Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 26: «Говно» ("Shit")
June 1, 1990, McKinley, Ohio
When I walked out of the consultation room on Friday, I saw Mary standing in the ambulance bay, so I sent my students to the lounge and walked out to join her.
"You OK?" I asked.
"I don't know why that hit me so hard," she said. "I've seen people die. But kids aren't supposed to die."
"Do you remember the first one?"
"The ten-year-old drowning victim about a year ago."
I nodded, "On the Fourth of July. What's different today?"
"I was a Fourth Year; now I'm a Resident."
I nodded, "Despite the red scrubs, we're not gods, so it's going to happen, and it sucks. Talk me through what you did before you called me in."
"I don't think I screwed up."
"Neither do I, but do it anyway, please."
"First, how are her parents?"
"Basket cases. They're with the Chaplain and Maureen Bishop."
"Isabella, sorry, Doctor Mastriano..."
"Save the formality for Dutch Wernher," I said, interrupting Mary. "We're colleagues."
"Did you see the memo?" Mary asked.
"I did, and I gave it the consideration it was due. Nobody except Doctor Wernher wants to be addressed as 'Doctor' by their colleagues. And contrary to the implications in the memo, I'm Doctor Mike, and you're Doctor Mary. I'm sorry I interrupted; continue, please."
"So long as we can come back to the memo."
"We can. Go on."
"Isabella caught an EMS transport with the paramedics reporting they were bagging a six-year-old girl who appeared to be in anaphylactic shock. I was available, so she asked for my help. We met EMS in the ambulance bay, and they reported they couldn't intubate. Isabella instructed me to intubate and hook up the vent, then monitor the patient's tidal volume and tidal CO₂ while she performed the primary exam, and med students and nurses hooked up monitors, inserted a Foley, and drew blood. Given the circumstances, I had the nurse administer only succinylcholine, as the patient was unconscious. I tried twice for the tube, but couldn't get it due to tracheal swelling; I tried a smaller tube, and when I couldn't get it in, I called for you for a crike."
"What were her vitals?"
"PO₂ 84%; tachy at 120; BP 80/50."
"How long did you spend trying to intubate?"
"About seventy-five seconds total, with Nurse Jen bagging between attempts."
It was no surprise that she hadn't been able to insert the endotracheal tube, as the little girl's tracheal swelling was so severe that it was a wonder she was receiving any oxygen at all from the bagging.
"What else could you have done?" I inquired.
"A crike if I knew how."
"And before I could perform the crike, what happened?"
"She had an MI, went into V-fib, and we couldn't revive her."
"Do you think we missed something or did anything wrong?" I asked.
"No. I just don't know why it hit me so hard."
"One of my mentors said that if the first one doesn't hit you hard, you aren't human. If you need to speak to someone, have a word with Maureen Bishop."
"You're referring me to someone in Psych?!"
"She told me she felt the doctor treating my friend in Cincinnati should have lost his license."
"Gutsy."
"It was."
"I'll be fine, Mike. I just needed a moment. What about Doctor Wernher's memo?"
"This isn't the military, and we don't operate on a strict chain of command, nor do we have formal ranks. I think requiring nurses to address us as 'Doctor' breaks down team cohesion, and I think requiring us to address each other as 'Doctor' imposes unnecessary formality. I also completely reject being called 'Doctor Loucks', and frankly, how I choose to be addressed is not up to Doctor Wernher."
"You're going to fight it?"
"I'm going to ignore it. He already complained to Owen Roth, and Owen mentioned it during my review. Owen wrote in my review that my style was 'informal', but he presented it in a neutral way."
"What was said?"
"That my informality was contagious."
"Me?"
"He did expressly raise you wanting to be 'Doctor Mary'. But here's the point — we work for Owen Roth, not Doctor Rupert Wernher. If Dutch Wernher doesn't like how you and I address each other and other doctors, he can take it up with Owen."
"Is it wise to fight Doctor Wernher?"
"In this case, I believe his way negatively impacts team cohesion, as I said, and thus impacts patient care. I'm happy to have the conversation with him and Doctor Roth. If you're uncomfortable, follow the memo with regard to ED staff, but you call me 'Mike' and our Fourth Years are Al and Tom, not Mr. Baker and Mr. Lawson."
"You did call me 'Miss Anderson' at times."
"Yes, and consider those times and what was said. In nearly every case, it was during friendly conversations or meant ironically. When we were treating patients, it was always 'Mary'. I don't intend to call Molly 'Miss Sexton' except in disciplinary or corrective situations. And I'm sure as heck not going to call 'Ghost', to whom I'm related by marriage, 'Doctor Casper' or call Loretta 'Doctor Gibbs' when I address either of them.
"That said, keep your own counsel. You are a PGY1, and while you're still my student, you are not my clone. You'll have your own style and your own relationships with doctors, nurses, and medical students. I think my approach is best, but you have to do what you think is best, with one exception, and I'm sure you know what that is."
"Nothing should interfere with providing each and every patient the best holistic care possible."
"Exactly. I think my style is better, and there are plenty of adherents; there are also detractors, and I don't just mean Psych, who think I'm arrogant and dangerous."
"«Чушь' собач'я» (Chush' sobach'ya)!" Mary declared. ("Bullshit!")
I laughed, "Clarissa?"
"Who else?"
"How many words did she teach you?"
"About a dozen. She said the most useful one would be «глупец» (glupys)!" ("blockhead")
I rolled my eyes, "Of course she did! And now that we're on equal footing, you're going to use it?"
"Probably not; Clarissa did say it's not nearly as appropriate now as when you two first met."
"She's not wrong about how I was as a Freshman in college. She administered sufficient beatings to whip me into some semblance of shape. I wouldn't be here if it weren't for Clarissa. She's a good person to go to for advice. Ready to go back to work?"
"Yeah, I just needed to come outside for a few minutes. I'm good."
"Do that whenever you need to. It's better for you to take five minutes than work under extra stress."
"Thanks, Mike."
"You're welcome."
June 2, 1990, Circleville, Ohio
"How are you feeling?" I asked Kris when we woke up on Saturday morning.
"«Comme un éléphant gravide!»," she replied with a painful smile. ("Like a pregnant elephant!")
"Nice comparison!" I chuckled. "I don't even need my MD to figure out what that means!"
"I'm tired, as I have been for the past few weeks. Fortunately, I have my last exam on Wednesday."
"Are you staying home this morning or coming with Rachel and me to band practice?"
"I think I'll stay home, if it's OK."
"Of course it is. Do you want us to pick you up for grocery shopping?"
"It's silly to drive back here to go to Kroger, and I'm positive Rachel will be very happy with Papa/Rachel time."
"Depending on her mood, which nobody can predict for a two-year-old! I'll make breakfast. You can stay in bed, if you want. And when we come home from shopping, I'll give you a back and neck rub."
"You're a good husband!"
"I do my best! Let me go make breakfast. I'm sure the Tsarina will wake up soon."
I left the bedroom, and as I was going down the stairs, I heard Rachel getting out of bed, so I went back to her room.
"Potty?" I asked.
"Yes."
I took her to the potty, something she was doing much better with, then took her downstairs to the kitchen to make breakfast.
"Mama is going to stay home, so we'll have Papa/Rachel time today," I said.
"Want to see Abi!" Rachel declared.
"Tomorrow," I replied.
We were having dinner with Anicka, Derek, Joel, Milena, and Abi.
"NO! TODAY!" Rachel demanded.
Rachel was nearly three, and she was absolutely taking after Elizaveta in terms of asserting herself and insisting on getting her way. Arguing with a toddler was a hopeless exercise, so it came down to whether she'd go with me or not.
"Let's make breakfast for Mama," I said, hoping she'd acquiesce.
"I can help?" Rachel asked.
"Yes," I said.
I got the step stool and helped Rachel onto the top step, which put her stomach level with the counter. At three, what she could do was limited, but I allowed her to do things like dump the measuring cups of Bisquick and other ingredients into bowls. I made sure the waffle iron was on the opposite side of me, and once everything was ready, I asked Rachel to get Kris, which she did.
"Rachel said she helped with breakfast," Kris said, sitting down at the table.
"She dumped ingredients into bowls, which is about the limit at the moment," I replied.
I served Kris and Rachel waffles, bacon, eggs, and juice, then poured coffee for Kris and me. Once they had everything, I prepared a plate for myself and sat down at the table.
"Rachel," I said. "Are you going with me to band practice?"
"NO! Want to see Abi!"
"Tomorrow," I said.
"Rachel, don't you want to go with Papa?" Kris asked.
"NO!" my petulant toddler declared.
"Then you'll have to stay home with Mama," I said.
Rachel crossed her arms and gave me an evil look, but I ignored her and returned to eating my breakfast. She was in a mood, and as I'd said several times, the difference between a toddler and a terrorist is that you could actually negotiate with a terrorist. I wondered if the impending arrival of a baby sister had Rachel's nose out of joint, but if that was the case, then I would have expected her to want time with me. Being not quite three, I doubted seriously she could connect the dots to blame me for Kris being pregnant.
We finished our breakfasts, and I cleaned up the kitchen while Rachel and Kris went to the living room. When I finished, we said our morning prayers together as a family, and I gave Rachel one more chance to go with me. She simply scowled, so I went upstairs, dressed for band practice, then returned to the living room.
"I'll see you both after band practice and shopping," I said.
Kris and I exchanged a quick kiss, but Rachel turned her head when I went to kiss her forehead. Kris and I exchanged a look, both of us rolling our eyes at our toddler, and I left the house. Twenty minutes later, I walked into the music room. Kim was already there, and the others arrived within the next five minutes. We started practice on time, and when we finished, I packed up and headed to Kroger to do the weekly grocery shopping.
When I arrived home, I put away the groceries, then made lunch for Kris, Rachel, and me. After we ate, we put Rachel down for a nap, and Kris and I went to the bedroom so I could rub her shoulders and back.
"Rachel is in a mood," I observed.
"She was like that the entire time you were gone," Kris said, then added. "Ooh, that feels nice!"
I was gently massaging her neck and shoulders.
"The 'Terrible Twos' don't go away just because the toddler in question turns three," I observed. "I didn't have a lot of early childhood development training, but she's pretty typical in that regard. Sometime in their twos, toddlers figure out that their parents and other adults can't actually make them do anything they don't want to do. Parents don't learn that lesson, and we see it in spades with teenagers."
"I'm curious how you would respond to outright defiance," Kris asked as I continued to rub her shoulders.
"It would depend, but generally, timeouts, grounding, and loss of privileges seem to be the best approach, but that only works if you've already taught them the relationship between privileges and responsibility. At this stage, Rachel can't do things on her own, so when she petulantly refused to go with me, her only option was to stay home, which, I'm going to guess, did not make her happy."
"It did not. She asked for «Tante» Lyuda and was unhappy with me when I refused to call my sister." ("Aunt")
"Nice to know we're both in the doghouse with our daughter!"
Kris laughed, "Just wait!"
"Oh, I can," I chuckled. "Are you referring to when Charlotte Michelle is born or when Rachel is a teenager?"
"Yes!"
I laughed hard.
"Rachel is going to be every bit the imp and troublemaker as her «tante préférée»," I observed. "I do NOT envy the teenage boys on the receiving end of that!" ("favorite aunt")
"No, but they will if they play their cards correctly!" Kris teased.
"Let's hope our daughter has good discernment in that regard," I said. "Ready for the back rub?"
"Absolutely!"
June 3, 1990, McKinley, Ohio
"Got a second, Lissa?" I asked after the Divine Liturgy at Saint Michael on Sunday morning.
"Sure. Privately?"
"Yes. Let's go out to the bench."
Clarissa smirked, "So you can demand I marry you?"
"There might be one or two impediments to that," I chuckled.
"It's good you can laugh about that, Petrovich."
"You know what? Rather than the bench, let's go see Elizaveta."
Clarissa nodded, and we left the narthex and walked the short distance to the churchyard where my Kitten lay, awaiting the general resurrection. I said abbreviated prayers with Clarissa providing the responses, then we moved a short distance away from the grave.
"What's up?" Clarissa asked.
"You and Mary Anderson have been talking," I said with a sly smile.
Clarissa laughed, "She deployed her Russian?"
"Yes. When I told her what Psych said about me being arrogant and dangerous, she called it 'BS' in decently pronounced Russian. She also indicated someone told her which word would be most useful with me!"
Clarissa smirked, "Deny it, Petrovich!"
"Back at Taft, it certainly applied far more often than it did once I married."
"Because Lizochka kept you completely in line the way any good Russian woman would!"
"Svetlana Yakovovna wasn't a slouch, despite not having a drop of Russian blood! Anyway, that was all immaterial to why I wanted to talk to you."
"Uh-oh."
"Not me this time! Mary lost a six-year-old girl with anaphylaxis on Friday, and it hit her hard. The girl was in severe distress when she was brought in, and Mary was unable to intubate. She called me for a crike, but before I could start, the little girl coded and we couldn't revive her. I checked, postmortem, and it was no surprise Mary couldn't intubate; what was surprising was that the patient was getting any oxygen at all from bagging because her airway was almost completely occluded.
"Mary and I spoke afterwards, and I did my best to counsel her, but I think you should have a talk with her. She respects you, and obviously the two of you get along well enough that being 'sister work wives' won't be a problem!"
Clarissa rolled her eyes, "In your dreams!"
"She is a cute Scandinavian girl who can give your redhead a run for her money, though, like you, I'm partial to redheads."
"All teasing aside, is Mary OK?"
"I think so, but you know how hard the first one hits. Sure, she had plenty as a med student, but this is her first as a doctor. She worked with Isabella, who ran the trauma, but still feels she could have done something. I am absolutely positive that nobody could have done anything for that little girl unless they'd had an epinephrine autoinjector when she had the bad reaction to whatever it was."
"I take it McKnight has her?"
"Yes. An autopsy tomorrow morning. I expressly asked him to call me because I want to be able to tell Mary definitively that there wasn't a damned thing she could have done. I handled the notification with Isabela because Mary needed a moment and went out to the ambulance bay. Maureen Bishop and Chaplain Bob were with us. You can imagine how distraught the parents were."
"I could, but I don't want to."
"Me, either. I saw how Elizaveta's death hit Viktor and Julia, and as bad as it was for me, it was worse for them."
"Rachel ensured you made it through," Clarissa observed.
"And you," I said firmly.
"Along with Lara, Robby, Anicka, and a host of others."
"All true, but you were the one who helped me keep my head screwed on straight. I'll always be grateful."
"Thank you. And I hope none of us ever have to go through anything like that again for the rest of our lives."
"Amen to that," I replied.
"I'll find Mary tomorrow and see if she'll have lunch. You're her official mentor, right?"
"Yes, but in this case, I think she needs another perspective. I talked to Shelly a lot, but I talked to you, too. Both of you gave good advice, but from different perspectives."
"Does Mary have a boyfriend?"
"No. She dated some, but you know what it was like during Fourth Year; you know what it's like now."
"True."
"Are you thinking stress relief?" I asked with a smirk and an arched eyebrow.
"Get your mind out of the gutter, Doctor Pig!" Clarissa declared mirthfully.
"I didn't mean with you," I replied with a grin.
"Oh, yes, you did!" Clarissa retorted.
"Maybe," I allowed. "Shall we get our food?"
"Yes."
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