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  He frowned, his piercing blue eyes raking over her. “I said, we’re adding a new resident.”

  “In January?” The residency year ran from July to July, and it was very unusual for anyone to start off-cycle. In fact, she couldn’t remember ever having seen that happen.

  “We’ve had an empty third-year slot since Elliott decided he couldn’t cut it. Now we have a body to fill it. Are you complaining?”

  “No, sir, but why is he switching programs in the middle of the year?”

  Ambrose Rifkin smiled wryly. “She.”

  Pearce flushed, knowing that he would enjoy her inadvertent confirmation that surgical residents were usually men. She knew it was his opinion, and that of most of his contemporaries, that they should be men. She was one of the few exceptions in the program, and despite the fact that more female surgeons were trained every year, the specialty remained the last bastion of male privilege within medicine. She said nothing, wishing to avoid another trap.

  “She’s technically a fourth-year, but she missed six months because of some…personal issues. Spent a few months working in an emergency room, apparently.” His tone was both dismissive and disdainful. “But she has good credentials, and I know the chairman of her program. He says she has good hands.”

  Coming from a surgeon, that was the highest compliment another surgeon could receive. It was better to be the most technically proficient than to be the smartest. Brains didn’t help much when you were faced with a bleeding vessel and twenty seconds to stop it before the patient bled to death. The only thing that mattered then was the steel in your spine and the skill in your hands.

  “When is she starting?”

  “She should be here at seven.”

  “Today?”

  “Problem, Dr. Rifkin?”

  “No sir,” Pearce said quickly, reshuffling the day’s priorities in her mind. Every night before she left the hospital, she double-checked the surgery schedule to make sure that nothing had been changed without her knowledge. Nothing made a staff surgeon angrier than showing up for a case and discovering there was no resident available to assist him. Unfortunately, sometimes the secretaries canceled or, worse, added cases without informing the resident in charge, and it was the resident who paid for such miscommunication. She’d already assigned today’s cases to her team, and she had no one who could orient the newcomer. “Uh, could Connie take care of her this morning, until I’m done with the aneurysm?”

  Connie Lang was the department chair’s admin, and the go-to person for anything that the residents needed.

  “Call Dzubrow and tell him to assist on the aneurysm. Whatever he’s doing in the lab can wait.”

  Pearce bit back a protest. An abdominal aortic aneurysm resection was a major case, and as the senior resident on the service, it was hers. She needed every major case she could get if she wanted the chief surgical resident’s position the following year. Henry Dzubrow was her only real competition for the position among the other fourth-year residents, and he was supposed to be spending the next six months working in the shock-trauma lab. It seemed to her, though, that he was showing up in the operating room at every opportunity.

  She stood, because she knew if she stayed much longer, she was going to complain about Dzubrow’s preferential treatment. And that would surely doom her. A surgery resident did not complain about anything. Period. She could still remember her first day and her father standing in front of the auditorium where the twenty-five new first-year residents sat nervously awaiting his instruction. His expression had been unreadable as his cold blue eyes had swept the room, passing over her face as if she were just one of the indistinguishable bodies. She could remember his words and knew that he’d meant them.

  If you’re not happy here, all you need to do is come to me and say so. There are fifty people waiting for every one of your positions, and I can guarantee they will be happy to take your place. Never forget that being here is a privilege, not a right. He’d looked over the room one more time, his gaze settling on Pearce just a moment longer, it seemed, than on the others. Privileges can be lost.

  “What’s her name?” Pearce asked.

  The chairman looked down at a folder on his desk. “Thompson.”

  “Okay.”

  He said nothing, and Pearce left, closing the door behind her without being asked. She took a deep breath and let it out, forcing down her anger and the frustration that always accompanied any kind of interaction with her father. The only time they ever seemed to be comfortable together was in the operating room. She probably should be used to it by now, but she wasn’t.

  “Fuck.”

  “Having a rough day already, Pearce?”

  Pearce jumped in surprise and spun around. Connie Lang stood behind her balancing two cups of coffee in cardboard containers and a Dunkin’ Donuts bag.

  “The usual,” Pearce said. “You’re starting a little early, aren’t you?”

  Connie nodded toward the closed door. “He’s got a budget meeting at six thirty.” She smiled, a predatory gleam in her eye. “He knows that the desk jockeys can’t think clearly this early in the morning, and he has a much better shot at getting exactly what he wants this way.”

  “Doesn’t he always?”

  Wisely, Connie said nothing. “He told you about the new resident?”

  Pearce nodded.

  “She’s downstairs at the admissions desk. I heard her ask for directions to the surgeons’ lounge.”

  “Jesus. Already?”

  Connie smiled. “She’s eager. Isn’t that what you want?”

  “Oh, sure. Can’t wait.” With a sigh, Pearce started toward the elevators. “I better go find her. What does she look like?”

  “Just a little bit shorter than you. Nice looking. Shoulder-length hair, a little bit blond, a little bit reddish brown. She’s wearing navy scrubs.”

  “I’ll find her,” Pearce said, wondering just what Connie meant by nice looking. She was getting tired of dating the usual suspects—nurses and other residents. She didn’t date anyone for very long and didn’t have much time to look elsewhere for new prospects, so new faces, especially pretty ones, were welcome. Maybe this won’t be so bad after all.

  Chapter Three

  Pearce turned the corner toward the elevators and caught sight of a woman in navy blue scrubs at the far end of the corridor heading toward the surgeons’ lounge.

  “Hey, yo!” She sprinted down the hall. “Are you the new—” She skidded to a halt, her voice trailing off as she looked into the face she had not expected to see again. Wynter’s face had lost the soft fullness of youth and taken on the angular lines of full-blown womanhood. She looked tired, but that was to be expected. She looked leaner than Pearce recalled, too, as if she had taken up running in the intervening years. “Are you…Thompson? We met—”

  “Yes,” Wynter said quickly, not wanting to bring up the specifics of an interaction she still didn’t understand. She had expected to run into Pearce at some point, because she remembered Pearce mentioning where she had matched. She just hadn’t expected it to be so soon, and not this way. “Pearce, right?”

  “That’s right,” Pearce said, trying to fit the pieces together in her mind. The match card had said Wynter Kline. She knew, because it was still stuck in the corner of the mirror over her dresser. Why she’d never thrown it away, she wasn’t certain. Married name, Pearce thought with a jolt. Thompson must be her married name.

  “I, uh…I’m starting today,” Wynter said into the silence.

  “I know.” Pearce tried to hide her shock. It didn’t matter who Wynter was. Didn’t matter that for just a moment four years ago they’d shared…something. She needed to stay on track, needed to regain control of the situation. “I’m your senior resident, and we’ve got two minutes to make it to rounds. Follow me.” Then Pearce turned and pushed through the fire door into the stairwell at the end of the corridor. Wynter hurried to keep up.

  The senior resident? God, we’re go
ing to be working together every day for the next four or five months. She could only imagine what Pearce thought of her. She’d practically let Pearce—a total stranger—kiss her, in the bathroom of all places. And then, to make matters worse, she’d just walked out without a word. Could you have been any more stupid, or more unkind? She’d thought of those moments often over the years. It was a night she’d regretted ever since, for a multitude of reasons. With a deep breath, Wynter put the memories of that brief interlude out of her mind. That was in the past and had nothing to do with her current situation. There were much more important things to deal with now. “We’re on Rifkin’s service, right?” Wynter asked of Pearce’s back. “The chief’s service?”

  “Yeah.” They reached the bottom of the stairwell, and Pearce shouldered open the door, belatedly holding it for Wynter. Reluctantly, she started her orientation spiel. It was the last thing she wanted to do at any time, but especially not right before rounds when it was going to cost her a great case. “Did Connie give you the breakdown of the services?”

  “Not exactly,” Wynter said, pulling even with Pearce, who had picked up her pace again. “This all happened kind of fast, and I only interviewed with Dr. Rifkin a couple of days ago. Connie walked me through getting my ID, parking sticker, payroll information, and my employee health physical yesterday afternoon. Then she just told me I’d start on Rifkin’s service today and that someone would pick me up at seven.”

  “Did you meet with any of the residents?”

  “No.”

  Pearce clenched her jaw. It was perfectly within her father’s purview as the chairman of the department to hire anyone he wanted, but it was very unusual to interview a new resident without soliciting the input of at least one of the senior residents. He had obviously known for a few days that Wynter would be joining the service, but he hadn’t said anything to her. She’d been cut out of the loop, but then, no one ever said the hospital was a democracy.

  “You didn’t know anything about it, did you?” Wynter said quietly. No wonder she’s peeved.

  “Doesn’t make any difference.” Pearce stopped and turned to face her. The hospital was waking, and nurses and other personnel hurried through the halls around them, preparing for the shift change. They stood like an island in the sea of white, ignoring the passersby. “We’ve been down a resident since September—one of the third-year guys decided that he wanted to go into anesthesia. We carry fifty patients on the service and it’s every third night.”

  Wynter blanched. “Every third? That’s rough.”

  Pearce grinned and a feral look came into her dark eyes. “We do things here the way they’ve been doing it for sixty years or so. We don’t cross-cover at night. Every surgical service has its own residents in house. I guess Connie didn’t tell you that, huh?”

  “I’m sure it never crossed her mind,” Wynter said steadily. She’d gotten her balance back. She was being tested, and she didn’t intend to show weakness. “And if it had, it wouldn’t have made any difference. I was just surprised.”

  “Yeah, well, like I said. It’s not the norm, but it’s the way we do it here.”

  “No problem.”

  “We make dry rounds every morning in the cafeteria at five thirty. That means you have to see your patients before then. We need a rundown of vital signs, I and Os, updates on lab tests, that kind of thing.”

  Wynter nodded, mentally doing the math. If she needed to be at the hospital by five, she’d need to be up at four. She could handle it. She had to handle it. She didn’t have any choice.

  Pearce made a sharp left, and they descended a set of stairs into a basement cafeteria. The round tables in one half of the room were filled with residents and students, most of them in scrubs and white coats. “Let’s get some coffee.”

  “Amen,” Wynter murmured.

  As they made their way through the cafeteria line, Pearce said, “There are five of us on the service, counting you. Two first-years, a second-year, and me.”

  “You’re acting chief?”

  “Yeah.”

  “The other fourth-years are either in the lab, on the other two general surgical services, or on vascular.” Pearce grabbed a bagel and a plastic container of cream cheese, then filled a twenty-ounce Styrofoam cup almost to the brim with coffee. “We only have one chief resident slot. The other fifth-years get farmed out to the affiliate hospitals in the system.”

  Wynter could tell by the tone of Pearce’s voice that anyone who didn’t finish their final year of training at the main hospital as the chief surgical resident automatically qualified as a loser in Pearce’s mind. She could understand the sentiment. You didn’t give up five years of your life to come in second. She’d already lost one year of training because she had to accept a third-year slot or give up surgery. She felt the anger rise and quickly pushed it aside. What was done was done. All she could do now was go forward. “If there’s five of us now, why are we taking call every third?”

  Pearce handed a ten to the cashier and said, “For both of us.”

  “You don’t have to—”

  “Tradition.” Pearce looked over her shoulder at Wynter. “Chief buys. And as far as the schedule goes, on this service, you and I back up the first-years—so we’re on every third and the second-year fills in the blanks. The chairman doesn’t trust the first-years alone with his patients.”

  Wynter ran the night call schedule in her head. Two first-year residents and a second-year, also technically a junior resident. Then Pearce. It didn’t jive. “So who’s been backing up the other first-year if you’re the only senior resident on the service?”

  “Me. We have to stagger the call now so I can cover one of them every other night.”

  “Every other?” Wynter tried not to sound appalled. Twenty-four hours on, twenty-four off could get old really, really fast. She’d only ever done it for a day or so when another resident had a family emergency or had been too ill to get out of bed. She remembered one of the first rules of surgery she’d been quoted. The only reason for missing work is a funeral. Your own. “How long have you been on every other?”

  Pearce shrugged. It didn’t matter to her if she was officially on call or not. She was always around. She had to be. She knew what she wanted and what it took to get it. “A while.”

  “Okay.” Wynter decided it was not prudent to bring up the newly instituted eighty-hour rule. In theory, house officers—all the residents in any specialty—were prohibited by law from working more than eighty hours in one week, were required to have one day off out of every seven, and were supposed to be allowed to go home after twenty-four hours in a row on call in the hospital. Surgical training programs, however, often interpreted those rules very loosely. The dictum was that surgery could only be learned in the operating room, and if there were cases to be done, the residents needed to be there, no matter what time of the day or night. Residents who questioned their hours often found themselves being assigned to the least interesting cases, or worse, being cut from the program. Pyramid programs like the one at University took more residents during the initial years of training than they could finish, knowing that some would quit or be cut before their fifth and final year. Wynter couldn’t afford to lose her position. If she needed to work a hundred hours a week, she would. She’d just have to make some adjustments in her personal life.

  “There’s the team.” Pearce nodded toward a table where three young men waited. “I bring reinforcements, guys,” she said as she sat. She did not apologize for being late.

  Wynter took the seat between Pearce and a rangy Asian who looked too young to be a doctor. Must be one of the first-years. She nodded to each man in turn, fixing a name with a face, as Pearce introduced them in rapid-fire sequence. Liu, Kenny, and Bruce. They acknowledged her with a range of grunts and clipped hellos. It wasn’t hard to tell which one had been on call the night before, because he was unshaven and he smelled like he could use a shower. It didn’t bother her, because she’d gotten used t
o the familiarity bred by shared stress and the camaraderie that made it tolerable. She was exquisitely aware of Pearce just to her left, radiating energy that warmed her skin. She could still remember how hot Pearce’s hands had been. All these years later, the memory burned as brightly as the touch.

  “Bring us up to speed, Kenny, and then you can get out of here,” Pearce said.

  Kenny, despite his weary appearance, shook his head. “I want to stay for that lap chole that Miller is doing. I’m up for the next one, right?”

  “There’s one on the schedule tomorrow,” Pearce replied. “You can have that one. You’re supposed to be off at eight. The rest of the day’s light. Take advantage of it.”

  He didn’t look happy, but he nodded. He pulled a folded piece of paper from his shirt pocket, unfolded it, and began his morning litany. “1213, Constantine, fem-pop bypass, postop day four. Tmax, 101. Temp 99.9. I pulled his drain and wrote for him to be out of bed to a chair TID.”

  “Pulses?” Pearce asked, making a note on the clean sheet of paper where she had written the information just relayed to her.

  “Plus four in the posterior tib.”

  Pearce raised her head. “What about the dorsalis pedis?”

  “I couldn’t feel it.”

  “It wasn’t there or you couldn’t feel it?”

  Pearce’s expression made him squirm. “I…don’t know the answer to that.”

  “Go back and find out. Next.”

  Wynter leaned close to Pearce. “Got another piece of paper?”

  Wordlessly, Pearce slid a second sheet out from beneath her fresh page and passed it to Wynter, who began to make her own list.

  It took another twenty minutes to go through the fifty patients on the service, the other two residents chiming in with the information on the patients assigned to them. They finished at six fifteen.

  “Liu, you’ve got the mastectomy at eight with Frankel. Bruce, you’re with Weinstein for the amp, and Kenny, you’re out of here. Thompson and I will take the floors.”