one thing, your timing couldn’t be worse. I’ve spent most of the day in meetings, listening to reasons why Compassionate Medical Systems is the only answer.”
“You don’t believe that.”
“I don’t not believe it. CMS has an excellent reputation,” he said, hearing the hollowness in his voice. “And, frankly, the peninsula needs an infusion of cash. We need more doctors, a new hospital, new equipment. That’s never going to happen the way things are now.”
Sarah began picking at the knees of her jeans again. Moments passed. “You’re not thinking of selling out yourself, are you?”
“It’s not selling out, Sarah,” he said, his voice sharper than he intended. “The bottom line is providing quality care. Olympic can’t do that under the existing structure. The money isn’t there.”
“Wait.” She cupped her hand to her ear. “That sounded suspiciously like an affirmative.” “I haven’t decided yet.” In Sarah’s world, he was remembering now, there were no shades of gray. Black or white. Good or bad. Right or wrong. Fair or unfair. Remembering too the impossibly high standards she expected, from others as much as from herself. There was Sarah’s way of doing things and there was the wrong way. “Just once,” he remembered shouting, after they’d argued about some high-school project they were working on together, “I want to hear you say that something is good enough, that it doesn’t need fine-tuning.”
“I know something about Compassionate Medical Systems,” Sarah said. “When I first left the peninsula, I made the mistake of going to work in one of their hospitals in Seattle. Ted had a similar experience. We both realized it would never work for us. That’s when we decided to go to Central America. I mean, these companies answer to stockholders. I won’t work in an environment where the real focus is money, not patients. Bottom line, money’s going to dictate which doctor you see, how many tests can be run, what medicine you should take. Patients wait months for appointments that used to take days—”
“I can’t decide whether it’s the Frugal burger or this discussion,” Matthew said, “but I’m getting a headache.”
“Sorry.” She stretched her legs out, wriggled her toes in her beat-up sneakers. “I get up on my soapbox and there’s no stopping me.”
“I noticed.”
“Well—” she wrapped her arms around herself “—it’s getting cold. I should probably get going.”
But neither of them moved. Out on the horizon a few stripes of pink cut through the indigo sky. “Things change, Sarah,” he finally said. “Sometimes that’s a good thing, sometimes it’s not so good. But it’s reality. The way things are now, I go to work. Get home, sometimes not till one in the morning. Sleep the night, if I’m lucky. If not, I get a call from the E.R. because they can’t locate the doctor who’s supposed to be on call. I end up spending time on call that I’d rather spend with my daughter—”
“But I don’t understand. You’re chief of staff. Why would they page you?”
He laughed. “We have a chronic physician shortage. No new people coming in, old ones dying off. Right after you left, the mill closed, so one huge source of employment shut down and, well, you know the peninsula. There weren’t that many jobs to begin with. A good percentage of my patients who’d worked at the mill lost their insurance, but I still see them. They’d pay if they had the money, but there are no jobs. All of that makes it harder to attract new physicians.” He picked up a pebble and tossed it into the dark water. “So if it seems like selling out to you, I’m sorry. Idealism is fine, but I also have to make a living.”
After that, they fell into silence again. Sarah, hunched into her windbreaker, her hair hiding her face. The mood had shifted, and he didn’t know what to do about it.
“Aw, come on,” he said, “it’s not that bad.” The sun had dissolved, turning the sky shades of pink and vermillion against the navy sea. “You don’t get views like this everywhere.”
THE FOLLOWING DAY, Rose stopped by the apartment and, as they were having coffee, announced she was selling the practice. “I was waiting for the right moment, but I didn’t want you to hear about it from someone else.” Sarah stared at her. “You’re not serious.”
“Yes, I am.”
“You’re retiring?”
“Compassionate Medical Systems is buying me out. For a very good price, I might add. And take that horrified look off your face.”
“I’m shocked.”
Rose took a deep breath. “Welcome to the real world. The handwriting is on the wall. Sure, I can hold on for a few more years, but it’s like those mom-and-pop stores—like McGregor’s. I remember when I used to do most of my grocery shopping there and I still drop in to pick up milk or something I’ve run out of, but that’s mostly out of loyalty. When I need a lot of groceries I go to Albertsons or Safeway. Everyone does, it’s a fact of life.”
Her hands suddenly icy, Sarah wrapped them around her coffee mug. Rose was going on about managed care being the wave of the future and encouraging her to apply to Compassionate Medical Systems. Sarah flashed back to the time as a kid when she’d saved her allowance to buy her mom a Norman Rockwell print: a country doctor’s office, the small boy baring his bum for the kindly old doctor’s injection.
She could still see Rose’s bemused expression as she unwrapped the gift. Years later, she’d understood. Too sentimental. Generations of Benedicts might have practiced medicine out of the same family home, but they’d never been a Norman Rockwell family. And now that the money was right, Rose was casually parting with tradition. Selling out.
“Sarah, I know this is a disappointment,” Rose said, apparently reading her expression, “but it’s honestly the only way to go. It’s getting harder and harder to make a living this way. More uninsured patients.”
“Someone has to take care of them.”
“Someone also has to make a living,” Rose said. “And if you think I’m being hardhearted, talk to Matthew—”
“I already have.”
“Uh-oh.” Rose’s mouth twisted. “And?”
“Take a wild guess.”
“Didn’t I try to tell you?”
After Rose left, Sarah stood in the kitchen, staring out at the gulls and the tankers on the water and the wind-tossed trees. Things did not look promising.
On the wall of her clinic in Central America, she’d tacked up a pain-assessment chart with six cartoonlike faces whose expressions ranged from happy and smiling to great discomfort and unbearable pain. Small kids couldn’t read the captions underneath—annoying, nagging, miserable, horrible, excruciating and so forth—but they knew that a furrowed brow, down-turned mouth and falling tears weren’t good things.
She’d stuck the chart on the refrigerator. Right now, she was definitely among the scowls and grimaces group. Coming back to Port Hamilton was supposed to be like completing a circle. A return to the place where she’d been the happiest, an opportunity to practice medicine with a doctor she admired for his ideals and who was also her best friend.
So
