Private Practices (29 page)

Miss Viviani padded out and returned with a slim manila file. He told her to delay sending in his next patient and quickly perused the file. It was filled with letters requesting Sidney's appearance, then demanding it, then hinting at legal action if he didn't comply. The letters reminded him of the progressively threatening form letters relied upon by bill collectors. The last one stated assertively that Sidney would be subpoenaed to explain himself unless he voluntarily came down to a hearing on Tuesday.

Grabbing the file, he charged down the corridor and across the waiting room and burst into Sidney's office. He didn't knock, even though Sidney had a patient with him.

“I've got to speak with you at once,” Ben said, ignoring the curious glance of the patient.

“I'm busy,” Sidney intoned coldly.

“Busy or not.” Turning to Sidney's patient, he added, “Excuse me, but you'll have to leave for a moment.”

The woman obediently stood up.

Sidney raised a hand as if to signal her to sit down again. “What the hell's going on?” he said. But Ben had already eased the woman through the door and shut it behind her.

“That's what I want to know,” Ben fumed as soon as the door was closed. “That's what I want you to tell me!” He slammed the file down on Sidney's desk. “What are you doing about this?”

Sidney's voice was expressionless. “Oh. Those jokers.” He swept the file to a corner of his desk with an impatient gesture.

“You've got to go down there on Tuesday,” Ben said, lowering his voice in case Sidney's patient was waiting just outside the door.

Sidney swiveled his desk chair so that his back was turned. “I'm not going. You know how I feel about those fucking forms.”

“Sid, be reasonable. They'll drive you out of practice if you don't show up.”

“I'm a surgeon, not a computer,” Sidney roared, and swung his chair noisily around so that he was facing Ben. His face looked so gaunt and his eyes so huge that for a moment Ben didn't recognize him. He seemed almost as emaciated as the concentration camp victims from whose photographs he had always turned away his eyes. Looking at him, he couldn't proceed with his argument. At last he focused his eyes downward, concentrating on his brother's refusal and not his appearance, and was able to say, “You won't have to sign the forms. You just have to put in an appearance. Just make up some bullshit story about why you haven't signed them in the past, say you're sorry, and promise that from now on you will. It'll be months before they get after you again.”

“I'm not going,” Sidney declared suddenly, his will not in the least diminished. “I didn't become a doctor in order to do paperwork. I don't have to explain myself to
anyone
.”

“You've got to go,” Ben expostulated, his eyes still cast down. “It's either that or plan on shutting down your practice. They're going to subpoena you.”

Sidney leaned back in his chair and shoved his feet up on the desk in his favorite posture of resistance. Why did he so often assume this position? Spasmodic trembling often afflicted street addicts. Did his legs tremble less when he propped them against some firm surface? But he didn't have time to pursue his thoughts. Sidney was saying, “You go for me. You go down and say you're me.”

Startled, he had to look at Sidney's face again. It was unshaven and the hair on his cheeks was growing in grey and wiry. Beneath the stubble, his skin was pimply and rashed. As Ben stared at it, Sidney seemed to become conscious of a tickling sensation, and he began to scratch himself. “I don't know any of these jokers,” he said, and dug his nails into the stubble. “And they don't know me. They don't know what the hell I look like. You go. Say you're me. Tell them anything you want. Just get them off my back for a while.”

It was true, Ben thought, that the men at the hearing didn't know Sidney or what he looked like. And it was just as well that they didn't, although in a way he wished that they could see him as he looked right now, his nails digging compulsively at his sparse beard. But if the men from the Department of Professional Conduct did see Sidney, he realized, just the sight of him might make them keen to penalize him. It was best, for both their sakes, to avoid that. He decided he would agree to Sidney's request.

The hearing was in a building on lower Park Avenue, a cold-looking modern building made all the less appealing for being set down on a block still lined with ornate turn-of-the-century mansions. The building was an imposition on old ways of doing things, Ben thought as he approached it, just as the very fact of a Department of Professional Conduct was an imposition on doctors' old ways of doing things. Entering the lobby, his resolve to impersonate Sidney weakened. He shouldn't be doing this for Sidney. He should have found a way of forcing Sidney to come himself. For all he knew, if he got caught impersonating his brother, the department could start an action to revoke his own license too.

Inside the revolving doors, he peered at his reflection in a mirrored wall. His face was furrowed, nervous. His shoulders were hunched. He ought, he thought, to smile and stand straight, to stop stooping and emulate the self-confident stance that Sidney had always had, at least in the days before his addiction. Thrusting back his shoulders and relaxing his face, he tried to assume the air of an eminent researcher. But although he was wearing his best suit and had borrowed Sidney's gold snake and staff cufflinks and one of his monogrammed handkerchiefs, when he entered the elevator he still felt insecure about his appearance.

The hearing room had windows on three sides and bright sunlight flooded Ben's eyes as he walked in, so that at first he couldn't see who else was present. Then he made out a large, T-shaped conference table and five men, four seated together at the top, like judges, and one sitting solitary across from the door, along the table's length. The solitary man had a stack of documents at his elbow.

“Over here, Dr. Zauber,” one of the four men at the top of the table said, gesturing him to a chair opposite the man who sat alone. “I'm Dr. Martin,” the man who had spoken went on, “And this is Dr. O'Connor, Dr. Kaplan, and Dr. Ferlinghetti.” He waved a plump hand at his companions. “And this is Mr. Stoner, our counsel,” he added, pointing at the solitary man.

Ben slipped tremulously into the chair Martin had proposed, and knew he should introduce himself, but when he opened his lips, no sound came out. Crossing his arms, he laid them heavily on the table for support and at last was able to say, “I'm Dr. Zauber. Sidney Zauber.”

“You didn't bring counsel?” the lawyer asked. He had a piercing voice and looked at Ben aggressively.

“N-No,” Ben stammered. “I thought this was an informal hearing.” The sound of words coming out of his mouth, like the sound of a scream after a moment of paralyzed terror, reassured him, and he managed to add, “I thought I only needed a lawyer if you decided to proceed against me.”

“True enough,” Dr. Martin said. “Although it's customary to bring a lawyer.” He had a flat, upstate New York accent and Ben had to concentrate at first to understand his emphases. “Well, no matter,” Martin went on. “We can manage well enough on our own.”

Ben looked at him closely. His face was round, with gold-rimmed glasses that shielded his small eyes, and he was wearing a yellow and green plaid sports jacket.

Suddenly Ben was glad that Sidney hadn't come. Sidney had always characterized doctors who took assignments with administrative committees as specialists in red tape, dullards who couldn't make a proper living at the practice of medicine and so had to resort to extra-medical occupations. And certainly Martin looked the part, with his plump face, his dull eyes, and his ridiculously provincial jacket. Sidney would have felt immediately antagonistic to Martin, and would have made no effort to conceal his sense of superiority. For that matter, Ben thought, he would undoubtedly have considered himself superior to the other doctors as well. Two of them looked very young and inexperienced, and the third was elderly and wore a hearing aid.

“We were rather surprised you actually showed up this morning,” the lawyer said coldly, interrupting Ben's thoughts. “Based on your responses to our letters. Or, should I say, your nonresponses.”

Martin made a gesture with his plump hand, shoving at the air between himself and the lawyer. “It's all right, Mr. Stoner. I'll address Dr. Zauber. Since he hasn't brought his own counsel, I think it would be fairer if we medical men questioned him.”

He began to feel more comfortable.

“We've had numerous complaints against you,” Dr. Martin said, leaning forward. The three men alongside him also sat forward, the one with the hearing aid perching on the very edge of his chair. “A Mrs. Farber first contacted us last January, saying that despite repeated requests on her part, you had refused to fill out her insurance forms. Subsequently we have received complaints from several other women. A Mrs. Daniels. A Mrs. Smith. A Mrs. Evans. Are these patients of yours?”

Ben nodded a polite yes.

“And is it true that you have refused to fill out their health insurance forms?”

Again, he nodded. “Yes. It's true.”

“But why?” Dr. Martin looked perplexed. “Don't you recognize that these patients expect to pay you for your services to them by being reimbursed by the health plans? That they have already, in effect, paid out money for your services by subscribing to a health plan?”

“Yes. Yes, I do,” he said humbly. But he couldn't think of what to say next. How could he possibly explain to them, in any way that would seem sufficiently rational to them to prevent their moving to revoke Sidney's license, a behavior of Sidney's that he himself knew to be irrational. Could he tell them that Sidney was phobic about signing his name? Could he tell them that Sidney wasn't even sending out bills anymore? Could he tell them that not signing insurance forms, and not asking to be paid, were the least worrisome of Sidney's new habits? Could he tell them that his brother was a barbiturate addict whose professional life met almost no standards of professional conduct?

He shifted uneasily in his chair, and then at last ventured, his voice low, “I have a philosophical objection to the procedure, sir.”

“A philosophical objection?” Behind his glasses, Martin's eyes blinked. “By the way, you don't have to call me ‘sir.' We're all peers here.”

Ben raised his voice slightly. “My objection to the procedure is that—well, it's always seemed just a little bit socialistic to me.” The man with the hearing aid smiled.

“Filling out those forms smacks of Big Brotherism,” Ben added.

“What's that?” Martin's plump face looked perplexed.

“Third-party payments make a mockery of the doctor-patient relationship. Right now it's insurance companies that are dictating to us, but the next thing we know, it'll be the government.”

Martin began to nod and the two young doctors bobbed their chins up and down infinitesimally.

“We're told what to charge, what tests to perform, and we're even asked to put down questionable diagnoses, just to suit the forms. We're not our own men anymore,” Ben said. He could see he had given the committee an argument it found not altogether unreasonable. Perhaps it had been made before by other recalcitrant medical men. Although he was certain that Sidney's refusal to sign the forms had nothing to do with philosophy, he went forward with the argument, his voice at last reaching its customary pitch. “Medicine used to be a matter of private practice. But these days we have no privacy. And neither do our patients, really. Do you realize what an invasion of privacy these insurance forms constitute?”

Even the lawyer was looking at him a little less hostilely than he had earlier. “We're being told how to practice medicine by insurance salesmen,” Ben continued, turning slightly to include the lawyer in his gaze. “Middle men. Economic vultures.” As he warmed to the argument, he raised his voice even louder. There was no point in playing Sidney as altogether humble. Surely some of his reputation for irascibility and arrogance had preceded him here.

“But Dr. Zauber,” Martin said cajolingly, “None of us likes it. But we do it. We go along with it because it's accepted practice.”

“We can't take this kind of thing into our own hands,” the man with the hearing aid interrupted. “Much as we might like to.” He smiled again.

“You can't fight city hall,” one of the young doctors interposed. “Or the state capital, for that matter. Not barehanded.”

Ben allowed himself to look thoughtful.

“And it's not as if your philosophical stance was harmless,” Martin said. “It's all well and good. We understand how you feel. But you're hurting innocent parties—patients—when you undertake this battle. After all, they've already paid the insurance companies. They expect reimbursement.”

Ben thought of saying, as Sidney surely would have, “Not if I don't bill them,” but he knew that would make the committee lose its feeling of identification with him. He looked down at his arms on the table and then said slowly, “Well, yes. Yes, I see.”

“You would be better advised to take your stance by writing for some of the professional journals,” Martin went on. “I mean, when you can spare time from your other writing.” He looked at Ben deferentially. “We're all familiar with your research, Dr. Zauber.”

Ben allowed himself to accept the implicit compliment and to smile appreciatively at Martin. “Yes. Yes, I suppose you're right. I suppose battles like these are best fought in print, and not through direct action.”

“Yes. That's just it,” Martin said. “So if, in the future, you would just start filling in and signing the forms—”

“There'll be no further action against me?” Ben finished his sentence.