“Okay, Miss Grazdani. Today is Thursday. Monday morning, first thing, I shall expect you to resume your responsibilities as a fourth-year medical student. I am also reminding you to stay away from Dr. Rothman’s laboratory. This is compassionate leave, not an opportunity for you to play epidemiologist again. We have real epidemiologists who are qualified to do the work. Do you understand?”
Pia nodded.
“Please say, ‘I understand,’ ” Dr. Bourse said. She wanted to be absolutely clear.
“I understand,” Pia said, almost inaudibly.
“Mr. Wilson. You’ll return to Radiology today—”
“Absolutely, Dean,” George said, cutting her off.
“And you will also cease enabling Miss Grazdani. Perhaps you might want to ask yourself why you, with a hitherto spotless record, are drawn into the kind of behavior we saw last night. Gnothi seauton—do you know what that means? It means ‘Know thyself,’ and it’s something that we as physicians need to remember always.
“I doubt that it was your idea, Mr. Wilson, to break into Dr. Rothman’s lab, and I hope that in the future you will let your actions be guided more by your intellect than by your id—by your cerebrum more than your hypothalamus.”
George eagerly nodded agreement.
“Everyone clear?” Dr. Bourse said. Pia and George nodded in unison.
“Well, thank you. You can go.”
Dr. Bourse watched George hold the door open for Pia, who left without acknowledging George. She acted as if George holding the door for her was a matter of right.
Dr. Bourse sat at her desk for a few minutes of contemplation. Since a large part of her job was to get to know her population of medical students at the Columbia University College of Physicians and Surgeons, she thought about the strange relationship between Pia and George. Of course, fraternization between students was not necessarily encouraged, nor was it discouraged, provided it did not interfere with performance. In this romance, it was pretty obvious what he saw in her as she was the source of considerable gossip around the center as a particularly beautiful, intelligent, but enigmatic young woman. What wasn’t so clear was whether there was any reverse attraction.
Relations between staff and students, on the other hand, were officially frowned upon, but it was difficult to enforce a ban when the parties were all consenting adults and the students mostly in their late twenties. There had been persistent rumors concerning Pia Grazdani and Dr. Rothman. Again, Pia’s exotic beauty and obvious intelligence were lost on few people, but what she might possibly have seen in him was beyond most people’s comprehension. But nothing was ever substantiated and while there was every reason to believe that Dr. Rothman had given his student significant responsibilities and privileges, there was never any evidence that he had done so inappropriately. And now, Dr. Bourse thought, the conundrum of their relationship would just have to remain one of life’s little mysteries.
31.
COLUMBIA UNIVERSITY MEDICAL CENTER
NEW YORK CITY
MARCH 24, 2011, 12:10 P.M.
After leaving the dean’s office, Pia spent the rest of the morning stewing in her room. Her feelings were in absolute turmoil, emotions and thoughts swirling in and out of her consciousness so that one minute she felt utterly depressed, the next she was sharp and motivated. She was still angry at Rothman for getting sick, and also at Springer, the chief of Infectious Diseases, for letting Rothman die, which she believed he did by selecting an outdated antibiotic despite the supposed sensitivity testing that Rothman himself had done. And why did it have to be her, a lowly fourth-year medical student, who made the diagnosis of the incipient peritonitis, the onset of which had heralded the man’s death?
But most acutely, Pia knew she was devastated by the simple fact that Rothman was dead. She was depressed at the thought of what it meant to her future. Pia had a lot of practice at dispassionately breaking down a situation and identifying how it affected her. It was the emotional aspects of her state of mind that she struggled with the most.
Pia had been completely convinced by Rothman’s argument that she wasn’t suited to clinical medicine, since she actually didn’t like most people, especially when they were sick and complaining about it. She had little sympathy for illness and none at all for any kind of complaining. At one point during her residency, after thirty-six hours without sleep, she had had to take blood from a patient, a tough-looking young policeman who was deathly afraid of needles. As the man wriggled and squirmed and Pia couldn’t for the life of her find a vein, she told him to “quit whining like a baby.” Fortunately, no one overheard her, and the man didn’t complain, although the staff did wonder why he made such an effort to avoid Pia for the rest of his stay.
With Rothman gone, she didn’t know if she had it in her to follow through with getting a Ph.D., which was a requirement if she was serious about pursuing a future in research. Most of all, the nagging issue of what had happened to Rothman wouldn’t leave her alone, and she mulled it over continuously. It could have been an accident, she knew, but it seemed very unlikely knowing Rothman as well as she did. He was too careful, too compulsive. And the two of them getting sick simultaneously? It didn’t make sense. But the alternatives seemed equally unlikely, especially the idea that he did it deliberately. The only other possibility, namely the idea that someone else did it deliberately, like Panjit, who might have had the opportunity, seemed even more unlikely.
The longer Pia sat in her room, the more agitated she became and the more motivated to take some action. But what? She paced around the room as best she could, given the close confines of the living area. She lay on her bed, but that was intolerable. She thought about calling Will or Lesley, but she didn’t know what she would say to them. She walked down the corridor to the soda machine, but she didn’t want anything to drink. Her mind was buzzing, racing, overheating.
Suddenly Pia knew what she could do to get herself centered, to regain some focus. George had been hanging around, offering to help. She thought there was something he could do for her, as he’d done a few times in the past. George wasn’t so different from any other man she’d ever encountered. But each time it had happened, when Pia thought George would have been put off by her needs, there he was, back again the next day.
Pia imagined that George would be on his lunch break, one of the benefits of a rotation in something predictable like radiology or pathology. There was a predictable schedule. She wanted to call him, but she couldn’t find her cell phone. And when she did find it, in the pocket of her coat, she saw that the battery was dead. She plugged the phone into the charger and called George, catching him as she had hoped on his way over to the cafeteria.
“I was going to swing by later to make sure you were okay,” George said. They hadn’t parted on the best of terms after meeting with the dean, and George’s perennial insecurity about Pia had surfaced again.
“You offered to help. Is that still the case or are you still mad at me for getting you in trouble?”
“I’m not mad at you, I’m just worried about you.”
Pia rolled her eyes.
“So you’ll help me?” This was awkward. Pia wanted George to say yes, I’ll be right over. Instead, he said, “Not if it means going back up to the lab.”
“No, George. What I’d like you to do is come over here for a few minutes.”
“Right now?”
“Right now, George! I assume you’re on lunch break?”
“Okay,” George said. “I’ll be right there.”
Pia prepared. Almost to the minute of his expected arrival there was a knock on Pia’s door. She pulled it fully open.
George’s eyes sprang open to their fullest extent. He was clearly taken aback. Nervously he glanced up and down the dorm hallway to make sure no one could see what he could. Pia was standing in the open doorway buck naked.
“This isn’t quite what I expected,” he managed, as Pia pulled him into the room. She was shockingly deliberate,
as she had been on previous occasions, and again, as on those previous occasions, he didn’t resist. Under the circumstances she was a force greater than him, and he was powerless. Pia grabbed at the belt in George’s pants, and he obliged. She then pulled his sweater and T-shirt over his head. Pia pushed him onto the bed and handed him a condom just as she had on the other occasions. He was ready—achingly so—and Pia got up on him immediately. She closed her eyes and looked up, rocking herself rhythmically and hard against him. He knew it was simply sex, that she was looking for the endorphin rush, and she found it fast, shuddering slightly as she did so.
As soon as she was finished, Pia put her hands on George’s chest and slipped off him. She looked right at him, but it was like she didn’t see him. “Thanks. I needed that,” she said. She walked over to her bathroom, turned on the shower, and, after a couple of seconds, jumped in.
George put his hands behind his head and looked down at himself for a few beats. He then slipped off the condom, walked into the bathroom, and flushed it away. From a birth control perspective, it had been a waste. Pia had finished showering and was toweling off. George couldn’t help but admire her athletic body, exquisitely shaped breasts, and deep, flawless, honey-colored skin.
“Would it kill you to kiss me?” George was bemused; he didn’t know what to think. He was being used, he knew, and didn’t understand why.
“I don’t like kissing. Doesn’t do anything for me.”
George could tell Pia’s mind was already elsewhere. There was no point in him saying, “Well, what about me?” He could hear her reply: “What about you?” George didn’t know what else to say. Each time they had sex, George hoped it meant they’d made a breakthrough, that their relationship had climbed out of its curiously stalled state into a level of true intimacy. But it had never been the case. Nor was it now. She was a train running on a totally separate track. In many respects his role was irrelevant, as if it could have been anyone lying there.
“Thanks,” Pia repeated airily as she passed him coming out of the bathroom. There was no modesty, whether pretend or real. In her upbringing there had never been an opportunity for even pretense.
“What for? I didn’t do anything.”
“No, you did! Really. You’ve given me a reboot like what needs to be done with a modem once in a while. You’ve made it possible for me to see what I have to do, rather than sit here paralyzed.”
“Is that what it was? I want . . . I want us . . .” George felt like that hopeless teenager again. Pia was dressing quickly. George was standing naked and felt very self-conscious. He slipped on his boxers. “So tell me. What are you going to do?”
“Get in more trouble, I expect.”
“What does that mean?”
“You should just leave, George. My problem is I don’t think Rothman was treated correctly, whether people believe it or not. There was something wrong about how he got sick and there was something wrong about how he was treated. Chloramphenicol? It’s almost never prescribed these days. Third-generation cephalosporins are where it’s at now, so why give him something old that potentially causes truly catastrophic side effects?”
“You told me yourself. They used it because of Rothman’s own sensitivity studies.”
“That’s what they said. He shouldn’t have died, period, yet he was dead within what, fifteen, sixteen hours? He got sicker in the hospital—there was no delay in treatment, he was taken straight to the ward right after he showed the first symptoms. I think the treatment made him worse.”
“Okay, I understand you’re frustrated,” said George, “but the dean told you directly not to interfere. Not to play epidemiologist. Do you want to get kicked out of here in your fourth year?”
“I’ve got time off, I’m not sitting here, I’ll lose my mind. I’m going to talk to Springer about the treatment and why it didn’t work. No one said I couldn’t talk to him.”
“Springer! Everyone knows he hates med students. By reputation he was second only to Rothman. You pull him as a preceptor for your rotation in internal medicine and half the students try to switch within a week. And the other half are lining up on the roof to jump off the building. Not to mention the fact that you’ve already pissed him off.”
“Don’t worry, George, I’ll be my normal diplomatic self.”
“That’s exactly what I’m worried about.”
32.
COLUMBIA UNIVERSITY MEDICAL CENTER
NEW YORK CITY
MARCH 24, 2011, 2:05 P.M.
As Pia sat and sat in the narrow waiting room of Dr. Helmut Springer, her determination to see him didn’t waver. Her tryst with George had succeeded in establishing in her mind what she needed to do. She had a burning need to know two things. The reason why Dr. Rothman became sick was one issue; another was why the vaunted and lauded Columbia medical staff had, in her mind, apparently screwed up his treatment. She knew she was only a fourth-year medical student, but from her perspective she couldn’t come up with a compelling reason why Dr. Rothman and Dr. Yamamoto should have died at all, let alone died less than a day after the men were admitted to the infectious disease ward at the hospital. It wasn’t as if they were in some backwoods operation—this was one of the absolute premier medical institutions in the world.
Though Springer probably wouldn’t be happy to see her, she was hopeful that if she talked with him he could aid her quest to find out what had happened. He was, after all, a world-renowned infectious disease specialist. She knew his reputation of not treating medical students with anything close to respect and she knew their meeting the day before had not ended well; still she was optimistic. If he didn’t know that she was the one who first recognized Rothman’s incipient peritonitis, she was going to tell him herself, thinking it should count for something.
After forty-five minutes of waiting, Springer’s receptionist finally announced to Pia that the doctor could see her now. Pia quickly entered his office. Springer was at his desk facing into the small room. There were no other chairs; it was Springer’s way of keeping meetings short.
“Dr. Springer, I’m sorry to bother you again, and I know I annoyed you the last time we met. I apologize for all that. But I’m a medical student, and if I can’t learn from my experiences, then I’m a pretty poor excuse for one. And I apologize for questioning—”
“Yes, yes,” Springer said, cutting Pia off midstream. Her apologies sounded rehearsed and there was nothing resembling contrition in her eyes. Worst of all, his schedule was completely full with residents, at that moment, awaiting his arrival in the emergency room. He cleared his throat. “From our last chat I suspect you believe you know better than some of the foremost authorities in the land what has taken place here. Well, I want to disabuse you of that notion. Also I’d like to say that I wouldn’t have even taken the time to see you this morning were it not for the fact that you discovered the early signs of peritonitis in Dr. Rothman. Dr. De Silva told me about a medical student who she assumed was on rotation catching rebound tenderness in Dr. Rothman’s abdomen, which had not presented itself previously. We’ll overlook the fact that this medical student was not, in fact, on rotation and had essentially broken into the ward and was wholly unauthorized to approach the patients. Of course, I later learned that this medical student was yourself.”
It took Pia a couple of seconds to realize that Springer was paying her a slight compliment, even if it was cloaked in a sardonic reprimand. Pia took it as an opening. “I fully admit it was, and perhaps I shouldn’t have been there,” she said. “But it was an important discovery with important consequences. The man was clearly getting worse, which makes one wonder why the original antibiotic was chosen.”
“Please,” Springer said, his face empurpling. “This is where we left off last time. I just indicated that we were grateful for your help, and now you’re back with this nonsense. I can’t win. Again, there is nothing to indicate that chloramphenicol wasn’t doing the best job under the circumstances. And, as we have sa
id about fifty times, we were informed by the sensitivity studies carried out by Dr. Rothman himself that it was the correct choice of antibiotic. We are working under the assumption that Dr. Rothman’s work in the study was as thorough and accurate as was customary.”
Pia couldn’t believe what she was hearing. Was Springer attempting to shift some of the responsibility onto Rothman? In this case it seemed especially crass to even suggest blaming the victim. “So how come, considering those sensitivity studies, neither Dr. Rothman nor Dr. Yamamoto showed any sign of response to the chosen antibiotic?”
Springer closed his eyes for a moment. “The answer to your question is simple. The virulence of the involved strain of salmonella overwhelmed both the antibiotic and the patients’ defenses. Remember, antibiotics, contrary to myth, do not cure. It is the patient’s immune system that cures. Obviously with Rothman and Yamamoto, their immune systems were completely overwhelmed. Simple as that.”
Pia started to respond, but Springer cut her off. “Listen, we’ve been over this issue. And let me add that a department head at this hospital does not have this kind of conversation with a medical student. A department head does not have this kind of conversation at all—there are protocols to be observed, there are panels that are convened if there are questions about the diagnosis or treatment. It’s not clear in this case that there are any questions. Jesus, why am I justifying myself to you? This is not how we conduct business around here.”
Pia wasn’t picking up on Springer’s rising sense of outrage. She had him in the room and she wanted answers. “Why weren’t Rothman and Yamamoto being monitored more closely?”