(Disclaimer: As I was writing this chapter I realized that like 4 yr olds, most physicians don't have a filter when it comes to joking about bodily fluids. So apologies in advance!!)

I was starting intern year in Internal Medicine on the ER rotation. Chicago, a city of almost 2.7 million people, had its fair share of accidents, violence related injuries as well as the never ending heart attacks, strokes etc. And since we were one of the biggest hospitals in the area, our ER was always full.

It didn't help that because of the poor state of primary health care (similar to general practitioners in other countries) and the even poorer health insurance system in the country, the majority of people tended to use the ER as their primary care facility (instead of going to a general practitioner). So along with the real emergencies, we also saw many people who visited the ER only because they had run out of their diabetes or blood pressure medicine.

Our ER shifts in general lasted for 8 hours, which may seem like an improvement over the 36 hours surgery shifts that I had done as a medical student in Pakistan, but no one had mentioned how much heart stopping medical drama went on in this particular ER.

So by the 7th hour of my 8 hour long shift, I knew I had done a decent job with patient care, but I was completely exhausted and hungry and I couldn't even remember the last time I had drank any liquid. But I was a new intern on my first day of the ER rotation and I knew how important first impressions were. So when a new patient rolled into the ER, and the head nurse called out, "50 year old male with intense abdominal pain that started 3 hours ago...who can see him?"

I immediately stood up from my workstation and volunteered to examine him. The nurse handed me some of the paperwork that the paramedics had bought in with him as I walked into the new patient's room.

"Hello Mr Jacob, I am Dr Khan. What brings you in today?"

"Don't know what happened doc...but I was at my job, and sitting at my desk as usual and all of a sudden I started to get this really bad pain in my stomach", the man said, placing his hand on the left lower side of his abdomen.

I immediately envisioned the man's anatomy under the spot that he was pointing towards. The only anatomical structure in the left lower part of the abdomen is the large intestine.

"Mr Jacob tell me a bit more about the kind of diet you have and what you do for a living"

The patient described details of his diet, which mostly included fast food and quick-fix dinners and hardly any fiber or fruits and vegetables. He was a night-time security guard at one of the nearby high-rise buildings and his job basically included sitting and monitoring the feed from the security cameras installed around the building.

After examining him quickly, I explained to him what I thought was going on, "So Mr Jacob I think you have diverticulitis..."

"I have what-the-itis?", he interrupted, looking very concerned.

"Diverticul-itis...which is basically inflammation of the diverticulum. A diverticulum is a small pocket that forms at the end of the large intestine when the muscle of the large intestine starts to become weak with age. A low fiber diet can make things worse by causing constipation, because pieces of stool can get stuck in the pocket and cause infection of that area...", I tried to explain.

"Wait...so I have pockets in my stomach and there is poop stuck in it?", he seemed even more aghast than before.

"Essentially...yes! And usually surgery cures it so you don't have to worry about anything..."

"Surgery? Wait...What? No one said anything about cutting me up...", he sat up in the bed, his mouth wide open, "What the hell doc? NURSE...GET ME OUT OF HERE...", he yelled as he frantically pushed the nurse call button.

"No no...wait, maybe surgery won't be necessary. Why don't we just admit you overnight and monitor you for now...", I mumbled, then stumbled out of the room.

Oops...maybe I should not have been so quick to suggest surgery...

The ER attending was still busy in the trauma room so I looked up the senior resident on-call for the in-patient medical team. The call list said an M. Ahmed was on-call today, so I paged the number, ordered some pain medications for the patient and then started working on the patient note.

M. Ahmed? I wonder where he is from. It would be nice to know another desi guy around here.

Twenty minutes later I still hadn't heard from the senior resident and was contemplating paging him again when I noticed a woman, with striking facial features and jet black hair pulled back in a neat ponytail, coming out of my patient's room. She was wearing scrubs without a white coat so I figured that she was a nurse, and I called out to her.

"Nurse, how is Mr Jacob doing? Did you give him the pain medication I ordered?"

Without looking at me she walked over to a nearby workstation and started typing in her login information. She had been standing close enough to me that I was sure she had heard me, yet had chosen to ignore me.

What the hell?

I was too tired to deal with people's attitude problem right now, so I strode over to her.

"Excuse me, nurse!"

She looked up at me with a confused expression on her face, "Are you talking to me?"

"Who else could I be talking to?", my voice came out more curt than I had intended it to be.

Her eyes immediately darkened and a frown appeared on her forehead.

"Are you blind? Or just stupid enough to assume that every female here is a nurse and could not possibly be a doctor?", she said, pointing to her badge where it said in relatively large letters that I should not have missed, Dr Madiha Ahmed.

Oh no...she is the senior resident? The one I thought would be a male? Oh crap...

"Uhh...I am so sorry Madiha...I am Omar...umm, the new intern", I introduced myself, even though I could feel my face flush with embarrassment.

"That would be Doctor Ahmed...", she glared at me.

"Yes...Dr Ahmed...I am really sorry about that...but umm...thank you for coming to see this patient...", I stuttered.

I was not one to be easily intimidated, but the way that this woman was scowling at me made me take a couple of steps backward, and forget how to form complete sentences. Then she got up from her seat, and took a couple of steps towards me. I was about 6 ft tall, and she must have been 5-6 inches shorter than me, but she looked up at me with such intensity that I felt like a dwarf in front of her.

"Did you just tell the nice man in there that he would need surgery for a simple stomach ache?", she said, anger pouring out of her dark brown eyes that were framed by thick, long eyelashes.

Why am I looking at her eyelashes?

"Umm...yes...", I had said that, because I really did think that he had diverticulitis and I had seen at least 3 such cases being taken to the OR during my surgery rotation in medical school.

"He is freaking out because he doesn't have insurance, and he could never afford a surgery. Why would you say that without first asking any senior resident or your attending?"

Now that she mentioned it, I probably should have waited and run this case by someone with more experience than me. It was, after all, my very first day as an intern. And I had been doing research for the last 6 years. So perhaps my medical knowledge was not as good as it used to be.

"I am sorry...Dr Ahmed. I really should have waited. It's just that during my medical school surgery rotation I saw a number of these cases in the operating room"

She raised an eyebrow at me, but her tone softened just a tiny bit, "News flash Dr Khan, you are doing an internal medicine residency, not a surgery residency. We can treat a lot of diseases with medications alone. So maybe learn to do things the right way, instead of being overconfident in your ability to recommend surgery"

I nodded to her, feeling instantly humbled by her words, but also slightly amused by the fervor with which she had reprimanded me. I could tell she was the type of person to always speak her mind, and have no qualms about standing up for herself.

Qualities that deserved respect!

I followed her into the patient's room and she got some more details about his illness. It turned out, and I had completely missed this, that he attended a family BBQ recently and several of his family members also had the same symptoms as him.

"Mr Jacob you probably just have food poisoning of some sort. So let's give you some fluids, and observe you in the ER for a little while. If you are feeling better, we can probably just discharge you from here"

The relief on the patient's face was very obvious. "Oh thank you so much doc. Your friend here scared the shit out of me...no pun intended!"

Dr Ahmed smiled, and her face lit up briefly when she looked over at me, "You are very welcome! It is my colleague's first day on the job, so you'll have to excuse him for his over enthusiasm"

By the time we stepped out of the patient's room, the ER attending had come out of the trauma room so we updated him on the patient and our plan, which was really Dr Ahmed's plan, and he completely agreed.

"Thanks for coming by Madi! Really appreciate it...that trauma case took forever", he said to her.

Madi? That's a pretty nickname. Not that I will ever be calling her anything other than Dr Ahmed!

"Oh no worries at all", she smiled warmly at the attending, and then turning towards me said, "Keep your head in the game Dr Khan! Trying to send your patient to surgery without them needing it, is not a good way to make a first impression"

I nodded at her, and as she walked away I considered walking after her and apologizing again. It was quite stupid of me to assume she was a nurse. Many people did not wear white coats here and the absence of one should not have been an automatic assumption that she was not a physician. And then on top of that I got flustered and didn't address her appropriately. But while I was still debating with myself, she had already gotten in to the elevator.

Ok, next time I see her, I'll make it a point to apologize...

And so ended my very first day of Internal Medicine intern year. As I walked out of the ER shortly afterwards, I realized something...I had not thought about Noor even once during that 8 hr shift.

Maybe this is exactly what I needed to finally get over her.

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