Doctored

by Sandeep Jauhar

  I nodded, surveying the space, feigning awe. I asked him how long he had been working there.

  “You want to know if I am renting?” he said coyly. “That is what you want to know?”

  “Yes,” I lied.

  He took his time answering. “So let us just say we own the whole operation,” he said proudly.

  It was a huge practice with nearly a dozen employees and a plenitude of patients, mostly Dominican immigrants, who were shuffled through a dense maze of exam rooms. The waiting area always had a loud buzz, a communal conviviality, even at nine o’clock on Saturday morning. Spanish-speaking assistants were available, but they had many duties besides translation, so patients would sometimes wait hours to be seen. There was a podiatrist down the hall who was also renting space. He had an alert, shiny face and a streetwise, almost sinister aura. He would periodically come over, hinting that he wanted referrals, forcing small talk, slowing me down. He kept promising to refer his diabetics to me—as if I needed more patients—but he never did. We set up an echo machine next to my exam room so patients could be scanned while waiting for an interpreter. As soon as one became available, I’d take advantage and quickly go through two or three examinations without a break, slightly decanting the crowded waiting area. If I ordered a stress test, the patient would be offered car service to Chaudhry’s office on Long Island, along with a voucher for lunch.

  By the end, Chaudhry was treating me like a naive younger brother whom he was merely tolerating. He was clearly dissatisfied with my performance, though technically I was doing everything he was asking of me. Maybe he knew how I felt about his practice—or about private practice in general. At one point he drew up a contract giving me a small portion of the echo and stress fees as an incentive to work harder, but when payday arrived, I was reimbursed according to the old flat-fee formula.

  When he finally let me go in the spring of 2008, it was over the phone. “What I am saying, Sandeep, is, you have a shop, you open up a shop, anybody who walks in, you have to have a smiley face, right? These are small things that I hate to tell you, but these things are missing.”

  I had that sad, strange feeling of being jilted by someone I’d never wanted to be with.

  “If the money comes in, I don’t mind paying you, but right now you are living on my pie. What I have been trying to do for the last two years is create a separate pie for you, but somehow we have failed.”

  Unsure of how to respond, I stared at the speakerphone in my office. My leg was jumping up and down like a jackhammer.

  “I don’t see anybody referring patients to you, Sandeep. Sameer Chawla was sending in January, February, March—and then zero. I want to help you, but in this tight situation at least one patient should be referred to you through some connection. But not a single patient is coming.”

  “I don’t know why Sameer stopped referring,” I said. Sameer Chawla was a good friend of Rajiv’s. In January, Chaudhry and I had gone to his ramshackle office in Queens Village with a platter of Indian sweets and a few referral pads printed with Chaudhry’s contact information and a list of the insurance plans we accepted. We waited cravenly in our white coats among quiet turbaned patients until we were called in to see him. When we finally sat down with him, he seemed friendly enough, and he pledged to lend his support; but the goodwill had lasted only a few months.

  “Sandeep, you have to understand, running a big show costs a lot of money,” Chaudhry said. “I have two thousand square feet to cover, plus staff, plus nuclear machine, plus echo tech, plus Malik, plus Denis, plus certifications. I am no longer even doing stress tests every Saturday because if only five patients are coming, I still have to give full payment to Denis, full payment for the staff, full day to Malik. If I am not doing ten-plus nuclears on a given day, I am losing money.”

  My throat was dry. The other line rang, but I ignored it.

  “Last Thursday I canceled my office,” he went on. “I was sitting down like a CEO and thinking, Hey, Amir, what is going on? Why your revenue is so scanty? Do you know that now I only get thirty dollars for a follow-up and a hundred dollars for a new consult? If we don’t order a test—echo, carotid, arterial Doppler, nuclear, or stress echo—well, seeing patients is just garbage.”

  “But I order those tests,” I said weakly.

  “I am not talking about you, Sandeep! What I am saying is that in private practice the overhead is so high. And then on top of it I have to pay my biller. I’m telling you honestly, last year I was in debt.”

  I didn’t believe him, but at this point it didn’t matter.

  “So we can meet with Dr. Richards, like you wanted,” I said, trying not to sound desperate. “We can invite Dr. Kapoor out to lunch again.”

  But it was too late. “Sandeep, I respect you and I love you, but dollar has to come to pay you. If I get nada, then rather we both sit at home on the weekend. I have a family, four kids; living that lifestyle is expensive. If money is not coming, Amir cannot pay you. You have to understand, I am not a hospital.”

  After hanging up, I felt woozy, so I went outside for some air. I sat down on a bench near the parking lot. In the distance, tulips were shooting out of tiny plots on the sidewalk, like hands coming out of a grave. Chaudhry’s admonitions kept echoing through my head. “In private practice, you have to stay busy. If you don’t stay busy, you can’t make it work.” Now what to do? What did this mean? Were we going to default on our apartment? Were we going to have to switch Mohan to the shitty local school? Was I going to have to go back to taking Sonia’s father’s handouts? Or perhaps worst of all, was I going to have to quit my job and go into private practice full-time? I resolved not to tell Sonia anything, at least not immediately. I was hoping to find more work before we spent down the little savings we’d accrued.

  Shortly afterward, Sonia and I went on a long-planned trip with Mohan to Block Island, our first vacation in over a year. I hadn’t wanted to go, but I couldn’t bring myself to cancel at the last minute. We packed a cooler and a couple of suitcases and drove up to Point Judith, Rhode Island, to catch the ferry. The dock was brimming with summery excitement. Pretty girls in clingy summer dresses were clutching their boyfriends and sipping beer. We were the picture of happiness: a successful Manhattan doctor couple on an exclusive weekend getaway with their four-year-old son. But the picture lied.

  The ferry ride was choppy. Halfway across Block Island Sound I was wiping vomit off Mohan’s seat. When we arrived on the island, the sky was like a jar of dirty cotton balls. Stormy winds had started to blow. We hailed a cab to our inn. When we pulled up on the gravelly drive, it was already dusk. Whitewashed wood recliners were arrayed randomly on the sloping front lawn. A flock of blackbirds were zigzagging in the distance like one collective organism, apart from a lone straggler trying to merge with the group. Transfixed, I watched them fly overhead.

  That night, after unpacking, I went for a run. The rain had stopped, though the trees were still dripping noisily. The path through the field was muddy. The tall grass scraped against my green Gap pants. Because I had stupidly forgotten to bring my sneakers, I was wearing old leather dress shoes that were coming apart at the soles. I sprinted in near pitch darkness, feeling the pasty wetness in my toes. The shadows of trees sliced across the path. The air smelled of manure. My feet were splashing into puddles and crunching on fallen branches. I tripped on a reed, but I kept on going.

  Errant thoughts were racing through my head, flitting away like tiny minnows before I could grasp them. What is happening to me? Maybe I am depressed, or perhaps I am going mad; I don’t know. I want to regain some control, but the reality is that there is very little one can control in life. I find it hard to accept that, to let things go, to let things be, to see beauty in the obstacles, the denials, the thwarting of your goals and ambitions, to accept things as they are, as having their own kind of beauty and logic.

  A strange feeling had settled over me like a film of perspiration. At times it would well up inside me
like fluid filling a cavern, and as I would fill up, my neck and shoulders would get tight, and it would flow over my eyes, and that was when I felt most out of control. The fount would gush forth at the most inopportune times, and I could not control it, no matter how hard I tried. Dr. Adams, the psychiatrist I’d been seeing for the past few months, asked me to describe it as I faced him squarely in his tiny office on the Upper West Side.

  “It’s like butterflies in the belly,” I said. “It isn’t anger. Perhaps it’s anxiety that I cannot express the anger.”

  “Why the anxiety?”

  “I don’t know, but I am waking up with it and the workday hasn’t even begun. How do I make it stop?”

  I had become a slave to my circumstances. Dad was, too, for most of his life, but he didn’t experience the anxiety, just the darkness. I used to be so happy when Dad was happy. I didn’t want that to be the case for Mohan. I didn’t want his happiness to depend on me. I had adopted so many of Dad’s traits: paranoia, brooding, reluctant embrace of responsibility, a tendency to blame others for one’s own problems. Of course, I took on some good qualities, like commitment and perseverance—but, unfortunately, also self-righteousness, melancholy, insecurity, inflexibility. Recognizing this didn’t make it any easier, though. Perhaps what I was grieving over most was the inability to overcome my limitations.

  The following day I finally got to spend some one-on-one time with Mohan. “Did you have a good dream or a bad dream?” I asked him when he woke up.

  “I had”—he mulled over the answer—“a funny dream! A doggy came to my house. I loved it.”

  We spent the morning at the inn. The clouds had cleared, and the sun was shining brightly. Mohan and I tossed water balloons on the lawn. We visited a nearby petting farm. We swung together on a hammock strung between two trees.

  “I want to go forward, not backward.”

  “That’s forward, too, Mohan. Another forward.”

  “Another forward?”

  “Yes, another forward. You want to try?”

  “Uh-kay!”

  In the afternoon we went down to Old Harbor and had ice-cream cones while Sonia window-shopped. A band was playing at a tavern across the street. Mohan jiggled in my arms to the music. We watched as the ferry brought in another group of travelers. “It was a bad boat, Dadda,” he reminded me. “It was a bad ride!”

  That night, as a storm again raged, he settled next to me on a rocking love seat on the porch. Resting on my shoulder, his big head was a weight of stability and contentment. At that moment, nothing else seemed to matter. All the sacrifices in my life seemed worthwhile. I nuzzled him, smudging the lenses of my spectacles. I rubbed my stubbly cheek on his neck and shoulder. He giggled.

  “This whole town is a pool,” he declared.

  “You’re right,” I said. “That’s funny.”

  We stared into pitch. Water streamed in rivulets off the awning. Flowerpots were swinging wildly as the sky roared, periodically issuing electrical discharges into the blackness. Like me, Mohan seemed to find the storm relaxing. Clutching his hand, I could almost feel it vibrating, as if he were possessed of some otherworldly spirit. I palmed his cranium, squeezing it softly the way my father used to whenever I had a fever. He looked up at me and smiled, his tiny teeth arrayed like two rows of Chiclets. I wanted to be around him every single moment of his life. Marriage, I told myself, is the price of admission to the amusement park that is Mohan.

  No doubt our marriage had suffered in the four years since he was born; it had slowly, inexorably turned into an anxious wait to be disappointed. My mind had been going over old issues, old arguments, regurgitating the nasty things that were said, the old irritations. The stress of the financial situation and the moonlighting, adding to the pressure of my regular job and the ongoing guilt of not spending enough time with my patients, my colleagues, or my family, led to a state of chronic edginess and angry outbursts. When I’d come home, I’d feel stressed, unhappy. I didn’t want to talk, but it was impossible to avoid interaction in our shoebox apartment. And when I told Sonia any of this, it inevitably led to more conflict. “The way you reacted yesterday with obvious seething anger makes me wonder what good are these sessions with Dr. Adams,” she once said.

  “What do you want me to say? Tell me what you want me to say, and I’ll say it.”

  “I want to let go of resentments and live in the present moment, Sandeep. I’m being beaten down by all this.”

  “Can we please stop having these discussions in front of Mohan?”

  “What do you want me to do, Sandeep? Mohan, stop it! We are living lives of quiet desperation. I’ve been trying to tell you, but it doesn’t seem to bother you.”

  I had almost forgotten the way things used to be: the secret smiles, the tenderness. What had happened to those times? Were they a figment of my imagination? Perhaps they were, and the true reality was exposed only after we became parents. I had been a success at everything I’d tried: physics, medicine, fatherhood. Except perhaps at being a husband. But entropy is an inexorable force. It takes two to have a healthy relationship but only one to screw it up.

  I was constantly fantasizing about living my life all over again. It felt as if all the big adventures were finished and now I was just running out the clock. I was having dreams that I had never gotten married, never become a doctor or husband or father. I was going through the motions, searching for something, but I didn’t know what. No doubt I was following a script. But character is destiny. There is only so much you can do to overcome the constraints of your biology.

  On the porch I looked down at Mohan. A tear trickled down the bridge of my nose. Deep love is always mixed with a tinge of sadness because of the constant threat of its evaporating and the knowledge that it is short-lived, that it will all be over one day.

  “Dadda, you’re sad.”

  “No, I’m not.”

  “Yes, you are. You have that sad look on your face.”

  I forced a smile. “Give me a kiss.” He brushed his soft lips gently on my cheek. It tickled.

  “Why do you have to go to the office?”

  “You know why.”

  “Why?”

  “You know.”

  “Money?”

  I laughed. “Yes.”

  “So we can have money to buy lunch and clothes and toys?”

  I had to smile. “Yeah!”

  “But if you need money, you can just go to the bank.”

  “And if you don’t have money in the bank?”

  He thought for a moment. “Then you have to sit on a chair or a piece of wood and say”—his voice suddenly got deeper—“‘I want some money. Give me some money, please.’”

  Again I laughed. “Let’s go,” I said.

  He stood up. “You can’t pass unless you answer my riddle,” he said. I nodded. He paused for a moment. “What has hair, swings from branch to branch, and goes ooh ooh ooh ooh?”

  “Monkey?”

  “Yes.” Lightning crackled. “What’s big and strong and stomps like this?” He held out his arm and made a trumpet sound.

  “Elephant.”

  “Right! Okay, what runs fast in the dark and has hair and is really strong and scary?”

  “Lion?”

  “No.”

  “Is it a bird or an animal?”

  “Animal.”

  “I give up.”

  “Monster!”

  After putting Mohan to bed, I went to the bathroom. I looked into a mirror, one of those concave reflecting surfaces that magnify your reflection, your flaws and imperfections. I started brushing my teeth. Sonia came in. I still hadn’t told her what had happened with Chaudhry (though I did as soon as we returned home). There was a long silence, as if we were trying to think of something to say. Finally she said: “I think we should floss more. It’s the next best thing to going to a dentist.”

  PART III

  ADJUSTMENT

  FOURTEEN

  Deception

&nb
sp; We don’t want to admit that we are fundamentally dishonest about reality, that we do not really control our own lives.

  —Ernest Becker, The Denial of Death, 1973

  There is one thing that is liberating about middle age. Time is limited. You’re old enough to realize that life is finite but still young enough to act on that knowledge. But how to make the most of the time you are allotted? How do you find meaning in an existence you know is going to end? If life is a guaranteed tragedy, what prevents us from sinking into hopelessness, whiling away our time till our time comes?

  Perhaps it’s children. For many of us, children are our legacy, and what are we striving to do in this world more than bequeathing a piece of ourselves? The anthropologist Ernest Becker argues that anxiety over death is the most powerful force affecting human behavior. He says we deny our certain mortality by accruing symbolic victories of enduring value: conquering an empire, building a temple, writing a book. We strive for heroism as a means of denying our eventual fate. And in the vast array of possible immortality projects, perhaps none is as powerful as having children. Kids help you learn to accept your mortality because you start to love something more than yourself. Our selfishness consumes us. Children can rescue us from this fate.

  In many ways my children have been the redeeming grace of my middle years thus far. They are the reason I’ve compromised and also my salvation from the distress of compromise.

  * * *

  When I finally told Rajiv that Chaudhry had let me go, he of course blamed me. “You should have listened,” he said sadly. “It was easy money. Now what the hell are you going to do?”

  We were sitting in my office with the door closed. I yawned, trying to feign a lack of concern, but in reality I was petrified. The savings that Sonia and I had put away from the past two years of moonlighting were dwindling rapidly, and we were expecting our second child to boot. “I could try talking to him again,” I said. “I could go to Richmond Hill on Sundays when he doesn’t want to work.”