"What did Surgery say about the pneumothorax?" Dr. Westin asks.

I blink at him. "What? What pneumothorax?"

A pneumothorax occurs when air gets into the space between the lung and the chest wall. It can potentially collapse the lung, so if it's bad enough, Surgery can stick in a needle or a tube to release the air.

But why is Dr. Westin talking about a pneumothorax?

"It was on Mrs. Jefferson's chest X-ray," he says. "Wasn't it? Here, let me bring it up on my computer."

I practically leap off my chair to get a closer look at the computer screen. Within seconds, a picture of Mrs. Jefferson's chest cavity fills the monitor.

And there it is, on the upper right side: a very clear pneumothorax. A vein starts to throb in my temple.

"I see it!" Connie chirps. "It's on the right."

"She had a PICC line put in recently, didn't she?" Dr. Westin muses. "That probably did it."

I jerk my head up to look at Alyssa, who is silent. Not acknowledging the fact that she was the one who misread the X-ray as negative.

And now that patient is dead.

My eyes fall again on her list of patients, at Mrs. Jefferson's name crossed off the list. Like she's nothing. Like her death didn't even matter. All the awful things Alyssa's said to me this month flash through my brain until I start seeing red. And at that point, I just can't stop myself.

"This is your fault," I hiss at Alyssa. My cheeks feel like they're blazing. "You are the one who read the X-ray. You read it wrong! If you were competent at your job, that woman would still be alive right now."

Alyssa stares at me, shocked by my outburst. "Jane, I didn't-"

"Didn't what?" I burst in. "Drop the ball? Obviously you did. You talk about high standards and being knowledgeable when it comes to total bullshit, but when it's actually important and a person's life is at stake, you don't have a clue what you're doing. You can't even read a goddamn chest X-ray!"

Alyssa's mouth is open. She looks like she has something to say to me, but she can't get the words out. Good. Because I've got one more thing left to say to her.

"You killed Mrs. Jefferson," I practically spit at her. "You deserve to lose your license."

Everyone sits there in stunned silence for at least 60 seconds. Even I'm sort of stunned, to be perfectly honest. I can't believe I said all that. I was thinking it, but I can't believe I actually said it. But now that I did, I'm glad. She deserved every word of it.

Alyssa rises from her seat. She's taller than I am, and for a second, I'm slightly afraid she might hit me. I sort of deserve it. But she doesn't. Instead she whirls around and storms out of Dr. Westin's office.

We all watch her leave. It's only after she's gone that I get an inkling that I did something kind of inappropriate. What was I thinking?

"That," Dr. Westin says, "was incredibly unprofessional."

I hang my head. "I'm sorry."

Dr. Westin considers me for a moment, contemplating my fate. I'm suddenly really embarrassed. Why did I say all that? I'm not five years old. I'm in control of my words. It's not my fault! I'm just really, really tired.

"You need to go apologize to her, Jane," he says.

I nod. I can't believe he finally got my name right. And now he'll remember it forever.

_____.

I try paging Alyssa but she doesn't answer. That freaks me out a little, because unlike Sexy Surgeon, Alyssa always answers pages promptly. If she's ignoring her pager, I must have really upset her.

I end up searching the whole damn hospital for Alyssa. She's not in any of the usual locations: the wards, the resident lounge, the call rooms, the cafeteria.

I'm about to give up when I remember that night when I declared that patient dead for the first time and Ryan took me up to the roof. On a whim, I head up to the roof. At the very least, I'll get some fresh air. I could use it.

As the door to the roof swings open, I immediately see her. Alyssa. She's leaning over the edge, facing away from me, holding her phone in her hand. She's not talking to anyone though. She's just looking at the phone. As I get closer, I realize she's looking at a photo of her son.

My chest tightens. She's not going to jump, is she? If I drove her to do that, it's a million times worse than whatever she did or didn't do to Mrs. Jefferson. "Alyssa," I gasp.

She whips her head around. When I see her face, I notice that her eyes are red-rimmed.

"Are you okay?" I say, trying to sound gentle, like the way I'd talk to patients on my psychiatry rotation.

Alyssa snorts and shoves her phone back into her pocket.

"I'm sorry about what I said," I say, taking a careful step towards her. "Just... you know, don't do anything crazy."

Alyssa wipes her eyes. "Don't worry, I'm not going to throw myself off the building, if that's what you're thinking."

"Oh," I say, my shoulders sagging in relief. "Alyssa, I shouldn't have said that you... that you killed Mrs. Jefferson. You didn't."

I'm being honest. Yes, Alyssa missed the pneumothorax. But now that I'm being realistic, that pneumothorax was admittedly pretty small. Mrs. Jefferson was a really sick woman, and as of now, it's not clear that any intervention done for that pneumothorax would have made a difference. In all likelihood, she still would have died. If not today, then tomorrow. It was inevitable-even Mrs. Jefferson realized it.

"No, you had it right the first time," Alyssa says. "I did. I killed her. Or at least, I let her die." She takes a deep breath. "That's something I'm going to have to live with the rest of my life."

I don't know what to say to that.

"I hope it never happens to you," she says.

We stand there in silence for a minute, then Alyssa shivers with a passing breeze. She hugs herself for a moment then pushes past me to go back into the hospital and get back to work.

Chapter 34.

It feels decadent, but I stay on the roof for several minutes after Alyssa leaves. After my meltdown in Dr. Westin's office, I'm pretty sure nobody expects me back quite yet. They're probably debating if they need to call a psychiatry consult on me.

That might not be an entirely terrible idea, actually.

I take Alyssa's place on the edge of the roof, watching all the people milling about on the street. None of these people have any idea that Mrs. Jefferson just died. They don't even know who she is. Why would they?

But I know. And I will always remember.

"Don't jump."

My breath catches in my throat and I whirl around. I should have known: it's Sexy Surgeon. He's standing at the door to the roof, still looking sexy as all hell in his blue scrubs, his short blond hair being tossed every which way by the wind. He's smiling crookedly, which is better than the hateful glare he gave me last time I saw him.

"I wasn't going to jump," I say, shaking my head.

"It's still worth saying," he says, joining me at the edge. He gets close enough that I can feel the heat of his body. "I heard you lost a patient last night. I'm sorry."

I nod. I turn my face away from him so he can't see the tears gathering in my eyes. Why do I keep crying? Nobody else here cries when they lose a patient. It must be the lack of sleep.

"I wish I could be more like you," I say bitterly. "Like, not caring when a patient dies. That would be much easier."

"I care," Ryan insists, his blue eyes wide.

"Yeah, right."

"I do." He hesitates for a moment, then says, "Your patient, Mrs. Coughlin-she died on the operating table right in front of me. The reason I didn't tell you wasn't because I didn't care. I couldn't tell you because I felt so awful about it."

I raise my eyebrows, daring to look at him. He seems to be telling the truth.

"The surgeon who operated on her is a complete asshole," he begins.

"Worse than you?"

"Way worse," Ryan says. "You have no idea. Anyway, I thought he missed tying off one of the vessels and I didn't say anything because I was scared he was going to ream me out, and I figured I was probably wrong. Then she bled out and she died." He closes his eyes. "She died right in front of us. It was horrible. And I kept thinking that if only I'd said something, she would have lived." He pauses, and when he opens his eyes again, they're wet. "She was a nice lady. It was hard to tell her family what happened. Really hard."

So the Great Ryan Reilly is actually a human being. Who would have thunk it?

"And," he adds, "I'm sorry I got pissed off at you the other day. I know I dropped a huge bombshell on you and it's unfair that I expected you not to react."

I nod. "It was... surprising."

"I'll bet."

We're both quiet for a minute, staring down at the city below. I can just barely pick out individuals, going about their daily lives. A man hosing off the sidewalk in front of his store. A homeless man shaking a cup of spare change. A lady hailing a cab. Three people waiting for the bus to arrive.

"You know," I say thoughtfully. "I was just realizing that if you do make it to age 50, you're in the clear, right? Probably, I mean."

Ryan narrows his eyes. "Yeah, so?"

"Well," I say. "That means when you're 50, you can go ahead and get married and have kids."

I think of Mrs. Jefferson's husband sitting at her bedside as she passed on, holding her hand. I want Ryan to have that when he dies. Everyone should have that.

"Great," Ryan snorts. "I'll be the only 60-year-old dad at Little League. Just what I want."

"You'll just have to find some young, trophy wife to marry," I say. "But I'm assuming you'd do that anyway."

"Oh, yeah, of course," Ryan laughs.

"Your future wife probably isn't even in kindergarten yet," I add.

"Hell," Ryan says, "she probably isn't born yet."

I warm up to the game: "Her future parents probably haven't even undergone puberty yet."

Ryan laughs again, but then he gets quiet for a minute, staring off into the distance.

"Or maybe you'll be available," he muses. He smiles winningly and I feel his hand slip into mine. "What do you think?"

I roll my eyes. "If you think I'm waiting for you 20 years, think again, buster. You're not that good-looking."

"You don't have to wait for me," he says, grinning. "You can just dump whatever loser you're with 20 years from now."

I imagine Ryan Reilly 20 years from now. His blond hair will be threaded with gray and there will be crow's feet around those blue eyes, but I can tell he'll still be incredibly sexy. Maybe even more so. And he'll be a great surgeon by then. Maybe he'll be head of the whole surgical department. He definitely has it in him.

And me? I'll still be Dr. Jane McGill.

Hours awake: Lost track.

Chance of a happy ending: At least 50%.

Acknowledgements.

First and foremost, I owe a huge thanks to my family for sleeping long enough to allow me time to write this. And also for not spilling anything sticky on my keyboard during the process.

I am eternally grateful to my bestest cyber pals: Dr. Orthochick, Gizabeth, Dr. Grumpy, Carolyn, and Jenica for their advisement, inspiration, and encouragement. I also want to thank Dr. Arnold and NeuroTrumpet for flashes of inspiration. And a very big thank you to Dr. Katherine Chretien, who introduced me to the wonderful world of blogging.

And finally, I want to thank the real Dr. Alyssa Morgan, for being such a big bitch that I had to write a whole book to complain about you.

end.