Chapter 30: What Are You Going to Do About It?

August 1, 1989, McKinley, Ohio

"Mike," Nate said from the door to the lounge. "You have a visitor."

"Who?" I asked.

"She said her name is Jenny."

"Around fifteen, right?"

"Yes."

That meant it was Jenny Leonard, the girl who'd lost her brother in an MVA and whom I'd promised to help become a doctor after consoling her. I asked Mary and Tom to wait in the lounge and went to the waiting room, where I saw Jenny, who had developed into a beautiful young woman.

"Hi, Jenny," I said. "Come on in."

"Hi, Mike! Or is it 'Doctor Loucks' now?"

"I go by 'Doctor Mike', but you can call me 'Mike'."

I led her to the consultation room and left the door open to deflect any possible questions from anyone in the ED.

"How are things going?" I asked.

"Good. I had all A's for Freshman year. I'll be a Sophomore in a few weeks."

"That's good to hear. How are you feeling?"

"I miss Jeff a lot," she said. "Do you miss your wife?"

"Every day," I replied. "It hurts, but not as bad as it did. I hope that's true for you, too."

"It is. Mom had me talk to a counselor who helped some."

"I did the same thing."

"When did you become a doctor?"

"I graduated at the end of May, then started working in the hospital as an Intern on July 1st. Are you still planning to be a doctor?"

"Yes. I wanted to ask you what classes I should take, I mean, for electives?"

"I would make sure you take every science class available because the most important criterion for getting into medical school is how well you do in science, and that's what the MCAT — the admission test for medical school — focuses on. Otherwise, take classes that interest you. I found Latin very helpful, but I don't think Hayes County offers Latin."

"No. Just French, Spanish, and German."

"Otherwise, philosophy, psychology, or sociology will all help with your coursework and in becoming a good, well-rounded doctor."

"And you'll help me?" she asked.

"I promised to do that, and I'm not going to break that promise."

"How is your daughter?"

"She's great. Would you like to see her? She's in daycare."

"Yes! I love babies! I just don't want one!"

"I understand that sentiment. I had some friends who were pregnant in High School, and it was extremely difficult."

We left the consultation room, I let Ellie know I was taking a break, and then Jenny and I walked to the nursery, where I asked Marcie to bring Rachel out, which she did.

"Papa!" Rachel exclaimed.

I took her from Marcie, then turned to Jenny.

"Jenny, this is Rachel; Rachel, this is my friend Jenny! Say 'hi', please."

"Hi Djenny!" Rachel said, not quite getting the 'J' sound right.

"Hi, Rachel! You're a pretty girl!"

"Would you like to hold her?" I asked.

"If it's OK."

"It is."

I handed Rachel to Jenny, and happily, Rachel didn't object to Jenny balancing her on her hip.

"I take it you babysit?" I inquired.

"Yes. That obvious?"

"You balanced her on your hip like a pro!"

"Who watches her when the daycare is closed?" Jenny asked.

"My wife, my sister-in-law, or her grandparents."

"You remarried?"

"In January."

"I think it's important for a girl to have a mom."

"Me, too," I replied.

We stayed for about five minutes, then I handed Rachel back to Marcie, and Jenny and I left.

"Is there anything specific I can do for you?" I asked.

"No. I just wanted to say 'hi' and ask about electives. I called to make sure you were here, and when they said you were, I rode my bike. I'll get my learner's permit in November."

"It sounds as if everything is going well," I said. "Apart from being a bit sad."

"Do you go to the cemetery?" Jenny asked.

"Occasionally, though, I went more during the first year."

"I go there and read, sometimes out loud. Is that weird?"

"Not at all," I replied with a smile. "I spent a lot of time talking to Elizaveta, and that was a good thing."

"And you think they can hear us and know we're there?"

"I do. I can't tell you how because it's a mystery, that is, something hidden from us, but I believe it. You remember I wore my cassock, right?"

"You were a pastor of some kind."

"A deacon, but I had to step down in order to get married."

"Really? Why?"

"Because while our clergy are permitted to be married, it has to happen before they're ordained. Because I wanted to marry, and because I had to focus on Rachel and medicine, I really couldn't fulfill my obligations as a deacon."

"Is it OK to come see you again?" she asked as we walked into the Emergency Department.

"Yes, of course. Just call to check if I'm here, and if I'm not, ask when I will be."

"Great! Thanks so much!"

"You're welcome."

"Is it OK to hug you?" Jenny asked.

"It is," I confirmed.

She gave me a quick, friendly hug, then I walked her to the door of the waiting room. Once she'd left, I walked back to the nurses' station to let Ellie know I was available.

"I'm way more fun than that jailbait could hope to be!" Ellie said, her eyes twinkling.

"Her brother died in an MVA about two years ago, and I consoled her as a deacon and promised to guide her on her quest to be a doctor. There is nothing more to it than that!"

"Uh-huh. She had the 'I am in the presence of a god' look in her eyes."

"Well, I do have on red scrubs," I chuckled. "But I don't get that vibe at all. And I have to ask you not to imply that ever again."

That last bit was said sternly.

"Sorry, Doctor," she said.

"I don't mind you teasing on occasion," I said. "But that is a line you simply cannot cross."

"Yes, Doctor."

"It's Mike," I said.

She smiled, "Thanks."

"Mike?" Nate called out. "EMS three minutes out with an unspecified groin injury."

"Male or female?" I asked.

"Male. Use Trauma 3."

"OK."

I called Mary and Tom, and the two of them and Nurse Kellie accompanied me to the ambulance bay. Two minutes later, the EMS squad pulled up, and Julie, the lone female paramedic, jumped out.

She was smirking, which told me this was going to be 'interesting'.

"Sam Hoffmann, nineteen; BP 120/70; pulse 80; PO₂ 99% on air; penile bleeding due to torn foreskin inflicted dentally when he and his partner were surprised in flagrante delicto."

"Trauma 3," I said, knowing the story was going to be 'interesting'. "Mary, monitor; Kellie, we'll need an irrigation syringe, saline, and a basin."

"Labs?" she asked.

"I don't see a need," I replied.

We moved Mr. Hoffmann to Trauma 3 and moved him to the trauma table.

"Mr. Hoffmann, I'm Doctor Mike. Can you tell me about your injury?"

"It hurts like hell!" he exclaimed.

"Let me take a look, please," I said.

"Do we have to have chicks in here?" he asked.

"You have a choice about who treats you," I said. "Kellie, Mary, would you step out, please?"

Mary frowned, but Kellie gently took her arm, and they stepped out of the room.

"Tom, hook up the monitor, please, then get the irrigation syringe, saline, and a basin, please."

"Just the pulse oximeter, right?" Tom verified.

"Yes. No need for the blood pressure cuff or EKG. Mr. Hoffmann, Tom is going to put a monitor on the index finger of your left hand, and I'm going to move the sheet to examine you."

An examination of the injured member showed a torn foreskin, as Julie described. I had no experience with foreskins as I'd been circumcised as an infant, so I wasn't sure how severe the tear was, though I was positive it 'hurt like hell'.

"Tom, after you set up the irrigation tray, call Urology for a consult, please."

"Right away, Doc."

"Mr. Hoffmann, I'm going to irrigate your wound, and then we'll have a specialist examine you. How did this happen?"

"I was at my girlfriend's house, and her dad came home while she was ... you know. He opened the door, saw us, and she bit me. How bad is it?"

"I'm not a urologist," I replied. "But it does not look as if there is any damage to your member beyond the foreskin. I'm going to irrigate it with saline. When was your last tetanus shot?"

"I don't remember having one."

"Then we'll give you one and start you on a course of antibiotics. Human bites often cause infections. Do you have diabetes?"

"No."

"Drink to excess?"

"No."

"Are you taking any medications?"

"No."

I finished irrigating the wound and covered Mr. Hoffmann's groin with a clean cloth.

"Meyer, Urology," Doctor Pete 'Oscar' Meyer said, coming into the room.

Under the circumstances, I felt it was more appropriate to call him by his first name rather than refer to 'wieners'.

"Hi, Pete. We have Sam Hoffmann, nineteen, with a torn foreskin as a result of a bite accidentally inflicted during fellatio. I've irrigated the wound and ordered a tetanus shot as well as a course of antibiotics."

"Hi, Mr. Hoffmann," he said to the patient, "I'm Doctor Meyer from Urology. May I take a look at your injury?"

"Sure."

Doctor Meyer performed the exam.

"Mr. Hoffmann, I recommend a circumcision, given the tearing, which makes a repair difficult and might well result in circumcision, anyway. There's also a higher risk of infection if we attempt a repair."

"Shit!" Mr. Hoffmann swore. "How bad will that hurt?"

"We'll use topical anesthetic for the procedure, and it'll be uncomfortable for a week or so, but it'll heal completely in about two weeks."

"And if you fix it?"

"A similar recovery time, though, as I said, with a risk of needing the circumcision if it doesn't heal properly."

"Remove it," Mr. Hoffmann said. "My girlfriend doesn't like it, anyway."

"Mike, you can give the tetanus injection, but we'll take care of the antibiotics. Send him up when you're ready."

"Will do."

"Mr. Hoffmann, I'll see you upstairs," Doctor Meyer said.

He signed the chart and left the room. I excused myself, stepped out, and retrieved the pre-packaged tetanus shot. I took it to the trauma room and had Tom administer it. Once that was done, I had him call for an orderly while I completed the chart. Ten minutes later, Mr. Hoffmann was on his way upstairs.

"Sorry about that," I said to Mary when I found her in the lounge.

She smirked, "Did his girlfriend really bite off his foreskin?"

"Not off, but enough that he'll need it surgically removed. Not something I'd want to contemplate at his age!"

"Mike?" Ellie said from the doorway. "Detectives Kleist and Tremaine are here about your patient."

"Tom is taking him upstairs right now. What do they want?"

"They just said they wanted to speak to him."

"Send them up to Urology," I replied.

"OK."

She was back thirty seconds later to let me know they wanted to speak with me, so I left the lounge, and the three of us went to the lounge in the absence of a Resident's office.

"What can I do for you, Detectives?"

"Tell us about Sam Hoffmann's injuries," Detective Tremaine requested.

I described them, then asked, "What's going on?"

"Her father filed a sexual assault complaint," Detective Tremaine replied.

"She's underage?"

"She's sixteen, but for a minor, a parent can lodge a complaint up until they turn eighteen."

Something of which I was aware.

"You should see Doctor Peter Meyer in Urology," I said. "He has the patient who's going to have surgery."

"I'll want your chart notes, Doc," Detective Kleist said.

"The hospital requires a subpoena for the actual notes," I replied. "I'll coöperate, of course."

"We'll get it by the end of the day. Preserve all your notes."

"I always do, both the chart and notes in my personal notebook."

"Thanks, Doc."

"From the way the patient described it, it was consensual. You can't cut the guy some slack?"

"Take it up with her dad and the State Legislature," Detective Tremaine said.

I nodded, "Understood."

They left, and I went back to the lounge, where Mary was waiting.

"What was that?"

"She's sixteen, and her dad lodged a complaint."

"That's over the age of consent!" Mary protested.

"And under Ohio law, a parent can lodge a complaint for a minor, even if she can legally consent. Given they were caught in the act, and he has an injury from the act, denial on her part won't help."

"Wow. That sucks!"

I chuckled, "Not how I'd put it, but yes."

Mary smirked, "And it really sucks to be him!"

"Some joking is OK," I said. "But you need to be very careful about when and where."

"Sorry," Mary replied quickly.

"That wasn't a reprimand, just a reminder."

"Do you agree with the law?"

"No, but my solution would be to not file charges in a similar situation. What other parents do would be up to them."

"Why not try to get the law changed?"

"I have plenty of other windmills at which to tilt," I replied. "I'm sure you've seen the changes which have taken what used to be mostly a probation offense in the 70s to one that now has penalties approaching forcible rape and manslaughter. I have limited capacity to fight injustice, and I have to pick my battles, most of which revolve around mental health care or hospital policy."

"That makes sense, though I hear doctors make some fairly offensive jokes."

I nodded, "They do. Don't be like them. And be very careful about using medical slang around patients, especially words like 'gorked' or 'gomer'. Ultimately, the answer is simple — treat others as you would have them treat you."

"Jesus' command?"

"Yes, and combined with his other great command — 'love one another' — a perfect approach to medicine and all of life."

"Mike?" Nate said from the door to the lounge, "Doctor Varma needs help with walk-ins."

Tom came in just then, with perfect timing.

"Mary, Tom, let's go!" I said.

Over the course of two hours, we treated four patients for a mix of minor ailments which ought to have been treated by a primary care physician. Just before lunch, I caught an ambulance run with a rule-out MI that turned out to be severe indigestion caused by what was best described as poor dietary choices. After the patient was discharged, I went to the cafeteria to have lunch with Clarissa. A few minutes later, Sophia came to sit with us rather than her friends.

"I had a word with Kelly," Sophia said. "I'm not sure it did any good."

"What happened?" Clarissa asked.

"A Third Year," Sophia replied, "who, when Mike asked what Match she wanted, replied, 'You and me'. I pointed out that he's married and has a kid, then spoke to her later. Her response was 'all doctors cheat'."

"Not Petrovich!" Clarissa declared emphatically.

"That's what I told her, but she didn't believe me. She has her sights set on you, Mike."

"Then she's going to be as disappointed as Nurse Ellie and Erin Edwards. By the way, I heard through the grapevine Erin is getting married, so that should resolve that situation."

"Why would you think that?" Clarissa asked. "She was willing to be the 'other woman', so what makes you think she's going to be faithful to her husband?"

"Good point. I'll be careful."

"Is Ellie behaving?"

"Mostly. She flirts lightly but isn't obnoxious, though I did have to speak sternly to her this morning. Jenny Leonard stopped by for a visit, and Ellie called her 'jailbait' with all the implications of that word."

"Who's that?" Sophia asked.

"A girl I counseled and consoled after her brother died in an MVA about two years ago. They'd had a fight, and instead of going with him to school, she decided to take the bus. He was involved in the fatal MVA while driving to school."

"Survivor's guilt?" Sophia asked.

"Yes. She came back not long after for a tour and asked about being a doctor. I gave her advice and said she should come by occasionally to check-in. She did that this morning. And, no, I do not get that vibe at ALL from her."

"She's what? Fourteen?" Clarissa asked.

"Fifteen, and will be a Sophomore. Ellie claims she saw 'hero worship' in Jenny's eyes, but I don't think so, given I was the enemy who let her brother die. I think Jenny might be in awe of me being a doctor, but she certainly doesn't think we're gods because we didn't save her brother."

"I get hit on all the time by patients," Sophia said.

"So does Clarissa! Ask her about the football player from Hayes High!"

Clarissa laughed, "He was cute, not obnoxious like some."

"I had an interesting case this morning," I said with a goofy smile.

"Oh?" Clarissa asked.

"Foreskin injury when a nineteen-year-old and his sixteen-year-old girlfriend were surprised by the father coming home from work unexpectedly."

"I'm a girl, but 'ouch!'" Sophia exclaimed.

"Yeah. He went up to urology for an adult circumcision."

"Double 'ouch!'" she exclaimed. "I'm curious about your position on that. Circumcision, I mean, not sixteen-year-olds, because we KNOW your position on that one, at least in the past!"

"Yeah, well," I chuckled. "As for the procedure, I disagree with my Dutch Calvinist dad. Strongly. He had it done after I was born as 'routine', and I would never contemplate that. I get the religious significance for Jews, but the idea that Christians practice it at all is mind-boggling, given the clear statements against it in Paul's letters."

"I thought you said it was «ekonomia»."

"It was, but Christians do not need that sign, as our covenant is different. The so-called Judaizers lost the debate, and rightly so. Medically, there is no reason to perform a circumcision, with the usual arguments, such as cleanliness, being complete BS. Fundamentally, it's an unnecessary procedure, and with the exception of religious ritual, ought never to be performed without medical necessity."

"What's your take on cosmetic surgery?" Sophia asked.

"I object if it's purely for vanity. If it's in response to some kind of disfigurement due to disease, defect, or trauma, I'm OK with it. That said, I wouldn't make it illegal; I just wouldn't participate."

"So similar to your view on elective abortions."

"Yes. Any interesting cases on your services?"

"Just routine," Clarissa replied.

"Same here," Sophia added. "Mike, what is your schedule for September?"

"Monday, Tuesday, and Thursday 0500 to 2100; Wednesday 0800 to 1700 at the Free Clinic; and Friday and Saturday 0500 to 1700. I saw you're on five sixteen-hour shifts that roughly coincide with mine."

"I asked Doctor Casper if I could be assigned to you, and he agreed. I assumed you wouldn't have a problem with that."

"Of course not!"

We finished our lunches, and I headed back to the ED, and as things were quiet, I sent Mary and Tom to have their lunches. We had a busy but calm afternoon, with no severe trauma and at 6:00pm, after handing over to Kylie, I headed up to the surgical locker room for a shower.

"How are you doing?" Shelly asked when I walked in.

"Good," I replied. "I'm doing my best to control my windmill-tilting impulses."

"Pick your battles wisely."