Dr. TooToo Medvalli, MD stood on the deck of his newly purchased houseboat and watched the cruise ships glide past. They moved like fat white geese across Tongass Narrows, their passengers waving at the picturesque Alaskan landscape, oblivious to the small brown man who waved back from his floating prison.
The houseboat had cost him his entire signing bonus plus half his relocation package. It was anchored off Gravina Island because even the marina operators in Ketchikan proper had refused his business. Word traveled fast in a town of eight thousand souls.
Dr. Medvalli is not welcome here.
The boycott had been comprehensive, almost impressive in its coordination. No landlord would rent to him. The grocery stores turned him away at the door—politely, always politely, with that particularly Alaskan brand of courtesy that made rejection feel like a favor. The dispensaries claimed to be out of stock. Even the ferry operators, those stoic civil servants, found reasons why he couldn’t board. “System’s down.” “Weight limits.” “Weather advisory.”
TooToo had wanted to point out that it was a clear day with calm seas and he weighed 165 pounds, but there seemed little point in arguing meteorology with a ferry operator who was pretending to check a computer screen that was clearly showing a screensaver of bald eagles.
It was remarkable, really, how a community could mobilize against one Marxist gastroenterologist who’d had the audacity to win a years-long legal battle for hospital privileges. He’d seen less organized responses to actual public health emergencies.
TooToo checked his phone. No service, of course. The signal barely reached Gravina. He’d have to row his dingy across the narrows just to send an email, and even then, he’d need to do it from the parking lot of the medical center—the building where he now, legally, had the right to practice.
The right, he thought grimly, pulling his coat tighter against the October wind. Just not the ability.
His first day of hospital privileges had been three weeks ago. He’d rowed across the narrows at dawn, tied up his dingy, and walked the mile and a half to PeaceHealth Ketchikan Medical Center. His white coat was crisp, his badge freshly laminated, his credentials irrefutable.
Behind the nurses’ station, he heard it immediately: He is the doctor. Whispered like a curse. Not his name, never his name. Just the definite article and the profession, as if there were only one doctor in all of Ketchikan and he was it—a distinction that would have been flattering if it weren’t spoken in the same tone usually reserved for announcing a sewage backup.
The nursing staff had looked through him as though he were made of glass.
“Dr. Medvalli,” he’d introduced himself to the charge nurse. “I’m here to see my first patient.”
“You don’t have any patients, Doctor.”
“I’m on the hospitalist roster. I should have been assigned—”
“The roster is full today.”
“I can see the board from here. There are three patients without—”
“Dr. Roz is covering those.”
“Dr. Roz is already covering six patients. That’s why I’m—”
“Have a nice day, Doctor.”
That had been the template. Polite. Professional. Absolute.
TooToo had learned during his residency to recognize institutional resistance. At UCSF, it had been overt—the old guard protecting their territory, the pecking order enforced through public humiliation and impossible call schedules. Here in Ketchikan, it was different. No one raised their voice. No one wrote him up. They simply… didn’t need him.
Which was fascinating, really, considering they’d been advertising for hospitalists nationally for two years. Apparently what they needed was hospitalists who hadn’t committed the cardinal sin of believing that winning a lawsuit meant winning anything at all.
Patients requested other doctors. Referrals went elsewhere. His clinic appointments, carefully blocked out in the system, remained empty.
The boycott extended even to the mundane. The hospital cafeteria claimed their register was broken when he tried to buy lunch. The staff bathroom was always occupied when he approached. His locker, freshly assigned after months of legal wrangling, was in the old wing—the one where they stored broken equipment and outdated files.
TooToo had briefly considered requesting a locker upgrade, but decided against it. There was something poetically appropriate about storing his personal belongings next to a defibrillator from 1987 and a box labeled “OLD CHARTS DO NOT DESTROY (YET).”
On his houseboat, TooToo opened a can of beans he’d brought from Michigan. His stores were running low.
The first time he’d tried to buy groceries in Ketchikan, the Safeway manager had simply shaken his head. “We reserve the right to refuse service.” The next day, he tried the IGA. Same story. Then the liquor store, the coffee shop, the general store—all politely declining his business.
At the liquor store, the clerk had at least been honest: “Look, doc, my cousin works at the hospital. I got nothing personal against you, but I also got to live here after you leave.”
“I appreciate the candor,” TooToo had said. “Any chance you could at least sell me some beer?”
“How about I don’t make eye contact with you, and you just… move along?”
“That’s very Alaskan of you. Really captures the frontier spirit.”
His only option had become absurd but necessary: day passes to board the cruise ships.
For sixty-five dollars, any tourist could purchase a day pass to board a docked cruise ship and access its facilities. The cruise lines didn’t care about local boycotts. They didn’t know about his legal battle with PeaceHealth. They just saw another paying customer.
So twice a week, when the big ships came in—the Norwegian, the Celebrity, the Princess—TooToo would row his dingy across the narrows, walk to the docks, and purchase a day pass. Then he’d board like any other tourist and spend three hours stocking up on food from the buffet, buying toiletries from the ship’s store, occasionally treating himself to a beer at the bar.
Wherever he went in Ketchikan—the docks, the parking lot, the hospital—he heard the whispering. He is the doctor. Not “Dr. Medvalli” or even “that surgeon.” Just “the doctor,” spoken like a warning. The way people in old movies said “the vampire” or “the communist.”
The cruise ship crew members thought he was eccentric. “Back again, buddy?” they’d joke. “You really love cruising, huh?”
“I’m conducting important research on buffet efficiency,” TooToo would deadpan, loading his backpack with dinner rolls. “For a paper I’m writing. ‘Comparative Analysis of Shrimp Cocktail Availability Across Major Cruise Lines.’ Very cutting-edge.”
He never explained that he was a board-certified physician with hospital privileges living off Gravina Island because the entire town had collectively decided he couldn’t buy bread. Or that he’d begun rating the ships on a complex scale: Norwegian had better toiletries, but Celebrity’s buffet restocked faster. Princess had the friendliest bartender, which mattered when you were spending $130 a week for the privilege of basic human commerce.
The irony wasn’t lost on him: he’d won the legal battle for hospital privileges, but he had to buy day passes to cruise ships to eat.
His phone buzzed—a rare moment of connectivity. An email from the hospital administrator.
Dr. Medvalli, we’re writing to inform you that due to low patient volume and scheduling efficiency concerns, we’re adjusting the hospitalist coverage model. Your shifts for November have been reduced to one per week. We’ll reassess in December.
One shift per week. Barely enough to maintain privileges, certainly not enough to live on.
TooToo forwarded the email to his attorney—the one who’d cost him seventy thousand dollars and three years of his life to secure these privileges in the first place. He knew what the lawyer would say: This is constructive termination. We can fight this.
They could always fight this. That’s what lawyers did. They fought things. For money. Lots of money. TooToo had learned that the law was less about justice and more about how long you could afford to be technically correct while still being practically destroyed.
But TooToo was tired of fighting. More importantly, he was beginning to understand the game.
PeaceHealth hadn’t wanted to give him privileges because they knew exactly what would happen next. The medical center didn’t need to exclude him officially; the community would do it for them. Every single employee at that hospital lived in Ketchikan. Their kids went to school together. They shopped at the same three grocery stores. They attended the same churches.
And TooToo? He was the outsider who’d sued their hospital.
It didn’t matter that PeaceHealth had violated antitrust law by tying hospital privileges to employment. It didn’t matter that he’d proven they maintained an illegal monopoly on healthcare services in a captive market. It didn’t matter that he was right.
He’d won the battle and lost the war.
A cruise ship horn echoed across the water—one of the big ones, probably the Norwegian Sun or the Celebrity Millennium. TooToo watched it glide toward the dock, three thousand tourists ready to spend three hours in Ketchikan buying salmon jerky and totem pole magnets before returning to their floating city.
The cruise ship would have a doctor, he thought. Multiple doctors, probably. A whole medical center, pharmacy, even a small operating suite. Floating medical infrastructure serving tourists who would never set foot in PeaceHealth Ketchikan Medical Center.
He’d been boarding these ships twice a week just to buy food. The day passes cost sixty-five dollars each—one hundred thirty dollars a week just for the privilege of shopping like a normal human being. He’d smile at the crew, fill his backpack with provisions from the buffet, buy soap and shampoo from the ship’s store, and row back to Gravina before the ship departed.
The other day-pass tourists thought he was quirky. “You really love cruises!” they’d say, seeing him for the third time. He’d nod and smile, not mentioning that he was a board-certified physician with hospital privileges who literally couldn’t buy groceries on land.
Once, a retiree from Minnesota had asked him, “Do you work on the ships?”
“No,” TooToo had said, loading up on mini shampoo bottles. “I’m a doctor.”
Behind him, two crew members had paused mid-conversation. He is the doctor. Even here, on a cruise ship, the whisper had followed him.
“Oh! A ship doctor?” the retiree asked, delighted.
“Not yet,” TooToo said. “But I’m working on it.”
An idea began to form.
TooToo opened his laptop—the battery was at forty percent, he’d have to be quick—and started researching cruise ship employment. The money was terrible, but it came with room and board. More importantly, it came with something he’d lost three years ago: the freedom to practice medicine without having to wage legal war for the privilege.
Or buy day passes just to eat.
Cruise Ship Medical Officer Position Available
Carnival Cruise Lines
Must be Board Certified
Contract: 4-6 months at sea
Benefits: Room, board, travel
Salary: $7,000-$9,000/month
It was a third of what he should have been making at PeaceHealth. But he’d be able to buy groceries without traveling to another city. He’d be able to sleep without wondering if someone would cut his dingy loose in the night.
He’d be able to practice medicine.
The laptop battery died at thirty-two percent—it always did; he’d need to replace it, but how do you replace a laptop battery when you can’t buy anything in your own town?—so TooToo closed it and looked out at the water.
Another cruise ship was approaching. In the distance, he could see Ketchikan itself, the colorful buildings clinging to the hillside, the docks bustling with tourist activity. From here, it looked like a postcard. Charming. Welcoming. The kind of place people put on their bucket lists.
He thought about his colleagues from residency, scattered across the country now, all of them employed by large health systems, all of them complaining about corporate medicine but none of them willing to do what he’d done.
He’d stood up to the monopoly. He’d fought for independent practice. He’d believed, genuinely believed, that winning the legal battle would change things.
What had Dr. Roz said during the deposition? “PeaceHealth is part of this community. We take care of each other.”
And they did. That was the problem. They took care of each other, and TooToo Medvalli, Marxist gastroenterologist from Michigan with his fancy credentials and his legal victories, was not part of that “each other.”
He would never be.
TooToo made his decision that afternoon, as the sun began its early descent behind the mountains. He would apply for cruise ship positions. He would finish out his month of “one shift per week” at PeaceHealth—maintaining his hard-won privileges for exactly long enough to prove a point—and then he would leave.
The hospital would claim he’d voluntarily resigned. His attorney would be furious. The legal community would call it a waste.
But TooToo had learned something important in Ketchikan: you can win every battle and still lose the war. You can be right about the law and wrong about the reality.
You can have privileges and no patients.
Rights and no respect.
Victory and no future.
Hospital credentials and a dependency on cruise ship buffets.
The American Dream, he thought, but for doctors.
As darkness fell over Gravina Island, TooToo lit a small propane heater and ate his beans cold from the can. Tomorrow he would row across to send his applications. Next month, he would be on a ship.
The cruise ships would welcome him. They needed doctors and didn’t care about local politics or community feelings or three-year legal battles. They needed someone board-certified who could handle acute care for tourists who ate too much at the midnight buffet.
From his houseboat, TooToo watched one more cruise ship pass. He didn’t wave this time.
He just watched it
This is a work of fiction. While it references real places and institutions, all characters and events are imaginary and satirical in nature.
Oskar Rausch is a researcher at the Make America Constitutional Again Institute (MACAI) in San Juan, Puerto Rico. He can be contacted at oskar.rausch@proton.me.
Minimally invasive software 