Chapter 54: A Partnership of Equals

November 23, 1988, McKinley, Ohio

"How was your interview?" Clarissa asked when we met Maryam for lunch on Wednesday.

"Just fine, I think," I replied. "I did tangle a bit with the doctors about my proposal, but I believe I acquitted myself well."

"But it was approved," Maryam protested.

"It was about why I felt I could make the proposal in the first place. The questions were legitimate, and I was prepared. The more interesting part was when Doctor Collins asked me about socialized medicine."

Clarissa laughed, "Of course, and you gave your usual spiel about Medicare, Medicaid, and private insurance not being different from European systems in any practical way and pointed out that all of them were government employees. How did they react?"

"Doctor Getty laughed when Doctor Collins asked, and after I explained that, he asked about anything else I felt strongly about."

"Uh-oh," Clarissa said, shaking her head.

"Yep!" I chuckled. "I asked why I was being interviewed by four white male doctors, why the only female interviewers were a Resident doing the psych profile and the Nursing Supervisor, and why nobody on the interview team was a minority. Doctor Getty made the point about the fact that my valedictory speech at Taft was in my file and that the other doctors should read it."

"My interview team at Edward Hospital is all male," Maryam said.

"That's where my grandfather is being treated for his heart attack," I said. "Is that your primary?"

"I think so, yes. The new President and CEO is a woman — Pamela Meyer — and according to the doctor who conducted the phone interview, she plans to turn it into the premier cardiac hospital in the Midwest. I suspect, with a female in charge, things will be different."

"Did you have phone interviews for all the programs?"

"Yes, because I asked them all for accommodation so I could do all five interviews the first week in December."

"Did you speak to Doctor Washington at the University of Chicago?"

"No. I spoke to a Resident. The University of Chicago is my second choice, then Northwestern, though obviously the order could change before February. You're going to Chicago this weekend, right?"

"Yes. Kris and I are driving up on Saturday, and we'll be back on Tuesday."

"Do you plan to see Doctor Barton?" Clarissa asked.

"No. We simply don't have enough time," I replied. "Kris is missing two days of school, and I'm missing two days here as it is."

"When is your next interview?" Maryam asked.

"Clarissa and I are going to Pittsburgh on December 5th. They and Indiana accommodated us in that way. Cincinnati and Ohio State are close enough that we didn't ask for either of those to be on the same day. How are things with Matta?"

"Good," Maryam replied with a smile. "I'll be staying with his family when I'm in Chicago. He'll be here as my date for your wedding."

"Awesome," I replied. "Clarissa, did you receive your invitation?"

"Yes. For 'Clarissa Saunders and guest'. Tessa will be my guest, obviously."

"Obviously."

"What did you decide about a honeymoon?" Maryam asked.

"Kris' parents booked us a suite at Hotel LeVeque for three nights," I replied. "In June, the three of us are going to Gatlinburg, Tennessee."

"Leave it to Mike to take his daughter on his honeymoon!" Clarissa exclaimed.

"She'll be at her parents' wedding, just as Jocelyn was," I replied.

"How did that happen?" Maryam asked.

"The usual way!" I chuckled. "She was conceived while her parents were dating. They married after she was born."

We finished our lunches, and I headed back to the hospital basement. We had one routine autopsy, and while I was doing the paperwork, the complete tox screen and other reports came back on the patient who had died during the laparoscopic surgery. I reviewed them, and they showed absolutely nothing to give us any clue as to the cause of death. I got up and took them to Doctor McKnight's office.

"Labs are back on the inconclusive autopsy last week for the laparoscopic surgery. Nothing."

"Nothing?"

"Every single line is within normal range, and the tox screen was negative for everything, including nicotine."

"I really hate 'cardiac arrest due to unknown cause'," he said, "but Doctor Blake and Doctor Cutter are going to hate it more."

"Is there anything else we can do?" I asked.

"You tell me," Doctor McKnight said.

I considered everything and couldn't think of anything we might have missed or anything more we might have done.

"There's nothing I can think of," I replied. "The EKG showed no anomalies until he arrested, his blood work is basically perfect, including lipids, there was no sign of coronary artery disease, no bleeding in the brain, no tumors besides the benign one on his adrenal gland, and no toxins of any kind."

"A mystery, and we can't even present it at an M & M because there is literally nothing to discuss. I spoke to John Cutter about it, and he's as perplexed as we are. I ran through everything with him, and he hoped the tox screen and complete tests on tissues and blood would show something. I'll give him a call, but I think we're at a dead end, so to speak."

"Then I'll go back to completing the report for this afternoon's autopsy. That was no mystery."

"The only mystery is why he didn't die before his main coronary artery was 90% occluded. There's also no way he wasn't having severe chest pain and shortness of breath."

"A hundred and fifty pounds overweight, smoker, drinker, and obviously a poor diet with no exercise is pretty much textbook for coronary artery disease. And the autopsy confirmed that."

"It certainly did!"

"I'll bring you the report by the end of the day."

"Thanks, Mike."

November 24, 1988, Thanksgiving Day, McKinley, Ohio

Pathology was one of the few services that had Thanksgiving off, though the Resident was on call for any emergencies. With no scheduled procedures and as many patients as possible discharged, most services ran skeleton crews, except for the Emergency Department, and even there, only one Attending and two Residents were at the hospital with the others on call. That meant I had a rare weekday off, in fact, two, as Doctor McKnight had no autopsies scheduled for Friday. I'd need to stay in the area, though, because it was always possible, albeit unlikely, for him to be called in.

The days off gave me a chance to pack some things I didn't need at the moment, including lightweight clothes and books. There were also clothes that no longer fit Rachel, and I set those aside to donate to the Salvation Army or Goodwill. I also took the opportunity to go through Elizaveta's things.

It was difficult and emotional as I remembered how beautiful she'd looked in various pieces of clothing, but in the end, it made no sense to keep most of it. Ultimately, I decided to keep three of my favorite sweaters and her limited jewelry, and donate the rest. Those things I kept would one day go to Rachel, though I'd absolutely clear it with Kris first. I didn't think she'd have a problem with it, but I felt I had to check.

One amusing thing that happened was Rachel, who was toddling quite well, tried to 'help' with the packing by putting things in boxes or taking them out, seemingly at random. I didn't reprimand her at all because it was cute, and she had no idea what was going on. I wondered, as she 'helped', how she'd react to moving to a new house, and to having Kris around basically full-time. Clarissa was, without a doubt, Rachel's favorite person, though she also loved Lara and the women who worked in daycare.

"Papa! Poo!" Rachel announced, interrupting my thoughts.

One thing that had happened recently was that her words were more 'normal', and less strident, and she was starting to string pairs of words together logically. Of course, those pairs usually were 'more' and some food item which I limited, such as grapes, French fries, or ice cream. In response to her most recent utterance, I changed her diaper, then gave her a sippy cup with apple juice to drink while I finished packing.

Once I finished, I packed Rachel's bag for the afternoon, fed her, gave her a bath, then bundled her into the car to head to my grandparents' house in Rutherford.

November 24, 1988, Thanksgiving Day, Rutherford, Ohio

Rachel and I arrived at my grandparents' house just before noon, arriving before everyone except my mom and Stefan, who had Elaine and April with them. My sister and Paul arrived a few minutes later, followed by Kris and her family. Rachel was in her element with attention from Mama, Grandma, and Great-grandma.

"How is your father?" Mom asked.

"I haven't spoken to him again," I replied. "I'll see him on Sunday. Kris and I will drive up after Liturgy, which will get us to the funeral home in time for the visitation. Liz, are you going?"

"No. I don't want to see him."

"You wouldn't be going for him, but for Grandma Loucks," I replied.

"No."

"OK," I replied, deciding there was no value in pressing the issue.

"Dinner in about ten minutes," my grandmother announced.

"I'll help you get everything on the table," I offered.

I got up and went to the kitchen with her.

"Making a point to your new wife?" Grandma asked.

"No," I replied with a grin, "protecting you from the modern, liberated French woman who does not believe in traditional roles in the home!"

"She's not planning to stay home with Rachel and the children you have together?"

"No. She intends to complete a Master's in Public Administration, then find some kind of government job. She'll be home nights and weekends, and Rachel very much enjoys daycare. Rachel can begin at the church daycare next Fall, so we'll have that option, in addition to the hospital."

"I'm surprised, Mike," Grandma said. "That seems out of character."

"Not really, Grandma. I had encouraged Elizaveta to go to college, but she elected not to. And if you mean because I made the point of saying Rachel needs a mom, that's still true, and Kris will be there for Rachel."

"You do plan to have more children, right?"

"Two," I replied. "Well, at least. We'll just work on the timing, and Kris will adjust her class schedule."

"I'm not trying to be critical, Mike," Grandma said. "But this is very different from what I thought you wanted."

"A lot has changed in the last sixteen months," I replied. "Kris is a faithful, Orthodox girl whose spirituality is a perfect match for mine, and whose worldview is actually very similar to mine. I'm not stuck in the Old Country, or even in being Russian."

"Don't let your grandfather hear that!"

I laughed, "Grandpa knows. He's known since the day about seven years ago he started speaking to me only in English. We have no intention of teaching the kids any language other than English, except so far as necessary for the few prayers and hymns we sing in Greek or Church Slavonic. Mom is an American through and through!"

"Obviously," Grandma said with a wry smile. "Would you please get the turkey from the oven and take it to the table?"

"Right away!" I replied.

Five minutes later, we had everything on the table, and Grandma called the others to dinner.

"Mike, would you pray, please?" Grandpa requested.

I said the blessing prayer, and then he began carving and serving turkey while we passed the bowls and plates of stuffing, mashed potatoes, gravy, corn, bread, butter, and cranberry sauce.

"I've never had a meal such as this!" Kris declared about five minutes later.

"Americans do tend to go a bit overboard on Thanksgiving!" I replied.

"What can I give Rachel?"

I considered for a moment, then said, "Mashed potatoes, bread, stuffing, and very small bits of turkey should be fine. She can have her bottle after dinner, if she wants it. And yes, you may serve her apple pie and ice cream!"

"Not pumpkin?" Liz asked.

"Too spicy, I think," I said. "I suspect she wouldn't like it. You're welcome to offer some to Mikey!"

Liz smirked, "He won't like it, he hates everything!"

Everyone except the Korolyovs laughed, so I explained.

"She's referring to a commercial for Life cereal," I said. "With a picky kid named Mikey who won't eat anything."

"Sad but true," Liz declared. "Our Mikey is like that! He wants to nurse, and that's about it. He'll eat cereal, but it's a struggle every time."

"What does his pediatrician say?" I asked.

"She said that he's not quite a year old, so it's nothing to worry about. Some babies just take longer to wean than others. Do you agree?"

"I'm not studying to be a pediatrician," I replied. "So I only know what Doctor O'Neill has told me, which basically matches what your pediatrician told you. Rachel is different because she's not nursing. One thing I've learned about Rachel is she likes to be cradled when she has her bottle, and it's the same basic position you hold Mikey when he nurses."

"But didn't you do a pediatrics rotation?"

"I did, but it wasn't a neonatal rotation. I didn't see a patient under age two, which is an even narrower specialty than just regular pediatrics at the hospital. The little humans are very different from even the kindergarteners and very different from adults."

"It's really that specialized?" Liz asked.

"Yes. Clarissa and I will both be generalists, though she'll study about longer-term care and treatments, while I'll study about immediate care and treatments. Once I treat a patient, I'll turn them over to someone like Clarissa in Internal Medicine, or Maryam in Cardiology, or Fran in Pediatrics, or Peter, as a cardiothoracic surgeon."

"But won't you do surgery?"

"Emergency procedures only. And in many cases, it'll just be a stop gap until a regular surgeon can work on them. My role will be to save lives by stabilizing the patient then handing them off to another service, or discharging them if there is no specific follow-on treatment or they should see their personal physician. And for many things, especially cardiology or neuro, I'll call a specialist to the Emergency Department to help. There is simply too much for any one doctor to know."

"You're saying I can't call you to verify what a doctor says?"

"You can, but I might have to ask someone because it's outside my area of specialization. And just so you know, if you were to show up in the Emergency Department while I was on shift, I couldn't treat you unless there were literally no other options."

"Why?" Liz asked.

"Because it's an ethical problem and would violate hospital policy," I replied. "Fundamentally, there is a risk that the doctor wouldn't use their best judgment or might violate standard treatment protocols."

"Mike, you had your interview this week, right?" my grandfather asked.

"Yes, and it went well. But they can't commit to anything because of the rules for the Match. I won't have an answer until the third week in March, when all Fourth Years across the entire country receive their assignments simultaneously. I'll know on Monday that I Matched, but won't know until Thursday where I matched."

"Why?" he asked.

"To give people who didn't Match a chance to find a program in what is called the 'Scramble'. There are always programs that still have openings after the Match and always students who don't Match. Those students then apply for those openings, which means they may not get their choice of specialties or locations. Oh, and there is the military Match, which occurs first, so that if you aren't selected for a commission, you can apply for a hospital Residency."

"You could end up doing something you totally hated?"

"That might be the only option for a medical license. That said, it is possible to switch your Residency after a year, though you would basically have to start over unless it was a very similar program. The other option would be to wait a year and try again."

"What would you do?"

"List enough hospitals and programs that I'm sure to Match for surgery or emergency medicine. That said, if some bizarre set of circumstances arose, I'd Scramble to an emergency medicine position in an undesirable location, which often means places like central and eastern Appalachia, rural Louisiana, and similar. If I couldn't find a program like that, I'd take an Internal Medicine position, do two years, get my license, then look for a second-specialty Residency. The other option would be to apply to the Navy after one year of Residency.

"But this is all idle speculation because my Match with Moore Memorial is as close to a sure thing as there is. I helped design the program; I'm ranked first in my class at McKinley Medical School, don't have a single negative mark anywhere on my record, and have done all but one clinical rotation at Moore Memorial, and that one was OB, which I did at the Catholic hospital for personal ethical reasons."

"I had no idea it was so complicated," Liz observed.

"And I only had the barest inkling of what was truly involved until I was a senior at Taft, and even that vision was incomplete. Ask me again after next year!"

"Kris," Mom said, "what's your plan for the Fall?"

"To attend Ohio State and work towards a degree in political science, with the ultimate goal of a Master's in public administration. I could even think about a PhD, but that's not all that important."

"So we'd possibly have two Doctor Loucks."

"It would be Doctor Korolyov," Kris replied. "In France, your legal name stays with you for your entire life, even if you use another one socially. Mike agreed that isn't a concern."

"It's not," I confirmed. "I briefly toyed with the idea of changing my last name to Borodin, but decided that everything about me has my last name as Loucks, so it would introduce confusion. That said, the kids will have the last name Korolyov-Loucks, including Rachel."