by Robin Cook
“It is apparent that her neck is deformed,” Noah said, coming to Ava’s rescue. He didn’t want the conversation to get out of hand. “It is flexed and fixed. And the patient is moderately obese. That contributes. Isn’t that right, Dr. London?”
Ava nodded.
“Well, wasn’t that taken into consideration?” Dr. Jackson snapped, looking directly at Ava. “This is your specialty, for God’s sake.”
“I didn’t know about the neck,” Carla said. From the sound of her voice, she was as anguished as Ava.
“You mean to tell me it wasn’t in the ER resident admitting note?” Dr. Jackson demanded.
“It wasn’t,” Carla managed. “There was nothing about neck problems.”
“Good God!” Dr. Jackson voiced. He turned to Noah. “This morning we hear about a resident who didn’t even do an admitting note. Now we hear about a resident leaving out a mighty important finding that’s indirectly caused this patient’s death. That’s your department, Mr. Super Chief. Sounds like I’ll need to talk to Dr. Hernandez as well as Dr. Kumar.”
“I will certainly look into it,” Noah said. Inwardly, he groaned. At that morning’s M&M he’d barely avoided a personal disaster, and now he was facing another potential one for the next M&M.
“You’d better!” Dr. Jackson barked. He tore off his gloves and threw them to the floor. He did the same with his surgical gown. After that juvenile show of misplaced anger, he left the room.
While Doctors Wilson and Wong gathered up the cardiac-arrest paraphernalia and Dawn disgustedly picked up the discarded gloves and gown, Noah turned to Ava and Carla, particularly looking at Ava. He wanted to say something supportive if not give her a reassuring hug, but he didn’t dare. Instead he merely nodded, hoping to communicate his concern in some nonverbal way. “Sorry,” he said simply. He held her eyes for a moment with his own, but she didn’t react. Then he, too, left the room.
As Noah hurried back to room 18 he thought again of the next M&M, wondering if they were going to be his bane for the entire year. At least on this case he wasn’t going to be harassed by the concurrent-surgery issue, which was a definite plus. On the negative side, he would be dealing with an unleashed Dr. Mason, who normally was an active participant in M&M discussions. Noah knew full well that during the next one, Dr. Mason wouldn’t be constrained as he had been that morning in his role as the involved surgeon. What Noah was already worrying about was Dr. Mason’s reaction to Ava’s being involved in yet another death, because he obviously still blamed Vincent’s on her.
Intent on getting back to OR 18 as soon as possible to apologize and explain his absence in case they hadn’t heard, Noah practically collided with Dr. Mason, who had just emerged from room 15. He was in the process of removing his surgical mask and not looking where he was going. Noah’s heart skipped a beat.
“Ah!” Dr. Mason exclaimed, seeing who he was confronting. “Just the person I wanted to find.”
Instantly, Noah’s fears were confirmed. Mason knew. It was confirmation that bad news traveled quickly around the OR, especially when the PA system played a role.
“I’ve got a case in room number eighteen and I’m awfully late,” Noah said. He tried to detour around his antagonist, but Dr. Mason blocked his way.
“So, my friend,” Dr. Mason said sarcastically, “are you proud of yourself now?”
“Excuse me?” Noah asked. He was confused. Proud? Why would he be proud after what had happened?
“You get to take some credit for what just happened in OR number eight,” Dr. Mason explained. He was sporting a nasty smile. “You more than anyone else have been supporting that incompetent bitch of an anesthesiologist, and now you are being rewarded with another unnecessary death.”
“Dr. London was only the supervisor on the case,” Noah said, but as soon as he said it, he wished he hadn’t.
“And you think that exonerates her? Bullshit. She shouldn’t be supervising anyone. Somebody needs to supervise her. We’re supposed to be one of the best hospitals in the whole damn country, if not the best, and we lose two healthy young people in two weeks? There’s something wrong with this story.”
“There were complications,” Noah said.
“Complications, my ass. I heard that she couldn’t even get a goddamn endotracheal tube in. Simple as that. I never heard of an anesthesiologist who couldn’t get an endotracheal tube in, not with all the tricks they have up their sleeve.”
“Dr. London wasn’t even in the room when the problem began,” Noah snapped.
“That’s an explanation? Give me a break! Where the hell was she?”
“She was supervising an induction on another case,” Noah said. “It’s an Anesthesia rule that the supervising anesthesiologist be in the room throughout the induction process. The attending surgeon on the case in question was insistent a new first-year anesthesia resident start even though the supervisor wasn’t immediately available.”
“So it was Dr. Jackson’s fault?” Dr. Mason questioned superciliously. “That’s bullshit. That’s like me being to blame for the Bruce Vincent fiasco.”
“I’m not saying it was Dr. Jackson’s fault,” Noah said. “But what I am saying is that he shouldn’t have been encouraging a new resident to break the rules.”
“Let me ask you something, Dr. Rothauser,” Dr. Mason said. “Why do you protect this bitch? I don’t understand. You’re a smart man. I mean, I’ve been asking myself this question over and over.”
“I’m not protecting anyone,” Noah said. “I try to see the whole picture and get all the facts. I will certainly be investigating this case, as it will obviously need to be presented and discussed.”
“Wait a second!” Dr. Mason said. A slight smile formed with his narrow lips. “I’m suddenly seeing the light. I bet I know why you are protecting her. You want to know what I think?”
“I’m not protecting her,” Noah said. “I don’t protect anyone who doesn’t deserve it.”
“Here’s what I think,” Dr. Mason said. “Have you been banging her? Tell me straight! Have you and she been getting it on? One thing I can give her credit for is having a decent body, and she’s got a house in a hell of a neighborhood.”
Noah’s mouth went dry, and for a moment words abandoned him. He stared at Dr. Mason with shock, wondering just how he had known. He and Ava had been so careful, almost obsessed with their secrecy.
“Okay,” Dr. Mason said derisively, noticing Noah’s deer-in-the-headlights response. “Why didn’t I guess this before, I haven’t the foggiest, but it all makes sense. Of course, I don’t know how you got to first base since she is such a cold fish. So I have to give you credit where credit is due.”
“This is ridiculous,” Noah managed. He realized Dr. Mason was guessing, and Noah lambasted himself for hesitating to respond.
“I should have guessed,” Dr. Mason snapped, ignoring Noah’s attempt at denial. “You’re so transparent it’s a joke. And let me tell you this: It doesn’t help your image in my mind. I don’t know why, but it really pisses me off big-time.”
I know why, Noah thought but didn’t dare say. As a narcissist, Dr. Mason would see Noah’s success with Ava as the reason she had spurned him, and that was probably the reason he’d come up with the accusation. It was better than admitting Ava might not find him attractive.
“Maybe you’d better start packing your bags,” Dr. Mason said, reverting back to poking Noah in the chest with one of his thick index fingers as he’d done in the past. “I’m going to make sure that Dr. Hernandez knows about this.”
Dr. Mason then literally pushed Noah out of the way and continued down the OR corridor, heading toward the surgical lounge.
Noah watched him go, feeling a mixture of anger and disgust toward the man. His threat to tell the chief about his suspicions of Noah and Ava having an affair could have serious consequences. Although Noa
h couldn’t imagine it could threaten his job, it would certainly affect his relationship with Ava. She had made it clear that she prized her privacy, and Noah agreed with her. But was it a legitimate concern over the long haul? Noah doubted that their being circumspect about their interactions in the hospital was going to be enough to shield their affair. Eventually someone in the hospital community was bound to see him coming or going from Ava’s Louisburg Square home since a number of them lived in the Beacon Hill neighborhood. It was only a matter of time.
“What a bastard,” Noah mused out loud as he hurried toward OR 18. Ava described a narcissist like Dr. Mason as a bull in a china shop. Noah thought the simile should be a lot stronger and be about people, not dishes. Spontaneously he came up with a rabid gorilla at a picnic. The thought made him smile. It was to be the last time he smiled for the day.
14
WEDNESDAY, JULY 12, 9:31 P.M.
Noah had hoped to get out of the hospital much earlier, but it wasn’t to be. At around 5:30 he’d been informed that several organs were available because of a motorcycle accident on the Cape that afternoon and that a kidney was on its way to the BMH. Noah had been pleased, although certainly not for the motorcyclist. Although he’d ridden one as a teenager, as a resident he’d learned to see motorcycles as a method of nonintentional suicide for the riders and, as a result, a gift to those needing organs.
Once it had been confirmed that the organ was on the premises, the sixteen-year-old girl recipient was inducted under anesthesia, and by the time the gifted organ arrived in the OR, Noah was nearly ready for it. It was a happy time for everyone, including Noah, who had known the patient for several years as she had waited. What made it particularly exciting was that the organ was a particularly good match, with an outstanding prognosis for the patient.
The kidney operation had been the highlight of Noah’s day. It was one of those episodes that confirmed for him that he had made the right career choice and more than justified all his efforts. It had even nearly erased the bad feelings associated with the unfortunate death of Helen Gibson and the confrontation with Dr. Mason, although Noah had yet to communicate on any level with Ava after the disaster in OR 8.
Noah had tried between surgeries to casually run into Ava to be assured she was okay, a shrug or a nod to suggest she was coping, but he hadn’t seen her. After he’d finished his last scheduled case, he’d made a concerted search for her around the entire OR area. It wasn’t unusual for anesthesiologists to remain after hours, even though it wasn’t Ava’s habit. Noah finally went so far as to ask for her in the Anesthesia office, where he was told she had left for the day. It was at that point that Noah had resorted to digital means to contact her.
The first thing he had done was text her. While he waited for her response, he’d started afternoon work rounds with the residents on the surgical floor. When rounds were done and she hadn’t responded, he texted her again, indicating it was urgent that she respond. Meanwhile, he’d started seeing his own inpatients, including the patients he’d operated on earlier. Between the colectomy and the hemorrhoid, he’d tried to call her. Not only had she not answered, but after listening to her stock outgoing message, he’d been told that her voice-message box was full.
Feeling frustrated by the technology that promised immediate contact but wasn’t delivering, Noah tried Facebook messaging, then went back to seeing his post-op patients. It wasn’t the best time to visit, since most were eating dinner, but still they were glad to see him. More important, there were no complications such as fevers or complaints of pain, and they were even complimentary about the food. Noah wasn’t surprised. Hospitals today, even tertiary teaching hospitals like the BMH, knew they were in competition and made an effort with their food service. It was just as Noah was seeing his last patient that the kidney notification had come through.
With the surgical call team prepared to take over for the night, Noah left the hospital through the main entrance. It was a warm summer evening and the sidewalks were busy. He crossed the green space created when the Big Dig had put the main north-south traffic artery underground. From there he walked through a portion of downtown Boston to emerge at the northeastern tip of the Public Garden. It was Noah’s usual route when heading home. But he wasn’t heading home. He was heading to Ava’s house.
He entered Louisburg Square from the opposite direction than when he was coming from his apartment. Ava’s building looked dark and uninviting.
Noah climbed her stoop. He entered the foyer. There was an overhead light, but it wasn’t on. To find the doorbell he had to go by feel. He pressed it and listened. In the far distance, he could hear a phone ringing, which was the way Ava’s doorbell worked, since it was tied into the phone system. It rang six times. No one answered.
“Shit,” Noah said. “Where the hell are you?” Out of frustration he pounded on the door. The moment he stopped, a heavy silence returned.
After a long sigh, he went back through the outer door. Stepping into the street, he walked over to the fence that circled the greensward and then looked back up at Ava’s house. There had been no change. All the windows were dark, including the three dormers on the top sixth floor. Although he couldn’t see any of the windows in the L portion of the house nor the workout room, he felt confident she was either not home or hiding from the world. Knowing what he did about her, he doubted the latter. There was nothing about her that suggested she was the depressive type. Besides, what could he do even if she was keeping to herself? It was her house. He couldn’t break down the door and look for her.
For a moment Noah debated what to do, but ultimately he recognized he didn’t have much choice. He had to either go back to the hospital if he wanted any companionship whatsoever or go back to his apartment. Under the circumstances, both destinations seemed pathetic. If he went back to the hospital, as the super chief resident he would be hard put to explain why he was there, and people would most likely ask. He had no idea what he would say, and it might turn out to be embarrassing. As for his apartment, at least he wouldn’t have to explain himself, although the idea of being there was far from enticing for a multitude of reasons.
Finally, as the least bad idea, he decided on his apartment and began to head in its direction. As he walked he found himself back to wondering if Ava could be seriously depressed, but then dismissed it again. He was convinced she was a doer like himself. When the chips were down and things weren’t going your way, you didn’t cry and mope. You sucked it up and worked harder.
As he climbed the stark stairs in his building, he couldn’t help but compare the experience with going up the stairs in Ava’s home with its mahogany handrail, hand-turned balusters, and custom carpeting. Yet the thought surprised him. Had four days and three nights spoiled him?
When he got into his unit, the comparisons were even more dramatic. It was like night and day. He couldn’t quite believe the barrenness and impersonal nature of the place.
Trying to ignore the decor or the lack of it, he sat down at the miserable folding table and booted up his HP, still wondering when he’d hear from Ava and wishing he’d inquired about her schedule when he’d visited the Anesthesia office. Quite suddenly, the disturbing thought came to him that she might have some time off and be away on one of her frequent trips without telling him.
After quickly checking if he had gotten any emails or Facebook messages on his computer that might have mysteriously eluded his phone, Noah sent another email to her. He struggled with the phrasing so as not to sound as irritated as he felt. In many respects, it was rude and unempathetic of her to ignore him like this. She had to know he would be beside himself with concern.
Then he picked up his mobile phone, and against his better judgment, he typed her yet another short text, urging her to text back and included a sad-face emoji. But then he held up for a moment with his finger poised to hit the send button, trying to talk himself out of doing it. He’d already sent
her a half-dozen unanswered texts.
In an attempt to salvage a modicum of self-esteem, he deleted it instead and tossed the phone onto the table in disgust. He wondered when he would hear from her, whether the next day or the day after that or if at all. Could the next time he saw her be in the OR corridor, ignoring each other and passing like two ships in the night? He had no idea, but he realized it was a possibility, as were a half-dozen other scenarios. Not since high school when his first love had suddenly turned her affections elsewhere had he been quite so confused, irritated, and worried all at the same time.
“Maybe I’m in love,” Noah questioned out loud. As lonely as he’d been over the last two years, he knew he was possibly a needy, love-starved nerd who’d been swept off his feet over the previous three or four days by an exceptional woman who had been hiding out in plain sight.
BOOK 2
15
SUNDAY, JULY 16, 9:10 P.M.
The next four days did not rank among Noah’s favorites. To try to avoid obsessing over Ava’s disappearance and her total lack of communication, he buried himself in work. Not only did he do more surgery than his usual amount and see far more people in clinic, he found the time to plan the basic science lectures and Journal Club meetings for the entire next month. He also met with each first-year resident to hear his or her complaints and raves.
Even though he told himself he wasn’t going to hear from Ava, every time he got a text message or an email or even a phone call he thought it might be her and his heart quickened. Unfortunately, every time he was disappointed. In order to avoid looking for her in the OR each day, he made it a point to go back to the anesthesia office the day after she’d disappeared and ask the secretary when Ava was due back. To avoid stoking any gossip, he’d used the excuse that he had to talk with her about the Helen Gibson case. What he had learned was that she wasn’t scheduled until Monday.
