Chapter 90: Doctor Michael Peter Loucks

May 19, 1989, Circleville and McKinley, Ohio

"What are you doing today?" Kris asked when we got out of bed on Friday morning.

"This morning I'll put the finishing touches on my speech, then take a copy to Doctor Mertens. I'm meeting Antonne and his group for lunch for our last mentoring session of the school year, and then we'll stop at the record store."

"Rachel is going with you, right?" Kris asked as we went into the bathroom to shower.

"I'd be in the doghouse with Doctor Mertens and Conchita if I didn't bring Rachel with me! Anyway, after the record store, we'll come home so Miss Rachel can have her nap."

"Where are we meeting the gang tonight?"

"We're going for Italian instead of Chinese because we're having a belated birthday celebration for Lara."

"Did you get her a gift?"

"What do you get a girl who literally has everything, including a million bucks in savings and investments?"

"Higher taxes!" Kris declared mirthfully.

I laughed, "Nice. But that does not sound like a gift that would be appreciated. Out of curiosity, do you make a distinction between earned wealth and inherited wealth?"

"There should be limits on inherited wealth," Kris declared. "After all, the children didn't earn it in any way. Why should Lara have such an extreme advantage over everyone else? Just because she happened to be born to the right parents?"

"Just a minor point, her stepdad is the extremely wealthy one, not that her biological dad isn't well-to-do. Everyone except her stepdad is an attorney. He's a senior executive at US Steel, though Lara says he's retiring at the end of this year."

"Again, does she deserve all that money?"

"I'll counter with the question if society has the right to take the money from her family simply because there are enough votes to do so."

"You're starting with a false premise," Kris countered. "That it is OK to hoard resources."

"And you're starting from the false premise that accumulation of capital is wrong. The history of the Industrial Revolution says otherwise. Remember, I'm not arguing for unregulated capitalism, but against socialism, as you define it, not as the average American imagines it."

"The average American is economically and politically clueless!"

"Present company included," I replied. "My knowledge of both of those things is severely limited, and the depth of my arguments is likewise limited. That said, I do base my position on how Jesus and the Apostles handled wealth — if one is more in love with wealth than God, that's a problem between the individual and God, and sharing of one's resources is a voluntary act; just don't lie about it.

"And before you bring up taxes, I consider them, in effect, an invoice for services rendered. Property taxes pay for the schools, utilities, police and fire protection, and so on, while income and payroll taxes pay for state and federal government services. Do I agree with every priority on how that money is spent? Of course not, but that's the point of living in a republic which is designed to require broad consensus and limit wild swings."

"PAPA!" I heard Rachel call over the baby monitor, interrupting our conversation.

"Saved by the Tsarina!" Kris teased.

I quickly rinsed off, got out of the shower, put on a robe, and went to Rachel's room.

I picked her up, hugged her, then changed her diaper. I dressed her in a lightweight sweatsuit, then brought her to the bedroom so I could get dressed. Once Kris and I were dressed, the three of us went downstairs to say morning prayers, then went to the kitchen to have breakfast.

After breakfast, Kris left for school, leaving Rachel and me to our own devices. I read to Rachel, played with her a bit, then put on music and used the computer to make a few final changes to my speech. Once I was finished, I printed two copies, packed Rachel's bag, and then headed to the medical school.

"May I hold Rachel?" Doctor Mertens asked after we greeted each other.

"That's up to her!" I replied. "Rachel, is it OK if Doctor Mertens holds you?"

Rachel scowled but didn't object, so I handed her to Doctor Mertens.

"She's getting big!" Doctor Mertens observed. "Twenty months, right?"

"Twenty-one," I replied. "And already a chocoholic!"

Doctor Mertens laughed, "I think it comes along with the pair of X chromosomes! Any developmental or other concerns?"

"None. Ask me about other concerns in about twelve years."

"To quote someone from a different context, 'These are the times which try men's souls'."

"Funny you should mention that, but I paraphrased Thomas Paine from that exact same pamphlet in my speech. I said, 'The harder the challenge, the more glorious the triumph. What we obtain too cheaply, we esteem too lightly'."

"Obviously, I'll read it, but what quote from Doctor King did you include? Or quotes, if I know you, and I think I do."

I smiled. "I'll let you read, but the key one is the theme for the speech — Life's most persistent and urgent question is — 'What are you doing for others?'. I threw in a paraphrase of the JFK quote for good measure."

"And the parable of the Good Samaritan?" she asked.

"A reference to it, yes."

"I'm very much looking forward to reading it and hearing it. Would you like to know your score on the MLE?"

"So long as I passed, I don't really care," I replied. "And I'm sure I passed."

"276, which is the 99th percentile overall and the second-highest score ever at the school. The median score was 239; passing was 209."

"I have to ask..."

Doctor Mertens smiled, "So long as you promise not to say anything, I'll tell you."

"NO!" I groaned, knowing exactly what that meant. "What score did Clarissa receive?"

"277."

"I'm very happy for her, but I will never hear the end of this. Ever!"

"What do the kids say these days? Sucks to be you? Or in my day, this..." she said as she rubbed her forefingers across her thumbs.

I laughed at the signal for the world's smallest violins playing just for you ... in stereo.

"I take it there were no problems for others in my study group?" I asked.

"All above median, including Nadine Cross," Doctor Mertens said.

"That's awesome!"

"I suppose then I'll see you on Thursday afternoon for graduation. Are you and Kris coming to the banquet on Friday evening?"

"Yes."

"We'd also like you and Kris to attend the banquet in the Fall for the incoming students. You'll receive an invitation in July."

"Thanks. We'll do our best to be there."

"You'll be allowed a few hours off to attend if you're on shift."

"Then I'll be there."

"Great! Don't forget to pick up your cap and gown."

"I won't, thanks."

"See you Thursday!" Doctor Mertens exclaimed.

I took a reasonably content Rachel back from Doctor Mertens and headed to the classroom where the gowns were being distributed.

"Loucks," I said to the young woman at a table in front of boxes and stacks of regalia.

"Michael?" she asked after consulting her list.

"Yes."

"ID, please."

I set Rachel down so I could get my medical school ID from my wallet and showed it to the young woman.

"According to my list, in addition to the standard regalia, you have gold cords for summa cum laude and a purple shoulder lanyard as valedictorian. There is an instruction sheet with your gown, which will explain how to put on all the items. I see you've paid for your gown, and that your tuition and fees are paid, so let me get you your items."

She selected items from various boxes and stacked them on the table — a black gown with green piping; a black stole with a royal blue lining and green trim; a black eight-sided tam with a green tassel; a gold honor braid and a silver medical graduate braid, and a green stole with the symbolic Staff of Aesculapius on each end.

That made me think about the paramedics' uniform I'd be wearing while doing my ride-alongs which had, instead, caduceus, on the shoulder patch. That was often confused by Americans with the Staff of Aesculapius (⚕️), but differed in that caduceus(☤) had a pair of snakes and wings, and had its origins in common US usage with the Army Medical Corps before the Civil War, and had been formalized just before World War I as the symbol for military medicine.

Once she had everything on the table, she checked off each item and put it into a paper bag with handles. She had me sign for everything, I picked up Rachel and the paper bag, and we headed out to the car. From the medical school, we headed to the diner, where I'd meet Antonne and his study group.

As usual, Conchita immediately took Rachel from me, and Rachel was quite content, as she liked Conchita, and Conchita was willing to feed her as many French fries as she wanted, my protests to the contrary notwithstanding. That caused my daughter to give me a look, which could only be described as smug contentment.

The study group and I had a nice chat at lunch, though they were all uptight about finals coming up the following week. All of them were going home for the Summer, except Antonne, whose family had moved to the area. He'd have to share a room with his brother for the Summer, but he felt that was a good trade for them, having escaped the housing project and gangs back in Cleveland.

"How does it feel to be graduating next week?" Jordan asked.

"In one sense, it's a non-event, because the real goal is a Residency, and that was confirmed back in March. Without that, graduation wouldn't mean much. The MLE Step 1 is the second-biggest hurdle after the Match, and that's at the end of Second Year."

"Not the exam you just took?" Paul inquired.

I shook my head, "No. There's an adage we've heard about what you need to prepare for the MLE — two months for Step 1, two weeks for Step 2, a number 2 pencil for Step 3. I studied a bit more for Step 2, but I wanted to achieve the best possible score, not just pass."

"Did you?" Antonne asked.

"DON'T ASK!" I growled.

He laughed, "That can only mean one thing! Clarissa scored higher!"

"You know me too well," I said with a wry smile. "Yes, by a point."

"Girls rule, right Rachel?!" Conchita exclaimed.

Rachel giggled, and for some reason, a feeling of doom spread over me. Of course, if she took after Elizaveta at all, 'Tsarina' was the correct appellation for her.

"Mike is valedictorian," Julius said. "And I believe he outscored her on every other test!"

"You do realize that's not going to matter one bit, right?" Paul asked, causing everyone to laugh.

When we finished lunch, I shook hands with the guys, received chaste hugs from the girls, and then Rachel and I headed to the record store, where I bought a copy of Disintegration by The Cure. Purchase in hand, Rachel and I headed home for the afternoon. Kris arrived home just before 3:00pm, bringing Lyudmila with her, as Lyudmila would babysit while Kris and I were out with the gang celebrating Lara's birthday.

"Hi, Petrovich!" Clarissa said with a smirk. "One of us has the highest score in the history of McKinley Medical School! Care to guess who?"

"The only reason you would ask that way is if you scored higher!" I chuckled. "Congratulations."

"YOU KNEW!" Clarissa exclaimed. "There is no way you would react this way if you didn't know!"

"Doctor Mertens told me I'd scored the second-highest score ever, and when I asked, she said I had to not say anything. That made it totally clear what had happened. I'm happy for you, Lissa."

"You know it's no fun if I can't gloat!" Clarissa groused.

"Poor baby."

"You're annoying, Petrovich!"

"Thank you!"

"Play nice, children!" Fran, who was standing just behind me, said.

Clarissa and I looked at each other, smirked, then simultaneously said, "Yes, Mom!"

"Not yet!" Fran declared. "I need to complete my Residency first!"

"Haven't you been babysitting your entire study group, not to mention your husband, for the past eight years?" José asked mirthfully, causing everyone to laugh.

"There is that," Fran replied, giving Jason a kiss on the cheek.

"All kidding aside," I said, "Fran has been instrumental to all of us finishing in the top fifteen in our class."

"Five in the top ten," Nadine added. "I just wish I'd met you guys at the beginning of First Year."

"And, ultimately, meaningless when you have an MD and Board certifications on your wall," Peter interjected. "Well, other than Clarissa, who is still annoyed that Mike finished first to her second!"

Lara and Nathan walked in, and everyone greeted her with a hearty 'Happy birthday!' and most everyone hugged her. The hostess seated us shortly after that, and we had a wonderful meal to celebrate Lara's twenty-second birthday. After dinner, we went for ice cream, then saw Road House, starring Patrick Swayze, Kelly Lynch, and Sam Elliott, which we all enjoyed. After the movie, Kris and I headed home, and she drove Lyudmila to her parents' house before the two of us went to bed.

May 20, 1989, Centerville, Ohio

After band practice and grocery shopping, we stopped at the computer store and picked up our new computer. Once we'd put away the groceries, we had lunch. When Rachel went down for a nap, we unpacked the new computer and set it up.

"What are we doing with the old one?" I asked.

"If you don't object, my sister would like to have it."

"I don't object at all. You're going to have to explain the concept of a hard drive. The guy at the store said it was some kind of permanent storage."

"Yes, it's inside the computer, and I'll copy all the programs we use onto it. That means you don't have to insert the floppy disk for each program when you want to use it. You just start the program from the computer itself. You don't need floppy disks to save your work, either, though there is limited space on the computer, so at some point, older files that you don't need immediate access to can be copied to floppy disk to save. And we'll have to make backup copies from the hard disk to floppy disk to ensure we don't lose anything if something goes wrong, similar to how you make two copies of important files."

"I did print an extra copy of my speech yesterday just to be safe."

"When you copy something from a floppy to the hard drive, the original stays on the floppy disk. You have to do something special to move it instead. Honestly, for what you do, nothing should change except you won't need to change the floppy disks from the program disk to your data disk."

"I hope you'll forgive me for being technologically clueless."

Kris laughed softly, "I'd do far worse in «SAMU»! I have no idea how to use any of the equipment or what any of the information actually means except pulse and blood pressure."

"It's all a matter of learning and studying," I replied.

"And not having a mental block! Clarissa said you have one about computers and that you can be a 'blockhead'."

"She's not wrong!" I chuckled. "She's not the only person to discern that about me! The one exception is medicine."

"Your one, true love. And before you say what I know you are going to say, I knew that coming into our marriage, and it does not bother me. It's your passion!"

"I can show you another kind of passion if you're interested!"

"Yes, please!"

I took her hand and led her upstairs to the bedroom.

May 25, 1989, Graduation Day, McKinley, Ohio

"Your last shift as a medical student," Doctor Casper observed just after 1:00am on Thursday morning. "How does it feel?"

"Strange," I replied. "It's been a long, interesting journey."

"This time tomorrow, you'll be a doctor!"

"This time tomorrow I'll be asleep!" I retorted.

"Did you hear the results of the Risk Management investigation?"

I nodded, "They told Mr. Ferguson in a most polite, lawyerly way to pound sand. As they should have."

"Someone, not me or you, needs to point out to him that it takes two to tango, and his daughter invited her paramour into her bedroom and into her bed!"

"I gotta give the kid credit, though!" I chuckled. "If I had been able to get laid before taking tests, I'd have been WAY less uptight!"

Doctor Casper laughed, "It is a very effective form of stress relief! Cute girl?"

"I honestly turned off that part of my brain, and for good reason! They were «déshabillés», and I had to keep it totally clinical!" ("scantily clothed")

"Of course. And «déshabillés»?"

"Blame my wife! But I've developed a mode of working where I literally don't pay attention to how a patient looks. I'd hate to treat one differently from another because of looks."

"Come on! You can't help but notice a pretty girl!"

"I think the best way to put it is that I don't 'take notice' or maybe 'remember' is a better word. I honestly couldn't even give you more than a vague description of either of the teens. Partly it's a strategy, and partly it's an effect of the sheer volume of patients we see, and except for 'frequent flyers' and 'GOMERs', there are too many to remember. Of course, when I was single, I did notice Kari, though that was more because she flirted and was being goofy."

"Your duets with her on the Meat Loaf songs are awesome."

"Thanks."

"Mike?" Jamie called from the door to the lounge. "Doctor Gabriel needs you for a walk-in with a six-year-old with asthma. Exam 2."

"Be right there," I replied, then turned to Felicity and said, "Game time!"

We got up and followed Jamie to Exam 2.

"Mike, this is Patty Grumman, and this is her mom," Doctor Gabriel said. "H&P, please."

"Yes, Doctor," I said, then washed my hands and put on gloves.

"Hi, Mrs. Grumman," I said, then pulled the stool over to the treatment table. "Hi, Patty, I'm Mike. How are you feeling?"

"I ... feel ... like I can't breathe."

"When did this start?" I asked.

"After ... dinner."

"Give her something!" Mrs. Grumman demanded.

"As soon as I examine her," I replied in as soothing a voice as I could muster. "We need to make sure we don't give her the wrong medication."

I turned to Patty and asked if it was OK to listen to hear heart and her breathing.

"OF COURSE IT IS!" Mrs. Grumman half-screamed.

I turned to her, "Mrs. Grumman, would you be OK with me coming over to you and putting my hand inside your shirt without asking?"

"That's different!" she insisted.

Actually, it wasn't, but she didn't see her six-year-old as an individual with some semblance of bodily autonomy.

"I prefer to ask to be sure," I replied. "Is it OK, Patty?"

"Yes!" she half-gasped.

I listened to her heart and heard no murmurs, but when I listened to her lungs, I heard rales, stridor, and wheezing. Her pulse was high, at 114, her PO₂ was 88%, and she had a slight fever at 37.5°C. Those were all indications of a diagnosis of asthma, as was Patty's inability to speak more than a word or two in a single breath.

"Have you been sick, Patty?"

"No," she wheezed.

"Have you had any itchy areas or red spots on your skin?"

"No."

That indicated that the asthma was likely not caused by an allergy.

"Are you taking any medicine? Any kind?"

"No."

"Jamie," I said to the nurse, "peak flow monitor, please."

He retrieved one from the cabinet, put a sterile mouthpiece on it, then handed it to me.

"Patty, I want you to take a deep breath and blow as hard as you can into this, like blowing up a balloon, or one of those party whistles with the rolled-up paper."

She nodded, and I held it while she blew into it, coughing hard at the end of her breath. I read the results to Jamie, then estimated Patty's height and reported that. Jamie used a chart and a calculator to determine the result.