Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 9: Yes or No?
March 28, 1990, Circleville and McKinley, Ohio
On Wednesday morning, the headline of The McKinley Times caused my heart to sink.
Local Doctor Arrested on Sex Abuse Charges
Doctor Gale Turner, the most senior physician at the McKinley Free Clinic, was arrested by McKinley Police on multiple charges of sexually abusing young women who used the services provided by the Free Clinic. Doctor Turner was arrested by the Hayes County Task Force, comprised of Sheriff's Deputies, McKinley Police Detectives, and the Ohio State Police.
The Times attempted to reach someone in authority at the clinic for comment, but we were unable to do so before press time. At press time, no attorney of record was shown for Doctor Turner. Doctor Turner is being held in lieu of a $500,000 bond in the Hayes County Jail.
I tossed the paper on the table, downed the last of my coffee, and headed to the hospital for my shift. I went to the locker room, changed into scrubs, then went to check on Erin and Todd. They confirmed that all the pre-op labs were back and that nothing prevented either of our two patients from having their surgeries.
We prepped the first patient and had them in the OR at 6:00am sharp, then returned to the lounge. I had a busy morning with three ED consults, and just after 10:00am, Marjorie let me know that Clarissa was on the phone.
"What happened with the Free Clinic?" I asked.
"It's open, but I have the day off because, without an Attending there, I can't work. Trina is keeping her appointments, but they have to send anyone who needs a doctor to the ED."
"Wonderful. Do you know what they're doing?"
"Trying to hire a locum OB/GYN. Trina said they hope to have someone by Monday."
"Were the protestors still there?"
"Yes, but now with signs that mention the arrest."
"That was awfully fast!"
"A poster board and a jar of paint or markers? And it was in the paper this morning."
"I suppose."
"Do you think he's guilty?" Clarissa asked.
"I don't know what to think," I replied, "but I still find it hard to believe."
"Me, too. Trina said it's all BS."
"If anyone would know, it would be her."
"I'll let you go. Tessa and I both have the day off, which is rare."
We said 'goodbye', and I hung up. About twenty minutes later, I had another call.
"Doctor Loucks, this is Mark Van Zandt from Dismas House. Do you have a moment to talk about Alan Edwards?"
"I do. I go by Doctor Mike professionally."
"My apologies. Alan says that you might be able to help him with a job?"
"Do you have his skills assessment?"
"I do."
"If you'll fax it to me, I'll discuss it with some men from the church and see what's possible. I'm sure you realize that a rape conviction where the victim was thirteen is going to make this extremely difficult."
"Yes. Only murderers are more difficult."
"You know, I've never asked, but what happens if they're completely unemployable?"
"That's up to the judge and parole officer. Generally, if the parolee follows the rules and makes an effort, they could be placed with law-abiding relatives, if they have any, even if that is out of state. They can also qualify for public assistance, though housing is often a problem. There are some agencies that do provide low-cost housing, but none in McKinley."
"OK. If you'll fax that assessment to me, I'll get to work."
I provided the fax number for the machine in the lounge, and we ended the call. Five minutes later, I had the assessment, which was as bad as I had expected it to be. With an undergrad degree in music and no work experience except two years at McDonald's in High School, it was going to be tough to place him.
His physique wasn't suited to manual labor, and according to Elias, none of the apprenticeship programs would take convicted felons for at least two years after they had completed their sentence. Alan Edwards was thirty-one, which was another strike against going into one of those programs.
The rules he had to live by made things even more difficult, as, for example, he couldn't try to find music gigs in any place that served alcohol. There were other restrictions, including associating with known felons, though that one could be waived by the parole officer so that Alan could take a job where another felon worked.
All I could do was make phone calls or speak directly to the men at Saint Michael and the Cathedral and hope something came of it. Given I could be interrupted at any time when I was at the hospital, I'd do that at Vespers or the Divine Liturgy. I walked to the locker room, put the assessment in my locker, and returned to the lounge just in time to be called for a consult in the ED.
"What do you have, Isabella?" I asked when Todd and I walked into Exam 2.
"Ken Jones; thirty-six; rule-out appy."
"Good morning, Mr. Jones," I said. "I'm Doctor Mike from surgery. I'm going to evaluate you, and if I confirm Doctor Mastriano's diagnosis, we'll take you upstairs right away."
"It hurts like a mother, Doc."
I nodded and performed a physical exam, detecting rigidity and guarding, and confirmed with an ultrasound that he had a seriously inflamed appendix requiring immediate surgery.
"Todd, call up and let them know we have a hot appy and need an OR immediately."
"Right away, Doctor!" Todd replied.
"Linda," I said to Doctor Mastriano's student, "we need a gurney. We won't wait for an orderly."
"That bad, Doc?" Mr. Jones asked.
"You have a significant inflammation, and we want to get you into surgery before your appendix ruptures. Isabella, I recommend a prophylactic dose of cefuroxime."
She agreed and gave the order to Jamie, who administered the antibiotic.
"OR 2 in ten minutes," Todd announced. "Doctor Edmonds."
"Thanks. Mr. Jones, I need to get you to sign consent forms and go over the procedure with you, including the risks."
"I'll sign, Doc. If you don't do it, it'll burst, and I'll die, right?"
"That would be the most likely outcome, yes. I do need to review this with you, but we can do it quickly. You'll be given general anesthesia, which has significant negative outcomes for a small percentage of people, including coma or death. In addition, all surgeries risk infection, and that risk is higher with appendicitis. Your appendix could burst, leading to peritonitis, which could result in death."
"How often do those happen?"
"Rarely, but they do."
"Let me sign. The pain is killing me!"
Unfortunately, with only ten minutes to go before surgery, I couldn't give him anything for the pain. I handed him the clipboard, and he signed the forms, which I countersigned and clipped to his chart.
"Let's set up on a 5-lead," I suggested. "That'll save time upstairs."
"Linda, 5-lead, please," Isabella said to her student.
Linda set up the 5-lead and connected the portable monitor, and Jamie switched the nasal cannula from the hospital system to a bottle. Once that was complete, Todd, Isabella, Jamie, and I helped Mr. Jones slide onto the gurney.
"Linda," Isabella said. "Go with Doctor Mike and bring back the portable monitor, please."
Linda, Todd, and I pushed the gurney into the corridor, then towards the elevator. Three minutes later, we delivered him to the surgical team in OR 2.
"Scrub in as second surgeon, Mike," John Edmonds said. "Your students as well."
"Todd, go let Erin know, and both of you join me in the scrub room."
He left, and I went to the locker room to put my baptismal cross and wedding ring in my locker. That accomplished, I headed to the scrub room, where Mary, the scrub nurse, assisted me in donning gloves, a gown, a mask, and one of my trademark black surgical caps. I entered the OR and took the place reserved for the second surgeon. Mr. Jones was hooked up to the necessary monitors, and anesthesia was being administered as the nurses prepared for the procedure. Todd and Erin joined us, with Todd standing in the observation spot and Erin standing next to me to assist with suction, retraction, or any other task assigned to me by Doctor Edmonds.
"He's under," Doctor Plumb, the anesthesiologist, announced. "Good pressure, pulse, and sats. Clear to proceed."
"Here we go!" Doctor Edmonds stated. "Mike, we're performing an open procedure. Ready?"
"Yes."
The procedure was routine until Doctor Edmonds ligated the inflamed appendix when fluid began flowing from it.
"Rupture!" I declared.
"Son of a..." Doctor Edmonds growled. "OK. Terry, lavage kit to Mike, please. Fran, hit him with the pre-filled dose of cefuroxime; Mike, I'll cut; you remove the organ with forceps."
"Jackie," I called out. "Forceps and basin!"
Everyone moved quickly, and thirty seconds later, all those tasks had been accomplished.
"Mike, pour in the saline for lavage; Erin, suction."
I took the stainless steel pitcher and poured a litre of saline into the open wound, and Erin carefully suctioned it out. We repeated that twice more before Doctor Edmonds declared the field was clean, and we worked together to close the incision. Ten minutes later, we were finished.
"Great job, John," Doctor Plumb said. "His vitals were good the whole way through."
"Mike, get him to Recovery; chart a standard course of high-dose IV antibiotics against sepsis. Keep him on the cardiac monitor and have your student stay with him for the next two hours."
"By your command!" I replied in a 'Cylon' voice.
Doctor Edmonds laughed, "I take it you saw the Battlestar Galactica poster in my office?
"I did!"
Erin, Todd, and I scrubbed out, then escorted Mr. Jones to Recovery, where Erin hooked up a cardiac monitor and pulse oximeter. I wrote the orders on the chart, then gave Erin verbal instructions.
"If he spikes a fever over 38.5°C, his PO₂ drops, he has respiratory difficulties, or there are any cardiac anomalies, call me immediately."
"Yes, Doctor."
I spoke to Janet, the charge nurse for Recovery, and relayed the orders for the IV antibiotics. She immediately retrieved the appropriate IV bag and connected it.
"I'll be back in thirty minutes to check on him," I said.
Todd and I left Recovery and returned to the lounge.
"How often does that happen?" he asked.
"It's actually rare that it ruptures during the procedure, but around 10% of the cases we see involve ruptures. In many cases, the pain isn't bad enough for the person to come to the ED until they're vomiting or they spike a fever. There is also the problem of what amounts to a false signal — when an appendix ruptures, pain can disappear temporarily until peritonitis sets in."
"I was really surprised to see you pour saline directly into his abdominal cavity."
"You have to wash out any of the fluid that flows from the appendix, and the only way to do that with any level of reliability is a warm saline lavage; suction alone can't do it. Even so, we pumped him full of antibiotics, given that peritonitis is a major risk. Normally, one dose is all we give, and that's pre-surgery. Post-surgery all depends, but it's usually oral antibiotics that we'd give after any surgery."
"And recovery?"
"Longer, and he'll stay here around five days instead of the usual two. Other than that, the risks are similar for any open abdominal procedure."
"Is there anything we could have done differently?"
"From the time I was called for the consult? No. Ten minutes is basically the absolute minimum from ED to OR. I didn't look at the chart to know if there were any delays in the ED. And we don't know how long he delayed coming to the hospital."
"Couldn't you save time by having the ED doc simply make the call?"
"Theoretically, yes, though ED docs are not, generally speaking, trained to evaluate a patient for surgery. In the case of a hot appy, they could, as there is a scoring system based on symptoms, and the diagnosis can be confirmed by ultrasound. A seriously inflamed appendix in the typical anatomical location is easy. But it can also be hidden behind other organs or be atypically formed. That can mislead someone who isn't a specialist."
"I'm going to ask something that might get me in trouble..."
"No question you could possibly ask me will get you any trouble of any kind unless you ask me to violate the law."
"You're an Intern. How are you more qualified than Doctor Mastriano, who's an Attending?"
I laughed, "That is, indeed, the flaw in the logic. The answer to that is really territorialism, which is part of the whole system of political BS that I do my best to avoid. That said, at this point, nine months in, I do have more experience in the OR than Doctor Mastriano does. But you're absolutely right that in June, when Mary Anderson becomes an Intern, she'll perform surgical consults starting her first day. I had one significant advantage over Mary, and that is that I opted for a Sub-I in pathology."
"Nobody does those unless they're going into pathology."
"A false statement, given I did."
"OK, but you know what I meant, right?"
"Yes, of course. I know the thinking behind avoiding that Sub-I, but there's an alternative way to think about it. Consider what that might be, and I'll ask again after lunch. Let's go check on our patient for the afternoon surgery."
After we checked on the patient, I went to Recovery to check on Mr. Jones, who had not come out of the anesthesia but had good vitals. I left, went to the cafeteria, ate a quick lunch, then returned to Recovery to find that Mr. Jones was awake. He had expressed discomfort, and the nurses had followed the standing orders of a mild analgesic.
"What happened, Doc?" he asked.
"Your appendix looked us in the face and gave us the finger," I said.
He laughed and grimaced, "Don't make me laugh, Doc."
"Sorry. We were just about to remove your appendix when it ruptured. We were prepared and got you cleaned up to limit the risk of peritonitis, but you'll need to stay in the hospital for five days, most likely."
"It's sick time, so I'll get paid for lying in bed for a week!"
"Erin is going to stay with you, and I'll come check on you in about an hour."
"Nothing personal, Doc, but she's a hell of a lot easier on the eyes than you are!"
"On that, we agree! Erin, no changes in my orders."
"OK, Doctor Mike."
I left, returned to the lounge, and walked over to Todd.
"Before I send you to lunch, why would a prospective trauma surgeon think a pathology Sub-I was valuable?"
"It would be a refresher in anatomy," Todd suggested.
"Absolutely, and that's the second most popular answer on the board!"
Todd laughed, "Nice. What's the number one answer?"
"What are the rules for using a scalpel for anything other than debriding a wound?"
"Only doctors."
"Yes..."
"You could practice surgical techniques in pathology that you would otherwise have no way to practice!"
"Exactly. Go get your lunch, and I'll see you here in thirty minutes to prep our patient. Erin is staying with Mr. Jones."
He left, and I relaxed until he returned. We prepped our afternoon patient, and once he was safely with Doctor Burke, I returned to Recovery to check on Mr. Jones.
"I'd say we can move you to a regular room," I said once I'd performed an exam. "Erin, make the arrangements, please. Once he's transferred, you can get your lunch."
"Will do," she agreed.
"Mr. Jones, I'll see you during afternoon rounds," I said.
"Thanks for everything, Doc!"
"You're welcome."
The afternoon was routine, and at the end of my shift, I headed home. I had dinner with Kris and Rachel, and then we went to Saint Michael the Archangel for the Vesperal Divine Liturgy. After the service, I asked Viktor if we could speak privately before he and Yulia took Rachel for her biweekly visit.
"I have a significant challenge from my prison ministry," I said. "A recent parolee is at Dismas House and is looking for a job."
"What was he convicted of, and how much time did he serve?"
"Eight years for sex with an underage girl, but which was classified as rape because she was thirteen."
"And you're seriously asking for my help?!"
"Yes, and I needed to, though I was reasonably certain of the answer. I do know more about the circumstances, as I was tangentially involved."
"How so?"
"The girl was the precocious daughter of the dean with whom I had all my trouble. The arrest happened while I was taking music lessons from Anicka Blahnik, who was his professor."
"There's just no way I can do that, Mike. You can ask Geno, as he's mostly running things now, but the employees would stage a revolt if they ever found out."
"I'm open to ideas," I said.
"I wouldn't even know where to begin. I don't believe any of the men would be receptive, given they all have daughters or granddaughters."
"That was my fear, but I do have to try because I was asked as part of my ministry."
"I understand. I don't believe you'll have any luck."
"I strongly suspect you're right. I'll discuss it with His Grace on Sunday."
"Changing topics, have you met the new Chief of Emergency Medicine?"
"I will on Monday. I'll be back in the Emergency Department full-time."
"What do you know about the Doctor at the Free Clinic who was arrested?"
"That I find it hard to believe, but there were at least four complaints, which indicates my perception might have been off. That said, the organized protestors have an incentive to see something like this happen."
"You think it might be a setup?"
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