In Hiram’s mind, election as Regent to the board of directors of the International College of Surgeons had lifted him far above the sixty thousand plus general surgeons in the world. But for a number of years, he’d known being on the board was not enough; he had to be president. There were things to do in healthcare and education, and ascending to national prominence as president of the International College would give him the authority he needed.

Hiram had flown first class from his latest periodic visit to the foundation hospital he created in Nepal and was first off the connection to Chicago, where he would lead a conference of state leaders on delivery of healthcare to the uninsured. Once he cleared customs in the U.S. concourse, he went straight to the baggage-claim carrousel of DL 4534. He waited fifteen minutes, reading, replying, and deleting emails on his cell phone until deplaned-passengers arrived for their luggage. Hiram looked for Michael O’Leary, MD, MBA, FACS, from San Francisco, a key member of the college’s Board of Governors executive committee.

He waved to Michael to get his attention.

“I know what you want. Not the right time, Hiram,” Michael said as Hiram approached.

“Wrong, Michael. Perfect time.” Hiram led Michael to a second carrousel where there were fewer people. They stood hidden by a six-foot diameter concrete support post painted off-white.

“Look,” Hiram began. “I need the votes you can deliver.”

“I don’t sell votes,” Michael said, waiting for the conveyor belt to start.

“What will it take?” Hiram asked. “You deserve better in this organization, Michael. You work hard. You’ve got the skills.”

“I’m offended, Hiram.”

“Jesus. This isn’t a bribe. I’m building a new direction for the College, putting it back as the world leader in surgery. But I’ve got to get elected first, and then I’ve got to have new leadership, new ideas, new staff in the right places. You’re integral to that.”

“You’re offering?”

“Executive director.”

“I’d have to resign from the board. You trying to get me off the board, Hiram? Is that what’s behind this?

“Never!”

“You’ve tried that before.”

“Goddamn it. Not with you. Hey, you’ve got experience running executive committees. I want you running the organization. Trust me.”

Michael bit his upper lip, a habit when he was thinking. “Academia doesn’t hold much excitement for me now,” he said.

“Perfect time to change.”

“But it’s a career risk. I need to think about it.”

“Christ. You’ve been wanting it for a couple years. Don’t lie to yourself. This is a new career. I’ll put you on the President’s healthcare task force too. I’ll be co-chair in the fall.”

“My family,” Michael said.

Hiram took Michael’s arm to start him walking toward the security exit. “Angie will be proud. And the kids too. You’re the right person. Look at the realities. Tom’s lousy as director. We need to dump him.”

“He’s our friend.”

“But a shitty director.”

“Can you wait a few days?”

Hiram took a deep breath. “I wish. But I need a head count. I’ve got commitments to make.” Hiram paused. “You hail a cab, the offer’s gone.”

The conveyor for luggage cranked up.

“Well?” Hiram said, looking at Michael.

Michael nodded almost imperceptibly.

“Good choice,” Hiram said, concerned with Michael’s tentative reaction, his unmistakable lack of enthusiasm. Why is he so hesitant? It’s what he’s always wanted.

“I wish I could trust you,” Michael said. He walked to the head of the conveyor, and Hiram left without further words.

Hiram hailed a taxi. Michael had a reputation as ambitious and driven, but a straight shooter, honest, never out of season or over the limit. Hiram wasn’t sure he could deliver the directorship. But first I need to get elected, he thought. I’ll deal with the wrinkles later.

In the months since their meeting at the airport, Hiram avoided Michael and gave no words of appreciation for Michael’s help. Michael swung the seven decisive votes for nomination and Hiram successfully gathered support of the membership. Michael waited expectantly for the announcement of his appointment as executive director.