Pia started to respond, but Springer cut her off. “Listen, we’ve been over this issue. And let me add that a department head at this hospital does not have this kind of conversation with a medical student. A department head does not have this kind of conversation at all—there are protocols to be observed, there are panels that are convened if there are questions about the diagnosis or treatment. It’s not clear in this case that there are any questions. Jesus, why am I justifying myself to you? This is not how we conduct business around here.”

Pia wasn’t picking up on Springer’s rising sense of outrage. She had him in the room and she wanted answers. “Why weren’t Rothman and Yamamoto being monitored more closely?”

“They were being monitored extremely closely. Each had his own nurse.”

“Closely? How did it happen that a medical student had to pick up on the signs of developing peritonitis?”

“That was a fluke. It would have been picked up very quickly. Trust me. Now, is there anything else I can help you with, any other hospital policy you might want to critique for me?”

Springer’s sarcasm was lost on Pia.

“This case confuses me,” Pia continued. “In fact, it’s one of the worst cases of salmonella or typhoid that I’ve ever come across.”

“In your vastly broad experience,” Springer said.

“In my experience, yes.”

“Well, what are you alluding to? I’m sure you’re alluding to something. So enlighten me, please.”

“One of the first things they told us when we got here was about diagnosis. ‘When you hear galloping hoofbeats, you should think of horses, not zebras.’ ”

“Yes, of course, it’s the oldest saw in medicine. What about it?”

“Should we be looking for zebras here, Dr. Springer?”

“We are not looking for anything here, Ms. Grazdani. But I am dying to know what it is that you are looking for. So enlighten me again.”

“Okay. Is it possible that this case represents some exotic form of an antibody/antigen reaction the body can have, like a Shwartzman reaction? In which case would it not have made sense to use Decadron or some similar anti-inflammatory agent, something potent, to try to head it off at the pass?”

“If that is your great revelation, well, I’m sorry to say it’s not much of one. Because we used Decadron in the evening when it became clear that the two researchers were approaching extremis. Perhaps you should review the patients’ charts before making accusations like that.”

“Of course. If I had been given access to the charts I wouldn’t have made the mistake. But I’m not making accusations, I just want to get to the truth, Dr. Springer.”

“We all do, Ms. Grazdani.”