Contents

1. Publication Info

2. Dedication

3. Other Books in This Series

4. Other Books by Michael Loucks

5. I. The Doctor is IN (or is he?)

6. II. Farewells

7. III. Field Work

8. IV. It's going to be a very busy year!

9. V. And That Makes ME Happy!

10. VI. I'm Sure You Can!

11. VII. Red Scrubs

12. VIII. What A Stupid Way to Die

Copyright © 2015-2022 Michael P. Loucks

Сам Себя Издат

First publication date: TBD

First revision publication date: TBD

You may contact the author at: author@michaelloucks.com

https://a-well-lived-life.com/

Scripture taken from the New King James Version®. Copyright © 1982 by Thomas Nelson.

Used by permission. All rights reserved.

For Jennifer

Other Books in This Series

Freshman Year

Sophomore Year

Junior Year

Senior Year

Medical School I

Madical Shool II

Medical School III

Medical Schoo IV

Residency I (\)*

- Work in Progress

Other Books by Michael Loucks

A Well-Lived Life, Series I

Book 1 - Birgit

Book 2 - Jennifer

Book 3 - Pia

Book 4 - Bethany

Book 5 - Stephanie

Book 6 - Kara I

Book 7 - Kara II

Book 8 - Stephie

Book 9 - Anala

Book 10 - The Wife

A Well-Lived Life, Series 2

Book 1 - Bethany

Book 2 - Stephie

Book 3 - Jessica

Book 4 - Elyse

Book 5 - Michelle

Book 6 - Samantha

Book 7 - Sakurako

Book 8 - NIKA

Book 9 - Kami

Book 10 - Bridget

A Well-Lived Life Series 3

Book 1 - Suzanne

Book 2 - The Inner Circle

Book 3 - A New World

Book 4 - Coming of Age

Book 5 - The Pumpkin Patch (\)*

Cliimbing the Ladder

Book 01 - The First Rung

Book 02 - The Second Rung

Book 03 - Climbing Higher (\)*

From the Files of Doctor Fran Mercer (\+)*

A Sailor's Diary

Book 1 - The War Years (\+)*

- Work in Progress

+ Available exclusively on Patreon or BuyMeACoffee

I. The Doctor is IN (or is he?)

May 25, 1989, Graduation Day, McKinley, Ohio

I accepted the leather-bound diploma from Doctor Warren with my right hand, instead of the usual left, as Rachel was in my left arm and was snuggled against my chest. I tucked it under my arm and shook his hand.

"Congratulations, Mike," Doctor Warren said. "An excellent valedictory oration."

"Thanks."

"She's beautiful. And it was a nice touch to walk her across the stage."

I smiled and nodded, but had to move on, as Tom Meyer's name had been called and he was right behind me. I shook hands with the other deans, then the President of the Medical School Board, and then returned to my seat. Just under fifteen minutes later, Medical School Board President Thomas Abbott gave us our commission to serve our fellow men, and closed the ceremony.

"Dada? Eat?" Rachel asked.

"As soon as we get to Mama," I said. "She has some cookies and juice for you."

I found my extended family and friends, and went to give Rachel to Kris, but Grandma Borodin intercepted. I let her know Rachel was hungry, and Kris gave Rachel's bag to my grandmother. Kris gave me a quick hug, but protocol dictated what I did next. I turned and took two steps to where my bishop was standing.

"Congratulations, Mischa," Bishop JOHN said.

"Thank you, Vladyka."

"A very good speech, one worthy of publication in the church bulletin of every parish in our diocese. It's a message that applies to all Orthodox Christians."

"I'm honored," I said.

"Then with your agreement, I'll have it published."

"I agree."

"Your grandfather looks as if he's about to burst!" Vladyka said with a smile. "I think I've monopolized you long enough!"

"Master, bless," I said.

I turned my hands up, and he gave his blessing, then I turned and took a step over to my grandfather.

"Congratulations, Mike!" my grandfather said.

"This one will result in wearing white, not black," I replied with a smile.

"Speaking of that," he said with a smile.

He handed me a package and nodded that I should open it. I did and found a long white medical coat, signifying a physician, rather than the short one signifying a student. Embroidered in black above the pocket was 'Doctor Michael P. Loucks'.

"Thank you, «Дедушка»," I said.

"You're welcome, Mike! Stefan and I reserved the overflow room at the steak house in McKinley and everyone is invited, including Viktor. I spoke to His Grace and he'll join us, and per your mother, I cleared it with Kris. Your friends are welcome, of course, though I expect Svetlana Yakovovna will want to be with her parents."

I laughed, "I haven't called her that in ages! And yes, she's going to be with her parents and grandparents tonight. Maryam, Fran, Peter, and Nadine all have their parents and others here as well. We're having a get-together at the house on Sunday."

"Congratulations, Mike!" Stefan said, coming over to us.

That started a string of congratulations from everyone else who was there - my mom and dad, my two grandmothers, Paul and Liz, Holly, Jocelyn and Gene, José, Lara, the Korolyovs, Doctor Smith, Doctor Forsberg, Doctor Casper, Doctor Strong, Doctor Roth, and Doctor Gibbs, who looked about ready to pop.

"You should not be here!" I said, looking at her positively huge abdomen.

"My feet and my hemorrhoids agree with you!"

"TMI, Doc!" I chuckled. "You aren't a patient!"

"I'm losing patience with Bobby Junior right now! And with his dad!"

"I bet! Go home, Doc! Doctor's orders!"

"That didn't take long!" she said, laughing. "Did you get your schedule for next week?"

"Yes. I'm on Bobby's three twenty-four-hour shifts starting at 0700 on Monday, Thursday, and Sunday."

"When do you leave for your vacation?"

"The Monday following my last ride-along shift, so Kris will do most of the driving. It's only about six hours, so I'll get a two hour nap before we leave."

"Sorry about that."

"Don't apologize! I want to do this. It'll be instructive and interesting to see what happens before the guys roll the patients out of the squad. It's just too bad they're Squad 2!"

"There are only twelve in the county, so no 'Squad 51' for you!"

"The real bummer is that fire stations no longer have poles to slide down!" I declared.

Doctor Gibbs laughed, "True, but they do have the mandatory Dalmatian!"

"What's his or her name?"

"Brigid, because she's the Irish goddess of the hearth and sacred flame, as well as of water."

"That makes perfect sense."

"Bobby named her."

"I have one for you," I said with a smirk. "Cerberus, the hell-hound and guard dog of the Underworld, comes from the root Indo-European word '∗k̑érberos', which evolved into the Greek word kerberos, which changed to Cerberus when it went from Greek to Latin. That Indo-European root word '∗k̑érberos' means 'spotted'. That means that Hades, Lord of the Dead, literally named his pet dog Spot!"

Doctor Gibbs laughed, hard.

"Don't do that! You'll make me go into labor!"

"I think there might be a doctor or two here to assist," I chuckled.

"More like two hundred! But there is no way YOU are delivering my baby!"

"I'd say 'The Doctor is IN' and ask for 5¢, but the LAST thing I want to do is deliver your baby! Now go home!"

"Yes, Doctor," Doctor Gibbs smirked.

We exchanged a light hug, she left, and I spent a few minutes speaking with Anicka and Milena, then our entourage began filing out of the auditorium. As we were walking to the parking lot, Maryam called my name so she could introduce me to her parents, and more importantly to Matta, who I was sure would be her husband in less than a year. We shook hands, but really didn't have time to talk. He was heading back to Chicago with Maryam's parents, so wouldn't be at the house on Sunday.

"I should go home and change," I said to my grandfather. "We'll meet you there about fifteen minutes after you arrive."

"OK."

Kris took Rachel from my grandmother, and we got her settled in her car seat in the back of my Mustang, then got in so we could head home.

"How do you feel, Mike?" Kris asked as I pulled out of the parking lot.

"As I said to Doctor Casper and Doctor Gabriel, the most important thing was the Match. To me, the Match letter was a bigger deal than the diploma. Graduating without Matching would have been depressing, and graduation has been a done deal since I passed all my core rotations."

"You're not excited?"

"I am, just not as excited as I think you expect me to be!"

"How about later?" she asked in her sultry French accent.

"You always excite me!" I declared.

"Dada Mama kiss!" Rachel giggled.

"Dada is driving," I replied, laughing, then said, "OK, who taught her THAT?" I asked.

"My sister, I bet!" Kris replied. "Like most fifteen-year-olds, she's very curious about that part of life! And I could just see her teaching Rachel to say that to tease you."

"Me?"

"You! She knows better than to tease me!"

I laughed, "Hell hath no fury like the elder sister scorned?"

"You know we really don't torment each other the way you and your sister did, or even the way you and Jocelyn did."

"Or Clarissa?"

"That's more like, well, a married couple, than anything. I'm positive if she were straight, you two would have married long ago."

"You aren't wrong," I replied. "But I've known her orientation since Freshman year. Angie was around then, and you know how I felt...feel about her. Sorry."

"Don't apologize," Kris said. "There is literally nothing you can do to change the past, and I don't feel slighted because you care for Angie and want to help her. I want you to help her."

"Thanks. What did I do to deserve you?"

"You listened to my cousin!" Kris declared mirthfully. "We each now have the doctor best suited for us!"

"I'm curious..."

"Doctor Casper needs a devoted wife who will spend quiet, relaxing time at home with him; you need a partner in crime!"

I laughed, "Clarissa, Jocelyn, or both?"

"Both! And your mom."

"Of course," I chuckled. "The three women who basically ruled my life until Elizaveta and Rachel came along!"

"Clarissa still does, at least outside our house."

"But never in a way that would interfere with my relationship with you," I countered. "She helped shape me into the man I am today. You would not have liked me eight years ago!"

"Eight years ago I was ten!" Kris declared mirthfully.

"You know what I meant!" I countered.

"I do, of course."

"And inside our house?" I asked.

"We both know who's really in charge."

"Rach!" my daughter giggled.

"Uh oh," I said quietly. "We're so dead!"

"Dada?"

"Yes, Rachel?" I inquired.

"«Zha'tim»!"

"I'm not sure what you just said, Rachel," I replied.

Kris laughed softly, "I think she tried to say «Je t'aime»! My sister strikes again!"

"Rachel, «Je t'aime»!" I said.

"Mama! «Zha'tim»!" Rachel declared.

"«Je t'aime, mon petit lapin!»" ("I love you, little bunny rabbit.")

"So it would appear she's going to learn French after all," I said as I pulled into the driveway of our house.

"Is that a problem?" Kris asked.

"Not really," I replied. "We had decided not to teach her Russian, at least as a toddler, but I'm sure she'll pick up the odd phrase here and there from my grandparents or Clarissa, who will, no doubt, revel in teaching my daughter how to tease me in Russian!"

"Clarsa!" Rachel exclaimed. "Love Clarsa!"

"Ok, now I'm positive I'm doomed!" I declared.

"Poor baby," Kris teased.

"Yeah, yeah," I chuckled. "I will admit that I signed up for this willingly."

"Perhaps you just need some personal attention later, after Rachel goes to bed?"

"Perhaps I do!"

I parked, we got out of the car and went into the house. While I took off my graduation regalia, Kris changed Rachel's diaper and packed food in her bag, as there was no way Rachel could eat anything at the steakhouse except perhaps the warm breadsticks they served with the salads and some baked potato.

We had an enjoyable time at dinner with Bishop JOHN, my extended family, including the Korolyovs, José, Lara, and Jocelyn and Gene. After dinner, Kris, Rachel, and I headed home, and once Rachel was in bed, Kris supplied the personal attention she'd promised.

May 26, 1989, McKinley, Ohio

"What do you plan to do today?" Kris asked when we got out of bed on Friday morning and went to the bathroom to take a shower together.

"If they'd let me, I'd work in the Emergency Department, but I can't actually do that before June 1st, when the Residency position is officially available. They couldn't pay me until then, and I wouldn't be covered by malpractice insurance."

"That's such a foolish concept! The state should simply pay compensation to those who are truly harmed and dispense with the silly lawsuits."

"The problem there is that it turns it into a political fight as much as one about medicine. That said, going to court is a losing proposition because juries almost always find for the plaintiff."

"And you told me the insurance companies settle for that reason, so why even bother with insurance companies? You could even simply take the premiums and put them in a pool administered by the state. No more insurance companies and no more court battles."

I laughed, "Oh you poor, naïve French girl!"

"What?"

"Instead of suing the hospital and the insurance company, they'd sue the government or the board that made the decisions, or sue the doctors and hospitals, anyway. It's almost impossible to avoid a lawsuit, no matter what you do."

"But the government could make it so you couldn't go to court, right?"

"Yes, and then there would be lawsuits over that. But you'd never get a law like that passed. Every attempt to reform malpractice is fought tooth and nail by what are politely called 'plaintiff's attorneys' but which most people at the hospital call 'ambulance chasers'. They have serious political clout because they have serious money to donate."

"The entire system is corrupted by money!"

"Perhaps so, but the First Amendment guarantees a right to free speech and free press, and the courts generally include an individual spending their own money to advance a political cause as covered by the First Amendment. I read about a case going to the Supreme Court this year about corporations being able to spend money on politics, and the consensus appears to be that the Supreme Court will allow those restrictions because corporations aren't people."

"Well, obviously!"

"Actually, not so obviously under American law," I replied. "I learned in High School that there are two important points. First, a corporation is owned by individuals who cannot be forced to give up their Constitutional rights to gain some service or benefit from the government. Second, in some things, corporations are treated as individual persons. That's necessary fiction because if that fiction weren't maintained, a lawsuit against IBM or GE would, under our system, necessitate suing every individual stockholder as an owner, rather than suing the corporate entity."

"That's just silly!"

"Maybe so, but that's how things work in our Common Law system. Remember, the basis of our system is different from the French system. Well, except Louisiana, which is based on French Civil Law. All the other states are based on English Common Law."

"How can one state be different?"

"ALL states are different! The laws in Ohio are different from the laws in Indiana, Michigan, Pennsylvania, West Virginia, and Kentucky, even though the states are contiguous with Ohio."

"The system is far too complex, and it should be simple for the national government to pass any necessary laws!"

"The system is actually designed to prevent that," I chuckled. "You don't have to like it, but you do have to accept that's the way things are. Well, at least until the glorious people's revolution hoists the red and black flag over the White House!"

"Are you mocking me?" Kris asked, hands on her hips.

"Me? Would I do that?"

"YES!"

"Perhaps," I chuckled.

We finished our shower, dried off, and dressed.

"You never did answer as to what you planned to do today," Kris said when we went down the hall to get Rachel.

"I think the Tsarina and I will just have some daddy-daughter time. I'll see if I can deprogram her from the French cult your sister is trying to indoctrinate her into!"

"You like this French girl!"

"I also like French kissing her!"

"Of course you do!"

"But neither of those things make it any less vital to teach Rachel the truth about France!"

"And what is that, Michael? Hmm?"

"What's the first thing you teach a French soldier?"

"Uhm, how to march?"

"No. This!"

I raised my hands to the 'surrender' position.

"Oh, please!" Kris exclaimed, rolling her eyes.

"Did you hear about the new French battle tank?" I asked as I began changing Rachel's diaper.

"No."

"Five speeds -- four in reverse; one forward, in case the enemy gets behind them."

"Are you going to keep going?" she asked, tapping her foot.

"New French military rifles for sale! Never fired; dropped once!"

"Perhaps you would like to sleep on the couch?" Kris threatened.

"Why are French main roads lined with trees?" I asked.

"Don't even go there, Michael Loucks!"

"Because the German Army likes to march in the shade!"

"Are you quite through?"

"I'm all out of French military jokes," I said with a grin. "I mean, besides the French military itself!"

"Gilbert du Motier, Marquis de Lafayette, is rolling in his grave!"

"I actually never knew his name," I replied. "He was always referred to by his aristocratic title."

"So, this French girl taught you something!"

"More than one thing, and I've returned the favor."

"To your own advantage!" she said mirthfully.

"And to yours!"

"True!"

I finished changing Rachel's diaper and the three of us went downstairs for breakfast.

"I still don't understand why Americans make fun of the French! We were your allies and helped you defeat the British king and his German mercenaries!"

"I honestly don't know, but I strongly suspect it has to do with World War II and Vichy."

"An outrage, though worse was the «collaboration horizontale»."

"Survival often necessitates setting aside ones' principles in favor of food and shelter. I find it hard to judge someone at risk of starving to death for whatever they might do to obtain food, short of physically assaulting someone or killing them. I assume you've read Les Misérables? Do you think Jean Valjean should have been sentenced to hard labor for taking a loaf of bread when he was hungry?"

"Isn't theft always wrong?"

"Isn't refusing to feed the hungry also wrong? One begets the other, don't you think?"

"Yes, of course, but you're a capitalist!"

"And an Orthodox Christian. The two are not as incompatible as you think they are. I would never refuse to share what I had with someone in need, to the extent of my ability to do so. Remember, 'sell all you have and give to the poor' was about love of riches, NOT a command for everyone to live in abject poverty. And, as we've discussed, in Acts, where Marx cribbed 'from each according to his means; to each according to his needs', it was voluntary, as shown by the incident with Ananias and Sapphira.

"You and I will have two above-average incomes, and we'll happily pay our taxes, tithe, and give generously to charity. But that does not mean we shouldn't enjoy some of the fruits of our labor. After all, as Jesus said in Luke's Gospel -- 'the worker is worth his wages'. Paul repeats it in his letter to Timothy with reference to supporting individuals engaged in Christian ministry. I daresay if ministers are to be appropriately compensated, then so are doctors.

"In the Old Testament, in Fourth Kings, it makes the point that religious leaders were to be compensated by the people so they could dedicate their lives to service to the community. I think there's a clear parallel for physicians. And it's not as if I'm doing this for the money. You heard my 'call to arms' yesterday, and that's the important thing. The compensation comes second, and while I won't turn it down or be embarrassed by it, I will follow the same course with money as I do my medical skills."

Kris smiled, "For somebody who hates politics, you have very strong political convictions."

"I'm an American and I believe in capitalism, so sue me!"

Kris laughed, "Only Americans would use 'so sue me' to make a point! The phrase works because you run to court at the drop of a hat!"

"And, sadly, our justice system provides little justice and plenty of retribution."

"Do you still plan to visit the man who murdered Lee after we come back from our vacation?"

"I'm going to try. I have no idea if he'll see me. I do have to find out the rules for visiting him, because his sentence was life without parole. I know visiting death row inmates is very difficult, and he's in the same prison where they house them."

"The death penalty is barbaric!"

"I agree, and so are the conditions in most prisons in the US. Had I remained a deacon, eventually I would have become involved in prison ministry."

"There's no reason you can't do that as a lay person, is there?"

"With the caveat that I'd be able to bring the Eucharist if I was a deacon, yes. And it's something to consider in three or four years when things calm down with regard to my schedule at the hospital."

"When will you know your schedule?"

"Not long after we return from Tennessee, though the first week is technically orientation week, but I'll start my regular shifts immediately because I don't need orientation on the hospital."

"What do they do for that?"

"The first week is a series of ten, four-hour shifts in each department where the new Resident shadows a PGY2 to become familiar with the other services."

"All Residents?"

"From the Emergency Department, yes. But because I had time on all those services at Moore, I don't need to do it."

"What do the other services do?"

"Nothing at the moment. In the future, Residents from all the major services will spend three months of their first year in the Emergency Department. That way, when we have major incidents, everyone will have recent experience in trauma. The typical Resident outside of trauma almost never does intubation, for example. Neither do the paramedics, for that matter, which is going to change and is why they'll spend time training in the ED in the future."

We finished making our breakfast, ate, and then Kris left for her final day of High School. She had two exams, though she was at absolutely no risk of not having straight A's, and we'd attend her graduation ceremony on Saturday.

"What would you like to do?" I asked Rachel.

"Dada sing!"

"You really are learning a bunch of words!" I said. "I'll get my guitar and play for you."

Rachel was twenty-one-months old, and her vocabulary was growing by leaps and bounds, and she was able to express herself in simple ways, but that was far more than even three months previous. To satisfy her, I got my guitar and sheet music, then sat on the couch in the great room to play for her.

As she often did, Rachel sat on the couch and leaned against me while I played and surprised me by trying to hum along with the guitar. Many of the songs I knew she preferred I knew by heart, but I also took the opportunity to practice some of the newer songs. When I finished playing, I put the guitar and sheet music away, then decided Rachel and I should take a walk.

Instead of putting her in her stroller right away, I held her hand until we reached the end of the driveway. I picked her up and met immediate resistance.

"NO! RACH WALK!"

"We'll try it your way," I replied.

She was determined, and I saw so much of Elizaveta in her personality. It could only be genetic, as except for a few brief seconds, Elizaveta hadn't even held her. Of course, she could have inherited that through me from my mom and grandmother because she had a double dose of Russian X chromosomes! Her Borodin stubbornness lasted about a hundred yards and she plopped down, her little legs clearly tired. I picked her up, and this time she didn't resist going into her stroller.

After our forty-minute walk, I read to Rachel, played with her, and then we had lunch. After lunch, I called Viktor and as he and Yulia were home, I took Rachel to see them, as she hadn't been to see them for several weeks.

When we arrived, I left Rachel with Yulia and Viktor and I went into his study.

"Thank you," I said. "I wouldn't be where I am without your help."

"You're welcome. And thank you for bringing Rachel to see us. What are you doing before you begin your Residency?"

"Next week, I'm going on ride-alongs with EMS as part of the new program. Then Kris, Rachel, and I are going to Gatlinburg, Tennessee, for ten days."

"When you return, we'd like you to join us for dinner at the country club."

"We'd love to," I replied.

"How are things going other the medical school?"

"I'd say they're good. You saw Rachel, and she's healthy and happy, and developing at a slightly advanced pace."

"Elizaveta was like that as well. She was helping Yulia in the kitchen by age three."

"That doesn't surprise me in the least!"

"The anniversary is on a Saturday this year, and I planned to ask Father Nicholas to conduct a graveside memorial service in the morning."

"If you do that, we'll be there."

"May I ask about you leaving the parish?"

"You may, but Father Nicholas didn't tell you why?"

"No."

"We left because I spoke the truth and was taken to task for doing so."

"About?"

"Oksana and Greg Casper," I replied. "Ghost, as Doctor Casper prefers to be called, felt he was being pressured into converting, which, of course, he was. I pointed out that there is nothing in the canons which required him to be chrismated before the wedding. Oksana didn't have a problem with that, but Father Nicholas did, and confronted me about it. When I pushed back, he said he was tired of my attitude, so, in keeping with him being tired of me telling the truth and acting like a Christian, I announced we were transferring our membership to the cathedral."

Viktor sighed, "I do not understand why Father Nicholas feels it necessary to get into confrontations with you at every turn! Father Roman is your spiritual father and confessor, and if Father Nicholas had a problem with you, he should have taken it up with Father Roman, who, I daresay, would not reprimand you for telling the truth. What did His Grace say?"

"That he was happy to have us at the Cathedral. The incident wasn't even mentioned. The same was true for Father Luke. Of course, Kris is happy, because her parents and sister attend services at the Cathedral."

"Does anyone else know the reason for you transferring your membership?"

"I only spoke to Clarissa about it, and I believe Kris only informed her parents, but she didn't give a reason. I didn't want to put Subdeacon Mark in the middle of things, so I simply let him know Kris and I had talked it through and made the decision. I have no idea what Father Nicholas might have said to him, and I don't want to open a can of worms."

"Wise. Shall we spend some time with my granddaughter?"

"If you can wrest her away from her grandmother!"

Viktor did get a chance to hold Rachel and read a book to her before we left. We arrived home just before Kris, who had brought Lyudmila with her to watch Rachel while Kris and I were at the graduation banquet. About two hours later, with me in a suit and Kris in a formal dress, we left the house and headed to the Holiday Inn where the banquet was being held, a reprise of the banquet at the beginning of medical school.

For this one, we were at the head table because I was class valedictorian, though the downside was that meant sitting with the deans rather than with my classmates. On the positive side of the ledger, Matta had stayed, and I had a chance to speak with him for about ten minutes. After that talk, I was even more convinced that he and Maryam would marry, and very soon. Fran had Jason with her, of course, and Clarissa had Tessa, but both Peter and Nadine had come alone.

The banquet has, as most banquets did, had decent food, but nothing special, and the speeches were, for the most part, simply platitudes and congratulations. The one highlight was when Clarissa was given a special award for achieving the highest test score in the history of McKinley Medical School. Later, I received a certificate and plaque for being valedictorian, and Clarissa received a certificate for being salutatorian. Those awards ended the evening, and Kris and I headed home.

May 27, 1989, McKinley, Ohio

"Your turn today!" I declared when Kris and I got out of bed on Saturday morning.

"Yes, but I start school again in July."

"And when you receive your Master's degree in seven years, I'll still be a Resident!"

"Poor baby," Kris teased.

"Careful, young lady!" I said, trying to sound menacing.

"Or what? You'll throw me in bed and ravish me? Oh, darn!"

"Well, that would be punishment...for me!"

"We could stop doing it, if it's so terrible for you!"

"On second thought..."

"I thought as much!" Kris said mirthfully. "Let's take our shower."

We had our usual busy Saturday morning with band practice, grocery shopping, a trip to the bakery, and then lunch at home. After lunch, we put Rachel down for an early nap, and at 3:00pm, we were at the High School football stadium for Kris' graduation. Rachel and I sat with her parents and Lyudmila, and I thought back to my own High School graduation, when I'd finally had the courage to tell Jocelyn how I felt about her.

That had set off a sequence of events that nobody could have predicted, and our lives had been completely upended by a terrible accident that had nearly cost Jocelyn her life. So many things had happened since then, culminating with sitting in the stands watching my second wife graduate from High School.

After the graduation ceremony, we had a celebratory dinner at the Korolyovs, then went to the Cathedral for Vespers. After Vespers, Kris, Rachel, and I headed home. After we put Rachel to bed, Kris poured us each a glass of wine, and we sat together in the great room.

"To both our graduations!" she said.

"«Ваше здоровье»!" I declared. ("Cheers!")

"«Ваше здоровье»!" Kris replied.

We touched the crystal glasses, and each sipped the red wine.

"What class did you decide to take in July?"

"An English elective -- composition. Mom turned in the paperwork yesterday. They just need my final transcript."

"Did they waive the language requirement?"

"Yes, because I'm trilingual."

"I certainly appreciate your oral skills!"

Kris laughed softly, "I don't think you want me to demonstrate those at Ohio State!"

"Most decidedly not! On the other hand, there's tonight!"

"I will if you will!" Kris said mirthfully.

"You don't have to ask twice!" I replied.

May 28, 1989, Circleville, Ohio

On Sunday, Kris, Rachel, and I went to church, but left immediately following the services, taking Lyudmila with us, so we could get home to meet José, Lara, Subdeacon Mark, Alyssa, Elias, and Serafima to set up for a joint graduation party for Kris, Jocelyn, Clarissa, me, and the rest of our study group, as well as Mark and Alyssa, who were both graduating from Taft.

"It's been quite the month!" Subdeacon Mark observed as he and I set up the grill. "You, Clarissa, and Fran graduating from medical school, Robby finishing his Master's, Kris graduating from High School, and Alyssa and I both finishing our undergrad degrees."

"It has," I agreed. "And for me, the culmination of eight tumultuous years."

"I know there's more to your story from before Alyssa and I met you four years ago, but I've really only heard bits and pieces here and there."

"And depending on where you get your information, it may or may not be accurate."

"You're referring to Father Nicholas, aren't you?"

"I'd rather just leave the statement generic."

"You can tell me if I'm out of line for asking, but what happened?"

I considered my options, and the first and most important thing was that I wasn't clergy, and so was free to speak my mind, even if it contradicted something the bishop said, with the exception of specific points of dogmatic belief. I would, of course, be seen by Father Nicholas as a troublemaker, but evidence suggested he was going to see me that way no matter what I did. And I saw no point in hiding something which would be blatantly obvious when Ghost and Oksana married.

"Greg Casper, Oksana's fiancé, made a comment about being strong-armed into being chrismated, with the implication that it was absolutely necessary to be married. I explained to him that wasn't the case, and that so long as he agreed to allow any kids they have to be baptized, and wouldn't interfere with Oksana taking them to church, the priest could not object to the wedding on canonical grounds.

"I made it clear that the two people who had a say in the matter were Oksana and him -- his decision to be chrismated or not, and her decision to marry someone who wasn't chrismated. Because of that, I was called a 'troublemaker' and when I pointed out that I was following the teachings of the church and wasn't about to back down, Father Nicholas told me he was tired of my attitude. That was, as they say, the last straw.

"You most likely know, at least in a general way, all the other times he got on my case for something I did or said which was not actually problematic. Worse was when he got on my case for things I didn't say or didn't do that I was accused of saying or doing. I don't need to give you the details, but there were numerous instances, including the Nativity before last, that led me to not worship anywhere for a time, and then worship elsewhere for several months."

"Father Nicholas has not confided in me at all the way I believe he confided in you."

"And I suspect that's at least partly because we're friends, though much of the confiding was done after I became a deacon, so it's not directly comparable. How is your relationship with Bishop JOHN?"

"Fine, I guess. I mean, I don't see him nor talk to him as often as you did, but again, that was after you were made a deacon. I basically only see him when he visits or at the twice-a-year clergy meetings, of if I'm needed at the Cathedral for some reason."

"That's true for most deacons, too," I replied. "The only reason I had such close dealings with Vladyka JOHN was because of everything that had happened with Bishop ARKADY."

"Let's just say I'm glad I had nothing to do with any of that."

"I wish that had been the case for me," I said.

I lit the kindling under the coals, which I used so I didn't have to use lighter fluid, and then we went back into the house to join the others, with the number of guests eventually swelling to around fifty.

We had a nice afternoon and evening together, along with plenty of food and fellowship. Maryam and I had a chance to speak, and with a blessing from Kris, we walked to the furthest corner of the backyard to speak privately, but not out of sight of others, to maintain proper decorum.

"He's a great guy," I said. "When he asks, say 'yes'."

Maryam laughed softly, "As if I'd say 'no' to the guy I basically chose! I'm not fickle!"

"That is the last word I'd use for you," I replied. "Do you have a timeframe? I'd like to come to your wedding, if I can swing it."

"I'd guess September or October. Obviously, it has to be before Little Lent, and can't be during the Apostles' Fast or Dormition Fast. Would you drive up?"

"I think I'd fly simply because it would be a whirlwind trip where I'd arrive on Saturday and leave Sunday evening, if possible. And that would all depend on my schedule and if Kylie can take part or all of a shift. You know how tough it is during a PGY1 year."

"That's part of the problem for me, too. But I don't want to wait a whole year before..."

She left the word hanging in the air, and her eyes twinkled, make it absolutely clear to me what she was referring to.

"It is addictive!"

Maryam laughed softly, "Not when I was sixteen, but last year? Yes!"

"I wanted to be addicted at sixteen, but I couldn't find a supplier!"

Maryam laughed hard, "Cute! How are things going with Kris?"

"Very well. We have very different political views, but that has led to some very good conversations, rather than conflict."

"You appear to be very happy."

"I am," I replied. "I still miss Elizaveta, but as we discussed, I had to find a way forward, for Rachel's sake."

"And yours, Mike," Maryam said, touching my arm lightly. "It would have been too easy for you to withdraw and hide behind your cassock. As you've said, 'Monk Michael' was not outside the realm of possibilities, but that wouldn't have been good for you."

"No, it wouldn't."

"Especially for the reason given in Stripes!" she teased.

I laughed hard at the reference to a monk not being wildly fucked by teenage girls that I would never have expected from Maryam, though on second thought, in private, I should have expected it.

"Your private self is VERY different from your public self," I observed.

"As we discussed, for a very good reason," Maryam observed.

"True."

"And I haven't been a teenager for a long time!"

"And yet..." I chuckled. "But setting that aside, I'm going to miss you."

"And I'm going to miss you as well. We'll keep in touch. I let Matta know."

"And I let Kris know as well."

"I'll hug you when I leave, but I wanted to say 'goodbye' privately so I could express just how much I care for you."

"It's mutual."

"Then let's rejoin the others," Maryam suggested.

"Let's."

II. Farewells

May 28, 1989, Circleville, Ohio

"You have NO idea how badly I wanted to stick my tongue out at you at the banquet when I received my award," Clarissa declared when we stood next to each other at the snack table

"I saw the look on your face," I replied. "I can read you like a book!"

"And I can play her like a piano!" Tessa declared.

"Sassy as always!" I replied.

"High praise coming from a nut like you!" Tessa exclaimed.

"He may be a nut, but he's my nut!" Clarissa declared.

"You're lucky I share!" Kris said, coming over to the table.

"She's not interested in THAT!" Tessa teased.

"That I do NOT share!" Kris declared.

"Which works well for all involved, doesn't it?" I suggested.

"It does!" Kris declared. "At some point, the four of us need to talk."

"We do," Clarissa replied, turning serious. "But we have a few years before any decisions have to be made."

"When we come back from Tennessee and you two come back from California, we'll have you over for dinner," Kris said.

"That sounds good," Clarissa replied. "Ten days in Napa Valley is exactly what I need before I start my Residency. We'll bring you a couple of bottles of California wine."

"It's OK for cooking, but not drinking," Kris said with a silly smile.

"Funny," I chuckled, "you were drinking California white the other night."

"You're supposed to be on my side!" Kris protested.

"Good luck with THAT," Clarissa smirked. "Petrovich is going to give you more grief than he gives me, and that's saying something!"

"Who? Me?" I asked innocently.

"Yes, you!" Kris and Clarissa both said simultaneously.

"I think I'm going to go hang out with the guys," I said. "It's safer!"

All three girls laughed, and I made a point of joining Bobby, Ghost, Jason, Elias, Subdeacon Mark, Robby, Peter, Gene, Chris, and Pete.

"Be about twenty minutes early tomorrow morning," Bobby said. "I'll meet you there then and get you set up with a locker and rack, and check you out on your bunker gear and the squad."

"Mike Loucks as a fireman," Robby said, shaking his head.

"Mike Loucks is expressly prohibited from running into burning buildings!" I declared. "I have a provisional paramedic certificate based on my MD and passing the paramedic test, but I am NOT a firefighter!"

"Heck, I don't run into burning buildings," Bobby said. "That hero shit is not my gig!"

"But you would, right?" Ghost asked.

"To save someone if that was necessary?" Bobby responded. "Absolutely. That's why I had full firefighter training. But that's not my job any more than doing routine physicals is your job. That said, the rules expressly prohibit Mike from doing that. But to ride in the squad or on either truck, he has to be checked out in bunker gear. Just being near a fire can be dangerous, especially in farm country, where every fire is a potential explosion or chemical release."

"Bunker gear?" Peter asked.

"It's all the protective equipment we use," Bobby said, "including gloves, helmets, boots, trousers, and coats. Respirators aren't technically part of that, because they weren't traditionally kept in a fireman's bunk, but we generally refer to everything we wear on our person as 'bunker gear'. It's all designed to fit over our uniforms, and the uniforms are designed to be comfortable at the station, and eliminate the need for soft linings for the trousers and coats."

"Do you put them on for every response?" Peter asked.

"Paramedics usually don't. We keep our gear in the squad and put it on if we need it on site. The guys on the truck, except the engineers, all put on their turnout gear before they get on the truck. The engineers' gear is in the cab of their vehicle, and they put it on once we get to the site. We discovered it's safer for them to drive in their station uniforms than wearing all the heavy gear, especially their boots."

"How do you get water when you're out in the boonies?" Peter asked.

"Some we bring with. We have a pair of engines which carry the firefighting crew and all the equipment they need, including hoses, ladders, saws, hooks, the 'Jaws of Life', and all the respiration gear. Each engine carries a thousand gallons of water on board. After that, they draw from any available water source - a hydrant, pond, river, swimming pool, or other water source up to two hundred yards away. The county can also dispatch up to five water tenders that carry three thousand gallons of water.

"In addition to those two, we have our rescue squad, which is a combination ambulance and what you might have seen on Emergency. For a fire, MVA, or HazMat, we respond with all three vehicles; for rescue or medical emergency, we respond with two. In addition to the water, we have extinguishers on all three apparatuses."

"What if the water source is too far away?" Peter inquired.

"A water tender will drive to the water source, fill up, and return. It will deliver the water into what's called a drop tank from which the engines will draw. It's not ideal, but we do what we have to do. We can also draw from cisterns. Some of the big houses northeast of town that aren't on city water and either don't have a well or don't have a reliable well, have cisterns they fill with rainwater or have water delivered, and we can draw from those, too."

"What will you do, Mike?" Jason asked.

"Mostly observe," I replied, "but I'm allowed to do anything I could do as a medical student. That gives me one advantage over Bobby, which is that I'm able to intubate a patient. The paramedics will be trained to do that over the next two years. Me going on a ride-along is the first step in a complete rethinking of providing advanced life support, starting with EMS response. The name change - Emergency Medical Services -- finally acknowledged what paramedics do.

"We've come a long way in twenty years from 'scoop and run' ambulance service to paramedics being trained to do significant medical procedures. Eventually, we'll have trauma physicians available to respond to 'mass casualty' events. I'll be one of the first qualified to do that. They're still working out the malpractice and liability insurance problems."

"Problems?" Robby asked.

"Lawsuits," I replied. "Firefighters are indemnified against basically anything they do by state law, so long as they follow procedures or specific orders from county officials, or in the case of EMTs, from doctors. Doctors, on the other hand, are not, even if they respond to the scene of an accident. We can still be sued, and as such, the hospital has to negotiate with their insurance company for covering me when I'm outside the hospital grounds. I have some coverage if I happen upon an accident or illness, but specifically responding as part of a rescue isn't covered."

Ghost nodded and added, "If there is any topic where you'll find physicians in complete agreement, it's malpractice reform. You can't sue a firefighter for failing to rescue you, or for injuries sustained while rescuing you, but even the slightest adverse outcome can lead to a multi-million dollar settlement from a doctor or hospital, even if they weren't really at fault."

"There is," Doctor Gabriel interjected, "always a chance of adverse outcomes, no matter what we do. A perfect example is the drugs used for intubation. They are standard doses and have no significant contraindications. One person in a 100,000 will have an adverse reaction to them, and one percent of those who have a reaction will die. There is no way to know in advance, and no test we can run because intubation has to occur within ninety seconds for an airway obstruction. So we do it. And get sued if something goes wrong, even if it's beyond anyone's control."

"Has that happened?" Subdeacon Mark asked.

"Not since I've been at Moore," Doctor Gabriel replied. "We had one incident at Cook County, but it was never proved it was the intubation drugs. That said, we do have people who never come out of anesthesia, even with reversing drugs. And there's no way to know in advance. Ditto for pulmonary or cardiac arrest during anesthesia. Even testing can't tell you in advance when that will happen. Again, nobody is at fault, but we pay the price."

"So, what's the solution?" Subdeacon Mark asked.

I smiled, "My wife would say fully socialized medicine with the government paying all claims for actual injury."

"What about negligent doctors?" Elias asked.

"A different problem of a completely different character," Doctor Gabriel replied. "All of us, and I mean physicians and non-physicians, should work together to weed out negligent doctors. You don't need malpractice suits to do that, you need good oversight with a mix of physicians and regular citizens."

"And no lawyers!" Ghost added. "Shakespeare had it right!"

I shook my head, "When Shakespeare had Dick Butcher say 'The first thing we do is kill all the lawyers' he was speaking about how a tyrant establishes an autocracy. But I agree, no lawyers on any review board. And adherence to accepted best practices should be a complete and total defense to any claims of negligence or malpractice."

"What he said!" Doctor Gabriel replied. "Though Mike's idea that we currently have socialized medicine is non-conventional."

"Says the man who works for a government hospital which receives significant funding from taxes!" I countered. "Not to mention the very point of insurance of any kind is to pool funds to socialize the risk. I have State Farm for my auto and home, and it's a mutual insurance company, which means at the end of a year, any excess premiums collected over losses and operating costs are returned to the policy holders, minus any money retained for reserves."

"That's not socialism!" Subdeacon Mark protested.

"No, but it's what people here mean when they say 'socialized medicine'. Most proposals do not call for every doctor to be a government employee or for all hospitals to be publicly owned. The proposals are almost always about 'single payer' in the way Medicare and Medicaid operate -- insurance funded by premiums collected as taxes. True socialism is common ownership of the means of production. That's a VERY different thing. Volvo and Ericsson, despite being Swedish companies, are publicly traded on stock exchanges."

"When did YOU start discussing politics in a serious way?" Ghost asked, sounding surprised.

"When he married Kris!" Robby exclaimed. "She's the 'Red' in his bed!"

"She'd reject that nod to the Soviets," I said. "She and my grandfather have the exact same opinion of the USSR and the Communist Party, despite coming from basically opposite sides. He's a liberal, and she's a socialist, to put it in European terms."

Some of the guests began to leave, including Nadine, who was driving home before heading to California. I walked her to her car, where we exchanged a chaste hug.

"Thank you for everything," she said. "If you're ever in California, look me up at UCLA."

"Absolutely. I suspect you won't be coming back to Ohio anytime soon."

"If I'm going to fly for four hours, I'm going to Hawaii, which is only five hours away!"

"I hear you on that! I'll make it to Hawaii at some point, but that's probably ten years from now. As for California, after speaking with Clarissa and Tessa, Kris is interested in visiting Napa Valley, but that's what? Three hundred miles from LA?"

"Closer to four hundred, I think," Nadine replied.

"Let's keep in touch," I said. "You have my address and phone, so just call or write once you have yours. Fran, Clarissa, and I will all be in the area. I already have Peter's home address and phone number, as he plans to live with his parents for the first year. I have Maryam's apartment address and she'll get me her phone number as soon as she's in Chicago. I'll make sure you get all the information for everyone and be the one to keep up with all the addresses and phone numbers."

"Awesome. Thanks again, Mike. I hope to see you in my OR someday, but vertical, not horizontal!"

"The same for my trauma room!"

We hugged again, and she got into her car and drove away. The scenario repeated itself with Peter about ten minutes later, as he was flying home first thing in the morning.

"Thanks for being there for me for four years," I said.

"I was just about to say the same thing!" Peter replied.

"It was fortuitous that we met at the banquet and then were paired for CPR. I'm glad that happened, and I'm glad you were part of our study group."

"Again, I could say exactly the same thing. Come to Atlanta and I'll show you some real Southern hospitality!"

"It'll be at least a year, for obvious reasons. I'm going to miss you."

"I'm going to miss you as well," Peter replied.

We hugged and slapped each other's backs.

"Take care and stay in touch," I said.

"You, too."

He got into his car, which he'd agreed to sell to a Second Year, and as he drove away, Maryam came out of the house. We'd already said what we needed to say, so we hugged carefully, Maryam smiled, and kissed my cheek.

"I'll see you at your wedding, by hook or by crook," I said. "Have a safe trip."

"Enjoy your belated honeymoon!"

"We will."

Maryam got into her car, backed out of the driveway, and, with a wave, drove off. Once her car was out of sight, I went back into the house. The party wound down around 8:30pm, and several couples stayed to help us clean up. When we finished, they left, then Kris and I put Rachel to bed, and went to bed ourselves.

May 29, 1989, McKinley, Ohio

On Monday morning, even though she didn't have school, Kris had been up early with me for our usual joint shower, to say morning prayers with Rachel, and to have breakfast. I'd kissed them both, then headed to Fire Station #2, which was about two miles from Moore Memorial Hospital.

"Morning, Doc!" Bobby said with a grin when he met me in the small parking lot behind Fire Station. "Welcome to Station #2!"

"Also known as the Second People's Hospital for the Insane!" I said with a grin. "After all, only someone who was truly nuts would make a living by running into burning buildings!"

"You do realize we don't ACTUALLY do that very often, right?" a fireman said, coming over to us.

"Doctor Mike Loucks, Lieutenant Jim Greer."

"Lieutenant," I said, extending my hand.

"Doctor," he replied, shaking my extended hand. "Just call me Jim, please. Usually, only our captain is addressed with his rank."

"How many firefighters are on duty at any given time?" I asked.

"A captain, a lieutenant, two engineers, two firefighter-paramedics, and eight firefighters. There is a battalion commander, but he's responsible for three stations and only responds when multiple fire companies respond. He's based in Station #1."

"Let's get inside and get you settled," Bobby said. "A rack, a locker, and bunker gear. Did you get your steel-toed shoes?"

"UPS delivered them on Friday."

"Safety regs require you to wear those at all times, except in the shower or sleeping."

"Got it."

"Your uniforms are here, and ready for you."

We went into the station and Bobby was greeted by other firefighters, some coming on duty, some going off.

"What happens if a call comes in now? Or if the crews were on a call?"

"Until 7:00am sharp, the crew on duty would respond, and if they were out, they'd stay out until they finished the run or were relieved by another unit."

We went to the back of the station where the dormitory and showers were located, and Bobby showed me the rack and locker I'd been assigned.

"Let's get you into your turnout gear. Once I'm satisfied you know how to wear it, we'll store it in the squad with ours. Put your uniform on first."

I changed out of my 'street clothes' and put on the brand new uniform that was hanging in the locker. Once I had it on, I began to put on the bunker gear. I had reviewed my notes from the training class I had and mostly got things right. Bobby provided pointers as I put on the gear, especially about the flaps which covered the zippers on the turnout coat. Once he was satisfied I'd be able to put the gear on properly, I put on the new shoes I'd ordered. Once they were on, we took the gear to the squad and stored it behind the bench seat in the cab, along with my medical bag. Once we'd done that, he showed me where all the gear was stored in various compartments accessible from the outside, along with what was stored in the ambulance portion of the squad.

"One thing I wondered," I said, "is why you don't have the radio hookup they showed in Emergency where Doctor Bracket or Doctor Early would say 'send us a strip' to get an EKG."

"We didn't have the money LA County did when we started."

"What are your standards for defibrillating?"

"No pulse or no heartbeat. Basically, 'shock and see'. Our new ALS ambulance units will have EKG equipment, and the ability to transmit, but that's next year before they begin delivery, and Moore needs to install the new radio and telemetry equipment."

"And for compromised airways, all you can do is bag at the moment, right?"

"Yes. You brought your bag of tricks with you, right?"

"Yes. I have everything I need for intubation in my medical bag. Has your training been scheduled?"

"No. That starts in September, but they don't have individual schedules out. It's going to take some time to get eighty hours of training in."

"Not to mention the 'luck of the draw' with regard to patients needing intubation. You'll need to do six or eight before an Attending will sign off. Do you know how to read an EKG?"

"I think the correct answer is 'no', because other than what I learned in paramedic school, I have no experience."

"That'll take another chunk of time, probably ten hours to become proficient enough to know when administering a shock will work. That said, you pretty much can't hurt someone by shocking them. And CPR is always indicated, except for a suspected flail chest."

"Let's go meet the guys," he said.

"Any female firefighters? I know there is a female paramedic because I've met Julie."

"Only one female firefighter in the county so far, and she's at Station #1. Julie is at Station #3. Did you know that the first paid fire company was in Cincinnati, and was started in 1853, and while it was all men, there were women volunteers?"

"No, I didn't know that! Did you know the first Residency program in emergency medicine was at UC in 1972?"

Bobby introduced me to the other firefighters, some who I knew by sight from the hospital. I already knew Sam Collins, his partner who I saw regularly at the hospital, and who was one of the few African American members of the Fire Department.

"You know, I never asked, but what do you guys do when you aren't on a run?"

"Depends on the time and the person. Some guys play chess, some play bridge, some read, and some watch TV or tapes. We also have a ping-pong table, free weights, and a treadmill."

"How do you handle meals?"

"Each shift is responsible for their own food. In the galley you'll see cabinets labeled by shift, and we make a grocery run when we need to restock."

"How does that work?"

"Usually an engine crew goes to Kroger. The engineer stays in the truck and the four firefighters and the officer go into the store and do the shopping. If there's a call, the guys in the store are called by walkie-talkie and basically drop everything and respond from there."

"Come to think of it, I've seen that on occasion at Kroger. What now?"

"Relax and wait for the call, exactly as you do in the ER! The only difference is you're coming with us, instead of us coming to you."

"OK. I brought medical journals, so at least for this morning, I'll read. What's the scoop on sleeping?"

"Quiet hours are from 10:00pm to 6:00am, so it's up to you. Did you bring an eye mask?"

"I did. I'm used to sleeping when other people are moving around. I bet it's actually quieter here than in the on-call room at the hospital."

"The guys are pretty good about keeping quiet. Use any of the recliners, couches, or chairs. There aren't any assigned spots except for wherever Brigid decides she wants to sit. You move if she wants the recliner or spot on the couch."

"Does she go on runs?"

"Usually with Lieutenant Greer on the second engine."

"I meant to ask before, but why respond with an engine and the squad for purely medical calls?"

"We learned when we first started that having two extra guys is necessary in moving some patients out of second or third floors, and sometimes we have to remove doors. Having an engine crew along allows us to focus on the victim while the other guys deal with any obstacles, or assist in getting someone out of difficult spots. Think about some of the narrow staircases and how well a stretcher would work. In those cases, we'll use a ladder and take someone out a window in a Stokes basket."

"So Emergency wasn't fiction?"

"It was pretty accurate in most cases. Did you know that engineer Mike Stoker was actually an active LA County Firefighter at Station #69 in Topanga Canyon?"

"No, I didn't."

"Basically, they needed someone who could drive and operate an engine and other apparatus and he held a Screen Actors Guild card. The dispatcher for the series, who you mostly heard over the radio, was LA County Dispatcher Samuel Lanier, and the captain in the first season was LA County Fire Captain Richard 'Dick' Hammer."

"You seem to have had more luck with doctors than Johnny did with nurses!" I chuckled. "How was she this morning?"

"Cranky! But I think that's as much not being able to work as it is Bobby Junior being stubborn."

"I was hoping he'd be born before Kris, Rachel, and I leave on vacation."

"I think Lor is as well!"

A klaxon sounded, followed by a loudspeaker call.

"Station 2; structure fire; County Route 25-A at Ferry Market Road."

Some other details were given in jargon I didn't comprehend, and it certainly wasn't time to ask.

"That's us!" he declared, and I followed him towards the squad while Lieutenant Greer acknowledged the dispatcher.

I chuckled to myself that the only thing missing from his radio acknowledgment was 'KMG-365'. We were first out of the station, as we didn't need to put on bunker gear. I had a general idea of where we were headed, and if memory served, it was a farm, which meant it could be a house, barn, or, more dangerously, a silo. It would, at the speed we were moving, take about eight to ten minutes to get there.

"What's the drill when we arrive?" I asked Sam, who was sitting to my right on the bench seat.

"Assess and treat any victims and wait for the engines for anything else. If there's a need for immediate rescue, we'll gear up and go in; you stay by the squad until we come out or you're directed to do something by the Captain or Lieutenant."

"Got it."

"The only exception," Bobby said as he slowed for an unguarded railroad crossing, "is a simple kitchen fire, where we can use extinguishers. But it's usually too late for that by the time we arrive when we respond to the boonies."

"You have to figure," Sam continued, "that by the time someone calls it in, we're dispatched, and arrive for one of these remote runs, it's twenty minutes. At that point, either the fire is out or fully involved. Old barns and farmhouses go like kindling. Remember, keep your helmet on at all times, even if you aren't wearing the rest of your gear."

"Got it."

As we turned west, I could clearly see smoke rising, and when we reached the crossroads, I saw, true to Sam's prediction, a barn that was fully involved. We stopped about fifty yards away, I grabbed my helmet and medical bag and followed SAm out the right-hand side of the squad.

"Where's the fire engine?" a man of about sixty asked.

"About a minute behind us," Bobby replied. "Anyone in the barn?"

"No, and we got the cows and horses out."

"Anyone hurt?"

"Don't think so. None of my hands were in the barn, and my wife and I got the animals out into the pasture."

The two engines pulled up behind us and the crews set to work. Fortunately, there was a large pond next to the barn that appeared to be fed by a well to draw extra water from. Hoses were deployed and water was directed onto the barn, which I was positive was a total loss. Twenty minutes later, there was no longer any black smoke and fifteen minutes after that, Captain Brinker declared the fire out. He sent one engine back to the station while the other crew checked for any hot spots using axes and hooks.

"Squad 2, County Dispatch! Squad 2, County Dispatch!" the radio chirped.

"Squad 2!" Sam answered.

"MVA; County Road 25-A and Thompson Road; Engine 22 responding with you, ETA eight minutes."

Engine 22 was the second engine, which the captain had ordered back to the station, keeping Engine 21 at the scene of the fire.

Sam acknowledge the radio call and, then said "Let's go! That's about two miles from here."

We clambered back into the squad and five minutes later climbed out at the scene of a single-car accident with the car upside down in a drainage ditch. A Sheriff's cruiser was blocking the road, and we pulled up behind it.

"Two victims; no fire!" the Deputy called out.

"Mike, stay by the squad!" Bobby ordered as he and Sam jumped out and ran over to the vehicle.

I put on my helmet and stood next to the squad while they went over to the car.

"Gear up!" Bobby called back. "We're going to need cervical collars and IVs right away."

I got into my gear, grabbed my medical bag, and then followed Bobby and Sam back to the overturned late 60s Ford LTD. I watched as they quickly assessed the patients, inserted IVs, and cervical collars. The engine pulled up just then and the four firefighters and Lieutenant Greer hopped out and came over to us, while the engineer, Carl Voline, stood by the engine.

"Mike, move back," Lieutenant Greer ordered. "We'll get 'em out for you."

I moved about ten feet away, and Bobby and Sam joined me while the firemen assessed the vehicle. I saw Bobby and Sam removing their gear, so I followed suit. The firefighters pried open the driver's door with a crowbar, but couldn't get the passenger door open, so they extracted both victims via the driver's door.

Bobby, Sam, and I went to check on the victims and neither of them had compromised airways, so I simply observed while the paramedics assessed them. The firefighters brought the two transport gurneys from the squad and carefully transferred the victims, one conscious and one unconscious, to them, then rushed them into the back of the squad.

"With me, Mike!" Sam called out.

I followed him into the back with the patients while Bobby got into the cab. One of the firemen shut the door behind us and pounded on it three times to signal to Bobby to go.

"Assess the patient by you, Mike."

I connected the PulseOx sensor to the teenage male and turned on the monitor, then auscultated the patient's chest and abdomen. He clearly needed oxygen, so I hooked up a mask and set the flow to five liters per minute, then checked his BP. The patient had an obvious broken arm, as well as a serious contusion to his temple, likely responsible for his lack of consciousness, but his belly wasn't rigid and his ribs did not appear to be broken. I got my penlight from my bag and checked his pupils and the right one was blown and the left one sluggish.

"How are your patient's pupils?" I asked.

"Sluggish, major contusion to the chest from the steering wheel. No other apparent injuries. Yours?"

"GCS 6; one pupil blown, the other sluggish. Bobby?" I called out.

"Yeah?"

"Call in and ask for neuro to be standing by."

"Got it!"

He made the radio call and about three minutes later, we pulled into the hospital driveway.

"How do we report vitals?" I asked Sam.

"You and I will do it, otherwise I'd give Bobby the most critical patient bullet."

"Mine goes first," I said.

"You got it, Doc!"

A few seconds later, the squad stopped, Bobby jumped out and hurried to the back of the squad to open the door. I disconnected the PulseOx monitor and Bobby and I got my patient out first.

"Late teen male," I called out. "MVA restrained by lap belt; severe contusion and laceration to the right temple; GCS 6; right pupil blown, left sluggish; BP 80 palp; tachy at 110; PO₂ 93% on five liters; IV saline TKO."

"Trauma 1!" Doctor Gabriel replied. "Neuro consult is waiting for us."

He, Felicity, Jamie, and I rushed the patient into the trauma room and I was about to begin hooking up monitors.

"Mike," Bobby said, "You're a paramedic today. Get the oxygen bottle and we're out of here."

I nodded, and as soon as Jamie had the hospital oxygen hooked up, I grabbed the portable bottle and we left the trauma room.

"Sorry," I said.

"Don't be," Bobby replied. "Those trauma rooms are your natural element, and I expect you to go on autopilot."

"If you need the john, use it now in case we get a call on our way back to the station," Bobby advised.

I took his advice and started to go to the locker room, but realized I wasn't acting as doctor or medical student, so I used the public restroom. When I came out the door, I nearly ran into Ellie.

"I see you decided to join the Fire Department instead of being a doctor?" she teased. "Good!"

"That sounds like sour grapes!" I chuckled. "Can't have it, so I don't want it, and I want it out of my sight?"

"Oh, I want it alright!" she said sexily. "But I know better."

I smiled and nodded, then found Bobby and we headed back to the squad where we met Sam. The three of us got into the cab and headed back to the fire station.

"How long do you usually stay on site for a fire?" I asked.

"Until we're released by the officer in command of the site," Bobby replied. "At that point, we're released for dispatch."

"Out of curiosity, what were you expressly told about what I can and can't do?"

"You're officially an observer unless Sam or I expressly assign you a task, and we're only supposed to do that if we're shorthanded, or like today when we have two patients in the squad."

Which was what I had expected to be the case. That meant barring a mass-casualty event or a need for intubation, I was going to be doing a lot of standing around watching, which was not all that different from my Preceptorships. What I was doing really was just observation, and the real involvement would come in training the paramedics to do additional procedures.

"I figured that was the case," I replied. "The main rationale is for me to get used to Fire Department procedures so I can train you guys to do intubations, hook up EKGs, and perform other procedures when that program starts in the fall."

"That's basically what Captain Brinker said to us," Bobby confirmed.

"I'm curious why you guys didn't try to pry open the doors of the car."

"We do have pry bars and other light equipment in the squad, but by the time he had the cervical collars on and the IVs in, the engine was only about two minutes away. If the car had been on fire, we'd have done the extraction. Otherwise, unless we need to perform immediate CPR, we wait for the firefighters."

"That delay could be sufficient for a victim to die," I countered.

"It's a balancing act," Sam interjected. "We do risk our lives, but it's always a calculated risk. In this case, with that ancient LTD, prying open the door gave complete access. But with a compact car we'd likely have had to cut away parts of the frame to extract the victims, and we simply don't have those tools."

"That makes sense," I replied. "I'm just thinking about the Golden Hour and how much of it elapsed while we were on the scene before we transported the victims."

"I hear you," Sam replied. "But even in the city, it's probably about thirty minutes from the call to the dispatch center until the responding unit arrives at the door of the ambulance bay. You figure six minutes transit time, roughly, each way, so twelve minutes is gone right there. Then assessment, initial treatment, and loading into the squad are at least five minutes, often closer to ten. That's a third of the Golden Hour right there, in perfect conditions. I'm not sure there's much we can reasonably do to speed things up."

"Being able to do more procedures on arrival is the key," I replied. "But some things, like clot-busting drugs, are risky, even in the ED."

"Incremental progress," Bobby said. "You made the point that just over a decade ago, it was still 'scoop and run' ambulance service. Soon we'll add intubation to our repertoire, but the biggest problem, and one for which there isn't a solution beyond saline IV, is blood loss."

"That's a tough problem to solve given the requirements for storing blood and blood products like plasma. I haven't seen any articles on pre-hospital transfusions, but I know the military used them successfully in Korea and Vietnam in aid stations. What do you carry in your drug box?"

"Atropine, albuterol, epinephrine, insulin, morphine, naloxone, and nitroglycerin. We also carry Tylenol, aspirin, and of course saline and lactated Ringer's. We'll add a few drugs when we convert to ALS units, but I'm not sure what those will be."

"I'd speculate at least lidocaine as an anti-arrhythmic plus succinylcholine and etomidate for intubation. Those are the obvious ones. Maybe something like Haldol or midazolam. I'll look into it, actually, because we'll need to know to properly train you guys."

We arrived back at the station and had five more runs before quiet time began, none of which were exciting -- two MIs, two MVAs, and a broken limb. I observed on all of them, as without a proper EKG or drugs, there really wasn't anything I could contribute, and Bobby and Sam knew their job. I quietly said abbreviated evening prayers, put on my mask, and turned in for the night just after 11:00pm.

May 30, 1989, McKinley, Ohio

We had one overnight run, just after 2:00am, for an elderly man who had fallen down the stairs at home and had broken his hip. I managed about six hours' sleep, which was more than I'd get in the hospital. At 7:00am, I left the station and headed home.

"Morning!" Kris exclaimed when I walked in, coming to greet me with a kiss.

"Dada!" Rachel exclaimed, toddling over for her own hug and kiss.

"Breakfast in about fifteen minutes," Kris said.

"OK. I'm going to take a quick shower and put on shorts and a t-shirt."

I did that and was back downstairs in ten minutes.

"How was it?" Kris asked.

"Interesting, as far as it goes. I'm an observer, with the main point being to understand how the guys work and what they encounter, so I'm equipped to train them in the Fall."

"Did you get any sleep?"

"About six hours total. We had a run just after 2:00am and were back at the station about 3:15am. I don't plan to nap or anything today."

"OK. I planned to take Rachel to the park. We'll meet Abigail and her nanny there."

"That sounds like a great plan! Mind if I tag along?"

"Of course not!"

Breakfast was ready a few minutes later, and after we ate, we cleaned up, then said morning prayers. At 9:45am we left for the park, where Rachel and Abigail had a great time playing together for an hour, then we returned home for lunch, and after that, we had a lazy day at home.

III. Field Work

May 31, 1989, Columbus, Ohio

On Tuesday, I joined Bishop JOHN for lunch at the Cathedral at his request.

"Thank you for joining me for lunch," he said after I received his blessing.

"It's my pleasure, Vladyka."

We sat down in the comfortable wingback chairs in his office, he said the prayer of blessing, and we began to eat.

"Was there a specific agenda you had in mind?" I asked.

"No, though I would, if you're willing, like to discuss Father Nicholas."

"I'm not sure I'm the best person to give an opinion."

"I've heard from several people, and without naming names, I'm sure you can deduce who, that they are unhappy that he, in effect, ran you out of the parish."

Viktor was almost a certainty, and it wouldn't surprise me if Subdeacon Mark had spoken with Bishop JOHN. Serafima was also a possibility, as she could no longer see her goddaughter regularly at church. It also wouldn't surprise me if Oksana had not said something given Kris was her cousin and given Doctor Casper -- Ghost -- and I were friends and colleagues.

"I think," I said carefully, "that the last four years have been so stressful for the entire diocese, and Saint Michael specifically, that it's difficult to lay blame at the feet of anyone, except perhaps the deposed Robert Langley. Everything stemmed from his behavior. I am not excusing the response of retired Bishop ARKADY, nor of anyone else, simply pointing to the origins of the problem."

There were also the unproven allegations of sexual impropriety against Bishop ARKADY, which privately I believed, but as they had not been investigated nor had they been proven, I kept that opinion completely to myself.

"You have," Kris said, "on a number of occasions, made the point that while we can't control what others do, we're responsible for our own actions."

"Me and my big mouth!" I chuckled.

"You also have a history of being reluctant to assign blame to others, even when they are clearly at fault."

"Because of my own failings," I replied. "For the most part, I'm too busy trying to remove the log from my own eye. I figure when I achieve complete theosis, and thus synergistic perfection, that's the time to worry about other's faults."

"A Christian attitude with which I cannot find fault, and yet, as episkopos, I have a duty to oversee my diocese and to care for the wellbeing of individuals, parishes, and the diocese as a whole. I appreciate your desire to, in effect, shake the dust from your shoes and move on, but I have no such luxury."

"Permission to speak freely?"

Bishop JOHN laughed softly, then said, "As if I could prevent that! I might as well tell the mountain to go cast itself into the sea!"

"My Residents and Attendings at the hospital would agree with you!"

"You are always free to speak your mind and your heart to me, Misha."

"I'm sure you're well aware of the false allegations and that I don't need to rehash them."

"I'm curious as to why you think Father Nicholas would have considered those allegations valid; if you're willing to share."

"I think the best answer to that is, that at times when I was neither betrothed, married, nor a deacon, celibacy was not my strong suit, something of which Father Nicholas, Father Herman, Father Stephen, and Father Roman are all aware."

"I surmise, then, that you confessed and received absolution for your failing in that regard, and that no transgressions of your marital or diaconal vows occurred."

"That's accurate. And it's that history, along with the whisper campaign about Rachel's caregivers, which led Father Nicholas to not give me the benefit of the doubt, so to speak. The most recent incident had to do with Doctor Greg Casper and his upcoming marriage to Oksana Ivashko.

"Had I remained a deacon and that same situation had been brought to my attention, I'd have spoken to Father Nicholas directly, or to you. But as a layman, I felt it was my place to correct a misunderstanding he had, one which, in my opinion, was created intentionally by Father Nicholas. In my mind, something I heard back in High School when studying the Spanish Inquisition..."

"Which nobody expects, right?" Bishop JOHN interrupted with a twinkle in his eye.

I couldn't help but laugh.

"Well," I replied, "I am sitting in a comfy chair!"

"Sorry to interrupt. Please continue."

"No apology necessary! That's exactly the kind of thing I would do myself! In any event, what was said was 'A man converted against his will is of the same opinion still', and I think that's exactly right. Doctor Casper is attending services regularly, and has no objections of any kind to having his children with Oksana baptized, and has many views which align with the Church.

"The problem, at its root, is he felt compelled to convert. It's my firm belief that had Father Nicholas not adamantly insisted he be chrismated, he might well have chosen to do so voluntarily before the wedding. The pressure bothered him, and, to be honest, was completely inappropriate. It would be one thing if Oksana had made that a requirement, as I did for any girl with whom I was serious; it's a different thing when the priest makes it a condition, when the canons require no such thing."

"You did have a habit of what my protestant friends would call 'missionary dating'."

"So sue me," I chuckled. "But to be honest, it worked with Angie, and if not for her illness, my life would have turned out significantly different. The same is true with regard to Kimiko, where the deciding factor for her was not a rejection of Orthodox, but of American culture, such as it is."

"I can see how, from the perspective of a young Japanese woman, our culture would be too chaotic and foreign. Some of our brethren in Russia would certainly agree."

"The elections in Poland this weekend may well be a major turning point in history," I replied. "If the Communist Party loses power, I would say that the Kremlin wall might bear the prophetic phrase 'mene mene tekel upharsin'. My grandfather certainly thinks this will be the crack in the dam, and that nothing will stop the water from bursting through. The fear, of course, is that the CPSU decides to go out with a bang, not a whimper, and the world is destroyed with fire."

"Lord have mercy that is not the case," Bishop JOHN said. "But returning to your thoughts, are you making an accusation against Father Nicholas?"

"Not formally," I replied. "But it is the case that, from what I can tell from my conversations with Doctor Casper, that Father Nicholas misrepresented the canons and teachings of the Church, if not directly, then by omission. But in the end, the problem was not a disagreement about the approach, or even about the canons, but when he said, and I quote, 'this attitude of yours is very tiring'."

"Said in response to what statement?"

"He asked, after I answered his question about Doctor Casper deciding not to be chrismated before his crowning, why it appeared I was bent on causing trouble."

"I responded in my usual fashion, and concluded with a statement that if my behavior was such a problem, Kris, Rachel, and I would worship at the Cathedral in the future. He said I was being overly dramatic, and I replied that he was being overly critical, as he had been for years. That's when he made the 'very tiring attitude' comment. At that point, I said we were going to transfer our membership."

"By 'usual fashion', I'm going to guess a reference to the canons and the Scriptures?'

"I'd covered the canons before, when I'd raised Doctor Casper's concerns. As for the Scriptures, I pointed out that the established clergy of the day called Jesus a troublemaker and that the secular governments called Saint John Chrysostom a troublemaker. I also mentioned Socrates for good measure. I made it clear I wouldn't apologize for speaking the truth, and that's when I said we'd worship at the Cathedral and the conversation proceeded as described."

"You are not afraid to speak truth to power, which is a positive trait, so long as it's done in love. Was their animosity in your heart when you spoke to Father Nicholas?"

"Probably some," I replied. "I planned to discuss that in detail with Father Roman when I see him on the 24th."

"Good. Then I'll leave that in his capable hands. Do you think Father Nicholas is a good pastor?"

"Generally speaking, yes," I replied. "My one objection was him not quashing the rumors, backbiting, and whisper campaign, which required you to step in."

"Yes, and confidentially, I addressed that privately with Father Nicholas. Do you think he should remain as pastor of Saint Michael?"

"I have two responses, first, that's a decision that is WAY above my pay grade! Second, our tradition is that priests serve the same parish for their entire career, if possible."

"A careful answer, as usual. In your mind, what would be sufficient cause to break with that tradition?"

"If the needs of the diocese were such that the priest's unique skills could be put to better use, or, more rarely, if conditions in a parish necessitated a reassignment. What happened at Holy Transfiguration rose to that level."

"But not Saint Michael?"

"Honestly, I believe more harm than good would be done by transferring Father Nicholas, if that's what you're considering. I am a unique, difficult case, perhaps impossible for a parish priest to manage. Possibly for a bishop as well."

Bishop JOHN laughed heartily, "You are not even close to the most difficult! And that is NOT an invitation to try!"

"Darn," I said flatly.

"In all seriousness, Misha, a parish full of outspoken individuals who promoted love, joy, peace, patience, kindness, goodness, gentleness, and self-control would be far preferable to a quiet parish which did not exemplify Christian morals and ethics. Nobody, even those who might object to your methods, could level an accusation against you for not living your life as a Christian should."

"And yet, I'm a sinner."

"What's the saying?" Bishop JOHN asked with a smile. "Join the club? Not to excuse your sin, but you know as well as I do that the Christian life is not an easy one, and we all miss the mark. The joy of our faith is that God loves us and is there to give us a hand up when we stumble every single time, no matter how often we make a misstep."

I nodded, "Something for which I am eternally grateful. Are you considering moving Father Nicholas?"

"On that, I have to keep my own counsel, though you're a wise man, Misha."

"If I may offer advice..."

"Of course."

"See how things are over the next year with the thorn removed from Father Nicholas' side."

"And instead in Father Luke's?" Bishop JOHN asked mirthfully.

"Because I'm not involved in teaching, almsgiving, serving at the altar, or on the council, I doubt there will be any concerns. I say that as the Dimitrijevics have greeted me cordially, and if anyone has a right to complain, it would be them."

"If I understand correctly, it was Danijela's decision not to move forward."

"It's complicated," I replied. "We had agreed on a decision after the one-year memorial of Elizaveta's repose, and Danijela pushed me to decide before then, mainly because I was still seeing Danika Kurian. It's my belief that either Danijela's grandmother, or mine, pushed her to 'close the deal', as it were, and when I demurred, she broke things off. I did speak to Danijela before I had my second date with Kris, and Danijela rejected my overtures, which I felt left me free to continue with Kris."

"Quite a few words to say 'yes'," Bishop JOHN replied with a smile.

"I know," I replied. "But you also know I'm reluctant to place blame solely on anyone else when I've been involved in the matter."

"Something I wish more people would do."

"I typically have a forest in my eye compared to other's splinters."

"A proper attitude, but one which can be taken too far. Should I, never, as a sinful man, correct a member of my flock who strays?"

"Far be it from me to teach theology to a bishop..."

"So, you're changing then?" Bishop JOHN asked with a sly smile, interrupting me.

I laughed, "OK, so I do have a history of doing that! It's not about being sinless, but about being cognizant of one's own sins, and not holding others to a higher standard than the one to which we hold ourselves."

"Quite so. I know your availability is extremely limited over the next year, but would you have time to be involved in the Orthodox Prison Ministry project?"

That made me suspect Subdeacon Mark had been one of the individuals to speak to Vladyka JOHN, though he and I had discussed the topic back in April.

"I believe back in April you said I should take two years before I became involved in anything like that."

"The topic arose recently," he replied, confirming my thought.

"I intend to visit Frank Bush, if he'll see me, sometime after I return from Tennessee."

"If you're willing, I could commission you as a lay chaplain, which would give you more access. No pressure, and if you say 'no', I'll completely understand. I wouldn't make the commission public, though I would need to inform the Metropolitan. It would also let you, if you chose, serve as a chaplain at the hospital."

"That I cannot do," I replied. "The roles are completely separate for a reason, and need to stay that way. I can minister, when appropriate, but being a chaplain at the hospital would interfere with my role as a trauma physician. The division of labor is a critical component of how the hospital functions."

"Ah, OK. It was only a thought."

"Let me confer with Kris," I replied, "but I'm inclined to accept a commission expressly for prison ministry."

"Good. I take it all is well between Kris and you and Kris and Rachel?"

"Other than my wife being a card-carrying socialist, yes!"

Bishop JOHN laughed, "So, divergent politics aside, there are no concerns?"

"None. Our plan is to have a brother or sister for Rachel in June or July of next year."

"God willing, I look forward to that! Children are a blessing for their parents and for the Church."

"I question that when my little tsarina gets her back up about something!"

"What would you have said in the past? That she's a Russian woman?"

"Oh, that she is! She takes after her mother; both, actually. Though my Franco-Russian wife has a different way of applying her Russianness."

"She's a wonderful young woman."

"She is, and I'm fortunate to be her partner. Or, as she put it, when discussing the difference between Doctor Casper and me, he needed a devoted, loving wife to greet him when he arrives home and I need a partner in crime!"

"She's not wrong!" Bishop JOHN said mirthfully.

"This kind of abuse I can get from Clarissa!" I chuckled. "And soon enough from my daughter!"

"And if them, why not your bishop?"

"I'm not even going to try to answer that!"

"What? Michael Loucks lost for words? Now I can die happy, having seen everything!"

I laughed hard, "This is a side of you I haven't seen before."

"You know the reason why, of course."

I sighed, "Because certain people would get their noses out of joint, similar to how they did with me with regard to Rachel's caregivers and my close female friends."

"It's our cross to bear, Misha. But with you I can, as they used to say, let my hair down."

"It's longer than mine! As is your beard!"

"In all seriousness, you need to trim yours for your masks, right?"

"It helps, but I could let it grow out further. It's only in surgery that I wear a special mask with a beard pocket. In the Emergency Department that's not necessary, and we don't generally mask because it's not a sterile environment in the first place, the way an Operating Room is."

"What about your surgical cap?"

"I wear one designed for women with long hair, but they're all the same color and basic design, so it's not something that makes me stand out. Once I finish my first year of surgical Residency, I can choose my own design. That said, we mostly don't wear surgical caps in trauma."

"What color do you wear?"

"Light blue in the Emergency Department. After my second year, when I start my surgical rotation, I'll wear red to distinguish me from the other doctors in the Emergency Department. Attending surgeons usually wear Dark Blue, but Doctor Cutter wants to distinguish trauma surgeons."

"Doctor Cutter? A surgeon?"

"Not just a surgeon, but the Chief of Surgery! A perfect name! It would be like the Navy having a Doctor McCoy as a ship's physician or a ship's captain named Kirk!"

"Unfortunately, our time is almost up," Vladyka said. "I have a 1:00pm meeting that I simply cannot delay. Please let me know if you'll accept the commission, and I'll send you a proclamation as well as inform the Ohio Bureau of Prisons and the Hayes County Sheriff."

"I'll let you know before I leave for Tennessee."

"Excellent."

We finished our lunch, I received his blessing, then headed home.

May 31, 1989, Circleville, Ohio

"This isn't a backhanded attempt to lure you into accepting ordination, is it?" Kris asked after I explained the bishop's offer.

"No. It's actually neutral in that regard, but after today's meeting, I would wager that Vladyka will elect not to offer to ordain me in three years."

"Why is that?"

"I saw a very different side of him today, one he cannot show anyone who is clergy, and possibly not even his brother bishops."

"How so?"

"What I'm about to say is not something that can be shared with anyone."

"OK," Kris agreed.

"Vladyka treated me like a friend," I replied. "Joking, teasing, and generally being irreverent without being ungodly."

"And that makes you certain he won't ask?"

"Certain? No. Reasonably confident? Yes. Even as close as he and I were when I was a deacon, he was never this way with me. There is a protocol for such conversations, and this is the first one that didn't even come close to following the protocol. If you think about it, who can the bishop have as a true friend? With his brother bishops, he has to follow protocol; the same is true of his behavior when he's with his clergy. And most of the laity would never be willing, or possibly even able, to see His Grace as a man."

"But you, the most spiritual person I know, can?" Kris inquired.

"Actually, that's part of why I can," I replied. "Along with knowing the canons and traditions, I also understand the theology. It also helps that I have an understanding of my own sinful nature, and that is my primary focus."

"I'm sure Rachel will appreciate that when she's a teenager!" Kris teased.

"I may revise my views at that point!" I chuckled.

"I doubt you would do that."

"Of course not," I replied. "We'll teach her the ideal, and do our best to help her make wise choices, but in the end, she has to make her own decisions, just as you and I did, and we'll love her unreservedly. And the same is true for the kids we have in the future. In any event, back to the original question -- do you have any objection to me accepting a commission as a lay chaplain?"

"No. I think it's something you'll be very good at, and I know it's important to you to find a way to serve the Church."

"Then I'll inform him tomorrow. That will help when I try to see Frank Bush after our vacation."

"How do you think that will go?"

"Badly, but I have to try."

June 1, 1989, McKinley, Ohio

On Thursday, the first two hours at the fire station were quiet, but just after 9:00am the station was called to a house fire which required a rescue, with three victims brought out suffering from smoke inhalation.

"Mike, I think this one might have a compromised airway," Rob, one of the firefighters, said carefully setting down an unconscious young girl in front of me. "Soot around her mouth and nose."

I put an oxygen mask on her and turned the flow to maximum, which was ten liters, then quickly auscultated to her lungs. She was moving very little air, so I opened my medical bag and took out my equipment to intubate. I moved so I was in the correct spot, then tilted her head. I saw a lot of mucous.

"Bobby," I called out, "do you have suction?"

"No. It's not something we carry on the rig."

I replaced the mask and quickly considered my options. I had an idea and went to the supply box, got an irrigation syringe as well as an IV tube. Connecting the tube to the hypo was a challenged, but I solved that with a hemostat from my bag. My makeshift suction device worked well enough to clear some of the mucous, which allowed me to visualize the vocal cords and pass the endotracheal tube properly. I connected an Ambu-bag to the tube and held it with one hand while I held the diaphragm of my stethoscope to the young girl's chest. I squeezed the bag a few times and had good breath sounds. Given she had only minor burns and no other obvious injuries, I simply bagged her until Sam was finished assessing his patient, a young boy.

"Bag her while I finish my assessment, please," I requested.

I did that and quickly confirmed that her only immediate problem was smoke inhalation, which bagging would help improve. I connected a PulseOx monitor to her finger and saw that her PO₂ was 88%. A minute later it was 92%, which meant she was in relatively good shape, though she might have lung damage.

"She goes first," I said. "And right away."

"OK," Sam said. "Let's load her and go. The other two are conscious and breathing OK with only minor burns. We'll have the Sheriff bring them in."

We got the girl, who I guess was about thirteen or fourteen, onto the gurney, and loaded her into the squad. Bobby hopped into the front seat, I got into the back, Sam closed the doors, then pounded on them, signaling Bobby to go. As we pulled away, I continued bagging.

"Neat trick with the suction," Bobby called back. "I'll have to remember that."

"Hopefully, your new ALS units will have suction in the kit. Actually, do you have an equipment list?"

"We don't, but somebody in the department has to because the orders were placed at the end of last year."

"Could you get me a copy? It would help with planning your training for later this year if I knew what equipment you'll have."

"I'll speak to Captain Brinker and see what I can do."

I began giving him the vitals, and four minutes later we were at the hospital.

"Approximately fourteen-year-old girl," Bobby called out. "Unconscious at the scene of a structure fire; smoke inhalation with soot in her nose and mouth; intubated; PO₂ 94% with bagging; pulse tachy at 110; BP 130/80; first-degree burns on both arms. Two more with first-degree burns but conscious coming in by Sheriff's cruiser."

We unloaded the girl from the squad and I continued bagging as we moved to Trauma 2.

"Trauma 2!" Doctor Casper said. "You did this, Mike?"

"Yes. I had to rig up suction with an irrigation syringe, an IV tube, and a hemostat to clear mucus to visualize the cords, but then the tube went right in, and I had good bilateral breath sounds. Her PO₂ came up from 88% to 92% bagging and improved from there during transport."

"Excellent work, Doctor!"

"Thanks."

As was the case with every transport, once we were in the trauma room, the doctors, nurses, and medical students took over, and Bobby and I left, meeting Sam who had come in with the Sheriff and the two other victims in the corridor. Once they were both in the capable hands of the medical staff, we paramedics headed back to the station.

"How'd you come up with that idea?" Sam asked.

"In autopsy, when Doctor McKnight wanted to draw fluid from a body cavity, he used a device that is basically like what I put together. The difference is the tube is fitted to the syringe with a proper collar with a screw. The hemostat did the trick, and while I couldn't get a lot of suction, I got enough to allow me to visualize the girl's vocal cords so I could pass the endotracheal tube."

"Would she have made it to the hospital if you hadn't done what you did?"

"I'd say she probably would've, if you'd put her on hi-flow O₂ and transported her right away. Her PO₂ was low, but not dangerously low. In Denver, normal PO₂ would be around 92%, so she wasn't that much lower. There was no cyanosis, which is the key. If her lips or under her fingernails had been blue, that would be a different story. Another four or five points would make it dangerous, or if she was cyanotic from carbon monoxide, toxic fumes, or lung damage. The fact that her PO₂ came up with bagging indicates no serious lung damage. She'll cough up a lot of mucous over the next few days, but after that, she should be OK."

"Losing kids is the toughest," Bobby said.

"I agree," I replied.

"Squad 2, County Dispatch!" the radio squawked.

Sam answered, "Squad 2."

"Respond with Station #3, MVA, Route 50, mile marker 111."

"Squad 2, responding; ETA seven minutes."

"Lord have mercy," I said quietly.

"What?" Bobby asked.

"Jocelyn nearly died eight years ago on that stretch of Route 50."

"Who's that?" Sam asked.

"A close friend from the time I was in kindergarten. An elderly man had a stroke, crossed the center line, and hit her head-on. She was choppered direct to OSU."

"I remember you telling me about that," Bobby said.

"How is she?" Sam asked.

"Married, and she graduated from law school last Friday. She starts her job on Monday, and she and her husband will adopt a baby as soon as one is available."

"She's a really smart woman," Bobby said. "I spoke to her last Sunday. Her husband seems like a good guy."

"He is," I confirmed.

We arrived at the scene after Station #3 and three Sheriff's cruisers. The paramedics from Squad 3 were working on two victims and the firefighters were working to extract at least one other victim from a crushed Ford Escort that had collided with a minivan, which I couldn't identify.

"Is that the Doc?" Ralph, one of the paramedics, called out when I jumped out of our squad.

"Yes," Bobby replied loudly.

"You guys take the ones still in the Ford. Doc, come here!"

I hurried over and knelt down next to the patient.

"Male, mid-30s; unconscious restrained passenger; extracted about a minute ago; cervical collar and backboard; obvious tib/fib and forearm fractures; trouble breathing and difficult to bag; pulse thready, BP 80 palp."

I quickly auscultated the patient and was positive he had a tension pneumothorax and possibly a cardiac tamponade from broken ribs. The problem was, I couldn't put in a chest tube in the field and I couldn't do a pericardiocentesis as I'd only seen them done, never performed one.

"Get him into the squad and let's go. I can't do a chest tube or pericardiocentesis in the field. I'll ride with you and do a complete evaluation so the docs can do an immediate pericardiocentesis. We need someone with us to bag."

"John?!" Ralph called. "Let's load 'em and go!"

With assistance from two firefighters, we got the victims onto gurneys and into the squad. I hopped in and sat on the bench on the side with the patient, along with one of the firefighters from Station #3.

"Just bag as best you can," I instructed as I began my exam.

About two minutes after we pulled away, the patient's PO₂ had dropped to 85% and I detected cyanosis, which greatly concerned me.

"Ralph? ETA?"

"About four minutes, Doc!"

"I don't know that this guy has four minutes."

I felt the squad accelerate, but that wasn't going to cut more than a few seconds off the transit time. I could buy him some time with a needle decompression, but I didn't have the appropriate kit with me. I could improvise, though, as I'd read about how it had been done before specific needle-catheter systems had been developed.

"John, I'm going to try a needle decompression," I said.

"You're the doc, Doc!"

"I need a 12-gauge needle," I said.

"In the compartment to your left."

I opened the compartment and found the needle with the pale blue Luer taper, screwed it onto a syringe, removed the plunger, located the second intercostal space, and carefully pressed the needle into the patient's chest.

"Easier to bag," the firefighter announced

The victim's PO₂ reading came up to 89%. I listened and heard breath sounds on both sides of the patient's chest, and his pulse grew stronger. My solution was temporary at best, but it would ensure the patient at least made it to the hospital. By the time we reached Moore Memorial, the PO₂ reading was 91%.

When we stopped, Ralph hopped out of the cab and called out, "The Doc has the bullet!"

He opened the door, and I jumped out, giving the vitals as we moved the gurney out of the squad.

"Male, mid-30s; unconscious restrained passenger; cervical collar and backboard; tib/fib and forearm fractures; tension pneumo due to fractured ribs; emergency needle decompression performed after cyanosis was observed; pulse tachy at 110; BP 100/60."

"Trauma 3!" Doctor Nielson ordered. "Is that a syringe in his chest?"

"I didn't have a proper chest needle and catheter," I replied as we moved the patient into the hospital with the firefighter continuing to bag. "That was a technique described in JEM."

Doctor Nielson gave orders and, as was protocol, I left the trauma room with the firefighter and John.

"Great save, Doc," John said.

"That's on the list of procedures we'll teach you during your ALS certification. How do I get back?"

"2 is on their way here with the final victim," Ralph said, coming out of Trauma 2.

They left, and I went to the nurses' station to wait for Bobby and Sam. They arrived about four minutes later with the victim who'd been extracted from the Ford Escort by the firefighters, and who was obviously in bad shape as Sam was on the gurney doing chest compressions, and Rick, a firefighter, was bagging.

"That was probably futile," Bobby said when he, Sam, and Rick came out of the trauma room a minute later. "Arrested two minutes out. Major head trauma, plus both legs broken, one compound. The impact was on both driver's sides, obviously high speed, and the minivan driver had an airbag. How was your guy?"

"Tension pneumothorax, I resolved with a needle decompression."

"Good thing you were along. Let's head back to the station."

"Bobby!" Ellie called out. "Your wife just came into OB!"

"Sam, put us out of service for fifteen minutes while I check on Lor."

"Will do!"

"Mind if I tag along?" I asked Bobby.

"Not at all."

Sam made the radio call while I followed Bobby to the elevator that took us up to OB. We stopped at the nurses' station to find out which room Doctor Gibbs was in, then quickly walked there.

"I'm here to deliver your baby!" I announced when we walked in.

"Oh, HELL NO!" Doctor Gibbs replied.

"OK, maybe not," I chuckled as Bobby went over to kiss her.

"How are you, Lor?" he asked.

"Eight minutes apart, but my water broke, so I came in."

"Hi, Loretta," Doctor Alice Carmichael said, coming into the room. "Candace is aware and she'll be over in about an hour, and asked me to manage your delivery. OK with you?"

"So long as you keep the PGY1 in the paramedic getup there the hell away from me!"

"Hi, Mike," Doctor Carmichael said. "What's with the uniform?"

"Paramedic ride-alongs," I replied.

"I need to do an exam," Doctor Carmichael said.

"I'll step out," I announced, and went out into the corridor.

Five minutes later, Bobby came out into the corridor.

"Let's go. I'll come back when relief comes in. Shouldn't be a problem, as Doctor Carmichael thinks four to six hours most likely. Why'd you step out?"

"Because your wife is my mentor," I replied. "And I believe she'd prefer I wasn't in the room."

"You're a doctor!" Bobby protested.

"And yet, we only treat family in extremis and are very careful about treating friends. If you ask your wife, she'll agree with me. Anyway, how does this work for you?"

"Normally, I'd have to trade shifts, but cases like this, I can call the Chief's office and they'll find someone to cover the remainder of this shift."

"You know what I just realized?" I asked. "That you guys have it even worse than I do with regard to knowing what happened with a patient. I usually know if they're going to make it or not by the time we're done in the ED, but you guys drop them off and levae."

"Every once in a while someone stops by the station to thank us for a rescue, but otherwise, you're right -- we mostly don't know. Like you, we're just cogs in the healthcare machine!"

I chuckled, "It does seem like that at times!"

We met Sam in the ED, then headed back to the station where Bobby informed Captain Brinker that Doctor Gibbs was in labor, then called for a relief paramedic. About thirty minutes later, Gabe arrived and Bobby headed to the hospital.

June 2, 1989, Circleville, Ohio

The rest of the shift had been what Sam called routine -- minor injuries and possible heart attacks, and just after 6:00am on Friday morning, Bobby called to say that Bobby Junior had been born at 2:04am and both Doctor Gibbs and the baby were fine. At 7:00am, with the shift turnover, I had weighed visiting Doctor Gibbs, but was positive she'd be tired and cranky, so I'd headed home, where Kris and Rachel greeted me with kisses.

"Did you get any sleep?" Kris asked.

"About five hours total," I replied. "I'll be fine without a nap, though I could take one while Rachel takes hers."

"Go get your shower; breakfast will be ready in fifteen minutes."

I went upstairs, took a quick shower, then put on shorts and a t-shirt and went back down to the kitchen.

"Bobby and Loretta had their baby last night," I said. "Mom and Bobby Junior are both healthy."

"How typical! The man does two minutes of pleasurable work, then the woman carries the baby for nine months and labors and delivers, and the man gets equal credit!"

"Two minutes?! Excuse me?!" I protested.

"And another typical male reaction! Question their virility in even the slightest way and they lose their minds! What little they have of them, anyway!"

I rolled my eyes theatrically, then declared, "I have half a mind to prove you wrong!"

"Half a mind is right!" Kris teased. "But that's still more than most men!"

"Ah, then my decision is made," I said firmly. "Rather than demonstrate my prowess, I shall not bother, as, clearly, my efforts are not appreciated!"

"I didn't say that!" Kris countered. "It's just I want to needle you!"

"And what I have for you is bigger than a needle!"

Kris laughed, "You are a very virile and well-endowed man!"

"Thank you! Perhaps I'll relent and demonstrate after all!"

"In all seriousness, though, that doesn't seem like something you've ever had trouble with."

"No. My problem was one of a libido in overdrive."

"I don't mind," Kris replied with a smile.

"You don't mind?!" I asked with faux outrage.

"You are so easy to wind up, Mike!"

"Or," I said slyly, "I know you want to wind me up, so I play along to make you happy!"

"Wait!" Kris protested. "That's what you do with Clarissa, isn't it?"

"It is! And if you ever tell her, I'm going to be very unhappy!"

IV. It's going to be a very busy year!

June 5, 1989, On the Road to Gatlinburg, Tennessee

"What happens now that you've finished your time with the fire department?" Kris asked as she maneuvered her Tempo onto Ohio Route 23.

"Now I have a full twenty-five days off, and perhaps one or two more, depending on when I have my first shift."

"It doesn't start on the 1st?"

"Not necessarily. If I needed orientation, then it would. But I get paid starting the 1st no matter what."

"Do you know the other new doctors? I mean besides Kylie?"

"I know their names only, and where they're from. I haven't met any of them. Besides Kylie, there are four men and one woman, and one of the guys is from India, but went to medical school at UCLA."

"So, including you, five men and two women?"

"I'm technically not a trauma Resident," I replied. "So of the actual trauma Residents, it's four to two, which is an improvement, given there is only one female Resident, Doctor Billings, and only one female Attending, Doctor Gibbs."

"And you're OK with that?"

"I'll say the same thing I did when a similar question was asked about Taft -- you can only draw from the pool of applicants. My class was about two-to-one male over female, which was an improvement, and the ones behind us were less unbalanced. The most common Match for women in my class was pediatrics, followed by OB, and then going into general practice. Surgery, cardiology, and trauma combined had fewer Matches than pediatrics."

"Why?"

"Part history, part conditioning, part personality traits. And, yes, discrimination, especially in surgery."

"And you put up with that?"

"No, I simply acknowledge it to be true. I have spoken up when and where appropriate, just as I did at Taft. Things are changing, slowly, and the medical school is doing more outreach to women and minorities. But a smallish medical school in south-central Ohio is going to be more white and more male than, say, UCLA, simply because of the demographics. We don't have many Hispanics in the area, nor many Asians, just to identify two minority groups."

"What about what you call African Americans?"

"Not represented at the same percentage as they make up the population, but as Doctor Mertens said when I asked, it's an applicant problem, not an admissions problem. They admit a higher percentage of African American applicants than make up the applicant pool. Not to defend our system, but there must be discrimination in France."

"Mostly against immigrants from Africa, especially from Algeria. I believe the main cause is that many of them are Muslim, and do not agree with the absolute secularism which we maintain in French political life, called «Laïcité». It is very much like what you call 'separation of church and state'."

I shook my head, "I don't think so. In our system, the government is expressly forbidden from creating a national church, and that's it. That's been read to not allow it to favor one faith over the other, and I agree. But other than that, 'Free Exercise' means the government may not interfere with religious practice, but faith may not only be public, but openly influence public policy."

"But the 'wall of separation'?"

"That was Thomas Jefferson, and he's been seriously misinterpreted. In context, Jefferson's concern was being compelled to follow a specific religious practice by law, not that religious people expressed political opinions. And remember, at the time, there were still established churches in individual states, because the original Constitution did not prohibit state governments from having established churches, which they did into the 19th century."

"That make no sense at all!"

"It does if you understand the founding concept of the United States to treat every state similar to a country, albeit with a common foreign policy, a common national currency, a free trade zone, and no border controls. It's similar to the Schengen Agreement, with regard to borders, and the recently passed Single European Act with regard to a free trade zone. And I know there are proposals for a common currency, and there is quite a bit of common foreign policy."

"But you are one country!"

"We are fifty sovereign states," I replied. "And the Constitution delegates limited powers to the federal government. The main political argument in the US since 1789 is just how much power the national government ought to have."

"And what do you think?"

"I think the country is too large to be governed centrally with 'one-size-fits-all' policies. What concerns me in southern Ohio may not concern someone in southern California or in Alaska or in Texas. What we have in common is currency and foreign trade, and, in theory, the ethos of the American Dream, true or not."

"Do you believe in it?"

"My family, on my mom's side, lived it, and I'm a product of it. On my dad's side, they were well-to-do from the time they first arrived in Manhattan in the 17th century. My Russian grandparents came here with nothing except the clothes on their back, a few personal items, and a balalaika."

"The one you have, right?"

"Yes. My grandfather gave it to me about four years ago. It will be Rachel's, if she wants to learn to play, which I hope she will."

"She certainly loves sitting with you when you play!"

"Most girls did!" I said.

"Of course!" Kris said, laughing softly. "Boys who played the guitar attracted girls like bees to a flower!"

"I didn't learn to play until college."

"Poor baby," Kris said flatly. "But going back to Europe, I didn't realize you knew so much about European politics!"

"I've picked it up through reading the newspaper, mostly. Our civics classes here, at least when I was in High School, focused on the American system."

"My High School here didn't offer civics, but we did have a course in principles of government, which, of course, was so out of touch with reality that I couldn't stand it!"

"The usual American mischaracterization of socialism and a denial that we have programs which are, in their essence, socialist, by American definitions."

"Yes, of course! Not to mention treating Marx and Engels as 'class enemies' while denying 'class' theory!"

"Americans do tend to suffer cognitive dissonance on that topic. But I suppose I'm a class enemy because I believe the accumulation of capital is, overall, a good thing."

"We'll work on that!" Kris said lightly.

"And I say 'good luck to you in that endeavor'!"

"Changing subjects, we never really discussed what we'd do in Tennessee."

"I believe we should spend time with Rachel, hike, swim, and make love!"

"How do you think Rachel will respond to a brother or sister?" Kris asked.

"With a sister, I think if we make the point she's a 'big girl' and the 'big sister', she'll be fine. She's not keen on boys at the moment."

"That will change!"

"More than likely, but you know Clarissa, so you know that's not a given."

"And your response?" Kris asked.

"Will be to love my daughter," I said firmly, "no matter what."

"And speaking of Clarissa, we should probably discuss her request, so we're in full agreement before we have dinner with her and Tessa."

"I think, in the end, you have the master trump, and the right to play it."

"I'm not sure that's fair to you," Kris said. "To simply say 'no' without approaching it with an open mind, even if the result were to be the same. What is a partnership if one is a dictator? You do not want to be ruled by me any more than I want to be ruled by you, which is to say not at all!

"You know, because I've said it plainly, that there are only two absolutes -- absolutely no secrets and absolute sexual fidelity. And with regard to sex, I've promised to do anything you want, with you, with no limits and no restrictions, and you've made the same promise. Everything else is open to discussion.

"I reject completely all misogynistic practices, and it would therefore be completely out of line to turn the tables, so to speak. I know you like to tease about women controlling your life, but I hope you know that's not true about me, though I do reserve the right to give you guidance."

I laughed, "Guidance from a Russian woman is FAR more than just a suggestion!"

"Good advice ought to be followed, don't you think?"

"As much as it might sound as if I complain about women controlling my life, it's really not a complaint. As Mr. Sokolov told me before I married Elizaveta, God gives us wives to make us better men. I agree, and I don't feel controlled when you suggest a course of action or a change in behavior. My mom, Jocelyn, Clarissa, and Elizaveta never steered me wrong, even if I didn't always take their advice."

"You don't feel as if I'm trying to control you, do you?"

"No, I don't. You've made your views clear, but you've always been willing to hear my side, and consider my views, needs, and desires. I don't feel at all controlled or limited or restrained by our relationship, with the caveats about secrecy and fidelity, with which I wholeheartedly agree."

"I would hope so! I may not be jealous, but I do not share!"

"I learned to share in kindergarten," I replied with a silly smile.

"NOT THAT WAY!" Kris protested, though she laughed after she said it.

"Well, Jocelyn and I did hang our smocks on the same hook so they wouldn't be lonely at night!"

"You were five!"

"I grew up!"

"Allegedly!" Kris teased.

"Jocelyn and Clarissa would agree with you!"

"You know they're teasing, right?" Kris asked.

"Of course. That said, both of them were instrumental in making me the man I am today."

"So I owe them a debt of gratitude?"

"I don't know that 'owe' is the right term," I replied, "but you certainly should be grateful. There were others, too, especially Angie, who had a major impact as well, though mostly in terms of my views on the horrendous state of mental healthcare."

"That really is a focus for you."

"Some would call it an obsession," I replied. "How is it in France?"

"There are plenty of doctors and plenty of services, and they are covered by our health insurance system, but I cannot say how effective it is because I don't know. Have you decided what to do about the doctor who improperly treated her?"

"I spoke briefly to Lara at the graduation party and she and I will speak with Angie's mom later this month. In the end, it's up to her, as I don't want to put the Stephens through an ordeal they'd prefer to avoid. If she's OK, then we'll file a formal complaint with the Ohio Medical Licensing Board and use the malpractice settlement as proof something happened. We'll probably lose before the Licensing Board, but I think it's worth the time and effort, as does Lara."

"If he's a bad doctor, he ought to be identified as one."

"I agree. I'd prefer his license be yanked, but I've been told time and again that's not going to happen, and I'm going to tilt at that windmill despite being warned not to."

"By the psychiatrist at the hospital, right?"

"Among others. Basically, it would be Mrs. Stephens filing the complaint, and Lara bankrolling the attorney, and me providing guidance and input, but doing my best to stay out of the limelight."

"I'm curious whether you would choose to protect yourself or help Angie?"

"That's a difficult question to answer without understanding the exact risks, which I won't know until they occur. I think the best answer is I won't risk my future medical license, but I would risk alienating doctors and administrators."

"But wouldn't that harm your training?"

"Perhaps in some minor ways, but in the end, the literal worst-case scenario would be that I'd obtain my license as a GP and emulate Doctor Evgeni. But I don't see that happening. The psychiatrist absolutely failed to take Angie's best interest into account and literally ignored or discounted the indications that she might have been on the road to recovery, or, perhaps, stability at a level where she could regain her autonomy."

"I don't understand why that's no longer possible," Kris said.

"In part, because she has to be medicated, but in part because the psychiatrist's actions caused a mental breakdown and pushed Angie back to the exact place she had been at her lowest point. It took literally years of concerted effort to get her off the drugs, which is a prerequisite for obtaining a driving license and applying to have her right of self-determination restored. What happened means that task, which was already difficult, will now be impossible, as they'll point to that relapse as a reason to not release her from the guardianship orders."

"As I said when we first discussed this, that doctor is evil."

"Indeed he is."

June 5, 1989, Gatlinburg, Tennessee

Kris pulled into the drive of the Greystone Lodge in Gatlinburg just after 4:00pm, after an uneventful drive from McKinley. Rachel had slept a good portion of the way, as she often did on longer car rides. She parked, we got out, I took Rachel from her car seat, and we went into the lobby.

"We have a reservation under 'Loucks'," I said to the Reception clerk.

She flipped through cards and selected one.

"Doctor Michael Loucks?" she asked.

That was not how I'd made the reservation, and I smelled a rat, though I didn't know which rat it was.

"Yes, along with my wife and daughter."

"Welcome Doctor Loucks! We have you in one of our family suites for nine nights, departing on the 15th. I see the room rate has been paid. I'll need a credit card imprint for incidentals, please."

I handed over my MasterCard and the clerk took an imprint, then handed it back to me.

"Sign here, please," she said, sliding a registration card to me.

I signed and pushed the card back.

"Two keys?"

"Yes, please."

"Is your luggage in your car?"

"It is."

She tapped a bell, and the bellman came over.

"Doctor and Mrs. Loucks have luggage," she said, handing the bellman the room keys. "Doctor Loucks, we can park your car for you, if you like, and bring you the keys."

"Thank you," I replied.

"Enjoy your stay!"

I handed the car keys to the bellman, and we moved aside to wait for the bellman to retrieve our luggage.

"That American custom is annoying!" Kris said quietly. "As if I'm your property!"

"She could have said 'Doctor and Mrs. Michael Loucks' and made it sound worse," I chuckled. "But we're in the South, so you have to expect people to use traditional terms and make traditional assumptions."

"All that does is perpetuate the problem!"

"Maybe so, but we're on vacation, so just let it go and enjoy the hospitality, please."

The bellman retrieved our bags, then showed us to our suite, which had two bedrooms, one which had a bunk bed with side rails. The bathroom had a large tub and a large shower with a bench. And the main room had a 35" television and stereo system.

"We can move the trundle bed to the main bedroom if you wish," the bellman offered.

"Rachel will be fine in this room," I said.

I tipped the bellman, and he said someone would return with our car keys within ten minutes.

"Someone upgraded the room and paid?" Kris asked.

"Yes. Your parents?"

"No. They wouldn't do that without asking me. Viktor Kozlov?"

"I seriously doubt it," I replied. "If Yulia ever found out, she'd be upset."

"Lara?"

"She's one possible suspect, though, like your parents, she'd have said something. The thing is, the only people I told where we were staying were my mom and Clarissa. If I had to put money on it, either Stefan or my grandfather, or both."

"Does it upset you that they didn't tell you? I mean, whoever did it?"

"No. I'm OK with surprises and unexpected gifts. And that's why I don't think it was Lara, because she knows about your distaste for secrets and surprises. May I suggest you simply accept the gift graciously and let it go? I'll find a way to work your preference into a conversation so it doesn't sound critical but makes the point."

"You don't agree with me, do you?"

"I have a somewhat different opinion, but I support your desire to not have surprises or secrets. So, in the end, we'll do it your way because it's something that's important to you, but not particularly important to me."

"OK. What shall we do until dinner?"

"Well, given the Tsarina slept most of the way here, I'd say we should go to the pool."

"She'll be OK?"

"I don't plan to simply toss her in!" I chuckled. "Let me get her bathing suit on."

"What about her diaper?"

"My mom bought her something called a swimsuit diaper. It's basically plastic pants with a cotton liner and then a top."

I changed Rachel, then went to put on my bathing suit, and stopped dead in my tracks as I saw Kris in a pure white bikini.

"Wow!" I exclaimed.

"Thank you, but you've seen me naked!"

"I have, but sometimes leaving a bit to the imagination is sexy!"

"You don't have to imagine!" Kris protested.

"And yet, I stand by the fact that you look sexy in that bikini!"

There was a knock at the door and the bellman handed me the keys to our car. Once I put the keys with my wallet on the table in the bedroom, Kris, Rachel, and I went to the pool. Rachel didn't know what to make of the kiddie pool at first, but soon was splashing and enjoying the water. We spent about thirty minutes at the pool, and, as I didn't want Rachel to burn, we went back to the room and relaxed until dinner, which we ate in the hotel dining room.

"What do you make of the elections in Poland?" Kris asked as we watched the evening news on television after dinner.

"I think the genie is out of the bottle, so to speak, or Pandora's box has been opened. The repudiation of the Communist government is a major threat to the Kremlin, and Poland is a potential powder keg. All we can do is pray it ends relatively peacefully."

"You worry about the Soviet response?"

"I do. Hungary in 1956 and Prague in 1968 are precedents, though I don't think this would turn out the same way. And when it's obvious they will lose, what do the hard-liners in the Kremlin do? I hope they remember their humanity, but I fear they won't."

"I fear you're right," Kris confirmed.

Later in the evening, we said our evening prayers, and after Rachel went to sleep, Kris and I shared a warm bubble bath, then made love before falling asleep in each other's arms.

June 6, 1989, Gatlinburg, Tennessee

"Should we discuss Clarissa's request?" Kris asked as we cuddled in bed on Tuesday evening after a full-day hike and a nice dinner in Gatlinburg.

"It really does come down to your decision," I said. "I don't have any reason to say 'no'."

"Will you tell me why you want to do it?"

"During Junior year at Taft, when Clarissa and I had recognized we were basically soulmates, but with one glaring impediment, we discussed what kind of future we might have together. The obvious answer was going to medical school together, Matching at the same hospital for our Residencies, and then practicing together. Clarissa made the point that she did want to have a baby some day, and we discussed how that might work.

"Remember, at the time, there was no suggestion I would be a deacon, and my plans for marrying were for after my first year of Residency, at the earliest, with the most likely time being during my third year, given dating during my PGY1 year would be difficult at best, and given the amount of hours I'd be working. Had things gone the way we discussed, without Bishop ARKADY's desire to ordain me, it would have happened before I married, even possibly before I was engaged."

"But Clarissa has the same kind of schedule, right?"

"Yes, but there are ways around it, which Maryam considered when she and I discussed a possible future together. It's entirely possible to delay your Match for a year, which she would have done, but in the end, as you know, we decided that trying to raise a family when we both had eight or more years of Residency was a challenge that we both felt was too great.

"One option Clarissa has considered would be having the procedure done sometime midway through her PGY1 year, and then she could take off six weeks during her PGY2 year. Of course, we'd have had a nanny, but on two above-average salaries, we could have afforded that. Obviously, everything changed when Bishop ARKADY proposed ordaining me, and took everything off the table, as it would have been unacceptable for me to procreate outside of marriage as a deacon, even via artificial insemination."

"Did you discuss it with Elizaveta?"

"There really wasn't a point because it simply could not happen."

"Out of curiosity, did Clarissa consider conceiving the usual way?"

"Considered, but once I married, that was out of the question, for obvious reasons. As she said at the time, the physiology works, even if the desire isn't there."

"And it's something you want?"

"It's something Clarissa wanted that I could do for her," I replied.

"But do you want a baby with her?"

"I'm not sure how to answer that," I replied. "I agreed because it was something I could do for her and with her, but it wasn't something I needed to do, as I obviously could have children with whomever I married. I guess what I'm trying to say is that this isn't something I'd put ahead of my marriage to you."

"Did you discuss how the baby would be raised?"

"Not really, other than I'd want to be involved in raising him or her, though my assumption was that the child would live with Clarissa and her partner, who at the time was unknown. When Clarissa starting dating Abby, the entire thing was called into question because Abby did not like me at all."

"Why?"

"Simply because I was a faithful, practicing Christian. Clarissa reminded her time and again that I was loving and supportive, but Abby could never get past the teachings of the Church on marriage and sexual relationships, even if I didn't try to hold her and Clarissa to those standards. In the end, they broke up and Clarissa started seeing Tessa, though by that time, I was married to Elizaveta and a deacon, so even though Tessa was open to the idea, it was a non-starter."

"So you'd be a dad, but your son or daughter would mostly be raised by Clarissa and Tessa?"

"I suppose," I replied. "As I said, we didn't discuss it in detail because of the things that happened to make it basically out of the question."

"I obviously don't have a problem with Clarissa and Tessa raising a child, either one they conceive with outside help or by adoption."

"Ohio would never let them adopt," I replied. "A stupid policy, but the state makes it tough even for single people to adopt, and gay and lesbian couples are basically refused any opportunity. That said, Clarissa wants to conceive, and I obviously support her desire. It really comes down to a question of whether you can accept the situation. If not, say so now, because otherwise, we'll find ourselves in a very bad place."

"I'm not saying 'yes', but I'm also not saying 'no'," Kris replied. "I think we do need to have our conversation with Clarissa and Tessa, then you and I will discuss what to do. Is that acceptable?"

"Yes, it is, so long as you don't feel compelled or pressured to agree."

"I don't. You know I'll speak my mind!"

"I have no doubt about that at all!"

"Perhaps you'd prefer I did something else with my mouth right now?"

"I would indeed!"

June 15, 1989, on the road to Circleville, Ohio

"Did you enjoy the ten days?" I asked as I pulled out of the Greystone Lodge parking lot.

"I did!" Kris exclaimed. "We probably won't have a vacation like this for a number of years because of your Residency, my work towards my degrees, and having two more children!"

"Charlotte Michelle or John Michael?" I asked.

"Those are the names on which we agreed. It's simply a matter of making one of them!"

"Well, we've had plenty of practice, so it's just a matter of lowering the shield!"

Kris rolled her eyes, "A Star Trek reference with regard to sex?"

"I am fully functional in every way, and capable of multiple techniques; a broad variety of pleasuring."

"Star Trek, again?"

"Commander Data from the first season episode The Naked Now, which was a riff on The Naked Time from the Original Series. Thankfully, I'm not like Wesley, who on a planet where they make love at the drop of a hat, gets arrested for trampling flowers!"

Kris laughed, "You seriously do not like the Wesley Crusher character!"

"He's annoying! Though I do love when Worf tells him how to get laid in the second season episode The Dauphin -- 'Go to her door, beg like a human'!"

"As opposed to?"

"Klingons, where the female roars and throws things while the man reads love poetry...and ducks a lot!"

"And how do you see me? Hmm?"

"You do make wonderful sounds when sufficiently motivated!"

Kris laughed, "«La petite mort» makes me feel SO good!"

"And me, as well!"

"Dada kiss Mama!" Rachel exclaimed from the back seat.

"Not right now, young lady! I'm driving!"

"Do you think she knows what we're talking about?" Kris asked.

"I think she detects the tone of voice we use, not the topic. And we do use a different tone when we're talking about sex. That said, she's pretty smart, and she has been in the room when we've fooled around!"

"Not recently!"

"True, but who knows what goes on in the mind of a toddler? They don't have the language to express themselves. Rachel is just beginning to string more than two words together into what passes for speaking in full sentences. That'll accelerate rapidly in the next few months, and by the time she's two, she'll have several hundred words in her vocabulary and understand how to create proper sentences. At that point, she will be able, as is true of every woman in my life, to tell me exactly what I'm doing wrong!"

Kris laughed, "What do you say? It's the Y chromosome?"

"Or as Jocelyn put it, when describing her boyfriend Karl, Dale, and me -- testosterone poisoning."

"There might be something to that! Men do not always consider the risks associated with their behavior."

"Which is why we pay higher premiums for auto insurance," I replied. "My premium dropped by nearly half when I turned twenty-five. Part of that was driving a muscle car, but most of it was being a male between sixteen and twenty-five."

"Speaking of insurance, I never asked, but how does that work for us with regard to medical care?"

"So long as we see doctors affiliated with the hospital, and receive all our care there, it's covered one hundred percent with a $5 copay on prescriptions and a $10 copay on office visits. If we have to go to a doctor outside the hospital who is not affiliated, or to another hospital, it's covered at 80% up to an out-of-pocket maximum of $1000 per person, or $2500 for the family. You should decline whatever insurance OSU offers students as it cannot be anywhere near as good."

"Then I need to find a primary physician affiliated with the hospital."

"Ask Doctor Forsberg when you see her before we begin trying to make a baby."

"Baby?" Rachel asked.

"Uh oh," I said quietly, and Kris laughed.

"A baby brother or sister for you," I then said aloud. "But not soon."

"No baby!" Rachel declared. "Rachel!"

"Well, that deteriorated quickly," I said quietly to Kris.

"Rachel," Kris said, "Mama and Dada love you lots, but they want to have a baby together."

"NO!" Rachel declared.

"You are not going to win this debate," I said quietly to Kris. "Do you know the difference between terrorists and toddlers?"

"No."

"You can negotiate with terrorists!"

Kris laughed hard, "I can't actually argue with that one, given our daughter's stubbornness!"

"She is a Borodin, through and through!" I declared.

"Stubbornness is OK in some things, not in others," Kris said.

"Determination versus stubbornness," I said. "Determination is good; stubbornness is often problematic."

"True.

"That said, I believe the Tsarina expects her wishes to be carried out!" I chuckled. "Maybe distract her with an Oreo and a juice box?"

Kris retrieved a cookie and a juice box from Rachel's bag and gave it to her, which had the usual effect of distracting Rachel from whatever it was that was annoying her. In the end, in about a year, Kris and I would have our first baby together and Rachel would just have to deal with it.

June 16, 1989, McKinley, Ohio

On Friday morning, Kris and I stayed in bed cuddling until Rachel woke up, then we had breakfast and said our morning prayers together. I called Viktor, and he suggested dinner that evening at the country club, though it wouldn't be in a private room. I checked with Kris, and she agreed, so we confirmed for 6:00pm.

"There's no fasting until after Sunday, right?" Kris asked, looking at the calendar.

"Correct. Even though the calendar shows fasting resumes at Ascension, the practice in our diocese is, as our bishop once put it, to 'party until Pentecost'. And then in two weeks we have an abbreviated Apostles' Fast. And, then, of course, the Dormition Fast for the first fourteen days of August."

"Should we do our shopping today?" Kris suggested. "That way, we won't have to rush tomorrow because of the wedding."

"That makes sense," I replied. "We can also stop at the hospital so I can check my schedule."

"Will it change every month?"

"No. It should be the same for six months, but, obviously, things can change if something were to happen with one of the doctors or they need to adjust staffing based on changes in patient loads. We can go whenever you're ready."

"Then let me dress Rachel and we can go."

Five minutes later, we were in my Mustang on our way to the hospital. I was totally not surprised when Rachel attracted all the attention she could handle, which was a lot. I went to the lounge to check my schedule, but I wasn't on it, then remembered I was officially on the surgical service. I went up to the surgical lounge, saw my name on the schedule, wrote the details in my notebook before returning downstairs. When I walked into the Emergency Department, I saw Kris at the nurses' station where Rachel was the center of attention.

"My first shift starts on Monday, July 3rd at 0600 and runs until 1800 on Tuesday," I said, using military time, which Kris was used to from having lived in Europe. "My next shift starts on Thursday morning, and runs until Friday evening, then I have a twelve-hour-hour shift on Saturday from noon until midnight. I'll be able to attend Vespers on Wednesday and the Divine Liturgy on Sunday, and Friday nights are free, too."

"That seems like the best possible outcome," Kris observed.

"I'm fairly certain Doctor Gibbs accommodated church. There was a note for me from Kylie that she'll cover for me on the afternoon of the 4th so I can play the concernt Code Blue has scheduled at the lake."

"You're going to be very tired!"

"Possibly, but I do want to play. And the fact that I have Friday evenings free means there's a good chance we can play gigs."

"Hi, Mike!" Kylie said, coming up to us. "Hi Kris! Hi Rachel!"

"Thanks for leaving a note about the 4th."

"You're welcome. I confirmed with Doctor Northrup that it's OK, because I'd only have about four hours between the end of my shift and when I have to be back for yours, but it'll work out OK. Did you hear about Tim?"

"No, I was happily completely incommunicado for the past ten days!"

"He failed his rotation and was given the option of dismissal or starting over."

"Rotations or coursework?"

"Coursework. He's a First Year again, as of August 1st."

"We'll see if he learned his lesson or not," I replied. "How does it feel to be a doctor?"

"Not all that different," Kylie replied. "Except I get to assign all the scut to the Third and Fourth Years! I don't get my own trauma cases, but I do get walk-ins to handle on my own. Well, obviously I have to clear things with an Attending, but you know what I mean."

"I do."

"How were your paramedic ride-alongs?"

"Mostly observation, but one intubation and one needle decompression for a pneumothorax."

"I heard about that! Just a large-bore needle and a syringe?"

"They don't carry the correct equipment to do that in the current EMS units. They will carry the necessary equipment in the new ones configured for ALS, which is why we'll train them in procedures starting in August."

"Doctor Baxter?" Nurse Kelly said to Kylie. "Four-year-old with a suspected broken wrist."

"Duty calls! See you in two weeks!"

She left to check on her patient, and I managed to rescue Rachel from the clutch of nurses so that she, Kris, and I could head to Kroger to do our grocery shopping. After Kroger, we stopped at the bakery for fresh bread, bagels, and croissants, then headed home for lunch and a quiet afternoon. Rachel had her nap, and then about 5:45pm we left the house for our dinner with Viktor, Yulia, Geno, Anna, and Viktor Gennadyevich. Little Viktor was his usual rambunctious self and Rachel gave him the evil eye throughout the meal.

"Cousin Viktor's behavior appears to not be to Rachel's liking," Viktor observed as dessert was served.

"I'm surprised she isn't rolling her eyes and saying 'Boys!' the way Elizaveta used to say 'Men!'," I replied. "But he's a healthy, active kid, and obviously would much rather be outside playing than sitting in a formal dining room."

"Just as his father and grandfather would!" Yulia interjected. "Except they'd be playing golf!"

"We'll get Mike out there with us again eventually, though I don't think his schedule as a Resident is conducive to playing golf!"

"It's not," I replied. "It should be better next year, and, of course, during my PGY3, I'll be on a surgical team, which means regular Thursday afternoon golf. The surgeons brook no interference with that tradition!"

"How will that work?" Geno asked. "I mean being what amounts to a surgical Intern but in your third year?"

"I'll participate in some scheduled surgeries for teaching purposes, but my main role will be surgical consults and emergency surgery. Basically, I'll identify surgical cases and then assist with the surgery. That frees up regular surgical Residents to participate in scheduled surgeries and to care for patients on their service. Longer term, that's what I and three other trauma surgeons will do. If the program is as successful as I expect it to be, that will be the norm, and there will be enough trauma surgeons, so no general surgeon has to cover trauma."

"And the new Emergency Medicine wing will be finished right about that time," Viktor said. "We break ground on April 16. The final surveys and permits were completed last week."

"I'm very much looking forward to the 'telemetry beds'," I said. "That, combined with the ALS certification for EMS, is going to make a world of difference in patient care. And being a Level I trauma center will make even more of a difference, though that certification has to wait for the new surgical wing, which won't be finished until 1995."

"We're hoping to advance that by a year, at least," Viktor said. "If we can complete everything by the end of next year, we'll start in early '91 instead of '92."

"How long will construction take for the new ER?" Anna asked.

"It will be about eighteen months until it opens," Viktor said. "They broke ground last week, but some of the equipment has a very long lead time and takes significant time to set up and install."

"What are you doing for the next two weeks, Mike?" Geno asked.

"As little as possible! We have a wedding in Cincinnati tomorrow, then next weekend we're going to the monastery so I can visit with Father Roman. Other than that, just resting and relaxing as a family before my Residency begins and Kris begins her degree work at OSU."

"It's going to be a very busy year!" Kris declared.

"That it is," I agreed.

V. And That Makes ME Happy!

June 17, 1989, Milford, Ohio

On Saturday afternoon, just before 1:00pm, I pulled into the parking lot behind Saint Andrew's Catholic Church in Milford. The lot was between Milford Main, the middle school, the church, and the parochial school attached to the church. Kris got out of the car, I got Rachel from the back seat, and the three of us went around to the front of the church, which faced Route 28.

An usher held the door for us and we walked into a traditional Roman Catholic church, complete with pews and an altar which was set so the priest faced the congregation, rather than facing liturgical east. There were statues, rather than icons, and the closest thing to an icon were the reliefs of the Stations of the Cross. Those reliefs were the only thing which adorned the walls and were austere compared to a typical Orthodox church where the walls were literally covered with icons.

We sat in pews on the groom's side, six rows back from the steps that led to the sanctuary, with me holding Rachel in my lap. Normally, she'd be allowed to crawl around the nave at Saint Michael, but that wasn't possible here with the pews and kneelers and a marble floor rather than rugs, though there was a wedding runner in the center aisle.

"Dada? Down!" Rachel demanded, seemingly reading my mind.

"You have to stay in either Mama's or Dada's lap," I said. "Or sit in the pew."

"NO!" Rachel declared. "DOWN!"

"Having fun, Petrovich?" Clarissa smirked from the aisle next to me.

"Maybe you can reason with my toddler! I certainly can't."

"Rachel, want to come to Aunt Clarissa?" she asked.

"YES! Clarsa!"

"I see where I rank!" I chuckled.

Clarissa took Rachel from me, then she and Tessa moved past to sit to the right of Kris. Rachel looked at me and scowled, and I just shook my head. She certainly had a mind of her own, and there was going to be a serious contest of wills, which, from everything I knew, was normal for the 'Terrible Twos', even though Rachel wasn't quite two.

The wedding service was typical of Roman Catholics, with a nuptial mass, with Father Robert Buschmiller as the celebrant. The Roman mass generally followed the same liturgical order as the Orthodox Divine Liturgy, though somewhat simplified, and they used an organ, which was something that was categorically prohibited in an Orthodox temple.

Sticks was acting as José's best man, and Sierra had only her maid of honor, and just the four of them stood at the altar once Sierra's dad had walked her up the aisle. When the service ended, we filed out of the church and a large group of our friends gathered in the parking lot to decide what to do before the reception. It wouldn't start until 4:00pm, which gave us about two hours to kill. It was in Loveland, about twenty minutes away.

"Is there anything close by to do?" Robby asked.

"The Cincinnati Nature Center is in Goshen," I said, "but by the time we get there, and if we allow for time to get to Loveland, we'd have maybe an hour to walk."

"Why don't we go to Frisch's?" Tessa suggested. "I saw it on Route 50 on the way here."

That was the consensus, though I wondered if they could handle close to two dozen people at once. We headed there, and they did manage to seat all of us, using two large booths and a number of tables pushed together. We couldn't all sit together but it did work, and we all ordered coffee, soft drinks, and a snack of some kind, which for Kris, Rachel, and me was a plate of French fries.

"Perhaps the French fries will improve Rachel's attitude towards you!" Kris suggested.

"Until I enforce the limit of how many she's allowed to have!" I said. "But then she's my mom's problem!"

"I wondered if you were bringing her to the reception," Clarissa said.

"My mom is meeting us at the banquet hall and will keep Rachel until we pick her up after the reception. Kris and I didn't think Rachel would do well sitting for four hours and unable to roam freely. Not to mention some adults do not tolerate toddlers at these kinds of events."

"Clarsa? Fry?" Rachel asked, causing everyone at our table to laugh.

"She knows who's boss," Sophia declared.

"Well, Petrovich?"

"I surrender. I mean, it fits, being married to a French woman!"

"«Придурок»!" Kris exclaimed.

"'Jerk'" Clarissa translated for everyone, resulting in laughter.

"«Je t'aime chérie!»," I said.

Kris smiled and kissed my cheek, knowing I was teasing her. Clarissa fed a very happy Rachel a stream of French fries, and about 3:20pm we all left Frisch's to head to Loveland for the reception.

June 17, 1989, Loveland, Ohio

"Congratulations!" I said to José when I finally had a chance to speak to him at the reception.

"Thanks!" he replied as we exchanged a hug.

"How was your vacation?" he asked.

"Relaxing. I never asked -- where are you two going?"

"We fly to Orlando tomorrow morning for six days at a Disney resort. Ever been?"

"No. I haven't been to many places in the US. In fact, I've been to more European countries than I have states! Ohio, Pennsylvania, Kentucky, Indiana, Illinois, and Michigan is it. How did you swing Disney on short notice?"

"Sierra and her parents had planned a vacation and her parents ceded the room to us. That's why we're going there."

"Cool. I noticed you crossed yourself in Orthodox fashion and I saw the priest raise an eyebrow the first time!"

"I may have been exposed to a bad influence!" José replied with a goofy smile. "It's really too bad you aren't in your «ryassa», because that would really have attracted attention!"

"Which is exactly the opposite of the intent, though you aren't wrong."

"I might even hold up my palm for a blessing!"

I laughed, "Not something a deacon can do, though had I'd been made a monk, there are circumstances where it's appropriate."

"That was about as likely as me being a monk!" José chuckled.

"Believe it or not, without Rachel, I'd have seriously considered it."

"You did take that calling seriously, even if it was your secondary calling."

"True. What I can say, though, is 'May God grant you many years'!"

"Thanks, Mike."

"You're welcome!"

We hugged, and he moved on to the next person he wanted to speak to while I returned to the table where Kris and a group of our friends were sitting. We had an enjoyable time, Kris and I danced, and with her blessing, I danced with Clarissa and Tessa, and when the reception ended, Kris and I headed to my mom's to collect our daughter and then head home.

June 19, 1989, Circleville, Ohio

"Did you have any plans at all for this week?" Kris asked at breakfast on Monday morning. "I mean, besides having dinner with Lara and Nathan tomorrow evening?"

"Nothing beyond spending time with you and Rachel. Well, I'll practice playing my guitar, of course, but that entertains the Tsarina, so it's something she and I can do together."

"What is the plan for the weekend?"

"Father Roman expects us for dinner at the monastery," I replied. "We'll leave just after lunch, which will get us there by 5:00pm. We'll have dinner, attend Vespers, and then I'll spend some time with him. On Sunday we'll attend Matins and the Divine Liturgy, then come home after lunch."

"My sister is looking forward to spending the weekend with Rachel!"

"So she can further corrupt her with French?" I asked.

"Oh, stop!" Kris commanded. "You like my French accent!"

"And you know I like to tease you about being French, even if I do like French kissing!"

"Feel free to demonstrate any time!"

"Dada kiss Mama!" Rachel giggled.

With my wife and daughter ganging up on me, there was only one thing to do! I got up, went around to the other side of the dinette table, and gave Kris a deep French kiss that tasted of maple syrup.

"You know, there's another place that needs a kiss like that!" Kris said sexily.

"I bet it doesn't taste like maple syrup!" I chuckled.

"It could!"

"Perhaps Rachel would like to visit your sister this morning!"

Kris smirked and mimicked picking up a telephone, "Hello, Lyudmila?! I want to have my husband cover my «minou» with maple syrup and lick it off! Could you please watch Rachel?"

I laughed, "And how would she respond to that?"

"She'd laugh, of course. It's not as if she's ignorant of such things! She is French, after all! And it's not as if she doesn't know we make love! I'll call her after we finish breakfast. We'll have to take Rachel to my parents' house, though, as Lyudmila can't drive and my parents are both at work."

"And then pick her up before dinner?"

"Perfect!" Kris agreed.

We finished breakfast, said morning prayers, and then Kris called Lyudmila, who was more than happy to take Rachel for the day. Rachel was happy to see Lyudmila, who was her second favorite after Clarissa, and when we were leaving, Lyudmila called out, "Have fun!".

And fun we had, spending the day either in bed or in the large tub, except for lunch. I preferred chocolate fudge to maple syrup, but that didn't detract from the enjoyment of licking maple syrup off my wife, nor hers from licking it off me, nor from the deep French kiss that followed my release which tasted of Kris, me, and maple syrup.

"Is there anything you want to do that we haven't done?" Kris asked as we lounged in a warm bubble bath late in the afternoon.

"Besides making a baby?" I asked.

"Soon!" Kris said happily. "Is there anything else?"

"No. I think you've noticed how I prefer to make love to you."

"Our sitting position?"

"Yes. And, of course, kissing you all over."

"Especially a very specific place!" Kris exclaimed.

"Yes," I agreed. "Are you asking the question because you want to be...more adventurous?"

"We are not inviting another girl into our bed!" Kris declared.

"Been there, done that!" I chuckled. "But you knew about that."

"I did. I just want you to be as physically satisfied as I am."

"I am sure I am," I replied. "Well, perhaps it's better to say I'm as physically satisfied as I could possibly be. That said, I do enjoy play time like we had today."

"You know, one thing I've never heard is how long into pregnancy you can make love."

"It's more about comfort and desire than anything medical," I replied. "At some point, you simply won't feel like doing it because you're tired, uncomfortable, or just don't want to. Medically, until your water breaks, there is no risk from having intercourse, unless you're in a high-risk situation."

"What would that be?"

"The most common one is elevated blood pressure. That's generally not a serious concern unless it spikes significantly. You'll also retain water, so your feet will swell, and in addition to the obvious weight gain and changes to your abdomen, your breasts may get larger, and will likely be more sensitive. I think the short answer to your question is that up through the second trimester. After that, it'll depend on how your pregnancy progresses, which is different for every woman and even for individual children from the same woman."

"That's not how our textbooks or teachers described it."

"They gave you the statistical norms, which are true for all women as a group, but as I say about diagnosing and treating patients, statistics are not determinative for an individual. All they can do is provide a baseline from which you have to develop an individualized treatment plan. The same is true for pregnancy. Doctor Forsberg will guide you through it."

"Not you?"

"I'm not an OB/GYN! I'm expert at making babies, beyond that, I'll send you to an expert in pre-natal care!"

Kris laughed, "I suppose Rachel is evidence that you are, indeed, able to make a baby!"

"Well, at a minimum, I know the correct physiological activities to create the chance of pregnancy."

Kris laughed again, "In other words, you know how to fuck?"

"Yes. But that's not exactly rocket science!"

"I do like your guided missile when it's in my silo!"

I chuckled, "The missile leaves the silo to function!"

"Oh, stop! I was trying to be silly!"

"And you know I am nothing if not pedantic, and I find that to be funny."

"Of course you do!"

June 20, 1989, Circleville, Ohio

"What's up with Rachel?" Lara asked when Rachel didn't want to be held.

"She's in a mood today," I said. "I think it might be that she hasn't seen any of her friends in daycare for three weeks, and her friend Abigail is in Spain."

"She's going back to daycare, right?"

"Yes. Kris starts classes at OSU in less than two weeks, and Rachel will go to daycare at least three days a week. The other days, at least for July and August, Lyudmila will help out. How is summer school?"

"I have the remedial kids who didn't pass math," Lara said. "Nathan has the ones who failed American government."

"That sounds like fun! Not!"

Nathan laughed, "I do have a few kids who are taking the classes as electives so they can participate in drama and speech, or band and choir, which each occupy one class period per quarter."

"Speaking of band, are you going to be able to play on July 4th?" Lara asked.

"Yes. Kylie is covering for me. It's already arranged with Doctor Northrup."

"I'm still shocked at the hours you have to work," Nathan observed. "Who knew?"

"I certainly didn't until I was at Taft working on my undergrad degree."

"What are you planning to study at OSU, Kris?" Nathan asked.

"Political science, and I'll go for a Master's in Public Administration."

"Where are things with your citizenship application?" Lara asked.

"The papers will be filed on July 5th. Then it's a matter of processing which can take months, though our attorney says that with our situation, it should go relatively quickly."

"The main thing is the investigation," I added. "They will want to ensure this isn't a sham marriage solely for citizenship purposes."

"We'll have to lie, of course!" Kris declared with a silly smile.

"Riiiggghhht!" Lara exclaimed. "As if Mike would do that!"

"I suppose it would depend on the emoluments," I chuckled. "Money and sex with a hot French girl in exchange for marriage to get citizenship? You never know!"

"Oh, please! As if I'd do that with anyone except a real husband!" Kris declared.

"Of course," I said slyly, "I am providing money and sex so Kris can get her citizenship! And that helps her parents, too!"

"As if you would trade sex for anything!" Kris retorted.

"Well, there are plenty of cute female medical students and nursing students!"

"I'll send to France for a guillotine, but it won't be the head above your neck which is chopped off!"

"Ouch!" Nathan said, wincing.

"A food processor was suggested by Elizaveta," Lara smirked.

"Remind me NEVER to piss off a Russian woman!" Nathan said, shaking his head.

"Something learned very quickly by anyone who encounters them," I chuckled. "And that started with my mom for me!"

"Oh, please!" Kris exclaimed. "You prefer Russian women!"

"Maybe," I replied with a sly smile.

"You married Elizaveta, and you considered Maryam, Lara, Oksana, Tasha, Danijela, and Danika, all before choosing me!"

"You might have a point," I chuckled.

There were actually a few more, but Oksana didn't know the extent of my relationships with Sara, Tami, Irina, or Susana, not to mention Sheila, though she'd become Orthodox after the fact. I heard the timer on the oven, so I excused myself and went to the kitchen to check the roast, which was ready, so I asked Kris to help get everything on the table, and a few minutes later, the five of us sat down to eat.

I continued to be impressed by Nathan, and really liked him, and I was reasonably certain he and Lara would marry, and probably soon. He'd been coming to church regularly with Lara, which was a good sign. Given her timeframe for kids, I expected them to marry within a year and start a family soon after.

Rachel didn't get out of her mood, so with agreement from Lara and Nathan, the five of us said evening prayers and we put Rachel to bed a bit earlier than usual.

"You say morning and evening prayers every day?" Nathan asked once Rachel was in bed.

"Mike's fastidious in his prayer life," Lara said before I could answer. "He's been that way since I first met him."

"And long before that," I replied. "My mom was fairly consistent, and my grandfather is like me."

"The only time I regularly prayed was when I was little and prayed the morbid 'Now I lay me down to sleep...' prayer. I mean, who teaches a kid to pray 'if I should die before I wake'?"

"I agree," I replied. "That's the last thing I want Rachel to think about."

"Kris, did your family say regular daily prayers?" Nathan asked.

"Yes, very similar to what Mike and I do now with Rachel. I've done it since I was a baby, so it's normal for me. Lara had a different experience growing up."

"My biological dad and my step-mom generally say evening prayers," Lara said, "though not fastidiously. My stepdad, well, he's irreligious in the extreme."

"How are things with your stepdad?" I asked.

Lara shrugged, "He's convinced I've thrown away my life, but you know I don't see it that way. In the Fall I'll have an after-school club to encourage girls to pursue careers in science or technology."

"Then make sure you get in touch with Taft, and send anyone interested in a medical career to see someone at McKinley Medical school. Our incoming group of Residents in trauma is four guys and two girls, which is double the number in the previous two incoming groups. Only one matched for surgery, and Clarissa is one of two in Internal medicine out of six."

"It starts in grade school," Lara said. "I've been talking to the Superintendent about similar clubs in the elementary school. I also want to have women scientist, engineers, and doctors come in and talk to the kids. I already asked Clarissa."

"Cool. You should try to get in touch with Katy Malenkov. I know she's out in the Bay Area in California, but she comes home fairly often. She'd be a great resource."

"I'll do that. She's working for a company that makes computers, right?"

"Sun Microsystems," I said. "It was started by some guys from Stanford, so that got her an 'in' with them."

"I'll call her mom and get her phone number."

"Let me know if you need any introductions at the medical school or the hospital."

"I will!"

June 24, 1989, Monastery of the Dormition of the Mother of God, Rives Junction, Michigan

"How have you been Michael?" Father Roman asked.

"For the most part, very good."

"And the part that isn't?"

"My most recent interaction with Father Nicholas, which I called you about when it happened."

"First, I will say that comparing yourself to Socrates, Saint John Chrysostom, and Our Lord might actually qualify as overly dramatic, given the circumstances."

"I won't dispute that."

"You are not intemperate, or prone to wild swings of emotion, so I have a theory about why you felt it necessary to speak to your colleague and your response to Father Nicholas. I believe, based on how you described the conversation with Father Nicholas, it was your intent to provoke him so that you had an excuse to transfer to the Cathedral, and lay the blame at his feet."

"Except I didn't actually need a reason, given I'm no longer clergy."

"That's not true, Michael. Well, it's true you didn't need a reason for the bishop; on the other hand, you did need a reason for yourself. You had to justify your actions, and Father Nicholas has been your target of choice for six years. Was he actually being overcritical? Stop to think before you answer, and no self-justification or martyrdom, please."

I took a few moments to consider, and while I certainly agreed I had most likely intentionally provoked Father Nicholas during our conversation, I didn't feel I had spoken to Ghost with any sort of ill intent, though I had known it would create a potential conflict.

The question I was asking myself now was whether I had some personal motive in doing so. I didn't think so, but one of the points of having a «старец» was for him to conduct a deep, spiritual examination, much like a medical exam. Like a medical exam, it was diagnostic, with a goal of determining the root cause of «ἁμαρτία» -- 'missing the mark'.

"I would say that it was not unreasonable for me to challenge Father Nicholas for the way he responded to the false accusations against me."

"And, pray tell, Michael, what do the Scriptures, in which you are so well versed, have to say about that? Think carefully."

I was certain he had two points in mind -- how to respond to false accusers, and the standards for clergy. I carefully considered my response before I spoke.

"Two things come immediately to mind," I said. "First, the Holy Apostle Peter wrote:

Servants, be submissive to your masters with all fear, not only to the good and gentle but also to the harsh. For this is commendable, if because of conscience toward God one endures grief, suffering wrongfully. For what credit is it if, when you are beaten for your faults, you take it patiently? But when you do good and suffer, if you take it patiently, this is commendable before God. For to this you were called, because Christ also suffered for us, leaving us an example, that you should follow His steps:

"Who committed no sin, Nor was deceit found in His mouth";

who, when He was reviled, did not revile in return; when He suffered, He did not threaten, but committed Himself to Him who judges righteously; who Himself bore our sins in His own body on the tree, that we, having died to sins, might live for righteousness--by whose stripes you were healed. For you were like sheep going astray, but have now returned to the Shepherd and Overseer of your souls.

"How much of the Scriptures do you have memorized?" Father Roman asked, interrupting me.

"I don't know," I replied. "If I had to hazard a guess, about half the Psalms and about a third of the New Testament."

"I believe you follow the lectionary for your prayers, correct?"

"Yes. The daily Scripture readings as well as the appointed Psalms."

"Continue..."

"Second, the Holy Apostle Paul wrote to Timothy:

Likewise deacons must be reverent, not double-tongued, not given to much wine, not greedy for money, holding the mystery of the faith with a pure conscience. But let these also first be tested; then let them serve as deacons, being found blameless. Likewise, their wives must be reverent, not slanderers, temperate, faithful in all things. Let deacons be the husbands of one wife, ruling their children and their own houses well. For those who have served well as deacons obtain for themselves a good standing and great boldness in the faith which is in Christ Jesus.

Let no one despise your youth, but be an example to the believers in word, in conduct, in love, in spirit, in faith, in purity. Till I come, give attention to reading, to exhortation, to doctrine. Do not neglect the gift that is in you, which was given to you by prophecy with the laying on of the hands of the eldership.

"If I draw a conclusion from those two passages, I'd say you felt, and perhaps still feel, that you were being taken to task for things which you considered not just right, but righteous and holy."

"The accusations were patently false," I replied.

"I want to say something, and I understand that it, in effect, goes counter to the admonishment to 'have no further care' for any sins you confessed, but would you say that the accusations were patently false, or that they were premature?"

"Ouch," I said reflexively.

"As a student of the Scriptures," Father Roman said with a smile, "what would you say now?"

"I don't have them memorized, but Proverbs has several warnings against even walking past the door of the harlot's or the adulteress' house. Similarly, the Holy Apostle Paul wrote to the Ephesians:

Therefore be imitators of God as dear children. And walk in love, as Christ also has loved us and given Himself for us, an offering and a sacrifice to God for a sweet-smelling aroma.

But fornication and all uncleanness or covetousness, let it not even be named among you, as is fitting for saints; neither filthiness, nor foolish talking, nor coarse jesting, which are not fitting, but rather giving of thanks.

"Did you stop there for a specific reason?" Father Roman asked.

"Yes, I did," I replied. "The point I think you were trying to make is that my behavior, even if correct, called my character into question, something against which Paul warns. Also, despite your caveat about 'have no further care' in this instance, I place myself in God's hands, desiring mercy and love. Or, as Paul writes to the Romans, I know the law, and the law is good when it shows me my sin."

"No quote?"

"I could..."

"Not necessary. What I want to point out is that you were a self-admitted fornicator, and had ample warning, and yet..."

I nodded, "I know."

"Yes, Michael, you know, and yet, even after the false accusations, you were determined to prove them ultimately correct. It was, in fact, only a matter of timing. The question is, why, if you know the following verses, and you have the demonstrated ability to remain chaste, why did you fornicate?"

"Honestly? Because I wanted to."

"Thank you for being forthright. I have to ask, Michael, how you know that you won't simply decide you want to commit adultery?"

"Because, and I say this with the caveat that no specific sin is worse than any other, adultery is of a different character than fornication, because in addition to a sin against the body, it would be a sin against my wife, not to mention a complete betrayal of the commitments I made to her. It's also the case that being married provides an outlet for the desire."

"And you've never once been tempted while you were married?"

"No. And that includes both betrothal periods."

"To what do you attribute that?"

"That I could never countenance of such a breach of trust and violation of my word. And that applies across the board in all my endeavors."

"What would you say your primary philosophy is?"

"I think it can best be distilled into the vow physicians make -- 'first, do no harm'."

"And would you say your actions were harmless?"

"The Orthodox answer is an unequivocal 'no'."

"But you disagree?"

"We teach that all sin harms the sinner spiritually, but concepts of harm are also very personalized."

"In other words, it's how you feel that matters?" Father Roman asked.

"I think what I'm trying to say is that perception matters."

"Yes, it does, as you stated before. But whose perception?"

"God's, of course."

"I feel you were going to make some kind of argument that if your partners consented and didn't feel they had done anything wrong, that absolved you of your sin against them. Does it?"

"No, of course not."

"And does their opinion that it was not sinful actually matter?"

"No, it doesn't."

"So, when you confessed, what was it exactly you repented?"

"My inability to control my desire."

"But that's not true, is it?" Father Roman pressed.

"No," I admitted.

"So you see the source of my concern? You are able, when you choose, to suppress your desire to sin sexually. But you also, at times, have chosen to set aside your ability to remain chaste. I am sure Father Nicholas was aware of that propensity, and again, his comments were premature, but not his concern."

"Are you saying we should return to Saint Michael?"

"That is not my place," Father Roman said. "That's between you and Bishop JOHN. On the other hand, I do believe you should sit down with Father Nicholas and talk this out, but only if you can approach him non-confrontationally. You have a habit, when you are convinced you are right, of being extremely confrontational. I don't believe that's how you practice medicine."

"It's not," I replied. "Being a forceful advocate for my patients is not about confrontation, but collegiality. There is a time when confrontation becomes necessary, but it's a last resort, and only when there is imminent risk of death."

"I'll accept that exception, as I have little experience in emergency medicine. I doubt you believe any lives were at risk during your conversations with Father Nicholas."

"They weren't."

"Are you able to do what I've suggested?"

"Yes."

"Good. As for where you attend services, that is, as I said, between you and Bishop JOHN. My opinion, and it's only that, is you are probably best served spiritually at the cathedral. I'd like you to spend the rest of the evening praying and meditating in the chapel, and to keep the monastic hours overnight."

"Yes, Father."

June 25, 1989, Circleville, Ohio

"I'd like to hear your thinking about your desire to have a baby with Mike as the father," Kris said as she, Clarissa, Tessa, and I relaxed in the great room after dinner.

"I've always wanted to have a baby," Clarissa said. "But once I understood my orientation, I was faced with a serious challenge. Unlike Jocelyn and Gene, the state won't allow Tessa and me to adopt, and, honestly, I'd rather have a baby, if possible. After I met Mike, and came out to him, I considered the possibility that I might have one with Mike, given his stated timing on marriage, which was sometime during Residency.

"Your former bishop made a mess of that, and, despite my orientation, Mike and I actually discussed marriage, but, in the end, I couldn't act contrary to my nature. Mike and I discussed alternatives, and finally I asked if he'd be willing to help me conceive through artificial insemination at the time of my choosing, and he agreed. That was before he began seeing Elizaveta, of course. We had no formal plans at that time, and I wasn't contemplating having a baby before I finished Residency, so nothing was said. Of course, you know what happened after that."

"Alternatives? Besides artificial insemination and marriage?"

"Every possible option, including thinking outside the box," Clarissa said. "From conceiving naturally to some kind of setup where I was legally married to Mike and Tessa lived with us."

Kris laughed, "And Mike would be allowed to have sex with both of you, of course!"

"On occasion," Clarissa replied. "But rarely with me, and possibly only to conceive. And that was the thing that Mike couldn't countenance, besides the problems that it would cause at church. I absolutely could have sex with a guy to conceive, and Tessa is bisexual, but Mike needed, and needs, a traditional relationship. And that was something I couldn't ever give him, as much as I might have wanted to."

"Were you going to acknowledge Mike as the baby's father?" Kris asked.

"That's not something we had decided, but Mike was strongly in favor of not keeping it a secret. He would, I'm positive, have insisted on his name being on the birth certificate."

"What about baptism?"

"Without question," Clarissa replied. "I know how important that is to Mike, and you know Tessa and I attend regularly at Saint Michael, though we don't go every Sunday. Whatever other considerations we'd make, we'd raise a child I had by Mike in the Orthodox Church because I know he'd have it no other way."

"What about raising him or her?" Kris inquired.

"We didn't get deeply into that conversation, though we did agree that my partner and I would be the primary caregivers. That was before I met Tessa, by the way."

"Mike made me aware of that."

"What do you think?" Tessa asked, speaking up for the first time.

"As I said to Mike, we'd speak with you, then he and I would discuss it and come to a decision together. As I said to him, I haven't made up my mind one way or the other as yet. How would you see things developing over the years?"

"I'd imagine Mike would be involved," Tessa said, "and that a child Clarissa and I were raising would spend time with the two of you and Mike's other kids. They'd be half-siblings, and I think they should spend time together."

"Out of curiosity, would you have allowed Mike and Clarissa to conceive naturally?"

"Yes, because, and please don't take this the wrong way, it would be about facilitating a baby, not about pleasure, though physiology being what it is, that might end up as part of it. Well, for Mike it's basically necessary, but you know what I mean. And the agreement Clarissa and I have allows expressly for that one possibility, though with Mike being married, it's obviously out of the question for him."

"But not for you?"

"I don't have any specific moral objection to extramarital sex of any kind, so long as both partners consent, and it fits within whatever relationships the individuals have. In other words, who has sex with whom isn't my business, and if a married man has a 'hall pass', then that's between him and his wife. Mike, for practical purposes, has the same view."

"How so?" Kris asked.

"She's referring to my non-judgmental approach," I interjected. "In other words, even if I have specific moral objections to certain behaviors, I tend to mind my own business and not interfere. I won't violate my own firmly held beliefs, but I also won't impose them on anyone else. You and I have a very specific understanding of the boundaries and I not only agreed to them, I endorse them and believe they are correct. But they aren't the only answer to the question. Add to that my own behavior, and as the saying goes, people who live in glass houses shouldn't throw stones."

"Why not quote the Scripture?" Kris asked.

"I can answer," Clarissa said quickly. "Because he knows that they don't carry the same weight with Tessa and me that they do with you and others who are practicing Christians."

"Are you a Christian?" Kris asked.

"I suppose the best answer is that I was baptized in the name of the Trinity, and I believe the basic moral teachings of Jesus, but I'm not sure about anything else."

"She's an agnostic," I said. "Much as I am. The difference is, I default to what the Church teaches to be true, where Clarissa is skeptical."

"WAIT!" Kris protested. "You're agnostic?!"

I smiled, "The word means 'I do not know' and that is my philosophical position. Or, to put it in Scriptural terms -- I do believe, help my unbelief."

"So you have doubts?" Kris asked.

"I've always had doubts," I replied. "It stems from being a scientist at heart, and someone who approaches almost everything with rigorous logic."

"That's what makes Mike a great doctor," Clarissa said. "Single-minded, clear thinking, and not swayed by emotion. I think the parallel with Doubting Thomas is apt -- Mike needs to see the proof to say he 'knows' and until such time he'll say that he's agnostic."

"You never shared that with me, Mike," Kris said disapprovingly.

"I should have," I admitted. "That said, it has no practical effect on anything at all with regard to me being Orthodox, or faithfully praying and attending church."

"Yes, but it is very much about who you are," Kris said. "We can discuss this later."

"OK," I agreed.

"Clarissa, do you have anything else you want me to consider?" Kris asked.

"Just that I love Mike more than anyone on the planet, something of which Tessa is aware. He is, without question, my soul mate, but the universe played a cruel trick on us, if you will, in that I was born lesbian. Or, as Mike irreverently put it, I like pussy just as much as he does!"

"He does like it a lot!" Kris said lightly. "And that makes ME happy!"

VI. I'm Sure You Can!

June 25, 1989, Circleville, Ohio

"Why didn't you feel it necessary to share your true feelings with me?" Kris asked after Clarissa and Tessa left, and after we'd said evening prayers, and put Rachel to bed.

"Because I didn't feel they were particularly relevant, nor did I feel they affected our relationship in any way. I faithfully attend church, faithfully say daily prayers, was ordained a deacon, even though I was laicized, and I'm a catechist, even if I haven't taught in some time."

"Did Elizaveta know?"

"No. Only two people knew -- Clarissa and Lara; Clarissa, before I married Elizaveta; Lara after Elizaveta reposed. And Lara only knew because it came up in the context of a conversation where I referenced Jonah being swallowed by the whale. Lara asked me if I believed that happened and the discussion led to me comparing myself to Doubting Thomas. Clarissa knew because she knew literally everything."

"Because you believe you're soul mates?"

"That was the conclusion we came to, but there was an insurmountable obstacle."

"Just as there was with Angie, yes?"

"Yes. And you know what happened with Elizaveta."

"Are you trying to tell me something?" Kris asked with an arched eyebrow.

"Only that there has been adversity with every young woman with whom I had a deep relationship."

"But isn't that true of all deep relationships?" Kris asked. "Every couple encounters challenges or obstacles and has to overcome them."

"That's true, but I believe I have more baggage than the average spouse."

"If we assume that's true, it's still the case that you chose to be with me. I don't see it as some might, that I was some kind of consolation prize, rather that you saved the best for last, so to speak. You and I both knew immediately that we were meant to be together. And, I know something important which I didn't know then."

"What's that?"

"That you love me! You even said so! In French!"

"I did, though in context..."

Kris put her finger to my lips, "Did you mean it?"

"Yes."

"Then nothing else matters. I know you believe Angie is your one, true love, that you and Clarissa believe you are each other's soul mate, and that you loved Elizaveta. But none of that interferes with the fact that you chose me and that you love me. And I knew it before you said it."

"You're handling all of this very well," I said.

"If you expected differently, you wouldn't have married me."

"True."

"Is there anything about you that Clarissa knows that I don't know? I mean, besides things which are purely related to being doctors."

I considered, and I didn't think so, except for one very specific set of facts.

"Other than knowing most, if not all, of the girls I dated, no."

Kris smirked, "And by 'dated' you mean 'fucked'?"

I laughed, "No, there's a shorter list she knows of the young women with whom I was intimate. I didn't run to her with 'after action reports', but she was an astute observer."

"I know I've agreed not to ask this question, and I fully understand if you refuse to answer, but you and Angie?"

"A single serious kiss. That kiss was when I had the first inkling of her problem, but had zero context to understand what I was observing."

"When did you find out?"

"She wasn't definitively diagnosed until 1984, and that kiss was in Fall 1981. The first serious symptoms showed up in Spring 1982, but it took a long time, a couple of breakdowns, erratic behavior, and eventual hospitalization to definitively diagnose her. Looking back from 1985, the signs were obvious, starting in High School, though I didn't meet her until Freshman year at Taft."

"You hoped she'd recover?"

"Yes, though it was unlikely. That said, she did show signs of recovery until the «мудак» who was treating her decided to intentionally destroy her."

"And he's still practicing, right?"

"Yes. How we proceed will be discussed when we have dinner with the Stephens on Thursday. I'm positive Mrs. Stephens will agree to proceed with a malpractice claim to the State Medical Licensing Board."

"But you don't think you can win, do you?"

"I suppose it depends on what we consider a victory," I replied. "But we're off track from our conversation."

"I think," Kris said, "that Clarissa is what I've heard described as a 'work wife'."

I laughed, "I've never heard that phrase before!"

"My dad heard it at work, about two co-workers. He asked what it meant and then described it for us at dinner that evening as a platonic relationship between a male and female co-worker that takes on aspects of a marriage because they spend so much time working together."

"I'm sure Tessa will be amused that Clarissa has a 'work husband'. But you know it's deeper than that."

"I don't think there's a good description that works, because 'friends' or even 'dear friends' isn't sufficient. And she was one of your main sources of advice, even after you married Elizaveta. From what I can tell, she's been more circumspect about offering advice with regard to me. I surmise that's because I'm, and please do not take this the wrong way, older and more mature."

"Elizaveta was mature for her age," I countered. "What I would say is that she was naïve, not immature, and that her worldview was much, hmm, narrower, I suppose, than yours. We had some struggles at first due to that."

"I surmise that she was uncomfortable with your past behavior?"

"Yes, but that was partly my fault for soft-pedaling how extensive my experience was. That led her to look at all my female friends with a jaundiced eye."

Well, except for Clarissa, because that was something I couldn't reveal to Elizaveta.

Kris smiled and her eyes twinkled, "I simply assume you've fucked every single female you're friends with, and then some!"

"Seriously?" I asked, instantly concerned she might suspect I'd been with Clarissa.

"No, of course not!" Kris said, laughing. "But that's the behavior you just ascribed to Elizaveta, at least indirectly."

"I guess I did, didn't I?"

"Yes, you did. How did she deal with you treating female patients?"

"Not well, if it involved any kind of intimate exams. She had a difficult time differentiating between medical and sexual contexts, and was a bit prudish about sex, except with me in private. Well, after a few days of marriage."

Kris smirked, "What's the American phrase? Having your brains fucked out? That does change one's perspective!"

"You were NOT naïve!"

"No, but I also had zero experience."

"While that's true, you were far better educated and informed. But back to the original topic -- do you want to discuss my agnosticism or Clarissa's request?"

"I'm not sure which is more pressing, actually."

"Why? Nothing has changed in my practice or in my faith from the time you met me. And leaving aside the problems with Bishop ARKADY and the discord at Holy Transfiguration, I'm basically back to where I was before Elizaveta reposed. Fundamentally, saying 'I do not know' has no practical effect on the expression of my faith nor on my belief in an eschaton of union with God."

"Heaven?" Kris asked.

"If you mean in the way it's usually conceived as a place, no, I don't believe that. It's a state of being, and I think the ultimate proof of my point, which is a theologoumenon or private theological opinion, is found in the Icon of the Last Judgment where the same river of fire bathes the saved and the damned. There is no difference between their eternal states except that the saved love God and the damned do not. It is not a place, but the direct experience of the energies of God."

"That is not what the Church teaches," Kris protested.

"Which is why I said it's a theologoumenon. The church has no dogmatic opinion, and before you ask about the Creed, it says «τοὺς οὐρανούς» in Greek, which can be understood as 'the heavens', which makes sense given the Apostles reported that Christ ascended. You know, like a missile leaving a silo!"

"Oh, stop!" Kris said, laughing and shaking her head.

"Hey, I'm not the one who made that analogy! And you know how pedantic I am!"

"I do," Kris said, rolling her eyes. "But in all seriousness, do you have other theologoumenon?"

"More than you can shake a stick at!" I declared. "But as I've said to the few people with whom I've shared those, in any church-related context, I speak the party line. Lara once asked me about Jonah, and I said that in church, I will unequivocally state that Jonah was swallowed by a whale, and I believe that it literally happened. Outside of church, though, I will only state that it's a metaphor for being swallowed up by the world and allowing it to deter you from your ministry."

"How can you have it both ways?"

"That's basically the same question everyone I've expressed my thinking to asks. It depends on whether I am evaluating with the «nous», the eyes of the soul, or to use shorthand, as Mike the scientist and physician. The thing is, that's Orthodox, and we refer to things as 'mysteries', in the sense they are hidden from us, which is the original meaning of the word, not in the sense they are 'mysterious'."

"But if you don't believe..." Kris said, sounding confused.

"I do believe; help my unbelief! I honestly don't think we're going to resolve this tonight, because it's such a deep-seated philosophical position that I have only discussed with a few people, and even then, only in a cursory way."

"Father Roman doesn't know?"

"No. We're not there yet. He's doing triage, which has been true from the first time I met him."

"You didn't say what you two discussed."

"My inability to control my passions, to put it politely."

"Being a boy, to put it succinctly," Kris replied.

"Or, as numerous women said to me, mostly in jest, being a pig."

"Mostly in jest?"

"Yes. I did treat the young women with...let me start over. From a secular and social point of view, I always treated them with respect, I simply took advantage of the multitude of opportunities which presented themselves to a future doctor who played the guitar. Father Roman would, of course, disagree with that assessment that I treated them with respect."

"Because you tempted them into sin?"

"It was a two-way street," I replied. "And not much tempting was necessary on either side. Father Roman's point, and that of the Church, would be that the act of fornication is innately disrespectful to both participants. Father Roman's concern, and it's valid, is that I willfully engaged in fornication when I had the demonstrated ability to remain chaste."

"You were, as they say, a perfect gentleman during our betrothal. And a perfect lover afterwards."

"I was always a perfect gentleman," I replied. "That's what attracted the young women. Please be honest, were you thinking about sex before we married?"

"From the first second I met you!" Kris exclaimed.

"It was mutual! Shall we discuss Clarissa's request?"

"You realize she really wants to conceive naturally, right?"

I nodded, "That was the initial discussion, and had Bishop ARKADY not intervened, that is probably what would have happened. Obviously, that can't happen now."

"Obviously. I don't have a problem with her request, but I think you need to have a clear agreement about it."

"I can't imagine ever disagreeing with Clarissa on anything."

Kris smiled, "Unlike me?"

"Clarissa isn't a socialist!"

Kris smiled, "Nobody's perfect! But in all seriousness, it's not just Clarissa."

"Tessa?"

"And Clarissa's parents. It's not that I expect trouble, but you have to make sure everything is in order, similar to how you did with Rachel and me."

"I'll discuss it with Clarissa, and with Stefan."

"What will he say?"

"Who knows? But it'll be a few years down the road. I'm more interested in what Bishop JOHN will say."

"What do you think?"

"I have no idea, but it will be interesting like so much else in my life."

"I can think of something interesting to do now!"

"And whatever might that be?" I asked.

"As if you don't know!"

"Let's go upstairs and see if we can figure it out."

"I'm sure you can!"

June 27, Southern Ohio Correctional Facility, Lucasville, Ohio

"I'm here to see a prisoner, Frank Bush," I said to the guard at the gate to the prison.

"I'll need to see some identification, please."

I handed over my driver's license, along with the chaplaincy ID that I'd received in the mail on Saturday.

"Profession?" he asked.

"Medical doctor," I replied.

"Doctor and clergy?" he asked.

"Lay chaplain," I replied.

"Relation to the prisoner?"

"No blood relation," I replied. "He murdered my friend."

He raised an eyebrow but didn't say anything.

"Are you carrying any weapons, anything that could be used as a weapon, or any contraband?"

"No."

"When I buzz you through, walk straight up the path to the building and go inside. Don't dawdle or step off the path. When you enter the building, approach the desk and present your ID. Have a good day."

"Thank you."

I heard a buzz, pulled the gate door open, walked through, and walked briskly to the door of the building. When I entered, I removed my fedora and approached the Plexiglass window.

"Doctor Michael Loucks to see prisoner Frank Bush," I said, handing over my ID.

"Good morning. I have you on the visitors list. Have you visited a prisoner here in the past?"

"No."

"OK. I need to go through a series of questions with you, you'll need to be searched, and then pass through a metal detector. You'll meet the prisoner in the visitor's room; the usual thirty-minute limit is waived for chaplains. As a chaplain, you're permitted to see the prisoner's cell, and to use the chapel. First, state your complete name, spell your last name, and provide your date of birth, place of birth, your full address, and your phone number."

I was tempted to ask if he was unable to read the information on my driver's license, but given I actually wanted to get inside, being a smart ass was not the right approach.

"Michael Peter Loucks; L-O-U-C-K-S; born 02–02–1963 in Rutherford, Ohio," I said, then provided my address and phone number.

"Have you ever been convicted of a felony?"

"No."

"Have you ever been arrested or charged with a felony offense?"

"No."

"Do you associate with known criminals, whether or not they've been convicted?"

"In my job, I treat anyone who presents at the Emergency Department, so I can't say. Outside of the hospital, I don't knowingly associate with anyone who has ever been arrested or who I would call a 'criminal'."

"I'll put down 'no'," he said. "Are you carrying with you any firearm, knife, or other weapon, or implement that could be used as a weapon?"

"The only thing in my pockets are my wallet and keys," I replied. "My stepdad is an attorney and advised me to carry nothing except those with me."

"Good advice. You will need to leave those in a locker. Are you carrying anything else with you? A bible, prayer book, or other religious items?"

"I wear my baptismal cross around my neck, but otherwise, no."

"OK. I'll keep your ID cards until you're ready to leave, and return them, along with your other property. I have a form you need to read and sign. The top part lists the prison rules. If you violate any of them, even in a minor way, you'll be asked to leave. The bottom part lists things which are considered criminal activity. If you violate any of those, you will immediately be arrested and charged. Please initial each line in both sections, then sign and date at the bottom."

I accepted the form and skimmed it, then read through it a second time more carefully. There was nothing in either part that concerned me, so I signed the form, dated it, initialed each line, then slid it back to the guard. The guard compared my signature with my driver's license, then used a paperclip to attach the ID cards to the form.

"When the buzzer sounds," he said, "pull open the door, step through, and wait. Once the first door closes, a second buzzer will sound. Pull open the door in front of you, and step through, then wait for the guard to give you instructions. Do not cross the red tape on the floor without being instructed to do so."

"I understand," I said, then moved over to the door.

The buzzer sounded, and I pulled open the heavy metal door, stepped through, then allowed it to shut behind me. I heard loud clicks as the locks reengaged, then waited for the buzzer to sound again. When it did, I pulled open the second door of the 'man trap', then stepped through, stopping before I crossed the red tape on the floor.

"Good morning, Sir," the guard said. "Please step to your right, away from the door, and wait."

I did as instructed, and he came over to me with a small basket. I put my wallet and keys in it, having left my watch in the glove compartment of my Mustang, along with my «chokti». He set the basket aside, then had me walk through a metal detector which pinged.

"What metal do you have on you?" he asked.

"My baptismal cross," I replied.

"Would you show me?"

I nodded, unbuttoned my polo shirt, and lifted the cross from beneath my undershirt.

"Just let it hang down, please," he said. "And hold your arms out."

I did, and he picked up a wand and swiped around me, with it triggering for both the cross and my belt buckle.

"I haven't seen a cross like that before," he said.

"It's a Russian soldier's cross," I replied.

"Loucks isn't Russian, is it?"

"No, it's Dutch. My mom is of Russian descent, and I'm a member of the Russian Orthodox Church."

"OK. I need to frisk you to check for anything which might not be detected by the machine or wand."

I nodded, and he frisked me quickly. I was tempted to say something about not buying me a drink before he ran his hands over my groin, but his job was, at least in that regard, similar to mine -- it had zero to do with sex, and everything to do with doing his job correctly.

"I'll put your wallet and keys in locker #4," he said.

He handed me a small cardboard disc with '4' imprinted on it, which I put in my pocket, then put my wallet and keys into a locker and closed the door, but didn't lock it. I was amused by the fact that he didn't lock it, but given where I was, it wasn't as if someone was going to break in and steal the thirty bucks or so I had in my wallet or my car keys.

"I'm going to escort you to the visitor's room. You have a bit more leeway as a chaplain, in that you're permitted to sit next to, rather than across from the prisoner, and can make physical contact for purposes of prayer, but you need to inform the guard on duty before you do that. Generally, your conversation needs to be audible, but you are permitted to speak quietly for a brief period for penitential purposes. Understood?"

"Yes, I understand," I replied.

"Then follow me, please."

He led me down a hall through another pair of doors configured as a 'man trap', which we were buzzed through, then down another hall to a heavy metal door, which he unlocked and ushered me through. A guard inside directed me to a simple metal stool on one side of a simple metal table, which was on a pedestal. I sat down and waited, and about five minutes later, Frank Bush, dressed in orange prison overalls, was led to the table.

"How are you?" I asked.

"How do you think I am?"

"I suppose that depends on how you mean. Are you getting enough to eat and getting exercise?"

"Yes."

"And you have sufficient reading material and access to a television?"

"Yes."

"Any medical problems?" I asked.

"No."

"Then I believe my answer would be 'as well as can be expected, given the circumstances'. And if any of those things were not acceptable, I'd do my best to rectify them."

"Why?"

"Because," I said, with a soft, friendly smile, "it's the Christian thing to do. I can do nothing else."

"I'm going to hell," he said firmly.

I shook my head, "That's only true if you want to go there. God does not send anyone to hell; we send ourselves. Does that mean you don't pray or attend services?"

"To what end? Nothing I can do can change my eternal fate, and I'm sure not getting out of here standing up."

"These facilities used to be called 'penitentiaries'," I said. "And with good reason. May I ask what you do all day?"

"My prison job is in the laundry, which is three hours every morning. I eat, watch TV, read, play chess, and, when it's nice enough, go out in the yard."

"I played competitive chess in High School, but haven't played much since."

Well, if you didn't count the 'strip chess' games with Grace Simmons!

"Do you have visitors?" I asked.

He shook his head, "No. My wife divorced me, which probably doesn't surprise you. I haven't seen my son or daughter since the trial."

"Melissa Matched, a year late, for internal medicine, at a regional medical center in eastern Kentucky."

"I didn't know that. Does that make you angry?"

"Why should it?" I asked. "She'll succeed or fail, and if she succeeds, it will be because she learned her lesson and reformed. You can do that, too."

"I was convicted of murder," he countered.

"I won't belabor the point, but I'll ask you to recall what Jesus said to Dismas, the penitent thief - 'this day, you will be with me in Paradise'."

"The Bible doesn't name him."

"No, it doesn't. It also doesn't contain a list of books to be included, which comes from tradition. I'm sure you remember the debate I had with Reverend Saddler."

"That fool had no grasp of the Scriptures," Frank Bush said, shaking his head.

"Do you want me to get in touch with Melissa?"

"I doubt she even cares," he replied.

"Well, I care."

"Why?"

"For the same reason I gave before," I replied. "It really is the Christian thing to do."

"Where did you Match?" he asked, changing the subject. "Moore Memorial?"

"Yes, for trauma surgery. My Residency begins on Saturday."

"Top of your class?"

"Yes."

"Melissa said you were extremely intelligent."

I shrugged, "That's only a small part of it. Hard work, dedication, and selfless service are the key to success. And that will determine if Melissa succeeds or fails. Do I have your permission to contact her on your behalf?"

"It won't do any good, but do it if you want to."

"Would you be OK with me visiting you each month?"

"Why?" he asked.

"To play chess, talk, and to give you hope."

"Hope for what? I'll never leave this place upright, and when I do, where I'm going is far worse than any punishment the State of Ohio can mete out."

"Then to talk and play chess."

"Again, why?"

"Because, whatever else may or may not be true, it's the right thing to do. One sinner to another."

"I suppose if we're going to spend eternity together in Hell, an hour a month is OK."

I wasn't going to take his bait.

"I'd like to see your cell and then visit the chapel with you."

"You don't stop, do you?"

"If you won't let me pray for you, then pray for me."

"The only one who would listen to my requests is the devil himself."

"The Scriptures say that God causes the rain to fall both for the just and the unjust. As I said, I'm as much a sinner as you are, so in one sense, we're in the same boat."

"One taking us directly to the gates of Hell without a return ticket."

"AC/DC might have been on a highway to hell, but there is an off ramp. Let me speak to the guard."

I got up and walked over to the guard, explained what I wanted, and after he used his radio to verify that I was, indeed, a chaplain, he escorted Frank and me to a cell in 'C Block'. It was, as I had expected, austere in the extreme, but it was what I didn't see on Frank's shelf that stood out -- he didn't have a Bible.

As I thought about it, that was actually a good thing at the moment, as the only thing he would find there would be condemnation. As a Five Point Calvinist, he'd find no solace and no refuge, despite the Scriptures being full of examples of God's love and mercy.

"Is there anything you need?" I asked. "Or that you want?"

"There's a new Tom Clancy novel that will be released in August. It takes forever for the prison to get new books."

"As soon as it's released, I'll get you a copy."

"You need to have it shipped directly from the bookstore," he said. "You can't carry it in."

"OK. I'll do that. Shall we go to the chapel?"

"You're bound and determined."

"As I said, if not for you, then for me."

The guard led us to the small chapel, which, thankfully, was empty.

"I'm going to say an abbreviated form of the Trisagion prayers, and then Psalm 50, which you know as Psalm 51."

"Why do you use a different numbering system?"

"Because we follow the numbering system in the most ancient texts, which are the Greek versions of the Jewish Scriptures used by Christians from the earliest times. Those differ from the later Hebrew manuscripts, which were never used by Christians before scholarship overrode tradition."

"What are those prayers you mentioned?"

"A formula," I replied. "Not all that different from the one you would have used in your Church, except that there are set petitions before the free-form ones."

I said the prayers while Frank Bush stood quietly next to me. Because he was silent, I gave the responses to the prayers and petitions, and when I completed the abbreviated set, I recited Psalm 50 from memory.

"Next time I visit," I said. "I'd like to play chess, if you're willing."

"Why not?" he asked. "It'll break up the monotony."

"May I leave you with one thought?"

"What's that?"

"If you ask for my forgiveness, I'll give it unreservedly."

"Why would you do that?"

"Because it's the right thing to do."

June 27, McKinley, Ohio

"Doctor," Clarissa said with a smirk when I walked into Frisch's after driving back to McKinley from my visit with Frank Bush.

"Doctor," I replied, then added, "all we need is a third for the Three Stooges routine!"

"True!"

The waitress seated us in a booth and we ordered right away.

"How did it go?" Clarissa asked after the waitress brought us our Cokes.

"Let's just say that it's not a place I'd like to spend a lot of time."

"No kidding! But I meant your conversation?"

"I'd say he's remorseful, but he's also convinced he's going directly to Hell, do not pass 'Go', do not collect $200."

"And you offered a 'Get Out of Hell Free' card?"

I shook my head, "He's not ready to hear the Gospel at this point. That'll take some time, and maybe it'll turn out to be a fruitless endeavor on my part, but that's not the point."

"You're a better person than I am, Petrovich," Clarissa said. "I couldn't do it."

"I'm not better than you, Lissa; we're all in the same boat. And while I know it's trite to say -- I can do all things through Christ who strengthens me."

"Speaking of that, how did things go with Kris after your surprise revelation about your interior life?"

"She was unhappy I hadn't shared that with her, but as I explained, it has no practical effect on the expression of my faith or of my belief in an eschaton of union with God. It did lead to a moment of sheer terror, though."

"How so?"

"Through a winding conversation, we discussed Elizaveta's insecurity based on my past partners and that she looked at all my female friends with a jaundiced eye."

"Except me!" Clarissa exclaimed. "She never even suspected."

"No, she didn't, and I had that thought when I made that comment. Kris' response nearly caused me to have a heart attack. She said, with her eyes twinkling, that she simply assumed that I'd fucked every single female I'm friends with, and then some!"

"WHOA!" Clarissa gasped. "She knows about us?"

"That was my concern, but when I asked if she was serious, she said she wasn't, and she said that was basically what I'd implied to Elizaveta."

"That's a relief. How do you think she'd respond?"

"Given how mature and open-minded she is, and the fact she called you my 'work wife', I'd say she'd have a serious problem with me not telling her, but not actually be surprised that it had happened. And that's the neat trap I've built for myself."

"Now that you know her well enough, you could tell her, but you can't tell her because she'd be very upset that you kept it from her, and that would create a serious problem."

"That is the trap. Damned if I do, potentially damned if I don't, because I didn't trust her enough to tell her at first. But the trap is even deeper."

"How so?"

"If she, at some point, decides that you and I have been together, and I haven't told her, then it'll be even worse than if I had told her after keeping it a secret. And I completely understand her 'no secrets' rule and why it makes so much sense. But, as I said, I'm trapped."

"I'm not sure what to advise, Petrovich. Did you discuss my request?"

"Kris said it was obvious you wanted to conceive naturally."

Clarissa laughed, "And she shut that down immediately, right?"

"Actually, I did, saying that I understood that was your preference but that it obviously couldn't happen now."

"I think she might suspect."

"I think if she did, she'd say something," I replied. "She's not one to stay silent or try to test me. With Kris, what you see is what you get."

"I bet!" Clarissa smirked. "She's hot! Tessa agrees!"

"There are no foursomes in our future, Lissa!"

"Darn," Clarissa replied flatly.

"Uh-huh."

"So, what did she say?"

"She's amenable to your request, but insisted I make sure we have a clear understanding of how things will work going forward."

"You mean with church?"

"That, and what you might call parental rights between an unmarried couple. Obviously, if, God forbid, something were to happen to you and Tessa, I'd want to ensure that legally nobody could interfere in my son or daughter being with Kris and me."

"Which is why you had Kris legally adopt Rachel."

"Exactly. Now, there is literally nothing that anyone could do if something happened to me."

"You mean Yulia?"

"She was the main reason, yes. And our joint wills appoint Elias and Serafima as guardians, with Subdeacon Mark and Alyssa being backups. My grandfather is our executor, with Jocelyn as backup."

"I don't have a problem with any of that."

"You need to discuss it with Tessa so that there aren't any questions. All four of us have to be on the same page and some of it has to be in legal documents. That said, we have plenty of time, right?"

"Yes. There's no point in trying before the end of PGY2. I'm thinking midway through PGY3 would be the right time to start, given it can take several attempts."

"That works for me. Discuss it with Tessa, especially how often you'll attend church, and if you're OK with Serafima and Elias as godparents, and once you two are of the same mind, the four of us will discuss it, and I'll have Stefan draw up the appropriate paperwork."

"Great!" Clarissa declared. "I'm excited!"

"Because you don't have to actually sleep with me to get it done!" I chuckled.

Clarissa rolled her eyes, "I enjoyed the closeness, if not the physical act, though that was pleasurable in it's own way. You know that making love with you was about being spiritually together, not you penetrating me."

"I do," I replied. "But I'm also not going to deny that I found it extremely physically pleasurable."

"Because you're a guy!" Clarissa smirked.

"Right, because you don't like orgasms at all!"

"You do admit it was a very different thing than your other lovers, right?"

"Of course. You're special to me in a way nobody else is."

"And yet, I can't hold a candle to Angie," Clarissa siad wistfully. "Nobody can."

"The universe is a truly fucked-up place," I sighed. "At times, I wonder if it's Loki who is running things rather than God."

"I can see that," Clarissa replied. "It does, at times, seem like a cruel joke -- Sandy, Lee, and Elizaveta."

"Yeah," I replied, thinking of my friends and my first wife.

The waitress brought our food, I said the blessing, and we began eating.

"Are you going to see Frank Bush again?"

"Yes. Once a month to play chess and talk. Nobody has been to see him since he was incarcerated."

"Does that surprise you?"

"Not really, when I think about it. His wife divorced him, neither of his kids has been to see him, and nobody from his church would visit because he's reprobate."

"I do NOT understand that."

"Sadly, I do. It's what happens when you give a French lawyer a copy of the Scriptures, he ignores the entire tradition of the Church, and comes up with his own private theology. His Institutes of the Christian Religion read more like a legal treatise than a theological text, which should come as no surprise, given Jehan Cauvin was a lawyer!"

"I take it that's his French name?"

"In Middle French," I replied. "It's Jean Calvin in modern French, and John Calvin in English. He published first in Latin, then later in French, which fit the notion that scholarly and theological work should be in Latin first, and one's mother tongue second. Luther's Disputation on the Power and Efficacy of Indulgences, better known as the Ninety-five Theses, was in Latin, and was later translated into German."

"Your instant recall of that kind of information is pretty amazing. It's no wonder you were an excellent student."

"We're still technically students, Doctor Saunders! Do you have a medical license? I don't."

"I'll get mine before you get yours!"

"True, given I need two years of surgical Residency before I can take my Boards, and I have two years of trauma before I begin that part."

"Ready for your first shift on Saturday?"

"Champing at the bit! I've enjoyed the time with Kris and Rachel, but I need to be back in the hospital and Rachel needs to see her friends. She's been in a mood and was asking for Abigail."

"They're in Spain, right?"

"Yes, though Joel could only stay two weeks. Milena, Abigail, Anicka, and Derek are there for a month or so."

"That was a fun visit."

"It was. Someday we'll do it again. With our kids."

"I like the sound of that."

"Me, too."

We finished our meal and walked out to the parking lot.

"I think I have to tell Kris," I said. "The risk of her finding out at some point in the future is too great. I'll take my lumps now, rather than risk something fatal to our marriage."

Clarissa was silent for a moment.

"Let me tell her. And tell her I swore you to absolute secrecy."

"She might change her mind," I said.

"Better now than a massive blowup at some point in the future, don't you think?"

"Let me think about it, OK? I'll tell you on Sunday at church."

"Sounds good."

We hugged, and once Clarissa had gotten into her car, I got into mine and headed home.

VII. Red Scrubs

June 29, 1989, Greater Cincinnati, Ohio

"Hi, Ang," I said when she greeted Kris, Rachel, and me at the door.

"Hi, Mike! May I hold Rachel?"

"That's up to her," I replied. "She's discovering her independence!"

"She's almost two, right?" Mrs. Stephens asked from behind Angie.

"At the end of August," I replied as I handed a willing Rachel to Angie.

Kris and I followed Angie as she carried Rachel into the living room, and once Angie was settled, I left the three girls and joined Mrs. Stephens in the kitchen. Mr. Stephens joined us a moment later.

"First," she said, "you should call us Marjorie and Ken."

"And you should continue to call me Mike," I replied. "Are you willing to proceed with the formal complaint to the medical board?"

"Yes," Ken replied firmly. "My only question is who'll be paying the attorney."

"A close friend who has the resources and wishes to remain anonymous," I replied. "I already spoke to my stepdad, and he recommended an attorney from his firm who specializes in malpractice. My friend will pay the bill directly."

"What do we need to do?" Marjorie asked.

"The attorney, Tom Kirkland, will call you in the next few days. He'll want to gather any records you have, and he'll likely subpoena files from Doctor Mercer and Doctor Greenberg. Stefan will provide him copies of the depositions and the settlement agreement."

"And that doesn't prevent us from doing this?" Ken asked.

"No. It says you won't take any legal action, and you aren't. The Ohio Medical Licensing Board is an administrative body, not a judicial one. Doctor Greenberg may try to make that argument, but according to Stefan it's a settled principle in Ohio courts that actions by licensing boards are administrative."

"Do you think he'll have his license revoked?" Marjorie asked.

"It's unlikely, according to everyone with whom I've spoken, but the complaint will go into his records, and that means any additional complaint would be given much greater weight, even if, in the end, he's not disciplined. That said, I think the argument I'm going to make is inescapable, and the board will have no choice but to, at a minimum, issue a reprimand. We'll go for more than that, of course, but sadly, that's the most probable outcome."

"Why?" Ken asked.

"Because he followed the standard treatment protocols, and that is almost invariably sufficient to defeat claims of malpractice. That said, I believe I can show he actually didn't do that, which will, I hope, force the Board to act."

"How do you plan to show that?"

"As I'm positive you know, one of the key symptoms of schizophrenia is not being able to process things long term -- literally everything is 'now'."

"Right," Marjorie said. "Angie wasn't able to think long term."

"And that right there is what Doctor Greenberg got so very wrong. When Angie decided she was going to do whatever was necessary to get to a point where she and I could marry, she was thinking about the future, outside the moment, had made a plan, and was successfully executing it. That is not a sign of someone who is suffering from full-blown schizophrenia and is a strong sign that something has changed. In my opinion, that's why the insurance company settled. They knew they would lose, not just on emotion, but on facts."

"And you saying that, as a doctor, carries weight?"

"They'll argue that I have insufficient experience, but I have the textbooks and peer-reviewed journal articles on my side, not to mention I believe, in the end, Doctor Mercer will confirm. I think she'll testify on our behalf, not Doctor Greenberg's."

"Angie really liked her."

"Me, too, until she listened to Doctor Greenberg instead of all of us. That said, I understand why she did, even if I don't agree. Anyway, I should spend some time with Angie before dinner."

"Thanks, Mike," Marjorie said.

"Yes, thanks, Mike," Ken added.

"You're welcome."

We went back to the living room where Angie had Rachel on her lap and I briefly flashed to an alternate universe where Rachel was mine and Angie's, though I suspected strongly she'd have had red, rather than black, hair. The source of Rachel's black hair could be either side of the family, as all of Elizaveta's family had black hair, as did my mom and grandfather, while I had my dad's sandy brown hair. The odd one out was my maternal grandmother, who had been blonde before her hair had turned white.

"How does it feel to be a doctor, Mike?" Angie asked.

"Not all that different, really. My final rotation in the Emergency Department was basically exactly what it will be like for the next few months, only I don't need close supervision and can work more independently. How are you doing?"

"OK, I guess. I'm working and going to Aikido."

Which was probably about the limit for her, given she was still taking psychoactive drugs, albeit at very low doses. I doubted she'd ever be able to go back to school, or get a better job than her data entry job, but it was something, when the alternative was nothing. I hated the situation and wished there was something I could do other than exacting a pound of flesh from the psychiatrist, but sadly, any last hope had been destroyed by his actions.

"That's good."

"Are you going to have more kids?"

"Angie..." her mom said firmly.

"It's OK," I said to Marjorie, then turned to look at Angie again, "Yes, Kris and I plan to have two more."

"What do you do, Kris?" Ken asked.

"I'm enrolled at Ohio State University in political science with a goal of an advanced degree in Public Administration."

"And you've been in the US how long?"

"Almost eighteen months," Kris replied.

"Her citizenship papers will be filed next week," I added.

"That's fast!" Ken declared.

"They were issued Green Cards based on her dad's job, and a Green Card holder can apply after eighteen months if they're married. Once Kris is approved, then her parents can apply early as well."

A timer rang, and Marjorie asked us all to go to the table while she brought the food to the table. She'd made oven fried chicken, home-style fries, bread, and coleslaw. I was asked to give the blessing, which I did, and then we dug in. The food was excellent, and I ate more than I probably should have, but it was so good that I simply couldn't resist. Dessert was apple pie and ice cream, along with coffee.

When we finished, I offered to help Marjorie with the dishes, which gave Angie more time with Rachel. After we finished the dishes, I spent a bit of time with Angie, and then Kris, Rachel, and I said 'good night' and headed home.

June 30, 1989, Circleville, Ohio

"What are we doing today?" Kris asked at breakfast on Friday morning. "You start your Residency tomorrow, and I start classes on Wednesday."

"I think we should do the grocery shopping today. We really won't have time tomorrow after band practice, and I can't skip that, given we have our concert on Tuesday."

"No, of course not! Grocery shopping today is fine. And a stop at the record store?"

"Yes. I also want to stop at Barnes & Noble and place a pre-order for the book I promised to buy for Frank Bush."

"We should obviously stop at the record store and bookstore before the grocery store, given how warm it is outside."

"Obviously," I agreed.

"What about tonight?"

"No plans, as most of the gang is gone and several others aren't available. You're OK with what Serafima and Alyssa suggested after Vespers on Wednesday evening -- that we restart in the fall with what we used to call Dinner Club, which would be them, us, and Ghost and Oksana, right?"

"Yes, of course! And, as you and I discussed, we'll find time to get together with José and Sierra, Gene and Jocelyn, and Clarissa and Tessa."

"Then let's just stay in, have a quiet family dinner, and once Rachel goes to bed, you and I can take a nice bubble bath."

"«C'est magnifique!»" Kris exclaimed happily. "And after the bubble bath?"

"Anything you want, of course!"

"As it should be!" Kris declared.

"Some day, Rachel will say that to YOU and I'll laugh!"

"She's much more likely to say it to you!"

"Dada? Want Abby!"

"She's in Spain, which is far, far away. She'll be home in about a week."

Rachel crossed her arms and stared at me, but there was really nothing I could do. She'd be back in hospital daycare on Wednesday, which I hoped would improve her mood. We needed more friends with daughters, but so far, except for Abigail, there were only boys, including my nephews. My half-sister and my adoptive niece lived too far away for Rachel to see her regularly.

"I think we need to find a few more girls for Rachel to play with," I said. "But the majority of the babies at Saint Michael, Holy Transfiguration, and the cathedral, and in my family, are boys. Anna has remarked a few times that we need more girls because Viktor Gennadyevich will need a wife!"

"It's a bit soon to worry about that, don't you think?" Kris asked.

"Specifically, yes, but the general problem is that when our young men marry outside the church, they usually leave and attend their wife's church. When our young women marry outside the church, their husbands usually attend our church. So if we have too many boys in the parishes, we have a long-term problem, unless the trend of which church mixed-faith couples attend is reversed."

"I never really paid close attention to that in Paris, but I've heard others here say that."

"In any event, Rachel will have her choice of boys in about thirteen years. But for now, she much prefers the company of girls."

"If I had to spend time with Viktor Gennadyevich, I would, too!"

I chuckled, "He is one hundred percent 'boy' and reminds me of his uncle, more than his dad."

"You mean Joe, not you, right?"

"I was more like Rachel when I was little, and you know I hung out with Jocelyn more than anyone else. And that was true even after Dale and I became friends in second grade, after I had some disagreement with Jocelyn. Whatever the source of our disagreement was, it's lost in the mists of time, but me hanging out with Dale caused Jocelyn to seek me out and that created a trio of fast friends."

"You do have some qualities which are more feminine."

"That's been said before, and I attribute it to a combination of my mom and Jocelyn."

"DADA! WANT ABBY!" Rachel demanded.

"I wish you could understand what it means to say she's in Spain," I said. "You'll see your friends in daycare on Wednesday."

"Why don't you take her on Monday?" Kris asked. "She really hasn't seen her friends in a month. I'll pick her up, and if you're able, we could have dinner together at the hospital."

"Let's give that a shot," I said. "I really do not want an unhappy toddler!"

"Think about my situation," Kris teased. "I have to raise two toddlers!"

"Oh, give me a break!" I chuckled. "I was already housebroken when you met me! You owe thanks to my mom, Jocelyn, Clarissa, and Elizaveta for that!"

"You are useful around the house," Kris observed. "Especially in the bedroom!"

"Gee, thanks," I replied with a grin.

"Would you prefer I said not in the bedroom?" Kris asked lightly.

"No."

We finished our breakfast, cleaned up the kitchen, then got ready to run our errands. Our first stop was Barnes & Noble, where I pre-ordered The Sum of All Fears for Frank Bush and arranged for it to be mailed to him at Southern Ohio Correctional Facility. Per the clerk, it would be shipped directly from their warehouse, rather than to the store first, as the warehouse was fully up to speed on the rules for sending things into prisons.

Our next stop was the record store, though it now carried more CDs and DVDs than vinyl albums.

"What's new I should listen to?" I asked Johnny.

"Bleach, by Nirvana. They're a grunge band from Seattle. I think they're going to be big."

"You've never steered me wrong. What else?"

"The End of the Innocence by Don Henley or Disintegration by The Cure, which returns to their early 80s style. And The Miracle by Queen."

"Decisions, decisions! How about the new group and Queen?"

"You got it! CDs, correct?"

"Yes."

He retrieved both CDs for me, put them in a bag, and rang up my purchase.

"I read in the paper that you graduated and are officially a doctor now."

"I am. I actually start my first official shift tomorrow."

"Cool. Your daughter is growing like a weed!" he said as I handed him three $10 bills.

"She is! You know, I've never asked, do you have kids?"

"A ten-year-old son."

"Business still good?"

"Being the only dedicated store in town helps, though I get undercut by K-Mart. But my selection is wider, and I do special orders, not to mention my regular customers. Adding video games helped, and I'm going to start carrying video game hardware, too. And I've expanded my used album business. I know you won't sell, but if you know anyone looking to unload vinyl or CDs, let them know."

"Will do."

Jonny handed me my change, I thanked him, and then Kris, Rachel, and I headed for Kroger. We completed our grocery shopping, stopped at the bakery, then headed home. After we put away the groceries, I put on the Nirvana album.

"You like this?" Kris asked.

"I have eclectic tastes," I replied. "Grunge isn't my preferred style, but I do appreciate the talent and artistry. I'd say Johnny is correct and Nirvana will be very popular."

After we listened to the album, we ate lunch, then put Rachel down for her nap. The rest of the day was quiet, and Kris and that evening, I had an enjoyable time in the bathtub and bed.

July 1, 1989, McKinley, Ohio

"How was Disney?" I asked José when he walked into the music room at Taft.

"You think the man even SAW the parks?" Sticks asked.

"I bet he did," I said.

"You'd win that bet," José replied. "Not that we didn't do what Sticks is implying! And yes, we had a great time."

"Shall we practice?" Kim asked. "We need to run through the two sets we're doing on Tuesday."

We did that, and Kim was happy with our practice. When we finished, we hurried to pick up Rachel at her grandparents' and then home for a shower. I dressed, put on the new long medical coat that my grandfather had given me, kissed my wife and daughter, then headed to Dorothea Rhodes Lummis Moore Memorial Hospital for my first shift of my PGY1. Because I was assigned to the surgical staff, I reported to Doctor Vince Taylor in the Surgical Department at 11:30am.

"We'll dispense with the usual first-day Resident BS," he said. "I've been assigned as your mentor, but I don't think you'll need much mentoring from me for your first two years. Your mentor in the ED is Ghost, and you should go to him for anything related to trauma, and to me for anything else. Doctor Cutter wants you to wear red scrubs."

"Marking his territory, so to speak?" I asked with a grin.

Doctor Taylor laughed, "That's one way to put it, but yes, he wants to ensure that everyone knows you're officially a surgical intern. He feels it's better to differentiate the surgeons from the other doctors in the ED."

"OK. I'll take several sets down to the ED locker room with me, so I don't have to come up here if I need to change."

"Actually, your locker is here," Doctor Taylor said.

"Turf war, right?"

"Good guess. It started as soon as you Matched. I assumed you knew."

"I didn't. I thought there was a requirement for surgical Residents to be supervised by surgeons."

"There is, but you're in a gray area, at least for the next two years. In any event, Doctor Cutter prevailed, but that hasn't stopped Doctor Northrup."

"Wonderful," I sighed. "Day one, and it's already political."

"Just be a doctor and ignore the BS. You can do that as a PGY1. Let the senior Attendings fight it out with the medical director. In the end, you're going to be a Board certified surgeon, and that's the master trump."

"Trust me," I said with a smile, "I'll ignore it for as long as I possibly can!"

"See Penny at the nurses' station. She has your ID, your keys, and your pager."

"Keys?"

"We began locking all supply rooms as of last week. Too many consumables were disappearing. Everything has to be logged, not just drugs."

"More paperwork," I said, shaking my head.

"Unfortunately, I think we have to get used to it. Our patient load is up and our funding levels are stagnant."

"Same old story. I did see the construction equipment in what used to be the grassy field outside the ED, so that's something."

"It is, but they should have built the new surgical wing first."

"Well, being on the surgical service, I'm not going to disagree with you, but I disagree with you!"

Doctor Taylor laughed, "I hear you. You're not a surgeon at heart, even if you'll make a very good one."

"Thanks, Doctor Taylor."

"It's Vince, please. All surgical Residents address each other by their first name."

"Thanks, Vince."

"Go see Penny and let me know if you need anything. I can't imagine what it might be, given you've been here for four years, which is longer than I have!"

I shook his hand and went to the nurses' station to see Penny, who was new.

"Hi, Penny," I said. "You have my ID, pager, and keys."

"Doctor Loucks?"

"Mike, please," I said.

"Protocol is to call all doctors by their title," she said.

"Then Doctor Mike, please."

"OK. I understand you were a medical student here, so I'm sure you know about the pager."

"I do."

She handed me the ID, pager, and keys, I thanked her, then headed to the locker room to change. Using the surgical locker room was a minor inconvenience for working in the ED, but, in the end, I was a member of the surgical service, so it made sense. I found the locker with the tag 'M. Loucks' on it, and opened it, finding it empty as was to be expected.

I walked over to the cabinet which held the red scrubs, selected the correct size, changed into them, slung my stethoscope around my neck, clipped on my new photo ID which identified me as 'Doctor Michael P. Loucks' and had the red 'S' symbolizing the surgical service superimposed on the lower left of my photo, while the lower right had the standard Staff of Asclepius.

Normally, surgical Residents wore surgical caps while on duty, and I had several I'd ordered, as they were personalized, but they were not usually worn in the ED, so I simply left them in my locker. Last, I put on my medical coat, which surgeons wore when not in surgery, but which was generally dispensed with by doctors in the ED except when meeting with families.

Properly attired, I shut the locker, attached my combination lock, closed it, spun the dial, and then left the locker room to head to the ED. I took the stairs, something I had resolved to do to get that bit of extra exercise with my schedule, making regular exercise difficult, if not impossible.

"Good morning, Kellie," I said to the nurse at the nurses' station. "Doctor Mike Loucks."

She was new, having just graduated from nursing school in May.

"Good morning, Doctor!" she said brightly. "It's nice to meet you. Doctor Casper is in the lounge."

"Thank you."

I went to the lounge and saw Doctor Casper stretched out on the couch.

"Morning!" I said.

"Hi, Mike," he said, sitting up. "What's with the red scrubs?"

"Doctor Cutter's orders," I said.

"Proving, in his mind, that he has the bigger dick."

"Of all the things I could possibly care less about, I'm not sure there are many I care less about than the relative size of two Attendings' dicks."

"You and me both!"

"Who's the Attending?"

"A new-hire you haven't met - Doctor Isabella Mastriano."

"Italian?"

"Yes. She graduated from OSU and served her Residency in Texas. Loretta spoke to her, so she's been warned about you."

I chuckled, "Of course. Who are the med students?"

"You have Callie Newsom and Gabriella Martin today; Newsom is the Fourth Year. Also, Doctor Gibbs wants you to take the First and Second Years on Tuesday afternoons."

"That should be fun at the end of a thirty-six-hour shift."

"Welcome to PGY1! Anyway, you'll get most walk-ins today. See me if you have questions, and Doctor Mastriano will sign your charts."

"Sounds good."

"Hi, Mike!" Nurse Alice said, coming into the lounge.

"Hi, Alice."

"Doctor Casper, EMS four minutes out with a fall from a ladder."

"Thanks, Alice. Which room?"

"Trauma 3 is open."

He got up, and I went to the triage desk to check in with the medical student and nurse who were manning the desk.

"Hi, Doctor Loucks!" Nurse Billie said.

"Hi, Billie."

"Hi, Mik...Doctor," Fred Lawson said.

"Hi, Fred. I'm assigned to walk-ins. I just need to do the handover with Doctor Billings."

"OK. There are two waiting, so they're all yours."

"What do we have?"

"Two days of nausea and diarrhea and a minor arm lac."

"OK. I'll be right back."

"What's with the red scrubs?" he asked.

"As a trauma surgeon, I'm on the surgical service, but assigned to the ED. Surgeons wear red."

"Interesting."

I left the triage desk, checked the board, and went to see Doctor Billings.

"Hi, Doctor Billings," I said as I stepped into Exam 2.

"Hi, Mike. Call me Kayla, please. I'll be finished in two minutes. Meet in the lounge?"

"You got it."

I returned to the lounge and a few minutes later, Doctor Billings came in.

"Nothing to turn over," she said. "I just streeted that sprained ankle and my last admission went up fifteen minutes ago. Ready for your first shift?"

"It doesn't feel that way, actually."

"The golden-haired boy who did more procedures as a Fourth Year than I did as a PGY1! And why do you rate red scrubs?"

"Jackpot," I chuckled. "You and every other person I've spoken to has asked or commented! I'm officially on the surgical team though I'm assigned to the ED. Doctor Cutter wants me to wear red."

"Dick measuring contest between him and Northrup."

"So it would appear. I have two patients waiting on me, so unless there's something else..."

"Nope. I'm outta here!"

We both left the lounge with Kayla heading to the locker room while I went to find Callie and Gabriella, both of whom were standing in the ambulance bay, with Callie smoking.

"Don't you know those will kill you?" I asked Callie.

"It helps with the stress," she replied. "How are you, Doctor?"

"I'm fine. Who's your cohort in crime?"

"Doctor Mike Loucks, Gabriella Martin, Third Year. Gabby, meet Doctor Loucks, PGY1."

"Doctor Mike, please," I said. "Nice to meet you, Gabby. We're catching walk-ins. Come with me."

Callie stubbed out her cigarette and the two of them followed me inside.

"Callie, I'll have you do the H & P."

"Seriously?" she asked. "On your first shift?"

"Yes. My job, in addition to healing, is teaching. I know how to do an H & P. Now we'll see if you do. And Gabby, pay attention, because you'll do one as soon as I'm sure enough about Callie to turn her loose on her own."

"On her own?" Gabby asked. "Don't we have to be supervised?"

"Yes. My definition of supervision is allowing Callie to do an H & P on a walk-in on her own, then verifying her findings. That's how she'll learn."

"Rumor has it that you know everything," Gabby said.

I chuckled, "Let's assume for a moment that's true. It's what you learn after you know everything that counts!"

"Hang on! If you know everything, you can't...wait, Zen, right?"

"Of that same basic idea, but I heard it from a Russian Orthodox monk."

We arrived at the triage desk, so I switched out of friendly teacher mode into doctor mode.

"Who's first?" I asked Fred.

"I'd say nausea," he replied.

"Me, too," I agreed.

"Kaylee Jennings, nineteen; last vitals: pulse 92; BP 120/70; temp 38.6°; no cough or sore throat; ears clear."

"OK. Chart please."

He handed me the chart, and I went to the door to the waiting room and opened it.

"Kaylee Jennings?" I called out.

A pretty girl stood up, as did a woman who I suspected was her mom, and came to the door.

"Hi; I'm Doctor Mike. Ms. Jennings, if you'd follow me," I said to the young woman, then turned to the older woman, "Ma'am, you'll need to wait here, please."

"It's OK, Mom," Kaylee said.

I checked the board, saw that Exam 1 was open, and brought Ms. Jennings there, with Callie and Gabby following me.

"Go ahead, Callie," I said.

"Hi, Kaylee," she said. "What brings you here today?"

That was literally the by-the-book first question to ask and was intentionally open-ended to elicit as much as possible from the patient.

"I've been sick to my stomach and have the runs."

"When did those symptoms start?" Callie asked.

"Thursday night."

"What did you do on Wednesday and Thursday?" Callie asked.

"Not much. A picnic at the lake."

I made a mental bet with myself that she had salmonellosis, or, as it was more commonly known, food poisoning. I almost laughed, thinking back to carrying Lara from the dorm to the infirmary at Taft, but that would have been inappropriate. Callie obviously had the same thought as she asked what Kaylee had eaten, then went through a complete H & P, reporting her findings.

"Preliminary diagnosis is food poisoning," Callie announced.

"I concur," I said. "Kaylee, I need to do a quick exam to check Callie's findings."

"She's not a doctor?"

"No. She's a medical student. This is normal for training."

I did a quick exam, hearing no anomalies in her heart or with her breathing.

"Kaylee and I need to present your case to our Attending," I said. "That's a senior doctor. Gabby, you stay with her."

"OK," Gabby agreed.

Callie and I stepped into the corridor.

"You'll present," I said. "What's your proposed treatment?"

"The choices are oral or IV rehydration, and given she's nauseated, I recommend IV Ringer's."

"Good. Anything else?"

"Ceftriaxone."

I shook my head, "Studies show that has no positive effect on otherwise healthy patients who are not very young or very old. Overuse of antibiotics is a serious problem, so we don't use them unless we have to."

"Patients want them."

"And I want shorter shifts!" I chuckled. "I don't see anyone granting that wish simply because I want it!"

Callie laughed, "Good point!"

"Anything else?"

"Not that I can think of."

"Antiemetic?" I asked.

"Is her emesis sufficient to need that?"

"I asked you first!" I chuckled.

"She hasn't vomited since we brought her into the exam room, so I'd say she doesn't need it."

"Think about that for a second," I suggested.

"She said she couldn't keep anything down. So, in addition to the IV, we give her some juice and see what happens."

"Excellent. How do we confirm our diagnosis?"

"Stool sample or blood test. If I suggest a stool sample, are you going to make me collect it?"

"What do you think?" I asked with a goofy smile.

"I think she needs a blood test!" Callie declared.

I laughed, nodded, and we went to the Attendings' office and I knocked on the open door.

"Doctor Mastriano?"

"You must be Mike Loucks.

"I am."

"What's with the red scrubs?"

"Doctor Northrup's orders," I replied. "We have a patient to present."

"Go."

"Callie?"

"Kaylee Jennings, nineteen-year-old female; pulse 94; BP 124/72; temp 38.6°; nausea and diarrhea onset on Thursday after a picnic at the lake; no cough or sore throat; ears clear. My preliminary diagnosis is food poisoning, likely caused by salmonella. Recommend treatment with IV Ringer's for dehydration and blood test to confirm."

"Antibiotics?"

"Not indicated for healthy adults. She doesn't appear to need antiemetics at this point. Observe for two hours."

"Approved. Let me have the chart to sign."

Callie handed over the chart, Doctor Mastriano signed it, and then handed it back.

"Mike," Doctor Mastriano said, "come see me when you have a break, please."

"Will do."

Callie and I left the office and stopped outside the exam room.

"Thanks for the tip on antibiotics," Callie said.

"All part of the service!" I replied. "Do you know if Gabby has done IVs?"

"I haven't seen her do one, no."

"OK. Then you do it. I'll ask her about it, but not in front of the patient. Blood draw?"

"Same answer."

"OK. You do that, too, and have her take the blood sample to the lab."

"OK."

We went into the exam room and I nodded to Callie.

"Kaylee, we're going to give you IV fluids, and run a blood test to confirm our suspicion that you have salmonella-based food poisoning."

"No antibiotics?" Kaylee asked.

"No," Callie replied. "They're usually not necessary for healthy adults. We will keep you for a few hours to see how you're feeling, as well as get the results of the blood test. If you'll lie back down, I'll get the IV going and draw the blood."

Callie did a good job on the IV and the blood draw, and as we agreed, asked Gabby to take the blood to the lab. Once that was done, I sent Callie to bring in Kaylee's mom.

"She'll be fine," I said. "We're giving her IV fluids to counteract the dehydration caused by her vomiting and diarrhea while we wait for the blood tests to confirm food poisoning. You can wait here with her. If the tests do confirm it's food poisoning, you can take her home and have her eat broth until her stomach settles. We'll come back to check on her every twenty minutes or so."

"Thank you, Doctor!"

"You're welcome."

Callie and I left the exam room and went to the triage desk.

"Arm lac or migraine next?" Fred asked.

"How long as the arm lac been here?"

"About thirty minutes," he replied.

"How many sutures do you estimate?"

"Five or six at most."

"Callie, may I see your procedure book?" I asked.

She handed it to me and I counted five signed-off sutures during her current rotation.

"OK. I'll do a quick exam, you can suture, and I'll check your work. While you're doing that, I'll see the migraine. I'll ask a nurse to help you; I'll have Gabby help me."

"Great!" Callie declared. "I'm going to enjoy working under you!"

The stress on the word might have been my imagination, but I didn't think so. I elected to simply let it go.

"Fred, we'll take the arm lac chart, please."

"Jack King; forty-eight; vitals normal; five centimeter lac on right forearm."

He handed me the chart, and we went to the door, I called Mr. King, and Callie led him to the new suture room that used to be the Residents' office. I went to the nurses' station and ensure there was an experienced nurse to help Callie. I was assigned Nurse Julie, and she followed me to the suture room.

I did a quick exam saw no contraindications and asked Callie to proceed.

"Call me when you're finished, and I'll sign the discharge papers."

"Will do, Doctor," Callie said.

I left the room and saw Gabby returning from the lab, waved for her to follow me to the triage desk.

"Migraine," I said.

"Take two aspirin and call you in the morning?" Josh, the clerk asked.

"Sadly, that may be about as effective as most treatments we have for migraines. Vitals, Fred?"

"Stephanie Smith, twenty-six; pulse 88; BP 124/74; temp 37°; onset shortly after waking this morning; previous visits in January, March, and May."

"Frequent flyer," I said. "Did you pull her records?"

"No. I can't leave the triage desk."

"OK. Gabby, go to the records room and find me the file for Stephanie Smith. Birthdate..."

"March 22, 1963," Fred said.

"Be right back," Gabby said.

Five minutes later she returned.

"What does it say?" I asked.

"I didn't know I was allowed to look."

"Required, is more like it. Tell me what you see."

She opened the file and flipped through it."

"Each visit is about eight weeks apart, she was treated the first time with a 'migraine cocktail'. What's that?"

"Basically Excedrin, but with higher dosage -- 500mg acetaminophen, 300mg acetylsalicylic acid, and 100mg caffeine."

"The second time, with IV metoclopramide; the third time they added dexamethasone.

"Any red dot on the inside folder?"

"No. Why?"

"That would indicate a drug-seeker," I said. "Claiming migraines or back pain are the most common excuses for asking for opiates. This young woman hasn't done that, so we believe she actually has migraines. Let's bring her in."

Fred handed me the chart and Gabby and I went to the door and called Ms. Smith.

"Hi, I'm Doctor Mike and this is Gabby, a medical student. Let's get you into an exam room."

I checked the board and Exam 3 was open, so we led Ms. Smith there and she climbed onto the exam table.

"What brought you here today?" I asked.

"I have terrible migraines."

"When did they start?"

"The first one was probably about a year ago, and Excedrin knocked them down for the first six months. When that stopped working, I came here, and they gave me a higher dose of the same stuff. The next times I had an IV, but can't tell you what it was."

"Are you sensitive to light or noise?"

"Both," she replied.

"Your migraines seem cyclical," I said. "Do you have any idea what triggers them?"

"No."

"When was your last menstrual period?"

"It should start tomorrow or Monday."

"Is there any chance you're pregnant?"

"No. It's been a couple of months since the last time, and I've had my period."

I went over her medical history, then said, "I'd like to do a physical exam, please."

"Sure."

I started with heart and lungs, then eyes, ears, nose, and mouth, and finally palpation of her abdomen.

"Gabby, let's get a CBC, Chem-20, and a glucose panel," I said, writing those orders on the chart, along with a medication order. "Let's also start her with 500mg acetaminophen, 300mg acetylsalicylic acid, and 100mg caffeine. Ms. Smith, I'm going to check on two other patients and I'll come back after Gabby draws the blood."

"Do you need Doctor Mastriano to sign off?" Gabby asked.

"No," I replied. "Only for scheduled drugs."

"Why would you need approval?" Ms. Smith asked.

"That's normal for Interns," I replied. "That's someone in their first year of Residency."

"You're a brand new doctor?"

"First day, officially, though I've technically been a doctor for over a month."

"First day? Seriously?"

"Yes."

"You're in good hands, Ms. Smith!" Gabby said. "Mike graduated at the top of his class and aced his exams!"

"I wasn't concerned," Ms. Smith said. "I was impressed!"

"I'll be back shortly," I said.

I went to check on Kaylee who was feeling OK and resting comfortably, updated the board, which I'd failed to do earlier, then went to check on Callie, who was almost finished.

"Those stitches look good," I said. "When you finish, fill out the discharge form, bring it to me to sign, then take it to Doctor Mastriano. Discharge if she signs off."

"Will do!" Callie said.

I left and went to check if there were any other walk-ins, but there weren't, so I returned to Exam 3 where Gabby was completing the blood draw. Given it was just the two of us, I went to the drug locker, retrieved the oral tablets, then went to the nurses' station knowing I'd need someone in the exam room when Gabby ran the blood to the lab. Nurse Jessica walked to the exam room with me, and Gabby took the blood to the lab. I administered the medication.

"I'm going to speak to my Attending," I said to Ms. Smith. "Nurse Jessica will stay with you."

I left and went to see Doctor Mastriano. I described Ms. Smith's complaint and what I'd done so far.

"What do you want to do next?" Doctor Mastriano asked.

"IV metoclopramide and dexamethasone. Once the blood test results come back, I'll return with any additional treatment plan."

"OK. Do you have a moment now?"

"Yes."

"Shut the door and have a seat."

I did as she asked.

"First day, first patient, and you have a Fourth Year do the exam?"

"It was impressed on me that teaching is an important part of a Resident's job, and from experience, I found that many Residents don't give their Third Years and Fourth Years enough opportunities. It was the right decision."

"I wasn't challenging, you," Doctor Mastriano said. "I was surprised a PGY1 would do that their first day. You'll have every student clamoring to be assigned to you."

"I don't see that as MY problem!" I chuckled. "I was under the impression Doctor Gibbs had told you about me."

"She did, but that doesn't mean I'm not surprised."

"I believe she should have warned you, not told you about me," I chuckled.

"I believe you're right!"

VIII. What A Stupid Way to Die

July 1, 1989, McKinley, Ohio

"How was your first day?" Doctor Casper asked just before midnight.

"Routine, really. Fourteen walk-ins, with the only truly interesting case being the young woman with the migraines. I had mixed emotions about the MRI, hoping it would show something but dreading what it might show."

"That's a common reaction," Doctor Casper said. "You have a tentative diagnosis that you really hope doesn't pan out. I think you had a leukemia diagnosis in a college-age student."

"Yes. That sucked, though she recovered."

"How do you know that?"

"José married her best friend. It sucks that we don't have an answer for the migraines."

"Yes, but you asked Doctor Mastriano for a neurology consult and they took her, so you did your job. The last three times they simply sent her home after giving her analgesic cocktails."

"But the consult turned up nothing."

"Mike, what's your job? And don't give me any bullshit 'heal the sick' answer, either."

"That is my job," I replied.

"No, that's your calling," Doctor Casper countered. "What is your job?"

"First line emergency care."

"Did you do your job?"

"Yes."

"Then as shitty as this sounds, that's a good day. You cannot heal, cure, or whatever you want to call it, every single person who walks into the ED or is brought in by ambulance. And as shitty as it sounds, and feels, it's not your job. You job is to triage, treat or stabilize, then admit or discharge. You know the catchphrase."

"Treat 'em and street 'em. We've had this conversation before."

"And we're going to have it again until you get it through your thick head that the 'S' on your badge does not stand for 'Superman'!"

"I don't believe I'm Superman," I replied.

"Then don't try to be Superman. How many of your patients walked out of the ED happy today?"

"Thirteen out of fourteen."

"That's a damned good day. How many died?"

"None."

"That's an outstanding day. Days like that are right up there with the pilot's refrain that any landing you can walk away from is a good landing. Do you want to know my count for the past eighteen hours?"

"Go on."

"Eighteen treated, three of them resulted in a consult from McKnight. Want to trade days?"

That was another euphemism that was used in the ED to indicate a patient had died without saying it where other patients could hear.

"No."

"Then in ten minutes, let's get our showers, put on our street clothes, and go home. You're back on Monday, right?"

"0600 for a thirty-six-hour shift."

"You may be the last class of Residents who have those shifts."

"The Libby Zion case."

"Yes. Word is that the end result, when all the smoke clears, is eighty-hour weeks and no more than twenty-four-hour shifts, with at least eighteen hours between shifts."

"Fortunately, I have that, but I know some of the shifts work out to only twelve hours between thirty-six-hour stints."

"Hi, Mike!" Kylie said, coming into the ED.

"Hi, Kylie."

"How'd your first shift go?"

"I handled fourteen walk-ins. My board is clear."

"Excellent. I'll see you on Monday morning."

"See you then," I said.

July 2, 1989, McKinley, Circleville, and Columbus, Ohio

Just after midnight, Doctor Casper and I left the lounge and walked towards the locker room.

"I'm upstairs," I said.

"Cutter is really pushing the point, isn't he?"

"Yes," I agreed. "But so long as the turf war doesn't have any effect on my training, I can deal with the petty stuff."

He went into the locker room and I headed upstairs to the surgical locker room. I took a quick shower, dressed, then headed home, where Kris was waiting up for me.

"How was your first day being a doctor?" she asked after we exchanged a hug a kiss.

"Not all that different from my last day of being a Sub-Intern," I replied. "The main difference is I can do basic procedures without seeking permission every time, order tests, and prescribe non-schedule drugs."

"Narcotics, right?"

"Yes. Those I won't be able to prescribe until I actually have my medical license, which is after I pass my Boards, which is sometime after PGY4. In theory, I could do it in two parts, if Doctor Cutter would sign off on getting my basic license before I spend any time in the OR, but I'm not sure he will, given the turf war."

"Turf war?"

"A contest over who is actually in control of my schedule and decides the course of my training. Doctor Northrup tried to change things, and Doctor Cutter reacted. The only real effect of their little battle is that my locker is in the surgical locker room, and I wear red scrubs instead of pale blue ones. It's really no big deal from my perspective."

"So, now you have medical students to order around?" Kris asked lightly.

I chuckled, "Yes, but you know me. The key is teaching, not having someone to do scut."

"Male or female?"

"Today? Two females. I'm not sure who I'll have on Monday, but med students are limited to twenty-four-hour shifts, and mine are thirty-six, so I could have as many as six different students during that period, depending on the schedule."

"Any interesting patients?"

"I treated patients who walked in, which means mostly minor stuff. The only really interesting one was a young woman with migraines, but in the end, all I could do was refer her to neurology. The MRI we ran showed nothing, so they gave her some stronger medication than you can buy over the counter. I suspect she'll be back. How was Vespers?"

"The same as it's been for over a thousand years," Kris said lightly.

I laughed, "OK, I deserved that. Shall we go to bed? We have to leave for Matins in just over six hours."

"Yes."

We headed upstairs and ten minutes later we were in bed, and two minutes after that, I was sound asleep. When the alarm rang early on Sunday morning, we got out of bed, quickly showered together, then fed and clothed Rachel, and the three of us headed to Dormition of the Mother of God Cathedral in Columbus for Matins and the Divine Liturgy.

Rachel wanted to be with Lyudmila during the services, which to me seemed to be one of her ways of showing independence. She still wasn't in a good mood, and I hoped going back to daycare would help, though I suspect it might take another few weeks until Abigail came home from Spain.

"You had your first day at the hospital yesterday, right?" Father Luke asked at lunch.

"Yes."

"I also heard from His Grace that you visited the man who murdered your friend in prison."

"I did. He was receptive to my visit, but he's locked into his Calvinist mindset and is convinced he's going to Hell."

"Just act in love, Michael."

I nodded, "I didn't take what might be considered his 'bait'. I'll see him again later this month to play chess. I did reach out to his daughter, who hasn't been to see him, but she hasn't returned my call. That could be because she elected not to, or because she's just starting her Residency in Kentucky."

"What's your goal?"

"To provide hope."

Father Luke nodded, and then moved on to speak to another parishioner, while I went to sit with Kris, Rachel, and the Korolyovs to have lunch. After lunch, Kris, Rachel, and I left the cathedral and walked out to the car for the drive home.

When we arrived, there was a message on the machine for Kris from Clarissa, and Kris returned it. I knew what it was about, and still wondered if what Clarissa intended was the right way forward, but I couldn't think of any real alternatives. I didn't know for sure how Kris would handle the revelation, but I hoped the 'privacy exception' would be sufficient to prevent serious problems between us.

Kris returned the call to Clarissa, and just over an hour later, Clarissa and Tessa arrived at the house. I wasn't surprised when Clarissa asked to speak to Kris privately, and they went into the study to talk.

"How do you think this will go?" Tessa asked quietly as we sat on the couch with Rachel playing with her dolls on the floor in front of us.

"Not as badly as if Kris somehow found out ten years from now, or whenever," I replied. "In the range of bad choices, this is the least bad. She's not going to mention you and me, is she?"

"No. I was adamant about that. It would serve no purpose except to create tension where none exists. Does Kris know about any of the other girls you were with?"

"Jocelyn and Tasha, because those two are, more or less, public. But she made it clear she didn't concern herself with what had happened before. And she doesn't see female friends as a risk the way Elizaveta did."

"Kris is very secure in who she is and views the world in a much broader way. Elizaveta was, and I mean no disrespect, very provincial where Kris is cosmopolitan."

"A very French way of putting it," I chuckled.

"But it's true, isn't it? Elizaveta was a very typical rural, religious person, whereas Kris is worldly, and mostly secular in her outlook, though also faithful. In other words, very much like you."

"I see the world through an Orthodox lens."

"Yes, you do, but how do you interact with the world? You're a scientist, not a monk. Think about your approach to miracles."

"I see your point," I replied, "but Elizaveta was growing in that regard, though she still had traditional conservative American values."

"And, as a deacon, that was what you needed. You need something different now."

"I don't disagree."

"Maybe Miss Cosmopolitan will allow you and Clarissa to conceive naturally!"

I laughed, "She's open-minded, but not that open-minded!"

"Just think," Tessa smirked, "It might take dozens of attempts!"

"Which actually wouldn't be as enjoyable for me as you might think, because I know how Clarissa feels about it."

"Weirdly, I believe you. Most guys would be happy to bang the hot lesbian!"

"Which is not how I feel about it. I banged you, but not Clarissa, if that makes sense."

"Of course it does. You and me was just casual sex, and purely physical. It was awesome, but it was just sex. That was not true between you and Clarissa."

"Exactly."

A few minutes later, Clarissa and Kris came out of the study.

"We're going to head home, Petrovich," Clarissa said calmly. "See you at the hospital for lunch tomorrow?"

"Sounds good."

I walked Clarissa and Tessa to the door, but couldn't discern anything from Clarissa, nor could I from Kris' demeanor when I returned to the living room.

"I never would have guessed," Kris said. "But it makes sense."

"Are you upset with me for not telling you?" I asked with a bit of trepidation.

"No. Clarissa pointed out that she swore you to absolute secrecy and it did fall under the exception I allowed for my 'nothing but the truth' rule. You look relieved."

"I am," I replied, after realizing I had been holding my breath. "I wasn't sure how you'd react. I thought you'd be OK, but I wasn't absolutely sure. You're OK with me spending time with Clarissa?"

"She made it clear that she could tolerate doing that with you to make a baby, but has no interest in doing it with anyone except Tessa. I trust both of you."

"Thank you."

"Was it your idea for her to tell me?" Kris asked. "Or hers?"

"Hers," I replied. "I wanted to tell you, but it was something I wasn't allowed to share."

"Which I understand. Given how she feels about you, I don't see how she could have done anything else."

"Is there anyone who would concern you?"

Kris smirked, "Besides the nurse that has had the hots for you for four years?"

I chuckled, "Ellie will just have to make do with her fantasies."

"Did you ever consider it?"

I shook my head, "No, for several reasons, the most important of which was she tried to entice me to cheat, and that, in and of itself, precluded even thinking about it. That was before I'd formulated my rule about relationships in the hospital, which really didn't matter except in terms of ethical behavior and patient care, because I was married to Elizaveta. Once she reposed, I made two firm rules -- I wouldn't date anyone who was on the same service and I would never even consider fooling around in the hospital."

"That happens a lot?"

"It does, unfortunately. And there are no rules against relationships, only against favorable or unfavorable treatment based on those relationships. The problem in my mind is that there is, in effect, no way to know unless someone makes a complaint. We all know about female students who use sex to gain advantage and male doctors who take advantage of female students, but it's difficult to prove. I would just ban any relationships where there was any supervisory or teaching relationship."

"It sounds as if you would prohibit relationships between students and doctors."

I nodded, "Completely. I don't see any way to allow that without opening the door to all sorts of potential ethical violations. Think about how easy it would be for a Resident to coerce sex from a student, given the doctor basically holds the student's medical career in their hands."

"Not quite as easy as playing a guitar," Kris smirked.

I laughed, "OK, but in that case, there is no ethical problem!"

"What will all those poor Code Blue groupies do now that José is married?"

"Cold showers," I chuckled. "Kim and Sticks get hit on, but not at the same level as José did."

"And you?"

"I was not lacking for attention," I replied.

Kris laughed softly, "Of that, I'm sure! Out of curiosity, was there anyone besides Ellie who wasn't a groupie who was persistent?"

"Erin Edwards," I replied. "She, too, was OK with cheating, which is, as I've said, an automatic lifetime ban, as it were. She did try to see me after Elizaveta reposed, but I was completely uninterested."

"Who is she?"

"The daughter of the President of the Hospital Board of Directors. I met her when she was a patient during my OB/GYN Clerkship. In those rotations, though, I couldn't touch patients, nor observe exams directly, if you get my meaning. She persistently hit on me despite me being married. The last time I saw her was about a year ago at Stirred Not Shaken."

"What is it with people willing to cheat?" Kris asked. "It makes no sense to me!"

"I agree. I mean, how could you ever trust someone who cheated with you? Well, I guess in Ellie's case, it's just sex, so that doesn't matter, but Erin strongly indicated she wanted a relationship, not just a roll in the hay. If I had to speculate, though, I'd say it's that the 'other woman' thinks she's so much better that she can hold on to the guy, but that's illogical."

"It makes sense you would see things through the eyes of logic, but attraction isn't based on reason, is it?"

"No. The heart wants what the heart wants," I replied.

"Or in their cases," Kris smirked, "the «minou» wants what the «minou» wants!"

"And you?"

"We could put Rachel down for her nap and you could find out!"

"Sounds great!"

July 3, 1989, McKinley, Ohio

"I hope you're happier after you see your friends in daycare," I said to Rachel as we walked into the hospital at 5:45am.

"Want Abby!" Rachel insisted.

"In about two weeks," I replied. "When she comes home from Spain."

"NOW!" Rachel demanded.

I suppressed a sigh because, as the quip went, the only difference between terrorists and toddlers was that you could actually negotiate with terrorists.

"Good morning, Rachel!" Marcie exclaimed when we walked into daycare. "We've missed you!"

Thankfully, Rachel gurgled happily as I handed her to Marcie.

"She's done with bottles," I said. "She's drinking exclusively from her sippy cup, and it has to be the purple one."

Marcie laughed, "OK. Is it in her bag?"

"Yes. Kris will pick her up around 5:30pm. I'm on until tomorrow evening."

"Ugh. Those shifts are terrible!"

"I do have a few hours off to play with my band at Milton Lake for the Fourth."

"But close to the end of the long shift, you're going to be beat!"

"I know. My goal is to catch a nap overnight, but there are no guarantees."

"We'll take good care of Miss Rachel!"

"Thanks."

I left my daycare and headed up to the surgical locker room to change, then reported to the ED for my shift.

"Morning, Mike!" Kylie said when she saw me in the corridor.

"Morning! How was overnight?"

"Sunday nights are usually quiet. Twelve hours down, twenty-four to go."

"Who's the Attending?"

"Doctor Taylor."

"Anything interesting on the board?"

"No. Sue Townsend, who's going off shift, just streeted her fender-bender. She's in the lounge."

"Thanks."

I went to the lounge and saw a short, stocky doctor with close-cropped brown hair.

"Sue Townsend?" I inquired. "Mike Loucks."

"Nice to meet you! Nothing to see here, so if you're set, I'm gone! I have a date with a bubble bath and a bed!"

"I'm set," I said. "Who are the students?"

"Bob Banks, Fourth, and Len Godwin, Third. They went to get breakfast."

"Thanks."

She left, and I went to the Attendings' office.

"Morning, Doc," I said to Doctor Taylor.

"Well, well, well, if it isn't Doctor Michael Loucks! How was your first shift?"

"Routine. I caught all fourteen walk-ins."

"You're on the regular rotation today, so you'll get a mix of cases. Check any procedures beyond the basics with me, please. I know you can do them, but we do need to follow protocol."

"Understood. OK to have Bob Banks do procedures he's had signed off in his book?"

"Yes. You can give Lawson a shot at the basics, too; he's competent."

"OK. I'll check in at the nurses' station and await my first case!"

"We're glad to have you here," Doctor Taylor said.

"Thanks."

I left the office, checked in with Ellie, and then went to the lounge. About five minutes later, two medical students walked in.

"Bob and Len?" I inquired. "I'm Doctor Mike Loucks."

"I'm Bob," a short, stocky guy with black hair said. "This is Len."

Len was tall and lanky and had blonde hair that was almost white.

"Nice to meet you both. Please call me Doctor Mike, I much prefer that. May I see your procedure books?"

They both handed them to me, and I flipped through them. Bob had done the usual procedures I'd expect a 'competent' Fourth Year to have done, while Len had far fewer, but that was no surprise, given this was his first clinical rotation.

"Have you decided on a specialty, Bob?" I asked as I handed back the books.

"Surgery," he said. "Doctor Roth said I should learn as much as possible from you."

"That should be true of every rotation with every doctor. And that means asking to do procedures, especially as a Fourth Year. I already cleared that with Doctor Taylor. You'll do as many as I can reasonably assign to you. Len, you'll have opportunities as well. Do either of you know how to read an EKG?"

"No," they both said.

"Len, during your Clerkship in cardiology, make sure you ask Doctor Strong to teach you. Bob, are you doing a Sub-I in cardiology?"

"Yes."

"Then do the same. I take it you know how to attach EKG leads?"

"Yes. I've done it."

"You should have written that into your procedure book," I said. "Next time, do so, and I'll sign off. Len?"

"I've seen several done, but haven't ever done it."

"Do you have a diagram in your notebook for the correct placement and lead colors?"

"No."

"Then the first time we do a twelve-lead, take notes, make a drawing, then study it. I'll expect you to know it by the end of the next shift."

"Got it."

"Doctor Loucks?" Nurse Jenny said. "EMS four minutes out with an MI."

"Doctor Mike, please. Which room?"

"Trauma 1 is open."

"Thanks. Meet us in the ambulance bay."

She left.

"Game time, gents. Bob, twelve lead EKG; Len, draw blood for CBC, Chem-20, and cardiac enzymes. Let's go!"

We left the lounge, put on gowns and gloves, and headed to the ambulance bay, where we waited with Jenny for the ambulance to arrive. I smiled when I saw the large white '2' emblazoned on the ambulance, and when it pulled up, Bobby hopped out.

"Hi, Doc! Jerome McArthur, sixty-eight; complained of severe chest pains while at breakfast; pulse tachy at 110, BP 90/60; diaphoretic; PO₂ 94 on five liters by mask; no history of heart trouble; no known medications."

"Trauma 1!"

Bobby and Jim unloaded the gurney, and the six of us began moving towards Trauma 1.

"Mr. McArthur, I'm Doctor Mike. Where is the pain?"

"Chest and left arm," he said, his words muffled by the oxygen mask.

"When did the pain start?"

"During breakfast, maybe thirty minutes ago."

We moved into the trauma room.

"On my count!" I said. "One, two, three!"

We all lifted the sheet and moved Mr. McArthur to the treatment table. Jenny switched the oxygen supply from the portable bottle to the hospital system, and Bobby and Jim left.

"We're going to get you on an EKG, draw some blood, and do an exam," I said to Mr. McArthur. "Do you smoke?"

"No," he replied as Bob cut open his shirt and undershirt to gain access.

"Drink?"

"Socially."

"Exercise?"

"No."

"Are you taking any medication?"

"No. Aspirin if I have a headache, but not today."

As Bob attached the EKG leads and Len drew blood, I performed an exam and on auscultation, I heard 'distant' heart sounds. I called out the vitals to Jenny, who scribed them on the chart. Bob turned on the EKG and I looked at the screen.

"No ST elevation," I said. "Len, call for a cardiology consult, then get that blood to the lab, stat, please."

"What does that mean?" Mr. McArthur asked.

"ST-Elevation is a sign of the most dangerous type of heart attack. You don't show any elevation in the S-T segment of your EKG, which measures electrical activity of your ventricles. What I do see is something called a low-amplitude QRS complex, which measures both electrical activity and contraction of your ventricles. To put it in layman's terms, your heart is struggling to beat."

"Why?"

"That's what a cardiologist will tell us. You aren't in any significant danger right now. How is the pain?"

"Stabbing."

"Jenny, 5 megs sublingual nitroglycerin, please."

"Right away, Doctor!" she exclaimed.

"Jenny is going to put a tablet of nitroglycerin under your tongue, which will help with the pain."

We continued to monitor Mr. McArthur until the cardiologist arrived.

"Well, well, well," Doctor Alana Pace chuckled as she came into the trauma room with a female Third Year. "Pace, Cardiology. What do we have, DOCTOR?"

"Jerome McArthur, sixty-eight; complained of severe chest pains while at breakfast; tachy at 110, BP 90/60; distant heart sounds on auscultation; weak distal pulse in both legs; diaphoretic; PO₂ 96 on five liters by canula; no previous history of heart trouble; no known medications. 5mg nitro sublingual. CBC, Chem-20, and cardiac enzymes ordered. EKG shows low-amplitude QRS complex, suggestive of pericardial effusion or infiltrative myocardial disease. Suggest transthoracic echocardiogram to confirm pericardial effusion."

"Good morning, Mr. McArthur," Doctor Pace said. "I'm Doctor Pace from cardiology. May I examine you?"

"Yes."

She repeated the exam I had done, then asked me to step out. I waved for Bob and Len to follow us into the corridor, as did Doctor Pace's student.

"How confident are you in your diagnosis?" she asked.

"Very," I replied. "He has the classic signs; the EKG and exams are consistent with pericardial effusion. We're waiting on blood tests, but I think the echo ought to be done right away."

"I agree. There's no need to wait for the blood test results. I'll take him, and we'll do the echo upstairs. Excellent diagnosis, Doctor!"

"Thanks."

"I see Cutter has you in red," she said.

"Does everyone know about that little battle?"

"I'd say so, given there was a heated debate at the Attendings' meeting that Doctor Getty told us about. He has no dog in the fight, so to speak, so he just sat back and ate popcorn."

"Of course!"

We went back into the trauma room.

"Mr. McArthur," Doctor Pace said, "Doctor Loucks and I agree you need to have an echocardiogram. That's an ultrasound of your heart and will help us confirm your diagnosis."

"Which is?"

"The most likely condition indicated by your symptoms is pericardial effusion, which is an accumulation of fluid around your heart. It's not technically a heart attack, but it could easily lead to one if not treated. Once we confirm, we'll most likely perform a pericardiocentesis, which means draining the fluid."

"What causes that?"

"Any number of things, and I can't really speculate until we do some tests. Once we confirm the fluid buildup, we'll look for the root cause."

"OK."

"Carol," Doctor Pace said to her student, "call for an orderly and bring Mr. Pace up. No need for an EKG during transport as he's not having an MI."

"Yes, Doctor," she replied.

Ten minutes later, Mr. McArthur was on his way up to Cardiology.

"You made a diagnosis straight from the EKG?" Len asked.

"A preliminary one," I replied. "But ultimately, what we found is secondary to the cause of the effusion. There are strong odds it's not a heart problem, so he might end up in Medicine once Doctor Pace performs the pericardiocentesis, assuming it's not some latent heart disease of which he was unaware."

"That happens?" Len asked.

I nodded, "Unless there are obvious symptoms, what happens today is the most common result -- a trip to the ED due to onset of chest pains. Most effusions aren't symptomatic, at least in a way that the person suffering from them would notice. And if they're due to viral infection, they usually clear themselves with no intervention. Did you make your drawing?"

"Yes."

"Good. Bob, I'll sign your procedure book."

He quickly wrote in the procedure and I signed off, then said, "Let's report to Doctor Taylor."

We went to the Attendings' office, and I let Doctor Taylor know that I'd sent the patient up to cardiology. He reviewed the chart, scribbled a note and his signature, and handed it back. I thanked him, returned the chart to the nurses' station, and Ellie directed me to the triage desk.

"Morning, Alex," I said to the Fourth Year manning the desk. "What do you have?"

"Take your pick! Nothing critical. Toddler with an apparent ear infection; FF with back pain; carpenter with an infected finger."

"I'll take toddlers with ear infections for $500, Alex," I grinned, hoping someone else would catch the Frequent Flier drug seeker.

"Good lord!" Nurse Lily groaned. "That joke!"

Alex handed me the chart, and I went to the door to the waiting room and opened it.

"Ms. Lopez and Arturo?" I called out.

"Us!" a very pretty Hispanic woman called out, standing up and walking over carrying a crying toddler of about three.

I escorted her and her son into the ED, checked the board, and took them to Exam 5, the larger of the two makeshift exam rooms.

"I'm Doctor Mike and these two men are medical students I'm training. What brought Arturo to us today?"

"He's been crying a lot and started pulling on his ear a couple of days ago. This morning, he complained about pain, so my husband suggested taking Arturo to his pediatrician. They couldn't see him until late this afternoon and he's miserable."

"Let's get Arturo on the table and we'll check him out."

I was reasonably certain what I'd find -- otitis media -- but obviously I had to do a complete exam.

"Has Arturo had an ear infection in the past?"

"No."

"Any recent injuries or illnesses?"

"No. He's pretty healthy, except for the usual scrapes a little boy gets playing."

"How is his appetite? Any changes in the past few days?"

"He eats a lot, but he burns it up playing fútbol at the park."

I was positive she meant what we usually called 'soccer'.

"OK to examine him?"

"Yes, of course!"

I turned to the fussy little boy sitting on the exam table, who eyed me warily.

"Hi, Arturo. I'm Doctor Mike and I'd like to listen to your heart and breathing, count your heartbeats, look in your eyes, ears, nose, and mouth, and take your temperature. Is that OK?"

"Mama?" he asked.

"He needs to check you, Arturo." Ms. Lopez said.

"OK," Arturo replied, sniffing with a tear running down his cheek.

I washed my hands, put on gloves, and began my exam by listening to Arturo's heart and lungs, explaining each thing I was doing. I used an otoscope to check his ears and nose, changing the speculum between each ear and each nasal cavity. I used my penlight to check his pupils, and combined with a tongue depressor his tonsils.

Arturo's left tympanic membrane was red and bulging, which was a strong indication of otitis media. I checked his tympanic temperature in his non-infected ear, and determined he had a fever of 38.1°C, or just over 100°F. His pulse was elevated, at 85 beats per minute, but he had no other symptoms.

"I believe Arturo does have an ear infection," I said to Ms. Lopez. "Generally, they resolve without treatment beyond Advil or Tylenol to help with the pain. You should give him over-the-counter children's pain killers and follow up with his pediatrician in two days if he's still complaining about pain."

"No medication?" she asked.

"Most ear infections resolve in less than a week without medical intervention. In addition, it could be from a virus, which would mean antibiotics won't help. Except for infants, the best option is Children's Tylenol or Advil, and allow the infection to run its course. Your pediatrician will decide if further treatment is necessary."

"I could have just waited, then, right?"

I nodded, "Yes, though we prefer you err on the side of caution. You should take his temperature every three hours, and if it reaches 102°F, bring him back right away. I can get you the medication now, but honestly, it'll cost ten times as much if I get it for you as if you stop at the drug store just down the road."

"OK."

"Let me fill out the paperwork, and we'll get you on your way."

Bob, Len, and I left the exam room and went to the nurses' station where I filled out the chart and the discharge form, then took everything to Doctor Taylor for his review and signature.

"Any pressure to prescribe antibiotics?" he asked.

"His mom asked, but seemed to accept my answer that they weren't necessary."

"She'll get them from his pediatrician," Doctor Taylor said, writing notes on the chart and signing it and the discharge form. "But not much we can do about that. OK to discharge."

"Thanks," I said as he handed me the clipboard.

We returned to the exam room, I reminded Ms. Lopez about taking Arturo to his pediatrician, then asked Arturo what kind of candy he liked.

"Skittles!" he said.

I pulled a pack from a fanny pack I had purchased to use in the ED when I wasn't wearing a medical coat, and handed them to him, making his eyes light up.

"Doctor Houdini?" Ms. Lopez asked.

"I have a dozen different things in my pack plus spares in my locker," I chuckled, then turned back to my patient and said, "Arturo, you only eat those when your mom says it's OK."

"Arturo, thank the doctor!" Ms. Lopez said.

"Thank you," he said.

"Ms. Lopez, you can see Patient Services on your way out. It's the office next to the door to the waiting room. They'll get your insurance information and make arrangements for billing them."

"Thank you, Doctor!"

We all left the exam room and Ms. Lopez and her son went to Patient Services.

"I thought antibiotics were routine for infections," Len said.

"They used to be," I replied. "But their efficacy with ear infections is iffy at best, and as I said, if it's viral, they won't do any good. Overuse of antibiotics is a major problem, which should have been covered in your pharma class."

"It was, but they didn't say anything about not prescribing for ear infections."

"OK. Just something to remember."

"Why did Doctor Taylor say her pediatrician would prescribe them?"

"Because it's easy for us here in the ED to say 'no', but pediatricians often give into parental pressure because it's the path of least resistance, not to mention the guidance on antibiotics for ear infections is relatively new."

We went to the lounge and less than a minute later, Nurse Ellie came to the door.

"Doctor Mike?" she called out. "Multi-victim MVA. Doctor Taylor wants you with him and Doctor Foulks."

"On it!" I said. "Bob, Len, let's go!"

We gowned and gloved and met Doctor Taylor in the ambulance bay where Doctor Foulks and his medical students, along with two nurses were waiting.

"Any idea how bad?" I asked Doctor Taylor.

"Two critical," Doctor Taylor said. "One in arrest."

Which meant that a firefighter would be assisting with CPR and the chances of survival were low.

"Nick," Doctor Taylor said to Doctor Foulks, "we'll take the arrest. You take the other one."

"OK," Doctor Foulks agreed.

A minute later the first EMS squad came to a stop in the ambulance bay and a paramedic jumped out.

"Male, fifty-ish; unrestrained driver; cardiac arrest as we prepped him for transport; continue CPR and bagging; obvious head, chest, and leg injuries. IV saline TKO."

"Trauma 3!" Doctor Taylor ordered. "How long was he down?"

"It's been at least twenty minutes," the paramedic replied.

The gurney was removed from the ambulance and a firefighter got on, straddling the patient, performing chest compressions while the paramedic bagged the patient. Doctor Taylor, Bob, Len, Nurse Kelly, and I all rushed the patient to Trauma 3.

"Mike, EKG and monitor! Bob, Foley! Kelly, hang a bag of plasma, draw for a blood gas, type, and crossmatch."

I grabbed the bandage scissors and quickly cut away the patient's shirt while Bob did the same with his jeans. I began attaching the leads which required a bit of contortion on my part so the fireman could continue with compressions.

"Hold compressions," Doctor Taylor commanded.

He quickly listened.

"No heart sounds," he said. "Continue compressions."

I turned on the EKG and quickly scanned it.

"PEA!" I declared. "Atropine and sodium bicarb, IV push."

"Do it, Kelly!" Doctor Taylor ordered. "Mike, he needs a chest tube. You're wearing red and have the 'S' on your badge, and we can't wait for a surgical consult."

That wasn't protocol, but it was technically within the rules, as I was a surgical intern and I was being supervised directly by an Attending.

"Len, chest tube tray!" I ordered.

He brought it to me, ripped it open, and I squirted Betadine onto the correct area.

"Atropine and bicarb are in!" Kelly called out.

"Cease compressions," I ordered.

Once the fireman stopped, I proceeded with the steps Doctor Rafiq had reluctantly taught me.

"Blood in the chest cavity!" I announced as blood came out of the tube.

"Heartbeat!" Bob called out. "Irregular, I think."

The firefighter climbed off the table and I looked over at the EKG and there was, indeed, indications that the patient's heart was beating. While I connected the ThoraSeal, Doctor Taylor auscultated and nodded.

"Faint heart sounds," he said. "Len find the on-call surgical Resident!"

The firefighter and the paramedics left, as CPR was no longer necessary.

"Thoracotomy?" I asked.

"If we can stabilize him," Doctor Taylor replied. "OK, heartbeat is weak but regular, let's intubate and do a full exam. Mike, tube him."

"OK to have Bob try it?" I asked.

"Once. First time or you do it."

"Kelly, intubation tray, please," I requested. "Bob, come stand by me."

"Are you sure, Doc?" he asked.

"I am, but if you aren't, stand aside, watch, and I'll do it and give you step-by-step instructions."

"Uhm, that's probably better."

"OK."

I intubated the patient and hooked the tube to the ventilator.

"Lindsay, surgery," Doctor Lindsay said, coming in with Jack Talbert, a Fourth Year.

It was odd for a Senior Resident to catch an early morning consult, but it happened from time to time. Most likely that meant her scheduled procedure had been canceled.

"Fifty-ish male; unrestrained MVA; arrested on site; CPR; PEA detected; revived with atropine and bicarb; pulse weak at 60; BP 80 palp; vent at eighteen with PO₂ 98%. Blood in the chest cavity; broken right tibia; severe contusion left temple; chest tube is in."

"Who did that?!" Doctor Lindsay asked, surprised.

"The surgical Resident!" Doctor Taylor said. "On my orders."

"Let me check that first, please. Hi, Mike."

"Hi, Doctor Lindsay. I followed Doctor Rafiq's technique."

She examined the tube, the ThoraSeal, and the sutures and nodded. "Looks good."

She did a quick exam and nodded, "We need to find the source of the blood, but he's unstable. Let's give him some pressers and blood and see if we can get his BP up. If not, he'll never survive me opening him up, and might not even make it upstairs."

"Kelly," Doctor Taylor said, "hang a unit; a meg of epi IV push, half a meg every five minutes."

"Yes, Doctor!" Nurse Kelly replied.

"Emergency thoracotomy?" I asked Doctor Lindsay.

"We don't have what we need here in the ED," she said. "You know the protocol."

I did, and when the new ED wing opened and I'd completed enough of my Residency, we would have emergency thoracotomy kits in the ED, but for now, we didn't, and couldn't, per hospital protocol.

The monitor blared, and I looked up.

"V-fib!" I said.

"Mike, charge to 150!" Doctor Taylor ordered.

I flipped the switches on the defibrillator, twisted the dial, then handed Doctor Taylor the paddles and squired gel on them.

"Charged!" I declared when the machine beeped.

"CLEAR!" he commanded.

I removed the vent connection and everyone stood back while he shocked the patient.

"No conversion!" I said once the EKG settled from the massive rush of electrical energy.

"Charge to 200!"

I did and Doctor Taylor shocked the patient again."

"No conversion," I said.

"250!"

I twisted the dial but before the machine beeped and the monitor tone went steady.

"Asystole!" I said.

"A meg of epi down the tube!" he ordered.

I grabbed the vial, as I was closest, drew the liquid into the syringe, then squirted it into the vent tube and reconnected the vent.

"Nothing," I said fifteen seconds later.

"There's no point in flogging him," Doctor Taylor said. "He's had three doses of epi, and another dose isn't going to make a difference. He was down for at least twenty minutes before he got here. Time of death, 0811."

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

I turned off the EKG and monitor, waved for Bob and Len, and we left the room.

"Why give up?" Len asked.

"At some point, you decide it's hopeless," I replied. "With a potentially severe head injury, internal bleeding, and having been down for thirty minutes, it was a near miracle we got any kind of heartbeat at all. You know the survival rate for CPR, right?"

"Under 20%," he replied.

"And that's for heart attacks. While it won't appear on Doctor McKnight's report this way, his cause of death was not wearing a seat belt."

"What a stupid way to die," Len said.

"I agree."