Chapter 50: Bored to Tears

April 2, 1987, McKinley, Ohio

On Thursday evening, before Elizaveta and I went out for our weekly date, I called Doctor Smith to check on how he preferred me to dress in his office.

"Our dress code is a medical coat, shirt, and tie with black slacks," he said. "I can ask the Medical Director for an exception, if you wish."

"How will that be received?" I asked.

"I have no idea, but he is a stickler for men wearing ties."

"Then it sounds as if I should do that," I replied. "I have a blessing from my bishop to dress however I'm required when I'm working in a medical practice, clinic, or hospital."

"That would attract less attention. I'm not quite sure how Doctor North would respond to you in a cassock meeting patients."

"No problem, Doc," I said. "That's why I called to ask. I'll change before I come to the office. I will wear my ryassa, which is the cloak-like garment you see me wear over my regular cassock when I'm outside, but I'll hang it in the coat closet."

"I read somewhere that your deacons and priests wear special hats."

"Only if granted by the bishop, and it's not the norm for a married deacon in a parish. For me, it would be something akin to a service award. My priest wears one."

"Back to medical topics, how was your evaluation at the Free Clinic?"

"Fives across the board, with check marks in the plus column."

"As I expected. Well, on Tuesday you'll be introduced to the world of annual physicals, generalized complaints, and very little in the way of excitement. That's perfect for me, but students with the mentality for the ER or surgery tend to be bored silly in situations like our practice. Heck, I consider my wife's job too exciting!"

"Well, if more people saw their personal physicians, and followed their instructions, every doctor's life would be less exciting except emergency medicine!"

"True. You'll see a lot of 'in one ear, out the other' with patients. It's frustrating, but it's also part of human nature. Just so you know, we'll float you and Maryam between all eight doctors in the practice so you can see the widest range of patients. We see them from cradle to grave, so to speak. We have two pediatric specialists and a geriatric specialist, but all of us see all patients, and call in the others if we need to. And, of course, we refer to specialists in the medical building and hospital, when necessary."

"Will I be able to take medical histories or draw blood?"

"When you're with me, certainly, but you might only be with me one afternoon. I can't speak for the others, but ask, politely, and mention what you've done before."

"Got it," I replied. "Thanks."

"See you on Tuesday, then."

We said 'goodbye' and I hung up the phone.

"Medical coat and tie?" Elizaveta asked.

"Yes. That's standard for their practice."

"Did he say you could actually do stuff?"

"For him, yes, but he can only speak for himself, because he's not the Medical Director of their practice. But, in eight weeks, I'll start my first clinical rotation, and that time is going to go fast!"

"And in August, we'll have a baby! That's only five months from now!"

"Well, shall we go?"

"Yes."

We walked out to my Mustang so we could drive to meet Milena and Joel for dinner, though they were leaving Abigail with Anicka, because she had a tendency to get fussy in restaurants.

"How is your studying going for your exam?" Elizaveta asked as I pulled out of the driveway.

"I think we're all in very good shape," I replied. "Honestly, I'm surprised at how easy things are now, at least in comparison to last year. They sure weren't kidding about anatomy being the thing that knocked out the largest number of students. Now, if you can pass the MLE, it's simply a matter of not failing any core clinical rotations. That does happen, though you can recover by giving up an elective."

"Have you heard anything more about Melissa Bush?"

"No. According to Mr. Winston, these things take time, and the school's reply isn't due for another two weeks. He still thinks the most that will happen is that I'll have to give a deposition which basically repeats what I said at her hearing at the medical school."

"What can she do?"

"Graduate. She'll have her MD and the right to be called 'doctor', and could work in research or for an insurance company. And then look for some way to get into a Residency program. It's not impossible, but it is unlikely. If I were her, I'd look at underserved places and keep an eye out for ANY openings for Residents. It does happen, and she might be able to convince someone at a place like that to give her a shot."

"Would you?"

"As an outside observer, maybe after I interviewed her. Given what I know about her? No chance."

"Changing topics, I found the bassinet I wanted at the store today. Do you want to see it before I buy it?"

"Do what makes you happy, Kitten. I'm OK with your decorating decisions, and as we discussed, I am basically clueless about babies!"

"But not how to make them!" she giggled. "You taught me!"

"As has been said, a dumb jock and airhead cheerleader can figure it out, so it can't be too difficult!"

"Well, I'm happy you taught me! What does the song say?" she asked, then sang, "Nobody does it better; Makes me feel sad for the rest."

"And do you tell your friends about it?"

"Only that it's the most amazing feeling to make love to my husband! What do you tell your friends?"

"Nothing," I replied. "Though Clarissa constantly teases me about my pussy cat."

Elizaveta laughed, "Because you call me Kitten, right?"

"Exactly. But she does not get any real information, because that's private between you and me."

"None of the girls get any details," Elizaveta said, "though I did have a fairly detailed conversation with Alyssa before she and Mark married."

"As expected. Mark was pretty much up to speed, so to speak."

"I think it's different for the girl, because she's the one being penetrated, and that can be a bit scary to think about."

"True."

"You're thinking about our wedding night?" Elizaveta asked.

"I wasn't thinking about anything specific, just agreeing with you. Not being a woman, I can't really understand what it's like for you."

"It was only the first time," Elizaveta said. "After that, the ONLY thing I wanted was to be penetrated! Repeatedly!"

"And I was very happy to oblige!"

April 5, 1987, McKinley, Ohio

"I verified that we have everything we need for Holy Week," I said to Father Nicholas when I arrived at the church on Sunday morning. "Mark did a good job."

"Then all that's left to do is our liturgical work. The ladies will handle everything else."

"As they usually do! How did your meeting go with the inquirers last night?"

"Quite well. I expect they'll be at liturgy this morning. Starting that Vespers service on campus has yielded excellent results. On a related topic, would you have any time to visit one of the former Evangelical Orthodox Churches to celebrate a liturgy?"

"Possibly, but you know how difficult it is with school. Did you have a specific parish in mind?"

"I think the closest one is in Gary, Indiana."

"Almost to Chicago," I replied. "That's tough."

"I figured. It was simply a request from Bishop DMITRY in Toledo to Bishop JOHN. He passed on the request, knowing it was likely difficult for you. I'm sure there's an OCA deacon in Chicago who can do it."

"Have they finished bringing in all the churches?"

"I think the last ones are today, in Alaska, if I'm not mistaken."

"Sadly, Father Schmemann of blessed memory didn't live to see the fruits of his extensive labor, at least here on earth."

"Your philosophy about the OCA is very similar to his — you're ethnically Russian but want the church to be open to all, of any ethnicity."

"I don't recall Jesus saying anything along the lines of 'I come not to call anyone but Russians to salvation'!"

Father Nicholas laughed, "Tough, given Russia didn't exist in any proper form until around the eighth or ninth century, and it wasn't unified!"

"You know what I meant! The source of the problem in the US is the Russian Revolution. What we need is our own Patriarch of America to unify the jurisdictions. You know my view on that."

"That the Ecumenical Patriarch should decamp from Constantinople and land in Washington, DC or New York City."

"Similar to the Patriarch of Antioch being in Damascus," I replied. "I know it would cause an uproar, and likely a schism, but that's how it has always worked. And after everyone has a hissy fit, things settle down and after a few decades, everyone accepts the new status quo. I mean, it's not like the Turks are going to allow any expansion of the EP's flock. Ever."

"True. But you and I aren't going to solve that problem! Shall we say our entrance prayers?"

"Yes."

Four hours later, after Matins, the Divine Liturgy, and lunch in the parish hall, I met with my Sunday School class. My lesson for the day was about the life of Saint Mary of Egypt. There were lots of smirks and titters when I described her life before her conversion, and some questions about the 'unseen force' which I answered, similar to how I'd answered Clarissa on the same topic during our Senior year at Taft.

"You were very careful," Clarissa said after class. "You said basically the same things you did to me, but with a bit more circumspection about the miracles."

"I have to," I said. "There's a difference between a private conversation with you and public teaching. In public teaching, unless I have specific authorization from the bishop, I can't teach my private opinions. But, if someone comes up to me after class and asks, I can discuss it with them, assuming I trust them to understand the difference between private opinion and church teaching."

"I remember. Anyway, I need to get home to Tessa. She did agree to come to Pascha. She said any church that throws a wild party at 2:00am has to be OK!"

"Whatever it takes to get them in the door," I chuckled.

"See you later at study group!"

She left, and once Elizaveta finished speaking with Irina, she and I headed home.

April 7, 1987, McKinley, Ohio

"Michael Loucks and Maryam Khouri," I said to the receptionist. "We're medical students here for our Preceptorship."

"Doctor North is expecting you. If you go through the door to my left, turn right, and go all the way down the hall, you'll find his office."

"Thanks," I replied.

"Thank you," Maryam added.

We went through the door as directed, and walked to Doctor North's office where I rapped gently on the open door.

"Michael and Maryam, I presume? Come in and sit down, please."

We did as directed, sitting in chairs across from him at his desk.

"Welcome to Medical Practice Associates," he said. "I'm Doctor Roger North, the Medical Director, and one of the two founders of the practice with Doctor Sherry England. Our practice is family medicine, and I think you'll find it a bit different from the Free Clinic, where both of you did your first Preceptorship in general practice.

"Normally, there are six or seven of us here at any given time, and we'll float you between doctors so you see the widest range of patients as well as different styles of interaction. Mike, if you're with a male doctor seeing a female patient, our practice rules require a female nurse to be present. Otherwise, all our patients are informed that medical students are observing, and we've only ever had one patient object over the years. Remember, you're observing, and that's your role. Any questions?"

"I was allowed to do blood draws and take histories at the Free Clinic."

Doctor North nodded, "That's not uncommon at the clinic, but in our practice, the nurses do the blood draws, and we want to keep patients comfortable with our medical staff, so the doctors take the histories. That's part of the relationship."

Which fit what I'd read in the medical journal of how not to train new doctors, but he was the Medical Director, and his decisions were the ones I had to follow. I was disappointed, but there was nothing I could do about it, and, in eight weeks, I'd be on Doctor Roth's surgical service, with a promise that I could actually participate.

"Understood," I said.

"Then let me introduce you to a pair of doctors you'll be observing today. Michael, Doctor Shelly Jacobs; Maryam, Doctor Pete Best."

I almost laughed at the name in common with the original drummer for the Beatles before he was replaced with Ringo Starr. Doctor North stood up and Maryam and I did the same and followed him to meet the doctors. We met Doctor Best first, and after introducing Maryam, Doctor North led me to a small office where I was introduced to Doctor Jacobs.

"Shelly, Michael Loucks; Michael, Doctor Shelly Jacobs."

"Is 'Mike' OK? Or do you prefer Michael?"

"Either one is fine," I replied. "People call me both, depending on relationships and situations."

"I'll leave you to it," Doctor North said, turning and walking away.

"I reviewed your medical school transcripts," she said. "Impressive."

"Thanks."

"Any idea what specialty you're going to try for?"

"Emergency medicine or surgery, though I'm considering splitting the difference with the newly developing 'trauma surgeon' specialty."

She nodded, "Then I think, unfortunately, you're going to find this part of medicine boring."

"As I said to Doctor Smith, primary care means less disease, which, overall, is a good thing."

"I wasn't implying we weren't necessary, just not exciting."

"How long have you been practicing?" I asked.

"I completed my Residency in Internal Medicine three years ago."

Which meant she'd been out of medical school for about six years. Six years after I graduated, I'd likely still be a Resident because of the additional requirements for doing both trauma and general surgery.

"Who's our first patient?" I asked.

"Female grandmother, who is as healthy as anyone I've ever seen. I bet she could out lift me if we went to the gym!"

"Sounds like my grandmothers! Three of them are Russian, and one is Dutch. I wouldn't bet against them in any kind of contest!"

"With four grandmothers, you must be married, unless there were divorces and remarriage."

"I'm married," I replied, holding up my left hand.

"How long?"

"About two years," I replied. "We married right after I graduated from Taft."

"Doctor Jacobs?" A nurse said from the doorway. "Mrs. Carter is in Exam 6."

"Thanks, Wendy. This is Mike, a medical student."

"Hi, Mike!" the pretty blonde nurse exclaimed.

"Hi, Nurse Wendy," I replied.

"Just Wendy is fine."

"Now that introductions are out of the way," Doctor Jacobs said, "let's go see our patient."

We left the office and went down the hall to the exam room, and followed the usual knock, wait, enter protocol.

"Hi, Karen," Doctor Jacobs said. "You know Wendy, of course, and this is Mike, a Second Year medical student who's observing."

"Hi, Wendy! They told me at the reception desk that a medical student was observing. Hi, Mike."

"Hello, Mrs. Carter," I replied.

I moved to a spot near the wall where I could observe and watched Doctor Jacobs perform a very routine annual exam. After Doctor Jacobs completed the exam, she left, and Nurse Wendy drew blood for blood chemistry, a glucose panel, and a lipid panel.

"You're all set, Mrs. Carter," Nurse Wendy said. "Just see reception on the way out."

"Thanks!" Mrs. Carter said.

She left, and I followed Nurse Wendy to a small room where she added the tubes to a group of others, which were waiting to be taken to the lab at the hospital.

"Where did you go to college?" she asked.

"Taft. I'm from West Monroe, which is about forty minutes west of here. Where did you go to nursing school?"

"University of Cincinnati. My family is from Loveland, near Cincinnati."

"I should probably go find Doctor Jacobs," I said.

She nodded, and I walked back to Doctor Jacobs' office, where she was writing her notes on Mrs. Carter's chart. I waited quietly, and a few minutes later, Nurse Wendy announced the next patient, which began the next cycle, something that continued without interruption until 5:00pm. I met Maryam in the reception area, and we left the medical building together.

"You look unhappy, Deacon," Maryam observed when we reached the parking lot.

"I'm just a bit frustrated because the next seven weeks are basically going to be a waste of time. We'll receive good evaluations for simply standing in the corner and being quiet. This isn't teaching. When I turn in my evaluation, I'm going to make that clear."

"You don't think something should be said right away?" she asked.

"I'd hate to have my evaluation affected by challenging Doctor North on how he handles medical students in his practice. And I also realize that it's only because we're in our last Preceptorship that it's a concern. If this were during our First Year, I would understand. I know I'm champing at the bit, but training needs to adapt to the needs of the individual student, not the wishes of the teacher."

"You've had doctors do that several times, which most of us haven't."

"And I suppose that's what's really bothering me. As I said, I'll write it out on my evaluation, and probably refer to that journal article I read. I just need to be careful so as not to get Doctor Smith in any trouble. But I can't just let it go, because, to be honest, it's unlikely I will learn a single thing during this Preceptorship."

"I feel the same way. Even though I was at the Free Clinic way back when we first started, the cases were interesting and I had no experience, so it was all new. Now, as you say, if we can't draw blood or take histories, it feels like wasted time."

"I need to get home," I said. "I'll see you in a few hours."

"See you soon, Deacon."

April 8, 1987, McKinley, Ohio

"The Medical Director overruled Doctor Smith," I said to Clarissa on Wednesday morning. "We can't do anything except quietly watch."