Noah was about to leave the operating room when the circulating nurse approached him. He knew her reasonably well. Her name was Dorothy Barton. Noah thought of her as competent and knowledgeable but also moody and opinionated, such that he generally made it a point to avoid her. He was surprised when he saw her making a beeline in his direction. He wished he hadn’t dallied.
“Dr. Rothauser,” Dorothy said. She glanced over her shoulder as if concerned someone might be listening. “Can I have a word with you?”
“Of course,” Noah said. “How can I help?’
“Do you mind if we go into the supply room?”
“I guess not,” Noah said. It was an unexpected request. He followed her back into the room he’d just left. He wondered if she had seen him and Ava in an embrace, and if so, he tried to think up an explanation. But he needn’t have worried. She wanted to speak to him about Ava, but not in a way he could have anticipated.
“I noticed something that I think you should know,” she said. She was a heavyset woman shaped like a box, with broad features and thick lips. Her face mask was untied from behind her head and draped over her ample chest. “I’ve had the misfortune of being involved in two malignant hyperthermia cases. The first was at another hospital. So I know something about the condition and what should be done when it occurs. Dr. London did not turn off the isoflurane when the problem started.”
“Oh,” Noah commented. “Did she leave it on long?”
“No, not long, but it wasn’t until I’d come back to her after following her orders to send out the alarm, which I did by using the phone.”
“I see,” Noah said, but his attention was diverted by an insistent knocking on the wire-meshed glass pane in the door to the OR corridor. Turning his head, Noah caught a glimpse of the last person he wanted to see, Dr. Mason. When the visibly livid surgeon saw Noah look in his direction, he angrily gestured multiple times for Noah to come out into the OR corridor on the double.
“Sorry, but I have to go,” Noah said hastily to Dorothy. “Thanks for the info and for being so attentive. I’ll certainly take it into consideration. But right now I’ve got to talk with Dr. Mason.”
Bracing for yet another tongue-lashing, Noah abandoned the surprised nurse and stepped out into the OR corridor.
“I hope you are fucking happy,” Dr. Mason snarled. “This is the last straw. This poor child’s death is one too many, and since you have been protecting this woman whose incompetence is directly responsible, it’s now on your shoulders, too.”
“This was a case of malignant hyperthermia,” Noah said, trying to remain calm in the face of Dr. Mason’s fury. He knew that by talking back to Dr. Mason, he was taking a chance of further inflaming the man, but he couldn’t help himself. “It was a bolt out of the blue, and it had nothing to do with anyone’s supposed incompetence.”
“Three deaths in three weeks?” Dr. Mason practically shouted. “If that’s not incompetence, I don’t know what is.”
Noah thought of a good retort for his last comment, but he wisely held his tongue.
“This has gone too far,” Dr. Mason snapped. “I’ll tell you what I’m going to do. I’m going to have a heart-to-heart conversation with the chief of Anesthesia. I was tempted to do so after the first two disasters, but now I’m going to do it for certain. I want her to be given her walking papers and be gone. And then I’m going to do the same with Dr. Cantor about you. Your days are numbered. Three preventable deaths are totally unacceptable.”
Dr. Mason stared at Noah, defying him to defend himself. When it was apparent Noah wasn’t going to try, Dr. Mason spun on his heel and stomped away.
Noah watched the man recede and then disappear from the OR suite, presumably heading to the surgical lounge. Noah was momentarily paralyzed. The death of the boy, the worry about Ava, and now these threats from Dr. Mason combined to make him feel drained of emotion. He didn’t think Dr. Mason would be any more successful on this occasion in getting Ava or himself fired, but it was anxiety-producing and worrisome because it was making a bad situation that much worse, especially since Dr. Hernandez had specifically ordered him to do something about the poor relationship he had with Dr. Mason.
Noah sighed and shook his head. He had no idea how to deal with Dr. Mason even in the best of circumstances. With the M&M coming up the day after tomorrow, which Dr. Mason threatened to make memorable, combined with this new malignant hyperthermia death, Noah feared things were going to get worse before they got better.
20
MONDAY, JULY 24, 7:15 P.M.
As Noah climbed Ava’s front steps, he glanced at his watch, realizing that it wasn’t the best time for him to be arriving, since she would still be involved with her workout. He’d been held up when one of his post-op patients had spiked a fever.
Noah had not spoken with Ava after she had walked out of the supply room. He’d thought about calling her to ask if he should stop for take-out food as per usual, but he’d decided against it, thinking it best to leave her alone, hoping she had found something to occupy her mind.
After pressing the doorbell, Noah prepared himself for a wait and possibly the need to ring the bell several times. He knew that Ava and her trainer invariably had music blaring in the workout room as they went through their routine. He was surprised when the door buzzed open almost immediately, and even more surprised to confront Ava when he entered.
“Hello,” Noah said, giving her a hug. She didn’t respond but didn’t turn away, either.
“Are you okay?” Noah asked. He stepped back and looked at her. Her face was unnaturally flaccid, almost expressionless.
“I’ve been better,” she said. Her voice was flat and lifeless.
“I thought for sure you’d be working out.”
“I canceled the session,” Ava said. “I wasn’t up to it.”
“Are you depressed?” Noah asked.
“Obviously.”
“What can we do to cheer you up? Are you hungry? I can bring us back some take-out or we could go out like normal people. What do you say?”
“I’m not hungry. But you can go and get yourself something.”
“I can wait. Let’s talk. Should we go up to the study?”
“Whatever.”
Once they were in their customary chairs, Noah tried to think of what to say. He knew he wasn’t particularly good at psychiatry or talk therapy of any sort. As a surgeon who was accustomed to facing problems head-on with action, he’d never given the field much thought or credence. Yet he felt he knew a bit about depression, having recently dealt with a mild case himself after Leslie Brooks walked out of his life. More important, he had also managed to deal successfully with the issue when his mother had been diagnosed with early Alzheimer’s and he had to drop out of medical school. “Let me ask you this,” he began. “Have you ever had any problem with depression?”
“Yes,” Ava said. “In middle school, mostly around the time I told you I got cyberbullied. Depression, eating problems... I had the usual complement of symptoms associated with poor self-esteem.”
Noah inwardly recoiled, sensing he was already out of his comfort zone, the way he imagined a psychiatrist might feel if he were suddenly forced to do an appendectomy. “Other than the online harassment, was there ever any specific event that made you depressed?”
Ava didn’t answer right away but rather stared at Noah while nodding almost imperceptibly, as if she were struggling with Noah’s question and debating how or whether to respond. Noah resisted a strong impulse to say something to ease the moment, but he was glad he didn’t.
“There was an event that really bowled me over and made me seriously depressed,” Ava said finally. “It was when my oil-executive controlling bastard of a father committed suicide by blowing his brains out. I was just sixteen, a junior in high school.”