Man's 4th Best Hospital, page 15
“The issue was our humor,” said Gilheeny. “Humor for Freudians is never humor. Humor is aggression. These bonker shrinkos never just laugh—they analyze. They wear a fookin’ filter to the world. Killed us, Quick and me. Let me give you an example.”
“Look, I really gotta go—”
“Not to worry. It’s the shortest Jewish joke ever, which I told to those anal-stage crackpots at the seminal seminar on Freud’s ‘Mourning and Melancholia.’” He cleared his throat. “Max and Jacob, two businessmen, meet on the street. Max says to Jacob: ‘I hear you had a fire in the warehouse yesterday.’ Jacob says: ‘Shhh! Tomorrow!’”
Even Nolan laughed.
“And how did the shrinks react?”
“Not even a smile—not even a grin on the roadway to a smile. Next thing we know, I fail, and the loyal Quick quits.”
“And even after a whole cold year of analysis, Dr. Roy,” said Quick, “I still had my attraction to bendy-kinky plastic straws. And, warse, I’d still tell the wife when she wouldn’t stop naggin’ me—‘Go bite a fart!’”
“Surely, we are disturbed policemen,” said the redhead, red face wrinkling in false concern. “Wouldn’t you say?”
“Would you be policemen if you were not?”
Gilheeny turned to Quick. “Yer man Basch here is a you know what.”
“A textbook in himself.”
Laughing, they wheeled on out, away.
10
Flying high from the company of the policemen, I settled into my seat at the table for the day’s checkout. Fats was not yet there. Our phones were all in the pile, but they were not crying out to us for help. Fats calling them “Bad phones!” must have sunk in.
Having had one whole delicious free afternoon of not being able to click boxes for OUTGOING, while still getting the useful data for INCOMING, had us feeling good. A burden had been lifted, our patient load lightened, and our banter was happy—all because we were free. Fats trundled in, bright tie unknotted further, and, sensing the relief in the room, smiled big. Humbo and Mo the medical student followed. We went around the room, quickly checking in. All of us, unboxed, were on a shared high.
“Ohhhh-kay!” Fats said. “Let’s pray the OUTGOING stays on the fritz for as long as possible, yes?” Chorus of “Yes!” “Now. About getting more women docs, extending our lives? Well, we lucked out. Two new women docs are joining the FMC, starting tomorrow. So we’ll be at three women, six men—not counting me, and I’m kinda both, right?”
“You just think that, Fats,” said Naidoo, “because you’re a man. But thanks.”
“Oh.” He considered. “Wow. So we men can’t see what we can’t see?” She nodded. “But women can see that in us?” Another nod. “And can women see what they can’t see?”
Naidoo rolled her eyes. “You don’t get it. It’s not ‘either/or.’ It’s ‘and.’”
“Cool. Betcha there’s an invention in that. Get with me later, ’kay? So lemme introduce our first new woman. Almost-a-doctor Mo Ahern. She’s now a subintern and a potential great doc, who Roy and I have gotten to know on the wards, and she’s as good as it gets.” He paused. “And she is a screen genius!”
Amazement. Applause. Mo blushed.
“She’s of an age that she has never used paper medical records. And what’s your opinion of our medical screens and especially HEAL?”
“All of them stink. But I’ve tried to be a kind of expert in how to get around them in the interest of patient care.”
Oohs and aahs from us.
“Bingo!” said Fats. “She can’t sign her own orders quite yet, so we’ll all mentor her and cosign. Welcome, Mo!” She nodded. “A few words?”
“Oh. Well, to be honest, I don’t—”
We were so revved up and she was so delightful and young, we shouted out, “There’s always a first time” and “Don’t hurt yourself, Mo” and “Now or never” and “Alegría!”
Mo blushed again, her hazel eyes lit up, and her smile got wide in her slender face. She covered her blush with her hands.
“Well, up on the wards, except for the patients, it was demoralizing. We students never got to do much. We could write notes on HEAL but they were secret; the house staff had to unclick the ‘Med Student Opinion Box’ to view them! And at the end-of-morning glance-in rounds, when the house staff runs away from patients and jumps into HEAL, we students have nothing to do. We’d wait around, sneak out. Snack out. Waste of time. And fattening.”
“And expensive,” said Fats. “You med students are paying tuition to see patients. The house staff is getting paid for clerical work—and also to see patients. The more time you spend seeing patients, the less you pay per hour to learn medicine. The less time they spend seeing patients, the more they get paid per hour to do medicine. So for them, spending eighty percent of their time milking that cash cow HEAL, and spending less time with real live patients, pays off big-time.”
“When I first saw HEAL,” Mo went on, “I go, ‘OMG—this has nothing to do with clinical care.’ In class they taught us, like, it was a great discovery: ‘Patient stay has been cut in half. It’s the new era, the era of quote “high throughput.”’ It’s like nobody cares about giving good care anymore.” She caught herself. “Oops—not a, um, charitable way to put it. Nobody can give the care we want to. Care like what my mom used to do in her practice?”
“What was her practice?” Fats asked.
“Pediatrics. Just she and a dear friend of hers—a solo, independent practice. At least so far. But they’re in crisis mode right now. In fact yesterday she said, ‘The vultures are circling.’”
“See, team? Mo’s a rough gem. And are we ever gonna polish her up and—”
The door opened.
“Yes!” Fats cried out. “Our third woman doc has arrived!”
In walked Gath, in green surgical scrubs, red hair fluffing up out of his V-neck.
With him was a compact woman in a short white coat bulging over a pregnancy, her brown face aglow. Blue eyes a wake-up call—clarity and power—lids slightly Asian, epicanthic fold of upper eyes, and higher nasal bridge. Dark brown hair, high cheeks. Lips a tight line, as if from holding a rough life together. Her low-heeled shoes were a-dazzle—snakeskin?—her gait striking, each step gliding, as if she was aware of the earth. All in strange sync, but strangely familiar to me. A small pendant around her neck, a silver-and-turquoise animal—a bear?
“Sorry ah’m late, team,” said Gath. “We lucked out. It is mah pleasure to introduce Dr. Jude Nanabah. Best orthopedic resident I ever had—and the nicest. Mind you, she’s tough too—she coulda just as easily been an Indy Five Hundred winner, changin’ her own tires. Jude was s’posed to graduate from Man’s 4th Best ortho residency next June, but truth be told, she’s had a hard time from the other 4th Best orthopedic residents and the creepy cochiefs, Buck and Barmdun. Jude’s filed a gender-discrimation suit. Waitin’ for the trial to start. Fats’ll find time to explain later?” Fats nodded. “So now they only let her operate with me—how lucky can y’get?” She smiled. “A lot of her time’ll be here in clinic. She can do anything: family medicine, outpatient surgeries, consult, OB, cancer, nutrition—hell, she can even teach us healing circles, rituals. Build a lodge, get us all naked and sweaty, the works. She’ll fit right in, ’cuz she’s smart, dextrous, and, like I said, nice. Listen up: this lady has spine, courage. She’s a fighter, like us. I’m the only ortho doc who’s stickin’ up for her in the court case. We gonna win. How ’bout a warm welcome?”
We applauded, whistled. With no OUTGOING that day, we were riding a wave.
“Oh, and how could I forget? She grew up in Arizona, in the Navajo Nation. And the person that got her here to us, a few years ago, is Roy.”
I was startled—but then recalled how, in Berry and my first visit to Fort Defiance to look at the Indian Health Service, one of the surgeons told me about a young woman who’d just graduated from the University of Arizona general surgery program and was looking to move east to specialize in orthopedics. I didn’t have time to meet her in person. On the phone she sounded great. I sent her to Gath. Never met her in person.
“Yes,” Jude said, “that one phone call changed my life. Thank you, Dr. Basch. Dr. Gath has been a wonderful mentor, and he is . . . well . . . still standing with me, in these legal issues. At a risk to his own position.” She looked at Gath.
He faked a shrug. “Hey, nuthin’ I love bettah, kid, than stickin’ it to high-paid lawyers and orthopedic fascists. You watch. We gonna kick ass and win. Go, ’Bama!’”
“Ohhhkay!” said Fats. “The FMC’s got your back. Anybody got anything else?”
“Do you mind telling us, Jude,” I asked, “what your Navajo name, Nanabah, means?”
“It may be the only cool thing about me. Nanabah means ‘went again into war.’”
“You’re in the right place!” cried Fats. “The Fat Man Tribe, at war with the White WASP Man. Yes!” He rubbed his fat hands together palm to palm as if starting a fire of glee. “Before we break, let’s look around into each other’s eyes. Eye contact, okay?”
And so we did. I recalled how one of Berry’s great Buddhist teachers, Joanna Macy, always, on parting, made sure to hold your gaze with hers—because you never know if it might be the last time. Now, holding eye contact, awkward at first, ended as a comfort.
Afterward I wanted to talk with Jude, but Naidoo, Mo, and Angel were with her.
Fats asked me to walk out with him and Humbo. We threaded our way toward the parking lot. For once he was silent. I too.
His phone rang—those three ordinary rings like the phones of our youth. Fats glanced at the number, mouthed “Krash,” put a finger to his lips, and put the call on speaker.
“You got no OUTGOING?” Krash shouted.
“I got no OUTGOING!” Fat shouted back.
“So you can’t bill?”
“I can’t bill! And I can’t enter any clinical data into the rec—”
“Fuck clinical, Fats. You gotta bill!”
“Well, then, fix it, Krash!”
“BUDDIES forced us to spend 2.6 billion, with a ‘b,’ to buy and install that shit-can HEAL for itself and Man’s Best and Women’s Best and all other BMS hospitals. Had to take a twenty-year mortgage to pay for it! Could bankrupt us all! So I myself am totally on the line for HEAL actually working—”
“You’re the one that scrapped BEEMR, your homemade doctor-friendly screen system, for HEAL. You hired the numbskulls who can’t fix HEAL, so you’re responsible and I only agreed to come here if it did not crash, Krash, so y’better fix it, ’cause patients are suffering—”
“Profits are suffering, Fat Boy, and—”
“—but luckily we still got INCOMING data, and so we can still treat patients by—”
“Your response borders on insubordination. We can replace you in a heartbeat.”
“Keep talking like that, and Man’s 4th loses its stake in the invention, the boxcars.”
A pause.
Click.
Krash had hung up.
Fats and Humbo burst out laughing. I asked what was so funny.
“What’s funny is that OUTGOING crashing is exactly what we all want, right?”
“Yeah. And what’s the ‘stake in the invention’?”
“I sold Man’s 4th a lotta shares. My 34 million phase two tranche is making him drool.”
“So the term ‘I have him over a barrel’ pertains?”
“Yup.” He winked, and said, “He thinks.”
“What?! You mean—”
“Who said that?” He looked around. “Not me!” He stood there beaming. “Y’gotta be deft, Basch. Deft.”
In the garage, at the Fat Man’s Tesla, we were waiting for something. Fats took out a Katz’s kosher salami, already scarred with nibbles, and peeled back the Star of David wrapper slickly to renibble. But for his prodigal chomp, chomp-de-chomps, it was quiet.
“You said the previous system the 4th had was called Beemer, from BMW?”
“Nope. Acronym. Best Ever Electronic Medical Record. Man’s 4th Best figured they had the best computer guys—led by a doctor on loan from the House—and designed it themselves. And it was the best, for doctors and patients and care. But for billing, the BEEMR was the WEEMR—the worst. They took a 250-million-dollar loss, then bought HEAL for an added 2.6 billion.” Chomp, de-chomp.
From the shadows a small man walked up, awkwardly, on tiptoe. Sev.
“Oh,” he said. Seeing me there, he went on. “Sorry, my bad.” He turned away.
“Nah, it’s okay. Do that Sev shuffle on over here.” He did, actually, shuffle over.
“Roy,” Fats said, “I gotta be on the West Coast tomorrow—a crucial moment of the calcium and boxcars and L-amphetamine.”
“Amphetamine? The invention is speed?”
“Nope. There are two amphetamine mirror isomers: ‘L’ for levoamphetamine and ‘D’ for dextroamphetamine. The D is speed. The L has no stimulatory effect. And the L consolidates memory! We mapped it all out, from genes to mouse-memory water mazes. Talk about elegant! Big fortuna. Doing good. Critical moment. Gotta be there in person. Don’t know for how long. So I anoint you, Roy, to step up, take charge. Not officially, subtly. Do you do subtle?”
“Better than you.”
Startled, he choked, turning red, then blue, so I thought, Heimlich, and then thought, Impossible with that girth unless Humbo, Sev, and I link arms around him—but then he coughed out bits of salami, first big lung chunks through his mouth and then littler specimens out through his nose so he had to dig for a hankie and cough and blow into it for a long time, phlegm-snot-clearing sounds echoing in the clean WASP garage. Finally he spoke. “And part of it is top secret, agreed?”
“What part?”
“No one else in the world but me ’n’ Sev knows what I’m going to tell you now. Sev has devoted his genius to electronic medical records—on our side, docs and patients. What a coincidence that only OUTGOING crashes?”
“Sev?”
“The best. We four hold the secret. Our only contact now’ll be on pristine dumb phones—Medicaid flip phones like yours, Roy. Didja bring ’em, Sev?” He handed us the dumb phones. “These things leave no e-record. Can’t be hacked. All these babies do is, well, phone. Got ’em programmed so every number you call or calls you is instantly erased.” We pocketed our cute phones, pack rats in our burrows, secure.
“Thanks, Sev,” said Fats. “Let’s stay in the most intimate touch, all four of us.”
Sev squirmed. “Aww . . . shucks.” And shuffled off.
“Unreal,” I said.
“All too. Man’s 4th Best IT will fight back. But there’s nobody like Sev. He’s been groomed for this moment his whole life, his biggest moment, same as you and me—”
“My biggest moment, this?” I asked, and he looked, for once, sheepish.
“Well, y’got me.” He sighed. “I know, I know. You got tsuris from Berry, the bunny birthday, family crisis—but I’m talkin’ big picture.”
“Nothing is bigger than Berry and Spring—and Cinnamon—y’understand? Nothing.”
“Understood. Don’t worry. I’m on it, this big enchilada, the FMC dream. It’s complex right now—you don’t know the half of it. It’ll work, Roy, long as we stick together.” A yawn. “Really beat. Thank God for private jets. Remember: no e-contact with me; they’ll hack it. Dumbo phone only.” A hippo yawn. “Whoa! Good-bye and luvya kid and—”
“One question. You gotta rush?”
“Nah. Got lotsa time. The plane waits for me, not me for it.”
“How’d you get to be such a great leader?”
His fatigue vanished. He smiled, rubbed his hands together like he was warming himself up, which was strange because it had to be a stifling, humid 90 in the garage. “When I was ten, in Brooklyn, my parents sent me to Hebrew school, to start preparing for my bar mitzvah. One day the woman who was president of the Hadassah took a bunch of us boys into the synagogue to teach us about the traditions that had to be obeyed in the sanctuary. We went up front to the raised, sacred bimah, gathered around—maybe ten of us. She started talking, and we started spacing, fidgeting. It was the most boring moment in my life. I’m standing in the back. My mind wanders, maybe to geometry homework, or to Zetzel Persky, a really cute girl in my class. Suddenly this woman’s staring at me, with black holes for eyes, and she raises her arm and points at the doors hiding the Torah, and she has this arm that . . . this arm that . . .” He was overcome with laughter. I waited. “This Hadassah arm! Y’know, where the flab hangs down and wobbles when she points?” We let out blasts of laughter. I, in fact, bent over, laughing—I knew that flapping flab, yes! “And . . .” He couldn’t catch his breath. “And then she says to me, ‘Do you have something better to do than this?’ and up from the soles of my feet to my mouth comes a shout: ‘Are you kidding?! And I’m leaving now to do it!’ I turn to go, but then a light bulb goes off in my head and I turn back and I raise my arm and wave it toward the door and shout: ‘And any a’you who wanna follow me, c’mon!’” He smiled, breathing himself down. “And all but one of ’em come with me, running down the center aisle of that shabby, moldy synagogue. I stop in front of the exit and look back. Only one kid is standing with her, staring at us.”
He paused for dramatic effect. I said: “Jared Tristram Krashinsky.”
“A guy that eats salad for dinner. We’ve been rivals ever since.” He sighed, satisfied. “Jeez, I can’t wait to get back home.”
His phone rang again. “Yeah, yeah, sweetie, okay. I’ll be there in six hours. Stanford, private terminal, yeah. Bye, honey bunny.”
“‘Honey bunny’?”
He blushed, stuttered something like “Um, R-Rrr-osie. Discussing the crucial step, boxcars, memory, bye-bye.”
