anything, mainly because he thought, without knowing exactly why, that doctors in general were a poor risk, marriagewise. It was only relatively recently that Jack’s tortured road to recovery had given him the insight to explain his earlier gut reaction—namely, that the whole medical training process either selected narcissistic people or created them, or some combination of the two. In Jack’s estimation, Craig was the poster boy in this regard. His single-minded dedication to medicine almost guaranteed that his own personal relationships would be correspondingly shallow, a kind of psychological zero-sum game.
“I told him you didn’t feel that way,” Alexis continued. “In fact, I said you admired him because you told me that once. Am I remembering correctly?”
“I told you I admired him as a consummate physician,” Jack said, aware that he was being mildly evasive.
“I did qualify it by saying you were envious of his accomplishments. You did say something to that effect, didn’t you?”
“Undoubtedly. I have always been awed by his ability to do real, publishable basic-science research while handling a large, successful clinical practice. That is the romantic goal of a number of physicians who never even come close. I made a stab at it back when I was an ophthalmologist, but in retrospect, my supposed research was a joke.”
“I can’t imagine that’s true, knowing what I do about you.”
“Getting back to the critical issue, how does Craig feel about me actually being here? You really didn’t answer that.”
Alexis took a sip of her wine. It was apparent she was considering the answer, and the longer she paused while doing so, the more uneasy Jack became. After all, he was a guest in the man’s house.
“I suppose my not answering it was deliberate,” she admitted. “He’s embarrassed to be asking for help, as you suggested he might be on the phone. There’s no doubt he sees dependency as a weakness, and this whole affair has made him feel totally dependent.”
“But I have a feeling he’s not the one asking for help,” Jack said. He finished his pasta and started in on his salad.
Alexis put her wineglass down. “You are right,” she said reluctantly. “I’m the one who’s asking for help on his behalf. He’s not all that happy about you being here because he’s embarrassed. But I’m ecstatic you are here.” Alexis reached across the table and took Jack’s hand. She squeezed it with unexpected ferocity. “Thank you for caring, Jack. I’ve missed you. I know it’s not the best time for you to be away, and that makes it even more special. Thank you, thank you, thank you.”
A sudden flash of emotion washed over Jack, and he felt his face flush. At the same time, the avoidant nature of his personality kicked in and asserted itself. He detached his hand from Alexis’s, took a gulp of wine, then changed the subject. “So, tell me about the opening day of the trial.”
Alexis’s slight smile turned up the corners of her mouth. “You are smooth, just like the old days! That was an impressively quick U-turn from an emotionally charged arena. Did you think I might not notice?”
“I keep forgetting you’re a psychologist,” Jack said with a laugh. “It was an instinctual reaction for self-preservation.”
“At least you admit to your emotional side. Anyway, about this trial, all that’s happened so far are the two opening statements by the opposing attorneys and the testimony of the first witness.”
“Who was the first witness?” Jack finished the salad and picked up the wineglass.
“Craig’s accountant. As Randolph Bingham explained later, the whole reason he was included was merely to establish that Craig owed a duty to the deceased, which was easy, since the deceased had paid the retainer fee, and Craig had been seeing her on a regular basis.”
“What do you mean ‘retainer fee’?” Jack asked with surprise.
“Craig switched from a traditional fee-for-service practice to a concierge practice almost two years ago.”
“Really?” Jack questioned. He’d had no idea. “Why? I thought Craig’s practice was booming, and he loved it.”
“I’ll tell you the main reason even if he won’t,” Alexis said, moving herself in closer to the table as if she was about to reveal a secret. “Over the last number of years, Craig has felt he has been progressively losing control of patient decisions. I’m sure you know all this, but with more and more involvement of insurance companies and various health plans with cost containment, there’s been more and more intrusion into the doctor-patient relationship, essentially telling doctors what they can and cannot do. For someone like Craig, it has been a progressive, ongoing nightmare.”
“If I were to ask him why he made the change, what reason would he give?” Jack questioned. He was fascinated. He’d heard of concierge medicine, but he thought it was a small fringe group or a mere trendy quirk in the system. He’d never talked with a doctor who practiced in such a setting.
“He wouldn’t admit he’d ever compromised a patient decision because of outside influence, but he’d be fooling himself. Just to keep his practice solvent, he had had to see progressively more patients in any given day. The reason he gives for switching to concierge medicine is that it affords him the opportunity to practice medicine the way he was taught in medical school, where he could spend as much time as needed with each patient.”
“Well, it’s the same thing.”
“No, there’s a subtle difference, although there’s an aspect of rationalization on
his part. The difference is between a negative push and a positive pull. His explanation emphasizes the patient.”
“Is the style of his practice playing a role in the malpractice case?”
“Yes, at least according to the plaintiff’s attorney, who I have to say is performing better than anticipated.”
“How do you mean?”
“To look at him, and you’ll see for yourself if you come to the courtroom, you’d not imagine on first glance he’d be effective. How should I say this: He’s a composite stereotype of the tawdry, ambulance-chasing personal-injury lawyer and the mafioso defense attorney, about half Craig’s defense attorney’s age. But he’s relating to the jury in a surprisingly effective manner.”
“How is Craig’s practice style supposed to play into the case? Did the plaintiff’s attorney address it in his opening statement?”
“Absolutely, and very effectively. The whole concept of concierge medicine is predicated on being able to satisfy patient needs, like a concierge at a hotel.”
“I get the association.”
“To that end, each patient has access to the doctor through cell phone and/or e-mail so that they can contact the doctor at all hours and be seen if necessary.”
“Sounds like an invitation to abuse on the part of the patient.”
“I suppose with some patients. But it didn’t bother Craig. In fact, he seemed to like it because he started making house calls at off-hours. I think to him there was something retro and nostalgic about it.”
“House calls?” Jack questioned. “Making house calls is usually a waste of time. As a modern-age doctor, you’re so limited in what you can do.”
“Nonetheless, some of the patients love it, including the deceased. Craig had seen her often after hours. In fact, he had seen her at her home the morning of the very day the malpractice was supposed to have occurred. That evening she took a turn for the worse, and Craig made a house call.”
“It seems to me it would be hard to find fault with that.”
“One would assume so, but according to the plaintiff’s attorney, it was Craig’s making the house call rather than sending the patient to the hospital that caused the malpractice, since it delayed the diagnosis and emergency treatment of a heart attack.”
“That seems absurd,” Jack said indignantly.
“Not when you hear it coming from the plaintiff’s attorney during his opening statement. You see, there are other circumstances surrounding the episode that are important. It happened when Craig and I were officially separated. At the time, he was living in an apartment in Boston with one of his nubile secretary-cum-file clerks named Leona.”
“Good God!” Jack exclaimed. “I don’t know how many stories I’ve heard of married physicians having affairs with their office help. I don’t know what it is about male medical doctors. In this day and age, most men in other endeavors know not to date their employees. It’s asking for legal troubles.”
“My sense is you are being too generous to the middle-aged married males who find themselves locked in a reality that didn’t live up to their romantic expectations. I think Craig falls into such a group, but it wasn’t Leona’s twenty-three-year-old body that was the initial lure. It was, ironically enough, the change to the concierge practice, which provided something he’d never had: free time. Free time can be a dangerous thing for someone who’d spent half of his life as single-minded as Craig. It was like he woke up and looked at himself in the mirror and didn’t like what he saw. All of a sudden he had this manic interest in culture. He wanted to make up for lost time and become overnight his image of a well-rounded person. But it wasn’t enough for him to do it alone like a hobby. Just as he did with medicine, he wanted to indulge it with one hundred percent effort, and he insisted I go along with it. But obviously I couldn’t, not with my job and the responsibility of the girls. That’s what drove him out, at least as far as I know. Leona came later, as he realized he was lonely.”
“If you’re trying to make me feel sorry for him, it’s not going to work.”
“I just want you to know what we’re up against. The plaintiff’s attorney knows that Craig and Leona had tickets for the symphony on the night the plaintiff’s wife died. He says witnesses will prove that Craig made the house call even though he suspected the patient had a heart attack on the outside chance it wasn’t. If he had found that to be the case, he would have been able to make the concert. Symphony Hall is closer to the plaintiff’s house than Newton Memorial Hospital.”
“Let me guess—this Leona is scheduled to be a witness.”
“Of course! She’s now the spurned lover. To make matters worse, she is still working in Craig’s office and he can’t fire her for fear of another lawsuit.”
“So the plaintiff’s attorney is contending that Craig put the patient at risk by playing the odds against the possible diagnosis.”
“That’s essentially it. They’re saying that it’s not up to the standard of care in terms of making a timely diagnosis, which for a heart attack is critical, as events have shown. They don’t even have to prove that the woman would have survived had she been taken to the hospital immediately, just that she might have. Of course, the cruel irony is that the allegation is diametric to Craig’s practice style. As we’ve said, he’s always put patients first, even before his own family.”
Jack ran a hand through his hair in frustration. “This is more complicated than I thought it would be. I assumed the question revolved around some specific medical issue. This kind of case means there is even less chance of my being any help than I thought.”
“Who knows?” Alexis said fatalistically. She pushed back from the table, went over to the service desk, and hefted a sizable manila envelope stuffed with papers. She brought it back to the table and plopped it down. It made a resounding thump. “Here’s a copy of the case I put together. It’s pretty much everything, from interrogatories to depositions to medical records. The only thing that’s not included is a transcript of today’s proceeding, but I’ve given you a good idea of what was said. There’s even a couple of Craig’s recent research papers he suggested I include. I don’t know why: maybe to save face, imagining you’ll be impressed.”
“I probably will be if I can understand them. Anyway, it looks like I have my work cut out for me.”
“I don’t know where you want to work. You have a lot of choices. Can I show you a few alternatives besides your room downstairs?”
Alexis led Jack on a tour of the first floor of the house. The living room was huge but appeared uncomfortably pristine, as if no one had ever stridden across its deep pile carpet. Jack nixed that. Off the living room was a mahogany-paneled library with a wet bar, but it was dark and funereal with poor lighting. No thanks! Down the hall was a media room with a ceiling-mounted projector and several rows of La-Z-Boy chairs. Inappropriate, and worse lighting than the library. At the end of the hall was a sizable study with matching his-and-hers desks on opposing walls. His desk was neat, with each pencil in a pencil cup sharpened to a needlelike point. Her desk was the opposite, with haphazard stacks of books, journals, and reprints. There were several reading chairs and hassocks. A bow window similar to the one in the great room looked out onto a flower bed with a small fountain. Directly opposite the window was floor-to-ceiling shelving on either side of the entrance door. Among a mixture of medical and psychology texts was Craig’s old-fashioned leather doctor’s bag and a portable ECG machine. As far as being a work area, the best thing about the room was the lighting setup, with recessed ceiling fixtures, individual desk lamps, and floor lamps by each club chair.
“This is a terrific space,” Jack said. “But are you sure you don’t mind me in your personal study?” He switched on one of the floor lamps. It cast a wide, warm glow.
“Not in the slightest.”
“What about Craig, since it’s his space, too?”
“He wouldn’t mind. One thing I can assure you about Craig. He’s not territorial.”
“As the saying goes, knock yourself out. I’m off to bed. With the need to get the kids off to school, tomorrow comes early around here. There are plenty of drinks in the kitchen refrigerator and more in the wet bar, so help yourself.”
“Terrific! I’m all set.”
Alexis let her eyes wander down Jack’s frame, then back to his face. “I have to tell you, brother, you look good. When I visited you out in Illinois, and you had your ophthalmology practice, you looked like a different person.”
“I was a different person.”
“I was afraid you were going to become overweight.”
“I was overweight.”
“Now you look hale, hungry, and hollow-cheeked, like an actor in a spaghetti western.”
Jack laughed. “That’s a creative description. Where did that come from?”
“The girls and I recently watched some old Sergio Leone movies. It was an assignment for a film class Tracy’s taking at her school. Seriously, you look like you’re in good shape. What’s your secret?”
“Street basketball and bike riding. I treat them like second careers.”
“Maybe I should give them a try,” Alexis said with a wry smile. Then she added: “Good night, brother. See you in the morning. As you might expect, it’s always a bit chaotic with three girls.”
Jack watched Alexis walk down the hall and then with a final wave disappear up the stairs. He turned around and scanned the room again. A sudden silence descended like a blanket. The place looked and smelled so different from his own surroundings, it could have been on a different planet.
Somewhat self-conscious about being in someone else’s space, Jack sat down in the easy chair illuminated by the floor lamp. The first thing he did was take out his cell phone and turn it on. There was a message, and it was from Warren, with the promised name and phone number of his friend in Boston. The name was David Thomas, and Jack called immediately, thinking he might be in need of exercise if the morrow turned out to be as stressful as he feared. Alexis’s evasiveness about Craig’s response to Jack’s visit was enough to make anyone feel less than welcome.