Chapter 21: I Need Some Advice

July 17, 1988, McKinley, Ohio

On Sunday morning, Elias and Serafima arrived to pick up Rachel for church. Once they had left, Danika and I ate breakfast, then said morning prayers. After we had finished our prayers, Danika suggested we take a walk, and we spent an hour strolling around downtown McKinley before heading back to the house.

"Have you given thought to what I said to you on Friday evening?" Danika asked about halfway through our walk.

"Yes, but I haven't reached any conclusions."

"You never struck me as indecisive," Danika said. "Was I mistaken?"

"I'm decisive when necessary, otherwise, I'm thoughtful. I've had situations in the past where I've dithered when I shouldn't have and been impetuous when I shouldn't have. I've sought to find a balance, and be patient when necessary, but take action when required. And didn't you say 'better to be slow and sure than rash' on Friday night?"

"About theology, yes! I won't belabor the point, but I do want you to consider it."

"I will," I replied. "When do you plan to return for classes?"

"August 18th, which is the soonest I can get into the dorms."

"So only about a month," I replied. "I suspect we won't see each other before then."

"Most likely not. When do you have your schedule for August?"

"I already know it," I replied. "I'm on Surgical Team A with Doctor Roth, Doctor Lindsay, and Doctor Taylor. Week one, we're on for scheduled surgeries, so my hours are 4:30am to 4:30pm. Week three, we're on-call days, from 6:00am to 6:00pm. Weeks two and four are scheduled surgeries. For September it should be the same, except the on-call will be nights."

"Who is going to watch Rachel?"

"That's where it gets tricky. The plan was for her godmother to watch her, but you saw her and she's due at the end of this month. That means I'll rely on my friend Lara until the 15th when she begins her student teaching. After that, it's a mix of my in-laws, Rachel's godparents, and my friends Subdeacon Mark and his wife Alyssa. We've done that before, and they'll stay here so that I don't have to wake Rachel at 4:00am. They'll bring her to daycare at the hospital before work or class. There are several women at church who'll pitch in, and of course, my in-laws."

"May I point out it would be much easier if you were married?"

"Obviously," I replied. "But, well, we had this discussion."

"Yes, and I didn't mean for the conversation to go back to that."

"At least the following rotation is Pathology, which is 7:00am to 5:00pm for October and November. I can just use daycare then."

"What would you do in the case where your wife worked or went to school?"

"Either a regular babysitter if she was in school or a live-in nanny if she worked. Or, in your case, your grandmother."

"You've done an amazing job, given all the challenges you've faced."

"Thanks."

We returned home and played backgammon until lunch, and when Serafima and Elias brought Rachel home, I fed her, then put her down for her afternoon nap. Later in the afternoon, Danika made dinner, and after we ate, we followed my usual evening routine of reading to Rachel, prayers, then putting Rachel to bed. Once she was in her crib, Danika and I drank tea, and because I had to be up at 5:15am for my shift, went to bed in separate rooms.

July 18, 1988, McKinley, Ohio

Danika was up early so that she could make breakfast for us before I had to leave for the hospital. We ate, and she cleaned up while I packed Rachel's bag, changed her, and fed her breakfast. When it was time for me to leave for the hospital, the three of us left the house together.

"See you in about a month," she said. "I'll call once a week, if that's OK."

"Of course it is. Early Sunday evening is probably best."

"Then I'll call you next Sunday around 7:00pm."

I had my arms full, so I put Rachel in her car seat, then Danika and I exchanged a chaste hug. We each got into our cars and Danika headed for Cleveland while I headed for Moore Memorial.

"Morning, Mike!" Marcie exclaimed. "How is our little girl today?"

"She's pretty much past the teething pain, so she's been in a good mood. She's had her breakfast and a clean diaper."

"Then I'll take her so you can get to work."

"Thanks!" I exclaimed as I handed Rachel to Marcie.

Rachel gurgled and cooed, indicating she liked Marcie, which made it much easier to leave her, and I headed to the Emergency Department where I'd be on triage and walk-in duty for the week. Nate was on vacation for two weeks, so Kris, who usually worked evenings, was covering for him. Whereas Nate was about five years older than me, Kris was my mom's age.

"Morning, Kris."

"Morning, Mike."

"Morning, Jen," I said to the Fourth Year, whose shift was ending. "Anything going on?"

"No. Nobody waiting in chairs, and no walk-ins for the past three hours. Typical Sunday night to Monday morning. This whole lotta nuthin' is all yours!"

She got up, and I sat down. I reviewed the log and saw only three patients had come in overnight, and all of them had been discharged. As there was literally nothing going on, I pulled out the latest issue of The Lancet to pass the time. I'd barely skimmed the table of contents when a worried looking couple rushed through the doors carrying an infant.

"Help!" the woman cried out.

I got up and went through the door to the waiting room to meet them.

"What's the problem?" I asked.

The man answered, "He's having trouble breathing, and he's coughing, and he won't really wake up!"

"How old is he?"

"Eight months," he replied.

"Let me take a quick listen to his lungs, please."

I auscultated his lungs and detected stridor — high-pitched breath sounds — which meant there was a good chance he had laryngotracheobronchitis, or, as it was more commonly called, croup. His lips possibly had a slight bluish tinge, but it was borderline.

"Let's get him into a treatment room," I said to the parents. "Kris, what's open?"

"Take your pick."

"Exam 1," I replied.

I led the couple and their baby into Exam 1.

"I'll get a doctor to see you right away," I said, then left and found Doctor Gabriel in the lounge.

"Eight-month-old male; coughing and with stridor; possible mild cyanosis; air entry is decreased with mild chest wall retraction; mom says he won't wake up. I believe he has moderate laryngotracheobronchitis; if confirmed, corticosteroids and nebulized epinephrine are indicated."

"Good initial diagnosis. Did you try to rouse him?"

"No. Once I heard the stridor and saw the possible cyanosis, I brought him to Exam 1."

"OK."

He called out to Lauren and Nurse Jenny, and they went to Exam 1 to treat the infant while I went back to the triage desk. Lauren would end up doing the paperwork, as I'd felt the parents would have lost it if I'd tried to collect more information before an exam. That was always a judgment call, but with panicky parents, it was usually better to get them into the exam room than try to gather information in the waiting room.

"My eldest had a terrible case of croup when he was just over a year old," Kris said. "That was in 1959, and the doctor made a house call."

"I only know one doctor who still makes house calls," I said. "And he's mostly retired."

"Doctor Petrov, right?"

"Yes."

"He delivered both my children and was our family doctor until about ten years ago when he began limiting his practice."

"He's a member of our parish."

Our conversation was interrupted by two men helping another through the main doors. I got up and went to meet them.

"How can we help you?"

"We're pretty sure he broke his ankle," one of the men said.

"OK. If you could get him into a chair, I'll get some basic information and check his heart and breathing."

"Why do that here?" the other man asked.

"New protocols," I replied. "In the past, he'd have just given his name and why he was here, and then be called in turn. Now we make sure there aren't any possible life-threatening symptoms as soon as someone walks in."

They helped the man into a chair and I asked the usual set of intake questions. His pulse was slightly elevated, and his breathing was clear. A quick visual exam of his ankle showed swelling and ecchymosis, which could indicate a severe sprain, but were also signs of a fracture. I filled out the details on the chart, writing in an order for an x-ray which I was positive he'd need.

"How did it happen?" I asked.

"Stepped in a hole at the construction site," he replied.

"OK. Give me a couple of minutes and we'll get you in for x-rays."

I went back into the ED and because Doctor Gabriel was still in Exam 1, I went to the Attending office to speak with Doctor Gibbs.

"Lee Martin; male; thirty-three; construction site injury to his right ankle; pain, swelling, and ecchymosis, and he's unable to put any weight on it. Pulse is slightly elevated; breathing is normal. I suggest an immediate full ankle series."

"Approved. Get an orderly with a wheelchair to take him to Radiology. Let me have the chart, please."

I handed her the chart I'd started, she signed next to the x-ray order, and handed it back. I went to the nurses' station and handed the chart to Nurse Ellie and asked her to call for an orderly with a wheelchair, then went back to the triage desk.

"An orderly with a wheelchair will come take you for your x-rays," I announced through the plexiglass partition.

About three minutes later, the orderly arrived and, with the help of Mr. Martin's friends, got him into the wheelchair, then pushed him into the ED, and down the corridor towards Radiology.

"No exam first?" Kris asked. "Usually they take them to an exam room for a doctor to decide on an x-ray."

"Doctor Gibbs accepted my exam and signed off," I replied.

"Nate says you're special, and I guess it's true. You wouldn't be interested in a twenty-seven-year-old secretary, would you?"

"Your daughter?" I asked.

"Yes! She's dating a complete loser!"

"I'm actually seeing someone," I replied.

"It probably doesn't matter," Kris said. "She's not open to my input."

"That sounds similar to my little sister and my parents," I replied. "She was just as likely to do the opposite of what they suggested than follow their guidance."

"And you?"

"With a few differences, a clone of my mom."

"Not your dad?"

"No. Mom was the strong one in the family when I was growing up, and at one point my dad even said that when I spoke, he heard her. My mom and I have had our differences, of course, but for the most part, we see eye-to-eye."

"That sounds like my eldest and his dad. Nick is basically a clone of my husband, Adam. Marie is, well, to put it politely, a free spirit."

We were once again interrupted, and that was the start of a steady flow of walk-ins, most of whom had relatively mild complaints, but there was a possible MI who I immediately took to a trauma room. I had lunch with Maryam and Lauren and then spent the afternoon treating walk-ins.

At the end of the day, I collected Rachel, then headed home to meet Sara, who arrived just after we did with a prepared meal. While Sara got everything onto the table, I made Rachel's bottle, then juggled feeding her while Sara and I ate. The meal she'd prepared was delicious, and once we'd eaten, I helped clean up, then followed the usual evening routine of reading to Rachel and saying our prayers, with Sara joining in.

Once Rachel was in bed, I went downstairs to the great room, and when I sat down next to Sara, she moved to my lap and put her arms around my neck. We exchanged a few soft kisses, then she put her head on my shoulder.

"You know what I want," Sara said softly.

I did, and considered if I would be sending the wrong message by taking her to bed given we were nowhere near a place where I would be comfortable asking her to marry me when the time came. There had been no commitment or promise when we'd first gone to bed, and in that regard, nothing had changed. Acceding to her request would, in my estimation, help build her self-confidence, which was important for any successful relationship.

My answer to her was to slip my arm under her legs and the other around her back, then stand up and carry her up the stairs to my bedroom, where we made love before showering together.

"Thank you," Sara said as we dressed. "Friday?"

"Yes," I replied. "Dinner, ice cream, and a movie?"

"Die Hard?" Sara suggested.

"Do you want to see it, or is it because you think I want to see it?"

"I want to see it!"

We finished dressing, I walked Sara to her car, we exchanged a soft kiss, and after she'd driven away, I went inside to complete my bedtime routine and get to bed.

July 20, 1988, McKinley, Ohio

"I need some advice," I said to Kari after we'd put Rachel to bed.

"About?"

"Someone strongly suggested that I'd be much better off with my future wife at my side at the end of August instead of waiting until after the anniversary of Elizaveta's repose to ask someone."

"Someone with a vested interest?" Kari asked.

"Yes, though I didn't feel as if it was couched to give them an advantage or as an ultimatum."

"You do not respond well to ultimata."

"Does anyone?" I inquired.

"Doubtful," Kari allowed. "I'm going to guess it had to be Danika. How much does she know about Nadiya and Sara?"

"Very little. And yes, I see how a suggestion such as that could be seen to work to her advantage, but that's not how she presented it. She made the point that I should select someone strong enough to support me through that time. She also made the point that if I didn't think she could, then we'd be wasting our time, and the same is true of any other girl."

"My gut reaction is that she has a good point," Kari said, "though you do have other options for support, of which she is probably unaware — Lara and me, and in a different way, Clarissa and Doctor Blahnik. The question is, then, which approach is correct? This is obviously off the cuff, but it strikes me that going through that emotional period with the woman who will be your wife could strengthen the bond between you."

"Or shatter it," I interjected.

"But isn't that a perfect test?"

"Perhaps, but think of the downside."

"If you commit to someone, you have to tell the other two, and if it goes wrong, you've lost all three."

"Fulfilling the Russian proverb that if you start chasing two hares, you will catch neither."

"Could you split the difference?" Kari asked.

"How so?"

"Invite one of them, whichever one you think is the future Mrs. Loucks, to the memorial services and to Rachel's birthday, but without making a commitment."

"An idea with a significant flaw," I replied. "Sara will be there and if I were to invite either Nadiya or Danika, it would send an obvious message to Sara."

"Well, then you're screwed," Kari said with a smirk. "And speaking of being screwed..."

I laughed, took her hand, and led her up to my bedroom.

July 21, 1988, McKinley, Ohio

"Having slept on it," Kari said when we got out of bed early on Thursday morning, "I think it's in your best interest to decide by mid-August."

"Which is too soon for you," I replied as we got into the shower.

"Before graduation will be too soon, Mike. You know that. And you don't want to wait that long, which I totally understand. And, as we discussed, I can't even sign up for living with you because I'm just not ready to be responsible for a kid, even part time. Do you have a feeling as to which girl is best for you and for Rachel?"

"Well," I grinned, "Rachel said 'MAMA!' to Nadiya."

"No way!" Kari exclaimed in disbelief.

"Twice, even," I chuckled. "But I don't read anything into it because it's the easiest sound for an infant to make, and nobody says 'mom' or 'mama' to her."

"OK, so discounting that bizarre occurrence, do you have a feeling of who would be best?"

"I'm not sure I can answer that at the moment. I think the better question is who I think could fulfill our needs, and so far, the only one I'm positive about is Danika. Well, Danijela could, but she decided she couldn't wait. Nadiya is still an open question. I'm not sure Sara is mature enough to handle it."

"Playing the Devil's advocate, Danika and Danijela said basically the same thing, right?"

"Yes, but one was couched as something I needed to do, whereas the other one was couched as something I needed to consider. In my mind, there's a world of difference between those two positions. Another difference was Danijela basically saying 'you have to pick me now or forget it' versus 'you should pick soon, and I understand if you choose someone else'."

"Two very different views of marriage," Kari observed. "At least from how you've described them."

"Yes. For Danika, it's a social and family contract, if you will. For Danijela, it's semi-romantic, I guess is the best way to describe it. And that explains Danika's businesslike approach."

"Out of curiosity," Kari smirked as we got out of the shower, "of the three, who do you most want to sleep with?"

"The gorgeous redhead with green eyes!" I declared as we began drying ourselves.

Kari laughed, "I did say 'of the three' for a reason! I know you have a thing for redheads with green eyes!"

"To be honest, I haven't really given that any thought. I'm confident that any of them would make a satisfactory lover. You know full well that my needs in that regard are pretty conventional."

"Given the extent of my experience is with you, and we haven't done anything I'd consider crazy, I'll have to take your word for it!"

"Just out of curiosity..." I asked with a smirk as we went to the bedroom to dress.

Kari laughed, "Having been in concert band, I heard some wild stories. The wildest was this one time, at band camp, where a group of five guys and five girls drew random cards and did what was on the card with a random partner. I didn't go to band camp, so I can't say if it's truthful or not, but every girl had sex with every guy, either oral or screwing, and everything was done in front of everyone else."