Chapter 29 — I Agree With Doctor Mastriano

_July 31, 1989, McKinley, Ohio_

{psc} "I may have to take off on the 21st of next month," I said to Doctor Gibbs on Monday morning. "The INS sent subpoenas for both Kris and me to appear for interviews. She's going to ask her attorney to request that INS conduct the interviews here at the hospital, but I suspect that will fall on deaf ears."

"An actual subpoena?"

"Yes. Both letters are entitled _Subpoena ad testificandum_, a command to appear and testify."

"Bring me a copy and you can have the time off. Finding coverage is our responsibility, not yours. That's hospital policy with regard to subpoenas. It's meant mostly for medical cases, but it doesn't say that in the policy manual."

"I'll probably only need about twelve hours," I replied. "The appointment is at 9:00am and I can't imagine it would go past 5:00pm, and I can be here by 6:00pm. We will see if the interview can be moved, but if not, then I'll take advantage of that policy."

"Any concerns?"

"No. The main thing they're looking for is evidence of a sham marriage. According to our attorney, the fact that Kris legally adopted Rachel is dispositive, though the government will go through the motions to ensure it's not a sham."

"Do they really ask questions about sex?"

"According to our immigration attorney, yes. That appears to be a key deciding factor, but it's silly because a bit of planning can defeat any questions they could ask, and I seriously doubt they'd get away with asking for a demonstration!"

Doctor Gibbs laughed, "'Please demonstrate how this is accomplished'?"

I chuckled, "My response would be identical to Pulaski's — 'Not likely'. Though, had it been Crusher instead of Pulaski, I suspect she'd have happily demonstrated with Picard!"

Doctor Gibbs smirked, "'Wesley, the Prime Directive isn't the only thing I regularly violate on this ship!'"

I laughed hard, "A perfect line for the guy who goes to the planet where literally everyone gets laid and where they make love at the drop of a hat — any hat — and ends up with the death penalty for trampling flowers."

"Worf had the best straight line in that regard — 'Go to her door. Beg like a human.'"

I chuckled, "And Worf's description of Klingon mating rituals sounds suspiciously like dating and marrying a Russian woman!"

"Did you warn Ghost?"

I chuckled, "No, because the benefits far outweigh the suffering! In that way, it's like surgery."

"Go heal the sick!"

I left the office and went to find Kylie so we could do shift turnover.

"Two waiting on beds in Medicine," she said. "Or, rather, waiting until the lazy Resident goes off shift. Clarissa will take them right away, I'm sure."

"Have you reported that?"

"I let Doctor Nielson know before he left this morning. This is the third time. The first time, OK, sure. The second, maybe? The third? No way. And I asked one of the nurses. There are eight open beds."

"Wonderful," I said, shaking my head. "Anyway, I may need coverage for concerts in September and October," I said.

"None this month?"

"At Taft, but it's a Friday night, so I'll gut it out. Once the new schedules hit on August 15th, I'll talk to you about September and October. Anything else?"

"No. It was a mostly quiet night."

"How's your mom?"

"Still alive and kicking, which wasn't a sure thing back when we traded shift schedules."

"That's good to hear."

"And your family?"

"Rachel will be two at the end of August, and she's asserting herself."

"Having more?"

"That's the plan!"

"You proved to my satisfaction you know how that's accomplished!"

I laughed, "Fortunately, only as practice!"

"Fortunately! I'm outta here!"

She left, and I went to the lounge to find Bob and Len.

"Up to speed on the two admissions?" I asked.

"Yes," Bob replied. "Now that it's 6:00am, I'll call upstairs and speak to Doctor Saunders and get them transferred."

"Good. Len, let's go see if there are any walk-ins."

There was actually nobody waiting, so I sent Len to have his breakfast, and I sent Bob for his once the two patients had been admitted. I picked up my first paycheck, or rather a receipt, as the money was direct deposited into my bank account, then went to the lounge.

"Morning!" I said to Ghost when he came into the lounge just before 7:00am. "How was your week off?"

"Enjoyable! Loretta said you had an interesting week."

"You could say that."

"You're going to clash with Psych for the rest of your career. I tend to agree with you, but I'm not nearly as passionate. Just be smart about it."

"Did Lor tell you I'm seeing a counselor recommended by Shelly Lindsay?"

"No. It's almost always off limits to reveal counseling, for reasons I suspect strongly you understand."

I nodded, "To avoid stigmatization, among other things. In my case, it really comes down to what happened with Angie, which sensitized me to mental health issues, something also reinforced by a friend's attempted suicide and another friend's successful suicide, along with my own battles with depression on more than one occasion."

"I've had my own struggles, though nothing compared to yours."

"Ghost? Mike?" Ellie called from the door of the lounge. "Nate says EMS is on scene of a high-speed MVA. Four victims, but no ETA due to potentially lengthy extrication. We're clearing all four trauma rooms."

"Any further details?" Ghost asked.

"No," Ellie replied. "Just Doctor Gibbs saying it's an all-hands-on-deck response."

"Thanks," Ghost said.

"This is where we need paramedics who can intubate," I observed. "Or doctors responding to the site."

"We're understaffed as it is," Ghost said. "The juggling I'm going to have to do with the schedule will be worthy of a circus!"

"Have you heard of Sergej Ignatov?" I asked.

"No."

"A Russian who's called 'The Poet of Juggling'. He often juggles seven balls and holds the world record for juggling eleven rings in the early 1970s."

"That's about what I need for the next ten months. Cutting PGY1s back to eighty hours didn't help, and means PGY2s will be on eighty hours and PGY3s on seventy-two. All Attendings are on sixty hours. And having to have a babysitter for one Attending doesn't help, either."

"For how long?"

"End of August, though ultimately it's up to Northrup. I really need those additional two Residents right now. We're busier than we've ever been, and it's only going to get worse. Patient loads are up nearly twenty percent since last year, and fifty percent over five years."

"EMTALA. I've treated more people who should have been seen by a GP or a 'doc-in-a-box' than I have severe traumas."

"And it's going to get worse," Ghost replied. "Shall we go slum by the ambulance bay doors?"

We got up, grabbed gowns and gloves, but didn't put them on, and went to stand with a gaggle of other ED staff by the door.

"I called for a surgical Intern and one from Medicine," Doctor Gibbs said. "The Medicine Intern will cover anything that comes in while we're on this trauma, and the surgical Intern will pitch in where we need them."

"Which one?" I asked.

"Mary Wilson. Concerns?"

"No, just curiosity."

"Somebody called for the best Intern in the hospital?" Clarissa asked, coming to join us.

"I'm already here," I chuckled.

"277, Petrovich!" she exclaimed.

"Double valedictorian!" I countered.

"And yet, I still had the highest MLE Step 2 score in the history of the medical school!"

"By one point!"

"Now, children…" Doctor Gibbs warned. "Clarissa, you'll need to cover walk-ins. Take the Third years — Len, Kim, and John — to assist. Ellie can fill you in on the patients in the exam rooms."

"What's coming in?" Clarissa asked.

"Four high-speed MVA victims."

"ETA?" Doctor Wilson asked, walking up to us with a male student in tow.

"Lengthy extrication," Doctor Gibbs said. "Send your student to help Clarissa."

"Let's go, little ducks," Clarissa said to the Third Years.

I laughed as the four students followed her towards the triage desk.

"First squad is three minutes out with two victims," Nate called out. "Other two are still being extracted."

"We'll double up," Doctor Gibbs said. "Mike, with me; Mary, with Ghost. We'll take the first two. Chuck and Naveen wait for the next squad. Send a nurse to me if you need surgical help."

Two minutes later, the first squad rolled up and Bobby jumped out.

"First patient male, about thirty, restrained passenger; Multiple crush injuries; possible collapsed lung; tachy at 120; BP 80 palp; PO₂ 92% on ten liters; GCS 6; IV saline TKO, backboard and cervical collar."

"Trauma 1 with me!" Doctor Gibbs ordered.

She, Bob, nurse Jamie, nurse Anne, Bobby, and I quickly moved the patient towards Trauma 1.

"Mike, verify the collapsed lung and get a chest tube in; Bob, EKG and monitor then Foley; Jamie, a unit of plasma; Anne, full trauma panel."

We reached the room and rolled the gurney next to the trauma table.

"Carefully, on my count!" Doctor Gibbs ordered. "One…two…three!"

We hoisted the backboard with the patient on it to the trauma table and, after disconnecting the oxygen bottle, Bobby left.

"Absent breath sounds on the left," I announced. "Chest tube tray to me!"

"Plasma running!" Jamie announced. "Chest tube tray to you, Mike!"

"Sinus tach!" Bob announced.

I glanced up at the monitor and confirmed his read.

"Agreed," I said.

Jamie brought the chest tube tray, and I began the procedure.

"Foley is in!" Bob announced. "Blood in the bag!"

"Flail chest, possible skull fracture, crushed right arm," Doctor Gibbs announced.

The patient was, in ED parlance, a 'train wreck'.

"Rigid abdomen," Doctor Gibbs announced. "Surgical belly."

"Let me finish the chest tube and I'll confirm," I replied. "Anne, I need the ultrasound cart."

"I'll get it and give the blood to a student to run to the lab."

I finished the tube and auscultated the patient's lungs.

"Weak bilateral breath sounds," I said. "PO₂ hasn't come up. He needs a vent before I confirm the belly. Intubation tray to Bob!"

I supervised Bob putting in the endotracheal tube, and once he'd hooked up the vent, I verified bilateral breath sounds.

"Good bilateral breath sounds," I said.

The monitor blared and Doctor Gibbs called out, "V-Fib! Charge to 200!"

"Paddles to you," Jamie said to Doctor Gibbs, moving the defibrillator to her.

I grabbed two pads and slapped them on the patient's chest just as the machine pinged.

"CLEAR!" Doctor Gibbs ordered.

We all raised our hands and Doctor Gibbs applied the shock as Anne returned to the room with the ultrasound.

"Sinus tach," I said, then auscultated. "Weak heart sounds. Suspect tamponade or effusion. I need a pericardiocentesis tray!"

Anne grabbed one, remove the cover and set it on the stand next to me, replacing the chest tube tray. Before I could begin, the monitor blared again.

"V-Fib!" Bob called out.

"Charge to 200!" Doctor Gibbs ordered.

Before the machine was ready, I heard the continuous monotone from the monitor and looked up.

"Asystole!" I announced. "Beginning compressions!"

"Anne, 1 meg of epi, IV push!" Doctor Gibbs ordered as I began performing CPR.

"Bob, take over compressions," Doctor Gibbs said. "Mike, resolve that tamponade!"

Bob took my place and as quickly as I could, I performed a blind pericardiocentesis.

"Blood in the syringe," I announced, knowing what that meant.

"Bob, stop compressions!" Doctor Gibbs ordered.

She listened for his heart and shook her head.

"Bob, resume compressions; Anne, another meg of epi!" she ordered.

Two minutes later, nothing had changed and after checking pulse, pupils, and cornea, Doctor Gibbs shook her head.

"Time of death, 07:13."

"I'll get the death kit," Jamie said.

"Mike, let's see if anyone needs help."

Ghost's patient hadn't made it, but the other two were still alive, so we pitched in to help, and sent one upstairs with Mary for emergency surgery while the other continued to be treated in the ED.

"Mike, see what Clarissa has and relieve her," Doctor Gibbs said.

"Right away!" I acknowledged.

I found her in Exam 3 and asked her to step out.

"How'd it go?" she asked.

"Two didn't make it, one emergency surgery, they're still working on the other one, but she should make it. What do you have?"

"Two needing sutures which Len and Kim are doing, and John is splinting a broken finger."

"Doctor Gibbs said to relieve you; Bob and I will take over."

"Then I'm off!"

"That's for sure!" I teased.

"277, Petrovich. 277."

"Go back to pushing pills, Lissa!"

She stuck her tongue out at me, winked, then headed for the stairs.

"I take it you two have extensive history?" Bob asked.

"Partners in crime since Freshman year at Taft. We agreed to go to medical school together, serve our Residencies together, and practice together."

"But you couldn't marry?"

"Clarissa's _girlfriend_ might have something to say about that."

"Oops. Sorry."

"Nothing to apologize for. She doesn't advertise, but she also doesn't hide it. Check on our suturing ducklings, please."

"Can I have you sign my procedure book for the intubation?"

I took his book, signed, then added a notation he was cleared for unsupervised intubation.

"You think so?"

"I didn't have to guide you and you got it right, with time to spare. The chances you'll need to do one unsupervised are slim, but you can let any Resident or Attending know you're completely cleared. Good job on the EKG as well."

"I should have called out 'Asystole'."

"I beat you to it because it's basically a reflex for me from Fourth Year. I should have let you do it. Would you supervise Len and Kim, please? I'll check on John and his splint."

"Right away, Doc. Thanks for the faith."

"Keep doing what you're doing."

We cleared the three patients, along with two more walk-ins, before another EMS run for a rule-out MI, who we admitted to cardiology with uncontrolled A-fib. I had lunch, and we had a steady flow of patients during the afternoon, and I joined Kris, Rachel, and Clarissa for dinner in the cafeteria.

"Mr. Burge said it's very unlikely the government will agree to do the interviews at the hospital, but he'll ask. He strongly suggested not trying to change the date because the usual response is for the government to put it off for months and then to be difficult about it."

"OK," I replied. "Doctor Gibbs said if I bring a copy of the subpoena, I can have the time off and the hospital will find someone to cover the hours."

"Subpoena?" Clarissa asked.

"That's how INS summons you for a citizenship interview," I replied. "And they put you under oath, too."

"All to decide if the marriage is real?"

"Pretty much," I replied. "You remember the idiocy when we returned from Europe, right?"

"Of course."

"That was when they questioned your marriage to Elizaveta, right?"

"Yes, though that was because she was sixteen. They weren't the only ones who looked askance, but Ohio law permitted the marriage. The Federal law they might have tried to apply — The Mann Act — expressly does not apply to married couples, and marriage is a state function, not a Federal one, just as driver's licenses, medical licenses, and other licenses are."

"You know it makes no sense to me that you can be a doctor only in Ohio."

"I realize, but occupational licenses, with a few exceptions such as pilots and ship captains, are all issued by the states. That said, it would be simple and straightforward to obtain a medical license in another state, so long as my license in Ohio is in good standing. Of course, I have to get it first."

"What about now?"

"So long as a hospital hires me, the Chief Attending, or whoever is supervising me, needs a license. I don't."

"So you have more freedom now than when you're licensed?"

"In the sense of government control? Yes. But transferring Residency programs is not easy to do because slots are limited, especially the further on you go. There simply aren't that many that are open because someone would have to drop out, transfer, or die, and that just doesn't happen very often. So while I have the freedom to change, I don't really have the opportunity. Granted, I could switch to an unfilled PGY1 slot in another specialty, but that's not a real option."

"But don't you think everything should be consistent across the country?"

I shook my head, "No. In fact, the system was expressly designed to prevent that. People in Ohio do not want people in California or New York telling them what to do and how to live any more than people in New York or California want people in Ohio telling _them_ how to live. That's the entire point of the US Senate, which is meant to represent the states, and ensure that simple majorities cobbled together from the largest states cannot overwhelm the small states. Without what was called the Connecticut Compromise, the Union wouldn't exist, which is why the Constitution forbids removing equal representation among the states by amendment, unless it's on a unanimous vote of every state legislature."

"I remember that," Kris said. "I just don't agree."

"And so long as you only disagree via rhetoric, we're fine. Heck, you can even wave your red and black banner! You just have to promise not to have ever advocated overthrow of the government!"

"But that's what your Founders did!" Kris replied.

I chuckled, "Do as I say, not as I do. But the second Civil War ended that."

"Second?" Kris asked.

"Petrovich is just being himself!" Clarissa interjected. "He's going to point out that the Revolutionary War was actually a civil war for independence from Great Britain. Well, either that, or that it was British subjects fighting for traditional British rights against a German king and his German mercenaries."

"You know me too well, Lissa!" I chuckled. "But both those statements are accurate."

"Mr. Black must have been a fun teacher."

"The best!"

"Who's that?" Kris asked.

"I've mentioned him before — he taught English and Current Events, and was a font of all manner of interesting trivia, and he had a quirky take on history, including the comment about the German King."

"The Germans are _always_ causing trouble!" Kris declared.

"Including founding France," I teased.

"How have you put up with him for so long, Clarissa?" Kris asked playfully.

"I ask myself that question almost every day!" Clarissa teased.

"At least ONE woman here appreciates me, right Rachel? Love Rachel!"

"Love Daddy!" she replied.

"She'll learn," Clarissa declared. "Just wait!"

"I figure about a year from now with a sibling, especially if they're of the opposite gender."

"If that happens, I'd say you're a dead man!"

"She'll just have to live with it!"

"Yes, but will YOU live?!" Clarissa teased.

We finished our meals, and I walked Kris and Rachel to the car, kissed and hugged them both, and after they'd driven off, I returned to the ED where Mary and Tom had relieved Bob and Len. The evening saw a steady flow of minor injuries and a few EMS runs, none of which were critical. Just before midnight, there was a complete lull, so I took the opportunity to take a nap.

_August 1, 1989, McKinley, Ohio_

I managed to sleep for seventy-five minutes before Nurse Alice woke me.

"Paramedics are bringing in an assault victim," she said. "About three minutes out."

"OK. Are Mary and Tom awake?"

"Yes."

I quickly went from the on-call room to the lounge, emptied my bladder, and joined Mary, Tom, and Alice in the ambulance bay just seconds before the EMS squad rolled to a stop, followed by a McKinley PD cruiser. The paramedic hopped out and gave the usual report.

"Johanna Stern, twenty-two; facial and abdominal contusions; pulse 76; BP 110/70; PO₂ 99% on air."

When they unloaded the patient, I immediately recognized her as one of the four 'pact' girls I'd met at Stirred Not Shaken.

"Hi, Jo," I said.

"Mike?"

"Doctor Mike now," I replied. "But it's OK to call me Mike. What happened?"

"I was…raped."

"Trauma 2," I ordered.

"Got the scumbag here," a uniformed McKinley PD officer called out, getting out of his car. "He claims he needs medical assistance."

"Tom, wake Doctor Mastriano and assist her, please. I'll take Mary with me."

Mary, Alice, the paramedics, and I quickly moved Johanna to Trauma 2 and moved her to the treatment table.

"Alice, I'll need a rape kit; Mary, please call OB and have someone come down for the exam."

As I'd given them orders, I hooked up the pulse oximeter and blood pressure cuff myself and turned on the monitor.

"Jo," I said. "I'll do a brief exam just to check your heart and lungs, but we'll need to wait for the OB/GYN and a police detective."

"OK," she agreed.

I carefully auscultated hear heart and lungs, doing my best not to disturb any possible evidence. Everything checked out, and about a minute later, a female McKinley PD detective came into the room.

"Detective Iverson," she said, introducing herself.

"Doctor Mike Loucks. We're waiting on the OB/GYN Intern before we begin processing the rape kit."

"I need to take some photos with the Polaroid," Detective Iverson said.

"I'm familiar with the process. I've done several of these, unfortunately."

"Miss, do you consent to photos being taken?" Detective Iverson asked.

"Damn straight!" Jo declared. "I want that asshole in prison!"

"Moore, OB/GYN," Doctor Roger Moore, nicknamed 'Saint', announced, coming in.

"Jo," I said. "Are you OK with a male OB/GYN doing the exam?"

"Uhm, I prefer a woman, please."

"I'm the only one available," Doctor Moore said. "Everyone else is delivering babies."

"Mike," Jo said, "you could do it, if you're allowed. But not him."

"May I see you in the corridor, Mike?" Saint requested.

I nodded and stepped out.

"What the hell?" he asked.

"I _always_ ask female patients who are not critical who need gynecological exams if they prefer a female doctor. In this case, one isn't available and because she knows me, she asked me to perform the exam."

"You're not supposed to treat friends."

"She's an acquaintance," I replied. "Not a friend. I dated two friends of hers, and I've seen her maybe three times, and the last time was more than a year ago."

"Who's your Attending?"

"Mastriano or Nielson. Have your Attending call down, but the patient is the one to decide. And I'm qualified to do basic gynecological exams and rape kits. It's signed off in my procedure book."

"Have it your way, but Doctor Carmichael is not going to be happy."

I wanted to say that I couldn't care less if Doctor Carmichael was happy, and that the patient's needs and desires trumped any turf wars, but I remembered the cautions about my attitude.

"I understand," I said. "I just want to honor the patient's request. Go see Doctor Carmichael and have her call down if she has a concern. It'll be a good ten minutes before the exam begins."

He turned on his heel and left, and I went into the trauma room.

"We're ready to begin," Alice said. "I discussed the procedure with Johanna."

I picked up the checklist and gave directions while Alice and Mary helped Jo remove her clothes while standing on the white butcher paper. When Jo was completely undressed, Alice used a small comb on her pubic hair, and then we had Jo get back onto the bed and covered her with a clean white sheet from the rape kit, and I began gathering samples. Once that was completed, I began my full exam.

"I don't find anything except facial and abdominal contusions and vaginal abrasions," I said when I finished my exam. "Do you have any pain anywhere?"

"Just the bruises," she replied. "I think he's hurting more because I managed to kick him in the nuts when he got off me."

"Are you taking birth control?"

"Yeah, I'm still on the Pill."

"Are you OK for the detective to interview you?"

"Yes."

Detective Iverson conducted the interview, and it was clear almost immediately that it was a case of 'date rape'. They'd been making out, and he'd pushed for intercourse, and when she'd refused, he'd called her a tease, among other things, then forced himself on her, pulling aside her shorts and panties and raping her.

"Detective," I said. "You should get a judge to order an STD test for her attacker. I doubt he'll consent."

"I'll make the call!"

"Use the wall phone."

"If that asshole gave me VD, I'm going to kill him!" Jo growled.

Detective Iverson made the call, obviously speaking to a judge who authorized the test. She made a second call to the station to have someone pick up the warrant from the judge and bring it to the hospital.

"Mary, will you get a set of scrubs for Jo," I requested.

Mary left to do that and returned about a minute later. Alice, Mary, and I stepped out while Johana dressed, then went back into the room.

"I can release you when you're ready," I said.

"I should call my parents," she said.

"I believe the uniformed officers did that," Detective Iverson said.

"Mary, come with me and we'll see if they're in the waiting room."

We left the trauma room and went to the triage desk and I asked Bill, a Fourth Year, about the Sterns and he pointed to a couple sitting in the waiting room. Mary and I went through the door to the waiting area and to the couple.

"Mr. and Mrs. Stern?" I asked.

"Yes," the man said. "How is she?"

"Physically, she's fine, with just a few bruises and scrapes. I can take you to see her."

"Did they catch the bastard?" Mr. Stern asked.

"I believe he's in custody, but you can ask the detective who's with Jo."

I led them to the trauma room, then went to report to Doctor Nielson. After I made the report, I went back to the trauma room, and while I was there, a uniformed officer arrived with a search warrant that authorized blood typing and STD testing.

"I'll come with you and observe the blood draw," Detective Iverson said.

I nodded and left the room. I looked at the board over Nicki's head and saw the alleged attacker was in Trauma 2.

Mary, Detective Iverson, and I went into the room.

"I have a warrant authorizing a blood draw for typing and VD," Detective Iverson announced.

"May I see that, please?" Doctor Mastriano asked.

Detective Iverson handed it to her.

"Tom, syringe and tubes for typing and STD," I said.

"WAIT!" Doctor Mastriano ordered. "Mr. Mueller has refused any invasive tests."

"He doesn't have a choice, Doctor," Detective Iverson said. "This court order authorizes me to obtain it by force if necessary."

"Not in my trauma room!" Doctor Mastriano declared.

"Doctor Loucks agreed to draw the blood," Detective Iverson said. "If you interfere, I'll have Officer Brown arrest you."

"Mary," I said. "Go get Doctor Nielson, please."

She left and returned two minutes later with Doctor Nielson.

"What's the problem?" he asked.

"Detective Iverson has a court order for a blood draw, and I agreed to do it," I said. "Doctor Mastriano objected on behalf of the patient, who refused any invasive testing. It's my understanding that the patient cannot refuse a court order."

"Mike, Isabella, let's step out."

The three of us left the trauma room and went to the Attending office.

"State your case, Isabella," Doctor Nielson said.

"I object to using force to perform a medical procedure. If the police want to do it, that's their business, but doctors should not do any procedure against the wishes of a patient."

"Mike?"

"I agree with Doctor Mastriano. When I agreed to make the blood draw, I didn't know the patient had refused any invasive testing. I will, if you order me to, do it, though I prefer not to. I will note the detective threatened to arrest Doctor Mastriano if she interfered."

"An empty threat," Doctor Nielson said. "No physician can be forced to perform a procedure against their will. I won't give an order like that, which I suspect you knew when you suggested you'd follow my order."

I nodded, "I did. I also know the law says that we cannot be forced to do a procedure. They drilled that into us in practice of medicine at the medical school."

"Mike, ask the detective to come in, please."

I went across the corridor and asked Detective Iverson to come to the Attending's office.

"Detective," Doctor Nielson said, "It's the policy of the hospital not to perform any procedures on a patient who has refused them. Doctor Loucks agreed to draw the blood before he knew the patient had objected."

"I have a fucking court order!" she growled. "And it was Doctor Loucks who suggested the blood test for VD!"

"I did," I admitted. "And suggested she get the warrant. When we went to the room to execute the warrant, Doctor Mastriano stated quite clearly that the patient objected. At that point, I asked for Doctor Nielson's assistance, as he's the senior Attending on duty."

"You won't do it?" Detective Iverson asked.

"Not against the patient's will."

"He's a fucking rapist!"

I began to answer and Perry held up his hand so I stopped.

"Whatever else he is, he's a patient, and ethically speaking, we have a duty to him to not perform any procedures to which he objects. I suggest you take him to your lockup and have your nurse draw the blood and send it here for analysis. You can use force there which is not acceptable here at the hospital."

"God damned bleeding heart liberals," she growled.

"I need a few moments with my doctors," Doctor Nielson said.

Detective Iverson left and Doctor Nielson nodded to the door which I pushed closed.

"I don't actually need anything," Doctor Nielson said. "I just wanted to allow Detective Iverson to calm down. How is your patient Isabella?"

"Experiencing some discomfort, but no rupture or other damage from a kick to the groin. He's ready to be discharged, though he's under arrest."

"Mike, are you ready to release the young woman?"

"Yes."

"I did hear from Doctor Carmichael, but I have zero time for turf wars. There was no injury, right?"

"Minor vaginal abrasions, but no tearing and no treatment required. The rape kit was completed."

"Psych or social worker?"

"I don't see any point in keeping her longer, so I'll refer her to social services or a private counselor."

There was a knock at the door and Doctor Nielson called out for whoever it was to come in.

"Doctor Varma needs an Attending in Trauma 3," Nurse Louise said.

"I'll be right there," Doctor Nielson said. "Isabella and Mike, discharge your patients. Do not get into it with the police. Send them to me."

I went back to the trauma room where Jo was waiting with her parents. I filled out the discharge forms and gave her a counseling referral.

"What about the VD test?" she asked.

"He objected, and hospital policy is to not forcibly treat patients. They'll take him to the city lockup and draw the blood there."

"What do you mean?" Mr. Stern asked.

"If he were to fight, someone would have to forcibly subdue him, which is not something we can do here without putting staff at risk. The jail is better suited for that. They'll draw the blood and send it to us. If it's positive for any sexually transmitted diseases, a social worker will be in touch. We'll also run blood typing test to match what we found on exam. Any questions?"

"No," Mr. Stern said.

"Then you're all free to go."

"Mom, Dad, can I have a minute to talk to Doctor Mike?"

"We'll be right outside," her dad said, and they left the room.

"Someone has to stay," I said to Johana. "Either the nurse or my medical student. The Emergency Department rules forbid me from being alone with a female patient. Alice, would you leave us?"

"OK," she agreed.

"What can I do for you?" I asked.

"I wanted to know what happened after you and Samantha broke up."

"I ended up marrying a girl from the Russian Cathedral in Columbus. We married in January."

"Congratulations."

"Thanks. How have the four of you been?"

"Good. I'm working for an architecture firm here in McKinley as a mechanical engineer. Becka, Les, and Samantha are home for the summer, and Becka and Samantha both start law school next month, and Les starts on her MBA. Samantha has a stead boyfriend and they're pretty serious. Les is still seeing the same guy, and Becka has a guy she sees regularly, but they aren't a couple. I saw you have a gig at Stirred Not Shaken in September, and the other three will come home for that, so all four of us will be there."

"It'll be good to see all of you."

Alice came back to the trauma room and let me know that there were two walk-in patients who needed attention so I said 'goodbye' to Jo and Mary and I went to triage.

"Bar fight," Bill said. "One with an obviously broken nose, the other with probable a broken hand."

"Wonderful. Is everyone else busy?"

"Yes."

"OK. Mary, you take the hand, do a primary exam, and arrange for an x-ray. Bring me the chart to sign the orders."

"Will do."

We each called our patient and escorted them to exam rooms, with Alice joining me and Louise joining Mary.

"Mr. Baxter," I said. "Does anything hurt other than your nose?"

"No."

"I'm going to do a quick exam, and then we'll take some x-rays to see how badly your nose is broken."

"OK."

I did the exam and found nothing out of the ordinary, except for the contusions on his face and the quickly blackening eyes, a strong indication of a broken nose. Thirty minutes later, after receiving the x-rays, I called for an ENT consult and also reviewed Mary's findings, which resulted in an admission for surgical repair of the hand.

"With the displacement," Doctor Robbins, the ENT said to Mr. Baxter, "it'll need to be reduced. There's no urgency, so we'll give you pain medication and you can follow up with my office in the morning to make an appointment."

"It can wait?" Mr. Baxter asked.

"Yes," Doctor Robbins said. "Anytime in the next three days is fine. Mike, six hundred of Advil every six hours until I see him."

Doctor Robins left, and I explained everything to the patient, wrote out the prescription for Advil and gave him his first dose. After verifying that he wasn't seeing double or feeling dizzy, I discharged him, then went to take a nap, managing to get sixty minutes of sleep before being woken for an ambulance run just before 5:30am for an MI. He was admitted to Cardiology just before 7:00am and I went to the cafeteria to have breakfast, finding Sophia sitting with some other students.

"OK for a doctor to sit with you?" I asked.

Sophia laughed, "Sit down, Mike! Nobody here will object. Doctor Mike Loucks, Intern, meet Jenny Brown, Fourth Year, and Nancy Burke and Kelly Atkins, Third Years."

"Nice to meet you all," I said.

"Surgeon?" Kelly asked.

"Trauma surgeon," I replied. "I'm a surgical intern, but assigned to the Emergency Department. Trauma surgery is a new specialty. What Match do you hope to get?"

"You and me?" Kelly said brightly, flashing a smile.

"I hate to break it to you," Sophia said, "but he's married and has a daughter,"

"Bummer!"

"I'm flattered," I said, "So besides that?"

"Surgery."

"And you two?"

"Internal medicine," Jenny replied.

"Either trauma or surgery," Nancy replied. "I haven't decided yet. What exactly does a trauma surgeon do?"

"The duties haven't been fully fleshed out, but as a surgical intern I'm allowed to do chest tubes and pericardiocenteses, and I get to occasionally scrub in for surgery. After two years in the ED, I'll be in the direct surgical training program, but assigned to cover the ED and perform general emergency surgery."

"That sounds cool! Will there be other trauma surgery spots?"

"The next one will open when you Match," I replied. "I suggest listing it first, then listing either trauma or surgery here. There are other hospitals with programs as well. Right now I know of Indiana University and the University of Chicago, but I'm sure there will be others. Sophia, are you all set for San Francisco?"

"Robby will have a spot at Stanford, so it's all a question of Matching. I can't schedule my interview yet, obviously."

"You'll only apply in the Bay Area, right?"

"Yes. There are at least a dozen programs that would fit in the general category of neonatal surgery, though only the one that's doing the _in utero_ surgery at the moment."

"I'm sure you'll get it," I said.

"Me, too! But you know contingencies are necessary!"

"Absolutely. Jenny, when is your trauma Sub-I?"

"November and December."

"And your Clerkships?"

"January and February," Nancy replied.

"November and December," Kelly replied. "I really look forward to working with you!"

She flashed another smile and her eyes twinkled, indicating she was flirting.

Sophia and I exchanged a look, and I was positive she'd say something to deter Kelly who seemed to have decided that me being married didn't matter. I finished eating, bade everyone 'goodbye', then headed back to the Emergency Department.