Chapter 93: A Movie Night and a Visit to Columbus

March 23, 1988, McKinley, Ohio

When Doctor Forth arrived for his shift at 10:00am on Wednesday morning, Joy still wasn’t willing to discuss her suicide attempt. She was still restrained and lightly sedated to reduce her agitation, but unless and until she was willing to speak to one of the doctors, there wasn’t much that could be done except keep her on a hold as long as legally possible.

I’d managed to get some sleep, though I’d spent quite a bit of time in the bed in the on-call room thinking about my conversation with Doctor Forth, and my response to what had happened to Angie. The one thing I could point to in his analysis with which I could find fault is that my own analysis was not post hoc. I had determined the correct course of action in advance, and even predicted the negative result. That was a far cry from being a Monday morning quarterback or operating with 20/20 hindsight.

That said, I did have to ask myself if I could live up to the standard I was setting, and if I could survive as a physician operating under that standard. No matter how I analyzed the standard, the answer had to be a resounding ‘no’. It would, as Doctor Forth had suggested, mean there would be no doctors, as perfection was literally impossible. Much like Orthodox Christianity, the goal was to try to live up to the ideal, while recognizing the extreme difficulty of doing so.

In a sense, Morbidity and Mortality Conferences were an opportunity for public confession of ‘missing the mark’, with absolution and guidance for the future. The analogy actually held, as did the theology supporting the idea of Christ being the Great Physician, who offered the ‘medicine of immortality’ in the Eucharist, and a treatment plan via spiritual direction. In either case, failing to follow the prescription led to adverse results.

That was what had happened with my intemperate words to Doctor Mercer. I’d failed to follow the direction of Father Roman, and that had led me to fail to follow the guidance I’d received from Stefan. I’d have my call with Father Roman on Thursday, and I’d get some kind of spiritual butt-kicking, though it would be done in love. Which, truth be told, was how Doctor Forth had handled it.

The bottom line was that Doctor Forth was right in the general case, and I judged he was likely right about Doctor Greenberg with regard to discipline. The question I had to ask myself was whether or not it was worth the risk to joust at that windmill, when someone I trusted, and who had the experience to know, promised it would be a losing effort.

Some losing efforts were worth it, but they were few and far between. I had managed to get Angie away from Doctor Greenberg, which was a major victory. The effort might well be better spent on trying to improve mental health care, but that seemed to me to be a similar exercise in windmill-tilting. Limiting my focus to patients needing mental health care at Moore Memorial was likely going to be equally frustrating, but I could, hopefully, have some impact by taking a collegial, rather than confrontational, approach.

The day was fairly routine, and I made two attempts to engage Joy in conversation, but she rebuffed me with a ‘go away’ each time. No progress had been made by the end of my shift, and as I always tried to do, I cleared my mind as I drove home. I wouldn’t be back on shift until late Sunday evening, and by then, nearly every patient would have been discharged and new ones admitted. Joy might still be there on a ten-day hold, but I hoped, somehow, someone could get her to talk.

“Rachel had a good day,” Lara said after I greeted her. “I found her standing in her crib after her morning nap, holding on to the rails for dear life.”

“She just needs to build a bit of leg strength and she’ll be toddling! She’s pretty much on target, as the earliest babies try to stand is around six months, and she’s seven months old. She’s likely to add new words soon, too.”

“She has!” Lara exclaimed. “She said ‘BA!’ obviously meaning ‘bottle’ when I brought her down for lunch.”

“Evening nap or no?” I asked, picking up Rachel from the rug in the great room.

“She took a longer afternoon nap, so no. I think the evening naps are done, and the late-morning and late-afternoon naps are sufficient given she’s sleeping close to eight hours a night. Besides, there’s too much interesting going on for her to sleep in the evenings when you’re home!”

“Thanks, Lara. I appreciate it.”

“You’re welcome! See you Friday evening at your gig?”

“Sounds good!”

I walked out to the porch with Rachel in my arms to watch Lara drive away, then went back inside. Tami arrived about ten minutes later with the pizza, and the three of us went to the kitchen. I gave Rachel Cheerios to eat while Tami and I ate our pizza.

“How did things go with the suicide attempt?” Tami asked.

“No progress. I meant to ask, what shifts do you have next month?”

“6:00am to 6:00pm, Monday through Friday, in Pediatrics, thanks to you! You’re in Internal Medicine, right?”

“5:00am to 5:00pm Tuesday through Saturday.”

“What time does Rachel go to bed?” Tami asked.

“Around 10:30pm, and she’ll sleep until around 6:30am, or even a bit later because she’s not taking an evening nap very often. Her total sleeping time is about thirteen hours, roughly. How long are you staying?”

Tami laughed, “That question again?”

“It’s a legitimate question with no implications! We’re having pizza, and maybe you leave when we finished dinner, which would fit your request to have dinner. Maybe you stay longer. It’s really up to you because you have to drive home.”

“You are very careful with your words!”

“Partly because I’m at least as clueless as the next guy when I’m trying to pick up subtle signals, partly because I don’t want to assume anything, and partly it’s being very careful about anyone at the hospital. I think that last one you understand, given what your aunt said and given the recent situation with the medical student and nursing student.”

“Do you think there should be stronger rules against that?”

“My major concern is for any supervisory relationship, and I’d make that against the rules. For colleagues, I’d leave it up to the individuals. There was nothing wrong with that relationship, except screwing in the on-call room, which is disrespectful of patients and other staff. That said, you know why he was dismissed.”

“Missing a code call because his pager was off.”

“The batteries ran out, but that was a sign of carelessness, and screwing in the on-call room didn’t give the administration any positive ideas about his judgment. The nursing student got a pass because she didn’t impact patient care.”

“You’re OK with that?”

“It’s not my place to tell the nursing supervisor how to manage her nurses or train nursing students, nor tell the nursing school how to operate.”

“That’s not an answer!”

“It’s an answer, just not the one you wanted!” I countered. “But yes, I’m OK with it because the nursing student exercised poor judgment, but wasn’t careless or negligent.”

Rachel got my attention with ‘PA!’ and I got up and got her a few more Cheerios and made a bottle of apple juice, as she’d need it to wash down the cereal.

“What else does she eat besides Cheerios?” Tami asked.

“Applesauce and bagels so far. That’s what her pediatrician recommended, keeping her formula as her primary nutrition at least until she’s a year old. Well, assuming she doesn’t get tired of the bottle. She’d have had her applesauce with her dinner before I arrived home.”

“You are coping way better than most guys would, I think.”

“I honestly think you’d be surprised that most guys are more like me than the stereotype. At least guys my age. My dad never changed a diaper, but I would have either way, assuming my wife let me into the nursery!”

“I’ve met some Antiochian women who are like that! Especially ones where Grandma lives with the family.”

“I always joke about Russian women, because that’s my experience, but it’s ethnic Orthodox women in general, with a very different mindset from what passes as ‘normal’ in the US. And surprisingly, those marriages seem to last for life and the incidence of divorce is tiny.”

“Because the men are afraid!” Tami declared.

“I’m sure you know the saying, right?”

“The bishop fears no man, but every woman?”

“Exactly!”

We finished our pizza, and I put away the leftovers, then washed Rachel’s face and hands with a soft washcloth. I took her from her high chair and offered her the bottle of apple juice.

“I’ll hang out,” Tami said, “if that’s OK.”

“Absolutely. Rachel won’t eat again, so I plan to say evening prayers at 9:30pm then put her to bed.”

“Do you say morning and evening prayers every day?”

“I make a supreme effort to do that. If I’m on shift, I’ll say an abbreviated form silently. And I always include Rachel when we’re together, even if she’s sleeping.”

“Do you go to every service?”

“In the past, yes. My clinical work prevents that now, and I’ve had some spiritual struggles since Rachel was born.”

“You’re referring to what happened with your wife, right?”

“Yes, but I have to stay focused on Rachel’s birthday as the primary thing to remember that day. Can you imagine if I don’t do that?”

“That would be a pretty heavy thing to lay on a kid — ‘Happy birthday, your mom died today’.”

“Spot on,” I replied. “I won’t hide it, but Rachel shouldn’t suffer on my account. I’ll mourn privately, but she never knew her mother, so she has nothing to mourn, really. And by the time she’s old enough to understand, she’ll have a mom, and that mom will be the only one she’ll ever know.”

“And you’re conducting auditions,” Tami said with a silly smile.

“And the path to success requires Rachel’s approval as a primary step.”

“You’ve sidestepped every hint or attempt to flirt,” Tami observed. “Including the ‘audition’ euphemism.”

I had done that, despite Tami being the epitome of the cute, bubbly nursing student. My rationale had been that I didn’t need an additional casual sex partner, that was true, but in the last four months, ‘need’ often took a back seat to ‘want’. I might be reading more into Tami’s flirting and the hints she had dropped than she meant, but I didn’t think so. And truth be told, I didn’t like sleeping alone at all.

We weren’t on the same service, and in all likelihood, wouldn’t be, as she wasn’t going for surgery, was about to complete her trauma practical training, and there were no nurses in pathology, let alone nursing students. The chances I’d ever be in a supervisory position with her were vanishingly near zero, and even if that somehow happened in the future, beyond her practical training, I’d be married and the relationship would be over.

“Most of that has been at the hospital,” I replied. “And that invokes my aversion to inappropriate behavior.”

“Even in the cafeteria?”

“Yes.”

“But holding my hand and calling me your girlfriend is OK?”

“That was medical necessity, not flirting! And it worked!”

“I have to say the doctors and nurses all think you’re amazing with kids. At least one of them said you should be a pediatric emergency medicine specialist.”

I shrugged, “Maybe, but I think trauma surgery is more challenging, and I can still handle pediatric cases, I just won’t focus on them. And honestly, I do better with High School and college kids, mostly because I’ve taught Sunday School to that group for the best part of seven years, though I’m not teaching now because I can’t commit to a regular schedule due to my clinical rotations.”

“You did do a great job with the college kids who ‘lost’ their condom!”

“That may well go down as the funniest thing I do as a medical student.”

“You handled it like a pro, including using the speculum and forceps.”

“You get used to it, or you don’t do it. The first time I had to insert a Foley was pretty strange, but now it’s just another procedure. The same was true with internal exams for laboring women. The first time was weird, but by the tenth, it was just another procedure.

“The biggest part of the problem is that American culture, and others, too, always associate nudity with sex, and genitals with sex. I learned that wasn’t true when I saw an ex-girlfriend nurse her baby when I was eighteen and she was seventeen. Suddenly, breasts took on a whole new meaning as mammaries, to make the distinction.

“Seeing babies born gave me a whole new perspective on female anatomy as well, and similar to breastfeeding, induced awe. Before I became a medical student, I’d have had the same puritanical or prudish view of female anatomy, and male anatomy, for that matter, that most of society has. I can change clothes in the locker room, and even shower, and not think twice about it, or even look at the women in the locker room. That would not have been true in High School.”

“Including Nurse Ellie?”

“Nurse Ellie and her translucent underwear?” I asked with a grin. “I noticed, but I was immune because I was married. I know that’s not a concern for Ellie, but it sure is for me. And she didn’t get any attention from me beyond the fact that I did notice her when she made a point of changing in front of me. And that’s exactly the kind of behavior I find inappropriate.”

Rachel finished her bottle, so I put her back into her high chair so I could wash the plates Tami and I had used.

“Cheating sucks,” Tami said. “So I don’t disagree with you on that. But it wouldn’t be cheating now.”

“No, it wouldn’t, but being OK with cheating is not OK in my book. People are free to do whatever they want, so long as it’s consensual. That doesn’t mean I have to approve or participate. And why are we wasting even a single breath on Nurse Ellie?”

“Sorry,” Tami replied. “I saw a VCR. Do you have tapes?”

“Blank ones I use to record things, but no pre-recorded ones. I have a membership at the video store a few blocks east, just before you get to Taft.”

“If I rented something, are you up for watching a movie?”

“Sure. I strongly prefer science fiction, mysteries, and dramas, but I’m OK with action movies like James Bond. I’m not a big fan of love stories.”

“Got it! And you can stay up late enough?”

“Yes. I don’t have anything tomorrow until I have to leave for Columbus around 10:00am. Do you have a shift tomorrow?”

“No. Where’s your card?”

“In the rack there, where my keys are hanging.”

She got up and located the card.

“Back in fifteen minutes or less!”

She left, I finished the dishes, then read Ten Apples Up On Top to Rachel. I finished just before Tami returned.

“What did you get?” I asked.

“Debbie Does Dallas and Insatiable,” she smirked.

“What did you really get?” I asked with a grin.

“Witness, starring Harrison Ford and Kelly McGillis.”

“Let me guess; you discovered the video store’s back room?”

“Yeah. I saw a black curtain with an ‘Adults only’ sign and asked about it. Imagine MY surprise!”

“Even here in conservative Hayes County, people want to see pornography. And our City Council isn’t Puritanical the way Cincinnati’s is.”

“Just out of curiosity, would you watch a movie like that?”

“Probably out of curiosity,” I replied. “I’ve had scenes from both those movies described to me, and it would be an interesting intellectual exercise to see them, but otherwise? I don’t have any particular voyeuristic proclivities.”

Well, besides watching Tessa and Clarissa, but that was truly limited to that special relationship and I had no real desire to watch anyone else.

“Me, either, though I might watch one out of curiosity.”

“I’m going to say evening prayers with Rachel. You’re welcome to join us, or you can hang out in the great room. It’ll take us about twenty-five minutes.”

“I’ll join you. We said evening prayers at home in Chicago as a family. I usually only pray them now when I visit my parents.”

Tami joined Rachel and me for prayers, then went to the great room while I took Rachel up to her room, changed her into a onesie from her sweatsuit, then put her into her crib. I covered her with her blanket, then went back downstairs. I put the tape into the VCR, turned on the TV, then sat down next to Tami on the couch.

I totally wasn’t surprised when, a few minutes after the movie started, Tami pulled her legs up onto the couch and leaned against me. I put my arm around her and she snuggled close.

The movie was pretty good, with the premise being that an eight-year-old Amish boy and his mother, played by Kellie McGillis, were on a trip. During that trip, the boy witnessed the brutal murder of an undercover cop. Harrison Ford’s character was a police detective assigned to investigate the murder, and discovered the boy was a witness, and that the boy and his mother were in grave danger.

“What did you think?” Tami asked when the movie ended.

“I liked it,” I replied. “The juxtaposition between the two worlds was well done, seeing both the pacifist Amish and the grizzled cop through his eyes as he discovers a world he never knew existed. The symbolism was nice, too, especially the part where Rachel takes off her bonnet.”

“Signifying she was no longer spiritually married?”

“Yes.”

“May I ask when you took off your wedding ring?”

“I actually still wear it, but on a chain around my neck. That started at the hospital back in December, mostly to accommodate surgical gloves. I’d put it on when I left the hospital. About a month ago, I stopped putting it back on my finger when I left the hospital.”

“Want me to stay?” Tami offered.

“Birth control?”

“I’m not on the Pill, if that’s what you’re asking. My mom and grandmother are both on blood thinners for thrombophilia, so my gynecologist advised never taking the Pill. I have rubbers in my bag if you don’t have any.”

“I do. No needle sticks or cuts?”

“No. And I had a recent STD test, if that’s why you’re asking.”

“It is. I’ve had a recent one as well. And no needle sticks or cuts.”

“AIDS is scary.”

“It is,” I agreed, “and that’s why I’m exceedingly careful with sharps.”

“You don’t double glove; I know some nurses who do.”

“The added protection isn’t worth the loss of sensation,” I replied.

“I know guys who would say that about rubbers, but my motto is ‘No glove, no love’.”

“Having unprotected sex is dangerous and irresponsible. Shall we go up?”

March 24, 1988, McKinley, Ohio