I lost weight. I had the permanent dark circles of someone who does not sleep enough and has stopped pretending otherwise. I was academically ranked third in my cohort but socially invisible because I could not afford to go anywhere or do anything that cost money or required staying awake past seven in the evening. My classmates thought I was aloof. I was exhausted.
The night things changed, I had just transported a severe trauma patient to the regional teaching hospital at four in the morning and needed ten minutes of quiet before driving back across town. I found an empty break room on a surgical floor, sat down at the table, opened my pharmacology textbook to the page I needed to review before an exam in four hours, and fell asleep with my head on the book. I do not know how long I was out. I woke because someone was standing close enough that I registered their presence before I registered anything else.
Dr. Caroline Pierce was the head of pediatric surgery at that hospital, which is the short version. The longer version is that she had written three of the textbooks we were using in our program, had published research that established new standards in neonatal cardiac care, and had a professional reputation for being the most demanding attending in the department by a margin that her residents described as significant when they felt safe enough to say so. She was in her mid-fifties, precise in everything, and was looking at me with an expression that I could not read but which was not, I realized with a bolt of adrenaline, contempt.
She asked me to explain the mechanism of action for a beta-1 adrenergic receptor antagonist in a pediatric tachycardia context. It was the kind of question you ask when you want to know what someone is made of. My brain, which had been running on insufficient sleep and vending machine caffeine for two years, gave me exactly what I needed in that moment, which was the full answer, every step of the pathway, delivered in two uninterrupted minutes while I stood in a break room at four in the morning in an EMT uniform that smelled of the night’s work.
When I finished she was quiet for a moment. Then she asked why a second-year medical student was working overnight ambulance shifts. I told her the truth without editorializing. No co-signer for federal loans, high-interest private loans for tuition, EMT income for everything else. She listened the way people listen when they are deciding something. Then she told me to come to her office that afternoon at three o’clock.
