The Baby Doctors

He waited a moment. “And?”

“I have a plan.”

Matthew grinned. “You’ve always had a plan.”

“This is different. This is a grown-up plan. A huge plan. And it involves you.”

As Matthew dug around in the paper sack for more fries, he felt the shift in her mood. Whatever Sarah’s huge plan turned out to be, he wasn’t in the right frame of mind to hear it. Her presence had been a welcome distraction from the looming Compassionate Medical Systems crisis, and he felt a reluctance to be drawn into more serious discussion. He also knew that Sarah in full-steam-ahead mode could be nigh on impossible to stop.

She shot him a glance. “You want to hear it?”

“Do I have a choice?”

“You sound tired, Matthew.”

“I am.”

“Work?”

“Essentially.” In the gathering darkness, he saw the glimmer of a smile flicker across Sarah’s face. “Don’t tell me, your plan is the solution.”

“It could be.”

He gave in to the inevitable. “Tell me.”

“Okay.” She drew in a breath. “Remember when you first started medical school, you used to talk about the kind of medical practice you wanted to have? Not just treating disease and patients who were already sick, but patient-centered care that promoted wellness with traditional healing arts, home mind-body therapy—”

Matthew groaned.

“What?”

“Tell me I was never that hopelessly naive.”

Sarah turned to face him. Eyes gleaming, body tensed, she seemed a cat poised to pounce. He braced himself.

“Matthew,” she said, “listen to me. There’s nothing naive about that. It’s exactly what I want to do. What I want us both to do. An integrated approach that doesn’t abandon mainstream medicine. I mean, kids are still going to break bones or need surgery…”

Presumably where he came in, he thought, as he listened to her describe the practice they would set up together along with herbalists, hypnotherpists and an assortment of other practitioners.

“Ted used to talk about establishing that kind of practice,” she said. “And when he died, I thought that his dream died with him, but then—” her voice softened “—it was the strangest thing. I was going through a box of old letters that you had sent me when you were in med school and I found this one that almost spelled out word for word the same thing Ted and I were planning to do. That’s when I knew I had to come back.”

Matthew looked out at the water. The ferry from Victoria appeared on the horizon, its lights punctuating the darkness. “Sarah, I don’t know how to say this—”

“Please don’t tell me it won’t work, because—”

“I wasn’t going to say it won’t work. I think it could. I appreciate the fact that medicine is changing. I don’t believe one school of thought offers all the answers. It’s just not going to work for me.”

Sarah took a deep breath. “Why not?”

“For one thing, your timing couldn’t be worse. I’ve spent most of the day in meetings, listening to reasons why Compassionate Medical Systems is the only answer.”

“You don’t believe that.”

“I don’t not believe it. CMS has an excellent reputation,” he said, hearing the hollowness in his voice. “And, frankly, the peninsula needs an infusion of cash. We need more doctors, a new hospital, new equipment. That’s never going to happen the way things are now.”

Sarah began picking at the knees of her jeans again. Moments passed. “You’re not thinking of selling out yourself, are you?”

“It’s not selling out, Sarah,” he said, his voice sharper than he intended. “The bottom line is providing quality care. Olympic can’t do that under the existing structure. The money isn’t there.”

“Wait.” She cupped her hand to her ear. “That sounded suspiciously like an affirmative.” “I haven’t decided yet.” In Sarah’s world, he was remembering now, there were no shades of gray. Black or white. Good or bad. Right or wrong. Fair or unfair. Remembering too the impossibly high standards she expected, from others as much as from herself. There was Sarah’s way of doing things and there was the wrong way. “Just once,” he remembered shouting, after they’d argued about some high-school project they were working on together, “I want to hear you say that something is good enough, that it doesn’t need fine-tuning.”

“I know something about Compassionate Medical Systems,” Sarah said. “When I first left the peninsula, I made the mistake of going to work in one of their hospitals in Seattle. Ted had a similar experience. We both realized it would never work for us. That’s when we decided to go to Central America. I mean, these companies answer to stockholders. I won’t work in an environment where the real focus is money, not patients. Bottom line, money’s going to dictate which doctor you see, how many tests can be run, what medicine you should take. Patients wait months for appointments that used to take days—”

“I can’t decide whether it’s the Frugal burger or this discussion,” Matthew said, “but I’m getting a headache.”

“Sorry.” She stretched her legs out, wriggled her toes in her beat-up sneakers. “I get up on my soapbox and there’s no stopping me.”

“I noticed.”

“Well—” she wrapped her arms around herself “—it’s getting cold. I should probably get going.”

But neither of them moved. Out on the horizon a few stripes of pink cut through the indigo sky. “Things change, Sarah,” he finally said. “Sometimes that’s a good thing, sometimes it’s not so good. But it’s reality. The way things are now, I go to work. Get home, sometimes not till one in the morning. Sleep the night, if I’m lucky. If not, I get a call from the E.R. because they can’t locate the doctor who’s supposed to be on call. I end up spending time on call that I’d rather spend with my daughter—”

“But I don’t understand. You’re chief of staff. Why would they page you?”

He laughed. “We have a chronic physician shortage. No new people coming in, old ones dying off. Right after you left, the mill closed, so one huge source of employment shut down and, well, you know the peninsula. There weren’t that many jobs to begin with. A good percentage of my patients who’d worked at the mill lost their insurance, but I still see them. They’d pay if they had the money, but there are no jobs. All of that makes it harder to attract new physicians.” He picked up a pebble and tossed it into the dark water. “So if it seems like selling out to you, I’m sorry. Idealism is fine, but I also have to make a living.”

After that, they fell into silence again. Sarah, hunched into her windbreaker, her hair hiding her face. The mood had shifted, and he didn’t know what to do about it.

“Aw, come on,” he said, “it’s not that bad.” The sun had dissolved, turning the sky shades of pink and vermillion against the navy sea. “You don’t get views like this everywhere.”

THE FOLLOWING DAY, Rose stopped by the apartment and, as they were having coffee, announced she was selling the practice. “I was waiting for the right moment, but I didn’t want you to hear about it from someone else.” Sarah stared at her. “You’re not serious.”

“Yes, I am.”

“You’re retiring?”

“Compassionate Medical Systems is buying me out. For a very good price, I might add. And take that horrified look off your face.”

“I’m shocked.”

Rose took a deep breath. “Welcome to the real world. The handwriting is on the wall. Sure, I can hold on for a few more years, but it’s like those mom-and-pop stores—like McGregor’s. I remember when I used to do most of my grocery shopping there and I still drop in to pick up milk or something I’ve run out of, but that’s mostly out of loyalty. When I need a lot of groceries I go to Albertsons or Safeway. Everyone does, it’s a fact of life.”

Her hands suddenly icy, Sarah wrapped them around her coffee mug. Rose was going on about managed care being the wave of the future and encouraging her to apply to Compassionate Medical Systems. Sarah flashed back to the time as a kid when she’d saved her allowance to buy her mom a Norman Rockwell print: a country doctor’s office, the small boy baring his bum for the kindly old doctor’s injection.

She could still see Rose’s bemused expression as she unwrapped the gift. Years later, she’d understood. Too sentimental. Generations of Benedicts might have practiced medicine out of the same family home, but they’d never been a Norman Rockwell family. And now that the money was right, Rose was casually parting with tradition. Selling out.

“Sarah, I know this is a disappointment,” Rose said, apparently reading her expression, “but it’s honestly the only way to go. It’s getting harder and harder to make a living this way. More uninsured patients.”