“I gather you specifically asked him if he had had anything to eat.”
“Absolutely. No question. I always do. He lied to me, that is clear. The question is why, because it had to be deliberate, meaning it wasn’t as if he just forgot not to eat. If I had to guess, I’d say it was because he thought he knew more than he did.”
“I don’t follow.”
“He was a bit anxious about being late when I reminded him Mason could be a bear about waiting and that Mason had two big pancreatic cases that morning besides his hernia repair. But about his surgery, Mr. Vincent was cool as a cucumber and mentioned he was scheduled for a spinal, which is why I believe he thought he could get away with eating whatever he wanted. I think this is an example that a little learning can be a dangerous thing. My sense is that Mr. Vincent thought he knew enough about anesthesia to game the system.”
“You might be right,” Noah said with a nod. He wasn’t going to try to guess what was on Bruce Vincent’s mind that fateful morning. Yet what Martha was saying made a certain amount of sense, even though Noah believed for a patient to have a full meal before any surgery was suicidal. “What about reflux disease? Did you ask him about that?”
“I didn’t. Nor do I generally ask patients about reflux symptoms. Maybe I should, but I think that’s an issue for the anesthesiologist to ask so they can gauge the degree.”
“Perhaps,” Noah said, being noncommittal. It wasn’t something he’d thought much about, yet it might be a good issue to bring up at the M&M to keep the discussion away from more problematic areas.
“Did you know that Bruce Vincent was working in the hospital parking garage the morning of his surgery like it was a normal day for him? I saw him myself.”
“I didn’t know that,” Noah said.
“That’s why he was late,” Martha said. “Supposedly, he had to solve a personnel problem because one of the parking attendants didn’t show up. Can you believe it?”
“I can’t,” Noah admitted. The case was becoming stranger by the minute, as most people were understandably intimidated the morning of their surgery. “Well, thank you for your time. If you think of anything else before Wednesday, please let me know.” He stood up.
“Okay. And good luck. I have a feeling this case is going to raise some hackles.”
“That’s my worry, too. Are you planning on attending the M&M Wednesday morning?”
“I wouldn’t miss it. I think it’s going to be a full house. At least that’s the general word. People are very upset. He was a popular guy.”
“Great,” Noah said, and moaned. He could feel his anxiety ratchet up a notch.
From Martha’s office, Noah walked into the area where patients changed out of their clothes and into patient garb. He again talked briefly with Helen Moran and learned nothing new, although he was reminded she was the one who marked Vincent’s right hip to avoid an operation carried out on the wrong side. With the way things were going, Noah thought that operating on the wrong side might have been the only way that the case could have been worse than it was.
In the pre-anesthesia section Noah searched for Gloria Perkins and Connie Marchand. Gloria was off for the day, but he did get to talk with Connie. She told him that she had asked Vincent all the usual questions, as Martha and Helen had, including if he had been NPO since midnight, meaning nothing-by-mouth.
“I assume he denied eating?” Noah said.
“Absolutely,” Connie said.
“Anything I should know that you didn’t write in the EMR?” Noah asked.
“I don’t think so,” Connie said. But then she corrected herself. “Come to think of it, I didn’t mention in my note that we had gotten several calls from the OR asking where Mr. Vincent was, and each request was accompanied by a friendly reminder that Dr. Mason doesn’t like to wait.”
“Martha Stanley got the same call. Is that typical?”
“Put it this way: It is not atypical for the OR to check on what was going on if a patient is significantly late. It just doesn’t happen very often, because patients are rarely late.”
“Then why did you mention it to me?” Noah asked.
“Only because I heard through the grapevine that Dr. Mason ended up keeping the patient waiting for an hour with the spinal in place. Personally, I don’t think that’s right, and I know a lot of other people feel the same, especially after the OR had called over here looking for him.”
Noah felt another unpleasant uptick of anxiety. The case was definitely morphing into an argument against concurrent surgery, which was going to irritate the hell out of Dr. Mason and a handful of other top surgeons, and Noah knew all too well who was going to suffer the consequences.
7
FRIDAY, JULY 7, 3:05 P.M.
After donning a surgical hat and mask, Noah walked from the pre-anesthesia holding area directly into the OR to check the main OR scheduling monitor that listed the day’s surgeries. Each entry had the estimated or actual start time, the patient’s name, the procedure, the surgeon, the anesthesia person, the scrub nurse, and the circulating nurse. When the surgery was completed the color changed from blue to yellow.
Noah’s goal was to find Dr. Ava London to see if he could speak with her when she finished for the day, which he knew was around 3:00. Although most of the anesthesiologists made it a point to hang around for a time after their shift to socialize in the surgical lounge, he had never once seen her participate during the entire five years he’d been a resident, which he knew happened to be nearly the same amount of time Dr. London had been on staff. Although she was always friendly when they worked on a case together, which had probably happened some fifty times over the years, he thought of her as consistently reserved and private, qualities that Noah respected because he thought of himself as being somewhat similar. Like Ava, he had never availed himself of the surgical-lounge chitchat sessions, even though most of the other residents did. Noah felt uncomfortable talking about his social life because he didn’t have one, though he suspected there was a big difference with Dr. London. With her constant tan even in the dead of winter, which she always politely refused to explain or gloat about to anyone, and the fact that she was lean and fit, Noah assumed she had a particularly active life outside of the hospital.