CHAPTER FOUR

GABRIELA’S POV

By now, I could practically hear my own heartbeat pounding in my ears loud, rhythmic, and completely uninvited. I didn't need a stethoscope to know that my heart was betraying my nerves. Professor Nathaniel stepped forward, his tall frame looming slightly as he glanced at the monitor beside the patient’s bed.

“Check the monitor,” he said calmly, yet with an edge that made my stomach tighten. “Review the patient’s echocardiogram and MRI and tell me what you see.”

I swallowed hard and nodded, forcing my feet to move. With each step, I could feel the weight of everyone's eyes on me the other residents, nurses, even some of the more alert patients nearby. My palms were already damp.

I reached the monitor and bent slightly to examine it. First, I opened the MRI scan, letting my eyes sweep across the black and white image that revealed the complex inner workings of the patient’s heart. I studied it carefully, trying to block out the chaotic rhythm of my own anxious thoughts.

Then, I navigated to the ECG results. Numbers, waveforms, and patterns danced on the screen, each detail demanding my full attention. I stared at it longer than I probably should have, trying to ensure I wasn’t missing anything. I could feel a thin trickle of sweat making its way down the back of my neck.

Finally, I straightened up slowly, trying to regain control over my shaking breath. Professor Nathaniel looked at me, waiting. His expression unreadable.

“What do you observe?” he asked.

I took a slow, silent breath in and let it out carefully. My voice came out steady somehow though I could feel the thudding of my heart echoing in my chest.

“Sir,” I began, gesturing toward the screen, “on the MRI scan, I observed a backflow of blood from the aorta into the left ventricle during ventricular diastole. It appears to be due to a defective closure of the aortic valve right here.” I pointed to the area on the scan.

Professor Nathaniel didn’t say a word. He just kept looking at me.

My chest tightened.

“And the ECG?” he prompted.

I took another breath, this time a little less shaky. “The ECG shows an increase in the left ventricular end-diastolic pressure (LVEDP) and left atrial pressure (LAP), with a regurgitant jet diameter of twenty-two percent and a pressure half-time of 550 milliseconds.”

A small, approving smile tugged at the corner of Professor Nathaniel’s lips as he glanced at Dr Gabriel. My pulse quickened, unsure if it was a good sign or a polite precursor to correction.

“And your diagnosis?” Professor Nathaniel asked, folding his arms.

I paused for a moment to gather the courage to continue “Based on the findings, sir, I believe the patient has acute aortic regurgitation, currently still within the mild range.”

There was silence for a moment.

Professor Nathaniel turned toward Dr. Gabriel, the chief resident, standing just a few feet away. “Dr. Gabriel, do you agree with her diagnosis?”

Gabriel gave a small nod. “Yes, sir. That diagnosis is accurate.”

A wave of relief crashed over me, but I didn’t let it show on my face. Instead, I stood straighter, more confident now.

Professor Nathaniel looked back at me. “And how do you know it’s acute and not chronic?”

I answered without hesitation this time. “The ventricle appears normal in size. It hasn’t undergone hypertrophy or dilation, which are features more consistent with chronic aortic regurgitation. Since there are none of these signs then, I believe this is acute.”

He gave a slow nod, clearly satisfied with the reason.

“Good,” he said. “Then tell me what is the appropriate treatment for this diagnosis?”

My heart rate spiked again. Why is he asking only me? I wondered briefly.

I pushed the thought aside and responded, “Treatment typically involves either aortic valve repair or replacement. But since this is a mild case of acute aortic regurgitation, a valve repair may be the preferred option at this stage.”

He nodded again. “Correct. We’ll still discuss whether repair or replacement is better for this particular case with the surgical team. But you’re thinking in the right direction.”

I allowed myself the smallest exhale of relief.

Then he turned back to the rest of us. “First-year residents, take note. Expect more like this going forward.”

Just then, Ava, who had been standing beside me this entire time, nudged me gently and gave me a thumbs-up. I caught her grin and mouthed a quiet “Thank you” in return, grateful beyond words.

Professor Nathaniel turned to me again. “Gabriella, you’ll be in charge of this patient, alongside Dr Charles.”

“Yes, sir,” I replied, my voice now more certain. My heart was still racing, but this time, it wasn’t just from fear it was from a flicker of pride.

After we moved on from the patient I had just diagnosed, Professor Nathaniel began assigning the remaining patients to the rest of the resident doctors. I watched quietly as names were called and duties were distributed.

Once the final assignment was given, Professor Nathaniel dismissed us for the day. The group slowly dispersed, some whispering among themselves, others retreating into thoughtful silence.

As we exited the ward, Ava fell into step beside me, nudging me again with a smirk. “You absolutely crushed that,” she whispered.

I smiled, the adrenaline still humming faintly in my veins. “Barely survived it.”

“But you did survive,” she said. “And you made it look easy.” I shook my head with a small laugh.

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