Chapter 30 — What Are You Going to Do About It?

_August 1, 1989, McKinley, Ohio_

{psc} "Mike," Nate said from the door to the lounge. "You have a visitor."

"Who?" I asked.

"She said her name is Jenny."

"Around fifteen, right?"

"Yes."

That meant it was Jenny Leonard, the girl who'd lost her brother in an MVA, and who I'd promised to help become a doctor after consoling her. I asked Mary and Tom to wait in the lounge and went to the waiting room where I saw Jenny, who had developed into a beautiful young woman.

"Hi, Jenny," I said. "Come on in."

"Hi, Mike! Or is it 'Doctor Loucks' now?"

"I go by 'Doctor Mike', but you can call me 'Mike'."

I led her to the consultation room and left the door open to deflect any possible questions from anyone in the ED.

"How are things going?" I asked.

"Good. I had all A's for Freshman year. I'll be a Sophomore in a few weeks."

"That's good to hear. How are you feeling?"

"I miss Jeff a lot," she said. "Do you miss your wife?"

"Every day," I replied. "It hurts, but not as bad as it did. I hope that's true for you, too."

"It is. Mom had me talk to a counselor who helped some."

"I did the same thing."

"When did you become a doctor?"

"I graduated at the end of May, then started working in the hospital as an Intern on July 1st. Are you still planning to be a doctor?"

"Yes. I wanted to ask you what classes I should take, I mean, for electives?"

"I would make sure you take every science class available, because the most important criteria for getting into medical school is how well you do in science, and that's what the MCAT, the admission test for medical school, focuses on. Otherwise, take classes that interest you. I found Latin very helpful, but I don't think Hayes County offers Latin."

"No. Just French, Spanish, and German."

"Otherwise, philosophy, psychology, or sociology will all help with your coursework and in becoming a good, well-rounded doctor."

"And you'll help me?" she asked.

"I promised to do that, and I'm not going to break that promise."

"How is your daughter?"

"She's great. Would you like to see her? She's in daycare."

"Yes! I love babies! I just don't want one!"

"I understand that sentiment. I had some friends who were pregnant in High School and it was extremely difficult."

We left the consultation room, I let Ellie know I was taking a break, and then Jenny and I walked to the nursery where I asked Marcie to bring Rachel out, which she did.

"Daddy!" Rachel exclaimed.

I took her from Marcie, then turned to Jenny.

"Jenny, this is Rachel; Rachel, this is my friend Jenny! Say 'hi', please."

"Hi Djenny!" Rachel said, not quite getting the 'J' sound right.

"Hi, Rachel! You're a pretty girl!"

"Would you like to hold her?" I asked.

"If it's OK."

"It is."

I handed Rachel to Jenny, and happily Rachel didn't object to Jenny balancing her on her hip.

"I take it you babysit?" I inquired.

"Yes. That obvious?"

"You balanced her on your hip like a pro!"

"Who watches her when the daycare is closed?" Jenny asked.

"My wife, my sister-in-law, or her grandparents."

"You remarried?"

"In January."

"I think it's important for a girl to have a mom."

"Me, too," I replied.

We stayed for about five minutes, then I handed Rachel back to Marcie, and Jenny and I left.

"Is there anything specific I can do for you?" I asked.

"No. I just wanted to say 'hi' and ask about electives. I called to make sure you were here, and when they said you were, I rode my bike. I'll get my learner's permit in November."

"It sounds as if everything is going well," I said. "Apart from being a bit sad."

"Do you go to the cemetery?"

"Occasionally, though I went more during the first year."

"I go there and read, sometimes out loud. Is that weird?"

"Not at all. I spent a lot of time talking to Elizaveta, and that was a good thing."

"And you think they can hear us and know we're there?"

"I do. I can't tell you how, because it's a mystery, that is, something hidden from us, but I believe it. You remember I wore my cassock, right?"

"You were a pastor of some kind."

"A deacon, but I had to step down in order to get married."

"Really? Why?"

"Because while our clergy are permitted to be married, it has to happen before they're ordained. Because I wanted to marry, and because I had to focus on Rachel and medicine, I really couldn't fulfill my obligations as a deacon."

"Is it OK to come see you again?" she asked as we walked into the Emergency Department.

"Yes, of course. Just call to check if I'm here, and if I'm not, ask when I will be."

"Great! Thanks so much!"

"You're welcome."

"Is it OK to hug you?" Jenny asked.

"It is," I confirmed.

She gave me a quick, friendly hug, then I walked her to the door of the waiting room. Once she'd left, I walked back to the nurses' station to let Ellie know I was available.

"I'm _way_ more fun than that jailbait could hope to be!" Ellie said, her eyes twinkling.

"Her brother died in an MVA about two years ago and I consoled her as a deacon and promised to guide her on her quest to be a doctor. There is nothing more to it than that!"

"Uh-huh. She had the 'I am in the presence of a god' look in her eyes."

"Well, I do have on red scrubs," I chuckled. "But I don't get that vibe at all. And I have to ask you not to imply that ever again."

That list bit was said sternly.

"Sorry, Doctor," she said.

"I don't mind you teasing on occasion," I said. "But that is a line you simply cannot cross."

"Yes, Doctor."

"It's Mike," I said.

She smiled, "Thanks."

"Mike?" Nate called out. "EMS three minutes out with an unspecified groin injury."

"Male or female?" I asked.

"Male. Use Trauma 3."

"OK."

I called Mary and Tom, and the two of them and Nurse Kellie accompanied me to the ambulance bay. Two minutes later, the EMS squad pulled up and Julie, the lone female paramedic, jumped out.

She was smirking, which told me this was going to be 'interesting'.

"Sam Hoffmann, nineteen; BP 120/70; pulse 80; PO₂ 99% on air; penile bleeding due to torn foreskin inflicted dentally when he and his partner were surprised _in flagrante delicto_."

"Trauma 3," I said, knowing the story was going to be 'interesting'. "Mary, monitor; Kellie, we'll need an Irrigation syringe, saline, and a basin."

"Labs?" she asked.

"I don't see a need," I replied.

We moved Mr. Hoffmann to Trauma 3 and moved him to the trauma table.

"Mr. Hoffmann, I'm Doctor Mike. Can you tell me about your injury?"

"It hurts like hell!" he exclaimed.

"Let me take a look, please," I said.

"Do we have to have chicks in here?" he asked.

"You have a choice about who treats you," I said. "Kellie, Mary, would you step out please?"

Mary frowned, but Kellie gently took her arm and they stepped out of the room.

"Tom, hook up the monitor, please, then get the irrigation syringe, saline, and a basin, please."

"Just the pulse oximeter, right?" Tom verified.

"Yes. No need for the blood pressure cuff or EKG."

"Mr. Hoffmann, Tom is going to put a monitor on the index finger of your left hand, and I'm going to move the sheet to examine you."

An examination of the injured member showed a torn foreskin, as Julie described. I had no experience with foreskins as I'd been circumcised as an infant, so I wasn't sure how severe the tear was, though I was positive it 'hurt like hell'.

"Tom, after you set up the irrigation tray, call Urology for a consult, please."

"Right away, Doc."

"Mr. Hoffmann, I'm going to irrigate your wound and then we'll have a specialist examine you. How did this happen?"

"I was at my girlfriend's house and her dad came home while she was…you know. He opened the door, saw us, and she bit me. How bad is it?"

"I'm not an urologist," I replied. "But it does not look as if there is any damage to your member beyond the foreskin. I'm going to irrigate it with saline. When was your last tetanus shot?"

"I don't remember having one."

"Then we'll give you one and start you on a course of antibiotics. Human bites often cause infections. Do you have diabetes?"

"No."

"Drink to excess?"

"No."

"Are you taking any medications?"

"No."

I finished irrigating the wound and covered Mr. Hoffmann's groin with a clean cloth.

"Meyer, Urology," Doctor Pete 'Oscar' Meyer said, coming into the room.

Under the circumstances, I felt it was more appropriate to call him by his first name, rather than refer to 'wieners'.

"Hi, Pete. We have Sam Hoffmann, nineteen, with a torn foreskin as a result of a bite accidentally inflicted during fellatio. I've irrigated the wound and ordered a tetanus shot as well as a course of antibiotics."

"Hi. Mr. Hoffmann," he said to the patient, "I'm Doctor Meyer from Urology. May I take a look at your injury?"

"Sure."

Doctor Meyer performed the exam.

"Mr. Hoffmann, I recommend a circumcision, given the tearing, which makes a repair difficult, and might well result in circumcision, anyway. There's also a higher risk of infection if we attempt a repair."

"Shit!" Mr. Hoffmann swore. "How bad will that hurt?"

"We'll use topical anesthetic for the procedure and it'll be uncomfortable for a week or so, but it'll heal completely in about two weeks."

"And if you fix it?"

"A similar recovery time, though, as I said, with a risk of needing the circumcision if it doesn't heal properly."

"Remove it," Mr. Hoffmann said. "My girlfriend doesn't like it, anyway."

"Mike, you can give the tetanus injection, but we'll take care of the antibiotics. Send him up when you're ready."

"Will do."

"Mr. Hoffmann, I'll see you upstairs," Doctor Meyer said.

He signed the chart and left the room. I excused myself, stepped out, and retrieved the pre-packaged tetanus shot. I took it to the trauma room and had Tom administer it. Once that was done, I had him call for an orderly while I completed the chart. Ten minutes later, Mr. Hoffmann was on his way upstairs.

"Sorry about that," I said to Mary when I found her in the lounge.

She smirked, "Did his girlfriend really bite off his foreskin?"

"Not off, but enough that he'll need it surgically removed. Not something I'd want to contemplate at his age!"

"Mike?" Ellie said from the doorway. "Detectives Kleist and Tremaine are here about your patient."

"Tom is taking him upstairs right now. What do they want?"

"They just said they wanted to speak to him."

"Send them up to Urology," I replied.

"OK."

She was back thirty seconds later to let me know they wanted to speak with me, so I left the lounge and the three of us went to the lounge in the absence of a Resident's office.

"What can I do for you, Detectives?"

"Tell us about Sam Hoffmann's injuries," Detective Tremaine requested.

I described them, then asked, "What's going on?"

"Her father filed a sexual assault complaint," Detective Tremaine replied.

"She's underage?"

"She's sixteen, but for a minor, a parent can lodge a complaint up until they turn eighteen."

Something of which I was aware.

"You should see Doctor Peter Meyer in Urology," I said. "He has the patient who's going to have surgery."

"I'll want your chart notes, Doc," Detective Kleist said.

"The hospital requires a subpoena for the actual notes," I replied. "But I'll cooperate, of course."

"We'll get it by the end of the day. Preserve all your notes."

"I always do, both the chart and notes in my personal notebook."

"Thanks, Doc."

"From the way the patient described it, it was consensual. You can't cut the guy some slack?"

"Take it up with her dad and the State Legislature," Detective Tremaine said.

I nodded, "Understood."

They left, and I went back to the lounge, where Mary was waiting.

"What was that?"

"She's sixteen and her dad lodged a complaint."

"That's over the age of consent!" Mary protested.

"And under Ohio law, a parent can lodge a complaint for a minor, even if she can legally consent. Given they were caught in the act, and he has an injury from the act, denial on her part won't help."

"Wow. That sucks!"

I chuckled, "Not how I'd put it, but yes."

Mary smirked, "And it _really_ sucks to be him!"

"Some joking is OK," I said. "But you need to be very careful about when and where."

"Sorry," Mary replied quickly.

"That wasn't a reprimand, just a reminder."

"Do you agree with the law?"

"No, but my solution would be to not file charges in a similar situation. What other parents do would be up to them."

"Why not try to get the law changed?"

"I have plenty of other windmills at which to tilt," I replied. "I'm sure you've seen the changes which have taken what used to be mostly a probation offense in the 70s to one that now has penalties approaching forcible rape and manslaughter. I have limited capacity to fight injustice, and I have to pick my battles, most of which revolve around mental health care or hospital policy."

"That makes sense, though I hear doctors make some fairly offensive jokes."

I nodded, "They do. Don't be like them. And be very careful about using medical slang around patients, especially words like 'gorked' or 'gomer'. Ultimately, the answer is simple — treat others as you would have them treat you."

"Jesus' command?"

"Yes, and combined with his other great command — 'love one another' — a perfect approach to medicine, and all of life."

"Mike?" Nate said from the door to the lounge, "Doctor Varma needs help with walk-ins."

Tom came in just then, with perfect timing.

"Mary, Tom, let's go!" I said.

Over the course of two hours, we treated four patients for a mix of minor ailments which ought to have been treated by a primary care physician. Just before lunch, I caught an ambulance run with a rule-out MI that turned out to be severe indigestion caused by what was best described as poor dietary choices. After the patient was discharged, I went to the cafeteria to have lunch with Clarissa. A few minutes later, Sophia came to sit with us, rather than her friends.

"I had a word with Kelly," Sophia said. "I'm not sure it did any good."

"What happened?" Clarissa asked.

"A Third Year," Sophia replied, "who, when Mike asked what Match she wanted, replied 'you and me'. I pointed out that he's married and has a kid, then spoke to her later. Her response was 'all doctors cheat'."

"Not Petrovich!" Clarissa declared emphatically.

"That's what I told her, but she didn't believe me. She has her sights set on you, Mike."

"Then she's going to be as disappointed as Nurse Ellie and Erin Edwards. By the way, I heard through the grapevine Erin is getting married, so that should resolve that situation."

"Why would you think that?" Clarissa asked. "She was willing to be the 'other woman', so what makes you think she's going to be faithful to her husband?"

"Good point. I'll be careful."

"Is Ellie behaving?"

"Mostly. She flirts lightly, but isn't obnoxious, though I did have to speak sternly to her this morning. Jenny Leonard stopped by for a visit and Ellie called her 'jailbait' with all the implications of that word."

"Who's that?" Sophia asked.

"A girl I counseled and consoled after her brother died in an MVA about two years ago. They'd had a fight and instead of going with him to school, she decided to take the bus. He was involved in the MVA while driving to school."

"Survivor's guilt?" Sophia asked.

"Yes. She came back not long after for a tour and asked about being a doctor. I gave her advice and said she should come by occasionally to check in. She did that this morning. And, no, I do not get that vibe at ALL from her."

"She's what? Fourteen?" Clarissa asked.

"Fifteen, and will be a Sophomore. Ellie claims she saw 'hero worship' in Jenny's eyes, but I don't think so, given I was the enemy who let her brother die. I think Jenny might be in awe of me being a doctor, but she certainly doesn't think we're gods because we didn't save her brother."

"I get hit on all the time by patients," Sophia said.

"So does Clarissa! Ask her about the football player from Hayes High!"

Clarissa laughed, "He was cute, not obnoxious like some."

"I had an interesting case this morning," I said with a goofy smile.

"Oh?" Clarissa asked.

"Foreskin injury when a nineteen-year-old and his sixteen-year-old girlfriend were surprised by the father coming home from work unexpectedly."

"I'm a girl, but 'ouch!'," Sophia exclaimed.

"Yeah. He went up to urology for an adult circumcision."

"Double 'ouch!'," she exclaimed. "I'm curious about your position on that. Circumcision, I mean, not sixteen-year-olds, because we KNOW your position on that one, at least in the past!"

"Yeah, well," I chuckled. "As for the procedure, I disagree with my Dutch Calvinist dad. Strongly. He had it done after I was born as 'routine', and I would never contemplate that. I get the religious significance for Jews, but the idea that Christians practice it _at all_ is mind boggling, given the clear statements against it in Paul's letters."

"I thought you said it was «ekonomia»."

"It was, but Christians do not need that sign, as our covenant is different. The so-called Judaizers lost the debate, and rightly so. Medically, there is no reason to perform a circumcision, with the usual arguments, such as cleanliness, being complete BS. Fundamentally, it's an unnecessary procedure, and with the exception of religious ritual, ought never to be performed without medical necessity."

"What's your take on cosmetic surgery?" Sophia asked.

"I object if it's purely for vanity. If it's in response to some kind of disfigurement due to disease, defect, or trauma, I'm OK with it. That said, I wouldn't make it illegal, I just wouldn't participate."

"So similar to your view on elective abortions."

"Yes. Any interesting cases on your services?"

"Just routine," Clarissa replied.

"Same here," Sophia added. "Mike, what is your schedule for September?"

"Monday, Tuesday, and Thursday 0500 to 2100; Wednesday 0800 to 1700 at the Free Clinic; and Friday and Saturday 0500 to 1700. I saw you're on five sixteen-hour shifts that roughly coincide with mine."

"I asked Doctor Casper if I could be assigned to you, and he agreed. I assumed you wouldn't have a problem with that."

"Of course not!"

We finished our lunches, and I headed back to the ED, and as things were quiet, I sent Mary and Tom to have their lunches. We had a busy, but calm afternoon, with no severe trauma and at 6:00pm, after handing over to Kylie, I headed up to the surgical locker room for a shower.

"How are you doing?" Shelly asked when I walked in.

"Good," I replied. "I'm doing my best to control my windmill-tilting impulses."

"Pick your battles wisely."

I nodded, "I made the point earlier today to Mary that it was important to pick my battles, but that was on the topic of a non-medical concern."

We both walked to the showers, then dried off, dressed, and headed for the elevators."

"How do you feel about your Residency so far?" she asked.

"I'm happy. I mean, the hours suck, but they're being reduced to eighty as of next month, which means there are basically dedicated sleep periods in those long shifts. That will make a huge difference."

"What about practicing medicine?"

"I'm mostly allowed to operate autonomously in all but the most severe traumas."

"And your students?"

"I enjoy teaching, and all six of them are eager to learn."

"Would you change anything?"

"I would have said the hours, but given they're being reduced by at least ten, I can't really complain about that. I think the only thing I'd point to is that some Residents and Attendings aren't with the program, so to speak."

"Mastriano?"

"For one, but also the lazy ones on other services. We had a situation where a Resident refused to admit patients despite having empty beds, insisting they were 'too busy' to take patients. It's not the first time with this Resident, and Doctor Northrup was informed."

"You won't find that on the surgical team. Doctor Cutter simply won't tolerate it."

Which was, ultimately, the problem with Doctor Mastriano, and Doctor Northrup had dealt with it, so I didn't mention it.

"Given increasing patient loads, it's something no service can or should tolerate."

"Exactly!" Shelly said as we reached our cars.

"Good night. See you later in the week."

"'Night!"

I got into my Mustang and headed home for dinner and a quiet evening with my wife and daughter.

_August 2, 1989, Rutherford, Ohio_

On Wednesday morning, Rachel and I left home early so that we could have breakfast at my grandparents' house with my grandparents, my mom, Elaine, April, Liz, and Michael. I'd also stop in to see my dad at work before my lunch with Doctor Mercer. I hadn't seen my half-brother Peter and half-sister Faith in some time, but I didn't feel right stopping at the house when my dad wasn't home.

"I'll take my granddaughter!" my mom said when I arrived at my grandparents' house.

"I believe Grandma has seniority," I said, seeing my grandmother come into the foyer behind my mom.

"Thank you, Mike!" Grandma said. "You're a very wise grandson!"

Mom scowled, "Oh, sure, Mom, feed his ego!"

"I'll leave you two to fight over Rachel," I chuckled, putting her down on the foyer rug.

With her safely, at least in theory, with my mom and grandmother, I went into the living room to greet my grandfather. We shook hands and just as I sat down, Liz arrived with Michael, and Elaine came into the room with April.

"How are things going at the hospital?" my grandfather asked.

"I'm not getting enough sleep, but that was something we knew would be the case. I'm enjoying my work, and I'm able to care for most patients who present without direct supervision."

"All by yourself?" Elaine asked.

"No. Almost always two medical students and a nurse assist me, and for very severe trauma, two doctors work together with the students and nurses. And, of course, I call for help for areas when I need an expert opinion, or if I'm unsure how to proceed."

"Do they check on you the way they did when you took care of me?"

"No, but I report everything to my supervisor and discuss things with them. When I call a specialist for help, they do check my work because the rules require it."

"And everything is OK at home?" my grandfather asked.

"Mikey married a hot eighteen-year-old!" Liz teased. "I'm sure _that's_ OK!"

"Be respectful, Elizabeth," my grandmother admonished.

"Yes, Grandma," Liz replied.

"Everything is good," I said to my grandpa. "You can see Rachel is happy and healthy and loving the fact that her grandmother and great-grandmother are making her the center of attention."

"Breakfast is almost ready," Grandma said, putting Rachel down on the floor with her cousins.

Fortunately, Michael wasn't nearly as rambunctious as Viktor, so Rachel tolerated him, though she was far more interested in April, who was only a few weeks older. Rachel would be very happy on Friday, as Abigail and her parents had returned from Spain, and Rachel hadn't seen Abigail for nearly a month.

"Mike, come to my study for a few minutes before breakfast," my grandfather requested.

We left the living room and went to his study, where he shut the door.

"How are your finances?"

"They're good. I received my first paycheck on Monday, so we're in very good shape. I also received the check in the mail from you. That's the last one, correct?"

"Yes."

"Rachel, Kris, and I are extremely grateful for the assistance. If there is anything I can do for any of you, ever, please let me know."

"Well, I do have this pain…" my grandfather teased.

I laughed, "Fortunately, that hasn't happened yet, but I'm sure it will. Your health is OK? And Grandma's?"

"Yes, thank God! Shall we join the others for breakfast?"

We left the study and went to the dining room for a breakfast, which, sadly, did not include bacon, as it was a Wednesday, but we had waffles, eggs, fruit, and juice. Rachel tolerated scrambled eggs, but really loved waffles dipped in maple syrup.

After breakfast, I helped my grandmother clean up while my mom spent time with Rachel and her other grandchildren.

"How are you doing, Grandma?" I asked as I dried a plate.

"Besides being old?" she asked with a smile.

"What did your doctor say at your last checkup?"

"That my heart is fine, and there was nothing wrong with any of the blood tests. He said I need to take iron and calcium supplements."

I nodded, "That's not uncommon for women who are past menopause. No arthritis or memory problems?"

"None! My fingers don't work quite as well as they once did, but I still do my needlepoint. I also don't drive very much, but with your grandfather here all the time, it's not necessary."

Those were things which also came with age. She was seventy, and my grandfather seventy-two, and both appeared, from what I could observe and what they said, in excellent health for their ages. We had no real information about longevity on the Russian side of my family, as nobody knew how long my great-grandparents had lived.

On the Dutch side, there was a history of heart disease in the men despite complete abstinence from tobacco and alcohol until my dad, who drank. That family history was something to watch out for, and something I'd mentioned to Doctor Smith at my most recent checkup. What it meant was that at around age forty-five, I'd start having an EKG as part of my annual physical.

"I'm glad you're feeling well, and I'm sorry we can't visit more often. Kris sends her regrets, but she had class today at Ohio State."

"May I ask why she's going during the Summer right after you married?"

"So that she can graduate on time even when she takes a semester off after each new great-grandchild."

"She's pregnant?" Grandma asked hopefully.

"No, but we'll start trying soon."

"Nothing will make me happier!"

"Please don't say anything yet. We'll let everyone know once Kris is past her second month."

"I would never betray your trust, Mike!" Grandma declared. "Just keep me supplied with great-grandchildren!"

I chuckled, "We'll do our part!"

"Do you enjoy being a doctor?"

"Very much," I replied. "It's what I've wanted to do since I was ten."

"I'm glad you're happy, Mike."

"Me, too!"

We finished in the kitchen, then had coffee with the rest of the family. Rachel and I stayed until 11:00am, then headed to the building which housed the Harding County Property Division to see my dad. We spent about fifteen minutes with him, and despite my desire to normalize the relationship, it was still strained. We did agree that he, Holly, and the kids would come to dinner sometime in September, once my schedule changed.

Rachel and I left and headed to Lou's to meet Doctor Mercer. We arrived a bit early, and I asked for a booth and a booster seat for Rachel, then took her to the bathroom so I could change her diaper. When we came out, Doctor Mercer had arrived and the three of us sat down in the booth, Rachel in the booster seat next to me.

"She's a beautiful little girl," Doctor Mercer observed.

"She takes after Elizaveta!"

"Obviously! I can see it in her eyes and her nose."

I nodded, "And soon enough, with her hands on her hips reminding me why I ought to bow down before the Tsarina of the Known Universe!"

"Does Kris do that?"

"No, but genetics being what they are, I expect it. I already see something of Elizaveta in the way Rachel cocks her head to look at things, and the way her eyes twinkle when she's about to do something mischievous."

"Do you make those observations to anyone else?"

"No. And I haven't said anything at all to Rachel. She calls Kris 'Mama' and I haven't even pointed to the small framed picture that we added to our icon corner after Kris and I discussed it. We'll do that at some point, probably when she asks who is in the picture with the black ribbon."

"Do you know what you'll say to her?"

"I think it depends on how old she is, but I wrote a letter to Rachel on the advice of the hospital social worker, along with one to Elizaveta. Those were part of my recovery process."

"Writing letters such as those is an effective strategy," Doctor Mercer said. "How are you doing?"

"I'm OK. The problem now is more stress and lack of sleep than anything. That said, Resident hours in the Emergency Department are being reduced to eighty per week from ninety to ninety-four."

"Why?"

"The result of the Libby Zion case in New York. The State of New York changed maximum Resident hours to eighty, with at least twelve hours between shifts. I won't have twelve hours between shifts because we don't have enough Residents, but I will have dedicated time I can sleep, which I don't have now, which was the main point of the New York law. Eventually, we'll match the New York rules, and I expect eventually the AMA will endorse them."

"That's a good thing."

"I think so."

"Have you seen Angie?" Doctor Mercer asked.

"About a month ago. We probably shouldn't discuss her before the hearing on the 23rd."

"Tell me about your wife, if you would."

We were interrupted by the waitress, who took our orders, then I described how Oksana had introduced me to Kris, and how we'd come to a quick agreement to marry, and how things had been since January.

"You do not do anything conventionally," Doctor Mercer said with a slight smile. "But that seems to work for you."

"May I say something that will probably offend you?"

"I think it's probably best if you just say what you're thinking."

"With Liz, you got it exactly right. With everything after that, you got it exactly wrong. Your advice, in each instance, was the opposite of what proved to be the correct course of action. My relationship with Clarissa, my marriage to Elizaveta, Angie's treatment, the situation with Samantha, and my grieving process.

"The bottom line, and the cause of all of those, is pigeonholing people and expecting every person's experience to necessitate the exact same advice or treatment. Oh, sure, there are slight variations, but in each case that I mentioned, you assumed that the 'norm' was the _only_ answer. And in each case, you were completely wrong."

"You don't pull any punches."

"I don't with Attendings, why would I with you?"

"That's going to get you into trouble."

"Which is not a reason not to do it, which is what you implied. Bad advice. Again."

"Did you agree to this lunch to take pot shots at me?"

"No, but you made a statement about my methods, and admitted they worked for me. I pointed out that I acted contrary to your advice in every situation except the one with Liz. If we're to have any kind of relationship in the future, you have to know how I feel. And you also know that I expect blunt talk right back. I don't flinch; I listen and learn."

"I'm going to assume from what you said that you had sex with Samantha Gilbert."

"Yes."

"You're reckless, Mike."

"That's the exact opposite conclusion to which every Attending and Resident who has supervised me has come. Which ought to tell you something."

"In your _personal life_," Doctor Mercer countered.

"I disagree. Evidence suggests I've evaluated each situation correctly, made the correct choices, and taken the correct action. Every time I went against your advice, except with Liz, it turned out properly, and when you went against _my_ advice, it turned out badly."

"You were lucky."

"I suppose you'll say that about every patient I save from now until I repose. I mean, after all, my judgment is terrible and I always have terrible outcomes, except for dumb luck, right?"

"Again, you're mixing your personal life with medical practice."

"As if those two things could be separated in any way?! Being a doctor is not just _what_ I am, but _who_ I am. And again, I'll point out that despite your belief that I've been lucky, my judgment has been good. Have I made mistakes? Absolutely. I've made them at the hospital, too. But I've rectified those mistakes and learned from them.

"I do need to correct one thing I said — you were right about telling Elizaveta about the extent of my experience before we were engaged. I misjudged, but I also corrected it. But in all the other cases? Clarissa and I absolutely _had_ to make love because we had to know if a marriage was possible. Marrying Elizaveta was the best possible course of action for me, and despite her repose, was exactly what I needed, and gave me Rachel.

"As for Angie, you never once gave her a _real_ chance. You relied on your statistics and generalized treatment plans, rather than an individualized one. I don't treat every patient who presents in the ED exactly the same way because they aren't the same. Do I consider the standard of care? Absolutely. Do I follow it slavishly? Not when something doesn't fit.

"Samantha's situation was one where I'd completely misjudged her problem, missing the whole 'Catholic guilt' thing because I don't have that experience. You, on the other hand, should have picked up on it because you're Jewish and have mentioned a similar mentality. The problem was, according to Samantha, that you flat-out refused to discuss religion based on a flawed notion that even talking about it with most patients is an ethical violation.

"Let me be even more blunt, Doctor Mercer. You need to rethink your entire approach to psychology. If you can't, you're going to have more disasters similar to the one with Angie. Had I listened to you, I would never have married Elizaveta and Rachel wouldn't have been born. Samantha is in her first long-term, successful relationship. Clarissa and I are as close as we've ever been, and we're going to have a child together."

"WHAT?!" Doctor Mercer gasped.

"You heard me. Artificial insemination, of course, but that was the plan from about halfway through our undergrad work. And yes, Kris is aware, and does not have a problem with Clarissa conceiving via artificial insemination. She does draw the line at conceiving naturally, obviously."

Doctor Mercer shook her head, "As I said, you do not do anything conventionally."

"True. So why do you assume that conventional answers will work with me?"

Doctor Mercer frowned, "You have a point, but only to a point."

"I have it all off my chest now," I said. "But I do want you to give serious consideration to what I've said and treat your patients individually, using the standard of care as a guideline, not a straitjacket."

"You're awfully arrogant for an Intern."

I shrugged, "That doesn't make me wrong. And whatever else I may be, or whatever else I might think, or whatever I might do, my patients come first. Every single thing I do is in the best interest of the patient in front of me, not ones from the past, even when it goes against standard practice. Nothing will ever deter me from being a forceful advocate for my patients, or in Angie's case, for people I love who need medical care."

"Have you been subject to an M & M?"

I smiled, "Yes, but I was on the side of the angels, as it were. I objected to 'standard care' because I was convinced that wasn't sufficient. My Attending disagreed, and I insisted they write their order on the chart and sign it. I was right."

"You're going to be wrong, Mike."

"Of course I will. As I said, I've made mistakes, and despite your diagnosis of 'arrogance', I ask for help when necessary. I'll make an error in judgment on that someday, but so far I've asked for help when I've needed it, and I'm careful about that. But my Attendings have signed off on procedures that no Intern normally does because I'm that good. Call it arrogant, but it's true and I can show you the evaluations and signatures in my log books."

"What happened to humility?"

"You're mistaking self-confidence for arrogance. Would YOU want a trauma specialist or surgeon to doubt themselves? How well would that work out?"

"This is a side of you I haven't seen and wouldn't have expected."

"Thus proving my point, at least partly. But answer my question, please."

"Of course I wouldn't want them to be tentative or lack confidence in their skills."

"You also have to take into account I'm speaking to you the way I'd speak to an Attending who challenged me. I don't speak to patients in this way, or to Kris, and certainly not to Rachel."

"It seems that you've concluded I'm incompetent."

I shook my head, "No, you're a product of the system that trained you, just as I am. And we both know that mental health is poorly understood, and poorly treated because of that poor understanding. I know for a fact that if I remove an inflamed appendix, it's going to resolve the appendicitis.

"Yes, there might be other ailments, and there might be complications, but the appendicitis will be resolved. You can't say that about _any_ mental health condition. I can, in effect, follow the printed instructions in the surgical manual and they will work every time, allowing for complications which are rare. That doesn't work for mental health issues, and yet, that's how you and Doctor Greenberg treated Angie."

Doctor Mercer was quiet for a bit, and the waitress brought our food, which included the strange combination of mac and cheese and French fries for Rachel, but she loved both and I wasn't going to deny her as she had to tolerate my meeting with Doctor Mercer. I said grace, then helped Rachel eat while eating my own lunch.

"I suppose I admitted as much in my statement to the Medical Licensing Board," Doctor Mercer said a few minutes later.

"Yes, and that brings us to the most important question — what are you going to do about it?