Chapter 27: All I Can Do Is Try

July 25, 1989, Centerville, Ohio

"I need to apologize for dinner last night," I said to Kris after I greeted her and Rachel when I arrived home on Tuesday evening.

"You were upset and stressed," Kris replied. "But please don't walk away from Rachel and me that way again."

"I have an appointment tomorrow morning with Maryann Manning, a counselor in Columbus who specializes in doctors," I said. "Shelly Lindsay recommended her. Clarissa called Vince Taylor, and he asked Shelly to talk to me. Clarissa will watch Rachel."

"You're still going to the prison, right?"

"Yes. My appointment is at 9:00am, and I can be at the prison at any point between 10:00am and 5:00pm. Technically, as a chaplain, I can visit other times, but I don't want to use up any possible goodwill I might need at some point in the future."

"Go change," Kris said. "Dinner is in five minutes."

I went up to our room, put on shorts and a T-shirt, then returned downstairs, where I picked up Rachel.

"How's my little girl?" I asked.

"Rachel miss Papa!" she declared.

"I know, little one, but Papa has to take care of people at the hospital."

"'Papa' needs to care for himself, too," Kris interjected.

Kris put the finishing touches on dinner, and we sat down to eat, with Rachel sitting on my lap. It made eating a bit of a challenge, but I knew she needed my attention.

"Are you going right to bed?" Kris asked.

"I managed two forty-minute naps overnight, so I'm actually doing OK. I can spend some time with you and Rachel before bed. I think I'll go to bed when she does around 8:00pm so we can say evening prayers together."

"Papa sing?" Rachel requested.

"If it's OK with Mama."

"Of course it's OK," Kris agreed. "And I can come to bed with you, if you have enough energy."

"I think I can find the energy for that."

After our meal, Kris and I cleaned up while Rachel played, then I retrieved my guitar and sang for Rachel for about thirty minutes before we said evening prayers. After prayers, I read The Bears Picnic to Rachel as part of her bedtime routine, and after we put her down, Kris and I went to bed and made love before falling asleep spooned together.

July 26, 1989, Columbus, Ohio

"Tell me why you're here," Maryann Manning, who was in her late thirties, said after I sat down in her office on Wednesday morning.

"The snarky answer is that I was ordered to," I replied.

"Let's accept that as true," she said with a smile. "Why were you ordered to?"

"I wasn't really ordered," I replied. "I was counseled because, actually, I can't give a specific reason except by describing a fairly lengthy series of events."

"I blocked out a full hour, so tell me what you think I need to know that led to you sitting in my office today."

I decided to start with the first time I'd seen Angie and ended with the treatment of the patient who averred alien contact. That used nearly thirty minutes, and Maryann was mostly quiet, asking only four questions of a clarifying nature.

"Why, then, did Shelly send you to me?"

"Because I'm at a risk for burnout or depression, and those are the primary causes of alcohol abuse, drug abuse, domestic violence, and infidelity amongst physicians."

"And knowing that, you allowed your understandable anger about your friends' treatment to lead you to a place where burnout or depression are not only possible but likely, at least in the eyes of your mentors. What does that tell you, Doctor?"

"Well," I said with a wry smile, "the phrase 'physician, heal thyself' advises a course of action that can lead to dismissal from the hospital staff. That tells me I need to speak to someone who can help me because self-help by physicians almost always leads to one of the abuses I mentioned before."

"Who are you accountable to with regard to alcohol or drug use?"

"In addition to the Chief Attending in the Emergency Department, my mentors, one in the ED and one on the surgical staff."

"I'm going to assume you're accountable to your wife for fidelity?"

"Yes, of course, but also to my «старец» (staretz) at a monastery in Michigan, as well as my bishop at the Russian Orthodox Cathedral here in Columbus." ("Elder")

"What's a «staretz»?"

"A spiritual guide who has the gift of insight into a person's interior life. Call it the religious equivalent of a combined trauma surgeon, GP, and life counselor."

"So why come to me rather than go to him?"

"Oh, I'll go to him, but his guidance tends to focus on spiritual topics and my interior life, not on externals, which, for Orthodox, are a product of interior life. Or, to put it in secular terms, the psyche is responsible for our actions. It's also the case that he's not well-versed in the trials and tribulations of physicians, and his guidance in that area would have to be somewhat generic and open to interpretation. And like most Orthodox, I'm a fairly expert rules lawyer."

"What do you mean?"

"With regard to just about everything, save a few clear dogmatic statements, most Orthodox rules are open to interpretation and can be applied with strictness or lenity. Thus, it's both easy to read them in either way, as well as to find opinions amongst the Church Fathers and teachers that interpret them either way. I'm a catechist, which authorizes me to teach at church, as well as a prison chaplain."

"Prison chaplain?"

"Starting this year, with exactly one person. And that's another story that involves tragedy."

"Besides your first wife and Angie?"

"There are several others, including the suicide of one of our medical school classmates who I'd been involved with; a close friend who was badly injured in an accident and later attempted suicide; and a friend who was murdered, which is what led to my appointment as a chaplain."

"There's a lot to unpack here, even compared to most doctors."

"Life has thrown me a ridiculous number of curveballs."

"If I may make an observation — your reaction to your friend's treatment for her illness is stronger and more visceral than how you described your reaction to your wife's death in childbirth."

"I suppose that's at least partly because Elizaveta isn't suffering now, while Angie will suffer for decades. And while there's a hole in my heart that will never completely heal, that's different from spending every moment for the rest of my life aware of Angie's predicament and knowing it didn't have to be this way."

"There's no need to get into a debate about the specifics, but you do understand the logical fallacy of 'hypothesis contrary to fact', right?"

I nodded, "The idea that changing something in the past would have guaranteed a different outcome when there is no way of knowing what else might have changed because of that change or what other events might have occurred."

"But knowing that, you still believe an alternative outcome was guaranteed?"

"If I implied that, I'm sorry because no, I don't know what the outcome would have been, only that it could not have been worse than the one that actually occurred."

"But you don't know that. Perhaps that chain of events would have led to her being permanently institutionalized?"

"And perhaps I'll sprout wings and fly to Europe," I countered. "If I've learned one thing, it's that there are no guarantees in life. That said, if Angie had gained even one more day without psychoactive drugs, that would have been a better outcome, which has been my point all along. I never once had the idea that she was cured or that complete remission was in any way likely. That said, I won't dispute that I've obsessed about the situation and allowed my visceral reaction to that to color my responses in just about any instance where psychiatry is involved."

"I notice you make the point to say 'psychiatry' versus 'mental health' or even 'psychology'."

"Can you prescribe medication?"

"No."

"That's why. I have an aversion to pharmaceutical intervention unless strictly necessary."

"You have the typical surgeon's mentality that all other doctors are 'pill pushers'."

"Because they are," I chuckled. "But I had that even before I chose the dual path of trauma surgery. My goal since fourth grade was emergency medicine. The trauma surgery thing came along after I learned about a program started by a doctor at Indiana University Hospital."

"We only have about fifteen minutes left today, so I'd like to discuss the negative interactions you've had with doctors at Moore Memorial."

I nodded and described my experiences with Doctor Rosenbaum, Doctor Mastriano, Doctor Lawson, and, to a lesser extent, Doctor Rafiq.

"We're basically out of time," Maryann said. "I know you have a crazy schedule, so shall we say two weeks from today?"

"Yes."

"I'll leave you with this question, which I don't need you to answer today — do you believe you can solve every single thing that ails medicine?"

July 26, 1989, McKinley, Ohio

"I'd say she asked exactly the right question," Clarissa said after she, Rachel, and I sat down in a booth at Frisch's.

"What can I get you?" the waitress asked.

"FRIES!" Rachel exclaimed happily.

"You need something other than fries," I said.

"More fries!" she giggled.

"Your mom, aunt, and I are going to have words!" I chuckled.

I ordered a chopped salad, given it was Wednesday, Clarissa ordered a Big Boy platter, and we ordered chicken strips and fries from the kids' menu for Rachel.

"She made a good point, you know," Clarissa said once the waitress had left.

"I don't want to cure every ailment, just the ones that affect me."

"So, as she said, every ailment. Come on, Petrovich! You know darn well it all affects you one way or the other because you care so deeply about both the practice of medicine and your patients. And you need to focus on your patients."

"You do realize that was what I was doing with Mr. Alien Encounter, right? Looking out for my patient."

"I know this is going to sound wrong, but you care too much."

"How is that even possible?"

"What is your job, Mike? I know you've been asked that question before, and I know you know the answer. I want to remind you that every single day, you pray to the Savior of the World, and that is not you. Honestly, if you can't do your job the way it's meant to be done, you'll prove Lawson correct."

"What if the way it's meant to be done is wrong?"

"When it's YOUR department, you change it. Until then, and that will happen, you have to work by the policies that are set by the Chiefs. And guess what? Even when you're Chief of Emergency Medicine, you can't tell the other chiefs what to do. And unless you become medical director, a job you don't want, that's going to be the way it is."

"That's defeatist!"

"No, it's not, Petrovich! It's reality. And I'm not saying you have to be complacent, but you have to accept reality. I know it's not an Orthodox prayer, but it's one I know you could pray - 'God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.'"

"Martin Luther King was influenced by Reinhold Niebuhr."

"Which is high praise in your book."

"He was also an avowed socialist in the 1930s."

"So high praise from your wife, too! You understand the key phrase, right?"

"The wisdom to know the difference."

"So do that. You won't do anyone any good if you burn out, or worse, have someone decide you aren't really qualified to be a doctor. We know that's not true, but you're giving idiots like Rosenbaum and Mastriano ammunition they don't deserve, and you KNOW they'll try to use it against you."

"I'm just trying to be the best doctor I know how to be," I protested.

"Remember the prayer, Petrovich! If you're lacking anything, it's what I think you call discernment, but which Niebuhr called 'wisdom'. Mike, you're regarded as the best young doctor in the hospital. Be that doctor. Don't throw it away in some Quixotic crusade to single-handedly save the world."

"The entire system is fu ... messed up."

Clarissa laughed, "Don't want a certain little tape recorder to repeat what you say?"

"That would be bad," I chuckled. "She'll learn those words eventually, but why give her a head start?"

The waitress brought our food, and after I prayed, we began eating, with Rachel greedily and happily eating her fries, which she finished before she ate her two small chicken tenders, which she slathered in catsup.

"Are we OK, Petrovich?" Clarissa asked.

"If anyone can call me on the carpet, you can."

"But how many times before you actually listen? It's been three years, Petrovich. And it's the same story over and over again. Something offends your notions of right and wrong, and your response every time is, 'damn the torpedoes; full speed ahead!' Well, this isn't the Navy, and it's not a suicide mission."

"Papa! Poo!"

"You got that exactly right, Rachel!" Clarissa said through barely contained laughter.

I cleaned Rachel's face and hands with a pre-moistened towelette that came with her meal, then took her to the restroom, where I changed her diaper. After washing my hands, we returned to the table so I could finish eating.

July 26, 1989, Southern Ohio Correctional Facility, Lucasville, Ohio

"Doctor Michael Loucks, chaplain, here to see prisoner Frank Bush," I said to the officer behind the plexiglass.

We went through the same basic motions as during my previous visit, and ten minutes after I'd arrived, Frank Bush, dressed in orange prison overalls, was escorted to the visitors' room and sat down across from me.

"How are you?" I asked.

"How do you think I am?"

"We had this conversation last time, so rather than repeat it, I'll simply assume your answer would be 'as well as can be expected, given the circumstances'. The book you asked me to order will be shipped directly here next month."

"Thank you."

"What else can I do for you?"

"Nobody can do anything for me."

"That's demonstrably false because I arranged for you to get your book."

"Meaningless in the larger scheme of things, but if it makes you feel good..." he shrugged.

"I expect you'll obtain some amount of enjoyment from the book, even if the locale leaves something to be desired. If that weren't true, you wouldn't have asked me to get it for you."

"How do you find being a doctor?"

"Not all it's cracked up to be," I replied.

"You're an Intern, and that's tough in general but toughest in emergency medicine. What has you disillusioned?"

"Mostly things which are outside my control."

"That's the exact reason I went into private practice instead of working in a hospital. I made my own rules, set my own hours, chose my patients, and practiced medicine exactly the way I wanted. But I get the feeling that's not you. You're driven in a way I never was."

"I'm interested in how you became a doctor."

"The same way everyone does — medical school and Residency."

"Obviously, but was it a family thing?"

"My dad was a physician, though a GP, not a pediatrician."

That had been Melissa's goal as well, and in theory, she could be a pediatrician or a GP despite matching for internal medicine. The track to being a pediatrician was a bit complicated but could be done by taking shifts in pediatrics during her Residency. I suspected that in her rural medical center, that would be easier than it would in a big city hospital or even at Moore Memorial.

"I'm the only physician in my family. My dad's side were all businessmen or government employees; on my mom's side it was all trades of some kind in Russia and here. Would you like to play chess?"

"If you want."

I signaled the guard and asked for a chess set, which was brought from an adjoining room. Frank took the white pieces, and I took the black, and we began to play while we talked.

"I spoke to Melissa," I said.

"I'm going to guess she has no interest in speaking with me."

"Correct, but I'll keep in touch with her. At a minimum, I can let you know how she's doing."

"What is it you want?" Frank asked, moving his queen-side knight.

"Why do I have to want something?" I asked. "I'm sure you recall Matthew 25, starting at verse 31:"