Chapter 6: Busy Days; Restless Nights

September 3, 1987, Indian Hill, Ohio

“How was your day?” Lara asked when I arrived at Doctor Cooper’s house on Thursday evening.

“Being busy helps,” I replied. “How is Rachel?”

“Good. She wasn’t fussy at all, she ate OK, and fell asleep OK. I made a chart to mark when she ate and when I changed her diaper and when I put her down in the portable bassinet.”

“I appreciate your help,” I said. “I have no idea how I’ll ever pay you back for this.”

Lara smiled, “You saved my life!”

I laughed and nodded, then said, “You rewarded me for that, even if that statement was a bit of an exaggeration!”

“You don’t owe me anything, Mike. I want to help, just as everyone else does, including Clarissa, Tasha, and Jocelyn.”

“I’m going to guess you all spoke.”

“Of course. There was an ‘‘All-Party Congress’!”

I laughed again.

“I don’t think there’s a single liberal, let alone communist, in that group!”

“I’m glad I can make you laugh; I’m sure it can’t be easy.”

“It’s not.”

“I’m going to head out,” Lara said. “See you early tomorrow morning.”

“Thanks again, Lara,” I replied.

She smiled and I walked her out, then returned to my room to change. I checked Lara’s chart and saw that it was almost time for Rachel to eat, so I carefully picked her up and sat on the small sofa, just holding her and wondering if I was going to be a good dad, and how we’d make it without Elizaveta.

“Mike?” Annette said quietly from the door to my room, “dinner in five minutes.”

“Thanks,” I said.

I decided I’d take Rachel with me, so I put her in the baby carrier and went to the dining room and sat down with Rachel on the chair next to me which was usually empty, as Neil and Doctor Cooper sat at the head and foot of the table, and Annette and Alan sat side-by-side across from me.

Everyone else came into the dining room with Doctor Cooper and Annette bringing in the food, which was a roast, mashed potatoes, and corn. Fortunately, Rachel waited until after we’d eaten to decide it was time for her bottle, and while Neil and Alan cleared away the dishes, Annette changed Rachel’s diaper while I made a bottle of formula. When I had it ready, I took Rachel from Annette and went to sit in the living room to allow Rachel to eat, with Annette following me and sitting at the opposite end of the sofa.

“How was your day at the hospital?” she asked.

“I kept busy, which is important,” I replied. “Having to focus on medicine pushes the swirling thoughts out of the forefront.”

“I can’t believe what you’re going through.”

“I wish I didn’t believe it,” I replied. “It’s a nightmare from which I can’t wake.”

“Is there anything I can do to help you?”

“Other than help with Rachel? Not that I can think of.”

I finished feeding Rachel, burped her, put her down in her crib, then elected to stay in my room and read. I had a tough time concentrating on The Stand, but I was almost finished so I kept reading. There were a few twists, even after what amounted to the final confrontation between the forces of good and the forces of evil, and I had just a few pages to go when I decided I needed to turn in because Rachel would be waking me up a few times during the night.

I emptied my bladder, brushed my teeth, turned out the overhead lights, and got into bed. Sleep didn’t come easily, and the more I tried to clear my mind, the more overwhelming the sense of loss, the emptiness, and the feeling of being untethered became. Eventually, I got up, put on a robe, went to the kitchen, and got a drink of water, hoping I could clear my head.

It didn’t work, but I went back to bed anyway, not fighting the tears that welled up, eventually sobbing and crying myself to sleep.

September 4, 1987, Greater Cincinnati, Ohio

“You look like hell,” Lara said when she arrived on Friday morning.

“I couldn’t sleep,” I said. “Nothing I tried worked.”

“Could you call in sick?”

“Could I? Yes, but what’s that going to do? I’ll just sit around here and think about Elizaveta. The one place I can get peace at the moment is the hospital, where I basically always have something to do. And honestly, it’ll be worse during my first year of Residency.”

“I can’t dispute that,” Lara said, “but this is different. The emotional toll combined with the lack of sleep is not the same as just having to stay awake for thirty-six hours.”

“And yet, as a doctor, I have to set that aside and keep working.”

“I’m concerned, Mike.”

“I’ll be home tomorrow afternoon,” I replied. “And I have a few days off.”

“I’m not going to be able to talk you out of this today, but I’ll come by tomorrow with Clarissa.”

I realized it was pointless to argue with her.

“OK. I do need to get going or I’ll be late.”

“Take care of yourself and I’ll see you when you get back.”

I checked on Rachel in her crib, kissed her forehead, then left for the hospital.

“Deacon,” Maryam said when I walked into the locker room, “you look very tired.”

“I didn’t sleep well last night,” I said.

“Did Rachel keep you awake?”

“No, I just couldn’t get my mind off what’s happened.”

“How can I help you?”

“Right now? I just need to make it through today. Tomorrow I have a half-day in Doctor Cooper’s office, then I’m going home until Monday evening.”

“Who’s helping you this weekend?” she asked.

“I haven’t worked that out, but I’m sure the cabal has a plan.”

“Who?”

“Clarissa, Tasha, Jocelyn, and Lara.”

“You know I’ll help you in any way I can, Mike.”

“Thanks,” I replied.

She went to one of the shower stalls to change, as she usually did, and I began changing into scrubs. Five minutes later we joined Nicole for pre-rounds, then met with Doctor Kelly and Doctor Phillips to present on the three women who were in labor and two who would be discharged. Three women had called in to say their labor had begun, which meant they’d arrive within a few hours.

“You look like shit,” Doctor Kelly commented when she pulled me aside after rounds.

“I believe that’s a unanimous opinion,” I replied, “though the others said ‘you look like hell’ and ‘you look tired’. I didn’t sleep much last night.”

“The baby?”

“No.”

“Ask Doctor Cooper to prescribe a mild sedative.”

“Then I couldn’t work,” I replied.

“If the dose is low enough and you take it early enough, she can write you an exemption which will be approved.”

“And then who takes care of Rachel?”

“You’ll need to find someone.”

“I don’t like that idea,” I protested.

“And if you don’t get some sleep, you’ll be of no use to your patients, your daughter, or yourself.”

“Thirty-six-hour shifts as a Resident?” I countered.

“Difficult enough without emotional trauma. This is your last hospital shift until Tuesday, right?”

“Yes.”

“Then speak with Doctor Cooper, ask her for the prescription, and see if you can sleep through the three nights.”

“Are you trying to tell me I shouldn’t be here today?”

“Are you a danger to patients or yourself?”

“No more than I usually am,” I said with a wry smile. “My best friend often says she can’t leave me alone for a minute without me finding some way to get into trouble.”

Doctor Kelly laughed.

“So, like most men!”

“You know, you’ve never mentioned a boyfriend.”

“You’re right, I haven’t.”

There was something in her voice that made it clear why, though if pressed, I couldn’t have identified what it was.

“My best friend is lesbian, and my closest guy friends are gay or bi,” I said quietly.

“Why would you say that?” she asked.

I shrugged, “A gut feeling.”

“I’d prefer not to discuss my private life,” she said, which in my mind confirmed my suspicion, not that it mattered much one way or the other to me.

“Then I’d like the same courtesy, please,” I replied.

“There’s a difference — I’m responsible for you, and one of the things I evaluate is your mental and emotional fitness to be a physician, as well as your judgment. If your personal life affects, or has the potential to affect, your performance, then it is my business, and Doctor Cooper’s business.”

“My non-snarky answer to your question is that I am not a danger to myself, nor am I a danger to my patients. This is where I need to be.”

“Do the two discharge exams and the three incomings, please.”

“Yes, Doctor,” I replied.

It was basic medicine, not scut. I’d been briefly concerned that Doctor Kelly would decide to keep me away from patients, but she’d given me the benefit of the doubt, and that meant I had to be absolutely sure I did everything ‘by the book’. Despite being tired, I was able to focus, but I made use of the procedures checklists I’d written in my notebook to ensure I complied with every step.

Both discharge exams were routine, and I found nothing which would indicate a need for either of them to stay in the hospital another night. I updated the charts, then reported to Doctor Kelly that both women could be discharged. She signed the forms and had me take them to Doctor Phillips for approval.

“How are you doing, Mike?” Doctor Phillips asked, after he reviewed the paperwork and signed it.

“I’m as tired as I look,” I said. “I had trouble sleeping last night. But I’m focused and Doctor Kelly is keeping an eye on me.”

“I was more concerned about your mental health,” he said. “Doctors function on little or no sleep all the time.”

“Honestly? Medicine is an escape, and being able to focus on my work helps.”

“Are you seeing a counselor?”

“Yes. Doctor Fran Mercer, in Milford. I had a past relationship with her because a very close friend is suffering from what appears to be schizophrenia.”

“That’s a rough diagnosis. College-age when she was diagnosed?”

He’d made an assumption, which was fairly safe, that it was a female friend.

“Yes. She started exhibiting symptoms during Freshman year, but none of us recognized them for what they were.”

“Not surprising, really. I’ll let you get back to work.”

“Thanks, Doctor.”

I left his office, returned to Doctor Kelly’s office which was just down the hall where I handed her the discharge paperwork, then went to see if Mrs. Baker had arrived. She had, so I went to the room where a nurse was getting her settled.

“Good morning, Mrs. Baker,” I said. “I’m Mike, a Third Year medical student. I’d like to take your vitals, please, and review your admission paperwork.”

“Medical student?” an older woman who was in the room queried.

“Yes, Ma’am,” I replied. “I’m qualified to check your pulse, blood pressure, and breathing. I’m also qualified to hook up the fetal monitor to check the baby’s heartbeat. Once I’ve done those things, I’ll report to Doctor Kelly, my Resident, and she’ll come to see Mrs. Baker.”

“It’s OK, Mom,” Mrs. Baker said. “Doctor Phillips explained how this works. Go ahead, Mike.”

“Thanks,” I replied.

I checked her pulse, blood pressure, heart, and lungs and noted that her BP was a bit high at 140/86, but that wasn’t high enough to warrant me calling Doctor Kelly or Doctor Phillips immediately, but it did mean I’d need to check it again once I ran a strip on the fetal monitor.

“I’m going to attach the monitor to you,” I said. “I’ll need to touch you under your gown to attach it. If you’re uncomfortable with that, the nurse can assist.”

“Go ahead,” she said.

I hooked up the monitor, then ran a strip which showed a good fetal heartbeat, with typical variation during the two contractions she had in the ten-minute span. I removed the monitor, then checked her BP again, and found it to be 134/72, which was in the typical range. But, that change also meant I’d need to check once more after ten minutes. I used the time to review the admission paperwork and ensure it was completed, as well as had her blood type listed. Everything appeared to be in order, so I repeated the blood pressure measurement.

“Why are you taking my daughter’s blood pressure so many times?” Mrs. Baker’s mother asked.

“Because the first reading was slightly elevated, and the second wasn’t. I need a third to determine if it needs attention.”

I checked and received a consistent reading of 134/70.

“It appears to have been a temporary spike,” I said. “I’ll go report to Doctor Kelly, the Resident, and she’ll come to see you.”

I took the readout strip from the fetal monitor and went to Doctor Kelly’s office and made my report. She looked over the strip and agreed everything looked good.

“To what do you attribute the BP spike?” she asked, handing back the readout.

“Stress, most likely,” I said. “Being driven to the hospital and checking in. Well, that or her hovering mother.”

“Explain.”

I did.

“Husbands can be wimps or freak out,” she said, “but soon-to-be grandmothers are the worst. They raise MY blood pressure. Did you ask about the baby’s father?”

“No. I didn’t believe that was my place.”

“Doctor Phillips will know, as she’s his patient. Did you do an internal exam?”

“You didn’t expressly tell me to do one, so, no, I didn’t.”

“It’s part of the standard admission process, right?”

“Yes, but given your caution earlier, I felt it was better to perform the exam the way a typical Third Year here would, and that does not involve a pelvic exam.”

“Why the caution?”

“Because you’re concerned about my mental, emotional, and physical state. While I think I’m able to perform my duties, I also realize I might not be the best judge.”

“Good insight. Do you drink?”

I knew her concern, because the situation I found myself in — stressed, emotionally distressed, and not sleeping were prime indicators of the potential for alcohol or drug abuse, according to our Practice of Medicine course.

“Only rarely, and by rarely, I mean special occasions, and even then, only a splash so I can participate in traditional Russian toasts. I basically teetotal otherwise.”

“No history with drugs?”

“I’ve never taken anything stronger than an aspirin or ibuprofen. Well, I was given a sedative right after Elizaveta reposed.”

“‘Reposed’? I’ve never heard that word.”

“It’s a typical Orthodox usage,” I replied. “I’ve never heard of any other group who uses it. We also would use the more traditional ‘fell asleep in the Lord’. But I know from training that we’re never to use euphemisms for someone who dies when speaking to a family.”

“Do you know which sedative they gave you?”

“Half a milligram of lorazepam.”

“One of the possible side effects is rebound insomnia.”

“I don’t think this is that,” I replied. “That was a week ago, and just enough to allow me to fall asleep.”

“Any memory loss?”

“In some ways, I wish, but no.”

“Hold out your hands, please.”

I did and to me they were steady.

“OK. Let’s go see Mrs. Baker and perform a pelvic exam. You can report to Doctor Phillips.”

I knew I was being tested to see if I could handle the stress in my personal life, and that meant continuing to exercise caution. I followed Doctor Kelly to Mrs. Baker’s room where Mrs. Baker’s mother was hovering at the bedside and reminded me of Yulia before I had put my foot down at the start of my marriage. I shoved that thought out of my mind and tried to focus on medicine.

“Good morning! I’m Doctor Kelly and I’ll be assisting Doctor Phillips with delivering your baby. You’ve met Mike, one of our brightest medical students.”

“Hi, Doctor,” Mrs. Baker replied.

“And who do we have with you?”

“My mother, Mrs. Mueller.”

“Good morning, Mrs. Mueller,” Doctor Kelly said. “Would you please have a seat so we can perform our exam?”

Mrs. Mueller didn’t say anything but moved away.

“Mrs. Baker, we need to do a pelvic exam. This is a teaching hospital, so I’d like Mike to do the exam and then I’ll confirm.”

“Susan!” Mrs. Mueller exclaimed. “You don’t want to be a guinea pig!”

“Doctor Kelly,” I said, wanting to prevent a fight between the two women, “I have another patient for an admit exam. Why don’t I take care of that?”

“Go on,” Doctor Kelly said.

I left and went to the nurses’ station to find where Ms. Schulz was. I checked the board, then walked down the hall to her room, knocked, and walked in.

“Good morning, Ms. Schulz,” I said. “I’m Mike, a Third Year medical student.”

“Oh, for heaven’s sake! I’m Kathy! Good morning.”

“Kathy, then,” I replied. “Doctor Kelly sent me to do a basic exam — take your vital signs and hook up a fetal monitor to check your baby’s heartbeat. Do you have someone with you?”

“No. My boyfriend was in Indianapolis for work and is driving back. Hopefully, he’ll make it. The LAST person I want here is my mom!”

“I hear you! If your boyfriend has already started driving, he should make it easily. OK to begin the exam?”

“Yes, of course!”

Everything checked out with her pulse, BP, heart. and breathing.

“I need to put the fetal monitor on you, which means reaching under your gown.”

“You’re going to be here for the delivery, right?”

“Probably, but I have other patients as well. Why?”

“Well, if my feet are going to be in stirrups with my legs spread wide, somehow attaching a monitor seems totally modest!”

“True,” I agreed.

I ran a strip and then disconnected the monitor.

“What does it show?” Kathy asked as I updated her chart.

“Your baby’s heart rate is exactly where it should be. I’m going to report to Doctor Kelly, my Resident, and then she’ll come to see you for a pelvic exam.”