Chapter 46: I Surrender

October 8, 1988, McKinley, Ohio

"What do you think?" Kris asked after we ordered at Steak 'n Shake.

I was feeding Rachel, and she was eating properly.

"That if you give Rachel a French fry, she's going to be in a mood again when I limit how many she can have! Of course, if you don't give her a French fry, she's going to BE in a mood!"

Kris laughed softly, "I meant about why she was unhappy last night!"

"I don't know. I find it hard to believe she was objecting to going to her grandparents' house, but it's possible."

"Maybe she wanted to be with me?" Kris said with a smile.

"Is that true, Rachel? Did you want to be with Mama?"

"MAMA!" Rachel declared. "FA!"

I laughed because I was sure of what Rachel meant! She wanted a French fry!

"Well, that escalated quickly," I said to Kris.

"Why do I feel as if I'm in real trouble now?" Kris asked.

"Because you gave her a French fry last time, and she associates this place with French fries! Just wait until she tries your chocolate shake!"

"It's OK, right?"

"Yes. I don't have a problem with her having an occasional treat like that, but obviously we don't want to make a habit of it, and she should have her regular food first, as she's having now."

"You didn't give her a bottle first."

"She seems to prefer solid food, so at lunch we usually skip the bottle. She has her sippy cup of juice, and a good variety of food, so it's not a problem nutritionally. At some point, she'll decide the bottle isn't worth the effort, but she gains comfort from being cradled while she's drinking, too."

"I have a lot to learn about babies!"

"You'll get on-the-job training the same way I did, though you'll have the advantage of the things I've figured out so far."

And that was something that was very different between Kris and Elizaveta. Kris was no homemaker, nor was she a stay-at-home mom, which Elizaveta absolutely had been. I didn't see that as a problem, though I had encouraged Elizaveta to think beyond that. She had demurred, choosing to wait until after we'd had our children to decide what to do about a career, if she even chose to have one. That had not, of course, come to pass, and I'd been left without her guidance in raising Rachel.

"I've been thinking about the baby question," Kris said.

"I'm positive you know the process for making one!"

Kris laughed, "Of course I do, but a demonstration of that knowledge will have to wait until January 1st! I meant the timing!"

"What were you thinking?"

"That what we discussed before makes the most sense; we have the first one about eighteen months from now, and the second two years after that. I'll take Summer courses, as we discussed, in case nature doesn't coöperate."

"Will you begin next Summer?"

"Yes, though I'll only be able to take courses during the second session because we'll be away on holiday at the beginning of June. And the following Summer will depend on when the baby is due, but we'll work that out when the time comes."

"That makes sense," I replied.

The waitress brought our food, and after I gave the blessing, Kris and I began to eat.

"PAPA! FA!" Rachel demanded.

"All yours, Kris," I said with a smirk.

Kris rolled her eyes and handed our demanding toddler a French fry. Rachel shoved the fry into her mouth and held out her hand for another one.

"Let her finish chewing the first one before you hand her a second one," I advised. "She's likely to continue shoving them into her mouth as soon as she gets them."

"FA!" Rachel mumbled through a mouthful of French fry.

"Just finish chewing the first one, little one," Kris said.

Rachel made a face, but she did chew and swallow her fry before holding out her hand to demand another one.

"How many?" Kris asked.

"You're going to give her some of your shake as well, so let's stick with three. For the shake, I think you'll need to use a spoon, because I don't think she'll be able to manage a straw."

Rachel was happy to receive two more fries, but fussed when she wasn't given a fourth one. Kris offered her some chocolate milkshake on a spoon, and at first she made a face, but then clearly wanted more. After two tastes, I gave Rachel her sippy cup with grape juice and some crackers, but she was absolutely not interested in either of those and made it plain to me by scowling.

"Such an evil look!" Kris observed.

"She'll live. The only question is if I will!"

Fortunately, Rachel didn't get too fussy, and I could just ignore her attempts to convince Kris and me to give her more French fries. When we finished eating, I paid the bill, and then we headed for Kroger to do the weekly grocery shopping. After Kroger, we headed to Hartman's Bakery to get bagels, as well as some fresh bread for dinner.

Once we'd completed our shopping, we headed home. After putting away the groceries, Kris and I cleaned the house, and I did my laundry while Rachel napped. Kris and I prepared dinner together, and after dinner we listened to music, and I read to Rachel. The three of us said our evening prayers together, we put Rachel to bed, and then Kris headed to Oksana's house to spend the night.

October 10, 1988, McKinley, Ohio

On Monday morning, after an autopsy on a seventy-eight-year-old man who had died from lung cancer due to a lifetime two-pack-a-day cigarette habit, Fran showed up in Pathology.

"What's up?" I asked.

"A Student Ethics Board meeting to review disciplinary action."

"Now what?"

"A First Year, who appears to be the class clown, made a seriously inappropriate attempt at a joke about the cadaver his team was dissecting. He's already been reprimanded three times for inappropriate comments to female members of his team and off-color jokes."

"What's the proposed discipline?"

"A one-week suspension. He'd lose credit, but he could still pass. He appealed, so we need to meet."

"When?"

"That's the problem. Our schedules are a mess. Could you skip lunch today? 11:45am?"

That would interfere with my plan to call Father Roman, but I could do that on Tuesday.

"If we start on time and we're done by 12:45pm, then I could do it," I said. "It won't interfere with today's schedule. Is everyone else available on such short notice?"

"Surprisingly, yes. You and I are the only ones on shift this morning."

"OK. I assume there are witnesses?"

"For each offense. There are written statements, so if they can't attend, we'll use those."

"It seems to me to be a waste of time, if there are witnesses. He's not going to get a reduced sentence, so to speak."

"I agree, but according to Doctor Warren, the student feels the punishment is unwarranted."

"He's barking up the wrong tree!"

"Undoubtedly, but we do need to approach it with an open mind."

"Yes, of course. I'll see you at 11:45am."

She left, and I went back to completing the forms for the autopsy we'd just performed. The one thing about pathology I hadn't internalized was just how much paperwork was involved, especially if there were any potential legal ramifications. While I normally wouldn't follow up on cases, I had been following the case of Rosemary Butler, the young teen who had been raped and murdered.

The DNA evidence was, for all intents and purposes, conclusive, and that meant, I was certain, the death penalty for the murdering rapist. The State of Ohio would exact their retribution, but that would do nothing to help the young woman soon to be lying in a cold grave, or her family and friends.

I finished the paperwork and took it to Doctor McKnight for his review and signature, and let him know about the Student Ethics Board meeting.

"Does your year have a class clown?" Doctor McKnight asked.

"Not anyone of whom I am aware," I replied.

"There's almost always some guy, and it's always a guy who thinks 'Hawkeye' Pierce is the proper model for a doctor."

"Doctor Hunter 'Patch' Adams?" I asked.

"An exception that proves the rule, but that said, it was after medical school and after he had established himself. You'll tilt at similar windmills, but using different tactics."

"I don't think aiming for improvement in the medical profession is tilting at windmills."

"I agree with you; most of the medical community won't, especially with regard to your ideas for reforming medical education."

"If we don't do it, politicians will. Which would you prefer?"

"As I said, I'm in agreement with you. I suspect we also agree on topics such as medical errors and malpractice, but again, you're sailing against the currents."

"Which, if I correctly understand how that works, means tacking properly into the wind and steering a proper course."

"No clue," Doctor McKnight said with a smile. "I'm a pathologist, not a sailor!"

I laughed, "Nice Star Trek reference."

"I am, like Doctor McCoy, just a good old country doctor. If I wasn't a huge Sherlock Holmes fan, and a fan of shows like Quincy, M.E., I'd have been a GP making house calls. There are a few who still do."

"Doctor Evgeni Petrov, though he's down to a handful of patients, as he's in his 70s."

"It's certainly a practice that is falling out of style, and while it's less efficient, it's more likely to reach patients who otherwise might not avail themselves of medical care. He used to simply drop in on patients when he was in the area, which was very effective for farm families."

I nodded, "I think society is worse off with that change, but I'm not sure it was sustainable. We still have the same challenges, specifically with getting generally healthy men in their twenties, thirties, and forties, to seek routine medical care, which would help prevent significantly negative outcomes."

"Dropping dead from a heart attack is, indeed, a 'significantly negative outcome'!"

I chuckled, "Yes, but not just that. You know how many people early detection of cancer could save, along with things like hypertension, diabetes, obesity, and so on."

"Yes, of course, but I was trying to make a funny!"

I smiled, "Stick to your day job!"

"Speaking of day jobs, how is your band doing?"

"We're enjoying ourselves. We're playing at Goshen High School's Harvest Ball next month, and we're playing an end-of-the-semester concert at Taft. After that, a lot depends on what's available and what my schedule looks like. If you don't mind, I'm going to grab a quick bite to eat before the meeting. There's nothing pressing at the moment, and we don't have another autopsy until later this afternoon."

"By all means!"

"Thanks."

I left Doctor McKnight's office and went to the cafeteria, where I bought a cup of yogurt, an apple, and a bottle of grapefruit juice. I ate the yogurt and drank the juice, then ate the apple as I walked from the hospital to the medical school. As I walked, I considered what the 'class clown' might possibly say in his defense. I reminded myself to keep an open mind, but off-color jokes, especially during cadaver lab, and mistreatment of female medical students warranted some punishment, and the student, whoever he was, was lucky to only receive a suspension after three reprimands.

At the medical school, I had a few extra minutes, so I went to Doctor Mertens' office to see if she was available, finishing my apple while I waited for her to complete a phone call.

"What's up, Mike?" she asked when I was shown into her office.

"I just stopped in to say 'Hi' before a Student Ethics Board disciplinary review meeting."

"I'll be there," she said. "It's a student assigned to me, and I wrote all three reprimands."

"Then we shouldn't discuss that."

"You're right, of course. I understand congratulations are in order.

"Thanks."

"And how is Rachel?"

"I'd say she's a fairly typical toddler, discovering she's an independent person and expressing her desires, albeit in a limited way."

"Is she in 'no' mode yet?"

"And quite forceful in expressing it! She's also very insistent on getting more French fries when she's permitted to have three."

Doctor Mertens laughed, "So, like any other person who likes good French fries! You can never get enough!"

"True, I just want to do my best to keep her on a healthy diet."

"Something which would do more for public health than anything any of us can do as physicians."

"And the fact that so many people don't do that ensures I'll have a steady stream of patients arriving in the Emergency Department with MIs, strokes, severe hypertension, untreated diabetes, and a host of other ailments, not to mention the other health problems associated with smoking."

"The second most important thing we can do — convince our patients to stop smoking. Shall we head to the auditorium?"

"Yes."

We left her office and walked to the auditorium where I joined Fran, and three Third Year students who had replaced the Fourth Years who had graduated in May ... I knew all three new students — — Patricia, Lindsay, and Kent — by sight, but hadn't actually spoken to any of them other than in passing at the hospital.

As I'd suspected, the hearing would begin at noon, and that gave us fifteen minutes to review Doctor Warren's findings, as well as review the three written reprimands from Doctor Mertens. Reading through everything, I saw what in my mind was a slam-dunk case for expulsion, or if that was too extreme, mandatory counseling and a repeat of his first year. He was damned fortunate to only have received a one-week suspension.

At exactly noon, Barbara Kelly, a Fourth Year, convened the Student Ethics Board.

"We're here today on the appeal of a one-week suspension by Jack Strickland for violation of behavioral standards and ethics violations. Our first witness is Doctor Nora Mertens. Doctor Mertens?"

She came forward and stood at a lectern to address us.

"Good afternoon. On three separate occasions, complaints about what I will call 'boorish' behavior were made against Mr. Strickland, and were sustained upon investigation. You have the details in front of you, so I won't belabor them, and simply state that on two occasions offensive sexual comments were made to female medical students, and on the other occasion, an offensive, racist comment was made to an African American medical student.

"Those comments made by Mr. Strickland, with witnesses to each occurrence, violate the norms for professional and ethical behavior, and raise serious questions about his character and his qualification to be a physician. It was hoped that a combination of written and verbal reprimands would encourage Mr. Strickland to change his behavior. The fact that we are here today demonstrates that it did not."

"Are there any questions for Doctor Mertens?" Barbara asked.

The other four members of the Ethics Board shook their heads, as did I.

"Thank you, Doctor Mertens," Barbara said. "Our next witness is Doctor Dennis Nagle. Doctor Nagle?"

He came forward and stepped to the lectern.

"Good afternoon. The incident which brings us here today occurred just over two weeks ago, on September 22nd. On that day, during cadaver lab, Mr. Strickland, to put it as delicately as possible, compared the female cadaver to one of his fellow medical students with regard to sexual activity. The details are in Doctor Warren's report, and as you can see, were corroborated by the other four members of his lab group.

"It was my recommendation to Doctor Warren that, in light of the three previous incidents, Mr. Strickland be expelled. Upon consideration, Doctor Warren imposed a one-week suspension with a loss of credit for any work done during that week. While I believe the punishment is insufficient, it does send a strong message and will be entered into Mr. Strickland's permanent record."

Which might well screw him with regard to the Match, and explained, at least to me, why he was taking a longshot at having the suspension rescinded. His inappropriate comment would still leave a black mark on his record, but not in the same way a suspension would.

"Are there any questions?" Barbara asked, looking at all of us, who shook our heads. "Seeing none, we'll hear from Jack Strickland."

He came forward and stood in front of the lectern.

"Good afternoon," he said. "I screwed up. Period. I won't make any attempt to excuse my behavior. My lame attempts at humor were inappropriate, and I understand that I violated the student behavior code. I will not allow it to happen again, and I ask you to not impose a suspension, which would have a significantly negative impact on my medical career. Thank you."

"Thank you," Barbara replied. "Are there any questions?"

There were none.

"Then," Barbara said, "if there is nothing else, we'll adjourn to review the record and render our verdict."

We left the packed auditorium and headed to the meeting room we'd used in the past. Barbara shut the door, and we all took seats.

"Mike, you're the other Fourth Year, so you go first."

"After three reprimands, he compared the cadaver to his fellow medical student in bed," I said, shaking my head. "He ought to fail the entire year and undergo counseling if he wants to return. As we can't do that, we uphold the suspension."

"Patricia?" Barbara asked.

"Can we suggest being flayed and strapped to an anthill full of fire ants?" Patricia inquired.

"No," Barbara replied.

"Then I concur with Mike."

"Lindsay?"

"Tarred, feathered, and run out of town on a rail, as my grandfather would have said?" Lindsay suggested.

"Not that, either," Barbara said with a smile.

"Then I concur with Mike and Patricia."

"Kent?" Barbara asked.

"I wouldn't want him as my doctor if I were dying, and he was the only physician in town. Unfortunately, that's not up to me, so I concur with the others."

"And I'll make it unanimous," Barbara said.

"He'll screw up again," Patricia said. "And then they have to bounce him."

"You would think so," I replied, "But it appears the punishments are less harsh than they have been in the past."

"I'd go to the guy who was bounced for screwing in the on-call room before I'd go to this clown," Lindsay observed.

"He was actually bounced for failing to respond to a code because he didn't replace the batteries in his pager," I corrected. "Being caught in flagrante delicto didn't do him any favors, mind you, but it was missing the code that had the hospital demand he be expelled.

"I'd compare this to the student who was disciplined for negative comments about an AIDS patient. She wasn't expelled, but ended up not Matching because of the tarnish on her record. The cases are similar in that they were boorish behavior, whereas failing to answer a code is, even for a physician, an offense which can lead to dismissal.

"My real problem with this situation is that it reinforces the idea that doctors, especially male doctors, can get away with totally inappropriate behavior. That's why I'd like to see a tougher punishment applied. It has to start in medical school if we're actually going to change things."