Chapter 78: You're Not Wrong

January 15, 1989, Circleville, Ohio

On Sunday morning, Kris, Rachel, and I attended Matins and the Divine Liturgy, but skipped Sunday School so we could set up for the housewarming. Kris' parents and sister joined us, and the four adults made quick work of getting everything ready while Lyudmila played with Rachel, happy to fulfill the role she'd described as «tante préférée». ("favorite aunt")

"Your sister is really into being an aunt," I said as Kris and I prepared snacks to set out.

"She likes the idea of a baby who she can return whenever she wants to! Having your own doesn't work that way!"

I nodded, "That's similar to what my mom has said about the best part of being a grandparent."

"And how do you feel?"

"About Rachel? That I don't get enough time with her. Of course, that was a choice I made when I was ten, when I decided to be a trauma physician. I just didn't realize the impact because the only doctors I ever saw had regular office hours."

"You're not regretting your choice, are you?" Kris asked.

"No, I'm simply making an observation. It obviously affects you, too, as I won't be able to spend as much time with you as I would like. But, as the saying goes, I've made my bed, so now I have to lie in it."

Kris laughed softly, "English is so funny. You make the bed when you get up, not before you go to sleep!"

"I believe the context of the phrase changed, as people 'made their bed' before they went to sleep, in the sense that they prepared it. Now, we 'make the bed' in the morning, because we have permanent beds. Or at least that's how it seems."

"That would make more sense."

We carried bowls of chips and pretzels, along with plates of cookies to the great room, where Ignatiy and Nadezhda were setting up folding chairs we'd borrowed from the church. I returned to the kitchen for the trays of vegetables — carrots, celery, broccoli, tomatoes, bell peppers, and cauliflower, which Kris had prepared while I was on shift at the hospital on Saturday. I set those out, then put pop and beer into coolers, and added ice that we'd picked up on the way home. I'd just finished when our guests began to arrive.

Milena, Joel, and Abigail were the first to arrive, as they only lived a short distance from us. I took the opportunity to ask about my idea for May.

"Of course!" Milena agreed. "Abigail will love to have Rachel spend the days with her. Jill won't mind at all."

"Great! I'll drop Rachel off in the mornings, and Kris will pick her up in the afternoons."

"Mama! Play with Rachel?" Abigail asked.

"Of course! Go on."

Abigail hurried over to where Rachel and Lyudmila were sitting and plopped down next to Rachel. A steady stream of guests arrived, spread out over the next few hours, with some staying only a short time and others staying for the fried chicken dinner we were providing.

A number of the doctors from the hospital showed up, including Doctor Gibbs, who had Bobby with her. And, unless I totally missed my guess, a 'passenger', though the bulge was slight. It was only noticeable because she was wearing a tight sweater and was in very good shape, and I was sure she hadn't simply gained weight.

"Why, Doctor Gibbs," I said with a goofy smile, "what have you been hiding under your scrubs?"

"Four months," she replied with a smile. "I was going to tell you the next time I saw you, but you haven't been in the ED for a month! Not even to visit!"

"I think he had a few other things on his mind, Lor," Bobby said.

"Not to mention it's only been three weeks," I replied. "I stopped in on Christmas Eve and you shooed me away!"

"Because you were on the code team and couldn't get involved in treating any patients."

"Play nice, kids," Doctor Casper said, having walked in with Oksana on his arm.

They all joined the others in the great room, and shortly thereafter, Doctor Forsberg and Doctor Smith arrived, which was a mild surprise, given Doctor Forsberg was nine months pregnant. My mom, Stefan, Elaine, Liz, Paul, and the kids arrived mid-afternoon, as did Father Nicholas and his wife. The true surprise was the arrival of Bishop JOHN, whom we had invited but had not expected.

"I wish to bless the house," he said after I greeted him. "There wasn't a chance before your wedding."

The blessing, which included prayers and sprinkling rose water in each room from an aspergillum, took about fifteen minutes, after which it was time to eat dinner. We ate, and the housewarming party wound down around 7:30pm, as nearly everyone had to work on Monday morning. Subdeacon Mark, Alyssa, the Korolyovs, and Robby and Sophia stayed to help clean up.

Rachel was tired from playing with her friends and all the attention, so we said evening prayers, and put her to bed, then Kris and I relaxed together listening to music until bedtime.

January 27, 1989, McKinley, Ohio

The final two weeks of my cardiology Sub-I were routine to the point of being boring. Things at home had settled into a routine as well, as Kris, Rachel, and I adapted to living together. We'd visited the monastery, and I'd had a good talk with Father Roman, and together with Kris, we'd worked out a fasting rule that was much closer to my original rule than the lax one he'd assigned before I married. The only downside of the visit was that we'd missed most of the Super Bowl, though that was a blessing, as I didn't get my hopes up before the Bengals blew a 13–6 fourth-quarter lead, losing 20–16 to the 49rs.

On the last Friday of January, after lunch, I had my evaluation with Doctor Getty.

"You turned in your evaluation at the medical school?" he asked after I sat down across from him.

"Yesterday, on the way home. It was after hours, so I left it in Doctor Mertens' box."

"I think you know the results of my evaluation without me telling you."

"Even though Doctor Javadi thought I was a cowboy?" I asked.

"You won her over. Doctor Strong's advice was right on target — be a bit less aggressive with Residents and Attendings until they get to know you. That will be necessary in the ICU, because none of those doctors know you or trust you, unlike the ED, where all of them know you and trust you."

"Message received."

"You received checkmarks in the plus boxes, of course, and I marked the 'Select for Match' box as well. I also have a commendation letter from Doctors Strong and Javadi, which will go in your permanent file."

A commendation was something special, and very few were ever granted, even to top students. If I was looking for a Match at a place like Stanford or Johns Hopkins, it would basically guarantee a Match.

"Commendation? For what?"

"You single-handedly turned around Felicity Howard. You first turned animosity to respect, then you taught her how to be a successful medical student. You're a natural teacher and have a natural ability to relate to pretty much anyone — patients, nurses, doctors, and fellow medical students. John sang your praises when I gave him his evaluation earlier today."

"I'm not sure it was single-handedly," I replied.

Doctor Getty smiled, "Yes, it was a team effort, but you were the first person to manage to get through to her after three sub-par rotations. One of the most underrated skills for new Residents is their ability to teach. It's something I would add to the evaluation, and I'd require a passing grade to advance. I included that in my prose evaluation, and I'm forwarding a recommendation to the medical school to adopt a teaching component to the formal evaluation. Do you have any questions for me?"

"Nothing comes to mind," I replied.

"Any feedback for me?"

I smiled, "PGY1s need to be in the cath lab or the OR from day one, not six months into their Residency."

Doctor Getty nodded, "I understand your point, but somebody has to do the basic doctoring, and that's the role of new PGY1s. It'll be different for you in the ED, obviously, but every surgical service has PGY1s learn to be doctors before they assign them procedures. The alternative would be having more experienced doctors doing the basic work."

"I totally understand the principle, but I also think it's a good thing for even the most senior doctors to occasionally do the basic work."

"You're not wrong, but Attendings view not having to do that as a privilege of rank, and you're going to encounter pressure to not do those things as you advance. In addition, with limited time and division of labor, an Attending's skills need to be applied to the complex procedures and difficult cases."

"Some kind of balance could be found," I countered.

"We have found a balance. You just don't agree! And that's typical of Fourth Years and PGY1s!"

"You're not wrong," I chuckled. "But that doesn't mean I won't agitate for change."

"I'd be shocked if you didn't! Just remember, reality rudely intrudes on idealism, and does its best to crush it. Don't allow it, but don't go tilting at windmills."

"Understood. I've been reminded of that time and time again!"

Doctor Getty smiled, "Because none of us have been able to beat the idealism out of you, and that's a good thing! Annoying, but good. The key is not to become a gadfly or suffer the fate of Socrates."

"History does suggest that questioning authority and assumptions is often detrimental to one's position."

"That it does. Learn the lesson of Ignaz Semmelweis and take it to heart."

"Subtlety is often more successful than confrontation. That said, sometimes confrontation is necessary. Felicity is a prime example."

"Yes, that's true, but in most cases, that approach would be inappropriate, and a more subtle approach would be preferable."

"I agree."

"It's been a pleasure, Mike. I look forward to calling you 'Doctor Loucks'."

"I'll most likely go by 'Doctor Mike'," I replied.

"Which totally fits your personality and your reputation for dealing with kids."

"Thank you, Doctor Getty."

"You're welcome."

We stood, shook hands, and I headed back to the lounge. When I walked in, Felicity jumped up and came over to me. It was obvious she wanted to hug me, so I gave a brief nod, and she gave me a quick, chaste hug.

"Thanks," she said. "You saved my butt."

"You're welcome. I'll see you in the ED in two months."

"It'll be fun."

January 30, 1989, McKinley, Ohio

My schedule for my first month in the ICU was three twenty-four-hour shifts, starting at 0600 on Mondays, Wednesdays, and Fridays. That meant I would miss Vespers on Wednesdays, and band practice would be two hours after the end of my Friday to Saturday shift. On the plus side, it meant I could spend Tuesdays and Thursdays with Rachel, though I'd need someone to watch her while I met with Antonne and his study group for lunch on Thursdays.

I got up at 5:00am, and by agreement with Kris, she stayed in bed. I showered, dressed, then went downstairs to have a banana, toast, and a glass of grapefruit juice. Once I'd finished, I grabbed my bag and headed to the hospital. At the hospital, I went inside and reported to the nurses' station, which, unlike most others, had monitor displays for all beds and patients.

"Mike Loucks, Fourth Year," I said to the nurse. "I'm reporting for my first shift."

"Good morning, Mike," the nurse replied. "I'm Carolyn, and you're assigned to Doctor Friedman, who is in the Resident's office. We use the Internal Medicine locker room, but we have our own small lounge and on-call room here behind the nurses' station."

"Thanks," I said.

"Remember, put on a fresh mask, cap, and booties each time you go into the ward."

"I will. Is there a pager?"

"No. Except for scheduled meal breaks, you're expected to be in the ICU — either in the ward or in the lounge. Doctor Friedman will approve your meal breaks."

"Purple scrubs, right?"

"Yes."

I went to the Internal Medicine locker room, changed, then used one of the three empty lockers to store my bag and clothes. I clipped my badge onto the shirt of my purple scrubs, slung my stethoscope around my neck, then headed to find Doctor Friedman. She was in the office, as Carolyn had indicated. She was looking at a chart, so I knocked to announce my presence.

"Mike?" she asked, looking up.

"Yes."

"Come in and have a seat."

I did as she suggested and sat down across from her.

"In the ICU, Fourth Years do hourly checks of the patients and work with the nurses to provide round-the-clock care. That means overnight, you can catch naps, but you still need to do hourly checks and ensure charts are updated. You're qualified to run a code, right?"

Not being able to sleep, except for naps, meant I'd have less time for Rachel, and also meant someone would need to watch her on Tuesday and Thursday mornings so I could get some sleep. I made a mental note to speak to Serafima about that.

"Yes," I replied, "though obviously only under supervision of a Resident or Attending."

"We all respond to codes, so if you're there first, make a determination and begin. A doctor will arrive within a minute or two. The nurses are all qualified."

"Got it."

"The usual staffing level is one Attending, one Resident, a Fourth Year, and three or four nurses, and we can call Internal Medicine or Surgery for backup. You know what that means."

"Scut rolls downhill," I replied with a wry smile.

"Exactly. You won't do much except monitor patients and do admissions. Nurses change drains and catheters in addition to their usual tasks."

"Is it OK to have a nurse show me how to change a drain or chest tube? And how to deal with clogged tubes?"

"Yes. I'll make sure Carolyn knows, and she'll put it in on the standing order list. The other thing you'll do is coördinate with all other services, so if there's a change in a patient's condition, good or bad, you inform whichever service sent the patient to us, and when appropriate, arrange for transport, either to a service or downstairs."

'Downstairs' was a euphemism for pathology, which many doctors used so that if overheard, it wouldn't concern patients or their families. Doctor Friedman had confirmed my fears about two months in the ICU, but realistically, I didn't have any other options that would be interesting and exciting. I couldn't do something like oncology because those slots were limited to students who were trying to Match, nor could I do a third Sub-I in the ED because there simply weren't enough slots, given nearly everyone did an emergency medicine Sub-I no matter what their plan, as emergency medicine was a fallback in the Match.

That meant, for two months, I was going to be doing what amounted to babysitting, as I'd discussed with Clarissa. Worse, I would have little or no actual interaction with patients, which I'd had during my previous rotations in the wards. And finally, being the only student, there wasn't even someone with whom I could pass the time.

"Thanks," I replied. "Who do I get the patient information from this morning?"

"Me. There isn't a Fourth Year on Sunday 0600 to Monday 0600. The other three days are covered by Mark Kenseth. You'll hand over to him in the morning. We currently have eight patients in the ward — three MIs, a stroke, one smoke inhalation, one uncontrolled diabetes that led to coma, and two post-surgical who had complications on the table."

"What times are rounds?"

"0800. Residents or Attendings from the other services attend those."

"If I do my checks at thirty minutes past each hour, I can brief you before the 0800 rounds."

"That works well and is usually what we do."

"Then, with your approval, I'll review the charts."

"Please do."

I left her office and went to the nurses' station to get the charts. Carolyn gave them to me, and I took them to the lounge to do my review.

January 31, 1989, Centerville, Ohio

"How was your first shift in the ICU?" Kris asked when I arrived home just before 6:30am on Tuesday morning.

"Completely uneventful," I replied. "It's exactly as I suspected — babysitting."

"Speaking of babysitting, Serafima called a few minutes ago to say she's on her way."

"Perfect."

"I have breakfast for you, then you can go to bed."

"After we say morning prayers, please. I want a few minutes with Rachel, as well."

"PAPA!" she exclaimed, toddling into the kitchen.

"Hi, Rachel!" I said, scooping her into my arms.

"She had her breakfast," Kris said. "I need to leave in about thirty-five minutes."

"OK."

I sat down at the table and held Rachel in my lap while I ate my eggs, sausage, and toast, washed down with grapefruit juice and herbal tea, as the last thing I wanted was caffeine when I needed to sleep four or five hours.

"What do you plan to do today?" Kris asked.

"I'll sleep this morning, then Rachel and I will spend time together until you get home from school. We'll make dinner and spend the evening together as a family. I'll sleep at my normal time."

"Did you get any sleep overnight?"

"A pair of forty minute naps," I replied. "That's enough that four hours this morning will keep me fresh."

"You seem to handle weird sleeping schedules very well."

"Nearly four years of practice," I replied. "Granted, the first two years it was our study group, and I did sleep every night, but I learned how to nap and shift my sleep such that I didn't totally mess up my internal clock or end up too tired to function properly."

"It will be nice to have you in bed! I missed you last night! It's just not the same wearing a flannel nightgown!"

"Good to know I'm useful as a bedwarmer!" I chuckled.

"It's how you warm the bed!" Kris said invitingly.

"Good to know I'm useful for that, too!"

"Oh, stop! You're good for more than that! And while I have nothing to compare it to, I also have no complaints about that at all!"

"Also good to know!"

"Is this where I do the American thing and use all three names?" Kris asked lightly.

"That would be the usual response to me being difficult. Of course, it could be worse!"

"How so?" Kris asked.

"You could do what José says his mom does and call me Michael Peter Loucks Borodin!"

Kris laughed softly, "The Spanish way! I have to come up with some other thing! I am not usual!"

"No kidding!" I chuckled. "Let's just say French girls are very different from American girls!"

"That's a good thing, right?" she asked, narrowing her eyes and putting her hands on her hips.