Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 43: «Lasciate Ogni Speranza, Voi Che Uscite»
July 29, 1990, McKinley, Ohio
The rest of the week had been routine, with the usual collections of MIs, MVAs, and walk-ins, and I was very happy to be in church for the Baptism and Chrismation of my second daughter. Because we had begun regularly attending services at Saint Michael the Archangel, Vladyka JOHN was in attendance to perform the ceremony, as he had requested in March.
The Bishop elected not to serve a Hierarchical Divine Liturgy, so following Matins, Charlotte was handed over to Serafima and Elias, who would serve as her godparents. Following the usual pattern, Vladyka JOHN gave the initial blessing, followed by the prayers of exorcism. Once those were complete, and the affirmations of renouncing Satan were complete, we recited the Niceno-Constantinopolitan Creed.
Following that, the actual baptism service commenced with Father Nicholas, acting in the place of a Deacon, singing the Great Litany, then the Bishop blessing the baptismal waters and pouring olive oil three times into the water in the form of the sign of the cross. Once that was complete, he anointed Charlotte with olive oil, then took her from Serafima, who had removed all of Charlotte's clothing.
In traditional Orthodox fashion, Vladyka JOHN immersed Charlotte in the water three times in quick succession, saying, 'The Handmaiden of God, Charlotte, is baptized in the name of the Father, and of the Son, and of the Holy Spirit!' each time. When he finished, he handed Charlotte back to Serafima, who dressed Charlotte in a white baptismal gown.
After the chanter read a Psalm, Vladyka JOHN anointed Charlotte's forehead, eyes, nostrils, lips, ears, chest, hands, and feet with chrism, each time saying, 'The seal of the gift of the Holy Spirit!' and the congregation responding, 'Seal!' as was our local tradition.
This was followed by chanting, 'As many as have been baptized into Christ have put on Christ' three times, followed by the Prokeimenon, the Epistle, and the Gospel passage, which Father Nicholas sang. The service was completed with the Rite of Ablution, where Vladyka JOHN used a sponge to wash the chrism from Charlotte, and finally, the Rite of Tonsure, where a small lock of Charlotte's hair was clipped and then burned in the censer.
At that point, he carried her through the Royal Doors into the altar and held her over the altar table. He said a quiet prayer, then returned out through the Royal Doors. He handed Charlotte to Serafima, then moved to his cathedra, where he would participate in the services, but not lead them.
We proceeded directly to the Divine Liturgy, served by Father Nicholas with assistance from Subdeacon Mark. As was our custom, Charlotte was the first to receive the Eucharist, carried forward by Serafima and Elias. After the service, we had a celebration lunch with the congregation, then Vladyka JOHN asked to speak with me.
"How are things at the hospital?" he asked.
"Improving, I think. My schedule will change as of Wednesday; I'll work only fourteen hours a day, and no work on Saturdays. Almost equally important, Doctor Gibbs is returning to work on Wednesday."
"She's recovered?"
"She needs forearm crutches, but she'll be able to see patients. She is slowly regaining improved use of her legs, but nobody knows how far that will go. There is far too much we don't understand about spinal cord injuries."
"I will continue to keep her in my prayers, as well as the doctors caring for her. I know you missed your visit with Father Roman because of your schedule; do you have a new date set?"
"No. I intend to call him tomorrow, now that I have Saturdays free. I also missed my visit to the prison, but I sent word to the men through Protodeacon Ivan that I had to work. I intend to visit on the 18th."
"Very good. How are things between you and Kris?"
"In one sense, very good; in another, I haven't seen her and my daughters as much as I would have liked. I don't think there are any problems, and Kris is not one to be silent if there is something that bothers her!"
Vladyka JOHN laughed, "Not many of our women are! And that's mostly a good thing. The Church in Russia has survived only on the strength of faithful women."
"It will be very interesting to see how the Russian people respond to freedom. I expect it to be mostly with joy and industriousness. Russia has many advantages, so long as she doesn't squander them."
"Do you plan to visit?"
"It's something I had always hoped to do, and now it seems possible without great risk."
"A trip I should like to make, if only to worship in the great Cathedrals in Moscow and Saint Petersburg."
"I'm hoping for the restoration of that name," I observed. "I think it is likely to happen; far less likely is for Istanbul to be renamed Constantinople."
"I think that awaits the return of our Lord!" Vladyka observed.
"Me, too! The last thing we need is the war THAT would cause."
"Do you believe the Soviet Union will completely dissolve?" Vladyka JOHN asked.
"My grandfather believes that the Muslim republics will go their own way, with loose alliances with Russia. Belarus will likely be more strongly allied, and, well, Ukraine will be Ukraine. There will be conflict over territory that is largely ethnic Russian, though hopefully both nations will allow the people to decide."
"What chance do you give that?"
"Near zero. Ever since the Congress of Vienna, diplomats have tried to draw national boundaries that ignored ethnic borders. That worked no better than military conquest, as proved by the Franco-Prussian wars, World War I, World War II, Korea, Indo-China, and colonial Africa."
"I didn't take you for a pessimist, Mike," Vladyka said with a smile.
"A realist, Vladyka. If there is one constant in this world, it is military conflict, which has happened since the first group of humans settled and claimed space as their territory."
"Sadly, which is why we always pray for peace in the world, and seek to end all conflict without violence."
"If only that were possible in this world."
"If only. Are you in need of anything?"
"No, Vladyka, I am not. Thank you for asking. Do you need anything from me?"
"Not beyond that which you are doing. You do plan to return to teaching Sunday School in the Fall, do you not?"
"I do."
"Good."
I asked his blessing, and once he gave it, I found Kris and the girls, and we headed to visit Loretta, Bobby, and Bobby Junior for what would likely be the last regular Sunday, given Loretta was returning to work on Wednesday.
July 30, 1990, McKinley, Ohio
On Monday, I took the time to complete my evaluations of Al Baker and Molly Sexton, as well as provide input to Mary for Tom Lawson and Nelson Jones, and finally, to Naveen Varma, for my Saturday students who mostly had worked under him. Once I'd completed Al's and Molly's evaluations, I presented them, along with the letters of recommendation I had written for Al and Tom.
I didn't particularly like administrative work, but that was FAR preferable to dealing with the legal case that Arthur Braun and Amanda Temple were continuing to build against the hospital and, specifically, Paul Lincoln and Ross Burnside. The only positive result of their examination of my procedure book was that they did not issue any subpoenas against other doctors at the hospital. What they had done was subpoena Melissa Bush, Tim Burg, Krista Sandberg, and Mo Rafiq, as well as subpoena the transcripts from the hearing for Doctor Jules Greenberg.
It was blindingly clear to me they were going to try to undermine my testimony, and Mr. Crowe agreed. That was a concern, but a bigger concern was the potential damage they could cause regarding my medical license, which I could apply for in just under a year. Everything would depend on the tenor and tone they took, and after a call to Melody Coates, my concerns were not allayed.
"I'm going to retain private counsel," I said to Mr. Crowe. "I'm invoking the hospital rule that covers those costs when I'm being called as a witness for the hospital."
He nodded, "That is what I told the Hospital Administrator and Medical Director after our chat earlier. Do you intend to alter your testimony in any way?"
"No. Melody agrees that they're going to try to throw as much mud as they can and see what sticks. After chatting with her, I'm not too concerned about Melissa Bush, though I would strongly encourage we honor her request to have someone qualified for surgical procedures in the ED go there and train them."
"Risk Management nixed that, and I had to agree with them. I still think that was the right decision, but if we were to change it, it would have to have been before they asked for the subpoena. At this point, it would look like we were, in effect, trying to buy her testimony."
I sighed, "Unfortunately, I can see how that would look bad. Forget I mentioned it."
"Mentioned what?" Leland asked with a smile.
"Thank you. As for Burg, well, the record speaks for itself. And for Mo Rafiq, ask Shelly Lindsay, Loretta Gibbs, or any of his female medical students. I'd wager the LAST thing he'd want to do is have that on the record."
"I agree, and I'll attend any deposition with him, and I'll be able to ask questions. I'll speak to Doctor Lindsay and Doctor Gibbs, at least, beforehand. Is there anyone else about whom I should be concerned and whom they haven't named?"
"The entire Psych staff besides Maureen Bishop," I replied.
"We're aware of that, as is Volstead & Braun, and they haven't subpoenaed them. It's my opinion they believe they would undermine the case."
"Then why the subpoena for the records from the Medical Board?"
"I would say simply as a long shot that you contradict yourself in some way. Given you have your own counsel, I'm not permitted to advise you on that."
I nodded, "Melody made it clear that I need to state that my opinions there were given as a layman and bang that drum the entire way."
Mr. Crowe nodded, "Wise counsel. I'll have a chance to rebut anything they twist, and I will object if they state clearly, rather than imply, that you gave evidence as a physician. Ms. Coates may, of course, petition the judge for an order of protection, if she feels it necessary."
"She does," I replied with a smile. "But she won't ask for it until after the final pre-trial conference and the setting of a date. Is it true they can't add additional witnesses or subpoena anyone at that point?"
"Yes and no. A judge can always allow it, but they look askance unless a specific rebuttal witness is necessary to testimony which they didn't expect. Given the extensive depositions, that's going to be a difficult argument to make."
"I don't know; Braun appears to have been surprised by some things in the hearing before the Medical Board."
"A different venue, with different rules. Trust me, that won't happen in this trial. If there is anything surprising, it'll arise from something he elicits from his witnesses that we missed, not from one of ours, and we'll be the ones who might need a rebuttal witness."
"I'm curious about that. What might you have missed?"
"If I knew the answer to that, I wouldn't have missed it!" Leland said with a grin. "There are four possibilities with regard to knowledge, and I'm sure you, with your logical mind and your medical training, know them."
I nodded, "Things of which we are aware, and we understand; things of which we are aware and do not understand; things which we are not aware but understand; things of which we are not aware nor do we understand. I know that sounds confusing and a jumble, so let me give a pair of examples.
"An example of a 'known unknown' would be gravity — we are implicitly aware of it and can observe it, but we have no idea how it actually operates and don't know what it actually is. The 'unknown unknowns' are often called 'Black Swan' events – events that are rare, and which are beyond the realm of normal expectations in history, science, finance, and technology. For the Romans, who coined it, black swans did not exist."
"Exactly right," Leland said. "It is one of the most important things I learned in law school — nothing can predict a Black Swan event, and you never see it coming."
"I'm curious, but what else is on that list?"
"Nobody, and I mean nobody cracks under examination the way they did in Perry Mason!"
I laughed, "Every single time! It was a trope!"
"Yep. The other one is, of course, the proverbial 'never ask a question to which you do not know the answer in open court'. Sometimes the 'in open court' is left off, but that's an error because the point of depositions is to ask those questions so you don't get caught out in court.
"The thing is, sometimes you are in a spot where you need to ask a question for which you don't know the answer. It happens, and all manner of trouble can arise, which is why you prepare. As an attorney, you cannot look surprised, and you must continue as if it were the most natural answer possible and try to recover. If you're properly prepared, you can do that.
"It's also the case that's only for civil trials. In a criminal trial, no witness has to speak to anyone, not even the cops. In most states, there are no depositions or interrogatories, nor any other way of questioning a witness. They might have been called before a Grand Jury, but that testimony is sealed. So, in criminal defense cases, you DO have to ask those questions. Do you have time for an apocryphal anecdote that has made the rounds of the legal community?"
"Sure."
As legend has it...
In a trial, a Southern small-town prosecuting attorney called his first witness, a grandmotherly, elderly woman, to the stand. He approached her and asked, "Mrs. Jones, do you know me?"
She responded, "Why yes, I do know you, since you were a little boy, and frankly, you've been a big disappointment to me. You lie, you cheat on your wife, and you manipulate people and talk about them behind their backs. You think you're a big shot when you do not have the brains to realize you'll never amount to anything more than a two-bit paper pusher. Yes, I know you."
The lawyer was stunned. Not knowing what else to do, he pointed across the room and asked, Mrs. Jones, do you know the defense attorney?
She replied, "Why yes, I do. I've known Mr. Bradley since he was a youngster, too. He's lazy, bigoted, and he has a drinking problem. He can't build a normal relationship with anyone, and his law practice is one of the worst in the entire state. Not to mention, he cheated on his wife with three different women. One of them was your wife. Yes, I know him."
The defense attorney nearly died.
The judge asked both counselors to approach the bench and, in a very quiet voice, said:
"If either of you idiots asks her if she knows me, I'll send you both to the electric chair."
I couldn't help but laugh hard.
"That's awesome! It's too bad that never happened!"
"As my law school buddy said when he sent it to me last year, something similar has had to have happened at some point in the long history of English Common Law, which is why it resonates."
"My teacher in High School Civics said that we've effectively abandoned Common Law."
Leland nodded, "Since the decision in Erie v. Tompkins in 1938, where the Supreme Court stated that 'there is no general federal common law', overruling a decision from about a century earlier. We still have many of the forms and features of common law, but nearly everything is now statute-based, both at the federal and state levels. There are some exceptions, but that's a specialist situation outside my expertise, much as chemotherapy is outside yours."
"I'll pass on both of those, thanks," I said.
"Me, too! I couldn't do your job."
"Nor I yours."
"I'll keep you posted. The judge gave them two weeks to complete the three depositions, and he authorized conducting them by telephone if necessary. Of course, with out-of-state depositions, there is no guarantee they'll be able to enforce the subpoenas. They usually can, but not always. Our next pre-trial conference is on August 10th. Hopefully, that will be the last."
"I'd prefer to put this all behind us."
"As would I," Leland agreed.
We shook hands, and I returned to the ED, hoping to actually practice medicine. My hopes were fulfilled by a steady stream of patients that lasted until my shift ended at 9:00pm. After a quick shower, I headed home.
July 31, 1990, McKinley, Ohio
"Mo Rafiq!" Shelly Lindsay growled. "That «sphincter ani externus» has NOTHING to say!"
Clarissa, Carl Strong, and I all laughed.
"You should use «мудак» (mudak)," Clarissa declared. "You really don't have to worry about random Ohioans speaking Russian!" ("asshole")
I laughed, "Yeah, other than half my church, you, Anicka Blahnik, and Mary Anderson, at least with regard to the key profanities!"
"Stop being pedantic!" Clarissa commanded.
"You'd have more luck telling him to stop breathing!" Carl Strong observed, causing the rest of us to laugh.
"What happened, Shelly?" Carl asked.
"A comment in Mike's procedure book by Mo Rafiq led the attorneys for Ken Webber's family to issue a subpoena."
"What did he write?" Carl asked.
"That he was required to teach me a procedure against his own judgment," I replied. "He was covering his ass in case something went wrong."
"What was the procedure?" Carl asked.
"A chest tube. Shelly, I think you saw my evaluation of Doctor Rafiq as a teacher."
"You said 'You suck!' in the appropriate way."
I chuckled, "What I wrote was that he was an 'ineffective teacher, and insensitive to the holistic needs of his patients, especially females'."
"Translation," Shelly said, "Uncaring, sexist pig. Debbie Sherman actually used those words because of his insistence on ignoring a woman's wishes with regard to a uterine resection. She was one of many in the line of female medical students and patients to complain about Doctor Rafiq."
"What did Leland Crowe have to say?"
"He notified the attorneys he'd call rebuttal witnesses for anything Mo Rafiq might say."