The New Deputy Chair Has Arrived

Cardiology and Cardiothoracic Surgery — the two departments that bore the worst of the overnight emergency load.

Starting at one in the morning, Nora's duty phone didn't stop.

"Dr. Ward, bed three — patient went into convulsions in his sleep. ECG shows ventricular fibrillation."

"Dr. Ward, ER just admitted an acute heart failure case. Needs surgical assessment."

"Dr. Ward, bed nine — hyperkalemia. And we're out of monitored beds."

...

By eight o'clock, when the day team came in for handoff, Nora's phone finally fell silent.

Summer, one of the nurses, brought breakfast to the doctors' office. "Another all-nighter?"

Nora kneaded her stiff neck. "Got four and a half hours of sleep. Pretty lucky, actually."

Stay up all night and survive — a doctor's core competency. Every chief resident went through it.

Summer sighed. "My heart breaks for you."

Nora smiled and nodded at Summer's phone, buzzing nonstop. "Aren't you going to check that?"

"Morning gossip."

Not quite on the clock yet, Summer settled next to Nora to chat.

"Big news today! Cardiothoracic Surgery is getting a new deputy chair. They're bringing someone in from outside!"

"Bringing in a deputy chair?"

Zoe perked up immediately at the word "gossip."

"Didn't know the dean had a son!" she cracked.

There was a reason for the joke. In every hospital, powerhouse departments didn't do external hires. No administrator wanted the risk of bringing in an outsider to run a department. Hard to earn respect. Easy to breed resentment.

External hiring only happened when a department had internal problems — or a generational gap in talent. Northridge had neither. Number one cardiac center in the country. People fought tooth and nail just for a residency spot.

And now an outside deputy chair?

Zoe craned her neck toward Summer's phone. "Anyone in the group chat know this guy's background? Who's got that kind of pull?"

The chat was nothing but gushing over how young and handsome the new deputy chair was.

Summer shook her head and generously let Zoe scroll. "The cardiac surgery girls say he doesn't actually seem like a nepotism hire."

"Tch."

Zoe scoffed. "Yeah, right."

"Name me a better cardiac center in this country. Or are we supposed to believe one of those big-shot chiefs from the coast decided to slum it here as a deputy?"

"Right, Nora?"

Today was nineteen elective surgeries. Nora had been listening with half an ear, not really processing.

"Hm? Sorry, I wasn't paying attention. Say again?"

Zoe didn't bother. Chief residents were dead on their feet. Nora wasn't a gossip person anyway. She shook her head and went back to Summer.

Summer said, "I heard he's not from a domestic hospital."

"The HR people say the new deputy chair just got back from America."

"America?" Zoe laughed. "From America — does he even have a US residency completion certificate?"

"Why doesn't he just put 'Mayo Clinic' on his résumé while he's at it?"

Mayo Clinic. Best hospital in the world.

Unless someone was coming from Mayo, returning to China and walking straight into a deputy chair at Northridge?

Yeah. Definitely connected.

Zoe was so confident because she'd bet everything against this new chair being some hotshot from a top-tier international hospital. Not because she looked down on her own workplace, but because that was the reality.

In this country, being a doctor meant being livestock. Abroad, doctors were the elite. Life on easy mode. Just the absence of doctor-patient disputes alone was incomparable. Never mind the cardiothoracic surgeons pulling seven figures — in dollars.

Zoe wasn't buying it.

Summer heard her out and found it hard to argue.

They gossiped a bit longer before heading back to their stations.

Surgeons coming off night shift didn't get to go home. The day's work still had to be done.

Yesterday's rounds hadn't happened. Dr. Vaughn showed up at the conference room ten minutes early to go through each patient.

Zoe, sleep-deprived and foggy, botched several answers.

No surprise — she got torn into.

She was used to it.

Back at her desk, she complained to Nora. "I must have been a war criminal in a past life. That's the only explanation for ending up in clinical medicine."

Nora laughed and handed her one of the coffees she'd just picked up.

"Iced Americano. Wake up. Nineteen elective surgeries today."

Elective meant the cases weren't urgent — they could be scheduled after further evaluation. But on top of those, every day brought a flood of emergency surgeries. The final tally was anyone's guess.

Dr. Vaughn would be the primary surgeon. Nora and Zoe on first and second assist. The OR always scheduled the hardest cases first.

The coffee was a necessity.

Zoe chugged half the cup in one go and wiped her mouth.

"Dr. Ward. Expect my triumphant return by noon!"

Nora nodded. "See you at the summit."

—

Nora's morning was two procedures. One premature ventricular contraction — catheter ablation. The other, an elderly patient who'd had recurring dizziness and chest tightness for years. The family had ignored it, and now atrial fibrillation had triggered a stroke. Ablation plus left atrial appendage closure.

The surgery stretched until two in the afternoon.

Lead apron off. Nora hadn't even had lunch when the consult phone rang.

It was one of Zoe's patients. Myocardial infarction. Originally scheduled as the afternoon's first case — stent placement. But once the angiogram went in, Dr. Vaughn found the patient's vessels were congenitally underdeveloped, and the blockage was in a tricky spot.

This needed a cardiothoracic consult — to evaluate whether open-heart surgery was safer.

Nora rolled her shoulders and made it back to the office. Zoe had gotten out of the OR first and was already waiting.

"The cardiothoracic consult is in fifteen. Coming?" Nora asked.

"I'm coming."

Zoe nodded and pulled out the burger she'd saved for Nora. Stone cold by now. They headed for the microwave.

At the door, they nearly collided with Summer, who was looking for Nora to sign something.

Summer had caught the tail end of the conversation. "Dr. Ward, you're heading to Cardiac Surgery now?"

She hesitated.

Nora looked at her. "What's wrong?"

Summer swallowed and pulled out her phone. "Maybe wait a bit. The group chat says Leo just got chewed out by the new deputy chair. I'm guessing the vibe in Cardiac Surgery is... tense right now."

Leo Hart. Cardiothoracic Surgery's chief resident. Unlike Nora, Leo was on his second round as chief resident. Even the cardiac surgery chair rarely scolded him.

Zoe stared at Summer, stunned. "...This new deputy chair has that kind of temper?"

In a hospital, who hadn't been yelled at by a department head? But that was for your own students.

An outsider. A nepotism hire. Coming in to assert dominance day one?

Zoe was genuinely offended on Leo's behalf. "You know what he got in trouble for?"

Summer said, "Apparently he was a few minutes late intubating a patient."

Old colleagues. Summer's sympathy was clear. She couldn't help defending Leo. "Honestly, it wasn't really his fault. Cardiac Surgery got eight aortic dissections this morning. Six of them Type A. They ran out of ORs. Leo had no choice but to send patients to the ICU."

"Right then, a community hospital transfer came in. Leo was busy admitting, so the intubation was five minutes late."

Medicine was a team sport. In that situation, Leo should have delegated to another resident in his treatment group before leaving.

Zoe knew that too. But she was already biased against the new deputy chair, and her sympathies were entirely with Leo. "A few minutes late is normal."

"Nora. Come on. Let's go meet this new deputy chair."