Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 66: Now It's All on Us
March 22, 1991, Centerville, Ohio
On Friday evening, rather than go out with our friends, Kris and I had dinner with the girls, then, much to Rachel's delight, we took her to Abi's house, where she'd spend three nights. Once Rachel was settled with Abi, Milena, and Joel, we took Charlotte to the Korolyovs, then headed home.
Kris and I spent a quiet evening together, culminating in our evening prayers and an early bedtime as we were leaving for Philadelphia at 5:00am.
March 23, 1991, Philadelphia, Pennsylvania
The drive from McKinley had taken just over nine hours, and we checked into the Wyndham in the Historic District, which was within walking distance of the things we wanted to see. The four of us quickly checked in, and after Nathan, Lara, Kris, and I changed clothes, we walked to City Tavern for a late lunch. After lunch, we took a tour of Independence Hall, followed by a visit to see the Liberty Bell.
I'd seen both when I was in Philadelphia with Clarissa and Jocelyn, but Kris had not, and this was part of her introduction to American History, something she'd mostly missed, given she'd grown up in France. I didn't mind seeing them again, and Nathan hadn't been to Philadelphia, so it was good for him as well.
We had a late dinner at Old Original Bookbinder’s, then, after some discussion, took in a late showing of Sleeping with the Enemy.
"That was a long day," Kris observed when she and I reached our room just after midnight.
"That's true, but we'll have a more leisurely time tomorrow at the Philadelphia Museum of Art, seeing Betsy Ross House, and checking out Elfreth’s Alley. We have no timelines, and we'll grab lunch at Reading Terminal Market. Then, by agreement, we'll have couples' time, and you and I will order room service and have a nice, warm bubble bath."
"That does sound nice," Kris agreed as we got into bed.
She snuggled close, and we fell asleep.
March 26, 1991, Gettysburg, Pennsylvania
At Gettysburg, we had a private tour much the same as the one I'd had when I'd visited with Jocelyn and Clarissa. Interestingly, neither Nathan nor Lara had been to Gettysburg, which was particularly surprising, given Lara had grown up in Pennsylvania. Kris, of course, hadn't been there, though she did know about the battle, even from her history classes in France.
"I take it we're not swapping like you did when you were here before?" Lara asked with a smirk when we had a few moments alone while our spouses used the facilities.
"Who snitched?" I asked with a smile.
"It wasn't so much snitching as a conversation between Clarissa and me when the three of us were sorting things out after Elizaveta died. Clarissa tried very, very hard."
"I'm aware, but some things just can't be overcome, and probably shouldn't be."
"I agree, and that applies to you and me and possibly to you and Maryam."
"That was more about hardly ever seeing each other for anywhere from three to seven years. There's a married couple who matched in surgery, and they're basically on opposite shifts. They had similar challenges as medical students during their clinical rotations. It was hard enough with Elizaveta being a stay-at-home mom that I can't imagine what it must be like for them."
"That was really the challenge with Danika, wasn't it?"
"Yes, though Stanford was the bigger concern. It was similar to the challenge with Katy. I wasn't about to move, and they would have had to act against their own best educational and career interests."
Kris and Nathan returned, which ended the brief conversation, and the four of us left the battlefield for dinner and a good night's sleep.
March 27, 1991, Duquesne, Pennsylvania
"Do you still have the stuffed animals and Care Bears posters in your room?" I asked Lara as we pulled into the driveway of her stepdad's house on Wednesday afternoon.
She laughed, "I do! It'll be interesting sleeping with my husband in my teenage bed!"
"Is that some fantasy of yours of which I'm not aware, Laura?" Nathan asked with a smirk as he parked the Mercedes sedan Lara had bought for him in the driveway.
She laughed, "I'll tell you my fantasies later!"
The four of us got out of the car and went to the front door, where Luisa greeted us. Kris and I were shown to the 'blue' guest room — the same room I'd stayed in when I'd visited the previous time, which was when Lara and I were exploring our relationship.
"This is a little much, don't you think?" Kris asked quietly as we put our bags on the bed.
"That was my reaction when I was here seven years ago."
"That was when you were dating Lara, though that was the time before Elizaveta."
"Yes. There was no way Lara was going to marry a clergyman, and after Elizaveta, it was about praxis. You and I are a much better fit."
"It fits alright!" Kris smirked.
"Later!" I chuckled.
Lara and Nathan returned from her room, and the four of us went downstairs to see Mr. Bragg and Lara's biological mom, Elena. We all greeted each other, and I could feel the tension in the room, given Mr. Bragg was unhappy with Lara's choices — teaching High School and marrying another teacher.
"Laura tells me you've been appointed Chief Resident," Mr. Bragg said.
"As of June 1st," I replied.
"Congratulations! Lara, what are your plans?"
"The only specific plans we have are to visit the Duquesne Incline, see the Penguins on Saturday, and attend Palm Sunday Services at the monastery on Sunday before heading back to Ohio."
"Will you join us for dinner tonight?"
"Yes. If you don't mind, the four of us will go to the basement."
"We'll see you at dinner."
The four of us went downstairs, and Lara got us cans of pop, rather than calling Luisa.
"Your dad didn't roll his eyes, but he sure wanted to when you mentioned the monastery," I observed.
"You know he disapproves of basically everything," Lara replied. "I half-expected him to say something about your choice of hospitals."
"He, like everyone else, is entitled to their opinion, no matter how wrong they are!"
Nathan laughed, "That applies to just about every parent who calls or visits to complain about how terribly I've treated their darling angel with my grading."
"And medical students," I observed. "I actually had one who felt she should get a good grade simply for showing up because the rotation wasn't her specialty."
"Did she Match?" Lara asked.
"No, and she failed to Scramble. The last I heard, she's talking to programs that were unable to fill, but her chances of success are slim unless someone in a rural clinic or maybe a tribal clinic is willing to hire her. I tried to help her, as did Mary Anderson, but we couldn't get through to her."
"I suspect it's similar to student teachers who basically prove they can't teach. For them, there are inner-city schools that might take them."
"Mike, feel free to spend time with Kris, if that's what the two of you want. As we discussed, tomorrow is a free day, and if you want to borrow the car, that's fine. Nathan and I can use one of my dad's cars. Friday, we'll go into Pittsburgh for the day, and obviously on Saturday we'll be at the Igloo."
"We would like to borrow the car. We want to spend the day at the monastery."
"No problem at all."
The rest of the afternoon was quiet, and after dinner with Lara's mom and stepdad, Kris and I took a walk, then spent the rest of the evening in our room, relaxing, listening to music, and, of course, making love.
March 28, 1991, Ellwood City, Pennsylvania
"Good morning, Michael," Mother Christophora said when she greeted us at the Monastery of the Transfiguration.
"Good morning, Mother. This is my wife, Kristina Korolyov."
"Good morning, Kristina!" Mother Christophora said.
"Mother, I have a cassock in my car and permission from Vladyka JOHN to wear it, if you require."
"I would prefer it, please. Then return so we can catch up."
I went back to the car, put on my plain black cassock, then returned to Mother Christophora's office, where she and Kris were waiting with tea and fasting-acceptable cookies.
"Kristina tells me you have another daughter," Mother Christophora said. "I wish you could have brought your daughters!"
"This was a vacation for Kris and me," I replied. "But I don't see any reason we couldn’t visit as a family once our new schedules are in place after June 1st."
"What changes then?"
"I'll be in my third year, and have been appointed Chief Resident as of June 1st."
"Congratulations! Have you continued to see Father Roman?"
"Yes, though we speak over the phone because my schedule has been difficult since November. I have been to see him a few times."
"And the prison ministry?"
"It's going well, though I haven't made any progress with the man who was the reason for starting the ministry."
"The Holy Spirit works on his own timeline," Mother Christophora replied. "There are other men, are there not?"
"Yes, and I'm having much better success with some of them."
"Good. Kristina, tell me about yourself, please."
We spent another twenty minutes with Mother Christophora, then, with her blessing, went to walk the grounds and spend quiet time together, then joined the nuns and a few other visitors for lunch. We spent the afternoon the same way, though we joined the nuns for the hours, and finally, just before 5:00pm, we left the monastery to drive into Pittsburgh to have dinner.
March 30, 1991, Pittsburgh, Pennsylvania
Nathan, Lara, Kris, and I entered the Igloo about thirty-five minutes before the late-season Patrick Division rivalry game against the Flyers. Games between the cross-state rivals were always exciting, and even more so because the Penguins were going to win their division. After tonight's game, they had one more game to play against the Rangers, but had the division sewn up.
The Flyers, on the other hand, were in a rebuilding year and had missed the playoffs. Of course, all THAT did was make them play even harder against the Pens. That led to a wild third period, with each team scoring three times, and the game ending in a 4–4 tie based on single goals in each of the first two periods — the Flyers late in the first period and the Pens late in the 2nd period.
I had hope the Pens would pull it out, but they gave up the tying goal with less than three minutes to go. Despite that, I enjoyed the game and looked forward to seeing the Penguins progress through the playoffs. Unfortunately, most of it wouldn't be on TV, but a few games would be shown, and I'd do my best to catch them.
After the game, we made our way back to Lara's stepdad's house.
March 31, 1991, Palm Sunday, McKinley, Ohio
On Sunday morning, we had attended Palm Sunday services at the monastery, then driven back to Ohio. The timing was tight, but we arrived just in time for the first Bridegroom Matins Service of Holy Week. My mom and Stefan attended the service at Saint Michael the Archangel so that they could bring Rachel and Charlotte to us.
"Thanks for watching the girls," Kris said to my mom after the service.
"Don't thank her yet," I said. "We don't know how spoiled the girls are just yet!"
"Very!" my mom declared mirthfully. "Grandmother's privilege!"
"Did you girls have fun?" I asked Rachel who was in my arms.
"Yes! I played with Abi and with April! Baby Charlotte didn't play much."
"She's only nine months old," I said. "She'll play soon. Shall we go home?"
"Will you sing to me before bed?"
"Two songs," I said. "Then bed."
"Yes, Papa."
April 1, 1991, McKinley, Ohio
On Monday morning, I returned to the hospital, refreshed both by my vacation and the first services of Holy Week. I arrived a few minutes earlier than I typically did, and after changing in the locker room, I checked in with Kayla Billings.
"It was a quiet week," she said. "We need to find some time to discuss scheduling as well as newbie orientation."
"This week is bad due to Holy Week, but after Pascha, which is next Sunday, we can find a time that works for both our schedules."
"Then I'll speak to you next Monday."
I went into the locker room, poured myself some coffee, and about five minutes later, went to put my name on the board. Once that was done, I walked over to Walter Foster and Margie Temple.
"Good morning," I said. "Congratulations on Matching here for pathology, Walt."
"Thanks, though I was the only one to apply, so it kind of made it a done deal!"
"Margie, may I see your procedure book, please? Yours, too, Walt."
I reviewed their procedure books, and both were typical for their situation — Margie at the end of her MS3 year and Walt at the end of his MS4.
"If it were up to me, I'd have you two do intake H&Ps on your own and present your findings, but that's not permitted, so please get a chart and bring in a patient. It's OK to ask the triage nurse for any younger patients or more complex cases; just let her know you're my students."
A minute later, we were in Exam 3 with a very unhappy toddler.
"What brings you here today?" Walt asked Mrs. Hereford.
"Danny woke up screaming and pulling on his ear," Mrs. Hereford replied.
"How old is he?"
"Eighteen months."
"When was his last pediatrician visit?" Walt inquired.
"About three months ago; he has his next appointment next week."
"May I examine him?"
I could see it was going to be a challenge because Danny was clinging tightly to his mom, but I wanted to see how Walt handled it.
"Yes, of course."
"Do you think we can get him onto the exam table?"
"We can try," Mrs. Hereford said. "He has a death grip on my blouse."
She got up from her chair and moved to the exam table, where she — in the only word that fit — pried her son from her chest. That only caused him to scream louder and to thrash.
"Margie, would you try to hold Danny's body?" Walt requested. "And Mrs. Hereford, could you hold his head still between your palms so I can look in his ears, nose, and mouth?"
I smiled because Walt had it down pat, which was a good sign, given he'd be an MD in eight short weeks, though if his patients thrashed, something would have to have gone terribly wrong!
It was a struggle, but he eventually completed his exam.
"Mrs. Hereford, you can hold him again," Walt said. "We'll step out into the corridor for a moment."
"What's wrong?"
"That's what we're going to discuss. As a trainee doctor, I have to confirm my diagnosis with Doctor Mike before I present it to you."
"OK," she agreed.
The three of us stepped into the corridor.
"What do you think?" I asked Walt.
"It appears to be a classic case of otitis media. He has all the symptoms — crying, pulling at his ear, interrupted sleep, low-grade fever, red and bulging right tympanic membrane."
"Very good. Causes?"
"Bacteria or a virus."
"How certain are you?" I asked.
"He has no signs of strep or any other complaint, heart and lungs are normal, no guarding or rebounding, and according to his history, he was fine yesterday, hasn't had a fever, and both his appetite and bowel movements have been normal."
"Proposed treatment?"
"Liquid acetaminophen or ibuprofen for pain and follow up with his pediatrician in two days."
"And if she demands antibiotics?"
"They're not indicated," he said.
"That's true for children over two; for a severe case, especially with children under two, they are indicated, at the physician's discretion. How severe is the infection?"
"Serious bulging. I think I'd be screaming if that were my ear!"
"What's the standard treatment then?"
"Amoxicillin."
"Let's go back in, I'll check his ear, and if my findings match yours, I'll nod, and you can present the treatment plan."
The three of us returned, and I was able to check Danny's ear while he clung to his mom. His tympanic membrane was bright red and bulging, which meant Walt's diagnosis was correct, so I nodded to him.
"Mrs. Hereford," he said. "Danny has a severe ear infection. The standard course of treatment for a child under two is amoxicillin and liquid children's analgesics — Tylenol or Advil. You should follow up with his pediatrician in forty-eight hours. If you'll give us a few minutes, we'll get the paperwork done, and you can be on your way."
"Thanks, Doc ... what do I call you?"
"Walt is fine. I'll be an MD in about eight weeks."
"Thanks, Walt."
We went through the process of presenting to Doctor Mastriano, who signed the chart and the prescription form. Once we had approval, we returned to Exam 2 and provided Mrs. Hereford with the paperwork, reminding her to make an appointment with Danny's pediatrician. She thanked us, and Margie showed her to Patient Services.
"Excellent job, Walt," I said once Margie returned.
"But I missed the antibiotics."
"I'd rather you missed that way than prescribe them when they weren't indicated," I replied. "Your first instinct was the correct one. Margie, get the next chart in the rack, and you conduct the H&P."
"I haven't done one before," she said.
"But you've witnessed some, right?"
"Some, yes."
"And you didn't skip the 'Doctoring 101' class, right?"
"No."
"Then you know what to do. I'll be right there for questions, and it's OK to ask. I'll say you're a medical student and explain to the patient or their guardian about Moore being a teaching hospital. Go on, please."
A minute later, we were in Exam 4 with a nineteen-year-old girl who had an ankle injury.
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