Death Benefit

30.

COLUMBIA UNIVERSITY MEDICAL CENTER NEW YORK CITY MARCH 24, 2011, 7:00 A.M.

Pia and George arrived separately at the suite of offices of the dean of students. They were each buzzed in by the dean herself as the secretary, due in at eight, had yet to arrive. They sat at either end of the leather couch outside the office proper, avoiding eye contact, not saying anything. For Pia, such silences came naturally, while for George, who’d happily talk to anyone, it was a strain not to communicate. At the same time he had no wish to be told to shut up again by Pia, which was what he was certain would happen since all he wanted to do was apologize, again, for inadvertently upsetting her. It was part of his nature to feel responsible.

A few minutes after the hour, Helen Bourse emerged from her office.

“Thank you for being on time this morning,” Bourse said, beckoning Pia and George to follow her. She gestured to a couple of straight-backed chairs for them to sit in. She had seen a note in Pia’s file, which she’d read overnight, written by a particularly zealous clinical preceptor during her second-year introduction to surgery. It said that Pia had difficulty arriving on time for early-morning appointments, even after being admonished that such behavior was not tolerated in surgery. Although it was usually only about five to ten minutes, it was consistent, and the preceptor indicated that she thought it was a serious lapse.

Dr. Bourse sat down and regarded her two students. “To begin, I’m afraid I have some very bad news.” Her voice had the gravity appropriate to the situation. “There’s no way to say this other than just to say it. Doctors Rothman and Yamamoto both died this morning. They were being prepped for surgery for rapidly developing peritonitis, but they didn’t make it.”

“I know,” Pia said.

“How do you know?” Dr. Bourse was confused. She had just learned it herself.

“I went to the infectious disease unit this morning. I woke up early. I thought maybe the new antibiotic would have had an effect, but I was told they had died.”

Dr. Bourse stared at Pia, whose voice sounded as if all the fight had gone out of her. She could see that the young woman’s eyes were rimmed with emotion and fatigue. Dr. Bourse sighed. Here was yet another example of Pia’s marked willfulness, as she herself had told both Pia and George in no uncertain terms to go back to their rooms, check their temperatures regularly, and stay there until this meeting. Yet Pia had willfully ignored the order.

Dr. Bourse sighed again, still looking directly at Pia, whose eyes were, as usual, diverted. “Okay, I’ll try to overlook the fact that I told you to stay in your dorm room. I gather you went to the hospital because of your closeness with Dr. Rothman?”

Pia nodded. She had an urge to admit that for her, Rothman had morphed into the father she never had, but she held her tongue. It wasn’t in her to be forthright with her secrets.

“At least you made no attempt to go back to the lab, or did you?”

George looked quickly at Pia, worried. The thought that Pia might try to go back to the lab without him had not occurred to George.

“No, I didn’t,” Pia said quietly, and George exhaled.

“Did you both check your temperatures as I asked?”

Both students nodded, although George had had to abandon his thermometer when Pia flew out of his room that morning.

“And I assume everything was fine. Okay. Rothman’s and Yamamoto’s deaths are a blow to everyone here at the medical center, particularly the school. I knew Dr. Yamamoto a little, and he was a fine colleague. Dr. Rothman I knew better, of course, and I understand you got along well with him, Miss Grazdani. He certainly took a keen interest in your progress and afforded you more privileges than he did other students.” And any fellows, thought Dr. Bourse. “I viewed that interest as a compliment to your abilities as a researcher and to the potential that Dr. Rothman recognized in you.”

Pia was staring at the ground.

“Of course it’s terribly ironic that Dr. Rothman, who spent so much time uncovering the pathogenicity of salmonella, should die from the same organism he’d come to understand so well. . . .” Bourse let the thought drift.

“So, Miss Grazdani, I have arranged for you to do research, starting today, with Dr. Roselyn Gorin, who is one of the most talented people on campus. She has a Lasker Prize, as you may know, and she’s doing absolutely groundbreaking work on the differentiation of stem cells into specific adult cells. Roselyn is a friend of mine. She’s a wonderfully warm and understanding person. I just talked with her ten minutes ago, and she’s very happy to take you on. Happy’s not the right word in these circumstances, but she’s very willing to help.”

Dr. Bourse smiled hopefully.

“Today? I can’t possibly start today,” Pia said.

George winced as it was apparent to him that Dr. Bourse’s first reaction was of intense irritation.

Dr. Bourse paused in order to gain control of her emotions, as she was as irritated as George had sensed. Roselyn was a friend, but in fact she hadn’t been overjoyed about taking on a new student, especially Rothman’s student, who had built up a reputation of her own, fairly or not. Dr. Bourse wanted to tell Pia to get her act together, but she held her tongue.

“I’m very grateful for what you’ve done,” Pia said quickly, trying to sound sincere. “Really,” she added, as if she sensed she was pushing it. “But I just got this news an hour ago, and I really can’t think straight. I need a couple of days. To get my head together.”

Dr. Bourse sighed again. Pia was not the easiest individual to get along with. At the same time what she was saying was undoubtedly true. Everyone at the center was going to be shaken by the deaths. Dr. Yamamoto was a very popular presence and even if few could tolerate Rothman on a one-on-one basis, his death was still a blow, especially under these circumstances. He was, after all, the center’s scientific celebrity.

“Okay, Miss Grazdani. Today is Thursday. Monday morning, first thing, I shall expect you to resume your responsibilities as a fourth-year medical student. I am also reminding you to stay away from Dr. Rothman’s laboratory. This is compassionate leave, not an opportunity for you to play epidemiologist again. We have real epidemiologists who are qualified to do the work. Do you understand?”

Pia nodded.

“Please say, ‘I understand,’ ” Dr. Bourse said. She wanted to be absolutely clear.

“I understand,” Pia said, almost inaudibly.

“Mr. Wilson. You’ll return to Radiology today-”

“Absolutely, Dean,” George said, cutting her off.

“And you will also cease enabling Miss Grazdani. Perhaps you might want to ask yourself why you, with a hitherto spotless record, are drawn into the kind of behavior we saw last night. Gnothi seauton-do you know what that means? It means ‘Know thyself,’ and it’s something that we as physicians need to remember always.

“I doubt that it was your idea, Mr. Wilson, to break into Dr. Rothman’s lab, and I hope that in the future you will let your actions be guided more by your intellect than by your id-by your cerebrum more than your hypothalamus.”

George eagerly nodded agreement.

“Everyone clear?” Dr. Bourse said. Pia and George nodded in unison.

“Well, thank you. You can go.”

Dr. Bourse watched George hold the door open for Pia, who left without acknowledging George. She acted as if George holding the door for her was a matter of right.

Dr. Bourse sat at her desk for a few minutes of contemplation. Since a large part of her job was to get to know her population of medical students at the Columbia University College of Physicians and Surgeons, she thought about the strange relationship between Pia and George. Of course, fraternization between students was not necessarily encouraged, nor was it discouraged, provided it did not interfere with performance. In this romance, it was pretty obvious what he saw in her as she was the source of considerable gossip around the center as a particularly beautiful, intelligent, but enigmatic young woman. What wasn’t so clear was whether there was any reverse attraction.

Relations between staff and students, on the other hand, were officially frowned upon, but it was difficult to enforce a ban when the parties were all consenting adults and the students mostly in their late twenties. There had been persistent rumors concerning Pia Grazdani and Dr. Rothman. Again, Pia’s exotic beauty and obvious intelligence were lost on few people, but what she might possibly have seen in him was beyond most people’s comprehension. But nothing was ever substantiated and while there was every reason to believe that Dr. Rothman had given his student significant responsibilities and privileges, there was never any evidence that he had done so inappropriately. And now, Dr. Bourse thought, the conundrum of their relationship would just have to remain one of life’s little mysteries.