Chapter 71: Developments

January 1, 1990, Circleville, Ohio

"Happy anniversary!" I said to Kris when I arrived home on Monday evening.

"Happy anniversary!" Kris replied, giving me a hug and a kiss.

"«Joyeux anniversaire, papa!»" Rachel giggled. ("Happy Anniversary, Papa!")

"Your Aunt Lyudmila is a menace!" I declared. "But thank you."

The three of us went into the great room, where Kris and I exchanged cards and small gifts. Once we finished, I read to Rachel, the three of us said our evening prayers, then Kris and I put Rachel to bed.

"Would my husband like to make love to his wife on their anniversary?" Kris asked when we left Rachel's room.

"Indeed he would!" I agreed.

January 7, 1990, Monastery of the Dormition of the Mother of God, Rives Junction, Michigan

The week following New Year's Day had been fairly typical, both in the hospital and at home. On Saturday, after dinner, I'd left Rachel and Kris at home and driven to the monastery so that I could spend time with Father Roman. I'd attended Vespers the previous evening, then Matins and the Divine Liturgy, before having a light lunch. With all of that out of the way, Father Roman and I met.

"What's on your heart today?" Father Roman asked.

"Several things," I replied. "My dad, my prison ministry, my family, and my work."

Father Roman laughed softly, "I think 'my life' would have been a more succinct way of saying that. Is there a specific place you want to begin?"

"Probably with the thing that weighs heaviest on me, and that's the simple fact I don't have enough time for Kris and Rachel. It's not something that is a surprise, but it's been weighing on me recently."

"If I recall correctly, there is little to nothing you can do about that in the short term."

"In terms of hours I spend at the hospital, that's absolutely true. On the plus side, I get to sleep at home every night. The downside is that's basically what I do. I arrive home from the hospital, read to Rachel, we say our evening prayers, we put her to bed, and then Kris and I usually go right to bed."

"Given what you've confessed about your past behavior and the stress you're under, I have to ask if you and Kris are fulfilling your marital agreement."

I laughed softly, "The impending arrival of a second little bundle of joy indicates we are."

"Pardon me for being flippant, but that accounts for one encounter. And yes, I know enough about the physiology to know that it often takes time to conceive."

"I'd say that taking everything into account, we're physically intimate to sufficiently slake the desire. Emotional fulfillment is a very different story."

"Something those who engage in promiscuous sex usually discover, much to their chagrin."

"Point taken," I replied.

"Setting aside physical intimacy, are you and Kris intimate partners?"

"Honestly? Not the way we should be. I'm more intimate with my colleagues, especially Clarissa, whom we've discussed, along with Doctor Greg Casper and Doctor Shelly Lindsay."

"I infer from things you've said that's pretty common for new doctors."

I nodded, "Yes. I spend far more time with them than I do Kris, if you discount sleeping in the same bed. In some ways, I have more in common with them than I do Kris, though Kris and I both come from the same general spiritual background and have similar goals and desires."

"You may decline to answer this next question if you wish, but how would you differentiate Kris and Elizaveta?"

"I'll answer," I said. "One of the things I realized during my period of mourning was that despite my desire to find a mom for Rachel, I didn't want someone who was a, well, interchangeable part for Elizaveta. That struck me as a disaster waiting to happen, as that's not possible."

"A good insight," Father Roman confirmed. "I was reluctant to ask you to compare them, but I felt you could answer in a way that didn't feel as if you were disrespecting Elizaveta."

"The two women are very different," I said. "But each was exactly what I needed at the time I became involved with them. Elizaveta had no goals other than being a good wife, a good mother, and helping me be successful as a medical student and doctor. Kris, on the other hand, is very much focused on her career and being an independent woman who does not depend on a husband or children to validate her."

"What would you say the key differences are?"

"Interestingly, both were very mature when I met them, though their maturity was different. For both of them, it was the strong conviction that each of them could do the things they each felt were important. For Elizaveta, it was, as she once put it — cooking, baking, cleaning, doing laundry, sewing, and caring for babies. She did add that despite lack of experience, she could figure out how to make babies as well."

Father Roman laughed softly, "Teenagers have never had a problem figuring that out! Go on."

"For Kris, that list, minus the 'figuring out how to make babies', was basically anathema. For her, it was education, career, and independence. All the things on Elizaveta's list are, in Kris' mind, shared responsibilities. I actually agree with her, but Elizaveta was as stubborn as I am. She believed that those things were for women to do, not men. Of course, given my schedule, Elizaveta got her way while Kris had to accommodate her views to the reality of being married to a medical student and, later, a new doctor."

"I'm curious why you say that after Elizaveta's repose, you felt you didn't need the things she provided. It seems to me that's exactly what you need."

"In the very short term, yes; in the long term, no. And honestly, I could hire someone to do most of those things if need be."

"Yes, you could. But you also could have married a traditional girl, at least according to what you've said to me. You didn't."

"I think one key differentiator is that Elizaveta was extremely mature, even if she was a bit naïve. And it was naïveté that concerned me about some of the other girls I considered. Kris was anything but naïve and had a very European outlook, which more closely matches mine, though I could do without the occasional harangues from the 'Political Officer' facet of her personality!"

Father Roman smiled, "You did say she was strident in her socialist beliefs."

"Absolutely. The thing is, I believe they are a reflection of the Christian life, with the exception that they are imposed rather than voluntary. I've pointed out to her that the story of Ananias and Sapphira makes it clear that 'having all things in common' was a voluntary act. Kris and I have more or less agreed to disagree on politics."

"Are you expressing discomfort with your relationship? Or regret?"

I shook my head, "My only regret is not having enough time with Kris to develop a truly deep relationship. I had that with Elizaveta because, despite spending so much time studying, we had time to be a couple and time for ourselves. Kris was, to use a colloquialism, 'instant family, just add ring'."

"Which, I think, is the source of your, well, unease, I think is the right word. Is that creating a rift or separation?"

"No more than what I would expect from my life outside of the hospital, which consists basically of church, meals, and sleeping. Kris was aware of that before we married."

"Do you think she feels the same way?"

"Actually, no, or at least not to the same extent. I'm the needy one in the relationship."

"Have you told her how you feel?"

"No, because there is literally nothing we can do about it at the moment. Things will change a bit in July, as I'll have more seniority and thus can work a schedule more to my liking. And in eighteen months, I'll be on a normal surgical service, which, because of the training I need, means scheduled surgeries."

"What does that mean, practically?"

"More than likely twelve hours each weekday, and on-call on the weekends. But I won't know for sure until June 1991."

"I don't know that I can offer anything other than a suggestion that you have this same conversation with Kris. Send Rachel to her grandparents' or a friend's house for a Sunday afternoon so you can have a deep conversation. And talk, Michael."

I chuckled, "What? You think we might use it for other activities?"

"Given your schedule, the temptation will be there!"

"Point taken!"

"Let's speak about your interior life. Are you keeping your prayer rule?"

"Yes. And praying for each patient, silently, of course."

"Have you had any further instances where you've 'gone off' on someone, as you've called it?"

"Not since before the last time we spoke, but then again, there hasn't been a reason to do so. The sources of the problems have basically been eliminated. The hospital and medical school changed the rules, there's a new Medical Director, and there are new guidelines about assignments. All of them were resolved in a way that fit with how I felt they should be resolved."

"Because you pitched a fit or in spite of it?"

"Both," I replied. "But except for direct application to healing the sick in the Emergency Department, I do not subscribe to the theory that the ends justify the means."

"How do you mean that with regard to caring for a patient?"

"That I might inflict pain or do something to save a life that inflicts some kind of lifelong disability on someone. While it's not my specialty, consider oncology, where you, in effect, poison a patient to the point where they almost die in order to cure the cancer, or more directly applicable to me, cut into healthy tissue to get to something that needs surgical repair, or relief only a surgeon is authorized to provide."

"Examples?"

"Chest tubes, central lines, and other invasive procedures we do during a trauma, sometimes without anesthetic because we either can't wait or can't use because of depressed heart rate or breathing."

"OK, I see your point, but what you're doing isn't unethical or immoral, which is the implication of the 'ends justify the means' as it's usually meant."

"I am nothing if not pedantic," I chuckled.

"Something that will serve you well as a physician and father but not so well as a husband or chaplain."

"Are you suggesting my darling daughter will parse every word I say to look for loopholes or advantages?"

"If she's like every other pre-teen or teen on the planet!"

I chuckled, "And she's going to have a cohort in crime in her best friend, Abigail."

"A girl from church?"

"No, the daughter of a professor at Taft named Milena, whom I dated briefly when I was an undergrad and she was a graduate student. The professor's mom, also a professor, taught me to play guitar. Milena and her husband Joel are good friends, and Rachel and Abigail are inseparable, except under duress. Rachel has friends at church and at daycare, but Abigail is her absolute best friend."

"She and Kris attend church even when you cannot, correct?"

"Yes. And she'll go to Sunday School once she turns five."

"And everything is progressing properly with Kris' pregnancy?"

"Yes. She's due in late June, so thankfully, she'll be done with classes before things become too uncomfortable, at least based on what other pregnant women have said, including Elizaveta."

"Is there anything weighing on your heart that you feel the need to expressly confess?"

"Impatience," I replied.

"Because your job basically trains you to act and not wait."

"That's true. It's about acting quickly but not precipitously. As strange as it sounds, call it cautiously aggressive. As I'm sure you've deduced, my impatience is with process and procedure."

"No, really?" Father Roman asked with a grin.

"My reputation precedes me," I chuckled. "On a serious note, I am not pleased with my relationship with my dad."

"Is there a conflict?"

"I think I hit the nail on the head when I said he has never truly understood me or my motivations. I fix the blame on what he was taught growing up — that what we practice is works-righteousness. He cannot help but see the world through a TULIP-colored lens."

"Nice turn of phrase! Let me ask you this — could you ever see the world differently from your Orthodox faith?"

"I can't imagine what might have to happen to cause that, and I don't believe I want to. That's not to say that I don't have my doubts at times, and on occasion want to shake my fist at God, but in the end, I see the world from an Orthodox perspective and cannot do otherwise."

"Then you understand your father's struggle. You know the answer, too."

I nodded, "To do as Saint Seraphim of Sarov taught — 'Acquire the Spirit of Peace and a thousand souls around you will be saved'. This is going to sound like whining, but it's difficult to do that with my dad."

"And gaining your MD was easy? Or any other worthwhile thing, including caring for your wife or raising a daughter, especially as a single father?"

"Well, no. I suppose I'm simply frustrated in that he cannot understand that I refuse to take sides in family disputes if taking sides means sundering a relationship. It happened with my little sister's troubles and again with my parents' divorce. I love all of them, so how could I possibly take sides? That doesn't mean I condone sinful behavior, but I don't think my parents' divorce is as one-sided as my mom and grandparents believe it is."

"Except in the case of physical abuse, it almost never is. I've counseled married couples, and invariably, there is more than enough blame to spread around. The key is identifying the areas of discord and addressing them, similar to how you practice medicine — perform the emergency repairs, then time can be taken to heal the patient holistically."

"What do you do when you can't even communicate on a basic level with someone because their mind is already made up?"

"Physician, heal thyself?" Father Roman said with an arched eyebrow.

"I do have that trait, don't I? And I suppose I came by it honestly from two parents who do the same thing."

"It's human nature, Michael. I'm sure you know the concept of 'cognitive dissonance'?"

"Yes. Ignoring valid data points which don't conform to your belief. In medical school, they compared it to pilots who crash aircraft due to 'target fixation' — you're so focused on one thing that you ignore all other inputs until that split second before the plane hits the ground. Or, in the case of a patient, so focused on one element that they die because you didn't see the warning signs."

"I think you know the answer."

"Remove the log from my own eye..."

"Yes. Is there anything else on your heart?"

"No."

"Then let me say the prayers of absolution, and you can be on your way home to your wife and daughter."

January 8, 1990, McKinley, Ohio

"Mike?" Nate said when I walked out of Exam 2 late on Monday morning. "Krista Sandberg is in the waiting room and would like to speak to you. If you don't want to speak to her, I'll have Jamal send her away."

I considered and then said, "No, I'll speak to her. Do you know where Kellie is?"

"She was assisting Doctor Gibbs in Exam 4."

"Thanks."

I went to Exam 4 and asked Doctor Gibbs if I could borrow Kellie for ten minutes, and she agreed.

"What do you need?" Kellie asked when we were out of the exam room.

"I have a LONG list, but right now, Krista wants to speak to me, and I need a witness.

"Are you sure you should?"

"No, but I do want to give her advice, so I'll take the chance. That's why I want you."

"I must be losing it if that's all you want!" Kellie teased.

"Go ask Kris for permission. I'll say nice things at your memorial service!"

Kellie laughed, "No married men for me, not that the sentiment isn't shared. Under different circumstances..."

I smiled and nodded, "If you'd bring Krista to the consultation room, then stay with us, I think that would work best."

"Against my better judgment, but OK."

I went to the consultation room, and a minute later, Krista walked in with Kellie right behind her.

"Hi," I said. "Kellie is going to stay."

Krista nodded, "I understand."

"What can I do for you?"

"I was hoping you'd give me advice on what to do."

"I'm going to be blunt and direct," I said. "OK?"

"Yes."

"You are unsuited to be a doctor," I said firmly. "You simply do not have the clinical skills, personality, or aptitude to practice medicine. You should not, under any circumstances, think about applying to a medical school in the future. That said, you had top marks in your coursework, including anatomy lab, and you scored well on the standardized tests. Based on that, I believe your best option is to use the settlement money to earn a PhD and become a researcher. You'll be VERY good at it."

"You weren't kidding when you said 'blunt and direct'," Krista replied.

"Your evaluation for your emergency medicine rotation would have been harsh and would have been part of your permanent record. Whether you agree with that or not, that is the direction you were headed, despite my best efforts to prevent it. You should thank your lucky stars the medical school simply allowed you to withdraw, even after the stunt you pulled. You have my advice; I strongly encourage you to follow it."

"Jesus," she said in a very low voice, just above a whisper.

"Krista, you're fortunate Mike will even talk to you," Kellie said. "You asked for his advice, and he's given it. I think it's good, and trust me, you were never cut out to be a physician. Go into research. It suits you. Caring for patients does not. I'd also suggest you see a counselor and get your head on straight."

"I suppose I deserved all of that," Krista said.

"Honestly," I said, "go to graduate school, earn your PhD, and discover new medicines or new equipment or new procedures. You won't have direct patient interaction, but you'll participate in their treatment at arm's length. Your other option is to simply abandon science and do something else. I'd discourage that because you can achieve a lot of good as a researcher."

"My attorney said I could go back to medical school in two years."