Chapter 46: Patient Choice

February 18, 1987, McKinley, Ohio

"Last night, I realized I'm starting to feel like a doctor," I said to Clarissa when we met at the medical school on Wednesday morning.

"Because you're allowed to draw blood?"

"As odd as that sounds, yes, because I'm actually allowed to do something."

"I wish I had Trina instead of Heather; Trina seems much more interested in teaching than Heather."

"Unfortunately, the guidelines for Preceptorships state 'observation', and with the exception of Trina allowing me to draw blood, that's how all of them have basically worked, except pathology."

"Except for your extra teaching during your cardiology Preceptorship."

"And Doctor Gibbs allowing me to listen to Bobby's heart and lungs, though we've done that in class, along with drawing blood."

"Somebody is smiling on you, Petrovich. Well, minus being assigned to Frank Bush for your Pedes rotation."

"And minus Melissa Bush. And Lee. And Sandy. And my parents' divorce. And Angie. And the accusations surrounding Liz. And Jocelyn's accident. And Deacon Vasily. And Bishop ARKADY."

"OK! OK! I get it! But you have to admit that nearly every doctor with whom you interact has taken you under their wing and given you special treatment."

"You've had some similar experiences."

"But nobody has actually taken me under their wing the way several doctors have with you."

"Do you feel it's unfair?" I asked.

"Maybe a bit, but I'm not sure how you could fix it. During Residency, our Attending decides what we're ready to do, and I'd hate to have some kind of mandatory participation rules because that would put patients at risk. I guess I'm just jealous of you."

"Now there's a first!"

"You're jealous of me?" Clarissa asked.

"Besides the redhead with freckles everywhere?" I asked with a silly grin.

Clarissa laughed, "Yes, besides that!"

"That your life was always so calm, with the exception of that confrontation with your parents. That you could relax so easily. That you had the courage and foresight to ask me to study with you."

"Don't get all sappy on me, Petrovich. It's not you!"

"But it is, Lissa. It always has been. I let 'Doctor Mike' get in the way of the caring, nurturing side until you basically broke me out of that mould. Now, I can turn it off when necessary, but it is me."

Clarissa nodded, "You're right; you have changed. I just wish ... no, never mind, I can't say that."

"I know how you feel, Lissa, but it was a bridge too far. You know how much I love you."

"I do. And you know how much I love you, too."

"I do."

We entered the building and went to the cafeteria to get our coffee. As we waited in the short line, I contemplated the conversation with Clarissa and wondered briefly how that alternate timeline would have played out. I certainly wouldn't have become a deacon, nor would I have married Elizaveta, and that reality was so different from the one I was experiencing that I couldn't relate to it in any way. Of course, being me, I immediately thought of Clarissa's half-jesting about finding a bisexual girl to include in our relationship. Tessa certainly qualified from everything Clarissa had hinted.

I nearly laughed out loud as I mentally heard my mom say 'Deacon Pig'. She had a point, but there was nothing in Heaven, on earth, or under the earth that would cause me to leave Elizaveta. Any sane man would realize I was living my fantasy. Of course, there were legions of people who would testify that I was anything but 'sane', and I'd be hard-pressed to dispute that testimony.

I got my coffee, paid for it, then joined the rest of my study group for the walk to the lecture hall.

February 19, 1987, McKinley, Ohio

"How are you feeling, Elizaveta?" Doctor Forsberg asked after she greeted us on Thursday night.

"Good! No morning sickness, and I feel great."

"That's good. Any concerns of any kind?"

"Not at this point."

"And you're taking your prenatal vitamins and folic acid?"

"Yes."

"Then we'll dispense with the medical talk!"

Elizaveta laughed, "Yeah, right! Two doctors and a medical student aren't going to discuss medicine? That'll be the day!"

"She has a point," Doctor Smith interjected. "And it starts with me asking how Mike is doing with his Preceptorships and his studies."

"I'm still ranked first in my class, though only by a slight margin over my friend Clarissa. The Preceptorships have been good, and as strange as it sounds, I enjoyed pathology because we were able to actually do things. My current Preceptorship is at the Free Clinic, and the nurse-practitioner to whom I'm assigned is allowing me to do blood draws."

"That will get old VERY fast," Doctor Smith said with a knowing smile. "But I understand how exciting it is to do even the most minor procedures. I know you're champing at the bit, but remember, in your Clerkships, you'll do very little. You'll do more in your Sub-Internships, but really, until about halfway through your first year in Residency, you won't do much, though, in the ER, you'll have more opportunities than you would in surgery."

"Doctor Roth promised actual participation in surgery, and I took him at his word. After all, if he wants me to consider a surgical specialty, he can't renege."

"Don't count on much more than holding a retractor or suction or possibly putting in a few sutures."

"Even those things would be far better than sitting or standing in a corner!"

"Point taken. Of course, you could just go my route — one Internship year, one year of Residency in internal medicine, and then I hung out my own shingle together with a classmate."

"It really only takes that long to be a doctor?" Elizaveta asked.

"For a GP or Family Practitioner? Yes. Our job is mostly managing and coördinating care for our patients, which we accomplish by doing annual physicals, administering inoculations, and treating minor illnesses. It's truly a role for a 'people person' because it's all about a long-term relationship with the patient, historically, from cradle to grave, or, if a child sees a pediatrician as their regular doctor, from the teen years on. In a sense, you could call my job one of encouraging healthy living and acting as an early warning device."

"Kitten, do you remember the patient I told you about with the brain tumor?"

"Yes."

"If I had to list a cause of death, I'd list 'no personal physician' because, in the end, that's the source of the lengthy delay in diagnosing her."

"Mike makes a very good point," Doctor Smith said. "Had she been my patient, I would have been aware of all of her hospital visits, and it's very likely we'd have been able to intervene sooner. That doesn't mean she'd have been cured, but early detection is the key for all health concerns."

"Do you make house calls?"

"I've been known to do that on occasion, but it's exceedingly rare. For Evgeni Petrov, that was a common thing."

"Including for delivering babies!" Doctor Forsberg added. "I prefer having an operating room nearby for those times when things don't go as planned."

"How often does that happen?" Elizaveta asked.

"One answer is not very often; another is far too often because it's tragic to lose a mother or baby, or both, in what should have been a routine delivery. We're very good at managing labor and delivery, but nature is not always on our side. That said, most things we can manage, even if they don't go exactly as planned."

"Think about Sasha," I said. "She had a spike in blood pressure, but they managed it, and she and her baby are healthy. But please don't worry about it because you're perfectly healthy."

"Which you know from thorough exams!" Elizaveta giggled.

"And that's how you got into this situation!" Doctor Smith said, causing everyone to laugh.

"Just out of curiosity..." I said.

"Usually, if mom and baby are healthy, through the sixth month. After that, it can become uncomfortable."

"Are orgasms a problem after that point?" I asked with a smirk.

"Mike!" Elizaveta protested.

"I was thinking of you, Kitten! I know how much you like them!"

"Miiiike!" she protested, her voice bordering on a whine.

Doctors Smith and Forsberg both laughed.

"There are no known medical contraindications to orgasms right up to delivery," Doctor Forsberg said with a sly smile. "Well, for the woman. SHE might not be in the mood to provide them!"

I couldn't help but laugh, though Elizaveta was giving me a 'Husband!' look. A timer rang in the kitchen, and Doctor Forsberg and Doctor Smith went to bring dinner to the dining room table. We all sat down and began eating.

"How is school going, Elizaveta?" Doctor Forsberg asked.

"Physics and calculus are both challenging, but I'm making all A's."

"Is anyone giving you any grief?"

"No. I got some last year, but when I didn't have a baby less than nine months after marrying, it proved the girls who said I had to get married to be liars."

"Gossip is cruel, and teenage gossip is particularly cruel. Are you and Mike going to your Prom?"

"Mike can't dance while wearing his cassock, and we don't think it would be a good idea to ask for permission. And that would also mean Code Blue couldn't play. Besides, we've already done the usual after-Prom activity!"

Both doctors laughed, and I just smiled.

"Most girls want to go to Prom," Doctor Forsberg replied.

"Most girls aren't married before Prom!" Elizaveta exclaimed. "I was!"

I thought back to my plans for my Prom and was thankful that I'd dodged that bullet, though only because April had changed her mind. Had she not, she would have assumed that having sex meant we would eventually marry, and the situation would have quickly become even uglier than it had been. And once again, I was sure that my life was better than any alternate reality I might consider.

February 20, 1987, McKinley, Ohio

"Mike, Father Nicholas called a few minutes ago. He asked that you call him."

"Did he say what it was about?"

"No."

That meant it most likely wasn't about someone being suddenly taken ill, or worse, as Father would have shared that with Elizaveta. I put my bag in the small bedroom, which Elizaveta was slowly converting to a nursery, though we'd agreed to wait until May to buy a crib. She intended to use a bassinet in our room for the first few months, and I'd elected to allow her to make that decision, as I truly had no clue about caring for an infant. Sure, I knew they needed to be fed, bathed, and have their diapers changed, but the limit of my experience with babies was holding April's daughter, Chastity, and that wasn't much. I picked up the extension and dialed Father Nicholas' house.

"Hi, Father, it's Deacon Michael."

"Thanks for calling back. Would you be able to lead Vespers on Wednesday, if it's necessary?"

"Yes, of course. What happened?"

"My mother-in-law is ill, and we're leaving right after Sunday School to go see her. My father-in-law is an invalid, so Matushka will probably stay, and I'll come back on Wednesday afternoon, if I can. If not, I will be home for the weekend."

"I'll keep both of them in my prayers. I'll see you tomorrow night."

"Thank you, Deacon. God bless."

We said 'goodbye', and I hung up, then went to the kitchen to let Elizaveta know. It wouldn't change our plans at all, as I normally served Vespers with Father Nicholas. I'd just need to sing a few extra prayers, though with some slight modifications to the benedictions. Once I'd let her know, I went to the bedroom and changed into a clean cassock, and then Elizaveta and I headed to the Chinese restaurant to join our friends for dinner.

"What do you think about seeing Light of Day?" Fran asked. "It stars Michael J. Fox and Joan Jett and is about a local rock band in Cleveland trying to make it big."

"So, Code Blue, then?" Dona asked.

"We have NO delusions of making it big," José declared. "We're a cover band that is mostly playing because we like to play, not because any of us are driven to be rock stars!"

"José is right," I agreed. "And there will be times when I'm not able to play, at least for the next four years. Not to mention, he's graduating and looking for a job. Sticks has one more year, and Kim is going to grad school. All we can do is play things by ear, so to speak."

We enjoyed our meal, then walked to the theatre to see the movie, which was gritty, and I was sure how it was in a 'real' band. Our experience was nothing like theirs, and compared to The Barbusters, Code Blue was a hobby. One thing did resonate, and that was something Patti, played by Joan Jett, had said — 'Music is all that matters. One hour on stage makes up for the other twenty-three'.

I understood that, because there was a certain euphoria which came from performing on stage, and it certainly allowed me to forget everything else that was happening in my life. It had also led to meeting Kimiko and Lara, two women who I felt had helped me to become a better man. For me, being 'lost without my music' would mean being without my collection of albums and CDs, not about not playing in a band.

As was our usual practice, we went for ice cream, and then Elizaveta and I headed home to fool around.

February 24, 1987, McKinley, Ohio

"Does this happen very often?" I asked when I sat down in the small office Trina used.

"No. It's rare that we have an empty waiting room and no patients. Now you get to see the dark underbelly of medicine — paperwork!"

"They've drilled into us the importance of charts and notes," I replied. "I never saw Doctor Gannon or Doctor Early or Doctor Bracket ever do any real paperwork!"

Trina laughed, "Nor Dixie McCall on Emergency or any of the nurses who worked for Marcus Welby or any other TV doctor!"

"You know, I never asked, but how is the clinic funded?"

"A small amount of money comes from the city, county, and state, and some patients are covered by Medicaid. The rest of the funding comes from patients paying for services, from Moore Memorial Hospital, and from charitable donations, which actually make up the bulk of our funding. The big fight every year is over the provision of abortions, with some politician or group of citizens trying to block our funding."

"Do you get protestors?"

"In January, when they have the big march in DC and usually when the city budget is being discussed. Occasionally, churches have people stationed outside, but we do far more general medical care than we do abortions. You've seen two weeks, and what you've seen is typical. I write more prescriptions for birth control pills than I do referrals to Doctor Turner for abortions."

"Is he the only doctor here?"

"The only full-time doctor. We have others who volunteer time and one or two moonlighters. You could volunteer here once you get your license, which would be after two years of Residency."

"I'd have to speak with my bishop about that."

"Because we perform elective abortions?"

"Yes."

"So does Moore Memorial Hospital."

"Yes, but if I'm on either the emergency medicine or surgical services, I'm not part of a service that is performing abortions. Working here, I would be. I know it sounds like a trivial distinction, but it's important to my church, and to me, to be able to make that distinction."

"That's unfortunate. We can always use empathetic, caring physicians. I'm curious, how does it work as a medical student?"

"I'm not permitted to perform any procedures, and the agreement with the medical school is that I won't observe abortions. As a student, I can make the argument that I'm taking what amounts to a required class. Once I can actually interact with patients, that changes things, which is why I'll be doing my OB/GYN Clerkship at a Roman Catholic hospital."

"That is a pretty fine distinction."

"Yes, and that's my bishop's direction, so I'm bound to follow it."

"Bound?"

"As a deacon, I owe obedience to my bishop in all things spiritual and in some other areas of my life. I voluntarily accepted that when I accepted ordination. But, as Jesus said, 'My yoke is easy, and my burden is light'. My bishop loves me and cares for me and won't place any burden on me which I cannot handle."

"That's a heck of a lot of trust!"

"And the typical teenager or young adult who walks in here doesn't place similar trust in us simply because we're wearing white coats with stethoscopes around our necks?"

"An interesting comparison."

"Well, one of the things we say about Jesus is that he is the Great Physician, and the Eucharist is received for the healing of soul and body. As our priests say in confession, 'Take care, therefore, that having come to the Physician, you not depart unhealed'. And, before you ask, we believe God works through doctors, priests, and bishops, and our clergy would never, ever suggest that anyone should refuse medical treatment. After all, the miracle that comes through the surgeon's hands may be the only one we ever see in our lives. Well, childbirth, but I haven't experienced that as yet. As an observer, obviously."

"Obviously, unless that dumb Billy Crystal movie somehow came true in real life."

"Which one was that?"

"Rabbit Test. It came out the year I graduated from High School. The basic premise is that after losing his virginity during a one-night stand consummated on a pinball machine, Billy Crystal's character turns up pregnant. It's played as a comedy, and I found it funny, but a lot of people didn't like the fact it made fun of religion, sex, and ethnicity."

"So, sort of Airplane?"

"This pre-dated that. It's worth seeing, if you don't mind religious jokes."

I smiled, "Sometimes I think me being a clergyman is the biggest joke I know!"

Trina laughed, "Well, then you might like it."

"I have a copy of Joe's Garage," I said. "And I'm a fan of George Carlin and Steve Martin."

"Interesting."

"Humor is often the best social commentary. And having your own ox gored, and enjoying it, is a sign that you're on the right track. Self-deprecating humor is only possible if you are confident in your beliefs and abilities."

"You are the strangest religious person I've ever met."

"Have you met many Orthodox Christians?"

"I can't say that I have."

I smiled, "That might explain it. Orthodox Christianity is a very different take from Roman Catholic and Protestant Christianity, and incorporates many beliefs and practices which are associated with Eastern Religions, especially Buddhism."

"Trina?" the nurse said from the doorway. "You have a patient."

"What's the complaint?"

"From the symptoms? I'd say syph."

"Thanks. Which room?"

"I'll bring him to Exam 1."

"Thanks.

"What would be the symptoms?" Trina asked me.

"A lesion on his penis," I replied. "That's the primary symptom. If he's in secondary, then fever, chills, general skin rash, especially on the palms and soles of the feet. There are other symptoms, but those are the most common."

"Detection?"

"A blood test, unless you happen to have equipment that Moore Memorial Hospital doesn't have."

"No dark-field microscopy equipment here. We'd have to send him to Columbus or Cincinnati. The blood test is sufficient."

"Treatment?" she asked.

"One dose of penicillin if it's primary. After that, it depends on the spread of the infection whether IV antibiotics are needed. I believe the protocol is to give him the injection so long as he's not allergic to penicillin. No sex until the lesion is fully cleared."

"Correct. And then the usual contact tracing and follow-up. Adverse reactions?"

I thought for a moment and then remembered the potential side effects of benzathine benzylpenicillin.

"He could have a Jarisch-Herxheimer reaction, and it manifests between one to three hours after injection. Symptoms would include fever, chills, hypotension, tachycardia, and hyperventilation. Most commonly, a general rash that is caused by the release of toxins into the bloodstream when the bacteria die."