As he trudged up Pinckney Street on his way to Louisburg Square his thoughts went back to his busy day, which had included several important conversations that he was eager to share with Ava. After the run-in with Dr. Mason, which jolted him into remembering exactly how close the M&M Conference was, he first made it a point to investigate which junior resident had been assigned to the emergency room on that particular day. It was Dr. Harriet Schonfeld. He’d found her in the ER sewing up a laceration. He was pleased with what he had learned from her and looked forward to telling Ava.
Next Noah had met with the anesthesia resident, Dr. Carla Violeta, plus the circulating nurse and the scrub nurse on the Gibson case, but he didn’t learn anything from the three of them that he didn’t already know. Finally, following Ava’s encouragement the night before, he had arranged to meet with Dr. Warren Jackson, which he dreaded and had put off just as he had put off meeting with Dr. Mason before the last M&M. As an older surgeon who had trained at the same place Dr. Mason had trained, Dr. Jackson shared some of Dr. Mason’s unpleasant narcissistic traits, in particular an easily offended, arrogant attitude and a stubborn reluctance to accept any blame, even if warranted. To his surprise, Noah had found Dr. Jackson much more reasonable than Dr. Mason.
Ava was particularly happy to see Noah when he finally rang her bell and got buzzed in. It was nearly 10:00 P.M., and she admitted to being starved when Noah found her in the kitchen. She had opened a bottle of wine and had already drunk a quarter of it while she’d used her iPhone to go on Facebook while she waited. Noah apologized for being kept at the hospital because of a late-afternoon emergency.
They ate at their usual location, looking out at the garden. Noah was eager to tell her what he had learned but had to bide his time while she told him about several demanding cases she’d had that day that had required more anesthesia skill than the usual. Noah was impressed with how she had handled them. Her encyclopedic knowledge of anesthesia rivaled his command of the minutiae of surgery. After dinner they ended up in the study as per usual. Noah had come to understand why it was her favorite sitting room in the house. It was rapidly becoming his as well. Almost like Pavlov’s dogs, each took the exact same chair they’d occupied on previous evenings, as if responding to some internal directive.
“Okay, your turn,” Ava said, realizing how much she had been dominating the conversation. “Sorry for carrying on.”
“Not at all,” Noah said. “I’m intrigued by your command of your field.”
“I’ve had superb training,” Ava said, pleased.
“I have some good news and some bad news,” Noah said. “Which do you prefer first?”
“Let’s get the bad out of the way so we can rest on the good.”
“Unfortunately for me, I ran into Dr. Mason in the OR hallway,” Noah said. “He cornered me as usual and mouthed off with a complaint about the assistants I’ve been assigning him, which is all a bunch of nonsense. But more important, he warned me not to shield you during this M&M like he feels I did during the last M&M.”
“He said that specifically?” Ava questioned.
“Very specifically,” Noah said, “using the exact same words.” Noah did not add that Dr. Mason had referred to her as “your lover.” “He also remarked that he’d been muzzled at the last M&M, which wasn’t going to be the case this time.”
“Okay, that’s the bad news. What’s the good?”
“My meeting with Dr. Jackson wasn’t anything like I expected,” Noah said. “He actually admitted that he’d made a mistake pressuring the first-year resident into starting the case before you were in the room. He said he’d come to the realization after giving the episode more thought.”
“That’s terrific,” Ava said, her face lighting up. “Do you think he might be willing to say something to that effect at the conference?”
“I think so,” Noah said. “I also talked with Dr. Violeta.”
“I know,” Ava said. “She told me.”
“She’s willing to confirm being pressured,” Noah said. “So I won’t mind bringing it up.”
“You’ll have to bring it up,” Ava said. “It has to be established that I wasn’t in the room when the patient was given the paralyzing drug and had already arrested. Both are key.”
“You are right,” Noah agreed. “I’ll definitely mention it.”
“This is good news,” Ava said. “I feel better already about this M&M.”
“And I got more significant news today,” Noah said. “I talked with the junior surgical resident who handled the case in the ER. When I told her that the neck problem wasn’t in the electronic medical record, she was astounded and insisted that she had included it.”
“It wasn’t in the EMR,” Ava snapped. She sat up and moved forward in her chair, ready to do battle.
“It was, and it wasn’t,” Noah said. He reached out and put a calming hand on Ava’s thigh. “What we found were two EMRs for the same patient with an inversion of two letters in the spelling of the name, one with the problem described and another without it. Somehow the computer had made two records. I already visited IT about it, and one of their people is going to look into it, figure out how it happened and how to keep it from happening in the future.”
“That’s perfect,” Ava said. With a sigh of relief, she sat back in her chair. “That alone could eat up a good portion of the discussion time. Most of the staff are down on the EMR already and will love to offer their opinions.”
“Exactly my thoughts as well,” Noah said. “It’s looking good, like we’ll be able to get through this next M&M as well as we did with the first. What I plan to do is leave Helen Gibson for last, just like I did with Bruce Vincent. If I time it right, maybe there won’t be any discussion time and we won’t have to listen to Dr. Mason carry on.”
“I was just going to suggest as much,” Ava said. “I love it.”
“I do have one question for you, though,” Noah said. “Were you familiar with the video laryngoscope you were using that day? I know there are a number of different brands, each a little different.” Noah tried to use an offhand tone of voice as he asked this question, as if the idea just occurred to him. It was an issue that had been bothering him in the back of his mind since the event. He’d had the impression Ava had seemed less than adept with the instrument than she should have been, although he was the first to admit he might have been expecting the impossible. When Ava was using the device, the patient’s head had been bouncing all over the place from the cardiac massage, which would have made it difficult for anyone. Putting in an endotracheal tube on certain patients with restricted neck motion could be incredibly difficult, as Noah painfully knew from personal experience.