Annie's heart dropped as she walked to Teddy's office. She knew she had messed up at least she had failed to give her interns the supervision they needed. She was struggling to keep her group of interns under control. This group was tough. They only wanted to work in preferred specialties and disregarded skills labs. Today they had disappeared after being assigned to the pit. Annie had spent the day with Nathan on a transplant and expected her interns to stay in the pit and do as they were told. Three of her five had actually left the hospital, two had been found having sex in the closed clinic.
Annie hesitantly knocked on Teddy's door.
Teddy opened it, "have a seat dr Altman."
"Yes Chief," Annie replied. Taking the seat across from Teddy's desk.
"Dr Altman I need you to tell me why three of your interns felt it was all right to leave the hospital during their shift," Teddy asked.
"I apologize Chief, I didn't provide appropriate supervision," Annie replied, "they were assigned to go see Hunt in the pit while I went with Nathan Riggs for an organ recovery and transplant."
"What time did you leave," Teddy asked.
"Between 8:15 and 8:20 am," Annie replied, "prior to meeting dr Riggs I assigned two to the clinic with dr Silverstone and the remaining three were sent to report to Dr Hunt in the pit."
"Which Hunt," Teddy asked.
"I didn't specify," Annie replied, "I was unsure which one was there."
Teddy asked, "did you check?"
"I did not," Annie replied, "I didn't think to."
"Your interns typically have little respect for you," Teddy stated, "why do you think that is?"
"I'm too soft on them and don't hold them accountable for mistakes," Annie replied, "I fix it myself or just do it for them."
"You don't hold them accountable," Teddy said.
"I didn't set a good foundation in July and August," Annie admitted, "I was caught up with the Wedding and honeymoon and the spat with mom and dad."
"It's only October you can pull it back," Teddy said, "you're going to bring the hammer down on them."
"Suspension," Annie replied, "scut, no surgeries until they earn my trust."
"And there are consequences for you," Teddy said, "you dropped the ball. Annie you messed up."
"I know I did," Annie replied, "what's the consequences?"
"You're taking them into everywhere with you, they are chained to you and you're doing extra hours in the clinic," Teddy said, "they will watch, they will not touch a patient but they will not be out of your sight."
"Clinic hours," Annie replied, "the cold and bruise brigade."
"Yes," Teddy said, "you need to help me find out why they left."
"They don't respect me. I was too caught up in the summer with the wedding and I didn't lead. Now I don't know how to get it back," Annie said.
"Demand their respect," Teddy said, "it's Dr Altman not Grace. You say jump, they say how high."
"I don't know how to command," Annie replied, "that's you. It's not me."
"Learn," Teddy said, "watch how Owen, Meghan and I do it."
"I can't do the bossy pants tone. I sound like a kid trying to sound like their mom," Annie said, "I lead by example."
"Example isn't enough," Teddy said, "you have to direct. Give directions and expect them to follow through. Make sure they do. You don't have to raise your voice or yell. How often do I actually yell?"
"Never," Annie replied.
"You don't have to yell but you have to be firm. Firm doesn't mean yelling," Teddy said.
"I don't like leading," Annie said, "I don't do telling people what to do. It feels wrong."
"If you want to move beyond residency you have to," Teddy said, "you can not move forward there will be no fellowships if you don't start leading. This isn't the first time you've had this conversation. You have to step up."
"I can't get my parents to connect with me why would my interns," Annie asked.
"This and the McKellars are two separate issues," Teddy snapped, "at home we can discuss the McKellar issue. Right now we are talking about your lack of leadership."
"I don't know how to lead," Annie admitted, "I'm scared to. I'm better as a member of the team then the captain."
"You have to be a leader here," Teddy said, "it's a skill you learn and practice. You put thousands of hours into surgery. How many thousands did you put into dancing? Annie, you know how to work for a skill. Leadership is another skill you have to master. Your first three years of residency that's fine you're a junior resident but you're a senior resident now. You have to lead. All of the attendings are watching you this time next year you're asking us for fellowship references. The programs you talk about wanting you won't get unless you show some leadership and take initiative to get things going. We're going to talk again in three days and I want you to have something planned to show leadership with your interns and something to take initiative in the whole hospital."
"I have an idea for the second one but people won't go for it," Annie said.
"Throw it out there," Teddy said, "it's just me right now."
"I want to look at our patient sensitivity when it comes to kids under 12. We don't talk to the child we talk to the parent which is just as valid but the child is the patient. It's their body we're doing things to, they need to understand what we're doing and why. Make it explicit," Annie said.
"Building on those books you're doing for some procedures," Teddy said, "let's keep talking and refine it but you could be on to something."
"I want to approach you for funding for the books," Annie said, "a formal application. I've written the text, I need an illustrator. There's a program at the university of Washington for children's books and children's book illustration. I want to connect with them and see if they have a student who would be interested."
"Let's keep talking," Teddy replied, "make a formal proposal because those could go beyond our hospital. Write them, use internet images or take photos and try them on kids piloting it."
"I'll do the formal proposal for both ideas," Annie replied.
"On my desk by Monday," Teddy replied, "and about your interns we have a meeting with them and Webber in 20 minutes."
"I know I'm accountable for their actions," Annie replied, "I didn't think any of them were stupid enough to leave during a shift. Those three piss me off more then the two having sex in the clinic."
"Really," Teddy replied, she looked shocked. She thought Annie would be equally angry with both situations, knowing Annie's reaction to her friends being caught.
"Most hospital couples do at some point," Annie replied, "they just chose a rather stupid location."
"If I ever hear of you getting caught you will not like the conversation we will be having," Teddy warned.
"God no never," Annie gasped, "we're not that dumb. We work with my parents and his uncle. How stupid do we look?"
"Parents," Teddy asked.
"Mama, uncle Owen," Annie replied, "my parents. We know who my family is. Actions spoke."
"They did," Teddy agreed, "the thought of your dad hearing or walking in that's horrible."
"A hug or a quick kiss when we pass is one thing but never where patients could see," Annie replied.
"You've always been respectful," Teddy agreed, "but I've seen you both go to the same on call room."
"Actually sleep, maybe cuddle or just talk," Annie said, "never that here. This is work, it would be like doing that at church."
"We are going to meet with Webber and your interns in the conference room," Teddy directed, "you will be expected to participate in the conversation. Have you thought of a suitable consequence?"
"Since they left the hospital something that keeps them here. Making up the lost time for sure," Annie replied, "a mountain of scut or extra clinic time and no surgery."
"The keeping here makes sense but the hours issue is strictly enforced," Teddy reminded.
"Equal to the time they were absent," Annie replied, "making up the time they shouldn't be paid for time they left the hospital."
Teddy knocked on the conference room door before entering, "dr Webber we have discussed dr Altman's role in this and there is a plan in place to improve her leadership skills."
"Dr Altman, the resident Altman, can you walk me through what happened today," Richard asked.
"Between 8:10 and 8:20 this morning I was paged by Dr Nathan Riggs to go with him for an organ recovery in Centralia. I assigned my interns to the clinic or the pit in my absence. Those in the clinic were sent to dr Silverstone who was running the clinic today and those in the pit were told to find either dr Hunt," Annie explained, "I failed to confirm which Hunt was in the pit this morning so did not give specific enough instructions. Returning from the organ recovery I joined Dr Riggs in the OR to assist with the heart transplant. Upon completion of that surgery I paged my interns to check in and there was no reply from the three that had left the hospital. I then heard through Dr. Josh Riggs that they had left the hospital and we're not responding to pages. At that point I was paged to Chief Altman's office to explain the events of the day."
"Dr Altman explain why your interns did not have the respect for you to follow through with the clear direction you gave them," Teddy commanded.
Annie took a deep breath, "I failed to provide leadership and establish their respect and trust this summer because I was too caught up in my wedding. I am willing to work with both of you to come up with a plan to gain their respect and rebuild your trust. You trusted the interns to me and I failed."
"Thank you Dr. Altman," Richard said, "I know this is not the first time we have discussed your leadership."
"I know Dr. Webber and there are no more excuses," Annie replied looking at her feet.
"Grace, we are willing to work with you," Richard said, "our biggest concern is your lack of leadership. You have other skills that are very strong but you're passive, you let others speak for you."
"I'm aware sir," Annie replied.
"We understand why you're struggling with this," Teddy said, "you just have to do it. Being soft with them wont make them like you. They will like and trust you because you give guidance and expectations. They don't believe you're serious and in control you need to show them that you are."
"How do I do that," Annie asked.
"Follow through," Teddy replied, "you can't go back on your directions to them."
"I won't," Annie replied.
"Go get your interns," Richard directed.
"I will," Annie replied, she walked towards where her interns were told to wait.
"Grace," one of the interns called.
"It's dr Altman," Annie replied in a clipped tone, "before we meet with Dr Webber and chief Altman do any of you want to tell me why you thought it was appropriate to leave the hospital during your shift when you had clearly been assigned to the clinic and pit?"
"We had nothing to do," a young man replied.
"You were told to go see Hunt in the pit, it's Friday there is always a Hunt down there on Friday," Annie snapped, "not only did you disrespect me you left the hospital understaffed. You are here on my licence, it's my reputation on the line if you mess up like that again. You will have consequences from chief Altman and dr Webber but there will also be things you need to do to earn my trust. I hope you enjoy scut. The pre and post ops you were to be monitoring for me have not been done, the charts are not updated and you will not leave tonight until that work is done."
"Yes dr Altman," a meek woman mumbled.
"Now we are going to see chief Altman and dr Webber and you will take responsibility for your actions and accept the punishment without complaint," Annie directed.
Teddy was out of sight just around the corner preparing to do her most commanding chief talk with the group of interns when she heard Annie starting to take a strip off her interns. She wondered if Annie was waiting for permission and to be told she could take charge. Annie often waited for permission to do things even at home. Teddy thought about when Allison was an infant and she would ask or wait to be offered before holding her sister, it came across as disinterest at first but it was actually respect. Annie had had so little respect from other people towards her space, belongings and even her body growing up with Jessica. It really mattered to Annie that she showed the respect she had been denied. Annie asked her little siblings for hugs if she wanted them or waited for them to pounce on her. Teddy wondered if Annie's lack of leadership was linked to how she had been raised, that Annie was not to speak up or be a leader.
Annie ranted, "how careless and disrespectful can you be. Not only of me and the direct order I gave you but of yourselves. You wasted a day of learning to do what? Have coffee, go shopping? You have no excuse to leave my patients to leave any patients without a doctor. "
"That is enough for now Dr. Altman," Teddy said.
The interns looked relived.
"Wipe those smug looks off your faces," Teddy commanded, "you have no clue what's about to come to you. Have a seat."
Teddy began to lay into them taking up Annie's rant, "do you have any clue how irresponsible that was? You compromised the safety of my patients and my staff! You put this hospital at risk. You were assigned to attendings who can confirm that they never saw you."
"Grace didn't check on us; she was off somewhere with Dr. Riggs," an intern said.
"I am aware of where Dr. Altman was, her schedule from today has been confirmed by Dr. Nathan Riggs," Teddy snapped, "you will address your resident as Dr. Altman not Grace she is not your friend she is your superior."
"Who calls her mother mama," the intern taunted.
"That was our choice together," Teddy said, "we don't need to justify it to anyone."
"Still," the intern said.
"Who's idea was it to leave the hospital and your patients during work hours," Richard asked, pulling the conversation back on topic.
The interns sat silent and stone faced not saying a word.
"Somebody speak," Richard demanded.
"We're going to sit here until we understand what happened today," Teddy said, "the longer you drag this out the longer your punishment will be."
"What's the punishment," asked a woman.
"Right now your at one week of no surgery," Teddy replied, "I'm adding a day each time we have to ask you."
"A week," the woman squawked.
"Minimum," Teddy replied.
"What about Dr. Altman," a man asked, "she's the one that didn't supervise us."
"I should be able to assign you to a task or an attending and the work get done. You're doctors not children," Annie replied.
"Dr. Altman has her own consequence that we have already discussed," Teddy replied.
"It wasn't my idea I was here the whole time," the man said.
"We know what you were doing," Teddy replied, "I'll be having a separate conversation with you and Dr. Plant."
"What," dr. Plant asked, "why us? People do that at the hospital all the time. Your own daughter and her husband have been seen coming out of the same on call room."
"We are not here to discuss my daughter," Teddy snapped, "there is a difference between two people who happen to be married coming out of the same room and being caught in the act by the deputy chief of surgery in the clinic, a patient area. I will be meeting with the two of you later."
Teddy was planning her most motherly, be safe talk. Plant reminded her a bit of Annie and she wanted to make sure the girl was safe.
"You need to tell us why you left today," Richard demanded, "I will sit here all night if needed so will chief Altman and dr Altman."
"We didn't know what we were supposed to do," a man said.
"I told you to go find Hunt in the pit," Annie replied.
"She wasn't there," the man said.
"Cosco there are two Hunts it's Friday one of them should have been there," Annie replied.
"No shouting redheads," Cosco replied.
"Watch your tone," Teddy snapped, "I will not tolerate insubordination and disrespect in my hospital."
"This isn't the army," Cosco retorted.
"Two weeks no surgery," Teddy replied, "there is a hierarchy in medicine. You walk around treating residents and attendings as your peers they are not. They are your teachers, your superiors. You will do as you are told you I will ask you to leave."
"But yet Grace gets to call you mama and the Hunts auntie and uncle," Cosco yelled, "you talk about hierarchy but she doesn't have to follow it."
"I am her mother, Owen is her step father and we've used the name Uncle Owen for about ten years to show respect," Teddy snapped
"How does her dad feel about that," Cosco quipped.
"My father isn't involved in my life," Annie replied, "but my personal life is none of your business. You will explain your actions today. Either verbally to us now or I can get you paper and a pen and you can write it out."
"We'll put nothing in writing," the third woman said,
"Then you'll talk," Richard said.
"Not until Dr. Altman does," the third woman replied, "it's her fault. She flew off somewhere and didn't give us directions."
"She was on an organ recovery," Richard replied, "with her mentor."
"Then we should have gone," Cosco complained.
"What have you done to earn it," Annie asked,"we only had two seats."
"Nothing," Plant admitted.
"Now you're starting to take responsibility for your actions," Teddy said, pacing along her side of the table. She was ready to let a full rant loose on this group of interns. She was angry at the interns for leaving and frustrated with Annie and her fear of leadership. But Richard was still in charge of all the residents and interns. Teddy was holding back her rant for now seeing Annie's face. Annie looked terrified.
"Altman," Richard snapped, "take a breath."
Annie and Teddy exchanged a glance before both taking a deep breath.
"Now," Teddy continued, "since you won't explain yourselves as a group Plant, Cosco with me. Dr Webber will meet with the rest of you one on one in his office. Dr. Altman you can take the ones Dr Webber is not meeting with you to the pit and they can make up the time they missed earlier."
"Johnson with me," Richard commanded.
"Wood, Kandler with me," Annie commanded, "we are going to see Hunt in the pit."
"It's Owen on tonight," Teddy said.
"I'll tell him what happened," Annie replied, "how many hours do they owe?"
"Five," Wood said, hanging her head.
"I will be down in 5 min I need to let my husband know I won't be home for dinner and that I'll probably just stay here tonight," Annie replied, "go directly to Dr. Hunt and let him know you're available."
"Plant, Cosco meet me at the door to my office," Teddy Commanded.
When it was just Annie and Teddy in the room Teddy asked, "does Josh know?"
"Not yet," Annie replied, "mama I'm embarrassed. I thought I gave clear direction but I didn't I really messed up."
"You did," Teddy said, "but we're a teaching hospital we want you to succeed. This isn't a firing or even probation worth thing Annie. Your interns are facing probation and will blame you. They have a really poor work ethic. Tonight you need to oversee them for their hours. It's only 6 if you go home at 11 you'll be fine. Do the 5 hours, go home, sleep in your own bed and have your cry."
"I don't know how to fix it," Annie replied, "this is the worst group of intern's I've had."
"I know," Teddy replied, "I'm going to see what Richard says but I'm thinking probation."
"Then we meet the day after tomorrow to come up with a plan for me to fix my leadership," Annie said.
"I would like to involve Meghan in that," Teddy said, "I want to mentor you but I can't take you where you need to be. We're too close."
"Not Meghan" Annie said, "can I have some one outside the family?"
"Who would you like," Teddy asked.
"Maybe Pierce or Shepard," Annie suggested.
"I like the idea of Shepard," Teddy replied, "she's a gentle leader but gets respect. It might be a good match for you."
"I don't want neuro I just need a driven mentor outside the family," Annie said.
"I agree," Teddy smiled, "Amelia would be a good fit. Plus she's made mistakes and had her share of challenges to come back from. She's a very empathetic one. I'll ask her as the chief."
"Thank you," Annie said, "I should call Josh and go yell at my interns more. I may try Owen's style tonight and bark like a crazed seal."
"Not in front of him," Teddy laughed.
"Not today," Annie replied, "he's probably pretty mad at me."
"As your attendings were disappointed," Teddy admitted.
"How mad," Annie asked.
"He'll say something," Teddy replied, "but you know when we get frustrated with you here it doesn't change anything at home. We all agreed to seperation of home and hospital."
Annie nodded, "I know but I hate letting you down."
"I know you do," Teddy smiled, "you just need to learn from it. I get angry when you don't learn from it. You're a resident, we don't expect you to do it all. You're not the first to struggle with leadership and won't be the last. Kepner, Christina Yang, me. I'm not a natural leader, I had to learn."
"Okay," Annie nodded, "I'll figure it out."
"I know you will," Teddy replied, "now go call Josh and get to the pit. I'm going to lecture those two."
"You can't do the be safe lecture," Annie groaned.
"I'm doing the have some class one," Teddy replied , "and I'm serious I will be pissed if that's ever you."
"I'm going," Annie said, not wanting to hear any more. She wasn't looking forward to seeing Owen she though Meghan would have been a bit more understanding. Owen would tell her exactly what she did wrong and roar at her, probably in front of her interns. But Annie had learned that his roar was worse than anything. He would roar and yell but once he said it he would be uncle Owen again.