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11 Thinking about my childhood in rural West Texas was not something I had ever really done much of. To begin with, I did not have the type of personality that would lead me to contemplate my navel and ponder introspectively about how my experiences growing up had shaped my grown-up outlook on life. Nor did I have much awareness of, or interest in, my family history. Having consciously decided to leave what had been a distinctly rural upbringing and an early career in school teaching and coaching to pursue a more lucrative calling in hospital administration, I traded the country for the city, country people for city people, and kinfolk for business associates. I traded the underpaid teaching profession for the overpaid medical business—traded the past for the now, and had pretty much stopped thinking about the earlier times. I still stayed in contact with a few friends from the old days, exchanged Christmas cards with them and a scattering of relatives every year, but our communications were short and mostly impersonal, not really actively engaged—just sort of doing what was socially required, but nothing more. Looking back, I can pinpoint almost to the minute when that changed, when my family and its closets that turned out to be full of skeletons began to dominate my life. It was when I answered that telephone call from my secretary, just after two o’clock in the afternoon on the first Tuesday of October. “Son Cable died?” I said. “That can’t be right.” Sitting at my requisite over-sized desk in my office in the executive suites of the West Austin Medical Center, I had been staring mindlessly out across the live oak-covered, rolling hills to the west of Austin. An ugly, contentious meeting with the president of the medical staff and the chief of Obstetrics and Gynecology had just concluded. Anger and resentment still hung in the room like dust particles in a shaft of sunlight. Another crisis was the last thing I needed at that moment,being smack in the middle of a major crisis in my career and a minor mid-life crisis in my personal life. At this stage of my “now” life, I had achieved what I had thought of, up to this point, as pretty solid success, having ascended to the position of chief executive officer of the West Austin Medical Center. However, it had come as something of a shock and disappointment to me that life in the top position was not as much fun or nearly as personally Chapter 3 2:00 PM,Tuesday, October 5, 2004, Austin,Texas 12 satisfying as I had anticipated while on the way up, and—to top it off—this day had turned out to be a particularly unpleasant one. The meeting with the two medical staff leaders had turned decidedly ugly when I told them that I would not support their dream of the women’s health center they wanted to build adjacent to the hospital. For several months the two entrepreneurial medical chiefs had been lobbying to convince me to move women’s services outside the main hospital into a separate, freestanding facility to be owned by physicians, with these two among the largest shareholders.Such a facility would undoubtedly make the physician owners rich, but it would be financially ruinous for the hospital. This clearly did not concern the physicians, who were focused only on their own potential enrichment. “Doctors,” I finally interrupted their arguments. “I understand why you want to do this. If I were in your place I would probably want to do it too, but as the CEO of this hospital I have to protect the interests of the hospital. The center you want to build would be very rewarding for you, but would be devastating to the hospital. I’m sorry, but I can’t support the project, and I will have to strongly oppose it.” At that the two physicians became very angry and very energetic in proclaiming my lack of wisdom and vision.I knew this would not be the end of the debate.The employees of the hospital would regard such a decision by me as a final answer and accept it, but the physicians would not hesitate to take the argument over my head to my superiors, the board of directors, to seek a different answer. In some ways they were probably pleased at being able to take that route, because...

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