On the first day of my inpatient surgery rotation in medical school, it took me a while to choose just the right outfit to wear. I decided on a navy-blue sheath dress and matching platform heels. I needed to make the best possible first impression. My classmate, Alicia, was already in the third-floor conference room when I arrived. She is shaggy like a dog, with long, stringy hair and a rumpled white lab coat. She’s a do-gooder hippie going into family medicine and probably doesn’t even shave her legs.

I knew from a young age that I was destined to be a doctor. My parents are both surgeons. My oldest brother is a plastic surgeon. My younger brother is at Cornell but wants to be a wildlife biologist. Such a disappointment to our parents. I plan to become an ophthalmologist.

Right after me, the residents strode in. The tallest, a handsome man wearing green scrubs, a long lab coat, and a sardonic grin, sat at the head of the table.

“Are you doctor . . .” Alicia glanced at her clipboard, “Dr. Ansari?”

The tall resident smirked. “Ansari is the attending for the month. I’m the chief resident, Jackson Hussel. You can call me Jackson. You’ll have Ansari for noon conferences on Tuesdays and Thursdays.”

Alicia nodded and made a note on her clipboard.

“Oh, hi, I’m Jennifer Ross,” I said. “I’m really looking forward to this rotation. I’m hoping to get a surgery residency when I graduate.” No time like the present to start sucking up.

Jackson looked me up and down with a sneer. “What are you dressed up as? An ophthalmologist?”

Crap. Trying too hard. I laughed with him, even though I could feel my blush rising.

“Let me introduce the team. Over here, heading for a plastic surgery fellowship next summer, is none other than Georgio Sapienti, our fourth-year resident.” Jackson motioned to a handsome man with curly black hair and gorgeous eyelashes.

“Call me Gio,” he said, smiling.

Jackson continued, “And over here,” motioning to a gaunt man tipping his chair back while playing with a surgical clamp, “is none other than Earl Cumberland, University Hospital’s own, now a second-year. Glad you could join us on time today, Earl.”

“Yeah, yeah,” mumbled Earl.

“And last and certainly least, is our intern, Peter Vlodny, the man with the bohunk name and the Frankenstein looks.”

“Hi guys,” said Peter. He was disheveled and pale, his curly, blonde hair flattened on one side, his white coat grimy and spattered with tiny dots of blood on one sleeve.

“You can tell we weren’t on call last night,” said Jackson. “Peter’s hair only looks like that when he’s actually gotten some sleep. Be prepared, we are on call tonight. We’ll divide up admissions as we go along, and you’ll follow your patients to surgery. Starting tomorrow, you are expected to have reviewed all your patients and their charts before rounds. Rounds start at 6 a.m. in the surgical ICU. Peter, where is the surgical ICU?”

Peter looked up from his clipboard. “Huh? Second floor?”

“Give the man a star,” said Jackson. “That’s the only question he’s gotten right all week.” Peter looked at his clipboard while blushing bright red. “And one more thing,” said Jackson, “You medical students, they tell us you can’t work more than 80 hours a week, which includes call. And get this, if you take call, then after 24 hours, we have to let you have the next day off. So the department decided it made more sense to just have you work 12 hours a day and only eight on Sundays and not take call. Duty hours suck. They’re for babies. I guarantee if you don’t work 100 hours a week you won’t learn anything.”

I nodded in agreement. I’d heard of surgery residents falsifying their duty hours, and I suspected Jackson would happily sign off on my hours log if I worked a ton of hours but only reported 80.

 When we got to the ICU, Jackson led us from bed to bed, talking about each patient and telling us what labs to order or results to check. At one bedside, we saw one of Earl’s patients, a sallow man with sunken cheeks. Jackson whipped off the sheets to expose the patient’s dressing, which was red with blood. He ripped off the tape to find that the surgical wound was coming apart.

“It wasn’t like that when I looked at it,” said Earl. He stood with his arms akimbo, his surgical clamp dangling from a buttonhole on his long white coat.

“Marjorie!” yelled Jackson. A middle-aged nurse hurried over.

“Yes, doctor, what is it?” Marjorie looked irritated. Peter whispered to me that she was the unit supervisor.

“This wound is dehiscing. How come I wasn’t notified?”

Marjorie frowned. “I told Dr. Cumberland this morning,” she said, a note of defensiveness in her voice.

Earl’s expression didn’t change at all. “That’s news to me,” he remarked, his face unrevealing.

“Marjorie, you gotta do better here,” said Jackson. “This guy is diabetic, he’s on steroids for COPD, and we did surgery for a bowel obstruction. Very high risk for not healing.” He then went into a lecture on how to dress the wound and when to let Earl know about problems. Marjorie didn’t say anything, but her face was flushed and her lips were pursed when he finished. I understood Jackson’s frustration. My dad talks a lot about how hard it is to work with stubborn nurses.

Jackson marched to the next bed. “Earl, tomorrow, be prepared to tell us the treatment options for wound dehiscence.”

Earl nodded, and, pulling out his smartphone, made a note to himself.

The team sped around the ICU, then Jackson led us up the stairs, two at a time, to the surgical floor. “Move it, crew. We’ve got surgery in 45 minutes!”

We clustered near the nurses’ station as Jackson supervised “card rounds,” where we talked about the patients without seeing them. Jackson barked out orders, and I copied them down for the ones assigned to me. I had a long list of “scut” to do later in the day: examine patients, check labs, write progress notes.

After rounds, Jackson told me I would be in surgery that morning for an exploratory laparotomy on a patient with abdominal pain. He looked around at the group. “OK everybody. We have exactly five minutes to get a quick bite to eat.”

Peter leaned toward me. “You can get scrubs in the locker rooms outside the OR. And wear comfortable shoes. We’re not supposed to wear sneakers, but we all do.”

I didn’t have time to go back home to get my designer scrubs, but I did run to the medical student locker room to get the pair of running shoes in my locker. When I got to the nurses’ locker room in the surgery suite, the supply of scrubs was low, and I had to search high and low for something that would fit. I’m short and slim (cute and petite, my mother would say), and I finally put on what I could find, rolling up the waistband of the pants and taking in the front of the top with a big safety pin. Definitely not a great look for me. I put blue gauze booties on over my sneakers, stuffed my hair into a blue gauze cap (so long, perfect ‘do), and put on a mask. All you could see of my face was my eyes. I checked myself in the mirror. Good thing I did a good job with my mascara and eyeliner this morning.

When I got to the OR, Jackson was already outside scrubbing his hands at the row of sinks.

“You’re late,” was all he said.

Darn it. Strike number two. I made a mental note to arrive early for everything from now on. Jackson held up his arms then backed through the OR door. I could see Peter through the window, already putting on his gown and gloves.

When I grabbed my betadine sponge, I was torn between scrubbing quickly so I could get into the OR sooner, or doing a thorough job, which would take time, but would be proper technique. I decided to do a thorough job. I focused on scrubbing under each nail for ten strokes. Then ten times on each side of each finger, then on each side of the hand, and on each side of the forearms. It felt like it was taking forever. I glanced through the OR window to see Jackson looking at me. He watched me scrub for a minute, then nodded at me. Whew. I was right to be thorough. I’d heard about students being sent back to scrub over and over until they got it right. By the time I was done, the patient was anesthetized, and Jackson was draping the abdomen. The scrub nurse looked irritated that she had to help me with my gown.

“For God’s sake, don’t touch anything,” she said. She reminded me that the only sterile places were the operative field and the shiny fabric on the front of my gown. “Don’t touch below the waist, don’t touch your face, do not adjust your mask. Tell me if you get a break in your glove and we’ll get you a new one.”

I nodded, pretending I didn’t already know all that. I’d observed a ton of surgeries with my parents. I knew the routine. I clasped my hands together in front of me as I approached the OR table. Peter motioned for me to stand next to Jackson. He was tall and had the table cranked up high so he wouldn’t have to stoop.

“Could I have a step stool, please?” I asked, loudly. Peter raised one eyebrow at me while the scrub nurse rolled her eyes. I understand that med students are supposed to be invisible and silent and stay out of the way. Still, my mother, who was about my height, always requested a stool when she operated. I figured there was no sense in my being in the OR if I couldn’t see what the surgeons were doing.

A few seconds later someone pushed a stool up against my leg. I yanked it into place with my foot and stepped up. Now I could see that Jackson had made a huge incision down the middle of the patient’s abdomen. Peter used gauze to mop up the blood after every swipe of the blade, and the nurse was like a mind reader, ready with each new instrument. When the wound was fully open, she said “Deaver” and handed me a wide, curved metal retractor. Jackson grabbed the retractor out of my hand, positioned it the way he wanted, and told me to pull hard.

My right arm was in front of Jackson and I could feel him intentionally leaning against me. For a second, I wondered what he was up to, whether he was coming on to me, but then I decided it didn’t matter. It meant he noticed me.

Jackson said that this patient had severe abdominal pain and acted like he had an obstruction. They weren’t able to pass a colonoscope, so they were going in to find out what was wrong and fix it. Just then, the attending surgeon entered. He was older and wide, with a florid complexion. As the nurse gowned him up, he peered at the OR table.

“So Jackson, you got a head start on me, huh?”

Jackson nodded. “Dr. Thomas, so glad you could join us!”

Thomas laughed. “None of your lip, young man.”

Peter looked visibly relieved that the attending had arrived. Residents weren’t supposed to perform surgery without supervision. He edged down the table to stand across from me, making room for Dr. Thomas, who peered into the open incision. Jackson worked his way down the abdominal cavity, finally reaching the intestines and running them through his fingers, feeling every inch of them along the way. Jackson showed something to Dr. Thomas, who reached in to feel it. Their eyes met. “Anything in the omentum?” Jackson shook his head no. They said something about a cold section, then Jackson grabbed my hand and pulled it and the retractor far to the side. “I said hold it hard!” He wasn’t leaning against me anymore.
      Peter now had a retractor, and he pulled his back too. We stood like that for what seemed like forever. There was clamping and suctioning and snipping and dissecting. A section of intestine was slopped into a dish and taken to the lab. The report came back positive, meaning the patient had cancer, which resulted in Jackson and Thomas mumbling some more about what they wanted to do, and then they dissected out a long stretch of bowel, clamped it off, and threw the removed section into another bowl. After the cutting and sewing, Jackson on his side and Thomas on the other, felt around deep in the abdomen, the intestines sitting outside on the blue drapes. They found a few more things to dissect and remove. There was more checking, irrigating, counting sponges. I did my best to stand up straight and focus, but my arms were shaking with the effort of pulling on the retractor. I made a note to myself that I needed to increase the intensity of my upper body workouts. Finally, they stuffed the intestines back in and took the retractors out. Dr. Thomas backed away from the table, snapping his gloves into a waste bucket.

“Good job, Jackson. As usual,” he said in his booming voice. “You’ll do the dictation, yes?”

Jackson nodded. Thomas removed his gown and strolled out of the OR, his large belly leading the way. Peter had moved into his spot across from Jackson.

“You start from your end,” said Jackson, and Peter nodded. The nurse handed each of them a suture driver with a needle clamped on the end. Jackson deftly grabbed the deep tissues and sutured them together. At first, Peter seemed hesitant about what to suture. “No, no!” said Jackson, grabbing Peter’s hand. “Not there. Deeper.” He reached into the wound with a forceps. “See? Here.” Peter nodded, grabbed the tissue with his forceps and drove the needle through it.

The nurse handed me a pair of scissors.

“Move close,” commanded Jackson. “You gotta be able to see so you can cut the suture.” I was aware that my side was touching his. Through the multiple layers of surgical garments, I could feel Jackson leaning against me. Whenever Jackson nodded, I cut the suture, having no choice but to rub my arm across his chest every time I reached with the scissors. He then responded with “Too long.” That seemed to alternate with “Too short.” Peter never said anything but “Thanks” when I cut his sutures.

When the surgery was over, Jackson snapped off his gloves, trying to hit the waste bucket but missing. The scrub nurse rolled her eyes, but I pretended I hadn’t noticed. Jackson went to dictate an operative note while Peter wrote post-op orders.

After that, we went to lunch; Peter and Jackson chowed down while I stared into my bowl of soup and tried not to think about the smells of the operating room: blood and feces mixed with antiseptic and sweat. I wondered if it would help if I wore more perfume. I tried to imagine the OR smell mixed with Chanel. I wondered which perfume Jackson would like best. Then his beeper went off.

“That’s the Emergency Room,” he said. “We’re on call tonight, so we get admissions all day and all night, too. Prepare to get creamed.”

And so for the rest of the day, I tagged along, seeing patients in the ER, taking their histories, doing exams, writing orders. Alicia went home at 6 p.m. to comply with duty hours, but I stayed. I was determined to get a good grade on this rotation. I wanted to have my choice of the best residency programs when I graduated.

 At one point, Jackson, Peter, Gio, and I were sitting around the nurses’ station on the surgery floor. I was trying to keep my eyes off Gio’s nicely bulging biceps, when Jackson got a page with an admission from the Emergency Room. It was Earl’s turn to do the evaluation; Jackson paged him, but he didn’t answer.

“Maybe he’s in a call room,” said Peter. “You want me to go get him?”

Gio and Jackson laughed. “I’m sure he’s in a call room,” said Gio. “Not much point in getting him, though.”

“I heard he got a new stash yesterday,” said Jackson, winking at Gio. He looked at Peter. “Just so you know, if I’m in a call room, don’t go knocking on my door, either!” said Jackson.

“What’s her name this week?” asked Gio.

“Susan,” said Jackson. “I’ll give you her number when I’m done with her.”

“Gee, thanks,” said Gio.

“Jennifer here could probably help you get your rocks off if you get desperate.”

I could feel myself blushing as Gio glanced at me, expressionless. He pushed back his chair and stood up. “I’ll see the patient in the ER,” he said. “Next time we’re on call, Earl’s going to get ALL the admissions.”

We were up all night. The next morning, everyone else was all irritable and drowsy, but I wasn’t. I had gotten a prescription from my brother for Adderall, a stimulant, so I could stay alert. I had this rotation totally covered.

A few days later, I got to scrub in again with Jackson, along with Earl and Peter, on a routine gallbladder removal surgery. I was right on time getting to the OR.

“Earl,” said Jackson, “this is a good case for you. It’s just a laparoscopy. She isn’t fat or infected, so it should be a piece of cake.”

“How many of these have you done before, Dr. Cumberland?” asked Dr. Pandya, the attending.

“A couple,” said Earl. Jackson handed him a trocar, a pen-shaped instrument with a sharp, triangular point, and talked him through how to stab it through the patient’s abdominal wall, then fill the abdomen with air. The nurses tilted the table to one side so the intestines fell away from the gallbladder, giving the camera a better view.

Earl took his place at one of the eyepieces of the scope while Jackson looked through the other. Jackson stabbed more trocars through the patient’s abdominal wall, handing the camera and suction to Peter and handing one with a rounded end to me. He put his hand around mine and moved it, and the trocar, around until he found the right position. I could see on the projector screen that my instrument was holding the intestines out of the way. Jackson gave my hand a squeeze before he let go. Earl had a probe with a clamp on the end.

Jackson moved his clamp and grabbed the gallbladder, pulling it out of the way, then dissected around it to expose the bile ducts and blood vessels. Dr. Pandya held back, observing on the TV screen. Jackson had hinted that morning that Dr. Pandya wasn’t a very good surgeon and didn’t really know how to do laparoscopic procedures. That’s why he had the residents do them for him.

Earl seemed blurry-eyed and slow, and Jackson kept correcting him. Every so often, Jackson would grab Peter’s hand or mine and crank the probes around until he could see what he wanted.

He looked at me. “Look at the video screen,” he said. Jackson pointed at structures with his probe and asked me what they were.

“Duodenum. Gall bladder. Common Bile duct.” My parents liked to quiz me when I observed their surgeries.

Jackson glanced at me, surprised. “Give the girl a star!” he moved his probe again. “What’s this triangular space?”

Hah. My father had taught me this. “Triangle of Calot,” I said.

“Damn. Give her another star!” said Jackson, grinning. He pointed with his dissecting scissors. “Earl, you see that? There’s the common duct and that’s the cystic duct. There’s the cystic artery. Ok, Earl, just put a clamp on the cystic artery.”

Earl’s probe with the clamp on the end moved and swayed, then with a sudden swoop, clamped down on a structure.

“No,” said Jackson with an edge to his voice. “That’s the right hepatic artery. Let go of it. You want the cystic artery.”

Earl straightened up, looking at Jackson. “That’s what you told me to clamp!”

Peter and I watched on the screen as Earl’s probe jerked, pulling the artery toward the camera.

“That’s the right hepatic artery. Let go!” said Jackson, his voice rising.

Earl jerked his clamp again as he went back to looking through the eyepiece. As the clamp moved, the tissues around it started to tear. The anesthesiologist, the scrub nurse, Peter, Dr. Pandya, and I all watched on the screen as blood spurted all over the gallbladder, then started to puddle, then filled the screen with solid red.

“Fuck! You ripped the fucking artery, Earl!” yelled Jackson.

Earl let go, putting his hands in the air as if he didn’t have anything to do with the situation.

“Peter! Suction! Now! Nurse, get another goddamned suction!” Jackson moved to Earl’s position at the table.

The scrub nurse unwrapped a sterile suction trocar while the anesthesiologist plugged the tubing into a second suction machine. Dr. Pandya stepped up to Jackson’s former spot and stared through the eyepiece but didn’t say or do anything. I just stood there, holding my trocar solidly in place and holding my breath in horror.

Peter and the nurse sucked out the blood while Jackson tried to clamp the artery, but the blood seemed to come from everywhere. “The artery is shredded,” he muttered. Finally, he yelled, “We’re converting to open.” He yanked the laparoscope out of the belly and threw it across the room. He grabbed all the other trocars and instruments, including mine and Peter’s, and threw them against a wall.

“I need a scalpel. Nurse, what’s the matter with you? Are you deaf? I need a scalpel, now!”

“Yes, doctor.” The scrub nurse was opening a surgical tray as fast as she could, but Jackson reached over and grabbed a scalpel off it without waiting for her.

He jabbed the blade into the patient’s abdomen and made a long, curved incision under the ribcage on the patient’s right, then sliced through the underlying layers of tissue. He then threw the scalpel on the floor and grabbed the edges of the wound and pulled them apart with his hands. Blood spilled everywhere.

“Nurse, a lap pad! Jesus, are you asleep over there?” He stuffed the big gauze pad into the wound and used it to push the intestines out of the way.

“You,” he pointed at me, “Put your hands here.” I hurried to put my hands in the wound and pulled as hard as I could. Peter kept suctioning like crazy. The nurse handed Jackson more instruments and piled huge gauze pads all around the operative site. Jackson finally located the bleeding artery and clamped it. In the meantime, Dr. Pandya peered into the patient’s open abdomen. “Looks like the common hepatic, does it not?” he said with his thick accent.

“Here, hold this,” said Jackson as he gave his clamp to Pandya. “No. Right hepatic. Nurse, suture.”

She handed it to him, then quietly said something about getting a vascular surgeon.

“We don’t need a fucking vascular surgeon.” Jackson managed to suture the artery together, then proceeded to dissect out the gallbladder and remove it.

“See, Earl, that’s how you do it the old-fashioned way.”

Earl didn’t answer. I looked up and realized that Earl wasn’t even in the room. I looked at Peter, and he just shrugged.

“That guy just doesn’t know how to have a good time,” said Jackson. “I think we’re in good shape here,” he said, just as another doctor walked into the room.

“Run into a little trouble, Dr. Pandya?” said the man.

“Dr. Nelson, so good of you to join us,” said Pandya.

“I told them I didn’t need a fucking vascular surgeon,” said Jackson to me in a low voice.

I felt like he was confiding in me. I nodded.

Dr. Nelson put on a gown and gloves and pushed Jackson out of the way at the table. “Right hepatic artery, was it?” He poked around in the surgical wound. “Nurse, get her a retractor, will you?” He put the retractor where my hands were and handed it to me to pull on. “You never want to retract with your hands,” he said. “Too much chance to get nicked with a knife or a suture.” He called radiology, who injected dye. We could see on the screen that blood was running through the repaired artery. No leaks.

“You were lucky this time.” Dr. Nelson looked sharply at Jackson. Somehow, he knew that the problem hadn’t been caused by Dr. Pandya.

We finished up like it had been a routine surgery, except nobody dared say anything. Later, at the nurses’ station on the surgical floor, Peter said that we should let Jackson do all the talking to the patient and her family. “As far as they’re concerned, the surgery was uneventful.”

I nodded.

“You might not want your name on the chart, just in case . . .”

I nodded again. I supposed every doctor, even medical students, worries that someday there will be a lawsuit against them. But what would be the issue here? Everything had come out all right in the end. Later, I looked at the operative note that Jackson had put in the patient’s record. It just said that the surgery was converted to an open approach due to some unexpected bleeding. It wasn’t a lie. Describing all the events would just look bad if you got sued.

Alicia came up to us scowling. “I’ve been talking to the nurses. I can’t believe Jackson could get away with that behavior in the OR!” she said. “He let Earl do a procedure he wasn’t ready for, and then he was screaming, throwing things, abusing the nurses. He broke $5,000 worth of equipment. The nurses are talking about reporting him.”

“Report him for what? He saved the patient’s life,” I said.

“He had no regard for the safety of anyone else in the room.”

Jackson came out of the utility room with a cup of coffee in his hand. Alicia clamped her jaw and looked down at her hands. He looked at Alicia for a minute. “You think I should have been nice, and polite, and ‘Nurse, take your sweet time, when you feel like it, could you pretty please get me some suction?’ while the patient bleeds to death? No! There will not be any bad outcomes on my watch. And anyway, who are you to judge me? If you don’t like something I do, you can just go fuck yourself.”

The next morning, Dr. Ansari, the attending who was supposed to be supervising our work, approached us on the surgical floor. He told Alicia and me that our rounds with him would need to wait till the next day. He left with Jackson and Earl. Alicia couldn’t stop smiling. “Finally, the administration is taking safety and professionalism issues seriously,” she said.

Whatever.

By afternoon, Jackson was back with the team, but Earl was not. The rumor was that Jackson was too good a surgeon for the department to lose, but that Earl got sent to rehab. Regardless, we pretty much resumed where we left off. I still took call, still took my Adderall, and still reported only 80 hours a week on my call log even though I worked well over 100. Alicia still slacked off, going home every night. She told me there was a petition asking for Jackson to be reprimanded for endangering and abusing staff, but I refused to sign it, and I made sure Jackson knew that.

The rest of the rotation went fine. Jackson gave me increasing amounts of work, like extra patients and presentations on rounds, and I made sure I got everything done. I volunteered to scrub in on extra surgeries. Jackson grew bolder in the ways he touched me during surgeries, and I just flirted back. My mother had warned me about sexual politics and said that the fun was in the pursuit. You just had to make sure you never were caught.

The closest thing to a possible issue was the day I took an extra Adderall to stay awake in the afternoon, after being up all night, and broke out in a sweat and started shaking so bad my fingers couldn’t hit the right keys on the computer. Jackson laughed at me, said I must be going through the DTs. I laughed, too. Inside, I was mortified that he had noticed. I had worked hard to show no weakness. You can’t be a surgeon if you show a hint of weakness. Thankfully, Jackson sent Alicia and me home early that day. It was our last week. We had the next two days off anyway before our final exam. I was so hyped up, I stayed up all night studying.

You can bet I got honors on that rotation. Jackson gave Alicia an F. The only way she passed was because of her perfect grade on the exam.

This is the way medical school should work. You work as hard as you can, help out your resident, watch his back, and you get a good grade and a good recommendation. Someday, Alicia will be out in Podunk in a do-gooder job, seeing fat, smelly Medicaid patients for peanuts while I’ll get into the top ophthalmology residency in the country. I’ll make a million dollars a year working eight to three with Wednesdays off. I’ll work in an upscale suburb with upscale patients in a state-of-the-art office next to a state-of-the-art surgical center. I’ll wear clothes and heels by top designers, and drive a Mercedes sports car.

No bad outcomes for me.