Chapter 36: Stop and Smell the Roses

November 27, 1987, McKinley, Ohio

“Mike?” Nurse Julie said from the door to the lounge just after 9:00am, “There’s someone to see you at the admit desk.”

I got up and went to the desk and saw Kari Hendricks. I asked Nate to buzz her in, which he did.

“Hi,” she said. “I came to see my dad. Do you have time today for coffee or maybe lunch so we can talk?”

“Lunch would be fine,” I replied. “Just come to the Emergency Department. You might have to wait if we’re busy.”

“I don’t have anything to do today, so that’s OK. Are you busy?”

“Not right now. We admitted two people this morning. They came in last night after I went off shift. One stabbed with a carving knife, the other with a serving fork. They had a disagreement about how to carve the turkey.”

“You’re joking!”

“Nope. Fortunately, neither wound was serious, but psych put holds on them. They’ll decide today if they can go home.”

“Crazy! Let me go see my dad and I’ll come back around noon.”

“See you then!”

She left, and I went back to the lounge and sat down on the couch.

“Who was it?” Maryam asked.

“A girl whom I met the other day. She came to see her dad and we’re going to have lunch.”

“Oh,” Maryam replied. “Like a date?”

“Just someone I’m getting to know,” I replied.

“When are you moving?”

“Probably a week from today, because I don’t work.”

“I don’t have a shift next Friday,” she said. “If you need help cleaning before you move in, I’ll help.”

“I hadn’t even thought about that,” I said. “I expected it would be clean.”

Maryam laughed softly, “For a guy? I’m sure. But if it’s been empty, you’ll need to dust, wipe out the fridge and wipe down the appliances, and so on.”

Which was exactly what Elizaveta would have done, if not more.

“That does make sense.”

“Who’s helping you move?”

“Jason and Pete. They’re free at lunch. Tomorrow, I’m going shopping for a few things for the new house. It has some furniture, but the study needs a desk and chairs.”

“Is someone going with you?”

“Derek and Anicka,” I replied.

“Doctor Nielson needs you, Mike!” Nurse Julie called out from the door. “Exam 2.”

“Be right there,” I replied.

“I have two patients to check on,” Maryam said, getting up with me.

We left the lounge, and I went to Exam 2 where Doctor Nielson and Nurse Anna, a pretty nurse with black hair whom I hadn’t worked with before, were waiting with a male patient who I guessed was about thirty.

“Yes, Doctor?”

“Hand lac with no tendon damage for you,” he said. “Christmas tree saw versus palm. Mr. Cutler, this is Mike, and he’s going to suture your hand.”

“Good morning, Mr. Cutler,” I said.

“Hi,” he said. “You’re a doctor?”

“Medical student,” I replied.

“Doc, you’re teaching him on me?” Mr. Cutler asked.

“First, this is a teaching hospital; second, and more importantly, in your position, I’d prefer him to me! I almost never suture. Mike does it all the time, and he’s very good at it.”

“Why don’t you do it?”

Doctor Nielson laughed, “Because I have medical students to do it for me! In all seriousness, this is normal, but, if you insist, I can do it.”

“He’s really that good?”

“The best,” Doctor Nielson said firmly.

“OK,” Mr. Cutler said, acquiescing.

“Anna,” I said, “a suture kit with 4-0 nylon, please. Also saline, an irrigation syringe, a syringe with a 25-gauge needle, lidocaine times two, Betadine, and a stick swab.”

“Right away,” she said brightly.

“I’ll leave you to it,” Doctor Nielson said. “I’ll sign off when you’re done.”

“OK,” I said.

“You’re really that good?” he asked as I washed my hands.

“Doctor Nielson seems to think so, and I haven’t had any complaints. What happened?”

“My brother-in-law and I had cut the tree and were removing some branches from the base. The saw slipped and ran across the heel of my hand. I thought about just putting those butterfly bandages on, but my wife insisted I come to the ER.”

“You’d likely have a nasty scar if you used butterfly bandages, not to mention I’m going to irrigate and paint it with Betadyne. When was your last tetanus shot?”

I put on my gloves and sat down on the stool in front of Mr. Cutler.

“High School, I think.”

“Then we’ll get that updated as well. Anna, would you put that on the chart and ask Doctor Nielson to sign off and bring me a tetanus kit, please?”

“Right away, Mike!”

She set out the supplies I’d asked for, then picked up the chart and left the room.

“Are you allergic to anything?” I asked.

“No.”

“When was your last dentist visit?”

“High school. Why?”

“The anesthetic I’m going to use is the same one they use when they fill cavities. If you’d had an adverse reaction, we’d use something else. Have you had an adverse reaction?”

“No cavities, so I don’t know.”

“OK. Then I’m going to give you the first shot and wait fifteen minutes to see if you react badly. The small dose isn’t life threatening, and any reaction, if there is one, should be mild. We have all the drugs necessary to counteract it right here in the exam room.”

“Like?”

“Epinephrine and Benadryl, and albuterol if you were to have bronchial spasms.”

“How common is that?”

“It’s rare, and severe allergies are rarer still. About 17 patients in 1000 will have some kind of reaction, but of those, less than half will actually be allergic, and only one would be severe.”

“What else could happen?”

“Low blood pressure, low pulse, irregular heartbeat, fainting, nausea, ringing in your ears, and some less common reactions. But those aren’t an allergic reaction, which most commonly would be reduced respiration, bronchial spasms, shortness of breath, or a rash.”

“It sounds like you’ve been paying attention in school.”

“They wouldn’t let me within ten feet of you if I hadn’t!”

“Are you going to start?”

“Because you have no history of anesthesia, I need to wait for the nurse to return in case you do have an adverse reaction so she can assist me until Doctor Nielson comes in.”

“Would Doctor Nielson be this cautious?”

“Yes, but he’s licensed to perform any medical procedure. I need to get permission for pretty much anything I do. The nurse would give you the epinephrine because she has a standing order for that.”

“It seems complicated.”

“It’s meant to protect both of us from me!”

Mr. Cutler laughed, “Nice. Made any mistakes?”

“Not really. I’ve only been on clinical rotations for five months, and I’m limited to taking histories, checking vitals, hooking up monitors, drawing blood, inserting IVs, and suturing.”

“I thought nurses did most of that stuff.”

“In a non-teaching hospital, they do some of it. Otherwise doctors do it.”

Nurse Anna returned with the tetanus kit and set it on the counter.

“Doctor Nielson said you can administer the tetanus shot,” she said.

“OK. I’ll do that after I suture. First, I need to do a needle test for lidocaine allergy. Mr. Cutler hasn’t had any dental work. Would you verify we have epi, albuterol, and Benadryl?”

She checked the cabinet.

“Yes,” she said.

“OK. Administering lidocaine,” I said to Anna.

I carefully injected .5 millilitres of lidocaine into the wound.

“Now we wait,” I said. “Tell me if you feel faint or lightheaded or your chest feels tight.”

“So far, so good,” he said.

“How tall is the tree?”

“About ten feet. We have a vaulted ceiling. The kids love the huge tree.”

“I bet. How many kids?”

“Two; they’re six and four.”

“What do you do for a living?”

“I work in the Hayes County Clerk’s office as a supervisor.”

He had no adverse reaction to the lidocaine, so I proceeded to anesthetize the laceration, irrigate it, paint it with Betadyne, and then put in six sutures. After Doctor Nielson reviewed the sutures, Anna dressed the wound, and then I picked up the tetanus kit.

“Mike, have you administered a tetanus injection?” Nurse Anna asked.

“No.”

“This is a pre-filled kit; tear it open, shake it, then administer it into the deltoid.”

“Alcohol wipe, please,” I requested.

I cleansed the spot on Mr. Cutler’s upper arm, then opened the package that contained the pre-filled syringe. I shook it, then administered the injection as Anna had directed.

“All set,” I said. “Let me speak with Doctor Nielson. Once he signs off, you can take your discharge forms to Patient Services.”

Ten minutes later, Mr. Cutler left.

“You did a great job on those sutures,” Anna said.

“Thanks.”

“And your bedside manner is awesome, too.”

“Thanks, again,” I said.

“It was good working with you! Maybe I’ll see you in Internal Medicine when you do your rotation.”

“That’s in April,” I replied. “Is that your usual service?”

“Yes. I wanted the OT, so I took the overnight ER shift. I was a ER nurse for the first two years after nursing school before I moved to Medicine two years ago.”

She went to the nurses’ station, and I went to the lounge, where Clarissa and Maryam were doing the handover. They finished, Maryam said ‘goodbye’, and then went to the locker room to change.

“How was your Thanksgiving?” Clarissa asked.

“Other than eating late, fine. What did you and Tessa do?”

“Ate dinner together about 11:00pm. She bought a pre-packaged Thanksgiving meal for two from Kroger. All we had to do was heat it up. You and I are in for messed up holidays for four or five years.”

“It comes with the territory,” I replied. “By the way, I’m having lunch with Kari.”

“And having Annette for dinner?” Clarissa smirked. “Or is that for dessert?”

“Lissa, please stop pushing. I know your opinion. It almost feels as if I made an error confiding in you about wanting a mom for Rachel.”

Clarissa sagged, “I didn’t realize you felt that way.”

“I know what I’ve said, but I also know it’s only been three months and despite outward appearances, I’m struggling with what happened, and I’m torn between competing emotions. And maybe that’s the source of the physiological problem. I promised Elizaveta I’d never be with another woman besides her, and I suspect that’s part of the problem. I know that promise was based on the idea that we’d be married for fifty or sixty years, and my acceptance of what appeared to be an extremely remote possibility of lifetime chastity. But it didn’t work out that way.”

“You know you can never gain her approval, right?”

I nodded, “I know. But that’s only part of the problem. I’m not sure I can avoid comparing a future partner with Elizaveta. That’s a recipe for disaster.”

“You never compared Lizochka to any of the other girls you were with.”

“I left that to her,” I replied with a smile. “She pointed out the deficiencies in the other girls, mostly that I wasn’t fishing in the correct pond. And that’s why I kind of dumped everything on Kari. The ‘handsome young doctor’ has a lot of baggage and some non-negotiable conditions. As crass as it might sound, I’m not going to waste time on someone who isn’t open to becoming Orthodox.”

“Don’t you think someone could fall away?”

“Yes, of course, but that’s just as likely with someone who is cradle as for a convert. In fact, it might be more likely for someone who is cradle.”

“None so zealous as a convert?” Clarissa suggested.

“Something like that.”

“Well, there are six or seven girls who are at least seventeen and Seniors at Saint Michael, though I’m not sure marrying a single mom makes sense.”

“Tasha?” I asked.

“She’s not at Saint Michael! I was referring to Vickie. Tasha is different. I don’t think Sheila would be a good idea, except as a friend.”

“I heard that emphasis, Lissa! I don’t think I need friends like that. If I did, I’m sure Erin Edwards or Nurse Ellie would be very happy to be friends. I’m not interested.”

“I’m not trying to be difficult, but how are they different from Annette?”

“She doesn’t work at the hospital and she’s not the daughter of the Chairman of the Hospital Board!”

“I’m going to work at the same hospital as you, Petrovich!”

“You’re exempt from all the rules, Lissa. Well, minus my inviolable rule against cheating on my spouse.”

“You know,” Clarissa smirked, “we could have our one and you and Tessa could have two...”

“I’m not quite sure how I’d explain that to Vladyka JOHN!”

“If you aren’t clergy, do you have to?”

“I’m still a catechist,” I replied. “And a Sunday School teacher. I’d have to give that up in a situation like that.”

“And our kid?”

“I think that’s solved by saying we decided to do it while we were at Taft before I was ordained and you had complete control over the sperm. It might cause some heartburn, but it’s not sinful in any way. And that allows us to acknowledge our child publicly.”

“That would end any chance of you being a deacon, right?”

“I would think so, but if you want to have our baby, I’m not going to accept the bishop’s offer to ordain me, if the offer actually were to be made, which it might not.”

“You know my take on that. With everything that happened after you were ordained, I can’t imagine why you’d even consider it. Well, that’s not true; I know why. Your belief that obedience to your bishop has to override your own good.”

“I think it’s more my servant’s heart,” I replied. “It’s why I’ve been talked to about the amount of time I spend with patients on all three Clerkships, and about half my Preceptorships. I feel a deep need to serve others and be compassionate. Remember, none of the BS was relating to any of my duties, but came about because of my grandfather and Tasha pushing me to get involved. And hopefully, that drama is done.”

“Do you really believe that?”

“A man can hope!”

“I think you need the freedom that comes with not being clergy, but I’ve said my piece on it. Just don’t let that cause you to make a bad decision about a mom for Rachel. Is being a deacon in the future what’s best for her?”

“The master trump,” I replied. “Rachel.”

“I’ll leave you with one final thought — Rachel needs her dad to be healthy, not just physically, but spiritually, mentally, and physically.”

“Clarissa?” Nurse Trudy said from the door, “Doctor Boyd needs you in Exam 2.”

Clarissa left and, about two minutes later, Nurse Trudy returned.

“Paramedics five minutes out with a possible MI. Meet Doctor Nielson at the ambulance bay doors.”

The rest of the morning was busy, and I finally came out of the trauma room fifteen minutes late for my lunch after helping Doctor Casper with a toddler who had decided to sample one of his Mom’s Christmas cookies without letting it cool and had burned the roof of his mouth to the point it had blistered.

“Sorry about you having to wait,” I said to Kari.

“It’s OK. You were doing doctor stuff!”

“How are your dad and his girlfriend?”

“Dad is cranky, but they say he’ll make a full recovery. His girlfriend is suffering from a bit of amnesia, but the neurologist thinks it’s temporary, as she’s regained some of the memory loss. Dad can go home on Monday, most likely, but she’ll probably be in the hospital for another week. You don’t get updates?”

“No. Our job in the Emergency Department is to stabilize a patient and pass them onto to other services if we can’t treat and release them. Once they leave the Emergency Department, they aren’t our responsibility.”

“So you never know what happens?”

“For the most part? No. We’ll hear about exceptional cases in the M & M conferences, or through the hospital grapevine, but otherwise, no.”

“What’s an M & M conference? Do you sit around and eat candy?”

“Hah-hah! It stands for Morbidity and Mortality and it’s where doctors, nurses, and medical students review cases to find where we might have done a better job. It’s all off the record, and can, on occasion, get a bit heated because people don’t like criticism, even if it’s accurate.”

“So, like if someone dies because of a mistake?”

“In some cases, yes. More often, though, it’s cases where a diagnosis is not quickly made because the true problem is masked, or presents in a way that is out of the ordinary, or someone has a condition that wasn’t detected in time for some reason. Fortunately, negligence is really rare. Unfortunately, sub-optimal treatment is not.”

“You sound like you think that’s OK.”

“I don’t think it’s OK, but it is a function of medicine not being an exact science. The entire point of the conference is to find out where we can improve our process or our knowledge. If you’re concerned about us not blaming anyone, that’s not the function of an M & M conference. That happens in court or before a medical review board.”

“Have you made mistakes?”

“Yes, but not in any procedures, as I’m really limited in what I can do. I have missed things in taking patient histories, but I’ve either caught them myself or had a nurse or doctor catch them. It’s part of the learning process.”

We arrived at the cafeteria and I paid for our lunches, receiving the subsidy discount for mine. We sat at a table away from most people so we could have a bit of privacy. I silently prayed a blessing and Kari and I began eating.

“I’ve been thinking about everything you told me last time,” she said. “Can I ask you a question?”

“Always. If I can’t answer for some reason, I’ll tell you why.”

“Did you dump all that on me on Wednesday because you weren’t interested?”

“No. I know it seems like I was trying to sabotage any chance of a relationship, but I really wasn’t. I simply felt you deserved to know what you were walking into.”

“Don’t you think it would have been better to go out first? Or get to know each other?”

I shrugged, “Maybe. But I have my reasons.”

“Care to share?”

“I’m sure you remember I said my daughter takes precedence; what I didn’t say directly is that I believe with all my heart that she needs a mom. I don’t have much free time and won’t for the next four years, so I need to make the most of the time I do have. That means not spending time on a dead-end relationship.”

“Harsh.”

“I know. But if the purpose of dating is to decide if you want to marry someone, shouldn’t you stop dating as soon as you figure out that you don’t want to marry them?”

“I suppose that’s true when you’re ready to get married, but if you’re just dating, then there’s no reason to break up if you enjoy doing stuff together, even if it’s not going to be permanent.”

“You see the conflict, right?”

“You’re looking to get married? This soon after your wife died?”