Good Medicine - Medical School IV - Cover

Good Medicine - Medical School IV

Copyright © 2015-2023 Penguintopia Productions

Chapter 33: Winding Down Some Relationships

August 17, 1988, McKinley, Ohio

"Is it Rachel's bedtime?" Kris asked when we finished our prayers.

"Almost," I replied. "I want to read to her first."

"Then after that, I'll have a chance to show you an important skill!" she said with a twinkle in her eye.

"Changing a diaper?" I asked with a smile.

"Of course! What else would I ever have meant?" she teased.

"Why, nothing, of course!" I replied. "Rachel, is it OK if Kris changes your diaper and puts you to bed?"

"GA!" Rachel exclaimed.

"Does that mean 'yes'?" Kris asked.

"It's her generic syllable. So far, she only really uses 'PAPA' and 'BA' or 'BABA' with intent. She's working on other syllables and pretty soon she'll be using words. She babbles now, but only she knows what she's saying."

"So, like most High School boys, then?" Kris teased.

"At least you didn't say 'men'," I chuckled.

"Well..." Kris said with a silly smile.

I got Go Dog. Go! from the bookshelf and read to Rachel. When I finished, I handed Rachel to Kris, then led them upstairs to Rachel's room. I watched as Kris changed Rachel's diaper, dressed her in a clean onesie, then put her in her crib and covered her with a blanket she'd received as a gift from Serafima. Once Rachel was settled, Kris and I left the room and went downstairs.

"What time do you go to bed?" Kris asked.

Before I could answer Kris' question, the phone rang.

"I do need to answer the phone," I said. "If you'll excuse me."

"Of course!"

I went to the kitchen and picked up the phone.

"Loucks Residence; Mike speaking."

"It's Danijela."

"Hi."

"There's no need to come to Columbus on Sunday," she said.

"OK," I replied. "I assumed that was going to be the answer, but I felt I had to ask."

"I understand."

"Good night."

"Good night."

I hung up the phone and realized I was neither sad nor upset with that outcome. I was sure part of it was how well Kris and I had hit it off so far, but it was also the fact that the ultimatum still grated on me.

"Sorry about that," I said. "To answer your question, this week, because I'm on duty in the Emergency Department, about 10:00pm because my shift starts at 6:00am. Next week, around 8:30pm because I have to be at the hospital around 4:30am."

"Why so early?"

"I'm on the surgical service, and students are responsible for ensuring all test results are back and vitals are stable enough for surgery. That has to be done before rounds which are before the first surgery. Then we do pre-op, which means putting in a catheter and an IV, and after surgery, we stay with the patient in recovery."

"You don't get to do anything else?"

"Normally, a Fourth Year would only observe in the OR, but I've had the chance to intubate, to use the suction machine, and to hold a retractor. That's all part of the bribe."

"Bribe?"

"Doctor Roth wanted me to switch to surgery from emergency medicine based on how I did in anatomy and in my Preceptorship. He offered the bribe of having a chance to do more than a usual student if I switched. I ended up splitting the difference by helping institute a new Residency in trauma surgery at Moore Memorial."

"That was your idea?"

"No, it's been done at other hospitals. I copied it from a doctor I met who used to be at Indiana University but is now at the University of Chicago. He's trying to recruit me, but I plan to stay in this area."

"Why?" Kris inquired. "If I can ask."

"You can. I want to serve my community. People here need access to the best possible medical care, and I aim to provide it. I considered applying to Stanford and Emory, but in the end, I want to train here, complete my Residency here, and practice here. My best friend Clarissa and I agreed to do all of those together when we were undergrads at Taft.

"Best friend? If that's true, why..."

"Clarissa's girlfriend might have something to say with regard to the answer to your question."

"Oh!" Kris exclaimed. "Uhm, yeah."

"Is that a problem?" I asked.

"You mean that she's a lesbian?"

"Yes."

"You do remember I grew up in Paris, right?" Kris asked.

"Sodom and Gomorrah?" I asked with a silly smile.

"Not quite that bad, but Paris is very libertine, as you should know from your visit unless you spent all your time in the hotel room!"

"Not all of it," I chuckled. "We did the usual tourist stuff, of course — Eiffel Tower, Arc de Triomphe, Notre-Dame, The Louvre, and a cruise on the Seine. We also went to a show at Moulin Rouge."

"What show did you see?"

"Femmes, femmes, femmes," I replied.

"Interesting!"

I chuckled, "It was eye-opening, but fun."

"I bet, especially for two American kids. So you saw Paris, but you didn't really see Paris."

"If you mean the Paris where people live and work, no, we didn't. We missed that everywhere we went."

"Well, if things go the way we both appear to want them to go, someday I can show you the real Paris."

"That might be years from now, given my training regimen. You've decided?"

Kris smiled, "OK to be «некультурный» (nekulturny)?" ("risqué")

"Sure."

"Have I decided that I want to go to bed with you? Of course! And it's obvious to me you want that as well. The path from here to there has to detour through the nave of the church."

"That's not really sufficient reason to marry," I protested gently.

"Didn't the Holy Apostle Paul write 'It is better to marry than to burn'?" Kris asked with a smirk.

I couldn't help but laugh, "You do realize he's speaking to women there, not men, right?"

"Because everyone knows men can't control themselves!" Kris declared. "They're a lost cause!"

"There might be sufficient anecdotal evidence to support that claim," I replied with a grin.

"You?"

I nodded, "I was experienced when Elizaveta and I were betrothed. That said, I was teasing about what Paul wrote, as the context is widows and the unmarried, and reading back a few verses, it's a generally applicable command, even if the specific verse appears to refer only to unmarried women and widows."

"Yes, but you said what you said because you found it amusing, and you knew I would find it amusing as well."

"True. But in all seriousness, wanting to go to bed together isn't sufficient, is it?"

"No, of course not. But not wanting to go to bed with someone would be a reason not to marry, wouldn't it?"

"Yes."

"So it's necessary, but not sufficient," Kris said with a smile.

"Isn't that what I said?" I asked.

"I was confirming!"

"And you're really ready to marry?"

"It really is just a matter of timing, isn't it? I mean, for anyone who plans to marry and have kids."

I nodded, "That's true, and my timing changed due to circumstances. I had planned to wait until after my first year of Residency."

"And I had expected it to be after university," Kris replied. "But here we are."

"May I make a suggestion?" I inquired.

"Of course."

"Take three days to think about it. Rachel and I will come to the Cathedral on Sunday, we can have lunch, then speak with Father Luke and His Grace, if you think it's appropriate."

"And that gives you three days and three nights to think about it as well. Appropriate for Orthodox Christians!"

"Is this the outcome you anticipated?" I asked.

"Oksana was positive we'd be compatible, and she explained your situation, both with regard to your marriage and your training. I knew exactly what to expect, was comfortable with it, and it really was a matter of seeing if we 'clicked' as you Americans say. We did, obviously."

"Obviously."

"I'll give you an answer right now if you wish."

"Sunday, please," I said.

"Being cautious?"

"Giving both of us time to think about it. It will make Vladyka JOHN more comfortable if we can truthfully say we didn't agree to marry less than two hours after meeting!"

Kris smiled, "A fiction, but one which is not a lie."

"I think so, too. Are you driving back to Ashville tonight?"

"No. I'm staying at Oksana's house, then driving back tomorrow. Fortunately, Mom doesn't need her car tomorrow morning."

"I take it they'll want to meet me on Sunday."

"I'm sure they will, but they won't object or be obnoxious. French parents give their kids much more freedom than most parents here do, or so I've seen with my friends at school."

"I've heard that about Europe from several different friends. I think it's a good thing, but I see parents here becoming more strict, not less."

"My children will be raised the way I was," Kris said firmly. "And that would include Rachel, who would be my daughter, if things progress the way they appear to be progressing."

"That was how it worked in my family," I replied. "My mom, for the most part, gave me freedom. Of course, I didn't really make use of it, but she did allow more than most of my friends had."

"Which allowed you to gain your 'experience'?"

"That was after High School graduation, but not for lack of trying!"

Kris laughed softly, "The eternal battle between boys and girls!"

"So true," I agreed.

"I'm going to say 'good night' and I'll see you on Sunday."

"OK," I agreed. "Let me walk you to your car."

I did, and Kris gave me a quick hug before getting into her mom's Mercury Tracer. Once she'd driven off, I went back inside, went upstairs, completed my usual bedtime routine, and got into bed. As I'd taught myself to do in order to survive medical school, I cleared my mind and quickly fell asleep.

August 18, 1988, McKinley, Ohio

"You're a nut, Petrovich!" Clarissa exclaimed when I related what had happened the night before with Kris. "But you're my nut!"

"I have never denied being nuts!" I chuckled. "I couldn't do it with a straight face!"

"So, a cute, blonde Franco-Russian girl shows up, and that's it? Mike Loucks is off the market, permanently?"

"I thought that was true four years ago," I sighed, my heart heavy at the thought.

"Sorry," Clarissa said. "This is even more whirlwind than with Elizaveta."

"I know," I replied.

"When would you marry?"

"After Nativity," I replied. "She turns eighteen on November 20th, which is during the Nativity Fast, so that means waiting until the Sunday following Nativity, at the earliest."

"I take it Danijela turned you down?"

"She did, as I expected her to. But you know the problem I had with her post-ultimatum."

"And Danika?"

"We'll have dinner tonight, but I won't say anything until after Sunday. Danika won't push. In fact, she probably won't ask unless I raise the subject. She's the most patient girl I've ever met!"

"What about me?"

I laughed, "Surely you jest!"

"I'm not jesting and don't call me Shirley!" Clarissa retorted.

"You're as pushy as any Russian woman I know, Svetlana Yakovovna!"

Clarissa laughed, "You haven't called me that in ages!"

"I prefer 'Lissa'," I replied. "But it is true! Nobody has pushed me harder than you have, not even Elizaveta!"

"If there was ever a guy who needed help, it was you, Petrovich! But you haven't turned out half bad!"

"You're a sweetheart, Lissa!"

"You're a free agent until Sunday, right?"

"Yes."

"One more sleepover, then? Saturday night would work."

"So long as Tessa agrees."

"A threesome?" Clarissa asked with a smirk.

"That is not what you meant or what I meant, and you know it!"

"Obviously! Let's plan for Saturday night."

"OK. I'm having dinner with Sara, but she'll go home right after, I'm sure, because I'm going to tell her it's not going to work between us."

"Do that someplace private, Petrovich. Unless I miss my guess, she's going to be extremely emotional."

"I suspect so," I agreed.

"I'm out of here. See you tomorrow morning!"

We hugged, then walked out of the locker room, with Clarissa leaving the hospital and me joining Debbie and Doctor Rafiq in the lounge. I ended up being busy all morning, as there was a steady stream of patients needing suturing and enough emergency runs that the med students assigned to the ED were busy. That gave me a chance to teach Debbie, which she appreciated.

Marcie joined us for lunch again, and I wondered if she had some kind of agenda, but, ultimately, 'missionary dating' wasn't going to work on me, even if I had tried it myself. Marcie simply would not be able to overcome my extreme skepticism based on my experience with April Nash during my Senior year of High School, and what had happened with my dad. The worldviews of Calvinists and Arminians were too far from Orthodoxy to make such a transition easy. It could happen, as with Mark and Alyssa, and Alyssa's parents, but I wasn't going to stake my future on it.

The afternoon was less busy, and we had three surgical consults, only one of which ended up being sent up to an OR. At 6:00pm, I picked up Rachel from daycare, and headed home for my dinner with Danika. She arrived about five minutes after I did, but before Mrs. Sokolov arrived with our meal. That gave me time to prepare Rachel's dinner.

"How was your week so far?" Danika asked.

"If you remember, this week we're covering the Emergency Department, so it's a lot of sitting around waiting for things to happen. That said, the ER was slammed this morning, so I and the Third Year on our team were tasked with suturing. We saw four patients, and then had three consults in the afternoon, but we don't do anything other than assess and send the patients up. There was one chest tube, but my Resident is unwilling to allow me to do them."

"What can you do about it?"

"I could say something to Doctor Lindsay or Doctor Roth, but I have to be careful not to sound as if I'm whining. What I intend to do is next month, the Friday before we're on call, is to ask Doctor Roth if Doctor Rafiq can allow me to insert a chest tube. He'll say 'yes', and will, most likely, instruct Doctor Rafiq to allow me to do it."

"Dad said it's normal to have to fight for procedures," Danika observed.

"Sadly," I replied. "But if you think about it, a surgical Intern does not get a chance to touch a scalpel in the OR, so they're going to hoard any procedures that allow them to cut, and the one thing they can do is a thoracostomy for a chest tube. Doctor Rafiq wants nothing to do with IVs or catheters or blood draws. I don't mind doing them, and I won't mind doing them next year either, though in the Emergency Department I'll have my hands full with other things, so I'll teach my students to do those as quickly as possible."

"You strike me as the kind of person who will be a doctor who will care about his students."

"I believe that will be the case. And the cutthroat method does not sit well with me. Fortunately, it's not nearly as bad at Moore Memorial as it is at a large hospital in a city such as Chicago. That is, in my mind, a good argument for attending a medical school like McKinley. I don't believe my education is of lower quality."

"What about technological advances and advances in medicine?"

"Honestly, I'd prefer to spend my time on patient care and allow others to perfect the technology or procedures. For example, the first laparoscopy equipment at Moore Memorial is being installed this week, and we'll be taught how to use it starting on Monday. I'm fine with that, because I really wouldn't want to take time away from patients to do the research, testing, and evaluation to perfect the procedures. I suppose the best way to put it is I want to be 'just a good, old country doctor'."

"Whom are you quoting?"

"Doctor McCoy from Star Trek. But it's also how Doctor Evgeni Petrov from our parish practiced medicine. Of course, he was a GP and I'm going to be a trauma surgeon, but I think certain areas of medicine have moved in the wrong direction, ignoring the holistic approach."

Mrs. Sokolov arrived, interrupting our conversation. Once she'd set out our meal, she left and Danika and I sat down to eat, with me doing my usual juggling act of eating and feeding Rachel.

"You seem to be against technology and technical expertise," Danika observed.

"Not against it, but I think it is far more important to focus on the patient. I'm not opposed to those things, but they are only part of the answer. What I see is the more technical fields create physicians who focus too much on technical skill. My example is surgeons who, and I'm only exaggerating slightly, cut first and ask questions later. As with everything in life, balance is necessary, and that requires a holistic view.

"And that holistic view requires spending time with the patient, talking to them, and getting to know them. I do that, and that is the one criticism I receive consistently — that I spend too much time with individual patients. In my mind, it's impossible to spend too much time with a patient, so long as it doesn't impact the care of another patient or my specific duties."

"Dad would be very unhappy if you were his Resident," Danika observed.

"It's a different approach. I don't like referring to patients as 'the MI in 1' or 'the appy in 302'. I understand why it's done, but I don't like it. It's dehumanizing, and the procedures we do are already dehumanizing as it is."

"You have a very different view of medicine from my dad."

"I don't doubt that because I have a very different view than most doctors I've met. My study group all have the same basic view as I do."

"Have you begun applying for your Residencies?" Danika asked.

"I requested application packets from the hospitals last week," I replied. "They should be here no later than next week."

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