Chapter 61 — Pressured

_November 13, 1989, McKinley, Ohio_

{psc} "How did you respond to Doctor Gibbs?"

"I said something along the lines of having heard that before."

"The reprimand didn't bother you?"

"That afternoon, while giving the alumnus speech at the medical school, I stated I wore it as a badge of honor."

"Why is that?"

"Because Socrates was a pain in the ass, so was Doctor Martin Luther King, Junior, and, frankly, so was Jesus."

"We should take a break," Melody suggested.

It was agreed, and she, I and Mr. Crowe went to his office.

"I think you're giving him what he wants," Mr. Crowe said.

"I don't disagree," I replied. "But I don't think it helps him, because if he puts me on the stand in front of a jury, I'm going to testify that she made the false accusation. The fact that she withdrew it _after_ she was caught and dismissed doesn't save her."

"His goal is to show she was treated unfairly, and that it was all because of the bad behavior of the doctor during her Third Year Medicine rotation. The point is to maximize the damages against him, and show a pattern of bad behavior by the hospital and medical school."

"So, this isn't an attempt to be reinstated?"

"I don't see how," Mr. Crowe said. "She was dismissed specifically for lying in a sworn statement, and she admitted today that she did lie. Even with an apology, there is zero chance she could be reinstated, and no court is going to countenance such a remedy. The only remedies requested in her suit are monetary damages and an admission of guilt by Doctor Mark King."

"Which would cost him his medical license," I replied.

"I think that's gone anyway," Mr. Crowe said. "In my discussions with Arthur Braun, I discerned they have some kind of proof of a sexual relationship. A competent lawyer can draw a straight line from your testimony to a demand for sex in exchange for an improved grade."

"Which is not what I thought I was giving them."

"Don't worry. You haven't said anything I didn't hear from Doctors Gibbs, Casper, Gabriel, Javadi, and Lindsay. All of it leaves Doctor Mark King swinging in the breeze if they have _any_ proof of a sexual relationship, which I believe they do."

"Will the hospital have to pay?"

"That's the usual outcome in a sexual harassment case where there's enough evidence to convince a jury it happened."

A few minutes later, we reconvened in the conference room, and the deposition continued.

"What happened next?" Arthur Braun asked.

"The schedule for medical students was published and Miss Sandberg was assigned to shifts that did not overlap mine."

"In order to prevent you from teaching her?"

"You'll need to ask Doctor Gabriel for his reasoning," I replied. "I don't know."

"But that was the effect, was it not?"

"It is true that if a medical student is not on the same shift, I would not be able to teach them. That goes for any medical student."

"Did Miss Sandberg approach you about the schedule?"

"She did."

"What was your response?"

"That scheduling was up to the Chief Resident, and I had no input, other than being asked which shifts I preferred, and if I would be willing to work a schedule to include a day at the Free Clinic, and also allowed the Surgical service to not assign a Resident to the ED for consults during the day, freeing them for elective surgeries."

"What's the advantage of that?"

"Elective surgeries are one way for the hospital to increase revenue, which is necessary to make up for what amounts to underfunding by Medicare and Medicaid, and to help cover costs for indigent patients."

"Did Miss Sandberg make a request?"

"She did, and I declined to intervene, as I would decline for any student, though I stated that I would accept her as my Fourth Year if Doctor Northrup approved."

"Was the schedule she was referring to the original schedule?"

"I have no first-hand knowledge, as I hadn't looked at the medical student schedule when it was first published. Miss Sandberg said that it had been changed to switch her shifts away from working with me."

"What happened next?" Mr. Braun asked.

"Miss Sandberg acted on my advice and went to see Doctor Northrup, the Chief of Emergency Medicine."

"Did he discuss it with you?"

"Completely off the record," I replied.

"Once again," Melody said, "you'll need to answer."

"What was said?" Mr. Braun inquired.

"He asked about Miss Sandberg's request and I stated that I felt we had failed as teachers. I also stated that she, like every other student, deserved a chance to succeed and that our job as teachers was to provide her with every opportunity to do so, right up to the final day of her rotation."

"How did Doctor Northrup respond?"

"He asked if I thought Doctor Gibbs was wrong in her assessment of Miss Sandberg. I replied that I suspected that Doctor Gibbs was correct, but that didn't change our obligation to teach Miss Sandberg, and we should continue doing so until she showed she was unwilling to learn or incapable of learning."

"Was anything else said?"

"I was asked, directly, and again, off the record, if I was involved with Miss Sandberg in any way. I stated that other than teaching, I was not. I asked about the question, and Doctor Northrup admitted he'd been told that Miss Sandberg had been involved with another doctor and that was how she had passed a rotation."

"Doctor Mark King?"

"No names were mentioned, nor was the service identified."

"Did Doctor Northrup indicate he believed the report?"

"He said he had no proof, and I replied that I had never once seen her behave in an unprofessional or unethical manner. He asked if anyone had behaved that way towards me, and I replied that other than flirting by nurses and female law enforcement officers, the answer was 'no', and I considered that flirting harmless."

"Have you ever had such a relationship?" Mr. Braun asked.

"Objection," Melody said. "That's not a question directly related to Miss Sandberg."

"I think it's important to know if Doctor Loucks has had any inappropriate relationships."

"May I have two minutes to speak to my client?" Melody asked.

"Yes, of course. We're off the record."

Melody and I left and went to Mr. Crowe's office for a private conversation.

"Here's the dilemma," she said. "If you refuse to answer, they'll assume you have, and ask every single other deponent about it, and if they develop _anything_, they'll depose you again and this time the limits won't apply. If you do answer, you're staying outside the boundaries of the questioning. Normally, I'd advise you to say nothing, but given there is no _legal_ problem with anything you've done, I have to leave it to you."

"Could I agree to answer that single question, with a firm denial, of course, and then refuse to answer further questions?"

"You could, but once you've opened the door, you risk him trying to figure out what it is you don't want to say."

"Yeah, I think we passed that point as soon as you objected at the start of the deposition, not that there was any real option."

"I agree. This is one of those rare cases where you have to decide what's best, as there isn't really a legal question."

"How should we play it?"

"Just answer his question with a firm denial, as you suggested, but don't be overly firm. Hopefully, he'll accept that and move on."

"OK."

We returned to the conference room, and Mr. Braun put us back on the record.

"I'll answer that single out-of-bounds question, Mr. Braun," I said. "I've never once engaged in any inappropriate behavior of any kind at the hospital or with any hospital staff."

"To confirm, you observed no inappropriate behavior by Miss Sandberg?"

"None," I confirmed.

"How did your meeting with Doctor Northrup conclude?"

"He asked what I would do in fifteen years when I was sitting in his chair. I responded that relying solely on what we knew to be true, not what we might suspect, that Miss Sandberg's complaint about unfair treatment shouldn't be dismissed out of hand, and that her request to change shifts to work with me ought to be given proper consideration.

"I weighed the factors, including the policy of not allowing students to directly select their teachers, balanced against the fact that I felt I was the only one who would give Miss Sandberg a fair shake. Given I was positive she'd be assigned pure scut for five weeks if she were assigned to anyone else, on balance, it made sense to honor her request."

"How did Doctor Northrup respond?"

"He asked why he should take the advice of a relatively inexperienced doctor, who had just completed the second month of his Internship over that of more experienced doctors. He asked, specifically, what I knew that they didn't. I countered that it wasn't what I knew, but my philosophy that everyone deserves the same respect, which meant doing our best to teach them until such time as they proved they were unwilling or incapable."

"Was Miss Sandberg unwilling or incapable?"

"Not in my opinion."

"What happened then?"

"He said he'd take her request under advisement."

"Did you, at any point, discuss what had happened with any doctors other than your supervisors or the colleague you mentioned earlier, Doctor Javadi?"

"I had a lengthy discussion with Doctor Clarissa Saunders, who has been a close confidante since Freshman year at Taft."

"And your relationship with her?"

"Is what I just said. To answer your implication, you should probably ask Doctor Saunders' girlfriend."

"She's a lesbian?" Mr. Braun asked.

"Yes. She's not 'in the closet', but they also don't advertise."

"What was said between you and Doctor Saunders?"

"Mostly a reiteration of what I've told you, with the observation that I expected Doctor Northrup to turn down Miss Sandberg's request."

"Why did you feel that way?"

"Because, in the end, he couldn't set a precedent of allowing a student to select their Resident. That would make scheduling difficult, if not impossible. Later that same day, Doctor Northrup called me into his office and confirmed my suspicion as to what he'd decide to do."

"What exactly was said?"

"That he'd conferred with other doctors and concluded that they couldn't allow Miss Sandberg to choose her Resident. He did say that he would instruct Doctor Paul Lincoln to treat her fairly and not assign her only scut."

"What was your response?"

"That I would have made a different decision, but it was his call, and as such, I'd abide by it and not make any public statements to the contrary. Unfortunately, you've forced me to violate my word with regard to not discussing my opinion of his decision publicly."

"I'm sure you will understand, Doctor," Mr. Braun said, "that allowing you to refuse to answer because a conversation was 'off the record' or 'unofficial' would provide a simple way to cover up any improper behavior or activity, including conspiracies."

"Not liking something doesn't mean I won't do it, if required," I replied, "so long as it's not unethical or illegal."

"You clash with senior doctors quite often, don't you?"

"I express my opinions forcefully," I replied. "That has, as I noted before, led to being called a 'pain in the ass', and created some conflicts, but I know you know that because of our previous encounters."

"You understand, of course, it's not personal animosity, but a zealous defense of my clients, similar to what your attorney has done for you."

"One more thing I understand but don't like," I replied.

"Mr. Braun, do you have further questions about Miss Sandberg?" Melody prompted.

"I do, Counselor," he replied. "What happened next, Doctor?"

"Another medical student approached me and indicated that Miss Sandberg wanted to swap shifts, and he asked if that was what I wanted. I replied that I was neutral and had to stay neutral, and that he had to decide what was in his best interests. He elected not to swap shifts."

"Did you feel he should have?"

"No. He had been assigned to me, and that was, in his estimation, the best for him. It's not my place to decide. Just as students have to accept their teachers, so, too, teachers have to accept their students."

"Did you have an opportunity to speak to Doctor Paul Lincoln?"

"I did and asked him to give Miss Sandberg a fair shake."

"Did he?"

"You'll have to ask him or Miss Sandberg, as I didn't observe their interactions and, as such, can't comment on them. I know Miss Sandberg complained to Doctor Nora Mertens at the medical school about not receiving enough procedures, but I have no first-hand knowledge of whether that is true or not."

"I'd like to hear your opinion," Mr. Braun said.

"I don't have one," I replied. "I can't form an opinion based on rumor or innuendo, and that's the reason you're talking to me today — I rejected rumor and innuendo and operated solely on facts and events which I could observe and evaluate."

"Did Miss Sandberg approach you after that?"

"She did. She stated that she believed everyone except me wanted her to fail. I asked her if she wanted to be a physician more than anything, and she affirmed that she did. I then asked her about what I considered inappropriate relationships with Attendings, and she stated that there were no rules against it, and that there had been two separate relationships, but never with a supervisor or even a doctor on the same service. I later discovered that was, very likely, a lie."

"We'll get to that in a moment," Mr. Braun said. "At the time, did you believe her?"

"I did. I also stated that it was my opinion that such relationships ought to be considered ethical violations on both the part of the doctor and the student."

"Did you say that to others?"

"It's more a question of to whom I _didn't_ say it. I think the situation we now find ourselves in speaks volumes about the correctness of my position on the matter."

"What else was said by Miss Sandberg?" Mr. Braun asked.

"That she knew female medical students who had slept with their supervising Resident or Attending, something she claimed not to have done."

"Are you aware of any relationships such as that?"

"Off limits, Counselor," Melody interjected.

Mr. Braun frowned, but moved on.

"What did you do next?"

"I spoke with Doctor Nora Mertens and pushed hard for a rule from the medical school to make relationships between students and doctors an ethical violation."

"How was that received?"

"Doctor Mertens was non-committal, and we discussed Miss Sandberg's situation. When asked by Doctor Mertens, I stated that I believed Miss Sandberg was telling the truth about her relationships, but I had nothing to go on except her word against the rumor mill. I expressed the opinion that if Miss Sandberg was being honest, it was possible someone was blackballing her."

"Do you think that was the case?"

"I strongly suspected it was then; I no longer believe that theory is correct."

"Did you propose a course of action after your discussion with Doctor Mertens?"

"I did," I confirmed. "I suggested that Miss Sandberg be assigned to me for the remainder of her rotation, without changing my other student's hours. That proposal was shot down by Doctor Northrup. Instead, he proposed Miss Sandberg repeat her trauma Sub-I, and that her grade for both rotations would depend on the grade she received for the repeated rotation. He'd also ask, but not require, that her schedule largely match mine."

"Was there any discussion of your proposed rule change?"

"Yes. Doctor Northrup rejected it out of hand, saying that everyone involved was an adult."

"Did you discuss your position with anyone else?"

"Doctor Gibbs and I had a fairly heated discussion where I defended Miss Sandberg."

"Before or after Doctor Northrup made his decision?"

"Before."

"Did you discuss it with anyone else?"

"Clarissa Saunders."

"What happened when Miss Sandberg was informed of the decision?"

"She said she accepted it, but wasn't thrilled."

"Did you extract any commitments from her?"

"I asked her to promise not to be involved with any doctors until after graduation. She agreed."

"And you feel it was appropriate to make such a request?" Mr. Braun asked.

"Given where we're sitting right now, I'd say so."

"What happened next?"

"Nurse Kellie Martin warned me that Krista was lying to me, and that she was having an affair with an ED doctor."

"Who?"

"I'd prefer not to answer," I replied. "As I have no first-hand knowledge. You should ask Nurse Martin."

"I understand your reluctance, but who did Nurse Martin identify?"

"You do need to answer, Mike," Melody counseled.

"Bill Schmidt," I replied.

"What did you do in response?"

"I discussed what Kellie had said with Doctor Saunders and Doctor Lindsay."

"Shelly Lindsay?"

"Yes. She's my surgical mentor and a friend."

"What advice were you given?"

"Doctor Saunders said to be careful; Doctor Lindsay suggested I record any private interactions with Miss Sandberg."

"Why?"

"Because, according to Doctor Lindsay, Miss Sandberg had used sex to manipulate her supervisors, and she was concerned that Miss Sandberg would try that with me."

"And you recorded an exchange between you and Miss Sandberg?"

"Yes, I did."

"Do you have the tape recording?" Mr. Braun asked.

"I have the original, and Mr. Crowe has a copy."

"I'll provide it to you, Arthur," Mr. Crowe interjected.

"Doctor," Mr. Braun said, "you're required to preserve the original tape."

"Mike," Melody said, "turn the original over to me after this deposition and I'll hold it for you."

"OK," I agreed.

"What happened next?" Mr. Braun inquired.

"An accusation was made, and I used the tape recording to prove it was false. At that point, I was cleared. Miss Sandberg was suspended, and an investigation was begun. From then, until you called me, I had no interaction with Miss Sandberg, nor with anyone other than Mr. Crowe, at which point I spoke to Ms. Coates. Other than her, I've spoken to no one about this except Clarissa Saunders."

"Doctor, I'm going to subpoena your notebooks," Mr. Braun said.

"Those are privileged," Mr. Crowe said firmly. "They contain patient details, diagnoses, and other information to which you are not entitled under state law without an adversarial court order, and even if you win, you're entitled only to redacted portions directly related to the case, which you must spell out in detail."

"I'll get a preservation order while we work out the details."

"Mike, can you put those in my custody as well?" Melody asked.

"I keep a clinical notebook, a procedure book, and a regular notebook. I use all of them on a day-to-day basis and cannot part with them without impacting my practice of medicine. Just so we're clear, the first two have only privileged information. The third one has, as far as I'm aware, nothing privileged, as no patients are identified. That said, it contains things like detailed drawings of procedures that I need in order to practice medicine."

"I'll seek the appropriate order," Mr. Braun said.

"And I'll oppose it," Mr. Crowe replied firmly. "Precedent is clear on this, so I have both statutory and case law on my side. Doctor Loucks, do you have an intention of destroying or defacing your notebooks?"

I wanted to ask if that was a serious question, but decided that was a bad idea.

"No, of course not," I said firmly.

"Then, Mr. Braun," Mr. Crowe said, "we'll see what a judge has to say."

"Do you have anything further for my client?" Melody asked.

"Just one more question, with potential follow-up questions. Doctor, do you hold any grudge or have any malice against my client?"

"No."

"I'm supposed to believe that?" Mr. Braun asked.

"Yes," I replied. "And as evidence, I'll mention that I make monthly visits to Southern Ohio Correctional Facility in Lucasville to visit with and minister to the man who murdered a close friend."

"Why would you do that?" Mr. Braun asked.

"Because I take Jesus at his word, Mr. Braun."

"Nothing further," he said. "This concludes the deposition of Doctor Michael Peter Loucks."

The stenographer lifted her hands from her machine, and we were off the record. Melody and I got up and Mr. Crowe asked to see us in his office.

"Mike, do you have a sec?" Krista asked.

"I'd advise against speaking to her at this time," Melody counseled.

"Miss Sandberg, that's inadvisable," Mr. Braun agreed.

"I have to follow my attorney's advice," I said. "Sorry."

She nodded and Mr. Crowe, Melody, and I went to his office and shut the door.

"Is there anything in your third notebook that is material and of which I'm unaware?" he asked.

"I don't believe so," I replied. "It has things like diagrams for five-lead and twelve-lead EKG placement, anatomical drawings for chest tubes and central lines, and is basically a study guide. I do write in the names of my medical students and their schedules, but no other information."

"Do you carry all three?" he asked.

"Yes," I said, taking the clinical notebook from the shirt pocket of my scrubs. "As you can see, this is a small spiral notebook you can buy at any store. When I fill it up, I toss it in a drawer. I use it for patient vitals, medication orders, and that kind of thing, as a kind of portable memory because at times things are so hectic that I need to double-check before I discuss a patient."

"And the procedure book?"

"Five-by-seven and bound, with a hard cover. I actually don't have that one in my pocket right now because I left it with my third notebook and stethoscope in a locker in the ED."

"I'll want to take a look at those, if it's OK."

"Yes, of course."

"Do you actually write patient names?"

"In the notebook I handed you, but not the other two. They contain significant details, though, which could fairly easily be traced to an actual patient. For example, all you would need is police and fire reports, and you could then identify anyone transported by EMS and have every bit of medical information you wanted about them."

"Is that the standard practice?" Melody asked.

"For clinical and procedure notebooks, yes; for the one I just handed Leland, names are included, so I have that refresher if I need to speak to the family or law enforcement."

"Where do you keep them when they're full?"

"A locked drawer at home," I replied.

"Forever?"

"I hadn't decided, but I do need to keep them at least until there's no chance of an M & M conference on something they contain."

"Who has access to that drawer?"

"Just me. I carry the key with me, and the spare is kept by Doctor Saunders."

"Not your wife?"

"No. She knows the rules, and if we talk about the ED, no names are ever used. Do you think there's any chance he'll get access to the notebooks?"

"Maybe this one," he said, handing it back. "But not the other two. They're considered medical records by the State of Ohio, similar to chart notes, and as such, are privileged. I don't see a court ordering disclosure in a case such as this one. About the only way would be a malpractice case, but even then, it would be redacted such that only directly relevant information was revealed, and it would be placed under seal."

"What does that mean?" I asked.

"It could be used in the case, and the judge, jury, and both sets of lawyers could see it, but the general public could not."

"But aren't trials open to the public?"

"Yes," Mr. Crowe confirmed, "and a reporter or citizen could gather information from the trial and publicize it, but that's rare. The alternative would be secret court proceedings and I suspect I don't have to tell you the problem with that."

"No, you don't. It was one of the things Jefferson listed as justification for Independence and the Revolution. I don't disagree."

"Nor do I," Mr. Crowe replied.

"Is there anything I need to do?"

"Not beyond what your attorney advised," Mr. Crowe said. "And that was very deft handling of the limitation, Ms. Coates."

"Thank you. The point about doctors being able to testify by deposition even if they're in the same county was on the Bar exam when I took it last year."

"You're in rarefied company, Leland," I said. "Melody intends to be the first female Chief Justice of the United States."

"There might be one or two steps between here and there," he replied with a smile.

"I clerked for a federal judge for a year right out of law school, with the blessing of the firm that hired me."

"Then you have a leg up already! It was nice meeting you."

"And you."

Melody and I left his office, and I walked her to her car in the parking lot.

"Don't speak to Miss Sandberg," she said. "No possible good can come from that."

"Understood. I have no inclination nor reason to do so, and in any event, I'd follow your guidance on that."

"Where is the tape?"

"At home in my locked drawer. I'm on until 9:00pm, so unless you want to hang out until I get home, I'll have to get it to you another way."

"I'd hate to have it lost in the mail or anything like that," she said.

"We can get Clarissa's key," I said. "Kris will be home, so I can call her and let her know, and she'll let you into the house to get the tape. It's the gold 'Realistic' tape in the locked drawer on the left side of my desk."

"Perfect. I'll send you an invoice for the hours."

"I appreciate it."

We went back into the ED, got the spare key, and then Melody gave me a quick, chaste hug.

"Keep in touch, Mike."

"You, too."

She left, and I reported to Doctor Gibbs that the deposition was over.

"How did it go?" she asked.

"I told the truth," I replied.

"Including that you felt Krista was being treated unfairly."

"Because, at the time, I felt she was. And that was separate from her lying to me or who she was sleeping with. Just tell the truth, Lor, and there won't be any problems. Her false accusation did her in with regard to ever being a doctor. Mark King's inability to keep it in his pants did him in with regard to keeping his job and will probably cost him his medical license, at least for a time."

"Any concerns?"

"Only that her attorney is, well, a _lawyer_, and is going to try to cause as much trouble as he legally can. It appears they can prove the sexual relationship, and if that's the case, the best solution is for Mark King to admit having sex, make no admission about trading sex for a grade, resign, and pay her. If he fights it, it'll be even uglier."

"What kind of proof?"

"Who knows? Leland Crowe believes they have enough to convince a jury."

"What a fucking idiot," Doctor Gibbs said, shaking her head.

"On that, we agree."

"Go heal the sick!"

_November 14, 1989, McKinley, Ohio_

"Well, THAT was fun! Not!" Clarissa groused when she returned from her deposition on Tuesday afternoon.

"So long as you told the truth," I replied.

"Oh, I did. And thanks for the heads-up about the question about our relationship. I deflected it the same way, saying I had a girlfriend. He let it go."

"Thankfully, Melody was a rock star."

"And during Freshman year, you strummed her strings!"

"Perhaps," I replied with a goofy smile.

"Banged her like a drum?" Clarissa teased.

"Lissa…"

"Sorry. I have the impression that Mark King is fucked, and not in a way he'll enjoy."

"I have the same impression. Bill Schmidt was called in by Doctor Rhodes."

"I hope she was a really good lay," Clarissa said, "because it's going to cost him."

"I suspect just a warning because it wasn't against the rules and she hadn't received an evaluation for her trauma rotation when she was dismissed. Of course, Mrs. Doctor Schmidt will probably extract her pound of flesh."

"Did Krista name him in her suit?"

"No, she just claimed a pattern of sexual harassment. She'll win on that, or rather, the hospital and medical school will pay her off and leave Mark King swinging in the breeze. And they'll do it before she amends her complaint to name other names, which is the implied threat. The hospital can't have half-a-dozen doctors dragged through the mud."

"Even if the pigs deserve it?" Clarissa asked.

"You call _me_ a pig all the time!" I objected.

"You know I'm teasing about you, and there is a significant difference between exercising a healthy libido and banging a medical student you're supervising."

"True," I agreed. "I need to check on a patient."

"And I need to find my medical students and see what mischief they got up to while I was away!"

_November 15, 1989, McKinley, Ohio_

"Morning, Doctor Mike!" Tamara exclaimed when I walked into the Free Clinic on Wednesday morning. "You have four appointments today, two each in the morning and afternoon."

"Thanks, Tamara."

I went through the door from reception, stopped to say 'hello' to Gabe Turner, then went to the break room where Trina was drinking coffee and eating a Danish.

"Morning, Mike!" she exclaimed.

"Morning! How's my favorite nurse-practitioner?"

"Flatterer!" she said with a soft laugh. "One of these days, you need to bring your daughter here to see us!"

"That's a bit complicated because of daycare," I replied. "But I'll see what I can do."

"Doctor Mike, your first appointment is here," Michelle said from the door to the break room. "Exam 2."

The morning was basically routine, with the two appointments before for birth control pills, and five walk-ins, four for minor injuries, and one because the young woman's partner had tested positive for syphilis. I ate lunch at the deli, then returned for my first afternoon appointment, which was for a pregnancy test. I saw three walk-in patients before my final appointment of the day arrived.

"Doctor Mike, this is Leslie Corbin," Michelle said. "Leslie, Doctor Mike."

"Hi, Leslie," I said. "What brings you to see us today?"

"My boyfriend wants me to go on the Pill," she said.

"Are you currently sexually active?" I asked.

"No. But he wants to."

"Chart please, Michelle," I requested.

She handed it to me and I saw the girl was younger than I'd thought. My first impression was she was likely a college Freshman, but according to the chart, she'd only turned fifteen in July. Her age, combined with her responses, raised some caution flags.

"Before I can write your prescription, I need to perform a basic exam and ask you some questions, OK?"

"Sure."

"First, I need to listen to your heart and lungs. Would you remove your jacket and unbutton the top two buttons of your blouse, please?"

She did so, and I listened to her heart, then her lungs, and found nothing concerning. I had Michelle take Leslie's blood pressure and pulse, and those were both in the typical range for a teenage girl.

"Let's start with a few questions," I said. "When did you have your first period?"

"When I was twelve."

"And your most recent one?"

"Last week."

"Did you know that you can only start the pills immediately after your period and you need to take them for a solid month before they're effective?"

"No, I didn't know that. That's true?"

"Yes, it is. You absolutely have to wait, or use condoms."

"Oh," she replied.

"The other thing you need to worry about is contracting a sexually transmitted disease. Is your boyfriend experienced?"

"Uhm, yeah," she replied.

"I strongly encourage you to use condoms to protect yourself. We'll give you a brochure about Safe Sex."

"He doesn't want to," she said.

"I understand the feeling, but it's about you being safe, which is very important. Remember, it's up to you what you do, and when. Three times you've mentioned what your boyfriend wants, not what you want. Are you sure you're ready?"

Her body language screamed 'no', but she said, "Yes."

"How long have you been seeing your boyfriend?" I asked.

"Uhm, since July."

Her answers and her reactions did nothing to allay my concerns, and only feed them, so I decided to ask a question I normally wouldn't ask.

"Is he in your same grade?"

"Er, no, he's older."

"The same school?"

She shook her head, and I had a decision to make.

"Nurse Michelle and I are going to step out so I can write your prescription. We'll be right back, OK?"

"Yes."

Michelle and I stepped into the corridor.

"You detected the same thing I did?" I asked once we were out of the room.

Michelle nodded, "It sounds as if she's being pressured hard by a much older guy."

"What's the protocol?" I asked.

"Normally, we write the prescription and provide the Safe Sex brochure, then, because she's under sixteen, and we believe her partner is much older, we place a call to Family Services."

"And if she were sixteen?"

"It's not illegal, so we don't report it unless there are actual signs of abuse or the girl admits abuse."

"OK. I want to make the call. I think when we go back in, you give her the Safe Sex brochure, suggest she wait if she's not truly ready, and use condoms. I'll give the spiel about using the combined oral contraceptive."

"OK."

I wrote out the prescription while Michelle retrieved the brochure, then we went back into the exam room.

"Leslie, here's the brochure Doctor Mike mentioned," Michelle said. "It's very important to read it. Also, if you aren't ready to have sex, tell your boyfriend and wait. And, as Doctor Mike said, you should use condoms to protect yourself from sexually transmitted diseases."

"Uhm, OK," Leslie replied.

I handed her the prescription form, explained how to use the pills, including being fastidious about taking them and using condoms if she ever missed, and having to wait until she completed the first round before having sex, unless she used condoms.

When I finished, I asked if she had any questions, and she said 'no', so I had Michelle show her out, then went to the small office assigned to me. I consulted a laminated sheet and dialed the number for Family Services. When they answered, I identified myself and asked for a case worker.

"Nancy Maitland," a woman's voice said.

"Hi, Ms. Maitland. This is Doctor Mike Loucks, calling from the McKinley Free Clinic."

"What happened to Gale Turner?"

"He's here. I'm an Intern working at the clinic one day a week."

"OK. What can I do for you?"

"I just prescribed birth control pills for a fifteen-year-old girl who I suspect is being pressured by an older male into having sex."

"Based on?"

"She said her boyfriend wanted her to go on the Pill, her boyfriend didn't want to use condoms, and her boyfriend didn't want to wait. I asked about age, and she said he was 'older' and that he doesn't go to her school. Her entire demeanor was of a young girl who was not ready to have sex and was being pressured. My nurse agrees completely."

"Do you have an address?"

"Yes. And phone number."

"I have a pen, go ahead."

I read the information from the chart, she repeated it back, thanked me, and then we ended the call. I updated the chart, made notes about Leslie's demeanor and my suspicions, then filed the chart in the rack where Doctor Turner would retrieve it for review. I went to his office to give him a heads up.

"Good call," he said. "We see one or two of those a year. Did you note it on the chart?"

"I did."

"Thanks."

I went back to the break room and treated one more walk-in with a hand laceration who needed sutures. I finished just before 5:00pm, and once I completed the chart, I headed home to have dinner with Kris and Rachel, then attend Vespers at the Cathedral.