Chapter 51: Doctor Mike Loucks, Reporting as Directed

September 20, 1989, McKinley, Ohio

Tuesday at the hospital and Wednesday morning at the Free Clinic had been busy but routine. That changed at 11:22am on Wednesday morning.

"Doctor Mike, you have a phone call," Tamara, the receptionist, said, coming into the small break room. "Line 2. You can take it here or in your office."

"Thanks," I said, getting up from my chair.

I picked up the handset, then pressed the flashing button on the wall phone.

"Doctor Mike Loucks," I said.

"Doctor, this is Peggy Burch from Doctor Anderson's office. He needs to see you immediately."

Doctor Nels Anderson was the Hospital Administrator, who had an MD and a PhD in public administration and who hadn't practiced medicine since completing his Residency when he'd gone back to school for his PhD rather than seek an Attending role. I found that curious but had no real way of finding out the reasons behind it.

"As in, I need to leave the Free Clinic right now?"

"He said 'immediately'," she replied.

"May I ask what this is about?"

"He didn't say. He simply said to locate you and ask you to come to his office immediately."

She'd said 'immediately' three times, which meant it was urgent, and I really had no choice.

"OK. I need to let Doctor Turner know. It'll take me about twenty minutes by the time I do that, drive to the hospital, and come to the admin wing."

"He'll expect you in twenty minutes."

I hung up and contemplated whether I should call Shelly, who was my mentor, or Doctor Roth, who was my supervising Attending. As I thought about it, I couldn't imagine they weren't aware of whatever the concern was, and I certainly hadn't made any medical mistakes or said anything to anyone that might attract attention from the Hospital Administrator. That left exactly one possibility in my mind.

I left the break room and went to see Doctor Turner and explained I needed to leave.

"I don't know how long it will take," I said. "But I'll take my lunch break, which will minimize the impact."

"You don't know what they want?"

"No, but I have a sneaking suspicion. I'd rather not say anything at the moment."

"Understood. I can't imagine you're in any trouble."

"As Doctor Clarissa Saunders would say, that only means you don't have an active enough imagination! She maintains she can't leave me unsupervised for two minutes without me finding a way to get into some kind of trouble!"

He laughed at that and said he'd see me when I returned. I let Tamara know I was leaving, but I would be gone longer than the usual thirty-minute lunch break. I made sure she had my pager number in case she needed to get in touch with me, then left for the hospital. Unlike the hospital, I wore slacks, a shirt and tie, and my medical coat at the Free Clinic, and felt that was more appropriate than scrubs to meet with Doctor Anderson.

When I arrived at the hospital, rather than go directly to Doctor Anderson's office, I stopped at my locker to retrieve what I expected to need — the pocket tape recorder with the mini-cassette that I'd had when I'd spoken to Krista. On the drive over, I had gone over and over in my mind the possibilities, and barring something about which I was completely unaware, it was the logical reason to be called in front of the Hospital Administrator on short notice.

I walked along the second-floor corridor to the far end of the building, turned right, and went into the administration wing and to the end of that corridor, where I entered Doctor Anderson's outer office.

"Doctor Mike Loucks, reporting as directed," I said to his secretary.

"He's expecting you, Doctor. Go right in, please."

I nodded, and went into the office and saw Doctor Warren from the medical school, whose presence confirmed in my mind that it was about Krista Sandberg.

"Good morning, Doctor Anderson," I said. "Doctor Warren."

"Good morning, Doctor," Doctor Anderson said. "Please have a seat."

I did, and his secretary closed the office door behind me.

"May I ask what this is about?" I inquired.

"There has been a very serious accusation against you," Doctor Anderson said. "Would you describe the interaction you had with Krista Sandberg, a medical student, on Monday morning in the Emergency Department consultation room?"

"With your permission, I'll do one better," I said, taking the tape recorder from my pocket.

Doctor Warren, who had looked grim when I had come into the room, looked relieved, which told me I was on the correct path.

"A tape?" Doctor Anderson asked.

"Yes."

"Let him play it, Nels," Doctor Warren suggested.

I didn't wait for an answer. I pressed play, though the first thirty seconds were silence, except for the rustle of cloth and muffled background voices.

"This tape ran continuously from the time of a conversation I had with Nurse Kellie Martin before I spoke with Miss Sandberg until I spoke to Kellie Martin again after the interaction with Miss Sandberg."

Mike: "I need to speak privately with Krista. I'm going to use the consultation room, but I'll leave the door open. Would you stand where you can see into the room but can't hear?"

Kellie: "Is this about our conversation the other day?"

Mike: "Yes."

Kellie: "OK."

[Rustling noises and muffled voices in the background, then a door opening]

Mike: "I need a minute."

[Rustling noises and muffled voices in the background, then sounds of a chair moving]

Mike: "I have sufficient information and evidence to be reasonably certain you've lied to me. I'm not going to debate you or get into an argument about that. What I am going to do is say this once, and only once — if, from this point forward, you lie, obfuscate, dissemble, or dissimulate, I will fail you. Period. And I'll make it stick. That's all. You're dismissed."

Krista: "But..."

Mike: "You're dismissed. Go."

[Rustling noises and muffled voices in the background]

Mike: "You observed that the door was open the entire time, right?"

Kellie: "Yes."

I reached over and stopped the recorder.

"I'd say that's definitive," Doctor Warren observed.

Doctor Anderson nodded, "I agree. Would you leave the tape with us?"

I thought about it for a moment and decided I could because I'd made a copy on Monday evening out of an abundance of caution.

"Absolutely, provided I receive a brief memo, signed by all of us, that we listened to it together, and it disproves what I'm going to assume was an accusation that I demanded sex from her in exchange for a passing grade."

"Yes, to both of those. You obviously suspected she was going to do that. May I ask why?"

"I was warned by three different female staff members, who I would prefer remained nameless, to be very careful around her and not to be alone with her."

"May I ask what information you have that shows she lied?"

"I'm reluctant to say because it was personal and not a policy violation."

"I told you, Nels," Doctor Warren said firmly. "You know what he's implying."

"And you know the pushback about interfering in doctors' private lives."

"I do, and I'm going to endorse Doctor Mertens' recommendation that we make engaging in inappropriate activities during a shift or in the hospital while off shift an ethics violation for medical students. That's the purview of the medical school. We can't control what happens when they aren't in the hospital, obviously. You know our position on the propriety of teacher-student relationships."

"And you know everyone involved here is an adult. This isn't some High School English teacher sleeping with a student."

Something which had happened the previous year at Hayes County High, which had led to the teacher leaving but not being arrested, as they couldn't prove anything had happened before her eighteenth birthday.

"I know the arguments," Doctor Warren said. "I just don't buy them."

"Let me have Trudy write a quick memo," Doctor Anderson said.

He got up and left the office, and Doctor Warren leaned close.

"I was positive it was a lie," he said, "but my hands were tied because she made a formal accusation that you had helped her out of expectation of sexual favors then demanded them in exchange for a grade. I am VERY happy you had that recording because otherwise, it would be 'he said/she said', and it might have become very ugly."

"I have $10 that says she changes her story, claiming to have misremembered when the conversation occurred."

"Earlier this morning, she gave a formal statement, under oath, to the medical school's legal counsel. She signed a transcript in front of a notary. She stated unequivocally the demand was made during that conversation you have on tape."

"When did she actually make the complaint?"

"Yesterday morning. Doctor Mertens reported it to me, we consulted with legal counsel for the hospital and the medical school, then invited her to make a sworn statement. The tape you have directly contradicts what she said and, in my mind, proves she lied in her sworn statement. That is grounds for immediate dismissal. Hospital policy dictates her student privileges here are automatically suspended, as they would be for any hospital staff member who was suspected of lying in a sworn statement."

"Guilty until proven innocent?" I asked with an arched eyebrow.

"It's with pay for the hospital staff, but think about the possible liability for the hospital if they allowed someone to interact with patients whom the hospital administration is aware willfully perjured themselves by making a false statement. Remember, charts are legal documents, and falsifying them is a criminal act. The same is true of drug inventory records and prescription forms."

I nodded, "It does make sense, even if it seems to fly in the face of innocent until proven guilty."

"Which, believe it or not, does not apply to the operation of the hospital, despite it being a public hospital, at least with regard to suspensions with pay. In a way, you could say they are comparable to being released on bail after an arraignment."

"OK," I replied. "Explained in that way, it makes perfect sense."

Doctor Anderson returned with a memo which had been printed on a laser printer, which created much nicer documents than the printer we had at home, which was dot matrix. When Kris needed better quality, she would take a floppy disk to Ohio State, where she could print in color, as well as with higher quality. The wording of the memo was acceptable and clear, so I signed it, then passed it to Doctor Warren, who signed it. Doctor Anderson signed as well, then took it to his secretary to make copies, which she brought in about two minutes later.

"If you don't mind," I said once I had my copy, "I'll head back to the Free Clinic."

"How is that working out?" Doctor Anderson asked.

"Fine, I think, and Doctor Turner seems happy. I think it's great experience for medical students and PGY1s, and should be continued."

"Thank you, Doctor."

"You're welcome."

"Thanks, Mike," Doctor Warren said.

I nodded my acknowledgment, then left Doctor Anderson's office, saying a silent prayer of thanks for Shelly's advice about using the tape recorder. I checked my watch and decided to go to the cafeteria to get my lunch to go. Given I was going to eat while driving, I bought a sub sandwich, an apple, and a Sprite, all at subsidized prices, then left the hospital. I drove back to the Free Clinic, finishing my apple and pop just as I pulled into the parking lot.

"I'm back," I said to Doctor Turner from the door of his office.

"Everything OK?"

"Yes. There was a concern about a medical student which needed my immediate attention. I'm sure you'll hear about it through the grapevine, but I can't say anything just yet."

"Understood. And you're right about the gossip. Doctors are the worst! Did you manage to get lunch?"

"I ate on the way back from the hospital. I let Tamara know I'm ready to see patients."

"And you have your first one," Nurse Michelle said from the door to the office. "It's an easy one. New city employee who needs their pre-employment physical and drug test."

I got up and began my afternoon. I saw a total of seven patients, including the pre-employment physical, and at 5:00pm, I headed to the hospital to get Rachel from daycare, then headed home.

September 20, 1989, Circleville, Ohio

"I needed to use the tape I made on Monday," I said to Kris when Rachel and I arrived at the house after finishing my shift at the Free Clinic.

"I can't believe your student was foolish enough to make that claim! You were the only one trying to help her!"

"I know, and I have the feeling that when I confronted her about lying, she thought I had discovered proof she'd slept with an Attending or Resident to get a grade."

"Did she?"

"As I said when we discussed it, she denied it, as did the doctor, but given she lied about other relationships, who knows? As I see it, once she knew she had been caught lying, she decided the accusation was her only gamble, and but for Shelly's prescience, it might well have worked. I'm also going to guess that a complaint against the other doctors with whom she slept would be forthcoming at some point."

"And that would help her?" Kris asked.

"It certainly would put the hospital and medical school in a difficult position if she were to fail, and I would have been in serious hot water. The impression I had from the Hospital Administrator was that in a 'he said/she said' situation, they have to give the benefit of the doubt to the person making the complaint.

"That doesn't mean they'd win, but I would have been suspended until the investigation was complete, and with no evidence, there's no telling how it would have turned out for me or for the other doctors against whom she made the accusation. Ultimately, the worst case for her would have been a payoff from the hospital and doctors and transfer to a different medical school."

"I'm very glad you made that cassette tape," Kris said.

"Me, too."

"Dinner is in about twenty minutes. Will you help by setting the table?"

"Of course. Let me change the Tsarina and change my clothes, and I'll be right back down."

Ten minutes later, Rachel was doing her best to help me, but her 'help' often created extra work, though that didn't stop me from allowing her to try. We finished, and about ten minutes later, we sat down to eat. After our meal, we quickly cleaned up, then dressed and headed to the Cathedral for Vespers.

September 21, 1989, McKinley, Ohio

"Krista Sandberg is not here," Kayla Billings said when I approached her on Thursday morning for the patient handover. "She was suspended yesterday."

"OK," I replied. "I take it there was no official word?"

"Correct."

"They can't really replace her or add hours for someone else, so that means I'll have only Al for an hour this morning, then for three hours this evening. You suffer with only having one student overnight."

"Only for another nine days at most. She might be back before the end of the month."

There was zero chance of that in my mind, and I was surprised that the reason for the suspension hadn't leaked.

"Al's a solid Third Year," I said. "You can rely a bit more on him. I'm sure you saw my sign-offs in his procedure book."

"Including a frickin' Air Ambulance flight! Must be nice! I'm PGY2, and I haven't had a single flight, and you were certified as a flight surgeon BEFORE you started your Residency!"

"Right places, right times. Shall we run the board?"

"Only one for me to hand over — suspected acute IBS waiting on admission to Medicine for testing. On Ringer's IV due to dehydration. Vitals are otherwise stable."

"OK. I'll coördinate with Doctor Saunders."

"Al is in the lounge. I'm outta here; see you tonight."

She left, I checked the patient's chart, then went into the lounge.

"Morning, Al," I said. "Would you call upstairs and see when Doctor Saunders can take Mrs. Iverson?"

"Right away!" he declared.

I poured some coffee and sat down, and Al came back about three minutes later.

"Doctor Saunders said we can send Mrs. Iverson up any time," Al said.

"Then would you call for an orderly with a wheelchair and escort Mrs. Iverson upstairs, please?"

"Sure thing. Can I ask you about Krista? Nobody seems to know what happened."

"I haven't heard anything official," I replied. "And until we do, it's probably best to avoid speculating. I did suggest to Doctor Billings that she give you more tasks."

While my statement was technically true, I knew exactly what had happened, though I felt it best to discuss it only with Shelly. I was sure Kellie would say something when she arrived for her shift, which, checking my watch, meant any moment, but I didn't feel I should say anything to her at this point.

"I think this is the only educational program where people ask for MORE work!" Al declared. "And more difficult work, to boot!"

"I'd say there's a good chance that's true," I agreed, "though I suspect flight school has similar situations."

"Minus the hours! We don't let pilots or truckers work the hours we do! And I'm including you doctors and the nurses as well!"

"Society, at times, has its priorities screwed up," I replied.

"It sure does," Al agreed.

He left to escort Mrs. Iverson up to Medicine, and a minute later, Kellie came into the lounge and sat down next to me. The lounge was empty, something that was common at this hour, which allowed us to stay there.

"Your doing?" she asked quietly.

"I was asked about her and provided information. I didn't initiate it."

Doctor Varma came in and greeted us, which meant the conversation had to end, though I was sure Kellie would ask again at some point.

"Mike, Naveen?" Ellie said from the door to the lounge, "EMS on their way with at least three victims from a rollover MVA. I just notified Ghost and Isabella. First victim is four minutes out."

"Thanks, Ellie," I said. "Kellie, with me, please. Al is taking a patient up to Medicine."

Kellie, Naveen, and I headed to the ambulance bay, donning gloves and gowns along the way.

"Morning, Mike; morning, Naveen," Ghost said. "Isabella and I will take the first two, Naveen the third. Mike, do your surgical Resident schtick; I'm sure at least one of them will need it, given it was a rollover."

And need it, they did. An hour later, having inserted two chest tubes and a subclavian line, and performed a pericardiocentesis, all three patients were stable enough for admission or surgery, which two of them needed. The one pleasant surprise was that the first patient, who was in the worst shape, had been intubated in the field by Roy, a first for the Hayes County Paramedics.

"I want to do what you do," Al said when he joined me as soon as he'd returned from escorting Mrs. Iverson to Medicine.

"For your Sub-Is, a double in emergency medicine, a double in surgery, one in pathology, and one in cardiology. You should speak to your advisor immediately, as there are only a limited number of pathology Sub-Is offered. If you want to Match here, the big challenge is that, as things now stand, there's only one guaranteed trauma surgery slot available for your Match. The contingency way to do it would be to use emergency medicine as your backup, then try for one of the slots that open after your PGY1. Of course, you could also apply to other hospitals with programs, and you should, but the order of your Match selections will depend on your priorities."