Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 13: I Believe It's Called a 'Come to Jesus' Meeting
April 8, 1990, Palm Sunday, Circleville, Ohio
"How did things go with Father Roman?" Kris asked when I arrived home on Sunday afternoon.
"I very much enjoyed the Palm Sunday services at the monastery," I replied, "but I took my usual beating on Saturday from Father Roman."
Kris laughed softly, "The only reason to visit a «старец» (staretz) is for a spiritual beating! If we didn't need the beating, we wouldn't need to visit the holy monk!" ("Spiritual Director")
"I tend to need more beatings than most!"
"I disagree — you're simply more aware of your interior life than most people. And you take the commands in the Beatitudes and David's Psalm as seriously as anyone I know."
"And I have many failings to discuss with Father Roman."
"One area where you absolutely have not failed is your devotion to Rachel, nor in your commitment to me."
"Failing in either of those areas would create my own personal Hell."
"What about a personal Heaven?" Kris asked with a twinkle in her eye. "It would be the last time because of Holy Week."
"What did you have in mind?" I asked with a grin.
Kris winked and carefully moved from the couch to the floor and ran her finger over my flaccid shaft. Her intention became exceedingly clear when she unzipped my slacks.
"What if Rachel wakes up from her nap and comes downstairs?" I asked as Kris unbuttoned the button of my slacks
"Then she'll see just how much Mama loves Papa!" Kris said lightly.
"I'm not sure our toddler needs to see that to know how much we love each other!"
"I can stop," Kris said, reaching into my briefs to grasp me.
"No," I whispered. "Don't stop."
Fifteen minutes later, after a very sexy blowjob, my wife tucked me back into my briefs, having had no interruption from our daughter. Kris moved to my lap, and we exchanged a soft French kiss. When we broke the kiss, she snuggled close and rested her head on my shoulder.
"You don't have to do that," I said.
"Of course not, but I want to," she replied. "I do it because I love you, because I know it feels good, and because I enjoy doing it. I can't imagine it's not similar to you enjoying using your mouth on my «minou». You've told me many times how much you enjoy it and like how I taste." ("pussy")
"I have," I admitted.
"And you have no qualms using your tongue even after we have made love, nor any about kissing me after I've sucked you."
"You know I will do anything you ask."
"And I will do anything you ask. Our bodies belong to each other and are, among other things, for giving pleasure to each other."
"And babies!" I declared, running my hand lightly over Kris' baby belly.
"And babies!" Kris agreed happily.
"Papa!" Rachel exclaimed, carefully coming down the stairs.
"Hi, Rachel!" I said. "Come sit with Mama and Papa!"
She came over, and Kris and I shifted a bit so that Rachel could join us despite my wife's ever-growing baby belly.
"What did you do while Papa was at the monastery?" I asked.
"Shop, played with Abi, played with «Tante» Lyuda, and church. Papa play guitar?" ("Aunt")
"Papa can play guitar if it's OK with Mama."
"Mama?" Rachel asked.
"Yes," Kris replied. "Let's get you a snack; Papa can change clothes and then play his guitar."
Kris got up from my lap and took Rachel to the kitchen. I zipped my slacks, then got up and went upstairs to change. Ten minutes later, all three of us were back in the great room, and I had my guitar. After playing for about an hour, we had dinner, then headed to Saint Michael for the first Bridegroom Service.
April 9, 1990, Holy Monday, McKinley, Ohio
Doctor Roth asked to see me as soon as I arrived at the hospital on Monday morning.
"I've heard some disturbing things," he said.
"About?" I asked.
"You," Doctor Roth replied. "I've heard you and Doctor Saunders are planning to leave for Residencies in Chicago. But I also heard that you asked about switching to a pure emergency medicine Residency here."
"Do you trust the nurses?"
"Yes, of course, but what does that have to do with those rumors? Well, the second one isn't a rumor, per se, because I heard it straight from Mrs. Cartwright."
"I can't help it if rumors are spreading, and did Mrs. Cartwright tell you the context?"
"No."
I smiled, "Context is everything, Owen."
"You're not answering me any more directly than you answered Shelly. You're usually forthright, and you aren't now, which is giving me heartburn. And not just me — Ron Getty, Carl Strong, Tim Baker, and others."
"All I can say is I didn't start the rumors, and Mrs. Cartwright appears to have left out key context. I'll ask you the same question I asked Shelly — in my position, what would you do?"
"And I suppose the answer I have to give is the same one she did – please do not act precipitously."
"You know that's not me."
"And that's what has me concerned. Things will work out here, Mike."
"Can you actually guarantee that? You and I both know I'm not cut out to be a pure surgeon, and I'm also constitutionally incapable of simply sitting around for hours at a time when I could be treating patients. For better or worse, I'm wired for emergency medicine, and this last week has been pure torture. Not to mention it basically violates my Residency contract."
"So you are considering leaving here," Doctor Roth said. "Violation of your contract is the one way you can leave on your own with no recriminations and no black marks."
"I'm considering all options," I replied.
"Please don't make any final decisions until we have time to work on this."
"As I said, I'm considering all options, and I won't act without due consideration."
"I suppose that's all I can ask at this point. Would putting you on a regular surgical rotation and splitting ED consults amongst the other Residents help?"
"Somewhat, but at what expense? Upsetting the rest of the team? Creating more dissension in the ranks?"
"Give me a day or two to discuss this with Bob, Nelson, Vince, and Shelly. OK?"
"Yes, of course."
"Thanks, Mike. You know this is not what any of us wanted."
"Well, somebody wants it, or it would have already been undone, and we wouldn't be facing a strike by the nurses because their working conditions were unilaterally changed without consultation as required by their contract."
"The Hospital will get an injunction against what amounts to a wildcat strike."
"Oh, brilliant," I sighed, shaking my head. "Forcing nurses to work against their will is not conducive to good patient care. And that will make them even more steadfast in their demands for their new contract. It's a war the hospital cannot win in the long run, and one in which the patients are the collateral damage."
"I didn't say I agreed; I simply noted what would happen; it's happened in other hospitals around the country. I'm sorry to cut this short, but I need to prep for surgery."
"I understand."
"On a positive note, baseball starts today. Finally."
"That is something to be happy about," I agreed.
I left his office and went to the lounge to wait for an ED consult. It was nearly 8:00am before I was paged. I found Nick, who was in a sour mood, which I suspected stemmed from my conversation with Shelly on Friday. If he raised the topic, I'd discuss it with him, but I wasn't going to ask.
"Mike Loucks, Surgery," I announced as I walked into Trauma 3 with Nick in tow.
"Morning, Mike," Kayla Billings said. "Larry Peters; fifty-one; suspected cardiac tamponade; BP 80/50; tachy at 120; shortness of breath; PO₂ 92% on five litres by mask; patient is suffering from acute kidney failure and awaiting transplant."
"Good morning, Mr. Peters," I said. "I'm Doctor Mike, a surgeon. I'd like to examine you, please."
"Sure, Doc," came the muffled response.
I first checked his neck and found distended jugular veins, and when I listened to his heart, I heard muffled sounds. Those two signs, in addition to hypotension, were called Beck's triad and were strong indicators of tamponade.
"Nick, I need an ultrasound so I can confirm, please."
Nick left, and suddenly, the monitor changed.
"No pulse!" Kayla declared. "Electrical activity indicates PEA!"
"That's definitive, and he can't wait," I declared. "Wendy, cardiac needle with a lead and an alligator clip to me, please."
She moved quickly, and I performed a blind pericardiocentesis and filled the syringe, and the patient's pulse returned.
"He's going to need a catheter," I said. "There's still fluid in his pericardium. We need to get him on dialysis."
I inserted the catheter with Kayla's assistance, and the patient's blood pressure came up ten points, and his pulse slowed to 102. That meant he was stable enough for emergency dialysis, and Kayla had her student make those arrangements.
"Thanks for the assist, Mike," Kayla said.
"You're welcome."
I left the trauma room, and Ellie stopped me.
"Doctor Wernher would like to speak to you," she said quietly. "He's in his office."
I nodded and turned to Nick, "Head back upstairs."
He acknowledged me, and I went to Doctor Wernher's office, stopping at the open door and knocking on it.
"You wanted to see me?" I said when he looked up.
"Come in, Doctor, and have a seat."
I walked in, closed the door, and sat down. Just like the first time, I waited for him to speak and nearly laughed when nothing was said for the first thirty seconds. I simply continued to look him in the eye and silently prayed the Jesus Prayer. He didn't let it go as long this time, speaking after about forty seconds.
"You've managed to turn the tables on me several times now. Friday afternoon was a nice judo move."
"Something for which I was taken to task by my spiritual advisor."
"Whatever for? It was calm, cool, rational, direct, and effective."
"Before I answer, how much do you know about me, Doctor?"
"I read your clinical evaluations and your medical school transcript. Why?"
"May I speak freely?"
"Go ahead."
"If all you know about me is from my evaluations and my transcript, you have a very incomplete and very inaccurate picture of me. Do you know which church I attend?"
"I don't give a tinker's damn about which church you attend! It's not particularly relevant to anything other than you possibly needing Holy Days off, if they can be accommodated."
"On the contrary," I countered. "I'm sure you heard from Mrs. Cartwright."
"Yes. Another area you outmaneuvered me, though that does raise a question."
"Yes, it does. But more importantly, is that my beard and ponytail are religious and are the sign of a clergyman."
"You're clergy?"
"If you didn't know that, at least in a general way, then please explain why you think you can understand me at even the most basic level?"
"I don't need to understand you. I need to know if you're a good doctor. Anything outside the hospital is your business and completely irrelevant to your work here."
"May I speak bluntly? And I do mean bluntly."
"Go ahead."
"You showed up and, without having done even the most basic homework, picked a fight with me. That's foolish in the extreme, no matter who you are or who I am. It's akin to showing up on a combat ship and picking a fight with a Chief who has been on that ship for the previous five years. That's Captain Queeg territory, Doctor. What's next? An investigation of missing strawberries from the lounge refrigerator?"
"You're out of line, Doctor!" Doctor Wernher growled.
"Not as far out of line as you are, Doctor," I countered calmly. "I am absolutely positive I know your goal, and you went about it completely the wrong way. In fact, you went about it in a way that will ensure failure. A different approach was called for, and, to be frank, can still work."
"Explain to me how a PGY1 thinks he knows my goals, please."
"First, I checked on your background — UC Berkeley; Emory Medical School; Residency as a commissioned officer in the US Navy at Bethesda Naval Hospital, then two years at Cam Ranh Bay in Vietnam; hired at Rush-Presbyterian in Chicago as an Attending in Internal Medicine; switched to emergency medicine in 1972; married, with three daughters. «N'est-ce pas»?" ("Right?")
"You did your homework," Doctor Wernher said. "Why French?"
"You would know if you had done your homework. May I continue?"
"At this point? Why not?"
"In just over a year, we'll be in the new ED and working towards Level I certification. That requires staffing the ED with specialists beyond emergency medicine. You want all those other specialists to be on your staff, not on their respective services. You picked the fight with me to force the issue now, rather than wait, on the theory that if you could move me to your service, you could claim all the specialists and thus avoid the potential problems of matrix management. How'd I do?"
"That is the gist of it," Doctor Wernher admitted.
"Don't you think, Doctor, that learning about me and enlisting me as an ally might have been a much better plan?"
"You were a vocal supporter of Doctor Gibbs."
"And I'll never cease to be, but I also know she's not able to return to duty at this point, and it could be months, maybe even a year or two, before she'll be cleared. I'm not irrational or impractical, Doctor."
"Spit it out, Doctor. What is it you want?"
"To be a forceful advocate for my patients and provide the best care I am able to provide."
"Besides the textbook answer?"
"I live the textbook answer, Doctor; something you would know if you had taken even ten minutes to talk to Ghost or Isabella in the ED, or Carl Strong, Shelly Lindsay, or Clarissa Saunders. Anyone here could have pointed you to them."
"Fine, you live the textbook answer. Now, what is it you want?"
"Restore things to the status quo ante, treat the nurses with respect, and we work together to make this the best Level I trauma center in the state. You might even achieve your ultimate goal of being Medical Director in the process. If you continue on your current path, I don't see that ever happening."
"I'll look weak if I do that."
"Fine, you'll look weak. Big deal! That will not matter in the long run. Handled correctly, you'll come out smelling like a rose. Confession is, as they say, good for the soul."
"So, what is your story?"
"I'm not the one to tell you. Call Loretta Gibbs and ask her. And while you're at it, ask her about everyone else in the ED. We are far more than our transcripts and evaluations."
"You have balls, that's for sure."
"I don't see how anyone can work in emergency medicine without them, well at least figuratively. There isn't a single shrinking violet out there. If you meant confronting you, well, you should have expected that, but again, you didn't do your homework. Anyway, put me back on the ED schedule, take the 'Officers Club' sign off the lounge, and let's work together rather than fight. So, how about it?"
"How do I know you aren't going to try to undermine me?"
"You don't. The only way to know that is to earn each other's trust. You don't trust me; I don't trust you. There, it's out in the open. Now, we can try to fix it, or this entire thing can spiral out of control, and we'll be lucky to get out of it alive."
"Red October?"
"Yes. I'm half Russian, and I always have a plan. I'm also half Dutch, so it's always logical and methodical. Call Loretta and go see her today. She's home, and her PT is right before lunch. Once you speak to her, I think you'll have a much better picture. It's what you should have done in the first place."
"You've made your point, Doctor."
"Then, if I'm dismissed, I'll go back up to the surgical lounge."
"Dismissed."
I got up, opened the door, then walked out. As I was leaving the ED, Kellie followed.
"It's my break," she said. "What was that about?"
"I believe it's called a 'Come to Jesus' meeting."
"He doubled down?"
"No, I invited him to come to Jesus or experience Hell. His call."
"And his response?"
"Call me if he signs out for a few hours for a meeting, please."
"Will do. Not going to give me a clue?"
"Not at this time. Just let me know if he leaves for a few hours, OK?"
"Will do. Have coffee with me?"
"Sure."
I joined her in the cafeteria, where I paid for both our coffees.
"How are things going otherwise?" I asked.
"I'm still seeing John, the lieutenant from Station 4."
I chuckled, "John Gage always struck out with nurses on Emergency. But all kidding aside, I hope it works out."
"John spent six years as a damage control specialist on the Enterprise before he joined the fire department about ten years ago."
"Think they'll ever let women serve on combat ships?"
"It'll happen, and probably in the next five years. Carriers are big enough to accommodate segregated female quarters. Other ships are more difficult, and subs are nigh on impossible, though you might make it work with boomers. Of course, in order to do that, Congress will have to repeal 10 USC 6015, which bans women in combat billets."
"I take it you'd have asked for sea duty?"
"In a heartbeat! I wanted to serve on a carrier, but the boys put up the 'No girls allowed' signs for their dumb club!"
I chuckled, "Calvin and Hobbes?"
"Yep!"
We finished our coffee quickly because Kellie had to return to the ED, and I headed up to the surgical lounge. I picked up a surgical journal, but my mind was really on the conversation with Doctor Wernher. I'd been blunt and impertinent, but I felt my heart had been in the right place because my goal really was to make peace, not just between him and me, but with the doctors and nurses who worked in the ED.
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