Michael Palmer: The fifth vial

For as long as Natalie had been affiliated with the medical school, Dr. Sam Goldenberg had been dean. An endocrinologist by trade, he was as kindly and concerned a man as he was brilliant — clearly dedicated to the principle that getting into medical school should be much harder and more stressful than staying there.

As requested by Goldenberg, Natalie had called his office when she was ten minutes out. Now she sat in his comfortably appointed waiting area and tried to work out phrasing by which she could underscore that no one had been hurt by her ordering the tests she did, but that she understood there might have been better ways she could have handled the situation. All she wanted now was to make things right with Cliff Renfro and get back to work.

She had been there just a few minutes when Goldenberg came out, shook her hand with an uncharacteristic lack of warmth, thanked her for being so prompt, and escorted her into his office. Standing by chairs at his conference table, their faces grim and troubled, were her closest allies on the medical school staff, Doug Berenger and Terry Millwood, and her friend, Veronica Kelly, cherubic, exceedingly bright, and often more intolerant of pompous, self-important professors than even Natalie herself.

The sudden chill through Natalie's spine had nothing to do with the temperature of the office. Both surgeons shook her hand formally. Veronica, with whom she had traveled to Hawaii and once to Europe, smiled tensely and nodded. The two of them enjoyed Boston together as often as busy med students could manage, and Veronica's stockbroker boyfriend was responsible for fixing Natalie up whenever her resistance slipped be-low the "I'm fine, really, I am" level. Goldenberg motioned everyone to sit, and took his place at the table. Natalie's expectations of charming the dean and making whatever reparations were necessary toward Cliff Renfro began to evaporate.

"Ms. Reyes," Goldenberg began, "I want you to read the notarized statements submitted to my office at my request by Dr. Clifford Renfro and Mrs. Beverly Richardson, the nurse who was present at the time of this morning's incident. Then I would ask if your account of the events would differ substantially from theirs."

Still astonished that things had moved forward so swiftly and force-fully, Natalie read through the statements. Aside from a word here and there, both were in concordance and were accurate. Bev Richardson did her best to explain what she felt Natalie's mindset was at the time. How-ever, she also stated, nearly verbatim, the clash with Renfro. On paper, the statements were cold and damning. Natalie felt the earliest grip of fear, and flashed momentarily on the eight-letter word in her mother's crossword puzzle.

"Both of these are substantially accurate," she managed, "but I don't think they capture the motivation behind what I was trying to do."

"Nat," Berenger said, "I promise you that we understand that there was nothing overtly malicious in your motives."

Seated next to Berenger, Millwood nodded his agreement.

"I'll be more than happy to admit that what I did was wrong, and to apologize to Dr. Renfro."

"I'm afraid it's not that simple, Ms. Reyes," Goldenberg said. "Dr. Schmidt, who as you know is Dr. Renfro's chief of surgery, has insisted that you are unfit to be a physician and he has demanded that you be expelled from the medical school."

The words were a dagger thrust into Natalie's chest. "I can't believe this. My grades have been honors level, and as far as I know, my clinical work has been strong."

"Actually," Goldenberg said, "while there has never been anything negative reported about your work with patients, there have been several complaints suggesting a consistent lack of respect for authority, an intolerance for some of your residents, and even some of your classmates, and an arrogance that one faculty member has suggested could be a source of serious problems in the years to come."

"I just can't believe this," Natalie said again. "My only incident with a classmate that I know of was when I refused to partner with him because he was throwing cadaver parts around the anatomy lab."

"Excuse me, Dean, for breaking in here," Veronica said, "but I feel as if I need to back Natalie up on this one. When Dr. Millwood called and told me what was happening, I asked him to find out if I could come. I appreciate your allowing me to. The student Natalie was speaking of was to-

tally inappropriate, and deserved her response. Natalie and I have been close friends since before we started med school. I wanted to make sure you knew how well-liked and respected she is among almost all the students, men and women, and also how difficult Dr. Renfro can be at times. He and I clashed more than once during my surgical rotation."

"But you never ended up being reported to me," Goldenberg said.

"No," Veronica said, clearly deflated. "No, I didn't."

"Thank you, Ms. Kelly."

"Nat," Millwood said, "didn't you stop to think about the trouble you were asking for by bringing back a patient that a senior resident had discharged without even consulting him?"

Natalie shook her head. "I know now that it was wrong, but I was upset with Dr. Renfro, and all I was thinking about was the patient, a poor old drunk whom I felt was being booted out of the hospital without a complete evaluation of his problems."

Millwood turned to Goldenberg, as did Berenger. Natalie watched her future unfold in an unspoken three-way conversation, battling back the knee-jerk urge simply to say, "Oh, screw this! I quit." Veronica, probably sensing that, subtly raised a calming hand. Finally, Goldenberg nodded that he had reached a decision, and turned to Natalie.

"Ms. Reyes, there are a number of faculty members, including your two biggest boosters here, who have written glowing evaluations about your potential to be an exceptional physician. I also appreciate the effort your friend Ms. Kelly has made to be here today, as well as the things she has had to say. I know for a fact that you are being seriously considered for selection into the Alpha Omega Alpha medical honor society. I can assure you now that will not happen. You are an unusual person, with many fine qualities, but there is an edge to you — call it hardness, call it arrogance — that will contribute nothing toward making you the sort of physician we want to graduate from this school. With the help of your supporters here, I have decided that expulsion is too severe a punishment for what you have done — but not by much. As of today, you are suspended for four months. If there are no further incidents after that, you will graduate with the next class after yours. Other than a legal challenge in court, there is no mechanism in place for reconsideration of this decision. Do you have any questions?"

"My residency?"

"Nat, we'll go over the possibilities for you later," Berenger said. "I can tell you that your place in the surgical program at White Memorial will be filled by someone else."

"Jesus. What about my work in your lab?"

Berenger got tacit approval from Goldenberg before responding.

"You can still work for me, and even attend grand rounds and any other conferences you wish."

"Making this decision doesn't please any of us," Goldenberg said.

"It seems too harsh to me," Natalie said coolly, much closer to an angry outburst than to tears.

"Possibly, possibly so. But it is the hand you have dealt yourself."

"Tell me one thing, Dean Goldenberg. Would we still be sitting here if the CT scan I ordered on that poor man had shown a large clot pressing on his brain?"

Across from her, Terry rolled his eyes and sighed. Veronica shook her head.

Sam Goldenberg seemed almost ready for the question. He fixed some papers in front of him, then leveled his gaze at her.