by Robin Cook
“They are ready for you now,” the secretary called out to Noah five minutes later, interrupting his musing.
Getting to his feet, Noah straightened his tie, took a deep breath, and walked over to the imposing, oversized doors of the boardroom. After another slight pause to take yet another deep breath, he entered. He was moderately surprised that only Dr. Cantor, Dr. Mason, and Dr. Hiroshi were seated at the expansive table. None of Noah’s resident colleagues were present. Noah’s heart skipped a beat. Maybe his optimism had been premature. He closed the door behind him and walked to the near end of the long, boardroom table. The three faculty members representing the executive committee of the Advisory Board were at the opposite end.
“Thank you for returning,” Dr. Cantor said. “Sit if you’d like.”
“I’ll stand,” Noah said. He looked at each of the men in turn. Dr. Mason refused to make eye contact, staring at his hands clasped on the table in front of him.
“By a unanimous vote of the Advisory Board with one abstention,” Dr. Cantor said formally, “it has been decided that you will be reinstated as the super chief resident.”
Relief spread through Noah with such suddenness he had to support himself by grabbing the back of the chair in front of him and leaning on it.
“However,” Dr. Cantor continued, “we want to make sure you understand how important we as medical educators feel about the central role ethics play in our profession. We want to make certain that you don’t feel that expediency can justify ethical lapses, and furthermore . . .”
Noah was no longer listening to Dr. Cantor. He was already absorbed in thinking about getting himself up to surgery to go over the surgical schedule for the morning to make sure the residents were appropriately assigned as assistants. Then he was going to tour the surgical intensive-care unit to familiarize himself with all the cases. Following that he was going to go to the surgical floor to do the same. The reality was that he had an enormous amount of work to do just to get acclimated back into the system . . .
“Dr. Rothauser,” Dr. Cantor said. “We’d like an answer to our question.”
“I’m sorry,” Noah said clearly flustered. “I’m so pleased to be reinstated that I am already thinking about all that I have to do to get up to speed. I didn’t hear the question. Could you repeat it?”
“The question is: Is there anything else of an ethical nature that you would like to reveal to the board? This current problem with your thesis surprised all of us coming out of the blue, and we don’t like surprises, especially involving our super chief, who we are considering offering a staff position.”
Noah stared back at the program director with his mind in a sudden turmoil. He wanted to say a lot, but how could he? He wanted to explain how difficult it was to be caught in a standoff with an industry he despised and a woman he thought he loved. The truth was that he was caught between the past and the future, between old-school ethics and the new reality of an ever-expanding technological and connected world where the real and the virtual were fusing.
“Well?” Dr. Cantor persisted.
“I don’t know,” Noah said, stumbling over his words.
“Dr. Rothauser!” Dr. Cantor said sharply. “That is hardly the answer we are looking for. What do you mean you don’t know?”
Noah audibly sighed, sounding like a balloon deflating. “Maybe I should sit down,” he said. Suddenly his legs felt weak. He pulled out the director’s chair directly in front of him and sat heavily. After a deep breath, he looked up, noticing that Dr. Mason was staring at him as intently as the others but with a slight smile of anticipation. Noah was painfully aware that time was passing, and each second was making the situation worse. He should have said “no” immediately and be done with it, but he couldn’t. The question had caught him completely unawares, upsetting the unsteady balance he’d been trying to maintain in his mind, sending it into tumult.
“Dr. Rothauser!” Dr. Cantor snapped. “Explain yourself!”
Noah cleared his throat as he struggled to regain control as an idea emerged from the fog of his addled brain. “This thesis situation surprised me as well,” he said haltingly but gaining confidence, “and it awakened an old fear that has dogged me since I was a teenager that something unexpected would happen to prevent me from becoming the best academic surgeon my abilities would allow. I had never thought about what I did with my thesis as an ethical issue, but now I can see that it could be considered as such, and I apologize for not having cleared the air on my own accord. But with that thought in mind, there is something else that is more clearly an ethical issue that I believe I should reveal to clear the air.”
“By all means,” Dr. Cantor said hesitantly with building concern and dismay. He’d never expected a positive answer to what he thought was a pro forma question.
“Once I bought a paper off the Internet, and after doctoring it, I presented it as my own work. I knew it wasn’t right, but it was in the very beginning of my freshman year of college, and I was under a lot of pressure to perform.”
Dr. Cantor’s face, which had hardened considerably from expecting the worst, suddenly softened. He was ostensibly relieved by Noah’s benign mea culpa. “That’s it?” he questioned with relief. “Early in your college career you bought a paper online?”
“That’s correct,” Noah admitted. “Others were doing it, too, but I know that is no excuse.”
After a quick reassuring glance at his colleagues, whom he judged were as relieved as he, Dr. Cantor assumed a knowing yet condescending smile. “Thank you for your forthrightness, Dr. Rothauser. Although we surely cannot condone plagiarism on any level, I believe we can all relate to the competitiveness we all had to experience early in our lengthy education.” He again glanced at his fellow board members to make sure he was speaking for them. Dr. Hiroshi nodded his head in obvious agreement.
“Any other issues besides this freshman-year paper, Dr. Rothauser?” Dr. Cantor asked, redirecting his attention at Noah.
“That’s the extent of it,” Noah said.
“Okay, fine!” Dr. Cantor said. With a satisfied expression, he sat back, extended his arms, and pressed his palms against the table. “It is good to clear the air. Thank you and welcome back! I know I can say with support of my colleagues, your services have been sorely missed.”
“Thank you, Dr. Cantor,” Noah said as he got unsteadily to his feet. For a split second, he allowed his eyes to dart in Dr. Mason’s direction. He could immediately tell that his erstwhile antagonist didn’t share Dr. Cantor’s contentment, yet under the circumstances he stayed thankfully silent.
Without another word or even a glance back at the residency program directors, Noah headed for the door on rubbery legs. He felt as if he had dodged a speeding train but needed to do something to control the anxiety that Dr. Cantor’s unexpected and open-ended ethical question had unleashed. Luckily, he had just the right antidote. He’d head up to the operating room as he planned and dive back into work.
3:10 P.M.
An eight-ton, intimidating, black Lenco BearCat armored truck with BOSTON POLICE stenciled on its rear panel lurched up onto the curb on School Street in downtown Boston and screeched to a halt. To the shock of several dozen tourists milling about the plaza in front of the refurbished, Old City Hall building, six heavily armed Boston Police SWAT officers, some carrying Colt CAR-15 submachine guns, leaped from the vehicle in a highly rehearsed and synchronized fashion and ran toward the entrance of the ornamental Victorian building. Despite the August heat, they were in long-sleeved black combat gear with military helmets and ballistic vests festooned with additional ammunition clips, flash bang grenades, and Tasers. All but one member of the team were wearing black balaclavas, making them even more sinister.
There was no hesitation or conversation among the group. There didn’t need to be. The operation had been planned to the T, with each knowing their position a
nd exactly what was expected. The first officer to reach the building’s outer door pulled it open as the others dashed within. He followed immediately on their tail.
Since they had already remotely shut down the elevators, they ran toward the main staircase and entered it on the run. Once inside, they rapidly climbed the stairs in step like a precision dance troop. They exited the stairwell one after the other on the fourth floor and stacked up single-file at the entrance of the ABC Security office. Instantly, the second officer in the line removed a door-breaching Thor Hammer strapped to the back of the first officer who then moved out of the way. The officer with the Thor Hammer stepped to the side and without a second’s hesitation swung the heavy hammer so that it hit the door adjacent to the doorknob with as much force as he could muster. With a shockingly loud splintering noise, the door burst open, allowing the next two men in the stack to rush into the room, sighting along their Colt submachine guns with fingers curled about the triggers as they shouted “police arrest warrant.” The first man took the right side of the room as his area of concentration, the second man the left as they executed a classic SWAT dynamic entry. Two more officers followed immediately on the tail of the first two while holding Glock automatic pistols out in front of them in both hands.
There were three totally stunned people in the room. George Marlowe was sitting on a couch to the right of the entrance, using a PC laptop. Keyon Dexter was standing at the window, gazing out over the Kings Chapel Burying Ground with his hands in his pockets. Both had removed their suit jackets and had their sleeves rolled up. Charlene Washington, a temp, was at a desk to the left.
“Down!” yelled the first officer into the room, keeping his Colt trained on George. He knew the second man into the room was doing the same for Keyon. “On the floor, now! All of you! Hands extended!”
George and Keyon recovered quickly, their highly trained military minds rushing through the OODA loop of “observing, orienting, deciding, and acting.” But it was to no avail. In the split second it took to recover their senses, there was no time to act. Resignedly raising their hands, they obeyed the repeated shouts to lie on the floor. It was different for Charlene, who was frozen in place, paralyzed by fear as she stared into the barrel of a Glock pistol.
The two officers who had been responsible for breaching the door and the last to enter the room now came forward and quickly handcuffed Keyon and George as they lay facedown. Once the prisoners’ hands were secure, the same two policemen removed the weapons from the prisoners’ shoulder holsters and their mobile phones and fake FBI badges from their pockets. Once that was accomplished, they hauled the two men to their feet. No one said a word. Only then did the officers with the Colt submachine guns remove their fingers from the triggers and lower their weapons.
The commander of the high-risk-warrant service team and the first person to enter the room stepped forward. He was also the only one not wearing a black balaclava. After handing off his Colt rifle to a colleague, he proceeded to pull out a tattered 3x5 card inscribed with the Miranda Rights. Stepping up to Keyon Dexter, he addressed him with his full name, and informed him that he was being arrested for the murder of Roberta Hinkle of Lubbock, Texas, kidnapping, and for impersonating a federal officer. Moving on to George Marlowe, he repeated the charges. When he was done with the arrests, he read both men their Miranda Rights.
Stepping back from the prisoners, the SWAT team leader purposefully fell silent while eyeing the two handcuffed men. As was often the case during an arrest, prisoners frequently said incriminating things as a normal reaction to the stress of the situation even after being informed of their rights to remain silent. But it wasn’t to be. Keyon and George were professionals and trained to remain silent, knowing full well that ABC Security would have formidable lawyers on the case within hours of learning of their arrest. They were not intimidated by being arrested, since they were certain they would be quickly out on bail.
AUTHOR’S NOTE
The profession of medicine has always had a problem with charlatans, and there have been quite a number of infamous cases in which the perpetrators literally “got away with murder” after assuming the identity of a real doctor who had either died or moved to another state. Now that the world is engulfed in the digital age, the situation is getting worse and accelerating because of the vulnerability of databases, which make it possible to augment curriculum vitae or even create them completely de novo. Such hacking activities trump the old-fashioned need for identity theft. Compounding the problem is the easy availability of specialized professional knowledge on the Internet, as well as the training potential of virtual reality programs combined with modern simulation systems composed of remarkably realistic, computer-driven mannequins that precisely mimic human pathophysiology and response to treatment. The consequence is that the difference between the physician and the motivated non-physician in terms of apparent basic knowledge and know-how will progressively narrow, effectively blurring the line between the real doctor and the fake.
The origin of the term “charlatan” comes from sixteenth-century French, and it initially referred to a medical quack, although its meaning expanded to include all imposters. Today the word is garnering new significance and meaning. With social media exploding around the world (currently the number of people using Facebook alone is approaching two billion) and the fact that it is estimated that more than 75 percent of the people using Facebook lie to “airbrush reality,” there are a lot of new charlatans of varying degree. In a very real sense, being an imposter on some level is rapidly becoming the norm. Indeed, it is generally estimated that 5 to 10 percent of Facebook’s almost two billion accounts are “sockpuppets” or fake, online charlatan profiles. Others believe the percentage is significantly higher. Of course, such a situation is hardly surprising considering the attraction. Psychologists think of social media as a virtual-playground for a culture that is becoming progressively narcissistic. The inherent lack of the usual social restrictions of face-to-face interactions creates a dissociative anonymity devoid of any meaningful reprisal, while offering the potential of unlimited and continual egotistical affirmation and gratification. People can be whoever they want to be and say whatever they want to say for whatever reason with both harmless and not-so-harmless consequences even to themselves. It is a “brave new world,” and it is evolving rapidly.
Members of the medical profession are no exception in the use of social media, including Facebook, Twitter, Instagram, Snapchat, various dating sites, and other sites. They too fall prey to its allure and pitfalls. Surveys have shown that more than 90 percent of physicians are using it for personal reasons and a lesser percentage for business purposes. This personal use has not been without consequence. More than 90 percent of State Medical Boards have received complaints of inappropriate online behavior by physicians while using social media, and there have been episodes of disciplinary action.
Like society in general, the medical profession is in a state of rapid change due to digitization and associated technologies. No longer is it the major source of medical information for the public since that role has been co-opted by the Internet. A few years from now the entire paradigm of the practice of medicine will change from hospital-centric sick-care that began in the nineteenth century to patient-centric personalized preventive-care built around continuous real-time monitoring and treatment algorithms, and it will take place mostly in the home, workplace, and ambulatory care centers, not in pricey and dangerous hospitals. In response to this tectonic shift due partially to the pressure of runaway costs of healthcare, medical education will have to be dramatically altered to remain relevant, especially since it is one of the most conservative professional pedagogies. The current expensive, long drawn-out, overly competitive path of four years of college, four years of medical school, and up to seven years of hospital-based residency, all of which was instituted in 1910 and hasn’t changed much since, will have to be drastically updated. The no
vel Charlatans presages the need for such a change. And on a lighter note, the novel also begs the question: Did your doctor truly get the training he or she so ostentatiously advertises with all those easily reproduced diplomas hanging on the office wall?
ACKNOWLEDGMENTS
I would like to acknowledge my extended family and friends, who are always willing to offer opinions and honestly critique drafts. Thank you all for your invaluable help and support.
SELECTED BIBLIOGRAPHY
Asch, David A., M.D., and Debra F. Weinstein, M.D. “Innovation in Medical Education.” The New England Journal of Medicine 371 (2014): 794–795.
Diller, Vivian, Ph.D. “Social Media: A Narcissist’s Virtual Playground.” The Huffington Post, March 23, 2015.
Offit, Paul, M.D. “How Lobbyists Will Keep You Hooked on Vitamins.” The Daily Beast, December 21, 2013.
Sales, Nancy Jo. American Girls: Social Media and the Secret Lives of Teenagers. New York: Vintage, Reprint edition, 2017.
Sass, Erik. “People Believe Their Own Lies on Social Media.” MediaPost, December 29, 2014.
“You’re Losing Your Rights to Buy Natural Vitamins” (featuring Mel Gibson), YouTube, 1993..
ABOUT THE AUTHOR
Robin Cook, M.D., is the author of thirty-four previous international bestsellers and is credited with creating and popularizing the medical thriller genre with his wildly successful second novel, Coma. His most recent bestsellers include Host, Cell, Death Benefit, and Cure. He divides his time among Florida, New Hampshire, and Massachusetts.
