Chapter 33: New Students

August 4, 1989, McKinley, Ohio

"A result of the hypovolemia?" I asked.

"That would be my guess," Shelly replied, "though we won't know for sure until McKnight examines her."

"The McKinley PD and Hayes County Sheriff's Department are investigating. Do they know she died?"

"I have no idea. I'm sure at some point they'll come speak to us."

"I think I better go inform them," I said. "See you next week."

I left the locker room and walked down the corridor to the far end of the building where Doctor Northrup's office was located.

"Excuse me," I said from the door. "Shelly Lindsay just informed me that Miss DeJong died in the ICU about fifteen minutes ago."

"Who was the surgeon?" Doctor Northrup asked.

"Bob Anniston," I replied. "Assisting were Lindsay, Wilson, and me."

"We'll need to speak to him, as well as the doctor in the ICU," Detective Rehling said.

"Mike, you can go," Doctor Northrup said.

I nodded and turned to leave, and as I was walking down the hall, Doctor Gibbs came up behind me.

"Did you run the trauma?" she asked.

"No, it was Perry."

"I heard you took over."

"She was clearly a surgical case, and there was no time to waste, so I simply gave the necessary orders. Did I do something wrong?"

"On the contrary, Perry said you handled it like a grizzled pro — decisive, authoritative, calm, cool, and collected, and with appropriate urgency. Most Interns can't or won't do that."

"I'm not most Interns," I said with a wan smile.

"No kidding," Doctor Gibbs replied flatly. "I just wanted to say 'good job'."

"I'd feel a whole lot better if we'd done something differently last night."

"Pete is beating himself up as well," Doctor Gibbs observed. "As Doctor Northrup has said, we're not social workers, nor are we law enforcement."

"And yet we still somehow failed that young girl."

"They arrested her father," Doctor Gibbs said.

"The cops told you that?"

"Yes. As best I can tell, because they're being cagey, she revealed her pregnancy, and he threatened the boyfriend, which caused an argument, she said something offensive, and well, you can guess what happened next."

"Lord have mercy," I sighed, shaking my head. "But our concern was the guy who brought her in. That seems misplaced after what she said, though the cops sure like him for something."

"Their angle is she blamed her boyfriend, who's her age, to protect the guy."

"He wasn't behaving the way I'd expect a guy who was at risk for a sexual assault charge would behave. Why bring her here and run the risk of people assuming he's the father?"

"Maybe he didn't think we'd do a pregnancy test, or maybe he didn't think about that at all."

"Or maybe it's as innocent as my relationship with Jenny Leonard."

"Who?"

"Little sister of an MVA two years ago who I counseled."

"Ah, OK. I recall the incident but not the name. What is your relationship with her?"

"Mentor. She stopped by the hospital to ask about her High School electives. She also wanted to see Rachel."

"Babies are magnets for teen girls!"

"Speaking of babies, who watches Bobby Junior?"

"Bobby's mom. Just be smart about that young girl."

"The bigger risk is medical students who don't care that I'm married."

"One of the ones assigned to you?"

"No. A Third Year who is friends with Sophia Jackson."

"I was surprised she changed her name. Most medical students and doctors don't."

"That was a thumb in her meddling grandmother's eye. 'You WILL teach your children Greek! You WILL send them to Greek school!' Sophia and Robby aren't having any of that and decided that abandoning the Greek last name was the right way to make a statement. Anyway, I need to get a shower and get home for dinner and sleep."

"We'll speak more on Monday, but great job."

"Thanks."

I returned to the locker room, where Shelly was just about to leave, but she sat down to wait for me while I showered. Once I was dressed, the two of us headed for the parking lot.

"What did they say?"

"Nothing, really. They asked who led the surgical team, and I answered that question, then spoke privately to Loretta Gibbs. The cops arrested the girl's father."

"Wow!"

"Yeah. I was surprised you waited for me."

"I wanted to make sure you were OK."

"I am. I just wonder if we could have handled things differently last night, but as I'm routinely reminded, we're not social workers, nor are we law enforcement."

"And you know why that latter thing is important, right?"

"We don't want people to forego medical treatment because they think their doctor is going to narc on them."

"Which is why we'll almost always err on the side of not reporting things short of stabbings or gunshot wounds. And mostly, we don't snitch on girls fourteen and up, even though technically it's sixteen."

"It was explained that the courts had ruled fifteen-year-olds could access birth control and pregnancy services without parental consent."

"Don't you find it odd that those limits are lower than the age of consent?"

"No, because age of consent laws, at least in Ohio, are structured to prohibit men over eighteen from having sex with girls under sixteen, not prevent girls under sixteen from having sex. If push came to shove, I'd say fifteen is the correct place to set the age limit, though I may change my tune in about thirteen years!"

Shelly laughed, "You sound like every other parent of a present or future teenage girl! Of course, you spent High School and college trying to get laid, right?"

"No comment," I chuckled.

"I'll take that as a 'yes'! I was certainly not a nun in college, though you wouldn't know it from medical school and Residency!"

"You're engaged, right?"

"Yes, but only as of about four months ago. You know what it's like for surgical Residents before PGY4."

"They basically never leave the hospital except to get a few hours' sleep."

"Now, I'm not pulling nights, and I'm on a regular surgical team and get to lead. That lets me have something of a personal life, finally. Oh, before I forget, Doctor Rafiq is transferring to a hospital in Dearborn, Michigan."

"Color me not surprised," I replied. "He's going to a city with a large Arab population. I think it's close to half."

"How do you know that?" Shelly asked.

"The Antiochian Orthodox Archdiocese, a sister jurisdiction, is Syrian, Lebanese, and Jordanian, and they have numerous churches in Michigan that are ethnically Arab. When is his last day?"

"The end of September. They had a Resident die in a traffic accident ten days ago."

"That was fast!" I declared.

"His uncle was hired there as an Attending in June after having worked in California for more than a decade. His uncle knew he was unhappy and called him."

"How did you get the details?"

"Through the surgical Attending grapevine. All the top guys know each other from conferences. Doctor Roth called a friend at that hospital to get an off-the-record scoop."

"So what happens here?"

"Privately? No great loss. Publicly, we'll accept a transfer, and if nobody applies, we'll draft an extra med student in March. Our Resident count doesn't specify how many in each year. You're a perfect example because you're ours, but you aren't in the surgical program, if you understand what I mean."

"I do."

"That said, great job today on the chest tube. You're signed off to do those, right?"

"Yes, and pericardiocenteses as well. I think that proves there's no reason an ED Resident or Attending can't do them."

"Patience, Grasshopper!" Shelly declared. "You're forging a new trail, and you know Cutter isn't going to authorize that at this point. You prove it can be done, and whoever fills the next slot in two years does the same, and then the argument can be made."

"When have you known me to be patient?" I asked with a grin.

"Never! I'm not, either. I was champing at the bit from the middle of Third Year to cut something, anything! You're way ahead of the game."

"Given emergency medicine as we know it is less than two decades old except for the Chicago and Baltimore programs, we've come a long way, but we have a long way to go."

"And we'll get there. Don't push too hard, or you run the risk of wrecking it."

We reached our cars, said 'good night', and each headed home.

August 5, 1989, McKinley, Ohio

On Saturday morning, Kris, Rachel, and I drove to Taft for band practice. We had a good practice, and I let Kim know about my schedule for September and October.

"Is there any time you could practice?" she asked.

"The only reasonable times would be Friday evenings or Sunday afternoons. Neither of those is very good, obviously, but the schedules are being set up to give us dedicated sleep periods, which is why I won't have thirty-six-hour shifts. The problem with Friday is that I have to be at the hospital at 0500 on Saturday, so I need to be in bed early. The problem with Sunday is that's literally the only day I'm with the family during the day."

"I think Mike will be OK without practice," José observed. "The rest of us can meet, and Mike can run through his parts at home. Then we reëvaluate in October when he receives his next schedule."

"It probably won't get better until next June," I said.

"We knew this was coming," Kim said.

"And I have no problem with you guys playing gigs without me."

"Nah, we're all cool with limits for now," Sticks said. "Let's play Taft, Stirred Not Shaken, Newtown, and Goshen. Then we'll play only one or two Proms and July 4th. We can figure it out from there."

"That works for me," José agreed.

"And me," Kim said.

"It'll let me spend more time on my concert pieces," Kari added.

"Sounds like a plan, then," Kim said.

I packed up my things, then Kris, Rachel, and I headed home for an early lunch before I left for my shift at the hospital. Doctor Gibbs had come in so we could give Callie and Gabby their evaluations. I did the handover with Kayla Billings, then went to the Attending's office for the evaluations. Both were rated as 4, though Callie did not receive the coveted 'select for Match'. I asked Doctor Gibbs about that afterwards.

"Neither Lewis nor Townsend felt she was worthy of that. Remember, it doesn't mean she won't be selected, it simply means she won't be actively recruited. We have a limited number of those to hand out, and I know you agreed Mary should receive one."

"Absolutely. And Bob as well."

"Was she better than Bob?"

"A judgment call that could go either way, but if push came to shove, I'd pick Bob and Mary as the two."

"Which is what we did, based on input from all the Residents."

"Any further fallout from yesterday?"

"No. The cops really do want to blame her older friend, but they have no evidence other than their moral outrage."

"Which I suspect they'd have directed equally at me when Elizaveta ordered me to marry her."

"That did turn heads, at least until people met her."

"The problem with making judgments based purely on age. I know plenty of twenty-year-olds who not only shouldn't marry but probably shouldn't even have driving licenses!"

"Did you hear the news about Mo Rafiq?"

"Yes. It didn't surprise me, really, as he didn't fit in here."

"I'm happy to see him gone," Doctor Gibbs said. "There are a few more Residents I'd be happy to see gone as well."

"Anybody on our services?"

"Besides you?" she asked with a goofy smile.

"I know you love me," I chuckled. "The women who love me the most give me the most grief!"

"Clarissa?"

"Obviously. My friend Jocelyn, my mom, my sister, Elizaveta, Kris, and as sure as the sun rises in the East and sets in the West, eventually Rachel!"

"Going back to yesterday, no real fallout. The cops just had a bug up their butts about her being pregnant at fourteen and our failure to call social services or law enforcement."

"Shelly and I discussed that, and the last thing we want is patients foregoing treatment because they're afraid we'll narc on them. It's always a tough call when we have an arrestee."

"There's discussion amongst the Attendings of creating a policy that requires law enforcement to stand outside the doors of the trauma or exam rooms, rather than be in the room. I think that Doctor Northrup will agree and propose it to the Medical Director."

"The cops are going to HATE that, but I like it. When?"

"It'll be proposed at the Monthly Attendings' meeting next Monday afternoon. Then it's up to the Chief. I hear you and Mastriano are getting along OK."

"I have minimal interaction with her, given every order she might give has to be countersigned. I just go to whoever is running the ED to cut to the chase. We'll see what happens once she's off double-secret probation."

"I believe she got the message. Anyway, I'm out of here. This is supposed to be my day off!"

"And I'm supposed to be working!"

"Then go heal the sick, and I'll see you Monday with a fresh crop of medical students!"

Which meant two on Preceptorships on Tuesdays, and three Third Years and three Fourth Years on shift with me at various times. I'd looked at the schedule and didn't recognize any of the names of Third Years. I did know the Fourth Years, but I hadn't worked with any of them when they were Third Years. The only downside was that the Fourth Years would still have to cover the triage desk for August, as the new nursing schedule for covering triage didn't start until September 4th.

The afternoon was routine, though busy, with a mix of walk-ins and EMS runs but no critical injuries. I took my break at about 4:00pm and used my AT&T calling card to call Father Roman. We had a good talk and agreed that Kris, Rachel, and I would visit him on the second Sunday in September. Until then, he directed me to confess to Father Luke so that I could continue to receive the Eucharist.

After the call, we handled walk-ins until dinner, when I met Clarissa in the cafeteria.

"I heard you had a bad one yesterday," she said.

"We did," I replied, then explained what had transpired.

"And, of course, you're beating yourself up for that, right?"

"Shelly Lindsay and Loretta talked to me about it," I replied. "That doesn't mean I don't wish we'd done something differently."

"Sure, though with the competing priorities, you know what has to come first."

"Yes, of course, but did we do everything reasonable in our power to help her?"

"I'm not sure calling the cops would have turned out better because her dad would still have found out she was pregnant."

"I'm still trying to sort out why she told him," I replied. "That's the one thing that makes zero sense here."

"You said you gave her the brochure for the Free Clinic. Maybe he saw that?"

"Possible," I replied. "But I would have thought she'd have been more careful, given she knew she was pregnant before she came in. The cops were fixated on the relationship with the older guy and think she named her boyfriend as the dad to protect the older guy."

"What's your take?"

"That was actually my first thought, but by the end, I didn't get that vibe, which is why I didn't object to Doctor Williams' decision."

"You worked with Mastriano?"

"My problem with her is only laziness," I replied. "If she fixes that, I won't have any problem with her as a doctor."

"Just her cheating?"

"That's her business so long as it doesn't affect anything that happens at the hospital. I did get two pieces of good news."

"Oh?"

"First, the ED Attendings are recommending banning cops from being in trauma or exam rooms in most cases. That's a good thing because patients are often reluctant to talk in front of the cops, which means we don't get the full story. It will require agreement by Doctor Northrup and the Medical Director, but I think they'll do it."

"That's good. And the second thing?"

"Doctor Rafiq is transferring to a hospital in Dearborn, Michigan."

"Wow! During his PGY2 year?"

"According to Shelly, they had a Resident die in a traffic accident, and Rafiq's uncle, who is an Attending there, called him. There's a surgical Residency open for transfer as of September 1st, though if it's not filled, they'll draft another med student."

"Think he'll have better luck there?"

"Dearborn is about half Arab, which I think will work better for him, not that I'd ever want him to be my surgeon."

"I'd let Tessa operate on me before him!"

"But only after a thorough oral exam!" I teased. "Though patients don't generally examine their doctors!"

"Kari certainly did!"

"True."

"Sheila?"

"No comment."

"That's a 'yes'. I'd say Elaine was interested, and you shut her down quickly."

"Very. Though she did play it as marriage. But that was a mess I didn't need, and at that point, even eighteen was a question in my mind."

"And yet..." Clarissa teased.

"We had this discussion!"

"You know I'm yanking your chain, Petrovich!"

"Obviously! How are things in Medicine?"

"No mysteries this week; just routine care. I'm OK with that, too, because I'm not an adrenaline junkie like you!"

"Fortunately, there is plenty of opportunity for both our styles."

"Mike Loucks, Chief of Emergency Medicine?"

"It might happen, but you know that's not my goal. Clarissa Saunders, Chief of Internal Medicine?"

"Someday, maybe."

We finished our meals and headed back to our respective services.

"Mike," Carol, one of the weekend clerks, called out when I returned. "I was just about to page you. Doctor Gabriel needs a surgical consult in Trauma 3."

I hurried to the trauma room and announced myself.

"There's free fluid in Morison's," he said after giving me the patient's vitals.

I quickly confirmed with the ultrasound machine and called up to the surgical scheduling nurse, and booked an OR for an ex-lap for a patient who had sustained injuries in a bicycle accident. I called for an orderly, then escorted the patient up to surgery, where I turned him over to Doctor Burke and returned downstairs to treat walk-in patients. I did that for the rest of the evening and at midnight, handed things off to Kayla Billings, then headed to the surgical locker room for a shower before heading home.