Animals: Chapters Twelve, Thirteen & Fourteen
WHEN SURGEONS OPERATE ON PEOPLE WHO DON’T NEED IT, HOW FAR WILL THEY GO TO PROTECT THE SECRET AND KEEP THE MONEY COMING IN?
Chapter Twelve
The flight from Dublin was seven hours and Karen made herself stay awake for most of it, the trick she’d learned over the years for beating the jet lag that turned the first day home into a lost cause. She had a Diet Coke and watched 17 Again on the small screen, which was considerably more enjoyable than she’d expected. She laughed twice. She counted that a success.
She’d spent the week with Maura in Malahide, north of Dublin, in the house with the garden where her sister’s twin boys, seven now, were running a dedicated campaign against all furniture within reach, and where Sean, her brother-in-law, stayed quiet and dry and reliably funny in the way of people who don’t need you to know they’re funny. Her parents had flown over with her, which was the tradition, the way Maura and Sean and the boys came to Philadelphia every July. Karen had friends who talked about family obligations with the weariness of people describing a tax they resented, and she’d always found it faintly incomprehensible. Her family was easy. It was easy to be around them. She knew that wasn’t universal and tried not to take it for granted.
Philadelphia announced itself the way it always did on the approach, the Schuylkill and the skyline and the flatness of the land that made the city look more compact than it was, everything gray and clear in the mid-November afternoon, the trees stripped now, the light in its seasonal retreat. By seven she was through her front door, bag dropped in the hall, coat on the hook, the smell of her own place meeting her like a small welcome she hadn’t known she needed.
She was asleep by nine.
Monday she was up at six without an alarm, which was what happened when you forced yourself awake on the transatlantic and crashed hard on the other side. She ran five miles along the river in the cold, the path mostly empty at that hour, the water dark and moving, and was at her desk by eight-fifteen with a coat that smelled of November and the alertness of a body fully reset.
She had a strict rule about work communications. Her personal phone, her personal iPad, her personal laptop, none of them carried Chubb accounts, none received work email, none got checked after hours or on weekends or during a week in Ireland with her family. She was not a surgeon. She was not a high-ranking diplomat. Whatever waited in her inbox had been waiting since the Tuesday she left and would wait another forty minutes until she was at her desk with her coffee.
In the break room she found Marcus from commercial claims in front of the Keurig.
“How was Ireland?” he said, without turning.
“How do you know I was in Ireland?”
“You told me before you left.” He looked over his shoulder. “You also have that look. The been-somewhere-else look. The one where you come back and the office seems slightly smaller than you remembered.” He handed her the cup that had just finished and put in another pod for himself.
“Really good trip,” she said. “How was the week?”
“Robert’s case closed. The one from Hartford. Two years. I’m thinking of putting something on the wall. A plaque.”
“You deserve one. I’ll sign the petition.”
He laughed. She took her coffee and went back down the hall, past the stack of opened, time-stamped papers Diane had assembled in her absence with the chronological instinct of someone who’d worked with her long enough to know what she’d need when she walked back in. Her calendar was empty by design, blocked for the first two days back, the one exception the staff meeting at two, which she knew from seven years of attending would be largely indistinguishable from every staff meeting before it.
She turned to her email.
She worked through it in the order it had arrived, her habit, oldest first, no triaging, no cherry-picking the interesting ones. A few new cases forwarded for initial review, which she flagged for the week. Some reports she’d been waiting on for two other claims, which she opened, scanned, set aside for proper reading. Two questions from a junior analyst about a case she’d closed in September, both straightforward enough to answer in a paragraph each. She typed the responses, sent them, moved on. Karen did not close cases that weren’t ready to be closed. She didn’t need to say it often.
She was midway down the list when she saw it.
The sender field read s.gula@lehigh.edu. The subject line read: none.
She sat a moment before she clicked.
Dear Ms. Callahan:
I will be out of the US for a conference, returning on November 21st, a Thursday, and would like to meet with you to discuss a matter of interest. I will be staying in Philadelphia through the 25th.
S. Gula
She read it twice.
Of all the people who might have come out of the woodwork in the weeks since the meeting with Connor and McGuire, Gula had seemed among the least likely. He’d sat across from her in that cramped office on the Lehigh campus and been, to put it plainly, one of the coldest people she’d encountered in seven years of work that required encountering a wide range of people. He’d told her nothing. Volunteered nothing. Informed her, with a flatness that left no ambiguity, that she’d wasted her time making the drive, and turned back to his computer before she was fully out the door.
And yet here he was. A matter of interest. The phrasing was careful in the way of lawyers and people who think about their words before writing them. Not a matter of concern, not a question, not a response to any inquiry she’d made. A matter of interest. His interest, presumably, though he hadn’t said so.
She thought about the L.L.Bean backpack and the office with its doubled rows of books and the historical map on the wall, and the life he’d built with such apparent deliberateness on the far side of whatever had happened at White Plains Surgery Centers. He’d seemed, when she met him, like a man who’d shed everything from the previous version of his life and wasn’t looking back. The house on Market Street was the only anomaly, too substantial, too carefully kept for an assistant professor, the house of someone who’d arrived with money brought from elsewhere.
She’d left him alone because he’d given her nothing and she’d had other threads to pull.
She had not stopped thinking about him.
She hit reply.
Dr. Gula,
I’d be happy to meet with you. My office is at 436 Walnut Street, Philadelphia, PA 19106. I can work around your schedule entirely. Please let me know what works for you.
Karen Callahan
She read it back, added nothing, and sent it. Then she moved to the next email.
The morning went fast, the way mornings go when you’ve been away a week and the work has waited with patience and there’s nothing to do but sit down and address it. She looked up at twelve-forty and realized she’d skipped lunch, which happened more than it should, and gathered her things for the two o’clock.
The staff meeting on the fourteenth floor proceeded with the unhurried institutional rhythm of a meeting that has a standing agenda and a standing cast and has long since stopped surprising anyone. She took notes on two items, drank a cup of bad coffee from the credenza, and waited for Charlie Bruchner to formally close it.
Charlie was her boss the way good bosses are bosses, present enough to be useful, absent enough to be trusted, with the sense to understand that the people who worked for him were better at their specific jobs than he was. He was sixty-seven, gray-haired, a former underwriter who’d come up through the claims side, with the institutional knowledge of a man thirty-two years inside the Chubb organization. He trusted her instincts. She knew it and didn’t abuse it.
As the room cleared he caught her eye and raised his chin slightly. She stayed.
“How was the vacation?” he said, when the last person had gone.
“Lovely. My sister’s boys are at the age where everything is either a game or a catastrophe and there’s no visible distinction between the two.”
He smiled. “That tracks.” He squared his papers. “The Connor matter. Where are we?”
She leaned back. “Honestly? I’m most likely closing it out.”
“Most likely,” he said. The distinction didn’t escape him.
“There are a few loose ends I want to tie up first. Connor is.” She paused. “He’s an asshole, Charlie. Genuinely. But being an asshole doesn’t make a claim fraudulent.” She held his eyes. “I think we’re probably going to pay it. But I want to be sure.”
Charlie nodded slowly. He didn’t look thrilled, which she’d expected. He looked like a man absorbing news he’d been braced for and had hoped to avoid. “How much time do you need?”
“Not much. A few more conversations. I want to make sure I’ve turned over everything before I sign off.”
“Take the time,” he said. Then he set down his pen and looked at her directly, the signal that they were now speaking with the formality the situation required. “You know what this one costs us regardless of outcome.”
“I know.”
“Four years. Policy’s forty-eight months old. We write a check on this, we feel it.”
“I know that too.” Charlie treated every payout as if it were critical to Chubb’s survival, which a seven-million-dollar check was not, but she’d stopped arguing the point years ago. It was how he’d gotten to thirty-two years.
He looked at her a moment. “You said loose ends.”
“I did.”
“Anything worth discussing?”
She thought about the email from s.gula@lehigh.edu sitting in her inbox with its careful phrasing and its subject line of none. “Not yet,” she said. “I’ll let you know.”
Charlie nodded, picked up his papers, stood. “Good trip,” he said.
“It was. I should do it more often.”
“Then do it more often,” he said, and left her with the empty conference room and the bad coffee and the thought of Steven Gula in Philadelphia in a week with something he wanted to discuss.
She sat with that a moment.
Then she gathered her things and went back to her desk.
Chapter Thirteen
Larry McGuire’s email arrived around four, after the staff meeting. She read it standing at her desk with her coat still on, coffee in hand, and knew it for what it was inside the first two sentences. Brief, professional, carefully non-pushy, which was what made it pushy. He was simply making himself available, he said. Happy to provide whatever documentation would help resolve the matter. Completely understood she’d been traveling. Hoped she’d had a wonderful trip. She set the coffee down and typed back that she’d just returned from an extended vacation and planned to get to the file this week, next week at the latest. She sent it, took off her coat, and moved on.
Two days later the follow-up from Gula came in. She was reviewing a separate file when it arrived. She stopped. s.gula@lehigh.edu. Time-stamped 11:47 PM. She sat back and read it.
His days were packed on his return to Philadelphia at the end of the week, he said. It would suit him to meet and eat, kill two birds with one stone, the phrase he used, which she noted. He had reservations for two at five-fifteen on the twenty-second at Parc. He’d be eating there regardless, he said, so she shouldn’t worry if she couldn’t make it. He might not be able to check his email until that day, so no need to confirm.
She read it twice. Then a third time, slowly, the way you read a thing when the words are clear but what’s under them needs separate attention. He’d reached out to her. He’d set the table, made the reservation, named the place and the time, and then offered her a graceful exit from the whole arrangement in the same paragraph, no need to confirm, don’t worry if you can’t make it. It was either the absentminded generosity of the quirky-professor type or something a good deal more deliberate. She’d sat across from him in that cluttered office and was fairly sure it wasn’t the former. She wrote back that she would be there, sent it, and wondered when he’d get it.
The second email came thirty-six minutes later, at 12:23 AM. It said only: Good. A man who might not be able to check his email until Friday had checked it inside the hour. She filed that beside kill two birds with one stone. He was either genuinely out of the country or a person who conducted his correspondence at the hours when the rest of the world was otherwise occupied. She’d known a few of those. Insomniacs, usually, or people with something to think about. Sometimes both.
She spent the two days before the dinner doing what she always did when a case called for it, being thorough without being too visible. She ran everything she could run on Gula. The Market Street house had been bought outright in 2018 for just over nine hundred thousand, which in Bethlehem was substantial but wouldn’t have raised a flag in Philadelphia or New York. The money, she imagined, came from White Plains Surgery Centers. He’d been well paid. An obituary told her his father had been a foreman at a machine-parts company outside Cleveland, his mother a school nurse. Middle class, comfortable.
He had a sister in Portland and a brother, Chris, the detail Sam had flagged early. Chris Gula had owned the medical supply distributorship the Boston AUSA believed was at the center of the kickback arrangement. She looked at him carefully and found, as Sam had implied she would, a great deal of nothing arranged with considerable deliberateness. Chris’s device company had been dissolved in 2018, the same year the practice folded. He’d filed papers closing the LLC.
From what Karen could tell, Steven Gula had never married. No joint accounts, no shared leases, no power bills with another name on them, though she had only so many resources to really know. His social media was present but careful. The LinkedIn hadn’t been touched since he started at Lehigh. An occasional travel photo on Facebook, most of them old. The White Plains years had generated press, local coverage of ribbon cuttings, conference appearances, the civic visibility of someone who’d been the public face of something significant and understood what that required. She found a photograph from a regional business magazine, 2014, Gula in a dark suit shaking hands with a hospital administrator at some kind of awards dinner.
His faculty profile showed him at his desk, looking up at whoever had taken the picture with an expression that wasn’t quite a smile and was more interesting than one. His hair a few weeks past when it should have been cut, which she’d filed under professorial and now considered differently.
Karen had spoken briefly to a nurse named Colleen, listed as COO of the group. Gula was a great guy, she said, in the flat tone of someone reporting a fact they’ve decided not to attach anything to. Like everyone else Karen had tracked down from White Plains, she was cool and contained, not unfriendly exactly, but with the manner of people who’ve made a decision about a door and had the decision become easy through practice.
The most interesting thing about Steven Gula, Karen had concluded by the end of the week, was how comprehensively uninteresting he appeared to be. Which was, in her experience, its own kind of information.
The night of the dinner she left the office at four. In the women’s room she brushed out her hair and studied herself a moment with the practical assessment of someone who wants to look appropriate without appearing to have tried. She pulled the pale green Hermès scarf from her bag, bought in Paris during her year at the Sorbonne and still the best thing she owned, and tied it at her neck. It shifted the work outfit into something that could pass for dinner without announcing that had been the point. She took the stairs.
Parc was a ten-minute walk west on Walnut, through blocks that had the feel of a Friday late afternoon, the work week loosening its grip, the streets gaining a different energy, the restaurants beginning to fill. Rittenhouse Square opened up ahead of her, the trees stripped, the last of the afternoon light going flat over the buildings, and the restaurant sat on the south side of the square, dark red awning, French doors, the warm noise of it reaching her from half a block away. Even at five-fifteen it was busy, the kind of busy that suggests a room that has been doing this long enough to know exactly what it is.
She stood inside the entrance and looked around. Red leather banquettes, well-worn wooden chairs, vintage prints on the lacquered walls, the long zinc bar at the back with its aproned waiters moving at the unhurried efficiency of people who’ve done this for years. Butter and good wine and baking bread. She didn’t see Gula.
The maître d’ approached, a trim man in his fifties with the bearing of someone who has spent his working life managing other people’s comfort and arrived at a genuine expertise.
“Good evening. Do you have a reservation?”
“I’m joining someone. Last name Gula.”
“Of course.” He smiled as if confirming something he’d been told to expect. “May I take your coat?”
She handed it over, and he disappeared briefly and returned, and she followed him through the dining room toward a corner table near the window, the kind that took either long standing or a thoughtful phone call.
She would not have recognized him.
He stood as she approached, and she saw him fully and had about one second to revise everything she’d been carrying about Steven Gula since the office at Lehigh. He was taller than she’d registered there, or the sitting-down quality of that meeting had compressed him, and here with the full length of the room behind him he had his actual dimensions. His hair was shorter and swept back, which removed the overgrown professorial quality she’d noted and filed and replaced it with something far more deliberate. The glasses were silver-framed and clearly chosen, the kind of frames that announce without announcing that the person wearing them has thought about how they look. The suit was custom and it fit the way custom suits fit men actually built for them, the shoulders and chest of someone who kept himself in shape and had the tailoring to acknowledge it. None of this had been visible in the lecture hall.
Chameleon, she thought, and felt the word land differently than the first time.
He smiled. His eyes didn’t participate.
Not hostile. Not threatening. Not even cold, exactly. Simply absent from the smile, the way warmth is absent in a person for whom it’s a decision rather than a reflex, and who hasn’t made the decision yet.
“Dr. Gula,” she said.
“Please. Steven.” He gestured to the chair across from him. “I’m glad you could make it.”
“I have to say I was surprised to hear from you,” she said, sitting.
He looked at her a moment, in no hurry to get to it. “You’re an attorney,” he said. Not a question, and not small talk. A card placed on the table to let her know he’d done his work.
She felt her eyes narrow before she could stop them. He’d done more than she’d given him credit for. “Yale,” she said. “For whatever that’s worth. I went to Chubb straight out of law school.” She said it with the small smile of someone acknowledging she’s been found out and isn’t especially bothered.
“I’m sure you know quite a bit about me as well,” he said. Not defensive. The observation of someone who has considered the situation from both sides and found it symmetrical.
She smiled. She did.
“I’ve been in Germany,” he said, picking up his menu. “A conference in Hamburg. I wanted to talk to you when I got back.” He said it with the plain ease of a man stating a fact, not performing one.
“You seemed fairly certain you had nothing to say to me the last time we met.”
He looked at her over the menu. “Circumstances change.”
“About?”
“In a moment,” he said, easy, a man used to setting the pace of things, and glanced toward the approaching waiter.
The waiter was young and French in the committed way of people who’ve made their nationality a professional asset. He presented the specials with the precise earnestness of someone who has memorized something important and wants you to feel it, his accent carrying the English words with the care of someone translating in real time and making it sound better in the original.
Karen looked up from her menu. In French, she said it all sounded wonderful and asked what part of France he was from.
The waiter’s professional composure gave way briefly to something more genuine. Lille, he said, in the north. He complimented her accent.
She said she’d done a year at the Sorbonne, and that now her French was podcasts and a glass of wine on weeknights.
He laughed. Across the table, Gula watched. He’d put his menu down.
“Something from the bar while you look?” the waiter asked, recovering.
“Perrier,” Karen said. “Lemon on the side.”
“Absolut on the rocks,” Gula said. “With onions.”
The waiter nodded and left. A small silence settled.
“You speak French,” Gula said.
“I rarely get to use it.” She felt, unreasonably, a little embarrassed by it, the way you feel embarrassed by a thing you’re glad you can do when someone notices.
“Don’t apologize for it,” he said, and looked at his menu.
They sat with the menus a moment. The room had filled further while they talked, the noise climbing to the pitch of a Friday evening at a French restaurant that knows what it is, alive but not loud, the sound of many conversations that have found their own rhythm.
“Anything look good?” he said.
“The warm salad. And the trout.” She set her menu down. “So.”
He closed his menu and laid it on the table with the deliberateness of someone putting a period at the end of a sentence. Then he reached into his breast pocket, took out his phone, unlocked it, and set it face-up in front of her.
She looked at the screen.
An email. The sender field showed an address she recognized at once. The time stamp read 2:17 AM, the night after the Madison Avenue meeting. She read it once.
I know what you’re doing. Keep your fucking mouth shut or God help you. You of all people. Don’t test me. Say one word and I will bury you in lawyers. You will be paying legal bills until you’re in a home.
Unsigned. It didn’t need to be.
She set the phone back on the table without looking up right away, giving herself the second she needed. Then she looked at him.
“Wow,” she said. “Nice guy.”
“Yeah.” He put the phone back in his pocket like someone who’d had time to decide how to feel about a thing and arrived at the far side of it.
“So you do have something to tell me,” she said.
He looked at her, and she raised one hand slightly, the small gesture of before you do.
“Dr. Gula, you need to understand something first. Whatever you tell me I will use. There’s no privilege between us, no confidentiality.” She said it evenly, without apology, the professional disclosure she’d learned to deliver early after two people had been furious to find that what they’d shared over a meal had turned up in a report that triggered consequences they hadn’t seen coming. The disclosure was honest. It was also, and she knew it, the fastest way there was to make a person trust you.
He looked at her without sympathy and without condescension, which in her experience was a rare combination. Neither was performance. He was simply a person for whom this piece of information did not call for any expression at all.
“I’m not looking for counsel, Karen,” he said. “Legal or otherwise.”
The use of her first name was deliberate. She noted it and said nothing.
The waiter returned, setting down the Perrier and lemon and the vodka with its pale onion pearl at the bottom, and turned to Karen with the warmth of a man revisiting a pleasant surprise. Still in French, he asked if she knew what she’d like.
She ordered the warm salad and the trout amandine. He wrote it with the focused attention of someone taking dictation from a person he’s decided to like.
Then he turned to Gula and asked, in English, what he’d like.
Gula put down his menu and said, in French that was both fluent and entirely without self-consciousness, not the French of someone demonstrating that they speak French but the French of someone for whom it’s simply available, that he’d have the frog legs to start, the steak rare with no potatoes and buttered haricots verts, and a bottle of the Gevrey-Chambertin if they had the ‘19. He said it the way he might have said it in Paris, which is to say as if the language required no translation.
The waiter’s composure came apart completely, in the best possible way. He switched to French and stayed there, confirming the wine with real enthusiasm, praising the choice, noting that the ‘19 was exceptional and they had two bottles left and he’d bring the first immediately. Anything else?
Karen asked for a Johnnie Walker Blue, neat, and said she’d share the wine if that was all right.
“Of course,” Gula said.
The waiter left, still visibly pleased.
Karen looked across the table. Still in French, she said he’d gotten her completely, that his French was excellent. She wouldn’t have known he wasn’t French, actually.
He raised his eyebrows a fraction. “It didn’t come up in your Google search?” Without irony. Simply a question.
“No,” she said. “It did not.”
A small silence. The room moved around them.
She switched to English and looked at him directly. “Now, Dr. Gula. What is it you want to tell me?”
He picked up the vodka and turned the glass once, slowly, on the table. She had the impression he’d been thinking about this conversation for some time and had arrived at the decision to have it through a door that hadn’t been easy to open.
“I assume,” he said, in French again, his voice dropping to the register of a private conversation in a room full of public ones, “that you’re familiar with the United States Attorney’s Office out of Boston.”
The room was full and warm and loud with other people’s Friday evenings, and she sat in the corner of it across from Steven Gula and understood, with the clarity of a moment that has been building a long time and arrives without fanfare, that she had not been wrong.
“You know the narrative,” he said. “That Jack and I started the kickback arrangement with my brother.”
Karen set down her water glass.
She’d spent weeks now circling this case, the archived website, the Wayback Machine, the late-night calls to former colleagues, the drive to Bethlehem, the office with its overfull shelves, the Madison Avenue conference room and Jack Connor’s face when Gula’s name landed in it. And now here was the man himself, in a custom suit at a corner table at Parc, telling her what the United States government had been trying to learn for years, and the sensation wasn’t triumph exactly but something closer to what Alice must have felt in the instant before falling down the hole.
He looked at her across the table. “Do you know any of the details?”
There was no reason for pretense. “Does anyone?” she said. “I know some of what was alleged. That you, Connor, and your brother were running illegal kickbacks. And I know about the bank note, the personal guarantees renegotiated before the group dissolved. The default, then the full payment.” She paused. “I don’t have access to the US Attorney’s files.”
He took a sip of vodka. Set the glass down. His expression shifted almost imperceptibly, not anger, not pain exactly, but a man revisiting something that offended him at a level below the personal, below even the professional, something closer to aesthetic.
“The bank note,” he said. He said it the way you say the name of something distasteful you nonetheless have to name. “That bothered me. Genuinely. I would never have done something like that.” He looked at the table a moment. “There was a man at the bank I’d worked with for years. Tim. Good man. Professional. To pull the guarantees out from under him like that, without warning.” He shook his head once, a small movement. “That wasn’t me.”
Karen watched him. She’d been in enough rooms with enough people to have a fairly reliable sense of what performed integrity looked like versus the real thing, and what she was looking at did not feel performed, and at the same time it did, which was its own complication. She thought of Thomas Crown, the film, Faye Dunaway across the chessboard from Steve McQueen, two people of roughly equal intelligence recognizing each other across a table and finding the recognition itself unexpectedly pleasurable. She was aware the comparison wasn’t entirely professional.
“Honor among thieves,” she said. “Or something like that.”
He looked at her. Then he smiled, and this time the smile reached something, not warmth exactly but its precursor, a door opened a fraction. His teeth were white the way they are in someone who’d never smoked and avoided tea and simply arrived at sixty with the mouth he’d been born with.
“Something like that,” he said.
He picked up his drink and turned it once on the table, and she had the impression of a man deciding how far into a room to take her. Then he said: “What very few people know about me, or remember at this point, is that my training was in biostatistics.”
She nodded. She’d seen it in the archived faculty materials from his White Plains years, one line of his biography, never elaborated.
“I knew more,” he said, “than almost anyone at the time about why a population of a certain size would seek care for back pain. I knew, almost to the dollar, how much was being spent. On aspirin, on MRIs, on surgery, on chiropractic, on rehabilitation. The whole continuum.” He paused. “The numbers were extraordinary.”
He looked at her, and she felt her attention beginning to drift toward the abstract, the way attention does when it senses a long road ahead and isn’t yet sure of the destination. He caught it.
“I know that look,” he said, pointing at her across the table. Not unkindly. “Seems dull. I know.”
She tilted her head. She didn’t deny it.
“More than cancer,” he said. “More than almost anything except the common cold, in terms of the number of people seeking care at any given time. Back pain.” He let it land. “I started to model what it would look like to capture not the surgery alone, but the entire state of back pain, from the first day of work missed, to the primary care visit, to the physical therapy, to the imaging, to the procedure, to the recovery, to the rehab after. All of it. Every dollar, every encounter, every decision point. If a hospital system or a practice could look at back pain as a single longitudinal experience and capture the whole of it, the MRIs, the injections, the surgery, the post-surgical care, you weren’t just a surgeon. You were the spine.”
He paused and looked at his drink.
“I was in graduate school,” he said. “Just a kid. But I modeled it. I saw what it would look like if you owned all of that. Not just the operating room but the entire problem.” He looked up. “In the world of spine care, what I built was the equivalent of someone first seeing that you could organize all of the world’s information and make it searchable.”
Karen looked at him.
“You have my attention,” she said.
“Good,” he said.
She leaned forward slightly. “How did you get into it? Spine, specifically.”
He sat back. “I was studying GBM,” he said. “Glioblastoma. Brain tumors. A rare and lethal kind.” He said it without drama, in the same matter-of-fact register he’d used for everything. “Noble work. Everyone died. The cases were rare, the survival curves discouraging, and to build a career around it I’d have needed to be at Stanford or Hopkins.” He paused. “I didn’t have the grades for that.”
Given everything she’d observed about the man across the table, the custom suit, the fluent French, the biostatistical modeling he was describing with the quiet confidence of someone who has never needed to oversell it, the statement sat oddly.
“You’re a professor,” she said. “Your French is perfect. I find it hard to believe”
He held up one hand. Not impatient. Corrective, the way a teacher corrects without condescension. “I didn’t say I wasn’t smart enough,” he said.
She considered that. “I’m sure you had the grades.”
He looked at her a long moment. “There is more to grades,” he said, “than what shows up on a transcript.” Something in his expression shifted, not into warmth, but into something more revealing than warmth, a glimpse of the actual person behind the careful presentation of him. “At the time I had no particular interest in putting in the work Stanford required. I had other interests.” A pause. “Other priorities.”
He picked up his drink.
“And for what it’s worth,” he added, and now there was something in his eyes closer to actual amusement, “only Americans are impressed by someone who speaks two languages.”
Karen laughed. She couldn’t help it. A genuine laugh, the kind that arrives before you can decide whether it’s appropriate, and she was aware, hearing it, that the evening had shifted into something she hadn’t quite anticipated when she’d tied the Hermès scarf at her neck at four o’clock and told herself this was a professional meeting.
He was watching her the way you watch someone you’ve just made laugh in a restaurant and are deciding what to do about.
It was then that the waiter arrived with the appetizers, the goat cheese salad warm and fragrant, the frog legs arranged with the precise elegance Parc brought to things both rustic and refined, and set them down with the quiet ceremony of someone delivering things he believes in.
They both looked at the food. The waiter asked if there was anything else and Gula said in French that it was perfect, and the waiter left with the slight extra brightness of someone who has been appreciated by a person who knows what he’s talking about.
They tried the food. It was, as Parc generally was, excellent. The goat cheese warm, the lardons crisp, the dressing with the acidity that lifted everything. Gula’s frog legs were done the classic way, butter and garlic and parsley, and he ate them with the focused appreciation of a man who has eaten them in France and finds these satisfactory by comparison.
“It’s impressive,” Karen said, setting down her fork. She meant the work, the modeling, the vision. “The spine care framework. All of it.” She paused. “But I want to come back to what you said about Stanford. About the grades.” She looked at him directly. “I don’t think that’s actually what stopped you.”
He regarded her. The faint amusement still there, back behind the eyes, the door still slightly open.
“No,” he agreed. “It wasn’t.”
She leaned in. “Tell me more,” she said.
He picked up his glass. Outside, Rittenhouse Square was doing its Friday evening thing, the city moving past the windows with the comfortable indifference of a world that didn’t know or need to know what was being said at this corner table. The Gevrey-Chambertin had arrived while they were eating, and Gula poured her a glass with the unhurried ease of a man accustomed to being the one who pours, and she let him, and they sat in the warm noise of the room with the food between them and whatever was coming still ahead of them, and he looked at her with the look of someone who has made a decision and is now only deciding where to begin.
Chapter Fourteen
He began while they were still on the appetizers.
The goat cheese was warm and the lardons crisp and the room had settled into its Friday rhythm around them, and Gula set down his fork and picked up his vodka and looked down at the table a moment, a man deciding where to enter a story that has more than one possible beginning.
He started with Jack and how they met.
Connor had trained at Yale and then come to White Plains, which was where White Plains Spine Surgery found him, or where he found it, depending on how you told it. He’d arrived the way most residents arrive at a group, looking for a position, presenting well, saying the right things to the right people. The practice had a solid spine program and the patient volume to give a young surgeon enough cases to build on. He was a good surgeon. That was clear early. The partners liked him, the OR staff liked him, and he had the quality high-volume surgical practices look for in a new hire, someone willing to work without requiring the recognition the senior partners have already decided is theirs.
“We’d bump into each other,” Gula said. “I was in the biostatistics department at Westchester General. I’d done my graduate research there, and they offered me a job after I graduated. My work was to evaluate and monitor their spine surgery department. Nobody at that hospital was particularly interested in spine. Heart and cancer, those were the flags they flew. Spine was a service line, not a mission. I was not what one would call a player.”
The proximity did what proximity does, he said, for him and Connor. The coffee machine. The corridor outside the hospital conference room. The little waiting area outside the OR lounge where the schedules were posted. Jack would stop and talk, would ask questions, would actually listen to the answer.
Which was, Gula said without apparent sentiment, rarer than it should have been.
“He saw it for what it was. The spine business. He could see the potential the way I could. Most people, you explained it and they nodded, and you could watch them not see it. Jack saw it the way I saw it. I didn’t have to translate.”
After-work beers became a standing thing. Then the occasional run. Connor was disciplined about it, which Gula found he respected, the six AM miles regardless of the night before, the pace always slightly harder than comfortable. They talked through their ideas the way people do when their bodies are occupied and their guards are down. They shared a vision, something more like a cancer center but built entirely around back pain, imaging and spine surgery under one roof. They went from ideas to weekend mornings at the practice digging into the data. The foundation had been laid so gradually that neither of them ever declared it. It simply existed.
“EMRs were new,” Gula said. He took a sip of wine, set the glass down. “Electronic medical records. Most practices had just adopted them, and nobody understood what they had. They knew it stored patient information. They didn’t understand it was a statistical instrument.” He paused. “Jack would pull data from the group’s system. He’d sit across from me with a printout, and I’d tell him what I was looking at, and he’d just watch.” He stopped a moment, and Karen thought she caught something in the pause that wasn’t quite nostalgia but occupied the same country.
“I think in numbers,” he said, as if it were a simple statement of preference and not the description of something unusual. “The calculations I do in my head. The complicated ones I rough out on paper, a post-it, whatever’s nearby. A few minutes and I have what I need. It’s not remarkable. It’s just how the thinking works.”
Karen thought about the post-it notes on the edge of his desk at Lehigh, the ones she’d taken for absentminded scrawl.
“By any reasonable calculation,” he said, “if the group brought in-house all the care it was referring out, pain management, imaging, physical therapy, the whole continuum from the first visit to post-surgical rehab, they’d quadruple the income with no additional patient load. None. The patients were already there. The referrals were already happening. The money was simply going somewhere else.” He looked at the table. “And if they eventually opened their own surgical facilities, independent of the hospital, the numbers became something else entirely. Not a medical practice. A machine.”
He said it without excitement, the way you describe a calculation that turned out to be right.
Connor had written the business plan, Gula said. Spent weeks on it, every evening after OR, weekends at his house, a new build in the suburbs, four bedrooms and three and a half baths, the kind of house that was very nice and that both of them had looked at with the impatience of men who regard comfortable as insufficient.
Their daughter Maya was a toddler then. When they’d worked the plan into a polished presentation for the group, Ilana fed them pizza and watched them rehearse the pitch at the kitchen table, listened to it twice and told them where it dragged and where it sang, and encouraged them with the steadiness of a woman who understood what her husband needed and had decided to give it to him.
“She was...” Gula stopped. He looked at his plate a moment. “She was generous,” he said finally. “With her time. With her patience. She didn’t have to do any of that.” He picked up his wine.
Karen said nothing. She watched him.
The waiter arrived with the entrees, the steak rare and the trout amandine with its butter sauce and haricots verts, and set them down with the efficient discretion of someone who has read the table correctly and understands the conversation is the main event. Gula nodded without looking up. Karen thanked him. He left without a word.
Gula cut into the steak. He ate with full attention and no ceremony, the way he did most things. Karen poured herself a glass of the Gevrey-Chambertin and picked up her fork.
The partners’ meeting had been on a Wednesday, the regular monthly gathering in the group’s conference room, twelve surgeons around a table, six of them partners, the rest associates. Gula described them the way he described most things, economically, having assessed a set of variables and knows exactly which ones matter.
Valmore Brent was sixty-two, the senior partner, the kind of physician who had built the practice from a two-man operation in the late seventies and confused that founding authority with permanent authority. He wore bow ties and remembered the name of every patient he’d ever operated on and genuinely believed the two facts were related. Patricia Howe was the only woman of the six, orthopedics, sharp, her husband an OB-GYN at the affiliated hospital, which gave her a read on the institutional relationships the others either lacked or had stopped thinking about. Robert Connelly was spine, late fifties, the kind of surgeon who operated beautifully and drank the way people drink when they’ve decided it isn’t a problem, though others might wonder. Richard Scott was pain management, conscientious, he’d prescribed a lot of opioids and now spent a lot of time trying to correct it, which had left him somewhat diminished. The other two, Frank Adler and Gene Chu, had joined when the practice was already established and had the comfortable politics of men who’d never needed to build anything.
They’d known Gula only by face, from hospital meetings, from the corridors and the coffee machine. They liked him well enough, which was to say they had no reason not to. He wasn’t a surgeon. In that room, that was the relevant fact.
“Val was generous before it started,” Gula said. “When Jack asked for agenda time, Val said it was good to have new energy in the room. New blood was the phrase.” He said it in the flat tone of a man describing a thing he’d heard with the cynicism of someone who already knew how the story ended.
Jack had presented for forty minutes. The slides, the projections, the patient-flow diagrams, the revenue models. He’d prepared for every objection. He hadn’t prepared for indifference, which was a different thing.
Frank Adler spoke first. “I appreciate the work here,” he said, in the tone of someone who does not appreciate the work. “But this is a significant operational undertaking. We have a practice that works. I’m not sure what problem we’re solving.”
Gene Chu nodded. “I have two kids starting college next year. I’m not in a position to take on capital risk right now. The timing isn’t right for me personally.”
Karen looked at Gula. “He said personally,” she said.
“He did. As if the practice were a restaurant he’d been invited to invest in.”
Robert Connelly said little. He looked at the slides with the careful attention of a man managing a headache and finally offered that the OR expansion was interesting in principle, but that the regulatory pathway for independent surgical facilities in New York State was, in his experience, a significant undertaking. He said the word undertaking twice.
Patricia Howe was more direct. She waited until the room had said its piece, then folded her hands on the table and looked at Jack. “My husband’s referral relationships run through St. Peter’s. If we open competing ORs, those relationships get complicated. The hospital’s been a difficult partner at times, but it’s a known quantity. I’m not willing to trade a difficult known quantity for an unknown one.” She paused. “And I say that with respect for the work you’ve put into this.”
“She was the only one in the room who engaged the actual argument,” Gula said. “The rest were protecting their afternoon schedules.”
“And Valmore?” Karen said.
Gula set down his fork. “Val waited until everyone else had spoken. Then he leaned back in his chair, he had the chair at the head of the table, naturally, and said he had a concern about the underlying philosophy of the plan.”
“The philosophy,” Karen said.
“His word. He said that all the business we planned to ‘harness’, harness, he used it twice, was revenue that currently flowed to their colleagues. That opening competing services would drain referrals. That the hospital’s goodwill was not something to be spent lightly.” Gula looked at his plate. “Then he said the group had been built on relationships. That relationships were not a line item on a spreadsheet. And that perhaps Steven,” he said his own name with a slight pause around it, the way you hold a thing at arm’s length, “would benefit from spending more time in a clinical setting before offering strategic counsel.”
Karen said nothing for a moment. “He said that in front of the room.”
“In front of the room. With Jack sitting beside me.”
They had all said they admired the effort. They were surgeons, not businesspeople. They appreciated the thinking. They’d keep it in mind. Jack had gathered his slides without a word, and the meeting moved on to scheduling.
“Jack was furious,” Gula said. Not with relish. As a fact. “Not the controlled kind. The kind the room could see. And once they saw it, the dismissal turned terminal in a different way, not just the plan, but Jack. Val took him aside afterward. Told him he needed to work on his attitude. Like a resident being corrected.” He paused. “He also reminded Jack that Ilana worked at the same hospital. That they had a child on the way. And that he had a non-compete.”
Karen watched him. The candle between them had burned a third of the way down.
“When Jack told me,” Gula said, “he said he wanted to open his own group. I didn’t tell him he was crazy.” A beat. “I told him business was just math. That I knew math. That we both knew spine.”
She looked at him across the table.
“We decided,” he said, “that the best way to start was to take the group.”
Karen put her fork down.
“Take as in stealing?” she asked.
He nodded, then looked at her, patient, having said something that sounds absurd, knows it sounds absurd, and is waiting for the absurdity to arrange itself into sense.
“Who steals a medical practice?” she said.
“We did,” he said.
He picked up his wine. He explained it the way he’d explained everything else, efficiently, without inflection, the way a surgeon describes a procedure they’ve done many times. The precision of it was, she thought, either the most frightening thing about him or the most impressive. She hadn’t yet decided which.
They’d started after hours. Gula had gone into the practice on a Saturday morning when the building was empty, using a key Jack had made. He’d sat at the front desk terminal and downloaded the patient database, every chart, every referring physician, every insurance relationship the practice had built over twelve years. Ninety minutes. He’d put it on a drive and walked out.
They hired a lawyer in Philadelphia to open an LLC. The lawyer engaged a real estate firm. They obtained a line of credit. Gula had inherited a hundred and ten thousand dollars from his grandfather, a man who’d spent his life in a machine shop outside Cleveland and saved with the disciplined patience of someone who believed in the accumulation of small things. They used it as seed capital.
“The elegant part,” Gula said, and Karen registered the word and filed it, “was the dismantling.”
Karen hadn’t touched her trout since he began this part. The butter sauce had gone from glossy to dull. She didn’t notice.
He’d installed password-tracking software on Valmore Brent’s computer. Late at night, from a laptop in his apartment, Gula logged into Val’s email with the captured credentials and composed messages in his voice, to the partners, the staff, the hospital administration, that were slightly wrong. Not dramatically. Slightly. A confused reference. An inappropriately casual remark. The quality of a sentence written by a man whose grip is starting to loosen. He sent them from Val’s account and deleted them from the sent folder, leaving only the replies, which grew steadily more concerned. When the partners confronted Val about certain communications, he’d been, correctly, Gula noted, with a flatness that didn’t invite commentary, bewildered.
Karen sat with that a moment.
Patient appointments had been canceled without notice, leaving holes in the schedule that made the group look disorganized and bled revenue. Or they’d been double-booked, filling the waiting room with people who sat ninety minutes and left furious. The physicians directed their frustration at the front desk staff, who directed theirs at each other, and the morale of the practice declined with the slow, gathering momentum of a thing that has lost its structural integrity and is waiting for the moment it becomes visible.
Mandatory hospital committee meetings had been removed from the physicians’ calendars. The physicians missed them and didn’t understand why. The hospital was not pleased.
“People were still new to computers,” Gula said. “Fraudulent emails. Password theft. It seemed like something out of a film. Nobody thought to look for it.” He said it without pride, or at least without the kind that announces itself. An observation about the environment they’d operated in.
Then he turned to Robert Connelly, the surgeon with the drinking problem. Gula had called the state medical board with a complaint about a case in which a vertebral level had been operated on incorrectly, a mistake that did happen, he said, and that practices managed through their morbidity and mortality process, the closed-room weekly meeting where complications were reviewed with the unsparing candor medicine reserves for conversations with itself. The complaint triggered a formal inquiry. Connor, meanwhile, kept a small spray bottle of whiskey in his white-coat pocket, and when he passed Robert’s office between cases he’d spray a brief mist in the hallway. Twice he sprayed the collar of a coat hanging on the back of Robert’s door. Robert’s drinking problem was well established in the minds of his colleagues before anyone had looked for evidence of it.
Then there was Richard Scott.
Scott’s problem with opioid prescribing had been known. He’d genuinely tried to address it, Gula said, had tightened his prescribing, turned away patients he recognized as seeking drugs rather than care, done the work of a physician who understood he’d made a problem and was trying to unmake it. It hadn’t been enough protection.
Gula had found a woman who was a patient of Scott’s, he said the word patient the way you mark a word whose meaning is being used loosely, who was having her medications reduced. He’d followed her from the hospital to a bus stop. Introduced himself as a fellow patient, dressed differently than himself. Told her Scott was doing the same to him. That Scott had always made him uncomfortable during examinations. That the way he’d been treated in that office was not how a physician should treat a patient.
“They will do almost anything,” he said, looking at her directly, “for their prescriptions.”
She held his gaze and said nothing, though something moved in her she didn’t show.
“She filed a complaint with the Office of Professional Medical Conduct. The investigation found nothing actionable. But it required Scott to complete a professional boundaries course and put his prescription monitoring under review. He retired six weeks later.”
By January, Gula said, the group was in collapse. Val was understood in the wider medical community to be experiencing cognitive decline. Robert was understood to have a drinking problem. Scott was gone. Jack had resigned the second week of January, loudly and without negotiation, and with him gone and Scott gone and the morale of the staff in the state it was in, the non-compete was the last thing anyone was going to spend energy enforcing.
White Plains Spine Surgery, eighteen years old, effectively stopped functioning before February. White Plains Surgery Centers was ready. The advertisements had run. The office fit-out was complete. Gula had the full patient database and the referring-physician list. Connor had his hospital privileges intact. The key staff, seeing which way the wind was blowing, had arrived at the new practice before the old one finished falling.
“That’s how it started,” Gula said.
He picked up his wine. The plates were half cleared between them, the evening having moved through its courses while he talked. He’d told the story the way he described everything, efficiently, without visible affect, the voice of a man narrating a sequence of events from which he’d achieved a useful distance. Not cold. Not proud. Simply finished.
Karen looked at him across the table.
She’d been in enough rooms with enough people to know when she was in the presence of real intelligence, and what she was sitting across from was not the kind you met often. Not the academic kind, not the credentialed kind, but the applied, structural, patient kind that identifies a problem as a set of variables and solves it without needing the solution to be clean or admirable. He’d taken a practice apart the way a mechanic takes apart an engine, component by component, in the right order, without wasted motion. The part of her that had spent six years at Chubb understanding how fraud worked was producing a cold, methodical admiration she wasn’t entirely comfortable with. And beneath it, settling in with the quiet certainty of a conclusion that had been building since she first drove up the hill at Lehigh on an October morning with nothing but a hunch, was the thought that maybe Jack Connor had killed his wife.
She did not arrive at the thought. The thought arrived at her. It settled into the cleared space with the ease of something that had been waiting for the room to empty, and she sat with it a moment and understood, with the clarity of a woman who trusts what her gut tells her when it speaks this plainly, that this was exactly what Gula had wanted her to think.
She looked at him.
He was watching her across the table, attentive, a man who had said what he came to say and is waiting to see where it lands.
She picked up her wine.
“The kickback arrangement,” she said. “That comes later.”
“Yes,” he said.
“And you’re going to tell me about it.”
He considered her a moment. Outside, Rittenhouse Square was dark now, the Friday evening fully arrived, the room around them warm and full and entirely unaware of the conversation happening at this table.
“Yes,” he said again. “I am.”
A silence settled between them. Not uncomfortable. The silence of two people who’ve covered a great deal of ground and are taking stock of where they are.
Gula set down his wine and looked at her, a man who had been going for several hours and was willing to admit it. “I’m exhausted,” he said. Not as an apology. As a fact. “I’ve been traveling for two weeks and the jet lag hasn’t been my friend.” He paused. “I’m in town through Monday. If you’re free tomorrow, around one, we could finish this.”
Karen met his eyes. She was tired too, she realized, the kind of tired that comes when you’ve been paying very close attention for a long while and the attention is finally released. Her wine glass was empty. The restaurant had thinned around them, the later crowd replacing the early one, the noise lower, the candles shorter.
“Tomorrow at one works,” she said. “I’ll make it work. My office is just up Walnut, we could meet there.”
He shook his head slightly. “I’d be more comfortable somewhere else, if you don’t mind.” He said it without explanation and without apology, a man who has his reasons and feels no need to present them.
She didn’t push. “Where did you have in mind?”
“I’m at the Four Seasons. The restaurant should be quiet enough on a Saturday afternoon.”
She nodded. “I’ll be there.”
He signaled for the check with the small, practiced gesture of a man used to being the one who does that, and the waiter appeared almost at once with the discretion of someone who’d been watching the table. Karen reached for her bag and Gula shook his head once, not emphatically, just once, the way you close a door that didn’t need to be opened.
They walked out into the cold of Rittenhouse Square together and separated on the sidewalk, a brief goodbye, professional and direct, no ceremony, and she stood a moment and watched him walk north along the square until the dark took him.
She walked home through the cold thinking about everything she’d been told and everything still to come, and about a man eating a steak in a French restaurant while describing, without inflection, how he’d dismantled eighteen years of other people’s professional lives and built something new from the pieces. It was ten-fifteen when she got through her door. She stood in the kitchen with her coat still on, looking at her phone, deciding whether it was too late to call Sam.
Tomorrow at one.
She’d be there.
