Foreign Body

Chapter 5

October 15, 2007

Mondey, 10:45 a.m.

Los Angeles, USA

(Simultaneous with Rajish Bhurgava’s Leaving the Queen Victoria Hospital)

Jennifer was in the process of making her way from the medical school back to the main building of the UCLA Medical Center and felt amazed at what she’d been able to accomplish despite her emotional fog. From the moment she terminated the conversation with the Queen Victoria Hospital case manager a little over an hour ago, she’d dealt with her new preceptor, dashed home, called back to India to give her passport number, made her way to the med school, got the blessing of the dean for a week off, arranged a replacement for her gainful-employment blood-bank job, and was now hoping to solve her emotional fears, economic concerns, and the problem of malaria prophylaxis. Although she’d taken out the almost four hundred dollars she had in savings, she was worried it might not be enough even with her credit card and Foreign Medical Solutions of Chicago paying her major expenses. Jennifer had certainly never been to India, much less on a mission dealing with a dead body. The possibility she would need a significant amount of cash was hardly far-fetched, especially if cremation or embalming was not something that could be charged.

Being as busy as she’d been over the hour-plus had had the secondary benefit of keeping her from obsessing about the reality of her grandmother’s passing. Even the weather helped, since it was as glorious as the dawn had predicted. She could still see the mountains in the distance, although not with quite the same startling clarity. But now that she was almost finished with her errands, reality began to reassert itself.

Jennifer was going to miss Maria terribly. She was the person with whom Jennifer was the closest, and had been since Jennifer was three years old. Besides her two brothers, neither of whom she spoke with for months on end, her only relatives that she knew were in Colombia, and she’d met them only once back when her grandmother had taken her there for that expressed purpose. Relatives on her mother’s side were a complete mystery. As far as Jennifer was concerned, her father, Juan, didn’t count.

Just as Jennifer had passed through the revolving entrance of the main redbrick hospital building, her cell phone sounded. Checking the screen, she could see it was India calling back. She answered the phone and in the process stepped back outside into the sunlight.

“I have good news,” Kashmira said. “I’ve been able to make all the arrangements. Do you have a pencil and paper?”

“I do,” Jennifer responded. Getting a small, stiff-backed notebook from her shoulder bag and tucking her phone into the crook of her neck, she was able to write down the flight information. When she learned she’d be leaving that afternoon but not arriving until almost the wee hours of Wednesday, she was appalled. “I had no idea it would take so long.”

“It is a long flight,” Kashmira admitted. “But we are halfway around the world. Now, when you land here in New Delhi and reach passport control, go to the diplomatic corps line. Your visa will be waiting there. Then once you have your baggage and come out of customs, there will be a representative from the Amal Palace Hotel holding a sign. He will handle your luggage and get you to your driver.”

“Sounds simple enough,” Jennifer said, while she was trying to figure out from the departure times and the arrival times just how many hours she would be in the air. She quickly realized she couldn’t do it without knowing all the time zones. In addition, she found herself confused by having to cross the international date line.

“Wednesday morning we will arrange a car to pick you up from the hotel at eight. Will that be alright with you?”

“I guess,” Jennifer said, wondering how human she would be feeling after being on a plane for nine years and having no idea how much sleep she would be able to get.

“We look forward to meeting you.”

“Thank you.”

“Now I’d like to ask you once again if you have made up your mind between cremation and embalming?”

A wave of irritation washed over Jennifer just when she was beginning to like the case manager. Didn’t she have any intuition? Jenifer wondered with amazement. “Now why would I change the way I thought just a couple of hours ago,” she questioned irritably.

“The administration made it clear to me they believe it would be best for everyone, even best for your grandmother’s body, if we got on with it.”

“Well, I’m sorry. My feelings have not changed, especially since I have been so busy that I haven’t had time to think about anything. Furthermore, I don’t want to feel like you are pushing me. I’m coming just as soon as I can.”

“We certainly are not pushing you. We are just recommending what is best for everyone.”

“I don’t consider it the best for me. I hope you people understand, because if I get there and my grandmother’s body has been violated without my consent, I’m going to make a big stink. I’m serious about this, because I can’t believe your laws are that much different than ours in this kind of situation. The body belongs to me as the responsible next of kin.”

“We certainly would not do anything without your expressed approval.”

“Good,” Jennifer said, recovering to a degree yet surprised about the vehemence of her response. It wasn’t lost on her that she was probably experiencing a significant amount of transference with her emotions, blaming the hospital and even Maria. Not only was she sad about her grandmother, she was also mad. It hardly seemed fair that Maria had not confided in her about running off to India, having major surgery, and then getting herself killed.

After terminating the call, Jennifer stood where she was, recognizing it was probably going to take her some time and effort to sort through her psychological issues. But then she realized what time it was and that she had to catch a flight whose departure was not that many hours away. With that in mind, she hustled back through the revolving door and headed for the emergency department.

As per usual, the emergency room was bedlam. Jennifer was looking for Dr. Neil McCulgan, who had risen in rapid fashion from chief emergency-medicine resident to his current position as an assistant emergency-room director in charge of scheduling. Jennifer had met him during her first year, when he was still a resident. As a character unknown on the East Coast, he was entirely unique to her, and she found him intriguing. Neil was a stereotypical Southern California “surfer dude” sans blond hair, which, in his case, was nondescript brown. What Jennifer found so distinctive was his openly friendly laid-back attitude that was in total contrast to his being a closet intellectual and a compulsive studier with a near photographic memory. When she’d first met him she truly couldn’t believe he’d been attracted to a tense, highly demanding medical specialty like emergency medicine.

Although Jennifer was well aware she didn’t share his social graces, she did share his general interest in knowledge for knowledge’s sake and his study habits, and found him a fertile source of all sorts of information. Over a period of a year Neil became the first man with whom she felt she could truly converse, and not only about medicine. As a consequence, they became best friends. Actually, Neil had become her first real boyfriend. She thought she’d had boyfriends before, but after meeting Neil she realized that was not exactly true. Neil had been the first person to whom Jennifer had been willing to confide her most private secrets.

“Excuse me!” Jennifer called out to one of the harried nurses at the chaotic central station. The nurse had just shouted something to a colleague who was leaning out a doorway several rooms down the main corridor. “Can you tell me where Dr. McCulgan is?”

“I haven’t the faintest,” the man said. For some reason he had two, not one, stethoscopes draped around his neck. “Did you try his office?”

Taking that suggestion, Jennifer hurried over to the triage area, where the office was located. Glancing in, she felt lucky. He was sitting at his desk with his back to her, dressed in a starched white coat over green scrubs. Jennifer plopped herself down in the chair squeezed between the desk and the wall. Startled, he looked up momentarily.

“Busy?” Jennifer managed, with a catch in her voice. Her question only elicited a scoffing chuckle from the man, whose attention had returned to the massive ER schedule for the month of November that he was poring over.

Neil had pleasant features, intelligent eyes, and a slight dusting of premature gray along his temples. He also had the broad shoulders and exceptionally narrow waist of a surfer. On his feet he wore white-leather wood-soled clogs. “Can I talk to you for a moment?” she questioned. As she spoke she had to choke back tears.

“If you can make it quick,” he said, but with a smile. “I have to have this schedule ready for the printer in one hour.” He looked up again and only then became aware that she was struggling with her emotions. “What’s wrong?” he said with sudden concern. He put down his pen and leaned toward her.

“I had awful news this morning.”

“I’m so sorry,” he said, reaching out and gripping her arm. He didn’t ask what the news was about. He knew her well enough to know that she would tell him if she was inclined but wouldn’t tell him if she wasn’t, despite any amount of cajoling on his part.

“Thank you. It was about my grandmother.” Jennifer pulled her arm free and reached across Neil’s desk to grab a tissue.

“I remember. Maria, right?”

“Yes. She died just a few hours ago. It was even announced, believe it or not, on CNN.”

“Oh, no! Gosh, I’m truly sorry. I know what she meant to you. What happened?”

“I’m told a heart attack, which definitely surprises me.”

“I can understand why. Didn’t the medical department here recently give her a remarkably clean bill of health?”

“They absolutely did. They even gave her a stress test.”

“Are you going to head home, or is that a problem? I mean, didn’t you start your new surgery rotation today?”

“No and yes,” Jennifer said cryptically. “The situation is a bit more complicated.” She then went on to tell Neil the whole story about India, about being needled concerning cremation or embalming, about getting the dean to grant a week’s leave, about a medical-service company paying her expenses, and about leaving in just a few hours.

“Wow,” Neil said. “You’ve had quite a morning. I’m sorry you are going to India for such a sad reason. As I told you last May when I came back, it’s a fascinating country, full of unbelievable contrasts. But I guess this won’t be a pleasure trip.” Neil had been to India five months before to speak at a medical conference in New Delhi.

“I can’t imagine anything about this trip being pleasurable, which brings me to the issue of malaria. What do you think I should do?”

“Ouch,” Neil said, wincing. “I’m sorry to say you should have started something a week ago.”

“Well, there’s no way I could have anticipated this. I’m okay on everything else, even typhoid, from the scare last year with my patient in internal medicine.”

Neil grabbed a prescription pad from his drawer and rapidly wrote one out. He handed it to Jennifer, who looked it over.

“Doxycycline?” Jennifer read out loud.

“It’s not the number-one choice, but the coverage starts immediately. The best part is you probably don’t need it. It’s the south of India where malaria is a true problem.”

Jennifer nodded and put the scrip into her shoulder bag.

“Why did your grandmother go to India for her surgery?”

“Purely cost, I assume. She didn’t have health insurance. And I’m sure my bastard of a father encouraged it big-time.”

“I’ve read about medical tourism to India, but I’ve never known someone who actually did it.”

“I wasn’t even aware of it.”

“Where are they putting you up?”

“A hotel called the Amal Palace.”

“Wow!” Neil said. “That’s supposed to be five-star.” He chuckled, then added, “You’d better be careful; they must be trying to buy you off. Of course I’m kidding. They don’t need to buy you off. One of the negatives about medical tourism is you have no recourse. There’s no such thing as malpractice. Even if they screw up big-time, like taking out the wrong eye or killing someone by mistake or incompetence, there’s not a thing you can do.”

“It’s my guess they’ve negotiated some kind of deal with the Amal Palace. It’s just where they put people up. I mean, it’s not like I’m getting a special deal. Apparently, they pay airfare and hotel for one relative. That’s why I’m getting the trip. My lazy father claimed he couldn’t go.”

“Well, I hope something positive comes out of this journey,” Neil said. He gave Jennifer’s wrist one last squeeze. “And keep me informed. Call me anytime: morning, noon, or night. I’m so sorry about your grandmother.” He picked up the pen as a signal he had to get back to work.

“I have a couple of requests,” Jennifer said, maintaining her seat.

“Sure. What’s on your mind?”

“Would you consider coming with me? I think I need you. I mean, I’m going to be completely out of my element. Except for a trip to Colombia when I was nine, I’ve never been out of the country, much less to some exotic place like India. Since you were just there, you already have a visa. I can’t tell you how much more comfortable I’d feel. I know it is asking a lot, but I feel so provincial; even going to New Jersey used to make me anxious. I’m kidding, but I’m not a traveler by any stretch of the imagination. And I know that one of the benefits of emergency-room medicine is that you can take time off, especially since you covered for Clarence a couple of weeks ago, and he owes you.”

With a sigh, Neil shook his head. The last thing he wanted to do was wing off to India, even if he could get time off. In truth, it had been part of his initial motivation for the specialty, and he’d specifically set up a twenty-four-hours on, twenty-four-hours off schedule for himself so that when his workweek started seven a.m. Monday it was essentially over seven a.m. Thursday, unless he wanted overtime. The four remaining days of the week were available for his true love, surfing. At that very moment he was looking forward to a surfing meet over the weekend in San Diego. It was also true that his friend, colleague, and fellow surfer Clarence Hodges did owe him for a Hawaiian trip he’d made. But all that didn’t matter. Neil did not want to go to India because of a dead grandmother. If it had been Jennifer’s mother who had passed away maybe, but not her grandmother.

“I can’t,” Neil said, after a pause, as if he’d given the idea true consideration. “I’m sorry, but I can’t go. Not now, anyway. If you can wait a week, maybe, but it’s not a good time.” He spread his hands awkwardly in the air over the schedule he was working on as if it was the problem.

Jennifer was taken aback and disappointed. She’d given a lot of thought about whether to ask him or not and if she truly needed him. What had tipped the balance was the realistic question in her mind whether she could actually handle the situation once she got to India. What was clear to her was that after the initial shock of learning about Maria’s death, she’d marshaled significant defenses, including all the rushing around, making the plans to take the trip, and what psychiatrists called “blocking.” So far things had worked reasonably well and she was functioning. But as close as her grandmother had been to her, she feared there would be problems when the reality of the loss set in. She truly feared she could get to India and be an emotional train wreck.

Jennifer stared daggers at Neil. Surprise and disappointment had instantly metamorphosed into anger. Jennifer had been so confident that if she asked him directly and admitted she needed him, which she felt she had done, he would surely acquiesce as a direct spin-off of the confidences they shared. The fact that he was turning her down so promptly and with a flimsy, ridiculous explanation, something she never would have done had the situation been reversed, could mean only that their relationship was not what she thought it was. In short, like men in general, in her mind he was demonstrating he couldn’t be counted on.

Jennifer stood abruptly and without saying anything walked out of the tiny office and back into the crowded emergency room. She could hear Neil call her name, but she didn’t stop or respond. It tormented her that she knew now that it had been a mistake to confide in him. As for asking to borrow some cash, at this point she wouldn’t even consider it.