Chapter 3
Robin Hood in Gucci
PRESTON
Day Three
The problem with saving lives is that it is remarkably inconvenient.
There is the lighting, which is fluorescent and unflattering to anyone over the age of twelve. There is the smell, which oscillates between "bleach" and "regret." And then there is the coffee.
The coffee at St. Jude’s is a hate crime. It is sludge. It is battery acid pretending to be a beverage.
Which is why, at 7:00 AM on my third day of residency, I am not rounding on patients. I am currently overseeing the installation of a La Marzocco Linea Mini espresso machine in the interns' break room.
"Careful with the chrome," I instruct the delivery guys. "If you scratch it, I’ll have to sue you, and my lawyers are very bored right now."
"Dr. York?"
I turn around. A girl—Foster, I think—is standing in the doorway. She looks like she has slept inside a dryer. Her scrub top is buttoned wrong.
"Good morning, Foster," I say, signing the delivery receipt with my Montblanc pen. "You look... present."
"Is that..." She stares at the gleaming Italian machinery sitting on the wobbly break room table. "Is that an espresso machine?"
"It is," I confirm. "I tried the cafeteria brew yesterday. I saw God, Foster. And he was angry."
"We aren't allowed to have personal appliances," she whispers, looking terrified. "Dr. Silva will confiscate it. He confiscated Levine’s toaster oven yesterday."
"Levine was heating up fish," I say, dismissing her concern. "This is a humanitarian aid package. Now, do you want a macchiato or are you going to report me?"
Foster looks at the machine. She looks at the door. "Double shot," she whispers. "Please."
I am just tamping the grounds—a custom blend I have flown in from a roaster in Portland—when the atmosphere in the room changes. The temperature drops ten degrees.
I don't need to turn around to know who it is.
"York."
The voice is deep, raspy, and sounds like it has been gargling gravel and judgment.
I turn slowly.
Dr. Lucas Silva is leaning against the doorframe. He looks terrible. And by terrible, I mean he looks like a tragic, beautiful disaster. His curls are a mess, there are dark circles under his eyes that could bruise a peach, and he is holding a stack of files like he wants to set them on fire.
"Chief," I say, leaning against the counter. "Coffee? It’s on the house."
He stares at the machine. He stares at me.
"You brought an espresso machine," he says flatly. "To a hospital."
"I brought morale," I correct. "And caffeine. Which, technically, makes me the most valuable person on this floor."
"Get rid of it."
"No."
He blinks. "Excuse me?"
"I said no," I say, pushing a tiny porcelain cup toward Foster, who grabs it and scampers away like a startled squirrel. "You can write me up. You can yell at me. You can make me manually disimpact the entire Knicks roster. But I am not drinking the sludge downstairs, and neither are you."
I start pulling another shot. The rich, caramel scent fills the sterile room. I see Silva’s nostrils flare. I see the weakness in his eyes. He is a man on the edge, and I am the devil with a steam wand.
"I take it black," he mutters, defeated.
I smirk. "Coming right up."
I hand him the cup. He takes a sip. His eyes close. For a second, the tension in his shoulders drops. He looks almost... human.
Then his pager goes off.
The peace shatters. The shoulders go back up. He slams the cup down.
"Rounds. Now. And hide that thing before Mama sees it, or she’ll charge you rent."
We are standing in Bay 2. The patient, Mrs. Rosa, has a bright red, angry rash on her forearm that is baffling the Dermatology Chief, Dave.
“It looks like contact dermatitis,” Dave says, adjusting his glasses. “But she hasn't changed soaps. We’ve ruled out latex. I’m thinking… rare tropical fungus?”
Lucas sighs, rubbing his temples. “Dave, Mrs. Rosa lives in New Jersey. Unless she’s been wrestling poison dart frogs in Newark, it’s not tropical.”
I lean forward. I sniff the air. I smell… chemicals. Specifically, the acrid scent of cheap dye masquerading as luxury.
My eyes land on Mrs. Rosa's handbag, sitting on the bedside table. It is a bright orange Birkin.
Or rather, it is pretending to be a Birkin.
“It’s the bag,” I announce.
Lucas turns to me. “The bag?”
“Mrs. Rosa,” I say gently. “That is a lovely bag. May I ask where you acquired it?”
“My nephew sent it to me!” Mrs. Rosa beams. “From Italy!”
“Ah,” I nod. “Canal Street Italy. Or perhaps eBay Italy.”
“York,” Lucas warns. “Don't insult the patient’s accessories.”
“I’m not insulting it, I’m diagnosing it,” I say. I pull on a glove and pick up the bag. I examine the stitching. “Uneven saddle stitch. And the leather… it smells like gasoline and sadness.”
I turn to Dave.
“It’s ‘Faux-Leather Rejection Syndrome,’” I declare. “This isn't Hermes leather, Dave. It’s pleather treated with a formaldehyde-based dye to mimic the orange hue. Mrs. Rosa carries it on her forearm. The heat transfers the toxins. Hence, the rash.”
Dave stares at me. “Is that… in the textbooks?”
“It’s in Vogue, Dave. September Issue, 2018. There was a whole article on toxic knock-offs.”
I turn to Mrs. Rosa.
“I’m prescribing a steroid cream,” I tell her. “And I am prescribing that you burn this bag. It is a biological weapon.”
“But it has the logo!” Mrs. Rosa protests.
“The logo is crooked, darling,” I say gently. “And you deserve better. I’ll have my mother send you a catalogue. She has a closet full of the real thing she hasn't looked at since 1999.”
Lucas stares at me. He looks at the rash. He looks at the bag.
“Formaldehyde dye?” Lucas asks.
“Common in the counterfeit market,” I shrug. “It’s a scourge on the industry.”
Lucas shakes his head. He writes on the chart. Contact Dermatitis. Cause: Fashion Crime.
“Good catch, York,” Lucas mutters. “Remind me never to buy you a gift without a certificate of authenticity.”
“Oh, I would know, Chief,” I wink. “I would know immediately.”
By 10:00 AM, the caffeine buzz has worn off, replaced by the crushing reality of American healthcare.
I am standing at the nurses' station, pretending to update a chart but actually online shopping for a new watch, when I hear it.
The sound of Dr. Lucas Silva losing his mind.
He is on the phone at the end of the counter, gripping the receiver so hard his knuckles are white.
"I understand the policy," he is saying, his voice tight.
"I am looking at the policy. I am also looking at a seventy-year-old woman who has a mass on her pancreas that we cannot identify without the contrast MRI.
.. No, an ultrasound is not sufficient..
. Because I said so... I am the Chief Resident. .. Hello? Hello!"
He slams the phone down. He puts his head in his hands.
"Trouble in paradise?" I ask, sliding over.
He looks up. If glares could kill, I would be a smudge on the linoleum.
"Insurance," he spits the word out like a curse. "Mrs. Gable. Bed 8. She needs a specific MRI sequence to rule out a tumor. Her insurance—'BudgetCare Plus', which is neither budget-friendly nor caring—denied it. They want us to do a 'wait and see' approach."
"Wait and see?" I repeat. "Wait and see if she dies?"
"Essentially," Silva runs a hand through his hair, making it even more chaotic. "I have to file an appeal. It takes forty-eight hours. We don't have forty-eight hours. Her enzymes are spiking."
"So just do the scan," I say.
Silva laughs. It’s a hollow, bitter sound. "Oh, right. I forgot. You’re a York. You think things just happen because you want them to. If I order that scan without approval, the hospital eats the cost. Five thousand dollars. And then Administration eats me."
He stands up, grabbing Mrs. Gable’s chart.
"I have to go tell a sweet old lady that we’re going to 'monitor her condition' because some actuary in New Jersey decided she isn't profitable enough."
He stalks off toward Bed 8.
I watch him go. I look at the phone he just slammed down.
I look at the computer screen in front of me.
I hate this place. I hate the smell. I hate the shoes. But mostly, I hate the fact that Lucas Silva—who is annoying, rigid, and has terrible taste in footwear—looks so defeated. It ruins his face. He has a very symmetrical face. It should be smiling, or at least yelling at me.
I sigh. I straighten my scrub top.
"Time to mingle," I whisper.
Mrs. Gable is delightful.
She is a tiny bird of a woman with white hair and a hand-knitted shawl. When I walk into her room, she is doing a crossword puzzle.
"Seven down," she mutters. "Five letters. 'A sharp pain'."
"Grief," I suggest, stepping inside. "Or maybe 'Agony'. Though that's five letters too."
She looks up and beams. "Dr. York! The handsome one. Don't tell Dr. Silva I said that, he looks like he carries the weight of the world, poor dear."
"He does," I agree, checking her vitals monitor. "He needs a hobby. Or a Valium. How are you feeling, Mrs. Gable?"
"Oh, fine, dear. Just a little tummy ache." She reaches into her purse and pulls out a strawberry hard candy. "Would you like a sweet?"
I look at the candy. It is covered in lint.
"I would love one," I say, taking it and slipping it into my pocket.
"Dr. Silva was just here," she says, her smile dimming a little. "He says we have to wait a few days for the picture-machine. He seemed very upset about it. He’s a good boy."
"He is," I say. "But he’s a terrible liar."
"Excuse me?"
"You aren't waiting, Mrs. Gable," I say, tapping the edge of her bed. "There has been a... clerical error. I just checked the system. You’ve been upgraded."
"Upgraded?" She blinks. "Like on an airplane?"
"Exactly like on an airplane. First class is boarding."
I walk out of the room before she can ask questions. I head straight for the nurses' station.
The computer system at St. Jude’s is ancient. It runs on Windows 98 and hope. But it also runs on the York Foundation’s endowment.