Chapter 55: On Your Way

June 12, 1987, McKinley, Ohio

"Think back over every interaction," Clarissa suggested as we drank coffee in the lounge on Friday morning, waiting to start pre-op rounds. "Have you seen anything that would indicate why Doctor Roth would feel the way he does about Hope?"

"I've wracked my brain, and the only thing I can come up with is that her father, grandfather, and uncle are all orthopedic surgeons. She called it the 'family business'."

"Entitlement," Clarissa said, shaking her head. "I bet you anything that's it, and she's playing the 'girl' card because, in her mind, you're an interloper into her family business. Where did the others go to school?"

"Uncle and grandfather here; dad at Emory. She said she decided to return to the 'family roots'."

"I'll bet you anything you care to wager she couldn't get into Emory, even as a legacy. Then, she starts her Fourth Year expecting to get more procedures, and for you to do all the scut."

"Logical," I said, "but speculative."

"It fits the facts, Petrovich. And it makes sense because it allows her to explain away a mediocre grade."

"Well, whatever she thinks, nobody is entitled to be a doctor; not you, not me, nobody. And being a surgeon means being the best of the best. Residency Matches in surgery are the most selective and even then, you don't necessarily get to choose your surgical specialty from all possible options. Not to minimize emergency medicine or internal medicine, but a Match in either of those is easier, and we're basically guaranteed to be what we want to be if we Match."

"I don't disagree with you," Clarissa said, "but I'd bet anything you care to wager I'm right."

"What do I do?"

"Nothing, actually. It's Doctor Roth who's the target. Knocking you down directly doesn't help Hope's case; she has to knock down the guy who's going to write her review, or use the threat of doing so to get more procedures. Because you're a Clerk, fewer procedures won't hurt you, in terms of your grade or for the Match."

"No, but it will annoy the heck out of me!"

"Along with a host of other things! But now, it's time for rounds!"

Doctor Roth had two hernia repairs scheduled for the morning. Both were simple enough that they could easily be completed before lunch. Doctor Lindsay did the repairs, while Doctor Taylor closed, and I assisted with suction on both procedures. Hope was fuming by the time we escorted the second patient to Recovery.

"Fucking boys club," she muttered.

"Did you somehow miss Doctor Lindsay doing both procedures today?" Doctor Taylor asked. "I don't know about you, but I learned the difference between boys and girls long before I graduated med school."

"Then explain why a Third Year gets procedures and I don't!"

"You mean a Third Year who is at the top of not just his class, but the entire medical school? Who had perfect scores in his Preceptorships? Who wants to Match here? And who Doctor Roth personally invited onto his service for THOSE reasons? Trust me, it's not gonads that make the difference."

"What are you saying?" Hope asked, with her hands on her hips.

"That it's about merit and qualifications, not gender. It's also about attitude. You think drawing blood and chasing labs is beneath you. Mike does it, and he doesn't just put on a happy face, he does it happily. I'd drop the BS sexism complaint, because it's not going to fly."

"Just another guy covering for a guy."

"Go speak to Doctor Lindsay," Doctor Taylor said firmly. "Mike can handle Recovery."

"You're dismissing me?"

"I'm sending you to your Senior Resident. Talk to her about your complaint. We have work to do."

Hope stormed out of Recovery and I finally felt I could say something.

"I'm not sure it was wise to provoke her," I said.

"That's my job," Doctor Taylor said with a knowing smile. "PGY1s are supposed to mentor medical students in basic doctoring. Go ahead and assess Mr. Livermore, please."

I checked the monitor, then did my own count of pulse and breathing, and listened to Mr. Livermore's chest.

"No appreciable abnormalities," I said. "Pulse, blood pressure, heart, and lungs are all typical of a post-operative patient who was under general anesthesia."

"Make your notations on the chart and wait with Mr. Livermore until he's conscious."

"Will do."

He left, and I waited for Mr. Livermore to regain consciousness, which he did about fifteen minutes later.

"How are you feeling, Mr. Livermore?" I asked.

"Like somebody cut me open," he replied.

"How bad is the pain, on a scale of one to ten?" I asked.

"Three, maybe, four."

"Doctor Roth wrote an order for the nurse to give you Tylenol 3, which is a combination of codeine and acetaminophen; acetaminophen is the same drug that's in regular Tylenol. That'll take the edge off. You'll get that once you're in your room. Are you feeling light-headed or nauseated?"

"No. My mouth is kind of dry."

"That's normal from the oxygen. Let me give you some water. Just take a few small sips."

I held the bottle so he could take his sips via a flexible straw, then put it back on the cart.

"I'm going to call for the orderlies to move you to your room, and Doctor Roth will see you after lunch."

"Thanks ... what do I call you?"

"Mike will do," I said. "I'm officially a surgical Clerk, but medical students are called by their first names."

"Clerk? Like in a store?"

"The same word, yes. In this context, it basically means the low man in the pecking order. Next would be Sub-Interns, such as Hope, who's a Fourth Year medical student. Then comes Residency, and Doctor Taylor is a PGY1 Resident — Post-Graduate Year one — which is often called an Intern. Doctor Lindsay is a PGY3 Resident — Post-Graduate Year three — and is the Senior Resident on the team. Doctor Roth is an Attending Surgeon, which means he has overall responsibility for the team."

"How long before you're officially a doctor?"

"Just under two years."

"You seem to know your stuff."

"It's almost all book learning, classroom lectures, and lab work. Students aren't allowed to touch patients, except to draw blood, before they finish two years of instruction. Is there anything I can explain to you or any questions you might have?"

"Not that I can think of, though a few more sips of water would be nice."

I helped him with the water, then called for an orderly to take him to his room, while I went to the lounge to write my notes for the morning, and add the procedures to my list. We had lunch as a team, and Hope gave me evil looks the entire time. I wondered if her complaints would come back to bite Doctor Roth in the butt, and potentially derail his training plan. I hoped Doctor Lindsay's disagreements with Doctor Roth didn't lead her to take Hope's side, despite the evidence that it wasn't about gender. There was really nothing I could do but focus on my tasks and hang on for the ride.

June 13, 1987, McKinley, Ohio

"Are you available on July 4th?" Kim asked when I walked into the music room on Saturday morning. "The city had a band cancel, and they called to ask if we could perform. We'd do two twenty-five-minute sets with ten minutes between."

"I could. Our parish is having a picnic at the lake, so I'll be there. I don't think anyone would object to me playing. And that's a Saturday, so I'm not working at the hospital."

"That's right, you work holidays now."

"I will, at least some of the time, over the next five years or so. Surgeons usually take the major holidays off, and Third Years don't generally get assigned to weekends for surgery, unless their team is on call, because there are usually no scheduled surgeries. I'm not on call that weekend. And every rotation will be somewhat different."

"OK. I spoke to Sticks last night, and he's in. I'll ask José when he arrives."

As if summoned, José walked in just then, and agreed to play on July 4th. We worked out an abbreviated playlist, then ran through the songs before Elizaveta arrived following her piano lesson. I let her know about July 4th, and then we headed to Kroger to do our usual weekly grocery shopping. After shopping, we joined my in-laws for our usual Saturday meal.

"Any chance I could convince you to play golf tomorrow afternoon?" Viktor asked.

"Our friends usually arrive around 4:00pm, so even if we left church right after the Divine Liturgy, I'm not sure we'd finish on time. A Saturday might work better, if we left right after our meal, and were home in time for me to get to church for Vespers. Next Saturday, though, I'm on call, so I can't be out on the course."

"Then let's plan for the 27th. Geno will play with us. How have your rounds been with the doctor?"

"OK, I guess. I'm not breaking 120, but I've improved week to week."

"That's to be expected after a long layoff. If you play every week, you'll steadily improve."

"I won't play this week because I'm on call, as I mentioned. So it'll be two out of every three weeks. And it's only for this Clerkship. I probably won't be able to play in Cincinnati. After that, who can say!"

"Still excited about your surgical assignment?" Geno asked.

"Very," I replied. "I'm hoping my other Clerkships are equally interesting. I'm sure OB/GYN and emergency medicine will be, and those are the next two. It's hard for those not to be exciting. How are you adjusting to managing the electrical and plumbing supply businesses?"

"It's very different from the dealership. Mostly, it's about managing inventory and ensuring we deliver to contractors on time. And managing the staff, of course. A year of this, and then Dad will step back and I'll take over, with Dad advising me, of course."

"I'll have WAY more time for golf and grandkids!" Viktor declared. "Two to start with, and hopefully many more!"

"One at a time," I chuckled. "But we are planning to have another one, at least. Of course, the timing is up to Elizaveta."

"And Anna," Geno confirmed. "Though I suspect it won't be too long."

"Elizaveta suggested two years would be a proper separation, though that would bring our second child just as I begin my Residency."

"Did you get in touch with the doctor in Chicago?" Viktor asked.

"I left a message for him yesterday around noon our time. I didn't really expect to catch him in his office. I'm hoping he's willing to have a call during the evening or on the weekend."

"Dinner is ready," Anna announced from the door to Viktor's study.

We had a nice meal, as we usually did, and after dessert, Elizaveta and I excused ourselves because she wanted to nap before Vespers. We had a good nap, and just as we sat down to have tea, the phone rang.

"Deacon Michael's residence," I said. "Deacon Michael speaking."

"Is this Michael Loucks?" a male voice asked.

"Yes."

"Mike, this is Doctor Al Barton, calling from Chicago."

"Hi, Doctor Barton! Thanks for calling me on your day off."

He laughed, "I'm in my office! Before we get to the reason for your call, I believe you just started your clinical rotations, correct?"

"Yes. I'm on my surgical Clerkship."

"Not emergency medicine?"

"Doctor Roth strongly encouraged me to do surgery first, with an eye to enticing me into being a surgeon."

"And?"

"He suggested I get in touch with you about creating a Residency program for trauma surgery, similar to the one you were proposing in Indianapolis. Speaking of which, Jessica Wilton graduated, right?"

"Yes. She's here in Chicago, and just started a surgical rotation after being in the ER. She called herself the 'Queen of Scut' the other day!"

I laughed, "I'm not surprised by the fact that she followed you to Chicago, nor that she's doing scut. I've been lucky; Doctor Roth believes in giving students opportunities to assist."

"I do as well. What have you done?"

"Suction," I replied. "And held a retractor."

"As a Third Year? That's even beyond what I was able to do at Indianapolis. How much pushback is he receiving?"

"Quite a bit."

"From your request before, I misunderstood Victoria's note that you wanted to speak about Residency. I mistook it for a call about an interview, then remembered you were only in your Third Year, so you're obviously not ready at this point."

"I understand you've actually created a program in Chicago, and I was hoping you would be willing to share the proposal and the other documents which define the Residency."

"Why not just come here for your Residency?" he asked. "I can basically guarantee you a slot, based on your grades and MLE, and what I saw in your interview at Indiana."

"You spoke to Doctor Mertens?"

"Of course. When a medical student calls, I call to check. I did that late yesterday afternoon."

"Then I'm sure she told you that I want to stay in Ohio."

"The same thing you said when you turned down my generous offer in Indianapolis."

"I will point out, respectfully, that you left Indiana University and I wouldn't have been able to study under you had I done that."

"A reasonable defense. Well, I'm not going anywhere now. I have personal reasons for being in Chicago, in addition to being Chief of Emergency Medicine at one of the top trauma centers in the country. Will you do one thing for me?"

"What's that?"

"Promise to interview here. I'll arrange for your friend to interview as well and lean on whoever is necessary to get her a spot."

"I'd feel as if I was wasting both your time and my time," I replied.

"Nonsense. At least give me a chance to make a pitch to you."

"I'll have to discuss it with my wife," I replied.

"You're married?"

"Yes. Immediately after graduation. The Orthodox Churches only ordain married men, and my bishop wanted to ordain me."

"Jessica and her husband attend an Orthodox Church on occasion."

"She's married?"

"Yes. To a guy who started his own software company right out of college with several friends. It's going gangbusters. He's actually from Southern Ohio."

"Where?"

"Milford."

I laughed, "Please tell me his name isn't Steve Adams!"

"OK, you got me!" Doctor Barton laughed. "You did your own research!"

"Actually not," I chuckled. "I've met a few ex-girlfriends of his, and even dated one of them. I've never met him, but I know quite a bit about him, including him being a chess player and spending time in Sweden as an exchange student. In fact, I met one of his Swedish ex-girlfriends in Amsterdam while my wife and I were on our honeymoon."

"I'll have to mention that to Jessica. Anyway, back to your situation; do you have your emergency medicine rotation next?"

"No, OB/GYN, because I needed a visiting student spot at a Catholic hospital."

"Abortion, right?"

"Yes. As a clergyman, I can't participate in an elective abortion, and I'm morally opposed to elective abortion. And before you say anything, I also do not think it should be illegal."

"I'm sure you've heard it before, but as physicians, our role is to treat the patient, whatever their condition, and provide the necessary procedures."

"I understand. There's a reason why I'm not going to be an OB/GYN. If called upon to assist on an emergency D&C or D&E to resolve a miscarriage, I'll do it. And that wouldn't create a conflict, as saving a woman's life is an acceptable justification. But it has to be literally to save her life, not the way the abortion-rights activists define it."

"We can have that debate over tea when you're in Chicago. Let me have your address, and I'll send you the materials you requested. And I'll expect to see you in Chicago in about eighteen months for your interview."

I gave him the address, and he repeated it back to me to confirm, and promised to put the documents in the mail on Monday. I thanked him, we said 'goodbye', and then I hung up.

"Ask your wife what?" Elizaveta inquired.

"I think you can guess."

"He wants you to come to Chicago."

"Of course. I agreed I'd interview, though I do think it's a waste of time."

"Then why do it?"

"Because he gave me something I wanted, and I felt it was appropriate for me to give him something he wanted. He'll put on the hard sell, but we both know I have no desire to leave the area. And I would never make a decision like that without your approval."

"And Clarissa's, of course."

I chuckled, "He basically guaranteed a spot for her in Chicago. He remembered that we came as a matched set during medical school interviews."

Elizaveta laughed softly, "I am SO glad she's a lesbian, or I wouldn't have had a chance!"

Truer words were never spoken. Of course, had Angie not had her mental illness, the story would have been very different as well. There was no point in dwelling on the past, and I was very happy with how my life had turned out so far, and with the prospects for the future.

June 13, 1987, McKinley, Ohio

"How does this week work?" Elizaveta asked.

"I work 6:00am to 6:00pm covering the ER and emergency surgeries. Hope has the opposite shift. Doctor Taylor and Doctor Young, the two PGY1s, will be there full time, switching off on thirty-six-hour shifts. Doctor Lindsay and Doctor Roth will be available at the hospital or by pager."

"You mean that the brand new Residents decide if the patient needs surgery?"

"Supervised by the ER Attending," I replied. "It's always up to the Attendings to sign off on any planned procedure."

"What will you do?"

"Be an extra set of hands in the ER and assist in any surgeries. And surgeries don't just come through the ER. They could come from cardiology, or if someone on another service needed unscheduled surgery."

"What happens if all the surgeons are busy?"

"Then it's possible for a Resident to begin, and the Attending moves between ORs, supervising or assisting as appropriate."

"That means you can sleep in tomorrow? No pre-rounds?"

"Correct. I just need to be at the hospital at 5:50am, so I have time to review the trauma board."

"Every day, right?"

"Yes, including Saturday and Sunday. I can be at Vespers, but I'll miss the Divine Liturgy. The next time we're on call, I'll have the overnight shift."

"Ugh!"

"OB/GYN is actually worse," I said. "I'll be on call for two months, because as we discussed, babies come when babies come, and don't follow doctor's schedules."