Good Medicine - Residency II

"Uhm, Daddy, will you be mad if I say you should go in the hall?"

"No, Princess, I won't."

He got up and left the exam room with me.

"I understand a bit of what you're going through," I said. "My wife died shortly after giving birth to our daughter."

"Jesus," Mr. Peterson breathed. "That sucks, Doc."

"It does. I've since remarried, but it was a scary time when it was just Rachel and me."

"I try my best, but I can't be her mom."

"No, but you can be her dad. She seems like an intelligent, mature young woman, and that tells me you're doing a great job with her."

"Yeah, but what do I know about what my wife and I used to call 'girl stuff'?"

"There are very good books available from the library, and I can give you some pamphlets. Mostly, you just need to be there for her. Would you like some coffee or a Coke?"

"Coffee would be good."

I led him to the lounge and poured him a cup of coffee. I got a bottle of water from the fridge to drink, and about ten minutes later, Amelia came into the lounge.

"You were right, Mike," Amelia said. "I'd say about two months accumulation."

"What?" Mr. Peterson asked.

"I'll take this, Amelia," I said. "Mr. Peterson, your daughter has a very minor medical condition called an imperforate hymen. What that means is that she has her monthly cycle, but the blood cannot flow out. It's easily resolved, and there is no lasting damage."

"I'm clueless," he said.

"Not to worry," I replied. "I'm sure you at least have a vague idea of the 'hymen' or what is colloquially called a 'cherry'?"

"Only what I know from what other guys have said."

"It's a thin membrane that covers the opening to the vagina, just inside. Usually, it has one or more small holes which allow menstrual blood to run through. In some small percentage of women, those holes do not exist. When that happens, the blood builds up behind it, and that's what's causing your daughter's symptoms."

"How do you fix it?"

"Doctor Lockhart?" I prompted.

"We'll give your daughter a mild sedative and a mild muscle relaxer and make two small incisions to allow the blood to run out. There might be a tiny bit of pain, not all that different from receiving an injection. She'll be able to go home about two hours later."

"Can you explain it to her?"

"Of course. Mike, I have this one. We'll take her upstairs by wheelchair."

"Thanks, Amelia. Mr. Peterson, you're in great hands."

"Thank you, Doctor."

"Joe, with me, please," Amelia said. "Mr. Peterson, if you'll come with us."

They left, and a minute later, Gabby came into the lounge.

"How did you know that just off the top of your head?" she asked.

"You know the answer!" I replied.

"Flashcards."

"Flashcards. Add this to your deck. Ron, do you use flashcards to study?"

"Yes."

"Good. Do the same. And study all the time. Carry part of your deck with you at all times. I still do."

August 10, 1990, McKinley, Ohio

"You asked to see me?" I said to Leland Crowe when I went to his office late on Friday afternoon.

"Yes. The trial is set to start on November 5th. It's my intention to call you as the first defense witness, but I don't know when that will be because I can't predict how long it will take for the plaintiff's witnesses to testify. It could be anywhere from three to five days."

"OK. I assume you'll let Owen Roth and Dutch Wernher know?"

"Yes, of course."

"What happened with the additional depositions?"

"Melissa Bush refused to give a deposition; Mo Rafiq gave a scathing deposition, which we expected. Neither Tim Burg nor Krista Sandberg said anything that could be of any use to the plaintiff, nor did they say anything that would help us."

"May I see Mo Rafiq's deposition?"

"Yes. One reason I wanted to see you is to set up a series of two-hour blocks over the next five weeks so I can prepare you. I'll speak to Doctor Roth and Doctor Wernher about that. As for the depositions, I had planned to create summaries — Cliff's Notes versions, if you will. Because you asked, I'll provide you with the complete transcript from Doctor Rafiq. I'm of the opinion that your procedure book, as well as other testimony, and your natural charm, will overcome what are obvious exaggerations by Doctor Rafiq."

"I've been told by several attorneys that juries are unpredictable."

"Including me, but in this case, a likable, friendly, down-to-earth doctor is going to shine. Arthur Braun will try to get under your skin; don't let him."

"I've dealt with the man before. He's had lousy hands in the previous cases; he has a very good one now, and that means I have to be very careful."

"Yes, it does. I did review all of those previous cases, even the ones where I was involved, and you're right — those were loser cases, but each time he gleaned information he could use in the future, and all he needed was one win. He's going to get it here, and our goal is damage limitation."

"Which is where I come in."

"Yes. Just be aware that if Arthur Braun recalls a witness, which he can reserve the right to do, I may need to call you back to rebut the rebuttal."

"I'm going to assume that can't go ad infinitum."

"No, it can't. I've never once seen a witness called for a third time, or even heard of one. In theory, it could happen, but I don't believe it's a real concern."

"If there's nothing else, I'm going back to the ED. I'll wait to hear from you, Owen, or Dutch about the prep sessions."

"Thanks, Mike."

I left his office and returned to the ED, where my students were, in effect, cooling their heels in the lounge, as there had been very few walk-ins during the afternoon. That ended about ten minutes later when Nate let us know about a multi-victim MVA with four patients being transported. Fortunately, three of them were only slightly injured, and the fourth — an unbelted passenger — had only moderate injuries, which included a severe contusion to the head and a broken wrist.

When we finished treating and admitting that patient for observation, I joined Janelle Greene from Pediatrics and John Abercrombie from Medicine for dinner. After dinner, my students and I handled a non-STEMI, then at 8:00pm, I headed upstairs for a shower, after which I headed home.

August 11, 1990, McKinley, Ohio

On Saturday morning, Rachel and I went to band practice, though it was shortened, as we were performing at the Music Festival at 3:00pm.

"Mike, is your schedule going to be better as you had hoped?" Kim asked before we started playing.

"Yes. I'll work 5:00am to 5:00pm Monday through Friday.

"Then I'll see what gigs are available. We do have the Taft and Goshen gigs on tap."

"I remember."

"OK, then let's practice!"

We ran through our set and encores twice, and when we finished, Rachel and I went to Kroger to do our weekly grocery shopping.

"I like Papa time," Rachel said as we walked into the store. "I miss you when you are gone."

"I like Rachel time," I replied. "I miss you when I'm gone, too. You know Papa loves you, but he has to help sick people at the hospital."

"I love you, Papa!"

I picked her up and put her in the cart. She wanted to help, but most things we bought were either on a shelf out of reach or too heavy for her to lift. I did allow Rachel to place the order at the bakery and allowed her to hand the money to the clerk, which made her happy.

At home, we put away the groceries, had lunch as a family, then headed for Milton Lake for the start of the Music Festival so we could hear other groups play. Abi was there with Milena and Joel, much to Rachel's delight, and the two of them found a small group of girls their age with whom they could play.

"Rachel expressed unhappiness with how much I'm away," I said to Kris. "Unfortunately, there isn't much I can do about that."

"You'll be on a better schedule starting next month, right?"

"Yes. Doctor Roth confirmed that yesterday — 0500 to 1700 weekdays, alternating weeks between surgery and the Emergency Department."

"That should make Rachel happier."

"Yes, it should. I'll be glad to see more of all three of you, and it will be nice to have family dinners together."

"Has anything changed with the nurses?"

"The new union was formed, together with the technicians and the few remaining orderlies. That reset the clock on negotiations, and it will be months before there's a risk of a strike, based on Ohio labor law. With the new tax levy, there may be enough money to provide a slightly larger raise than was offered, but most of that has to go to operating the new ED and new surgical wing."

"You know my opinion," Kris said.

"I do, but that actually wouldn't change anything in this case because the nurses are already government employees, and they're negotiating with the government!"