“I’m the P.A.!”

“You’re not a physician’s assistant.”

“Didn’t say I was, I’m the Pathology Assistant. The most important person in the department.”

This was Franklin Washington’s kingdom. The surgical pathology gross room was built upon decaying masses of tissue and discarded medical devices. He was a pathology assistant, a PA, a title he inflicted upon everyone within earshot. Hospital employees mistakenly interpreted PA as shorthand for a physician’s assistant, a far more common term. Franklin lost no time correcting their ignorance.

Franklin was 47 years old but his muscular build, accentuated by surgical scrubs a size too small for him, halved his age in the eyes of his admiring female associates. His café-au-lait complexion, a combination of a Greek mother and Puerto Rican father, was deepened by innumerable hours sunning himself on the front lawn of the hospital, much to the ire of hospital administrators.

Franklin introduced all the new pathology residents to his domain. “Any tissue removed from a patient must come through my surgical pathology gross room and to the pathologist’s attention.”

Franklin assisted the residents and attendings with the gross examination and dissection of surgical specimens, the frozen sections, cytology, and autopsies. New residents quickly tired of his pedantic chatter, as he reminded them of his former position at a prestigious hospital in Boston. It was the gold standard for the training of pathology assistants, he boasted to disinterested ears. “At Boston, I had my own office with a phone. They treated me with respect.”

“Then go back there!” Dan once shouted back during an orientation session.

“Who would make sure you don’t screw up, Doc?”

It was the end of James’ second month in surgical pathology. At 7:30 AM, the operating rooms began the day’s cases.

“Dr. Deetan, I highlighted all the cases on the OR schedule that may require an intra-operative consultation or frozen section,” Franklin announced.

“Thanks, Franklin.”

A thyroid lobectomy arrived at 9 AM. Franklin hummed “I Love Rock and Roll” as he inked the specimen, while James bread-loafed the tissue, finding a gritty nodule.

“Don’t eat it all at once, Doc!”

James ignored him, focused on the scrape prep. By the time Carlos and Dan joined at the multi-head scope, the diagnosis was already taking shape.

“Follicular neoplasm…capsule looks intact,” Dan said. “But getting a papillary feel. Got a scrape prep?”

James handed him the slide.

“Good job. Ah, there it is — little Orphan Annie eyes.”

James feigned understanding until Carlos explained the cartoon reference. He forced a smile. Another idiom to file away. Another gap to close.

“Tell the surgeon it’s papillary carcinoma,” Dan said. “They’ll do the total thyroidectomy.”

James made the call. The operation proceeded.

Afterward, Carlos lingered. “Good frozen section. More importantly, good scrape prep. You saved that case. Don’t forget it.”

Franklin smirked. “Yeah, Doc — but remember: when you screw up too often, it’s sayonara.”

James shot back, “So why are you still here?”

“Because Haas likes my eyes!” Franklin fluttered his lashes, flexing his biceps. Carlos rolled his eyes. “Ignore him. He’s a pain, but he’s good. More than you realize.”

Then Carlos leaned closer, lowering his voice. “Speaking of frozen sections…you ever hear about Lucas Harris?”

James shook his head.

Carlos told the story in hushed tones: the senior resident who missed a metastasis on a lymph node frozen, urged a junior to destroy the slide, and was caught by Franklin and Haas. Fired that very day.

James felt the weight in his gut. He had never heard of such treachery.

Carlos’ voice dropped further. “Haas told the department: ‘In all my years of practice, I’ve never seen anything so despicable. The patient always comes first. If you screw up, you own it.’”

James sat in silence. The moral was clear. Haas was merciless, yes — but she also drew lines that could never be crossed.

Back in his office, James stared at his hands. They were surgeon’s hands, steady and sure, but could they shoulder the weight of judgment? Carter’s words came back to him: There is always a patient at the other end of the slide.

And then another voice — Deanna’s — replayed in memory from conference: You’re smarter than you think, James.

It was that encouragement, not Haas’ tirades, that kept him steady.

Wilma had also brushed against his hand in the histology lab earlier that week, whispering with her playful Cajun lilt, “Only for a gentleman.” Her teasing was flattering, but it wasn’t an anchor — it was a temptation he couldn’t afford to misread.

Two women lingered in his mind that night: Deanna, who grounded him, and Wilma, who unsettled him.

But Lucas Harris’ ghost walked beside them. In this world, one mistake — or one lie — could end it all.

Next Chapter: Chapter 11-A Patient Is At The Other End