Page 14 of Obeying

"Mhm." She gives me a look over the rim of her mug. She doesn't believe me. She's too smart to believe me and too polished to say so directly. That's the thing about her: she sees everything, says just enough to let you know she sees it, and then lets you figure out what to do about it.

"Just make sure 'accordingly' doesn't cross into 'personally,'" she says. "You know how this place talks. And you know who listens."

She's right. You'd think a building full of people who save lives for a living would be above petty gossip, but hospitals run on two things: caffeine and other people's business. And the last thing either of us needs is the rumor mill deciding there's something worth talking about in the way I treat one resident.

"I'll keep that in mind," I say.

She smiles the kind that says you'd better, and stands with her coffee. "Good talk, Dr. Maxwell." She leaves without looking back.

Today I put Kristen on a case that's going to force her hand.

A patient comes in mid-morning with symptoms that don't line up.

His heart rate is elevated, but his blood pressure is stable. His white count is high, but his fever is barely present. The abdominal pain is diffuse, vague enough to make the diagnosis feel just out of reach.

The residents grab onto the most familiar possibilities.

Appendicitis. Cholecystitis. Early sepsis.

None of them are unreasonable. They are just not the answer.

I assign Kristen as the lead.

"Portland. This one's yours."

She looks at me like I just handed her a live grenade. "Mine?"

"Did I stutter?"

A couple of the other residents exchange a glance. I don't miss it. They've been watching the dynamic between Portland and me for a week now, trying to decide whether I'm pushing her or setting her up to fail.

The truth is neither.

But I'm not explaining myself to a group of second- and third-years who still hesitate every time they have to interpret a difficult scan.

She takes the chart.

I step back and lean against the counter, arms crossed. At first, she hesitates. Her eyes flick toward me, looking for direction, looking for confirmation that she's heading the right way.

I give her nothing. She's on her own. And I need her to remember what that feels like.

She reviews the chart, studies the labs, and goes quiet.

I recognize that silence.

It's the same silence she had in medical school right before she caught something everyone else missed. The room could be falling apart around her, and Kristen Portland wouldn't notice because her mind would already be three steps ahead, connecting details no one else had thought to connect.

Then she moves.

She orders a CT angiogram of the abdomen and pelvis with contrast.

She returns to the patient's bedside and starts asking questions the others didn't think to ask. Not just the standard intake questions. She asks about recent travel, episodes of dizziness or fainting, new medications, over-the-counter drugs, supplements, and herbal products. She asks about chest fluttering or racing heart episodes that the patient may have dismissed as insignificant.

She's thorough, but fast.

I watch her examine his abdomen. Her hands are precise and controlled as she palpates each quadrant, applying steady pressure while watching the patient's face for the subtle reactions people don't realize they're giving away.

The other residents are watching too.