Chapter 50: A New Routine

September 2, 1990, McKinley, Ohio

In order to be able to attend Jeremy and Sheila's wedding, Kris and I attended Matins and the Divine Liturgy at Saint George in Loveland, but left before the reception in the parish hall had finished, so we could get to the Country Club for the extended family celebration of Rachel's birthday.

She was, of course, in her element, having her third birthday party in eight days. I was happy to see my grandfather, as I had not had an opportunity to speak with him at length in some time. The gathering allowed that, as Rachel was the center of attention and was very happy about that.

"How have you been, Mischa?" my grandfather asked.

"Overall, pretty good, «Дедушка» (dedushka)," I replied. "As you can see, Kris and the girls are all healthy and happy. How are you?" ("Grandpa")

"Your grandmother and I are in good health for our ages, and I have very little about which I can complain except for the foolishness in the Middle East."

I frowned, "American soldiers and sailors are going to be in harm's way because our diplomatic efforts were inept."

"The problem is intractable," my Grandfather observed. "The British and French made a complete mess of the Middle East following World War I."

"Just as they did in Africa and Southeast Asia," I replied. "Of course, they had help in Africa from Germany, Portugal, Spain, and others."

"Sadly. If only men could learn to live together in peace," my grandfather lamented.

"Something for which the Church has been praying since the First Century, and which will come to pass only when we live together in the throne room of God."

"Sooner for me than for you," my grandfather said with a smile, showing he wasn't being morbid.

I nearly said, 'unless something happens to me', but my conversation with Father Roman acted as a filter.

"I hope that will not be for a long time, «Дедушка» (dedushka)." ("Grandpa")

"As do I; your grandmother, I'm not so sure!"

That last bit was said with a twinkle in his eye.

I chuckled, "We Borodin men can be quite difficult, and I believe all the women in our lives would agree! How is Alex?"

"He doesn't like TWA as much ever since Carl Icahn bought the airline, but he's happy in his job. Your cousin Diane is pregnant and is due in March; your cousin Jack is working at TWA, where he schedules planes."

"I'm not surprised by either of those. Do any of them go to church?"

"No. Aleksey has ensured none of them have any love for God. I pray for them daily."

"As do I."

"How are things at the hospital?"

"Mostly good. I have to testify in a wrongful death suit in November."

"Your mother told me about that; she said you have no fault."

"With regard to the patient dying, I agree. I'm positive Mom could list my faults, and the list would be long!"

"Mine, too," my grandfather chuckled. "Rahil is a determined woman and does not hold back her opinions!"

"I might have some experience with that," I chuckled.

"Eh, it is the lot in life for Orthodox men! That is why God gave us vodka!"

I laughed because I knew my grandfather was teasing. He wasn't teetotal, but he was careful how much he drank, though not as careful as I was. Unfortunately, that ended our private chat, as dinner was served, and I sat with my wife and daughters.

We all had a very enjoyable time, and after a wonderful meal, followed by cake and ice cream, Rachel opened a haul of presents from her three sets of grandparents; five great-grandparents; a pair of aunts — my sister and Lyudmila; and an uncle — Geno.

The only downside, from my perspective, was that my dad and Holly had declined our invitation. More unfortunate was that, with everything going on in my life, the opportunities I'd have to see him and my half-brother and half-sister were limited. I pushed those thoughts from my mind and enjoyed the rest of the evening with the extended family.

Because the entire extended family was Orthodox, we said evening prayers as an extended family, then everyone said 'goodbye', wished Rachel a final 'Happy birthday!', and we all headed home. Kris and I got Rachel and Charlotte into bed, then enjoyed a warm bubble bath and some lovemaking before snuggling together to fall asleep.

September 3, 1990, McKinley, Ohio

The only real change for Monday morning was that I received a new Fourth Year, or MS4, as I was supposed to refer to them — Lauren Peterson. I knew her, but she'd never been assigned to me.

"Morning, Lauren," I said when I walked into the surgical locker room.

"Hi, Doctor Mike! How does this work?"

"You put your head through the big hole, your arms through the little holes!"

She laughed and rolled her eyes, "I know how to put on scrubs!"

"Obviously," I chuckled as I began to change. "We're on call for surgical consults and EMS transports. We'll respond with the primary physician for all MIs and any traumas transported, as well as the usual surgical consults requested by other ED physicians. If the circumstances necessitate, we may see some walk-ins, but that won't be the norm. Generally speaking, there won't be any babysitting or even handovers from Mary, as we're not supposed to be primary on cases. Have you decided on a specialty?"

"Cardiology with a cardiothoracic surgery subspecialty."

"A long way of saying 'heart surgeon'," I replied. "Then I'll do my best to teach you the procedures, but I cannot allow you to do any that require a scalpel. That said, I'll make sure you know how to do them so you can hit the ground running wherever you Match. Are you planning to Match here?"

"I'm going back to Arizona, preferably Phoenix, but Tucson or Mesa would be OK. My family lives southeast of Phoenix."

We finished changing and arrived in the ED about two minutes before my shift started.

"How was overnight?" I asked Mary Anderson.

"Relatively quiet all around. Sunday nights are pretty calm. Two consults; one EMS for a trip and fall. No procedures. See you tonight at 5:00pm."

She left, and I checked in with Tracey at the clerk's desk, then erased Mary's name from the 'On Call Surgeon' spot and wrote in my name. Lauren and I went into the lounge, and I poured myself some coffee.

"May I see your procedure book, please?" I asked.

Lauren handed it to me, and I quickly read through her Sub-I in cardiology and her first four weeks in her surgical Sub-I.

"Ward duty, and you didn't get into the OR even once?" I asked.

"Doctor Kennedy wasn't asked to scrub in, so no."

'Doctor Kennedy' was Sue Kennedy, the female half of the married PGY1s. I wondered if it was just the luck of the draw or if there was some concern about Sue Kennedy, given that not scrubbing in even once during the third month of PGY1 was slightly out of the ordinary.

"Did you learn to read EKGs during your cardiology Sub-I?"

"I can identify irregular readings, but not tell you the condition."

"That's sufficient for our purposes as surgeons in the ED. Do you have a second cardiology Sub-I scheduled?"

"It's my last one of the year," she replied.

"That's obviously after you interview and Match, so from now until you interview, spend as much time as you're able learning the various rhythms and what they indicate. The more you know for your interviews, the better you'll look to the hospital."

"Mike?" Nurse Becky said from the door to the lounge, "Doctor Jefferson has an incoming MVA."

"On our way!" I said. "Lauren, let's go."

We grabbed our protective gear on the way to the ambulance bay and joined Letitia, her two students, and Nurse Angeline.

"Morning, Letitia."

"Morning," she replied. "Rollover, single victim. About a minute."

Because it was still before 6:00am, I didn't hear sirens, but did hear the air horn when they went through the major intersection about a half-mile from the hospital. About twenty seconds later, Squad 5 turned into the driveway, and a few seconds later, pulled up in front of us.

"John Kellogg; nineteen; restrained driver, rollover MVA; twenty-minute extraction; severe laceration to the left temple; GCS 4; crush injuries to both legs; BP 80/50; pulse thready at 120; PO₂ 95% on five litres by mask; IV saline and a unit of plasma."

"Trauma 1!" Letitia ordered. "Jacqui, call neuro and ortho!"

"Lauren, we'll need an Attending and another nurse," I said as we began moving. "Find Doctor Mastriano."

Both Jacqui and Lauren hurried ahead, and the remaining five of us, which included the two paramedics, moved Mr. Kellogg to the trauma table. Letitia gave instructions, and we began to work.

"Hang another unit of plasma!" Letitia called out to Angeline.

"I suspect a skull fracture," I announced as I examined the head lac. "Pupils are sluggish. Recommend prophylactic mannitol, IV push!"

"Do it!" Doctor Mastriano ordered, coming into the room with Nurse Becky. "Letitia?"

"Good airway, good breath sounds, sinus tach; I suspect internal bleeding, but I had Mike check the severe head lac first."

She and Doctor Mastriano began checking Mr. Kellogg's legs while I palpated his belly.

"Rigid belly; Lauren, ultrasound, stat!"

"Weak distal pulse," Letitia said. "Compartment syndrome."

There were just too many things wrong with this patient, and I was resigned to how it would end. Despite three doctors, three nurses, and three med students all working on Mr. Kellogg, we never managed to stabilize him, and he coded about ten minutes after he'd arrived.