Chapter 51: When It Rains, It Pours

October 15, 1985, McKinley, Ohio

With all the time in class and all the studying, the one thing that I looked forward to each week was my Tuesday afternoon in the ER with Doctor Gibbs. As I walked in for what was my penultimate ER Preceptorship, I realized that after one more week, I'd lose what I considered the only bright spot in my training. From what I'd heard from Clarissa, Fran, Maryam, and Peter, they'd basically sat in the corner of exam rooms and watched routine exams. That struck me as entirely boring, though I knew it was a necessary step on the path to a Residency in trauma.

"Need help putting on your scrubs?" Ellie asked with an inviting smile and a twinkle in her eyes as I walked into the locker room.

"I've been able to dress myself since I was five," I chuckled. "I think I have it."

"I bet my way would be way more fun!"

"And it would be the last thing I ever did because I'd be dead!" I replied, holding up my left hand.

She didn't respond, but stayed to watch as I quickly changed into my scrubs. I ignored her, and once I had changed, I locked my locker and went out into the hall without a word. I checked the board and saw it was relatively full, so I asked Nate where I could find Doctor Gibbs.

"Exam 1," he said. "Head lac. Human versus golf club."

"Ouch!" I replied and walked down to Exam 1, knocked, waited five seconds, then went in.

"Paid attention in your kindergarten class, I see," Doctor Gibbs said mirthfully.

She was watching Jill suture a laceration that looked to be about three inches long on the temple of a pretty teenage girl. Melissa was not in the room.

"Erin, this is Mike, another one of my medical students. Mike, Erin had the misfortune to be standing too close to another member of the golf team."

"Wood or iron?" I asked after looking to Doctor Gibbs for permission.

"Wood," Erin replied. "Do you golf?"

"What I do on the course bears only the most fleeting relationship to what, say, Arnold Palmer or Jack Niklaus do! My father-in-law has been trying to teach me, and I've taken lessons from the club pro, but I'm not very good. You?"

"I've been playing since I was twelve. I'm the captain of the team."

"Senior at Harding County High?"

"Yes."

"Mind if I ask how it happened?"

"I was walking away from the tee, and a Freshman didn't wait until I'd moved far enough before taking a backswing."

"Ouch."

"You can say that again!"

"Ouch," I smirked.

She laughed and grimaced, "You're funny! And cute!"

"Thanks!"

"All done, Doctor Gibbs," Jill said.

Doctor Gibbs moved to take a closer look.

"Very good. Well-placed, even sutures. Dress the wound, and I'll write the discharge order for Doctor Carlton to sign."

Jill put on a sterile dressing while Doctor Gibbs wrote out her discharge orders.

"Erin, just take Tylenol or Advil for the headache," Doctor Gibbs said. "If you have blurry vision, become dizzy or nauseated, or the headache lasts beyond Thursday, come back. The same is true if there's swelling or other signs of infection. Otherwise, see your family doctor in a week to check the stitches. He'll advise when they can come out. You can play golf tomorrow if you feel up to it, and you promise to stay out of range of Freshmen swinging golf clubs!"

Erin laughed softly, "Promise! Thanks, Doctor Gibbs!"

"Mike, you can walk her out to her mom in the waiting room and let them know to see Patient Services. Erin, I'll bring the paperwork to Nate, the clerk at the admitting desk."

"OK," she said.

"Yes, Doctor Gibbs," I replied.

Erin got up from the exam table, and I walked her out to the waiting room to find her mom.

"Doctor Gibbs will bring the paperwork to the desk shortly," I said.

"Thank you, Doctor!" Erin's mom said.

"I'm a medical student," I replied. "The short lab coat is a dead giveaway! I just watched, and now I'm playing escort."

"He's cute, Mom!" Erin smirked. "Can I bring him home?"

I smiled and held up my left hand, "I'm pretty sure this is supposed to remind me that someone has a prior claim on me!"

"Bummer!" Erin declared.

Erin's mom laughed, "Not that I'd have said 'yes'!"

"You never let me do ANYTHING!" Erin whined, but I could tell from her eyes she was teasing her mom.

"Right, because all those golf lessons were nothing? The trip to Scotland last year?"

"Mrs. Edwards?" Nate called out, interrupting the banter. "I have Erin's discharge papers."

"And I need to get back inside," I said. "Good luck!"

"Thanks, Mike!" Erin replied with a smile.

"You're welcome!"

I left and went back into the ER and found Doctor Gibbs in the hallway with Jill.

"Instant crush!" Doctor Gibbs teased. "White coat, stethoscope, and handsome will do it every time!"

"Handsome?" Jill teased. "I wouldn't go THAT far!"

"But I would!" Ellie said as she passed by.

Doctor Gibbs and Jill laughed, and I just shook my head. The idea that Mike Loucks, a consummate nerd in High School, had become a 'chick magnet' was still mind-boggling to me, even after four years at Taft and a score of women who had shared my bed.

"Erin did ask her mom if she could take me home!" I chuckled.

"I take it you don't tell your wife everything that happens here?" Doctor Gibbs asked.

"For my safety," I replied, then grinned, "and yours!"

Doctor Gibbs laughed, "She's a feisty one, for sure. Let's go check on my other patients."

"Doctor Gibbs, you might want to wait," Nate called out. "Paramedics two minutes out with pre-term labor."

"Call up to OB," Doctor Gibbs replied. "We want to get her up there as quickly as possible. Have the on-call Resident come down."

"On it!" he replied.

"Jill, please check on the other patients on the board. I'll want a report from you as soon as I get the pre-term up to maternity."

"Will do!" Jill said, turning to review the board as Doctor Gibbs made her way to the ambulance bay with me in tow.

"What happened to Melissa, if I'm allowed to ask."

"Chasing labs, X-rays, and," Doctor Gibbs laughed softly, "getting me a Coke."

"Remind me not to piss you off," I replied.

"I have ZERO time for the kind of crap she pulled. When I was a First Year, like you, I watched a patient die because he wouldn't let a black doctor work on him. Karma. And you have to have heard the stories about discrimination against women doctors, which is NOT karma. And I suspect you can imagine the opinions of people about patients like the Kaposi's sarcoma last week."

"Greg?"

"At some point, you'll discover that except in the treatment room, patients' names are a luxury for doctors working in the Emergency Department. We describe them by their symptoms or their diagnoses, and that's the only way we can communicate. Nobody else would know him as 'Greg', just as the man with Kaposi's sarcoma. Cold and heartless as it sounds, it's the only way to do it."

"You seriously watched a patient die in, what, 1979, because he didn't want a black doctor?"

"Yes. Had a heart attack, and Doctor Washington was on call. The patient refused to allow Doctor Washington to touch him, had a second, massive heart attack in the trauma room, and died about fifteen minutes later. As I said, karma."

"I met Doctor Washington," I replied. "He did the procedures on Deacon Grigory, the deacon who preceded me at my church."

"I think I remember that. He came into the ED when I was here. He was a patient of Doctor Evgeni Petrov, right?"

"Yes."

"And then later, I think one of your bishops was here."

"Correct."

"Did your deacon make it?" she asked.

I shook my head, "No."

The ambulance turned into the drive and, a few seconds later, pulled up in front of us. The paramedics jumped out and pulled the gurney from the ambulance.

"Linda Peters, twenty-two," the paramedic said, "in premature labor at 32 weeks. BP 150 over 100; pulse strong at 90; resps normal; on oxygen per her OB. We picked her up at his office. He's right behind us."

"Exam 3," Doctor Gibbs said. "How are you feeling, Linda?"

"Scared," the woman on the gurney said as the paramedics pushed the gurney down the hallway.

"We have great doctors here, and your doctor is on his way. We'll take good care of you!"

We entered Exam 3, and I moved out of the way as two nurses and a Resident whose name tag read 'Ustinov', came into the room.

"What do we have, Loretta?"

"Hi, Phil," Doctor Gibbs said. "This is Linda Peters."

She repeated the vitals the paramedics had given her as the nurses checked Linda's pulse and BP.

"Let's get a saline IV in, please," Doctor Ustinov said. "They're ready upstairs, so we can go as soon as that's done."

An older man in a coat and tie came into the room.

"Doctor Sutter," he announced. "Hi, Linda."

"Hi, Doc."

"Hi, Ken," Doctor Ustinov said. "We're about to take her upstairs."

The nurse finished the IV, and an orderly came in to take the patient up to maternity. He helped the patient into the wheelchair, and the two doctors left with her.

"That was quick," I said.

"Would YOU want to deliver a pre-term baby?" Doctor Gibbs asked. "Here? In the ED?"

"No!"

"And you can guess why they brought her in by ambulance."

"To skip triage and ensure she went right to maternity."

"Exactly. We're somewhat busy today, and coming to the desk could delay her being seen. Her doctor was smart to call the paramedics."

"Is anyone brought in right away if they show up at the desk?"

"Chest pains, serious breathing difficulty, or significant bleeding. Otherwise, they wait."

"How long?"

"Here? Almost never more than an hour. At some big-city Level 1 trauma centers? It can be several hours."

"Can I ask a question about Erin?"

"I don't have her phone number, but Nate might!" Doctor Gibbs teased.

"Why wasn't her mom in the treatment room?" I asked, ignoring the teasing.

"Erin is eighteen and didn't want her mom with her. Her coach brought her in, and she called Erin's mom."

Jill came out of an exam room and walked over to us. She updated Doctor Gibbs on the patients, and just as she finished, Melissa walked down the hall with a bottle of Coke in one hand and a sheaf of papers in the other. She scowled as she handed them to Doctor Gibbs.

"I need you to call up to Medicine," Doctor Gibbs said, "and find out why they haven't admitted the gallstones. Don't take 'no' for an answer."

Melissa turned wordlessly and went to the desk to make the call.

"How long does this last?" I asked quietly.

"Until she figures out that having an attitude will only prolong it," Doctor Gibbs replied, then turned to Jill, "Write up a proposed order for the bee sting and bring it to me."

"Yes, Doctor!" Jill said happily.

"Allergic reaction?" I asked.

"Inside the nose of a twelve-year-old boy. His family doctor advised his dad to bring him here. Other than severe discomfort, he's OK. But his doctor was right to send him here because internal stings in the nose or mouth can have serious complications."

"What do you do?"

"We extracted the stinger and gave him some antihistamines."

"What should Jill come back with?"

"What do you think?"

"I'm still at 'take two aspirin and call a real doctor'!" I chuckled.

"Obviously, but what does your gut tell you?"

"Antihistamines, some kind of pain reliever, and call his doctor or come here if there is swelling or discharge, or if he has breathing difficulties."

"Congratulations! You just wrote your first order!"

"Common sense, really."

"You'll discover that common sense is not very common! And that goes double for treating injuries and illnesses."

"You asked me what my gut told me; is that something that's common?"

"How did I know that was Kaposi's sarcoma?"

"Training and reading current literature."

"But I didn't know until the lab report came back."

"But isn't training different from a 'gut feeling'?" I protested.

"Strictly speaking? Yes. In the ED? No. We often don't have the luxury of waiting on labs or looking through a differential diagnosis book. So it's a combination of knowledge, assessment, and going with your gut if you can't wait. The difference between a great emergency medicine specialist and a good one is that intuition that I call my 'gut'."

"I take it you're good at it?"

"Great!" she replied with a laugh. "You know the difference between doctors and God, right?"

"God doesn't think he's a doctor!"

"Exactly. My point is, you can have all kinds of reactions to what happens here. I know your eval isn't due until next week, but what do you think of emergency medicine now that you've had a few months to get a feel for it?"

"When I walked in today I was just thinking about how much I liked being in the ER and that it was the bright spot in my week."

"Most people would suggest you need a psych eval for thinking that; I think it means you're cut out for this, and what I've seen so far is promising. Don't let the mundane and routine Preceptorships get you down. You'll learn if YOU want to. Remember that — you learn only if YOU want to, and you only get out of it what YOU put into it. You can be like Jill or like Melissa, and that's one hundred percent on you. Attitude can make or break you, just like any other part of your training. There are any number of things which can trip you up, even late in your Residency."

"Understood."

"We'll do your formal review at the end of next Tuesday's session. Plan to stay at least thirty minutes past the end of your shift. I'll do my best to do the review on time, but as you know, that's up to the patients."

"Doctor Gibbs?" Melissa said, still scowling. "They said they don't have a bed."

"That's a load of crap! Go upstairs, walk down the ward, and count empty beds. Then go to the nurse at the desk and tell her you want a bed. Solve this, Melissa."

Melissa frowned and headed for the elevators.

"What's the problem?"

"Who knows? But this is one of those things you have to learn to do if you want to work in a busy emergency department. You have to clear patients either by admission or discharge. As one of our Attendings says — treat 'em and street 'em. Otherwise, get them admitted and out of the ED. We simply can't provide the level of treatment that Medicine or Pediatrics or Cardiology is able to provide."

"Is Melissa going to make it?" I asked.

"That's up to her, not me," Doctor Gibbs said firmly.

Jill came out of the treatment room with a clipboard and handed it to Doctor Gibbs who reviewed it, signed it, and then the three of us went to the Attending's office so that Doctor Simons could sign off on the discharge. The rest of the afternoon was a stream of patients, though none were major trauma cases, and I wasn't surprised when it was time for me to leave, that Ellie happened to be in the locker room and just happened to change her scrubs while I was dressing. She was putting on the full-court press, but I simply ignored her, not even saying 'goodbye' when I left the locker room.

October 16, 1985, McKinley, Ohio

"Do I need to hire a bodyguard for you, Petrovich?" Clarissa teased on Wednesday morning when I told her what had happened with Erin and Ellie.

"I'm perfectly capable of taking care of myself!" I replied firmly.

Clarissa laughed, "Oh right, sure! You? I leave you alone for five minutes, and you get into all kinds of trouble! Just this week, a visit from a Sheriff's Deputy, an offer of an illicit affair, AND an eighteen-year-old who wanted to take you home!"

"And what happened? Nothing! Let's get our coffee and go to class."

"Mike?" Doctor Warren called out as we walked into the building.

I walked over to him, "Yes?"

"Do you have a moment?"

"Sure."

"Let's go to my office," he said.

"Is something wrong?"

"Let's speak privately."

I followed him upstairs to his office, where I sat across his desk from him.

"I had a call from the Sheriff about you," he said.

"If this is about Grace Simmons, to use a TV phrase, I have an airtight alibi for my whereabouts all day Saturday, Saturday night, and Sunday morning, with something on the order of twenty people who can confirm that, including my wife."

"I'm actually more concerned about something else he said."

"What's that?"

"That you were accused of sexually abusing your sister and that you used legal trickery to avoid being punished."

I took a deep breath and carefully let it out to control my rising anger.

"I know who made that claim, but it's false. Nothing came up on my background check when you ran it. I know that for a fact, or I wouldn't be here. Did you ask the Sheriff for proof?"

"No. I assume he has it."

"Call him, please. Right now. Ask if anything showed up when he ran my name through their system."

"Who would make such a claim?"

"Doctor Warren, if you'll make the call and confirm, then we can talk further."

He thought for a minute, then picked up the phone. He dialed a number, asked for the Sheriff, and was put through.

"Sheriff Peters, this is Doctor Warren at McKinley Medical School. May I ask you about the situation you mentioned earlier?"

I couldn't hear the other side of the call, but clearly, the Sheriff assented.

"Did you run Michael Loucks through your system, and did you find anything confirming what you said?"

Doctor Warren listened for a moment, thanked the Sheriff, and hung up.