Chapter 63: Everyone Has to Start Somewhere

November 19, 1989, Circleville, Ohio

On Sunday, after the Divine Liturgy, we skipped lunch with the congregation to head home so that Lyudmila and I could set up for a gathering to celebrate Kris' birthday. It was a day early because I had to work until 9:00pm on her actual birthday, so, similar to Holy Week services, we were celebrating the feast 'by anticipation'.

"What do I need to know about your sister's friends who are invited?" I asked as we worked together in the kitchen.

"They are pretty, friendly, and intelligent, same as me!" Lyudmila said with a smile.

I laughed, "Good to know! What are they studying?"

"Marlene is pre-law, and Beth is studying computers. They both have boyfriends, and both went to High School with my sister. The boyfriends' names are Karl and Ted."

"Thanks."

"Is anyone I don't know coming?" Lyudmila asked.

"No. Ghost and Oksana, Joel, Milena, and Abigail, Clarissa and Tessa, Loretta and Bobby. And your parents, of course."

"I believe I've met them!" Lyudmila declared with a silly smile.

"No boyfriend?" I asked.

"I think my dad would be upset if my mom brought a boyfriend!"

I laughed, "I mean you!"

"Really?" she smirked. "No. My sister scooped up the handsome doctor! Of course, he might be a little old for me!"

"Just a bit," I chuckled. "Serious question, though."

"There are one or two guys at the Cathedral who might be interesting."

"And if they're anything like I was, they're scared to death to ask you out. You might want to make the first move."

"You were scared?"

"To death! Tasha was the most beautiful girl I knew; she was interested, and I was more afraid than a mouse in a room full of cats!"

Lyudmila smirked, "Boys can be pretty dumb!"

"Your brother-in-law included!"

"He appears to have outgrown that, or else my sister would never have married him!"

"I think you might want to ask her," I chuckled.

"No, it's Clarissa who thinks you haven't grown up!"

"She knows me too well!"

The party came off without a hitch, and once we'd had coffee, cake, and ice cream, our guests left. I read to Rachel, the three of us said evening prayers, and then we put Rachel to bed.

"I'm not suggesting anything," Kris said, "but when do you have a chance to change your schedule?"

"In January for February and March. Why?"

"When you couldn't join us in a toast at dinner, it felt uncomfortable."

"Not for me," I replied. "My rule is imposed on me, not on anyone else. Clarissa didn't drink, either, because we didn't eat until 6:00pm. Does it bother you that much?"

"It just feels uncomfortable."

"Because of something I've said or done?" I asked. "If so, I apologize."

"No need to apologize, Mike. I wasn't saying it to be critical. We need to be able to discuss things without becoming defensive and without you instantly taking blame for something where there is no blame to assign."

"I'd say I was sorry for apologizing, but that would go against what you just said!"

Kris laughed softly, "Cute. I don't think we have any major areas of disagreement, do we?"

"Minus card-carrying, flag-waving socialism?" I asked with a smile to show I was teasing.

"Well, yes, except for that! But you are coming around!"

"As if," I chuckled. "While I may agree with you on certain aspects of social democracy, I believe private ownership of property is the correct approach. Or do you think this house has living space for thirteen families?"

"You say that as if I should know what it infers."

"It's from Doctor Zhivago. In the film version, when Yuri returns home from World War I, he finds a Residents' Committee has been established and that other families now live in his house. The Chairwoman of the Residents' Committee says there was sufficient space for thirteen families, and Yuri pretends to agree by saying it's a 'better arrangement' and 'more just'."

"And you disagree, of course."

"I was more offended that they renamed Holy Cross Hospital to the Second Reformed Hospital. Then again, I could argue that Soviet Communism is what you get if you apply Communist Party Reform ideas to the Orthodox Church!"

"OK, I have to hear how THAT could possibly be true!"

"Well, let me ask you this first — what's the point of Lenin's mausoleum and tomb? Not the obvious one to most people, but the meaning that Orthodox Christians would understand?"

Kris thought for a moment, "Incorruptibility. Like the saints' bodies, which are reported to be incorrupt."

"Exactly. Now, consider the May Day parades and what they reflect."

"Paschal processions, replacing Jesus and the saints with Lenin and Stalin."

"Yes, so the Party seeks to replace the Church, but rather than offering grace and love to all, they only offer it to the elect."

"And we've agreed that the Soviet Union isn't socialist!"

"Except in Zhivago that was before the complete corruption of the local soviets by Lenin and Stalin. They were converting private property to public property and distributing scant resources as best they could. Remember, Yuri came home between Russia's withdrawal from World War I and the beginning of the Russian Civil War. So, Yuri was actually commenting on socialism as you define it, before it became a Stalinist personality cult."

Kris laughed softly, "Who knew Mike Loucks was so informed about Russian politics!"

"You can thank my grandfather, who rejected the Tsarists and Bolsheviks and supported, as I've said, a liberal platform, as Europeans mean 'liberal' — right of center. But the point is, do you agree we shouldn't own a house, cars, or any other property?"

"No, but I do think the means of the production should be held in public trust, not privately."

"And we're going to go around in circles because the major industries in this country are owned by the public trust, usually via pension plans or retirement systems. Soon enough, we'll own shares via a mutual fund. And it's not as if our workers aren't compensated for their labor. Elias makes more than I do as a journeyman electrician! Tessa makes more than I do as Assistant Director of the Emergency Communications Center."

"And the robber barons?"

"Have all been dealt with! Standard Oil, AT&T, and others have been broken up. The technology moguls I read about all have become rich by having a good idea and convincing others to invest, and have made many others rich! The system works, and social democracy, that is, shared services and a safety net, is a far better answer than what amounts to nationalizing industry. That has worked SO well everywhere it's been tried!"

"Don't look now, but you're having a political discussion!"

"I'm having an economics discussion! Pretty much everyone in the US is capitalist, except maybe a few people in Milwaukee or Madison and Bernie Sanders! Our political argument is how best to provide the safety net and which shared services are handled at which level — local, state, or federal. Even Ted Kennedy isn't arguing for remaking the economy after a socialist pattern."

"And yet, there are so many people exploited by capitalism!"

"And those numbers pale before the number of people subjugated by 'state socialism'!"

"Personality cults!"

"And yet, they're the only examples of socialism in the world. That system always devolves into a cult of personality. We in the West reserve that for movie stars, musicians, and athletes!"

"Sadly. We should probably go back to the original question."

"I like my current schedule as it allows me to work one day a week at the Free Clinic, I'm home every night, and I can attend services on Wednesdays, Saturdays, and Sundays. That said, if something would work better for you and Rachel, I'll obviously consider it."

"I know you'll have a similar number of hours for next year, but what about when you begin your surgical training?"

"I wouldn't be surprised if I didn't have a similar schedule so that I can cover the ED during the day, and the new trauma surgery Interns will cover nights and weekends. Doctor Cutter is already ensuring I have opportunities to be in surgery, though those are limited at the moment. During PGY3, I'll have more, but that means being there during the day to train. But all of that is speculation. I think, ultimately, my response is there is no need for you to feel uncomfortable. If you want the symbolism, white or purple grape juice will work."

"I probably should have approached it differently."

"No, you approached it exactly right because you conveyed what you were thinking, and we've had a good discussion, even if we followed rabbit trails."

"There's another thing bunnies do we could follow!" Kris said invitingly.

She didn't have to ask twice. I scooped her up with a stifled squeal from her and carried her up to bed.

November 20, 1989, McKinley, Ohio

"Hi, Nancy," I said when I walked into her room late on Monday morning.

"Hi, Mike!" she exclaimed. "I hear you saved my life! Thank you!"

"You're welcome! I wouldn't go quite that far, though I did get a good look at your insides!"

"Did you really stick a needle into my heart?"

"No! The needle went into the pericardium, which is a sac around your heart. There was an accumulation of fluid that was causing an irregular heartbeat, and I aspirated it. The chest tube, which went where you now have the drain, was to re-inflate your lung. And the surgery was to fix some bleeders and a liver laceration. How are you feeling?"

"Like I was hit by a truck! Matt told me the police cited the other driver."

"Good."

"How badly was he injured? Nobody here knew."

"A broken ankle and bumps and bruises. I was happy to see Matty!"

"He's a handful already, and he's only three months old!"

"Rachel was a handful then, but just wait until he's mobile! And worse, when he learns to say 'no'!"

Nancy laughed, then grimaced, "Please don't make me laugh! It hurts."

"I bet. Did they give you any guidance as to when they'll spring you?"

"They haven't said, but there's no way I can be home for Thanksgiving. They put casts on my leg and arm earlier today, but because I had what they called an 'open procedure', I might have to stay as long as four weeks!"

"Unfortunately, we can't use laparoscopy in emergency surgery at this point because speed is usually of the essence. Eventually, we probably will. How have you been otherwise?"

"Good. I enjoy managing the Quick Mart for Mr. Sokolov. You know he's mostly retired, right?"

"Yes. You know it'll probably be at least six weeks before you're allowed to go back to work, right?"

"Yes. Mr. Sokolov was here yesterday to see me. He's scrambling a bit, but he interviewed some Taft students this week to cover the shifts. He'll be in the store more, obviously. How are things with you?"

"Good. I love my work, I love my wife, and I love my daughter. Despite the things that have happened, I'm a very lucky man."

"It's good that you can have a positive outlook after what had to be a nightmare."

"I learned quite a bit about myself and the world and was able to bond with Rachel in ways that otherwise wouldn't have happened. That doesn't take away the pain or sadness of losing Elizaveta, but life has to go on, if only for Rachel's sake."

"What will you tell her?"

"The truth," I replied. "Probably first when she's around five, though I'm pretty sure Elizaveta's mom has already said something to Rachel."

"She's two, right?"

"Yes, so she probably doesn't understand. Anyway, I need to go back to the ED."

"ED?"

"Emergency Department. What you probably call the ER."

"Yes. Isn't that what it's called?"

"By the public, yes, and that's a remnant of the days when it was literally a room near the entrance to the hospital staffed by the surgical team. Think Emergency or Medical Center."

"Ah, OK."

"I'll come see you until you're discharged."

"Thanks, Mike. Matt, Matty, and I owe you, big time."

"You're welcome."

I said 'goodbye', left her room, and returned to the ED.

"How is she?" Clarissa asked when I walked in.

"In good spirits, but in pain, as is to be expected. No neuro deficits at all, but she has to have a whopper of a headache. Shelly said Nancy asked about being discharged on Wednesday so she could be home for Thanksgiving, but she needs the cervical collar for another week, and they cast her left arm and left leg, so six weeks or so there. I bet they keep her for three to four weeks."

"Doctor Mike, we're ready," Nicole announced.

I nodded and followed her into an exam room.

November 23, 1989, Thanksgiving Day, McKinley, Ohio

One significant downside of being a PGY1 working in the ED was no holidays off. And me being in the hospital allowed the entire remainder of the surgical staff to take the day off, though Nelson Burke was on call, and lived just four minutes from the hospital. My grandfather had arranged for a family gathering on Saturday evening, to which everyone was invited, and he'd obtained «ekonomia» from Vladyka JOHN to have our Thanksgiving celebration that day.

As was typically the case on Thanksgiving, the morning was extremely quiet, with only a handful of walk-in patients and only a single EMS run. That had allowed me to spend about twenty minutes with Nancy, who was recovering from her severe injuries. She was in reasonably good spirits, all things considered, but being stuck in the hospital over Thanksgiving was not conducive to happiness.

The calm began to change just after noon, and at 2:00pm, things became crazy.

"EMS transporting five injured in some kind of cooking accident," Teri, the Clerk, said. "First squad is five minutes out."

We were shorthanded for that, with just one Attending, three Residents, and seven medical students. I was positive we'd need help, but that was up to Isabella Mastriano.

"Cooking accident?" Doctor Mastriano asked. "Five people?"

"That's what they said," Teri replied. "Severe burns and lacerations."

"What the heck?" Clarissa asked.

"Got me," I replied. "No clue!"

"Teri, call for a surgeon and two Residents from Medicine, please," Doctor Mastriano instructed.

"I'll call Doctor Burke," I said. "He's at home, five minutes away. I'm the only surgeon on duty."

"We are SO screwed!" Clarissa teased.

"Love you too, Lissa!"

I went to the phone and dialed Doctor Burke's number. He answered on the second ring, and I explained the situation. He swore but said he'd be at the hospital in five minutes. I hung up, then hurried to the ambulance bay to join Isabella, Sue Townshend, Clarissa, six medical students, and four nurses.

"Nelson will be here in five minutes," I said. "How do you want to handle this if the Medicine Attendings don't arrive?"

"We'll assess as they come in. You run triage, Mike, and if there's a clear surgical case, you take it, and Sophia and Kent will handle the least injured patient. The other doctors should be here by then."

The plan went sideways as soon as the first squad pulled up, and Roy jumped out.

"Two patients; both severe burns and shrapnel from an exploding turkey fryer."

"Say what?!" Isabella interrupted.

"They tried to deep fry a frozen turkey. Patient one, approximately forty-five-year-old male; oil burns over forty percent of his body, including his face; aluminum shards embedded in his chest and face; BP 140/90; tachy at 120; PO₂ 96% on cannula; 10 megs morphine; GCS 6; IV saline."

"Trauma 1!" I ordered. "Clarissa, Marv, Emily, Kellie, with me!"

Emily was Clarissa's Third Year; her Fourth year, Kent, was going to have a baptism by fire together with Sophia.

"Clarissa, intubate; Marv, monitor, no EKG due to burns; Emily, Foley, then notify the burn unit; Kellie, stat ABG, Chem-20, CBC! Roy, any name?"

"No. Everyone present was injured, and we didn't look for ID."

Roy, a fireman, and my team rushed the patient to Trauma 1 and quickly moved him to the trauma table. I grabbed surgical scissors and carefully cut away the patient's shirt, though some material was stuck to his skin and would need to be debrided.

"There's a six-inch, jagged shard of aluminum in his left pectoral muscle," I announced.

"The one in his cheek penetrated into his oral cavity," Clarissa replied. "It's going to interfere with the tube."

"Marv, find Doctor Burke!" I ordered. "Lissa, keep him on the cannula for now; his PO₂ is 95%."

"He'll lose his airway," she countered.

"I can't remove the shard," I replied. "I'm not cleared for that procedure."

About thirty seconds later, Doctor Burke came into the room.

"What do you have, Mike?"

"Aluminum shards in chest and cheek; I'm not cleared for those procedures. The one in the cheek penetrated the oral cavity and is interfering with intubation."

"I'll walk you through it," he said. "Bullet?"

"Approximately forty-five-year-old male; oil burns over forty percent of his body; BP 120/80; tachy at 120; PO₂ 94% on cannula; 10 megs morphine in the field; IV saline."

"We'll need tin snips, a pair of hemostats, two-by GELFOAM, a needle driver, and 4-0 nylon."

Marv and Kellie retrieved the things we needed and set everything on a tray.

"Do you know the theory for this type of wound?" Doctor Burke asked.

I nodded, "Grasp the metal via the oral cavity with a hemostat, cut the metal as close to the skin as possible, trimming any part that might catch. Once that's done, pull it gently into the oral cavity, then out the mouth."

"Correct. Use the GELFOAM inside the cheek to control bleeding into the oral cavity, then dress the exterior cheek and intubate. Plastics can clean it up later."

"Doctor Mike," Sophia said from the door. "We need help."

"Clarissa, go!" I directed. "Marv, carefully grasp the aluminum protruding into the oral cavity with a hemostat and hold it steady; Emily, same with the external metal."

They did what I asked, and I used the tin snips to cut the aluminum as close to the skin as I dared, leaving as little metal as possible. I carefully pulled the metal through his cheek, extracted it, and dropped it in a basin. I placed the GELFOAM between his teeth and cheek, then quickly moved to perform the intubation and hook up the vent.

"Good bilateral breath sounds," Doctor Burke announced once I had the vent connected.

"What do you want to do about that metal in his chest?" I asked.

"We'll need a portable chest to assess. Keep him hemodynamically stable and continue fluids, checking electrolytes. I need to call in at least one team. Let me check with Isabella, and I'll come back with a plan. Did you call the burn unit?"

"Isabella did as soon as we knew we had burn patients."

"Are you cleared to perform an escharotomy?"

"I've participated but don't have a sign-off. I know the technique and the procedure."