Chapter 50 — I Should Have Expected That Answer!

_September 18, 1989, McKinley, Ohio_

{psc} Band practice had gone well on Sunday, and I felt we were ready for the concert at Shaken Not Stirred. But that was Friday, and it was Monday, and I had to confront Krista about her lies to me. I'd decided on a plan and cleared it with Shelly, and now I was going to execute it. I received the patient handoff briefing from Kayla Billings, had a quick word with Kellie, then went to find Krista.

"I need a minute," I said to her when I saw her in the lounge.

I led Krista to the consultation room, but left the door open.

"I have sufficient information and evidence to be reasonably certain you've lied to me," I said. "I'm not going to debate you or get into an argument about that. What I am going to do is say this once, and only once — if, from this point forward, you lie, obfuscate, dissemble, or dissimulate, I will fail you. Period. And I'll make it stick. That's all. You're dismissed.

"But…" she began.

"You're dismissed," I said firmly, cutting her off. "Go."

Krista frowned and left the consultation room while I went to speak to Kellie.

"You observed that the door was open the entire time, right?" I asked.

"Yes," Kellie confirmed.

I nodded, then reached into the pants pocket of my scrubs and pressed 'Stop' on the pocket tape recorder Shelly Lindsay had provided when I'd seen her in the locker room upon my arrival. I hadn't told Kellie about the recorder, but I'd started it right before I spoke to her before meeting with Krista to provide a timeline and a witness.

The tape would never see the light of day unless Krista forced my hand. I didn't like the subterfuge, but Shelly had insisted I record the conversation, and after thinking about it, I had decided she was correct. What happened next was completely in Krista's hands, but I was resolute in my plan to fail her if I caught her being less than completely honest at any point during her trauma rotations.

I stopped at the clerk's desk to make sure there were no immediate needs from walk-ins, had a brief conversation with Nicki, then went to check on the two patients Kayla had handed over — a concussion who was being monitored and would be released, and a rule-out MI who was waiting on blood work. The concussion patient was ready to be released, so I filled out the discharge form and allowed him to leave. The blood work was not back for the MI, so after reviewing the EKG, I left the exam room.

"My office, please," Doctor Gibbs said as she walked into the ED just as I was taking a chart from the rack.

I put the chart back and followed her to her office.

"Is this about a clinical matter?" I asked flatly.

"Shut the door, sit down, and drop the attitude!"

I shut the door, but didn't sit, nor did I change my attitude. Rather, I said the Jesus Prayer forty times and kept my mouth shut.

"We have to find a way to work together," Doctor Gibbs said.

"I don't have a problem working with you," I replied.

"And the only way this can ever be solved is if I commit career suicide?"

I suppressed a strong urge to roll my eyes and took a few breaths before I responded.

"I don't believe saying something such as 'I agree with Doctor Loucks in principle, but I would have approached it differently' would be career suicide. Instead, you refused to lift a finger to back me up, and then agreed to unjustly monitor me and be a «стукач», which is best translated in this case 'rat fink' rather than snitch." ('stukach')

"You are insufferable," Doctor Gibbs said, sounding exasperated. "And I don't think that's a fair characterization."

"You are, obviously, entitled to your opinion," I replied.

"Damn it, Mike! Will you just stop? You're trying to score points and to intentionally piss me off."

"Right, because I shouldn't be bothered by you refusing to back me in front of Doctor Northrup on a topic about which I *know* you agree with me. Then, to twist the knife, you wouldn't even admit, privately and off the record, that you agreed with me in the past. How _should_ I have taken that betrayal? May I go treat patients, please?"

"Stop being an ass!"

"Grow a backbone."

"Get out of here," Doctor Gibbs growled.

I left her office and saw that Jake and Heather had arrived, so I asked them to get the first chart in the rack and let me know when he or she was ready to be seen. That was the first in a stream of fourteen patients we saw before lunch, a relatively busy morning, as Doctor Varma saw a similar number of patients.

There were a number of factors that had led to the increase in patients, and a major one was drugs. When I was in High School, just ten years previous, pot and alcohol were the drugs of choice, and it was rare to see, or even hear about, anyone using anything harder. Now, we were seeing a spate of cases related to MDMA, methamphetamines, and other drugs.

And it wasn't just the drugs, but the violence associated with the drug trade that had increased our patient load. I'd read that the police had discovered significant quantities of MDMA and methamphetamine in the room of the man who had shot Detective Townshend, along with several firearms and quite a bit of cash. What had started as a simple case of statutory rape had turned into a major drug bust, and it explained why the man had come out shooting. Detective Townshend had been discharged, but would likely be on disability for several months before he could return to work.

At lunch, I chose to eat with the surgeons, as Clarissa couldn't take her break, which was, in a way, my fault, as I'd sent her three admissions between 10:30am and 11:45am. When We finished eating, I spoke briefly to Shelly Lindsay to let her know what had transpired with Krista. I also let her know about the conversation with Doctor Gibbs.

"I'd cut Loretta some slack," Shelly advised. "She really can't take a position where she supports the surgical team over Emergency Medicine."

"Except it wasn't about that," I replied. "It was about supporting _me_."

"May I be blunt?" she asked.

"Yes."

"You're being naïve, Mike. Or maybe you've decided you can live in some fantasy world where internal politics simply do not exist, and no consideration has to be made for them."

"At the expense of patient care and medical training?" I queried.

"Aren't you the one who has said, time and again, that students have to find a way to learn from doctors who are poor teachers or who treat them badly?"

"And I am doing that. I will engage with Doctor Gibbs on any clinical or medical concern."

"Do you know the psychological concept of 'splitting'?" Doctor Lindsay asked.

"Yes. It's a defense mechanism that people use where they divide the world into 'good' and 'bad' and everyone goes into one category or the other, and there are no gray areas."

"And Doctor Gibbs is now…what's the name of the guy you joke about being slapped by Santa Clause for being a heretic?"

"Arius," I replied with a slight smile.

"Him. Or Judas Iscariot?"

"I don't believe that's what I've done," I countered. "I'm simply insisting that the relationship be purely professional."

"If you cut off every friend who ever, in your mind, does you wrong, you're going to be very lonely and become a bitter man. You admit you aren't perfect, Mike; don't demand others do what you insist you cannot do. You have a tendency to be like a dog with a bone on certain topics, and in many cases, that's a good thing. But finesse and subtlety are necessary to succeed.

"If you either cut off or piss off everyone, what possible good can come of it? Not only will you not achieve your goals, but you'll likely end your own career. I understand your righteous indignation, but when it becomes _self-righteous_, it goes too far. Take a cue from your heroes, and figure out a way to achieve your goal that doesn't involve burning down the hospital and your career with it. Neither of those things is in the best interest of your patients."

"All I can do right now is promise to consider what you've said," I replied.

"Be smart, Mike. Rome wasn't built in a day."

"And tolerating injustice only furthers injustice," I countered. "But I did hear everything you've said."

"Then find a balance that doesn't end with you losing everything. Going down in flames won't change anything, and, in fact, will make it less likely anyone will step up. Check in with me tomorrow, please."

"I will," I replied.

Shelly and I parted, and she headed upstairs for her next surgery while I headed back to the ED, where I was immediately called for a consult on a potential surgical case.

"What do we have?" I asked Doctor Nielson when I went into Trauma 2.

"Grady Brown, eighteen, tackled hard during a pick-up football game. Ultrasound shows free fluid in the peritoneum. BP 90/60, pulse 100, PO₂ 95% on nasal canula. Abdominal tenderness and visible contusion. Weak distal pulses in both ankles, slow cap refill."

"Sounds like a splenic rupture," I observed. "Given he's hemodynamically unstable, we'll send him up as soon as I verify the ultrasound findings."

"Grady, I'm Doctor Mike, a trauma surgeon. With your permission, I'll examine you and determine if you're going to need surgery."

"OK, Doc," he replied.

I performed a gross exam, finding the same symptoms Doctor Nielson had reported, then verified the free fluid in Grady's abdomen."

"Confirmed," I said. "Grady, you're going to need surgery. Janice, please call upstairs and book an OR."

Janice, Doctor Nielson's Fourth Year, went to the phone and made the call.

"They'll be ready in ten minutes," she reported when she hung up the phone. "The nurse said that Doctor Burke requested you and your Fourth Year scrub-in, as they're short-handed."

Which made sense, given Shelly had mentioned they had a full slate of scheduled surgeries for the afternoon.

"Perry, I'm going to call my students back from lunch, and we'll take the patient up."

"Thanks, Mike."

"Grady, in about ten minutes, we'll take you up to an OR."

"You're doing the surgery?"

"I'll assist," I replied. "I'm still training."

And I actually wouldn't get to do very much, as I'd be an extra pair of hands for Doctor Burke, but I wouldn't say that to Grady.

"How long does it take to become a trauma surgeon?"

"About twelve years, if you include four in medical school. And that's after an undergraduate degree."

"What about just working in the ER?"

"About seven years of training, including medical school," I replied. "But all of us will continue to learn for the rest of our careers because medicine is constantly changing."

"Thanks, Doc."

"See you in a few minutes," I said.

I left the room and asked Nate to page Jake and Heather with '99999' so they would come back right away. He did that, and about ninety seconds later, the two of them hurried into the ED.

"We have a surgical patient," I said. "Surgery is booked solid, so Jake and I will scrub in to assist Doctor Burke."

"Bummer," Heather groused. "Is there any way I can scrub in?"

"I can ask when we get upstairs," I said. "Did you guys actually get to eat any of your lunches?"

"I'd skip meals for a week to scrub in!" Heather declared.

"And pass out from low blood sugar in the OR," I replied. "But I understand the sentiment. If you didn't eat much, grab some peanut butter crackers or even a candy bar, we have about five minutes."

They both went to the supply room and got packages of peanut butter crackers, which would be enough to tide them over, and I let Doctor Gibbs know I was going up to surgery. Once my students had wolfed down their crackers, I had Heather get a gurney. Once she had done that, the three of us went into Trauma 2.

"Grady, these are my students, Jake and Heather. I need to go over the consent form, then they'll help you onto the gurney and we'll take you upstairs."

"OK, Doc."

I picked up the clipboard and began reading the consent statements, which were a list of potential negative outcomes, including death. Per policy, we had to read them and not try to couch or finesse them, though the document did say such instances were 'rare' and 'uncommon'.

"Do you have any questions?" I asked.

"How many lawyers did it take to create that list?" he inquired.

I chuckled, "Dozens, I'm sure. But, as the form says, significantly negative outcomes are possible, but rare. They do happen, which is why you'll need to sign the form."

He accepted the clipboard and signed the form, then Doctor Nielson and I both signed it as witnesses. I put the clipboard in the small rack on the gurney, then had Heather switch the nasal canula to a portable oxygen bottle. She did that, then she, Jake, and I helped Grady scoot onto the gurney.

Five minutes later, we handed him off to a pair of masked medical students and a nurse, then went to the scrub room.

"Doctor Burke, would you permit my Third Year to observe?" I asked.

"She's your student, so that's up to you."

"Thank you. Heather, do you remember how to scrub from your Preceptorship?"

"Yes."

"OK. Let's put on clean scrubs, then scrub in," I said.

Ten minutes later, the three of us were in the OR with Doctor Burke, three nurses, and an anesthesiologist.

"Mr. Grady, we're going to put you to sleep now," Doctor Burke said, then nodded to the anesthesiologist, who began the flow of drugs.

"He's out," Doctor Cromwell, the anesthesiologist, said.

"Thanks, Tom," Doctor Burke said. "Mike, you're officially second surgeon, but with limited time in the OR, I'll have you operate suction for me; Jake can hold the retractor. If everything goes well, I'll supervise you closing."

"OK," I acknowledged, then turned to my student, "Jake, step up to my left, please. Do _exactly_ as you're told, no more, no less."

"Absolutely, Doctor Mike!"

I could tell he was extremely happy to be able to participate, which was a very rare thing, and was only possible because of the full surgical schedule. The surgery was textbook, there were no complications, and as he'd promised, Doctor Burke walked me through closing the incision.

"Before you start, Mike, what's the difference between 'layered' closure and 'mass' closure?"

"Layered closure is the sequential closure of each fascial layer individually; mass closure is continuous fascial closure with a single suture. The two have relatively equal negative outcomes, so it's a choice by the surgeon. What's yours?"

"I prefer 'mass'," Doctor Burke said. "It provides even distribution of suture tension across the entire closure, and it's faster. 'Layered' closure provides better closure integrity, in that a single suture breaking won't allow dehiscence or a hernia, but those risks are minimal, making it a free choice. We'll use the small-bite technique; do you know that?"

"Yes. It means keeping the distance between the suture and the wound edge to between 5 and 8 millimeters, and the distance from stitch to stitch of about 5 millimeters."

"Then proceed. I'll act as assistant."

I nodded, "Nurse, Kocher clamps to Doctor Burke, please."

She handed them to him and he clamped the fascial layer midway through the incision and then applied tension.

"Zero PDS on a suture needle, please," I requested, saying a silent prayer of thanks that I had studied closure techniques regularly since my surgical Sub-I.

"I'll begin at the superior aspect of the incision," I said.

I passed the first suture through the vertex of the fascia, making a loop and passing the needle through the loop to lock the stitch, then ran a continuous suture, with each bite including tissue from the linea alba, the rectus sheath, and muscle itself, closing all fascia at once.

"Very nice technique, Mike," Doctor Burke observed. "How would you close the sub-cu layer?"

"A continuous suture," I replied. "With the same absorbable sutures."

"Then continue."

I completed that, then closed the skin with 3-0 nylon, which I preferred.

"Owen wasn't kidding when he said you were an ace at suturing," Doctor Burke observed. "An excellent job, Mike. Make sure you bring me your procedure book later. Tom, you can stop the sedation. Mike, if you and your students would escort Mr. Brown to recovery, I'll send someone to relieve you in a few minutes."

"We'll take care of it," I confirmed.

Heather, Jake, and I carefully moved Grady to a gurney, assisted by the nurses, and moved him to recovery. About five minutes later, two surgical students arrived to take over, so my students and I headed back to the ED.

"That was too cool for words!" Jake declared.

"Write it in your procedure book and I'll sign it," I said. "That'll improve your chances of holding retractors or even handling suction during your Sub-I."

"I am SO glad I didn't switch schedules!" he declared. "I'd never have had this chance with anyone else."

"Same here," Heather replied. "Just watching was pretty cool, though participating would be better."

"We'll see what we can do next year during your trauma Sub-I," I said. "I can't promise, because this doesn't happen very often, but as with today, it does happen."

"Now I just need a helicopter flight to basically cover everything," he said. "You're a qualified flight surgeon, right?"

"Yes, though there will be fewer opportunities in the future because once we're certified at Level I, we'll have literally everything except a major burn unit. That said, if you Match for trauma or internal medicine here at Moore Memorial, you'll do a week of paramedic ride-alongs."

"I heard Internal Medicine Interns are going to do rotations in the ED," Heather said.

"Yes, that starts next month. Paramedics are already doing their rotations to learn intubation, but they're being taught by Attendings."

We reached the ED, and Nate let us know there were several walk-in patients waiting, so I instructed Jake and Heather to get the first chart and call me when they were ready. We had a busy afternoon, and about 6:30pm, I took my dinner break when Clarissa was available.

"How was your day?" Clarissa asked.

"On the plus side, I closed after an emergency splenectomy this afternoon; on the negative side, I had another uncomfortable interaction with Doctor Gibbs this morning, and Shelly got on my case about it at lunch."

"You've decided Loretta is the enemy, and you won't even call her by her first name at this point!"

"You know I don't deal well with betrayal," I said.

"Obviously, but don't you think it's in your best interest to cut her some slack?

"And if she would, even now, acknowledge that she agreed with me before Doctor Northrup intimidated her into toeing his line, I would. I've given her ample opportunity to admit it, privately, and off the record, and every single time she deflects. I can't trust her, Lissa. What happens the next time I confide in her?"

"Would you cut me off that way?" Clarissa asked.

"No, because you would never betray me that way, nor would I you. Literally all Doctor Gibbs had to say was 'I agree with Doctor Loucks in principle, but I would have approached it differently', and that would have been sufficient. And now, I'm happy to work with her, but she's trying to be friends."

"Are you able to explain how you can be friends with Frank Bush, but Loretta Gibbs is now a sworn enemy? Murder is forgivable, but declining to back you on a policy issue isn't? Lisa Bush has a bad reaction in 1985 that _still_ has a majority of the country freaked out, and that's forgivable, but Loretta Gibbs isn't? There is something seriously wrong with you Petrovich. I mean that. You need to see someone and figure out what it is before it destroys you."

"There's nothing wrong with me," I protested.

"Call Father Roman, explain everything to him, and see what he says about your response to Doctor Gibbs. Seriously, Petrovich, you've forgiven Doctor Mercer, who hurt the person you love more than anyone in the world except your daughter, but you can't see your way to forgive Doctor Gibbs for what is at worst a minor slight? Mike, if you don't call Father Roman, I'm going to call Bishop JOHN."

"_Et tu, Lissae_?"

"Before I respond to that, why change my name?"

"You took Latin with me! In Latin, it's _Et tu, Brute_, because you have to decline the name Brutus, which is a second declension masculine noun, with the stem 'Brut'. In the vocative case, it takes an 'e' instead of 'us'. Your name ends in an 'a', so it's first declension, and in the vocative case, it adds 'ae' to the stem 'Liss'."

"And I remember almost no Latin except the words we use in medicine," Clarissa replied. "Back to what you said — you're comparing me to Doctor Gibbs and Brutus? Seriously? I do not get why this is the hill on which you've chosen to die. It makes no sense at all. I'm telling you as your best friend, and the future mother of your child, to make the call as soon as we finish eating. If for some reason I can't fathom, you won't do it for me, do it for Rachel."

"You're not going to leave me alone until I call, are you?"

"I'm not going to leave you alone until we find out what's wrong with you. I want you to have a complete physical as well. You haven't had one in quite some time."

"Where 'quite some time' is six months or so, since I saw him in February."

"You can do it voluntarily, or I can discuss it with Doctor Lindsay," Clarissa said.

"What is with you, Lissa?" I asked, exasperated. "Are you _trying_ to bait me?"

"Yes. Are you going to stop being my friend?"

"Is that what you want?" I asked, becoming annoyed.

"OK, now I _know_ something is wrong, Mike. If everything was OK, you wouldn't dare ask that question. Let me see your prescription pad, please."

"What the…" I asked. "You're joking!"

"Try me," Clarissa said flatly.

"I've written prescriptions here and at the Free Clinic. The serial numbers won't line up if you only pull the hospital records, and you can't get the records from the clinic for patient privacy reasons. I'll make you a deal — I'll take a piss test and let you draw blood for a tox screen, but when they're negative, and they will be, you drop this completely. And I mean not another word.

"Also, if you think I'm foolish enough to write myself a scrip, I'm not sure who you are and what you've done with my best friend, because there is something wrong with YOU if you think I'd _ever_ use drugs. I'd be equally offended if you accused me of cheating on Kris, but given my history of promiscuity, it would at least be a plausible accusation. And to answer that question before you ask it, the answer is an unequivocal 'no'."

"Well, _something_ has you behaving in a way that makes no sense, given everything I know about you. If it's not drugs or infidelity, then it has to be stress, and for whatever reason, you've taken it out on Doctor Gibbs. I reiterate what I said before — if you can be friends with Frank Bush, how you're treating Doctor Gibbs makes no sense at all."

"And I fail to see how I'm the one in the wrong here! YOU agree with me, but Doctor Gibbs stabbed me in the back. Or are you going to refuse to admit you agree completely with me about doctors and medical students?"

"Of course I agree with you," Clarissa replied. "You know that!"

"And I also know that Doctor Gibbs agreed with me until she was intimidated by Doctor Northrup. And _that_ is how the entrenched powers protect their position. Doctor Gibbs was the last person I thought would kowtow to the establishment, but even if that was a tactical move on her part, refusing to admit that she agreed with me, in private, and off the record, tells me that she no longer trusts me. And _that_ is a huge problem."

"She trusts your medical judgment," Clarissa countered. "And you trust hers."

"Yes, and that is sufficient to be colleagues. But if she can't trust me to keep a confidence, how can we be friends? That is the sticking point here, Lissa. You're mistaken in thinking something is wrong."

"Melissa Bush betrayed your trust."

"Did she? Really? We never trusted her, and she behaved exactly as we expected her to. I never trusted Frank Bush, and he certainly didn't trust me. Neither of them were ever friends, and I certainly wouldn't call Melissa a friend. Contrary to what you said before, I'm not friends with Frank Bush. I'm friendly with him, but not friends. Maybe that happens eventually, but you know the driving force there."

"Salvation."

"That's between him and God, as is «metanoia». My witness is only to God's love, something Frank Bush rejects as even possible."

"Which is, in your mind, the only unforgivable sin."

"I know I've said or implied that, but only because of the Western Christian notion of 'unforgivable' sins keeping us from 'heaven'. Nothing can prevent us from union with God except our own decision to refuse God's grace. As I've said before, God sends no one to hell, we send ourselves to hell, if that's our decision.

"But even that is in Western terms, because 'heaven' and 'hell' are not places, per se, in that they are separate, identifiable locations, with heaven being 'up', and hell being 'down'. You've seen the icon of the Last Judgment, which shows the river of fire, representing God's love. It's refining for those who love God, and torture for those who do not."

"The point remains, you see him as redeemable, and worth the effort, as you do Melissa, and others, including Tim Burg, Jack Strickland, and Krista Sandberg, but not Doctor Gibbs."

"Not true, Lissa! The _only_ thing Doctor Gibbs would need to do is acknowledge that before Doctor Northrup's intervention, she agreed with me. She's free to change her mind, and free to believe what she wants, but she's not free to pretend she hasn't changed her mind, not to mention her obligation to back her Residents. Could you imagine me behaving that way? Could you imagine _you_ behaving that way? Or Peter? Or Maryam? Or Sophia? And do I have to remind you that Doctor Cutter, Owen Roth, and Shelly Lindsay all backed me?"

"You have a point, but I still feel like something is wrong. 'Splitting' is not in your nature. I mean, seriously, you refuse to put anyone in the 'bad' category except Arius and Judas!"

"That's not quite accurate," I replied.

"I did forget Greenburg."

"I think you're missing the point here! I'm not putting her in the 'unredeemable' category. I'm simply choosing to limit my interactions with her to be strictly professional. In a sense, it's no different from how I interact with most physicians in the hospital. Your freak out over this is because I changed how I relate to her, not that I'm treating her any differently that I am, say, Doctor Baker or Doctor Rajaswaran. Heck, it's how I treat the other PGY1s in the ED, except for Kylie. I have a purely professional relationship with Fitzgerald, Lewis, Townshend, Lincoln, and Varma. And a host of other doctors in this hospital. You, Shelly, Carl, and Ghost are friends and confidantes. Doctor Gibbs was, but I can't trust her not to run to Northrup, despite the agreement between Northrup and Cutter."

"And that's politics, which you detest."

"Anything that interferes with patient care or training is a problem," I declared firmly. "And I'll be damned if I keep my mouth shut about it. No physician should! I have, and I will, ensure my opinions are expressed in a professional manner when in public or in a conversation with anyone who is not a confidante. But you know I can't keep silent in the face of injustice or about anything that harms patient care. We took an oath, even if it had its basis in one that invoked pagan gods!"

"I was both surprised and not surprised that you didn't have a problem with the Hippocratic Oath."

"Given it was only used ceremonially, it wasn't a big deal. And the version we had to sign used 'promise' not 'swear' and didn't have any references to pagan gods. The Hippocratic Oath is symbolic, and I treat it similar to the Scriptures — it has a message, and the message is the key, not the individual words. Back to the point at hand, do you agree I'm not mentally ill?"

"NO!" Clarissa declared mirthfully.

"I should have expected that answer!" I chuckled. "But you know what I meant."

"I still say there's something at the root of your behavior with regard to Doctor Gibbs beyond what you consciously know."

I shrugged, "Maybe, but it's not interfering with my relationships with my family and friends, nor is it causing me to not to be able to do my job. And contrary to what you said before, I have not chosen a 'hill to die on' except in the sense of setting a minimal action by Doctor Gibbs for me to consider her a friend, rather than my boss."

"Ouch. That's about the lowest thing you would say about someone!"

"That is where we are, and the ball is in her court. I'm not seeking confrontation, she is."

"But you give her a full dose of attitude when she tries to talk to you."

"Yes, I do, and perhaps that's a bit too much, but the point remains, she's trying to pretend nothing happened, and that is decidedly not the case. But this entire conversation has convinced me that I should call Doctor Mertens and press for the change in the medical student ethics code to make having sex while on shift an ethics violation. That will put an end to much of the shenanigans, and there won't be a damned thing Northrup can do about it."

"Because, you know, nobody could find another time and place to have sex!"

"It's not a full solution, obviously, but it does erect a barrier."

"Erect?" Clarissa smirked. "More like deflated!"

"Glad to see you climb down into the mud with the rest of us pigs!"

"Mud wrestling?" Clarissa smirked.

"Talk about mood swings! From threatening to go to the bishop to teasing me about sex! Does that mean you accept that I'm not suffering from mental or spiritual illness, at least with regard to Doctor Gibbs."

"I still think you should just let it go."

"I'd argue that I have, but she is the one who is trying to force things. If she simply interacts with me as a clinical instructor and the Chief Attending, there won't be any problems. It's the fact she's trying, in effect, to pretend nothing happened, or at least nothing important.

"I'm not kidding when I said that if she simply acknowledged, off the record, that she agreed with me in the past, that would be sufficient. She deflects every time. I won't go scorched earth, but I also won't pretend nothing has changed. I don't see how you, or anyone else, can argue that it's not a valid approach."

"I do think you should speak with Father Roman."

"Which I plan to do next month. My current schedule makes it difficult because I only have Sundays off. And it really won't improve for another three or four years, because my hours basically match what PGY2s are doing, and the following year, I'll have a typical Intern schedule, because it'll be the first year of surgical training."

"I wonder about that. You have chances to be involved in surgery already, things which a typical surgical PGY1 doesn't have. I suspect things might be different."

"You may well be right, but I can't count on that. Until I hear otherwise, I'm going to assume things will follow the protocols set forth when the new Residency was approved."

"What's the saying? 'No battle plan survives first contact with the enemy'? You've already seen changes, right?"

"True, though you never know what might happen due to the internecine warfare. That said, unless I totally miss my guess, Northrup will leave if he isn't appointed Medical Director."

"Do you think Doctor Gibbs will become Chief of Emergency Medicine?"

"No, I don't think so. Typically, it's a doctor in their 40s or 50s, and here it's mostly an administrative job, though I think a large part of that is the sheer amount of time he has to spend on the new trauma center."

"You felt he was a bureaucrat before that."

"Except I've come to realize that there was no before, really. The project started five years ago, before we even entered medical school. Granted, I think he wants to be an administrator, but even if he didn't, I can't imagine how much time the project has consumed and will consume before it's finished. And that's why I don't think Doctor Gibbs would want it, even if they offered it. Once the new trauma center is completed, then it's a different story."

"Won't it hurt to lose him, then?"

"I have no clue how the upper level of hospital leadership works, beyond knowing the chain of command and their ostensible duties. And I really don't care, either. I'm sure there are contingencies, and I suspect Viktor and the other members of the Board are prepared for them."

"I suspect you're right."

"Are you satisfied?" I asked.

"Along with every other woman you ever took to bed!" Clarissa smirked.

I rolled my eyes theatrically, "I meant that I'm not _completely_ out of by gourd."

"Provisionally, yes, though I reserve the right to confront you when I think you're acting out of character."

"I wouldn't have it any other way, Lissa!"

We finished our meals, left the cafeteria, and Clarissa headed upstairs to Medicine while I returned to the ED. As I walked, I mulled over the conversations I'd had with Shelly and Clarissa and reviewed the events of the previous week. I was reasonably certain I hadn't done anything out of line, even if I had pushed the edges of the envelope.

"Mike," Nurse Angela said when I walked into the ED, "I was just about to page you. Doctor Mastriano needs you in Trauma 3."

"What's the situation?"

"A recalcitrant five-year-old," she said with a smile. "He is completely uncooperative and is refusing to let Doctor Mastriano examine him."

"Complaint?"

"Febrile, cranky, and his mom reports he's not eating properly."

"OK, thanks," I said, and went into Trauma 3.

"Hi, Isabella; Angela said you needed me."

"Doctor Mike, this Mrs. Larson and her son, Kenny. Mrs. Larson reports Kenny has a fever, has been irritable, and hasn't been eating. I haven't completed a primary exam because he's emphatically refused to cooperate."

"Thanks, Isabella. Mrs. Larson, does Kenny see a pediatrician regularly?"

"Once a year, for his normal checkups."

"Has he had all the recommended vaccinations?"

"He has," she confirmed.

"When did he become more irritable than the usual five-year-old boy?"

Mrs. Larson laughed softly, "I like how you put that! He's usually very active and is what they call 'one hundred percent boy', much to the annoyance of his older sister."

"I had a younger sister who was likely equally annoyed with me, just as my daughter is annoyed with her male cousin. Did anything out of the ordinary happen recently?"

She shook her head, "No. He came down with the fever on Saturday, and I gave him Children's Tylenol, but he still has the fever and he wouldn't eat lunch or dinner today, so I brought him in."

"No health issues of any kind?"

"None."

I nodded, pulled up the stool, and sat down near the chair where Kenny was sitting.

"Hi, Kenny; I'm Doctor Mike. Will you tell me what's wrong?"

"NO!" he declared emphatically, crossing his arms.

"I know you don't feel well," I said. "If you talk to me, I can make you feel better."

"NO!"

I could tell I wasn't going to make any progress with words, so I decided to resort to outright bribery. I had to make a guess, but I knew nearly every kid liked Life Savers, so I pulled a roll from my fanny pack and offered it to Kenny. He eyed me suspiciously, but then accepted it, and I knew I had him.