“The noon time Morbidity and Mortality Conference is now beginning in the fourth-floor conference room.”

The hospital speaker blared as James scurried up the fire exit stairs. Hospital elevators were always too slow, especially when he was already late. He carried a slide carousel and a small folder summarizing the biopsy results of one of the cases that was being presented. Haas would oversee his presentation but it was his show, his time to shine or flop. She would be scrutinizing his every word, ready to interrupt the discourse if he missed an important point. His stomach muscles tightened as he envisioned the audience of attendings, fellows, residents, and medical students all listening to his explanation. Why did the patient die, Dr. Deetan? What do you mean you don’t know? Aren’t you the Doctor’s Doctor? It was only the third month of training but James needed to own the title.

“You’re late.”

“I’m sorry, Dr. Haas. It was a frozen section, we ran over.” James placed his slide carousel on the projector and took the seat next to Haas, in the front of the room. This was his first encounter with her since the frozen section with Dr. Elliot.

Haas frowned. “Next time, get someone else to cover. The chief resident should have been there. Are you ready?”

“Yes ma’am.”

“Speak slowly and clearly…” Haas pursed her lips. “Sometimes people have difficulty understanding you when you speak quickly.”

“Let’s get started. The first case is being presented by the Department of Surgery. Dr. Morris?”

“Can we review the pathology?”

The moderator, Dr. Silverstein, chief of medicine, motioned in the direction of James and Haas. James attempted a confident stride and kept his hands tucked in his lab coat pockets, hoping no one could see the shaking. Heads in the audience bobbed and whispers of “He’s just an intern,” and “He looks so young,” followed each step. Just don’t trip, James kept repeating to himself.

As he stood at the podium and surveyed the audience, the room seemed so much larger, a sea of white coats and green surgical scrubs. The doors were also packed with late arrivals, unable to find a seat. James braced his hands on the sides of the lectern and fingered the control for the slide carousel. The first slide appeared on the large screen pulled down behind him to his right. An image of a neatly dissected pancreas appeared, recognizable only to about three knowledgeable physicians who were not pathologists or surgeons.

“We received the Whipple resection containing the head of the pancreas, a portion of the duodenum, stomach and accompanying omental tissue. Dissection of the main pancreatic duct revealed a tumor measuring 2.5 cm in diameter that extended into the surrounding pancreatic tissue.” James flashed his laser pointer on the tumor. “Dissection of the peripancreatic lymph nodes revealed grossly metastatic disease in 3 of the 17 nodes.” The slide advanced. “On microscopic sections, a poorly differentiated adenocarcinoma was identified with extensive areas of perineural invasion.” The laser danced around the screen as James pointed out the sinister course of the tumor. “Final diagnosis is adenocarcinoma of the pancreas, poorly differentiated, metastatic to 3 of 17 lymph nodes.”

The lights flipped on and James waited for the accolades, like his first M&M in medical school. Hurray for the Doctor’s Doctor! Bravo!

“Thanks, Pathology. Dr. Harvey, you saw this patient in consultation for radiation oncology. What was your impression?”

James stood motionless at the podium, uncertain whether to remain. A glance over at Haas as she pointed to her empty seat next to her answered his confusion. Disinterested looks followed his descent. Why no questions? Was it good or confusing? James looked to Haas for feedback.

“Next time, hold the laser pointer with both hands. You were so nervous it looked like a flea jumping from one dog to another.”

“Yes, ma’am.”

The conference was over, and James slunk back to surgical pathology where Wilma was cleaning up for the day.

“Conference didn’t go well? That was a lot of slides I pulled for you.”

“Thanks, Wilma. You are always so helpful.”

“Let me guess, Dr. Haas embarrassed you at the conference?” James said nothing.

“Listen, Dr. Deetan. It seems that every year there is always a resident she picks on. I’m afraid you may be the one. It’s the same with the histotechs, except she’s never stopped picking on me, she just kept right on going.”

“You? Why would she do that? You’re great at your job.”

“Ah, you’re a sweetheart, Dr. Deetan. The thing is, it is not about competence, it’s about giving her what she wants, much harder to predict. Kind of like a marriage.”

“I wouldn’t know about that!”

“All the life lessons you need can be found in this department.” Wilma pointed at the now empty histology laboratory. “Keep your eyes and ears open and watch your back.”

“Will do.”

“And if you don’t, I will.” Wilma stared into his eyes. Her olive eyes were a striking contrast to her auburn hair.

For a moment, James felt a charge—Wilma’s gaze was different than Deanna’s gentle encouragement. Deanna anchored him, giving him hope for a future. Wilma tested him, pulling him toward temptation and risk. He wondered which version of himself each woman saw: the fumbling intern or the doctor he wanted to become.

“We all have to look out for each other,” James blurted. The moment was gone.

“Of course, Dr. Deetan. Let me put those slides away for you.” Her hand brushed against his, as she turned and left.

James lingered in the empty room. Wilma’s words and Deanna’s laughter at Dogtown both echoed in his mind. Two women, two mirrors, each reflecting a different possible path.

Next Chapter: Chapter 14-Bad Needle Day