Робин Кук - Charlatans

With quick strokes of the razor Noah made short work of his overnight stubble, then climbed into the tiny shower. A moment later he was out and vigorously drying himself. There was no doubt that it was going to be a very busy year, but on the positive side he would not have any official night call, even though, knowing himself, he’d be spending most evenings in the hospital anyway. The difference was that he would be doing what he wanted to do with interesting cases that he’d get to choose. And equally important, he would not be bogged down with busy work, the typical bane of house officers or hospital residents, particularly surgical residents, since there was always some menial task that had to be done, such as changing a dressing, advancing a drain, or debriding a gangrenous wound. Noah would be able to designate others to do all that stuff. For him, the learning opportunities were going to be off the charts.

The only fly in the ointment, and it was a big fly and a nagging, persistent worry for Noah, was the responsibility he now had for the damn bimonthly surgical Morbidity and Mortality, or M&M, Conference. This conference was different from all the others, since Noah would not have the option of farming out any aspect of the responsibility to other residents. It was going to fall to him and him alone to investigate and then present all adverse-outcome cases, particularly those resulting in death.

Noah’s fear of the M&M Conference was not some irrational concern. Since the conference was specifically about cases that didn’t turn out well, often involving mistakes and individual shortcomings, blame and finger-pointing in an emotionally charged environment with dirty laundry hung out for everyone to see was the norm and not the exception. Considering the egotistical mind-set of many of the surgeons, the atmosphere could be explosive and a breeding ground for hard feelings, with the potential of creating enemies unless an underling scapegoat could be found. Noah had seen it happen over the last five years, and the scapegoat often was the messenger: the presenting super chief resident. Noah worried that the same could happen to him now that he was super chief, especially considering the Bruce Vincent fiasco. The case had trouble written all over it for many reasons, not least of which was that Noah had been involved. Although Noah had never second-guessed his decision to put the man on emergency bypass, he knew others might.

Adding to Noah’s concern, the death of the popular parking czar had the entire medical center in an uproar and gossip was rife. Prior to the event, Noah hadn’t even known the man, because Noah didn’t have a car and never had any reason to visit any of the hospital’s three garages. Noah walked to work, and when the weather was bad, he merely stayed in the on-call facilities, which were expansive and more inviting than his own apartment. He’d seen the kids’ photos on the cafeteria bulletin board but had never known whose children they were. Yet now he knew and understood he had been in a distinct minority of not being a Bruce Vincent fan, all of which was going to make the M&M Conference a standing-room-only affair.

The main reason Noah was fearful was that the Vincent case involved Dr. Mason, who Noah knew to be egotistical, quick to export blame, and outspokenly critical of Noah. Over the previous year and a half, Noah had made an effort to stay out of the man’s way as much as possible, yet now, with this next M&M coming in less than two weeks, they were on a definite collision course like a certain cruise ship and a giant wayward iceberg. Whatever Noah was going to find in his investigation of the case, he knew it was going to be a diplomatic nightmare. From the little the anesthesiologist had said at the time, it seemed to Noah that a considerable amount of responsibility had to be directed at Dr. Mason, who had been running two other concurrent surgeries. The concurrent-surgery issue alone was an emotionally charged hot-button issue within the department.

Noah ducked back into the bedroom and went to the bureau for underwear and socks. There were only three pieces of furniture in the room: the bureau, a queen-size bed, and a single bedside table that supported a lamp and a stack of medical journals. There were no pictures on the walls or any draperies over the two windows facing out into a rear courtyard. There were no rugs on the hardwood floor. If someone had asked Noah about the decor, he would have described it as spartan. But no one asked him. He didn’t have visitors and wasn’t there much himself, which was probably the reason he’d experienced a few break-ins since Leslie had left. At first such episodes had bothered him as a personal violation, but since he had almost nothing to lose, he came to accept it as part of city living with lots of impecunious students visiting the tenants above him. Mostly, however, he didn’t want to take the time or effort of finding a new apartment. In lots of ways he didn’t even consider it a home. It was more a place to crash a few times a week for five or six hours.

There had been a time several years ago when he’d felt differently, and the apartment had been warm and cozy with things such as throw rugs, framed prints of famous paintings on the wall, and curtains over the windows. There had also been a small writing desk covered with framed photos, and a second bedside table. But all that homey stuff had belonged to Leslie Brooks, Noah’s long-term girlfriend, who had come with Noah from New York to go to Harvard Business School after she graduated from Columbia in economics and he in medicine. She had lived with Noah until she finished her graduate degree two years ago, but after graduation had moved back to New York with all her stuff to a great job in finance.

Leslie’s departure had taken Noah by surprise, until she’d explained that she had come to the realization over the three years that his professional commitment was such that there was little room for her. Most surgical residents got progressively more time with their families as they advanced up the residency ladder. Not so with Noah. Each year his hours got longer by choice. There had been no rancor on either of their parts when they went their separate ways, even though Noah had been initially crushed, as he had come to assume they would marry at some point. Yet he quickly realized that she was right and he had been selfish with his time and attention. At least until he finished his graduate training, which he thought of as a 24/7 activity, he was metaphorically married to medicine and had spent very little time in her company and in the apartment.

On occasion Noah missed Leslie and looked forward to their monthly FaceTime phone calls, which she made the effort to continue. Each considered the other to be a true friend. Noah was aware she was now engaged, which tugged at his heartstrings when he thought about it. At the same time, he was thankful that she had been forthright about her needs, and he was relieved that her contentment was no longer his responsibility. At least until his residency was over, medicine was his overly demanding mistress. Ultimately, he truly wished the best for her.

From the closet Noah got a white shirt and a tie and went back into the bathroom to put them on. Once he was satisfied with the knot, which often took several attempts, he dealt with his rather thick, closely cropped dirty-blond hair by parting it on the left and brushing most of the rest to the right and off his face. Back when he had been a typical teenager, Noah had been vain and worried about his looks. He had spent a lot of time wanting to believe he was a stud, as a couple girls had referred to him. Although he wasn’t exactly sure what they had meant, he had taken it as a great compliment. Now he was not concerned about his appearance other than to look appropriately doctorlike, which he interpreted as being reasonably manicured, with clean, pressed clothes. He despised those residents who thought it a badge of honor to wear wrinkled, bloodstained outfits, especially scrubs, to advertise how hard they were working.