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IT WAS EXACTLY SEVEN POINT TWO MILES FROM SARAH Baldwin’s North End apartment to the Medical Center of Boston. Today—a Monday—the roads were dry, the humidity low, and at six A.M., the traffic virtually nonexistent.
Sarah squinted up at the early-morning glare, getting a sense of the day. “Nineteen minutes forty-five seconds,” she predicted.
She straddled her Fuji twelve-speedy, adjusted her safety helmet, and set her stopwatch to zero. Just fifteen seconds either way had become the allowable margin in the contest. More often than not, she won. Over the two years she had been commuting by bike to MCB, she had honed her accuracy by factoring into her average time as many arcane variables as she could remember on any given day. Tuesday or Thursday? … Add thirty seconds. Regular coffee at breakfast instead of decaf?… Deduct forty-five. Two nights in a row off call? … A full minute or more to the good. Today she also factored in the need to pedal hard enough to feel she had exercised, but not so hard as to break much of a sweat.
She glanced along the quaint row houses lining her narrow street, keyed her stopwatch, and shoved off. Once a near fanatic about fitness, she had now all but given up on formal workouts. Instead, she would push herself to the limit on the ride to work, shower at the hospital, and then change into her scrubs for rounds. But today nothing would be usual. At the Medical Center of Boston, as at most of the teaching hospitals around the country, this was July 1—Changeover Day.
For every physician in training in every specialty, Changeover Day marked a major rite of passage. Brand-new M.D.s stepping into hospitals as first-year residents. First-year residents one minute becoming second-year residents the next. For Sarah, the changeover would be from second-year resident in obstetrics and gynecology to third year. Suddenly more responsibility. Literally overnight, less supervision, especially in the operating room. It helped put some perspective on the tension she was feeling, to reflect on the fears she had dealt with on Changeover Day a year ago, or worse, the year before that.
Now, all things being equal, in another year Changeover Day would usher in Sarah’s tenure as the chief resident of her department. On that day, in most situations, her decisions, her clinical judgment, would become the final word. It was a sobering thought. And although being a chief at a modest facility like MCB was hardly like being one at White Memorial or the other huge university hospitals, it was still impressive—especially considering that less than seven years ago, becoming a physician had been the farthest thing from her mind.
She dropped into third gear for the ride over Beacon Hill and then cruised into the Back Bay. Just a few blocks away was the huge, corner brownstone that had once housed the Ettinger Institute of Holistic Healing. As usual when she passed near that building, she wondered about Peter Ettinger—why had he never answered any of her calls or letters? Was he married? Was he happy? And what of Annalee, the West African girl he had adopted as an infant? She had been fifteen when Sarah left. Sarah had felt very close to her. It was still a source of sadness that their relationship had not survived.
Three years before, when she returned from Italy with her M.D. degree, Sarah had stopped by the institute. The place that had once been her home and the focus of her life was now six luxury condominiums. Peter’s name was not among the residents. Months later she had learned of Xanadu, Peter’s holistic community set in the rolling hills west of the city. She would drive out there sometime, she thought. Perhaps face-to-face they could set some things straight.
But she never did.
Distracted, Sarah cruised through a yellow light, drawing an obscene gesture from a cabby who was preparing to jump the green.
Be careful, she warned herself. Be very careful. The last place anyone should end up was in an emergency room on Changeover Day.
As she turned off Veteran’s Highway onto the MCB access road, Sarah checked the time. More than twenty minutes already. She dismounted and decided to walk the final few hundred yards. Her little contest had no predictive significance that she had ever discerned. Nevertheless, she did make a passing mental note that this Changeover Day had begun with a loss.
Up ahead of her, picketers lined both sides of the drive, jeering those entering to work and occasionally joining in a ragged chant. MCB had gone a week or more without a demonstration—the longest span Sarah could remember. Now some group or other was on the warpath again. Sarah tried to guess which one. Nurses—RNs and LPNs—maintenance, transportation, security, dietary, clerical, physical therapy, nurse’s aides, even house staff—at one time or another, each had run some sort of job action at the beleaguered institution. Today it was maintenance.
DOWN WITH GLENN PARIS … MCB = MORE COCK AND BULL … BETTER MANAGEMENT, NOT BETTER PROMISES … MCB NAY HMO YEA …
The placards were, in the main, professionally done. The messages on them ranged from snide to malicious.
Is PARIS BURNING? WELL WHY NOT?… PAY US OR FIX IT YOURSELF … YOU TRUST THIS PLACE WITH YOUR LIFE?!!!
Whatever their beef with MCB, Sarah noted, the maintenance workers had some money behind them.
“Nice day for a demonstration, eh?”
Andrew Truscott, a senior resident in vascular surgery as of today, fell into step beside her. Originally from Australia, Truscott had an acerbic wit, made even deadlier by an outback accent he could fine-tune from trace to dense. Now thirty-six, he was the only other resident Sarah’s age. He was a difficult person to warm up to—rigidly traditional, opinionated, and too often facetious. But he was also a damn fine surgeon. The two of them had met the day she arrived at MCB and had quickly connected. At first Sarah expected that rapport—that sense of comrades-in-arms—to grow into a true friendship. But comrade-in-arms turned out to be as close as Andrew ever allowed anyone at MCB to get.
Still, Sarah enjoyed her contacts with the man, and had certainly benefited from his teaching. She also acknowledged to herself that had Andrew Truscott not been married, she would gladly have dusted off her feminine wiles to try and break down his reserve. As things stood, she was still without the solution to the nagging problem of how she was to become a competent surgeon herself without totally suppressing the need for love, companionship, sex, and whatever else of merit went with life beyond the hospital.
“What would Changeover Day at MCB be like without a few pickets, Andrew?” she said.
“Ah, yes. Changeover Day at the Medical Center of Boston. At the east wing we have a lineup of professional drug-seekers, duping the new residents with textbook performances of the passing of a kidney stone or the slipping of a lumbar disk. At the west wing, we have a lineup of disgruntled maintenance workers, looking to squeeze a few more bucks from this stone of a hospital. Ain’t medicine grand?”
“MCB nay, HMO yea,” Sarah said. “Since when are the maintenance workers into hospital politics?”
“Probably since someone told them they might actually get those bucks if Everwell took the place over.”
“It’s not going to happen.”
Truscott smiled. “Try telling them.”
For several years, the ambitious—some said avaricious—Everwell Health Maintenance Organization had been waiting and watching like a predatory cat as MCB staggered beneath a crippling weight of fiscal problems, labor unrest, and the controversy surrounding its emphasis on blending nontraditional healing with traditional medicine and surgery. By charter, a vote of the hospital trustees, if approved by the state Public Health Commission, would turn the hospital over to the definitely for-profit operation. And each job action, each piece of negative publicity, brought the unique institution closer to its knees.
“It’s not going to happen, Andrew,” Sarah said again. “Things have gotten better every year since Paris took over. You know that as well as I do. MCB has become one of a kind. People from all over the world come here for care because of the way we do things. We can’t let Everwell or anyone else ruin that.”
“Look, mate,” Truscott said, his accent deepening, “if you’re going to become impassioned about anything, you’ve got to turn in your surgeon’s merit badge. That’s the rule.”
“You get just as impassioned about things as I do,” Sarah said. “You’re just too macho to let it show.” She glanced past the demonstrators at the bicycle rack, which was empty save two rusted three-speeds, whose tires appeared to have been slashed. “I think the nurse’s aides were a bit less physical during their strike,” she observed. “It looks like my bike gets chained to the bed in the on-call room. Andrew, don’t you have the feeling that someone other than the maintenance men has helped organize all this?”
“You mean Everwell?”
Sarah shrugged. “Possibly. But they’re not the only candidate. Thanks to Axel Devlin, there are more than a few people who have the wrong impression about the way we do things here.”
Devlin, a Herald columnist with an unabashedly conservative slant, had dubbed MCB Crunchy Granola General. He made it a frequent target of “Axel’s Axe” in his popular Take It or Leave It column. As an M.D. with extensive training and expertise in acupuncture and herbal therapy, Sarah herself had been mentioned in the column on two occasions, not at all flatteringly. She never had figured out how Devlin learned of her.
“Who knows?” Andrew responded with no great interest. He nodded toward the dozen or so picketers. “They are a gnarly group, I’ll say that for them. Not a tattooless deltoid in the bunch.” He paused at the door marked Staff Only and turned to her. “Well, Dr. Baldwin, are you ready to pop up a level?”
Sarah stroked her chin thoughtfully, then took Truscott’s arm.
“What options exist for me are either unacceptable or illegal, Dr. Truscott,” she said. “Let’s do it.”