Chapter 49: What's the Protocol?

September 13, 1989, McKinley, Ohio

After lunch with Doctor Mertens, I returned to the Free Clinic, and my next patient was a sixteen-year-old girl seeking an abortion. Per protocol, I performed a rapid pregnancy test, which came back positive, and an ultrasound, which showed a properly developed eight-week fetus.

"You are absolutely pregnant," I confirmed. "Have you considered having the baby and putting him or her up for adoption?"

"I can't have a baby," Tracy, the young woman, said, close to tears. "My parents would freak out! And I'm only sixteen!"

"Have you told the boy?" I inquired.

"We broke up after we ... you know. I think he just wanted that, and when he got it, he started acting like a jerk."

A story I'd heard a number of times over the years. I didn't understand that behavior because, in High School, I'd have become a body slave to any girl who'd have gone to bed with me!

"OK," I replied. "I'm going to have you speak with Doctor Turner, who'll perform the procedure. Michelle will wait with you while I speak to him. Give me a few minutes, and he'll see you."

"You don't do it?" Tracy asked.

"No. I'm morally opposed to abortion, so I won't perform the procedure, but as a physician, I have an obligation to provide you with the medical care you want and need."

"You're Pro-Life?"

"I am. But I'm not the one who is pregnant at sixteen. It has to be your decision, not mine."

She nodded, and I left the exam room. I walked down the hall to Doctor Turner's office and rapped lightly on the open door.

"What's up, Mike?" he asked.

"Sixteen-year-old prima gravida seeking an abortion. RPT was positive, and ultrasound showed a properly developed eight-week fetus. I asked about adoption, but she rejected the suggestion to consider it and would like to schedule a procedure."

"As I've said, you're an odd duck, Mike. You can bring her in."

"I have an unwavering duty to my patients," I replied. "My personal concerns cannot interfere with their choices, though, as you know, I won't participate in the procedure."

"As I said, an odd duck."

I nodded, went back to the exam room, then escorted Tracy to see Doctor Turner, where I introduced them. Nurse Michelle and I stood near the closed door while Doctor Turner counseled Tracy. After about ten minutes of discussion, Doctor Turner scheduled the procedure for the following day, and we left his office.

Over the course of the rest of the afternoon, I saw seven additional patients with a mix of complaints. At 5:00pm, I headed home for dinner with Kris and Rachel, and then the three of us attended Vespers at the Cathedral.

September 14, 1989, McKinley, Ohio

On Thursday, Antonne and the other members of the study group came to the hospital to have lunch with me. To make Conchita happy, I retrieved Rachel from daycare and brought her with me to the cafeteria.

"Hi, «amorcita»!" Conchita said when I helped Rachel into a booster seat in a chair next to Conchita.

"Hi!" Rachel exclaimed. "Papa? Hot dog?"

"And fries?" I asked, knowing the answer.

"Yes! Fries!" Rachel exclaimed giddily.

"I take it those are a treat?" Conchita asked.

"Yes, because my darling daughter would live on a diet of hot dogs and French fries if I allowed it."

I bought lunch for Rachel and myself, though I chose healthier options for myself. Rachel could have 'junk' food once a week, but that was the limit. Otherwise, she ate as healthily as Kris and I did.

"How are things going?" I asked the group once I'd sat down with my food and given Rachel hers to eat because, as a 'big girl', she insisted on doing everything she could by herself.

"We're back into the swing of things after the Summer," Antonne replied. "Everyone is in the Honors Program and while we're only three weeks into the semester, we're on course for straight A's."

"Excellent."

"How are things going for you, Doctor Mike?" Jordan asked.

"Just 'Mike' is fine," I replied. "I'm enjoying the clinical work and hating the politics, which is not news to anyone who knows me."

"That bad?" Julius asked.

"Yes. I'm sure Danika can tell you stories if her dad has shared."

"That's the one thing Dad constantly complains about at home," Danika replied. "He hates hospital politics because they get in the way of excellent patient care."

"Like what?" Conchita asked.

"The Medical Director at Moore Memorial is retiring at the end of the year, and the competition for his job has created more than a bit of trouble."

"For you personally?" Paul inquired.

"Especially me because I'm on the surgical service but assigned to the ED, and the battle for supremacy is between the two department heads — the Chief of Emergency Medicine and the Chief Surgeon."

"Do you have an opinion?" Danika asked.

"I always have opinions," I chuckled. "And expressing them often lands me in hot water! In this case, I'd prefer the Chief Surgeon, who is the odds-on favorite. But I'm doing my best to stay out of the line of fire, though given my position, that's difficult."

"Why is that?" Conchita asked.

"I have two separate hierarchies over me with competing interests and differing opinions. The Chief of Emergency Medicine objects to the 'only surgeons supervise surgeons' rule."

"As if that will ever change!" Danika declared. "Even Dad, as a Senior Attending Cardiologist, is technically supervised by the Chief Surgeon for any invasive procedures, including catheterization."

"I know it's off-topic," Jordan said, "but is there any way you can get us into your concert at Shaken Not Stirred?"

I shook my head, "Unfortunately, no. They card hard, and nobody under twenty-one is allowed into the club. The only exception they've made is for band members, and they have to stay on the stage or backstage. They can't be in the club proper. The club was busted about five years ago for underage drinking, and they'll lose their license if they do it again. That restriction applies to my wife, too."

"That sucks! Do you have any other gigs?"

"In October, we're playing a club in Newtown, just east of Cincinnati. They allow anyone over eighteen and use a bracelet system to serve drinks."

"How does that work?" Antonne asked.

"They put a color-coded bracelet on each person. The colors are randomized and dated, so you can't try to game the system, and one color allows you to order drinks. If you remove your bracelet, they kick you out, and they're made such that you have to tear them to remove them."

"That seems awfully complicated," Conchita observed.

"The State of Ohio is bound and determined to enforce the concept that young men can be drafted and sent to kill or be killed, but not legally able to have a beer."

"That's just about the dumbest thing I've heard of," Jordan said.

"You'll hear dumber," I replied. "Trust me."

We finished our lunches, I took Rachel back to daycare, then returned to the ED. The afternoon was busy but routine, and my students and I saw a dozen patients. As was typical for Thursdays, I had dinner with Kris and Rachel.

"Papa? Hot dog?" Rachel asked sweetly.

"You had a hot dog and fries for lunch, young lady. You'll have chicken and steamed carrots."

She crossed her arms and gave me a death stare reminiscent of the ones I'd received from Elizaveta over the years, but I was immune.

"She can be petulant!" Kris observed.

"Just like every other Orthodox woman I know!" I replied with a smile.

Kris rolled her eyes and didn't say anything, which had become her usual response to my quips about Orthodox women. Fortunately, Rachel relented and was willing to eat her chicken, carrots, and dinner roll, washed down with milk. When we finished our meal, Kris took Rachel home, and I returned to the ED.

"Mike, there's a patient asking specifically for you," Trish, one of the triage nurses, said.

"Who?" I asked.

"A Michelle Latham."

I hadn't seen Michelle for well over a year.

"Complaint?"

"She said she'd only speak to you. Do you want me to insist?"

I wondered how she'd known I was at the hospital, given the last time I'd seen her was when I was a medical student, but in the end, it didn't matter. She might have simply asked for me, knowing I'd be a doctor by now.

"No," I replied, "just prepare a blank chart with her name, and I'll see her. Both my evening students are male, so let me ask Becky to bring her in."

I found Becky in Exam 3 and asked if she was available. She was, so I asked her to bring Michelle in and meet me in Exam 6. I'd have done that myself, but the new protocol had doctors not going to the waiting room except in the case of a true medical emergency. I waited for Becky to escort Michelle in, then went into Exam 6.

"Hi, Michelle," I said.

"Hi, Mike. Or Doctor, uhm, I forget your last name."

"It's Loucks, but I go by Doctor Mike, and it's OK to just call me Mike as we knew each other before I received my MD. What brings you in today?"

"Can we talk alone?"

I shook my head, "No. Hospital policy mandates that I have a female staff member or student in the room at all times when I treat a female patient. There are no exceptions to that policy."

She frowned, but there wasn't really anything I could do about it, as violating that policy could not be defended, and the last thing I wanted to do was give Doctor Northrop any additional ammunition.

"I'm, uhm, afraid I might have AIDS."

"Why do you think that?" I asked, skeptical that was actually true, though knowing it was possible.

"I'm tired all the time, I have a fever, and the glands in my neck are swollen."

"Those symptoms could be caused by any number of things," I said reassuringly. "Let me ask you a few questions. First, are you or anyone you've had sex with an IV drug user?"

"Besides you, I've only been with Toby, and he doesn't do drugs."

I saw Becky smirk out of the corner of my eye, but I had to simply go with the flow.

"And he's not bisexual?"

"No."

"Have either of you had a blood transfusion?"

"I haven't, and I don't think he has 'cause he said he's never been in the hospital."

"Do you have a sore throat, or did you have one recently?"

"Last week, but it mostly went away."

"OK. I need to do an exam, get your medical history, and run some tests, but it's far more likely you have infectious mononucleosis, or 'mono', than AIDS. I mean, a thousand times more likely. And it might not be that, either."

I performed my exam, noting pharyngitis and enlarged tonsils, then palpated her neck, noting enlarged lymph nodes, all of which were signs of mononucleosis.

"Becky, let's draw for a CBC, a heterophile antibody test, a throat culture, and a full-spectrum STD panel, please."

Becky drew the blood and called for a student nurse to take the vials to the lab.

"The test for mono takes about a day," I said. "We'll have the other results in about an hour. Has Toby had any symptoms?"

"He says he's tired, but that's it."

"I'm going to recommend that he go to the McKinley Free Clinic and have a mono test, and he should do that right away. Or you can send him here."

"He's in the waiting room."

"OK. Hang tight."

I left the room and went to the door of the waiting room, saw the nerdy guy I vaguely remembered, called him in, and escorted him to Exam 6. I explained the situation, and he consented to an exam.

"Becky, would you start a second chart, please? Then draw blood for identical tests for Toby?"

"Right away, Doctor," she replied.

She did as I asked, then I performed the same exams on Toby I had on Michelle, though the only symptom I noted for him was mild pharyngitis.

"At this point, I think you can both go back to campus," I said. "I'll receive the results of the throat culture and mono test late tomorrow afternoon, and I'll call you with the results."

"What prescription?" Toby asked.

I shook my head, "It's a virus, so antibiotics wouldn't have any effect, and there is no vaccine. You can use Tylenol or Advil, or generic acetaminophen or ibuprofen for fever and discomfort, but the only cure is time. You should both rest, drink plenty of fluids, take Tylenol or Advil for pain, and refrain from kissing or any other activity that would share saliva, including oral sex, drinking from the same glass, or sharing a toothbrush."

"No antibiotics?" Michelle asked. "Really?"

"Really. They simply don't work against viral infections. If your throat cultures happen to be positive, then we'll prescribe antibiotics because that would mean strep rather than mono, though I think that's unlikely. Let me complete the charts, fill out the discharge forms, and you can go. We'll give you a pamphlet that explains everything, and if any of your friends have similar symptoms, they should go to the Free Clinic or come here for an exam. You should both see a primary care physician — what you might call a GP — as well. If you don't have one, we can provide you with a referral."

Fifteen minutes later, they were discharged and left the room.

Becky raised her eyebrow and smirked, "It appears you had fun with that one!"

"I don't kiss and tell, Mom!" I replied with a grin.

"She already told! And we agreed 'older sister'!"

"You're the one who brought up the late 50s!"

"Me and my big mouth!" Becky said with a soft laugh. "And I say you had fun!"

"Whatever!" I chuckled. "It was eighteen months ago and before I remarried."

"I suppose you could say that 'The Doctor Is In'! ALL the way in!"

I laughed hard, "I didn't charge her 5¢!"

"I think the early 80s were WAY more fun than the late 50s!"

"Not to hear my mom tell it," I chuckled. "This conversation is entertaining, but I do need to see if there are other walk-ins."

"You realize I'm just teasing you, right?" Becky asked.

"Yes, of course! I have a very good sense of humor, and I didn't take it in any way but humorous. I'm not upset in any way, shape, or form. That said, it does have the chance of going beyond what is wise, so I chose to extricate myself before I said something that might actually get me into trouble!"

Becky nodded, and we left the room. I asked Al to bring in the next patient. The remaining ninety minutes were busy, and I saw five patients before I left for home at 9:00pm.

September 15, 1989, McKinley, Ohio

"We need to speak privately," Kellie said when she arrived in the ED just before 6:00am on Friday.

"About?" I asked.

"Privately," Kellie insisted.

"Exam 3 is open," I suggested.

We went to Exam 3, and Kellie shut the door behind us, something that was out of character and rare and meant it was something serious.

"What's up?" I asked.

"Rumor has it that you went to bat for Krista Sandberg," Kellie said.

"I did, though I have to ask who's talking."

"Krista is telling people she has a guardian angel."

Which went against what I had advised Krista to do and made me suspicious.

"Drop the other shoe, Kellie," I requested.

"She's sleeping with a pair of doctors."

"I'm aware of that," I replied. "There's no rule against it, despite the objections I've voiced, so I'm not sure it matters. Ongoing?"

"Yes, and one of them is on our service. I have to tell you something important that you need to know — she wanted you, but Becky warned her off, saying you would not respond well and it would cost Krista dearly."

"That's an understatement if there ever was one. Attending or Resident?"

"Resident."

"Well, she's mostly been assigned to me, Kylie Baxter, Kayla Billings, or Paul Lincoln. I'm positive it's not any of those three, and it's not me, so it's not someone who is evaluating her.

"How do you know it's not Paul?"

"Don't ask that question," I replied.

"Got it," Kellie said with a knowing look. "I won't say anything."

"There is a problem, though," I said. "Krista told me both 'flings', as she called them, were short-lived and over."

"They're ongoing, as I said. And there were others. It's Doctor Schmidt."

"If that's true," I replied, "then she lied to me about several things. She said it was two, that they were over, and neither of them were married. Schmidt is married, and you say the affair is ongoing and that there were more than two. That presents a huge problem because if she's lying to me about that, she could be lying about anything.

"The thing is, a medical student having a relationship with a doctor is not against the rules, even though it ought to be. As far as I can tell, there does not appear to be an appetite to change the policy, which means there isn't much I can do about it. What I can do something about is the lies. And that means I need to confront her, but I can't do it by myself. I need to think about the best way to handle it."

"Just be careful."

"As I said to Shelly Lindsay, I will be careful and only act after I speak to her, that is, Shelly. Thanks for the heads up."

"You're welcome, Mike."

We left the exam room, and I contemplated what I should do. While I took issue with Krista's behavior with doctors, my real concern was that she'd lied to me. Fortunately, I wouldn't see her before Monday morning, so I had some time to think about how best to proceed.

I had a fairly busy morning, though it was all routine, then joined Clarissa for lunch.

"Kellie believes Krista is lying about her relationships," I said when we sat down at a table for two, away from the other Residents.

"Marvelous," Clarissa said, her voice dripping with sarcasm. "What did she say?"

"She said Krista is currently involved with two doctors, and one of them is a Resident in the ED. And she's had other relationships with doctors in the past."