Chapter 13: Doctor’s Orders

September 21, 1987, McKinley, Ohio

“Hi, Mike.”

“Hi, Doctor Smith.”

“What brings you here today?” he asked, using the standard question we asked of any patient who presented.

“Do you want the answer of Mike the med student or the usual vague complaint and incomplete answer patients give?”

Doctor Smith laughed, “I think I’ll take the med student’s answer.”

“Fatigue, irritability, racing thoughts, and occasional tachycardia. All classic signs of stress, and mainly induced by difficulty sleeping unrelated to having to get up with my daughter at night.”

“Medical school is extremely stressful to start with, and when you add in Elizaveta’s tragic death, I’m surprised you’re managing.”

“Barely,” I replied. “Through sheer force of will.”

“You’re still refraining from alcohol, right?”

“Yes.”

“No drugs, prescription or otherwise?”

“No. And that includes nicotine.”

“Good. I think you know I need to ask you about sexual activity, too.”

I nodded, “Not since early last month with Elizaveta, but I have no desire at all.”

“How is your judgment?”

“Doctor Kelly, my Resident, was concerned at first, right after Elizaveta died, but she’s satisfied I’m functioning well enough. But the minute I get away from the hospital, all bets are off.”

“You’re getting help with Rachel, right?”

“Yes, from my friends Lara, Tasha, Serafima, and Alyssa, as well as Doctor Cooper’s daughter in Cincinnati.”

“Any other complaints?”

“None that are medical,” I chuckled.

“Unless they induce stress.”

“Basically it all comes down to my training, losing Elizaveta, and caring for Rachel.”

“Do you do anything at all for stress relief?”

“Not really,” I replied. “I’ll discuss that with Doctor Mercer on Thursday.”

“OK. How’s your diet?”

“Good. I eat regular meals and I’m careful about the amount of sugar and caffeine, though I probably drink a bit too much coffee.”

“Common for medical students and Residents. You’ll need to be careful with that, and I’d suggest decaf for the next week, at least.”

“I should be able to do that as I don’t have to be at the hospital.”

“Exercise?”

“Minimal. I simply haven’t had the time.”

“Once you start in the ER, I want you to do some light cardio for at least twenty minutes three times a week. The hospital has a treadmill and weight machines.”

“I’ll do my best,” I replied.

“I know it’s tough, but make a serious effort. Resuming your martial arts training would be a good choice as well, as that will give you flexibility as well as cardio workouts.”

“Time is the problem there, but I’ll consider it.”

“Then let me do a complete exam and have my nurse draw blood for a complete panel.”

Twenty minutes later, after the exam and the blood draw, we went to Doctor Smith’s office — now the larger medical director’s office — to discuss his proposed treatment.

“I’m inclined to prescribe a mild sedative to help you sleep, though there are a few concerns. First, you can’t work within twelve hours of taking it. Second, you would need someone to care for Rachel, as any drug I give you might cause you to sleep through her crying. I’d also prefer you weren’t alone, though I’m not suggesting someone would have to sleep in the same room with you.”

“Tomorrow is my last day at Good Samaritan, so I could take it tomorrow evening before bed. If I sleep at Doctor Blahnik’s house — a former professor — I won’t be alone and I could have one of my female friends help with Rachel.”

“Then I’ll prescribe Seconal, 100mg, to be taken about thirty minutes before bed. You start your next rotation on October 1st, so I’ll prescribe a week’s worth. You shouldn’t drive or do anything that requires significant hand-eye coordination for twelve hours after you take it, and you should do everything you can to see you aren’t disturbed during the night.”

“I can do that. I’ll fill the prescription at Emmerson’s as soon as I leave here.”

“Let me call it in now, so they’ll have it ready by the time you get there.”

“Thanks.”

Doctor Smith consulted his appointment book.

“Let’s set a follow-up appointment for Wednesday of next week, which is the 30th, at 4:30pm.”

“I’ll be here.”

“Hopefully you’ll be refreshed by then, and we’ll break the cycle of sleeplessness. Make sure your professor is aware of what you’re taking, please.”

“Will do.”

“Lastly, I have instructions from my wife — you’re to come to dinner either Monday or Tuesday of next week.”

“Let’s say Monday,” I replied.

“Monday it is.”

Doctor Smith wrote the prescription on his pad, signed it, handed it to me, then called Emmerson’s so they could have it ready for me when I arrived. We shook hands and I headed to the drug store. The prescription was ready so I paid for it, then made my way back to the car for the drive to the country club.

When I arrived, I parked my car, let the attendant know I was meeting Viktor, then went into the building. Viktor was waiting, and as we had the previous times, we went to the small, private dining room.

“What did Doctor Smith have to say?” Viktor asked.

“Exactly what I expected — that I’m suffering from stress, which is causing insomnia. He prescribed Seconal, which I’ll start taking tomorrow evening, and take for a week. The goal is to get sufficient sleep and see if that will break the cycle. Obviously, I’ll still have the challenge of having to get up with Rachel during the night, but all I can do is see what happens.”

“Who’s going to help you with Rachel?”

“Serafima and Alyssa will alternate,” I replied. “I’ll be staying at Doctor Blahnik’s house, because I need someone around when I take the Seconal, and it really can’t be the same person who’s watching Rachel. I’ll have either Mark or Elias, as well as Doctor Blahnik and possibly Derek there.”

“I wish Yulia was in a frame of mind to help,” Viktor said, “but she was prescribed Valium for what they’re calling an acute anxiety disorder.”

That didn’t surprise me in the least; the only question was whether she’d comply with the treatment plan.

“And she’s taking it as prescribed?”

“As of this morning, yes.”

“Good.”

“Did Doctor Smith say anything else?”

“Other than a bit of tachycardia, everything is fine. The fast heart rate is very likely related to a lack of proper sleep. He’ll run a complete blood panel, but we won’t have the results until Wednesday.”

“He doesn’t suspect anything else, does he?”

“No, but it’s always better to do a full exam, including blood work, even when you’re reasonably certain as to the cause of the symptoms.”

“You’ll let me know if there is anything amiss?”

“Yes, of course. Doctor Smith suggested cardio exercise three times a week. I’m considering karate lessons again, but I’m not sure how that will be received by the Sensei at the dojo. He’s a stickler for dedication, and you know what my schedule will be like for the next four years.”

“I would think if you sit down and explain the situation to him, he’d understand. And if he didn’t, then perhaps you might want to consider a different instructor.”

“I’ll stop in and chat with him on Wednesday.”

The waiter came and took our orders, then brought our salads. We had a nice meal and good conversation, and when we finished, I declined a drink, which I knew Viktor had offered out of politeness, not expecting I’d accept. He decided to join some friends of his in the bar, so I said ‘good night’ and left the club, heading for my car.

“Mike?” a female voice called from behind me when I was only a few feet from my Mustang.

I stopped and turned and saw Erin Edwards hurrying to catch up to me. Of all the people I might run into, she was probably the last I wanted to see, except perhaps Nurse Ellie. But there was no reason not to be polite.

“Hi, Erin,” I said when she came up to me.

“I heard from my dad what happened. I’m so sorry!”

“Thank you,” I replied. “How is school?”

“Fine. I just started my Sophomore year at Ohio State. I made varsity golf.”

“Congratulations.”

“You don’t have your daughter with you?”

“No, she stayed with some friends while I had dinner with my father-in-law.”

“I’d love to see her. And if you need a babysitter, I’m available on the weekends. Or if you just want to talk, I have a friendly ear!”

“Thanks,” I replied. “I’ll keep that in mind.”

She smiled brightly and pulled a piece of paper from her pocket and handed it to me.

“I hope you’ll call!”

“I do need to get going,” I said.

“OK. Good night, Mike.”

“Good night,” I replied, then quickly got into my car.

As I pulled out of the parking spot, Erin waved, I waved back, then headed for Doctor Blahnik’s house. I wasn’t at all surprised that Erin knew about Elizaveta — there had been an article in the newspaper, but given Erin’s dad was the Chairman of the Board for Moore Memorial Hospital, she’d have heard even without the article. The fact that she’d already had her number written on a piece of paper concerned me. I wasn’t going to call her, and I hoped she didn’t seek me out.

When I arrived at Anicka’s house, I thanked Serafima and Elias, then packed up Rachel’s things and got her into her car seat. Once she was settled in, I got into the driver’s seat and we set off for Cincinnati for the final day of my OB/GYN Clerkship.

September 21, 1987, Indian Hill, Ohio

“Can’t sleep?” Annette asked, coming into the study where I was in the rocking chair with Rachel.

“She just finished eating,” I said. “She likes being rocked. I’m going to have to buy a rocking chair. You’re up late.”

“I was finishing an English paper that’s due tomorrow and came down to get a drink.”

“What’s the subject?”

“Ibsen’s A Doll’s House. I’m using August Strindberg’s criticism of Nora to show she’s not really a heroine.”

“My problem with her was she claimed to be a Christian then abandoned her kids,” I replied.

“That’s part of it. Anyway, I need to proofread it and then print it.”

“What kind of computer do you have?”

“A Macintosh II.”

“Elizaveta had a Macintosh 128K,” I replied.

I’d actually used it to write my evaluation of the OB/GYN service, as I had too much to say to hand-write it.

“I had an original Macintosh, but Dad bought me this one over the Summer. I’ll take it to college with me.”

“Cool,” I replied.

Rachel had fallen asleep so I said ‘good night’ and went to my room while Annette went to the kitchen. I put Rachel in her bassinet, then changed into the lightweight shorts I slept in while I was at the Cooper’s, turned out the lights, and got into bed. I was tired, but sleep wouldn’t come. I couldn’t take the Seconal, because then I wouldn’t be able to complete my last day at Good Samaritan, and that could create problems with the agreement that had been struck. I tried to sleep for about thirty minutes, but it was useless, so I got up, turned on the reading light, and picked up my copy of The New England Journal of Medicine, then got back into bed to read.

I couldn’t focus, so I got out of bed, put on a t-shirt, then opened the patio door and stepped out into the cool September night. I sat down on a chaise and tried to clear my mind, but nothing seemed to stop the thoughts from swirling around. They were disjointed and jumbled, and my mind made strange leaps from one thing to the next. There was no doubt I was suffering from lack of sleep, but there really wasn’t a solution for about another twenty hours when I was back in McKinley.

I got up, went inside, checked on Rachel, then went to the kitchen to make a cup of tea. Doctor Blahnik had suggested chamomile tea might help me sleep, and had given me some. I was skeptical about herbal remedies in general, but there was anecdotal evidence that chamomile helped people sleep. I carefully heated the water in the kettle, turning it off before it whistled, then steeped my tea for three minutes.

“Mike?”

I turned to see Annette, who was now dressed for bed, come into the kitchen.

“You’re still up?” I asked.

“I just finished,” she said, setting her empty glass on the counter next to the sink. “Can’t sleep?”

“No. I have a prescription to help, but can’t take it because I have to be at the hospital in about six hours. I can start taking it tomorrow evening.”

“What kind of tea is that?” she asked.

“Chamomile. One of my former professors suggested it might help.”

“I read in one of Mom’s medical journals that cuddling can help,” Annette said with an inviting smile.

I nodded, “It releases oxytocin, which helps regulate cortisol, and has an almost narcotic effect. Why were you reading your mom’s medical journal?”

Annette laughed softly, “It was an article about why men often fall asleep after sex. I saw it on the cover and decided to read it! Maybe cuddling would help you fall asleep?”

I knew my defenses were weak, and standing close to a sexy, athletic blonde dressed in only a camisole and panties created thoughts I shouldn’t be having. I badly needed sleep, and I knew from my own experience that it was much, much easier to fall asleep cuddling Elizaveta, or after having made love, than it was at other times. I was sorely tempted, but what I’d said to Clarissa had to be the deciding factor — if I violated my vows, then I was the one in the wrong, and it would give Father Nicholas a reason to doubt my veracity AND give the bishop cause to suspend or depose me.

“Remember what I said about the vows I’ve taken?” I asked with a soft smile. “They prevent me from taking you up on your very tempting offer.”

“Who would know?” Annette asked.

She didn’t sound malicious, just curious.

“I would, and I’d need to confess, and that would create a serious problem.”

“You confess everything?”

“Yes,” I replied, after sipping some tea. “Everything. And that includes what you’re offering.”

“You would really just go into the confessional and tell the priest you had sex?”

“We don’t use confessionals,” I said. “Our confessions are done in the nave — the part of the church where the congregation stands — in front of the icon of Jesus Christ. It’s to Him we’re confessing. The priest is a witness, and provides spiritual guidance, but forgiveness comes only from God and the person against whom you sin.”

“So everyone can hear you?”

“No, it’s done quietly, though in ancient times it was done publicly.”

“What happens? Do you get penance?”

“Not in the sense Roman Catholics usually mean it, where you say X ‘Our Fathers’ and Y ‘Hail Marys’. Confession isn’t about meting out discipline, but about spiritual healing and providing aid in avoiding sin. For the laity, it’s usually about assigning a prayer rule, which is an ongoing thing, not a one-time thing, as well as finding ways to avoid occasions to sin. For clergy, the same is true, but later, outside of confession, discipline could be applied, depending on the sin. Breaking the celibacy rule is pretty much an automatic suspension, and very likely it would result in me being deposed from the clerical ranks.”

“This isn’t about arguing you into agreeing ... well, OK, it is, but I have a legitimate question from what you said the other night — if you’re going to remarry, you have to do whatever it was you said to, uhm, resign your commission, or whatever. If you plan to do that, then why not?”

“It’s the order in which things are done,” I replied. “Before I could take you up on your offer, I’d have to ask to be laicized. And I’m not prepared to do that at this point.”

“‘At this point’? It sounds as if you’ve decided to do that.”

“Truthfully, it’s about a mom for Rachel more than anything else.”

“Not the prospect of never having sex again?”

“I could deal with that, if I had to,” I replied, “even if it’s not ideal. But you aren’t even aware of the biggest fear I have other than Rachel not having a mom.”

“What’s that?”

“That some idiot would get the idea that I would make a good bishop!”

“Couldn’t you ‘just say no’, as Nancy Reagan says?”

“I could, but that’s not my way. I didn’t seek to be ordained a deacon — the congregation asked the bishop to do it, and when he asked me, I said ‘yes’ out of duty and obedience.”

“But he’ll let you quit?”

“Usually that’s the case, though he’s not required to honor a request. That said, I could simply refuse to serve, but then I’d be subject to discipline, including being denied the Eucharist for a time, and potentially for a long time.”

“I need to get to bed,” Annette said. “Either alone or with you.”

“As much as I want to, I’m sorry, I can’t.”

“Promise me something?”

“What?” I asked, having a good idea what it was she was going to request.

“Take a ‘rain check’ on going to bed and when you tell your bishop you want to quit, call me and we can get together.”

“When do you turn eighteen?” I asked.

“In November, but sixteen is legal in Ohio!”

“I know,” I replied. “But I’m twenty-four, and honestly, six years is a huge age difference.”

“Your wife was sixteen when you married!”

“And I was twenty-two. Six years. Besides, it’s not likely I’m going to ask the bishop that question in the next two months, assuming that I do.”

“Last chance...” she said with an inviting smile.

“Not according to what you just said about a rain check!”

Annette laughed, “Then I’ll just say ‘good night’.”

“Good night.”

She left, I finished my tea, and went back to my room just in time for Rachel to need a fresh diaper and a bottle.

September 22, 1987, Greater Cincinnati, Ohio

I had managed to sleep for about three hours, total, which I felt was enough for me to make it through the day. I had breakfast with Annette and Alan, and Lara arrived at her usual time, and quickly got settled with Rachel.