I didn't go to lunch. Instead, I headed straight to the surgical lounge at 12:15. Better early than scrambling at the last minute. The lounge was empty except for a surgical tech folding scrubs on a metal table.

  "You're early," she said without looking up.

  "First day. Didn't want to be late."

  She gestured to the shelves. "Scrubs are organized by size. Small, medium, large. Shoe covers and caps are in the bins. Change in the locker room, leave your stuff in a locker. Don't bring your phone into the OR."

  I grabbed medium scrubs; loose green cotton. Changed in the locker room, shoved my clothes and phone into an empty locker. Put on the shoe covers, then the surgical cap. Looked at myself in the mirror. I looked like every other medical student who'd ever stood in this room, nervous and trying not to show it.

  By 12:40, other people started filtering in. Dr. Kimathi appeared, already in scrubs. "You're here. Good. First case is the appendectomy I mentioned. Dr. Okafor is the primary surgeon. You'll observe. Remember; don't touch anything, don't talk unless asked, don't faint."

  "Got it."

  "Come on. Scrub sink is outside OR 3."

  I followed her down the hallway. Then we stopped at a large sink outside OR 3. There were already two people scrubbing—Dr. Chen and Dr. Petrov.

  Dr. Kimathi demonstrated. "Watch first."

  She turned on the water with her elbow, no hands. Wet her hands and forearms up to the elbows. Grabbed a pre-packaged scrub brush with betadine soap. Started scrubbing—nails first, each finger, back of hand, palm, wrist, forearm. She counted under her breath, timing each section.

  "Three minutes total," she said. "Don't miss anything. Don't touch anything non-sterile once you start. If you do, you start over."

  She finished, held her hands up, elbows down, letting water drip off her elbows instead of her hands. Backed through the OR doors using her shoulder.

  "Your turn," Dr. Chen said to me.

  I turned on the water with my elbow. Wet my hands and forearms. Grabbed a scrub brush. Started the process. The System flickered on.

  I kept scrubbing. Palms, backs of hands, wrists, forearms. The betadine was orange and the smell was medicinal. Finally finished. Held my hands up, elbows down, exactly like Dr. Kimathi had shown. Water dripped off my elbows.

  "Good," Dr. Chen said. "Now back through the doors without touching anything."

  I used my shoulder to push through the door, hands held up in front of me like I was surrendering. Inside OR 3, everything was bright, cold and sterile. The surgical lights were massive, positioned over an operating table where a young guy was already unconscious. The anesthesiologist sat at the head of the table, monitoring screens. A scrub nurse stood at a table covered in surgical instruments, all precisely arranged.

  Dr. Okafor was already gowned and gloved, standing next to the table. Dr. Kimathi was across from him. A nurse helped me into a sterile gown, held it open so I could slip my arms in without touching the outside. Then gloves. She pulled them on for me, carefully, not to contaminate them.

  "Stand there," Dr. Kimathi pointed to a spot against the wall, about six feet from the table. "Don't move. Don't touch anything. If you need to scratch your face or adjust your mask, step away from the sterile field first and tell someone."

  I nodded and moved to the designated spot. There were other medical students already there, pressed against the wall. I recognized two from my year. We exchanged glances but didn't talk. Dr. Okafor looked at the team. "Everyone ready?"

  Nods all around.

  "Let's begin."

  He picked up a scalpel. Made the first incision—a small cut in the right lower quadrant. Blood welled up immediately. The scrub nurse handed him a cautery device. He touched it to the bleeders, the smell of burning flesh filling the OR.

  I was too far back. Could barely see over Dr. Chen's shoulder. The other students were having the same problem, all of us craning our necks, shifting positions slightly, trying to get a better view. One of the students, took a small step forward.

  The scrub nurse noticed immediately. "Back. You're in the sterile field."

  That student stepped back immediately, face red behind his mask.

  I stayed where I was. This was the unspoken hierarchy, students were observers, not participants. We could watch from a distance but we couldn't get close. If we wanted to see better, we had to earn it by not being in the way.

  Dr. Okafor inserted the first trocar—a port through which he'd insert the laparoscopic instruments. The monitors above the table flickered on, showing the inside of the patient's abdomen. That was better. I could see the screen clearly from where I stood. The System activated.

  I watched the screen. Dr. Okafor maneuvered instruments inside the abdomen and found the appendix; red and swollen. Used graspers to manipulate it into view.

  "Camera up," he said calmly. Dr. Chen adjusted the camera angle. "Better. Now focus on the base."

  The appendix filled the screen. Dr. Okafor clamped the base where it connected to the cecum. Placed a ligature around it, tied it off to prevent spillage. Then cut above the ligature. The entire process was smooth, no wasted movement.

  My nose itched, I ignored it. Fifteen minutes later, it itched worse. I tried to ignore it longer, but it became unbearable. If I moved my hand, I’d ruin everything. If I didn’t, I’d go insane. I stepped back from my position. Raised my hand slightly. "Dr. Kimathi?"

  She glanced over. "What?"

  "My nose itches. Can I—"

  "Step back to the door. Use your elbow to adjust your mask if you can. Don't touch your face with your hands."

  I backed up to the door, used my elbow to rub my nose through the mask. It barely helped but it was better than nothing. Stepped back to my position.

  One of the other students, a girl, shifted her weight. Her elbow bumped the instrument table. The scrub nurse's head whipped around. "Don't touch that."

  "Sorry, I didn't mean..."

  "If you contaminated anything, we have to re-sterilize the entire setup. Pay attention to where you are."

  Her face went red. She pressed herself flatter against the wall.

  Dr. Okafor removed the appendix through one of the ports. "Specimen to pathology." He irrigated the surgical site with saline, checked for bleeding, then nodded to Dr. Chen. "Close."

  Dr. Chen stepped in to close the port sites. The procedure was winding down. I glanced at the monitors one more time, trying to memorize the anatomy, the technique, the way everything fit together.

  My hand drifted slightly; not intentionally, just absent-mindedly and my finger touched the edge of the sterile instrument tray. The scrub nurse's voice cut across the room immediately. "Student. Stop."

  I froze.

  "Don't move." She looked down at the tray, checking the arrangement of instruments with her eyes. Then looked at me. "You're in my zone."

  I stepped back. "I'm sorry, I didn't mean to."

  "I don't care if you meant to." Her voice was controlled but pointed. "This tray is my responsibility. Everything on it is accounted for. When a student's hand appears near it, I don't know what you've moved, what you've disturbed, what you've knocked out of position. I can't do my job if I'm watching you instead of watching the surgeon."

  Dr. Kimathi looked at me from across the table. "Ashrahan. Step out."

  "I'm sorry—"

  "Don't apologize. Step out. Re-scrub if you want to come back in. Otherwise, wait in the lounge."

  "I'll re-scrub."

  I backed out of the OR, careful not to touch anything else.

  Outside, I stripped off the contaminated gloves and gown. Dropped them in the biohazard bin and went back to the scrub sink. Started the entire process over. This time I paid attention to every movement. Every position of my hands. Didn't let my mind wander. Finished scrubbing. Backed through the doors again.

  The nurse helped me into a new gown and gloves. I went back to my spot against the wall.

  Dr. Okafor was finishing the closure. He didn't look at me but I knew he'd noticed. Everyone had noticed.

  "What did you learn?" Dr. Kimathi asked quietly.

  "To pay attention to where my hands are, always."

  "Good. Don't make that mistake again."

  "I won't."

  The procedure finished. Dr. Chen placed the final suture. The drapes came off. The patient was wheeled out to recovery.

  Dr. Okafor stripped off his gloves. Looked at me directly.

  "First time in an OR?"

  "No, sir. I observed cases during Orthopedics."

  "Did you contaminate the field then too?"

  "No, sir."

  "Then why today?"

  I didn't have a good answer. "I wasn't paying attention. I'm sorry."

  "Sorry doesn't help the patient if you introduce bacteria into a surgical site." His tone wasn't angry, just matter-of-fact. "You're a student. Mistakes are expected. But you don't get to make the same mistake twice. Understood?"

  "Yes, sir."

  "We have another appendectomy in forty minutes. You can observe that one if you want. But if you contaminate the field again, you're done for the day."

  "I understand. Thank you."

  He left the OR. Dr. Kimathi stayed behind, stripping off her gown.

  "You got off easy," she said. "Some attendings would've kicked you out immediately."

  "I know. I'm sorry."

  "Don't apologize to me. Just be better." She paused. "The position against the wall isn't ideal for seeing. But you're not entitled to a better spot. You earn it by proving you can be trusted not to fuck up. Fourth-years get to stand closer. You're third-year, so you need to work hard. Show up consistently, don't make stupid mistakes, and eventually you'll get better positions."

  "How long does that take?"

  "Depends on the student. Some people earn trust quickly. Others never do." She looked at me. "You've got good assessment skills on the ward. I saw your work with the nausea patient this morning. That was solid but the OR is different. Everything is sterile, everything is precise, and there's no room for distraction."

  "I understand."

  "Good. Next case is in forty minutes. Get some water, take a break. Be back here at 1:40."

  I left the OR and went to the lounge. Sat down in a chair and put my head in my hands. My phone was still in the locker. I couldn't check for updates on Akki or text Murin. Couldn't do anything except sit here and think about how I'd fucked up something as simple as standing still.

  I dismissed it. Didn't need the System to tell me I'd screwed up. Sat there for thirty minutes. Other students filtered in and out. Some were talking about their cases. Others looked as shell-shocked as I felt. At 1:35, I got up and went back to the scrub sink. This time I'd pay attention.