Homeland Elegies(79)
By 2012, Father was nearing the end of his career. He’d been through two and a half boom-and-bust cycles: his first cardiology practice—as you’ll recall—going fully out of business in the early ’90s, his second practice only barely averting collapse in the aftermath of the World Trade Center attacks. Across the country, brown doctors saw their patient load decline after 9/11, and my father’s cardiology group—staffed almost entirely with South Asian physicians—was no exception. He lost 40 percent of his business within three months; most of those patients never came back.
To compensate for lost capacity, Father came up with a counterintuitive strategy: expand into the farther rural reaches of the state. People out there had heart problems, too, of course, and they usually traveled hours to be seen, often needing to stay overnight in big-city hotels when they were scheduled for tests. Father believed—and convinced the doctors in his group—that shorter drives and the prospect of sleeping at home the night before a procedure would outweigh any conscious or unconscious bias a patient might have.
As my father tells it, it was a full five years before his group saw results, but by 2007 they were seeing more patients than any other cardiology practice in the state. It wasn’t long before their startling growth drew the notice of a corporate health-care network I will call Reliant Health for the purposes of this narrative. In 2010, my father’s cardiology group would get bought out by Reliant, and the resulting clash of administrative cultures—one driven by doctors, the other by MBAs—forms an important backdrop to the story I’ll be telling here.
Christine saw my father at a clinic in La Crosse, a small city along Wisconsin’s western border with Minnesota, a place known to most, now, for having lent an archaic Old French version of its name to America’s most popular brand of flavored sparkling water, La Croix, a drink concocted there in the early ’80s and eventually sold to a publicly traded holding company based, for the tax purposes of its owner, in Fort Lauderdale, Florida. Christine lived an hour southeast of La Crosse, in a small town called Westby, where she worked as an elementary school music teacher and taught private piano lessons to pupils on Saturdays. Father remembered this detail about her in particular, as it came up during her examination, how she gave piano lessons and how his son—I—used to take them. Something else Father recalled about that exam was the argument it provoked with Thom Powell, the administrator at Reliant overseeing the group’s business. Ever on the lookout for new ways to increase revenues, Powell had recently ordered his doctors to shorten their visits and delegate more of their duties to the group’s nurse practitioners; this was cheaper and created more room in the schedule for the lucrative billable appointments with MDs. When Powell discovered from an end-of-week report that Father had spent forty-two minutes with Christine—the average was ten minutes per patient—he went ballistic.
The reason for Christine’s considerably longer-than-usual exam was a series of EKG scans in her case file that Father worried had never been read properly. They showed the expected elongated QT intervals, but not only that. Father thought he saw further irregularities in the scripts, irregularities that suggested another potential problem: Brugada syndrome, the ailment that brought Father and Trump into contact in the mid-’90s. Father was particularly concerned by the hints of Brugada he was seeing on Christine’s EKGs, as the beta-blocker she was taking, propranolol, was dangerous for Brugada patients, quite apart from its prenatal risks. After spending the extra time to take Christine’s complete medical history, Father told her that nothing he’d heard convinced him she didn’t have Brugada, and the only way to know for certain was a gene test that typically took six weeks, even when expedited. Considering that propranolol was potentially harmful to her fetus, he advised her to think seriously about discontinuing it until they were able to run the necessary test, and perhaps for the full term of her pregnancy, no matter the result. His advice was offered with the usual disquieting medical equivocations: as a specialist only just familiar with the details of her case, he could give her the information; the decision was for her to make with her cardiologist. Father recalled that she pressed him for a more definitive answer. “Do you mind, Doctor, if I ask—do you have a daughter?” she asked.
“I don’t,” he said after a moment’s hesitation.
“If you did, and if she had my medical history—what would you tell her to do?”
As I’ve imagined the moment—with Christine on the examining table, looking over her shoulder at him; Father already at the door, his hand on the knob—I see Father register something that moves him to stop. Against his better judgment, he entertains the thought experiment. Then he finally says: “I would tell her to stop taking the propranolol.”
Christine took his advice.
Two weeks later, she and her unborn child were dead.
2.
The first I heard about any of this was on the morning after the night I drove up from Chicago to fish my father out of jail. It was late October in 2017, and I was in the final week of rehearsals for the opening of my newest play. I’d been in the rehearsal room with my phone on silent until late that evening, which is why I initially missed his call from the police station. He’d left a slurred, reluctant message in a pebbly bass that sounded nothing like his usual voice: “Beta. I’m in the Elm Brook jail. You can call Benji. He said you can come and get me if you can.”