# The Intern Who Was Afraid to Make the Wrong Call

*Two fears that sound alike, and the telephone call an intern keeps rehearsing*

Kanwar Partap Singh Gill, MD · November 5, 2026 · Becoming a Doctor

Imagine an intern standing beside a telephone on a hospital ward late at night. He is hypothetical, built from no particular person and no particular hospital, and nothing that happens to him in this essay happened to anyone I could name. A patient he is covering, whom he knows only from a few lines at the evening sign-out, is not quite as well as she was at midnight. Nothing is dramatic. A number has drifted the wrong way. She seems a little less herself. The nurse has mentioned it twice, the second time with more emphasis, and has now gone back to the room without saying a third thing, which he finds more unsettling than the first two. He has examined the patient and looked at what can be looked at, and he has formed an impression that is incomplete. The senior resident is asleep, or busy with someone sicker, and is in any case one call away.

He does not pick up the phone at once. He rehearses. He composes the opening sentence, then a better one, then wonders whether he ought to check one more thing first, so as to have an answer ready for the question he expects to be asked. He knows a fair amount: what the number means in general, what the patient was admitted for, what the plan was at the evening sign-out. He does not know whether this drift is the beginning of something or the noise of an ordinary night, and that is exactly the question he cannot answer alone. He imagines the voice at the other end, and in imagining it he hears, in advance, a small sigh. He imagines the question *what do you want me to do about it?*, and he imagines having no good reply. He imagines, without quite putting it into words, that the call will reveal something about him: that he is slower than the others, that his training is thinner than it looked on paper, that he is the kind of intern who calls.

That rehearsal is the subject of this essay, and its title carries a double meaning that suits it. The wrong call can be a poor decision. It can also be a telephone call made, or not made, at the wrong time. For a first-year doctor the two meanings tend to merge, because the decision he is most afraid of getting wrong is often the decision about whether to ask.

## Twelve Minutes with Döderlein

The fullest account I know of that fear was written by a man who had nobody to call. In the autumn of 1916 Mikhail Bulgakov, newly graduated from the medical faculty at Kiev, was sent to a small hospital at Nikolskoye in Smolensk province, and in the mid-1920s he turned the experience into stories that appeared, most of them, in a Moscow medical journal, and were later gathered as *A Young Doctor's Notebook*. Readers usually remember their comedy. I have come to read them as a study of what a young doctor does with fear when there is no one above him.

In the first story the narrator, sitting alone on his first evening, recalls that back in the big city he had told the authorities he wanted to go out as a second doctor, under someone. They had smiled and told him he would settle in. Now, as the evening comes on, he lists the emergencies that might be brought to his door, and sends a prayer out into the darkness: anything but a strangulated hernia. He had asked, in other words, for exactly what the intern beside the telephone has: a senior colleague within reach. He was refused, and the rest of the cycle is about a man improvising supervision out of books, nurses and luck.

The story called "Baptism by Rotation" in Michael Glenny's translation is the one I return to. The doctor is fetched at night to a woman in labour whose baby lies crosswise. The experienced midwife, Anna Nikolaevna, has already made the diagnosis; his own examination, he admits, could tell him nothing she had not. While he scrubs he thinks, in my rendering, *if only I could read Döderlein now*, Döderlein being the author of his textbook of operative obstetrics. The midwife, unable to restrain herself, remarks as if to no one that a version onto the foot is needed, and the doctor confirms, weightily, that yes, a version onto the foot. The one sentence that surfaces from all his reading is that a transverse lie is an absolutely unfavourable position, which, he reflects, is true both for the woman and for a doctor six months out of university. Then he does something every beginner will recognise. He tells them to get her ready for the anaesthetic while he slips home for his cigarettes, lets a nurse throw his coat over his shoulders, and runs to the book.

He reads, and the reading makes everything worse. Every page insists on danger, the varieties of version multiply, and within minutes he is convinced he understands nothing at all. He looks at his watch and discovers that he has been at home for twelve minutes, while they wait. *Hours are made of minutes,* he observes, *and in such cases the minutes fly madly.* He throws the book down and runs back. And at the basin, as they scrub side by side, the midwife tells him, between the woman's cries, how his predecessor used to perform the manoeuvre. Those ten minutes, the narrator says, gave him more than everything he had read on obstetrics for his state examinations, in which he had received the highest mark precisely in obstetrics. From broken words and unfinished sentences, hints dropped in passing, he learned the one necessary thing that is in no book. He performs the version, relying, as he puts it, on a sense of proportion without which a doctor is good for nothing. Mother and child survive. That night, back at his table, he opens Döderlein again and finds that every dark passage has filled with light.

I read three things in that story. The first is that the twelve minutes with Döderlein are the intern's rehearsal beside the telephone, in an older costume. Both are attempts to arrive at competence privately before being seen; both cost time that belongs to the patient. The second is that the help which worked came sideways, in fragments, from someone lower in the official order, offered so as to leave the doctor's role intact while supplying what he lacked. The midwife's tact, speaking *as if to herself*, is one of the most exact portraits of good supervision in literature, and it was given by someone who was not, formally, a supervisor at all. The third is that the book became intelligible only after the act. Knowledge read in advance and knowledge read after experience are not the same knowledge, and the second kind depends on someone having been willing to stand beside the beginner while the first kind failed him.

## Two Fears in One Voice

The fear of making the wrong call is not a single feeling. Some of it is concern for the patient, which is exactly what one wants a doctor to feel. Some of it is a less admirable worry about how one's limits will look to other people. Inside a tired head the two can sound identical, and they ask for different things. Concern for the patient asks for more attention, sooner. Worry about appearances asks for a more convincing performance of confidence, and sometimes for delay.

Punjabi grammar has a way of describing fear that I find more honest than the English. One does not say *I fear*; one says ਮੈਨੂੰ ਡਰ ਲੱਗਦਾ ਹੈ, *mainūṅ ḍar laggdā hai*, which comes out literally as "fear attaches to me". The speaker is not the agent of his fear but the place where it lands. I would not build a psychology on a grammatical construction, but the picture is useful. Fear arrives; nobody chooses it, and nobody should be shamed for it. What one does once it has attached is another matter, and that is where responsibility begins.

Medical education has studied the second fear more carefully than one might expect. In a study published in the *BMJ* in 2009, Tara Kennedy and her colleagues observed teaching teams in internal and emergency medicine at three Canadian teaching hospitals for 216 hours and then interviewed their members about how trainees decide whether to ask a supervisor for help. The decisions turned on the clinical question, on the supervisor's availability and approachability, and on the trainee's own skill, desire for independence and awareness of being evaluated. Trainees believed that asking too often, or for the wrong reasons, would damage their credibility, and they protected it with recognisable tactics: building a case for the importance of a request, saving requests for opportune moments, making a plan before asking, and directing requests to particular members of the team.

None of those tactics is foolish. A plan made before calling is a courtesy and often an improvement. But each of them can stretch. The case can keep being built after it is already strong enough; the opportune moment can be waited for while the inopportune one goes on unfolding at the bedside; the plan can be polished until the polishing is the point. A simple test helps me to tell the two fears apart. If the question one is preparing to answer is about the patient, the preparation is probably care. If it is about oneself, about how one will sound and what will be thought, the preparation has probably begun to serve the second fear, and every further minute of it is a minute the patient is lending.

For a doctor trained in another country, I suspect the question can acquire a second edge: whether a call for help will be heard as a verdict on the training he brought with him. I would not claim that edge for every international graduate, or say how it felt to any particular one. I mention it because pressures of that kind are seldom said aloud, and a weight that is never named is hard to put down.

## The Invitation Not Taken

It is tempting to think that the problem is permission, and that an intern who has been told plainly to call will call. The best evidence against that comfortable idea comes from a surgeon's account of his own error. In "When Doctors Make Mistakes", published in *The New Yorker* in 1999 and later collected in *Complications* (2002), Atul Gawande describes a night as a surgical resident when his attending, busy in the operating room with another patient, told him as he left that if he ran into any trouble he should call, and one of them would peel away to help. Gawande ran into trouble, with an emergency airway in a badly injured woman, and did not call until the situation had become a crisis. The patient survived because an anaesthesiologist managed to secure her breathing in time, which Gawande attributes frankly to luck. His verdict on himself is a single sentence: "I should have immediately called Dr. Ball for backup."

What makes the essay valuable is what followed. The next day the attending took him aside, and what troubled the older surgeon most, Gawande reports, was not the gap in his skill but that he had not called when there were clear signs of trouble developing. At the hospital's morbidity and mortality conference, the attending answered for the case; nobody there asked the resident why he had not called sooner, because in the hierarchy addressing his errors was the attending's role. Gawande promised to be quicker to ask for help.

The permission in that story was explicit, specific and recent. It was given minutes before the trouble began, by the person who would have answered the call. It still did not produce the call. Whatever stops a trainee from asking is therefore not only the absence of permission. It is the momentum of a task already under way, the wish to be the one who handled it, the narrowing of attention under stress, and a whole informal curriculum about what calls cost, learned from how earlier calls were received. A team's stated policy and its lived policy can differ, and the trainee learns the lived one faster, because it is taught at every hour of the day by tone.

Consider a hypothetical contrast. Two teams in the same hospital work under identical written rules: call your senior about any patient who worsens overnight. On the first team, an intern who calls at two in the morning hears, *Thanks for calling; tell me what you're seeing.* On the second, the same call is met by a pause, and then: *And?* No rule differs between the two. Within a few weeks, though, the interns on the second team are calling later and less often, and presenting their calls more defensively when they do make them, and nobody has told them to. They have learned the lived policy. They have also learned it from one another, because interns compare notes, and a senior's manner on the telephone travels through a residency faster than any memorandum. A new intern can arrive already afraid of a voice he has never heard.

The stated policy has its own history, and it is worth remembering that it was written out of grief. After Libby Zion, an eighteen-year-old college student, died in a New York hospital in 1984, a state panel chaired by the physician Bertrand Bell examined how residents were supervised and how long they worked; New York adopted its recommendations in 1989, requiring attending physicians to be present at all times and limiting residents' hours. The national accrediting body for residency programmes adopted limits on hours for every programme in July 2003, and in 2011 its revised requirements described graded levels of supervision more explicitly. None of this guarantees a call at three in the morning. But it establishes something that a frightened intern can lose sight of: supervision is not a favour the senior grants. It is a duty the institution owes the patient, and the intern who calls is helping the institution keep it.

## Versions of One Call

Go back to the intern at the telephone and let him, at last, make the call. It can be made in many ways, and a few of them are instructive.

In the first version he says something like: *She's just not right. Can you come?* That is vague alarm. It is not useless; it has the great merit of being made, and an experienced listener will sometimes hear in it exactly the urgency that matters and come at once. But it hands the whole work of interpretation to someone who has not seen the patient. The listener cannot tell whether the caller is frightened by the patient or by the night, and has to begin a cross-examination that takes longer than a clearer opening would have.

In the second version he says: *Just letting you know, her numbers have drifted a bit, I've reviewed everything, I think it's fine, I'll keep an eye on her.* That is the overconfident summary, and it is more dangerous than the first because it sounds like competence. It is shaped to need nothing from the listener. A tired senior resident, offered a reason to go back to sleep, will often take it. The call has been made, and the question that prompted it has been quietly withdrawn.

In the third version he says, in substance: *I'm calling about this patient. Since midnight this has changed, and she seems less herself; the nurse is worried too. Here is what I've checked, and here is what I found. Here is what I don't understand. I'm concerned this may be the start of something, and I'd like you to see her, or tell me what you'd do.* That is a candid statement of concern and uncertainty. It separates what he knows, what he suspects and what he cannot explain, and it says each in its own tone. It asks for something specific. It also does a thing the other two do not: it lets the listener assess the caller as well as the patient.

That last virtue of the third version matters more than it first appears. In an earlier study, published in 2008, the same Canadian group examined how supervisors judge whether a trainee can be trusted with independent work, and found that they weighed four things: knowledge and skill, discernment of limitations, truthfulness, and conscientiousness. They also found that supervisors relied a great deal on cues in the trainee's language. Read beside the intern's fear, the finding is almost consoling. The call he dreads as an exposure is one of the main ways a supervisor learns that he is trustworthy, because a candid call displays exactly the qualities on that list. Discernment of limitations cannot be shown by a doctor who never reaches his. It can only be shown at the moment he says where they are.

There is a fourth version, so common that it hardly sounds like a version at all. It opens with an apology: *Sorry to bother you, this is probably nothing, but.* The caller means it as courtesy, and as insurance against being thought alarmist. Its effect is to instruct the listener, before any fact has been offered, to discount what follows. A concern that has been pre-apologised for arrives already half withdrawn, and a tired listener will often take it at the value it has been given. The courtesy that serves a call best is a clear first sentence.

Hospitals have built structures to help with this. One of the most widely taught, SBAR, which stands for situation, background, assessment and recommendation, began in military communication, reportedly aboard nuclear submarines, and was brought into hospital practice in the early 2000s; team-training programmes add graded phrases by which anyone, of any rank, can say that they are concerned, then uncomfortable, then that something is a safety issue. These structures are useful, and I would not want a trainee to be without them. But I would not supply a universal script in their place, and I am wary of the belief that a mnemonic solves the problem. A structure can carry a concern once someone has decided to voice it. It cannot make the decision.

## The Other End of the Line

There is an unfairness in discussing courage only from the caller's end. Consider the person who answers. He may have been asleep for twenty minutes after most of a day and a night awake, or he may be standing at another bedside with a patient who is plainly sicker. He hears a voice he may barely know, describing a patient he has never seen, with information that is incomplete in ways neither of them can yet specify. His irritation, if he feels it, is often aimed at the night rather than the caller. The caller, however, cannot tell the difference, and will remember the tone long after he has forgotten the content.

He may also be afraid, and of something similar. In most teaching hospitals the senior resident is only a year or two further on, and he too has someone above him whom he may hesitate to wake. A vague call puts him in the intern's position one level higher: he must decide whether this is something he can settle himself or something he must carry upward, and now his own credibility is in play. Fear in a hierarchy is seldom located in one person. It runs along the chain of calls, and a reluctant link anywhere along it can stop information that every person below has correctly passed on. Gawande's account shows this end of the line as well. Asked at the conference what he would have done differently, the attending said that he probably should have sent his chief resident up sooner, or come himself; and when he took Gawande aside, his voice, Gawande writes, was more wounded than angry. A supervisor who reacts badly to a call is sometimes reacting to the position the call has put him in. That is understandable. It does not change what the reaction teaches.

The person answering the phone is teaching, whether or not teaching is on his mind. A reply can answer the immediate question and leave the caller less able to ask the next one. It can also answer the question while making the reasoning visible: *this is the part that concerns me; this is the detail I need; this is why I want to see her myself.* The difference is not always warmth. A brief, direct reply can be generous if it shows the trainee how the work is done. A long, kindly one can be useless if it leaves him no wiser about when to call again.

An intern may need courage to speak, but a service should not require an unusual supply of it before relevant information reaches the person who can help. If asking an appropriate question repeatedly carries a social penalty, the atmosphere has become part of the clinical problem. That does not mean every call is well prepared or that every concern can be answered at once. Preparation matters, and so does learning from feedback. But useful feedback separates the quality of the presentation from the legitimacy of asking. *Next time, have the latest results in front of you* teaches a task. *You shouldn't need me for this* makes a statement about identity, and it can outlast the task by years.

One of the most quoted sentences in Western medicine already contains this point, though it is usually quoted only by its first half. The first of the Hippocratic *Aphorisms* begins with life short and the art long, the occasion fleeting, experiment perilous and judgement difficult. Its second sentence, in the nineteenth-century English of Francis Adams, reads: "The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate." The cooperation of others is placed inside the physician's duty, not outside it. And the word the Greek uses for the fleeting occasion, *kairos*, is the word for the right moment, the one that will not wait. The intern's rehearsal and Bulgakov's twelve minutes are both spent from that account.

## The Case for Fewer Calls

Calling has its own costs, and they are not trivial. Trainees who call about everything do not learn to decide. Supervisors who are woken for every small drift become exhausted, and exhausted supervisors make their own errors. A culture of reflexive calling can diffuse responsibility until nobody owns a decision, and a doctor who has never been allowed to sit with uncertainty for an hour will meet it, alone, for the first time on the day he finishes training. Graduated responsibility exists precisely so that people learn to carry more of it, and that requires, at some point, not calling.

All of that is true, and none of it is an argument for fear. Fear is a poor teacher of judgement because it suppresses calls indiscriminately: it silences the unnecessary call and the necessary one alike, and it is often strongest in exactly the conscientious trainees who most need to be heard. If the aim is fewer unnecessary calls, the tools are explicit rather than atmospheric. A programme can say plainly which situations must always be called, so that the trainee does not have to guess. Supervision can be fitted to the task, close for the unfamiliar and lighter for what the trainee has already shown he can do. And feedback can come after the fact, in daylight: *you could have handled that one; here is how I knew; here is the sign that would have made me want the call.* That kind of answer teaches the trainee to call less by teaching him what the calls were for. Fear teaches him only that calling is costly, which he will remember on the night when it is not optional.

Nor should a trainee's remaining concern be dismissed because advice has been given. Sometimes the intern describes the patient, receives a reassuring reply, and still finds that his concern has not gone away. That is not insubordination. It may be information. The useful responses are modest and institutional: to restate the specific thing that worries him, to ask what would change the senior's view, to ask the senior to see the patient, or to use the route the hospital provides for exactly this situation. Team-training programmes formalise the habit of voicing a concern a second time if the first was not heard. Local policy and the patient's circumstances should govern what happens next, not a doctor's private heroism or an essay's general advice. The point is only that a concern answered is not the same as a concern resolved, and that a well-run service makes the difference speakable.

## Confidence After the Call

What should confidence mean for a young doctor? It cannot mean that doubt has disappeared before a decision is made. Doubt is sometimes the mind noticing something that deserves more work, and a doctor who has trained himself to silence it has lost an instrument. Nor can uncertainty become a permanent shelter. There is a difference between acknowledging one's limits and using them to avoid being answerable. The hard thing is to remain answerable without making certainty the price of acting.

Durable confidence grows from three sources: an accurate sense of what one can and cannot do, dependable supervision that catches what one misses, and feedback about how things actually turned out. It is easily confused with something cheaper, which is simply receiving fewer corrections. Fewer corrections may mean greater competence. They may also mean that nobody is watching closely, that the trainee has learned to present only what will pass, or that supervisors are checking quietly and fixing things without comment. Kennedy's group, in a study published in 2007, named that last practice *backstage oversight*: double-checking of which the trainee is not directly aware. It is often wise and kind. It also means that a trainee who concludes from silence that he has become independent may be mistaken about the very thing he is most proud of.

The third source, feedback about outcomes, is the one a training hospital supplies most erratically. Trainees work in shifts and rotations, and a patient handed over at seven in the morning may leave an intern's working life entirely by noon. He may never learn whether the drift he called about became the illness he feared, or whether the call he did not make would have changed anything. Without that knowledge his calibration has nothing to correct against, and he is left to infer his accuracy from the tone of the replies, which measures something else. A team that tells a trainee, a day or a week later, what became of the patient he called about is giving him the one kind of feedback that can make his next judgement better and not merely braver.

The English poem most often given to young men as a model of self-command is Kipling's "If—", published in 1910. "If you can keep your head when all about you / Are losing theirs and blaming it on you," it begins, and the next line offers the ideal of trusting yourself when all men doubt you. Kipling said that he had the character of Leander Starr Jameson in mind. Jameson was a physician, trained at University College Hospital in London, who had gone out to practise at Kimberley in South Africa, and whose most famous act was the raid he led at the end of 1895, a privately armed incursion into the Transvaal that ended in surrender. It is a strange model for imperturbable judgement: a doctor remembered for an unsupported venture that collapsed. But the poem is wiser than its occasion. The line about trusting yourself is followed by another: "But make allowance for their doubting too." That second line is the one I would give an intern. Self-trust that makes no room for other people's doubt is not confidence. It is a refusal to be checked.

## ਹੌਸਲਾ

Punjabi has a word for what the frightened intern needs, and it is not the word for fearlessness. ਹੌਸਲਾ (*hauslā*) means courage, fortitude, heart. It came into the language through Persian from an Arabic word for the crop of a bird, the pouch in which a bird holds what it has gathered, and in Persian it had already come to mean patience, forbearance and the courage that patience makes possible. I like that history. Courage, on this account, is a kind of holding capacity: the room inside a person to carry what has not yet been digested.

What interests me more is how it is used. In ordinary Punjabi hausla is given as often as it is possessed: ਹੌਸਲਾ ਦੇਣਾ (*hauslā deṇā*), to give someone heart, is what a friend does at a hospital bedside or an elder does before an examination. One is told to keep it, ਹੌਸਲਾ ਰੱਖ, and not to lose it. The grammar of the word assumes that courage passes between people. If fear, in the Punjabi construction, attaches to a person, courage is something another person can hand over.

The Mool Mantar, at the opening of the Guru Granth Sahib, names freedom from fear among the attributes of the One. I read that, for my own purposes and not as a statement of what Sikh teaching requires, as a reminder that fearlessness is not the standard a human beginner should be held to. The human vocabulary is the other word: courage given and kept, with fear still present. An intern does not need to stop being afraid in order to make the call. He needs enough hausla to make it with the fear attached, and some of that hausla has to come from the people at the other end of the line.

## What the Experienced Owe

Those of us further along have a responsibility for the atmosphere around questions, and it is a responsibility of manner more than of policy. The young doctor learns what calls cost from how they are received, and he learns it from everyone senior to him, not only from those formally assigned to teach.

My own preference, stated as a preference, is plain. Were I the one answering, I would rather be told of a concern that turns out to be unnecessary than discover in the morning one that was never voiced. I would rather the first thing a caller hears is an answer, and the teaching come after. I would like feedback to separate the presentation from the right to ask, so that a trainee can leave a difficult conversation knowing both what to improve and that the next necessary question still belongs in the room. And I think the strongest argument for asking is the sight of someone senior doing it without apology: a consultant ringing a colleague, an experienced physician saying in front of a student, *I'm not sure; let me find out.* Kennedy's group suggested something similar, that supervisors could weaken the ideal of the wholly independent doctor by letting trainees see them seek help. It teaches that asking belongs to the work at every stage of a career and is not a phase one is expected to outgrow.

Go back, one last time, to the intern beside the telephone. He has been standing there for some minutes now, and the rehearsal has done what rehearsals do: it has made the first sentence better and the call later. Bulgakov's young doctor spent twelve minutes with his textbook and learned in the end that the necessary thing was at the basin, in a midwife's unfinished sentences. Gawande was invited to call and did not, and afterwards wrote one of the most candid accounts I know of how that happens. The intern's fear is real, and part of it is care, and part of it is pride, and he will not sort the two perfectly tonight. He does not have to. He has only to let the fear send him toward the patient and toward the person who can help, and to trust that, at the other end, someone who was once where he is will pick up the phone in a way that makes the next call easier to make.

## Evidence and Editorial Note

**Documented findings.** Public biography: PGY-1 at the University of Arkansas for Medical Sciences, 2007–2008, after an MBBS in Amritsar. Bulgakov's graduation from Kiev University in 1916 and posting to Nikolskoye, Smolensk province; publication of the stories in 1925–1927, chiefly in the Moscow journal *Meditsinsky rabotnik*, and as a cycle in 1963; Michael Glenny's 1975 translation and its story titles: Wikipedia, "Mikhail Bulgakov" and "A Young Doctor's Notebook", and the Russian Wikisource edition. The request to go as a second doctor and the reply "you'll settle in", the prayer against a strangulated hernia, the midwife's diagnosis and murmured "version onto the foot", the one remembered sentence on the transverse lie, the pretext of cigarettes, the twelve minutes at home with Döderlein's *Operative Obstetrics*, "hours are made of minutes", the ten minutes at the basin worth more than the obstetrics read for the state examinations, the sense of proportion, and the book filling with light afterwards: the Russian texts of «Полотенце с петухом» and «Крещение поворотом» (Wikisource, public domain), in the author's own renderings. Atul Gawande, "When Doctors Make Mistakes", *The New Yorker*, February 1, 1999 (collected in *Complications*, 2002): the attending's invitation to call, the delayed call, the sentence quoted, the conversation the next day and the attending's voice "more wounded than angry", the morbidity and mortality conference and the attending's answer that he might have sent his chief resident sooner, the patient's survival: the article on newyorker.com; the collection's date and contents: Wikipedia, "Complications: A Surgeon's Notes on an Imperfect Science". Kennedy, Regehr, Baker and Lingard, *BMJ* 2009;338:b128 (three Canadian teaching hospitals, 216 hours of observation, influences on requests for support, the four credibility-preserving strategies); Kennedy and colleagues, *Academic Medicine* 2008 (four dimensions of trustworthiness; reliance on language cues); Kennedy and colleagues, *Journal of General Internal Medicine* 2007;22:1080–1085 (routine, responsive and backstage oversight): abstracts via Europe PMC. The suggestion that supervisors let trainees see them seek help: the 2009 paper as summarised by the Washington University Journal Club and CORE. The Libby Zion case, the Bell Commission, New York's 1989 rules on attending presence and hours, and the ACGME's national limits of July 2003: Wikipedia, "Libby Zion Law"; the 2011 revision of supervision requirements: general knowledge of the ACGME Common Program Requirements. SBAR's military origin and adoption at Kaiser Permanente in 2002: Wikipedia, "SBAR"; the graded concern phrases and the practice of voicing a concern twice in team training (TeamSTEPPS): standard descriptions. The first Hippocratic aphorism in Greek and in Francis Adams's translation, including the second sentence quoted: Wikipedia, "Ars longa, vita brevis". Kipling's "If—" (*Rewards and Fairies*, 1910), its inspiration in Leander Starr Jameson per Kipling's *Something of Myself* (1937); Jameson's medical training at University College Hospital, practice at Kimberley and the failed raid of 1895: Wikipedia, "If—" and "Leander Starr Jameson"; the lines quoted are public domain. ਹੌਸਲਾ from Classical Persian *ḥawṣala* (crop, maw; patience; courage) and Arabic *ḥawṣala* (a bird's crop): Wiktionary; the constructions ਮੈਨੂੰ ਡਰ ਲੱਗਦਾ ਹੈ, ਹੌਸਲਾ ਦੇਣਾ and ਹੌਸਲਾ ਰੱਖ: standard Punjabi usage. The Mool Mantar's naming of freedom from fear as an attribute of the One: standard description; no Gurbani is quoted. **Vendor representations.** None.

**Recollection and tradition.** The intern at the telephone, the versions of his call, the two teams with identical rules and the reply of the person answering are hypothetical and illustrative; they do not describe a real person, patient, hospital or night, and no clinical details are intended as guidance. The intern is not the author. No remembered moment of fear, decision, call or supervision from the author's own training is described, and no supervisory practice of the author's is claimed. The remark about international medical graduates is the author's speculation, explicitly not a claim about any individual, including himself. The reading of the Mool Mantar is the author's personal reflection, not a statement of Sikh teaching.

**Analysis and forecast.** The readings of Bulgakov, Gawande, the Hippocratic aphorism and Kipling, the distinction between concern and self-protection, the analysis of the three calls, the answer to the case for fewer calls, the account of confidence, the reflections on ਡਰ and ਹੌਸਲਾ, and the closing preferences are the author's present-day interpretation and ethical preference as of November 6, 2026. **Independence.** This essay is not sponsored by any institution, company, health system or technology developer. It is personal reflection, not medical advice; readers seeking care should contact their own physician's office.



## Related reading

- [Little Rock, 2007](https://personal.kpsgill.com/essays/little-rock-2007/)
- [The Art of Saying “I Don’t Know Yet”](https://personal.kpsgill.com/essays/the-art-of-saying-i-don-t-know-yet/)
- [The First Time Someone Called Me Doctor](https://personal.kpsgill.com/essays/the-first-time-someone-called-me-doctor/)