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The only surprise for Noah had been Dr. Mason’s total silence during the hour-long proceedings. Although Noah had been told by Keyon and George that they had uncovered some potentially compromising information about Dr. Mason, which had been communicated to him, Noah had suspected the worst from his long-time antagonist. He hadn’t known why it hadn’t happened until last night at Ava’s.

As they had eaten their dinner overlooking her garden, she’d explained that Keyon and George had discovered that Dr. Mason had made it a habit over the years to insist that Arab sheiks from the Emirates and Saudi Arabia provide progressively extravagant gifts for the privilege of being seen in a timely fashion, which was important for pancreatic cancer patients. At first these gifts had been mainly in the form of large contributions to his research efforts or to hospital building projects, but then about seven years previously, they became more personal, including his beloved, flamboyant red Ferrari.

After consulting with several knowledgeable tax attorneys, Keyon and George had ascertained that from the IRS’s point of view, these gifts had to be considered income, since they were required to secure an appointment and were therefore fee-for-service and not voluntary. Since the amount of money involved was more than 25 percent of Dr. Mason’s academic salary, there was the specter of statutory fraud, meaning possible prison time. This information had been provided to Dr. Mason with the advice that it would be best for him to curtail his ongoing harassment of Dr. Noah Rothauser.

Noah took the Stanhope’s elevators up to the third floor. Once there, he walked across the sumptuous carpeting toward the double mahogany doors leading into the hospital boardroom where the Advisory Board meeting had been held the day before. He told the hospital president’s secretary whose desk was nearby that he was there and then took a seat in the administrative waiting area. It was 1:58 P.M. He had wanted to be exactly on time, not too early and certainly not late, and he could congratulate himself on his timing. Although he’d been optimistic about the upcoming meeting, now that he was waiting to be seen, he felt the old anxiety he’d always felt when forced to confront authority figures. There was always the chance his life could once again be upended. Nervously, he flipped through a magazine that he’d picked up from the low table in front of him.

After the previous night’s dinner and following the revelations about Dr. Mason’s tax fraud, Noah and Ava had retreated up to her study. He’d been staying with her the whole week, and each night they had gone to the study to continue their conversations. Last night, just when they were ready to call it a night, Noah had said he had a condition he wanted to run by her that involved her babysitters. After explaining what he had in mind, Ava’s response had been she’d think about it although a half-hour later she’d reluctantly agreed.

“They are ready for you now,” the secretary called out to Noah five minutes later, interrupting his musing.

Getting to his feet, Noah straightened his tie, took a deep breath, and walked over to the imposing, oversized doors of the boardroom. After another slight pause to take yet another deep breath, he entered. He was moderately surprised that only Dr. Cantor, Dr. Mason, and Dr. Hiroshi were seated at the expansive table. None of Noah’s resident colleagues were present. Noah’s heart skipped a beat. Maybe his optimism had been premature. He closed the door behind him and walked to the near end of the long, boardroom table. The three faculty members representing the executive committee of the Advisory Board were at the opposite end.

“Thank you for returning,” Dr. Cantor said. “Sit if you’d like.”

“I’ll stand,” Noah said. He looked at each of the men in turn. Dr. Mason refused to make eye contact, staring at his hands clasped on the table in front of him.

“By a unanimous vote of the Advisory Board with one abstention,” Dr. Cantor said formally, “it has been decided that you will be reinstated as the super chief resident.”

Relief spread through Noah with such suddenness he had to support himself by grabbing the back of the chair in front of him and leaning on it.

“However,” Dr. Cantor continued, “we want to make sure you understand how important we as medical educators feel about the central role ethics play in our profession. We want to make certain that you don’t feel that expediency can justify ethical lapses, and furthermore...”

Noah was no longer listening to Dr. Cantor. He was already absorbed in thinking about getting himself up to surgery to go over the surgical schedule for the morning to make sure the residents were appropriately assigned as assistants. Then he was going to tour the surgical intensive-care unit to familiarize himself with all the cases. Following that he was going to go to the surgical floor to do the same. The reality was that he had an enormous amount of work to do just to get acclimated back into the system...

“Dr. Rothauser,” Dr. Cantor said. “We’d like an answer to our question.”

“I’m sorry,” Noah said clearly flustered. “I’m so pleased to be reinstated that I am already thinking about all that I have to do to get up to speed. I didn’t hear the question. Could you repeat it?”

“The question is: Is there anything else of an ethical nature that you would like to reveal to the board? This current problem with your thesis surprised all of us coming out of the blue, and we don’t like surprises, especially involving our super chief, who we are considering offering a staff position.”

Noah stared back at the program director with his mind in a sudden turmoil. He wanted to say a lot, but how could he? He wanted to explain how difficult it was to be caught in a standoff with an industry he despised and a woman he thought he loved. The truth was that he was caught between the past and the future, between old-school ethics and the new reality of an ever-expanding technological and connected world where the real and the virtual were fusing.

“Well?” Dr. Cantor persisted.

“I don’t know,” Noah said, stumbling over his words.

“Dr. Rothauser!” Dr. Cantor said sharply. “That is hardly the answer we are looking for. What do you mean you don’t know?”

Noah audibly sighed, sounding like a balloon deflating. “Maybe I should sit down,” he said. Suddenly his legs felt weak. He pulled out the director’s chair directly in front of him and sat heavily. After a deep breath, he looked up, noticing that Dr. Mason was staring at him as intently as the others but with a slight smile of anticipation. Noah was painfully aware that time was passing, and each second was making the situation worse. He should have said “no” immediately and be done with it, but he couldn’t. The question had caught him completely unawares, upsetting the unsteady balance he’d been trying to maintain in his mind, sending it into tumult.

“Dr. Rothauser!” Dr. Cantor snapped. “Explain yourself!”

Noah cleared his throat as he struggled to regain control as an idea emerged from the fog of his addled brain. “This thesis situation surprised me as well,” he said haltingly but gaining confidence, “and it awakened an old fear that has dogged me since I was a teenager that something unexpected would happen to prevent me from becoming the best academic surgeon my abilities would allow. I had never thought about what I did with my thesis as an ethical issue, but now I can see that it could be considered as such, and I apologize for not having cleared the air on my own accord. But with that thought in mind, there is something else that is more clearly an ethical issue that I believe I should reveal to clear the air.”