When my alarm screamed at 6:15 AM, I felt worse than if I hadn't slept at all. My shoulders ached from holding the airway position, my lower back from kneeling on hard tiles, my hands from gripping that BVM mask like my life depended on it.

  Murin was already dressed, his hair wet from the shower. Akki was still in bed, one arm thrown over his face, his jaw clenched even in stillness. We got ready in silence and headed to the hospital.

  Ward 6 was already busy when we arrived. Dr. Bennett was at the nurses' station, reviewing overnight admissions. He looked up when he saw me. "You were involved in the cardiac arrest last night. The hostel emergency."

  It wasn't a question, news traveled fast in teaching hospitals. I nodded.

  "Good response time. The patient is in the ICU now, intubated and sedated. We'll know more in twenty-four hours whether there's significant neurological damage." He paused, then went back to his charts. "You're still with Dr. Priyana today. She has three new admissions from overnight. Start with Bed 22."

  No praise or criticism, just back to work. Maybe that was the point: one emergency doesn't change the fact that there are thirty other patients who still need care.

  I found Dr. Priyana near the medication room, preparing IV antibiotics. She gave me a tired smile when she saw me. "Hell of a first week." She handed me a chart. "Bed 22. Forty-two-year-old male, came in at 2 AM with progressive weakness in both legs. Started two days ago, now he can barely walk. No trauma, no pain. Neurology wants us to work him up before they see him."

  I took the chart and walked toward Bed 22. Progressive bilateral leg weakness. The differential started forming in my head. The patient was sitting up in bed, a lean man with tired eyes and worry etched into his face. His legs were visible under the thin hospital blanket; normal-looking, no obvious atrophy or deformity.

  I introduced myself and started taking the history. The weakness had started in his feet two days ago, a strange tingling sensation, then numbness, then difficulty standing. Yesterday it progressed up to his knees. This morning he'd fallen twice trying to walk to the bathroom.

  "Any recent illness? Fever, cough, diarrhea?"

  He thought about it. "Actually, yes. I had bad diarrhea about two weeks ago. Lasted three or four days. I thought it was food poisoning."

  Guillain-Barré. An autoimmune attack on the peripheral nerves, often triggered by infection. It could progress rapidly, paralyzing the respiratory muscles. People could die if not treated quickly. "Any difficulty breathing? Trouble swallowing?"

  "No, nothing like that. Just the legs."

  "Can you lift your legs for me? One at a time."

  He tried. The left leg barely lifted off the bed. The right leg moved even less. Significant motor weakness, bilateral and symmetric. I tested his reflexes with the reflex hammer. Knee jerks—absent. Ankle jerks—absent. In peripheral nerve disease, reflexes disappear. These absent reflexes were exactly what I'd expect with Guillain-Barré.

  I moved to sensory testing. Light touch, pinprick. Decreased sensation in both feet and lower legs, with a glove-and-stocking distribution. Everything pointed to Guillain-Barré.

  I found Dr. Priyana quickly. "Bed 22. Forty-two-year-old male with progressive ascending weakness over two days. Started in feet, now up to knees. Recent gastroenteritis two weeks ago. On exam, bilateral leg weakness, areflexia, decreased sensation. I think this is Guillain-Barré syndrome."

  "Did you check respiratory function?"

  "He's not having difficulty breathing yet."

  "Yet being the key word. Show me." We went back to Bed 22 together. She confirmed my findings, then pulled out a spirometer from the equipment cart.

  "I need you to take the deepest breath you can, then blow into this as hard and fast as possible."

  He did. The number that appeared made Dr. Priyana pause. "Forced vital capacity is 65% of predicted. Not critical yet, but it's already declining. We need to establish a baseline and monitor this closely—if it drops below 20 mL per kilogram or he develops bulbar symptoms, he'll need intubation." She turned to me. "This needs urgent neurology consult and ICU admission for serial respiratory monitoring."

  Within the hour, the neurology team was at the bedside. They confirmed the suspected diagnosis, ordered a lumbar puncture to check for elevated protein in the cerebrospinal fluid, and arranged for nerve conduction studies. The patient was started on IV immunoglobulin—the treatment that could stop the immune system from attacking his nerves further.

  By afternoon, he was transferred to the ICU for close respiratory monitoring. Dr. Bennett found me writing notes at the nurses' station.

  "Dr. Priyana said you caught the Guillain-Barré early. Most students would have missed it. They would have focused on the weakness, ordered imaging, wasted time. You connected the pattern." He paused. "You're learning to think like a doctor. Keep it up."

  A case of theft: this story is not rightfully on Amazon; if you spot it, report the violation.

  He walked away before I could respond. I sat there, staring at my notes. A man had come in barely able to walk, and within hours he might not be able to breathe on his own. But because we'd caught it early, started treatment immediately, he had a chance.

  My phone buzzed. A text from my mother.

  How is everything? Are you eating properly? Your father says hello. Zoya aunty mentioned she's going to the city for some medical tests next week. Make sure you eat vegetables.

  I smiled at the randomness of it. I typed back a quick response. Everything's fine. Eating well. Say hi to Dad. Will call at night.

  The next three days passed in a blink of eyes, if anything in a teaching hospital could be called routine.

  Wednesday: Rounds, admissions, discharge planning. I examined a patient with chronic kidney disease, drew blood from someone with pneumonia, assisted with a lumbar puncture that I mostly observed rather than performed. The Guillain-Barré syndrome patient in Bed 22 showed improvement—his weakness had stabilized, and his respiratory parameters remained steady. He still couldn’t walk independently, but the progression had halted. Dr. Bennett called it a good outcome.

  Thursday: More of the same. A new admission with chest pain that turned out to be gastroesophageal reflux, not a heart attack. I felt simultaneously relieved and foolish for having considered acute coronary syndrome. Dr. Priyana reminded me that ruling out dangerous things was part of the job, even when they turned out to be nothing. I placed three more IVs. Failed one, succeeded on two.

  Friday morning started with pathology class. Then rounds at 10:30 AM, the usual parade of patients with familiar problems. Until we reached Bed 31.

  The patient was a woman in her mid-fifties, admitted two days ago for poorly controlled diabetes. She'd been stable, responding well to insulin adjustment. But overnight, something had changed. "She's complaining of left arm pain," the night intern reported during handoff. "Started around 3 AM. Gave her some paracetamol, pain improved. Vitals stable."

  Dr. Bennett frowned. "Left arm pain? Any chest discomfort?"

  "She denied chest pain. Just the arm."

  "Did you get an ECG?"

  Pause. "No, sir. She said it was muscular pain from lying in bed too long."

  Dr. Bennett's expression darkened. "Are you the doctor or is she? She's a diabetic woman with arm pain and you didn't consider cardiac etiology?"

  The intern's face went pale. "I... I thought..."

  "You didn't think. That's the problem." Dr. Bennett turned to the nurse. "Get an ECG now and call cardiology."

  We moved to Bed 31. The patient was sitting up, looking uncomfortable but not acutely distressed. When Dr. Bennett asked about the pain, she described it as a dull ache in her left arm, nothing terrible, probably just from sleeping wrong.

  But her voice had that quality I was starting to recognize: the careful minimization of symptoms that women often did, downplaying discomfort, not wanting to be dramatic or demanding.

  The ECG machine arrived. The technician placed the leads quickly, and the printout emerged. Dr. Bennett studied it. "Subtle ST depressions in the lateral leads. Possible NSTEMI." He looked at the intern. "This is a heart attack. Atypical presentation, but still a heart attack. Women often present without chest pain—arm pain, jaw pain, nausea, fatigue. You should know this."

  The intern looked like he wanted to disappear into the floor. Orders were given rapidly. Blood tests for cardiac enzymes, aspirin administered immediately, cardiology consulted urgently, the patient transferred to the cardiac monitoring unit. Within fifteen minutes, Bed 31 was empty, she wheeled away for further evaluation and treatment.

  Dr. Bennett turned to our group of students. "Learn from this. Not every heart attack looks like the textbook. Not every patient clutches their chest and collapses dramatically. Diabetic patients often have silent ischemia, they don't feel typical cardiac pain because of nerve damage. Women present differently than men. If you only look for classic presentations, you'll miss half your diagnoses."

  He walked away, leaving the intern standing there, visibly shaken. Dr. Priyana put a hand on his shoulder. "You'll never make that mistake again," she said quietly. "That's how we learn."

  I stood there, watching the intern process his near-miss, and realized how easy it would have been to make the same error. Left arm pain? Could be muscular. Could be nothing. Except it wasn't nothing. It was a heart attack that could have been fatal if caught any later.

  The intern worked quietly, double-checking everything, clearly traumatized by the experience. Her cardiac enzymes came back elevated—confirmed NSTEMI, non-ST elevation myocardial infarction. She'd undergo cardiac catheterization the next day. She'd survive, probably, because someone had finally taken her arm pain seriously.

  I spent most of Saturday practicing physical exam techniques on whoever would let me. Akki volunteered his abdomen for palpation practice. Murin let me examine his cranial nerves repeatedly until I could do it without fumbling through the sequence.

  Sunday afternoon, I was in our room studying microbiology when my phone rang. Unknown number.

  "Hello?"

  "Ashru? This is Zoya aunty."

  My neighbor. The one whose shoulder impingement I'd diagnosed weeks ago.

  "Aunty! How are you? How's the shoulder?"

  "Much better, thank you. Listen, I'm going to be in the city this week for some medical tests. Nothing serious, just routine checkup. Your mother insisted I call you, maybe we can meet for lunch?"

  "Of course, that would be great. What day?"

  "Wednesday, probably. I'll let you know once I confirm the appointment time."

  We chatted for a few more minutes: neighborhood gossip, my mother's constant worry about whether I was eating properly, my father's latest project and other normal things.

  After we hung up, I felt a strange pang of homesickness. I'd been so consumed by the hospital, by learning, by trying not to kill anyone, that I hadn't thought about home in weeks.