medical student who could have survived clinical rotations, with their barrage of questions, without a basic wrist computer.
Susan had seen the mechanization of supplies on her interview visit, but the woman at the podium explained them in more detail. When a patient entered the hospital, the system generated a series of cards, one for each staff member involved in the patient’s care. She cautioned the residents to keep these cards safely in the pocket of their white coat or shirt. Anytime they needed supplies, they swiped the appropriate card through the slot of the machine, and it vended the required item, charging it to the proper bill.
The residents’ shared call rooms, the correction of mistakes, the change of command, and all eleven forms of public transportation to the hospital were discussed. Manhattan Hasbro had three paging systems, in addition to direct calls to personal Vox. Nearly every bed also served as a monitor. All charting was electronic and could be accessed through the many stations and, with certain privacy installations, through portable palm-pross terminals. She ran through the various colors of codes and how to handle every one. The security systems seemed overbearing and Orwellian in their duplication and complexity, especially on the Obstetrics Unit.
Just when Susan wondered if her brain could absorb any more information, the woman finished.
A moment later, another man took the stage. He sported a face full of honest wrinkles and a head of thin white hair. He wore a pair of glasses balanced on a leathery nose. Either his age had caught up to his eye surgery or he had chosen not to risk it. Despite appearing ancient, he walked with a solid and deliberate tread and did not look debilitated in any way as he stepped to the podium.
“My name is Dr. Kevin Bainbridge, University of Pennsylvania, class of 1985. I’m sure you’re all happy to know I’m your last speaker this morning.”
Scattered murmurs and bits of applause followed.
Bainbridge cleared his throat, then spoke some of the most dreaded words in the English language: “When I was a boy . . .”
Susan dodged Kendall’s gaze. If he so much as smiled, she would burst into laughter.
“. . . just beginning my residency, things were much different, much harder.”
Susan settled more comfortably into her seat, prepared for another long-winded speech, this one more self- serving.
“Our call schedule was one in two. That means, we were on call every other night, and there was no such thing as an ‘after-call’ day off.”
Kendall leaned toward Calvin and stage-whispered in a gravelly, old-man parody, “And we liked it.”
Calvin choked a laugh into a snort, biting her lips.
Oblivious, Bainbridge continued. “And we worried we were missing half the good cases by going home every other night. Some rotations, we had shifts that went twelve hours on, twelve hours off or twenty-four hours on, twenty-four hours off every day for a month. And we still worried we were missing half the good cases.
“We once calculated our pay at ninety-seven cents an hour, working approximately one hundred to one hundred twenty hours per week. Then came a few high-profile cases of sleepy residents making foolish mistakes, and the system that had worked beautifully for a hundred years became obsolete overnight.” Bainbridge sighed deeply, shaking his head. “There followed all the so-called humane residency laws that treat you all like grade school babies. Limited call, after-call days off, minimum wages.” His head shaking grew more vigorous, as though the very idea of wanting mere sixty-hour weeks and expecting half a living wage made a person soft as bread dough.
“I want you all to realize how lucky you are compared to your teachers. We don’t want to hear any complaining about hours or wages; you have it easy. We expect you to spend a significant amount of your home- time learning, reading, and studying journals. You will come to work up-to-date on diagnoses and treatments, prepared for difficult patients and conundrums, and ready for any emergency. From this moment forth, lives depend on your capability as medical professionals, on your ability to retrieve knowledge, on your every small decision.
“You had best not think of your off-time as downtime. The law demands you take this time for rest and to refresh your brain, to make sure you’re not a danger to your patients, not for fun and games. It exists solely to make sure you come to work ready to perform your duties to the best of your abilities. If you attend a party, it had best be someone’s birthday or retirement. If you find an alcoholic drink in your hand, think about how it will affect your performance, and your sleep, before downing it. Your years of residency are not the time to give birth, get unnecessarily ill, or entertain your hobbies. The next several years belong to Manhattan Hasbro and to your future patients, not to you. Whatever you do, think how it will improve your acumen and the lot of your patients. If it won’t, don’t do it.”
Susan dared a glance at Kendall. He looked straight ahead, but his profile revealed a grin she could not currently handle. She turned her attention to her Vox, where Bainbridge was saying his thank-you and stepping down from the podium.
Susan typed a quick message to her father: “Hey D. Lss thn 1 hr & alrdy broke 1 crdnal rule. Only othr thng lrnt is dn’t wnt wrk w/ ol doc Bainbridge. Hpfully, he’s pathologist or smthng. Luv S.”
Brentwood Locke, the first man who had spoken, retook the podium. “And now, if you will all step out into the hallway, we will divide you by residency program. You will find someone holding a sign with your specialty, and that person will take you to your residency quarters and lockers.”
The residents rose, turning toward the exit. In the conversational din, Kendall resumed his scratchy, mocking voice. “Patient records consisted of piles of parchment, which we scratched out of inkwells using turkey quills. We performed surgery by gaslight, using nothing but nitrous oxide. And, when we did these things, we worried about missing half the good cases.”
Chapter 2
The psychiatry residents’ office consisted of fifty cubbies, two-thirds of which contained medical bric-a-brac; a circular table that held three palm-pross computers; eight chairs; and lockers lining every wall. Taped to several of the lockers, Susan saw comics, silly drawings with cryptic jokes, photos, and small dangling toys. The new residents were called away in groups of five until only Susan, Kendall, and three others remained with the young man who had escorted them all to the office.
Susan studied their guide. He had a perfectly round head topped with a frizzy ball of dark blond hair. She doubted even the greasiest hair care products could tame it. His ears and lips stuck out prominently, making his nose look relatively small, and his cheeks were pudgy and flushed. Though not fat, his figure had a softness to it; his arms and legs were a bit short for his torso, and his hands were enormous. When he spoke, tiny bubbles pooled at the corners of his mouth.
“Hello, R-1s.” He used the shorthand term for first-year residents.
“My name is Clayton Slaubaugh. I’m the R-2 assigned to oversee you on the PIPU, the Pediatric Inpatient Psychiatry Unit.”
“Pediatric
Clayton glanced at the Vox on his left wrist. “Are you Susan? Nevaeh? Or Sable?”
The woman bobbed her head, her face a long oval. “Sable Johnson, R-1. It’s just we learned in medical school —”
Clayton interrupted, anticipating the question. “Pediatric inpatient psychiatry has become rare, but it’s not defunct. We even have ‘lifers,’ kids who’ve been there so long, they might as well call it home.” He looked around the table. “It’s the most heartbreaking unit in all of psychiatry, which makes it the perfect place to start. That was my first rotation as an R-1, too.” He hitched his chair toward the table. It caught on the rug, teetered, and fell backward, dumping Clayton to the floor.
Horrified, Susan leapt to her feet to assist. Kendall turned his head, as if to wipe something from his face, but Susan suspected he politely hid a smile. The other three R-1s simply stared in surprise.
Clayton scrambled awkwardly to his feet, tangling himself up with the chair’s legs in the process.
Worried about getting caught in his thrashing, Susan stepped back.
