Death Benefit

19.

COLUMBIA UNIVERSITY MEDICAL CENTER NEW YORK CITY MARCH 3, 2011, 9:02 P.M.

Pia waited more than two and a half hours for Rothman and Yamamoto to finish their work in the BSL-3 lab. She spent the time productively reading papers on tissue engineering and organ printing on the Internet, which is what she would have been doing anyway if she’d gone back to the dorm. As the time had passed and her empty stomach growled, she became progressively concerned it had something to do with her being late two days in a row. Eventually, Rothman and Yamamoto appeared. Yamamoto immediately left. Rothman wordlessly waved for her to join him in his office, where he got straight to the point.

“I want to talk to you about the future. Your future. I need to know that you are committed to this work.”

“I am, truly,” Pia said. She was panicked. “I know I was late this morning-”

“You were late two mornings in a row, at least according to Miss Langman.”

“I’m sorry . . .” Pia stammered. Her fears were coming to pass.

“It doesn’t help to be sorry,” Rothman shot back. “I’m concerned about what it implies.”

“I will make sure it never happens again,” Pia offered.

Rothman waved her off. “Let me speak while I’m inclined to do so. As you know, I’m not accustomed to talking too much about this kind of nonsense. I don’t have the time. Last year I confided in you some information about myself because I had been progressively confident that you were turning out to be the person I thought you could be. Remember, as I told you, I played a role in getting you admitted when others on that damn admissions committee where I was forced to serve were reluctant because of your foster care experience. Since I had the same experience, I thought you might have promise of being a researcher.”

“I’ve come to the same conclusion,” Pia blurted.

“Don’t interrupt!” Rothman snapped. “Last year when I told you those secrets about me that are only known by my wife, bless her soul for putting up with me, concerning my foster care history and my Asperger’s, I wasn’t completely open. I said my sons were not as healthy as I would like. To be more specific, not only are they too on the Asperger’s spectrum, but even worse, they have type 1 diabetes. Having passed on the Asperger’s was reason enough for guilt and depression. The diabetes has put it over the top. The main reason I’ve turned to stem cell work is to see that my boys are cured in my lifetime. It’s a quest that pulled me out of a serious bout of depression. Depression has been my bete noire.”

“I’m so sorry to hear about your boys,” Pia offered.

“I’m not telling you this to elicit any sympathy. I’m telling you this so that you understand me better. I have never ever agreed to mentor anyone, and it is not just because my Asperger’s puts me at a social disadvantage. I feel I don’t have the time for other people’s nonsense, and this includes Ph.D. students as well as medical students. You were a first. I thought your foster care experience would make you thrive in the lonely pursuit of science and that you should have been given a chance.”

“I think you’re right,” Pia said. “I know I struggle with social issues as well.”

“Pia, commitment to research has to be total. Two days ago you came in here and told me that, yes, you were going to take me up on my offer to do your Ph.D. here in my lab. At the same time you told me you were going to do a simultaneous residency in internal medicine. And then you expected me to be pleased. Pia, that old myth of the doctor doing both clinical medicine and research at the same time is totally passe. It wasn’t even true when it was current. Research is more than a full-time job.”

For one of the first times in their three and a half years of knowing each other, Pia and Rothman held each other’s eyes. It was a kind of Mexican standoff. Both were conflicted. Pia had struggled hard and surmounted considerable obstacles in her drive to become a doctor. And now she was so close. In months she would be getting her M.D. degree. The problem was she wouldn’t yet be a doctor, one that can get a license from the state. A resident was on his or her way to becoming a real doctor. If she didn’t take a residency, she’d always be a medical student with an M.D.

Both individuals looked away.

“I realize that I’m hard to read,” Rothman said, breaking a short silence, “or at least my wife tells me so. She advised me to have a conversation with you.”

“She knows about me?”

“She knows about everything in my life. It is the only way we could have survived as a couple. I’m not easy to live with.”

Rothman had been rehearsing this speech for days so he was relatively comfortable once he had started talking.

“What I seek in a colleague is commitment. A med school graduate knows nothing. No offense. But if they’re able to pass through medical school it means they have the basic intellectual wherewithal to do research. After the initial flash of inspiration that tells you what to look for, most of the success in research lies in doggedness. In covering every angle, tracking down every lead. I’m mixing metaphors but you know what I mean. Dr. Yamamoto was in fact a rather mediocre student, but he exhibited more application than ten other men who had better grades. I can already tell what kind of doctors your colleagues will be. Ms. Wong is desperate to help sick people, and she’ll be very good at it. Mr. McKinley will probably end up doing something flashy but unchallenging, like surgery, and worse yet, plastic surgery.”

Pia didn’t know what to say.

“I’m pleased you made the right decision about the nuns. It shows me that you’re orienting yourself in the direction of research, but I don’t want you to make the same mistakes I made. For me, doing a residency in internal medicine was a big waste of time.”

Rothman paused.

“I think we’re similar in a number of ways.”

Pia’s eyes opened wide, and she flushed and looked down at her feet. She didn’t share Rothman’s newfound comfort in discussing such personal matters.

“I need more help here. Dr. Yamamoto can’t do everything, and I can’t rely on med students rotating in and out of the lab. No offense. The two of us are spread thin, working on salmonella and organogenesis at the same time. But the university is committed to helping us, and I hope we’ll be able to add laboratory staff and take over more lab space to ramp up our organogenesis work. We need at least another researcher. Which is why I’m talking to you about commitment. Although I usually have no time for excuses, tell me why you were late the last couple of days.”

“There’s no excuse, really,” Pia admitted. “But I’ve been having trouble sleeping.” Silently she cursed George for her getting accustomed to him waking her up even though she knew it was totally unfair.

“Why have you been having trouble sleeping? Anxiety?”

“Nightmares.”

“About what, if I may ask?”

“Childhood memories. Ancient history.”

“Pia, I think I need to know more about you. You’ve told me little about yourself even though I’ve tried to be open with you about me.”

“What do you want to know?”

“Everything!”

Pia took a deep breath. Occasionally in life there is a key crossroads moment that can be identified as such even as it’s taking place. Pia understood she couldn’t hide or keep quiet. The time to talk was now. Except with her caseworker, Sheila Brown, she’d never talked about her childhood. She took another breath. She felt as if the room were closing in on her. The only light in the room was a small library light on the desk, which put Rothman’s face in shadowy relief.

“I do remember my mother-not much, just little things. She was also a Pia. My first name is actually Afrodita, but we were both called Pia. Sometimes out of the blue, a scent on someone or a gesture will make me think of her. But she died when I was little. I don’t know how, and I don’t even know how I know she died, but I do. I lived somewhere in the city with my father, Burim, and his older brother, Drilon, who stayed with us. They were Albanians, real Albanians, just off the boat, very rough around the edges. My father was away a lot, and I had to spend time with my uncle, who was a real creep. Have you got any water or anything?” Pia’s throat was dry.

Rothman got out a bottle from a small fridge under the Nespresso machine. He pushed it and a cup across the desk’s leather surface.

“He hit me a couple of times, my uncle. He used to touch me, never when my father was around, he was very careful. He made me touch him inappropriately, to say the least. He took pictures of me, you know, and developed them himself, and I think he used to sell them to other creeps like him. It developed into a side business for him. One night I had enough, and I went for him.”

“What did you do?”

“I tried to stab him in the penis with a pair of scissors. Unfortunately I missed the target. It bled a lot. I remember later during first-year anatomy when the professor was talking about the femoral artery and joked about how you should avoid puncture wounds there. I suppose that’s where I must have stabbed my uncle.

“When he got out of the hospital, he beat me up pretty well, and I guess someone called nine-one-one about a little girl with a bruised face because the police came and grabbed me. My uncle and my dad both got arrested. So I became the property of New York City Child Protective Services.”

Pia took another drink of water.

“And your father?”

“He vanished. Years later I made Sheila Brown, my final and best caseworker, tell me what happened. She managed to find out that the two of them made bail and disappeared into the city. I’ve no idea where he is, if he’s even alive. I guess I convinced myself that my father wasn’t to blame for what his brother did to me. When I was in foster care, I used to fantasize that he would suddenly appear and rescue me from those places I was in, but he never did. I gave up hoping after a few of years.”

“How old were you when you were taken into care?”

“Six. I was a problem for the foster care people from the get-go. My father hadn’t officially given up his parental rights, so I couldn’t be adopted. He had to register with Child Services before-I wasn’t in school, I guess-and genius that he was, he said I was a Muslim, which, as an Albanian, he may have been. Sheila said he must have thought I’d get better treatment if I was a minority, but it just meant none of the religious agencies wanted me. Back then the system was dominated by Catholic, Protestant, and Jewish organizations. So instead of having a chance at some reasonably appropriate placement, I was put in a kind of temporary group home, and a janitor there tried to abuse me like my uncle did, but I fought him off. I complained about it, and I guess that marked me down as a troublemaker.

“I ended up in juvenile court a couple of times. I was lucky not to get locked up, I suppose, but I was designated a ‘person in need of supervision’-I love that phrase. So the first dump I got sent to was called the Wilhelmina Shelter for Troubled Children. I got in trouble a lot. They’d write me up for not looking the staff in the eye, which they interpreted as being insufficiently remorseful, that kind of thing.”

Pia looked at Rothman. His face was impassive. He nodded almost imperceptibly.

“When I was twelve or so, I got shipped to the Hudson Valley Academy for Girls, in a town called Eden Falls. It sounds nice, right? Eden Falls. The supposed school was a nineteenth-century institution. They used to send teenage prostitutes there, you know, to reform them, but when I was there it was all the hard cases who’d been thrown out of everywhere else-the girls no one wanted to adopt or deal with appropriately. The girls lived in these cottages. The paint was peeling, the plumbing didn’t work. Roasting in summer, freezing in winter. That was bearable. It was the other girls that were the problem.

“The place was run by these girl gangs that were like crime families. Well organized-‘daddies’ at the top, then ‘housewives,’ ‘cousins,’ ‘uncles,’ and so on. They’d take your money, make you do their chores, beat you up for no reason. They came out at night. There was a lot of abuse-you know, physical stuff, sexual stuff sometimes. The staff knew, but they didn’t care-the girls kept much better order than the staff ever could. I tried to stay out of the way, but they got everyone in the end. They found me hiding one night and attacked me in a bathroom. . . .” She paused.

“Anyway, I found an old book on boxing in the library and a couple of the younger girls knew some karate so we did a makeshift self-defense class. I was determined. Every time they came looking for something from me, I fought back. So I never joined their ‘shadow society,’ as one social worker called it. I got into a lot of fights, spent quite a lot of days and nights in the little punishment room, which was the moniker for solitary confinement. I spent a week there once. What I did was get the girl who was the leader of the group that attacked me in the bathroom off by herself and gave her one hell of a beating.”

Pia worried that she was saying too much, but Rothman simply nodded again when she looked at him.

“I worked really hard at the lessons that were available at Hudson Valley Academy. It was my escape. There were some teachers who cared. I was determined not to end up pregnant on welfare or in jail like most of the girls did when they left. For the most part the staff didn’t care what happened or what anybody did as long as we didn’t actually kill each other. Excuse my English, but it was like a goddamn garbage dump. Leave the trash there till it’s eighteen and had developed a taste for drugs and then release them into the world with no supervision. Good luck.

“The superintendent there, he knew it was the system that created as many problems as it fixed. Papitano was his name. He tried to get better therapists and teachers. He even tried to have the place shut down, but he was threatened so he stopped trying.

“I knew about that because the superintendent lived in a big mansion on the school grounds and a few of us used to clean his house and make his meals. He helped me out by putting me on that detail and getting me the good teachers. But he was a real sad sack and abusive-I guess his wife had left him, and he never saw his kids. I was sixteen, and I was around his house a lot and he got it into his head that I was interested in him even though I had resisted all his advances. One night he got really drunk, and I was in the library reading-it was the only library in the whole school-and he came down and said he loved me. He was really pathetic, but he got me in a corner, and I don’t like being cornered. I think he said he got the black eye falling in the shower.

“I think Papitano was more embarrassed than mad at me because nothing happened to me. Except he wanted to get me out of there, which was a good thing. In retrospect I don’t think it was for me, but rather so he wasn’t tempted again or whatever his problem was. But his intercession worked by finding me a good and competent caseworker.”

“Sheila Brown,” Rothman said.

“Sheila Brown. She was very persistent, and she went to court, and Child Protective Services agreed to move me to a group home so I could possibly get my high school diploma before I was ‘emancipated’ out of the system. Emancipation, which is a very well chosen word. So I left Eden Falls, thank God. I was happy to leave, but that Papitano guy, the superintendent . . .”

Pia’s voice trailed off and she paused to collect herself. When she resumed she talked very quietly, leaning forward, practically addressing Rothman’s desk.

“You know, I really had grown to trust him. I thought we had a connection. But before I got shipped out, he got drunk again, and he was a big man. He caught me alone in the library again. I’d let my guard down, and he betrayed me.”

Pia stopped talking. They were sitting so still that the motion-detector-operated switch in Rothman’s office doused the lights. The sudden pitch darkness caused both Pia and Rothman to jump. The lights came right back on.

“Jesus, I thought they fixed that,” Rothman said. “Used to happen to me all the time.”

“You must think I have an antisocial personality disorder,” Pia said, regretting saying so much about her violent past. It had been like a dam bursting. “I’ve never really talked about it straight out like this. Not to anyone except maybe Sheila. But with her it wasn’t all at once. It was over time.”

“I don’t think you have a personality disorder in the slightest,” Rothman said. “You did what you had to do. I admire you. My foster care experience was nowhere near as bad. With Jewish parents, I got a decent placement right off. It wasn’t a picnic, and I had to do without much nurturing, but I was older to boot. I was eleven at the time. Also I got to spend vacations with an aunt who wasn’t the warmest of souls but at least was family. Even though my label then was only ADHD, my parents couldn’t deal with me, so they had given up. In their defense, I was a handful. They had four older children, and I just figured that my mom and dad had run out of love by the time it got to me.

“Listen, Pia, I’m not trying to make you feel grateful to me, or feel any different about me because of what I’ve told you. I’m just saying that I understand some of what you went through-more after what you’ve been willing to share tonight. It’s no wonder you have nightmares, and to tell you the truth, your being late doesn’t bother me as much as it bothers Marsha and Junichi, especially with what I know. Ironically, it bothers them because they believe it bothers me. The major point I want to leave you with is that research is the calling where I found myself despite my past and despite my Asperger’s. I think it could be for you as well, but you’re going to have to make a decision. It can’t be halfway. It’s got to be either research or clinical medicine. It can’t be both.”

“Reactive attachment disorder,” Pia said. “One of the social workers at Hudson Valley Academy told me I had reactive attachment disorder. It’s supposed to mean I can’t establish a relationship with anyone.”

“Well, I guess we make quite the pair then,” Rothman said, and smiled. Pia had never seen Rothman smile before and his whole face lit up for a second. “You think about your future. You don’t have to say anything now. But I have to know soon so I can prepare. Once our article for Nature comes out, things are going to accelerate.”

Rothman stood up. “Now I have to go back in the biosafety unit for another hour or so.” Typical of his Asperger’s syndrome behavior, he didn’t comment further, just left.

Pia remained sitting after Rothman had departed. Except for the sounds emanating from some of the automatic equipment out in the lab, there was silence. Even the desk lamp went out again until she waved her hand in the air. She’d been taken aback by the evening’s events. She felt exposed, emotionally naked, and found herself worried that Rothman might decide on further thought that she was much too big a risk. She sat in her chair for at least ten minutes before she got up and left. As she descended in the elevator, she started to feel better, relieved to a degree that she’d been as open as she had. Having been in foster care himself, Rothman understood her. All at once Pia felt confident all was going to work out. It was her opinion that you can trust only a man whose actions match his words, or better still, who acts without asking for anything in return. The only person she knew who fit that bill was Dr. Rothman. She knew that even George, as generous as he was, had his own agenda.

Exiting into the cold night, Pia didn’t know exactly what she was going to do, but she had to admit that Rothman had made a lot of sense. And as unbelievable as it was, she felt he’d morphed into the father figure she’d never had.