Charlatans

by Robin Cook

  Noah left the hospital by the main entrance and crossed the swath of greenery that covered the freeway tunnel on his way home. Once he was out of the hospital with all its demands on his attention, time, and energy, he was unable to stop his mind from mulling over his problems. Dr. Mason had made good on his threat to tell Dr. Hernandez about Noah and Ava possibly having an affair. Noah had become aware Thursday morning when he had gotten a message as he was scrubbing for his final surgery that he was wanted ASAP in the chief of surgery’s office.

  The meeting had not been pleasant. It got off on the wrong foot because Noah had gone ahead and finished his last case and didn’t show up in the chief’s office for almost two hours. Clearly miffed despite Noah’s explanation for the delay, Dr. Hernandez started out by saying the hospital administration didn’t condemn fraternization or romance between hospital employees, as they are grown-ups, but it did frown on such relationships if they affected performance. He went on to say that it was Dr. Mason’s strong opinion that Noah had deliberately shielded Dr. London from blame in the Vincent case during the M&M Conference by not bringing up the fault of Anesthesia choosing to use a spinal rather than general anesthesia.

  Noah had tried to defend himself by denying any attempt to shield Dr. London and by mentioning that Dr. Mason’s secretary had requested the spinal. But his attempts seemed to fall on deaf ears. Instead of listening, Dr. Hernandez had gone on to criticize Noah’s role in reawakening the concurrent-surgery debate, which had already been adequately vetted and cleared. At that point, Noah tried to remind the chief that the issue had been raised by a member of the audience and not by him.

  “Let’s not quibble about the details,” Dr. Hernandez had said with a wave of his hand. “The point here in both these circumstances is that we expect you to side with the Department of Surgery as a potential member of the staff. Now, I don’t know what you have done to get under Dr. Mason’s skin, nor do I want to know. But whatever it was or is, I think it would be in your best interest to rectify it. You have been a wonderful resident, Dr. Rothauser. I would hate to see you ruin it in this final sprint to the finish line. Do I make myself clear?”

  As Noah thought again about this brief meeting, it irritated and scared him. It was disheartening to see how blind the administration was to Dr. Mason’s personality flaws just because of his exceptional surgical skills. Noah had had to fight with himself not to bring up the Meg Green dismissal issue as the real cause of Dr. Mason’s discontent. That unfortunate affair was still a sore subject, and Noah feared bringing it up might make the situation worse.

  Noah reached the eastern corner of the Boston Common and began to cut diagonally across the park, heading in the direction of the gold-domed Massachusetts State House. In contrast with the downtown area, which had been relatively deserted, the park was full of people enjoying the Sunday summer evening. Despite it being after nine P.M., there were still children in the kids’ playground. Noah felt distinctively out of place in his hospital whites, surrounded by healthy, normal people who he knew thought of his world as a scary place.

  As bad as the meeting with Dr. Hernandez had gone, the meeting with Dr. Edward Cantor, the surgical residency program director, had been worse. Noah had been summoned a few hours after the meeting with the chief. As soon as Noah had arrived in the director’s office, it had been obvious that Dr. Mason had also passed on to him the story of Noah and Ava’s possible romance and his possible shielding of her at the M&M Conference.

  “I don’t like this one bit,” Dr. Cantor had snapped. “It is not the role of the super chief surgical resident to protect a possibly incompetent anesthesia attending because of an affair.”

  “Dr. London is far from incompetent,” Noah said before thinking. In retrospect, he should have stayed mostly quiet, as he had with Dr. Hernandez. By denying Ava’s incompetence, he was in a fashion affirming the allegation that he’d been protecting her.

  “Her competence or lack thereof is not for you to decide,” Dr. Cantor said. “It is a different department. We wouldn’t tolerate anesthesia residents protecting possibly incompetent surgeons. Don’t do it. If you do, we will find someone else to take your place. It is as simple as that. And I want to remind you that any screwup by a junior resident, such as the lack of an H&P on the Vincent case, is on your shoulders. As super chief, you are responsible for junior resident performance, plain and simple. Are you clear on this?”

  As Noah walked he had to smile wryly as he remembered this portion of the meeting. At the time, he’d considered reminding Dr. Cantor that he had not been the super chief when the Bruce Vincent case had occurred. It had been Dr. Claire Thomas. Luckily, he hadn’t done it, as it might have pushed the already upset man over the top.

  Suddenly, Noah stopped. He was close to a flight of stairs that led up to Beacon Street that ran along the north side of the park. He had just by chance glanced behind him to take one more quick look around the pleasant summer evening scene in the Common. What had caught his attention was a man in a dark suit and tie. There weren’t many men in suits at that time of the evening. In fact, as he glanced around again, he didn’t see another.

  What had caught Noah’s attention was more than just the suit. It was that he had the impression he’d seen the same man earlier, with his impressively trim physique and short, light hair. Noah had noticed the man, who had been standing alone at the side of the circular drive at the hospital’s main entrance. It was the suit at that time of night that made the man stand out, but Noah quickly forgot the incident until by chance he had taken this one last glance around the Common. Was it the same man? Noah didn’t know. But if it were, was it just a coincidence, or could the man be following him?

  “Good grief,” Noah said out loud, mocking himself. “Now you’re having paranoid delusions. What a pathetic lame-brain.” Without giving the man in the suit another thought, Noah went up the stairs, taking them in twos and threes. At the top, he had to stop for the traffic on busy Beacon Street, joining a group of people waiting for the light to change. Most were dog walkers with their pets.

  When the walk sign came on, the group surged forward. As Noah allowed himself to be carried along, he managed a quick glance behind him down the flight of stairs. At the bottom, he caught a fleeting look at the man in the suit. He was bent over, seemingly tying a shoe.

  Noah paused on the other side of Beacon Street where it met Joy Street. His normal route took him up Joy Street to Pinckney, where he took a left. But at this time of night, Pinckney Street was quiet, with few pedestrians. Noah decided to continue on Joy Street and make a left on Myrtle, which was busier, with multifamily buildings and a playground. If he was being followed, as crazy as that sounded, he preferred people around.

  A moment later the man in the suit appeared across the street. He was now waiting for the walk signal just as Noah had done. Noah turned and ascended Joy Street at a rapid walk. Since there was plenty of pedestrian traffic, he felt reasonably relaxed. He still thought that he was being paranoid in thinking that this man, whoever he was, was following him. It all had to be a coincidence. Why would someone be following him, a surgical resident? It made no sense.

  But then a few minutes later when Noah ventured a look behind him, the same man was there, walking in the same direction as Noah and seemingly at the same pace.

  At Myrtle Street Noah turned left. As he had expected, there were lots of pedestrians. There were even a few families still in the playground using the swings. As Noah crested Beacon Hill and started down on the other side, he looked behind him. The man was still there. Could it be a coincidence? Noah didn’t know, but he felt the chances were getting progressively slimmer. Revere Street, his street, ran parallel with Myrtle one short block to the north. There were several streets Noah could have taken, but he waited until Anderson Street because there was a convenience store on the corner, meaning more people.

  Once on Revere Street, Noah had only
a short way to go. Remembering hearing stories in the past about people being mugged when they paused at their front doors, searching for their keys, Noah made sure he had his in his hand. As he turned to his front door, he looked back. The man was still there, coming toward him, walking quickly.

  In a rapid fashion, Noah keyed his front door, pushed it open, entered, and slammed it closed. He heard the reassuring click of the lock and breathed a sigh of relief. He’d not been aware he had been holding his breath. Then, going up on his tiptoes, he was able to see out one of two small glass panes in the upper panels of the building’s front door. In a moment the man in the suit appeared, but as Noah watched, he didn’t pause or even look in Noah’s direction. Instead, he passed by in a flash, heading down Revere Street, which meant the whole episode had been a product of his emotionally overwrought state.

  Noah laughed at himself. He felt like a fool as he climbed his utilitarian staircase, heading for his lonely apartment. At that moment, he really missed Leslie Brooks and wished he’d made more effort in their relationship. If he had, maybe she would still be here. He keyed his apartment door and pushed it open. Inside he turned on the harsh overhead light, which was a cheap fixture with two hundred-watt bulbs.

  After taking off his white coat, hanging it up, and kicking off his shoes, he went into the small kitchen and opened the refrigerator door. There wasn’t much in there, and what was didn’t appeal to him. It was to be another night without dinner. Instead of eating, he sat down at the folding table, booted up the old HP laptop, and went on Facebook. Although he knew it probably wasn’t an emotionally healthy thing for him to do, he had in mind to look over the many photos of Gail Shafter, including a couple baby pictures. But what he found was more interesting. It was a brand-new selfie of Ava pouting at the camera with the caption: Relaxing after a hard day’s work. She was clad in a luxurious terry-cloth robe. There was a logo on the breast pocket, but Noah couldn’t make it out. Checking the background, he thought it looked like an upscale hotel room. He wished there were some indication where it was. As he looked at it, it seemed awfully cruel to him that she had taken the time and effort to post a photo on Facebook for her myriad Facebook friends but didn’t have the time or inclination to send him a single text.

  Looking down at the likes and comments, he was surprised at the number of people who reacted to the post. Most of the comments were short, like “hot” or “aesthetically flawless” or just a thumbs-up emoji, as if they were from teenagers. Noah shook his head at the inanity of it all. Knowing what he knew of Ava’s intelligence, education, and training, he couldn’t explain her attraction to such a superficial activity. Why did she bother? Did she get enjoyment from the responses she got, in particular the three comments saying her photo was hot?

  Wondering if his suspicion that the authors of the short comments were as young as he envisioned, Noah decided to look at one of the commenters’ Facebook page. He chose Teresa Puksar’s because she was one of the people who wrote “hot” and because the surname jumped out as being unique. He’d seen the name before on his previous visits to Gail Shafter’s homepage, as she was one of a half-dozen or so people who were loyal followers of Gail Shafter and commented on every post.

  “Just as I thought,” Noah mused when he had Teresa Puksar’s homepage on his screen and saw that Teresa Puksar was thirteen. Then he noticed some of the young girl’s photos as being overly provocative. There were even a few nudes with her coyly covering nipples and the genital area. Even so, Noah was shocked that Facebook allowed them, as they could be considered by some conservative people as child pornography.

  At that moment, the silence in his apartment was shattered by the raucous sound of his front door buzzer. Concentrating as he was, Noah leaped at the sound. “What the hell?” he questioned when he recovered. No one ever rang his doorbell, especially not after ten on a Sunday night.

  Confused, Noah got up and went to the window. He pressed his face against the glass to see what he could on the sidewalk in front of his building, but he didn’t see anybody. He wasn’t surprised, because there was an alcove at his building’s front door where the apartment buzzer was located. Whoever had rung was most likely standing in there. Raising his line of sight, he saw that there was a dark SUV pulled over to the curb on the opposite side of his street with its blinkers going. That wasn’t normal, either.

  Noah straightened up. Who the hell could be visiting? All at once the memory of the man in the suit came back in a rush. He’d decided that the episode had been all in his paranoid imagination. But was it? Could this strange visitor somehow be associated?

  Then the buzzer sounded again. Knowing that he wasn’t going to find out anything unless he went down to the front door, Noah put his shoes back on. He looked around for some sort of weapon to defend himself if need be, but then dismissed the idea as coming from a sick, paranoid mind.

  When he got down to the front door, he debated what to do. Should he just open the door and face whoever was there? It seemed more prudent to call through the door and get some idea before opening up. “Who is it?” he yelled.

  “It’s Ava,” a woman’s voice responded.

  For a second, Noah was startled. It was as if his brain was momentarily scrambled. “Ava? Is that really you?” he asked incredulously. What he was doing was playing for time to recover. Without waiting for an answer, he struggled with the door to undo the dead bolt that was used after nine. A moment later he was staring at Ava, dressed in a businesslike pantsuit. The blond streaks in her hair gleamed in the harsh overhead entrance light.

  For a moment neither spoke. Finally, Ava said, “Well? Can I come in?”

  As if waking from a trance, Noah said, “Sorry! Sure, come in.”

  “Upstairs?” Ava asked.

  “Yes,” Noah said. “One flight.”

  He followed her up the stairs, feeling confused. While he was thrilled to see her, he was furious that she had disappeared and totally ignored him. “The door is unlocked,” he said as they reached the landing.

  He followed her inside his apartment and closed the door behind them. She had stopped a few feet from the door and let her eyes roam around the small, sparse room. “I’d describe this as minimalist,” she said.

  “That’s being kind,” Noah said.

  For a beat, they stared at each other. Noah was still fighting his emotions. All at once tears appeared in Ava’s eyes and spilled out onto her cheeks. Her hand shot up and covered her eyes, and for a moment she sobbed quietly, her shoulders shaking.

  Noah was beside himself with indecision. He didn’t know how to respond. But then charity won out and he stepped forward and enveloped her in his arms. They stood that way for a few moments until Noah led her to the small couch and encouraged her to sit down.

  “I’m sorry,” she managed. She wiped her tears from her cheeks with a knuckle, but it was a losing battle.

  “It’s okay,” Noah said. He went back to his bathroom and brought out a small box of tissues. She took one and noisily blew her nose. She took another and wiped her eyes. This time she was more successful.

  “I want to apologize to you for not contacting you,” she said when she was more in control.

  “Thank you,” Noah said. “Why didn’t you?”

  “I don’t know exactly,” Ava said. “At first I was just too distraught after being involved with another death. I’m still distraught, obviously. Anyway, I just wanted to get away and forget everything. I thought about quitting anesthesia.”

  “No!” Noah said without hesitation. “Don’t say that. Not after all your training and effort. You are a talented anesthesiologist. You wouldn’t be on the BMH staff if you weren’t.”

  “I never expected to be involved with one death,” Ava said. “Suddenly, it’s two. I thought that by constant studying, by constant attempts to make myself better, it wouldn’t happen. But it has.”

  �
�You know the expression ‘medicine is more art than science,’” Noah said. “It’s true. As a doctor, even if you do everything exactly right, things can disintegrate into chaos. There are too many variables. It’s part of the human condition.”

  “I thought I could be different. I thought dedication and commitment would be enough.”

  “We are all in this together,” Noah said. “We do the best we can. That is all that can be expected of us. You didn’t do anything wrong on either case. I know. I was there.”

  “You really think so? Honest?”

  “Absolutely! No question. I think you are a terrific anesthesiologist.”

  “Well, thank you. Your support means a lot to me.”

  “But it’s not going to be easy to put all this to rest,” Noah said. “I had several run-ins with Dr. Mason. The first was right after the M&M and the second after the Gibson death. I’m afraid he’s still on our case.” Noah went on to tell Ava the details about the two confrontations, particularly about Dr. Mason’s accusation that Noah was purposefully protecting her. He then went so far as to tell her that Dr. Mason suspected that they were having an affair.

  “Oh, no,” Ava said with consternation. “Why? How?”

  “He has no evidence,” Noah said quickly, alarmed at Ava’s reaction. “He came up with the idea out of the blue when he was talking with me, saying he couldn’t understand why I was protecting you. He wants to put you down because you’ve rebuffed him, and obviously, he saw through my ruse at the M&M of avoiding the anesthesia issue entirely.”

  “Do you think he has told anyone about his suspicions?”

  “I know he has,” Noah admitted. “I got called on the carpet by both the head of the Surgery Department and the head of the surgical residency program.”

  “They had the nerve to reprimand you for possibly having an affair with me?” Ava questioned with disbelief. She didn’t know whether to be insulted or more worried about the inevitable rumors.