No sense in kidding himself: He was nervous about tomorrow. He had never testified before a committee of any sort, let alone one being run by the ferocious Senator James McCready. Why on earth had he agreed to do it? Why would anyone set himself up for a grilling by a bunch of politicians? Crazy!
It was all Mike—pardon: Congressman—Switzer's fault. If he hadn't sweet-talked Alan into this, he'd be home safe and sound in his own bed before his own tv set.
No, that wasn't true. Alan knew he really had no one to blame but himself for being here. He had wanted a chance to say something against the Medical Guidelines bill, and Mike had given it to him.
But would it matter?
He had begun to wonder if maybe he wasn't a vanishing breed… a dinosaur… a solo physician practicing a personal brand of medicine, developing one-to-one relationships with his patients, gaining their trust, dealing with them person-to-person, becoming someone they came to with their problems, someone they called when their children were sick, someone they placed high on their Christmas card list.
The coming thing seemed to be the patient-as-number served by the doctor-as-employee who worked for a government or corporate clinic, seeing X number of patients per hour for Y hours per day, then signing off and going home like everybody else.
Alan was not totally immune to the allure of the 9-to-5 setup: normal hours, guaranteed income and benefits, no calls in the middle of the night or on Sunday afternoons in the middle of the Jets game. Enticing…
Great for robots, maybe, but not for dinosaurs.
Switzer was styling himself as the champion of the American doctor, but how much was real and how much was a role, Alan couldn't say. He had known Mike in their undergraduate days at N. Y.U. and they had been fairly good friends until their postgraduate paths parted: Mike to law school and Alan on to medicine. Mike had always struck Alan as a decent sort, but the fact remained that he now held—and intended to continue to hold—an elected office; and that meant he had to keep an eye on which way the wind was blowing.
Switzer certainly seemed to know how to keep his name in the paper, what with his feud with the City MTA on the home front and his butting heads with Senator McCready on the national level. But how much of his opposition to McCready's Medical Guidelines bill was real commitment and how much was because McCready and the MTA's Cunningham were members of the other party?
Not knowing for sure made Alan slightly queasy. For the moment, however, he would have to trust Switzer. He had no choice.
And tomorrow I put my head on the block.
The hearings started at the unheard-of hour at 7:00 a.m., so he turned off the tv, undressed, made himself another scotch, and lay there in the dark. He tried to find an oldies channel on the radio, but the reception was poor, so he resigned himself to waiting for sleep in silence. He knew he'd have to be patient, because he could tell already it was going to be one of those nights.
Here we go, he thought as he lay there.
It never failed. Whenever he left town, he spent the first night running through his own peculiar variation on A Christmas Carol.
He wrestled with the covers on the unfamiliar mattress, plagued by the ghosts of Patients Present: the sick ones he had left behind. They were in good hands, but he was out of town and they were out of reach. He wondered if he'd made any diagnostic blunders or therapeutic errors that wouldn't be found in time. The same worries nagged him every night, but never with the same intensity as when he was out of town.
He wondered if other doctors lay awake nights worrying about patients. He never mentioned it to anyone because it sounded phony, like cheap PR, like dime store Marcus Welbyism.
The worries about current patients flowed naturally into the ghosts of Patients Yet to Be, products of Alan's chronic anxiety over keeping up to date in all the fields his practice touched on. A virtually impossible task, he knew, but he fretted about not knowing of a new diagnostic tool or a new therapy that could change the course of a patient's disease.
And last—his subconscious always saved the worst for last— the ghosts of Patients Past. He feared them the most. Like a silent crowd around an accident, all the failures of his medical career ringed the bed, crouched on the covers, and hovered overhead as he slipped toward sleep. The failures… the ones who had slipped through his fingers, the lacerated lives that got away.
Caroline Wendell was first tonight, appearing at the foot of the bed, baring her shoulders and legs to show him all those utterly gross bruises that kept popping out and threatening to like simply ruin her prom because her gown was, you know, off the shoulders. She hadn't known then that her bone marrow had gone wild, destroying her along with itself. Alan hadn't known immediately, either; but now he relived the weak, sick feeling that came over him when he spun down a hematocrit and saw the much-too-thick buffy coat of white cells in the capillary tube. Eventually she faded away, just as she had in real life from the acute lymphocytic leukemia that had kept her from seeing the end of her senior year.
Little Bobby Greavy crawled up on the bed to demonstrate that what a wild bone marrow did to a young girl's body was nothing compared to what people did to each other. Bobby was a visitor from Alan's training years, and now he gracefully turned to show off the red, blistered second-degree burn in the skin of his back—a perfect triangular imprint of his mother's steanviron.
Bobby almost always brought along Tabatha, the little seven-month-old who had been clouted on the head so many times she was blind. Despite Alan's pleas and demands and strident protests, both had been returned to their respective parents by the court and he never saw them again.
Bobby and Tabatha dissolved into Maria Cardoza. She was a frequent visitor. Slim, beautiful, nineteen-year-old Maria.
As usual, she floated in on her ICU bed, naked, bleeding from her nose, her mouth, her abdominal incisions, her rectum and her vagina. That was how he had last seen her, and the image was branded on his subconscious. Four years ago he had been passing through the ER when the first aid brought her in from a two-car head-on accident on 107. He had seen her only once before in his office for a minor respiratory infection. Since there was no one else available, he had assisted the surgeon on call in removing her ruptured spleen and sewing up her lacerated liver. The procedure had been effective, but all the clotting factors in her blood had been chewed up and she simply would not stop bleeding. Alan dragged a hematologist out of bed but nothing he did would make Maria's blood clot. Once again, fresh as that very night, he felt the grim, almost hysterical frustration of his impotence, of the futility of every effort to save her as he stayed by her bed until dawn, watching liter after liter of the various solutions and plasma fractions that poured into her veins run out the drains in her abdominal cavity. She went into renal shutdown, then congestive heart failure, then she went away.
But not for good.
Maria and her touring company lived on, visiting Alan on a regular basis.
It was almost time.
Mike Switzer, all eyes behind his hornrimmed glasses, wavy brown hair falling over his angular face, had hovered at Alan's side all morning.
"Just stay cool, Alan," he kept saying. "Don't let them rattle you."
Alan kept nodding. "Sure. Don't worry. I'm fine."
But he wasn't fine. He felt as if he were about to be fed to the lions. His stomach kept twitching and his bladder urged him to the men's room again despite the three trips he had already made there.
He'd heard about McCready and how he could cut you up and eat you alive before you even knew he was talking to you.