Charlatans

“We met Lynn Pierce last night at the Change Party,” Lorraine said. “I think it is going to be fine. She’s actually excited about being thrown into the deep end of the pool. Those were her exact words. She thinks she lucked out.”

The famed Change Party was a yearly surgical department event held at the nearby Boston Marriott Long Wharf hotel on the evening of June 30, no matter what day of the week it occurred. The party’s main purpose was to send off the fifth-year residents with a fun-filled event that included a number of irreverent homemade videos, generally mocking the attending staff of BMH but in actuality celebrating them and the institution. As a command performance, Noah had attended the celebration, as he had previous Change Parties, but such gatherings weren’t his cup of tea. To be sociable and try to relax, he’d had several drinks, which had made him feel less than top-notch this morning.

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.”

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