Chapter 46: A Tireless Advocate

September 10, 1989, Monastery of the Dormition of the Mother of God, Rives Junction, Michigan

"Good morning, Michael," Father Roman said to me just before Matins on Sunday morning.

"Father, bless!" I replied.

He made the sign of the cross over my upturned palms, and I kissed his hand.

"What time did you arrive?" he asked.

"Just after midnight," I replied. "I had a shift at the hospital until 5:00pm."

"Did you travel alone?"

"Reluctantly. Kris and I agreed it made no sense to disrupt Rachel's schedule so badly. And it allows me to focus on the reason I'm here."

"We'll speak after Matins and Liturgy."

"I'd like you to hear my confession, please."

"Let's do that this afternoon unless there is something so heavy on your heart that you need to confess before you receive the Eucharist."

"There is not."

"Good. Then worship in peace, and we'll have a private lunch after Liturgy."

"Yes, Father."

I moved to a spot just in front of the choir, cleared my mind, and for three hours and forty minutes, I allowed sights, sounds, and smells of Orthodox worship to draw me near to the Throne Room of God. As it had for my entire life, with very few exceptions, it created a sense of internal peace. I received the Eucharist, and once the Liturgy had ended, I joined Father Roman in a small private room for lunch.

"How have things been, Michael?" he asked after he gave the blessing.

"Overall, they are good," I replied. "I don't have enough time with Rachel, but that's a result of decisions I made long before she was born."

"Do you feel guilty?"

"I've thought quite a bit about it during the past week," I replied, "but I'm not sure that's the right word. I feel bad for Rachel, but I can't say I regret the course of action I chose when I was ten. Fundamentally, if Elizaveta hadn't reposed, I wouldn't have spent as much time with Rachel, and she wouldn't have been used to it. That said, the time I did have with her was amazing, and I'm not sure I'd be willing to give it up."

"You were feeling guilty?"

"I expressed to Kris that I felt guilty, and she suggested that I needed to forgive myself the way I forgive others. I accepted that, though the more I think about it, I don't feel guilty, but I'm unhappy with how things worked out. The problem is, it's all because of my conscious decisions."

"So, is it, or is it not, weighing on your conscience?"

"Yes," I replied with a grin. "In another context, I made the point that the situation with Rachel is undesirable, but because I chose my course of action freely, the consequences aren't actually undesirable because I knew about them and accepted them as a direct result of my own choice; a price, if you will. Kantian logic. What I didn't count on was Elizaveta's repose."

"And your marriage to Kris?"

"Is very different from my marriage to Elizaveta. Elizaveta planned to be a stay-at-home mom, at least until the kids started school. Kris is at Ohio State and has career plans."

"Do you have regrets?"

I shook my head, "No. Again, I signed up for this, and so did Kris. Rachel didn't."

"In layman's terms, you're beating yourself up for something over which you had no control — the situation which occurred after Elizaveta's repose. In spiritual terms, you counted the cost at each stage and made a conscious decision. There's no sin here, Michael. Is your daughter healthy, fed, clothed, bathed, and loved?"

"Obviously," I replied.

"Not so obvious, Michael. I'm sure you've seen abused or battered children or those who are malnourished or ill. Is Rachel any of those things?"

"No," I admitted.

"And are you doing the best you are able to do, given your circumstances?"

"I believe so."

"And are you a good father?"

"My friends and my wife seem to think so."

Father Roman smiled, "Well, as I see it, you've made logical decisions, none of which you regret or would change; your daughter is well cared for, your marriage is stable and successful, you appear to have the respect of your friends and colleagues, and you're serving God and your community as a physician. What advice would you give to someone in your situation if you were me?"

"When you put it that way..." I replied. "But it simply feels as if my daughter is suffering from my choices."

"How so? Because she wants more time with you?"

"Yes."

"Had Elizaveta not reposed, would you have had more time for Rachel?"

"Obviously not."

"Then I'm missing the problem, except for what appears to be a guilty conscience that seems to have no basis in fact. May I use a secular phrase?"

"Yes."

"Get over it!"

I laughed because there was nothing else to do. He had a point, and I was beating myself up for things over which I had ceded control at age ten and from which there was no going back.

"You do appear to have a propensity to obsess," Father Roman continued. "I suppose that trait is key to your success as a physician in the ER but not in other areas of your life. The Scriptures, as I'm sure you know, contain admonitions about obsessing, and I would propose that such thinking is what leads to destructive behavior — drinking, drug abuse, infidelity, and so on."

"I suspect you're right," I replied. "On that last one, for accountability, I should tell you that before I was betrothed to Elizaveta and after I was returned to the order of the laity, but before I became betrothed to Kris, I was not chaste."

"That was confessed, and you received absolution?"

"Yes."

"And there was no infidelity, even emotional?"

"No. I do have a close female colleague, but Kris is fully aware, and the young woman and her partner are often guests in our home."

"You do realize that is how it starts, right?"

I nodded, "And both Clarissa and I are aware. I met her during my Freshman year at Taft, and she is one of the main people responsible for me being a doctor and a better man. It's similar to a relationship I had with a young woman from kindergarten until the Summer after I graduated from High School."

"What happened there?"

"Our relationship didn't survive a terrible automobile accident she was in, mainly because we were both too immature to handle what happened."

"Would you explain?"

I recounted Jocelyn's story from meeting her in kindergarten through the accident and her suicide attempt, as well as my bout of depression, our eventual reconciliation, and her marriage to Gene.

"Have you had a truly close male friend besides Dale?"

"During medical school, a fellow student, Peter, but he's in Georgia for his Residency, and Robby, who is the emcee for our band, but he and his wife are likely moving to San Francisco when she finishes medical school. I do have male doctors who are mentors and colleagues but not close friends. My best friend, as I've said, has always been female."

"I won't belabor the point, as I'm sure you understand, but you need to be very, very careful and should develop close male friends. Is there anything else specific on your heart?"

"Impatience with the medical establishment and their intransigence on making fundamental changes."

"Arrogance, too, if you think after such a short time as a physician that you know better than those who have practiced for decades," Father Roman countered.

"Actually, my mentors, some of them very experienced, agree with me on those things, but inertia prevents needed changes from occurring in a timely fashion. A perfect example is Resident training hours and the Libby Zion case."

"You'll have to explain."

I explained, concluding with, "If things don't change, then lawmakers will change them, and that's the last thing we need."

"I have no expertise in the area, but I believe your correct course of action is patience, which I believe you know."

"I do."

"Is there anything else?"

"No."

"Are you keeping your prayer rule?"

"Religiously!"

"And you're using the Jesus Prayer to maintain internal quiet?"

"To the best that's possible in a busy Emergency Department. And I pray silently for every patient."

"Are you able to attend services?"

"When my schedule allows, which for the next two months is Vespers on Wednesdays and Saturdays, and Matins and the Divine Liturgy on Sundays."

"Fasting?"

"The basic relatively lax rule you assigned. We're trying to get pregnant, so after discussing it with Kris, we think the rule about no red meat is probably the best."

"I would agree. Fish or chicken are acceptable for both of you. We'll revisit fasting after your baby is churched. How else can I help you?"

"For now, pray for me," I replied. "I'm sure I'll hit some kind of spiritual or secular brick wall and need spiritual surgery to correct it. That seems to be the pattern of my life."

"All our lives, Michael. I'm sure you know the saying — we fall down, we get up, we love God; that is the Christian life. Continue to pray, fast, attend services, and love your family. I'm positive I don't have to remind you to care for your patients in a loving Christian manner."

"It never hurts to be reminded."

"Let's finish our lunch, and then you can be on your way home."

September 10, 1989, McKinley, Ohio

"PAPA!" Rachel squealed when I walked in the door.

I held out my arms, and she hurried to me so I could pick her up. She gave me a kiss on the cheek and I kissed her forehead.

"How's my big girl?"

"Good! I help Mama with dinner!"

"About fifteen minutes, Mike," Kris said, coming into the room. "I just put the spaghetti noodles in the pot."

She greeted me with a kiss.

"How was your day?" I asked.

"We spent the afternoon with my parents and sister, as we'd planned. How was your visit with Father Roman?"

"Mainly, we discussed my discontent about the time I can spend with Rachel."

"And did Father Roman kick your butt and set you straight?" Kris asked with a smile.

"We had a good chat, and it's a work in progress. I need to stop obsessing over things long ago decided and which cannot be solved except by the passage of time."

"So long as you accept that."

"I do," I replied.

We sat down to dinner about ten minutes later, with Rachel in her chair but close to me so I could help her with her spaghetti, which, as usual, left her hands and face painted red with tomato sauce.

"She's so insistent on feeding herself," Kris observed. "But what a mess!"

"How about I bathe her while you clean up?"

"I think she'll appreciate that."

Kris' observation was correct, as Rachel did appreciate me bathing her, and enjoyed splashing in the bubble bath. When I finished bathing her, we returned to the great room, where I read her two books, and then we said our evening prayers together. Once Rachel was in bed, Kris and I went to bed to work on a sibling for Rachel.

September 11, 1989, McKinley, Ohio

"Do you have five minutes?" Krista asked when I arrived in the ED just before 5:00am on Monday morning.

"Let me finish the handover with Ron, then I do."

There was only a single patient waiting for admission, and he was being handled by Al, so I got a cup of coffee in the lounge, and Krista and I went to stand in the ambulance bay as the consultation room was occupied.

"What's up?" I asked.

"Everyone except you has decided I should fail this rotation, and they don't think I should be a doctor. It's totally unfair because I wasn't even given a chance to succeed."

I actually didn't completely disagree with her, as I didn't believe she was being given a proper chance. The challenge was what I could do about it. I didn't believe approaching Doctor Northrup would be successful, nor did I think going back to Doctor Gibbs would bear any fruit. The only thing I could think of was to speak with Doctor Mertens, who was Dean of Clinical Instruction.

"I know how this is going to sound, but I have to ask two questions. First, do you want to be a physician more than anything else?"

"Yes."

"Second, and I'm sorry for asking, and you need to be completely honest, but there are rumors you've slept with Attendings. Is that true?"

"Yes. There are no rules against it."

That made her situation much more difficult, and not only might a conversation not help, it might cause trouble for me.

"The rumor goes further — it's been said that you did that to pass a rotation."

"That never happened!" Krista protested. "Both times were doctors on different services from my rotation, and I wasn't assigned to them before or after."

"Just so we're clear, I believe there should be a firm rule against doctors sleeping with medical students for what I think are obvious reasons. And now you can see why the rumors spread."

"Oh, please! I know girls who have slept with their supervising Attendings or Residents! I never did that."

"I understand, but people make all manner of inferences. That creates a serious potential problem because it calls every rotation into question. I'm not saying there was ever an instance when you behaved improperly, but even the suggestion of impropriety is problematic. That's why I think there needs to be a rule."

"You think that's the problem?"

"I have no idea," I replied. "But had you not done that, then I could say definitively it wasn't. But what's done is done."

"Is there any way you can help?

"I have serious reservations, but if what you're saying is true, you didn't break any rules. All I can do is have a word with Doctor Mertens. I'll call her later this morning and see if she can come here to discuss the situation. That's all I can promise, given it's the Attendings and Doctor Northrup who have the final say."

"I know. You're basically my only hope."

"Is Doctor Lincoln giving you procedures?"

"Some, but not enough, and I honestly don't think it matters, given everyone except you has concluded I don't belong here."

"You realize I'm neutral on that, right?"

"Yes, but you think I could make it; the others don't."

"OK. Let me see what Doctor Mertens has to say."

"Thanks, Doctor Mike."

"You're welcome."

About ninety minutes later, after handling two walk-ins, I placed a call to Doctor Mertens, who, when I told her the reason, reluctantly agreed to meet me at 10:00am. I cleared that with Doctor Gibbs without mentioning the reason, and she agreed I could move my lunch break to 10:00am. I'd eat an apple and a granola bar in the ED, which would tide me over until my dinner break.

Doctor Mertens arrived as planned, and we went to a small conference room in the administrative wing.

"I think I want to approach this differently from how I first intended when I called you."

"Go on," Doctor Mertens said.

"I think it's high time for there to be a firm rule against doctors sleeping with medical students. I only have circumstantial evidence, but I have the feeling that someone is blackballing Krista because she slept with two different doctors, but never one who was on the same service or to whom she was ever assigned."

"Based on?"

"Nothing else makes sense," I replied. "The rumor is that she slept with an Attending for a grade, but she denies that, and I'm inclined to believe her. I don't condone that behavior, obviously, but it isn't against the rules."

"You don't appear to have all the relevant information," Doctor Mertens countered. "I have a specific report of an incident with an Attending from the service to which she was assigned."

"From whom, if I might ask? Position only, as I'm sure you cannot name names."

"A fellow medical student."

"As an eyewitness?" I asked.

"You're joking, right?"

"Well, with the pager incident, we actually DID have an eyewitness, so no, I'm not joking. May I ask what was said?"

"Simply that she was having an inappropriate relationship with her Attending."

"And did you verify that?"

"I asked, and there was a flat denial."

"While I know that an Attending in that position has an incentive to lie, this smells more and more like someone blackballing Krista. The reason I'm saying that is because I was warned never to be alone with her AND to never leave her alone with a patient. Whatever the basis for those warnings might have been, I haven't seen a single thing that would indicate that either warning was prescient.

"Krista is not a rock star, but she's also not Tim Burg. She's competent, and frankly, the world needs competent physicians. Is she cut out to be an emergency medicine physician? No way. But then again, neither are you, Doctor Forsberg, Doctor Baker, or Doctor Saunders. And no, I'm not saying any of you aren't very good, simply that not everyone is cut out for emergency medicine. That said, she's competent at it, but she's not being graded appropriately and not being given the procedures an average student would be given. And I think it's because someone is blackballing her."

"Tell me your theory."

"There are a few possibilities — first, it's innuendo and rumor, with no substance; second, it's retaliation either from a doctor she slept with or one she refused to sleep with; third, Krista and the Attending are both lying to cover up a quid pro quo. I honestly think that the last one is the least likely unless you're prepared to name that Attending and bring them up on ethics charges.