Man's 4th Best Hospital, page 35
How could it be that in an instant, when all was going okay— Bang! Dead. Dead?
The usual.
The waiting in the waiting room kept waiting; we docs kept doctoring—enraged.
I asked Chuck, “Why can’t they just lock up these shooters?”
“Because, man, they’d have to lock up half the country.”
For relief, I found myself ignoring the slaughter and being drawn to the commercials—gorgeous dramas, especially for drugs, which comprised maybe 25 percent of all peak-time TV ads. The purpose was to snare the worried. They were stoking the fires of suggestion and, in our patients, of deep and nagging fear about their own diseases. Riveting. Clearly, drug commercials had become the classic American success story, in three acts.
Act one: Pain. A beautiful, spotlessly clean fake patient—usually a woman—clutches her stomach with a grimace. This causes the viewing customer to identify with her, for who has not had stomach pain? No one at all! And so she feels hints of the same pain in herself.
Act two: Solution. A handsome young doctor in whites or a rumpled good ol’ family doc hands her a pill bottle of stomach de-painer.
Act three: Happiness. The woman is smiling or hugging a child or playing a hole of golf or winning a triathlon.
Amazingly, the TV drug cures all the things that the TV ads caused. And, of course, induces people who do have an ailment to request the latest drug, which the doctor might go along with, even if it’s worse and more costly than the old one.
Finally, the warnings about taking the drug, starting slowly with slight indigestion and faster and faster into cancer, ruptured spleen and—old Mr. Reliable—“risk of sudden death and if so call your doctor.”
It was sickening.
But our real patients, despite the shit on TV, held true to the hard reality of their lives—at least many of them. Soldiering on, limping or wheeled into my office, some angry and bitter, but many rooting for their doctor to just plain help them out.
That day my heart opened to them. My brief suffering and afterburn were now a bridge to their chronic.
We are all more human than otherwise. Living human-sized lives. What our patients want is what anyone wants, the hand in their hand, the sense that their doctor can care.
I asked Chuck, “Has anyone in a commercial ever cried?”
He considered, stroked his chin soberly. “Never happen, Roy, never. Their ain’t no money in cryin’. Us black-skinned people have done a lot of cryin’, and the jury’s still out.”
* * *
One patient that morning stands out. I finished a follow-up with my pigeons-on-dryer woman, still in recovery from the magician, and was coming out of my office when I heard someone yelling in a high-pitched voice as he backed out of Chuck’s office, stumbling.
“—so donchu dis’ me!” said a rail thin, tight-faced thirty-something man with blazing eyes and a goatee, limping backward, leaning heavily on a cane with one hand and jabbing a finger at Chuck, standing in the doorway of his office. “You Uncle Tom!”
Quickly, a security guard was moving toward him, and something in me said, Do not let the guard get there before you do, and I hustled over to him. Chuck approached warily. I scanned the worn leather coat and baggy jeans for bulges of “dangerous”—a gun, a knife—worried that the cane hid a stiletto. Nothing in sight. But that meant nothing.
“I’m Dr. Basch. How can I help?” My using “how” implied that I could help; it was only a question of finding a way. The man’s eyes were accusing—the pupils not pinned, no opiates—but wide with rage. His knuckles on the cane were deformed, swollen, and angry. I held out my hand.
He stared at it. “How the hell you gonna help me?”
“What’s your name?”
He hesitated. “Pen. How?”
“First, Pen, by keeping security off of you.” I waved the guard away. “Okay?” He nodded. “Chuck, what’s up?”
“Chronic sickle cell, in crisis now. Talking about dealing with the pain.”
“And he won’t give me relief! Thinks I’m an addict. Pain, man. Sickle cell pain!”
“Oh! Well, then, you’re in luck. Pain is my specialty. We’re busy, but how ’bout you and Chuck come into my office, we try to figure out how?”
He didn’t move, looked around at the hushed crowd. “What you people starin’ at?”
“Pen, do you have anybody with you we need to include?” He gestured for his wife and child to come. Horace was in the clinic. “Do you know Horace Haskins?” He shook his head no. “He’s a recovering addict, our link to twelve-step programs—y’ever been in one?”
“Like I said, I ain’t no addict! I need somethin’ strong, like OxyContin.”
We sat together in my office. Chuck had offered nonopiate pain meds, but Pen said they weren’t enough. He was staring at me. I met his gaze. What is there?
“So,” I said, “you felt that Dr. Chuck didn’t believe how bad your pain is?”
“Yeah, man, he’s dissin’ me. I wouldn’t ask if I didn’t need it. Donchu know African Americans have a higher pain tolerance than any other ethnicity cohort?”
“I do know that, Pen. With all that pain, it’s amazing you’re functioning at all. And on top of that, you come here asking for help and you feel your doc disrepects you?”
“Big-time. This sickle cell—my joints, head, gut—it’s worse than withdrawal!”
Saying “withdrawal” meant that he had been an addict at one time—but was he telling the truth now? We stared at each other. I felt a hit of a new clarity. He was an active addict. I said nothing.
He caught his slip and my catching it. “Shit! Let’s go!” He stood up and left, wife and child following.
We stood there and watched him limp out.
Fats was bending down to a kid, handing him a lollipop. Just as Pen, moving fast and mumbling, got to him, Fats straightened up and they collided—hard!—the Fat Man’s mass knocked Pen off his feet to the floor. The Fat Man reached down to him, but Pen scrambled up and with his cane popped him hard in the chest, rocking Fats back. Fats struggled to stay on his feet, and Pen got into his face, yelling, and to my surprise, Fats lost it, and they were shouting practically nose to nose, and we watched Pen reach back under his leather coat to the back. No, don’t let there be a gun in that belt.
But no, Pen saw the guard coming, took his hand away, and, cursing and shaking a finger in the Fat Man’s face, shouted, “I’m gonna get you!” and hustled out.
Chuck and I stared at each other, wide-eyed, stunned not by the addict but by Fats losing it so badly. We joined the crowd. He was okay. I was in a cold sweat. We went back to work.
* * *
At lunchtime Fats collared me to follow him out. He had picked up a large bag of food from Demos, which consistently won awards from us as “Worst Greek Restaurant in the World.” Munching a piece of soggy pita, he kept on trundling along through the thin and chilly spring sunlight, down a maze of old streets. All at once, he stopped, shifted the Greek mess into his other hand, and grabbed me with a greasy arm, pulling me into a stairway that led down three flights of a nasty parking garage into a dim, urine-scented corner. A finger to his lips indicated “silence.” We sat on the hood of an old Capri, he noshing, me watching.
Shuffling feet—and a misstep and recovery—coming closer. A small bearded man.
“Seven Eighty-nine?” I cried. He raised a flipper and nodded.
“Where the hell’ve you been?!” Fats cried. “Why haven’t you been answering?”
“Too dangerous. Physically. Man’s 4th is Man’s Best, at threats. We gotta hurry.”
“Why did OUTGOING come back?”
“Seven Ninety-nine. Nicknamed ‘Niners.’ He’s the House of God screen maven. We’re rivals. But he’s better. Makes me look like chopped liver. No social skills, but boy oh boy. He’s as good as those 400-pound bedridden Ukrainian hackers.”
“Is Seven Ninety-nine,” I asked, “the guy who invented TORAH?”
“Yup. Best for-profit system in the USA. If Niners or the House had any sechel, they’d put EPIC out of business and make a fortune.”
“But can you hack and break OUTGOING again?” Fats asked.
“Nope. Niners will heal HEAL as soon as I rebreak it—he’ll easily unhack my hack. And it’s not ‘healthy’ for me to be in touch with you. Me, my wife, Emma, and our little Pinkle are moving to Miami, Ponce de León Dialysis LLC. Founded by Molly’s ex-husband, who’s settled in Jerusalem.” Sev peered into the dank gloom, scanning. “Gotta go. Man’s 4th Best Intelligence is onto me.”
“Throckster,” said Fats, chewing hard on something tough, say, burned baklava—I had no idea what he was saying. We waited for a swallow, then another, figuring he’d talk, but, unable to, he waved and nodded and for some reason gave the sign of the cross.
“Sev,” I said, “one last question. Do you think that screens will ever be better for the care of patients and the care of us doctors?”
“If billing is involved? Nope. If not, yup.”
“You sound pretty sure.” He nodded. “Why so sure?”
“Seven Ninety-nine said so.” He started to shuffle his feet as if doing a dry run for walking.
“But why did he say that?” I was suddenly on edge, seeing clearly, wanting—even, then, almost yearning—to have this basic question in medicine answered with clarity.
“Niners was real cryptic, dismissive, as if any idiot including me should know why. He said, ‘They, the screen machines, are iterative. We, the doctors, are integrative.’”
“Can you explain that?”
“I can, but I gotta go.”
“Sev,” Fats said, “we need to hear this. Give us the thumbnail.”
The little urologist was sensitive, and sighed. “Okay. The screen. ‘Iterative’ means that it demands we fill in its own box-filled protocol—click a box, a new screen drops down, click a box on its list, drop down, et cetera. We have to teach it over and over again each time, click by click. It’s just plain dumb. Twenty-six clicks for a prescription? Waste of time and money—it’d be cheaper to teach docs penmanship.” He looked at his watch. “Us docs? ‘Integrative.’ It’s what we’ve always done. Gather the data from the patient’s paper record, talk to and examine the patient, then let it all riffle through our experience and creativity, and, without us doing anything, it gets clear. We think, feel, and intuit. We write a prescription in five seconds. It’s HAL verses human.”
He started to shuffle, but stopped himself.
“One more thing. I know a lot of the hot-shit artificial intelligence idiots. I used to be one of ’em, but I chose med school. They don’t care about patients, so they just don’t get it. Never will.” Another shuffle and stop. “One really last thought? As a doc, not a nerd? It’s not that billing machines are too complex for docs and other humans—they’re too simple. We humans get bored, make coding errors, like in that Lancet article ‘Why do British men get pregnant so often?’”
“Just to make money!” Fats spat out with a morsel of gop. “All because of the Jared Krashinskys of the world, seething greed!” He was panting, scowling. “Screens are terminally boring! And boredom leads to rage!”
I was startled by this explosion and tried to cool him down. “Easy, Fats, easy, okay?” He didn’t say okay.
“Gotta go,” said Sev.
“Thanks for trying, Sev,” I said, feeling sad that I might never see him again.
“Welcome.” He turned away and shuffled off.
Fats finished eating. Calming.
“Y’know, Basch, I hate to say it—and don’t tell the team—but I feel I’m starting to lose some of my power. I mean, we are up against a fucking monster.”
“Lose power? Really?”
“It’s a toughie.” He gathered himself, puffed up. “Plan B, at six a.m. tomorrow.”
* * *
“‘The Five Good Things of Relationship.’”
Berry. Standing at the blackboard for the day’s checkout, chalking as she spoke.
Everybody was there, even Gath and Jude, Gilheeny and Quick. Fats had given an effusive introduction. I was worried about how she would come through to the others. All of us were really worn down by our day on the front lines.
“Thanks,” Berry said. “Now. Take a few seconds, eyes closed, to picture a good connection you’ve had with someone recently, say, a lunch or a coffee or a walk. Anything, really.”
We did.
“Okay. If it’s a good meeting, both of you leave with Five Good Things.” She wrote and said, “One: you each have an increased sense of Energy, or Zest. Two: you each feel an increased sense of your own Self-Worth and the Worth of the Other person. Three: an increased sense of Self-Knowledge and Knowledge of the Other. Four—and this is crucial for being a doctor in these huge hierarchies of the House and the 4th: Power. You each leave with an increased sense of Power, and that of the other person. Five: you both leave with a Desire for More Connection—you each say, ‘Hey, let’s do this again,’ right?” Nods. “That’s a good connection. A bad connection is the five opposites: Decreased energy, decreased self-worth, self-knowledge, power—and no desire to do it again. What’s that describe—?”
“Depression!” shouted Eat My Dust. “Berry, that’s me! That’s my life!”
“Thanks a lot, Edward,” said Naidoo.
“Until I met you. All the guys who knew me then know it’s true.”
“Right,” Berry said. “It’s a relational definition of depression—and of health. What do I mean? Take number four: power. When you went to the lunch, you may have, say, come from a really bad morning here—you may even have felt that you just couldn’t make it through another afternoon. But if it’s a good connection, you leave with a sense of power to take action—doing things in medicine that afternoon that you had been putting off or didn’t have the stomach for. These huge systems disempower us. But at that lunch, in our connecting, power arises in both people. Good connection makes you a better doctor. Good connection is good medicine.” She looked around the circle.
I sensed an electricity in the room, as if each of us had been, well, powered up.
“The usual, ‘normal’ model in the dominant culture—power over—says that power resides in this”—she gestured to her body—“in a person. Like saying Henry Kissinger is a powerful person and—”
“Hey,” said Hooper, “he got his name on the Kissy-Saudi Tower, didn’t he?”
“We can’t all be that unlucky,” Berry said, to laughter. “In a tower, the power flows down, top to bottom. The lower down we are, the more down-and-out we are made to feel. More isolated, ‘outsidered,’ retreating into ‘self,’ alone and lonely, without support. Bereft. To get to mutuality in a power-over system is a real challenge! I’m talking about a different model of power, the”—she chalked it up—“relational model. Power arising in relationship, mutually. Not power over. Power with.”
“What do you mean by ‘mutually’?” Molly asked.
“If the connection at lunch is good, the five good things are felt mutually, by both people.” Her eyes showed her excitement. “Each person sees the other, each feels seen by the other, and each senses the other feeling seen. There’s that click! Not just empathy, mutual empathy. All good connections are mutual; if it ain’t mutual, it ain’t that good. We’ve all felt it sometime, right?”
Many nods.
“Let’s be radical. Let’s call it ‘love.’”
She let this settle and looked around at each of us as we considered “love.”
“Our job here,” she went on, “is to deal with suffering. Mutuality brings compassion to suffering.”
I found myself opening up to her, relieved that she was here now with us all. The room fell still.
“But how’s that going to help us here?” said Fats. “Can you give us some takeout? Oops. I mean take-home?”
“Next time. But let me frame this even more grandly.” She wrote on the board:
SELF MODEL: “SELF” AS CENTER OF UNIVERSE—EXCLUSIVE
RELATIONAL MODEL: “RELATIONSHIP” AS CENTER—INCLUSIVE
“The basic shift? The measure of a person’s psychological health and growth is not in the self, but in the quality of their relationships. Their connections. Their ‘wes.’”
“Oh my God!” said Molly. “That is amazing.”
“It’s true,” said Angel, “and real.”
“Finally,” said Naidoo, “someone has understood and put this into words.”
“There’s not a male surgeon on earth who understands that,” said Jude.
“Agreed!” said Gath.
Mo and Dr. Ro smiled at each other. The men, mostly, seemed puzzled.
“Sounds good,” said Eddie, “but if I go deeper into the relationship with Naidoo, won’t I be less myself?”
“But haven’t we found,” Berry said, “that when we’re in a good connection, we feel more ourselves, not less? Like right now?”
We men considered this. Then light bulbs went on and out came “Yeahs” and “Damns” and two “Holy shits!” and a “Mía Madre!” The women laughed.
I was really happy for Berry—for not just talking it, but showing it, just really being there with all of us. I sensed in the room relief, even euphoria—that crinkly, fresh texture when actually, often when you least expect it, you hear something that might just change your life. To us, beaten down that day, she offered some just plain hope.
“If only I’d larned this,” Gilheeny said, glancing at Quick, “before I met the wife.”
Quick glanced back. “My own spousal torment often devolves to harsh words. But this shifty paradigm offers a way out for suffering humanity—and huwomanity?”
