Chapter 46: Consultation and Confrontation

September 24, 1985, McKinley, Ohio

Elizaveta left after about fifteen minutes when a Fire Department ambulance brought in a man in his sixties who was suffering from emphysema and who was having difficulty breathing even with his oxygen. After an exam, Doctor Gibbs handed him off to pulmonology, and after the pediatric consult for Donald agreed with her diagnosis of 'colic', which required no treatment, she discharged him. Once the paperwork was done, we went to the lounge.

"Mike, what in God's name possessed you to think it was a good idea to let your wife unload on someone who could flunk you out of medical school?" Doctor Gibbs asked.

"It might not have been my best idea," I replied apologetically.

"Is that what you think? Or what you think I want you to say?"

"I think I made a mistake."

"Are you SURE about that?"

She was trying to tell me something, but I wasn't understanding.

"Doctor Gibbs, I know you're trying to make a point, but I'm sorry, I'm totally missing it."

"Why did you bring your wife here to ambush me?"

"Because I thought you were wrong when you asserted that no sixteen-year-old could be ready to marry and that it was a dumb idea to suggest it."

"Do you agree with that assessment?"

"Obviously not."

"And you're positive you're right?"

"Yes, or I wouldn't have married Elizaveta."

"Then why in the world would you apologize to me? If you believe you're right, you STICK TO YOUR GUNS, Mister! Despite our training, doctors are just as prone to bias and jumping to conclusions as anyone else. Someday, some doctor senior to you is going to make a diagnosis or propose a treatment you know to be wrong. When you correct that doctor, he or she will push back. If you apologize, the patient may die. Got it?"

"Yes, Doctor."

"The other point is to speak your mind! Do not keep your mouth shut!"

"Yes, Doctor."

"Now that we have that out of the way, your wife is a real pistol!"

"Russian women are like that."

"I do need to hear the story."

"The short version is that I needed to marry before ordination. Elizaveta accosted me, explained exactly why she was mature enough to marry and that she was ready to marry, and then basically proposed."

"I thought your priests could marry?"

I shook my head, "No. We ordain married men, but clergy can't marry. I still think I should have handled this entire thing differently."

"Yes, you should have. A quiet conversation is better than a confrontation, though I do have to say sometimes confrontation is necessary. That said, you learned two lessons, so we'll call it a success."

"Could you really flunk me out of medical school?"

"If I give you an unsatisfactory grade, you'd have a strike against you, but you wouldn't flunk out. But, accumulate too many black marks, and you could end up on probation and eventually be dismissed. You don't want extra black marks on your record. That said, if you violate your pledge of ethics, you could be immediately dismissed."

"Can I ask you something?"

"That's the whole point of these Preceptorships."

"What's your evaluation so far?"

"You show a lot of promise, but that's not enough. You have to actually make good on that promise. Keep doing what you're doing. Watch your stress levels because stress will sneak up on you. And don't get discouraged when it seems like all you're doing is scut."

"Scut?"

"A form of hazing of medical students and interns, and sometimes even Residents. You actually experienced that and didn't know it when Doctor Evans had you escort the family to the burn unit."

"That didn't feel like hazing to me!"

Doctor Gibbs smiled, "No, it wouldn't, given you're a First Year med student. Doing that as an Intern or Resident would."

"I'm sorry, but again, I think I'm missing something. That seems like something a doctor would do. And I'm the low man, so to speak."

"That's a good attitude, and you should do your best to keep it. You'll see how it plays out next week when a pair of Fourth Years begin Sub-Internships. They'll chase lab reports and X-rays, draw blood, suture, and do all the crap jobs. Basically, heavy on service and light on education. You basically need to grin and bear it because it's the only way through."

"But isn't that all part of patient care?"

"Yes, but how would you feel if I sent you off to chase down lab reports or take blood samples to the lab? Or sit on hold with social services? Or try to get a consult when the other service is busy and tries to blow you off? All when you're trying to learn procedures and get the necessary practical experience to pass the licensing exam or your boards?"

The door to the lounge opened, interrupting our conversation.

"Doctor Gibbs, a seventeen-year-old boy who thought he was Evel Knievel. Probable broken wrist and concussion. His mom brought him in. He's in Exam 2."

"What did he do?" Doctor Gibbs asked.

"Built a ramp for his bike and tried to jump his dad's car."

I couldn't help but laugh, but that was obviously OK because Doctor Gibbs was laughing, too.

September 26, 1985, McKinley, Ohio

"When you get out of school this afternoon, come to Rutherford and meet me at The Yolk's On You," I said to Elizaveta at breakfast on Thursday morning.

"Why?"

"We'll have dinner at Lou's, but first, we're going to try to see my dad at work."

"Do you think that's a good idea?"

I shook my head, "No, but I don't have a better one. It's basically a last-ditch effort."

"You're giving up?"

"No, because I'll be ready to talk whenever he is, but I feel like I have to make one more proactive attempt to talk to him. You helped get through to him last time, so maybe having you along will help."

"But this is different..."

"Yes, but Matushka Elizaveta can handle it, even if she's offended by his sinful behavior."

"It's just that ... I don't know."

"Some things are unforgivable? A 'mortal sin' to borrow the term from the Romans? He's proved he's 'reprobate' to borrow a term from the Calvinists?"

"And you think I'd forgive you?" she asked.

I shook my head, "No. But God has infinite love and infinite capacity to forgive. Neither you nor I are in a position to forgive my dad's transgression — that's up to my mom and God. Our job is to help him in any way we can, with a hope for his salvation. Don't get me wrong, he's hurt me and Liz, as well as others, but nobody has been hurt as badly as my mom, or my dad, for that matter."

"Hang on! He's the one who is committing adultery!"

"Yes, and harming himself in the process. I know you think I harmed myself by my inappropriate behavior, and you feel I harmed you by it, though more for not being forthright from the beginning."

"I guess I didn't think of your dad hurting himself."

"Consider the situation with Paul and Liz. Paul suffered greatly, albeit he was the cause of his own suffering. But the fact he caused his own suffering doesn't reduce it in any way. Even taking the notion of 'sin' out of the equation, he did serious harm to himself, to his ex-wife, and to his son. Liz was hurt as well, though I have a different take on why she was hurt than most people do."

"Because he went to prison, and in a sense, she blames herself?"

"Exactly!" I exclaimed.

"You know, I do listen to you, husband!"

"I know you do, Kitten. I'm sorry if I sounded condescending."

"And you know I've talked to Liz, too."

"Yes, I do know that. So, will you come to Rutherford?"

"Yes, though I hate the idea of driving home in separate cars, I guess that can't be helped."

"Not really."

"Promise you'll drive fast and keep up with me?" she asked with a smirk.

"No tickets, Kitten."

"You're just no fun!"

"We'll just have to see about that!" I declared.

We finished our breakfast, cleaned up the kitchen, then I walked Elizaveta out to her car. We kissed, she got in, and after she'd driven off, I went back inside to review for my physiology class.

September 26, 1985, Rutherford, Ohio

"I'm here to see Doctor Fran Mercer," I said to the receptionist.

"One moment, and I'll buzz her."

She did, and Doctor Mercer came out to greet me, then led me into a small counseling office. I removed my ryassa, hung it on a coat rack, then sat down in one of a pair of chairs which were close together and slightly angled. Doctor Mercer sat in the other one.

"How are you doing, Mike?" she asked.

"OK, I think. I'm pretty much over the initial shock of seeing someone die, though I think it's going to take some getting used to, as crass as that sounds."

"Given your sensitivity, I'd say that's always going to be a struggle for you. Did you participate when the family was told?"

"No. They hadn't come to the hospital by the time I left. I did stand in the room while a doctor talked about a young woman who was badly burned, but that was a positive talk."

"How did that make you feel?"

"I guess I'd say I had mixed feelings because I felt the doctor knew more than he was telling the family, though I think I understand what was going on."

"Could you elaborate?"

"The doctors discussed the likely outcome and likely treatment plan but told the family they needed to do further evaluations. That felt accurate but not true, kind of like telling Elizaveta I was experienced but not revealing that I'd had nearly two dozen lovers before her."

"I'm not a medical doctor, so I'm taking this from a counseling point of view — how have I addressed Angie's situation with you?"

I smiled wanly, "With a lot of weasel words. Or, to put it politely, you've been very careful about making definitive statements."

"Why?"

"Because you don't know for sure and can't promise any given outcome. You don't want to give me false hope."

"Yes."

I nodded and smiled, "You're using rhetoric the same way my mom does! Doctor Evans didn't want to give false hope or suggest a course of treatment until he was sure, or reasonably sure, what was going to happen."

"It's something every caregiver has to learn — balancing what they know, what they think, what they suspect, and what the person they're talking to can hear and understand. Sometimes, people want blunt details; mostly, they prefer embroidery. And in nearly every case, you'll need to put things in layman's terms so they can understand, even if the layman's terms are imprecise. I take it you've started to learn the vocabulary?"

"I have around a thousand flashcards so far, mostly for anatomy, but some for physiology, too."

"How many of those terms did you know in advance?"

"A few, because you hear them — you know, 'clavicle' for 'collar bone', but not most of them."

"So what terms would you use when speaking to a family?"

"It would have to be the non-medical ones."

"Even if they're less precise?"

"I would think so, or else use the medical term and then define it in a way that they'd understand."

"But in every case, you have to shape what you say to what the person can hear and what they can understand."

"So, what you said to Angie's mom is different from what you said to me?"

"In style and language, but not in content. Changing topics slightly, how are you doing stress-wise?"

"OK, I think. One of my study partners wisely suggested we use the steam room after our anatomy sessions and that certainly has helped reduce some of the tension."

"I'm hoping against hope this is your male study partner."

"He's gay," I smirked. "So, you know..."

"Oh, stop!" Doctor Mercer said, laughing. "You're as straight as they come! That said, I find it interesting that you have another gay friend."

"I didn't know until he came out to me. The only other person who knows is Clarissa, and I think you can understand why he felt safe talking to her. She let him know it was safe to talk to me."

"You're sympathetic, which is a double-edged sword for you. It's going to give you a good bedside manner, but it's also going to cause your job to weigh on you. Speaking of that, how did things work out with the young woman you knew who showed up in the ER?"

"It's even more complicated than I thought," I sighed. "When Elizaveta met with that girl's sister on an unrelated topic, everything became related and in a sense, the problem became worse. I have a sneaking suspicion that the father of the girl's baby isn't her boyfriend, but a college student she met at an orientation party at OSU she attended with her older sister back in August."

"How old was the girl again?"

"Fifteen."

"Well, generally, a doctor would refer situations like that to a social worker or Family Services, depending on the situation. Right now, that's up to the Resident who is training you, not you, so I think you can safely let it be, at least with regard to your medical ethics. You said you advised the young woman to speak to your pastor, see her physician, and speak to her parents, right?"

"Yes, all of that is true, but there are scenarios where that can blow up in my face — she reveals she's pregnant and lets slip that I knew about it, or worse, she has an abortion that's somehow discovered, and it becomes known I knew she was pregnant."

"I understand, but from my perspective, you've met your obligations to her and to your ministry. What did your parish priest say?"

"He advised me to speak to a doctor in the parish, and the bishop confirmed that would be sufficient, though my priest did remind me of the Archdiocese policy about abuse, which this technically is, but given my experience with Liz, I'm not so sure I'd say that. I don't know enough details to make that judgment.

"In fact, the only thing I actually know is that she's pregnant. The rest is either hearsay or speculation. And one way or the other, the pregnancy issue will resolve itself — either she'll have an abortion, or she'll have to tell her parents. Hiding behind medical ethics, if you'll pardon that way of putting it, won't prevent an outright scandal in the parish."

"I'm not sure how you can resolve that particular dilemma," Doctor Mercer replied. "If the congregation won't accept 'medical ethics', and your potential dismissal from medical school or, in the future, losing your license, then you have a minefield of infinite size, from which you can never escape, and your only hope is you never happen to step on a mine."

I nodded, "I know. I just feel I could potentially resolve this if there were some way I could explain all the details to the bishop, but I can't do that because it wouldn't be all that difficult for him to figure out, after speaking to Father Nicholas, who the girl is."

"What you're experiencing is a general problem called 'dual relationships', which in my field we're taught to avoid like the plague. You and I have one, but, to be honest, you don't need counseling the way Angie or most of my patients do. The conversations we have are mostly like the ones I have with my mentor — they border on counseling, but they really aren't. Your situation is somewhat worse because your obligations as a clergyman and your obligations as a physician come into conflict."

"Actually," I replied with a wry smile, "they don't. My obligations have a different focus but the same goal — the healing of soul and body. Both callings are about being a physician, though, in church, the spiritual care I provide is an adjunct to my service, not my main role. The only conflict is what I'm allowed to say, and in this case, is ONLY because the young woman isn't sixteen."

"You wouldn't have the same scandal if she was over the age of consent?"

"Oh, we would, but the difference is, my obligations to the bishop would be different. I think, maybe, I've kind of conflated the two concerns — my obligations versus the potential for scandal. The latter is always there, no matter what. My initial concern, and the one that had me tied up in knots, is the policy. Ultimately, I think I can talk to the bishop about it, but time has to pass so that I can discuss the issue without revealing who the young woman is."

"What happens if she has the baby? Won't it be obvious that she's pregnant, and you aren't revealing anything?"

"I suppose. That would be a question for my advisor at the medical school."

"I think, maybe, you've found a way to navigate at least that part. The scandal issue, well, that's kind of out of my area of expertise. I suspect your doctor friend at your church can answer that better than I'm able to. I'm sure he's run into situations where he had to remain silent even in the face of something leaking which might offend the other parishioners."

"I'll talk to him."

"May I ask about your family? How are things?"

"They went from bad to worse to nightmare. My mom filed for divorce because my dad is having an adulterous relationship with an eighteen-year-old girl."

Doctor Mercer's face changed for an instant, showing shock, but she quickly hid it.

"OK, that is NOT what I expected to hear."

"No kidding," I replied wryly. "I saw the look on your face before you got back into 'Doctor Mode'."

"You have to admit it's shocking."

"Oh, I'll admit that. My sister suspects it's his second affair with a teenage girl, but I can't bring myself to believe that. And really, in the end, it doesn't matter with regard to my mom — once is enough, so to speak."

"Have you spoken to your dad?"

"No. He cut off all contact with everyone, including his family in Illinois. My mom is living with her parents right now and will move in with Liz and Paul in December."

Doctor Mercer shook her head, "This just gets stranger and stranger. They've reconciled?"

"Yes. Which leads me to conclude what I thought to be the case actually is the case — the problem was my mom trying to keep her marriage together."