Chapter 74 — You're Punishing Yourself

_January 26, 1990, McKinley, Ohio_

{psc} "So, about that fantasy…" Kellie teased when we had a moment alone in the lounge early on Friday morning.

I chuckled, "This is where, if I was the typical Resident, I'd say that I'd tell you if you agreed to fulfill it!"

"And if you weren't married, I'd insist on it!" Kellie said with a twinkle in her eye.

"In all honesty, I actually don't have any specific fantasies," I replied. "I actually never did, unless you consider being happily married and having a family as a fantasy."

"That actually doesn't surprise me," Kellie replied. "Nor does the revelation that the threesome wasn't your thing."

"Out of curiosity…"

"No. It's a two-person sport! But SO many guys have that fantasy. It seemed like every guy I dated dreamed of having one. I'm curious, but if you weren't interested, why seek one?"

I chuckled, "You missed the fact that the girls accosted ME!"

"From any other guy, I'd say you were bragging, but again, that fits!"

"Time for you to fess up — are you seeing anyone seriously?"

"Bobby Murphy introduced me to Frank Parker, a fireman from Station 4. We've been out a few times."

"The firemen all seem like good guys," I said. "During my ride-along shifts, I didn't meet a single one I didn't like."

"Doctor Mike?" Jenny called out from the door to the lounge. "We're ready to present in Exam 1."

"Be right there!"

She left, Kellie and I exchanged a quick, chaste hug, and I went to Exam 1 to do a bit of doctoring before starting morning interviews. The patient was suffering from gallstones, but it wasn't surgical, so I called for a Medicine consult, and unsurprisingly, Clarissa showed up ten minutes later. She examined the patient, and after a discussion, we agreed to discharge the patient with a referral to his personal physician.

"Can you take some extra time at lunch today?" I asked. "Maybe ten minutes to meet someone?"

"Who?"

"You'll see!"

"Ooh, a mystery!" Clarissa smirked.

"See you for lunch at noon!"

She left, and I conducted evaluations with my students, who both scored slightly above average on the new system, then spent the following forty-five minutes caring for patients before I had to head upstairs to interview candidates for emergency medicine. Three of the four candidates were what I would call average and scored between 30 and 40. The fourth candidate, Erik Hubbard, was a local student who had his Sub-I in the ED when Clarissa had served her time. He had a letter of recommendation from Alana Pace, and we all scored him in the mid-40s.

"What's the big secret?" Clarissa asked as we went up to the Critical Care Unit.

"You'll see," I said.

We walked into the ward, and I saw Jessica's mom sitting with her.

"Doctor Clarissa Saunders, please meet Jessica Melbourne, née Glazer. Jessica, my closest friend and confidante, Doctor Saunders."

"Nice to meet you," Clarissa said.

"And you, Doctor."

Jessica knew what was up, and the timing was key, as at the end of the day, she'd be moved to a bed in Internal Medicine, and my chance to mess with Clarissa might have disappeared.

"Jessica, do you mind if Clarissa examines your right bicep?"

"Not at all, Doctor."

"What's going on, Petrovich?"

"Examine Jessica's arm and see if you can figure it out."

Clarissa did and looked confused.

"A scar from an injury that happened at least ten years ago."

"Sixteen, to be exact," I said.

Clarissa looked at me, cocked her head, the smiled.

"No way!" she exclaimed. "The girl from fourth grade?"

"Yes! She came into the ED by ambulance on Saturday when I was on shift."

"He's saved my daughter's life twice now," Mrs. Glazer said.

Clarissa shook her head, "Only you, Petrovich!"

"Why do you call him that?" Jessica asked.

"Mike is half-Russian, and his name in Russian is Mikhail Petrovich. Friends call each other by the patronymic — their middle name. I started calling him that years ago."

"Ask her where she works," I prompted Clarissa.

Jessica laughed, "P&G. I'm in marketing."

"And, of course, you work with Sheila Nixon, right?"

"Yes. I've even met Mike's godson, though I didn't know it at the time."

"It really is a small world," Mrs. Glazer observed.

"Jessica, you'll see Clarissa — Doctor Saunders — when you move to Internal Medicine later this afternoon. She'll take very good care of you, and she'll let me know when you're going to be discharged so I can come to say 'goodbye'. I'll check on you once or twice before then."

"Thanks so much, Mike!" Jessica exclaimed.

"Thank you, Mike," Mrs. Glazer said.

Clarissa and I left, and I walked her back to Internal Medicine.

"How did you recognize her?" Clarissa asked.

"I don't know, really. When they said her married name, it didn't mean anything, but there was this idea floating in my mind. Suddenly, in the elevator on the way to surgery, I had a revelation and asked the nurse to check Jessica's arm. That's when I knew who she was. I recognized her parents when they came in, of course."

"I can always count on something weird with you, Petrovich!"

"You love me anyway, Lissa!"

"It's actually one of the reasons I love you! It's always interesting! Not something I could say during our first year together at Taft."

"Ancient history at this point," I said. "Sorry to run, but I have interviews to conduct."

We hugged, and I left Medicine and headed to the conference room.

_January 28, 1990, McKinley, Ohio_

On Sunday, we attended Matins and the Divine Liturgy at the Cathedral in Columbus, then headed straight from there to Saint Michael the Archangel for Lara and Nathan's wedding.

"I meant to ask," Kris said, "but how is your friend from fourth grade?"

"She was moved to a bed in Internal Medicine on Friday afternoon. She's under Clarissa's care, so she might be in for a long stay!"

Kris laughed, "You two can be as bad as you and Liz!"

"Worse! And Lara and I are like that as well, but I don't see her very often because I'm working so much and she's teaching full-time."

"Jesting with girls does seem to be a pattern for you!"

I nodded, "Nancy, Emmy, Melody, and Tasha as well. Not to mention some nurses."

"Nancy was your first college girlfriend, right?"

"Yes. I learned a lot from that relationship. I think I'd call it my first adult romantic relationship. Ultimately, it failed. In a weird twist, both Nancy and Jessica were hurt the same way at the same place — T-boned at that light on 23 just north of the hospital. I don't think I mentioned Nancy by name — she was the emergency surgery where I was allowed to scrub in. But remember, you can never say anything."

Kris' severe aversion to secrets had led me to be a bit more forthcoming about my work, though I usually avoided names. In Jessica's case, I hadn't, as Kris would meet her eventually. And that had led to using Nancy's name. But those were exceptions.

"May I say that I very much appreciate that you set aside your rule for me? And you know I would never say anything."

"I know," I replied, "though we do have to be careful of the self-portable tape recorder we have with us."

Kris laughed, "She does like to repeat things she's heard, and without context, they can be very amusing!"

"Or embarrassing! We've been lucky so far."

"Do you mean me?" Rachel asked from the backseat.

"Yes," I chuckled.

"Mama said never say anything about people Papa helps at the hospital."

"You're a good girl, Rachel," I said.

"I know!" she giggled.

"We're doomed," I said _sotto voce_ to Kris, who simply laughed.

We arrived at Saint Michael the Archangel at the same time as Chris, Tasha, and Larisa, and the two girls began chattering as soon as they were out of the cars.

"We have news, Mischa!" Tasha said happily.

"Congratulations! When?"

"Around the first week in August!"

"Well, then you and Kris need to agree on who has the boy and who has the girl, and we'll have them betrothed the same day yours is baptized!"

Tasha laughed, "That would have been something my dad would have tried if it were possible!"

"According to Tasha, he had you two fitted for crowns when she was fourteen!" Chris said.

"And Mischa didn't even know!" Tasha said with a laugh. "He was afraid of me!"

"Nothing personal, Mike," Chris said, "but I'm glad that didn't happen!"

I looked at Tasha, smirked, and said, "Me, too!"

"YOU!" Tasha exclaimed. "You can be such a little boy!"

"No kidding!" Kris exclaimed. "All men are little boys in adult bodies! All of them!"

"So sue us," Chris chuckled. "Shall we go into the church? Our daughters are already at the doors."

They'd taken off immediately after they'd started chattering as Rachel had seen Abby with Joel, Milena, Anicka, and Derek. All of us made our way into the narthex, and about fifteen minutes later, the combined betrothal and crowing service began. It was, without variation, identical to every other one I'd witnessed, save the names of the bride and groom.

When the ceremony ended, there was a reception in the parish hall, and I took the opportunity to greet Lara's parents and their spouses, whom I hadn't seen in quite some time. I also finally met Kaitlin, Lara's friend from Pennsylvania, whom Lara had suggested as a playmate during our purely hedonistic period.

Kaitlin was taller than Lara but had a nearly identical build, with long black hair and brown eyes that twinkled when we were introduced. There was no doubt in my mind she'd have been a lot of fun, but I was also positive Lara and I had made the right decision in choosing to forego that encounter.

The formal reception was held at the Country Club, with the entire space rented by Lara's stepdad after I had put him in touch with Viktor. It was Winter, so there were no golfers, and thus, the reception didn't interfere with the normal operation of the club. I had to be careful with the vodka toasts, taking just one tiny sip for the first one. After the meal, the dance floor opened, and I danced with Kris, then Rachel, then a few of the girls from Saint Michael, and finally, with Lara.

"I'm very happy for you," I said.

"Thanks," Lara replied with a smile. "I saw you dance with a gaggle of girls. How many of those girls did you _not_ sleep with?"

"You know the answer to that question as well as I do!" I chuckled.

"I noticed you didn't dance with Kaitlin!"

"Now you're just being a troublemaker, Mrs. Burke! And you'll notice how very proper my dances were."

"Including with Tasha!"

"Especially with Tasha. She's pregnant, by the way! Due in August."

"Awesome! I suspect Nathan and I will be in the family way by the end of the year. There's no point in waiting."

"Kris will call you, if she hasn't already, to invite the two of you to a dinner party on the 11th."

"I promise we'll be there!" Lara declared.

The song ended, she kissed me on my cheek, and I was immediately accosted by my daughter demanding another dance, though this time, I was ganged up on by Rachel, Abby, and Larissa. Chris received the same treatment, as did Joel, and when the girls were dancing with Joel, I asked Milena to dance.

"Having nightmares already?" she teased.

"If in twelve or thirteen years I were to meet those three as a teenaged Mike, I'd flee in sheer terror!"

Milena laughed, "And college Mike, too! My mistake was going down that path, but you helped me correct my course."

"As did you for me."

"And my mom!" Milena smirked.

I chuckled, "That was actually the _least_ important thing she did for me."

Milena laughed again, "That was for _her_, not you!"

"True," I agreed. "How long are the leashes on the kids?"

"We have to let them live their lives, Mike, just as we did. All we can do is provide guidance. They'll make mistakes, just as we did, but they'll all turn out to be wonderful young women."

"That doesn't make it easier," I said.

"I don't think any dad is ever completely comfortable with his daughter's intimate relationships."

"Of that, I'm certain."

We finished our dance and I asked Kris to dance when I heard the first notes of _Just the Way You Are_, which was 'our' song. We danced quietly, and when the song ended, she whispered, "Ask Lyudmila to dance. You'll make her day!"

"So long as you're OK with it."

"Of course! I'm neither worried nor jealous! I have you, she knows it, and more important, YOU know it!"

I laughed, "Good point!"

I asked Lyudmila to dance, and she smiled brightly as I led her out to dance.

"So," she smirked, "did you figure out who the better sister is?"

"You know there's only one possible answer for a married man to give! Especially if he values his life!"

"And his «яйца» (_yaytsa_)!" she teased. ("eggs", a euphemism for testicles)

"Did you ever approach James or Anthony at the Cathedral?" I asked.

"You knew?!"

"I know which guys never take their eyes off you and which ones you smile at! Ask Natalya Vasilyevna about how it was when I was seventeen and she was fourteen!"

"So, _she_ was the one who scared you!"

"And she still does," I chuckled.

"You aren't really upset that I'm teaching Rachel to speak French, are you?"

"No, of course not. But that doesn't make you any less of a menace!"

"And yet, still the better sister!" she teased as the song ended.

We left the dance floor, and I returned to the table where my wife, Joel, Milena, Anicka, and Derek were sitting. My daughter and her friends were dancing together, shooing away any little boys who dared come close but allowing any girls who wanted to join them to stay.

"That won't last," I chuckled.

"I believe girls think boys are annoying at that age," Joel replied.

"That doesn't change when they get older!" Anicka teased, causing everyone to laugh.

"And yet, you love us anyway!"

"We do!" Kris, Milena, and Anicka declared.

_January 31, 1990, Circleville, Ohio_

"Korolyov-Loucks residence. Mike speaking," I said when I answered the phone early on Wednesday morning.

"Mike, it's Fran Mercer. Is this still a good time?"

"It is. I'm in my study, so I have privacy."

"Good. I think the first thing we should do is to have you catch me up on things. I hope you'll satisfy one curiosity, even if it's out of order — the prison visits?"

"It started with me visiting Frank Bush, the man who murdered my friend Lee. It's turned into a regular prison ministry, authorized by my bishop."

"I have to ask — why see him?"

"If you have to ask THAT, we need to start all over at the very beginning."

"I know the pat answer from you, Mike. I'm asking for a deeper answer. You have plenty of other opportunities to share your faith."

"You say that, but visiting those in prison is one of the differentiators between those who are saved and those who are damned. It's something I've wanted to do since I was a teenager, and Frank Bush provided me with the motivation to start now. If anyone needs the gospel, it's certainly him.

"It paid other dividends as well, as I was able to arrange proper medical treatment for a friend of his, as well as begin ministering to a Greek Orthodox man. And in a weird coïncidence, I remember you saying you treated a victim of the Seven Hills Rapist. I met his killer, Mark Stroll."

"That poor young woman has suffered another tragedy," Fran said. "About a month ago, her husband, an officer in the US Navy, was murdered."

"Lord, have mercy!" I exclaimed. "Kids?"

"One young son. Fortunately, she has very good support from her friends. She's a practicing psychologist."

"I know how bad it was for me, so I can relate."

"How many other men are you ministering to?"

"It's seven total," I replied. "We're arranging for a regular monthly Sunday service led by a deacon who can serve the Eucharist to the Greek man."

"What's he in for, if I might ask."

"Manslaughter. He killed someone in a bar fight. One of the others is in for the same thing for which Paul Reynolds was incarcerated, though his sentence is far longer. He's actually from the Cincinnati area."

"How are your sister and her husband doing?"

"Great. I know you'll object, but literally, everything Liz said about Paul was true. That doesn't excuse him cheating on his wife, but he's been very good to my sister and is a great dad to their son."

"Marrying your abuser is never a good idea."

"All things being equal, Liz never felt abused by Paul. I know what the law says, Fran, and Paul paid the price for breaking it. Liz always maintained she loved him, and it's obvious he loves her. Whatever else might be true, they are happily married, work hard, and are excellent parents to my nephew."

"I'll leave that be because we're never going to agree."

"This is another one of those black-and-white issues for you," I said. "One thing that practicing medicine has driven home is that the entire world is shades of grey. Every person and every situation is unique. Yes, we have standard treatments, but we do not blindly administer them. There is no 'one size fits all' answer to anything, with the sole exception of Rapid Sequence Intubation. Let's agree to disagree and switch to another coïncidence — the girl whose life I saved presented in the ED after a rollover MVA. I saved her a second time."

"Your life is very strange, Mike."

I chuckled, "That is exactly what Clarissa would say — one of those 'only Mike' things, like making an emergency landing in a helicopter returning from Ohio State because of an engine failure."

"That must have been frightening!"

"It was. The nurse who was with me served in the Navy, and I don't think she blinked or had her pulse rise at all. She calmly said, 'We have two engines' while my medical student had a panic attack and I nearly wet my pants!"

"You were flying as a flight surgeon?"

"Yes. I qualified after making several flights, earning my MD, and then spending a week with the paramedics doing ride-along shifts, which are now part of standard training for Emergency Medicine Residents."

"Are you attending church regularly?"

"My current schedule allows us to attend the regular weekly cycle of services."

"And you're seeing your spiritual guide monthly?"

"Either in person or by phone, yes."

"Then let's talk about this unease or disquiet you're feeling."

We spent the rest of our call rehashing the conversations I had with Father Roman, Clarissa, and Kris and concluded with Lara's wedding.

"That wedding goes counter to just about everything else you've said," Doctor Mercer observed. "If I could sum up everything you've said, I'd say that for at least the past two years, you haven't taken any time to enjoy life and haven't had fun. I understand the demands of your Residency schedule, but you've stopped doing everything that would be considered relaxation or fun and even stopped exercising.

"I know your time is limited, but you absolutely need to find time to enjoy life, even if it can only be in small doses. I also think your attitude would improve if you exercised regularly. You used to run, and before that, you practiced karate. I know what I'm saying is difficult, at least for the next five months, but you need to try. What I want to suggest is that we speak after you have your dinner parties."

"That's fine, though the root cause is, in effect, impossible to overcome until June, and even then, it's not clear what my schedule will be."

"I understand, Mike, but so long as you insist it's impossible to have fun, it will be impossible to have fun. When's the last time you went to the movies?"

"Probably close to a year ago," I replied. "The last movie we saw was on VCR back in September."

"When's the last time you were at the music store?"

"Maybe last June," I admitted.

"I think that proves my point that you aren't trying, and in fact, I think you're punishing yourself for your focus on your medical career."

"By focusing on my medical career?" I asked.

"You're denying yourself even the most basic pleasures that take very little time. You don't go to band practice; you don't go to the movies; you don't go out with your friends; you don't even go to the music store. Given how important music is in your life, that last one is quite telling. Mike, you're heading for depression or a mental health crisis."

"I need to think about that," I said. "I recall during my first semester at Taft telling a girl that everything had to take a backseat to my medical career, even my music, if it came down to that."

"You do need to think about it. Discuss it with Kris and your spiritual guide, and we'll talk on February 21st. Call me before then if you want to talk. If you have any kind of crisis, call me or see someone at the hospital right away. Do I have your word on that?"

"Yes."

"Then I'll speak to you in three weeks."

The day at the hospital was taken up by interviews, and I vowed that if I was asked in future years, I would decline to serve on more than one interview team. Being limited in my practice of medicine wasn't helping my mental health. I did have one positive note, and that was that Liz called to let me know Emmy had her baby, and had named her Carrie.

That evening, after dinner, Kris, Rachel, and I got into the car to drive to Saint Michael the Archangel for Vespers.

"What are you going to do about what Doctor Mercer said?" Kris asked.

"I'm open to suggestions," I replied. "She made a big deal about not visiting the record store, and she's right about it, but what's the solution before June? I work six days a week until 9:00pm three days a week, and while I'm off at 5:00pm on the other three days, we have Vespers on two of them. The record store isn't open on Sunday. It's the same problem with band practice — the only times are Friday evenings or Sunday afternoons, which already take away time from you and Rachel."

"I don't have a solution," Kris admitted.

"Neither do I. I suspect Doctor Mercer's solution, which she can't say for ethical reasons, would be to stop attending Vespers. That would free up Wednesdays and Saturdays, but I don't think that's a good idea. I'm already going to miss many Holy Week services because of my schedule — the Holy Monday and Holy Tuesday Bridegroom services; Liturgy and the Twelve Gospels on Holy Thursday, and the Liturgy on Holy Saturday morning."

"But you can take Friday off?"

"I already arranged to trade half shifts with Kylie Baxter and Paul Lincoln, which I'll have to make up. I'll miss other services as well, and we have to discuss the _Akathist_ services because that would take away Friday nights during Great Lent. I totally get Doctor Mercer's point, but the one thing that might give is the one thing that keeps me balanced and on an even keel."

"I know it's changing the subject, but what about vacation?"

"I intend to take it in June, and hope that John Michael or Charlotte Michelle coöperates with that plan! Fortunately, that's after I begin my surgery rotation, as the ED is going to be short-staffed because Doctor Gibbs and Kylie Baxter are going to a conference in Toledo. Loretta wanted me to go but agreed that would be a very bad idea given your due date. That's why she's sending me to Indy for a weekend conference in May."

"What happens if our little boy or girl doesn't coöperate?"

"We'll call an audible," I replied with a grin.

"You've lost me," Kris said.

"In what you call 'American football', or 'Gridiron', an audible is when the quarterback changes the play after coming to the line of scrimmage, that is, the beginning of each 'set piece', as you would call it for soccer."

"Your version of rugby makes NO sense!"

"Less sense than the offsides rule in Association Football, or 'leg before wicket' in Cricket?"

"Hockey has similar complicated offside rules!" Kris protested. "You don't consider that making no sense!"

"Oh, yes I do!" I declared. "The 'two-line pass' rule is hurting the game. It was designed to limit forward passes when they were first made legal, but the game has changed significantly, and teams have realized they can simply flood the neutral zone and force either face-offs or dump-and-chase. But we're off-topic now!"

"It's your fault for using a word you _knew_ I didn't know!"

"Who? Me?" I asked with a grin.

"Yes, you!"

"To answer your question, Doctor Roth will accommodate, but taking June 18 to June 29 should cover it."

"You don't mind if my sister is at the house then, right? She planned to stay with me during the day once school is out at the end of May."

"Of course not. Despite all the teasing, she's a wonderful young woman. I'm already outnumbered by girls, so what's one more!"

"And if we have a girl?" Kris asked as I turned into the church parking lot.

"I may need a vacation from the estrogen!"

"Papa? What's 'est-ra-jen'?" Rachel asked from the backseat.

"It's something inside you that makes you a girl! Boys have testosterone."

"Yuck!" Rachel exclaimed, making a face.

"She's going to be impossible if you have a boy," I said to Kris _sotto voce_.

"And it'll be your fault, Mike! I can't provide a 'Y' chromosome!"

"Yeah, yeah," I chuckled as I parked. "Let's go inside and worship."

_February 2, 1990, McKinley, Ohio_

"How's your birthday going so far?" Clarissa asked at lunch on Friday.

"It started with my daughter giggling and saying '«Joyeux anniversaire Papa!»', so you know, same as every OTHER day in my Franco-Russian household!"

Clarissa laughed, "Your sister-in-law loves to tease you."

"Along with every OTHER woman, of every age, in my life!"

"I do believe that worked to your advantage at Taft!"

"More ancient history, Lissa. Will everyone be at the Chinese restaurant tonight?"

"Basically the old gang except Maryam and Peter. Fortunately, Sophia, Fran, and I don't have shifts, nor does Tessa. Everyone from Code Blue will be there with a significant other, along with Subdeacon Mark and Alyssa, Elias and Serafima, Jocelyn and Gene, Joel and Milena, and Anicka and Derek. Are you bringing the Tsarina?"

"No. She's staying with her maternal grandparents."

"Are you having a family celebration?"

"At my grandparents' house in Rutherford tomorrow after Vespers."

"You're seeing Angie on Sunday, right?'

"And my godson, too. We'll stay at my mom's to make that more convenient. Changing subjects, how is Jessica?"

"Baker plans to discharge her on Monday. Neuro was concerned about that repeat bout of double-vision earlier in the week, but it resolved within a few hours."

"Post-concussion syndrome?"

"Possibly. Neuro isn't willing to say that now. They're split between 'accident neurosis' and post-concussion syndrome, and I'm positive you know there are no firm diagnostic criteria for PCS."

"Similar to the debate between the 'combat fatigue' faction and the proponents of the new 'PTSD' diagnosis. As they say, Medicine is both an art and a science. What we don't know, or what we don't fully understand, would fill almost as many volumes as what we do know! Fortunately, perfect knowledge isn't necessary to heal the sick. Let Jessica know I'll come see her tomorrow."

"Have you thought more about what Doctor Mercer said?"

"Yes, and discussed it with Kris at length. No matter which way I look at it, my potential solutions are severely limited, at least until June 1st. I think the best I can do is what we've already planned — the dinner parties and visiting the other parish. I did schedule my vacation around Kris' prospective due date, but babies do not always coöperate!"

"No kidding! You found that out the hard way!"

"That had ZERO to do with Tommy and everything to do with OB/GYN blowing us off! Which led to the memo you saw from Cutter last week, I'm sure."

"I heard Zenker blew a gasket!"

"He brought it on himself," I replied. "Honestly, Cutter was on completely solid ground because 'Active Labor' is right there in EMTALA's name! So now, if Zenker can't send a Resident within ten minutes, he has to send an experienced OB nurse with a neonatal cart and delivery tray, AND page a Resident or Attending, who will have to arrive within fifteen minutes, like every OTHER on-call physician."

"How does the change to Level I certification affect that?"

"He'll have to, in effect, have a spare Resident in the hospital at all times. You know they play fast and loose with staffing because babies have their own schedules. That's worked fairly well, but it won't work when JCAHO does their accreditation review."

"Next year, right?"

"Yes. The new ED is scheduled to open on June 1st, and the accreditation team will show up on August 6th. The regular schedule would have seen it in February, but they delayed to avoid having to re-certify less than six months later."

"Must be nice when you know the inspection is coming that far in advance!"

"It's a difficult balancing act," I observed. "Snap inspections with no warning would play havoc with hospital operation. Having no warning would create a staffing problem for the accreditation period. The flip side, of course, is that if you know the team is coming, you can fake it long enough to pass. And it's not like they can do the 'Secret Shopper' thing!"

"True!"

We finished our lunches and Clarissa returned to Medicine while I went to the conference room for the surgical interviews. Four hours later, I left the hospital and headed home to change for my birthday celebration at the Chinese restaurant that had been our hangout during our undergraduate and post-graduate years. Immediately after arriving, we received some very good news.

"We were approved for adoption!" Jocelyn gushed. "Now it's just a matter of waiting."

Everyone congratulated them.

"What happens now?" Robby asked.

"We wait," Gene said. "Jocelyn and I agree we'd be OK with up to age two, which makes it a bit easier than if we only wanted an infant. According to Family Services, it could happen at any point, and we've been in contact with Catholic dioceses in Cincinnati, Columbus, Cleveland, and Toledo, which everyone says is our best bet. Jocelyn also spoke to a Lutheran adoption agency. We're playing every card we have!"

"I would think an attorney and a researcher with a PhD would be at the top of everyone's list," Derek observed.

"The social worker who assisted us with the process said the same thing," Jocelyn said. "But the demand far outstrips the supply, so to speak. In other news, we're looking for a house in Circleville!"

"Welcome to the neighborhood!" Milena declared.

"Mike and I promised each other we'd live close and our families would be friends. Unfortunately, his insane schedule makes that tough right now."

"Things should improve in June," I said. "I'll be on a regular surgical team, so I'll work Monday through Friday and only be on call one weekend a month."

"Daytime hours?" Subdeacon Mark asked.

"Surgical teams usually work from 5:00am to 3:00pm," I replied. "But because I'll cover the ED, I'll have a twelve-hour shift, rather than ten. The new Resident will cover the other twelve hours, plus a weekend shift."

"Who'll cover the other times?"

"A PGY1 or PGY2 from surgery, the way it worked before the move to use specialists in trauma surgery. Eventually, that will only happen in very rare cases. When the new ED opens, we'll need a surgeon on duty in the ED at all times. That's going to require a bit of juggling for the next five years until we have enough trauma surgeons."

"I heard you delivered a baby," Fran interjected.

"Not by choice! OB basically refused to send us a Resident or even a nurse. The new Medical Director took the bull by the horns, and that won't happen again except in the most extreme cases. In that one, the Resident didn't show up until after the baby was born, despite about twenty minutes passing from the first call to them."

"You guys don't get enough shop talk at the shop?" Elias asked with a grin.

"Sorry," several of the doctors said at the same time.

We had a great evening together; my friends sang _Happy Birthday_, and we had a cake, which the Chinese restaurant had arranged with the bakery next door, along with ice cream from Verner's. After dinner, everyone went to see _Driving Miss Daisy_, and then Kris and I headed home for a very private birthday celebration.

_February 3, 1990, McKinley, Ohio_

My new Saturday medical students — Phil Longstreet and Cathy Lee — were complete unknowns to me, as I hadn't had any interactions with them before they arrived in the ED on Saturday morning. I followed my usual practice and reviewed their procedure books and was happy to see both of them were slightly above average with regard to the number and type of procedures.

"Phil," I said. "Grab the first chart in the rack. When you complete the H&P, present it to me."

"Right away, Doctor Loucks!" Phil said.

"Doctor Mike, please," I requested.

"Sorry."

"No need to apologize; I'm the outlier here in just about everything!"

They left, and I went to the Attending's office to check in with Isabella Mastriano. There was nothing important to note, so I went to the lounge to wait for my students. I had barely sat down when Nicki, the clerk on duty, let me know EMS was three minutes out with an MI. The temperatures were unseasonably warm, so it wasn't a snow-shoveling MI.

"My students are busy," I said. "I'll need a pair of nurses, please."

"Julie and Amanda are assigned to EMS transports."

"Thanks."

I got up and walked quickly to the ambulance bay, grabbing a gown, gloves, and goggles along the way.

"It was 60°F yesterday!" Amanda protested. "Now it's 38°F!"

"Don't complain," I said. "Six or seven years ago, it was around -20°F!"

"I should have insisted my husband move to Florida, where I grew up, instead of coming here!"

"What's he do?" I asked.

"Teaches computer science at OSU. He could easily have found a position in Miami!"

"How did you meet?"

"He was in his last year of graduate school, and I had just finished my first year of nursing school. He was in Florida for Spring Break. We hit it off, and just over two years later, here I am in Ohio!"

"It could be a LOT worse," Julie said. "I'm from International Falls, Minnesota!"

"Also known as 'Frostbite Falls' in _Rocky and Bullwinkle_!" I said as the EMS squad turned into the driveway. "Amanda, EKG and monitor, please; Julie, stat ABG, CBC, Chem-20, and cardiac enzymes."

When the patient was unloaded, we rushed him to Trauma 2, and once I saw the EKG, I called for an urgent cardiac consult as the patient was showing ST elevation. Barbara Abbot caught the consult request, and seconds after she arrived with her student, the patient coded, and the five of us couldn't revive him. That wasn't surprising, given he was morbidly obese and smelled of cigarette smoke.

"You'll handle the notification?" Barbara asked.

"Yes. Pretty much a lost cause."

"You would think by now people would have a clue," she said, shaking her head.

"You would think, but human nature being what it is, I think this problem will get worse, not better.

"Sadly, I think you're right."

She and her student left; I asked Amanda to get a death kit, then I went to check with the triage desk about next of kin. The patient's wife was in the waiting room, and after bringing her to the consultation room, I gave the standard speech then took her to see her deceased husband. It was, sadly, a routine to which I'd been totally accustomed and one that I would repeat hundreds, if not thousands, of times during my career.

Not long after she had left, my students came to present, and I went to see a patient who would absolutely survive their visit to the Emergency Department.