INTO THE WHITE
Pediatricians called them FLKS, funny-looking kids. Not a very sensitive term but professionals knew what it meant. There was something wrong with the infant but they couldn’t quite make a diagnosis.
At birth, he was labeled an FLK. His forehead was very prominent, his eyes were large and bug-like. His ears were set very low and stuck out almost at ninety degrees. He looked to be stuck in the embryo stage of human development yet he made it down the birth canal.
With time FLKS tend to normalize but not so in his case. Being different he was bullied and so retreated to the safety of the library. He studied obsessively, went to college, graduated in two- and- one-half years, and was off to medical school on a nerdy fast-track lack of humanity program. He would get an M.D. degree in two years and then he would show them.
Wounded and hurt he would seek revenge by education.
Some of his features softened but there remained an unusual look about him. The doctor had a peculiar, pale, waxy complexion. His translucent skin never felt the warm sunshine. He preferred the anatomy lab.
In his twenties, his skin color was caramel or butterscotch or khaki. His hair was dishwater blond. A wispy mustache and fading freckles provided a bit of contrast and color to his face, but they were like grains of sand that would be blown away with time and misdeeds, leaving him absent of color.
Evil deeds are supposed to darken the soul. “Blackbeard the pirate, whose heart was blacker than his beard.” In the doctor’s case, as his actions became more devious and cruel, he bleached white.
At the start of his medical internship, he was given a short white coat on which his name was embroidered. He did not like his doctor’s coat. It made him look like everybody else and he thought himself special. When he was an adolescent he wanted to look like everybody else, but no longer.
Medical students, interns, residents, and senior medical attendings wore a short white coat unless elevated to full professor. He thought the short coat was okay for a medical student but was undignified for a doctor and gave the appearance of an ice cream man.
Full professors of medicine wore a long white coat that signified academic success and prestige. For the younger doctors, a short white coat was a cocoon from which to emerge, for the older ones it was the straight- jacket of career failure.
The young doctor vowed that one day he would wear a long coat, but not just any long coat, from any hospital. The more prestigious the hospital the fewer full professors and the fewer long white coats issued. Second- and- third-rate hospitals gave doctors a long coat as soon as they graduated from medical school. He would not go to one of those hospitals but would obtain a long coat from a distinguished medical center where it meant something.
He thought the long white coat would fit him well and grant him all its privilege and opportunity. He thought it would compensate for, and perhaps enhance his looks.
During his interview for a medical internship, he said he went to Harvard. After fact-checking, it was found to be a false statement. He did one summer in a research lab at a Harvard-affiliated hospital, but he did not have a Harvard appointment. It was a huge difference and fraudulent on a curriculum vitae.
The academic fraud was discovered and he came very close to being blackballed from prestigious programs. He said it was a misunderstanding for which he was sincerely sorry. He got a second chance and his academic career remained on an upward deceitful trajectory. The doctor kept his buggy eyes on the prize of the long white coat.
A few gray hairs appeared in his mustache. He assumed that the anxiety of the discovery of his academic fraud worried him and brought on the gray. But he weathered that storm and obtained a prestigious internship.
The close call made him stronger and more resolute. He learned lies could be useful, but you had to be careful. You needed a good memory and his was photographic so lies would be in his portfolio.
He made a rare mistake and had to get married during his internship. Once the child arrived, he only went home to sleep or to change into clean clothes that his wife washed and pressed. She was very proud of her driven husband and made allowances for him. She believed his neglect would be temporary. After all, they were a team.
He remained in the hospital long after his fellow interns went home. The baby was a disturbance. The doctor was a big-time suck- up to those above him and terrible to those below him. He was “kiss up and kick down.” But it worked. It got him promoted to chief resident where he could lord over the first-, second-, and third-year residents. The power became a narcotic.
He was ruthless and berated younger doctors for trivial mistakes and for greater mistakes he got residents disciplined or removed from the program. It was almost unheard of, but he managed to do it. The young doctor used a few lies when necessary, especially when a resident showed academic promise and was a perceived rival for the long white coat.
He liked to watch his political victims squirm and have them wait for months before their fate was known. That became an acquired taste. Now he was the bully.
Oh, how the worm turned.
The doctor spent more time away from home, slept little. Once his infant cried so loudly that he picked the child up and was about to shake him into silence. His wife smacked him on the head with a medical text and saved their baby and his career.
She had enough violence and divorced him. He didn’t have much yet, just ambition. No great loss he figured, got rid of baggage. Visiting rights never came up because he never pursued them.
The almost shaken-baby incident turned the divorce in her favor, she didn’t have to mention the occasional black eye.
That incident turned his mustache white, and some flecks of gray appeared around his temples. At thirty-three, he was graying prematurely.
He heard stories of people who went gray overnight after exposure to severe emotional trauma. He didn’t feel emotional about anything, so he wondered how the gray leached in.
He thought of Grecian Formula or Just for Men. No, he thought, the gray made him appear scholarly, wise beyond his years. He started to wear bow ties. It made him feel natty and professorial.
From chief resident, he got promoted to the attending staff. He was still in a short white coat, the same as those worn by medical students and the failures. A bow tie and a short white Chaplinesque coat were not a match. He continued to gaze at the long white coats with envy. That coat was made for him. It would bring fear and respect.
The doctor got the job of Assistant Chief of Medicine. He worked at the behest of the Chief. Whatever the Chief wanted; he would do. If a staff doctor complained of the high mortality and complication rates in cardiac catheterization the complainer was dismissed from the staff because the Chief told him to find a reason. He manufactured one. He loved ruining the careers and lives of colleagues.
He became grayer which didn’t bother him but the remaining pigment on his face began to fade to a different shade of white. Patches of ivory appeared on his chin and cheeks. The medical term for the lack of pigment was vitiligo. He worried that it could be an indication of an underlying disease, a glandular disorder. Inner turmoil, and emotions out of check, could bring on vitiligo but once again he felt no emotion. The changes to his body perplexed him, but eventually, he dismissed them.
His mentor and Chief arranged incentives, kickbacks really, for high-earning doctors with the expectation that they brought procedures and admissions into the hospital. Money did not change hands, but they were given breaks with rent, supplies, and support staff. Those that did not receive the kickbacks complained. The complainers were suddenly found to have made too many medical mistakes and were removed by the Chief of Staff. There were no more complaints about hospital kickbacks.
Research money was absconded and put in the general fund which was controlled by the Chief and Assistant Chief of Medicine. The researchers that obtained the grants complained. An accounting error was discovered, and the medical researchers were given the option of resigning or losing their license, or being prosecuted for malfeasance.
Mortality statistics were doctored in the hospital’s favor. Whistleblowers banished. Mistakes whitewashed. The two worked as bad cop, worse cop. But the Chief had the long white coat that he coveted.
He saw his opportunity when he heard a rumor that the Chief of Medicine was having an affair with a medical student. He amplified the rumor. He didn’t know and didn’t care if it was true. It happened a lot so it would be believed. The Chief could have fought the allegations, but he took his retirement and left. You don’t fight the hospital, they have too much money and too many lawyers, and he needed to keep his retirement.
The exiting Chief understood the power of lies in a pathologically protected and insulated institution. After all, he created it and thrived in it and his protégé did exactly what he would have done. Checkmate.
The doctor became the acting Chief; he was only thirty -six and on a tear to become the full-time Chief. Rule of law and due process were his. He understood hospital discipline was political and arbitrary. His behavior was getting so bad that some of the doctors discussed forming a union. He had insiders; ambitious men like him, only younger and coveting a long white coat, give him the names of the doctors who wanted to form a union. The hospital was mortally afraid of collective bargaining and fairness. He gave the union organizers’ names to the corporate administrators and the rebellious doctors were fired. He made it worse by bringing their competency into question and had them placed in the career-ending Medicare data bank. Once in the data bank, you can never work in an accredited hospital. That should be a lesson to others of like mind. He pressed on and several white patches bleached his face and appeared on his arms.
The advent of the computer allowed him to track the activity of physicians. If they became a problem, he could work with the IT department and the higher-up thugs in security to get the doctors kicked off for bogus HIPAA violations. The computer would back his lies.
Older doctors that wrote in the charts with Mont-Blanc fountain pens and were hunt and peck typists often left the computers on. He had others tailgate their computers, framed them for a breach, and had them dismissed on a fabricated HIPAA privacy violation. He got rid of deadwood with seniority which would make more long white coats available. The computer and electronic medical records turned lies into convincing unassailable truths.
His hair was cotton white. But he was promoted to Chief because he busted the union. The youngest Chief of Medicine in the country. He had just turned forty.
He married again. His wife got breast cancer, had a mastectomy and chemo. He started dating, once his wife died, he married for the third time. He didn’t wait the usual year. You needed to be married to get the long white coat and with his wife dying he had to start dating before she died.
He kept the staff under his thumb, but it was no longer enough. He learned that for every physician there were ten administrators. They knew nothing of medicine or surgery, but they were accountants and called the shots. He would have to suck up to them.
His pale blue eyes focused on the corporate administrators. He could never get them under his thumb because they held all the cards and money. For him to get the long white coat he would have to ingratiate himself to them. It was no longer about academics or research or teaching. The administrators were non-medical and from the lower third of the business schools and he thought them beneath him, but things had changed. He had to befriend them. The hospital was no longer into heath care. The businessmen used it as a screen to get not-for-profit tax breaks for what the hospital really was-a real estate company. Hospitals being in health care was a bigger lie than he ever told. His lies no longer seemed so bad. He liked being in the company of corporate administrators and the grifters on the hospital’s Board of Directors. They were his people and made a lot more money than the doctors and nurses who took care of patients.
The administrators never took the oath as he did, but then taking the oath never would have stopped him.
The hospital corporation built offices, headquarters, shopping centers, even a hotel with a golf course. The tax-exempt real estate money flowed to the board members and their friends. The doctor went along with and legitimized their deceit. They paid for him to get an MBA and so legitimized him to their business world.
His eyebrows were white, his hair was white, his mustache white even the hair on his arms was white, all homogenized with the fish belly white of his monochromatic face. And, he got the long white coat, finally. Thanks to the businessmen who ran the hospital. He gave them sanction to divert life-saving funds, equipment, and personnel away from patient care and that got him the long coat.
To celebrate his success, he went to a specialty store that sold rare antique furniture. He bought a Chippendale desk for his new office. The ball and claw carving appealed to him.
A mysterious woman sold him the desk and gave him a full-length mirror at no charge. It was mahogany and decorated with gold leaf. She said she had heard of him and congratulated him on his becoming a full professor. He didn’t understand how this old woman could have known.
“Your reputation precedes you,” she said.
She shook his hand and with her other hand stroked his arm. He tried to pull it back, but she was surprisingly strong and held him fast.
“Your skin is so white, so smooth, like wax,” she said and smiled. “I can see your veins snaking under your skin.”
“Yes, well I try to avoid the sun. It causes cancer.”
“Ture, white skin is prone to a type of cancer. What do you call it?”
“Yes, melanoma, the Queen of Cancers.”
He gave her the directions to his office and left in a hurry. The old woman frightened him.
The furniture was delivered to his corner office. The doctor put on the white coat and looked into the ornate antique mirror but there was a problem. His whiteness blended into the coat’s whiteness and he was no longer visible.
He was absent of pigment and blended into the white coat. The white coat moved with his breathing. When he moved his arms, wrinkles appeared in the fabric. There was life under the coveted white coat
He walked out of the office and nobody spoke to him or noticed him.
They talked behind his back.
“He has no feelings.”
“He’s a sociopath, he’ll do anything to get power.”
“He’s a prick but the suits love him. He signs off on their business deals. Making them legitimate.”
“I heard that,” he said.
They kept talking.
“He lies about everything.”
“He married his third wife before the second was cold.”
“Stop talking about me.”
Nobody could hear him. Perhaps they were talking about someone else. Yes, that was it, he thought.
He left the hospital. It was cold and though it was April he walked into a late winter snowfall. The snow was heavy and wet and stuck to him like glue. The snowstorm became a blizzard. He stepped on the crosswalk, a car nearly creamed him. White slush splashed his shoes. He stood on the median, caught his breath, and walked across. He needed to find the parking structure and get out of the storm.
The snow was blinding and he became disoriented because everything was white. He pressed on, but with the absence of landmarks, he felt as if he walked in a circle, not getting anywhere.
The snow continued for two days, the final total was twenty-two inches. The heavy plows worked day and night making small mountains of snow.
A few weeks later the weird lady from the antique shop came to retrieve her mirror.
She explained to the hospital that the professor didn’t pay for the mirror and a doctor should always pay his debts. You should die standing pat she told them.
“We haven’t seen him since the storm hit. How do you know he’s dead?”
“It’s just a cliché, a figure of speech.”
The hospital wrote a check to the old lady.
By the end of April the temperature hit fifty degrees. The snow mountains melted revealing various items of clothing lost in the storm. Woolen hats, scarfs, mittens, and a long white coat. A homeless person collected the lost clothing and put on the long coat and draped a red scarf around his neck.
He danced and smiled.