Charlatans

by Robin Cook

  “I’m not going to change my mind,” Ava said.

  Twenty minutes later, when Noah entered his apartment and collapsed dejectedly onto his tiny couch, he was furious with himself for not resisting the temptation to go on Ava’s computer. How could he have been so stupid? And then, to make matters worse, how could he have been even stupider to bring up his misgivings about her professional performance as an explanation? It had been like adding fuel to a goddamn fire.

  “You are fucking hopeless,” he said out loud to himself while he knocked his head multiple times with the knuckles of his fist. He knew he was terrible at navigating relationships, but this evening’s performance was a study in ineptitude, especially since they were just getting over a major misunderstanding, for which he now realized he was as guilty as she was. He should have responded to her initial text and let her know how he felt.

  Noah wondered how long it would take for Ava to come around, if she was going to come around. He recognized there was a chance she’d decide he wasn’t worth all the angst, preferring her social media activities as much easier and cleaner. Gloomily, his mind switched over to the letter he’d read on her computer screen. In some ways having graphic proof that she was figuratively in bed with the nutritional-supplement industry was almost equally as disturbing as being sent home. Prior to reading the letter he’d made a specific effort to ignore her involvement. Now he couldn’t. She was recommending defaming people who he felt were on the responsible side of the issue. That was serious.

  26

  FRIDAY, AUGUST 4, 3:50 P.M.

  The melodic alarm on Noah’s smartphone went off, breaking his concentration. He was on the eighth floor of the Stanhope Pavilion in what was still called the chart room, even though charts were relics of the past. Now all the information on each patient was in their EMR stored in the central computer, so the chart room should have been called the monitor room, but tradition played a significant role at BMH and the old name stuck. Noah had been busy going over all the appropriate inpatient records in preparation for work rounds that would begin at their usual time of 5:00 P.M., but in his usual compulsive manner, he liked to be up on all the patients even before rounds began.

  Noah had set his alarm to meet with Dr. Kumar, chief of Anesthesia, and he didn’t want to be late or, worse yet, forget. Noah stood up and pulled on a freshly pressed white jacket. He was nervous about the upcoming meeting. Deciding on doing it had not been easy, and he had argued the pros and cons for almost two days before making the plans.

  Clicking off the monitor, Noah headed for the elevators. Dr. Kumar had scheduled the meeting in his department chair office in Administration on the third floor. Although Noah would have preferred to meet someplace on the surgical floor to keep things more casual, Dr. Kumar had insisted, and Noah had been forced to agree, so even the formal setting was adding to Noah’s unease.

  The past week had not been Noah’s favorite. As a disturbing replay of the previous weekend, Noah had not heard from Ava. To avoid any repeat of the misunderstanding that had contributed to that unpleasant situation, Noah had sent her several texts, starting Sunday night. Each time he’d thrown any pretext of pride out the window and had apologized effusively for what he had done and, more or less, pleaded to get together to talk it out. Ava had responded once, late Tuesday afternoon in her signature terse style: I need a break.

  Wednesday Noah had changed tactics. He texted her that he thought they should at least get together to plan the following week’s M&M Conference, but she didn’t respond. It was becoming perfectly clear what she meant by “a break” was no contact. When they had had encountered each other by chance in the OR, she’d even avoided eye contact.

  In the beginning of the week Noah had struggled with a mixture of regret and remorse, but by Wednesday, when she chose not to respond to his text about the M&M, his feelings began to shift. Although he admitted he’d made a mistake violating her trust by accessing her computer, he began to sense the punishment was more than the offense warranted. The idea resurfaced that there was a disconnect with her current behavior and the intimacy he thought they had shared. Such thinking brought back Leslie’s warnings and his own concern that Ava might have been using him. It also reawakened his nagging misgivings about her training and competence. Feeling a flash of irritation over her lack of communication, he found himself wondering something he never thought he’d question: Could Dr. Mason be right about Ava?

  From Noah’s perspective, the problem with such an idea was that she had been hired by one of the best anesthesia departments in the country, which meant that she’d been seriously vetted way beyond having just passed the anesthesia boards and obtained a Massachusetts medical license. At a minimum, a complete file of her training, including letters of recommendation, would have been required. It was that fact that made him overcome his reservations about approaching Dr. Kumar.

  Noah pushed into the crowded elevator, which was occupied mostly by nurses leaving the hospital at the end of their shift. In contrast to the usual elevator silence, there was a lot of conversation. Noah stayed near the door, as he was only going to the third floor and not the ground floor.

  As the elevator descended, Noah thought more about the past week and why it was going to go down emotionally as one of his worst. Although he had tried the same defense mechanism for his heartache that he had used over the weekend, namely by concentrating on his work, he’d had less to do because he had done so much from Thursday through Sunday. He’d also felt reluctant to stay in the on-call room again, so he’d gone back to his apartment each night. The result was comparatively too much free time on his hands to keep from mulling over the situation with Ava. And on top of that, he’d had another one of his paranoid reactions.

  Although Noah couldn’t have been certain, it seemed to him that the same man in the dark suit who had followed him a couple weeks earlier reappeared and followed him again late Tuesday evening. This time Noah had taken a particularly circuitous route, going through Louisburg Square to gaze longingly up at Ava’s lighted study window. Each time he had turned a corner and glanced back the man had been there, seemingly talking on a cell phone. Noah had first noticed him in the Boston Common. When Noah had arrived back at his building on Revere Street, he’d pulled off the same maneuver of getting his door quickly locked behind him, only to see the man again walk by without so much as a glance in Noah’s direction.

  Although Noah had again attributed this episode to his overwrought emotional state, he didn’t impute it to his imagination when he got upstairs to his apartment to find his door had been forced. Since it had happened five times over the past two years, most likely thanks to the woman college student who lived above him and who had a lot of after-hours fellow-student male visitors to whom she gave front door keys, he wasn’t terribly surprised or concerned, a testament to how the human mind could adapt to an inconvenience if it happened often enough. After the first four episodes, he’d complained to the landlord, who’d patched his door, but after the last he hadn’t even bothered to do that. After all, there wasn’t much to steal in his unit beyond his aged laptop. He didn’t even have a TV. Although he’d been initially thankful his computer was still on the card table on this occasion, he did become moderately concerned when he realized someone had been using it!

  As a surgeon, Noah had some compulsive traits, like a lot of his colleagues. One of the traits involved how he dealt with his tools, and in his mind tools included electronics. He was very particular about the way he handled his laptop, which had caused a good deal of merciless teasing by Leslie, who thought it silly that he insisted it be lined up with the edges of the table. Frequently she’d move it just to playfully aggravate him. Tuesday night it was as if Leslie had been there.

  Recognizing someone had been on his computer, Noah had immediately checked his bank account information. When that had seemed okay, he’d checked his browser’s history to find that it had been wip
ed clean, including what he had done the previous night. It was apparent someone had used his computer and then had covered his tracks. After checking all his documents, including his surgical case log, which thankfully didn’t include any personal patient information, Noah hadn’t known what to make of the incident and had tried not to dwell on it, although it had fanned his paranoia.

  When the hospital elevator arrived on Stanhope 3, Noah got out. As he hurried along the administration corridor, he checked his watch. He still had a full five minutes before the scheduled 4:00 meeting.

  It turned out that Dr. Kumar was about twenty minutes late, but he was gracious about it. He came directly over to where Noah was waiting in a common waiting area and apologized. He explained he’d been called in on a problematic cardiac surgery case and had come down as soon as he was free. Noah assured him there was no problem, explaining he’d enjoyed the brief respite from a typically busy day. Dr. Kumar then led Noah into his office, the decor of which had an Indian motif. There was a collection of framed Mughal miniatures on the walls.

  “Please have a seat,” Dr. Kumar said in his charmingly melodic Indian accent. He was dressed in a long white coat over scrubs that emphasized his darkly burnished skin tone. He went around and sat behind his desk, putting his elbows on the surface and clasping his hands below his chin.

  “I assumed when you requested this meeting that the subject would be Dr. Ava London,” Dr. Kumar said. “That’s why I thought it best to meet down here rather than upstairs. Let me say at the outset, there is no need for you to worry about her tenure here at BMH, despite Dr. Mason’s recent comments. He is a passionate man, but I have spoken with him about Dr. London since his outburst at the M&M, and I believe he feels differently now. Does that put your mind at ease? And, by the way, I believe you handled both M&M conferences superbly, from the Anesthesia Department’s point of view.”

  “Thank you,” Noah said. “I tried my best to present the facts.”

  “You did a superbly diplomatic job.”

  “I thank you again,” Noah said. “I did want to talk with you about Dr. London, but for a different reason.”

  “Oh?” Dr. Kumar questioned. He visibly stiffened. His clasped hands lowered to the desk surface.

  “There were a few aspects of Dr. London’s performance that I did not mention in my presentations but which I feel is my ethical duty to bring to your attention.”

  “I’m listening,” Dr. Kumar said, with his voice changed. It had hardened a degree, but Noah pressed on.

  Noah started with the Gibson case, followed by the Harrison and then finally the Vincent, describing in as much detail as possible his mild, and purely subjective, misgivings about Ava’s performance. When he was finished, a heavy silence reigned. Dr. Kumar stared back at him with his penetratingly dark, unblinking eyes, making Noah uncomfortable. The man had not shown any reaction during Noah’s monologue.

  Noah felt an irresistible urge to add: “With the Gibson case I was directly involved, meaning I saw the situation. With the other two cases, what I’m relating is hearsay from a circulating nurse or Dr. London.”

  When Dr. Kumar still didn’t respond, Noah said: “My motivation for coming to you is for you to hear my concerns and either substantiate them or dismiss them as you see fit. I haven’t said anything to anyone else and don’t plan to do so.”

  “I find this all very troubling indeed,” Dr. Kumar snapped. “These are all very vague and, as you say, subjective observations. Our department and I have looked into these three cases with close attention to detail and found nothing wrong. If anything, Dr. London handled them very appropriately, if not superbly. Consequently, I can’t help but take your comments as a value judgment of my leadership skills and my competence as an administrator, since I was personally responsible for hiring Dr. London.”

  Noah was flabbergasted. Instead of being thankful of his efforts, Dr. Kumar was taking his visit as a personal affront.

  “There is only one question about Dr. London’s résumé,” Dr. Kumar said angrily, “and that is that she trained at a new, relatively unknown institution. But because of that, I and the faculty hiring committee went over her application with great care. And something else you might not know: Dr. London scored remarkably well on her anesthesia boards, both written and oral. I spoke to several of the examiners directly. She’s also passed muster with the Massachusetts Board of Medicine.”

  “I certainly knew she had passed her anesthesia boards,” Noah said. “And I had heard she had done exceptionally. I am not surprised. She knows the science remarkably well.”

  “We wouldn’t have hired her otherwise,” Dr. Kumar said with obvious annoyance. “And let me say this: If you continue to defame Dr. London by talking with others about these unsubstantiated and, frankly, vague impressions, you could be putting yourself and the hospital in a difficult legal situation. Am I making myself clear?”

  “Perfectly clear,” Noah said. He stood up. It was painfully obvious that coming to Dr. Kumar had been a big mistake.

  “Dr. Mason told me that it was his impression that you and Dr. London were having an affair,” Dr. Kumar added. “Is that now on the rocks, and are you coming to me out of spurned lover’s spite? Honestly, that’s what it sounds like.”

  Noah stared at the Anesthesia chief with total disbelief. It was such an outrageous idea that Noah suddenly questioned if Dr. Kumar himself was a spurned lover of Ava’s. And what about Dr. Mason? Could his anger be from spite based on more than just having his advances rebuffed? From the little Noah had told Leslie about Ava, she had classified Ava as a manipulative person with a possible personality disorder. Could Leslie be right? Yet the moment the shocking idea of Ava’s possible promiscuousness occurred to him, Noah immediately dismissed it out of hand, sensing his paranoia was running away with itself. Dr. Kumar was not behaving like a spurned lover in the slightest. He wasn’t putting Ava down but rather the absolute opposite. He was truly convinced of Ava’s competence, as well as his own leadership abilities for having hired her. And it was his leadership that Noah was challenging by voicing his misgivings.

  “My only motivation is my ethical duty,” Noah said. The last thing he wanted to do was get into any kind of discussion about his relationship with Ava. “Thank you for your time.”

  Noah started to leave, but Dr. Kumar stopped him. “One last piece of advice: In the future, if you have any concerns about people in my department, I advise you to go through channels. You should speak with your chief, Dr. Hernandez, and not to me. Am I making myself clear?”

  “You are,” Noah said. “Thank you for seeing me.” He turned and left. As he headed back to the elevators, he mocked himself for previously thinking that he was making progress in the diplomatic arena. It seemed that handling staff egos at the BMH was certainly not his forte. In retrospect, there was no doubt in his mind that it had been a remarkably poor decision to seek out the Anesthesia chief. Worriedly, he wondered if Dr. Kumar would mention their tête-à-tête to Dr. Hernandez. Unfortunately, he thought the chances were better than good.

  27

  MONDAY, AUGUST 7, 2:38 P.M.

  Mondays were always difficult for Noah, even though he’d spent the entire weekend at the hospital, searching for things to do to avoid obsessing over Ava’s continued silence. Although he was completely caught up on all his responsibilities, the Monday surgical schedule was particularly heavy as every attending wanted OR time and pressured Noah to provide it. Everyone felt it was far better to get their cases done earlier in the week, the better so that by the end of the week patients could be sent home, which was more pleasant for patients and surgeons alike. To add to his burden, Noah had three of his own cases. Luckily, those had gone well, so he now had time to finish one of the projects he’d started over the weekend.

  Changing out of his scrubs, Noah headed to the surgical residency program office. The administration area was in full sw
ing, especially around the hospital president’s massive corner office. As Noah passed the anesthesia office he cringed, thinking of the unpleasant meeting he’d had with Dr. Kumar Friday afternoon. So far there had been no fallout, but Noah was quite certain it would happen, maybe even later that day.

  Noah’s goal was to pick up some files from Shirley Berenson, the surgical residency program coordinator, who managed the complicated resident evaluation process upon which the program’s accreditation depended. Every month each resident was evaluated as to his or her progress in a wide variety of arenas, such as surgical skills, patient care, medical knowledge, attendance, timeliness, and a host of other subjective attributes such as professionalism and communication skills. As super chief, it was Noah’s responsibility to get the completed forms from all chief residents evaluating the residents under their tutelage for the month. Noah had done this on Saturday. On Sunday, he had used this material to help him fill out his own evaluations of all fifty-six residents, including all the chief residents, and put all the paperwork in Shirley’s inbox. Since it was Noah’s first attempt at this process, it had taken him longer than he’d expected. And he wasn’t finished.

  Shirley had told him that she would collate all the material, fill out the required regulatory forms, make four separate copies of the complete report, and have them all done by noon. At that point it was Noah’s job as super chief to deliver a copy to Drs. Hernandez, Cantor, Mason, and Hiroshi. Why it had to be the super chief to act as delivery boy, Noah didn’t know, but he assumed it was a holdover from days past, when a certain amount of hazing was part of surgical training. The next year, by tradition, Noah was to become a member of the BMH staff, and accordingly he had to be appropriately humbled before he joined the august community.