Chapter 64: Because I Care

December 15, 1988, McKinley, Ohio

"How did the concert go?" Clarissa asked when I arrived at the hospital after taking Kris home after the concert.

"Great, as usual," I replied.

"I'm sorry I had to miss it."

"And I'm sorry about your crappy schedule for January."

"It worked out OK because Tessa has an 8:00pm to 4:00am shift at the 9-1-1 center."

"I thought she was on a regular day shift now."

"She is, but with open positions, they had to juggle because they need senior people on every shift. She'll be back to her usual 7:00am to 3:00pm shift in March after the newbies are trained. Did you get the keys for the house?"

"Yes," I replied. "Everything is set. Anything interesting in the ward?"

"Nine either being monitored or recovering, plus one scheduled valve replacement for the morning. Two of the nine will be discharged in the morning. I had two code calls today, one made it."

"Any recent admissions?"

"No," Clarissa responded. "The last one was at 4:15pm. It's been quiet, with just one consult for a rule-out MI since then."

"OK."

We hugged, she left, and I went to the lounge to find John.

"All labs ordered, and personally verified," he said. "I have the charts for you to review."

"Thanks," I replied. "Anything of note?"

"No. Ten total patients; one valve replacement and two discharges in the morning."

"Sounds good. Get some sack time, if you want."

"Thanks," he replied.

He left, and I reviewed the charts, returned them to the nurses' station, checked each monitored patient to record their current vitals in my notebook, then went to find Doctor Javadi. The door to the Resident's office was closed, and I didn't see light coming from under the door, so given nobody was dying, I went to the on-call room and got into a bunk to sleep.

December 16, 1988, McKinley, Ohio

I managed about two hours of sleep before I was woken very early Friday morning for an admission of a patient who'd survived a STEMI. He was going to the ICU, but was being admitted to the Cardiology service, and Doctor Javadi, wanting to get some sleep, had returned to the ward and sent me down to complete the admission. I completed the paperwork, ensured Mr. Owens, a forty-nine-year-old man, was taken to the ICU, and then John and I returned to Cardiology.

"Is this normal?" he asked.

"It's a perfect example of Fourth Year scut," I replied. "Once Doctor Javadi accepted him onto our service, verified there was an ICU bed available, and signed the form, it's the ICU Resident who is responsible. We were, in effect, clerks and babysitters. That allowed Doctor Javadi to get some sleep, and given I'd had two hours of sleep and had only come on about four hours ago, and she's midway through a thirty-six-hour shift, it makes sense.

"I mean, it's not as if there were no doctors around, with Doctor Nielson and Doctor Gabriel from trauma, and Doctor Klein from the ICU being there. I'm sure you've realized by now that Residents do almost all the work, except surgical procedures. That's the norm for teaching hospitals, and med students do all the stuff Residents don't want to do, don't have time to do, or in this case, babysit so the Resident can get some sleep. It's really not all that different from how you'll make use of nurses in your practice — they'll take vitals, draw blood, give injections, and so on."

"That all makes sense."

"Let's get some sleep. I have pre-rounds in just under ninety minutes, and you have to hand things over to Felicity."

I managed to sleep until 4:50am, when Beth, the student nurse, woke me for pre-rounds. John had been up for about twenty minutes and had done the handover to Felicity. She and I collected the charts and performed our pre-rounds checks. Once Felicity had reported to Doctor Javadi, she returned, and we prepped the patient, Mr. Nichols, for his valve replacement surgery.

I wasn't invited to observe, so I spent the morning in the ward, checking on patients, confirming labs, and discharging two middle-age men. Just before lunch, the patient in the ICU had a second heart attack and the combination of the code team and the ICU could not revive him. As he was on our service, it was my responsibility to do the necessary paperwork and have him transported to the hospital morgue.

Felicity and I had lunch together, then I went to daycare to visit with Rachel. After spending ten minutes with her, I had a relatively quiet afternoon, though Felicity had three consults with Doctor Javadi, one of which resulted in an admission. I had dinner after Felicity handed over to John at 5:00pm, and received two patients who had procedures scheduled in the morning.

Clarissa arrived about ten minutes before midnight and I conducted the handover.

"Nine on the ward," I said, "plus one in the ICU recovering from valve replacement. One discharge in the morning. We lost one in the ICU who had been admitted post a massive STEMI. Two angioplasties in the morning, both patients are resting comfortably with good vitals."

"How's Felicity?"

"Better. You should try to speak with her. I believe she could use your advice."

"Want to clue me in?" Clarissa asked.

"I can't, because what was said was in confidence."

"OK. You're away this weekend, right?"

"Yes. Kris and I leave for Rives Junction in the morning."

"Your mom is staying with Rachel at the house, right?"

"She is," I confirmed. "Elaine is coming along so that April and Rachel can play together."

"Those little Orthodox girls are going to be thick as thieves in a few years!"

"Agnostic ones, too," I replied. "Rachel and Abi Greene get along very well!"

"Your daughter doesn't like boys?" Clarissa asked with a smirk.

"Oh, stop!" I chuckled. "And you know little girls do not like little boys."

"You and Jocelyn?"

"I was different."

"There's an understatement if there ever was one!" Clarissa teased.

"Love you too, Lissa!"

"You said it, Petrovich, not me!"

"I did."

We hugged, I left the hospital, and headed home.

December 17, 1988, Monastery of the Dormition of the Mother of God, Rives Junction, Michigan

"I once again let my indignation cause me to speak intemperately," I said to Father Roman.

"That does seem to be your major weakness. What were the circumstances?"

I explained what had happened with Doctor Mercer and Father Roman listened until I indicated I was finished.

"Were there any other times you felt a similar way?"

"Yes, with a Third Year medical student, but I managed that situation properly."

"Are you able to tell me the difference between the situations?" he asked.

"Angie," I replied.

"The young woman His Grace refers to as Angela?"

"Yes."

"And do you think intemperate words help or hurt her situation?"

"They certainly don't help," I admitted.

"May I ask what you would say to a patient who returned to your ER with the same complaint, having failed to use the prescribed medication?"

"I'd counsel the patient that healing would only come by following the treatment plan, including taking their prescriptions. It's one of the biggest problems doctors face."

"Priests, too," Father Roman said lightly. "You know the prayer said when the penitent approaches the priest...

"Take care, therefore, that having come to the Physician, you not depart unhealed."

"And yet?" Father Roman asked gently.

"I believe 'and yet?' translates to 'Physician, heal thyself'."

"So if you know the right way to respond, and you have the prescription to help you achieve it, why not follow it?"

"I have no excuse, and I agree with Paul's lament that he did things he knew to be sinful, even knowing better."

"Much the same as medical patients, wouldn't you say?" Father Roman asked.

"You've made your point, Father," I replied.

"Yes, and what evidence do I have that it has not, as they say, gone in one ear and out the other?"

"None," I replied. "I've failed to follow the prescription."

"So, what do we do?"

"One approach is to follow Proverbs and simply avoid the trigger," I replied.

"Is that possible?" Father Roman asked.

"Yes. Even if I see Angie, I can avoid seeing or talking to Doctor Mercer."

"Which was your plan, was it not?"

"Yes. She called, I answered, and I allowed her to draw me into a conversation. I don't think she'll call again."

"And there isn't a chance you'll see her at the hospital? Or in a social situation?"

"It's highly unlikely," I replied. "She practices and lives in Milford, which is just east of Cincinnati. McKinley is about ninety minutes from Milford, so I seriously doubt I'll run into her."

"That's good," Father Roman acknowledged. "I wonder, though, what else might trigger that indignation? And would you be able to avoid whatever that might be?"

"I honestly can't say," I replied. "Mostly, I've come to a place of inner peace."

"Have you been following the instructions I gave you with regard to Hesychasm?"

"Yes. I pray the Jesus Prayer while I'm feeding Rachel her bottle, or when I lay down to sleep at the hospital."

"Good. Did you have the same kind of emotional responses before Matushka reposed?"

"Not to the same extent, though a local preacher did get my hackles up by the way he spoke to my friends and others on campus."

"This is the man with whom you had the debate?"

"Yes. He took a new position in Rutherford, about forty-five minutes away, and again, it's unlikely I'll run into him anytime soon. With him, though, I'm positive I could walk away, no matter what he might say."

"But not with the psychologist in Milford?"

"Evidence suggests not, given I thought I could handle speaking with her."

"I'm curious, but were all your confessions this easy on your confessors?"

"The confession part? Yes. The treatment part? Not so much."

Father Roman smiled, "Yes, well, that's a common situation which all priests encounter. Let's discuss your prayer rule. Are you keeping it?"

"Yes. Morning and evening prayers, together with Rachel. When I'm home, sometimes in the evening, others will join us. When I'm not able to be home, I say the prayers silently. I also pray silently for each patient."

"And your attendance at services?"

"When my medical schedule permits," I replied. "This month, that means Saturday Vespers and Sunday Matins and Liturgy. Next month I'll be able to attend Wednesday Vespers as well. I won't know my schedule for February, when I'm in the ICU, until mid-January."

"And fasting?"

"I'm following the rule you assigned, and Kris and I follow it together when she's with me. I don't ask about what she does at home."

"You're following your daughter's pediatrician's guidance about feeding her, correct?"

"Correct."

"Continue to do that at least until she goes to confession for the first time, at which point discuss it with her confessor. The same is true for Kris, when the time comes. Your family rule should follow the guidance provided by her obstetrician, in consultation with her confessor."

"That's the rule Elizaveta and I followed."

"Good. Is there anything else you feel a need to confess?"

"A lack of chastity," I replied. "Well, before Kris and I agreed to marry. I have not behaved at all inappropriately with her."

"Was this once, occasionally, or a pattern?"

"A pattern which followed on from before I married Elizaveta."

"You were completely faithful to her?"

"Yes."

"So the accusations were not inaccurate?"

"They actually were," I replied. "I was absolutely chaste prior to Vladyka returning me to the order of the laity, and for some time after."

"You concealed that from Father Stephen?"

"No. Nor from Father Nicholas before I married Elizaveta. I mention it now only to give you context."

"So you don't need to confess, then?"

"Technically, no, but I felt it was important for you to know I had missed the mark."

"Do you believe there is no risk you will fail again?" Father Roman asked.

"There is always a risk, which is why I have to be vigilant."

"How long were you and Elizaveta betrothed?"

"About seven months," I replied.

"If you could remain chaste for seven months, why not after Elizaveta reposed as well?"

"I chose not to."

"Your honesty is refreshing, but I have to ask, what happens if you chose not to in the future?"

"Besides my immediate death at the hands of an irate wife?" I asked with a grin.

"Yes, besides that!" Father Roman replied with a knowing smile.

"I won't. I take the promises I've made to Kris, and that I will make, to be as firm as the oaths I've taken with regard to medicine and those are inviolable."

"Is Kris aware of your history?"

"To the extent she knows that I engaged in sex outside of marriage, yes, but not any details, which I feel would be inappropriate."

"Indeed they would. You can expect questions in this area from me in the future."

"I'd have been surprised if that were not the case. I told you about it for accountability, among other reasons."

"I do want to ask about tobacco, alcohol, and drugs."

"No tobacco, ever; no illicit drugs ever; I rarely drink because of hospital rules."

"Define rarely, please."

"I think I might have had an ounce or two of hard liquor in the past year. I don't drink beer, I've had one glass of champagne on New Year's, and I've had maybe five glasses of wine in the past year. Fundamentally, given my schedule, there is almost no opportunity to drink that is outside the twelve-hour window, which I follow strictly."

"Out of curiosity, and this is not any kind of accusation or probe, but do you have access to prescription drugs? Or to illegal ones?"

"Absolutely. Scheduled drugs are locked up, but they're easily accessible, especially in trauma. In many cases, a full ampule of a drug isn't used, or the entire contents of a hypodermic aren't injected. It would also be possible to obtain pills via a variety of methods. There are some procedures in place to limit those, but, again, especially in the Emergency Department, those are often ignored for expedience in treating a patient."

"Have you ever been tempted?"

"Never. Not even to try pot in High School. I never saw the point. The same is true with tobacco, and that was freely available, whether it was cigarettes, pipes, or chaw."

"What do you read in your free time?"

"What free time?" I asked with a wry smile. "But to answer your question, either books I read to Rachel or medical journals. On occasion I'll read a novel, but that's an exception. I am reading the Tom Clancy novels about Jack Ryan as they are released, and in the past I enjoyed reading science fiction, but I just don't have the time. Of course, I do read the lives of the saints each day, and I read The Ladder of Divine Ascent and Mystagogy of the Holy Spirit per your guidance."

"I'd like you to read In the Image and Likeness of God by Vladimir Lossky between now and when you visit again, hopefully in January. We have the book in our bookstore."

"I'll get a copy before I leave."

"Good. Let's return to the chapel so I may say the prayers of absolution and then I'd like you to spend the rest of your time here in quiet contemplation, praying the Psalms when we are not praying as a community in the chapel. When can you visit again?"

"Late in January should be doable," I replied. "My schedule leaves Saturdays and Sundays free."

"Good. Shall we say January 21st?"

"That would work."

"And the nuns are insisting I instruct you to bring Rachel with you so they may fawn over her!"

I chuckled, "The maternal instinct does not go away with the taking up of the apostolnik!"

"Nor should it!" Father Roman declared. "We call our tonsured nuns 'mother' for a reason."

We walked to the chapel where Father Roman said the prayers of absolution, after which I went to the bookstore to purchase a copy of In the Image and Likeness of God. Once I'd done that, I found Kris with several of the nuns, let her know Father Roman's direction for me, then went to the chapel to read the Psalms in quiet contemplation.

December 18, 1988, on the road from Rives Junction, Michigan to McKinley, Ohio

"Being at the monastery seems to recharge you, almost like a battery," Kris observed.

"It's been suggested that had I not been so committed to being a physician, 'Monk Michael' was the most likely path forward. Given my personality, most likely as a celibate priest, not an eremitic monk."

"I don't see you ever having been a skete monk," Kris said. "You love people too much to spend significant time in an isolated cell. That said, having seen you with Rachel, I wonder if that assessment is accurate."

"It would have been a very different life, and not one I was called to, which is why I asked Vladyka JOHN to release me and return me to the order of the laity. Things would have been very different had I gone to seminary or entered a monastery at eighteen. And as I've said, that might well have led some idiot, or group of idiots, to try to make me a bishop!"

Kris laughed, "I think the diocese could do worse!"

"Sadly, it has," I replied. "That said, I'm not sure I'm even remotely godly enough for the heavy obligations that come with the office."

"Which is the first sign someone is qualified for it! If you do not consider yourself unworthy, you are too arrogant to be a bishop! Imagine how unseemly it would be for someone to campaign for clerical office, or say directly that they felt worthy and qualified. Those things must be recognized and said by others, and if said by the person, they are disqualifying."

"I agree, which is why Viktor, my grandfather, and I put forward Vladyka JOHN's name, though he was Father Jeremiah Loch when we put his name forward. He is actually from my home parish, which, in the oddest of coincidences, so was Bishop ARKADY."

"That is strange! Two men from a single small parish?"

"It could have been three," I chuckled.

"May I say I'm happy that was not the case?"

"You may."

"Did Father Roman give you any new instructions?"

"Beyond the reading assignment, no. It dawned on me that we need a second icon of Saint Christina of Persia, as one goes over your side of our bed and the other in our icon corner. I'll call the monastery in Boscobel, Wisconsin, as they can produce a copy of just about any icon in existence."