Chapter Text
As soon as she stepped inside, Dr. Baran Al-Hashimi noticed the auditorium at Gaffney Chicago Medical Center had a familiar energy. One that usually accompanied a room full of doctors forced to be somewhere in the morning — too little sleep, too much coffee, and a weird attraction to baked goods and bagels.
When Gloria had asked her to participate in a panel on emergency medicine leadership on behalf of Pittsburgh Trauma Medical Center, Baran couldn’t say no. She was never opposed to a professional discussion, especially one that promised differing viewpoints. Gaffney had also managed to assemble a strong lineup of panelists: physicians who valued metrics but not at the expense of quality patient care. Baran was optimistic she could bring new ideas back to Pittsburgh and convince Gloria, along with the rest of administration, to dedicate additional resources to her department.
She slipped into her seat at the table on the stage, flipped through her notes in her conference folder, and waited for the moderator to begin.
The moderator introduced the four panelists before shifting into questions. There was an older man who served as Director of Emergency Medicine at Cleveland Clinic, an older woman from Jefferson’s emergency department, Baran, and another woman a few years younger than Baran who happened to run Gaffney’s own emergency department: Dr. Caitlin Lenox, also a trauma surgeon according to the embroidery on her lab coat.
“Impressive…” Baran thought as she watched the other woman respond to the first question.
She respected Caitlin Lenox quickly. Caitlin was close to her age, also ran a major Level I Trauma Center, and carried herself with precision. Her speech was measured, straightforward, and difficult to argue with. At least until one of the final questions.
The panel began with the usual subjects where nearly everyone’s answers aligned: physician burnout, staffing shortages, increasing patient volume, operational efficiency. Then, the moderator turned to artificial intelligence.
“Do you believe AI-assisted technology is a helpful tool for operational efficiency and education, or a dangerous shortcut?”
Baran answered without hesitation. “I think it’s important to leverage emerging technology to our advantage. AI can be a useful tool. Used properly, it can make good physicians more efficient. If it can summarize notes in minutes instead of taking an hour manually documenting, that’s time returned to patients. Its value depends on how the physician is using it.”
Across the long table, she watched as Caitlin stopped taking notes and looked up. “That assumes the physician stays in control.”
Baran nodded. “They should.”
The moderator was already preparing to shift the conversation. “Doctor Williams, Doctor Jennings, do you…” He turned to the other panelists.
“I wasn’t finished,” Caitlin said abruptly, her words cutting cleanly through the moderator’s sentence.
The moderator stammered for a second before pausing. Baran looked down at her notes to hide the amusement that had crept into her expression.
“These types of tools change behavior, and not for the better. It allows mediocre providers to look competent for longer than they should.” Caitlin continued without a shred of hesitation before pausing to allow for a response.
A murmur moved through the audience.
Baran held Caitlin’s gaze. “Then the problem is the provider, not the tool.”
Caitlin’s eyebrow rose slightly. “The provider is only using the flawed resource they were given. AI is creating more providers who rely on generated differentials and recognizing patterns created by a program, rather than recognizing patterns in physiological response.”
The room quieted.
“If a provider accepts a generated differential without understanding it or relies solely on AI transcription without proofreading,” Baran continued, “the issue isn’t the existence of the software. It’s that no one taught them how to do the job without it.”
“And if the software makes learning feel unnecessary?”
“The attending should do a better job.”
A few people in the audience laughed under their breath. The moderator looked delighted.
Caitlin considered Baran briefly. “AI is not supportive. It’s a point of failure.”
“Failure points existed before AI.”
“Yes,” Caitlin said. “But AI hides failure until it’s too late.”
For a beat, neither of them looked away.
The moderator glanced between them. “Do we finally have a challenge on this stage?”
Caitlin answered without taking her eyes off Baran. “I think we’re disagreeing about where the danger begins.”
Baran nodded. “And where the responsibility belongs.”
The rest of the panel passed quickly. Each question drew the group back into respectful conversation, and in Baran and Caitlin’s case, spirited disagreements with neither woman seeming particularly interested in surrendering ground.
At the end of the session, the moderator looked at the clock. “Looks like our time is up.” He turned back to the panelists. “Though I think Doctors Lenox and Al-Hashimi could keep this going another hour.” The audience laughed.
Later, the hallway outside the auditorium buzzed with attendees exchanging business cards and making promises of collaboration that would be forgotten the moment they returned to their hospitals.
Baran stood at a high-top table, answering emails on her phone, when a paper coffee cup appeared at the edge of her vision.
“Dr. Al-Hashimi, I believe I owe you half a disagreement.”
She looked up to find Caitlin standing beside her. “Dr. Lenox. I thought we finished disagreeing.”
Caitlin took a sip of her coffee, grimaced, then dropped the cup into the nearest trash can. “We just ran out of scheduled time.”
Baran paused briefly, letting her amusement register internally. “The moderator did keep cutting us off.”
Caitlin glanced toward the exit. “There’s a decent coffee shop a block from here. I’d like to hear the rest of your argument.”
“What if I don’t have one?”
Caitlin shrugged as if the answer was obvious. “We’ll talk about something else.”
Baran laughed softly and collected her belongings. “Fair enough.”
The coffee shop was quieter than either expected. After a day spent in crowded lecture halls, the absence of ambient chatter felt comforting. Caitlin and Baran ordered their drinks and then settled into a corner table with comfortable chairs.
“I still think you’re underestimating the risk of AI dependency,” Caitlin said, wrapping her hands around her coffee.
“And I think you’re giving the software too much blame for human failure.”
“Your point assumes people will always use it as intended.”
“And you’re assuming they won’t.”
Caitlin took a sip of her coffee. “Experience has taught me to prepare for disappointment.”
Baran lifted an eyebrow. “That’s bleak.”
“It’s realistic.”
“I didn’t say you were wrong, just bleak.”
“So, I’m not wrong… Does that mean I win the argument?” Caitlin joked as she stirred a small pod of cream into her coffee.
“I didn’t say I concede. I just agreed with you.” Baran held back a grin and took a sip of her tea.
Caitlin tried her coffee again, it was acceptable. “Based on what you said earlier during the education question, your residents really seem to like you.”
“I’m certain they just tolerate me.”
Caitlin wasn’t convinced. “Do your residents ask you questions?”
“They do.”
“Then they like you.”
Baran shook her head. “You’ve never met my residents.”
“I don’t need to.”
If the statement had come from anybody else, Baran would have thought the person was arrogant. But something about the way Caitlin spoke made the words feel like she was simply sharing a fact she had already verified.
“How do you teach yours?” Baran found herself asking.
“For diagnostics, I make them explain their reasoning.”
“And if they’re wrong?”
“We work through where the reasoning broke down. It’s better to help them get to the right conclusion than to hope they guess correctly.” Caitlin paused to take a another sip of her coffee. “With procedures, it’s basically the same. But you want to give more direction, make sure they get it right when you’re in the room so they don’t kill or maim someone when they’re on their own.”
Baran nodded. “Smart guidance sets them up to understand the process, not just the answers.”
“That’s the goal.” Caitlin stated with a small nod, clearly glad to have found common ground.
The discussion wandered from teaching philosophies, to mass-casualty protocol, from difficult patients, to difficult administrators. As they wrapped up a discussion about being in leadership, they didn’t realize the bright sun outside had shifted to the duller ambiance of late afternoon.
Baran finished her coffee. “I’ve found that being in leadership isn’t always about making tough decisions...”
Caitlin nodded. “It’s about living with them.”
Baran blinked, not expecting Lenox to finish her thoughts. A smile tugged at the corner of her mouth. “Yes, exactly.”
The following silence that settled between them felt natural rather than awkward. Caitlin looked outside and then glanced at her watch.
“It’s been two hours, I should probably get back to the hospital.”
Baran looked at her own watch. “So it has.”
“I’m sorry if I kept you. I thought you had an early flight.”
Baran waved the concern away. “It’s not a big deal.”
They put on their coats and headed outside, beginning the walk back to the hospital.
When they stopped at a crosswalk, Caitlin turned to Baran. “I enjoyed our conversation.” The words were straightforward, almost clinical.
Baran found herself smiling, “So did I. If you’re ever in Pittsburgh, let me know.”
“I have been considering attending the disaster response symposium coming up.”
The two Chiefs exchanged numbers and emails.
“I’ll probably send you a few articles I have saved when I get back to Pittsburgh.” Baran admitted as they crossed the street. “I’d appreciate a new perspective.”
“Articles about AI?” Caitlin asked, her tone edging between joking and serious.
Baran shook her head. “It will be a surprise.”
“Honestly, not a huge fan of those. But I’ll allow it.”
As they both continued their paths back – Caitlin to Gaffney and Baran to her hotel, neither of them considered their meeting remarkable. It had simply been two emergency medicine chiefs discussing their jobs over coffee. Nothing more.
Yet, as Baran walked into her hotel she found herself replaying parts of their café meeting in her head. It had felt good, like she was talking to someone she had known for years, not just hours.
Back at Gaffney, Caitlin sat at a workstation in the ED, looking at her conference folder. But she wasn’t thinking about the conference, she was thinking about Pittsburgh. Without hesitation, she picked up a phone and pushed a few buttons. “Sharon, I’m going to attend that symposium in Pittsburgh. Can you send me the reimbursement forms?”