COLUMBIA UNIVERSITY MEDICAL CENTER
NEW YORK CITY
MARCH 24, 2011, 12:10 P.M.

After leaving the dean’s office, Pia spent the rest of the morning stewing in her room. Her feelings were in absolute turmoil, emotions and thoughts swirling in and out of her consciousness so that one minute she felt utterly depressed, the next she was sharp and motivated. She was still angry at Rothman for getting sick, and also at Springer, the chief of Infectious Diseases, for letting Rothman die, which she believed he did by selecting an outdated antibiotic despite the supposed sensitivity testing that Rothman himself had done. And why did it have to be her, a lowly fourth-year medical student, who made the diagnosis of the incipient peritonitis, the onset of which had heralded the man’s death?

But most acutely, Pia knew she was devastated by the simple fact that Rothman was dead. She was depressed at the thought of what it meant to her future. Pia had a lot of practice at dispassionately breaking down a situation and identifying how it affected her. It was the emotional aspects of her state of mind that she struggled with the most.

Pia had been completely convinced by Rothman’s argument that she wasn’t suited to clinical medicine, since she actually didn’t like most people, especially when they were sick and complaining about it. She had little sympathy for illness and none at all for any kind of complaining. At one point during her residency, after thirty-six hours without sleep, she had had to take blood from a patient, a tough-looking young policeman who was deathly afraid of needles. As the man wriggled and squirmed and Pia couldn’t for the life of her find a vein, she told him to “quit whining like a baby.” Fortunately, no one overheard her, and the man didn’t complain, although the staff did wonder why he made such an effort to avoid Pia for the rest of his stay.

With Rothman gone, she didn’t know if she had it in her to follow through with getting a Ph.D., which was a requirement if she was serious about pursuing a future in research. Most of all, the nagging issue of what had happened to Rothman wouldn’t leave her alone, and she mulled it over continuously. It could have been an accident, she knew, but it seemed very unlikely knowing Rothman as well as she did. He was too careful, too compulsive. And the two of them getting sick simultaneously? It didn’t make sense. But the alternatives seemed equally unlikely, especially the idea that he did it deliberately. The only other possibility, namely the idea that someone else did it deliberately, like Panjit, who might have had the opportunity, seemed even more unlikely.