“And tell me more about your Ph.D. thesis in genetics from MIT,” Ava said. “That’s really impressive. I’ve never heard of someone getting a Ph.D. so quickly. How on earth did you manage it?”
“It sounds more impressive than it was,” Noah said. “I had started it as an undergraduate project in bacterial reproduction, so I had a jump on it. But to be honest, I didn’t do it for the purest intentions. I did it with the hopes it would get me into Harvard Medical School, which it did. I was scared; when I’d finished my undergraduate degree in biology, I was turned down by both Columbia and Harvard Medical School. I knew I had to do something out of the ordinary.”
“You’re just being modest,” Ava said.
“I don’t think so,” Noah said. “I even fudged on it a bit, at least initially. But that’s another story.”
“What do you mean?”
“It doesn’t matter,” Noah said. “The whole project was more busy work than a real breakthrough, and in that sense somewhat of an embarrassment.”
“Sounds imposterish, if I can coin a new term, just like we were talking about last night.”
Noah pointed at Ava’s nose and said with a laugh, “Very clever. You got me! I suppose I am kind of a Ph.D. imposter.”
19
MONDAY, JULY 24, 2:35 P.M.
“For your first endoscopic gallbladder removal, that was well done, Mark,” Noah said to Dr. Mark Donaldson in operating room 24. Mark had just withdrawn the gallbladder out of one of the four tiny endoscopic incisions in the patient’s abdomen. The second-year resident had done a commendable job, and Noah knew it was important for him to be told. When one was a junior resident, praise from a senior, especially a super chief, was critical when it was deserved just as much as criticism when that was appropriate.
“Thank you, Dr. Rothauser,” Mark said while handing off the small, diseased organ to the scrub nurse. He then visibly relaxed a degree, as he had been tense through the entire hourlong procedure. Noah also relaxed. He, too, had been tense with the instruments mostly out of his hands, certainly more tense than if he had been doing the procedure himself. It was part of the strain of teaching surgery. Both residents were looking at the monitor, which gave them a good view of the raw gallbladder bed under the edge of the liver.
“You’re practically home free,” Noah said. “It looks good. All you have to do is suture up the bed to prevent adhesions, make sure there are no bleeders, then pull out the instruments.”
Mark set to work. Some inexperienced surgeons had trouble with coordination when looking at a monitor at eye level as their hands manipulated the instruments below, inside the patient’s body. Mark wasn’t one of these. Noah had never had any problem, either, which he attributed to his playing computer games where the play was carried out by manipulating a computer mouse off to the side while looking straight ahead at a monitor. This realization had given him some satisfaction that gaming hadn’t been as worthless as his mother had complained.
Once the gallbladder bed had been closed, Noah encouraged Mark to irrigate the area with saline and then suck up the fluid. It was the best way to look for any tiny leaking blood vessels that could cause big trouble after the surgery. A few moments later, when Mark was done with this last suturing chore, everything looked perfect. The case was essentially done.
“We are going to be withdrawing the instruments,” Noah said to the nurse anesthetist so she could begin lightening up on the anesthesia. Surgery was a team sport, and it was important to keep everyone informed.
At that moment, the PA system suddenly sprang to life. Everyone started and momentarily froze with their attention focused. Announcements over the inconspicuous speakers rarely occurred, but when they did, it meant something critical was happening. It was Janet Spaulding, and her voice was urgent: “We have an apparent malignant hyperthermia in room number ten. I repeat, we have a malignant hyperthermia in room number ten. The MH cart and all available personnel are needed immediately in room number ten.”
Although the anesthetist, the scrub nurse, the circulating nurse, and Mark immediately regained their composure and went back to work on the case at hand, Noah felt differently. Despite being involved in an ongoing operation and therefore not expected to respond, he desperately wanted to do so: Ava was the anesthesiologist assigned to room 10 for an emergency appendectomy on a twelve-year-old boy named Philip Harrison. Noah was aware of this because it had been up to him, as per usual, to assign a resident assistant for the surgeon, Dr. Kevin Nakano.
“Mark!” Noah said sharply. “Do you feel confident to close the incision sites on this case?”
“I suppose,” Mark said, a bit taken aback.
“It’s not hard,” Noah snapped. “But you must close the fascia, particularly at the incision in the umbilicus. We don’t want her to get a belly-button hernia. Understand?”
“Got it,” Mark said.
“I want to get down to room number ten in case I’m needed,” Noah said, as he stepped back from the operating table, snapping off his surgical gloves in the process. He nodded to the nurse anesthetist to make sure she knew he was leaving before the case had ended.
As he went through the OR room door, Noah struggled out of his surgical gown. He left it and the used gloves next to the scrub sink and started running down the hall toward room 10. What was propelling him with such urgency wasn’t necessarily the patient’s well-being but rather Ava’s. He had never seen a case of malignant hyperthermia, known as MH, but he knew a significant amount about the condition, a rare but life-threatening problem usually triggered by exposure to certain drugs used for general anesthesia. The body’s muscular machinery went into uncontrolled overdrive, potentially leading to organ failure and death.
What was worrying Noah was the possibility that Ava could be facing yet another anesthesia catastrophe so soon after experiencing two others that already had undermined her self-esteem and had her questioning her competence. Noah wanted to be present for moral support, if nothing else. Although he’d never seen a case of malignant hyperthermia personally, he’d participated on numerous occasions in practice sessions spearheaded by the Anesthesia Department for dealing with the critical emergency.