Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 41: I'm Not Sure I Want to
July 18, 1990, McKinley, Ohio
"Thanks for coming to see me, Mike," Doctor Cutter said when I stepped into his office on Wednesday morning. "Grab a seat."
He indicated the sofa, so I sat down, and he sat in a wingback chair slightly offset from the sofa.
"How are things in the Emergency Department?"
"Allowing for the situation with the nurses, I'd say things are going well. Doctor Wernher and I have some disagreements over style and approach, but we've worked through them."
"Would you tell me? No repercussions either way, I promise."
I smiled, "Are you sure about that?"
Doctor Cutter laughed, "I promise you won't be drummed out of the surgeons' guild for refusing to think you're a god!"
I laughed, "Pretty much right on target. I believe that, even in the ED, we can provide holistic care and treat patients as individuals, and ensure they are in control of their own healthcare. That means, among other things, asking permission before performing any exam or procedure, unless the patient is so severely injured that seconds count.
"I believe in being approachable, and that means going by my first name, using first names for colleagues, and dispensing with medical coats in most cases. I also believe strongly that medical students should never be assigned pure scut, and that we ought to get them into the hospital more during First and Second Year. And we need to acknowledge that girls are just as good as boys, and sometimes better."
"That matches Doctor Wernher's assessment. He says you do a good job of meeting him partway, while still leading the 'resistance', as it were."
I chuckled, "You've clearly mistaken me for my wife!"
"Ghost indicated she can be outspoken."
"An understatement if there ever was one! Back to the hospital — I do agree with Doctor Wernher's assessment that we've found a modus vivendi and work well together."
"I'm curious what you would change with regard to 'girls and boys', as you put it."
"Too often male doctors treat the profession as if it were Calvin's G.R.O.S.S. club in Calvin and Hobbes." ("Get Rid Of Slimy GirlS")
"And you're Hobbes, looking to have your belly rubbed by Susie Derkins?" Doctor Cutter asked with a smirk.
"So long as by 'Susie Derkins' you mean my wife, then yes!"
"You want Shelly to be Chief Surgeon."
"Because she's the best-qualified young surgeon on the service. Doctor Gibbs should have been Chief of Emergency Medicine, but an idiot with a handgun put an end to that idea."
"I take it you know she's why I called you in."
"Yes."
"According to Dutch Wernher, you have a frank assessment and presented a plan to evaluate Doctor Gibbs' performance."
"I did. And yes, I did say that if she cannot handle it, she should switch to Medicine or work in a free-standing urgent care facility."
"Have you spoken to your ... what should I call Viktor Kozlov?"
"You could say 'father-in-law', and I wouldn't be upset because he is Rachel's grandfather. It's also OK to just use his name. I'm fine either way. To answer your question, no, I haven't spoken to him recently except casually at church or when Rachel visits. Why?"
"There's an interesting proposal being discussed by the Hospital Board — to open a county-sponsored urgent care facility associated with the hospital in the building formerly used by the McKinley Free Clinic."
"I think Doctor Gibbs would be a perfect Medical Director for such a facility," I said.
"Shocking," Doctor Cutter said with a grin.
"I am nothing if not predictable!"
"Are you sure you want to use that line that way?" he asked.
I couldn't help but laugh, "Are you a secret Star Trek fan?"
"I'm a sucker for sexy, redheaded, medical officers!"
"Me, too! I was offended when they brought in Diana Muldaur as Doctor Pulaski. She could have fallen down a turboshaft, and I'd have been very happy! Did you know she was in a pair of episodes in the Original Star Trek?"
"I did. May I ask your favorite Star Trek line?"
"It depends on the series, but for TNG it has to be Worf telling Wesley 'Go to her door, beg like a human'."
Doctor Cutter laughed, "Something with which every teenage boy on the planet can identify, and we can all remember!"
"I do have a favorite parody line, if you'd like to hear it."
"Sure."
"Wesley, the Prime Directive isn't the only thing I've regularly violated while on this ship!"
Doctor Cutter laughed hard, "OK, just wow! I'm somewhat surprised to hear you tell an off-color joke."
"Ask Clarissa Saunders. I can be as «некультурный» (nekulturny) as the next guy, in the right circumstances." ("uncultured")
"That means 'uncultured' or 'uncouth', right?"
"Yes, or 'rude' or 'socially unacceptable' depending on context. Back to this proposed urgent care center — how likely is that to happen, given finances?"
"It's being proposed as a money-saving idea. The cost of treating a patient would be much lower than the cost of an ED visit. It would also help control the volume of patients, which has shown an uptick since the clinic was forcibly closed by the false allegations against Gale Turner."
"I like the idea," I said. "May I suggest a course of action?"
"Could I stop you?" Doctor Cutter asked with a friendly smile.
I chuckled, "Dutch asks that question all the time, and I say that he can, but that he won't. I believe the same is true here!"
"Go on, please."
"Bring Doctor Gibbs back to the ED as I suggested. When the urgent care center is approved, Doctor Gibbs will have demonstrated she's able to handle the level of cases an urgent care center would treat and could be offered the medical director's role. I'd do everything in my power to convince her to take it."
"Because, in your honest opinion, she'll never be able to handle severe trauma cases."
"Her limited mobility and the fact that she needs both arm crutches for stability or to move indicate that is the case. Is it possible she'll be able to walk or stand without them? Yes. Is it likely? Not according to Ortho. It sucks, but it won't stop her from practicing medicine, if she wants to continue to do so, which I believe she does."
"How do you think she'll respond?"
"At first? She'll hate it. But in the end, she'll accept it because it is basically the only way she's ever going to be the head of a service."
"I know I'm treading on thin ice with you on this, but discrimination against what they're calling the 'physically challenged'?"
"It's a fine line," I replied. "In the end, the question is whether or not you can do the job. If Bobby Murphy suffered a similar injury, he couldn't return to duty because he wouldn't be able to do the core job. Loretta could do that in Medicine, urgent care, or private practice. I'd make one modification."
"What's that?"
"Offer her an Associate Professorship in Medicine and have her teach the Emergency Medicine section of Doctoring for Toddlers."
Doctor Cutter laughed, "So that's how you see the Practice of Medicine course?"
"Don't you?" I asked
"Yes, and I have heard you, and other Residents, refer to med students as toddlers, and I may have done that myself in the past."
"May have."
Doctor Cutter shook his head, "Your reputation for being a smart ass is not inaccurate."
"No kidding."
"Don't say anything to Loretta, please, and do not share this with your colleagues."
"Understood. Are you bringing her back?"
"Yes. As of August 1st, along the lines you and Dutch Wernher discussed."
"I believe that's a very good decision."
"I was sure you would."
"Is there any movement on the nurses?"
"It's going to arbitration, so basically, we wait. The County Board did file a complaint about the sickout."
"A foolish move," I replied. "I understand it's tactical, but in the end, we have to work with the nurses, and we need them."
"I don't disagree, but the system effectively forces both sides' hands."
"A friend suggested a likely tactic by the nurses — to decertify their union and form a new one, including techs and orderlies. That would evade the law banning strikes by unions consisting solely of nurses."
"I hope you haven't discussed that with any nurses!"
"I have not. But you can be sure they know it, given the back-to-work order expressly referenced the Ohio statute."
"I'll only ask this one question — was the friend a hospital employee?"
"No."
"OK. That's all I had unless you have something for me."
"No. The only question is schedules, but until the labor dispute is settled, we can't really do much."
"No, we can't. Thanks, Mike."
July 20, 1990, McKinley, Ohio
I left the hospital at 5:00pm on Friday. Mary had come in two hours early to cover the last part of my shift so I could go home, eat, and then get to Shaken Not Stirred for Code Blue's gig. Lyuda came to the house to watch the girls, as Kris wanted to sing our duet, despite it only being a month since she'd given birth.
"You know what today is, right?" I asked as we drove towards the bar.
"Besides the concert? No."
"The twenty-first anniversary of the Apollo 11 Moon landing."
"Knowing that fits with your love of science fiction!"
"Please, please, please tell me you are not a Moon landing denier!"
Kris laughed, "No, of course not! It simply fit that someone who enjoys Star Trek would be interested in a program that spent billions of dollars, which could have had much better use if directed to social services."
"Not even close, my dear socialist wife!" I declared. "We spend FAR in excess of what was spent on the entire Apollo program each year, and yet we still have poverty, hunger, and homelessness. Not to mention the scientific and technological gains made by the space program, including materials technology, communications, miniaturization, and a host of other things."
"Tang?" Kris asked with a smirk.
"Invented in the 1950s, not for the space program as some would have you believe. That story is as apocryphal as the one about the US spending a million dollars to invent a pen that could write upside down or in weightless conditions, while the ingenious Soviet Union simply used pencils."
"What did the US actually use?"
"Mechanical pencils, but they were expensive, so NASA sought an alternative. Regular pencils were flammable, so NASA let it be known they were looking for an alternative. Paul C. Fisher of the Fisher Pen Company spent something on the order of a million dollars developing a pen that could write not just upside down or in weightlessness, but also at extreme temperatures and underwater. NASA adopted it and bought quantities at a reasonable price."
"Interesting."
"Even more interesting is the apocryphal tale of Neil Armstrong saying, 'Good luck, Mr. Gorsky' while he was on the Moon."
"There obviously is an interesting story there."
"Obviously! According to the legend, at a press conference after the Moon mission, a reporter asked about the cryptic phrase. Armstrong answered that because Mr. Gorsky had died, he felt he could answer the question. As the story goes, when Armstrong was a kid, he was playing baseball with his brother in the backyard. His brother hit a fly ball which landed in front of his neighbors' — the Gorskys' — bedroom window. As Armstrong leaned down to pick up the ball, he heard Mrs. Gorsky shouting at Mr. Gorsky, 'A blowjob? A blowjob you want? You'll get a blowjob when the kid next door walks on the Moon!'"
Kris laughed, "That's too funny. Would you like one later? You don't even have to wait for the neighbor boy to walk on the Moon."
"Only a great fool would turn down such an offer! And Clarissa's opinion to the contrary, I am not a great fool!"
"I have my gynecological exam next Thursday. Perhaps you would like to make love on Thursday evening?"
"Perhaps I would!"
July 21, 1990, McKinley, Ohio
"How was your concert?" Mary asked when I arrived at the hospital early on Saturday morning.
"Great, as always," I replied. "Kris decided to sing our duet, which I very much enjoyed."
"And gave your sister-in-law time to start teaching Charlotte to speak French!"
I chuckled, "I'm positive that was a lost cause the moment I married Kris. How was overnight?"
"A usual stupid July Friday night — MVAs, drunks, fights, and the odd MI to keep things real. Two drunks sleeping it off; the two pugilists are waiting on admission due to matching broken noses and orbital bones, and I suspect misdemeanor charges for the bar they wrecked during their fight; one MVA victim went to surgery, three others treated and released; a STEMI who was basically DOA, and a STEMI taken to the cath lab. Only one procedure — chest tube on the MVA. That said, the two hours I covered for you were quiet. Did you get hit on?"
"Does my wife propositioning me count?"
Mary laughed, "No! That's kind of the default, isn't it?"
"Pretty much. I did see several girls I know, but they all know I'm married and that I have no intention of even considering such an offer."
"I honestly never understood why someone would want to be with a cheater," Mary said.
"Me either, though I suppose if it's just for physical pleasure, I could understand, even if I would never do it. It's the ones who think the cheater will not cheat on them that just baffle me."
"Me, too. One of the new Residents, and I won't say the service, but not ours, is in the process of divorcing her doctor husband, whom she married as a Second Year after they had an affair during First Year. Guess why?"
"Said doctor couldn't keep it in his pants."
"Correct. He can't contest because if she revealed WHO he cheated with, he'd be suspended or dismissed."
"Another thing I don't understand — a doctor who wants to get laid has all manner of opportunity outside the hospital, not to mention nurses, nursing students, and the few candy stripers who are left. Why break the rules and risk dismissal?"
"The dick wants what the dick wants?" Mary asked.
I chuckled, "Is that true for pudenda as well?"
Mary laughed, "Seriously? You can't say 'pussy'?"
"I could but it was funnier to use a Latin term we generally don't use in medical conversations! Not to mention it technically could be used for either sex, though it's mostly for females when it is used."
"To answer your question, I'm positive you know girls like sex just as much as guys, but societal pressure discourages females from engaging in sex while celebrating male sexual prowess. I also suspect you object to that just as much as I do, AND you agree about medicine being stupidly prudish despite doctors going at it like bunny rabbits on speed!"
I chuckled, "And guess who, therefore, gets all the cases that have anything to do with sex?"
Mary laughed, "Condom extract? Locked braces?"
"And others over the years, not to mention the cases at the Free Clinic."
"Did you hear Planned Parenthood acquired space?"
"No. Where?"
"On Kenworth Drive, across from the factory."
"Thus, not in McKinley, and a less convenient place for picketers. That makes sense. Now we just need a new Free Clinic, but I'm not sure where the money would come from."
"Maybe the organization that sponsored it in the past?"
"According to my friend Lara, they've been approached but are not interested. You can't really blame them."
"I suppose not."
"Doctor Mike?" Nurse Angie said. "The Sheriff is bringing in a woman who the nurse at the jail says has high blood pressure. ETA is about five minutes."
"Thanks. Are there any more details?"
"No."
"OK."
I went to the lounge and collected Marissa and Taryn, and Jamie joined us in the ambulance bay. A few minutes later, a cruiser pulled up, and Deputies Scott Turner and Mary Sparks climbed out of the car. Deputy Sparks went to the rear door and assisted a young woman whom I suspected was around eighteen and visibly pregnant, out of the car.
"Let's get her in a wheelchair, please, Taryn," I said. "Scott, can we get the cuffs off, please. Hospital policy does not allow pregnant women to be cuffed, even in front."
Taryn brought a wheelchair around, and Deputy Sparks removed the handcuffs.
"This is Amanda Reed," Deputy Sparks said. "She complained of a headache and feeling flushed. The nurse checked her, and her BP was 150/110, and she has swelling in her feet."
"Exam 4, please, Taryn," I directed.
We all moved to Exam 4.
"Scott, I'll ask you to wait outside," I said to Deputy Turner. "Amanda, are you OK with the female deputy hearing your answers to medical questions?"
"No," Amanda replied. "I most decidedly am not."
"Mary, you'll need to step out as well. Obviously, you're free to guard the door."
"Doc..."
"She has a right to privacy," I replied. "A new policy went into effect on July 1st with regard to pregnant women."
"And it applies to Law Enforcement?" Deputy Sparks asked.
"Yes. When she's discharged, she'll be given a sealed copy of her treatment records to be given to the jail nurse."
"Fine," Deputy Sparks said unhappily.
She stepped out, and I waited for the door to close.
"Amanda, you have a right to have a female physician if you choose, along with a female nurse. Are you OK if Jamie and I treat you?"
"What about those two?" she asked, nodding to Marissa and Taryn.
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