by Robin Cook
“And indeed they should be.”
Laurie smiled wryly at Jack’s humor. “You are never going to change.”
“I disagree. I can tell I’ve changed. I might be a tad late, but I’m glad I’m here. Will you marry me?”
Laurie’s smile broadened. “Yes, of course. That’s been my intention for more years than I care to admit.”
“I can’t tell you how thankful I am that you were willing to wait.”
“I suppose you have some elaborate explanation for this anxious, down-to-the-wire arrival.”
“I’m looking forward to telling you. Frankly, the denouement in Boston has me stunned. It’s a story you are not going to believe.”
“I’m looking forward to hearing it,” Laurie said. “But now you’d better get into the church and up onto that altar. Your best man, Warren, is fit to be tied. Fifteen minutes ago, he was out here and said he was, quote, ‘going to whip your ass.’ “
Laurie propelled Jack forward into the interior of the church, where he was engulfed by the organ music. For a moment he hesitated, looking down the length of the impressive nave. He was overwhelmingly intimidated. The right side of the church was packed, with hardly a seat available, whereas the left was nearly empty, although Jack saw Lou Soldano and Chet. Ahead at the altar stood the priest, or reverend, or pastor, or rabbi, or imam: Jack didn’t know and didn’t care. He was not thrilled by organized religion and did not feel one was any better than another. Next to the clergyman stood Warren, and even from a distance, he looked impressive in his tuxedo. Jack took a deep breath for fortitude and started forward into a whole new life.
The rest of the ceremony was a blur for Jack. He had to be pushed and nudged in this direction or that or whispered to in an attempt to get him to do what was required. Because of his being in Boston, he’d missed the rehearsal, so from his perspective, it was all ad lib.
The part he liked the best was running out of the church, because it meant the ordeal was over. Once in the car, he had a rest, but it was much too short. The drive from the church to Tavern on the Green and the reception was only a quarter of an hour.
The reception was less intimidating than the wedding, and in different circumstances of being less exhausted, he almost would have found it enjoyable. Particularly after a heavy meal including wine and some obligatory dancing, Jack was beginning to fade. But before he did so, he needed to make a call. Excusing himself from his table, he found a relatively quiet spot at the restaurant’s entrance. He punched in Alexis’s cell phone number and was pleased when she answered.
“Are you married?” Alexis asked as soon as she knew it was Jack.
“I am.”
“Congratulations! I think it’s wonderful and I’m very happy for you.”
“Thank you, sister,” Jack said. “I particularly wanted to call to apologize for my role in creating more turmoil in your life. You invited me to Boston to help Craig and thereby help you, and I ended up doing the opposite. I’m terribly sorry. I feel complicit.”
“Thank you for apologizing,” Alexis said. “I surely don’t hold you responsible for Craig’s behavior and for it being exposed. I truly believe it would have eventually. And to be entirely honest, I’m glad to know. It will make my decision-making much easier.”
“Did Craig reappear in court?”
“No, he didn’t, and I still have no idea where he is. There is a warrant for his arrest, and the police have already appeared at the house with a search warrant. They have confiscated all his papers, including his passport, so he’s not going far. Wherever he is, he’s just putting off the inevitable.”
“Surprisingly enough, I feel sorry for him,” Jack said.
“I feel sorry for him as well.”
“Has he tried to see the children or call?”
“No, he hasn’t, although that doesn’t surprise me. He’s never been close to the children.”
“I don’t think he’s ever been close to anyone, except maybe you.”
“In retrospect, I don’t think he was even close to me. It’s a tragedy, and I personally believe his father shares a portion of the blame.”
“Please keep me posted!” Jack said. “We’re heading out on our honeymoon, but I’ll have my cell phone.”
“I did learn something else disturbing this afternoon. A week ago, Craig had refinanced our house, taking out several million dollars.”
“Could he do that without your signature?”
“He could. Back when we bought the house, he insisted it be in his name only. He gave me some excuse about taxes and insurance, but at the time I didn’t care.”
“Did he take it in cash?” Jack questioned.
“No, I’ve been told it was wired to a numbered offshore account.”
“If you need cash, let me know. I have more than I’ve ever had, thanks to not spending even a pittance of my salary for the last decade.”
“Thank you, brother. I’ll keep that in mind. We’ll make out fine, although I might have to augment my salary with some private practice.”
After a few endearments, Jack disconnected. He did not return to the party immediately. Instead, he thought about the unfairness and capriciousness of life. While he was looking forward to a honeymoon with Laurie and a promising future, Alexis and the children were staring at uncertainty and emotional pain. It was enough, Jack thought, to make someone an epicurean or very religious, one extreme or the other.
Jack stood up. He opted for the former and was interested in getting Laurie home.
EPILOGUE
HAVANA, CUBA
Monday, June 12, 2006
2:15 p.m.
Jack had wanted to take Laurie to someplace unique and off the beaten path for their honeymoon. He’d thought of someplace in Africa, but decided it was too far. He’d thought of India, but that was worse, as far as distance was concerned. Then someone suggested Cuba. At first Jack had dismissed the idea because he thought it couldn’t be done, but going on the Internet, he soon learned he was wrong. A number of people, but not too many, were going to Cuba through Canada, Mexico, or the Bahamas. Jack had chosen the Bahamas.
The flight from New York to Nassau on Saturday, the day after the wedding, had been ho-hum, but the one from Nassau to Havana on Cubana Airlines had been livelier and entertaining, and had given them an early taste of the Cuban mentality. Jack had arranged for a suite in the Hotel Nacional de Cuba, sensing it would have a hint of old Cuban charm. They hadn’t been disappointed. It was sited on the Malecón in the Vedado section of old Havana. Although some of the amenities were dated, the original Art Deco splendor shone through. Best of all, the service was a joy. Contrary to what Jack might have thought, the Cubans were a happy people.
Thankfully, Laurie had yet to insist on more sightseeing than relaxing walks through the old, central section of Havana, which had been restored for the most part. Several of their strolls had taken them beyond the restored area and into sections where the buildings were in a sad state of disrepair yet still with a vague hint of their original grandeur.
For the most part, both Jack and Laurie had been content to sleep and eat and lie in the sun. Such a schedule had given Jack adequate time to tell Laurie the details of what had happened in Boston as well as to discuss the situation at length. Laurie was sympathetic to everyone, including Jack. She’d called it an American medical tragedy. He’d agreed.
“How about we arrange for a tour into the countryside,” Laurie suggested suddenly, breaking into Jack’s rejuvenating, mindless repose.
Jack shielded his eyes from the sun and turned to look at his new wife. Both were reclining poolside on white lounge chairs. Both were clad in bathing suits and mutually slathered in SPF forty-five sunblock. Laurie was regarding him with eyebrows raised. He could just see them over the top of her sunglasses.
“Do you really want to sacrifice this wonderfully indolent life?” Jack questioned. “If it’s this hot seaside, it will be like an oven in the countryside.”
“I suppose,” Jack said without a lot of enthusiasm. Just thinking about the heat of the island’s interior made him feel thirsty. He sat up. “I’m going to get something to drink. Want me to bring you back something?”
“Are you going to have one of those mojitos?”
“I’m tempted,” Jack said.
“You really are on vacation,” Laurie said. “All right. If you’re game, I am, too. I just might have to nap this afternoon.”
“Nothing wrong with that,” Jack said. He got to his feet and stretched. What he really needed to do was rent a bike and go for a serious ride, but that thought stayed with him only halfway to the bar. Lazily, he decided he’d look into it tomorrow.
Catching the eye of one of the bartenders, Jack ordered the two drinks. It was exceptional for him to drink at all, much less in the afternoon, but he’d been encouraged to try it the day before, and he’d enjoyed the utterly relaxed feeling the alcohol had given him.
While he waited, Jack’s eyes wandered around the pool area. There were a few women with world-class figures that encouraged a brief appreciative glance. His eyes then wandered out to the broad expanse of the Caribbean Sea. There was a slight, silky breeze.
“Your drinks, sir,” the bartender said, catching Jack’s attention. Jack signed the check and picked up his drinks. As he started to turn back toward the pool, his eyes caught the face of a man across the peninsula-shaped bar. Jack did a double take. He leaned forward and unabashedly stared. The man’s eyes briefly engaged Jack’s, but without recognition, and were soon redirected to the handsome Latin woman sitting next to him. Jack watched him laugh with easy grace.
Jack shrugged, turned again, and started back to his lounge chair, but he got only a few steps before he turned again. Making up his mind to get a closer look, Jack walked around the bar and approached the man from the rear. He advanced until he was directly behind the individual. He could hear him speaking. It was passable Spanish, certainly better than Jack could muster.
“Craig?” Jack said, loud enough for the man to hear, but the individual did not turn around. “Craig Bowman,” Jack said a tad louder. Still there was no response. Jack looked down at the two drinks he was holding, which were restricting his options. After another short debate, Jack leaned into the bar on the side of the man opposite his companion. Jack put one of the drinks on the bar and tapped the man on the shoulder. The man swung around and met Jack’s gaze. There was no recognition, only a question with eyebrows raised and forehead furrowed.
“Can I help you?” the man questioned in English.
“Craig?” Jack questioned, watching the man’s eyes. As a former ophthalmologist, Jack tended to look at people’s eyes. The same way they often gave hints of general illness, they could give hints of emotion. Jack saw no change. The pupils remained exactly the same size.
“I believe you have me confused with someone else. My name is Ralph Landrum.”
“Sorry,” Jack said. “I didn’t mean to be a pest.”
“No problem,” Ralph said. “What’s your name?”
“Jack Stapleton. Where are you from?”
“Boston originally. How about yourself?”
“New York City,” Jack said. “Are you staying here at the Nacional?”
“No,” Ralph said. “I’ve rented a house just out of town. I’m involved in the cigar business. How about yourself?”
“I’m a medical doctor.”
Ralph leaned back so Jack could see his lady friend. “This is Toya.”
Jack shook hands with Toya across the front of Ralph.
“Nice to meet you both,” Jack said after stumbling through a little Spanish for Toya’s benefit. He picked up his drink. “Sorry to be intrusive.”
“Hey, no problem,” Ralph said. “This is Cuba. People expect you to talk with them.”
With a final nod, Jack took his leave. He skirted the bar and returned to Laurie. She pushed herself up on one elbow and took one of the drinks. “It took you long enough,” she said jokingly.
Jack sat down on his lounge chair and shook his head. “Have you ever run across someone, and you are sure they are someone you know?”
“A few times,” Laurie said, taking a sip of her drink. “Why do you ask?”
“Because it just happened to me,” Jack said. “Can you see that man talking with that buxom woman in red on the other side of the bar?” Jack pointed toward the couple.
Laurie pulled her feet around, sat up, and looked. “Yeah, I can see them.”
“I was sure that was Craig Bowman,” Jack said with a short laugh. “He looks enough like him to be his twin.”
“I thought you said Craig Bowman had sandy-colored hair similar to yours. That fellow has dark hair.”
“Well, except for the hair,” Jack said. “It’s incredible. It makes me question my impressions.”
Laurie turned back to Jack. “Why is it so incredible? Cuba would be a good place for someone like Craig to go. There is certainly no extradition treaty with the United States. Maybe it is Craig Bowman.”
“No, it’s not,” Jack said. “I had the nerve to ask him and watch his response.”
“Well, don’t let it worry you,” Laurie said. She regained her reclining position, drink in hand.
“It’s not going to worry me,” Jack said. He, too, lay back on his chair. But he couldn’t get the coincidence out of his mind. All at once, he had an idea. Sitting up, he fumbled in the pocket of his robe and pulled out his cell phone.
Laurie had sensed his sudden motion and opened one eye. “Who are you calling?”
“Alexis,” Jack said. She answered but told Jack she couldn’t talk and that she was between sessions.
“I just have a quick question,” Jack said. “Do you by any chance know a Ralph Landrum from Boston?”
“I did,” Alexis said. “Listen, Jack, I really have to go. I’ll call you in a couple of hours.”
“Why did you put it in the past tense?” Jack asked.
“Because he died,” Alexis said. “He was one of Craig’s patients who died of a lymphoma about a year ago.”
AUTHOR’S NOTE
Concierge medicine (also known as retainer medicine or boutique medicine or luxury primary care) is a relatively new phenomenon that first appeared in Seattle. As described in Crisis, it is a style of primary-care medical practice that requires an annual membership fee that varies from hundreds to many thousands of dollars per person (the median being about $1,500 and the maximum about $20,000). In order for this fee not to be construed as a health-insurance premium, which would be against regulations, the patient is offered a laundry list of specified medical attention or services not covered by health insurance, for example, elaborate yearly physicals, preventive care, nutrition counseling, and individually tailored wellness programs, to name a few. But the real perk stems from the physician’s guarantee to limit enrollment in the practice to a number far less than usual, making possible special amenities and special access to standard medical services (but not payment, which remains the responsibility of the patient either through health insurance or out of pocket).
The amenities might include: a very personal doctor-patient relationship, unhurried appointments that are as long as needed, nicer and uncrowded reception areas (not called waiting rooms since as an amenity waiting is to be avoided), house calls or patient office visits if appropriate and desirable, facilitation of appointments to needed specialists and immediate consultation, and even possible travel by the doctor to distant locales if the patient becomes ill or injured on a trip. Special access includes same-day appointments if needed or certainly within just a day or so, and twenty-four-hour doctor accessibility with the doctor’s cell phone, home phone, and e-mail address.
There have been a few articles about conci
erge medicine in professional journals as well as in The New York Times and other mass-media publications, but, for the most part, the slowly burgeoning practice style has gone unnoticed by the vast majority of the public. I believe this will and should change, because concierge medicine is yet another subtle but significant symptom of a healthcare system that is out of whack since good, patient-oriented medicine used to be available, and should be available, without a considerable up-front fee. More important, it is common knowledge that there are already significant inequities involving healthcare access worldwide, and one doesn’t have to be the proverbial “rocket scientist” to understand that concierge medicine will make a bad situation only that much worse: Those doctors practicing in this style will, by definition, see far fewer patients, and all those patients who do not come up with the retainer fee for whatever reason will face less choice in a further constrained system. Indeed, a handful of U.S. senators officially complained to the Department of Health and Human Services about the phenomenon’s potential impact on limiting the ability of Medicare recipients to find a primary-care physician. In response, the Government Accountability Office issued a report in August 2005 suggesting that concierge medicine was not yet a problem, but that the trend would be monitored. The implication was that there will be a problem as the practice style mushrooms. Unfortunately, I can personally attest that it has already reached this situation in Naples, Florida, where concierge medicine has taken root. Currently in Naples, it is difficult for a new Medicare patient to find a physician without anteing up the requisite concierge retainer, or paying an exorbitant, out-of-pocket yearly physical fee, or opting out of Medicare altogether. Although Naples is admittedly a unique community economically, I believe it is a harbinger of what is to come in other communities both in the U.S. and internationally as well.
Although there have been articles about concierge medicine, none that I have read have truly addressed the question of why this phenomenon has emerged at this particular time. What is usually offered are economic explanations revolving around the idea that concierge medicine makes sense from a marketing perspective. After all, provided he or she can afford it, who wouldn’t want the promised amenities, considering what the experience of going to the doctor is like all too often in today’s world, and what physician wouldn’t prefer to have financial security right out of the starting gate and to be able to practice the unhurried medicine they learned in medical school? Unfortunately, this superficial answer doesn’t explain why the phenomenon makes sense now and didn’t, say, twenty years ago. It is my belief that the real answer is that concierge medicine is a direct result of the dire, unprecedented state of disarray in current healthcare on a worldwide basis. In fact, there are those who evoke the metaphor of the perfect storm to describe the current situation, particularly in the United States.