Friday evening, June 4, Greenbeck Dermatology

Jake

Five days after returning from the Cape, I find myself facing another unsettled weekend. In a couple of days, Jess will drive the kids back to Chatham, where they’ll spend the rest of the summer. Without me.

Can’t think of that now, Jake. Just focus on work.

“Fuck,” I mutter.

“Yeah, I know. That dude was a total nightmare.”

I glance up at Erin, realizing she must think I’m reacting to our last patient – a skittish-looking guy who seemed disappointed to learn the brown spot on his chest wasn’t a melanoma.

“Jeez,” she whispers. “From the way he reacted, you’d think he wanted cancer.”

“On some level, he probably did.”

“But that’s nuts.”

“Yup.” I check my wristwatch, realizing I may have a shot at getting home before Jess this evening. “Some people have personality disorders, and if you let them, they’ll draw you right into their dysfunctional world.”

As if on cue, Nina Greenbeck catches my attention, frantically waving to me from across the room. Everything is urgent with Nina. Decked out in a tangerine dress suit, she looks like an exotic bird engaged in a vibrant plumage display. When we make eye contact, she taps her watch and holds up five fingers, then points to her office.

“Shit,” I say under my breath. “I have five minutes to live.”

Nina’s on the phone (surprise, surprise), seated behind a modernistic glass desk she probably commissioned to showcase her long legs, which always seem to be on display. She greets me with a wave of her perfectly manicured pinkie-finger, then turns her back to me and continues her phone conversation. Apparently, Howard Stern threw a kick-ass party out in Southampton this weekend.

How long am I supposed to sit here and listen to this shit? I pretend to be busy with my iPhone, re-reading old e-mails and texts. When I’ve worn out that distraction, I size up the woman who’s technically my boss. At fifty plus years (her exact age remains a heavily guarded secret), she still has a body capable of turning heads from a distance, but up close, there’s something jarring about her look. A photograph on her desk confirms she once had some natural beauty, but now, she looks more like a cut-and-paste version of body parts meeting the stereotype of beautiful: a Frankensteinish beauty. From what I’ve heard around the office, she’s spent much of her adult life traveling the world in search of the best plastic surgeons, accruing a Deforde nose and chin from Park Avenue, Sloan eyes from Beverly Hills, Gonzalez breasts from Rio, and regular liposuction tune-ups from Mitch Markum. At this point, she’s been worked over so many times it’s impossible to tell what’s real anymore.

“Jake?” She finally lifts the mouthpiece of her headset to signal her conversation’s over. “Did you have a good week?”

I pretend there’s a trace of sincerity in her question. “Yes, absolutely. Things have run smoothly in the office.”

“And Jessica and the children?”

“They’re doing well, thanks. How were the Hamptons?”

“Oh you know, the usual. Too many functions to catch a breath. One of these weekends, Al and I will just have to sneak out there without telling any of our friends. Perhaps then we’ll finally get a real break.”

A break from what? I think as I nod and give her a fake smile. You don’t fucking do anything.

Satisfied that she’s offered me enough small talk, Nina turns her attention to a thick stack of spreadsheets. She slides them across the desktop toward me, her tone suddenly all business.

“Now I know you’ve had a busy day, but I’d like you to take a look at these before you go home.”

“Sure… what are they?”

“They’re your accounts receivable for last quarter. I’ve highlighted some items for you to review. You’re still having some of the same – problems.” Her voice breaks nasally over the last word.

I glance at the spreadsheets, noting the messages scrawled in red ink, and suddenly feel like a school kid who’s just been handed a corrected piece of homework. We’ve gone through this exercise before, and the take home message is always the same: you’re not billing enough.

“I’ll look these over,” I grumble.

“Yes, please do that. And I’d especially like you to focus on your cosmetic product sales for March and April. After our last conversation, I was surprised to see your numbers actually went down last month. How can you explain that?”

“The economy hasn’t been so hot.”

She dismisses my point with a flick of her wrist. “This is Greenwich, Jake. Just look at the other providers’ numbers. They’re tripling or even quadrupling your cosmetic revenue stream. Right here, for example…” She holds up the spreadsheet, looking like she’s about to swat my head with it. “Would you like to guess how many patients you referred to our spa for microdermabrasion last month?”

“A few,” I offer.

“Try three. That’s an appalling number, Jake.”

“But look at my patients! Half my visits last month were kids, coming in for problems like acne or warts. Am I supposed to sell ‘Greenbeck Eye-lifting Serum’ to a bunch of teenagers and toddlers?”

“They have parents, don’t they?”

“You’re joking, right?” I can tell from Nina’s expression that she’s actually dead serious. “Really – do you honestly expect me to sell cosmetic products to a mother bringing in her child for an acne visit?”

She leans forward, ice-blue eyes locking with mine. “Yes, I do. And if you can’t, then at least send that kid out with our full line of acne products and an appointment for a teen facial. If you see a baby with eczema, recommend our gentle soap-free cleanser and moisturizing cream. When someone comes in for a skin check, you send her out with a bottle of our sunscreen. Bottom line: everyone should leave with at least one Greenbeck product. We’re not a charity operation, Jake. We’re a business.” She taps her bright orange fingernails against the glass desktop. “And a profitable business at that, when we all do our jobs correctly.”

“But I’m a doctor, Nina.” I palm my forehead. “I didn’t go to medical school to earn a degree in sales and marketing.”

“Oh please. Don’t take that ‘holier than thou’ attitude with me. You want to earn a good living, just like the rest of us.”

“Sure, but it’s not like I’m not contributing to the practice. When I last checked, I’m still taking home less than a quarter of what I bring in.”

She purses her Juvederm-pumped lips and sighs. “I hate to break it to you, but you barely cover your overhead. And what do you think’s going to happen next year when Medicare cuts our reimbursements another five percent? What’s going to happen when all the managed care plans jump on that bandwagon?”

I shrug. “Guess we’ll have to find other sources of income to cover the losses.”

“Exactly. That’s why you should be selling tubes of antibiotic ointment instead of giving them away!”

“I get your point, Nina.” You soulless harpie. “I’ll keep it in mind.”

“Good. Oh, and before you go – there is one more thing that I’d like to discuss. I believe you saw a patient named Briana Caulder last Friday.”

“That’s right,” I answer cautiously. Judging from Nina’s tone, she’s not about to thank me for seeing her husband’s last minute pain-in-the-ass add on.

“Yes, well, I read your office note and would like to point out the Caulders are very important clients. You should know they weren’t very happy with the service you provided. They’ve already requested copies of Mrs. Caulder’s medical record.”

“That’s fine with me,” I snap. “You don’t need to be worried about my documentation.”

Nina flashes me a look like I’ve just spilled cheap beer on her Versace. “It’s not your notes that concern me. It’s your professional demeanor. We’re in a service profession, Jake. Now if our important clients aren’t satisfied with the service we provide, then they’ll go elsewhere.” She shakes her head in disgust. “And they’ll take their friends with them.”

“That may be the case." I shift to the edge of my seat. “But I’m not going to perform malpractice just to keep some VIP happy.”

“Malpractice?” Nina arches an eyebrow. “Aren’t we being a little bit melodramatic?”

“Actually, that’s exactly what Mrs. Caulder asked me to do. She wanted a script for Accutane without the required work-up, so I refused. Under the circumstances, what was I supposed to do?”

“For starters, you could’ve handled the situation more tactfully. The Caulders are a very influential family in this area. If I were a young doctor trying to build my practice, I’d be bending over backward to keep them happy.”

I shake my head. “I’m sorry, Nina, but I just don’t work that way.”

“Riiight.” She dismisses my words with a lazy hand wave, her bangles jingling loudly. “Suit yourself. You obviously know better. But don’t say I didn’t try to help you.”

Before I can reply, the queen of Greenbeck Dermatology swivels in her chair, showing me the back of her platinum blonde head, and launches into another phone conversation.

Sitting in my cubicle-sized office a few minutes later, I stare at my computer screensaver, trying to put the meeting with Nina out of my mind. Unable to forget her words, I try scribbling the words “bitch bitch bitch bitch” over and over again on a bunch of Post-it notes. Fortunately, Albert Greenbeck doesn’t see my tribute to his wife when he strolls into my office. He grins broadly and places his hand on my shoulder.

“There he is!” he announces, looking relaxed and as tanned as a dermatologist can respectably look. “The man who held down the fort while we were away.”

I rise to greet him with a handshake – an awkward gesture given the cramped nature of my office – and notice he’s dressed more casually than usual, wearing a white Oxford shirt with the top button open, beige trousers, and a tweed sports jacket instead of his usual Armani suit ensemble. Dressed down like this, he looks surprisingly young and engaging, like a college professor returning from a sabbatical.

“So,” he continues, brushing a few strands of salt-and-pepper hair away from his eyes (for a man in his mid-60s, Al Greenbeck has a remarkably full head of hair). “I hear Nina’s been giving you a hard time about your numbers.”

“You could say that. She wants me to bill more. I’ll try, but –”

“Jake!” he interrupts cheerfully, “Say no more. You’ll get there. Don’t worry about it. I’ll tell Nina to back off, but that’s not why I’m here. I wanted to talk to you about something much more important. How is the Replacidin trial going?”

“It’s going well.” I study his expression. “Would you like to review some of the data?”

“Sounds good. I’d love to see what you’ve got, but first…” He rests his hand on my shoulder. “Let’s grab some coffee. You must be tired after a busy week.”

I follow him to his office, feeling my anxiety grow with every step. Al Greenbeck never does anything without an agenda, and this level of personal attention can only mean one thing:  he wants something from me. When he asks his secretary to bring us two coffees, my heart starts to race. He must want something really big.

“So tell me,” he begins, leaning forward in his plush leather desk chair. “How are you finding the practice? Have we met your expectations?”

“Absolutely,” I lie. “It’s been a wonderful learning experience so far.”

Greenbeck smiles. “You’ve certainly come a long way, my friend. I’m especially impressed by the clinical trials work you’ve done for us.” He leans forward as if he’s about to share an important secret. “That’s the part Nina doesn’t get, Jake. You and I are researchers at heart. We’re not in this for the money. We’re in it for the discovery. We’re explorers, out to change the landscape of our field. Isn’t that what gets you out of bed fired up every morning? Isn’t it the chance to make a difference that counts?”

I nod eagerly, which is how I respond to most of Doctor Greenbeck’s grandiose statements. Jess likes to call it brown-nosing, but in my defense, I’m not the only one who reacts this way to the man who Oprah recently called the “Dermatologist to the Stars.” Most people treat him more like a high-profile politician or actor than a doctor, and he clearly relishes the role, exuding confidence from every pore.

“Take our work with Replacidin, for instance,” Greenbeck continues. “Do you know how many centers worldwide are involved in our phase three trial?”

“Twenty five,” I say, remembering how he recently boasted about the number.

Greenbeck frowns. “Try nineteen. That’s the number of centers that have given us data we can actually use.” He reaches over to pull a bulky binder from the bookshelf, then pages through its contents. “That leaves us with a cohort of 280 eligible patients.”

“But… don’t we need at least 300 subjects to meet the protocol?”

We both share a moment of silence, acknowledging the gravity of this development.

Replacidin, a neurotoxin engineered to cause long-acting muscle paralysis, has been in development for close to a decade. In that time span, the lethal molecule has traveled far, moving from the obscurity of rain forests and coral reefs into research labs throughout the world, finally finding its way to Pulsar Nanotechnologies – an ambitious biotech startup with dreams of creating the next big thing.

With Replacidin, they’ve found it. Once the drug gains FDA approval, it will dethrone Botox as the most popular cosmetic procedure in the world. When our results are published, all competitors will be wiped out, practically overnight.

Which is why even a week of delay could translate into millions of dollars lost. As Replacidin’s lead clinical investigator, Greenbeck is directly responsible for keeping the project running smoothly.

“You see our problem,” he notes somberly.

The human trial stage – called the “Replacidin Efficacy and Safety Trial,” or REST for short – started a few months before I joined Greenbeck Dermatology. The preliminary data, which someone recently leaked to the press, promises to make Replacidin an instant blockbuster worth countless billions to Pulsar Nanotech.

But that’s just the tip of the iceberg. Replacidin is only the first of many drugs in Pulsar’s R & D pipeline. Its launch is sure to make a big splash, but the line-up of innovative treatments to follow will represent the true medical revolution – one that’s based on a patented nanotechnology vehicle designed to deliver drugs with mind-boggling precision. As Greenbeck once put it to me: “It’s not just about treating wrinkles. Imaging sheaths of carbon nanotubes for neurons, allowing stroke victims and paraplegics to walk again. Imagine nanospheres implanted as islands in the pancreas of a diabetic, making insulin shots a thing of the past. Or tethered to a tumor mass, releasing targeted chemotherapy for decades.”

“How do we get the other centers to enroll more volunteers?” I ask, my thoughts returning to the problem at hand.

Greenbeck shoves away the study binder in disgust. “We don’t, Jake. They’ve royally screwed up already. I don’t trust them.”

“So what’s the alternative?”

“Well, my friend…” Greenbeck flashes me his made-for-TV smile – the one that supposedly charmed the ladies of The View so much a few months ago. “We’ll just have to do it ourselves.”

He must notice my dazed expression, because he bobs his head enthusiastically. “Hey, you said it yourself. People are dying to get into the study! We have hundreds of names on our waiting list.”

“But,” I stammer, thinking of what it would take to start two dozen patients from scratch, “There isn’t enough time. Even if we could recruit that many people… it’s just too much.”

“Nonsense! Here’s how it can work: Nina and I will prescreen our list of potential candidates. Starting next week, we’ll free up your schedule so that you can dedicate enough time to the study. You’ll only have to enroll” -- he closes his eyes while making the calculation -- "an average of five new subjects per day. For you, that’ll be a cake walk.”

I nod dumbly, which he takes to be a sign of approval.

“Perfect! Now if we start tomorrow, we should finish all new treatments within a month. That still gives us six full months to draft and revise our paper. We can add the new data right at the end.”

“I’m still not sure…” I trail off when I catch the warning flicker in Greenbeck’s eyes.

“Listen, Jake.” He leans forward so I can smell his cologne from across the desk.  “I’ve just offered you the chance to be one of the REST paper’s lead authors. Don’t kid yourself. This is the kind of opportunity that only comes around once in a lifetime… if you’re lucky.”

“But what about my scheduled patients?”

“Don’t worry about that.” Greenbeck’s gray eyes fix on mine. “Our study takes priority. Again: I’ve just invited you to be second author on what’ll probably turn out to be the most important scientific article of the decade. So what do you think?”

“Wow,” I stammer. “I, um… I don’t know what to say. This is such an honor.”

“No need to thank me.” Greenbeck holds out his hand, waiting for me to take it. “You’ve earned this opportunity.”

Now is the perfect moment, a chance to finally listen to my inner voice. I should tell Greenbeck that he wants more from me than I can give, that I can’t be his work mule any longer.

But then what? As I play out the consequences, it’s clear I’ve left myself with alarmingly few options. If I defy Greenbeck now, then he can erase the past year of my professional life.  I’ll have nothing to show for all that mind-numbing work but a few residual pay checks and a lukewarm job reference. The painful truth is that Greenbeck can replace me in less than a week, since there are hundreds of aspiring mules eager to take my place. I’m trapped.

“So what do you say?” Greenbeck asks, an impatient edge entering his voice. He’s not used to being left hanging, even for a few seconds.

I shake his hand and thank him for yet another exciting opportunity. Of course I’ll get the job done, I promise. What else can I do?

It wasn’t always this way. One short year ago, I had jumped at the opportunity to join Greenbeck Derm. It was, after all, the opportunity of a lifetime. Who wouldn’t want to be Al Greenbeck’s protégé? Back then, if someone had asked me to describe the man, I would have gushed with praise. I would have pointed to his many accomplishments, then proudly explained how I’d been hand-picked to follow in his impressive footsteps. In short, Al Greenbeck represented everything I dreamed of becoming – the promise of a bright, exciting future.

Now, glancing around his grand office, at the gilded walls adorned with countless diplomas, awards, publication clippings and other professional trophies, it’s hard to fully grasp how empty that promise has become.

*

“So Slick Al’s dumping this all on you.” Jess eyes me knowingly. “Can’t say that I’m surprised.”

“I can always refuse.”

“Yeah, but you won’t. You never do.”

“Here, I’ll call him right now.”

I move toward the phone, but Jess waves me off. “Don’t sweat it Jake. I understand. We’ve both got work to do.”

It’s Friday night and I’ve just broken the news that I’ll be going into the office for most of the weekend. Jess is standing in the foyer of our center-hall colonial, still dressed for work, with an expression of total exhaustion on her face. For a moment, it feels as if we’re strangers, surprised to run into each other in a setting as familiar as our home.

“I’m really sorry,” I say, “but I just couldn’t find a way to get out of it. Can’t you and the kids stay for one more day? I just don’t want you to…” I trail off miserably, not wanting to say the words “leave so soon.”

Jess lets out a barely audible sigh and shakes her head. “I don’t think that’s such a good idea. My folks are expecting us in time for dinner tomorrow. Besides, it’s not wise to drag things out, don’t you think? You know how Emma is with transitions.”

“Yeah," I concede, following her into the kitchen, “but I haven’t really had a chance to say goodbye to the kids.  It’s just one more day. You can still head out Sunday morning.”

As I plead my case, she rummages through the refrigerator to pull out a bottle of Evian, eyeing me with annoyance in between sips. By the time I’m done talking though, her expression has softened into something approaching pity.

“Hey." She reaches out to touch my shoulder. “Don’t make this into something it’s not, okay? We’re just talking about a few months. Summer will be over before you know it.”

“And then what?”

Instead of answering right away, she hangs up her navy suit jacket, then kicks off her pumps before turning to face me. Standing in the narrow hallway, our bodies are suddenly so close I can smell the mint on her breath, and in that instant, my wife looks more beautiful, and distant, than ever – like an idealized memory, already fading into the past. “I wish I could tell you that I knew, Jake,” she whispers.

“Yeah,” I whisper back, wishing I could just give her the right answer. But there is none. “So do I.”

How did we get to this point? It’s a question I’ve asked myself every night for months now, ever since I found myself sleeping alone. There are no simple answers.

Sometimes, like tonight, I go back to the beginning, closing my eyes and picturing the moment when we met. I was a first-year med student at the time, spending an afternoon at the Harvard University Health Services. I remember the scene with surprising clarity. Time hasn’t blurred the faces, or erased trivial details: the acrid smell of the patient cubicle, or the pained expression on her boyfriend’s face. He’s seated at the edge of the exam table, doubled over in pain, and Jess has her arm draped around him, gently massaging the small of his back. They make a striking couple: the kind of handsome pair that would be hard not to envy when you saw them walking down the street together, hand in hand.

As I enter in my dorky white lab coat, the boyfriend – Chris or something – gripes about not wanting to deal with another med student. That’s when Jess looks up at me and I catch the sparkle in her eyes, like she’s recognizing an old childhood friend. When she reaches out to shake my hand, the look of familiarity is gone, replaced by the formal body language of a pleasant stranger. Even if things had ended there – if Jess and I had never crossed paths again – I’m sure she’d still be in my memories thanks to that one brief encounter. But of course our paths did cross again, less than a week later.

Alone now with these memories, I think of something Mom once told me, years before I lost her, Dad and my sister Abby in the tragedy that changed my life. I remember dismissing it as a cheesy cliché at the time. She’d described a healthy relationship as a tree. First, you set down solid roots, and then everything that follows grows from that foundation. All the experiences that fill a happy life together, all the branches, the leaves, the flowers – they’re supposed to draw their life from that one sturdy base. It’s your shared past together that nourishes the present, right?

But what if Mom had it backward? What if it’s the present that feeds the past? Maybe that’s where the roots really lie, keeping those perfect memories alive, giving them all their color and meaning. And if those roots become poisoned, then how long before that poison seeps into the past?

What if it starts to feel as if Jess and I were never right for each other – not even in the beginning?
 

***

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