Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 32: Back to Work
June 28, 1990, McKinley, Ohio
"Welcome back!" Shelly Lindsay said when she walked into the surgical locker room on Thursday morning.
"Hi, Shel."
"How are Kris and Charlotte?"
"Both healthy, both sleeping like babies!"
Shelly laughed, "Waking up every two hours, right?"
"Yep! I always laugh at 'sleeping like a baby', 'cat nap', or 'eating like a bird' because those phrases mean basically the opposite of what they mean when taken at face value."
"Morning, Mike!" Mary Anderson declared, coming into the locker room.
"Morning, Mary! How has the week been so far?"
"I had to call Tom Dierks down a few times, but now I'm ready to be signed off on pericardiocenteses as soon as you see me do one more. Doctor Dierks was going to sign off, but Doctor Roth said it had to be you because we're our own sub-specialty."
"Well, look who's special!" Shelly teased.
"Maybe so, but one day we'll both work for you when you're Chief Surgeon!"
"Oh, right, the boys are going to let a girl be president of their club!"
"This boy would be very happy with you as Chief Surgeon, and, as they say, times they are a-changin'. I'm looking forward to Monday when Leticia Jefferson starts her Residency. The ED is closing in on matching county demographics, which I think is important."
"Enough to enforce it by policy or law?" Shelly asked.
"No. It has to be done organically; otherwise, minorities and women will always be viewed as not measuring up, which is exactly what we're trying to change. I've said many times, Mary is at least as good as I was at her level, and probably even better."
"I've had a very good teacher," Mary interjected.
"Thanks. Anything new on the nurses' contract negotiations?"
"No," Shelly replied. "The County isn't budging."
"And neither are the nurses," Mary added.
"Did anyone come up with a contingency plan?" I asked
"Oh, they did," Mary replied, "and you aren't going to like it!"
"How bad?"
"Because we're assigned to the ED, if the nurses strike, you'll have sixteen-hour shifts Monday through Saturday; I'll have them Sunday through Friday. You'll start at 0500 and end at 2100; I'll start at 1900 and end at 1100. That'll continue until the nurses return."
"Ninety-six hours?" I asked, surprised.
"Doctor Wernher intends to invoke the emergency provisions in the scheduling rules. Attendings would have their hours extended by four hours per shift; PGY1s by eight hours; and PGY2s and PGY3s by six hours. Medical student hours would be extended as well."
"Wonderful."
"The County Board called a special meeting for tonight about the overall budget," Shelly said. "Several of us are going to go and speak during the comment period. You should join us."
"Why is it that at every turn people seek to involve me in politics?" I asked.
"Because you cannot avoid the 'affairs of the city'," Shelly declared.
"OK, no fair quoting Aristotle to me, despite him actually being a moron when it comes to theology!"
"Wow!" Mary exclaimed. "A Princess Bride reference AND dissing the father of science?"
"While true, those who followed him, that is, the West, careened down an uncontrollable course that led to modernism and nominalism, and the complete and utter bankruptcy of Western philosophy and theology!"
"What brought that on?!" Mary asked, clearly taken aback.
"Asking me to get involved in politics! I'll stick with Plato's criticisms of Democracy. In his thought, in a system in which everyone has a right to rule, selfish people who care nothing for the citizenry, motivated by their own personal desires, are able to attain power. In his thinking, democracy risks bringing dictators, tyrants, and demagogues to power. He also observed that democracies have leaders without proper skills or morals and that it is quite unlikely that the best equipped to rule will come to power.
"I'd say he hit that one out of the park. Of course, I also tend to agree with Churchill — 'Many forms of Government have been tried, and will be tried in this world of sin and woe. No one pretends that democracy is perfect or all-wise. Indeed, it has been said that democracy is the worst form of Government except for all those other forms that have been tried from time to time'.
"But seriously, what will my speaking do other than draw attention to myself? That's the last thing I want to do! You're obviously more than welcome to go and speak, and I support your efforts, but please, please, do not ask me to get involved in political action. I'll study issues, learn about candidates, and vote, but I do not want to engage in politics."
"I obviously touched a nerve," Mary said. "Sorry."
I took a deep breath and let it out.
"No, I need to apologize for basically going off on the two of you over what most people would consider a reasonable request."
"Mike," Shelly said, "don't you think there are issues that are important enough to set your aversion to the political process aside? I do think it's the process that bothers you, not the idea of coming together to decide what's best for society."
"I suppose you're right," I said. "What time is the meeting?"
"7:00pm at the County Administration building."
"We're churching Charlotte tonight at 7:00pm, and that needs to be done today, as it's the eighth day. I'm not sure it's possible, even if I wanted to, which I'd have to think about."
"I honestly didn't mean to upset you," Mary said.
"As the saying goes, it's me, not you, but in a good way! Shall we head to the ED?"
"Yes!"
Mary and I left the locker room and headed for the stairs.
"Did you hear about the new dress code in the ED?" Mary asked.
"No. Now what?"
"Medical coats at all times except in trauma rooms, and First through Third Year students are slacks, a shirt, and a tie for men; a dress or skirt and blouse for women."
"Does he believe that applies to us, along with the students on surgical rotations?" I asked.
"I'm not sure. The memo said 'ED staff', and we aren't, and nobody said anything to me."
"Probably because of the red scrubs. I'm sure he'll speak to me about it. Do you know if he spoke to Owen Roth?"
"Nothing was said by Doctor Roth or by Shelly, and I saw both of them every day while you were out. I take it everything is good at home?"
"Yes. Kris and Charlotte are doing well, and Rachel does not seem to have her nose bent out of shape by the addition of a baby to the family."
We reached the ED, and I checked in with Ellie, who let me know I was catching EMS runs. I acknowledged her, then checked my ED mailbox and found the memo from Doctor Wernher about 'professional attire'. It was consistent with his other memos on addressing colleagues by their titles and not using inappropriate language. I preferred a more informal, casual style, but I had never undergone a JCAH certification review. I strongly suspected the changes he was making were all in service of ensuring that we passed that certification with flying colors.
My students, Al and Molly, were in the lounge, and I let them know we were catching EMS runs, so they could relax until we were called. We'd only catch walk-ins if there were too many patients waiting to be seen. I sat down to read the latest Journal of Emergency Medicine. About an hour later, having seen no patients, Ellie let me know Doctor Wernher wanted to see me.
"You asked to see me?" I said, standing in the doorway.
"Come in, Doctor. Shut the door and have a seat, please."
I did as I was bidden and waited for him to speak.
"You're aware the nurses are very likely going to strike at midnight on Saturday when their contract expires?"
"Keenly," I replied. "Doctor Mary informed me of the emergency scheduling, and I have no objection. I assume you cleared that with Owen Roth?"
"I did. I was sure you'd understand the extreme nature of the situation. Fourth Years will handle triage, the same as it was done before we transitioned to nurses doing it. I'm going to ask you and Doctor Anderson to supervise, given the two of you will mostly handle incoming trauma cases. Unfortunately, Residents are going to have to take on some of the nursing duties. That will fall mainly on the new PGY1s, who start July 1st."
That was going to totally suck for the new PGY1s, as they would be champing at the bit to be doctors.
"You know Doctor Mary and I will both pitch in where needed."
"I was certain that would be the case. Did you check your mailbox this morning?'
"I did. I saw the memo about medical coats."
"This is a request, not a command, but I would ask if you and Mary Anderson would wear medical coats when speaking to family members, and, preferably, when supervising triage. That presents a more professional image to the public than do scrubs."
I actually disagreed with him, as I felt scrubs were much more appropriate in the hospital, and, in fact, expected by the public, as opposed to in a medical practice, where a medical coat and tie were expected of men. That thought aside, this was Dutch Wernher's ED, and it didn't do me any harm to accede to his request.
"I don't have a problem with that," I replied. "Mary and I will put on our coats in those circumstances."
"Thank you. I appreciate your coöperation. You're dismissed."
I thought about coming to attention or saying 'Aye, Aye, Sir!' but decided against it, as I didn't want to push the impertinence too far. I stood, nodded, then left his office. I saw Kellie Martin, so I walked over to her and asked her to speak privately, and she and I walked out to the ambulance bay.
"What's the scoop?" I asked.
"First, how are Kris and Charlotte?"
"Doing well, thanks."
"The County Board is still trying to balance the hospital budget on the backs of nurses, orderlies, and techs. You know where that started."
I nodded, "I do. It was when the new Board members discovered they would have to raise taxes or significantly cut costs because of the hospital expansion. All the capital costs were covered, but operating costs were not."
"Exactly. And six of the nine members would have to go back on the pledges they signed to not raise taxes."
"A foolish pledge to make without SOME kind of caveat," I declared. "And here I thought politicians always used weasel words!"
"They piggybacked on President Bush's 'Read my lips: no new taxes!' pledge."
"That was rash. I'm no fan of taxes, but as the saying goes — somebody's got to pay. It would be one thing if the taxes were being raised on a whim and for new spending, but we're talking about a core service — a Level I Trauma Center."
"You're preaching to the choir, Mike! Maybe you should go with the Residents to the County Board meeting tonight."
"Shelly Lindsay and Mary Anderson encouraged me to do that, but you know me. Not to mention I have a conflict."
"I do know you, but if there ever was a time to act politically, it's now. If they implement all the cuts and changes, there will be no way we'll be able to become a Level I Trauma Center. I suspect you haven't heard the latest."
"I haven't."
"Delaying most of the new equipment, among other things."
"OK, now that's flat-out stupid! If they delay the telemetry beds, they'll need more nurses!"
"Nobody said politicians were logical OR intelligent!"
"True. The blame for this lies with the previous Board members, who should have put the tax increase through with the bond issue to raise the money for the capital spending part of the project."
"That's the other piece — delaying the new surgical wing for several years."
"Wonderful. Do they still propose cutting staff?"
"Yes, and limiting raises to no more than 2% per year for nurses, orderlies, and techs. There is also talk of eliminating orderlies."
"Brilliant!" I observed. "Who is going to do that work?"
"Mike, you really DO need to pay attention to the political side, even if you detest it."
"I'm surprised nobody has mentioned all those proposals."
"They only became public on Monday when the Board published their agenda for the meeting tonight."
"OK. The problem is, as I said, that I have a conflict. I'm not sure I can change it, because it's a specific church ceremony for Charlotte that has to be performed today, and it's scheduled for 7:00pm."
"You should change it if you can. The nurses will be at the meeting, handing out literature, but not picketing or protesting."
"Wise."
I heard sirens, so I suggested we go back inside and put on our gear.
"Mike, EMS arriving in a minute with an MI," Ellie called out. "I just let Al and Molly know. Use Trauma 1."
"Thanks."
Kelly, Al, Molly, and I all put on gowns, gloves, and goggles, then headed for the ambulance bay. About thirty seconds later, the EMS squad pulled to a stop in front of us, and Roy jumped out.
"Luther Clay; forty-eight; severe chest pain radiating to left arm; diaphoretic; BP 90/50; pulse weak and tachy at 110; PO₂ 95% on five litres by mask; 2 megs nitroglycerin sublingually."
"Trauma 1!" I declared. "Mr. Clay, I'm Doctor Mike. We'll take good care of you!"
The paramedics helped us rush Mr. Clay to Trauma 1, and I gave instructions to my team on the way. The six of us moved Mr. Clay to the trauma table, and Molly swapped the oxygen to the hospital system and inserted an IV; Al hooked up the EKG and monitors; Kelly drew blood for ABG and cardiac enzymes; and I performed a primary exam.
"ST elevations on the EKG!" Al called out.
"Molly, call for a cardiology consult; Al, print a strip; Kelly, 350 megs ASA IV push. Mr. Clay, you are having a heart attack. We're going to call a cardiologist and give you some medicine."
"OK," he responded, his voice muffled by the oxygen mask.
About five minutes later, Alicia Moore entered the trauma room with a male medical student.
"Moore, Cardiology. What do we have?"
"Luther Clay; forty-eight; classic STEMI; severe chest pain radiating to left arm; diaphoretic; BP 90/50; pulse weak and tachy at 110; PO₂ 95% on five litres by mask; 2 megs nitroglycerin sublingually from EMS; 350 megs ASA, IV push following exam."
She performed her exam, looked at the EKG strip and the current monitor, then had her student call up to the cath lab. Five minutes after she arrived, she, her student, and Molly took Mr. Clay up to Cardiology. When I left Trauma 1, I saw Mary and asked her to step out into the ambulance bay to speak.
"What's up?"
"Dutch let me know that if the nurses strike, we'll be responsible for supervising Fourth Years handling triage because we'll be catching EMS runs. He also requested we wear our medical coats when we're speaking with family members or at the desk supervising triage. I agreed."
"What do you want from Doctor Wernher?" Mary asked with a sly smile.
I chuckled, "To keep him onside with the trauma surgery program and show we can be coöperative. Wearing coats really is a minor thing, and I totally get where he's coming from, even if I would do it differently. He's old school in that he believes medical coats, suits, and ties create the proper professional appearance. I agree with regard to physicians in private practice, but in the hospital, everyone expects surgeons to wear scrubs. Think about what you see on TV."
Mary nodded, "The surgeons come out of the OR in scrubs and go straight to talk to the families."
"Exactly. And while shows like St. Elsewhere, Emergency, or M✶A✶S✶H might be less than accurate; that is how the public perceives things should be. The same goes for shows like Quincy, M.E. with regard to pathology."
"Doogie Howser, M.D.?"
I chuckled, "A sitcom! And talk about suspending disbelief? Allegedly, he had a perfect score on the SAT at age six; completed high school in nine weeks; graduated from Princeton University at age ten; and finished medical school four years later. All of that, according to the show's universe, made him the youngest licensed physician in the country at age fourteen! Think that's even remotely possible?"
"No!" Mary exclaimed firmly.
"Not to mention, there is no chance he'd be able to receive a license, be covered by malpractice insurance, or any of the other necessary things based on what we learned in Practice of Medicine. He also wouldn't be able to prescribe meds. I don't believe there are any doctors under age eighteen anywhere in the West. I can't speak to the East Bloc, Asia, or Africa.
"That said, I did read an article about Balamurali Krishna Ambati, who was accepted to Mount Sinai School of Medicine for the Fall. He's thirteen. That would make him seventeen when he graduates. I'm not sure how I feel about that, but obviously, Mount Sinai thinks he's worthy of admission."
"That does seem a bit crazy, given I remember all the application materials I saw set the age limit at seventeen."
"They obviously granted an exception. I'll be curious to see how that works out. In any event, if things go the way they appear to be going, you'll need your medical coat handy. Personally, I'm going to hang mine on the hooks behind the nurses' station; I suggest you do the same."
"Have you thought more about tonight?"
"Kellie Martin encouraged me to attend and at least show moral support, but she wants me to speak. She had information Shelly didn't convey about the radical ideas the County Board is putting forward, including delaying some of the new equipment and delaying the construction of the surgical wing."
"Are they complete morons?" Mary asked.
"They have a tough job," I replied. "The question is, are they willing to do it?"
"Are you willing to stand up and call them out?"
"You know I believe medicine should be apolitical."
"The rest of the world appears not to," Mary observed.
"I know," I sighed. "Let's go back and heal the sick!"
"Do you think they'll allow Doctor Gibbs to come back?"
"There is a reason I'm trying to stay on Dutch Wernher's good side," I said. "And you just hit the nail on the head. That's not to say it's the only reason, but it's the primary one at the moment."
We went back into the ED with Mary going to her students to get a walk-in, while I went to the lounge to await the next EMS transport, which occurred just ten minutes later.
"Mike," Ellie said, "EMS four minutes out with a self-inflicted gunshot wound. Use Trauma 2."
"Who's available to help?"
"Ghost or Doctor Wernher."
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