Робин Кук - Charlatans

Although the Change Party was to acknowledge the residents who were leaving, it was also secondarily an opportunity to welcome the twenty-four first-year residents who were about to join the BMH family. Only eight of the twenty-four were categorical residents, meaning they were expected to stay for all five years of surgical training. The other sixteen were planning on finishing only a year or two of surgical training before going on to various surgical subspecialties, such as orthopedics or neurosurgery.

During the course of the evening and despite generally feeling like a fish out of water, as he always did in large social situations, Noah tried to introduce himself to a few of the incoming surgical residents, a couple of whom he had met when they had come for their interviews before being accepted. One of them was Lynn Pierce, and he had been impressed with her, although she’d had a similar effect on him as Dorothy, making him wonder if physical attractiveness was now a criterion for the program.

“Are you going to stay for SICU rounds?” Dorothy asked.

“No,” Noah said. “Seems there is no need, and I have a lot on my plate before the welcoming ceremony this morning. And you guys are planning on attending, right? Remember, everyone is expected to show up.”

“We wouldn’t miss it for the world,” Dorothy said with a smile. “That is, unless the roof falls in here in the SICU.”

“Don’t count on it,” Noah said. “Be there!”

The welcoming ceremony was as preordained as the Change Party but a lot less fun. It was supposed to welcome the first-year residents, but Noah saw it more as an opportunity for the departmental bigwigs to hear themselves bloviate. Over the years he had come to understand that there was always a lot of posturing and jockeying going on in the front office of top academic surgical programs, and the surgery department at the BMH was no exception. Competition was the name of the game in medical academia, particularly in the surgical arena, and it never stopped. Luckily, Noah considered himself good at it.

As had been the case for the last four welcoming ceremonies he had attended, Noah was not looking forward to it. The first one had been different because he had been eager to start his residency. He had been so eager that he had found most of that June five years ago to be almost intolerable. The days had seemed to drag by from medical school graduation until July 1, despite his having been busy finding the Revere Street apartment and setting it up with Leslie.

From Noah’s perspective, this year’s welcoming ceremony was going to be more trying than usual. He was not going to be allowed to sit passively and persevere as he had the previous four years. As the new super chief resident, he was going to be asked by Dr. Carmen Hernandez, the chief of surgery, to say a few words. Unfortunately, this wouldn’t happen until after the chief and then Dr. Edward Cantor, the surgical residency program director, had exhausted everyone with long, boring speeches about the history and importance of general surgery and the BMH in the development of modern medicine. Noah knew that by the time he was introduced, the audience would be close to comatose.

Of course, Noah understood it made sense for him to address the group, since he was the new residents’ day-to-day boss. The structure of the surgical residency program was as simple as it was medieval. The first-year residents were the serfs, or, according to in-house parlance, the “grunts,” Noah their liege lord, Hernandez the king. Each year the residents ascended the rigid ladder, with increased perks and responsibilities.

Noah had never been fond of public speaking, particularly in a formal setting. He was fine if not brilliant in informal settings, such as on surgical rounds, considering his command of the medical literature to back up any point he was trying to make. The reason public speaking bothered him stemmed from his competitive quest for academic excellence, which he thought was put at risk in such a circumstance. He always had the fear that his mind might go temporarily blank or he’d inadvertently say something outlandish. It wasn’t necessarily a rational fear but real nonetheless, similar to his fear of social engagements like the Change Party. To make matters worse, he had been so busy preparing to assume the role of super chief that he hadn’t planned his remarks. He was going to have to improvise, which only increased the likelihood he’d say something inappropriate in front of the surgical hierarchy.

Leaving the SICU well before 6:00 A.M., Noah took an elevator up to general surgery on the eighth floor. Work rounds with junior and senior residents weren’t scheduled until 6:30, giving Noah time to check in with the night-call senior resident, Bert Shriver, a solid, dependable resident. Like everyone else, Bert had risen in stature overnight, if only in name. He was now a fifth-year chief resident. He gave Noah a quick rundown of the night. There had been two surgeries, both appendectomies that had come in through the ER, and the patients were doing fine. With all the surgical inpatients, there had been no problems whatsoever. There had been one consult from the internal medicine floor to do a cut-down on a patient who needed an IV but had no superficial veins.

“You’ll be at the welcoming ceremony, right?” Noah asked. As the new super chief, he was now responsible for no-shows.

“Wouldn’t miss it for all the tea in China,” Bert said with a grin. “Can’t wait to hear whatever pearls you have conjured up.”

Noah gave him the finger and an exaggerated dirty look.

Still with time to spare before general work rounds would begin, Noah used the phone in the nurses’ station to call the OR to see if anything had been scheduled behind his back. He had checked the evening before, prior to the Change Party, and had been told no surgeries would be scheduled until 10:30 A.M. His concern was that if surgeries had been scheduled overnight, which needed resident helping hands, it would be up to him to supply them. He was happy to learn that no cases had been added. For once, word had apparently gotten out so that the entire surgical department knew about the welcoming ceremony. Noah was pleased on one hand and a bit more nervous on the other. The implication that the ceremony might be even better attended than usual added to his anxiety about speaking.

Noah next went around to check in on his three private patients whom he had operated on. He thought it important for him to visit each at least twice a day to have direct, personal, face-to-face contact. Though he would see them again on work rounds, that was different, as it would be with the whole resident team. Noah had never been a patient himself, but he was sure that if he were, he’d want to have a few private moments with his doctor every day. His attitude about the importance of communication was one of the many reasons he was so popular.

Two of the three patients were still asleep when Noah entered their rooms, and Noah had to wake them up. During his first couple years as a surgical resident, Noah would not wake patients, thinking he was doing them a favor by letting them sleep. A dressing-down by a patient made him change his mind. Patients truly valued the personal, one-on-one time.

All three patients were doing fine, with one scheduled for discharge that afternoon. Noah spent a little more time with him to let him know what he could and could not do. He also assured him that he would see Noah and not another resident in the clinic for follow-up. The man had been a patient of the BMH for years and knew the ropes. Sometimes when residents rotated onto different services they didn’t get to follow patients they had taken care of on previous rotations. Noah had always made sure that didn’t happen to him. It was one of the benefits of the sheer number of hours Noah spent in the hospital, which married residents with families simply couldn’t do. Noah was never bothered by this added effort; in fact, he thought the opportunity gave him a leg up.