A muted collective gasp emanated from the otherwise passive audience. Everyone was stunned, no one more so than Noah. He was expecting trouble from Dr. Mason, but this was ridiculous. When Mason continued on with his ad hominem outburst, a number of people hissed, as most everyone in the audience knew Ava on some level, liked her, and thought of her as totally competent. Up until these last two M&Ms, her name had never come up in a single adverse-outcome case.
When Dr. Mason finally fell silent, Noah struggled with what he should say. Luckily, Dr. Kumar stood up and worked his way to the aisle before descending into the pit. He was a tall, handsome man with a heavy mustache who had grown up in the Punjab region of India. Noah was more than glad to step aside and allow the chief of Anesthesia to take over the lectern.
In sharp contrast to Dr. Mason’s muckraking style, Dr. Kumar lavished praise on Ava, citing her incredible performance on the anesthesia boards as evidence of her terrific training. He also mentioned that he had personally observed her providing anesthesia on numerous occasions when she first joined the staff and found her performance to be exemplary. He said it was his professional opinion that the way she handled the current case and the Vincent case were similarly commendable. Then, to everyone’s surprise, he lavished equivalent praise on Dr. Mason, calling him a brilliant surgeon and a tribute to the hospital, and he offered to meet with him to discuss his concerns about Dr. London or about anyone on the anesthesia team.
At this point, most of the people in the audience clapped.
“The woman was involved in yet another death just two days ago,” Mason blurted out. “That’s three deaths in so many weeks. I find that unacceptable.”
There was more hissing.
“I have already reviewed the case from Monday,” Dr. Kumar said calmly. “It was a fulminant malignant hyperthermia episode. Again, it is my belief that Dr. London and the entire MH protocol worked admirably.”
Dr. Kumar then went on to give an extended explanation of how the Anesthesia Department handled supervising residents and nurse anesthetists. He did this to explain why Ava was not in the room at the time when Helen Gibson’s anesthesia was initiated, because she was in another room supervising another resident. Staff anesthesiologists were expected to supervise up to two residents and four anesthetists simultaneously.
While Noah listened to Dr. Kumar’s staffing explanations, he thought back to when he’d first burst into the operating room when Helen Gibson was already in extremis. The fleeting impression of Ava fumbling with the advanced video laryngoscope nagged at him. Should he have perhaps mentioned this impression to someone like Dr. Kumar, or was the fumbling due to the patient’s head bouncing around from the external cardiac massage? And what about why she hadn’t ordered an emergency tracheostomy or used a large-bore needle with jet ventilation?
“Thank you for allowing me to speak,” Dr. Kumar said to Noah, stepping away from the lectern and interrupting Noah’s thoughts.
“You are entirely welcome, sir,” Noah said hurriedly. He returned to the lectern and looked up at the restive audience who’d erupted into many individual whispered but animated discussions.
“I’d like to say something,” a voice called out.
Noah looked in the direction of the request. It was Dr. Jackson. Noah pointed to him, giving him the floor.
“I know it is generally not the involved surgeon’s role to speak at an M&M unless asked a specific question, but I feel I should do so in this case. I never did get to operate on the deceased, even though I am the surgeon of record. What I’d like to say is that I made a mistake by actively urging the anesthesia resident to start the anesthesia before her staff supervisor was present. In my defense, the case involved a compound fracture. In such circumstances the chances of infection increase the longer the surgery is delayed. Nonetheless, I shouldn’t have forced the issue.”
There was a smattering of muted applause as people appreciated Dr. Jackson’s mea culpa, since it was as unexpected as Dr. Mason’s inappropriate comments. For a second, Noah locked eyes with Ava. She was one of the people who was quietly clapping. Noah wondered if it was for Dr. Jackson or for Dr. Kumar. Both had helped exonerate her.
After a quick glance at his watch and seeing it was already after 9:00 A.M., Noah concluded the M&M. The audience stood up immediately. Most everyone had to get to surgery, as they were already late for their scheduled 9:00 A.M. cases.
Stepping away from the lectern, Noah turned to the representative from the IT Department. She had been sitting in the lone chair in the amphitheater’s pit for the entire conference, waiting to speak her piece about the Helen Gibson case.
“I’m terribly sorry,” Noah said. “I didn’t expect we would run out of time.”
“No problem,” the woman said graciously. “I actually enjoyed listening. I’ve never been to an M&M Conference. As a layperson, I’m glad to hear these tragedies are not ignored.”
“We try our best to learn from each one,” Noah said. “Thank you for coming and for your time. I’m sorry we didn’t get to hear your presentation.”
Noah turned to look up, in hopes of catching Ava’s eye. He was certain she had to be pleased. Instead, he found himself facing an angry and empurpled Dr. Mason, who was beside himself with barely contained rage. He was heedless of all the other bigwigs, who had already descended into the pit and were standing around, socializing in small groups.
“You think you are so goddamn smart,” Dr. Mason jeered, poking his face within inches of Noah’s. “Maybe you’ve gotten your prissy girlfriend off the hook because she is in a different department, but let me assure you, I’m sure as hell not finished with you. Not by a long shot. If I have anything to say about it, you are out of here!”
Sensing it was best to remain silent, Noah just blankly stared back. Dr. Mason glowered at him with narrowed eyes. Then, with even more ostentatious drama than after the prior M&M, he stormed out of the room.
By reflex, Noah hazarded a glance in the direction of the nearest group of surgical attendings and caught them rolling their eyes for his benefit. It was apparent they had overheard Dr. Mason and were being supportive. It gave Noah a modicum of confidence that staff members were cognizant of Dr. Mason’s personality shortcomings, but Noah was still nervous. As Dr. Hernandez had said the day before, Dr. Mason was a force to be reckoned with. Unfortunately, Noah had no idea how to help his case, as he was caught in the web of Dr. Mason’s narcissistic ego.
22
WEDNESDAY, JULY 26, 3:10 P.M.