Author: Dr. Jim Bailey
Publisher: The Healthy City
Purchase on Amazon
Dr. Don Newman, a resident physician at the renowned University Hospital, awakens in a windowless call room in the middle of the night to the screams of his pager. As he runs to a dark ward to attend to a dying woman strapped to a bed, Don realizes that despite having worked long and hard to become a doctor—and having sworn to do no harm—harm has become his business.
So begins Dr. Newman’s quest to become a healer in a system that puts profits ahead of patients. Abandoning his plans to become a cardiologist, Dr. Newman enrolls in an Ivy League graduate program in health system science, where an unorthodox professor promises to guide him ever deeper into the dark secrets of the healthcare industry. Along with fellow students Frances Hunt, a sharp and alluring nurse practitioner, and Bruce Markum, a cocky, well-connected surgeon, Dr. Newman begins a journey into the medical underworld.
When Dr. Newman unearths evidence of a conspiracy stretching from the halls of Congress to Wall Street and even to his small campus, his harmless course of study becomes deadly serious. Will he be silenced? Or will he find a way to save his patients and others from needless torture? One thing is certain: the path to healing is fraught with danger. Will this path lead Don to a dead end?
I know what it is like to be out of place, to be an idealist in a world of pecuniary traitors, to be hated for doing what is right. And so I know something of Dr. Don Newman’s story. He starts his journey much as I did, a disappointing protagonist and unlikely hero who finds himself in a dark place where the straight way is lost. He discovers treachery, torture, and killing where he least expects—in the sacred halls of healing—the hospitals, pharmacies, operating rooms, and intensive care units where your generation places its greatest hope and trust. He is ill-equipped to deal with the world he inadvertently uncovers. You can justly call him idealistic, naïve, even foolish.
History does repeat itself. Old temptations present themselves in new and surprising ways. Our best stories ebb and flow through time in tides of glacial speed and periodicity. Dr. Newman’s story is an ancient one. It has been told in many tongues and many lands; it is my story and your story. Just as my Comedy captured the critical events of our time, displayed the underlying currents for all to see, and turned the tide of history, Dr. Newman’s story will reveal the hidden darkness of your time.
Therefore, let me beg your indulgence for our unlikely hero. Travel a little while with this unseasoned young man. Bear with him as he discovers he has stumbled into hostile territory, succumbed to base influences, and benefited from the very corruption he loathes. Our most innocent ones often bear the curse of seeing things as they really are. So it is with young Doctor Newman. He seeks to be a healer in a world where true healing has nearly ended.
With him, perhaps you can find a way out of darkness into paradise. I entreat you to follow him and behold: everything necessary to find the right path through the perils of modern healthcare—the path to true health and healing—is available to Don Newman all along.
Let us go with him and see.
In the middle of the journey of our life I came to myself within a dark wood where the straight way was lost.
Dante Alighieri, Inferno 1, 1 – 3
Dr. Newman dreaded the task ahead. Like countless others in these so-called halls of healing, Sibyl Bellamy was more victim than patient.
He’d been on the night shift three months earlier—the first time she was brought to the emergency room. He’d admitted her to the hospital and worked her up for the team that would care for her starting the next morning. He’d known at once she had suffered a very big stroke. It didn’t take a genius to see that. She couldn’t move anything on her right side, her mouth drooped and leaked drool from the right corner, and she couldn’t speak or squeeze his fingers. Mucus rattled in her windpipe with every breath and she showed little inclination to cough it up. Her eyes were wide open and filled with fear. Cords of muscle in her good arm strained against the padded leather strap around her wrist.
Her panicked daughter had rushed into the room and launched a battery of questions: “What’s going on, Doctor? What’s wrong with my mother? Why can’t she talk? Can you help her? Will she be okay?”
He took a deep breath before answering. “I’m Dr. Newman. Your mother is very sick. Could you tell me what happened?”
Words erupted in a breathless rush. “I found her this morning in her house on the floor and I don’t know how long she was there but she was fine when I saw her yesterday morning—she had gone to the bathroom on herself and she couldn’t move so I called the ambulance and they brought her to the emergency room about ten this morning—I’ve been in the waiting room ever since and no one has told me anything!” Tears filled the wells beneath her eyes and overflowed. “What’s wrong with her, Doctor? Was it a stroke?”
The physical exam left no doubt—yes—she’d suffered a large middle cerebral artery stroke. The left half of her brain was dead. She would probably never walk, talk, or eat again. But he was trained never to give a diagnosis until the history was complete and all test results were in.
“Let me ask you a few questions first. Does your mother have high blood pressure or other medical problems?”
“Yes, she takes medicine for high blood pressure. It runs in our family.”
“What medicine was she taking?”
“Well, she used to take a water pill, I think.”
“Yes, that’s it! She took it for years.”
He nodded and noted it in the chart. Hydrochlorothiazide prevents strokes better than anything. “Go on,” he encouraged.
“Mom stopped taking it when the doctor gave her free samples of a new medicine. Norvasc, I think it was. She didn’t like the new medicine because she said it stopped her up but the doctor told her it didn’t have any side effects.”
“When did she last see her physician?”
“Four months ago. That’s when the receptionist said the doctor couldn’t keep seeing her since she didn’t have insurance anymore. He was nice enough to give her those free samples but she couldn’t go ask him for more after that lady told her not to come back and she didn’t have the money to fill the prescription. The new drug cost over fifty dollars for a month’s supply so she just quit. Her old pill had worked fine and it only cost five dollars.”
“She lost her insurance?”
“We are not fancy people, Doctor. My mom has worked every day of her life, mostly two jobs. She’s worked right here at the University Hospital as a housekeeper for years. You know they outsourced housekeeping five months ago, right? The new cleaning service company kept her on but dropped her health insurance.”
He did know. The hospital had signed a management contract with New American Healthcare in July 2000, right at the beginning of his third and last year of specialty training in internal medicine. Contracting out the housekeeping service was one of the ways New American Healthcare was helping the University Hospital save a little money. Mrs. Bellamy might not have health insurance for a simple doctor’s office visit, or a prescription to control her high blood pressure, but now she was so sick no hospital could legally turn her away. She’d be declared disabled, Medicaid would kick in, and the expensive hospital tab would get paid—courtesy of the American taxpayers.
The daughter’s body shook with silent, heaving sobs. Dr. Newman put his hand on her shoulder and waited. She took a deep breath to steel herself, shook off his comforting arm, and looked him hard in the eye. “What is wrong with my mother?” she demanded again.
He’d tried to give her the straight scoop. Pulling two molded plastic chairs over alongside Mrs. Bellamy’s gurney, he motioned for the daughter to sit down across from him. He reached out, took her hand in both of his, and spoke slowly. “I think your mother has had a very large stroke. I’m sorry to tell you this, but I’m afraid she will never recover no matter what we do. Your mother is dying.”
The daughter’s face was blank, flat, as if she hadn’t comprehended a single word of what he just said. She wasn’t ready to process the horrible news. After all, her mother was lying nearby, asleep and breathing on her own.
“There is a slim possibility that dehydration is a contributing factor,” he offered. “Perhaps with fluids, feeding, and rehab, your mother might be one of the lucky few to partly recover.”
He intended his words to comfort the daughter just enough to tide her over until she was ready to process the grim reality that her mom was essentially gone. Once the words were out, however, it was too late.
Mrs. Bellamy’s daughter’s eyes lit up and she clapped a hand to her chest. “Oh, Doctor, please, I want you to do everything possible to save my mama!”
Everything possible. The magic words. That was all it took to set the gears of the hospital machine in motion to grind out a whole slew of hopeless interventions and procedures, or—as Sibyl Bellamy would call them if she could speak—torture.
Mrs. Bellamy had fought against every intervention. The GI team hadn’t inserted a PEG tube to funnel food directly into her stomach because she would have ripped it out with her good left hand. Instead, they had stuck a feeding tube down her nose, which she could pull out without really hurting herself. As expected, she had pulled the feeding tube out of her nose again and again. Each time, the team had shoved the greased tube back through her nose and down the back of her throat. They had alternated between drugging her up—a medical form of bondage politely termed “chemical restraints”—and tying her left hand to the side of the bed.
Her second week in the hospital, she regurgitated and inhaled some of the blue liquid nutrition formula they pumped through the feeding tube into her stomach. She had nearly drowned in the blue food, which damaged her lungs and resulted in a severe case of pneumonia. She had survived only with the help of powerful antibiotics. After fifteen more days in the hospital, she had been discharged to a nursing home, where they kept her alive with more artificial feeding and hydration. Three more times she had returned to the University Hospital for lung infections caused by breathing in the spit she couldn’t swallow, and each time she was discharged on another round of antibiotics. Don had followed her course from afar, glad he was not responsible for her hopeless case.
Until today. It started like every other call day. He slept in until 6 a.m. On his way to the hospital he stopped at Caffe DiMartino for a double cappuccino at 6:25 a.m., as he did each fourth day when he was on call. The coffee bar on the Italian North End near Don’s one-room apartment had served the best espresso in Boston since 1932.
The barista looked up and smiled. “Ciao Dottore. Buongiorno! On call today?”
Don smiled back as he leaned on the marble bar, “For the hundredth time, Giulio, call me Don. Yeah, on call. Every fourth night—the worst.”
“Your mamma would want me to tell you that you have dark circles under your eyes, Dottore. How ‘bout you sit down over by that window, and taste your latte for a change?”
“Not today, Giulio, gotta go,” Don said.
“Okay, Dottore, just this time, I will give you the best cappuccino in Boston to go. But you must come back when you are ready to enjoy life.”
“I’ll do that Giulio. Grazie,” he said, completing the charade Giulio always required before he’d allow Don to take his steaming espresso to go. Don grabbed the tall frothy drink and headed out the door.
By 6:45 he was walking into the hospital, and by 6:50 he was finishing his cappuccino as he scanned labs on the hospital computer for the fourteen patients on his service. He figured he could discharge at least three before the onslaught of new patients that evening.
His day was unremarkable—examining patients and writing notes from seven to ten, rounding with the attending and team from ten to twelve, noon conference with a drug company lunch, stabilizing a patient who crashed and had to be transferred to the ICU, dictating three of the five discharge notes for the day, aspirating a swollen joint. Before he knew it, it was already 5:00 p.m. and his team was on call for the night.
At 5:05 his pager went off—he glanced at the number—the emergency room. He wasted no time in getting there. In minutes his long strides brought him face-to-face with the automatic doors before they opened. He had to stop short.
Looking through the glass window across the crowded emergency department, he spotted Sybil Bellamy strapped to a sheet-covered gurney in Exam Room 8. His heart sank. A quick review of her chart revealed the depressing details of the heroic measures the hospital staff had taken to keep her alive. The resident physician’s notes from that first admission documented the daughter’s insistence they “do everything possible.” Apparently, the original care team hadn’t been able to get the daughter to hear the hard truth, either.
Now she was back again, her congested lungs cultivating yet another crop of drug-resistant bacteria. Sibyl Bellamy was a spunky woman who might withstand the daily blood draws, intravenous lines, and tube insertions for months before being blessed by a resistant infection that antibiotics couldn’t cure. Or maybe one time she would be lucky enough to arrive at the hospital too late to be forced back to this brutal reality. But on this night Dr. Newman was on call, she was still among the living, and he would do his job.
He was glad he didn’t need to take a history. Sibyl Bellamy couldn’t speak. As he walked up to her gurney he heard secretions rattling in her throat as she struggled to breathe. Her eyes locked on his.
Dear God! She recognized him. He was sure of it.
Her wide eyes accused him. Her irises disappeared, overmatched by her dilated pupils and the whites of her eyes, and she opened her mouth wide to scream.
AAAAAAAAAA! AAAAAAAAAA! AAAAAAAAAA!
He had committed no crime, but her stare and mandrake screams unnerved him as if he had.
Don managed to complete a brief physical without meeting her eyes again. The exam added nothing to what he already knew. The chest x-ray showed her lungs were cloudy where they should have been clear. Aspiration pneumonia again.
He couldn’t reach the daughter and suspected the usual—the daughter thought she was doing the right thing keeping her mother on artificial feeding and was angry the greatest hospital in the world couldn’t cure her. Who wouldn’t be angry? People had come to expect the great hospital and its brilliant doctors to bring life from death. And no one, including Dr. Newman, had been honest enough to tell Mrs. Bellamy’s daughter the whole, unvarnished truth: the help of the hospital in Sybil Bellamy’s case was a joke and no doctor possessed the power to make her well again.
It would have been kinder to tell the daughter everything, keep Mrs. Bellamy clean and comfortable, and allow her to die with dignity. Instead everyone strung her along, encouraging vain hopes of an impossible recovery as they rushed to accomplish the business of prolonging Sibyl Bellamy’s death.
After admitting Sibyl Bellamy and seven more patients, Dr. Newman had finally crawled into the hard twin bed in his windowless call room at one-thirty in the morning. His body ached all over. Having worked up patients nonstop for nineteen hours, all he wanted was a good night’s sleep. He was out the instant his head hit the pillow.
AAAAAAAAAA! AAAAAAAAAA! AAAAAAAAAA!
Her siren screams set his heart pounding before morphing into the earsplitting screech of his pager. He groped for it on the nightstand, silenced it, and hit the light switch on the wall above the narrow bed. The stark call room materialized in a buzz of artificial light.
He shielded his eyes and squinted at the clock. Three-fifteen. Less than two hours sleep, yet he felt a stab of guilt for indulging in the luxury when a pile of admission paperwork and progress notes from the previous day’s parade of new patients awaited his attention. He forced himself upright and dialed the number on the pager.
A nurse picked up before the first ring. “Will you please come see Mrs. Bellamy right away? She’s thrashing around so much I had to put her in restraints to keep her from falling out of bed. She lost her IV and I can’t get it back in.”
After four years of medical school and nearly three years of residency, Dr. Don Newman was annoyed to be woken up in the middle of the night to do medical student scut work. He started to tell the nurse to call his intern, Edward, but the reason she had skipped protocol was obvious. Don was the third-year resident physician in charge of the medicine service for the night. It would not be easy to get the needle back into Mrs. Bellamy’s vein, and Edward—who was in the seventh month of first-year training—would end up calling him for help anyway.
He stepped out of bed right into his Nikes, splashed cold water on his face from the sink in the corner, and burst through the door into the hallway of the half-abandoned old hospital. Someone had removed the fluorescent tubes in every other fixture. He ran down the half-lit hall under the stripes of light and dark toward the new hospital, his ears still ringing with the screams of the pager.
AAAAAAAAAA! AAAAAAAAAA! AAAAAAAAAA!
He ran like Dr. Joe Gannon, the doctor in blue scrubs he had admired as a boy in television reruns of Medical Center. Dr. Gannon always ran and he always arrived just in time to rescue his patient from the brink of death.
Of course, this was the real world. Fewer than one in six CPR recipients survive to leave the hospital, and many of those survivors are pretty messed up. He knew that now. Nonetheless, from old habit he emulated Gannon’s heroic dash to the bedside.
He ran into the unbearable bright light of the new hospital, following the painted blue line contrived by some diabolical Daedulus-architect to lure people into the maze. The blue line snaked through a labyrinth of hospital corridors, past countless procedure rooms and operating rooms, down the stairs and past the radiology suites and laboratories, through billing and administration, then past pharmacy and central supply. To anyone who saw him run by, he appeared to be a confident young doctor eager to get to the patient’s bedside. Little did they know how he dreaded what he was expected to do to poor Mrs. Bellamy.
He considered the options. There were a couple of ways to get an intravenous line in without patient cooperation. He could give her a painful intramuscular shot of Demerol, but it would be tricky to administer enough to knock her out without impeding her breathing. Or, he could get the nurse to pin her down so he could stick the line into her arm, neck, or groin, while she fought and screamed and stared at him with her damning eyes.
The nurse shot him an exasperated look as he entered the room. “Oh, I thought you’d never get here!” she said. “What do you want to do?”
He went to Mrs. Bellamy’s bedside and pulled the covers back. The overpowering stench of diarrhea hit him like a wave. A stained hospital gown was twisted around her midsection. The head and foot of the adjustable hospital bed were elevated, causing a pool of liquid stool to cradle between her thighs. The greenish-brown slime covered her lap and bottom. An IV in the groin was clearly out of the question; it would surely get infected.
“Why don’t we clean her up, for starters?” he said in a businesslike voice. He silently cursed the nurse for not having washed her before he got there.
The nurse rolled Mrs. Bellamy over like a dead log and wiped the raw bedsores of her backside with a wet rag. The translucent skin of her pale arms and hands was scarred, swollen, and mottled purple. Her thin skin and mutilated veins wouldn’t take another IV. It would have to be the neck.
Damn it! Mrs. Bellamy was only fifty-seven years old. Worst of all, the thinking part of her brain was alive. Her furious stare indicated she was keenly aware of her desperate state.
But she had no control, no choice. She was the hospital’s prisoner. She jerked her good hand and struggled against the leather shackle binding her wrist in a vain attempt to reach the tube in her nose. She writhed in the foul sheets as violently as if she were having a seizure, but she did not meet the diagnostic criteria for a seizure. She was fighting. She looked straight at Dr. Newman. Her eyes demanded recognition and begged for mercy.
He hung his head and looked away. He was sure Sibyl Bellamy regretted surviving her stroke three months earlier. She wanted to die but couldn’t verbalize it. All she could do was to glare at her doctors and try to pull out the tubes that kept her alive.
“Give her that Demerol, now!” he heard himself shout at the nurse. “Where is that central line kit? Let’s hurry up and get this done!”
He was relieved when the narcotic began to kick in and Mrs. Bellamy grew calmer. Gently turning her face away from the side of the bed where he stood, he stretched wide cloth tape from one side of the bed frame to the other, strapping it across her temple to hold her head to the side. He painted her neck with Betadine and covered her head with a large blue paper drape. The blue shroud had a window cut out, leaving only a portion of her stained skin exposed.
For a quiet moment she was just a neck. He numbed the skin with a bee sting of lidocaine, studied the anatomical landmarks to find the right spot, and stabbed her neck with the three-inch needle. She screamed beneath the drape. Dark blood shot from the hub of the hypodermic. He passed a long stiff wire through the needle into the jugular vein and deep into her body.
The pager started screeching again but he couldn’t reach under his gown to turn it off. A voice in his head whispered the oath he had taken at the beginning and again at the end of medical school: and at least I will do no harm. Bullshit! Harm is my business. How could any good ever come out of what I’m doing here to Sibyl Bellamy?
His bloody gloved fingers worked to thread the Silastic tubing over the wire, through her soft skin, and down to the first chamber of her heart. Sibyl Bellamy began to whimper.
Out of nowhere, water filled his eyes and blurred his vision. What was this? It wasn’t like him to become emotional while dealing with a patient, and he bristled with irritation at the sudden unprofessional display. He blinked hard, hoping the nurse didn’t notice the single drop that spilled from the corner of his eye and trailed across his cheek and around his mouth to balance on the tip of his chin.
Mrs. Bellamy had once been a beautiful woman. Something about her reminded him of his own mother. Momma was gone now, and he had done nothing to help her, either. As he struggled to suture the line into place, the tear dropped off his chin. It landed on the sterile blue drape and spread into a dark circle over Sibyl Bellamy’s heart.
AT EIGHT the next morning he dragged himself to Grand Rounds at the University Hospital auditorium. Dr. Desmond, Medical Director and Chief of Cardiology—renowned for his encyclopedic knowledge as well as his bowtie collection—would not abide any of his residents missing this weekly pompous lecture. Per Desmond’s rule, he had donned brown leather loafers, a dress shirt, and a necktie, as scrubs and tennis shoes were not tolerated during normal work hours. Don Newman admired Dr. Desmond, but he wouldn’t be caught dead wearing a bowtie.
Don collapsed in a seat near the back next to Sarah Moore, his intern from the previous month. A faint yet familiar scent of jasmine stirred about her, calming his nerves. His eyes met hers in a millisecond of recognition. How did she always manage to look so good, even after a long night in the hospital?
Sarah was a good doctor, too. Her kind voice would have comforted Mrs. Bellamy and eased the pain. Their month working together had been incredibly busy, yet Sarah had handled the pressure far better than most first-years, making another month of hell a little easier for Don to bear….
A deep voice rumbled through the auditorium like an earthquake tremor and commanded Don’s attention.
“You are in the trenches! You know the problems in American medicine are serious! Almost one-fifth of Americans have no health insurance and no preventive care, but they still get expensive emergency and hospital care after things go bad. Americans pay a ridiculous tab for these end-stage medical heroics…and nearly a third of our healthcare dollars pay for bureaucratic paperwork.”
The speaker slammed his fist on the podium, making everyone jump.
“That’s right, we pay middlemen a third—middlemen who make more money if they deny people the basic, preventive healthcare they need most.”
The lecturer looked out of place. He wasn’t wearing a suit like most Grand Rounds speakers—not even a white coat. Just a blue shirt with sleeves rolled partway up his broad arms, a dark tie, and black horn-rimmed glasses. He inspected the crowd coolly, as if he faced an angry army of Philistines.
Resolute, he rumbled on. “A conscientious doctor has a tough time making his practice economically viable because the system discourages a focus on preventive care—even though most fatal diseases are preventable. The payment system pressures doctors to pack more and more visits into every hour, perform as many surgeries, tests, and treatments as possible, and speed patients out the door. Procedures and hospital stays, whether they’re needed or not, generate profits. Doctors and hospitals get paid more for complications. Should it surprise us that waste and serious medical errors are routine? Did you plan on a career in an assembly line that produces so much needless suffering and death?”
Don sat up straight in his chair. Was he hearing this right?
“My question for you today,” the speaker said pointedly, “is the same one Rosie Greer put to his crack-addicted friend Richard Pryor: ‘What are you going to do?’”
Sarah nudged Don with her elbow and whispered in his ear, “This is exactly what you keep talking about! What are you going to do?”
He turned to look at her. Sarah’s light brown eyes met his and she smiled, raised her eyebrows, and nodded her head, intimating the question was meant for him.
Don shrugged and looked back to the speaker, trying to appear unfazed. The truth was, he was quite taken aback. In all his years of training, Don had never heard any attending physician talk this way. Doctors were trained—brainwashed, really—to believe they could fix any problem. They might gripe about this and that, but he had never heard anyone condemn the entire premise of the health care system in this way.
The plainspoken words rang true and intensified Don’s gnawing sense that he was no Dr. Joe Gannon, that the idyllic medical center where everyone was healed was a television fantasy. At the same time, the speaker’s question hinted at the possibility of liberation and planted a fledgling idea in Don’s brain: there might be another path.
The speaker dimmed the lights and began his slide presentation. He detailed the major causes of premature death and disability in America and the evidence-based treatments most proven to help. He shared concrete data from study after study showing how little money Americans spend on care proven to save lives—and how much we spend on services that do more harm than good. He concluded with the heretical claim that most healthcare spending is misdirected and does little to encourage health.
“But,” he said, turning the lights back up, “there is hope. My colleagues and I are working with legislators in Washington, D.C., to reorganize American medicine. I am helping the Senate Health Committee draft revolutionary legislation to reform the way we pay for healthcare. We want to incentivize prevention and patient safety. The proposed Medicare Quality Improvement Act is the first step toward creating a healthcare system that would serve health before profit.”
The cold dark pit of the lecture hall faded away. Dr. Newman stood on a high green hilltop under the warm sun amongst the greatest healers of his knowledge and memory. Drs. Gannon, Welby, Kildare, Schweitzer, and Holmes stood beside him, and Sarah was there too, all bathed in golden sunlight. They greeted the arriving people with gentle words and stood together on the summit, healers and healed, caressed by a balmy wind in the full midday sun. Don felt warm, content, at peace with himself….
His head fell back and he snapped it forward with a jerk—back to the lecture hall and the draft of forced hot air from the vent above his head. What was he thinking? The new healthcare system the speaker described was pure fantasy. It was ridiculous to think American medicine was about to be reorganized. What was it Dr. Desmond always said? The best way to fix healthcare is to work in the trenches and give people the best care you can. You have to learn to work the system.
Yes, Dr. Desmond was right. During his first two years of residency Don had copied the way Desmond worked the system and admired how he rounded late into the night to make sure his patients got the care they needed. Don could pretty much do it all now: penetrate any vein, artery, or organ in the body with a needle, catheter, or intravenous line, and run a code so systematically he restored circulation of the blood more often than any other resident. He could keep the dead alive—whether they wanted to live or not.
He’d learned to push away the nagging reality that most of the patients he coded never lived to walk from the hospital, that most of the “survivors” were left with severely damaged brains from the lack of oxygen. He couldn’t allow himself to become discouraged by that. The important thing for him was to do his job.
His interns and his teachers knew he was good. Dr. Desmond had just offered him a coveted cardiology fellowship position at the University Hospital. Everyone knew it was the best program in the country. Don was thrilled. After that, he could go wherever he wanted. With only a couple more years in training, he would be doing cardiac caths for a cool half million a year.
He pictured himself working in the North Shore Cardiovascular Institute, that cool, mirrored-glass building on Lake Michigan near Loyola University. He had borrowed an obscene amount of money for medical school and residency, so he couldn’t afford to do primary care with its long hours and low pay. Why not do a little more training, focus on something simpler than primary care, and earn four or five times as much money?
He contemplated a life of days and nights in the cardiac catheterization lab. Cut the skin over the blood vessels in the groin and insert a big plastic tube right into the pulsating artery. Ram a long, thin, tubular wire through the artery and up the great aorta, the biggest artery in the body. Hope and pray not to knock loose any calcified cholesterol lining the aorta and cause a stroke. Finally, with the help of x-rays that give as much radiation as a year in the sun, twist that wire into the little coronary arteries and squirt in the poisonous dye.
He would be a hot shot in the cath lab. He would control the greatest technology modern medicine has to offer. Of course, occasional strokes and collateral kidney failure were an unfortunate cost of doing business—he knew he would have to accept that—and his authority to decide who needed testing would be limited. Like a trained monkey, he would stab and twist wire again and again, maybe four to ten times a day. Day after day, month after month, year after year…he began to imagine the fright-filled eyes of countless Sibyl Bellamys hidden beneath the great blue drapes….
Polite applause at the lecture’s end startled him out of his stupor. His heart pounded, his palms were sweaty, and the ideal health system the speaker had conjured had evaporated like a phantom. Obviously, this guy was one more in a long line of idealistic, ivory tower academics. He sounded good, but Don knew he had to work in the trenches and just do the best job he could for each patient.
He started toward the door, remembering the hospital wards and the giant stack of paperwork awaiting him, but Sarah held his arm.
“Come on,” she said, “let’s go talk to him. He’s a friend of my father. Remember Dad telling us about his training program?”
Sarah’s dad was a doctor. He had bought them coffee in the hospital cafeteria one night in the winter when Sarah’s parents were visiting from Minnesota, but Don couldn’t remember anything they’d talked about.
Sarah steered Don down to meet the speaker before he had time to object. “Hello, Dr. Sampson,” she greeted him.
“Well, if it isn’t Dr. Sarah Moore! It’s good to see you. How are your parents?”
“Oh, they’re doing well. You know Dad. He’ll never give up his patients. He seems to keep working harder than ever.”
The speaker was shorter than he had appeared from the back of the room, but he had a commanding presence, like an aging warrior captain. His arms and legs were thick as tree trunks. His hairline receded beyond the shiny crown of his head, encircling it with a ring of dark gray hair. His deep gray eyes looked from Sarah to Don.
“So, this must be Don Newman.” The speaker’s deep voice reverberated from his broad chest. “It’s a pleasure to finally meet you.” He thrust out a thick hand and gave Don a vigorous handshake.
“You know my name?”
“Oh, yes. Sarah has told me of your interests.”
“I’m always on the lookout for kindred spirits. I don’t find many among your generation. Guess I’m just a contrarian old doctor, born into a time known as the golden age of medicine.” He laughed. “For over twenty-five years I’ve been telling people who did not want to hear it that modern medicine isn’t nearly as good as it’s made out to be.”
“Don always gives us articles on how dangerous healthcare is and how many people get tests and treatments they don’t really need,” Sarah informed him.
“You’re a third-year resident?”
“And your plans?”
“I’m thinking cardiology.”
“After what Sarah has told me, I am surprised to hear that. Why are you planning to labor on the assembly line of an outmoded industry? You must see the writing on the wall. Why don’t you consider doing something to help change healthcare in America?”
Don was taken aback by these comments from a perfect stranger. Most people were impressed when he said he was thinking of cardiology. What in the world had Sarah said about him?
Don’s eyes wandered to the blackboard behind the podium, where the name DR. GIL SAMPSON was written in large block letters. He hadn’t noticed it from his hiding place in the back of the hall.
Oh, crap! This was the Dr. Sampson who authored the famous papers on variations in care for coronary artery disease. The Dr. Sampson that proved whether you got medicine, stents, or bypass surgery depended more on how many cardiologists and heart surgeons there were in your town than it did on which treatment was most likely to help prevent a heart attack. Sampson had made a career of studying why medical care varies so much across the country. His work had helped father the field of health services research in America.
“I just realized—you are Dr. Gil Sampson,” Don admitted. “I’ve read many of your papers and admire your work. Forgive me for not making the connection. I just had a horrible night in the hospital—how can you be a good doctor these days?”
Don was surprised to hear himself revealing his true feelings to this man he hardly knew.
“If you want to be a good doctor, you have to either work outside the system or work to change it. Either way is hard.” Dr. Sampson glanced around to make sure no one was listening and lowered his voice. “I’m sure you would make an excellent cardiologist. But you must see that cardiology will only pull you deeper into the current system. The procedural subspecialties like cardiology are flush with cash, and they draw the best and brightest into their ranks. The prestige and hefty paychecks quiet the voices screaming in their heads that much of the work is useless and vain. The champions of healthcare reform will address real health care needs and seek to eliminate the copious waste that is especially common in the procedural disciplines.”
“I want to be part of the change; I just don’t know how,” Don replied, looking down. “All I know how to do any more is put in IVs, catheters, and chest tubes. There’s no time to think.”
“If you are sincere in your desire to be part of the change, you must take another path. Why don’t you do a general medicine fellowship and become a health services researcher? There are many training programs you could consider, but the best is the one I run at Florence College, a short distance away in Florence, New Hampshire.”
Everyone knew of Florence College. One of the top Ivy League colleges in the country, it had a reputation for free thinking and intellectual rigor.
“I must go now to meet with Dr. Desmond and the faculty,” Dr. Sampson said. “Meet me this afternoon. Five o’clock in the Social Medicine annex of the School of Public Health.”
It sounded more like a command than an invitation.
“If I can get free from the hospital I’ll try to make it,” Don heard himself answer.
Dr. Sampson gathered his papers and walked with Sarah up the narrow stairs, out the back doorway, and into the hall outside the auditorium. The audiovisual staff dimmed the lights from front to back as everyone filed out. Don bounded up the stairs two at a time and headed back to the hospital.