Chapter 15: Forcing the Matter

June 18, 1988, Rutherford, Ohio

"MAMA!"

"I'm not sure what to say in response to that!" Nadiya declared a few seconds later, recovering from the surprise much more quickly than I did.

"Me, either!" I replied. "I mean, unless she's declaring her preference!"

"You're dating other girls? And I don't mean that as an accusation."

"Yes," I replied. "There are two girls I'm seeing regularly, but neither of them has moved beyond seeing me once a week or so. One of the girls is pre-med at Taft and went home for the Summer, so I'll only see her occasionally until her classes resume in late August."

"What year is she?"

"She'll be a Sophomore, so she's only a year older than you. The other girl works and is nineteen as well."

"So, about six years younger, which isn't a big deal. My dad is six years older than my mom."

"My parents were only two years apart, and my grandparents are about the same. Elizaveta was six years younger than I was when we married."

"You don't really think Rachel was expressing a preference, do you?"

"I have no idea what's going on in her little mind! But for her to say 'MAMA' for the first time ever, and to you, was disconcerting."

"Why?"

"We're on our first date," I chuckled. "Are you suggesting we act on the babbling of my toddler?"

"What?" Nadiya asked mirthfully. "You don't want to get engaged on our first date based on one word uttered by your obviously insightful daughter?"

"That might not be the wisest course of action," I chuckled. "That said, she seems to like you and you seem comfortable holding her."

"I am; I really love kids. I get the idea from everything you've said that it's 'sooner' rather than 'later'."

"That's true," I replied.

"How soon is 'soon'?" Nadiya asked.

"I'd say that barring some completely unexpected turn of events, I'm certain that by this time next year, I'll be married."

"And those other girls know your timeline?"

"They do."

"I'm not quite sure what to make of all this. Let's just say the conversation and the evening didn't go the way I'd expected!"

"Out of curiosity, how did you expect it to go?"

"Like a normal first date! Well, as normal as it could be with you bringing Rachel."

"Which means?"

"We'd have dinner, talk, then decide if we want to go out again and take it from there. It's as if we 'skipped to the end'!"

I laughed at the Princess Bride reference.

"I apologize for misleading you," I replied.

"You didn't! I wrote the note saying I wanted to get to know you and I basically asked you out. I don't feel as if you needed to say anything beforehand. And you didn't try to hide your situation the way some guys might have."

"Out of curiosity, when did you think you would get married?"

"When I met the right guy. It was never about how old I was, just the right guy. As I said earlier, I figured I'd meet him in college, or while I was working."

"Are you still interested in a second date?"

"Yes!"

June 19, 1988, Columbus, Ohio

"My grandmother is not happy," Dani said when we sat down for lunch at our usual diner.

"Oh, I'm sure," I replied. "Mine isn't either. But it's not about whether our grandmothers are happy or not."

"I know we agreed we wouldn't discuss specific plans until September, and I knew you were seeing some other girls, but this seems serious."

My grandfather's reminder of the proverb about 'chasing two hares' flashed into my mind. And it wasn't really two, it was three or four, depending on who I counted — Danijela, Danika, Nadiya, and Sara. If I made a mistake, I could end up with no viable options, and that was not something I wanted to contemplate. If I couldn't allay Dani's concerns, I'd have a tough decision to make, and before the end of August.

"Grandmothers aside, how much does it bother you?"

"I suppose I wonder what you think is lacking or missing between us that makes you want to have another girl's family meet your extended family."

"I don't believe I have an answer other than to say that I want to ensure I'm making the correct decision about Rachel's and my future."

"You get points for honesty," Dani replied. "But we've been seeing each other once a week for six months, and despite agreeing that we wouldn't make any decisions until September, I think you need to decide if you want to be with me, or you want to play the field. I believe I've been more than patient waiting for you to be ready to decide. If you weren't seeing anyone else, I wouldn't press, but I feel I must."

Dani's ultimatum, if I could call it that, didn't surprise me, given the warning I'd received from my grandmother through my grandfather, though he'd couched it in terms of me being happy, rather than upsetting my grandmother.

"I can't argue with you," I replied.

"I'm not going to be nasty and I don't want to make you look bad, so keep your plans for Saturday, but next Sunday I want an answer."

"You'll have one," I replied.

"Thank you. Now, let's enjoy the afternoon together."

June 20, 1988, McKinley, Ohio

"Morning, Mike!" Doctor Casper said when I walked into the Emergency Department lounge on Monday morning after taking Rachel to daycare.

"Morning, Doctor Casper," I replied.

"How was your weekend?" he asked as I went to my locker.

What I wanted to say was that it was 'complicated', but I didn't want to get into a discussion about my personal relationships with him. I really needed to speak with Clarissa, but our schedules made that difficult, especially when I was on ambulance duty, which was the case for the current week.

"I spent time with family and friends," I said. "You?"

"Oksana and I had a date on Friday night and I have to ask why you would fix her up with me?"

"You mean instead of dating her myself?"

"Yes."

"The short answer is you'll be an Attending in less than a year, with a reasonable schedule. Next year is my Intern year, and then I have seven more years of Residency, including both trauma and surgery, then a potential Fellowship. Oksana isn't interested in what amounts to an absentee husband and father for eight or nine years, depending."

"That makes sense," Doctor Casper said. "It's one of the reasons I always felt I'd wait until I finished my Residency to settle down."

"That was my plan, initially, but events kind of overtook me. Now I have the complication of having a daughter, in addition to the demands of training to be a trauma surgeon."

"You haven't wavered a bit on that, despite the demands."

"It is what I feel I'm called to do," I replied. "I've known I wanted to be a trauma specialist since fourth grade, and while I could just do that, the future of critical primary care is going to involve even more procedures in the Emergency Department and I want to be able to provide the absolute best care possible. That means making sacrifices in every other area of my life. As I said to Doctor Gibbs, I can't do anything else."

"That is the price we pay for dedicating ourselves to serving our fellow man, and placing the good of our patients over everything else in our lives, to the point where we pay for the privilege for two years before we get paid a pittance compared to professional athletes!"

"And politicians," I replied. "Congressional salaries are higher than those of anyone here, except the most senior Attendings. No nurses make as much as a Senator or Congressman."

"And they just received a $2,000 raise!" Doctor Casper declared. "But even that pales compared to the average pay of a player on the Yankees, which is over $700,000, or even the Reds, where the average is $330,000. And then you have players making more than two million, including Ozzie Smith and Jim Rice."

"Society rewards athletes and entertainers more than nurses and teachers," I replied. "And I'm not sure that's going to change any time soon."

"Sadly. What really frosts me is that baseball and football owners, all of whom are multi-millionaires, demand the public build stadiums with tax dollars. I don't mind paying taxes for public services, but funding stadiums for MLB and the NFL is unacceptable. Capitalists become good socialists when they can feed at the trough!"

"I don't think public stadiums are 'socialism'," I replied with a grin, "though I do agree they ought to be privately funded. Heck, Medicare isn't 'socialism', it's a public insurance scheme partially funded through taxes, and not all that different from private insurance. So, unless you're going to call Blue Cross/Blue Shield 'socialist', I don't think Medicare is 'socialist'.

"You're a pain in the ass, Loucks!" Doctor Casper declared. "You're ruining a good rant!"

"At your service, Doc!" I chuckled.

"Ghost," Nurse Ellie said from the door to the lounge, "paramedics are five minutes out with a Sheriff's deputy with smoke inhalation and burns."

"Just the deputy?" Doctor Casper asked.

"So far."

"Mike, let's go!"

Just under five minutes later, the ambulance pulled up and Bobby jumped out and hurried to the back of the ambulance to open the doors.

"Deputy Jim Garner," Bobby called out. "Smoke inhalation; second-degree burns on his hands and forearms; BP 150/90; tachy at 110; resps labored and shallow; PO₂ 88% on ten liters."

"Trauma 1!" Doctor Casper ordered. "What happened?"

"Fully involved structure fire," Bobby said as the four of us rolled the gurney into the ED. "Jim was first on the scene and went in to bring out two kids. He went back for an adult who hadn't been found when we left the scene."

"Kids are OK?" Doctor Casper asked.

"They'll come in the second ambulance," Bobby replied, "but only minor smoke inhalation. They're waiting to see if they find the adult."

We hurried into Trauma 1, where Nurse Julie and Lauren were waiting.

"Lauren, draw blood for a CBC, Chem-20, and blood gasses. Mike, EKG, please."

A Sheriff's deputy came in just then.

"I need his firearm," the deputy said.

"Mike, get that first, it's next to you."

I carefully removed the revolver from the holster and handed it to the other deputy, then cut away Deputy Garner's uniform shirt and began attaching EKG pads and leads while Lauren drew blood, Nurse Julie hooked up the oxygen, and Doctor Casper performed an exam. Once the leads were attached, I verified I hadn't crossed any wires, then turned on the machine.

"Sinus rhythm," I said. "Tachy at 115."

I connected the pulse oximeter to Deputy Garner's finger and waited for the display to update.

"PO₂ 90%," I said.

Next I put the blood pressure cuff on the Deputy's arm and used my stethoscope to listen for the appropriate sounds.

"BP 156/92," I replied.

"Soot in the nasal passages," Doctor Casper announced. "No singeing. For now, supportive treatment. Deep partial-thickness burns on left hand and forearm; superficial partial-thickness burns on right hand and forearm. Julie, IV with lactated Ringer's please."

"Do you want to intubate as a precaution?" I asked Doctor Casper.

"No. He has no signs of edema or other indications. He's breathing OK minus the coughing. We'll keep an eye on him and watch his sats."

"OK."

"Jim, how much pain are you in?" Doctor Casper asked the deputy, sliding the mask aside.

"My hands and arms hurt," he said between coughs, "but it's not too bad."

"Do you want something for it?"

"Just take the edge off, OK, Doc? Don't drug me up."

"Julie, 2mg morphine, IV push, please."

Given the deputy was over six feet tall and built like an NFL linebacker, that was a very mild dose.

"How is he, Doc?" the other deputy asked.

"He should be fine," Doctor Casper said. "The burns aren't bad, and his blood oxygen is coming up. We'll probably keep him overnight for observation."

"Thanks, Doc."

Lauren came back from taking the blood to the lab, and Nurse Ellie stuck her head in the room, "Ghost, Doctor Gibbs is asking if Mike is free to assess the kids the Sheriff is bringing in."

"He is," Doctor Casper confirmed. "Any word on the potential adult victim?"

"Coroner's case," Nurse Ellie replied. "Mike, use Exam 2."

"Thanks. Go, Mike. Lauren, go with him, please."

"Right away, Doctor!" I said.

I left Trauma 1 with Lauren following me and we went to the ambulance bay where we met a Sheriff's cruiser with two kids in the back seat.

"John and Kelly Simpson," the deputy said, getting out of his car. "Ages six and four. No apparent injuries, no coughing or any other symptoms."

"Lauren, take them to Exam 2, please. I'll be right there."

"Come with me, please," Lauren said, taking their hands. "I'm Lauren."

She led them inside.

"Parents?" I asked quietly.

"We're reasonably certain the deceased is the mother," the Deputy said. "Our department and McKinley PD are looking for relatives. Not sure about the father, but the kids said he didn't live with them and they hadn't seen him for a long time."

"What did you say to the kids?"

"Nothing, because we weren't sure."

"Thanks."

I hurried after Lauren and the kids and went into Exam 2.

"I'm Mike," I said. "We're going to check and make sure you're OK."

"I want my mommy!" Kelly demanded.

The person to tell the kids was a relative, or barring that, a social worker, and that meant deflecting the question for now.

"I know," I replied gently. "Let us check you and then we'll see if we can find your mommy."

"The house was on fire!" John exclaimed. "The firemen came!"

"I know," I replied. "Lauren, H&P on Kelly, please."

"She's not going to know her history," Lauren countered.

I smiled and turned to John.

"John, do you go to the doctor and get checkups and shots?"

"Yes! I hate shots! But the doctor says we have to have them!"

"And have you been sick? You know, throwing up or your head hurting or have you hurt yourself playing?"

"Just my knees! I scraped them playing kickball!"

Lauren smiled and began talking to Kelly, though at four, her responses were somewhat limited.

"Do you go to school, John?"

"Kindergarten! I start first grade soon!"

"Do you have any pets? A dog or cat?"

"No. Kelly sneezes around cats. Mom says she's 'lergic."

I looked over to Lauren, who nodded and wrote on her chart.

"OK to listen to your heart and breathing? And look into your eyes, ears, nose, and mouth?"

"Yes, Doctor Mike!" he exclaimed.

I thought about correcting him, but decided that because the kids were calm so far, I'd go with it to prevent any concern on their part. I performed the exam, with Lauren following my lead, doing as I had done. I found nothing wrong, and Lauren said the same about Kelly, though I did listen to Kelly's heart and lungs to confirm, as I knew Lauren had almost no experience doing that beyond what she'd been taught in class.

"You both were really good," I said, taking two suckers from my pocket and handing them to the kids.

"Thanks!" John said, unwrapping his sucker and sticking it into his mouth, while Lauren helped Kelly with her sucker.

"Lauren, stay with the kids. I'm going to report to Doctor Gibbs."

I left the exam room with both charts and went to the Attending office where Doctor Gibbs was on the phone. I waited until she hung up, then knocked on the door frame.

"What's up, Mike?"

"Two healthy kids," I replied. "Vitals are normal, no signs of exposure to smoke, no burns. Deputy Garner did a great job getting them out. He wasn't successful with the other victim."

"I was just on the phone with the Sheriff's office. Their dad lives out of state and the Sheriff's deputies are trying to track him down. They haven't confirmed the other victim is the mom, but it seems certain, given the circumstances."

"That's what the deputy who brought them in said. Social worker?"

"Yes. Do the kids know?"

"No. The little girl asked for her mommy, but I deflected the question. I placated them with suckers, and Lauren is with them."

"You and your bribery! Let me see the charts."

She reviewed them and looked up.

"How the heck did you find out a four-year-old is allergic to cats?"

"I asked her brother if they had pets and he said 'no' because his sister sneezes around cats!"

"Kid Whisperer strikes again!" she said, shaking her head as she signed the charts.

"I'll go see the social worker," I said.

"OK."

I took the charts with me and walked down the corridor to the Social Services office and found Jeanne Wilders sitting at her desk.

"Hi, Mike. How are you?"

"OK. I'm actually here about two kids the Sheriff brought in. John and Kelly Simpson, six and four. Rescued from a fully involved structure fire by a Sheriff's deputy. No injuries, but it's believed the mother died in the fire. Father lives out of state and the Sheriff is trying to find him or other relatives."

"A lovely way to start a new week," Jeanne sighed. "Where are the kids?"

"Exam 2 with Lauren Nichols. We examined them and they're healthy, well-nourished, and show no signs of abuse."

She picked up a clipboard, pulled some forms from a rack behind her, and stood up.

"Let's go see them."

We headed to Exam 2, where the kids were waiting with Lauren.

"John, Kelly, this is Mrs. Wilders," I said. "She's very nice, and she's going to take care of you because Lauren and I have other people to help."

"OK," John agreed somewhat apprehensively.

"Could you send in a nurse or student nurse, please?" Jeanne asked.

"Will do," I said.

Lauren and I left, and I went to the nurses' station and let Nurse Peggy know about Jeanne's request. She sent Noelle in to assist.

"I'd hate to be the one to tell them their mom died," Lauren said as we went to the lounge.

"Fortunately, in cases like this, it's almost always Social Services. I have watched while Doctor Gibbs delivered news like that, and I don't look forward to having to do it, but in our role, it's going to happen more than we like."