Julian
JUNE, YEAR 1
The morning after the residency mixer, my sister’s forehead scrunches into wrinkles on my phone screen. “What the fuck, ?”
“She called me a misogynist, Tori.”
Her brown eyes blaze. “You accused her of something awful.”
I love all my sisters, but I’m closest to Victoria, who’s only eighteen months older than me. I don’t love the way she’s looking at me, though. “I didn’t start the rumor.”
“You threw it in her face.” She props her phone up in her bathroom and grabs a paintbrush. No, a makeup brush. Same difference.
“I did not! I walked away. And I tried to apologize. She wouldn’t let me. I felt bad for her and tried to help, but she was mad and took it out on me.”
Tori pauses in her efforts, throwing shade my way. “I say this with all the love in the world, but you’re a dick.”
I am a dick. I’d dismissed her outright, but she insulted me and wouldn’t even hear my apology, so she’s kind of a dick, too.
I shouldn’t have been so distracted by that dress, but for fuck’s sake, that dress was bewitching, and she had the shoes and devil-red lips to match. The woman is fucking gorgeous and for thirty seconds, my very straight male brain was befuddled. Sue me.
It’s why I couldn’t stop the flash of irritation when I learned her name. I’m human. I make mistakes. Then I reminded myself not to get involved. Be polite. Move on. Except…it’s not exactly polite to abandon someone in the middle of a conversation.
Why did I have to throw out that sarcastic apology?
Nice dress, by the way. Matches the shoes. Sorry about that.
I am so cringe. I got riled up. Said something dumb, and now I’m annoyed with myself. Annoyed with her. Annoyed with it all.
She cried .
I rub my temples. Stupid headache. “Yeah, I’m a dick. I don’t know how I can feel this bad and still be mad at her.”
Tori smears something on her skin. “What that guy said about her is gross.”
“Yep. Why do you think I chased after her?”
Something clatters into Tori’s sink and she turns toward me. “What does she look like?”
Like a human.
Red lips. White skin. Black hair.
Not enchanting.
Not at all.
“Like those little spiders that live at the top of our lanai.”
Tori snorts. “That pretty, huh?”
“A hot version.”
Okay, so her skin is more tan than white, and her hair is more brown than black, and she has the kind of face that makes a person want to keep looking, but she’s just as irritating as those spiders with the red spikes.
Men like you.
I scowl. “I’m not a misogynist.”
“You were standing with them. You walked away as soon as you knew who she was. Can you blame her for thinking it?”
“God.” I glare at Tori as she takes some black weapon to her eyelashes. “Whose side are you on?”
“Hers.”
JULY, YEAR 1
Day one. We call the summer spike in deaths at teaching hospitals The July Effect . The medical errors of bumbling new interns are so numerous, many are overlooked. Despite layers of oversight, interns lack experience, and mistakes are frequent.
As an intern, I find these facts a tad nauseating.
I am determined to not fuck this up.
My sisters’ encouraging first-day texts have the opposite of their intended effect. I’m reminded that I’m still a kid. A twenty-eight-year-old fifth-year medical student with some fancy letters after my name.
But not the good letters.
Six a.m. shift change, aka sign out, with the night resident—a bleary-eyed second-year named Whitney Couvelaire—goes smoothly enough. I complete rounds with few issues. At this lower acuity hospital, labor and delivery isn’t slammed, but Maxwell and I are the only physicians on the floor. Seven postpartum patients are tucked in. Three laboring patients and a busy OB triage unit take most of our time.
Between patients, we sit in the doctor’s dictation area. It’s a tiny computer room meant for charting, but it’s become a storage closet for educational dioramas, discarded instruments, suture and a bony pelvis replica with a doll named Darla used to teach the cardinal movements of labor. Darla wears blue overalls with a pink flowered shirt and has a teardrop tattoo. She’s lived a rough life.
Papers are taped and pinned to every surface. Medical algorithms, resident schedules, anatomic diagrams, all of it plastered with cartoon dicks, memes and handwritten, well-timed notations of that’s what she said .
“Look at this.” Maxwell points at his computer screen. “Bed two got the TUMC special.”
I glance at the monitor, open to the patient’s lab results lit up like a Las Vegas casino.
“Christ. Is there any STD she doesn’t have?”
“Syphilis.” Maxwell scrolls. “Oh, and HIV. I’m gonna let you tell her about her new hep C diagnosis. Good practice for you.”
“Thanks.” My voice is dry, but I scribble another line on my to-do list.
“This is why we don’t mess with dirty dicks, ladies,” Maxwell murmurs as he flips to another patient’s chart. “Doubt that asshole in the room with her will bother to get treated.”
He proceeds to ask me a series of questions. How do you treat chlamydia in pregnancy? Does she need a test of cure? When? What about trichomonas?
Medical pimping at its finest. At least Maxwell’s pimping style is nice. He shows me how to find the answer when I don’t have it, instead of chastising me and telling me my patients will die. My attendings definitely won’t be this civil.
My pager beeps and I frown at the digits x5373 .
Leaning over, Maxwell groans out a sigh. “That’s the ER’s number. Welcome to your first ER consult. See what they want.”
I make the call, jotting notes, but my pen stills at a lilting feminine voice behind me. The sound creeps along my spine, and my skin pricks like it’s waking up after a long time without adequate circulation.
I sense a threat.
She’s behind me. I’m not sure how I know it’s her, but it’s definitely her. Tingles raise the hair on my nape.
When I hang up, Maxwell lifts his eyebrows, throwing a give-it-to-me sign.
I slide him my notes. “They have a consult for pelvic pain. I told them to get an ultrasound.”
Maxwell smiles and wags a finger at me. “Good man.”
My sigh of relief is subtle but calming. Even the smallest orders take on life-altering significance now that I’m the one in charge. Each go-ahead for Tylenol or TUMS has to filter through my safeguards. My easily distracted brain is already exhausted.
Maxwell returns his attention to our visitor and I turn toward her.
Grace Rose, standing in the dictation room doorway, wears powder-blue surgical scrubs, two pagers clipped at her waist and a rainbow of pens in her breast pocket. The giant mass of curls from two nights ago is contained in a messy knot, wisps escaping around her face. Without the red lipstick, a single freckle on her upper lip stares at me. Weird place for a freckle. Distracting.
I sigh and look away. “What are you doing here?”
“I had a second, so I escaped.” She turns to Maxwell. “Thought I’d come meet the senior on L&D.”
Aw, you didn’t want to see me too, Grace? I’m so sad. Even my inner voice is rolling its eyes.
Maxwell shakes her hand. “Sorry about the other night. I don’t believe any of it, just so you know.”
I throw him a raised eyebrow. That wasn’t exactly the impression I got…
Grace smiles. “That’s okay. And thanks.”
Oh, so she’ll accept his apology.
Nice, Grace. Guess we won’t be best friends.
Releasing her hand, Maxwell leans back in his chair. “What are you on this month?”
“General surgery.” Tight lines appear beside her mouth. “Four hours in, and it’s already draining my life force.”
“You don’t like surgery?” Maxwell asks.
“I don’t like surgeons.” She crosses her arms. “Or, I don’t like these surgeons.”
“Of course you don’t,” I mutter.
Maxwell chuckles. “We all deal with a bit of hazing.”
She scoffs and unclips a pager. “They gave me the penis pager.”
Maxwell pulls a breath through his teeth. “Sucks.”
I glance between them. “What’s a penis pager?”
“Urology,” they answer together, and Maxwell says, “A lot of old men who can’t pee.”
Grace throws a perturbed glance toward the ceiling. “Because that’s why I went into OB-GYN. To look at old penises all day.”
Maxwell laughs. I bite the inside of my lip. My pride won’t allow me to find her charming or funny. She’s a hypercritical shrew. End of story.
“My last consult had two propellers tattooed on his ass cheeks and was only too proud to tell me that he got them—” she deepens her voice “— so I can go deeper. ”
Pride thwarted, I turn to my computer to hide my damning grin. Little Miss Priss has a sense of humor. Who knew?
“I think his junk not working is cosmic justice,” she says.
I don’t want to give her the satisfaction, but a snicker escapes anyway.
Her sparkling glare settles on me. “You think it’s funny?”
“It’s only funny that you’re suffering.” I shoot her a sarcastic smile. “Karma.”
“You’ll get your turn, . Just wait.”
“It’s day one, girl,” Maxwell says. “Get used to being the scut monkey.”
Chastened, she bites her lip, hiding the freckle.
“I know.” She stares hard at me, narrowing her eyes in accusation. “Some people are just rude.”
Is that it, Grace? You think I’m rude? “Like us misogynists?” I ask, tone desert dry.
She opens her mouth to reply, but Maxwell interrupts her. “They’re general surgeons. They foist their misery upon others. It’s only a month. You can do it.”
“Dr. Rose!”
Grace spins in the doorway, nearly colliding with another resident, a man an inch shorter than her. Without smiling, the stranger takes a pointed step back.
Grace’s cheeks flood with color. “I’m—I’m sorry.”
The man I presume is her senior resident this month looks her up and down. “You’re not supposed to be on L&D. It’s time for lunch.”
Her mouth opens twice before anything comes out. “It’s nine-forty.”
“Eat when you can. Sleep when you can…” His head tilts, expectant.
“Um.” She glances at me and Maxwell, eyes wide and panicked.
I know the phrase he means—a popular one amongst surgeons—but I lift an eyebrow, refusing to help this sanctimonious woman. A bloom of pleasure spikes my blood as she chokes and stutters.
The surgery resident’s voice slows like he’s speaking to a toddler. “Don’t fuck with the pancreas.”
A muscle in her cheek twitches. “How was I supposed to know that, Dr. Halliwell? I’m a gynecologist. Why would I be near the pancreas?”
Dour Surgeon sneers. “I forget you guys aren’t real surgeons.”
I resist the urge to snort. What a douche.
Maxwell mutters, “Okay, Halliwell,” under his breath.
Grace’s knuckles whiten around the penis pager. “This coming from a man whose attending kicked him out of the OR this morning?”
Whoa. That won’t serve her well—even though the guy deserved it.
Halliwell’s eyebrows shoot up and his jaw hardens. “He didn’t kick me out—”
Maxwell stands, towering over the resident. “Take it easy on her, Halliwell, and stop being a prick.”
A faint smile appears on Halliwell’s humorless face. “I heard you guys let a DO in your program. Must have been really hard up.”
Ripples of heat spread from my face downward. My ID badge is flipped backward, so he can’t know that I’m the DO, but the reminder of never being good enough simmers in my bones. Like a virus replicating, it has insinuated into my very DNA.
Average student. Mediocre test-taker. Inattentive boyfriend. Too skinny. Too quiet. And now… DO.
I chose osteopathy. I wanted this.
Sometimes I wish I never had.
Fuck off, dickwad.
This is what I hate about medicine. The elitism. The hierarchy. The animosity between specialties. The malignancy.
This unfriendly surgery resident is everything that’s wrong with medicine and the tiniest shred of compassion rips through my distaste for Grace’s attitude. The poor girl has to be his slave for an entire month.
Maxwell shakes his head and reseats himself, not dignifying the asshole with an answer.
Halliwell smirks and motions for Grace to follow. “Come along, Doctor.”
She obeys but turns to mouth Thank you at Maxwell. She doesn’t spare me another glance.
“He’s got a raging case of short-man syndrome.” Maxwell spins in his seat, glancing at the fetal heart tracings. “But even if she didn’t sleep with someone to get in, that girl’s attitude is going to get her in trouble.”
I shrug. If it does, she’ll deserve it.
Maxwell jerks upright. “Shit!”
Startled, I turn to the monitor. Room eleven’s fetal heart rate has dropped to the sixties—far below the norm. Adrenaline rushes through my system as I fan through the empty textbook in my mind, trying to remember everything I’m supposed to do.
Maxwell rises and claps me on the shoulder. “The baby’s in distress. What are you going to do, Dr. Santini?”
Go assess the patient.
I hurry to room eleven. The patient moans as I enter, Maxwell following. Two nurses beat us there and have already placed oxygen. They roll the patient to her side. The patient’s husband stands beside the bed, whispering encouragement.
What’s her name?
Maxwell approaches the bedside. “Kaylee, how are you feeling?”
She moans again. “Hurts.”
Maxwell turns to me. “How would you like to proceed, Dr. Santini?”
I glance at the heart tones again. Still non-reassuring. My sweaty hands clench. Why can’t I think?
“Why don’t you check her cervix,” Maxwell says.
I nod and take a breath, donning gloves with nervous fingers. The slow beep, beep, beep of that baby’s heart is a noose around my neck. The rate is half my own.
I’m inexperienced and my cervical check is amateur. I’m fishing for anything that might be a cervix. Sweat gathers at my neck and temples. Kaylee screams as another contraction hits.
Beep. Beep. Beep.
Aha! My fingers slide into a ring about the diameter of a tennis ball. “Six centimeters.”
My gloved hand comes away with large clots of blood. Bright red saturates the bed beneath Kaylee. My stomach drops.
Maxwell raises his brows. “What do you want to do, Doctor?”
I don’t know.
I’m terrified.
Unpracticed and unprepared, I stare at the heart tracing—a flat line at sixty beats per minute.
“Kaylee, your baby’s in distress.” Maxwell approaches her bedside. “You haven’t dilated far enough to push and your bleeding has me worried something’s wrong.”
Fear clouds her eyes, and she wipes blond hair from her sweaty face. “Okay.”
“What does that mean? Is the baby okay?” her husband asks.
“It means we need to move toward delivery now. We’ll have to do a C-section. We’re going to call Dr. K.”
The husband visibly relaxes at the mention of our attending. Maxwell consents Kaylee for a Cesarean while the nurses prep. I stand useless off to the side, absorbing what I can.
Outside the room, Maxwell cocks his head. “What do you do next?”
“Call the attending.”
My report to Dr. Kulczycki is a stuttered mess, and he pimps the shit out of me over the phone while we hurry to the OR, and just like I thought, he’s not nearly so nice about it. He meets us there and continues to ask questions, digging deeper into my knowledge until I no longer know any answers.
He must think me competent enough because when we scrub in, he shoves me into the primary surgeon’s spot and hands me a scalpel. “Sink or swim, Dr. Santini.”
I’ve never primaried a C-section. I’ve observed dozens, memorized the steps, thrown a few sutures in the closure, but I’ve never cut my way down to a baby.
She has no epidural. No time for spinal anesthesia. The anesthesiologist has her asleep and intubated too quickly for me to run through the procedure again in my head.
Fuck, fuck, fuck.
He gives the go-ahead. With tingling fingers, I set the scalpel to her skin.
Splash and crash. That’s what we call it. Splash of Betadine and a crash C-section, reserved for true emergencies. I have the baby delivered within two minutes—not the fifteen seconds a seasoned attending might have done, but well within time to save his life. My senior and attending correct every wrong move before I can make it and the entire surgery takes far longer than a normal Cesarean, but mom and baby live through it.
And so do I. Sweaty, shaking and possibly in some sort of shock, but I’m alive.
Back in the dictation room, Maxwell is teaching me to put in post-op orders when Dr. K enters. “So, intern, did you make the right decision, taking her to section?”
I’m at a loss. Is that a trick question? The baby was in distress.
“Uh—”
Dr. K settles into a chair, hands over his midsection. His surgeon’s cap covers his curly black hair and his glasses reflect the multiple computer screens around us. “Review the case with me. Did you make the right decision?”
“The baby was in distress.”
He nods. “And?”
“And mom was bleeding.”
A wide smile spreads over his face. “But, Dr. Santini, bleeding is normal in labor.”
I scratch my jaw. “This was a lot of bleeding, though.”
“Ah.” His smile eases. “So what was her diagnosis?”
“She—she had a placental abruption.”
Dr. K’s eyes glint behind his glasses. “And what’s the treatment for an acute abruption?”
“Delivery.”
“Then tell me. Did you make the right decision, Doctor?”
“Yes.”
“Good answer.” Dr. K stands and walks away, throwing a last-second “Good job” my way before he disappears around the corner.
The adrenaline rush transitions into a surge of endorphins and I grin at the computer. “That was awesome.”
“Yeah.” Maxwell’s deep laugh resonates in his chest. “Nothing like a good crash section to get the blood flowing. Welcome to OB.”
Finally. The reason I chose this. All the late nights and years away from my family and massive amounts of debt will be worth it if I can learn to do this job well, to protect those who’ve received the shit end of the stick when it comes to health care.
Like my mom, who almost died when I was fifteen because her doctor didn’t listen, or my oldest sister, whose first pregnancy nearly killed her when a pulmonary embolism went undiagnosed.
I can do better for them.
I will save lives and today is the beginning.
* * *
The Red Hot Chili Peppers play in the background and ESPN is on mute while I stare at the massive textbook on my coffee table three days later. My one-bedroom apartment is furnished with hand-me-down items I obtained from Facebook Marketplace, but the large Samsung TV and Bose sound system I bought new—because, obviously . Not that they get much use with the twelve—usually thirteen—hour days I work.
I’m supposed to study.
I know this.
Everyone knows this.
Doctors study. That’s what we do. We’re the nerds who abandoned our social lives in college to become awkward med students and rack up hundreds of thousands of dollars in student debt.
After eight years of forcing myself to read the same information over and over again and still not retaining it the way other students do, I’m running on fumes.
Fumes with four more years to go.
Williams Obstetrics is more than a thousand pages of information I’m supposed to know and it doesn’t encompass even one-half of my specialty.
I take a swig of IPA and briefly wonder why I didn’t become an accountant.
You wanted this, remember?
The spine cracks when it opens for the first time, the smell of paper and ink wafting over me. I shudder at the fragrance, one that takes me back to long nights in a lonely study cubicle above my med school library.
I’m three paragraphs into the chapter on maternal physiology when a growl ripples in my chest and I hop off the couch. Pacing in my living room, I whip out my phone, Googling whether the book has an audio version—no—and if there’s an app—also no.
My fellow interns don’t share my distaste for textbooks and lectures and studying in general. Not that I’m surprised. Again, doctors are nerds.
Me: Did everyone but me read these assigned chapters?
Sapphire: probably
Me: Do you speak for the group now?
Kai: I read them
Raven: Me too. Twice.
Alesha: I did too, juju. sorryyyyyy
Sapphire: Told you
I scowl at the screen. Even in texts she’s annoying. Her prim tone filters through the screen into my amygdala, firing all the neurons dedicated to anger. I switch to Maxwell.
Me: Do I really need to read this stuff?
Maxwell: They assign the same shit every year. You read it this year, you won’t have to next year.
Maxwell: Or maybe you will. You got a thick head.
Me: good hands though
Maxwell: surgery aint everything, bro
Me: Chance to cut is a chance to cure
Maxwell sends a gif of Derek Shepherd from Grey’s Anatomy doing his surgeon thing, and I laugh, but the smile fades fast as the behemoth on my coffee table beckons. A sip of IPA and a narrow-eyed gaze don’t stop its silent taunts. I finish my beer, play Wordle and three levels of Candy Crush , text my sister, and manage six more paragraphs of the chapter.
Only four million to go.
Fuck this.
I’m going to bed.