Chapter 48: Internecine Warfare

September 12, 1989, McKinley and Circleville, Ohio

Shelly Lindsay and I met for lunch later on Tuesday morning, though we ate in the surgical Resident's office rather than in the cafeteria.

"I spoke to Owen Roth, and we went to see Doctor Cutter together. Doctor Cutter is very unhappy that Doctor Northrup reprimanded and disciplined you, and not just that he did it, but that he did it in front of outsiders. He has a meeting scheduled with Northrup this afternoon. Just hang tight until after that meeting, OK?"

"Other than my wife and Doctor Saunders, I haven't discussed this with anyone except Krista, and that was only a brief conversation this morning where I suggested that during her Medicine Sub-I, she go to Doctor Saunders for any questions or if she needed help."

"Good. Let's keep it that way."

"I do have a good idea who the source of the rumors and innuendo is."

"Oh?"

"Doctor Rosenbaum from Pedes. According to Krista, he hit on her, and she turned him down. Given how he treated me during my pediatrics Clerkship, I'd say blackballing Krista fits the pattern of his behavior. I can't prove it, mind you, but the evidence lines up that way."

Doctor Lindsay frowned, "That guy is a menace. He's ... well, let's just say this wouldn't be the first time. I complained to Doctor Roth about Rosenbaum when I was a Fourth Year, and Rosenbaum was my Resident for my second-to-last rotation."

And that sealed the deal for me as to my suspicions — I was positive that someone was covering for Rosenbaum. Of course, it could be deeper than that, but I was now reasonably sure of at least one situation that was being swept under the rug.

"You did a pediatric Sub-I?" I asked, somewhat surprised.

"General surgeons were encouraged to do a pediatric Sub-I when I was in med school here. The usual Sub-Is were emergency medicine, pediatrics, cardiology, internal medicine, and surgery times two. The next year it was a double in emergency medicine, dropping pediatrics. And after your experience, pathology is an option instead of the double in emergency medicine, but those slots are severely limited."

"Thanks for explaining. Did you know Rosenbaum was having an affair with Isabella Mastriano?"

"No, but it doesn't surprise me. Was? As in, it's over?"

"Yes. I believe Rosenbaum was the cause of how she treated me — he basically trashed me with her."

"Is that something you can share?"

"I don't have incontrovertible proof, mind you, so please don't repeat this."

"I won't."

"Someone, and I cannot reveal who, told me they had overheard him calling my church to check on service times and then designing my schedule expressly to prevent me from attending church."

"You're joking! Why?"

"Ostensibly, his objection to me wearing a cassock at the hospital on some rotations. He made a remark that supports my theory — that I was smart to have ditched the clerical robes. He also stated that religion and medicine do not mix and that Moore Memorial was a public hospital and required to be completely secular, which isn't actually how the law works."

"What an ass!" Shelly declared. "What did you do?"

"Nothing. In my mind, I would win by happily performing my tasks, and he'd be the one who was upset because his strategy of upsetting me had failed."

"A bit of psychological judo?"

"Yes. In the end, though, it didn't matter because Kylie Baxter asked me to swap shift schedules with her due to family concerns, and Doctor Sumner approved. Kylie and I have had a pact since then about swapping schedules or covering when we have a conflict."

"How did Rosenbaum react?"

"He wasn't happy, obviously, but there wasn't anything he could do about it. He had planned to give me only the worst scut, but with the new schedule, he wasn't my Resident. His attempt to retaliate was running me down with Isabella Mastriano."

"Today, on General Hospital," Shelly said, shaking her head.

"Pretty much. On that theme, I did suggest to Krista it would be wise to avoid relationships with doctors for the remainder of her time here."

"That would be for the best. I don't see anything wrong with what you said to her, so just let things be now."

"As I've said, I achieved my main goal of rectifying an injustice. I can pick my spots for the ethical issues when the time is ripe. And I have a backdoor way of fixing most of the problems."

"Care to share?"

"If the medical school makes having sex while on shift an ethics violation with dismissal as the standard, that will put an end to that problem fairly quickly. While the medical school probably can't ban relationships outside the hospital or school, they could require private disclosure, with failing to disclose a relationship being grounds for dismissal. That alone would end most of it because doctors wouldn't want to be on record, especially if they're married."

"And there is literally nothing the hospital can do about that because the rules apply to the students, not the hospital or doctors."

"Exactly."

"Do you think that can happen?" Shelly inquired.

"Doctor Mertens agreed to consider it and discuss it with the Board of Trustees of the Medical School. I think, given what happened with Gerald Kirby, there's a good chance the on-premises ban will happen. The other one, I'm not so sure about. I'm having lunch with her tomorrow."

"I'd wait a bit before you push for changes."

"Doctor Mertens said she'd think about it and discuss it, so I'm going to wait for her to bring it up.'

"Good. How are things with Loretta?"

"Frosty, because I declined to have any conversation that wasn't about clinical matters on account of the insistence that she snitch if I said anything Doctor Northrup thought was out of line."

"Hopefully, Doctor Cutter will resolve things. You know there's been low-intensity warfare between them about your Residency, right?"

"Yes," I replied. "I thought it had more or less died down."

"What you might not know is that Northrup wants to be Medical Director."

"No chance. It'll go to Doctor Cutter when Doctor Rhodes leaves at the end of the year. That position has always been filled by a surgeon since the hospital was opened. And it fits with the 'only a surgeon may supervise a surgeon' rule."

"Given you'll be a surgeon, that's no impediment," Shelly said with a smile.

"As if I'd want that job! No chance! And I'd only take a department head job if I could do it as a practicing physician, similar to Cutter or Baker."

"You think Northrup is simply a bureaucrat?" Doctor Lindsay asked.

"You said it, not me!" I replied with a smile.

"You seem to be in a better mood."

"Doctor Gibbs would likely disagree. It's all about demeanor. And the thing is, I was never not calm. That doesn't mean I wasn't upset, but there are Orthodox Christian strategies for maintaining inner peace. I haven't always practiced them, but I know how to use them. I did so yesterday and today."

"Some kind of meditation?"

"Using a very specific prayer, yes. Done properly, it's continual prayer during waking and sleeping hours. It's mostly a monastic practice, but then again, I have monastic and ascetic tendencies; well, minus the whole chastity bit!"

"Obviously, given you have a beautiful daughter!"

"And why I chose to resign my clerical office. To keep it would have required a vow of chastity as we ordain married men, but ordained men may not marry."

"Brutal."

"It has solid practical reasoning behind it, but I won't bore you with the details."

"Thank you!" she said with a smile.

We finished our lunches, and I returned to the ED, wondering exactly what might come of the meeting between Doctor Cutter and Doctor Northrup.

"Is everything OK?" Kellie asked when I walked into the ED.

"No, but it's not something I can discuss. Don't worry because it's being handled, and I'm fine."

"If there's anything I can do to help, just ask."

"Thanks. I appreciate it."

"Under different circumstances, I'd offer to take your mind off your troubles," she said with a twinkle in her eye.

"Remove the 'K' at the start of your name, and it's 'Ellie'!" I chuckled.

"Now that's low!" Kellie declared. "I did say 'under different circumstances', as in, if you weren't married!"

"Oh," I replied flatly.

"You're a goofball, Doctor Mike!"

"You are another in a long line of women to point that out!"

"Doctor Saunders?"

"Chiefly, yes. Let me..."

"Mike?" Nurse Mary interrupted, coming up to us. "Paramedics are three minutes out with a gunshot wound. Doctor Nielson wants your help."

"Kellie, would you let my students know, please?" I requested.

"Right away!" she confirmed.

I walked over to the cart, put on a disposable gown and a pair of gloves, then headed for the ambulance bay where Perry Nielson was waiting with his Fourth Year, Sam Braddock.

"Hi, Perry. Any details?"

"A McKinley cop," he said. "Report was two in the chest."

"No vest?"

"It doesn't seem so."

"Wonderful."

Jake, Heather, and Mary joined us just as the EMS squad turned into the driveway. It pulled up in front of us, rolled to a stop, and Roy jumped out of the cab.

"Detective William Townshend, forty-nine, two gunshot wounds to the right chest; no exit wounds; collapsed lung and significant blood loss; BP 70/30; pulse 106; PO₂ 90%; unit of plasma and saline IV."

"Trauma 1!" Perry ordered. "Mike, chest tube; Sam, intubate; Mary, type and cross match for two units, then trauma panel; Jake, EKG and monitor!"

"Heather, call surgery!" I declared. "He'll go up as soon as we stabilize him!"

"Calling surgery!" she confirmed.

We rushed Detective Townshend into Trauma 1 and, with help from the paramedics, transferred him to the trauma table. Everyone sprang into action, but because everyone had an assignment, I got my own chest tube tray and tube from the cabinet.

"At least 500ccs on the floor!" I declared after making the incision. "Mary, put a unit on the rapid infuser; I'm going to insert a subclavian! Heather, get me a kit!"

"BP 60 over 20, pulse 120; PO₂ 89%!" Jake announced. "Sinus tach!"

"OR ready in five minutes!" Heather announced. "Full team will be standing by!"

I quickly completed the chest tube, then inserted the subclavian line, to which Mary hooked up the rapid infuser. As the blood was going in, I stabilized the chest tube and hooked up the Thora-Seal.

Because he'd been shot twice in the chest, he had a classic 'sucking chest wound', which meant the lung wouldn't re-inflate. We couldn't do anything to actually close the wounds in the trauma room, but there was a technique I'd read in a journal article that would help - defibrillator pads, which were designed to stick to diaphoretic skin.

"There's blood in the Thora-Seal," I observed. "Heather, get me two defib pads!"

"No negative neuro signs," Perry declared. "Good breath sounds on the left. No trauma other than the gunshot wounds."

Heather handed me the pads, and I used them to temporarily seal the chest wounds. Perry listened and nodded.

"Breath sounds on the right," he announced.

"PO₂ coming up!" Jake announced. "93%."

"Better," Perry declared. "His BP isn't going to come up until they find the bleeders in the OR. Sam, get a Foley into him while the blood runs in, then we'll get him upstairs and let the sawbones have him! Heather, get a gurney."

Sam inserted the Foley, and as soon as he completed his task, we moved Detective Townshend to the gurney Heather had retrieved from the corridor.

"Take him up, Mike!" Doctor Nielson ordered.

"Let's go!" I said to Jake and Heather.

We rushed him from the trauma room into the corridor and towards the elevators. I called out for them to hold the elevator, which caused two nurses and two others to move out of the way and allow us to push the gurney into the elevator. Jake hit the button for the surgical floor, then held the button to close the elevator door. Thirty seconds later, we turned Detective Townshend over to the surgical team, with me providing his vitals. I had hoped I'd be asked to scrub in, but Doctor Roth was waiting with two other Residents, so I headed back down to the ED with my students.

Unsurprisingly, there were half a dozen cops in the ED waiting room, and Perry was speaking to them. I felt Detective Townshend had a good chance, but gunshot wounds often created significant damage, and he had lost a lot of blood. They'd do a rapid thoracotomy to find the bleeders, then set about repairing any other damage. I envisioned a day, likely ten years down the road, when someone like me would do that in the ED, and we'd have the patient fully stabilized before rushing them to surgery.

The rest of the afternoon was routine, and just after 6:00pm, Shelly Lindsay asked me to take my meal break. I checked with Doctor Mastriano, and she cleared me to leave the ED, so Shelly and I went to the cafeteria, got our food, and sat down at a table by ourselves.

"First," she said, "I'm your new surgical mentor, as Doctor Roth believes we click, and I'm positive he's correct."

"I agree, with no disrespect to Doctor Taylor."

"He's OK with the change, as he doesn't want to become enmeshed in the internecine warfare."

"Totally understandable. You?"

"I'm as fearless as all those Russian women before whom you quiver like a bowl of Jell-O!"

"There might be some truth to that statement," I chuckled. "And that includes girls, too, especially daughters."

"Having a kid would make ME quiver!" Doctor Lindsay declared. "But I also hear my biological clock ticking loudly."

"We give up a lot in the pursuit of serving our fellow human beings."

"True. Back to the topic at hand — Cutter and Northrup achieved something of a truce, though it's likely only a short-term ceasefire. Doctor Cutter can't tell Doctor Northrup how to manage his staff, but you're a surgical Resident, so while corrective actions on clinical matters may come from either service, any reprimands or discipline have to come from the Chief Surgeon, not the Chief of Emergency Medicine.

"Bottom line — while Doctor Cutter can't force Doctor Northrup to take you off double-secret probation, or whatever it is, because you're on the surgical staff, any concerns have to be addressed first with me, Doctor Roth, or Doctor Cutter. And while he's not willing to state a public opinion on the matter, Doctor Cutter believes you have the right to voice your opinions, so long as it's done professionally. Doctor Northrup disagrees."

"I'm going to guess Doctor Cutter is protecting his flank?"

"I'd say so. Without support from the other Chiefs, he'll have a hard time being appointed as Medical Director, let alone being able to manage all the egos involved."

"No thanks," I said, shaking my head. "I have enough trouble managing my own ego!"

"You're a surgical Resident, Doctor Loucks. It's a pre-req!"

"TELL me about it," I chuckled. "I'm going to guess Doctor Northrup is displeased."

"He threatened to go to the Board to have the program canceled, but that's not going to happen. Well, he might try, but everyone thinks it's working well; it's more your personality that's at issue. And, honestly, you're in red scrubs for a reason — you think like a surgeon and act like a surgeon. Doctor Roth saw that during your Clerkship, and it's why he pushed you towards surgery rather than emergency medicine."

"But my heart lies with emergency medicine," I replied.

"Obviously, and you found a way to satisfy both. As far as Doctor Cutter can tell, the only person in the entire hospital who has any problems with the program is Northrup. He lost the battle over which service would hire you, and I suspect you can guess his motivation and why he's so bothered by it."

"Because so long as only a surgeon can oversee a surgeon, the position of Medical Director will always be filled by a surgeon, similar to US Navy aircraft carriers only being commanded by former pilots."

"I didn't know that," Shelly said, "but it makes total sense. I mean, if your job is to command a mobile airfield, you should know a heck of a lot about flying. The same is true of overseeing a surgical service; or, really, any specialty service. The difference is, surgery truly is special because it's invasive. That brings considerations never encountered in other services and requires a different way of looking at medicine. I'm sure you see and feel it, having one foot in both worlds."

I nodded, "I do. Both services require split-second decision-making and complete accuracy. There is almost never a chance for a Mulligan. We can't 'try and see what happens' the way, say, Medicine or Endocrinology or even Oncology can. If you cut into someone, you have to be completely sure you're doing the right thing, the right way, every single time. The same is true of emergency medicine — you likely have one shot to save the life, and if you make the wrong decision, the patient dies."

"And you eat stress for breakfast and live for the adrenaline high that comes with that. Your friend, Doctor Saunders, does not."

"Clarissa thinks I'm nuts."

"Most internal medicine specialists think that about emergency medicine specialists. It's the same job, in effect, but one calls for considered, thoughtful, reasoned, and mutually agreed actions taken in measured steps; the other is usually fifteen minutes of sheer pandemonium, with a thin veneer of organization."

"It's not THAT bad," I chuckled. "But with one foot in each world, I can see why you would say so. Surgery is well-planned and well-orchestrated, much like an opera. It's only when something goes wrong that the 'pandemonium with a veneer of organization' kicks in. You find that troubling, whereas I find it exhilarating."

"Because the best emergency medicine specialists are bat-shit crazy!"

"I resemble that remark!"

"Back to our current situation — the bottom line is that Doctor Gibbs is to call me if there are concerns, and I'll discuss them with Doctor Roth and Doctor Cutter. That doesn't exactly solve the problem, but it does mean that Doctor Cutter has your back."

"I don't see this low-intensity warfare where I'm caught in the crossfire going away anytime soon. Could Northrup block Cutter's ascension to the throne?"

Doctor Lindsay laughed, "You have an interesting way with words! The short answer is that he could, but he'd have to have a reason other than sour grapes."

"Which is why Cutter is demurring on the policy about which I complained."

"Yes, and even if he agrees with you, he can't simply make that change unilaterally, even as Medical Director. He'll need a consensus, though if he can convince a majority, he could go to the Board and likely have some kind of change implemented. Politics, even in the hospital, is messy."