Chapter 34: Sabotage

November 24, 1987, McKinley, Ohio

Doctor Gibbs signed the chart and discharge papers, then I asked Nurse Susan to bring in two ibuprofen for Kari and went back into the exam room.

“All set,” I said. “Let me go over the discharge protocol with you. Doctor Gibbs has said you should use ibuprofen, which is the active ingredient in Advil, for your neck pain, and take it easy for the next few days. No sports, no running, no lifting anything heavier than your textbooks, and no strenuous activity. You’ll need to see your personal physician. Are you from the area?”

“Yes. My doctor is Kelly Preston in the medical building next door.”

“Make an appointment to see her right away. She’ll monitor your whiplash and recommend further treatment if necessary. Usually, mild cases resolve by themselves in a few days. If you feel lightheaded, nauseated, or have double or blurred vision, have someone bring you back to the Emergency Department immediately, or call 9-1-1.”

“What do those symptoms show?”

“They’d be signs of a subdural hematoma — a pooling of blood between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. The most common cause is a rapid change in velocity within the skull that stretches and tears small bridging veins. Alcohol abuse is another common cause, but your liver enzymes are normal and your EtOH level was 0.0.”

“EtOH?”

“Ethanol, aka grain alcohol, as in beer, wine, or spirits.”

“You did a blood alcohol test on me?”

“It’s part of a standard ‘Trauma Panel’, which is what Teri ordered. I wouldn’t have ordered it, but that’s just a style difference. You weren’t altered, so no EtOH level or tox screen was indicated, at least as I saw it. If you had been altered, I’d have probably ordered both. But there was nothing wrong with Teri being thorough. Had you been injured such that you needed an X-ray, we’d have done a pregnancy test.”

“Why?”

“X-rays can injure a fetus, as can any number of medications we use during a trauma assessment. Asking doesn’t help, as it’s entirely possible to be pregnant and not know it, and we can’t accept a statement from a patient about sexual activity because we’d have liability no matter what. Back to your discharge, other than the instructions I’ve given and the questions you’ve asked, is there anything else that concerns you?”

“Just how my dad and his girlfriend are doing.”

“Let me check, and I’ll be right back. I’ll also get you a scrub top to put on. It won’t be warm, but at least it’ll cover you.”

“Thanks.”

I left the room and went to the nurses’ station to ask about her dad’s condition and his girlfriend’s, then went to the locker room to get a size M scrub top.

“Your dad was taken to surgery to repair a compound fracture to his leg,” I said, coming back into the exam room. “Barring any complications, he should be fine. His girlfriend is in critical condition and was admitted to the ICU. She appears to have struck her head on the windshield. She’ll be monitored by neurology and they’ll be able to give you more information.”

“That sounds bad,” Kari said, pulling off her ruined sweater and pulling the scrub top over her head.

“Her vitals are stable,” I replied, “which is important, and that means they can focus on the head and neck injury, rather than life support. I can’t give you a diagnosis or prognosis.”

“All because a dumb dog darted out into the road and Dad lost control of the car swerving.”

“How fast were you going?”

“Probably around 30MPH, I guess. The speed limit is 25MPH, but nobody follows it.”

I wanted to say ‘except me’, because I was a stickler for speed limits, something which had annoyed Jocelyn during High School and Elizaveta later on.

“OK. That’s sufficient to cause severe injury if you aren’t wearing a seat belt.”

“I told Dad that over and over, but he never listened.”

“Which is how doctors feel when they tell people to stop smoking, exercise, and eat right!”

“Am I discharged?”

“Doctor Gibbs signed the papers, so yes, you’re free to go, but you should probably stop in Patient Services and make sure they have your insurance information, either from your dad or from Taft, as well as contact information. I can take you up to the surgical floor once you’re ready.”

“Where’s Patient Services?”

“I’ll show you,” I said.

We left the exam room, and I pointed to the doorway.

“Come back to the nurses’ station and ask for me when you’re done.”

“OK.”

She went through the doorway and I turned in the chart and other paperwork with the duty nurse, double-checked the board, then went to find Doctor Gibbs.

“All set,” I said. “I’ll take her up to Surgery once she finishes with Patient Services.”

“Her dad should be OK, but I’m very concerned about the woman who was with them. Ghost is concerned about brain swelling and gave IV mannitol before sending her up to ICU. Neuro has to evaluate her.”

“That’s what I told Kari when she asked.”

“Good pickup on the bruise on her forehead.”

“Only because I asked about the type of belt and where she was sitting. I didn’t even think about it at first when the paramedics said she was ‘belted’ and the other two hadn’t been.”

“How did it come up?”

“I asked her what had happened, and it was just part of the natural flow of our conversation.”

“Lesson?”

“Talk to the patient!” I replied with a grin. “But that’s not a new lesson.”

“I should hope not! But the specific application of the lesson?”

“That asking a patient what’s wrong is insufficient; asking what led to the ED visit can provide clues to aid in diagnosis.”

“Exactly. We’re often short of time, so sometimes we don’t do it, and, of course, you have to watch your tendency to get too deep into conversation. I’m absolutely not telling you to stop, just to be mindful of your time. You should enjoy pedes because they encourage your style.”

“The opposite of surgery, where nearly every surgeon does their level best to avoid talking to patients!”

“Pretty much, though Doctor Roth is an exception.”

“Mike?” Nurse Susan said from behind me, “Miss Hendricks is ready to go up to Surgery.”

“Thanks, Susan,” I said. “Doctor Gibbs?”

“We’re done. Go ahead.”

I left and met Kari at the nurses’ station, and we headed for the elevators.

“Is it OK to ask now?”

“It is, though I need to tell you something first.”

“You aren’t wearing a wedding ring, so it’s not that! Please tell me you aren’t gay!”

“No, I’m not gay,” I replied. “Most doctors remove their rings when they work in the Emergency Department because they interfere with gloves and can cause tears, and surgeons remove all jewelry, including rings, watches, bracelets, necklaces, and earrings for hygiene purposes.”

“I didn’t know that.”

“Neither did I before I started my observations in surgery and my clinical rotation in the Emergency Department. What I wanted to tell you was that I was married, and I have a three-month-old daughter.”

“You’re awfully young to be divorced, but I hear medical school is a real bitch.”

“My wife died right after she gave birth to our daughter.”

“Oh, shit!” Kari gasped. “I am so sorry! Me and my big mouth!”

“It’s OK,” I replied. “You didn’t know. I don’t take offense.”

“I know, but I really am sorry, both for your loss and for making a really bad assumption.”

The elevator arrived, we got in, and I pressed the button for the surgical floor.

“But one that had a high probability of being true given the divorce rate amongst doctors and the stress and strain of medical school.”

“Even so, I should have been more sensitive.”

“There’s no need to beat yourself up about it,” I replied.

“I suppose this changes the landscape.”

“Perhaps,” I replied. “But maybe not the way you think.”

“What do you mean?”

“It’s complicated.”

“You mean because you have a baby?”

“That’s part of it.”

The elevator door opened, and we stepped into the surgical waiting room.

“I’m not sure what to say at this point,” Kari said, “because I’m not getting the same signals I saw before.”

“That’s my fault,” I replied. “I have to go back downstairs because I’m working.”

“You aren’t interested?”

“The answer to that question is not simple. Are you going to class today?”

“I was on my way to school when we had the accident. I missed my class.”

“I’ll leave it to you, but if you want, come downstairs around noon for lunch. If I’m busy, you might have to wait, but I’ll do my best to explain. Then you can decide if you want to ask the question.”

“You know what? I will.”

I nodded, then walked over to the nurses’ station.

“This is Kari Hendricks,” I said. “Her dad is having orthopedic surgery on his leg.”

“Good morning, Miss Hendricks. The surgery started about fifteen minutes ago and should take two or three hours. I’ll have Doctor Abrams give you a status update as soon as he can.”

“Thank you,” Kari said to the nurse. “Thanks, Mike.”

“You’re welcome,” I said.

I headed back down to the ED and was immediately asked to suture a walk-in with a hand laceration from slicing bread with a serrated knife. When I finished, there was nothing on the board, so I went to the lounge. Clarissa came in about ten minutes later.

“Busy morning?” she asked.

“Yes, but not too bad. An MVA with three victims — one to ICU for a head injury, one in orthopedic surgery for a compound fracture, and one discharged. Then I sutured a hand lac.”

“How was your dinner with Viktor?”

“He and I are fine; Yulia probably needs to be admitted to an inpatient program.”

“That bad?”

“I’m not an expert, but I’m positive she’s suffering from clinical depression. She doesn’t trust psychology or psychiatry.”

“That sounds like Tasha,” Clarissa observed.

“It’s a common problem amongst the Orthodox, especially ethnic Russians, because of how the Communists use psychiatry.”

“What will your father-in-law do?”

“He and Father Nicholas are doing their best to convince her to see someone, as are some of the other ladies.”

“You seem to have managed to avoid being depressed.”

“‘Seem’ is the key word,” I replied. “I’m not clinically depressed, which is where the problems arise. Obviously, my depression could turn into clinical depression, but being aware of the risks, and having people who hold me accountable means I have a much better chance of avoiding it than someone like Yulia who won’t even seek help.”

“Clarissa?” Nurse Julie said from the door to the lounge. “Doctor Taylor needs you in Exam 1.”

She got up and left, and I went back to studying my flashcards and notes. The rest of the morning before lunch was relatively calm, and I assisted on a rule-out MI and a broken ankle.

“Lunch, Petrovich?” Clarissa asked when I came out of the exam room after assisting Ellie in applying a cast.

“I might be meeting someone,” I said.

“Oh?”

“I’m not sure. If she doesn’t show in the next fifteen minutes, then we can go, assuming we don’t have any traumas.”

“Anyone I know?”

I shook my head, “No, I just met her. A student from Taft.”

“I thought for a second there you were going to say from Hayes County High!”

“No chance, Lissa! Eighteen is the minimum, and I think at this point, having graduated from High School is probably a requirement.”

“There will be a few disappointed girls at Saint Michael!”

“Do you seriously think that’s wise? I understand you like to tease, but you don’t actually think that makes sense, do you?”

“I think it depends. Your new thinking would have ruled out Elizaveta and Lara.”

“And I was twenty when I met Lara, and twenty-two when I married Elizaveta. I’m almost twenty-five now. That’s significant. I mean, sure, six years at age thirty is no big deal for me, but eight years for a seventeen-year-old girl? That’s huge! It’s half their life!”

“Are you ruling out the proposition from your tennis-playing friend in Cincinnati?”

“Here’s my dilemma,” I said. “I don’t want to date, at least as that’s usually understood. If a young woman isn’t already Orthodox, or willing to convert almost immediately, can’t handle me having a daughter, and can’t handle the stress of the next four years of medical training, I don’t even want to go out with her.”

“How do you get the answers to those questions without dating?”

“By asking, of course.”

“Oh, that’s a great idea!” Clarissa exclaimed. “‘Hi, Miss Possibly Right, will you agree to convert to Russian Orthodox Christianity before we have our first date?’.”

“I hear you, but just going out with someone because they’re pretty or interesting doesn’t appeal to me.”

“Then I suggest you ask Lara to marry you right away. She’ll say ‘yes’ and you won’t have to worry about any of the rest of it.”

“I’m not sure I’m emotionally ready to make that decision. I was thinking about the source of my problem, and really, it comes down to something I said to Elizaveta — that she was the only person I would have sex with for the rest of my life. And the only one I’d even think about having sex with.”

“I’d have to agree that is likely the source of your problem. And until you get past that, you absolutely shouldn’t ask someone to marry you. That could end in disaster.”

“I know,” I agreed.

“May I make a suggestion?”

I laughed, “Go on, say what I know you’re going to say!”

“If your tennis-playing friend calls, invite her to visit and take her up on her offer.”

“You know the problem with that, Lissa.”

“May I say something completely out of line?”

“Nothing is ever out of line for you to say.”

“Your understanding of sin needs to reset to how it was when you had your conversation with your mom about Jocelyn. That was much healthier. I’m not suggesting you go on a rampage or have another two dozen lovers, but you know as well as I do you were emotionally and mentally healthier than you are now.”

I debated telling Clarissa about my discussion with Bishop JOHN, and decided she was the one person I could tell, besides possibly Doctor Mercer.

“It’s a bit more complicated,” I said. “If I were to confess missing the mark in that area, it would preclude something Bishop JOHN and I discussed. You have to keep this completely to yourself, which I know you will, but he intends to consider ordaining me a deacon again after PGY1.”

“I thought that was totally against the rules!”

“You know better than that,” I replied. “There is always the possibility of «ekonomia» and while allowing me to remarry while I was a deacon would have created absolute uproar, there is precedent for it, though not in any Russian jurisdiction. He feels, and I tend to agree, that ordaining a twice-married man would create far less uproar, and would likely be accepted by people at Saint Michael the Archangel and Holy Transfiguration.”

“But you aren’t allowed to tell, are you?”

“No. And that means marrying Lara would preclude that. The same is true for Tasha. Or you, for that matter.”

Clarissa laughed, “Mike’s fantasy situation — married to me, with Tessa available to both of us!”

“I seriously never had that fantasy, Lissa. You know how the threesome with Milena and Deb made me feel.”

“Uncomfortable. At least after all the orgasms!”

I laughed, “I never said it wasn’t fun or enjoyable! But it left me feeling empty in a way that my one-on-one encounters never did.”

“There’s one other thing you’re forgetting, Petrovich. Our agreement to have a baby together. That will never, ever fly with you as a deacon. That was going to create no end of trouble if I revealed you were the father of a baby via artificial insemination.”

“True.”

“How do you propose to find out if the future Mrs. Loucks is willing to be married to a clergyman when you can’t tell her, and she’ll assume it’s not possible?”

“You obviously see my dilemma.”

“Again, using my privilege as Svetlana Yakovovna, I think your slavish obedience to your bishop’s wishes is causing you too much stress. It’s my opinion you drop that idea of being clergy again, no matter how much your bishop might want it to happen. That would free you to choose without having to try to guess how springing that surprise on the young woman would turn out.

“I want you to be healthy, happy, and successful. I want to have our baby together. And I want you to give Rachel the mother you desperately feel she needs. I don’t give a damn what your bishop wants, and frankly, at this point, neither should you.

“You said, all along, that you were happy being a catechist and Sunday School teacher, and never wanted to be ordained. Your ordination caused all sorts of heartache, and while it led to you marrying your pussy cat, and having a beautiful daughter, it also created more stress than medical school, and that’s saying a lot! Would you like my prescription?”

“Practicing medicine without a license?” I asked with a grin.

“No, because this is psychology, not medicine. I’m dead serious about this. Play tennis, have your bath with Doctor Blahnik, and spend the night with Tessa and me.”

“What part of a threesome making me feel empty did you miss?”

“I didn’t. This would be different.”

“I’m not so sure about that,” I replied. “Why do you think I should do those things?”

“Because they’ll reset you to where you belong. I’d really prefer you didn’t marry until after PGY1 so we could have our baby the natural way, but I don’t think that would be good for you or for Rachel.”

“Mike?” Nurse Susan said from the door to the lounge. “There’s a young woman to see you.”

“Be right there,” I said.

“Your lunch date?”

“If you want to call it that.”

I left the lounge to find Kari waiting for me by the nurses’ station.

“Hi. How’s your dad?” I asked as we began walking towards the cafeteria.

“Out of surgery. They said he’ll be fine, but I can’t see him until around 3:00pm because he’s in Recovery, then has to be moved to a room.”

“And his girlfriend?”

“They said she’s responding to the medicine they’re giving her and that her vitals are stable. They said she has a very good chance of a full recovery.”

“The determining factor is usually whether or not they can control the swelling in her brain. If they’re saying she has a good prognosis, then it means they believe they can.”

“But maybe not?”

“There are many things which have to be taken into account, and I’m not involved with her case, so I can’t say anything one way or the other. The thing to remember is that there are no guarantees in medicine. I suspect the exact words the neurologist used were couched in an ‘if/then’ statement.”