hypothesis. The illness was caused by salmonella, whose presence we ascertained in multiple ways, but most convincingly from blood culture. We classified the strain in multiple ways as well, particularly by DNA analysis. The offending organism was, without an ounce of doubt, the alpha strain of salmonella typhi that Rothman himself had had grown in space with the cooperation of NASA. There was no other pathogen, for Christ’s sake. The blood cultures only grew out the salmonella. Nothing else! Nothing at all!”
Undaunted, Pia changed the subject on a dime. “What about the hair loss? Does serious salmonella infection cause hair loss?”
Springer was having difficulty controlling himself, yet the woman seemed completely calm. “The stress of almost any severe illness, particularly one presenting with high fever, can cause hair loss. Anyway, what hair loss are you talking about?”
“I saw hair loss with Rothman before I discovered the rebound tenderness. The resident suggested it could be attributed to the chloramphenicol.”
“That’s not something I am aware of,” he said. And then, suddenly and angrily, “Oh, for God’s sake. You wait here!”
Springer bounded out of his desk chair, pushed past Pia, and disappeared. Pia stood in the room and waited. Within a few minutes, Springer reappeared and sat down, giving Pia a nasty look. Thinking she had probably maximized what she was going to get out of the conversation, Pia eyed the door.
“I told you to wait,” Springer said. “Stay there!” Confused, Pia did as she was told. There was silence except for Springer’s labored breathing.
“Dr. Springer, I sincerely thank you for your time.”
“Stay where you are!” Springer said brusquely.
Pia rolled her eyes, confused.
“Ah, Dean Bourse, it’s simply not possible for me to do my job if I am to be hounded by a medical student who thinks she should be running my department. She goes onto the floor and sees patients with no authorization, which I am sure could open us up to all manner of liability issues. She repeatedly questions my medical ability and second-guesses decisions that were made, and now she’s come up with an outlandish suggestion that we might have completely missed another organism which was responsible for Rothman’s and Yamamoto’s untimely deaths. First it was the choice of antibiotic, now it’s a second pathogen. This is outrageous and it has to stop.”
Pia looked at Springer, and she was unable to conceal the contempt she was feeling. He had run off like a coward and got the dean to come tell her off. She glanced at Bourse, who was standing arms akimbo, a hard expression on her face. She was angry and dumbfounded.
“I would like Dr. Springer to understand that I’m not trying to do his job,” Pia said in her defense. “I’m just trying to answer some questions that I would have thought were important ones. My sense here is that something is wrong.”
Neither Springer nor Bourse could believe the gall of the young woman. The question in both of their minds: Who the hell does she think she is? Springer found his voice first.
“Do you see what I’m talking about? This woman is off the wall. I’m going to talk with Groekest about the advisability of rescinding the position she was offered here as a resident/Ph.D. candidate. This is absurd.”
At the mention of the chief of the internal medicine department, Helen Bourse signaled with a snap of her head that Pia should leave Springer’s office. Pia was happy to oblige. Bourse then nodded to Springer to indicate that she had the situation under control. “I’ll get back to you. Sorry about this.” Bourse then followed Pia out of the office and into the hallway. Pia might be temporarily unbalanced, but Springer was a bully, and he’d made his point. Before Pia had a chance to say anything, Bourse lit into her.
“What the hell do you think you’re doing? When we spoke this morning, and I gave you time to get your head together, I don’t believe I said you should go see Dr. Springer and belabor the head of Infectious Diseases about his patients or his diagnosis. Where is your social sense? Good grief, woman! It’s common knowledge that Springer is not a fan of medical students in general, but this episode has pushed him over the edge. I have never heard him as exasperated as he was when he called.”
Pia started to speak, but Bourse wasn’t done with her.
“You’re fast developing a reputation as a troublemaker, Ms. Grazdani, and that will not look good on your resume if it gets recorded. You are here, essentially, as a guest of the institution, and guests do not behave like this. If they do, they’re usually asked to leave. I gave you a couple of days to get over the tragic death of your mentor and that wasn’t supposed to be time for you to come in here and stir things up again.”
“But don’t you think these questions need to be answered?”
“No, I don’t, not if he doesn’t,” Bourse said, gesturing at the door.
Pia started to speak again, but the dean had had enough. “Have you shown any signs of a fever?”
“No.”
“Then get yourself back to your room. If I hear you’re causing any more trouble over this unfortunate affair, I will think seriously about rescinding your welcome here as a medical student. Which would be something of a tragedy for you, considering you only have a couple of months left before you graduate. And it would be a tragedy for us because we’d be admitting we made a mistake in taking you in the first place. I don’t think Dr. Springer will go to Dr. Groekest on his own, but he might. So be careful, young lady. You are now officially on very thin ice. I must not have made myself clear last time we spoke. Am I making myself clear now?”
“Yes,” said Pia. “Perfectly.”
33.
COLUMBIA UNIVERSITY MEDICAL CENTER NEW YORK CITY MARCH 24, 2011, 4:45 P.M.
For Pia, being in trouble was as natural as breathing in and out. She’d spent most of her life under some kind of probationary supervision undertaken by people who didn’t know her, care to know her, or understand her situation. Long ago, Pia had wondered how it was that she was the one who ended up in front of some panel or other. She never instigated the trouble, she was always reacting to someone older and more powerful trying to take advantage. Somehow that fact got lost in the paperwork. More often than not, it was only she who suffered the inquisition and the punishment that followed. For her, injustice belonged with pain on the same one-way street.
By the time she reached age twelve, Pia had simply stopped questioning the way of the world as it concerned her. This was just how it was and how it was going to be. Over the years she’d come to know how the individuals of influence in her life operated. Dr. Springer was a familiar type. He was fiercely protective of his own reputation and would adopt any position that protected him, even at the expense of reason and fact. Quick to take offense, Springer had no backbone. When Pia pushed back and kept pushing, Springer literally ran away. He went and found someone who did have some fortitude-Dr. Bourse-and he hid behind her. Bourse was a different proposition. She wasn’t afraid, Pia could see that, and she wasn’t willing to take the easy way out and simply dispense with the problem-Pia-which she could have done.
Pia had spent the afternoon anxiously mulling over Springer’s behavior. She’d learned nothing. There was also the fact that no one seemed concerned about the medical issues she was raising, which couldn’t help but fan Pia’s semi-paranoid belief that the medical center, and the Infectious Diseases Department in particular, hadn’t looked after Rothman and Yamamoto properly. And how could anyone prove that some medical center personnel had nothing to do with their getting sick in the first place? Pia was starting to consider the idea that some kind of cover-up might be under way, orchestrated by Dr. Springer.
And Rothman was still emotionally in her head. If she hadn’t let him take such an influential role in her life, she wouldn’t have found herself in her current predicament. If you let people into your life, she thought, you were bound to hurt sooner or later.
A knock on her door jolted Pia out of her agitated state. It was George. Who else?
