Chapter 36: Spreading the News

August 22, 1988, McKinley, Ohio

Once we'd completed rounds on Monday morning, we brought up a patient for a laparoscopic cholecystectomy, which would be performed by Doctor Eugene Cranston, a surgeon from Ohio State. He would teach our team how to use the new equipment, and because it was a first for Moore Memorial, we were in the surgical theatre, rather than our usual OR, so that others who were interested could watch. Several surgical teams had kept their morning open, including the one to which Clarissa was assigned, and she was in the viewing gallery with her Resident and Attending.

Once the patient was anesthetized and intubated, Doctor Cranston began the procedure.

"Good morning," he said. "The patient has been sedated and intubated, and an aseptic surgical field has been created from just above the bilateral costal margins to the pubic tubercle and laterally to the right and left flanks. We make it wide enough to allow for conversion to an open procedure, should that prove necessary. Please know that conversion to an open procedure is not a sign of failure, but a judgment call by an experienced surgeon.

"Before I begin, I'll list the most common complications — bleeding, infection, and damage to the surrounding structure. Bleeding is a common one, as the liver is a very vascular organ. Surgeons must absolutely be knowledgeable about anatomical anomalies of arteries to prevent potential significant blood loss. The most severe complication is an iatrogenic injury of the common bile/hepatic duct. Injury to those structures may require a further surgical procedure to divert the flow of bile into the intestines.

"With that out of the way, let me describe the equipment. As you can see, I have two monitors, which are basically televisions without tuners. The laparoscope, in this case, a 10mm scope with zero angle, attached by a cord to the monitors. The laparoscope has its own light source, and that will enable us to visualize the operating field.

"In addition to the scope, I have several trocars which are used to create access points in the abdomen to allow the placement of instruments, as well as to allow any gases or liquids to escape. In addition, I have a small tank of carbon dioxide to infuse the abdomen to a pressure of 15mm of mercury. Finally, I have several specially designed laparoscopic instruments — atraumatic graspers in several sizes, a Maryland grasper, a clip applier, retractors, and an electrocautery. Of course, I have standard surgical tools as well, and a major surgery tray ready in case we need to convert to an open procedure.

"I'll begin with insufflation of the abdomen to 15mm mercury using carbon dioxide via this apparatus."

He gained access by using a trocar and cannula attached to the CO₂ tank, then his technician, who was also from Ohio State, turned the valve to allow CO₂ to flow.

"Next, I'm placing four trocars in the appropriate access points — one supra-umbilical, one sub xiphoid, and two right subcostal. The laparoscope and optic trocar should be inserted, whenever possible, in the sub-umbilical region using a semilunar or straight incision. Ten blade, please."

The scrub nurse handed him the scalpel, he made the incision, then carefully placed the optical trocar. The nurse handed him the other trocars, one-by-one, and he placed them as well.

"I'll now insert cannulas into the trocars."

He did that.

"Next, I'll insert the camera, followed by the graspers, the electrocautery, and retractors."

He did so.

"Now, you can see on the screen the images of the internal organs. I'll move the laparoscope and the instruments to retract the gallbladder over the liver. My goal is to have a proper view of the hepatocystic triangle. This view is defined by three things — clearance of fibrous and fatty tissue from the hepatocystic triangle, the presence of only two tubular structures entering into the base of the gallbladder, and the separation of the lower third of the gallbladder from the liver."

I watched in awe as he manipulated the various instruments and the camera and achieved a very clear view of his operating field.

"Now that I've properly isolated the cystic duct and cystic artery, I will clip them, then transect them."

He did as he said.

"Now, I'll use the electrocautery to separate the gallbladder from the liver bed. Once that's done, I'll reduce the CO₂ pressure to around 8mm of mercury, and wait for two minutes to ensure hemostasis. This helps avoid missing potential venous bleeding that can be tamponaded by the elevated intra-abdominal pressure we created with the CO₂."

He proceeded with that, then inserted an additional instrument which had a specimen bag attached to the end he inserted.

"Finally," he said, "the gallbladder is removed from the abdomen in a specimen pouch."

He did that, and I simply shook my head at how quick, easy, neat, and clean the procedure had been.

"The surgery is nearly complete," Doctor Cranston said. "I'll now remove each of the trocars in reverse order, viewing the field with the laparoscope as I proceed. Once I have them out, I'll make a fascial closure of each trocar incision to avoid incisional hernias in the postoperative period."

He closed the incisions with sutures using a standard needle driver and forceps.

"The patient may be moved to recovery," Doctor Cranston announced. "I'll take questions during lunch."

Doctor Rafiq, Debbie, and I escorted the patient to recovery, and as usual, Debbie and I stayed with him.

"How cool was that?!" Debbie exclaimed after Doctor Rafiq had left.

"Totally," I agreed. "I'm really interested in seeing Doctor Roth perform the procedure this afternoon. Doctor Cranston made it look so easy! And it's way better for the patient not having to recover from the typical abdominal incision we usually use for a cholecystectomy. Doctor Lindsay will perform at least eight procedures at Ohio State this week, so she'll actually be the expert, at least for the near future."

"Why her and not an Attending?"

"I honestly don't know," I replied. "That would have been a decision made by Doctor Cutter."

Debbie laughed softly, "I still don't believe the Chief of Surgery is named 'Doctor Cutter'!"

"I'd love to have the last name McCoy!" I chuckled. "That would be even better!"

"Or be in the Navy and be Captain Kirk?"

"Exactly!"

Our patient recovered fine, and after we escorted him to his room and turned him over to the nurses in Internal Medicine, we went to the lounge, where I wrote out everything I remembered from the procedure. I'd confirm my notes during the afternoon procedure, which was another cholecystectomy, as both procedures had been purposely delayed for teaching purposes, as neither patient was in severe pain nor had cancer that necessitated immediate removal.

At lunch, there were a number of questions about the technical aspects of the procedure, and I listened closely and took copious notes in my surgery notebook. After lunch, Debbie and I prepped our patient, and the second surgery proceeded along the same lines as the first, though this time it was Doctor Roth controlling the laparoscope and other instruments under the direction and close supervision of Doctor Cranston.

Everything went well, and once the patient was back in his room, I updated my notes in my notebook, and at the end of the day, went to daycare to retrieve Rachel. Once I had her, I headed home and fed Rachel while waiting for Chinese food to be delivered. Once both of us had eaten, I made several phone calls. My first call was to my mom.

"I'm getting married on New Year's Day," I said.

"Danijela or Danika?" Mom asked.

"Kristina Korolyov," I replied.

"Who?!" Mom gasped.

"She and her family are Russian, and they moved to the US from Paris in late December. They attend at the Cathedral."

"I didn't even know you were seeing her!"

"I wasn't, until Wednesday," I replied. "Oksana Korolyov introduced us."

"I'm not even sure what to say! That's awfully fast."

"As I said to Vladyka JOHN yesterday, Elizaveta proposed inside the first two minutes of our first real conversation. Kristina meets all my criteria, and I meet hers. We'll have a betrothal ceremony in two weeks at the Cathedral. You can meet her and her parents on Thursday evening. I'm sure Mrs. Korolyov will be in touch as soon as I let Kris know I've told you."

"Your grandmother is going to have a fit."

"Let her," I replied. "I believe she, together with Dani's grandmother, pushed Dani to change the timeline I'd set, and when I refused, Dani broke things off. I called her last Sunday to make a last effort, and she rebuffed me. That was before I'd even met Kris."

"Well, if you spoke to the bishop, I know your mind is made up."

"It's the right thing for me to do," I said.

"Well, you know we'll be there for both your betrothal and your crowning. Is Kris in college or working?"

I chuckled, "A Senior in High School. She'll be eighteen before January."

"Mike!" Mom exclaimed. "Seriously?"

"She was raised in Europe and is extremely mature. Yes, it's almost eight years, but surveying the field, as it were, she's the best choice."

"OK, but..." Mom started to say, but I interrupted her.

"She's only about eighteen months younger than Dani, and just under a year younger than Nadiya. I'm going to call Dad and Grandpa Mikhail. I'll see you Thursday evening."

"See you then, Mike."

We said 'goodbye' and after I flashed the switchhook, I dialed my dad's number.

"Hi, Dad, it's Mike."

"Hi, Mike. How are you?"

"Good. You?"

"All of us are good."

"I called to tell you I'm getting married on January 1st at the Cathedral. You and Holly are invited, of course."

"The Indian girl, Danika? Or Dani?"

"Neither. Kristina Korolyov, at the Cathedral. She's Russian, and her family moved here from Paris in late December."

"Recent immigrants? Have you checked with an immigration attorney?"

"No. They have green cards, so they're permanent Residents and they qualify for citizenship. I'll ask Stefan to be sure, but there's a Resident at the hospital who came here from India on a green card and she's marrying. Anyway, will I see you on Thursday evening?"

"Yes."

"Then you can meet Kris and her family."

We said 'goodbye' and I once again flashed the switchhook and called Jocelyn.

"Mik!" she exclaimed when Gene called her to the phone. "I've missed you!"

"And I've missed you, Jos, but your Internship and my clinical rotations make it tough. I have news."

"What?"

"I'm getting married on New Year's Day at the Cathedral in Columbus."

"No way! Who's the unlucky girl?"

"Hah, hah," I replied flatly. "Her name is Kristina, and she's a Russian who moved here with her family from Paris in late December."

"And you fell for her French accent, right?"

"It's sexy, and she's smoking hot!"

"Of course she is!"

"She's also very intelligent and has European attitudes, which are closer to mine."

"I'm happy for you, Mike. Will she be at the memorial service on Thursday?"

"Yes."

"Then Gene and I will see you then."

We said 'goodbye', I flashed the switchhook, and dialed my grandfather's number.

"Hi, «Дедушка» (dedushka)," I said when he answered the phone. ("Grandpa")

"Hi, Mike! How are you and my great-granddaughter?"

"We're good, thanks. I'm calling to let you know that I'm getting married to Kristina Ignatievna Korolyov on January 1st."

"The daughter of the physicist Ignatiy Igorevich, Vanya Igorevich's brother? The ones who emigrated from France?"

I suppressed a chuckle, because I was not surprised my grandfather knew the family, as he knew basically every Russian man over the age of forty in the Midwest.

"That's the one," I confirmed.

"Your grandmother is not going to be happy."

"I know," I replied. "But you can tell her that I tried to speak with Danijela Dimitrijevic last Sunday, but she rebuffed me. Grandma and her friend pushed Danijela to give me an ultimatum, and I do not respond well to those."

"Most people do not," my grandfather agreed. "Where will you have the crowning?"

"Columbus. We'll likely have a betrothal service on September 4th, but I'm waiting to hear from Kris about that."

"You know we'll be there, even if your grandmother is unhappy."

"Thanks, «Дедушка» (dedushka). I'll see you on Thursday evening." ("Grandpa")

"Just remember we love you, Mike."

"I know. I love you both as well."

We said 'goodbye' and I hung up, as it was too early to call Dale, given he wouldn't be home from work. The food arrived a few minutes later, and I ate. Once I finished eating, I wrote a note for Mark and Alyssa, who had a key and would let themselves in. I put the note where they would see it, then Rachel and I went to see Anicka Blahnik, with Rachel riding in her stroller.

"Hi, Mike!" Derek exclaimed when he opened the door.

"Is Anicka home?"

"She is. Come on in!"

I picked up Rachel from the stroller, and Derek brought the stroller into the house. He let me know that Anicka was in the music room, so I carried Rachel there.

"Mike!" Anicka exclaimed. "May I hold my 'niece'?"

"You're my sister now?" I asked with a smirk. "Of course, we are technically in Appalachia!"

Anicka laughed, "You live up to your reputation as a goofball! I'm not your sister but I'll be Aunt Anicka to Rachel!"

I handed Rachel to Anicka and Derek came in with tea, which I accepted.

"How are things going?" Anicka asked.

"Things are very good at the hospital. We have some new equipment that will make surgery less traumatic in some cases. Basically, you use a camera and long-handled tools and only have to make four very small incisions to remove a gallbladder, rather than a large incision across the patient's abdomen."

"I've heard about that," Derek said. "Lap-something."

"Laparoscopy. Rachel is obviously fine, as you can see."

"She's a big girl!" Anicka said.

"GA!" Rachel agreed.

"I do have news," I said. "I'm getting married on New Year's Day."

Anicka smiled, "Kari was reasonably sure that was going to happen very soon. At your church?"

"No; at the Cathedral in Columbus, which is her church. You'll receive an invitation, of course."

"Congratulations, Mike!" Derek said.

"Thanks."

"Do we get to meet this young lady?" Anicka asked.

"She and her family will be at Saint Michael on Thursday for Elizaveta's memorial service."

"We'll be at the memorial service, of course. Would the three of you join us for dinner some evening?"

"Absolutely. Let's speak on Friday evening. Kris and her family will be here for the concert as well."

"OK."

"And I hate to cut this short, but I need to get home and get to bed. I have to be at the hospital at 4:30am."

We said 'good night' and then Rachel and I headed home, where Mark and Alyssa were waiting. I told them the news and asked them to not say anything to anyone until I spoke to Father Stephen and Father Nicholas, which I'd do before Thursday. They agreed, and we said our evening prayers.

Once we finished, I turned Rachel over to Alyssa and made a quick call to Dale to invite him and Pam to my wedding. He promised to attend, and we chatted for a few minutes before we said 'goodbye' and I headed to bed.

August 23, 1988, McKinley, Ohio

On Tuesday evening, after the final two laparoscopic procedures were completed, Rachel and I headed home. I fed her and had just finished when Antonne and his study group arrived. I elected not to tell them about my wedding, and Danika had promised to keep it to herself.

"I ordered pizzas and they should be here any minute," I said as they came into the house.

"Rachel!" Conchita exclaimed and hurried over to pick her up. "My, she's grown so much since May!"

"She'll be a year old on Friday," I said.

"That's the day..." Conchita said, leaving words hanging.

"Yes," I replied.

"All of you should come to Mike's church on Thursday," Danika said. "They're having a memorial service for his wife."

The doorbell rang, and I went to answer it, accepting the pizzas and paying the delivery girl. I brought the pizzas into the great room, said the blessing prayer, then everyone helped themselves. While we were eating, the phone rang, and I excused myself to answer it.

"Mike, it's Kris!"

"Hi!"

"I spoke with Father Luke and he's agreed we can have our betrothal ceremony on September 4th. He'd like to meet with us next Sunday after the Divine Liturgy. I said that was OK, but he knows I had to check with you."

"That's fine," I replied.

"My mom and sister can watch Rachel while we're in the meeting, if you're OK with that."

"Yes, of course. What time?"

"Immediately following the Divine Liturgy so we can get to my house for a 3:00pm dinner. I figured that was best for you, given you have to be up at 3:30am the next morning!"

"That will work well," I confirmed.

"What's the plan for Thursday, Friday, and Saturday?"

"On Thursday, I finish at the hospital at 4:30pm, and I'm home by 5:00pm. The memorial service is at 7:00pm, and there is a reception afterwards. The graveside service is at 7:00am on Friday morning. There is a birthday celebration for Rachel at Saint Michael the Archangel at 5:30pm, and I have my concert at Taft at 8:00pm.

"My thought was that you and your family join me for dinner on Thursday evening. I don't have to be at the hospital on Friday, so you and I can spend the day together with Rachel. I have no specific plans for Saturday other than to come up to Columbus during the afternoon. Normally, I'd have band practice, but we don't practice the morning after a concert to give our voices a break. We can do whatever you like."