F. Wilson - The Select

"Did you get mugged or something?" Quinn said, looking him up and down.

He smiled and thought: In a way, yes.

He'd stayed up all night playing five-card stud. The other players had been stand-offish at first—because of his youth, Tim assumed—but after they'd seen he could play, they'd warmed to him. Even started buying him drinks after a while. Jack Daniel's. Many Jack Daniel's.

Good ol' Tim. C'mon back anytime.

They loved him. Why not? He'd dropped a couple of hundred.

Poker. Not his game.

"No. Just not enough sleep."

"Well, come on. You're late, and Dr. Alston will cut you up into little pieces."

"You go on ahead. I'm going to sit in the back. Way in the back."

He watched her cute butt hurry off and followed at a slower pace.

Dr. Alston's Medical Ethics: the semester's only non-regurgitant course. It was scheduled for only one hour a week but that hour fell at 7:00 a.m. on Wednesday mornings. Some days it was hell getting there, and today was pure murder, but Tim had never missed it; not simply because attendance was required and strictly monitored, but because the class actually was stimulating.

I could use some stimulating now, he thought as he slipped into the last row and took a seat in a shadowed corner.

Dr. Alston seemed to take delight in being provocative and controversial. His manner was brusque, witty, acerbic, and coolly intellectual, as if he were contending for the title of the William F. Buckley of the medical world.

Tim vividly remembered the first lecture a couple of weeks ago...

"Most medical schools don't offer this course," Dr. Alston had said on that first morning. He'd looked wolfishly lean in his dark business suit and one of his trademark string ties. The overhead lights gleamed off his pale scalp. His movements were quick, sharp, as if his morning coffee had been too strong. "I guess they expect you to become ethical physicians by osmosis—or pinocytosis, perhaps. And a few schools may offer something called Medical Ethics, but I assure you it's nothing like my course. Their courses are dull."

Amid polite laughter he'd stepped off the dais and pointed at one of the students.

"Mr. Kahl. Consider, if you will: You have a donor kidney and three potential recipients with perfect matches. Who gets the kidney?"

Kahl swallowed hard. "I...I don't have enough information to say."

"Correct. So let's say we've got a nine-year-old girl, a 35 year-old ironworker with a family, a 47 year-old homeless woman, and a 62 year-old CEO of a large corporation—who, by the way, is willing to pay six figures for the transplant." He pointed toward the rear of the room. "Who would you give the kidney to, Mr. Coyle?"

"The little girl."

"She has no money, you know."

"Money shouldn't matter. I wouldn't care if the CEO was willing to pay seven figures for the kidney."

"We wouldn't be indulging in a bit of reverse discrimination against a rich, older man over an indigent child, would we, Mr. Coye?" He turned to another student. "How about you, Mr. Greely? Think carefully and unemotionally before you answer."

Tim was impressed. This was Dr. Alston's first lecture to the class and already he seemed to know every student by name.

"I believe I'd also give it to the little girl," Greely said.

"Really? Why?"

"Because she's got the most years ahead of her."

"Years to do what? You don't know what she'll do with her life. Maybe she'll perfect cold fusion, maybe she'll die at eighteen with a needle in her arm. Meanwhile you tell the homeless woman, the ironworker, and the CEO to go scratch?"

He turned toward the second row. "Who would you choose, Miss Cleary?"

Tim leaned forward when he realized Quinn was on the spot. He saw her cheeks begin to redden. She wasn't ready for this. No one was.

"The ironworker," she said in that clear voice of hers.

"And why is that?"

"Because he's got a family to support. Other people are depending on him. And he's got a lot of productive years ahead of him."

"What about the CEO? He's very productive."

She paused, then: "Yes, but maybe he'll get twenty years out of the kidney. The ironworker might get twice that."

"Perhaps, perhaps not. But the CEO's present position places him in charge of the livelihoods of thousands of workers. Without his management expertise, his corporation could go under."

Quinn obviously hadn't thought of that, but she didn't seem ready to back down. Tim decided to buy her some time.

"Are doctors supposed to be playing God like this?" he called out.

Dr. Alston looked up and pointed at him. He didn't seem annoyed that Tim had spoken without being recognized.

"An excellent question, Mr. Brown. But 'playing God' is a loaded phrase, don't you think? It implies an endless bounty being dolled out to some and withheld from others. That is not the case here. We are dealing with meager resources. There are barely enough donor organs available at any one time to fulfill the needs of one tenth of the registered recipients. No, Mr. Brown, we are hardly playing God. It rather seems more like we are sweeping up after Him."

He returned to the dais and surveyed the class for a moment before speaking again. Tim found Dr. Alston a bit too pompous but the subject was fascinating.

"In an ideal world," Dr. Alston said, "there would be a donated organ waiting for every person who needed one, there would be a dialysis machine for every chronic renal failure patient who was a difficult match, bypass surgery for every clogged coronary artery, endarterectomy for every stenotic carotid, total replacement surgery for every severely arthritic hip and knee...I could go on all morning. The sad, grim truth is that there isn't. And there never will be. And what is even grimmer is the increasing gap between the demand for these high-tech, high-ticket, state-of-the-art procedures and society's ability to supply them.

"Consider: there are now around thirty million people over age 65 on Medicare. In the year 2011, when you are in the prime of your practice years, the first baby boomers will hit Medicare age. By the year 2030 they will swell the Medicare ranks to 65 million. That is nothing compared to what will be going on outside our borders where the world population will have reached ten billion people."

Dr. Alston paused to let his words sink in and Tim struggled to comprehend that figure. Ten billion people—almost twice the planet's present population. Who the hell was going to care for all of them?

As if reading his mind, Dr. Alston continued.

"Don't bother cudgeling your brains to figure out how to care for the world's population when you'll be hard-pressed enough satisfying the demands of the geriatric baby boomers. And believe me, those demands will be considerable. They will have spent their lives receiving the best medical care in the world and they will expect to go on receiving it."

" Is it the best?" a voice challenged from the rear.

"Yes, Mr. Finlay. It is the best. You can quibble about delivery, but when those who can afford to go anywhere in the world need state-of-the-art treatment, where do they come? They come to America. When foreign medical graduates want the top residencies and post-graduate training, where do they apply? To their own country's medical centers? No. They apply here. The U.S. can't handle more than a fraction of the foreign doctors who want to take residencies here. Conversely, how many U.S. medical school graduates do you hear of matriculating to Bombay, or Kiev, or even Brussels, Stockholm, Paris, or London? Have you heard of one? At the risk of sounding chauvinistic, this is where the cutting edge of medicine gets honed."

Tim felt a guilty surge of pride. If the U.S. had the best, then certainly he was enrolled in the best of the best. He made a little promise to himself to put what he learned at The Ingraham to good use.