Робин Кук - Charlatans

Noah found himself nodding. He could remember seeing the photo of Ava with the 2012 resident photo. As astounding as all this was, he was beginning to think she was telling him the truth. “What about your name change?” Noah asked. “When did that happen?”

“That didn’t happen until I had to take the U.S. Medical Licensing Examination,” Ava said. “That was when I needed the new identity. It was before I took the anesthesia boards.”

“So people think that Gail Shafter still exists,” Noah said.

“For sure. It was key,” Ava said. “Particularly my old boss, Dr. Winston Herbert, who is still dean of the Brazos University School of Dentistry. It’s why I keep a Facebook page in her name. Presently, she is working for a virtual dentist in Davenport, Iowa. I mean, at this point I suppose I could kill her off, but why? I enjoy contrasting my old life with the new. It makes me continuously appreciative of what I have achieved.”

“Good Lord,” Noah said. His head was spinning. “Who got the M.D./B.S. degree, Gail or Ava?”

Ava laughed. She was enjoying herself. “Of course it was Ava,” she said.

Although Noah was surprised at this news, he recognized that he shouldn’t have been. “In other words, you didn’t go to medical school, either?”

“Of course not,” Ava said. “Nor college, for that matter. That would have been a bigger waste of time than doing the anesthesia residency. I wanted to become an anesthesiologist. I didn’t want to waste time getting a general liberal-arts education, particularly not the kind you Ivy Leaguers think is appropriate.”

“So that means you are not even a doctor,” Noah snapped.

“That is a matter of definition,” Ava said. “I did take the USMLE as I said, and I did pass it with flying colors in the ninety-fifth percentile because I studied my butt off. According to the State of Massachusetts, I am a doctor. I have an M.D. license. They say that I am a doctor. I feel like a doctor, and I act like a doctor. I have the knowledge of a doctor. I’m a doctor.”

“What about the degree in nutrition?”

“Made up as well,” Ava said. “That was something I realized later that would come in handy. I just read about the field online.”

Noah closed his eyes and ran his fingers through his hair. This was all so incredible he was having difficulty wrapping his mind around what she was telling him. “I’m not sure I believe all this,” he murmured.

“Wake up, my friend!” Ava said. “Come and join the digital age in the twenty-first century! The basis of knowledge has changed. It is not hidden away any longer by professional societies, some more secret and restrictive than others. Knowledge of just about everything is now available online for everyone, not just the few who are lucky enough for whatever reason to go to the right schools. Even professional medical experience and expertise is available in simulation centers with computer-driven mannequins that are better in many respects to the real thing. With the mannequins, a student can learn to handle a problem by doing it over and over until it is reflex, like handling malignant hyperthermia. Most anesthesiologists have never handled a case of MH. I’ve handled seven, to be exact. Six with a simulator and one in real life.”

“So you really did use the simulation center?” Noah said. It was a statement more than a question.

“Absolutely,” Ava said. “Like there was no tomorrow. Within months of my arriving at Brazos University Medical Center, I started my quest to become an anesthesiologist by using the simulators almost every night when the medical students and the residents had gone back to their beds. I did it religiously. I even started writing programs and to trouble-shoot the system because initially there were a lot of bugs in it. But it was a fabulous way to learn, so much better than the standard methodology. It is almost a crime that medical teaching hasn’t been altered for a hundred years, still adhering to a paradigm that started back in 1910, for God’s sake. It’s almost unbelievable because everything else about our culture and technology has changed drastically. Don’t you find it embarrassing that medical education is the most backward of all the pedagogies?”

“I guess I haven’t given it that much thought,” Noah said.

“Well, I certainly have,” Ava said. “Do people really need four years of college to be a terrific doctor? Hell, no! Maybe they did in 1910, but not now. Maybe they think they have a richer life, but even that is open to question. Do people need four full years of medical school to be a terrific doctor? I don’t think so. Maybe they did in 1910, when most medical schools were for-profit diploma mills and a bad joke. Do people need to do research for a couple of years? Hell, no, again, unless they choose research as a career. Otherwise it’s like treading water. The proof of all this is that I am a damn good anesthesiologist, better than some at the BMH whom I have been able to observe, and I have handled more than three thousand cases and supervised my share of residents and nurse anesthetists.

“Now, I know you have had some misgivings about the three recent deaths I’ve had. And believe me, they disturbed me more than anyone because they were my first and hopefully my last. But let’s reassure you yet again that it wasn’t my lack of having had a formal anesthesia residency that was responsible. With Bruce Vincent, we both know that it was the pigheaded Dr. Mason, his fellow, and the patient himself who were at fault. With the Gibson case the problem lay with the departmental rule that it was appropriate for me to supervise two concurrent resident anesthesia cases at the same time and that the resident did not wait for me to be in the room before starting, as I was busy elsewhere. It also didn’t help that there was a computer glitch that created two records, one with the information about the patient’s neck problem and one without, which was the one that the anesthesia resident got. And the malignant-hyperthermia case could not have been handled any better than it was, despite the outcome. This was determined when it was reviewed. And I can tell you that the majority of the anesthesiologists at the BMH have never handled an MH case, either real or virtual. I don’t doubt that they could, but if it were my life on the line, I would rather have me there than them because of my experience. As for why the scrub nurse would tell you I didn’t turn the gas off immediately, I have no idea, because for me it was reflex. Maybe she is upset I am an anesthesiologist and she a nurse, or maybe it is that I am younger and more attractive. Who the hell knows...”

Ava suddenly threw up her hands as if she were surrendering and sat back. “That’s it,” she said. “That’s the whole story, and you are the only person who knows it.” Slowly she lowered her hands, watching Noah expectantly.

“Why have you told me all this?” Noah said. “Why put the burden on me?”

“Two main reasons,” Ava said. “First, to save your skin, and second, your career. The NSC sees you as a major threat in regard to me and has let ABC Security know how they feel. Use your imagination for what that might mean! The second reason is that I like you, and we are in many ways ‘two peas in a pod.’ That is a compliment. I enjoy your company. If you want to know the truth, initially I saw you only as a way to deal with the Dr. Mason problem without involving ABC Security. But that was before I got to know you.”

“I enjoy your company as well,” Noah admitted. “But—”

“There cannot be any ‘buts,’” Ava interjected. “You have to let sleeping dogs lie. I’ve gone out on a limb for you. I know from your perspective I’ve gotten to where I am today following a unique path that you don’t agree with. But understand that I am the future. Medical education is going to change dramatically in the next five or ten years. It has to change. It took me ten years to get where I am, but I had to work to support myself while I was doing it, and if I didn’t, it would have taken half the time. It is inevitable that becoming a specialist like an anesthesiologist will soon take, say, six years or even less from high school to board qualified instead of the current twelve. The costs of healthcare have to go down, and one of them is the cost of training doctors like anesthesiologists. Hell, it’s more like a trade than we like to admit.”