Chapter 13 — I believe it's called a 'Come to Jesus' meeting

_April 8, 1990, Palm Sunday, Circleville, Ohio_

{psc} "How did things go with Father Roman?" Kris asked when I arrived home on Sunday afternoon.

"I very much enjoyed the Palm Sunday services at the monastery," I replied, "but I took my usual beating on Saturday from Father Roman."

Kris laughed softly, "The only reason to visit a «старец» (_staretz_) is for a spiritual beating! If we didn't need the beating, we wouldn't visit the holy monk!" {green}("Elder"){/green}

"I tend to need more beatings than most!"

"I disagree — you're simply more aware of your interior life than most people. And you take the commands in the Beatitudes and David's Psalm as seriously as anyone I know."

"And I have many failings to discuss with Father Roman."

"One area where you absolutely have not failed is your devotion to Rachel, nor in your commitment to me."

"Failing in either of those areas would create my own personal Hell."

"What about a personal heaven?" Kris asked with a twinkle in her eye. "It would be the last time because of Holy Week."

"What did you have in mind?" I asked with a grin.

Kris winked and carefully moved from the couch to the floor and ran her finger over my flaccid shaft. Her intention became exceedingly clear when she unzipped my slacks.

"What if Rachel wakes up from her nap and comes downstairs?" I asked as Kris unbuttoned the button of my slacks

"Then she'll see just how much Mama loves Papa!" Kris said lightly.

"I'm not sure our toddler needs to see that to know how much we love each other!"

"I can stop," Kris said, reaching into my briefs to grasp me.

"No," I whispered. "Don't stop."

Fifteen minutes later, after a very sexy blowjob, my wife tucked me back into my briefs, having had no interruption from our daughter. Kris moved to my lap, and we exchanged a soft French kiss. When we broke the kiss, she snuggled close and rested her head on my shoulder.

"You don't have to do that," I said.

"Of course not, but I want to," she replied. "I do it because I love you, because I know it feels good, and because I enjoy doing it. I can't imagine it's not similar to you enjoying using your mouth on my «minou». You've told me many times how much you enjoy it and like how I taste."

"I have," I admitted.

"And you have no qualms using your tongue even after we have made love, nor any about kissing me after I've sucked you."

"You know I will do anything you ask."

"And I will do anything you ask. Our bodies belong to each other and are, among other things, for giving pleasure to each other."

"And babies!" I declared, running my hand lightly over Kris' baby belly.

"And babies!" Kris agreed happily.

"Papa!" Rachel exclaimed, carefully coming down the stairs.

"Hi, Rachel!" I said. "Come sit with Mama and Papa!"

She came over, and Kris and I shifted a bit so that Rachel could join us despite my wife's ever-growing baby belly.

"What did you do while Papa was at the monastery?" I asked.

"The store, played with Abi, played with «Tante» Lyuda, and church. Papa play guitar?"

"Papa can play guitar if it's OK with Mama."

"Mama?" Rachel asked.

"Yes," Kris replied. "Let's get you a snack; Papa can change clothes and then play his guitar."

Kris got up from my lap and took Rachel to the kitchen. I zipped my slacks, then got up and went upstairs to change. Ten minutes later, all three of us were back in the great room, and I had my guitar. After playing for about an hour, we had dinner, then headed to Saint Michael for the first Bridegroom Service.

_April 9, 1990, McKinley, Ohio_

Doctor Roth asked to see me as soon as I arrived at the hospital on Monday morning.

"I've heard some disturbing things," he said.

"About?" I asked.

"You," Doctor Roth replied. "I've heard you and Doctor Saunders are planning to leave for Residencies in Chicago. But I also heard that you asked about switching to a pure emergency medicine Residency here."

"Do you trust the nurses?"

"Yes, of course, but what does that have to do with those rumors? Well, the second one isn't a rumor, per se, because I heard it straight from Mrs. Cartwright."

"I can't help it if rumors are spreading, and did Mrs. Cartwright tell you the context?"

"No."

I smiled, "Context is everything, Owen."

"You're not answering me any more directly than you answered Shelly. You're usually forthright, and you aren't now, which is giving me heartburn. And not just me — Ron Getty, Carl Strong, Tim Baker, and others."

"All I can say is I didn't start the rumors and that Mrs. Cartwright appears to have left out key context. I'll ask you the same question I asked Shelly — in my position, what would you do?"

"And I suppose the answer I have to give is the same one she did – please do not act precipitously."

"You know that's not me."

"And that's what has me concerned. Things will work out here, Mike."

"Can you actually guarantee that? You and I both know I'm not cut out to be a pure surgeon, and I'm also constitutionally incapable of simply sitting around for hours at a time when I could be treating patients. For better or worse, I'm wired for emergency medicine, and this last week has been pure torture. Not to mention it basically violates my Residency contract."

"So you _are_ considering leaving here," Doctor Roth said. "Violation of your contract is the one way you can leave on your own with no recriminations and no black marks."

"I'm considering all options," I replied.

"Please don't make any final decisions until we have time to work on this."

"As I said, I'm considering all options, and I won't act without due consideration."

"I suppose that's all I can ask at this point. Would putting you on a regular surgical rotation and splitting ED consults amongst the other Residents help?"

"Somewhat, but at what expense? Upsetting the rest of the team? Creating more dissension in the ranks?"

"Give me a day or two to discuss this with Bob, Nelson, Vince, and Shelly. OK?"

"Yes, of course."

"Thanks, Mike. You know this is not what any of us wanted."

"Well, _somebody_ wants it, or it would have already been undone, and we wouldn't be facing a strike by the nurses because their working conditions were unilaterally changed without consultation as required by their contract."

"The Hospital will get an injunction against what amounts to a wildcat strike."

"Oh, brilliant," I sighed, shaking my head. "Forcing nurses to work against their will is not conducive to good patient care. And that will make them even more steadfast in their demands for their new contract. It's a war the hospital cannot win in the long run, and one in which the patients are the collateral damage."

"I didn't say I agreed; I simply noted what would happen; it's happened in other hospitals around the country. I'm sorry to cut this short, but I need to prep for surgery."

"I understand."

I left his office and went to the lounge to wait for an ED consult. It was nearly 8:00am before I was paged. I found Nick, who was in a sour mood, which I suspected was a result of my conversation with Shelly on Friday. If he raised the topic, I'd discuss it with him, but I wasn't going to ask.

"Mike Loucks, surgery," I announced as I walked into Trauma 3 with Nick in tow.

"Morning, Mike;" Kayla Billings said. "Larry Peters; fifty-one; suspected cardiac tamponade; BP 80/50l; tachy at 120; shortness of breath; PO₂ 92% on five litres by mask; patient is suffering from acute kidney failure and awaiting transplant."

"Good morning, Mr. Peters," I said. "I'm Doctor Mike, a surgeon. I'd like to examine you, please."

"Sure, Doc," came the muffled response.

I first checked his neck and found distended jugular veins, and when I listened to his heart, I heard muffled sounds. Those two signs, in addition to hypotension, were called Beck's triad and were strong indicators of tamponade.

"Nick, I need an ultrasound so I can confirm, please."

Nick left, and suddenly, the monitor changed.

"No pulse!" Kayla declared. "Electrical activity indicates PEA!"

"That's definitive, and he can't wait," I declared. "Wendy, cardiac needle with a lead and an alligator clip to me, please."

She moved quickly, and I performed a blind pericardiocentesis and filled the syringe, and the patient's pulse returned.

"He's going to need a catheter," I said. "There's still fluid in his pericardium. We need to get him on dialysis."

I inserted the catheter with Kayla's assistance, and the patient's blood pressure came up ten points, and his pulse slowed to 102. That meant he was stable enough for emergency dialysis, and Kayla had her student make those arrangements.

"Thanks for the assist, Mike," Kayla said.

"You're welcome."

I left the trauma room, and Ellie stopped me.

"Doctor Wernher would like to speak to you," she said quietly. "He's in his office."

I nodded and turned to Nick, "Head back upstairs."

He acknowledged me, and I went to Doctor Wernher's office, stopping at the open door and knocking on it.

"You wanted to see me?" I said when he looked up.

"Come in, Doctor, and have a seat."

I walked in, closed the door, and sat down. Just like the first time, I waited for him to speak and nearly laughed when nothing was said for the first thirty seconds. I simply continued to look him in the eye and silently prayed the Jesus Prayer. He didn't let it go as long this time, speaking after about forty seconds.

"You've managed to turn the tables on me several times now. Friday afternoon was a nice judo move."

"Something for which I was taken to task by my spiritual advisor."

"Whatever for? It was calm, cool, rational, direct, and effective."

"Before I answer, how much do you know about me, Doctor?"

"I read your clinical evaluations and your medical school transcript. Why?"

"May I speak freely?"

"Go ahead."

"If all you know about me is from my evaluations and my transcript, you have a _very_ incomplete and very inaccurate picture of me. Do you know which church I attend?"

"I don't give a tinker's damn about which church you attend! It's not particularly relevant to anything other than you possibly needing Holy Days off, if they can be accommodated."

"On the contrary," I countered. "I'm sure you heard from Mrs. Cartwright."

"Yes. Another area you outmaneuvered me, though that does raise a question."

"Yes, it does. But more importantly, is that my beard and ponytail are religious and are the sign of a clergyman."

"You're clergy?"

"If you didn't know that, at least in a general way, then please explain why you think you can understand me at even the most basic level?"

"I don't _need_ to understand you. I need to know if you're a good doctor. Anything outside the hospital is your business and completely irrelevant to your work here."

"May I speak bluntly? And I do mean bluntly."

"Go ahead."

"You showed up and, without having done even the most basic homework, picked a fight with me. That's foolish in the extreme, no matter who you are or who I am. It's akin to showing up on a combat ship and picking a fight with a Chief who has been on that ship for the previous five years. That's Captain Queeg territory, Doctor. What's next? An investigation of missing strawberries from the lounge refrigerator?"

"You're out of line, Doctor!" Doctor Wernher growled.

"Not as far out of line as you are, Doctor. I am absolutely positive I know your goal, and you went about it completely the wrong way. In fact, you went about it in a way that will ensure failure. A different approach was called for, and, to be frank, can still work."

"Explain to me how a PGY1 thinks he knows my goals, please."

"First, I checked on your background — "UC Berkeley; Emory Medical School; Residency as a commissioned officer in the US Navy at Bethesda Naval Hospital, then two years at Cam Ranh Bay in Vietnam; hired at Rush-Presbyterian in Chicago as an Attending in Internal Medicine; switched to emergency medicine in 1972; married, with three daughters. «N'est-ce pas»?"

"You did your homework," Doctor Wernher said. "Why French?"

"You would know if you had done _your_ homework. May I continue?"

"Yes."

"In just over a year, we'll be in the new ED and working towards Level I certification. That requires staffing the ED with specialists beyond emergency medicine. You want all of those other specialists to be on your staff, not on their respective services. You picked the fight with me to force the issue now, rather than wait, on the theory that if you could move me to your service, you could claim _all_ the specialists and thus avoid the potential problems of matrix management. How'd I do?"

"That is the gist of it," Doctor Wernher agreed.

"Don't you think, Doctor, that learning about me and enlisting me as an ally might have been a much better plan?"

"You were a vocal supporter of Doctor Gibbs."

"And I'll never cease to be, but I also know she's not able to return to duty at this point, and it could be months, maybe even a year or two, before she'll be cleared. I'm not irrational or impractical, Doctor."

"Spit it out, Doctor. What is it you want?"

"To be a forceful advocate for my patients and provide the best care I am able to provide."

"Besides the textbook answer?"

"I _live_ the textbook answer, Doctor; something you would know if you had taken even ten minutes to talk to Ghost or Isabella in the ED, or Carl Strong, Shelly Lindsay, or Clarissa Saunders. Anyone here could have pointed you to them."

"Fine, you live the textbook answer. Now, what is it you want?"

"Restore things to the _status quo ante_, treat the nurses with respect, and we work together to make this the best Level I trauma center in the state. You might even achieve your ultimate goal of being Medical Director in the process. If you continue on your current path, I don't see that ever happening."

"I'll look weak if I do that."

"Fine, so look weak. Big deal! That will not matter in the long run. Handled correctly, you'll come out smelling like a rose. Confession is, as they say, good for the soul."

"So, what is your story?"

"I'm not the one to tell you. Call Loretta Gibbs and ask her. And while you're at it, ask her about everyone else in the ED. We are far more than our performance reviews and evaluations."

"You have balls, that's for sure."

"I don't see how anyone can work in emergency medicine without them. There isn't a single shrinking violet out there. If you meant confronting you, well, you should have expected that, but again, you didn't do your homework. Anyway, put me back on the ED schedule, take the 'Officers Club' sign off the lounge, and let's work together rather than fight. So, how about it?"

"How do I know you aren't going to try to undermine me?"

"You don't. The only way to know that is to earn each other's trust. You don't trust me; I don't trust you. There, it's out in the open. Now, we can try to fix it, or this entire thing can spiral out of control, and we'll be lucky to get out of it alive."

"_Red October_?"

"Yes. I'm half Russian, and I _always_ have a plan. I'm also half Dutch, so it's always logical and methodical. Call Loretta and go see her today. She's home, and her PT is right before lunch. Once you speak to her, I think you'll have a much better picture. It's what you should have done in the first place."

"You've made your point, Doctor."

"Then, if I'm dismissed, I'll go back up to the surgical lounge."

"Dismissed."

I got up, opened the door, then walked out. As I was leaving the ED, Kellie followed.

"It's my break," she said. "What was that about?"

"I believe it's called a 'Come to Jesus' meeting."

"He doubled down?"

"No, I invited him to come to Jesus or experience hell. His call."

"And his response?"

"Call me if he signs out for a few hours for a meeting, please."

"Will do. Not going to give me a clue?"

"Not at this time. Just let me know if he leaves for a few hours, OK?"

"Will do. Have coffee with me?"

"Sure."

I joined her in the cafeteria, where I paid for both our coffees.

"How are things going otherwise?" I asked.

"I started seeing John, the lieutenant from Station 3."

I chuckled, "John Gage always struck out with nurses on _Emergency_. But all kidding aside, I hope it works out."

"He spent six years as a damage control specialist on the _Enterprise_ before he joined the fire department about ten years ago."

"Think they'll ever let women serve on combat ships?"

"It'll happen, and probably in the next five years. Carriers are big enough to accommodate segregated female quarters. Other ships are more difficult, and subs are nigh on impossible, though you might make it work with boomers. Of course, in order to do that, Congress will have to repeal _10 USC 6015_, which bans women in combat billets."

"I take it you'd have asked for sea duty?"

"In a heartbeat! I wanted to serve on a carrier, but the boys put up the 'No girls allowed' signs for their dumb club!"

I chuckled, "_Calvin and Hobbes_?"

"Yep!"

We finished our coffee quickly because Kellie had to return to the ED, and I headed up to the surgical lounge. I picked up a surgical journal, but my mind was really on the conversation with Doctor Wernher. I'd been blunt and impertinent, but I felt my heart had been in the right place because my goal really was to make peace, not just between him and me, but with the doctors and nurses who worked in the ED.

The thing I simply didn't understand was why he had taken the approach he had. It made no sense, and I couldn't imagine at least getting the lay of the land before trying to make wholesale changes. Moving his office made sense, given he was expected to be hands-on, unlike Northrup, who had mostly taken a «laissez-faire» approach to running the service while he focused on the construction of the new ED, which was taking shape, and would come into service in about a year.

My thoughts were interrupted by Carl Strong coming into the lounge.

"Got a sec, Mike?" he asked.

"Sure. What's up?"

"Privately, please?"

I nodded, got up, and we went to the consultation room.

"I know it's not your style," he said. "But be patient and don't do anything rash."

"I may be impatient, but I am not impetuous," I replied. "I assume you've heard the rumor?"

"I think everyone has. Is there any truth to it?"

"I'll tell you the same thing I told Shelly and Owen – given the situation, I am keeping all my options open. I am not cut out to be a pure surgeon, and I've spent most of the last six days in the hospital sitting on my butt, waiting for consults. All my ED shifts were canceled."

"I'm aware. As I said, please be patient."

"I'll ask you the same question I've asked Owen Roth and Shelly Lindsay — what would you do in my position?"

"I hear you, Mike. Wasn't your primary goal to serve your community?"

"Yes, and if things stay the way they are, that won't be possible. I can't even ask for one day a week at the Free Clinic because it closed as of Friday."

"A travesty."

"Worse; Gale Turner is innocent."

"Is that how you feel or what you know?"

"Both. I was sure it was BS, and once I learned a few more facts and spoke to Gale and his attorney, I'm positive the accusations are false. I'll bet you anything you care to wager, the County Prosecutor offers a plea deal for misdemeanor battery or some similar BS charge. And it's possible they'll dismiss the charges completely if Gale refuses the plea bargain."

"What makes you say that?"

"It's one thing to tell fibs to the cops; it's another thing to get on the stand and perjure yourself. One of the four will crack or recant, and the case will fall apart. It was all about getting the Kelsey Foundation to pull their funding. That's what the protestors wanted, and magically, claims are made against Doctor Turner that caused that to happen."

"Son of a…"

"Yeah. So, here I am, twiddling my thumbs, waiting for my pager to go off. That is not what I signed up for, and having no ED shifts is a violation of my Residency contract."

"The escape clause."

"Yes."

"Please don't exercise that."

"As I said, I'm keeping all my options open. I have not made any decisions as yet."

"Talk to me before you do, please."

I smiled, "I'll add you to the list."

He left, and I returned to the lounge and wasn't paged until 11:10am for a rule-out appy, which caused me to miss my lunch, but which resulted in me performing my second appendectomy under the watchful eye of Bob Anniston.

"Textbook," he said. "Good job, Mike."

"Thanks."

"Take your patient to Recovery, then get some lunch."

I did as instructed and had Penny sit with the patient while I ate lunch. When I finished lunch, I returned to the recovery ward and, about thirty minutes later, escorted the patient to a semi-private room in the surgical ward. I wrote out the necessary orders, then returned to the lounge.

At 2:10pm, Kellie called to let me know that Doctor Wernher had left the building, and I hoped it was to see Doctor Gibbs. I had two more consults in the ED, but both resulted in admissions for scheduled, rather than emergency, surgery. At 5:00pm, I headed home for dinner, and after dinner, we attended the second Bridegroom Matins service of Holy Week.

_April 10, 1990, McKinley, Ohio_

"Why did Tim Baker ask if I had accepted a Residency in Chicago?" Clarissa inquired when we met for coffee mid-morning on Tuesday.

"What did you say?" I asked.

"That I hadn't spoken to anyone in Chicago. He asked if you had, and I said that was a question he'd have to ask you. What's going on?"

"Someone started the rumor that I've arranged a transfer to University of Chicago Hospital for both of us. I saw no reason to deny it, but I also haven't admitted it. I simply say that I'm keeping my options open because the hospital violated my Residency contract."

"Is that actually true?"

"It all depends on how you read it, but I _could_ make the case that being kicked out of the ED means I won't be able to take the emergency medicine boards. Let's just say that nobody has pushed back when I mentioned that, so I think at least the doctors agree. And in the end, if Chicago did sign us to contracts, there isn't really anything Moore could do about that."

"But it's not real, is it?"

"Yes and no. What are my options? Pure surgery? We both know I'm not cut out for that. That would mean switching to a pure emergency medicine Residency. I _could_ do that, but it could come at the expense of patient care. Think about the difference in response times in the ED now compared to the past.

"My other option is to find another program with an opening, but what are the chances of that? You know Doctor Barton would move heaven and earth to create positions for both of us. We'd be going someplace where we were wanted and could do what we're both cut out to do. Yes, it would be disruptive, and I haven't even mentioned it to Kris, but it is an option, even if it's the last resort. Oh, and I could probably finally meet Steve Adams!"

Clarissa laughed, "I think the universe might collapse into a singularity if that ever happened! Your orbits have crossed any number of times, but an actual meeting? I have to be there, Petrovich! Back to the topic at hand, what's next?"

"I confronted Wernher yesterday and read him off."

"I cannot leave you unattended for five seconds without you finding a way to get into trouble!"

"While that's true, in this case, I did it in a way that can't get me into trouble. I called him out for acting precipitously and without any information. The only thing he knows about me is from my evaluations for my clinical rotations and transcript. I challenged him to talk to Loretta about me and others in the ED, and I think he might have done that yesterday. I also told him that he was being a moron in picking an unnecessary fight with the nurses, though I didn't use that word."

"And you don't think he'll use it against you?"

"He could certainly try," I replied. "But I pointed out he needed me as an ally if he wanted to achieve his goals."

"Wait?! Ally?!"

"What is my goal, Lissa? My _only_ goal as a physician?"

"To provide the best possible care, everything else be damned — politics, money, titles, or rules."

"Yes, and if that means finding a way to work with Doctor Wernher, I'll do it. I know what _he_ wants; he knows what _I_ want. If he wants to achieve what he wants, he has to give me what I want."

"What does he want?"

"At the root, it's really a turf war, right? Well, I, and the trauma surgery program, are simply proxies for Doctor Wernher to have more control over the ED. Once we move to the new ED, we'll be working towards Level I certification, which calls for the ED to be staffed with pediatricians, cardiologists, and surgeons.

"The current plan is for all of them to be members of those respective services. There will be a dozen or more doctors from other services assigned to the ED who don't report to him. Right now, there is exactly one person in that situation — me. If he can win the battle and break the longstanding tradition that only surgeons supervise surgeons, he can win the war. If not, he's going to have to deal with staff who aren't his, per se."

"Suddenly, it all makes sense!"

"That's what Mary Anderson said when I spoke with her after she expressed a concern about the program. It's also the case that Wernher wants to achieve what Northrup couldn't — to be Medical Director."

"And you'd help him?"

"I would do what was best for overall patient care," I replied. "That means finding a _modus vivendi_ with Doctor Wernher and finding areas where we agree. I called him out on that plan and pointed out that what he's doing now will make it impossible to achieve his goals. I proposed he restore things to the _status quo ante_, that he treat the nurses with respect, and that we work together to make this the best Level I trauma center in the state."

"I can't see him backing down."

"He said it would make him look weak, and my response was, 'Big deal!' and pointed out that it wouldn't matter in the long run because if he handled it correctly, he'd come out smelling like a rose. That's when he asked for my story. I declined on the grounds I shouldn't be the one to tell him and referred him to Loretta."

"And you'll talk the nurses out of striking?"

"I'm sure I could offer Ellie something to change her mind," I smirked.

Clarissa laughed, "She'd take a pay _cut_ to get that!"

"If Wernher rescinds the changes, that will resolve the grievance and end the immediate strike threat. Only the Hospital Board and County Board can head off the strike coming in July. The problem is, the money has to come from somewhere. And it won't surprise you that Kylie mentioned they've seen an uptick in patients presenting who would normally have gone to the Free Clinic."

"Have you heard anything more?"

"No. I suspect the next thing we'll hear is about a plea bargain or the charges being dropped."

"I need to get back. Hang in there, Petrovich."

"I did get to do an appy myself yesterday, so there is that. But sitting around waiting sucks."

"I hear you."

We hugged, and Clarissa headed back to Medicine while I returned to the surgical lounge. About fifteen minutes later, I was called for a consult, and together with Doctor Vanderberg from neuro, admitted a patient with a large cyst pressing on his spinal cord. Unfortunately, because it was neurosurgery, there wasn't space in the OR for me to even observe, so I had lunch with Sophia.

In just over six weeks, she and Robbie would move to California. I was really going to miss them, both as friends and as our emcees for Code Blue. José and I would take over those duties, but it just wouldn't be the same. We had briefly discussed trying to find replacements, but none of us knew anyone with whom we'd felt comfortable enough to offer the role.

After lunch, I had three consults and wasn't able to scrub in on any of the surgeries because I had to be available for consults. At 4:45pm, Ellie called and said Doctor Wernher wanted to see me. I let Carol know I'd be in the ED, then went downstairs.

"Doctor Mike, reporting as ordered," I said from the door to his office.

"Come in, Doctor."

I shut the door and sat down, and this time, he didn't play the 'silence' card.

"I had a very interesting conversation with Doctor Gibbs," he said.

I was tempted to remind him he should have done that _first_ but felt I should give him whatever 'win' he wanted to claim, so I decided to give a non-committal answer.

"OK," I replied.

"First, I have a serious concern about your testimony against a fellow physician before the Ohio Medical Licensing Board."

"May I suggest you read the transcript and then speak to Doctor Fran Mercer, a clinical psychologist? I'll sign the release so she can discuss the entire case with you. The psychiatrist in question literally ignored medical protocol and admitted as much when he accepted a ninety-day suspension of his license. My testimony was purely about my relationship with the young woman, and per the Licensing Board, my testimony was that of a layman, not a physician."

"I had a word with Bill Lawson about you."

"And I guarantee he left out some key details, including the time he called me, as an Intern in emergency medicine, for a consult for a psych patient. That was for a _psych_ consult, not a medical consult. I also suspect he left out the true source of his animosity."

"And what is that?"

"He failed to Match for surgery and had to Scramble. The only Residency he could find that would accept him was psych. He had applied to eight surgical programs and was rejected by all of them. According to Brent, the hospital in Detroit where he served his Residency wouldn't hire him as an Attending."

"How do you know all of that?"

"Another hospital physician related that information. It's all accurate. But we're not here to discuss my difficulties with Psych. Can we find a _modus vivendi_?"

"Before I answer that, I need a commitment from you that you will never undermine my authority. You have a reputation as being contrarian, even subversive. Neither of those are conducive to good order and discipline."

"I can commit to that with two conditions. First, that I may always speak my mind in private, and you will listen. That doesn't mean you'll agree, just that you'll hear me out."

"Acceptable. And the second one?"

"I practice medicine my way, within hospital policy. That means if I want to humor a patient who thinks he's been infested by aliens or is a Scientology reject, I'll be allowed to do that."

"Scientology rejects?"

"They believe that the human condition, such as it is, is the result of our bodies being infested with the souls of Thetans who were murdered by the evil galactic overlord, Xenu. Allegedly, he strapped them to volcanoes and used hydrogen bombs to kill them after they were brought to Earth from Teegack."

"You're joking!"

"What would you expect from a religion made up by a science fiction writer?"

"You're unconventional, and I can accept _some_ variation in patient interaction, but only some."

"It's mostly about kids," I replied. "Did anyone you talked to tell you my nickname?"

"Yes; they indicated you had a perfect bedside manner with kids."

"Then, if you can tolerate me handing out candy as a surprise reward, not as a bribe, we're good."

"If I have complaints from parents, I'll need to act on them."

"Moms like candy, too," I chuckled. "They usually ask me to produce some for them, too!"

Doctor Wernher actually laughed, which was a good sign.

"My daughters are all chocoholics. Back to the topic at hand — can you give me eighty hours a week in the ED?"

"Certainly until August 31st, as I'll be training Mary Anderson during that time. Well, I have vacation time scheduled at the end of June because my wife will deliver our daughter. I can be flexible about the days. I also have May 18th for a conference in Indianapolis.

"If you're OK with it, 5:00am to 9:00pm, Monday through Friday would work best. That allows me to attend services on Saturday and Sunday, plus practice with my band. I do have a pair of Prom gigs on May 11th and 12th, but I'll get someone from surgery to cover the evening hours I'll miss."

"I can work with those hours," Doctor Wernher said.

"Starting in September, Doctor Roth intended for me to alternate weeks between the ED and surgery. When I'm in the ED, Mary will work nights; when I'm in surgery, she'll work days. That will mean alternating between a hundred and twenty Surgical Resident hours and eighty alternate weeks. That will augment your usual ED coverage.

"The times when neither of us is on would be covered through the old consultation protocol until we add another Resident. Eventually, you'll always have a surgical Resident in the ED. And none of those are part of your current budget, at least how things stand. You are, in effect, getting free hours."

"That was not in the Residency description."

"That's _my_ interpretation of it, and nobody has told me to stop. Well, you did, but nobody from the surgical service. I felt sitting in the lounge waiting for consults made no sense, so I handled walk-ins and filled in when there were multiple simultaneous EMS transports, and, of course, handled all surgical consults."

"Is it true that, as a PGY1, you've performed multiple appendectomies?"

"Yes. The training program has been accelerated in two ways — first, a second Residency slot was created; and second, I'm being given the opportunity to do things usually reserved for PGY3s and above."

"That's awfully fast."

"I'm awfully good."

"Spoken like a surgeon. Your evaluations and the input I received from Doctor Gibbs, Doctor Cutter, and Doctor Mastriano backs up the claim."

"It's also the case that I know when to ask for help and know how to not get in over my head. If I didn't, nobody would let me within ten feet of an operating table."

"You're a cocky son of a bitch, Doctor."

"Blame the system. The only way most medical students or Interns are allowed to do anything other than the most basic procedures is by demanding they be permitted, which means making your case forcefully. That _has_ to come across as cocky, or it's not going to work. Honestly, Casper Milquetoast would end up doing scut for years. I strongly suspect one of those doctors explained my theory of medical education."

"You do like to do your best to upset the applecart."

"When I see something wrong, I do what I can to right it. Having strong opinions should not be a disqualification so long as they're expressed properly. I'll make the point that for you to achieve your goal, you're going to express contrarian views and have to be just as cocky as I am now. Whatever happens, I won't try to undermine you. Show me that your way provides better medical care or the same level of care more efficiently, and I'll be right next to you when you try to take the hill."

"I was Navy, not Marines."

"I don't know a proper naval metaphor because 'Damn the torpedoes, full speed ahead' doesn't work. And contrary to the opinion of some, that is _not_ my approach. My turn to ask for concessions."

"The lounge and the nursing schedule?"

"Yes. Taking the second one first, let the administration and the Hospital Board fight that battle. The nurses' contract expires at the end of June, and negotiations are ongoing. Make your wishes known to Doctor Nels Anderson, the Hospital Administrator, and let him fight. You'll also need to apologize publicly to the nurses."

"You can't be serious!" Doctor Wernher declared.

"Deadly," I replied. "If you do that and revoke the changes, they'll drop the grievance, and you'll avert the strike. You'll also change the dynamic so you are no longer the enemy. I will have a word with the three most influential nurses and ensure your gesture is received properly."

"I'll think about it."