7. Chapter 7
Sarah
The conference room on the second floor holds forty people and this morning it's trying to hold sixty.
I get there at seven-fifty and take a seat in the third row next to Theo, who's already there with a notebook open and nothing written in it.
Attendings line the back wall with their arms folded.
Residents fill the chairs. There's a coffee urn in the corner that ran out before I arrived, and a woman from administration is guarding the empty urn like it might still be useful.
I slept four hours in a bed that wasn't mine, showered in a shower with six settings, and drove here in yesterday's clothes with my hair wet, and I'd know it about myself if I saw me, so I keep my eyes forward and my badge straight and my hands still in my lap.
Theo leans over. "You look nice."
"I look like a night shift."
"You look like a night shift that went well." He clicks his pen. "Do you know what this is about? Nobody knows what this is about. I asked three people."
"I know exactly what you know."
Nick comes in at seven-fifty-eight.
I feel the door open before I turn, which is its own diagnosis, and when I do turn, casually, the way half the room turns, he's walking the side aisle in clean scrubs with a coffee he must have bought in the lobby, and there's nothing on his face at all.
He takes a spot on the back wall between two other attendings, sets the coffee on the windowsill, folds his arms, and looks at the front of the room like a man with no interior life whatsoever.
Twelve hours ago that man had my wrists pinned to a mattress. Eleven hours ago he pulled a blanket over my shoulder because he thought I was asleep.
I face the front.
Whitfield comes in at eight sharp. I've never met the program director, only seen his signature on my transfer paperwork, and in person he's smaller than his signature, a neat silver-haired man in a suit with no tie, carrying nothing, which somehow makes him more alarming than a man with a folder would be.
"Good morning. I'll keep this short, because you have patients.
" He stands at the front with his hands loose at his sides.
"Three days ago, this hospital concluded a personnel matter involving a member of the anesthesia department and a member of the nursing staff.
Because the matter involved a supervisory relationship, and because it wasn't disclosed, both individuals have been separated from the institution.
That's public as of this morning. You'll hear it in the cafeteria, so you're hearing it from me first."
The room is very quiet. Somebody's pager goes off and is silenced in one second flat.
"Effective immediately, the disclosure policy is not a suggestion.
" Whitfield's voice doesn't rise. It doesn't need to.
"Any relationship between a supervisor and a person they evaluate gets disclosed to this office before it gets discovered by this office.
Disclosed, we can manage. Reassignments happen.
Careers survive. Discovered—" he lets the sentence rest a moment, looking around the room the way a teacher looks around a classroom "—is what happened three days ago.
A twenty-year anesthesiologist is updating his resume this morning.
The nurse, who did nothing but fail to fill out a form, is doing the same.
I found that outcome avoidable. I find most bad outcomes avoidable.
That's the whole meeting. Questions go to my office, not to this room. "
He nods once at the back wall, at the attendings, and walks out, and sixty people exhale at different speeds.
Theo writes one word in his notebook. I can read it from my chair. yikes.
"See, that's a normal meeting for a normal person," he says, closing the notebook. "You know what's funny? Half this hospital is dating the other half. My med school class had two weddings come out of one rotation. They can't fire everybody."
"They fired those two."
"Yeah." He caps the pen and stands, then pauses. "The nurse thing is what gets me. She didn't even do anything wrong except not tell them. That's the part everyone's going to remember wrong by Friday."
I don't look at the back wall on my way out.
At eleven I'm writing the consult note at the fourth-floor station when Rosa sets a paper cup of coffee at my elbow without being asked.
"You didn't get any at the meeting," she says. "Urn was dry by seven-forty. I have sources."
"Your sources are correct." I wrap my hands around the cup. "You heard?"
"Everybody heard." Rosa pulls the chair next to me and sits, which she does not do, Rosa doesn't sit, and I put down my pen. She smooths the front of her scrub top with both palms and looks at the monitor bank across the station, all the little green rooms doing fine without us for one minute.
"Carmen," she says. "The nurse. Worked here fourteen years.
She trained half this floor, me included, back when this unit was eight beds and a prayer.
" Rosa's mouth goes tight at the corners.
"He was leaving his wife the whole fourteen years, if you ask around, but nobody asked around, because he's got twenty years and a golf membership, and she's got a badge that stopped working yesterday at five. "
"You said both of them—"
"Both of them, sure. He'll have a job by fall. Anesthesiologists land. Nurses fall." She stands up, chair pushed back in, herself again in one motion. "Anyway. Drink your coffee."
She's three steps gone when she stops, comes back, and picks a piece of lint off my shoulder that I'm not sure exists.
"You're a good doctor," she says, to the lint, not to me.
"The kind this place doesn't get to keep unless somebody's careful.
So. Be careful." She flicks the lint away and goes back to her cart, and I sit there with the coffee she brought me, understanding that I've just been told everything Rosa knows without one name being said.
The nurses fall. That's the piece I carry into the afternoon like a stone in my shoe.
Not the anesthesiologist with the resume.
Carmen, fourteen years, badge banned at five o'clock.
In every version of this story that ends badly, there's a senior person who lands and a junior person who falls, and I've been so busy guarding his career in my head, the chief, the department, the years he built, that I never once ran the math with me as the casualty.
I run it now, over a suture cart in the supply room, alone.
If we're discovered, he gets a reprimand and a reassignment and a rough year.
I get to explain to my third residency program why I left my second one.
There is no explaining that. That's not a rough year, that's the end of the road, four years of medical school and four years of residency and a two-thousand-mile bet, all of it, on a stairwell and a shower with six settings.
I close the suture cart drawer. My pager goes off. Room 421. I go.
Room 421 is a new admit off the morning list, and the name on my printout says REYES, C., and I stop in the doorway because Carla is sitting up in the bed with a magazine, two weeks post-op, back on my floor.
"There she is," Carla says, like we had an appointment.
"What happened? You were doing beautifully in clinic—"
"Nothing happened. Relax your face." She waves the magazine at me.
"Little fever, little redness at the one end of the scar.
My sister made me come in. Yolanda treats a hangnail like a code blue.
They said one night of the IV antibiotics and I'm out, so here I am, one night, and my only demand is a room where the television gets channel nine, which this one does, so we're fine. "
I check the incision. She's right and Yolanda's right, a small cellulitis at the inferior edge, caught early, already less angry after the first dose if the nursing note's honest. Her belly is soft, her labs are boring, and she watches my face the whole exam like she's the one assessing me.
"You look different," she announces when I straighten up.
"I look tired. It was a long night on the unit."
"No, tired I know. I raised Bree alone, I've got a doctorate in tired." She sets the magazine down flat. "Different. You had your hair down when you came in this morning, I saw you go by the desk. Two weeks ago you had it in that bun so tight I got a headache looking at it."
"You were unconscious for most of our relationship, Carla."
"I was unconscious for two hours of it. Sit."
"I have four other patients."
"They can spare you three minutes. Sit down." She points at the chair, and I sit, because I've learned this about myself on this unit, I sit down when told to by women recovering from surgery, it's apparently policy. Carla studies me a moment, then nods at whatever she finds.
"Bree wants to be a doctor now," she says.
"Since the accident. She made Yolanda buy her a little kit with the fake stethoscope, and she goes around the apartment taking everyone's blood pressure wrong.
" Her voice stays level, and her eyes go bright and stay bright without spilling.
"She asked me what the lady doctor's name was.
The one who promised to call. I said Dr. Mitchell, and she said, first name, and I said I don't know her first name, and Bree said, that's okay, Mitchell can be a first name. "
I laugh without meaning to.
"So somewhere in this city," Carla says, "there's a seven-year-old calling herself Doctor Mitchell-the-first-name, taking wrong blood pressures, because you found my phone and called my sister.
That's all I wanted to say. Now go see your four patients, and tell whoever's got your hair down that Carla Reyes says he better be worth it. "
"I didn't say—"
"You didn't have to. Channel nine, one night, out by lunch tomorrow." She picks the magazine back up. "Close the door, it echoes in here."