Chapter 71 — Developments

_January 1, 1990, Circleville, Ohio_

"Happy anniversary!" I said to Kris when I arrived home on Monday evening.

"Happy anniversary!" Kris replied, giving me a hug and a kiss.

"«Joyeux anniversaire, papa!» Rachel giggled.

"Your Aunt Lyudmila is a menace!" I declared. "But thank you."

The three of us went into the great room where Kris and I exchanged cards and small gifts. Once we finished, I read to Rachel, the three of us said our evening prayers, then Kris and I we put Rachel to bed.

"Would my husband like to make love to his wife on their anniversary?" Kris asked when we left Rachel's room.

"Indeed he would!" I agreed.

_January 7, 1990, Monastery of the Dormition of the Mother of God, Rives Junction, Michigan_

{psc} The week following New Year's Day had been fairly typical, both in the hospital and at home. On Saturday, after dinner, I'd left Rachel and Kris at home and driven to the monastery so that I could spend time with Father Roman. I'd attended Vespers the previous evening, and then Matins and the Divine Liturgy, before having a light lunch. With all of that out of the way, Father Roman and I met.

"What's on your heart today?" Father Roman asked.

"Several things," I replied. "My dad, my prison ministry, my family, and my work."

Father Roman laughed softly, "I think 'my life' would have been a more succinct way of saying that. Is there a specific place you want to begin?"

"Probably with the thing that weighs heaviest on me, and that's the simple fact I don't have enough time for Kris and Rachel. It's not something that is a surprise, but it's been weighing on me recently."

"If I recall correctly, there is little to nothing you can do about that in the short term."

"In terms of hours I spend at the hospital, that's absolutely true. On the plus side, I get to sleep at home every night. The downside is, that's basically what I do. I arrive home from the hospital, read to Rachel, we say our evening prayers, we put her to bed, and then Kris and I usually go right to bed."

"Given what you've confessed about your past behavior, and the stress you're under, I have to ask if you and Kris are fulfilling your marital agreement."

I laughed softly, "The impending arrival of a second little bundle of joy indicates we are."

"Pardon me for being flippant, but that accounts for one encounter. And yes, I know enough about the physiology to know that it often takes time to conceive."

"I'd say that taking everything into account, we're physically intimate to sufficiently slake the desire. Emotional fulfillment is a very different story."

"Something those who engage in promiscuous sex usually discover, much to their chagrin."

"Point taken," I replied.

"Setting aside physical intimacy, are you and Kris intimate partners?"

"Honestly? Not the way we should be. I'm more intimate with my colleagues, especially Clarissa, whom we've discussed, along with Doctor Greg Casper and Doctor Shelly Lindsay."

"I infer from things you've said, that's pretty common for new doctors."

I nodded, "Yes. I spend far more time with them than I do Kris, if you discount sleeping in the same bed. In some ways, I have more in common with them than I do Kris, though we both come from the same general spiritual background and have similar goals and desires."

"You may decline to answer this next question if you wish, but how would you differentiate Kris and Elizaveta?"

"I'll answer," I said. "One of the things I realized during my period of mourning was that despite my desire to find a mom for Rachel, I didn't want someone who was a, well, replaceable part for Elizaveta. That struck me as a disaster waiting to happen, as that's not possible."

"A good insight," Father Roman confirmed. "I was reluctant to ask you to compare them, but I felt you could answer in a way that didn't feel as if you were disrespecting Elizaveta."

"The two women are very different," I said. "But each was exactly what I needed at the time I became involved with them. Elizaveta had no goals other than being a good wife, a good mother, and helping me be successful as a medical student and doctor. Kris, on the other hand, is very much focused on her career and being an independent woman who does not depend on a husband or children to validate her."

"What would you say the key differences are?"

"Interestingly, both were very mature when I met them, though their maturity was different. For both of them, it was the strong conviction that each of them could do the things they each felt were important. For Elizaveta, it was, as she once put it — cooking, baking, cleaning, doing laundry, sewing, and caring for babies. She did add that despite lack of experience, she could figure out how to make babies as well."

Father Roman laughed softly, "Teenagers have never had a problem figuring that out! Go on."

"For Kris, that list, minus the 'figuring out how to make babies', was basically anathema. For her, it was education, career, and independence. All the things on Elizaveta's list were, in Kris' mind, shared responsibilities. I actually agreed with her, but Elizaveta was as stubborn as I am that those things were for women to do, not men. Of course, given my schedule, Elizaveta got her way while Kris had to accommodate her views to the reality of being married to a medical student and, later, a new doctor."

"I'm curious why you say that after Elizaveta's repose, you felt you didn't need the things she provided. It seems to me that's exactly what you need."

"In the very short term, yes; in the long term, no. And honestly, I could hire someone to do most of those things if need be."

"Yes, you could. But you also could have married a traditional girl, at least according to what you've said to me. You didn't."

"I think one key differentiator is that Elizaveta was extremely mature, even if she was a bit naïve. And it was naïveté that concerned me about some of the other girls I considered. Kris was anything but naïve, and had a very European outlook, which more closely matches mine, though I could do without the occasional harangues from the 'Political Officer' facet of her personality!"

Father Roman smiled, "You did say she was strident in her socialist beliefs."

"Absolutely. The thing is, I believe they are a reflection of the Christian life, with the exception that they are imposed rather than voluntary. I've pointed out to her the story of Ananias and Sapphira makes it clear that 'having all things in common' was a voluntary act. Kris and I have more or less agreed to disagree on politics."

"Are you expressing discomfort with your relationship? Or regret?"

I shook my head, "My only regret is not having enough time with Kris to develop a truly deep relationship. I had that with Elizaveta because, despite spending so much time studying, we had time to be a couple and time for ourselves. Kris was, to use a colloquialism, 'instant family, just add ring'."

"Which, I think, is the source of your, well, unease, I think is the right word. Is that creating a rift or separation?"

"No more than what I would expect from my life outside of the hospital, which consists basically of church, meals, and sleeping. Kris was aware of that before we married."

"Do you think she feels the same way?"

"Actually, no, or at least not to the same extent. I'm the needy one in the relationship."

"Have you told her how you feel?"

"No, because there is literally nothing we can do about it at the moment. Things will change a bit in July, as I’ll have more seniority and thus can work a schedule more to my liking. And in eighteen months, I'll be on a normal surgical service, which, because of the training I need, means scheduled surgeries."

"What does that mean, practically?"

"More than likely twelve hours each weekday, and on-call on the weekends. But I won't know for sure until June 1991."

"I don't know that I can offer anything other than a suggestion that you have this same conversation with Kris. Send Rachel to her grandparents’ or a friend's house for a Sunday afternoon so you can have a deep conversation. And talk, Michael."

I chuckled, "What? You think we might use it for other activities?"

"Given your schedule, the temptation will be there!"

"Point taken!"

"Let's speak about your interior life. Are you keeping your prayer rule?"

"Yes. And praying for each patient, silently, of course."

"Have you had any further instances where you've 'gone off' on someone, as you've called it?"

"Not since before the last time we spoke, but then again, there hasn't been a reason to do so. The sources of the problems have basically been eliminated. The hospital and medical school changed the rules, there's a new medical director, and there are new guidelines about assignments. All of them were resolved in a way that fit with how I felt they should be resolved."

"Because you pitched a fit, or in spite of it?"

"Both," I replied. "But except for direct application to healing the sick in the Emergency Department, I do not subscribe to the theory that the ends justify the means."

"How do you mean that with regard to caring for a patient?"

"That I might inflict pain or do something to save a life that inflicts some kind of lifelong disability on someone. While it's not my specialty, consider oncology where you, in effect, poison a patient to the point where they almost die in order to cure the cancer, or more directly applicable to me, cut into healthy tissue to get to something that needs surgical repair, or relief only a surgeon is authorized to provide."

"Examples?"

"Chest tubes, central lines, and other invasive procedures we do during a trauma, sometimes without anesthetic because we either can't wait or can't use because of depressed heart rate or breathing."

"OK, I see your point, but what you're doing isn't unethical or immoral, which is the implication of the 'ends justify the means' as it's usually meant."

"I am nothing if not pedantic," I chuckled.

"Something that will serve you well as a physician and father, but not so well as a husband or chaplain."

"Are you suggesting my darling daughter will parse every word I say to look for loopholes or advantages?"

"If she's like every _other_ pre-teen or teen on the planet!"

I chuckled, "And she's going to have a cohort in crime in her best friend, Abigail."

"A girl from church?"

"No, the daughter of a professor at Taft. I dated her, briefly, when I was an undergrad and she was a graduate student, and her mom, also a professor, taught me to play guitar. Milena and Joel are good friends, and Rachel and Abigail are inseparable, except under duress. Rachel has friends at church and at daycare, but Abigail is her absolute best friend."

"She and Kris attend church even when you cannot, correct?"

"Yes. And she'll go to Sunday School once she turns five."

"And everything is progressing properly with Kris' pregnancy?"

"Yes. She's due in late June, so at least she'll be done with classes before things become too uncomfortable, at least based on what other pregnant women have said, including Elizaveta."

"Is there anything weighing on your heart that you feel the need to expressly confess?"

"Impatience," I replied.

"Because your job basically trains you to act, and not wait."

"That's true. It's about acting quickly but not precipitously. As strange as it sounds, call it cautiously aggressive. As I'm sure you've deduced, my impatience is with process and procedure."

"No, really?" Father Roman asked with a grin.

"My reputation precedes me," I chuckled. "On a serious note, I am not pleased with my relationship with my dad."

"Is there a conflict?"

"I think I hit the nail on the head when I said he has never truly understood me or my motivations. I fix the blame on what he was taught growing up — that what we practice is works-righteousness. He cannot help but see the world through a TULIP-colored lens."

"Nice turn of a phrase! Let me ask you this — could you ever see the world differently from your Orthodox faith?"

"I can't imagine what might have to happen to cause that, and I don't believe I want to. That's not to say that I don't have my doubts at times, and on occasion want to shake my fist at God, but in the end, I see the world from an Orthodox perspective and cannot do otherwise."

"Then you understand your father's struggle. You know the answer, too."

I nodded "To do as Saint Seraphim of Sarov taught — 'Acquire the Spirit of Peace and a thousand souls around you will be saved'. This is going to sound like whining, but it's difficult to do that with my dad."

"And gaining your MD was easy? Or any other worthwhile thing, including caring for your wife or raising a daughter, especially as a single father?"

"Well, no. I suppose I'm simply frustrated in that he cannot understand that I refuse to take sides in family disputes if taking sides means sundering a relationship. It happened with my little sister's troubles, and again with my parents' divorce. I love all of them, so how could I possibly take sides? That doesn't mean I condone sinful behavior, but I don't think my parents' divorce is as one-sided as my mom and grandparents believe it is."

"Except in the case of physical abuse, it almost never is. I've counseled married couples, and invariably there is more than enough blame to spread around. The key is identifying the areas of discord and addressing them, similar to how you practice medicine — perform the emergency repairs, then time can be taken to heal the patient holistically."

"What do you do when you can't even communicate on a basic level with someone because their mind is already made up?"

"Physician, heal thyself?" Father Roman said with an arched eyebrow.

"I do have that trait, don't I? And I suppose I came by it honestly from two parents who do the same thing."

"It's human nature, Michael. I'm sure you know the concept of 'cognitive dissonance'?"

"Yes. Ignoring valid data points which don't conform to your belief. In medical school they compared it to pilots who crash aircraft due to 'target fixation' — you're so focused on one thing that you ignore all other inputs until that split second before the plane hits the ground. Or, in the case of a patient, so focused on one element that they die because you didn't see the warning signs."

"I think you know the answer."

"Remove the log from my own eye…"

"Yes. Is there anything else on your heart?"

"No."

"Then let me say the prayers of absolution and you can be on your way home to your wife and daughter."

_January 8, 1990, McKinley, Ohio_

"Mike?" Nate said when I walked out of Exam 2 late on Monday morning, "Krista Sandberg is in the waiting room and would like to speak to you. If you don't, I'll have Jamal send her away."

I considered and then said, "No, I'll speak to her. Do you know where Kellie is?"

"She was assisting Doctor Gibbs in Exam 4."

"Thanks."

I went to Exam 4 and asked Doctor Gibbs if I could borrow Kellie for ten minutes and she agreed.

"What do you need?" Kellie asked when we were out of the exam room.

"I have a LONG list, but right now Krista wants to speak to me and I need a witness.

"Are you sure you should?"

"No, but I do want to give her advice, so I'll take the chance. That's why I want you."

"I must be losing it if that's all you want!" Kellie teased.

"Go ask Kris for permission. I'll say nice things at your memorial service!"

Kellie laughed, "No married men for me, not that the sentiment isn't shared. Under different circumstances…"

"If you'd bring her to the consultation room, then stay with us, I think that would work best."

"Against my better judgment, but OK."

I went to the consultation room and a minute later, Krista walked in with Kellie right behind her.

"Hi," I said. "Kellie is going to stay."

Krista nodded, "I understand."

"What can I do for you?"

"I was hoping you'd give me advice on what to do."

"I'm going to be blunt and direct," I said. "OK?"

"Yes."

"You are unsuited to be a doctor," I said firmly. "You simply do not have the clinical skills, personality, or aptitude to practice medicine. You should not, under any circumstances, think about applying to a medical school in the future. That said, you had top marks in your coursework, including anatomy lab, and you scored well on the standardized tests. Based on that, I believe your best option is to use the settlement money to earn a PhD and become a researcher. You'll be VERY good at it."

"You weren't kidding when you said 'blunt and direct'," Krista replied.

"Your evaluation for your Emergency Medicine rotation would have been harsher, and would have been part of your permanent record. Whether you agree with that or not, that is the direction you were headed, despite my best efforts to prevent that. You should thank your lucky stars the medical school simply allowed you to withdraw, even after the stunt you pulled. You have my advice, I strongly encourage you to follow it."

"Jesus," she said in a very low voice, just above a whisper.

"Krista, you're fortunate Mike will even talk to you," Kellie said. "You asked for his advice, and he's given it. I think it's good, and trust me, you were never cut out to be a physician. Go into research. It suits you. Caring for patients does not. I'd also suggest you see a counselor and get your head on straight."

"I suppose I deserved all of that," Krista said.

"Honestly," I said, "go to graduate school, earn your PhD, and discover new medicines or new equipment or new procedures. You won't have direct patient interaction, but you'll participate in their treatment at arm's length. Your other option is to simply abandon science and do something else. I'd discourage that, because you can achieve a lot of good as a researcher."

"My attorney said I could go back to medical school in two years."

"I made an agreement with my attorney — I would leave the law to him and he'd leave the medicine to me. I suggest you do the same. Yes, legally, you _could_ go back to medical school; you shouldn't. And you have to know someone from the admissions department of any medical school will call here to ask about you. Imagine how THAT would go."

"Nobody can say anything bad, according to the agreement."

"You're right, but if the answer is 'I do not wish to say anything' or 'I am forbidden from saying anything', how do you think that will be interpreted? Nobody here has to say anything bad, they just have to not say anything good, and the admissions committee will understand they shouldn't touch you with a ten-foot pole. That's the reality you face. What you need to do is admit to yourself that you aren't physician material, and then do something for which you're suited."

"Mike?" Ellie said from the door to the trauma room. "EMS four minutes out with MVA with extraction. Ghost needs you in the ambulance bay."

"Be right there," I replied. "Krista, all I can say is good luck, and I encourage you to take my advice and not listen to your attorney, who is providing you with bad advice. I'm sorry, but I have to go now. Kellie?"

She and I left the room and hurried towards the ambulance bay, grabbing gowns, gloves, and goggles along the way.

"Harsh but accurate," Kellie observed. "Think she'll take your advice?"

I shrugged, "I have no idea. Hopefully she understands and accepts she's not cut out to be a doctor any more than I'm cut out to pilot the Space Shuttle."

"Mike Loucks, Space Cadet!" Kellie teased.

"Careful, Nurse, or YOU will need a trauma team! Or, in the imortal words of Ralph Cramden, 'One of these days, Alice…'!"

She laughed, we went through the doors, and joined the others waiting for the ambulance.

_January 9, 1990, McKinley, Ohio_

"Mike, Doctor Cutter would like to see you," Doctor Gibbs said just before 9:00am on Tuesday.

"About?" I asked.

"He didn't say. He just called down and asked if you could come to his office and I said we had a lull at the moment."

"OK."

I let Ellie know I was going to the Medical Director's office and left the ED. I climbed the stairs up to the second floor, walked past the vacated Chief of Emergency Medicine's office, and into the administration wing. When I reached Doctor Cutter's office, his assistant sent me right in.

"Have a seat, Mike," he said, pointing to the sofa where coffee and muffins were set out.

Him not addressing me as 'Doctor' was a strong indication this was a positive meeting, and the coffee and muffins confirmed that. I sat down, and after a nod from Doctor Cutter, poured myself coffee and selected a blueberry muffin.

"Are you satisfied with the way your training is being handled?" he asked after pouring his own coffee.

"I am," I replied, wondering if that question implied that someone wasn't.

"Is there anything you'd change?" he asked.

"I'm probably not the best person to answer that because I've been afforded opportunities that most likely won't be available to the next PGY1 in trauma surgery."

"I know you well enough to know you can provide an objective analysis."

"I think, for anyone else coming into the program, training should be structured. In other words, a set of specific training goals with a timeframe for completing them. I had the distinct advantage of being signed off for a number of procedures before I started, and, if you'll pardon the self-promotion, had the chops to back up my demands to be taught."

Doctor Cutter smiled, "I had several ears-full from Doctor Rafiq before he left for the hospital in Dearborn."

"It's a generalized problem with all Residencies, but in this specific case, only the on-call surgical Resident could teach me the techniques, and the one who was assigned was reluctant to do so. Once he was told to do it, then things improved. And, the advantage of that was clear and obvious — the ED rarely calls for a consult when I'm on shift."

"That has worked very well, both for you and for the PGY1 and PGY2 surgeons who could scrub in for more surgeries than in the past. Is there anything you'd change?"

"Again, it worked very well for me, and I don't think we'll see a repeat of some of the 'not invented here' or 'who do you think you are?' attitudes when the program first started. I totally understand people's discomfort with the radical change, and I suspect it was the same when the first Emergency Medicine Residents appeared at Taft.

"There were some surgeons who had their noses seriously out of joint. For me, closing the 'Emergency Room' in favor of a properly staffed Emergency Department meant I could focus on surgery, not non-surgical cases. Now, though, we're understanding that having qualified general surgeons who specialize in emergency medicine improves patient care, alleviates staffing concerns, and provides for overall better outcomes.

"I won't argue with that, and given we're only fifteen years from the creation of the first Residency in Emergency Medicine, I'd say we've come a long way, though we have a long way to go. Setting aside all the BS, I'm very happy with the program."

"My goal is to limit the BS insofar as I'm able," Doctor Cutter said. "I don't like it any more than you do! Some amount is necessary, but I object to the idea of doctors being stymied by Mickey Mouse bureaucratic procedures."

"You're preaching to the choir. Sadly, neither Medicare, Medicaid, nor the County Board see it that way."

"Something I've said my piece about to the Hospital Administrator. His job is to block ALL that BS from the medical staff. It's his job to deal with it; our job is to heal the sick."

"Amen, Doctor!" I replied.

"And yet, you know how it goes."

"Of course. The paper pushers and pencil-necked geeks in accounting mostly get their way because, in the end, money is our limiting resource."

"So we find ways to make it work," Doctor Cutter said. "And that's why I'm talking to you. I've discussed some changes to the program with Owen Roth, and would like to hear your feedback. First, rather than one Resident slot every two years, we're going to switch to one every year. You've proved the utility and wisdom of the program."

I nodded, "That is a good thing. That means we'll basically be fully staffed with trauma surgeons in six years.

"Exactly right. And there is no controversy over doing so, and it fits within our headcount without negatively affecting scheduled or emergency surgery. In fact, it helps with the elective surgery as we won't have to bump anyone if there's a single emergency surgery, and we won't have to keep anyone on standby, as it were."

"Mary Anderson will be very happy to hear that."

Doctor Cutter smiled, "I know. She's been lobbying Owen since you encouraged her to do so last year. Obviously, no guarantees, but she's an excellent candidate. On that note, I want you to participate in interviewing prospective surgical and emergency medicine students and participate in determining our Match list. In the past, we've used only PGY3s and above, but nobody has your specific experience because you're the first trauma surgeon at Moore."

"I'd be honored."

"Good. Adding the new Residency slot also gives us freedom to experiment with training trauma surgeons. Owen and I have discussed changing the protocols and making years two through six surgical training, but with shifts in the ED. It's not clear yet what that might look like, but we're thinking about a weekly rotation where you'd be on a regular general surgery team one week, then the next you'd cover the ED. At the moment, the theory is that would continue until you pass your surgical Boards.

"What happens at that point isn't determined, but the working theory Owen and I have is that an Attending in trauma surgery would lead the team of all trauma surgeons, and be responsible for covering the ED and handling emergency surgery. Obviously, that's at least six years in the future, but it's what we're working towards. Thoughts?"

"I think that makes sense," I replied. "Though I think you might see resentment from PGY2s in surgery."

Doctor Cutter nodded, "That is a consideration. One thing Shelly Lindsay has been pushing for, along with Carl Strong, and a few others, is giving PGY2s more opportunities to do procedures, rather than mostly observing. You know the usual progression — PGY1s manage the ward and handle pre-op and post-op tasks, PGY2s observe, and PGY3s and above participate. A year-long observation period seems too long to them, and I'm inclined to agree, though it will have to be on a case-by-case basis."

"Given I am a believer in Doctor Osler's theory, I can't object to that."

"I didn't think you would. I'm going to discuss this with Nels Anderson over lunch, and if it goes the way I expect, we'll have a Match slot for a trauma surgery Residency. Keep this under your hat, please."

"Mum's the word."

"I'll have an answer by the end of the week, which is when our final Residency list is due. Interviews begin next week. I'll get the schedule to you. Owen will assign someone to cover the ED for you."

"How many interviews are we conducting for surgery and emergency medicine?"

"Forty, for ten slots — six for emergency medicine, four for surgery, one of which is the trauma surgeon slot. We'll have more once the new surgical wing open in 1993. We're breaking ground this year, a year early."

"That's very good news!"

"I agree. Keep up the good work, Mike."

"Thank you, Doctor Cutter."

"John, please, when we're in private."

"Thank you, John. May I say something on a different subject?"

"You may."

"Doctor Gibbs should be the next Chief of Emergency Medicine," I said. "I know you have to interview multiple candidates, but she should be your choice."

"I believe I knew your opinion before you gave it," he said. "You tend to wear your heart on your sleeve."

"I do. I hope you'll consider my input."

"Of course. And to allay your concerns, expressed many times, her lack of testes will in no way impact my decision, and it’s mine. I don't like the 'Boys Club' attitudes any more than you do."

"I appreciate that. Thanks."

I downed the last of my coffee and ate the last bite of my muffin, then we both stood, shook hands, and I headed back to the ED.

"What did he want?" Loretta asked when I let her know I was back.

"Mostly just checking on my perspective of my training, given it's a new program. I also engaged in a bit of Loretta Gibbs promotion. Doctor Cutter agreed that testes are not required for the Chief of Emergency Medicine role."

Doctor Gibbs rolled her eyes, "You didn't need to do that."

"Yes, actually, I did. The bosses need to know what the worker bees are thinking. In any event, I expressed satisfaction with how the training is progressing. No complaints at all."

"That would be a first!" Loretta said with a smirk.

"Yeah, yeah, but he's heard them all, so no need to repeat them!"

"Go heal the sick!"

"Yes, Ma'am!"

_January 12, 1990, McKinley, Ohio_

"Did you know about this?" Doctor Gibbs asked, showing me a memo from Doctor Cutter.

"I knew it was being considered, but I was told in no uncertain terms to not say anything to anyone."

"Which means that if I behave the way you did, I should fly off the handle and stop being your friend, right?"

"Very different circumstances, Lor," I replied. "And remember, the _only_ thing I demanded was for you to admit what you had said to me in the past, privately, with a promise to not repeat it. That was the cause of the problem between us. And do you _really_ want to have this fight again? I sure don't."

"You're a pain in the ass, Loucks!"

"Thank you."

"Thus proving what I just said! So I have to break in a newbie?"

"That was going to happen in two years anyway," I replied. "Does the memo discuss the scheduling?"

"Yes. A week in the ED, a week in surgery. The new PGY1 will cover days while you're in surgery, and nights when you're in the ED. Sucks to be them!"

"And yet, that beats the heck out of the ninety-plus-hour weeks that were the norm until this year."

"True. The second memo lists you as the Resident from the ED for interviews for Emergency Medicine and from Surgery for those interviews."

"I do not relish forty interviews over the next four weeks. That basically means very little time practicing medicine. It also means I won't be able to guest lecture at the medical school as planned."

"This time in January is the worst, because every department is basically short-staffed so we can conduct interviews. I'm on the interview team for the ED."

"As you should be, as Chief Attending. Who's the third?"

"Ghost and Pete Gabriel are splitting duty. That was my request."

"And I bet they didn't object."

"Right the first time! Are you going to the M & M?"

"Yes."

"OK. I'll walk down with you in ten minutes."

"Sounds good."

The M & M Conference was, without question, the ugliest one I'd seen since I'd started medical school. A nephrectomy had removed the _healthy_ kidney, not the diseased one, leaving the patient on dialysis and in need of an emergency kidney transplant. It was a fuck-up of major proportions, and one that was, without question, going to result in a malpractice suit AND a referral to the state medical board. The mistake had been made by a Resident, Rob Thornton, who had misstated which kidney was to be removed, and that error was not caught by anyone from the patient to the PGY1 doing pre-op to the Attending, John Edwards.

The questions were withering, and I wondered if either Rob or Doctor Edwards would survive the ordeal. Rob was a PGY4, and from everything I heard, it was all on him, and I didn't think anything could save him. John Edwards might survive by the skin of his teeth, but in my mind, the Attending was fully responsible no matter what the Resident did, short of the Resident disobeying clear instructions.

"What do you think, Petrovich?" Clarissa whispered.

"That they both need to consider new careers," I replied quietly. "I can't see any way they have a favorable ruling from the Medical Board. Best-case scenario is a suspension for Edwards and probation for Thornton, but I think more."

"I think so, too. It's unconscionable."

"Doctors, nurses, and students," Doctor Cutter said, coming to the podium. "We have a new protocol going forward. A memo will be distributed over my signature requiring that indelible ink be used by the Attending surgeon to mark the location on the patient's body that represents the procedure to be performed, and that mark will be verified in pre-op, by the anesthesiologist, by the OR circulating nurse, and by the assisting surgeon. Each of these steps is mandatory. Complete details will be in the memo, and it is effective as of Monday morning. That is all."

When I left the auditorium with Clarissa, Shelly, and Ghost, I saw Mary Anderson and walked quickly to catch up with her.

"Hi, Mary."

"Hi, Doctor Mike."

"Did your Resident tell you about the new trauma surgery Residency slot?"

"No! For next year?"

"Yes. It was announced in a memo today. I cannot promise you anything, but make sure that in your interview you state unequivocally that you want to Match for the trauma surgery Residency."

"I will! Thanks! Is there a time when we can talk so I can prep?"

"I'm on the interview committee, so I have to be very careful about what I say to you. I'd hate for you to lose out because someone felt I was playing favorites or feeding you inside information. I believe your Clerkship provided you with everything you need to be successful. Just remember what I taught you."

"Now I wish my schedule was different."

"Don't sweat it. I'm positive you'll do fine. Just be yourself. I look forward to seeing you at the interview."

"Thanks, Doctor Mike!"

She left and Clarissa came up to me.

"What's the scoop?"

"They modified the trauma surgery program to have a Residency slot each year, instead of every two years. In addition, I'll be on a surgical rotation starting next year, instead of PGY3. I'll do a week in surgery, then a week covering the ED. And PGY2s are going to be hands on. I have Shelly Lindsay to thank for that one."

"That's a pretty significant change! You're going to have a general surgery schedule, right?"

"Bankers hours!" I chuckled. "Which means playing golf on Thursdays on alternate weeks."

"4:00am to 4:00pm, Monday through Friday, right?"

"Yes. The new PGY1 will cover the 4:00pm to 4:00am shift when I'm in the ED, and the 4:00am to 4:00pm shift when I'm in surgery."

"Sucks to be them!"

"That's what Loretta said! But I bet Mary Anderson doesn't complain if she's the one who Matches here. She'll have my vote."

"You're on the interview team?"

"Yes, for the team that handles surgical and emergency medicine candidates. Did they assign you to the general team?"

"Yes. Are you coming out tonight?"

"No!" I exclaimed with a smirk. "I'm already out as a straight, heterosexual male!"

"Not what I meant, and you know it, smart ass!"

"Obviously! No, we're not going out tonight because I need the four hours with Kris and Rachel before bed."

"Trouble?"

"Trying to prevent trouble. I had a long discussion with Father Roman last Sunday, and Kris and I are going to talk tonight."

"'Talk'?" Clarissa smirked, making 'air quotes' with her index fingers.

"Father Roman suggested that would be a bad idea to use our time that way. Rachel is going to visit Abigail on Sunday after church so that Kris and I have some time together. I'm positive Rachel won't object."

"Can you imagine those two in fourteen years or so?"

"I'm not sure I want to!" I chuckled. "If Abigail is anything like her mom…"

"And if Rachel is like her biological mom?"

"God help me and any boy she sets her sights on!"