I remember that afternoon clearly — the fluorescent lights casting a sterile glow, the post-call haze hanging in the hallway, the squeak of clogs on tile. I was a Fellow, rounding with my third-year resident. We stepped into the room of a post-op patient who had just been transferred out of the ICU earlier that day.
Cleared by an attending — a peer I had known for years — the patient was supposedly stable.
But as soon as I looked at him, something felt…off.
His eyes tracked slowly. His skin was warm, yes, but flushed in a way that felt unnatural. I reached for his hand — instinct more than thought — and there it was: a pulse that was both there and not. Erratic. Irregular. Disorganized. It thudded against my fingers like the uneven echo of a war drum.
I pulled out my stethoscope, heart pounding in my own chest, trying to push past the ambient noise — machines beeping, pagers buzzing, distant voices discussing dinner plans — to hear what my gut already knew.
Atrial fibrillation. Fast, irregular, uncontrolled. A common post-op arrhythmia, yes. But sometimes, a warning sign. A prelude to something worse.
I turned to my resident. “Did he have this earlier?”
“Yeah,” he said. “He was irregular this morning too. But Dr. X didn’t think much of it. Cleared him to the floor.”
And there it was — the trap.
I now stood at the intersection of instinct and institution. Do I trust what I see, what I feel, what I know — and risk challenging the judgment of an attending? Or do I say nothing, let inertia carry this moment forward, and hope I’m wrong?
I’d trained beside this attending for nearly a decade. He was a gifted surgeon, well-respected. But I’d been in the room with dying patients too. I’d seen how quiet the signs could be before a storm.
Still, the politics were clear: I was the subordinate. He had made the call. To reverse it meant questioning his judgment — a move with real consequences in the political arena of a hospital. And I had already learned that doing the right thing often carried a price.
But I couldn’t ignore the rhythm of that heart. The pulse that wouldn’t let go.
I tried a workaround. Transferring the patient back to the ICU wasn’t realistic without blowing things up, so I called cardiology, expecting that they’d back me. Expecting they’d see what I saw. But they screened the patient over the phone — never laid eyes on him. “Stable for the floor,” they said.
That night, he had a heart attack. He died.
A lawsuit followed.
The attending who had cleared the patient in the morning was implicated. So was the hospital.
And so was I.
My Chair hired the attending a personal attorney — the best money could buy. A seasoned defender, known across the city, who worked to protect him with the full weight of institutional support.
Me?
I was assigned the hospital’s lawyer — a man I’d never met, who introduced himself with a smile that didn’t reach his eyes. With every meeting, every phone call, it became clearer: I wasn’t his client. The hospital was. I was a liability. A loose end to tie off. A character to manage in the larger narrative of risk mitigation. He reminded me, subtly but unmistakably, that I was expendable.
I couldn’t afford my own attorney. So I clung to the truth — the clean, aching truth — and hoped it would be enough.
But the truth doesn’t shout. It doesn’t hire high-powered lawyers or curry favor in the C-suite. It just sits there, patient and quiet, waiting to be heard.
The day of my deposition, I walked into the small conference room — beige walls, flickering overhead lights, pitchers of stale water sweating onto paper doilies. Across from me stood the family’s lawyer — tall, sharp-eyed, all coiled intensity. He didn’t sit. He leaned in. He raised his voice. He interrupted. His goal was clear: shake me. Rattle me. Trap me in contradiction.
His face was inches from mine at times. He paced. He pounced. He spun my words back on me like barbed wire.
I kept my answers short. “Yes.” “No.” “Correct.” I didn’t offer more than what was asked. I didn’t argue. I didn’t explain.
I wanted to cry. Not out of guilt — but out of helplessness. I had tried to do the right thing. I had done the right thing. But in that room, I was alone. No backup. No voice behind me saying, She did what she could.
Later, my resident was deposed. He had kept detailed notes from rounds — his habit born of diligence, not defense. But those notes were my salvation. They told the story: of my concern, my assessment, my call to cardiology. They corroborated what I had said. They also documented the presence of the arrhythmia on morning rounds that was noted and not addressed.
Eventually, the case was quietly settled. I was dismissed with no fault.
No apology came. Not from my Chair. Not from the institution. There was no debrief. No inquiry into how this happened — how a gifted, intuitive clinician could be unsupported, isolated, and nearly sacrificed in the name of institutional protection.
Just silence.
Another opportunity for reflection, for culture change — missed.
Medicine often talks about professionalism, about integrity, about putting the patient first. But those words don’t mean much if the system punishes the very people who try to live them.
The lesson I carry from that day isn’t just about trusting my clinical instincts. It’s about what it takes to lead ethically in a culture that still protects hierarchy more than truth. About the strength it takes to keep speaking up when the cost is high. About the pain of doing the right thing, quietly, and still being left alone.
I’ll never forget that patient. Or the way his pulse pressed against my fingertips — chaotic, urgent, unfinished.
It was a warning. Not just for that moment, but for all of us.
Because the real arrhythmia in medicine isn’t just in our patients. It’s in our culture — and if we don’t correct it, the cost will continue to be borne by the vulnerable.
Here’s what I learned about leadership:
Leadership isn’t defined in the OR. It’s defined when something goes wrong.
It’s defined when a patient dies and you have to choose between protecting your ego — or telling the truth.
It’s defined when you choose to stand up for someone beneath you on the ladder — or throw them under the bus to save yourself.
Too often in medicine, the latter prevails. The culture rewards silence, deference, and self-preservation. We say we value truth and integrity, but in the hallways, it’s politics and reputation that win.
I also learned this: If you are a woman in medicine, especially a trainee, you are more likely to be left without a safety net.
Women physicians are more often blamed for adverse outcomes, less likely to receive mentorship, and less likely to be supported during crises — especially in male-dominated fields like surgery. A 2023 study in JAMA Surgery showed that female surgeons are more frequently the subject of performance-related complaints, even when outcomes are equal or better than those of their male counterparts.
But here’s the paradox: studies also show that patients treated by female physicians have lower mortality and readmission rates (Tsugawa et al., JAMA Internal Medicine, 2017). Female surgeons, despite the bias, often deliver safer and more attentive care.
Still, we’re left out of the locker rooms. We’re excluded from the tennis matches. We’re not invited to the dinner table where the real decisions are made.
And when things fall apart — we’re the first to be blamed.
So what kind of leadership do we need in medicine?
We need the kind that values courage over hierarchy.
We need the kind that refuses to protect bad behavior just because it comes from someone with a reputation.
We need the kind that lifts up truth-tellers instead of isolating them.
We need more women in leadership — not just because we bring different skills, but because we’ve already been forged in the fire. We know what it means to lead without power, and that is the purest kind of leadership there is.
I stayed honest. I stayed present. I did what was right for that patient. And while it nearly cost me, it also clarified my purpose: to be the kind of leader I never had.
Not just for myself — but for the ones coming up after me.
Finding My Rhythm: Healing, Leading, Becoming 
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