Leaving his final scheduled case for the day, an open cholecystectomy, or gallbladder removal, Noah again looked for Ava. Seeing that it was past 3:00 when her shift ended, he checked the PACU, where he had run into her the day they had their first real conversation. But she wasn’t there. Checking the scheduling board, he saw that her last case had finished almost an hour earlier, meaning she’d most likely left the hospital on time.
Disappointed not to have even made eye contact during the day, Noah looked forward to seeing her that evening at her house. Although he’d been staying with her almost every night since she’d gotten back from Washington, he hadn’t the previous night, due to emergency surgery that had kept him in the hospital. As he sat down in one of the dictating booths, he found himself fantasizing about the upcoming evening. There was a wine shop on Charles Street appropriately called Beacon Hill Wine, and he planned on stopping in and getting a bottle of champagne to celebrate the outcome of the M&M. At least she was out of the woods, even if he wasn’t.
Just before Noah began his dictation, he made up his mind to call Ava a bit later to find out her thoughts about take-out that night. He even entertained the possibility of their going out to an actual restaurant, either that night or over the coming weekend. He had no idea how she might respond, but it seemed like a fun idea. And why not? Wasn’t the cat out of the bag? With what Dr. Mason had publicly said at the M&M, it probably wasn’t possible to maintain the secrecy of their affair even if they continued overtly to ignore each other in the hospital.
When Noah was finished with the dictation, he went back into the PACU to make sure everything was fine with the cholecystectomy patient. When he had left the OR, the operation hadn’t been totally over. The six-inch incision in the right upper abdomen was still open. This was standard protocol in a teaching hospital. With the open gallbladder removal, Noah had brought in a first-year resident to provide traction. When the key part of the operation was done, it was standard protocol for the most senior resident, meaning Noah, to leave so that the next senior resident, Dr. Klim, could teach the first-year resident basic suturing technique.
Noah briefly glanced over the postoperative orders, which the first-year resident had written, again under the auspices of the third-year resident. This was par for the course and hadn’t changed in years. Medical education in general hadn’t altered much over the last century, despite everything else involving medical science and technology being drastically different.
Noah hurried back to the surgical lounge to change into his whites. He had an enormous amount of work to do above and beyond work rounds and seeing his private patients. Now that the M&M was over, there was a lot of catching up to be done, which he intended to do and still leave the hospital close to 6:00. If it was at all possible, his hope was to get to Ava’s before she started her workout so that by the time she was finished showering, he’d have their celebratory feast, including champagne, ready to be enjoyed.
Almost at the exact moment he hurriedly pushed into the men’s surgical locker room, Noah felt his phone buzz with a text. Curious who might be texting him on his phone rather than his hospital tablet, which was where he received the vast majority of his messages, Noah pulled out his phone and was happy to see it was a text from Ava. With a mixture of titillation tinged with relief to finally connect with her, he opened it.
Noah stopped in his tracks, his euphoria evaporating. With almost total disbelief, he read over the message multiple times. It was brief: On a business trip for a few days. Will text when I return.
Noah sank down on a low bench, still holding the phone in his hands, staring at the screen in dismay, amazed that Ava would be insensitive enough to send such a short, emotionally unexpressive text. Under the circumstances, it seemed almost deliberately cruel. Either that or she lacked empathy, although either explanation seemed equivalently heartless. Immediately, the question rose in his mind about how long she had known about this trip or whether it was something that had happened that afternoon as a response to a lobbying emergency, if there was such a thing. He hoped it was the latter, because if it wasn’t, she should have told him she was going the moment she’d heard about it.
As Noah thought more about this totally unexpected development, he realized she must have some days off, as she had worked more than a week straight, including the entire past weekend. At the time, Noah hadn’t questioned it, because he worked every day and every weekend as a matter of course. The idea it was rare for her to work more than five days in a row hadn’t even entered his mind. But why didn’t she bring it up last night that she was scheduled to be off tomorrow?
“It must have been an emergency,” Noah said out loud in a vain attempt to buoy his sagging emotions. “Surely she must have been in a rush, and I’ll be hearing from her with all the details.” But the attempt to make himself feel better didn’t work. It would have been so easy for her to express some emotion; even just a few words would have made a complete difference.
He tried to rally his injured self-esteem by coming up with another potential explanation. With all the time she devoted to social media, maybe it didn’t even cross her mind that he might be sensitive about not being told in advance. Her constant communicating in a virtual world without all the rich, nonverbal aspects of real-time, face-to-face interaction had probably made her less sensitive to nuances of other peoples’ feelings. By her own admission, she spent most of her free time in a world where everything could be handled by a mere click of the mouse, and whatever interaction was in progress was gone without consequence. Considering all the wonderful intimacy they had enjoyed together that week, there was no way she would have wanted to upset him. It had to be more oversight than purposeful.
Feeling a strong need to be proactive rather than just sitting there feeling sorry for himself, Noah leaped to his feet. He quickly changed out of his scrubs and into his normal hospital clothes. He even decided to stop by the laundry and get a freshly cleaned and pressed white jacket to look his best. For Noah, work had always been his fallback. It had been the way he’d handled Leslie’s departure.
Fifteen minutes later, Noah was on the surgical floor, rallying the troops by calling for afternoon work rounds to begin earlier than usual. With a burst of energy, he goaded all the residents to the max, demanding particularly thorough and up-to-date presentations on all the patients as they went room to room. He quizzed everyone on the latest journal articles apropos of each case, turning afternoon work rounds into teaching rounds.
When rounds were done, Noah visited each of his own inpatients and had lengthy conversations about their progress and what they should expect over the next few days, discharging three of them. Noah then visited two patients who were scheduled for surgery the next morning. Both had been transferred from hospitals in the western part of the state, where their surgery had been botched and needed to be redone.
With no more work to be done on the surgical floor, Noah retreated down to his desk in the surgical residency program office. Since it was now well after 5:00 P.M., he happily found the place empty. His intent was to read the journal articles for the following day’s Journal Club, but instead of calling them up on the monitor as planned, he had a different idea. Although his initial intention was to visit the Annals of Surgery, he googled Brazos University instead.