Chapter 44: Feelings of Guilt

August 31, 1989, McKinley, Ohio

I met Clarissa for lunch just after noon.

"I can't even leave you in the ED without you finding a way to get into trouble!" she said, shaking her head.

"Right, because saying I want to teach my medical student is 'getting into trouble'?"

"Even there, you find a way to rock the boat or stir up a hornet's nest!"

"Gee, Lissa, did you give up on me Freshman year?"

"I'd argue that was different, but you won't accept that argument, no matter how well I make it."

"My point is not about specifics but about giving up too soon. Nobody has given Krista a failing grade, and I honestly don't believe she deserves one now. Right now, I'd give her between a 2 and 3 for her rotation, with a 3 being likely if she continues to improve. A 3 won't end things for her, though it'll make it tough for her to Match to a top program, and she'll very likely Scramble to a third-tier program in a rural area, similar to what happened with Melissa Bush."

"How is Melissa doing?"

"I haven't spoken to her again, though I will call her sometime in September to catch up."

"You're a strange guy, Petrovich."

"You have heard that it was said, 'You shall love your neighbor and hate your enemy.' But I say to you, love your enemies, bless those who curse you, do good to those who hate you, and pray for those who spitefully use you and persecute you, that you may be sons of your Father in Heaven; for He makes His sun rise on the evil and on the good, and sends rain on the just and on the unjust. For if you love those who love you, what reward have you? Do not even the tax collectors do the same? And if you greet your brethren only, what do you do more than others? Do not even the tax collectors do so? Therefore, you shall be perfect, just as your Father in Heaven is perfect."

"Matthew's Gospel, right?"

"Yes. I figure if I can't take Jesus at His word, well, to paraphrase Paul, I've run a race in vain."

"I noticed you memorize things Jesus said and the Psalms but not much else."

"David was a man after God's own heart, and Jesus is God. Paul and I have very different ideas on a number of topics, but that's OK because his letters are akin to the canons — specific advice for specific situations, not meant to be generalized. I'm also partial to James and John.

"But coming back to our topic. I don't think it's right to give up on a student like Krista. She's not Tim, who failed rotations. That said, there is an accusation that she used sex to pass a rotation, but barring either confession or the doctor coming forward, it's just rumor. I mention it only because Doctor Northrup brought it up, and it does track with what I told you Leila Javadi said."

"Krista has never come on to you?"

"No. Ellie and Detective Kleist have actively flirted and want to have a fling; Kellie is absolutely interested but wisely won't sleep with a married man. And a few med students have flirted or made rare suggestive comments, but Krista never has."

"Who is she assigned to as of now?" Clarissa asked.

"Mostly Paul Lincoln, given the schedule," I replied. "He works more or less opposite shifts to me now and also will next month."

"What do you think Northrup will do?"

"It's an interesting dilemma. He can't really allow students to select their Residents, but I'm likely the only Resident who would give Krista a chance. Think about a formal complaint and how it would work out when she pointed that out AND he denied her request."

"So she's found a way to force his hand?"

"In his position, under the current circumstances, that is what I would do, but I'm not sure what he would do. I believe he sees it as a situation where he's damned if he does and damned if he doesn't. On the one hand, set a precedent where students are allowed to influence or even select their Residents, which creates a serious problem as students will gravitate to the best teachers through word of mouth; or, on the other hand, have her lodge a complaint that might actually succeed in some kind of formal proceeding."

"Why does this sound almost like the 'wine in front of you' bit from the movie?"

"Because he's basically screwed either way. I think he'll come down on not changing her schedule because, as I've been told time and again, no medical school or hospital has ever lost a lawsuit with regard to training medical students."

"Melissa Bush?" Clarissa suggested.

"I don't think she would have won in the end, but they chose not to take the risk and to save the time and effort of defending themselves. The fact that she got her act together says the exercise was a success for both sides."

"What will you say if Krista does make some kind of formal complaint?"

"The truth, and only what I have personally observed. I did that with Doctor Northrup, even after he declared our conversation to be off the record."

"So you'd tell him what you thought versus what you were willing to say if asked?"

"Yes. As Residents, and especially during our Intern year, we're only provisional members of the guild. Doctor Northrup didn't want me to say anything on the record that might cause either of us a problem, and you know who comes out on top in that situation."

"It sounds as if you think she's going to get screwed," Clarissa observed.

"I think she put herself into a position where it was possible, and given she doesn't compare favorably with the other med students assigned to the ED, she's going to receive a sub-par evaluation and might even fail. I'll object to failing her, but the thing is, this will be her second sub-par evaluation, and that's the kiss of death for any program other than the kind Melissa found in her second attempt."

"What would it take to fail in your mind?"

"Tim Burg deserved to fail; Krista doesn't, at least at this point. Someone, somewhere along the way, decided she wasn't worth teaching, and that started a downward spiral."

"Or, the rumor about her sleeping with an Attending to get a passing grade is true, and that is why she's being treated the way she is."

"I have no way of knowing, and as such, I won't consider it as material to anything."

"But if it were true..."

"Then she'd deserve to fail, and the Attending ought to be suspended."

"Fat chance," Clarissa replied.

"I know."

We finished our lunch, and I returned to the ED, and had Krista take her meal break while I supervised Al suturing a leg lac. The rest of the afternoon was quiet, and, as promised, Doctor Northrup asked to see me just before 6:00pm. I checked with Doctor Gibbs, then went up to Doctor Northrup's office. As he had earlier, he signaled me to shut the door.

"I spoke to John Cutter, Ron Getty, and Tim Baker to get their input. The consensus is we can't, at this late date, change the schedule, especially for a sub-par student. And before you object, you did say she was clinically challenged. Are we going to have a problem?"

"No," I replied. "I understand your decision and will obviously abide by it and not publicly contradict it, but I don't agree."

"I understand. You'll find, over the course of your career, many instances where you don't agree with decisions that are made. How you respond is key — it's OK to disagree, but it's not OK to stir up dissension."

"I understand."

"I will instruct Paul Lincoln to give Ms. Sandburg the benefit of the doubt and not simply assign her pure scut. She is also free to attempt to trade shifts, but I suspect she won't meet with much success."

I was positive that wouldn't happen, as there was no chance Jake Green would switch with her.

"OK. I consider this matter closed."

"But you're unhappy," Doctor Northrup observed.

I nodded, "Yes, but I'm not in charge, and I'm not the one who has to make those calls. I've provided my feedback and my opinion. If this were a medical question, I'd be much more forceful."

"As I would not only expect but demand. All reports I have are that you're doing an excellent job. Keep it up."

"Thank you."

I knew I was dismissed, so I left his office and returned to the ED, meeting Krista, who had obviously been summoned, on the stairs. I acknowledged her but didn't say anything, as it wasn't my place. There was nothing pressing, so I was able to take my dinner break and meet Kris and Rachel in the cafeteria.

"How did your test go today?" I asked once we had our food and had sat down.

"It was easy," Kris replied. "You know I can read, speak, and write English, so that wasn't even a challenge. And I only had to answer ten questions from the list they provided and I am positive I answered all ten correctly. I should hear sometime in the next three weeks; then, I simply need to appear to take the oath at a scheduled ceremony."

"When are those?"

"At varied times. Once my application is approved, I'll do my best to work around your schedule."

"I'm curious, but will you take the standard oath?"

"No. I'll say 'solemnly affirm' rather than swear, and I won't say 'so help me God'."

"What about bearing arms in defense of the US?"

"I can use the modified version, which says that I will perform non-combatant services, which I am sure you would insist on if you were drafted."

"Well, I'd certainly be a doctor, but before I graduated, I'd have asked to be a corpsman or something similar rather than carry or use a firearm. I take it your parents will apply once you're approved?"

"Not until after I take the oath, according to Mr. Burge."

"Papa?" Rachel said.

"Yes?"

"Home?"

"Not tonight," I replied. "Papa has to take care of sick people. Papa will be home tomorrow night. One more sleep and one more nap."

"I think your idea that we shift her bedtime is exactly right," Kris observed. "She really misses you."

"As we said, she didn't sign up for this the way we did, and at two, she doesn't understand. Fortunately, I'll have at least two months of the new schedule, and that will take us a third of the way through my Intern year."

"Maybe have lunch with her more often when she's in daycare here?" Kris suggested.

"I think I'll do that. I just hate that for two years, she's paid the price for a decision I made seventeen years ago."

"She enjoys visiting Abi one day a week and being with Serafima another day, and she has her friends in daycare."

"I know, but she clearly wants her dad."

"And if you continue to beat yourself up for a decision you made when you were ten, where will that leave you? And where will it leave her?"

"You're right, of course. That doesn't make it any easier."

"And yet, as they say, the die is cast. The Rubicon was crossed long before she was born."

It was more complicated than that, but I couldn't say it out loud. My original plan had been to marry after my Intern year, which would have avoided the situation, but saying that would convey regret that I had Rachel, something I could never do. Nor could I say anything that would convey regret that I had Kris despite the circumstances that had led to our marriage.

"I promise not to obsess about it," I said. "It's just that she tugs at my heartstrings."

"That's how it should be, shouldn't it?"

"Yes, of course. It's just that her little life has been difficult."

"Has it? Or do you think it's been difficult? She is a very happy toddler with lots of friends. She doesn't know what happened. Her life is what it is, and you should be proud of what you've accomplished as a dad despite all the adversity with which you've had to deal."

"You're right, of course."

"Keep saying that!" Kris said with a smile. "I like hearing it!"

"I'm sure!" I chuckled.

"How was your day?"

"Routine and not too busy, though we lost a seventeen-year-old who wrecked his car early this morning."

"What is it with boys driving fast?"

"Don't ask me! I've never had a single traffic ticket. I left those to Jocelyn, who collected them like kids collect baseball cards!"

"How is your medical student?"

"She tried a Hail Mary today and didn't connect."

"A 'Hail Mary'? The prayer?"

I chuckled, "Good thing American football wasn't on your citizenship test! It's a last-minute attempt to score by throwing a long forward pass into the endzone in the hopes one of your team will catch it or the defenders will commit a penalty."

"Such a silly sport! You should play proper football! Or at least rugby football! And stop calling cars going around in circles 'racing'!"

"Ovals," I chuckled. "Ovals. But NASCAR does race on road courses a few times each season, I think."

"Formula One is proper racing."

"Listen to the Euro-snob!" I teased.

"There is no city in Ohio which even comes close to Paris!"

"Most people here would take that as a compliment!"

Kris laughed, "Of course they would! They're mostly Germans, after all!"

"As an Ohioan, I do have to point out that there are no Skyline Chili restaurants in Paris!"

"You say that like it's a bad thing!" Kris teased.

"Those are fighting words, Missy!" I growled.

Kris laughed and winked, and we continued eating. When we finished our meal, I took a short walk with Rachel, and then my wife and daughter headed home. I walked back to the ED and found Serenity and Al waiting for me. About two minutes later, Joyce, a new clerk, let us know EMS was bringing in an MI. Serenity, Al, and I gowned, gloved, and headed for the ambulance bay, along with Nurse Alice. The patient arrived in full arrest, and despite our best efforts, we couldn't revive him.

"Time of death: 19:17," I announced. "Put it on the chart, but we'll need an Attending to pronounce officially."

I sent Al to get Doctor Taylor, who came into the room and performed an exam. I completed the chart and filled out the physician's portion of the death certificate. Doctor Taylor signed the chart and the death certificate.

My students and I left the trauma room while Alice began the death kit. I asked Joyce if the patient had any next of kin, and she said his wife and son were in the waiting room. I asked Serenity to bring them to the consultation room, and once she had, I relayed the news.

I realized I was becoming anesthetized to death, and I wasn't sure I liked it despite it being necessary to be able to do my job. Each death weighed less and less, though I understood that the family and friends of each patient who died felt the full weight of their loved one's passing, and I had to show empathy while remaining detached, which was no easy task.

Once I left the family in the hands of the chaplain, I took the chart to Joyce, who would ensure it was recorded on the computer and then given to whichever Attending was responsible for the chart review.

The rest of the evening was relatively quiet, and I managed to sack out in the on-call room just before midnight.

September 1, 1989, McKinley, Ohio

"How was your day?" Kris asked when Rachel and I arrived home on Friday evening.

"Calm, actually. I managed to get about four hours of sleep, and Rachel and I had lunch together today."

"I'll take her so you can go change. We're staying home, right?"

"Yes. I don't want to foist Rachel off on anyone, given she clearly wants to spend time with me. Not to mention, you and I have some business to attend to!"

Kris laughed softly, "So, making love to me is work?"

"No! But I'm concerned about the 'tape recording' feature that someone seems to have installed in our daughter!"

Kris laughed again, and I went upstairs to change into shorts and a T-shirt, then went down to the kitchen to help with the final preparations for dinner. I helped Kris finish making dinner, then the three of us ate. After Kris and I cleaned up, I read two books to Rachel, then played my guitar for her. We said our evening prayers together, and then I gave Rachel a bath and put her to bed.

"I think I need a bath," Kris said invitingly.

"Before or after?" I asked.

"Before, I think, so we can just fall asleep after we make love."

We went to our room, I drew a bath, added a capful of liquid bubble bath, and then Kris and I undressed and got into the tub.

"Did having lunch with Rachel help you feel better?" Kris asked as we lounged in the warm, sudsy water.

"Yes, and it did assuage some of the guilt, but it's only a partial solution."

"Mike, you need to forgive yourself the way you forgive others. What you're doing isn't sinful, so it should be even easier."

"As the saying goes, 'easier said than done', but I understand. I think I'll feel better starting Sunday because I'll have time for her every day. And equally important, time with you every day."

"And I will be happy to have you home more."

"When would your period normally start?"

"Around the 16th," Kris replied. "Are you expecting me to be pregnant?"

"If you aren't, it won't be for lack of trying!"

Kris laughed softly, "And we should try three times tonight to improve our chances?"

"I certainly got enough sleep last night that we can do that."

"Great!"

September 2, 1989, McKinley, Ohio

Kris, Rachel, and I had our usual Saturday morning — band practice, shopping, the bakery, and lunch together. I left my wife and daughter at about 11:40am and headed to the hospital for my final shift of the August rotation, even though it was September on the calendar.

"Doctor Mike, do you have a moment?" Jake asked after I'd done my handover with Kylie.