Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 2: Aftermath
February 22, 1990, McKinley, Ohio
On Thursday morning, when I arrived at the hospital, Nurse Nicole let me know that Doctor Roth wanted to see me. I decided to go straight to his office, wearing my tie and medical coat, and change afterwards.
"You wanted to see me?" I said to Doctor Roth from the door to his office.
"Come in, please, and shut the door."
I did as he asked and sat down across from him at his desk.
"How are you?" he asked.
"Fine," I said. "I slept OK last night, and I don't feel impaired in any way."
"Good. We have a bit of a staffing problem due to Shelly being out for an extended period of time. I spoke with John Cutter and Brent Williams, who is the Acting Chief in the ED, to work out a solution. We've had to juggle, and Medicine is going to lend Emergency Medicine a pair of Residents and bring in locum tenentes to cover Medicine.
"Two are necessary, as he needs to cover for Loretta and for you. I'm sure you know that it's nigh on impossible to fill an empty Resident slot in February, and Shelly is a PGY5. The best we could possibly do is someone who failed to Match last year, and that is not something I want to contemplate. That means you'll take on some of Shelly's responsibilities and be on call for the ED. Basically, going back to the old way, or how it is when you aren't on shift in the ED."
"It sounds as if my hours are changing."
"As of today, unless you need time to make childcare arrangements. You'll have Shelly's current 0500 to 1700 shift, the same as we plan for you to have in June."
That meant I could leave at 5:00pm, which was a good thing, and having my weekend free was a good thing. There was, though, one concern.
"What about the Free Clinic?" I asked.
"Doctor Saunders will take over that shift," Doctor Roth said. "We can't afford to lose a surgeon, even if you can't completely cover for Shelly."
I really didn't want to give up that shift, but there wasn't much I could do about it, as nobody outside surgery could perform the procedures I was authorized to do in the ED.
I nodded, "OK. Who from Medicine?"
"Doctor Gómez and Doctor Saunders. The rule used to be that we'd use more senior Residents, but Doctor Saunders has completed her ED rotation and had very high marks. She works a shift schedule almost identical to your old one, so she'll take on your students; you'll take Shelly's."
"The ED will be short an Attending," I observed.
"Fortunately, that's not my problem," Doctor Roth said. "Brent Williams was authorized to accelerate hiring an Attending who was to start in June. He can fill you in, if you want more information.
"OK. Who are Shelly's students?"
"Erin Jackson and Todd Blythe. You interviewed Erin, and she's on our Match list; Todd is a Third Year and hasn't decided."
"OK. Does Brent know I won't be in the ED today unless I'm called?"
"Yes."
"Dress code?" I asked with a raised eyebrow.
Doctor Roth laughed, "John Cutter suggested I cut you some slack and permit you to conduct rounds in your scrubs."
"And what do you think?"
Doctor Roth smiled, "That 'advice' from Cutter is similar to 'advice' from your Bishop!"
I laughed and nodded.
"And off the record?" I asked.
"I think the general perception is that patients are actually more comfortable with a doctor in scrubs in the hospital. In private practice, ties and medical coats are still appropriate."
"I agree and I appreciate the accommodation. Who is handling Shelly's surgeries?"
"Some of the more junior Residents will have a chance. I'll see what I can do for you, but with you covering the ED, we have to be smart about it."
"Am I cleared for all procedures?"
"I don't see why not. You seem to be on an even keel, and Doctor Mercer believes it's OK to throw you back into the fray. Go find your students and bring them up to speed on the new plan. You'll be supervising prepping Burke's patients today and tomorrow. Shelly was on his team."
"Any updates on Shelly or Loretta?"
"Shelly continues her recovery, and if it continues apace, she'll move from the CCU to Medicine on Monday. Her liver function is good, which was the obvious concern beyond the hypovolemia. Loretta has an incomplete SCI at L3. Late yesterday, she regained some sensory function in her right leg, which is a hopeful sign but is not definitive one way or the other. Neither specialist is willing to make any kind of prognosis at this point."
"OK. I'll check in on both of them each day I'm here."
"Then get to it, Doctor!"
"Right away!"
I left his office and went to the locker room to change into my usual red scrubs, then went to the lounge where I saw a pair of students — a short brown-haired girl whom I knew and a lanky black-haired guy whom I didn't.
"Good morning, Erin; I presume you're Todd?"
"Yes," he said as they both stood up.
"Hi, Doctor Mike," Erin said. "Shall we present the pre-ops?"
"Yes, please. A quick note before you begin — things will change because I have a different role from Doctor Lindsay. Todd, I'll want to see your procedure book after Erin presents."
"We have two procedures today," Erin said. "We verified all labs and vitals for each patient are in range..."
"Sorry to interrupt, but I'd like to hear the actual vital signs and any labs that are borderline, please."
"Sorry, Doctor."
"It's OK. I do things differently. Continue, please."
"Patient one is a sixty-seven-year-old male scheduled for a resection of a functional adenoma. BP is 150/82; pulse 75; PO₂ 98% on room air; EKG shows normal sinus rhythm with no variation; fasting glucose is 162; cleared for surgery by Doctor Burke.
"Patient two is a nineteen-year-old female scheduled for excision of an osteochondroma of the right knee. BP is 114/62; pulse 64; PO₂ 99% on room air; EKG shows normal sinus rhythm with no variation."
"Distance runner?" I asked.
"Marathons," Erin replied. "All labs were completed and verified for both patients, and no anomalies other than the fasting glucose on patient one. Both have been NPO since midnight."
"What's next?" I asked.
"Patient one needs to be shaved and an IV inserted."
"OK. We have a few minutes before we need to do that. Todd, may I see your procedure book?"
Todd handed me his book, and I flipped through it. While I had interviewed Erin, I hadn't worked with her, as I hadn't been in the ED when she had served her Clerkship. Her Sub-I would be in April and May, but with my new assignment, I wouldn't see her in the ED.
Todd hadn't had an Emergency Medicine rotation — it was scheduled for April and May as well. His book showed what I considered sufficient procedures for a Third Year who hadn't yet had his Emergency Medicine Clerkship.
"I'm assigned to cover the ED," I said. "That will be our main focus. The usual procedure is for the Fourth Year to stay on the ward and the Third Year to accompany me. If possible, I'll take you both to observe. Any questions?"
"Will we have a chance to scrub in?" Erin asked.
"I can't promise, given I'm a PGY1, and I've been assigned to the ED as part of the trauma surgery program. Let's go see our first patient. Todd is to present when we go into the room. Please introduce me as 'Doctor Mike'."
"Yes, Doctor," he said.
The prep was routine, with Erin inserting the IV and Todd shaving the area where the incision would be made. Doctor Burke came to check on the patient, and Erin presented at his direction. Shortly after he left, anesthesia arrived, and twenty minutes later, we moved the patient to OR 2.
"I'm going to go check on Doctor Gibbs and Doctor Lindsay," I said. "Use the time to study, please."
I left the surgical ward and headed for the CCU to see both Shelly and Loretta.
"Morning," I said to Shelly. "I hear things are looking up."
"That's what they tell me. Give me a peek at my chart?"
I chuckled because patients weren't usually allowed to review their own charts, and there was no official exception for doctors. I took the chart from the hook at the end of the bed and handed it to her. She flipped through it, handed it back, and I hung it on the hook again.
"Hoping to get rid of the catheter?" I asked with a grin.
"Yeah, but the screws won't let me out of bed until I move to Medicine."
"I've been inside Southern Ohio Correctional Facility in Lucasville," I said. "This is nothing compared to that!"
"What were you doing there?"
"Prison ministry. I thought I told you about that, but perhaps not. Anything I can get you?"
"A pizza?" Shelly suggested.
"I wonder if anyone has ever tried to call for delivery from a hospital bed?"
Shelly laughed, "I should do that just to see Baker's reaction!"
"On a serious note — anything I need to know about your Third Year?"
"He's competent and attentive, about all we can say about most Third Years. You know we put Erin on our Match list, though I don't know if we're her first choice."
"Where else did she interview?"
"Every hospital in Cincinnati. If you recall, she's from Milford, and I think she'd prefer to go back."
"I had the impression during the interview that she had a reason to be in this area."
"Boyfriend, but they broke up right before her Match list was due."
"Well, that was inconvenient. I take it he works in the area?"
"He's an engineer who works for the McKinley Water Department. They met at a chess tournament and then went to UC together."
"We played against Milford during my Junior year in a regional tournament, but I don't recall seeing her, and I haven't played much at all since I graduated. I bet she knows a friend of a friend whom I met in Cincinnati. Anyway, I need to see Loretta and then get back to the ward. I'll come see you tomorrow; call me if you need anything I can provide."
"Thanks, Mike."
I squeezed her hand and then went to Doctor Gibbs' bed.
"Morning, Lor," I said. "Owen Roth said there was a significant improvement."
"Hi, Mike. I have feeling in my right leg except for a few spots on my inner thigh; no voluntary muscle movement, though."
"You had significant trauma, Lor. It's only been three days. Getting feeling back is a good sign. Did they tell you about the staffing changes?"
"No. What?"
"Clarissa Saunders and Antonio Gómez are assigned to the ED until the end of May; I'm covering for Shelly but handling ED consults during my shifts. Obviously, I can't do everything Shelly did, but they're short surgeons, so I'll be doing most of the daily scut. Burke is bringing in two locum tenentes to cover for Clarissa and Antonio. Clarissa will cover my Free Clinic shift as well. Owen Roth says that Brent Williams is going to try to accelerate hiring an Attending and has permission to hire right away if he's able."
"What a mess," Loretta said. "Any more information about what happened?"
"The Sheriff is not saying much because they're still investigating the original incident. He scheduled a press conference for 1:00pm tomorrow to give a status update. They did arrest two suspects in the original incident. You know what happened with the guy who attacked you and Shelly and killed Tracy Sommers. Her funeral is tomorrow."
"Scott Turner, right?"
"And Jill Kleist. Five rounds total, all hits."
"How are you doing?" Doctor Gibbs asked.
"I'm sleeping OK and have no nightmares. I went to the ED yesterday and didn't have a bad reaction."
"Keep talking to your counselor."
"You, too. I hate to cut this short, but I need to get back to the ward. I'll stop in on my way out today."
"Thanks, Mike."
I left the CCU and returned to the ward just in time to be called for a consult. I went to the lounge and asked Todd to join me, and we went down to the ED.
"Mike Loucks, surgery," I said, walking into Trauma 2. "What do we have?"
"Hi, Mike," Naveen Varma said. "Kelly Jordon; twenty-year-old female; high-speed MVA; stable vitals; unit of cross-matched whole blood; abdominal guarding and distension; no penetrating wounds. Ultrasound is ready for you."
"Thanks, Naveen."
I performed an exam, confirmed Naveen's observations, then performed an ultrasound.
"Free fluid in Morison's," I said. "Todd, call upstairs and let them know we have an ex-lap with possible splenic involvement. Report the vitals, please."
"Right away, Doctor Mike!" Todd replied, then made the call.
After a brief conversation with the nurse, he said Doctor Roth wanted to speak to me.
"Yes, Owen?"
"Looks like it's you and me," he said. "Bring your patient up, and both your students can scrub in. We'll decide on whether to do an open or laparoscopic procedure after evaluation."
"We'll be up shortly," I said.
I hung up and asked Naveen to have one of his students call for transport, which they did. Eight minutes later, we wheeled Ms. Jordan into OR3. Todd and I went to the scrub room where Erin was already scrubbing in under the watchful eye of Nurse Ellen. Once we all finished scrubbing in, we joined Doctor Roth, Doctor Birch, and an anesthesiologist I didn't recognize.
"Open procedure, Mike," Doctor Roth said. "You're third surgeon, so you handle the suction, and if there are no complications, I'll have you close."
"Understood," I said.
Fifteen minutes later, the spleen was exposed.
"That doesn't look like a lot of damage," Paul Birch observed.
"I agree," Doctor Roth replied. "Mike, what's the choice for the best prognosis?"
"Resection," I replied. "It's possible to repair minor splenic lacs, but in anyone over eighteen, splenectomy is the preferred choice, based on overall outcomes."
"Mike is correct," Doctor Roth said. "Paul, this should be an easy one. Are you ready to perform your first splenectomy?"
"I am," Doctor Birch replied.
"Then switch places with me, and I'll assist."
The procedure was textbook, with no complications, and I was allowed to close, something I'd done several times. That boded well for my training rotation, which would start in June, as I had demonstrated proper technique and knowledge to move to the next phase, which would include performing initial incisions.
When I completed the last suture, Doctor Roth asked Paul to take the patient to recovery, as I had to remain on call. I was extremely happy I hadn't been called out of the surgery, as that had been a distinct possibility, given we were short-staffed.
I had just changed into fresh scrubs when Sarah, the Charge Nurse, let me know that I was needed in the ED for a central line. I called out to Todd, and we took the stairs down to the first floor and hurried down the corridor into the ED. I stepped into Trauma 3 to find Ghost and Clarissa working on a patient who had been in a construction accident. I quickly inserted the central line, then, at Ghost's request, performed a pericardiocentesis and finally performed a surgical assessment.
"I'll take him," I said. "Todd, call up and let them know we have a patient coming right up."
He made the call while Ghost and I reviewed the chart. Clarissa, Max, Todd, and I transported the patient to OR3, which the nurses were hurriedly preparing.
"What do we have, Mike?" Doctor Roth asked when my students and I joined him in the scrub room.
"Traumatic amputation of the left arm at the elbow; central line and two litres of plasma; fluid in the pericardium aspirated by pericardiocentesis; BP 90/50; tachy at 110; intubated; PO₂ 96%; five of morphine in the field; tourniquet applied just under forty minutes ago by a co-worker. No recovery of the severed limb."
"Any other injuries?"
"None appreciated. Main concern is hypovolemic shock, but the tourniquet was applied almost immediately, and the paramedics got plasma into him right away, along with IV saline."
"OK. It's a cleanup job, then. How much of the arm is left?"
"The humerus appears intact to the trochlea. I'm not sure if there's enough muscle to cover the bone."
"Tendons?"
"None appreciated on visual inspection."
"Julie, get the fluoroscope set up, please," Doctor Roth said to the circulating nurse.
Five minutes later, we were in the OR, and Doctor Roth began examining the patient's arm.
"What have you got for me today, Owen?" Kenneth Cole from Orthopedics asked.
"Traumatic amputation of the left arm at the elbow. Humerus is intact, there does not appear to be enough muscle to cover the end of the bone, and there's significant ligament and muscle damage all the way to the deltoid."
Doctor Cole joined Doctor Roth, and they viewed the fluoroscope together, then Doctor Cole performed a visual examination of the injury.
"I suggest we revise the amputation to facilitate a prosthesis," Doctor Cole said.
"I concur," Doctor Roth said. "Todd, we're done with the fluoroscope," Doctor Roth said. "Please store it. Julie, bone saw tray, please. Mike, no need for you and your students to stay."
"OK," I agreed.
I was disappointed, but I knew I had responsibility for consults, and with Doctor Cole in the OR, there were four surgeons, as Doctor Cole's Resident had come with him. My students and I left the OR and went to the lounge.
"I hear you played on the Milford chess team," I said to Erin. "I know a guy who played with you — Larry Higgins."
"Our best player! He's a Grand Master now. I take it you met him at a tournament?"
"Yes, and then again, when Doctor Saunders and I went to interview at UC medical school."
"He didn't get in," Erin said. "So he decided to go to nursing school. He's working at The Christ Hospital in Cincinnati."
"Feel free to refuse to answer, but I strongly suspect you knew the guy who invented 'strip chess'."
Erin laughed, "Oh my God, talk about crazy! I'm sure you're referring to Steve Adams, but it was his girlfriend, Jennifer, who actually invented it."
"That's the guy," I said. "Was Milford as crazy as the rumors say it was?"
"And then some!" she said, shaking her head. "But it was a lot of fun!"
"I bet! Harding County High was not like that, despite the best efforts of my closest guy friend and me!"
Erin laughed, "I'm pretty sure our High School wouldn't have been nearly as crazy without Steve and his female friends. He's in Chicago now, and from what I hear, he runs a computer company."
"Todd, where are you from?"
"Detroit. I went to University of Detroit Jesuit High School and Academy, an all-boys school. That kind of limited the craziness!"
"Bummer!" Erin declared with a soft laugh.
"Yeah," Todd agreed.
To read the complete story you need to be logged in:
Log In or
Register for a Free account
(Why register?)
* Allows you 3 stories to read in 24 hours.