Робин Кук - Charlatans

Work rounds went especially smoothly for a number of reasons, primarily because there were no problem cases that needed extended discussion as to future course of action. Another reason was that it was Saturday, when it was rare for attending surgeons to show up and try to turn work rounds into a variation of chief-of-service rounds, whose goal was teaching or at least pontificating. Work rounds, by definition, were a time to merely review the chief complaint, what had been done so far, and what was going to be done that day or in the near future, and then move on to the next patient.

The final reason the work rounds proceeded apace that morning was that the junior residents who did the actual presenting were now all second-year residents and knew the ropes. Presenting cases was a learned skill, which all had mastered, except for Mark Donaldson, who was obviously either not prepared or, worse yet, had somehow failed over the year to grasp an appropriate sense of what was important and what was not. Noah spared him the embarrassment of calling him out on the spot, which had been a typical pedagogical surgical-rounds teaching method honed by some attendings to the level of torture. Noah had hated it when he was a junior resident, even though it had rarely been directed at him. Nonetheless, Noah had vowed never to do it as he rose up the ladder. With the belief that persuasion was a far better teaching method than ridicule, he planned to take Mark aside at some appropriate time, probably later that day, and have a heart-to-heart discussion.

Since it was Saturday and there were to be no chief-of-service rounds, Noah had a bit of free time. The welcoming ceremony wouldn’t commence until 8:30 and it was now 7:00. After reminding all the other residents about attending the welcoming ceremony and after entering his progress notes on his three patients in the electronic medical record, or EMR, Noah took the elevator down to administration on the third floor.

In sharp contrast with the rest of the hospital, which operated on a 24/7 basis, the administration area was all but deserted on a Saturday morning.

Noah’s destination was the surgical residency program office, which was at the far end of a carpeted hall where all the graduate medical education offices of the various specialties were located. When he got to his office door he fished out the lone key he had in his pocket. It had been dutifully handed over to him a few days ago by Dr. Claire Thomas, the outgoing super chief responsible for shattering a few significant glass ceilings. She had been the first African American woman to be the BMH surgical super chief and was, as of that very day, the first African American woman on the BMH surgical faculty. Noah knew she was going to be a hard act to follow, as everyone liked and respected her, including Dr. Mason. She had never been chastised in front of the Residency Advisory Board by the program director, Dr. Cantor.

Using the key, Noah opened the door. He stepped over the threshold and closed the door behind him. For a moment, he just stood there and surveyed the room. There were five desks. One was for Marjorie O’Conner, the surgical residency program manager. She ran the show from a bureaucratic standpoint. Another smaller desk was for the coordinator, Shirley Berensen. Her area of concentration dealt with managing the complicated evaluation requirements to make sure the program retained its accreditation and residents reached appropriate milestones. Another desk was for Candy Wong, also a coordinator, who oversaw the equally complicated issue of resident duty hours and the on-call schedule. Miss Wong had been the person whose attention Noah had spent so much effort avoiding after he had been threatened with dismissal for violating duty hours when he was a junior resident. For Noah, there was a certain irony that now he would be working closely with her.

There were two more desks, both smaller than the coordinators’. One was for the secretary, Gail Yeager, and the other for Noah. Looking at them, Noah had to smile. The irony here was that he and the secretary were probably going to be the busiest people in the surgical residency program and yet had the least impressive real estate. But the worst part, from Noah’s perspective, was not the size of his desk, which had no significance to him, but rather that his desk was completely out in the open, meaning there was no privacy whatsoever except after hours and on weekends. For something like the conversation he needed to have with Mark Donaldson, the venue was completely inappropriate. For such situations, Noah was going to be forced to improvise.

Two days ago when Claire had given him the key to the surgical residency program door, Noah had brought in office supplies, along with a significant amount of paperwork, including his very initial ideas for the choices of faculty mentors for each of the new first-year residents. Every new resident was assigned a faculty mentor. Even though Noah had never utilized his mentor other than enjoying a few pleasant dinners at the man’s home, he still thought the program had merit. There were always a couple of first-year residents who found adapting to the role of a surgical resident challenging. Being a resident was a world of difference from being a medical student.

Sitting down at the desk, Noah took advantage of the preternatural stillness of the deserted office. He got out the list of first-year residents and the list of faculty members who had volunteered to be part of the mentor program and went back to trying to match them. Quickly it became apparent that there was too much guesswork involved, because Noah knew very little about the new arrivals. The only thing he knew for certain was their genders and the medical schools they had attended. On the other hand, he knew the faculty members reasonably well, maybe too well in some instances.

When Noah had done what he could, he turned to managing and planning the plethora of meetings and conferences. Of particular concern was the weekly basic science lecture, since it was going to be the first conference under his tutelage and was fast approaching in less than a week. The basic science lecture was held every Friday at 7:30 A.M., and he had yet to decide on a subject for the first meeting, much less a lecturer. What he didn’t admit was that he was avoiding even thinking about the even more worrisome and problematic M&M Conference.

Time went by quickly, and before Noah knew it, the alarm on his cell phone went off, shocking him back to reality. It was quarter past eight. He’d set the alarm in the rare eventuality he wasn’t called, texted, or paged for some problem someplace in the hospital, which was what he fully expected. During the early morning, there was always something that happened that needed his attention. Certainly, had he stayed on the surgical floor, he would have been inundated. Taking full advantage of the peace and quiet, he’d made progress and had now outlined the first three basic science lectures and had emailed appropriate potential lecturers to ask if they would lend a hand.

After putting away his paperwork, Noah headed out the door. His destination was the Fagan Amphitheater in the Wilson Building, which was reached by a pedestrian bridge located on the second floor of the Stanhope.

SATURDAY, JULY 1, 9:27 A.M.

“Thank you, and welcome to the best surgical residency program in the world,” Dr. Edward Cantor said with a wry smile to acknowledge he might be exaggerating to a degree. He was a tall, slender, angular man, fit and assertively intelligent. He picked up his notes from the Fagan Amphitheater’s lectern and sat down in the chair he had vacated twenty minutes earlier. It was one of five in the amphitheater’s pit. The others were occupied by Dr. Carmen Hernandez, chief of surgery, and Dr. William Mason and Dr. Akira Hiroshi, both associate surgical residency program directors. The fifth chair was noticeably empty.