Chapter 21 — You Run It _May 3, 1990, McKinley, Ohio_ {psc} "I can't speak to what Doctor Gibbs was thinking," I replied, "but at the time, we weren't short an Attending the way we are now. I'm not sure what can be done at this point, as I have a commitment to present at Career Days at Rutherford High that morning. That's where I went to High School, and it's too late for them to find a replacement for me." "I wasn't looking to force either you or Doctor Casper to not go, just simply seeking insight into Doctor Gibbs' thinking. Things were fairly loosey-goosey under Northrup and Gibbs, and I'm encountering quite a few things that need to be addressed." "All I can say is their system seemed to work." "Let me ask this way — would that system pass muster with the Joint Commission for a Level I trauma center?" The 'Joint Commission' or the 'JCAH' was the Joint Commission on Accreditation of Hospitals, the accrediting body we'd need to satisfy to receive our Level I designation. "I believe our liberal interpretations of the rules during that time might have raised questions, and probably some eyebrows. To put a very fine point on it, they would very likely not have appreciated the leeway I was given to operate as if I were an Attending. Yes, it worked, but it pushed the rules literally as far as possible without directly violating them." "I'd counter that that violated the _spirit_ of the law, if not the letter. You and I both know that Residents without licenses are required to be actively supervised. Let's be honest, shall we, Doctor? You do not have a medical license and you were treating and discharging patients without so much as a signature on a chart from a licensed physician." "That is true," I replied. "And does that follow policy or the law?" "Not in a way which we could successfully defend in court," I replied. "May I make an observation without the intent to influence you to follow the same policy?" "Yes." "It worked, and it worked well, mainly because I had the wherewithal to know when I needed help, and I didn't screw up." "And the response would be that, eventually, you would because everyone does. And at that point, you, Doctor Gibbs, the Attending on duty, and the hospital are exposed to not just civil penalties, but potential criminal charges. Please don't take this the wrong way, but ALL of you were damned lucky. You are a VERY good Resident, Doctor. But you are not yet a licensed physician, and the rules are clear. "As I said the other day, this isn't about you, personally, because it appears you only write checks your skills can cash, but all it would take is one lapse in judgment and it would all come crashing down. And my other Residents, as good as they are, aren't you, and if they try to be you, it will end in disaster. The same is true for medical students. Miss Anderson is one of the best I've ever seen, and the same argument applies. I can't have other medical students who don't follow your methods and who don't have you as a teacher trying to emulate Miss Anderson." "You are not the first person to make those observations," I said. "Though usually, they came as gripes from other Residents or medical students about the 'special privileges' I was granted. I fully admit I was granted special privileges, but I earned them. That said, I am _not_ arguing against you enforcing the rules more strictly." "More? It would be impossible to do less short of not even scheduling an Attending to provide a fig leaf of cover." "May I ask a question you might choose not to answer?" "Yes." "Is this the reason Doctor Cutter hired you?" "Of course it is. He raised the issue in my interview, so I'm sure he did that in all the interviews." I nodded, "Thank you. I'll say something I hope I don't need to say, but what has just been said does not leave my lips outside these walls, though I reserve the right to discuss it with my wife." Doctor Wernher nodded, "We all need someone outside the system to speak to, and our wives are the safest in most cases. Unless you had more to discuss, you can return to duty, Doctor." "Nothing more at this time," I said. I stood and left his office, and Mary came up to me. "Everything OK?" "Yes. Just a discussion about how we'll handle things in June and then in September. Doctor Wernher, Doctor Roth, and I are all on the same page. He also reïnforced the changes in how we handle discharges and supervision." "We've followed them to the letter!" Mary protested. "Yes, of course, but Doctor Wernher's style appears to be to say the same basic thing to everyone, whether or not they're the main target. That does ensure we're all on the same page. Get another chart, please, then we'll have dinner." _May 5, 1990, McKinley, Ohio_ On Saturday morning, Kris, Rachel, and I went to band practice, and Kris and Kari discussed the Proms. Ultimately, Kris decided that given how tired she had been, it would be better if Kari sang with me. I wasn't thrilled with that decision, but I knew it made sense, and I made it clear I supported Kris' decision. After practice, we went to McKinley Music and Movies. "Hi, Mike!" Johnny called out when we walked in. "Hi, Kris! Hi, Rachel!" "Hi, Johnny," I replied. "Hi!" Rachel exclaimed. "What do you have for me today?" I asked. "I'd say something new, and something recovered. _39/Smooth_ by Green Day and _Violator_ by Depeche Mode." "Oooh!" Kris exclaimed. "Depeche Mode is wonderful!" "I don't take her car shopping," I said with a grin. "Tell me about Green Day." "A new rock band from California. It's on an independent label, Lookout Records, and I think they're going to go major. The album has very good reviews and is critically acclaimed." "Then we'll take those two, please." "Papa?" Rachel asked. "Yes? "Raffi?" "Anything new from Raffi, Johnny?" "No. But you can't go wrong with _Disney Sing-Along Songs_. The first one in the series is _Zip-a-Dee-Doo-Dah_. Then _Heigh-Ho_, _The Bare Necessities_, _You Can Fly!_, _Very Merry Christmas Songs_, and _Fun with Music_. They're all VHS at this point, not DVD." "Let's get the first one," I said. "OK." "Rachel, they don't have any Raffi discs, but we can get a tape with songs where you can sing along." She scowled, "Want Raffi!" "I'm sorry there isn't a new one," I said. "But we'll get you something. I promise you'll like it. Can we try, please?" "Yes," my petulant toddler agreed. Johnny retrieved the CDs and the VHS tape, and rang up our purchase. "Is everything set for the music festival?" I asked. "It is. It's been a lot of work, and I'm really looking forward to that work coming to fruition." "We're looking forward to playing." I paid Johnny for our purchase, and after leaving the store, Kris, Rachel, and I went to Kroger to do our weekly grocery shopping. After Kroger, we stopped at the bakery, then headed home to have some family time. After lunch, Rachel insisted on watching her new tape, so the three of us sat down to watch it. "Are we taking the typical American trip to Disney World?" I asked Kris. "How old would the kids need to be for that to mean something to them?" "Probably at least six or seven, so I guess it's nine or ten years from now, depending on the timing of our second." "What about Clarissa and Tessa?" Kris asked. "That timing should work, from what Clarissa has said." When the video finished, we put Rachel down for her afternoon nap, and Kris and I went to our bedroom. She needed a nap, and she very much liked me cuddling her while she napped. After our nap, I made dinner, and then we went to Saint Michael the Archangel for Vespers. _May 7, 1990, McKinley, Ohio_ "Doctor Wernher would like to see you," Ellie said when I arrived in the ED early on Monday morning. I went to the lounge, poured myself some coffee, then walked to Doctor Wernher's office. "You asked to see me." "Come in, Doctor. No need to close the door." I stepped into his office. "Mr. Crowe asked me to remind you not to discuss the Ken Webber malpractice suit with anyone except Mr. Crowe or personal legal counsel." "Understood." "Are you retaining personal counsel?" "No. May I make a comment to you about why?" "Yes." "I've tangled with this law firm several times, and I do not want to give even a hint that there is any disagreement or dissension or that I want to distance myself from my co-workers or the hospital." "OK. This is the last we speak of it." "Understood." "Send Miss Anderson in, please." "Right away." I left his office and let Mary know Doctor Wernher wanted to see her. "Trouble?" "No, just a directive from Legal." "OK." She went into Doctor Wernher's office and came out about a minute later. "No surprise, right?" I asked. "None at all. OK to get a chart?" "Absolutely." Our first patient had a broken hand that required an ortho consult, followed by a five-year-old with very badly scraped knees. Mary and I brought him and his mother into Exam 2. "I'm Mary, a Sub-Intern, and this is Doctor Mike, my supervisor," Mary said to Mrs. Evans. "Is it OK for me to examine Mickey?" "Yes, of course," Mrs. Evans replied. "NO!" Mickey exclaimed. "I don't want a girl doctor! I want him!" "Mickey, be nice," Mrs. Evans said. "NO!" he declared. "No girl doctors!" "I think this one is yours," Mary said quietly. I nodded and stepped forward, with Mary stepping back. "Hi, Mickey. I'm Doctor Mike. How did this happen?" "I was trying my brother's skateboard." "His brother is nine," Mrs. Evans interjected. "Is it OK if I listen to your heart and your breathing?" "Yes." I found nothing amiss with Mickey's heart or lungs, then asked if I could check his eyes, ears, mouth, and nose. He agreed, and I again found nothing amiss. "Mary, irrigation basin, saline, and irrigation syringe, please." She acknowledged me and collected them from the various cabinets and drawers. "Mickey, I'm going to use some special water to clean your knees." "Will it hurt?" "No," I replied. "It's just special water." He allowed me to irrigate his scrapes and wash away the dirt. There were a few flecks of asphalt, and I managed to wash them away rather than having to use forceps. "Mary, triple antibiotic ointment, please." She retrieved a tube from a bin and handed it to me. "Mickey, this is something to make sure bad germs don't cause an infection. It will feel cold, but it shouldn't hurt. I'm going to put some on each of your knees, OK?" "Are you sure it won't hurt?" "I don't think it will, but you're brave, so you'll be OK. May I?" "Yes," he answered reluctantly. I changed gloves, then spread ointment on each knee. "That didn't hurt!" Mickey exclaimed. "I'm glad. Mary, gauze and tape, please." Mary retrieved them, and cut several lengths of tape for me, and I loosely covered each knee. "Mrs. Evans, Mickey needs to keep his knees dry and covered for forty-eight hours. You should check them twice a day, and if you see anything other than a bit of blood or clear fluid, bring him right back. That means spreading redness, pus, or swelling. He can have Children's Tylenol if he complains of discomfort. After forty-eight hours, it's OK to wash his knees with a soft cloth and mildly soapy water, and after five, no restrictions. You should follow up with your pediatrician or family physician with any questions. OK?" "Yes, thank you, Doctor." "If you'll give us five minutes, I'll do the paperwork, and we'll get you on your way." "Great!" she exclaimed. Mary and I left the exam room, and I went to the Clerk's desk and completed the discharge form. I confirmed the chart was complete, signed it, then Mary and I went to Doctor Wernher's office to have him sign off on the discharge. I presented the case, then handed him the chart. "May I ask as to why you presented, and not your student?" "Our young patient is a paid-up member of Calvin and Hobbes' 'No girls allowed' club." Doctor Wernher actually laughed. "I have a pair of nephews who are also paid-up members, who very much do not appreciate their girl cousins!" He signed the chart and handed it back, then dismissed us. We returned to the exam room, and I reviewed the discharge form with Mrs. Evans. "Mickey, next time, there might only be a girl doctor, and girls make very good doctors, especially my friend Mary here." He scowled, "Do you have a sister?" I nodded, "I do. How old is your sister?" "Eight! And she's…uhm, I'll get in trouble if I say it!" I chuckled, "OK. Just remember next time that girl doctors are very good." He crossed his arms, and I wasn't going to fight with him, so I let it be and asked Mary to escort them to Patient Services. She was back about two minutes later. "OK, I'm confused," she said. "No candy?" "I wasn't about to reward him for disrespecting you!" I replied. "Seriously? He's five!" "Seriously. I don't reward Rachel for not liking boys! Candy is reserved for kids who don't diss my best student just because she's a girl!" "You noticed?" Mary asked. I chuckled, "Obviously, but I'll tell you the same thing I said to Shelly Lindsay when she asked a similar question — is that how you want me to think about you in the locker room?" "No chance! I totally get your point, I was just really surprised you didn't hand out candy." "And in three weeks, you'll have the choice!" Mary laughed softly, "So, I'm supposed to become Kid Whisperer II?" "No, you have to develop your own style and your own identity as a physician. You can be Doctor Anderson, if you prefer, and how you treat patients has to match your views, not mine." "I'm going to be Doctor Mary. I completely agree with you on that, and I believe I should follow my mentor so far as I'm able. Your approach to medicine is the one I believe is correct." "Thanks. Get the next chart, please." _May 11, 1990, Goshen, Ohio_ "Where is Kris?" Angie asked when I greeted her and her mom on Thursday evening at the Holiday Inn in Goshen. "She's very tired," I replied. "Our baby is due in about a month, and Kris needs sleep because she needs to finish out the semester at Ohio State. How are you doing?" "OK, I guess. I'm working and going to Aikidō." "That's good." "Will you come to church soon so I can see Rachel?" "I'll speak to Kris and see if we can do it this Sunday." "Thank you." I left Angie and her mom and joined the rest of the band in a small lounge that was set aside for our use. "How is Kris?" Kari asked. "Tired. She and Rachel were going to bed early tonight. I won't get home until after midnight, so I'll slip quietly into bed." "Mind if I ask who's covering for you?" "Paul Lincoln tonight, and Kylie Baxter tomorrow. Is your boyfriend here?" "Yes. Goshen is pretty chill about having people who aren't in the band hang around; Hayes County, not so much." I nodded, "That's true. Angie and her mom are here, and Mrs. Kane is mellow about others. Ready to sing like we're madly in love?" Kari laughed, "That was never us! Our relationship was about deep friendship, not romantic love." "And Doug?" "He's as logical as you ever were! I think lawyers and doctors are cut from the same cloth, at least in that regard!" "Both professions have to be dispassionate in their analysis, even if they are passionate in the practice of their art. Emotions don't really have a place in legal analysis any more than they do in diagnoses." "Very true." "I take it this one has serious possibilities?" "Yes; you know what kept us from moving forward." "'Instant family, just add ring'." "Rachel was adorable but also frightening." I laughed, "You have no idea how true that statement is!" "Time to tune and warm up!" Kim announced. We all went to the stage and tuned our instruments, performed mic and sound checks, and ran through a pair of songs to warm up. We had just finished when we heard students coming into the banquet room. We were served a meal along with the students, though we were at a table of our own, with Angie and Mrs. Stephens sitting with us. Doug joined us, as did Sierra. When we finished our meal, we returned to the lounge and, about fifteen minutes later, assembled on the stage. Robby and Sophia ran through their spiel for the penultimate time, and we kicked off with _I Write the Songs_. We played three sets and finished our encore with _Endless Love_. Given the hour, I packed my instruments and sheet music as soon as we'd taken our final bows and headed home to Circleville. _May 12, 1990, McKinley, Ohio_ On Friday evening, just after 5:00pm, I headed to the Holiday Inn to set up for the Hayes County High Prom. Given the strict rules of 'fraternization', we tuned and performed mic checks before the students arrived, then left to have dinner at the steak place just down the street. It was still the Paschal season, which meant no dietary restrictions were in force. "I never asked," Kari said as we ate, "but why is Hayes County so strict about the band?" "About four years ago, they had an 'incident'," Kim said. "At a turnabout dance, two fifteen-year-old girls got very cozy with the band, if you get my drift. That's when the school administration locked it down completely. When José and Mike were both single, girls at Goshen hit on them, big time. But, at a Prom, everyone is at least sixteen, so no Imperial entanglements would have ensued." "Did the band members get into trouble?" Kari asked. "They were fortunate it was the previous County Prosecutor. He let them plead to misdemeanor 'contributing' charges, with expungement after two years. The current Prosecutor would have thrown the book at them." "How old were the guys?" Kari asked. "Nineteen and twenty, so I totally get why the Prosecutor basically let it go." "Personally, I'd set the age of consent at fifteen, like most of Europe." "I agree," I replied. "Though I think I might set a maximum five-year age difference until age eighteen. That basically allows a Freshman girl who is dating a Senior to continue a relationship without risk." "That's _more_ restrictive," Kim protested. I shrugged, "I simply gave my opinion. I think a good part of it is maturity levels. What works in Europe won't necessarily work here. I see such a big difference in how mature Kris was when we met versus the average American teenager." "Elizaveta?" Sophia asked with an arched eyebrow. "An exception that proves the rule, mostly. No disrespect intended, there were things for which Elizaveta wasn't prepared, which Kris handled with aplomb. Don't get me wrong, these are not regrets, simply observations." "Does having a daughter change your view of autonomy for teens?" Kim asked. "No," I replied. "Rachel and Charlotte will make their own decisions, and Kris and I will equip them to do so." "Can I slightly change the subject?" Kim asked. "Sure." "What can be done about the Free Clinic?" she asked. "Sadly, not much," I replied. "Their budget was about $1.3 million, of which $1.1 million came from a grant. Someone would have to replace those funds and then overcome the opposition of the protestors and the County Prosecutor." "You're Pro Life, but you supported the clinic." "Because Mike isn't a fanatic," Robby said. "Faithful and zealous, but not a fanatic." "And abortions were less than five percent of the services provided," I replied. "Mike is a firm believer that health care decisions can _only_ be made between a doctor and patient," Sophia declared. "He insists nobody should interfere — not the government, not an insurance company, and not any church. I agree with him." We finished our meal, then headed to the Holiday Inn for our gig, reprising the set list from the previous evening. It was bittersweet, as it was the last time Robby and Sophia would emcee for us. At the end of our three sets, we brought them out and presented them with a check in the amount of our fees from both Goshen and Hayes County, something Kim had arranged and for which there had been no disagreement. "You guys are too much!" Sophia exclaimed. "Thank you!" "You're welcome!" Kim declared. We all hugged, then we played our encore, ending with Kari and me singing _Endless Love_. _May 13, 1990, Circleville, Ohio_ "How was it last night?" Kris asked when we woke on Saturday morning. "Bittersweet," I replied. "Sophia and Robby really appreciated the gift." "San Francisco is very expensive, from what I hear." "It is, as is Silicon Valley, which is where Stanford is. Katy Malenkov made that point when I saw her the last time she was home. She's paid a tremendous amount, but her housing costs are outrageous, so the salary works out to something similar to if she was here." "Did you confirm with Lara and Nathan for the 26th?" "Yes, and Jocelyn and Gene. All four of them will arrive by 4:00pm to help set up for the party. Nathan and Gene will run the grill. Your sister will watch the munchkins, right?" "Yes. She'll pick up Rachel from daycare while I'm at school. I'm going to nap as soon as I get home." "That makes sense. Do you want to stay home today? Rachel and I can do the grocery shopping." "If you wouldn't mind. Charlotte was very active last night, and I had a hard time falling asleep." "I don't mind at all. Rachel will enjoy Papa-Rachel time." "She certainly will! And I enjoy Kris-Mike time! Can we stay in bed until our little Tsarina wakes?" "Absolutely." We cuddled for about twenty-five minutes before Rachel came to the door of the bedroom and asked to use the potty. I took her, then dressed her, and once she was dressed, we went to get Kris. The three of us went downstairs, and I made breakfast. Once we'd eaten, I cleaned up, then Rachel and I went to Kroger and the bakery. She very much enjoyed our Papa-Rachel time, and when we arrived home, I played guitar for her. We had a quiet family afternoon, then attended Vespers at Saint Michael the Archangel. _May 14, 1990, Loveland, Ohio_ "Rachel, will you stand with me?" Angie asked when Rachel, Kris, and I walked into the narthex at Saint George in Loveland. "Papa?" Rachel asked. "You may," "Yes!" Rachel exclaimed. Angie took Rachel's hand and led her to the nave while Kris and I walked over to Sheila Nixon, Mikey, and Jeremy, who was now Sheila's fiancé. "Think my godson will stand with me?" I asked. "What do you think, Mikey? Go with your Godfather?" "Yes!" Mikey exclaimed. I took his hand, and he, Kris, and I walked into the nave, followed by his mom and Jeremy. Three and a half hours late, all of us were in the parish hall for lunch. Father Stephen came over to say 'hello', then Kris, Rachel, and I ate lunch with Angie, Mrs. Stephens, Sheila, Mikey, and Jeremy. "Have you set a date?" I asked Sheila. "September 1st. We had to find a possible Sunday that wasn't in the Nativity or Dormition fasts, and where our parents were available. Invitations are going out next week." "We'll be here." "Who said YOU were invited?" Sheila teased. "Well," I said with a sly smile, "given all church weddings are open to anyone, I technically don't _need_ an invitation." "Are there any girls you know who don't give you a hard time?" Kris asked. "None I can think of, including the Tsarina!" Everyone at the table laughed. "How does Rachel give you a hard time?" Mrs. Stephens asked. "By speaking French, which her aunt is teaching her." "«Oui Papa!»" Rachel giggled. {green}("Yes, Daddy"){/green} "As I said!" I chuckled. "Does she speak any Russian?" Mrs. Stephens asked. "She knows a few words, but mostly by osmosis. My sister-in-law gives me a hard time by teaching Rachel French!" "«Tante Lyuda est très intelligente!»" Rachel giggled. {green}("Aunt Lyuda is very intelligent!"){/green} "Seriously?" I asked as everyone else laughed. That, of course, only encouraged Rachel, and she mainly spoke French for the rest of the time at Saint George. I was actually impressed by how much she spoke, though for the most part, it was simple sentences that were intelligible without translation, given the sheer amount of French words that had been imported into English following the Norman conquest. We finished lunch, and with permission from Kris, Angie and I took a brief walk around the church grounds to talk. She was doing as well as anyone could expect at this point, though it did make me wonder what might have been had her psychiatrist not committed gross malpractice. It more than likely wouldn't have changed my situation, as Stefan was fairly certain Ohio wouldn't lift their restrictions on Angie without a long period of time elapsing, and perhaps not even then. After my brief walk with Angie, Kris, Rachel, and I left the church to head home, where my wife and daughter would both nap. _May 14, 1990, McKinley, Ohio_ "Is there any way I can work shifts after the 24th?" Mary asked on Monday morning. "Technically, no, given you won't be an enrolled medical student and your Residency contract is for June 1st. You could ask Doctor Wernher to change the contract to May 25th, but I suggest, strongly, that you take some time off. It's only a week, and you're not going to get a vacation for at least a year. And don't forget, you'll have six shifts a week. I took off nearly a month, though I did my paramedic ride-alongs during the time off." "I know. I just…you know what? You're right." "I know you're champing at the bit, but those six days off will do you good. I assume your family will be here for your graduation." "Yes. Mom, Dad, my younger brother, and a cousin. I wish we could get more than four tickets." "You and everyone else! I managed, but there were special circumstances." "I heard you carried Rachel with you to receive your diploma." "I did. She struggled through two years of medical school with me as what amounted to a part-time dad." "I still don't know how you did it, especially after what happened with your wife." "Faith, sheer determination, and a lot of help from my friends." "Are you coming to graduation?" "I wouldn't miss it for the world!" I was about to ask her to get a chart when Nate let us know that EMS was transporting two possible MIs. "Synchronized heart attacks?" I asked. "Two different runs – Squad 2 and Squad 4 — from different locations. You have Kellie as your nurse." "With an MI, I need a fourth set of hands." "Student nurse OK?" "Yes." "Jacqui." "Thanks." Mary and I grabbed gowns, gloves, and goggles and made our way to the ambulance bay. "You run it," I said. Mary acknowledged me, and we walked through the ambulance bay doors to find Ghost and his two students waiting. Kellie and Jacqui joined as, as did Ellie who was assigned to Ghost. As the first squad turned into the driveway, Ghost stated he'd take that one, and I'd receive the one following about a minute behind. When the second squad rolled up ninety seconds later, Rob jumped out of the cab. "Alfred Tate, fifty-eight. Collapsed at breakfast after reporting tightness in his chest; Reported diabetic; EKG shows ST elevations; PO₂ is 95% on five litres; pulse 114; BP 150/80; 250mg ASA IV push. Time from call to arrival, thirty-six minutes." The ASA treatment in the field was new, having only started as of May 1st, and according to Carl Strong, was already showing positive results, though long-term survival rates for STEMI were still abysmal. "Trauma 2!" Mary ordered. "Jacqui, O₂, PulseOX, and switch the EKG; Kellie, ABG, cardiac enzymes, and do a finger-stick glucose! Doctor Mike, Foley! Move, people!" The two paramedics and our trauma team quickly moved to Trauma 2, where Mary's orders were carried out, including me cutting away the patient's pants and underwear to insert a Foley catheter. "Glucose 270!" Kellie announced. "Confirm STEMI," I said, looking at the monitor as Mary completed her primary assessment. "Wide QRS complex." "Recommend streptokinase," Mary said. "Estimate weight at 114kg. Call for a cardiac consult." It was a bit risky, given we had no patient history, but I concurred that the chance he'd receive PCI inside the sixty-minute optimal window for angioplasty. "I concur," I said, moving to the phone. "Proceed!" Mary consulted a chart and ordered the streptokinase IV push. I called Cardiology and requested a stat consult, and let Mary know that Alana Pace was on her way. "What do you want to do about the blood glucose?" I asked Mary. "Nothing. Under 300 is acceptable in the ED and doesn't require intervention. It can be managed by Medicine or Cardiology." "Correct," I confirmed. "What else?" "He's had ASA and streptokinase, so it's up to Cardiology at this point." "Also correct." A minute later, Doctor Pace came through the doors with her medical student. "Morning, Mike! What do we have?" "Mary?" I prompted. "Alfred Tate, fifty-eight. Collapsed at breakfast after reporting tightness in his chest; Reported diabetic with glucose 270; EKG shows ST elevations; PO₂ is 93% on five litres; pulse 114; BP 150/80; ASA IV push in the field, streptokinase in the ED. ABG and cardiac enzymes ordered. Time down, approximately fifty-five minutes." Alana performed her evaluation and, as I expected, accepted the patient. She, her student, and Mary transported the patient to the cath lab. Mary returned about five minutes later. "Good job," I said. "You'll be ready for June 1st." "How does that work?" "Because you're a local student, you'll have a half-day with Human Resources to complete all your paperwork, get your ID, and so on. You can work that afternoon, but it isn't required. Out-of-town Residents have a full day of orientation, but most of them start July 1st." "I'll work." "Shocking," I replied with a grin. "OK to get a chart?" "Absolutely." _May 17, 1990, McKinley, Ohio_ "Happy birthday!" I said to Lara when she arrived at the hospital after school let out. "Thanks! And thanks for inviting me for coffee." "I figured if I tried to invite you for dinner, Nathan might put out a hit contract on me!" Lara laughed softly, "We are going out to dinner, but he's as much a pacifist as you are." "How are you doing?" "We're great! And you're going to have a godchild in about seven months!" "Congratulations! Late December?" "Yes. Not ideal, but nature is what it is." "Knowing you, it was not from lack of trying!" Lara laughed, "Perhaps." "How does that work with school?" "I'll take my maternity leave and then a sabbatical and return in the Fall. That makes it easier for the school, and honestly, I want some time with my baby. I made that decision while I was caring for Rachel. Those first six months are really important. Not that the next eighteen years aren't, but you know what I mean." "I do. I couldn't have done it without your help. You know how much I appreciate that." "I do! Just as much as I appreciate you saving my life!" I laughed, "Uh-huh." "OK, so maybe that's a tiny bit of exaggeration!" "A tiny bit. Do you have names picked out?" "Not yet, though either Nathaniel or Nathania for a middle name, pseudo-Russian style." "You?! Seriously?!" Lara laughed, "It was Nathan's idea, and I have no objections." "Who else knows?" "You're the first, after three sets of parents." "How did your stepdad take it?" "He's come around a bit, though you know his take on my life choices." "He missed the fundamental point that they're _your_ life choices, not his. It's the same problem my dad has, and to a lesser extent, my mom, at least in the past. And similar to Elizaveta's mom, depending on the topic. Fortunately, my new in-laws are not like that at all. I take it your biological dad is ecstatic?" "He is, and you know he supports me in making my own decisions, which, strangely, is what my stepdad claims to do." "People are inconsistent," I replied. "And often do the very thing they tell others not to do. Before I forget, do you want to tell others? I need to share with Kris, but we'll keep your secret if you wish." "You don't think Sophia and Robby will mind if we announce it at their going-away party on Friday, do you?" "I'm sure they won't." "That was a great gesture at the Prom. May I make an observation?" "Sure." "You and Kari are good, but nothing like you and Milena." "Nobody is like Milena!" I replied. "You two would have been awesome together if it weren't for Joel." "Actually, it was because of Joel we were so good together. Milena without her backstory is no more Milena than I would be without mine." "I hear you, but I think you understand my point about your connection." "I do. Speaking of connections — I saw Angie on Sunday. She took Rachel for the service, and it got me thinking about what might have happened. I could tell Angie was very happy, but also sad, if that makes sense." "It does," Lara replied. "But you know Ohio would have taken a decade to release her, if even then." "That was the same conclusion I reached. Even had she achieved her goal, my timeline was never going to be ten years, with no guarantee of success. And there were no interim solutions, given Angie couldn't even babysit Rachel on her own due to the State's determination. And I'm sorry to cut this short, but my break is over, and my med student is likely ready to send out a search party!" "The Viking princess?" Lara asked with a smirk. "That's the one! Blonde, blue-eyed, and of Swedish descent. She reminds me of me at the end of Fourth Year." "Champing at the bit and ready to be a doctor?" "Exactly. She won't have the autonomy I had because Doctor Wernher is a 'by the book' Chief." "You found a _modus vivendi_. Is it still working?" "Yes. It doesn't bother me, and he hasn't questioned my judgment in a negative way. He made a very good point the other day — the way things were would never in a million years have passed muster with the accreditation commission. Level I takes things to a whole new level, so to speak. The rules are very different. It's been quite the transition in fifteen years — regional medical center to Level II trauma center and next year, to Level I." Lara and I finished the last of our coffee, then left the cafeteria. I walked her to the main doors, we exchanged a quick hug, then I returned to the ED, where Mary was impatiently waiting to see another patient.