Chapter 50: An Offer

February 16, 1985, Greater Cincinnati, Ohio

"Good morning, Subdeacon," Father Stephen said when Elizaveta and I walked into the main lobby of The Christ Hospital in Cincinnati.

The hospital was on Mt. Auburn, one of the highest points in the city, and offered a nice view of the city below. Father Stephen was clad in his ryassa.

"Father, bless!" I said, holding my cupped hands for his blessing.

"Bless you, Subdeacon," he said, making the sign of the cross over my upturned palms.

I kissed his hand, and then Elizaveta received his blessing as well.

"Go ahead and put on your cassock and orar, and we'll go up to the ward."

I set down my bag, unzipped it, and took out my cassock. I put it on, buttoned the two neck buttons and the two buttons at the base of my rib cage, then tied the cord around my waist. I took my gold orar from the bag, held it for Father to bless, kissed his hand once again, and then wrapped it around me, crossing it in the front. When I finished, we made our way to the elevator and went up to the psychiatric ward.

The ward was locked, and there was a nurse behind a Plexiglass window who asked us who we were visiting.

"Angela Stephens," Father Stephen said. "I'm her pastor, Father Stephen, and this is Subdeacon Michael, who is also clergy, and Matushka Elizaveta."

That was a bit of a stretch because she wasn't technically, but I understood his point. Elizaveta smiled broadly, and I felt her hand touch mine and then squeeze.

"Doctor Hoffman notified us you'd be coming. I'm going to buzz you through and call her. Please wait just inside the door, and she'll take you to Angela."

"Thank you."

A buzzer sounded and Father Stephen pushed open the door, and the three of us went inside. A moment later, a pretty blonde doctor walked over to us.

"Doctor Hoffman," Father Stephen said. "I believe you spoke to Subdeacon Michael on the phone. And this is his fiancée, Elizaveta."

"Hi!" Doctor Hoffman replied.

"Good morning," I said with a smile.

"Hi!" Elizaveta exclaimed.

"We were able to remove Angie's restraints this morning, so she's in the common room right now," Doctor Hoffman said in a wonderful Southern accent. "We'll bring her into the larger consultation room so you can have some privacy for your religious rites."

"That's actually up to Angela," Father Stephen said. "But if it's going to be disruptive to other patients, we can do that."

"No. The patients who are here are neither violent nor aggressive, so it wouldn't be an issue. Let me go ask her. Please wait here."

She left and was back a moment later to lead us to the common room where Angie was sitting. She was wearing sweatpants, a sweatshirt, and slip-on deck shoes rather than a hospital gown, but as with the previous time I'd seen her when she was medicated, her normally shiny red hair was dull, her complexion was even more pallid than normal, and her eyes somewhat vacant. I felt like crying, but I knew that wouldn't help.

"Hi, Ang," I said.

She looked up and saw me and smiled but then caught a glimpse of Elizaveta, and her smile turned to a frown.

"Hi," she replied dully.

"Good morning, Angela," Father Stephen said.

"Father, bless," she replied slowly.

She held her hands up, he gave a blessing, and she kissed his hand.

"Would you like to receive the Eucharist?" he asked.

Angie nodded, so Father Stephen removed the gilded box he was wearing around his neck and set it on the table. He took a candle from his bag and handed it and a lighter to me. I lit the candle and held it while he opened the box and removed a tiny chalice, a small container with the reserved Eucharist, and a small vial of wine. He opened the container and, using tweezers, took one particle of the reserved Eucharist and placed it in the chalice. He then opened the vial of wine, said a quiet prayer, and poured the wine into the chalice. After it sat for a moment so that the dried Eucharist had softened, he picked up the small chalice.

"The Handmaiden of God, Angela, receives the Body and Blood of Christ for forgiveness of sins and unto life everlasting."

"Amen," Angie said quietly.

Father Stephen held the chalice to Angie's lips, she tilted her head back, and he poured the Eucharist from the chalice into her mouth. When the chalice was empty, he used a cloth from the box to wipe it clean, then placed everything back into the box. The cloth would need to be hand washed just like the communion cloths we used at church, and the water used to wash it poured into the garden to ensure that none of the Eucharist was flushed into the sewers.

Next, Father Stephen took a small vial of chrism from the gold box and a small paper bag with a Q-tip from his bag. He opened the vial, removed the Q-tip from the bag, and used it to apply chrism to Angie's forehead, chin, and the backs of her hands.

"The Handmaiden of God, Angela, is anointed for the healing of soul and body," he said.

When he finished, he carefully wrapped the Q-tip in a paper towel and put it back into the paper bag. Someone would burn it using a barbecue grill at church to ensure that the chrism did not find its way into the trash. The ashes would be spread in a small pit used for anything which needed to be disposed of but which couldn't be thrown into the trash because it had been blessed in some way. I blew out the candle and handed it back to Father Stephen, who held it until the wax dried.

"Ang," I said as gently as I could, "why won't you take your medication?"

"I don't want to," she said slowly, struggling with her words. "It makes me like this."

"But if you take it, they'll reduce the dose, just like last time," I countered. "Then you can go to work and school."

"Don't want to," she said. "Can't be ... me. Can't be ... with you."

Angie's words were like a punch in the gut, and I struggled to keep my composure. A few deep breaths allowed me to maintain emotional control, and then I looked over at Doctor Hoffman, who nodded, agreeing I needed to say what we'd discussed. I hated having to say it, but I didn't see any other option.

"Ang," I said gently, "Elizaveta and I are going to marry at the end of May, as we planned. Even if that weren't the case, Ohio won't let you get married."

Tears began flowing down her face, and she pulled her legs up onto the couch, wrapped her arms around them, and began rocking. I felt a hand on my arm and turned to see Doctor Hoffman, who used her head to indicate we should step away.

"You should probably leave," she said quietly. "Angie can't hear you now, and I need to have the orderlies take her back to her room."

"Catatonic?" I asked.

"Not quite, but this is what she does when she withdraws and refuses to talk or listen. It's the response we get when we try to do any kind of counseling. A stronger dose of antipsychotics would prevent it, but then she won't be lucid at all."

"Lord, have mercy," I said quietly.

"She didn't lash out, which is a good sign," Doctor Hoffman said. "But I have a strong suspicion she'll fight us when the time comes for her medication, and we'll need to restrain and sedate her again."

"«Говно» (gavno)," I said reflexively.

"Russian?" Doctor Hoffman asked.

"Yes. It means 'shit', but I really didn't want to say that in front of you."

Doctor Hoffman laughed softly, "I've heard far worse! May I ask if you've decided on a specialty?"

"Emergency medicine," I replied. "What's your next step with Angie?"

"To try to wean her from the drugs, but if she fights us, we can't really make any progress. Wait here a moment, OK?"

"Sure."

She went to call the orderlies, and Elizaveta came to stand next to me.

"Hi, Matushka," I said quietly.

Elizaveta laughed softly, "I like it! Now, if it were only REALLY true!"

"Soon enough! And you won't be able to get rid of me!"

"As if I would want that!" she replied, but then became serious, "What happens now?"

"They'll take her to her room and continue to treat her. Unfortunately, what happens now is up to her, but she's not in any condition to act rationally. I'm at a loss, and I honestly believe the doctors are as well. There's a good chance she'll be medicated like this for a long time, maybe even forever."

"It's really scary," Elizaveta said. "Mr. Dubrovskiy lost his leg in Viet Nam, and Mrs. Gurchenko is blind, but they can live pretty normal lives. Angie is healthy, right?"

"Physically? Yes."

"Scary," Elizaveta said soberly.

"I agree."

Doctor Hoffman came back, and I watched as two orderlies moved Angie to a wheelchair. One of them pushed it out of the common room and down the hall, and Father Stephen walked over to join Doctor Hoffman, Elizaveta, and me.

"Is there anything that can be done?" he asked.

Doctor Hoffman shook her head, "All we can do is work with her and try to get her past her desire to, uhm..."

"It's OK, Doctor," Elizaveta said. "I know all about Mike and Angie. I know she was the girl he most likely would have married, but nobody can do anything about what happened."

"How old are you, if I may ask."

"Fifteen. I turn sixteen in April, and we'll marry at the end of May after Mike graduates from Taft."

Doctor Hoffman looked at me, rolled her eyes slightly, but said nothing.

"Is it OK if I call you to check on Angie, Doctor Hoffman?"

"Yes."

"And let me know if you get into any trouble," I said. "I'll be happy to tell your Attending that I made this happen after talking to Angie's parents."

"Thanks, but I think things will be OK."

"If you think visiting her will do any good, please let me know. Father," I said, turning to him, "will you make regular pastoral visits?"

"That is my intent. I'll call her parents later this morning. You're meeting with Doctor Mercer when you leave?"

"Yes. She'll be downstairs. We'll probably just go to the cafeteria for coffee."

"OK."

I asked for his blessing to remove my orar, and once he'd given the blessing, I removed the orar and my cassock and put them both into my bag. Elizaveta and I asked for his blessing, which he gave, and then we left the psychiatric ward. We got into the elevator and rode down to the lobby, where we sat down to wait for Doctor Mercer, who arrived about twenty minutes later. The three of us went to the cafeteria, and Doctor Mercer bought coffee for the three of us.

"How is she?" Doctor Mercer asked when we sat down at a table in the corner of the room, away from most people.

"She smiled when she first saw me, but that turned to a frown as soon as she saw Elizaveta. Father Stephen served her the Eucharist and anointed her. I asked her about her medication, and she said it makes her not herself and makes it so she can't be with me. Then, with Doctor Hoffman's blessing, I reminded Angie about my upcoming wedding to Elizaveta. At that point, Angie basically curled up in a ball and cried. Doctor Hoffman had orderlies take her back to her room. Doctor Hoffman believes Angie will fight them over the drugs."

"I expect her to," Doctor Mercer said. "But she was so hysterical that we didn't really have a choice. They'll do their best to wean her off the antipsychotics, but if she fights them, that makes it difficult."

"Why not just stop the drugs and see what happens?" I asked.

"That is an option, but it's not one that is likely to be considered because she needs the antidepressants to stay stable."

"So just stop the antipsychotics," I said. "Maybe negotiate with her."

"That's a bad idea," Doctor Mercer replied gently, "because we can't really negotiate away possible treatment options. If we committed to that, and she needed them, there would be a serious ethical problem. Not to mention, patients often don't know what's best for them. You're going to discover that on the very first day of your very first clinical rotation. You'll find out soon enough that patients decide they know better and will take less or more of a drug than prescribed, often with very bad effects. One good example is that patients often stop taking antibiotics before they finish the course of treatment. That leads to resistant strains of bacteria. I'm no expert in that area, but I'm sure you've had that mentioned in class, at least."

"MRSA," I replied. "Discovered in England in the 1960s. And there was an outbreak in Detroit among IV drug users a few years ago, according to my biochemistry professor."

"The situation is analogous — if we negotiate away the antipsychotics, then her psychosis could continue unabated, feeding on itself."

"Sorry, I didn't think that through."

Doctor Mercer smiled, "It's OK. You'll learn these things once you get into your clinical rotations. Keep an eye out, and you'll learn to judge if the man on your exam table really does have back pain or if he's drug-seeking. You won't always get it right, but you'll develop a sense for who is telling the truth and who isn't."

"But there is no test for that, right? I mean, we can't measure pain; the patient can only tell us how they feel."

"That's true, but you can look for other signs and ask them or their loved ones questions about their daily activities and what makes the pain worse. We don't need to get into the details; you just need to be aware of the concept. Your professors and mentors will teach you. When you have your elective rotations, may I suggest you do a double psych rotation? One adult and one adolescent? I think it'll pay big dividends in the ER."

"So what do I do now?" I asked.

"At this point, just wait. Let her doctors work with her and let her pastor provide whatever spiritual help he is able to provide."

"How are you involved with her treatment here?"

"She's under inpatient psychiatric care, so while they'll consult with me, it's up to the doctors here to determine the best course of action."

"And her psychiatrist?"

"Has admitting privileges here, so he's more directly involved. Once she's at a point where she's home again, if she can go home again, then I'll be able to work with her."

"I thought you were a doctor," Elizaveta said.

"I am, but not a medical doctor. I have a PhD in psychology. A psychiatrist is an MD who specializes in mental illness. The main difference is that I'm not permitted to prescribe drugs. There are also slightly different rules with regard to what tests I can perform, but the practical difference really is the ability to write prescriptions. I started working with Angie before we knew she had a condition which would require medication."

"What causes something like this?"

"We don't know," Doctor Mercer replied. "And I'm sure Mike has told you there is no known cure."

"He did, and it's really scary because it could happen to anyone!"

"That's true, but it's also not common enough for you to worry about. Is there anything else I can help either of you with?"

"I don't think so," I said. "Elizaveta and I were going to go to the Cincinnati Nature Center and walk around, then have lunch before we head back to McKinley. I'll call Doctor Hoffman during the week to check on Angie. If you hear anything, will you call me?"

"Yes, of course. I assume you'll keep in touch with Father Stephen as well?"

"I will."

We finished our coffee, then Elizaveta and I said 'goodbye' to Doctor Mercer and headed out to my Mustang. We got in, fastened our seat belts, and headed for Route 50, which would take us to Clermont County, where the Nature Center was located.

"You looked like you were going to cry when Angie said she couldn't be with you," Elizaveta said.

"That's because I almost did," I replied. "I can't even imagine what it felt like for her to hear me say what I said after that."

"Because you'd rather be with her?" Elizaveta asked, her voice soft and trembling.

I took a slow, deep breath and let it out before answering.

"That's not really a fair question, and I don't know how to answer it," I said carefully. "I care a great deal for Angie, but we were never a couple, and she was never in a mental state where we could be a couple. According to Doctor Mercer, nobody can be sure how much of our relationship was a product of Angie's illness; it's possible all of it was."

"But you were in love with her, weren't you?"

"Yes. But the Angie I was in love with doesn't exist, and I doubt that Angie ever existed."

"What do you mean?"

"Just what I said before — nobody knows how much of our relationship, or how much of Angie's personality, was a product of her illness. In a sense, it would be like falling in love with an actress based on a role she played in a movie. You have no idea if she's even anything like her role in reality. So what I'm saying, I guess, is I can't answer the question except to say I want to marry you and spend my life with you, and I mean that. I want you to be my wife and the mother of my children."

"You're sure?"

"Positive! If I didn't want to be with you, I wouldn't have agreed to marry you and would have put off my ordination. I care about Angie a lot, but I want to marry YOU. And nothing is going to change that."

She put her hand lightly over mine, which was on the stick shift, and we drove on in silence, with just the hum of the tires, the growl of the motor, and the soft music of Q-102 floating from the speakers.

February 17, 1985, The Sunday of the Last Judgment (Meatfare Sunday). McKinley, Ohio

"Good morning, Subdeacon!" Father Nicholas said when I arrived at the church on Sunday morning.

"Father, bless!" I replied.

I received his blessing and kissed his hand.

"I spoke with Mark and Alyssa at length last night. They made a very strong request to have you and Elizaveta as their godparents, but I have some serious concerns about the amount of time you're going to have available. You're getting married, you're being ordained, and you're starting medical school. Your ages were a consideration but not the deciding factor. In other circumstances, say, if you were graduating and taking a job and not being ordained, I'd have probably acceded to their request."