Chapter 29: Both Positions Are Defensible

August 7, 1988, McKinley, Ohio

After our lunch, I'd taken Nadiya home, and then Rachel and I had returned to McKinley. I felt Nadiya and I had made progress, though she was still very much on the fence about marriage. During my drive back, I'd considered how long I would give Nadiya to make a decision, and I felt it had to be no later than August 18th, the day Danika would return and would expect an answer from me.

I'd also considered Lara's and Clarissa's concerns about Nadiya, and felt, after our conversation, that I could trust Nadiya's decision in that regard. She'd promised to read both books before our next date, and that made me confident she'd have all the information she'd need, though, ultimately, her struggle was with her idea that romantic love was always a precursor to marriage.

"What do you think, Rachel?" I asked as I prepared her bottle.

"GA!" she exclaimed.

"I'm not sure that helps," I chuckled. "Could you add another few words to your vocabulary, please?"

"NA!" Rachel giggled.

I was positive my not-yet-one-year-old daughter was mocking me, which, for a Russian girl, would be par for the course. I finished making her bottle and took her to the study so I could sit in the rocking chair while she drank her formula. She had just finished when the phone rang.

"Loucks residence; Mike speaking."

"Michael, it's Vladyka JOHN."

"Master, bless!" I exclaimed.

"The blessings of the Lord be upon you and Rachel. Are you available to talk?"

"Yes, of course," I replied.

"I've heard from Father Nicholas that you had planned Elizaveta's memorial services, and that you asked him to serve the panikhída on Thursday evening, August 25th, then have the graveside service on Friday morning, the 26th. Is that still the case?"

"It is," I replied. "I arranged with Doctor Roth, the surgeon who leads the team to which I'm assigned, to miss that morning's surgery."

"Would you permit me to conduct the services?"

"Of course, Vladyka! It is your church, but I am grateful for you asking."

"I understand from Father Stephen that you are attending everywhere except Saint Michael, though I haven't seen you at the Cathedral for a few weeks."

"I'm no longer seeing Danijela Dimitrijevic," I replied.

"I see. Do you still intend to see Father Roman?"

"I do, though, after the end of the month when I've completed the traditional year of mourning."

"Then I won't keep you any longer. I'll see you on the evening of the 25th. Would you be free for dinner?"

"I would like that. I look forward to seeing you, Vladyka."

We said 'goodbye' and I hung up, then took Rachel to the kitchen so she could have the rest of her meal. Once I'd fed her, I made a note on the calendar about dinner with the bishop, then prepared my dinner. I ate while Rachel sat with me in her high chair, and just as I finished eating, the phone rang again. I answered it, expecting it to be Danika, which was the case. We had a nice, friendly chat, and she didn't raise the question of our future, so I didn't either. We had just finished our call when Lara arrived.

"How did things go with Nadiya?" Lara asked.

"I brought up the things I'd failed to discuss with her and we had a good conversation. I bought her copies of both books by Bishop KALLISTOS, and she promised to read them. Her big hangup has nothing to do with Orthodoxy; it's that she expected to marry someone with whom she had fallen in love and who had fallen in love with her."

"Is that a surmountable obstacle?"

"I believe so," I replied.

"And later, if she decides she needs 'true love'?" Lara asked.

"You really think that's a risk? That she'd decide to end the marriage?"

Lara shrugged, "I don't know, but if she really believes in romantic love, and thinks it's the path to a happy marriage, I'd say you need to think about what that means, both in the short term, and for the future. Danijela never made that point, did she?"

"No."

"And Danika obviously didn't, nor did Elizaveta, right?"

"It certainly wasn't Elizaveta's primary concern, but she did ask if I was in love with her. I suspect that was a bit of insecurity because she was so young. I couldn't say that when she first asked, but eventually I answered 'yes' because I felt it reflected how I felt about her. But that was after we'd agreed to marry."

"You don't expect that to happen again, do you? To fall in love?"

I shrugged, "I have no idea. I didn't expect it to happen with Elizaveta. It's not something I could promise someone, that's certain."

"Then you need to be sure that Nadiya will be happy for the rest of her life with you not being in love with her, and possibly not being in love with you."

"How can anyone know that?" I asked. "I thought my parents were happily married, and they were, until they weren't."

"I was really too young to understand," Lara replied, "but I remember having the feeling that something was a bit off, but I had no idea what was going on, and didn't understand what had happened until I was older. I suspect there were things going on with your parents, but they kept it hidden."

"I'm sure you're right, though I'd have to ask my mom if she saw any signs, though it might only be in hindsight. All I saw was my mom and dad loving each other and my dad appearing to have fully embraced the Orthodox faith."

"Appearing," Lara echoed. "Which, you know, was always the concern your priest and former bishop had about the non-Orthodox girls you were dating."

"I've seen plenty of successful relationships with married-ins."

"Men, though, from what you've said, right?" Lara asked. "The guys usually go to their wife's church?"

"True," I admitted. "That's something Marcie pointed out. Angie was different, but as I've said many times, her illness had already begun to manifest, so it's difficult to draw any firm conclusions."

"You still seem convinced that Nadiya is the right girl."

"And you seem opposed."

"More like playing Devil's Advocate," Lara countered. "Or consider it checking to make sure you're evaluating the situation correctly. You know I love you and don't want to see you get hurt."

"You could solve that right now," I replied with a smile.

Lara laughed softly, "You certainly are stubborn!"

"So say 'yes' and there are no further cares!"

"You know it's not that easy!"

"I know nothing of the sort!" I retorted. "Your objection four years ago was that I was a subdeacon, and that I was going to be ordained. That objection no longer applies. And I'm not as zealous about praxis as I once was."

"That's true, but you're uncomfortable with your current praxis, aren't you?"

"Yes," I admitted.

"And you still plan to have Father Roman as your spiritual father?"

"If he'll accept me, yes."

"Then I think you just answered your own question. You aren't stubborn or inflexible, because you did modify your praxis on Elizaveta's behalf, but you, and she, would have returned to a stricter rule once she'd had your children."

"Probably," I admitted.

"Because that's who you are, Mike. And you know what? That's one reason you're going to make a good doctor — strict adherence to accepted practice. You learn the procedures and you follow them. Your personality won't allow you to deviate except in the case of a situation where it's necessary to save the life of a patient."

"Two very different things," I replied.

"Not really," Lara replied. "You're a rule follower, Mike, and you always have been. It's who you are."

"And yet, I agree with Doctor King that some rules are meant to be broken."

"Unjust laws? Yes, of course. But practices for healing patients which have been developed and tested over centuries? Not a chance. You make the argument all the time about Christ being the Great Physician and the Eucharist being the 'medicine of immortality'. Well, your prescription includes asceticism, and that comes as naturally for you as breathing. You're out of sorts when you fight those natural tendencies."

"I can't argue with my own words," I replied.

"Oh, you could, because you're a guy!" Lara teased. "But you'd never be the one to say 'do as I say, not as I do'. In fact, you're more likely to advise someone not to do as you do with regard to your asceticism. The only thing that keeps you from being a monk is that you like sex far too much!"

"I have made that comment," I said with a smile.

"You've said you feel unstable or adrift, and you've pointed to Elizaveta's repose as the source of that. But I think it's more than that. I believe it's because you're disconnected from the Church. You won't feel stable until you pick a parish, regularly attend Vespers, Matins, and the Divine Liturgy, confess, receive the Eucharist, fast, and keep your prayer rule, as you did for twenty-four years. That is how you get through the end of this month. Danika wasn't wrong, she just didn't have the complete picture."

"And perhaps not an accurate one," I replied. "She's seen the 'disconnected' me, not who I was before all the crap hit the fan in the last eighteen months."

"I'm going to lay ALL of that, except for Elizaveta, at the feet of your former bishop, who couldn't keep his monastic vows any more than you could have. He, in effect, ripped you away from your usual practices and horribly damaged your spiritual self. You need to recover that, and in my mind, the only way that happens is if you return to your pre-ordination practices. The question you have to ask yourself is, is that something for which Nadiya will sign up?"

"I don't know," I replied.

"Is Danika's family strict or lax?"

"On the strict side," I replied.

"As was Danijela's family, right?"

"Yes."

"But not Sara's."

"No. Only Oksana's family, of the girls I have considered, is strict."

"And you pawned her off on a doctor!" Lara teased.

"She's as needy as Tasha," I replied. "That is the last thing I need because there is literally nothing I can do to change my training schedule. Doctor Casper is in his final year of Residency and has a reasonable schedule. They seem to be getting along well, though who knows what will happen when she brings him to church regularly."

"Well," Lara smirked, "if she's like the rest of us Russian girls, she'll be very passionate!"

"Why do you think we Russian men put up with you?" I asked with a silly smile.

"Let's say evening prayers, and I'll demonstrate before you have to get to sleep!"

"That's an outstanding idea!" I declared.

August 8, 1988, McKinley, Ohio

"Morning, Mike!" Kylie said when she saw me in Internal Medicine, as Debbie and I were on our way to prep our Monday morning partial colectomy.

"Hi. How have you been?"

"I have the 10:00pm to 10:00am shift this month, so how do you think I am?"

"It could be worse," I replied.

"I don't want to think about next year; I just want to get through this year and pass the MLE! Want to get together next weekend?"

"I have band practice, my annual physical, and then I'll be in Goshen. And the following weekend, I have plans. Sorry."

"Bummer. Let's at least have coffee in the next week."

"Sounds good."

Debbie and I continued to Mr. Feldman's room so we could prep him for his surgery. We went through our usual procedure, and once the anesthesiology Resident had administered a sedative, we escorted Mr. Feldman to the OR, then went to scrub.

"Do you think this could be done by the new procedure?" Debbie asked as we followed the protocol for cleaning our hands and arms.

"I suspect so," I replied. "We're only removing about ten inches of bowel, so the minimally invasive procedure would probably be indicated once everyone is trained. I'm looking forward to the week after next, when the guest surgeon will be here to teach Doctor Roth how to do the procedures."

"And Doctor Lindsay will be at Ohio State, right?"

"Yes. I'm sure you saw the boxes with the new equipment in the hallway. According to Ally, a tech will be here on Friday afternoon to unpack, set up, and test the equipment. It'll be really interesting to see it used 'live' for the first time here."

We finished scrubbing, and with the help of the scrub nurse, donned gloves and masks, then went into the OR to wait for the surgeons, who arrived about five minutes later, along with the anesthesiologist.

"Mike, intubate, please," Doctor Roth requested once the patient was anesthetized. "Explain the steps to Debbie as you do it."

"Yes, Doctor," I replied.

I carefully followed the steps for intubation, not needing to rush as the patient was breathing on his own and intubation during surgery was procedural, not emergent. Once I finished, I checked for bilateral breath sounds, and hearing them, asked for permission for Debbie to listen as well, which was granted. I instructed her in what to listen for, and once she'd auscultated Mr. Feldman's lungs, we stepped back to observe the procedure.

"Debbie, what are we doing today?" Doctor Roth asked.

"An extended hemicolectomy," she replied.

"More detail, please," Doctor Roth instructed.

"Resection of a portion of the descending colon and transverse colon due to infarction resulting from mesenteric ischemia."

"Mike, risks?"

"The usual for any abdominal surgery, as well as dehiscence of the anastomosis, which would result in a leak leading to peritonitis. He's to have a reversible colostomy, and the risks there are para-stomal hernia, bowel prolapse, ischemia, and skin irritation."

"Doctor Rafiq, how do we limit the risk of dehiscence?"

"Ensure good blood supply," Doctor Rafiq replied, "and ensure no tension on the anastomosis."

"Good. Doctor Lindsay, this one is all yours. Doctor Taylor, you assist. I'm going to do a crossword puzzle."

He wasn't, but that was a slight dig at the anesthesiology team, who had a practice of reading medical journals or doing crossword puzzles during simple surgeries when the patient was perfectly stable. That was something I'd never do, as being distracted in the OR for even a few seconds might lead to an adverse outcome.

"I left my Tom Clancy novel in the lounge," Doctor Bernard, the anesthesiologist, said, causing everyone to laugh.

I hadn't had time to read the latest book, The Cardinal of the Kremlin, but given it focused on Russia, I had it on my reading list. I'd enjoyed The Hunt for RED OCTOBER and Red Storm Rising, but hadn't read Patriot Games as it involved Irish terrorists, which didn't hold any interest for me.

The surgery went well, and after Doctor Roth inspected the anastomosis, he instructed Doctor Taylor to close the incision, and asked Doctor Rafiq to assist. Once the surgery was complete, Doctor Rafiq, Debbie, and I escorted Mr. Feldman to recovery, where we waited until he regained consciousness. I did a final vitals check, Doctor Rafiq signed the chart to allow Mr. Feldman to be returned to his room and then the three of us joined the rest of the team for lunch.

"Mike?" Nurse Angie called out when we returned from the cafeteria. "Your father called. He left a number at Harding County Regional Hospital for you to call."

"I suspect I have a new baby brother or sister," I replied.

She gave me a strange look, which I understood, and explained that my parents had divorced and my dad had married a much younger woman. I took the message slip and went to the lounge to place the call. The operator who answered directed the call to Holly's room, and my dad answered.

"It's Mike," I said. "X or Y?"

"What?" Dad asked. "Oh, wait! You mean girl or boy? A girl."

"Congratulations. I assume she has a name?"

"You are definitely your mom's son!" My dad declared. "Faith Esther Loucks. She and Holly are doing fine."

"That's great! Rachel and I will come visit in a couple of weeks, if that's OK."

"It is, of course. I should let you know we put in an offer on a house in Rutherford. I believe it'll be accepted and we'll move next month."

"I'm not surprised. That apartment would be awfully cramped for two kids!"

"It would. I look forward to seeing you, Mike. Talk to you soon."

We said 'goodbye' and I hung up.

"Well?" Clarissa asked.

"Faith Esther Loucks. Faith is my grandmother's first name. Not sure why 'Esther', and I didn't ask."

"Think that's it for them?"

"I have no idea," I replied.

"How are things between your dad and his parents?"

"Strained. I believe the names were a peace offering, because it's not traditional on his side of the family the way it is on ours."

"Will you name your son Peter?"

"Maybe. I could go with my great-grandfather's name, Ivan, though I'd Anglicize it to John."

"What about Holly's parents? Did they come to terms with the situation?"

"Grandkids are the great levelers," I replied. "Once Jonathan was born, Holly's mom chilled somewhat."

"What do you have this afternoon?"

"Surgical excision of an adrenocortical carcinoma."

"Those are really rare! Something like one in two million!"

"And a fifty percent survival rate for successful surgery, and a complete resection is often difficult, if not impossible. The oncologist isn't hopeful, but after reviewing the CAT scan, Doctor Roth felt he has a good chance to remove it and get clean margins. What do you have?"

"Double coronary bypass graft."

I checked my watch and saw it was time to prep our patients, so Clarissa and I both joined our Residents and fellow medical students to visit our patients and prepare them for surgery.

"Doctor Rafiq," I said when I'd checked Mr. Nielson's vitals, "I'm observing hypertension and tachycardia. In addition, the patient is running a low-grade fever."

"Temp?" he asked, moving to the bedside.

"38.2°C," I replied. "It's borderline for surgery."

He nodded, then repeated my vital checks.

"Debbie, please call Doctor Roth," Doctor Rafiq requested.

"What's wrong?" Mr. Nielson asked.

"Your pulse and blood pressure are elevated," Doctor Rafiq said. "You also have a low-grade fever. Doctor Roth will need to evaluate you."

"You mean I might not be able to have my operation?" Mr. Nielson asked worriedly.

Normally, I was supposed to allow the doctor to answer, but I was concerned about how Doctor Rafiq would respond, as I felt he was insensitive, and his bedside manner left something to be desired.