Chapter 75 — An Interesting Insight

_February 4, 1990, Loveland, Ohio_

{psc} On Sunday morning, we left my mom's house just after 7:00am so we could drive to Saint George in Loveland. We'd had a nice evening with my mom's side of the family the night before, and we'd stop in to see my dad and his family on our way home from church. The major announcement had been that Liz was pregnant and was due in July.

The church services were nearly identical to those at the Cathedral, minus the slight variations between Slavic and Greek traditions. At Eucharist, I took my godson Mikey with me, as was the tradition, and we received together. I didn't see him nearly often enough, but there wasn't much I could do to rectify that at the moment.

When the service ended, my family joined the rest of the congregation in the parish hall, and we took seats by Angie and her mom. Angie, as she usually did, wanted to interact with Rachel, and Rachel sat in Angie's lap while they talked. Angie's speech was still off by a beat, as I'd observed, but the doses of her medication were low enough that her eyes were clear and her hair shiny. Sadly, that was the best that could be hoped for at this point. Perhaps someday, a cure or a treatment that did not produce the negative side effects might be found, but I knew that was a long shot.

"Hi, Mike!" Sheila Nixon exclaimed, sitting down at the same table.

"Hi, Sheila! Where's Mikey?"

"He's decided Mom is useless and is hanging out with the other little boys in the playroom!"

"Terrible twos in full force?"

"And then some! I had a call from Jessica Melbourne! Talk about a surprise coïncidence!"

"How are things going?"

"Great! Jeremy and I are still together, though he's on a business trip this weekend."

"That's good to hear! I mean, being together."

"I got that meaning," she said with a smile. "How are things with you?"

"The usual life of a PGY1 Resident," I replied. "Very little time for anything other than the hospital. Things will calm down a bit in June when I start PGY2. And in something you'll appreciate, I delivered a baby!"

"In the ER?! Really?"

"OB blew us off, so I had no choice. Fortunately, it was a routine delivery, except for having a trauma surgeon do it! Baby and teenage mom were healthy."

"You seem to have an affinity for pregnant teenagers!" Sheila teased.

"Including me, technically!" Kris declared. I'm due in June, so I'll still be nineteen when our baby is born!"

"And we'll have an OB in attendance for that one!" I declared.

We finished our light meal, and with permission from Mrs. Stephens and agreement with Kris, Angie and I took a short walk in the mild Winter weather.

"How are you doing?" I asked.

"OK," she replied, speaking slowly. "I'm working full time and practicing Aikido."

"That's good."

"Would you and your family come to dinner?"

"Yes. I'll work out the timing with your mom. You know I'm very, very busy at the hospital."

"Yes."

"Are you able to see your friend Anna?"

"Yes, she comes to visit about once a month. Some girls from the church take me to dinner after Vespers most Wednesdays. I wish I could see you more often."

"I will try my best, but most likely, it won't be until Summer because I work six days a week. I'm glad you're doing things with the girls from church."

"When you come to dinner, will you bring Rachel?"

"Yes, of course."

"Thank you."

We walked in silence for about five minutes, during which I contemplated what might have been had it not been for the heinous malpractice by a doctor who should have lost his license permanently. I pushed that last thought out of my mind, as all it would do was frustrate me and make me angry. I loved Angie dearly, and while I didn't believe in unforgivable sin, Doctor Greenberg had certainly committed a grievous one.

As we walked back to the church, Angie took my hand, squeezed it, then let it go. I wondered if Angie's situation was part of my current mental and emotional state and decided it most certainly was, though there wasn't much I could do except, as the saying went, suck it up and deal with it.

_February 5, 1990, McKinley, Ohio_

"How is Angie?" Clarissa asked at lunch on Monday.

"The same, which, at this point, is the best we can hope for. I realized that Angie's situation is absolutely feeding into my emotional and mental fugue. I don't get to see her often enough, and I absolutely don't see my godson often enough, either."

"It all comes down to your personal relationships. I think only Kris, Rachel, and I have anything even remotely resembling how you dealt with relationships before we graduated. Even at your lowest point after your Kitten reposed, you didn't cut people out of your life. In fact, you clung to them," she said, then smirked and added, "Especially nubile young women!"

"They were an effective balm," I replied.

"Yes, but it wasn't the sex; it was the closeness. I know that for a fact because we spent so many nights cuddling. Not that I'm saying you didn't enjoy the sex, too, just that it wasn't your _primary_ need."

"I'm fairly sure that's always been the case," I replied.

"Which fits with your rejection of some of the more hedonistic ideas that were proposed by some of the girls, going back to Taft. Not to mention the 'feminine' qualities which so many of us noticed, even though they really aren't 'feminine', per se, just that men tend to hide them. You never did.

"Working in the ED requires you, at least on the outside, to be emotionless. I know you've tried to compensate with your relationships with Kellie, Shelly, and a few others, but there's a limit. Heck, even our relationship is limited. Minus the period during which you were a deacon, I don't think we spent more than five minutes together that didn't result in hugs and often cuddles. Me being lesbian was actually to your advantage."

"I will reject THAT idea to my dying day!" I declared. "I very much enjoyed having sex with you, Lissa!"

"But it was for the same reason I enjoyed those encounters — the closeness. But we achieved that with just cuddles on many, many occasions. Roll all of that together, and I think you're on target with your feeling that it's your personal relationships that have you feeling morose and unfulfilled. You achieved your primary goal in life, and that meets one of your needs but leaves the others destitute, so to speak."

"The very thing I warned every young woman about along the way, sometimes to their frustration. Kris eventually told me to shut up about it because she understood and didn't need it repeated."

"Which proves she was the correct choice for you. She can handle it. I do think Doctor Mercer went a bit overboard in saying that you're actively punishing yourself. I equate it to fasting — you deny yourselves something to enhance your spirituality, just as you deny yourself things to enhance your medical career. The difference being there are no feasting periods, and you don't have anyone assigning a rule the way you do with prayer and fasting."

"An interesting insight, Lissa."

"I know you better than anyone on the planet, including your wife and your «старец» (_staretz_). And it makes sense if you think about it. Over the past nine years, who have you spent more time with?"

I smiled, "Only Anicka comes close."

Clarissa laughed, "And it only took her six years to get what she wanted from day one!"

"And you know that was about her, not about me."

"Of course, but it could only happen for _you_ if you were very close to her. Otherwise, you would have declined. She could never have been a…dalliance is a good word, the way the girls auditioning for the role of Rachel's mom were!"

"I don't think it was quite that casual," I replied.

Clarissa laughed, "Seriously? How many of those girls felt they had a real chance, and how many just wanted a surreptitious fuck, knowing full well they'd never marry you? Susana Razumovsky, for sure, and probably Irina Gromova. And in some ways, Oksana Korolyov, because I think she knew there was no chance when you went to bed together. In fact, that was her version of a Hail Mary."

"I suppose," I replied.

"Add in the girls who just wanted to screw like Annette Turner-Cooper, Lexie Grey, Michelle Latham, and the four High School friends attending college together, plus your fuck buddy Kylie, and, well, you get the picture."

"OK, OK. You've made your point! I was a male slut! However, I do need to remind you that Annette would have been a candidate had she not had a scholarship to Vanderbilt."

Clarissa laughed, "You being a slut wasn't my point, and you know it! Yes, you had a lot of sex, but what you _really_ wanted was closeness. The girls wanted to fuck! But my point remains, casual or not, that's what it was really about. And that's what you're missing. I don't mean the sex; I mean the close relationships.

"Go back to pre-doctor days — Lara, Sophia, Sandy, Jason, Pete, Clark, Peter, Robby, Elias, Milena, Anicka, Angie, and on and on. And then there were Tasha and Lara, who were in a completely different class — girls who, under different circumstances, you would have married. And, of course, your one true love."

"Angie."

"Obviously. But you don't have those close relationships, and _that_ is the problem, as you and Kris identified. And, to be blunt, it's of your own making because of your single-minded focus."

"And yet…"

"Yes, it's the program, but it's also you. Your needs are VERY different from mine, Shelly Lindsay's, Leila Javadi's, or any of the male doctors. Or if not different, more intense. You and I both know how many doctors self-medicate in one way or another. You need the closeness, and if you don't get it, something bad is going to happen."

"Which is my gravest fear."

"And a self-fulfilling prophecy if you don't find a way to reconcile it."

"I know. And I hate to cut this short, but I have interviews."

"Me, too."

We hugged, returned our trays, and I headed for the conference room to interview medical students for surgical Residencies.

_February 7, 1990, McKinley, Ohio_

On Wednesday, I decided to take my lunch hour outside the hospital and visit the record store. Clarissa chose to accompany me, and after changing into street clothes, we drove through Wendy's to get our lunch, which we ate along the way.

"Mike?!" Johnny exclaimed. "Long time, no see!"

"Hi, Johnny," I said. "I've been busy."

"You graduated, right?"

"Yes."

"So, Doctor Loucks?"

"I go by 'Doctor Mike' at the hospital," I replied. "But just call me Mike, please. I'm going to browse, but I'd like recommendations, please."

"It's been some time," he said. "I think right off the top of my head I'd suggest _Freedom_ by Neil Young, which is far better than anything he's released in the 80s. I'd also suggest _Let Love Rule_, by Lenny Kravitz, a new fusion artist, and finally, _Pretty Hate Machine_ by a new industrial rock band from Cleveland, Nine Inch Nails."

"I'll take all three of those and browse for one more."

"You used to buy one a month," he said with a smile. "Perhaps you should catch up!"

I chuckled, "I did, but my time is severely limited, even to listen to music. I promise I won't stay away as I have for the past year."

"Vinyl or plastic for those albums?"

"Plastic," I replied. "I'm only going to buy vinyl for things that aren't on CD."

"OK."

I browsed for about fifteen minutes, selected _Storm Front_ by Billy Joel as my fourth album, and took it to the counter where Johnny rang up all four CDs for me.

"Could I interest Code Blue in playing at a music festival I'm organizing at the lake in August?"

"You could. Talk to Kim Liang. I'll give you her number."

I pulled out my pocket address book and wrote down Kim's name and phone number, then paid for my purchases.

"Thanks, Johnny," I said.

"See you soon, Mike!"

"I promise."

We shook hands, I accepted the plastic bag with the CDs, and Clarissa and I left the record store.

"Feel better?" she asked.

"It's not magic, Lissa!" I chuckled. "But it is a start."

"You without your music is almost unfathomable."

"Rachel agrees with you. She insists I play my guitar and sing to her."

"Just wait until she has a dozen fifteen- and sixteen-year-olds at the house to hear you play!"

"I get the joke, Lissa, but you know my take on that topic. Kris is at the extreme range of what I think is reasonable at our ages."

"Obviously, but who would I be if I wasn't teasing you, especially about nubile girls? It's how I show I love you!"

"You, Liz, my sister-in-law, Anicka, and a host of others!"

We got into the car, and I headed back towards the hospital.

"What's next?" Clarissa asked. "Band practice?"

"Not until after Pascha. I spoke to Kim, and we'll practice on Sundays, which gives us four practice sessions before the two Proms, and then we'll have Saturday practice sessions before the concert on the Fourth. Fortunately, the trauma conference in Indy doesn't conflict, though it does take away one practice session."

When we arrived at the hospital, I went up to the surgical locker room, changed into scrubs, stashed my CDs in the locker, then headed to the conference room.

"Mike, Nate was looking for you," Shelly said when she came in.

I nodded, went to the phone, and dialed the number for the ED Clerk's desk.

"Mike here," I said when Nate answered. "Shelly Lindsay said you were looking for me."

"I have a message from a Mary Kopech at Harding County High. She'd like you to call her."

That was the guidance counselor, and I was sure I knew what she wanted.

"OK. I'll call on our next break."

We conducted an interview with a student who was not at all impressive, and he scored a 26 on my tally sheet. If it had been appropriate, I'd have suggested he arrange for interviews outside surgery, as I doubted he was going to Match.

"How did that one slip through?" Doctor Burke asked.

"His grades are impressive," Shelly observed. "But he's far too tentative and unsure of himself. He fumbled Mike's usual surgical question that any Fourth Year should be able to answer off the top of their heads."

"If you'll excuse me, I need to make a phone call, please."

I went over to the phone and dialed the number for Harding County High. When a secretary answered, I asked for Mrs. Kopech and was put right through to the guidance office.

"Hi, Mrs. Kopech, it's Mike Loucks."

"Hi, Mike, or should I refer to you as Doctor Loucks?"

"Just Mike is fine; I use 'Doctor Mike' professionally. I'm going to wager you're calling about 'Career Days'."

"You'd win that bet! Would you be available on either May 11th or May 18th to speak to Juniors?"

"Let me speak to my Chief," I said. "I can probably get the day off, but if not, I'll trade shifts. OK to call you back in a day or so?"

"Yes, of course. Thank you."

We said 'goodbye', and I hung up.

"Owen will give you a day off for career days," Shelly observed. "Just let him know."

"Actually, now that I think about it, if I do it on May 18th, I already have the day off to travel to Indianapolis for a conference. The first event is dinner at 7:00pm, so if I finish at the High School by 3:30pm, I can easily make the dinner. I'd miss cocktail hour, but I don't drink, and there is a social event on Saturday evening."

We couldn't continue the conversation because a medical student arrived with a candidate, and we had to begin the next interview.

_February 9, 1990, McKinley, Ohio_

"I am SO glad the interviews end today," I said to Clarissa when we met for lunch on Friday. "I've barely been able to practice medicine for a month! A few hours in the mornings, a few in the evenings, and Saturdays."

"They rotate who does the interviews, right?"

'That's the theory, but I could be asked by either Chief, and then I'd have to choose."

"Just decline next year, Petrovich. They'll abuse you if you allow it. Remember, nobody can take advantage of you without your permission."

"Hah! Tell that joke to medical students and Interns!"

"We signed up for it, Petrovich! We gave consent! But now we can start saying 'pick on somebody else' because we're only a few months from the end of PGY1, and they'll have a whole new crop of Interns and medical students to abuse! Did you make arrangements for the Career Day?"

"Yes. I'll do it on the 18th because I was given the time off, so I could get to Indianapolis by noon when registration starts, but I'll just take late registration after 5:00pm and spend the day at the school."

"What are you going to wear?"

"That's an interesting question. If it were me, I'd go with scrubs, but the standard attire for surgeons is dress slacks, a dress shirt with a tie, and a medical coat. As much as I like to rock the boat, I think I'll follow protocol."

"Either way, you'll have a gaggle of teenage girls drooling over the 'hot' doctor!"

"Do you ever stop, Lissa?" I asked with feigned exasperation.

"No! It's true; you just won't do anything about it! It happens when you play at the High Schools, and you know it!"

"And that's _exactly_ why they limit student access to the band!" I chuckled. "José was in his element before he married!"

"I'm surprised he and Sierra aren't pregnant yet, as good Catholics!"

I chuckled, "About the last thing I'd call José would be a 'good Catholic'! And you know, conception can be problematic for something like a quarter of married couples. Not that they can't get pregnant, just that it takes a long time, and there are a large number of miscarriages before the end of the first month."

"That is the one thing that worries me about getting pregnant — what if it doesn't 'take'?"

"All we can do is trust the medical procedures and the fertility specialist you'll see in a couple of years. Evidence suggests I have VERY motile sperm!"

Clarissa laughed, "Within a month of your first attempt, both times! Though your Kitten was beside herself when she didn't get pregnant the first time."

"I partially blame what passes for sex ed. While it's absolutely true you can get pregnant your first time, and from just doing it once, that is actually very rare. But it impresses young women with the idea that they ought to get pregnant the first time, and when they don't, it causes anxiety, which…"

"Makes it less likely they'll get pregnant. What would you do?"

"Besides dumping the stupid 'abstinence only' sex ed which is about as effective as Nancy Reagan's 'Just say no to drugs' campaign…"

"That would be not," Clarissa interjected, interrupting me.

"Pretty much. The most effective deterrent at this point would be AIDS, which should scare the bejeezus out of anyone and cause them to _always_ use condoms unless they're in a monogamous relationship. But the only way to do THAT is to have frank, open conversations about sex, and not just heterosexual sex."

"That is the real source of the problem, isn't it?"

"For sure. To talk about AIDS in any detail, you have to acknowledge homosexual sex AND discuss it because it turns out straight people engage in anal sex, too! Add in the whole concept of 'technical virginity', and you have a recipe for unsafe oral and anal sex while permitting the fiction of virginity. Kris was flabbergasted by girls at school having that idea."

"She thinks oral sex is more intimate than intercourse," Clarissa said. "She and I discussed it, and she has some valid points."

"Despite being French," I chuckled.

"You do realize I know you're only saying that to maintain the ability to tease her, right?"

"She knows it, too! Worse, so does my menace of a sister-in-law! I need to find her a boyfriend so she can annoy someone besides me!"

"As if _that_ is going to stop her! You're the safest guy on the planet to tease because you're married to her sister!"

"Oh, I know, but I can hope!"

"She's just practicing on you for when she has to keep her boyfriends and eventual husband in line!"

"All she has to do is pay attention to the older ladies at church to learn how to do that!"

"Have they tried to match her with anyone?"

"Yes, and she's flat-out refused to participate. That's pretty much the attitude of all the girls at all the parishes these days."

"Speaking of which, are you planning to attend Vespers at Saint Michael every Wednesday?"

"Yes. It gives me back an hour. I'm considering Saturdays as well. I still want to be at the Cathedral on Sundays because I like seeing Vladyka regularly."

"Is he going to ask you about being a deacon again?"

"I suspect so, given the ministry at the prison and everything else, but Kris will never accept it, so it's a non-starter, even if I was willing to subject myself to it again, which I decidedly am not."

"That won't upset him?"

"Kris will provide all the cover I need. If she objects, it's a dead letter, and I won't need to say more. I need to get back. See you tonight at the Chinese restaurant!"

"I am so glad you started coming to the Friday night outings again. I know others are, too."

We hugged, and I headed to the conference room for the final four interviews.

_February 10, 1990, McKinley, Ohio_

"Free at last! Free at last! Thank God Almighty! Free at last!" I said when I saw Isabella Mastriano very early on Saturday morning.

"That bad?"

"Yes. I'm going to decline to serve for at least two years, I think. Another plus from declining besides time is that frees me to write letters of recommendation for students who want to Match here for surgery or emergency medicine."

"What's your assessment?"

"There are some very good candidates, and there were some weak ones I wouldn't even list at the bottom," I said. "We'd be better off with someone who Scrambled because they didn't get their preferred programs. Beyond my three top picks, I'm more interested in who is offered the second Attending slot. We all know Pete Gabriel is going to be offered a position, and I'm positive he'll accept."

"Any thoughts? Not that we have any actual input."

"I'm not sure how to set the odds," I replied. "We don't know who the Chief of Emergency Medicine will be, and I suspect he or she might want to bring in at least one of their PGY3s from whichever hospital they are from."

"I thought you were gung-ho for Loretta."

"I am, but the rumor mill is insisting they'll go with someone with experience running a Level I trauma center, and Loretta will keep her Chief Attending role. She's only been in it a short time, which doesn't work in her favor. But that won't stop me from lobbying Cutter every chance I get!"

"Just insist! You seem to get every _other_ thing you insist on!"

"If only that were true!" I chuckled. "I don't have the power some people think I do."

"Tell me one thing you want that can't have!"

"World peace!"

"I meant here at the hospital, you nut!"

"Oh," I replied with a grin. "More resources; more hands-on training; more time with patients. Need I go on?"

"You have had some success on the 'hands-on' time issue."

"True, with help from Shelly Lindsay and Carl Strong. And honestly, that's the one thing I would prioritize because it's something we can actually do. What would you want?"

She smirked, "You!"

"I thought you learned your lesson about married doctors from Rosenbaum!"

"He was a jerk; you aren't."

"I think 'cheating on your wife' and 'jerk' go hand-in-hand. I'll accept the flattery, but you know better."

"Of course! You wanted to know what I wanted and couldn't have!"

"That's quite the change in attitude."

"I never wasn't attracted; I was just annoyed at how everyone seemed to bend over backward for you."

"And what do you think now?"

"All kidding aside, it's earned. Becky nailed it when she said you were the best doctor in the ED. I surprised myself and learned some things from you."

"And I from you. That's what this is all about. I need to go find my students and do some actual doctoring!"

I left the Attending's office, found Phil and Cathy, and then checked on the patients Paul Lincoln had handed over before I'd gone to see Doctor Mastriano. It was a happily routine day, and I treated a total of nineteen patients, one more than I'd treated in the five preceding days combined. Of those, only two were EMS transports, and they were admitted with good prognoses.

Just before 5:00pm, I had a surprise visitor — Jack Strickland.

"Doctor Loucks, do you have a moment?"

I nodded and chose not to correct his form of address, as there would be time to do that in the future. We went to the lounge, as he hadn't asked for privacy.

"What can I do for you?"

"I received my schedule for Third Year," he said. "My first Clerkship is in the Emergency Department, and I wanted to ask your advice."

"On?"

"What should I study before my first day?"

"Make sure you practice suturing," I said. "That's the number one thing you can do to show Residents and Attendings you are trustworthy. Buy bunches of bananas and suture until you can do it almost automatically. Second, know how to set up a five-lead and twelve-lead EKG. If possible, learn how to recognize the major conditions — sinus tach, V-tach, ST Elevation, V-fib, and A-fib. And, finally, be able to take a good history and perform a thorough physical."

"Anything else?"

"You'll learn to insert Foley catheters, so knowing the procedure and how they're sized is important. In addition, make sure you know the reference levels for Chem-20 tests. Yes, I know they're printed on the reports now, but you need to know them anyway. You also want to study basic emergency diagnostics and know what to do for common conditions such as hypoglycemia, hyperglycemia, hypokalemia, and so on. Nobody will expect you to know all of that the first day, but it will help. You have a small mountain to climb."

"I know. I screwed up badly. And I received very bad advice from a friend about retaining a lawyer. That was an error."

"Yes, it was. How were your grades?"

"If it weren't for Pass/Fail, I'd have been screwed. I scraped by that first semester. I've had no disciplinary black marks, and I've passed all my Preceptorships with at least average scores. But the suspension and letters of reprimand from the first few months are an albatross."

"One you can overcome if you do what I said."

"Any chance I'll be assigned to you?"

"Unlikely," I replied. "I'll be on a surgical rotation, so I'll be upstairs alternate weeks, and when I'm covering the ED, I'll have surgical students. You might get me when you have your surgery Clerkship."

"Thank you."

"You're welcome. You have a tough row to hoe," I said. "You cannot make a single error in judgment, and a single inappropriate or boorish comment will sink you permanently. Your challenge will be that others will be able to say things in jest with impunity, but you'll be held to a higher standard. One transgression will get you bounced."

"I know."

"Then, as I've said to others, being a doctor better be the thing you want more than anything in life, and you better show it every single second of your waking existence for the next two years."

"It is, and I will. I learned my lesson."

"Good. I'll see you in June."

He extended his hand, I shook it, and once he left, I noticed it was time to leave. I went to find Kylie, turned my patients over to her, and headed home so Kris, Rachel, and I could have dinner and then attend Vespers at the Cathedral.

_February 11, 1990, Sunday of the Publican & Pharisee, Circleville, Ohio_

On Sunday, after church, Kris, Rachel, and I headed home to begin preparing for our dinner party with Jocelyn and Gene, Clarissa and Tessa, Chris and Tasha, Elias and Serafima, Subdeacon Mark and Alyssa, and Lara and Nathan.

"Will Larisa be here today?" Rachel asked as we walked into the house.

"Yes," I replied. "And Aunt Lyudmila will come get you two and take you to her house for a special dinner together."

"«J'aime tante Lyudmila!»" {green}("I love Aunt Lyudmila!"){/green}

"_Somebody has to_," I said _sotto voce_ to Kris, so Rachel couldn't hear, and Kris laughed softly.

Kris and I changed into comfortable clothes, then Kris helped Rachel change. The three of us went downstairs, and Kris and I went to the kitchen to begin preparing the meal. Rachel helped by setting the dining room table, which she did one plate, one bowl, and one glass at a time after I had set them on the kitchen table so she could use her stepstool to reach them.

Just as Rachel began putting out the flatware, the doorbell rang. I went to answer it because Rachel wasn't able to do that yet. I went to the door and opened it, and Tasha, Chris, and Larisa came into the house. Before I could shut the door, a car pulled into the driveway.

"«Lyudmila! Grand-père et grand-mère!"» Rachel exclaimed.

"Are you ready to go, Rachel?" I asked, suppressing an eye roll.

"«Oui papa!» she giggled.

I hugged her, and when Lyudmila came to the door, Rachel and Larisa left with her, and I returned to the kitchen, only to be shooed away by Tasha because she wanted to have a private conversation with Kris. I went to the great room and asked Chris what he wanted to drink, but before I could do that, more of our guests arrived. Fifteen minutes later, the entire gang was with us.

We had a great time, and I felt a lot better by the end of the evening when Rachel and Larisa returned. Our guests left, and I read to Rachel. Kris, Rachel, and I said our evening prayers, and after Kris and I put her to bed, we took a bubble bath and then climbed into bed together.

"You seem in a much better mood," Kris observed.

"Somewhat," I agreed. "I just need to find the right balance. I do think we should attend Vespers on Saturdays at Saint Michael. That extra hour will make a big difference between now and June."

"That's fine, Mike. I'm OK with worshiping at Saint Michael. Have you figured out what you want to do about your godson?"

"I think we have to worship at Saint George in Loveland every four to six weeks, then have dinner with Sheila and Jeremy. That would also give me a chance to see Angie more often, which I think is very good for her."

"I think it will be good for you, too."

"Medicine failed her miserably, as it fails most patients with mental illnesses."

"Well, we're not going to solve that tonight!"

"Is there something I can do for you?"

"Just wrap your arms around me and sleep."

"I can do that!"

_February 12, 1990, McKinley, Ohio_

"Morning!" I said to Sue Townshend when I arrived in the ED on Monday. "Quiet night?"

"Very. Only five patients total, and none to turn over. I managed to get four hours of uninterrupted sleep!"

"Then have a good day!"

"I can actually do a few things this morning because I don't need to go home and go right to bed! Later!"

"Later!"

She left and I went to the lounge where Ghost, his students, and my students were all relaxing on the couch or in easy chairs. I poured a cup of coffee, tossed a quarter into the bowl, and sat down in the remaining chair. About thirty seconds later, Ellie came to the door of the lounge.

"Multi-victim MVA," she said. "EMS transporting three; first is about three minutes out. Same intersection on 23."

"They need to do something about that," Ghost said. "This is the fourth major accident at that intersection in the past two months. Let's go, gang! Ellie, who's the third doctor?"

"Varma. He's aware."

"Let Doctor Gibbs know, please. Mike may be very busy."

We all got up and hurried to the ambulance bay, joined by Doctor Varma and his students, Doctor Gibbs, and four nurses. That left only Ron Lewis and his students to cover anyone else who presented while we worked on the accident victims.

It was a crazy ninety minutes where I inserted two chest tubes, performed a pericardiocentesis, and inserted a central line but we managed to transfer all three victims to surgery alive. I had hoped to scrub in, but with all three being surgical cases, Owen Roth had simply pushed all four non-emergency procedures, so they had sufficient surgeons.

The rest of the morning was calmer, with only walk-ins, until Nate let me know about an MI being transported by EMS. Laurie, Max, and I headed to the ambulance bay, accompanied by Kellie.

"Laurie, if you were going to run this, what would you do?"

"EKG, monitor, cardiac enzymes, and standard trauma panel."

"Correct, though I prefer you list the specific tests you want so there is no confusion."

"ABG, CBC, and Chem-20."

"What are we looking for with regard to an MI?"

"On the EKG, any deviation from normal sinus rhythm; in the blood, O₂ and CO₂ levels, plus elevated cardiac enzymes."

"Max," I asked, "Are you able to read an EKG?"

"No. My cardiology Clerkship starts in April."

The EMS squad turned into the driveway, and I made the usual assignments. The squad pulled to a stop in front of us, and Julie, still the lone female paramedic, hopped out.

"Nikolay Kozlov, 71; reported chest pain and difficulty breathing after breakfast; portable EKG shows inverted T-waves; BP 90/60; Pulse 90; PO₂ 95% on eight litres; IV saline TKO, and nitroglycerin tab sublingually."

That was a new thing for the paramedics, which would help with MI survival rates and accounted for the depressed blood pressure.

"Trauma 2," I ordered. "Patient is a smoker and drinker but has no history of heart trouble."

"How do you know, Mike?" Kellie asked.

"This is Elizaveta's paternal grandfather. Nikolay Vladimirovich, we'll take very good care of you!"

We got him to the trauma room and transferred him to the table. Kellie drew blood while Max switched the oxygen to the hospital supply, and Julie attached the EKG and monitor.

"Confirm inverted T-waves," Julie announced as I performed my primary exam.

"Max, call for a cardiology consult; Kellie, 250mg ASA IV push."

"Mike?" Ellie said from the door. "Viktor Kozlov is here and asking about his father."

"Tell him I'm busy and will come out as soon as I can. No status, please."

"OK," she acknowledged.

"Nikolay Vladimirovich, you've had a heart attack," I said to him. "I've called for a cardiologist, and we'll take very good care of you."

He tried to speak, but it was muffled by the mask. I moved it away from his mouth so I could hear him.

"«Позвоните священнику!» (_Pozvonite svyashchenniku_)," he whispered. {green}("Call the priest!"){/green}

"«Я сейчас позвоню отцу Николаю» (_Ya seychas pozvonyu ottsu Nikolayu_)." ("I'll call Father Nicholas right away.")

"Max, I'm going to give you a number to dial, please, then bring me the phone."

"Doctor Mike, what did you say?" Julie asked.

"He asked for his priest and I replied I'd call him right away."

I gave Max Father Nicholas' number, and he dialed it, then stretched the phone to where I was standing.

"Kuznetsov residence," I heard his wife say when she answered.

"Matushka Natalya, it's Mikhail Petrovich. I need Father Nicholas at the hospital. Nikolay Kozlov has had a heart attack and is asking for Father."

"Lord have mercy! How is he?"

"We're still evaluating him. Please have Father come right away. Viktor is here, but I haven't spoken to him yet."

"I'll tell him, Mike!"

"Thanks."

I handed the phone back to Max, who hung it up.

"Pace, Cardiology," Alana announced as she came into the room with her student.

"Hi, Alana," I said. "Nikolay Kozlov, Elizaveta's paternal grandfather; 71; smoker; reported chest pain and difficulty breathing after breakfast; portable EKG shows inverted T-waves; BP 90/60; Pulse 90; PO₂ 95% on eight litres; IV saline; ASA 250mg, nitroglycerin tab sublingually in the field."

"Got it," she said.

She introduced herself, performed an exam, and checked the EKG.

"Jake, we're taking him up," Alana said. "Call upstairs and tell them we'll do a cardiac ultrasound in the Cath lab _right now_. We need a gurney."

"Max, get a gurney," I ordered. "Alana, if you have this, I'm going to speak to his son."

"I have it."

"Julie, with me, please."

Julie and I left the trauma room, and I went to the triage desk and waved for Viktor to come through.

"How is he, Mike?"

"Alana Pace is taking him up to cardiology for more tests. The EKG shows some potential damage to his heart. He asked for Father Nicholas, and we called him. I expect him here momentarily."

"Can I see him?"

"When they bring him out, I'm sure Doctor Pace will be OK with you walking with them to cardiology."

"Thanks, Mike."

Just as he said that the red strobe above the door to Trauma 2 flashed, indicating they'd called a code.

"Wait here, please!" I said as I turned quickly and hurried to Trauma 2 with Julie following right behind me.