Chapter 73 — Preliminary Diagnosis

_January 20, 1990, McKinley, Ohio_

{psc} "Finally, a full day of practicing medicine!" I exclaimed when I saw Isabella Mastriano on Saturday morning.

"How is this year's crop of candidates?"

"I don't have previous years to compare it to, but we've only knocked out a total of four from surgery and emergency medicine."

"You're on both teams?"

"Yes. That was Cutter's idea."

"Protecting the patients?" Isabella asked with a smirk.

"Hardy-har-har," I deadpanned.

"Mike?" Nurse Jenny called out. "EMS three minutes out with a rollover MVA."

"What a way to start the day," I said. "Where are Andy and Karl?"

"Lounge. I'll let them know."

"Thanks. Isabella, care to join me? Rollovers usually require two docs."

"I suppose my crossword puzzle could wait," she replied with a theatrical sigh.

Isabella and I headed to the ambulance bay, putting on gowns, gloves, and goggles on the way. Andy and Karl joined us, along with Nurse Mindy.

EMS Squad 4 pulled up in front of us about two minutes later, and Roy jumped from the cab.

"Jessica Melbourne, twenty-seven; restrained, high-speed rollover MVA; pulse 120; BP 100/60; PO₂ 93% on 5 litres; resps labored; crush injuries to the chest; broken left arm and leg; multiple lacerations and contusions, including the head; GCS 6; IV saline TKO; backboard and cervical collar; vehicle was t-boned."

"Trauma 1!" I ordered. "Andy, Foley; Karl monitor, but hold the EKG until we assess the chest; Mindy, hang a unit of plasma, then stat ABG, type and cross-match; then CBC, Chem-20, RPT; Isabella, assess the head injuries!"

Somewhere in the back of my mind, an idea that I knew this patient floated ephemerally, but I pushed it aside and focused on the immediate problem. We moved to the trauma room, and six of us carefully transferred the patient to the trauma table. Everyone sprang into action, and Andy and I cut away most of Jessica's clothing.

"Pneumothorax; probable collapsed lung," I announced. "Andy, chest tube tray as soon as you have the Foley in."

"In!" he announced about thirty seconds later. "Urine in the bag; pink tint."

"OK. Dip it once you get me the tray!"

"Pupils sluggish; no cranial fluid in the ears or nose," Isabella announced.

"Karl, call upstairs," I said. "We're going to need a surgical team. I don't know the extent yet. Just tell them multiple abdominal injuries."

I inserted the chest tube, and that brought Jessica's PO₂ up to 98%, so intubation wasn't necessary, at least for the moment.

"Positive urine dip!" Andy announced.

"Abdomen is rigid," I said. "Certainly internal bleeding. Andy, EKG, please."

"Surgery says fifteen minutes," Karl announced.

"V-tach!" Andy announced. "Run of five!"

I looked up at the monitor and confirmed, but it wasn't severe, so the best course of action was to not administer drugs, leaving those choices to the surgeon and anesthesiologist. I continued my exam, and given the time we had, I asked for the ultrasound, which would save time upstairs. I confirmed free fluid in her abdomen, and the urine dip confirmed the presence of blood.

"What do you think, Isabella?" I asked.

"Neuro consult can wait until after they repair her internal injuries. I'd say severe concussion, but no skull fracture."

"Then let's take her upstairs. Karl, get a gurney! Andy, portable monitor."

He did, and we carefully transferred Jessica to the gurney.

"Karl, Andy, Mindy, with me; Karl, grab the portable paddles."

He grabbed the portable defibrillator and put it at the foot of the gurney along with the monitor, and we rushed Jessica from the room and down the corridor.

"HOLD AND CLEAR THAT ELEVATOR!" Karl called out in his booming voice.

Fifteen seconds later, we were in the elevator on the way to the second floor, and that idea that had been floating in the back of my head suddenly focused.

"Mindy, check the right bicep and tell me if you see a jagged scar."

"Why?"

"I think I know this patient."

Mindy checked the arm and looked up, "Five-centimetre scar about three centimetres above the elbow."

"Unreal," I said, shaking my head.

"What?"

"This young woman is why I became a doctor."

The elevator doors opened, and we rushed her to the operating room where Doctor Roth and Doctor Lindsay were waiting, having been called in. I very much wanted to scrub in, but we were shorthanded in the ED because the schedules had been scrambled to allow for interviews.

"Doctor Mike, what did you mean?" Karl asked.

"In fourth grade, she cut her arm badly on some jagged metal on the playground equipment, and blood pumped out. I took off my shirt and used it to apply pressure the way I'd seen on _Emergency!_. I did that until the ambulance arrived. I was written up in the local paper for saving her life. That's when I decided I wanted to be a doctor and specialize in emergency medicine. Her family later took me to a Reds game as a 'thank you'. I hadn't seen her since sixth grade when they moved, but something triggered the memory. That's why I asked about the scar."

"That's quite the coïncidence!" Mindy declared.

"Just another one of those 'Only Mike' moments, as Doctor Clarissa Saunders would say."

When we reached the ED, Deputy McCallum was waiting for us.

"Any updates?" he asked.

"She's undergoing an exploratory laparotomy. Did anyone get in touch with her family?"

"They're in Cincinnati. Her husband and parents are on their way here. I directed them to come to the ER."

"I'll take care of it," I said. "Why only one transport?"

"The driver who t-boned her wasn't belted and went through the windshield."

"That'll do it every time," I said, shaking my head. "Alcohol?"

"No idea. Witness says he ran a red light on 23 just south of here. Any idea when we'll be able to speak with her to close out the investigation?"

"Days, at best. Once they repair her internal injuries, she'll need a neurological assessment. She took a pretty good whack to the left side of her head. I'd bet at least forty-eight hours in the ICU."

"OK. Whose working on her?"

"Owen Roth and Shelly Lindsay."

"Thanks, Doc."

He left, and  I went to the triage desk and asked them to let me know when Jessica's husband and parents arrived. I spent the next ninety minutes treating four walk-in patients before Nurse Amelia called me to the triage desk. I immediately recognized Jessica's parents despite the fifteen years that had passed. I made the assumption that the man with them was Jessica's husband.

"Mr. Melbourne?" I called out, with Karl beside me, as he'd provide the escort.

"Yes," he said, coming over to me.

"I'm Doctor Mike," I said. "Your wife is in surgery."

"How is she?"

"We stabilized her and sent her up for emergency surgery to control internal bleeding. Someone upstairs will provide more details, and a surgeon will speak with you as soon as the surgery has been completed."

"What injuries?"

"I can't say the extent of her internal injuries, but a broken arm and leg as well as head injuries. Most importantly, she was breathing on her own, and her heartbeat was strong. We gave her blood and performed emergency life-saving procedures, then rushed her to surgery with the two best surgeons in the hospital. My student, Karl, will take you up to the surgical waiting room."

"Thank you, Doctor."

"Mr. and Mrs. Glazer?" I said with a smile.

"Do we know you?" Mr. Glazer asked. "Nobody said our name."

I nodded, "Indeed we do. We met about seventeen years ago."

A look of recognition spread across Mrs. Glazer's face.

"Mike? Jessica's Mike? From fourth grade?"

"Yes, Ma'am. I was a bit shorter and didn't have facial hair!"

Both she and her husband laughed.

"Gary," she said to Jessica's husband. "This is _the_ Mike. The one who saved her life when she was ten."

"And it was that incident that led directly here," I said. "That day was when I decided I wanted to be a doctor and work in the Emergency Department."

"I suppose we owe you another Reds' game!" Mr. Glazer said.

"Are you married, Mike?" Mrs. Glazer asked.

"Yes. I have a two-year-old daughter, and my wife is pregnant and due in June."

"Mom, Dad, I want to go upstairs," Mr. Melbourne said.

"Yes, of course," Mr. Glazer said.

"Karl," I said, turning to my student, "please escort them up to the surgical waiting room. Mr. Glazer, I'm on until 5:00pm today, then I'm back on Monday at 5:00am."

We shook hands, and Karl led them towards the elevators that would take them to the surgical floor. The rest of the morning was busy but unremarkable, and at noon, I met Antonne and his study group in the cafeteria.

"Sorry about the weekend scheduling," I said. "But this is really the only time that worked for me until late next month."

"We'll let you slide," Antonne declared.

"No, we won't!" Conchita protested. "Rachel isn't in daycare today!"

"Sorry," I chuckled.

"You could have one of your own!" Jordan teased.

"No chance!" Conchita declared. "I can't think of a better way to mess up my education than having a baby!"

"We'll have you all out to the house once it's nice enough to grill," I said. "Conchita can get her fill of Rachel! How are things going otherwise?"

They were all doing well and were having no trouble in school, which was to be expected. Five out of the six were set on attending McKinley Medical School, with the lone holdout being Danika, which didn't surprise me. I couldn't imagine that she'd go against her dad's wishes and attend anywhere but Stanford. Ultimately, that had been what had taken her out of the running.

When we finished lunch, they left, and I returned to the ED. I was busy during the afternoon, but it wasn't overwhelming. Just before 5:00pm, I called up to surgery to check on Jessica. They'd repaired a liver laceration and a kidney laceration, as well as removed her spleen, then sent her to the ICU, where she'd had a neuro consult. After my call to surgery, I called the ICU, and they reported she was stable and that the neuro exam suggested only a severe concussion.

My shift ended, and I hurried home for dinner, then Vespers at the Cathedral.

_January 21, 1990, McKinley, Ohio_

"How was your visit with the prisoners today?" Kris asked when I returned from Southern Ohio Correctional Facility in Lucasville.

"About the same as always. I played chess with Frank Bush, but he's still deflecting any discussion of faith. The other men are doing well, and I had good talks with them."

"I meant to ask earlier — how often does Protodeacon Ivan visit the Greek prisoner?"

"Every two to three weeks. Vladyka is considering having the Protodeacon serve a Typika once a month. I believe all five of the men besides Frank Bush would attend."

"Would you participate?"

"Maybe. I have to keep my schedule flexible, so sometimes there are more than four weeks between visits. Once June rolls around, and I have my regular weekday schedule, I'll have Saturday and Sunday off, though I have to be on call one weekend a month, so we'll see."

"How long will that last? The entire year?"

"Probably. A lot depends on how quickly things progress with the surgical training. This is all new, and they're kind of making it up as they go along."

"How does being on-call work?"

"I'm required to carry a pager at all times and cannot be more than fifteen minutes from the hospital. On those weekends, we'll need to attend services at Saint Michael the Archangel because the Cathedral is more than fifteen minutes from the hospital."

"How do you feel about attending there?"

"I'm OK with it," I replied. "I seriously doubt Father Nicholas would give me grief about anything at this point. When we had lunch, we buried the hatchet and not in each other's backs. And Ghost will be chrismated on Holy Saturday, so in the end, Father Nicholas' goal was achieved, just not the way he wanted."

"What did you decide to do about counseling?"

"I'm going to call Doctor Mercer, though, with my schedule, it'll be difficult to meet with her face-to-face."

"Papa!" Rachel called out.

"I guess she's done napping," I observed.

I got up from the couch and went up the stairs. I unlatched the gate which prevented Rachel from coming down the stairs by herself, then carefully helped her navigate them. As a 'Big Girl,' she was insistent on doing things herself, something which came naturally via Elizaveta and by nurture from Kris.

"What should we do?" I asked my daughter.

"Papa should play guitar and sing!" she declared.

I hadn't been to band practice in months, and our next gigs were our usual two Proms — Goshen and Hayes County High. Kim had arranged a pair of gigs for the Summer, and my new schedule made that easier. We'd play on the Fourth, and we had a gig at Shaken Not Stirred. Once I'd been given my new schedule, Kim had begun looking for other gigs.

"I'm going to have to find some time for band practice," I said.

"You'll have Saturdays off starting in June," Kris said.

"Yes, and that covers four practices before the Fourth. I think I need more. It's going to have to be Sunday afternoons after Pascha. That would give us eight or nine practices before our first Summer gig."

"I think Rachel would love to hear you practice."

"I suspect so. Of course, we also have the random event sometime in mid-June, though you could be as late as the first week in July, which could throw a wrench into the works."

"Unless I'm in active labor, you should play. Lyudmila promised to watch Rachel."

"I bet she did!" I chuckled. "Abby and Rachel are forming their own little subversive cell, and your sister is egging them on!"

"You know it's all about you, right? She still has a crush on you; heaven knows why!"

I chuckled, "Which doesn't say much for YOUR judgment then, does it, «ma chérie»?! Let me get my guitar. We can continue this later!"

"In bed?" Kris asked with an inviting smile.

"It appears pregnancy hasn't reduced your libido at all!"

"Is that a complaint?!" Kris asked with an arched eyebrow.

"Never! I know on which side my bread is buttered!"

"You just like «la pipe»!" Kris teased.

"I'm not going to deny that!" I declared. "And I dare you to deny you like my tongue in your «minou»!"

"Is that an offer?"

"It is! Now, let me get my guitar before the Tsarina sends for the headsman!"

_January 24, 1990, McKinley, Ohio_

Monday and Tuesday had primarily been occupied with interviews, and I'd checked on Jessica Melbourne each day. Finally, on Wednesday morning, she had been moved from the ICU to the critical care ward, which was a step down from the ICU but had more intensive nursing than a regular ward. After I ate lunch, I went up to see her and found her husband with her.

"Good morning," I said from the foot of the bed in the six-bed ward.

"Hi," Jessica replied. "I couldn't believe it when my mom told me who the ER doctor was!"

"The universe is a strange and mysterious place. Mind if I check how you're feeling?"

"You mean an exam?"

"No, I want to look at your chart, but you aren't my patient, so I ask permission before I look."

"Of course."

I took the chart from the foot of the bed and paged through it, then returned it to the hook.

"What's it say?"

"That you were in a horrible accident, needed repairs on your liver and kidney, had your spleen removed, and likely have a headache from the severe concussion. How's your vision?"

"Better. I was mostly seeing double until last night. The ringing in my ears has mostly gone away. Mom says you're married and have a toddler and one on the way."

"That's right. You?"

"Two little boys who I think are in training to be terrorists!"

I chuckled, "That sounds like my nephew. He's four and he's one hundred percent boy. My daughter and my niece both think he's too rambunctious."

"My boys are non-stop! They're five and three. How long have you been a doctor?"

"Since the end of May last year," I replied.

"And you work in the ER?"

"Yes. I'm a Resident in trauma surgery, but the initial training is in the Emergency Department. What do you do?"

"I'm a marketing specialist for P&G."

"Do you know Sheila Nixon?" I asked.

"I do! How do you know her?"

"I helped care for her during my OB/GYN rotation in medical school. I'm actually godfather to her son."

"Wow! Another 'small world' connection! Wait! Her son is named 'Michael'! After you?"

"Yes. I'm sorry I can't stay long. I just wanted to come to say 'hi', and I'll come to see you again. You'll be our guest for at least another ten days, I suspect."

"That is what Doctor Lindsay said this morning. Dad said we owe you another Reds game!"

I chuckled, "And I'll be happy to accept. Have him get in touch with me, though sometime after June 1st is probably best, based on my schedule."

"Thanks, Mike; I mean Doctor."

"It's OK to call me 'Mike'; all my friends do. I go by 'Doctor Mike' professionally."

I shook hands with her husband, said 'goodbye' to them, and returned to the conference room where we were conducting surgical interviews. Our first interview of the afternoon was with Felicity Howard, which surprised me, given she had stated her intent to Match for oncology. She was greeted and given a chance to say her piece. When she finished, Doctor Burke nodded to me.

"I'm curious, why surgery?" I asked.

"After my oncology Sub-I, it was clear that wasn't for me. On the other hand, I very much enjoyed my surgical Sub-I."

The questions were routine until Shelly asked a question I'd known was coming.

"You received sub-par scores during your first three Clerkships," Shelly said. "What happened?"

"I didn't have a proper focus and didn't understand how different clinical work was from coursework. I had excellent grades and test scores and thought that was enough. When I had my first sub-par evaluation, I developed a bad attitude, which led to two more sub-par evaluations."

"What happened to turn it around?" Doctor Burke asked.

"I met Doctor Mike," she said. "He was a Fourth Year and refused to give up on me, eventually forcing me to admit that I was the problem, not the system."

"Doctor Mike thinks the system is a problem!" Shelly Lindsay said mirthfully.

I chuckled, "Yes, but as I said many times as a medical student, I wanted to join the guild, and that required the current members to approve my application! Miss Howard has received outstanding evaluations in all her rotations since that Clerkship in cardiology."

"I have," she said. "The most important lesson I learned was that I had to take responsibility for my education as a physician. Once I understood that, everything fell into place. Unfortunately, it took several weeks of Mike whacking my nose with a rolled-up newspaper to get the point across."

"He's been the recipient of more than a few of those whacks," Shelly said. "So was I. Being able to accept correction is vital for a young physician. Why do you want to be a doctor?"

"At first, it was because I thought I was smarter than everyone around me, and I wanted the most difficult challenge to prove how easy it would be for me. That worked right up until my first clinical rotation. By the time I met Doctor Mike, I'd had those poor evaluations. He challenged everything I believed and forced me to reëvaluate. Now, I believe I can put my talents to use to serve others, not for personal gain or recognition."

The rest of her interview went along the usual lines, and when her time expired, she thanked us and left.

"She was your first reclamation project, right?" Shelly asked.

"Yes, and obviously a successful one; some others weren't successful."

"You're hardly to blame for a young woman who thought she could sleep her way to a medical license," Nelson said.

"It was a bit more complicated than that," I said. "I did encourage her to get her Master's and PhD and go into research because she'll be VERY good at that. She was simply incapable of doing clinical work. To be honest, we failed because that should have been clear after her first two rotations during Third Year. That was the point to try reclamation, not halfway through Fourth Year."

"Score?" he asked.

"43," I replied. "I think she'd make a good Resident, but we've seen at least four better so far."

"45 for me," Shelly said. "Her improvement speaks volumes."

"And 40 for me," Doctor Burke said. "There are much better candidates who didn't have trouble in three straight Clerkships."

"No points for recovering from that?" I asked.

"That includes points for recovering," Nelson said. "I'm a harsh judge."

"No kidding," Shelly said. "He gave ME a 41, Mike!"

I chuckled, "Do I even want to know?"

"You received perfect scores for all your interviews. Nelson wasn't on the team last year, as you know! And I'm not sure scores mattered; it was a _fait accompli_ at that point. There was no way we were going to lose you to another hospital. Heads would have rolled."

We took a comfort break and then saw three more applicants, the first two of whom scored in the low thirties. The last one was one of the applicants for the trauma surgery Residency.

"Doctors, this is Ryan Harrison," Max Tyler, a Third Year, announced.

Ryan was a student at Cornell University Medical College and was near the top of his class. He was from Columbus and expressed a desire to return to the area. He was an excellent candidate, but Mary had the home-field advantage. He would be my second choice, and I wasn't worried he'd displace Mary because he wasn't married.

I was cautious not to treat him differently from how I'd treated Mary, asking him the same tough questions I'd asked her. He answered them competently, which didn't surprise me, though he wasn't quite as confident in his answers as Mary had been.

"I'm curious about your ranking, Mike," Nelson said once Ryan had left the conference room.

"He's almost as good as Mary," I replied. "Based on my notes and the evaluation criteria, I'd score him at 47, the difference being he wasn't quite as confident in his answer to the diagnostic questions as Mary. He'd absolutely be my second choice of the two we've seen so far. For an emergency medicine Residency, he's second to Leticia Jefferson. For surgery, he'd be my first choice. His application indicated interest in surgery, emergency medicine, and trauma surgery."

"I concur," Shelly said. "47 for me as well, for the same reason. Mary is a better candidate for the trauma surgery slot. I'd rank Ryan equal to Leticia, and it's a tossup which to list first or second. It really comes down to which way gives us the best chance to land them both. My solution is listing him first for surgery, second for trauma surgery, and second for emergency medicine."

"I agree," Nelson said, "though I'd score Ryan and Mary equally. That said, Mary is a known quantity with letters of recommendation from six physicians here, so she gets a slight nod. He would be my first choice so far for surgery. With regard to an emergency medicine Residency, it's a bit more complicated. I think, and no disrespect to either of you, that you are giving Leticia Jefferson the advantage because she's a black female."

I shook my head, "While I see the value of diversity, I would never allow that to control my decision. In a case where two candidates were otherwise equally qualified, perhaps it might be the deciding factor. In this case, though, she is better. The solution to our lack of diversity is expanding the applicant pool, which is the same answer I gave when asked at Taft and at the medical school.

"Is Leticia Jefferson truly the only qualified black medical student in the US? The answer to that obvious rhetorical question is a resounding 'no'. And yet, she's the only black female candidate we're interviewing. I didn't see the statistics for the complete applicant pool before it was winnowed, but I bet there was no more than one other minority female who wasn't from India."

"I think you'd win that bet," Shelly said. "We don't have enough female applicants in general. And I agree completely that the solution is expanding the pool of applicants. The last thing I want is for someone to think that Loretta, Leila, Clarissa, or I have our positions simply because we're girls."

"I believe Paul Lincoln agrees with you as well," I replied. "He is a doctor who happens to be African-American, not an African-American doctor, if that makes sense."

"Perfectly," she agreed. "And we don't have the final say, nor do we know how their psych evaluations went, nor their other interviews."

"That's true," Nelson Burke said. "But our evaluations carry the most weight. In any event, see you both tomorrow afternoon for the next round."

The three of us left the room, and, as it was Wednesday, I headed to the surgical locker room, showered, changed into my street clothes, and headed home for dinner and then Vespers.

"You know," Kris said while we were driving home from the Cathedral, "you would gain nearly an extra hour on days we attend services if we attended Saint Michael the Archangel."

"That's true, but your family and friends are at the Cathedral, and I enjoy being able to see Vladyka most Sundays, even if we only chat privately about once a month."

"Perhaps just Wednesdays, then?" she suggested. "That's the day Rachel usually spends with the Kozlovs, and they could bring her to church rather than me picking her up on the way home from OSU."

"That would actually work well," I replied. "And this conversation reminds me of something I thought of the other day — I need to see my godson, not to mention Angie. This weekend is obviously out because of Lara's wedding, but I think on February 4th, we should attend at Saint George in Loveland. I'll confirm that Angie and Sheila will be there."

"And we need to have Jocelyn and Gene to the house as well," Kris said. "Perhaps on the Sunday of the Publican and the Pharisee? We could invite Chris and Tasha, Elias and Serafima, and Subdeacon Mark and Alyssa."

"That sounds good. If you're OK with it, for Meatfare, we should invite Robby and Sophia, Ghost and Oksana, and Loretta and Bobby. We also need to somehow find time to see my parents and grandparents."

"Is _that_ was has been bothering you?" Kris asked.

"I think it might be. Without band practice, our usual Friday nights out, and not seeing people who were very close, I'm out of sorts. It's not what I thought it was.'

"Which makes sense because you couldn't identify a single problem other than lack of time. But what's truly suffered is all your other relationships. Would I like to have more time with you? Of course, but with the exception of your visits to the prison, Rachel and I have you for basically every moment outside the hospital. Your struggle is between your feelings of obligation to us versus taking care of yourself."

"Which is, in the end, the root of the problem for physicians — they forget to care for themselves and end up self-medicating with drugs, alcohol, or sex. Perhaps I don't need to see Doctor Mercer after all."

"I think you should at least call her if you haven't already done that."

"I haven't."

"I don't think it could hurt to talk to her, as I said. Even if what you just said about the root cause is true, it might not be the complete truth."

"I promise I'll find time to make the call."

"Good."

_January 25, 1990, McKinley, Ohio_

"Thanks for calling back at a specific time," I said when Doctor Mercer returned my call at 12:45pm on Thursday.

"You're welcome. How are you?"

"Busy," I replied. "Very busy. Probably too busy, but that is the life of a PGY1."

"Yes, it is. How are Kris and Rachel?"

"They're fine. Kris is due mid-June."

"Congratulations! Do you know what she'll have?"

"My extensive medical education indicates a baby homo sapiens."

Doctor Mercer laughed, "You're still a smart aleck!"

"We chose not to ask," I replied. "Rachel is adamant it needs to be a sister because she'd had enough of her cousin Viktor over a year ago. He's, as they say, one hundred percent boy."

"I want to ask more questions, but I think it's better to simply ask why you called."

"All things considered, you helped me understand myself, and I have this feeling of unease that won't go away. Kris and I spoke about it, and I spoke with my «старец» (_staretz_), but I'm not sure the conclusions are correct."

"That's your Father Confessor, right?"

"Close enough for a Russian Jew," I chuckled. "That's what Roman Catholics would call it."

"Spiritual guide?"

"That's part of his role, yes. The translation is Elder, but that has connotations of Protestantism, which is why I use the Russian term. In any event, the partial diagnosis of my unease or disquiet is that other than work, the only thing I do is go to church, spend time with Kris and Rachel, and see my «старец» (_staretz_). The one exception is my monthly visit to Southern Ohio Correctional Facility."

"I'm sure there's a story there, but we'll save it for later. What about your band?"

"I haven't been to practice in ages because of my schedule. I haven't been exercising regularly for the same reason."

"Have you gained weight?"

"About five pounds. It would be worse if I wasn't basically on my feet all day, though the past two weeks have involved a lot more sitting because we're conducting interviews for the Match."

"How can I help?"

"Kris thinks it would be good to talk, but the problem is that I work six days a week. I work until 9:00pm on Monday, Tuesday, and Thursday, until 5:00pm on Wednesday, Friday, and Saturday. I start at 5:00am every day except Wednesday when I start at 8:00am."

"That schedule effectively precludes even telephone consultation!" Doctor Mercer declared. "It would seem only Wednesday mornings would work, But it would have to start before 7:00am to allow you time to get to the hospital."

"Clinic, actually. On Wednesdays, I work at the Free Clinic as part of an exchange program."

"If we started at 6:30am, would that give you enough time?"

"With a fifty-minute session? Easily."

And it would work for the next two weeks, as I didn't have to be at the hospital until a few minutes before the first interview, which would be at 8:00am.

"I do need to ask you a few questions. First, are you having any suicidal thoughts?"

"No."

"Thoughts of harming yourself or others?"

"No."

"Abusing alcohol or drugs?"

"No."

"Have you just misled me or lied to me?"

"No."

"OK. Then let's do this by telephone. I'll put you down for Wednesdays at 6:30am, starting next week. Just call my direct number, as the main office number will still go to the service at that time."

"Will do," I agreed. "I'll speak to you next Wednesday."

We said 'goodbye', I hung up, then headed upstairs for the ninth round of interviews for the new surgical Residents. The candidates were qualified, but only one of them scored above 40 on my sheet. I had dinner with Shelly, Leila, and Clarissa, then headed to the ED for three hours of being an actual doctor.

"How did your interview with Internal Medicine go today?" I asked John Abercrombie when I arrived back in the ED.

"I think it went well," he replied. "Having a recommendation letter from you certainly helped.

"At dinner the other day, Clarissa Saunders suggested to me that was the 'kiss of death'!"

John laughed, "I know Doctor Saunders is as much of a smart ass as you are, no disrespect intended.'

"I'd consider it disrespect if you _didn't_ think I was a smart ass! What do we have?"

"I was just about to get the next chart. Nothing on the board when Doctor Blake left ten minutes ago with Doctor Gabriel's approval."

"OK. Get your chart, take Kelly with you, and call me when you're ready."

"Right away, Doctor!"

He grabbed the first chart from the rack, and I went to the Attending's office to check in with Doctor Gabriel.

"How were the candidates today?" he asked.

"No standouts in either group," I replied. "We've seen four candidates for emergency medicine that are 'must have', though you know how that works."

"Convincing them to list us first is no easy task! That's Loretta's job, as we don't have an ED Chief at the moment."

"Heard anything about that?"

"Just the same rumors I'm sure you've heard — a pair of candidates from Ohio, plus one each from California and New York. And Loretta, of course."

"I lobbied Doctor Cutter for Lor," I said. "She deserves it."

"You won't get an argument from me, but with the change to a Level I trauma center next year, it wouldn't surprise me if they brought someone in from the outside who has experience running one."

I frowned, "I can understand, but I think the last thing we need is another Chief of Emergency Medicine who sits in his office and pushes paper. Yes, I know Doctor Northrup had significant responsibilities with regard to that building that's taking shape across the driveway, but not taking any shifts? Not even a single half-shift a week? That's wrong, and it's the last thing we need."

"Which means someone else has to do some of the paperwork."

"I was told that was what Residents were for!" I chuckled.

"You can laugh because you're on the surgical service, so YOU won't get stuck with it!"

"True, but all kidding aside, even a single half-shift would give a better perspective on how the department is running and the challenges we'll face. And I know the counter-argument that we're effectively doubling capacity and staff, so a full-time manager makes sense. I don't disagree, but I'd do it differently."

"That is your style," Doctor Gabriel said with a smile. "You enjoy rocking the boat!"

"You know it's not about that; it's about providing the best possible care for our patients and making the best use of our resources while ensuring we take care of the staff as well."

"When the day comes, you can do it your way!"

"Assuming anyone is foolish enough to put ME in charge or give me that kind of authority!"

"Good point!" Doctor Gabriel chuckled.

"Doctor Mike?" John said from the door to the Attending's office. "We're ready to present."

"Be right there," I said. "Which room?"

"Exam 4."

"OK," I said, and he left.

"Anything else, Mike?" Doctor Gabriel asked.

"No."

"Then go see your patient."

I left and walked to Exam 4, where John presented a patient with an arm lac. I quickly evaluated it and decided it was something John could easily do. Once we conferred, I left the Exam room and went to the lounge to wait for him to report back. I had barely sat down when Teri, the clerk, came to let me know EMS was three minutes out with an MI. As my med students were busy, I asked Andrea, the charge nurse, for a pair of nurses and was happy when she assigned me Kellie and Becky.

"Where are the toddlers?" Becky asked.

"Suturing an arm lac in 4," I replied. "I'm happy with this threesome!"

Both nurses laughed.

"In your DREAMS!" Becky declared.

"Believe it or not, that's not my fantasy," I replied. "I had the opportunity and discovered it just wasn't my cup of tea."

"Why am I not surprised AT ALL?!" Kellie asked mirthfully. "That said, if there were a more devoted family man who believed in the ideal of one man, one woman for life, I'm not sure who it would be."

"Unfortunately, it didn't work out that way," I said ruefully.

"Sorry," Kellie said.

"No need to apologize."

"You do have me curious now," she said. "What _is_ your fantasy/"

"Wouldn't YOU like to know?!" I chuckled as EMS Squad 2 rolled to a stop in front of us.