"Fine! Let's continue."
Randolph returned to the podium. Fasano sat back down at the plaintiff's table.
"Objection sustained," Judge Davidson said for the court reporter's benefit. "Continue."
"Ladies and gentlemen of the jury," Randolph said, "motivation is not usually part of medical malpractice proceedings. What is normally at issue is whether the standard of care has been met such that the doctor possessed and used that degree of learning and skill in treating the patient's condition that a reasonably competent doctor would employ in the same circumstance. You will note that in his opening statement, Mr. Fasano said nothing about his experts suggesting that Dr. Bowman did not use his learning and skill appropriately. Instead, Mr. Fasano must bring in the concept of motivation to get his allegation of negligence to be substantive. And the reason for this, as our experts will testify, is that from the instant Dr. Bowman knew the gravity of Patience Stanhope's condition, he acted with commendable speed and skill, and did everything possible to save the patient's life."
Alexis found herself nodding in agreement as she listened to Randolph. She liked what she was hearing and thought he was doing a good job. Her eyes switched to Craig. He was at least sitting up straight. She wished she could see his face from where she was sitting, but it was impossible. Her eyes then went to the jury and her evaluation of Randolph 's performance began to erode. There was something about the jurors' posture that was different from when Tony Fasano was speaking. They seemed too relaxed, as if Randolph wasn't sufficiently engaging their attention. Then, as if to confirm her fears, the plumbing assistant gave a long, sustained yawn, which spread through most of the others.
"The burden of proof lies with the plaintiff," Randolph continued. "It is the defense's job to rebut the plaintiff's allegation and the testimony of the plaintiff's witnesses. Since Mr. Fasano had indicated that motivation is his key stratagem, we, the defense, must adjust accordingly and present with our witnesses an affirmation of Dr. Bowman's commitment and sacrifice throughout his entire life, beginning with a doctor kit given to him at age four, to be the best doctor and to practice the best medicine."
"Objection," Tony said. "Dr. Bowman's commitment and sacrifice during his training has no bearing on the particular case at hand."
"Mr. Bingham," Judge Davidson asked. "Will your witnesses' testimony relate Dr. Bowman's commitment and sacrifice to Patience Stanhope?"
"Absolutely, Your Honor."
"Objection overruled," Judge Davidson said. "Proceed."
"But before I outline how we plan to present our case, I'd like to say a word about Dr. Bowman's practice. Mr. Fasano described it as 'concierge medicine' and suggested the term had a pejorative connotation."
Alexis glanced back at the jury. She was concerned about Randolph 's syntax and wondered how many of the jurors could relate to the words connotation and pejorative, and, of those who could, how many would think they were pretentious. What she saw was not encouraging: The jury looked like wax figures.
"However," Randolph said, raising one of his long, manicured fingers into the air as though he was lecturing a group of naughty children. "The meaning of the word concierge in its usual sense is help or service, with no negative connotation whatsoever. And indeed that is the reason it has been associated with retainer medicine, which requires a small, up-front fee. You will hear testimony from a number of physicians that the rationale for such a practice format is to spend more time with the patient during appointments and during referrals so the patient enjoys the kind of medicine all of us laypeople would like to experience. You will hear testimony that the kind of medicine practiced in a concierge practice is the kind of medicine all doctors learn during medical school. You will also hear that its origins have come from the economic bind in traditional-practice settings that forces physicians to crowd more and more patients in a given hour to keep revenues above costs. Let me give you some examples."
It was reflex rather than conscious thought that propelled Alexis to a standing position in reaction to Randolph 's foray into dull medical economics. Excusing herself, she moved laterally along the church-like pew toward the central aisle. Her eyes briefly met those of the man who was dressed identically to Tony Fasano. He was sitting in the aisle seat directly across as Alexis exited her row. His expression and unblinking stare unnerved her but then immediately dropped out of her consciousness. She headed to the door to the hall and opened it, trying to be as quiet as possible. Unfortunately, the heavy door made a click heard all around the courtroom. Momentarily mortified, she stepped out into the hall and then walked out into the large elevator lobby. Sitting on a leather-covered bench, she rummaged in her shoulder bag for her cell phone and turned it on.
Realizing she had poor reception, she took the elevator down to the ground floor and walked back out into the sunlight. After being indoors, she had to squint. To avoid the smog of cigarette smoke from the nicotine addicts sprinkled around the courthouse entrance, she walked a distance until she was by herself. Leaning on a railing with her bag over her shoulder and tucked safely under her arm, she scrolled through her phone's electronic address book until she came to her older brother's entries. Since it was after two in the afternoon, she used his work number at the Chief Medical Examiner's Office in New York City.
As the call went through, Alexis tried to remember exactly when the last occasion had been that she'd called and talked with Jack. She couldn't remember but knew it had to have been months, maybe as much as half a year ago, as much as she'd been consumed by her family's disarray. Yet even prior to that there'd been only intermittent, haphazard contact, which was unfortunate because she and Jack had been extremely close as children. Life had not been easy for Jack, specifically fifteen years previously when his wife and two daughters, aged ten and eleven, had been killed in a commuter plane crash. They had been on their way home to Champaign, Illinois, after having visited Jack in Chicago, where he was retraining in forensic pathology. When Jack moved east to New York City, ten years previously, Alexis had been hopeful they would see a lot of each other. But it hadn't happened because of what she'd said to Craig earlier. Jack was still struggling to get over his tragedy, and Alexis's children were a painful reminder. Alexis's oldest daughter, Tracy, had been born one month after Jack's tragic loss.
"This better be important, Soldano," Jack said without so much as a hello after answering the phone. "I'm not getting anything done."
"Jack, it's Alexis."
"Alexis! Sorry! I thought it was my NYPD detective friend. He's just called me several times on his cell from his car but keeps getting cut off."
"Is it a call you need to take? I can call you back."
"No, I can talk to him later. I know what he wants, which we don't have yet. We have him well trained, so he's enamored with the power of forensics but he wants results overnight. What's up? It's good to hear from you. I never expected it would be you at this hour."
"I'm sorry I'm calling while you're at work. Is this a good time to chat, apart from your detective friend trying to get ahold of you?"
"Well, to be honest, I do have a waiting room full of patients. But I suppose they can wait since they're all dead."