“So when are you going to talk with Dr. Mason?”
Noah shrugged. “I guess as soon as I can. He has patients in the hospital right now, and when he does, he usually comes in on Saturday. I’ll try to work up my courage and talk to him tomorrow.”
“Tread lightly, my friend,” Ava said with obvious empathy.
A wry smile appeared on Noah’s face. “Tread lightly! Those were the same words Dr. Mason used when he warned me about my presentation.”
“Sorry,” Ava said. “Let me change that to: ‘Prepare well’! To help you, we should get together again after you speak with Dr. Mason. I am here this weekend, so let me know if you get to speak with him. Meanwhile, I will give the whole mess more thought. I’m certain you will, too. The more prepared you are, the better. Agreed?”
“Absolutely,” Noah said.
“This case is disturbing for both of us,” Ava said. “Nonetheless, it’s been great talking with you. Thank you for being willing to come over here to my home. I’m really glad you approached me. I had thought about approaching you but felt reluctant. I’m not sure why.” She shrugged. “Let’s stay in touch. I’ve given you my mobile number. How about texting me so I have yours? Do you use Facebook or Snapchat?”
“I use Facebook a bit more than Snapchat,” Noah said. “Mostly FaceTime, to be honest.”
“We can use Facebook. The name I use is Gail Shafter.” Ava gestured for Noah to precede her out of the room. They started down the main stairs.
“You don’t use your real name?”
“I don’t,” Ava admitted. “On LinkedIn I do, but on the other social-media sites I don’t. I’ll explain it more to you sometime if you are interested.”
“I’m interested,” Noah said.
“I don’t think we should be seen talking together in the hospital come Monday, when I will be back for my next shift. It would surely start the gossip mill we both can’t stand. We also don’t want Dr. Mason to get wind that we have been talking. Agreed?”
“Absolutely,” Noah said. “One last thing: Assuming I am successful in corralling Dr. Mason tomorrow, what time would you like to get together?”
“How about tomorrow night at the same time, at eight,” Ava said. “We could even get take-out again if you are up for it.”
“That would be terrific,” Noah said. “Apart from an unexpected disaster at the hospital, I will be here.”
They had reached the front door, and being the social nerd he knew he was, he felt suddenly flustered and self-conscious about how to end this pleasant evening. He hadn’t expected to like her as much as he did. Should he shake hands, give her a hug, or what? Luckily, Ava came to his rescue. She leaned forward and pressed her cheeks one after the other against his and made a hushed kissing sound, making him realize how much more cosmopolitan she was than he.
“Thank you again for coming over,” Ava said, straightening back. “You have made my evening.”
Noah could feel himself blush. “And you mine,” he managed. “It’s been a delight.” Then, gathering up his courage, he said, “One last question: You have a charming accent, but I just can’t place it. Where are you from?”
“You’re too kind,” Ava said with a laugh. “Lubbock, Texas. And you?”
“Scarsdale, New York,” Noah said. “Westchester County.”
Fearing he was acting like a smitten teenager, Noah mumbled a good night. Halfway down the front steps he turned and waved. Ava waved back and closed the door.
“What a jerk,” Noah mumbled, castigating himself for his social awkwardness. Yet he felt great. As he walked back toward his apartment in the soft summer night, he felt an excitement he’d not felt since high school with his very first love, Liz Nelson. Right under his nose had been a person with whom he now felt a strong connection of mutual interests, particularly a 100 percent commitment to medicine, not just as a career but as a way of life. He had been impressed when he overheard her give her mobile number to the nurse in the PACU and when he learned she religiously worked on her anesthesia recertification every day. He was also impressed that she had rescued cats from the animal shelter. And on top of all that, Noah had to admit that she was a pleasure to look at, even seductive. Noah had no idea if their friendship would continue and maybe even grow after the M&M, but if it did, he was confident he would never have to explain to Ava why he had to spend as much time at the hospital as he did. In that important way, Ava would be the opposite of Leslie Brooks, who had never understood.
Arriving at his building on Revere Street, Noah hesitated before keying the front door. For a moment he considered dashing over to the hospital just to check on things. But then he admitted he was being far too compulsive. If there was a problem that the chief resident, Tom Bachman, couldn’t handle, he would have called. Noah sensed that his showing up unannounced and unrequested might be interpreted by Tom as a lack of confidence, something Noah did not want to communicate. Once again, Noah was realizing just how much diplomacy and psychology were involved in being the super chief.
After entering his apartment and closing the door, Noah stood for a moment, surveying the room. In comparison with Ava’s place, it was a joke. The postage-stamp size, the lack of furnishings and decoration, and, most important of all, the lack of any personal touch were striking. He couldn’t help but remember all the framed pictures of Ava in her study, which he could still see in his mind’s eye, such as those in sporty venues such as ski areas and scuba-diving locales. There was even one of her about to skydive and another of her about to bungee-jump, activities that Noah thought were certifiably crazy. At the same time, he gave her credit for being adventuresome, since he certainly wouldn’t do either one. Most of the other photos were just smiling selfies Ava had taken at various tourist attractions such as the Coliseum in Rome and the Taj Mahal in Agra. Vaguely he wondered if she went on these trips solo, and if she didn’t, why a companion wasn’t in any of them.
Thinking about Ava’s mansion and the money it represented, Noah again wondered exactly what her business connections were that could support such a lifestyle, since he was certain, the more he thought about it, that her anesthesia salary would not be enough. Her explanation that her business involved “consulting” was unclear. He wondered if her outside work involved anesthesia in some way. If their friendship did blossom, he’d ask her. One of the qualities that he particularly liked about her was her apparent self-confidence and openness in who she was, something Noah felt he lacked except for his role of being a doctor.
Trying to tamp down his excitement of a potential new relationship with an attractive, sexy, and impressively intelligent woman with mutual interests and a similar value system, Noah sat down at his card table and booted up his HP laptop. Hungry for more information, he was eager to check out Ava’s Facebook page under the name of Gail Shafter. As the comparatively ancient machine labored through its routine, Noah had to smile at the difference between his computer and Ava’s setup. It was as stark as their living styles.
When Gail Shafter’s page came up, Noah was fascinated. There were lots of photos going back to Ava’s childhood. There were even some of the same selfies that Ava had on the wall of her study, as if Gail Shafter was a globetrotter as well. Looking at the “friends” category, he was duly impressed that she had 641, which made him laugh when he thought about his own page. He couldn’t remember exactly, but he thought he had about ten. Then Noah looked at the “about” information and saw that Gail Shafter had gone to high school in Lubbock, Texas, and now worked for a dentist in Iowa. What Noah found most interesting was trying to decide what was real and what wasn’t.
Something else caught his attention. There was a fan page listed over to the left on Gail Shafter’s homepage. When he clicked on it he found Gail Shafter’s Nutrition, Exercise, and Beauty page, where he found multiple videos of Ava significantly disguised, providing tips on all sorts of subjects involvin
g makeup, exercise, and general health. But what surprised him the most was when he clicked on “likes,” he found that she had 122,363 followers! No wonder she spent so much time on social media. It was a command performance.
Next he pulled up her LinkedIn page. This was decidedly professional. He was interested to read that she had attended Brazos University in Lubbock, Texas, in a combined B.A./M.D. program with an undergraduate major in nutrition. She then went on to an anesthesia residency at the Brazos University Medical Center. Noah thought that nutrition was an interesting major for a premedical student, as nutrition was one of those subjects that medical school did a poor job teaching. He thought it was a smart choice and wondered if nutrition had anything to do with her consulting business.
Glancing over the rest of the material, Noah suddenly burst out laughing. In the skills and endorsement section, he noticed that Gail Shafter was one of the people who gave Ava a positive endorsement as to her anesthesia skills. “Why not?” Noah remarked out loud. He knew what he had found was an example of sockpuppetry, which some people looked down on, but in this instance he thought it was humorous.
After turning off his computer, Noah got to his feet and stretched. He then headed into the bedroom, knowing that 4:45 A.M. would come all too quickly.
10
SATURDAY, JULY 8, 10:52 A.M.
So far the morning had gone brilliantly, but Noah knew it was about to head south. He was on his way across the pedestrian bridge that connected the Stanhope Pavilion with the Young Clinic Building, where Dr. William Mason had an office. Noah was facing a semi-impromptu meeting with “Wild Bill” for 11:00 A.M. that had been arranged when Noah had run into the surgeon by happenstance on the general surgical floor less than an hour earlier. When Noah had asked if he could have a moment of his time, Mason had responded gruffly that he would be available around eleven in his clinic office for a short time. Noah didn’t know exactly what to expect, but the chances the interaction would turn out pleasant were essentially nil.
Noah had arrived at the hospital as per usual around five and gone straight to the surgical intensive-care unit. He was particularly interested to see how John Horton was getting on, even though he was a private patient under the moment-to-moment care of the critical-care people. It was comforting to see that he was doing reasonably well. The same was true with all the other SICU patients. It had also been nice to hear that Carol Jensen, as a unit supervisor, continued to be complimentary about the new residents.
Leaving the SICU, Noah had met up with the residents who had been on call overnight. No problems there. The Saturday-morning work rounds had gone smoothly, although with the new residents it had taken much longer than usual. When Noah had run into Dr. Mason around 10:00, work rounds were just ending, even though they had started at 7:30. As expected, the newbies had yet to master the technique of quick but thorough bedside presentations. That being said, all in all, Noah felt very good about how the first full week of his super chief residency had gone. He wasn’t surprised. He’d always been a fast learner. It was the coming second week that had him worried.
Saturday clinic was a mere shadow of its normal weekday self, and the Young Building was comparatively empty. Noah was the only one in the elevator as he rode up to the fifth floor, home of the General Surgery Clinic. Although he was certainly not looking forward to the next fifteen minutes or so, what bolstered his courage was a sense of secret camaraderie that Ava was now providing. It was reassuring to not be alone in regard to the looming M&M.
Noah walked directly back to where he knew Dr. Mason had a small office that also functioned as an exam room. The man’s real office was in the much plusher Franklin Building, which catered to the likes of Arab sheiks, billionaires, and heads of state and had been named after one of Mason’s former patients, who’d financed it.
Noah knocked on the open door and stepped over the threshold. Dr. Mason was dressed in a light blue seersucker jacket, a white shirt, a bow tie, and dark slacks. He was sitting at the small wall-mounted desk, typing on a keyboard. To his right was an exam table. Hearing Noah’s knock on the open door, he swung around and pointed to one of two generic molded plastic chairs. He didn’t say anything but rather tipped back and interlaced his fingers across his expansive chest. His expression was a half-scowl with pursed lips. Noah was not encouraged.
Taking one of the indicated seats, Noah faced his bête noire as he struggled to decide where to begin. The trouble was he was there because of protocol. He was expected to interview the involved surgeon as part of investigating the case. In reality, he didn’t expect to learn anything that he didn’t already know. “Thank you for seeing me,” Noah said, hoping at least to start out the discussion in a friendly, mutually respectful fashion. In the back of his mind he was hearing Ava’s characterization of the man. To Noah, her description of him as a serious narcissist seemed spot-on, meaning that under the circumstances there was zero chance for any reasonable interaction. Not only was the man presumably still furious at Noah’s outing of his reputed lover, he was clearly challenged by Noah’s work ethic and jealous of the kudos Noah was getting in the process.
When Dr. Mason did not respond or even change his facial expression at Noah’s pleasantry, Noah took a deep breath and pressed on: “I’ve gone over the Bruce Vincent record and have spoken with most of the people involved except you. What I’d like to ask is whether there is anything that you might be able to tell me that I might not know.”
“I suppose you saw there was no resident admitting note?” Dr. Mason snapped.
“I did,” Noah said. “And I know why. I spoke at length with Martha Stanley, who said—”
“Yeah, I know,” Mason interrupted. “The poor overworked bastard was backed up. Bullshit on that excuse.” Dr. Mason was now stabbing the air with a thick index finger. “He fucked up, plain and simple. I tell you, with the residents nowadays it’s amazing any of us senior men get anything done. When I was a resident that wouldn’t have happened, and we saw way more patients than you guys do today and were on call every other night.”
Noah was well aware that a number of the senior surgeons bemoaned how easy they thought the residents of today had it, but he resisted questioning the idea. Attempting to calm Dr. Mason, who was already riled, Noah said, “My understanding is that the lack of a resident H&P was a decision made by Ms. Stanley. The junior resident was totally unaware and didn’t even know that Mr. Vincent passed through Admitting.”
“Well, then it’s Ms. Stanley who is to blame. If the junior resident had done what he is supposed to do, all this wouldn’t have happened.”
“The requirement is that there needs to be an up-to-date history and physical, which was the case. Your fellow Dr. Kolganov had done one the day before that Ms. Stanley thought was adequate.” Noah thought briefly about bringing up the deficiencies of Kolganov’s H&P as a copy-and-paste job with after-the-fact doctoring but quickly decided against it. Dr. Mason was supposed to have been supervising the man’s work and was therefore ultimately responsible. Once again the blame would fall on Dr. Mason’s shoulders.
“Then the system has to be changed,” Dr. Mason barked. “Residents should see all surgical patients prior to surgery, particularly same-day surgery.”
“That can be a good subject for the discussion of the case,” Noah said.
“You bet your ass,” Dr. Mason agreed.
“Let me ask you this,” Noah said. “Did you see and examine the patient before surgery?”
Dr. Mason rocked forward in his chair with such suddenness that the chair squeaked in protest. “What the hell are you implying with a question like that? Of course I saw the patient before surgery. I see every one of my patients before surgery.”
“I’m not implying anything,” Noah said defensively. “I didn’t know how much of the pre-op process you delegated to Dr. Kolganov.”
“Rest assured, my precocious friend, I examine all
my patients thoroughly. Especially since Dr. Kolganov was not going to be part of the surgery. He was needed elsewhere for one of my much more serious cases.”
“Then you were aware that Mr. Vincent had had some symptoms of bowel obstruction,” Noah said, ignoring Dr. Mason’s condescending remark.
“Of course,” Dr. Mason said. “It was even mentioned in the referral note from his GP. It was why we were doing the goddamned operation.”
“And yet you still favored spinal anesthesia?”
“I didn’t favor any particular anesthesia,” Dr. Mason snapped. “That is what anesthesiologists are for. They don’t mess around in my area of expertise during the surgery, and I sure don’t mess in theirs.”
“But your office requested spinal,” Noah said. He knew this issue was going to come up no matter what, and he had to know the details.
“On the few hernias I have done over the years, spinal was used. I’m sure that was what my secretary was conveying. It is still up to the anesthesiologist to determine what is best.”
“You may be right,” Noah conceded but held back what he wanted to say—namely, that anesthesiologists needed all the facts, which plainly were not available in this circumstance for a multitude of reasons, least of which was that Dr. Mason was not available for the pre-op huddle.
“What else?” Dr. Mason demanded. He had returned to tipping back in his chair, fingers again interlocked. His earlier anger had dissipated and the pursed-lipped scowl had returned.
“It seems to me,” Noah said, trying to organize his thoughts and be as diplomatic as possible, “the patient didn’t take his upcoming surgery as seriously as he should have.”
Dr. Mason laughed derisively. “That’s the understatement of the year. I heard he was forty minutes late to Admitting. The guy was working that morning. I saw him myself. He even parked my car. But worse yet, he ate a goddamn full breakfast and then lied about it. I tell you, you try to do a guy a favor and he kicks you in the teeth.”