Chapter 1: Chapter 1
Rotations
A/N: This was rather hastily written for the Carolight Fan Fic week on Tumblr ( igsy-blog); it kind of begs for expansion, I think. Anyway, it's a Modern AU Dwight/Caroline fic where Dwight is a med student and Caroline a chief resident in Obstetrics and Gynecology. I work with med students, so this gave me an opportunity to write out some of my observations of their relationships with residents over the years. I apologize if it's a little too jargony. I wanted realism without a lot of stopping for exposition. I might add a glossary of med school terms later.
"How was vacay, Penvenen?"
Caroline looked up at the weary woman in her doorway, dark blue scrubs wrinkled and stained with coffee (hopefully). She finished pinning up her own hair and caught a glance of herself in her blank monitor. Beginning of the ward shift - in four weeks she would look similar to the junior resident. Similar. She never got quite that disheveled. But for now she was perfect - hair, makeup, white coat.
"Have you ever vacationed with the undersecretary of a congressman? Every five minutes a call on the cell phone, half of them to arrange hotel rooms for his mistresses. From a god damned continent away."
"Yeah - but, London. Paris. Tell me he proposed in Paris."
Caroline averted her eyes. "No. Maybe he intended to. He's certainly been dropping hints. But we had a fight that started at one end of the Channel and ended … well, did it ever? London was fine. I was able to visit my Aunt Sarah and listen to how if I had stayed with my mother's people I would be dating investment bankers and aging British rock stars and old world money, instead of trying to earn daddy's approval by working sixteen-hour days in a hospital. Paris was a disaster. My one and only vacation this year, and after this is over I'm going to be sweating over boards and trying to persuade some douchebag private practice asshole to hire me."
"You could stay here."
"Funny, Stettinger. Academic medicine is for stooges. Speaking, of, do you have a printout of the schedule? My computer is not logging on, per usual. That's your academic medicine, for you."
"You never switched over to a passphrase - you're probably locked out. Password1234 isn't HIPAA compliant, you know." She reached around and pulled something off the wall right outside the office. A good old fashioned print-out of a 4-week calendar.
Caroline took it, squinting down at the tiny font listing her team for this week. The ward attending this week was OK. She had Anne Fendick as 2, Marissa Santos as Intern. No AI this week. All good. "Oh, shit, we have an MS3. A boy one."
"All block, yep."
Caroline curled her lip. Third year medical students were far and away her least favorite creatures. They were required to take the clerkship rotation, but only ten percent, at best, were interested in her specialty, and between zero and one percent of those were male students. Male students who, by virtue of having gone from their parents' country clubs to their parents' alma maters to their parents' med school were arrested-development frat boys, rolling their eyes at her patients, cracking jokes after rounds, all because female body parts were so freaking funny to them. Avoiding work at all costs, they'd learned the trick of following laboring patients at -1 station at the end of the shift, then begging off just when labor would get going because their duty hours were almost up, or they had lectures or continuity clinic. The ones who were actually into delivering babies were even more obnoxious, butting in on the junior residents' deliveries, or showing up after the rest of the whole team arrived, having never yet even met the patient and suddenly expecting to be the one who got to catch the baby.
It had been a while since she'd been assigned an MS3. Her evaluations from students had not been great, and the clerkship coordinator at the med school typically avoided sending students to NOVA Women and Children's when she was on the L&D Rotation. So - someone had fucked up. Either the scheduling coordinator had not sent out the schedule with her vacation switch on it, the clerkship coordinator had misread the schedule (as usual) or the student himself had requested NOVA. Which rarely happened. Small hospital, long hours, patients without insurance, awful coffee and a coed call room that smelled like feet and condoms. Any student who actually requested this site she would have to look upon with extreme suspicion.
Well, time to get to it. Four weeks on the floor. Six AM to 10 PM. Small hospital, long hours, patients without insurance and a med student named Dwight Enys.
She walked into the conference room at 6:01. Anne and Marissa were both already there. This was Marissa's first L&D rotation, and she'd had the bad luck to be scheduled for it right after her emergency medicine rotation and looked like the weekend had put no dent in her extreme exhaustion. She had the dark, hollow-eyed look of an Intern in the homestretch of the year. Anne had just come off clinics and Caroline off of vacation, so they were both well rested. But only Anne was in a good mood.
"I see no boy here," said Caroline without preamble. "I suppose he's late."
"He's getting coffee," said Anne. "He was here at like 5:30, just sitting here with his nose in a book."
"Assigning scut work on the first day," smiled Caroline. "That's my job, but I'm pleased, yes - very good."
"No," Anne frowned, slightly. "He offered."
"Well," said Caroline, glancing toward the door. "He's late now." A legitimate negative mark for his evaluation, she thought, and she hadn't even met him yet. "Let's get started." She walked to the computer podium at the front of the room and struggled with it a second before she got the projector screen down and the computer turned on. She was typing her EMR password for the third time when the conference room door opened and closed and the smell of hot coffee suddenly flooded the small space. She stiffened and tried the password one more time, when she remembered.
She turned around in frustration only to see her girls smiling over the young man who had appeared with three cups of coffee. At first, she was sure that there was some mistake. He was not as young as he should be - not twenty-five or twenty-six, but more like thirty, probably right around her own age. That happens sometimes; not everyone goes straight to college or med school. And some people need extra time for both. But it messed up the nice, smirking frat boy image she had conjured for herself.
He had bright eyes and a head of thick, wavy hair and he was still standing, smiling lightly.
"You're late."
"Yes, I'm sorry - there was a hold up in the cafeteria. Someone spent the night there and security was having some trouble getting them out."
"Late is late, doesn't matter why," she said brusquely. "Anne, could you log in to EMR - I forgot, there is some problem with my password; I just found that out this morning,"
She grabbed the wireless laptop and a seat, then her eyes widened as the med student leaned over to her, holding out a cup.
"That's yours, isn't it?" She asked sharply.
"No, it's yours, Dr. Penvenen"
Great. A kiss-ass - or a gunner. Even worse than a bored frat boy.
"Here you go," said Anne. "I've brought up today's patients."
"You have the advantage of me," said Caroline. "You are?"
"Dwight Enys, I'm the student from UVA."
"Sit down, please," she said coolly. "OK, well, welcome to the L&D rotation. We all seem to know each other, so that saves some time. Enys, we don't have an AI on the rotation, at least not for the first two weeks, so that gives you the opportunity to get more hands-on than normal. You will shadow us at every opportunity, in particular Dr. Santos. Make sure we have your pager number and that your pager is on 24/7. Make sure we know when you are supposed to be back at school and how soon you can get back after lectures. Make sure you meet the patients on pre-round or in the labor room before you even think about joining in on a delivery.
"Our attending this week is Dr. Choake, who is really chill, but will ask you all questions on the first day. Let's familiarize ourselves with the current patients on the ward before hand off and pre-rounding. OK, we'll start with KD. Enys, what can you tell us about KD?"
This was the moment most students fell down on their asses. They usually didn't bother to get their EMR logins until after the first day, let alone bother reading up on the patients. "KD," said Enys, squinting at the projection screen, " is a 22‐year‐old G1P0 presenting with frequent contractions every 5 minutes and getting stronger. She has had regular prenatal care and is 39 1/7 weeks pregnant. She has no medical problems and has had no problems with the pregnancy. She reports active fetal movement and no leaking of fluid. She is 5'6", 185 lbs., with a 40 lb. weight gain. BP 110/60, 1+ pretibial edema, and the urinanlysis is negative for protein. Her husband is …"
"OK," Caroline said, holding up her hand. "Let's let Marissa finish with social and genetic history."
Gunner, she thought, wrinkling her nose. It was going to be a long four weeks.
There were only three patients currently on the maternity ward, so they were done by 6:30. Caroline reached for the coffee cup, then remembered where it had come from and withdrew her hands as if she had touched a hot potato.
"Enys," she said, eyeing him again for the first time since he had handed her the cup. He had not become suddenly less handsome or less annoying in the interim.
"Yes?"
"I have a little job for you." She pulled her note pad out of her coat pocket and scrawled on it. She tore out the sheet and handed it to him. "Take this to IT; they're in the basement level. If they need to confirm this, have them call me. My password got locked out while I was on vacation and I need it changed to a passphrase ASAP. This is my current username and password …."
He took the paper from her with a puzzled look. "I'll miss pre-rounding, won't I?"
She set her jaw. "Not all of it. I need this done this morning."
He looked up and met her eyes. His eyes challenged her, knowing that she was assigning him scut work - something she had been spoken to about before, and maybe he had heard the rumors about her - the med student rumor mill rivaling the Hollywood entertainment networks. But she was his chief resident for four weeks and this was his chance to prove a loyalty to her beyond the bureaucratic constraints of his school, his own pride, whatever ambitions he held.
He twisted his mouth, looked back down at the paper. "Who's Horace87? The Roman Poet - or your boyfriend?"
"My dog."
"Your - dog?"
"Yes, and he's a beautiful thing with silky ears. Just - change it to a passphrase, write it down for me and then forget it."
.
.
As pre-rounding ended and Dr. Choake left the maternity ward, Dwight Enys edged toward her. He had had a bad morning, but if it was bothering him at all, he did not let it show. Choake had berated him for interrupting them in front of the final patient of the morning, quizzed him mercilessly on a patient who had in fact been discharged yesterday, and ordered the residents to make sure to keep him away from the laboring patients today and put him to work on writing admission notes and prepare a presentation on post dates induction of labor for the team tomorrow morning. It was for the best, Caroline thought. Put him in his place now, and he would be easier to work with, overall.
"Here's your passphrase," he said to her, handing her a piece of paper.
"Th-" she began, then did a double-take. "'The quick brown fox jumps over the lazy dog?' Seriously? You expect me to type this every time I log on here?"
"With a pound sign and an exclamation point at the end," he said. "All the letters are there - it should be quite secure."
She took a deep breath. "Well, you heard Dr. Choake. You should jump on a computer and start working on your presentation. There's a free computer behind the nurse's station and we have an Up-to-Date subscription in house, so …."
"I have my own subscription," he said. "I believe I need to check out a vocera, too, don't I?"
"Vocera's the paging system for deliveries. You heard Dr. Choake - that won't be necessary today."
"OK."
Anne edged up to her. "You want me to check out a vocera for him, for the morning?"
"No," said Caroline, "I'll take care of it."
.
.
At ten o'clock, Caroline handed off to the night float team, leaving KD and her problematic contractions behind her. She didn't bother changing out of her scrubs, just went wearily out through emergency to the back parking lot. Always hyper-aware of sound and movement in this neighborhood, late at night, she hitched her step at the soft sound of footsteps behind her. She rounded the corner and pressed herself against the brick wall, waiting for whomever was behind her to pass her by. There were two ambulances and a police car flashing its lights to her right, so she anticipated no real problems; she just hated to be followed.
When he walked up into the light of the parking lot lamps, she breathed a sigh of frustration.
"Are you following me, Mr. Enys?" she said, stepping out of the shadows.
"I saw you leave and thought you might need my help."
"Am I like to?" she asked, irritated.
"I've been warned about this neighborhood at night."
"I find this parking lot rather dull," she said, looking around.
"But others may not."
As if on cue, another ambulance and two more police cars came tearing into the emergency room parking lot. They watched as two stretchers were pulled out and teams of ER docs ran out to greet them. "Thugs," she said, coldly.
He raised his eyebrows at her. "In a mass," he said, "perhaps. But - take each person individually, every one likable in his own right - selfish and afraid, as we all are, but also generous and kind and peaceable and hardworking and good to their families. At least as much as you or me."
"I'm flattered by the association. Whatever they are, they won't be bothering me tonight, so if you'll excuse me …."
.
.
"So at that point, you begin induction through pharmacologic means, and if she progresses without need for labor augmentation, it should go rapidly to an anterior rim of cervix (9+ cm) vertex ROP at ‐1 to 0 station. ..."
Caroline sat at the back of the conference room, watching him with an increasing sense of frustration. He had not only done his homework, he had put together a freaking powerpoint presentation, with animations, and he could only have done that after he left here last night. She was not going to be able to defeat him by normal means.
"Vocera today?" he asked her, as he joined the team in the hallway following his presentation.
"Not yet. Today, you'll work with me, anyway, on the delivery simulator. We only have two patients in this morning, and both have private attendings, so we'll leave those to Anne and Marissa."
"Whatever you say, ma'am," he replied.
But even after just a half hour of this - her demonstrating proper hand placement and techniques for effaced, breech, and normal births using the plastic OB model - he had delivered the life-sized baby doll about ten times and hadn't raised an eyebrow. He was breaking her.
"What specialty are you going in to?" she asked, finally, resentfully.
He gave a light shrug. "I honestly haven't made my mind up yet."
Her mouth tightened. That's what they taught the med students to say on rotations they weren't interested in. So that answered that.
"I'm having a hard time choosing between outpatient continuity care, or inpatient medicine," he continued, before she could say anything. "That's one advantage to OB/GYN, isn't it? You have the clinic side - and then also the surgical aspect, or the wards depending on if you go into OB or GYN. So -."
"Did you do your gyn block, yet?"
"Yes - I did Benign Gyn at UVA, Gyn Onc at Veterans. That was -."
They were interrupted by her vocera, and a pager beep for good measure. She glanced down. "Miss Smith is going to C-Section; I gotta go."
She bolted from the break room where they had been working with the model and she streaked toward the OR. She had gowned and was about to glove when he suddenly appeared in the room, yanking his scrubs off - panting and out of breath.
"What are you doing?"
"Shadowing you," he replied, with a hint of anger - finally - in his voice. "I put the model away, first, but …" his words were muffled under his replacement scrubs as he pulled them over his head. "I mean you can't not let me scrub in on a c-section. It's a required learning activity."
She watched as he used perfectly correct technique to glove - elbowing the sink on, keeping his hands held up away from any possible contaminants. He was playing with fire. Theoretically she could not let him do whatever she pleased. This wasn't his school - it was her residency program, her hospital, her residents. But she could get in real trouble for that.
It was still a temptation, though. If she had one month to go, instead of three, she might actually go through with it. She might have him fetching coffee, presenting topics and delivering placentas (rather than babies) all month long. She expected he would be a perfect little assistant in K. Smith's c-section.
And he was.
.
.
"I don't know why he bothers you," Anne said to her frankly. The next two days were days off from dealing with Dwight Enys - he had lectures at his school one day, then his scheduled day off the next. "As far as med students go, he's not bad. And, frankly - not bad looking, either."
Caroline shook her head. "And that has what to do with it? Personally - it's annoying to me when a trainee acts like I have absolutely nothing to teach him. He's hiding it pretty well, but you just know he's one of those misogynist orthopod wannabes who thinks women's health is akin to chiropractic medicine in terms of legitimacy."
"Or - he's a nice kid."
"Kid? He's thirty if he's a day."
"True, I keep forgetting about that. Do you know why he started med school later?"
"Not a clue."
Anne stared at the other woman for a while. Caroline Penvenen was prickly, opinionated and more than a little arrogant. She didn't always get along with authority figures, and some times she didn't get along with patients, either. But … she had been designated chief resident for a reason. Caring for her patients and her staff was her first instinct - despite her brusque nature and her supposed distaste for academic medicine and the public hospital. Med students? It's true she didn't care for them - they drifted in and out of their lives, two to four weeks at a time. Just when you get used to them - pushy or timid, smart or … not so smart, helpful or constantly in the way - they were gone. And that was probably the thing.
"Are you going to invite him to journal club?" she asked Caroline.
"It's on his day off."
"Still."
Caroline smiled faintly. "Do you want to lay a bet as to whether he will or will not show up anyway?"
"Why not?"
.
.
Caroline hopped up the steps to her Georgetown townhouse. It was good to have a break from the call schedule, if only by four or five hours. She had only just beat the caterer, and was unlocking the front door even as they were opening up the van.
"Unwin!" she called. "Unwin!" The empty house echoed back his name. Not too surprising - his hours were often as long as hers and a lot more sporadic. She flipped on all the downstairs lights, then ran up the stairs to the second floor, screaming at the caterers to lay dinner out wherever.
She peeled off her scrubs and her sensible flats and changed into a very short black skirt, silky black tights and a pink cotton tee-shirt. Business-formal-comfort-wear. Her go-to costume for work obligations post-hours. She looked exactly like the daughter of a diva, the near-fiancee of a power-player and a harried medical resident all rolled into one. She unpinned her hair and ran a brush through the tangles until the curls settled into place.
Downstairs, the crab cakes, mini-quiches and Swedish meatballs were adorning her coffee and side tables. The wine and sparkling water was out on the dining room table and the thai lemon chicken breast bubbling in a warming plate in the kitchen. She had had journal club RSVPs from not only the attendings in her department, but quite a few gynecologists from some of the regional hospitals in Baltimore and DC and they needed impressing. And yes, like every single person in the medical profession, from the first year med student to the professor emeritus, the freer and better the food, the better the impression.
She was grateful that not only Anne and Marissa, but a few other of the residents, were here and here early - all her fellow fourth year residents, Tina, Drake, Liz and Dee; Dr. Ciotti, the residency advisor; Dr. Lin, the faculty advisor (hint, hint, they were still trying to recruit her to stay after June). This calmed her nerves as she waited for the Maternal-Fetal Medicine Division chief from Sinai and the OBG Department chair from St. Elizabeth's to arrive. She even had those stuffy folks from Camellia Womens' Health Group - whose practice she longed to join - expected in. They were late arrivals … straining her nerves until she thought she couldn't bear it.
It was when she finally had everyone settled in, sipping wine and eating finger food - when she had handed out her print-outs of the journal club questions and had stuttered out the first one - something about the rate of twin pregnancies, in relation to incidents of Down syndrome - when the door opened and closed. Expecting Unwin, she frowned and got ready to apologize for the interruption. But it was Dwight, looking vaguely apologetic in dress clothes and a white coat. She had lost the bet.
.
"Isn't it your day off?" she asked him.
He had followed her into the kitchen with a stack of small plates in one hand and two wine glasses precariously threaded among the fingers of his other. Out in the dining/living rooms, dessert was winding down.
"Yes, but - I rarely get to go to journal club. And I wanted to see your house." He grinned at her. "It's nice."
This threw her, for some reason. She collected the dirty dishes from him and placed them in a big plastic tub the caterers had left.
"Small," she said, looking around. But he probably knew as much as anyone how expensive it was to live in Georgetown. And this was hers. Unwin didn't even help her with the mortgage payments. "But what I meant was - why are you even wearing the white coat?"
"Oh, that," he shrugged. "Well, I was at Jane Venitti today."
"What? What's that?"
"That's one of the student-run clinics at UVA. I've been a co-director there since first year, but I don't get to go in too often since third year started, of course."
She was silent. Of course. The UVA student-run clinics were - just that. Volunteer clinics staffed by med students, each one targeting a specific underserved population. Homeless. Vets. Immigrants. Jane Venitti was the women's clinic, offering basic testing - breast and pelvic exams, pregnancy - and sliding-scale contraceptive care - to women without insurance.
"Don't burn yourself out," she said. "You only get one and a half days off a week and long hours. You still have three more weeks to go, here."
"I know, but I figure - third year is like intern year, right? I might as well get used to the hours. And anyway …"
"What?"
"You'll laugh at me."
"No …"
"Well - it's not really like work for me."
"You also have to study for your rotation exam. Those are high stakes on this clerkship."
He shrugged. "I learn better hands on, and anyway - you seem bound and determined to give me plenty of study time on wards."
She jumped back, as if burned. It was a rebuke - in tone, as well as words. There was no mistaking his meaning. "I find you a little impertinent for one of your rank, Mr. Enys," she said, letting the diva in her take over.
"I don't suppose my rank to be that of a lackey."
"You might establish your claim with some show of respect, then. There are conventions in medicine."
He blushed. "Yes, there are conventions - even in medicine. But I've not noticed any strict attention to them on your part."
"It's very gracious of you to instruct me," she said. "I wonder you even bother, considering how much you dislike working with me."
"You misunderstand what I …."
"Naturally."
Someone shouted her name from the other room, and now they both jumped. Unwin. For some reason - completely indefinable to herself - she felt a need to keep them separate from each other, Unwin and Dwight. It was ridiculous and silly and absurd and foolish. But they existed in two different universes, and needed to remain in that state. She ran out of the kitchen and greeted Unwin - his fair, foolish face gaping around in surprise at the "party" either he'd forgotten she was throwing or that she had forgotten to tell him about. Equally, it could be either. She got him safely sent upstairs with promises that the house would soon be free and that she had set aside some dinner for him. And that she would bring him dinner in the bedroom and the wine and who knows what then?
It was the first warming toward him she had showed since their return from Paris and he was disarmed and obedient. She breathed a sigh of relief, then went back into the living room only to see Dwight chatting amiably with Anne and Marissa - and a few of the others. Everyone liked him. Just like he was competent at everything. And right about everything. She was suddenly exhausted and had a brief longing to be back on the maternity ward, catching up on her notes and checking over the fetal monitoring strips. He was exhausting.
.
.
Over the long weekend, slow for deliveries, she kept him at arms' length and made Marissa deal with him. It was good practice for her, anyway, to get used to the teaching part of her job as a resident, though she seriously doubted there was anything Marissa knew that Dwight didn't. Whether or not he delivered any babies that weekend - how much Marissa let him do - she didn't even care.
The next week, she assigned him to the night float team, so she wouldn't have to see him except for at hand off and rounds. That kept him busy, no doubt - so many deliveries happened overnight, and there were fewer people to say no to a student eager to participate. The following week they had an AI, an acting intern - a fourth year student - named Denise, and Caroline was better pleased. Fourth year students were on the rotation electively, and usually because they were planning to match on OBGYN. But Denise was a classmate of Dwight's, and all day they were either hanging out together, or Dwight was chilling at the nurses' station - making conquests all around.
She was just walking past him when her vocera and pager went off. He looked up at her and she nodded permission for him to follow her - this time to the ER. A teenager had been admitted with heavy bleeding and - after her baffled parents denied it a dozen times - it was confirmed that she was at 26 weeks.
Caroline called an immediate ultrasound. It was too hectic to quiz Dwight - this was a true emergency. But as he ran beside her to the OR to find an available room, he asked her what she thought would be found.
"You tell me," she huffed.
"Previa or abruption."
"Yes, and after the u/s - what next?"
"Drug screens, anemia test … perhaps tocolytic to stop labor."
"And if we have to deliver?"
"Corticosteroids to prep the fetus' lungs."
She stopped abruptly, staring at a chart on the wall showing the free OR rooms. "You're good," she said softly. Then she turned to him, a little calmer now. They had a moment - a sweet moment when the best could still be possible, as they waited for the results of the ultrasound. "Why do you hang around the nurses all day?"
He shook his head at her. "You never gave me vocera access. There's no other way for me to know when a delivery or an emergency is about to happen."
She felt like she was falling over for a moment. "I forgot. Remind me in the morning to give you access."
"Thanks … Dr. Penvenen."
"Caroline," she said, weakly.
He smiled, slowly. "No, you're my chief resident. You've earned your title. When this rotation is over - maybe."
And just like that, he had completely disarmed her. He wasn't obnoxious or patronizing or too perfect or anything. He was just decent and hard-working and a good student who was probably going to be a damn good doctor. And that was it. "Come on," she said, pulling herself together. "Let's see if we can save this baby."
.
.
He found her in the call room, budging his way in even though she had locked the door. Even though the lights were out and she was huddled in the tight corner between the bunkbed and the closet door. Even though she told him to get lost.
"Are you OK?" he asked her.
"Do I look it?"
She looked up at him in the darkness and could see that his scrubs, like hers, were still stained with blood.
"It's not your fault," he said. "Dr. Choake was saying …."
"Did I say I thought it was?" she said, voice rising. "God! I can't wait to get out of this place!"
"Why?"
She heard the creaky springs of the bed as he sat down on it. She wiped her face. "Why? I'm tired of this place - these people who don't take care of themselves and expect us to pick up the pieces. They never leave us enough time. I can't wait until I go somewhere where women want their babies, and have insurance that covers private rooms and water births and 3D ultrasounds. And they're not fifteen and on cocaine and hiding a pregnancy. What is the point of that, even?"
"You don't mean this."
"Yes! Yes I do! And I'm telling you … even you, Dwight Enys, will need sleep some day, and rest, and a break from all of this! Especially you - I suppose you'll go into emergency medicine or internal medicine or surgery - guess what? You will have patients die on you every other day. And you will burn the fuck out - same as all of us."
"I've already seen that," he says. "And you're wrong. I was an EMT for five years after high school. There was no money in my family and financial aid could only get me so far - so I got the closest I could to … to all this. Because I wanted to be there - to be the one who tried. To pick up the pieces. To pick up the people. My mother grew up in a small town and she was pregnant with me when she was 16. I never knew my father. Was it ideal? No. Did she make bad choices? Sure, but - in the end, she started making better choices, and better. She got good at life, eventually. Not everyone can start out in that place - in a private room, with a water birth. Some girls have to hide it - for as long as they can. Sometimes it's until they can figure out a way to avoid getting beat up or kicked out of their house. Sometimes it's until they can figure out a way to come to terms with it in their own head. That's - where we come in. We have to bridge the gap between the real and ideal sometimes. There are so many more successes than failures …"
When he stopped, she was silent, wanting him to keep talking. Everything he was saying was making her feel simultaneously better about herself and more ashamed. She wondered. Here she was on the precipice of her medical career. Her family had money - plenty of it - so she had not gone into debt in medical school. She could - without too much financial damage - leave at the end of June. Figure out something else to do. Something cleaner, neater, less painful. She could move to London, date aging rock stars, marry an investment banker.
"You're good," he said suddenly.
She snorted derisively. "Good? I was a B-minus undergrad. My dad had to talk me into a third-rate med school. I scraped by there and matched in this crappy place."
"Yeah, but - you're still good. The residents respect the hell out of you. The patients can tell you care."
"I don't."
"You do. You just don't right now because - right now, it hurts. Today was a bad day."
She sighed. "You think? In the modern age, it takes a real effort to lose a woman in childbirth."
"Caroline," he said.
The pain of her name on his voice made her grip her knees tighter. "I'll have to present this at the next M&M. Will you be there for that?"
He paused. "If I can."
Oh, right. Next week was his last week on L&D. After that, he'd be off, flitting out of her life and on to his next rotation. She'd get an evaluation request from his school and she'd fill it out with an Honors grade and a glowing recommendation. In a year, he would be matching somewhere probably great - GWU or Boston or UCLA or something. And he'd leave the public hospital patients and the free clinic patients behind to people like her - vaguely competent people with just enough motivation to slog through medical training. Vaguely resenting the patient population in these places that their own incompetence or indifference took them. Or would he? Maybe - he would be different. He'd broken every one of her expectations, so far.
.
.
Three weeks later, she was standing in front of the lecture hall for the OB Morbidity and Mortality conference. All the resident fails were brought to light in this meeting, examined by faculty and by her peers and her trainees - to try to see what had gone wrong, what to do differently next time. Learning opportunities all around. Caroline had managed to avoid this meeting until now. Her patients lived. They thrived. Until this time.
She had swept the room for his face - his pale, distinctive face and the wavy hair - but did not see it. She was disappointed, but could not be surprised. He had other obligations. Amy had told her he had Pediatrics next, and he was doing that rotation somewhere in Baltimore. So she recited the case, in an expressionless tone - the 15 yo who presented with abnormal bleeding in her second trimester. The patient had had no prenatal care and had ignored severe pain for two days before coming to the ER. Tests had found evidence of recent cocaine use. Ultrasound confirmed placental abruption. Any hope of attempting to deliver the fetus had been lost when the patient had gone into cardiac arrest.
After it was over, the usual bagels and coffee were available in the back of the room and, being doctors, they all swarmed it. Free food. The lifeblood of a medical institution. Caroline observed the line, decided to head over to the cafeteria instead. At least they served oatmeal.
She had just stepped out of the lecture hall when she felt the hand on her shoulder.
"Hey," he said.
She whipped around and opened her mouth in surprise. How had she missed him?
"What are you doing here?" she asked. "Aren't you skipping class?"
"We had a donation of supplies at Jane Vitteri. Gloves, gowns, speculae - new ones."
She stared at him widely.
"I thought it was you," he smiled.
"I haven't changed my mind about them," she said. "They could do so much better if they would learn just a little self care."
"Then why did you do it?"
She shook her head, vaguely. "I owed you," she said.
"I'm very obliged."
He made as if to turn away, and she stopped him, desperately, with the first thing she could think of to say. "You amuse me very much, Dwight Enys."
He looked at her. "I like you very much, too."
She blushed. "Don't be impertinent," she replied, faintly
He narrowed the distance between them, so the emptying lecture hall could not witness what he said. "Wasn't it impertinence you said you admired?" he murmured. "I forget."
"You forget a great deal." Including just how shallow I really am.
"I'll not forget this."
And she knew he meant more than the gesture of supplies. He meant her. And suddenly she saw it - all the clearing up she had to do in her life. Unwin for starters. Her ambitions for private practice possibly next. "When will I see you again?"
"What's wrong with now?" he said.