Death Benefit (4 page)

Finally Rothman, half standing, leaned over his desk and handed a copy of the
Lancet
paper to Pia. “Make sure this is up to snuff. I’ll want it by morning. Tomorrow we’ll talk again about what you will be doing for the month.” He still did not look at her. “Let me say that I know you have always been more interested in my stem cell work than my salmonella work, and I’m fine with that. You’ve earned it, considering you finally know something practical about genetics rather than the garbage they taught you in class. And one other thing: Two fourth-year students have been foisted on me for a month of elective by the damn dean. So I want you to give some thought to what they can do while they’re here. It’s not going to be easy. I’m sure they’ll be worthless.”

“Where are they and how can I meet them?”

“They are supposed to start tomorrow. Dr. Yamamoto will introduce you. The main thing is that I don’t want them tying up a lot of Junichi’s time as he seems to enjoy that kind of crap. I need him to concentrate on our work.”

“I can’t do anything with that maintenance man in my office.”

“My understanding is that he’ll be done sometime today. So, tomorrow then.” Rothman was never much interested in the details of running his massive lab. Suddenly he was again absorbed in the
Lancet
manuscript.

Ignoring Rothman’s dismissal, Pia said, “There is something I want to tell you. The residency matching results came in. I’m going to be here at Columbia doing a combined program getting a Ph.D. in cellular biology with you, as you so generously offered, and completing a residency in internal medicine. I hope you’re pleased.”

“Well, I’m not!” Rothman said with emotion, his infamous ire rising. “I’m disappointed. If I told you once I told you a dozen times that for you, doing an internal medicine residency would be a complete waste of time, just like it was for me. I think it is totally apparent that you, like me, are cut out for research, not clinical medicine. You should be here in the lab full-time! I said as much in my letter of recommendation for the Ph.D. program.”

A level of tension hung in the air. For a few beats neither spoke, nor did they so much as exchange a glance.

“But I have the sisters to think of,” Pia said. Pia’s education had been partly underwritten by the Missionary Sisters of the Sacred Heart, an international religious order situated in Westchester County. Pia had fled to the order for emotional safety after aging out of foster care at age eighteen. Although initially Pia had thought briefly of joining the order as a nun, after finishing her high school equivalency and a portion of college at New York University, she had changed her mind. Consequently the relationship with the sisters, particularly the mother superior, had become more transactional. Although Pia would complete her medical training and still go to Africa to help with the organization’s missionary work, she would not become a novitiate.

Although Pia had received full scholarships from New York University and Columbia Medical School, the Sisters’ contribution had been considerable. She felt justifiably obligated. “I don’t think I can renege on a plan I made ten years ago. Although I’ve come to agree with you that my personality is more suited to research, I think I have to go through with the original plan to become a doctor and, at least for a time, serve the order’s needs.”

A rush of mumbled profanity escaped from Rothman’s lips. He shook his head in disbelief. “Here I am offering you a part in making medical history with my stem cell research, and I have to be concerned about a bunch of nuns in Westchester.” He paused for a moment to collect his thoughts. “What kind of money are we talking about?”

“I don’t know what you mean.”

“Come on. Don’t be obtuse. What do you think you owe them in dollars?”

“I’m not sure I can think of it in those terms.”

“Let’s not be difficult. Give me a figure however you want to create it.”

Pia thought for a moment. It was not an easy task. She’d never put a figure on how the sisters had nurtured her and given her a sense of protection from the evils of her foster care experience. She shrugged. “I don’t know. Maybe fifty thousand. Something like that.”

“Done,” Rothman said. “You’ll get a loan from my bank to the tune of fifty thousand, and I’ll cosign for it.”

Pia found herself momentarily speechless. Never in her life had someone stood up for her financially, especially to the tune of fifty thousand dollars. She didn’t know how to react. “I don’t know what to say,” she mumbled.

“Then don’t say anything! We’ll revisit this issue, but for today I want you to jump on this paper for
Lancet
. It needs another set of eyes and the statistics checked. I know you are a whiz with statistics.”

Rothman got up from behind his desk. With his attention buried in the piece of paper he’d been intermittently studying, he walked out of his office. Pia was stunned. Rothman had just essentially lent her a large sum of money and asked for her help on a vitally important paper.

“Okay,” Pia said to herself, “I’ve got work to do. Now I just have to get that man out of my work space.” Following Rothman out through the door, she headed back to the lab bench where she had set up her temporary work space.

 

 

A
rmed with Dr. Rothman’s pledge of financial support, Pia made an appointment with the mother superior of the convent of the Sisters of the Sacred Heart for that same evening. It wasn’t a meeting she looked forward to. Pia recalled how years before the mother superior had found her as a teenager sitting on the convent wall after getting into a fight with her foster family at the time, who lived a couple of miles away. She had brought Pia inside, and they had talked. The result was that Pia returned the very next weekend, with her family’s permission, to help out in an unstructured fashion. The rest was history, culminating in Pia’s decision, when she aged out of foster care, to join the convent with the idea of possibly becoming a novitiate.

Pia would be forever grateful for what the mother superior had done for her in the years following her moving in, especially as it was an enormous improvement on what she had experienced in the foster care system. Although it was, in reality, another institution, Pia had finally been at peace. She had found the mother superior to be sympathetic not only in helping her adjust to the convent’s community living but also in helping her navigate the tempestuous waters in the real world beyond the tranquillity of the convent. It had been at the mother superior’s insistence that Pia turned to academia and became a superior student rather than an adequate one. But obtaining her high school equivalency and attending college had allowed Pia to learn about herself to the extent of realizing that a nun’s life was not for her. Instead she decided on a career in medicine, where she sensed she could excel and find equivalent peace. After all, during her entire tumultuous foster care experience, she had always viewed the doctor as the sine qua non of power and control of one’s personal destiny. But the decision had had consequences, especially with regard to the mother superior.

About five years earlier Pia had made a similar appointment with the woman. It was then that Pia admitted that she was not going to become a sister but rather a doctor. It had been a difficult meeting as the mother superior had been obviously disappointed and made her feelings known. At the same time she had been encouraging about Pia’s new career track and voiced how desperately doctors were needed at their missionary locations in East Africa. Now, as Pia walked into the mother superior’s stark office, she knew she faced as difficult a situation as—and maybe even worse than—when she had decided against becoming a nun. The more she thought about her goals, the more she thought Rothman was right about her being uniquely qualified for medical research.

“Pia, my dear, it’s a blessing to see you. We have all missed you. All the sisters ask about you day after day.”

“And you, Reverend Mother.”

Pia kept her eyes glued to her hands as they worked at each other in her lap. Her anxiety had peaked. She hoped it was not reflected in her voice. She had dressed simply in a black dress that broke at the knees and plain pumps. At first glance, the mother superior had looked the same as when she first met her ten years before. The uniform of the order helped with that. But Pia could tell that age was taking its toll. The mother superior had moved slowly when she walked around her desk to greet Pia. From Pia’s perspective her hand had felt bonier and more delicate when she placed it on Pia’s shoulder than on Pia’s previous visit a month or so previously.

On the short train ride out of Manhattan, Pia had rehearsed what she was going to say. She wanted to be clear so there would be no misunderstanding. She was confident in her decision, more confident then than she’d been in Rothman’s office, but she knew the mother superior had a talent for ignoring what someone was saying as she worked the conversation back to a position more in tune with her interests and opinions.

As the pleasantries continued, Pia’s mind rapidly played over the extraordinary changes her life had taken since she arrived at the convent in what, at that moment, seemed like a previous life. She was now in her fourth year at Columbia Medical School, as amazing as that sounded even to her. She recalled how difficult it had been to convince Columbia to accept her. She remembered how she’d had to explain why, at age eighteen, she’d decided to join a Catholic African missionary order. Her experience at New York University had been a breeze. From the get-go the college admissions people were convinced, no questions asked, that Pia, as a young woman emancipated from foster care, would make a valuable addition to the rich tapestry of NYU undergraduate life.

Columbia, on the other hand, had expressed early concern about Pia’s history and its potential effects on her independence and ability to empathize with patients. They didn’t voice their concerns in such a clear fashion, but Pia had gotten the message, especially when she was asked to undergo an interview by one of the medical center’s psychiatrists. Recognizing that she wouldn’t have been asked to do the interview if they weren’t interested in her, Pia had acquiesced. To her surprise, the interview turned out to be more pleasant than she had feared. The psychiatrist had been well versed in the inequities of the New York foster care system and seemed sympathetic when he learned that she had been under its questionable aegis from age six to eighteen. Unfortunately, she had never experienced an adoption or even a final placement.

Although the psychiatrist did not have access to her records by law, Pia was rather open with him and explained her experiences, although she downplayed some of the grittier elements. She fully admitted that in retrospect she knew that she had been abused and that she had had to grow up without a nurturing presence in her life, but she added that rather than hindering her, she believed, her experiences would make her a better doctor. She also downplayed any symptoms she’d experienced such as her mild brush with an eating disorder as a teenager and the recurrent nightmares she still experienced.

As the interview had progressed, Pia’s openness apparently won the day as the psychiatrist was equally open with her. He actually told her that he was impressed with how she had been able to cope and that he agreed with her that her experiences might make her a better doctor, especially if she became interested in a specialty like pediatrics. He told her that he was particularly impressed by her near perfect grade point average at NYU, her near perfect MCAT scores, and the fact that she had won acclaim as an actress with the NYU theater group. He said it was all indicative of her commitment to her goal of becoming a doctor and to the adjustment she had achieved to everyday life despite her history. He also told her that he would be strongly recommending her for admittance to the class of 2011.

After the psychiatric interview, Pia had been ecstatically hopeful that she would be accepted. But months later she found out that it had not been enough to convince the admissions committee. There had been a number of people who’d apparently demurred, thinking it was too big a risk despite the psychiatrist’s recommendation. It took an unexpected last-ditch intervention by two people to carry the day. First, the mother superior offered to become involved and sent a flurry of carefully worded, beautifully argued, and persuasive e-mails. And the second person was Dr. Rothman, who, at the time, was sitting on the admissions committee for an obligatory three-year term. Pia found out about this surprising twist of events only years later, after working with Rothman during her third-year elective. He’d brought it up suddenly at one of their typically uncomfortable meetings. He admitted to her something that he said no one else knew: that he too had suffered through the New York State foster care system because he had been a difficult, hyperactive child. He said a diagnosis was not made until he was an adult, when he himself recognized he had Asperger’s syndrome. Pia had been stunned and was still stunned. Respecting his confidence, she had told no one about the revelation.

“The last time you made a formal appointment to see me,” the mother superior continued, “you had sad news for us here at the convent, saying you had decided against joining us by becoming a novitiate. My intuition tells me that you are here today for similar reasons. I hope that is not the case. We love you here at the convent and are very proud of you and your accomplishments.”

Pia looked up briefly to engage the mother superior’s unblinking stare, but she couldn’t maintain it. Almost immediately she looked away, finding herself staring at the crucifix on the wall over the woman’s shoulder, thinking of pain, sacrifice, and betrayal. Pia took a fortifying breath. As usual the mother superior was miles ahead of her, seemingly sensing what was coming. “I’m starting another month of research in Dr. Rothman’s laboratory.”