Good Medicine - Senior Year - Cover

Good Medicine - Senior Year

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Chapter 56: Holy Week and Pascha - Part I

April 5, 1985, McKinley, Ohio

When I got up on Friday morning, I ran, then said my morning prayers, including an additional petition, a very rare one for a very specific thing — ‘For a quiet and blessed Holy Week, Lord have mercy!’. Under normal circumstances, the only changes I made to my petitions were to add anyone who wasn’t on my regular prayer list but who was struggling or suffering, but in this case, given everything else going on, a quiet and peaceful Holy Week was just what the doctor ordered.

“Morning, Mike!” Robby said when I opened the door to his knock. “Ready for breakfast?”

“I am,” I replied.

I stepped out into the hall, closed the door behind me, and then joined the rest of the gang, who were waiting for the elevators to take us downstairs. Ten minutes later, all of us were sitting at our usual table with our breakfast.

“Can you believe we only have seven weeks until graduation?” Pete asked.

“No!” came a chorus from Fran, Jason, and Sandy.

“And then on to grad school or medical school for all of us!” Clarissa declared.

“Not until after a Summer of fun!” Sandy exclaimed. “But then ... ugh. No time off for five or six years!”

“All you doctor types are insane,” Larry said. “Ain’t no two ways about that!”

“I’m not sure teaching High School is much better!” Sandy said, shaking her head.

“I get Summers off,” he said. “So think about me being in Florida while you’re emptying a bedpan or whatever it is medical students do!”

“It’s mostly classroom and lab work for the first two years,” Clarissa explained. “But the first year is 51 weeks, and then it’s 52 weeks after that, with no breaks until a short one between graduation and our first PGY work.”

“PGY?” Larry asked.

“Post Graduate Year,” she replied. “It’s the easiest way to refer to it because your program for Residency varies tremendously based on your choice of specialty. In some states, like Illinois, a PGY2 can be a GP, you know, a regular family doctor, or whatever. On the other extreme, it can be PGY7 or 8 before a surgeon is fully qualified and has completed their Fellowship.”

“And you guys?”

“For me, with internal medicine, after PGY3, I’ll be eligible to be hired as an Attending. The same is true for Mike, though given the changes that are happening in Emergency Medicine, he might need to do a couple of surgical rotations, which would make it PGY4 for him. Sandy, with pediatrics, can be an Attending after PGY3. Fran still hasn’t made up her mind.”

“I’m leaning towards cardiology,” she said. “And an Attending position would be around PGY6 or 7. That said, OB/GYN is a good option and would only take four years.

“Sophia, you’re still planning on OB/GYN, right?” Sandy asked.

“Yes, and that’s four years, as Fran just said.”

“Wait a minute! Mike can be an ER doc after three years, but you have to have four years to be an OB?” Dona asked. “How does that make sense?”

I chuckled, “Except in the most extreme cases, I’ll call someone like Sophia to deliver the baby. My job will be to ensure patients survive long enough for the surgeons and others to work on them.”

“You won’t do surgery?”

“In the ER? At best, it would be procedures necessary to stop bleeding or whatever, but you want a full surgical team to do the actual surgery, not the ER doctors who don’t have that as their specialty. But, as Clarissa said, things are changing, so I might end up doing more surgery than was done by ER docs in the past.”

“Are you sure you’ll Match?” Sarah asked.

“Emergency Medicine and Internal Medicine are way down the list of most med school graduates,” I said. “If Clarissa and I put them at the top of our lists, we’ll very likely get our first choice with regard to hospital. The toughest one to Match is surgery. And a lot depends on your scores on the national exams we have to take. I’m pretty confident, based on our MCAT scores, that we’ll do well on those tests. According to what I read, something like three-fourths of students with good NBME exam scores Match one of their top three programs and half get their first choice. That said, everything depends on the number of positions and the number of applicants.”

“And if you don’t Match for some reason?” Lara asked.

“There’s something called ‘The Scramble’,” Clarissa said. “Basically, they tell you if you Matched or not. If you didn’t, they release a list of all the programs that didn’t fill, and you apply to as many of those as you can, though you might have to select a different specialty.”

“And if you don’t make that?”

“Then you basically don’t get to be a doctor,” she replied. “You can try again the next year, but your chances go down each year.”

“Wait!” Gene protested. “You could go to medical school, graduate, and still not get to be a doctor?”

“Yes, and that is why Mike and I are so obsessed with doing everything perfectly.”

“Wow. I thought it was like Jocelyn’s situation — if she graduates from law school and passes the bar, she’s a lawyer and can practice law. No wonder you guys are so fanatical!”

“Exactly,” I confirmed.

We finished breakfast, and after going to the dorm to retrieve our books, Clarissa and I headed to our Abnormal Psych class. The professor returned our mid-term papers, and both Clarissa and I had A’s. Mine also had a handwritten note which said ‘See me, please’. At the end of class, I went to talk to Doctor Johnson.

“You wanted to see me?” I asked.

She nodded, “Are you seeing someone?”

“Seeing someone?”

“For help dealing with your friend’s illness?”

I nodded, “I’m seeing Doctor Fran Mercer in Milford. I met her about four years ago because of something unrelated.”

“OK. I just wanted to check. Your paper conveyed a lot of pain and anguish, and I wanted to make sure you were dealing with those feelings.”

“I am, thanks. Between my counselor and my pastor, I’m getting the professional and spiritual support I need, and my friends are very supportive as well.”

“OK. I just wanted to check. May I make a suggestion for your final paper?”

“Sure.”

“I’d like you to write on the history of psychology and psychiatry and the problems with the provision of mental health care. You touched on those topics in your first paper on schizophrenia, and I’d like you to expand on them. I think that will be useful for your practice of emergency medicine.”

“You aren’t the first person to suggest that. And I think it’s an appropriate topic for several reasons.”

“Excellent. I look forward to reading it. See you on Monday.”

“Thanks, Doctor Johnson.”

She smiled, and I turned and left the classroom, meeting Clarissa and Sandy in the hall where they were waiting for me.

“Everything OK?” Clarissa asked as we started walking to P-Chem.

“Doctor Johnson wanted to make sure I was talking with a counselor or therapist about the obvious pain and anguish that came through in my paper.”

“That was pretty obvious. No matter what happens, you’re always going to love Angie.”

“True. Doctor Johnson also suggested I do a paper on the history of psychology and the problems with the provision of care. She thinks it’ll help me in the ER, and I suspect she’s right. I also think she’s hoping it helps me with my struggles with what’s going on with Angie. I think it might also frustrate me because ‘care’ amounts to drugs which, on balance, don’t do much other than making the person docile.”

“I think your paper was somewhat cathartic,” Sandy said.

“I suppose it was,” I said. “It let me put on paper some things that were really gnawing at me. I think the second paper will do that to some extent as well — I can rant about the terrible state of mental health care and the terrible public perception of mental illness.”

“Except you don’t actually rant,” Clarissa observed. “Your commentary is well-reasoned and presented in a calm, logical manner. You showed that with that idiot preacher.”

“It helps when your opponent comes to a battle of the wits unarmed!” Sandy said, causing Clarissa and me to laugh.

We entered the P-Chem classroom and took our seats, with Fran arriving just after us. We received our mid-term exam results at the beginning of class, and all four of us scored 95 or more, with Clarissa scoring a perfect 100, while I had a 99.5 because I’d made a math error I hadn’t caught when I reviewed my answers before handing in the exam.

When class ended, we headed back to the dorm to listen to music until lunch, and after lunch, the four of us trooped back to the science building for our biology stats class. There, the results were reversed, with me scoring a perfect 100 thanks to regular help from Clark and Clarissa scoring a 99.5 due to a minor math error she’d made.

Our final class of the day was Doctor Blahnik’s Russian literature course. She’d returned our papers on Lolita on Wednesday, and that meant we’d begin discussing One Day in the Life of Ivan Denisovich by Aleksandr Solzhenitsyn. It was his one and only novel published in the Soviet Union, and had led to him being awarded the Nobel Prize for Literature in 1970. It, along with other unpublished writings, had also led to his expulsion from the Soviet Union in 1974.

After class, Clarissa and I decided to have coffee in the Student Union.

“Russian nationalist and pro-Russian Orthodoxy,” Clarissa said. “Sounds like Tasha’s father!”

I chuckled, “Only Deacon Vasily was never in a gulag!”

“No, but Tasha’s sister sure was!”

“True. I do agree with Solzhenitsyn on why the Communists took power and why the Iron Curtain exists — men have forgotten God. Solzhenitsyn, like Dostoyevsky, was a fervent patriot and equally fervent Christian. And I also agree with what he said at Harvard about seven years ago — ’But members of the U.S. antiwar movement wound up being involved in the betrayal of Far Eastern nations, in a genocide, and in the suffering today imposed on 30 million people there. Do those convinced pacifists hear the moans coming from there?’.”

“I thought you were a pacifist!” Clarissa protested.

“I’m also rabidly anti-Communist. For that, you can thank my grandfather. Violence should never be initiated and should be avoided as a response until such time as there is no other possible action short of surrender or death.”

“Martyrdom?”

“One is called, specifically, to that; one does not choose it. He’s right in his assessment that America is spiritually weak and mired in what he called ‘vulgar materialism’.”

“Not you! Nor your family or most of the people in your church from what I can tell.”

“I think Solzhenitsyn would approve. That said, I totally disagree with him on his views on music and the free press.”

“He doesn’t like modern music?”

“That’s an understatement if there ever was one!” I chuckled. “Even Deacon Vasily has his guilty pleasures of Rolling Stones, Aerosmith, and Bob Dylan, though he keeps those albums out of plain sight at his house!”

“What’s Solzhenitsyn’s complaint about the press?”

“That unfettered press is a serious violation of privacy. I kind of agree with him, but I’d hate to live in a country without a free press. I think we have to take the privacy violation with the fact that investigative reporters uncovered the corruption in the Nixon administration.”

“I had no idea you were into this in that way!”

“Solzhenitsyn is one of my grandfather’s heroes. I heard a lot about him growing up. Another one I heard a lot about is the dissident nuclear scientist Andrei Sakharov.”

“I see a pattern!”

“You think?” I chuckled. “Don’t get me wrong, my grandfather is fully aware of the failings of the Tsars, but I think any neutral observer has to say things are far worse under the Communists than under the Romanovs.”

“I think things are far worse under Communists anywhere they’re in charge!” Clarissa declared.

“I obviously agree!” I replied. “Changing subjects, which services are you going to come to?”

“Palm Sunday, the Twelve Gospels, the two late services on Friday, and Pascha.”

“What about Abby?”

“She’ll be at Palm Sunday and Pascha. I heard from Sophia that she’s going to about half the services, and Robby and Lee will tag along for some of them, including Pascha.”

“They don’t want to miss the best party of the year! Lara is going to almost all the services, though she’s skipping the Friday morning and early afternoon services because she has class.”

We finished our coffee and headed back to the dorm, where I decided to take a short nap before eating dinner. After dinner, I drove to Elizaveta’s house to pick her up for the first service of Palm Sunday weekend — the Little Compline with the Canon of Saint Lazarus. When we arrived at church, I donned my cassock, and we went into the building. She took her usual place with the choir, and I went into the altar to prepare for the service.

The service began with the usual preparatory prayers, three Psalms — 50, 69, and 142. Those were followed by the Little Doxology and the Nicene Creed. At that point, the choir and chanters began to sing the canon.

Let us all sing a triumphant song unto God, Who has done strange wonders with His mighty arm, and has saved Israel: for He is glorified

Thereafter followed the other odes, with the ninth portending what we would come to know at the Paschal service, which was a week away...

To confirm men’s faith in Thy Resurrection, O Word, Thou hast called Lazarus from the tomb and as God hast raised him up, to show the peoples that Thou art both God and man in very truth, Who dost raise up the temple of Thy body.

Glory to Thee, our God; glory to Thee.

Shaking the gates and iron bars, Thou hast made Hell tremble at Thy voice. Hell and Death were filled with fear, O Savior, seeing Lazarus their prisoner brought to life by Thy word and rising from the tomb.

The canon was followed by the Trisagion prayers, prayers for the day, and the dismissal. As was true to the ‘otherness’ of Orthodoxy, the ‘dismissal’ wasn’t, and everyone proceeded to venerate the icon of the Raising of Lazarus the Righteous while the troparia and kontakia for the day were sung. Once everyone had venerated the icon, Father Nicholas concluded the service with a final prayer, and then, as was our tradition, everyone left the church in silence.

Lazarus Saturday, April 6, 1985, McKinley, Ohio

On Saturday morning, I ran, said my prayers, and then Robby and Lee helped me carry boxes of records down to my car. We made two trips each, and then I headed to Elizaveta’s house to pick her up. I didn’t eat breakfast as there was a Divine Liturgy for Lazarus Saturday. At her house, she and her dad helped me carry the boxes of albums to the cottage, then she and I left for Saint Michael. As was going to be the case for the entire week, when we arrived, I donned my cassock, Elizaveta went to be with the choir, and I went into the altar to help prepare for the Matins and Divine Liturgy.

The services were normal for a non-Sunday Divine Liturgy, which meant slight changes to the hymns and prayers, in addition to the troparia and kontakia for Lazarus the Righteous, and following that theme, the Epistle was Hebrews 12:28-13:8 and the Gospel lesson of the day was John 11:1-45.

When the service ended, Father Nicholas and I went to the vestry to remove our vestments.

“Subdeacon, would you be willing to read the Paschal Homily of Saint John Chrysostom this year? In the past, Deacon Grigory has read it, and to be honest, by that point, having had to sing all seven gospels on Wednesday and all Twelve on Thursday, my voice is going to be shot!”

“Father Herman always said the same thing, which is why he had Deacon Vasily read it at Holy Transfiguration. Yes, of course, I’ll do it.”

“Thank you. It will be nice when you’re a deacon, and I don’t have to sing BOTH parts! I am grateful that His Grace allows you to do the Little Litanies, which provides some relief. Shall we join the congregation for lunch?”

We left the vestry and went to the church hall, where I took my place next to Elizaveta at the table where most of the High School and college kids were sitting. After Father Nicholas gave the blessing, we were served a Lenten meal of lentil stew and bread.

“Mark,” Oksana asked, “now that you’ve made it through your first Great Lent, what do you think?”

“I think I had no idea how little attention I paid to what I ate in the past!”

“And you, Alyssa?”

“Praying and fasting are very different from what I did before, which was just read the Bible and go to Church and Sunday School. It made me think about how being a Christian needs to affect my whole life, from the moment I get up until the moment I go to bed. And even with the lenient rule Father gave me, I actually had to think about eating, which made me think about being a Christian at times when I never would have in the past.”

“Do you have a cover for your Pascha basket?” Viktoriya asked.

“Yes. Maria made one for us. I suppose that means we have to get married because both our names are on it!”

There was laughter around the table, and when I looked at Mark, he shrugged sheepishly.

“Wasn’t that kind of foreordained before you even came to Saint Michael?” Serafima asked. “You’ve been a couple for some time, right?”

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