Crisis (46 page)

"Why not," Jack said. Even though he wasn't all that enthusiastic, he felt a rekindling of sympathy for Alexis and wanted to be supportive. As they returned to their seats in the courtroom, he wondered how a finding for the plaintiff would affect Alexis's relationship with Craig. Jack had never championed their union, from the first time he'd met Craig some sixteen years previously. Craig and Alexis had met while in training at the Boston Memorial Hospital and had come as houseguests to Jack's home while they were engaged. Jack had found Craig insufferably self-centered and one-dimensionally oriented toward medicine. But now that Jack had had a chance to see them together in their own environment, despite the current, difficult circumstance, he could see that they complemented each other. Alexis's very mildly histrionic and dependent character, which had been much more apparent as a child, melded well with Craig's more serious narcissism. In a lot of ways, from Jack's perspective, they complemented each other.

Jack settled back and got himself as comfortable as he could under the circumstances. Randolph was standing stiffly erect at the podium, exuding his normal blue-blooded resplendence. Craig was in the witness box, leaning slightly forward, his shoulders rounded. Randolph's voice was crisply articulate, melodic, and slightly sibilant. Craig's was vapid, as if he'd been in an argument and was now exhausted.

Jack felt Alexis's hand insinuate itself between his elbow and his side and then move forward to grab his hand. He squeezed in return, and they exchanged a fleeting smile.

"Dr. Bowman," Randolph intoned. "You've wanted to be a doctor since you were given a toy doctor's kit at age four and proceeded to administer to your parents and older brother. But I understand there was a particular event in your childhood that especially firmed this altruistic career choice. Would you tell the court about this episode."

Craig cleared his throat. "I was fifteen years old and in tenth grade. I was a manager for the football team. I'd tried to make the team but didn't, which was a big disappointment for my father, since my older brother had been a star player. So I was the manager, which was nothing more than the water boy. During the timeouts, I ran onto the field with a bucket, ladle, and paper cups. During a home game, one of our players was hurt and a time-out was called. I dashed onto the field with the bucket, but as I drew near I could see the injured player was a friend of mine. Instead of carrying my bucket to the huddle of players, I ran to my friend. I was the first one from the sidelines to get to him, and what I confronted was disturbing. He had badly broken his leg such that his cleated foot stuck off in a markedly abnormal direction, and he was writhing in agony. I was so struck by his need and my inability to help him that I decided on the spot that not only did I want to become a doctor, I had to become a doctor."

"That is a heartrending story," Randolph said, "and stirring because of your immediate compassionate impulse and the fact that it motivated you to follow what was to be a difficult path. Becoming a doctor was not easy for you, Dr. Bowman, and that al-truistic urge you so eloquently described had to be strong indeed to propel you over the obstacles you faced. Could you tell the court something of your inspiring Horatio Alger story?"

Craig perceptively straightened in the witness chair.

"Objection," Tony shouted, getting to his feet. "Immaterial."

Judge Davidson took off his reading glasses. "Counsels, approach the bench."

Dutifully, Randolph and Tony congregated to the judge's right.

"Listen!" Judge Davidson said, pointing his glasses at Tony. "You made character a centerpiece of the plaintiff's case. I allowed that, over Mr. Bingham's objection, with the proviso you established foundation, which I believe you did. What's good for the goose is good for the gander. The jury has every right to hear about Dr. Bowman's motivations and training. Do I make myself clear?"

"Yes, Your Honor," Tony said.

"And furthermore, I don't want to hear a flurry of objections in this regard."

"I understand, Your Honor," Tony said.

Tony and Randolph retreated to their original spots, with Tony at the plaintiff's table and Randolph at the podium.

"Objection overruled," Judge Davidson called out for the court recorder's benefit. "Witness may proceed to answer the question."

"Do you recall the question?" Randolph asked.

"I should hope so," Craig said. "Where should I begin?"

"At the beginning would be appropriate," Randolph said. "I understand you did not get parental support."

"At least not from my father, and he ruled the house with an iron fist. He was resentful of us kids, particularly me, since I wasn't the football or hockey prodigy like my older brother, Leonard Junior. My father thought I was a 'candy ass,' and told me so on multiple occasions. When my browbeaten mother let it slip that I wanted to be a doctor, he said it would be over his dead body."

"Did he use those exact terms?"

"Absolutely! My father was a plumber who was dismissive of all professionals, which he labeled as a collective bunch of thieves. There was no way he wanted a son of his to become part of such a world, especially since he never finished high school. In fact, to the best of my knowledge, no one in my family on either side went to college, including my own brother, who ended up taking over my father's plumbing business."

"So your father wasn't supportive of your academic interests."

Craig laughed mirthlessly. "I was a closet reader as a youngster. I had to be. There were occasions on which my father whacked me around when he caught me reading instead of doing things around the house. When I got report cards, I had to hide them from my father and have my mother sign them secretly because I got all A's. With most of my friends, it was the other way around."

"Was it easier when you got to college?"

"In some ways yes and some ways no. He was disgusted with me, and instead of calling me a 'candy ass,' I became a 'highfalutin' ass'. He was embarrassed to talk about me to his friends. The biggest problem was that he refused to fill out the financial forms necessary to apply for a scholarship and, of course, refused to contribute a cent."

"How were you able to pay for college?"

"I relied on a combination of loans, scholastic awards, and every type of job I could manage to get and still keep a four-point-oh grade point average. The first couple of years it was mostly restaurant work, washing dishes and waiting tables. During the last two I was able to work in a variety of science labs. During summers I worked in the hospital at any job they would give me. Also, my brother helped me a little, although he couldn't do much, since he'd already started a family."

"Did your goal of medicine and your desire to help people support you during these difficult years?"

"Absolutely, especially the summer work in the hospital. I worshipped the doctors and the nurses, particularly the residents. I could not wait to become one of them."

"What happened when you got to medical school? Were your financial difficulties worse or less severe?"

"Much worse. The expenses were greater and the curriculum required more hours, essentially all day every day in contrast to college."

"How did you manage?"

"I borrowed as much as I was allowed; the rest I had to earn with a myriad of jobs all around the medical center. Luckily, jobs abounded."

"How did you find the time? Medical school is considered a full-time occupation and then some."

"I went without sleep. Well, not totally, since that is physically impossible. I learned to sleep in short snatches even during the day. It was difficult, but at least in medical school the goal was in sight, which made it easier to endure."

"What kind of jobs did you do?"

"All the usual medical center jobs like drawing blood, type and cross-matching blood, cleaning animal cages: anything and everything that could be done at night. I even worked in the medical center kitchen. Then, during the second year, I landed a terrific job with a researcher studying sodium ion channels in nerve and muscle cells. I've even kept up that work today."

"With such a busy schedule in medical school, how were your grades?"

"Excellent. I was in the top ten percent of my class and a member of the Alpha Omega Alpha honorary scholastic society."

"What do you consider your biggest sacrifice? Was it the chronic lack of sleep?"

"No! It was the lack of any time for social contact. My classmates had time to interact and discuss the experience. Medical school is quite intense. During my third year, I was conflicted about whether to go into academic/basic-science medicine or clinical medicine. I would have loved to debate the pros and cons and have the benefit of others' opinions. I had to make the decision myself."

"And how did you make the decision?"

"I realized I liked taking care of people. There was an immediate gratification that I savored."

"So it was the contact with individuals that you found enjoyable and rewarding."

"Yes, and the challenge of coming up with the differential diagnoses, as well as the paradigm for narrowing the field."

"But it was the contact with the people and helping them that you cherished."

"Objection," Tony said. He had been progressively fidgeting. "Repetitious."

"Sustained," Judge Davidson said with a tired voice. "No need to belabor the point, Mr. Bingham. I am confident the jury has gotten it."

"Tell us about your residency training," Randolph said.

"That was a joy," Craig said. He was now sitting up straight, with his shoulders back. "Because of my grade point average, I was accepted to train at the prestigious Boston Memorial Hospital. It was a wonderful learning environment, and suddenly I was being paid, not a lot of money, but some. Equally important, I was no longer paying tuition, so I could begin to pay off the shocking debt I'd assumed from college and medical school."

"Did you continue to enjoy the necessarily close bonds that had to form between you and your patients?"

"Absolutely. That was by far the most rewarding part."

"Now tell us about your practice. I understand there were some disappointments."

"Not at first! Initially, my practice was everything I had dreamed it would be. I was busy and stimulated. I enjoyed going in each and every day. My patients were challenging intellectually and appreciative. But then the insurance companies began to withhold payments, often needlessly challenging certain charges, making it progressively difficult to do what was best for my patients. Receipts began to fall while costs continued to rise. In order to keep the doors open, I had to increase productivity, which is a euphemism for seeing more patients per hour. I was able to do this, but as it continued, I became progressively concerned about quality."

"I understand that your style of practice changed at that point."

"It changed dramatically. I was approached by an older, revered physician who was practicing concierge medicine but who was having health issues. He offered me a partnership."

"Excuse me for interrupting," Randolph said. "Perhaps you could refresh for the jurors the meaning of the term 'concierge medicine.'"

"It's a practice style in which the physician agrees to limit the practice size to offer extraordinary accessibility for an annual retainer fee."

"Does extraordinary accessibility include house calls?"

"It can. It's up to the doctor and the patient."

"What you are saying is that with concierge medicine, the doctor can tailor the service to the needs of the patient. Is that correct?"

"It is. Two fundamental principles of good patient care are the principle of patient welfare and the principle of patient autonomy. Seeing too many patients per hour threatens to violate these principles, since everything is rushed. When the doctor is pressed for time, the interview has to be forced, and when that happens, the patient's narrative is lost, which is tragic, since it is often within the narrative that the critical facts of the case are hidden. In a concierge practice, like mine, I can vary the time I spend with the patient and the location of the service according to the patient's needs and wishes."

"Dr. Bowman, is the practice of medicine an art or a science?"

"It is definitely an art, but it is based on a bedrock of proven science."

"Can medicine be appropriately practiced from a book?"

"No, it cannot. There are no two people alike in the world. Medicine has to be tailored for each patient individually. Also, books are invariably outdated by the time they come on the market. Medical knowledge is expanding at an exponential rate."

"Does judgment play a role in the practice of medicine?"

"Absolutely. In every medical decision, judgment is paramount."

"Was it your medical judgment that Patience Stanhope was best served by your making a visit to her home on the evening of September eighth, 2005."

"Yes, it was."

"Can you explain to the jury why your judgment led you to believe this was the best course of action?"

"She detested the hospital. I was even reluctant to send her to the hospital for routine tests. Visits to the hospital inevitably exacerbated her symptoms and general anxiety. She much preferred for me to come to her home, which I had been doing almost once a week for eight months. Each time it had been a false alarm, even on those occasions when I was told by Jordan Stanhope that she believed she was dying. On the evening of September eighth, I was not told she thought she was dying. I was confident the visit would be a false alarm like all the others, yet as a doctor, I could not ignore the possibility she was truly ill. The best way to do that was to go directly to her home."