A young man no older than thirty rose from his seat in front of one of the consoles. Tousled jet-black hair fell rakishly across his forehead, emphasizing eyes so strikingly blue, Susan assumed they were tinted. His nose jutted, perfectly straight, over a mouth that clearly smiled a lot. He had classic high cheekbones and a solid, undimpled chin. Though he was slender, his chest and arms revealed him as an athlete. Susan caught herself staring and swiftly looked away, only to notice every other R-1 studying him as intently.
“Stony Lipschitz,” Clayton introduced, passing the key he had used to open the unit doors on to the R-3. “Our peerless leader.”
“Hello,” Stony said. Accepting the key, he dumped it into the pocket of his dress polo, along with a pack of laminated patient cards. “I’m the R-3 supervising PIPU this month.” He spoke with just a hint of a lisp, which likely worsened with agitation. Susan winced at the irony of a lisper with so many s’s in his name. “Actually, I’ve been getting to know our patients the last three days. R-3s switch rotations a bit early so we’re ready for the new R-1s and the patients don’t completely lose continuity of care. Three days before you’re finished, I’ll train my replacement and move on to adult outpatients. But, for the rest of this month, you’re stuck with me.”
Clayton ran through a brief introduction, probably as much to refresh his own memory as to inform Stony. He pointed to each R-1 as he spoke his or her name. “Kendall Stevens, Monk Peterson, Sable Johnson, Susan Calvin, Nevaeh Gordon.”
Stony paid close attention to Clayton’s words and gestures, then nodded. “I think I have it, but I may ask once or twice more, if that’s all right.”
All of the R-1s bobbed their heads and mumbled their okays.
“The interesting thing about doctors is that no two treat patients exactly the same way.” Stony retook his seat, leaned back against the desk, and gestured for the others to sit as well.
A wild scramble for the chairs sent Clayton dropping to the floor again. Stony smiled, as if at a private joke. “Clay, do you mind handling the patient work for a bit while I finish orienting the -1s?”
Clayton’s round face turned pink, and he rose, brushing dirt from his pleated slacks. “Of course. No problem.” He headed off toward the nurses.
Stony watched him pass beyond hearing range, then pulled his seat closer to the R-1s. “Ol’ Clamhead’s not a bad guy, though he doesn’t have much grace, physically or socially.”
Though Stony could surely tell the R-1s needed a moment to process the nickname, he did not miss a beat. “Every doctor finds his or her own niche. Some are sticklers for procedure and use the most cautious approach to every patient in every circumstance. Some are more liberal and experimental in their approaches. Others fall various places in between.” He glanced around at each of them in turn, as if reading their futures. “You will wind up working with examples of each type of physician, and most of them will be excellent doctors in their own way. Despite protocols and studies, no two doctors approach a patient exactly the same way, and that’s not a bad thing.”
Stony leaned backward, against the desk again. “All of you will develop a style, and it might change over time. Some of the R-3s, and most of the attendings, believe their way is the only right way. I’m not one of them. I’m more of a hands-off leader. You can’t learn responsibility, or to think for yourselves, if I’m always telling you what to do. These are your patients. If you want to try something different, go ahead. If it’s outlandish, stupid, or dangerous, I guarantee the nurses will run to me before implementing it.”
Susan saw her peers’ heads bobbing in agreement and found herself doing the same thing. With long-term patients, especially children, nurses often became every bit as attached and protective as the parents.
“You’ve probably heard the pediatric inpatient unit is the hardest psych unit, and it is. But it’s also a great place to try new approaches. It takes a serious situation to land a child here, and conventional medicine has already failed them. You’re unlikely to make things worse, and who knows? You might have a brilliant breakthrough that doctors with more rigid ideas have missed.”
Stony looked around the group. “If you’re uncomfortable with the sink-or-swim approach, Clamhead and I are here to help you with any problems or questions. Any. You’re here to treat the patients. We’re here to keep you, and the hospital, out of trouble. So, if you feel you need some backup, or just some advice from someone more experienced, come to Clammy or me.”
Stony reached into a cubby and removed a baseball cap, which he held upside down by the bill. “He called me your peerless leader, but I’m just a resident, like you. Every day, we will round with the real man in charge, our attending physician. He will want to hear about your patients and their progress, and he’s the one you have to impress. Tomorrow, he’ll expect you to give a detailed presentation of each of your patients, so read your charts. After that, he’ll just want to hear what’s new and different. We were lucky enough to get assigned the head of Psychiatry himself, Dr. Kevin Bainbridge.”
Susan’s blood ran cold.
Monk spoke their realization aloud. “Isn’t he the older man who talked to us in the auditorium?”
Kendall hauled out his gravelly old man Bainbridge imitation. “And by working only twelve-hour days, we missed half the good cases.”
The R-1s snickered, and even Stony smiled broadly. “That’s the one. He’s a bit intense, but he’s an excellent diagnostician.” He tapped the Vox on his wrist. “He’s not a fan of devices, though. He prefers you try to memorize every bit of medical knowledge and have it on the tip of your tongue when he asks a question. But he’s also slow enough, you can usually sneak the answer off Vox with a bit of distraction. Just be on time, don’t try to slip out early, look busy even when you’re not, and you’re fine. He growls sometimes, but there’s not a mean bone in the old coot’s body.”
Stony shook the cap, then held it out toward Nevaeh. “I’ve separated patients into reasonably balanced groups of four. Whichever bunch you pick is yours.”
Each of the R-1s took out a torn sheet of paper with Stony’s sloppy writing on it. Susan read hers:
1. Monterey Zdraziclass="underline" 12-yo white female:
traumatic mute
x 6 years
2. Dallas “Diesel” Moore: 10-yo black male:
psychotic depression
,
attention deficit hyperactivity
,
oppositional defiant disorder
3. Sharicka Anson: 4-yo mixed female:
juvenile conduct disorder
4. Starling Woodruff: 13-yo white female:
dementia
status post aneurysm repair
Susan stared at the paper, a strange mixture of emotions washing over her: excitement, fear, and uncertainty blending into a cacophonous mix that held her spellbound. My patients, my patients. The awesome responsibility for those children lay in her inexperienced hands. They deserved the best treatment she could devise, the wisest decisions; yet Susan wondered what she could add that previous doctors, more veteran and capable clinicians, had not already considered, discarded, or tried.
Doubts descended upon Susan an instant later. What if I make a mistake? What if I say the wrong thing and further damage their delicate psyches? What if I take away the only medication allowing them to function or add one that causes permanent harm? What if I kill someone?
Susan glanced at her companions. All of them stared at their own small pieces of paper, their expressions sober; and she imagined the same painful insecurities bombarded each of them. Doctors throughout history had contemplated their place in the world, had worried about these same issues, had realized the delicate balance of life, health, and sanity in those they served. Unlike those in other professions, doctors could not afford to have a bad day. A physician who got lazy might make a fatal mistake. Vox and other fast, portable computer-links helped; but the human behind it still had to know enough to put the pieces together, to calculate the direction of thought, and to access the proper information.