Teddy gathered the fifth year residents in the conference room.
"Good morning ladies and gentlemen," Teddy began, "welcome to your fifth and final year of residency. This year is unlike any other. This year you will take the lead on many of your cases and act as the lead surgeon, everything you do this year could end up in your oral board exams at the end of June. We will be watching you closely not just for your or record and Dr Webber will explain the points system for that but remember you must stay under 15 points, any more than that and it will be a meeting with me or Meghan Hunt. We will be watching you for fellowship spots as well as recommendations for those of you that wish to leave us. Of any group of residents I've worked with this is the one I know best the one I feel most connected to. Many of you have spent time at my home and with my children some of you have become family. Your attendings and mentors are here to support you and help you grow I am here as a coach and mentor as well and not just to those interested in cardio. This year we've taken in our largest intern class ever, with our rising ranking to number three in the country and the best in the west we are getting more applicants and being pressured to take more interns. It's the changes that were made in teaching this class that are bringing our ranking up. That being said all of you except dr Silverstone will be taking a group of interns this year. Mentor them, teach them well, set our expectations high right from the beginning. Dr Webber has a few words then you all know where you need to be."
"Okay our points system," Richard began, "losing a patient will get you points, the type of loss and the specialty are a factor we know trauma, cardio and neuro have more losses then ENT or Plastics. Post op complications get you points, mistakes, any negative outcome gets points. They will be reported to Chief Altman and we will look at your record from there. I have emailed the points table to everyone."
"Can a really good save reduce your total points," a man asked.
"No," Richard replied, "but it can help us with our recommendations. So will working on research."
"We all know who will get the chief's project," grumbelled Rachel.
"Rachel I didn't see your application for it," Teddy replied, "I received two properly completed and took both. I needed every section complete. I also looked at the track records for assisting with research and work ethic. I considered all applications but took the two that were fully complete. If you can not complete an application properly how can I trust you to do my research with me?"
The voices fell silent.
"You gave your daughter's best friend chief resident," Rachel gumbelled.
"Because Dr. SIlverstone earned it. She organizes outreach activities, mentors medical and pre med students, does research with Dr. Shepard, takes extra shifts in the ER and is consistently finding ways to help make us better," Teddy said, "Dr. West I am aware that you have been jealous of my daughter and her husband since you were interns and your role in a lot of the gossip about my family, it doesn't impress me or make me think very highly of your character. You are all a team, I expect you to at minimum be respectful of each other. You all know what your doing so go find your attending and get to work. We will meet the interns at noon."
The group spread out.
Annie showed Josh a text on her phone , "we need to reschedule with Carina. If we don't do it today or tomorrow she wants to push it back a month. It has to be timed with my period or it makes it hard to remove it."
"You have our call schedules," Josh replied.
"I do," Annie said, "I'll do the blood work later today."
"Do you need me," Josh asked.
"No I can do it," Annie said, "I'll take the form down to the out patient lab when I get a chance."
"I have time and could do it," Josh said.
"It's okay," Annie said, "it's just thyroid labs I can get anyone to do it."
"If your sure," Josh said, "you hate being the patient."
"I'm fine its two minutes," Annie said, "don't you have traumas to save or attendings to annoy?"
"It's Kepner today," Josh said.
"Have fun," Annie replied, "call me if theres cardio."
Annie's phone buzzed, "Robbins wants me. I'm off to the Nicu."
"Go save babies," Josh said.
Annie ran to the peds floor.
"Dr Robbins what do we have," Annie asked.
"32 week baby," Arizona said, "hole in the diaphragm and a septal defect. Your scrubbing in with me and Riggs sr to repair the heart."
"When," Annie asked.
"As soon as she's stable," Arizona said.
"I'll get her stable and ready for the OR," Annie said.
"Then go," Arizona directed.
Annie walked into the unit and met her patient. She took the time to introduce herself to the parents and explained what she would do in the OR. Nathan stood back and smiled watching Annie take point, since their trip a few months before she had gotten more confident and was taking on more leadership roles.
"Annie text your mama and tell her you'll be in surgery and will find your interns after," Nathan reminded.
"Already done," Annie replied.
At noon Josh met the other residents and the new interns in the lobby. Teddy hadn't been kidding about more interns then ever. Their class had started at around 40 and was down to 20, this group looked to be nearly 70.
"Teddy I'll grad Annie's group now since shes in surgery," Josh said.
"You two usually work with both groups," Teddy said.
"I can get their paper work and stuff handed out," Josh said.
"Do you know what she has," Teddy asked.
"32 week premie septal defect and a hole in the diaphragm. Uncle Nathan has her taking point," Josh said.
"Good," Teddy replied, "she's ready for that."
"She is," Josh said, "I'll get her interns organized for her. I've already told her that."
"Thank you ," Teddy replied.
Josh joined the other residents on the stairs, he was the last to call his group.
"Hello," Josh greeted, "only half of you are my group. The other half are with Dr. Altman she's in surgery on a nicu baby right now and will meet us when she is finished."
"Which group is which," a man asked.
"I have Rothell, Park, Yee and Smith," Josh said, "Eaket, George, Grewal and Rooney are with my wife."
"Your wife," Eaket asked.
"Dr Grace Altman and I have been married a year," Josh replied, "I'm going to get every one what they need and she will join us as soon as she's available."
"What does she look like," George asked.
"Blond curls, she has her hair in a bun today she often does, green eyes, about 5'3"," Josh said.
"The tiny blonde woman with the chief this morning," asked Eaket, "are they related they looked similar?"
"Yes," Josh replied, "the chief is my mother in law. You all need scrubs then we'll get organized and go down to the pit where we're needed."
Josh lead them to the locker room and waited for them to change in the hall.
"Too slow," Josh said when the last intern joined him, "that should be under three minutes."
"Really," Yee asked.
"Really," Josh replied, "let's move people. Dr Altman have the same expectations of our interns there are 5 rules memorize them they will not be repeated. 1. You do as you are told when you are told to do it. 2. You answer every page at a run, we should never beat you there. 3. When your resident moves you move. 4. Do not kill your patient. 5. If page us and wake either of us the patient should still be alive when you get there."
"Yes doctor," the interns chorused.
"What did we do to get put with the chiefs daughter," Eaket whispered.
"I dont know," Rooney said, "do you know her steciality?"
Josh heard them, "I'm trauma and Grace is peds cardio."
"Cardio like the chief," Eaket asked.
"Yes," Josh replied, "here are your code protocols, memorize them."
Josh handed out the forms.
"I'm giving you two minutes to put those in your lockers and be ready," Josh said.
This time the interns ran and were ready in two minutes.
"Your on for 36 hours," Josh said, "so are we."
"What time do we have rounds," George asked.
"After noon rounds start at 4," Josh said, "we need to start pre rounds at 2:30 to be prepared. For morning rounds they start at 7:00 which means ready for your resident at 5:30. You will be given a list of tasks to do before pre rounds so you will need to arrive before that."
"What time do we start,"Rooney asked.
"My wife and I are usually on the same schedule and we never are later than 5:15. She's more of a morning person than I am," Josh said.
"What happens if one of you isn't here," Eaket asked.
"You come find the other," Josh said, "Grace and I often share interns and work together to teach you. We have different strengths. You want her to teach you how to work with kids."
Josh lead the group into the pit.
"Dr Hunt," Josh greeted Owen.
"Big group there Josh," Owen said.
"Half are Annie's," Josh replied, "she's in surgery they rushed a nicu baby in."
"Cardio," Owen asked.
"Yes," Josh replied, "her interns are here as well. I'm going to put them to work."
"Lots of fools today," Owen said, "the chili cook off and watermelon chainsaw carving contest."
"Sutures," Josh said, "they will be on it."
Around four Annie found them in the pit.
"How do my interns look," Annie asked.
"Pretty good excited to meet you," Josh said.
Annie stood beside Josh after a quick kiss and put her arm around his waist. He put his arm around her tucking her close to his side.
"Which four are mine," Annie said, "I want to watch them and see how they do."
Josh pointed them out, "Eaket she seems good, George he's friendly, Grewal she seems interested in the family, Rooney is enthusiastic."
"Any appy contenders," Annie asked.
"Eaket," Josh replied, "your not coaching her."
"I thought mama was cancelling that," Annie said.
"I tried," Teddy replied, "but we're making it more supportive."
"How," Annie asked.
"Scrub in and assist not do the whole thing. Richard is the lead," Teddy replied, "what do you think of your group."
"I just scrubbed out and came down. So far they look good. I'm observing," Annie said, "I should introduce myself."
"You should," Teddy replied, "your surgery went well?"
"All the repairs went well she should be okay but will be in the nicu a while," Annie said.
"Your nicu babies always are," Teddy replied.
"I'm going to introduce myself," Annie said.
"Have fun. Lead this group sweetheart," Teddy commanded.
"I know," Annie replied before walking towards the group.
"Which of you are with Dr Altman," Annie called.
Four hands shot up.
"Come with me," Annie replied, "I'll go over things on the way."
"Where are we going," Eaket asked.
"Nicu," Annie replied, "I have three paitents up there. Come get to know our tiniest patients."
"Nicu on our first day," asked Grewal.
"Yes," Annie replied, "I assume Dr. Riggs went over the rules do you have any questions?"
"Are you really the chief's daughter," Rooney asked.
"I am," Annie replied, "next question. Actually related to medicine please."
"Why the nicu," Rooney asked.
"I have 3 patients up there, two HLH babies and one with CDH, I just operated on my CDH baby," Annie replied, "my speciality is peds cardio. You'll get a lot of nicu time with me. When we get in there do not reveal to the parents it's your first day unless asked. They are stressed and confused as it is, don't add to their stress. These babies require careful handling. Wait for me, Robbins of Karev, to give you directions. We don't talk about odds or worst case scenarios unless the parent asks. You are interns. You wait for the attending to deliver bad news, even I as a fifth year resident wait for my cue. Am I clear?"
"Yes doctor," the interns chorused.
Annie lead them into the nicu and introduced her interns to Alex and Arizona.
"What's your plan for them," Alex asked.
"Today observing and scut in here," Annie replied, "they can do dressing changes, check chest tubes in peds cardio."
"Where are you this week," Arizona asked.
"Peds cardio," Annie replied, "I wish we had one set attending for it."
"It's good we have you as the resident," Arizona said, "you're the continuity for it."
"I want to do both my peds and cardio fellowships and maybe start a true peds cardio program here," Annie said.
"Tell your mother," Arizona encouraged.
"She knows," Annie replied, "she's looking for a peds specialist for the new cardio attending position."
Annie's interns were whispering about her. They were curious after having worked with Josh this morning and now meeting their resident who they thought they may be older than.
Teddy met them in the peds cardio hallway for afternoon rounds, "dr Altman are you prepared?"
"Yes Chief," Annie replied, "starting in 3457, 3468, 3453, 3470, 3459."
"Thank you," Teddy replied, "are your interns up to speed?"
"Just about," Annie replied, "we were delayed by a complication with one of the HLH patients I'm working on."
"Did you sort it out," Teddy asked, "which attending?"
"Dr. Pierce," Annie replied, "I'm floating between the three of you."
"I'm interviewing a peds cardio specialist," Teddy said, "I want you to sit in."
"Sit in why," Annie asked.
"My peds cardio resident," Teddy replied, "who he will be teaching."
"I'm interested and if he does a surgery I would like to scrub in," Annie said.
"You would scrub in with both of us," Teddy said, "pick your strongest intern."
"So far I wouldn't recommend them," Annie said, "maybe Josh's group is stronger."
"Why," Teddy asked.
"Gossiping about the chief's daughter," Annie replied.
"That's your biggest pet peeve with your interns," Teddy said.
"It takes a lot to impress me," Annie said, "they need to work for it. You made us work for it."
"I pushed you harder than I've ever pushed anyone," Teddy said, "I've only had two of you that I can push the way you get pushed. You and Christina Yang."
"You know Christina Yang," Eaket asked.
"I taught her," Teddy replied, "she was my resident."
"She taught me and mentored me when I was pre-med," Annie replied.
"Wait both of you know Christina Yang," Rooney said.
"Yes," Teddy replied, "Grace even has a nickname from her."
"Because Thing One is so flattering," Annie said, "but it was good to see her last year in Whistler at the conference."
"My favourite is still the Christmas of your final year of med school when we showed up at Klausmen and demanded to see her," Teddy replied.
"And she had us scrub in," Annie smiled, "an HLH patient. 3D printed scaffolds. The scaffolds. My patient, it might work if I did the right scaffold. How did she do the calculations."
"Call her after rounds," Teddy replied, "we'll call from my office but you can talk to her, she'll know my number."
"Do you think she'll answer my questions," Annie asked, "I remember what we did in the OR with her. I think that you and I with a video and being able to talk to her we can do it. I want to try."
"Get the videos and study it," Teddy said, "read the articles. How is the patient?"
"Temporarily stable but it's going to be touch and go," Annie said, "he's preterm 31 weeks. I need to get him either a good fix or a transplant panel. He's going to be touch and go."
"We can call a panel while we work out the other surgery," Teddy said, "get prepared for both."
"I'll get my interns to help," Annie replied.
"Homework," Rooney grumbelled.
Annie turned, "you're here overnight might as well have something to do. I will go over what I need you to do before I leave for the night."
"What time are you off," Eaket asked.
"I'm scheduled to be off at 7pm," Annie replied, "I can stay later to make sure you're set up."
"If you can show us where to get the research materials we can do it," Eaket said.
"Thank you Eaket," Annie replied, "what do you prefer to be called?"
"Kira," Eaket replied, "my full name is Kristiana."
"I understand," Annie replied, "away from work and with my family I use a short form of my middle name. If you hear any of the Hunts, Altmans or Riggs ask for Annie they want me. My husband and step father are the most forgetful."
"What do you want us to call you," Rooney asked.
"Dr. Altman is preferred or Grace if you need to distinguish me from my mother," Annie replied.
"Yes doctor," Kira replied, "how can I help you?"
"Stick with me," Annie smiled, "work hard with the patients. When we're with kids I'm looking for you to make them feel confident and safe. Kids have to feel safe here, their parents need to be put at ease. These kids we're about to see smile, talk, engage in the games with them. They are children first."
"First patient," Teddy said, she was impressed with the way Annie was directing her interns, she had found her voice in the last few months.
Annie checked the chart, "James Colebrook age 7. In for complications after a bicuspid valve replacement done at Dillard. He loves race cars and dinosaurs, his favorite movie is cars and he hates green jello. Tomorrow we are going to revise the valve replacement and our tests have discovered an arrhythmia. I am recommending a pacemaker to correct it. I have anatomy Jane and the heart model to show him what we're going to do and a sample pace maker."
"Where," Rooney asked.
"She's Mary Poppins," Teddy laughed.
"The tote bag with my ipad and other supplies. I have a few different models and games to help kids," Annie replied, "ipad, my new toy, a merge cube, teens love it, heart model, anatomy jane doll, white board and multi coloured pens, google cardboard viewer."
"New toy," Teddy asked.
"I'll show you my merge cube later," Annie replied, "I was going to bring it to dinner on Friday to show Ali and Leo."
"How many toys do you have," Teddy asked.
"Enough teaching tools," Annie replied, "anything that helps kids visualize and playing with technology always works."
"Why do we do this," Teddy asked.
"Explain the procedure in kid friendly terms, provide age appropriate visuals, allow the child to ask questions not just the parent. It's relationship building and patient care," Annie replied, "when they feel safe and connected we have better outcomes."
They finished rounds then went their separate ways Annie assigned her interns to the research she wanted them to do in their down time and went to see Josh.
"Carina can't see me today," Annie replied, "hopefully tomorrow."
"If we wait we wait," Josh said, "you said it yourself you don't want to rush this."
"I don't," Annie said, "but I had it in my head that I was doing this today. But it gives us more time to work on the roommate issue and check my thyroid is stable enough."
"It will be," Josh said, "unless you've been having symptoms and not telling me."
"You know me too well for that," Annie replied.
"I'll talk to Duncan this week," Josh said.
"Before our anniversary," Annie asked.
"Yes," Josh ageed.
"Almost a year already," Annie smiled.
"I kept referring to you as my wife with the new interns," Josh said, "I still like doing that."
"I was talking about my husband," Annie replied, "a year of marriage."
"What should we do," Josh asked.
"Beach picnic then home and no roommate," Annie replied, "keep this one simple, we've done so many big things in the last year let's just enjoy being us."
"Just one of our picnics," Josh asked.
"Exactly," Annie smiled, "I just want to spend the day with you."
"Lazy morning in bed, go for a hike, come back and shower and head down to the beach," Josh suggested.
"Home for a campfire in the yard," Annie said, "stay up way too late."
"It sounds perfect," Josh agreed.
"It's us," Annie replied, "simple and quiet."
"A day just us," Josh agreed.
Suddenly the hospital was buzzing, they had chosen the intern for the first surgery but it wasn't an appy. This patient was going in for a bowel obstruction. Annie and Josh made their way to the gallery and took their seats, this was a new twist and Webber hadn't figured out what was causing the obstruction other than it was a forgin object. The poor intern watched as Richard opened and began to run the bowel.
"Hot wheels cars," Owen bellowed, "the man swallowed toy cars?"
"Page psych for when this man wakes up," Bailey echoed.
"Toy cars," Teddy shook her head, "like the ones I tripped over on the stairs this morning."
"How many," Bailey asked.
"This is car number five," Richard said, "it looks like it was a porsche."
They kept pulling out hot wheels cars, trying to name the car for each one.
"Thats it Leo has to be supervised with those things and his trains," Teddy declared.
"You really think our son is going to try to eat his toy cars," Owen chuckled.
"Mama your over mothering Leo," Annie teased.
Her interns looked at her, who was this mama their resident was talking to.
"Annie," Teddy laughed, "I don't over mother."
"Really," Annie teased, "I can give you examples from this week with me."
"Okay but I still want to see that new toy up close," Teddy replied.
Annie pulled her phone and merge cube from her lab coat pocket.
"Do you always have toys in your pocket," Nathan teased.
"Peds," Annie replied, "I was in peds cardio or the nicu all day. But this merge cube is cool. I bought two. One for here and one at home. It's a cool visualization tool."
"How does it work," Teddy asked.
Annie started the app on her phone and handed it to Teddy, "now point the camera at the cube and move the cube around."
"Am I in a lung," Teddy asked.
"You are," Annie replied, "isn't it cool."
"I want a turn," rang out through the gallery as the phone and cube were passed around.
"Woah," Owen called, "look at that."
"25 toy cars," Richard said, "and counting. Hunt I need you down here."
"Which one," Meghan called through the intercom.
"Owen," Richard replied.
Two Hunts the interns whispered.
A third year resident replied, "and two Altmans and two Riggs. Chief Altman is sitting behind mini Altman, Riggs sr has that cube toy in his hands and Riggs jr is sitting beside mini Altman. Chief Altman is married to Owen Hunt the head of trauma and the deputy chief Meghan Hunt is married to Riggs sr. A redhead barking orders in the pit is a trauma surgeon. The Hunt siblings and Kepner."
"How are they connected," an intern asked.
"Mini Altman is the chief's daughter, Riggs sr is Riggs Jrs uncle and mini Altman is married to Riggs jr."
"Why are the hot ones always taken," said one of the interns.
"Every year," Annie laughed.
Owen scrubbed in to assist with the surgery as the trauma caused by the cars was extensive and really needed a trauma surgeon. Plus Richard wanted to demonstrate team work for everyone. They repaired the damage caused by 29 toy cars and closed.
"That was something else," Annie said.
"Poor Julia following up on that," Josh said.
"So many jokes I could make if we didn't have interns," Annie said.
"When we get home," Josh said.
"Let me get mine the research materials I want them to look through for me to narrow my search," Annie replied, "then we'll go."
"Dinner," Josh asked.
"Pulled pork in the instant pot," Annie replied, "if you put it on it should almost be done when I get home."
"Okay," Just replied, "I'll see you at home."
"See you soon," Annie replied.
They quickly kissed and parted ways.