Chapter 24 — Wonderful!

_July 19, 1989, Circleville, Ohio_

{psc} "What did you do today?" Kris asked when she arrived home on Wednesday afternoon.

"Rachel and I hung out. I played my guitar, read to her, and we took a walk."

"How did your call with Doctor Mercer go this morning?"

"She capitulated," I replied. "And she agreed to support Angie's claims with the state licensing board, though as an error of judgment, not malpractice. But, with all the other facts, I believe that will be sufficient to cook Doctor Greenberg's goose."

"You mean he'll lose his right to practice?"

"I still think that's a longshot, but a formal reprimand is certain, and a suspension for a year is probable. And that information is public, so he won't ever escape it."

"And that would satisfy you?"

"Nothing will satisfy me because the situation can't actually be fixed, but it's the appropriate action by the State of Ohio. Call it a 'warning shot' to others not to make the same mistake. Sadly, I doubt it will be heeded."

"So, what can be done?"

"By me, very little except to try to encourage the psychiatrists I encounter to stop reflexively prescribing psychoactive drugs to create docile patients, rather than doing the hard work of trying to help patients overcome their illnesses. Fundamentally, it's a product of Western civilization, and I'm not sure how to address it."

"Western civilization? How?"

"In a hunter-gatherer tribe, what triggers would Angie have had? And if she was quirky and celibate, she might well have been a seer or a medicine woman. The so-called barbarians would have treated her with respect, and possibly even awe. Think also of the Russian tradition of 'Fools for Christ'. We so-called 'modern' and 'civilized' people treat her, and people like her, terribly.

"It's also the case for those tribes that nearly everyone engaged in some sort of labor that didn't require specialized knowledge, except that which was imparted from father to son or mother to daughter, and all of that revolved around food, shelter, clothing, and what passed for medical practice. If Angie is able to do data entry and practice Aikido, she could certainly have been a productive member of the tribe. More so if she was a medicine woman or seer, things which were valued."

"Are you saying we should go back to that kind of existence?"

"I'm no Luddite!" I chuckled. "And I prefer my creature comforts. What I'm trying to point out is that progress isn't always positive, and there is much to learn from the ancients. Were you aware that there was reliable herbal birth control in Roman times?"

"No!"

"A plant called _silphium_, which is thought to be extinct, mainly because the demand for it was so high, was a very effective contraceptive. It also had other medicinal qualities. It was also reported to be an abortifacient, because it would induce menstruation whether the woman was pregnant or not. A single monthly dose was as effective as the pills you take every single day."

"Why not plant more of it?"

"From what I've read, it would only grow in a very limited region around the ancient city of Cyrene, in what's now Libya. They tried to manage the harvest, but as you can imagine, the demand was simply too great. That's not the only ancient herb or medicinal plant that was effective. Modern aspirin is synthesized, but it's based on an extract of willow bark, which was used as an analgesic.

"Coca leaves, which are chemically processed to make cocaine, act as a mild stimulant and analgesic, and also suppress hunger, and are not addictive, nor do users suffer from withdrawal if they stop using it. Of course, we moderns have developed a process to extract it, concentrate it, and make it addictive, to the point where we no longer have what amounts to a natural remedy.

"And yes, Coca Cola did originally use coca leaf in Coke, but they stopped doing that just after the start of the twentieth century, when they substituted 'spent' leaves that had no cocaine. A bottle of Coke made with the original formula had around ten milligrams of cocaine, compared to a typical line of coke which has around sixty milligrams, give or take."

"And that was legal?"

"Absolutely. Until the passage of the _Pure Food and Drug Act_ in 1906, there were no effective limitations of what drugs could be sold or used. And that act only required proper labeling. Modern drug laws came about in 1938 with the _Federal Food, Drug, and Cosmetic Act_, and prescriptions became mandatory for listed drugs in 1951 with the _Durham–Humphrey Amendment_, which created two groups of drugs — prescription, also called 'legend', and over-the-counter. Interesting, Senator Hubert Humphrey was a pharmacist by trade. He later on became Vice President under Lyndon Johnson."

"So before that, anyone could take anything?"

"Yes, so long as they could find someone to provide it, and I don't mean just doctors or pharmacists. One of the reasons for the passage of the _Pure Food and Drug Act_ was the availability of so-called 'patent medicines' which where, as the term goes, 'snake oil'. Coke, Pepsi, and Dr Pepper had their start as 'patent medicines'. Coke was sold as a cure-all for, among other things, morphine addiction, indigestion, nerve disorders, headaches, and impotence.

"Pepsi Cola was first marketed as a cure for dyspepsia, that is, an upset stomach. The name refers to the digestive enzyme pepsin, but the drink never included that enzyme, despite some people thinking it did. Dr Pepper was sold as a digestive aid, and was claimed to restore 'vim, vigor, and vitality'. It, like Coke and Pepsi, was developed by a pharmacist and sold in drug stores, which, as you might guess, is the origin of the soda counter and soda 'jerks'."

"That's not a French thing at all, and I only know about it from things I've read or movies I've seen. Anyway, what's the plan for this evening?"

"Dinner, Vespers, and making love to my wife, if she's interested."

"She's interested! Shall we make dinner?"

"Yes!"

_July 20, 1989, McKinley, Ohio_

"Hi, Stranger," Lara said when I met her in the cafeteria for lunch on Thursday.

"We saw you and Nathan about a month ago!" I replied.

"And you and I saw each other nearly every day for the past eight years!"

"True, minus somebody's jet-setting during Summer breaks and my honeymoon with Elizaveta."

"How are you holding up?"

"Good, actually, despite being very tired. You won't believe what happened yesterday."

"What?"

"Doctor Mercer capitulated and agreed to write a letter stating that Doctor Greenberg had made an error in judgment by discounting clinically significant behavior."

"It was malpractice, and you know it!"

"It was," I replied. "But Doctor Mercer has to work within her community, so she couched it in terms that would help us, but also protect herself. Saying that he discounted clinically significant behavior is sufficient to have him receive a disciplinary letter and will likely result in suspension. He'll have a permanent black mark on his record at that point. That is the best we can do and is better than what I'd expected."

"You know the attorney was instructed to push for revocation of his license, right?"

"Yes, and knowing how this works, he'll work out the equivalent of a plea deal and accept the reprimand and suspension in lieu of losing his license permanently, and the licensing board will agree. That said, if there were other incidents, things might be different. As far as I'm aware, there aren't, and revocation usually requires a pattern, or some egregious act like performing surgery under the influence of alcohol or drugs, or committing an illegal act."

"Sadly, that makes sense."

"Let's change subjects! How are things with Nathan?"

"I invited him to church, and he hasn't run away screaming!"

I chuckled, "He was at my wedding!"

"Which isn't three or four hours on Sunday morning!"

"True. And?"

"I think, with your blessing, I'll say 'yes' when he asks me to marry him."

"As much as I object to that entire idea, you have my blessing."

"And you know I don't mean it in a patriarchal way, just that if you had anything negative to say, I'd listen carefully. I trust your judgment, Mike. It's been proven to be damned good for the past eight years."

"Minus a few significant mistakes."

"I think you've made fewer mistakes than you think, but that's bound up in your rigorist view of sin."

"As if there is any other option! I mean, for me, not how I apply it to others."

"You always did take the pre-Eucharist prayer literally."

"Yes and no," I replied. "It says _I believe, O Lord, and I confess, that thou art truly the Christ, who camest into the world to save sinners, of whom I am chief._ That's quoting the Holy Apostle Paul's First Letter to Timothy. And the point is to never, ever, look down on another person because of their sin. It _may_ disqualify them from ministry, but it is never to be lorded over them. It is not just to be forgiven, but forgotten. That is, it should have no meaningful effect on how I perceive the person."

"Frank Bush," Lara said.

"As one example. I'm no better than he is, in terms of sinfulness. He's paying an earthly penalty for his sin, but you know my take, right?"

"That he should live a long life so he has a chance to repent of his sin and ask God to forgive him. And you've made him your personal mission in life. What do you gain by that?"

"Personally? Nothing. And that's the point. I don't want anything for _me_ out of that, though I would obviously feel good if he were to acknowledge God's saving grace even while serving a life sentence without parole. But, in the end, I'll never know, at least in this life, if that happens. In the end, only God can see into Frank Bush's heart, and I'm certainly no «staretz» with the gift of insight into another person's interior life. My calling is to heal the body."

"So, is it just Frank Bush?"

"Long term? No. I hope to start a prison ministry that will also provide medical consultation. I'm sure I can find enough nurses to help."

"When you need funding, you know where to come."

"I appreciate it. Any idea when Nathan will ask?"

"I'd say before the end of the year."

"I'm happy for you," I said.

"I take it everything is OK with you, Kris, and Rachel?"

"Yes, minus not being able to see them as much as I'd like, but Kris and I knew that beforehand. Rachel is unhappy at times, but she enjoys our Wednesdays together."

"More soon?"

"Yes, Mom!" I chuckled. "We'll start trying in September."

"Did you receive your invitation to Maryam's wedding?"

"Yesterday. Kris and I plan to fly up on Saturday and fly back late on Sunday."

"That's going to be very tight. What do you think about flying in a private plane? We wouldn't be bound to a specific flight schedule, and split four ways won't be ridiculously expensive. I know someone with a Twin Beech who could fly us up and back. That means we could stay for the reception and still make it back so we could go to work on Monday morning."

"That would help," I replied. "I'd only have to trade a Saturday shift. Would you check into it and let me know how much it will cost? I think we'll likely leave Rachel with Lyudmila rather than try to take her along, because I'm not sure how well she'd tolerate the trip."

"I'll check into it and get back to you."

"Thanks! Invite Clarissa, because I'm sure she and Tessa received invitations."

"That will work. Six passengers will be fine."

"Great!"

We finished our lunch, hugged, and Lara left the hospital while I returned to the Emergency Department.

"Doctor Mike," Ellie called out as I walked towards the nurses' station, "Doctor Gibbs would like to see you."

I acknowledged her and went to the Attendings' office.

"You wanted to see me?" I asked.

"Come in, shut the door, and grab a seat."

I did as she asked and waited for what she had to say.

"Doctor Mastriano was placed on probation this morning," Doctor Gibbs said. "All her orders will need to be confirmed by another Attending until her probationary period has ended. There will be a memo published tomorrow, but Doctor Northrup asked me to tell you in advance. Doctor Mastriano claimed you set her up."

"And Doctor Northrup's evaluation of that claim?" I asked.

"Unfounded. She claimed you insisted on a written order for the express purpose of undermining her authority and that you failed to provide relevant details about the patient. The facts are not in dispute, and the charts from that night are definitive."

"I decline to respond to that accusation, and I'll stand on the facts and the orders on the charts."

"Which Doctor Northrup, Ghost, and I all knew would be the case, and why we didn't need to speak to you before Doctor Northrup concluded his investigation and determined the proper course of action. This will require a bit of juggling of schedules, as we'll need a second Attending on overnight. Doctor Northrup does have an Attending slot open that he hopes to fill this week."

"What do you want me to do?" I asked.

"Keep on keeping on. You did exactly the right thing that night, and in your position, I'd have asked for the order to be written. That should have been her clue she might have misjudged the situation with the patient. And that's something to remember. If your Resident feels strongly enough to insist you write your orders, in your own hand, that's the time to reconsider."

"Understood. On another topic, I may need to trade a shift in October; Maryam is getting married on October 15th and Kris and I will fly to Chicago on a Saturday and fly home late Sunday evening."

"OK. Let's discuss it when the schedule for September and October is published in August."

"Is there anything else? I saw patients in the waiting room when I walked past."

"That's all. Go heal the sick!"

I nodded, got up, and went to find Bob and Len so we could handle some of the walk-ins.

_July 21, 1989, McKinley, Ohio_

"Mike, Doctor Lawson would like to see you," Ellie said just before noon on Friday.

"Did he say what he wanted?" I asked, despite having a strong suspicion what it was he wanted.

"No, just that you should stop by his office between noon and three."

"I'll take my lunch now, then go upstairs."

I went to the cafeteria, ate my lunch quickly, then headed up to Psych to see Doctor Lawson. He was in his office and waved me in, indicating I should close the door.

"I had a call from Doctor Jules Greenberg. Your name appears on a witness list in a complaint against him filed by the parents of a patient. I believe we discussed this."

"We did," I replied. "And her family chose to proceed. I heard from their attorney, and if they do call me as a witness, I'll answer truthfully and forthrightly."

"You are unqualified to make any diagnostic comments."

"I have no intention of doing so, and no need to do so. I will simply state my observations, which, by themselves, are damning."

"A doctor supporting a claim that revolves around diagnostic decisions and treatment choices will forever tarnish his own reputation. You can decline to testify."

I stood up.

"I reject your advice, Doctor, and I will not remain silent in the face of errors. I'm needed in the ED, so if you'll excuse me."

"You're throwing away your career, Loucks."

I left without another word because there was nothing I could say to him. The only decision I had to make was whether or not to make a complaint about Doctor Lawson. My initial inclination was to simply let it go, but my second thought was better — to wait for the outcome of Doctor Greenberg's hearing. And before I did anything, I'd need to speak to Clarissa, and, more importantly, Kris.

When I returned to the ED, I found Mary and Tom, and as there wasn't an active trauma, we went to the triage desk to take a patient. Before we could take a patient, Nate let us know that EMS was eight minutes out with an MVA with severe trauma. That time meant some distant part of the county, and a long response and transport. The three of us gowned and gloved, and went to the ambulance bay and a minute later, were joined by Ghost and Kellie.

"You run it, Mike," he said. "I'll only step in if you ask me to."

"OK. Who's covering for you next week while you're on your honeymoon?"

"Gómez from Medicine. A _locum tenens_ is covering for him."

"Why not have the _locum_ directly in the ED?"

"Doctor Northrup's policy. Only PGY3s from Medicine or PGY2s or higher from Surgery, as they're known quantities."

"Makes sense."

"Let's chat privately after this trauma."

"OK," I agreed.

About six minutes later, the EMS squad arrived and pulled up.

"Ian Barnes, twenty-two, MVA versus telephone pole; BP 80 palp; pulse 110 and thready; resps labored and shallow; PO₂ 93% on ten liters; absent breath sounds on the left; crush injuries to both legs; severe head trauma; GCS 3."

"Trauma 1! Ghost, intubate," I said as we quickly moved with the gurney. "Mary, EKG and monitor; Kellie, trauma panel. Tom, call the surgical Resident. The patient will need a chest tube and I can only do it with an Attending present."

"Tom, get Doctor Gibbs," Ghost countermanded. "This guy can't wait!"

"Also get the ultrasound," I said.

In the room, Ghost, the two paramedics, Mary, Kellie, and I moved the patient from the gurney to the table and began our work. As I assessed, Ghost intubated the patient.

"Tube is in!" he exclaimed.

I quickly auscultated the patient's lungs and announced, "Absent sounds on the left, but all signs point to a collapsed lung."

"What do you have, Mike?" Doctor Gibbs asked as she came into the room.

I quickly repeated the vitals, taking the PO₂ and pulse from the monitor Mary had hooked up, and asked for permission to insert a chest tube.

"Do it," she declared. "I'll complete the assessment."

"Kellie, chest tube tray!" I ordered.

Four minutes later, the patient's lung was re-inflated, and I supervised Mary putting in several sutures to hold the tube in place.

"That didn't resolve the thready pulse," I said. "Ultrasound, please!"

I did a quick assessment and determined the patient needed a pericardiocentesis, and with Doctor Gibbs' assistance, performed it, which improved the patients' heartbeat. Next up was an ultrasound of the abdomen, which detected fluid in Morrison's pouch.

"Tom, call upstairs to surgery. He's going to need an ex-lap. We'll splint the legs. They'll have to wait. Mary, Foley; Ghost and Kellie, splint the legs, please."

"Abrams, Ortho!" Doctor Kelly Abrams announced as she came in with her student. "What do we have?"

I ran through the vitals and injuries, and she concurred that despite the crush injuries to the patient's lower legs, his internal bleeding was a priority. Five minutes later, Mary, Tom, and I escorted the patient upstairs and turned him over to a surgical team.

"We don't get to scrub in?" Mary asked as we walked towards the stairs.

"No, because he's going to need at least three surgeons, including Ortho, and the room will be crowded at that point."

"What are his chances?" Tom asked.

"Given we re-inflated his lung and resolved the pericardial effusion, pretty good. A lot will depend on the extent of his internal injuries, obviously, and his legs are pretty badly crushed, but he should live. Of course, I wouldn't say that to his family or friends."

"What would you say?"

"That he was severely injured and that we're doing everything in our power to repair the extensive damage to his body. Anything more than that is speculative, and you risk giving the family false hope, though you also don't want to completely crush their spirits. It's a tough balance. Even saying something like we stabilized him is a double-edged sword because 'stable' means out of danger to most people. Think about how we use that word internally."

"It's a point-in-time observation of the patient's vitals, and not specifically predictive, because, for example, the patient could arrest or suffer arrhythmia despite having stable vitals."

"Exactly," I said as we reached the ground floor. "You could say the patient was in critical condition, as that term is commonly understood by the general public to mean in severe danger of dying, which is true about our MVA, even though we resolved the weak pulse and collapsed lung, and brought his PO₂ up to 97%."

"Do you think he'll lose the legs?"

"I'm not qualified to answer that question even speculatively. What I'd tell his family or friends is that his legs were severely injured and we'd assess the extent of the damage once we'd dealt with his potentially life-threatening internal injuries. And who knows about the head injuries? At least his pupils weren't blown, so odds are that it's a severe concussion."

We reached the ED, and after removing our gowns and gloves, we went to the triage desk to get a patient.

"Got a full house," Jack, a Fourth Year assigned to Ghost, said. "Three with some form of stomach ailment and two with injured ankles."

"Did the three come in together?"

"Yes. They were all at a picnic yesterday."

"Food poisoning," I said. "Tom, Mary, you handle those three, and I'll take the worst ankle injury. Assess, then come to me with your reports."

"I'll take the girl," Mary said to Jack.

He handed her a chart, and one of the charts for the two guys to Tom, then handed me a chart for one of the ankle injuries. While Tom and Mary called their patients, I asked Kellie for assistance, and we took a wheelchair to the waiting room to retrieve the teenage guy with what I strongly suspected was a broken ankle from the discoloration and swelling.

Tom and Mary did a good job assessing the food poisoning patients, and I authorized IV Ringer's for each of them to counter dehydration along with anti-emetics to control their vomiting. Of the two ankles, one was broken and one was badly sprained, and Kelly Abrams assessed the broken ankle for me, declaring it was surgical and likely needed pins. I finally had a chance to see Doctor Casper after all those patients were treated and either admitted or released.

"Loretta said she spoke to you about Mastriano."

"She did," I confirmed.

"Anything you need to get off your chest?"

I smiled, "I have no problem speaking my mind to Loretta," I replied. "Or anyone else, for that matter!"

Ghost laughed, "So true, but sometimes we determine the politics of the situation require us to be circumspect, and that's where mentors come in."

"I'm not concerned about Mastriano," I said.

I thought about saying something about Doctor Lawson, but decided I was better off discussing that with Kris and Clarissa first before making it in any way 'official', even though I could speak to Ghost 'off the record', if necessary.

"Then we'll leave it. Good job on the MVA. You did everything in the correct order and we saved a good ten minutes by you doing the chest tube and pericardiocentesis."

"Every trauma doctor should be able to do both those procedures," I said.

"I don't disagree, but that's between Northrup, Cutter, and Getty, and you know that's political. Your red scrubs are Cutter marking his territory, and he's not about to cede anything he thinks is his domain."

"You know my take on that," I replied. "But I also know the rules about supervision of surgical procedures."

"Eventually, some of those procedures will be reclassified, and as there are more doctors trained similar to how you're being trained, the rules will change. But, as with everything, it's going to take time."

"Any rumors about Resident hours?"

"No, but obviously that can only change if we have a larger allocation of Residents or hire more Attendings. Your former father-in-law would have more information than any of us, except the Medical Director."

"I try to avoid discussing those things with him. I want to keep that relationship solely as Rachel's grandparents, and not seem as if I'm trying to gain any advantages. I already have doctors gunning for me."

"Besides Mastriano and Rosenbaum?"

"Those are the main ones, but there are others who aren't happy with how things have played out. I'm sure you know Doctor Rafiq had his nose out of joint because I was permitted to do things as a Fourth Year."

"I've always felt the idea that because I didn't have a chance to do something, that nobody should is stupid."

"I agree, obviously."

"Also, good choice in having Tom and Mary handle the food poisoning cases. It helps build confidence."

I nodded, "Those were my favorite opportunities during medical school. Sure, I loved learning new procedures and doing 'cool' stuff, but those few times I was assigned a patient and made responsible for them — under supervision, of course — were the true highlights."

"I do have one question for you — would you be willing to take an eight-hour shift at the Free Clinic during September and October?"

"Sure. Is this a new program?"

"Yes. Something they're trying out, rather than direct hires."

"I have to ask how we're going to cover the extra hours when we're already stretched thin."

"Believe it or not, the Free Clinic has funding to make it happen. We'll give them five eight-hour days and they'll fund a good portion of the salary for an Attending who'll work forty hours, Monday through Friday, 0800 to 1700."

"Interesting."

"It's a doctor who lives in Columbus and needs a regular schedule. He's worked in what they're calling an 'urgent care' facility that is closing. It's similar to the Free Clinic, but they provided more services. They lost their funding, and it wasn't a profitable venture, so it closed. He was a trauma Attending in Toledo before moving to Columbus for family reasons."

"Is this in addition to the Attending Doctor Northrup is hiring?"

"Yes."

"Thanks for explaining. I'll take a shift, obviously."

"Thanks."

There was a knock at the door of the consultation room, which served as the temporary Resident's office, and Ellie opened the door.

"Ghost, paramedics three minutes out with an MI."

"Thanks, Ellie."

We left the room, and I went to find Tom and Mary. We handled walk-ins for the rest of the afternoon, and just before 6:00pm I turned things over to Kylie, then headed up to the surgical locker room.

"How did the MVA do?" I asked Shelly Lindsay, who, as usual, was in the locker room at the end of the day.

"Splenectomy, liver lac, and bladder tear were all repaired. Flail chest being monitored overnight in the ICU and Ortho will work on his legs tomorrow. Neuro status is a severe concussion, but with no skull compromise. He'll have a CAT scan tomorrow as well. Good job on the chest tube and the pericardiocentesis — perfect placement for both."

"Thanks."

We both showered and dressed and left the hospital together.

"See you next week," she said as we got into our cars, which happened to be parked side-by-side.

I got into my car and headed home, where I planned to eat dinner and collapse into bed.

_July 22, 1989, McKinley, Ohio_

"Mike, when will you know your schedule for September and October?" Kim asked when I arrived at Taft for band practice early on Saturday morning.

"It'll be published in about three weeks," I replied. "Why?"

"Goshen's Harvest Ball and a gig at the club in Newtown."

"Take the gigs," I said. "One way or another, I'll work it out. But those two, plus Taft and Stirred not Shaken, are probably it for the next three months. Obviously, if you four want to play without me, I won't stand in your way."

"Nah," José said. "We're doing this for fun, not for cash, and I'm cool with limited gigs."

"Same here," Sticks said. "We'd starve to death trying to make money as a band!"

José, Kim, Sticks, Kari, and I completed our practice session, I headed home for a few hours, then drove to Moore Memorial for my Saturday shift. I'd be seeing Doctor Mastriano for the first time since the discipline had been handed down, so as I drove, I reminded myself to stay professional. It was imperative to not allow her to bait me or trap me, and I seriously hoped she wouldn't put her disagreement with me ahead of patient care. The saving grace was that Doctor Williams would have to sign off on any orders, and I could, for the most part, ignore her.

At the hospital, I went to the surgical locker room, changed into my red scrubs, then headed to the ED, where Callie and Gabby were waiting with Kayla Billings. She handed over three patients, all of whom were being admitted to Medicine. My students and I spent the next twenty minutes with Clarissa and her students transferring those patients to Medicine.

The afternoon was busy, but not crazy, with half-a-dozen walk-ins and three EMS runs, none of which resulted in admissions. Just before 6:00pm I took my dinner break and met Clarissa in the cafeteria.

"Complete secrecy?" I asked.

"Yes. Mastriano?"

"No, Lawson. He asked me not to testify at the hearing for Doctor Greenberg. He was careful not to threaten me, but he did say that a doctor supporting a claim that revolves around diagnostic decisions and treatment choices would forever tarnish his reputation, and when I rejected his advice, he said I was throwing away my career."

"Carefully worded to sound as if it was a warning and advice, but based on what he's said to you before, I'd say you're right to call it a threat. What are you going to do?"

"Nothing, though I did write down a summary of the conversation in my personal notebook, so the date can be verified."

"Not your procedure book, right?"

"Right. The other one I carry to make personal notes and to keep track of the types of cases I've handled. Nobody sees that except me, though I'd show it to you, if you asked."

"True about anything you have!" Clarissa teased.

"Before I asked Kris to marry me, yes. Now, no."

"You're just no fun, Petrovich!"

"Sure I am! Ask Kris!"

"Maybe I will! Do you plan to ever say anything to anyone about this?"

"Not unless he tries to mess with me. If he does, my notebook and your testimony will sink him."

"Mutual Assured Destruction?"

"No, because he literally can't hurt me, no matter what he thinks. Honestly, if he does anything, how do you think Doctor Cutter would react? Or Doctor Gibbs?"

"Badly. And you think Mastriano is defanged, but what about her boyfriend?"

"What can Rosenbaum do as a Resident on another service?"

"Not much, I suppose."

"And he has to consider what the revelation of his affair to his wife might cost him."

"You'd do that?"

"Only to show the link between him and Mastriano, not expressly to reveal it. I've told you all of this, and it's all in my notes or on charts, just in case."

"What do you plan to say at the hearing?"

"All I need to do is present observed behavior. Doctor Mercer will confirm it, and that will be enough to sink Doctor Greenberg's ship. Changing subjects, did you receive your invitation to Maryam's wedding?"

"Yes. It's going to be tough to go."

"Lara is arranging with a family friend to fly us to Chicago and back in a light airplane. It would be you, Tessa, Lara, Nathan, Kris, and me. We'd pay for the trip, of course, but we wouldn't be on a fixed airline schedule. We would fly up on Saturday and we could fly back late on Sunday."

"That would make things easier, but it has to be expensive."

"Lara indicated it wouldn't cost much more than airline tickets, and she'll let me know in the next few days."

"We're in," Clarissa said. "The problem will be getting coverage."

"We have enough time to sort it out, though obviously we can't do anything until the schedules are published in August."

We finished our meal, and I headed back to the ED while Clarissa went up to Medicine.

"Mike," Nurse Wendy said when I walked up to the nurses' station, "can you take a Sheriff's Deputy with a hand injury?"

"Sure. Which room?"

"Exam 3."

Because it would likely be simple, I sent Callie and Gabby to have their dinner, then went into Exam 3.

"No holes, Doc," Deputy Kenseth said as I walked in.

"That's good! What happened this time?"

"Serving a warrant and had my hand slammed in a car door."

"Let's take a look," I said.

I washed my hands and put on gloves, then sat on the stool near the exam table, and examined Deputy Kenseth's hand.

"That's going to need an x-ray," I said. "How much pain are you in?"

"I popped a pair of aspirin before I drove here, it hurts, but I can handle it."

"Let me call radiology and see if they can take you right away."

I went to the phone and made the call, and once I mentioned it was a Deputy, the radiology tech said we should come right down. I walked with Deputy Kenseth to radiology, and the tech quickly took four shots of his hand.

"Wet read, right?" the tech asked.

"Yes," I replied.

We left and went back to the exam room. I got a chemical cold pack from the supply cabinet, squeezed it, and handed it to Deputy Kenseth.

"Just hold that on it and relax. The radiologist will call in a few minutes."

"What are the possibilities?"

"Cast, most likely," I replied. "I don't _think_ it's surgical, but there's no way to know for sure until we see how bad the break is. If it's bad enough, I'll call for an Orthopedic consult. I meant to ask, is this your shooting hand?"

"No."

"OK. Then there's less of a concern, unless you're a concert pianist or do other work that requires significant dexterity."

"Like surgery?"

"That would be one, or a watchmaker, jeweler, or anything like that."

"The only thing I ever did like that was build model planes when I was a kid. The model sets just aren't the same now."

"I only ever built one model, and it was the Apollo Saturn V spacecraft with the lunar module."

"Still have it?"

"It's at my mom's house," I replied. "I didn't have room for it when I first moved out, and hadn't even thought about it until just now."

The phone rang, and I went to answer it.

"Mike Loucks."

"Neil Stephens. Your deputy needs an orthopedic surgeon."

"OK. I'll call for the consult. Would you have the x-rays sent over?"

"Will do," he agreed, and hung up.

I turned to Deputy Kenseth and said, "Well, I might have been mistaken about surgery. The radiologist recommended an orthopedic consult. I'll call up for that now."

"Well, shit," he groused. "I get shot and you throw in a couple of stitches, but get my hand shut in a door and it needs surgery?"

"Maybe. The point of the consult is that neither the radiologist nor I are qualified to make a final determination. He's sending the x-rays over so I'll show you, but my specialty is trauma, not orthopedics."

I placed the call for the Ortho consult then chatted with the deputy until the x-rays arrived. I put them up on the screen and saw immediately saw why Doctor Stephens had recommended a consult.

"There are three breaks," I said pointing to each one in turn. "One scaphoid fracture, here, and a pair of boxer's fractures, here and here. The scaphoid fracture is the problematic one, as that bone is very slow to heal and needs either external or surgical fixation."

"Wonderful," he sighed as the door opened.

"Hi, Mike," Doctor Val Jackson said, coming into the room with her student, Karl.

"Hi, Val. Deputy Sam Kenseth. Broken left hand. X-rays are on the viewer. Left scaphoid fracture and a pair of boxer's fractures as a result of the hand being slammed in a car door."

"Hi, Deputy, I'm Doctor Jackson from Orthopedics. Let me take a look at the x-rays and we'll let you know what we recommend."

Doctor Jackson, Karl, and I went to the viewer and Doctor Jackson confirmed what I now suspected — he'd need surgery.

"Deputy, we're going to need to surgically repair this break," she said. "This part of your hand is very slow to heal and if it doesn't heal properly, you're at risk for serious osteoarthritis. We need to do the procedure right away, as blood flow is often compromised. Karl will bring you up, and Doctor Cole and I will repair your hand."

"Wonderful."

"Mike, can you get your Attending to sign the chart please, and then I'll take the Deputy."

I took the chart and went to find Doctor Williams who quickly signed off. I returned to the room and handed the chart to Doctor Jackson.

"You're in good hands, Deputy," I said. "Good luck and let's stop meeting this way!"

"Thanks again, Doc. See you next time!"

"Wonderful," I chuckled.

I left the room and went to see if there were any walk-ins I could take.