"Just being thorough," I replied, updating his chart with mechanical precision. "I'll be back to check on you in thirty minutes."
In Room 3, an elderly woman named Mrs. Kim had been waiting for test results for her abdominal pain. She'd been asking about her grandson, trying to make conversation the way patients did when they were scared and alone. In the past, I'd have pulled up a chair, asked about her family, maybe even shown her pictures on her phone to pass the time.
"Mrs. Kim, your CT results should be back within the hour," I said, checking her IV line. "Are you experiencing any nausea or increased pain?"
"No, dear, but I was wondering —"
"I'll update you as soon as we have results," I cut her off, not unkindly but with a finality that ended the conversation. I had other patients to check, other assessments to complete. There wasn't time for stories about grandchildren.
In the hallway, I ran into Dr. Delaney Ward, one of the ER attendings. Ward was known for her razor-sharp intellect and ice-cold competence — the kind of doctor who could diagnose rare conditions with Sherlock Holmes-like deductive reasoning but had the bedside manner of a particularly efficient computer.
"Dalton, what's going on with Mr. Patton?" she asked, her voice crisp and direct. "His chart shows pain assessments every twenty minutes for the past four hours."
"I want to make sure we're not missing anything," I said. "Pain can be an indicator of complications."
Ward frowned, pulling up his chart on her tablet. "His vitals are stable, his imaging is unremarkable, and his pain is appropriately controlled for his injury. You're documenting at a frequency that suggests either deterioration or paranoia. Which is it?"
I met her cool gaze, recognizing something in her clinical detachment that felt familiar. "Just being thorough."
"Thoroughness has a clinical definition, Mr. Dalton. This is something else." She studied me for a moment with the same analytical intensity she brought to difficult diagnoses. "When's the last time you took time off?"
"I'm fine," I said, the phrase becoming as automatic as checking blood pressure.
Ward's expression didn't change, but something flickered in her eyes that might have been concern. "See that you are. Hypervigilance can be as dangerous as negligence."
Two weeks later, I was assigned to precept Chloe again. She bounded into the department with her usual enthusiasm, her face lighting up when she saw me at the nurses' station.
"Jimmy!" she said, practically bouncing on her toes. "I'm so excited to work with you again. I've been practicing my IV starts, and I think I'm finally getting the hang of the butterfly technique you taught me."
"That's good," I replied, not looking up from the patient assignment sheet. "We've got a full board tonight. Room assignments are posted."
Chloe's smile faltered slightly. "Okay... so what's our game plan? Should we start with the chest pain in Room 4, or do you want to tackle the psych patient first?"
"We'll start with the most acute and work our way down. Standard triage priorities." I handed her the assignment sheet and started walking toward Room 4. "Patient is a fifty-six-year-old male with chest pain onset two hours ago. I'll take the history while you prepare for the EKG."
"Right, but..." Chloe hurried to keep up with me. "Don't you want to hear about Mrs. Murphy? She asked about you last week. Said you were the only nurse who made her laugh during her gallbladder surgery admission."
"Patient rapport is important, but we have twelve patients to assess," I said, pushing open the door to Room 4. "We need to prioritize efficiency."
I watched Chloe's face fall, confusion replacing her earlier excitement. In the past, I'd have asked about Mrs. Murphy, probably would have made a note to stop by and say hello if she was still in the hospital. Now it just felt like a distraction from the work that needed to be done.
The chest pain assessment went perfectly — textbook history taking, flawless EKG placement, appropriate medication administration. But when Chloe tried to engage the patient in light conversation while we waited for lab results, I cut her off.
"Mr. Williams, we'll have your results within the hour," I said. "Chloe, Room 6 needs vitals."
In the hallway, Chloe caught my arm. "Jimmy, are you okay? You seem... different."
"Different how?"
"I don't know. Distant? You used to tell jokes during procedures, ask patients about their families. You made everyone feel comfortable. Now you're all business."
I looked at her earnest face, this young nurse who still believed that caring was enough, that good intentions could save people. I'd been like her once — optimistic, invested, convinced that the right combination of compassion and competence could fix anything.
"This job isn't about making friends, Chloe," I said quietly. "It's about providing safe, effective care. Everything else is secondary."
"But you taught me that connecting with patients was part of good care — "
"I was wrong." The words came out harsher than I'd intended. "Focus on the clinical skills. That's what matters."
