To the hospital—that unforgiving shrine of secular desperation! When he’d first come to St. Dymphna’s, the megalith had towered over Carnegie Hill like an ocean liner flung ashore, its rounded stone façade impregnable as the great vessels of yore. Now the patchwork of extensions and annexes that connected the “Old Hospital” to the germinating laboratories and conference centers and specialty suites along its periphery recalled a Rube Goldberg contraption. The institution’s mission had evolved too—all the talk of “service” and “duty” gone the way of Blakemore tubes, and of Harrington rods, and of the hospital’s two dozen iron lungs, their carcasses now beached like sea mammals in the subcellar. Where his bosses had once been content to mend the local community, a respectable mix of wealthy Upper East Siders and the urban poor in the housing projects north of 96th Street, now the focus was on recruiting, publicizing, promoting. Patients had become clients, customers—as though the hospital were running a discount car wash or a branch bank. Millard had read somewhere that Cadillac-style benefits for retired auto workers had transformed General Motors into an enormous healthcare insurer that happened to produce cars; well, St. Dymphna’s had become a colossal marketing firm that happened to treat sick people—or so it seemed, at least, each time he walked under the titanic banner reading, YOU GET BETTER BECAUSE WE ARE BETTER. What-ever, as his daughter Maia was always saying. We bring good things to life, he thought. See the USA in your Chevrolet You can be sure . . . if it’s Westinghouse. They might as well hire Dinah Shore and Betty Furness to do the ads—although he was confident his current bosses wouldn’t recognize their names. What-ever Not—as Maia said—our problem. He ducked through the hospital garden, its transepts abloom in heliotrope, and took the back stairs past the chapel. The Gothic clock above the oratory already read 8:15: St. Dymphna’s, a beast that roused with the dawn, growled and flailed in its madness.
Entering the hospital at that late hour, passing beneath the gargoyle-crested arch, DISPENSARY engraved in the sandstone, Millard always felt a tad sheepish, like a theatergoer slinking into his seat during the second act of a play. On the medical floors, the overnight residents had long since signed out their patients to the battle-ready interns. In the operating rooms, orthopedists were closing their second cases of the day. “Walking to work this morning,” he joked when he taught the fourth-year medical students, as part of his recruitment pitch for psychiatry, “I ran into surgeons going out to lunch.” As a consult psychiatrist, providing mental health services to the physically ill, Millard savored the best of both worlds—part of the lifeblood of the institution, yet still able to hit the snooze button on his clock radio with impunity. How Hal Storch had handled all those years as a classical analyst, exploring the perceived childhood slights of commodities brokers and sporadically filling Ativan prescriptions for overwrought housewives, mystified him. Of course, Hal’s perch on Park Avenue had sheltered him from the relentless and obdurate injustices of human suffering.
The consult team convened at 8:30 in the patient lounge opposite the Eating Disorders Unit. A paper sign taped to the door read “Reserved 8:30 am–9:30 am”—but that didn’t keep squatters (patients’ relatives, canoodling nursing aides) from fighting Millard’s crew for its territory. The vending machines hummed through their meetings, and occasionally a janitor or orderly on break sauntered in to buy a bag of chips. Over the years, the space had also become a repository for the portraits of less-distinguished former department chairmen: Norm Schumaker, who’d lost his license for sleeping with a patient; Clyde Terwilliger, escorted off the premises by security officers after allegations of embezzlement; dour, pipe-wielding David Atkinson, a man known for “letting heads roll first and then asking questions.” All white, all about sixty with the same Harvard clip; all dead as Napoleon’s undertaker. Over the years, Millard had called each of these men a friend—in the era before he realized that the boss, no matter how amiable, is never your friend. Back then, the consult team had met in the board- room.
Millard’s minions arrived, bedraggled and bleary, between 8:35 and 8:40: Stan Laguna, lapels stained, cuffs frayed, shoes scuffed—a first-rate clinical mind in the attire of a billing clerk; hypomanic, flamboyant Sameer Patel; Gabby Lu, his former fellow, lordotic with her third pregnancy. Not a single Harvard clip among them. And then there were the new residents, Greek, Liberian, a polychromatic stew of genius and timidity. Third-year med students too, in their pristine, truncated white coats, Snellen vision charts protruding from their overstuffed pockets, reflex hammers gleaming. (When he’d first arrived at St. Dymphna’s, the senior fellows had worn short coats, a hierarchical sign of their medical immaturity.) Laguna handed Millard a cup of tepid coffee from the cart on 98th Street. One cream. Two sugars. His team was loyal, and gifted, if somewhat tatterdemalion. While they assembled, Lu passed around a cell-phone video of her son toddling his first steps.
“Good morning,” said Millard. “Anything exciting happen over the weekend?”
“Define exciting,” quipped Laguna.
The gaunt bulrush of a resident who’d covered the service on Saturday and Sunday—a Dutchman named Kip—produced his rumpled sign-out list. “Yes, Dr. Salter,” he said. Stiff, deferential. “That patient on 9-East who we diagnosed with hysterical blindness. It turns out she’s actually blind. Ophthalmology reassessed her. Anton’s syndrome.”
“Score one against our malpractice insurer,” said Laguna.
“And Mr. Cappabucci has filed a formal complaint against us with the Office of Mental Health. He says he told you he felt suicidal and that you treated him like a joke and threw him out of the hospital . . . .”
Jack Cappabucci was a celebrated malingerer. Six hundred psychiatric admissions across the nation—in forty-two different states—and no mental illness. He’d feigned a schizophrenic break during his third week in the army to obtain disability benefits, which he’d been collecting since 1973; even the local VA hospital had banished him from its inpatient unit. The man owned a three-bedroom apartment on 79th Street and came to the ER during the weeks that he was able to rent it to tourists.
“Mr. Cappabucci is a joke,” said Millard. “Tell me, after I threw him out of the hospital, did he kill himself?”
“No, Dr. Salter. He told OMH he would have, but he felt a moral obligation toward other suicidal patients to stay alive until his complaint was reviewed . . . .”
Impostors like Cappabucci had once been a rarity, but now the hospital seemed to swarm with men and women faking illness. Defendants avoiding court dates. Deadbeat parents hiding from child support payments. Dope fiends escaping drug deals gone wrong. A teeming multitude of refugees from responsibility—from decency. Most on the bottom rungs of the socioeconomic ladder, but not all: Last month—and this was a first for Millard—a well-known television newscaster had feigned mania, hoping a brief stint in a mental ward might create an alibi for his extramarital affair. As the orange signs along interstate highways announced: Your Tax Dollars at Work. There was an old joke on the service that Republicans were former Democrats who’d worked in a psychiatric emergency room.
“Anything else?” asked Millard.
Kip shook his head and sat down.
“I have one,” said Laguna, glancing up from his phone. “Fresh off the presses . . .”
“We’ve all been fired?” suggested Millard.
“Better. It turns out there’s a baby lynx on the loose. A patient apparently brought an eight-month-old lynx cub with her to the dermatology clinic on Friday and it escaped . . . .”
“You for real?” demanded Patel.
“Urgent message from the president’s office,” continued Laguna. “If said lynx is spotted, please call security immediately.”
“How about if it’s striped?” asked Millard.
Not a single smile. Several of the foreign residents appeared befuddled.
“As I was saying,” said Laguna, “whether the lynx is spotted or striped, you should not attempt to apprehend it on your own.”
“At last! The missing lynx,” said Millard.
Again, nobody laughed.
In his heyday, he had prided himself on his wordplay. Discussing a patient from Bangkok who’d returned to his native country so that his own brother, a surgeon, could perform his coronary bypass, Millard had drawn guffaws from the house staff with his off-the-cuff remark, “Ah, the Thais that bind.” And while visiting Hal Storch at his summer “cottage” up in the Berkshires, when a plumbing van had blocked in the neighbor’s gardening equipment, he’d delighted Storch’s houseguests with “He wanted a snake, but not a mower-constrictor.” Isabelle had adored his puns; she’d never understood why he couldn’t publish them. A best seller, she’d predicted, so proud, if woefully naïve. Delilah enjoyed his wordplay too and even served up a few verbal jousts of her own. But these young doctors responded to his puns as though they were . . . a punishment.
Then there were the as-yet-unused puns, the arsenal of one-liners stockpiled like precision weapons—awaiting their moment of glory. If only someone, possibly his younger daughter, might describe a French novel as “monstrously cheesy,” so that he could remark, “That’s Gorgon-Zola.” Yet that had never happened. And now, with the clock ticking, his pent-up repartee would be lost to humanity forever, like a non-extant Greek tragedy, like the final symphony of Sibelius. Whatever happens, he mused, to a pun deferred?
“That was a joke,” Millard emphasized. He considered making a reference to Katharine Hepburn’s pet leopard in Bringing Up Baby, yet figured this would also fall flat.
“Aren’t they going to shut the place down until they find it?” demanded Lu. “I mean, isn’t this thing a safety hazard?”
“I guess it’s too small to be dangerous,” said Patel. “Or they have no idea where it is. They can’t shut down the entire city over a single lynx.”
“According to the president’s office, lynx cubs have been known to attack human beings when threatened,” interjected Stan Laguna. “An eight-month-old cub can take down an adult white-tailed deer.”
One of the junior residents—the pudgy Greek girl—raised her hand. “What is a lynx?” she asked.
“A big cat,” explained Laguna.
“Big like this,” inquired another foreign resident, spacing her hands as though miming a toaster and then broadening the gap between them. “Or like this?”
“Big like a leopard,” said Laguna. “Big like a tiger.”
“Not that big,” objected Patel.
Soon all semblance of order deteriorated as both men searched for the sizes of various feral felines on their smart-phones. “How do you like that?” observed Patel. “A bobcat is a variety of lynx. Who knew?”
“And now that this episode of Mutual of Omaha’s Wild Kingdom has concluded,” Millard interjected, “Dr. Laguna will assign the new consults.” He stirred his coffee with the back of a plastic spoon. “And don’t forget, I’m off this afternoon. Stan’s the boss while I’m gone.”
Stan would be the boss for good, very shortly. Or, at least, the acting boss; the final decision rested with the chairman. Millard could already picture his junior colleague presiding over their morning conclaves in dungarees and sandals, quizzing the residents on the previous afternoon’s football plays, rehashing the plots of television dramas. But he’d be a benevolent leader, reflective and fair-minded, if a bit too laissez-faire for Millard’s tastes.
“Famous last words,” said Laguna. “As of this afternoon, I will be addressed as ‘His Excellency’ in all official interactions.”
His Excellency Laguna proceeded to assign the day’s cases. Delirium. Dementia. Altered mental states of unknown etiology. Also a heart transplant patient with bipolar disorder, a schizoaffective asthmatic, a woman with myasthenia gravis who feared she’d been betrothed to the devil. Every case claimed its analogue in a previous patient, an endless series of shattered souls trapped inside shattered bodies. Nothing new under the sun. Millard enjoyed his job—especially the opportunity to provide succor, occasionally cure. Yet he would not miss it.
On the way out of the lounge, Millard surveyed the mismatched chairs, the recycling bins in variegated colors. Barring disaster, he would never see this room again. Stan Laguna followed him toward the elevator, an entourage of trainees trailing.
“An afternoon off, Mil?” asked Laguna. “You have a hot date?”
Millard hadn’t taken a vacation day in two years—not since Isabelle’s funeral. Before that, he’d consistently claimed one week in February and three in August. He could count on ten fingers—fewer—his other absences: Arnold’s wedding, Sally’s C-section, an incisor that broke off at the root. He had taken a full day when his father died, another for his brother’s death, an afternoon to attend his mother’s funeral. His aunts had both been interred on the weekends. He’d learned from experience that he more than paid for any time away in spades.
“A date with destiny,” replied Millard.
“Destiny. Sexy name.” Laguna slapped his shoulder. “I hope you get lucky.”