Chapter 35: Did You Learn Anything?

October 9, 1986, McKinley, Ohio

As I walked upstairs to Doctor Mertens' office after lunch on the second Thursday of October, I reflected on two very quiet, very calm weeks. For the first time in a long time, not only had nothing bad happened but also nothing of note. Routine days of medical training, routine study groups, routine band practice, quiet evenings with friends, and a lot of lovemaking had been a peaceful respite from the chaos which seemed to surround me.

"Hi, Mike," Doctor Mertens said. "Have a seat. This shouldn't take very long."

I sat down across from her, leaving the door open, as was my usual practice.

"I have a proposed schedule for your required clinical rotations and the electives you listed on the form you turned in last week. I was a bit surprised by the note saying you wanted your surgical Clerkship first, rather than emergency medicine."

I smiled, "Doctor Roth made me an offer I couldn't refuse!"

"Funny, he doesn't look Sicilian!" Doctor Mertens laughed. "So I'm going to guess it didn't have to do with a firearm and a personal services contract with a bandleader!"

"You're a fan of The Godfather?"

"One of the finest films ever made. And The Godfather Part II is even better! I take it you've seen them on videotape?"

"I have The Godfather 1902–1959: The Complete Epic on videotape. It's in chronological order, not film order, though. I was only nine when it was originally released, and the tapes matched the version I saw on TV when I was in High School."

"I'm going to guess you've managed to see Doctor Zhivago."

"Absolutely! I saw it a few years ago as a 'revival' in the theatre in Rutherford. Another amazing movie."

"Indeed. Mind telling me about the offer you couldn't refuse?"

"He's trying to convince me to Match for surgery, rather than emergency medicine, and promised if I did my surgical Clerkship first, he'd actually let me participate. I figured holding a retractor or suctioning is worth it, because, in the end, the order isn't important. He just wants to keep me out of Doctor Gibbs' clutches until he can argue his case!"

"I know you've already made your decision in this regard, but being at the top of your class, you could Match anywhere you wanted."

"Which is exactly what I'm doing!"

"Yes, of course, but you know what I meant. I'm not trying to encourage you to look elsewhere, just reminding you that you could. The other thing I want to confirm is a second psych rotation. That's not typical for someone considering emergency medicine or surgery."

"I was encouraged by a psychologist to do that, along with my psychology professor at Taft. I have a very close friend who has been diagnosed with schizophrenia, so it's important to me to learn about caring for patients with emotional or mental disorders."

"OK. Doubling up on both emergency medicine and surgery is good, but I'd like to offer an alternative to a third stint in the ER, a second in internal medicine, and one in cardiology."

"What's that?"

"A six-month Sub-Internship with «Médecins Sans Frontières», which you probably know as 'Doctors Without Borders'."

"I don't think I'd survive telling my wife about something like that, let alone actually trying to be in Africa or the Middle East for six months! We're very likely to have a baby by the end of next Summer, and I can't imagine being away for that period of time."

"I understand, but it's something to consider. You could apply any time before you begin your fourth year, and your schedule would be adjusted to accommodate."

"I'll keep it in mind, but I can't imagine anything will change in that regard."

"Understood. The way the schedule worked out, you'll start at Moore Memorial Hospital for your surgery Clerkship, then you'll have your OB/GYN Clerkship at Good Samaritan near Norwood in Cincinnati. Normally, we arrange housing for visiting students with doctors or nurses from the hospital, preferably from the same service, but I wasn't sure how you wanted to handle things, and that's especially true now that you've mentioned a possible addition to your family."

"I'll have to discuss it with Elizaveta, but is it possible to make those arrangements, and for me to decide which days or nights to spend there, depending on my schedule?"

"Third Years usually do four or five twelve-hour shifts here, though I'm not sure what they do at Good Samaritan. We won't know what shifts you're assigned to until they publish a schedule for August. But I'm sure we can come up with some kind of flexible arrangement for you. After your OB/GYN Clerkship, you'll have emergency medicine, pediatrics, psychiatry, and internal medicine. For your Fourth Year, it's the ER, surgery, psychiatry, cardiology, internal medicine, and lastly, the ER to get you primed for your Internship. There is an option to consider for the final two Sub-Internships, and that's doing them at a hospital in Columbus or Cincinnati, to give you a different look at those programs from what you might see at Moore Memorial Hospital."

"Again, I'd have to discuss that with Elizaveta. When would you need to know?"

"Not until December of next year. We know how many slots are available, but we don't fill particular slots until January of your Third Year. As you know, we'll lose some students before then. Well, we'll lose some in May, too, but we have to have a place for them even if they don't make it."

"What happens to those slots?" I asked.

"They go to other medical students from other schools. Sometimes, we don't lose as many as expected, and sometimes we lose more. The same is true for other schools. In the end, though, slots go unfilled, but that really doesn't cause any hardship for the programs, though it does mean Residents do a bit more scut than they normally would."

"Well, everything sounds good to me. I'll discuss the housing situation with Elizaveta, but I'm sure that at least for the OB/GYN rotation, I'll take you up on housing, and it'll just be a question of how often I drive home."

"Remember, you're likely to be very tired after twelve-hour shifts, and it's also the case that you aren't punching a clock. If you're needed, those shifts can stretch to eighteen or even twenty-four hours. Babies do NOT arrive on a set schedule!"

I chuckled, "If only they did, it would make planning MUCH easier!"

"Mine decided to arrive at the exact time I was taking my Boards. As I suspect you can imagine, in the late 1960s there were NO allowances made for female doctors in that regard. If you weren't in private practice, it could ruin your career."

"That's as dumb as the fact that nearly all OB/GYNs are male, which, of course, led to stupidity in marginalizing or outright banning midwifery!"

"You're pretty enlightened for someone who grew up in a very conservative church."

I laughed, "Have you met many Russian women? If you have, you'd know who is really in charge. As the saying goes, the bishop fears no man, but fears every single woman!"

"We do need to make a time for me to meet your wife. Would lunch next week, Thursday, work?"

"She'll be in school," I replied.

"Yes, of course. I wasn't thinking. How about breakfast here one morning next week? We'd be done in time for her to leave for school."

"Tuesday?"

She checked her calendar and nodded, "Tuesday it is. 6:30am?"

"We'll be here. Before I go, did you manage to align my schedule with Clarissa Saunders'?"

"Yes, I did. Your first year is identical, minus her doing her OB/GYN Clerkship at Moore Memorial Hospital, as she doesn't have the ethical limitation you have, and the number of slots we can get for visiting students is severely limited."

"That makes perfect sense. Were you able to accommodate Maryam Khouri?"

"Yes. I spoke with Good Samaritan and negotiated two slots in the August rotation."

"I really appreciate that. Thank you."

"You're welcome. Just don't let Good Samaritan entice you away!"

"I don't see that happening."

"Good. I think that's all, Mike."

I thanked her and headed down to join Peter, Maryam, and Nadine as Clarissa and Fran were meeting with their counselors. The others had appointments spread across the afternoon.

"You and I will be doing our OB/GYN Clerkship at Good Samaritan in Cincinnati in August," I said to Maryam. "Though there are no guarantees we'll have the same shifts."

"What about a place to live? That's a long drive to make."

"They arrange housing with doctors or nurses on the OB/GYN service."

"OK. Do you know of a church we could attend?"

"Either Saint George in Loveland, where my friend Angie attends, or Christ the Savior, which might actually be very close to the hospital. I'd have to check a map, but I'm pretty sure that's the case, now that I think about it. I've visited Christ the Savior parish a few times, and I recall seeing a hospital in the area."

"Must be nice to go first and get the best slots," Nadine observed.

"He's ranked first in the class," Peter said. "He deserves it. And it's not like it's hurting you because you're in the top half of the class, and pretty much everyone gets what they want down to the bottom quarter, who sometimes don't get their chosen electives."

"The world needs dermatologists!" Nadine declared. "And I was just grousing because I could. My class rank has improved by six spots since I joined your study group. I don't think I can make it into the top twenty with the rest of you, though."

"You should easily end up in the top third of the class," I said, "so unless you fail the exams or interview poorly, you'll Match well."

"I hate the idea that the Match is do-or-die, and you have no actual choice of where to go or what specialty to have."

"You could select only the programs you want and only the specialty you want," I said. "But that's extremely risky."

"What do you plan to do?" Nadine asked. "Not that it really matters."

"I'm going to list Taft for emergency medicine first, then Taft for surgery, then four emergency medicine programs."

"Why would you list surgery second?" Peter asked.

"Because the closest teaching hospitals besides Moore Memorial Hospital are in Cincinnati or Columbus, and I'd really rather be at Moore Memorial Hospital. It's also true that if someone were to leave the emergency medicine program for any reason, I could try to transfer. That happens very rarely, but it does happen. It's also the case that I could ask to cover the ER and, when the time comes, apply for an ER Attending role. Again, not easy to do, but possible. Going to another city would be a serious logistical problem with my wife and very likely two kids."

"You're certifiable, Mike!" Peter said, shaking his head. "I have enough trouble managing my own life, let alone having kids!"

"Ditto!" Nadine declared.

"That's actually the biggest sacrifice I've made," Maryam said. "I would have preferred to be married and start a family by now, but that just seemed too difficult. It's easier for men."

"True," Nadine agreed. "Women are discriminated against in medicine in a serious way. You're 'allowed' to have one kid, but have more? Forget your career, unless you're in private practice, and even then, it's tough. Add in the outright harassment that women are subject to, and it makes me wonder if it's worth it."

"It is," I said. "And if you ever feel like you're being harassed, report it. I know that creates its own set of problems, but until doctors who think nurses and medical students are their personal sexual playthings are called on the carpet, it'll continue. And I'll add it happens to men, too."

"Seriously?" Nadine asked. "I can name four male medical students who are happily banging nurses at the hospital. I seriously doubt any of them think they're being harassed!"

"How about a nurse continuing to try to tempt a married male medical student into an affair against his will?"

"You?!" Maryam gasped. "That's SO wrong! You're a deacon!"

"Yes, but that simply makes it MORE of a challenge for this nurse. I've told her to stop, but she still does her best to remind me without saying anything."

"I guess you do know how it feels, then," Nadine observed.

"A little bit," I replied. "I still have power as a male medical student you don't have, and I find that to be wrong on just about every level. The profession has to clean itself up, and we need to be catalysts for shoveling the crap out of the modern equivalent of the Augean Stables!"

"Greek mythology?" Peter asked.

"Yes. The Fifth Labor of Heracles was to clean the Augean Stables. They hadn't been cleared in over thirty years, and as the livestock were immortal, there was a prodigious amount of dung. Heracles, who you might know by his Latin name Hercules, rerouted two rivers to flush all the dung from the stables. And, in true mythological fashion, that led to the labor not counting, because he hadn't shoveled the manure himself."

"So you're saying the medical profession is full of shit?" Nadine asked.

"The part of it which discriminates against women, gays, and minorities, and harasses them, absolutely. And I'm dedicated to doing everything I can to fix at least my little part of the world!"

Clarissa returned a moment later, and we confirmed our schedules matched, as Doctor Mertens had promised.

October 10, 1986, McKinley, Ohio

"How's law school going?" Clarissa asked Jocelyn when we gathered for dinner on Friday night.

"I think I've read and written more in the last five weeks than I did my entire Senior year in High School!"

"She has her nose in law books or glued to the screen of her Mac pretty much every waking moment she's not in class!" Gene declared. "It's probably like Mike and medical school."

"Minus the computer," Elizaveta tittered. "We have one, but he won't even touch it. It's like he thinks he'll catch something!"

"There are computer viruses," Gene grinned. "But I don't think people can catch them!"

"You never know!" I declared. "Better safe than sorry!"

"You don't have computers at the hospital?" Lara asked.

"Oh, we do," I said. "But they're used by clerks and nurses, not doctors! The closest I come to touching a computer is the equipment in Radiology, which has computer chips and, I would guess, programs to run the displays."

"Probably embedded microprocessors," Jason offered. "The same with all the equipment you used in the lab at Taft. Your VCR has them, as does the remote control! And you like Star Trek and Star Wars where there are computers all over the place, along with robots!"

"And yet, I prefer the take in Hitchhiker's Guide to the Galaxy which portrays them in a negative light. And let's not forget what happened with HAL in 2001: A Space Odyssey! All I can say is that if any computer starts singing Daisy Bell, you'll see me heading for the escape pods!"

Everyone laughed and nodded. We finished our usual Chinese meal, then saw Crocodile Dundee, which was hilarious, then went for ice cream.

"I expect my period on Thursday or Friday of next week," Elizaveta said after we got into the car to head home. "We're getting close!"

"So, of course, you want to practice every night before then, right?"

"And every morning! When I have my period, you can have all the blowjobs you can handle because those are the last ones you're getting until I miss a period!"

"As if I would complain about it!"

"I was teasing, and you know it!"

"You've been taking your vitamins, iron, and folic acid?"

"Every day! I mark it off on the calendar to be sure. That's what the little orange dots mean. I'm going to follow what Doctor Forsberg said."

"Did you ask about exercise?"

"Yes. Until the sixth month, there aren't any real limits, so long as I don't do anything that could cause me to be hit in the stomach. After that, I have to be careful not to do things that increase my risk of falling or which overexert the muscles in my abdomen. And in the ninth month, nothing more strenuous than walking. And no heavy lifting once I'm pregnant."

"I'll defer to Doctor Forsberg because this is not my area of expertise, nor will it be!"

"You are an expert at the process of making babies!"

"No, I'm an expert at sex! Making babies is something I've never done!"

"I said the process!" Elizaveta protested. "You're being literalist again!"

"Only when it's funny!" I grinned. "Have you thought more about my OB/GYN rotation?"

"Yes, and as I said last night, it's necessary for you to go to Cincinnati so you don't have to do something evil. It really comes down to having our baby in June or July, so you're here on your surgery rotation."

"All we can do is wait to see what happens, as neither of us has any direct knowledge of our fertility."

Which wasn't technically true, as when I'd donated the sperm for a possible future child with Clarissa, they'd noted I had good 'sperm motility', which was important, but not the only factor. I'd learned that twenty percent of couples had difficulty conceiving even if they were both healthy, the man was producing sufficient sperm, and the woman was ovulating. It came down to body chemistry, really, and most of those couples did conceive within two years. The remainder had to resort to some kind of medical intervention, which had varying levels of success.

"It would be horrible to have a problem like that!"

"We're both young and healthy, and you aren't under any stress, so I expect we'll be OK. That said, you can't become upset if you don't get pregnant that first month. Or the second, for that matter."

"Doctor Forsberg said that between sixty and seventy percent of couples conceive in the first year, and eighty percent by the second year. She does have one couple who have four kids, and each one was conceived the first month after they started trying!"

"Wow! Now that's something to aim for!"