The Society

CHAPTER 6

Marybeth Langley was a petite, energetic woman with a sweet face and manner. For the week since Will’s call, she had been spending nights in a small B amp;B in downtown Fredrickston and days at the bedside of her husband, Jack. Despite the persistent refusal of their HMO to pay for any of Jack’s surgery, consultations, or hospitalization, she and her husband had decided to remain at FGH and under Will’s care until it was medically appropriate for him to return to lowa. Finally, that time had arrived.

It was mid-afternoon on a chilly, gray Thursday, the day of the Faneuil Hall managed-care forum. Will had repaired an electrician’s painful hernia in the morning, then worked his way through a reduced office schedule. He wanted to leave at least an hour for a final review of the mass of notes and articles he had accumulated regarding the shortcomings of managed care-especially Jeremy Purcell’s insights and strategies. Throughout college and medical school, Will never took an exam that he felt truly ready for, but never had he felt as ill-prepared for anything as he did for this debate. Saying yes to Tom Lemm and the Hippocrates Society was certainly noble enough, but it was evolving into one of the dumbest, most impetuous things he had ever done. He reminded himself for the hundredth time that he could only do what he could do, and then turned his attention to discharging his prize patient. The titanic struggle the two of them had endured together had forged a friendship that went well beyond the usual doctor-patient relationship.

“So, Jack,” Will said, “it looks like this is it.”

“Looks like.”

Langley had proven to be a bright, well-read man-a laconic Midwesterner with a subtle sense of humor, who listened to country-western music almost around the clock and loved his job selling heavy machinery, although his life’s dream had once been to become a veterinarian. The pictures of and by Langley’s kids had been taken down and packed. Nurse’s discharge instructions had been checked over by Will, then given. Langley, dressed in chinos and a loose-fitting Kansas City Royals sweatshirt, was seated in a wheelchair, the required mode of transportation for discharge.

For nearly a minute, nothing was spoken. Will, distracted momentarily from the impending forum, was trying to remember when he had ever felt so good about a case. Jack Langley was alternating between projecting what it would be like to hold his kids again and wondering when he would be able to return to work.

Marybeth, deeply religious, was processing her overwhelming gratitude for the droll, soft-spoken, surprisingly unassuming man who had saved her husband’s life, and thanking God that there were men and women in the world who could do what he had done for their family. She knew very little of him except that he was divorced and had two children, and that her husband, in his understated Midwestern way, absolutely adored him. Silently, she prayed that life was treating him well. Earlier in the day Will had quite casually mentioned that he had arranged for himself and all of the consultants to rub their charges off the massive balance sheet she and Jack were facing. She took a wad of tissues from her purse and dabbed at the corners of her eyes.

“So,” Will said finally, “you’ll keep in touch?”

“Of course.”

“And you’ll have your doctor call me straight off if there are any problems?”

“I don’t expect there’ll be any-not any medical ones, anyway.”

Will sensed a fullness building in his throat. He had never had that much reserve about crying in public, but this just wasn’t a time he wanted to.

“I heard some interesting news last night,” Marybeth said, as if sensing Will’s predicament. “I was talking to my cousin Peggy. She lives in a suburb of Des Moines. She was telling her friend Claire about what was happening to us with the HMO refusing to pay and all. Well, it turns out Claire used to work as a claims adjuster for that same HMO. She says that she and the others who worked her job were instructed by the company to reject one out of every ten claims out of hand. Don’t even bother to come up with a reason, just reject it. It seems the company had tried this approach to saving money and found that only thirty percent of the rejected claims were ever contested by the doctors. They just didn’t have the time or resources to battle over such things.”

“Lord. I’d like to say I’m surprised and stunned, but I’m not. In many instances, the cost involved in disputing an HMO decision makes it not worth it. I’ll make sure our hospital isn’t one of the seventy percent in this case, but I hope you’re planning on fighting this, too.”

“My cousin Pam’s husband is a big-time attorney in Des Moines,” Marybeth said, “as well as being one of the most obnoxious people on the planet. I’ve already spoken to him. He says he specializes in making people wish they had never crossed paths with him.”

“That’s quite a specialty. Well, Jack,” he said, taking the man’s hand in his, “you’ve been one hell of a patient. I don’t throw around the term hero very frequently, but you are certainly one of mine.”

“And you’re certainly one of ours,” Marybeth said. Not waiting for a handshake, she threw her arms around Will’s neck. “Thank you, Doctor,” she whispered in his ear. “Thank you for saving my husband’s life.”

Dr. Jeremy Purcell hadn’t been nearly as much help as Will had expected. For one thing, some pneumonia and a urinary-tract infection from the catheter were keeping him down. For another, his notes, while impressive in volume and scope, were not that well organized or easy to read. With Tom Lemm’s help, they had put together a reasonable, albeit dry, presentation. They even had a PowerPoint production of sorts, although it would never win any prizes for flair.

Anxious to get in some final rehearsal, Will hurried back to the office, where he had left the carton full of notes, articles, and slides in preparation for the trip into Boston. He was Custer, riding off to inspect the troops, only this time he knew what Little Bighorn held in store.

Fredrickston Surgical Associates occupied most of the second floor of the Medical Arts Building. The airy central waiting area was half full. On a Thursday, they would be Susan’s and Gordo’s patients. Will felt relieved knowing that none of them was his. He still had an hour or so to review before making the thirty-five-mile drive into Boston.

“We’re all excited about tonight, Dr. Grant,” the receptionist said.

“Are you coming, Mimi?”

“Once we knew you were going to be part of it, my husband and I tried getting tickets, but there are none. It’s a sellout.”

“You might be just as well off staying home together and watching professional wrestling. The guy Halliday who will be representing managed care has been preparing for months. I’ve had a week.”

“Oh, Dr. Grant, you’ll do great.”

“I wish I had your confidence.”

“Just tell them all what goes on around here with all the paperwork and delayed payments and grumpy patients.”

“I may do that.”

“Excuse me, Dr. Grant?”

A trim, attractive Asian woman approached him from one of the seats to his right. Her ebony hair, cut in a pageboy, was very appealing.

“Yes?”

“Dr. Grant, there’s no reason you should remember me, but there’s no reason I would ever forget you.”

“I’m embarrassed I don’t re-”

“Please don’t be. My name is Grace Davis. That’s my husband, Mark, over there.”

Will glanced over at an athletic-looking man in his early forties-business or perhaps law was his guess. He also caught sight of the ornate grandfather clock that Jim Katz had lent the practice. In forty-eight minutes he had to be on the road.

“I’m sorry,” he said, “I’m still not able to-”

“My maiden name was Peng. Grace Peng. For more than a year I was a regular at the-”

“Oh my God! Grace! I don’t believe this.”

Excitedly, Will held her by the arms and studied her face. It was most definitely Grace Peng, but it wasn’t. The Grace Peng he knew was a woeful, down-and-out alcoholic who was a regular patron of the Open Hearth a decade ago. She was a woman of intelligence and potential, whom he and everybody else around the Hearth was drawn to and wanted to help. But sooner or later, her anger and virulent drinking drove them all away. More than one of the volunteers and staff-perhaps Will included-predicted a premature and possibly violent death for the woman.

“Gosh, but you look wonderful. How long has it been?”

“More than ten years since I saw you and also since I had my last drink.”

Inadvertently, Will glanced at the clock again. Forty minutes.

“It sure looks as if you have a tale to tell,” he said.

“I’m so sorry. You’re in a rush. I didn’t mean to hold you up.”

“No! Well, I mean yes. I have a speech to give tonight in Boston. I’m a little nervous about it.”

The transformation in the woman was absolutely astounding. She was always filthy and disheveled-more so even than most of the Open Hearth patrons. To the best of Will’s memory, Grace had gone off to yet another treatment center and had never been heard from at the Hearth again. If, as she said, it had been more than ten years ago, the twins were about to arrive and he was hustling about trying to hook up with a practice. His involvement with the place he had helped found fell off for a couple of years.

“I had no idea you were working here,” she said.

“Well, who are you here to see?”

“Dr. Hollister.”

“For?”

“I was referred to her by the clinic where I had my mammogram. They’re suspicious of cancer.”

“I’m sorry to hear that. Well, I certainly hope that’s not the case.”

“I’m afraid it is. My husband has my mammograms. It’s not that big, but even I can see it.”

Thirty-five minutes.

“Dr. Hollister is one of my partners. You’ll really like her.”

“Now I don’t want her to be my doctor.”

“Why? You said you haven’t even met her.”

“I want you, Dr. Grant. If I had known you were here, I would have insisted they refer me to you.”

“But-”

“I’m sorry. I know you’re in a hurry. I’ll just cancel this appointment and reschedule with you. We can talk then.”

“Grace, we make it a point in our practice not to switch patients.”

“I’m sure Dr. Hollister will understand when I tell her that I wouldn’t be alive if it weren’t for you.”

Thirty minutes.

Will sighed inwardly. “Why don’t you and your husband come into my office,” he said.

“There is so much about me and my upbringing and my life that I would never let you or anyone else at the soup kitchen know,” Grace said as Will held her mammograms up to the window. As she predicted, the cancer was quite easily discernible-a marble-size density in the upper outer quadrant of her left breast. If the adjacent lymph nodes were cancer free, the lumpectomy to remove it would be quite routine. “You and some of the others at the soup kitchen were incredibly kind and nonjudgmental,” she went on, “but you were the only one who really pushed through my anger and denial to talk with me. Even when I was filthy and acting abominably, you kept trying. Then one night you told me that it was horribly difficult for you to see so many patients who wanted to live but had terminal illness, then to have to come to the soup kitchen and see me systematically killing myself. You gave me the name of a priest. Do you remember?”

“Father Charlie,” Will said wistfully. “I remember now. He was a patient of mine, sober in AA for many years.”

“And he was dying of cancer. You knew that when you sent me to him. He talked to me for a long time, then he arranged for me to go to a special treatment center. He never would tell me how it got paid for. I certainly didn’t have any money. I was there for nine months, during which time I had almost no contact with the outside world. While I was there, I got a letter Father Charlie had written to me just before he passed away, telling me how proud he was of me.”

“He was a wonderful man.”

“I went back to school in L.A. Eventually I got a master’s degree in social work and married Mark. It’s no surprise that I specialize in addictions. Last year Mark took a job as the head of the English department at Maplewood Academy, and we moved back here.”

“Now this,” Will said, gesturing to the mammogram.

“Now this,” Grace echoed wistfully, but without rancor.

“And I can’t talk you out of wanting to change from Dr. Hollister to me?”

“Absolutely not, unless you’re not on Steadfast Health’s list of approved providers.”

“I am.”

“Dr. Grant,” Mark Davis said, “take it from me. When Grace makes up her mind like this, there’s no sense even trying to argue with her.”

“Okay, okay, you guys wait here. I’ll see what I can do.”

As he left his office, Will stepped around the carton of material he had planned to review.

Well, he thought, it’s a good thing no one ever died of humiliation.

If Will expected Susan Hollister to give up her patient without discussion, he was mistaken. The two of them had clashed occasionally over treatment philosophy or a surgical approach, but even those conflicts were short-lived.

“Will, why didn’t you just tell this Mrs. Davis that we simply don’t do things like this in our practice?” Susan asked. “You know as well as I do how many times when we’re covering for one another, a patient decides she likes me better than you because I’m a woman, or Gordo better than me because the patient’s Scottish, or you better than Gordo because you’re not overweight. If we aren’t firm about not doing this sort of thing, there will be nothing but chaos and discord.”

A confrontation with Susan on this of all nights was the last thing Will wanted or needed. In no more than ten minutes he had to leave for Boston.

“I thought that because Grace had never met you,” he tried, “and had a history with me, we might make an exception.”

Susan was clearly exasperated.

“I don’t think so. This woman was referred to me, and I feel as if I should take care of her.”

Will checked his watch.

“Susan, I can’t believe I’m stuck in the middle like this. Listen, why don’t you come over and talk to her. I only have a few minutes before I have to head into the city, and I’d like to get this resolved. The poor woman has breast cancer. It seems the least we can do in this situation is to let her choose someone she’s known for ten years to operate on her.”

Susan glared at him for a moment, then visibly softened.

“I’m sorry, Will,” she said. “You’re absolutely right. My nose was just out of joint. This isn’t the typical case I was talking about. You two do have a history. Go tell your Grace Davis that it’s fine for you to take care of her. I’ll even assist in doing the procedure if you need me.”

Will felt a flood of relief.

“Thanks, Suze. In case you couldn’t guess, at this moment, my mind is on other things than who does this breast biopsy.”

“I understand. I’ll see you in Boston. And, Will, relax about tonight. I’m sure you’ll knock ’em dead.”