Chapter 66: Nativity Week

December 24, 1988, the Eve of Nativity, McKinley, Ohio

After moving two van loads from McKinley to Circleville, Rachel, Kris, and I attended Vespers for the Nativity at Saint Michael the Archangel. After Vespers, we headed back to my house for a private celebration with just our small family, though that wouldn't be official for another week.

Rachel had no idea of what to make of the wrapped presents and was much more interested in the paper and bows than the clothes and books she received from my side of the family. I did buy her a stuffed bunny rabbit, though this one was black to go along with the white one she already had, as well as a set of Duplo blocks, which were Legos, only larger and heavier. The set included people as well, similar to Lego minifigures, but larger. Her other toy was a set of wooden alphabet blocks.

Kris had gifts for Rachel as well, but we agreed we'd give them to Rachel on Christmas Day at Kris' parents' house. Once we'd opened the gifts, we said our evening prayers, and then put Rachel in her crib for the night.

"What time will you leave my parents' house tomorrow evening?" Kris asked when we returned to the great room.

"I was thinking that if I could take a nap, I could just head straight to the hospital from your parents' house. That would mean leaving around 11:15pm."

"I'm sure they'll be fine with you sleeping in the guest room. My parents bought a bed for Rachel to use when she stays at the house. It has wooden railings to keep her from falling out, similar to the one we bought for our house. For now, it's in my room, but in a week, that will be Rachel's room, or her siblings', when they visit grandma and grandpa."

"How is Lyudmila dealing with all of this?"

"Just fine. We get along well, and she's happy for me. She's looking forward to being an aunt!"

"Did Father Jacques get permission to travel?"

"Yes! He'll fly in with my grandparents on Thursday. Chloé and Pierre will arrive on Friday."

"Dale and Pam fly in on Thursday, but they'll spend time with his parents and with Jocelyn and Gene. They'll all be at Doctor Blahnik's party. I'm sure your friends could attend as well."

"I'll let them know," Kris said, "and I suspect they'll say 'yes'. I hate to say it, but I should head home. See you tomorrow morning for Liturgy?"

"Yes. We'll meet you at the Cathedral."

I walked her out to her car, we exchanged a chaste hug, and after she drove away, I went back inside and went to bed.

December 25, 1988, Feast of the Nativity, Ashville, Ohio

On Sunday morning, Rachel and I drove to Columbus for services for the Feast of the Nativity, and after the services ended, headed to the Korolyovs' house in Ashville.

"I think it's terrible you have to work tonight," Lyudmila declared after we all sat down in the living room by the fireplace.

"Worse for the person who had to work from midnight last night until midnight tonight! And even worse for the six kids who are in the hospital over Christmas."

"Lyudmila, do you think the hospital could close its doors on Nativity?" her father asked her.

"Well, no, but it's terrible to have to work on Nativity!"

"Almost anyone in a job in public service has to," I said. "Firefighters, paramedics, police officers, doctors, nurses, and so on. Hopefully, you won't ever need their services on a holiday, but if you ever do, you'll be happy they were working. I am positive there will be babies born at the hospital today!"

"You know this is our second Nativity this year, right?" Lyudmila asked.

"You celebrated in January not long after you moved here, because you were on the Old Calendar with ROCOR and now you're on the New Calendar with the OCA."

"I liked it being on different days," Lyudmila said. "That way it wasn't the same days everyone else worships Santa Claus!"

I laughed, "It does seem that way, with the way it's been completely overtaken by consumerism here."

"Americans worship the dollar!" Kris said with a wink.

"Not taking the bait, no Ma'am!" I chuckled.

"My daughter can be a troublemaker!" Ignatiy said lightly.

"A true statement about most of the women I know who are around my age!" I declared.

"My sister?" Lyudmila asked.

"At times," I agreed, winking at Kris.

Lyudmila and her parents both laughed, and Kris gave me a look that implied she'd get even, though it was mirthful, not vengeful.

"Nadezhda," I said, "if you need help in the kitchen, please let me know."

"Thanks, Mike, but at the moment, the ham is baking, so we need another hour before we begin with the potatoes."

"Let's open our gifts, then," Ignatiy suggested.

We did that, and Rachel received a cute dress, in the style of a formal dress a girl might wear to a Prom, which she'd wear to the wedding, along with soft black shoes. She was far happier with a Playskool bus with small people, but was nonplussed by the cute French beret Lyudmila had bought her.

My gifts included a new wallet, something I needed as the one I was using, which was ten years old, was about to fall apart. There was also a sweater, a wooden chess set, and a new pair of slippers. For Kris, Rachel and I had bought a sweater, a pair of earrings, and a necklace. Kris and I had gone in together on gifts for her parents and Lyudmila, all of which were received with appreciation.

Once we'd finished with the gifts, I joined Nadezhda in the kitchen to help prepare dinner, something I enjoyed doing and something I felt sent a good message, confirming what I'd said to Kris about my feelings on the division of labor. I had totally understood Elizaveta's position, even if I had disagreed with her. And no matter what my feelings, my PGY1 would ensure that most of the burden fell on Kris. I had to be sure I acknowledged that and, as she requested, helped when I was able.

After dinner and dessert, I took a thirty-minute nap, then spent the evening with Kris and her family before heading to the hospital for my shift.

December 26, 1988, McKinley, Ohio

"Did you get home at all?" I asked John after I'd received the handover from Jill.

"On Christmas Eve," he replied. "My mom wasn't happy I couldn't be home for Christmas dinner, but the uncle who's the GP is her brother, so she knows the drill."

"Two years after you graduate, you can be home for Christmas dinner every year! GPs don't work major holidays!"

"True! You're out all next week, right?"

"Yes. Clarissa will work overnight and they'll have a moonlighting Attending take my shifts, though that means Doctor Javadi will be in a foul mood because she'll be assigned to do the stuff I usually do. The moonlighter is a doctor who has admitting privileges, but only does outpatient procedures; to keep his privileges, he needs forty hours a year as a 'staff' physician. Once I'm back, Doctor Javadi will have her opportunities to participate in procedures. You've observed some, right?"

"Yes, six so far, and I've started taking notes."

"Good."

"Hopefully, I get some of the same shifts as you during my trauma rotation. Both Felicity and I have our Clerkship in April and May."

"Have you done any suturing at all since May?"

"No," John replied.

"Then sometime in March, start practicing on bananas. Elizaveta and I ate more than our fair share because I practiced constantly! If you need a refresher, just ask at the medical school and they'll set you up. The highlights of my Clerkship were when I was assigned to suture."

"Everyone I know hates that!"

"Well, given the alternatives are chasing labs, inserting IVs, and making phone calls, I preferred suturing. Sitting at the intake desk is no fun, either, compared to suturing."

"Nothing seems to bother you, though."

"Having a positive attitude helps a lot. And remember, all the crap we have to put up with ends after graduation. Sure, there's other crap, but we get to be doctors. And your worst-case scenario is two years of Resident crap, and then you'll be practicing medicine alongside your uncle! The light at the end of the tunnel is not an onrushing train!"

"Why does it sometimes feel like the tunnel is one of those Wile E. Coyote and the Road Runner fakes, and I'm going to slam into the side of the mountain at any minute?"

"Because what we're doing is hard, and it's meant to be hard, so that when we come out the other side, we're the best physicians we can be. Would I change things? Yes, in line with the quote on Doctor Getty's wall, but it's not up to me! We're constrained by the State of Ohio, the AMA, insurance companies, and tradition. That last one is the tough nut to crack, so we play by their rules to get into the club.

"From my perspective, nothing is gained by complaining about it or having a sour attitude. Given that won't change anything, why not be content? Not to mention the more we cooperate with the system, the more chance we have, the very thing Felicity was complaining about until she understood how to make it work for her. You haven't shown a poor attitude about anything, so don't go down that route. There's nothing there but pain, suffering, and tears."

"You have a very different attitude than most medical students I know. Clarissa has it, too."

"As do Fran, Peter, Maryam, and Nadine," I replied. "Sandy did, too."

"Sandy?"

"An original member of our study group who took her own life near the end of our first year."

"Because of med school?"

"The stress literally killed her."

"Damn," John said, shaking his head.

"Yeah. In any event, what do you know about my study group?"

"You and Clarissa are first and second in your class, the others are all in the top ten, right?"

"Nadine is just outside, but she joined us at the start of our second year, and she's moved up ten places. What's your rank?"

"Tenth, by a hair."

"MLE?"

"95th percentile."

"Those are good enough to get you into almost any program that interests you. So why not do your best to enjoy your clinical work? It beats the heck out of sitting in class!"

"Good point!"

"Things are quiet, so let's get some sack time."

We went to the on-call room, and each got into a bunk, and weren't woken up until it was time for John to hand things over to Felicity. I was surprised at how calm things had been overnight, but for once, was happy about it, because it meant fewer people were in the hospital rather than celebrating Christmas. The big excitement had been triplets born midday on Christmas, and that had nurses from every service finding their way to the neonatal nursery to check on the three very small girls.

We only had three patients on our service and no procedures, which meant we had very little to do. The Attendings didn't even bother coming into the hospital, and the Residents spent their time catching up on chart reviews. With Doctor Javadi's permission, I went down to the Emergency Department.

"Bored?" Nurse Ellie asked with a very inviting smile.

I was, but I wasn't that bored. I simply held up my right hand.

"Not for another week, right?" she asked with a twinkle in her eye.

"And then it would be a funeral, not a crowning!"

"Oh, she'd crown you all right!" Doctor Gibbs declared from behind me. "Slumming?"

"I suppose I could say I was trolling for patients, but the board is nearly empty."

"Don't jinx it!" she exclaimed.

Almost as soon as the words left her mouth, Nurse Kelly called out that the paramedics were four minutes out with multiple accident victims.

"See!" she exclaimed with faux disgust. "See what you did! Get out of here or we'll put you to work!"

"I'll help," I replied. "But I'm on the code team, so I'd have to cut and run if my pager were to go off."

"Which makes you useless!" she said with a smile.

She had a point, as I couldn't really get involved in a trauma. I thought about going to Pathology, but I hadn't asked Doctor Javadi's permission to do that, so I returned to Cardiology.

"No luck?" Felicity asked.

"Being on the code team makes it difficult to get involved in treating a patient because I'd have to simply walk away mid-exam or mid-treatment. I should have brought my guitar!"

"You play?"

"Yes. I'm in a cover band named 'Code Blue' and we play school gigs along with occasional club gigs."

"Lead guitar?"

"Lead singer, backing guitar. That's mostly because I didn't have as much time to practice when we first started. I suppose it's better to say that José and I share lead guitar duties, though he has the majority. He sings backing vocals."

"How many are in your band?"

"Five. Two guitars, keyboard, drums, and violin. I also sing duets with Kris, and used to sing them with the daughter of the music professor who taught me to play guitar and balalaika."

"Bala-what?" Felicity asked.

"The «балалайка» is a Russian stringed instrument, sometimes referred to as a Russian lute. It's the instrument with the triangle-shaped base you see in Doctor Zhivago, and I play the instrument my grandfather brought with him from Russia."

"I've never seen Doctor Zhivago."

"You should see it, but I don't believe it's available on VHS, unfortunately. I saw it at a revival showing several years ago. One of the songs I play is Lara's Theme which is from the movie. You probably know the basic melody as Somewhere My Love."

"Sure. What duets do you sing?"

"Kris and I sing Endless Love. I used to sing Up Where We Belong with my wife, but it feels wrong to sing that with anyone else now."

"A violin in a rock and pop cover band?" Felicity asked skeptically.

"Absolutely! She fiddles, too, so we have The Devil Went Down to Georgia on our playlist, along with Dust in the Wind, Sweet Child of Mine, and a few other songs. Our next gig is February 10th at Stirred not Shaken, a club in town."

"How does that work with your schedule?"

"It can be challenging, but so far, so good. I have someone who will cover for me, no questions asked, which has helped. There are others I can ask as well, if that person is already on shift."

"I know this is going to sound like I'm giving you attitude, but how did you manage to arrange a week off? We were told that was basically impossible."

"And this is going to sound like privilege, but I've been given accommodations because of what happened with my wife. It's also the case that the doctors feel I've learned what a Fourth Year is supposed to know. Had that not been the case, they would have been reluctant to grant the time off."

"The girl you're marrying is from your church?" Felicity asked.

"Same diocese, different parish, but yes."

Doctor Javadi came to the lounge to let Felicity know they had a consult, which didn't surprise me given there was a three-victim MVA. They left for the Emergency Department and I went to the nurses' station to chat with Marjorie, another moonlighting nurse, who was covering for Mary, who was on vacation. We chatted for a bit, then I checked on our three patients, and finally returned to the lounge to read JAMA until Felicity returned.

"One admitted to the ICU," she said. "Doctor Javadi is doing the paperwork. I think she's as bored as we are."

"Boxing Day is traditionally one of the lightest days at the hospital; Thanksgiving and New Year's are the heaviest, followed by the Fourth of July."

"Christmas is supposed to be bad," Felicity said.

"It's more spread out," I replied. "Stress ebbs and flows, and for some reason, at least here in Hayes County, culminates on Christmas Eve, with a lull until New Year's Eve when too many idiots decide they need to create more proof why we need tough laws against drunk driving."

"It doesn't stop it."

"Not completely, no, any more than laws against murder stop all murders. What it does do is make clear that your driving privileges will be revoked and if you hurt or kill someone, you'll go to prison for a long, long time."

"But don't most drunk drivers get off?"

"I suppose that depends on how you look at it. A first-time offense is met with a fine and sometimes a suspension of driving privileges except to and from work. But the real punishment comes when your insurance company quadruples your rates and they stay high for a long, long time. Or worse, they drop you completely, and you can't legally drive without insurance. Again, it doesn't stop the determined person, but it does deter most people."

"What do you think about checkpoints?"

I shrugged, "Given you can't drive without a license and the government can set the rules for holding a license, they can require you to stop at checkpoints."

"Doesn't that violate the Constitution?"

"You're asking the wrong guy!" I chuckled. "I am not well-versed in the nuances, except to know that driving is considered a privilege, not a right. It's not all that different from the medical licenses we'll obtain — they are discretionary, and a privilege, and graduating from medical school and passing Step 2 of the MLE doesn't grant you a right to a license, or even to a Residency. And no court will force a hospital to hire you or force the state to issue you a license."

"Can't you sue the State Medical Board if they yank your license?"

"Yes, but according to the attorneys I've spoken with, that's different from granting it in the first place. Once they grant a license, you have some rights to keep it, and the government has to follow the established rules to take it away, and do so to the satisfaction of a judge or jury. The exact words used when I asked were that 'granting a license is completely discretionary, taking one away requires due process'.

"It's not all that dissimilar to the Match. Nobody has a right to a specific Residency slot, and it's a 'take it or leave it' offer. Again, according to the attorneys I've spoken with, no court would find a problem with that system, and even if they did under some strange application of antitrust law, Congress would step in and codify the practice by law, and strip the courts of jurisdiction to change it."