The Tennis Partner, page 1
Dedication
For my sons, Steven, Jacob, and Tristan, and especially for Sylvia
* * *
In memory of David Smith, M.D., 1959–1994, James Searcy, 1936–1995, and Adolph Sanchez, 1950–1996
Contents
Cover
Title Page
Dedication
Prologue
Part I
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Part II
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
Chapter 35
Chapter 36
Chapter 37
Chapter 38
Chapter 39
Part III
Chapter 40
Chapter 41
Chapter 42
Chapter 43
Chapter 44
Chapter 45
Chapter 46
Chapter 47
Chapter 48
Chapter 49
Chapter 50
Acknowledgments
P.S. Insights, Interviews & More . . .
About the Author
About the Book
Read On
Praise
Also by Abraham Verghese
Copyright
About the Publisher
Prologue
He had started rounds at five-thirty in the morning, working his way from one room to the next, writing progress notes as he went. He was at the bedside of his last patient when his beeper went off.
When he saw the number displayed, his throat constricted. A crimson flush spread up his neck, to his cheeks. The elderly woman with Crohn’s disease and a short-bowel syndrome, who quite liked this blond, boyish doctor, looked up at him with concern. A minute ago he had been listening to her heart; now she could almost swear she heard his.
He staggered out into the corridor, and stood there, leaning on the chart rack. He took a step in the direction of the stairwell. Then stopped. Then took another step that way. Then turned back.
The flush on his face retreated, taking every drop of color from his skin until it matched the whiteness of the walls. His world and his vision narrowed and he was unaware of the nurse who walked by him.
He did not notice that his patient had come out of the bed, pushing her IVAC pump before her, the yellow, white, and clear bags dangling from their hooks. She stood staring at him through the doorway.
With great difficulty he wheeled the charts back to the nurses’ station and took up his pen in a peculiar four-fingered, childlike grip. His hand trembling, he brought the progress note he was writing to a close. To anyone but a nurse, his handwriting would have been completely illegible.
He did not answer the page from the phones nearby. Instead, he took the elevator down from the fifth floor to the lobby and walked directly to Dr. Lou Binder’s office.
Binder was waiting for the phone to ring. When he saw the intern in his doorway, he stood up. Before the intern could so much as open his mouth, Binder said, “Let’s go to the lab.”
But the intern could not move. He held Binder’s gaze for a second, then his face crumpled, his shoulders sagged, and he slumped into a chair in front of Binder’s desk.
“What have you done?” Lou asked, softly.
The intern sobbed, but no words came out.
* * *
An hour later, the two of them were at the El Paso International Airport, boarding a plane. Dr. Binder had not allowed him to go home for clothes. He had given one of his own jackets to the intern to put over his scrubs. The intern called his girlfriend from a pay phone but again the sobs robbed him of words. “I’m sorry” was all he could manage.
On the plane, a flight attendant had to remind him twice to put on his seat belt. He stared out the window as the plane took off, then made a steep, banking left turn allowing him to see the hospital clearly, and a few blocks beyond it, the Rio Grande, and Juárez, Mexico. The pilot leveled the plane, pointing it east for the one-and-a-half-hour flight to Dallas. Soon, El Paso receded from view, and with it his hopes and dreams. He had tried so hard, he told himself. Then he slapped himself in the face. Binder turned at the sound but was not surprised. “Not hard enough,” the intern said aloud, to no one but himself.
* * *
In Dallas, Binder walked him over to the gate for the flight to Atlanta, and handed him his ticket. “The Talbott-Marsh clinic is your only chance.”
The flight attendant collecting boarding passes could tell this was a significant leave-taking. She had a good sense about people, knew how to read the signs, having had years of practice. She was about to say something lighthearted about his scrubs, but decided not to when she looked in the man’s face.
Binder watched the intern walk down the jet way. He remained at the window until the plane pulled away from the gate.
* * *
In Atlanta, four men awaited him. They introduced themselves: two were surgeons, one was an orthopedist, and one was an anesthesiologist. One of the surgeons was his father’s age; the rest looked to be in their thirties or early forties. In the car, one of them said, “You won’t believe me, but you’ll look back and think of this day as the first day of your real life.”
* * *
When they arrived at the cluster of buildings in suburban Atlanta that constituted the clinic, he was taken in to meet Dr. Talbott.
Doug Talbott, a big man with thick, silvery hair, came around his desk with an alacrity that belied his seventy years. His handshake was firm, and he took the young man’s hand in both of his and led him to one of two armchairs that faced each other next to a fireplace. His smile, under a brigadier’s mustache, was warm and unaffected.
They sat without speaking, the older man’s fingers resting thoughtfully on the side of his face. Despite the scar over his eyebrow and a sunken cheek from what looked like an old orbital fracture, his face was kindly. After a long while, his voice emerged from the depths of his chest, soothing and with no trace of a Southern drawl, pausing after every sentence, letting each thought hang there before he brought out the next one.
“You have a terrible disease. You need lifelong treatment.”
The intern sat, mesmerized, numb, conscious only of the sound of his own breathing.
“I am told I was a world-famous cardiologist,” Talbott continued, his gnarled hands moving like delicate wands to punctuate his words. “But I don’t know how. I was an alcoholic. When I couldn’t swallow alcohol anymore because of the vomiting, the hiatal hernia, I switched to meprobamate, which was not considered addictive. Then Demerol, which was not considered addictive, then Talwin, which was not considered addictive, then Equinil, which was not considered addictive . . .” He smiled as he recited this, a tale he had told thousands of times, as if the naïveté of his generation of physicians still amazed him.
Talbott had been institutionalized several times, at one point spending a year and a half with psychiatrists who dismissed his alcohol use as a “cover-up for something deeper that you need to lie down on the couch and tell us about.” After many relapses, after many rounds with AA, after his oldest son, disgusted with him, beat him over a kitchen table, his wife finally committed him to an asylum for the criminally insane.
“When the inmates found out I was a doctor,” he said, his eyes twinkling, as if the funny part was coming, “they beat the hell out of me. Broke my face. Cracked my ribs. I remember lying on the floor in my own blood, spitting out fragments of my teeth.”
He smiled, and the intern could see the glint of a gold tooth peeking out from behind the mustache. The smile evaporated, leaving in its place an expression of pain that the younger man recognized as the equal of his.
“It was at that moment, lying on the floor, I swore to myself that if I ever got out of that place alive, I would find treatment that was specific for doctors. I would make that my life’s mission.
“Sobriety,” he said, shaking his head gently, “is the easiest part of recovery. We are only peripherally involved with sobriety here. You can get sobriety in El Paso detox, or the county jail. What you will get here is true recovery. This will come from your recognizing that you have a disease, like diabetes. And just like a diabetic taking insulin and monitoring blood sugars, every day for the rest of your life, you will need to monitor and treat your disease.
“Unfortunately, society doesn’t understand that you have a disease, a disorder in your forebrain, a genetic defect that makes you so susceptible. You—despite being a doctor—don’t understand that you have a disease. Instead you see yourself as reprehensible, morally flawed.” He leaned forward, as if imparting a secret. “And now, now that they caught you, you feel intense shame.”
That word seemed to pierce the thin veneer of the intern’
The older man leaned back in his chair, his hands forming a steeple in front of his face. He made no effort to intervene. But he observed the young man, felt his grief, watched him weep just as he had watched four thousand or so other doctors over the years weep tears of shame.
He could see their faces clearly. Some were now dead from their disease. He could picture, as if it were a road map, the events that had led them to this state. When they were young college students, they had worked incredibly hard to get into medical school, forgoing the parties, the quick pleasures, in pursuit of the doctor dream. When they were accepted into medical school, and then later, when they graduated and survived the ordeal of internship, they had come to feel special. They had learned to be self-sufficient, and even to think of themselves as invulnerable, as if they had struck a bargain with the Creator in return for caring for the ill. The very qualities that led them to be doctors—compulsiveness, conscientiousness, control over emotions, delayed gratification, fantasies of the future—predisposed them to use drugs. When they did, to the very end, the physician-patient denied his or her patienthood. And when it all came crashing down, what they felt was monstrous, crippling shame.
“Don’t confuse shame with guilt,” he said eventually. “Shame says, ‘I am the mistake,’ while guilt says, ‘I made a mistake.’ You made a mistake, but you are not a mistake.”
The young man composed himself as best he could. Despite what he was hearing, he could still think only of what he had lost, of how he had blown it, of how he was once again in a rehabilitation program. He had been on probation as a student, carefully monitored as an intern, given numerous chances, and now he felt in the pit of his stomach that he had blown the doctor dream, erased his ability to ever get a medical license in any state. What did it matter if he were sober or not—if he couldn’t be a doctor, what was the point of any of this?
“I know you’ve been to recovery programs many times before, probably to some good ones, but none that specialized in doctors with addiction. As a physician, you have unique issues that we will address here. Don’t get me wrong—the twelve steps are at the core of recovery, wherever you are. But as a doctor, what makes you unique is that your denial is exquisite, a hundredfold more entrenched than non-physicians. Even now as you sit there, you are in massive denial. In the back of your mind, you think that your biggest misfortune was to get caught.”
The intern had his head down. He did not try to deny this.
“We’ll talk more in the morning,” Dr. Talbott said, standing up. “You’re lucky to have arrived on the night of our weekly Caduceus Club. We started our first Caduceus Club here in Georgia twenty years ago.” He glowed with pride. “We now have seventy-three Caduceus Clubs all over the United States and Canada.”
* * *
They strolled across the grounds to a large building, the Anchor Hospital. Off to one side were some tennis courts, but if the intern, whose life and livelihood had for so long revolved around tennis, saw the courts, he gave no sign. The two men entered the building through a side door. The intern who had been to so many AA and NA meetings was unprepared for what he saw. Chairs had been pushed to the edges of a large dining hall to form a giant circle, and about a hundred physicians were seated, filling the room with a steady drone, as if this were a medical convention. Everyone was dressed casually, and he saw only one other person dressed in scrubs. His fear and shame rose again as his peers turned to glance at the newcomer with Dr. Talbott. But then, when he realized that every one of them was here for the same reason he was, he felt, for the first time that day, an easing of the weight in his chest. Some of the doctors smiled at him.
“If you think your problems are unique, you get over that in a heartbeat here,” his older companion whispered to him, putting an arm on his shoulder. “Terminally unique. Every one of us thought we were terminally unique. We thought that M.D. stood for M. Deity.” He sat down and guided the intern to a chair on his right.
“Shall we begin?” Dr. Talbott said, and the room quieted. Dr. Talbott nodded to a man sitting on his left.
“Hi, I’m Steve; I’m a neurosurgeon and an alcoholic,” the man began. He was an intense, dark-haired man, with spidery hands and quick, birdlike movements of his head.
“HI, STEVE!” a chorus of voices said.
“I’m leaving here tomorrow after a four-month stay,” he said, beaming. Others looked happy for him. “I feel good, grateful . . . This is my second stay at Talbott-Marsh. I’m looking forward to being with my wife and kids. Lots of issues there, many things she has to forgive me for . . . I’m not going back into practice just yet. Still a few licensing issues that are being sorted out . . . But I’m not worried about that . . .”
“When you look back, Steve,” Talbott asked, “what were the factors that made you relapse?”
“I stopped communicating,” he said quickly. “Hid my feelings, started looking for faults in other people—my wife, my partners, anyone to blame for what I felt. I got on my ‘pity pot,’ started with the ‘stinking thinking,’” he said, using his fingers to make quotation marks in the air, his words tripping over each other. “I was a dry drunk for months before I actually relapsed. I forgot that I had a disease. I thought I could actually take a drink and nothing would happen, no one would know. But I’m on a contract now with my medical society that involves daily Antabuse, urine checks, sponsor visits . . .” He had run out of steam. He added brightly, “One day at a time.”
The baton was passed to the left.
“Hi, I’m Judy; I’m an ER physician and a cocaine addict.”
“Hi, I’m Todd; I’m a nephrologist and a crack addict.”
“Hi, I’m Bob; I’m a radiologist and an alcoholic.”
Around the room, the litany continued: alcohol, amphetamines, crack, Valium, Lomotil, Xanax. Codeine in many forms. Every specialty in medicine seemed to be represented, particularly anesthesia. Fentanyl and sufentanil (both very potent narcotics) seemed to be the favorite of the anesthesiologists and surgeons.
It was now the turn of the other man in a scrub suit. He had linebacker shoulders, brown, curly hair, and handsome, movie-star features. The man had sat there with his arms folded, leaning back in his chair, wary of the proceedings. Now he uncrossed his arms.
“I just got in today. From California. I’m a vascular surgeon. I guess I’m here to find out if there is a problem. I’m here for . . . evaluation,” he said, looking at Dr. Talbott.
“Tell us what happened, Kurt,” Dr. Talbott said.
“I operated early this morning . . . As I was leaving the operating room, the administrator confronted me, along with the head of anesthesia. They said some fentanyl was missing.” He shrugged. “I told them I had nothing to do with it—”
The other doctors were shifting in their chairs. The momentum of the meeting had been retarded.
“And the reason they suspected you?”
“Allegations at another hospital I go to that I had removed fentanyl. I was under observation, I guess, though no one told me.” The silence in the room seemed to weigh on him. “No one has had any complaints about my work, I take good care of my patients—”
“Are you here of your own volition?”
“Well, yeah, I guess. If I didn’t agree to come out here for an evaluation, they were going to report me to the medical society. Which meant automatic suspension of my license. Takes away my livelihood. So . . . I said I’d come. I didn’t get a chance to pack, or to—”
“Tell us, Kurt, how is your marriage?” Talbott interrupted.
“My wife left me two months ago.”
“And I understand you have been having a major problem with your finances?”
“I have a lot of debt, if that’s what you mean. My partnership dissolved, so I had to set up my own office. But I’m getting back on track. I cover four different hospitals. No one has ever complained about my work—”
“The work is the last thing to suffer,” an intense older man across the room burst in, unable to keep quiet any longer. He wore half-moon glasses over which he peered at the newcomer. He had a thick Southern accent. “The order in which you dee-stroy your life,” he said, holding out his hand and pulling down fingers, “is first family, then you screw your partners, then you screw up your finances, then your health goes. Hell, your job performance is the last thing to go.”
