“You okay?”

“Yeah. Just need some air.”

I fling open the door to the loading dock and settle on the platform’s edge, stretching my legs over the empty space, shivering as the wind billows the thin cotton of my scrub pants. But instead of my legs I see the patient’s bloated ones, and I kick back hard against the concrete.

My patient. I only have two. Well, one now.

Wind drowns out the street sounds, but my ears cling to the recent past: overlapping voices, creaking bed springs, beeping monitors, ventilator alarms. Above it all, my intern Amelia’s clear voice:

…87 year old woman with a history of COPD, admitted for hypoxemic respiratory failure…

It should have been me presenting the patient to the dozens of people crowding the room. I’m the one who spent two hours interviewing her Thursday night while the intern admitted four patients to my one. But all I could do was gape at the dusky color of her skin and the unnerving way her feet bounced with each chest compression.

I button my white coat against the chill, sending the weight of the knickknacks in my pockets sliding forward: wads of creased alcohol swabs, trauma shears I’ve never used, a thick stack of wound dressing adhesive. A pocket medicine guide only half as useful as my smartphone. They pull me earthward like a yoke around my neck.

You’d better buck up if you’re going to make it in medicine, the intern had said as she left, after it was all over.

It’s nothing I don’t already know. In two years, I’ll be the intern. In three, I’ll be leading the code. The thought makes the world tip, and I scoot back a little from the edge.

The patient’s face flashes in my mind, not blue like her corpse just now, but pinched and unfriendly like it was yesterday. Moments ago, she’d been a person. She’d been one for longer than my parents have, with beliefs and opinions. She hadn’t been a nice person, but she’d had the ability at least, to choose whether to be nice or not. And now she was what? A pile of rapidly-stiffening flesh.

In through your nose, out through your mouth. The words of my therapist float through my mind, but I can’t focus enough for breathing exercises. It was a deficiency of air in my patient’s lungs, after all, that caused her death.

The door creaks behind me. When I look up, Freddy’s propping it open with a cinder block. His white coat, much longer than mine, whips in the breeze.

“Was that your first code?” He sits down next to me.

“Yeah.”

“Did she make it?”

I shake my head.

“I’m sorry. What happened?”

I have every intention of answering him, but everything runs together and all I can do is shake my head again.

He peers down at the ground below. “It gets easier.”

Freddy’s the resident on the other team. With his intern off today, he can’t possibly have time to babysit a weepy medical student.

I try to disguise my sob as a cough. Freddy lifts his head and studies me.

“You’re not responsible, okay? Our patients are really sick.”

Guilt’s not something I’ve even considered yet, and the prospect only deepens my despair. In two years, the blood will be on my hands.

“I don’t see how I’ll ever be ready.”

“We all felt the same way once,” he says. “But you’ll get better with practice.”

It’s hard to see that happening, the way things work around here. Whenever I ask Amelia a question, she just tells me to look it up. The expectation in my training program, it seems, is that I already know everything.

“I can’t see Amelia ever reacting this way.” I try to keep my voice neutral, but the bitterness leaks out anyway.

Freddy watches the traffic for so long I think he’s about to reprimand me. To her superiors, Amelia’s probably always sunshine and rainbows. “There will be Amelias at every stage of your training,” he says finally. “The key is to not let them drag you down.”

I rake at the strands of hair across my face, as if clearing them is even achievable on this gusty platform. Do I even want this anymore? I whisper, so that only the wind can hear me.

“I wish it wasn’t like this.”

“Cultures are hard to change.” The scraping of leaves over the pavement nearly obscures his voice. “Medical education has a long and toxic history. But you can be that change.”

I give him a bland smile.

“No, really,” he says. “Amelia’s smart and capable. She’s going to be a good doctor. But you? You have the potential to be a great one.”

He’s just saying that. I shake my head.

He waves his hands in circles, palms up, the way my therapist does when coaching me to breathe, and I inhale reflexively without understanding his meaning. The cold air bites my nostrils and a tiny drop of rain lands on my cheek.

“This,” he says, as he waves. “Your reaction. Don’t lose this.” He gets up. “Take a little time out here. Then try to let the patient go. Set her free.”

After he leaves, I breathe deeply again. The air stings my nasal passages, but it warms and sweetens as it enters my chest, splits down millions of passages to fortify my tissues. For a while I think about the woman who can no longer choose to be nice or not nice.

Something brushes against my windswept hair and settles next to me. I pick up the leaf and twirl it by its dry and fragile stem. It’s new, freshly severed from its tree, still free from damage or decay. With the next gust I release it from my fingertips, watching its fluttering course as it joins the eddies in the parking lot.

I get up, kick away the cinder block, and go back inside.

Katie Yang writes fiction in North Carolina. By day (and sometimes night), she also practices anesthesiology. She holds an MD from Duke University. First Code is her first publication outside of the scientific literature.