Noah hung back, watching Ava as she shut down the anesthesia machine and made some final entries in the EMR. On several occasions, she cast a fleeting glance at Noah but didn’t say anything. Nor did he. The circulating nurse and the scrub nurse were in the area, starting to clean up the room. They didn’t speak, either.
Without a word, Ava suddenly turned around, pushed through a side door, and disappeared into the equipment room that housed the sterilizer and surgical supplies. After a moment of indecision, Noah followed her. He found her leaning against the sterilizer for support. She was still wearing her mask, but Noah could tell she had been crying. He approached her, feeling profound empathy for what she was obviously feeling. He put his arms around her and hugged her. She didn’t pull away.
“Do you think it’s wise for us to be seen like this?” Ava asked after a few moments.
“You’re right,” Noah said. He let go and looked back through the glass pane in the door. He was relieved, as he half expected to see either the scrub nurse or circulating nurse staring at them.
“He was only twelve,” Ava said, her voice faltering. “I don’t know if I can take this. This is my third death. I never thought anything like this would happen.”
“It’s not your fault,” Noah said with emphasis. “It has to mean the boy had a genetic predisposition. That’s all. You said you even asked about it in your pre-op interview. You can’t ask any more of yourself than that.”
“He’d had anesthesia a year ago without a problem,” Ava said. “I even used the same agents. He had eaten lunch. That was what I was worried about, not malignant hyperthermia.”
“There is no way you could have anticipated this,” Noah said. “You can’t blame yourself.”
“Maybe that is true, maybe it isn’t,” Ava said dejectedly. “But after this third case, I don’t know if I can continue with clinical anesthesia.”
“I can understand your feeling,” Noah said. “But let’s not make any snap decisions on the spur of the moment. Medicine is always risky. It’s the nature of the calling. Think of how slim the chances are that you had to face this problem. As I remember, it’s like one in twenty thousand cases.
“You have been victimized by statistics or, if you prefer, bad luck. It doesn’t speak to your competence as an anesthesiologist. Try to remember the thousands of cases you’ve done with great results and no problems. You are a great anesthesiologist. You wouldn’t be here if you weren’t. Don’t even think about throwing away all your training and effort.”
“I don’t know what I’ll do,” Ava said. She looked at her watch. It was after 4:00 in the afternoon. “I want to go home.”
“Good idea,” Noah said. “Go home and do something to take your mind off all this. Go on social media!”
“Don’t make fun of me!” Ava warned.
“I’m not. You’ve told me how much you like it. Go do it. Do a video post for your Gail Shafter fan page and make your thousands of followers happy. I’ll come over as soon as I can tonight, and we can talk more. That is, if you’d like to talk more. Maybe in the short term we should do something completely different to take your mind off it, like go out to dinner and pretend to be normal people.”
Ava glanced up at Noah to see if he was being patronizing. “Okay,” she said quietly when she realized he was being sincere. Without another word, she brushed past Noah and exited out into the OR corridor. She didn’t look back.
Remaining where he was for a moment to get his own emotional bearings, Noah pushed back into the operating room. The cleanup had progressed. The two nurses had been joined by two orderlies. The MH cart and the cardiac-arrest cart were gone. He was mildly surprised that the dead boy was still on the operating table. He’d been covered by a fresh white sheet. Vaguely he wondered what the holdup was.
Stopping in the middle of the room, Noah winced at the thought of facing the parents of this child. He was thankful the job wasn’t his. Noah had had his share of deaths over the five years he’d been a resident. Most of them had been expected, but there had been two that were disturbing surprises that had made him more humble about his skills and the unpredictability of medical science. He remembered how it had affected him and how hard it had been to face the involved families. The remembrance made him even more sympathetic toward Ava, especially as his had been separated by more than a year. All three of Ava’s had been within a month.
Noah was about to leave the operating room when the circulating nurse approached him. He knew her reasonably well. Her name was Dorothy Barton. Noah thought of her as competent and knowledgeable but also moody and opinionated, such that he generally made it a point to avoid her. He was surprised when he saw her making a beeline in his direction. He wished he hadn’t dallied.
“Dr. Rothauser,” Dorothy said. She glanced over her shoulder as if concerned someone might be listening. “Can I have a word with you?”
“Of course,” Noah said. “How can I help?’
“Do you mind if we go into the supply room?”
“I guess not,” Noah said. It was an unexpected request. He followed her back into the room he’d just left. He wondered if she had seen him and Ava in an embrace, and if so, he tried to think up an explanation. But he needn’t have worried. She wanted to speak to him about Ava, but not in a way he could have anticipated.
“I noticed something that I think you should know,” she said. She was a heavyset woman shaped like a box, with broad features and thick lips. Her face mask was untied from behind her head and draped over her ample chest. “I’ve had the misfortune of being involved in two malignant hyperthermia cases. The first was at another hospital. So I know something about the condition and what should be done when it occurs. Dr. London did not turn off the isoflurane when the problem started.”
“Oh,” Noah commented. “Did she leave it on long?”
“No, not long, but it wasn’t until I’d come back to her after following her orders to send out the alarm, which I did by using the phone.”
“I see,” Noah said, but his attention was diverted by an insistent knocking on the wire-meshed glass pane in the door to the OR corridor. Turning his head, Noah caught a glimpse of the last person he wanted to see, Dr. Mason. When the visibly livid surgeon saw Noah look in his direction, he angrily gestured multiple times for Noah to come out into the OR corridor on the double.
“Sorry, but I have to go,” Noah said hastily to Dorothy. “Thanks for the info and for being so attentive. I’ll certainly take it into consideration. But right now I’ve got to talk with Dr. Mason.”
Bracing for yet another tongue-lashing, Noah abandoned the surprised nurse and stepped out into the OR corridor.