Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 56: Advice
October 25, 1990, Goshen, Ohio
"Hi, Ang," I said when Kris and I walked into Goshen High for Code Blue's gig at their Harvest Ball on Thursday evening.
"Hi, Mike," she replied. "Hi, Kris."
"How are you, Angie?" I asked.
"OK, I guess," she replied.
"I'm glad you're here. I'm sorry I haven't had time to come to Cincinnati to see you, but I was working six eighteen-hour shifts. That's calmed down, so I promise I'll bring the girls to see you in November."
Angie smiled, "Thank you."
I needed to get set up, so I excused myself. Kris stayed with Angie while I went to the gym to set my guitar on its stand and my sheet music on a music stand. After the sound man helped position the mic, we did a mic check before I joined my bandmates in the room set aside for us.
"I saw Angie," José said. "Is there anything more they can do to help her?"
I shook my head, "No. Teenage-onset schizophrenia in women almost never resolves. Angie is, and I hate to say this, lucky because she can hold a job and practice martial arts. She can't manage without the psychoactive drugs, which is why she seems like she's a beat behind. This is as good as it's ever likely to be, and the chance that the medication will become less effective grows every year, meaning they have to up the dose, which would likely mean she couldn't work or practice martial arts."
"I know I've said it before, but that sucks," José observed.
"It does, especially given she was making progress in getting off the psychoactive drugs through behavioral counseling."
And, I wasn't going to say aloud, Elizaveta's repose, which had given Angie hope for the future, even if it was an extremely unlikely one. Unlikely or not, it had given her focus that she hadn't had since our Freshman year, and it was all thrown away by a psychiatrist who put process over patients. That was something I would never do, no matter how much hot water it might land me in.
"Is Kris here, Mike?" Kim asked.
"Yes. She's with Angie. She'll stay with her until it's time to sing our duet."
Kari walked in just then, and José stood up.
"I have an announcement," he said. "Sierra and I are pregnant and due in late April."
"I'm pretty sure I paid close enough attention in medical school to know you can't be pregnant," I chuckled.
"Ignore Mike!" Kari exclaimed. "He's always like that! Congratulations!"
"I've known him for eight years, so trust me, I know!" José chuckled.
"Congrats," I said.
Kim and Sticks also offered their congratulations.
"Has Sierra's OB recommended folic acid?" I asked.
"Yes. Sierra started taking it as soon as she missed her period."
"Good."
"If you're done playing doctor, we can warm up!" Kim declared.
Kari smirked, "I've played doctor with Mike, and trust me, this is NOT playing doctor!"
Everyone laughed, including me, and I just shook my head as we went to the stage to warm up. Four hours later, Kris and I were in my Mustang heading back to McKinley.
October 26, 1990, McKinley, Ohio
On Friday, just after 10:00am, I called the hospital in San Francisco and asked for Sophia.
"Doctor Vasilakis."
"Doctor Mike."
"Hi, Mike!" Sophia exclaimed happily. "How are you?"
"Good. How are you and Robby doing?"
"Great! To what do I owe the pleasure?"
"I need some advice. Do you have ten minutes?"
"I do. What's up?"
I explained what Doctor Wernher had said and what Clarissa and I had discussed, then asked Sophia for her advice.
"Honestly, I think you know the answer," Sophia replied. "Your comment about 'sitting around in the lounge' pretty much tells the whole story. I'm sure you remember why you chose to push for the new program."
"To split the difference between what the surgical service and emergency medicine wanted."
"If I recall correctly, Cutter, Roth, and Lindsay put serious pressure on you to become a surgeon. In your usual way, you tried to find a way to satisfy everyone. And in your usual way, you put your own satisfaction behind the satisfaction of others."
"Back when I was a Junior at Taft, I had a conversation about that with Milena," I said. "I made the point that the human condition is such that you either serve yourself and Satan, or you serve others and God. I made the point that ALL sin is selfishness — putting your wants, your desires, over those of your fellow man or God. Milena asked if that made me a doormat, and I rejected that idea."
"You made the point that your decision comes down to deciding what's best for your patients, which I completely understand. The thing is, if you aren't fulfilled, or you are unhappy, how good is that for your patients?"
"Not very."
"Exactly. All of this stems from someone noticing that you were an expert with the scalpel. May I draw a very bad analogy?"
"Sure."
"A draftsman is perfect with his pencil and straight edge, but he's not an artist."
"Surgery isn't supposed to be art."
"No, it's not. Being a technically perfect surgeon is for someone with OCD; that is not you. You're the artist, and you get a rush from the artistry of an adrenaline-fueled save. You will almost never have that in surgery, at least during your training, and honestly, is removing a hot appy really going to fulfill you? And is that the best use of your time?"
"That is something to think about. I know we don't have much more time — how is the Bay Area?"
"We're loving it. Robby is happy at Stanford, and we're attending services at Holy Trinity Cathedral a few times a month. How are Kris and the girls?"
"They're all doing really well, and now that I see them more, I'm happier. Clarissa and I have lunch a few times a week, and we have our Friday night outings, though a bunch of people are missing, including you and Robby."
"That is the thing we both miss — the close friendships. We have to find a way to get together once my Intern year is over."
"All hospital, all the time?"
"Yes. I've seen some of the coolest procedures imaginable, but they don't let Interns within five feet of a patient on the operating table. But it's all good because we're saving babies."
"Any in your future?"
"One, in about five years, when Robby is established, and I can safely take a few months off without totally messing up my training."
"Medicine needs to fix that," I observed.
"I agree, obviously, but even here in the cloud-cuckoo land, they aren't doing it."
I laughed, "My wife would call the Bay Area 'reactionary'!"
"What does that make you?!"
"Provincial," I chuckled.
"Mike Loucks, redneck rube!" Sophia teased.
"Yeah, yeah," I chuckled. "I'll let you go. Thanks for taking the time."
"Anytime, Mike! Have you spoken to Maryam about this?"
"No."
"Speak to her, and for someone outside the profession, speak to Lara. I'm sure you'll speak to your confessor."
"I will. Thanks, Sophia."
We said 'goodbye', and I hung up. I'd been lucky to reach Sophia, as I didn't know her schedule, and wondered if my luck would hold with Maryam. I dialed the number for the Cardiology Department at Edward Hospital and asked for her, and was very happy when the nurse said Maryam was available.
"Maryam Khouri."
"It's Mike."
"Hi! I was SO happy to see the picture of your new daughter! She's adorable!"
"Thanks! How are things going in Naperville?"
"Excellent! I love what I'm doing, and Mata and I are very happy together. How are things going for you?"
"I'm alternating between the ED and surgery, and I've had opportunities to perform appendectomies and also close on some cases."
"You did the appendectomies? As lead surgeon?"
"Yes."
"OK, now I'm truly jealous! That's pretty amazing!"
"It is, though, that's what I wanted to talk to you about. Do you have ten minutes so I can explain and get your advice?"
"I can make that work. What's up?"
"Doc?" I chuckled.
Maryam laughed, "I didn't even think about the Bugs Bunny reference! You're just as goofy as you always were."
"Ah-hyuck!" I replied, trying to sound like Goofy from the cartoons.
"Stop it!" Maryam commanded, but she was laughing.
"I'd say I was sorry, but you wouldn't believe me! Let me tell you what's going on."
I did that, and Maryam was silent while I explained what Doctor Wernher had said. I purposely did not mention anything Clarissa or Sophia had said, only that I had spoken with them.
"As someone who knows me very well, and who is as faithfully Orthodox as I am, I'd like to hear your opinion."
"Do you believe you can be a good surgeon?"
"Yes, of course."
"You are destined to be a great physician, not a 'good surgeon'. Be a great physician, Mike."
"I'd say that's about as blunt as anyone could be."
"Given our relationship, did you expect anything less?"
"No, and I knew you wouldn't sugarcoat it. What you said basically matches the advice Clarissa and Sophia provided. My big concerns are reneging on my Residency contract and the fact that I'm the one who initiated the entire program."
"Yes, you did, and that's a good thing! It's not going to die because you elect to take an Attending slot after three years. You said Mary is actually better than you are, though I'd debate that. But if we assume you are correct, then you're leaving it in very capable hands. You can still mentor her and help ensure the program is successful."
"And going back on my word?"
"If you ask someone to release you, and they do, then you are no longer bound by your promise. Discuss that point with Father Roman, and see what he says."
"I'll do that. Thanks for your advice."
"You're welcome, Mike! Call me soon, OK?"
"I will."
"I love you, Mike. I always will."
"I love you, too, Maryam."
We said 'goodbye', and I hung up. The day was routine for the ED, and that evening, at the Chinese restaurant, I asked Lara to speak privately while we were waiting for our food to be prepared.
"I think I can simply ask one question — what doctor, of all the ones you know, would you emulate?"
I smiled, "Doctor Evgeni, of course."
"Then I think you have your answer."
We returned to our seats and had a nice meal with our friends, and after dinner, the gang went to see Memphis Belle. We all enjoyed the movie, and after it let out, Kris and I got in my car to head home.
"Are you going to tell me what you and Lara discussed?" Kris asked.
"Doctor Wernher made me an offer to switch to pure emergency medicine, with a guarantee of an Attending slot in about nineteen months. And, if I were to switch before then, he'd make me Chief Resident in June."
"And you felt you should speak to Lara before me?"
"I felt I should hear what the people who have known me the longest had to say before I had a deep conversation with you. That allowed me to properly order my thoughts before speaking to you and to Father Roman."
"Clarissa?"
"Yes, as well as Maryam and Sophia. I can't really speak to Shelly Lindsay, Ghost, or Loretta without causing potential problems if I choose not to change."
"May I ask a practical question?"
"You may ask any question, practical or otherwise!"
"Could you lose your position?"
"No. Once I completed my PGY1, I could only be dismissed for cause, and asking about switching Residency slots is not 'cause'. Doctor Wernher is actually more at risk for trying to poach me, as it were."
"Another practical question — right now, you're supporting all of us and will until I finish my Master's. I know you said surgical Residents make more than all other Residents."
"That's true, but the Chief Resident receives a stipend, which will basically make up the difference. The other thing about being Chief Resident is I'm able to choose my shifts."
Kris laughed softly, "And here I expected you to make a comment about me being 'mercenary' or 'capitalist'!"
I chuckled, "Nah. Socialist theory says workers should be paid better! In any event, I'd make even more as an Attending, and we could certainly build the house we've discussed from time to time in less than two years."
"You mentioned you couldn't be Chief Resident in your current role, but that it wasn't important."
"It's not, really, except for the stipend. It will look good on my CV, but given my goal is to be an Attending at Moore Memorial, and Doctor Wernher basically guaranteed that five years early, my CV won't matter much. In about a year, I'll have my license and be Board-certified in emergency medicine, which means I can practice without supervision. Of course, being Chief Resident adds some bureaucratic duties, including scheduling and overseeing the other Residents and medical students. On the plus side, it affords more teaching opportunities."
"I think, as with my career choices, it has to be up to you," Kris said. "I think your doctor friends are the best ones to advise you, because they are in the same field."
"I would still like to hear your opinion," I said.
"From everything you've said, you felt you belonged in emergency medicine from the time you were ten years old, and were sure that would make you happy. If that's still the case, I think you know the answer. My advice, therefore, is to do what makes you happy. It's important for me and for our daughters that you be happy and fulfilled in your career. Whatever you decide about your true calling is OK with me."
"Including being a deacon again?" I asked with a smirk.
Kris laughed, "What's the American saying? Let's not get crazy now?"
"That's the one," I chuckled. "Experience says that I would be singularly unhappy doing that, even if all the other concerns were ignored."
"What are you going to do?"
"Speak to Father Roman when I see him in two weeks. Once I do that, I'll decide how to move forward."
"Now, can I convince you to go crazy for a bit?"
"You can." And we did.
November 1, 1990, McKinley, Ohio
As was the usual case, I had only one opportunity to assist on a surgery for the first three days of the week, and that was to close an incision. That changed on Thursday morning, when we received a stable patient for an appendectomy. Doctor Roth permitted me to perform the procedure, which was completely routine, start to finish, with Tom Dierks assisting.
"Textbook work, Mike," Owen said when we finished. "Tom, take Mr. Knowles to Recovery, please."
"Will do," Tom replied.
"Mike, come to my office after you scrub out, please."
I scrubbed out, put on my usual surgical uniform of dress pants, dress shirt, tie, and medical coat, then went to Owen's office. He asked me to shut the door and have a seat.
"I hear from Cutter you had a conversation with him about the program and the future."
"If he was accurate, which I'm sure he was, he'd have told you I was careful not to express an opinion about the future and simply say that, other than wanting more procedures, I felt the program was working well. The only concern, if you will, is having two masters, as it were."
"I'm not sure that can be escaped, no matter what we do, as surgical training has to, of necessity, be done by surgeons."
"I agree, which was why I suggested some form of matrix management. The entire situation is a bit strange at the moment because it's only Mary and me, so things are not how they'll be in three or four years. That's why I deferred giving my opinion. I'm still of the same mind — it's too early to answer the future questions."
"Let me try a different tack — what are your sore points at the moment?"
"Sore? None, really. I mean that. Yes, I complain about not getting enough procedures in the OR, but if THAT is an indication of a problem, then every surgical Resident has a problem!"
"True," Owen agreed with a smile. "Anything else?"
"I'd prefer to see more patients when I'm in the ED, but given my role, that's not really possible."
"Dutch told me about your tumor catch. That was excellent work, Mike."
"Only because Loretta remembered Mr. Alien Encounter and sent a patient to me whom I otherwise wouldn't have seen."
"What are you trying to say?"
I shook my head, "Nothing other than I dislike the idea that a diagnosis basically turned on who saw the patient. That's a systemic problem, especially with regard to patients with mental health problems in addition to some ailment or injury. You know my take on that particular issue."
Owen nodded, "We all do, and you're not wrong in your assessment of how we handle patients with mental health concerns, at least as I see it. This is going to sound very bad, but you're too skilled to be a psychiatrist."
"I take your meaning," I replied. "But I think that what you just said touches on the root of the problem, at least within the medical profession. I saw my friend Angie last week, and it drove it home again, just as it does every time — as a profession, we do not do a very good job with mental illness."
"No, we don't. Changing subjects, do you know which day you'll need time off to testify in the Webber case?"
"No. Leland predicted anytime from Thursday on, depending on how long it takes for the attorneys for the Webbers to present their case. I'm the first defense witness. To answer what I am certain will be your second question — my testimony could take a day or more, depending on the cross-examination."
"OK. Let me know so I can ensure we have coverage."
"Will do."
"Good job today."
"Thanks."
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