I. CRASH CART! NOW!

August 26, 1987, McKinley, Ohio

"CRASH CART! NOW!" Doctor Lindsay commanded.

She quickly put an oxygen mask on Elizaveta and turned the dial to its maximum setting. A nurse hit the red 'crash' button on the wall and seconds later a nurse rushed in, wheeling a crash cart before her. Doctor Forsberg sprinted into the room and moved to Elizaveta's side, followed by Doctor Strong. I suddenly felt weak and my head spun, causing me to stumble.

Clarissa and Father Nicholas caught me and supported me while Doctors Lindsay and Forsberg evaluated my wife, the mother of our child.

"V-fib!" Doctor Forsberg declared as Doctor Strong rushed into the room.

"Lord have mercy," Father Nicholas said quietly.

"Charge to 200!" Doctor Strong commanded.

The defibrillator whirred as the capacitors charged, and Doctor Forsberg tore off Elizaveta's gown and put pads on her chest.

"Clear!" Doctor Strong commanded.

Doctor Forsberg removed the oxygen mask, then stepped back. Doctor Strong pressed the paddles against the pads and pressed the buttons, causing Elizaveta's body to convulse. A few seconds later, I saw a strong beat on the monitor, then another, then a third.

"Normal sinus rhythm," Doctor Strong said. "What happened?"

Doctor Forsberg put the oxygen mask back on Elizaveta's face, and Doctor Lindsay began an assessment using her stethoscope.

"Elizaveta was talking to Mike," Clarissa said. "She said she didn't feel well, went pale, then lost consciousness. That's when the monitor showed irregular electrical activity then V-fib."

"Post C-section?" Doctor Strong asked.

"Yes," Clarissa replied. "By Doctor Kendall and Doctor Forsberg. I observed. No obvious complications, minimal bleeding, no placental problems, and a healthy baby."

"Well, something caused an otherwise healthy eighteen-year-old young woman to crash! Doctor Forsberg, any trouble during her pregnancy?"

"None," Doctor Forsberg replied.

"Reason for the C-section?"

"Elizaveta called saying she was having what sounded like short runs of V-tach, so I told her to come in. Her blood pressure was normal when she arrived and we put her on a monitor. She had a run of V-tach while I was examining her, and the baby seemed to be in a bit of distress.

"I suspected Elizaveta was experiencing postural orthostatic tachycardia syndrome, and because she was a week past term and the baby appeared to be in a bit of distress with late decels not associated with contractions, I determined a C-section was the best course of action and had Doctor Kendall paged."

"Nulliparous and primigravida before delivery?"

"Yes, she's now G1, T1, P0, A0, L1."

I had to think back to what that meant. GTPAL was the mnemonic for Gravidity, Term, Premature, Abortion, Living with reference to the number of times pregnant, the number of babies carried past thirty-seven weeks, the number of premature births, the number of abortions, and the number of living children.

"She went into labor naturally?"

"She did."

"Amniotic fluid levels when she arrived?" Doctor Strong asked.

"Low, typical of post-term pregnancy, but within the acceptable range. That cost one point on the biophysical profile which was 9 with everything else being perfect."

"Placenta?"

"Sent to pathology, but grossly normal with no tears or other injuries, and no excess bleeding. Good cord perfusion."

"The baby?"

"Good initial and five-minute Apgar scores. Glucose stick test was in the normal range, as was bilirubin. She's well formed, properly developed, and in the nursery."

"Doctor Lindsay?" Doctor Strong inquired, "Your findings?"

"Moderate edema in both lungs identified by crackles and a third heart sound. BP is low at 90/50, pulse is tachy at 110, resps are shallow at 17. Unknown why she has not regained consciousness."

Doctor Strong moved to the side of the bed and used his stethoscope to listen to Elizaveta's heart and lungs.

"Pericardial knock," Doctor Strong said. "Doctor Forsberg, were there any signs of heart trouble during her pregnancy?"

"None at all until she reported the 'racing' or 'fluttering' when she called me. Mild peripheral edema, typical of pregnancy, but no identifiable circulatory problems, with strong distal pulses and good heart sounds."

"OK. Let's get a CBC, Chem-20, ABG, and start her on IV antibiotics as a precaution. I'll want to do an ultrasound as well. I'll stay with her until we can move her to the ICU. Someone page Doctor Kendall, please. And page Neuro as well, given we don't know why she's not conscious."

The nurses sprang into action, with one drawing blood, one going to the phone, and the other leaving to get the ultrasound.

"You OK, Petrovich?" Clarissa asked. "You look pale."

"No," I replied weakly. "I'm not OK."

"Let's get Mike into a bed," Doctor Strong advised.

"I don't need a bed," I protested. "Just sitting down will be fine. Worry about Elizaveta, not me!"

"Deacon Michael," Father Nicholas counseled, "you need to be healthy for Elizaveta. Let your doctors check you out."

"Do it, Petrovich," Clarissa commanded.

"Doctor Lindsay," Doctor Strong said, "please take Mike to a bed, perform a physical, then report back."

"Let's go, Mike," Doctor Lindsay said coming over to me.

"I'll stay with Elizaveta," Father Nicholas said. "I have my chrism, so I'll anoint her, and if anything happens, I'll come to see you."

I thought about resisting, but simply didn't have the energy. I let Clarissa guide me out of the room, and down the hall to an empty exam room. I got onto the bed and Doctor Lindsay checked my blood pressure and pulse, then listened to my heart and lungs, and checked my distal pulses.

"Your BP and pulse are elevated, which I'll chalk up to adrenaline," Doctor Lindsay said. "When's the last time you ate or had something to drink?"

"Dinner last night, then a large coffee on the way here."

"Caffeine plus adrenaline," Doctor Lindsay said. "That would explain it, along with interrupted sleep."

"Can I go back to my wife, please?"

"Let me check with Doctor Strong," she replied.

"Ask Doctor Forsberg," I requested. "She's an Attending."

Doctor Lindsay nodded, "She is, but she'll listen to the surgical and cardiology Residents because she's an expert in female anatomy."

"So is Petrovich!" Clarissa tittered.

"Lissa," I sighed.

"I was going to add 'not in cardiology or surgery'," Doctor Lindsay said with a smirk. "This is clearly a case for Cardiology at the moment. And I do get the impression you know your way around female anatomy."

"I had the required courses," I replied flatly.

"Uh-huh," Doctor Lindsay said. "I'll be right back."

She left, leaving Clarissa and me alone.

"Lizochka is in good hands, Petrovich," Clarissa said. "She's young and strong."

"Which didn't prevent her from going into V-fib!" I shot back.

"Mike," Clarissa said gently, "Do you trust Doctor Strong, Doctor Forsberg, and Doctor Lindsay?"

"Yes," I admitted grudgingly, knowing what was coming next.

"Then trust they'll figure this out and that you'll take your wife and daughter home in a few days."

"Nothing at all went wrong in the surgery?"

"It was textbook. Elizaveta's vitals were great the whole time, and your daughter announced her presence with authority as any Russian woman would!"

Doctor Lindsay came back into the room just then and said, "Doctor Forsberg would like you to rest for fifteen minutes. They're moving Elizaveta to the ICU so she can have continuous monitoring and nursing care while Doctor Strong, Doctor Kendall, and Doctor Forsberg try to determine a diagnosis. It'll take about ten minutes to get her settled, so you'll be able to see her then."

"How's her heart?" I asked.

"Sinus rhythm but with occasional runs of SVT, which seems to be what happened before her friends brought her in."

"Tamponade?" I asked.

Doctor Lindsay shook her head, "No, but she almost certainly has excess fluid in her pericardium. The ultrasound will tell us more, and they'll check for cardiomyopathy as well."

"Clarissa said the C-section was textbook."

"It was. Doctor Kendall and Doctor Forsberg were there, and I did the procedure from incision to closure, and I literally followed the textbook steps because everything was perfect except for your daughter's irregular heart rate, which resolved immediately after I handed her to the nurse."

"Any idea of the cause of Elizaveta's arrhythmia?"

"I can only speculate, but chorioamnionitis is a distinct possibility, and is likely part of why Doctor Strong ordered IV antibiotics. The other would be post-op infection, such as endometritis, but it's awfully soon for those symptoms."

"What about Rachel?" I asked.

"Her glucose was fine, and she had no jaundice. I'm sure Doctor Forsberg and the neonatal Resident will run a full spectrum to rule out any infection."

Father Nicholas entered the room and said, "They're moving her to ICU. Doctor Strong said her vitals are good, but she's still having occasional bouts of whatever it was that causes her heart to race."

"Runs of SVT," Clarissa replied. "That's SupraVentricular Tachycardia. In Elizaveta's case, it's paroxysmal supraventricular tachycardia, which basically means she has intermittent episodes of a racing heart with abrupt onset and termination."

"What causes that?" he asked.

Clarissa looked to Doctor Lindsay.

"Stress would be the main one," Doctor Lindsay said, "unless she's been smoking, drinking, or ingesting large amounts of caffeine."

"None of the above," I added.

"How are you doing, Mike?" Father Nicholas inquired.

"I want to go see her, but I'm being held prisoner until they get her settled in the ICU."

"Chill, Petrovich!" Clarissa ordered.

"That's good advice," Father Nicholas observed. "I'm going to call His Grace and let him know."

"You can use the phone in the Residents' office," Doctor Lindsay offered. "Clarissa can show you where that is."

Clarissa and Father Nicholas left, leaving me with Doctor Lindsay.

"Babysitting duty to make sure I stay in this bed for exactly nine hundred seconds, and not one second less?" I asked.

"Doctor Forsberg did instruct me to ensure you rested for fifteen minutes."

"To keep me out of the way."

"Medical students with family members as patients tend to try to 'help'."

"Did you see me do anything except move out of the way?" I asked. "Or see me freak out? Or anything like that?"

"No. But you're going to follow Doctor Forsberg's instructions because otherwise, she or Doctor Strong might ban you from the ICU, which you know they can do."

"And med students, as with patients, should be treated by how they present, not determined by baseless assumptions contrary to fact!"

"Give it a rest, Mike," Doctor Lindsay counseled. "Resting here while they transition Elizaveta to the ICU makes sense, and you'd know that if you weren't thinking like a doctor and instead were thinking the way the husband of a patient should think."

"I can't stop thinking like a doctor," I protested.

Doctor Lindsay smiled, "Quod erat demonstrandum."

I realized further protests would not help, as I'd just proved the point Doctor Lindsay was trying to make.

"How is your OB/GYN rotation going?" she asked.

"Really well, I think. It was something of an oddity for them because of the Preceptorships. Normally new Third Years are totally clueless and I had at least a partial clue, which caused conflict when I asked to be able to do more than stand around watching. Doctor Cooper and one of her Residents, Doctor Kelly, decided I knew more than the average med student and have allowed me to participate."

"I take it that caused some drama?"

"It did, but I've shown my ability to do basic procedures and exams, so it's kind of died down. The OB/GYN Chief at Good Samaritan is something of a dinosaur, but fortunately, all my interactions are with female Residents, and my Attending who is female."

"You don't think men can be OB/GYNs?"

"I think quite a few men who were trained in the 50s and 60s are not well suited to deal with modern obstetrics and gynecology. Let's just say that as familiar as I am with female anatomy, not having it does not provide me with a good perspective!"

Doctor Lindsay laughed, "An interesting perspective."

"One which keeps me alive," I replied.

"Your wife is a feisty one, and being young, strong, and determined are all indicators of a positive outcome. Just hang in there, Mike."

"That would be easier if I knew what was wrong."

"And we'll figure it out."

Father Nicholas and Clarissa returned and he let me know the bishop was going to have someone drive him to McKinley as soon as possible.

"Can I go see Elizaveta now, please?" I asked, looking at my watch.

"Yes," Doctor Lindsay said. "But ICU is limited access, as you know. It's up to the Attending and Resident if you can stay beyond the usual five minutes. Father Nicholas, as chaplain, you can visit, but again, with whatever rules the Attending and Resident set. And Mike, don't fight it, because you're not even assigned to Moore Memorial Hospital at this point."

"I'll behave," I replied.

"That'll be a first!" Clarissa teased.

"I'll deal with you later!" I said trying to sound cross.

"I need to go back to OB," she said. "Page me if anything changes, please, or if you need me."

"I always need you, Lissa," I replied.

She smiled and left, then I got out of bed and walked with Father Nicholas and Doctor Lindsay to ICU. We put on masks and gloves as required, and then went to Elizaveta's bed. The monitor showed sinus rhythm, though her pulse was elevated. I checked the chart and saw her BP was still low.

She had an IV and the chart showed vancomycin, lactated Ringer's, and vasopressors, or 'pressers' as we called them, to try to bring up her blood pressure. It also showed the orders for stat blood work, but I knew the process, and it would be another thirty minutes or so before all the results were back.

The chart also showed the results of the cardiac ultrasound -- a small pericardial effusion, which at the moment, did not require treatment, but would be checked every two hours by ultrasound. I was thankful she was breathing on her own and hadn't needed a vent, though she did have on an oxygen mask.

My goal was to stay with Elizaveta full-time, but that would require permission from the ICU attending, and I'd also have to convince the other Doctors who would, I was positive, demand I get some sleep.

"I'm Ken Jones," a Resident said. "She's stable. You're a med student, right?"

"Mike Loucks," I replied. "This is our priest, Father Nicholas, who's a hospital chaplain."

"OK. I'll allow you two to visit for ten minutes each hour, which is the most I can do."

I fought the urge to challenge him because I realized that the Attending, who the board showed was Doctor Roger Murtaugh, would have the final say, and antagonizing the Resident wouldn't help me win an argument.

"Is Doctor Murtaugh available?"

I could tell by the way Doctor Jones' mask moved that he was smiling.

"I'm the best you're going to get. Doctor Murtaugh doesn't usually grant any exceptions, but he'll back me on ten minutes an hour. If you go to him, be prepared to have the rules strictly enforced."

"Listen to him, Deacon," Father Nicholas counseled.

I sighed because I knew he was right. I wanted to hold my wife's hand and kiss her, but I knew I'd be immediately kicked out of the ICU if I did that.

"Let's pray for her, Deacon," Father Nicholas said.

I nodded and he quietly said the prayers for the sick. As I said 'Amen' the monitor beeped and the red light flashed as the EKG showed a run of SVT which lasted about five seconds then disappeared and a normal sinus rhythm resumed.

"Any idea what's causing the SVTs?" I asked,

"Have you done a cardiology rotation?" Doctor Jones asked.

"Yes. I understand SVTs."

"It's likely some sort of stress on her system, but we don't know what that is just yet. It could simply be a bad reaction to the spinal, or to the surgery. The real concern, obviously, is the V-fib. Doctor Strong is consulting with Doctor Getty about that."

"Deacon, have you spoken to Elizaveta's parents?" Father Nicholas inquired.

"No."

"Let me go call them, and tell Serafima and Alyssa what's going on."

"Thank you, Father."

He left and I stayed with Elizaveta until a nurse reminded me that I only had ten minutes. I leaned down and whispered, "I love you", then left the ICU. I removed my mask and gloves, then headed to the Maternity waiting room where I found Father Nicholas with Mark, Alyssa, Elias, and Serafima.

"I spoke with Viktor," Father Nicholas said. "They're on their way here."

And my mother-in-law was likely going to have a cow about the fact that she hadn't been called right away, and despite the fact that I'd been in Cincinnati, she'd take her wrath out on me.

"Yulia is going to be very unhappy with me," I said to Father Nicholas.

"Let Viktor deal with that, please," he advised. "Just be polite."

"It's my fault, Deacon," Alyssa said. "I'll tell Yulia that. She can be angry with me."

"I'm not sure that will help," I replied. "But, thank you."

"You can't stay with her, Deacon?" Serafima asked.

"Only for ten minutes each hour," I replied. "Normally the ICU is limited to five minutes a few times a day."

"Do you need anything?" Mark asked.

"Right now? Just your prayers for Elizaveta."

"Did you see Rachel?" Alyssa inquired.

"Yes. She's a cute little thing. They have her in the nursery. If you'll excuse me, I'm going to call my mom."

I went to the nurse's station and asked if I could use the phone in the Resident's office and was given permission. I walked there and dialed her new number from the small address book I carried in my pocket. I wasn't surprised when a groggy Stefan answered.

"It's Mike," I said. "I'm sorry to disturb you, but I need to speak to my mom, please."

"One sec," he said to me.

I heard him tell my mom it was me and he handed her the phone.

"Mike? Where are you?"

"McKinley. You have a granddaughter, but Elizaveta needed an emergency C-section and she's not doing very well right now."

"Lord have mercy! How bad?"

"She's in the ICU and they're monitoring her."

"What happened?"

"We don't know," I replied. "She had a bout of ventricular fibrillation, which is a type of irregular heartbeat. They're running tests on her. Father Nicholas is here and anointed her."

"Lord have mercy!" she exclaimed for a second time. "Stefan and I will get dressed and come there. See you in an hour! Did you call your father or grandfather?"

"No."

"I'll call my dad now, but you should call your father."

"I will," I replied.

I hung up and decided to wait another twenty minutes, as my dad would be up for work at that point. I went back to the waiting room and saw that Viktor and Yulia had arrived and were speaking to Father Nicholas and Alyssa. I walked over to them.

"Hi, Mike," my father-in-law said. "Do you know anything more?"

"No. I was just on the phone with my mom. She and my stepdad are on their way."

"Why didn't you call us immediately?" Yulia demanded.

"Yulia," Viktor said firmly. "I asked you not to start a fight. Please don't."

She looked daggers at her husband, but said nothing further. Doctor Strong came into the waiting room and asked to speak privately with me, and I invited Father Nicholas to join us, as Clarissa, who was my usual support, wasn't available. We went to a consultation room and sat down.

"Elizaveta is suffering from inflammatory cardiomyopathy," Doctor Strong said. "As I'm sure you remember, the cause and mechanism aren't well understood, but it's often a result of a viral infection. Doctor Getty believes that's the most likely cause, as Elizaveta doesn't have any of the other risk factors -- radiation exposure, heavy metal exposure, or a history of heart disease.

"Her blood shows increased C-reactive protein and an erythrocyte sedimentation rate consistent with viral inflammatory cardiomyopathy. The only way to be sure is a biopsy, which we will do if you sign the necessary forms. Other than that, we'll use supportive therapy with digoxin, and see if we can keep her stabilized."

"I agree to the biopsy," I said. "I know the risks."

Doctor Strong nodded, "I was sure you did, and Doctor Getty was sure you'd agree. I'll have Shawna, my Fourth Year, bring you the forms. Just wait here."

"Thanks, Doctor Strong."

"You're welcome. Keep your chin up. She's young and healthy."

I nodded and he left, closing the door behind him.

"OK, what didn't he say?" Father Nicholas said. "I saw you two exchange a look."

"That myocarditis causes up to twenty percent of all cases of sudden death in young people," I replied.

"Lord have mercy!"

I nodded grimly, "As he said, though, she's young and otherwise healthy. You know I'm only halfway through medical school, but I can safely say that it's entirely possible she's had this problem for some time, and the stress of pregnancy, labor, and the C-section exacerbated it."

"Undetected?"

"That's common, which is why it causes such a high percentage of sudden deaths in young people."

"You're awfully calm given what you just said."

"Well, I could lose it, become totally emotional, and be a basket case, but that doesn't help Elizaveta or me, does it?"

"No, but the stoic act?"

"What my friends call 'Doctor Mode'," I replied. "I don't think you've actually seen it. It's one of the primary traits of ER doctors as well as surgeons. Nothing is supposed to cause us to lose it."

"This is just you and me, Deacon," Father Nicholas said.

I nodded, "I know. And all I can do is trust the doctors to take care of her, and have faith that God will have mercy and work through them to cure her. You've anointed her, we're all praying for her, and I trust Doctor Getty, Doctor Forsberg, Doctor Strong, and Doctor Lindsay. I'd put my own life in their hands."

"They've all taught you?"

"Yes. Doctor Getty and Doctor Strong for cardiology, Doctor Lindsay for surgery, and Doctor Forsberg for OB/GYN. That's how we decided on her as Elizaveta's OB/GYN and her husband, Doctor Smith, as my GP."

"How dangerous is the biopsy?" Father Nicholas asked.

"They'll do an angiography, which means inserting a catheter into a femoral artery in her leg, then running a surgical tool through the catheter, through the artery, guided by fluoroscope, up to her heart, and retrieving a tissue sample. It's a relatively common procedure."

"You just calmly described the doctors cutting a piece of your wife's heart!" Father Nicholas said, recoiling. "That does not sound 'common' at all."

"But it is, really," I replied. "Doctor Getty has done hundreds of them, at least, if not over a thousand. There are almost no risks, except for possibly minor bruising or bleeding. But, as with any medical procedure, unexpected things can happen. But I trust Doctor Getty and Doctor Strong to deal with anything that arises."

There was a knock at the door and it opened.

"Mike? I'm Shawna Benedict, a Fourth Year. I have forms for you to sign. I suspect you don't need any explanations."

"No, I don't."

She handed them the forms to me. I quickly scanned them, signed and dated them, handed them back to her, and she left.

"Now what happens?" he asked.

"They schedule it with the cath lab -- the catheterization lab. It'll likely be in the next few hours, depending on the schedule, but it could be this afternoon."

"You should eat something and you're going to need a nap at some point."

"I can see Elizaveta again in about twenty minutes," I replied. "I'll get something to eat after that. I also want to find out from Doctor Strong when they're going to do the procedure."

"Will they let you watch?"

"That's up to Doctor Getty," I replied. "Usually not, but it's possible. I'll ask, but I'm prepared for him to say 'no'."

"Doctors really accept that?" Father Nicholas asked skeptically.

"For participation, yes. For observation, it would depend on circumstances. The problem here is there is no observation area for the cath lab, which would mean I'd have to be in the room, which means scrubbing in, and that probably won't happen. When they build the new surgical wing, every operating theatre and the cath lab will have an observation area so you don't have to be in the room. But that's years away. Same with the new emergency wing."

"Do you know when?"

"Completion is projected in 1997 for the new emergency wing and 2000 for the new surgical wing. There's a lot of fund-raising and planning to do, and both are in early stages."

"We should go tell Viktor and Yulia about the procedure," Father Nicholas advised.

We left the consultation room and went back to the group, I took Viktor aside to explain what had happened and what I'd decided, thinking it best to let him tell Yulia.

"How dangerous is this, Mike? Be honest, please?"

"I think the only way to answer that is that it's more dangerous to Elizaveta if they don't do it. It will tell us definitively if it's a viral infection. That's important because if it's not a viral infection, then more tests need to be done to try to determine the underlying cause."

"Why not do those tests first?"

"Because the condition she's suffering from is not well understood and it's scattershot. Most cases resolve on their own."

"Most?"

"Most."

"And the ones that don't?"

"Often have poor outcomes," I replied.

"Poor outcomes...you mean..."

I nodded, "Yes."

"Do we need to call in a specialist from somewhere?"

"Viktor, you're on the Hospital Board. Do you trust the physicians here?"

"Yes, of course, but..."

"But nothing," I replied. "Doctor Getty is an excellent cardiologist and cardiac surgeon. And if he needs help, he'll ask for it. I trust him; you should, too."

"She's my daughter, Mike," Viktor sighed.

"And my wife, and the mother of my new daughter."

He nodded, "That doesn't change how I feel, but you're right. When will they do the biopsy?"

"Today, though I'm not sure what time."

"Let me tell Yulia. Are you going to share this with the others?"

"Yes. But I wanted to tell you first, privately. Yulia is not going to take it well."

"Let me take her someplace private," he said.

"The consultation room we were in is empty."

"Will we be able to see Elizaveta?"

"She's in the ICU, so probably not. They already bent the rules so Father Nicholas and I could each spend ten minutes with her each hour. The usual limit is five minutes, once or twice a day, for all visitors."

"Yulia is not going to accept that."

"She can take it up with Doctor Murtaugh, but I can't be involved."

"OK. Let me take her to the consultation room."

We rejoined the others and Viktor carefully guided his wife to the consultation room and I went to my friends and explained what was going to happen.

"Mike, is she going to die?" Serafima asked, tears forming in her eyes.

"I honestly don't know," I sighed.

Elias put his arm around her and held her as she sobbed.

Mark put his arm around my shoulders, "What can we do for you?"

"You're doing it," I replied. "You're here with me, and you're praying. It's up to the doctors now."

I saw Sophia and Robby come out of the elevator and walk over to us. Both of them hugged me, something they could do as I was wearing scrubs, not my cassock.

"Clarissa called us," she said. "How is Elizaveta?"

"In the ICU with myocarditis," I replied. "She's unconscious, and they don't know why."

"Lord have mercy," Sophia said.

"What can I do for you, Mike?" Robby asked.

"Right now, being here is enough."

A nurse came over to our group.

"I'm sorry to have to say this, but your group is getting too large for our waiting room," she said quietly.

I nodded, "I understand. Would you call Doctor Roth and get permission for us to use the conference room in surgery?"

"Sure. Give me a minute."

As she went back to the nurses' station to make the call, the door to the consultation room flew open and Yulia stormed over to me, with Viktor hurrying after her.

"YOU HAD NO RIGHT!" she screamed. "None! She's my daughter!"

"Yulia," Father Nicholas quickly interjected, "Mike is her husband, and he's the one who has to consent."

"Not without consulting ME!" she growled. "He's a medical student, not a doctor! It shouldn't be up to him! They're going to cut out part of her heart!"

"He listened to the doctors, took their advice, and gave his consent, Yulia," Father Nicholas replied, then turned to me. "Mike, go see Elizaveta."

I walked away, and could feel the daggers Yulia was looking at me striking my back. I totally understood her position, but it was, no matter how you looked at it, my decision, not hers, and I was following the best medical advice available from doctors I trusted. And despite her dramatic statement, the amount of tissue they'd collect was tiny.

When I reached the ICU, I checked with the nurse, received approval to glove and mask, and after doing so, I went to Elizaveta's bedside. The monitor showed readings similar to what they were earlier, and the chart showed she'd had two more runs of SVTs. Something was stressing her body, besides the myocarditis, and something was preventing her from regaining consciousness. The neuro consult had been 'indeterminate' and an EEG had been ordered.

Her blood tests showed nothing new except for an increased white count, which was to be expected if she had an infection of some kind, viral or bacterial. The antibiotics would take care of a bacterial infection, but would have no real effect on a viral infection. I put the chart down and stood as close to her as I could without touching anything.

"I love you, Kitten," I said. "Please get better."

The ten minutes I was allowed passed far too quickly, and I left the ICU and went to the cardiology conference room where the group had enlarged with my mom, grandfather, and Stefan having arrived. Mom hugged me tightly and asked how Elizaveta was.

"No change," I replied. "They've run a bunch of tests, and they plan to do an EEG and a cardiac biopsy."

"Lord have mercy!" Mom exclaimed.

"What can we do, Mike?" my grandfather asked.

"Pray. And I think we're going to need to limit how many people show up at the hospital."

"Who do you want here?" he asked.

"Father Nicholas, my family, Sophia, Robby, Mark, Alyssa, Serafima, and Elias. The bishop will be here soon as well. What we can't have is half the church showing up."

"Let me speak with Father Nicholas," he said.

I nodded, "Thanks. I need to get something to eat."

"I'll walk with you to the cafeteria, Mike," Mom said.

As we started walking, Clarissa came up to us.

"My shift is over. How is she?"

"No change," I replied. "They ordered a cardiac biopsy for myocarditis and an EEG. I'm going to get something to eat."

"That's good; I mean eating. I checked on Rachel and she's doing great. They're giving her glucose water at the moment, and they'll give her formula around noon if Elizaveta isn't able to nurse her."

"OK," I replied. "There really are no other options."

"True," Clarissa agreed, "because wet nurses basically disappeared with the advent of baby formula. How are you holding up?"

I shrugged, "OK, I guess. Happy that my daughter is healthy; worried for my wife. Mom, did you call Liz?"

"Yes. Did you call your father?"

"No, I ended up speaking with Doctor Strong about the procedure. I'll call Dad once I've had something to eat."

I wasn't particularly hungry, but I knew I had to eat enough to sustain myself, so I chose a bowl of fresh fruit and a cheese Danish, along with a bottle of grapefruit juice and a cup of coffee. I decided to sit in the cafeteria to eat, knowing that someone could come to find me if it was necessary. My mom and Clarissa got food as well and joined me at the table. We ate in silence, and when we finished, we returned to the cardiology conference room. Yulia looked daggers at me once again, but didn't say anything.

"I went to see Elizaveta," Father Nicholas said. "No changes, but they're preparing to take her to the cath lab for her procedure."

"OK. I'm going to go see if I can speak with Doctor Getty," I said.

I left and went to Doctor Getty's office, where I found him speaking with Doctor Strong.

"I wondered when you'd come to see me," Doctor Getty said. "You want to observe?"

"Yes, if it's possible, and you'll allow it."

"I will, but we were just discussing whether we should send her for the EEG first. The fact that she's unconscious bothers me, and I really don't want any surprises in the cath lab."

"I trust your decision," I said. "But would a few hours make a difference for a viral infection? I mean, all you can do is supportive treatment, right?"

He nodded, "That's correct. It's really to rule out a viral infection, which would lead us to look for other causes. One of those would be some kind of brain injury, and an EEG might give us the clues we need."

"What did Neuro say?" I asked. "I saw the chart said 'indeterminate' with regard to what amounts to a coma."

"Not technically, because it hasn't been six hours," Doctor Getty replied. "And it could be a strange side effect from the spinal block. I wouldn't call it a coma until tonight or tomorrow, when the anesthetic would be completely metabolized, and even then, she does have response to stimuli, which would argue against a coma and for some kind of reaction to the anesthetic or some other brain injury."

"To ask the question my priest asked me after Doctor Strong spoke to us -- what aren't you saying?"

Doctor Strong and Doctor Getty exchanged a look.

"There's a chance she suffered a subarachnoid or intracerebral hemorrhage, or has an embolism. Neuro can't rule any of those out, which is why they want an EEG, and why we're discussing an angiography of the brain. We'd have to send her to Ohio State by helicopter for that, as we don't have the correct equipment for that kind of brain scan."

"Are you asking or telling?" I inquired.

"Feel free to give your input, Mike. There are no certain answers here, and she's your wife."

"I think I'd do the EEG first and decide what to do next. If the EEG is completely normal, then most likely she doesn't have a bleed or embolism, right?"

"Most likely not."

"Honestly, and you know I'm just a Third Year, I think the most important question is why she's not conscious, and secondarily why she went into V-fib."

"I agree. Let me call Neuro and arrange for a stat EEG. They can do it in the ICU, so we don't have to move her."

He picked up the phone and dialed. I only heard one side of the conversation, but it was clear what the outcome was.

"Hal? Ron...I want a stat EEG on the ICU patient we discussed...See you in fifteen minutes. Thanks."

He hung up.

"All set," he said to me. "Did you get something to eat?"

"I did."

"How about sleep?"

"Not yet," I replied. "I'll wait to see what happens with the EEG."

"You know you're no good to her if you collapse from exhaustion, right?"

"You aren't the first person to mention that," I replied.

"And I won't be the last! You're stressed, even if you aren't showing it."

He was right, and I knew it, and I wondered if I'd even be able to sleep before I simply collapsed out of exhaustion.

"I know," I replied as the overhead PA system emitted a triple beep.

'DOCTOR STRONG! CODE BLUE! ICU! DOCTOR STRONG! CODE BLUE! ICU!'

The three of us sprang from our chairs and sprinted to the ICU.