Chapter 56: The Ward is All Yours

November 30, 1988, McKinley, Ohio

"How was Chicago?" Clarissa asked when we met for lunch on Wednesday.

"I'd never been to a Calvinist church before," I said, "only Lutheran and Roman Catholic besides Orthodox churches. I was shocked at how austere it was, and Kris said it felt 'sterile'."

"So you were right at home ... if it were an operating room!"

"They take their iconoclasm to an extreme, and the only thing in the entire worship hall that had any kind of symbolism was a large wooden cross suspended over a stage. The true focus is on preaching, but weirdly they didn't read the Gospel during the service, only one abridged section from Paul's letter to the Romans."

"I'm curious what you think about your grandfather."

"I told my dad I was positive Grandpa Loucks was surprised in the afterlife, not because I felt he was in hell, but because of how many people he discovered were in heaven!"

Clarissa laughed, "That is such a 'Mike' thing to say! But it does cut to the core of your beliefs. How is your dad?"

"OK. He had plenty of time to prepare, given this was Grandpa Loucks' second heart attack. Anything exciting happen here?"

"Not much excitement in Endocrinology, and I'm happy to keep it that way! You thrive on trauma and surgery and draw energy from them. I'm happy to practice my diagnostic and long-term care skills, along with my bedside manner."

"I like your bedside manner," I smirked.

"Not like that, you pig!" Clarissa exclaimed, laughing.

"Oh," I replied flatly.

"Will the new Mrs. Loucks allow you to be yourself?"

"All evidence points to that being the case. She says she's not the jealous type, and she has no problem with our friendship."

"But she doesn't know just how close we've been, right?"

"Correct. But that falls into the 'no names, no details' agreement."

"Have you had any further discussions about our desire to have a kid together?"

"No. She hasn't brought it up, which I think is a positive sign."

"How so?"

"Because if she was adamantly opposed, she'd have said so. She's very straightforward and clear, and has no qualms about letting me know when there is a difference of opinion. My thought is that sometime next year you and Tessa invite us to dinner and we talk about it. Kris will absolutely listen, and she'll give you a straight answer. She's never hemmed nor hawed on anything. She's very practical and open-minded."

"European sensibilities?"

"Yes, though being French, also French sensibilities about the absolute separation of church and state."

"She must love Reagan and his public support for Evangelicals."

"Being a socialist, she doesn't like Reagan to start with! But, as I've pointed out, Reagan pays lip service to Evangelicals. Think about the Supreme Court justices he's appointed — O'Connor and Kennedy are both moderates, though I'd put them on the right side of the center line. That said, I remember reading earlier this year when Kennedy was nominated that he was supportive of a constitutional right for homosexuals to engage in sex. Think that would go over well with the people at Faith Bible?"

"No, but wasn't Kennedy only nominated after the Bork nomination failed, followed by the Ginsburg fiasco?"

"Yes, but the point remains, what has actually changed? Was Roe overturned? That's been THE cause for the Evangelical right since 1973. They also wanted to get rid of the Department of Education. That didn't happen, either. And you sure can't have teachers or the principal lead prayers in schools, which is another thing they want. And I don't see Bush, who was a liberal Republican when he was chosen by Reagan, lifting a finger beyond the same platitudes and lip service."

"A reasonable point."

"I'm far more worried that he used to be head of the CIA. If that doesn't scare the voters, I'm not sure what would! But enough politics. Back to your question — if she brings it up, I'll let you know, otherwise we wait until next year to ask."

"She's your wife, so I'll defer to your judgment."

"In just over a month," I replied.

"Not according to you! After betrothal, you need permission from the bishop to marry someone else, right?"

"Yes."

"So, wife."

"Again, not for just over a month!" I replied.

Clarissa laughed and shook her head, "Enforced celibacy again!"

"I haven't even kissed her," I replied.

"Torturing yourself?"

"Anticipation is a good thing, Lissa!"

"You're a nut, Petrovich!" Clarissa declared mirthfully.

"Something I've never denied!"

"I need to get back."

"Me, too, actually!"

We left the cafeteria, and I headed back to Pathology to work on an autopsy report. Late in the afternoon, I had my evaluation with Doctor McKnight, and as I'd expected, I received perfect marks.

"Mind if I ask about your evaluation of your Sub-I?" Doctor McKnight asked.

"I think it should be a required Sub-I for anyone who plans to Match for surgery. I suspect Doctor Roth and Doctor Cutter used me as a guinea pig to gather information to defend that decision."

Doctor McKnight laughed, "I'm sure that's the case. Owen didn't say so directly, but I'm fairly certain he intends to make that change. The challenge, of course, is getting other teaching programs to go along. He may well be training surgeons for other programs."

"It's not all that different from my situation, really, if somehow I were to Match anywhere but here or Indiana, which has the same program I'm preparing for. That said, nothing I've done is extraneous, given I plan to practice emergency medicine, no matter what."

"If there's anything I can do for you, Mike, let me know."

"Thanks, Doc! I very much appreciated the experience, and it was absolutely worthwhile."

"Even the scut?"

"Actually, writing the autopsy reports was valuable in that it reinforced concepts that will be applicable in the ED. Being able to visualize things that have gone wrong, so to speak, is hugely valuable."

"Cardiology next for you, right?"

"Yes."

"Stop in and see me from time to time and let me know how things are going."

"Will do."

We shook hands, and I left Pathology to head to the Country Club. 'Aunt' Clarissa had picked up Rachel from daycare at the end of her shift. She took Rachel to my house, where she and Tessa would watch Rachel so that I could have dinner with Viktor. When I arrived at the Country Club, I joined Viktor in one of the small, private dining rooms.

"First, I received a notice from the factory that the car will begin production on Monday, and will be delivered to the dealership on the 22nd. That will give us plenty of time to prep it before you pick it up on the 28th."

"Thanks. What about the loan?"

"You can sign the papers on the 28th. Just bring a check for the down payment, as we agreed. We'll have everything ready, and it'll take less than an hour from start to finish."

"That sounds good."

"Also, Zach Gleason let me know he hasn't seen your car in over a year. You should bring it in for a check. I'm going to assume you've had the oil changed."

"Yes. I'll make arrangements to bring the car in. How is Zach doing?"

"He's a shift supervisor, and I expect Geno will promote him to service manager in about a year when our current service manager retires."

"Is that an administrative job?"

"Some, but maybe only about a quarter of the time. The rest of the time is spent helping junior mechanics or working on very complex problems. Think of it like the Chief of Surgery, not the Chief of Emergency Medicine."

"You know my take on that."

Viktor nodded, "I do. What about the position of Medical Director?"

"A surgeon, and nearly always one who has reached the limits of dexterity, so that's different. Doctor Northrup, on the other hand, is in his early 50s and there is no reason he can't take shifts in the ED, which, in my opinion, he should do. I don't believe you can run a service without participating in that service. That said, the fact that he likes the admin BS frees up the Chief Attending and Chief Resident to practice medicine."

"You just talked yourself out of your position," Viktor said.

"Not really," I replied. "I hate admin as much as the next person, maybe more, but other than budgets, all of it is a necessary part of medicine. Attendings hate chart reviews, for example, but they are absolutely a good thing. Granted, we could do without the Medicare and Medicaid paperwork, but that's what admin weenies are for!"

Viktor laughed, "The amount of unnecessary paperwork grows every year because bureaucracies thrive on it. You don't even want to know how much paperwork is involved with my various businesses, and most of it is to satisfy some bureaucratic regulation. I'm sure you know buying a car involves signing a dozen documents, only two of which are loan documents. And wait until you're ready to buy a house!"

"I've heard some horror stories about title companies from doctors, and I've seen some in the local paper, too."

"On that topic, is everything taken care of for the house you and Kris are renting in Circleville?"

"Yes."

"Good. Would you and Kris join us for dinner one Saturday in December?"

"Of course. Let me check with her and I'll let you know which day works best for us."

"Who has Rachel tonight?"

"Her 'Aunt' Clarissa. Rachel really likes her, and Clarissa enjoys it, at least in small doses."

"You've done a very good job, Mike, despite the concerns of the ladies at the church."

"I don't object to their being concerned," I said. "I was concerned myself. My trouble with them was when they objected to my choices, none of which were bad, and made it contentious. And especially the scurrilous and completely untrue rumors about Tasha Antonov, who, I'm sure you know, is engaged to Chris Reed, though they'll do the modern combined betrothal and crowning as he won't be chrismated until Holy Saturday."

"You do have to admit how it looked, Mike," Viktor countered.

"No, actually, I don't. It was the assumption that being friends with Tasha, and accepting her help, somehow meant that I was, as a deacon, engaging in inappropriate behavior. That should never be the default assumption. In fact, the default assumption should be that the clergyman is respecting his ordination unless there is evidence to show otherwise, and a single dad receiving help from his female friends is simply not sufficient evidence.

"There's a reason Paul wrote directly about gossip! It's extremely destructive, and you know, from what Bishop JOHN and Father Nicholas, who were in a position to know, said. It was one thing for Elizaveta to be uncomfortable with me putting my hands on the genitals of female patients, but a whole different thing for anyone else to object to that. As Father Nicholas said, nobody once complained about Doctor Petrov, who delivered hundreds of babies.

"As for how it looked, well, you, and others, directly asked me about it and I denied it. But my denials were rejected, and the rumors continued until His Grace had to step in and impose discipline on those who refused to accept my denials. He also spoke to his brother Antiochian bishop about the lies Nik Antipov was telling about Tasha. So, no, I don't admit anything about 'how it looked'."

Viktor nodded and was quiet for a moment.

"I do have a question for you," he said, "and I will say up front that I don't have an answer — how do you plan to deal with Yulia referring to Elizaveta as Rachel's mother? You know she will, and there is nothing any of us can do to stop that."

"It's a difficult problem, because I totally understand Yulia's point, but it's also the case that Rachel never knew Elizaveta, and the only 'mom' she's going to have is Kris. The problem is, as I see it, that at the point where Rachel could grasp the concepts in a meaningful way is years past when the information will be conveyed. It'll likely confuse the heck out of her until she's a pre-teen, and I don't know any way around it. I suppose my real concern would be any attempt to set Elizaveta and Kris at odds in Rachel's mind."

"Can you expand on that?"

"If, for example, Yulia were to show Rachel a picture of Elizaveta and say 'mama' in a way that tried to diminish Kris or her role. Kris is going to be Rachel's mom, no matter what else might be true. And I certainly don't want to set up a situation where there is some kind of division between Rachel and kids I have with Kris. Well, more than the different sets of grandparents, which is a fact, and which I would never deny.

"I think, in the end, all we can do is take things as they come, and I ask you to use whatever influence you have on Yulia to have her not create tension or division. We're already going to have enough difficulties with holidays and birthdays, given the disparate sets of grandparents. I've given it some thought and I'm thinking about celebrating Nativity as our nuclear family, and then on Boxing Day having a celebration with all the grandparents and great-grandparents."

"That actually sounds like a reasonable compromise."

"Thanks. Of course, Thanksgiving is a bigger challenge, and I can't think of a good solution given it's during the Nativity Fast. I think that has to be left to Kris and me to decide, and I don't know if there's a way to make it 'fair'."

"Just a thought, but there is an option to reserve the Country Club banquet room and gather the entire extended families."

"I am not going to speak for my grandmother or Yulia about giving up their cooking on Thanksgiving!" I chuckled. "I suggest you take that up with my grandfather, my mom, and my dad, as well as Yulia and both sets of your parents. I don't have a problem with the idea if it can be made to work."

"Out of curiosity, would your dad attend?"

"I think so. He and mom are cordial; it's Holly who is uncomfortable."

"With good reason, don't you think?"

"Yes," I agreed. "But she is my dad's wife and the mother to my half siblings, so I want to do my best to make her feel comfortable. Nothing will undo the divorce and, honestly, what's in the past is in the past. All we can do now is move forward."

The waiter came and took our orders and returned shortly with our drinks.

"You had your interview at the hospital, right?" Viktor inquired.

"I did. And it went very well, at least from my perspective. I'm going to Pittsburgh for my interview on Monday. My interviews at Ohio State, UC, and Indiana are in January."

"Hopefully you won't need to rely on any of those."

"I shouldn't, but there are no guarantees until I'm handed the Match results on Friday, March 17th. Obviously I'll know I Matched on Tuesday, March 14th, but won't know where until Friday."

"I'm sorry if I've asked this before, but what's your next rotation?"

"Cardiology. I have three twenty-four-hour shifts, starting at midnight on Sunday, Tuesday, and Thursday. Clarissa has the shifts immediately following mine."

"Who covers midnight Saturday to midnight Sunday?"

"An Attending, a Resident, and a Third Year, as there are no scheduled procedures on Saturday or Sunday, so there is no pre-op or immediate post-op work to do. It's basically just doing twice-daily rounds and responding to any complications. I do find it interesting that as a Board member you don't know things like that."

Viktor smiled, "The Board is all about money; we leave all the medical concerns to the Medical Director. The Board is basically a rubber stamp for medical decisions because we're not experts. I believe you know there's only one physician on the Board of Directors, and he's retired."

"I was aware, and that does bug me."

"I can understand, but it's the case that despite the way it sounds, the Board of Directors truly has nothing to do with medical decisions, except insofar as we have to fund anything that the Medical Director proposes in the consolidated budget request he puts together. And you know the limiting factor there is income, which is a combination of taxes and fees for services, from whomever they might be collected — patients, insurance companies, or the state and federal government. When there's a mismatch between desired expenditures and income, it's the Medical Director and the service chiefs who have to solve it, not the Board. And remember, the ultimate trump card is held by the taxpayers of Hayes County, as the County Board determines the bulk of the funding for the hospital capital expenditures."

"I did hear that the new CAT scanner is an operational expense, not a capital expense."

"The companies that make them realized it's easier for the hospitals to lease them at a modest monthly rate with a fee for each use. That makes billing easier, as you can point to an exact cost for using the equipment, then add in the overhead of the space, the technicians, and so on. It also makes upgrades easier, as you just replace it under the lease."

"What happens to older equipment?" I asked.

"If it's still useful, it would be refurbished and leased to a smaller hospital who otherwise wouldn't be able to have one. For our lease, there is a minimum usage charge, so if we don't do the necessary number of scans, we have to make up the difference. A small hospital in Appalachia would never have enough use for the machine to justify that, but an older, refurbished machine might be affordable."

I frowned, "While I understand the economics of what you said, it also says that people in large parts of Appalachia, which technically includes us, don't get the same medical care as people in Hayes County, which bugs me. And no, I don't have a solution, because, in the end, resources are limited."

"In many cases, it's less expensive to use a helicopter to take someone from one of those smaller regional hospitals to a bigger hospital in a city than pay the cost of what amounts to an idle machine."

"For an emergent case, though, that might be the difference between life and death."

Viktor nodded, "It could, but don't you do triage when you have too many patients? This is just triage on a regional or national level. Allocating the resources where they'll do the most good and have the best chance of success."

"Which sucks if you happen to live in, say, Harlan County, Kentucky."

"Or if you need an expert from Mayo Clinic, if you live anywhere but Rochester, Minnesota," Viktor countered. "And lest you think this is a uniquely US problem, in Canada, where their healthcare system is tax-funded, they, too, have a triage system that works against people who live in less populated areas."