All By Myself
Voiceover (Alex): Life as a resident? It pretty much sucks. 24-48 hour shifts. Little sleep. You don't know what the hell you're doing most of the time. Doctors are constantly barking orders at you. You wonder how fetching someone's coffee helps you learn to be a better doctor. But what gets you through it is the promise of those first solo surgeries. That's what keeps you going and gives you hope. Those initial opportunities to slice someone open yourself. To fix them. To heal them. To be the doctor.
Jo and Bailey were standing at the OR board, and Jo's stomach was full of butterflies. She listened as Bailey explained that Tuck had a huge soccer tournament the next day and needed his Mama at those games. "I can't believe I'm saying this, Wilson," Bailey exclaimed, "but it looks like you're going to have your first truly solo appy tomorrow. I won't be there. Nobody will be hovering over you. It'll be your OR. You're ready."
Jo held herself together with every ounce of self-control she could muster. She was tempted to pick Bailey up and twirl her around in a giant hug. Yeah, Jo thought to herself, not advisable. Instead, she said maturely, "Thank you, Dr. Bailey. I look forward to the opportunity." Bailey handed Jo the Expo marker and said, "Well, then, go ahead. Write your name on that appy. Put it on the board and savor the feeling. Heck, take a picture if you want." Jo smiled as she wrote her name in the spot for surgeon. Bailey assured Jo, "I'll do the paperwork and let Hunt know."
Jo began to walk down the hall to find Stephanie and share the good news. Her cell phone buzzed and she saw a text from Alex: Bugging out early. Come home with me. You won't regret it. Jo laughed to herself, fully aware she still had six hours left on her shift. She texted back: Thanks for the offer but no dice. I'm done at 8. Alex wrote back: You know you want me. Jo responded: Yep and I want to keep my job too. I'll see you around 8.
Alex read the texts, disappointed but not surprised. He took his time driving home and puttered around the house. Not often having time off alone, he really was not sure what to do with himself. He cleaned a little, watched some TV, and took a nap. He rummaged through the fridge for some leftovers when he woke up, stealing Arizona's lasagna from that great Italian restaurant down the street. As he ate, he watched the minutes slowly tick by on the clock. Jo couldn't come home soon enough.
Finally, at 8:30, Jo drove up and Alex ran to the door to meet her. Jo walked in and was greeted with an overly eager boyfriend who scooped her up, carried her up the stairs, and fell onto the bed with her. "Well, that's a wonderful hello," Jo smiled. Alex leaned in to kiss her as he held her, speaking in between kisses, "I've been waiting all day for you to get home." Jo giggled and stroked the hair by his ear, gazing deeply into his eyes, "You, Alex Karev, are the best thing that's ever happened in my life." Alex began tickling her and said, "Aww, c'mon. Don't ruin the moment by getting all sappy." Jo laughed as she wiggled from the tickling. The tickling led to more kissing and to a wonderful night together.
As they lay snuggling, Alex asked Jo about her day. "You won't believe it! I get to do a solo surgery tomorrow. First one in my group. Bailey told me I'm ready – Bailey! Solo. My OR," Jo exclaimed. "That's a big deal. Don't screw it up," Alex offered with a grin. "You know, Alex," Jo suggested, "a 'wow, that's great, Jo, I have complete confidence in you' might be another option." Alex kissed Jo on the top of her head, "Just giving you some crap to keep you humble. It's a helluva lot better to go in with a little trepidation than with too much confidence." Jo responded, "Still…" Alex grimaced, "Well, you'd better sleep well. Big day tomorrow, solo surgeon."
The next morning in the car on the way to work, Jo had recited the steps of the surgery over and over. After the fifth or sixth time, Alex started quizzing her about potential complications. She answered each question perfectly. Alex and Jo walked into the hospital together – she was beaming and he was obviously proud. Alex leaned toward her ear and whispered, "I have complete confidence in you." Jo beamed at him in response.
As the couple reached the OR board, they said good morning to Hunt. Alex stopped to look at the board so he could see 'Wilson' written on it. He was planning to snap a picture with his cell phone, print it out, and stick in on the fridge. But, as he looked, he noticed her name was nowhere to be found. There was an appy, but Meredith's name was listed next to it. "Hey, Hunt, why isn't Wilson's name listed on that appy?" Owen, shuffling papers, looked up with confusion, "Ummm…because she's a resident." Owen began to walk away, obviously overloaded and busy. Alex started to follow him, but Jo stopped him, "Alex, I don't need my boyfriend navigating my surgery opportunities." Alex looked at her and insisted, "Then go follow him. Advocate for yourself."
Jo reluctantly walked toward Hunt, calling out, "Dr. Hunt?" Owen turned as he stood waiting at the elevator. "Dr. Hunt, my name was on the board last night when I left. Dr. Bailey gave me the surgery when she realized she would need to be away today," Jo explained. Hunt shook his head gently, "Wilson, I'm sorry. Bailey did not mention anything to me. I saw your name on the board, but I assumed someone was trying to play a joke on you or something." Jo looked directly at Hunt, "I can appreciate that, Chief, but I am telling you that Dr. Bailey assigned me that surgery last night around 7:45. It's supposed to be my surgery." By this point, Alex had maneuvered himself closer so he could see Jo's face. He saw her breathing slowly and knew the tears weren't far behind. He mouthed, "Don't cry," to her and modeled taking deep breaths. Jo nodded slowly in response and grinned. Owen looked at Jo. As the elevator doors opened, Owen said, "I'm sorry, Wilson. That's all the time I have. There will be other opportunities. You're with Kepner today."
Once the elevator doors closed, Jo began walking toward Alex. Alex tilted his head toward a nearby supply room. "Don't worry," Jo assured him, "I'm not going to cry." Alex smirked, "It's ok if you do, in here, you know." Jo responded, "I'm good, Alex. I'm pissed, but I'm good." Alex brushed some of her hair behind her ear, "You want me to talk to Hunt? I can explain it, mention my confidence in your skills." Jo shook her head, "Alex, don't jockey for me behind the scenes. It's not right. I want to do this on my own." "Ok," Alex said, "then you need to do something. What are you going to do?" Jo sighed, "I don't know yet. In the meantime, I'm going to go find Kepner." Alex offered to help her find Kepner before he headed up to the NICU.
When they walked toward the ER nurses' station, April approached, "Oh, wonderful," she said in her sing-songy voice, "My resident for the day! This will be great." Jo tried to fake excitement. Kepner continued, "I requested you specifically, Dr. Wilson. We can have a girls' day in the ER. It'll be fun!" Alex mimics Kepner, "It'll be fun." Kepner walked within a foot of Alex and looked him right in the eye, "Karev, don't you have someplace to be?" Alex raised his eyebrows, kissed Jo on the cheek, and headed toward the elevator.
Jo's day in the ER was swamped. One of her patients was complaining about pain that was doubling her over. After an initial exam, Jo paged Meredith for a consult. Meredith hurried down, examined patient and asked Jo, "So what do you think we're looking at, Wilson?" Jo explained that she would order a CT and draw labs. Her hunch was that the woman had gallstones. Meredith ordered, "Yes. Good call. Proceed." After Meredith turned to the patient and assured her that she was in good hands with Dr. Wilson, she said to Jo, "A moment, Dr. Wilson."
Jo followed Meredith to a consultation room. "Yes, Dr. Grey?" Wilson said as Meredith closed the door. "Wilson, I don't understand you. I hear you advocated for a solo surgery this morning, but then you called me for a consult on a simple gallbladder? You and I both know that's what the tests will show. Why did you call me down? You should make these kind of calls on your own now, Wilson." Jo had been a resident long enough to know that she should make eye contact, listen, and not respond. "I was considering asking you for more details about that appy that you said Bailey assigned to you, but now I'm so disappointed with this gallbladder, I'm not sure if you've got the confidence to be on your own. Don't waste my time with simple cases, Wilson. Step up." Meredith began to leave the room, and Jo took a deep breath, "Thank you, Dr. Grey."
When Jo stepped back into the hall, the paramedics were bringing in a man who had been in a terrible car accident. Kepner called out, "Wilson, take this. We have two more incoming. I need to get back out there." Jo nodded and listened to the paramedics recite vitals. The patient was wheeled into a room and Jo declared, "On my count. 1.2.3." She realized quickly that there was blood pooling in his chest. She called to the nurse, "We need to prepare for a chest tube." The nurse responded, "Do you want me to page Dr. Hunt?" Jo shook her head, "No, I've got this."
Jo successfully placed the chest tube and declared, "Let's get him up to the OR." As the group wheeled the patient toward the elevator, Hunt happened to walk by and joined the group. "What do you have, Wilson?" Jo recited the basics and then Hunt nodded, "Ok, I've got it from here. I need you back in the pit. And I need to speak with you later. Let's meet down here at 11:00am." Jo nodded, but was disappointed to not be invited to assist in the surgery.
The time to meet with Owen came quickly. Jo had just sat down for the first time all morning when Owen approached. "Wilson, let's…ummm…go over here." Owen motioned her to an empty exam room and shut the door, then he began bellowing, "What the hell were you thinking, Wilson? Why in the world would you place a chest tube on your own? Why did you run that case on your own? You are a resident, Wilson, not an attending. You crossed the line and you're damn lucky the patient is fine. But that's not the point. The point is that you overstepped the boundaries…"
Jo, knowing better but at the end of her rope, took a deep breath and held up her hand toward Owen, "Dr. Hunt. Please. Stop." Hunt was surprised and confused by her courage and direct manner. He looked at Jo and asked, "What? Excuse me?!" Jo's voice became more clipped as her volume increased the more she spoke, "Dr. Hunt, please just hear me out. I began the day anticipating a solo surgery that Dr. Bailey assured me I was ready to perform. That was taken away from me. Then when I called Dr. Grey down for a consult on a gallbladder, she admonished me for even paging her. She made it clear I needed to step up my game. Then you come down and tell me basically the opposite. I am more than willing to follow the boundaries and to know my place, however, it's pretty impossible to discern those lines when there are no guidelines, no written rules, no clarity." By the time she stopped speaking, Jo was yelling as loud if not louder than Owen had yelled at her. She paused to take a breath, glanced toward the window, and noticed Alex was outside the room looking in to the room stunned.
Hunt breathed in and looked Jo in the eye, "Well, Dr. Wilson…" Jo interrupted, "I'm sorry, Dr. Hunt. I apologize." Owen shook his head, "No, actually, Wilson, you have a point. There is a much, much better way to communicate it, and I'm a bit stunned by your volume. Now, having not been yelled at like that since my own residency, I'm going to step out and take a walk to cool down. I suggest you do likewise. Let's meet back in here in 30 minutes. Now, if you'll excuse me." Owen walked out of the room with a touch of intensity as Jo remained there taking in the interchange.
Alex walked in and said firmly but quietly, "What the hell were you thinking? You don't talk to the Chief of Surgery like that. Hell, I don't even talk to him like that." Jo rolled her eyes and responded, "Alex…not now. Please. I'm fully aware of what I just did." Alex approached her and put his hands on her shoulders as he grinned, "Do you need some time off? Should we go grab something to eat? It's not like you to be this intense with an attending other than me." Jo smiled, "I just need to step outside for a few minutes. Go back to the NICU. I'm ok. What were you doing down here anyway?" Alex shrugged, "Kepner paged me for a consult." Alex and Jo kissed, then he kissed her on the forehead and suggested, "Behave yourself. One hothead Karev is enough for this place and I've already claimed that role." Jo softly giggled. Just by his presence, Alex had calmed her down.
After about 40 minutes, Owen found Jo as she was treating a patient with a minor issue. He approached and said, "Dr. Wilson, could I pull you away for a brief consult please?" He did not truly need a consult, but it was a way to get her to step away and save face in front of the patient. Jo smiled toward the patient and explained, "I'll be back in a few minutes." Then, Jo followed Owen into an empty room.
Owen looked at Jo seriously and began, "Dr. Wilson, your behavior earlier was completely out of line. Without a doubt, you had a point that needed to be shared. However, if you cannot control your emotions, you have no business treating patients. Jo attempted to interrupt with an apology, "Dr. Hunt…" Owen looked at her sternly, "Stop right there, Wilson. I need you to step off the floor for a few hours and collect yourself. Go observe from the gallery, do some charting, study, whatever. Just make sure you get your act together, Wilson. You know there are more productive ways to communicate with a superior. See me this afternoon and we'll go from there." Jo nodded and said softly, "Absolutely, sir."
Jo's day had gone from bad to worse as the minutes passed. She paged Alex '910' – very important but not an emergency. She simply wanted to lean into his chest and sob. She didn't realize that he was swamped and in the middle of a surgery. As her page came through, Alex asked a nurse to check it for him. The nurse shared that Jo had paged 910. Alex asked, "Thanks. Could you please text back: Please elaborate. In surgery." Time went by and Jo did not respond. She decided to head up to the gallery rather than interrupt Alex as he operated.
When she stepped into the gallery, Jo was trying not to cry. Her plan was to look as if she was engaged as she attempted to re-center and catch her breath. She wasn't aware that Alex was operating because her eyes were fixed near the ceiling of the OR. Alex looked up and saw her, but couldn't seem to catch her eye. He asked the nurse to turn on the speaker so he could ask Jo to come down and scrub in to assist, "I need an extra set of hands. I need your hands. Can you get down here and scrub in?" Jo looked down with a gentle smile, recognizing Alex's voice. She responded that she'd be right down. After scrubbing in, Jo entered the room and stood by the patient. Alex explained, "We've got some bleeders. I keep thinking I've found them all but the patient is still unstable. There are more bleeders in here somewhere." Jo looked down and reached into the patient's abdomen. She asked for suction in an area near the edge of the retractor and stated, "Dr. Karev, it appears the retractor dug into the patient's skin over here." Alex was surprised and stopped what he was doing to look at the area. He celebrated, "Bingo, Dr. Wilson. Can you re-place the retractor and begin stitching that up? Great job." Alex returned to finish in the area where he'd been working, occasionally looking up at Jo to nod or to smile through his surgical mask, "Excellent catch, Wilson. Excellent. You saved the day." Jo smiled in response as she worked.
At sinks afterward, Alex kissed Jo in celebration, "What would I do without you?" Tears began to fall as Jo shared, "It has been the absolute worst day. I needed to hear that." Alex leaned toward her and placed his forehead on hers, "I love you." She continued to tell Alex about her day. Alex responded, "Oh, screw 'em. Just screw 'em. None of that matters." She leans into his chest, crying. He pulls her chin up gently and looks her in the eye, "Actually, instead of that, how about if we find an on-call room and start the day all over?"
Every resident dreams of the day they will no longer be a resident. They imagine it will be a life of freedom and authority, but the truth is that being an attending provides its own challenges. The upside is that the paychecks are a hell of a lot better, but, there's a lot more responsibility – responsibility for patients' lives. By the time you finally become an attending, you're pretty aware of what you know and what you don't know. When you're stressed, you snap at residents and interns even though they don't deserve it. Attendings like to believe we were never as clueless as the interns and residents we're teaching. It's true – we weren't as clueless. We were more clueless when we were in their shoes. And some days, we are more clueless as attendings than they are as residents.