Chapter 58: Rachel Is a Big Girl!

October 25, 1989, Circleville, Ohio

On Wednesday, I was able to sleep in, at least for me, which meant not getting out of bed until 6:30am when Rachel came into our room.

"Papa! Potty!"

Rachel had been asking to use the potty for a few days, but her timing was off — she'd ask after she'd wet her pull-ups, which she wore during the day, or in the morning when she had a messy diaper from while she was sleeping. I sat up, grabbed my robe, put it on, then got out of bed and took my daughter to the bathroom, where I put her on a potty seat which was on the toilet. Surprisingly, her diaper was dry, and she urinated into the toilet.

"Rachel is a big girl!" I said.

When she finished, I wiped her, then helped her wash her hands before taking her to her room to put on a pair of pull-ups, sweatpants, a T-shirt, and a sweater. Once she was dressed, we went downstairs where Kris had coffee brewing and had started making waffles.

"She used the potty," I said to Kris.

"Rachel is a big girl!" Rachel exclaimed happily.

"Very good, Rachel!" Kris acknowledged. "Mike, did you decide what to do about your prison visit?"

"I think it's better to keep the day consistent, and either the third or fourth Sunday of the month, usually the fourth. The only thing I have planned is lunch with Antonne and his study group tomorrow."

"And his friend Conchita will have her 'Rachel time'?" Kris asked.

"She does enjoy that! We'll stop in and see Anicka before lunch, but otherwise, Rachel and I will just hang out."

We had breakfast, then Rachel and I walked Kris out to her car, said 'goodbye', and, after Kris had driven away, went back into the house.

"What shall we do today?" I asked.

"Papa guitar!" Rachel exclaimed.

I honored my daughter's request and played for her for about an hour, which doubled as practice, which I was missing every week because of my schedule. After I played my guitar for my daughter, she and I took a walk, then returned to the house, where she hosted a tea party for her stuffed animals and dolls while I read the newspaper. We had lunch at noon, took another walk, then Rachel went down for her nap.

I used the time she was sleeping to write out checks for bills, to balance the family checkbook, and to compare our spending against our budget. We were spending less than we'd allocated, which was a good thing. That allowed me to transfer extra money to our savings account, where each dollar added brought us closer to being able to buy a house and begin building equity instead of paying rent.

When Rachel woke up from her nap, I gave her a bath, then we went downstairs so I could begin working on dinner while she played with her toys. When Kris arrived home, she helped me put the finishing touches on dinner, we ate, then headed to the Cathedral for Vespers. After Vespers, we returned home, put Rachel to bed, then shared a glass of wine, a rare occurrence due to my shift schedule.

"I was thinking about how to handle things next Summer," Kris said as we sipped red wine. "As we had discussed before we married, I'll take June, July, and half of August off from OSU. That will keep me on plan to graduate on time, even if I miss a regular semester because the timing of our second child doesn't work as conveniently as our first appears to have."

"That's completely up to you," I replied. "Assuming our baby arrives around June 20th, it would be June of the following year before he or she could go to the hospital daycare, and the parish daycare starts at age two. We'll need to sort out childcare for about ten months, roughly."

"Actually, I checked into the daycare at Ohio State and also spoke to my advisor. I'll be able to arrange my classes so that they are on Monday, Wednesday, and Friday, which would allow us to sign up for the three-day-a-week plan, which costs $36/week at our income level. They'll take babies as young as six weeks, and then, when he or she turns one, we transfer him or her to the hospital daycare."

"We can make that work with our budget, especially given my income will go up by about $3000 on July 1st of next year."

"You know, I never asked, but how does the daycare at the hospital work?"

"For medical students, it's free; for Residents, it's $5 per day; for Attendings, it's $10 per day. There are different fee schedules for nurses, orderlies, clerks, and administrators, all subsidized at different levels. The parish daycare at Saint Michael is $10 per day, but there are benevolence funds available for families who can't afford that."

"I think that answers the practical part, «non»?"

"I think so," I agreed. "It's also much more convenient. The only question I have is if you'll be OK with taking four classes per day."

"Yes, and having Tuesdays and Thursdays free gives me plenty of time to read and do coursework. Obviously, we don't know your schedule, but those days also allow for shopping and other things that I might need to do for the family. Also, I'm sure my sister will help out during the Summer while she's not in school."

"Rachel really likes her, and she's been a big help; well, minus teaching Rachel to speak French!"

Kris laughed, "As if that is so terrible!"

"I suppose French could be useful," I allowed.

"You love French ... kissing!"

"Perhaps," I replied with a smile.

"Perhaps you'd like to French kiss my «minou»?" ("pussy")

"Perhaps I would!"

October 26, 1989, Circleville, Ohio

"How was your day?" Kris asked when she arrived home early on Thursday afternoon.

"It was good," I replied. "We spent about twenty minutes with Anicka, then had lunch with Antonne, Paul, Julius, Jordan, Conchita, and Danika. As usual, Conchita helped Rachel with her lunch, and then we came home."

"If you don't object, we could do the grocery shopping as a family today," Kris suggested.

"That's fine with me," I replied. "I think we should let Rachel have her nap first. She was just about to go down."

"OK."

I took Rachel upstairs, had her sit on the potty, and was pleased when she urinated. I put on a clean diaper, which she wore when she slept, helped her climb into her bed, tucked her in, then kissed her forehead. I left her room, closed the door behind me, and went back downstairs to be with Kris.

"Do you have homework?" I asked.

"Just some reading," she replied. "I can do it now, if that's OK, then we'll have the evening free."

"Sounds good. Fran called to let me know that she and Jason plan to join the group tomorrow night."

"That's good!" Kris exclaimed. "We haven't seen them in some time."

"Babies do not care about schedules!" I chuckled. "Nor do they care if there is an OB available!"

"When should I go to the hospital?"

"The short answer is 'when Doctor Forsberg tells you to'. The longer answer has to do with how long you've been in labor, how close together your contractions are, and if your water has broken. You'll call her when your contractions start — they're usually about ten minutes apart at that point — and she'll advise you."

"Do you really not know much about OB/GYN?"

"I know the basics. If there had been any serious complications with the delivery, things could have gone very badly, very quickly. Fortunately, it was routine, and I even overreacted a bit."

"How so?"

"She lost a small amount of blood, which isn't uncommon, and her BP dropped, so I ordered a unit of plasma, which wasn't strictly necessary, but given I had insufficient experience by which to judge, I took the conservative approach."

"Of course you did!" Kris said lightly.

"Whatever!" I chuckled. "You know I didn't mean it politically! In the hospital, the thing we seek to conserve is life, so literally every doctor is 'conservative' by default. We take very few risks, though our willingness to take risks increases as the risk of a negative outcome increases."

"Have you had to do that?"

"No. At this point, anything that deviates from standard practices would need advance approval from an Attending. You know I mostly handle walk-ins, and when there are traumas, if they're significant, an Attending is assigned as well. The weird thing is that because I'm on the surgical service, I do surgical assessments that ED Attendings cannot do."

"That's very strange."

"It's all about the red scrubs," I chuckled. "But seriously, it's also the case that to transfer a patient to another service, a Resident from that service has to accept the patient. So, in a sense, it's not weird because even though I work in the ED, I'm officially a surgical Resident."

"When will there be more like you?"

"Never!" I declared with a goofy smile.

"You know what I meant!" Kris retorted.

"I did. There will be one, or possibly two, in June 1992, and then one per year after that until there are six Residents. After that, slots will open as they're needed. I don't know about Attendings as yet, because the soonest I could be an Attending is 1999. It's possible they could open a slot before I complete my Residency, but there are so few programs that anyone who completes their Residency will be snapped up by their own hospital."

"That's the point when you could leave if you wanted to, right?"

"Yes. The real question will be my Fellowship because there will be limited opportunities for trauma surgeons. If Moore Memorial doesn't have one, I might end up in Columbus, Cleveland, Cincinnati, or even Chicago."

"How long is that?"

"A year, typically. The challenge is that unless there is an Attending trauma surgeon, there can't be a Fellowship."

"That precludes you from being at Moore, then, right?"

"Unless they decide to create an Attending position before then and can fill it with someone from Chicago, or Indiana University, or one of the few other schools that started before Moore did. It's also possible I could do a Fellowship in a surgical specialty other than trauma surgery, but Moore only has one for cardio-thoracic at the moment, and the competition is keen."

"It sounds as if not everyone can do one."

"That's absolutely true. I could go straight from Resident to Attending and not suffer. That said, a Fellowship under someone like Doctor Barton in Chicago would be valuable both in terms of education and earning potential. The earning potential doesn't matter a lot, but the education and experience do. Interestingly, I will be a 'Fellow' without a Fellowship."

"What am I missing?"

"You probably have never run into it, but surgeons add 'FACS' as a post-nominal title. It stands for 'Fellow of the American College of Surgeons' and is a certification that you've met the criteria for education, qualification, and ethics required to join the American College of Surgeons. I could actually join the organization as a Resident, but the certification comes later. If I do earn that certification, which I intend to do, I will be styled 'Doctor Michael P. Loucks, MD, FACS'."

"From all of that, I gather you would only do it if it were available here or Columbus?"

"Or possibly Cincinnati. You'll have finished your Master's in public administration by then, and we'll have to consider where you work, along with the other needs of our family. In any event, it's not something to worry about for six years, and much will have changed by then, including more trauma surgeons being trained."

"Would you consider moving on account of my job?"

"We'd certainly discuss it, but my ability to move is severely limited for the next six to eight years. But, as I said, we can defer that discussion until Spring 1996. You know my desire is to serve the community here, but the bottom line is that you and I are an equal partnership, and I'll do what's best for our family."

"That's all I can ask."

October 28, 1989, McKinley, Ohio

"What did I miss?" I asked Isabella Mastriano when I saw her in the ED lounge on Saturday morning.

"Not much, from what I hear. It was a relatively quiet week, and it was strangely quiet overnight. Only two EMS transports and half a dozen walk-ins. Doctor Billings is sleeping, and the board is completely clear."

"That won't last," I replied.

"It never does," she confirmed.

Karl and Andy were also sleeping, and there was no point in waking them as there was nothing to do, so I set down with JEM and began reading. Three articles immediately caught my eye — 'Penetrating wounds to the posterior chest: Analysis of exigent thoracotomy and laparotomy', 'Laboratory tests during resuscitation', and 'Criteria for the assessment of disaster preparedness'. There were other potentially interesting articles, but with limited time, I chose the ones I felt were most appropriate.

The article on lab tests during resuscitation surprised me, as instead of being diagnostic in nature, was defensive — that is, arguing for them as a way to justify earlier termination of resuscitation. The argument was, in effect, that lab tests could more quickly show a situation to be hopeless than a physical exam. And while that was true, I asked for a 'trauma panel' — albeit by specifying the specific tests I wanted — in nearly every case. That was the accepted practice at Moore, but I could see how patient loads might lead to not running those tests for patients who were 'moribund', as the article called them.

The article on penetrating wounds provided statistics which supported early surgical intervention for posterior chest wounds, though the majority of the cases examined were gunshot wounds, something we rarely saw, though the frequency was increasing. The second largest group was stabbings, and we saw a fair number of those, but nothing like the numbers reported in the study, which had been conducted in Denver.

The article on disaster preparedness presented a method of objective assessment, and called for uniformity amongst municipalities, counties, provinces, states, and countries. A number of the ideas presented were excellent, and I made a mental note to flag the article to Doctor Gibbs.

I had just finished the article when Missy, one of the weekend clerks, came into the lounge to let me know there were walk-in patients in the waiting room. I acknowledged her, then went to the on-call room to wake Karl and Andy, nearly running into Kayla Billings as she came out of the on-call room.

"Nothing on the board," she said. "I'm outta here!"

"Have a good day," I said.

She left, I woke my students, and had them get the first chart from the rack. We had a fairly steady flow of patients, though nothing interesting or out of the ordinary. We streeted most of the patients, with only one being admitted to Medicine. The afternoon was somewhat busier, and we assisted with a multi-victim MVA, with two patients being sent up to surgery. I had hoped with two patients I'd get to scrub in, but that hadn't been the case.

At 5:00pm, I left the ED and headed home for dinner with Kris and Rachel, then Vespers at the Cathedral.

October 29, 1989, Southern Ohio Correctional Facility, Lucasville, Ohio

On Sunday, after the Divine Liturgy at the Cathedral, I dropped Kris and Rachel at home, then headed to the prison to see Frank Bush and Kurt Bowman. I had called on Friday and received permission to use the chapel at 3:00pm for the Trisagion Prayers, and a notice had been posted. I wondered who might attend, if anyone, but even if I prayed alone, that would fulfill my ministry.

When I arrived at the prison, I put on my grey cassock and went through the usual lengthy security procedures, which were slightly longer as I was bringing in a prayer book and diptych. After being wanded, patted down, and having my prayer book and diptych X-rayed, I was escorted to the visitor's room. Two minutes later, Frank Bush was brought in.

"What's with the getup?" he asked.

"I assume you saw the announcement of the prayer service I'm going to lead at 3:00pm. That's why."

"I thought you quit."

"I did, but I have permission from my bishop to wear the cassock as a chaplain when I'm here at the prison. Can't have anyone mistaking me for a Protestant pastor in slacks and a polo shirt!"

"They should never have gone away from suits and ties," Frank said.

I smiled, "I agree! We should all wear the traditional uniform for clergy. Our street clothing is simply thirteen centuries or so older than yours!"

"Smart ass!"

"I aim to please! How is Kurt?"

"Much better. I'm surprised that subterfuge worked."

"I suspect it had to do with me being able to claim to be an MD, as well as being listed as his official next of kin. I doubt that will work again, at least anytime soon. That said, if you have anyone who has medical complaints come to the prayer service, I can do my best to intervene. Obviously, I can't promise anything, and without a license, I'm limited in what I can say or do, but someone needs to be an advocate for the humane treatment of prisoners."

"You don't think everyone here is reaping what they've sown?"

"Yes, they are," I replied. "Though that does not make it humane, nor just, and certainly not Christian."

"Isn't it written, 'Let everyone be subject to the governing authorities, for there is no authority except that which God has established'?"

"Romans 13," I replied. "And I'm not challenging the authority of the government to incarcerate you any more than I challenge the authority of the government to lay and collect taxes. What I'm saying is that as Christians, we should follow Jesus' command to visit and love the imprisoned and ensure they are treated humanely and justly."

"Paul was speaking about the Romans, and they were anything but just and humane!" Frank countered.

"The fact that the pagan Romans acted unjustly and inhumanely is not license for us to do the same. Sometimes, Christians are called to disobey the law, with my primary example being Doctor Martin Luther King Junior. He and other civil rights activists broke the law, understanding they would be punished. They kept the moral high ground by not engaging in insurrection or rebellion but only civil disobedience.