Chapter 4

Chapter 4 — Rival

Alya had just finished reviewing a patient's laboratory results when Dr. Bagas called the entire team into the discussion room. Two new patients had been admitted since the early hours of the morning, and one of them required further evaluation before a decision could be made regarding medical intervention.

Alya carried the patient's notes as she walked alongside Naya toward the room. Rafi was already seated in one of the chairs with his laptop open, while Raka stood near the whiteboard, reading a report from the emergency department.

Alya chose the seat beside Naya without greeting her.

"Good morning," Dr. Bagas said once everyone had gathered. "Today, we will discuss two newly admitted patients. I want each of you to present your own analysis before we determine the treatment plans."

Dr. Bagas displayed a summary of the first patient's condition on the screen. The patient was a sixty-two-year-old man who had presented with shortness of breath and swelling in both legs. He had a history of hypertension and heart disease, but over the past several days, he admitted that he had not been taking his medication regularly.

"Who has examined this patient?" Dr. Bagas asked.

"Dr. Raka and I have, Doctor," Alya answered.

"Good. Alya, please present your findings first."

Alya stood and explained the patient's condition based on the medical history, physical examination, and available preliminary test results. She pointed out signs of fluid overload that required further evaluation, then outlined the additional investigations she believed were necessary to assess the patient's cardiac condition and kidney function.

Dr. Bagas listened without interrupting, occasionally jotting down important points in his small notebook.

"What about the initial treatment plan?" he asked when Alya had finished.

Alya explained the steps she intended to take, emphasizing the importance of closely monitoring the patient's condition. She also stated that the cause of the shortness of breath needed to be established before further treatment could be determined.

"All right. Raka, is there anything else you would like to add?"

Raka stood, holding his notes.

"Overall, I agree with Alya's analysis. However, I think we need to pay closer attention to the possibility of impaired kidney function because the patient reported a decrease in urine output since yesterday. I would also like to verify the previous examination results, particularly the information regarding the patient's adherence to the prescribed medication."

Alya turned toward him.

"The decrease in urine output certainly needs to be considered, but we cannot determine its cause based on that information alone. We still need to review the kidney function test results and assess the patient's overall condition."

"I'm not drawing any conclusions," Raka replied. "I'm only suggesting that those tests should be one of our priorities."

"And I'm not rejecting those tests. I simply want us to consider all the available data before deciding on a diagnostic direction."

Raka gave a small nod. "Then we're in agreement."

Alya sat down again and straightened her notes. She disliked the way Raka responded to her opinions, but she could not deny that his suggestion regarding kidney function was relevant to the patient's condition.

Dr. Bagas looked from one of them to the other before continuing the discussion.

"Good. You are allowed to have different opinions as long as you can explain the clinical reasoning behind them. I don't want you to agree with each other without conducting your own assessments, but I also don't want disagreements to turn into arguments that lead nowhere."

Alya nodded.

"Understood, Doctor."

Raka did the same.

The discussion of the first patient continued with input from the rest of the team. Afterward, they moved on to the second patient, who had a high fever accompanied by a decreased level of consciousness. The discussion lasted longer because the patient's condition required immediate evaluation and coordination with several other departments.

Alya and Raka presented their respective opinions again. This time, they were more careful in how they expressed their arguments, although they occasionally continued to question the reasoning behind each other's proposed decisions.

When the meeting ended, Dr. Bagas instructed them to proceed with the examination plans immediately and report any changes in the patients' conditions.

"For the weekend evaluation, I want each team member to prepare a case report based on a patient you have treated. Choose one case that you believe has taught you the most important clinical lesson, then present your analysis and treatment decisions."

Rafi immediately opened the calendar on his laptop.

"When is the presentation, Doctor?"

"Monday morning."

Rafi stared at the screen in disbelief. "This coming Monday, Doctor?"

Dr. Bagas raised an eyebrow. "Was there another Monday you thought I meant?"

Naya suppressed a laugh while Rafi rubbed his face.

"Understood, Doctor. I'll adjust my schedule."

Alya began noting down the deadline. She was already accustomed to academic assignments piling up alongside her clinical duties, but she still needed to manage her time carefully to ensure that preparing the report would not interfere with her responsibilities toward her patients.

"Since you are all on the same team, feel free to help one another discuss the cases," Dr. Bagas continued. "However, each person must prepare their own analysis. I want to see what each of you is capable of."

Alya had just finished taking notes when Raka closed his laptop and turned toward her.

"Have you chosen a patient for your presentation yet?"

"Not yet. I'll decide after checking how the patients are doing today."

"I'm considering the patient in room 318 whom we treated yesterday. The case is quite interesting because of the patient's history of previous surgery."

Alya nodded. "I'm considering that case too, but we need to make sure all the necessary data is available."

"Then we can take another look at it later."

Alya put her pen into her bag before standing. "I'm going to check on my patients."

Raka did not stop her. He simply nodded and returned to organizing his belongings.

---

Shortly before ten o'clock, Alya was in the examination room when a nurse brought in the latest laboratory results for the patient who had previously experienced shortness of breath. She reviewed the results carefully, then compared them with the earlier findings to assess any changes in the patient's condition.

After making sure nothing had been overlooked, Alya contacted the attending physician and reported the patient's progress. She then instructed the nurse to continue monitoring the patient according to the existing orders.

When she left the patient's room, she found Raka speaking with the patient's family in the corridor.

He was explaining why the patient needed to undergo several additional tests in simple language. He also listened patiently to the family's questions, occasionally pausing to make sure they understood the information he had provided.

Alya slowed her pace as she passed them, not because she deliberately wanted to listen, but because she had to wait for a nurse to push a trolley through the relatively narrow corridor.

"So, is there a chance my father will get better, Doctor?" a middle-aged woman asked.

"We're providing treatment to help improve his condition, ma'am. We'll continue monitoring his progress, and the attending physician will explain the next test results once everything is available."

The woman nodded, looking slightly more reassured.

"Thank you, Doctor. I'm sorry if we're asking too many questions."

"That's all right, ma'am. You have every right to understand your family member's condition. If there's anything else you'd like to ask, please feel free to let us know."

Alya continued walking once the trolley had passed. She did not want to admit that Raka was quite good at communicating with patients' families, but it was difficult to deny what she had just witnessed.

They might have plenty of personal issues between them, but Raka was still a doctor who understood his responsibilities.

That realization irritated Alya slightly, especially because she had spent much of the past few days focusing on the things she disliked about him.

However, she quickly redirected her thoughts to the patient waiting for her in the next room.

---

As lunchtime approached, Alya returned to the doctors' room to finish her documentation. She had just opened her computer when Raka arrived carrying two sheets of test results.

"Alya, I've received the additional test results for the patient in room 318."

Alya shifted her chair slightly to give Raka a better view of the computer screen.

"What do they show?"

Raka placed the documents on the desk and explained the findings from the tests. They then compared them with the previous results to determine whether any changes needed to be reported to the attending physician immediately.

After they finished discussing the results, Alya pointed to one section of the notes.

"This part is incomplete. The patient's medication history needs to be documented more clearly."

"I'll add it."

"Check the examination times as well. Two of the entries have different times recorded."

Raka read the section, then nodded.

"You're right. I'll confirm it with the nurse on duty."

Alya returned to typing on her computer. A few minutes later, Raka finished correcting the notes and showed her the revised version.

"Done. Take another look."

Alya read the document from beginning to end. After confirming that all the necessary information had been included, she nodded.

"Everything is complete now."

Raka pulled up a chair opposite her.

"Then, about Monday's presentation, what if we choose the same case but discuss it from different perspectives? You could explain the diagnostic process, while I cover the considerations behind the treatment decisions."

Alya thought for a moment before answering.

"Dr. Bagas asked each of us to prepare our own analysis. We can discuss the case together, but I don't want our presentations to depend too heavily on each other."

"That makes sense. I was just thinking that we could exchange information so we don't overlook any data."

"We can exchange information that's relevant to the patient. As for the analysis, I'll prepare mine independently."

Raka nodded without arguing.

"All right. If you find any additional relevant data later, let me know."

"I will."

Their conversation ended when Naya entered the doctors' room and announced that the cafeteria was serving a different lunch menu than usual. Rafi, who had been working at the neighboring desk, immediately stood up, while Naya invited Alya to come with her.

Alya saved the document on her computer before picking up her small bag.

As she passed Raka's desk, she noticed him reading the patient's test results again. He looked serious, occasionally writing something in the small notebook he always carried.

Alya said nothing and quickly followed Naya toward the cafeteria.

---

Two days later, the atmosphere in the conference room was more tense than usual. Dr. Bagas had asked each team member to present a case they had treated, then posed questions to test their understanding of diagnosis and treatment.

Alya was the third to present. She chose a case involving a patient with a digestive disorder that required a series of examinations before a diagnosis could be established.

During her presentation, Alya explained the patient's medical history, physical examination findings, laboratory results, and the reasoning behind each step of the treatment plan. She also discussed several alternative diagnoses that had been considered before the additional test results became available.

Dr. Bagas asked several questions throughout the presentation, but Alya answered most of them clearly. When she encountered one point she could not fully explain, she acknowledged the limitations of the available information and described the additional investigations she believed were necessary.

After Alya finished her presentation, Dr. Bagas offered several suggestions on how to make clinical reports more concise and systematic.

"Overall, your analysis is good. You were also quite thorough in explaining the reasoning behind your decisions. However, in the section on differential diagnoses, I want you to explain the reasons for ruling out other possibilities in a more structured manner."

Alya wrote down the feedback.

"Understood, Doctor. I'll improve it."

"Please take your seat. Raka, you're next."

Raka stood and connected his laptop to the screen. He chose a case involving a patient with a respiratory disorder who had required intensive evaluation during treatment.

His presentation was well organized, beginning with the chief complaint and continuing through the patient's progress after treatment. Raka also explained the clinical considerations behind the additional examinations and why particular interventions had been selected based on the patient's condition.

Alya listened while taking notes on several points she found interesting. Although she did not want to admit it, she had to acknowledge that Raka was capable of developing a systematic analysis and defending his reasoning when questioned.

At the end of the presentation, Dr. Bagas nodded.

"Good analysis. You were able to connect the clinical findings with the treatment plan clearly. However, several areas need further development, particularly your consideration of the risks and benefits of the chosen interventions."

Raka nodded. "Understood, Doctor."

Dr. Bagas then closed his laptop and looked at all the residents.

"I want you to understand that clinical competence is not judged solely by how quickly you arrive at a diagnosis. You must also be able to explain the reasoning behind your decisions, recognize the limitations of the available information, and work with the other members of your team. A good doctor is not someone who always believes they are right, but someone who is willing to reevaluate their judgment when new evidence emerges."

Alya wrote the final sentence in the corner of her notes.

For some reason, she felt that the advice applied to more than just their work.

After the evaluation session ended, the residents began packing their belongings. Naya approached Alya with a water bottle in hand, then glanced at Raka, who was speaking with Dr. Bagas.

"Your presentation was good," Naya said.

Alya put her laptop into her bag. "There are still parts I need to improve."

"There will always be something to improve. But you answered Dr. Bagas's questions well."

"Thank you."

Naya smiled, then lowered her voice. "Raka did well too."

Alya immediately turned toward her.

"Why are you telling me that?"

"Because you're both on the same team, and we're talking about the presentations."

"Then just talk about the presentations. There's no need to connect it to me."

Naya chuckled. "All right, the esteemed Dr. Alya."

Alya shook her head as she walked toward the door, leaving Naya still laughing behind her.

---

That afternoon, Alya was finishing a patient report when Dr. Bagas sent a message through the team group chat. They were required to attend an additional case discussion the following week, and each team member had to prepare one question based on their own clinical experience.

Alya read the message, then began compiling a list of cases she might use for the discussion.

Raka, sitting at the desk opposite hers, was reading the same message.

"Have you decided which case you'll use?" he asked.

"Not yet. I want to review the progress of the patients currently under treatment first."

"I'm thinking of choosing a case involving a patient with a respiratory disorder. There are several things I'd like to ask about the evaluation process following initial treatment."

Alya nodded. "That could make a good discussion topic."

Raka seemed slightly surprised by her response, perhaps because Alya was usually quicker to criticize than to express agreement.

"What about you?" he asked.

"I'm considering the case of the patient with abdominal pain whom we treated a few days ago. I want to review the diagnostic process again."

"If you need additional data, I still have a copy of the test results we used at the time."

"I'll review the patient's records first. If any information is missing, I'll contact you."

Raka nodded.

Their conversation ended when a nurse arrived with a new file that needed to be reviewed. Alya immediately took it, while Raka returned to his computer to continue working.

They still had plenty of differences, and Alya had no intention of changing her attitude toward Raka simply because they had managed to work together reasonably well over the past few days. However, she was beginning to realize that disliking someone did not mean she had to lose the ability to evaluate that person's work objectively.

To her, Raka was still someone who had once hurt her feelings, but here at the hospital, he was also a doctor who had responsibilities to fulfill.

Alya opened the next patient's file and began reading the report from the beginning. When she found a test result that had not been included in the summary, she immediately contacted the nurse to verify the information, then corrected the notes before moving on to the next patient.

Across the room, Raka was doing the same with the file he was handling.

Occasionally, they exchanged information about patients, reviewed test results, or discussed the steps that needed to be taken. Their conversations remained brief and professional, but at least their work was proceeding as it should.

When the wall clock showed five in the afternoon, Alya placed the final file in the archive cabinet. She picked up her bag and said goodbye to Naya and Rafi, who were still finishing their reports.

Near the door, Raka was speaking with a nurse about the schedule for the following day's patient examinations. Alya passed him with a brief nod, then continued toward the elevator.

"Alya," Raka called before she could step inside.

She turned around. "Yes?"

"We start rounds at six thirty tomorrow. Dr. Bagas has asked the team to arrive early because there's a patient evaluation before the meeting."

"I've already read the message."

"All right. See you tomorrow."

Alya gave a small nod. "See you tomorrow."

The elevator doors opened. Alya stepped inside and pressed the ground-floor button, then stood facing the doors as they slowly closed.

Meanwhile, Raka returned to the nurse who had been waiting for him and continued their discussion about the patient's examination schedule.