La Clínica: A Doctor's Journey Across Borders

Chapter Twenty-two

 I HAD NIgHTMARES ABoUT My HoUSE: IT HAD BEEN BoUgHT by the television newsman and converted to a studio with actors and actresses. I woke up in the dark wondering where I was. At 2:30 a.m., the night still stretched far ahead, and I had to confront it all alone. By morning, I was happy to go to work just to be able to get out of the house. Ihadafulldayofevaluationswithfacultyscheduled,andIexpected them to keep my mind focused. Each hour another faculty member knocked on my door and tentatively took a seat. It surprised me sometimes to think that these adults in their thirties, forties, and fifties could act like schoolchildren about to receive their report cards. They would dwell on every word, look for hidden meanings, argue about a criticism, cry, become angry, have tears of joy, or sigh with relief at the end. Rick was my last appointment of the day. I told him some of the criticisms from the nurses and what he needed to do to change their opinions. Even after all the years, the reversal of authority from our previous relationship, when he was the resident and I was the intern, still felt awkward. “I’ll meet with them,” he said. “I don’t like to get bad grades.” “It’s not exactly a bad grade. you’re a wonderful researcher and a great teacher, but this is an opportunity for improvement. Maybe we need to do a better job of aligning incentives.” “Sounds like you’ve been reading those management books,” he said. “you’ve got the lingo down.” chapter twenty-two  • david p. sklar Rick walked over to the window of my office and looked across the street to the drab, brown buildings that made up the undergraduate campus. “you can look right into the dormitories,” he said. “The girls’ dormitory.” “No, you can’t,” I said. “Anyway, that building is the dining hall.” “yeh—huh,” Rick hooted. “I really got you with that one. your face turned red.” “I’ve got to get back to work,” I said. “you know, all this work you do—all the memos, all the meetings, all of the letters to unhappy patients who complain about waiting too long, all the e-mails to hospital administrators about why we aren’t collecting enough money or why we should have more nurses or why someone died in the waiting room after sitting for eight hours—everyone will forget that you did that stuff the day after you leave. And a few days later, they’ll forget you were even chairman, and a few days after that, they’ll forget you were even here. They will say, ‘oh yeah, that was when that other guy—what was his name?—was chairman.’ I’ve watched what happens when people leave. It’s like they bring in a fresh coat of paint, and nothing’s left from before.” “Well, at least the patients will remember. And the residents; they’ll remember we were here.” “Hell, our patients can’t even remember to take their medicines. Do you think they will remember you?” “Well, the ones we take care of over the years. They’ll remember.” “So you’ve entrusted your place in history to the memory of our chronic seizure patients, the drunks, and the sicklers. To Clayton Jones, Mary Joe, and Pedro Nieto. None of them will be around very long. If those are your historians, you might as well make it all up. The only way people remember you is if you are a mass murderer. No, nothing that any of us has done in the ER will matter to anyone after we leave this place.” “Well, it will matter to me,” I said. “oK, when you and I retire we’ll sit down with a few glasses of beer, and then we’ll see how much it will all matter to either of us,” he said. “Rick, I never realized you were such a cynic,” I said. “I’m a realist. I know what motivates people. It’s money, sex, and power—not necessarily in that order. Doing good things is not even  la clínica • on the list except maybe for priests, and we know that for them, young boysarealothigheronthelist.Iwouldnevertrustado-gooder,because I’d know that his true intentions and motivations were hidden.” “So what motivates you?” I asked. “Well, these days, breaking...