Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 61: Home Again
November 20, 1990, McKinley, Ohio
"Happy birthday!" I said to Kris when I walked into the house on Tuesday evening.
"Thank you!"
"I brought Chinese, as we agreed, so you didn't have to cook, and we have reservations at the Japanese restaurant for Saturday evening after Vespers."
"A good choice, given we're in the Nativity fast."
"But with «ekonomia» for Thursday!"
"If the OCA were on the correct calendar, it wouldn't be necessary," Kris said with a smile.
"The calendar used by my bishop is the correct calendar, all other arguments aside."
Kris rolled her eyes, "You know what I mean!"
"I do. Let's have dinner so we can have family time, and then you and I can celebrate with a whirlpool and other enjoyable activities!"
November 22, 1990, Thanksgiving Day, McKinley and Circleville, Ohio
Being on the surgical service rather than being assigned to the ED meant I could celebrate Thanksgiving with my family. Viktor and my grandfather had arranged for the extended family to gather at the country club, minus my dad and his new family, as my dad had declined.
"I'm glad this worked out," my grandfather said.
"As am I," I replied.
"Do you work tomorrow?"
"There are no scheduled surgeries, so no, I don't. Kris and I are taking the girls to see my dad."
"How are things at the hospital?"
"They're good. It'll be crazy in April and May when we move to the new building."
"How does that work?"
"Just before midnight on whichever day they choose, a new shift of nurses and Residents will open the new emergency department. EMS will begin delivering there while the old area is cleared. The doors to the new waiting room will open at 6:00am, and we'll close the old one. We'll see the ones waiting in the old waiting area, in the old ED. Once they're all seen, everyone will move to the new area. If I had to guess, they'll choose a Sunday night because that's when we see the fewest patients."
"I hope you know your grandmother and I are very proud of you, Mischa."
"I do; thank you."
"I hear you have four days off," Liz said, coming up to us.
"I do. It's one of those rare instances, but I can't even count on having Thanksgiving off again for a few years. It all depends on the schedules and my assignments. How are things at the motel?"
"Good. We're getting ready to take over the restaurant as of New Year's Day."
"It won't be open, right?"
"Right. We'll open for breakfast on January 2nd with the same staff. The only difference will be I'll work a few hostess shifts at first so I can get a feel for the staff."
"I'm glad it's all coming together."
"Me, too!"
"Papa?" Rachel said, coming up to me.
"Yes?"
"Grandpa Viktor says it's time for dinner."
"Then we'll come sit down!"
We had a very nice meal and great conversation with the extended family, minus my dad, Holly, and my half-siblings. I really wished they would participate, but my dad had steadfastly declined Viktor's invitation. In a sense, I understood, but I had hoped he would get past that feeling.
On the other hand, I was very happy that Viktor and Ignatiy got along well, given the circumstances. Yulia was still a bit uncomfortable, and I knew she felt as if she didn't have enough time with Rachel, but I did make sure Rachel was with her at least once a week, and that would continue until at least when Rachel started kindergarten, at which point we'd have to figure out a new plan.
After our Thanksgiving feast, Kris, Rachel, Charlotte, and I headed back to the house for some family time.
"What are we doing tomorrow besides having dinner with your dad?" Kris asked once we were all settled on the couch with a Mozart album playing.
"I had no specific plans other than spending time with you and the girls," I replied. "We can do whatever the three of you wish."
"Papa, will you play guitar and sing?" Rachel asked.
"Absolutely," I replied.
November 26, 1990, McKinley and Circleville, Ohio
"I'm not going to be able to talk you out of this, am I?" Owen asked when we met on Monday afternoon.
"No, because it's in the best interest of the patients."
"That has always been your primary concern, which is as it should be."
"It's not as if I'm leaving you high and dry, either," I said. "Mary Anderson will take over as lead, and you'll receive an extra draft pick for the Match."
"Did Dutch not tell you his request?" Owen asked.
"What did I miss?"
"He requested you switch services immediately, or, in the alternative, at least four weeks before the new ED opens."
"I was under the impression the switch would happen at the end of my PGY2 year, if John Cutter approves."
"I believe that was the initial request, but Wernher came back to Cutter to ask if it could be accelerated because he's short a Resident. He suggested we could do without you."
"All things being equal, that's a reasonable point," I observed. "But I also know switching mid-year is next to impossible for a host of reasons."
"It usually is, but there is a way around that without harming your status — Dutch suggested I simply assign you to the ED for the remainder of PGY2, with Mary having whatever shifts I deemed best for her training."
"That's a budgetary problem," I observed.
"It's fixable," Owen said.
"You don't seem as upset as I'd expected you to be."
"I've had time to think it over, and I honestly cannot argue with what Dutch said nor what you said to Shelly. She's unhappy, but she acknowledged you belong in the ED. Is that what you want?"
"As I said to Shelly, emergency medicine was what drove me to become a physician starting at age ten."
"Then go see Dutch. I'll let Cutter and Anderson know I approve. You'll stay on the surgical service until the end of May, but be assigned to the ED. That said, I will reserve the right to call you to an OR in extremis. You can continue to perform procedures for which you're cleared, and we'll figure out how to handle those in the future before June 1st."
"Thank you."
"You went to some serious extremes to get out of playing golf!"
I chuckled, "Yeah, yeah. Speaking of that, what about my lectures at the medical school?"
"That's a Dutch problem, not an Owen problem," Doctor Roth said with a smile.
"Red scrubs until May 31st?" I asked.
Owen laughed, "You are technically on my service, so unless Dutch gives you a hard 'no', then yes. Same badge, and so on."
"I appreciate you accommodating me."
"You're welcome. I'll leave it to you to tell Mary."
"Thanks, I think."
"You're an excellent physician, Mike, and as you've said, the ED is your natural habitat."
We shook hands, and I left his office. I headed down to the ED and was happy to see Dutch Wernher was in his office. I went to the door and knocked on the jamb, as was my usual practice.
"Come in and shut the door," he said.
I did as he asked and sat down.
"I assume you and Owen Roth had your conversation," he asked.
"We did."
"You'll have the same shifts for now, though Thursday afternoons are a problem. I spoke to Nora Mertens, and she'll move the seminar to 2:00pm. Your shift would end at 1:00pm, but I'd need you for four hours another day. If I recall, Saturday afternoons would be best."
"Noon to 4:00pm would work," I said.
"Then, unless you have something else to add, I'll speak to John Cutter and Nels Anderson."
"Nothing from me."
"Then, as of next Monday, you're on the surgical service, but on loan to the ED until May 31st, when you'll officially be on my service."
"Thank you."
"Are you going to break the news to Mary Anderson?"
"I am."
"Dismissed, Doctor."
"Seriously?" I asked. "If it's not Dutch and Mike, at least in private, we're getting off on the wrong foot."
"Go on, get out of here, Mike!"
"Thank you, Dutch."
I got up and left his office, and walked to the lounge where Mary was sitting.
"My office?" I asked.
She got up, and we walked out the doors of the ambulance bay. It was a bit chilly, but not too cold to stand outside for a few minutes.
"Is something wrong?" she asked.
"I think the answer to that question depends on which side of the conversation we're on. I'm leaving the trauma surgery program."
"WHAT?!" Mary gasped in shock. "What happened?!"
"Dutch Wernher asked me to switch to emergency medicine. He cleared it with Cutter, Roth, and Nels Anderson. Effective next Monday, I'll be in the ED full-time."
"But why?! You're the best doctor in the hospital, and you started the program!"
"I was never meant to be a surgeon; I let Owen and Shelly talk me into it, and found a compromise to try to make everyone happy. But my heart is in emergency medicine, and it's where I belong. As for the trauma surgery program, I can't think of any better person to lead it than you, and I'm including myself in 'any' there."
"But you taught me!" Mary protested.
"How do you think I know you're better than I am! I've been saying it for months; ask Dutch, Owen, Shelly, or Clarissa if you don't believe me. It's not as if I'm going anywhere; you'll see me, and I'll be available for you at any time you need me."
Mary smirked, "I bet not!"
I laughed, "You'll have to find someone else to wash your back, Miss Anderson!"
"This is going to put me on night shifts, isn't it?"
"You'll need to speak to Owen about that, but certainly in June you'll be on the rotation I have now — split between the ED and surgery."
"How will that work if you're in the ED?"
"As I said, speak to Owen. Everything is going to change in April or May when we open the new ED. It's also possible I won't be able to perform procedures after May 31st. You know why."
"The 'no scalpel' rule. You don't think that'll change?"
"I think Owen and John Cutter will jealously defend that rule because if they give, then the trauma surgeons could report to Dutch."
"I hate hospital politics!" Mary said fiercely.
"You and me both. Are we OK?"
"Absolutely," Mary said. "It was just a shock because I had no clue."
"You'll have two slots for trauma surgeons for the Match. Choose wisely."
"The way you did?" Mary asked.
"Absolutely. This isn't public yet, so please wait until Dutch makes the announcement."
"Who else knows?"
"Just the people directly involved — Dutch, Owen, Shelly, John Cutter, and Nels Anderson. Clarissa knew Dutch had made the offer, but I felt I had to tell you first."
"I appreciate that."
"Do not hesitate to come to me if you need anything," I said.
"Count on it!"
We went back into the ED, and I made my way to Internal Medicine to let Clarissa know. She was in with a patient, so I chatted with Antonio Gómez until she finished.
"Hey, Petrovich!"
"Got a minute?" I asked.
"I do."
We walked down the corridor to an alcove with a bench next to the water fountains.
"This is on the QT," I said. "I'm back in the ED full-time as of Monday."
"How?"
"I'm still on the surgical service, but Owen Roth assigned me full-time to the ED. Dutch gave me the same schedule with the exception of Thursdays, so I can lecture. I'll have a four-hour shift on Saturday starting at noon to make up the hours."
"That was fast!"
"Said no woman ever!" I declared smugly.
Clarissa laughed, "With anyone else, they'd demand you prove it!"
"You just want cuddles."
"So true."
"Anyway, I'm still on the surgical service, so I can do my own consults and all my procedures. How that will work after May 31st is up to Cutter. You know the problem."
"Same as always — surgeons believe they're gods."
"Dutch will make an announcement sometime before Monday, so please keep it to yourself until then."
"Of course. How will Kris react to the Saturday shift?"
"Given the possible alternatives, she won't complain. I'll still be home for dinner every day and have the evenings with her and the girls. Rachel might complain, but half of that time is her nap time anyway."
"I meant to ask, how did things go on Thursday?"
"Great. Everyone gets along, and Yulia is at least cordial to Ignatiy and Nadezhda. I think the next conflict will come when Rachel starts kindergarten and isn't available during the day. But we have a few years before that happens."
"What about your dad?"
"No real change. Nothing I do seems to cause either him or Holly to relax and lighten up. My real concern is for Peter and Faith."
"Because your dad was a pretty lousy dad."
"In some respects, but there are worse."
"Becky van Dorn?"
"That's the one I was thinking of. In any event, I'll do my best to see my half-siblings as often as possible and hope my dad's second act is better than his first."
Later that evening, after we put the girls to bed, I let Kris know what had been discussed.
"Of course it's OK," Kris said. "Those shifts are still better than those horrid ones during your first year. You'll be the one making the schedules next year, right?"
"Yes, though that doesn't give me complete license. I'll do my best to maintain my current shifts, but there are no guarantees."
"How does this affect your medical license?"
"It doesn't. I'll take the test next year. It does mean I won't be Board Certified in surgery, but that doesn't bother me because I'll have my cert in emergency medicine, which is the one I really want. And I'll be an Attending in about nineteen months instead of six or seven years."
"Does anything else change?"
"Not really, no. My salary will stay the same until June, then I'll be Chief Resident, so my salary plus the stipend will be about the same as it would have been on the surgical service. The Chief Attending role has a larger stipend. The only downside is I'll have to do chart reviews starting in June, but there really isn't a way around that. Some of that will be done at home, unfortunately."
"And, as with every other thing, we'll make it work."
"Yes, we will."
December 1, 1990, McKinley, Ohio
The remainder of the week had been routine, though I had been assigned to ward duty, which didn't surprise me, given my new status. Some of the other surgical Residents had given me the cold shoulder, but a few were downright gleeful, as that meant they would have more opportunities in the OR. For my own part, I was happy and felt everything had finally fallen into place.
"I switched Residency programs," I announced when I walked into the music room at Taft for band practice on Saturday morning.
"Emergency medicine, right?" José asked.
"Yes. I'll be in the ED full-time starting on Monday. The only real difference is a slight change in my shifts, but it doesn't affect anything else. It does mean I have to work on New Year's Eve and New Year's Day, so I'll have to find someone to cover for me on New Year's Day, but that shouldn't be a problem."
It would mean I'd have to trade for a weekend shift, possibly two, if neither Kylie nor Mary were available, which would depend on their shift schedules. In a pinch, I could even ask Gale Turner to take a locum shift, as he had Board certification in emergency medicine.
"I put together a proposed set list," Kim said. "My thought is that at midnight, we play and sing Auld Lang Syne with the words most people know, then segue into Mike singing the old Scots lyrics. We'll follow that with Goodbye Yellow Brick Road, I Melt With You, and 1999."
"A decade too soon," I chuckled. "Well, 9 years, anyway."
"It's going to be hella strange to write '2000' on checks," Sticks observed.
"They'll have to stop putting the '19' on checks in about six years," Kari said. "And then switch to '20' after the millennium turns."
"So, January 1, 2001?" I asked with a grin.
"You're one of THOSE?!" Kari asked, sounding aghast. "Boy, did I ever dodge a bullet!"
All my bandmates laughed, as did Kris, who was standing by the door, as she had to keep the girls across the corridor to protect their ears.
"If there is someone who is more pedantic than Mike, I sure don't know who it is," José declared.
"I resemble that remark!" I said with a grin. "Shall we practice?"
Two hours later, Kris, Rachel, Charlotte, and I left band practice and headed to Kroger and the bakery, then headed home for lunch and a quiet afternoon together.
December 3, 1990, McKinley, Ohio
I saw Mary Anderson when I went into the surgical locker room just before 5:00am to get several sets of red scrubs to take with me to the ED, so I didn't have to come back upstairs.
"Sorry about the night shifts," I said.
"It's OK," she replied. "I actually prefer one or the other. Swapping every other week was rough. Do you have a minute for a question?"
"Sure."
"Owen gave me a stack of applications to review. What should I look for?"
"Viking shield maidens," I chuckled. "It worked for me!"
Mary laughed, "And besides that?"
"I always wanted to see well-rounded candidates. Medical students who earned good grades but also had extracurricular activities were the top candidates. In the end, you're looking for someone with a surgeon's ego who also has a bedside manner. Good luck with that!"
Mary laughed, "You found me."
"I did. So, go find one of you and one of me, and Moore Memorial will be in very good shape."
"Thanks."
I left the surgical locker room and made my way to the ED locker room to change.
"I need a huge favor," I said to Kylie Baxter when I walked in.
I put the spare scrubs into my locker and began changing.
"What's that?" Kylie asked.
"Take my New Year's Day shift; I'll take your Sunday shift the previous or following weekend. I have a gig in Cincinnati I agreed to when I thought I'd be on a surgical rotation."
"Of course! And you could have knocked me over with a feather on Friday when I read Doctor Wernher's memo! Nothing against Paul Lincoln, but I'd much rather work with you! I take it you're happy?"
"Very."
"Take the shift on the 30th, if that's cool."
"It is. I appreciate it."
"Just remember who your friends are when you're Chief Resident and making schedules!"
I chuckled, "PGY3s get the best shifts, and we're going to have nearly twice as many PGY1s because of the new ED."
"Ten instead of six, right?"
"Yes, and two additional Attending slots. Three, if you count Loretta's."
"I'm happy they found something for her."
"Me, too."
We left the ED, and I went to the board to check my assigned medical students. I didn't know either of them — MS4 Jessica Lake and MS3 Arjun Mehta. I went into the lounge and found them both waiting with a few other medical students.
"Jessica and Arjun, I'm Doctor Mike," I said. "I'd like to see your procedure books, please."
They both came over to me and handed me their procedure books. I flipped through both of them — Jessica's first, then Arjun's — and both appeared to be typical for their stage in medical school.
"What's your choice for the Match, Jessica?" I asked as I handed back the books.
"Radiology," she replied. "Though I'm only applying to hospitals with MRI machines."
Those were the cutting-edge devices, and we wouldn't have one until after the new surgical wing was built.
"Arjun, have you decided?"
"Family medicine. I plan to work in my Uncle's clinic in Chicago with two cousins."
"You'll Match in Illinois, I assume, to only have to serve a single-year Residency?"
"Yes."
"OK. We're primary for EMS runs, but until the paramedics bring us patients, we're on walk-ins. Jessica, you're allowed to ask the triage team for the most difficult case rather than the first chart. Give kids priority as well. You'll perform the H&P under my supervision. Let's get to work."