Chapter 10: Dutch Treat

April 2, 1990, McKinley, Ohio

I suppressed a sigh when I walked into the ED just before 5:00am on Monday morning. Two things jumped out at me immediately. First, a nameplate reading Doctor R. 'Dutch' Wernher, Chief of Emergency Medicine, had replaced what had been a placard indicating it was the Attendings' office. Second, a placard on what had been the lounge door read Attendings and Residents Only.

I recalled that Doctor Wernher had been in the Navy, and it appeared he had decided to create the equivalent of an Officers' Club in addition to commandeering the only office. I walked over to the nurses' station, where Ellie and two other nurses were standing.

"Do I even want to know?" I asked quietly.

"No," she replied.

"No nurses or medical students in the lounge?"

"No. Nurses are to be with patients or at the nurses' station. Our breaks are scheduled and have to be taken in the cafeteria."

"When does the strike begin?" I asked.

"You're not far off, Mike. But be very careful. Rumor has it he spent two hours bending Cutter's ear about you on Friday."

"Wonderful. Where do the medical students hang out when they aren't busy?"

"Chairs by the ambulance bay."

"OK. Nobody is going off shift, so I'll take the first chart in the rack."

"Mike," she said quietly, "you aren't on the ED rotation."

"What the...?" I asked.

"I don't know. Doctor Wernher will be here momentarily; you should see him."

"This is going to be bad," I said.

"For everyone," Ellie confirmed.

I considered going to see Owen Roth but decided it might anger Doctor Wernher, so I asked Ellie to let me know when he arrived. I went into the lounge, where I saw Kylie Baxter and Antonio Gómez.

"Hi, Mike," Kylie Baxter said. "Welcome to Hell."

"I got that idea. I'm not on the ED rotation even though I'm assigned here."

"And without Clarissa here, we're shorthanded if you don't see patients."

"I tried, but Ellie told me not to take a chart."

"Only doctors on the schedule can see patients. In addition to that, the nurses are pissed."

"I got that idea as well."

"Doctor Loucks?" a doctor who appeared to be about fifty said from the door to the lounge.

"That's me," I said. "I go by Doctor Mike. You must be Doctor Wernher."

"My office, please."

Kylie had her back to the door so she could roll her eyes without being seen. I followed Doctor Wernher into his office. Judging his personality by the little I knew, I stood straight, not quite at attention, and waited for him to indicate I should sit.

"Shut the hatch and grab a seat," he said.

That one phrase telegraphed one of two possible scenarios — he was through and through military, which did not make sense given he'd been out of the service for nearly twenty years; or it was an affectation to achieve some purpose, which I felt was more likely the case.

I shut the door, sat down, and waited for him to speak. I wasn't intimidated by silence, and I was positive I could sit quietly and look him in the eye longer than he could do the same with me. As the seconds dragged on, the silence became more and more obvious, but I simply recited the Jesus Prayer silently and waited him out. I absolutely wasn't going to fight with him, but I also wasn't going to be intimidated by him.

It was about seventy seconds before he finally spoke.

"You're the one with the temerity to design their own Residency program."

"While it's true I lobbied for it here at Moore Memorial, the program was designed and developed by Doctor Albert Barton while he was at Indiana University and implemented at University of Chicago Hospital where he's Chief of Emergency Medicine."

"You know Al Barton?"

"He arranged for a scholarship for me at Indiana University, but I elected to attend McKinley Medical School. He also strongly recruited me for the Match, but I elected to Match here."

"MCAT and MLE scores?"

"98th percentile MCAT; 99th percentile MLE Step 1; 99th percentile MLE Step 2."

"You had that MCAT and didn't go to Stanford, Yale, or Harvard?"

"I had no desire to do anything other than serve my community," I replied. "There were personal considerations as well."

He shook his head in obvious disapproval. I really wanted to ask what HE was doing at Moore Memorial training students from McKinley Medical School if he thought so little of it, but I held my tongue.

"I'm sure you observed some of the obvious changes I've implemented to bring order to the chaos that preceded my arrival."

"I did," I replied, electing to keep my answers terse.

"Nobody takes shifts in my ED unless they're on my service. And nobody works in my ED without wearing ED scrubs. If you want shifts here, you're ED staff, and you wear blue scrubs. Otherwise, you're surgical staff and are limited to consults in the ED. My staff is also clean-shaven, and men wear their hair cut short. And we do not use informal titles."

Given my beard and ponytail were religious, I knew I was legally entitled to an accommodation, but there was no possible way to raise that at the moment without starting an unproductive argument.

"It is your ED," I agreed. "Have you spoken to Owen Roth?"

"I've spoken to John Cutter, and I was given a free hand in the ED. There is some debate about your status, but I expect to resolve that today. We can solve it right now, if you want to be an emergency medicine specialist. I have an open Residency spot."

"My Match was for trauma surgery," I replied. "That is what I want to do."

"Then go up to surgery, and we'll call for consults when we need you."

"Yes, Doctor," I said, standing up. "May I be dismissed?"

"Dismissed."

I left the office and walked past Ellie, exchanging a look but saying nothing, and headed for the elevators. I rode up to the surgical floor, stepped out, checked the board, and walked to the scrub room for OR3. I put on a mask and a generic red cap, then stepped into the OR proper.

"Hi, Mike," Doctor Roth said, looking up. "I take it you talked to Dutch Wernher."

"Yes."

"And he kicked you out of the ED?"

"Only after suggesting I move to his service."

"I was afraid of that. Did you get into it with him?"

"No. I was the model of an obedient Able Seaman."

"Good. We'll fix this. For now, handle consults. You don't have med students, but you can use Shelly's Fourth Year. I do need you to do one thing for me."

"What's that?"

"Call Tim Baker and tell him 'Dutch treat'."

"May I ask?"

"He'll pull his Resident. I mean, if we're going to be territorial, we're going to be territorial. Baker is onside. So is Getty. I'll see you after I get out of this guy's guts."

"Thanks," I said.

I went to the lounge and dialed Doctor Baker's direct number and was happy that he answered.

"Doctor Baker, this is Mike Loucks. Doctor Roth said, 'Dutch treat'."

"God damn it!" he growled. "OK. Tell Owen I'll do it right now."

"Will do."

"And Mike, let us fight; you stay out of it."

"That was my plan."

"Good."

He hung up, and I wondered how Doctor Wernher would react to losing another Resident, as once Antonio Gómez was recalled, the ED would be short three doctors. I was reasonably certain how things would turn out in the end, but it could be very ugly in the interim. And it would suck because I would mostly be twiddling my thumbs.

I left the lounge and went to the nurses' station to find out who Shelly's students were.

"Aren't you supposed to be in the ED?" Carol asked.

"Don't ask," I replied. "Who's assigned to Shelly Lindsay?"

"Nick Duran and Penny Lewis. Nick is the Fourth Year."

"Thanks. I have my pager. I'm going to Medicine. If the ED needs a consult, page me, please, and send Nick down to meet me."

"Will do."

I left the surgical ward and made my way to Internal Medicine, where I found Clarissa speaking with Mark Perlman, one of the Attendings. She saw me and held up a finger to let me know she'd be a minute. I ducked into the lounge and got a cup of coffee, tossing a quarter in the jar as I wasn't part of their coffee club. A minute later, Clarissa came in.

"Mark Perlman just told me that Antonio was recalled. What happened?"

"Wernher is trying to remake the entire hospital to his liking. Take a walk in the ED and check out what he's done."

"It sounds like I might need an armed escort. What happened?"

"Well, the Attendings' office is now Dutch Wernher's office and the lounge has a sign that limits entrance to Attendings and Residents — no nurses or medical students. And that's just the start."

"What the..."

"I was also told in no uncertain terms I can't work in the ED unless I wear blue scrubs, shave my beard, and cut my hair."

"Bullshit!"

"And yet, here I am, waiting on consults rather than working my scheduled ED shift. The nurses are ready to strike because they have to be with a patient or at the nurses' station except for scheduled authorized breaks, and medical students are relegated to chairs by the ambulance bay. Roth, Baker, and Getty are all pissed, and that's why Antonio is being pulled. He's not ED staff, so..."