Chapter 25: Mixed Messages

October 25, 1987, McKinley, Ohio

When I arrived home late on Sunday afternoon, there were three messages on the answering machine. The first was from Doctor Cooper, calling to check on how I was doing and to invite me to dinner. The second was from Sheila, asking me to please call her. And the third was from Doctor Forsberg, also checking on how I was doing and inviting me to dinner.

I had enough time to return the calls, though I wouldn’t be able to spend much time on any of them. First, I called Doctor Forsberg and we had a brief chat, agreeing that I’d come to dinner a week from Monday. I made similar arrangements with Doctor Cooper, though the first day which worked for her family and for me was November 14th, which would mean missing Vespers, but it really couldn’t be helped.

“Hi,” I said when Sheila answered. “It’s Mike.”

“How are you?”

“Busy, as always! But I’m doing OK. You?”

“OK. I read the book, and it’s a very different take on Christianity from what I’ve ever heard. Well, before I met you, anyway.”

“What do you think?”

“I think I’m not sure I believe enough to put it into practice.”

“But you want to have your son baptized.”

“It seems like the right thing to do,” she replied.

“That is the Christian tradition,” I replied. “And in Orthodox countries would happen routinely, even if the parents rarely, if ever, attended church. That’s not the case here, and the reasons make sense, at least in some ways. In the end, though, it’s not up to me, but to Bishop JOHN. I believe he’ll want to speak to you about it, but I have no idea if he would grant «ekonomia» for your request, or if he’d ask you to become a catechumen or even be chrismated first. The latter is the default and the norm.”

“Do you have any free time soon?”

“That is the one thing that is the shortest supply for medical students, followed closely by sleep. And it’s worse for Residents, at least for their first year. And I have no vacation days or holidays off. And, as of December 1st, my schedule changes for my new rotation, so I can’t even make plans for December at this point. About the best I can offer is Sunday afternoons after church, though this week I’ll be with the bishop at the Cathedral in Columbus.”

“Two weeks from today?”

“Sure. How is work?”

“I’m getting back into the swing of things and I think Michael likes his playmate, but it’s tough to tell at this age.”

“I do need to cut this call short,” I said. “Rachel needs some attention, and then I’m meeting my friends for dinner.”

“Then I’ll see you in two weeks. I’ll most likely come to church.”

“Sounds good. I’ll see you in two weeks.”

We said ‘goodbye’, I hung up, then fed Rachel and changed her diaper. Once that was complete, I packed a fresh bag for her and we headed to Anicka’s house for our weekly ‘Dinner Club’.

October 26, 1987, McKinley, Ohio

“Time of death: 07:43,” Doctor Gibbs said reluctantly on Monday morning.

“He had no chance, Loretta,” Doctor Lindsay, who was the on-call surgical Resident, said. “Massive abdominal injuries and irreversible herniation of his brain.”

A sixteen-year-old kid had somehow rolled his pickup truck on the way to school. He hadn’t been wearing a seat belt and, according to Bobby and his partner, who had brought him in, the young man had been partially ejected from the cab.

“His parents and sister are in the waiting room,” Nurse Ellie stated.

“Ellie, please call the chaplain and have him come to the consultation room. Teri, please wash his face as best you can and cover him. Shelly, we’ll take it from here. Mike, with me, please.”

“I’ll be in the lounge if you need me,” Doctor Lindsay said.

I followed Doctor Gibbs to the consultation room, knowing what was about to happen.

“This is the toughest part of our job,” Doctor Gibbs said. “Do you know the guidelines?”

“Most importantly, don’t use euphemisms or words that can be easily misinterpreted. Explain in layman’s terms, even if it’s slightly inaccurate, rather than medical terms which people won’t understand. And, in a case such as this, use the word ‘died’ and say it clearly, so there is no room for misunderstanding.”

Doctor Gibbs nodded, “That’s the gist. Our usual practice in cases such as this is to say that the victim suffered severe injuries in a traffic accident, was transported here by the paramedics, and despite using all of our skills and abilities, we were unable to stabilize them and they died. The exact words aren’t important, so long as they’re clear and you use the word ‘died’, as you were taught.

“At that point, it’s in the hands of the chaplain, social worker, or Psych Resident. We do answer basic questions about the injuries, but we never, ever speculate on the specific cause of death, nor do we give specifics of treatment beyond saying, in effect, we tried everything humanly possible. The pathologist is the only one who should ever state a cause of death.”

“We were taught we could say that their heart stopped, and we were unable to revive them.”

“That would be OK because it’s a statement of an observable fact, not a speculation as to the cause of death. And before you respond in your usual way, yes, it is true that a patient will die because his heart stopped, but you know that’s not a cause of death, in and of itself, because pathology will trace that to the actual cause, which could be anything from system-wide organ failure to severe brain injury to a congenital defect.”

“I’m getting predictable in my old age!” I replied with a slight smile.

“If you want to live to be twenty-five, you won’t call yourself ‘old’ in my presence!”

“Sorry, Doc.”

“No, you aren’t! But that quality of yours of listening very carefully and parsing sentences very carefully is a good thing, even if it can be very annoying!”

“Doctor Gibbs?” Nurse Ellie said from the doorway. “The chaplain is currently engaged with a terminal cancer patient and their family. It’ll be at least thirty minutes.”

“Call the Psych Resident, please, and have them come down.”

“Will do, Doctor.”

She left.

“I can do the chaplaincy part,” I offered.

“Only if you take off the scrubs and put on your cassock, but then you aren’t a medical student and can’t be there. Take your pick. One job or the other.”

I shook my head, “I do NOT agree. I can do both. It’s not my job, but when it comes right down to it, caring for that young man lying dead on the table includes praying for him, which I did silently while we were working on him. I can pray audibly with his parents if they are so inclined and that enhances my service, it doesn’t detract from it.”

“I could rely on hospital policy.”

“You could, but ‘because I said so’ isn’t a legitimate answer to any question, except perhaps in the military when someone questions a legally valid order, or for a prisoner. I’m neither. One of the things I’ve noticed in medicine is the complete lack of humanity in many instances. That has to change, Doc. Love and faith are all part of the shared human experience, and both of those require compassion, not just cold, clinical behavior. This isn’t me becoming emotionally involved, but being a Christian and acting like a human being, not an android. Being Commander Data or Mr. Spock in the trauma room or operating room is good; not being Doctor McCoy outside the ER or operating room is bad.”

“You make good points, Mike, and when you’re an Attending, you can flout the rules and probably get away with it and possibly even change them. You’re a med student, which, contrary to what you just said, is, for all intents and purposes, equivalent to a soldier taking orders. I’m not as up on the Bible as you are by any stretch, but I remember a story about being under orders.”

I smiled, “The healing of the Centurion’s servant. He told Jesus that there was no need for Jesus to come to his house but simply speak with authority because he, the Centurion, understood authority. It’s not exactly on your point, but close enough. The problem is that by the time our group becomes Attendings, we’ll have conformed so long it’ll become habit. Medical students and Residents need to speak up when they’re still idealistic and not jaded or co-opted by the system.”

“Michael Loucks, Revolutionary!”

“Revolutions are almost always betrayed from within.”

“Be that as it may, you simply can’t do what you’re proposing without risking your status.”

“Not that I would do this, but imagine the newspaper headline ‘Medical student dismissed for showing compassion to the family of a teenager who died tragically in an accident’. How long would the hospital be able to resist the pressure, and do you really think they’d get away with saying it was ‘policy’? It’s not nearly as risky as you think it is.”

“Would you please not push this now? Let’s discuss it with the Chief before you act.”

“Asking forgiveness generally works better than asking permission when you intend to break the rules to change the rules.”

“If you’re willing to pay the price, yes.”

“While I am in no way making a direct comparison, Doctor Martin Luther King Junior had the courage of his convictions to break the law, and he accepted the consequences to change the law.”

“I don’t disagree, and if you want to go into private practice, have at it. You don’t; you want to be a trauma surgeon in this hospital. If this issue is so important to you, then change your plans. I do not want to potentially waste seven years training you, together with Doctor Roth, to have you dismissed because you won’t follow hospital policy.”

“Hi, Doctor Gibbs,” Doctor Stern, the Psych Resident said, coming into the room. “Hi, Mike.”

“Hi, Joanna,” Doctor Gibbs replied. “We have an MVA fatality; sixteen; parents and sister are here, waiting to be brought in. The chaplain is with a terminal cancer patient and their family.”

“Mike’s a deacon,” Doctor Stern observed.

Doctor Gibbs groaned and shook her head, “Not you too!”

“We just had this debate,” I said. “Hospital policy.”

“It’s a stupid policy,” Doctor Stern replied, “because as a clergyman, you are FAR better suited to deal with spiritual matters than I am. But Doctor Gibbs is, sadly, correct.”

“Mike, would you go get Mr. and Mrs. Leonard and their daughter, please? You know the drill on this, right?”

“Just say that you want to speak to them about their son and deflect any questions about his condition by saying I’m not a doctor, and you’ll provide the full details.”

“Exactly.”

I left the consultation room and stopped at the admit desk to have Nate point out the Leonard family, then went out into the waiting room and walked over to where they were sitting.

“Mr. and Mrs. Leonard?” I asked.

“Yes?”

“I’m Mike, a medical student. Doctor Gibbs would like to speak with you about your son.”

“How is he?” Mrs. Leonard asked.

“Doctor Gibbs will fill you in,” I replied. “If you’ll follow me, please.”

“Me, too?” the sister, who I guessed was around thirteen, asked.

“Yes. What’s your name, if I can ask?”

“Jenny; Jennifer.”

The three of them got up and followed me to the consultation room.

“Doctor Gibbs,” I said. “Mr. and Mrs. Leonard and Jennifer.”

“Hi, Mr. and Mrs. Leonard; hi, Jennifer. I’m Doctor Gibbs, this is Doctor Stern, and you’ve met Mike, who is a medical student. Have a seat, please.”

They sat, and Doctor Gibbs did as well. I went to stand next to Doctor Stern, just behind and to the side of Doctor Gibbs.

“Your son, Jeff, was involved in a serious motor vehicle accident and was transported to the hospital by the paramedics. His injuries were severe, and despite our best efforts, using all our skills and abilities, we were unable to stabilize him, and he died.”

“NO!” Jenny screeched. “NO!”

Mrs. Leonard collapsed, sobbing, against her husband, who I could tell was fighting mightily to hold his emotions in check.

Jenny ran from the room, and after a few seconds, without being told, I sprang to action and followed her from the room. I saw her running down the corridor towards the ambulance bay doors and hurried after her. I caught up with her as she crossed the driveway into a small park.

“Jenny,” I said, “please stop.”

“He can’t be dead!” she screeched, continuing to run. “He can’t!”

She didn’t stop running until she reached a small stream. I stopped next to her and gently put my hand on her shoulder. She turned and started pounding on my chest with both fists, screaming and crying, and I simply let her work out her anger. It took a couple of minutes before she stopped, and just then, Doctor Stern arrived.

“Jenny?” she said. “Can we go back inside and talk?”

“NO!” Jenny screeched. “You let him die! You were supposed to save him!”

I took a deep breath and let it out.

“Jenny,” I said gently. “His injuries were too severe. I was there, and we tried everything we know how to do and had the best doctors in the hospital doing everything in their power to save him. Sometimes it’s just not possible.”

“But why? Why?”

I looked to Doctor Stern, who nodded.

“I don’t think anyone can answer that question,” I said. “Sometimes things happen for a reason. Sometimes they’re just random events that lead to tragic outcomes. I can’t make sense of this for you, but what I can say is that I’m sure your brother would want you to live a happy, wonderful, productive life. You can honor his memory by doing that. It won’t be easy, but you can do it.”

“What do you know?” she asked, sounding almost angry. “Your brother didn’t die!”

“That’s true,” I replied. “But my wife died about two months ago, just after giving birth to my daughter. She was eighteen.”

Jenny’s hand went to her mouth, and she turned white.

“Uh, uhm, uh, I’m so sorry I said that!”

“It’s OK,” I replied. “You didn’t know. Will you come back inside, please?”

“OK,” she said meekly.

The three of us walked back to the hospital and went in through the ambulance bay doors. We found Jenny’s parents standing near the nurses’ station, so we walked over to them.

“Why don’t the three of you come with me?” Doctor Stern suggested. “Let’s go someplace private and talk.”

“Can Mike come?” Jenny asked.

“Mike’s job is to care for patients in the Emergency Room,” Doctor Stern said.

“But I want to talk to him! He’ll understand!”

And right then, I completely understood Doctor Gibbs’ point about doing one job or the other.

“Mike, Exam 3, please!” Nurse Mary called out. “Doctor Schmidt needs you.”

“I’m very sorry for your loss,” I said. “Jenny, Doctor Stern is a really good listener. I like her a lot, and I think you will, too. But I need to go help another patient.”

She pouted, but there really wasn’t anything I could do except go to Exam 3. I turned and walked away, unhappy with the entire situation. I went into Exam 3, followed by Nurse Mary.

“Yes, Doctor?” I asked.

“Hi, Mike. Fist versus plate-glass window. I’d like you to suture the arm lac, please.”

I took a quick look, and my rough estimate was at least twenty sutures, which would take a long time. It would also require at least six lidocaine injections, potentially as many as ten.

“Right away, Doctor,” I said.

“Mary, tetanus shot once the sutures are in, please,” Doctor Schmidt instructed.

“Tetanus booster after suturing,” Nurse Mary confirmed.

“Mr. Coons, this is Mike. He’s our top medical student, and if you want perfect sutures, he’s your man!”

“Hi, Mr. Coons,” I said. “How are you?”

“Wishing I’d thought twice before punching a plate-glass window,” he said sheepishly.

I quickly examined the wound so I could let Nurse Mary know what I’d need.

“Nurse,” I said, “I’ll need a suture kit, 4-0 nylon, saline, an irrigation syringe, a syringe with a 25-gauge needle, lidocaine times eight, Betadine, and four stick swabs, please.”

“I’ll leave you to it, Mike,” Doctor Schmidt said. “Mr. Coons, I’ll come back and see you once Mike has you fixed up.”

“Thanks, Doc.”

Nurse Mary set out everything I’d asked for on an instrument tray, then rolled over a treatment tray and put down three soft towels to cushion it, then helped Mr. Coons put his arm on it.

“Just relax, Mr. Coons,” I said. “As best you can, anyway. First, I’m going to anesthetize the wound, which will take six to eight shots of lidocaine. You’ll likely feel a prick each time, but then your arm will be numb, and you won’t feel much of anything.”

“OK, Doc,” he said.

“I’m a medical student,” I replied. “I don’t get to be called ‘Doctor’ until I graduate in about nineteen months.”

“But they let you sew me up?”

“Yes. And give injections, draw blood, take vital signs, hook up monitors, insert IVs and catheters, and generally assist the doctors. As I gain experience, I’ll be allowed to do more. This is part of our training, but rest assured, I’ve done this before.”

“He said you’re the best.”

“He did, and I’m grateful for his praise! Are you allergic to any drugs?”

“No.”

“Never had an adverse reaction to dental work?”

“No. Two root canals and they shot me up with xyl-something.”

“Xylocaine. It’s a brand name for lidocaine, which is what I’m going to use.”

“What if I was allergic?” he asked.

“Then we have alternatives. Any history of heart trouble of any kind?”

“No.”

“Nurse, BP at last measurement?”

“120/70.”

“The doctor asked all these questions,” Mr. Coons said.

“And I’m double-checking before I give you the injection. We do that because we want to avoid mistakes.”

I hadn’t done that previously and had realized it had been a mistake, though given the orders were written on the chart, I wouldn’t be responsible for any errors.

“Makes sense,” he replied.

I washed my hands, put on gloves, then sat down next to the treatment table.

“Ready?” I asked.

“Does it matter?” he asked with a slight laugh.

“You can always say ‘no’, though then I have to go get the doctor to convince you.”

“Nah, go for it!”

When all was said and done, it was seven injections and twenty-three evenly spaced sutures. Once I finished, Nurse Mary administered the tetanus shot.

“The arm looks great, Mike,” Nurse Mary said once she’d disposed of the needle and syringe.

“Thanks. Would you ask Doctor Schmidt to come back, please?”

“Right away!”

She left to get him.

“Let me guess,” Mr. Coons said, “the nurse was making sure you did everything correctly, right?”

“That she was,” I admitted. “Nurse Mary has been with the hospital for nearly twenty years and has probably seen four hundred medical students over that time.”

“I’m glad they didn’t stick me with some battle-axe of a nurse!”

“Nurse Ratched doesn’t work here!” I declared. “Or at least I haven’t met her, if she does!”

“What can I take for the pain?” he asked.

“Doctor Schmidt will have to answer that question,” I replied. “He didn’t write anything on the chart about post-discharge medication, and I have to follow his directions on that.”

“They trust you to sew me up but not to tell me to take Tylenol?”

“Believe it or not, that’s the law.”

“What effing idiot made THAT law?” Mr. Coons asked.

“The Ohio Legislature,” I replied. “But it does make sense because I’ve only been training for five months. Before that, it was basically book learning with a bit of observation. This is my third clinical rotation. The first two were surgery and OB/GYN.”

“So they let you perform surgery, deliver babies, and suture, but not tell me to take Tylenol?”