Changing of the Guard


When Charles Hayes departed America to go to China, he left with every intention of not coming back.  He was as resolute on that matter as any of Napoleon’s frozen and starving and bedraggled troops retreating from Moscow and the Russian winter.  Only the Pacific would afford him enough distance from the specter of three divorces over the course of the eleven years he called the Bay Area home.  Medical School had been UCLA, but for residency, he traveled north to Stanford where he studied internal medicine.  Attracted to the Bay Area, he stayed on, and bought a modest ranch-style house before the realty went sky high during the Internet boom.  There, in San Carlos, he practiced in a four man group.

The asperity of practicing internal medicine, paled in comparison to the domestic skirmishes he endured in each of his three marriages.  During the Internecine stands, he was bombarded by the cruel and ruthless demands of these women.  These women who once told him of their never-ending love, now set upon him like hounds upon the fox.  His checking and savings account drained, it was time to get as far away from the field of battle as he possibly could.  Not just from the Bay Area, but also the United States.  For a new job, he perused the Internet nightly.  There, late one night, after countless hours on the Internet, he found an ad that piqued his curiosity.  It was for a job doing internal medicine on the other side of the earth in Beijing. Charity Hospital was seeking two internists to ply their profession in China.  The salary was comparable to what he was making in his wavering practice.  It was his ticket out of the Bay Area.

Dialing the Charity Hospital the next day, he was transferred to the human resources director.  In a capsulized version that he was sure she had down by rote, she painted a picture of the medical care in Beijing.  Surrendering to the complaints of the expatriates who were fed up with the filth found in the medical facilities, the long queues to see the doctors, the negligence of their care, the Communist Party relented, allowing, in 1994, the first private clinic to be established.  But there were no private hospitals.  Into the void waded Lena Levinson.  With strong will and backers who had deep pockets, she built the Charity Hospital.  Though it was a modest-sized facility compared to the other hospitals in Beijing, it did a landslide business, for it was clean, it had Western doctors, and there were no long lines.  Suffused with a feeling of mid-life rebirth, he joined the internal medicine team as they rounded on their patients in the hospital the day after he arrived.  The other internists greeted him warmly, if not warily.

So Hayes was thrown into the fray.  Initially it was chaotic on the wards and in the clinics.  Chuck Mattingly was the head of the department, but it was Bud Majors, an internist there going on five years, who took him under his wing and showed him how to get things done.  True he worked more hours than he cared to, as he waded through the charts in the clinic, obtaining histories, doing physicals.  But he was glad to be working and not home alone contemplating the calamities of his conjugal adventures so far in life.  For Hayes, not yet forty, the marriages, in all their dreadful variations, played time and again in his mind like a sixteen millimeter film that never quit running.  There must have been good times, but he didn’t really recall them.  These nocturnal apparitions drove him to start taking something to sleep the nights he was not on call.  Determined to make the most of his time on the medical service, he never questioned a colleague over minor clinical matters that were long passé, never had a harsh word for a nurse, never challenged an emergency doctor about an admission.

To keep the doctors’ salaries high, their investors happy, Charity Hospital was, more than any institution he had ever worked for, an institution built on greed.  Sheer greed was the only word for it.  Rather than practicing conservative medicine, the doctors were goaded by the administration to get any conceivable test to diagnose or treat a condition.  Twice he was passed over for bonuses because his monetary production was not as high as the munchkins working in billing felt it should be.  But Hayes, nurtured in the old school, wasn’t going to change for them.

Fred Mattingly, the chief of the medical department, took him aside one morning after rounds.  “Charles, administration has no problem with your skills in medicine, but they wanted me to speak to you about your billing.  The numbers just aren’t where they should be.”

“Have I ever let the medicine down?  Lena won’t be happy until she controls all private medical care in the Middle Kingdom.  I’m a simple doctor.  I’ve always been a simple doctor.  I’m not about to become an accountant, too.”

“Charity Hospital is like any other.  Money greases its wheels.”

“Lena doesn’t regard the people who go through her doors as patients.  She regards them as marks.”

“Are you saying that we don’t practice good medicine here?”

“Take it any way you like.”

“I’m trying to watch your back, Chas.”

“You shouldn’t have to.  Now, if you don’t mind, I have to get to the clinic.

Mattingly was scarcely more sympathetic in the following days.  He felt that he was in some observation tank where everyone was looking at him.  Born and raised in Western Colorado, he had always been schooled by his parents to respect doctors and the medical profession.  Yet, whenever he heard his father speak of physicians, you could tell that there was the slightest trace of mistrust for them as well.  His parents never went to the doctor until they were on death’s door.

Time passed.  He felt no less scrutinized.   Then one day when he was working in the urgent care, one of his favorite patients, Jesse Graham, a seventy-something Englishman, came in with a recurrent medical problem.  Lavaging the wax out of someone’s ear was the bane of a primary care doctor.  But he had his own cure of the problem.  Before he attempted to remove a wad of wax, he instilled Ceruminex first to soften it up.  The Ceruminex was missing from the exam table’s drawer.  When he went out there, he found a woman at the pharmacy desk talking to Ping, the pharmacist on duty, about her medication.  Trying not to be too intrusive, he said, “Ping.  I don’t mean to interrupt you, but where do…”

“How dare you interrupt me?”  The woman was pointing a finger at him and continuing her harangue.  “I’m a friend of Lena Levinson’s.  A personal friend.  By tomorrow she’ll know what a mean and nasty doctor she has on her staff.”

Stunned by the woman’s reaction, all he could do was apologize, but she continued her harangue.

Her daughter, a child who looked to be four or five, wandered over.  She stood between him and the door to the pharmacy, where he knew the Ceruminex was.   Hayes attempted to get the girl by gently waving his hand, indicating that he needed her to move.  It worked.  He finished his shift in the urgent care in a black mood.

The next morning, there was a note informing him to report to Lena personally.  At first he was puzzled by the note.  Why would she want to see me?

No sooner than he sat down at the conference table, Levinson asked him, “You want to tell us what happened in the clinic yesterday?”  Sitting at the table with her were Mattingly and the risk manager for the hospital.  Hayes explained calmly – though a rage was being kindled in him – leaving nothing out.

“The father said that you traumatized his daughter,” said Levinson.

“I no more frightened her than I would have exposed myself to her.”

But the longer Hayes talked, the less credence they put into his story.   David Bull, the general practitioner who nursed him through the world, would have turned in his grave.  Patients as customers.  What would he have said, standing there being accused of traumatizing the daughter.  Would he have laughed?  Would he have sighed?  Would he have thrown the woman out of his clinic.  He was tough as saddle leather, and of good pioneer stock, as the old-timers referred to people who crossed the plains and took and nurtured the West.

“I want you to write a letter of apology to the woman,” said Lena.

“I’ll quit before I apologize for something I didn’t do.”

“I’ll accept your resignation by tomorrow morning,” said Levinson.


By Joseph Dylan


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