“So you really did use the simulation center?” Noah said. It was a statement more than a question.
“Absolutely,” Ava said. “Like there was no tomorrow. Within months of my arriving at Brazos University Medical Center, I started my quest to become an anesthesiologist by using the simulators almost every night when the medical students and the residents had gone back to their beds. I did it religiously. I even started writing programs and to trouble-shoot the system because initially there were a lot of bugs in it. But it was a fabulous way to learn, so much better than the standard methodology. It is almost a crime that medical teaching hasn’t been altered for a hundred years, still adhering to a paradigm that started back in 1910, for God’s sake. It’s almost unbelievable because everything else about our culture and technology has changed drastically. Don’t you find it embarrassing that medical education is the most backward of all the pedagogies?”
“I guess I haven’t given it that much thought,” Noah said.
“Well, I certainly have,” Ava said. “Do people really need four years of college to be a terrific doctor? Hell, no! Maybe they did in 1910, but not now. Maybe they think they have a richer life, but even that is open to question. Do people need four full years of medical school to be a terrific doctor? I don’t think so. Maybe they did in 1910, when most medical schools were for-profit diploma mills and a bad joke. Do people need to do research for a couple of years? Hell, no, again, unless they choose research as a career. Otherwise it’s like treading water. The proof of all this is that I am a damn good anesthesiologist, better than some at the BMH whom I have been able to observe, and I have handled more than three thousand cases and supervised my share of residents and nurse anesthetists.
“Now, I know you have had some misgivings about the three recent deaths I’ve had. And believe me, they disturbed me more than anyone because they were my first and hopefully my last. But let’s reassure you yet again that it wasn’t my lack of having had a formal anesthesia residency that was responsible. With Bruce Vincent, we both know that it was the pigheaded Dr. Mason, his fellow, and the patient himself who were at fault. With the Gibson case the problem lay with the departmental rule that it was appropriate for me to supervise two concurrent resident anesthesia cases at the same time and that the resident did not wait for me to be in the room before starting, as I was busy elsewhere. It also didn’t help that there was a computer glitch that created two records, one with the information about the patient’s neck problem and one without, which was the one that the anesthesia resident got. And the malignant-hyperthermia case could not have been handled any better than it was, despite the outcome. This was determined when it was reviewed. And I can tell you that the majority of the anesthesiologists at the BMH have never handled an MH case, either real or virtual. I don’t doubt that they could, but if it were my life on the line, I would rather have me there than them because of my experience. As for why the scrub nurse would tell you I didn’t turn the gas off immediately, I have no idea, because for me it was reflex. Maybe she is upset I am an anesthesiologist and she a nurse, or maybe it is that I am younger and more attractive. Who the hell knows...”
Ava suddenly threw up her hands as if she were surrendering and sat back. “That’s it,” she said. “That’s the whole story, and you are the only person who knows it.” Slowly she lowered her hands, watching Noah expectantly.
“Why have you told me all this?” Noah said. “Why put the burden on me?”
“Two main reasons,” Ava said. “First, to save your skin, and second, your career. The NSC sees you as a major threat in regard to me and has let ABC Security know how they feel. Use your imagination for what that might mean! The second reason is that I like you, and we are in many ways ‘two peas in a pod.’ That is a compliment. I enjoy your company. If you want to know the truth, initially I saw you only as a way to deal with the Dr. Mason problem without involving ABC Security. But that was before I got to know you.”
“I enjoy your company as well,” Noah admitted. “But—”
“There cannot be any ‘buts,’” Ava interjected. “You have to let sleeping dogs lie. I’ve gone out on a limb for you. I know from your perspective I’ve gotten to where I am today following a unique path that you don’t agree with. But understand that I am the future. Medical education is going to change dramatically in the next five or ten years. It has to change. It took me ten years to get where I am, but I had to work to support myself while I was doing it, and if I didn’t, it would have taken half the time. It is inevitable that becoming a specialist like an anesthesiologist will soon take, say, six years or even less from high school to board qualified instead of the current twelve. The costs of healthcare have to go down, and one of them is the cost of training doctors like anesthesiologists. Hell, it’s more like a trade than we like to admit.”
“I don’t think I can do what you are asking,” Noah said. “As a real doctor, I’m afraid that I will feel an ethical responsibility to expose you as the charlatan you are. I’m sorry. Maybe you are right about medical education. Perhaps it is behind the times as you say, but I don’t think I can be the judge and jury.”
“I’m sorry to hear you say this,” Ava said. “If you do out me, then I will feel equally obligated to do the same for you.”
“What do you mean?” Noah asked hesitantly. The fears he’d felt earlier came back in a rush.
“I mentioned a few minutes ago that Keyon and George, using the investigative powers of ABC Security, came up with a few secrets of yours that are certainly more prejudicial than some temporal data fudging on a Ph.D. thesis. Would you like to hear what they discovered?”
Noah nodded reluctantly.
“First and foremost, it was determined that your father did not die of a heart attack but rather is in prison and will be there for a long, long time, possibly for life for drug trafficking, attempted murder, money laundering, and a few other odds and ends amounting to an impressive felonious résumé. His name is Peter Forrester, and your name was Peter Forrester Jr. until it was legally changed to Noah Rothauser, with Rothauser being your mother’s maiden name. I like the choice of Noah, with its biblical connection. Should I go on?”
Noah didn’t move, nor did he even blink, yet perspiration appeared on his forehead as evidence of his inner turmoil.
“I’ll take your silence as a yes,” Ava said. “It was confirmed that you, too, were arrested with your father when you were fourteen for abetting some of your father’s activities, and you too went to prison in South Carolina for a time, but as a juvenile offender, since it had been judged that there had been an element of coercion involved. It was also confirmed that you were released at age eighteen and your felony record was sealed. Unfortunately for you but fortunately for us, nothing disappears in the digital age. In the old days, a page was literally torn out of a court log and thrown away. Today, there is no way to make a record such as yours vanish, and the ABC Security investigators, mostly Keyon and George, found all of it. Now, there were some commendable aspects to your backstory, such as you getting your high school diploma with some AP credits while in prison as evidence to your rehabilitation, to the delight of the prison officials. It is also impressive that the warden, hearing of your desire to become a doctor, made great efforts to get you accepted into Columbia University.”