Ren finished scrubbing on the neurosurgery case around four thirty. No point in trying to sleep then, and she was too wound up physically and too excited mentally to even consider it. Besides, in a little over an hour she’d be meeting with her new service, and she had plenty to do before then to get ready. First impressions mattered, especially for her. She knew what people thought when they first saw her. Beyond the obvious—too young, too inexperienced—their next thoughts often carried a hint of subtle suspicion—who was she, where had she come from, what special privileges had she been granted. She kept her private life private, which wasn’t hard since she never developed close relationships anyhow, but she was doubly glad now that no one knew Quinn Maguire was a family friend. She’d known Quinn since she was fifteen, and that was partly the reason she was here. But she’d had other offers from other training programs. None of that mattered now. What mattered was that she belonged here, even if no one but her knew it. That was up to her to change.
She planned to make rounds even before the other residents did, so she’d know the patients as well as, or better than, they did when they first sat down to discuss them at morning rounds. If she wanted to be in charge, she’d have to banish their doubts as to her abilities before they had time to form doubts. So no time to get home and even think about a change of clothes, not that she needed anything other than clean scrubs. She had all of her necessary items in her backpack. After a quick shower in the locker room, she dried her hair with a towel and a quick minute or two with a blow-dryer. She never worried much about styling it. It was thick enough and had just enough wave not to need anything special. She’d never really gotten the hang of makeup, as if she’d had time or reason to learn, or even wanted any when wearing a surgical mask all day long. And she’d never really had to worry about any other occasions, like having a date or anything. That had never been on her mind. When she was the age other people began doing it, she’d been in college and a full five years younger than everyone else. No, dating had not been on her horizon then, and by the time she might have been able to breach the distance between herself and her colleagues, other things seemed more important. Or at least more comfortable.
As she got dressed for the day, she kept thinking about the surgery of the night before. She’d scrubbed on only a couple of neuro cases a long time before, and they hadn’t been anything other than routine. This had been an emergency. A life-or-death situation, and she’d felt it, every second of the immediacy, the intensity, the controlled speed and pressure of getting him upstairs, getting him anesthetized, getting the access through the bone into the intracranial space, finding the large hematoma pressing on his brain, clearing it away, relieving the pressure, watching his vital signs stabilize. All within what felt like seconds, but had really been minutes. Twenty minutes that had spelled the difference between a future for him and a tragedy. She’d been part of that.
At one point Kos—Dr. Hassan—had told her that if she hadn’t moved as quickly as she had, hadn’t done the right initial emergency treatment, they might never have gotten him upstairs in time. She had saved a life. The very thing that had made her decide to go into medicine in the first place, to use the skills that she was good at—her brain, her focus, her eidetic memory—not just to impress teachers and mentors, but to make a real-life difference. She’d felt it even when she was so young no one else had taken her seriously. She’d believed it all the years she had to face the challenges alone, but she’d never before truly experienced it. Those few hours with Kos and Syd Stevens had shown her that everything she’d thought she’d wanted was true. She’d had success in the lab, she’d impressed people—not that that was new or even had much meaning to her—and she’d published papers, significant scientific findings that would make a difference, in theory and, hopefully, in practice at some point. But those successes would never come directly from her hands. Her research mattered. She was proud of her work, and she would finish her work, but this, this was like nothing she’d ever felt before. This sense of accomplishment, of fierce victory, was what she wanted. And she wanted more of it.
Still heady with the feeling of success, of triumph, she got coffee, toast, and eggs and splurged with a helping of the hash the cafeteria was famous for. Her usual breakfast was a protein bar while sitting at her computer in the lab. But last night warranted a celebration. She carried her tray to a small table on the far side of the cafeteria where she could look out the window and watch the sunrise. The view was one of her favorites, across the green lawns that sloped down to the fringe of trees that separated the grounds of the medical school and hospital complex from the neighborhood that surrounded it.
She’d just started on her toast when Dani Chan came in with Zoey Cohen, both of them in green scrubs like her and almost every other person in the cafeteria. Ren watched them for a few seconds and then averted her gaze back to the window. She didn’t want Dani to think she was staring at her, which she was, but just seeing Dani—someone she knew, even just a little—made her feel as if she was a part of things somehow. Even though she wasn’t really. She didn’t really know Dani, and Dani had probably forgotten all about her.
Dani said, “Hi, Ren, mind if we join you?”
Ren looked up, hiding her surprise, pleased that she hadn’t jumped at the unexpected sound of Dani’s voice. “Of course. I mean, of course I don’t. Mind. Please, sit down.”
Dani pulled out a chair, and Zoey sat beside her, facing Ren. After a second, Zoey extended her hand.
“Hi, I’m Zoey Cohen. I don’t think we’ve ever actually met, but you know, we’ve passed each other here and there.”
“Of course.” Ren extended her hand and, as they shook, added, “You’re a fourth year, right?”
“That’s right,” Zoey said. “And as of right now, I’m your fourth year.”
Ren frowned. “I’m sorry?”
“I’m on A service—fourth year.”
“Not according to the list I received from Dr. Maguire.”
“Well, apparently there’s been a switch,” Zoey said lightly. “I got a text this morning from Dr. Maguire that I was being transferred over to your service.”
“Oh,” Ren said, mentally calculating what that might mean while surreptitiously checking her phone for a missed text. She knew there wasn’t one—she’d been checking for a message from Axe for the last hour. She couldn’t come up with a reason for replacing her fourth year resident except that Dr. Maguire either wanted her to have a more experienced senior resident to watch her and report on her, or help her out. She could either be paranoid about that, which wouldn’t change whatever the truth was, or she could simply start out believing that Zoey was there to do what every other fourth year resident did—make sure the chief was well-informed at all times, never surprised by anything, and always had all the answers that an attending might want, and to see that the junior residents faithfully carried out the chief resident’s instructions. In other words, Zoey was there to be her right hand.
“Well then,” Ren said, stretching her hand across the table. “Welcome, and thank you. I’m glad to be working with you.”
Zoey took her hand, squeezed it firmly for a few seconds, and nodded. “Same here.”
Ren glanced at Dani, who’d been watching them intently, probably judging how the two of them were going to get on. Dani, it seemed, was an observer. Ren understood that. What it was to watch the interactions of others, to draw conclusions about them from what she saw. There was safety in observation, but there was very often also truth.
* * *
Dani leaned back in her chair while Zoey and Ren discussed the day’s OR schedule. They’d forgotten all about her as they settled into the familiar routine. She took in the little details, their body language and tone of voice, trying to get a fix on how they’d get on. And, she discovered, Ren did drink coffee in the morning—strong too, from the looks of it.
“I’m going to take Omati’s aortic aneurysm resection with one of the juniors. I was thinking Shelby. What do you think?” Ren said, glancing at Zoey before making a note on a handwritten list she’d laid on the table by her coffee cup.
“Shelby’s had a rotation on vascular already. Omati almost never lets the juniors do anything, so the case would be wasted on Patten…so yeah. Shelby.”
“Good,” Ren muttered. “Do you want the colon or the liver resection?”
“Liver,” Zoey said instantly. “You can put Patten and the first year on the colon. Daniels ought to be done with the floor work by the time that case starts.”
Dani sipped her coffee, light and sweet the way coffee should be, while she watched them work. All that was missing was the Cap’n. Ren was going to do fine. Her aura of quiet self-containment might look like shyness to some people, but Ren wasn’t shy. She was deliberate, and there was a world of difference. She was careful in what she said, but always definite. When she’d spent a little time with Ren that first day, Dani’d perceived a slight flicker in her gaze that most people probably wouldn’t notice. That fleeting sign told her Ren was a little surprised by something. And then just as quickly, the unwavering intention in her gaze returned. That’s when Dani knew she had sorted through the probabilities and come to a decision. She’d seen Ren do that on rounds when she’d been presented with patients in serious condition, who needed decisions about what to do next. She’d been silent, inwardly appraising, and then she stated her plan. With finality. Dani knew then she would do well as a chief with that approach. One of the first things she’d learned was that indecision was worse than no decision, even a wrong one. Indecision meant delays, halfway treatment, or even worse, no treatment at all. In an emergency, in a life-or-death situation, indecision was literally deadly. Ren was not indecisive. She made her moves with assurance. She’d make a good gamer.
Idly, Dani wondered if she played.
“I think you’re set,” Zoey said, just a hint of surprise in her voice. Ren didn’t seem to notice but smiled at Dani.
“Dani was a big help,” Ren said, dragging Dani back from her reverie.
“You didn’t need it,” Dani said, “but happy to serve.”
Ren laughed.
Dani rose. “I’ve gotta make rounds myself. Good luck, you guys.”
“Thanks,” Zoey said.
“Thank you,” Ren said, still smiling at her.
That little bit of formality. That was Ren too. Another of those little things she’d noticed, that she liked. Dani grinned, unaccountably lighthearted, and walked through the cafeteria toward the administrative wing. She’d decided to do this on a whim, somewhere between her truncated shower and the ten-minute walk with Zoey to the hospital. She’d been thinking about her family and questioning if anything, including a nationally recognized honor, would change their image of her, and how much any of that mattered. Thinking about the Franklin brought her face-to-face with the almost-certain reality that Ren was probably the stronger candidate. And Ren wasn’t the only competition—just the one who’d appeared out of nowhere and who occupied her mind more than anyone else she knew, other than her best friends. And Raven. Dani laughed to herself. If the best friend category was based on the strength and importance of a connection, then Raven qualified there too.
And since she was losing sleep over the whole Franklin thing, it mattered enough, it seemed, to propel her toward Quinn Maguire’s office. Really, she had nothing to lose. The question was, did she even have a chance.
The administrative wing was quiet at a little before six in the morning. The regular staff wouldn’t arrive until seven thirty or eight, and the surgeons all headed straight for the OR first thing in the morning. Except she’d often seen Quinn heading this way well before the first OR cases of the day were ready to start. She took a chance, which was, after all, kind of how she lived her life.
Sure enough, light shone in Quinn’s office. Dani walked past the empty reception desk and tapped on the inner office door. Quinn sat at her desk with files in front of her. When Dani knocked, Quinn looked up, saw her, and gave her a quizzical smile.
“Come on in,” Quinn said.
“Sorry to bother you, Chief, if you’ve got five minutes.”
“Have a seat,” Quinn said, obviously picking up on the fact that Dani wasn’t there because of some surgical emergency.
Dani sat and, before she could think about it, did what she always did. Plunged ahead without any plan besides her gut feelings. Overthinking never really helped her when she’d made a decision. “I wanted to talk to you about the Franklin award.”
Quinn nodded but said nothing.
“I, um, I know I’m a transfer, so I don’t have much of a track record, but I’m hoping to change that. So I might be considered.”
“You know I can’t talk about anything other than the general basis for the award, right?” Quinn said.
“Oh yeah, it’s not about that. Well, maybe it is. I guess I have a question. No, two questions.”
“Okay, go ahead. I’ll answer what I can.”
“I’m wondering how important research experience is, and if it matters, how I can get some.”
Quinn smiled. “That’s a request I don’t get very often.”
Dani laughed. “Yeah, I bet.”
Quinn blew out a breath. “You know the Franklin is voted on, and the votes are counted—no discussion. The parameters under consideration are pretty broadly drawn—the surgical resident who demonstrates the outstanding principles and ideals of the surgical profession. The senior staff can interpret that any way they like.”
“Department heads all vote,” Dani said.
“That’s right.”
“Okay, well, I’ve rotated on almost all the services but not everyone’s. Does that disqualify me?”
“No. Surgical residents get exposure to all the staff when they see ER and trauma patients. Not everyone rotates on every service, depending on what direction they’re planning to go in after they finish general surgery,” Quinn pointed out. “So you’ve still got plenty of opportunity to interact with all the staff.”
“Well, no place I’d rather be than the ER or the trauma unit.”
Quinn laughed again before saying, “As far as research is concerned, it varies as to how much emphasis each voter places upon it. But, in all honesty, it doesn’t hurt.”
“Yeah, that’s what I thought. It doesn’t seem reasonable that there’s anything I can do in the lab at this point,” Dani said almost to herself.
“That’s true,” Quinn said. “You don’t have time, realistically, to spend in a research lab with the number of cases you need for your chief’s year.”
Dani nodded. She’d known, but she’d just needed to hear it.
“But,” Quinn said, and Dani alerted, “surgery is a clinical specialty. Medicine is clinical. Of course, great advances are made in patient care as a result of bench research. Those are long-term goals. But what we have,” Quinn said, sitting forward, her voice intensifying, “is an amazing wealth of clinical material—hundreds, thousands, of clinical cases. Records of patients who presented with all manner of diseases, who’ve been treated in different ways, with different outcomes. Clinical studies, even retrospective studies, can be elucidating. Can give us springboards for treatment and further research.”
“Clinical studies. You mean, patient studies.”
“I mean outcome studies. Looking at the data from focused groups of patients who presented with similar conditions, but whose treatments may have varied, or whose treatment was similar, but the outcomes were different. Analyzing that data can give us valuable information about a disease and its treatment.”
“What would I have to do?” Dani said.
“Talk to Allison Carducci. I know she’s interested in looking at the impact of various nutritional regimens on kids with cardiac atresia. She’s got enough data there you could get a paper out this year, and it would mean something.”
“I’ll do it.” Dani didn’t even need to think it over. She didn’t have any idea exactly how she would go about doing it, because she’d never given it any thought, but she’d figure that out.
“Good,” Quinn said. “I’ll give her a call and let her know you’ll be coming by to talk to her.”
“I’ll do it today,” Dani said, rising.
“You know, Dani,” Quinn said quietly, “no matter who wins the Franklin, what matters is the kind of surgeon you’ll be this time next year and five years from now.”
“I understand,” Dani said, and she did. But this mattered too—more, she realized, every day.