Two days ago when Claire had given him the key to the surgical residency program door, Noah had brought in office supplies, along with a significant amount of paperwork, including his very initial ideas for the choices of faculty mentors for each of the new first-year residents. Every new resident was assigned a faculty mentor. Even though Noah had never utilized his mentor other than enjoying a few pleasant dinners at the man’s home, he still thought the program had merit. There were always a couple of first-year residents who found adapting to the role of a surgical resident challenging. Being a resident was a world of difference from being a medical student.
Sitting down at the desk, Noah took advantage of the preternatural stillness of the deserted office. He got out the list of first-year residents and the list of faculty members who had volunteered to be part of the mentor program and went back to trying to match them. Quickly it became apparent that there was too much guesswork involved, because Noah knew very little about the new arrivals. The only thing he knew for certain was their genders and the medical schools they had attended. On the other hand, he knew the faculty members reasonably well, maybe too well in some instances.
When Noah had done what he could, he turned to managing and planning the plethora of meetings and conferences. Of particular concern was the weekly basic science lecture, since it was going to be the first conference under his tutelage and was fast approaching in less than a week. The basic science lecture was held every Friday at 7:30 A.M., and he had yet to decide on a subject for the first meeting, much less a lecturer. What he didn’t admit was that he was avoiding even thinking about the even more worrisome and problematic M&M Conference.
Time went by quickly, and before Noah knew it, the alarm on his cell phone went off, shocking him back to reality. It was quarter past eight. He’d set the alarm in the rare eventuality he wasn’t called, texted, or paged for some problem someplace in the hospital, which was what he fully expected. During the early morning, there was always something that happened that needed his attention. Certainly, had he stayed on the surgical floor, he would have been inundated. Taking full advantage of the peace and quiet, he’d made progress and had now outlined the first three basic science lectures and had emailed appropriate potential lecturers to ask if they would lend a hand.
After putting away his paperwork, Noah headed out the door. His destination was the Fagan Amphitheater in the Wilson Building, which was reached by a pedestrian bridge located on the second floor of the Stanhope.
3
SATURDAY, JULY 1, 9:27 A.M.
“Thank you, and welcome to the best surgical residency program in the world,” Dr. Edward Cantor said with a wry smile to acknowledge he might be exaggerating to a degree. He was a tall, slender, angular man, fit and assertively intelligent. He picked up his notes from the Fagan Amphitheater’s lectern and sat down in the chair he had vacated twenty minutes earlier. It was one of five in the amphitheater’s pit. The others were occupied by Dr. Carmen Hernandez, chief of surgery, and Dr. William Mason and Dr. Akira Hiroshi, both associate surgical residency program directors. The fifth chair was noticeably empty.
The welcoming ceremony had started precisely at 8:30 A.M. as scheduled. Noah had entered from the second floor prior to its commencement with several minutes to spare and looked down into the pit to see Dr. Hernandez waiting at the lectern for 8:30 to arrive. The chief was a compulsive man, especially about time. The room was built as a typical half-circle medical-school amphitheater, with tiers of seats rising from the half-circle pit or arena a full story below, making it look like an ancient Greek or Roman theater. The room was nearly full, with the twenty-four newly minted and obviously eager first-year residents sitting front and center in the first row. They all had on glaringly white, highly starched coats similar to Noah’s. Over the whole scene was a surprisingly loud buzz of conversation as a testament to the room’s fine acoustics.
As Noah had begun to descend one of the amphitheater’s two rather steep stairways that divided the seating into thirds, his arrival caught the attention of the chief of surgery, who waved up to him and gestured toward the only empty chair in the pit. Noah had quickly signaled that he preferred to sit in the audience. It had been a snap decision predicated on his seeing that the empty chair was next to Dr. Mason. As nervous as he was about speaking in front of the packed amphitheater, Noah had no interest in compounding his anxiety by having to relate to his least favorite attending, so he took an aisle seat in the twelfth row. The fact that the empty chair was also next to Cantor’s also played a role. After the man had threatened to dismiss him for spending too much time in the hospital as a junior resident, Noah had never felt at ease in his presence.
The program progressed just as Noah had predicted. Dr. Hernandez carried on for almost a half-hour, letting Noah’s mind wander to all his newly acquired responsibilities. Unable to avoid observing Mason down in the pit, wearing one of his typical expressions of disdainful disinterest when he was not the center of attention, Noah had found himself mostly worrying about the damn M&M Conference and how the hell he was going to navigate the minefield he knew it represented. He had successfully avoided thinking about it all morning, until Mason’s presence made it impossible.
After the chief of surgery had spoken, the program director followed suit in an equally predictable fashion, enough to make Noah marvel that no one in the audience fell asleep. He could tell that Dr. Mason was not finding the program particularly stimulating, either, as he was constantly fidgeting in his seat and crossing and uncrossing his heavy legs.
The moment Dr. Cantor had taken his seat, Dr. Hernandez got up and returned to the lectern. After adjusting the microphone down to accommodate his height, he cleared his throat and said: “Now I want to introduce to you our brand-new super chief resident, Dr. Noah Rothauser.” With that he gestured up toward Noah.
As Noah got to his feet and began descending the steep stairs that lead down into the pit, he could feel the hairs on the back of his neck stand up, as well as his pulse begin to hammer in his temples. There was a smattering of applause and a few teasing catcalls and some playful laughter in the audience. Noah was popular not only with the nursing staff but also with his fellow residents. One of the reasons was practical: If ever anyone needed someone to cover for whatever reason, everyone knew Noah never turned anyone down regardless of the hour or the day of the week.
Noah kept his eyes down and concentrated on avoiding a fall, as that would be a scene he’d never live down. Not only were the amphitheater’s stairs abnormally steep, there was no handrail. Once in the pit, he walked directly to the lectern, feeling himself blush. Dr. Hernandez had returned to his seat.
After adjusting the microphone up, he still hunched over, then raised his eyes to gaze directly at the twenty-four brand-new first-year residents. He started to speak, but his voice came out in an otherworldly squeak, making him clear his throat. When he began again, he sounded relatively normal, at least to himself.
“I would like to add a welcome to you all,” he said while he made eye contact with each new resident in turn and gained confidence as he did so. “I had planned on giving a long, detailed speech about the history of surgery, but I believe that has been adequately covered by our own esteemed surgical professors, who are giants in their respective fields.” Noah briefly turned and nodded toward Hernandez and Cantor, both of whom smiled contentedly as the audience tittered in relief. Noah avoided looking at Drs. Mason and Hiroshi, although he had nothing against Hiroshi, with whom he never had much interaction.
“Instead I would just like to say you are about to begin the most exciting and demanding part of your extensive training, and leave it at that. I would like to add that I wish I could say my office door is always open for whatever reason you might have to pay me a visit, but unfortunately, I do not have an office.”
A few chuckles rapidly grew to a round of real laughter as a reaction to the pomposity of the previou
s speeches. Noah found himself smiling, too, although he worried that his off-the-cuff attempt at humor might offend Dr. Hernandez. A quick glance reassured him when he saw the chief was at least smiling.
“Office or not,” Noah continued, “I will always be available for whatever reason. Don’t be shy! I’m easy to find. Surgery here at the BMH is a team effort, and we expect everyone to be a team player. You all got your initial rotation assignments, so after the coffee and doughnuts served next door in the Broomfield Hall, we are off to the races. Thank you! And let’s have a fabulous year.”
Noah turned and faced Dr. Hernandez, who had risen to his feet. He was a square-built man, in some ways similar to Dr. Mason but a smaller version, with darker, thicker hair, an olive complexion, and a heavy mustache. In contrast to Dr. Mason’s bluster, he exuded an air of quiet confidence, which he maintained no matter the challenge in either the operating room or the boardroom. “I hope you didn’t take my attempt at humor as a complaint,” Noah said.
“Not at all,” Dr. Hernandez said. “It was unexpected, which made it funny. But you do have an office . . .”
“I have a desk,” Noah corrected. “Not an office.”
“I see,” Dr. Hernandez said, before his attention was hijacked by an attending surgeon who pulled him aside for a quick consult.
Noah noticed several of the new residents, including Lynn Pierce, coming down into the pit and heading in his direction. He couldn’t help but notice Lynn was wearing a very striking yellow summer dress under her white coat. With a minor wave of panic, Noah glanced back at the exit, but before he could beat a retreat, he felt a tap on his shoulder. He turned to face a nurse dressed in scrubs whom he had seen on occasion but with whom he had never spoken.
“Dr. Rothauser, I’m Helen Moran.”
“Hello, Helen,” Noah said.
“I don’t want to take much of your time,” Helen said. “I know you are busy, but I wanted to speak to you briefly about the Bruce Vincent case. I am one of the few people who didn’t personally know him, but I participated in getting him admitted. Rumor has it that he was a victim of the concurrent-surgery process. Is that true?”
Taking a deep breath, Noah tried desperately to organize his thoughts and figure out what to say. In truth, he didn’t want to say anything, as he had been trying to avoid even thinking about Bruce Vincent, but now, gazing into the indignant eyes of Helen Moran, that clearly wasn’t an option. Obviously, he was already being drawn into the minefield he was dreading. There had even been a few unflattering articles about concurrent surgery in the lay press.
“I have yet to investigate the case,” Noah said vaguely.
“I hope the case is going to be presented at next week’s M&M Conference.”
“I’m sure it will be,” Noah said. “It was a tragedy, which certainly needs to be aired to see if we can learn anything to keep it from happening again in the future.”
“Didn’t Dr. Mason have two other cases going at the exact same time? That’s what I heard.”
“I will be checking in on that for certain,” Noah said.
“I hope you do. I happen to know that was the situation, and I personally think that concurrent surgery shouldn’t be allowed here or anyplace. Plain and simple. Not in this day and age.”
“I’m not fond of the practice myself,” Noah said. “Now, if you can excuse me, I have to get over to Broomfield Hall.”
While Noah had been briefly speaking with Helen Moran, the covey of first-year residents that he had seen approaching had grouped themselves around him. The moment he was free, a batch of simultaneous questions erupted about the on-call schedule. Jokingly, Noah held up his hands as if he needed to protect himself, then pointed toward the exit. “How about we all go next door and get some coffee? I promise I’ll answer all your questions.”
As Noah watched Helen recede in the direction of the door, there was another tap on his shoulder. This time it was significantly more forceful, causing Noah to have to take a step forward to maintain his balance. With a twinge of irritation, he spun around to complain, but then swallowed his words. He found himself facing Dr. Mason. The man’s expression had changed from boredom to a scowl.
“I heard what you said to that woman,” Mason growled. “Let me tell you, my friend! You’d better tread lightly about this Vincent case or you are going to be in big trouble.” To emphasize his point, Mason stabbed Noah a number of times in the chest with one of his thick index fingers.
“Excuse me?” Noah managed. He’d heard Mason clearly but needed a moment to process what was obviously a threat.
“You heard me, you freaking Goody Two-Shoes. Don’t you dare turn this Vincent disaster into a cause célèbre against concurrent surgery. If you do, you’ll be messing with the most powerful surgeons here at the BMH who need double booking to meet demand of their services. You hear what I am saying? And let me remind you: The muckety-mucks in Admin feel the same, since we bring in the cold cash to run this place. You got it?”
“I hear you,” Noah managed. He stared into Mason’s unblinking black eyes. The man had his considerable chin tucked back like a boxer’s. “I will investigate the case thoroughly and present the facts dispassionately. That’s all.”
“Bullshit, my friend. Don’t take me for a fool! You can skew the facts whatever way you please. But I am warning you, Anesthesia screwed up, plain and simple, by giving the wrong anesthesia, compounded by the patient himself, which should have been discovered by Admitting. Keep it simple or, believe me, you are going to be looking for work.”
“I will not skew the facts,” Noah said, gaining a smidgen of confidence. He knew intuitively that Mason was in the wrong in trying to dictate the outcome of the M&M Conference. Yet as a realist, Noah also knew he was now deep into the proverbial minefield.
“Really?” Mason questioned superciliously. “Well, let me tell you a fact. Bruce Vincent was alive when you came flying in and sliced open his chest like the cavalry arriving at the last second. The only problem is you killed the patient. That is a fact.”
Noah swallowed. His mouth had become dry. There was some truth to what Mason was saying, but had Noah not “sliced” into Vincent’s chest, Vincent would have been dead in about three or four minutes. It had been a gamble, but a gamble that had not paid off. Still, someone could make the argument that Noah had been too rash, and that maybe the patient should have been merely defibrillated externally and bronchoscoped as an emergency.
“You’d better think about it long and hard!” Mason growled. He poked Noah a final time, hard enough to force Noah to take a step back. Then Mason turned on his heel and churned angrily through the crowded pit and out of the amphitheater like a speedboat in a packed harbor, leaving Noah in his turbulent wake.
4
WEDNESDAY, JULY 5, 10:48 P.M.
A light rain was falling as the late-model black Ford van with its snub nose and rakish headlights pulled over to the curb on a dark residential street in Middletown, Connecticut. There was no lettering on the nondescript, workaday vehicle with Maryland tags. The headlights switched off, but the engine kept running to keep the air-conditioning functioning. There was only one pedestrian visible down near the end of the street, walking a small white dog. He quickly disappeared into one of the homes, leaving the street deserted. Lights were on in many of the modest two-story houses that lined both sides of the street, although mostly on the second floors. It was bedtime in most of the households.
There were two men in the van’s front bucket seats, dressed in lightweight summer suits with black ties: George Marlowe’s was dark gray; Keyon Dexter’s was black. Both men were in their late thirties, athletic appearing, and were clean cut in a military fashion, with short hair and closely shaved faces. Both had been in the Marines and had been deployed to Iraq, where they had met in a special cyber unit. Keyon was African American, with medium dark skin; George was Caucasian and b
lond. They were staring out the windshield at a Craftsman-style house with tapered columns supporting a hip-roofed porch two houses down and across the street from where they were parked. Incandescent light spilled out of the first-floor windows, but the overhead porch light was off and the second floor was dark.
“Check and see if he is online now,” Keyon said from the driver’s seat. “And while you are at it, recheck the GPS coordinates. We wouldn’t want to be arresting the wrong dude.”
They both chuckled at such a suggestion as George opened his laptop, booted it up, and then let the fingers of both hands rapidly type on his keyboard. He was clearly adept at keying his laptop.
“He’s online,” George said presently. “Probably trolling and causing mischief as usual. And we’ve definitely got the right house.” He closed the computer, reached around, and put the machine on one of the rear seats. The back of the van was filled with sophisticated electronic surveillance and computer equipment.
“So now we get to see the real Savageboy69,” Keyon said.
“My guess is that we are not going to find a stud,” George said. “Ten to one he’s going to be a boring, colorless, middle-aged guy.”
“You got that right,” Keyon said. “I’d wager him being a real candy-ass despite his online persona.” They both laughed again. They knew that in current lingo, Savage boy was the same as Fuck boy in the world’s teenage smartphone “connected culture” and in rap lyrics. Neither man could define the term precisely, although both knew exactly what it meant, something like the way they thought about the concept of pornography, which they also struggled to define but felt they knew when they saw it.