It is quiet.
The other time you walked through this door was when he welcomed you to the hospital. He took you for lunch, brought a number of senior doctors, and invited you to sign documents that allowed you to work, get paid and call yourself a staff surgeon. That was years ago.
This time there are no lunches.
Nobody accompanying you.
In recent days, people in your department have been uncomfortably polite. Friendly, but guarded. You know something is up, but you didn’t asked. You pretended not to notice the change in your environment. You carried on.
In your pigeonhole this morning, you found a terse memo asking you to be here at 5:15. The meeting scheduled just after your shift and after most of the Admin staff have gone for the day.
You walk through the office door and the noise and bustle of the familiar hallways is snuffed out. Mrs. Whitaker stands behind her desk and points to a chair. Then, perhaps just a bit too quickly, she began packing her purse. Grabbing the umbrella she doesn’t need, she comes around and places her hand on your shoulder. “He’ll be five minutes, Dr. Nugent.”
“Patrick,” you suggested.
She nods once and turns toward the door. When she closes the door behind her, the quiet became thunderous.
The chair’s flat, wide arms provide a perfect levelness upon which to perch a mug of coffee, or a set of access cards. It is the perfect chair for a long conversation or a midday nap—supple leather, slightly distressed from use, firm but soft. But you are not here to rest.
In this office, the beige walls are decorated with high-quality lithographs, not the starving artist landscapes that adorn the other boardrooms and administration desks in the hospital. The lithographs are numbered—Picasso, Dali and that Catalan painter you like but can never remember his name. The one with the birds.
You hear the muffled rhythm of a telephone conversation on the other side of the closed walnut door behind Mrs. Whitaker’s desk. You can just hear the distant bustle of the triage or a ward—far enough away to be white noise. The slight buzz of early onset tinnitus intrudes upon your solitude.
You are here because of a ham sandwich.
An emergency surgery during your call, preceded by a double shift to cover for a colleague—you don’t remember which one. Leaving the OR, you struggled with getting your gloves and scrubs off. You had to hold onto a railing to put your street shoes on. You checked the patient in Recovery. She was asleep. You could just focus on her vitals, gaining enough information to give orders that the patient be transferred to a ward when she wakes. You were wired, exhausted, shaky and ravenous.
Rather than head home or to the burger place across the highway, as you could have done, you settled for the proximity of the hospital cafeteria. Get some sustenance and then worry about a final check on the patient before cleaning up your charts and heading home for a proper weekend.
You ordered a coffee and a ham sandwich, found a table and collapsed hard enough into the metal chair that the legs scraped the concrete floor, causing the other patrons to stop and look. Your stomach whined, saliva filled your cheeks, you focussed on that first bite, ignoring all else that was going on around you. Only half-swallowed, your pager went off: the charge nurse from the recovery room, your surgical patient. The stable patient, cleared for transfer to a ward not twenty minutes ago. You were hungry and could repeat the order to transfer after the sandwich. You would think better with something in you, you reasoned. A couple of minutes.
It was not a good ham sandwich. The brown bread was soggy, the ham slithery, the Swiss-like cheese semi-liquid. Not a good sandwich at all. But something. A few sips of coffee to wash things down and a wipe of your mouth before heading to the handset by the water fountain to answer your pager.
“Pat?” a head pokes out the walnut door. “Are they gone?”
You look around. “They?”
“Come on in, Pat.” He waves you into his office.
“Have a seat, Pat.” He gestures to the chair across the large desk.
The repeated use of your name makes you feel uneasy. His language stilted, belying the smile on his face.
The office is as spacious as some of the surgery suites. A panorama of LA’s hills embraces the corner windows. In the distance, through these windows, you see a plume of smoke and wonder what is burning. An oriole lands on the ledge of the balcony this office commands. Its orange breast stark against the grey-green of the streets outside.
“I guess you know why you’re here?” he asks.
You shrug and answer honestly, “I know it has something to do with the investigation. I know it likely is not to pat me on the back…”
He frowns. “No one talked to you?”
“About this meeting? No. But I got your note and, like I said, it isn’t a surprise or anything that we have to talk.”
You wonder what an oriole is doing in LA.
He shakes his head and looks down at his hands folded on the desk. “I’m sorry, then. This wasn’t supposed to be an ambush.”
“Sir?” He has your attention now.
“Pat,” he looks up and into your eyes. “You have to go.”
You sit for a moment, unclear as to what he means. “Go?”
A slight irritation shows in his face. “Yes, Pat. Go. I have to ask for your resignation from the staff and the hospital.”
The past weeks crash down upon you—interviews, statements, meetings. Lawyers. Restrictions on your surgical times. A mentor after six years of practice. The unvoiced accusations. Your feeling of guilt. It all coalesces into a tiny ball on your chest. You find it hard to breathe.
“It’s out of my hands.”
“It was just a sandwich.” The oriole’s breast distracts you and you feel some tension release.
“That’s what you always say. It isn’t the sandwich. It’s ignoring the pager.”
“Not ignoring. Waiting. Eating. We all do it.”
“But we don’t all do it when the family is at the next table.”
“I didn’t know who she—”
“I know! Would you stop? Can’t you see? It’s the shits, but this is not the usual circumstance.”
You watch the oriole bob along the ledge, tilting its head as if wondering what you are doing inside of the window when you could be out in the sun. “It didn’t even make any difference. There’s nothing I could’ve done anyway.” He waits, looking at you. “All the consultants agreed. It had nothing to do with any time in particular. She dehisced and no way anyone could have—”
“Pat! I get it! I even agree. But she was the mother of our biggest donor. You ignored a pager to finish a fucking ham sandwich and you did it right in front of the family. It’s political. But it’s done. I am trying to make this easy and let you resign.”
Then you see something in his face, behind the wire-rimmed glasses. A bead of sweat trickles from his left sideburn. At first you aren’t sure what it is, but as you sit there, contemplating his words, his expression suddenly makes sense: hope mixed with fear. The kind of hope that won’t announce itself. Like the face you might see in a little kid when they are asking for a popsicle in the ER but aren’t sure you are on their side. A self-interested hope. There is likely a German word for it.
As you process, the oriole disappears behind the corner of the building and appears now over the CEO’s left shoulder. The CEO pretends to thumb through some papers on his desk. The oriole is looking through the glass, right at you. Even if the windows are reflective on the outside, you feel as if the oriole is trying to tell you something. Your attention goes back to the wire-rims and the sideburns and the now beads of sweat down his jaw. You find something: it is all appearance and reconciliation, with you in the way. In the way. And then you figure out what is behind that hopeful look. You can’t believe this is happening.
You aren’t anxious; you are angry. In that anger, you understand your next move. If you dare to make it.
And you do.
“So fire me.”
His head jerks up. “What?”
“Fire me. I didn’t breach any standard of care. Didn’t cause any death. Didn’t do anything that anyone else here hasn’t done a dozen times. I worked for thirty hours without a break because of staff cuts and a colleague wanting to go fishing. I was helping, being a team player. I was fucking hungry. So, fire me. Give it a shot. But lawyer up if you do. I’m not going quietly.”
He places his elbows on his desk and bows his head in his hands. He scrapes the top of his buzz cut with his right hand.
You continue, “Resign and I get nothing. No reference letter, no package, nowhere to go. All because of some political bullshit that made no difference. You don’t care about me or my feelings or my reputation, no one here does. You are all just looking out for you. After I covered for all of you. She died, but not because of me. And if the millions donated to build the McTwithead wing means you are hanging me out to dry, well don’t expect me to use a towel. So, fuck you and fuck the hospital and fuck the administration that doesn’t have my back—”
“What will it take?” he interrupts.
You realize that you worked yourself up with the little speech. His eyes are a steely grey-green as he directs this question to you. The hope that was there is gone. His back is rigid, and you know. They have chosen the donor. Loyalty drips off you onto the grey-blue carpet and pools there.
“Three years and a letter of reference … from you.” You throw out a large figure, but not colossal.
He shakes his head, but answers, “I can do twelve months and a letter from John.” He is ready for this. You sense he expected it. Perhaps he would have been disappointed without it.
You know immediately that this is his low number. A strange clarity has come now. The low number is Plan B that he hopes to get away with. You can sense that he wants this done. Quietly. In that instant, you are done with this. The oriole flaps its wing and leaps into the LA sky. You put on your poker-with-the-cousins-at-the-lake face and look him in the eyes. You don’t flinch.
“Two years and the letter’s from you—glowing, effusive even. Final offer.”
He taps his ring finger on a stone paperweight and rubs his forehead with the palm of his left hand. Out the window, a bi-plane pulling “Eat at Dutton’s” groans across the sky. The moment stretches into hours.
Finally, he looks up at you. “Done.”
On the way out of the hospital, your backpack full of locker contents, relief washes over you. You are tired and for the first time in years, free. As you walk into sunshine a flutter overhead draws your attention. A familiar orange breast glides over to something on the sidewalk. The oriole turns its head one way and then the other, examining the possibility. As you approach, he takes off. A small dropping lands on what you now see is half of a cafeteria sandwich.