Almost immediately, Martha Stanley raised her hand to be recognized. Noah called on her.
“I couldn’t agree more,” Martha said. She then launched into a protracted self-reproachful statement of how it wasn’t enough to go through a list of questions just to check them off as she had unfortunately done when she had tried to speed Bruce Vincent through the process.
As Noah listened and occasionally nodded in agreement, he felt like running up the steps and giving Martha a hug. She was doing exactly what Noah and Ava had hoped someone would do—namely, chewing up the minutes on an issue everyone could agree on. Furtively, he glanced at his watch. There were only three or four minutes left before he could announce that the M&M was over. Already he saw a few people leaving who had been standing at the railing. He allowed himself to glance in Ava’s direction. For an instant they locked eyes. She flashed a brief thumbs-up, keeping her hand pressed against her chest so as not to be obvious. Noah nodded.
When Martha finished her monologue, a number of hands went up. Noah recognized a woman sitting to Martha’s immediate right.
“I agree with Martha,” the woman said. “But I think we should add to the list of what we ask. We always ask about whether they have eaten and if they have any allergies to medication and if they have ever had surgery and anesthesia, but we never ask if they have reflux disease. It seems to me that is an important piece of information.”
“I certainly agree,” Noah said. He then pointed to the person sitting on the opposite side of Martha who waved her hand insistently. Only then did he recognize who it was: Helen Moran, who had cornered him in that very pit after the welcoming ceremony. Noah’s heart skipped a beat as she began talking. He knew what was coming but couldn’t think of any way to stop it.
“Excuse me, Dr. Rothauser,” Helen said, “but I think you have left out an important aspect of this case that certainly could be used to memorialize Mr. Vincent. Isn’t this a prime example of the problems associated with concurrent surgery? My understanding is that Mr. Vincent was subjected to over an hour of anesthesia time before Dr. Mason showed up because he had two other people under anesthesia at the very same time. That’s atrocious. It would serve Mr. Vincent’s memory if concurrent surgery was eliminated here at the BMH.”
All at once the almost somnolent atmosphere of the room exploded in conversation. A few people even yelled out their opinion on the issue. Articles in the lay press, particularly The Boston Globe, had ignited the general public’s opinions either for or against, but on average mostly against.
Out of the babble, one nurse yelled out: “Dr. Rothauser. Is it true Mr. Vincent had to wait an hour under anesthesia?”
Noah raised both hands and fanned the air in an attempt to quiet the crowd. He avoided looking at Dr. Mason as he scanned the audience. “Please,” he said into the microphone several times. “Allow me to explain.” The effect was immediate, and for the most part the crowd settled.
“There was a delay,” Noah said. “Yet—”
He planned to say that the delay had no impact on the unfortunate outcome, but he was drowned out after Helen shouted: “I think an hour is more than a delay. If it had been me or a member of my family on that table, I would have raised holy hell.”
A number of people clapped. Nervously, Noah looked at his watch. It was now 9:00. Did he dare to conclude the conference under these circumstances? He didn’t know. Glancing back up at the restive audience, he saw that Dr. Hernandez had gotten to his feet and was climbing down into the pit. Noah gladly stepped from the lectern when the chief approached and indicated he wanted to speak.
“Let me say a few words,” Dr. Hernandez said over the commotion. He had to repeat the phrase several times before the audience finally calmed down enough for him to be heard.
While the chief of surgery was waiting to say a few words, Noah’s eyes scanned the audience to find Dr. Bernard Patrick, an orthopedic surgeon who had strong feelings against concurrent surgery. When their eyes briefly met, the man nodded. At least he was pleased the issue had been raised.
“I would like to say that I wish this last case had been the first case,” Dr. Hernandez said, causing Noah to wince. He couldn’t help but worry that the chief might guess the reason it was last. “Obviously, this tragedy has touched all of us here at BMH. The Surgical Department spent many hours looking at this case very carefully, as we do all deaths, but particularly so because the patient was a friend and colleague of ours. It is unfortunate that there was a delay in the arrival of the surgeon, Dr. Mason, but it is felt by all that the delay did not contribute to the unfortunate outcome and the cause of the delay was a legitimate complication elsewhere.
“The concurrent-surgery issue has been looked into with considerable care by the Surgical Department, the BMH administration, and by me, as well as the American College of Surgeons, and we will continue to do so. We strongly feel it is in the best interests of our patients but will be monitored. The Massachusetts Board of Medicine agrees but has demanded that our surgeons document when they enter and when they leave various ORs in situations requiring concurrent surgery. With that said, and since it is after nine A.M., this M&M Conference is adjourned.”
The audience immediately erupted into pockets of animated conversation as people got to their feet. Dr. Hernandez turned to Noah. “My sense is that you put the Vincent case last to limit discussion. Am I right?”
With his mind racing around for a noncommittal answer but not finding one, Noah guardedly admitted the truth. “I suppose that was the intent,” he said. “I knew emotions were high because of the patient’s reputation.”
“I don’t know whether it was clever or stupid,” Dr. Hernandez remarked. “I’ll have to think about it more.” With that said, he left the amphitheater.
Taking a deep breath, Noah turned to see if he could catch Ava’s eye. As upset as he felt at the concurrent surgery surfacing, at least he thought she’d be pleased that he had managed to avoid the whole anesthesia choice issue and any blame that could be directed toward her. But she was already on the stairs, heading away from him, on her way to the main exit on the upper level. It was at that moment that Noah saw Dr. Mason climbing down into the pit. For a brief second Noah considered bolting out the exit that Dr. Hernandez had used. But it was too late. Dr. Mason would have caught him one way or the other, so he stayed where he was.