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The air in the examination room was stale and tense.
Aaron Minyard sat with his back straight, hands folded loosely on the table in front of him, two other students arranged to his left. They were so close to the end. Four years of relentless, grinding study, and this was the final gate.
The head examiner, Professor Baum, a man with wire-framed glasses surrounding eyes that missed nothing, glanced down at his notes and then looked directly at Aaron.
"Mr. Minyard, what can you tell me about paraneoplastic syndromes?"
A familiar, sharp command cut through the fatigue in Aaron's mind: Focus. Focus. Focus. He took a breath and answered. "Paraneoplastic syndromes describe a variety of clinical effects, usually endocrine activity, that coexist with malignant diseases, most commonly in neuroendocrine tumors. Small cell lung carcinoma is one carcinoma often associated with paraneoplasias, such as SIADH or ectopic Cushing's syndrome. But there are others, for example insulinoma, pheochromocytoma, carcinoid syndrome, or Zollinger-Ellison syndrome."
Professor Baum nodded, his expression unreadable. "Good. You mentioned Zollinger-Ellison syndrome. Can you elaborate further on the pathogenesis and resulting symptoms?"
Aaron nodded and launched into a precise explanation of gastrin-secreting tumors, the resulting hypergastrinemia, and the elevated risk for severe, recurrent peptic ulceration. He was on autopilot, the information flowing not from his conscious brain but from a deep well of memorization built over countless solitary nights. Baum held up a hand, and Aaron stopped instantly.
"I see you studied well. One final detail, Mr. Minyard. Is there a classification system for bleeding ulcers, and if so, can you tell me what it is?"
"The Forrest classification," Aaron said, not missing a beat. "It classifies ulcers based on their endoscopic appearance, offering information regarding the risk of rebleeding, ranging from Forrest Ia, a spurting hemorrhage, to Forrest III, a clean-based ulcer."
A small, almost imperceptible smile played on Baum's lips. He gave a single, satisfied nod and turned his gaze to the group. "I believe that concludes things on our end. Would you three please step outside for a few minutes while we deliberate? We'll call you back in shortly."
They filed out into the hallway in a daze. As soon as the heavy wooden door clicked shut, Denise Fisher spun around, her face pale. "Oh god, oh god, what if I failed? I didn't know the virus that can be a cause for pancreatitis. I just blanked. This would be so embarrassing. My sister is already waiting outside, I'll have to tell her I'm a failure..."
Markus, a calm and friendly guy with whom Aaron had even met up to study presenting the cases, put a hand on her shoulder. "Hey, breathe. It was one question. You nailed the rest. They're not going to hold such a minor mistake over you. The fail rate for this exam is practically non-existent."
Aaron nodded in agreement, a silent pillar of solidarity. But a colder, more private thought traced its way through his mind: If I had failed, at least I wouldn't have to walk out that door and explain that to someone who had waited for me.
It was a strange thought, like his brain was trying to find the positives in the rather sad reality. A hypothetical luxury for a hypothetical situation. A luxury he would have, but only if he failed. Otherwise, it would just mean he'd stand alone in front of that hospital while his classmates had people waiting for them.
Because that was the problem. There would be nobody. Nicky had planned to come. Nicky had booked a flight. Nicky had wanted to be here and celebrate with him. But then Erik had fallen off his bike and broken his arm so badly he couldn't function alone, and Nicky's voice on the phone had been pure guilt as he'd explained and apologized and basically told him he wouldn't be able to make it.
And Andrew. Aaron hadn't asked him to come. He'd just asked, casually, what Andrew was up to that week, and Andrew had said, "Think I've got an away game." And that had been it. Aaron hadn't mentioned the exam. Hadn't mentioned the tradition of family and friends waiting for the soon-to-be doctors outside the hospital.
And then there were his "friends." The people he studied with. The people he spent his lunch breaks with. The people he actually shared a group chat with, messy full of memes and study tips. A few weeks ago, someone had asked for everyone's exam dates. A handful of people had replied, Sarah had been one of them: June 9th. Group C. Aaron had seen it and typed his reply as a thread to hers: Mine too. But I'm group A. Someone had sent a thumbs-up emoji. Someone else had said that they should all get drinks once exams were over and that had been it.
He'd scrolled through the chat the night before and this morning to be greeted by nothing. No messages. No one saying "good luck tomorrow." No one asking if he was nervous. No one mentioning planning anything. He'd told himself it didn't matter. Told himself they were busy, that they had their own exams to worry about.
So he was positive that, there wouldn't be anyone waiting for him. Four years of relentless focus had left him with a transcript full of A's and a contact list of study partners who were exactly that: not friends, just people he'd run cases with between lectures.
His way of studying had brought him to where he was now, but at what cost?
Before his thoughts could settle into anything heavier, the door opened again and Professor Baum beckoned them back in.
"In aggregate," Baum began, "this group performed exceptionally well. I want to note that—it isn't always the case. Your knowledge was thorough, your clinical reasoning was coherent, and your composure throughout was commendable."
Aaron focused on a point just past the man's ear.
"Ms. Fisher." Denise looked up. "A strong performance. Your breadth of knowledge is clear. Your grade is a B."
Her exhale was audible.
"Mr. Smith. Also a B. Your case-based reasoning in particular was sound."
Markus nodded, content about it.
Then Baum looked at Aaron.
"Mr. Minyard." A pause, deliberate. "Frankly, if our grading scale permitted it, I would offer you something above an A. But it doesn't, so an A it is."
Aaron couldn't quite name what he was feeling, but it most certainly was relieve.
"Your case integration, your command of detail, and—perhaps most notably—the way you approached each question with a kind of structural precision that is, in my experience, not teachable." Baum set his reading glasses on the table. "What specialty are you considering?"
"Emergency medicine."
The man looked at him before giving him a kind smile. "That will suit you," he said, as if it were a diagnosis.
He was a doctor.
The small space in front of the university hospital entrance was busier than usual. Clusters of families, friends holding funny or heartfelt posters, and a joyous cheer rose as the four stepped outside. People were holding phones up, filming the arrival of their new doctor. One group had set up a small camping table with muffins and champagne flutes. It's actually kind of cute, Aaron thought, after all you didn't graduate from med school every day.
He hovered at the edge of the crowd, scanning faces, when he spotted two familiar figures. Alex and Max. He'd shared lunch with them more times than he could count, helped Alex through pharmacology flashcards, walked Max through acid-base balance more than once. They were—well, they were as close to friends as he had.
His heart gave a small, treacherous lurch. They had remembered.
He started walking toward them, a smile already forming.
Alex spotted him first. "Hey! Aaron!" She waved, and Aaron's chest loosened. At least until she asked, "You here to pick up Sarah too?"
Aaron stopped.
Max turned, a banner in his hands. It wasn't for Aaron. It was bright and glittery, covered in sparkles. He glanced at Aaron and did a double take. "Wait. Oh, shit. Aaron. You had your exam today too, right?"
The words hit like a physical blow. Too. Not "congratulations." Not "great job." Just the awkward realization that they'd completely forgotten.
"Yeah," Aaron said, his voice careful. "Just finished."
Alex's face went red. "Oh god. Oh god, Aaron, I'm so sorry. I totally spaced. I knew yours was the this week too, I just—with Sarah's being today too, I—" She gestured helplessly at the banner.
"No worries! Yeah she's in Group C I think" Aaron said, managing to keep the smile on his face. "I was in Group A."
Max rubbed the back of his neck. "Fuck, man. I'm sorry. We should've—I mean, that's a huge deal. How did it go? I'm sure you got an A right? You always get A's—"
Aaron nodded and mumbled a "Yeah" while keeping the smile on his lips.
"That's amazing," Max said, but it came out thin. "We can—we should grab drinks later. Celebrate. We were going to celebrate with Sarah—A bunch of us are going out tonight, you should come."
"Yeah, definitely," Alex chimed in, nodding too fast. "We'll make it a thing."
Aaron's smile was still fixed firmly in place. "Yeah, maybe. We'll see what I'm doing but I'm rather tired so maybe I'll just call it an early night—"
They nodded, but the way they were already glancing back toward the hospital doors, scanning for Sarah, told Aaron this conversation was basically over. He mumbled his goodbyes; Max gave a half-hearted wave that Aaron returned, his arm moving like a puppet's.
He turned away, threading back through the crowd. His hands were trembling slightly, and he shoved them into his pockets. He didn't know what to do or where to go. Everyone seemed to be part of a group, while he was an island in the middle of a celebrations that weren't his.
"Aaron! Hey, Aaron!"
He turned. Markus was walking toward him, grinning, his red face still flushed with the pride of the moment. "Man, I can't believe it's over. Four years. Four years, and we actually made it."
Aaron managed a smile. "Yeah. We did."
Markus clapped him on the shoulder. "Seriously, though. An A. Baum practically bowed down to you in there. That was insane. You deserved it, by the way."
Aaron felt something warm flicker in his chest. It wasn't much, but it was something. "Thanks. You did great too."
"B," Markus said, shrugging, but he was still grinning. "I'll take it." He laughed, then looked around. "So, who's here to pick you up? Your family? Friends?"
The warmth vanished, replaced by that familiar hollow ache. Aaron's smile faltered for a second. "My cousin really wanted to come, but there was an emergency. His partner broke his arm, he couldn't get away."
Markus's face softened with sympathy. "Oh man, that sucks. I'm sorry."
"Yeah." Aaron shrugged, like it didn't matter. "And my brother had to work. He's got an away game this week."
"Your brother's the athlete, right? The one who was on the news?"
"Something like that," Aaron said. "And my friends are still busy studying—they've got their exams next week. So they couldn't make it either."
They couldn't make it. They forgot. Same difference.
Markus nodded, accepting the explanation without question. Then his eyes flickered with a hesitant curiosity. "And your parents? Are they—"
The question hung in the air. Aaron felt it like a physical blow, but he forced his voice to stay even. "Uhm—My mother died. About ten years ago."
Markus's face twisted "Oh. Oh, Aaron, I'm so sorry. I didn't—"
"It's fine." Aaron cut him off, not unkindly. "It was a long time ago."
"Still," Markus said, and he looked genuinely uncomfortable. "I shouldn't have asked."
"Don't worry about it."
There was a beat of awkward silence. Then Markus seemed to make a decision. "Look, my family's right over there. We've got way too much food—my sister went overboard with the muffins, I'm pretty sure she baked enough for an army. And there's champagne. You should come have something with us. At least until you figure out your plans."
Aaron hesitated. He didn't want to intrude. He didn't want to be the charity case, the sad guy someone felt obligated to include. But Markus wasn't looking at him with pity. He was just looking at him like a guy who didn't want his friend to stand alone.
"Okay," Aaron heard himself say. "Thanks. That's—thanks."
Markus grinned and steered him toward the cluster of people near the entrance. His mother and father were there, beaming, along with two sisters and a brother. They were a loud, happy group, the kind of family that seemed to exist in commercials. Markus's sister—the one who'd apparently gone overboard—pressed a glass of champagne into Aaron's hand before he could even introduce himself.
"You're one of Markus's friends? Here! Have a muffin. I made blueberry and chocolate chip. The chocolate chip ones are better, honestly, I think I put too much baking powder in the blueberry ones, they came out kind of—"
That's how Aaron found himself a chocolate chip muffin in one hand, a glass of champagne in the other, being talked at by someone who didn't ask him a single question about why he was alone. It was oddly comforting. He didn't have to explain himself. He didn't have to perform. He just had to stand there and nod and eat his muffin.
Markus's father clapped him on the back. "Markus mentioned you got an A. Congratulations. You must be so proud. All that hard work paid off."
"Thank you," Aaron nodded. "And thank you for letting me crash your celebration."
"Don't be silly," Markus's mother said, waving a hand. "The more the merrier. Anyone who helped our Markus through those awful case presentations is welcome."
Aaron blinked. He didn't remember helping Markus all that much. But he supposed he had, in his own way. They'd studied together. They'd talked through difficult concepts. It hadn't been friendship, but it had been nice.
"Hey, Aaron, could you take a picture of us?" Markus's sister interrupted, handing him her phone.
"Sure." Aaron took it, framing the shot—a family beaming with a proud new doctor in the middle. He clicked a few times, capturing the joy.
When he handed the phone back, Markus's sister said, "Should we take one of you?"
Aaron paused. "Yeah. Okay." He positioned himself in front of the hospital entrance, holding the half-eaten muffin and the champagne glass. He put on his biggest, most convincing smile. The girl took two pictures before calling over her friend.
"Wait, another one!" Markus's sister shoved a bouquet of bright flowers into his hands. "Looks more festive."
Aaron's smile flickered, before being reinforced with a dose of pure gratitude. "Thanks," he managed. At least now, he'd have a picture where he didn't look like a complete loser with nothing in his hands.
The photo was taken. He handed the flowers back—they weren't his, after all—and finished his champagne. He stayed for another quarter hour, nodding along to conversations, laughing at jokes he didn't quite hear, letting the warmth of Markus's family wash over him like a borrowed blanket.
But eventually, he had to leave. He couldn't stay in someone else's celebration forever.
"I should get going," he said, putting the flute back down.
Markus stood too. "You sure? You could join us for dinner. We were planning on going to—"
"I really should go. But thank you. All of you. This was really—" He stopped, not sure how to finish the sentence. This was really kind. This was really generous. This was more than I had any right to expect.
"Anytime," Markus's mother said warmly. "Congratulations again, Aaron. You're going to be a wonderful doctor."
He smiled, nodded, and walked away before the mask could slip.
He made his way to his car. Threw his jacket on the back seat. Sat down, took a breath and pulled out his phone to turn it back on.
As expected there were two new messages from his cousin:
Nicky: How did it go?
Nicky: ???
He shot back a short
Aaron: Went well :)
But before he could even put the phone away the screen lit up indicating a call from his cousin.
"AARON!" Nicky's voice was a sobbing, joyous shout from across the continent. "You're a doctor! I knew it, I knew you'd crush it! Tell me everything! Oh god, I'm so proud of you, and I'm so, so, so sorry I'm not there right now."
"It went well," Aaron said, his voice not quite as steady as he wanted it to be. "Got an A."
Nicky made a sound that was not quite a word. "An A. Of course you got an A!"
"They said if there were higher grades available, they would have given me—"
"Aaron, I'm so so proud of you! I'm so sad that I wasn't there because of Erik—"
"He broke his arm. I know. It's fine."
"It's not fine, I promised—"
"Nicky." He successfully managed to keep his voice level. "It's okay."
"We're going to celebrate. As soon as that man can move his arm without making sounds like a dying animal or do basic tasks without my support, I'm getting on a plane. We'll do the whole thing. Dinner, wine, whatever you want."
"Okay."
"And the graduation ceremony—we'll be there, we're already planning—"
"I know."
"Aaron." Nicky's voice went quieter. "How are you doing? Right now, how are you? Are you happy? Are you relieved?"
"Yeah I am. I'm good. Really."
His voice came out almost right.
"Go celebrate with your friends," Nicky said, soft. "You deserve it. We'll talk later."
Of course, Nicky would assume that would be what would happen. Why wouldn't he? Surely he had this whole vision of how, despite him not being there, there would have been other people waiting for Aaron. That he, of course, would end up going out with friends after such an achievement. Aaron didn't feel like breaking that illusion for his cousin. He simply answered with a small "Okay."
"I love you." Nicky told him, from the tone of his voice, crying again. But Aaron understood that this came from his cousin's heart. Nicky had always been one to show and voice his feelings more openly. Aaron was quiet for a moment before he mumbled a "Yeah, you too."
Then the call ended.
He managed to navigate from the parking lot down to the main road before the tears started to fall.
It began as a blur at the edges of his vision, the street signs smearing into blurs of red and white. He blinked rapidly, once, twice, willing his eyes to clear. The third blink didn't help. The fourth made it worse. A tear escaped, trailing down his cheek, and he wiped at it roughly with the back of his hand.
Don't. Don't do this. Not now.
But his body didn't care about his internal commands. His chest was tightening, each breath coming shorter and shorter until he realized he was gasping. He pulled the car over into a side street, threw it into park, and let his forehead fall against the steering wheel.
It wasn't pretty. It wasn't dignified. It was ugly, messy, the kind of crying that left you wrecked and raw, the kind he'd suppressed for years. The tears came hot and fast, soaking into the fabric of his shirt, his shoulders shaking.
He let himself have exactly as long as it took to stop—three minutes, maybe four, maybe five—then he straightened up, wiped his face with the heel of his hand, and checked the rearview mirror.
No one would ever know this happened. Not Nicky, who already sounded like he was carrying so much guilt about a broken arm and its consequences he had no influence over. Not Andrew, who would say nothing about it, probably just stare what would somehow make the nothing worse. Aaron would let them believe exactly what he'd already told Nicky: that it went well, that he got his A, that he was fine. He would not tell anyone about the few minutes on a side street with his face against the wheel.
Some things you carried by yourself. That was the whole point of being good at it.
Aaron Minyard was a doctor now. And he was going to be fine.
He had to be.