Chapter 21: You Run It

May 3, 1990, McKinley, Ohio

"I can't speak to what Doctor Gibbs was thinking," I replied, "but at the time, we weren't short an Attending the way we are now. I'm not sure what can be done at this point, as I have a commitment to present at Career Days at Rutherford High that morning. That's where I went to High School, and it's too late for them to find a replacement for me."

"I wasn't looking to force either you or Doctor Casper not to go, just simply seeking insight into Doctor Gibbs' thinking. Things were fairly loosey-goosey under Northrup and Gibbs, and I'm encountering quite a few things that need to be addressed."

"All I can say is their system seemed to work."

"Let me ask this way — would that system pass muster with the Joint Commission for a Level I trauma center?"

The 'Joint Commission' or the 'JCAH' was the Joint Commission on Accreditation of Hospitals, the accrediting body we'd need to satisfy to receive our Level I designation.

"I believe our liberal interpretations of the rules during that time might have raised questions, and probably some eyebrows. To put a very fine point on it, they would very likely not have appreciated the leeway I was given to operate as if I were an Attending. Yes, it worked, but it pushed the rules literally as far as possible without directly violating them."

"I'd counter that that violated the spirit of the law, if not the letter. You and I both know that Residents without licenses are required to be actively supervised. Let's be honest, shall we, Doctor? You do not have a medical license, and you were treating and discharging patients without so much as a signature on a chart from a licensed physician."

"That is true," I replied.

"And does that follow policy or the law?"

"Not in a way which we could successfully defend in court," I replied. "May I make an observation without the intent to influence you to follow the same policy?"

"Yes."

"It worked, and it worked well, mainly because I had the wherewithal to know when I needed help, and I didn't screw up."

"And the response would be that, eventually, you would, because everyone does. And at that point, you, Doctor Gibbs, the Attending on duty, and the hospital are exposed to not just civil penalties, but potential criminal charges. Please don't take this the wrong way, but ALL of you were damned lucky. You are a VERY good Resident, Doctor. But you are not yet a licensed physician, and the rules are clear.

"As I said the other day, this isn't about you, personally, because it appears you only write checks your skills can cash, but all it would take is one lapse in judgment, and it would all come crashing down. My other Residents, as good as they are, aren't you, and if they try to be you, it will end in disaster. The same is true for medical students. Miss Anderson is one of the best I've ever seen, and the same argument applies. I can't have other medical students who don't follow your methods and who don't have you as a teacher trying to emulate Miss Anderson."

"You are not the first person to make those observations," I said. "Though usually, they came as gripes from other Residents or medical students about the 'special privileges' I was granted. I fully admit I was granted special privileges, but I earned them. That said, I am not arguing against you enforcing the rules more strictly."

"More? It would be impossible to do less short of not even scheduling an Attending to provide a fig leaf of cover."

"May I ask a question you might choose not to answer?"

"Yes."

"Is this the reason Doctor Cutter hired you?"

"Of course it is. He raised the issue in my interview, so I'm sure he did that in all the interviews."

I nodded, "Thank you. I'll say something I hope I don't need to say — what has just been said does not leave my lips outside these walls, though I reserve the right to discuss it with my wife."

Doctor Wernher nodded, "We all need someone outside the system to speak to, and our wives are the safest in most cases. Unless you had more to discuss, you can return to duty, Doctor."

"Nothing more at this time," I said.

I stood and left his office, and Mary came up to me.

"Everything OK?"

"Yes. Just a discussion about how we'll handle things in June and then in September. Doctor Wernher, Doctor Roth, and I are all on the same page. He also reinforced the changes in how we handle discharges and supervision."

"We've followed them to the letter!" Mary protested.

"Yes, of course, but Doctor Wernher's style appears to be to say the same basic thing to everyone, whether or not they're the main target. That does ensure we're all on the same page. Get another chart, please, then we'll have dinner."

May 5, 1990, McKinley, Ohio

On Saturday morning, Kris, Rachel, and I went to band practice, and Kris and Kari discussed the Proms. Ultimately, Kris decided that, given how tired she had been, it would be better if Kari sang with me. I wasn't thrilled with that decision, but I knew it made sense, and I made it clear I supported Kris' decision. After practice, we went to McKinley Music and Movies.

"Hi, Mike!" Johnny called out when we walked in. "Hi, Kris! Hi, Rachel!"

"Hi, Johnny," I replied.

"Hi!" Rachel exclaimed.

"What do you have for me today?" I asked.

"I'd say something new, and something recovered. 39/Smooth by Green Day and Violator by Depeche Mode."

"Oooh!" Kris exclaimed. "Depeche Mode is wonderful!"

"I don't take her car shopping," I said with a grin. "Tell me about Green Day."

"A new rock band from California. It's on an independent label, Lookout Records, and I think they're going to go major. The album has excellent reviews and is critically acclaimed."

"Then we'll take those two, please."

"Papa?" Rachel asked.

"Yes?

"Raffi?"

"Anything new from Raffi, Johnny?"

"No. But you can't go wrong with Disney Sing-Along Songs. The first one in the series is Zip-a-Dee-Doo-Dah. Then Heigh-Ho, The Bare Necessities, You Can Fly!, Very Merry Christmas Songs, and Fun with Music. They're all VHS."

"Let's get the first one," I said.

"OK."

"Rachel, they don't have any Raffi discs, but we can get a tape with songs where you can sing along."

She scowled, "Want Raffi!"

"I'm sorry there isn't a new one," I said. "But we'll get you something. I promise you'll like it. Can we try, please?"

"Yes," my petulant toddler agreed.

Johnny retrieved the CDs and the VHS tape, then rang up our purchase.

"Is everything set for the music festival?" I asked.

"It is. It's been a lot of work, and I'm really looking forward to that work coming to fruition."

"We're looking forward to playing."

I paid Johnny for our purchase, and after leaving the store, Kris, Rachel, and I went to Kroger to do our weekly grocery shopping. After Kroger, we stopped at the bakery, then headed home to have some family time. After lunch, Rachel insisted on watching her new tape, so the three of us sat down to watch it.

"Are we taking the typical American trip to Disney World?" I asked Kris.

"How old would the kids need to be for that to mean something to them?"

"Probably at least six or seven, so I guess it's nine or ten years from now, depending on the timing of our second."

"What about Clarissa and Tessa?" Kris asked.

"That timing should work, from what Clarissa has said."

When the video finished, we put Rachel down for her afternoon nap, and Kris and I went to our bedroom. She needed a nap, and she very much liked me cuddling her while she napped. After our nap, I made dinner, and then we went to Saint Michael the Archangel for Vespers.

May 7, 1990, McKinley, Ohio

"Doctor Wernher would like to see you," Ellie said when I arrived in the ED early on Monday morning.

I went to the lounge, poured myself some coffee, then walked to Doctor Wernher's office.

"You asked to see me."

"Come in, Doctor. No need to close the door."

I stepped into his office.

"Mr. Crowe asked me to remind you not to discuss the Ken Webber malpractice suit with anyone except Mr. Crowe or personal legal counsel."

"Understood."

"Are you retaining personal counsel?"

"No. May I make a comment to you about why?"

"Yes."

"I've tangled with this law firm several times, and I do not want to give even a hint that there is any disagreement or dissension or that I want to distance myself from my co-workers or the hospital."

"OK. This is the last we speak of it."

"Understood."

"Send Miss Anderson in, please."

"Right away."

I left his office and let Mary know Doctor Wernher wanted to see her.

"Trouble?"

"No, just a directive from Legal."

"OK."

She went into Doctor Wernher's office and came out about a minute later.