The final act of dressing before heading off to the hospital involved his white pants and white jacket, both of which he was known to change several times in the same day, taking advantage that they were cleaned and pressed by the hospital laundry. When he was fully ready, with his computer tablet in his side pocket, he checked himself in the mirror that hung in the living room. The mirror had belonged to Leslie, and why she had left it she had never explained, nor had he asked. Otherwise, the living room was almost as stark as the bedroom. The furniture consisted of a small threadbare couch, a coffee table, a floor lamp, a folding card table with two folding chairs, and a small bookcase. An elderly laptop sat on the card table as the sole remnant of his teenage love of computer gaming. The only wall decorations in the room were a simple brick mantel painted white and the mirror. Like the bedroom windows, the living room windows were bare. They looked out onto Revere Street and the typical Beacon Hill brick buildings opposite.
When Noah exited his building, it was only a little after 5:00 A.M. On a normal day, when he didn’t take the time to shave, he always left before 5:00, proof of the efficiency of his morning routine. This time of year, it was a pleasant temperature outside and nearly full daylight, although the sun itself had yet to rise. In the winter, it was another story, especially on snowy mornings. Yet he liked the walk in all seasons, as it gave him time to think and plan his day.
His usual route took him to the left, heading farther up Beacon Hill, which was a real hill and not just the name of the neighborhood. At Grove Street, he switched over to parallel Myrtle Street and continued climbing. As was fairly typical, Noah saw no other pedestrians until he crested the hill, at which time, as if by magic, people materialized, mostly dog walkers and joggers, although a few commuters appeared, too. As he passed the Myrtle Street playground, he was showered with the sounds of summer. Even though he was in the center of a major city, the bird population was considerable and the air was filled with chirps, trills, tweets, and warbles.
As he walked, Noah couldn’t keep from fretting about the damn M&M. Why it bothered him so much was his abiding fear of authority figures such as principals, college or medical school deans, influential teachers, and powerful surgical faculty members. In short, it was anyone who had the power to derail his strong urge to be a consummate academic surgeon. He’d always known it wasn’t a totally rational phobia, since he had been a top student from eighth grade on, but such an understanding didn’t reduce his anxiety. He’d had a fear of authority figures throughout his schooling, but it had ratcheted up in both college and medical school and had even gotten worse during his residency, especially after it had been hugely reawakened when he had been blindsided during his second year.
The unexpected irony for Noah was that his total 110 percent commitment to his surgical residency had not been without problems above and beyond the social sacrifices in relation to Leslie. With a certain amount of dismay, after his first year as a resident he came to realize that there were attendings who thought of him as overzealous, particularly the more openly narcissistic surgeons, such as Dr. William Mason. The super chief at the time, Dan Workman, took Noah aside to explain that it might be better for Noah to rein himself in to a degree. Without naming specific people, he said that there were faculty who thought of Noah as a little too good, too ambitious, and getting far too much acclaim and needing to be humbled.
Noah had been shocked until he came to understand where the animosity was coming from. As a first-year resident, Noah had started interfering with a certain surgeon’s private cases because of his attention to detail. By his thoroughness, he had the uncanny ability to discover additional problems when he did routine admitting history and physicals. These discoveries not only got a number of cases canceled but also suggested that the original workup had been incomplete or sloppy, a fact that certain attendings were not happy to learn and had advertised. In many ways, it was yet another example of blaming the messenger.
At first Noah had just dismissed the problem, since he felt confident he was putting patients’ needs first, which a doctor is supposed to do. If anything, the criticism spurred him to even greater efforts until he was taken down a peg. With his degree of commitment to excellence and patient care as evidenced by his effort and thoroughness doing routine admitting histories and physicals, Noah spent way too much time in the hospital. He was always there, always available, even when he wasn’t on call. Whenever a fellow resident asked him to cover, he always agreed. He didn’t even take a day off until literally ordered to do so by the super chief.
Noah knew full well his behavior was in constant violation of the work limits imposed by the Accreditation Council for Graduate Medical Education, known as ACGME, yet he felt the rationalization for the limitations in terms of patient safety did not apply to him. He needed little sleep, rarely felt tired, and, in contrast to more than half the other residents, wasn’t married and didn’t have children. At the time, he thought Leslie understood and was supportive.
Eventually someone brought Noah’s work ethic to the attention of Dr. Edward Cantor, the surgical residency program director. The result was a personal warning, which had a mild effect on Noah for a few days before he switched back to his usual schedule. Then, as Noah would say, the shit hit the fan. On two occasions, he was hauled before the Residency Advisory Board, which was particularly embarrassing since he sat on the board, as voted by his fellow residents, and hence had to recuse himself. On the first occasion, he got another warning and was told that his behavior would put the hospital’s total graduate medical education program in jeopardy if the media were to get wind of it.
For a few weeks Noah tried to restrain himself, but it was difficult. For him, being in the hospital was like an addiction. He couldn’t stay away. Three weeks later, Noah was back in front of the Residency Advisory Board, whose faculty members were furious. To Noah’s absolute horror, on this occasion he was threatened with dismissal and told that from then on he was on probation such that a third violation would result in his walking papers.
Noah had indeed been taken down a notch. From then on he proceeded with extreme care and devised all sorts of inventive strategies, such as signing out from the hospital and leaving from one door only to enter another. Luckily, as time passed, the threat of dismissal lessened. By the time he finished his third year, he began to ease up on all his machinations of eluding attention because senior residents were not followed as closely as junior residents. As for a vacation, he hadn’t taken one and no one seemed to have noticed.
Now it was 5:26 A.M. when Noah entered through the main entrance of the Stanhope Pavilion. As he always did, he felt a shiver of excitement just coming through the door. Every day was a new experience; every day he saw something he’d never seen before; every day he learned something novel that would make him a better doctor. For Noah, arriving at the hospital was like coming home.
2
SATURDAY, JULY 1, 5:26 A.M.