Chapter 39: That Was Easy!

August 29, 1988, McKinley, Ohio

On Monday evening, I called Kris, and planned to do so each evening we were apart.

"Doctor Getty will allow me to take five days off," I said.

"That won't interfere with your training?"

"No. I'm already ahead of the curve in cardiology, and I can miss that much time without needing special permission from the medical school."

"What did you want to do?" Kris asked.

"Spend time together!" I declared. "It'll give us time to get our new house set up. I think it's best to plan our trip away for June, even though it's a belated honeymoon, but I'm open to other suggestions."

"I think that makes sense. Sometimes practicality has to win out."

"That's usually the case for me."

"Dad and I went to look at a house today, and I think it's perfect. It's just outside of Circleville and is available as of December 15. The current lessee will move out at the end of November, and the owner wants to paint and do some minor repairs. The house is very similar to the one you have now, with three bedrooms, a two-car garage, and a fenced back garden."

"You mean a lawn, right?"

"Yes, sorry; it's 'back garden' in British English."

"I remember, but wanted to check. Does it have hardwood floors or carpeting?"

"Hardwood. Do you need to see it?"

"I'd like to," I replied. "I could drive up after work tomorrow, if that works."

"Let me check with Dad, because he'll have to arrange it with the real estate agent. I'll call you and let you know."

"OK. How was school today?"

"Fine. How was the hospital?"

"Fine as well. Just two routine surgeries today. And you know I mostly do pre-op prep and post-op care. In the OR, I observe."

"How is Rachel?"

"Her usual self! As soon as we hang up, I'll read to her, and then we'll say our evening prayers."

"What are we doing next weekend? I mean, besides Church and a betrothal on Sunday."

"That's up to you," I replied. "My shift ends around 4:00pm on Friday, once the M & M Conference and the lecture are finished. The lecture is optional, but I like to attend when I can. I have to be at the hospital at 4:30am on Monday. Between Friday night and Monday morning, I'm all yours."

"You're all mine for life!" Kris declared.

"Absolutely true! How about I pick you up on Friday evening, and we join my usual group of friends for Chinese food? They're planning to see Young Guns. I'll take you home after the movie."

"That sounds good. I can borrow my mom's car on Saturday, so I'll drive down so we can spend the day together."

"That sounds good, too. Remember, I have band practice at 8:00am."

"I'll be at your house at 7:00am so we can have breakfast. Or is that not early enough?"

"7:00am is fine. On Sunday, is it OK to pick you up for church, or will your parents want you to ride with them?"

"You can pick me up. What time?"

"8:30am should do it."

"OK."

"Talk to you tomorrow?"

"Yes. I'll let you know about seeing the house."

"Thanks."

We said "goodbye", I hung up, then went to read Rachel her bedtime book.

August 30, 1988, McKinley, Ohio

"How are the plans coming along?" Clarissa asked, speaking quietly, when we met in the lounge on Tuesday morning.

"As you would expect, my mom, Mrs. Korolyov, and my grandmother have everything totally under control. Kris and her mom are shopping for a dress tomorrow."

"Formal, informal, or full wedding?"

"Formal white gown," I replied. "I'm wearing my black suit."

"Did you find a place to live?"

"I'm going to check out a house just outside of Circleville tonight. According to Kris, it's similar to the current house. I figure two years, at the most, and we'll be ready to build."

"You've really managed your money well."

"What about you and Tessa?"

"When we have a kid. I take it you haven't broached that topic with Kris."

"No. And if we're going to do it, it has to be artificial insemination."

"I figured that would be the case once you decided to remarry so quickly. Reaction at church isn't really a concern at this point, right?"

"Correct."

"May I suggest some subterfuge?" Clarissa asked.

"You know my take on lying."

"Little white lies included?"

I smiled, "Technically, the answer to 'do these jeans make my butt look fat?' has to be 'yes', if they do."

"And yet..."

"Self-preservation is key!" I grinned. "What are you thinking?"

"To say that we agreed to conceive by artificial insemination after Elizaveta died, and you gave me control over your sperm donation. The first part is totally true, and the second part is true, though said in a way that implies the donation was after Elizaveta died."

"My concern is answering a direct question about it."

"I think you can truthfully say we discussed it before Elizaveta approached you and that it was something we wanted to do, but we hadn't decided on the timing."

"I believe we'd have to give Kris a veto," I replied. "But I think, so long as we never let on about our physical relationship, she's open-minded enough to allow it. And I think it has to be that way because I would want to acknowledge that child as my own. You and Tessa would raise him or her, but I'd want to be involved."

"Obviously," Clarissa agreed. "What if she exercises her veto?"

"I'd ask you to honor it, despite our agreement. I suggest getting to know her, and becoming friends, before we raise the topic. You're thinking four years from now, roughly, right?"

"Yes. I want to finish my Residency. It's the same tradeoff all women have to make between being a physician and having children. It's something we need to work to change."

"I agree. The challenge is the entire system is predicated on physicians being men."

"No shit, Sherlock!" Clarissa exclaimed. "We see that every day, and doctors like your Resident are a major part of the problem."

"He has a cultural-religious problem that would exist even without the rest of the misogynistic BS of our chosen profession."

Debbie came in just then, as did Clarissa's Third Year, so the four of us left the lounge with our Residents to begin our day's work. Our first surgery was a kidney transplant, which had bumped a scheduled hysterectomy, much to the annoyance of the patient who was awaiting the hysterectomy.

The patient, a sixteen-year-old girl, had been notified before midnight that the kidney would be available, and it had been delivered just an hour earlier. Because of the timing, we'd skip rounds and the patient would go straight to the OR. The hospital transplant specialist would conduct the surgery.

"Good morning, Nichole," I said when we walked into her room. "Ready?"

"Anything to get off dialysis!" she declared.

I checked the chart, saw it was properly marked "NPO", and that labs had been run and were back.

"Did you have anything at all to eat or drink since midnight?"

"No. Well, ice chips from the nurse last night."

"Those are OK. Nothing else, though, right?"

"Right."

"Good. I need to check your pulse, listen to your heart and lungs, take your temperature, then insert an IV and a catheter. If you prefer, Debbie can do the catheter."

"Who's done more?"

"I have," I replied.

"Then you do it. I've been poked and prodded so much in every place imaginable that it no longer matters!"

I performed the exam, inserted the IV, then inserted the Foley catheter. I had just finished when the anesthesiology Resident, Doctor DeMille, arrived to administer the pre-op sedative. Once that was complete, I called for an orderly to transfer Nichole to the OR. When she had been transferred, Doctor Rafiq, Debbie, and I scrubbed in, and once the patient was anesthetized, I intubated her and hooked up the cardiac monitor.

"All set," I said. "Normal sinus rhythm; pulse 68; PO₂ 99; good air volume on the respirator."

"Thanks, Mike," Doctor Roth said. "Everyone ready to give this young lady a new kidney? It's your ballgame, Nick."

"Thanks, Owen," Doctor Nick DeBeers said. "Shelly, you may begin."

Doctor Lindsay made the necessary incisions to expose the location for the new kidney, which would be piggybacked with Nichole's failed kidney, as was standard procedure.

"Vince, retract that please; Angela, suction."

"V-tach!" Doctor Kelsey called out. "Run of five. Normal sinus and back to 66."

"Let's keep an eye on that," Doctor DeBeers said. "Shelly, proceed."

"Doctor Rafiq, the organ, please," Doctor Lindsay requested.

He retrieved the basin, which contained the kidney and brought it to Doctor Lindsay. She and Doctor DeBeers conferred, then they worked together to place and complete the anastomoses of the blood vessels and ureter.

"Pinking up," Doctor Lindsay reported.

"V-tach!" Doctor Kelsey called out again. "Not resolving."

"Bev, lidocaine, IV push!" Doctor Roth ordered.

The nurse injected the lidocaine.

"Normal sinus, 80," Doctor Kelsey reported.

"Let's get her off the table quickly," Doctor DeBeers said. "I don't want to wait for urine in the bag."

He and Doctor Lindsay worked quickly to close the incision. They had just finished when an alarm blared from the cardiac monitor.

"V-fib!" Doctor Kelsey reported.

"Paddles, charged to 200!" Doctor Roth ordered. "Jack, stop the anesthesia. Mike, bag, please."

I moved to disconnect the ventilator and grabbed an Ambu bag. Before I could attach it, the paddles were charged.

"Clear!"

Doctor Roth applied the shock to cardiovert Nichole's heart, but there was no change on the monitor.

"No change!" Doctor Kelsey reported.

"Charge to 240; amp of epi, IV push!"

I began bagging while the paddles charged and the nurse administered the epinephrine.

"Clear!"

I moved back; Doctor Roth applied the paddles and pushed the button to trigger them.

"Normal sinus rhythm," Doctor Kelsey reported.

"Debbie, call for cardiology to meet you in recovery. Shelly, you go with them. Mike, extubate and hook up the portable monitor."

"Yes, Doctor," I replied.

I removed the endotracheal tube, then disconnected the plug from the OR monitor and connected it to a portable monitor, which Nurse Luisa had rolled over to the side of the bed. An orderly was called, and together we moved Nichole to Recovery, where Doctor Pace met us.

"What do we have?" she asked Doctor Lindsay.

"Nichole Nielson, sixteen, kidney transplant due to chronic kidney disease of unknown aetiology. All vitals good, but had two runs of V-tach, the second one resolving only after lidocaine; then V-fib, requiring two attempts to cardiovert and epi to restore sinus rhythm. No previous indication of coronary symptoms."

"Who did the pre-op check?" Doctor Pace asked.

"I did," I replied. "I was supervised by Doctor Rafiq. There were no contraindications to surgery; she was alert and in good spirits. Everything is on the chart. She was NPO, which I confirmed from the chart and questioning. No medication except for the pre-op sedative administered by Doctor DeMille and the anesthesia administered by Doctor Kelsey."

"Any complications, Shelly?"

"None. When she had the second run of V-tach, Doctor DeBeers decided to close immediately. The transplanted kidney was pink, and I see urine in the bag now. We had just finished closing when she went into V-fib. Anesthesia was discontinued immediately."

Doctor Pace nodded and performed an exam.

"No anomalies," Doctor Pace said when she concluded her exam. "I want her in a monitored bed, so we'll send her to the ICU for at least the next twenty-four hours. I wouldn't keep her in recovery."

"Mike, call for an ICU bed," Doctor Lindsay instructed. "Let's get her ready to move."

I made the call, and a few minutes later we escorted Nichole to the ICU. As was the normal protocol, we stopped at the door, and the ICU staff took over. They disconnected the portable monitor so I could take it back upstairs, then moved Nichole into the ICU. Doctor Lindsay, Debbie, and I left to head back to the surgical floor.

"Thoughts, Mike?" Doctor Lindsay asked.

"That shouldn't have happened," I replied. "She was, other than her kidney trouble, a healthy young woman and physically fit despite her kidney problems. She had dialysis yesterday morning, so it wasn't toxins in her blood. Her blood work was exactly in line with the parameters for a surgical patient who is on dialysis. I'd speculate a reaction to the anesthesia as the primary reason. If not, then a cardiac response to the trauma of surgery."

"A reasonable analysis. What would you do?"

"What Doctor Pace ordered — closely monitor her for twenty-four hours. If there are no cardiac symptoms, then she can go home as soon as practicable, with instructions to let any future surgeons know about what happened. Follow-up with her personal physician, her nephrologist, and see a cardiologist in six months to be sure."

"Very good. Any other thoughts?"

"Figure out what caused her kidneys to fail in the first place," I replied. "But her chart made it clear she's had every test we know of, and was examined by a research nephrologist at Stanford with the same diagnosis — chronic kidney disease of unknown aetiology. That's the medical diagnosis equivalent to throwing up our hands in despair. That makes her prognosis uncertain, as whatever it is or was that caused her kidneys to fail could still be present."

"Pretty good, considering you didn't even know she was going to have her transplant until you arrived this morning."

"None of that is anything more than basic medicine," I replied. "Debbie could have provided an equally good response, had you asked her."

When we reached the surgical floor, Doctor Lindsay went to report to Doctor Roth and Debbie, and I went to the lounge.

"Thanks for what you said, Mike."

"What I said is true," I replied. "The key is, you need the confidence to answer. You still hesitate and qualify your statements."

"But I'm only a Third Year."

"That's true, and in twenty months, you'll be a doctor. Time flies, and before you know it, you'll be graduating. I'm still amazed that I have less than a year to go before I'm a doctor. It seemed like it would take forever when I was in High School, and suddenly it's almost over."

"I don't know how you do it! Medical school, raising your daughter, and playing in a band."

"It's a tricky balancing act, and only possible with help from friends and family."

"Did I hear right that you're getting married?"

"Yes. January 1st."

"Will she stay home to care for Rachel?"

"No. She's a full-time student," I replied.

"Where?"

"Right now? Teays Valley High School. She'll be at Ohio State a year from now."

"She's eighteen?"

"In November. That's part of the reason for waiting until January. The other reason is the Orthodox Church doesn't perform weddings during fasting periods, and the Nativity Fast begins five days before her eighteenth birthday."

"She's awfully young."

"I could say the same for you and me with regards to being doctors!"

"True!" Debbie agreed.

"Kris, having been born and raised in France, is much more mature than most girls her age. Her take is that she had planned to marry and have kids, though after college, but it would be foolish to pass on a guy she thought was the right one. She plans a Master's in Public Administration, by the way."

"That's what? Six years of college?"

"Something like that, yes."

Doctor Rafiq came in and let us know that Doctor Roth had decided to do the hysterectomy before lunch, which would shorten our lunch to about twenty minutes. The three of us went down to prepare Mrs. Tucker for her surgery. She was in a surly mood, unhappy that her surgery had been delayed, but I didn't let that affect how I treated her. The surgery went well, with the only negative being the shortened lunch break.

After lunch, we had a routine tonsillectomy, and when my shift ended, I collected Rachel, and we headed to Circleville to see the house Mr. Korolyov has found. The drive from the hospital took fifteen minutes, and was only about six minutes longer than my current drive, as driving through town was much slower than the highway between the hospital and Circleville.

August 30, 1988, Circleville, Ohio

Kris and a man who I assumed was the real estate agent were waiting in the driveway. I greeted Kris, and introductions were made. Once that was complete, the three of us, plus Rachel, walked up to the front door. The house looked very similar to the one in McKinley, though it had a larger yard and was in a more rural setting.

"The tenant is at work," Mr. Zucker, the real estate agent, said as he unlocked the front door.

We stepped inside, and I saw very nice hardwood floors covered by a runner.

"We'll start upstairs, if that's OK," Mr. Zucker said.

"Absolutely," I replied.

The house was a bit larger than the one in McKinley, but not significantly. The extra space on the upper floor appeared to be taken up by a large walk-in closet, which would be useful.

"No furniture at all with this rental," Mr. Zucker said. "That includes the rugs."

That would mean incurring some additional costs, but we could buy fairly inexpensive rugs. The bigger cost would be the furniture, but we could make do in the short term, and anything we bought we would move to our new house. The master bath had a nice, large tub, similar to the one I currently had, and I looked forward to bubble baths with Kris. After seeing the two smaller bedrooms, we headed to the ground floor to continue the tour.

"All the appliances were new three years ago," Mr. Zucker said. "Gas cooking, heat, and hot water, and it has central air."

"What do you think, Mike?" Kris asked.

"I think it's suitable for our needs for the next two years," I replied. "Mr. Zucker, what's the rent?"

"$575 per month, and you pay all the utilities."

That was less than the rent the men were paying for the house in McKinley, which would mean we'd have some money over and above what I'd saved and budgeted for living expenses. That was a good thing and would help keep my finances in excellent shape. I would take on some debt by buying Kris a car, but that was easily manageable.

After seeing the main floor, we took a quick look at the two-car garage, then went to the basement, which was unfinished, though there were shelves over the washer and dryer.

"The washer and dryer belong to the tenant," Mr. Zucker said.

That didn't surprise me, and I'd already factored the cost of those into what I'd need to spend. I was going to spend more money in November and December than I'd spent in any two-month period in my life, not counting the money I'd spent on tuition. But I had the money, and while I'd dent my savings, it wouldn't be terrible, and in July I'd have a very good income, which would increase significantly over the next several years.