Dr. Alan Quartermaine opened one eye to glance at the clock when he heard the door to their master suite open. It was five minutes before midnight. Monica had been gone for more than four hours. He opened both eyes and sat up in bed. "So, I guess that patient Dr. Harmon needed help with needed to go to the cath lab after all," he said.

"Eventually, yes, I got paged for a STEMI around nine right after I transferred Dr. Devlin's patient to the CCU and started the Heparin and Nitroglycerin Drip. She was still having significant pain after my STEMI patient was successfully stented, so I went ahead and did the catheterization. I got the RCA open but there was so much myocardial stunning I decided to place a balloon pump and then I went ahead and put in a central line so we could run Dopamine and Dobutamine overnight," Monica said.

"So, I guess it is a good thing that Dr. Harmon called you. I was really impressed with his ability to identify unstable patients early during the two months he spent with me," Alan said.

"Yes, he certainly is a strong intern. Truly, we have a strong intern class this year; Dr. Lambert, Dr. Ramsey, and family bias aside, Dr. Karen Baldwin-Cates are all outstanding as well," Monica said.

Alan refrained from suggesting that the whole family bias suggestion might also apply to Dr. Lambert who he thought was still dating Monica's brother. Or maybe she was. Or maybe Monica was right, and it was really none of their business. "So, do you want me to drop the kids at swim practice in the morning so you can sleep in?" he asked instead.

"No, I might as well take them and swim because it isn't like I can round after six when I have a patient on a balloon pump. If I'm able to get them off the balloon pump then hopefully I can get a nap before that benefit tomorrow night," Monica said as she disappeared into their en suite master bathroom.

XXXXXXXX

In the faint glow from the night light by Courtney's pack and play, Cooper Alden watched his wife sleep. Despite what Steffi likely believed he really did love her. That was why it was so hard to watch her return to modeling. He felt like she was playing Russian Roulette with her life, with their family's life and it was hard to not be frustrated by that. But beyond that it terrified him; Steffi had nearly died after Courtney was born. Another relapse really might kill her.

XXXXXXXX

Clearly ELQ's next innovative design project needs to be a chair bed someone could actually sleep on! Ned Ashton groaned as he attempted to roll over on his cramped sleeping space.

"Now, see, this is why you should have listened to me and gone home for the night. There really isn't any sense in both of us being uncomfortable," Carly Ashton said.

Ned laughed in spite of his misery. "Touché," he said as he sat up and extended his arm over to switch on the light. "Seriously, though, I really meant what I said earlier. We're in this together and I'm right here even if I have to sleep on this uncomfortable thing!"

"Thank you. Considering everything, I guess that is pretty inadequate but it's the best I can do," Carly said.

Carly's voice broke a little and Ned was almost sure he saw a tear escaping. He got up and made his way to her bed. "Hey, what's wrong?" he asked as he lowered the bed rail and then carefully lowered himself onto the bed and took her hand.

"I'm sorry; you've been so kind, and I'm just so afraid I'm going to mess this all up," Carly said as tears started streaming down her face.

Ned rubbed expanding and contracting circles across his wife's back. "I think you're going to do just fine. Pregnancy can be really scary, but I promise, I'm right here," he said.

Carly's eyes drifted closed. Ned gave her upright right shoulder a few squeezes and then leaned down and gently brushed his lips across her forehead. "Just rest, sweetheart, I'm right here," he whispered.

Ned extricated himself from Carly's bed carefully so as not to disturb her. He wasn't sure what had brought out her insecurity, but it was clear she didn't need any additional stress on her plate. He was going to need to resolve the Dr. Jones debacle by himself.

XXXXXXXX

As she lay in the dark, Sarah Webber debated her options. Presumably even a stickler like Mr. Graham would let her just skip the test if she missed it due to being admitted to the hospital. He should be able to just give her the grade she had earned thus far on her homework and quizzes; that would leave her with at least an A- and perhaps an A. Unfortunately, that still left Mr. Murty; she hadn't even started the paper which was supposed to be due in her sixth period class with him. Normally Sarah felt confident about her ability to obtain at least a forty-eight-hour penalty free extension, but she had already played that card once a few weeks earlier. Ultimately, she had gotten her extension along with a referral to the school counselor. It had been mortifying! She clearly needed to make sure that any future excuses were considered medical not mental health. So maybe desperate times really did call for desperate measures.

XXXXXXXX

Dr. Matt Harmon wheeled his way into the Housestaff Lounge. He was a little surprised to see his colleague, Dr. Eve Lambert pouring a cup of coffee. "I didn't realize you were also on call tonight?" he said.

"I'm on OB-Gyn. We have to take Q4 L&D call," Eve said as she sat down on the couch with her mug of coffee, slid her feet out of the clogs she was wearing and brought her legs up under her.

"Yes, I did that the second half of August and the first half of September. I really liked Dr. Meadows and Dr. Newman," Matt said.

Eve shrugged her shoulders. "Everyone does," she said.

"But you don't?" Matt asked.

"I never said that," Eve said flatly.

Matt decided he was meant to leave that alone. "Obstetrics isn't for everyone," he said. He noted that Eve seemed even more uncomfortable with that concession. That really hadn't been his intention. "So, I think I finally understand why just about everyone else hates Dr. Devlin," he said.

"I also never said I hated Dr. Devlin," Eve said.

Really batting 1000 there, Champ! Matt chided himself internally."Ok, so I have this patient who presents with classic ischemic chest pain, EKG shows new ST depressions in inferior leads. Of course, Dr. Devlin doesn't want to see the EKG or come in and see the patient. He is sure it is indigestion."

Eve rolled her eyes. "Dr. Devlin thinks everything is indigestion unless he is in the mood to go to the cath lab. Then he is ready to jump right on that AVR elevation band wagon!" she said.

"What is the AVR elevation band wagon?"

"Somewhat evolving literature from the EM side of the planet suggests that perhaps single lead AVR ST elevation should fulfill STEMI criteria. ACC hasn't taken that up other than to reemphasize the importance of urgent PCI for unstable NSTEMI patients."

"I guess that never came up last month during my month in the department," Matt said.

"Dr. Carmichael is a big believer in it. Monica points out the ACC STEMI Criteria but is pretty aggressive with early PCI in anyone who is not hemodynamically appropriate or chest pain free after initial management. Dr. Ford and Dr. Rothstein are less aggressive but will generally also eventually do the right thing. Dr. Devlin only does the right thing if it is personally convenient for him which is why the majority of his patients have their PCI done by anyone but him," Eve said.

"I see," Matt said.

"You probably will by the end of this month," Eve said.

"So, you picked all this up on your month of Cardiology with Dr. Quartermaine?" Matt asked.

"I haven't done my month of Cardiology yet. I'm doing that next block, but this also came up during my month in the ED and last month doing General IM wards with Dr. Phillips. Just between you and me, if you're really worried about that patient, if you call Monica she will let you fax her the EKG at home and she will come in and do whatever is necessary and somehow whether because she is charismatic and articulate or because she is married to the CMO she will survive any of the downstream fallout," Eve said.

"One step ahead of you, I called Dr. Quartermaine around eight, she came in, transferred the patient to the CCU started Heparin and Nitroglycerin, took a patient with a STEMI to the cath lab then came out and took my patient to the cath lab. She is on a balloon pump now so I'm kind of thinking it wasn't really optional," Matt said.

"No, probably not, although Monica is a bit more proactive than some of the rest of her department so it is possible if someone else had done the cath she wouldn't have a balloon pump. Of course, her post STEMI mortality statistics are a lot better than anyone else's so maybe that is why," Eve agreed.

"You picked all that up doing a month of Internal Medicine with Dr. Phillips?" he asked.

Eve shrugged her shoulders. "I guess," she said.

"Are you thinking about doing Cardiology?" Matt asked.

"Possibly," Eve said.

"I think you should," Matt said.

"I'm sure everyone thinks I should since that will be one less person competing for one of the three surgery spots," Eve said.

"I didn't mean that. If surgery is your passion then chase it," Matt said.

Eve laughed. "I actually was just giving you a hard time. Don't tell Chris, because I'm sure he will sense blood in the water, like the shark he is, but I don't think surgery really is my passion."

"Ok, if you don't tell Chris that I don't think surgery is really his passion either. I think it's a prestige and money motivated choice for him. If that is the case, then in the long run, he will find it unfulfilling. But what do I know? I'm not him," Matt said.

"So, is surgery your passion?" Eve asked.

"It actually is. I know it is an uphill battle, in general, and my disability adds another layer to that but, yes, it is my passion."

"Well, then, I really hope it works out for you," Eve said.

"Thank you, and I hope that whatever path you decide on in medicine works out for you," Matt said.

"Even if it ends up being surgery?" Eve asked.

"Sure, I know Chris may never believe this, but I really do see all of you as colleagues, not as competitors," Matt said.

"Don't be too hard on Chris. For what it's worth, he at least has convinced himself that surgery is his passion. Now perhaps that raises the question of why anyone who thought surgery was their passion would pick a transitional internship as the lead in for that. But I suppose that is a fair question for you as well?" Eve asked.

"Like I said, surgery is an uphill battle and I'm a big believer that it is wise to figure out plan B before plan A actually fails so a transitional internship with surgery emphasis gives me an opportunity to keep some options open and still have a fulfilling career as a physician even if not in the specialty of my dreams," Matt said. It was a well-reasoned answer and there was some truth to it. Of course, there was also the fact that most other legitimate surgery residencies were in major cities where Matt couldn't take any chances of being noticed.

The PCGH Surgery residency was a bit of a diamond in the rough. They were a level one trauma center with a a trauma volume that rivaled many larger programs. They also had clinical affiliations with both New York Medical College and Columbia University, so the academic potential was unlimited. Matt wasn't sure that the PCGH Surgery residency was really a bad choice under any circumstances but under his circumstances it was clearly the best choice. "So why did you choose PCGH?" he asked.

"I guess I wanted to keep my options open," Eve said with a laugh.

Matt smiled at his colleague even though her laughter seemed much more anguished than carefree. Perhaps it was. Dr. Evelyn Lambert was also a bit of an enigma to him. "Fair enough," he said.

"I didn't dislike surgery and I did well in my clerkship. But, even as a 3rd year medical student, I suspected it wasn't really how I wanted to spend the rest of my life. So, the transitional year internship was a way to take some time and really be sure before I locked in. Additionally, surgeons who do a more generalized internship are often better and more balanced in the long run. Dr. Quartermaine liked that answer when I interviewed with him although I swear I actually didn't realize that he had done his primary training in the PCGH program and done what they called a rotating internship back then when I said it," Eve said.

For some reason Matt did believe that. Eve might be enigmatic, but she seemed to have a lot of integrity at her core and Matt could appreciate that.