She had to take the day off so he could see a doctor. Time off was always a risk. Though she’d been halfway to her business degree when she’d left home, now she worked as a maid at the Osaka Hotel in Japantown, and they were strict about attendance. Even if the reason was good, Luz knewthat every day she missed work counted against her. The clinic said they could see him before noon—a miracle—so maybe she could get his prescription and have Ramiro back at school by lunchtime; then she could still put in a half day back at the Osaka.
She had lived in San Francisco for over ten years now, though she would never call the place home. After the opponents of land reform in El Salvador had killed her father, a newspaper publisher, and then her brother Alberto, a doctor who had never cared about politics, she had fled north with her baby inside her. It had taken her husband, Jose´, almost three years to follow her here, and then last year La Migra had sent him back. Now, unable to find work back home, he lived with her mother.
She shifted on her seat on her way to the Judah Clinic, which was not on Judah Street at all, but two blocks before Judah began, where the same street was called Parnassus. Why did they not call it the Parnassus Clinic, then? She shook her head, these small things keeping her mind from what it wanted to settle on, which was the health of her son.
And of course the money. Always money.
Ramiro’s tiny hand lay like a dead bird in hers as they walked from the streetcar stop to the clinic, a converted two-story Victorian house. When she opened the front door, she abandoned all hope that they’d get to her quickly. Folding chairs lined the walls of the waiting room. More were scattered randomly in the open space in the middle, and every seat was taken. On the floor itself, a half dozen kids played with ancient plastic blocks, or little metal cars and trucks that didn’t have all the wheels on them.
Behind the reception window, four women sat at computer terminals. Luz waited, then cleared her throat. One of the women looked up. “Be just a minute,” she said, and went back to whatever she was doing. There was a bell on the counter, with instructions to ring it for service, but the computer woman already had told Luz she’d just be a minute (although now it had been more like five), and Luz didn’twant to risk getting anyone mad at her. They would just go more slowly. But she was angry, and sorely tempted.
At last the woman sighed and came to the window. She fixed Luz with an expression of perfect boredom and held out her hand. “Health card, please.” She entered some information into her computer, didn’t look up. “Ten dollars,” she said. After she’d taken it and put it in a drawer, the woman continued. “Your son’s primary care doctor is Dr. Whitson, but he’s unavailable today. Do you have another preference?”
Luz wanted to ask why Dr. Whitson was unavailable, but knew that there would be no point in complaining. If Dr. Whitson wasn’t here, he wasn’t here. Asking about him wouldn’t bring him back. “No.” She smiled, trying to establish some connection. “Sooner would be better, though.”
The woman consulted her computer screen, punched a few more keys. “Dr. Jadra can see Ramiro in twenty-five minutes. Just have a seat and we’ll call you.”
The words just popped out. “But there are no seats.”
The woman flicked a look to the waiting room over Luz’s shoulder. “One’ll turn up any second.” She looked past her. “Next.”
While Ramiro dozed fitfully, Luz picked up a copy of the latest edition of San Francisco magazine. There were many of them in the room, all with the same cover photo of a strong Anglo businessman’s face. Luz read English well and soon realized the reason for the multiple copies. The story was about the director of Parnassus Health—her insurance company. The man’s name was Tim Markham. He had a pretty wife, three nice-looking children, and a dog. He lived in a big house in Seacliff and in all the pictures they took, he was smiling.
Luz cast a glance around the waiting room. No one was smiling here.
She stared at the face for another minute, then looked down at her sick boy, then up at the wall clock. She wentback to Mr. Markham’s smiling face, then read some more. Things were good in his life. His company was experiencing some growing pains, yes, but Markham was on top of them. And in the meantime, his patients continued to receive excellent medical care, and that was the most important thing. That was what he really cared about. It was his lifelong passion.
Finally, finally, a nurse called Ramiro’s name. Luz folded the magazine over and put it in her purse. Then they walked down a long hallway to a tiny windowless room with a paper-covered examining table, a sink and counter, a small bookcase and shelves. Posters of California mountain and beach scenes, perhaps once vibrantly colored, now hung faded and peeling from the walls.
Ramiro laid himself down on the table and told his mom he was cold, so she covered him with her coat. Luz sat in an orange plastic molded chair, took out her magazine, and waited again.
At 12:22, Jadra knocked once on the door, then opened it and came in. Small and precise, completely bald, the doctor introduced himself as he perused the chart. “Busy day today,” he said by way of apology. “I hope you haven’t had to wait too long.”
Luz put on a pleasant expression. “Not too bad.”
“We’re a little shorthanded today. Twenty doctors and something like eight have this virus going around.” He shook his head wearily. “And you’re Ramiro?”
“Samp2;´.” Her boy had opened his eyes again and gotten himself upright.
“How are you feeling?”
“Not so good. My throat…”
Jadra pulled a wooden stick from a container on the counter. “Well, let’s take a look at it. Can you stick out your tongue as far as you can and say ‘ahh’?”
That examination took about ten seconds. When it was over, Jadra placed a hand on the boy’s neck and prodded around gently. “Does that hurt? How about that?”
“Just when I swallow.”
Five minutes later, Luz and Ramiro were back outside. They’d been at the clinic for over two hours. It had cost Luz ten dollars, more than she made in an hour, plus a full day’s wages. Dr. Jadra had examined Ramiro for less than one minute and had diagnosed his sore throat as a virus. He should take Children’s Tylenol and an over-the-counter throat medication. He explained that the way viruses work, symptoms go away by themselves within about fourteen days or two weeks, whichever came first.
A joke, Luz supposed, though it didn’t make her laugh.
Two days later, Ramiro was worse, but Luz had to go to work. Last time they’d warned her about her absences. There were a lot of others who would be happy to take her job if she didn’t want to work at the hotel anymore. So she had to take Ramiro into urgent care at night, after she got off.
On the bus, she gathered him in next to her, wrapped her own coat over his shivering little body. He curled up and immediately fell asleep. His breathing sounded like someone crinkling a paper bag inside his lungs. His cough was the bark of a seal.
This night, the clinic was less crowded. Luz paid her ten dollars and within a half hour, full dark outside now, she heard Ramiro’s name called. She woke her boy and followed a stout man back into another tiny office, similar to Dr. Jadra’s except there was no art, even faded.
Ramiro didn’t notice. He climbed onto the paper-covered examining table, curled his knees up to his chest, and closed his eyes. Again she covered him with her jacket, and again she waited. Until she was startled awake by a knock at the door.
“I could use a nap myself,” the woman said gently in good Spanish. She wore a badge that saidDR. JUDITH COHN. She studied the folder, then brought her attention back to Luz. “So. Tell me about Ramiro. Where did he get this cut?”
“At school. He fell down. But he complains of his throat.”
The doctor frowned deeply, reached for a tongue depressor. After a longer look than Dr. Jadra had taken, Dr.Cohn turned to Luz. “The throat doesn’t look good, but I really don’t like the look of this cut,” she said in Spanish. “I’d like
to take a culture. Meanwhile, in case it isn’t a virus, I’ll prescribe an antibiotic.”
“But the other doctor…”
“Yes?” She reached out a hand reassuringly. “It’s okay. What’s your question?”
“The other doctor said it was a virus. Now it might not be. I don’t understand.”
Dr. Cohn, about the same age as Luz, was sympathetic. “Sometimes a virus will bring on a secondary infection that will respond to antibiotics. The cut looks infected to me.”
“And the drug will take care of that?”
The doctor, nodding, already had the prescription pad out. “Does Ramiro have any allergies? Good, then. Now, if for some reason the cut doesn’t clear up, I might want to prescribe a stronger antibiotic, but I’ll let you know when I get the results of the test.”
“When will that be? The results?”
“Usually two to three days.”
“Three more days? Couldn’t we just start with the stronger antibiotic now? Then I would not have to come back for another appointment.”
The doctor shook her head. “You won’t have to come here again. I can call in the other prescription if we need it.”
Luz waited, then whispered, “There is also the expense, the two prescriptions.”
Dr. Cohn clucked sadly. “I’m sorry about that, but we really don’t want to prescribe a stronger antibiotic than Ramiro needs.” She touched Luz on the forearm. “He’ll be fine. You don’t need to worry.”
Luz tried to smile. She couldn’t help but worry. Ramiro was no better. In fact, she knew that he was worse. Despite her resolve, a tear broke and rolled over her cheek. She quickly, angrily, wiped it away, but the doctor had seen it. “Are you really so worried?”
A mute nod. Then, “I’m afraid…”
The doctor sat down slowly and leaned in toward her. Shespoke in an urgent whisper. “Everything will be all right. Really. He’s got an infection, that’s all. The antibiotics will clear it up in a few days.”
“But I feel…in my heart…” She stopped.
Dr. Cohn straightened up, but still spoke gently. “You’re both very tired. The best thing you can do now is go home and get some sleep. Things will look better after that.”
Luz felt she had no choice but to accept this. She met the doctor’s eyes for a long moment, then nodded mechanically and thanked her. Then she and her bundled-up and shivering son were back out in the cold and terrible night.
1
At around 6:20 on the morning of Tuesday, April 10, a forty-seven-year-old businessman named Tim Markham was on the last leg of his customary jog. Every weekday when he wasn’t traveling, Markham would run out the driveway of his mansion on McLaren within minutes on either side of 5:45. He would turn right and then right again on Twenty-eighth Avenue, jog down to Geary, go left nearly a mile to Park Presidio, then left again back up to Lake. At Twenty-fifth, he’d jog a block right to Scenic Way, cut down Twenty-sixth, and finally turn back home on Seacliff where it ran above Phelan Beach.
In almost no other ways was Markham a creature of habit, but he rarely varied either the route of his run or the time he took it. This morning—garbage day in the neighborhood—he was struck by a car in the intersection just after he left the sidewalk making the turn from Scenic to Twenty-sixth. The impact threw him against one of the trash receptacles at the curb and covered him in refuse.
Markham had been jogging without his wallet and hence without benefit of identification. Although he was a white man in physically good health, he hadn’t yet shaved this morning. The combination of the garbage surrounding him with his one-day growth of beard, his worn-down running shoes, and the old sweats and ski cap he wore made it possible to conclude that he was a homeless man who’d wandered into the upscale neighborhood.
When the paramedics arrived from the nearby fire station, they went right to work on him. Markham was bleeding from severe head trauma, maybe had punctured and collapsed a lung. He’d obviously broken several bones including his femur. If this break had cut an artery, it was a life-threatening injury all by itself. He would clearly need some blood transfusions and other serious trauma intervention immediately if he were going to have a chance to survive.
The ambulance driver, Adam Lipinski, was a longtime veteran of similar scenes. Although the nearest emergency room was at Portola Hospital, twenty blocks away in the inner Richmond District, he knew both from rumor and personal experience that Portola was in an embattled financial state right now. Because it was forbidden by law to do otherwise, any hospital would have to take this victim into the ER and try to stabilize him somewhat. But if he was in fact homeless and uninsured, as Lipinski suspected, there was no way that Portola would then admit him into the hospital proper.
Lipinski wasn’t a doctor, but he’d seen a lot of death and knew what the approach of it could look like, and he was thinking that this was one of those cases. After whatever treatment he got in the ER, this guy was going to need a stretch in intensive care, but if he didn’t have insurance, Lipinski was all but certain that Portola would find a way to declare him fit to move and turf him out to County.
Last month, the hospital had rather notoriously transferred a day-old baby—a baby!—to County General after she’d been delivered by emergency C-section in the ER at Portola in the middle of the night, six weeks premature and addicted to crack cocaine. The mother, of course, had no insurance at all. Though some saint of a doctor, taking advantage of the administration’s beauty sleep, had simply ordered the baby admitted to Portola’s ICU, by the next day someone had decided that the mother and child couldn’t pay and therefore had to go to County.
Some Portola doctors made a stink, arguing that they couldn’t transfer the mother so soon after the difficult surgery and birth—she was still in grave condition and transporting her might kill her, and the administration had backed down. But it countered that the baby, Emily, crack addiction and all, would clearly survive the trip across town. She would be transferred out. Separated from her mother within a day of her birth.
At County General, Emily had barely held on to life for a day in the overcrowded special unit for preemies. Then Jeff Elliot’s “CityTalk” column in the Chronicle had gotten wind of the outrage and embarrassed Portola into relenting. If not for that, Lipinski knew that the poor little girl probably wouldn’t have made it through her first week. As it was, she got readmitted to Portola’s ICU, where she stayed until her mother left ten days later, and where the two of them ran up a bill of something like seventy thousand dollars. And all the while politicos, newspaper people, and half the occupants of their housing project—whom the administration accused of stealing drugs and anything else that wasn’t tied down—generally disrupted the order and harmony of the hospital.
In the wake of that, Portola put the word out—this kind of admitting mistake wasn’t going to happen again. Lipinski knew beyond a doubt that once today’s victim was minimally stabilized, Portola would pack him back up in an ambulance and have him taken to County, where they had to admit everybody, even and especially the uninsured. Lipinski wasn’t sure that the victim here would survive that second trip and even if he did, the ICU at County was a disaster area, with no beds for half the people who needed them, with gurneys lining the halls.
But there was still time before he had to make that decision. The paramedics were trying to get his patient on a backboard, and the police had several officers knocking on doors and talking to people in the crowd that had gathered to see if anyone could identify the victim. Even rich people, snug in their castles, unknown to their neighbors, might recognize the neighborhood bum.
Because the body was so broken, it took longer than he’d originally estimated, but eventually they got the victim hooked up and into the back. In the meantime, Lipinski had decided that he was going directly to County. Portola would just screw around too much with this guy, and Lipinski didn’t think he’d survive it. He’d just shifted into gear and was preparing to pull out when he no
ticed a couple of cops running up with a distraught woman in tow.
He knew what this was. Shifting back into park, he left the motor running, opened his door, and stepped out into the street. As the cops got to him, he was ready at the back door, pulling it open. Half walking, half running, the woman was a few steps behind them. She stepped up inside and Lipinski saw her body stiffen, her hands come up to cover her mouth. “Oh God,” he heard. “Oh God.”
He couldn’t wait any longer. Slamming the door shut behind her, he ran back and hopped into his seat. They had their identification. And he was going to Portola.
2
In the days long ago before he’d hit the big four-oh, Dismas Hardy used to jog regularly. His course ran from his house on Thirty-fourth Avenue out to the beach, then south on the hard sand to Lincoln Way, where he’d turn east and pound the sidewalk until he got to Ninth and the bar he co-owned, the Little Shamrock. If it was a weekend or early evening, he’d often stop here to drink a beer before age wised him up and slowed him down. Later on, the beverage tended to be a glass of water. He’d finish his drink and conclude the four-mile circuit through Golden Gate Park and back up to his house.
The last time he’d gotten committed to an exercise program, maybe three years ago, he’d made it the first week and then about halfway through the second before he gave up, telling himself that two miles wasn’t bad for a forty-seven-year-old. He’d put on a mere eight pounds this past decade, much less than many of his colleagues. He wasn’t going to punish himself about his body, the shape he was in.
The Dismas Hardy Novels Page 52
