Good Medicine - Medical School IV - Cover

Good Medicine - Medical School IV

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Chapter 31: Running Out Of Options?

August 14, 1988, McKinley, Ohio

Lara and I had our dinner, and given Danika usually called around 7:00pm, I decided to wait until after our weekly call to call Danijela. My call with Danika followed the usual pattern where we spoke about what we'd done the previous week, and carefully avoided discussing the future, except as it related to my schedule and her return to Taft.

"What time will you arrive on Thursday?" I asked.

"Around 4:00pm," she replied. "The dorms open around noon, but I won't leave home until about then."

"Join me for dinner?"

"Yes, of course!"

"What time?"

"6:30pm."

"Are you cooking?" Danika asked playfully.

"I think I could manage," I chuckled. "But one of the women from church will bring a meal. Also, on Friday, if you recall, I have a gig at Stirred Not Shaken, but they card, so you wouldn't be able to attend. We have our Taft concert on the 26th, and I have a ticket for you."

"Thanks!" Danika exclaimed. "I'm looking forward to seeing you on Thursday."

"Same here! Antonne suggested we meet the first time on the 23rd for dinner."

"That sounds good! See you on Thursday."

"See you then!"

We said 'goodbye' and I hung up, then went to my study to get Danijela's number from my address book. Once I had it, I dialed the number and after three rings, her mother answered.

"Hi," I said. "This is Mike Loucks. I'd like to speak to Danijela, please."

"One moment, Mike," her mom said.

I heard a muffled conversation, then clicks as Danijela picked up the extension and her mother hung up the other phone.

"Hi," she said.

"Hi. How are you?"

"OK."

"If Rachel and I were to attend the Divine Liturgy at the Cathedral, would you have lunch with us?"

"Did you run out of options?" Danijela asked.

"That's not an answer to my question," I replied.

"Then answer mine first," she countered.

"It was never about you being the last option, but about waiting until the weekend after next, as we'd agreed. I felt I should make another effort, but if I'm wasting my time, just say so."

"Let me think about it," Dani said. "I'll call you later in the week."

"OK," I replied.

We said 'goodbye' and I hung up.

"That didn't sound good," Lara observed.

"She asked for time to think about it after basically accusing me of running out of options."

"Which isn't true, because, in effect, it's Danika who's the fallback, though I wouldn't call her that, only that you were open to other options and you were sticking to your basic timeline."

"That's true, though you have to admit that from Danijela's perspective, it looked different."

"She was foolish to push you," Lara replied. "Had she been patient, she'd be holding the winning hand."

"Probably," I admitted. "But it's that impatience that concerns me, and her willingness to use an ultimatum."

"You don't think that might have been at least partly the grandmothers' doing? That they felt a little push was necessary?"

"That's entirely possible, but even if that's true, it was Danijela who chose to issue the ultimatum. You know how that would go in the future if what she wanted conflicted with what I felt I needed to do for my medical career. And add in her reluctance to agree to have lunch, and it does raise concerns."

"You feel she's too controlling?"

"I think you just articulated what I've been feeling. Elizaveta was determined, but she also knew the limits of what she could control."

"Speaking of control and grandmothers, isn't that also a concern with Danika?"

"Yes, though if she's to be believed, the men make the rules for the household. You know my take on that, of course, but Danika was adamant that her grandmother would run the household in the way I directed. I plan to discuss that again with Danika before I do anything else."

"That makes sense, though I suppose I have to ask your motivation for marrying at this point."

"It hasn't changed, really. A mom for Rachel and a wife. I feel both of those are necessary for me to move forward. After tonight, I'm losing the main source of stability in my life."

"That's a load of bull and you know it!" Lara countered. "We're close friends and that is not going to change! The only thing that is changing is that I start work tomorrow, and we won't be sleeping together."

"And I believe you know that sleeping in the same bed with you, even without having sex, is crucial to my emotional and mental health. And I can't replace you in that way because first of all, you aren't replaceable, and second, because I promised Father Alexi."

"I'm not sure your promise was wise," Lara said.

"I wanted to receive the Eucharist, and you know how I feel about confession."

"And you know how I feel about it, along with fasting."

"I do, and it's why you keep refusing my marriage proposals!"

"What if you were to decide to wait?"

"I'm not cut out for long-term chastity," I replied. "With Elizaveta, I had a date certain when it would end."

"So it's really about getting laid and having to confess?"

"No, it really is about me not doing well as a single man and Rachel needing a mom."

"Are you sure that's not just you obsessing over something you decided you needed eight months ago?"

"I discovered, after I met Angie, that I am not cut out to be single. Think about my experience at Taft before my betrothal. And if you think about it, I had someone as a life partner from kindergarten."

"It's not as if you're losing Clarissa or me!"

"Clarissa has a partner, and you're going to find one, which will change the character of our relationship. I know how it looks, but I'm not 'settling' for Danika any more than I 'settled for' Elizaveta. Think about what happened before Elizaveta; what's happened over the past eight months is nearly identical to that."

"So that's it?" Lara asked.

"Unless you're changing your mind."

"No, for all the reasons we've discussed. Are you going to ask Danika on Thursday night?"

"Possibly," I replied. "I have a few days to think about it, and even though I'm concerned, I do want to give Danijela the chance to call, and I would keep my word about having lunch with her next Sunday, should she accept. I also need to speak with Sara."

"Just be sure," Lara advised.

"I will not be taking any action I have not carefully considered."

"Are there any other options?"

"Besides waiting? Not really. OK, I accept that's not completely true because there are other Orthodox girls in each of the parishes, but I don't think any of them would be a better option than Danika or Danijela. Sure, there's Sara, but I honestly think she's too immature, and Oksana, like so many other girls, isn't interested in effectively being a single mom for a decade."

"Just be sure you're thinking clearly."

"I am. As I said, I'm not acting precipitously, and unless you can identify a better option, I think my current course of action makes sense."

"I do know some girls in Pittsburgh, but your timeline is so compressed, I'm not sure even the Orthodox girls would be able to deal with it. As I think about it, though, your point about how things worked with Elizaveta is correct. You dealt with a compressed timeline there because of your upcoming ordination and only waited because Elizaveta had to turn sixteen. Have you spoken to any of the priests or the bishop?"

"I intend to speak to Vladyka JOHN when he's here for Elizaveta's memorial services."

"When would you marry, if Danika accepts, and the bishop approves?"

"I prefer as soon as possible, though she'd need to be received first, but that's as simple as reciting the creed and affirming her acceptance of the seven Ecumenical Councils. A marriage license is a matter of applying and having it issued. The only actual concern would be waiving the pre-marital counseling requirement and then Danika's parents' schedule."

"I suspect the bishop will accede to your request."

"I suspect so as well, but there are no guarantees. The big question for me will be which parish to attend."

"You and Father Nicholas are still on the outs, right?"

"Since Nativity. That said, I do intend to have Father Roman as my «старец», so it would be a matter of how Danika was treated by the congregation."

"What about your in-laws?"

"I'll tell them as soon as I make a final decision. Viktor knows it's coming, and so long as I don't cut them off from Rachel, I don't think I'll have any trouble. That's something else I need to clarify with Danika."

"What about your other kids?"

"That'll be an interesting challenge, but I don't see my in-laws treating them the same as Rachel."

"No, I wouldn't imagine they would."

"On my family's side, there are challenges as well. I have no idea what my paternal grandparents will think or do, and I haven't really been in touch with them since right after my little brother was born."

"I take it you'll invite everyone and let them decide what to do, right?"

"Yes. I doubt my uncle Alex and his family will come, and I don't know that Dale will be able to fly in."

"He works for Boeing! They must have a spare plane lying around he could borrow!"

I laughed, "I don't think it works that way!"

"No, of course not, but you'll invite him, right?"

"Of course. I'll send an invitation to Kimiko and Brandon as well, but I'm sure they won't fly in from Japan! I expect they'll send a card and gift, which is what they did when Elizaveta reposed."

"A gift?"

"A Japanese tradition," I replied. "I don't think I mentioned it to anyone at the time; I simply took the packet of yen they sent to the bank and exchanged it for dollars, which I deposited into my account."

"Tell me to mind my own business, but how are your finances?"

"Very good, actually. You know my grandfather and his friends are paying for this house, and Viktor is paying my tuition. With what I had saved, the proceeds from selling Elizaveta's car, and the life insurance I signed up for with the medical school, I actually have about the same amount of money in the bank that I had when Elizaveta and I married. I have sufficient funds for a down payment on a house in a year once I have my Residency contract in place. And you know that Danika's father offered assistance as well, in lieu of the traditional dowry."

"I still can't believe you'll accept that!" Lara declared.

"But what he offered is almost identical to what Viktor offered," I countered. "Doctor Kurian will pay Danika's tuition, and give us the funds he would have spent on her room and board. That would mean I wouldn't deplete my savings at all over the next year. In effect, that's no different from Viktor paying my tuition and allowing us to live in the cottage rent free."

"I suppose, when you look at it that way."

"All in all, this is very much similar to how things progressed with Elizaveta, and that worked perfectly. It was only pure, random chance that put me in the situation in which I find myself. If not for that undetected congenital defect, I'd still be happily married to her, still be a deacon, and probably working on baby number two, if Elizaveta wasn't already pregnant."

"OK. I'm not trying to argue you out of a course of action. I just want to make sure you've considered all the possibilities."

"I believe I have."

"Changing subjects — you're working the on-call shift this week, correct?"

"Yes; 6:00am to 6:00pm, but I could end up staying longer if there's a consult just before the end of my shift."

"So this week, you don't need help, right?"

"Correct. Subdeacon Mark and Alyssa are taking next week, and after that, I'll take Rachel to Serafima's three times a week, and on the other days, Subdeacon Mark and Alyssa will be here."

"At 4:15am?" Lara asked.

"Elias is up about then because he has to be on his job site by 5:45am, and obviously John Elias is waking up every two hours to eat as it is. The real challenge comes in a month when I work overnight, because I need to sleep during the day and Rachel will be awake for a good part of that time."

"What's the plan?"

"If I'm not married, and it's looking increasingly likely that will be the case, Mark and Alyssa will sleep here, and then either my in-laws or Serafima and Elias will watch her during the day. My challenge will be when I get to see her, which will probably be a few hours in the morning, at best. And that's just a preview of how it will be next year. My hope is that on those long shifts, my wife could join me for a meal at the hospital, but you know patients do not arrive on set schedules."

"That would make your life a lot easier."

"No kidding! Anyway, it's time for evening prayers. Join us?"

"Yes, of course."

We said our evening prayers, put Rachel in her crib to sleep, then Lara and I went to my room for our last night together.

August 15, 1988, McKinley, Ohio

"Good morning, Rachel!" Marcie exclaimed.

"MAR!" Rachel exclaimed.

"That's new!" I observed.

Marcie smiled, "She said that for the first time last week."

"I'm happy she likes you, given how much time she spends here."

"Will you accept an apology for walking away from you?"

"If you'll accept an apology for how strident I was with you."

"Deal. I shouldn't have walked away like that."

"And I should have used my teaching voice, not my confrontational voice."

"I know you need to go, so let me take Rachel. What time will you pick her up?"

"Just after 6:00pm," I replied. "What time does your shift end?"

"3:00pm."

"Then I'll see you in the morning. Have a good day."

"You, too," Marcie declared, taking Rachel from me.

"Bye, Rachel!" I said, then kissed her forehead.

I left the daycare and hurried to the locker room to change into scrubs. I went to the lounge to check in with Doctor Rafiq, then went to find Clarissa, who was just finishing her overnight shift.

"How'd it go yesterday?" she asked.

"Nadiya isn't interested in playing second fiddle to medicine."

"She's not the first to bail because of that."

"No, she's not," I agreed. "I called Danijela, but she was cool to my offer to have lunch on Sunday."

"Danika, then?"

"That is the direction I'm headed, and I think it's the right one. On another note, Marcie was cordial this morning, and we exchanged apologies for our conversation at lunch a few weeks ago."

"And?"

I shrugged, "And nothing. It came about because Rachel said 'MAR!' when she saw Marcie."

"Is there anyone she doesn't like?"

"So far as I'm aware, no! How was overnight?"

"Two consults, one led to an emergency splenectomy. The sad part is we have to stay here and send them up to the Attending and the other two Residents to do the surgery."

"That's exactly why I'm doing the Pathology Sub-I! At this point, observing doesn't really add too much to our skill set. And the really crappy deal is for surgical PGY1s, who don't do much more than Sub-Interns."

"Doctor Roth will let you do more once you're a Resident, right?"

"That was his commitment, but I'll actually be a PGY3 when I have my surgical Internship, so he won't get too much flack for allowing me to do more. And you know the long-term goal is for me to do procedures in the ED and take patients right up to surgery, which would limit surgical on-call and allow more scheduled surgeries."

"Time for me to go home and get some sleep!"

We hugged and Clarissa went to the locker room while I went to the lounge, where I saw that Debbie had arrived.

"Morning, Mike," Doctor Gabriel said, coming into the lounge.

"Morning, Doc," I said. "Quiet?"

"Very. Only four cases overnight."

"Rare."

"True, but you know it happens. Last week, there wasn't a night with fewer than a dozen cases."

"I'd say I hoped for an exciting shift, but that means people have to be seriously hurt or seriously ill."

"That is the bane of our training," Doctor Gabriel agreed. "In order for us to learn, there have to be patients. Of course, without patients, we'd also be unemployed! And the accidents and illnesses are going to happen irrespective of whether you and I are sitting here."

"Doctor Rafiq?" Nurse Ellie called from the door to the lounge. "Patient in Trauma 1 needs a chest tube."

He got up, and Debbie I followed him to Trauma 1.

"Please explain each step," I requested. "Per Doctor Roth, I'm supposed to learn how to do this."

"You're a medical student," Doctor Rafiq said. "You don't do procedures with scalpels."

"Nonetheless, those are Doctor Roth's instructions."

He muttered something in Jordanian Arabic, which I didn't catch, but that was probably a good thing. I knew he didn't appreciate the advantages Doctor Roth was providing, but that was his problem, not mine. And if he didn't show me the procedures as he had been instructed to, it was his butt that would be in a sling.

"What do we have?" Doctor Rafiq asked Doctor Williams.

"Adult male; thirty-four; MVA with multiple fractured ribs; collapsed right lung; tachy at 110; BP 100/60; PO₂ 90 on ten liters; patient is prepped for thoracostomy; tray is prepped."

"38 French, Nurse," Doctor Rafiq said, looking at the patient who was around six feet tall and weighed around 220 pounds.

Nurse Peggy had prepared the chest tube by placing a Kelly clamp across one end of the chest tube and forceps across the opposite end. The patient's chest had been painted with Betadine, and a local anesthetic had been administered.

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