Chapter 69: Accountability Partner

December 24, 1989, Rutherford, Ohio

On Sunday, Kris, Rachel, and I attended Matins and the Divine Liturgy in the morning, then Vespers for the Nativity in the evening. Once Vespers ended, we headed to my grandfather's house for our extended family Nativity dinner. I didn't relish the drive back and forth, as I had to be up at 4:15am for a 5:00am shift at the hospital, but it was the only way we could celebrate Nativity.

Before we arrived, we had an important thing to do.

"Rachel?" I queried.

"«Oui, papa?»" my daughter giggled. ("Yes, Papa?")

I shook my head, and Kris laughed softly.

"Your «tante préférée» strikes again! Mama and Papa have something to tell you." ("favorite aunt")

"What?"

"Mama is going to have a baby! You'll be a big sister!"

"I want a sister! No boys!"

I chuckled, "Papa is a boy!"

"Viktor is noisy and doesn't play nice!"

Viktor was, as the saying went, 100% boy and did everything the way a male toddler was expected to do them — rough and tumble and very energetic. My daughter and Abby, on the other hand, were calm and gentle, though they had a habit of getting the giggles.

"Mama and Papa don't get to choose a boy or a girl," Kris said. "We'll love our baby no matter what, and you'll love your new brother or sister."

"When does the baby come?" Rachel asked.

"June," Kris replied. "It's a long time away."

"How long is that, Papa?"

"Lots and lots of sleep times," I replied. "It's about six months."

I saw in the rearview mirror that Rachel looked confused, but that didn't surprise me, as her concept of time was limited.

"Want to live with Abby! Not a boy!"

Kris and I both laughed.

"This is going to be fun," she said quietly.

"Just wait until the kids start ganging up on us!" I replied equally quietly.

"We might have a baby girl," Kris said to our recalcitrant daughter.

"Yes!" Rachel declared. "Want a sister!"

"You have NO idea what you're asking for, little one!" I chuckled.

Kris smacked me lightly on the arm.

"You know my sister just does things to tease you, right?"

"Obviously. The same as my little sister!"

"I suppose your half-sister is too young to tease you!"

"Faith's teasing will be directed at Peter, not me!"

"We're still having dinner with them next Sunday evening, right? On New Year's Eve?"

"Yes. I had hoped to have the entire family together today, but Holly is still uncomfortable with our side of the family. I suspect it will always be that way."

"Don't you think being the 'other woman' who breaks up a marriage would cause that?"

"Yes, though I wouldn't say Holly wrecked my parents' marriage. I'm positive it was already wrecked when he first slept with her, which, if I had to guess, was two years before she became pregnant."

"That's something you've never said before. Are you sure?"

"No, but all evidence points to the fact that they were involved when she was sixteen. It's not the age that bothers me, by the way; it's the cheating."

"I would think not, considering you were betrothed to Elizaveta when she was fifteen and crowned to her when she was sixteen! And betrothed to me when I was seventeen!"

"Obviously. I think that answer is almost reflexive given the amount of grief we received on account of Elizaveta's age."

"How old would be too old? I mean, in terms of a relationship?"

"For me? Or in general?"

"Both."

"Well, first of all, for me, it's irrelevant because I'm married to you! But, to answer the question, you were right on the very edge, given I'm seven years older than you are. In the general case, I think it's up to the individuals to decide, not me. Ohio says a sixteen-year-old is able to consent to sex and also to marriage with parental permission. At that point, it has to be up to the individuals."

"The law aside, you were OK with Liz and Paul?"

"No, because Paul was married and cheating. Had he been single, my response might have been different, but I'm not sure because I'm a very different person from the one I was when all of that went down."

"It was moral outrage over the cheating?"

"That was a large part of it, yes. My honest opinion is that age difference matters more for teenagers than adults. The ten years from fourteen to twenty-four are far more meaningful than the ten years from twenty-four to thirty-four. But again, my problem with Paul was mostly that he was married and had a kid. That wasn't all of it, but Liz never once wavered about being in love with him, and you see how they are now."

"He's an excellent husband and father," Kris said. "Just as you are!"

"Thanks!"

When we arrived at my grandparents' house, my family was already there, including my uncle, his wife, and my cousin Jack. My cousin Diane was with her husband and daughter in California, where they'd moved. A few minutes after we arrived, my in-laws arrived, and my grandmother invited everyone to come to the tables to eat. It was crowded, but it was great to have everyone there except for my dad, Holly, and their kids.

"We have an announcement," I said immediately after saying the blessing for the meal. "Kris is pregnant, and we're due in June."

"Many years, Mike and Kris!" Stefan exclaimed.

Everyone quickly added their congratulations, and my grandfather and Ignatiy began singing «Многая лета» (Mnogaya leta), or 'Many Years' in Russian, with those who knew that hymn in Russian joining in.

"Thank you," I said.

"Are you teaching Rachel to speak Russian?" my uncle Alexi asked.

"No. Obviously, she'll pick up some words here and there, and the few hymns we sing in Slavonic, but otherwise, no. She is, on the other hand, being taught French by a certain sister-in-law who finds it amusing!"

Rachel giggled then said, "«Je t'aime papa!»" ("I love you, Papa")

"I love you too, Rachel!" I replied. "Lyudmila, on the other hand..."

Lyudmila laughed, and her eyes twinkled because she loved to tease me.

"Will you deliver your baby?" Elaine asked as everyone began eating.

"No. First of all, I'm not an OB; second, except in the most extreme emergencies, and when no other physician is available, it's considered unethical to treat members of your own family."

"Why is that?" my uncle asked.

"Mainly because of the risk that emotions might interfere with care, but also because there is potential for either risk avoidance or poor risk evaluation, such that you want someone who is thinking completely clearly managing the patient's care."

"Like those two student doctors in New York?" my uncle asked.

"Don't believe everything you read in the papers," I replied. "There is far more to the story than the press is reporting, including a very interesting fact that an eighteen-year-old college Freshman had a pediatrician as her primary care doctor. That's not normal in any way, shape, or form.

"He had prescribed drugs for her, erythromycin and chlorpheniramine, for flu-like symptoms. She was also seeing a psychiatrist, who prescribed phenelzine for depression, along with, among other things, imipramine, flurazepam, diazepam, tetracycline, and doxycycline. She also received Percodan from her dentist when she had a tooth extracted.

"The two Residents had no idea that she was taking, or had recently taken, all of those drugs because the person who spoke to them was the family physician, who was neither the pediatrician nor the psychiatrist. Given the two Residents had no idea about the cocktail of drugs she was taking or had recently taken, it's hard to blame them.

"The problem lies in the fact that medical care is disjointed, and there isn't a unified collection of patient information. Each doctor keeps his own records, as does each pharmacy and each hospital. One of the biggest challenges I face is I see patients with no medical history other than what they can tell me, assuming they can even speak.

"The other problem, at least from my perspective, is that physicians are too free with their use of prescription drugs. That young woman was on at least eight different drugs when she was admitted to the hospital. Anything they gave her would have put her at risk, and the interaction that killed her was not understood at the time.

"On the plus side, I'm only working eighty-hour weeks with at least eight hours between shifts because of what happened to Libby Zion. Most hospitals haven't changed, and their PGY1s, that is, first-year Residents, sometimes called Interns, work thirty-six-hour shifts with no rules about time off between shifts."

"That's insane!" my cousin Jack declared.

I nodded, "Indeed it is. But shall we focus on the joyous time of the year rather than the failings of medicine?"

"A good suggestion, Mike," my mom said. "Did you pick names?"

"Charlotte Michelle or John Michael," I replied. "John for Great-Grandfather Borodin, as Michael Michael just sounds goofy!"

Everyone laughed.

"Yes," my grandfather said, "Mikhail Mikhailovich would work, but not in English, and Ivan sounds too Russian."

"I'm glad you didn't use Dad's name," Liz said.

"We have a half-brother named Peter, and I didn't want to duplicate."

"Don't remind me!"

"Elizabeth," my grandmother admonished, "be kind."

Liz rolled her eyes, exactly as she had as a teenager, despite being almost twenty-four. Even so, she had become a wonderful young woman despite all the challenges life had thrown her way as a teenager. And that made me wonder how things would develop with my children. My teen years had been, in a word, boring, pretty much the opposite of Liz, despite being raised in the same house by the same parents and attending the same school and the same church.

Elaine, whose experience in many ways mirrored my sister's, had matured significantly in the two years I'd known her, was a straight-A student, and was dating a Senior of whom my mom and Stefan both approved. At eighteen, I would have been very skittish about dating a girl with a two-year-old baby, but my mom said John, the young man, doted on April and was polite and respectful.

Thinking about Elaine and April made me think about April Nash and her daughter, Chastity. I wondered how they, along with April's husband Rob Peters and their son Richie, were doing, but I'd basically lost touch with them right around the time she'd married. I only knew about her son through my mom, so I decided to ask if she knew.

"Mom," I said, "do you know how April and Chastity are doing?"

"No, though I heard that they're moving to Chicago."

"Who's that?" Kris asked.

"My girlfriend from Senior year of High School," I replied. "Not long after we broke up, she found herself in the family way. That was my first experience holding a baby or seeing a baby nurse, and it had a profound effect on me, even though Chastity wasn't my daughter."

"I find it hilarious that April had a baby out of wedlock and named her 'Chastity'!" Liz opined.

"Perhaps a goal rather than a statement," my uncle suggested.

"Obviously!" Liz smirked.

"Elizabeth..." my grandmother admonished again.

I found it very interesting that my mom kept quiet and my grandmother was the one gently reprimanding Liz. I wondered if it was an intentional strategy or simply my grandmother wanting Liz to behave properly during family gatherings.

"How do you like being a doctor in the ER?" my uncle's wife, Caroline, asked.

"It's my natural element," I said. "One of my colleagues described working in the Emergency Department as insane, and my comment was that I fit right in!"

"Ain't THAT the truth!" Liz smirked.

"Watch it, Lizard Breath!" I warned playfully.

"Hey, you admitted it, Mikey!"

"You two sound like you did when you were pre-teens!" Mom said, shaking her head. "Not like a doctor and the co-owner of a successful business!"

"Brothers and sisters never really grow up with regard to each other," Caroline said. "I've heard Alex and Rachel do the same thing!"

"AHA!" Liz exclaimed. "I knew it!"

Everyone laughed.

"Gee, thanks, Caroline," Mom said sarcastically.

"I believe she's simply doing what sisters-in-law do naturally," I chuckled.

"You love me anyway!" Lyudmila declared. "And if you don't, Rachel does!"

"That's what worries me," I chuckled.

"Love Papa! Love Mama! Love Lyuda!" Rachel declared.

"And Abby?" I asked.

"I love Abby mostest!" Rachel declared happily.

"Wow, Mikey, dissed by your own daughter!"

"Just wait, Lizard Breath! You have a son! I can't wait to have a man-to-man talk with him when he's about fourteen!"

"Oh, God," Liz groaned. "No!"

"I do believe you asked for it, Liz," Paul smirked.

"So this is intergenerational?" Stefan asked.

Mom and I exchanged looks and simultaneously said, "Yes!" which caused everyone to laugh.

We finished eating with a minimum of teasing, then after Kris and I helped my grandmother with the dishes, everyone gathered in the living room to open gifts. Once we'd done that, we had pie and coffee, and then, because I had to be up early on Christmas morning, Kris, Rachel, and I left to head home.

"Does my sister really bother you?" Kris asked once we were on Route 50 heading east.

"No. But I know it makes her happy when I respond, and I can think of a lot of things worse than my daughter being bilingual in an actually useful language."

"You don't think Russian will be useful given the changes in Europe?"

"English and French are far more important, and outside the Eastern Bloc, there are very few Russian speakers. I mean, how many people under forty at the Cathedral speak Russian?"

"You, my sister, and me, plus a few others."

"And there are plenty who speak French, German, or Spanish. German is probably the most prevalent, then French, then Spanish, but Spanish is becoming more and more common."

"If Lyuda does start to actually bother you, let me know, and I'll ask her to back off."

"It's fine," I said. "She's just practicing for when she starts dating in about a year!"

Kris laughed, "Don't repeat this, but she has a boy she's seeing, though my parents don't know it."

"I'm not surprised, given she's fifteen. Personally, I think that's the age when it's appropriate to go on dates, but I totally understand sixteen, so long as that permits going to school functions like dances from age twelve or so."

"Fifteen is the right age," Kris confirmed. "Of course, we may change our mind in about twelve years!"

I chuckled, "The Tsarina and her best friend are going to be quite the duo!"

"Love Abby!" Rachel giggled.

"We're so dead," I said quietly.

"I know," Kris agreed with a smirk.

December 25, 1989, Feast of the Nativity, McKinley, Ohio

"Merry f-ing Christmas!" Isabella Mastriano said when I walked into the ED on Monday morning.

"What time did you come on?"

"4:00pm yesterday, and I'm on until 4:00pm today. Being the newest Attending stinks!"

"You'll have at least some seniority in July, as will I."

"This is not a complaint, just an observation — you get better shifts than any PGY1."

"I'm also different from every other PGY1 at the hospital. These red scrubs aren't just to make me look good!"

"No kidding!" she smirked.

I laughed, "OK, I deserved that."

"Sexiest PGY1 in the hospital!" Kellie declared, walking up to us.

"Uh-huh," I chuckled. "It's the red scrubs."

"If you weren't married, I'd prove it!" she said, her eyes twinkling.

"You're a troublemaker, Nurse Martin!" I declared.

"Of course! It's in my job description!"

I laughed, "Is that the 'other duties as required' clause?"

"Of course!"

"Morning, Mike!" Paul Lincoln said, coming up to me. "Only thing on the board is a rule-out MI in 2. Jenny and Kelly are with him, waiting on cardiology. Slightly elevated enzymes and T-wave inversion."

"Symmetric or biphasic?" I asked.

"Beyond my skill level! That's why I called for the cardiologist!"

"OK. I have it. Thanks. Merry Christmas."

"Merry Christmas. Doctor Mastriano, I'm out!"

"Merry Christmas, Paul. Have a good day."

He left, and I excused myself, asking Kellie to come with me to Trauma 2. I stopped to review the chart, then went into the room.

"Good morning, Mr. Crosby," I said. "I'm Doctor Mike."

"Hi, Doc. You the heart doctor?"

"No. I'm a trauma surgeon. I'm taking over for Doctor Lincoln so he can go home to his family. How are you feeling?"

"Like somebody put a hod full of mortar on my chest."

"Bricklayer?"

"How did you know?"

"Who, who was not a bricklayer, would know what a 'hod' is?" I asked.

He laughed, "You, obviously!"

"True! Jenny, run a strip for me, please."

She pressed the appropriate buttons on the EKG and, seven seconds later, handed me a strip. The inverted T-wave was symmetric, and unfortunately for the patient, it was on leads V₂ and V₃, which indicated a significant increase in mortality. I had just finished examining the strip when Patrick Shore came into the room with a female student.

"Merry Christmas, Mike. What do we have?"

"Merry Christmas, Pat. William Crosby, fifty-one; presented with chest pains. History of unstable angina; tachy at 110; BP 140/80; elevated cardiac enzymes; 3mm symmetrically inverted T-waves on V₂ and V₃, indicative of Wellens' syndrome. I believe he's a candidate for angioplasty for stenosis of the left anterior descending coronary artery."

"I could have stayed in bed!" he declared. "You or Paul?"

"Me."

"No surprise. Mr. Crosby, let me examine you, please. I'll confirm Doctor Mike's diagnosis, and we'll very likely take you up for an emergency angioplasty to correct a narrowed coronary artery."

"All that from that strip of paper?" he asked.

"EKGs are extremely sensitive," Pat said to Mr. Crosby.

"How bad is it?"

"Let me examine you first, OK?"