With a kind of rolling gait because of his girth, Mason bore down on Noah. His heavy face was set in his typical scowl. “You are your own worst enemy, Dr. Rothauser,” Mason snapped when he came up to Noah, crowding him and forcing Noah to take a step back. “I warned you not to skew the facts, which you most certainly did. You didn’t even mention that Anesthesia gave the wrong fucking anesthesia, a key point in the whole case. Who the hell are you protecting and why?”
“I’m not protecting anyone,” Noah said, knowing he was lying. “Least of all the patient, despite his popularity. He was the one mostly responsible for what happened, and I made that very clear. I also talked about the Admitting people and their role. Those are the two parties that you brought up to me when we spoke.”
Dr. Mason cocked his head to the side, looking at Noah askance and twisting his face into a wry smile. “You’re a goddamn liar. When we talked about this we were standing right here in this pit and then in my clinic office. I said specifically that Anesthesia screwed up plain and simple on both occasions. That’s what I said. Then I added something about the patient and Admitting, but it was Anesthesia’s fault, stupid, and this death should have been an anesthesia death, not a surgical one!”
“I did the best I could,” Noah said. He didn’t know what else to say. He had the sense that if he apologized, it wouldn’t help and would maybe even make things worse.
“Bullshit,” Dr. Mason snapped back. “Worst of all, you let the discussion disintegrate into the concurrent-surgery issue, something I specifically warned you not to do. If this thing blows up again around here, I’m going to hold you responsible, and you are out of here. You understand what I’m saying?”
“I think so,” Noah croaked.
“You know what really irks me about you is that you are one of those holier-than-thou, prissy snobs who thinks he is better than everybody else, like Meg Green, for instance, one of the best goddamned residents we had around here. You got her busted because she was taking Oxycontin for her shoulder.”
“She was abusing it,” Noah said.
“So you said,” Dr. Mason said, lowering his voice. “You are on thin ice, my friend. Just keep that in mind.”
13
WEDNESDAY, JULY 12, 2:10 P.M.
After using a disposable nail cleaner and tossing it into the toe-operated waste can, Noah began to scrub his hands for his final scheduled case of the day. He was with his assistant at the scrub sink between operating rooms 18 and 20 with a hood and surgical mask in place. He had been in 18 since coming up to the OR after the M&M Conference and had been busy and efficient. Already he’d completed a colectomy, or the excision of a portion of the large intestine, a removal of a benign but sizable liver tumor, and a hemorrhoidectomy. The first two patients were doing well and back in their respective rooms. The only one who wasn’t was the last case. He was still in the PACU, or post-anesthesia care unit, but he had been cleared to leave and was only waiting for a bed to become available on the general surgical floor. The next and final case on Noah’s schedule was a breast biopsy with a possible full mastectomy, depending on the results of the biopsy.
As the day had progressed, he’d felt better. Noah loved being in the operating room. With his natural technical ability and confidence, it was in the OR that he felt the most at home. It was his sanctuary where everyday concerns faded. Although the interaction with Dr. Mason after the M&M had been unnerving, it could have been worse. His warning was contingent on the concurrent-surgery issue blowing up again, but the chances of that happening, in Noah’s estimation, were close to nil. As Dr. Hernandez had mentioned in his short speech that morning, the matter had been fully vetted by the BMH hierarchy, the Massachusetts Board of Medicine, and even national surgical organizations, despite a number of patient advocate people being emotionally against it. What was clear to Noah was that the sticking point in his relationship with Mason was Meg Green’s departure and Noah’s role in that regrettable episode.
“I enjoyed the M&M Conference this morning,” Mark Donaldson said, interrupting Noah’s thoughts. Mark had been tapped to help Noah for the upcoming case. On the previous three cases that day, Noah had been assisted by one of the new first-year residents, but since she was scheduled for clinic starting at 3:00 P.M., Noah had called on Mark to come up and relieve her.
Over the previous week and a half, Noah had made it a point to assign the new residents to assist him in surgery so that he could evaluate their skills. So far he’d been exposed to a third of the group and was pleased with their performance. There was no doubt in his mind that they were a solid, talented bunch, which boded well for Noah’s tenure as the super chief. Often it was the new crop of residents who gave the super chief the most headaches as they adjusted or didn’t adjust to the demands of the program.
“I appreciate you telling me you enjoyed the conference,” Noah said, continuing his scrub. It was the fourth time he had done it that day, but he remained compulsive about following protocol, just as he did with everything else in medicine. But with hand washing he was particularly careful. The specter of postoperative infections was Noah’s biggest worry. He did everything possible to avoid them.
In between his surgeries, Noah had kept an eye out for Ava, surreptitiously, so as not to call attention. He certainly wasn’t about to ask anyone about her whereabouts. When he didn’t happen to run into her, he checked the scheduling monitor. When he didn’t see her name, he checked out the Anesthesia schedule. It was there that he learned why she wasn’t on the surgical monitor. It was her turn to supervise anesthesia residents and nurse anesthetists in rooms 6, 8, and 10. This kind of supervisory role was done on a rotating basis among all the staff anesthesiologists except the chief, Dr. Kumar.
Noah had no intention of talking with Ava even if he ran into her, for fear of starting rumors. Janet Spaulding, the OR supervisor, had an uncanny ability to be aware of everything that was going on in the department, professionally and otherwise. It hadn’t been a coincidence that she had come over to chat when she had noticed Ava and Noah sitting together in the surgical lounge the previous Friday.
Just before Noah had started scrubbing for this final case, he managed to catch a glimpse of Ava by glancing into OR 10 as he passed by. Although it had been a fleeting glimpse, he was certain it was she, standing behind a nurse anesthetist who was busy intubating a patient. Noah doubted that she had seen him. For a host of reasons he was eager to see her that night, especially to get her take on the M&M. He was certain she had to be pleased.