Chapter 91: Deep Subjects/Finding Limits

March 18, 1988, McKinley, Ohio

“Morning, Mike!” Doctor Gabriel said when I walked out of the locker room. “Good to see you!”

“I’m covering for Peter Baldwin.”

“Ghost let me know when he went off at midnight. He’s back at noon.”

“The board looks relatively clear,” I observed.

“Last night was calm. As you can see, all that’s left is a rule-out concussion. We’ll kick him at dawn, assuming he’s asymptomatic.”

“Doctor Gabriel?” Nurse Kelly called out. “Paramedics five minutes out with single MVA versus telephone pole.”

“Thanks, Kelly. Set up Trauma 1 please.”

“Will do!” she replied.

“Game time, Mike!”

We put on gowns and gloves and went to stand in the ambulance bay to wait for the paramedics, who rolled up four minutes later.

“Male; early forties; restrained MVA versus telephone pole; LOC at site with GCS 6; broken tibia and fibula; broken radius and ulna; facial contusions and lacerations; BP 90/50; pulse thready; resps labored and shallow; PO₂ 90% on ten litres by mask; IV saline TKO.”

“Trauma 1,” Doctor Gabriel ordered. “Mike, call for the portable X-ray.”

We moved the patient into Trauma 1 where Nurse Julia and Tami were waiting, and I went to the phone to call radiology while the two paramedics assisted Doctor Gabriel, Julia, and Tami with moving the patient to the treatment gurney.

“Carl is on his way,” I said to Doctor Gabriel after I replaced the phone on the hook.

“EKG, Mike.”

I retrieved a kit, cut the patient’s shirt off and began attaching leads while Julia drew blood and Doctor Gabriel continued his assessment.

“Tami,” Doctor Gabriel said, “call for neuro, please, I have fluid in the auditory canal.”

I finished attaching the leads, connected the cable, and turned on the monitor.

“Runs of SVT,” I said, after studying the monitor for thirty seconds. “Consistent with vitals.”

“Julia, a full ampule of mannitol, 25%, in the IV bag, please; have Tami take the blood to the lab. Mike, Foley.”

I got a Foley tray and began carefully cutting off the patient’s pants. I stopped when Carl arrived with the portable X-ray machine and everyone except him and Doctor Gabriel left the room. They put on lead aprons and shot the X-rays, then we went back in. I finished with the Foley just as Doctor Vanderberg arrived for the neuro consult. I waited while they discussed the case and Doctor Vanderberg conducted an assessment.

“Mike, Babinski, please,” Doctor Vanderberg requested.

I removed the patient’s shoes and socks and performed the test.

“Indifferent Babinski,” I announced. “No response on either foot.”

“He’s stable enough for a CAT scan,” Doctor Vanderberg announced. “Let’s splint the broken appendages, then I’ll take him.”

Tami had returned, so she and I splinted the broken arm and leg, then I helped Doctor Vanderberg’s student, a Fourth Year named Tom, move the gurney to the room where the new CAT scanner had been installed. I’d never seen it operate, but I couldn’t stay, as I needed to get back to the Emergency Department.

“How are you doing, Mike?” Tami asked when I returned to the Emergency Department.

“Good.”

“I was surprised to see you. You’re covering for Peter?”

“Yes.”

“Want to have lunch if we can swing it?”

“Sure.”

The next few hours were relatively quiet with a slow but steady stream of walk-in patients, but only one paramedic run which was a rule-out MI. Around 9:00am Doctor Gibbs asked me to help with a five-year-old with a broken finger. Twenty minutes, a splint, and a small bag of M&Ms later, the young man and his mom went to Patient Services.

“Word’s going to get out,” Doctor Gibbs said with a smile. “Kids are going to demand to come to the ER to get candy!”

“Somehow I don’t see the average five-year-old deciding that it’s worth seeing a doctor to get M&Ms!”

“Hi, Mike!” Nurse Ellie exclaimed, winking as she walked past.

“Hi, Ellie,” I replied.

“She’s still interested,” Doctor Gibbs said quietly.

“In EVERY swinging dick in the hospital!” Julia said, overhearing us as she went by.

“She’s smoking hot, but no thanks,” I replied. “Being OK with cheating isn’t cool.”

“Doctor Gibbs?” Nate called out.

She went over to him and a minute later, she waved me over.

“This one is for you,” she said. “Don and Tina are Taft students in need of some help in Exam 2. Take Tami with you.”

I asked Tami to join me, and we went to Exam 2.

“I’m Mike,” I said. “This is Tami. What seems to be the problem?”

“We, uhm, lost our condom,” Tina, a pretty blonde, said.

“OK, but wouldn’t it have been easier to go to Student Health Services?”

“No, uhm, like lost it,” Don, a tall, sandy-haired guy, said.

“Lost it?” I asked, confused.

“You know, after...”

It finally dawned on me what they meant.

“You’re going to have to tell me how that happened, please,” I said.

“We were fooling around this morning and when we finished, I couldn’t find it.”

“Did you go soft before you withdrew?” I asked.

“Yeah.”

“OK. Tina, we can remove the condom with a speculum and forceps, so it’ll be similar to a gynecological exam. Are you using any other method of birth control?”

“No,” she replied, resignedly, immediately figured out why I asked.

“There’s a very good chance that semen found its way into your vagina,” I said. “That means there’s a significant risk of pregnancy.”

“Shit,” Don swore.

“It’s very important that you always grasp the condom and withdraw while you’re still erect. What happened is exactly why. Tina, I can do this after I clear it with my supervisor, but if you’d prefer, I can get a female to do the procedure.”

“You seem cool, and my gynecologist is a guy. It’s OK.”

“Let me confirm with Doctor Gibbs. Tami, gynecological tray, please.”

I walked out into the corridor to find a smirking Doctor Gibbs.

“Permission to do a forceps extrication on a retained prophylactic?” I asked with a grin.

“Granted,” she said, barely suppressing a laugh.

I saw the nurses all tittering at the nurses’ station, so it was obvious they all knew.

“Why me?” I asked.

“First, to see your reaction; second, I’m confident you can do it; third I felt they’d respond better to you and your style.”

“I did mention the risk of pregnancy.”

“OK. Go ahead and if you see anything abnormal, or can’t extract the condom with forceps, come get help.”

“Yes, Doctor.”

I went back to Exam 2 and asked Tami to help Tina get into an exam gown, then stepped out into the corridor to wait. Tami called me in two minutes later.

“Tina, do I have your permission to examine you?” I asked.

“Sure.”

“Do you want Don to stay?”

“It’s fine,” she said.

I pulled the stool to the end of the exam table, Tami helped Tina put her feet in the stirrups while I washed my hands and put on gloves. I moved over to the stool, sat down, and picked up the speculum. Tami squirted lubricant on it for me, then squirted some onto my finger. I carefully spread lube between Tina’s labia, spread them with my fingers, and inserted the speculum.

I picked up the pen light, held it at the proper angle, and saw the condom. I picked up the forceps, carefully guided them through the speculum, twisted them slightly, and grabbed the used prophylactic. I extracted it and saw that semen had, indeed, leaked. I put the condom into an emesis basin, removed the speculum, then stood up.

“All set,” I said. “There was semen outside the condom. If you miss your next period, you should see your gynecologist. I’m going to step out. Tami will help you get cleaned up and then you can dress.”

I stepped out, filled out the chart, and took it to Doctor Gibbs to sign off.

“Obvious leakage,” she observed, shaking her head. “That could ruin their entire day.”

“Yep. I’ll remind Don again about proper condom usage, and suggest a backup method.”

“Good job, Mike.”

Tami opened the door and signaled for me to come in. I went over proper condom usage with Don and suggested Tina speak to her gynecologist about a diaphragm, or that they use a spermicide, or both. I also gave them a brochure for the Free Clinic, and after a brief chat, I sent them to Patient Services, and they left the exam room.

“I could barely keep myself from laughing,” Tami said after Don and Tina left and the door had closed completely.

“That is one for my procedure book that I bet nobody else in my class has!”

“I was surprised that Doctor Gibbs asked you to do this, and that Tina was OK with you doing it. You must have done more on your OB/GYN rotation than most Third Years.”

“I did. I was allowed to do internal exams, which isn’t typical.”

“How did that happen?”

“I asked! Doctor Kelly at Good Samaritan gave me a chance to prove I knew what I was doing, and once I did, she let me participate as much as the Attendings would allow. We got some grief, but it also proved that the articles I read about hands-on training being the best way to learn, and that it should start as soon as possible, are correct.

“It also conforms to what Sir William Osler, co-founder of Johns Hopkins Hospital, and the creator of the first Residency program said — ’Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from words in the lecture room or read from the book. See, and then reason and compare and control. But see first.’

“As a nursing student, you get to do practical training after one year; for us it’s close to six, because we have to have an undergrad degree and two years of medical school. In Europe, it’s a total of six years, but only two are classroom, the other four are practical. In effect, future physicians go straight to medical school, rather than a regular four-year university. But classroom work is all in my past now, and in just over two months I’ll be into my Sub-Internships and in about fourteen months, I’ll be ‘Doctor Mike’.”

“Totally cool! I should probably go see if there’s anything for me to do.”

“OK. I’ll be in the lounge.”

We left the exam room, and I headed to the lounge to read The Lancet. About twenty minutes later, Tami had her break, so we went to the cafeteria for lunch.

“If you aren’t doing anything on Wednesday after your shift, we could have dinner,” Tami offered.

I checked my schedule in my daybook and I actually didn’t have anything planned.

“Sure,” I said. “7:30pm?”

“Sounds good! I’ll bring the pizza.”

The afternoon was busy, but routine, and I was able to leave at 4:00pm when my shift ended, and headed home.

“Rachel had a good day,” Lara said after I greeted her with a hug. “She’s sleeping, obviously, but she’s on her normal schedule. How was your day?”

“I retrieved a lost condom,” I said with a grin.

“Lost con ... wait, it slipped off inside?”

“Yep!”

“He must be really small or she must be really tight!”

“Or, stupidly, he didn’t pull out before he went soft.”

“Oops. Semen?”

“Leaked. Which means they might have a nasty surprise.”

“Taft students?”

“Yes. I instructed them on proper condom use and advised backup methods.”

“That’s a new one for you, right?”

“Yes. A procedure I doubt any other Third or Fourth Year has in their procedure book! Doctor Gibbs loves me!”

“OK. I’m out of here. See you on Sunday evening?”

“See you then.”

We hugged, exchanged a quick kiss, and she left. I checked on Rachel, then called in an order to the Chinese restaurant. Rachel woke up just before Annette arrived, so I was feeding her when the doorbell rang.

“Hi!” Annette exclaimed. “Hi, Rachel!”

“Hi!” I replied.

Rachel, who was contentedly sucking on her bottle, ignored Annette. Annette gave me a quick kiss, and I was about to close the door when I saw the delivery girl from the Chinese restaurant. She came to the door, I paid and tipped her, and Annette carried the food into the house.

“Cute girl!” Annette observed.

“The owner’s sixteen-year-old daughter. His knives are WAY bigger than my scalpels!”

Annette laughed, “So don’t let him know!”

“High School Sophomores are WAY off limits,” I replied. “How are things at home?”

“Good. Mom is cool and Dad doesn’t give me too much grief. Are we eating right away?”

“Yes. Let’s go to the kitchen. I set out plates, so just unpack the food, then get yourself something to drink. I’ll have lemonade, please.”

By the time Annette had everything on the table and drinks poured, Rachel had finished her bottle, so I burped her then put her in her high chair. I said the blessing, then filled my plate with food. Once that was done, I alternated feeding Rachel applesauce and eating my dinner. Once Rachel had finished her applesauce, she ate her Cheerios while Annette and I ate the rest of our dinner.

“Solid food is new.”

“About three weeks now,” I replied. “At breakfast, she gets a quarter of a bagel, but mostly just slobbers on it so far. I do break off some small pieces for her to eat.”

“Pretty amazing, given how tiny she was when I first saw her!”

“For me, too! And I see her every day! She’s crawling and giving serious thought to standing up. She hasn’t quite figured out how to do it, but that’ll happen soon enough. She’s also using language, but so far, other than babbling, only ‘PA!’ means something.”

“That’s so cute!” Annette gushed.

“I agree, but then I’m biased! How are your preparations for school going?”

“Not much left to do, really. There’s still time to switch to the married dorms, and Mom and Dad would cover the difference from my full ride!”

“And the nanny we’d need?” I asked.

“The true source of the problem, really. I know you want to practice here, but we could easily move back. Our problem is no reasonable way to care for Rachel with me in school and you in Residency, and that would be a year from now, which would mean basically a long-distance marriage for a year.”

“Actually, I could probably do two electives at Vanderbilt as a visiting Fourth year.

“Interesting.”

“Of course, the other option is you giving up your tennis scholarship, but I wouldn’t want you to do that and would strongly suggest you don’t even consider it. I think that means we’re at an impasse.”

“Well, then there’s only one thing to do!”

“What’s that?”

“Fuck each other senseless from when Rachel goes to bed until I have to leave tomorrow around 7:30am so you can go to band practice!”

“We could take a bubble bath, too,” I suggested.

“Awesome!”

“My thoughts exactly!”

March 19, 1988, McKinley, Ohio

“We’re really good at that!” Annette declared when we got out of bed on Saturday morning following an energetic screw.

“That we are! Shower?”

“Yes! Think I can see you again? Maybe late in April?”

If I were to decide during Bright Week, that wouldn’t work, but it was increasingly unlikely I’d do that because I was still going round and round in my head about how to decide.

“That should be fine,” I replied. “We’ll check my schedule when we go downstairs.”

“Great! Now, get in the shower and rub your soapy hands over my body!”

We had a fun shower, after which we dried, then dressed. Rachel woke up while we were making breakfast, so I took care of her needs while Annette finished making breakfast. All three of us had our breakfasts, and after Annette and I cleaned up the kitchen, she retrieved her bag from my room and I walked her to her car, leaving Rachel in her high chair.

“See you on April 30th!” Annette said happily.

We hugged, exchanged a deep French kiss, and then she got into her car and drove off. I went back into the house, packed Rachel’s bag, then settled her into her stroller for the walk to Taft. I left her with Anicka, who also had her granddaughter, Abigail, with her.

“I thought of a potential problem,” I said to Kim when I walked into the music room.

“What?”

“Kari is only nineteen.”

“Nobody will card her at the stage entrance,” Kim said. “And once she’s in the club, nobody will check, because she’s with the band. Don’t worry.”

“I will trust your wisdom!”

Kim laughed, “I had a fake ID at seventeen and never had a problem. They don’t check girls as carefully as they do guys.”

“Morning!” José said happily, coming into the room with Maria and Sierra on his arms, with the girls carrying his guitar and music.

We greeted them, and Sticks arrived shortly after, with Kari right behind him. We had a good practice, with Milena showing up at the end so we could sing our duet. When we finished, I retrieved Rachel from Anicka, put her in her stroller, and we headed home. At home, she had her late-morning snack, and I put her down for her nap about thirty minutes later than usual.

Becka arrived just after I put Rachel into her crib. I poured myself a mug of tea and Becka asked for a Sprite, then we went to sit in the great room.

“Did it bug you that I didn’t want you to lick me last weekend when I had my period?”

“No. I totally get why you would think it was weird.”

“Actually, I was worried you’d try to kiss me.”

“I would have, though I’d have paused to give you a chance to object. The first time a girl asked for a kiss after a blowjob kind of freaked me out. The first time a girl wanted oral sex after screwing also kind of freaked me out. The first time a girl asked for a kiss after a blowjob without swallowing, it MAJORLY freaked me out. Now it doesn’t.”