Chapter 33: That Lying Bitch!

September 9, 1986, McKinley, Ohio

"Good morning," I said to Melissa when she sat down across from me at a table in the cafeteria on Tuesday morning.

As we'd agreed, Clarissa was sitting just far enough away from us that she couldn't hear the conversation.

"Hi. Thank you."

"I take it you had good news from Doctor Mertens?"

"I did. My probation is lifted, and you were the main reason why. I'd hug you, if that were acceptable."

"It's not," I replied.

"That's actually not too far from what my old church taught about how men and women who weren't married to each other should behave."

"Teachings on Christian purity are pretty consistent across all the denominations," I replied. "Of course, whether they're followed or not is a different question. And the struggles are real for all of us. The fundamental difference, at least between what Faith Bible taught and what I believe, is that there is redemption after a fall from grace."

"You're not just talking sexual sin, are you?"

"No. And what happened with you is a perfect example. By lifting your probation, the medical school is recognizing your change of heart, your acknowledgment of your error, and your resolution to do better. In a sense, you sinned and then repented, and once you repented, you were restored.

"That's how it should work in all aspects of our life, but especially in what I believe you call our Christian walk. We fall down, we get up, and we try to do better. And that applies to your dad, too. Proper repentance, «metanoia», will restore his relationship with God, and he can spend eternity in loving union with God."

"I just don't see how that's possible, given what the Scriptures say."

"The Scriptures do not say what you think they say," I replied. "I've told you before, you were poorly taught. But I'm not here to convert you, and unless you ask questions, I'll confine our talks to how you can achieve your goal of being a doctor."

"You don't think they go together?"

"Well, given my lesbian friend is going to make a great doctor, I don't think you must be Orthodox to be a good doctor."

"May I say something without you running off to Doctor Mertens or someone else in the administration?"

"Nothing you say to me will ever be repeated to anyone, except perhaps my bishop, who I must answer, no matter what the question."

"How can you have a close friend who is lesbian?"

"How could Jesus spend most of his time with 'publicans and sinners', such that everyone knew he did that? It was the self-righteous religious leaders who were excoriated and who he tried to avoid. Veering back to being poorly taught — being homosexual is no more sinful than being heterosexual. The sin is NOT in desire, but action. And my past sins in that regard are no less an offense to God than anyone else's. When I fully resolve MY sins, then I can worry about the sins of others. Plank and splinter, as it were."

"So you condone sin?"

"Condone? No. Understand? Yes. I guarantee you that Clarissa knows what the church teaches. And yet, she comes to church fairly regularly."

"That's just strange that you would allow openly homosexual people into your church."

"Where should sinners go? I guarantee you that every person in my church is sinful in some way, falling short of the perfection God would have of us. The church is a hospital where souls come for healing through the medicine of immortality. But set all of that aside. If there is to be a Doctor Melissa Bush, she has to accept everyone who is in need of her care. Did I make a mistake when I assured Doctor Mertens you had learned from your mistake and were properly repentant?"

"No! Don't say that, please!"

"But is it true? Are you unable to commit to the oath we made to give care to everyone? And the one you'll need to take to receive your MD? Not to mention the gay doctors, nurses, orderlies, technicians, and administrators you'll have to work with."

"You promised not to narc!"

"I didn't say I was going to go to Doctor Mertens; I asked if I was mistaken to plead your case. Was I?"

"God can't tolerate blatant sin!"

"And the medical profession can't tolerate blatant disregard of the oath. You'll excuse me, but this conversation is over."

"You promised not to tell!"

"I won't have to," I said. "You can't fake it all the time. Unless you have a genuine change of heart, you'll out yourself."

She glared at me as I got up and left the table, motioning Clarissa to follow me to a table on the other side of the room.

"What happened?"

"I got played," I said. "She heard the things I've said about repentance and used that to convince me to make her case for her. But it was all a cynical ploy."

"Shit!" Clarissa exclaimed. "Now what? Are you going to let Doctor Mertens know?"

"No. I'm sure that Melissa will hang herself. She's going to have a hell of a time getting recommendations as it is, and I'm sure not going to lift another finger to help her. She might Scramble to a spot, but I bet she blows it before March."

"So what happens when Doctor Mertens asks you about it?"

"I tell the truth — that all indications were that Melissa had changed, but it appears to have been a snow job to get her probation lifted. I learned my lesson, and I'll remember it for the future when I'm a Resident evaluating students."

"So she used you?"

"I'd say so. It's something I have to watch out for in the future, as I said."

"What did she say that tipped you off?"

"I can't reveal that because I promised the conversation would be private."

"Seriously, Petrovich?"

"Would you reveal a confidence told you by a patient?"

"There are exceptions," Clarissa replied.

"Yes, with regard to criminal activity, but even then, there are limits. Suffice it to say that what she said made it pretty clear, and I probed and confirmed my suspicions. She didn't correct me when she had the opportunity to do so."

"Why would she tell you, then?"

"It was inadvertent, and she was basically caught off guard by something I said. In any event, she's on her own now."

"And if she were to come to you and claim to be repentant?"

"She'd have to prove it beyond any reasonable doubt," I replied. "And I'm not sure how she'd do that."

"No coffee next week, then?"

"Not a chance."

September 11, 1986, McKinley, Ohio

"Mr. Loucks, what is the primary goal of a suture?" Doctor Ingels asked.

"To approximate the wound margins and to eliminate space between the wound walls so that the underlying tissue is held together sufficiently to heal."

"Correct. Ms. Khouri, what can occur if the space is not eliminated?"

"Blood will pool, and a hematoma may develop, preventing proper healing."

"Also correct."

Doctor Ingels asked other students review questions about scar avoidance, then began to explain the next suturing technique we'd learn — running, or continuous, sutures.

"A running suture, also known as a continuous suture," Doctor Ingels began, "consists of a single strand of suture material that runs for a lengthy distance along a wound, normally in a zigzag pattern, and tied at both ends. Running sutures provide an adequate closure with even tension across the wound and save significant time, which is important for wounds that are actively bleeding, such as scalp lacerations. Because they are meant to be fast, they are not meant to be pretty.

"You begin the same way you would with an interrupted single suture. But after you tie your first knot, you cut only the side away from the needle. Now, you'll need a nurse, doctor, or fellow medical student to hold the suture material between the needle and the first suture, so as not to tug on the previous suture. Once the second suture is in place, your assistant will release the suture material, and you'll carefully pull it tight. When you come to the last stitch, you'll make a knot using the loop of the suture material, then cut the loose ends.

"Spacing of sutures will depend on the type and extent of the wound, and depending on the location and type of wound, you may want to add individual interrupted sutures to strengthen the closure once the running suture is in. That will be a judgment call and something you'll need to decide each time you suture.

"As with our previous lessons, we are not worrying about anesthesia, sterilization, or irrigation. I'll show a video, then demonstrate."

She put a tape into the VCR, and we watched as a doctor sutured a four-inch laceration on the thigh of an accident victim, then she demonstrated on a banana, using a video camera so we could see what she was doing on the TV.

"Now that you've seen it twice, let's begin. Please use 5-0 suture material. Work in your usual pairs, with one person being the assistant and the other doing the suturing, then switch roles. I'll come around and check on you."

"I would not want to be a patient the first time we have to do this for real," Peter said as we took our positions at our lab table. "You first!"

I nodded, because that was Peter's usual way, and I didn't have a problem with it. I picked up a needle, threaded the suture material, then used a needle driver to take hold of the needle.

"Ms. Chiquita, I'm going to suture your wound now," I said, addressing the banana, causing Peter and Maryam, who was to my left working with Clarissa, to laugh. I took a deep breath, then let it out, then inserted the needle at a 90° angle through the banana peel, about five millimeters deep, then out, gently pulling the suture through the wound so that I would have enough material for six sutures. I carefully tied the knot, then cut the suture material as instructed.

"Good first stitch, Mike," Doctor Ingels said.

"Thank you," I replied.

She stood and watched while Peter held the suture material so I could make the second stitch, and satisfied that I understood the technique, she moved to check Clarissa's work. Peter and I worked together to complete the six sutures, and I tied the final knot.

"Too slow," I said, checking my watch.

"It was your first time," Peter objected.

"You know me," I replied. "Perfectionist, even the first time!"

I handed over the needle, needle driver, and forceps, and Peter repeated the steps I'd done using a second banana. When we finished, we waited for our sutures to be checked, and Doctor Ingels said we'd each done a good job. There were students who'd had trouble, so those of us who didn't need help were given a chance to practice on our own, which Peter and I did, simply turning the bananas over to suture the other side.

"Want to know the funny thing?" Clarissa asked at lunch.

"What's that?" I asked.

"Your wife would NEVER let you sew to repair your clothes, but you'll be sewing wounds!"

"I don't think that works quite the same way!" Maryam said, though she was laughing with the rest of us. "I know how to sew and cross-stitch, but this is totally different!"

"She's seen me practice but hasn't said anything other than noting that we're eating way more bananas than we did in the past!"

"I still wouldn't want to be on the receiving end of my first real sutures," Peter said.

I chuckled, "I was on the receiving end of your first IV, so I can sympathize!"

"You weren't supposed to agree with me!" Peter protested.

"You do realize we're only nine months away from being turned loose on unsuspecting patients, right?" Nadine asked.

"All too aware," I said.

"We'll all be Residents in two-and-a-half years," Fran observed. "That just seems crazy!"

"I think we need to focus on the MLE," I said. "In fact, we should probably think about how we'll handle the extra studying we'll need to do. I suggest we start reviewing in March."

"That sounds about right," Fran agreed. "I'll get a copy of the study guide and work out a group plan."

"When is Holy Week, Mike?" Clarissa asked.

"Palm Sunday is April 12th. During Lent, we have Friday night services, as I'm sure you recall, but those won't interfere with study group. Holy Week will be difficult, but given that it's six weeks before the end of the semester and four weeks before the MLE, I think I'll be fine."

"What about next year?" Maryam asked.

"I won't know until I see my schedule for clinical rotations. Once I have that, then I'll get in touch with whomever my supervisor will be and discuss what's possible. In the end, though, medical training will dictate what I do. I discussed that with Bishop ARKADY and with Vladyka JOHN, and I have «ekonomia» for my medical training, to whatever extent necessary. You just need to speak to Father Nicholas, who I am positive will give his blessing for you to do whatever is necessary."

"Have you decided on your electives yet?" Maryam asked.

"One psych rotation, two ER rotations, and two surgical rotations. That's based on suggestions from Attendings during my Preceptorship, plus my desire to better understand people in Angie's situation."

"How is she?" Fran asked.

"About the same," I replied. "And that's the best we can hope for right now. She's taking her medication, which has her what I'd call in music 'off a beat', but she can work, practice Aikidō, take a class, and spend time with her friends. But she has lapses, which is why I say it's the best we can hope for now."

"Lapses?" Nadine asked. "What are you talking about?"

"Our friend Angie is schizophrenic," I replied. "She had her first breaks while we were attending Taft together. She has mostly good periods while she's on her meds, which was a serious problem at first, but they keep her mostly steady. Unfortunately, at times, she becomes unstable, and they have to up her meds, which means she can't work or take classes. Fortunately, her work is very accommodating in that regard."

"Sorry to hear that."

I was sure she was, but not nearly as sorry as I was that I hadn't been able to help Angie more.

September 12, 1986, McKinley, Ohio

"What are we doing tonight?" Elizaveta asked on Friday morning.

"What we ALWAYS do on Friday nights," I smirked, then added, "I mean, AFTER we go out with our friends!"

"Warm-ups for next month!" Elizaveta said happily. "Remember, I'm seeing Doctor Forsberg today, so I'll get my prescription for the diaphragm."

"OK. Make sure you talk to her about proper diet, because taking care of our baby overrides any fasting rules. Whatever she says, goes. I got that direct from Father Nicholas."

"OK. Does that bother you at all?"

"No way! A healthy wife and a healthy baby are what matters. Following the rules just to follow them, against the advice of a physician, would be foolish, to say the least."

"I'll make sure I discuss that with her. So, besides you fucking my brains out, what are we doing tonight?"

"Dinner and then going to the jazz concert at Taft. And, of course, ice cream afterwards."

"I'll lick your cone if you want!"

"Unfortunately, we don't have time for that now! You need to leave for school in less than ten minutes!"

"And when we're trying to make a baby?"

"We'll just have to get up a little earlier so we have time in the morning!"

"Before or after we run?"

"Before, I think," I said. "Unless you want to be sweaty from running when we fool around."

"I don't mind! We're going to have to wash the sheets either way! Doing it three times at night and twice in the morning will make them STINK!"

"Five times a day?" I asked.

"Are you complaining?" Elizaveta asked, giving me the 'look'.

"Why, no, of course not, Kitten," I replied flatly.

"Husband..."

"You know full well how much I like to play with you, Kitten!"

"I could miss homeroom, and you could write me a note..."

"Is that the behavior to be expected from a Matushka?" I asked.

"No!" Elizaveta exclaimed. "It's the behavior of a horny seventeen-year-old who wants to fuck before school!"

"You wouldn't have time for a shower," I countered.

"We can do it IN the shower and save time!" she pleaded.

"Kitten..." I said, shaking my head.

"You're mean!"

"Go to school, Kitten. I promise to have sex with you as soon as I get home, before we go to dinner."

"I have to wait ELEVEN hours?!"

"Yes."

"Hmph!"

We finished eating, then Elizaveta gathered her things, and I walked her out to her car so she could drive to school. We shared a soft kiss, then I went back into the cottage to study for thirty minutes before heading to the medical school.

Eleven hours later, I arrived home to find Elizaveta lying naked on the bed. I quickly removed my cassock, shorts, T-shirt, and briefs and joined her. I fulfilled my promise, then we quickly showered, dressed, and headed to the car for the drive to the Chinese restaurant to meet our friends.

"What did Doctor Forsberg say?" I asked.

"That everything looks great!"

"I'm no OB/GYN, but I agree with her!" I replied.

"Not that way, you nut!"

"So you're saying it DOESN'T look great?"

"Husband..."

"So, besides the silly jokes?"

"Those exams are very weird," she said. "Now that I've had sex, they check inside and do a Pap smear."

"Which is necessary to look for any signs of abnormality in cervical cells."

"Are you going to do exams like that?"

"Probably, yes, and I'll absolutely do checks for dilation and effacement for women who are in labor."

"I don't like it."

"It has nothing at all to do with sex, Kitten. Zero. Neither do breast exams or mammograms. They're medical procedures."

"I don't have to like it, though."

"No, you don't. But put that aside for now. What else did Doctor Forsberg say?"

"I have my prescription for the diaphragm, and she explained everything about using it, including spermicide."

"I was aware of that," I replied.

"Of course you were," she said flatly.

"From my coursework!" I replied.

"Uh-huh."

"I thought we were past all that."

"Sorry. She wants me to take a multivitamin as well as folic acid supplements and iron pills."

"That's standard," I replied. "What about diet?"

"Fasting the way we do it isn't a problem. Not eating would be a problem. That said, she strongly encouraged me to eat one helping of protein a day, preferably fish or chicken, not shellfish."

"Fish is the usual «ekonomia» so I think that's the way to go, if she's OK with it."

"She is. She also suggested peanut butter as a good choice, so I can take celery sticks with peanut butter for lunch to get midday protein, or tuna fish."

"Good. I'll let Father Nicholas know what she said. When will you stop taking the Pill?"

"A week after I get the diaphragm, so there's a bit of overlap. We can pick it up tomorrow at the clinic where Abby works. I called the drugstore, and they referred me there."

"How much?"

"$25 with our insurance. Of course, I could have told the clinic that we have no income, and it would have been free, and while that's true, it didn't seem right."

"I agree. We've barely dented my savings, and we haven't touched yours. Given your dad is paying for medical school and we're not paying rent, we really don't have many expenses other than food and gas and our evenings out."