“So that you each may do the work you do best,” said Wilmot, “we have chosen our trustees strictly from among the abundant reserve of community leaders. This will come as nothing new to you. But in this we differ from those boards substantially comprised of physicians.” This was a sore subject, and we had no idea why he saw fit to revisit it now. “We are as empowered toward decision making as you each should be empowered toward healing.” All of us could feel the generalizations rise toward a disorienting crescendo, and we were on our guard, sensing there was a fucking afoot. “I am in contact, thanks to the good efforts of Darryl Coutts, with Heritage Asset Strategies of Eldorado, Oklahoma, specialists in the management of acute care hospitals in small places like ours. They are owned by various affiliates of private equity firms and know from top to bottom what institutions like ours require. Heritage Asset Strategies boasts a combined experience of almost a thousand years and hence has a perspective few of their competitors can match. Because of the confidence of fellow trustees Bob Comstock of Big Sky Florists; Olan Berg, a car salesman; Joseph Pancrack, a rodeo clown; Genevieve Shanstrom, housewife; Oliver Perkins of Hair Today Gone Tomorrow; and Dr. Dave Manovich, dentist, I have been entrusted with their proxies to open negotiations with Heritage Asset Strategies as of start of business Monday.”
Except for the emergency room and absolutely skeletal services in desperate cases, we shut the whole place down the next morning. Jinx made the somewhat sibylline remark, “I’m afraid we are always ruled by the collective disappointments of the community.” I had several patients in the hospital wing — not gravely ill, I admit — but I went on seeing them. That’s how I became a scab, persona non grata. Thus I visited Earline Campbell, recovering from an appendectomy, and arranged to have her television fixed; something in our food service was aggravating Roland Crowley’s gout, so I brought him colchicine tablets and meals from his preferred restaurants; I continued to monitor ninety-five-year-old Donald Fairhurst, who thought he was dying and may well have been and who therefore, despite his great age, was frightened.
Three days into this I found Gary Haack, our orthopedic surgeon, and Laird McAllister, a family practice doctor, waiting for me at my car. They looked sad, reluctant to tell me what they had to tell me, that as I had not stood by them at this crisis they hoped that I would see what was best for one and all. Laird began, “We are very reluctant to say what we have to say but cannot do otherwise.”
“Because I failed to stand by you during this crisis it would be better if I just left the clinic.”
“I told Laird you’d be a sport,” said Gary brightly. “You’ve made this easy.” These weren’t bad fellows, just committed to their situation, something that eluded me. However, I couldn’t go along with them.
“My thought is,” I said, “if you’re a doctor you’re a doctor. Who cares who they sell the business to? I had patients who needed me.”
“Very naive,” said Dr. Haack. “Bordering on infantile.”
I was sensing the prospect of relief from something whose burden I had barely let myself recognize. As soon as the picture was clear, I said, “Just let me get through my inpatients and I’m sure we can work this out. I’ll try to find a way to practice elsewhere.”
That night as I lay in bed swaddled in unclean sheets and smelling the rail yards on the light north wind, I felt abashed that I had made such bitter innuendos to my colleagues. I admitted to myself — at last! — that there was something more to my distaste for hospital bureaucracy than just ordinary irritation with management. I had long felt that those who bent to their work, whatever it was, sooner or later landed in the hands of swindlers like Raymond Wilmot. We had an informal slogan in our town: “You can get used to anything.”
I strolled over to the hospital in my new role to visit my handful of patients. Nurses were there seeing to the others and collaborating with the physicians by cell phone. There was little difference in the care the patients were receiving, and experience told me that my responsible colleagues were watching them closely while maintaining the front of negligent solidarity. On reflection, I felt they were on the right track and I, perhaps, was on the wrong one. If they kept the place from being sold to a consortium with its empty claims of local control, all except me would benefit. I was a scab. Even the nurses were distant, though I had to intervene when old Mrs. Kefler declined to “eat anything with a central nervous system” and had been put on cold cereal for several days. She complained of weakness, though she was overweight. I once read in an Icelandic book, “The world has never taken the tears of a plump woman seriously, and a fat martyr has always been considered contrary to the laws of reason.”
When I went in to see ancient Donald Fairhurst, who ranched up the Shields River for seventy years, I found him in good spirits and glad to be under the covers on a morning that was in his opinion “cold enough to freeze the nuts off a riding plow.” He asked me who the president was this time. I told him and he wanted to know about the legislature; he said Americans had to get out of the habit of sending the village idiot to Congress. His ninety-five years did not seem to have blunted his wit. Donald once told me that he had been a hellhound in his youth before he started going to church. “Now I’m sanctified.” He said he had no intention of dying until the time was ripe. He had attended the last public hanging in Montana as a boy and told me that in those days the young were encouraged to attend as a moral lesson. I asked him about the spectacle. “Wasn’t nothing to it,” he said. “It was like watching a turd fall from a tall cow.”
I saw the nurses rush toward the room of a patient who was singing “Jambalaya” in a loud and despairing voice. An older nurse headed his way with a syringe on a tray.
Jinx Mayhall came into my office. We were very good friends with shared interests in cooking and the outdoors. An unpleasant stillness came upon us. Jinx stared at my face, her eyes a pair of gloomy orbs. “Whatever possessed you to do away with that poor girl?” she asked. My blood ran cold, I don’t know why; though later I would wonder whether something like this had been in the air and I had registered it subconsciously.
“Do away with what poor girl?”
“Your old squeeze. The one who stabbed herself.”
“Jinx, I tried everything I knew to—”
“—saying such terrible things about you—”
“—keep her alive. I didn’t know that. I’d hardly seen in her in years.”
“Never out of her mind. She made that clear to one and all. It’s not that no one understands, a doomed soul surely.”
“Jinx, stop. Now just stop this. I tried my best to save her.”
“Did you.”
We sat without a word for a long time. I had my hands in front of me on the desk, and I was staring between them while my mind whirled. Finally, I told Jinx that I thought it best she go. She stopped in the doorway in her big loden coat and without turning to me, said, “I thought you knew.”
* * *
I looked at Bob Carmichael’s chart and felt sad and unsurprised. Bob wouldn’t be here much longer because of his age and diabetes, but he was so stouthearted he would doubtless have numerous amputations before the merciful failure of his heart. Retired from the railroad long ago, Bob was a ham radio operator and had a far-flung society of fellow “hams” he communicated with every day. He once picked up the distress messages of a crab boat sinking in the Gulf of Alaska, connected the crew to a Russian trawler, and from the comfort of his small house on H Street saved seven men from drowning in cold black water. Entering my office, he quickly sat to keep me from evaluating his mobility, which was greatly reduced. He wore a frayed flannel shirt, high-heeled logger boots, and suspenders. His white hair had the pinkish tinge of the redhead he formerly was. Bob and I were tired of sending him for blood tests and suggesting changes in his lifestyle. The unspoken thing between us was that it was in God’s hands, sooner or later, though one of us might have called it luck. Bob did not feel he had been cheated by life, and after fifty years of marriage he and his wife still had each other’s companionship. By checking in with me a few times a year, he felt he had done enough for his health. I agreed.