The hospital department chiefs hold monthly meetings in a conference room. The room has a high ceiling and tall windows. The walls are made of mahogany panels. There are large portraits of previous medical school deans on the wall. All of them are men in dark suits and black bow-ties, each holding either a pen or a book in their hands, looking straight ahead with an air of importance.

When Dr. Grant, the dean of the hospital, walks into the room, the department chiefs are already sitting there, waiting. Dr. Grant sits at his desk, facing them. He nods at the chiefs in the front rows and gives them a familiar smile. As for the first time, he takes notice of the uniformity among them: the chiefs of Internal Medicine, Surgery, Psychiatry, Anesthesiology, Obstetrics and Gynecology, Pathology, Ophthalmology, Radiology, Neurology, Pediatrics, and Pharmacy—all men. The only exception is the chief of Rehabilitation, who is a petite woman in her early sixties. She is the only physician in that service.

Dr. Grant’s eyes turn to the subspecialty chiefs scattered in the back rows: Primary Care and Family Practice, Cardiology, Gastrointestinal (GI) Medicine, Infectious Disease, Emergency Medicine, Intensive Care, Oncology, Allergy and Immunology, Rheumatology, Endocrinology, Pulmonary, Geriatrics, Dermatology, Dental, and Optometry; and the surgical subdivision chiefs: Cardiothoracic, General Surgery, GI, ENT (Ear-Nose-Throat), Neurosurgery, Orthopedics, and Vascular.

All of them are dressed in different shades of blue or gray suits with matching ties, meticulously groomed and clean shaven. The only difference among them is the degree of gray at their temples or the scarceness of their hair on the top of their heads.

In the late 1990s, Dr. Nancy Dickey becomes the first female president of the American Medical Association, then people begin to ask why there are fewer female surgeons than males.

Dr. Grant’s task today is not only to answer this question but also to take action. If I’m not convinced myself, how can I persuade others? He clears his throat and says, “Good morning.” As an odd group of people, most chiefs don’t even nod or at least not perceivably.  From their gaze, the dean senses their muted “good morning” in return.  Men are creatures of fewer words. He can relate to them. He continues, “Well, I hope everyone is doing well. At least, I haven’t heard any... unpleasant news.” He chooses his word carefully, then says, “As a matter of fact, we have a pressing topic to discuss today.” He pauses and glances around. “You might have guessed it. It’s about the workforce in medicine.” He pauses again and then continues, “As you can see in this room, it’s pretty uniformed. Right? Look around.” He stops and waits.

People turn their heads and scan the room. There is nothing wrong, they think.

Dr. Grant says, “I know. We don’t see the problem. We’re used to what we see. But we need to ask why we don’t have more women in this group?” He glances at the imposing portraits on the wall and senses the graveness of their gaze.

He sees some chiefs tilt their chins up and a couple scratch their heads.

“Do you see what I see? Look, we’ve made a lot of progress since the beginning of the century. In the 1970s, only 7% physicians were women. Today, in the late 1990s, almost 30% are women.” He drums his fingers on the desk. “That’s progress.”

Silence. Several chiefs nod.

“However, the change is not even among specialties. We have more women physicians in Family Practice, Pediatrics, Internal Medicine, or Gynecology, but scarcely in others. The question is why. Do women choose these specialties because they want to or because we have made it more difficult for them to choose other specialties? When I say we, I mean men. Let’s admit it, women physicians aren’t just career women like most men. Most women carry the burden of raising families too, which, of course, is important when they consider their choices.”

Silence.

Two chiefs switch their crossed legs. A couple of others stroke their chin with their fingers. The chief of medicine, Dr. Newton, leans back and looks around. His department has the highest number of female physicians, since Family Practice, Internal Medicine, Endocrinology, Geriatric Medicine and Rheumatology are under his wing.

The dean raises his voice. “We have to do better. I suggest when you hire physicians, you must consider hiring more women. I understand some of you don’t feel comfortable with this idea and may think it would affect the quality of patient care.” He turns his eyes to the chief of internal medicine. “Dr. Newton, your department has had many women physicians for a long time. How has your experience been?”

Dr. Newton says, “In my department women physicians are doing quite well. I haven’t heard any more complaints about them than I have with their male counterparts. As a matter of fact, many patients prefer women doctors.”

“Indeed. That’s what I thought, too. Thank you for sharing that. We have to have an open mind.” Dr. Grant nods.

Dr. Thomas, the chief of Anesthesiology, speaks, “I’m not sure how it works in my service. One of the practical concerns that I have is the complexity of the call schedules. My staff have to be extremely flexible. In case of emergency, patients can’t wait.  There is no time to arrange babysitters beforehand, let alone deal with the complexity of maternity leaves.”

Dr. Grant replies, “I appreciate your concern. Maternity leave is typically a four-week period and is usually requested ahead of time. In most cases, we should plan accordingly. The hospital can hire temporary or part-time staff.”

Dr. Thomas says, “Locum tenens—temporary physicians—work theoretically. In reality, they are almost never available when they’re needed. I’ve tried it before.”

Dr. Gilman, the surgical chief, joins in. “Let’s not do this in cookie-cutter fashion.”

Everyone turns their heads to him.

The chief of surgery is a big shot. The Surgery Department is considered one of the two pillars of the hospital, alongside with Internal Medicine. Even the dean bows to him.

“Equal Employment and Opportunity (EEO) is a matter of principle. I’m all for that. It doesn’t mean that everything has to be 50/50. We know that there are more men than women in the army, and there are more women than men in nursing. The reason is obvious. It is a business necessity, not inequality.” His voice is deep and unhurried; like himself, it carries weight.

A few surgical subdivision chiefs sit up straighter.

Dr. Gilman continues, “Let’s be realistic rather than idealistic. This is medicine, not politics. We have to put patients first. Like Dr. Thomas said, when an emergency operation needs to be done, it has to be done, now and then. No ifs, buts, or maybes. It’s not only about flexibility. Some surgeries take long hours and require strength and endurance. I’m not talking about simple biopsies. That, women can do. Besides, even though maternity leave is four weeks, how about the potential need in the late stage of pregnancy? That is a big unknown. An unpredictable factor. It could be months. Temporary staff usually are not good for continuity of patient care.”

Dr. Grant nods, “I hear you. Dr. Gilman’s concerns are legitimate. As I said before, I’m not asking you to compromise patient care quality. EEO means all things are considered equal, and if the only difference between two candidates is their gender, we can’t reject one based on gender alone. I just want to make this loud and clear. We’ve seen a trend that more women have chosen surgical residencies in recent years. A little over ten percent of surgeons nationwide are women now. Our hospital is behind in this aspect. We need to ask why? What are we afraid of?” He looks at the chiefs.

Silence. Why? They don’t know. It’s the unknown and fear of disturbing calm water.

Dr. Grant continues, “We got to step out of our comfort zone. Like Dr. Newman said, some patients prefer women doctors or surgeons. So, there is a need. I’m pretty sure that women who want to be surgeons are aware of the challenges that they face. If they still choose that career, it shows they are passionate about it.  I think that is very commendable.”

“Perhaps,” Dr. Gilman admits. But, passion doesn’t equal strength, he says to himself.

“Dr. Gilman, I understand your reservation. To be honest, we have no choice now. We have a quota to fill. Each department has one. Let’s be open-minded. The first step is always a hard one. Don’t be afraid. Let me know if you have any problems.”

*

It isn’t the first time that female physicians apply for surgical staff position in Dr. Gilman’s surgical department. In the past, they have always had “more competitive” candidates. Naturally, none of the female candidates has been chosen.

This year, the general surgery section has received a total of six applicants for the faculty position: three men and three women. For a subdivision, the number is right, but thinking about the quota,” Dr. Gilman shakes his head.

*

On the day of the interview, Dr. Gilman’s secretary, Mary, informs him that one of the male candidates has withdrawn. “Dr. Holland said that he’s gotten an offer from a private hospital. They have good pay, benefits, and sign-on bonus.  He knows that the state hospital doesn’t offer the same. He’s a father of three. So naturally.”

Dr. Gilman appreciates Mary’s sympathetic explanation and replies, “Thank you, Mary. I bet private hospitals don’t have a quota. That’s too bad. I’ve read his CV. He has several years of experience in general surgery. He was on the top of my list. I’m not surprised that he’s hired quickly.”

“Well, without Dr. Holland, it might be easier for you to fulfill the quota,” Mary consoles.

“That’s’ true. It must be God’s will.”

Two male physicians are scheduled before the female candidates. That’s Mary’s habit of prioritizing candidates according to their potentials. Dr. Gilman likes her organizational skill. For this, women are far better than men.

Dr. Ben Singleton is the first applicant, in his early thirties. When he enters the office, Dr. Gilman stands up and walks around his desk to shake his hand and then returns to his desk. He gestures to Dr. Singleton to sit in an armchair facing him.

“So, tell me about yourself,” Dr. Gilman begins.

Dr. Singleton tells him that he graduated from the University of Michigan and did residency training in New York. His family is from Chicago, so he would like to return to the city.

“Tell me why you have chosen General Surgery?”

“General Surgery covers a wide range of conditions: liver, gallbladder, pancreas, intestine, colon and so on. That’s what I like. I get bored easily.  To be honest, I can’t work on hips and knees every day, year after year.”

Dr. Gilman like his explanation. They share the same sentiment—the variety—the challenge.  He nods discretely, so as not to appear too ignorant of other specialties.

Then, the chief notices a ring on the candidate’s forth finger. He makes a note on a sheet of paper. When everything else is equal, he prefers a married man. The reason is simple. Married men tend to be less distracted by dating or hormonal surges. Most importantly, having a wife is like having a logistic person at home.

When the interview ends, Dr. Gilman writes 3.5 on a scale of five stars on the sheet. This is a good score. He never gives a five.

The second candidate, Dr. Kamal Ahmed, is a foreign graduate and has practiced surgery for five years before coming to the U.S. Dr. Gilman stands up to greet him. Compared to most surgeons, Dr. Ahmed is unusually talkative.

Dr. Gilman begins the interview. “So, tell me something about yourself.”

The question opens a flood of words. Dr. Ahmed says that he is married and has two children, one five-year-old girl and one three-year-old boy. They moved to the U.S. so that his kids would have a better education. He has done many surgeries in India and would like to learn more advanced medical technology. Then, he starts to name the kind of surgeries he has performed and under what conditions.

Dr. Gilman nods and then cuts his speech gently. “You know in the U.S., surgeons work very hard. There’re emergencies every day. We’re constantly on call.”

“I’m used to that. Back home, I never had a vacation. I enjoy working. Sometimes, I was away from home for days. My wife doesn’t work. She takes care of the kids at home. She’s used to that.”

Dr. Ahmed takes out a leather wallet from his suitcase and flips open to a plastic page. It is a photo of his family. He gets closer to the desk and shows it to Dr. Gilman. “You see, here are my wife and my children. Madhavi and Naresh. Like her name, my daughter is very sweet. I’m lucky. I have good kids. My daughter likes her school and already has made a few friends. My nephew, my sister’s son, who is fifteen, is doing so well that he’s going to compete in the Spelling Bee in May.”

Dr. Gilman nods in appreciation. He can relate to this young proud father. Once upon a time, I was like him. He discretely looks at the wall clock and turns to Dr. Ahmed. “I’m sorry. I wish we had more time to talk. But, my next candidate is waiting. We’ll let you know the result of the interview as soon as possible.” He verifies the contact information. He stands up again to shake his hand before Dr. Ahmed walks out of his office.

Dr. Gilman writes a four star: he underlines “experience” and likes him as a hard-working, family man, as well as his communication skills.

For Dr. Gilman, interviews are like dating. He learns about the candidates through their  CVs and reference letters. Talking to them gives him a personal feeling about the applicants. In ten minutes, he can tell if they click. So far, he likes both of the male candidates. Perhaps, he will go through the motion for the next interviews, since none of the female physicians have had working experience.

Dr. Kate Martin is a tall, large-boned woman. She has curly brown hair and a suntanned face with freckles on her cheeks. She wears a matching navy-blue skirt suit, a white shirt, and black leather shoes with medium heels. Dr. Gilman remembers her hobbies listed in her CV as cycling, triathlons, and swimming. That’s a sign of strength and endurance, Dr. Gilman thinks.

He does not stand up, but simply points to the armchair in the front and says, “Dr. Martin, I’m pleased to meet you. Please have a seat.” Then he begins, “Dr. Martin, tell me why you have chosen surgery, and specifically, general surgery?”

 “I’m an action-oriented person. I don’t have patience to try one medication after another. I like to go straight to the point and to get rid of a disease from its root. I feel that is very rewarding.”

Sounds like an honest answer. “You know that general surgery’s pay is lower than other surgical specialties,” Dr. Gilman says.

“I know. Unfortunately, higher pay specialties like Orthopedics take only men.” She shrugs.

“The main reason that surgery is a male-dominated field is because of its demanding schedule and hours. There are a lot of emergencies and a surgery can take hours.” The thought of the working hour makes him check on her fingers: she has no ring.

“I understand. That doesn’t mean women can’t do it. I’ve been athletic since I was very young. I bet I’m stronger than many men.” She raises her voice a bit. To be polite, she doesn’t say, I don’t like the cookie-cutter attitude.

Dr. Gilman senses a touch of argumentative tone, and he feels being forced to say, “I agree.”

“Actually, I feel the surge of adrenaline when I’m in an emergency situation. I can deal with it.”

“That’s good.” Dr. Gilman nods.

After a few minutes, the interview comes to an end.  Dr. Gilman writes two and half stars. A little unconventional for me, he thinks. He has to adjust his psyche to continue.

Dr. Sarah Steiner is the next woman. She is slim and average height with short brown hairlines at jaw level—without a band. The style makes her forehead look slightly protruded. Her well-fitted dark-gray skirt suit and white shirt give her a professional look.

When she enters, Dr. Gilman points to the chair in the front and says, “Pleased to meet you and have a seat.” After she sits down, he asks why she chooses surgery.

Dr. Steiner replies, “I like to challenge myself. Too many women are doing Internal Medicine, and I want to do something different.”

“Why don’t you choose more lucrative surgical specialties?”

“I’ve seen very few female physicians being accepted in other fields.”

“So, you don’t mind dealing with emergencies?” He glances on her hands and sees no ring.

“No. I’ve always worked hard. I have student loans for both college and medical school. I’ve always had a side job to support myself.”

“Why do you want to come to Chicago? I see your training is in Florida.”

“I can’t be choosy. I have interviews all over the place. Chicago is one of them. I have a few friends here. So, I’m attracted to the city.”

After the interview, Dr. Gilman gives her a three star. He likes her spirit of self-reliance, her flexibility and spontaneity. But who knows if she’ll get married and move away?

 

Dr. Maria Gonzales is the last candidate. When the chief sees her at the door, he gestures to her to sit down in the chair in the front and says, “Pleased to meet you.”

Dr. Gonzales is a tall woman. She has a long face, light brown skin, and long black hair tied in the back. She wears a gray skirt suit and black leather shoes.

 “Dr. Gonzales, what made you choose general surgery?” Dr. Gilman asks, then glances at the clock on the wall.

“My interest in surgery actually started when I was in medical school. Once I was in the OR during my surgical rotation. About five or six of us were at the operating table that day. The assistant surgeon cut an artery by mistake. Suddenly blood shot up, like a red geyser in front of my eyes. By instinct, I pressed my fingers on the spot to stop the bleeding, while others froze. I was very proud of myself. After the surgery, the surgeon told me that I should do surgery. ‘Really?' I thought.”

Dr. Gilman can picture the scene. He nods approvingly. “Hmm, that surgeon recognized your talent. You have good eye-and-hand coordination.”

“Yes. That idea has stuck in my mind until now.”

“What do you do outside of your work.” Dr. Gilman wants to learn more about her, especially about her family...

“I like gardening.”

“Gardening?” A woman likes gardening?

“Oh, yes. We grow all kind of things: fruits and vegetables. The most special is pepper, the very hot kind.” She fans her face with her hand. “You can’t touch these with your bare hands. You must wear gloves to handle them.”

“Interesting,” he says, but who are “we” ?

Dr. Gonzales adds eagerly, “During my years of residency in surgery, I devoted my six months selective rotation in general surgery to maximize my exposure to surgical cases.”

Dr. Gilman opens his eyes wider. “That’s good. You don’t mind long hours?”

“I’m very lucky. My mom lives with us. She loves taking care of our twins.”

Twins? Bingo! That’s an extra point. Not only she’s married, she also has kids. Maybe she’s done with having more kids.

“General surgery isn’t the most lucrative specialty.”

“I don’t care about money. My husband is a pediatrician. I don’t want to surpass him by too much. No competition at home.” She chuckled at her own humor.

Even Dr. Gilman smiles. Her simple manner makes him feel relaxed. He gives Dr. Gonzales a 3.5-star.

At the end of the day, the chief decides to hire Dr. Gonzales as a trial. He keeps Dr. Ahmed’s folder in his drawer, just in case.

*

The hospital staff on the surgical floor are surprised about the news. A woman surgeon? It’s never happened before.

Julie, a middle-aged nurse, is the most skeptical. She predicts, “I’ve been here for thirty years. I don’t think surgery is for women. I bet she’ll quit in no time.”

“She has twins.”

“Her husband is a doctor, too.”

“So, why does she even work?”

“Hey, ladies, having a woman surgeon here is new. Let’s be supportive,” Grace, the nurse manager, tells her staff.

One month after Dr. Gonzalez starts working, she operates on a patient who came to the emergency room at night. The second day, she visits him in his room. “Mr. Smith, how do you feel today?”

The patient answers, “I’m doing okay. Can you hand me a towel? I need to wipe my mouth.”

His wife stands next to him and hands him one.

“Can you give me a blanket? My feet are cold.”

Dr. Gonzales goes to the storage room and brings back a blanket. She puts the blanket on her patient’s feet, pats it, and asks, “You feel better now?”

“Oh, yes. Thank you. May I see my doctor?” he asks.

“I‘m your doctor, Sir,” she replies. “You had a perforated stomach and were unconscious when you came to the ER yesterday. I operated on you.”

The patient opens his mouth. “You did surgery on me?”

His wife holds his hand and says, “Yes, dear. This doctor saved your life.”

“No, it’s your wife who saved your life.” She turns to the wife. “Mrs. Smith, if you didn’t bring him here on time, we might not have saved him.”

Mr. Smith stares at the doctor. His lips tremble. He manages to say “thank you” before choking on his own words.

“You’re very welcome, Sir. It’s my job.”

“I thought you were a nurse. I’m sorry.”

“That’s okay. I’m happy to help you. How do you feel today?”

“I feel so much better today. I thought I was going to die.”

“That’s great. Tomorrow, if you do well, a physical therapist will see you. We’ll get you up and about.”

“Okay, doctor. I’ll do whatever you ask me to do.”

Time flies. At the one-year mark, Dr. Gilman calls Dr. Gonzales to his office: it’s the annual review time. He is satisfied with her performance. More importantly, he is secretly proud of his detective skill: knowing she has twins helps.

He tells her, “Maria, I’m very pleased with your performance. Frankly, you’ve changed my view about women as a workforce in the surgical department.”

“Really? I’m glad I did.”

“Not only I haven’t heard any complaints against you. I have also received compliments from patients and staff. They like your down-to-earth attitude.”

“That’s very kind of them. That’s just me. Aren’t we all together on earth anyway?”

“Of course. They like you, not because of you’ve shared home-made pickled peppers with them.” He laughs at his own joke. It’s rare to see Dr. Gilman’s humorous side.

Maria laughs too. Yes. She has shared her pepper recipes and dishes with some of the nurses.

“Actually, there are more patients asking for female surgeons. With this increased need, I plan to hire another woman surgeon. I would like to ask you to help me interview the candidates. I think you can answer their questions better than I can.”

“I’ll be happy to do that.”

“Remember, I have high standards,” Dr. Gilman adds with a tone of authority.

A few months later, while Dr. Gonzales stands by the nursing station talking to a patient’s wife, Julie hovers around and stares at the doctor’s face.  After the conversation is over, Julie pulls the doctor’s sleeve and asks in a low voice, “Hey, doctor, how are you?” Her eyes squint as if she’s discovered a secret.

“I’m good, Julie. How about you?”

“Oh, at my age, there is nothing new.” She giggles while gazing up and down at the doctor.

“What are you looking at?”

“Your face... are you...?” She stops short.

“Yeah, Julie. Don’t tell anyone, I’m expecting, not even three months. How can you tell?”

“Ah, I’ve seen many. All these young nurses here...” She points her chin toward a few women by the nursing station. “I’ve always been the first one to tell who is pregnant. A couple of times, they didn’t even know themselves. Be careful. It’s the water here. By the way, Dr. Gilman would like to know these things as early as possible. Oh no, he doesn’t like surprises.”

“I know. I just want to be sure. I plan to tell him in two weeks.”

“Congratulations. I promise, I’ll keep it to myself.”

Julie likes Dr. Gonzales. But after confirming the news, she starts to think, what did I say? Women can’t stay long in the surgical field. She has one set of twins already. Now she’s going to have a third child. She will have to quit. Too bad. She’s a good doctor.

Two weeks later, Dr. Gonzales operates on a patient who has colon cancer early in the morning. Then she operates on another patient who needs an emergency gallbladder removal. After two back-to-back surgeries, she feels unusually tired. It’s the pregnancy, she thinks. She didn’t have time to eat or drink in between the operations. Well, I’ll feel better after a bottle of water.

It’s exactly three months to the day according to her calculation. She feels safe now. She decides to tell Dr. Gilman about the news. She grabs a bottle of sprint water from the canteen and walks toward the chief’s office. She feels dizzy and drinks more water. She steadies herself before knocking on the door.

“Come in.”

She enters and walks straight to a chair by the wall and sits, while asking, “May I sit here?”

“Of course.” Dr. Gilman is aware of the morning’s OR schedule. Having two surgeries in a roll can be physically taxing even for a man.

“Am I interrupting?”

“Not at all.”

“Just finished an emergency cholecystectomy—removal of the gallbladder. It took longer than usual. Some people always wait until the last minute to come to the hospital.” She finishes the bottle water. Her hand trembles a bit.

“Are you okay? You want more water?” Without waiting for her reply, Dr. Gilman takes out a bottle of water under his desk and hands it to her.

Dr. Gonzales reaches out and says, “Thank you.”

“What brings you here today?” Dr. Gilman asks.

“I just want to let you know that I’m expecting and the due date is in six months exactly from today.” She smiles and looks at the chief.

Dr. Gilman’s face stiffens for a fraction of a second, then he says awkwardly, “Oh, congratulations. If I remember, you have twins, am I right?”

“Yes, well, you have good memory.” She drinks more water.

“Yeah. I do. Somehow, I... remember these kinds of things.” He is glad the words “keep track” didn’t slip out.

“How old are your twins?”

“Five.”

“That’s a big gap, isn’t it?” He thinks, Don’t they have a quota on how many kids they plan to have?

“Things happen.”

“All right. Thank you for letting me know early enough. I’ll start to arrange coverage.”

“Thanks! But I don’t think I’ll take more than one week of maternity leave. When I had my twins, I took only one week off. I hope the second time will be even easier. My mom will help me and my older ones go to kindergarten.”

“Well, you never know. We’d better be prepared.” The chief touches his chin with his fingers.

“That’s true. But, I’ve never been sick before.”

Dr. Gilman looks at her thoughtfully. Anything can happen between now and the due date. “Just don’t over work. Take care of yourself. Let me know if you need to take time off between now and then.”

Dr. Gonzales thanks him, thinking my boss is a reasonable guy.

After downing the second bottle of water, Dr. Gonzales’s head feels better. When she reaches the surgical ward, she suddenly has the urge to urinate. She walks fast to the washroom. When she pulls down her underwear, she sees a fresh blood spot on it. “Shit!” She knows something is not right. She walks out of the washroom, grabs the first nurse she sees in the hallway, and says, “I must leave now.” Before the nurse realizes what is going on, she rushes to the nearest telephone and calls her formal medical school classmate, who is her obstetrician. She tells her what she saw.

“Go to the ER now. I’m coming.” Her friend hangs up before hearing her reply.

Dr. Gonzales walks to the parking lot and gets into her Toyota sedan, turns on the engine and steps on the gas. The hospital is five minutes away. When she arrives, she parks her car and walks straight into the ER. Once inside, she feels warm liquid run down her legs. “Shit...”

A nurse at the front desk greets her, “Hello, how can I help you?”

Dr. Gonzales says, “I need to be hospitalized.”

How rude! Who is this woman who walks in by herself and tells me she need to be hospitalized? “Ma'am, I need to know what’s wrong with you. Have you been seen by a doctor?”

“I am a doctor!”

A doctor? Where? Why are you yelling? The nurse says sternly, “We don’t have a bed. You can go to another hospital if it’s urgent.”

“If you don’t admit me right now, I’ll be coded (a code blue is a medical emergency, that requires chest compression and resuscitation)! So, either find a bed now or code me,” she orders the nurse.

Then, she runs to the washroom, By instinct, the nurse follows her from behind. The moment she sits on the toilet, the toilet bowl is filled with bright red blood in front of their eyes.

The nurse rushes out of the washroom and brings a stretcher outside the door. Dr. Gonzales lies down on the stretcher. Then she sees another nurse prepare an IV line next to her. She asks, “What’s the size of the needle do you use?”

“22 gauge,” the nurse replies, surprised by the question. “This is what we’ve always used for IV fluid,” she explains calmly.

“Use 16!” Maria orders.

That’s a larger needle catheter. The nurse doesn’t have time to ask why. She runs out and comes back with a 16-gauge. She swiftly inserts the catheter into her vein and sets the IV fluid at a 6-hour rate, faster than the usual one liter per 8-hour rate. Maria grabs the line and changes the rate to “wide open.”

At this moment, her obstetrician arrives. Still breathing heavily, she says, “Maria...you’re crazy. You... have a miscarriage.”

“God dammit. I know it! Just take care of it!” Maria answers.

“We don’t have an anesthesiologist yet,” the nurse whispers in the obstetrician’s ear.

“I don’t care. Let’s go without it,” Maria says.

There is no time to do any blood tests. Without hesitation, the obstetrician wheels Dr. Gonzales into the operation room followed only by one nurse.

The next moment, Dr. Gonzales is placed on the obstetrician table. The nurse brings the blood pressure cuff. Dr. Gonzales takes it and wraps it on her arm. She turns the second bag of IV fluid to wide open. Her blood pressure is read as 60/40 mmHg. She can feel her feet are turning cold.

While washing her hands and putting on gloves and an operation gown, the obstetrician orders the nurse, “Please get ready quick, we’re going to do a curettage.”

By the time the anesthesiologist arrives, the procedure is done. The bleeding is stopped. Dr. Gonzales’s blood pressure climbs back to 80/50 mmHg. Warmth crawls back to Dr. Gonzales’s limbs.

Seeing her blood pressure up, the obstetrician scolds her friend. “Maria, you’d better be more careful from now on. You’ve almost given me a heart attack. Don’t scare me another time. You’d better take a few of weeks off too. This is serious.”

“Thank you so much! You’ve saved my life.” Maria shakes her friend’s hand.

The obstetrician gives her a scornful look.

Ignoring her friend’s advice, Dr. Gonzales is back to work after the weekend. Thank God the scare happened on a Friday and this weekend she was not on call.

Of course, nothing escapes Julie’s eyes. At first, she seems to be relieved to see the doctor on the unit. Then, she stares at her face and asks, “Are you alright, Dr. Gonzales?”

“Yes, thank you.”

“You look pale. And you seem to have lost weight over the weekend. Your cheeks are...not as full as before.”

The doctor replies, “You’re so sharp, Julie. I’m fine. I’m really fine.”

“Hmm...you’re tough, doctor. I can tell. Did you lose your baby? I heard you left earlier on Friday. I’m sorry.”

“That’s okay. Things happen.”

“You have to be more careful. Women are not men. We’re different.”

“I know. Thank you.”

The next day, Julie brings a pot of chicken soup and gives it to Dr. Gonzales. “Don’t forget to take it home today.”

“Oh my God! Julie, this is so kind of you.” Dr. Gonzales blinks a tear back and gives Julie a hug.

“I’ve got to take care of you, or we’ll lose you,” Julie says seriously, shaking her head as if she talks to her grandchildren.

“Thank you, Julie. I won’t leave you. I promise.”

The news of Dr. Gonzales’s miscarriage reaches Dr. Gilman. Grace informed him. He summons Dr. Gonzales to his office.

“Maria, I’m sorry about your loss.”

“Thanks. I’m okay now. Things happen.”

“I know you’re a hardworking person. But you should listen to your body, especially when you’re expecting. This is serious. Work is important. Your health and family are equally important. Please let me know if you need any time off. We have enough staff to cover each other. We’re men. We’re also humans. We have families too. Your colleagues will be happy to cover you.” His words are sincere. He speaks more like a friend, a brother, or a father, not a boss.

“Thank you very much, Dr. Gilman. This means a lot to me. I promise it won’t happen again.”

Two years pass. Dr. Gonzales is doing well. The surgical department has grown.  Dr. Gilman has hired two more physicians, one man and one woman.

Dr. Gonzales gets along with her colleagues and nursing staff. The head nurse likes her very much. She usually explains her treatment plans in great details to both patients and staff and  is never grumpy when a nurse calls her for a question, even if it is in the middle of the night when she is on call. She always visits her patients after the surgery in the evening before she goes home and early in the morning the second day before she goes into the OR. She has been awarded The Best Doctor of the Year twice in the hospital.

*

“Are you expecting...again?” Julie’s face turns red with excitement. “I’m so happy for you.”

Dr. Gonzales smiles and teases. “Nothing escapes you, Julie.”

“Of course.” Julie pats her own gray hair and raises her chin up. “Is it almost three months again?”

“Yes, in one week.”

“This time, you must be careful. Drink water and eat well. Check your blood pressure every morning.”

“Yes, doctor Julie,” Dr. Gonzales jokes.

On Monday, Julie brings another pot of chicken soup and gives it to the doctor.

Dr. Gonzales brings fresh vegetables to Julie from her garden and a bottle of homemade pickled hot peppers.

“Thanks. I love hot stuff. Yours are sweet actually.” Julie swallows. She opens the jar and sniffs.

Maria’s tummy grows bigger.  Like her previous pregnancies, she barely has any reactions and her appetite is good. She hasn’t slowed down in the number of operations and calls.

Dr. Gilman asks her if she needs time off.

“No, I’m good. Thank you,” she tells him.

Julie watches the doctor from a distance. She estimates if her walking speed slows down or if there are signs of side swaying. Sometimes, when she is at the doctor’s side, she drops a pen or a key on purpose so that she can see if the doctor’s feet are swollen. She has a plan. In case something is not right, she will follow the chain of command: to tell Grace first, who in turn will let Dr. Gilman know. It’s teamwork. Dr. G is the only one who can give her a bedrest order.

At the seventh month, Julie’s anxiety grows even worse when she hears that it is going to be twins again. “Gosh, her tummy is going to explode right here, on the surgical ward.”

No, the doctor says she’s not tired. There is no need to slow down. Her feet are not swollen. And her blood pressure is just fine. Hmm...is it because of the hot peppers?

A month later, Julie tells the doctor, “Are you sure you don’t want to take a few days off? I don’t think you should do surgery anymore, at least not as many or not the long ones.”

“I’m okay. I worked until the last day of the twins’ delivery last time,” she assures Julie.

 “Well, every time is different. You’re older now. Remember last time?” The more she thinks, the more worried Julie has become. She secretly takes more blood pressure pills.

Two weeks before the due date, Dr. Gonzales arrives at work and has a complicated surgery scheduled: a Whipple Procedure to remove the duodenum and pancreas. The surgery is a four to five-hour operation if everything runs smoothly; otherwise, it can take up to ten hours. The patient has cancer of the pancreas and two days ago asked Dr. Gonzales specifically, “Doctor, I would feel comfortable if you’ll do the surgery for me. Do you think it’s too much to ask?”

Looking at his yellow, bony face and anxious eyes, Dr. Gonzales reassures him. “Don’t worry, Sir. I’ll do it. Just have a good sleep today. Tomorrow, all will be well.”

Early the next morning, Dr. Gonzales arrives on the surgical floor to greet her patient. Before she goes to the OR, Julie stops her in the hallway. Pointing to her belly, Julie cautions, “Doctor, this procedure is a long one. I think it’s better to ask Dr. Hampton to cover you, just in case. He said he could. The babies may come out at any moment now.”

“Thank you. I feel fine. I’m pretty sure I can do it. Plus, I promised my patient yesterday.”

“The operation takes four or maybe five hours.” Julie doesn’t want to think the unthinkable.

“Don’t worry, Julie. I’ll be fine. Remember I did it once before.”

But that’s six years ago. Julie shakes her head. She likes Maria, but the doctor is too stubborn. What if something happens?

Dr. Gonzales washes her hands and forearms, then changes into scrubs and puts on two layers of surgical gloves. She walks to the operating table.

Julie and a couple of nurses wait outside the OR. They can hear instruments clanking.

Julie holds a piece of paper in her hand with Dr. Hampton’s pager number on it and says, “I bet she’ll be out of there in one hour.”

The two nurses look at her with wide eyes that say we are ready to help.

One hour has passed. The doctor hasn’t come out.

“Just wait,” Julie tells her colleagues.

Another hour has passed. There is still no sign of the doctor.

“You’ll see. Nobody’s bladder can hold this long at this stage of pregnancy,” Julie says with a know-it-all look.

Three hours pass. Still, nothing happens. The piece of paper crumbles in her sweaty hand. It’ll happen at any moment.

The three of them squeeze themselves by the double doors, press their noses on the narrow glass windows and peek in. For a moment, they wish their protruding noses were like those of fish, flat. They see the OR heads bent toward the middle of the operating table. Their arms move smoothly. No one raises their head.

Another hour later, the OR door opens. A patient’s stretcher is wheeled out toward the recovery room.

Dr. Gonzales, holding her belly with one hand, walks out. Pearl-sized sweat runs down her face. She walks fast into the washroom in the corridor and stays inside for a long time, or at least it seems to be ages for the nurses outside.

“Maria, are you okay?” Julie yells impatiently. Her voice quivers a little.

“Yeees.” They can hear a tone of relief. They, too, are relieved.

When the doctor exits, Julie looks at her with an open mouth. She is speechless and can only shake her head. She hands the doctor a bottle of water and says, “Drink this. You’re lucky to have made it.”

That evening, Dr. Gonzales delivers two healthy baby girls. She stays in the hospital that night and is home the next day.

On the third day, Dr. Gonzales arrives at the hospital with one tiny baby wrapped in her chest.

“What are you doing here?” Everyone is surprised.

“Where is the other baby?” Julie is anxious.

“I fed her just before I came. She’s sound asleep now.”

Julie’s shoulders drop.

Dr. Gonzales goes to visit her patient that had the Whipple Procedure. The patient sits in a chair next to his bed.

“Doctor, didn’t you just...” he chokes, looking at the doctor and the tiny baby.

“Sir, I just want to make sure you’re doing well,” she smiles.

“Doctor, besides some small pain, I feel fine. Thank you very much. You shouldn’t come just for me.”

“Trust me, I feel better after seeing you,” Dr. Gonzales says. Then she checks his blood pressure, heart rate, oxygen level, and the amount of urine from last night. Everything is in order. “You look good, Sir. I’m glad to see you out of the bed. I’ll leave you alone. Nurses will check on you every few hours. Please call them if you need anything. They will let me know if something happens.”

“Thank you, doctor. Please go home and take care of yourself and your babies.”

After visiting her patient, Dr. Gonzales goes home knowing her patient is in good hands.

Believe it or not, Dr. Gonzales had a third set of twins two years later. Is it the water? Julia says it must be. “It helps to have a pediatrician at home,” Dr. Gonzales jokes. And she has taken only one week of maternity leave each time.

*

In the hospital administration building conference room, the chiefs convene again. Dr. Grant looks at them: the same men as five years ago, only with grayer or scarcer hair, and a couple of them bald now. The dean loosens up his tie a bit, then speaks, “Good morning.” Seeing everyone looking at him, he continues, “Today, we have a new agenda. As you can see, most of us are no longer young. It’s time to think ahead about continuity of the leadership. I want you to work on the succession plans in your departments and sections. In case one leaves, someone has to run your service, at least temporarily.”

The chiefs knew this was coming. They agree. Yes, but who?

Dr. Gilman leans back. He is relaxed. He knows exactly whom he will endorse to succeed him in case he leaves.