Chapter Text
In the summer between her final year of undergrad and her first year of medical school, Rey Johnson spent a frankly embarrassing amount of time compiling various rules and tips that she’d either read online, or heard directly from some of her older friends who were in the home stretch or had recently begun their residencies. At some point, she’d managed to compile a top 10 list called “First Day of Med School—Do’s and Don’ts”, in no particular order:
1. Develop an effective study schedule ASAP. You start learning immediately. So do NOT let yourself fall behind.
2. Get a solid group together to study and practice for OSCEs*!!
3. Schedule some downtime into your day. Like cooking. Or sex. Whatever makes you feel warm and fuzzy inside.
4. Exercise. Preferably cardio a few times a week. Third-year you will be grateful.
5. Be flexible with your career aspirations. Don’t overspend on your stethoscope because it will probably go missing anyway.
6. Don’t start studying for boards too soon. You have about three months left of what you could call a “normal life.” Enjoy it as much as you can.
7. Use the online textbooks and resources (or suffer from agonizing kyphosis** for years to come).
8. Do not skip anatomy class!!
9. Make friends with your upperclassmen. They’ll give you more tips on residency applications when the time comes.
10. For the love of God, do NOT make any enemies.
Rey was quite proud of herself for putting that list together. A few days before classes began, she sent a screenshot to Finn and Rose in their group chat, to which Rose jokingly responded that they should frame the list and hang it up on the door to their shared dorm.
Finn quickly reminded them that Jannah, his cousin (fourth year and soon to be anaesthesiologist), and their primary mentor and point of contact during the previous application cycle, would never let him live it down.
Rose, of course, found this absolutely hilarious and suggested inviting Jannah to their housewarming party, where they could hang it up and take some selfies. Rey chuckled and seconded that motion, reminding Finn that Jannah had basically written tips 2-4 herself and might appreciate seeing her handiwork on display.
Several gifs were exchanged, mostly depicting Schitt’s creek reactions, and the conversation was subsequently dropped. But nevertheless, Rey found time to tack a copy of the list onto the cork board over her desk the night before classes began. Next to it, was a small light blue and maroon flag labelled “University of Chandrila School of Medicine.” The sight of them together made her heart swell with pride.
Admittedly, Chandrila Med hadn’t been her first choice. It was pretty isolated, all the way up in northeastern Ontario. It was also less than a decade old—a baby, by medical school standards. The general consensus among reddit users seemed to be that it had only been approved as a factory to pump out primarily family doctors: a resource that Canada was in desperate need of. But Rey wasn’t interested in family medicine. She had only accepted the offer because 1. It was the only school that had accepted her, and 2. Chandrila, despite being a new school, was affiliated with the Coruscant Cancer Research Centre in Hamilton. And if she could get her foot in the door there, then maybe…just maybe she’d boost her chances of one day becoming a part of their team.
Of course, she needed to actually pass her first two years before she could even begin thinking about that in any meaningful capacity. And within that time, she would have to master every inch of the human body, and the most common diseases, conditions, and breaks associated with each organ and limb.
Well, every inch except for the teeth. They had to give dentists something to do.
***
A week into her first year, Rey managed to screw up number 10 so spectacularly that she probably deserved a medal.
“Don’t make enemies.” It had seemed easy enough. Medical school was a team setting. She had been mentally preparing herself for the possibility of having to work alongside people who she wouldn’t otherwise get along with. It wasn’t—it shouldn’t—have been such a big deal. Rey was fully capable of controlling her anger and frustration. She’d spent years cooperating with assholes while often fantasising about stabbing her pen through their eyes.
But she’d never had to deal with Ben Solo before.
The first ‘incident’ happened in their second PBL*** class. The first week’s case was of a fictional girl named Yasmin Ahmed, who presented to her hospital with osteomyelitis: a severe bone infection secondary to sickle cell anemia. Rey had just been randomly selected to present one of the items on the list of learning objectives: differential diagnoses for blood disorders.
Dr. Tekka was the professor who had been assigned to their group. She’d lightly stalked him on the school’s website when she first got her class schedule. He was an older man, University of Toronto med school alumnus, and a longtime neurologist in Sudbury. Not exactly someone she’d need to suck up to for a reference letter, but ideally someone she shouldn’t piss off. Jannah had listed him as one of the ten toughest professors at the school.
He raised his gaze from his laptop and glanced in her direction. “Have you prepared something for number three?”
Rey swallowed, feeling her heart race, but nodded and stood up from her chair.
He wordlessly handed her a large black marker and directed her to the white board covering the wall behind him, whirling his chair around and crossing his arms to listen to her short presentation.
She stood there longer than she’d intended, trying to call the words to her mind. Think dammnit, you know this! She chastised herself internally.
The other students in the room were not particularly engaged. Three of them were leaning back in their chairs, sipping their lukewarm coffee. Two were glancing at the board behind her, but their drooping eyes and slouched shoulders suggested that neither of them had gotten a ton of sleep before scrambling out of bed five minutes before the class began. One other girl kept leaning over to ruffle through her backpack, likely to steal one last glance at her notes before stepping onto the chopping block. But Ben, who was sitting to her right and two seats back, was staring intently at her, mimicking Tekka’s pose while wearing an army green t-shirt and dark jeans. They hadn’t really spoken to each other since the first session on Tuesday, but he struck her from the start as a somewhat calm, mature person. He was also clearly the oldest student in the class, pushing 30 years old where most of them were five to eight years younger.
Even sitting, he was a head taller than anyone else in the room, with scruffy jet-black hair pushed back behind his ears, and an intense gaze that made her feel like it was piercing into her soul. She couldn’t quite discern if it was in judgement or quiet support, but in the moment it didn’t matter. It was her first time presenting in front of her classmates after a sleepless night of studying, and to see someone look like he had his shit together…it was strangely comforting. Honestly, he even looked a little familiar, though she couldn't quite put her finger on where she'd seen him before. But, steeling herself, Rey took a deep breath, met his eyes, then turned back, lifted her chin and began to write.
“Disorders of red and white blood cells can be sorted into anemias and cancers,” She began, scribbling the terms on the board as she wrote. It began well enough. Anemias—disorders of low hematocrit and hemoglobin—were sorted based on the amount of red blood cells in the body, and the size of them (also called the mean corpuscular volume).
“The most common microcytic anemias are iron deficiency anemia, anemia of chronic disease, and thalassemia,” Rey continued, moving down to continue.
“Good,” Tekka said. “Now—“
She tensed with the marker still pressed against the board, waiting for the quizzing to begin.
“If Yasmin had iron deficiency anemia, how would she have presented to the physician?”
Rey turned to face the class. “Umm…fatigue, fainting, pale conjunctiva, glossitis, ko-kolo—“ She stuttered, then stopped, leaving her mouth hanging open. Shit. The word was literally on the tip of her tongue, as was the image of the fingers with nails turned inwards like spoons.
Tekka let out a small sigh. “Anyone else?”
“Koilonychia.” A deep voice said. Rey realised, a moment later, that it was Ben who spoke. Soon enough, every head was turned towards him instead of her.
He seemed taken aback by this, but then uncrossed his arms and let out a small sigh, holding up a very large, pale right hand. “Spoon nails, I mean.” He said, pointing to his nails without taking his eyes off her. “They become extremely thin and brittle. It’s a dead giveaway for iron deficiency and rheumatic fever in a clinical setting.”
Rey nodded, but felt her shoulders tense slightly. She should have been grateful to him for saving her. But in the moment, all she could do was think about how stupid it was for her not to know the word immediately. She had promised herself that she’d make a strong impression, but now this guy was having to jump in on her behalf.
“Thank you Ben,” Tekka responded, turning back to Rey. “You may continue.”
She swallowed back the lump forming in her throat, then did as he said, working her way down the lists of normocytic and macrocytic anemias. Twice more, she found herself stuttering and hesitating, her mind blanking on items that she’d had no trouble telling Finn about the night before.
Both times, Ben was the one to jump in. The first time, it had come off to Rey like a gesture of pity. The second time, there was a twinge of annoyance in his voice, like really, does this girl not know the difference between hemolytic and aplastic anemia? The third time, it sounded genuinely patronising. And it made Rey’s jaw clench with frustration.
“Vitamin B12 and folate deficiencies both cause megaloblastic anemia, but B12 is usually lost from lack of intrinsic factor or ileal malabsorption. Folate is from low dietary folate, alcoholism, and some chemotherapeutic drugs.”
Rey was gritting her teeth, waiting for a chance to jump in and finish what she was going to say, but then blinked at the mention of chemo. She knew something about that.
“Methotrexate is one of the drugs that causes folate deficiency—“ When Ben and the rest of the class paused, her gaze drifted towards Tekka. “Right?”
She knew she was right. But she felt compelled to get his approval.
Tekka opened his mouth, then closed it again. “Right.” He said. “But you won’t be covering chemotherapy until your second year.”
She nodded, and hunched over a little bit, bringing the collars of her blouse a little closer together. Tekka wasn’t saying it aloud, but his comment it felt like an accusation. He must have thought she was a naive keener who had spent the previous night researching every last bit of information on the ancillary blood disorders. He didn’t need to know that she only knew that bit of trivia because she’d spent three of her teenage years taking folate supplements.
“Is that everything?” Tekka asked suddenly, snapping her back into focus.
Rey tilted her head towards the board, where the section on blood cancers was still completely blank.
“No, there’s more.” She said quietly, continuing her presentation. This part she was more than comfortable with. This part she wouldn’t screw up at all.
Without taking a breath, Rey gave a rundown of acute myelogenous and lymphoblastic anemias, briefly outlining what she knew about their causes and treatments. It was admittedly a way to show off, to demonstrate to Tekka that she had a strong background on the subject. She’d taken numerous oncology courses in undergrad, so this knowledge had settled into her mind long ago. She was about to continue onto the chronic leukemias when—
“That’s the wrong translocation.” Ben said, pointing to the board. “It’s not just twelve and twenty-one. The Philadelphia chromosome gives you the worse prognosis.****”
“I—“ Rey stuttered, then turned back to the board. “No, no that’s not true. The Philadelphia chromosome only shows up in CML.”
Ben shook his head, clearly annoyed. “You’re wrong. It can be in both of them.”
It was such a small comment, but the way that he said those words you’re wrong. Even with his even expression, she could clearly detect a smugness in his voice, an arrogance and venom that made every hair in her body stand on edge.
“Fine!” She snapped, closing the cap of the marker. “If you know so much, why don’t you teach it yourself?”
Something shifted in his expression then. He seemed almost stunned. Figures, though. He was the oldest student she had met so far. He probably already had a PhD and three years of hospital experience. He must have thought he was hot shit compared to the lowly Bachelors’ and Masters’ students.
“Well, do you want to? I’m sure you know way more than I do.” She said, holding up the marker towards him in challenge. He just glowered at her and began to stand up, while the entire class remained silent. Even the girl rummaging through her bag was engrossed in this situation. The tension was so thick you could cut it with a knife.
“That’s enough,” Tekka said quickly, giving Rey a displeased look. “Sit down, both of you.”
“Rey, you did not need to go into that much detail. This is the first week, and we only have--“ He raised an arm towards the clock on the wall, “Twenty minutes left to cover three more items and finish the case. You’ve been talking for ten minutes. Learn to pace yourself.”
Rey nodded sheepishly and settled back into her seat to his left. He barely paid her any mind, and instead returned to his laptop, reading out the next item and selecting backpack girl—Orla—to explain the complications of sickle cell anemia.
“And Rey,” Tekka said quietly as Orla stood up, not looking up from his laptop. “The Philadelphia chromosome can be found in both ALL and CML.”
Rey’s face flushed, and she slunk back deeper into her chair, unable to take the shame.
For the rest of the session, she felt like every eye in the class was on her, judging her for being so quick to anger. Ben got up to present after Orla, and seamlessly explained the management options for sickle cell complications; hydroxyurea to stave off sickle cell crises (though it is teratogenic and myelosuppressive, he felt the need to add), folate supplements, chronic transfusions, prophylactic vaccinations for the encapsulated bacteria infections, and antibiotics for any patients at risk of sepsis. When Tekka quizzed him, he had no trouble answering every last question.
The class actually applauded him as he sat back down. His eyes quickly fell to Rey, who only scowled and crossed her arms.
Finally, the session ended and they were all let go for the weekend. Soon, fifty or so medical students were scrambling out of the building to let the bright sunlight wash over their faces. Rey stepped out and breathed a sigh of relief before turning to scour the chatty crowds for Rose. Finn was probably still in their dorm enjoying lunch. Unlike Rey and Rose, his PBL sessions were in the afternoons.
“Hey Rey!” A voice called out.
She whirled to see her PBL group huddled together, though most were chatting with students from other groups. Orla was waving her hand high to call her over.
“Hey, what’s up?” She asked once she got closer.
“We’re thinking of going to the Pavilion for lunch. D’you wanna come?” Orla responded with a friendly grin.
“Uhhh—“ She hesitated, glancing around one last time for Rose. “Yeah, sure, why not?” She said awkwardly, making a mental note to text her friend later. Rose would be fine with this. Rey hadn’t really gotten out since the blur that was orientation, and she didn’t drink with the others very much. As such, she barely knew her classmates. Lunch together would probably be good in the long-term.
Suddenly, her eyes fell to Ben, standing at the back of the group, and she felt that lump in her throat again. He was staring at her, studying her, but she couldn’t tell if there was anything there anymore. She furrowed her brow, trying to search her mind for something to say. An apology for being too brash, maybe. But then he frowned, looked down at his phone, and turned to Orla.
“Hey, I won’t be able to come. I have to go…do a thing.” He said, trailing off.
Rey’s gaze fell to the phone in his hand. He had never turned it on.
Orla blinked, then nodded. “Yeah sure, but we can rearrange this if you want?”
“No!” He exclaimed, a little too loudly. “You guys go on,” His gaze fell to Rey for the briefest moment yet again, but then he turned away. “This is urgent. I’ll see you guys another time.”
Before anyone could respond, he was stalking off towards the parking lot and soon enough fell out of sight.
“Aaaahh, alright then.” Said Jessika, clearly detecting some of the awkwardness that had just occurred. “Should we start walking over?”
The others nodded, and soon enough they were off. In the ten minutes that it took to walk to the Pavilion, Rey and Jessika fell towards the back of the line, chatting with each other about how their week had gone and what they were planning to do for the weekend (besides more studying, of course). Jessika, or Jess, as she preferred to be called, was living with Kaydel and two boys a floor below Rey, Rose, and Finn.
“So if you ever want to prep for PBL together, let me know,” Jess said with a quick nudge and a wink.
Rey blushed, feeling some of the tension in her shoulders relax. “Thank you.”
When the group arrived at the Pavilion and sat down at a table, she looked around awkwardly and noticed that at least two of them were texting away furiously, barely registering the conversation around them. But they seemed to wrap up their conversations just as quickly, and the lunch went off without a hitch.
Twenty minutes later, she felt her phone vibrate in her pocket. Glancing down, she turned in on to check who it was from. Her blood ran cold when she saw Rose’s name and the message attached.
Lmao Rey, why am I hearing that you threw a whiteboard marker at a guy in PBL??
Rey would have laughed, if the sight didn't cause her to nearly gag from bile building in the back of her throat. She raised her head towards her classmates, who were all chatting away without a care. It hadn't even been an hour since PBL. Someone must have told their friend in another group, and then the rumour mill immediately went to work.
She texted Rose back immediately, Didn't throw anything. I'll explain later.
After lunch, she finally did, before flipping facedown onto the couch and digging her face into the pillow. Rose was beside herself laughing in the corner.
"What on earth were you thinking?!" She exclaimed, though her tone seemed a bit less serious than she was letting on.
Rey groaned and flipped onto her back, clutching the pillow close to her chest. "I wasn't. That's the problem."
She hadn't been thinking at all. In that moment, all she'd wanted to do was show Tekka that she knew what she was doing, that she had a strong base of knowledge in the fields of hematology and oncology. She just snapped at this guy unfairly because he happened to know more than she did. That was a common occurrence in this setting, given the wide range of degrees that people would walk in with. It was unfathomably stupid to blow up at him like that, especially on her first day.
"I'm sure it'll blow over soon," She said after a small pause. "You know how these things usually go. Frankly, I'm just impressed that you managed not to throw something at him."
She turned her head towards her friend, narrowing her eyes suspiciously. "And what is that supposed to mean?"
Rose smiled knowingly, standing up from her chair. "Remember that time you kicked Beaumont out of our biochem group project for not pulling his weight? Or when you stopped talking to Stellan because he just so happened to share your aspirations to work with Prof. Ithano on the honours thesis?"
Rey opened her mouth to say something, but Rose crossed her arms and continued. "Don't pretend you didn't do that. You're one of the most competitive people I know, Rey. And probably the smartest. But you can't let people get into your head like that. Paige was like that in first year too, and it bit her in the ass."
She stiffened, then relaxed. "Okay, so I shouldn't have snapped at him. What now?"
"Just apologise and move on. I doubt he actually cares."
Rey was almost ready to tell her about the way that he seemed keen to avoid her after class ended, but she bit her tongue for the moment. She was probably just reading into things too much.
"Okay, fine. I'll apologise."
"Yeah!" Rose said, humming with satisfaction. "I'm sure everything'll be fine by Monday!"
Rey’s fantabulous list of assorted med school terms:
*OSCE=Objective structured clinical examination
A key part of every medical student’s education. Basically, you go to several stations for about 6 minutes and perform an exam on an actor or mannequin. A professor will also be present to observe and quiz you on the subject. Most students cite these exams as “hell on earth,” “fucking insane,” and “the most accurate way to assess one’s skills as a doctor.”
Note from Jannah: There is a strict business casual dress code. A friend of mine was once kicked out for wearing sneakers.
**kyphosis (AKA medical term for hunchback)=curvature of the spine that causes the top of the back to appear more rounded than normal.
(Not to be confused with scoliosis=sideways curvature of the spine, or lordosis=inward curvature of the lumbar spine)
***PBL=Problem Based Learning
A structure of medical school teaching that has recently begun to grow in popularity in North America and some parts of Europe. Units are organised week by week based on certain cases. Twice a week, students walk through case studies of certain patients, play detective with their presentation, and create a set of study goals, presenting certain subjects to each other in subsequent sessions.
E.x. One week, a case study may discuss a man with colon cancer. Students will spend the week studying and presenting subjects such as lower digestive tract anatomy and physiology, diseases of the colon, carcinogenesis, colon cancer presentation, diagnosis, treatment, and prognosis.
****Philadelphia chromsome=t(9:22). Translocation between the corresponding chromosome arms. Cited as a cause of acute lymphoblastic and chronic myelogenous leukemia. Creates a chimeric protein called BCR-ABL, which can be targeted with the drug Imatinib.