Chapter 85: A Family Feud

April 16, 1989, Sunday of Saint Mary of Egypt, Columbus, Ohio

On Sunday, Kris, Rachel, and I worshiped at the Cathedral in Columbus with her parents and sister. Unsurprisingly, after the Divine Liturgy and a light meal, Bishop JOHN asked to see me, and we went to his office to have tea and chat.

"How is your training going?" Vladyka JOHN asked.

"I'm very much in the home stretch," I replied. "Our final exam is less than a month, and graduation is in five weeks. The week following graduation, I'm going to participate in a pilot program of paramedic ride-alongs, and then, as you know, Kris and I are taking a belated honeymoon trip to Tennessee. My Residency begins on July 1st."

"I would like to attend your graduation, if that's something that is possible."

"It is. I have extra tickets because I'm giving the valedictory speech, and you're welcome to use one."

"That won't keep anyone from attending, will it?"

"No. I have twelve tickets, and I've only allocated ten so far."

"Wonderful. Please send me the details. What will the topic of your speech be?"

"Service to the community. And I wouldn't be me if I didn't work Doctor King into my speech."

"Your affinity for him is well known and appropriate for someone who loves their fellow man and believes in peaceful resolutions to every problem. Changing subjects, when will you see Father Roman next?"

"After Kris, Rachel, and I return from Tennessee."

"Have you been attending liturgy regularly?"

"What?" I asked with a sly smile. "Your intelligence network hasn't reported in?"

Bishop JOHN laughed, "It's not quite like that!"

"Not quite, but I do know you speak to your parish priests regularly."

"Yes, of course! I haven't spoken to Father Nicholas in the past month because things at Saint Michael are blessedly calm."

"We've been attending the Divine Liturgy every Sunday, and I attend Vespers when my schedule allows. Kris and Rachel usually attend even when I miss."

"Very good. How are you and Rachel adjusting to your relationship with Kris?"

"Well, besides the conspiracy between the women in my life that appears to be impossible to prevent, things are fine."

Bishop JOHN smiled, "Well, you could have remained a deacon and avoided all of that!"

"As if!" I chuckled. "I'd still have a daughter to rule my life! Not to mention a mother, a sister, my grandmother..."

"I get the picture!" Bishop JOHN said with a hearty laugh. "But in all seriousness?"

"Things are going well. The relationship I have with Kris is very different from the one I had with Elizaveta, and, with no disrespect to Elizaveta, Kris is exactly what I need to be successful as a doctor, father, and husband."

"Is there an importance to that order?"

"I believe you know that my calling to medicine overrides every other consideration, with the exception of my love for God. Fortunately, those two things go hand-in-hand."

"Is the same true for your wife and daughter?"

"When I decided to be a physician at age ten, everything else in my life, except my faith, was sacrificed on the altar of my calling. There really is no other way to be a true physician. That is, after all, the model of the Great Physician."

"It is."

"And, as the Scripture says — no man can serve two masters. And despite my comment about Rachel earlier, my true master is medicine, but that, too, is an expression of my faith and my obedience to the command to love all men, including my enemies."

"And who are your enemies, Michael?"

"Bigots," I replied. "And those who judge, holding others to a higher standard than the one to which they hold themselves."

"And the man who murdered your friend?"

"Is as much a child of God as I am, though his misguided understanding of the gospel has made him serve dark forces. But he is not irredeemable, and sometime in the next year, I plan to try to visit him in prison."

"Where is he imprisoned?"

"Southern Ohio Correctional Facility in Lucasville, where they send all prisoners sentenced to life without parole or who receive the death penalty."

"Has he exhausted his appeals?"

"To my knowledge, yes. His motion for a new trial was denied by the Court of Common Pleas for Hayes County, and his appeal was denied by both the Ohio Court of Appeals and by the Ohio Supreme Court. I don't know that he has any federal claims, but my friend Jocelyn, who is about to graduate from law school, feels there are no grounds for appeal in federal court. Her opinions are similar to mine, in that neither of us is licensed, but we've both nearly completed our education."

"What do you hope to gain by seeing him?"

"To simply witness to him the true Gospel," I replied. "At that point, it's up to him."

"We don't actually have a regular prison ministry at that prison," Bishop JOHN said with a smile.

"If I had time, that is something that would interest me."

"Focus on your studies and your family, and in two years, we'll discuss how you may best serve the Holy Church."

One thing was certain — it would not be as ordained clergy. That was simply not something to which I'd subject myself in the future. Lay ministry, on the other hand, was something I would consider once the worst part of my Residency was in the rearview mirror.

"About two years from now," I replied. "But I'm sure we'll speak before then."

"I should hope so! Will you be able to attend Holy Week services?"

"Everything except Holy Thursday morning. My classmate, Kylie, will cover Friday for me, and I'll cover one of her shifts during Bright Week. That means a twenty-four-hour shift, but it's well worth it."

"Is the hospital required to make any kind of religious accommodation?"

"Not for medical staff. There are no official holidays, as the hospital never closes. The one pseudo exception is doctors who perform elective surgery can set their schedule mostly as they see fit. That will never be the case for me, though the more seniority I have, the more flexibility I'll have with my schedules in the sense that I can make scheduling requests and they'll be honored, if possible. For the next year, I expect to miss services more than make them, given I'll work two thirty-six-hour shifts and either one twenty-four-hour shift or two twelve-hour shifts."

"That cannot possibly be good for you or for the patients under your care!"

"I agree in principle, but it's also the case that the system has worked quite well for several decades. That said, there's a case working its way through the system in New York that might well lead to limitations on the maximum hours a Resident may work and establishing a minimum time off between shifts."

"What happened?"

"As best as I can determine from reading about the case in medical journals, two Residents, a PGY1 and a PGY2, at the end of a thirty-six-hour shift, made a mistake, exacerbated by poor communication by the patient and her personal physician. The larger problem was, in my mind, that there was no Attending physician in the hospital to supervise those Residents, which left them on their own."

"I thought your supervisor had to be there at all times until you were an Attending."

"There are numerous cases, especially on holidays and at night, when the Attending is 'on call' at home. He or she is available by phone and can be at the hospital within fifteen minutes. How that works in practice really depends on how much the Attendings trust the Residents. If that trust is misplaced, as it appears to have been in New York because of the extended work hours, bad things can happen.

"It's the case, even with me, a Fourth Year medical student, that I perform procedures without a Resident or Attending directly supervising me. I report to them after evaluating the patient, propose a treatment plan, and then receive authorization. That's exactly how it will work in about two months, though what I'm permitted to do on my own now is limited to simple procedures. Once I'm a Resident, and demonstrate my skills, I'll be allowed to do more complicated procedures with less supervision, until the point when I'm effectively allowed to practice on my own. At that point, I'd be considered for an Attending position."

"That is quite some time into the future, right?"

"Eight or nine years," I replied. "If I were simply going for straight emergency medicine, it would be three, but because I want to be able to do trauma surgery, I need the equivalent of a general surgery Residency in addition to one in emergency medicine."

"I should let you go, so you have time this afternoon with your wife and daughter. Please come see me again after you've been to visit Father Roman."

"Of course, Vladyka!"

I received his blessing, then left his office. I found Kris in the nursery playroom with Rachel, and the three of us headed home to spend the afternoon and evening together.

April 17, 1989, McKinley, Ohio

"This is where I say I positively hate you!" Kylie declared when I met with her just before 6:00am on Monday morning.

"What happened?" I asked.

"You have Felicity and I have Tim."

"I'd say I'm sorry, but I'm not. Mainly because when we were on our cardiology rotations together, I promised to mentor her during this rotation, if it was possible. She went to Doctor Gibbs, right?"

"Yes."

"Look at the bright side — you'll do every single procedure, and he'll do all the scut."

"There is that," Kylie replied. "Which almost makes up for having to babysit someone less competent than the average beginning nursing student!"

"What do you have on the board?"

"It was anything but quiet! Mix our local version of the Hatfields and the McCoys, or Capulets and Montagues, with a marriage between the clans and large amounts of alcohol, and you end up with three Sheriff's Deputies waiting to arrest five patients. The sixth was treated and released and enjoyed the amenities of the Hayes County Jail overnight instead of a hospital bed."

"The joys of living in a mostly rural county. I hope none of them was the groom."

"No, but one was a bridesmaid who stabbed a groomsman's sister with a broken champagne glass."

"You're joking!"

"The nineteen-year-old felon is in Exam 2. Her victim is upstairs recovering from surgery to remove glass shards from her abdomen."

"Hell of a way to ruin your life," I replied.

"I'm sure she'll plead down to a misdemeanor, especially given her EtOH was 0.15 when she arrived here."

"Ah, to be nineteen and able to hold your liquor so that you're still able to stand with that EtOH! What injuries do we have?"

"Well, besides the inebriated perp who simply got a banana bag, there's a fractured jaw, which will require surgery. That's set for about three hours from now when his EtOH is low enough to safely operate..."

"So, feeling no pain, even without morphine?"

"Exactly. The other two are a broken hand, which appears to have occurred when said hand connected the aforementioned jaw, and a periorbital hematoma administered by the best man to the brother of the bride. The best man also enjoyed the Sheriff's hospitality last night. And on that note, I'm going to shower, then go home and sleep off the nightmare night! Have fun!"

"What else is on the board?"

"A mild MI waiting for admission to cardiology and a toddler who won't stop puking. Jim has those two."

"OK. Thanks."

Kylie went into the locker room, and I went to check on the patients she'd turned over to me, with none of them needing any immediate attention.

"How many deputies responded?" I asked Deputy Jackson.

"Eight, and we had help from the Staties. McKinley PD sent us some guys, even though it was outside the city limits."

"A brawl?"

"Worst I've seen in ten years on the force. Those kids should have eloped to Vegas and moved to Alaska instead of trying to get their families together."

"Which families?"

"The Finlons and the Scanlons. Both have large farms northwest of the city. There's been bad blood between them for over a hundred and sixty years since a Finlon stole a cow from the Scanlons, and payback was a rope and a tree."

"That's a serious grudge, but 'cattle rustling' was a hanging offense, back in the day, at least out west."

"When handed down by a judge, it sure was. This was vigilantism at its 'finest'."

"And the couple?"

"Met in High School, fell in love, and kept it from their families until they announced they were getting married two days before the wedding."

"How many people were there?"

"Pretty much everyone on both sides of the family from Ohio, Kentucky, and West Virginia. Fortunately, they weren't dumb enough to pull guns, though there were enough of 'em of several makes and models."

"Every kid in my High School had a gun in the back of his pickup, and I don't remember anyone ever being threatened with a gun, except guys who got girls pregnant."

"Some High School kid gets my daughter pregnant," Deputy Jackson said firmly, "he'll pray for me to use a gun!"

I chuckled, "I bet. What are you charging them with?"

"We wrote a bunch of citations for drunk and disorderly. We only arrested the ones who actually hurt someone bad enough to bring them here. The paperwork is already eyeball deep as it is!"

"It could be worse," I said. "You could be in Chicago."

"No thanks! Any city where firefighters and paramedics need an armed escort, including SWAT, is someplace I would never work!"

"Doctor Nielson did his Residency at Cook County and saw more gunshot wounds in a day than we see in a year."

"I hate to say it, but we'll start seeing more of that here, too. For some reason, crack and meth cause far more violence than coke and heroin. We don't see much violence around pot or ecstasy, but that might change."

"There will be no limit to the needs of the community for our services."

"And never enough money to provide the service that's needed."

"Mike?" Ellie called out. "Doctor Billings would like to see you."

"Duty calls," I said to Deputy Jackson.

I acknowledged Ellie, then headed to the Resident's office.

"You rang?" I said from the door.

"If you're Lurch, does that make me Morticia?"

"If I say what popped into my mind, I probably won't live through this shift, and if I do happen to live, I'll regret it!"

"You've become downright sassy, as my grandmother used to say. You must be feeling very comfortable."

"The Emergency Department is my natural element, and I'm being treated more like a colleague than a student, so I feel somewhat freer to join in the verbal jousting."

"Two things for you. First, we're losing one consultation room and the Residents' office because we need more exam rooms. That will happen in the next month or so."

"Where will the Residents work?"

"The lounge. It's a stopgap until the new ED is built. That's the second thing. They accelerated the schedule further, and they'll break ground in June."

"Wow! When did that happen?"

"An emergency Board meeting last week. The memo was on my desk when I arrived last night."

"Hi, Mike!" Felicity exclaimed, coming up to stand next to me in the doorway. "Hi, Doctor Billings."

"I assume you know she's with you, Mike?"

"Kylie complained when she did the handover," I replied. "I told her I'd like to be able to say I was sorry, but I'm decidedly not."

"Nor am I," Doctor Billings stated. "He was Ghost's problem last night, not mine. Anyway, you're up to speed on the wedding brawl?"

"Yes."

"OK. I've filled out the discharge forms, so as soon as their EtOH is low enough, the Deputies can take them away. All that's needed is final vitals, time, and date, and I'll sign."

"OK."

"Doctor Billings?" Penny called out from behind us. "EMS four minutes out with a stabbing victim. Trauma 2 is prepped."

The four of us gowned and went to the ambulance bay to wait for the squad to arrive.

"Mike, vitals and monitors; Felicity, Foley and labs; Penny, CBC, Chem-20, blood gas."

"EKG?" I asked.

"ABC," she countered. "Unless there is direct cardiac injury."

I nodded, knowing that Airway, Breathing, and Circulation were the key. Any arrhythmia would likely be a result of hypovolemia, unless the penetrating trauma had damaged the pericardium or the heart itself. As we waited, I took in the view of the field where I'd once chased Jenny Leonard after her brother had died, and where, within two years, a completely new Emergency Department would stand.

Our current trauma wing would be converted for use for outpatient surgery, thus freeing space for more beds in wards on the second and third floors. The new surgical wing would be constructed at the opposite end of the building, and was due to break ground as soon as the new trauma wing was completed. My thoughts were interrupted by the squad sliding to a stop in front of us and Bobby leaping from the driver's seat.

"Cale Montrose, thirty-four; deep, penetrating wound to the abdomen; significant blood loss; pulse 90 and thready; BP 80/50; IV saline and plasma; GCS 8; PO₂ 90% on ten litres;"

"Trauma 2!" Doctor Billings ordered. "Mike, intubate first."

"Yes, Doctor!" I replied as the six of us rushed Mr. Montrose to Trauma 2.

In the trauma room, as Doctor Billings did her assessment and Felicity prepared a Foley catheter, I tore open the intubation kit, then removed the mask from Mr. Montrose's face. Bobby picked up the portable oxygen tank, nodded, and left with his partner.

"Penny, I estimate 80 kilos, so 12 megs sux and 40 megs etomidate, IV push."

"Right away, Mike!"

She administered the drugs necessary for intubation, and once they were in the IV, I picked up the laryngoscope and what I judged to be the correct endotracheal tube, and with two smooth motions, inserted it.

"Foley is in!" Felicity announced. "Urine in the bag."

"No heart or lung compromise," Doctor Billings announced. "Likely organ damage, given the location."

I withdrew the guide wire from the endotracheal tube, then connected the ventilator and turned it on at a low setting. I checked for bilateral breath sounds, and hearing them, adjusted the ventilator to the proper pressure.