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Malpractice: a homily.

Ernesto and I were part of a group of no more than 25 men and women, mainly students, marching, singing, and chanting slogans in front of the federal courthouse to protest the war in the Persian Gulf. He saw me, I saw him, but we did not speak; we were no longer speaking, my erstwhile friend Dr. Ernesto Guzman and I. Now, in the bitter cold, we were walking in what came to seem pointless, ridiculous, tail-chasing circles, and old Vietnam atrocity footage was flickering in my head. Ernesto was dressed for stevedoring in Alaska. I had no idea what he was wearing under the layers of wool and leather, the clumsy mittens, and the galoshes that buckled like my father's had circa 1939. Not, I suppose, silks and linens, and surely not an ascot tie to go with the Russian fur hat.

At the academic parties at which we used to meet, he often appeared in resorty-looking outfits: pastel-yellow trousers in early April, patent-leather loafers with tassels, short-sleeved shirts patterned in faux Mondrian designs. It was a way of intimating scorn for the square and bourgeois ways of our academic crowd, I thought. And I pictured him sporting a British ascot, although I can't have seen him in one more than two or three times over all the years that I'd known him. In fact, as his name suggests, he is a Latin American. Tall (but stooped), dark eyed (but fair skinned), and, as I've heard more than a few women say, "terribly distinguished looking," Ernesto was the very picture of the old-fashioned Hollywood Latin lover, now somewhat long in the tooth. For all the glittering exterior, however, he was a man with serious intellectual interests, a Sunday painter and a collector who had covered the walls of his house with uncompromising contemporary art. He'd refused to mitigate either his accent or a stubborn attachment to left-wing causes--refusals I was bound to respect. Transplant this complicated physician to a small upstate New York community in which most of the other doctors collect stocks, bonds, and art for investment, and one begins to hear dissonant music.

The relationship my wife and I had with Ernesto and his wife Katherine can be placed in the wide middle ground that stretches between the poles of genuine intimacy and casual acquaintance. We would have them over for an occasional evening or see them at academic parties. More frequently, we would be asked to the Guzman affairs: big, noisy, catered parties, the crowd more town than gown, with uniformed waiters passing around hors d'oeuvres and drinks and dowdy wives of professors making sotto voce remarks about putting on the dog. In the summer months, Ernesto and I used to play bad chatty tennis on the university courts. After the match, there was more talk and, like our pleasant and placid friendship, the conversation was an in-betweenish sort of thing. We never went in for heavy, personal, confessional stuff, but neither did we allow the talk to descend to automobile chatter or reports from the prime-time front. We enjoyed one another's company, the music of Ginastera and Villa Lobos, and the writings of Alexander Cockburn. Both of us preferred the human form in painting and sculpture to abstract expressionism (but not designer shirts), and we had fun weighing some of the doctors we knew on the scale of purblindness. Ernesto admired Fidel Castro, wished his revolution well, and so did I. From the Whitney in New York or the Tate in London, I might send Ernesto a picture postcard with a few jocular words on it, but I have never felt moved to write him the kind of free-wheeling, affectionate letter in which you say whatever pops into your head. The chemistry just wasn't there and, besides, you hesitate to get too close to the doctor-friend who has sent you in for a barium enema.

I am not saying that Ernesto was only an acquaintance. If in the years of near-intimacy he and I shared certain values, pre, and post-sixties politics, and selected objects of contempt, the kinship brought with it the obligations of genuine friendship, even though the temperature was less than tropical. So when bad things started happening to Ernesto--yes, and being done by him--I ought not to have been an onlooker taking notes and keeping his distance. But that was exactly what I did and what I was.

Another doctor friend, Henry Goldsmith (a cardiologist), retreated to censorious silence when the subject of Ernesto's troubles first came up. It was juicy soap-opera stuff, Henry's wife Libby told us, involving an extramarital affair and an out-of-wedlock child. And since we took Henry's refusal to join in the scandalmongering to be a confirmation of the rumor--if he had wanted to demur he would have spoken up--that left the field wide open for fun and games. Was it true that handsome Ernesto's inamorata, the nurse who was the mother of the child, was short, fat, wag-eyed, and a functional illiterate? Was is also true that the baby had been named Ernesto S. (for Salvador) Guzman, Junior--Guzman Junior! Was that, someone asked, a father's boast or a mother's insurance policy, a tether to tame an absconding Don Juan? We were having a pretty good time, and I won't pretend that the satire wasn't nasty or that I stayed honorably on the sidelines where I belonged. As for that anonymous nurse, the mother of Ernesto's child, she was the sort of woman one never encountered in our circles, and her facelessness made her a perfect target.

Most of us knew Ernesto and Katherine fairly well--we'd all been to their grand parties--but Henry Goldsmith was no friend of his. Born, raised, and returned to practice in our small town, Henry found Ernesto's flashy ways offensive; and when at last he let himself talk about his colleague, it was with undisguised hostility. Katherine, we heard, had kicked Ernesto out and enrolled in a Ph.D. program in anthropology; no one knew where he was living and no nonmedical sightings were reported. Since I saw Ernesto regularly only in the summer months and did not care to discuss his affairs on the telephone, I knew mainly what the rumor mills were grinding out, such as the assertion that he was about to escape into the army medical corps, challenged by the counterassertion that he was soon to return to his native Chile, where he was supposed to have retained his citizenship. (He was, in fact, a naturalized U.S. citizen.)

Ernesto was one of the busiest doctors in town. His office, infamous for keeping patients waiting, was populated, I estimate, at a five-to-one ratio of women to men. Though the waiting room looked gynecological, the practice was, in fact, gastroenterological and seemed to have survived the marital scandal without any harm. Henry told us--and this much he felt he could say without violating medical decorum--that Ernesto was also working regularly in the two hospitals in which Henry saw patients. From Henry, always tactful, we later heard hints, innuendos, and throat-clearings to suggest that Ernesto was also in some kind of medical trouble. Real trouble. In fairness to our crowd of tenured cynics, it must be said that it did not seem to us catastrophic for a well-heeled, middle-aged doctor to have fathered an "illegitimate" child at a time in our country's history when millions of single mothers (lacking rich lovers) were living in poverty. Medical trouble, we, with our professional pieties, took seriously. (Reverently, you might say.) Without spelling out any of the details, Henry dropped hints of malpractice, and we imagined lawsuits ending in million-dollar settlements. Now, however, no one was making jokes.

Ernesto's situation, it turned out, would not be settled in the law courts, and his name did not appear in the local newspaper. Henry, as a senior member of the staff committee governing Methodist Memorial, had been instrumental in the decision to deny Ernesto Guzman hospital privileges; in fact, Henry told us they had been revoked in all the hospitals in town. Pinned down by my badgering and no doubt prurient questions, Henry finally burst out, "The guy's a total charlatan. He's been killing people, for Christ sake. And for lots of years"

I don't know the exact charge that was brought against Ernesto by the medical authorities. Henry, who was not given to exaggeration, meant his assertion quite literally: a sloppy, lazy, arrogant, yet badly trained and negligent physician, Ernesto was guilty, Henry told us, of having hastened the deaths of who knows how many of his patients. But how had he managed over the years to operate as a dangerous incompetent and escape censure and whatever else the profession does to its malpractitioners? A naive question, Henry said, explaining that even now, disgraced though he was, Ernesto's license to practice medicine had not been revoked. Suspended, yes, but recently reinstated. Your charming, fashionable, and popular Dr. Guzman can continue to kill patients with impunity, Henry told me, having abandoned diplomatic silence; now that the case was out in the open, he could treat Ernesto's malfeasance with the severity it deserved.

I had seen those meek and trusting women--and one very old and doddering man, who had once sat next to me--in Ernesto's waiting room, and I never doubted that Henry's case against Ernesto was fairly, honestly, and soberly made. I thought I understood the gravity of Ernesto's misdeeds, but should I call them crimes? Henry did not hesitate to use the word. Because, however, his indictment did not take on life as an imagined reality, because for me these somewhat abstract offenses failed to make themselves felt as crimes, Ernesto was no criminal to me--which is not to say that my judgments were different from Henry's. It was just that I could not feel the repugnance and the sense of professional duty that fired Henry's indignation as he laid out the shocking case of Ernesto. Henry's wrath made me think of grim revengers, Faulknerian night riders. I did not want to lynch Ernesto and neither, in all fairness it must be said, did Henry; but he couldn't not loathe the physician who had committed these crimes, and I could not make myself feel a visceral disgust for the man who had committed those indubitably reprehensible acts. I'd have reacted quite differently, I suppose, had any of the mistreated patients been people I knew, friends whose funerals I would have had to attend. Were I a physician, I, too, might have trembled with outrage at the thought of what Ernesto had done to betray his profession.

For a year after Ernesto had begotten the no-longer-risible Junior--he was 57 years old, the father of a son in graduate school, and still the object of dirty jokes at cocktail parties--my erstwhile friend and I continued to chat amiably at the university library when we ran into each other or at the Grand Union, pretending that nothing whatsoever had happened to either of us and promising one another that we were going to get together for this or that. I must not give the impression that I gave Ernesto any kind of moral support; I did not call him, and he made no tennis dates with me. By chance one afternoon, we played tennis, though it would be more accurate to say it was by dint of mutual cowardice. It was one of those days when I'd gone to the university courts looking for a pickup game and, seeing Ernesto alone and forlorn and evidently looking for a partner, I offered myself as one. I say offered; he eyed me, and I--trapped, embarrassed, and unable to command myself to shun him--let the clumsy improvisation work itself out almost wordlessly through gestures. We said as little as possible. I'd have had to be more disciplined than I was to do what I knew was the right thing, which was to concoct an excuse--lame or plausible, it wouldn't have mattered: "Just here to watch the team work out" or "Sorry, tennis elbow"--and pretend this guy was just another stranger. In other words, just say no, get in the car, and go home.

Before Ernesto's disgrace, our friendship, as I have said, had been an in-betweenish sort of thing. At the tennis courts that day, I backed into a hedge-your-bets, play-it-safe, cozy and in-betweenish moral stance. I did not offer encouragement or sympathy. Conventional morality would not countenance forgiveness, and I'd have had to be a brother or a lover to feel compassion. But neither did I indicate (if only with cold, censorious eyes) that I knew of his terrible but not quite imaginable deeds and judged him to be a moral leper. What mediocrity, though: to fraternize with a murderer as if all the man had done was to get caught in a moment of madness at a K-Mart with a package of $3.95 undershorts bulging in his coat pocket! Oh, the cowardice of my fence, straddling! And how disingenuous--to make him feel, on account of what was not said or done or dared, that his old friend wasn't running with the wolves and would really like to be able to offer generosity and good wishes .. but, damn it all, what's a guy to do when's he's up against all those medical big-shots who insist that Dr. Guzman has done those unmentionable things? Sentimentality, I was beginning to recognize, isn't just shedding hot tears over the cold corpse of some elderly dog that had been dragging itself around the house on two legs for years and years.

Equable social relations teach us to march dispassionately down the broad, smooth road that is closed to the traffic of love and hatred. Ernesto had too much dignity to grope for love and, having been deceived by the misleading signals of my moral in-betweenness, probably did not suspect that I wanted to be able to hate the malpracticing Dr. Guzman as passionately as Henry hated him. Maybe, though, Ernesto blamed my moral cowardice on social conformity and consoled himself with the belief that, deep down in his timorous heart, his old friend remained a friend. I really don't know.

I can imagine what Ernesto is feeling now that all pretenses but one have been abandoned. Having gradually broken off relations, we now pretend perfect and insouciant non-recognition when our paths happen to cross; not even the perfunctory, acknowledging nod one gives an acquaintance must be offered. Like a Dostoevskian malcontent, Ernesto acts out the heavy-handed charade of "cutting" me, and I, possibly with even less grace, do the same. We are buffoons who have reached their comic denouement--and this is how we got there....

The local symphony orchestra, assisted by an imported professional chorus, was performing the Mozart Requiem, and I, alone that evening, had found an excellent seat in the crowded hall, a refurbished movie theater of 1920s Arabian splendor. As the orchestra tuned up, people were scrambling for places; it was going to be a sellout. On my left was the only empty seat in the row and, so far as I could tell, one of the few remaining seats in the house. A stout, red-faced, heavy-breathing woman, frantic to snatch the place, asked if the seat was vacant. I told her it was; then, still agitated, she turned and hastened up the aisle toward the lobby. I thought it a bit odd that she was trusting me to secure the seat for her, since she'd not left behind a coat or anything else to stake her claim. I assumed that she had a quick errand to run--a visit to the ladies room, perhaps, or a few words to exchange with a friend--and would be back. I never doubted that she'd return; indeed, it never crossed my mind that she might not; it was perfectly clear to me that I was holding onto the seat for the woman who was by now lost in the crowd at the back of the theater.

My seat and the empty one next to it were five or six places in from the aisle. A man had scrunched in crab-wise and had reached the empty seat on my left. I realized it was Ernesto. Even worse, he had one hand on the lip of the raised seat and was about to lower himself into it

Now it would be helpful, at this point, if I could be absolutely precise about one not insignificant detail: but I cannot say whether or not Ernesto knew I was the occupant of the adjoining seat before I spoke. If all along he could see that it was me as he, without speaking, took possession of the seat, Ernesto may have been imposing his presence on me quite deliberately--committing, that is, a hostile act. If, though (as I think more likely), he'd paid no attention to who was sitting in the adjoining seat, the shock he got would have been a double whammy.

"This seat's taken," I said. Only that--but it was enough to identify me as his false friend and, simultaneously, to make him feel the arrow of treachery pierce his side. He believed, I am absolutely certain, that I had improvised a desperate lie--that the bare seat, unclaimed and available, provided a pretext for spurning him.

Ernesto bent over lower than his normal stoopedness allowed so as to lock his wounded lover's eyes with mine. Seeing the pain and the perplexity smouldering there, I knew what he wanted me to know: by that fierce and anguished glance, he meant to pin the badge of Judas on me. He said nothing. If, like the dumb Jesus in Dostoevsky's tale of the Grand Inquisitor, he'd kissed me on the brow before vanishing, I'd have understood the terrible reproach of his silent kiss. If, less Hispanically proud, he'd been able to say something as simple as "Don't do this to me" or "Look, you don't have to play shitty games with me," that would have given me a chance to make him see the truth--that the empty seat was not mine to give. I had no opportunity to explain, to defend myself, or even to ask Ernesto to explain his game, that high-wire act he'd been trying to negotiate ever since he'd made that hapless nurse the mother of an unwanted child.

Perhaps, I remember thinking, I could track down the woman who'd appointed me keeper of the seat and ask her to testify on my behalf. Well, quite obviously the seat--this absurd bone of contention--was going to remain unoccupied for the duration and Ernesto was going to stay convinced that I was a liar. If he'd found a place anywhere other than in front of my row, he'd have two painful musical hours (Kyrie eleison) in which to observe the fact that seat four in row C remained incriminatingly vacant. As far as Ernesto was concerned, I'd maneuvered him out of a seat--and out of my life.

What I'd been unable to gird up my moral loins to do in a principled fashion, I'd accomplished through accident, willy nilly. The vacant seat had been given to me, and I'd made a moral weapon of it. I'd succeeded in making Ernesto feel the shame of ostracism, the scourge of judgment: peccata mundi. He could tell himself that I was a self-appointed judge, jury, and executioner, that I'd jumped into bed with the doctors (and other boy scouts) who hated him for his culture, his politics, and for the chutzpah of owning and flaunting museum-sized paintings that committed assault and battery with frontal nudity.

I'd been avoiding the local art shows, staying away from concerts, and steering clear of the university tennis courts for fear that I might run into Ernesto. I might have known that he would be there on the streets to shout no in anger to the hideous war in Iraq. So there we were--dodo-bird leftists, old-fart subversives bearing political scars that went back to the 1950s, political comrades-in-arms but estranged friends who were no longer speaking and who were feeling for each other the same distrust and disgust that our president elicited with his cynical excuses and his lovely war. On a placard printed in bloody red, George Bush was being called a murderer. Hysterical rhetoric? For Henry Goldsmith, Dr. Ernesto Guzman was someone who had gotten away with murder. It was that simple. But when I ponder the perplexities of innocence and guilt, and, most frustrating of all, when I try to jerry-build a bridge that will lead from the fog of interpersonal relations to the murk of politics and back again, I experience bitter defeat. That way, as I should have known, madness lies. Better, I tell myself, to muddle through unphilosophically in cheerful, unreflecting, pragmatic ignorance.

Melvin Seiden is a professor of English emeritus at Binghamton University and the author of numerous essays and short fiction. His most recent book is Measure for Measure: Casuistry and Artistry. The names in this article been changed.
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Title Annotation:social standing of a doctor accused of malpractice
Author:Seiden, Melvin
Publication:The Humanist
Date:Jul 1, 1993
Previous Article:Identification of physician incompetence: the ethical dilemmas.
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