Man's 4th Best Hospital, page 20
“There certainly should be,” I said. The guys nodded.
“Why? Why the hell isn’t there one?”
I had no answer to this except to repeat what he always claimed was his core philosophy: “Stay hyper—it’s the best defense.”
“Maybe, but it ain’t working for shit right now at home.”
The only ones who weren’t there were the surgeons, Gath and Jude. They were often late, but usually they’d send a text as to why and when they’d be there. No text yet.
Fats led us to the big circular table under the soaring sugar maple. We did a check-in. It was all “Thanks” and “Good to see you” and “Things are going well” and Fats saying “Meet my partner, Rosie Tsien”—all good, but for Hooper, who, without rocking, said, “Whoever said life would be fair?” and refused to elaborate.
And then the food and booze. All of it was pure Fats.
He and Humbo had catered the party/meeting on the theme of, depending on how you saw it, “The Best Food in the World” or “The Worst Food in the World.” The best, in his mind, shipped in from Katz’s Deli on the Lower East Side. All hot pastrami and corned beef and tongue and other slovenly slavering meats and coleslaws and potato salads and slogging along desserts like triple chocolate knishes with chocolate ice cream and whipped cream—in sum, dead animals with no fresh vegetables. At the initial sight of all this high-fat, high-salt, high-sugar, high-carb food, the revulsion of vegetarians rose, but right away Fats rolled out another banquet of low-fat grilled and raw vegetarian perfection, including a lifelike tofu turkey, from Kale City. And for me a whole bottle of Laphroig single malt whisky.
Fats called the meeting to order. The night started to bed down. The rare last male crickets chirped, leg sawings for departed mates hinting of a certain solitude, say that of Márquez.
Finishing the last forkful of Katz’s seven-layer cake with butter pecan ice cream and Reddi-Wip, Fats sighed with satisfaction, took another marzipan cookie, and sighed more.
“I’ve got three pieces of great news. First, our first-quarter PATSATs are the best of Man’s 4th Best!”
Applause, shouts. Slaps on backs and smiles.
“Second, because we’re bringing in nice green money, they can’t close us down. And third, data analysis shows that the PATSATs began to take off on the day that OUTGOING crashed. And that there’s no difference between our revenues when we bill on OUTGOING and when we bill on paper.”
Sighting a bowl of pistachios on steroids, he threw a palmful into his mouth and chewed, but then, realizing they had to be snapped out of their shells first, spit them back out into his hand and put them on his plate. He looked for his napkin to wipe his hand, saw it on the ground, tried to bend over, but his weight shifted suddenly on the folding chair and almost “went to ground.” Humbo grabbed him and with weird strength righted him—flushed and huffing—and gave him another napkin, gently cleaning pistachio bits off his florid shirt.
“Finally,” Fats went on, “about that recent cyberattack that totally shut down HEAL?” He trapped a chocolate chip, killing it. “The hospital lost HEAL billing for days—utter panic—lost a cool million.” He rubbed his hands with delight, face aglow. “Well, guess what. The only one still billing was us. The only secure billing is paper. You can’t hack paper. So it all comes down to . . .” He waved his hand like the conductor of a symphony orchestra, and said, “It starts with an ‘M’ and it’s . . .”
“Money!” we shouted.
“Bingo. Under pressure from the board, Krash sent us a note. On paper.” He tried to dig into a pants pocket, without success. Humbo had him lean over and dug the paper out.
Dear Fat Man,
Pat P. Flambeau, CEO of BUDDIES, and I congratulate you and the Future of Medicine Clinic, who, during the recent malware infection and crash, continued billing uninterrupted, with your retro-innovative-concept of “paper billing.” We are studying use of this method for backup. Please document your model carefully. We need details and solid data to see if this pen-and-paper innovation may be of use to any other cost centers. Even a short publication in the best journal—“The NEJ of Medicine” or, even the more “best,” “The Journal of Historic Hacks”—would be a nice contribution to the field.
Shalom, Jared T. Krashinsky, MBH, FRSQ, President of Man’s Best Hospital
“The golden age has begun,” Fats said. “Garçon?” Fats called out to the girls. “Champagne. Another round of desserts—go heavy on the whipped crème.”
In great spirits, we made toasts, we made jokes, and, following the Fat Man’s colossal appetite, even we on tender diets said the hell with it for a night and ate, ate, and ate.
“Fat Man!” cried Hooper. “I can’t remain silent anymore!”
During dinner, he hadn’t been his usual energetic self. Now his voice was harsh.
Things got real quiet. Fats, caught with an éclair halfway into his mouth and half on a cheek, turned to him, smiling, white stuff between his front teeth.
“Fats, you’re fat! Fat fat fat! You’re eating yourself to death, and I can’t stand watching it anymore. You’re eating crap! Your outside fat is one thing, but your IAF, Internal Abdominal Fat—that spare tire of fat wrapped around inside your belly—is something else! Your body’s BIQ—Bioelectric Impedence Quotient? Gotta be off the charts. I’m saying this out of respect, for all you’ve done for me, for us. But . . .”
He stopped himself.
None of us, ever, had dared to mention fat to the Fat Man before. How would he respond?
Fats closed his mouth, swallowed, took a napkin, and delicately wiped his lips, his cheeks, a stray glob of glop on his cheek. He composed himself, sat back, and said, “Nu?”
Hooper let out a long breath. “Look, I’m concerned about you and wanna save you. Like I’m saving all my fat patients—my PATSATs for the last month are the highest of any of you. All of you TURF your patients to me—‘nutrition consult’ code 37459-N—and almost none of ’em BOUNCE back to you. And I almost never TURF anyone back. Think about that. ’Cuz what I do works. None of you know what I do, what works and why. You never ask me. I tell you I’m in nutrition in primary care, and your eyes glaze over so that when you look at me you see that old-lady nutritionist with a mustache in high school telling you to eat your spinach—well, guess what. She was right.”
I, and others, could not help staring at Hooper’s mustache.
“How many of you even got back to me on my memo that this month is National Nutrition Month? How many followed the federal guideline ‘Bring your fork to work’?”
No one had brought their fork.
“You don’t want to deal with nutrition ’cause you don’t believe you can do anything about it. Well, guys, I can. I’m into preventing every toxic-food-caused disease we treat—diabetes and obesity, sure, but heart and maybe cancer. The reality? The food industry makes big money by killing us. I hate to say this, Fats, but Big Food’s got your number, bad.”
He bounced a bit, then laser-focused again.
“I’m sayin’ this because I love you, Fats. You not only saved my life in the House but you were key to my winning the Black Crow—which got me my research center at UCLA. So. Death, cause and treatment. Preventive food. Big Money. Five minutes tops?”
Fats looked around the table. Everyone nodded. “Go for it.”
Rocking, Hooper launched into something that, well, lit up the night. It was, in a way, obvious, but it was the obviousness of genius.
“The reason we die,” he said, “is we eat shit and get fat. Not fat on the outside only. That’s just manifest fat. The death fat is that fat tire inside, the IAF. Why? In 1970, a Big Food scientist at a company under the New Jersey Turnpike found the ‘bliss point’ for humans, the perfect combo of refined sugar, salt, and fat that was optimally addictive to humans—junk food. The reason you die from eating at the bliss point is that the inside fat tire grows and grows and provokes inflammation in the body, and that sounds the alarm for the immune system to rush at it all the time, but it keeps on growing and growing until at a critical moment it outgrows the blood supply and the bloodless fat cells die—really quickly die—and this attracts the macrophages, which migrate to the abdominal fat and eat up the dead cells and kind of circle the wagons.”
He paused, assessing.
Fats nodded him on.
“And inflammation goes bananas! The result is death, baby, in every part of the body: fatty liver, diabetes, heart, lung, neuro, kidney. Inflammation attacks everything blood can get to, and is a proven factor in breast cancer and maybe colon, pancreas, prostate, kidney. And an outside chance of Alzheimer’s—those fat bodies in the brain, right? Cancer? Sure, sometimes it’s a mutation caused by killer pesticides and all the plastic shit. But we all get mutations. Maybe cancer sometimes is a nutritional disease—a lifestyle disease—and not always a chance bolt from the thunder gods! To ignore the toxicity of the shit that we eat is the dummification of the American people, and of us docs too.”
He checked his watch.
“Treatment? No time. One stat: a five percent weight loss in a patient—not that hard—prevents fifty-eight percent of new cases of diabetes.”
We sat, awed. And all this cancer started by a guy under the New Jersey Turnpike?
“Immuno-nutrition?” Fats asked. Hyper nodded. “And it’s all the food industry?”
“Big Food, yeah, making big money by loading us—all of us—up to the eyeballs with totally addictive carb-based junk food, and we in medicine are stuck trying to clean up the mess of fat? One example, my biggest failure. I focused on red yeast rice—an ancient Chinese medicine—and found the bioactive ingredient. Lowers cholesterol twenty percent, no side effects. Statins, like Pfizer’s Lipitor, can eat away muscles so your triceps hang down like wet noodles—irreversibly.”
“Yeah!” cried Eddie. “Look.” He rolled up his sleeves. His triceps did hang down like noodles, his biceps pulling his arms up like a prizefighter’s. “My doc never warned me!”
“Oh, really?” said Hooper. “Are you telling me that Pfizer did not inform you of this liver damage? Did not alert the nation to this irreversible noodling? Imagine that.”
Humbo looked at his watch and then at Fats. Fats waved Hooper to proceed.
“For your noodling triceps, I’ll give you a thumbnail. I did the study on the active molecule in red rice. Proved that it worked to lower bad lipids. It worked. We began sell—”
“Great!” said Eat My Dust. “Congrats, man! High five! I want some!”
Hooper sighed. “The FDA ruled against it being an approved drug, so it got relegated to the vitamin shelf, lost in the crowd. Merck had gotten to the FDA. They stopped it in order to protect their three statins, the worst noodlers on earth, worth billions and—”
“Merck kill mía madre!” A string of obscenities, in Spanish, for a while.
Silence, one of Even if Hooper isn’t crazy, how could he humiliate the Fat Man?
“Oh, God, I’m sorry, Fats. I feel terrible. You’re my hero. It’s been a hard month—National Nutrition Month always is because nobody celebrates it. I feel so alone. But . . .” He stopped. Totally still. His face tightened, holding back pain. “But the real big deal right now is, I’m totally depressed about my marriage, looks like it might be MOR. Déjà vu all over again. I can’t take my Marriage on the Rocks again.” He hung his head.
“All . . . right,” Fats said firmly. “I get it. Have you got proven treatments, based on your research, that all of us, in each of our specialties, can really use on our patients?”
Hyper looked up, startled. “Yeah. Tried and true. And use it on ourselves too. At the Hyper-Winfrey Nutrition Center, we train doctors, nurses, PAs, and, yes, nutritionists.” He paused. “Some with mustaches.”
We laughed. He nodded and broke out that wild canyon-to-desert California smile.
“We’re eclectic. We work closely with OA—Overeaters Anonymous. The treatment is to snap them out of their secret eating, their craving, loneliness, and shame. Addiction is a disease of isolation.”
“And connection heals?” Fats said.
“That’s key, yeah. And protein-pomegranate shakes and any red vegetables—tomatoes, red peppers. It’s all in my book: Eat Red, Live Long: Lycopenes, Caratenoids, and—”
“Okay, okay,” Fats said, putting his hands palm down like an umpire calling the runner safe at home. “Thanks, Hooper.”
“For . . . for what, big guy?”
“You had the guts to point out the . . . umm”—he smiled—“the elephant in the room.”
We didn’t know whether to laugh or not.
“Laugh!” Fats said. “Laugh—or you die.”
So we did. Laugh, that is.
“And, Hooper, thanks for giving us the missing ingredient.”
“Which ingredient?”
“Money. Big Food. In cahoots with Big Pharma. Big Food’s making people sick. So the main causes of death in modern medicine are food, screens, and money.” He smiled, relieved. “Hey hey hey! Look at me. What internal spare tire, hunh? I’m living longer already. How ’bout a hand for Hyyy-perrr Hoooo-per!”
We cheered.
He rocked, hard.
“Great work, Hooper. We’ll follow up at the FMC, under your lead. Any other business?”
No one spoke up. We went back to party mode, high chatter, a kid’s pet show and parade—Olive, wearing an all-white vest reading “Olive in Wonderland”; the brave, young, and healthy Cinnamon chasing his ball with astonishing speed and joy, Lady Chubby watching with admiration. There was a sense of having come through something hard together, something that had softened us and Kaboooom!—an explosion—followed by Kabooom!—another—and a burst of flame from the high spruce alongside the driveway to the Garage Mahal.
We jumped, scared. Something was in flames halfway up the tree—a second fire was in another tree, a century-old sequoia up next to the main house, near the street. Everybody hit the ground. I stood up and shouted:
“It’s nothing! Nothing, relax!” I called out. “Relax! Look! Look!” I pointed to smoke coming from high up in the two trees. The crisp, edgy scent of cordite floated down.
“There’s no danger. It’s just my tenant in the main house, Paulie the Veal, blasting away my neighborly hedge funder’s surveillance cameras trained on Paulie and me.”
Gradually, we settled back down.
* * *
Gath and Jude finally showed up, still in their bloodstained operating room gear. A green surgical mask dangled from Jude’s neck. They were wired and tired—she very pregnant—having spent a whole day doing patriotic things like extracting bullets from bodies and attaching arms back onto shoulders—real civic-minded stuff. I offered drinks.
“Bourbon?” Gath asked Jude.
“A double,” she said, holding her big belly as she sat. “Third trimester, thank God.”
“Double that double fo’ me.” They sat, heavily, at the table. Drank quickly and started in, distractedly, on the food. “We got shit. We’re way past critical mass.”
“It’s about Jude’s suspension?” I asked.
“Nope, but they’ll make it about that.”
Fats put a hand on each of their shoulders. “We got your backs, no matter what. Go.”
Jude had been on probation for months on a trumped-up charge—and was restricted to only operating when supervised by Gath. The charge? Not following up with an emergency room patient she’d been called down from the ward to see, for a rare hip injury. She had done everything right: examined, diagnosed correctly—a partial labral tear—and did a nonsurgical treatment with a follow-up MRI in the morning, referral to clinic and physical therapy. The trumped-up part was that the MRI had vanished from HEAL, and the patient came back in more distress the next night and was admitted. The chief ortho resident, an ex–football cowboy from Texas who had long been sniping for her—the only woman in the program and a Navajo Indian at that—brought the matter to the two joint chiefs of Orthopedics, Buck and Barmdun. They ran the most lucrative practice in America—netting 13 million dollars a year each. Walt Buck was called by his residents, with pride, “the worst person on earth.” Barmdun was, in comparison, the brains—which was not saying much. His “thing” was mint-condition young women and mint-condition old cars.
A year ago Buck and Barmdun had put Jude on probation, which meant that now, in her sixth and final year of residency, she would not graduate from the program and could not be certified to practice surgery. Jude brought suit in federal court: gender discrimination. She had documented the pattern meticulously. She sued the Big Three: Man’s 4th Best Hospital, the BMS, and BUDDIES. The trial was about to begin.
“Last night, when Jude and I were making pre-op rounds,” Gath said, “I ran into an old Alabama buddy, Billy Clark. He needed a total hip replacement and was told that the best in America was one of the joint chiefs of Ortho, Dr. Buck. I didn’t say anything about Buck, but I told him to tell the nurse and the anesthetist that he wanted to be sure that Dr. Buck himself would do the whole operation. This morning Jude and I are in the OR suite getting ready for our first case. I look into Billy’s OR. A resident was making the first incision, alone. I ask the head nurse where Buck is. She hadn’t seen him. I tell her to let me know when he comes in. Jude and I begin our first case. Soon Prudence Kline, the head nurse, comes in, says the resident is still alone and ‘He’s not all that experienced.’ I ask if she’d paged Buck. She had. He hadn’t answered. I tell Jude to take over and call him on his cell. I tell him he’s got to get back here. He says he’s in a cab three miles away headed toward Women’s 2nd Best Hospital—which now is Man’s 4th Best’s fierce steel-cage-death-match rival for BUDDIES affection—to operate on a, quote, ‘household name.’ I say, ‘Y’got ten seconds to turn around or I make a call that’ll ream you a new asshole. One thousand one, one thousand two . . . ’ He laughed. By eight he turns around and comes back.”
