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What had made Lynn laugh so suddenly was an off-color joke about an angel who had traded in her harp for an upright organ. It had been told by Ronald Metzner, the jokester of the class, who had a phenomenal memory for jokes. What caught Lynn by surprise was that, although she usually didn’t find his jokes funny, somehow this one touched a nerve without her knowing exactly why, and only later would she realize it was because of suppressed tension she was trying to ignore.

Apologizing again to her companions for what she thought was a major faux pas, Lynn picked up her coffee cup and saucer to wipe off the table. She noticed that Ronald had a big, contented smile on his face, obviously pleased with the effect he had had on her and on the group as a whole.

The six medical students, four women and two men, appropriately dressed in their white coats, were hyped up and goofing off. For them, the almost four years of work, doubt, discovery, and challenge were all but over. Just over two weeks previously they had gotten the results of the National Residency Matching Program, so their uncertainty was behind them. They all knew where they were going for the next and, perhaps, most important part of their professional training.

For the final couple of months before graduation the group and several dozen other fourth-year students on the same rotation were supposedly getting their introduction to ophthalmology; ear, nose, and throat; and dermatology. But the rotation was not as organized or as important as had been the case in other, more basic disciplines, such as third-year internal medicine and surgery. They also had no real patient responsibilities, at least not yet. So far there had only been what they considered rather poorly planned and uninspiring lectures and demonstrations in the three specialties. That morning they had decided to skip the lecture to enjoy their sense of accomplishment. Truth be known, they were essentially in a cruise mode until getting their diplomas.

“I never knew you were interested in orthopedics,” Karen Washington said to Lynn after the group had recovered. Karen’s tone had a slightly captious tinge that only Lynn could detect. Just before the angel joke, Lynn had revealed her residency plans, which she hadn’t shared until that moment, and it had come as a surprise for Karen. She and Lynn were both from Atlanta and had known each other from high school and their undergraduate college days at Duke. They had been close friends during high school and their college freshman year, but when they both had decided on medicine as a career, competitiveness had interfered. But it wasn’t the only thing that came between them. Financial problems with Lynn’s family during sophomore year at college had impacted every aspect of her life, including her relationship with Karen, whose family was particularly well off.

Although Lynn and Karen ended up at the same medical school, their close friendship had never truly revived, as Karen’s keen competiveness continued. Instead Lynn had gravitated toward a close, platonic connection with Michael Pender. At one point during the first year of medical school Karen had confided to Lynn that she would have understood better if it had involved romance. Lynn’s response was that she was the one who was most surprised to have such a close, nonromantic friendship with a male, although Lynn’s boyfriend, Carl Vandermeer, had come in at a close second. Lynn had confided to Karen that Carl initially had a lot of trouble accepting the situation.

It had all started innocently enough and was based on the alphabetical proximity of their surnames, Peirce and Pender. As a consequence, from day one Lynn and Michael had been thrown together for everything that required medical students to pair up, mostly for labs and physical diagnosis. Although never romantic, they became a real team, somewhat like a brother and sister, making sure they had the same rotations, covering for each other, and studying together to the partial and unintended exclusion of others. The result was that Lynn and Michael had been saddled with the nickname “the twins.”

“Really? Orthopedics?” Karen continued, with disbelief. “It caught me totally by surprise, as much or more so than if you had told me you were going into urology. I always thought you were sure to become one of those brainy internal-medicine people.”

“I don’t know why it should have been a surprise,” Lynn responded, sensing a bit of the old hurt feelings on Karen’s part. “You of all people know that I was always a jock in high school and college, especially with my interest in lacrosse. Sports have always been a part of my persona. But what sealed the deal was doing orthopedics as my elective this fall. It surprised me how much I liked it. To me it is happy medicine, at least for the most part. That’s appealing.”

“But the surgery,” Karen complained with an exaggerated expression of distaste. “It’s not like what people expect surgery to be. It certainly wasn’t for me. It’s like a bunch of carpenters with hammers and saws, banging in nails and then having X-ray come and see where they went. Whereas ophthalmology! What a difference! That is surgery at its best: precise, bloodless, and you get to sit down while you operate.” Everyone knew Karen was off to Emory in Atlanta for a residency in ophthalmology.

“To each his own,” Lynn said. She was not going to be baited into a comparison of the two specialties.

“And you are staying here?” Karen asked, with continued incredulity. “Actually, for me that was even more of a shock. I thought you were destined for some Ivy League — affiliated hospital, like Mass General in Boston, considering your rank in class.” Everybody knew that Lynn was very near the top of the class, scholastically. She and Michael were always neck and neck in the ranking: two peas in the pod in more ways than one.

“I’m going to leave both internal medicine and the Ivy League to Michael,” Lynn said, acknowledging her partner’s coup. Michael smiled contentedly at the recognition. Everyone at the table knew that few people got a slot at Mass General and Harvard from Mason-Dixon University School of Medicine, whose stated goal was to supply well-trained physicians for South Carolina and its environs, and not for medical academia. “For me, I’m happy staying right here at Mason-Dixon,” Lynn continued. “And you should talk, Karen. Emory for ophthalmology! Not too shabby.” It was also common knowledge that, academically, Karen was in the top ten of the class as well.

“Everybody knows why Lynn is staying here for her residency,” Ronald said with artificial disdain. “Like the angel, she traded in her harp for Carl Vandermeer’s upright organ!”

There was another burst of laughter, this time at Lynn’s expense, although she too was smiling. She pelted Ronald with a balled-up napkin as he basked in the glory of having again gotten everyone to laugh over the same mildly salacious joke.

“Am I to gather that you and Carl Vandermeer are still going to be an item come graduation?” Karen questioned while struggling to control her laughter. The group’s outburst had again attracted disapproval from others in the coffee shop. It was, after all, a hospital.

Most of the class had met Carl Vandermeer through Lynn at various social functions over the course of their four years of medical school. It was common knowledge that Lynn and Carl had first met at Duke when Lynn was a sophomore and he a first-year law student. It had also been common knowledge that over the last couple of years they were seeing each other exclusively. What wasn’t known was the long-term seriousness of the relationship. Even Lynn didn’t know for certain. As close as they were, Carl was always evasive on the subject.

“We’ll see what happens,” Lynn said, tossing her long brunette tresses away from her face. She had yet to pull her hair back in a barrette, the way she always wore it in the hospital. What she didn’t say was that she felt rather strongly that it better work out with Carl, because the real reason she hadn’t applied for a training program in Atlanta or Boston was because Carl was committed to his job in Charleston. From her perspective there was no doubt it was a sacrifice. Truth be told, she had expected an engagement and wondered if it would be coming for graduation. In her mind, it would be a wonderful graduation present. As a competitive, modern woman, Lynn didn’t feel she needed love, but, having serendipitously found it with Carl, she wanted it. She also had enough self-awareness to suspect that her eagerness to create her own nuclear family had something to do with losing her father when she was in college. She and her father had been close, and it had been because of his early death that she had decided to become a doctor.