“He certainly did. Actually, considering everyone involved in this case, Dr. Mason might be the angriest at the patient. He described him as having a ‘pea brain’ despite the man’s beloved employee reputation around the hospital. Deep down, Dr. Mason certainly knows it was the patient’s fault by eating a full breakfast and lying about it. But Dr. Mason also faults Admissions for not being more aggressive and finding it out.”
“All right,” Ava said, suddenly motivated. “Let’s talk specifics.” She sipped her wine and then took a bite of her dinner. “I’ve given this situation a lot of thought since yesterday evening,” she said. “First off, I think you have to understand it will be counterproductive to get into any kind of argument with this man, because if he gets mad, we can both lose. You are going to have to present the case with that restriction in mind.”
“Easier said than done,” Noah responded. “He got mad this morning, and I was trying to be as diplomatic as I could.”
“So what did he get mad at? Let’s analyze it.”
At that moment Ava’s mobile phone chimed, indicating she was getting a call. She picked up the phone, noticed who was calling. Immediately she pushed back from the counter. “Sorry,” she said to Noah. “I’ve got to take this.”
“Quite all right,” Noah said. He watched her leave the room, vaguely wondering who could be calling after nine on a Saturday night. For him it would have been easy to guess: the hospital. But he knew Ava was not on call. Noah toyed with his food, thinking it was impolite to eat without her. In the distance, he could just barely hear her voice, although at one point it became decidedly louder, as if she were angry.
After about five minutes Ava returned, placed her phone facedown on the counter, and climbed back onto her seat. “Sorry about that,” she said. “I know taking calls makes me a less-than-perfect hostess. But what can you do? Silly business sometimes interferes.”
“Is everything all right?” Noah questioned.
“It’s fine,” Ava said, with a wave of her hand. She smiled reassuringly. “Now, where were we?”
“You were asking what Dr. Mason got mad at when I spoke to him this morning.”
“Right. So tell me!”
“I’d have to say he got the maddest when he was talking about the lack of a resident history and physical because the resident was backed up. Dr. Mason is one of those old-school surgeons who is convinced we residents today have it easy while he and his contemporaries worked themselves to the bone.”
Ava nodded. “I know the type. But it is interesting that he would zero in on that issue. I think that is important to remember. What else did he get mad at, specifically?”
“When I questioned him if he had personally examined the patient.”
Ava laughed. “Knowing what we do about his temperament, are you surprised such a question made him angry?”
“I suppose not,” Noah admitted, smiling in the face of Ava’s laughter. In retrospect, he lambasted himself for not being more circumspect. He should have worded the question to Dr. Mason differently so it wouldn’t have been interpreted as being critical. When dealing with a narcissist it is crucial to avoid any suggestion of blaming. “I was trying to be diplomatic but failing.”
“I’d say!” Ava responded. “Tell me this: Did he bring up again any nonsense of you being responsible for the death since you put the patient on bypass?”
“No, he didn’t.”
“At least that’s reassuring,” Ava said. “I’m starting to get an idea of how you should present this case.”
“Really?” Noah questioned. He sat up straighter. She was impressing him again, and he was eager to hear what she had in mind.
“Keeping him from getting mad is going to be key,” Ava said. “That’s number one. Number two, you have to steer the discussion away from the concurrent-surgery issue. That’s mainly for your sake. And number three, you have to avoid the issue of Anesthesia, meaning me, supposedly making the wrong decision about spinal versus general anesthesia.”
“That’s easier said than done,” Noah complained. “The facts are facts. I can’t change them.”
“What you will have to do is keep away from the troublesome facts. For instance, there is no reason to mention that the patient had been under anesthesia for an hour or more. As bad as that was, it didn’t contribute to the death. Instead, emphasize the two points Dr. Mason is most emotional about—namely, the lack of a resident H&P and that the patient ate a breakfast that Admitting didn’t uncover. If you are clever and mildly verbose, those two issues could be an hour discussion in and of themselves. Tell me! How many cases are scheduled for the conference?”
“Five so far,” Noah said. “There could be more.”
“Perfect,” Ava said. “Listen! Save Vincent’s case until last. Since the M&M has to be adjourned in an hour and a half without fail since surgery is scheduled and everybody has to get to the OR, you can run out of time. What do you think?”
Noah toyed with his food while he pondered Ava’s suggestion. The more he thought about it, the better he liked it, because it could work. The scheduling of the presentations was totally up to him. He had initially thought of doing the Vincent case first since there was so much interest in it, but there was no reason he couldn’t do it last, and if no one knew it was going to be last, no one, like Dr. Hernandez, could complain and try to change it. There was a good chance that whatever the discussion was, it could be prematurely terminated.
“I think you have some good points,” Noah said.
“I do, too,” Ava agreed. She picked up her wineglass and motioned with it toward Noah. They clinked glasses. “We have a few more days to plan, but I think we’re making headway. To your success!”
—
AFTER GETTING the serious stuff out of the way, Ava and Noah switched to more lighthearted banter as they finished their dinner and cleaned up the plates and flatware. Ava dominated the conversation, since she was full of stories about her recent travels and athletic episodes, such as her latest bungee-jumping excursion. Noah had been amazed to hear that she had flown all the way to New Zealand to do it, although she also used the trip to scuba-dive in shark cages off the southern coast of Australia. Noah was fascinated but also intimidated, as it made his life seem all that more insular and hospital-bound. The last trip he had taken had been more than two years ago, and only to New York City. He’d gone with Leslie to see a play, and only for a single Saturday night. At the time he had been reluctant to go, since he had several patients he’d operated on in the hospital. Although he had arranged for people to cover for him, it didn’t seem right, since he couldn’t help but put himself in his patients’ shoes.
“How about we head up to the study and relax?” Ava offered when the kitchen was back to spic-and-span. “We can have a cordial if you’d like.”
“Thank you, but I think I’ll pass on the cordial. Sorry. Two glasses of wine are enough for me.”
“Hey, don’t be sorry. I’m impressed with your self-restraint. Your dedication is awe-inspiring. I’d want you to be my doctor any day.”