Chapter 27: Conversations

November 1, 1987, Rutherford, Ohio

I hadn’t said anything to my mom about my conversation with the bishop when I’d retrieved Rachel from her, nor had I said that I was heading to Rutherford to see my grandfather, because I didn’t want to have to deflect questions unless I absolutely was forced to do so.

“Mike?” my grandmother said when she opened the door to the house. “What are you doing here?”

“I need to speak to Grandpa,” I said. “You wouldn’t mind taking your great-granddaughter from me, would you?”

“Of course not! She is always welcome! If grandparents spoil children, imagine what great-grandparents will do!”

I smiled, “I seem to have turned out OK!”

My grandmother laughed, “Yes, you did. Your grandfather is in the living room. I’ll take Rachel upstairs so you two can have some privacy. May I have her bag, please?”

I handed her Rachel and the diaper bag, then went into the living room.

“Hi, «Дедушка» (dedushka),” I said. (“Grandpa”)

“Michael? What are you doing here? Weren’t you in Columbus with Vladyka JOHN?”

“I was,” I replied. “I want to speak with you privately. Grandma took Rachel upstairs.”

“Do you want some tea? There’s a pot, so you’ll just need to fetch a glass from the kitchen.”

“I’ll do that,” I replied.

I went to the kitchen and got a tea glass and a silver holder, put the glass into the holder and returned to the living room where I poured myself some tea.

“What was so important that you arrived unannounced?” my grandfather asked. “Not that you aren’t always welcome.”

“First, this conversation needs to be private between you and me. Even Grandma can’t know what I say.”

My grandfather nodded, “Of course. Go on.”

“I’m struggling with a set of very difficult challenges, the biggest of which is the fact that I’m a single father. I don’t believe it’s in Rachel’s best interest to grow up without a mother, especially given the insane hours I’m going to have to work the next three or four years. This year it’s sixty to seventy hours a week, and it could go as high as a hundred during my PGY1 year — that’s the first year of Residency.”

“That is crazy!” my grandfather declared. “But, as with many things in life, there is no way around it. I think you have a valid point, but there is only one possible way for that to happen.”

I nodded, “And that is what Vladyka JOHN and I discussed a few weeks ago, and again today. I asked to be returned to the order of the laïty, and he agreed. Next Sunday will be my last as a deacon.”

My grandfather sighed, and nodded grimly, “That is not unexpected.”

“I don’t plan to re-marry immediately, but delaying laïcization makes no sense given I’ve decided it’s the way forward.”

“Natalya Vasilyevna?” he asked.

An obvious candidate, but given my discussion with the bishop, a potentially problematic one. If I were to marry her or Lara, that would most likely preclude being ordained a deacon in the future.

“Honestly, «Дедушка» (dedushka), it’s too soon to consider that.” (“Grandpa”)

“Mike,” my grandfather said gently, “if you weren’t already considering it, you wouldn’t have asked to be returned to the order of the laïty at this time. You would have waited.”

He had a legitimate point.

“Though,” he continued, “you will get some grief if you remarry so soon after Elizaveta’s death.”

I nodded, “I’m aware. And if it weren’t for Rachel, I most likely would have remained a deacon. In fact, had Rachel been John instead, I might also have chosen to remain a deacon. But a girl needs a mom, and a godmother won’t do. I mean, obviously, there are circumstances where that has to happen, but I have an alternative.”

“I would think a year would be sufficient, though I think you’ve telegraphed your intent by asking for laïcization, even if Vladyka says it’s due to the demands of your medical training.”

I nodded, “I know. And that is what he will say. He’s calling Father Nicholas, and I’m telling you now, and when I get back to McKinley, I’ll tell Viktor.”

“You understand there may be fallout, if not from Viktor directly, then from Yulia through him.”

I nodded, “I do. Yulia will likely see it as a threat to take her granddaughter away, but I would never do that. In the mother/daughter test of wills, I always felt Elizaveta was being too hard on her mother, and I’ve done my best to accommodate Yulia’s wishes, though there are some very hard lines which I will not allow her to cross.”

“You are her father, Mike, so you make the decisions. Rachel’s grandparents and great-grandparents may give advice, but in the end, you are responsible for Rachel and the decisions are yours.”

“Do you think I’m doing the right thing?”

“As much as I desired to have a clergyman in the family, I would not insist you remain unmarried for sixty years or more. I do not think the Borodin men are cut out for that. Or the women, for that matter!”

I smiled, “No comment!”

“Your mother was always strong-willed, and so is your sister. You have been a bit more controlled.”

I nearly laughed out loud because Clarissa would absolutely disagree with him, as she was constantly asking how I got myself into trouble so often. The thing was, I did my best to apply logic to my actions, though it didn’t always work out in a way that didn’t cause me trouble of some kind.

“I have my own challenges,” I replied. “Not just medical school and Rachel.”

“We all do, Mischa,” my grandfather said gently. “You know the proverb that life is suffering.”

“I know that all too well,” I replied with a sigh.

“I’m so sorry, Mischa. If I could do anything to fix it, I would.”

“I know, «Дедушка» (dedushka). And I appreciate it.” (“Grandpa”)

“If you have any trouble with Viktor Nikolayevich, please let me know. I’ll speak with him, if necessary.”

“I will,” I said.

I finished my tea, spoke to my grandmother for a few minutes, then left my grandparents’ house to head to McKinley for what I thought had the potential to be a much more difficult conversation.

November 1, 1987, McKinley, Ohio

I left Rachel in Anna’s watchful care and joined Viktor in his study.

“How were things at the Cathedral this morning?” he asked.

“Fine. I had a good talk with Vladyka. I’ll tell you about the conversation, but per Vladyka, this can’t go beyond you.”

“Why?”

“That was his command to me, and I need to follow it. If you don’t agree, I’m not permitted to tell you about the conversation.”

“Fine. I agree,” Viktor said flatly.

“After careful considering, prayer, and discussion with Vladyka, I decided to ask to be returned to the order of the laïty. After two very good heart-to-heart conversations, Vladyka JOHN agreed.”

“Why now, Mike?”

“Vladyka JOHN judged that the demands on my medical training and caring for Rachel make it difficult for me to effectively serve as a deacon.”

“I have a feeling there is more to this,” Viktor said. “I’m sure you intend to come to church as often as you do now, and serving only requires you to be at church a bit early, so that doesn’t feel like the complete answer.”

There was indeed more to it, but unlike with my grandfather, I felt it was better to stick to the ‘party line’, as it were. There was no point in creating problems before I elected to act on my intent to find a mom for Rachel.

“Those are the reasons for my request which were in my letter to His Grace, and in the «указ» (ukase) he issued which will be read by Father Nicholas on Sunday. As for serving, you know my hours are only going to get worse. It’s a minimum of sixty hours a week as a medical student, and over ninety as a first-year Resident. I can only attend church regularly now because Doctor Gibbs created a special schedule for me. The others all change shift assignments as of today. I don’t.”

“I wasn’t thinking about that,” Viktor admitted. “Does Father Nicholas know?”

“He knew I intended to make the request, and I met with him and Vladyka a few weeks ago. Vladyka was going to call Father Nicholas this afternoon after I left Columbus. I was permitted to tell you and my grandfather, but nobody else. I elected to drive to Rutherford before I came home.”

“You know people are going to talk.”

“And if they do, they’ll answer to the bishop. He won’t tolerate it.”

I could tell Viktor wanted to ask the question — did I intend to remarry. The answer was, obviously, that I did, but the true driving force behind it was the one thing that would absolutely set Yulia off — a new mother for Rachel. It was true that I didn’t see myself living the rest of my life alone, but that was secondary to Rachel’s needs. I was sure some people would think I was using Rachel as an excuse, but that truly wasn’t the case.

“It will be public next Sunday, then, once Father reads the bishop’s directive?”

“Yes.”

“Please do not let Yulia know that I knew in advance, or there will be hell to pay.”

I nodded, “I know. Vladyka JOHN made a concession for you and my grandfather, given your involvement in my ordination.”

“Do you feel that was a mistake?” Viktor asked.

I shook my head, “Nobody could have predicted the outcome. Had Elizaveta not died, things would have continued as they had, and we wouldn’t be having this conversation.”

“No, we wouldn’t,” Viktor said with a sigh.

“I’m going to get Rachel and then we’re going to spend a quiet evening in the cottage. She’s been dragged all over southern Ohio today, and I think she needs some peaceful time.”

“If you need anything, let me know.”

“I will. Thanks, Viktor.”

We shook hands, and I left his study. I retrieved Rachel, and we went back to the cottage.

November 2, 1987, McKinley, Ohio

“Eight-month-old male infant found non-responsive in his crib,” Bobby said as he helped move the gurney from his ambulance just after I’d started my shift. “Pulse 110; BP 130/80; fever, 38.2°C; resps shallow at 25; non-responsive to external stimuli; pupils sluggish; one litre O₂ by mask; no IV.”

“Trauma 1!” Doctor Nielson ordered. “Mike, call Pedes!”

“Right away, Doctor!”

I hurried after Doctor Nielson, Nurse Mary, and Kevin, a Fourth Year who had started a new shift schedule. Once in Trauma 1, I picked up the phone, dialed the extension for Pedes, and asked for the on-call Resident to come to Trauma 1. Once that was done, I joined the others at the exam table.

“Parents?” Doctor Nielson asked Bobby.

“Following us in.”

“Mike, go see them and get as much information as you can — when he last ate, when he had his last diaper change, when he went to bed, and so on. Move!”

“Yes, Doctor!”

“Surname?” I asked Bobby as I grabbed a clipboard.

“Sumner.”

I nodded and hurried to the waiting room, selecting the most likely couple — a pair of disheveled young adults, probably around twenty-one.

“Mr. and Mrs. Sumner?” I asked.

“Yes! How is Kyle?”

“The doctors are examining him right now,” I said. “I’m Mike, a medical student, and I need to get some information.”

“Can we see him?” Mrs. Sumner asked frantically.

“Once the doctors finish evaluating him, they’ll come talk to you; for now, though I need some information, please. Can you tell me when Kyle was last awake?”

“I’m not sure,” Mr. Sumner said. “The babysitter would have put him down.”

“Do you know when he last ate?”

“It would have been last night, before bed,” Mrs. Sumner said.

“Last diaper change?”

“This morning,” she said. “That’s when I noticed he wasn’t waking up! What’s wrong with him?”

“We don’t know yet,” I said gently. “Had he had a bowel movement?”

“You mean was his diaper dirty? Yes. Both.”

“Does Kyle usually sleep through the night?”

“Yes,” Mrs. Sumner said. “For about the last month.”

“Has he been sick? Had a fever? A cough? A runny nose?”

“A mild cough last week,” Mrs. Sumner said. “I called our pediatrician who said not to worry about it if it went away in a day or two, which it did.”

“Your pediatrician’s name?”

“Joy Early.”

“Did Kyle have a fever when he had his cough?”

“He didn’t feel warm, so I didn’t take his temperature. I hate those thermometers that go in his butt!”

“How has he been eating?”

“Just fine, I think. And he has regular dirty diapers.”

“Croup? Crying?”

“He can be a bit fussy after meals,” she replied.

“Does he eat solid food?”

“Baby food and Cheerios,” she replied. “Though he kind of gums those to death.”

“How long were you out last night?” I asked.

“We left at 7:00pm and arrived home about midnight,” Mr. Sumner said. “We checked on him as usual before I drove the babysitter home. He seemed like he was just sleeping.”

“OK. We’ll call Doctor Early, but has Kyle had all his immunizations?”

“Whatever Doctor Early recommended,” Mrs. Sumner said.

I thought about other information that might be useful.

“Have you done any work on your house? In your garden?” I asked.

“You mean like painting or fertilizer or insecticide?” Mr. Sumner asked.

“Yes.”

“No. Nothing like that. The last painting we did was the nursery, and that was two months before Kyle was born.”

“Any complications with the delivery?” I asked.

“No,” Mrs. Sumner said. “My OB was Doctor Zander, and he said everything was fine.”

“I think that’s all I need for right now,” I said. “I promise someone will come talk to you as soon as we know anything.”

I went back to Trauma 1 to give my report.

“Nothing remarkable in his history except a slight cough last week. He was with a babysitter last night and his parents checked on him when they returned home about midnight. They assumed he was sleeping. They found him unresponsive this morning when his mother went to wake him and she changed his diaper then. He’s eating solids, including baby food and Cheerios. No croup. Is fussy after eating. Delivery was uncomplicated, per his mother. His pediatrician is Doctor Joy Early. He’s had the normal course of immunizations, per his mother. No known contaminants in the home or on the property.”

“Name?”

“Kyle,” I replied.

“Benton, Pedes,” a Resident said, coming into the room. “What do we have?”

Doctor Nielson gave him the vitals, the results of his initial assessment, and the information I’d provided.

“Do we know his pediatrician?” Doctor Benton asked.

“Doctor Joy Early,” I replied.

“You are?”

“Mike Loucks, Third Year.”

“She’s at Pediatric Health. Call her, please. I want to talk to her.”

“Right away, Doctor,” I replied.

I went out to the nurses’ station and, with help from Nurse Anne, the duty nurse, found the number for the practice. I called and explained the situation and they put me through to Doctor Early. I asked her to hold, then had Nurse Anne transfer the call to Trauma 1. I hurried in and picked up the phone.

“I have Doctor Early,” I said.

“Speaker, please,” Doctor Benton asked.

I pressed the buttons on the phone.

“Joy? It’s Preston. I have one of your patients, Kyle Sumner, in the ER. Non-responsive in his crib this morning; pupils sluggish; vitals stable but BP and pulse are high; mild fever. Anything you can tell me?”

“I’d say he’s a generally healthy baby boy. A bit on the heavy side, but not obese. He’s had the regular course of immunizations. I last saw him about six weeks ago.”

“Can you fax over his medical records, please?”

“To the Emergency Department or Pedes?”

“Pedes, please. I’m admitting him.”

“Do you have a tentative diagnosis?”

“No. We’ll need a full set of labs, which were ordered, and a head series, along with an echocardiogram.”

“Meningitis?” Doctor Early asked.

“I’d prefer not to do a spinal tap on an infant until I rule out other causes.”

“Keep me informed, please,” Doctor Early requested.

“Will do,” Doctor Benton replied. “Thanks. Mike, you can disconnect and call for an orderly.”

Three minutes later, an orderly arrived with a gurney and Kyle was taken up to Pedes. I followed Doctor Nielson out to see his parents, joined by Kevin, the other med student.

“Mr. and Mrs. Sumner, I’m Doctor Nielson. I evaluated your son and we’ve decided to admit him to Pediatrics. He’s being evaluated now by Doctor Benton. Mike will take you up to Pediatrics.”

“What’s wrong with him?” Mrs. Sumner asked.

“We don’t know yet. Doctor Benton will tell you more once we have results from the tests. Also, you should probably call your babysitter and ask her if anything happened last night.”

“I did. She said nothing out of the ordinary happened.”

“OK. Mike?”

“Mr. and Mrs. Sumner, if you’ll come with me, please.”

I escorted them to Pedes, handed them off to a medical student, and then returned to the ER. I found Doctor Nielson in the lounge with Kevin.

“Thoughts, Mike?” he asked.

“Intercranial bleed or meningitis would be the most likely differential diagnoses, though I’d want to see the results of his blood work.”

“What would you do?”

“Besides the tests? Talk to the babysitter and see if she could provide more information. Do you have a suspicion?”

“If it’s not meningitis, I’d go with ‘shaken baby syndrome’. Do you know what that is?”

“I do,” I replied, “and that’s why I asked about croup and crying. And that’s why Doctor Benton asked for the head series, right?”

“Yes. To check for subdural hematoma. It’ll be easier once the new CAT scan machine is operational, but that’s not until January.”

“Doctor Nielson?” Nurse Ellie called from the door to the lounge. “Doctor Gibbs activated a Level I Emergency Disaster Protocol. School bus versus minivan. Unknown number of victims, but the bus was on the way to the High School.”

We left the lounge and went to find Doctor Gibbs, joining Doctor Williams, Doctor Casper, and Doctor Schmidt, along with four other medical students, which included Clarissa, who was now on the overnight 10:00pm to 10:00am shift.

“We’ll receive victims by ambulance, Sheriff’s cruiser, and likely private vehicles in about five minutes,” Doctor Gibbs reported. “I’ve called for help from Internal Medicine, Pediatrics, and Surgery. We’re going to quickly run out of trauma and exam rooms, so focus on critical patients. Fourth Years, you’ll get the non-critical patients, and may end up working on patients on gurneys in the corridors. Third Years, your duty station is the waiting room. Triage and evaluate with basic exams. Find Doctor Casper if you need help; he’ll be supervising the Fourth Years.”