Robin Cook: Crisis

Over the previous year, Craig had become committed to – even obsessed with – transforming himself into a more interesting, hap-pier, well-rounded, better person and, because of it, a better doctor. On the desk of his in-town apartment was a pile of catalogues from various local universities, including Harvard. He intended to take classes in humanities: maybe one or two a semester to make up for lost time. And best of all, thanks to his makeover, he'd been able to return to his beloved research, which had completely fallen by the wayside once he'd started practice. What had started out in medical school as a remunerative job doing scut work for a professor studying sodium channels in muscle and nerve cells had turned into a passion when he was elevated to the level of a fellow researcher. Craig had even co-authored several scientific papers to great acclaim while he'd been a medical student and then resident. Now he was back at the bench, able to spend two afternoons a week in the lab, and he loved it. Leona called him a Renaissance man, and although he knew the description was premature, he thought that with a couple of years of effort, he might come close.

The origin of Craig's metamorphosis had been rather sudden and had taken him by complete surprise. Just over a year previously, and quite serendipitously, his professional life and practice had changed dramatically with the double benefit of significantly raising his income as well as his job satisfaction. All at once it had become possible for him truly to practice the kind of medicine he'd learned in medical school, where patients' needs eclipsed the arcane rules of their insurance coverage. Suddenly, Craig could spend an hour with someone if the patient's situation required it. Appropriately, it had become his decision. In one fell swoop, he'd been freed of the dual scourge of falling reimbursements and rising costs that had forced him to squeeze more and more patients into his busy day. To get paid, he no longer had to fight with insurance personnel who were often medically ignorant. He'd even started making house calls when it was in the patient's best interest, an action that had been unthinkable in his former life.

The change had been a dream come true. When the offer had unexpectedly come over the transom, he'd told his would-be benefactor and now partner that he'd have to think about it. How could he have been so stupid not to agree on the spot? What if he had missed the opportunity to grab the brass ring? Everything was better, save for the family problem, but the root of that issue was how submerged he'd been from day one in his former professional situation. Ultimately, it had been his fault, which he freely admitted. He had let the exigencies of current medical practice dictate and limit his life. But now he certainly wasn't drowning, so maybe the family difficulties could be resolved in the future, given enough time. Maybe Alexis could be convinced how much better all their lives could be. Meanwhile, he resolved to enjoy bettering himself. For the first time in his life, Craig had free time and money in the bank.

With an end of the bow tie in each hand, Craig was about to try tying it again when his cell phone rang. His face fell. He glanced at his watch. It was ten after seven. The symphony was to start at eight thirty. His eyes switched to the caller ID. The name was Stanhope.

"Damn!" Craig blurted with emphasis. He flipped open his phone, put it to his ear, and said hello.

"Doctor Bowman!" a refined voice said. "I'm calling about Patience. She's worse. In fact, this time I think she's really sick."

"What seems to be the problem, Jordan?" Craig asked as he turned to glance back into the bathroom. Leona had heard the phone and was looking at him. He mouthed the name Stanhope, and Leona nodded. She knew what that meant, and Craig could tell from her expression that she had the same fear he had – namely, that their evening was now in jeopardy. If they arrived at the symphony too late, they'd have to wait for the intermission to sit down, which meant forgoing the fun and excitement of the entrance, which both had been keenly anticipating.

"I don't know," Jordan said. "She appears unnaturally weak. She doesn't even seem to be able to sit up."

"Besides weakness, what are her symptoms?"

"I think we should call an ambulance and go to the hospital. She's greatly perturbed, and she's got me concerned."

" Jordan, if you are concerned, then I am, too," Craig said soothingly. "What are her symptoms? I mean, I was just there at your home this morning dealing with her usual medley of complaints. Is it something different or what?" Patience Stanhope was one of less than a half-dozen patients that Craig labeled "problem patients," but she was the worst of the group. Every doctor had had them, in every kind of practice, and found them tedious at best and maddening at worst. They were the patients who persisted day in and day out with a litany of complaints that were, for the most part, completely psychosomatic or totally phantom and that could rarely be helped by any therapy, including alternative medicine. Craig had tried everything with such patients, to no avail. They were generally depressed, demanding, frustrating, and time-consuming, and now with the Internet, quite creative with their professed symptoms and desire for lengthy conversations and hand-holding. In his previous practice, after ascertaining their hypochondriasis beyond a reasonable doubt, Craig would arrange to see them as infrequently as possible, mostly by shunting them off to the nurse practitioner or to the nurse or, rarely, to a subspecialist if he could get them to go, particularly to see a psychiatrist. But in Craig's current practice setup, he was limited in his ability to resort to such ruses, meaning the "problem patients" were the only bugbears of his new practice. Representing only three percent of his patient base, as reported by the accountant, they consumed more than fifteen percent of his time. Patience was the prime example. He had been seeing her at least once a week over the last eight months and, more often than not, in the evening or at night.

As Craig frequently quipped to his staff, she was trying his patience. The comment never failed to get a laugh.

"This is far different," Jordan said. "It's entirely dissimilar to her complaints last evening and morning."

"How so?" Craig asked. "Can you give me some specifics?" He wanted to be as certain as possible about what was going on with Patience, forcing himself to remember that hypochondriacs occasionally actually got sick. The problem with dealing with such patients was that they lowered one's index of suspicion. It was like the allegory of the shepherd boy crying wolf.