The plan for the first day was for the assigned medical students to change into scrubs and meet their respective preceptors in the surgical lounge at eight in the morning. Jennifer was early, as was her habit. Consequently, although it was only seven-thirty-five, she’d already changed and was sitting in the surgical lounge, mindlessly flipping through an outdated Time magazine. At the same time she was keeping an ear to CNN on the TV while watching the comings and goings of the doctors, nurses, and other staff. The surgical day was definitely already in full swing. She’d been told Mondays were always busy, and she could tell from the whiteboard that every one of the twenty-three operating rooms was currently occupied.
Jennifer sipped her coffee. The anxiety about being late was now comfortably fading, and she began to wonder if she’d be accepted in the excellent UCLA surgery program if she decided on it as her specialty of choice. The exciting thing was that in the upcoming year, the whole hospital was moving into the new Ronald Reagan facility across the street, where the ORs were to be the latest and the best. As one of the hardest-working students, Jennifer was one of the top students in her class, and as such, she was confident she had a good chance to be asked to stay on if she applied. But in actuality, staying in L.A. wouldn’t be her first choice. Jennifer wasn’t from Los Angeles; she wasn’t even from the West Coast like the vast majority of her fellow students. Jennifer was from New York and had come west to take advantage of a four-year scholarship that had been established by a grateful and wealthy Mexican whose cancer had been cured at the UCLA Medical Center. The scholarship was for a needy Hispanic woman. Being all three, Jennifer had applied and won, and so began her unexpected foray to California. But now that her medical schooling was winding down, she wanted to go back east. She loved the Big Apple and considered herself a New Yorker. That’s where she’d been born, and as hard as it had been, that’s where she’d grown up.
Jennifer took another sip of her coffee, and switched her full attention to the TV. The two CNN talking heads had said something that caught her interest. They had said that medical tourism seemed to be threatening to become a growth industry in the developing world, particularly in South Asian countries like India and Thailand, and it wasn’t just for cosmetic or quack procedures, such as untested cancer cures, as it had been in days of yore. It was for full-blown twenty-first-century procedures, such as open-heart surgery and bone-marrow transplants.
Leaning forward, Jennifer listened with growing interest. She’d never even heard the term medical tourism. In her mind it seemed like an oxymoron of sorts. Jennifer had certainly never been to India, and with scant knowledge she envisioned it to be an appallingly poor country whose majority population was skinny and malnourished, dressed in rags, and lived in a hot, humid monsoon for half the year, and a hot, dry, dusty desert for the other half. Although she was smart enough to know such a stereotype was not necessarily true, she thought it most likely had an element of truth, or it wouldn’t be the stereotype. What she was certain of was that such a stereotype hardly suggested the appropriate destination for someone to go to for the latest surgical skills, modern and expensive technology, and twenty-first-century techniques.
To Jennifer it was apparent the newscasters shared her disbelief. “It’s shocking,” the man said. “In 2005, more than seventy-five thousand Americans traveled to India for major surgery, and since then, according to the Indian government, it’s been growing more than twenty percent per year. They expect by the end of the decade, it will be a two-point-two-billion-dollar source of foreign exchange.”
“I’m amazed, totally amazed!” the woman newscaster said. “Why are people going there? Does anyone have an idea?”
“Lack of insurance here in the States is the main reason, and cost is the second,” the man said. “An operation that would cost eighty thousand here in Atlanta might cost twenty thousand there; plus, they get a vacation at a five-star Indian resort to boot.”
“Wow!” the woman commented. “But is it safe?”
“That would be my concern as well,” the man agreed, “which is why this story that’s just come in is so interesting. The Indian government, which has been supportive of this medical tourism with economic incentives, has claimed over the last number of years that the results are as good as or better than anywhere in the West. They say the reason is that the surgeons are all board-certified, and the equipment and hospitals, some of which are accredited by the International Joint Commission, are state-of-the-art and brand-new. However, there’ve never really been much data and statistics in any of the medical journals to back up such claims. Just a few moments ago CNN learned from a known, reliable source that a generally healthy sixty-four-year-old American woman from Queens, New York, named Maria Hernandez, who’d had an uncomplicated hip replacement some twelve hours earlier, suddenly died at seven-fifty-four Monday night, India time, at the Queen Victoria Hospital in New Delhi, India. Of particular interest, the source said she was certain that this tragic passing of a healthy sixty-four-year-old was merely the tip of the iceberg.”
“Very interesting,” the woman said. “I trust we’ll be hearing more.”
“That’s my understanding,” the man agreed.
“Now, let’s move on to the interminable ’08 presidential campaign.”
Jennifer sat back, dazed. In her mind she repeated the name: Maria Hernandez from Queens, New York. Jennifer’s paternal grandmother, the most important person in her life, was named Maria Hernandez, and more worrisome, she lived in Queens. Even more worrisome, she had a bad hip that had been progressively worsening. Just a month ago, she’d asked Jennifer’s opinion if she should get it repaired. Jennifer’s advice had been that only Maria could answer such a question, since it depended, at this stage, on how much disability and discomfort it caused.
“But India?” Jennifer shook her head. The fact that it seemed so totally unlikely that her grandmother would go to India without discussing the idea with her was Jennifer’s main source of hope that the story was just a coincidence and didn’t involve her Maria Hernandez but some other Maria Hernandez who also lived in Queens. Jennifer and her grandmother were extremely close, since Maria was Jennifer’s ersatz mother. Jennifer’s real mother had been killed when Jennifer was only three, as the tragic victim of a hit-and-run driver on the Upper East Side of Manhattan. Jennifer, her two older brothers, Ramón and Diego, as well as her good-for-nothing father, Juan, had lived in Maria’s tiny one-bedroom row-house apartment in Woodside, Queens, almost from the day of the accident.
Jennifer had been the last child to move out, and that hadn’t happened until she’d left for medical school. In Jennifer’s mind, Maria was a saint whose own husband had abandoned her. Maria had not only allowed them all to live with her, she’d supported and nurtured them all while working as a nanny and housekeeper. Jennifer and her brothers helped with after-school jobs as they got older, but the main breadwinner had been Maria.
As for Juan, he had done nothing for as long as Jennifer could remember. Supposedly having suffered an old incapacitating back injury before Jennifer was born, he’d been unable to work. Before her death, Jennifer’s mother, Mariana, had been the only wage earner, a buyer for Bloomingdale’s. Now that Jennifer was nearing the end of medical school and knew something about psychosomatic illness and malingering, she had even more reason to question her father’s supposed disability and despise him even more.