Chapter 28: True Love

January 31, 1989, Chicago, Illinois

"Hi, Al," I said, sitting down across from him at our usual spot at Medici.

"Hello! I was very happy to hear you say she thinks she's being released on the 10th. That's great news! I'm sure that will be in the next report I get later this week."

"I would guess, and as I said, I'm worried that with the counseling, the reinstatement process, and working in a clinic that she's already going to be pushing too hard."

"The clinic work is really just basic medicine. She'll be taking histories, performing exams, and either dispensing meds or referring the patients for further treatment. She'll occasionally suture or splint or apply a cast, but it's nothing like in the ER. And it's set hours, during the day or early evening.

"The reinstatement process is a series of interviews, a complete physical, a psych eval, and a hearing. Obviously, she'll be under some stress to pass, but I don't think that'll be too much. As for her counseling, because I have no idea what the exact sources of her problems are, I can't really say."

"She never talked to you about growing up?"

He shook his head, "No. Other than seeing her grades from college and her MCAT scores. I don't know any details except what she said in the interview and on her application. You probably know more than I do."

"So her release from the place in Maine, what does that mean?"

"That they feel she's at a point where she can function as a doctor, so long as she's under the care of a therapist who will report back to the hospital on a regular basis. She can't skip any appointments, and she has to be an open book. If she isn't, they'll take appropriate action. Now, if she had an alcohol or drug problem, they'd require that she go to some kind of counseling for that as well, like AA. But you said she wasn't using alcohol, right?"

"I think I've seen Jess take five drinks in nearly three years, and most of those were at our wedding or on our honeymoon. And when she does, it's a swallow, nothing more. As for drugs, I can't even begin to imagine she's using anything."

"They did a full tox-screen at the facility in Maine and it was clean. And it wasn't just urine and blood; they did hair samples as well. Given her long hair, if she'd been using anything during or before her breakdown, they'd have found it."

"There's more there, Al. She as much as admitted that to me. I'd guess she was straight with the facility in Maine."

And that 'more' bothered me. I didn't know what it was, and I still wasn't sure that Jessica could handle it. It had taken me a lot longer than two months to work through my issues with Doctor Mercer back in Milford and Doctor Alborg here in Chicago. And despite concerted efforts by Bethany, Anala, Kara, Elyse, Sofia, and Jennifer, I STILL had issues. And I wasn't caring for patients.

"So it would seem," Al said. "Whatever it is, they think it can be dealt with as an outpatient and with her working."

Al had once told me that the system more or less was set up to protect itself. And I wondered if some of what I was hearing was part of that. If it was, I was going to be VERY unhappy. I should have been concerned about patients, but what I was really concerned about was Jessica and what would happen if the issues weren't truly resolved. I was afraid that the system in general, and Al personally, might actually be playing fast and loose, and I couldn't tolerate that.

"Is that real? Or part of the inside baseball you doctors play to protect your idiotic system?" I said snidely.

Doctor Barton sat back in his chair and simply looked at me. He took a couple of deep breaths.

"Look, we agreed it's broken," he said sharply. "And you know I love Jessica like a daughter. But if you think for ONE SECOND that I would put Jessica in charge of patient care ANYWHERE if she wasn't capable and ready, then you've misjudged me. And I've misjudged you as well."

Al had never raised his voice to me before, or really, even spoken sternly to me. I'd obviously crossed a line, and I owed him an apology.

"I was out of line. I'm sorry."

He took a deep breath and blew it out. The waiter arrived, and we ordered before the conversation continued.

"The thing is," he said, "there are times when the system does work the way you implied. Doctors do cover for doctors. I've personally seen it happen. But I won't tolerate any shenanigans like that in my area of responsibility, not even for someone like Jessica. If she's not ready, she's not coming back. But, and this is important, you need to accept my judgment, and that of the Review Board at the hospital. I won't let any games be played, but to be blunt, as smart as you are, you have neither the knowledge nor the experience to decide if she's ready to be a doctor or not. Period."

"I'm just worried about the cycle beginning again. When you add in the baby, I think it makes it a much more volatile situation."

"It does," Doctor Barton nodded. "Jessica getting pregnant was, well, again to be blunt, foolish. As a practical matter, and I know you don't want to hear this, she should have terminated the pregnancy. But that probably would have wrecked your relationship beyond salvage. Given the alternatives, I'd much rather have her with you. I think that helps her chances of successfully coming back. You have a nanny, which should help somewhat. The timing isn't great either, because she's due in July, and even if she only takes six weeks off, it's going to be tough on her Residency.

"Technically, her PGY2 year will start over, but she's going to be 'off-cycle', which creates problems for Residency programs which need to properly staff. I suspect, given everything that's going on, she'll be presented with two options. The first is to wait to re-enter the surgical program in June of next year, so sixteen months from now. She could work elsewhere until then. The other would be to accept an assignment to either Medicine or the ER, both of which usually have openings at odd times, or, potentially, have the budget for an 'extra', so to speak."

"Would missing her surgical year hurt her long-term goal?" I asked.

"Not really. If she does it as a PGY3 instead, it would just cause a few other things to be rearranged. The entire program is long enough that it will all work out in the end, though she's lost an entire year at this point. She won't receive credit for the time from June to October, because it was on the surgical service and she was dismissed from the program before she completed it."

"I sort of guessed that," I said. "What do you suggest?"

"She needs the ER rotation. The only reason to go to Medicine would be if she wanted to switch to that specialty, or if she wanted to be a pure surgeon. The time in the ER would count towards the total training hours she needs. But because she's starting late, she wouldn't officially graduate from the program until a few months later than most. THAT creates a problem because of the timing of fellowships."

"It sounds like you're saying that she's going to lose two years," I said.

"She plans another baby, right?"

I nodded, "Yes."

"Then there isn't much that can be done about it. She's going to be off-cycle for her entire career. One way to deal with it is to have the other baby during an ER rotation, not a surgery rotation, which limits the overall problem to total time in the ER, not on the surgical service."

"So, if I understand this right," I said. "She does ER from when she's reinstated until June of '90, then moves to the surgical service, ending in June of '91, when she'd come back to the ER. That's when she should have the baby. Then in June of '92, she'd start a surgery rotation. Then after that she'd do one more year in the ER before trying for a Fellowship. THEN she could apply for an Attending job. And an associate professorship."

Doctor Barton laughed, "Not bad for someone who isn't in the system. That would, I think, work out correctly. I'd have to map it out with Jessica when she comes back, but yes. It's also possible, although not common, to be able to count the Fellowship as part of her Residency."

"So she finishes her training somewhere around 1997, I guess, at age 36. Wow!"

"Well, if you think about it, medical students become Residents around age 26. If you want to be a surgeon, there are five to seven years of training. Even without problems, she would be 34 when she finished. That's pretty common for being a full Attending in any specialty. You can shortcut it and become a GP with one year of post-graduate training in Illinois, the 'Intern' year. But any kind of specialty, like OB/GYN or Urology, or whatever, adds several more years."

"It's just strange to me because I came out of college and started my own company. Heck, I did it in High School!"

"I don't mean to put you down, but what you're doing isn't exactly brain surgery. You yourself have said that people don't die if you make mistakes, and that you can do as much trial and error as you want. It's a VERY different system. On the other hand, if you wanted to be a lawyer, that adds three years of law school and usually includes Clerkships. Heck, plumbers have a training system with Apprentices, Journeymen, and Masters. Engineers need to be licensed. The military has ranks for a reason. You do realize that it's harder to get a license to drive a car than enter your field?! It really is a very special situation, if you think about it."

"OK! OK! You've made your point!" I chuckled. "Where are the clinics?"

"One is in Hyde Park. The other is in Bridgeport. They're walk-in clinics that provide basic health services. It's about as low-stress as any temporary doctor job could be. The other option would be 'supply' doctoring. Basically, you contract with a small community to cover for a sick or vacationing doctor, either in private practice or at a small community hospital. I don't think that is a good choice for Jessica, but it is an option."

"We want her close, Al," I said. "Both Kara and I."

He nodded, "I know. I have one last thing to say, which I know you're going to reject, but I'm going to say it, anyway. You might want to consider a change to your relationship with Kara, and with the mother of your other son."

"No chance, Al. I'll get all the counseling I need, and support Jessica in every way that is within my power. But I'm not going to set aside Kara under any circumstances. Forget what the State of Illinois says, Jessica, Kara, and I are married. The three of us. And that's not going to change."

He nodded, "I knew that would be your answer. I just think the three of you are in for a long, hard life because you chose a path that is not only difficult, but rarely traveled in our culture, and persecuted when it is. That's going to produce a huge amount of stress. Exactly the thing you are worried about."

"I know," I said. "But my views on divorce are like my views on abortion. It's fine for anyone else, but not fine for me. I don't believe in it. I gave my word and I'm going to keep it to the best of my ability. Please don't take that as a commentary on your life. You made the decisions that were right for you. And that's totally your business."

"You have some very, very strange ideas about the world. Not bad, necessarily, but strange nonetheless. But you also have the courage of your convictions. I've said my piece on it, and I won't raise either of those issues with you again. And that's some advice for when your kids get older, by the way. If you object to their choices, make your case solidly. But only one time. Then let it go. If they come to you to discuss it, fine. But otherwise, you have to let them make their own way."

I chuckled, "And Fawn?"

He laughed, "Yes, well, I didn't say I FOLLOWED my own advice. I suspect you've been in one of those situations yourself where you give advice you'd never take or use!"

I nodded and gave him a knowing smile, "Has she been on her first date?"

"The Fall dance at her school. I paced in my study for four hours waiting for her to come home! Now she wants to go out with the boy again."

"I remember her asking about dating a High School boy when I first met her back in Indy. You said 'no'!"

"She was just about to turn fourteen! Now she's just about seventeen. It's a bit harder to say 'no' at this point. Your day will come!"

"I believe that you and I have different views on that topic," I said carefully.

He nodded, "What I thought at twenty-five and what I think at forty-nine are two VERY different things! Just wait!"

I smiled, but didn't say anything. He was wrong in that regard, but this was a debate I wasn't going to win, and even if I could, winning might not be a good idea! Our food arrived, and we ate our lunch, and then I headed back to the office.

"Elyse needs to see you," Kimmy said when I walked in.

"Goody for Elyse," I chuckled.

"It's about the new receptionist!"

"Ah, yes, interviews. I figured that was coming."

"Are you free for lunch tomorrow or Thursday?"

"Tomorrow would be better. I have lunch with my friend Father Basil on Thursday."

Kimmy flashed me a big smile, and I went to Elyse's office.

"Yes, Dear?" I chuckled, leaning against the door frame.

"Your calendar for Friday is clear. I'd like to bring in the young woman I want to hire as a receptionist. Kimmy, Julia, and I have all met her."

"Sure. What time?"

"Can you do 7:30am? That way she can get to her job at 8:30am."

"Sure. I'm here by then."

"Thanks!"

I nodded and went to my office and got to work.

February 1, 1989, Chicago, Illinois

"How are you doing today?" I asked Katy at breakfast on Wednesday.

"OK. I talked to your friend Gwen yesterday. I'm meeting her after work today to go over my options. I'm going to get some things from the apartment today."

"Did you talk to Kenneth?"

"Just to tell him I was coming to get some things."

"You should talk to him," I said. "Even if it's just to explain why."

Katy sighed, "I know. I'm just not ready yet."

"Work's going OK?"

"Yes. Will you have some time to talk tonight or tomorrow?"

"After karate, yes. Is that OK with you, Kara?"

"Of course! Either night is OK."

"Then tonight," I said. "Probably around 8:45pm."

"Thanks. So who is it you run with in the mornings?"

"A karate student. She was seriously overweight and her parents sent her to the dojo to get in shape. After talking with my sensei, we agreed she needed help in developing good exercise habits. We've been running five days a week since last Summer. She's lost just over 30 pounds and is in great shape now."

"Wow. How old is this woman?"

"Girl, really. She's seventeen. Her family uprooted her from Pittsburgh and brought her here. She had no friends, gained a lot of weight, and was generally miserable. Now she's happy, doing well in school, and dating. Mostly it was about self-confidence, but it doesn't hurt that she's not overweight."

"How long will you keep running with her?"

"Probably until she goes to college, which would be in the Fall of next year. I'll probably find someone else to run with at that point, because it's really helped my endurance. Not to mention I can more or less eat whatever I want without gaining weight!"

"I wish!" Katy said. "OK. I need to get ready for work. See you tonight at dinner."

She put her dishes in the sink, leaving Kara, Elyse, and me together at the table.

"She's been spending most of her time in her room," Elyse said. "You should try to get her to hang out with everyone."