Good Medicine - Residency I

May 25, 1989, Graduation Day, McKinley, Ohio

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

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

"Thanks."

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

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

"Papa? Eat?" Rachel asked.

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

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

"Congratulations, Mischa," Bishop JOHN said.

"Thank you, Vladyka."

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

"I'm honored," I said.

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

"I agree."

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

"Master, bless," I said.

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

"Congratulations, Mike!" my grandfather said.

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

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

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

"Thank you, «Дедушка» (dedushka)," I said. ("Grandfather")

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

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

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

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

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

"My feet and my hemorrhoids agree with you!"

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

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

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

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

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

"When do you leave for your vacation?"

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

"Sorry about that."

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

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

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

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

"What's his or her name?"

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

"That makes perfect sense."

"Bobby named her."

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

Doctor Gibbs laughed hard.

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

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

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

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

"Yes, Doctor," Doctor Gibbs smirked.

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

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

"OK."

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

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

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

"You're not excited?"

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

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

"You always excite me!" I declared.

"Papa Mama kiss!" Rachel giggled.

"Papa is driving," I replied, laughing, then asked, "OK, who taught her THAT?"

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

"Me?"

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

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

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

"Or Clarissa?"

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

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

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

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

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

"I'm curious..."

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

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

"Both! And your mom."

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

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

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

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

"You know what I meant!" I countered.

"I do, of course."

"And inside our house?" I asked.

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

"Rach!" my daughter giggled.

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

"Papa?"

"Yes, Rachel?" I inquired, a bit surprised at the change from 'Dada' to 'Papa', but the reason became clear almost immediately.

"«Zha'tim»!"

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

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

"Rachel, «Je t'aime»!" I said.

"Mama! «Zha'tim»!" Rachel declared.

"«Je t'aime, ma petite lapine!»" ("I love you, little bunny rabbit.")

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

"Is that a problem?" Kris asked.

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

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

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

"Poor baby," Kris teased.

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

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

"Perhaps I do!"

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

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

May 26, 1989, McKinley, Ohio

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

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

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

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

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

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

"What?"

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

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

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

"The entire system is corrupted by money!"

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

"Well, obviously!"

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

"That's just silly!"

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

"How can one state be different?"

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

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

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

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

"Me? Would I do that?"

"YES!"

"Perhaps," I chuckled.

We finished our shower, dried off, and dressed.

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

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

"You like this French girl!"

"I also like French kissing her!"

"Of course you do!"

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

"And what is that, Michael? Hmm?"

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

"Uhm, how to march?"

"No. This!"

I raised my hands to the 'surrender' position.

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

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

"No."

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

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

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

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

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

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

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

"Are you quite through?"

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

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

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

"So, this French girl taught you something!"

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

"To your own advantage!" she said mirthfully.

"And to yours!"

"True!"

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

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

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

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

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

"Isn't theft always wrong?"

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

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

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

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

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

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

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

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

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

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

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

"The death penalty is barbaric!"

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

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

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

"When will you know your schedule?"

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

"What do they do for that?"

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

"All Residents?"

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

"What do the other services do?"

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

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

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

"Papa sing!"

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

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

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

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

"NO! RACH WALK!"

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

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

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

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

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

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

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

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

"We'd love to," I replied.

"How are things going other than medical school?"

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

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

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

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

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

"May I ask about you leaving the parish?"

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

"No."

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

"About?"

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

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

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

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

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

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

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

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

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

The banquet, as most banquets did, had decent food but nothing special, and the speeches were, for the most part, simply platitudes and congratulations. The one highlight was when Clarissa was given a special award for achieving the highest MLE Part 2 test score in the history of McKinley Medical School. Later, I received a certificate and plaque for being valedictorian, and Clarissa received a certificate for being salutatorian. Those awards ended the evening, and Kris and I headed home.