Noah was sorely tempted to bring up the issue of his inappropriately pressuring the first-year anesthesia resident to begin the case before Ava as the supervisor was in the room, but he held his tongue. He felt it wasn’t the time or place, as the man was already irate and it would serve no purpose other than to inflame the situation.
“In all my experience I have never seen a more difficult patient to intubate,” Ava said with a voice that seriously quavered. Noah understood immediately that she was making an attempt to support Carla, which impressed him because he could tell from getting to know her that she was devastated by the episode herself. Up until the Vincent case she’d never had an operative death. Now she had been involved in two.
“What made it so goddamn hard?” Dr. Jackson spat. “You’re supposed to be professionals at putting in endotracheal tubes.”
“It was a combination,” Ava managed. Her voice broke with emotion, almost anger. She took a deep breath to calm herself.
“It is apparent that her neck is deformed,” Noah said, coming to Ava’s rescue. He didn’t want the conversation to get out of hand. “It is flexed and fixed. And the patient is moderately obese. That contributes. Isn’t that right, Dr. London?”
Ava nodded.
“Well, wasn’t that taken into consideration?” Dr. Jackson snapped, looking directly at Ava. “This is your specialty, for God’s sake.”
“I didn’t know about the neck,” Carla said. From the sound of her voice, she was as anguished as Ava.
“You mean to tell me it wasn’t in the ER resident admitting note?” Dr. Jackson demanded.
“It wasn’t,” Carla managed. “There was nothing about neck problems.”
“Good God!” Dr. Jackson voiced. He turned to Noah. “This morning we hear about a resident who didn’t even do an admitting note. Now we hear about a resident leaving out a mighty important finding that’s indirectly caused this patient’s death. That’s your department, Mr. Super Chief. Sounds like I’ll need to talk to Dr. Hernandez as well as Dr. Kumar.”
“I will certainly look into it,” Noah said. Inwardly, he groaned. At that morning’s M&M he’d barely avoided a personal disaster, and now he was facing another potential one for the next M&M.
“You’d better!” Dr. Jackson barked. He tore off his gloves and threw them to the floor. He did the same with his surgical gown. After that juvenile show of misplaced anger, he left the room.
While Doctors Wilson and Wong gathered up the cardiac-arrest paraphernalia and Dawn disgustedly picked up the discarded gloves and gown, Noah turned to Ava and Carla, particularly looking at Ava. He wanted to say something supportive if not give her a reassuring hug, but he didn’t dare. Instead he merely nodded, hoping to communicate his concern in some nonverbal way. “Sorry,” he said simply. He held her eyes for a moment with his own, but she didn’t react. Then he, too, left the room.
As Noah hurried back to room 18 he thought again of the next M&M, wondering if they were going to be his bane for the entire year. At least on this case he wasn’t going to be harassed by the concurrent-surgery issue, which was a definite plus. On the negative side, he would be dealing with an unleashed Dr. Mason, who normally was an active participant in M&M discussions. Noah knew full well that during the next one, Dr. Mason wouldn’t be constrained as he had been that morning in his role as the involved surgeon. What Noah was already worrying about was Dr. Mason’s reaction to Ava’s being involved in yet another death, because he obviously still blamed Vincent’s on her.
Intent on getting back to OR 18 as soon as possible to apologize and explain his absence in case they hadn’t heard, Noah practically collided with Dr. Mason, who had just emerged from room 15. He was in the process of removing his surgical mask and not looking where he was going. Noah’s heart skipped a beat.
“Ah!” Dr. Mason exclaimed, seeing who he was confronting. “Just the person I wanted to find.”
Instantly, Noah’s fears were confirmed. Mason knew. It was confirmation that bad news traveled quickly around the OR, especially when the PA system played a role.
“I’ve got a case in room number eighteen and I’m awfully late,” Noah said. He tried to detour around his antagonist, but Dr. Mason blocked his way.
“So, my friend,” Dr. Mason said sarcastically, “are you proud of yourself now?”
“Excuse me?” Noah asked. He was confused. Proud? Why would he be proud after what had happened?
“You get to take some credit for what just happened in OR number eight,” Dr. Mason explained. He was sporting a nasty smile. “You more than anyone else have been supporting that incompetent bitch of an anesthesiologist, and now you are being rewarded with another unnecessary death.”
“Dr. London was only the supervisor on the case,” Noah said, but as soon as he said it, he wished he hadn’t.
“And you think that exonerates her? Bullshit. She shouldn’t be supervising anyone. Somebody needs to supervise her. We’re supposed to be one of the best hospitals in the whole damn country, if not the best, and we lose two healthy young people in two weeks? There’s something wrong with this story.”
“There were complications,” Noah said.
“Complications, my ass. I heard that she couldn’t even get a goddamn endotracheal tube in. Simple as that. I never heard of an anesthesiologist who couldn’t get an endotracheal tube in, not with all the tricks they have up their sleeve.”
“Dr. London wasn’t even in the room when the problem began,” Noah snapped.
“That’s an explanation? Give me a break! Where the hell was she?”
“She was supervising an induction on another case,” Noah said. “It’s an Anesthesia rule that the supervising anesthesiologist be in the room throughout the induction process. The attending surgeon on the case in question was insistent a new first-year anesthesia resident start even though the supervisor wasn’t immediately available.”
“So it was Dr. Jackson’s fault?” Dr. Mason questioned superciliously. “That’s bullshit. That’s like me being to blame for the Bruce Vincent fiasco.”
“I’m not saying it was Dr. Jackson’s fault,” Noah said. “But what I am saying is that he shouldn’t have been encouraging a new resident to break the rules.”
“Let me ask you something, Dr. Rothauser,” Dr. Mason said. “Why do you protect this bitch? I don’t understand. You’re a smart man. I mean, I’ve been asking myself this question over and over.”
“I’m not protecting anyone,” Noah said. “I try to see the whole picture and get all the facts. I will certainly be investigating this case, as it will obviously need to be presented and discussed.”
“Wait a second!” Dr. Mason said. A slight smile formed with his narrow lips. “I’m suddenly seeing the light. I bet I know why you are protecting her. You want to know what I think?”
“I’m not protecting her,” Noah said. “I don’t protect anyone who doesn’t deserve it.”
“Here’s what I think,” Dr. Mason said. “Have you been banging her? Tell me straight! Have you and she been getting it on? One thing I can give her credit for is having a decent body, and she’s got a house in a hell of a neighborhood.”
Noah’s mouth went dry, and for a moment words abandoned him. He stared at Dr. Mason with shock, wondering just how he had known. He and Ava had been so careful, almost obsessed with their secrecy.