Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 54: Nothing Says We Can't Root for the Good Guys
October 8, 1990, McKinley, Ohio
"Fourteen is really young," Kelly observed after Becky left the lounge.
"It is," I replied. "Our job does not involve moral judgments about the reason a patient presents — that includes people in custody or brought here from jail or prison. To make the point, I was involved in treating a patient who was in custody for murdering a friend of mine."
"Whoa!" Kelly gasped. "That just ... well, how could that even make sense?"
"Because our oath does not have any exceptions. The rapist and his victim receive the same medical care, to the best of our abilities. If you can't commit to that, you should go see Doctor Mertens and withdraw from medical school."
"WHAT?! Seriously?"
"Let me put a question to you — are you telling me you are going to give substandard care to a patient based on your opinion of them?"
"Er, no, because ... never mind."
"Actually, I'd like you to voice what you're thinking."
"The question is a trap," she said. "If I say yes, you're going to ask me if it would be OK for someone to treat black or gay people differently."
"Yes, I would, because we cannot discriminate in any way — race, creed, skin color, national origin, sexual orientation, or any other thing, including being accused of or convicted of a crime. When I was an MS1, an MS3 was nearly dismissed because she made what our Resident felt was a disparaging comment about a patient with Kaposi's sarcoma."
"That's one of the AIDS-defining cancers, right?"
"Yes. That was in 1985, and it was still mostly called GRID in the local community — Gay-Related Immune Deficiency. AIDS — Acquired Immune Deficiency Syndrome is a better name, as it does not stigmatize those who have it, which is important because it's possible to contract AIDS without having homosexual sex. You know the transmission pathways, right?"
"Any exchange of bodily fluid, though transmission by saliva is rare."
"Exactly. Do you see the problem?"
Kelly nodded, "Yes. We can't discriminate or make moral judgments. But don't you think it's wrong? I mean, a fourteen-year-old having sex?"
"I think once someone passes puberty, the answer has to be 'it depends'. In this case, it appears to have been consensual with a close-in-age boy. That's a FAR different thing from her being with a twenty-five-year-old man, right?"
"Sure, but can't both be wrong?"
"Sure. Who decides for you when you should have sex?"
"Me. Well, me and the guy; but me."
"And at what point did you think you were in control of that?"
"Uhm, always; I mean, since I thought about actually doing it."
"And did you care what the State of Ohio had to say?"
"No."
"Or your parents?"
Kelly laughed, "Definitely not!"
"So, our fourteen-year-old made a bad decision, driven by hormones, but she did make the decision to be alone with her boyfriend and make out. That's very different from a girl I met during my OB rotation in Cincinnati who was fourteen and had sex with her best friend's dad, who was in his mid-forties."
"Gross!"
"A reaction I'd expect from most teens thinking about that, but she'd had a fight with her mom about dating, and went to see her friend who wasn't home. Her friend's dad asked what was bugging her, and she complained about the fight and said she'd never been kissed. He offered to kiss her, and that led to the same result we saw just before. It was her fourteenth birthday as well, but the guy was forty-five and received a long prison sentence.
"Another situation, which happened before I started at Taft, a girl I knew who was fourteen was with a guy who was twenty-five. He ended up doing two years for statutory rape, but they ended up married and have a couple of kids. My feeling was that it was both wrong for them to have sex and to marry, but it wasn't up to me.
"And that's the key — it's not up to anyone but the individuals involved, so long as they're past puberty and it's consensual. The State's opinion is really irrelevant in my view, though I was careful to always follow it, given the possible ramifications. In today's case, probably nothing will come of it, but it could."
"You seem to know a lot of fourteen-year-olds who have had sex!" Kelly observed.
I actually knew a girl who was thirteen — Milena, but it had been the day before her fourteenth birthday.
"Two of those three I met in a hospital," I said. "In any event, my moral judgment isn't particularly relevant to my provision of medical care. How I react in about eleven years to my daughter wanting to date or have a boyfriend is an open question! I'd like to think I'd be reasonable, but Rachel's definition of 'reasonable' might not match mine.
"And that was the source of that girl in Cincinnati's pregnancy — she wanted to go to the movies with a boy just a year older, and her mom not only said 'no', but stated that the girl wasn't permitted to even go on a date until she was eighteen. That spawned the fight that caused her to go next door and decide to have sex."
"Eighteen? Even my dad said I could date at sixteen, and he was pretty strict. I was allowed to go to school dances before that."
"Are you staying?"
"Obviously."
"It wasn't obvious when this conversation started," I countered.
"Yes, I am," Kelly said. "You're right, of course."
"Just remember — you wouldn't be the first medical student to make it this far and have everything crumble before their eyes. That's true of Residents, and, frankly, of Attendings as well. You can be tripped up by many things; you need to always focus and consider your thoughts and actions every step of the way. Not doing so could have your medical license suspended or even revoked."
"Are you upset with me?" Kelly asked.
"No. This is me ensuring you become the best physician you can be. My job, in addition to teaching you how to do the clinical work, is to ensure you have the right attitude and a proper understanding of the job. The public puts tremendous trust in us, and it's incumbent on everyone to ensure we don't lose that trust.
"Think about someone who comes into the ED — they most likely have never seen any of us ever before in their life, and yet they trust us to heal them. Think about that young woman and the exam. I was a total stranger, but because I was wearing scrubs, she trusted me to examine her in the most intimate way possible. Consider what would happen to society if we ever lose that trust."
"Nothing good."
"Exactly. You're on track to be a good physician. Don't stumble when the brass ring is in sight. And lest you feel I'm singling you out, I had a very similar conversation with my Resident when I was an MS4, though the circumstances were slightly different. His advice was to do everything possible to guard my situation so as not to fail with the finish line in sight."
"May I ask?"
"The circumstances aren't really relevant, but the advice is the same."
"Mike?" Nate said from the door. "EMS is four minutes away with a GSW."
"At 6:00am?" I asked, shaking my head.
"LEOs on the radio said someone decided to try to shoot it out with Scott Turner."
"If the victim reaches us alive, it'll be a minor miracle. Who else?"
"Isabella, Letitia, and Letitia's students, plus Becky."
"OK. Kelly, let's go."
We left the lounge, grabbed gowns, gloves, and goggles, and headed for the ambulance bay.
"Why did you say it would be a miracle?"
"Deputy Scott Turner is the County pistol champion and finished second in an inter-county combat shooting competition to my friend Deputy Nelson from Harding County."
"Combat shooting?"
"Moving and random pop-up targets where some are good guys, and some are bad guys, similar to the scene in Magnum Force when Dirty Harry purposely loses so he can get a spent round to confirm ballistics."
"I'm pretty sure that movie came out before I was born!"
I chuckled, "I don't think so, given it was in the early 70s! I was around ten or eleven, so you were eight or nine. I saw it on VHS; well, I saw it on TV first, but those are cut to shreds."
"Hi, Mike," Isabella said when Kelly and I walked through the doors.
"Morning, Isabella. I heard Scott Turner was the shooter."
"Then this is likely a big waste of time," she commented.
"I told Nate it would be a minor miracle if the patient reaches us alive."
Which he did not. He had coded in the squad, and we couldn't revive him. Three rounds to the chest proved fatal, and about ten minutes after the patient arrived, Isabella called time of death.
"Did he make it?" Deputy McCallum asked.
I shook my head, "Scott Turner put three in his X-ring."
"Thought so."
"Why was he wanted?"
"Drugs. We were helping the DEA and Fibbies, and he pointed a pistol at Scott."
"Fatal mistake every time," I said. "I'm sure it was a righteous shoot."
"Damn straight, Doc. The guy had five pounds of MDMA tablets."
"So not personal use then?" I asked with a grin.
Deputy McCallum laughed, "No."
Kelly and I returned to the lounge.
"I'm confused."
"Because of the way I spoke to Pete McCallum?"
"Yes. It's like the opposite of what you said before."
"I was completely professional in the trauma room," I said. "There's nothing wrong with rooting for the good guys outside the trauma or exam room. We did everything we reasonably could to save the patient, but if I were to shoot you three times with a .357 magnum in the center of your chest in an OR with a full surgical team waiting, your chances of survival are near zero.
"You'll find doctors and nurses tend to have very good relationships with first responders. I've patched up a few firemen and LEOs in the past eighteen months, but I also treat their arrestees, and often annoy the LEO by requiring handcuffs be removed and treating the person in custody with compassion. Nobody says we can't root for the good guys; we just have to treat every patient to the best of our ability every time."
"This wasn't covered in our Practice of Medicine class other than to say that we're not allowed to discriminate."
"I think you've noticed there is a whole range of deficiencies in medical training. I was put in my place several times for pointing them out ad nauseam, to the point I annoyed several Attendings. This conversation actually served an unintended purpose — I now have a topic for my next lecture at the medical school next week."
October 9, 1990, McKinley, Ohio
"How are things going, Lor?" I asked when Doctor Gibbs and I managed to have lunch together on Tuesday.
"Can you use your pull with Wernher to get me out of triage purgatory?"
"Orthodox Christians don't believe in purgatory," I said with a grin.
"Jackass!" Loretta exclaimed, but she was smiling. "You know I'm Catholic!"
"We all have our faults," I teased.
"You're evading!"
"Yes, because nothing I say to Dutch Wernher at this point is going to change anything. I pushed hard for the current situation when he was inclined to say 'no'. My advice to you remains the same — take the job as Chief at the new urgent care facility that will open at the same time as the new ED."
"You want to get rid of me that badly?"
"You know that's not true! I believe you should be Chief of Emergency Medicine, but a «мудак» (mudak) with a handgun made sure that won't happen." ("asshole")
"What would you do in my position?" she asked.
"The same exact thing you are — fight 'em until I can't. I'd say, based on your latest evaluation by ortho, it's time to stop fighting and plot a new course for your future."
"You read my chart?!"
"It was provided to me as part of the evaluation process. I haven't spoken to Dutch yet, but I'm positive he'll ask me by the end of the week, and I have to give him an honest assessment. Lor, you need two arm crutches to move around and for stability. There is no chance you could function in a trauma room. With one, for walking stability? Maybe. Two, no."
"You can be a real prick."
"Do you want me to lie to you and blow smoke up your skirt?"
"Do you know how much I HATE wearing a skirt and medical coat?"
"About as much as I hate wearing a shirt with a tie and a medical coat. But we do what we have to do. Owen didn't order me to dress that way; he asked me to follow their usual practice when I'm upstairs. I agreed, just as I agreed to follow Dutch's guidance on wearing a medical coat when informing someone that their loved one has died."
"What happened to the anti-establishment rebel?"
"He became exactly who you and Shelly insisted he become — he follows the program and keeps his powder dry, picking and choosing his battles, and only occasionally tilting at windmills. Lor, I hate it as much as you do, but it's time to be honest and accept the possible future, rather than insist on the impossible one."
"Why do you think I should just give up?"
"Who said anything about giving up? Choose the path to success! Yes, sometimes we have to give up a specific battle we can't win, but that doesn't mean we should quit completely. You'll be in charge of your own practice, and it won't harm your career if the ortho docs and rehabilitation therapists are wrong."
"Cute," Loretta replied with a smile. "Ortho-docs!"
"In Greek, as I'm sure you know, 'ortho' means 'straight' or 'correct', so 'Orthodox' literally means 'straight glory' or, in the vernacular, 'proper worship'. Contra what some people think, and I'm pretty sure you remember, 'orthopedics' means 'correct children' not 'straight legs'."
"I did find that weird, but it's about the Greek spelling, right?"
"Yes, the æ [a-e] ligature has been lost almost completely in US English. It is retained, though with modern spelling using two letters, in the name American Academy of Orthopedic Surgeons, but here at Moore, as with most US hospitals, it's spelled with just the 'e', and it's the same root as in pediatrics, which should also have the æ ligature. The confusion arises because 'pedestrian' means 'on foot', but has a different root. But now we're WAY off base."
"YOU made the joke!"
"Actually, I didn't do it intentionally. I didn't even realize I'd done it until you said something."
"Bobby agrees with you."
"I knew the man was smart when he proposed to you; my opinion of him has not lessened in any way. Take the job, Loretta. I know they haven't offered it, but they will."
"How do you know that?"
"How would it look for them to refuse a doctor who literally took a bullet for the team? They can't afford the bad press. You deserve the job on merit alone, no question, but that injury makes it a lock. But even more so, I discussed it with Cutter in July before they brought you back. You can do a lot of good, Lor. A lot."
"I'll think about it."
"Take it from the hospital Don Quixote — don't tilt at this windmill."
October 11, 1990, McKinley, Ohio
"I'd like your assessment of Doctor Gibbs, please," Dutch Wernher said when he called me into his office on Thursday morning to discuss Doctor Gibbs.
"As much as it pains me to say it, she's likely never going to be able to handle trauma cases due to her lack of mobility and stability without using both arm crutches. She's a wonderful physician and teacher, but the physical aspects of the job are beyond her. It's my opinion she should continue in her triage role and apply to be the Chief Physician at the Moore Memorial Urgent Care Facility, which will open concurrent with the new ED."
"Knowing you, you told her that straight to her face."
"I did. I can't say for certain, but I believe she'll accept the offer when it's made."
"When?" he asked with an arched eyebrow.
"When. It was John Cutter who suggested it in July, and I agreed then that it was the most likely outcome. I believe it's in both Doctor Gibbs' and the hospital's best interest. She's extremely well qualified and should have the position on merit alone. The fact she literally took a bullet for Moore Memorial will create significant trouble for anyone who tried to block her."
"Me?"
"John Cutter will ask your opinion, and I'd be shocked if you didn't give him the same type of unvarnished assessment I will when he asks me. You'll take into account what I've said and form your own opinion. I know what I would do in your position, but I'm not in your position and don't want to be!"
"Ever?"
"I'm a doctor, not an administrator," I replied. "You split the difference and see patients every shift, but the last thing I want to do is be a cat herder!"
Dutch laughed, "It is like that at times. You have an option most surgeons don't have, in that you'll be Board-certified in emergency medicine as well."
"I figure it'll be thirty-five to forty years before I'm in a situation where manual dexterity becomes a concern for surgery, and my worst-case scenario is hanging out a shingle and becoming a good old country doctor like Evgeni Petrov, even seeing patients at home."
"You'll be drummed out of the guild!" Doctor Wernher said with a smile. "Not that you care."
"You're not wrong."
"May I give you a piece of advice?" Dutch asked.
"You may."
"When the time comes, and you're offered a leadership role, don't dismiss it out of hand; give it proper consideration."
"I'll worry about that in twenty years or so."
"You never know what might happen."
"Something I've learned from experience."
"On to another topic — how do you feel the new system is working?"
"I'd say it's working well. Next year will be better when we have a new PGY1 to take the night shifts while Mary is on her surgical shifts. The following year, we'll have weekend coverage as well. I'm curious about your perspective."
"I agree it's working well. Doctor Anderson is as good as you advertised. Do you have any feedback to offer on our PGY1s? I'm providing their ninety-day evaluations tomorrow."
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