As Noah spent more time in Ava’s virtual world, he couldn’t help but start questioning who was the real Ava London. Prior to their relationship, did the social-media world he was now visiting truly take the place for her of real-time, normal, face-to-face interactions? That was what she had implied, yet it hardly seemed possible, considering the vast difference between what he and Ava had been sharing over the previous three weeks and what he considered a vacuous substitute. Yet the issue raised a worrisome idea: Maybe Noah was wrong. Maybe they hadn’t been sharing what he so wanted to believe. Being “in love” certainly didn’t mesh with her flying off with essentially no explanation or the slightest endearment like “I’m sorry I have to go” or “I miss you.” And what about there being so little apparent gratitude for the considerable effort he’d made for her regarding both M&M Conferences, particularly after this last one?
All at once Noah’s eye rose from his laptop, and he stared blankly out the window. Suddenly, an even more disturbing thought entered his mind. Was this whole relationship with Ava a sham? Could Ava have been merely using him to navigate the rough waters of the M&M Conferences because of her irrational fear of being terminated from her dream position on the BMH anesthesia staff?
“Hell, no!” Noah blurted out with conviction. Almost as soon as the idea had occurred to him, he rejected it as a pathetic reminder of his own social insecurity. He’d never been with a woman more open, giving, and comfortable with her body than Ava. Thinking that such intimacy could be less than sincere reflected more on him than on her.
Yet as Noah went back to staring out the window, he couldn’t keep his mind away from those nagging misgivings that continued to trouble him about tiny aspects of Ava’s professional behavior in all three anesthesia deaths. In the Vincent case, did she truly do her own careful questioning of the patient regarding whether he’d eaten or whether he had any GI symptoms with his hernia? Did she critically evaluate the kind of anesthesia to use or just blindly follow Dr. Mason’s secretary’s wishes? During the Gibson case, was she struggling with the advanced video laryngoscope or was the problem that the patient’s head was bouncing all over from the cardiac massage? Why did she not do a tracheostomy? And concerning the Harrison case, did she turn off the anesthetic agent immediately or was there a delay, as suggested by the circulating nurse?
As soon as these questions resurfaced, Noah couldn’t help but remember Ava’s response when he’d mentioned the nurse’s comment on the Harrison case. The remembrance made him smile. Ava had been irate and had launched into a detailed monologue of malignant hyperthermia that had put his knowledge and understanding of the condition to shame. She had even said that it had probably been the anesthesia gas that had triggered the condition, so certainly she would have turned it off the second she suspected what was happening. He remembered she’d told him what had alerted her. It had been something so esoteric about carbon dioxide that Noah couldn’t even remember.
Just to reassure himself, Noah went back on his laptop and googled malignant hyperthermia. A few minutes later he confirmed that she had been right. It probably had been the isoflurane to blame. Since she said that she had learned about the condition by using the WestonSim Center at Brazos University Medical Center, Noah went back to their website. He reread all the material that was available. He was again impressed, especially since Ava had validated the concept that simulation experience was tremendously valuable. He thought he’d bring the issue up at the next Surgical Residency Advisory Board meeting as he was a sitting member. Stimulating the hospital to expand the BMH simulation center would be a valuable contribution of the board.
It was at that moment with the WestonSim Center still on his laptop screen that Noah’s mobile phone rang. Trying to rein in his hopes that it would be Ava, he struggled to get it out of his pocket. As soon as he did, his heart sank. It wasn’t Ava. It was Leslie Brooks making her bimonthly FaceTime call. When she did it, it was always on a Saturday afternoon. For a moment Noah held the phone in his hand, wondering if he should answer. His disappointment it wasn’t Ava was so strong that he worried Leslie might sense it, and it would then be an unkindness to her, who he knew only had his best interests at heart. He wasn’t in the mood to hear how great things were for her in New York or how happy she was with her fiancé, who showered her with attention. Thinking it would only make his circumstance that much worse by comparison, he hesitated, but by the fifth ring he relented and answered. He was, after all, desperate for companionship.
He propped his phone up against the laptop. She looked terrific as usual. He could always tell she made sure her hair was in place and her makeup was perfect when she called. After their initial hellos, Leslie was sensitive enough to comment that he didn’t look like he had been getting enough sleep. He agreed, saying that he had averaged only four or five hours over the last few nights.
“That’s ridiculous,” Leslie said. “You are in charge now. You are supposed to be delegating work to others, not doing it all yourself.”
“The reason I haven’t been getting enough sleep is not because of work,” he said, deciding to be forthright. He was in the need for some sympathy, and Leslie was the only person in the world with whom he felt he could be honest as she already knew his weaknesses. “I’ve met someone and started a rather intense relationship for the last three weeks.”
“That’s terrific!” Leslie said without hesitation. “Who is she, if you don’t mind my asking?”
“She’s a colleague,” Noah said, being intentionally vague. “She’s also a doctor and is as committed to medicine as I am.”
“That is a good start,” Leslie said. “You guys should get along fine. The only problem might be finding time together outside of the hospital, if she’s as busy as you are.”
“She’s an attending on the faculty,” Noah said. “So she has predictable hours. It’s my schedule that’s still the problem, but she completely understands the demands on me.”
“So now I understand why you look sleep-deprived,” Leslie said with a laugh. “That’s not the Noah I remember from our last few years together.”
Noah laughed himself as he understood Leslie’s implication. “That’s not the reason I’m sleep-deprived. I’m afraid I’ve been jilted just when I thought everything was going terrifically.”
“If you want my opinion, which I’m sensing, maybe you should tell me what’s happened with a bit more detail.”
Noah described his relationship with Ava as openly as he could. He also explained what sparked his current distress. What he left out for privacy reasons were Ava’s name, her medical specialty, her personal history, and where she had gone on her recent trip. Noah did want Leslie’s opinion, in hopes that she would tell him that he was reading more into Ava’s lack of communication than he should, and that Ava would return and all would be back to normal. Unfortunately, that wasn’t what happened.
When Noah finished his brief monologue, Leslie merely stared at him, slowly shaking her head.
“Well?” Noah questioned. “Aren’t you going to say something?”
“I’m not sure what I should say,” Leslie admitted. “I can guess what you want to hear.”
“I can guess what I want to hear, too,” Noah said. “But I think I need honesty.”
“Okay,” Leslie said. She pointed at him as if lecturing. “Now, don’t get mad at me when you hear my opinion. Promise?”