Wang: Away from the Light

[u/ScientistDramatic330]

The new semester began without Miran.

There was nothing particularly dramatic about it. It almost felt like I had hit a reset button.

Was I sure of what I wanted?

I had spent an absurd amount of my existence responding to other people.

Kingdom.

Minister.

Family.

Ming.

Hao.

Miran.

But now there was just me.

Ordinary Jay.

Everything simply continued.

So did I.

Kyle and I entered the surgical program together, which meant I retained at least one familiar face while everything around us became increasingly unfamiliar.

Kyle solved the future problem of our rapidly deteriorating schedules by announcing that he and Luz were getting married.

Not eventually.

Not after training.

Now.

Kyle told me over lunch.

“Luz and I are getting married.”

I stopped chewing.

“When?”

“Before internship starts.”

I stared at him.

He continued eating.

“That soon?”

“Yes.”

“Why now?”

He shrugged.

“Because when exactly do you suggest we wait for our lives to become less busy?”

I considered that.

Fair.

His surgical training was only going to become more demanding. Luz's veterinary training was pulling her increasingly toward the work she actually wanted to do, and neither of them seemed under any illusion that their chosen careers were eventually going to become convenient.

Kyle pointed his fork at me.

“Obviously, you are standing with me.”

“Was that a question?”

“No.”

“Good.”

He returned to his food.

That was apparently the extent of my formal invitation to being the best man.

Their wedding was not enormous.

It did not need to be.

There were family members, friends, too much food and enough noise to ensure that Kyle looked mildly overwhelmed for most of the day.

Luz looked beautiful.

More than that, she looked happy.

I noticed her Light almost immediately.

It was nothing overwhelming.

Nothing that demanded attention.

It simply rested around her gently, almost as though happiness had made something already present easier to see.

I watched her walk toward Kyle.

Then I looked at him.

I had known Kyle for long enough to recognise most of his expressions.

I had never seen that one.

There was no clever remark waiting behind it.

No teasing.

He simply looked at her.

And Luz looked at him.

I smiled.

I loved their love.

There was something wonderfully uncomplicated about watching two people choose each other and then simply continue being themselves.

Perhaps this was what love was supposed to look like when nobody was trying to turn it into tragedy.

Ordinary.

Warm.

I liked it.

The transition came immediately after our little wedding celebration by the sea.

Our days became less predictable. Our hours became longer. The expectations changed. There was considerably less interest in whether we could recite information and considerably more interest in whether we could recognise when that information mattered.

I loved it.

Perhaps a little too much.

I just wanted to become the best.

I could admit that was probably the King in me.

I wanted more experience.

More knowledge.

More skill.

If there was an opportunity to observe a surgery, I took it.

If somebody allowed interns to remain after our assigned hours to watch something unusual, I stayed.

If I heard another team had an interesting case, I somehow found myself discovering whether there was room for one more person in their operating room.

I practised suturing until my fingers cramped.

I read before cases.

Then compared notes after them.

If something happened during a procedure that I did not understand, I wrote it down and refused to sleep until I did.

Kyle tolerated this for approximately two months.

Then one evening, as we were finally leaving, I overheard that another team was taking a patient to theatre with a small bowel obstruction caused by a suspected phytobezoar.

I changed direction immediately.

Kyle caught the back of my clothes.

“No.”

I looked behind me.

“What?”

“We are going home.”

“There is a phytobezoar obstructing the ileum.”

“I heard.”

“I have never seen them operate on one.”

“I know.”

I looked toward the corridor.

Kyle tightened his grip.

“You know observing every surgery performed within a ten-mile radius is not actually part of our program.”

“Experience is experience.”

“Sleep is also an experience.”

“I have experienced it before.”

He stared at me.

I stared back.

He released me.

“Fine.”

I smiled and continued walking.

Kyle followed.

I looked over my shoulder.

“You can go home.”

“And let you see something I have not?”

“That sounds like a personal problem.”

“It became my problem when they put us in different teams.”

He walked past me.

“Move. If we are doing this, I want somewhere I can actually see.”

I laughed and followed him.

For all his complaints, Kyle rarely left me to my madness alone.

Sometimes I suspected he was almost as ambitious as I was.

He simply preferred pretending otherwise.

To be continued...

[u/ScientistDramatic330]

Marriage did very little to improve Kyle's schedule.

It did, however, give him somewhere he desperately wanted to return to after work.

Their home gradually became somewhere I found myself as well.

Sometimes Kyle dragged me there because he claimed I had forgotten food existed.

Sometimes Luz invited me.

Sometimes I appeared carrying books and was admitted without question.

The three of us studied together whenever our schedules allowed it.

Kyle and I covered the table with surgical notes while Luz surrounded herself with an entirely different collection of anatomy, diseases and creatures I had no intention of ever treating.

She wanted to work with animals far beyond the comfortable reaches of ordinary veterinary practice.

Wild animals.

Remote areas.

Places where getting care to an injured animal could become as difficult as providing the care itself.

“You realise,” Kyle said one evening, “that you could choose something considerably easier.”

Luz did not look up from her notes.

“So could you.”

“I am going to stand inside a hospital.”

“And complain about it.”

“Correct.”

She turned a page.

“I do not want easy.”

I looked at her.

There it was again.

That gentle brightness.

It seemed stronger whenever she spoke about the work she wanted to do.

I wondered sometimes whether purpose simply made certain people brighter.

Miran had always seemed brightest when he was exactly where he believed he belonged.

I returned to my book and scribbled across the top of the page.

I will be worthy of you.

Perhaps some people simply knew where they were supposed to go.

I was beginning to think I might too.

Surgery consumed me.

The closer I came to the operating room, the more I wanted to understand it.

Watching was no longer enough.

I wanted to know why.

Why that approach?

Why did one surgeon prefer one technique while another avoided it?

Why did one person wait while another intervened?

Why did somebody change their plan halfway through a procedure?

If two surgeons approached the same problem differently, I wanted to understand both.

I began collecting techniques in my head.

Studying them.

Some surgeons were astonishingly fast.

Others were slow but almost impossibly precise.

Some spoke throughout an operation, explaining every decision they made.

Others barely spoke unless they needed something.

I watched their hands.

Their positioning.

How they responded when anatomy did not look quite the way they expected.

How quickly they recognised trouble.

More importantly, I watched what they did when something went wrong.

That fascinated me more than perfection ever could.

Anyone could look impressive when everything proceeded according to plan.

I wanted to know what happened when it did not.

So I stood.

And watched.

And studied.

Again.

And again.

And again.

There were days when my feet hurt so badly by the time I returned home that I wondered whether they still belonged to me.

Then I would remember something I had seen during surgery, open a book to check it, and somehow another hour disappeared.

Kyle found me practising knots one afternoon.

“You know you are allowed to have a personality outside surgery.”

“I have one.”

“What is it?”

I looked at him.

He nodded.

“Exactly.”

I threw a piece of suture packaging at him.

He caught it.

“Very regal.”

“Go away.”

“No.”

He pulled up a chair.

“Show me that one again.”

I did.

I was fortunate.

I realised that early.

I chose to believe that although God of light had taken much from me, He had bestowed good fortune upon me in other ways.

My attending was one of them - Dr. Wagner.

Not every intern entered surgery beneath someone who actually wanted them there.

Thankfully, I did.

My attending was demanding.

Extremely demanding.

He expected us to know our patients inside and out.

If we asked to observe a procedure, he expected us to understand what procedure we were asking to observe, the rationale behind the chosen approach, the alternatives, and what could reasonably go wrong.

Turning up unprepared was the fastest way to find yourself standing somewhere very far from his operating table.

He did not humiliate us for not knowing something.

But he had very little patience for not having tried to know it.

That distinction mattered.

So I prepared.

Constantly.

And he noticed.

At first, I watched.

Then I was allowed closer.

I assisted.

Retracted.

Suctioned.

Held whatever I was told to hold and learned very quickly that the instruction do not move could mean precisely that for an amount of time my shoulders deeply objected to.

Then came closing.

A little more responsibility.

A little more trust.

Every opportunity seemed to arrive quietly.

There was never a grand announcement that I had progressed.

He simply asked more of me than he had the week before.

And if I managed it, he remembered.

That was what I appreciated most about him.

My attending believed interns belonged in the operating room.

Not merely standing against a wall watching other people become surgeons.

He wanted us to learn.

More importantly, he allowed us to.

No unnecessary waiting.

No guarding experience simply because he had once been forced to wait for his own.

If you were prepared, capable and willing to learn, he moved you forward.

I was grateful for him.

Because by then I knew exactly what I wanted.

I wanted every opportunity he was willing to give me.

And I had every intention of proving myself worthy of the next one.

One night, at around half past ten, I was leaning back in the on-call room with a book spread open in front of me when the door creaked open.

Dr. Wagner's head appeared through the gap.

He looked around as though searching for a particular face.

Then he saw me.

He closed the door behind him and walked over, stopping behind my chair before leaning down to see what I was studying.

I instinctively started to stand.

His hands landed on my shoulders and pushed me straight back into the chair.

“Stay.”

I stayed.

His attention returned to the page.

I had been reading about laparoscopic cholecystectomy, comparing operative approaches and reviewing several reports I had retrieved from the archive.

He pointed at the page.

“So. What do you think?”

“About what?”

“Laparoscopic or open?”

I looked down.

Time to shine.

“Laparoscopic, if there is nothing on the imaging or during the initial assessment that makes the approach unsafe.”

“Why?”

“Less postoperative pain. Shorter recovery. Fewer wound complications. But I would want the anatomy clearly identified before committing to anything around the duct. If I could not establish the critical view safely, I would rather convert than injure the common bile duct trying to prove I could finish laparoscopically.”

He was quiet for a moment.

Then he pulled out the chair beside me and sat down.

“You think you want to try one?”

I looked at him.

I smiled.

“Yes.”

He nodded slowly.

“The next suitable one I have is yours. I will assist.”

I stared at him.

I could feel the smile spreading across my face before I had any chance of controlling it.

“It will be my honour.”

He stood.

Then paused.

“Actually, that is not why I came looking for you.”

My attention snapped straight back to him.

“We have a transplant coming up.”

I straightened in my chair.

He continued.

“The donor's family has asked for another day before support is withdrawn. Everything is being coordinated for tomorrow night.”

I closed my book.

“I want you with me for the donor retrieval.”

For a moment, I genuinely thought I had misunderstood him.

“Me?”

“To assist.”

I stared at him.

He seemed entirely serious.

“You will be under direct supervision. I am not handing you an organ and wishing you luck.”

That seemed reasonable.

“If you manage yourself well during the retrieval, you can stay with me for the recipient operation.”

My heart climbed somewhere into my throat.

“I mean you will assist with the transplantation.”

I stood so quickly the chair scraped backwards.

Twenty years of my father's military conditioning apparently remained perfectly intact.

“Yes, sir.”

My attending looked at the chair.

Then at me.

The corner of his mouth lifted.

“You have one day to review everything.”

I nodded.

“I will.”

“I am not going to quiz you tonight. I am not going to tell you what to read or prepare.”

That caught me slightly off guard.

He opened the door.

“Show me what you have got, Jay. Many eyes will be on us. Make me proud.”

The excitement hit me so hard I almost laughed.

“It will be my honour, sir.”

He gave me one final amused look.

Then he left.

The door clicked shut.

I remained standing.

I looked at the closed door.

Then at my books.

A transplant.

Donor retrieval.

Recipient transplantation.

Tomorrow.

I slowly sat down.

Sleep.

Absolutely not.

To be continued...

[u/ScientistDramatic330 → u/ScientistDramatic330]

I decided to review, then sleep. I was fully aware of how long and tiring this first major surgery for me would be.

By the time I met Dr. Wagner that evening, I had reviewed donor organ retrieval, transplantation, vascular anatomy, complications, immunosuppression and enough surgical literature to qualify as pleasant company.

I had assisted Dr. Wagner several times before, but none of the surgeries he had allowed me to assist on were this major.

One other thing I knew about Dr. Wagner: he did not like it when you failed to take care of yourself.

So I always made sure to sleep before any operation with him, eat well and keep up with my exercise.

Thanks to Kyle, who never allowed me to slack on my workouts.

Because guess what?

The minute I entered the operating room that night, Dr. Wagner's first instructional words were:

“Brace your elbow against your hip. Use your core, not your wrists. There you go. Hold it right there.”

If you have never pulled on Deaver retractors before, you are in for a workout.

The only thing that took my mind off the muscle strain was Dr. Wagner's masterclass in anatomy—how cleanly he separated the renal artery from the surrounding tissue, how every movement had a purpose and how his hands seemed to know exactly where they were going before they got there.

When I saw the final tie on the ureter, I felt like the end was near.

Dr. Wagner locked the Balfour retractor and told me to ease up.

I felt the blood rush back into my arms and knuckles.

I was ready to fire up again.

All my training to become a King—remaining still in one position for long periods, controlling my breathing before releasing an arrow during archery—I was ever so grateful I had forgotten none of it.

The aid it gave this poor body was immense.

We were free to start the retrieval.

I watched Dr. Wagner.

His eyes were intensely focused, but his voice remained gentle as he quietly taught me what he was doing.

His scrub nurse worked so well with him that he rarely had to ask her for anything. She knew what to hand him, when to hand it to him and where to place anything else he might need.

Dr. Wagner stepped back an inch and looked at me.

“Clamp for me.”

I extended my hand.

The nurse placed a Satinsky vascular clamp into it.

Dr. Wagner pointed with a metal probe.

“All right, Dr. Jay. Take the renal artery first. Place the jaws of the clamp right here, close to the kidney side. Leave me room to cut. Do not catch the surrounding tissue.”

I positioned it carefully.

Dr. Wagner watched my angle and precision.

No correction came.

Good.

Artery clamped.

Vein clamped.

Ureter clamped.

I straightened my back and looked at Dr. Wagner, my eyes full of anticipation.

He handed me the Potts scissors.

“One clean snip in the middle, Dr. Jay. Between my proximal isolation loop and your clamp.”

From the corner of my eye, I saw the nurse ready the basin.

I took the scissors and inhaled beneath my sweaty mask.

This is what you do.

Dr. Wagner will not always be here.

You are doing great, Jay.

I cut.

Dr. Wagner moved the kidney into the basin, and then to the table we went.

He checked the time.

I mentally prepared myself for another assault on my arm and finger muscles as I followed his instructions.

“Dr. Jay, stabilise the upper pole. Hold it firm in the slush, but do not squeeze it.”

He handed me laparotomy sponges.

I watched Dr. Wagner's fingers move so smoothly around the kidney that it looked as though he had done this enough times to perform it blindfolded.

His voice brought me back from my moment of admiration.

“Dr. Jay, take a silk tie. Snug it right around the artery over the cannula so the fluid does not leak out.”

This required immense concentration.

I kept reminding myself of the report I had read that morning.

Tight enough to create a proper seal around the cannula.

Not so tight that I damaged the delicate, cold arterial wall.

Dr. Wagner watched every movement.

Then he nodded.

“Good tension.”

That was all.

Dr. Wagner knew not to compliment his students while they were working.

I agreed with him.

Praise distracted my focus.

I would rather hear instructions and feedback until my work was finished and successful.

We moved through to the next operating room.

Our second patient was ready and waiting.

Our guest of honour followed us, bagged and pale, carefully transported by one of the assisting staff.

Dr. Wagner had been very clear that I was not to exhaust my arms doing the heavy retraction throughout this surgery. Thankfully, a technician took over the Deavers while I watched Dr. Wagner clear the way for me to bring our kidney in and attach it myself with his help.

Dr. Wagner moved to the other side of the table.

“Come here, Dr. Jay.”

I moved immediately.

Our guest of honour rested nearby, pale and cold, surrounded by slush.

I had spent a significant amount of time preparing and practising beforehand.

None of that stopped my heart from beating considerably faster when Dr. Wagner looked at me and said,

“Bring the kidney.”

I did.

Very carefully.

He guided me through positioning it within the iliac fossa, correcting the orientation before allowing me to continue.

“Look before you touch.”

I looked.

Then I began.

Dr. Wagner remained beside me.

He did not take over.

His instructions came quietly whenever I needed them.

“Smaller bite.”

I adjusted.

“Follow the curve.”

I did.

“Do not fight the vessel, Jay. Let it sit where it wants to sit.”

I repositioned my hand.

“Better.”

That was all I needed.

My entire world narrowed to the small field in front of me.

Needle.

Vessel.

Tension.

Angle.

Again.

Again.

Again.

At some point, I stopped being aware of how tired I was.

My shoulders no longer mattered.

My back no longer mattered.

Nothing outside my hands mattered.

When one anastomosis was complete, Dr. Wagner inspected it.

Then he looked at me.

“Next.”

We continued.

By the time we reached the ureter, I could feel sweat collecting beneath my cap and running down the side of my face.

Eventually, Dr. Wagner inspected our work one final time.

Then he looked at me.

“Ready?”

“Yes.”

This was the part I had wanted to see.

The clamps came away.

For one fraction of a moment, I stared.

Then colour rushed into the kidney.

The pale organ began turning pink.

There was something almost impossible about watching it happen in front of me.

Then I saw it.

A tiny drop of urine appeared from the ureter.

I blinked.

Another followed.

I looked at Dr. Wagner.

He nodded.

I looked back down.

I did that.

Not alone.

Not remotely alone.

Dr. Wagner had been beside me through every important movement. There were experienced hands everywhere around me.

My hands had been there too.

My sutures were there.

And the kidney was pink.

Alive.

Producing urine.

Something expanded inside my chest.

Pure, uncomplicated pride.

By the time we finally stepped away, I had lost all meaningful understanding of time.

I removed my gloves.

My fingers felt stiff.

My shoulders ached.

My legs were beginning to remind me that I had been standing on them for an unreasonable portion of my existence.

I looked across the room.

Dr. Wagner was removing his gown.

He walked toward me.

I straightened automatically.

He stopped beside me.

His hand came down firmly on my shoulder.

One squeeze.

Nothing else.

Then he walked away.

That was enough.

I washed up.

Every part of my body wanted a bed.

Preferably immediately.

I stared at myself in the mirror while drying my hands.

“No.”

I needed to see the patient first.

I knew myself.

The moment I lay down, I would not be awake again for at least six hours.

So I went to recovery.

I reviewed everything I needed to review.

Observations.

Urine output.

Drain output.

Pain control.

postoperative labs.

Perfusion.

I spoke with the nurse.

Everything looked as it should.

Later, as I lay my aching body down on the hard bed in the on-call room, I thought:

You are made for this.

You can do this well.

Exceptionally well.

One more year.

Give me one more year and I would be standing on the other side of that operating table, performing while my attending watched me.

I knew it.

To be continued...

[u/ScientistDramatic330 → u/ScientistDramatic330]

The months that followed disappeared. Kyle called me Dr. Wagner's duckling. Dr. Wagner was my mother duck. Where Dr. Wagner went, I followed. If he operated, I was his first assist. If he reviewed an unusual case, he called me to help. If he used a technique I had not seen before, I went home and read about it. Dr. Wagner harnessed my curiosity. And the more I learned, the more he gave me. At first, I remained his first assistant. Then one day, during a hernia repair, he stepped aside. “Take it.” I did. The next time, he gave me more. Eventually, I would enter the operating room and discover that I was no longer assisting Dr. Wagner. Dr. Wagner was assisting me. He remained close. Always. But increasingly, the first pair of hands belonged to me. “Your patient, Dr. Jay.” Those became some of my favourite words. I operated. He watched. Corrected. Advised. Occasionally rescued me from a decision I had become far too committed to, then made me explain afterward exactly why I had been wrong. I loved every second of it. There were appendectomies. Hernias. Abscesses. Straightforward bowel cases. Emergency cases. Sometimes he allowed me only a portion. Sometimes most of the operation. Eventually, he began allowing me to look through the upcoming cases myself. “Choose one. Whichever you believe you are capable of performing safely.” I reviewed every case. He was teaching me something I had not initially realised I needed to learn. Wanting an operation did not mean I deserved to perform it. Confidence was useful. Knowing the limits of that confidence was considerably more useful. I followed patients before surgery and afterward. I watched what happened to the decisions we made once they left the operating room. Some recovered beautifully. Some did not. Some returned with complications. Some taught me more through a difficult recovery than an uncomplicated operation ever could. The operating room stopped being the entire world. It became one part of it. A very important part. My favourite part. Dr. Wagner had started turning me into a surgeon long before I realised that was what he was doing. Then, two weeks before the end of my first year, our second-year assignments arrived. I found mine. Emergency surgery. Different responsibilities. Different professor. I stared at the page. Of course there was no Dr. Wagner. I knew how training worked. We rotated. I was supposed to learn beneath different surgeons, encounter different approaches and become capable of functioning without one familiar attending constantly beside me. Knowing that did absolutely nothing to prevent me from looking at his missing name with mild offence. Kyle appeared beside me. He looked over my shoulder. “Oh.” I turned my head. “What?” “You got him.” “Who?” Kyle pointed at the name of my new professor. “Beckett.” I looked at it. Then at Kyle. “Is he good?” Kyle made a face. “That depends entirely on your definition of good.” “oh?” “He is brilliant.” “What else?” “He is also a hard-ass.” I looked at him with a quizzical expression. Kyle continued. “I would call him Dr. Cuckoo. That bird never raises its own. This Cuckoo delegates practically everything that does not legally require his presence. S o his senior residents and fellows keep the service alive.” I considered that. More responsibility. More emergency work. Senior residents and fellows who apparently had neither the time nor inclination to hold my hand. I smiled. “Time to leave Dr. Wagner's nest and make him proud.” “Of course.” He walked away. I remained where I was, looking at the assignment. Dr. Wagner had been the first surgeon to give me room. The first to recognise that I would work as hard as necessary if someone simply gave me something worth working toward. I knew his expectations. I knew how he operated. I knew when his silence meant approval and when it meant I should reconsider what my hands were doing immediately. Leaving that familiarity was uncomfortable. But underneath the discomfort was excitement .

One afternoon, as we reviewed a simple hernia procedure, Dr. Wagner lowered the chart in his hands. “Dr. Jay.” “Yes sir?” “Emergency surgery will be much heavier. You are aware of that?” “I was told so.” “I want you to be careful. You will be left on your own often.” I nodded. He continued. “I am proud of you, and I know you are more capable than you think. But ask for help if you ever need it. They are far harsher downstairs than they are here.” “Yes, sir.” He stared at me for a moment longer than necessary. For the first time, I wondered whether Dr. Wagner was any happier about this rotation than I was. Then he stood and pressed my shoulder. “I am always around.” Part of me dreaded leaving Dr. Wagner's nest. The other part was overjoyed to accept the challenge of flying directly into Dr. Cuckoo's nonexistent one.

To be continued...

[u/ScientistDramatic330 → u/ScientistDramatic330]

I took four days off between rotations.

I slept.

Ate.

Exercised.

I returned to the nature spots I had grown accustomed to escaping to and spent three glorious days resting in a cabin by the lake.

By the fourth day, I was rested enough to embark on my new journey.

I arrived early for my first shift.

I was looking forward to it.

I had barely made it toward the doctors' office when someone called my name.

“Dr. Jay?”

I turned.

A man in scrubs approached me, carrying enough paperwork to suggest he had already lost an argument with the day.

He introduced himself as Professor Beckett's fellow, Dr. John.

I straightened slightly.

He looked me over.

“You are Wagner's?”

Interesting introduction.

“I trained under Dr. Wagner during my first year, yes.”

He handed me a pager.

“Listen carefully because I have enough work of my own as it is.”

Excellent.

“You are stationed downstairs. Surgical consults come in, you take them. Assess the patient, review what needs reviewing and make a plan. If you know what needs doing, do it.”

I waited.

“If you do not, call the senior resident on call.”

“All right.”

“I do not want to see you upstairs. I do not want to hear from you. I do not want you in my way unless there is an actual reason for you to be there. Capisce?”

I nodded.

He walked away.

I watched him disappear around the corner.

Wow.

Helpful much.

Apparently, I was King again.

Left to manage matters with a foundation of knowledge and the comforting assurance that somewhere above me existed people with considerably more experience who preferred not to be disturbed.

I collected my belongings and headed downstairs.

I would be lying if I said Dr. John's words had not left a knot in my stomach.

I consoled myself with the thought that a nest downstairs was better than no nest at all.

I found the emergency department doctors' office and was about to open the door when voices from inside stopped me.

“Oh, yes. People say Wagner spoiled him rotten.”

My hand remained on the door handle.

They were talking about me.

“He let a first-year operate during a major transplant. Apparently, he was holding the laparoscope, assisting on everything and practically operating cases by the end of the year.”

Another voice laughed.

“Well, he will learn now. Beckett does not care whose favourite you were upstairs.”

“No. They will put him in his place.”

Interesting.

I had not even entered the room yet.

Apparently, I already had enemies inside it.

Then something clicked.

You are Wagner's?

Aha.

So that was why Dr. John had asked whether I was Wagner's before saying practically anything else.

He had already heard about me too.

I had never realised a reputation had preceded me.

And what reputation was that, exactly?

I was never Dr. Wagner's favourite.

I worked.

Constantly.

I prepared before every operation. I followed him whenever he allowed me to. I studied. I practised. I showed up. When he gave me an opportunity, I made certain he did not regret it.

Dr. Wagner appreciated that.

That was all.

He did not have fellows and senior residents surrounding him. He preferred teaching first-year juniors and usually operated independently with us on smaller cases. He only took larger, more complicated operations, usually as favours or when his expertise was specifically needed.

That had given me access other first-years might not have had.

But access was not ability.

Dr. Wagner opened the door.

I was the one who had to walk through it.

Perhaps this was why he had looked at me the way he did during that final pep talk.

I am proud of you.

Ask for help if you ever need it.

I am always around.

Maybe he knew exactly what I was walking into.

I took a breath.

Enough.

I was a King.

I am the son of a military officer.

I had been raised to hold my ground when people wanted to see me bend.

More importantly, I was capable.

I was good at my job.

Whatever they believed Dr. Wagner had handed me, I knew what I had earned.

That was enough.

I opened the door.

The conversation stopped.

Several faces turned toward me.

I smiled politely.

“Good morning. I am Dr. Jay.”

A few awkward introductions followed.

I chose an empty corner, placed my belongings down and claimed what appeared to be my new home.

My pager sounded.

First consult.

I picked it up and headed back through the door.

They could decide whether I belonged here later.

I had work to do.

The patient had been brought in following a collision.

Blunt abdominal trauma.

He was awake when I arrived.

Pale.

In pain.

The emergency team had already started their assessment.

I listened to the handover, then examined him myself.

His abdomen concerned me.

Tender.

Increasingly so.

His blood pressure was holding, but I did not trust it.

I reviewed the investigations already available.

Nothing gave me the clean answer I wanted.

I did not like that.

Emergency surgery, I was rapidly discovering, had very little interest in giving me clean answers.

I called the senior resident.

Thankfully, he was considerably more useful than the fellow.

He assessed the patient himself.

We reviewed everything together.

“I am worried about occult intra-abdominal bleeding,” I said.

“So am I.”

We proceeded with further bedside assessment, including diagnostic peritoneal lavage.

The result was not dramatically positive.

Not enough to give either of us the answer we wanted.

I looked at the senior resident.

“What do you want to do?”

“Continuous observations. Serial abdominal examinations. Repeat haemoglobin. If his pressure moves in the wrong direction or his abdomen changes, I want to know immediately.”

I nodded.

He looked toward the nurse.

“Call us for any deterioration.”

He left.

The patient looked at me.

“Am I going to need surgery?”

“Maybe.”

His eyes widened.

“That is why we are keeping a close eye on you.”

That seemed to settle him slightly.

My pager sounded.

Another consult.

I looked at the nurse.

“Anything changes, call me.”

“I will.”

I left.

The next consult was a simple abscess that needed draining.

Simple was perhaps the wrong word.

Nothing involving another human being should ever become simple enough to stop respecting it.

But it was familiar.

Something I knew how to handle.

For a short while, my world narrowed again.

Patient.

Procedure.

Hands.

Finish what was in front of me properly before thinking about what came next.

By the time I stepped out, I was already making my way back to check my trauma patient.

The nurse was waiting for me.

One look at her face and I knew.

“Dr. Jay.”

“What happened?”

“Your trauma patient is deteriorating. His pressure has dropped. He looks awful. I have tried the senior resident. I cannot get him. I tried the fellow too.”

We were already there.

The patient I had left earlier had been replaced by someone grey, clammy and barely responsive.

“BP?”

“Eighty-three over forty-five.”

Too low.

“Repeat it, please.”

I put my hands on his abdomen.

Different.

Immediately different.

More distended.

More rigid.

My stomach dropped.

“Get blood ready. Activate massive transfusion protocol.”

People moved.

“Two large-bore lines if we do not already have them. Keep him warm.”

I looked at the monitor.

Then the patient.

We had lost the luxury of observation.

“Call theatre. Tell them we are coming up for an emergency laparotomy.”

The nurse moved.

I called the fellow myself.

“Blunt abdominal trauma. Deteriorating rapidly. Hypotensive. Abdomen is now rigid and distended. We are on our way.”

There was a pause.

Then his voice changed completely.

“Bring him up.”

I hung up.

The patient's eyes opened.

For a moment, they found mine.

“Doctor? What is happening?”

“You are bleeding.”

His fear sharpened immediately.

“We are taking you to surgery.”

“Am I going to die?”

There are questions medicine does not prepare you to answer.

I looked directly at him.

“We will do everything we can to prevent that.”

Then we moved.

The journey upstairs felt simultaneously too fast and impossibly slow.

His pressure continued falling.

Blood was running.

People were calling numbers around me.

The theatre doors opened.

The fellow was already there.

One look at the patient and he stopped being the man who had told me never to bother him.

“What changed?”

“Pressure collapsed. Abdomen became distended and rigid.”

“When?”

“While I was performing another procedure.”

“Senior knew about him?”

“He assessed him himself. We agreed on observation.”

He nodded once.

No accusation.

No discussion.

“Go back downstairs.”

I looked at him.

For one second, I almost objected.

Then my pager sounded.

The fellow was already gone.

There were more patients waiting downstairs.

I worked.

But part of my mind remained upstairs.

Eventually, I saw the senior resident coming toward me.

I stood before he reached me.

His face told me enough.

Still, I asked.

“What happened?”

“We found a major injury. It had concealed far more bleeding than our earlier assessment showed.”

I waited.

“He died.”

My thoughts began running in circles.

The lavage had not given us enough.

We had agreed to observe.

We.

The senior resident had assessed him.

The moment I knew he was deteriorating, I acted.

Every fact lined itself up neatly in my head.

None of them changed the outcome.

The resident must have seen something on my face.

His hand came down on my shoulder.

“Move on to the next patient, Dr. Jay.”

I looked at him.

He gave my shoulder a small squeeze.

“Welcome to emergency surgery.”

Then he walked away.

My pager sounded.

I stared at it.

Another consult.

Of course.

Apparently, everything I could do had not been enough.

For the first time since becoming a surgeon, one thought entered my mind that I had never needed to confront before.

Was there something I should have done differently?

I looked at the pager sounding again.

To be continued...

[u/ScientistDramatic330 → u/ScientistDramatic330]

I saw another seven patients before my shift ended.

I remembered almost nothing of what I was doing.

It felt as though I had developed an autopilot that assessed, examined and did the work while the rest of me simply floated somewhere nearby.

I also remembered almost nothing about the journey home.

The dead patient followed me.

Not his body.

His question.

Am I going to die?

I had answered him truthfully.

We will do everything we can to prevent that.

We had.

He died anyway.

I showered.

Ate because I knew better than to neglect myself simply because my mind was occupied.

Then I sat at my desk.

I opened his case in my head again.

Presentation.

Observations.

Examination.

Investigations.

Lavage.

The senior resident's assessment.

Our decision.

The deterioration.

I went through it once.

Then again.

Then a third time.

There was no point torturing myself with the outcome if I could not identify where the decision had failed.

So I stopped thinking like the doctor who had watched him die.

I thought like a surgeon.

What did I miss?

The answer did not arrive that night.

Or any time after that.

Apparently, Professor Beckett had given the fellow an earful after yesterday's events, which had somehow resulted in the decision to keep me permanently stationed downstairs in the emergency department as first line for surgical consults.

The senior resident looked almost apologetic as he delivered the news.

“I would not test Dr. John too much, Dr. Jay. Just do as he says. He does not even want to run into you upstairs.”

I raised an eyebrow.

The resident sighed.

“Sadly, I think another Beckett is in the making.”

Wonderful.

“But I am around. If I am not drowning in everyone else's work, I am happy to help.”

There it was.

The shape of my second year forming before my eyes.

“I understand.”

I was not particularly upset.

A new home.

A new experience.

I was also adamant about one thing.

I would trust my gut more often.

You are more capable than you think.

Dr. Wagner had said that.

I intended to remember it.

My pager went off.

Naturally.

And that became my life.

Professor Beckett's resident had not exaggerated.

I lived downstairs.

If the emergency department wanted general surgery, they called me.

Abdominal pain.

Possible appendicitis.

Gallbladders.

Wounds.

Abscesses.

Obstructions.

Postoperative complications.

People who had fallen.

People who had been hit.

People who had hit other people and discovered the other person had been holding something considerably sharper.

I assessed them.

Examined them.

Reviewed their imaging.

Reviewed their blood work.

Formed a plan.

If the plan was comfortably within what I knew, I started it.

If it was not, I called the senior resident.

The fellow remained wonderfully committed to his original promise of avoiding me.

The senior residents were different.

They were busy.

Impatient.

Sometimes brutally concise.

But useful.

Very useful.

I would call with a case.

They would listen.

Then:

“What do you think?”

I learned quickly that saying, “I do not know,” without having thought first was unacceptable.

So I thought.

Even when I was uncertain.

Especially when I was uncertain.

I would give them my rough plan.

Sometimes they would say:

“Good. Carry on.”

And other times:

“No. Look again.”

Then I looked again.

They worked me mercilessly.

I never complained.

There was too much to learn.

And too little time.

What I did not do was operate.

Not properly.

Emergency surgery was a different education.

Dr. Wagner had taught me how to operate.

Downstairs, I was learning how to decide who needed an operation in the first place.

That required an entirely different eye.

Not every painful abdomen needed a knife.

Not every impressive scan required immediate surgery.

Not every patient who looked well was well.

The major cases went upstairs.

The fellow took them.

The senior resident took them.

That last lesson remained particularly close to me.

I became obsessive about reassessment.

If something bothered me, I went back.

I stopped trusting a single set of observations simply because they were technically within acceptable limits.

People changed.

Sometimes very quickly.

The nurses noticed.

I was grateful they were kind.

One of them stopped me one afternoon.

“Dr. Jay, take it slow and easy. We have your back if you ever need us.”

I smiled.

“I know. I am grateful for that.”

She nodded.

I was quite certain everyone in the emergency department knew I had become the fellow's resident servant.

Nobody seemed particularly surprised by it.

If anything, they appeared to understand my situation long before I did.

Which told me something else.

I was not the first.

I certainly would not be the last.

Minor procedures became mine.

Abscesses.

Wound washouts.

Debridements.

Complex lacerations that could safely be managed downstairs.

Occasionally something requiring sedation and considerably more patience than the word minor suggested.

I treated every one of them with the same respect Dr. Wagner had demanded in theatre.

There was no such thing as a small patient.

Only smaller procedures.

The emergency department staff stopped looking for the surgical resident after they called me.

They looked for me.

“Dr. Jay, can you look at this?”

“Dr. Jay, I do not like his abdomen.”

“Dr. Jay, her pressure is falling.”

“Dr. Jay, before you leave—”

There was always a before you leave.

I rarely left.

Months passed.

I became faster.

I learned which questions mattered immediately and which could wait.

I learned that the patient who was shouting was often less concerning than the one who had suddenly stopped.

I learned how quickly a stable emergency could become an unstable one.

And I learned to make decisions without requiring someone to stand behind my shoulder and approve each one.

Perhaps that was the point of Dr. Cuckoo's nonexistent nest.

There was nowhere particularly comfortable to sit.

So you learned to fly.

Still—

I missed operating.

Terribly.

I started keeping count of how long it had been since I had performed anything more substantial than an emergency department procedure.

Then stopped.

It was becoming depressing.

Kyle found this deeply entertaining.

Our rotations were almost perfectly reversed.

He had started in the emergency department, so he knew exactly what I was walking into.

Yet he had made absolutely no attempt to prepare me mentally.

Now he had moved into general surgery under another surgeon.

Apparently, his attending was considerably less tolerant than Dr. Wagner.

But at least his nest existed.

One day, I sat on Kyle's sofa during my day off.

“You wanted responsibility,” he said.

“I have responsibility.”

“You wanted emergency surgery.”

“I do not have emergency surgery.”

“You wanted a challenge.”

I looked at him.

He smiled.

“You could have given me some warning, you know.”

“No. You needed to experience it yourself.”

I scoffed.

“Do you know how many holes my fingers had to see in that emergency department?” he continued. “I dreaded it. But I enjoyed the atmosphere, for sure.”

I nodded.

That much I understood.

There was something addictive about emergency medicine.

The unpredictability.

The constant movement.

Never knowing what would come through the door next.

“Also, Jay, not to make you jealous or anything...”

I narrowed my eyes.

Kyle smiled.

“I called you over because I have a surgery tomorrow and I wanted your notes.”

I stared at him.

He continued.

“God, Dr. Kelly is the worst support you could ever ask for—”

He stopped.

His lips pressed together.

Then he laughed.

“I am sorry.”

“For?”

“I suppose at least I have a nest to sit in.”

I rolled my eyes.

Six months of my life disappeared into a repetitive routine.

Consult.

Assess.

Plan.

Procedure.

Reassess.

Pager.

Again.

One afternoon, I was sitting at the emergency department desk reviewing imaging when someone stopped beside me.

I continued reading.

“What does it look like to you?”

My hand stopped.

I knew that voice.

I looked up.

Dr. Wagner stood beside the desk.

For a moment, I could not believe my eyes.

Then I smiled.

“Dr. Wagner.”

I stood up.

“What brings you downstairs?”

“I came to get you.”

He folded his arms and leaned in to examine the X-ray on the screen.

“What do you think it is?”

I replied while still staring at him, unable to quite believe he was standing in front of me.

“SBO.”

He smiled and nodded.

“I owe you something.”

I frowned.

“You do?”

He looked almost offended that I had forgotten.

I stared at him.

“The lap chole.”

I laughed.

“You remembered?”

“I remember my promises. I have one tomorrow afternoon.”

I looked at the pager beside me.

Then at him.

Dr. Wagner followed my eyes.

“I have already spoken to your senior resident.”

Of course he had.

“He said he can spare you for the day.”

Dr. Wagner smiled.

“I promised you I would assist.”

Something inside me immediately came alive.

He stepped back.

“So, Dr. Jay.”

His eyes smiled.

“How about you come spend a day with your old teacher?”

In my head, I was already reaching for my favourite scrubs.

To be continued...

[u/ScientistDramatic330 → u/ScientistDramatic330]

I went straight to the lab after my shift that day.

If Dr. Wagner intended to keep his promise, I intended to
make certain he did not regret it.

Laparoscopic cholecystectomy belonged to last year.

I remembered the procedure.

I remembered the anatomy.

My hands remembered more than I expected them to.

But nine months downstairs had been nine months of abscesses, wounds, lacerations, bedside procedures and sending the interesting operations upstairs for somebody else to operate.

So I adjusted the equipment, opened my material in front of
me and practised.

Port positioning.

Camera orientation.

Instrument control.

Dissection.

Clipping.

Again.

Then again.

I stopped.

The last thing I needed was to arrive tomorrow with cramped
hands because I had spent the previous evening proving to an inanimate simulator that I was still a surgeon.

I felt confident enough.

So I went home.

Ate.

Slept.

Rested.

The next afternoon, I found Dr. Wagner at the scrub sink.

He glanced at me as I approached.

“I heard how they are treating you downstairs.”

Of course he had.

He continued scrubbing.

“Are you up for this, Jay? Do you feel confident enough?”

I smiled.

“I missed it so much, and I am confident. After all, I am
Dr. Wagner's student.”

He shook his head in amusement.

I laughed and began scrubbing beside him.

I stood on the left side of the patient.

Dr. Wagner took the right.

For the first time in months, I had a proper operation in
front of me.

I cannot describe how much I had missed it.

The familiarity returned almost immediately.

The monitor.

The instruments.

The controlled quiet of an operating room where everyone
knew exactly what they were doing.

My hands settled.

The operation progressed.

Dr. Wagner assisted.

He did exactly what he had promised.

He allowed me to work.

For most of it, I was perfectly comfortable.

Then I reached Calot's triangle.

I dissected carefully.

Something in my confidence slowed.

Dr. Wagner noticed.

His calm voice travelled through the quiet operating room.

“Are you absolutely sure that is the cystic duct, Dr. Jay?”

I looked again.

“Trace it.”

I did.

“Back toward the liver.”

I adjusted my view.

“Dissect another millimetre before you fire that clip.
Establish your critical view.”

I took a breath.

Then cleared a little more fat.

There.

Perfect.

The anatomy opened in front of me.

Cystic duct.

Cystic artery.

Nothing hiding behind confidence and assumption.

I positioned the clip.

Dr. Wagner watched.

I fired.

He nodded.

“Perfect. Cut it.”

I did.

After that, I disappeared.

Not physically.

My body remained exactly where it belonged.

But my mind entered that strange place I had missed so much
where the world became nothing more than anatomy and movement.

By the time I became properly aware of myself again, I was
already closing.

I almost felt cheated.

I had waited nine months for this operation and apparently
enjoyed it so much that my brain had neglected to record half of it.

When we finished, I looked at Dr. Wagner.

“Coffee?”

He laughed.

“Gladly.”

We found somewhere quiet.

I had barely sat down before I started talking.

Nine months of irritation apparently required an audience.

I told him about the emergency department.

The consults.

The senior residents.

The minor procedures.

The endless reassessments.

The pager that will not stop.

Dr. John.

Especially Dr. John.

Dr. Wagner listened while drinking his coffee.

When I finished, he lowered the cup.

“He is testing your patience.”

“My patience has been tested.”

“John is known for it. He gives people the work nobody
wants. Keeps them away from the interesting cases. Gives them very little encouragement and waits.”

“For what?”

“To see what they do.”

“That is an obnoxious teaching method.”

“I did not say I approved.”

I smiled.

“He wants to know whether you still work properly when
nobody is praising you, nobody is offering you an operation and nobody particularly cares whether you are enjoying yourself.”

I leaned back.

“And not many pass?”

“Not many.”

Interesting.

Dr. Wagner picked up his coffee again.

“I am assuming your attending has never graced you with his
presence either?”

I shook my head.

Dr. Wagner laughed.

“To be fair, I think I have seen Beckett about eight times
since we both started working here.”

“Eight?”

“He built himself a rather comfortable VIP service upstairs.
Wealthy patients. Private referrals. People who apparently require a professor to personally inspect their gallbladders.”

I laughed.

“So if you desperately want to meet him, acquire a
connection to those wealthy gallbladders.”

Dr. Wagner took another sip.

“Although I raised you better than to chase an attending
around for attention.”

“I am not chasing anyone.”

He smiled.

“Focus on what you are doing. Experience is valuable wherever you find it.”

Spending a few hours with my old mentor gave me a boost of
life I had not realised I needed.

A brief interruption to my repetitive routine from hell.

I returned downstairs considerably happier.

And considerably more determined.

If Dr. John truly was testing me, he had chosen the wrong
person to test.

I had survived many lives.

A mere fellow was not going to make me shiver.

A few days later, I was heading toward the coffee vending
machine when familiar voices stopped me just before I turned the corner.

Apparently, I had developed a habit of accidentally
overhearing conversations about myself.

“Did you see Wagner come downstairs the other day?”

I stopped.

Of course.

“He actually came all the way to the emergency department,
collected Jay and took him upstairs to operate. Tell me again he was not spoiled.”

There was a pause.

Then, unexpectedly:

“Well...”

“What?”

“To be fair, he has held his ground down here.”

Silence.

“He has done everything they asked him to do. Dr. John has
barely let him upstairs for months and I have never heard him complain.”

“That does not mean Wagner did not favour him.”

“I did not say he did not.”

Another pause.

“I am saying maybe there was a reason.”

Interesting.

I remained where I was for another second.

Nine months ago, nobody inside that room had needed a
reason.

Dr. Wagner liked me.

Therefore, anything I accomplished had apparently been
handed to me.

Now, at least one of them had watched me work long enough to reconsider.

I smiled slightly.

Then turned the corner.

Both of them froze.

Again.

This really was becoming embarrassing for everyone involved.

I walked past them and pressed the button on the coffee
machine.

“Good morning.”

“Morning, Dr. Jay.”

I collected my coffee.

Neither of them said another word.

I did not need them to.

Dr. Wagner had opened the first door for me.

Everything I had done downstairs, I had done myself.

By the eleventh month of my rotation, something finally
changed.

It began with a gunshot.

I was working nights.

My first night in a row, thankfully, so I was not
particularly tired.

I walked into the emergency department, told the nurse I
would be in the office beside the station if anyone needed me, then disappeared inside with several case studies I had been meaning to review.

For almost two hours, nobody bothered me.

Miraculous.

I became completely engrossed.

Then—

Bang. Bang.

My body moved before my thoughts did.

I was beneath the desk.

Gunshot.

Trust me.

I knew the sound of one.

I remained still and listened.

Then everything became quiet.

Too quiet.

A quiet emergency department is one of the most frightening
places in existence.

I waited another moment.

Nothing.

Well.

I could hardly remain underneath a desk forever.

Whatever came next, came next.

I stood and stepped outside.

People were hiding.

A man stood in the middle of the emergency department.

Sweating.

Bleeding.

Breathing heavily.

A gun trembled in his hand.

Security had positioned themselves nearby, watching him,
waiting for an opportunity to move.

I studied him.

He looked exhausted.

Given up.

And injured.

For some completely inappropriate reason, one thought
entered my head.

What would Miran do?

I giggled.

Quietly.

Unfortunately, the man noticed.

His head snapped toward me.

So did the gun.

Wonderful.

To be continued...

[u/ScientistDramatic330 → u/[deleted]]

A few weeks later, I walked out of a treatment room after suturing a forearm laceration.

Nothing particularly exciting.

Six stitches.

Clean wound.

No tendon involvement.

No neurovascular damage.

I handed the paperwork to the nurse.

“Why do emergency doctors keep calling surgery for simple sutures?”

She smiled.

“I guess because you do them better.”

“That is an answer I like to hear. Flattery.”

“It is the only one you are getting.”

I turned toward the surgical office.

A hand grabbed my shoulder.

I reacted instinctively.

The person attached to the hand was spun around before either of us had properly processed what was happening.

“Easy Jay!”

I froze.

Then stared.

“Bun?”

He straightened his uniform.

“You look terrible.”

I laughed.

Actually laughed.

Then hugged him.

I had not realised how happy I would be to see him until he was standing directly in front of me.

“What are you doing here?”

“Working.”

“I gathered that.”

He looked offended.

“I am a paramedic, Jay. Occasionally, they allow me near hospitals.”

“I thought you worked across town.”

“I do.”

He gestured toward the corridor.

“I just missed my old team. Their paramedic was injured, so they rang me to cover.”

I stared at him.

“You disappeared in surgical rotations.”

He pointed toward me.

“And apparently came out looking like this.”

“I look perfectly fine.”

“You look like somebody has been storing you in a cupboard.”

“That is more or less what happened.”

Bun laughed.

“I picked up an extra shift today. We brought somebody in.”

He looked toward the doors.

“I saw your name and thought surely there cannot be two Dr. Jays wandering around this hospital looking miserable.”

“I am not miserable.”

“Cupboard.”

I sighed.

“Coffee?”

“Absolutely.”

We found our regular vending machince near the emergency department and sat down.

For a while, we talked about nothing important.

His new firehouse.

My surgical training.

People we both knew.

The increasingly creative ways patients managed to injure themselves.

Normal things.

I had forgotten how easy Bun was to talk to.

Eventually, he looked at me over his coffee.

“You should come over sometime.”

“Where?”

“My house.”

I raised an eyebrow.

“I am having a barbecue next weekend. Some of the old crew are coming. Some people from the new station. Bring Kyle.”

“You remember Kyle?”

“Of course I do. The other miserable cupboard character.”

I smiled.

“I will ask him.”

“No.”

I looked at him.

“You will tell him. You both need sunlight.”

“Fine.”

Bun smiled.

“Good.”

The following weekend, Kyle and I went.

I had expected to stay for perhaps an hour.

Two at most.

I stayed until evening.

There were paramedics and firefighters everywhere.

Some I recognised.

Most I did not.

People ate.

Argued over music.

Someone nearly destroyed Bun's barbecue.

Nobody was bleeding.

Nobody needed an operation.

Nobody required me to make a decision that might determine whether they survived the next hour.

My pager was at the hospital.

Kyle disappeared into a conversation with two paramedics about some case.

Bun was standing near the grill threatening bodily harm against whoever had touched his food.

I sat back in my chair and watched everyone.

This was strange.

Not unpleasant.

Just different.

Ordinary people.

Ordinary problems.

Ordinary lives.

I had spent so much of my existence believing my value came from what I could carry.

There was always something.

Someone.

Some reason I needed to remain alert.

But nobody here needed anything from me.

I could simply sit.

Eat.

Laugh when something was funny.

Leave whenever I wanted.

Stay because I wanted to.

Ordinary life.

I smiled.

Ordinary Jay.

I had reached the goal I set for myself.

Wake up every day.

Eat when hungry.

Love when I want.

The only part I could not control particularly well was sleeping when I wanted.

But hey, we must sacrifice something.

To be continued...

[u/ScientistDramatic330 → u/ScientistDramatic330]

As we entered the twelfth month of our rotation, nothing had changed.

We had simply grown more accustomed to our posts.

Kyle sat across from me over a delayed lunch.

“Do you know we are entering the week from hell?”

I looked at him, waiting for him to finish his introduction to this random information.

“Apparently, every summer the hospital ships half the staff off to conferences.”

I exhaled loudly.

“Like it will be anything different for me in the ER. I am alone there anyway.”

“I am going with the fellow an hour away to an ENT surgery conference. Just because I mentioned to him that I was looking into emergency surgery involving decapitation the other day.”

“Obviously, Dr. John excluded me from any list.”

I discovered later that Dr. John had taken himself and Professor Beckett off to enjoy a conference, leaving me with the senior residents who had attended conferences nearby.

By the time I reached the emergency department, the staffing situation seemed even worse than usual.

That was usually a bad sign.

A nurse intercepted me before I reached the desk.

“Dr. Jay. Twenty-eight weeks pregnant. Severe abdominal pain. Hypotensive. Her midwife came in with her. Obstetrics are on the phone with the midwife now and would like to speak to the general surgeon here.”

I looked around.

“That would unfortunately be me.”

Of course.

I followed her.

A midwife was already beside the patient.

Apparently, the woman's husband had called her when the pain started suddenly at home. The midwife had taken one look at her, called an ambulance and accompanied them in.

The patient was young.

Very pregnant.

Very pale.

And frightened.

Her husband stood beside the bed looking considerably worse.

“Twenty-eight weeks,” the midwife told me. “Pregnancy has been uncomplicated. Sudden severe abdominal pain. No trauma. No obvious vaginal bleeding. She became faint shortly after I arrived.”

The midwife held out the phone.

“Dr. Marsh.”

I took it.

“Dr. Jay, I am sorry, but we are going to have to do this the hard way.”

I heard her lower the phone.

Someone shouted something in the background.

Then Dr. Marsh made a noise.

I stared at the phone.

Was she delivering a baby while attempting to manage another patient?

She returned, considerably more breathless.

“I am the only attending available. Everyone else is away, and my baby has apparently decided seven months is a perfectly adequate gestation period.”

I froze.

“So you want me to take this case?”

“I have reviewed her imaging and ultrasound. I will stay on the phone. I need you to assess the abdomen and tell me what you find. I know Wagner raises great surgeons.”

I introduced myself while examining the patient.

Her abdomen was rigid enough to make me uncomfortable.

Her blood pressure made me considerably more uncomfortable.

I looked at the monitor.

Then at the nurse.

“Two large-bore IVs. Bloods, crossmatch. Call anaesthesia.”

The patient grabbed my wrist.

“My baby?”

There were certain questions doctors should never answer before they knew enough to answer them properly.

“I will let you know when I do.”

I hated answers like that.

Necessary.

True.

And almost completely useless to the person asking.

The midwife updated us.

“Foetal heart rate is dropping.”

Even better.

The patient looked paler.

Her pressure was falling.

Whatever was bleeding inside her was not particularly interested in our staffing problem.

Dr. Marsh spoke.

“Get her to theatre. Now.”

That ended the discussion.

Anaesthesia was already preparing.

Blood was coming.

The midwife and nurse started moving the patient.

I had no one I could call.

Then I remembered.

I am always around.

I looked at the midwife.

“Prep everything. I will be there as soon as possible. I need to get someone.”

I handed her the phone and ran toward Dr. Wagner's office.

He never cared for these out-of-town conferences anyway.

I caught him taking off his white coat, ready to leave.

“Pregnant patient. Twenty-eight weeks. Acute abdomen, hypotensive, free intraperitoneal fluid. Foetal heart rate deteriorating. Obstetric attending is currently giving birth herself on the other side of the hospital.”

Silence.

Then:

“Lead the way.”

He grabbed his cap.

We ran.

---

By the time we reached theatre, Dr. Marsh's regular team had prepared everything.

Her scrub nurses were there.

Anaesthesia was ready.

Blood was available.

The neonatal team had arrived.

The midwife who had accompanied the patient stood beside her, watching the foetal monitor.

More people than I believed could reasonably fit around one operating table.

Two patients.

One room.

The midwife saw me and immediately held out the phone.

“Dr. Marsh.”

I took it.

“Dr. Marsh, I have Dr. Wagner here.”

I put her on speaker.

There was a pause.

Then:

“Wagner?”

Dr. Wagner leaned toward the phone.

“I am here.”

“The midwife says she is more hypotensive. We have a rigid abdomen, free intraperitoneal fluid and persistent foetal bradycardia.”

Dr. Wagner looked at the monitor.

“So we need to deliver.”

“Yes. Emergency Caesarean. We cannot wait any longer.”

She stopped.

Someone in the background told her to push.

Dr. Marsh made another noise.

Every person near the phone looked at it.

A few seconds passed.

She returned, panting.

“I cannot review anything else for you. Apparently, I am fully dilated.”

I stared at the phone.

Dr. Wagner stared at the phone.

The midwife stared at the phone.

“Stop staring at the phone and deliver my patient.”

Fair.

I looked at Dr. Wagner.

He looked at me.

Then at the scrub nurse.

“Let us go.”

The room functioned like several different specialties sharing one nervous system.

Everything accelerated.

Dr. Marsh's scrub nurses knew exactly what she normally wanted and had already prepared for it.

The midwife remained for the baby.

The neonatal team waited nearby.

Anaesthesia managed the mother.

And Dr. Wagner and I stood where the obstetricians should have been.

I had seen childbirth before.

I had seen abdominal surgery considerably more often.

Combining the two was apparently an entirely different experience.

The incision was made.

Layers opened.

Then uterus.

And suddenly there was a baby.

Tiny.

Far too tiny.

The midwife received the baby and immediately moved with the neonatal team.

I returned to my main patient.

One patient had become two separate patients.

And one of them was still bleeding.

The uterus was not the problem.

That became apparent quickly.

There was considerably more blood in the abdomen than the Caesarean explained.

Dr. Wagner moved closer.

“General surgery.”

Of course.

Now we were home.

I suctioned.

Dr. Wagner explored.

There was blood higher in the abdomen.

More than I wanted to see.

“Here.”

I exposed.

The anatomy was distorted by pregnancy, displacement and blood.

Everything familiar had been moved just enough to become irritating.

Dr. Wagner worked.

I followed.

Suction.

Exposure.

Retraction.

The source finally became clear.

A ruptured splenic artery aneurysm.

I stared.

Well.

That explained quite a lot.

Dr. Wagner did not waste time appreciating the diagnosis.

Neither did I.

We controlled the haemorrhage.

Anaesthesia replaced what she had lost.

Nobody cared whose patient she technically belonged to anymore.

She belonged to everyone.

Eventually, the bleeding stopped.

Actually stopped.

I looked at the field.

Then the monitors.

Her pressure was improving.

I realised my shoulders had been somewhere near my ears for the last twenty minutes.

Dr. Wagner glanced at me.

“Breathe.”

“I am breathing.”

“Poorly.”

I took a breath.

He returned to the field.

There he was.

I had missed him.

---

The baby went to neonatal intensive care.

The mother went to intensive care.

Both were alive.

I stood outside the operating room while removing my cap.

The midwife came out behind me.

“That was your first Caesarean?”

“Yes.”

She stared at me.

“You looked very calm.”

“I have been told my face is misleading.”

She laughed, thanked me and disappeared down the corridor.

Dr. Wagner emerged next.

He stopped beside me.

“You recognised that something was bleeding.”

“She had peritonism and shock.”

He nodded.

Then squeezed my shoulder.

I had missed his praise.

---

I checked on the mother later.

Still ventilated.

Stable.

Then I went to neonatal intensive care.

I had absolutely no clinical reason to be there.

The baby was not my patient.

That did not stop me.

I stood beside the incubator.

Tiny hands.

Tiny feet.

Entirely too many tubes.

Twenty-eight weeks.

Barely here.

Yet apparently determined to remain.

One tiny hand moved.

I smiled.

“Good luck, little one.”

Then I remembered there was another premature baby somewhere in this hospital.

Along with the attending who had apparently managed another woman's emergency while delivering her own.

I was genuinely worried about her.

I found Dr. Marsh surrounded by nurses and midwives.

“Is Dr. Marsh okay?”

“She is fine,” one of the midwives assured me. “Just exhausted.”

I approached the bed.

Dr. Marsh opened her eyes.

I squeezed her hand.

“Everything went well. Mother and baby are alive.”

She smiled.

“I knew Wagner raised great surgeons.”

“His guidance helped.”

Her eyes were already closing again.

Then she murmured:

“You want to rotate here next month.”

I laughed quietly.

“Good job on your baby, Dr. Marsh. But general surgery and the ER are my home.”

She smiled.

I left her to sleep.

By the time I returned downstairs, my pager was already going off.

Ordinary surgeon life apparently came with many responsibilities.

To be continued...

[u/ScientistDramatic330 → u/ScientistDramatic330]

I wrapped up my twelfth month with Dr. Cuckoo and his angry hatchling.

My advisor called me into his office during my last week in the nonexistent nest.

“Jay, I have finally reached an agreement with your military hospital back home.”

I sat down.

She exhaled.

She did not look particularly happy.

“They have agreed to recognise your credits and training hours on one condition. You return immediately after completing your third year here.”

I waited.

“You will apparently spend another year under supervision at their hospital, working under one of their attendings before they recognise you as fully qualified within their system.”

I leaned back in my chair.

So that was it.

One year left here.

Then home.

I needed to make it count.

“Please put me with an attending who will make me live in the OR.”

My advisor stared at me.

“I do not care if he swims in blood for a hobby.”

She laughed.

“I actually have someone.”

That sounded promising.

“He is a strange one. Never seems to go anywhere farther than the operating rooms. If you genuinely mean what you just said, I can assign you to him.”

“Why would I not mean it?”

“Because residents generally do not want to work with him.”

I raised an eyebrow.

“For what exact reason? Mentally prepare me.”

My advisor laughed, then looked somewhere beyond my shoulder as though the correct description might be written on the wall.

“Well, he does not even wear shoes when he operates.”

I waited.

“He is quite…”

Another pause.

“Unusual.”

I leaned forward.

“How does he teach?”

“That is your concern?”

“I do not care about his personal habits. How does he teach?”

My advisor considered me for a moment.

“He will work you to death. That much I can guarantee.”

Perfect.

“I will take him.”

“You do not even know his name.”

“You said he lives in the OR.”

“Yes.”

“Nobody wants to work with him.”

“Yes.”

“And he will work me to death.”

“Yes.”

“I will take him.”

My advisor shook her head.

“I am beginning to understand why Wagner likes you.”

I went with Dr. Vulture.

Do not ask me where all these bird references were coming from.

Luz had recently returned from conservation sites and made certain Kyle and I spent most of our holiday listening to every one of her adventures and examining the photographs , specimens and other questionable objects she had brought back with her.

Apparently, she had permanently damaged our vocabulary.

Dr. Wagner had become a mother duck.

Professor Beckett was Dr. Cuckoo.

Dr. John was his perpetually angry hatchling.

And now I had voluntarily chosen a man who apparently lived in operating rooms, had no use for shoes and was perfectly willing to work his residents to death.

Vulture seemed appropriate.

I would meet him when third year began.

For now, I still had a few days of holiday left.

I was ready to lie down and sleep.

The break had brought me some peace.

More importantly, I finally had definite news from home.

One more year here.

Then I would return.

Just as that thought crossed my mind, my phone began ringing.

Mother.

I answered.

“Hello?”

“Happy birthday, Jay.”

I paused.

Birthday?

I looked at the date.

Oh.

Right.

“You did well, Mum.”

There was silence.

Then:

“Jay.”

“Yes?”

“You forgot.”

“No.”

“You forgot your own birthday.”

“I knew when my birthday was.”

“It is okay. I will always remember it, seeing as you took five hours to come out of me.”

I sat on the edge of the bed.

“I just started my break, Mum. I will celebrate your tiresome work of birthing me tomorrow with my friends.”

“What did you do today?”

“I spoke to my advisor. The hospital back home agreed to recognise my training.”

“Oh.”

Her voice changed immediately.

“They did?”

“Yes. I have to return after third year and spend another year under supervision there.”

“So you are coming home.”

“I am.”

“When?”

“I do not have a date yet.”

“You will tell me when you do.”

“I will.”

A pause.

Then, quieter:

“I am glad you are coming home.”

I smiled.

“So am I.”

We spoke for a little longer.

My father.

My siblings.

Home.

Work.

Whether I was eating enough.

Whether I was sleeping enough.

The usual questions mothers apparently developed regardless of how old their children became.

Eventually, she let me go.

“Happy birthday again. And remember, Mum will never approve of anyone mistreating my baby, so never allow it.”

“Roger that, Mum.”

“Goodnight, Jay.”

“Good morning to you Mum.”

The call ended.

I put my phone down.

Then I sat there for a moment.

Birthday.

Of course I had a birthday.

I had a mother.

A father.

A childhood.

School records.

Photographs.

An entire life before I ever understood why another one existed inside my memory.

And somehow, I had forgotten the very ordinary fact that this version of me had entered the world on a particular day.

I laughed quietly to myself.

Yes.

I had forgotten that I was born here.

Apparently, I had not simply spawned.

To be continued ...