The Ties that Bind

The Ties that Bind

Faith Pernitelli walked into her office and plunked into the chair, exhausted after a long day.

“Busy?” David asked.   There had been a cesarean section early in the morning, rounds after the operation had taken longer than usual, and extra patients had come to the office for one thing or another.

“No, Dad, just the usual,” she answered. It was time to finish a few charts and look at some lab results. The mail was piled in a stack tray. Thankfully, no one was in labor.

“Have a seat. I can’t believe you’re done with patients already.”

“Did you look at the resumés?”

“Actually, yes. They are both impressive. Perhaps we should consider hiring them both.”

“Do you think we could afford them both?” David asked. “I’m not sure how that works.”

“Suppose they don’t start at the same time, say, staggered by three months. By that time, the first one would have a revenue stream, and we could start the second one.”

The older shook his head, “We could interview them first, then make a decision.”

“Let me finish this up and we can talk about it after dinner. Mom invited me over, and so we can talk after dinner." 

David said, "Good idea. Don’t forget you and I will get chewed if there is any shop talk at the dinner table.”

“Yeah, don’t I know!”

David shuffled off to his office, while Faith finished her charts. There were laboratory results from a handful of patients, none of them urgent, so she postponed calling the patients until morning. The mail contained the usual new drug advertisements, the latest gadgets for the office or the operating room, and the monthly issue of the American Journal of Obstetrics and Gynecology. But notably, there was a manilla envelope from Josh Menkowicz, now the director of Obstetrics at a community hospital of 180 beds in southern Colorado. 

“Josh!” she said when he answered the phone. “It’s nice to hear your voice.”

“I guess you got my envelope.”

“Yes. Tell me more about this.”

“Haley, Ricky, and I have become busy in our practice and we need another partner. We don’t have that many extra patients, but one of the busiest physicians in the community is going to have to retire in the next six to twelve months because he has developed Parkinson’s disease. Besides that, he says he is tired and tired of it.”

“I can see that. I hear it from Dad frequently.”

“How is that going with your Dad?”

“Oh, that part is fine. He does what he wants, and I do the rest. It has been a good pace for us.”

“Your voice doesn’t sound like it’s all that good.”

“The practice part is fine,” she said, taking the phone into the hall to be sure that David had already left for home. “But Crystal Springs gets tinier every day. There is not a lot to do here, and it’s a three-hour drive to Albuquerque.”

Josh began his sales pitch, “We are less than an hour from downtown Colorado Springs, and there are limitless things to do here.”

“But I would be your partner. That would be awesome.”

“Well, we’re ready for you to come.”

There was a breeze of silence before she could speak. “We have two resumés of good candidates to take over here. It would let my dad retire and me to escape. But I haven’t breached this with Dad yet.”

“Well, think it over. Let me know.” Josh was brief, not his usual. Ordinarily there would be some small talk, but not tonight. Maybe he was in the hospital and restrained.

Faith drove to her parents’ house thinking about how to talk about separation from the practice. Her Dad, now seventy, needed to extricate himself from what had been a rigorous practice for forty years. For most of that time, he had been by himself. Faith had helped out for three years, passed her board examinations by collecting a case list and sitting for the orals. But Crystal Springs, while the community in which she grew up, left her isolated and empty. She needed more.

Aromas wafted in the kitchen as Faith came in through the garage. Garlic, oregano, rosemary, and tomato unleashed her appetite, up to now unapparent. Her mother’s cooking always warmed her soul and splintered her diet. Pasta, bread, meatballs.

“Hi, Mom,” she said. “Mmm, bread.”

“Have a piece,” Marianna replied. “It just came out. There’s butter over there.”

Faith tore off a fist-sized chunk, slathered it, and lit in. “Wow, Mom. It’s heavenly.”

“Your father’s in the living room.”

She wandered into the soft, quiet room, walled with books, lushed with carpet, and furnished with comfortable nestling spots. Down into one of the soft wing chairs she went, a gesture dating back to teenage years.

“You’re quiet tonight,” David said. “What’s on your mind? Did the cesarean go well this morning? Did the baby do well?”

“Yes, and yes. Stan said he didn’t hear a heart murmur. He said if we hadn’t identified the defect, he would not have suspected. The baby can be evaluated in Dallas later this month.”

“Boy. Different from my early days, it’s wonderful that we can find heart defects before the baby is born. And I am proud that you can do it, too.”

“I need to discuss something else.”

“OK.”

“I think we should hire two partners.”

“You said that at the office. How are we going to afford that?”

“We aren’t.” She waited for his response.

“I don’t know how we don’t, unless you are talking about setting them up as separate entities.”

She mustered some courage. “I was thinking we hire them both, you bow out, and then I bow out.”

“Whoa. I didn’t see that coming.” He moved uncomfortably in his recliner. “But maybe I did. You have been restless, have taken weekend trips away, and kept in contact with several of your residency colleagues.”

“I didn’t want to drop a bomb,” she said, “but Josh has been talking about me coming to Colorado Springs.”

“Josh. I remember Josh,” he said. “How could I forget Josh.”

“I’m surprised you are so calm about this. You have been married to this practice for a long time. For you it is a huge life milestone.”

“Five years ago, I would have moved mountains to preserve this business. Now, my age, energy, and brainpower are becoming more insistent that I retire. I have finally accepted the fact that there’s no way to have a part time practice.”

“I understand,” she said. “I hope you are not disappointed.”

“Oh, I am,” he emphasized. “I had hoped that you would continue the legacy. But that was my first choice. Second choice is that someone delivers babies here. Third choice is I just close the practice and walk away. I was beginning to think that was what I was going to have to do.”

“Maybe we can work out something in the middle. Interview and hire two replacements, and both of us bow out.”

“God, Faith.” He was choked up.

Sensing his torment, she decided she had to say something, but lacked good words. “I like the patients, I like the independence, I like the office and the way you have equipped it, and it is wonderful that all the women in the hospital are our patients. I can’t stand Crystal Springs. A live theater, a live orchestra, or a major sports event would be wonderful without driving six hours round trip.”

“What? You don’t think high school volleyball is all-consuming, electrifying entertainment?” he quipped. His face turned sullen, “I understand that.”

“Albuquerque is almost not a day trip. If you go out to dinner and have a drink, you can’t drive home. The last sixty miles from Vaughn is torture.”

“And maybe dangerous.”

She shook her head in agreement. “And maybe dangerous.”

“Hence the weekend trips.”

“Yes,” she said. “What do you think, Dad?”

“God, Faith. This is hard.” 

“I’m sorry.”

“Well, at least we have some applicants. Before you, I was afraid I would have to close and leave Crystal Springs without a delivering physician.”

“How can I help you?”

“Let’s interview both of the people who sent us resumés and go from there. Do we know if the two people know each other? Maybe they should become acquainted before they come.”

“That could torpedo our plans, Dad. How about if they come for interviews at the same time?”

“A better idea.” His face changed. “Have you told your mother about this yet?”

“No.”

“There’s your next hurdle. I’m not doing that for you.”

“Dad!”