Chapter 33: Reconciliation

November 18, 1987, McKinley, Ohio

“Mike, Mr. Crowe in legal would like to see you,” Susan said on Wednesday afternoon when I returned from lunch.

I acknowledged her, checked with Doctor Williams, then went to the administrative wing.

“Mike Loucks to see Mr. Crowe,” I said.

“He’s expecting you. Go in, please.”

I went down the short hallway to his office and knocked on the open door.

“Come in, Mike. I just wanted to let you know that the court dismissed the claims by Melissa Bush this morning. In theory, she could file again, but I doubt it. I called your attorney and let him know.”

“That’s excellent news, thanks.”

“You’re welcome. May I say how sorry I am for your loss?”

“Thank you. What makes you think Melissa won’t file again?”

“She has no hope of success with any of her claims, and the court was clear about that in the rulings.”

“What about the claims of harassment and trading of sexual favors claims?”

“In the end, she didn’t name names, times, or locations. Those could be re-filed, but she’d have to make specific claims, and what happened with her false claims against you would likely be fatal to any other claims she might make.”

“But there are no records of that,” I protested.

“Nothing in anyone’s file,” Mr. Crowe said. “But there are private notes, including ones you and your friends kept about your meetings with her. Honestly, there is nothing to worry about at this point.”

“Do you happen to know what Melissa Bush is doing?”

“I don’t. It hasn’t come up in any of the filings or during the proceedings in court. Why?”

“Just my usual curiosity,” I replied. “Thanks for letting me know about the dismissals.”

“You’re welcome. I signed off on your proposal from a legal perspective. You, Doctor Roth and Doctor Gibbs are doing a good thing.”

“Thank you.”

“Don’t hesitate to call me if you need anything.”

“Thanks again.”

I headed back to the ED and let Clarissa know what Mr. Crowe had said.

“Do you think that’s the end of it?” she asked.

“I hope so,” I replied. “But with my luck?”

“You do always find new and interesting ways to get yourself into trouble!”

“Says the woman who is encouraging me to have a glass of wine and a bath with Anicka!”

Clarissa smirked, “So you are thinking about it!”

“I’ve thought about a lot of things that I haven’t done, Lissa.”

“I bet!”

“I do like redheads,” I replied with a silly grin.

“The latent pig arises!”

“May I point out that YOU were the one who brought up the fact that Tessa likes guys as well, AND you were the one who suggested that as a ‘solution’ to my problem?”

“Who? Me?”

“Always the troublemaker!”

“And your point is?”

“Mike?” Ellie called out. “Doctor Casper needs you for a possible MI two minutes out.”

“OK,” I replied.

I left Clarissa and headed for the ambulance bay where Doctor Casper and a nurse, Susan, were waiting. The ambulance pulled up about a minute later.

“Albert Casey; fifty-two-year-old male; complains of chest and left arm pain; tachy at 110; BP 150/100; resps labored at 25; diaphoretic; O₂ five litres; 1mg nitro sublingually.”

“Trauma 3!” Doctor Casper ordered.

When we arrived in the trauma room, Ellie was waiting for us, and the five of us moved Mr. Casey to the trauma table.

“Mr. Casey, I’m Doctor Casper. What seems to be the problem?

“It’s ... like ... an ... elephant ... is ... sitting ... on ... my ... chest,” he said, huffing and puffing.

“Ellie, CBC, Chem-20, ABG, cardiac enzymes; Mike, nasal cannula at five litres and cardiac monitor.”

I moved quickly to hook up the oxygen and set the controls, then put a pulse oximeter on Mr. Casey’s finger while Doctor Casper performed a physical exam. I got a pair of bandage scissors and cut away his shirt, then began attaching the cardiac leads. Once they were attached, I turned on the monitor.

“PO₂ is 97%; pulse 116; BP 150/90; ST elevation on the monitor.”

“Mr. Casey,” Doctor Casper said, “it appears you are having a heart attack. Mike, what do we do for ST elevation MIs?”

“Cath lab,” I replied. “Angiogram and likely angioplasty; manage pain with nitro; administer 250mg ASA IV push.”

“Correct. Ellie, ASA per Mike’s orders; Mike, call upstairs to cardiology and tell them we have a patient for the cath lab. Mr. Casey, we’re going to get you up to cardiology for an angiogram — procedure to look for a blood clot in the vessels around your heart.”

Five minutes later, Doctor Casper and I escorted Mr. Casey to cardiology, following the procedure that a patient having an active MI was never not attended by a physician.

“You’re in good hands, Mr. Casey,” Doctor Casper said after we handed him off to Doctor Getty and a new Resident, Doctor Pace.

Doctor Casper and I headed back down to the ED, and I updated the board, removing Mr. Casey’s name. The rest of the afternoon was routine, though I did have an opportunity to suture a small hand lac for a construction worker.

After dinner and Vespers, I returned to Anicka’s house to await my call from Doctor Mercer.

“Thanks for taking the time out of your evening,” I said when she called at 9:00pm.

“You’re welcome. I know your schedule is hectic, and my family is used to me being paged at all hours. I received the results of your exam and the blood test results. I would have to say at this point that it is as I suspected — a combination of stress and what I’ll call mild PTSD, though not diagnostically.”

“I don’t exhibit the classic symptoms.”

“No, but individuals with stoic personalities, and especially those with the personality type to be an ER physician or a surgeon, internalize the stress. Often, they resort to prescription drug abuse, alcohol abuse, or other destructive behavior. In some cases, and this is what has me concerned about you, they exhibit no self-destructive behavior until they have what amounts to an emotional and mental breakdown.”

“You know the situation,” I replied. “What do you recommend?”

“I admit saying ‘find ways to reduce your stress’ is not only trite, but probably impossible given your situation. You’re playing in your band and practicing martial arts, right?”

“Yes, and going to church, though my next Clerkship precludes going to church for services.”

“That very much concerns me, because that is one of the few places of sanctuary for you. And yes, I understand some stressful things occurred in your church organization, but going to your temple was, and is, your place of refuge. Not having that creates significant risk of some kind of event, whether it’s self-destructive behavior or emotional breakdown.”

“I don’t disagree, but as you say, there doesn’t appear to be a solution.”

“Is there anything you can do to reduce your stress?”

I laughed, then asked, “You mean besides the method I used during my undergraduate years?”

“You know my take on that, but as we’ve discussed, that, too, is a source of stress. In fact, it’s probably a source no matter which way you look at it — performance anxiety, risky behavior, or, in your case, belief that it’s sinful. Remember, I do not object to healthy, consenting sexual relationships, but taking everything into account, trying and succeeding might be almost as stress-inducing as trying and failing.”

“You mean because of my change in mindset once I accepted Elizaveta’s proposal?”

“Yes, and now you measure yourself by her standards. The challenge there is that you’re not only using her standards, but they are cast in stone, so to speak, and can’t be discussed, challenged, or negotiated.”

“You think they could while she was alive?” I asked lightly.

Doctor Mercer laughed softly, “You might have a point! But in all seriousness, she did move away from some of her more rigid thinking.”

“True,” I agreed.

“I’m treading on somewhat dangerous territory, but I think with you I can do that. Does simply being in the temple help?”

“It has in the past,” I replied. “I believe I told you about Tasha finding me there twice when I’d suffered serious emotional trauma.”

“Then perhaps, and I say this advisedly, make regular trips to the church to simply pray or whatever it is that helps you relax.”

“That’s a good idea,” I replied. “And you don’t have to qualify your answers with me. I understand the ethical considerations, but you know how important my faith is to me, and without it, well, I don’t even want to think about what that might be like.”

“Who are you accountable to? Professionally and personally?”

“Professionally, Doctor Gibbs, and to a lesser extent, Doctor Roth, as I don’t see him very often. And, of course, Doctor Smith is my physician and Doctor Mertens is my advisor. Personally, Clarissa, Lara, Peter, Robby, and Doctor Blahnik. But also the rest of my study group, though to a lesser extent than Peter.”

“You’re living with Doctor Blahnik now, correct?” Doctor Mercer asked.

“Yes, until the first week in December. My grandfather and several of his friends rented a house for us in McKinley. We can move on December 1st, but given my schedule, it’ll be later in that week.”

“You’ll be living alone, then? Well, with Rachel, of course.”

“Yes, though Lara will watch Rachel for my pediatric shifts, including the twenty-four-hour ones. She’ll have help from Serafima and Alyssa, and, hopefully, my in-laws.”

“I was going to ask you about them. Things have improved?”

“I’m meeting my father-in-law for dinner on Monday evening.”

“Good. I have one additional question for you — how does your lack of libido make you feel?”

“I don’t know for sure,” I replied. “But I think you hit on something before about Elizaveta, and not just her standards.”

“I’m curious about that; you don’t seem to hold her as a bar to finding a mother for Rachel, as you’ve put it.”

“Elizaveta never had a chance to be a mom,” I sighed. “So I have nothing really to compare to.”

“But as a wife, friend, and sex partner, you do. And that’s normal, but until you are able to evaluate a life partner without making that comparison, you need to be extremely careful.”

“How can I ever not make that comparison?” I asked.

“Let me rephrase — without that comparison being primary in your mind, as it would be now. It’s only been about three months, so it’s no surprise you think that way, but you need to be in the right frame of mind to make the kind of decision you’re talking about.”

“I’m not sure how to do that.”

“Part of it is time, part of it is counseling, and part of it is communication with whoever it is in the future you believe is someone with whom you might want to spend the rest of your life. We’ve been over this before, and despite your focus on Rachel, that’s going to fail if you don’t put your own needs and the needs of a future partner on at least equal footing. I’m not saying Rachel shouldn’t be your priority; she should. But in this specific thing, her needs cannot override your needs, or the needs of the young woman, whoever she might be.”

“I hear you, Doc.”

“I know you do, and I also know you well enough that I can’t simply argue you into changing your position.”

“My grandfather made the point that the Borodins are a stubborn bunch.”

“No kidding,” Doctor Mercer said flatly. “But that will pay off in your pursuit of your medical license. You aren’t one to give up, no matter what life throws at you.”

“The incident with Jocelyn?”

“You weren’t consciously giving up, Mike. You were in shock, according to the account you and Clarissa both provided. That’s a very different thing. I suspect something similar might have happened when Elizaveta died had you not had Rachel.”

“I believe there’s a good chance something like that might have happened. What next?”

“There isn’t a clear path forward that I can recommend, other than suggesting caution in starting a new relationship. I’m curious, but do you plan to date, or do you plan something akin to what you did before?”

“I honestly have no idea,” I replied. “I mean, I could ask Lara tomorrow morning and she’d most likely say ‘yes’. The same would be true for Tasha.”

“I’m not encouraging you, but why haven’t you asked either of them?”

“A mix of reasons, I think, including my emotional state and my respect for Elizaveta’s memory.”

“As we discussed, that’s a double-edged sword. In the short-term, it’s no problem. In the long term, it could create no end of trouble for a future partner, and because of that, for Rachel.”

“As I said before, I hear you, Doc. Let me ponder.”

“I will. Call me in a week, or sooner if you feel the need.”

“I will.”

We said ‘goodbye’ and I hung up. I checked on Rachel, then went downstairs to make myself some tea. Once I’d made it, I went back upstairs for a warm bath. After my bath, I changed Rachel’s diaper, giving her a quick sponge bath, though I knew Lara did that on a daily basis. I went downstairs, made a bottle, and then Rachel and I went to sit in my room in the rocking chair. After feeding her, I put her in her crib, then crawled into bed and fell asleep.

November 23, 1987, McKinley, Ohio

I had spent a lot of time thinking about my conversation with Doctor Mercer, but by Monday evening, I hadn’t come to any resolution about how to proceed, other than to simply continue my training, caring for Rachel, going to church, practicing with the band, attending karate class, and spending time with my friends.

I also didn’t know what I was doing for Thanksgiving. Anicka had asked if I wanted to join them, offering to have their meal at 7:00pm to accommodate my schedule, and I’d demurred, at least until after my conversation with Viktor. If things could be repaired, at least to some kind of neutrality, eating with my in-laws would be a better choice.

Lara would be going home to Pittsburgh for Thanksgiving, and because I had to work, Anicka and Milena would watch Rachel on Thursday, and my mom would come to McKinley on Friday. We weren’t having band practice, and the dōjō was closed from Thursday through Sunday, which meant I had more free time, though both karate and band practice were relaxing distractions.

I arrived at the golf club just before 7:00pm and parked in a guest spot, then let the parking attendant know I was meeting Viktor Kozlov, and he made a note in his book. I went inside and was shown by the hostess to the small, private dining room where Viktor and I had met before.

“Good evening, Mike.”

“Good evening, Viktor.”

I sat down across from him, and a waiter promptly took a drink order. I would be on shift in less than twelve hours, so I couldn’t even have a splash of alcohol, so I ordered ginger ale, as I did my best to avoid caffeine after 6:00pm.

“How have you been?” he asked.

“Fine. Between the hospital and Rachel, I don’t have a lot of time for anything else, though I am going to karate and band practice.”

“And how is Rachel?”

“She’s doing well. She’s sleeping a bit longer at night, and I think in six to eight weeks she’ll be sleeping six hours, which more or less matches how long I usually sleep. How are you and Yulia doing?”

“I believe the phrase you young people use is ‘hanging in there’. I’m sure you understand that Yulia is still mourning.”

I nodded, “And so are you. And so am I. But we each do it in our own way. I have the advantage, if you want to call it that, of being constantly busy because of all my commitments. That was the main reason His Grace granted my request.”

“But not the only one. You plan to re-marry at some point.”

“I won’t deny that has been something I’ve thought about, but it was not the primary reason. Take your pick between being overcommitted and all the gossip generated because I befriended and evangelized a young woman I met during my training and because of my choice of Lara Federov to care for Rachel, plus the scurrilous rumors started by Nik Antipov.

“All of those decisions were discussed with Father Nicholas and Vladyka JOHN, and, ultimately, they were my decisions to make as Rachel’s father. Whatever Yulia might have thought, she was in no state to care for Rachel when she, in effect, demanded I give up custody to her, something which I would never do for her, or anyone else, for that matter.

“You know as well as I do there was tension between Elizaveta and Yulia, which the two of us worked diligently to resolve, or at least attenuate. I have never objected, at any time, to Yulia’s involvement with her granddaughter, nor did I object to her giving advice to Elizaveta. My sole objection was Yulia’s belief that her word was final on any matter having to do with Elizaveta or Rachel, and that simply was not, nor could it be, the case.

“What I want, and I realize I’m giving a speech, is to find a way to resolve the tension and to come to some kind of agreement on a way forward. I have no desire to keep Rachel away from her grandparents, and that will be true no matter what happens in the future. But that way forward has to include an acknowledgment that I’m Rachel’s father, and ultimately, it’s up to me to make decisions about what is best for her. I’ll listen to advice, but I’m the one who decides.”

“You’ll be happy to know that both His Grace and Father Nicholas agree with you. I received quite the tongue-lashing from His Grace for what I said to you. Deserved, mind you, and I owe you an apology.”

“Accepted. Forgiven and forgotten.”

“It really is that easy for you, isn’t it?”

“Yes. And I’ll make it known to Vladyka JOHN.”

Viktor smiled, “So, you have a back channel to the bishop?”

“His offer to take my call at any time, and to provide whatever support or help it was in his power to provide. But I’m also sure there will be payback!”

“For?”

“Orchestrating his election!”

Viktor laughed, “Something I would wish on nobody.”

“How is Yulia?”

“She needs help, Mike, but she’s refusing.”

I took a deep breath and let it out.

“Have you considered checking her into an inpatient facility?”

“Committing her?”

“I doubt you could do that. I remember from my psych Preceptorship that to do that you would have to prove that she’s an immediate danger to herself or others, and cannot care for herself even with assistance. I don’t believe you could meet that standard. She would have to check herself in.”

“I don’t think she’ll do that. Any other recommendations?”

“Not really. She certainly won’t listen to me, and I doubt she’d listen to anyone I recommended. And you’ve tried Mrs. Sokolov or Mrs. Malenkov, right?”

“Both, actually, and her parents as well.”

“What about Anna?”

“She doesn’t believe in psychiatric care.”

“Has she been whispering in Yulia’s ear?”

“I suspect so, but not in front of me.”

“What is Geno’s opinion?”

“Similar to mine, though I’d say we’re typically Orthodox.”

I nodded, “I thought as much, based on Elizaveta’s view, which was similar to Tasha’s — that too often psychology and psychiatry are used to cover for sin. I don’t agree, but that is a common Orthodox opinion.”

“You don’t think that happens?”

“I think sin is the province of priests, not secular counselors. You know I see a counselor and I see Father Nicholas. Both help in their own way, and both bishops suggested secular counseling, as did Father Nicholas.”

“He’s encouraged Yulia to see a counselor, but she’s not listening. I know you’re still a student, but what do you think the problem is? Just privately; I won’t repeat it.”

“She has the same problem that both you and I have, but we respond in different ways. It’s called post-traumatic stress disorder. Most people think it’s related to violence or war, but around a fifth of the diagnosed cases are related to the unexpected sudden loss of a loved one. Psychologically speaking, losing a child is the worst of all, far more than a parent or even a spouse.”

“You’re being treated for that?”