Homeland Elegies(93)

After we adjourned on Friday, neither Father nor I availed ourselves of the chance to offer our Muslim prayers. After lunch, as we were checking out at the front desk, Father asked if I would pay for his room. He was a month behind on his Amex payments, he explained when Brynne stepped away from her computer. He didn’t want to risk having the charge declined. It didn’t occur to me to be concerned; I told him I was fine to pay.

The route back to Elm Brook took us through Wonewoc and Spring Green, small towns with libraries I wanted to visit on the way. Republicans in Madison—where they controlled both houses as well as the governor’s mansion—were more than a decade into a sustained attack on the state’s intellectual infrastructure: school funding was dwindling; history and philosophy and literature and music and sociology departments were being shuttered; libraries found themselves each year with less money for fewer books and programs. It was the damage being done to libraries that I took personally, and I was resolved to do something, however humbly, about it. I’m not sure it’s worth telling here the story of exactly how it was I came to the idea of visiting municipal libraries in my travels around the country and giving away money. Suffice it to say it’s what I’d started doing a few months after Riaz made me rich. Five hundred dollars meant a library wouldn’t have to stop buying the best new novels coming out after July; as little as a thousand could keep a book club going for another year. I knew almost nothing about most of the communities I visited; usually, I was there to speak at a college or support a small production of one of my plays. But the towns of Wonewoc and Spring Green were different. The former is home to an author, David Rhodes, who has written what I consider some of the finest fiction about rural American life since Sherwood Anderson; as for the latter, I’d been there already a half dozen times. Spring Green was the unlikely site of one of the nation’s finest outdoor classical theater companies. Tiny as these towns were—with populations of 816 and 1,637 respectively—each mattered disproportionately to the cultural life of my home state.

It was over an hour to Wonewoc, part of it on the interstate, the rest by way of a county road carved through the heart of the Driftless Area, a rugged, stream-rich region named for its escape from the flattening glacial drift of the last Ice Age. Father wanted me to drive and offered to navigate. He held the phone, which directed us along a narrow, undulating road, past fields of soybeans, alfalfa, cornstalks, mud. Cows tottered on pitched pastures through which—as in some early Dutch landscape—a teeming brook tumbled or a knotted, solitary trunk stood watchful guard over acres and acres of empty rolling space. The land seemed to have been shaped for effect, the bluffs and ridges releasing views of a sky that looked bigger, bluer, filled with vivid, rippling clouds. There was majesty here, and it imbued even the endless parade of dilapidated barns and neglected homes—all as Hannah had described over dinner—with natural dignity.

Father wasn’t paying much attention to the scenery. He’d been on the subject of Reliant and Thom Powell for much of the ride, and as we turned onto a sloping dirt road—which our handheld navigator promised would save us ten minutes—he started in with a story about Powell I found hard to believe at first. And this despite having heard so many anecdotes from my father over the years about unethical medical practices: the overbilling, the phony drug trials, the aggressive diagnoses, the unnecessary procedures. Nothing could have prepared me for the tale he would tell me now: Before joining Reliant, Powell had worked for Chiroh Health, a similar health-care company just across the state line. In the early ’90s, Chiroh purchased a cardiology practice not dissimilar to Father’s, run by a doctor named Rex Dumachas. Tall, blond, dashing, Dumachas had played college baseball at a Big Ten school—All-American—before going to medical school and ending up in interventional cardiology. Dumachas approached his job as an athlete would—driven by the competition, reveling in the physical demands—and his surgical output reflected it. Some weeks, upwards of eighty patients would come through his operating room to have their arteries widened and stents put in, an unheard-of number, Father explained.

Dumachas had been working at this prodigious pace for two decades, and by the point of his medical group’s sale to Chiroh, Dumachas’s handiwork was the stuff of local legend. But there were also murmurs of darker things. For years, Father had heard that Dumachas was more than a little too eager to cut you open and send you a bill. Some called him greedy. Having offered a number of second opinions for patients who weren’t convinced they needed the procedures Dr. Dumachas was suggesting, Father concluded the same.

In fact, greed didn’t even begin to cover it.

For fifteen years, Dumachas had not only performed unnecessary procedures on his patients, he had also used those unnecessary procedures to harm them. Gaining access to their coronary arteries, he would go in with his catheter and intentionally abrade an area along the healthy arterial lining. This created a future site of plaque buildup and eventual heart disease, each such abrasion worth at least a half million dollars in billable follow-up for a decade to come. It was criminal conduct, of course, but it didn’t come to light until after Chiroh bought the practice—bought it in large part for the extraordinary cash flow produced by these criminal activities, which Chiroh was not aware of and which were discovered, Father said, only because of an affair with an OR nurse gone awry. A participating accessory in his scheme, Dumachas’s jilted mistress took her revenge by alerting the administrative authorities; an internal review of patient records followed and found the recurrence of heart disease in precisely the same spot on the same coronary artery in over 2,500 patients. Statistically implausible at best.