You Should Have Known (38 page)

She couldn't think what to say to it.

How about:
Thank you
?

“Thank you,” said Grace.

“No, no, don't thank me. I'm just so fucking grateful to be in the same room with you, I want to do whatever I can to keep you here. Metaphorically, of course. You probably have to be somewhere else.”

Grace nodded. She did indeed have to be somewhere else. She had to go pick up Henry at the Housatonic Valley Regional School and take him for greasy pizza in Lakeville. She got to her feet, and almost immediately she felt horribly awkward. “Well, this was really nice.”

“Oh, shut up,” said Vita, coming around the desk. “Do I need to warn you this time? Or can I just go ahead and hug you?”

“No,” Grace said. She wanted to laugh. “I still need a warning.”

R
obertson Sharp III preferred not to meet in his office, for reasons Grace had no real wish to probe, but when he arrived—late—for their appointment, he had barely settled himself into the booth before he unburdened himself about the breadth of his conflict.

“I want you to know,” he said gruffly, “that it is not the wish of the board that we speak to each other.” Then, as if this were all that needed to be said, he picked up the menu and started examining it.

The menu was vast. The place he had chosen was the Silver Star on 65th and Second, a coffee shop so eternal that she had once broken up with a boyfriend in one of the booths on the other side of the room. There was a long countertop where you could get a serious, if stodgily old-fashioned, drink (like a highball or a gimlet) and, just inside the door, a standing glass case full of revolving cakes and colossal éclairs and napoleons.

Grace said nothing in response; she didn't think it was necessary, and also she didn't want to be antagonistic if she didn't have to be. He was doing her a favor, even if his board hadn't objected. That he was seeing her at all—the wife of a former employee, a terminated employee!—she supposed she appreciated. Though she also wanted to kick him under the table.

Sharp was a big man, long-legged, well enough dressed in a blue bow tie and a shirt of narrow brown and white stripes, over which he wore his very clean, very pressed white coat. His name—his real name, not the one Jonathan had given him—was embroidered on the breast pocket, out of which peeked two pens and a cell phone. Then, amiably enough, as if his previous comment belonged to an entirely different encounter, he said: “What are you going to have?”

“Oh, maybe a tuna fish sandwich. You?”

“That sounds good.” He slapped the heavy laminated menu shut and dropped it on the table.

Then they looked at each other.

Robertson Sharp, known for years within her own household as “the Turd,” Jonathan's attending physician for the first four of his years at Memorial and later the chief of pediatrics, seemed to have momentarily forgotten why he was here. Then he seemed to remember again.

“I was asked not to meet with you.”

“Yes,” Grace said mildly. “You mentioned that.”

“But I thought if you were motivated to reach out to me personally, you certainly have a right to whatever insight I can offer. Obviously, this has been a horrendous experience for you. And…” He seemed to search his own database for any available information but came up with nothing. “Your family.”

“Thank you,” Grace said. “It has been, but we're doing all right.”

This seemed more true than not, at least as far as her “family” was concerned. Henry, bizarrely enough, now officially loved his school and had made a little cell of friends, all of whom had a passionate grasp of Japanese anime and the film school oeuvre of Tim Burton. He had contacted, on his own, the local baseball league and was now eagerly awaiting his opportunity to try out for something called the Lakeville Lions, and he even seemed to have adjusted to the cold, though he had made a request, this morning as they'd driven into the city, for a few more of his warmer clothes from home. It had taken longer to get into Manhattan than she'd planned, however, and she'd had to drop Henry at her father and Eva's and come right here.

A waiter appeared, a thick Greek man who could not possibly have emitted less warmth. Grace, in addition to her sandwich, asked for tea, and that arrived a moment later, the bag still wrapped in its paper envelope at the edge of the saucer.

Even in those few minutes she had decided that Dr. Sharp might be very mildly autistic. Brilliant, no doubt, but with marked social deficiencies. He did not meet her gaze except when thoroughly necessary, and then only to emphasize a point of his own, not to better take in anything she might be saying. To be fair, she wasn't saying much. She didn't have to. Sharp, as Jonathan himself had always insisted, had a great love for the contents of his own mind and the voice that shared those contents with the world. He began, without the slightest sensitivity, to discuss what he had long considered “the problem” of Jonathan Sachs, MD, and as she listened to him—tried very hard to listen to him—it was all she could do not to leap to Jonathan's defense.

There is no Jonathan left to defend
was what she told herself. This did not make her feel any better.

“I didn't want to hire him. You can imagine the caliber of applicants we see.”

“Of course,” Grace said.

“I wanted to overrule the chief resident. The chief resident wanted him. The guy was just swept away.”

Grace frowned. “Okay,” she finally said.

“And I got that. I really did. You met Sachs, you just thought:
Wow, this guy's got a personality and a half.
And let me tell you something. You can't be any kind of doctor and not have the most profound respect for the power of placebo. Lots of things can be the placebo. Personality can be the placebo. I was trained by a surgeon. This was in Austin, where I was a resident. He specialized in a very, very difficult operation, on a kind of tumor that lodges in the aorta. You know the aorta?”

Then he looked at her, more or less for the first time since he'd sat down. This point, evidently, was important enough for that.

“Yes, sure.”

“Right. So people are coming to Austin, Texas, from all over the world to have this particular surgeon operate on them, and they're right to do it, because he's one of the best surgeons on the planet for this particular operation. And here's my point. This surgeon is missing two fingers on his left hand. Crushed by a stone when he was a kid. Climbing accident.”

“Okay,” Grace said. She was trying to follow, trying to connect what he was saying to what she imagined they were here to discuss, but also wondering if she could stop him now. She didn't really care about a surgeon in Austin, Texas.

“Now. How many people you think ever looked at their surgeon's hand and thought:
You know what? I think I prefer the hand that's going inside my heart to remove a tumor to have all its fingers
and went and got another surgeon?”

Grace waited. Then she realized he was actually waiting for her.

“I don't know. None?” She sighed.

“Not one. Not one patient, or family member. He had that personality. He had so much personality it was like a drug of its own. Placebo! You see my point? I never had that.”

No shit
, thought Grace.

“Not that that means anything about whether the science is there, the diagnostic insights. Those were the only things we thought about a generation ago. But your husband happens to come along at a very particular time. The patients have been trying to say something to us about it for years and years, and now, for the first time, we're trying to listen to them. I mean”— he laughed, mainly to himself—“we're
trying
to listen. We're trying to think
patient
care, not just disease care, if that makes sense to you.”

Did it?
Grace wondered. But he wasn't looking at her, so she didn't have to say.

“In the eighties, early nineties, we're doing all this navel-gazing about what makes a good doctor and a great hospital. You know, the patient or the patient's family member shouldn't have to go running down the hallway after the doctor to ask him what he's talking about, or what it means for the patient. And for pediatrics it's like that times a thousand. They don't have just themselves to worry about, they're worried about how the child's going to react to what the doctor's saying, or his body language. And we heard it forever from parents, and we were trying to think about it in a new way. And then here's Jonathan Sachs from Harvard.”

He was looking, of course, not at her as he said this, but across the room at the waiter, who was approaching with identical platters. He never took his eyes off the waiter and leaned back as the plate approached. Grace said thank you.

“So I let the chief resident talk me into it. And big surprise, Sachs is hugely popular with the patients. They love him. We get these devoted letters. ‘He was the only doctor who took the time to really connect with our child and us.' ‘The others didn't even know our names after four months in the ward.' One guy told how Sachs bought his son a stuffed animal on his birthday. So okay, I'm fine with being wrong. I don't need to be the authority on every single thing. There's more to being a great doctor than just knowing what to do,” he said. He was chewing his dill pickle with less than dainty bites. “When you have a sick child it's very comforting to feel there's a strong personality in charge. I've known a number of very brilliant diagnosticians, very, very adept at formulating a treatment plan. They didn't communicate very well, not with the parents and especially not with the children.” He looked actually thoughtful when he said this, and Grace marveled at his imperviousness to his own deficiencies. That in itself was something of a survival strategy, she thought. “You give a parent of a sick child a choice between the doctor who maybe won't look at them and the one who sits them down and says, ‘Mr. and Mrs. Jones, I am here to make your child's life better.' What do you think they're going to pick? You've got kids, right?”

Now he was looking at her. Now she was the one who would have loved to look away.

“Yes. We have a son. Henry.”

“Right.” He plunged on, one hand holding his sandwich aloft, just to the left of his mouth. “So, say Henry's in the hospital. He's got…let's say, a tumor. Brain tumor, let's say.”

Grace, feeling weak, just stared at him.

“What kind of doctor would you want? You want a doctor who connects, right?”

She would have said
: The one who will heal him, fuck the personality
. But she was quaking just from the briefest idea of Henry with a brain tumor on a ward in Memorial, and livid that Sharp—Sharp-the-Turd indeed—had so wantonly put her through it.

“Well…,” she said, playing for time.

“But the truth is, if you're thinking in terms of the overall performance of the hospital team, which is a sum of everyone bringing their individual talents together to serve the patient, then we're better off if we have a Sachs as well as somebody like a Stu Rosenfeld or Ross Waycaster. He came in the same year. Stu did, too. He was Jonathan's supervisor.”

“I remember,” Grace said, trying to breathe through it. She took an experimental bite of her sandwich. It was heavy on the mayonnaise, but she'd expected that. “So you're saying Jonathan had some sort of…deficiency. Like being short some fingers. But he had such a big personality people overlooked it?”

“He had a big deficiency,” Sharp said, sounding affronted. “Much bigger than a couple of missing fingers. I'm not telling you anything you don't know. This is
your
field now. Yes?”

No
, Grace thought. But she nodded anyway. “How did you make up your mind about him?”

“Oh…” He shrugged, as if this were the least important part. “By the end of the second or third year, I'm hearing stuff. Not from the patients, or the family members. They're crazy about him, like I said. But I'm not the only one who's on edge around this guy. The nurses don't like him. A couple came to me right before he started his residency, but it wasn't anything you could base an action on. I didn't think I could even put it in the file. I just wrote myself an e-mail about it and hoped I'd never have to come back to it.”

“What—,” she said sharply, and then stopped until he had to look at her. “What was the complaint?”

“Oh, nothing earth-shattering. He was arrogant, blah blah. This is not the first time I've heard that about a doctor, from a nurse.”

Grace surprised herself by laughing. “No, I suppose not.”

“Flirtatious with some of the women. They didn't like it. Well, I think some of them didn't like it, and maybe some of them did.”

Even at this, she noted, he didn't bother looking at her.

“But nothing concrete to my way of thinking, so I just let it go. And look, I've got other big personalities on my service. You know, shrinking violets don't become oncologists, at least not here. We have whole generations who never got the God complex memo, they're just grandfathered in, all over the hospital. The field!” he insisted, as if she'd challenged him.

But then, without being able to help herself, she did just that.

“I don't think Jonathan had a God complex. Is that what you're saying?”

“No, no…” He shook his head. “Well, I might have thought so at the beginning, but I watched him for a long time. Mainly because I had to, because he was a hot spot—he was someone my attention kept being drawn to. And I started to realize, here was a guy who didn't just
behave
differently to different people, he
was
a different person depending who he was with. Stu Rosenfeld never had a bad word to say. He covered your husband's patients for years.”

“They covered each other,” Grace corrected.

“No. Somebody else covered Rosenfeld. Different people—Sachs got out of it somehow. He wasn't covering anyone, not for years, but I never heard about it from Rosenfeld. He had a massive blind spot about your husband, like a lot of the others. I'm telling you, I got to be fascinated with the guy. I almost got to like him.”

It wasn't mutual
, Grace thought. She picked up one of the potato chips on her plate, looked at it, and put it back down.

“But you know what made me finally make up my mind was that story in
New York
magazine, for the Best Doctors. You know what he said?”

Of course Grace knew what he'd said. She'd read the short piece many times. But that didn't seem relevant.