Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 68: Is That a Medical Diagnosis?
April 27, 1991, McKinley, Ohio
On Saturday, at band practice, José surprised us by bringing Sierra and Marco José. The bigger surprise was when Rachel decided to go with Sierra to Anicka's office because even being in the room across the hall would be too much for a baby.
"It appears all boys aren't bad," I observed to Kris as Rachel followed Sierra out of the building.
"All little girls like newborns," Kris replied. "And you know our daughter's real objection is just how noisy and active little Viktor is. If he were calm and gentle like you, Rachel wouldn't object as much."
"Was I calm and gentle last night?" I asked with a smirk.
Kris laughed, "No, because I didn't want you to be! Sometimes I like you to be very vigorous, though you know I mostly prefer our usual way."
"As do I."
"Do you mind if I go with Sierra?"
"No, of course not. You've heard me play many, many times!"
"Perhaps I'll play your flute later," she said with a twinkle in her eye.
She left, and I went into the room to join the others.
"I saw the Pens finished off the Capitals," Keri observed. "You must be happy."
"I am! Four straight wins after losing the first game bode well. They play the Bruins next, and that will be a tougher series, I think."
"Is there any chance you can go to a Stanley Cup Final game?"
"Lara might be able to get tickets for one, but everything depends on my work schedule."
"That would be cool!"
"It certainly would!"
"Let's practice!" Kim requested.
We began by running through our sets for our gig at Stirred Not Shaken on May 2nd. We had enough songs in our repertoire that fewer than a third of the songs would be repeated from the previous gig. We'd added a few James Bond theme songs to our playlist — For Your Eyes Only, All Time High, and Nobody Does It Better, all of which Kari or Kim would sing, as females sang the songs during the opening credits for the movies.
When we finished rehearsal, Kris, Rachel, Charlotte, and I drove to Kroger and the bakery, then headed home for lunch. After we ate, I went to my study to work on the schedule for Residents, which I needed to complete no later than the following weekend, so I could circulate it and request what were called 'bids' from the PGY3s. I'd also have to work out a rotation for the overnight shifts.
Fortunately, I had more doctors to work with, as we were gaining ten PGY1s but only losing six PGY3s. Kayla Billings would become an Attending, and the others had all taken positions at other hospitals. Our two additional Attendings were being hired from outside, but that was being handled by Dutch Wernher, Brent Williams, and Ghost. By dinner time, I felt I had a workable plan, but I wanted to run it by Kayla before I circulated it.
I double-checked that I had complied with the staffing plan, then joined my family for dinner. After dinner, we attended Vespers at Saint Michael, then had a quiet evening together at home. When Kris and I went to bed, she did play my flute for me, which was extremely pleasurable.
May 2, 1991, McKinley, Ohio
I had reviewed the proposed schedule with Kayla, then had run it by Ghost for a sanity check. Once I had done that, I circulated it to the current PGY2s and PGY1s and asked them to make their primary and secondary choices, with the understanding someone would be assigned the overnight shifts if nobody requested them. In that case, though, that assignment would only last for three months.
Given the specific requirements I had for teaching on Thursdays, I blocked out the shifts I had created for myself — 0600 to 1700 on Mondays, Tuesdays, Wednesdays, and Fridays, and 0600 to 1200 on Thursdays. That schedule, in addition to allowing me to teach, ensured I could attend Vespers on Wednesdays and Saturdays, as well as Matins and the Divine Liturgy on Sunday, as well as have dinner with my family every night.
Happy with the results, I gave the blank scheduling sheet to Nate to copy and put in each PGY2's and PGY1's mailbox.
"Do you have a sec?" Kylie Baxter asked when she saw me in the lounge a few minutes later.
"I do. What can I do for you?"
"It's more about what I can do for you. I'll take the Sunday through Thursday night shift, for at least the next six months."
"I'm not going to say 'no', but I am curious why."
"I'm dating a McKinley PD detective who works nights."
"Serious?"
"Enough, I guess. He's divorced with a kid, so I'm taking things slowly."
"Those shifts are yours," I replied. "If something comes up and you want to change in September, just let me know before mid-August."
"Thanks, Mike. We haven't been on similar shifts for some time, so we haven't had much chance to talk since last July. How are you doing?"
"Good. I'm sure you heard through the hospital grapevine about Charlotte."
"I did! You have a house full of girls! If I remember, you planned to have two kids with Kris. What will you do with THREE daughters?"
I chuckled, "Buy a shotgun and a case of shells!"
"That takes care of the shifty-eyed suitors, but what about the estrogen overload?"
"We all have our crosses to bear! Changing subjects, how is your mom?"
"She's still with us, has her mental faculties, and can do most things for herself, so I call that a huge win."
"Me, too."
"Doctor Mike?" Ellie said, coming to the door. "EMS three minutes out with an MI."
"Thanks, Ellie; I'll need a nurse. Kylie, I'll see you later. Walt, Margie? Let's go!"
I gave orders as Walt, Margie, and I headed to the ambulance bay with Nurse Becky to await the EMS squad, which arrived just over two minutes later. When Squad 3 pulled into the parking spot, the second female paramedic in Hayes County — Jessica Wentworth — hopped out of the cab.
"Charles Robbins, fifty-two; complained of severe chest pain and shortness of breath; BP 160/110; pulse 120; PO₂ 95% on five litres by mask; sublingual nitro for pain."
"Trauma D!" I commanded, then said, "Mr. Robbins, we'll take good care of you."
The four of us, plus the two paramedics, rushed Mr. Robbins to Trauma D and transferred him to the treatment table. As I began my exam, Walt hooked up the EKG, Margie hooked up the monitor, and Becky drew blood for CBC, Chem-20, and cardiac enzymes.
"Inverted T wave," I said after looking at the EKG screen. "Suggests cardiac ischemia. Margie, call for a cardiac consult, please."
"How bad is it, Doc?" Mr. Robbins asked.
"The EKG indicates your heart has been damaged in some way. Just try to relax, please. We're calling for a cardiologist, and we'll provide you with some medication. Walt, insert an IV, please; Becky, 250mg ASA, IV push. How is the chest pain, Mr. Robbins?"
"It doesn't hurt as bad as before the paramedics arrived, but it still hurts."
"Margie, sublingual nitro, please. Mr. Robbins, do you have a history of hypertension — high blood pressure?"
"No, but I don't see a doc regularly; haven't for years 'cause I felt pretty good."
"Your blood pressure is somewhat high, and that was after a dose of nitroglycerin."
"Explosives?" he asked, surprised.
"Same chemical, different formulation. It's good for reducing chest pain and blood pressure."
"Weird."
About five minutes later, Paul Belmont, a PGY1 from cardiology, arrived with his student. He examined the patient and accepted him onto his service. I sent Margie with them to assist, and they headed for the elevator that would take them to the skybridge to the main hospital building. One major benefit of the new setup was that the elevator was used only for admissions, so it was always available and set to automatically return to the ground floor.
"Mike?" Nate called out. "Mr. Crowe would like to see you when it's convenient."
There were only a few people in the waiting room, so I updated the board to indicate that I should be paged if needed and made my way to the administration wing of the main hospital. When I arrived, his secretary directed me into his office.
"You asked to see me?"
"Yes. Has Paul Lincoln contacted you?"
"He has. It was, in effect, a courtesy call to let me know he intended to subpoena me in a civil rights lawsuit. He also made a request to which I demurred."
"Is there anything you're willing to share?"
"He didn't say anything except that he's engaged a civil rights attorney with the goal of having his records updated to show he resigned rather than having been dismissed due to medical error, which, if you'll pardon the coarseness, was complete and utter bullshit and everyone knows that."
"I assume you would say that in a deposition?"
"My options would be to say that, to refuse to say anything, or to lie. You know I won't lie, and I don't see how I can remain quiet when a clear injustice has been done. Do not get me wrong — I have zero evidence or any suspicion that it was racially motivated, but that's not what they need from me and any other deponent.
"They'll lay out the facts, then point out that the only person who suffered in any way was Paul Lincoln, and he was the only black person in a sea of white faces, from top to bottom. Yes, I know Ross Burnside retired, but he received his full pension despite it being three years early and is likely making more working for the outpatient surgical clinics."
Leland nodded, "Your assessment is accurate. Do you know what he intends to do if the dismissal is changed?"
"I don't think it's appropriate for me to share that," I replied. "I will say he has no intention of trying to come back here."
"OK. That's all I wanted to know."
"Leland, find a way. Paul Lincoln was wronged and did not deserve what happened to him."
"All I can do is advise, Mike."
"I understand."
I left his office and returned to the ED, wondering who would be deputized to try to convince me not to, in effect, throw the hospital under the bus. The rest of the day was busy, but routine, and I saw fourteen more patients before heading home for a quick dinner before Code Blue's gig at Stirred Not Shaken.
May 6, 1991, McKinley, Ohio
The 'who' revealed itself on Monday and was one of the three people I suspected who might be deputized.
"Mike, can I see you in the Attendings' office?" Ghost asked.
"Sure," I replied.
I followed Ghost into the office and closed the door behind us.
"Did you draw the short straw?" I asked.
Ghost smiled wryly, "I suggested they approach Clarissa, but nobody had the balls to try that approach."
I chuckled, "Lissa is a pussycat with everyone but me! That said, she'd have told them to pound sand."
"So did Shelly and Leila. I was, in effect, ordered to ask you to simply withhold your opinion."
"With all due respect, and in Christian love, they can fuck off."
Ghost nodded, "That was exactly what I suggested your response would be. The problem they have is that it would open a major can of worms and might even lead to the settlement agreement being torn up."
"They have a big problem then," I replied. "You can count on the attorney Paul hires to ask me if I have an opinion. Am I supposed to lie and say 'no'? If I don't, you can be sure they'll ask me to give my opinion, and when I decline to offer it, guess what happens? It proves, beyond any shadow of a doubt, that there is a conspiracy to do exactly what Paul is claiming.
"They already have my testimony, which included changing the standard of care for periumbilical pain. It also included the fact that I believe the outcome would likely have been the same had Mr. Webber been admitted for surgery the previous evening. But guess what? There is no guarantee he'd have been admitted, and I said as much. This is a loser case for the hospital because all the circumstances point to the black guy getting the shaft.
"Lastly, I'll point out that I didn't initiate this; Paul did. He got in touch with a civil rights organization, which put him in touch with the attorney, and, in the future, will try to help him secure a medical license. In addition, there is someone with whom Paul's attorneys could speak who would completely doom Moore Memorial. I'm sure the administration can work out who that is and why it puts them in a position where they have to give Paul what he wants."
"I don't disagree with you, and, as I said, I was certain what your response would be."
"What do they want me to do?"
"Not offer an opinion, but as you say, that only digs them deeper. Do you think there was racism at play?"
"I never saw any overt racism except from a few patients, and to my knowledge, nobody treated Paul differently from any other Resident in our class. Obviously, I can't speak to anyone's thinking, but actions speak louder than words in that regard. Paul was happy, and his evaluations were positive, at least as far as I'm aware. What are you going to tell them?"
"The truth — you stand behind the testimony you gave in court and in the previous depositions, and you'll give your opinion if asked, but won't volunteer it."
"That is the bottom line. They could try to fight the subpoena, but I won't fight it."
"I'll relay that."
"Out of curiosity, why didn't Dutch Wernher approach me?"
"As best I can tell, it's about plausible deniability. According to Mr. Crowe, you only expressed your full opinion to Father Roman, and you declined to vent even to Owen Roth or Shelly Lindsay."
"Or you," I replied. "I suppose it makes sense, but as I said, I don't think the hospital has a leg to stand on."
"Truthfully, neither do I," Ghost agreed.
We left the Attendings' office and returned to seeing patients.
May 10, 1991, McKinley, Ohio
On Friday afternoon, the new ED had its first true test.
"Mass casualty protocol!" Nate called out loudly. "At least eighteen smoke-inhalation victims from a fire at Ponderosa. Some by EMS, some by cruiser, some by personal vehicle, first arriving in about five minutes!"
"Send out the disaster protocol pages!" Doctor Wernher commanded, coming out of his office. "Nurse Green, how many beds do we have?"
"Nine in Curtains, four Trauma rooms, and two Exam rooms."
"OK. Let's see if we can clear out some of those beds. Call the services and tell them to take their patients right now! Doctor Mike, you and Doctor Jefferson are in charge of triage. Use portable oxygen for anyone you can't get into a bed. Put the worst ones in the telemetry beds."
"Yes, Doctor," I said. "Leticia, let's go to the ambulance bay. Walt, Jerry, and Margie, please retrieve six portable oxygen bottles from the supply room and bring them to the vestibule of the ambulance bay. Trish, get four fingertip PO₂ meters."
The four medical students gathered the items I'd requested, and we were waiting when the first two squads arrived about two minutes later. It was chaotic, but none of the patients we received, except the cook who had been at the grill when the grease fire had started, were in any danger from the small amount of smoke they might have inhaled.
Even the cook wasn't seriously injured, having only a second-degree burn on his arm and having breathed in some smoke. He was treated, examined by a pulmonary specialist, and released with instructions to return to us or see his personal physician if any symptoms developed.
"Much ado about nothing, in the end," I reported to Doctor Wernher once the cook had been discharged. "It was smart of the Police to send everyone here, but only one actually needed treatment."
"Agreed. I canceled the disaster protocol and sent everyone who had been paged home. Everything worked smoothly, though the real test comes when we see significant casualties."
"I'll be happy if that never happens," Ghost interjected. "Sadly, experience says it will."
"Were there any difficulties?" Doctor Wernher asked.
I shook my head, "Not from a triage perspective."
"Nor from an exam and treatment perspective," Ghost added.
"Good. If either of you thinks of anything we can do to improve our response, please let me know."
He returned to his office, and I went to find my students so we could begin seeing patients from the somewhat backed-up waiting room. By the end of the day, we resolved the backlog caused by the two hours we'd spent examining a total of nineteen patients from the fire, and I was able to leave at 5:00pm.
As was typical for a Friday night, we met the gang at the Chinese restaurant, though José didn't join us because he wanted to stay home with Sierra and Marco. There was nothing playing at the movie theatres we wanted to see, nor was there anything interesting at the repertory theatre, so Milena arranged for all of us to spend the evening at Anicka's house listening to music and socializing.
May 12, 1991, McKinley, Ohio
On Sunday, after the Divine Liturgy but before Sunday School, Lara came to find me in the Parish Hall.
"I checked with my stepdad, and the Stanley Cup finals games in Pittsburgh are on Wednesday, Friday, and Thursday."
"That's not going to work, unfortunately," I replied. "I really do want to see the Penguins playing for the Cup, but all my vacation days are spoken for, and finding someone to cover two days would be rough, given there isn't really any time for me to work a pair of traded shifts."
"Is there anywhere you can watch the games?"
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