by Robin Cook
Noah had no problem with tradition and liked it to a degree. There was something reassuring about it as a direct connection with the hospital’s venerable past. Delivering copies of the resident evaluation report to Dr. Hernandez and Dr. Cantor was easy. Their offices were right there in the administration area, and Noah handed copies to their secretaries, who were literally around the corner from the surgical residency program office. It was the last two heavyweights that required a certain amount of effort because their offices were in the swanky Franklin Building.
Noah looked at his watch as he crossed the pedestrian bridge. It was a little after 3:00, so he was confident that he wouldn’t run into Wild Bill at his office, since he’d still be in surgery, having been scheduled for three big cases. Even though he was a remarkably fast surgeon who relied on his fellow to open and close, Noah was relatively certain he’d still be occupied.
As he walked, Noah thought about Ava and how he hadn’t seen her that morning, nor even her name on the surgical schedule, suggesting that she was not working that day. On Saturday night, after he’d left the hospital later than 9:00 P.M., Noah had again detoured through Louisburg Square, even though he had tried to talk himself out of doing it. En route he’d argued with himself whether he would have the courage to ring her bell if he saw a light in her study, but he needn’t have bothered. There’d been no light in the study or in any other window, suggesting she was again out of town, most likely back in Washington. With a heavy heart, yet rationalizing that it was for the best, Noah had continued on to his drab apartment. At least he didn’t have the impression he’d been followed, making him feel as if his paranoia was under control.
Dr. Mason’s office was on the eighth floor and Dr. Hiroshi’s was on the sixth. To speed up the process and get Dr. Mason’s delivery out of the way sooner rather than later, he took the elevator to the eighth floor with the idea of then using the stairs to get down to the sixth. Entering Dr. Mason’s posh, mahogany-clad domain, Noah headed directly for his secretary, Miss Lancaster. She was somewhere in her fifties, with an impressive ash-blond chignon piled on her head. She had an imperious manner that caused her to treat surgical residents like hired help. Noah had had to deal with her in the past and had never found it pleasant.
As Noah approached, Miss Lancaster was on the phone, angrily dealing with someone who apparently wished to see Dr. Mason as soon as possible. “I’m sorry, but Dr. Mason is a busy man,” Miss Lancaster scolded. “No, he will not call you back.”
Noah held up the resident evaluation report, which he knew that Miss Lancaster surely recognized, as it was a monthly tradition and had a distinctive red cover. The secretary looked at Noah over the top of her reading glasses. There was no recognition or any semblance of graciousness. Instead, she merely nodded irritably toward the open door into Dr. Mason’s inner sanctum and then gestured with her free hand as if shooing away a pest. She didn’t interrupt her conversation with what Noah assumed was a desperate patient, most likely dealing with a recent diagnosis of pancreatic cancer. “Have your doctor call me,” Miss Lancaster snapped into the phone. “But first make sure that the CT scans are sent so Dr. Mason can review them before speaking with your doctor.”
Feeling considerable empathy for the patient, Noah resisted the temptation to say something appropriately harsh to Miss Lancaster. She was treating the caller outrageously. After having recently filled out all the evaluations of the residents, he wished there was a mechanism for doing the same with staff secretaries.
Dr. Mason’s corner office appeared to Noah the way he imagined the office of a CEO of a major international corporation would look, as a reflection of the amount of money the man brought to the hospital. It was ridiculously large, commanded an impressive view of Boston Harbor, and was also paneled in mahogany. The furniture in the sitting area was upholstered in a soft, premium leather. Covering the walls were a profusion of framed diplomas, both earned and honorary. The desk size matched the renowned surgeon’s ego.
For a second Noah debated where to put the resident evaluation report as he noticed correspondence waiting Dr. Mason’s signature on the table in front of the couch. Still, Noah decided to put his report front and center on the desk, but as he approached with the report outstretched something caught his eye. Lying on the desk off to the side was a bound Ph.D. thesis. Noah did a double take. To his shock, he thought he recognized it. It looked like his!
Noah dropped the evaluation report on the desk’s blotter, and then after a glance over his shoulder to make sure Miss Lancaster was still preoccupied with her phone conversation, he reached out and snapped up the bound thesis. A second later he confirmed it was indeed as he suspected: Genetic Control of the Rate of Binary Fission in Escherichia Coli by Noah Rothauser. Someone, presumably Dr. Mason, had inserted a number of Post-it bookmarks.
After another fleeting glance in Miss Lancaster’s direction, Noah opened the bookmarked pages. They marked various tables of data. One table in particular made Noah’s heart leap in his chest. For a brief second he thought about taking the thesis to get it out of Dr. Mason’s hands, but immediately he decided against the idea. Miss Lancaster’s eagle eye would undoubtedly see him carrying it, as it would be difficult to conceal. The only way possible would be to hold it under his white coat, but that would be awkward and most likely wouldn’t work. And even if he succeeded in getting it by her, she’d remember it had been sitting on the desk when Noah had visited. Reluctantly, Noah replaced the thesis, convinced that taking it would only serve to call attention to it and probably make things worse.
28
TUESDAY, AUGUST 8, 1:13 P.M.
“Dr. Rothauser?” the OR intercom announced. “This is Janet Spaulding. I just got a call from Dr. Hernandez. He wants to know how long you might be. He would like you to meet with him as soon as possible.”
Noah straightened up suddenly, as if a bolt of electricity had descended his spine. Once again he was being summoned to the principal’s office, and it made his heart race. It had been two weeks to the day that he’d been texted to see Dr. Hernandez out of the blue. Although that meeting had gone well, Noah had no idea why the chief wanted to see him yet again, but it couldn’t be good news. It was certainly out of the ordinary for such a request to come through the OR intercom. “Tell him I’m finishing up now and I’ll be available in a half-hour or so. Where does he want to meet?”
“His departmental office,” Janet said.
“Got it,” Noah replied. He tried to calm himself, but it was difficult. He was watching Dr. Lynn Pierce, a first-year resident, sew up the skin under the watchful eye of Dr. Arnold Wells, a third-year senior resident. Dr. Pierce was doing a credible job even though it was her first time doing so. She had spent her first month in the SICU, or surgical intensive-care unit, where she had done a superb job. Now she was rotating on the gastrointestinal service.
The operation had been a pancreatectomy, Dr. Mason’s specialty, and Noah was pleased with his performance. He’d used Dr. Mason’s technique to the letter and had accomplished the difficult surgery almost as quickly as Dr. Mason, a tribute both to the technique and Noah’s dexterity. Noah was known as one of the fastest residents when it came to doing surgery. It wasn’t that he rushed. It was just that he knew the anatomy cold and had exceptional hand-eye coordination. There was never any wasted motion.
“Would you guys mind if I duck out?” Noah asked. He couldn’t stand the tension of not knowing why the chief wanted to see him, especially by having him paged in the middle of an operation.
“Not at all,” Arnold said. Lynn didn’t respond, as she was concentrating on her suturing.
After a quick chat with the anesthesiologist about post-op orders on the patient, Noah hurried toward the men’s locker room to change out of his scrubs. As he powerwalked the length of the OR suite, it occurred to him that the most likely explanation was that Dr. Kumar had finally gotten to Dr. Hernandez to complain abou
t Noah’s importunate Friday-afternoon visit. Racking his brains, Noah tried to think up some elaborate explanation of why he had gone directly to the chief of Anesthesia bypassing Dr. Hernandez. Unfortunately, Noah didn’t feel very creative, since he was exhausted and already on edge.
The previous night Noah had slept little, unable to stop fretting about his Ph.D. thesis being on Dr. Mason’s desk. For the life of him, he couldn’t figure out why or how it had gotten there and why there were bookmarks at various data tables. Recalling Dr. Mason’s threat to do his best to have Noah dismissed, there could be only one explanation. Was that something Noah had to worry about? He didn’t know, but it had made him feel extremely agitated.
Unable to sleep with his mind in turmoil, Noah had gotten up at three in the morning and had returned to the hospital. For lack of anything else to do, he’d started his prep for the next M&M Conference, even though by doing so he’d also had to contend with thoughts of Ava. When he had done the Tuesday resident surgical schedule, he’d seen that she was assigned to cases on Tuesday, meaning she was back from wherever she had gone. It had made him wonder if he’d run into her by chance, and if he did how he would react, but it hadn’t happened.
Noah took the stairs to get down to the third floor, once again anxious about heading to a confrontation with someone who had the power to derail his career ambitions. Obviously, it was a fear he was never to outgrow.
When Noah presented himself in front of Dr. Hernandez’s charming secretary, Mrs. Kimble, who was the antithesis of Miss Lancaster, he was asked to take a seat in the common administrative waiting area. She said she would come and get him when Dr. Hernandez was ready. Her pleasant attitude seemed entirely normal, which Noah took as a good sign. As he sat down he felt a bit more at ease. Another idea had occurred to him. Maybe Dr. Hernandez wanted to congratulate him on his first resident evaluation report, which Noah had turned in the day before. Noah did feel confident the report had been done with appropriate attention to detail, and it was entirely positive, which was unique. Contrary to most years, none of the first-year residents were having any difficulty adapting to the rigors of the program.
With these thoughts in mind, Noah was feeling confident until a small parade of additional authority figures appeared, including Dr. Cantor, Dr. Mason, Dr. Hiroshi, and, strangely enough, Gloria Hutchinson, the president of the hospital. Chatting together, all of them trooped into Dr. Hernandez’s office and disappeared behind a closed door.
Now Noah’s anxiety returned in a rush as the minutes ticked by. Were all these bigwigs going to be part of the meeting with Noah, or was Noah merely waiting until their meeting with Dr. Hernandez was over? If it was to be the former, something rather extraordinary was afoot, especially with Dr. Mason’s presence. If it was the latter, things might turn out okay. Noah took his pulse, which was normally in the sixty-per-minute range. Now it was one hundred and ten, and he could feel it in his temples.
Tossing aside an old issue of Time magazine, Noah concentrated on Mrs. Kimble. He’d concluded that her behavior was key. To his dismay, a few minutes later, after hanging up her phone, she pushed back from the desk and stood. As she started in Noah’s direction, he could feel his pulse rate jump from its already fast pace.
“Dr. Hernandez can see you now,” Mrs. Kimble said with the same pleasantness she’d used before. This time Noah wasn’t fooled. The meeting was going to be with the whole group.
When Noah got into the inner office, his worst fears seemed justified. Dr. Hernandez did not get up as he usually had in the past, and he exuded an alarming intensity. Dr. Cantor and Dr. Hiroshi were sitting by the window in side chairs. Gloria Hutchinson was on the couch, looking as serious as Dr. Hernandez. Next to her was Dr. Mason with an expression of pompous self-satisfaction. But worst of all, from Noah’s viewpoint, was catching sight of his wayward thesis perched on Dr. Hernandez desk. This impromptu meeting was not about the resident evaluation report, or his misguided meeting with Dr. Kumar, but something far more serious.
With no seat available and no verbal direction from Dr. Hernandez, Noah stopped in the middle of the room. He felt agonizingly vulnerable, facing not one but four authority figures. His heart was racing. When no one spoke or moved, Noah felt pressured to break the silence: “You wanted to see me, sir?” The pitch of his voice was higher than he would have liked.
“That’s correct,” Dr. Hernandez snapped angrily. Then, in his signature bombastic style, he launched into a mini-lecture about how seriously the surgical department took ethical breaches, emphasizing that the BMH, as one of the country’s premier tertiary-care and teaching programs, was obliged to set a high standard for professional integrity and honesty.
As Dr. Hernandez droned on, Noah glanced at the other people in the room. Most had assumed a glazed look, except for Dr. Mason, who was enjoying every second. A sudden slapping sound yanked Noah’s attention back to Dr. Hernandez. The chief’s hand was now resting on the top of Noah’s Ph.D. thesis.
“With these standards in mind, we are faced with a major problem,” Dr. Hernandez continued. He picked up the slender volume and held it aloft, reminiscent of a preacher with a bible. “It has been brought to the department’s attention that there is falsified data in this thesis, which we understand played a significant role in your acceptance to Harvard Medical School. Is that your understanding, Dr. Rothauser?”
Noah stared with disbelief at the chief. He couldn’t believe this was happening. He felt like he was teetering on the edge of a precipice. “Yes,” he said after a short pause. “I believe that my thesis made the Admissions people look more positively at my application.”
“Then perhaps your acceptance was based on falsehood,” Dr. Hernandez said. “If that is the case, we have a serious dilemma that requires attention. So I ask you directly, does this thesis of yours contain falsified or contrived data?”
“To a degree,” Noah said, struggling to decide how to answer.
“That seems inordinately evasive,” Dr. Hernandez snapped. “I think the question deserves an unambiguous answer. Yes or no!” He glowered at Noah.
“Yes,” Noah said reluctantly. “But let me explain. By working day and night I was able to complete my Ph.D. work in two years. For it to be officially part of my medical school application, I had to hand in my thesis on a specific date. To make that date, I was forced to make some very modest outcome predictions for my final confirming experiment, whose results had already been proven by previous work. Those estimates remained in the hard copies I submitted, one of which you are holding. When the final data was available within the month, which was more positive than my conservative estimates, I changed the digital version, which is the version that is online and cited in the literature.”
“In other words,” Dr. Hernandez said while still holding Noah’s bound thesis in the air, “there is definitely falsified data in this work.”
“Yes,” Noah repeated. “But—”
“I’m sorry,” Dr. Hernandez said, interrupting Noah in a tone of voice that was the opposite of being sorry. “This is not the time for explanations of why purposely falsified material exists in a Ph.D. thesis. The fact that it does forces our hand. From this moment, Dr. Rothauser, you are suspended from your duties as super chief resident pending an ad hoc hearing of the Residency Advisory Board. The board will adjudicate the situation and determine if the suspension will be reversed or made permanent. The board will also decide if the Massachusetts Board of Medicine should be advised.
“That will be all, Dr. Rothauser. Needless to say, we are all shocked and disappointed.”
Noah was the one who was the most shocked. He couldn’t believe he was being summarily dismissed and, worst of all, suspended. He was momentarily paralyzed. He’d expected something bad, but more in line of being formally censured for ignoring proper channels and meeting with Dr. Kumar to question the competence of one of his staff members.
“That will be all, Dr. Rothauser,” Dr. Hernandez repeated irritably. He tossed Noah’s bound thesis onto his desk in an overt display of indignation.
“What about my patients?” Noah pleaded, finding his voice. He had six post-operative patients in the hospital at that moment, several still in the PACU, and he had surgical cases scheduled for the week.
“Your patients will be taken care of by others,” Dr. Hernandez said. “You should leave the hospital until this issue is resolved. Dr. Cantor will be in touch with you in due course.”
Noah literally stumbled out of the chief of surgery’s office, totally stunned. In a semi-trance, he walked the length of the corridor toward the elevators. He couldn’t believe that Dr. Mason had succeeded in accomplishing what he had threatened. As Ava had reminded him, his reputation as a resident among staff, fellow residents, and patients was sterling. The whole situation was a nightmare.
For Noah, the potential implications of being permanently dismissed from his residency and losing his medical license was the worst news imaginable, akin to being diagnosed with an untreatable cancer. Suddenly, everything he had worked for since he’d decided on medicine as a career was in jeopardy. It was as if his life was unraveling.
BOOK 3
29
SATURDAY, AUGUST 12, 1:51 P.M.
Noah felt oppressively hot as he stepped out of his Beacon Hill building into the hazy summer sunshine. Typical of Boston in mid-summer, the humidity had climbed along with the temperature. As he walked up the few steps to the corner of Revere and Grove Streets, he could feel perspiration run down his back despite his summer attire of T-shirt, shorts, and flip-flops. Heat radiating up from the brick sidewalk seemed equal to the heat streaming down from the sun above.
