Until philosophers are kings…cities will never have rest from their evils, no, nor the human race.
Early afternoon was clearly one of the better times to shop at the Whole Foods Market. Natalie would have had no reason to know that fact until today. With her mother's grocery list in one hand and hers in the other, she made her way up and down the uncrowded aisles in no particular hurry. It had been three hours since she was booted out of the Metropolitan Hospital ER by Cliff Renfro, and for the moment at least, she had more time on her hands than she had things to do.
Tomorrow she would make an appointment with her advisor, and maybe with Doug Berenger, and together they would straighten things out. It wasn't as if anyone had gotten hurt. Compared to a hemostat being left in an abdomen, or a lethal medication error, or the wrong leg being amputated, the events in the ER were small potatoes. If she was guilty of anything, and in truth she didn't believe she was, it was a crime with no victim. As Bev Richardson had said, even though Renfro was well along in his training, he was still immature. For the time being Natalie and he were destined to be enemies, at least until she got the chance to prove to him what a dedicated, driven, caring physician she was. At the worst, she would have to complete her ER rotation elsewhere. Ideally, after a day or two of cooling off, perhaps the two of them could meet and patch things up on the spot, and with her promise not to repeat what she had done, she could resume the rotation where she left off.
The foods Natalie picked up for herself were the freshest and healthiest. Whole Foods Markets, noted for their produce and seafood, were the only places she would shop. The ridiculous hours of medical school were unavoidable, but in her soul, she was still an athlete. She worked out as much as possible, often at absurdly early or late hours. Her repaired Achilles tendon would keep her from ever coming close to the world-class times that were once routine, but as she got older, she could see the day approaching when her times for various distances in her age group would be competitive, if not among the leaders. Goals. Always goals. Having them, pushing toward them, reinventing them — along with the care she gave her body, never being without well-defined goals was the secret to her success in school and in sports.
She grimaced as she scanned down her mother's list, dictated to her last night over the phone. Steak, frozen fries, pecan rolls, Cherry Garcia ice cream, trail mix, hot dogs (and buns), whole milk, whipped cream, Pringles…half of the items, Whole Foods wouldn't even deign to carry. Hermina Reyes was a piece of work — beloved by so many, yet as abusive of herself and her body as Natalie was meticulous. A bigger concern for Natalie, however, was her niece, Jenny. Hermina was responsible for most of the girl's meals. With that fact in mind, she added some broccoli, yams, cheese, and salad to her mother's order.
At the bottom of the list Natalie had reluctantly penned in Winstons — one carton. After it, she had written a note to herself: optional. She laughed ruefully. More often than not, in what she knew was a futile gesture of protest, she refused to buy her mother's cigarettes. It didn't matter. Hermina had a car, and didn't hesitate to leave Jenny at home for brief periods. Plus, there were others the woman could call on, plenty of them, who knew an unbreakable bond when they saw it. They also knew that if there were ever justification for smoking, the death of one's child was it. Hermina would be wedded to her Winstons until the day she died, more than likely at the hands of her beloved cancer sticks.
Natalie spent a leisurely half hour selecting her own fruits and vegetables. With the vast summer selection, she felt especially fortunate to care about such things, particularly today, with a few hours of unexpected free time on her hands. She really had to try harder to be more tolerant of people like Renfro, she was thinking as she squeezed, then tapped, then shook a honeydew, testing for ripeness. First thing in the morning she would do whatever was necessary to straighten things out with him.
Whole Foods was far too responsible to sell cigarettes, so after loading eight plastic bags of groceries into the trunk of her Subaru, Natalie trotted across the street to a pharmacy. It wouldn't be a problem showing up at her mother's place earlier than expected. The time when Hermina knew the details of her life and schedule had passed long ago, so there wouldn't be any but the most cursory questions about why she wasn't in the ER. Nor was there much chance that Hermina would be out. With Jenny to care for, she tended to stay pretty much close to home when the girl wasn't at school.
Dorchester, a rapidly aging, gritty community directly south of the city, was just a few miles along Route 203 from Natalie's quaint Brookline apartment, but sociologically and demographically the two towns were widely distant. Small pockets of elegant, well-maintained homes still survived in Dorchester, but they were islands in a sea of poverty, inv migrants, drugs, and too often, violence. Natalie pulled to the curb and popped the trunk in front of a peeling, gray clapboard duplex with a small dirt lawn and a sagging front porch. She had left home shortly after her mother's move to this place, but her younger sister Elena, who was eight at the time, had grown up there, and until the accident, lived there when she wasn't in detox or rehab.
Natalie doubted there was anyone in Dorchester who didn't know that Hermina Reyes kept her house key under a withered potted plant by the door.
"There's an advantage to having nothing to steal," her mother liked to say.
As always, the pungent odor of burnt and burning cigarettes hit Natalie the moment she opened the door.
"Health inspector, ditch the butts!" she called out, hauling five bags at once down the hall and into the kitchen.
The flat was, as always, neatly kept and clean, including Hermina's decades-old Fenway Park ashtray, which she ritually emptied and washed down after every second or third smoke.
"Mom?"
Hermina was usually ensconced at the kitchen table, with a cup of half-consumed coffee, a box of vanilla wafers, her Winstons, the ashtray, and a book of Sunday New York Times crossword puzzles. In fact, all of her accoutrements were in place, but not the woman herself. Natalie set the groceries on the floor and hurried to her mother's room.
"Mom?" she called again.
"She's taking a nap," Jenny called out.
Natalie followed her niece's voice to her prim and feminine room — lace curtains, pink walls. Jenny, dressed in shorts and a floppy sweatshirt, sat in her wheelchair, a book propped up in the apparatus that made it easier for her to turn the pages. The ankle braces that enabled her to walk with crutches lay on the floor by her bed. Jenny's official diagnosis was mild cerebral palsy, but Elena had used and drank and smoked throughout her pregnancy, and now that Natalie knew what fetal alcohol syndrome was, that diagnosis had taken the top spot on her list of the possible causes of the girl's disabilities.
"Hey, babe," Natalie said, kissing her on the forehead. "What's happening?"
"Staff day today, no school." Jenny had the creamy skin and wide, engaging smile of her mother. "Gram was awake for a while doing her puzzle, then she just went to bed."
"If I ever ever catch you with a cigarette — "
"Let me try, let me try this time. You're going to break both of my lips."
"Actually, I like the sound of that. What are you reading?"
"Wuthering Heights. Have you read it?"
"A while back. I think I loved it, but I also think I had some trouble following it. You're not having trouble with the way time and the scenes bounce all over the place?"
"Oh, no. It's so romantic. I would love to visit the moors someday if they're still there."
"Oh, they're still there. We'll go. I promise." Natalie stepped to where her crippled niece couldn't see the sadness in her eyes. "Jenny, you make everyone around you a better person, including me."
"Now what's that supposed to mean?"
"Nothing that serious. Listen, you want to come in and help me wake Gram?"
"No, thanks. I want to read a bit more. Heathcliff isn't very nice to people."
"As I recall, when he was young, people weren't very nice to him, either."
"It's like a vicious cycle."
"Precisely. Are you sure you're ten?"
"Almost eleven."
Hermina, wearing a print housedress, had dozed off on the bed. A cigarette, burnt down to the filter, was still smoldering in a saucer on the bedside table. The kitchen was still her favorite spot, but more and more over recent months, this was the scene that greeted Natalie — either here in the bedroom or on the sofa in the living room. The cigarettes were taking their toll on her mother's oxygen levels and stamina. Before too much longer a green oxygen tank on a roller would be accompanying her wherever she was.
"Hey you," Natalie said, gently shaking the woman awake.
Hermina rubbed at her eyes and then propped herself on one elbow.
"I expected you later," she said somewhat dreamily.
Natalie was bothered by the unnatural depth of her sleep when she had been awake enough to light up a cigarette that was still burning. At fifty-four, this once vibrant and entrancingly beautiful woman was aging rapidly, and growing more leathery-skinned with every butt. Her cocoa complexion was much darker than Natalie's — understandable, given that Natalie's father, whoever he really was, was white — but unlike her deteriorating skin, Hermina's wide, hazel eyes were playful, intelligent, alluring, and virtually identical to Natalie's.
"Ma, you've got to stop smoking in here," Natalie said, helping her up and into the kitchen.
"I almost never do it anymore."
"I can tell."
"You're not attractive when you're cynical."
Hermina was Cape Verdean. She was brought to the States by her parents when she was Jenny's age, and still retained more than the hint of a Portuguese accent. By the time she was nineteen, she had graduated from high school and was a certified nurse's aide with plans to go to nursing school. That was when she became a single parent for the first time.
"Jenny seems okay."
"She's doing fine."
"That's good."
There was a brief, uncomfortable silence. To Hermina, Jenny was Elena, and no matter how many rehabs had given daughter number two the gate, no matter how fast the police said she was driving when she slammed through the guardrail, Hermina always considered her to have been the victim of external circumstances.
Daughter number one, who had run away from home at fifteen, was another story. If Hermina Reyes knew nothing else, she knew how to harbor a grudge, and in this household, Elena was still and always would be the child of choice. The grocery shopping, the monthly checks, the trophies, the Harvard degree, and soon the one from medical school, still didn't balance off the hurt Natalie had brought on her mother.
"So, help me out here," Hermina said, picking up her pencil and pointedly turning her attention to the crossword puzzle in front of her. "Eight-letter word for nervous?"
"No idea. I'm never nervous. Ma, it's wonderful that you're taking care of Jenny the way you are, but you've got to try not to smoke when she's in the house. Secondhand smoke is no different than firsthand when it comes to — "
"So what about you? You seem tense."
There were many, including Natalie and her late sister, who equated Hermina's remarkable intuitiveness with sorcery.
"I'm okay," she replied, putting the groceries away. "Just tired is all." "That doctor you were seeing hasn't worked out?" "Rick and I are still on good terms."
"Let me guess. He wanted a serious relationship, but you just didn't love him."
Sorcery.
"The demands of the surgical residency I'm about to start make it hard to be available to someone else."
"What about that Terry who you brought over for dinner? He's so nice and so very handsome."
"He's also so very gay. That's why I like him so much. He doesn't want anything from me except my friendship and my company. There's never any talk about commitment and moving our relationship to the next level. Ma, believe me, almost every one of my friends who is married or living with someone is miserable over it a good deal of the time. Just trying to make their relationship work absorbs ninety percent of their energy. In this day and age, love is temporary and marriage is unnatural — the product of Madison Avenue advertising executives and television producers."
"Daughter, I know you're long past listening to me, but you've got to break through that hard shell of yours and let love in or you're going to be a very unhappy woman."
Let love in. Natalie kept herself from speaking too soon or, worse, laughing out loud. With two children born of different swains, both long gone, Hermina Reyes wasn't exactly the poster child for true love. In her case, at least from Natalie's viewpoint, physical beauty had proven to be a mortal enemy. Still, her enduring sense of romance, trust in men, and unflagging enthusiasm for life were as unfathomable as her inability to put away the Winstons.
"Right now I don't have time to be unhappy."
"You sure you're okay?"
"I'm fine. Why do you keep asking that?"
"No reason. Sometimes, when I came to watch you run, you would hold yourself before the race in a funny way — an awkward, uncomfortable way. Almost always, when you did that, you didn't run well and you lost. You're sort of doing that here."
"Well, nothing's the matter, Ma, trust me."
At that moment, Natalie's cell phone announced a call. The caller ID displayed a number she didn't recognize.
"Hello?"
"Natalie Reyes?
"Yes?"
"This is Dean Goldenberg."
Natalie stiffened, then walked into the front hallway, out of earshot from her mother.
"Yes?"
"Natalie, I wonder if you're free to come over to my office to discuss the incident this morning at Metropolitan Hospital."
"I can be there in twenty or twenty-five minutes."
"That will be fine. Please call my secretary when you are ten minutes away."
"O-okay."
Goldenberg waited until Natalie had a pencil, then gave her the phone number of the medical school and his extension. Throughout their brief conversation, she had tried unsuccessfully to get a read on his voice, and now was stifling the urge to ask for the details of why she was being called in. Over the years, Dr. Sam Goldenberg had expressed any number of times what a fan he had been of her running, and also of her performance as a medical student. Whatever was up now, they could work out. She felt certain of it.
"Trouble?" Hermina asked as she returned to the kitchen.
"Nothing that drastic. Just some problems with my schedule at school. But I do have to rush off. Sorry."
"That's okay."
"I'll be back to see you both before long."
"That would be wonderful. Take care of yourself."
"You, too, Ma. Jenny, I'll see you again soon."
"I love you, Aunty Nat."
"I love you, too, babe."
"Panicked," Hermina said.
"What?"
"That eight-letter word for nervous. It's 'panicked.'"
Natalie's teenage years had been written up in a number of publications. Her tumultuous struggles on the streets of Boston ended after almost a year when workers at an agency called Bridge Over Troubled Waters managed to convince her and the Edith Newhouse School for Girls in Cambridge that the two of them were potentially a good match. It then took many months in the school before an uneasy truce with the teachers and administration enabled her to discover her talent for track — and for academic success. Three and a half years later, she started at Harvard.
After her graduation from college, in addition to training and racing, Natalie worked in the laboratory of Dr. Doug Berenger, then and now a huge booster of hers and of Harvard track. By the time of her injury at the Olympic trials, she had her name as coauthor on half a dozen papers for research work performed with the cardiac surgeon and his team. She had also taken all of the required courses for medical school admission. Sooner or later, she probably would have applied anyhow, but the accidental step onto her Achilles tendon by the woman running in second place definitely sped up the timetable.
For as long as Natalie had been affiliated with the medical school, Dr. Sam Goldenberg had been dean. An endocrinologist by trade, he was as kindly and concerned a man as he was brilliant — clearly dedicated to the principle that getting into medical school should be much harder and more stressful than staying there.
As requested by Goldenberg, Natalie had called his office when she was ten minutes out. Now she sat in his comfortably appointed waiting area and tried to work out phrasing by which she could underscore that no one had been hurt by her ordering the tests she did, but that she understood there might have been better ways she could have handled the situation. All she wanted now was to make things right with Cliff Renfro and get back to work.
She had been there just a few minutes when Goldenberg came out, shook her hand with an uncharacteristic lack of warmth, thanked her for being so prompt, and escorted her into his office. Standing by chairs at his conference table, their faces grim and troubled, were her closest allies on the medical school staff, Doug Berenger and Terry Millwood, and her friend, Veronica Kelly, cherubic, exceedingly bright, and often more intolerant of pompous, self-important professors than even Natalie herself.
The sudden chill through Natalie's spine had nothing to do with the temperature of the office. Both surgeons shook her hand formally. Veronica, with whom she had traveled to Hawaii and once to Europe, smiled tensely and nodded. The two of them enjoyed Boston together as often as busy med students could manage, and Veronica's stockbroker boyfriend was responsible for fixing Natalie up whenever her resistance slipped be-low the "I'm fine, really, I am" level. Goldenberg motioned everyone to sit, and took his place at the table. Natalie's expectations of charming the dean and making whatever reparations were necessary toward Cliff Renfro began to evaporate.
"Ms. Reyes," Goldenberg began, "I want you to read the notarized statements submitted to my office at my request by Dr. Clifford Renfro and Mrs. Beverly Richardson, the nurse who was present at the time of this morning's incident. Then I would ask if your account of the events would differ substantially from theirs."
Still astonished that things had moved forward so swiftly and force-fully, Natalie read through the statements. Aside from a word here and there, both were in concordance and were accurate. Bev Richardson did her best to explain what she felt Natalie's mindset was at the time. How-ever, she also stated, nearly verbatim, the clash with Renfro. On paper, the statements were cold and damning. Natalie felt the earliest grip of fear, and flashed momentarily on the eight-letter word in her mother's crossword puzzle.
"Both of these are substantially accurate," she managed, "but I don't think they capture the motivation behind what I was trying to do."
"Nat," Berenger said, "I promise you that we understand that there was nothing overtly malicious in your motives."
Seated next to Berenger, Millwood nodded his agreement.
"I'll be more than happy to admit that what I did was wrong, and to apologize to Dr. Renfro."
"I'm afraid it's not that simple, Ms. Reyes," Goldenberg said. "Dr. Schmidt, who as you know is Dr. Renfro's chief of surgery, has insisted that you are unfit to be a physician and he has demanded that you be expelled from the medical school."
The words were a dagger thrust into Natalie's chest. "I can't believe this. My grades have been honors level, and as far as I know, my clinical work has been strong."
"Actually," Goldenberg said, "while there has never been anything negative reported about your work with patients, there have been several complaints suggesting a consistent lack of respect for authority, an intolerance for some of your residents, and even some of your classmates, and an arrogance that one faculty member has suggested could be a source of serious problems in the years to come."
"I just can't believe this," Natalie said again. "My only incident with a classmate that I know of was when I refused to partner with him because he was throwing cadaver parts around the anatomy lab."
"Excuse me, Dean, for breaking in here," Veronica said, "but I feel as if I need to back Natalie up on this one. When Dr. Millwood called and told me what was happening, I asked him to find out if I could come. I appreciate your allowing me to. The student Natalie was speaking of was to-
tally inappropriate, and deserved her response. Natalie and I have been close friends since before we started med school. I wanted to make sure you knew how well-liked and respected she is among almost all the students, men and women, and also how difficult Dr. Renfro can be at times. He and I clashed more than once during my surgical rotation."
"But you never ended up being reported to me," Goldenberg said.
"No," Veronica said, clearly deflated. "No, I didn't."
"Thank you, Ms. Kelly."
"Nat," Millwood said, "didn't you stop to think about the trouble you were asking for by bringing back a patient that a senior resident had discharged without even consulting him?"
Natalie shook her head. "I know now that it was wrong, but I was upset with Dr. Renfro, and all I was thinking about was the patient, a poor old drunk whom I felt was being booted out of the hospital without a complete evaluation of his problems."
Millwood turned to Goldenberg, as did Berenger. Natalie watched her future unfold in an unspoken three-way conversation, battling back the knee-jerk urge simply to say, "Oh, screw this! I quit." Veronica, probably sensing that, subtly raised a calming hand. Finally, Goldenberg nodded that he had reached a decision, and turned to Natalie.
"Ms. Reyes, there are a number of faculty members, including your two biggest boosters here, who have written glowing evaluations about your potential to be an exceptional physician. I also appreciate the effort your friend Ms. Kelly has made to be here today, as well as the things she has had to say. I know for a fact that you are being seriously considered for selection into the Alpha Omega Alpha medical honor society. I can assure you now that will not happen. You are an unusual person, with many fine qualities, but there is an edge to you — call it hardness, call it arrogance — that will contribute nothing toward making you the sort of physician we want to graduate from this school. With the help of your supporters here, I have decided that expulsion is too severe a punishment for what you have done — but not by much. As of today, you are suspended for four months. If there are no further incidents after that, you will graduate with the next class after yours. Other than a legal challenge in court, there is no mechanism in place for reconsideration of this decision. Do you have any questions?"
"My residency?"
"Nat, we'll go over the possibilities for you later," Berenger said. "I can tell you that your place in the surgical program at White Memorial will be filled by someone else."
"Jesus. What about my work in your lab?"
Berenger got tacit approval from Goldenberg before responding.
"You can still work for me, and even attend grand rounds and any other conferences you wish."
"Making this decision doesn't please any of us," Goldenberg said.
"It seems too harsh to me," Natalie said coolly, much closer to an angry outburst than to tears.
"Possibly, possibly so. But it is the hand you have dealt yourself."
"Tell me one thing, Dean Goldenberg. Would we still be sitting here if the CT scan I ordered on that poor man had shown a large clot pressing on his brain?"
Across from her, Terry rolled his eyes and sighed. Veronica shook her head.
Sam Goldenberg seemed almost ready for the question. He fixed some papers in front of him, then leveled his gaze at her.
"Since part of the issue here is your assault on Dr. Renfro's clinical judgment, I feel the need to remind you that there was no such clot. The CT scan on which you staked your medical school career was normal, Ms. Reyes. Absolutely normal."
For nearly ten seconds after the final passage of Beethoven's violin sonata in F had drifted through Queen Elizabeth Hall, there was absolute silence. Then, as one, the audience erupted, leaping to its feet, drowning out the quivering echo of the last note with shouts and applause.
"Bravo!"
"Huzzah!"
"Wunderbar!"
The seventeen-year-old beauty, cradling her two-hundred and ninety year old Stradivarius as if it were a newborn babe, beamed as she gazed out across the throng. She looked too small for the stage, but everyone who knew music, and that was most of those in the hall, knew she was a titan. Her accompanist took his bows and then left the stage so that she might bask in her return to performing — the moment many had felt might never come.
Standing in the tenth row center, an Indian man, resplendent in his tuxedo, continued applauding as he turned to his taller companion.
"Well?"
"I am very proud of her, and very proud of us," the other man, square jawed and elegant, said. "The scar down her chest has barely healed, and yet there she is."
"Beautiful. Just beautiful. I don't think I've ever heard the 'Spring sonata' played with more feeling or technical brilliance."
As was the Guardians policy, the men never spoke one another's names in public, and even on their frequent conference calls used only Greek pseudonyms, which each of their members was required to commit to memory.
The tumultuous applause continued, and the young virtuoso, destined now to enthrall the world for decades to come, took one curtain call after another.
"Those roses she is carrying are from us," the Indian said.
"Nice touch."
"I agree, thank you. You know, it is amazing what the minor addition of a new heart and lungs can accomplish in the right body."