Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 71: An Unfair Outcome
June 1, 1991, McKinley, Ohio
"Did your schedule change the way you expected?" Kim asked when I arrived for band practice on Saturday morning.
"Officially, yes, though the nurses went on strike at midnight last night, so everyone has an additional two hours on each of their shifts. For me, that means my schedule is 5:00am to 6:00pm on Mondays, Tuesdays, Wednesdays, and Fridays, and 4:00am to noon on Thursdays. Hopefully, the strike is resolved in the next ten days, or I'll have to cancel my vacation."
"That sucks," Kari observed. "Is there any hope?"
"There's always hope, but at the moment, there aren't any bargaining sessions scheduled, so you can easily work out the odds."
"Close to zero."
"The only glimmer of hope is that the McKinley Times laid the blame fully and completely on the Hospital Board and County Board of Supervisors."
"Speaking of the newspaper..." Kari said.
"It's all BS, and they buried the lede that there were no disciplinary actions or any negative marks on my record."
"Why not say that?" Sticks asked.
"On the advice of Melody and Jocelyn. They both felt nothing I could say would help, and once I started talking, they'd keep coming at me. It's better to just let it die down."
"Has anyone said anything?" José asked.
"Not really, no."
I wasn't going to get into the problems at Saint Michael the Archangel, as the last thing I wanted to do was make things even more difficult.
"That's good."
"Mike," Kim said, "I assume the Goshen Harvest Ball is OK? They don't have a problem with having the same band every year, the way the Prom committee does."
"That's fine. July 4th is a Thursday, and we perform at 3:30pm, so I won't have to trade. I'll just have a short seminar at the med school that day."
"Cool. We have gigs at Stirred Not Shaken on July 18, August 22, and October 17. I'm also trying to get another date at Southgate House, and a club in Dayton expressed interest."
"Sounds good to me!"
"Last thing — we'll have a studio recording session in September or October for our CD."
"Crazy!" I declared.
"Yep!" she agreed. "Let's practice!"
We did, and two hours later, I met Kris, Rachel, and Charlotte in the small music room where Sierra was keeping Marco to avoid damaging his ears. I recalled putting earmuffs on Rachel when she was little, but it had been just the two of us, so things were different from Sierra, José, and Marco.
As usual, we went to Kroger and the bakery, then headed home for lunch and a quiet afternoon. We had dinner at 5:30pm, then headed to the Cathedral for Vespers, arriving about twenty minutes early so I could meet with Vladyka JOHN.
"Have you seen the newspaper article?" I asked once I'd received his blessing.
"I'm sure this won't surprise you, but someone sent it to me in the mail; anonymously, of course."
"Of course," I said, shaking my head.
"Having read it, I wasn't surprised when Father Luke let me know you had called him to discuss transferring your membership. Would you tell me about your interaction with Father Nicholas?"
I nodded and explained what had happened, from my side, and drew an express parallel with the Nativity morning confrontation nearly four years ago.
Vladyka JOHN nodded, "I was afraid that is what had happened. When you spoke to him, did you raise your voice or become angry?"
"No. I did confess to Father Roman that I had been disrespectful in not allowing Father Nicholas to speak, and I apologized for that when I spoke to Father Nicholas on Tuesday evening."
"I assume you've spoken to Kris?"
"I have, and she's in full agreement."
"Are you willing to discuss the article?"
"What did you want to know?"
"I think, from all of our conversations, I know about more than half of the situations. Was there anything in any of the others for which you needed absolution?"
"No. All of them were discussed in detail with Father Roman, albeit without using names. Were you aware of the plaintiff's attorney who tried to pierce the seal of confession at the malpractice trial?"
"No. What can you tell me about that?"
"It was related to having discussed the shooting incident at the hospital with him, though my attorney suspected it was a way to ask me what other things I had discussed with him. The judge refused their request. The attorney then attempted to introduce all the items mentioned in the newspaper article, but the judge refused, deeming none of them relevant to the case. That's how the reporter discovered everything."
"The article implied that there is a lot of inappropriate behavior at the hospital."
"That is true, but a few changes to policy have reduced it somewhat. Let's just say that if I were of a mind to violate my marriage vows, I would have no trouble doing so with multiple partners."
"That is troubling to hear," Vladyka said with a frown.
"I am not making any excuses, but it's a combination of culture and the stress of the job. Doctors have higher rates of drug abuse, alcoholism, and divorce than the general population. It requires me to be on guard at all times."
"Distressing," Vladyka JOHN observed. "You know it's not my place to tell you where to worship, but I will be happy to see you more often."
"Thank you, Vladyka."
"Do you know who is spreading the gossip?"
I shook my head, "I do not, and I would not want to speculate."
"Understandable. I will discuss it with Father Nicholas. Is there anything I can do for you?"
"Just your prayers, Vladyka."
"Always, Michael; always."
June 3, 1991, McKinley, Ohio
On Monday, I arrived at the hospital at 4:45am for my 5:00am shift, as I wanted a few minutes to speak with Sue Townshend. I made my way to the lounge, then found Sue standing near the nurses' station, where an MS2 and a nursing student were stationed.
"Morning, Sue."
"I'm glad you didn't say 'good'," she groused.
"I hear you. How are things?"
"It was a relatively quiet night, so no real trouble. Doctor Wernher issued a standing order allowing MS2s to draw blood under supervision, but that's the limit of what they can directly do."
I nodded, "That makes sense, given we allow nursing students to draw blood under supervision. Take me through the board, please."
"Mild concussion in Curtain 3, being monitored for discharge at 8:00am; fractured tib/fib in Curtain 5, waiting on ortho surgery, likely mid-morning, but could be longer depending on nursing staff; food poisoning in Curtain 9, undergoing rehydration therapy; heroin overdose in 100, waiting on the locked ward in Medicine."
"Which explains the Deputy sitting outside the door," I said. "I'll take over now; you can head out."
"Thanks, Mike. See you this evening."
"Oh, before you leave, I didn't see any pickets."
"Supposedly, they'll be here at 6:00am. That's when they showed up yesterday."
"OK. Have a good day."
Sue left, and I went to the lounge where I found Gary Simpson and Nora Jones, my medical students.
"How does it feel to be an MS4, Gary?" I asked.
"I can see the light at the end of the tunnel, but with my luck, it's an on-rushing train!"
"I know the feeling. Have you decided on a specialty?"
"Ortho," he replied.
"May I see your procedure book? Yours too, Nora."
Gary's procedure book showed good progress, and I'd checked with Mai, who had given him high marks on his previous ED rotation as an MS3. Nora's procedure book was extremely limited, as she was on her first Clerkship.
"Miss Jones, you are about to receive a baptism by fire, given we have no nursing staff other than the nursing students."
"Doctor Mertens warned us," Nora said.
"Good. We have three patients we're monitoring," I said.
I provided the details about those patients, then asked Gary to retrieve a chart from the triage desk. A minute later, we had a patient with a routine arm laceration in Room 200, the dedicated suture room. I asked Gary to conduct the H&P under my supervision, then had him suture under my direct supervision, ensuring Nora observed closely so she could do the next one. As was required, we reported to Doctor Mastriano to sign the chart.
The morning was relatively routine, and having nursing students helped. That had surprised me at first, but then it had dawned on me that they were in the same situation as medical students — paying for the opportunity to work in the hospital as part of their training. So far, the ED hadn't been impacted beyond the extra hours, but all elective surgeries had been canceled, and emergency surgeries were limited by the minimal staffing the nurses' union allowed for that purpose.
Just before noon, Nate let me know someone had asked for me and was in the waiting room. I wasn't surprised to discover it was a process server who handed me a subpoena to give a deposition in a Federal civil rights lawsuit filed by Paul Lincoln. The filing of the suit had been referenced in the article about the hospital, so it had only been a matter of time. I accepted the subpoena and, after notifying Nate and my students, made my way to Leland Crowe's office.
"Go in, Doctor Mike," his secretary said. "He was sure you'd come up."
"Thanks."
I walked into Leland's office, closing the door behind me.
"Settle," I said without any preliminaries, handing him the subpoena.
He handed it right back, as I was positive he knew it would be served.
"That was my advice to the Hospital Administrator, the Medical Director, and the Hospital Board. I assume you intend to provide your unvarnished opinion when asked."
"I do," I replied.
He nodded, "Will you push the deposition into next week so I can try to resolve this?"
"Yes."
"Good. Thanks for coming to see me."
I left his office and returned to the ED, where I went into the Attending's office and called the attorney listed on the subpoena. I was transferred to his secretary, who put me through.
"Marvin Green," he said when he answered the call.
"This is Doctor Mike Loucks. I'm calling to ask if we can set the deposition for next Monday or Tuesday evening so I don't have to miss work or church."
"We generally don't conduct depositions outside of normal business hours due to the additional costs."
"I understand, but you know as well as I do that I can refuse and provide written answers to written questions, both for a deposition or for a trial. I believe I'm your best possible witness, so I believe it's in your best interest to accommodate me."
"Point taken," he said. "Let's plan on Monday at 7:00pm at our office in Columbus, if that will work for you."
"It will."
He provided the address, and after I repeated it back to him, I ended the call. I called Leland's secretary and let her know the deposition had been scheduled, and then returned to work. I had lunch, and when I returned, the patient waiting on orthopedic surgery was still in his monitored bed in the ED. I verified with him that nobody from surgery had spoken to him, then called the surgical scheduling desk.
"Pete Smith, Surgical Scheduling."
"Medical student?" I asked.
"MS4," he replied.
"This is Doctor Mike in the ED. When will you take the tib/fib for ortho?"
"I don't know. We had a scheduled bowel resection for a malignant tumor, you sent us an appendectomy, and we have a gall bladder in front of your patient."
I could debate with him that the tib/fib should go before the gall bladder, but it wasn't my call, and he was likely simply reporting what he'd been told by one of the surgeons.
"Thanks," I said.
I ended the call, then dialed Shelly's pager. She called me two minutes later, and I explained the situation.
"You aren't short beds, are you?" she asked.
"No."
"Then it's better if you keep him because you're set up for regular monitoring."
"Do you have any idea when you'll take him?"
"I'd say the earliest is 3:30pm, but I can't promise anything."
"How are the nurses handling it?"
"There is one full set of OR nurses scheduled around the clock, and we could call in another, but the hospital has to go on Disaster Protocol for that to happen. I know Owen and Dutch discussed that with Cutter, but decided the nurses might balk if they decided it wasn't a legitimate emergency."
"Wonderful."
"Hit him with Demerol; it's at least three hours before we can take him."
"Wonderful."
"Sorry, Mike."
"I'm not blaming you, Shel. You know where my sympathies lie."
"Mine, too, but the tightwads on the County Board don't care what we think."
We said 'goodbye', and I ended the call, then went to see Dutch to let him know. He sympathized, but there was nothing he could do other than sign the chart authorizing more Demerol. I handled administering the drug via IV, reassuring the patient that we'd get him to surgery as soon as possible. Sadly, that did not happen before Sue Townshend arrived at 5:00pm for her shift.
"You have to be kidding me," she said.
"I know, right? I called upstairs about fifteen minutes ago, and they said it would be at least another hour."
"Why?"
"Honestly and off the record? The nurses are doing everything they can to slow things down, likely working to the letter of the expired contract. You know they're only here because they'd lose the PR battle if we couldn't perform emergency surgery."
"They can cry me a river! No nurse ever worked a thirty-six-hour shift or ninety-plus hours per week for what amounted to $5.00 an hour. They receive overtime for anything over forty hours! Guess who doesn't?!"
"I hear you, but we have received raises each year that are in line with the increase in the cost of living; they haven't. Resident salaries are rising while nursing salaries have leveled off."
"You do realize that senior nurses make more than we do, right?"
"Yes, and after about five years as an Attending, the only nurse whose salary will come close is the Nurse Manager. But this isn't about relative salaries, it's about the County doing the right thing."
"We'll have to agree to disagree," Sue declared.
"Fair enough. I have an hour left on my shift, but the tib/fib is all yours."
"Gee, thanks."
I left Sue, and my students and I saw two more patients before I left the hospital to head home for dinner and an evening with my family.
June 4, 1991, Circleville, Ohio
The phone rang while Kris and I were doing the dishes after dinner on Tuesday. Because my hands were wet, Kris answered the phone.
"Korolyov-Loucks residence; Kris speaking."
She put her hand over the mouthpiece.
"It's Subdeacon Mark," she said.
I dried my hands on a dish towel, then accepted the handset from her.
"Hi, Subdeacon, it's Mike."
"Do you have some time to talk?"
"I do. What's up?"
"I'd rather do it face to face, if you don't mind."
"I don't mind. If you want to come here, that's fine."
"Thanks. Alyssa and I will be there in about twenty minutes."
I acknowledged him, then hung up the handset.
"Mark and Alyssa are on their way over."
"Why?"
"He didn't say, other than he wanted to speak face-to-face."
We quickly finished the dishes, then I put on water for tea, and Kris prepared a plate of cookies. We set everything in my office, and when Mark and Alyssa arrived, Mark and I went into my study. I offered tea, which he accepted along with two cookies.
"What's up?" I asked.
"Father Nicholas was suspended indefinitely," he said.
I took a deep breath and slowly let it out. I was positive I knew why it had happened, and my initial thought was that it was an overreaction by Vladyka JOHN.
"What did His Grace say?" I asked.
"He instructed me to lead Reader's Vespers on Wednesdays and Saturdays, and Matins on Sunday mornings. Protodeacon Ivan will serve a Typika following Matins. His Grace will be at Saint Michael the Archangel tomorrow."
"You have a copy of the Typikon, right?"
"Yes. I've led a few Vespers services, but never a Matins service. Father Nicholas informed me on Sunday that you and Kris had transferred your membership to the Cathedral. I can do simple math, so you know the question I want to ask."
"First, I was not aware of the suspension, nor any hint that it was going to happen. Did Father Nicholas tell you why we decided to worship at the Cathedral?"
"No, but he implied you and he had a falling out."
"Anything I say here, and I have to be very careful, has to be in complete confidence."
"Of course."
"Do you remember what happened on Nativity morning four years ago?"
"That's what I was afraid of. I assume someone read the newspaper article and went to Father with a 'concern' about you teaching Sunday School."
"You assume correctly. Someone, and probably it was the same someone, anonymously sent a copy of the article to His Grace."
"The article made it clear you hadn't been disciplined!"
"Yes, in the final paragraph, thus burying the lede, as it were."
"Do you have any idea who is behind the false accusations at Saint Michael?"
"No, and if I had to hazard a guess, Father Nicholas didn't tell His Grace."
"Why would he refuse to answer?" Mark inquired.
"It's a tricky problem if the person brought it up during confession and expressly said they didn't want their name used."
"Thereby gaming the system!"
"That is one way to look at it, and is likely what His Grace concluded. It would have put Father Nicholas in a very difficult situation. If he reveals the person's name, and that gets out, nobody would ever trust him to hear confessions. If he doesn't answer, well, you see what happened. I'm speculating, of course, but it makes sense.
"What's your advice?"
"Stay out of it, except insofar as you need to tell people that Father Nicholas has been suspended."
"His Grace called the members of the Parish Council to let them know, then called me about the services and to let me know his plans for tomorrow."
"OK. I'm not sure what I can say other than to advise you to stay completely out of it and not to discuss it with anyone except me or whomever His Grace appoints as your interim confessor."
"Father Luke. I'm able to stop in to see him after class."
"How are things going?"
"I'm an MS3 in a PhD program as of June 1, so you know, I have no time for anything except school, studying, and clinical rotations."
"Which rotation?"
"Cardiology. You wouldn't want to lend me your Cardiology notebook, would you?"
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