The weight of the title

The official appointment email was short, formal, and utterly devoid of emotion. No champagne, no handshake, just a cold digital confirmation that my decade of meticulous, punishing work had paid off. I was Senior Cardiologist. The title felt heavy, like a new piece of specialized surgical equipment—powerful, precise, and requiring total focus.

My first act was to purge the excess. I tore through the old scheduling protocols like they were diseased tissue. The department had been running on seniority and favors; I replaced that with efficiency and triage scores. This wasn't about being liked; it was about protecting the lives I was now responsible for. If a middle-aged patient with stable angina had to wait a day longer so I could fit in a critical congenital defect repair on a child, that was the ethical cost of my title.

The resistance was instant, though silent. The nurses, used to Dr. Chen’s relaxed three-day weekends, now had to operate with my demanding, optimized schedule. The junior fellows, used to coasting, were suddenly drowning in complex assignments. When they complained, I simply presented them with the new department metrics: 15% improvement in patient throughput and a drop in post-op complications. Data always silenced dissent.

My biggest source of friction, however, came from the floor below us: Emergency and Trauma.

They were a vortex of chaos. They would seize resources without notice, hijack OR time with zero coordination, and then send us post-trauma heart patients who were so poorly stabilized, we had to start from scratch. They were brilliant, yes, but they were messy, arrogant, and seemed to believe their adrenaline-fueled urgency justified ignoring every single rule of coordinated care.

"This is unacceptable," I told my Chief Resident, pointing to the latest report. "Trauma is holding our recovery beds hostage for non-critical monitoring cases. They must respect our protocols. Send a formal directive: no exceptions."

I spent two weeks establishing a strict new triage agreement with the ER, which earned me a furious phone call from their chief administrator. She accused me of being a "brick wall," an "inflexible automaton." I listened, waited until she paused for breath, and said simply, "My rigidity saves lives. Your chaos costs the hospital resources and patients time. The new protocol stands." Then I hung up. I didn't care about their bruised egos or their messy processes. I only cared about the heart in my hands.

The defining moment came during a complex Mitral Valve repair. The patient was 78, frail, and everyone in the department had flagged the case as high risk. It required steady hands and absolute emotional control. I spent twenty hours prepping the procedure—not just the surgical plan, but every possible contingency.

In the OR, the tension was immense. Three hours in, the patient crashed. Instantly, the anesthesiologist panicked, ready to abort. But I was already two steps ahead. I had practiced this exact scenario. My hands, calm and utterly separated from the fear in the room, executed the pre-planned rescue sequence. We brought him back, and I finished the repair, the stitches perfect, the valve functioning flawlessly.

When the patient was wheeled out, stabilized and alive, the lead nurse simply looked at me, her eyes wide with a respect deeper than any formal title. "Dr. Sharma," she breathed. "No one else could have pulled that off."

I didn't smile. I just nodded, already calculating the next patient’s needs. I had won the title, and now I was proving that my merit and my control were the only things that truly mattered in this sprawling institution. I was at the top of my game, carving out a space based on discipline alone. I didn't need the connections, the parties, or the goodwill. I just needed my scalpel and my protocol.

And yet, there was a persistent hum of dissatisfaction, a sense that I was constantly fighting an invisible, entitled force. I was making too many waves, stepping on too many well-heeled toes—especially those belonging to the loud, chaotic surgeons from the Trauma department. My reign was effective, but it was also making me the hospital's most powerful antagonist.

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