Chapter 51: A Request for Spiritual Guidance

November 11, 1988, McKinley, Ohio

"That was crazy!" Lauren declared when she, Debbie, Clarissa, Maryam, and I left the Morbidity and Mortality Conference covering the heart tumor on Friday afternoon.

"Doctor McKnight constantly remarks on just how many things can go wrong in your body that you don't know about and don't kill you. This one did, similar to what happened to Elizaveta."

"You say that so emotionlessly," Debbie said.

"Petrovich can separate his personal loss from medical fact," Clarissa interjected. "It's an important skill for an emergency medicine specialist or surgeon. He's going to be both."

"And it's not as if I'm not struggling emotionally," I said. "But, really, between my commitments to Rachel and to medicine, I don't really have any choice but to, in effect, suck it up. I cried a lot at first, but my responsibilities forced me to continue to move forward."

"To the point of getting married so quickly?" Lauren asked.

"That's not so much about Mike as it is about Rachel," Clarissa interjected before I could answer. "Being a single dad, and Rachel not having a mom, weighed heavily on him."

"I can speak for myself, Lissa!" I declared.

"You two are like a married couple!" Debbie observed.

"If Lissa wasn't more interested in someone with YOUR anatomy than with mine, we might have married years ago," I said.

"Oops," Debbie said. "I didn't know."

"'Gaydar' is not a thing!" Clarissa smirked. "And I don't advertise, but I am out. I've brought my girlfriend to hospital functions."

"It's easier for lesbians than gays," I said. "Gay men are discriminated against, and most of them are not out. I suspect it might be different in larger cities on the East and West Coast. And even here, part of it is the environment. I know a lesbian who works for a religious hospital who has to keep it secret."

"I think it's disgusting the way people treat gays and lesbians," Debbie said, "especially doctors who bang everything in sight even though they're married!"

"Morality is a tricky thing," I observed. "And people are often blind to their own failings. It's why Jesus commanded people to examine their own sins first before trying to correct another person's sins, and did so in a way to point out that the ones who complain the loudest are often the biggest hypocrites. He took religious leaders to task more often than anyone else."

"Are you going to the nephrology lecture?" Lauren asked.

"Yes, because Clarissa is interested. Dialysis and long-term care of patients with systemic renal problems is not really necessary for a trauma surgeon."

"I wish they would just say 'kidney' for both those instead of Latin!"

"Latin and Greek," I replied. "The study or treatment of systems is nearly always Greek, but beyond that, it's almost random. So-called Medical Latin is a terrible mishmash of Latin and Greek prefixes, roots, and suffixes. So we get fun things, like a cardiothoracic surgeon doing vascular surgery.

"And sometimes we mix and match, even for totally related things, such as 'artery' being from Greek, 'vein' being from French, and 'capillary' being from Latin. That said, French is really just 'street' or 'vulgar' Latin that transitioned to a new language, and the Romans borrowed the Greek word for artery, too. In the end, there is no rhyme or reason, you just have to memorize the terms. You have flashcards, right?"

"Yes," Lauren replied. "What do you think of the AMA objecting to NPO in literature and on charts?"

"Given we all know what it means, I think it's silly. They spell out 'nothing by mouth' in articles, and want NBM on charts. The thing is, NPO is completely clear, even if you don't know it's 'nil per os' or 'nihil per os', depending on which word for 'nothing' you prefer."

"Pussy!" Clarissa teased.

"What?!" Debbie asked.

"Lissa is being her usual goofy self!" I chuckled. "In Shakespeare, the term 'nothing' refers to female anatomy as if they have 'nothing' between their legs. It's used in a joking way in Hamlet, and of course, that gives a whole different meaning to the title Much Ado About Nothing which is about lovers being deceived, including one character being tricked into believing another is not a virgin."

"My English teacher said 'nothing' was referring to gossip, intrigue, and trickery," Debbie said.

"Yes, I'm sure they did! I bet he or she also didn't tell you about all the bawdy sex jokes scattered throughout Shakespeare, either!"

"No."

"We can chat about it later, because we need to get coffee and get to the lecture," I said.

We walked quickly to the cafeteria, got our coffee, then returned to the auditorium for the lecture by a nephrologist from Ohio State. The lecture was informative, but not all that interesting, as it was outside the area where I'd practice. While I might diagnose renal failure or other nephrological problems, I wouldn't treat them. I made a few notes about best practices with regard to diagnosing renal diseases, but otherwise, I didn't need to know much of what was said.

That was the reason why very few surgeons or emergency medicine specialists were in attendance — it simply wasn't relevant to their, or my, day-to-day practice of medicine. Even the diagnostic information wasn't critical, as any renal insufficiency in the ED would result in calling someone from Internal Medicine for a consult, which was why Clarissa took copious notes.

When the lecture ended, Clarissa walked with me to daycare, as had become her habit on Fridays. As usual, Rachel was happy to see Clarissa and wanted to be held by her. Clarissa and I walked out to my car, with Clarissa carrying a content Rachel.

"Are you coming to dinner tonight?" Clarissa asked.

"Yes, but we're skipping the movie. The next one I really want to see is Twins in December, and I'll figure out childcare for Rachel for that Friday evening."

"And you're sticking to your plan for Saturday afternoon meals with the Kozlovs?"

"For now. I need to see my December schedule for Cardiology, which we'll get on Tuesday, then discuss it with Kris."

"Next weekend you're going to the monastery, right?"

"Yes. And my mom will take Rachel."

"Kris is OK with you having a monk as your confessor and spiritual father?"

"Remember, I'd be a moderate in ROCOR!"

"They're really that fanatical?"

"They're more traditional, and their bishops are less likely to exercise «ekonomia» with the canons. They also tend to be stricter about fasting and prayer, and they use the Old Calendar. Kris and her family are on the more liberal side of ROCOR, but that's still more conservative than most members of the OCA. The Antiochians are similar to the OCA, while the Greeks are, except for Greek culture and ethnicity, the most lax. The OCA, Antiochians, and Greeks use the New Calendar. Those are generalizations, but they are borne out by my observations and what Orthodox writers have observed."

We reached the car, and Clarissa put Rachel in her car seat and buckled her in.

"Ready to go see Mama?" I asked Rachel.

"Mama!" she gurgled.

I hugged Clarissa, then we each got into our Mustangs, and I headed home. Kris arrived a few minutes after Rachel and I did, and not long after that, we joined the gang at the Chinese restaurant. Rachel enjoyed the attention she received, as well as the rice she was offered by Serafima. When we finished eating, Kris, Rachel, and I went for ice cream, and once again, Kris shared hers with Rachel, who enjoyed it, despite making faces because it was cold.

After ice cream, we headed home, where I read to Rachel, we said our evening prayers, and then Kris and I put Rachel to bed.

"What do you plan to wear for our wedding?" Kris asked.

"My black suit and a blue tie. How about you?"

"French tradition is a chic, white gown with a train, but not so formal or showy as American ones. That's what I plan to wear."

"Is my black suit OK?"

"Yes, perfect. We should get a special dress for Rachel to wear."

"That's a great idea, though I think we should wait until towards the end of next month because she's growing so fast!"

"Are there any special traditions Americans do before their wedding?"

"The women at the Cathedral will probably hold a bridal shower for you, and Robby and Peter will plan a bachelor party, though it'll probably be just getting together for a meal and some music."

"Yes, I know about the bridal shower! It's Monday evening, so we can avoid the Nativity Fast, which starts on Tuesday. I meant anything else?"

"Not really, no. With about seven weeks to go, I think everything is basically set, except for the new furniture being delivered and moving my things from this house and your things from your parents' house. I'll sign the papers for your car on December 23rd, and Viktor will have it delivered to your house on the 28th. The only other thing is a new phone number, because the new house is in a different exchange. The phone company will put a new number message on the old line for sixty days."

"It sounds as if everything is coming together," Kris said.

"I think so," I agreed. "Did your parents make the reservations?"

"Yes. At Hotel LeVeque. It's a luxury hotel, and they booked January 1st through January 4th, so we'll have three nights there."

"Excellent! Do you like Star Trek?" I asked.

"It's OK. Why?"

"Because the new season of The Next Generation starts next Thursday. I tape the episodes, so I can wait to watch with you on Friday, if you want."

"Sure. I saw a few episodes of the first season and enjoyed them. Do you watch much TV? It hasn't been on when I've been here."

"Only Star Trek and videotapes. I'm too busy to watch much TV, and if I need something on in the background, it's always music. Always. I have put on the news on occasion. I did have it on Tuesday night, even though the election was a foregone conclusion."

"Whom did you vote for?"

"Bush," I replied. "I simply couldn't bring myself to vote for Governor Dukakis."

"Neither of those candidates was a good choice," Kris declared.

"But the only two viable options," I replied. "Third parties do not have much of a chance of winning a state, let alone a majority of the electoral votes. But I didn't mean to discuss politics."

Kris laughed softly, "And yet, you do not seem to be able to avoid it!"

"Unfortunately."

We went to the study, I put on some music, and we chatted for about twenty minutes before she headed to Oksana's for the night.

November 18, 1988, McKinley, Ohio

"I'll be in Pediatrics for about twenty minutes," I said to the Pathology clerk on Friday afternoon.

"OK," he replied.

I walked towards the elevator so I could go up to daycare and get Rachel for her DPT vaccination. The week had been routine, with no interesting cases and nothing out of the ordinary outside the hospital, other than that the women at the Cathedral had thrown a bridal shower for Kris, to which a number of my female friends had been invited.

As for Pathology, autopsies were now completely routine for me, and I was far more comfortable with internal anatomy than I had been at the start. It seemed to me that a Pathology Sub-Internship ought to be required for all surgical Residency candidates. I was far more prepared for that part of my Residency than I had been by anatomy lab.

I had my schedule for Cardiology, and it was going to be challenging, as I had three twenty-four-hour shifts — Monday, Wednesday, and Friday from midnight to midnight, which matched Doctor Pace's schedule. Clarissa had the other days — Tuesday, Thursday, and Saturday, and we both had Sunday off.

I'd arranged with Serafima and Elias for Rachel to stay with them, though the logistics were a bit convoluted, as I didn't want to drop off Rachel or pick her up just before or just after midnight. In the end, we'd settled on me bringing Rachel to Serafima after dinner on Sunday, Tuesday, and Thursday, and then picking her up around 10:30am on Tuesday, Thursday, and Saturday. Rachel wouldn't go to daycare, and I could manage my sleeping schedule around hers.

"I'm here to get Rachel so I can take her to Pediatrics for her vaccination," I said to Marcie when she came to the door.

"She has a clean diaper and just had a cup of apple juice, so she should be happy!"

"Until they jab her with the needle, when she'll become quite cross!" I declared.

She left and returned with Rachel.

"Dada!" Rachel gurgled.

I took her into my arms, knowing that in less than ten minutes I was going to be about as popular as ants at a Fourth of July picnic! I carried her to the elevator, and we went up to the Pediatric ward, where I stopped at the nurses' station.

"I arranged via Doctor O'Neill to have Rachel receive her DPT," I said to Nurse Candace.

"I have the order, and I can do that for you right away. Unless you object, we'll just do it in the lounge."

In my mind, there was no point in requiring bedding to be changed simply because a ward room was used, which was hospital policy. Unlike Good Samaritan, which was a private Catholic hospital, we didn't have novice nuns working for free to change bedding.

"That's fine," I replied.

"Let me get the vaccine, and I'll meet you there."

Five minutes later, Nurse Candace came in with the hypo and alcohol wipes. I sat down on the couch, removed Rachel's sweat pants, and held her so that Nurse Candace could use the alcohol wipe to sterilize the injection site. Rachel squirmed, so I held her tightly, and Nurse Candace jabbed her with the hypo. Rachel squealed and cried, which I'd expected, so I held her on my shoulder to comfort her.

"Sorry," I said quietly to her, "but we need to make sure you stay healthy."

"You know the signs to watch for, right?" Nurse Candace asked.

"Yes. She's going back to daycare, and they know why I brought her up here. If she shows any signs of anaphylaxis, has an injection site reaction, or cries constantly, they'll call you right away."

"OK. I'll fill out a vaccination form, let Doctor O'Neill know, and fax it to her office so it can go into Rachel's chart."

"Thanks very much!"

"You're welcome!"

Nurse Candace left while I stayed until Rachel stopped crying, which took about five minutes, then took my unhappy toddler back to daycare. When I handed her to Marcie, Rachel gave me a dirty look and clung to Marcie.

"If she shows any adverse symptoms, please call Pediatrics right away," I said.

"We will. I put a note on the board about her injection."

"Thanks. I'll be back to get her in a few hours."

I left and went to meet Clarissa, Peter, Maryam, Debbie, and Lauren for the M & M and the oncology lecture to follow.

"How did Rachel take her vaccination?" Clarissa asked.

"Like a girl!" I smirked.

"So, not a sound and then..."

I laughed, "I know where you're going with that comment!"

"What did I miss?" Debbie asked.

"Something that, if I say here, will violate the code of ethics!" Clarissa declared. "And Mike just had to deal with a student who made an 'off color' joke of that kind. Ask me privately."

"OK," Debbie agreed.

"Rachel cried," I said. "But only for a few minutes, and other than giving me an evil look when I took her back to daycare, she's fine."

The M & M and the lecture were coördinated, and several cases of rare cancers that had been diagnosed over the past year were presented. I made copious notes during both the M & M and the lecture about the diagnostic material presented, as cancer was often the last thought anyone in the Emergency Department had for acute symptoms.

I couldn't, as an emergency medicine specialist, make a diagnosis, but knowing when to call oncology for a consult might well be the difference between life and death. In one of the cases presented, the person had presented three times in the ED before an oncology consult was called, and the delay in calling the consult had, very possibly, contributed to the patient's death. It may well have been inevitable, but beginning treatment three months earlier might have made a significant difference in the patient's prognosis.

"It sucks that person died because of a missed diagnosis," Lauren commented as we left the lecture.

"It goes back to something we discussed," I replied. "People who use the Emergency Department rather than a personal physician often have poor outcomes, or at best, worse outcomes than those who see their personal physician regularly and for all complaints which are not immediately life threatening. They didn't cover it because it was almost four years ago, but there was a missed diagnosis of a tumor because there was no coördination of care through half-a-dozen visits to the ED."

"Mike caught that one," Clarissa said.

"Only because of something that had been said in one of our courses at the medical school, and only because I had the time to look through all the charts and piece it together. I commented then that a computer might help, if there was a way for doctors to easily access it to look at the history of a 'frequent flyer'. I don't think we're there yet, because either it would have to be a pocket computer of some kind with a radio or we'd have to have computer terminals in every patient room. If a busy doctor had to go to a special place to access the information, it would happen about as often as looking at the old charts happens."

"And who is going to put up the money for that in a public hospital?" Peter asked. "Moore Memorial is already strapped for funds, especially with the projects to upgrade the surgical and ED facilities."

"And it's getting worse," I said. "People have begun to realize they can see an emergency medicine specialist at no cost, and so the volume of patients in the ED is rising. Add in the increased number of drug abusers we're seeing because methamphetamine is cheap and easily produced, and it's only going to get worse. On the plus side, we don't see the results of gang violence in places like Chicago or LA, nor do we have the homelessness problems of San Francisco. And I'm only using those as examples, because we all know about them. We also don't have a significant volume of HIV infections that are found in bigger cities."