Chapter 47: Nice Soapbox Speech!

February 25, 1987, McKinley, Ohio

"Irina spoke to me while Father Nicholas was hearing your confession," Elizaveta said after we got into my Mustang after Vespers on Wednesday night.

"All I can say to that is 'good', and we'll have to leave it at that."

"Even though she told me what happened?"

"Yes. In this case, I could probably discuss it with you, but I have to be very careful."

"I think you're being a bit too careful," Elizaveta said firmly. "I know Irina came to the clinic to get birth control pills and that you advised her to speak with me. And I heard that directly from her. You aren't breaking any rules, and this is certainly a pastoral issue!"

"And I'm not the pastor," I protested.

"You know what I meant; please stop being pedantic and obtuse!"

"Sorry," I said. "But it is something about which I have to be very, very careful."

"I understand, but in this case, Irina followed your advice and spoke to me."

"And what did you tell her?"

"That sex is awesome, and she should have as much as possible!"

"Oh, you did NOT," I chuckled.

"OK, maybe I thought that!"

"Now that I believe! So what did you actually say?"

"I mostly listened, then gently reminded her of the teachings of the Church on sex outside of marriage. Without going into details, she was invited to Prom by a Senior."

"Now that sounds familiar!"

"Except I'm pretty sure she hasn't agreed; she's just trying to be prepared."

"The thing to discuss with her is whether she feels compelled to do it or it's something she actually wants to do."

"Doesn't getting birth control pills signify consent?"

"Does it? It could be that she's resigned to it happening and wants to make sure she doesn't get pregnant."

"I hadn't thought about that. You think that's possible?"

"I think April was resigned to it happening, and only because I didn't push her to go through with it once she said she didn't want to, we didn't."

"You think she would have, if you had pressured her?"

"I think, based on what happened afterwards, that had I threatened to break up with her, she would have, and that would have turned into a nightmare when I insisted she start coming to church with me."

"Which is the reason you eventually broke up, right?"

"Yes. And once I broke up with her, she offered to 'let' me."

Elizaveta laughed, "Let you? As if it's not the most fun you can have with your clothes off!"

"I hope you didn't say that to Irina!"

"No, of course not! But I will have another chat with her to make sure she's not being pressured."

"I think that's a great idea."

"You know what else is a great idea?"

"What?" I asked, knowing the answer.

"Seeing how much fun we can have with our clothes off!"

I reflexively pushed the accelerator closer to the floorboard.

March 3, 1987, McKinley, Ohio

The four hours on Tuesday afternoons were the highlight of my week because, for those four hours, I was actually practicing medicine, at least insofar as I was allowed. And it was getting better.

"I want you to take the history for this next patient," Trina said as we headed to Exam 1.

"That's permitted?" I asked warily.

"So long as you don't touch the patient, except for a blood draw, there's no rule against it."

We knocked and waited, then went into the exam room.

"Hi, Will, I'm Trina, a Nurse-Practitioner, and this is Mike, a medical student who I'm training. Mike?"

"Hi, Will. What caused you to come to see us today?"

"I stepped on a nail in the lumber yard, and it went through my work boot. My boss sent me here saying I need a tetanus shot."

"Do you know when you had your last tetanus injection?" I asked.

"No. I had all my shots when I was little, according to my mom."

"How old are you?"

"Nineteen."

"OK. Nurse Carlslyle is going to examine your foot, and I'll ask you a few more questions. Would you take off your boot and sock?"

He did, and Trina had him turn and lie back so she could more easily look at his foot. She went to the sink to wash her hands and put on gloves.

"Do you have a regular physician?" I asked.

"Doctor Smith."

"John Smith?"

"Yes."

I asked the standard questions about his last visit and his general health while Trina evaluated his foot.

"A puncture wound which won't require stitches," she said. "I'll clean the wound, dress it, and you'll need a tetanus shot. You'll need to change the dressing regularly, and walking will be uncomfortable for a few days."

"Can I work?"

"Yes, though I'd suggest taking two days off and walking as little as possible, if you can do that."

"I'm hourly and need to work," he said. "I got no sick time."

Trina nodded and then cleaned and dressed the wound, which was in the ball of Will's foot. When she finished, she took his temperature, pulse, and blood pressure, then listened to his heart and lungs. Satisfied, she had me retrieve a tetanus shot kit from storage, and she administered it.

"If you see any pus or the pain gets worse, or your foot swells, come right back," she said. "Your arm may be a bit stiff or hurt from the tetanus shot, but that's normal, and it'll go away in a day or two. Do you have any questions?"

"Nah," he said, shaking his head.

"Then you can put your sock and boot on. Just be careful with the dressing. Please see the receptionist on your way out."

"Thanks," he said.

Trina removed her gloves, and we left the exam room.

"Comments?" she asked once we were in her office.

"My first observation isn't medical, but political — the idea that an injured guy has to go right back to work, when he got hurt on the job, bugs me."

"Workman's Comp is pretty good about paying medical bills, and they'll cover his treatment here today, but sick time is up to individual employers, along with short-term disability. Most hourly employees don't have much in the way of benefits, and many don't have health insurance."

"According to what we learned," I replied, "employer-based health insurance is a product of wage controls enacted during World War II. That was because the government decided that benefits such as sick leave and health insurance didn't count as wages, which were heavily controlled along with prices. After the war, President Truman proposed a voluntary public health insurance program, with premiums paid by individuals, but the AMA denounced it as 'socialism'. Because the political fight would have been bruising, unions decided to bargain for health insurance, and, well, here we are."

"What's your take?" Trina asked.

"In a sense, we have a partially 'socialist' system with Medicare, Medicaid, and federal funding of Residency. My problem, I guess, is that even today, the arguments are about the provision of health insurance as opposed to the provision of health care. I really don't care who pays the bills in the end; I care about patient outcomes. The problem, as always, is that no matter who pays or who administers the system, there will always be insufficient resources. In the end, something has to give. I prefer to stay out of politics and care for patients."

"What do you think of the European or Canadian systems?"

"I don't know too much about them other than they are tax-funded. I think I might have preferred the European medical training system, which requires only six years of study rather than eight. That said, I enjoyed the additional electives at Taft, and I think they make me a more well-rounded person. Like everything in life, there are trade-offs. I don't know enough to decide which system is better, and, honestly, the only thing I personally care about is providing the best possible care to the maximum number of patients."

"Which is dictated in large part by the resources available, or, quite often in our current system, whether or not a patient has insurance."

"Oh, I know. And I think the AMA was probably wrong to describe what amounts to a government-administered, voluntary plan as 'socialism', but I'm not sure I want the federal government in control of healthcare."

"You're a Republican?" she asked.

"I'd call myself an independent, though my family would call us 'Reagan Democrats'. But as I said, I avoid politics as much as I can. I vote, but otherwise, I focus on church, friends, family, and school."

"Interesting order."

"I wasn't listing them in priority order," I replied. "You know that my studies occupy most of my time and have to be a priority."

"I'm curious — what's your take on nurse-practitioners?"

I smiled, "The same as on midwives. Anything that improves patient care and improves the outcome of that care is a good thing. I have no ox being gored by you being licensed to do exams, give injections, suture, or write prescriptions. I have no problem with midwives delivering babies. Neither of those things diminishes my future role as a doctor."

"As I said the other day, very enlightened."

"Yes, you did, and to counter that, I'll say I am driven by two very specific goals — to act with Christian love and to provide the best possible medical care to every patient. The rest is, if you'll pardon the expression, stupid politics which interferes with both of those goals. I mean, honestly, how does you doing what you're doing hurt me as a future doctor in any way? I say it helps."

"Yes, but you aren't an old male doctor jealously guarding his privileges."

"To the detriment of patient care with an attendant increase in costs. That's completely ignorant and abhorrent behavior from someone who took an oath to serve the community."

"Nice soapbox speech," Trina smirked.

"My other one is about equality and acting out of Christian love. It's basically the valedictory speech I gave at Taft a couple of years ago. See the pattern?"

Trina nodded, "Both of those are about furthering the two goals. All I can say is, gird yourself for battles royal with other doctors who disagree with you."

"My friends and I are marshaling our forces, but we have to be careful about what we do or say until we're admitted to the club."

"And therein lies the true source of the problem because by the time you're admitted to what I would have called a 'fraternity' in the 70s due to male dominance, you'll be co-opted by the system."

I shook my head, "Not happening, at least not with Clarissa and me. We're going to do our Residencies together and practice together in the same hospital. With her supporting me, and vice versa, we'll get through it without succumbing to it."

"Trina?" the nurse said from the door. "Your 2:00pm is here. She's in Exam 3."

"Thanks, Nadia," Trina replied.

"Birth control?" I asked.

"Yes."

I chuckled, "Proms are in about six weeks."

Trina laughed, "We do see a bit of a surge in February and early March, which I never thought about."

"My band plays Prom gigs, among other things."

"Band?"

"Code Blue," I replied. "We play at Taft, we've played a Summer gig at Milton Lake, and some High School dances."

"I heard you at the lake but had no idea that was you! What do you play?"

"Guitar, and I'm the lead singer. My buddy José plays lead guitar and sings. Kim is our keyboard player and leader, and Sticks is our drummer."

"How do you have time for that?"

"We're a cover band, and we don't take a lot of gigs because we're mostly doing it for fun. It kind of grew out of concerts I did with one of the music professors at Taft."

"How long have you played guitar?"

"About four years, roughly. I also play the balalaika."

"That's the Russian guitar, right?"

"A stringed instrument, yes."

"Do you sing in church?"

I chuckled, "That's ALL we do in church! Everything is sung or chanted, with the exception of the Nicene Creed, which is recited."

"What about readings from the Bible?"

"Chanted. Oh, the homily is spoken, too, but that's not technically part of the Divine Liturgy, and in some churches, is given at the end of the service rather than immediately following the reading of the Gospel."

"Interesting."

"You keep using that word," I chuckled.

"It's neutral because I don't really have an opinion and don't want to get into a debate. Shall we go see our prospective Prom Queen?"

I laughed, "Sure."

The patient was a pretty seventeen-year-old girl named Deb, and Trina took the lead as Deb seemed a bit reluctant to have me in the room but, fortunately, didn't ask that I leave. The exam was typical, as was the conversation about STDs and how to properly handle being on the Pill. As Deb wasn't sexually active, there was no pelvic exam, and with her prescription and the appropriate pamphlets clutched in her hand, Deb left the exam room.

"That one is DYING to have sex," Trina said once we were back in her office.

"Once she became comfortable with me in the room, that was pretty obvious. I caught the hints that she and her boyfriend had come very close to taking an enormous gamble. And it was very clear when you made the point about it taking a month for the pills to be effective three times, AND mentioned condoms twice."

Trina nodded, "If she's not careful, we'll see her again in a month or two. I take it you don't buy into the myth that girls are not interested in sex?"

"Given my experience, I'd say the myth is exactly that, a myth. And one of the sources is the absolute refusal, until very recently, of the medical profession to even acknowledge women's sexuality."

"It's a feedback loop — poorly trained male doctors, taught in the 50s and 60s, combined with societal objections to women being sexually liberated. The only way to break it is to have more women in the medical field and to have open, frank discussion about sex and sexuality, both as a profession and in society."

"Good luck with THAT," I said, shaking my head.

"I know. It's one of the things most of the anti-abortion protestors push — limited sex education and absolutely no discussion of female sexuality in a positive light."

"I've seen it," I replied. "But I've tended to avoid fundamentalist evangelicals because we do not see eye to eye on just about everything."

"Voting for Reagan?"

I laughed, "My family voted against Carter and against Mondale, along with tens of millions of others who don't necessarily agree with everything Reagan says or does. Some men were just not meant to be President, and sometimes, you have to pick the lesser of two evils. But I really don't want to discuss politics."

"OK. I'll drop it."

"Thanks."

"When is your next concert?"

"The Hayes County High Prom. And we're playing the Goshen High Prom."

"That's near Cincinnati, right?"

"Yes."

"What do you play?"

"Mostly 70s and 80s covers, with some older stuff. And we do a Blues Brothers schtick to open. Our emcee made a silly joke when we showed up to play a class reunion gig about us being the 'Good Old Blues Brothers Boys Band', and we decided to run with it, complete with fedoras and a harmonica."

"No music of your own?"

"None of us is a composer or lyricist. We just play."

"With medical school, church, and your band, how do you find time for your wife?"

"We have date nights, which are just us, and we run together. We also eat breakfast and dinner together, with the exception of Monday morning, when I have breakfast with my study group. Elizaveta and I discussed all of this before we married. I had the discussion about church and medical school with several women, and Elizaveta was the first one who felt she could handle it and be happy."

"Why were you thinking about marriage when you were so young?"

"I think I mentioned that we ordain married men, but ordained men can't marry. When our deacon died, the bishop asked me to consider ordination, which I did. That meant marrying as soon as I reasonably could."

"I have to upgrade from interesting to 'crazy'."

"I don't disagree, but in the end, everything has worked out very well."

"What if, God forbid, something happens to your wife?"

"Then I would either be required to remain chaste for the rest of my life or be laicized."

"That seems pretty extreme."

"Those are the rules, and I accepted ordination knowing those rules. But my wife is young and healthy, and it's not something I worry about. And trust me, it beats the situation the Romans have where they have to be chaste to be clergy at all!"

"Are your bishops married?"

"No. Historically, some were, but the modern practice, by which I mean the past eight centuries or more, is to only elevate monks or celibate priests to the episcopate. And that is why I, and every other married clergyman, pray for our wives to have long, healthy lives! Being elected bishop would be my worst nightmare!"

"Elected?"

"Yes, by representatives of the parishes in the diocese. That's the norm for Orthodoxy. After all, the faith is the bishop together with his people, and both are necessary."

"Trina?" Nurse Nadia said from the door. "Walk-in sixty-year-old male with what I'd say is a severe case of influenza. Exam 2."

We got up and went to the exam room, following the usual protocols.

"Hi, Mr. Benson," Trina said, reading his name from the chart.

"Bad case of the flu, I think," he replied. "Coughing, runny nose, and after lunch, I felt like I couldn't catch my breath."

"How long have you been sick?"

"Over a week; it started Monday of last week."

"Before I do anything else," Trina said. "I want to take your temperature and listen to your chest."

Mr. Benson agreed, and she listened and frowned.

"Mike, ask Doctor Turner to come in, please."

"What's wrong, Miss?" Mr. Benson asked.

"I'm afraid you might have pneumonia. You have a fever, and I hear bronchial breathing and crackles, which indicate inflamed lung tissues and fluid in your lungs. I need Doctor Turner to confirm."