Chapter 30: An Answer

August 13, 1988, Greater Cincinnati, Ohio

"TGI Friday's and Young Guns?" Nadiya asked after she greeted me at the door of her parents' house.

"Sounds good. Shall we?"

We walked to the car, and I opened the door for her. Once she was settled, I closed the door and went around to the driver's side to get in. After we both buckled in, I headed for Tri-County Mall, where the restaurant was located.

"How was your physical?" Nadiya asked.

"Other than my physician saying he'd prefer I got more sleep, just fine. I won't know the blood test results until Tuesday, but I suspect they'll be fine because everything else checked out OK."

"But don't the tests show things that don't show symptoms?"

"That's true, but mostly what they're looking for is blood sugar, cholesterol, and liver function. With any of those things, I'd likely have experienced symptoms. The things you're talking about are rare enough that they're unlikely — thyroid problems, cancer, or some other blood malady. Would it be possible? Sure, but there's no family history of any problems, which is a strong indicator."

"Do you get extra shots or anything?"

"None are required," I replied. "Though some hospital staff take annual influenza vaccines. I don't, but I don't have any risk factors. I'm rarely sick, even being around sick people all the time. They did verify I had all my standard immunizations when I enrolled in medical school. I assume you've had yours?"

"Yes. I've heard of people who refuse all vaccinations for various reasons."

"Even with the fiasco with the vaccine for Swine flu in 1976, there is no good reason, nor any valid science, for not taking the MMR, DPT, and polio vaccines. The fiasco with Swine flu reignited vaccine hesitancy which followed an unmitigated disaster from 1955 known as the Cutter Incident. A lab made an error and some live polio virus cells were included with the inactivated ones. That caused over forty thousand polio cases, around fifty cases of paralysis, and five deaths. The disease could be transmitted to recipients' families, which led to another hundred or so cases of paralysis and an additional five deaths."

"Wow!"

"That rivals the thalidomide disaster in the 50s and 60s, though the US managed to avoid the brunt of that problem because the FDA refused to approve the drug for use in the US. Globally something like ten thousand babies were born with severe birth defects, and nearly half of them died shortly after being born."

"Whoa!" Nadiya exclaimed. "How did that happen?"

"Thalidomide was hailed in the late 50s as an anti-emetic and a treatment for insomnia. Only nobody tested it on pregnant women and that led to the disaster. That said, something important was learned, and not just about drug testing. Prior to that, most scientists and physicians did not believe drugs could cross the placental barrier.

"Sadly, they were dead wrong, and horribly deformed babies were the result. Further research showed that if the drug was only taken after forty-two days of gestation, there were no birth defects. If it was taken before forty-two days, horrible birth defects occurred with alarming frequency. That incident led to strengthening the FDA rules for new drugs."

"That's a terrible way to learn!" Nadiya protested.

"Many medical advances come because of situations such as the two I just described. Thalidomide led to the FDA requirements that drug makers prove efficacy and also to the requirement that they disclose all side effects, even minor ones, encountered in testing. Similarly, the sale of 'snake oil' cures led to the Pure Food and Drug Act of 1906, which was the first federal regulation of medication."

"Did you learn all of that in medical school?"

"Most of it, yes. We had an entire course on pharmacology, which covered all aspects of medications, including history. Similarly, our practice of medicine courses included quite a bit of the history of medicine, stretching back to ancient Egypt. There's a document, the Kahun Gynaecological Papyrus, which describes gynecological diseases, contraception, fertility, and pregnancy. The treatments were rudimentary, but they do appear to have been effective in some cases. It's from about 1800BC."

"Wow!"

"On the flip side, when it was discovered that handwashing reduced hospital mortality, physicians fought it because, and I kid you not, many physicians argued that a gentleman's hands couldn't spread disease!"

"Oh, come on!"

"That was before the germ theory of disease was understood, and is similar to the thought that no drug could cross the placenta. We learn, slowly, but we do learn."

"Have you made any mistakes?"

"With one exception, I'm not permitted to do things where I could make a significant mistake. The exception is intubation, which I only recently learned to do."

"Rachel has an upcoming exam, right?"

"Yes, the day after her birthday."

"Which day is that?"

"The 26th."

"If I understand correctly from the books, you'll also do a memorial service."

"Yes. Thursday evening we'll have the panikhída, which is the service most people will attend, and then on Friday morning, the graveside service. The bishop will be at Saint Michael for both services, as Elizaveta was a matushka when she reposed."

"What does that word mean?"

"Which one?"

"Actually, both — panikhída and matushka."

"Panikhída means 'vigil', and we'll serve it in the church, then share koliva, which is a special dish made from wheat kernels boiled until they're soft and sweetened with honey or sugar. Our church's tradition adds sesame seeds, almonds, cinnamon, raisins, and anise. On Friday morning, we'll do a similar service at the graveside, without the koliva.

"The other word, 'matushka' is the term used for the wife of clergy, and literally means 'mommy'. I was called 'Father Deacon Michael' and our priest is Father Nicholas. The bishop is referred to as Vladyka, which means 'master'. In English we use 'Your Grace' or 'Master'. Was there anything in the books that confused you or raised a concern?"

"Not really. You explained a lot of it, including fasting and how rigorous you were about it, before I read the books. Do you intend for that to be the rule?"

"There is room for compromise," I replied.

"But you think your spiritual health is directly related to how rigorously you follow the guidelines."

I nodded, "Yes, that's true, but again, there is some flexibility, and if you can sign up for the spiritual discipline, we can find something that works for both of us. I think the only real question is whether or not you're able to set aside your preconception of how to create a successful marriage? And if you are able, am I the person you want to marry?"

"I have a question or two."

"Ask away."

"The books implied that it takes a year or two as a catechumen before a convert is chrismated. Would you wait for that to happen before we married?"

"It's not necessary to wait," I replied, "So long as you've been baptized in the name of the Trinity, we could marry in the church. As for how long it would take, I'm positive I could properly catechize you in time for you to be received by chrismation on Holy Saturday, which is April 9th next year. In my mind, there's no need to wait until then to marry, so long as you committed to be chrismated."

"That actually answers both questions. I have one more — why do you think I'm the right girl?"

"We have shared interests, our visions of the future are compatible, our worldviews are not too dissimilar, Rachel likes you, my two closest friends like you, and, even though this isn't a requirement, you're drop dead gorgeous."

The point about Clarissa and Lara was true, though not the complete picture. But they didn't know Nadiya as well as I did, and I was confident she could overcome their objections about not being Orthodox.

"You mean Clarissa and Lara, right?"

"Yes. Tasha likes you as well, and you and Angie seemed to get along, though that's always unpredictable because of her illness and medications."

"So what concerns do you have, even if they're minor?"

"Two things, though one is more of a concern than the other. The one that's least concerning is one both Clarissa and Lara raised, and that's whether or not you'd be comfortable with my ascetic approach to life, but I think we've covered that sufficiently. The main one is the one I raised a few minutes ago, which you voiced last weekend — your perception of how to create a successful marriage. Or, to put it another way, can you overcome your view that romantic love precedes marriage?"

"If I said I could, that's sufficient?"

"If I didn't trust you at your word, it would be foolish for us to marry, don't you think?"

"Yes," Nadiya agreed, laughing softly.

"And," I replied, "as I said, I believe we could find a mutually acceptable compromise. You didn't object to morning and evening prayers. Church services are going to be a challenge for the next two or three years, if not longer, based on my schedule, but other than being surprised, you didn't object. What's your take on fasting?"

"I think it's way outside my experience, so it's hard to say, other than the logic makes sense, and the book indicated that most people don't follow it strictly. You suggested some flexibility, so I think all I can say is that so long as you're willing to discuss it, it's something I can commit to doing."

"Then we're down to the final and most important question."

"Why are doctors and medical students alien beings from an alternate reality?" Nadiya asked with a slight smile.

I laughed, "You have no idea how true that is!"

"Obviously, I do, or I wouldn't have said it!"

"And the only answer I can give is that the personality required to dedicate oneself to the practice of medicine is unique. It requires a single-mindedness that most people neither have nor can understand, and in a parallel to the Christian message, it's about dying to self to serve others. Christ, as the Great Physician, is the icon for doctors, no matter what their faith.

"Everything else in our lives has to take a back seat, and now that I think about it, that's the true impediment, not romantic love. It's not that you aren't in love with me or that I'm not in love with you, but about accepting that you would always be second behind medicine. No matter what happens in our lives, the needs of the hospital and my patients will always come first. It has to be that way; there is no alternative."

"My doctors don't seem like that," Nadiya countered.

"You're seeing their bedside manner during an office visit," I replied. "But did you know your OB/GYN is on call basically twenty-four hours a day, seven days a week?"

"No way!" Nadiya exclaimed.

"Do you think babies are born on a schedule and only during normal working hours?"

"Well, no, obviously not."

"And every OB/GYN I know delivers every baby for every patient, barring being sick, on their annual vacation, or if two of their patients happen to deliver almost simultaneously. Think about what that means for the OB/GYN's family."

"Your schedule won't be like that, though, right?"

"There will be occasional times when I'm on call during my surgical training, but beyond that, I would be part of an escalation team. That means I would carry a pager at all times, but I'd only be paged in the case of implementation of a disaster protocol. Those are relatively rare, but they do happen.

"When one is implemented, it means having to literally drop what I'm doing and head to the hospital. I've said, many times in the past, and I know I've said it to you, that medicine is a harsh, demanding, jealous mistress, and she does not brook anyone or anything interfering with her demands. And that, ultimately, is what is making you hesitant about marrying me."

"May I ask a question that might seem out of line?"

"I don't find any valid question to be out of line, and I can decline to answer if I think the question is inappropriate."

"How could you ever imagine that you could be a doctor and a deacon?"

"That's a very good question, and one that is not out of line in any way. And the answer is that I agreed to ordination out of obedience to my bishop. It's a bit more complicated than that, because there were others who wanted to see it happen for various reasons, including my grandfather, but in the end, it was obedience to my bishop. And that is what led to my marriage to Elizaveta, as I would not accept ordination until I'd married."

"Was she the only one you considered?"

"No. Tasha and I discussed it, but she wasn't interested in being married to a deacon after she'd been the daughter of a deacon, and she also wasn't able to accept playing second fiddle to medicine. The girl at the wedding, Maggie, was interested, but we didn't click. It didn't help that her father was adamantly opposed to her dating me under any circumstances, and did his best to interfere. But things weren't that great anyway, and Elizaveta approached me, so it ended."

There was also Lara, but I felt it was better to not say anything about that.

"And now? Are you seeing anyone else?"

"I've dated quite a bit, but there's only one other person whom I would consider, and it's an arranged marriage situation as well."

"Would she accept the conditions?"

"She's pre-med at Taft."

"When do you see her? During the week?"

"She's at home in Cleveland," I replied. "I've only seen her once over the Summer."

"When does she come back?"

"Thursday."

"And when do you owe her an answer?"

"There isn't a specific deadline," I replied. "She'd like an answer sooner than later, but she'll wait. And she won't be angry or upset if I turn her down."

"For me?"

"I haven't been spending all this time with you for no reason."

"You're not frustrated, are you? Or upset?" Nadiya asked.

"Not in the slightest. I know this is not what you expected when you gave me your phone number and asked me to call you. If anyone has a right to be frustrated or upset, it's you."

"You didn't mislead me and basically explained the situation on our first date. I mean, not in complete detail, but enough. I could have put a stop to it then, but I didn't because I was interested in you. And we needed to spend time together so I could get to know you, and so you could tell me the things I needed to know. And I believe I absolutely owe you a straight up 'yes' or 'no'. Let's have dinner, see the movie, then go to church tomorrow. I promise I'll answer after church. A single word answer, 'yes' or 'no', with no equivocation."

"OK."

We had a nice meal, elected to have ice cream at Farrell's, and enjoyed the movie. When I arrived home, Rachel was asleep, and my mom invited me to have tea before I said my evening prayers.

"You're seeing a lot of Nadiya," Mom said. "Have you made your choice?"

"I think things would be slightly easier with Nadiya, because there aren't any cultural differences. She's a typical Midwestern girl, just as I'm a typical Midwestern boy. Danika is Indian way more than I was ever Russian, even more than during my Tashenka phase."

Mom laughed, "You really did become very Russian to please Deacon Vasily, even speaking Russian more than you had since you were around ten. You've stopped using Russian completely except for some specific words for church."

"I've actually used some lately, and for some reason, back in February, I said '«Пойдем, Царица, пора наши вечерние молитвы читать!' (Poydem, Tsaritsa, pora nashi vecherniye molitvy chitat') to Rachel." ("Come along, Tsarina, it's time to say our evening prayers!")

Mom laughed, "What moved you to say that?"

"I have no idea! It just kind of came out. I do call Rachel 'Tsarina', so maybe it's that."

"If Danika were a 'typical Midwestern girl', would that change your decision?"

"She'd never have approached me if that were the case," I countered. "Honestly, it's her culture that makes it possible for her to do what Elizaveta did, and the fact that she's pre-med that makes it easy for her to accept the demands of medicine. You know that's the main thing that kept Tasha and me apart."

"What about Danijela?"

I nodded, "She was in many, many ways just like Elizaveta."

"It sounds to me as if you aren't sure about Nadiya."

"Nadiya isn't sure about Nadiya," I replied. "Fundamentally, she's struggling with the fact that she, along with everyone and everything else, would take a back seat to medicine. She promised to give me a straight, single word answer tomorrow after church."

"And if she says 'yes'?"

"Then I'll ask her to marry me."

"You're not concerned about the fact she's struggling with your medical career?"

"I have to trust she'll tell me the truth. I can't imagine she'd lie. It's not like I'm going to make huge amounts of money in the next five or six years, and even then, a trauma surgeon in McKinley or Rutherford is not going to be rich. Will I be comfortable and make more than the typical person in either county? Sure. But that would be a silly move for a gold digger, and I don't get that vibe."

"And you're confident she's committed to be Orthodox?"

"What happened with Dad did give me pause," I replied, "but Nadiya isn't coming from Calvinism. Her church has sacraments, closed communion, and is liturgical. Dad's old church had none of those things. Sure, the step is much further than for Stefan, but nowhere near what it was for Dad."

"Would you wait for her to be chrismated?" Mom asked.

"No. I'd shoot for her chrismation on Holy Saturday next April, but marry as soon as possible. I intend to petition His Grace for «ekonomia» to skip pre-marital counseling and to have a wedding as soon as we could get a marriage license."

"Where?"

"Most likely Holy Transfiguration. Once I begin my Residency, I'll look for a place between McKinley and Rutherford, somewhere along Route 50 or Route 30, so that can be my home parish."

"Are things that bad at Saint Michael?"

"I don't feel at peace there after what happened at Nativity. And you know I'll miss plenty of services over the next few years."