Comfort Zone

Chapter 3

Miriam had opened her office three years before, visualizing a micropractice with minimal overhead, and freedom to spend more than ten or fifteen minutes per patient. She also planned to follow her own hospitalized patients, instead of ceding their care to a hospitalist. She rented space in the medical office building attached to the hospital, hired a small staff, and later a biller when she got tired of chasing after insurance companies to get the money she'd earned. She knew she had to make a living but didn't plan to sacrifice all her do-gooder intentions; if that meant waiving a copayment now and then, she would do it gladly.

She watched with satisfaction as her practice grew into as complex and spicy a dish as Miami itself: culturally diverse and multilingual. Though her feelings about Miami were mixed, especially in the summer, she still got a kick from the city's international vibe. When she first arrived, eager and energetic, she'd carried around lists of words and phrases in Spanish and Creole. Three years later, if she wasn't quite as enthusiastic, she was still intent on making a go of it.

Solo private practices were reputed to be dead. Hospitals were voraciously buying them, or they were merging with large groups, in pursuit of a steady paycheck and less stress for the doctor.

Good luck with that, Miriam always thought.

Maybe bucking trends was in her blood. Her great aunt, a proud lesbian, had once traveled the world. On a bicycle. Against everyone's advice, Miriam had married young, before going to medical school. She was now divorced, paying alimony to the lazy, scheming lawyer who'd played her just right. She was usually able to shake off the thought by remembering her resolution to avoid regret and bitterness altogether. Not good for her health, not good for her happiness. That's what she counseled her patients day after day.

"Be positive."

That advice definitely wasin her blood, B+ being her type, and it especially appealed to her HIV patients, for whom "positive" had a very specific meaning. When Miriam first started practicing in Miami, she became aware of the large HIV positive population. Finding the field fascinating and the patients inspiring and often colorful, she drove herself to keep up with the newest treatments and concerns.

Be positive, Miriam thought, as she drove to work the next morning, ignoring the honking of the cars behind when she slowed to let a texting pedestrian pass. She tried to soak up energy from the soothing greenery and immense Royal Poinciana trees en route. The trees bloomed every June and quickly burst into red flames, but even their brilliant blossoms looked droopy to her this morning, as if their initial enthusiasm was waning and the summer heat was just too much for them.

She swiped into her office building, shivering as her overheated skin encountered the typically frigid indoor air. It's always too hot or too cold in Florida, she thought. Some people thought the cold air was necessary to kill germs, but Miriam had never seen any scientific literature to back it up and was convinced some hot-blooded hospital administrator had started the trend.

She rode up to her office in the private doctors' elevator, traveling with a small group of colleagues, most sporting cups of coffee and looks of fatigue. The elevator was slow, but Miriam always enjoyed the ride; it was the safe place for gossip and bitching.

"I told a patient yesterday I became a doctor because of my passion for data entry," Ezzy said. Ezra Egozi was an internist around Miriam's age who'd started at Miami Health the year before.

Whether motivated by a love for trees, a hatred of government penalties for those who failed to comply, or simply the need to keep up, most doctors had adopted electronic health record systems, EHRs, in lieu of paper charts. Miriam remembered her vendor explaining all its features years before, and her naïve hope it would make medical life easier.