Noah knocked on the open door and stepped over the threshold. Dr. Mason was dressed in a light blue seersucker jacket, a white shirt, a bow tie, and dark slacks. He was sitting at the small wall-mounted desk, typing on a keyboard. To his right was an exam table. Hearing Noah’s knock on the open door, he swung around and pointed to one of two generic molded plastic chairs. He didn’t say anything but rather tipped back and interlaced his fingers across his expansive chest. His expression was a half-scowl with pursed lips. Noah was not encouraged.
Taking one of the indicated seats, Noah faced his bête noire as he struggled to decide where to begin. The trouble was he was there because of protocol. He was expected to interview the involved surgeon as part of investigating the case. In reality, he didn’t expect to learn anything that he didn’t already know. “Thank you for seeing me,” Noah said, hoping at least to start out the discussion in a friendly, mutually respectful fashion. In the back of his mind he was hearing Ava’s characterization of the man. To Noah, her description of him as a serious narcissist seemed spot-on, meaning that under the circumstances there was zero chance for any reasonable interaction. Not only was the man presumably still furious at Noah’s outing of his reputed lover, he was clearly challenged by Noah’s work ethic and jealous of the kudos Noah was getting in the process.
When Dr. Mason did not respond or even change his facial expression at Noah’s pleasantry, Noah took a deep breath and pressed on: “I’ve gone over the Bruce Vincent record and have spoken with most of the people involved except you. What I’d like to ask is whether there is anything that you might be able to tell me that I might not know.”
“I suppose you saw there was no resident admitting note?” Dr. Mason snapped.
“I did,” Noah said. “And I know why. I spoke at length with Martha Stanley, who said—”
“Yeah, I know,” Mason interrupted. “The poor overworked bastard was backed up. Bullshit on that excuse.” Dr. Mason was now stabbing the air with a thick index finger. “He fucked up, plain and simple. I tell you, with the residents nowadays it’s amazing any of us senior men get anything done. When I was a resident that wouldn’t have happened, and we saw way more patients than you guys do today and were on call every other night.”
Noah was well aware that a number of the senior surgeons bemoaned how easy they thought the residents of today had it, but he resisted questioning the idea. Attempting to calm Dr. Mason, who was already riled, Noah said, “My understanding is that the lack of a resident H&P was a decision made by Ms. Stanley. The junior resident was totally unaware and didn’t even know that Mr. Vincent passed through Admitting.”
“Well, then it’s Ms. Stanley who is to blame. If the junior resident had done what he is supposed to do, all this wouldn’t have happened.”
“The requirement is that there needs to be an up-to-date history and physical, which was the case. Your fellow Dr. Kolganov had done one the day before that Ms. Stanley thought was adequate.” Noah thought briefly about bringing up the deficiencies of Kolganov’s H&P as a copy-and-paste job with after-the-fact doctoring but quickly decided against it. Dr. Mason was supposed to have been supervising the man’s work and was therefore ultimately responsible. Once again the blame would fall on Dr. Mason’s shoulders.
“Then the system has to be changed,” Dr. Mason barked. “Residents should see all surgical patients prior to surgery, particularly same-day surgery.”
“That can be a good subject for the discussion of the case,” Noah said.
“You bet your ass,” Dr. Mason agreed.
“Let me ask you this,” Noah said. “Did you see and examine the patient before surgery?”
Dr. Mason rocked forward in his chair with such suddenness that the chair squeaked in protest. “What the hell are you implying with a question like that? Of course I saw the patient before surgery. I see every one of my patients before surgery.”
“I’m not implying anything,” Noah said defensively. “I didn’t know how much of the pre-op process you delegated to Dr. Kolganov.”
“Rest assured, my precocious friend, I examine all my patients thoroughly. Especially since Dr. Kolganov was not going to be part of the surgery. He was needed elsewhere for one of my much more serious cases.”
“Then you were aware that Mr. Vincent had had some symptoms of bowel obstruction,” Noah said, ignoring Dr. Mason’s condescending remark.
“Of course,” Dr. Mason said. “It was even mentioned in the referral note from his GP. It was why we were doing the goddamned operation.”
“And yet you still favored spinal anesthesia?”
“I didn’t favor any particular anesthesia,” Dr. Mason snapped. “That is what anesthesiologists are for. They don’t mess around in my area of expertise during the surgery, and I sure don’t mess in theirs.”
“But your office requested spinal,” Noah said. He knew this issue was going to come up no matter what, and he had to know the details.
“On the few hernias I have done over the years, spinal was used. I’m sure that was what my secretary was conveying. It is still up to the anesthesiologist to determine what is best.”
“You may be right,” Noah conceded but held back what he wanted to say—namely, that anesthesiologists needed all the facts, which plainly were not available in this circumstance for a multitude of reasons, least of which was that Dr. Mason was not available for the pre-op huddle.
“What else?” Dr. Mason demanded. He had returned to tipping back in his chair, fingers again interlocked. His earlier anger had dissipated and the pursed-lipped scowl had returned.
“It seems to me,” Noah said, trying to organize his thoughts and be as diplomatic as possible, “the patient didn’t take his upcoming surgery as seriously as he should have.”
Dr. Mason laughed derisively. “That’s the understatement of the year. I heard he was forty minutes late to Admitting. The guy was working that morning. I saw him myself. He even parked my car. But worse yet, he ate a goddamn full breakfast and then lied about it. I tell you, you try to do a guy a favor and he kicks you in the teeth.”
“Was he informed of the seriousness of what he was facing?”
Dr. Mason tipped forward again and eyed Noah. Instinctively, Noah leaned back as much as his chair would allow.
“I told him I was going to operate on him,” Dr. Mason said slowly, emphasizing each word. “What went on in his pea brain, I have no idea. But listen, my friend. We are wasting time here. Tell me! Did you talk to Dr. Ava London, the uppity bitch?”
“Yes, I have,” Noah admitted, trying to maintain a neutral expression. Knowing what he did, he was appalled at Dr. Mason for calling Ava an uppity bitch.
“Well, she is the one mostly responsible for this catastrophe,” Dr. Mason snapped. “And to tell you the truth, I don’t know if she should be on the staff here at BMH. I don’t know if she is qualified.”
“She is board-qualified in anesthesia,” Noah offered.
“Yeah, well, I don’t know how good anesthesia boards are to let someone like her pass. I’ve never been all that impressed with Dr. London, nor have some of the other staff. I’ve tried to be nice to her, but there is some disconnect in her personality. Frankly, she is a cold fish.”