Man's 4th Best Hospital Read online

  II

  Man’s 4th Best Hospital

  “Virtue? A fig! . . .

  Drown thyself? Drown cats and blind puppies . . .

  Put money in thy purse. Follow thou the wars . . .

  fill thy purse with money.”

  —Iago, Othello

  2

  Man’s Best Hospital was the third hospital founded in the United States, through a charter of the legislature by a group of Mayflower descendants in the first decade of the 1800s. All funds were donated, including a farm complete with cows and a bull.

  Its first patient was a tailor with the pox. He claimed that he did not catch it in the city of Man’s Best Hospital, but far away, in Boston. Man’s Best mission was summed up in two new-world oaths for its doctors, carved in stone in foot-high letters on the facade of the original Pink Building:

  “In pain, everyone is our neighbor.”

  “Our best charity of spirit is the easing of human suffering.”

  Everyone our neighbor? Charity of spirit? A best mission, yes, back then.

  The lineup of oil portraits in the marble halls was all White Anglo-Saxon Protestants. They had a noble mission: to provide good health care for all, even the poor. Imagine that. If you didn’t have the money, you still got the care. In its first year, it became the teaching hospital of the Best Medical School, the BMS.

  For the first 100 years, non-WASP docs were non-welcome. There were no places in the city where Jewish med school graduates could go for their internships. This led to a wave of construction across the USA of Jewish hospitals, Houses of God, including a flagship, the House of God. This soon filled with red-hot young Jewish doctors—much like some of the ones at MBH, but these guys, like any subordinate group who was denied the best, were hungry. By some miracle—a recognition of their red-hotness—the House too eventually became affiliated with the Best Medical School.

  The two hospitals were different. The House was run by “God’s Chosen People,” MBH’s by “God’s Frozen People.” MBH was hard-nosed. The House was hamisch, a Yiddish word for a hospital featuring mensches, good-hearted guys.

  In the modern era MBH had become a magnificent hospital, in every way.

  But several years ago MBH had been bought by BUDDIES, a corporate conglomerate of most of the BMS hospitals. Bought, and being crushed under, the deadweight of BUDDIES—a 73,000-weak bureaucracy—filled, oddly enough, with bureaucrats.

  None of them provided any health care.

  This 26-billion-dollar cost center, this corporate whale, was inserted into the health-care food chain between hospitals and insurance conglomerates—for no other reason than cash. It had succeeded in its mission: using its purchasing power against insurance, “To get prices up. To monetize. To cost more.” Never mind that in health care Value = Outcome/Cost. Who cared about “value”? It became the biggest health-care empire in imperial America.

  And so a great hospital, its great doctors and other health-care workers, as well as its tens of thousands of patients—all of us became allies, as victims of BUDDIES.

  Being bled of cash by BUDDIES, MBH was soon deep in debt. BUDDIES realized that MBH could no longer make any real money by honoring its mission of service to the sick poor, and insisted it “reengineer” its mission to make money off the healthy wealthy.

  But worse than losing money, Man’s Best Hospital was losing prestige.

  Many years ago U.S. News & World Report, a tabloid magazine that knew nothing about hospitals, for some reason—say, cash—began rating hospitals. The ratings, seemingly by whimsy, changed each year. Hospitals were at their mercy, going up and down as if they were passing each other on escalators in Macy’s.

  MBH was the exception. It was steadily #1. But then in lockstep, as BUDDIES rose, Man’s Best fell. Two years ago it had dropped to #2, behind Stanford. And just this year it had dropped another two rungs down the ladder to #4, behind New York University—which was kinda, y’know, okay—but also behind the House of God. Not okay! For some reason the House of God, a BMS hospital, had not joined BUDDIES. Neither Stanford nor NYU had BUDDIES.

  Now Man’s Best was known as Man’s 4th Best.

  A few WASPs on Man’s 4th Best Board showed hints of a strange feeling: sadness. One even got depressed.

  Why did they call in the Fat Man and offer him “whatever he wanted to do”?

  Because Fats now embodied, and might just reclaim for them, the two fallen icons of Man’s 4th Best, and of America itself: money and fame. Fats had become incredibly rich and famous—first in Hollywood doing “The Bowel Runs of the Stars,” then in Silicon Valley founding a biotech start-up, hot on the trail to find a pill to restore memory.

  * * *

  On the morning of July the first, which was to be my first day at Man’s 4th Best, Berry and I had a problem and then a fight. Two weeks earlier, with all our savings, we’d bought a house. Two houses, really—a big, crumbly Victorian on a high hill in the dull suburbs, with a huge carriage house in which we three would live and I would write, while I rented out the main house, making just enough money to survive.

  Mornings with five-year-olds can be crazy—and this one was. I remembered that Berry, a psychologist, had an early meeting of something or other, so I was tasked with getting Spring out on time to the Whole World summer preschool—her second week there—and walking Cinnamon, our beloved dog.

  The fight at the door was our usual one—exacerbated by our hard but exhilarating past two years on Navajo time in Arizona, working in the Indian Health Service, time much less tight and punitive.

  “And get Spring there on time—she’s all dressed and fed—and—”

  “You don’t have to tell me—”

  “It would be a first.” She, as always, had dived into her “I”-phone, texting.

  “Two minutes don’t matter.”

  “To Margaret, two seconds matter—get her there early, and don’t forget that today you’ve got to get snack.” Texting, texting.

  I blanked. For a second I couldn’t remember if I’d already bought snack.

  “You forgot?” she said. “You forgot snack?”

  “No, no. In fact I got snack two nights ago. I’m good with snack—in fact, I have a knack with snack.” She rolled her eyes. “Gimme a break. I’m a little distracted.”

  She paused. “You mean, worried? I thought we already talked about—”

  “Nah. What’s there to worry about?”

  “Oh, boy, here we go again.”

  “No, really, it’s not like the House of God—that first day, I was scared stiff, remember?”

  “Your fear broke through your denial, yeah. Made you open up. It was good to see.” She checked her watch. “Gotta run—can’t be late—first meeting.” She stopped, stared.

  I tried like hell to remember what this first meeting was—and failed.

  “You forgot?”

  “Not really ‘forgot,’ but—”

  “Unreal. I know you’re hassled, but maybe, just maybe, you can tune in to my new world a little bit?” She turned toward the door.

  “Sorry. Really. I’m psyched that you’re back into . . . umm . . .”

  “Relational theory.”

  “And it’s great—I mean it.” She smiled, sensing I did mean it. She lived in as attuned a relational nature as I’d ever known. I’d watched it grow and blossom, all these years, and envied the depth of her women’s friendships.

  “Okay,” she said, softening. She glanced at her watch. “I’m sorry I can’t be the one to take her today, but it’s good for you. If we both survive, I’ll see you tonight.” She turned to go, but turned back. “Okay, okay, what’s with you right now?”

  “Nothing. What can go wrong? I totally know medicine—and even the Navajo way. Getting back with Fats and the other guys’ll be great.”

  “Oh
, boy.” She looked into my eyes. “Roy, this is new. You’re going to be a teacher of interns and residents now—which you’ve never done—in another huge institution like the House and Mount Misery that you never, ever have functioned well in. Plus you’ve been away from high-pressure BMS doctors for two years . . . and it’s gonna be great?”

  “An outpatient clinic? No night call or weekends, nine to six? What could be bad?”

  She shook her head in disbelief. “You have absolutely no anticipatory anxiety.”

  “So?” Her eyes widened, as if seeing a car crash coming. “Hey, this time is different. Can’t be as bad as the House—or, worse, that mind warp Misery. No way.”

  “It can be. A different bad.”

  “Like what?”

  “How the hell do I know? God!” She sighed. “Don’t be late. And get snack.”

  “I told you I got snack and I’ll be on time and it’s all gonna be great with Fats—life with him would be great anywhere. And with all my old buddies. It’s a chance to create something good in medicine, something human. Fats said they gave him ‘total control’—we even profit share. If it works, we make the big fortuna—which, lest we forget, we can really use—I mean, 24 grand for private preschool? So she can learn to do Lunch Bunch?”

  Halfway out the door, she paused. “After all this, you are so innocent.”

  “How am I innocent?”

  “See? You’re even innocent about being innocent.” She shook her head, then stared me down. “On time. Pack snack.” And was gone.

  Spring was five going on either three or seven, depending on how her day was shaping up. Today, luckily, it was seven. I easily dressed and fed her—and fed and pooped and peed the puppy dog, Cinnamon. We got to the Whole World, where she was learning important things like “water play” and, yes, the dread “snack.”

  I got there and deposited her—a little early, actually—and proudly handed over a giant bag of “snack” to Margaret, the founder and boss. She was a Quaker, wrinkled and strong and as tall as me and kinda hated me because so far in my two chances I had been six minutes and then eight minutes late. She examined snack. I had bought a variety of Drake’s Cakes, including my own childhood favorites, fake-crème-filled, sweet-chocolated Devil Dogs, Yankee Doodles, and the luscious Ring Dings. She glared at me as she laid these out on a table in the Snack Shack, but they passed, barely. The soda didn’t.

  “Snack is not soda,” said Margaret in a voice that could have cut glass. “Snack is juice. Apple juice or grape. You have two hours to get it.”

  Spring squirmed, looking awful: Dad Was Dumb. Feeling squeezed, I ran out to get juice—and lucked out. Down the street was a convenience store—named Convenience Store. It didn’t have any big bottles of juice—but it did have those little boxes. I bought all the apple and grape boxes and went back. Margaret opened the bag and did not smile. “You bought thirty-seven little boxes of juice?” I replied it was all they had. Spring and the other kids stared at a Dad Being Treated like a Dumbo Five-Year-Old. I fled. Only driving like a maniac might I get there on time. Not a good time to have a Prius.

  Berry was wrong. I wasn’t innocent. I was hepped up, full of earned confidence in my ability to take care of just about anything in medicine. After my year in the House, we’d traveled the world together, me working as a doctor to pay our way, from Australia through Asia to Sweden and a lot of places in between. It had been raw and dangerous and marvelous. After the hell of internship, it took time to rebuild our love. A second rebuilding. We had met when we were in college; a dynamite love carried us through until graduation and what should have been marriage, me going to the Best Medical School, she to Man’s Best Psychology. But without working it through with her, I’d applied for a Rhodes scholarship and gotten it—Oxford for three years. We crashed. The love got all twisted; the relationship died.

  But we grew up. Back in America, we salvaged it. We both continued our training in psych at Mount Misery, the flagship mental health hospital of the BMS. I went into psychiatry because I thought it would be more human, even humane. As in Casablanca, “I was misinformed.” There were pedophiles, drunks and drug addicts, borderlines, manics and depressives, passels of psychopaths, and serial sexual abusers—and these were just the psychiatrists! Humane? Ha. We lasted there only a year. We wound up at the Indian Health Service. I worked as a general practitioner, Berry as a psychologist. What a time that was! With our baby, Spring, at an isolated clinic near sacred Canyon de Chelly, we were dedicated to trying to doctor the worst poverty, disease, reduced life span, addiction, suicide, violence, and death in America. We witnessed all this, the residue of the postcolonial genocide—but we also saw the Navajo spirit, not only in resistance, but in healing. We both had to become specialists in addiction—alcohol and drug abuse.

  I had always wanted to be “the one at the end of the ambulance ride.” Now I figured that even if I might have my usual trouble working in big heirarchical systems, I would never doubt my competence in, and caring about, what I at best called “healing.” And with Fats again? Driving into Man’s 4th Best, I mused on a kind of medical heaven.

  * * *

  I parked in a six-story lot and got lost. I had been here often during med school, but everything had changed. On the crest of a hill, the glorious Art Deco Pink Building and garden and the 1816 neoclassical granite Blue Building were darkened by skyscrapers. I forgot the building name and asked Information for the office of hospital president Jared Krashinsky.

  “Oh, that’s your Twitter Building.” She handed me a map, as complex as linguine.

  A whispering rocket ride to floor 40 and out. Staggered by the sheets of morning sunlight backlighting a panorama of sea and threads of bleached clouds and then nothing but magical realism blue. The meeting was in the dimly lit, hushed boardroom, leather and chrome. On a giant bright screen was a slide. As my eyes adjusted, I saw, at a square glass table as big and blocky as my Prius, the Fat Man in a florid and horrific Hawaiian shirt. Beside him was Humbo, a young, compact Hispanic guy in a short white doctor coat. And then what he’d called his “A Team” from the House of God: Eat My Dust Eddie, Chuck, Hyper Hooper, the Runt, and Gath, an Alabama cracker who’d been a surgical resident. A nurse, Angel Jones, the Runt’s wife, sat beside him. I hadn’t seen most of them for many years. Also, a woman doctor of color, I guessed from India. I slipped into a seat. Panting, wiping off sweat. Way late.

  Jared Tristram Krashinsky, of the Lithuanian Krashinskys, Man’s 4th Best president and titan of industry, stood at a lit screen in dim light, a power suit reading a PowerPoint:

  “—this slide shows Core Concept One: Mobile Self-Management. Notice the two-headed arrow. I manage up, and I manage down. Man’s Best Hospital uses world-class managerial material of the BBS—the Best Business School. I use both hard and soft power. I go down hard. I come up soft, and—”

  “Hraaak-a-hraaak!” coughed Eat My Dust Eddie, our giant, red-haired, wild-man master of irony, straight from a lucrative Newport Beach cancer practice and wife-lucrative divorce. He kept fake hraaacking and, doubled over, exited.

  The Krash stopped. Pissed at Eddie? Nope. He was staring at the screen calmly, with eyes closed, smiling, sucking on something. He was a short, fit-looking guy with a handsome face—plump lips, dimpled cheeks, and, for Lithuania, a reasonable nose. Silky dark hair carefully cut, combed over. Appealing, in a boyish way. He was what my immigrant grandmother, Molly, had called me, in Yiddish, a zeesa boyala—a sweet boy.

  I looked around. My guys had been sitting there listening to him for a while. They did not look happy, rolling their eyes at one another and me.

  Krash shifted the sucking into a pouch of a cheek.

  “You may be wondering why I’m waiting, as if I’m doing nothing. I’m not. I’m doing Core Concept Two: Maximum Meditative Mindfulness. Man’s Best Wellness Program, directed by Bernard, Lama Llassi. Nickname, Mango. Ma
ngo Llassi.” No one laughed. Click. And there he was, Mango Llassi: shaved head, a diamond in his nose, looking like everybody’s uncle Louie.

  “What if my religion prohibits meditation?” asked Runt. He’d come into the internship mortally scared of doctoring, and under the thumb of a scary dry poet. Chuck and I had freed him up, into an erotic machine. Eventually he wedded the second-most-erotic nurse, Angel—who had never completed a sentence that whole year, except with a gesture. In Denver Runt had become an orthodox Freudian psychoanalyst. Now he was wearing a lime green bicycle helmet, as if a lid for his id. “What if it prohibits Mango Llassi?”

  “Why, then, you, so to speak”—Krash smiled, a boyish smile meant to be friendly—“choose your poison. Or none at all.”

  “Y’mean, man,” Chuck said, “if the sacred ain’t sacred to you at all?” He was black, a gentle soul, a magical basketball player and singer, from a poor family of eight in Memphis. At first the higher-ups thought he was just a dumb affirmative action black guy. But he was the best doc of us all—and the kindest. He and I loved to play basketball and drink. Both of us going to work tipsy, if not drunk. Looking back, our internship floated in alcohol! I’d come to love Chuck. Now I was startled by the touch of gray in that “cool”-cut hair. Last I heard he’d gone home to Memphis to be a family doc and singer. He was not the kind to stay in touch.

  “If it’s not sacred,” Krash said, “try the ‘No-Name Chapel.’”

  “But!” cried Hyper Hooper, our high-octane, competitive manic from California, rocking back and forth. His mustache had gone gray, his wavy hair receeding. He’d been “into death,” winning the prize for most autopsies. But by the end he’d succumbed to MOR—Marriage on the Rocks—separated from his Sausalito wife, and had taken up with an Israeli pathologist in the morgue. He wound up in LA, and through an aqua-nude-couples therapy group, he had repaired the marriage, had kids. A science genius and skeptic about Big Pharma’s pills that kill more people than they cure, he’d founded at UCLA the Hyper-Winfrey Nutrition Center, and published a bestseller: Eat Red, Live Long.