“I did, days after I got there with Dr. Winston. He was a surgical resident like you, but from Serbia.”
“I’m sorry,” Noah said. Her former husband being a surgical resident made him feel weirdly complicit.
“It feels like it happened in another life,” Ava said. “How about you? Have you ever had some major life-changing episode make you depressed?”
Happy to get Ava out of her shell and talking, Noah was willing to be equally open. Like she, he didn’t like to talk about such things, and he said as much, but then went on to describe how depressed he felt when his mother started showing signs of dementia and he had to take a leave of absence from medical school. And more recently he mentioned how disconsolate he’d felt following Leslie Brooks’s unexpected departure.
“Did Leslie leave totally out of the blue like my bastard of a husband?” Ava asked irritably.
“No,” Noah admitted. “For quite a while she had been upfront about my work hours and never having any time for her, and it was getting worse, not better.”
“Still, it is a blow to self-esteem.”
“Tell me about it,” Noah said with a self-mocking laugh.
“Self-esteem is critical,” Ava said. “I’ve been thinking about it all afternoon. I realize it’s why I can’t leave clinical anesthesia even after these three unfortunate episodes. For me, being a practicing anesthesiologist is too much of my self-image.”
“I’m glad to hear you say that,” Noah said. He repeated what he’d said before about how good an anesthesiologist she was and what a tragedy it would be for her to throw away all the training she had been through.
“Thank you for saying that,” Ava said. “Your support has certainly influenced my thinking. But on all three cases, I truly believe I did all the right things . . . Well, maybe I should have waited for Dr. Mason to get into the room before starting the anesthesia on the Vincent case . . . but even so, I think I did everything as well as anybody in the department, even Dr. Kumar.”
“I’m sure you did,” Noah said.
“The problem is there’s still a chance I could become a departmental scapegoat with Dr. Mason on my case. Is that still your impression?”
Noah thought quickly how he should respond after having just spoken with Dr. Mason. Since Ava seemed to have pulled herself out of her most current nosedive, he didn’t want to give her reason to regress, yet she needed to know the truth. “He’s still upset with both of us,” Noah said. “Not only did he warn me Friday about not protecting you at the M&M, he sought me out this afternoon after the malignant-hyperthermia episode. He said he is going to speak with Dr. Kumar.”
“As if he hasn’t already,” Ava said. “The bastard. I tell you, one of the reasons I’m concerned about being dumped is that I didn’t train at one of the overrated Ivy League institutions like most everybody else.”
“That doesn’t matter,” Noah said. “In many ways it is a myth about Ivy League institutions being better than other places. You and Brazos University are a prime example. Tell me about your residency training! How many cases did you do in total?”
“I don’t like to feel I have to justify my training,” Ava said indignantly. “Nor justify myself. It irritates me to death, as if I’m struggling to stay in a discriminatory, old-boys’ club. I’d rather talk about my grades on my Anesthesia boards, which were better than most of my BMH colleagues, and my daily progress with anesthesia MOC. I put in more effort to stay current than anyone else in the entire department. Trust me! On Anesthesia rounds I’m always the one who brings up new developments, not the Ivy League graduates with their supposedly gilded diplomas.”
“Okay, okay. I understand completely,” Noah said, raising his hands as if he thought he needed to defend himself. Ava always seemed to surprise him. Only on Friday she had voiced the wish that she had had an Ivy League background, and now she was decrying it. “Some people do feel their training makes them superior. All of which means we must protect you from this narcissistic, spiteful blowhard, Dr. Mason. In specific terms, it means being prepared for this next M&M.”
“Are you prepared?” Ava asked.
“I think so,” Noah said. “As we talked about Friday night, I’ll present it last after four other cases. Dr. Hernandez suspected I had presented the Vincent case last to limit discussion. Still, I think it is important to take the risk. With the IT Department talking about how two separate electronic records were created and Dr. Jackson being reasonable about his role in the outcome, I think we should be okay. Those two issues should use up the discussion time. Of course, a lot depends on Dr. Mason and what he says. Whatever it is, I’m going to have to make an effort to sound neutral. I hope you understand that.”
“Do you think today’s MH case will even be mentioned?”
“Not by me,” Noah said. “If it does come up by Dr. Mason, I’ll say that I haven’t investigated it yet, and it will be presented at the next M&M.”
“In a way it is too bad,” Ava said. “I couldn’t have handled a case of MH any better than I did, despite the terrible outcome.”
“That reminds me,” Noah said. “Are you friendly with the circulating nurse on the case, Dorothy Barton?”
“Nobody’s friendly with Dorothy Barton,” Ava said. “She’s an odd duck. She even asked me one day if I was gaining weight. Now, that is one hell of a catty thing for a woman to say to another, especially someone who obviously struggles with her own weight.”
“Well, she’s not a fan,” Noah said. “After the MH case she took me aside to tell me that you didn’t turn off the isoflurane immediately, which I guess is crucial.”
“What?” Ava practically shouted. Her legs dropped off her ottoman, and she slid forward in her chair. “What the hell is she talking about? Absolutely I turned off the isoflurane instantly, the absolute second I noticed a sudden jump in the end-tidal carbon dioxide. And of course it is crucial. It was probably the isoflurane that triggered the whole problem in the first place.”
“I figured as much,” Noah said. “But I’ve never seen a case.”
“You don’t have to have seen a case to know that,” Ava snapped. She gave Noah a ten-minute monologue about the rare condition, demonstrating an extraordinarily in-depth knowledge of MH and how to treat it. Noah was both taken aback and impressed, especially as someone who prided himself as a source of medical minutiae helpful for making points on teaching rounds. She was even able to quote the latest statistics and cited the last lengthy review article about the condition in The New England Journal of Medicine.
“Wow!” Noah said when Ava finally fell silent. “I’m amazed at your knowledge about MH, as rare as it is.”
“I know anesthesia,” Ava said, as she slid back in her chair and raised her feet onto the ottoman.