Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 65: That Probably Wasn't My Smartest Move
February 27, 1991, McKinley, Ohio
"It's worse than I thought for Medicine," Clarissa observed when we met for lunch on Thursday. "Unless I miss my guess, we'll come up three short on the Match. According to Antonio, that hasn't happened before."
"Did someone call the candidates?" I asked.
"Three of us — Tim Baker, Antonio Gómez, and I made the calls. The top four candidates received two calls — one from Tim Baker and one from either Antonio or me. There was way more hemming and hawing than last year."
"I'm going to have a word with Viktor; this can never happen again. The hospital is going to pay for throwing Paul Lincoln under the bus for years to come."
"Do you think it will do any good?"
"It won't undo it, but maybe, just maybe, it'll prevent problems in the future. Besides the Match, how are things?"
"I'm living the boring married life of a PGY2!"
"That's a new word for you," I observed.
"What else would you call it?"
"It's an interesting question given how the word has been defined and used since at least Roman times. It all depends on how you define the words, really, and the traditional definition has always been husband and wife, male and female. The overall concept, though, is exclusive life partners. I guess, in the end, it's up to you what you call your relationship."
"Would you have a problem with the state allowing gays and lesbians to marry?"
"If by that you mean to have all the same benefits Kris and I do without having to jump through extra-legal hoops and without risking your agreement being torn up by some random judge, then, yes. I think you'd be better off choosing a different term for that legal union, at least from a pragmatic point of view."
"Because people would object to 'marriage' as opposed to something like 'domestic partnership'?"
"Honestly, from a secular point of view, call them all domestic partnerships and the State can then wash their hands of any religious involvement of any kind. You go before a JP, sign the forms, say 'I do' and then have whatever religious or secular ceremony you want."
"You'd be OK with that?"
"You know the Jefferson quote, right?"
"The one about picking his pocket or breaking his leg?"
"Yes. I quoted that to Shelly when she asked my opinion on gay marriage. As I said to her, so long as nobody tries to force the Orthodox Church — or any church for that matter — to marry a specific couple, then what society does as a whole in that regard is more or less immaterial."
"I wager plenty of people in your church wouldn't agree."
"I'd say you were right, but that's true about nearly any political topic you can imagine. That said, we're way less likely to try to force our views on people by statute than, say, Faith Bible."
"No kidding! Changing topics, how are things at home?"
"They're good. Time is tight again because of the Saturday shifts, but we're down to three months before we're PGY3s and we get the best shifts."
"What about your promotion?" Clarissa asked quietly.
"Dutch will announce it after the Match, which is the norm. Any idea who your Chief Resident will be?"
"Tim Baker asked if I was interested, and I said I was, but I know he also asked Shauna Tomlinson."
"I barely know her. I think in the past two years, I might have seen her two or three times."
"She prefers night shifts because her boyfriend is in the State Patrol and works nights."
"What do you think your chances are?"
Clarissa shrugged, "Tim Baker likes me, and I've had excellent evaluations, so I like my chances. Any fallout from your MS4?"
"Jessica Lake? No. Mary is nonplussed, and I suspect the evaluation will be in the low 'Expected Performance' range. I actually did Miss Lake a favor by asking Shelly to assign her to Mary because the trauma surgery rotation is actually easier for an MS4 than a regular surgical rotation."
"That's weird, but I see how that's the case — in effect, it's a supercharged ED rotation combined with ward care. It's really hard to screw up ward care!"
"And yet, it's happened!" I declared.
"True," Clarissa agreed.
We finished lunch and, after a quick hug, returned to our respective services.
March 3, 1991, Circleville, Ohio
After Kris, the girls, and I arrived home from church on Sunday, John and Candace joined us and brought their two-year-old son, Jacob, with them. Rachel was wary, as she was with most male toddlers, but Jacob was nowhere near as rambunctious as her cousin Viktor, so after a short time, they began playing together.
"Think they'll play that nicely in twelve or thirteen years?" Candace asked with a smirk.
"If they're together and that quiet, that's when we worry!" I chuckled. "Any thought of a second?"
"Thoughts? Yes. Actions? No."
"That'll be the day," I chuckled.
"You know exactly what I meant, Doctor Smart Aleck!" Candace declared.
"Anyone who is surprised at Mike being a Smart Aleck hasn't been paying attention!" John declared.
"Truth!" I agreed.
"You two are planning another, right?" Candace asked.
"Yes," Kris replied. "In perhaps a year."
"When will you finish your degree?"
"If all goes according to plan, May 1994. Then I'll start a Master's, which I should be able to complete in the usual two years."
"What discipline?"
"Public administration. There are plenty of opportunities in the area where we could live for Mike to be close enough to the hospital."
"Mike, John tells me you switched your Residency," Candace said.
"I guess hospital gossip doesn't travel to OB," I replied with a grin.
"You know we're only in the hospital to deliver and do post-delivery checks."
I explained briefly what had happened, and Candace agreed I'd made the correct decision.
"How are things going with the Match for OB/GYN?" I asked.
"I'm not part of the team, but I hear not so hot."
"The entire situation would have given me second thoughts, that’s for sure," John said. "I guess you wouldn't have changed, right, Mike?"
"Probably not. And that should probably be it for shop talk!"
The others agreed, and we had a very nice afternoon together, followed by a fasting-acceptable dinner of shrimp stir-fry.
March 4, 1991, McKinley, Ohio
"Doctor Mike, there's a police officer here with a patient she would like you to see," Len said.
"Complaint?"
"She appears to have swallowed evidence."
"Wonderful. Bring them in. Which room is free?"
"Exam 2."
A minute later, I walked into Exam 2 to find Detectives Kleist and Rehling with a young woman.
"Hi, Doc," Detective Kleist said
"Hi, Jill. Fill me in, please."
She smirked, and I knew exactly what she wanted to say, but couldn't in front of her prisoner and my medical students.
"This is Trisha Woodford. When we moved to arrest her for possession with intent to sell, she swallowed two balloons of what we believe was cocaine."
"OK. I'll need you to remove the cuffs so I can perform a basic exam."
Detective Rehling pulled out her keys and moved to Miss Woodford.
"No funny business," Detective Rehling said as she removed the cuffs, then moved to stand between the patient and the door.
"Good afternoon, Miss Woodford," I said. "I'm Doctor Mike. What did you swallow?"
"I know my rights!" she declared. "I don't have to say anything!"
"Not to the police, but I'm not the police."
"Yeah, but both of those bitches are standing right here! No chance!"
"Watch your mouth!" Detective Kleist growled.
"Jill, would you and Louise step into the corridor? I need to be able to ask questions to treat her properly. You can guard the door."
"Sure thing, Doc."
"Kevin, we need a nurse, please. Miss Woodford, we'll be right back. Detectives, you can stay in the room until we have a nurse."
He left the exam room and returned with Kellie Martin, after which the detectives stepped into the corridor.
"What did you swallow?" I asked.
"You'll tell those cops!"
"No, I won't," I replied. "I'm bound by oath and statute not to divulge any information."
"You're buds with them!"
"I'm friendly with them, but that has nothing to do with doctor-patient confidentiality. What did you swallow?"
"Not cocaine."
"An answer, but not a meaningful one," I replied.
"Two rubbers with X."
"How many tablets?"
"Twenty in each."
"How long ago?"
"I dunno, maybe an hour."
"I'm going to do a quick exam, then perform an ultrasound and get some X-rays. Most likely, you'll need an endoscopy to remove them."
"What's that?"
"We'd give you a sedative and then use an endoscope — a medical device that would go through your mouth and into your stomach to retrieve the two condoms. If they've passed out of your stomach, then you would need surgery."
"And if I refuse?"
"For every minute that passes, there is an increased risk that one or both condoms would rupture and you would, in effect, overdose on MDMA, and very likely die. If they don't rupture, you'll have to pass them as you would feces. Either way, they're coming out, assuming you live long enough to pass them."
"That probably wasn't my smartest move."
"Probably not. May I examine you?"
"What exam?"
"Just a basic physical — eyes, ears, nose, mouth, and vitals. Then we'll perform the ultrasound and get the X-rays."
"Sure."
"Kevin, fingertip monitor, please."
He did as I asked, and I performed the history and physical, which was grossly normal. I asked Kevin to get the ultrasound machine, but because there was a chance I would be called as a witness in any trial, I performed the ultrasound myself, though I explained to my students what I was doing at each step.
"Both condoms are in your stomach," I said. "I can remove them by endoscopy using a fluoroscope. As I mentioned, it can be done with a mild sedative, or we can knock you out. If you opt for being awake, we'll do it here; if you elect anesthesia, then we'll send you up to surgery. Either way, assuming there are no complications, you'll be released to the detectives later today."
"What happens to the drugs?"
"In the end, they'll be turned over to the police. If you object, they'll simply get a warrant, and a judge will order me to turn them over. The same thing is true if you refuse to consent to the endoscopy — they'll get a judge to sign a warrant and issue a writ, and the procedure will be performed even if you object."
"Hang on!" she protested. "That can't be right!"
"Right or wrong, that's the law," I replied.
Of course, the cops might have a problem finding a doctor who would perform an invasive procedure without the consent of the patient, but in the end, I chose not to share that with the patient, as it might risk her refusing treatment, despite the ultimate outcome being inevitable.
"Who'll do the procedure?"
"If it's done here in the Emergency Department, I will, though I'll call a gastroenterologist to confirm and assist; if it's upstairs, a general surgeon."
"You're cool; you can do it. Is there any way I can convince you to lose the condoms?"
"I'd be dismissed from the hospital and lose my right to practice medicine," I replied. "Let me make a call for the consultation, and then we'll get the equipment. I do need to allow the detectives back into the room now."
"They'd be in here for the endo thingy?"
"Yes. I'm no lawyer, but it's about the chain of custody."
"If I got a lawyer, could they prevent it?"
"I have no idea, but I do need to warn you that any further delay might lead to surgery or death."
"You're not joking about that?"
"What would happen if you took fifty hits of X?" I asked.
"Nothing good."
"Exactly. Len, please call Medicine to arrange a gastroenterology consult for an endoscopy. Kellie, draw for CBC, Chem-20, ABG, and type and cross-match, please."
He made the call, and Kellie drew the blood, which Kevin took to the lab. About ten minutes later, Dave Brown, an Attending, arrived with a Resident and a medical student in tow. I wasn't surprised, as I'd need an Attending to supervise the procedure. Once the consultation exam was completed, I asked Len to call radiology to bring the portable fluoroscope to Exam 2.
After the labs were back, we invited the detectives back into the exam room, which made it very cramped. There was just enough room to work, and with Dave monitoring, I sedated Miss Woodford, then carefully removed the two balloons of MDMA from her stomach, depositing them in a basin.
"I'm going to have to wash them with alcohol," I said. "It's too dangerous to allow you to handle them."
"What if we just take pictures, then you remove the tablets and put them in a vial?" Detective Kleist suggested.
"If that's OK for your chain of evidence, then that works for me."
"It'll work if both you docs sign the form. Can I get an image from the fluoroscope?"
"With a warrant," I replied. "It's part of Miss Woodford's medical records, so I can't turn them over to you without a court order, per hospital policy."
"OK. We'll get the paperwork done."
I washed the two condoms, dried them, then carefully cut them open, depositing the pills into a vial and placing the condoms in the evidence bag. Once that was complete, Dave and I both signed the evidence form, and about two hours later, Miss Woodford was discharged.
"Can a judge really order someone to undergo a procedure?" Kevin asked once we were back in the lounge.
"Certain procedures, yes, but the challenge is finding a physician who will perform anything more invasive than a blood draw on a patient who refuses consent, and some physicians won't even do that much. I'm in the latter camp — nothing invasive without consent, except in the case of life-saving procedures on a patient who is unable, due to their injuries, to give consent. Moore Memorial has a policy that no order may be given to a physician or nurse in such an instance."
"What do the cops do then?"
"It depends. For a blood draw, they'll take the patient to either the holding area at the police station or the infirmary at the County Jail, where a nurse will perform the procedure. In any other case, it's highly unlikely they would find a doctor at a public hospital who would do it. They might find someone in private practice, but that's unlikely, too."
"You seemed pretty friendly with the cops."
"Detective Kleist, the one who was flirting with me, was a responding officer when we had the shooting here. If she hadn't shot the gunman dead, he'd likely have killed several of my friends. As it was, he came close to killing Doctor Gibbs and Doctor Lindsay, and you've seen what happened to Doctor Gibbs. I was in Trauma 1 with Deputy Sommers when she was shot."
"Whoa!" Kevin exclaimed.
"So you can see why I might be friendly with the cops. I've patched up a bunch of them, along with firefighters, too, so they're all friendly. They do get a bit testy at times when we treat patients better than the cops think we should, but you know our oath, right?"
"I do."
"Good. Give me a couple of minutes to use the john, and we'll get the next patient."
March 11, 1991, Match Monday, McKinley, Ohio
Six very routine days had passed, and just past 10:00am on Match Monday morning, Doctor Wernher called Brent Williams, Kayla Billings, and me into his office.
"How bad?" Brent asked as soon as the door was closed.
"Only five of ten filled," Dutch replied. "Fortunately, both Mary Kealty and Len Godwin Matched here. The other three Matches are Sarah Williams, Christopher Miller, and Jessica Brown, just as Doctor Mike predicted."
"Well, that sucks," Kayla groused.
"Doctor Williams, please call Nora Mertens and let her know we have five spots for Scramblers."
"I suspect we'll be competing with Internal Medicine," I observed. "Doctor Saunders was reasonably certain they'd have the same problem."
"I'll give Tim Baker a call to see if we can work together on that," Dutch said. "Remember, say nothing to anyone about who Matched here until 10:00am Thursday. Dismissed."
That evening, after dinner, I called Viktor Kozlov to discuss the unmitigated disaster that was our Resident Match.
"I'm not sure what you think I can do about it," Viktor said.
"Never allow a Resident to be dismissed for following both the standard of care and hospital policy," I said. "We're going to pay for this for several years, and at the worst possible time — opening the new ED in a month or so and the new surgical theatre in two years. The best students, even those from McKinley Medical School, are avoiding Moore Memorial."
"Mike, you have to understand the situation," Viktor protested. "We had to find a way to settle because of the potential cost to the taxpayers."
"By considering only money, you're not serving the community," I protested. "It's also entirely possible Residents will have to work even more hours because we cannot fill the slots. That's a three-year problem, at least, and if this problem extends to next year or even a third year, it could be six years of reduced staffing and reduced care."
"And without money, the problem is actually worse."
"I disagree. I know I've complained about a lack of money in the past, but I also know that the bulk of Resident pay comes from Medicare, and the absolute biggest problem in the ED is staffing. That was ignored when the settlement was reached."
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