The last Monday in Internal Medicine felt like the end of something I hadn't realized I'd gotten attached to. I stood at the nurses' station finishing discharge summaries, my handwriting slightly better than it had been three weeks ago but still looking like a drunk spider had walked across the page.

  The Guillain-Barré patient from Bed 22 had transferred to rehabilitation two days earlier. Before leaving, he'd gripped my hand with fingers that could finally move again, his wife crying beside him. I'd mumbled something about just doing my job, uncomfortable with gratitude I didn't think I'd earned. The ICU team had saved him. The neurologists had managed his treatment. I'd just connected some dots that happened to be in the right order.

  Dr. Bennett passed by the station twice during morning rounds but didn't stop to talk. He nodded once in my direction while discussing a case with the senior resident, acknowledgment that I existed, which from him counted as warmth. My rotation here ended tomorrow. Thursday I'd start Orthopaedics under Dr. Desmond Pierce, about whom I'd heard exactly nothing good.

  Tuesday passed in a fog of routine ward work. Medication adjustments. Discharge planning. A woman with pneumonia whose lung sounds had finally cleared, the crackles replaced by smooth air movement that meant she'd probably survive to complain about hospital food at home instead. My phone buzzed during lunch.

  Murin: Surgery rotation is actual hell. I've been holding retractors for 4 hours straight. My arms are dead.

  Me: Ending Internal Med tomorrow. Starting Ortho Thursday.

  Murin: RIP your soul.

  Akki: At least Ortho patients can usually talk. Paeds is just screaming. Constant screaming. I'm going deaf.

  Murin: Anyone going on that hill trek thing next month?

  The college had announced it last week, some mandatory bonding experience involving hiking and camping that nobody wanted to do but everyone would attend anyway because missing it meant being labeled antisocial.

  Me: Maybe. If we survive till then.

  The chat went quiet after that.

  Wednesday morning I woke at six-thirty, earlier than necessary. Zoya Aunty's appointment was at ten. My mother had texted three times over the past two days with reminders: Make sure the doctors treat her properly. Sit with her if they allow it. She's nervous about these things.

  I'd tried to explain that medical students weren't allowed to just sit in on random consultations, that there were protocols and privacy concerns. My mother had responded with: Then stand outside and wait. She shouldn't be alone.

  So at nine-forty I stood outside the Outpatient Department, watching the steady stream of people moving through the entrance. Most looked tired already, resigned to hours of waiting in plastic chairs under fluorescent lights.

  Zoya appeared at nine-fifty, wearing a bright blue dress that stood out against the drab hospital colors. She spotted me immediately and her face broke into a smile that made her look younger than I remembered.

  "Ashru!" She pulled me into a hug. "Look at you in your white coat. So professional."

  The coat was wrinkled and had a coffee stain near the hem, but I didn't correct her. She stepped back, still holding my shoulders, examining me the way mothers do.

  "You're too thin. Are you eating properly? Your mother says you're always at the hospital."

  "I eat, Aunty."

  "Hospital food doesn't count." She finally released me and sat on one of the waiting benches, setting her handbag beside her with careful precision.

  I sat next to her, watching the small movements. The way she kept adjusting the bag's position. The quick glances toward the consultation room doors.

  "It's just a routine checkup," she said, more to herself than to me. "The doctor probably just wants some blood tests. I'm being silly getting nervous."

  "What brought you in?"

  "Oh, nothing serious. Just tired lately. And my appetite isn't what it used to be." She waved a hand dismissively. "Your mother insisted I see someone, you know how she worries."

  I looked at her more carefully. The blue dress hung looser than it should have, fabric gathering at her waist where it used to fit snugly. Her face had a drawn quality I hadn't noticed during our previous visits, the cheekbones more prominent, slight hollows under her eyes.

  The System's assessment hovered in my peripheral vision. Vague symptoms, there're too many possibilities. Nothing specific enough to narrow down without more information.

  "How much weight have you lost?"

  She tilted her head, considering. "Three kilos? Maybe four? I thought it was just the summer heat affecting my eating."

  "Over how long?"

  "Two months. Maybe three." She said it casually, like it didn't matter.

  Unintentional weight loss over two to three months. The differential diagnosis started forming automatically—cancer, hyperthyroidism, diabetes, tuberculosis, chronic infection, malabsorption. None of them good.

  Before I could ask more questions, a nurse emerged from one of the consultation rooms and called out: "Zoya Mirza? Dr. Vernon will see you now."

  We stood. Zoya gripped her handbag tighter and I followed her toward the consultation room.

  Dr. vernon's consultation room was standard hospital issue, desk with computer, two chairs facing it, examination couch behind a curtain. The doctor himself sat behind the desk, gray hair, reading glasses, typing something without looking up as we entered.

  He gestured vaguely at the chairs. Zoya sat, back straight, hands folded in her lap with that careful posture people adopt when trying to seem less nervous than they are.

  I stood near the door, trying to be invisible.

  Dr. Vernon finally looked up from his screen, his eyes sliding over Zoya.

  "What's the problem?" His tone suggested he'd already decided this would be simple.

  "I've been feeling tired lately, doctor." Zoya's voice was softer than usual. "And I'm not eating as much."

  "How long?" He was already typing again.

  "Two or three months."

  "Any pain?"

  "No."

  "Fever?"

  "No."

  "Cough? Breathing problems?"

  "No, nothing like that."

  His fingers moved across the keyboard with practiced efficiency, documenting her answers without really processing them.The entire interaction had taken maybe 1 or 2 minutes. He printed something, lab requisition forms and held them out.

  "Probably anemia. Common in women your age. Complete blood count, thyroid function, blood sugar. Collect these from the desk outside, go to the lab, come back in a week for results."

  That was it. Consultation over. Zoya reached for the forms, already half-standing.

  My mouth moved before my brain caught up. "She's also lost about four kilograms."

  Dr. Vernon's eyes shifted to me for the first time. Taking in the white coat, the student badge, the presumption.

  "And you are?"

  "Medical student, sir. Third year. I'm her neighbor."

  "I see." He turned back to Zoya with the slight head tilt that suggested tolerance running thin. "Weight loss is consistent with anemia. The blood tests will show it."

  I could feel the dismissal coming but pushed anyway. "Shouldn't we examine her? Check for lymphadenopathy, hepatosplenomegaly, thyroid enlargement..."

  "Are you the doctor or am I?" His voice hadn't raised but the temperature in the room had dropped several degrees.

  "I just thought... "

  Stolen story; please report.

  "You're a third-year student." Each word precisely enunciated. "You don't think. You observe and learn. If I need your opinion, I'll ask for it."

  The shame hit immediately. I'd overstepped. Spoken out of turn. Questioned an attending in front of a patient. All the things students were explicitly told never to do.

  Zoya touched my arm gently, her fingers a light pressure that meant stop talking.

  Dr. Vernon had already returned to his computer. We left. The door closed behind us.

  Zoya collected the lab requisition forms from the front desk while I stood there, jaw clenched, hands shoved in my coat pockets to stop them from shaking. The anger wasn't at being put in my place that was expected, deserved even. It was at the casual dismissal of symptoms that felt wrong, the 2 minute consultation that had missed everything important.

  "It's fine, Son." Zoya's voice pulled me back. "He's probably right. Just anemia."

  But looking at her, the careful way she moved like her body was heavier than it should be—I couldn't accept that.

  "Aunty, can I examine you? Quickly, before you go to the lab?"

  She blinked. "Here?"

  "There's an empty consultation room across the hall. Five minutes. Please."

  Something in my expression must have convinced her because she nodded.

  We reached that empty room and gestured to the examination couch.

  "Sit first. I'm going to check your neck and lymph nodes."

  She sat, watching me with curiosity mixed with concern. I washed my hands at the small sink, dried them, then stood in front of her.

  Thyroid examination first. I positioned my fingers on either side of her trachea, feeling for the butterfly-shaped gland.

  "Swallow for me."

  She did. The thyroid moved under my fingers, normal size, no nodules, smooth contour. Good.

  Lymph nodes next. I palpated systematically, cervical chain along the sides of her neck, supraclavicular above her collarbones, submandibular under her jaw. Everything normal. No swelling, no hard masses, no tenderness.

  "Lie down on the couch please. On your back."

  She complied, adjusting her dress, looking up at the ceiling with that expression patients get when they're trying not to think about what's being examined.

  I stood beside the couch and placed my hands on her abdomen, starting with light palpation. The skin was warm, soft, no obvious masses. No distension. I worked systematically, right upper quadrant first, feeling for liver edge.

  "Take a deep breath in."

  She inhaled and I felt downward, catching the liver edge as it descended. Normal size. Smooth. Good.

  Left upper quadrant now. The spleen wasn't supposed to be palpable unless it was enlarged to at least twice its normal size. I positioned my right hand below her left costal margin, my left hand behind supporting her back.

  "Deep breath again."

  She breathed in deeply and I pressed gently upward with my right hand, feeling for—

  There.

  My fingers caught something firm, moving with respiration. The edge of the spleen, definitely palpable, extending about two centimeters below the costal margin where it had no business being.

  I pressed again, more carefully, making sure I wasn't mistaking the splenic flexure of the colon or kidney edge for spleen. No. This was definitely spleen, the characteristic notched border, the smooth contour, the movement with breathing.

  My heart was beating faster. This changed everything. "Does this hurt when I press here?"

  "No. Maybe a little tender, but not painful."

  I examined the rest of her abdomen. No other masses. No ascites or hepatomegaly. But that enlarged spleen rewrote the entire clinical picture.

  "You can sit up."

  She did, reading my face with growing concern. "What is it? You look worried."

  How to explain this without terrifying her? I chose honesty. "Your spleen is enlarged. I can feel it below your ribs, and normally it shouldn't be palpable at all."

  "What does that mean?"

  "It could be a lot of things—infection, blood disorder, liver problems. But combined with your weight loss and fatigue..." I stopped, trying to find words that were honest without being catastrophic. "You need more than basic blood tests. Ultrasound of your abdomen at minimum. Peripheral blood smear. Liver function tests."

  The color drained from her face, "Is it serious?"

  "I don't know yet. But it needs proper investigation."

  She sat silently for a moment. Then she nodded once, that determined nod people make when they've decided to face something difficult. "Okay. What do we do?"

  "We go back to Dr. Vernon. Tell him what I found."

  "Ashru, he already threw you out once."

  "I know. But this is important."

  Dr. Vernon's door was closed. I knocked, harder than necessary, and pushed it open without waiting for permission. He looked up from his computer, and his expression cycled through surprise, recognition, then irritation in rapid succession.

  "Yes?"

  I stepped inside, aware that I was probably ending any chance of a good reference from this rotation but unable to care. "Sir, I examined the patient. Her spleen is palpable, approximately two centimeters below the costal margin. Combined with the weight loss and fatigue, we need to expand the investigations. Ultrasound abdomen, peripheral blood smear, liver function tests—"

  "You examined her?" His voice was dangerously quiet.

  "Yes, sir. With her permission."

  He stood slowly, his chair rolling backward. "You're a student. You don't examine patients outside supervised clinical rotations and order investigations. What are you playing at?"

  "I'm not playing at anything. She has splenomegaly. That's clinically significant with her presentation—"

  "Get out of my consultation room."

  "But—"

  "OUT. Before I report you for overstepping your boundaries and practicing without license."

  Zoya was behind me, her hand on my arm, pulling gently. "Ashru, please. Let's just go."

  Every instinct screamed to argue, to make him understand that his cursory examination had missed something important, that his 2 minute consultation was inadequate. But Zoya was pulling harder now and causing more of a scene wouldn't help her.

  I turned and left, the door closing behind us with finality. Outside in the corridor, I stood with fists clenched, shaking with frustration that had nowhere to go.

  Zoya touched my face, her palm cool against my burning cheek. "Maybe you're wrong. Maybe it's nothing."

  "I'm not wrong." My voice came out rougher than intended. "I felt your spleen. It's enlarged."

  "But you're still learning, son. Maybe you made a mistake."

  "I didn't." I took a breath, forcing myself to speak more calmly. "Aunt, I know what I felt. This isn't normal. Please, just promise me something."

  "What?"

  "When the blood tests come back, if anything is abnormal, push for more investigations. Ultrasound at minimum. Don't let them brush you off."

  She studied my face for a long moment, then nodded. "I promise."

  She went to the lab. I watched her walk away and felt the particular helplessness of knowing something is wrong but lacking the authority to fix it.

  I pulled out my phone. Thumb hovered over my mother's contact. Started typing a message, deleted it, tried again.

  Met Aunty Zoya. Getting blood tests. Results in a week.

  Reply came fast. Thank you son. What did doctor say?

  Thinks it's anemia.

  Good. Not serious then.

  I stared at that message. Then shoved the phone back in my pocket.

  The hospital corridor kept moving around me. People shuffling between departments with folders clutched to chests. I needed air. Headed for the exit, out into the courtyard where the afternoon heat hit hard. Found a bench under a half-dead tree that barely gave shade. I Pulled out the notebook Dr. Priyana had given me two days ago.

  Pages fell open to a section titled When Patients Minimize Symptoms. Her handwriting was neat, actual letters instead of my usual scribbles.

  Women downplay discomfort. Cultural thing. They'll call crushing chest pain "a bit of pressure." Severe pain becomes "some discomfort." Read between the lines. Watch body language over words. How they move tells you more than what they say.

  Zoya's face came back. How still she'd sat on that exam table. The small wince when I pressed her spleen that she'd covered up with "maybe a little tender." How long had she been brushing off symptoms?

  The System was right. I could've emailed Dr. Vernon my findings. Created a paper trail. Contacted Dr. Bennett. Done things properly instead of arguing and getting thrown out. But that required thinking clearly. Not watching someone you know get inadequate care.

  I closed the notebook. Three weeks ago I could barely take a history. Now I could find splenomegaly on exam and recognize a shit consultation. Knowledge without authority just felt frustrating.

  I stood up and headed back inside, discharge summaries wouldn't finish themselves.

  The hostel at eight PM had its usual chaos. Music bleeding through walls on the third floor, Hollywood competing with rock two doors down. I could smell instant noodles from second floor. Someone's cooking disaster. Voices from the common room where cricket played on the busted TV.

  Murin sat at the desk with a box of pizza, picking one apart. Akki paced between bed and desk. Three steps, turn, three steps back. He saw me and stopped. Shoulders tense, jaw tight. The look he got when he'd decided something.

  I closed the door and grabbed a slice of pizza. Murin glanced up, gave me a small shrug. Akki paced twice more before speaking. "Not going on the hill trek."

  Murin set down his pizza, wiped his fingers. Akki's hands moved while he walked, gesturing at invisible arguments. "Exams are six weeks out. Clinical cases, practicals, vivas. Three days on a mountain isn't going to help me pass. Just puts me three days behind."

  Sound logical. He'd probably calculated exact study hours lost versus social cost of skipping. Murin leaned back. Chair creaked. "Parents want me to go. Well-rounded physician thing."

  Akki's face shifted through disappointment and resignation. Looked at me, eyebrows up. I'd been avoiding thinking about the trek. Future problem for future me. Three days away from hospital and books sounded good in theory. In practice I'd probably spend the whole time anxious about not studying. "Haven't decided."

  Akki's shoulders dropped. Not what he wanted to hear. He opened his mouth, closed it, dropped into his chair. Defeated posture.

  Room went quiet. Murin went back to dissecting his pizza. I finished mine, grabbed the last one. Akki stared at his laptop without turning it on. His phone buzzed, screen lit up: Mum calling. He declined it, flipped the phone face-down.

  Murin watched. "You should probably answer eventually."

  "Tomorrow. When I have energy."

  Phone buzzed again. Text this time but Akki ignored it. We sat there another ten minutes without talking, existing in the same space while processing separate anxieties.

  Murin stood first, brushing crumbs off his shirt. I followed him and left Akki staring at his dark laptop screen.

  Murin walked ahead, hands in pockets, shoulders hunched. The posture that meant he was thinking hard about something. Back in our room he went straight to his desk. Pulled out pharmacology notes and started reading with that focus that meant no more talking tonight.

  I tried the same, opened my textbook to cardiovascular drugs. Words refused to make sense. Eyes tracked across sentences about ACE inhibitors and beta-blockers but brain was still in that consultation room. Eventually exhaustion pulled me under but even then dreams were full of enlarged spleens and doctors who wouldn't listen and exams where I'd forgotten how hands worked.