Chapter 81: Charting

March 16, 1989, Match Thursday, McKinley, Ohio

Clarissa went next, and she had, as we had planned and hoped, Matched to the Internal Medicine program at Moore Memorial. Fran had Matched to Riverside Methodist in Columbus, an excellent hospital, though they'd had multiple fatalities due to a serious accident with an incorrectly calibrated cobalt teletherapy unit in the mid-70s. That hospital had been her second choice after Ohio State, but didn't feel like a downgrade, as it was a top-ranked hospital despite the accident.

Peter had, much to his delight, matched to Emory for surgery. Maryam had Matched for Cardiology at Edward Hospital in Naperville, as she'd hoped, and Nadine had matched at UCLA, her last-minute switch from Stanford.

"Well, that went about as well as anything we could have expected!" Fran declared.

"You're not bothered by getting your second choice?" Nadine asked.

"Not at all. It really was a toss-up, and I put OSU first because Jason is there."

"Did you hear there were five students who didn't Match and couldn't Scramble?" I asked.

"Talk about totally wasting eight years!" Nadine said.

"Remember, if they pass the MLE, they'll receive their MD," Fran said. "And there are options, including trying again next year. One girl who didn't Match found a clinic in South Carolina that will hire her, and she will be able to work under supervision. She'll add clinical experience and try again next year at the affiliated hospital."

"That's a good plan," Clarissa observed. "Similar to a prelim, but without credit for the year's experience."

"I wonder why those five didn't Match?" Peter said.

"Actually, only five is very good," Fran said. "Some schools have rates as high as twenty percent who fail to Match or Scramble."

"Insurance companies do need MDs to deny coverage recommended by actual doctors," I groused.

"Sadly," Fran agreed.

"I'm going to miss you guys," Maryam said.

"And we'll miss you, too," I replied. "But I'm sure we'll see each other at some conference sometime. We're all going to be either here or in large cities where medical conferences are held."

"I plan on going to every medical conference in Hawai´i, no matter what the topic!" Fran declared, causing all of us to laugh.

The supplemental information with our letters stated that we would hear from our programs within seven days, and if we did not, to contact the program directly, only contacting the NRMP Staff if there was some kind of disagreement between the hospital lists and our letters. Everyone except Maryam was on shift, so they had to leave, and she and I chose to have lunch together at Frisch's south of town.

As we were walking out, we ran into Kylie, who let me know she'd Matched to Moore. I congratulated her, and then Maryam and I left the hospital and got into our cars to drive to Frisch's.

"We've made it, haven't we?" Maryam asked once the waitress took our orders.

"We have. We'll all do well on the MLE, so really, we just have to finish nine more weeks of medical school, and then we're doctors!"

"You know, I never asked anyone, but what happens during the last week in May when there are no Fourth Years?"

"Residents have to do all the procedures unless they have a trusted Third Year who is able to do it. There are a few. And it's actually two weeks because we get the week off to study for the exam, and then we graduate on the 25th."

"You're going on your official honeymoon, then, right?"

"Yes. And on that same general topic, how are things with Matta?"

"Progressing as best they can at a distance," she replied. "I did see him when I went to Chicago for my interviews. I suspect, strongly, he'll ask me to marry him sometime in the Fall. May I ask a question?"

"Of course."

"Does Kris know we dated?"

"She was tuned into the 'who is seeing whom' circuit via Oksana, so, yes, she does. That said, nobody knows the depth of our relationship."

Maryam's eyes twinkled, "Deep is right!"

Almost as quickly as she'd dropped the façade, she raised it again, and I knew better than to say anything in response to her risqué remark, which conveyed so much. I simply smiled at the memory, which Maryam acknowledged with a smile of her own.

"I assume you'll leave right after graduation?" I asked.

"Probably around June 1st. I'll go home for a few weeks and work on finding an apartment in Naperville."

"My paternal grandmother lives in Naperville, so if you need a place to stay, I'm sure she'll accommodate you for a few days."

"I could stay with Matta's parents, and I'll probably do that. They live in Warrenville, which is not too far from Naperville."

"I assume you'll attend Saint George in Cicero?"

"Yes. That's the Antiochian church; well, there's a convert church on the north side of the city, but they're, well, some EOC churches are too Protestant in their outlook, if you know what I mean."

"I've heard that," I replied. "One priest said the best way to describe the differences is that the Arab parishes all vote Democratic, while the EOC parishes all vote Republican."

"Most people at Saint Michael are Democrats, right?" Maryam asked.

"I would assume from what I've heard, but it's a subject I scrupulously avoid at church. The last thing I want is partisan politics intruding on worship, Sunday School, or any other activity. I was just repeating what I heard an Antiochian priest say."

"Returning to our earlier topic, I really like Kris."

"Me, too!" I chuckled.

"You are such a goofball! I am going to say something completely out of line, but she is exactly what you needed, not a stay-at-home, 1950s homemaker."

I nodded, "I know. Elizaveta was who I needed four years ago; Kris is who I need now. And that is not meant to disrespect Elizaveta in any way, or say that I didn't love her, but everything that has happened changed me."

"Of course it did," Maryam said. "Nobody could go through what you did and come out unchanged. And as difficult as it might be to hear, the suffering has made you a better person."

"What brought this on?" I asked. "I mean the conversation?"

Maryam smiled, "I love you, Mike. I've loved you from the first moment I met you. And now we're parting. I wanted you to know how I feel, and to know that I believe everything that happened between us was beautiful, that I have no regrets, and that I hope, somehow, we could stay close."

I smiled, "There is this cool invention called the telephone," I said. "I assume you've heard of it!"

Maryam laughed softly, "Obviously."

The waitress brought our salads, I said the blessing, and we began eating.

"We should have a regular call," I suggested.

"I'd like that," Maryam said. "I'll let Matta know, and you should let Kris know."

"Accountability?" I asked

Maryam nodded, "We are the last two people on earth who would cheat, but doing something like that in secret creates a risk neither of us could afford to take."

"Very wise."

And I felt I should have similar calls with Peter, though Nadine and I had never become close, so with her, it would likely be Christmas cards. Fran would be in the area, and Clarissa would be at Moore, so I'd continue to see them regularly, I was sure. And that reminded me that I needed to call Clark in Chicago. He'd been invited to the wedding, but hadn't been able to make it, and we'd only had a brief call with a promise to catch up later.

We ate and talked about the future, and when we finished, I walked Maryam to her car. She hugged me tightly, surprising me.

"Hugs have to be public," she said in response to what I was sure was a confused look on my face.

"Temptation?" I asked.

"Why run the risk? You know the Scriptures."

I nodded, "To not even walk down the street where temptation is waiting. And to say that there is no risk at all is to set oneself up for failure."

"I really am going to miss you after May."

"And I, you."

We hugged again, she got into her car, and once she'd driven away, I got into mine, then headed home to spend the rest of the afternoon with Rachel.

March 22, 1989, McKinley, Ohio

On Wednesday following Match Week, I met with Antonne and the study group at the diner near the Taft campus, and, as usual, Conchita quickly confiscated Rachel from me.

"Did you and Clarissa Match at the hospital?" Danika asked as soon as I saw her.

"Yes. All of us matched with our first choice, except Fran, who matched with her second choice, but she's not unhappy, as it was a toss-up for her."

"When do you start?" Jordan asked.

"July 1st. Kris and I are taking a ten-day vacation in early June. It'll be my first vacation since I went to Europe four years ago."

"How long were you in Europe?" Julius asked.

The waitress took our orders, and then I answered the question.

"We were in Europe for about six weeks, and we traveled by train, managing to make it to the Netherlands, Belgium, France, Spain, Italy, Switzerland, Greece, Austria, Germany, Denmark, Sweden, and England."

"Wow!" Julius exclaimed. "That must have been crazy expensive!"

"Actually, it wasn't too bad," I replied. "We used Eurail passes, which give you unlimited train travel, and we mostly stayed in youth hostels, which are really inexpensive, though fairly often all six of us shared what amounted to a dorm room."

"Six?" Jordan asked.

"Elizaveta and me, Pete and Sandy, and Clarissa and Abby. Abby was Clarissa's girlfriend at the time, and sadly, Sandy, who was a member of our study group, took her own life towards the end of our first year in medical school."

"Shit, man," Antonne said, shaking his head.

"The stress can be brutal," I said. "It's something about which you absolutely have to be aware, and have some way of dealing with the stress."

"What did you do?" Conchita asked.

"I was married, so you figure it out," I replied with a grin, causing all the others to laugh.

"Last I checked, you don't have to be married to do that!" Jordan declared.

"True," I agreed, "but it made my point without having to be «некультурный» (nekulturny). I do strongly advise against alcohol, and drugs are a non-starter because use of anything illegal results in automatic dismissal from the medical school. Alcohol can only be consumed if you won't be on shift or in the lab within twelve hours of your last drink." ("uncouth")

"Man, they take away all the fun!" Paul declared.

"If 'sex' isn't in your definition of 'fun', I'm not sure what would be!" Jordan declared.

"You do realize," I said, "that some people choose to wait until they marry. Not saying that's true in Paul's case, mind you, because it's none of my business."

"I was being sarcastic," Paul interjected, "and obviously failed. None of us use drugs, and I don't think any of us drink much."

The others all shook their heads as the waitress brought our food. I said the blessing, then responded to Paul's comment as we began to eat.

"The thing that helped me the most is actually my music, both listening and playing, combined with regular attendance of services at church. That helped with a sense of peace and calmness."

"Man, you have to go to my mom's church," Antonne said. "The last thing I'd call it is calm or peaceful!"

"Pentecostals are a bit animated in worship," I agreed.

"It's not for me, but Mom really is into it."

"My advice to all of you is to find something that helps you relax and take your mind off your studies. Music, church, martial arts, or anything, really. Exercise is important, too, even if it's just taking brisk walks."

"What else do we have to worry about?" Conchita asked.

"Time," I replied. "That is the enemy during the first two years of medical school. Strangely, once you begin your clinical rotations during Third Year, you'll have more free time, because you won't be scheduled for more than about sixty hours, and you mostly have time to study flashcards and read medical journals during downtime, except in the ED, and even there, you could manage."

"How much did you study?" Jordan asked.

"Somewhere around thirty-five hours a week."

"That's almost a full-time job!" she exclaimed.

I nodded, "And you have about fifty hours of classroom time, plus your Preceptorship. All in all, you have to figure about a hundred hours a week devoted to medical school. There are only 168 hours in a week, so if you sleep seven hours, you're left with maybe twenty hours for everything else in your life; around ten, if you need eight hours of sleep."

"That seems crazy," Conchita observed.

"From everything I've seen, I don't believe there's another vocation that requires the kind of dedication and discipline over an extended time that it takes to become a doctor. Four years of tough undergrad studies; two years of tougher classroom and lab studies in medical school; two years of clinical rotations; three to ten years of Residency.

"Attorneys can pass the bar at age twenty-five. Engineers can be licensed at age twenty-two. The earliest you could receive a medical license would be at age twenty-seven, if you were in a state that permitted you to be a GP with only a single year of Residency. Illinois does that, for example. For anything else, it would be at age twenty-nine before you could be an Attending, which is when you have your full, unrestricted medical license."

"So you aren't a full doctor in June?" Jordan asked.

"I will be a Resident, but I won't have my license for at least two years when I take the final part of the MLE. And even at that point, as a Resident, I will still need authorization from an Attending to perform any procedures, and an Attending will have to sign off on all my charts. That will be true for about eight years, with five in surgery and three in the ED, though a good portion of my time in surgery will be covering the ED. Once I finish those eight years, I'll be an Attending Physician in trauma surgery.

"Also, at some point, I'll take additional exams to become board certified in emergency medicine and in general surgery. That's not strictly necessary, but it's key to obtaining an Attending role at a Level I or Level II trauma center, or to being chief of a department. All in all, I'll be about thirty-five before I'm fully licensed to independently practice and have board certifications."

"How long is Residency for someone who goes into pediatrics or OB?" Conchita asked.

"Three years," I replied. "Most surgical specialties are seven. Others vary, and some specific subspecialties in surgery could be as long as ten years, including a Fellowship. Neuro is probably the longest and most difficult."

"It will be seven or eight for me," Danika observed. "And it could be longer, depending on the type of Fellowship."

"I think the best thing to say is to count the cost now, when you have options, rather than after you've started medical school. I have several friends who basically went through the same undergrad courses but elected to pursue advanced degrees in biochemistry and do research instead. For truly insane, you have to consider my friend Mark."

"Insane?" Antonne asked.

"He'll start a joint MD and Master's in physics at Ohio State in the Fall, then complete a PhD during his Residency. His goal is clinical research in radiotherapy."

"Two doctoral degrees?" Jordan asked.

I smiled, "One. An MD isn't technically a doctoral degree. Doctors appropriated the term 'doctor' from PhDs. Despite being four years, medical school is really only two years of classroom study, which is more akin to a Master's degree, and there is no dissertation requirement for an MD. You can see that in the UK, where surgeons are referred to as 'Mr.', 'Mrs.', or 'Miss'."

"That's true in India as well," Danika interjected. "Medical professionals who teach are called 'Professor'."

"There was a debate in the etiquette community over whether it's appropriate, in a social setting, for anyone other than physicians to use 'doctor' as a title, which is what most newspapers do in their reporting, usually referring to the holders of doctoral degrees as 'PhD physicist' or whatever their specialty is. According to Kris, in France, only physicians and research scientists may call themselves «docteur»."

"What is it in Russian?" Danika asked.

"«Врач» (Vrach)," I replied. "Though the cognate for 'doctor' is also used."

"In German, it's «Arzt»," Julius said. "You have to be an actual PhD to call yourself «Herr Doktor», though colloquially, people do use it for physicians."

"I hate to eat and run," Conchita said, "but I have class at 1:00pm."

Paul did as well, so we finished eating and paid the check. They headed back to campus, and Rachel and I headed home for some daddy-daughter time.

March 24, 1989, McKinley, Ohio

Late on Friday morning, Stefan called to let me know that our adoption petition would be presented to a judge on April 6th, but that there was no need for us to appear, as Family Services had raised no objections and filed a positive report.

"Is there anything we need to do?" I asked.

"No. Once the judge signs the petition, I'll send you a certified copy. Just keep it with the copies of the wills and other documents I prepared for you. The only possible time it would be needed would be in the case you were unable to make decisions due to death or disability, and someone challenged Kristina's rights.

"The only people who would stand a chance in a situation such as that would be biological relatives, generally, grandparents. I've spoken with Viktor in the past, and he's an eminently reasonable man, so I can't imagine he'd challenge anything, but it's better to be safe than to leave it up to a judge to decide."

"There's no change to Rachel's birth certificate, correct?"

"Correct. The only instances where those could be changed are for corrections of actual errors. Otherwise, they're unalterable. What Rachel will have to do when she applies for a driving license, a passport, or a professional license is show the writ changing her name along with her birth certificate. That's not all that different from a married woman who changed her name having to show a marriage certificate in those instances. Kris won't have that concern, as she didn't change her name."

"And there's no problem with putting a hyphenated name on a birth certificate for future kids?"

"No. What most people don't realize is that the mother, when she signs the form, could put anything she wants as a name, with a last name that is completely different from her name or the father's name. And, anticipating your next question, it is the mother who has the final say, including who is listed as the father."

"Implying she could name anyone she wanted?"

"Yes, and the man would have to challenge the assertion, and he should, given being named on a birth certificate is a primary way to adjudicate custody and child support. In Ohio, the man has a chance to challenge before the official copy is filed."