Chapter 55: Are You Happy?

October 2, 1989, McKinley, Ohio

"I'm all ears, Lissa," I replied.

"I know for a fact that's not true!" she smirked.

"Whatever! What's your theory?"

"What was your major dispute with Doctor Mercer? I mean, at its core?"

I thought for a few seconds, then said, "Her reliance on statistics over individual diagnosis."

"No, I don't think so. What was the one thing you demanded she do?"

"I think I'm missing your point here."

"That she refused to agree with you even when you were positive she knew you were right. With Doctor Mercer, it was for her to acknowledge that Angie wasn't a statistic and shouldn't have been treated as if she was. With Doctor Gibbs, it's for her to acknowledge that she had once agreed with you. In both cases, you were right, and you knew it. All you wanted was an acknowledgment, not even an agreement."

I considered her analysis for about a minute before I responded.

"I see your point," I said. "But I think it was deeper with Doctor Mercer."

"More visceral, yes, but in the end, it was when she acknowledged you were right that you were able to restore your relationship, at least to a point."

"Well, Doctor Gibbs has shown absolutely no indication of even acknowledging a fact from the past, so I don't see any way forward except a purely professional relationship."

"You know that will happen with others in the future."

"Yes, and if I hadn't considered Doctor Gibbs a friend, nothing would have changed. What bothers her is I'm not interested in being her friend. She can change that in a heartbeat. Or are you suggesting I be friends with someone who betrays me and denies the truth?"

"My turn to play your game, Petrovich!" Clarissa declared. "Consider these..."

Immediately, a rooster crowed. And Peter remembered the word of Jesus who had said to him, "Before the rooster crows, you will deny Me three times." So he went out and wept bitterly.

"And..."

"Very good, Lissa! Did you memorize those for today?"

"You know I do pay attention in church, right?" Clarissa asked.

"I do, and therefore you know that Peter repented. That's the key! Heck, I don't even need Doctor Gibbs to repent, only acknowledge that she, at one time, agreed with me and had told me so."

"Playing the Devil's Advocate..."

"That's Roman practice," I said, interrupting her. "The devil has plenty of advocates! The church doesn't need to appoint one!"

Clarissa rolled her eyes theatrically.

"And you know the purpose!" she said. "To present the counter-arguments! The point I was going to make before I was so rudely interrupted is this — don't you think Doctor Gibbs is concerned about retaliation from Doctor Northrup? And that he might have ordered her not to support your position?"

"Then she should have said so! That, too, would be different. Instead, she simply evaded the question. A simple 'I was told not to engage with you on this topic in any way under threat of my job' would explain it."

"Unless she was told not to say that."

"Now we're getting into KGB levels of thought and behavior control! And let's assume that's true, once Doctor Cutter made it clear that I was permitted to speak my opinion in a professional manner, that put Northrup in a difficult position."

"And the only person he can take it out on is Doctor Gibbs," Clarissa countered.

"And if things go the way everyone expects, Doctor Cutter will be Doctor Northrup's boss, and Northrup will bail. And do you think Doctor Anderson would tolerate any action against Doctor Gibbs?"

"Actually, you don't know that, and, in fact, that might be part of the problem. What if Doctor Anderson thinks Doctor Northrup should succeed him?"

"Then he's fighting what is likely a losing battle," I replied.

"And might take down Doctor Gibbs out of spite. You don't know all the relationships or the internal intrigue because you try to avoid it like the plague. But you know people CAN be that petty. Think about Dean Parker."

"I'd rather not."

"But you get my point, right?"

"Yes, I do, and let's assume all of that is true. That means, then, that Doctor Gibbs doesn't trust me to not rat her out."

"Would you put your career in someone else's hands? Wait! Never mind! You do that all the time!"

"Hence your repeated lament that you can't leave me unsupervised for thirty seconds! But do you see my point at least?"

"I suppose so. Usually, I find a weakness in your behavior or thinking, but this time, I think you might be right."

"Bobby spoke to me and made the comment that both Doctor Gibbs and I are as stubborn as mules."

"He's not wrong about you!" Clarissa declared gleefully.

"Hey, I come by my stubbornness honestly! I've said so myself because I consider it a good trait, especially when I'm advocating for my patients or for change that benefits everyone, even if it ruffles some feathers."

"And you only get away with it because, and I hate to feed your ego, you're so dammed good at being a doctor."

"Hard work and dedication pay off," I replied. "It hasn't been easy for any of us — you, Maryam, Fran, Peter, and Nadine — and I'd say we're all damned good junior doctors. And it's only through continued study, continued hard work, and continued dedication that we'll become damned good Attendings. And we both know Third and Fourth Years with the same traits.

"In the end, I know I'm not the smartest, but I challenge you to find anyone who works harder or studies more. I often hear that it 'comes so easy' for me, but it doesn't. None of this is easy, which I know you know. It only appears easy because I have my flashcards with me all the time, and I'm fastidious about my practice."

"I believe the word you're looking for is 'anal'!" Clarissa smirked.

"What is the primary trait of a surgeon?"

"Doing the same thing the same way every single time unless there is strong and convincing evidence contraindicating the standard."

"As I described it to Kris, being obsessive and compulsive are the primary characteristics of surgeons. Do you remember the characteristics of obsessive-compulsive personality disorder?"

"They should put your picture in the textbook!" Clarissa smirked. "It's an excessive obsession with rules, lists, schedules, and order. That's accompanied by a need for perfection that, when taken to an extreme, interferes with efficiency and the ability to complete tasks or devotion to productivity that hinders interpersonal relationships and leisure time. It also involves rigidity and zealousness on matters of morality and ethics. And it manifests restricted expression of emotion. In other words, Michael Peter Loucks, MD, Orthodox zealot!"

I laughed, "I won't deny resembling that in basically every way. Orthodoxy cuts both ways, though, because, in the quest for perfection, it understands we will miss the mark. Having that understanding attenuates the perfectionism that would otherwise override the mentality necessary to be an emergency medicine specialist — it's not about perfect outcomes, it's about keeping them alive, even if it's not 'perfect'."

"And the line between it being a mental illness and a positive trait is unclear."

"The key is that I'm able to maintain relationships. Which takes us full circle to your comment about what's wrong. I don't need Doctor Gibbs to be perfect, I need her to be trustworthy. Those are two very different things. That said, this conversation has been helpful because it's forced me to distill the problem down to its essence."

"You know how much I care for you, Petrovich!"

"I do. And may I engage in a bit of shameless Russian promotion and supremacy?"

Clarissa laughed, "Which thing now?"

"It's actually on topic! Пётр Бори́сович Га́ннушкин (Pyotr Borisovich Gannushkin), a Russian psychiatrist, developed a very early theory of personality disorders, which he called 'psychopathies'. He developed the main methodological aim of social psychiatry, which, in my opinion, appropriately analyzes interpersonal and cultural aspects of mental wellbeing."

"Your belief that in a pre-industrial society, Angie would not suffer the way she has in our so-called 'modern' society."

"Yes, and one of Gannushkin's professors, Серге́й Серге́евич Ко́рсаков (Sergei Sergeyevich Korsakov), said something very important — 'mental patients should not be regarded as soulless creatures: they should be considered personalities familiar to everyone who is somehow related to them'. Sadly, his teaching has largely been ignored."

"When was that?"

"Sometime in the 1890s, when Gannushkin was studying under him at Moscow State University. Interestingly, he went straight from the equivalent of High School into the medical school program at Moscow State. The program was five years, and he had an MD. Sound familiar?"

"Similar to the European systems we discussed."

"In those systems, we'd have become doctors two or three years ago. And I honestly don't think our practice of medicine would have suffered from what would have amounted to taking fewer electives as undergraduates. I'm all for a well-rounded education, but given it takes a minimum of eleven years from High School graduation to become an Attending, and as much as twenty for the most demanding specialties, cutting out two or three years of classroom work wouldn't hurt, and I believe it would help."

There was a knock at the door, and I called out for whomever it was to come in.

"There are patients in the waiting room," Sophia said. "Are you going to be much longer?"

"We're finished," I said. "Let's go see some sick people, Lissa!"

October 4, 1989, McKinley, Ohio

"Doctor Mike, you have a phone call," Tamara said to me at 11:15am on Wednesday. "Line 2."

I went to my small office at the Free Clinic and picked up the handset.

"Mike Loucks," I said.

"Mike, it's Lara. Do you have a moment?"

"I do. What's up?"

"I have the details for our trip to Chicago on the 14th. Got a pen and paper?"

"Always!" I said, taking my personal notebook from my pocket. "Go ahead."

"We'll leave from Pickaway County Memorial Airport, which is convenient to all of us, at 0900 on Saturday, October 14th. The flight to Chicago is about two hours, and we'll land at Meigs Field, which is just outside the Loop on the lakefront. I booked three rooms at the Intercontinental Hotel for Saturday night."

Which meant she and Nathan were sharing a room, which didn't surprise me at all and was a logical development in their relationship.

"I arranged for a limo to take us from the hotel to the church," she continued. "That's Saint George Antiochian, in Cicero. I called and verified with Father Nicholas Dahdal that we'll all be able to receive the Eucharist. Knowing your preference, we'll arrive in time for Matins. We'll have lunch at the church with the congregation following the Divine Liturgy.

"The wedding is at 2:00pm, with the reception starting at 4:00pm. Our flight home will depart Meigs at 2100, so we'll leave the reception around 8:15pm, which, according to Maryam, will be after they cut the cake. We're back at Pickaway County around 12:15am with the time change, and you should be in bed by 12:45am or so. I know that means you only get about three hours of sleep, but I don't think that can be avoided."

"That sounds like the best we can do," I replied. "Flying commercial would be worse, and there's no way I'm going to miss Maryam's wedding. The only fly in the ointment is that Clarissa and I both need to find someone to cover for us on Saturday. Kylie is available, but we're having difficulty finding a second person. I'm going to ask Ghost, even though he's an Attending because he has Saturday off. My other option is to see if Gale Turner from the Free Clinic can do it."

"Why two emergency medicine docs?" Lara asked.

"Clarissa is doing a two-month rotation in the ED. It's a new protocol for training Internal Medicine Residents. An emergency medicine Resident is assigned to Medicine in exchange."

"That narrows your options, right?"

"Yes. Pretty much any Resident from any service can cover Medicine, but that's not true for the ED. It's the same with nursing."

"That would suck if she can't take time off."

"I know. We're working on it. Tessa doesn't start her new role until November 1st and has enough vacation saved up that her last day in the Hayes County Dispatch Center is October 12th. And, of course, you, Nathan, and Kris have weekends off."

"Let me know about Clarissa and Tessa so I can cancel their room if necessary."

"I will. I'm fairly confident we'll find someone."

"I'll let you go, then. Oh, one more thing, pack only what you absolutely need, as there is limited space on the plane with six passengers."

"Will do. Thanks for arranging everything."

"You're welcome!"

We said 'goodbye', and after I hung up, I went to an exam room where Michelle had brought a walk-in patient with an infected laceration on his finger. I treated him, ate lunch I bought at the nearby deli, then had a busy afternoon in the Free Clinic before picking up Rachel from daycare and heading home for dinner. After dinner, Kris, Rachel, and I attended Vespers at the Cathedral, then headed home to put Rachel to bed. Once she was in her bed, Kris and I continued our attempts to make a baby.

October 5, 1989, McKinley, Ohio

"How have your first few days in the ED been?" I asked Nicole just before noon on Thursday.

"Pretty amazing! None of my friends have had the kind of opportunities you've provided."

"I took Doctor Osler's ideas and methodology to heart. Just keep up the good work and you'll be able to use your procedure book as evidence you should be allowed to do more than the typical Third Year on your upcoming rotations. No guarantees, obviously, but if you don't ask, it won't happen."

"I didn't ask you!" she observed.

"I'm different," I replied.

"TRUTH!" Sophia declared with a silly smile.

"I could assign you scut for the next seven weeks, Greek Girl!"

"But you won't!" she declared mirthfully.

"We'll see you on Monday, Nicole," I said. "Sophia, get a chart, please, and work up the next patient. Take Marv with you."

"Right away!" Sophia declared.

Nicole left, and I went to talk to Ghost about the 14th.

"We can't really trade," he said. "But I'll take the shift in exchange for you and Clarissa both owing me favors to be collected at some point in the future."

"We really appreciate that."

"Thank Oksana; she insisted I help you and Clarissa. And on that, I have news."

"When is she due?"

"Honeymoon baby!" Ghost declared with a grin. "Late April."

"Talk about not wasting any time!" I chuckled. "Congratulations!"

"She's telling Kris today, so please don't spill the beans in advance."

"Mum's the word!"

"Mike?" Nate called out. "Bobby Murphy would like a word."

"Is that about what I think it's about?" Ghost asked.

I nodded, "Yes."

"You know my take," he said.

"And you know mine. Excuse me, please."

I walked towards the ambulance bay where Bobby was standing just inside the doors.

"How do we solve this?" Bobby asked.

"Nothing has changed," I replied. "All Doctor Gibbs has to do is admit that she, in the past, had agreed with my position on relationships between doctors and medical students. She can do so privately, and I won't ever repeat it. The bottom line is, if she can't trust me enough to admit that she did agree with me in the past, no matter what she thinks now, then a friendship is nigh-on-impossible."

"I don't know all the details, but I'm sure you know there are other forces at work."

"Oh, I'm fully aware. And that's why I said a private admission. There's an alternative, and that's to admit that she was ordered by Doctor Northrup not to express an opinion under threat of discipline. If that's true, I can understand. But again, she has to tell me. And if she was forbidden from telling me, and thinks there is ANY risk in violating that order, again, she's not viewing me as the close friend I thought we were."

"Northrup is a bastard," Bobby growled. "But forget I said that because Lor would have severe trouble if anyone knew I'd said that because they'd blame her."

"And you think I'd ever sell you down the river that way? Or Doctor Gibbs?"

"No. I just don't know what to do. Lor is unhappy and upset, and that's causing tension at home."

"I'm sorry," I replied. "I'm not sure what you want me to do because pretending everything is cool and nothing happened isn't a recipe for success. I had a long talk with Clarissa Saunders about it, and she's good about whacking me on the nose with a rolled-up newspaper when I'm off base. She didn't on this."

"Don't get me wrong, Doc. I understand your point completely. I hope you understand my position."

"I do."

Sam, who was sitting in the squad outside, turned on the flashing lights indicating they had a call, so Bobby quickly left and I walked back to Nate's desk just in time for Marv to let me know they were ready for me. I saw Clarissa, so I let Marv know I'd come into the room in two minutes, then walked over to Clarissa.

"Ghost will take the Saturday shift," I said. "Oksana insisted he help me, but given we can't trade, we both owe him a favor to be collected in the future."

"Worth it!" Clarissa declared, then smirked, "What do you owe Kylie?"

"She would never sleep with a married man, so even if I would, she wouldn't! I'll take a shift for her sometime in December, including a holiday shift. I figure the scales are tipped heavily in her favor at this point in terms of who owes whom. She doesn't see it that way, but I do."