A Midlife Intermezzo

By Boas Gonen

REVIEWS of A MIDLIFE INTERMEZZO

**** Four stars (out of five)
Fans of schadenfreude will devour this compelling story of a midlife crisis that deteriorates into obsession. Boas Gonen offers a drama of the human soul in A Midlife Intermezzo, the compelling story of one mans midlife crisis gone awry The first-person perspective, which can be tricky, is well crafted. The voice is candid and honest. It provides suspense just when the story needs it: It was time to quit while my sanity was intact, although I wondered whether it wasnt too late for that. The characters are fully dimensional and fallible This is a tale of one mans struggles, providing enough interest to inspire pressing on through all four hundred pages

-Clarion (Foreword) Review

Gonens writing flows competently, including scenesetting, dialogue and point of view (some sections are in Svetlanas voice); he uses Vips medical background to good effect, and his discussions of opera are well-informed ...

-Kirkus Reviews

• Language: English
• Publisher: AuthorHouse
• Release date: Dec 19, 2013
• ISBN: 9781491844083

Boas Gonen

Boas Gonen is a physician who has been interested in literature for his entire life, though most of his writing has been on medical subjects. He is an avid reader, who considers Homer’s Odyssey the best book ever written, and is partial to all the Russian Classics. Two additional books—“The Third Patient” and “Tashi Delek”—will be published in 2014, and a fourth book, “Saving Marina K.”, in 2015. On a good day (after two cups of coffee), he can understand parts of seven languages and read in four alphabets. He has visited forty-two countries and lived on three continents. He is interested in philosophy, music and politics and plays chess at a high level. Dr. Gonen lives in Philadelphia, is married, and has three children.

Book preview

A MIDLIFE

INTERMEZZO

Boas Gonen

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This is a work of fiction. All of the characters, names, incidents, organizations, and dialogue in this novel are either the products of the author’s imagination or are used fictitiously.

© 2013, 2014 Boas Gonen. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

Published by AuthorHouse 12/18/2013

ISBN: 978-1-4918-4409-0 (sc)

ISBN: 978-1-4918-4408-3 (e)

Library of Congress Control Number: 2013922835

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and such images are being used for illustrative purposes only.

Certain stock imagery © Thinkstock.

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Contents

Prologue

Act One

I

II

III

IV

V

VI

VII

VIII

IX

X

XI

XII

XIII

XIV

XV

XVI

Act Two

XVII

XVIII

XIX

XX

XXI

XXII

XXIII

XXIV

Act Three

XXV

XXVI

XXVII

XXVIII

XXIX

XXX

XXXI

XXXII

XXXIII

XXXIV

Finale

Post-Finale

About the Author

Prologue

I have been dealing with life and death issues on a daily basis for a long time, and I will let others opine as to how this fact may have sculpted my soul and found its expression in my personality. I have no claims to great accomplishments in my life, though I don’t lack intellectual or financial resources. I have a family and a job, and my ambitions are reasonably modest on both fronts, so the course of events described hereafter should be viewed as wildly out of character for me. It all started with a perfectly innocuous visit to the Metropolitan Opera in New York. The hand of chance gradually changed my life and gave it a new and unexpected direction, but in retrospect, I see that there must have been a seed planted inside me at some point, a seed that was fertilized by that fortuitous visit to the opera.

If you’re looking for a lesson or a moral to the story, be my guest. You are bound to find many lessons, but not a single one was preplanned. As in every series of events consisting of human interactions, there are winners, and there are victims, though usually one can’t predict who will become what, and often the outcome may not become evident until long after the events take place.

At its core, this is a story about the deep connection—real as well as mystic—between music and intimate romance. It is not universally appreciated that, music and the human voice are among the most potent aphrodisiacs, closely following alcohol. It is also a story about how all of us, not only professional performers, are actors who alternate between who we really are and who we try to be at any given moment. Most of us play many roles in our lives—son or daughter, parent, spouse, employee, boss, friend, lover, stranger—but are they all real? When we fall in love, it’s unclear which of our several characters makes us more or less attractive. In any event, the fact that an average person could succeed in winning the most glorious singer of our time is a testament to the power of daring and persistence, and quite a bit of luck.

Act One

I

So wrote Dante, pondering midlife: Nel mezzo del cammin di nostra vita mi ritrovai per una selva oscura ché la diritta via era smarrita.

Winter, 2007

I was the chairman of the department of neurology at Franklin Hospital in New York City. Actually, I was the acting chairman, but in social situations I tended to omit the acting part. What this really meant, as far as I could discern, was that Omar, the chief of medicine and my direct boss, couldn’t make up his bird-sized mind about my leadership abilities and install me as the full chairman. I knew for a fact that he was doing this only to rattle my chain, and he knew I knew it, but for the time being we both pretended to play nicely in the sandbox. I knew something he didn’t: he was not going to find any prominent scholar to take this particular job, because right now the department was in shambles. It was a small, messy, chaotic, inefficient collection of second-rate physicians whose practice of neurological medicine was leading to alarmingly high rates of death.

Three types of people never fail to drive me up the wall, and all of them are paper shufflers: dumb ones, arrogant ones, and especially bureaucratic ones. Omar had the distinction of being all three. I knew that Omar thought that I was a big part, if not the sole cause, of our problems because I had been on the faculty for the past seven and a half years, though I had been the acting chairman for only the past year. I knew this because he once said so outright. Vip, he had said—my real name is Arthur, but since I was twelve, everybody had called me Vip—don’t think that I don’t realize that you’re a big part of the problem. If you had paid attention to the department while James was screwing around, we could have avoided this whole mess.

In the end, I think that Jim—the previous chairman, James Long—was the smartest of us all. About a year ago, he abruptly left the department and took with him our perky, busty secretary, Rhonda. Jim had been close to early retirement, having accumulated substantial wealth (he was a savvy gambler on Wall Street and a tournament-level poker player), and Rhonda sure liked their business trips to medical conventions in Vegas and Monte Carlo. He liked Rhonda because she laughed aloud at all his jokes and because of her enticing, prominent curving lines and bursting curves. As a matter of fact, there was very little about Rhonda not to like, so when I got a postcard from Jim, mailed in Curaçao, I only wanted to shake his hand and congratulate him. The bastard had finally done what every male and half the females on the eighth floor of the hospital dreamed of: running away with Rhonda and forgetting about the dreariness of their safe, manicured lives in general and of our stale, dysfunctional little department of neurology in particular.

I was much younger than Jim—I was forty-seven, and he was fifty-eight. My boyish looks could be one reason why Omar didn’t want to make me the full chairman—he was from the Old-World European school and believed strongly that unless your hair was snow-white or was all gone, you were not distinguished enough to run an important department in a top-notch hospital. His belief could not be shattered by one’s informing him that there was really nothing exceptionally important about this department or top-notch about this hospital, and doing so would have been pointless. He did not take kindly to any perfidious opinions, so the end result would only have been a heated argument that I could not win. Furthermore, loud exchanges with Omar, though they had their time and place, were hardly going to help me remove the word acting from my title.

Though I had no hard feelings toward Jim, it’s worth noting that Rhonda seemed to like me too. After all, during our very first encounter she grabbed me by the crotch. I was taking off my jacket in front of the open closet, and since I was wearing dark sunglasses, I didn’t notice that somebody was bending down inside the darkness, apparently looking for something on the floor. That somebody sprang suddenly out of the blackness of the closet into the light and grabbed my crotch. I believe she said, Sorry, and I believe she made a short, playful grunt, but I’m not sure which came first. I am sure, however—given my extensive familiarity with human anatomy, which has served me so well in my career—that in the process Rhonda closed her fist. Was she crazy? Excessively friendly? Both? It’s even possible that it was just a case of mistaken identity. Still, you’d think a woman wouldn’t set out to clasp a crotch until she had a very high degree of certainty about its owner. For Rhonda’s part, she always claimed afterward that she had just been nervous and confused. I didn’t tell anybody about the strange welcoming episode (no one important, anyway), but Rhonda and I had a good laugh about it one night when we were both drunk in a hotel bar during a conference in Chicago, and she playfully tried to reenact our first encounter. But that was many winters later.

A casual visitor to our department would have been immediately struck by its permeating drabness—it was a study in off-white, brown, and gray. The walls, doors, patient-room screens, doctors’ uniforms, nurses, orderlies, sheets, and bed covers all used to be white at some point but now looked grayish, even when they were fresh out of the wash. The rest was tree-bark brown—the odd chairs in the rooms, the food trays, the desks in the nurses’ stations. There was also the issue of smell—there was the permanent stench of food that hadn’t been ingested and food that had been deposited back into the environment after having been partially digested. This was a testament to the fact that our patients were very sick, but it also highlights the poor service they received. Adding to the chaos were the family members always milling about, trying clumsily to help their helpless and self-insufficient relatives. Most rooms had three or four beds, maximizing the distressing effect each patient’s condition had on the others. The exceptions to the drabness were two VIP rooms reserved for the occasional very wealthy and/or famous patient. These rooms remained empty almost the entire year, but their beds were kept in top condition—shining white at all times—and fresh flowers were deposited daily in orange-colored vases.

The numerous deaths in our department were certainly of concern. (If I had been a full chairman, perhaps a slightly dramatic full chairman, I would have exclaimed, of utmost and deepest concern.) As best I could tell, most of the physicians seemed to be in fairly robust health, but the patients, alas, were not. Morale was very low among the physicians, and I was still trying to figure out whether the low morale was causing the surge in unexpected deaths or whether it was the result of the deaths. Cause and effect are fascinating things, but because I was only the acting chairman, I was not entirely sure how fascinated I was required to be by the daunting task of investigating an alarmingly high death rate among very old and sick patients. I knew I should query Omar next time he burst into my office asking for some minor snippet of information, such as the projected budget of our department for the next five years. He kept saying that he planned to create an independent committee to look into the causes of the deaths, but it was unlikely that I would be able to trust its findings: independent committees simply don’t exist—everybody has a bias and an ax to grind.

If Omar did in fact insist that I devote my every waking moment to the issue of excess patient mortality, however, I would also have a real family problem, because my wife, Eve, would read me the riot act. She would not like any digging into the side effects of drugs. My niece, Dora, would side with her as a matter of principle, and she was even tougher to please than Eve. Since they were both tough to please, most of the time I didn’t even bother trying. My brother (and Dora’s father), Grant, would be sniffing for a potential lawsuit, and his wife, Romi, would look for a scandal that could be splashed on the front page of her newspaper. On the other hand, my friend Milo, the sober philosopher, would just chuckle and give me one of his supportive minihomilies, soon to be transformed into a Socratic dialogue, at the end of which the whole issue would seem to be nothing more than a ridiculous distraction. The one thing that none of us would accomplish, of course, was anything tangible and actionable.

There were a baker’s dozen physicians in the department. (Again, if I were the full chairman, I would have emphatically and proudly intoned here, my department). This was a reasonable number, considering that we have inpatients, clinic patients, medical students, house staff, and research laboratories. Based on their résumés, most of the physicians should have been quite competent and some could have been superb. But, alas, in the real world of patients with paralyzed limbs, weak muscles, and speech impediments—the bread and butter of neurology departments—they showed remarkably lousy attitude and poor decision making. Two stood out as the worst—downright dangerous and menacing to patients. Jim had made all kinds of noises, as if he had been trying to get rid of these two, but they were only hollow threats. The dangerous two were tenured, and Jim broke rules only in a careful, measured way, and never for something as inconsequential as saving a few lives. (I knew now that he had been too busy scheming to run away with Rhonda.) Besides, Alexander, one of the two bungling doctors, was Jim’s weekend bridge partner and firing him would have forced Jim to look for a fourth player—too arduous a task for such a languid doctor. Most of all, Jim would never have fired Alexander because Alexander was a very gregarious and funny character, which meant that he was beloved by everyone but me. I can’t stand gregarious and funny characters, because they always suck the air out of every gathering. So, while Alexander might have been gregarious and funny (to others), he was a very lousy doctor.

The other incompetent doctor was named Norman Romantokowski. When people tried to get under his skin, they called him Normanowski, which he hated at first but had now grown accustomed to. Some of the more mean-spirited students called him Doorman, but not to his face. In many ways he was the exact opposite of Alexander: lugubrious, bent, and trembling, and, if not for his white coat, he could have easily been mistaken for one of the patients, even on one of his better days.

It was on the same day that Jim and Rhonda performed their South-American absconding act that Omar had proclaimed me the acting chairman of the department. All members of the department had been assembled in the conference room inside the library, and Omar had been standing erect in front of the group. He wore a white coat (like the rest of us, though his was newly ironed, and ours were crumpled and had various neurological testing devices dangling from all the pockets). He never had any contacts with patients, only with pens, papers, calculators, computers, and other bureaucrats. While he was talking, all I could think about was Rhonda and Jim snuggling in their first-class seats, flying toward the hot sun and away from the snow and howling winter winds—and yes, all the fading patients.

Dr. Van Buren is now the acting chairman, Omar droned. His voice was nasal and throaty all at once, and on top of it, he had a foreign accent. He was born in Portugal, I believe, though other people thought he was from Kazakhstan or Albania or Libya or some other unlikely place. We never bothered to find out which country for sure.

We are going to put together a search committee to find a replacement for James, he continued.

And for Rhonda, we assume, Alexander said, and everybody laughed—except me; I just smiled—because they always laughed when he spoke. Even when he hadn’t said anything funny, people still smiled when he entered a room. Now they laughed, but we all wished he weren’t joking. Rhonda was the only ray of sunshine among this tedious group of people, physicians and patients alike. They would have had to search long and hard to find a secretary who was as friendly as Rhonda (especially when greeting faculty members on their first day), and as generally upbeat, amiable, and charming.

Even though Dr. Van Buren has the title only of ‘acting chairman,’ he will be making all the day-to-day operational decisions. Until we find a replacement, that is, Omar continued.

I gave a little cough and made a serious face. All eyes turned to me, and I noticed several surprised looks. They had assumed, no doubt, that acting meant lame duck and that I would do nothing of consequence. Ordinarily, they would have been quite right on this. The ones who knew me well, however, were aware that I was prone to the occasional random act of vigor and ambition, a frantic burst that would put some of the characters in the room on notice and impress the others. It even impressed Eve sometimes, when she was in a good mood. Incidentally, another thing that stunned her at the time and that still impresses her, is my weekly stints as a general practitioner in a children’s clinic in Harlem—I started these a few years ago, and most of the time they are the most satisfying part of my medical life. They are done for free, of course, but they may soon come to an inglorious end because of local political scrambles. Almost nobody in the department knew about them (except Omar), and I was happy to keep it that way.

It is possible, of course, Omar went on, grinning, that Dr. Van Buren will be the best candidate, assuming he applies for the position, and then we will stop him from acting and make him our full-time chief.

Omar’s attempt at a little humor didn’t work. It rarely did. Because of his strong accent, people wondered whether they had heard him make a mistake and rarely dared to laugh. Omar himself chuckled a bit, but the rest of us sank into an awkward silence. I remained grim-faced and started shaking my beeper, as if an important message had gotten stuck and failed to burst out. Now everybody turned their gazes toward me, and I could sense cogs sliding against other cogs inside the skulls in that room. I could detect some deep sighs, indicating that the kissing-up period of the acting chairman was on the verge of being launched. I knew that some were worried about their jobs, but, as best I could tell, Alexander and Norman, the most likely candidates for getting the boot, were unconcerned. Alexander smiled in my direction, and Norman just sat there, wiping his thick glasses with his coat in a slow, repetitive motion with his trembling hand.

Regarding the investigation, I have nothing more to add. When I have more news, you’ll be the first to know. It’s practically underway, and we expect full cooperation from everybody. Thank you all. Omar concluded his little presentation with a tiny smirk, invisible to everyone except me, and walked briskly out of the library.

The investigation he referred to had to do, of course, with the exceedingly high number of deaths in our department. A stroke patient seemed to live fewer days than the average patient in other hospitals, and late-stage multiple sclerosis patients fared only slightly better. I thought I knew most of the reasons why, but nobody among the top brass cared to listen to me. I doubted that my bright, shiny, new title and enhanced powers would change the attitude of my bosses.

You may be right, Omar mumbled whenever I brought it up, but we don’t want to preempt any future investigation, do we? Omar himself was in a conundrum here, because he had to decide which side to take. Our department was his responsibility, as chief of medicine, but he seemed convinced that if he could keep himself above the fray for long enough, he would somehow become the savior in the eyes of the board, should new actions be recommended.

All the reasons for the increased rate of deaths came down, in the end, to one: we had too many clinical studies with new drugs going on at the same time. Representatives of drug companies literally tripped over each other in the hallways, at the nurses’ stations, in the elevators, and even in the restrooms. Study monitors from Anvers, who checked on clinical trials, ran into their own company’s sales reps pushing another drug recently approved by the FDA. There was no amount of groveling that my fellow doctors wouldn’t do in order to land a lucrative study. Being an investigator on clinical studies can mean fat checks, prestige, all-expenses-paid boondoggles to swanky resorts and, most of all, job security—and all it costs the investigator is distraction from taking good care of patients and the not-insignificant chance that one of these miracle drugs would wind up killing those patients directly. Once I was fully in charge of the department, the first bastards to go would be the ones with the most drug company studies. Until that day came, however, rocking the boat wouldn’t be easy. A vicious cycle, difficult to break, was at work here. All the fat income from the drug companies allowed Omar and the board of directors to build bigger departments and new hospitals with more beds. New hospitals with more beds, in turn, attracted more drug studies that brought in more money that would make their empires even bigger. Therefore, Omar and the board of directors loved drug studies too much—and for them, shortening the lives of a few elderly citizens whose time might have come anyway, was a reasonable price to pay.

There were also personal complications involved in any attempt I might make to rock the boat. Eve, my wife of fourteen years, was a senior executive at Anvers, a (relatively) respectable drug company. She was their senior vice president of marketing, with special responsibility in the neurology space. (In fact, we met when I was a neurology fellow, and I was teaching sales reps the basics of neurological disorders.) She always tried to tell me that her colleagues at Anvers were caring, responsible, compassionate professionals and that they would never engage in anything that could possibly harm any patient. And besides, she reasoned with me each time we had this argument, what could Anvers possibly gain by contributing to the premature demise—her words—of patients with stroke or Parkinson’s disease? My usual answer was that, while Anvers might not want to kill patients on purpose (the word kill, especially in the context of drug research, sends visible shivers down her spine), between sloppy research, eagerly recruiting the wrong types of patients, and rushing to treat very sick patients before all the evidence was in (mostly thanks to the pressure that her charming marketing division spread around so thickly), stuff happened. She would tell me that I didn’t know what I was talking about, and I would tell her that I might be wrong—in fact, I hoped I was wrong—but if somehow I turned out to be right, her company was in deep trouble, and her meteoric career was careening straight toward a dark, damp jail cell.

That was usually about the point where she turned her back to me and switched off the light, mumbling something about how I should lose this attitude, especially when engaging in conversations with the Anvers brass. (She was working on some party for her people and was already very worried about my behavior.) That was on a good day. On a bad day, she would tell me to leave the apartment and go see a movie or something if I was not capable of acting like an adult.

At any rate, I tried my best to reduce, or at least control, the damage caused to patients by some drug studies. Assuming that was the real cause, of course. I hadn’t yet entirely ruled out the sheer incompetence of our medical staff as a culprit too.

All materials related to clinical studies were kept in a locked closet, with keys available only to the study coordinator. These materials include documents like protocols, case report forms, patient consent forms, all correspondence with the FDA and the like, as well as the drugs used in the study. We had devised an elaborate system that kept track of which patient participated in what study, and we made sure (in principle) that the right pill or injection was given to the right patient at the right dose and the right time. In some cases we made a note as to which cheek of the patient’s rear end had been stabbed with the needle. So much documentation, yet safety was far from guaranteed. Even when studies were completed and a drug was approved for sale in pharmacies, the companies continued pushing all kinds of protocols, thereby ensuring that we continued using their particular brand, especially when their brand was indistinguishable from another company’s brand.

Once in a while, usually on an otherwise bad day, I broke down and tried to convince myself that we had made progress, that nobody was going to die this time, at least not from anything but natural causes, but deep inside I knew I was just kidding myself. With the workload and the nonstop activities, the overstrained nurses often forgot that the patients were human beings with actual names. When a nurse and a study coordinator discussed a patient over stale coffee and staler donuts at midnight, they always spoke in numbers:

Let me see. Patient 017, did you give him the shot IM or SC?

Hmm … did you say 017 or 070?

Seventeen. One seven.

Oh.

A pause, a search through a bunch of papers, intermittent glances at the monitor.

No. 017 gets a pill.

Really? He’s in the TPN-44 study, right?

Nope. You’re thinking of the AN-363 study.

Oops.

And so it went. My own belief was that the only thing that would trigger a real top-to-bottom investigation was the death of a relative of a famous person—a mayor, at least, possibly a senator, or, worst of all, a lawyer. I knew, however, that this would never happen. Our investigators (who were quite astute when it came to protecting their own skins) were careful not to put such risky subjects into a study—relatives of important people or lawyers were somehow always excluded.

So I’d been the chairman—I mean the acting chairman—of the department of neurology for more than eleven months, and I hadn’t done anything yet that could be considered meaningful or even memorable. Some—the cynics—viewed this as a remarkable accomplishment in itself. Others were more critical. I was slowly coming to the realization that wanting the position (and making grandiose plans for change) and actually having the responsibility were two different things. I wanted to have the title Chairman, but it was rapidly becoming apparent that the only thing that would come with that title was more fruitless work toward an unachievable goal. I was beginning to understand why Jim was so happy to take things easy and let sleeping dogs lie. Faced with the need to supervise the geniuses in the department (starting with Alexander and Norman and moving downward toward simple incompetence) and seeing far too much of Omar for my own good, I was tempted to do the same. Worse, unlike Jim, I had to do so with full knowledge of the fact that Rhonda was gone and by now must be sprawled on a beach in the Netherlands Antilles thinking up ways to spend Jim’s money as fast as possible, while he was rubbing suntan lotion into her bronzed back and thighs.

The only relaxation I found while at work was listening to music in my office. I am very partial to classical music and opera, and the sounds of a Mozart piano concerto, a Bach cantata, or a Puccini or Bellini aria usually set my mind in a more peaceful frame. I am anything but an expert, and I didn’t spend as much time listening to live music or opera as I used to, but I could drop words like adagio or tessitura or high C with the best of them. I also liked to dabble in writing—short stories and the like—and had even outlined some ideas for a full-length novel that would rock the literary world (if you hadn’t noticed, I do sometimes stray into hyperbole), but I had never found the time or energy to sit down and actually write it. One day I would.

It was Monday morning, and I was taking a bunch of students on rounds. Medicine wasn’t what it used to be, and the number of kids signing up for medical school was shrinking every year. The glory and dignity of the profession had been lost years ago, and now that the big bucks were swallowed by managed care, there were few incentives left. Those who did decide to go to medical school were the natural-born optimists; they still believed in helping people (and the prestige associated with helping people), and they still hoped that the money would somehow magically return to the profession. But whatever their motives for going into medicine, while accumulating huge debts in the process, none of them cared about neurology. Neurology is centered on managing untreatable diseases and watching them progress—stroke, Alzheimer’s, Parkinson’s, and the like. There is no glory involved and no big income. The few special and expensive procedures associated with neurology usually wind up referred out to other specialists like radiologists and neurosurgeons. Those are the specialties that bring in the big bucks. Needless to say, they are also the specialties that have no problem attracting students and trainees.

So, we were on rounds as a group of seven people: one adult and six kids trying to learn medicine. Some of those kids were allowed to put the letters M and D next to their names because they had graduated from medical school, but they were kids all the same. All six follow me around like zombies, too tired to keep their eyes open. They had just finished the most important traditional hazing ritual in med school—night call. This entails sleeping (or, mostly, failing to sleep) in a tiny room, phone ringing every few minutes, jumping up with thumping heart to respond to each life-threatening emergency, such as a novice nurse with an irrelevant question that could just as easily have waited until morning. In any event, the morning after a night call, the student or house staff is bleary-eyed and sleepy, with images of a nice, quiet bed and pajamas and white sheets dancing in his head. On such mornings, and they came up quite often, all communications were by nods, grunts, and short words only.

We walked into a room. Three beds side by side. Two of them contained patients. The third, near the window, was empty.

Where’s Frank? asked the third-year medical student, pointing to the empty bed.

Who? I asked.

Frank O’Brien. Came in last night, had a mild stroke. He looked okay when we saw him at four.

Passed away, said Tim Morgan, the fellow. He coded at five-forty. We worked on him for a long time.

I shrugged. We were all, in our own ways, too depleted to care.

Hello, Molly, I said to the lady in the first bed. How are you today?

And so I gave them a little lecture on the patient and her Parkinson’s disease, her therapy, her prognosis. The members of my entourage tried to give the impression that they were listening. They made faces, nodded, looked at the chart, and once in a while contributed with a monosyllable, usually mumbled sotto voce. If I could read minds, I would have discovered that half of them stare at me and think about sex (not sex with me, I hope), and the other half thinks about sleeping first and then about sex. Sometimes they are too tired to think about sex, so they think about their remaining duties before they can go home, sleep, and have sex (or have sex and then sleep). I was sure about all that because I used to be just like them some time ago (twenty years, give or take). Really, I was not so different now. There was nothing I liked more than to daydream during rounds, perhaps think about Rhonda and Jim (or Rhonda and me). I was surrounded by all these patients, students, residents, and fellows, though, and I had to concentrate on my little speeches.

Soon, we were done wasting our time together—them learning while tired, me teaching tired people. Mercifully, rounds didn’t take that long, partly because we lost four patients overnight—two from stroke, one from advanced multiple sclerosis, one from a blood infection that started in the brain. On my way out, I stopped at the nurses’ station. Donna was there, yawning as I approached. She didn’t cover her mouth, which seemed to be open forever—a big, gaping hole lined with large, white squares, an occasional tinge of gold mixed in.

I asked her about the four deceased patients, and she went through the charts at an excruciatingly slow pace. Finally, while she was still at the second case, I just grabbed the charts from her, sat down, and looked for the information myself. I often reflected that if only stupidity were literally painful, our nurses’ station (and, for that matter, the adjacent physicians’ quarters) would make me deaf from all the screaming and yelling. Donna annoyed me. Perhaps I would get rid of her when I became the full chairman of the department. Maybe Omar wanted to see some tough action, some leadership. Maybe firing Donna would guarantee my promotion.

It turned out that all four patients who had died during the night were in clinical trials sponsored by pharmaceutical companies. Anvers, Eve’s company, sponsored only one of the trials, the one involving stroke. I didn’t know whether the study had anything to do with the patient’s death, or whether the patient even received a medication or a dummy pill, but I was somewhat intrigued at the prospect of having another open and frank conversation with Eve when I got home.

Taking the A-line subway home, standing in a sardine-crowded car, holding on to dear life in the form of a metal pole, I realized how tired I was. Was it more stressful to be acting chairman or the real chairman? Would I be more tired if and when I was the chairman? A few more days like this one, and I would seriously consider leaving the job to some hotshot neurologist who had the advantage of not having been involved with this messy department. I could also retire—in fact, retiring sounded good right then. I knew I was way too young for that, though often it didn’t feel that way. I’d certainly been planning my retirement for long enough: golf (in Florida), skiing (in Colorado), traveling (between Florida and Colorado). I could finally reignite my love of live music (in New York, nowhere but New York, always New York). Maybe I’d finally write that book I’d been fantasizing about; my book would become a best seller; I’d orchestrate a bidding war between all the big studios; and Brad Pitt and Angelina Jolie would threaten to fire their managers if they didn’t get the lead roles in my film adaptation.

If for some bizarre reason (such as, I didn’t have the talent required), it didn’t happen quite that way, however, then I supposed Eve would continue to make lots of money, including all the stock options she would no doubt continue to get, because Anvers would continue to bring more and more blockbusters to the market. I didn’t know whether they’d have new blockbusters for stroke or multiple sclerosis, because so far more patients died than lived on these investigational drugs, but they might have winners to treat heart disease or bone disease or impotence or something. Impotence. I wondered how Jim was doing in Curaçao. I thought that when I got home, I’d take a shower, drink half a bottle of red Chilean wine, and make love to Eve for a couple of hours (an hour is also good; who am I kidding?). Maybe it would be better to wait until afterward to mention the patient in the department who took the Anvers medication and died.

He took the medication (or possibly took it) and died. It could have been a coincidence. It didn’t have to be cause and effect. There was no point giving up one peaceful night with Eve before I knew for sure. As I walked into our well-groomed building on the Upper West Side and waved to the doorman, I could feel my high spirits returning and the drained sensation evaporating.

II

So wrote Aleksandr Sergeyevich Pushkin:

Она его не замечает,

Как он ни бейся, хоть умри.

Свободно дома принимает,

В гостях с ним молвит слова три,

Порой одним поклоном встретит,

Порою вовсе не заметит;

Кокетства в ней ни капли нет ―

Его не терпит высший свет.

Бледнеть Онегин начинает:

Ей был не видно, иль не жаль;

Онегин сохнет и едва ль

Уж не чахоткою страдает.

My name is Svetlana, but almost everybody calls me Svyeta. When I realized I had a chance of being successful singer, I decided to dictate into a tape recorder the most important and interesting parts of my life. Maybe one day somebody will want to use it to write book about me.

My life had very difficult beginning. I was born in a small little village, maybe two thousand people, near Kiev in the Ukraine. My mother, Larissa, lost three children during pregnancy; my father Sergey disappeared one day when I was sixteen months old. I and my two older brothers, Arkady and Dimitri, followed my mother on the long trip to the big city of St. Petersburg, where my mother had some family. When I was six, my mother married a much younger cousin named Misha, who was a bank teller during the day and a piano player in the night. He played in bars, how you say, in fancy hotels where rich tourists came to do their business, visit our art museums, or buy cheap women. Misha has these long, thin fingers, you know, like pencils, with almost all bone and no meat, but all the meat was in his wide hands, and he would—do you say, pound—on the keyboards with so much strength that the walls of the house would shudder, but in the bar