“Could you write me a prescription for Valium?”
It was the worst of times as far as Dr. Giuliano was concerned. His call group had fallen apart several months ago and since then he had been on call for himself every night and every weekend. His nurse, Jessica, was sure she had heard him talking to himself behind closed doors and thought he was looking more and more like the toxic interns she remembered from her days at the university hospital.
Earlier that morning, he's finally had the sit-down he had been anticipating for so long with two of the clinic higher-ups. He had asked to be moved from his lonely satellite office to the main clinic building, where he might enjoy the camaraderie of other physicians. They had refused; it wasn't in the clinic's best interests, they had said. He had asked whether he might be moved to another satellite closer to home, to cut down on his one-hour commute. Again, they had refused. He had expressed his dismay over the financial statements they had given him: his collections during the previous year had totalled $300 000, but he was entitled only to a salary of $60 000. Overhead, he had been told. See more patients.
After the meeting had followed the usual parade of upper-respiratory infections and psychosomatic complaints. Then came Mrs. Janice. Fiftyish, with a history of countless cosmetic surgeries, including a breast augmentation and a facelift (Giuliano supposed he could bounce a quarter off her face), she had returned to request for the umpteenth time a letter stating that it was medically necessary for her augmentation to be revised. Fumbling with the change in his pocket, Giuliano had declined.
And now here was Mr. Byrthen, back again for benzodiazapines for which he had no discernible need.
How many more patients like this was he fated to see? How many more would come, asking him to practise something that bore no relation to medicine the way it was supposed to be? How many men wanting more scalp hair? How many women wanting less facial hair? When, he wondered, had medicine assumed the goal of moving hair from women's faces to men's scalps?
What was he doing? It seemed as if somewhere along the way his life had slipped off the tracks. No, if the truth were known, it seemed as if somewhere along the way some malevolent hand (had it been his own?) had thrown a switch and sent him careening in an unforeseen direction. But what could he do? He felt a growing tightness in his chest and a lump in his throat, which a recent flirtation with Chinese medicine told him was probably stagnation of liver-qi, rule out angina pectoris. He sighed deeply.
As his mind's eye searched its horizon for a way out, its physical counterpart moved too, happening on a picture on the wall before him.
It was a photo of one of his patients skydiving, taken during free fall. Giuliano closed his eyes and imagined what that must have felt like. He was sure such an experience must have a salutary effect on the mind. He imagined the upward rush of air blowing the dust out of his brains, the upward rush of earth rendering irrelevant such concerns as “I hate my job,” or “How will I pay my mortgage,” or even “What is the meaning of life?” No, the only question that really mattered was, “Is my parachute going to open?”
“ ... hear what I said?”
Giuliano's attention returned to Mr. Byrthen. “I'm sorry?”
Byrthen, visibly agitated, was glaring at him. “I asked whether you'd heard anything I said!”
“I did,” Giuliano affirmed, rising from the chair and walking over to stand before his patient. He paused. He felt ... different. He smiled for the first time in a long time. “I can't write that prescription for you — philosophical reasons, you understand — but I'll deputize you so you can write it yourself.”
“I can't do that!” Byrthren (who most assuredly did not understand) spluttered.
“Sure you can,” Giuliano replied calmly, delighted that he had found a way to accommodate Byrthren without compromising himself. He touched first Byrthren's left ear, then his right, and then his precordium, in the sign of the stethoscope.
“Dr. Giuliano — Byrthren started, shaking his head from side to side in protest.
Giuliano's smile faded for just an instant. “No, no, no, it'll be fine,” he said, touching Byrthren on the shoulder reassuringly. The smile returned. He removed the Hewlett-Packard stethoscope from the pocket of his white coat and draped it around Byrthren's neck. Then, reaching out, he shook Byrthren by the hand, turned on his heel, and swung open the door of the examining room.
Jessica was standing with her hand in the air, ready to knock. It was time for the next patient.
Giuliano swerved past her, snapping off a crisp salute without breaking stride. He was humming a phrase from “California on my mind.”
Jessica called after him as he headed for the office exit.
“Dr. Giuliano, you have four more patients this morning.”
Without turning, he answered, “Dr. Byrthren will see them.”
Jessica turned to Mr. — Dr. — Byrthren.
“Does this mean I get my co-payment back?” he asked.
Frederick Paola Assistant Professor of Medicine Division of Medical Ethics and Humanities University of South Florida College of Medicine Tampa, Fla.