Chapter 26: Learning to be a Teacher

August 1, 1988, McKinley, Ohio

"I have to beg off the team lunch," I said to Doctor Lindsay after the successful cholecystectomy. "I promised to meet someone for lunch today without thinking about the team lunch."

"We'll let it slide this time," she replied with a smile. "You agreed to play golf, so I'll take that into account at evaluation time!"

"So long as my grade doesn't depend on my score!" I replied. "I haven't picked up a club since my surgical Clerkship."

"We'll make an allowance. You know the real value is the conversation and developing the relationships. I tried to convince Vince of that, but he's singularly uninterested."

"What about Doctor Rafiq?" I asked.

"Won't play," she replied. "Some religious restriction."

"Islam, as far as I'm aware, has no problem with golf. They do have a ban on alcohol, but I don't drink, and the clubhouse serves all manner of beverages. If I had to guess, based on something I've observed, it's because you play and mixing sexes is «ḥarām», which means 'forbidden', for Muslims."

"But he can work here?" she asked.

"I suspect, but I don't know, that there is something equivalent to Orthodox Christian «ekonomia» or 'dispensation', as you would probably call it. I'm sure you recall my bishop gave permission to wear a shirt and tie on the surgical service, rather than my cassock. Out of curiosity, does Doctor Rafiq listen to you?"

"Impatiently would probably be the best way to describe it. He listens to Vince and Owen attentively."

"And I'm also going to guess he's overbearing and dismissive of nurses, too."

"I'd say so."

"Well, this ought to be fun," I replied. "He's the one I would need to agree for Debbie to do anything. I want to teach her how to insert an IV and a Foley. She had the bad luck of drawing Psych for her first rotation, which I'm sure you know."

"I do. Let me check with Owen, but I'm positive he'll be OK with it. If he gives his approval, I'll let Vince and Mo know."

"Thanks. I need to get to lunch."

"See you for the hysterectomy this afternoon. Before you go, have you learned intubation?"

"Yes."

"Then we'll have you intubate the patient when she comes to the OR."

"Thanks."

I left the Resident's office and headed to the lounge where I called daycare to let Marcie know I was going to lunch and she said she'd arranged to have her lunch break coincide with mine, so she'd join me. Ten minutes later, we both had our food and had sat down at a table for two, close to the windows.

"I know this may sound strange," I said, "but what are you looking for?"

"Isn't that the question the girl usually asks the guy?" Marcie asked.

"I suspect so, which is why I said it might sound strange."

"I take it you want a clear, direct answer?"

"That would be best."

"A husband," Marcie said with a sweet smile and a twinkle in her eyes.

"Me, specifically, or in general?"

"Yes?" she replied with a soft laugh.

"You had that general intent, then saw a target of opportunity?"

"An interesting way to put it, but I suppose it's reasonable."

"And the fact that I'm a widower and have a daughter?"

"You're an amazing dad from everything I can tell, and that's super-important to me. You're also handsome, and you'll be a doctor next year."

"An Intern," I countered. "With all the insane hours that come with that."

"Do you think I wasn't aware of that after working in the hospital for over a year?"

"I wasn't sure, but better to simply say it directly."

"Does that mean you're interested?" she asked.

Things were moving far faster than I'd expected, and I had hoped to have known what Nadiya intended. I had to be careful so as not to lead Marcie on, not to mention I still had reservations about her friendship with Sasha, despite the disclaimer Marcie had given about not having seen Sasha for some time.

"You're pretty and Rachel likes you," I replied, "though I don't know you well enough to give you an answer beyond the fact I find you attractive."

"Isn't that where it starts? You're attracted to someone, so you try to get to know them?"

"I'd agree that's the usual way. You know there are significant differences between your church and mine, right?"

"You've been baptized and received Jesus as your personal savior, right?"

"No. Well, not the way you mean it. What you just said is individualistic, and to be blunt, the only thing we do as individuals is sin. Everything else we do as the Body of Christ, the Church, with Christ as its head. We worship together, we pray together, we fast together, we feast together, and we are saved together, much as Noah's family was saved together in the ark. Your church teaches the solas, right?"

"You mean like Sola Scriptura?"

"That's one of them, yes. I suspect, and correct me if I'm wrong, but you believe that salvation is by grace alone, through faith alone, of Christ alone, as taught by Scripture alone, and that God is the sole actor in salvation, right?"

"Yes, of course. That's the basis of Christianity."

"Actually, it's not," I countered. "That list is in direct contradiction to the teaching of the ancient Church. In fact, that list contradicts itself because it stipulates five things which operate 'alone' and yet requires all of them to operate together. And that doesn't even get into the serious problem of the absolute rejection of 'Faith Alone' in the Scriptures."

"You can't be serious!" Marcie protested.

"I'm deadly serious," I replied. "The only place, in the entire Scriptures where the words 'by faith alone' appear, they are preceded by the word 'not'. James says — 'You see that a man is justified by works and not by faith alone' and 'But are you willing to recognize, you foolish fellow, that faith without works is useless?' That right there refutes the notion of 'faith alone'.

"Moving on to 'Sola Scriptura', it is an incontrovertible fact that there has never been a time when the Scriptures were 'alone'. Put succinctly, there was a time when there was a Church and not a single book of the New Testament canon existed, but there has never been a time when the canon existed and the Church did not. The church collected, collated, circulated, and promulgated the Scriptures. Thus it is literally impossible for the Scriptures to have created the Church, which exists independently of them."

"That is not what I've been taught since I was little," Marcie declared.

"I understand. Fundamentally, individualism is not Christian, and that's made clear in the Scriptures and the teachings of the Church. We sin alone, but are saved together. The church is the ark, as I said, and we, the believers, gather in the 'nave', which has the same root as 'navy' to worship and be carried to the safety of theosis — union with God.

"What we are saved from is not sin, but death. We share in Adam's mortality, but not in his sin. We are mortal because of Adam's sin. Not because we are guilty of his sin, but because his sin allowed death to enter the world — ' ... as by one man sin entered into the world, and death by sin; and so death passed upon all men, for that all have sinned'. We are all mortal, and that mortality, and fear of death, leads us to sin."

"You've, like, contradicted almost everything I've been taught."

"I suspect not, because your church accepts Chalcedonian Christology."

"I don't know what that means."

"Jesus Christ is one 'person' in two 'natures', in a hypostatic union, even if you don't use those words to express the concept."

"How do you know all of that? From your training to be clergy?"

"No, I learned it before that, simply by attending Church, but I'm also a catechist, that is, an approved teacher. The point I'm making is that for this to go anywhere at all, you'd need to join my church."

"In my experience, the guy joins his wife's church if they aren't already members of the same church."

"Not happening," I said firmly.

"Why did you say that?" Marcie asked, sounding unhappy.

That was a good question for her to ask, and besides the obvious, it traced back to the fact that I was concerned about her having been Sasha's friend and having testified against Deacon Vasily. While I didn't blame her, I couldn't get that picture out of my mind. It was absolutely true that I was not going to leave the Orthodox Church and my spouse would need to join. That was not a concern with Danika, obviously, nor was it a problem with Nadiya, though she had not yet said she was willing to move forward.

"Because it's too important to me," I replied. "And fundamentally, that's a crucial concern that would be a serious impediment."

"You wouldn't even consider attending another church? There are plenty of options."

My mind went back to my conversations with April Nash during my Senior year of High School, and her adamant refusal to even set foot in an Orthodox Church. She'd made the same suggestion about finding a church that was mutually acceptable, and I'd rejected the idea then, just as I was now. I didn't have a problem with April's opinion, but it did mean we couldn't be a couple. And that was true now.

I shook my head, "No. And it's better to be up front with it. That's why Maryam asked you what church you attended."

"She attends your church?" Marcie asked.

"Yes."

"You'd really let church stop you from dating someone?"

"Can a leopard change its spots?" I asked. "I'm unable to act against my nature any more than you are."

"I'm sorry I wasted your time," Marcie said, getting up.

She walked away, leaving her half-eaten lunch on her tray. I quickly finished my lunch, then returned both trays, then left the cafeteria and began walking towards the elevators.

"Petrovich! Wait up!" I heard Clarissa call from behind me.

I stopped and waited for her to catch up.

"What happened?" she asked.

"I suppose the short answer is she's interested, but I'm not. I probably just should have said that instead of trying to be nice and then giving her both barrels."

"You've lost me."

"When I asked her what she was looking for, she said, quite honestly, a husband, but in a general way, not specifically. And if you think about it, that makes sense at her age, and given she chose not to go to college. But as I mentioned this morning, she was friends with Sasha, which gave me pause. When she asked if I was interested, I said she was pretty and got along well with Rachel, but that I didn't know her well enough to say more than I was attracted to her.

"She commented that attraction is usually where it starts, and I agreed, but I said that there were big differences between our churches. I knew she attended the Evangelical Free Church because Maryam had asked her last week, and Marcie asked me the usual Evangelical question — had I been baptized and accepted Jesus as my personal savior?"

"Oops," Clarissa said as we got into the elevator. "That's basically the kiss of death."

"It is. So I answered pretty directly, refuting the solas and refuting Christianity as a purely individual endeavor. She wasn't very receptive, and made the comment that in her experience, a husband attends his wife's church. I said, quite clearly, that wasn't going to happen. And yes, that is actually a shared experience, including my dad changing churches to satisfy my mom."

"You think he never really took it to heart, right?"

"All evidence suggests he is, was, and is likely always going to be, a Calvinist. Anyway, Marcie asked if I'd consider attending another church, obviously not meaning a parish, but a Protestant Church and I said there was no way that was going to happen. She made the comment that there were plenty of options and wondered why I wouldn't consider attending one."

"Because if there is one thing that is true about you, Petrovich, is that you are Orthodox, through and through. Your entire world view is Orthodox, and you can't abandon it any more than your dad could abandon his Dutch Calvinism."

"That was something that had flashed through my mind, not to mention the parallels with April Nash in High School."

"You dodged that bullet!" Clarissa declared, as the elevator doors opened on the surgical floor.

We went to the lounge as we had a few minutes before we'd need to do pre-op for our afternoon patients.

"I did, though I wouldn't have been so careless as to have unprotected sex. Anyway, the parallels are there, in that April felt it was on me to, in effect, give up my faith and 'compromise', something I could never do. Once I made that clear, Marcie got up and walked away, leaving her half-eaten lunch on her tray."

"Not having heard the conversation, I can't say anything other than it was better to get that out up front than to wait. And once she said 'husband', even in a general sense, you had to do that, because anything else would have been leading her on. And even if that wasn't a concern, you'd always wonder about her relationship with Sasha. You said Marcie testified, right?"

"Yes. I asked Tasha when I was at Holy Transfiguration yesterday, but she said she doesn't keep up with Sasha's friends, which makes sense, especially given Sasha's behavior towards their family. Tasha does watch Vika from time to time, but that's it."

"Did Nadiya go to church with you?"

"Yes."

"She's the one in your mind, right?"

"I'd say that's the case, but she's not sure, and until she's sure, it doesn't matter what I think."

"I assume you want my advice?"

"You assume correctly. Well, no, I want you, but that's something unobtainable."

"You know I wish it were different," Clarissa replied. "But what's the saying in the Bible? The leopard can't change its spots?"

I laughed, "That's the exact verse I used to respond to Marcie about leaving the Church."

"Because it's who we are. You and I will be the closest possible friends, but there just isn't a solution because even the fantasy three-way relationship doesn't work for you because you'd be the third, if you will."

"I know," I sighed. "You're my soul mate, and you're a lesbian; Angie was, and is, my true love, and she has schizophrenia; Elizaveta, well, you know."

"You loved her with all your heart, Petrovich, even if you weren't 'in love' with her. And your wife, whomever it might be, has to accept all of that. If she can't, it's a recipe for disaster. And your wife needs to be unquestionably and unswervingly faithful, and by that I mean Orthodox. Elizaveta obviously was, and Angie accepted it unhesitatingly."

"Drop the shoe, Lissa," I replied, knowing what she was going to say before she said it.

"If you cannot be one hundred percent sure that Nadiya is going to convert and remain Orthodox, you can't marry her."

"Which means I ask Danika to marry me," I replied.

"Or you go hat-in-hand to Danijela and ask her to reconsider. Well, unless you think Sara is mature enough."

"I don't."

"Neither do I," Clarissa agreed.

"I do plan to ask Lara one more time."

"Why do I hear Lara's Theme playing in my head?"

I laughed, "I have been playing it for some time!"

"And that's supposed to be what? Foreshadowing?"

"No. Just one of those interesting coincidences," I said, then checked my watch. "I need to find Debbie and prep our 1:00pm."

"Same here. Continue after the surgeries?"

"Yes."

I found Debbie with Doctor Rafiq at the nurses' station, and the three of us went down to Internal Medicine to prep Mrs. Chambers. I inserted the IV, explaining step-by-step to Debbie as I did it.

"Mrs. Chambers," I said. "I need to insert a Foley catheter. Are you OK with that?"

"Could she do it?" Mrs. Chambers asked.

"She's never done one," I said. "I could talk her through it, but I'd need to get permission from Doctor Lindsay or Doctor Roth. I can call a nurse if you prefer a female to do it."

"I do. I hope you aren't offended."

"Not at all," I replied. "Patients are generally permitted to choose their caregivers, except in emergency situations, and this isn't one. Let me get a nurse. Debbie, stay with Mrs. Chambers, please."

I left the room and went to the nurses' station.

"I have a female patient who would prefer a female to insert her Foley," I said to Nurse Kim, the charge nurse.

"What about your Third Year?" she asked.

"She had her Psych rotation first, so hasn't done one, and I haven't had a chance to demonstrate on a female patient, and don't have permission to allow her to do it yet."

"OK. Let me send Becky in to do it."

"Thanks."

I went back to the room and let Mrs. Chambers know a nurse would be in shortly, and Nurse Becky arrived about a minute later.

"Hi, Mrs. Chambers," Nurse Becky said. "I understand you want a female staff member to insert your Foley?"

"Yes, please. I don't mean to be difficult, but...

"You're not," Nurse Becky replied. "It's a common request, and one we all understand."

Nurse Becky performed the procedure expertly, and I explained the steps to Debbie, while standing such that Mrs. Chambers' modesty was protected.

"Mrs. Chambers," I said, "we do need to shave part of your pubic hair, but Debbie can do that."

"OK," she replied.

"Thanks, Becky," I said.

She left, and I supervised Debbie shaving about an inch off the top of Mrs. Chambers' pubic hair, finishing just as the anesthesiology Resident arrived to administer the sedative. Doctor Rafiq left at that point, and ten minutes later, with the help of an orderly, Debbie and I moved Mrs. Chambers to a gurney from her bed. The orderly wheeled her out of her room and to the elevators, with Debbie and me following behind. On the surgical floor, we escorted Mrs. Chambers into the OR, then went to the locker room to change into scrubs.

"Has that happened before?" Debbie asked.

"A few times," I replied. "You may run into it with a male patient, though for the most part, they aren't as concerned about modesty as some women are. I mean, if you think about it, you can't get much more intimate than touching someone's genitals, even if it's purely medical in nature. We're trained to separate sex and exposed genitals; most people are not. Think about the steam room at the medical school, if you used it."

Debbie nodded, "Everyone wears towels that cover their breasts and groin, even though it's all girls."

I nodded, "That was mostly true in the men's steam room, but not universally so. Peter, from my study group, and I would simply sit on our towels. But again, that goes back to notions of modesty. Right or wrong, based on culture, religion, or personal preferences, we have to respect the patient's wishes, with the exception of emergencies. In those cases, all questions of modesty go out to the window in favor of saving a life."

"How many Foleys have you done?"

"Dozens," I replied. "Basically, anyone who needs surgery or is unconscious when they're brought into the ED gets one. The very first one I saw was on a teenage girl, and it was uncomfortable and disconcerting to watch. Now it's just something I do and don't even think about it. It's like blood for some people. That never bothered me, but some people have to get used to it, and if they can't, they elect a specialty which minimizes their exposure to blood and gore."