“But to have that much information at your fingertips is truly unique. Did you handle a number of cases during your training?”
“No, I’ve never seen an actual case until today,” Ava admitted. “But I was well schooled in how to handle it because of the simulation center that we had at Brazos University Medical Center. It’s called the WestonSim Center, as it was named after a West Texas oil baron who donated it. It’s truly state-of-the-art. In comparison, it makes the simulation center here at BMH seem as antiquated as a pinball arcade.”
Noah had to laugh. He knew the simulation center at BMH wasn’t up to par, as the hospital hadn’t designated adequate space or computer time. It was a problem he was working on.
“The anesthesia mannequin had a malignant hyperthermia program, which I took advantage of many times when I was a resident.”
“I guess it paid off,” Noah said. “And I guess Dorothy Barton is envious of your ripped figure.”
Ava laughed with real humor, which made Noah feel like he had accomplished what he had hoped—namely, to pull her out of her depressive thoughts.
“That must be the explanation,” Ava said.
“Any chance your appetite has improved?” Noah asked.
“It has,” Ava said. “And you?”
“I could eat something,” Noah said.
“Let’s not do the take-out thing,” Ava said. “I don’t have a lot of food in the house, but there are eggs, bacon, and toast. How does that sound?”
“Perfect,” Noah said, and he meant it.
21
WEDNESDAY, JULY 26, 8:44 A.M.
“Okay,” Noah said. “Let’s move on to the last case. This is a thirty-two-year-old woman who had been hit by a car on the corner of State Street and Congress Street and suffered a compound fracture of her right tibia and fibula. If everyone can turn to the final page of the handout, I will begin.”
Noah was back in the Fagan Amphitheater facing another packed M&M Conference. It wasn’t as crowded with standees as the previous conference, but most of the seats were taken. As was the case two weeks ago, the first two rows front and center had all the big guns of the department, including Dr. Hernandez, Dr. Mason, and Dr. Cantor. As far as Noah was concerned, they were the big three.
The previous day in the middle of the afternoon, Noah had been ordered again to Dr. Hernandez’s office, which had made his heart race, as such an ordeal always did. After the run-in with Dr. Mason the afternoon before, it wasn’t hard to guess the reason for the call. When Noah arrived, he was moderately surprised to find Dr. Cantor there as well. Although he had expected the worst, the meeting turned out not to be as bad as it could have been. Dr. Hernandez had done most of the talking, with Dr. Cantor merely nodding at key points. The message had been simple and to the point. Dr. Mason wanted Noah gone.
“I can tell you straight out,” Dr. Hernandez had said with Noah literally standing on the carpet in front of the man’s desk, “I don’t totally understand Dr. Mason’s reasons for his beliefs, but he is convinced that Dr. London is incompetent and you are complicit in protecting her and therefore bear some responsibility for three deaths. Be that as it may, I made a point to talk privately with Dr. Kumar, mentioned Dr. Mason’s feelings, and asked him straight out if Dr. London was up to snuff, and he has assured me that he personally had vetted her and is completely confident of her performance.
“Which brings us to your circumstance . . .”
Expecting the worst, Noah remembered having cringed at that point, but it wasn’t necessary. Dr. Hernandez had gone on to say that because of Noah’s meritorious record as a resident, he and Dr. Cantor could currently prevail over Dr. Mason’s wishes, meaning Noah would not be dismissed. Yet he warned Noah to be extremely careful and not rock the boat, particularly in regard to Dr. Mason. He went on to add that the surgeon wasn’t the easiest person to deal with, yet because of his skill and reputation he was a force to be reckoned with.
“Dr. Cantor and I want to be certain,” Dr. Hernandez had concluded, “that you will not treat Dr. London’s role in the upcoming M&M tomorrow with anything but factual truth and candor.”
“Absolutely,” Noah had said without hesitation. There was no way he was prepared to lie. As he left Dr. Hernandez’s office he’d been thankful that he hadn’t been asked if he was having an affair with Ava. If he had been asked, he had been prepared to be honest, although he had no idea what he would have done or said if he were ordered to break it off.
“Does anyone have any questions so far?” Noah asked after a pause a few minutes into his presentation. He looked up from his notes and let his eyes roam around the audience. Briefly he made eye contact with Ava. So far he had just given Helen Gibson’s complete medical history, which included four normal pregnancies and a serious bike accident resulting in a cervical neck fracture. As he had done when presenting the Vincent case, he was trying to use up time even though there was only a smidgeon more than fifteen minutes left before the conference would have to end.
When there were no questions, Noah went on to present the rest of the case, beginning with Helen Gibson’s arrival in the ER up to her untimely death. He recounted everything that had happened without embellishment just as he had promised Dr. Hernandez, including the two salient facts: that the attending surgeon had pressured the first-year anesthesia resident to begin anesthesia before her supervisor was in the room and that two separate EMRs, with slightly different names and slightly different information, had been inadvertently produced so that the anesthesia resident was unaware of the patient’s cervical problems. He pointed out that according to an international rating system, the patient represented the worst-case scenario in regard to placing an endotracheal tube because of her prior history of neck trauma and moderate obesity.
Just as Noah was about to turn over the discussion to the IT representative who was going to talk about exactly how the two separate EMR records had been created, Mason loudly demanded to be recognized. Reluctantly, Noah gave him the floor.
“Excuse me, Dr. Rothauser,” Dr. Mason said in his booming voice. “You have put off this particularly tragic case to last to limit discussion time. I know this, and I am certain other members of the faculty do, too. And we know why.” He then went on to do his best to fault Ava’s performance, throwing the usual accepted academic decorum to the wind by personally disparaging and discrediting her and openly accusing Noah of protecting her and possibly carrying on a secret liaison.