Charlatans

by Robin Cook

  “Why didn’t you do the legal work in Brownfield?” Noah asked. He hadn’t thought about checking the court records in Lubbock.

  “I’m not sure they would have let me do it in Brownfield,” Ava said. “When you want to change your name, the authorities discourage and often deny celebrity names, and Ava was a local celebrity.”

  “You said you had a need for a new identity,” Noah said. “I don’t understand. Why?”

  “I was being held back by my old identity,” Ava said. “When I moved with my dentist boss to Lubbock and got a taste of what an education could do for you, I needed a new beginning. Becoming Ava London was that new beginning. She had had a different outlook on life and a different scholastic record. She would have gone to college and become something more than a dental assistant. She would have at least been the dentist.”

  “In the articles I read in The Brownfield Gazette, you, as Gail Shafter, as well as two other classmates were named as having harassed Ava London after her father’s suicide on AOL Instant Messaging to encourage her to follow her father’s lead,” Noah said. “Was that true?”

  “It might have been, on some level,” Ava admitted. “But there were a lot of girls who were jealous of Ava London, and she was an entitled snob. What irked me and a sizable number of other female classmates at the time was that she began using her father’s suicide to her advantage, looking for more acclaim and status because she was supposedly suffering, the poor dear. It made a lot of us sick, and I wasn’t afraid to tell her. But I never encouraged her to kill herself.

  “She and I had been friends, or at least as friendly as was possible with the most popular girl in the class who was never satisfied with her status. But when I was honest with her about using her father’s suicide as she was, she ostracized me and got me harassed big time about being a slut. And one other thing. When I was in the ninth grade I got harassed so much online I couldn’t go to school for a week, and Ava London and two of her then closest friends were the culprits.” Ava shook her head. “Growing up is getting progressively more difficult with social media providing instant, nonstop communication. And I think it is harder for girls than boys with the mixed messages we must deal with about sex. If you don’t indulge, you’re a prude. If you do, you’re a slut. I wasn’t a slut. I only had one boyfriend in high school and that was short lived.”

  “And you didn’t harass Ava to follow in her father’s footsteps?”

  “Never,” Ava said, “but I was clear about how it was for her to try to benefit from the tragedy.”

  “Why didn’t you tell me about this identity change earlier in our relationship, as intimate as we’d become?” Noah asked.

  “I don’t know,” Ava said. “What might surprise you is that I don’t think about it that often. I’ve adjusted to my new reality, and I much prefer it to the old one. I might have told you eventually, but then I might not have. I don’t see it as important. And thinking about what is important leads me to another more serious issue I want to bring up with you.”

  Ava moved even closer to Noah by pulling the ottoman she was sitting on against his chair so she could lower her voice even more. “Before I say what I plan to say, I want you to know that I like you, Noah Rothauser. I really like you and respect you, which is why we have gotten along as well as we have, and I hope our relationship can continue and hopefully even blossom. I think we were made for each other, but whether or not it happens is going to depend on your cooperation.”

  “Cooperation on what?” Noah asked hesitantly.

  “That you join the team,” Ava said “My team! Above and beyond my personal interest, I think you could be a big help to the NSC. You and I together. Understand that I have lobbied for you strenuously, which is ironic, me lobbying a lobbying organization! My success at this particularly lobbying effort is why you are sitting here at this moment rather than having disappeared to God knows where, which would have been easy as no one knew you had gone to Lubbock or why.”

  A chill descended Noah’s spine, making him tense.

  “I’ve had to make a huge pitch to have you brought back to Boston to have this talk,” Ava said. “I even essentially ransomed several planned trips to Washington to make it happen, threatening not to go. Now, I want to remind you of the metaphor you used the first evening you visited my home to plan for the initial M&M Conference, and that was when you described us as ‘two peas in a pod.’ Do you remember?”

  “Of course I remember,” Noah said. “It was when I learned how similar we were in our total commitments to medicine and our specialties.”

  “Unfortunately, it seems that the metaphor is not as apropos as I was counting on,” Ava said.

  “What does that mean?” Noah said. He knew intuitively that something was coming that he was not going to like.

  “Believing that you felt as committed to surgery as I feel toward anesthesia, I was sure that if you were suspended from your super chief resident position that you would be so totally consumed by getting yourself reinstated that you wouldn’t have time or energy to cause trouble for anyone else—namely, me.”

  A sudden feeling of anger and betrayal surged through Noah’s brain. He regarded Ava with disbelief. “Are you telling me that you were responsible for my suspension?”

  “Only indirectly,” Ava said. “All I did was tell my babysitters, Keyon and George, that you had somehow fudged or fabricated data on your Ph.D. thesis. I also told them that Dr. Mason was eager to have you fired. With that little bit of information and their considerable resources, they were able to accomplish getting you temporarily furloughed.”

  Noah could feel his face redden. It was almost too much to believe that he had been jilted by someone he’d felt so very close to and trusted.

  “I can see you are upset,” Ava continued in the same even tone she’d been maintaining. “But before you allow yourself a paroxysm of righteous indignation, I want to tell you that I wasn’t completely confident you would stop causing me potential trouble with your supposed misgivings about my competence even after your suspension. Accordingly, for backup, I encouraged Keyon and George to use the full investigative power of ABC Security to delve into your background. It is fascinating what they have come up with. It seems that you, Dr. Noah Rothauser, like most people, have a few secrets that seem at odds with the persona you present, which might be more like a Facebook sockpuppet than you would have us believe. Who is the real Noah Rothauser?”

  The color of Noah’s face that had so recently appeared now drained away. It took him a minute to organize his thoughts. “Let me ask you a question,” he said in a halting voice.

  “Please do,” Ava said.

  “Why are you and the NSC so against my checking into your training? Initially, I was just interested to know how many and what kind of cases you did as a resident, which is all I was trying to do when I used your computer.”

  “The NSC doesn’t want my training questioned because I told them emphatically I did not want it questioned,” Ava said. “It is as simple as that.”

  “Does the NSC know why you feel that way?”

  “No, they don’t,” Ava said. “My turn for a question. Why are you concerned about my training when I have passed my anesthesia boards both written and oral with honors, and as you have reminded me I’ve handled upwards of three thousand cases at BMH without a problem.”

  “It’s mostly those niggling questions about the three deaths that I felt ethically obligated to check out. I told them to you.”

  “And I explained fully that your concerns were without basis in all three instances,” Ava said. “What else? Let’s clear the slate.”

  “Okay, I’ve also wondered about your syntax in your anesthesia notes,” Noah said. He felt embarrassed to bring up such an insignificant issue, but it had been bothering him like a pebble in a shoe. “You use fewer acronyms and more superlatives than other doctors.”r />
  “That’s an absurd notion,” Ava said. “If anything, it’s mainstream medical snobbery. I write my notes the way notes are written in Brazos University Medical Center in Lubbock, Texas. What else?”

  “It surprises me that you have no real friends at the hospital,” Noah said. “You keep everyone at arm’s length and apparently prefer social media to face-to-face interaction. Why? It seems so strange to me because I know you as warmly personable. It makes no sense, especially with your ability to read people so well.”

  “Isn’t this a little like the pot calling the kettle black?” Ava said. “When it comes down to it, you are the same. Remember: ‘two peas in a pod.’ Maybe you go more out of your way to be superficially friendly with everyone than I, but you’re not close friends with anyone except an alleged girlfriend who no one ever met and who decided she needed more of a relationship, which you weren’t supplying. As for social media, I think you don’t indulge in it because you don’t have the time, at least not until you finish your residency. When you do, the ‘gamer’ in you is going to reassert itself, and currently there is no better online game than social media.

  “Here’s the reality. We are both products of the new digital age, where truth and intimacy are becoming less and less important. Thanks to the ubiquity of social media in all its forms, we’re all becoming narcissists, maybe not as overt as our friend Wild Bill Mason, but we all thrive on continuous reaffirmation, which is why you work so damn hard and I love anesthesia. Everyone is becoming an elaborate fusion of the real and the virtual, including you and I.”

  Noah stared back at Ava. Earlier he had had a foreboding about where their strange, digressive conversation was going, but now he was sure, and a deep-seated atavistic fear spread through him. It disturbed him to recognize she was in control and not him. She knew all her own secrets and apparently some of his.

  “The growing popularity of Facebook and other social-media sites is a harbinger of the future,” Ava said after a pause to see if Noah would speak. When he didn’t, she continued: “People can be what they want to be by managing technology, and those who do it the best, like you and I, will thrive despite our pasts.”

  Ava paused again. This time she resolved to wait for Noah to respond. Her expression was a contented semi-smile of the one in control, in sharp contrast with Noah’s clenched, thin-lipped, anxious grimace.

  For a moment Noah looked away. Ava’s self-assurance and apparent amusement were galling, as he thought of himself as the injured party who should have been treated as such, rather than being toyed with like one of her cats playing with a mouse. When he looked back, he decided once again it was time to go for broke. What he didn’t expect was another surprise and an even bigger shock.

  44

  FRIDAY, AUGUST 18, 12:05 A.M.

  “Let’s stop beating around the bush,” Noah said irritably. “I want you to tell me directly why you are so protective of your anesthesia training.”

  “It’s simple,” Ava said, her smile broadening. “I don’t want people checking into my anesthesia training, because I didn’t do it.”

  Noah’s jaw dropped open. Again he stared at Ava, but now it was in total disbelief. “Maybe you better tell me what you mean.”

  “I am what you might call a modern-day charlatan, which is a world of difference from a charlatan in the past,” Ava said. “And I’m not talking about the kind of charlatan everyone is becoming today because of little lies on social media. I’m talking about being a full-blown charlatan but of a different ilk. I am a fully competent charlatan.”

  “What part of your formal anesthesia training did you not do?” Noah asked with hesitation.

  “None of it,” Ava said.

  “I’m not sure I understand,” Noah said, dumbfounded.

  “Let me explain,” Ava said. “Remember I told you I was giving anesthesia under the supposed supervision of my dentist boss, which wasn’t much supervision. What it did was make me very interested in the science of pharmacology and anesthetic gases. When we moved to Brazos University Medical Center, I started going to various lectures and even an anesthesia conference that the school sponsored. My boss was very encouraging. So I started reading in the field online, which turned out to be better for me than the lectures, since I could read with better retention and much faster than professors could talk. I found the information fascinating. I was also impressed with the salary and respect anesthesiologists got and wanted it for myself. I mean, I was kind of doing the same thing but as an assistant in a dental office instead of in an operating room. And I was doing it without the fabulous equipment and support of nurses and residents.”

  “So let me understand,” Noah said with mounting incredulity. “You never did an anesthesia residency?”

  “No,” Ava said. “I didn’t need to.”

  “What about the anesthesia boards?” Noah asked, his mouth agape. “Did you take them?”

  “Oh, yes, of course!” Ava said. “I took the boards and passed them with no problem. I even enjoyed them, as it was an affirmation of a lot of effort I had expended preparing for them.”

  “But to qualify to take the boards you must do a residency,” Noah sputtered.

  “That’s the usual prerequisite,” Ava said. “In my case it was different. I decided to skip the residency part as unnecessary and even exploitive. From my perspective, the residency is a way for the hospital to have people giving anesthesia for three to four years and paying them a pittance in comparison to what the hospital is charging for the service. And the supervision that they are supposed to get is often not all that great.”

  “How did you manage to be accepted to take the boards?” Noah asked. He was flabbergasted and wasn’t sure if Ava wasn’t still toying with him.

  “It was all relatively easy,” Ava said. “The critical event was moving from Brownfield to Lubbock when my dentist boss became dean of the new school of dentistry. As a founding faculty member, he had administrative status with the Brazos Medical Center computer. Using his log-in, I had full access. With my computer skills, it was not difficult to create an entire record for Ava London that matched the other anesthesia residents, complete with grades, evaluations, and letters of recommendation. What helped enormously was that the entire university and the medical center were growing geometrically. It was almost like a revolving door with new personnel, profiles, and résumés being uploaded daily. It also helped that the system had an almost nonexistent firewall, so I probably could have done it all without my boss’s log-in. But the log-in made it so easy. I was even able to insert pictures of myself with the real residents for the appropriate years.”

  Noah found himself nodding. He could remember seeing the photo of Ava with the 2012 resident photo. As astounding as all this was, he was beginning to think she was telling him the truth. “What about your name change?” Noah asked. “When did that happen?”

  “That didn’t happen until I had to take the U.S. Medical Licensing Examination,” Ava said. “That was when I needed the new identity. It was before I took the anesthesia boards.”

  “So people think that Gail Shafter still exists,” Noah said.

  “For sure. It was key,” Ava said. “Particularly my old boss, Dr. Winston Herbert, who is still dean of the Brazos University School of Dentistry. It’s why I keep a Facebook page in her name. Presently, she is working for a virtual dentist in Davenport, Iowa. I mean, at this point I suppose I could kill her off, but why? I enjoy contrasting my old life with the new. It makes me continuously appreciative of what I have achieved.”

  “Good Lord,” Noah said. His head was spinning. “Who got the M.D./B.S. degree, Gail or Ava?”

  Ava laughed. She was enjoying herself. “Of course it was Ava,” she said.

  Although Noah was surprised at this news, he recognized that he shouldn’t have been. “In other words, you didn’t go to medical school, either?”

&n
bsp; “Of course not,” Ava said. “Nor college, for that matter. That would have been a bigger waste of time than doing the anesthesia residency. I wanted to become an anesthesiologist. I didn’t want to waste time getting a general liberal-arts education, particularly not the kind you Ivy Leaguers think is appropriate.”

  “So that means you are not even a doctor,” Noah snapped.

  “That is a matter of definition,” Ava said. “I did take the USMLE as I said, and I did pass it with flying colors in the ninety-fifth percentile because I studied my butt off. According to the State of Massachusetts, I am a doctor. I have an M.D. license. They say that I am a doctor. I feel like a doctor, and I act like a doctor. I have the knowledge of a doctor. I’m a doctor.”

  “What about the degree in nutrition?”

  “Made up as well,” Ava said. “That was something I realized later that would come in handy. I just read about the field online.”

  Noah closed his eyes and ran his fingers through his hair. This was all so incredible he was having difficulty wrapping his mind around what she was telling him. “I’m not sure I believe all this,” he murmured.

  “Wake up, my friend!” Ava said. “Come and join the digital age in the twenty-first century! The basis of knowledge has changed. It is not hidden away any longer by professional societies, some more secret and restrictive than others. Knowledge of just about everything is now available online for everyone, not just the few who are lucky enough for whatever reason to go to the right schools. Even professional medical experience and expertise is available in simulation centers with computer-driven mannequins that are better in many respects to the real thing. With the mannequins, a student can learn to handle a problem by doing it over and over until it is reflex, like handling malignant hyperthermia. Most anesthesiologists have never handled a case of MH. I’ve handled seven, to be exact. Six with a simulator and one in real life.”