Foreign Body

Chapter 1

October 15, 2007

Monday, 7:35 a.m.

Los Angeles, USA

(Simultaneous with Veena’s Being Forced to Vomit)

It was a glorious day in Los Angeles. The heat, smog, and smoke from the inevitable wildfires of late summer and early fall had finally been blown inland to be replaced by the first clear air in months. Not only had Jennifer Hernandez been able to see the nearby Santa Monica Mountains on her way to the UCLA Medical Center, but she’d even caught a glimpse of the more distant San Gabriel range, beautifully backlit by the rising sun.

Jennifer was excited on this crisp morning, and not just because of the weather. It was the first day of a new rotation in general surgery. Jennifer was a fourth-year medical student at UCLA who’d enjoyed the third-year program in surgery enough to consider it as a specialty, but she felt she’d not been exposed to enough surgery to make the decision. Although more women were studying surgery than did in the past, they were still a minority. It was not an easy decision. General surgery was particularly demanding time-wise, particularly for a woman with goals of having both a career and a family, and Jennifer thought she wanted a family. Needing more experience so she could make an intelligent decision, she’d selected general surgery as one of her fourth-and-final-year electives. On the plus side, she was confident she was decisive of mind and good with her hands, both qualities needed for surgery, and from her experience during her third-year course, she knew that surgery was both challenging and exciting.

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only seven-thirty-five, she’d already changed and was sitting in the surgical lounge, mindlessly flipping through an outdated Time magazine.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.

As the lounge chair she was sitting in was low with high arms, Jennifer had to struggle to get to her feet. She couldn’t just sit there with the disturbing worry about her grandmother. She also knew that even the slight possibility that the news release involved her grandmother was going to make it near impossible to concentrate when she met her new preceptor. She had to find out for certain, which meant she was going to have to do something she was loath to do — call her hated, lazy-ass father.

Jennifer had barely spoken to her father since she was nine, preferring to pretend he didn’t exist, which was somewhat difficult, as they were all living together in such tight quarters. In that regard, it had been a relief since she’d come to L.A., as she hadn’t spoken to him at all. During her first year, if he ever happened to answer the phone when she’d called Maria, she just hung up and would try later when she was certain her grandmother would be home. But mostly she let her grandmother call her, which her grandmother did on a regular basis. Even the phone was no longer a problem when her grandmother, at Jennifer’s insistence, got a mobile phone and allocated the land line to Jennifer’s father. As far as Jennifer visiting New York was concerned, she hadn’t done it for four years. It was partly because of her father and partly because of the expense. Instead, she’d had her grandmother come out to the West Coast every six months or so. Maria had loved it. She’d told Jennifer that for her, coming to California to see Jennifer was the most exciting thing she’d done in her whole life.

Inside the women’s locker room, Jennifer undid the safety pin that held her locker key, opened her locker, and got out her cell phone. After walking around the room and searching, she was happy to find a hot spot with an adequate signal. She dialed, and as she waited for the call to go through, she gritted her teeth in anticipation of hearing her father’s voice. As it was seven-forty-five in L.A., she knew it would be ten-forty-five in New York, just the time Juan usually raised himself from the dead.

“Well, well, my uppity daughter,” Juan scoffed after the initial hellos. “What’s the occasion I get a call from the snooty doctor-to-be?”

Jennifer ignored the provocation. “It’s about Granny,” she said simply. She was insistent that she wasn’t going to be baited into expanding the conversation beyond the issue at hand.

“What about Granny?”

“Where is she?”

“Why do you ask?”

“Just tell me where she is.”

“She’s in India. She finally had her hip repaired. You know how hardheaded she is. I’ve been asking her to do it for a couple of years since it was really getting in the way of her work.”

Jennifer bit her tongue about the comment concerning work, knowing her father’s history. “Have you heard from the doctor or the hospital or anything?”

“No. Why should I?”

“They have your telephone number, I assume.”

“Certainly.”

“How come you didn’t go with her?” It pained Jennifer to think of her grandmother going all the way to India by herself and facing major surgery when the most distant travel she’d ever done was come to California to visit Jennifer.

“I couldn’t go with my back the way it is and everything.”

“How was this surgery set up?” Jennifer questioned. She wanted to get off the phone. The fact that no one had called Juan was definitely encouraging.

“By a company in Chicago called Foreign Medical Solutions.”

“Do you have the number handy?”

“Yeah, just a sec.” Jennifer could hear the receiver drop onto the tiny side table. She could picture it by the entrance door in the part of the apartment that was supposed to be used for a dining table but which contained Juan’s bed. A minute later Juan came back and rattled off the Chicago number. As soon as Jennifer had it, she hung up. She didn’t feel like hypocritical small talk or even saying good-bye. With the number in hand she dialed Foreign Medical Solutions, and after telling an operator who she was and what she was calling for, she was switched to an individual named Michelle, whose title was case manager. The woman had an impressively deep, resonant voice with a slight southern accent. After Jennifer repeated her story, Michelle asked her to hold the line. For a few moments Jennifer could hear the unmistakable sound of a computer keyboard in use as Michelle pulled up Maria Hernandez’s file.

“What is it you were hoping to learn?” Michelle asked, coming back on the line. “As a medical student, you’re probably aware that HIPAA rules limit what we can give out, even if you are who you say you are.”

“First I wanted to make sure she’s okay.”

“She’s doing very well. She had her surgery, which went smoothly. She spent less than an hour in the PACU, and then was moved to her room. It’s indicated she’s already started fluids by mouth. That’s the latest entry.”

“Was that recently?”

“It was, indeed. Just a little more than an hour ago.”

“That’s good news,” Jennifer said. She was even more relieved than when Juan said he’d heard nothing. “Do most of your patients from the Queen Victoria Hospital do well?”

“They do. It is a popular hospital. We’ve even had one patient insist on going back to the Queen Victoria for his second knee.”

“A testimonial is always good,” Jennifer said. “Can I call the hospital and try to talk with my grandmother?”

“Certainly,” Michelle said, and rattled off the number.

“What time is it now in New Delhi?” Jennifer asked.

“Let’s see.” There was a pause. “I often get this mixed up. It’s nine-fifty-five a.m. here so I believe it is nine-twenty-five p.m. in New Delhi. They are ten and a half hours ahead of us here in Chicago.”

“Would it be an okay time to call?”

“I really couldn’t say,” Michelle responded.

Jennifer thanked the woman. For a moment she thought about trying her grandmother’s cell phone but then nixed the idea. In contrast to Jennifer’s AT&T phone, she didn’t think her grandmother’s Verizon would work in India. She called the Queen Victoria Hospital. As the call went through in literally seconds, Jennifer couldn’t help being impressed, especially since she had no idea how cell phones, or any phone for that matter, worked. A moment later she found herself conversing in English halfway around the world with a woman with a pleasantly melodic and distinctive Indian accent. It was somewhat similar in Jennifer’s ear to an English accent but more musical.

“I can’t believe I’m talking to someone in India,” Jennifer effused.

“You are welcome,” the hospital operator said somewhat inappropriately. “But you probably talk to India more than you realize, with our many call centers.”

Jennifer gave her grandmother’s name and asked if she could be connected to her room.

“I’m very sorry,” the operator answered, “but we are not able to forward calls after eight in the evening. If you had the extension, you could call direct.”

“Can you give me the extension?”

“I’m sorry, but I’m not allowed, for obvious reasons. Otherwise, I would connect you.”

“I understand,” Jennifer said, but she still felt there hadn’t been any harm in asking. “Can you tell me how she is doing?”

“Oh, yes, of course. We have a list right here. What is the surname again?”

Jennifer repeated “Hernandez.”

“Here she is,” the operator said. “She’s doing very well and already taking nourishment and has been mobilized. The doctors say they are very pleased.”

“That’s terrific,” Jennifer responded. “Tell me, does she have someone there at the hospital who is in charge of her case?”

“Oh, yes, indeed! All our foreign visitors have a host-country case manager. Your grandmother’s is Kashmira Varini.”

“Can I leave a message for her?”

“Yes. Would you prefer I take it or would you like to leave it on her voicemail? I can connect you.”

“Voicemail would be fine,” Jennifer said. She was impressed. Her brief exposure to an Indian hospital suggested it was quite civilized and certainly equipped with contemporary communications.

Following Kashmira Varini’s pleasant outgoing message, Jennifer left her name, her relationship to Maria Hernandez, and a request to be kept informed of her granny’s progress or, at the very least, to be informed if there happened to be any problems or complications. Before disconnecting, Jennifer slowly and distinctly gave her cell phone number. She wanted to be certain there would be no mistakes because of accent. Jennifer knew she had a strong New York accent.

Flipping her phone closed, Jennifer started to put it back into the locker but then paused. She thought the likelihood of another Maria Hernandez from Queens having surgery at nearly the same time as her grandmother in the same hospital in India was quite small. Actually, it seemed completely far-fetched, and the idea of calling CNN and telling them as much crossed her mind. Jennifer was an activist, not a ponderer, and didn’t hesitate to speak her mind, which she felt CNN deserved for not adequately vetting their story before putting it on the air. But then a more intelligent, less emotional frame of mind prevailed. Who could she call at CNN, and what were her chances of getting any kind of satisfaction? Besides, she suddenly looked at her watch. Seeing that it was now after eight, a shiver of anxiety descended her spine like a surge of electricity. She was late for her first day of her surgery elective, despite her efforts to the contrary.

Jennifer slammed the locker closed, and as she ran for the door, she put her phone on vibrate and slipped it into her scrub pants pocket along with the safety pin and the key. She was truly worried. Being late was not the way to begin a new rotation, especially with a compulsive surgeon, and from her experience in third-year surgery, they were all compulsive.