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Tensions between teacher and student were probably inevitable as graduation approached and M.J. systematically reviewed the black ''competency book" that listed the skills Julia would need to succeed. Ericka Coutts, one of the first to complete Mass. General's ICU training for first-year nurses, said she came to despise the book so much that, when she graduated, she used the book for kindling.

But there was also a clash of wills going on between two proud women. M.J., one of the most senior nurses in the ICU, was forceful in correcting even small mistakes, like an insufficiently clear ''6" in the patient's record. And she wanted Julia to do something that came hard to her -- acknowledge her errors so they wouldn't be repeated. ''Doesn't she know I'm putting my heart out on the floor, because I'm getting nothing from that girl?" she asked irritably one day when she felt Julia was disregarding her advice.

Julia was quieter than her teacher, but equally self-assured. She was by no means convinced that M.J. was right every time she corrected her. In nursing, Julia explained, there are often conflicting goals -- like relieving pain without stifling the patient's will to breathe -- and good nurses can make different choices.

Julia didn't openly disobey M.J., but her cheerful expression could turn to a scowl as she carried out her instructions. As a long winter gave way to spring, Julia was growing tired of being a student. ''It works much better for me knowing that there's no backup," she said. ''Whatever happens, it's my responsibility."

One March morning, Julia could no longer contain her frustration at the relentlessness of M.J.'s critiques. M.J. had been worried that their patient, a 66-year-old man, was endangered by poor blood circulation, and she was irritated when Julia paused to listen to his abdomen through a stethoscope before going for a doctor. ''Julia is a really smart girl, and she has a lot of book knowledge," M.J. said within earshot of her student, ''but . . . it's not her job to make a diagnosis."

''Sometimes it's like, OK, OK, I get it already," Julia snapped back, flipping the stethoscope behind her neck and heading off to look for a resident.

However, both M.J. and Jeanne, Julia's second instructor, agreed that there was more than a personality conflict at work. Maybe, the two nurses thought, Julia, who brought less experience to the ICU than most other trainees, just needed a little more time.

Still, M.J. worried. Even after their testy exchange, she had tried to leave the care of the 66-year-old patient to Julia. But M.J. didn't stand back for long.

She chided Julia for not paying enough attention to the doctors' instructions during morning rounds about the patient's ventilator setting. (''You should really be able to spit back what they told you.") M.J. didn't like it that Julia hadn't seemed to notice that the semiconscious patient was slowly raising his hand toward his breathing tube, a device so uncomfortable that patients will often try to remove it. (''OK, I'm just going to butt in here . . .") Finally, M.J. criticized Julia for trying to wrestle the big man into a johnny before she administered a potent sedative.

''Oy, vey," said M.J. at how far off-track the day had gone.