Page 4 of Silver Fox's Intern Dilemma

4

JACK

With the incision made, I inserted the laparoscope and fed it toward the lower right abdomen of our patient. Dr. Chen stood opposite me, watching the monitor along with me as I guided the long, narrow camera toward its goal. Our patient presented with acute abdominal pain and high fever and after triage was diagnosed with appendicitis. We, of course, had the joy of removing the infected tissue to treat the patient, and with Dr. Briggs out for the day, I called Dr. Chen in to assist.

"What you're seeing now are the internals, of course. The colon gets sort of pushed up and twisted in places, but the scope will show us what we need to see." I pushed it deeper and navigated it where I needed it until the swollen appendix came into view.

"Wow," Dr. Chen breathed, and I watched her eyebrows rise. "A few more hours and this thing would have ruptured. Our man would've gone septic." She reached for and handed me the diathermy device, and I took it, though I kept my eyes on the screen for all but the brief second I needed to insert it into the second incision we'd made previously.

"He's lucky he came in when he did," I told her as the tip of the tool came into view via the laparoscope's camera readout. The vessels were stubborn and bled a little even as I tried to cauterize them, but I managed to finish without much trouble. When I pulled the tool out, Dr. Chen was there to take it from my hand as I used the laparoscope to resect the appendix which I'd cauterized.

"Dr. Thornton," Dr. Chen said, pointing at the screen with her gloved finger. "The infection has spread there. We need to resect more of the cecum."

Once I used the graspers to slide the swollen, puss-filled appendix back, I saw the reddish area of infection she was talking about. It was a good call, and one I might have missed if I weren't careful. Though, I was always extra cautious during surgical procedures, knowing how sue-happy people were these days.

"Nice call, Chen," I told her. I removed the appendix, careful not to allow it to burst or spread infection, and went back a second time to resect more of the tissue and avoid our patient going septic. When we were finished, I walked her through the few different ways of doing sutures and then showed her my preferred method. With the patient stitched up, we allowed the nurses to apply the dressing and Dr Chen and I stepped out to scrub out of surgery.

She stood next to me at the sink, tearing off her bloody gloves then plunging her hands under the hot water. I was impressed. When I called her in for this surgery, I assumed she'd be hesitant and skittish again. I thought I'd be coaching her through things and she’d probably faint at the sight of blood after these past two weeks of working with her and seeing her be so anxious. But she did so well I probably could have let her do the surgery herself and she'd have done as well or better than Dr. Briggs.

"You know, Dr. Chen, I'm genuinely impressed." I took a sterile towel off the rack to dry my hands and rested my hip on the edge of the scrub sink, watching her finish. She smiled softly and her cheeks flushed light pink, but she said nothing so I continued. "You were very put-together in there. I might have missed that additional infected tissue without your keen eye. Well done."

"Thank you, Dr. Thornton. I’m just doing my job." Her head dipped, and she reached past me to pick up a towel too. For a brief second, she was close enough that I could have smelled her perfume if she'd been wearing any.

How many times had I caught Dr. Briggs wearing cologne on shift, but it was against hospital policy? Dr. Chen's only scent was sterile, like bleach or disinfectant. For some reason, that appealed to me. It was the smell of ethical behavior and commitment. I felt the corner of my mouth turn up a little. I was impressed with her for the first time.

"Why don't you come by my office here in about twenty minutes? I'd like to talk with you a little more in depth." I tossed the towel into the hamper and pulled my mask off and tossed it too. Dr. Chen straightened and dried her hands while looking up at me with a bit of hesitation in her expression. "You're not in trouble," I added to reassure her.

Relief washed over her features and she nodded. "Alright, twenty minutes."

I walked out the door past her and toward my office where we'd do the surgical debrief. It was a habit I picked up while doing my residency with my mentor at the time. We would go over every step of what happened and how we could improve or what we did well. The digital recorder in my pocket picked up every detail of every conversation, though it didn't provide video. I'd thought at times to bring this to the medical boardas a means of helping students learn, since this was a teaching hospital, but I hadn't ever gotten around to it yet.

My office wasn't as much an office as it was an old storage room with no windows and only one door tucked on the back side of the doctors' on-call room. When I was made chief resident, they had to clear things out for me to have this space. The surgical head told me all chiefs had their own office space but in order for me to have my own, without sharing, I had to humble myself. I didn't care. It gave me a space to speak privately with my interns and residents about their performance, and that was good enough.

I sat behind my desk, squeezed between a file cabinet and the wall. The small chair I had wasn’t ergonomic, nor was it new. It had been scraped from someone else's office as they moved out for a promotion. I was lucky to even have the space, though, so I didn't complain at all. I brought my own laptop since the hospital didn't issue computers to lower-level management like myself, but they did give me the standard-issue tablet for tracking my charts.

When Dr. Chen knocked, I found myself feeling slightly embarrassed by the space. It was clean, but it was tiny, and there was nothing personal in here. I'd been chief resident for more than a year now, but I was so busy working, I never took time to hang pictures or even bring a plant in here. What sort of plant would even survive with no sunlight? The most personal thing I had was a small, framed school portrait from Leah's kindergarten.

"Come in," I called, but I didn't bother standing. I didn’t feel like banging my knees on my desk. The door opened and Dr. Chen walked in. Her eyebrows rose a tick, but she was good at hiding her astonishment about the size of my office. "Come on in. Have a seat." I nodded at the single metal and plastic chairsituated opposite my small desk, and she nodded once, shutting the door behind herself.

"Wow," she breathed, and I noticed the smirk on her face briefly. "They stuff you in a closet?"

I chuckled, already feeling like she was more relaxed than I'd ever seen her. The rigors of this job were so intense, I didn't blame her for being on edge during work hours. Seeing a new side of her during surgery had opened my eyes to how I had probably missed the real Dr. Chen under all the stress and strain of diagnosing and performing surgeries.

"It's this or the doctors’ lounge… I figured this was a bit more private." I leaned forward over the desk with my elbows resting on it and folded my hands together. "Thank you for joining me."

"Yeah, no problem. What do you need to talk about?" Dr. Chen bit her lip nervously, and I saw the first hint of her self-doubt that I'd seen in a few hours. Only twenty minutes ago, she was so confident and self-assured. Now I was beginning to see the anxiety creep back in and I wanted to nip that in the bud. She was so talented and capable, and if I were being honest, much prettier when she was confident.

"Well, first of all, you did a fantastic job. I had my doubts when I called you in, but you outperformed even Dr. Briggs. I see a little of myself in you, how I used to be when I first took my internship." I spoke with my hands as I talked, gesturing for emphasis. She seemed to watch what I was doing, and I wondered if she was listening.

"Thank you," she muttered, and I continued.

"But I'm concerned.” I furrowed my brow, not trying to discourage her. I just knew how hesitant she'd shown herself to be and I didn't want her to be put on the spot. I didn't need her up in my office crying her eyes out. "During rounds and lectures, you seem so indecisive—hesitant, even. I wondered if there issomething I'm doing that makes you intimidated. Or perhaps you're doubting yourself too much.”

I expected her to be overly sensitive and perhaps even defensive, but she smiled sadly and looked down. "You're right. I do have that problem. I tend to get nervous in groups and feel like my opinion or thoughts aren't as good as other people’s." She looked back up at me and smiled. "I know I need to work on that. It's just a confidence thing. I'll do better." Her hands stretched out on her knees and she sat with her shoulders squared, but not stiffly.

I was impressed by that as well, how she took my gentle criticism with grace and acknowledged her area of needed growth. And the way she carried herself made me take notice of how attractive she was too, simple beauty without fanfare or pomp. She wore no makeup, had no fancy jewelry or hair clips. It was her simple, dark, straight hair tied back in a ponytail and a clear complexion. I found myself staring and had to shake that off.

"Then I have a solution. I want you to work one-on-one with me until you've gained the full confidence you should have. You're brilliant, and I want to see how much more you can impress me, but I feel like I'm doing you a disservice by lumping you in with Dr. Briggs. Of course, he's going to outshine you a little. He's second year. You just need to get your feet under you, and I can help you.

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