Cutting for Stone - Abraham Verghese [209]
Gandhi grabbed my arm. “Marion, sit down. Wait. Of course you didn't apply,” he said soothingly. “You didn't want to waste your time on the Massachusetts General Hospital.”
I still didn't get it.
“See here,” he said, taking a saltshaker and pepper shaker and putting them side by side. “This pepper shaker is our kind of hospital. Call it a—”
“Call it a shit hole, mon,” said Nestor.
“No, no. Let's call it an Ellis Island hospital. Such hospitals are always in places where the poor live. The neighborhood is dangerous. Typically such hospitals are not part of a medical school. Got it? Now take this saltshaker. That is a Mayflower hospital, a flagship hospital, the teaching hospital for a big medical school. All the medical students and interns are in super white coats with badges that say SUPER MAYFLOWER DOCTOR. Even if they take care of the poor, it's honorable, like being in the Peace Corps, you know? Every American medical student dreams of an internship in a Mayflower hospital. Their worst nightmare is coming to an Ellis Island hospital. Here's the problem—who is going to work in hospitals like ours when there is a bad neighborhood, no medical school, no prestige? No matter how much the hospital or even the government is willing to pay, they won't find full-time doctors to work here.
“So Medicare decided to pay hospitals like ours for internship and residency training programs, get it? It's a win-win, as they say—the hospital gets patients cared for by interns and residents around the clock, people like us who live on site, and whose stipend is a bloody fraction of what the hospital would pay full-time physicians. And Medicare delivers health care to the poor.
“But when Medicare came up with this scheme, it created a new problem. Where do you get your interns to fill all these new positions? There are many more internship positions available than there are gradua ting American medical students. American students have their pick, and let me tell you, they don't want to come and be interns here. Not when they can go to a Mayflower hospital. So every year, Our Lady and all the Ellis Island hospitals look for foreign interns. You are one of hundreds who came as part of this annual migration that keeps hospitals like ours going.”
B.C. sat back in his chair. “Whatever America needs, the world will supply. Cocaine? Colombia steps to the plate. Shortage of farmworkers, corn detasselers? Thank God for Mexico. Baseball players? Viva Dom i n ica. Need more interns? India, Philippines zindabad!”
I felt stupid for not having seen this before. “So the hospitals where I was going to interview,” I said. “In Coney Island, Queens—”
“All Ellis Island hospitals. Just like us. Allthe house staff are foreigners and so are many of the attending physicians. Some are all Indian. Some have more of a Persian flavor. Others are all Pakistani or all Fili pino. That's the power of word of mouth. You bring your cousin who brings his classmate and so on. And when we finish training here, where do we go, Marion?”
I shook my head. I didn't know.
“Anywhere. That's the answer. We go to the small towns that need us. Like Toejam, Texas, or Armpit, Alaska. The kinds of places American doctors won't go and practice.”
“Why not?”
“Because, salah, in those villages there's no symphony! No culture! No pro-ball team! How is an American doctor supposed to live there?”
“Is that where you will go, B.C.? To a small town?” I said.
“Are you kidding? You expect me to live without a symphony? Without the Mets or the Yankees? No, sir. Gandhi is staying in New York. I am Bombay born and Bombay bred, and what is New York but Mumbai Lite? I'll have my office on Park Avenue. You see, there is a crisis in health care on Park Avenue. The citizens are suffering because their breasts are too small or their nose is too big, or they have a roll around the belly. Who will be there for them?”
“You will?”
“Fucking right, boys and girls. Hold on, ladies,