After they finished eating, Noah and Ava cleaned up, keeping the conversation light. Mostly they had talked about Ava’s opportunities to do touristy things in Washington. For her it had been unique because on her other visits to the District, she’d always been too busy. Noah had admitted that he’d seen her posts on her Gail Shafter Facebook page and had read all the comments out of desperation to hear about what she was doing. “You should have texted me,” Ava had said. “I would have told you directly.” Sensibly enough, Noah had not responded to that comment.
When Ava was finished rinsing the dishes they had used, she leaned back against the sink, drying her hands. “For me the sudden trip to Washington turned out to be a godsend,” she said. “This last MH death almost put me over the top. Getting away was what I needed. The fact that the patient was a twelve-year-old boy made it so much harder for me to accept. Not that the others were easy, mind you.”
“I can understand,” Noah said, as he put the plastic containers into the recycling bin. “I’ve always found pediatrics harder to deal with than other specialties. Life can be unfair, everyone knows that, but it seems particularly unfair when the patients are kids.”
“I was again seriously considering giving up clinical anesthesia,” Ava said wistfully.
“You mentioned that.”
“While I was away I decided I’m going to use these three deaths to motivate me to work even harder than I have been on my anesthesia MOC.”
“That is a very healthy way to deal with these tragedies,” Noah said. “There is always something more that we doctors need to learn for our patients.”
“The one thing that makes this last case easier than the first two is that we don’t have to worry about the M&M. I don’t believe there is a single thing in this case that I would change. Nor is there anything that someone like Dr. Mason could challenge.”
“Good point,” Noah said, but he couldn’t keep his mind from remembering Dorothy Barton’s remark about Ava not turning off the isoflurane when she should have. He wasn’t going to bring that up again but the remembrance keyed off another issue. “You said that the reason you knew so much about how to handle a malignant hyperthermia case was from using the WestonSim Center.”
“Absolutely,” Ava said. “I ran the MH program a bunch of times.” She hung up the kitchen towel on the oven handle.
“While you were gone, I went on the WestonSim Center website,” Noah said. “I was impressed with the building and the setup. It makes what we have at BMH seem rather pitiful. But while I was looking at their facts and figures, I noticed it didn’t open its doors until 2013.”
For a few moments Noah and Ava stared at each other. Suddenly there was a sense of unease in the air like static electricity.
“Are you doubting what I told you?” Ava asked challengingly.
“I’m not doubting anything,” Noah said. “I just noticed the date, which is the year after you and I started at the BMH.”
Ava laughed derisively. “Two thousand thirteen is the year that the center moved into its new building. The robotic human mannequins had been in the main hospital building since I was in college and had been regularly upgraded. I started using them way back when.”
“Oh,” Noah said. “Okay. That explains that.”
“Any other questions about my training and timing?” Ava said challengingly.
“Well, since you asked, I’m still curious about how much experience you had during your residency training with the advanced video laryngoscope? Did you use them a lot?”
“That seems like a pointed question,” Ava said. “Is this issue coming back? Why are you asking this?”
“I’m just curious,” Noah said breezily. He could tell that Ava was annoyed again.
“I don’t buy that,” Ava said with a definite edge to her voice. “What’s on your mind? What are you implying?”
“Nothing in particular,” Noah said, struggling to come up with an explanation. “I’m just wondering if there are differences in anesthesia programs like there are in surgery.”
“Are you suggesting that my training at Brazos University might not be as good as your Ivy League background? I’m appalled. You were the one telling me it was all a myth just last Monday, and now you are questioning me because I didn’t train at a known medical center? Give me a break!”
“While you were away I checked out the Brazos University Medical Center and the medical school. It was a way to feel closer to you because I missed you. And I was impressed. It looks like a terrific facility.”
At that moment Ava’s phone rang. She snatched it up from the countertop and looked at the screen. “Oh, damn! It’s my NSC boss. He’s going to want to debrief me about the weekend. Do you mind? I should talk with him, but it might take a while. I’m sorry.”
“Not a problem,” Noah said graciously. In truth, he felt a little like a boxer being saved by the bell. “Do what you need to do.”
“It might take as long as an hour,” Ava said as the ringing continued. “I ended up seeing a lot of congressmen, including over dinner with two very important senators, including Orrin Hatch.”
“Take your time!” Noah said. “I’ll head up to the study. You’ve got enough coffee table books up there to keep me busy all night.”
“Okay,” Ava said. “I’ll be up as soon as I can.” She then clicked on the phone and held it to her ear. “Howard, hold on just a second.” Then to Noah she mouthed, “See you!” and gave him a wink.
As Noah headed for the main stairs, he was aware of Ava already describing her dinner Saturday night at the Washington, D.C., Capital Grille as she headed over to the sitting area of the expansive kitchen. He was glad to put a bit of space between them. He’d not expected her to react so sensitively to the laryngoscope issue. All he wanted to know was if it was in common use during her residency. Her response made him wonder just what she would say if he voiced all his misgivings.