Author's Notes: Chapter 9
Two POVs
Sophie
The Silence
I looked at Kane. He looked away.
That was the moment. Not when the nail split the tibia; that was just a complication, the kind we all may have, and I will learn to avoid. Not when Judith said I should have reamed it first; that was just feedback, the kind I needed to hear. The moment was Kane’s silence. His eyes sliding past mine. His mouth staying shut.
I had called him from emergency the night before. Standard procedure: registrar calls consultant, describes the case, asks for guidance. Eighteen-year-old male, closed oblique fracture, lower tib and fib. I thought he should have a tibial nail. “Should I ream it first?”
“No,” Kane said. And hung up.
So I didn’t ream. The nail got stuck in the hard bone of a young male. I hammered it. It split the tibia above the fracture. I salvaged the situation with cross screws, but it wasn’t as good as it should have been. I knew it would look bad on Monday morning.
What I didn’t know was that I’d be standing there alone.
When I called Kane that night, I was making myself vulnerable to him. I didn’t think of it that way at the time, it’s just what registrars do, what the system requires. But that’s what trust is. You put yourself in a position where someone else’s judgment, someone else’s character, will affect what happens to you. You believe they’ll treat your situation as if it were their own.
Kane didn’t treat my situation as his own. When it mattered, he protected himself.
I felt bad enough botching the operation but this was something else. This was discovering that I didn’t matter enough to him for him to acknowledge his part in it. I was nothing to him. Of no consequence.
Ted found me under the Leichardt tree afterwards, sweating in the heat, staring at nothing.
“You should be able to trust your seniors to support you,” he said. “Kane put his own reputation before yours. He let you down.”
“It feels much worse than that.”
“Yes. He betrayed you.”
There’s a difference between disappointment and betrayal. If my car won’t start, I’m disappointed. It’s only a machine I rely on. But if a colleague I counted on throws me under the bus, I’m betrayed. The difference is that I care whether people regard me as someone who matters. Kane showed me I didn’t.
Ted told me about a surgical registrar who called his consultant for advice during the night. The next morning, when the decision was questioned, the consultant denied he’d agreed to it. “I can still see the hurt in his eyes,” the man who told Ted the story had said. Twenty-five years later.
I understood. Some harmful actions you do don’t fade from your memory.
“How do I trust anyone after this?” I asked.
“By learning to trust wisely,” Ted said. “Not blindly, not without protection, but wisely. You know now that Kane is capable of protecting himself at your expense. That’s valuable information, even though it hurts to learn it. You can trust his technical knowledge without trusting him with your vulnerability.”
Trust is specific, Ted explained. It’s not a single thing you either have or don’t have. I can no longer trust Kane to put my welfare first when his reputation is at stake. That doesn’t mean I can’t trust his knowledge of anatomy, or trust that he’ll show up for shifts. Trust is context-specific, relationship-specific. Not a binary switch.
I still have to work with Kane. I still have to learn from him when he has something to teach. But I’ll do it with my eyes open now.
What I keep thinking about is the moment I looked at him and he looked away. He could have said something. He could have said, “I advised Sophie not to ream based on the information she gave me. In retrospect, with hard bone in a young male, reaming would have been safer. We both learned something here.” That would have been honest. It would have shared the responsibility appropriately.
But he said nothing. And that silence told me everything about who he is when it matters.
Judith was kind about it. “In orthopaedics, perfection is sometimes the enemy of good enough. It’s a forgivable mistake. Sophie will learn from it.” She supported me in the meeting when Kane wouldn’t.
Ted reminded me that most people are better than Kane showed himself to be that day. The system only works if most people, most of the time, honour the obligations that come with their positions. Seniors have to be trustworthy. Not just competent but genuinely committed to their juniors’ development and welfare.
I don’t know what Kane felt afterwards. Guilt, maybe. The sting of conscience when you know you’ve failed someone. Or maybe he rationalised it, told himself it wasn’t really his responsibility. I’ll know by what he does next. Guilt can lead to reflection and change if someone has the courage to face it. Rationalisation just leads to more of the same. Either way, I learned something that day about trust, about vulnerability, about who I can count on when things go wrong.
Questions for Reflection
1. Sophie trusted Kane because the system required it. How should training programmes protect juniors when seniors prove untrustworthy?
2. Ted distinguishes between trusting someone’s technical knowledge and trusting them with your vulnerability. How do we learn to make these distinctions?
3. Kane could have shared responsibility honestly. What stops people from acknowledging their part in things that go wrong?
4. The essay suggests betrayal differs from disappointment because we care whether people regard us as mattering. Why does this distinction matter ethically?
5. Sophie says she’ll know Kane’s character by what he does next. What would genuine remorse look like, and would it be enough to rebuild trust?
Kane
The Walls
Sophie looked at me. I looked away.
I knew what she wanted. I knew what I should have said. But I sat there in the back row with my mouth shut while Judith told her she should have reamed the nail, while Sophie explained the difference between reamed and unreamed to the students, while she turned to me and asked, “That’s right, isn’t it?”
“Yes,” I mumbled. And said nothing more.
The morning had already gone wrong before I arrived. Isobel and I had been arguing from the moment we woke; about what, I can’t even remember now. I was late leaving, pushing through traffic, punching the horn. At the roundabout on Lake Street, I tried to squeeze past a truck, couldn’t see properly, and smashed into a red Mercedes. An old man with white hair, shaking. I called him a stupid idiot. He had the right of way.
By the time I got to the meeting, Sophie was already showing the X-rays.
She had called me from emergency a few nights before. Standard procedure. She described the case—eighteen-year-old male, closed oblique fracture, lower tib and fib, and asked if she should ream the nail first.
“No,” I said. And hung up.
I don’t remember why I said no. I don’t remember thinking about it carefully. I was probably distracted, probably irritated, probably wanting to get back to whatever I was doing. A young male with hard bone. I should have known. She was asking because she didn’t have the experience to decide on her own. That’s what consultants are for.
When Sophie looked at me in that meeting, I saw what she needed. She needed me to say, “I advised Sophie not to ream. In retrospect, with hard bone in a young male, reaming would have been safer. We both learned something here.” That’s all it would have taken. A few words. Shared responsibility.
Instead, I calculated. I’m a junior consultant, still establishing my reputation. If I admit I was involved in the decision, it reflects poorly on me. Sophie is even more junior, a registrar. The system will blame her anyway. If I stay quiet, I’m protected.
So I stayed quiet. I watched Sophie’s face freeze. I watched her take the blame alone.
I left work early. The house was empty except for Toby, running around in circles. I ignored him and went to the fridge looking for something sweet. Found a chocolate cake. Went to the toilet. Came back to find Toby on the table, finishing it off.
I roared. I chased him around the room, shouting, waving my arms. I threw a cushion that tumbled him over. Cornered, he quivered with fear. I shaped to kick him. Lifted my foot.
And stopped.
My God, it’s happened again.
I put my hand down slowly, palms out. Waited for him to stop cowering. Put my arms around him and gently scruffed his fur. “I’m sorry,” I said. “Sorry.” Toby licked me. Tentatively.
When the children came home, I couldn’t move from the couch. Milly brandished a mouth organ. The others jostled behind her with their gifts. Olivia persisted. “Look what I got. It’s a wabbit.”
“GO AWAY!”
Her face collapsed. Tears flowed. “You shit,” I heard Isobel say.
She was right.
That night, when everyone was asleep, I sat alone and thought about walls. Grim grey walls that shriek and rock, that forbid entry, that warn you away. I had spent my life climbing them, scaling them, never pausing to hear their calls. And when I finally reached the top and stopped to stare, my heart felt cold.
There was nothing there.
I had climbed over everyone to get here. Isobel, who gave up her career to follow mine. My daughters, who wanted nothing but my attention. Sophie, who trusted me to support her. The old man in the Mercedes, who had the right of way.
And now I sat at the top of the wall, and there was nothing there. All for nothing.
I called out in despair, “Help me.” No one heard.
I don’t know yet what I’ll do with this. Whether I’ll find the courage to face what I’ve become, or whether I’ll rationalise it away and carry on as before. I know what guilt feels like. The sting of conscience when you know you’ve failed someone. I know what Sophie’s face looked like when I said nothing. Twenty-five years from now, will I still see that face? Will I have changed, or will I still be climbing walls that lead nowhere, hurting everyone who gets in my way? The answer depends on what I do next. And I don’t know yet what that will be.
Questions for Reflection
1. Kane’s betrayal of Sophie came after a morning of accumulated stress. Does context mitigate moral failure, or only explain it?
2. Kane stopped himself before kicking Toby. What does that moment of restraint tell us about his capacity for change?
3. The essay connects Kane’s treatment of Sophie to his treatment of his family. How do patterns of behaviour in one domain reflect character more broadly?
4. Kane knew what he should have said but calculated the cost to his reputation. When does self-protection become betrayal?
5. “Help me,” Kane called. “No one heard.” What kind of help might he need, and who could provide it?