Ava paused again. This time she resolved to wait for Noah to respond. Her expression was a contented semi-smile of the one in control, in sharp contrast with Noah’s clenched, thin-lipped, anxious grimace.
For a moment Noah looked away. Ava’s self-assurance and apparent amusement were galling, as he thought of himself as the injured party who should have been treated as such, rather than being toyed with like one of her cats playing with a mouse. When he looked back, he decided once again it was time to go for broke. What he didn’t expect was another surprise and an even bigger shock.
44
FRIDAY, AUGUST 18, 12:05 A.M.
“Let’s stop beating around the bush,” Noah said irritably. “I want you to tell me directly why you are so protective of your anesthesia training.”
“It’s simple,” Ava said, her smile broadening. “I don’t want people checking into my anesthesia training, because I didn’t do it.”
Noah’s jaw dropped open. Again he stared at Ava, but now it was in total disbelief. “Maybe you better tell me what you mean.”
“I am what you might call a modern-day charlatan, which is a world of difference from a charlatan in the past,” Ava said. “And I’m not talking about the kind of charlatan everyone is becoming today because of little lies on social media. I’m talking about being a full-blown charlatan but of a different ilk. I am a fully competent charlatan.”
“What part of your formal anesthesia training did you not do?” Noah asked with hesitation.
“None of it,” Ava said.
“I’m not sure I understand,” Noah said, dumbfounded.
“Let me explain,” Ava said. “Remember I told you I was giving anesthesia under the supposed supervision of my dentist boss, which wasn’t much supervision. What it did was make me very interested in the science of pharmacology and anesthetic gases. When we moved to Brazos University Medical Center, I started going to various lectures and even an anesthesia conference that the school sponsored. My boss was very encouraging. So I started reading in the field online, which turned out to be better for me than the lectures, since I could read with better retention and much faster than professors could talk. I found the information fascinating. I was also impressed with the salary and respect anesthesiologists got and wanted it for myself. I mean, I was kind of doing the same thing but as an assistant in a dental office instead of in an operating room. And I was doing it without the fabulous equipment and support of nurses and residents.”
“So let me understand,” Noah said with mounting incredulity. “You never did an anesthesia residency?”
“No,” Ava said. “I didn’t need to.”
“What about the anesthesia boards?” Noah asked, his mouth agape. “Did you take them?”
“Oh, yes, of course!” Ava said. “I took the boards and passed them with no problem. I even enjoyed them, as it was an affirmation of a lot of effort I had expended preparing for them.”
“But to qualify to take the boards you must do a residency,” Noah sputtered.
“That’s the usual prerequisite,” Ava said. “In my case it was different. I decided to skip the residency part as unnecessary and even exploitive. From my perspective, the residency is a way for the hospital to have people giving anesthesia for three to four years and paying them a pittance in comparison to what the hospital is charging for the service. And the supervision that they are supposed to get is often not all that great.”
“How did you manage to be accepted to take the boards?” Noah asked. He was flabbergasted and wasn’t sure if Ava wasn’t still toying with him.
“It was all relatively easy,” Ava said. “The critical event was moving from Brownfield to Lubbock when my dentist boss became dean of the new school of dentistry. As a founding faculty member, he had administrative status with the Brazos Medical Center computer. Using his log-in, I had full access. With my computer skills, it was not difficult to create an entire record for Ava London that matched the other anesthesia residents, complete with grades, evaluations, and letters of recommendation. What helped enormously was that the entire university and the medical center were growing geometrically. It was almost like a revolving door with new personnel, profiles, and résumés being uploaded daily. It also helped that the system had an almost nonexistent firewall, so I probably could have done it all without my boss’s log-in. But the log-in made it so easy. I was even able to insert pictures of myself with the real residents for the appropriate years.”
Noah found himself nodding. He could remember seeing the photo of Ava with the 2012 resident photo. As astounding as all this was, he was beginning to think she was telling him the truth. “What about your name change?” Noah asked. “When did that happen?”
“That didn’t happen until I had to take the U.S. Medical Licensing Examination,” Ava said. “That was when I needed the new identity. It was before I took the anesthesia boards.”
“So people think that Gail Shafter still exists,” Noah said.
“For sure. It was key,” Ava said. “Particularly my old boss, Dr. Winston Herbert, who is still dean of the Brazos University School of Dentistry. It’s why I keep a Facebook page in her name. Presently, she is working for a virtual dentist in Davenport, Iowa. I mean, at this point I suppose I could kill her off, but why? I enjoy contrasting my old life with the new. It makes me continuously appreciative of what I have achieved.”
“Good Lord,” Noah said. His head was spinning. “Who got the M.D./B.S. degree, Gail or Ava?”
Ava laughed. She was enjoying herself. “Of course it was Ava,” she said.
Although Noah was surprised at this news, he recognized that he shouldn’t have been. “In other words, you didn’t go to medical school, either?”
“Of course not,” Ava said. “Nor college, for that matter. That would have been a bigger waste of time than doing the anesthesia residency. I wanted to become an anesthesiologist. I didn’t want to waste time getting a general liberal-arts education, particularly not the kind you Ivy Leaguers think is appropriate.”
“So that means you are not even a doctor,” Noah snapped.
“That is a matter of definition,” Ava said. “I did take the USMLE as I said, and I did pass it with flying colors in the ninety-fifth percentile because I studied my butt off. According to the State of Massachusetts, I am a doctor. I have an M.D. license. They say that I am a doctor. I feel like a doctor, and I act like a doctor. I have the knowledge of a doctor. I’m a doctor.”
“What about the degree in nutrition?”
“Made up as well,” Ava said. “That was something I realized later that would come in handy. I just read about the field online.”
Noah closed his eyes and ran his fingers through his hair. This was all so incredible he was having difficulty wrapping his mind around what she was telling him. “I’m not sure I believe all this,” he murmured.
“Wake up, my friend!” Ava said. “Come and join the digital age in the twenty-first century! The basis of knowledge has changed. It is not hidden away any longer by professional societies, some more secret and restrictive than others. Knowledge of just about everything is now available online for everyone, not just the few who are lucky enough for whatever reason to go to the right schools. Even professional medical experience and expertise is available in simulation centers with computer-driven mannequins that are better in many respects to the real thing. With the mannequins, a student can learn to handle a problem by doing it over and over until it is reflex, like handling malignant hyperthermia. Most anesthesiologists have never handled a case of MH. I’ve handled seven, to be exact. Six with a simulator and one in real life.”