Робин Кук - Charlatans

“The NSC doesn’t want my training questioned because I told them emphatically I did not want it questioned,” Ava said. “It is as simple as that.”

“Does the NSC know why you feel that way?”

“No, they don’t,” Ava said. “My turn for a question. Why are you concerned about my training when I have passed my anesthesia boards both written and oral with honors, and as you have reminded me I’ve handled upwards of three thousand cases at BMH without a problem.”

“It’s mostly those niggling questions about the three deaths that I felt ethically obligated to check out. I told them to you.”

“And I explained fully that your concerns were without basis in all three instances,” Ava said. “What else? Let’s clear the slate.”

“Okay, I’ve also wondered about your syntax in your anesthesia notes,” Noah said. He felt embarrassed to bring up such an insignificant issue, but it had been bothering him like a pebble in a shoe. “You use fewer acronyms and more superlatives than other doctors.”

“That’s an absurd notion,” Ava said. “If anything, it’s mainstream medical snobbery. I write my notes the way notes are written in Brazos University Medical Center in Lubbock, Texas. What else?”

“It surprises me that you have no real friends at the hospital,” Noah said. “You keep everyone at arm’s length and apparently prefer social media to face-to-face interaction. Why? It seems so strange to me because I know you as warmly personable. It makes no sense, especially with your ability to read people so well.”

“Isn’t this a little like the pot calling the kettle black?” Ava said. “When it comes down to it, you are the same. Remember: ‘two peas in a pod.’ Maybe you go more out of your way to be superficially friendly with everyone than I, but you’re not close friends with anyone except an alleged girlfriend who no one ever met and who decided she needed more of a relationship, which you weren’t supplying. As for social media, I think you don’t indulge in it because you don’t have the time, at least not until you finish your residency. When you do, the ‘gamer’ in you is going to reassert itself, and currently there is no better online game than social media.

“Here’s the reality. We are both products of the new digital age, where truth and intimacy are becoming less and less important. Thanks to the ubiquity of social media in all its forms, we’re all becoming narcissists, maybe not as overt as our friend Wild Bill Mason, but we all thrive on continuous reaffirmation, which is why you work so damn hard and I love anesthesia. Everyone is becoming an elaborate fusion of the real and the virtual, including you and I.”

Noah stared back at Ava. Earlier he had had a foreboding about where their strange, digressive conversation was going, but now he was sure, and a deep-seated atavistic fear spread through him. It disturbed him to recognize she was in control and not him. She knew all her own secrets and apparently some of his.

“The growing popularity of Facebook and other social-media sites is a harbinger of the future,” Ava said after a pause to see if Noah would speak. When he didn’t, she continued: “People can be what they want to be by managing technology, and those who do it the best, like you and I, will thrive despite our pasts.”

Ava paused again. This time she resolved to wait for Noah to respond. Her expression was a contented semi-smile of the one in control, in sharp contrast with Noah’s clenched, thin-lipped, anxious grimace.

For a moment Noah looked away. Ava’s self-assurance and apparent amusement were galling, as he thought of himself as the injured party who should have been treated as such, rather than being toyed with like one of her cats playing with a mouse. When he looked back, he decided once again it was time to go for broke. What he didn’t expect was another surprise and an even bigger shock.

FRIDAY, AUGUST 18, 12:05 A.M.

“Let’s stop beating around the bush,” Noah said irritably. “I want you to tell me directly why you are so protective of your anesthesia training.”

“It’s simple,” Ava said, her smile broadening. “I don’t want people checking into my anesthesia training, because I didn’t do it.”

Noah’s jaw dropped open. Again he stared at Ava, but now it was in total disbelief. “Maybe you better tell me what you mean.”

“I am what you might call a modern-day charlatan, which is a world of difference from a charlatan in the past,” Ava said. “And I’m not talking about the kind of charlatan everyone is becoming today because of little lies on social media. I’m talking about being a full-blown charlatan but of a different ilk. I am a fully competent charlatan.”

“What part of your formal anesthesia training did you not do?” Noah asked with hesitation.

“None of it,” Ava said.

“I’m not sure I understand,” Noah said, dumbfounded.

“Let me explain,” Ava said. “Remember I told you I was giving anesthesia under the supposed supervision of my dentist boss, which wasn’t much supervision. What it did was make me very interested in the science of pharmacology and anesthetic gases. When we moved to Brazos University Medical Center, I started going to various lectures and even an anesthesia conference that the school sponsored. My boss was very encouraging. So I started reading in the field online, which turned out to be better for me than the lectures, since I could read with better retention and much faster than professors could talk. I found the information fascinating. I was also impressed with the salary and respect anesthesiologists got and wanted it for myself. I mean, I was kind of doing the same thing but as an assistant in a dental office instead of in an operating room. And I was doing it without the fabulous equipment and support of nurses and residents.”

“So let me understand,” Noah said with mounting incredulity. “You never did an anesthesia residency?”

“No,” Ava said. “I didn’t need to.”

“What about the anesthesia boards?” Noah asked, his mouth agape. “Did you take them?”

“Oh, yes, of course!” Ava said. “I took the boards and passed them with no problem. I even enjoyed them, as it was an affirmation of a lot of effort I had expended preparing for them.”

“But to qualify to take the boards you must do a residency,” Noah sputtered.

“That’s the usual prerequisite,” Ava said. “In my case it was different. I decided to skip the residency part as unnecessary and even exploitive. From my perspective, the residency is a way for the hospital to have people giving anesthesia for three to four years and paying them a pittance in comparison to what the hospital is charging for the service. And the supervision that they are supposed to get is often not all that great.”

“How did you manage to be accepted to take the boards?” Noah asked. He was flabbergasted and wasn’t sure if Ava wasn’t still toying with him.

“It was all relatively easy,” Ava said. “The critical event was moving from Brownfield to Lubbock when my dentist boss became dean of the new school of dentistry. As a founding faculty member, he had administrative status with the Brazos Medical Center computer. Using his log-in, I had full access. With my computer skills, it was not difficult to create an entire record for Ava London that matched the other anesthesia residents, complete with grades, evaluations, and letters of recommendation. What helped enormously was that the entire university and the medical center were growing geometrically. It was almost like a revolving door with new personnel, profiles, and résumés being uploaded daily. It also helped that the system had an almost nonexistent firewall, so I probably could have done it all without my boss’s log-in. But the log-in made it so easy. I was even able to insert pictures of myself with the real residents for the appropriate years.”