Chapter 3
Sebastian
Four distinctly different doctors are arranged around the glass table, each projecting their own version of competence. I stand at the head of the table, coffee untouched beside my stack of patient files, studying them as they pretend not to study each other.
Dr. Harper Langston sits closest to me, his posture impeccable, his tie precisely knotted at his throat. Every few seconds, he checks his reflection on his phone screen, adjusting nothing but clearly reassuring himself that his sandy-blond hair remains perfectly styled. The fourth-generation physician radiates the particular confidence of someone who's never seriously considered failure as an option.
Beside him, Dr. Naima El-Sayed arranges her files with mathematical precision, the edges perfectly aligned. Her deep emerald hijab frames a face that gives away nothing, her dark eyes coolly assessing everything. She hasn't spoken a word since entering, but her silence feels deliberate rather than shy, a calculated choice to observe before engaging.
Dr. Jonah Kim nervously taps his pen against his notebook, then catches himself and stops, only to begin again thirty seconds later. He drops the pen once, then again as he tries to retrieve it, a flush creeping up his neck as he finally secures it. His credentials are impeccable—his recommendation from Stanford particularly glowing—but his demeanor suggests a man perpetually expecting to be exposed as an impostor.
And then there's Dr. Phillips.
She sits at the far end, her wild red curls partially contained in a fresh braid, though rebellious strands already frame her face. She's changed since our encounter in the ER—now wearing a crisp white coat over simple green scrubs that match her eyes. Unlike the others, she's not pretending to review notes or check her phone. Instead, she's watching me directly, her gaze unwavering and a slight curve to her lips like she's privately amused by something.
Like she knows exactly what I'm thinking.
I clear my throat.
"Welcome to the Diagnostic Medicine fellowship at Sierra Mercy," I begin, my voice level and professional. "You've all been selected from hundreds of applicants based on your exceptional academic records, clinical skills, and potential for growth in diagnostic medicine."
I make brief eye contact with each fellow, lingering a half-second less on Dr. Phillips because something about her direct gaze makes me want to look too long.
"Let me be perfectly clear about what this year entails," I continue. "This is not a collaborative fellowship where everyone wins participation trophies. At the end of twelve months, one of you will be offered a permanent position on my team. The rest will receive recommendations commensurate with your performance and move on to other opportunities."
Dr. Langston's smile tightens marginally. Dr. El-Sayed's expression doesn't change at all, though her posture straightens further. Dr. Kim swallows audibly. Dr. Phillips simply tilts her head slightly, as if I've presented an interesting puzzle rather than a threat to her career aspirations.
"You will be evaluated on diagnostic acumen, clinical skills, research contributions, and your ability to work within the established protocols of this department." I put the slightest emphasis on the last criterion, watching Dr. Phillips' eyebrows rise fractionally in response. "Questions?"
Dr. Langston raises his hand and without waiting to be acknowledged he speaks, "Will we be assigned individual cases or working as a team?"
"Both," I answer. "Some cases will require collaborative effort. Others will test your individual abilities. You'll need to excel at both to succeed here."
Dr. El-Sayed speaks for the first time. "What is the current case load?"
"Six active cases, with three pending referrals," I say, appreciating her direct approach. "We'll begin rounds immediately to familiarize you with our current patients."
Dr. Kim raises his hand tentatively. "Will we have research time built into our schedules?"
"Twenty percent of your time is allocated for research. Use it wisely."
I wait, but Dr. Phillips doesn't ask a question. She simply watches, those bright green eyes taking in everything.
"If there's nothing else," I say, gathering my files. "Let's begin rounds. Bring your tablets, patient files have been uploaded to the secure server."
They follow me out of the conference room and through the hallways of Sierra Mercy like a small academic procession. We visit three patients in succession—a middle-aged man withunexplained seizures, an elderly woman with progressive vision loss, and a teenage boy with recurrent fevers of unknown origin. With each case, I observe their approaches.
Dr. Langston is thorough but impersonal, focusing on test results and measurable data while barely making eye contact with the actual patients. Dr. El-Sayed asks precise, targeted questions that reveal her methodical thinking process. Dr. Kim is gentle with patients but becomes flustered when I press him on his diagnostic reasoning. Dr. Phillips balances technical questions with genuine human connection, somehow making each patient smile despite their circumstances.
By the time we reach Cheryl's room, I've compiled initial assessments of each fellow's strengths and weaknesses. All except Dr. Phillips, who continues to defy easy categorization, shifting between brilliant technical observations and disarmingly genuine human interactions that make my carefully maintained professional distance seem cold by comparison.
Cheryl is sitting up when we enter, looking more alert than she did earlier. She's even added a colorful scarf around her neck.
"Ms. DuBois," I begin. "These are our new diagnostic fellows who will be consulting on your case."
"The fresh minds you promised," she says, her eyes moving quickly from one fellow to the next, assessing them with the same shrewd perception she applies to everything. "How delightful."
I introduce the fellows one by one, then summarize her case. "Ms. DuBois, age seventy-two, admitted two weeks ago with progressive weakness, intermittent fevers, persistent nausea, and advancing peripheral neuropathy. Previous diagnoses of atypical Guillain-Barré and paraneoplastic syndrome have been ruled out. CT shows no obvious masses. Blood work shows elevated inflammatory markers but no clear pattern of autoimmune disease."
