Thomas McGuane - Driving on the Rim

Aren’t there things that your parents should tell you? After my mother’s death, I had found her reading glasses. I’d sat down on our old sofa in front of the window, with its view of a stunted row of odorless rugosa roses, still knowing, after all those years, which part I could sit on without feeling the springs. I put my mother’s glasses on. The earpieces were too short for me, and I had to press them down on my nose uncomfortably. It didn’t matter: I could barely see through them.

I only felt that something quite terrible had happened to me. My first instinct was flight: I would just leave town, leave the area, try to leave myself; but that soon struck me as irrational and no more than a conversion of this terrible feeling into weakness that would open up into something worse. And something happened that was quite meaningless, however unsettling: driving home from the hospital, I saw children standing alongside the road holding tombstones; at closer range the tombstones turned out to be skateboards, but the first impression endured.

The death of Tessa gave rise to some misunderstandings in town, and at first the doctors stood by me. But we began having trouble with our board of directors, and the clinic went half speed as a kind of protest or strike. Raymond Wilmot was now chairman of the board.

But I wanted to work. I had to work. It was the only balm I had for the several kinds of mental pain that had beset me. I may have taken the whole thing too seriously. I had a classmate at medical school who was now marketing a homeopathic cure for jet lag; when I saw him at our reunion and asked if it actually worked, he said blandly, “There’s no fucking way.” He pointed out another classmate who had invented a universal stool softener. “He’s making a fortune.” It seemed that believing we were surrounded by people who enjoyed being fooled is what united all Americans. I had begun in the emergency room. Trauma was different: we knew exactly what to blame, and the literal qualities of the obvious thing that caused the injury was but a poor object to resent. The beauty of trauma lay in its peculiarly genuine qualities.

We kept having meetings, most among ourselves, and sometimes with the board, an altogether tiresome exercise, since the board really didn’t understand what we did and seemed to regard doctors as a necessary evil. Wilmot preached fiscal responsibility and local control. He saluted himself for “giving back to the community” which had been so good to him by taking it in the shorts on every Wilmot transaction. He never failed to thwart us on equipment and facility enhancements and would blow up if challenged. Any doctor raising questions about the finances of the clinic was urged to stick to his knitting. We also had an obsequious clinic manager, Darryl Coutts, a native of Tennessee whose genial Southern ways masked his spineless inability to grasp the essentials of the job. We ignored him too.

It seemed that we had barely recovered from one of Wilmot’s board meeting pep talks when it was time for another, with fresh rants about “emerging challenges” and “opportunities for greatness.” It didn’t help that Alan Hirsch made a cylinder with his right hand and raised and lowered it over his crotch while rolling his eyes. If the roof leaked, Wilmot assured us that a “capital infusion” was on the horizon and that our only obligation was to close ranks and provide better care for our patients. Hirsch whispered to me, “An absolute dribbling fuckwit.” As Wilmot was looking my way, I nodded gravely, hoping to give the appearance of having just absorbed some insight supportive of his bottomless inanities. “He loves you,” whispered Hirsch.

“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.”