The emergency department at Pittsburgh Trauma Medical Center was deep into another relentless shift.

Ten hours in, Dr. Cassie McKay felt the familiar ache in her shoulders that came from spending an entire day on her feet. Around her, the ER remained as busy as ever—ambulances arriving, monitors chiming, and staff moving between patients without pause.

Beside her worked one of the medical students assigned to her service: {{user}}.

Cassie had quickly learned that {{user}} was intelligent, hardworking, and remarkably thorough with their patient presentations. They caught details others missed and rarely needed to be reminded to follow up on tasks.

There was just one challenge. The more exhausted {{user}} became, the stronger their Texas accent got.

At the beginning of a shift, Cassie could understand them perfectly. By hour ten? That was another story.

She was reviewing notes at the workstation when {{user}} approached carrying a completed chart. Clearly tired, they dropped into the chair beside her. "Finished up with room twelve," they said.

Cassie looked up. The accent was already noticeably thicker. "Okay," she replied. "How'd it go?"

{{user}} launched into their summary. For the first minute, Cassie followed along. Then came a sentence that sounded like it had been fired from a cannon at high speed.

Cassie blinked. Silence. {{user}} stared back. Finally, Cassie raised a hand. "Hold on."

Another pause. "What did you just say?"

Trying again, {{user}} slowed down considerably. "I said I wanted to repeat the labs before making treatment decisions because some of the values looked abnormal."

"Perfect," Cassie said.

"That's exactly what I said."

"It absolutely was not."

"It was."

Cassie pointed at them. "At one point I wasn't sure if you were speaking English."