Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 31: Economics, Politics, and the End of History
June 20, 1990, Circleville, Ohio
"How are you feeling?" I asked Kris late on Wednesday as we drove home from the hospital with Charlotte Michelle.
"I'm very tired. Labor is hard."
"Many of my female friends have maintained that men could never handle it, and I do not disagree with that assessment."
"What's typical?"
"There is no such thing," I replied. "Every woman and every baby is different, and babies come on their own time, so averages are misleading. Things everyone 'knows' about childbirth have a kernel of truth. For example, first babies are usually late and labor takes longer, but only in relation to the same woman having a subsequent child. Remember, all due dates are estimates, and count LMP — last menstrual period. But you can get pregnant anytime during your cycle, though the odds are stronger mid-cycle. Even progression during labor is individual — dilation and effacement do not progress at any predictable pace."
"Which explains why the Resident came in to check regularly," Kris said.
"Exactly. It's impossible to predict progression, so regular internal exams are done. The closeness of contractions is a rough guideline, but think about what happened with you."
"They were five or six minutes apart, then suddenly only two minutes apart."
"And I pressed the call button, because it happened between checks, which is common. That is exactly why it's not advisable to wait to come to the hospital until contractions are closer. It's entirely possible for them to go from eight minutes apart to two minutes apart in a short time, though that's not common."
"What happened that you had to deliver that baby?"
"OB blew us off completely. Yes, the girl was late coming into the hospital, but there was plenty of time to get her up to OB. I hope to never repeat that!"
Kris laughed, "You're so funny about that."
"It's not my specialty, and SO many things could have gone wrong for which I'm not prepared. I had two months in OB at the end of Third Year, and that's it. What I know about delivering babies is about 1% of what a PGY1 in OB knows."
"That continues to surprise me, even after two years."
"The same is true for just about every specialty. I know enough to stabilize patients with just about any condition, and then turn them over to other doctors to treat."
"And perform surgery."
"Yes, of course, though I'm still limited there, and will be for another five or six years."
I pulled into the driveway, and Lyuda came out of the house with Rachel in her arms.
"Our welcoming committee," I said.
I parked in the driveway and got out of the car. I went around to the passenger side and helped Kris out, then removed the carrier portion of the infant car seat so I could carry Charlotte Michelle into the house.
"«Bienvenue à la maison, petite sœur!»" Rachel declared when we reached the porch. ("Welcome home, little sister!")
"Troublemaker!" I said to Lyuda.
"«Qui? Moi?»" Lyuda smirked. ("Who? Me?")
"Yes! You!" I declared. "Let's get everyone inside, please."
We went into the house, and I got Kris situated on the couch, then unbuckled a sleeping Charlotte from her carrier and handed her to Kris. I sat down, and Rachel climbed into my lap.
"This is your baby sister," Kris said to Rachel. "Her name is Charlotte Michelle."
"She's little!" Rachel exclaimed.
"Yes, she is," I interjected, "and we have to take very good care of her because we love her."
"I love Papa and Mama!" Rachel declared.
"And we love you, too! Lyuda, how long are you staying?"
"Kris asked me to stay for a few days so I can help around the house."
"I hope that's OK, Mike," Kris said.
"Yes, of course. Rachel and I will take care of the grocery shopping and any other errands."
"My parents would like to see Charlotte as soon as possible," Lyuda said.
"As soon as your sister feels up to it. My mom and grandparents will visit on Sunday for an hour or two. Kris, is there anything I can get you or do for you?"
"Charlotte Michelle needs to eat, then I'll put her down and take a nap."
"Do you mind if I play my guitar? I'll play the few classical pieces I know."
"Anything that's mellow is OK. I don't think Charlotte or I are ready for Born to Run!"
"No power ballads! Got it! Rachel, Papa needs to get up to get his guitar."
"I get it!" Rachel exclaimed, scrambling from my lap.
I wondered if she would be able to manage, but my determined toddler brought the guitar case to me, holding it with both hands and obviously straining to carry the weight.
"Thank you," I said. "Please get the folders with the music."
"YES!" she exclaimed and scampered back to the study to get the folders. She brought them to me, and I opened the thin folder with the music for the five classical guitar pieces Anicka had taught me years ago. I selected one by Brahms and began playing.
"No, Papa! Play Rachel's music!" my daughter protested.
"I'll play for you later," I said. "Right now I'm playing for Mama."
Rachel crossed her arms, narrowed her eyes, and gave me a look, all reminiscent of what Elizaveta would do when she was unhappy with me because I wasn't doing what she wanted.
"Now you've done it," Lyuda teased.
"Living in a house with three strong-willed women, it's going to be like that!" I chuckled. "Not to mention my sister-in-law being here to egg on a certain young lady!"
"Would I do that?" Lyuda asked with faux innocence.
"In a heartbeat!" I chuckled.
I played three pieces, and then Kris went to take a nap, so Rachel and I went to the study so I could close the door and play the songs she liked. When I finished, we joined Lyuda in the kitchen to help prepare dinner. Despite my sister-in-law doing her best to torment me, she was actually very sweet and very helpful.
Kris joined us for dinner, and after dinner, she fed Charlotte while Rachel and I helped Lyuda clean up the kitchen. We had a quiet evening together, and after we said evening prayers, we all went to bed.
June 21, 1990, Circleville, Ohio
"How are you feeling this morning?" I asked Kris when we woke up just before 8:00am on Thursday.
"Out of sorts," Kris replied. "Giving birth, lack of sleep, and nursing a baby are not things I've done before. I can't imagine how you felt having lost Elizaveta and having to care for Rachel."
"That's in the past," I replied. "We're a team, and we'll handle the challenges as they present themselves. Right now, I want you to make sure you get enough sleep. I'll be here full-time for the next six days, so you should sleep as much as you can. I'm positive Rachel will appreciate the extra attention from Papa."
"Until she decides she needs to see Abi!"
I chuckled, "True. When did you want your parents to visit?"
"Saturday," Kris said. "They're both at work today. Are you going to band practice Saturday morning?"
"I hadn't planned to, but if Lyuda is going to be here, and it's OK with you, Rachel and I will go. I'll call Milena and see if she can bring Abi."
"You should go," Kris replied. "Charlotte and I are going to sleep a lot."
"OK. What are your plans for church?"
"I'll go to Vespers and the Divine Liturgy, but Charlotte and I will sit in the cry room."
"Do you want to church her on Sunday, or wait a week, so eight days have passed?"
"If we aren't going to do it on the exact day, this Sunday is fine."
"I'm sure Father Nicholas would accommodate us a week from today, if you prefer."
"What about work?"
"We could do it next Thursday evening. Would you like me to call Father Nicholas?"
"Yes, please."
"One other point, Father Nicholas follows the tradition published by the Antiochian Archdiocese based on scholarship from Greece, which means he'll take Charlotte into the altar and raise her over the altar table."
"You're joking!" Kris exclaimed.
"No, I'm not. Bishop ARKADY allowed either practice, and Vladyka JOHN has not changed the policy for the diocese. You know my position."
"Yes, but even you admit female deacons could not serve liturgically!"
"That's true, but the idea that a boy baby is presented at the altar table and a girl baby is not offends my sensibilities, probably just as much as taking a girl into the altar offends yours. That said, I will leave it up to you, as your position is defensible from longstanding little 't' tradition."
Kris considered for a moment, "I'm OK with it, but we'll need to warn my parents."
"That's fine, obviously, and I appreciate you yielding on the point. I'll make the call after breakfast. I can smell the pancakes your sister is obviously making."
"Unless Rachel got out of bed, went downstairs, and started making breakfast!" Kris said mirthfully.
"I wouldn't put it past her!" I chuckled.
I checked on Charlotte, who was asleep in the bassinet at the foot of the bed, then put on my robe and went to Rachel's room. She wasn't there, so I went back to our room to let Kris know I was going downstairs and found Rachel with Lyuda, helping make breakfast.
"Good morning," I said.
"«Bonjour, Papa!»" Rachel giggled.
"Your aunt is a menace!" I declared.
Lyuda laughed, "«Доброе утро, Михаил» (Dobroye utro, Mikhail)!" ("Good morning, Michael")
"That's not much better," I replied. "But at least it's a language I speak."
"After a fashion!"
"Yeah, well! Kris is up; how long until breakfast?"
"About ten minutes."
"Thanks."
I left the kitchen and returned upstairs to find Kris nursing Charlotte.
"Breakfast is in about ten minutes," I said.
"OK. She only sucks about five minutes on each side, so I'll be able to join you."
"I'll see you downstairs."
About ten minutes later, the five of us sat down to a breakfast of pancakes, fruit, and juice. After breakfast, Lyuda, Rachel, and I cleaned up; then I placed a call to Father Nicholas at the church to arrange for Charlotte's churching. We agreed on 7:00pm on Thursday, which would allow my family to attend if they chose to do. It was a simple ceremony that would take less than five minutes, so they might not, but doing it on the eighth day was important to Kris.
Once that was taken care of, Rachel and I left to do the grocery shopping. It was two days earlier than usual, but doing it meant Rachel and I would be home earlier on Saturday from band practice. Rachel enjoyed her time with me, and she seemed to be doing OK with Charlotte joining our family, but I was sure something would happen that would annoy Rachel, and she would not be shy to let us know about it.
When we returned home, I put away the groceries, then played my guitar, mixing songs Kris wanted me to play with those Rachel wanted me to play. Kris, Rachel, Lyuda, and I had lunch together, then I read medical journals while Kris and Rachel napped. We had a quiet evening together as we adapted to having the newest member of our family in our home.
June 23, 1990, Circleville, Ohio
"How was band practice?" Kris asked when Rachel and I arrived home about 11:30am on Saturday morning.
"We ran through our sets for July 4th."
"Who's covering for you?"
"Tom Dierks; he was assigned by Doctor Roth. He'll relieve me at 1:00pm. I'll cover for him for four hours on Saturday, July 21st, from 1:00pm to 5:00pm. That doesn't interfere with any plans we have."
"Your schedule for August is the same as now?"
"Yes. Mary will cover days when I'm in the OR and nights when I'm in the ED. She'll also have a Saturday shift. The only downside of the privilege of having a sixty-hour week as a PGY2 is that I can be called in if another Resident is sick. It's not normal pager duty; I'll know at least an hour before I have to arrive at the hospital, or if I have to stay late."
"How often will that happen?"
"Probably no more than two or three times in a month."
"Are the nurses going on strike?"
"There hasn't been any movement on the contract, so I'd say yes. That reminds me, Margaret Teasdale, the Nursing Director, wanted to speak to me, and Charlotte's arrival interfered. If you don't mind, I'll call her before your parents arrive."
"That's fine."
"How is Charlotte doing?"
"As Oksana told me Ghost said about John — we have a four-function baby: eat, poop, sleep, and cry. Upgrades come later!"
I laughed, "That sounds like Ghost! Let me make that call."
I went to my study and dialed the hospital and asked for the Nursing Director's office and was put through.
"Margaret Teasdale."
"Hi, Margaret," I said. "It's Doctor Mike."
"Congratulations on a beautiful little girl!"
"Thank you."
"How is Kris?"
"Happy to be a mom, but tired. Otherwise, she's doing well."
"Good," Margaret said.
"You sent word you wanted to speak to me privately."
"Yes. Would it be fair to say that the nurses have your unqualified support?"
"With regard to pay, working conditions, and patient-to-nurse ratios, yes; with regard to the strike, I'm concerned about patient care."
"I understand your concerns, and I have them as well. Would you be willing to work with me to try to head this off?"
I didn't like where this was going, and I was fairly certain what she was about to ask.
"What is it you want me to do?"
"The union needs someone who is neutral and trusted by both sides to act as a back channel."
"I'm sorry, but I can't do that. The last time someone made a similar request, all hell broke loose."
"At the hospital or medical school?"
"No; with church. Because of what happened there, I simply cannot do it."
Not to mention not wanting to create any potential problems with my father-in-law, who sat on the Hospital Board.
"I can voice support for the nurses," I continued. "But I can't do what you ask."
"I understand, but please think about what would happen if the nurses do actually go on strike."
"I'll think about it," I said.
"Thank you, Mike. Hopefully, we'll find a way to avoid the strike."
"Hopefully."
We said 'goodbye', and after I hung up, I went back to Kris and explained the request.
"I'm glad you refused," Kris said. "As much as I have sympathy and empathy for oppressed workers, you can't get in the middle of this one."
"'Workers of the world unite'?" I asked with a grin. "Or should I say, «Пролетарии всех стран, соединяйтесь!» (Proletarii vsekh stran, soyedinyaytes')?"
Kris smiled, "Of course!"
"Except for one teeny, weeny, little problem. What Marx actually said was «Proletarier aller Länder, vereinigt Euch!» — 'Proletarians of all countries, unite!'. Nurses at Moore Memorial are NOT proletarians in the way Marx meant it — they are employees of the state, and are middle class. They are NOT being oppressed by the capitalist bourgeoisie! Your class struggle theory doesn't apply!"
"Of course it does!" Kris countered. "Who runs the hospital? The people? Or capitalist, bourgeois businessmen like Viktor Kozlov? And show me a socialist government in the US at any level — federal, state, or local. The government is run by the bourgeoisie to their own benefit, and I actually know you agree with me on that!"
I chuckled, "Except for the whole 'class struggle' BS! Remember, propaganda claims to the contrary, the vast majority of company stock is owned by individuals, either directly or through union pension funds or retirement funds. Half of all American households own stock in one form or another.
"In other words, the people own the means of production, something Marx couldn't conceive of because he wrote before the modern industrial period began. He died in 1883, and the first modern automobile wasn't built until 1885, and that was a three-wheeler. Large-scale production, with assembly lines, didn't begin until 1901, with Ransom Olds leading the way.
"Marx and Engels also didn't take into account what became the modern middle class because it didn't exist until after the turn of the 20th century. It doesn't fit into any of Marx's theories, which is, of course, why Marxism has not found a foothold in highly educated, highly industrialized societies."
"Who are you and what have you done with my husband?!" Kris teased.
I chuckled, "I never said I didn't know anything about socialism; I simply said I preferred to avoid political debates and discussions. And technically, what I just discussed is economics, not politics. You can have a totalitarian socialist system and a democratic capitalist system, or vice versa.
"The usual complaint from the global left is that the global right are 'fascists', but the only difference between the totalitarian Marxist systems and the totalitarian fascist systems is that fascism relies on nationalism or religion or both — Spain being the example of 'both', and I'm sure that's a sore point for you, given the Spanish Republicans lost."
"I'm not sure I'd equate the systems."
"National socialism is socialism. The difference is the 'national' part. Anyway, back to the topic at hand — the nurses. You know I agree with you that they deserve better wages and better working conditions, and providing the best possible care to patients requires maintaining or improving the patient-to-nurse ratio, not decreasing it to save money. That said, the money has to come from somewhere, and that means, potentially, robbing Peter to pay Paul, as the saying goes."
"Perhaps spend less on the military now that the Cold War appears to be over?"
"I wouldn't go quite that far. The Soviet Union still has thousands of nuclear weapons, and things in Eastern Europe are unstable, to say the least. The Germans have, so far, agreed on monetary, economic, and social union, but formal unification is still in the future. Not to mention, Moore Memorial is sustained by the taxpayers of Hayes County. Yes, there are payments for services, but those only go so far, as do the funds provided by Medicare for Resident salaries. But, even allowing for the idea that some kind of change to the funding structure is necessary, that won't happen in the next seven days."
"Are you going to do anything?"
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