"I told you I admired him as a consummate physician," Jack said, aware that he was being mildly evasive.
"I did qualify it by saying you were envious of his accomplishments. You did say something to that effect, didn't you?"
"Undoubtedly. I have always been awed by his ability to do real, publishable basic science research while handling a large, successful clinical practice. That is the romantic goal of a number of physicians who never even come close. I made a stab at it back when I was an ophthalmologist, but in retrospect, my supposed research was a joke."
"I can't imagine that's true, knowing what I do about you."
"Getting back to the critical issue, how does Craig feel about me actually being here? You really didn't answer that."
Alexis took a sip of her wine. It was apparent she was considering the answer, and the longer she paused while doing so, the more uneasy Jack became. After all, he was a guest in the man's house.
"I suppose my not answering it was deliberate," she admitted. "He's embarrassed to be asking for help, as you suggested he might be on the phone. There's no doubt he sees dependency as a weakness, and this whole affair had made him feel totally dependent."
"But I have a feeling he's not the one asking for help," Jack said. He finished his pasta and started in on his salad.
Alexis put her wineglass down. "You are right," she said reluctantly. "I'm the one who's asking for help on his behalf. He's not all that happy about you being here because he's embarrassed. But I'm ecstatic you are here." Alexis reached across the table and took Jack's hand. She squeezed it with unexpected ferocity. "Thank you for caring, Jack. I've missed you. I know it's not the best time for you to be away, and that makes it even more special. Thank you, thank you, thank you."
A sudden flash of emotion washed over Jack, and he felt his face flush. At the same time, the avoidant nature of his personality kicked in and asserted itself. He detached his hand from Alexis's, took a gulp of wine, than changed the subject. "So, tell me about the opening day of the trial."
Alexis's slight smile turned up the corners of her mouth. "You are smooth, just like the old days! That was an impressively quick U-turn from an emotionally charged arena. Did you think I might not notice?"
"I keep forgetting you're a psychologist," Jack said with a laugh. "It was an instinctual reaction for self-preservation."
"At least you admit to your emotional side. Anyway about this trial, all that's happened so far are the two opening statements by the opposing attorneys and the testimony of the first witness."
"Who was the first witness?" Jack finished the salad and picked up the wineglass.
"Craig's accountant. As Randolph Bingham explained later, the whole reason he was included was merely to establish that Craig owed a duty to the deceased, which was easy, since the deceased had paid the retainer fee, and Craig had been seeing her on a regular basis."
"What do you mean 'retainer fee'?" Jack asked with surprise.
"Craig switched from a traditional fee-for-service practice to a concierge practice almost two years ago."
"Really?" Jack questioned. He'd had no idea. "Why? I thought Craig's practice was booming, and he loved it."
"I'll tell you the main reason even if he won't," Alexis said, moving herself in closer to the table as if she was about to reveal a secret. "Over the last number of years, Craig has felt he has been progressively losing control of patient decisions. I'm sure you know all this, but with more and more involvement of insurance companies and various health plans with cost containment, there's been more and more intrusion into the doctor-patient relationship, essentially telling doctors what they can and cannot do. For someone like Craig, it has been a progressive, ongoing nightmare."
"If I were to ask him why he made the change, what reason would he give?" Jack questioned. He was fascinated. He'd heard of concierge medicine, but he thought it was a small fringe group or a mere trendy quirk in the system. He'd never talked with a doctor who practiced in such a setting.
"He wouldn't admit he'd ever compromised a patient decision because of outside influence, but he'd be fooling himself. Just to keep his practice solvent, he has had to see progressively more patients in any given day. The reason he gives for switching to concierge medicine is that it affords him the opportunity to practice medicine the way he was taught in medical school, where he could spend as much time as needed with each patient."
"Well, it's the same thing."
"No, there's a subtle difference, although there's an aspect of rationalization on his part. The difference is between a negative push and a positive pull. His explanation emphasizes the patient."
"Is the style of his practice playing a role in the malpractice case?"
"Yes, at least according to the plaintiff's attorney, who I have to say is performing better than anticipated."
"How do you mean?"
"To look at him, and you'll see for yourself if you come to the courtroom, you'd not imagine on first glance he'd be effective. How should I say this: He's a composite stereotype of the tawdry, ambulance-chasing personal-injury lawyer and the mafioso defense attorney, about half Craig's defense attorney's age. But he's relating to the jury in a surprisingly effective manner."
"How is Craig's practice style supposed to play into the case? Did the plaintiff's attorney address it in his opening statement?"
"Absolutely, and very effectively. The whole concept of concierge medicine is predicated on being able to satisfy patient needs, like a concierge at a hotel."
"I get the association."
"To that end, each patient has access to the doctor through cell phone and/or e-mail so that they can contact the doctor at all hours and be seen if necessary."
"Sounds like an invitation to abuse on the part of the patient."
"I suppose with some patients. But it didn't bother Craig. In fact, he seemed to like it because he started making house calls at off-hours. I think to him there was something retro and nostalgic about it."
"House calls?" Jack questioned. "Making house calls is usually a waste of time. As a modern-age doctor you're so limited in what you can do."
"Nonetheless, some of the patients love it, including the deceased. Craig had seen her often after hours. In fact, he had seen her at her home the morning of the very day the malpractice was supposed to have occurred. That evening she took a turn for the worse, and Craig made a house call."
"It seems to me it would be hard to find fault with that."
"One would assume so, but according to the plaintiff's attorney, it was Craig's making the house call rather than sending the patient to the hospital that caused the malpractice, since it delayed the diagnosis and emergency treatment of a heart attack."
"That seems absurd," Jack said indignantly.
"Not when you hear it coming from the plaintiff's attorney during his opening statement. You see, there are other circumstances surrounding the episode that are important. It happened when Craig and I were officially separated. At the time, he was living in an apartment in Boston with one of his nubile secretary-cum-file clerks named Leona."