Chapter 23 — A Nerf Bat and an Olive Branch

_July 18, 1989, McKinley, Ohio_

{psc} "Get any sleep?" Clarissa asked when we met for breakfast very early on Tuesday morning.

"About thirty minutes before the smoke inhalation victims you accepted, and about thirty minutes after. You?"

"About an hour before you called. After that I was caring for those two. I also spent some time in the ICU because all three of those patients are Medicine patients."

"How's the dad?"

"So far, so good. Jacobs from Pulmonology will evaluate him in about an hour. His monoxide levels have come down, and his PO₂ is at 92%. He inhaled a lot of particulate matter and probably some toxic fumes. The other four are in much better shape, and the mom and eldest son will be out of the ICU this afternoon."

"Good."

"Anything else interesting?" Clarissa asked.

"A subarachnoid hemorrhage that Neuro took. That one didn't look good at all."

"Gorked?"

"I'd say that's the odds-on bet," I replied. "I don't know what the CAT scan showed, but the physical signs were indicative of a major bleed. How is the hypertensive crisis?"

"One foot in the grave. Both feet if he doesn't quit smoking, limit his drinking, change his diet, and exercise. We got his BP out of the stratosphere, but it's still too high."

"And it'll stay there, as you say."

"I just don't get it!" Clarissa said, shaking her head. "If you know it's going to kill you…"

"Because if that's what you've done for your entire adult life, change is hard."

"You'd think staring death in the face would be sufficient."

"You would, but we know it's not. Let's be honest, my behavior during the interregnum was irresponsible and dangerous, given the prevalence of HIV and other 'gifts that keep on giving'."

"I wonder what the incidence of STDs is at Taft."

"That would be a question for Trina at the Free Clinic," I replied. "I bet she could tell us. But I was extremely lucky."

"I never did know the exact body count…"

"Somewhere around fifteen, I think, not counting you or Lara. I was a bit out of control."

"Given what you went through, you were far more in control than out of control. Sure, you had a lot of sex, but you cared for Rachel, graduated first in our class, passed your exams, Matched, and found the perfect partner in crime for the rest of your life."

"Which doesn't excuse my behavior."

Clarissa rolled her eyes, "Did _any_ of those girls feel used? Heck, did any of them feel anything other than expertly fucked? It might be different if you had lied to them or abused them, but name ONE girl you went after. Just one!"

"You."

"Very special circumstances, and we'd been together before. Besides me? Heck, you lusted for Tasha, and she had to basically drag you to bed! You couldn't even get up the courage to ask her for a date in High School despite the fact you both wanted to fuck each other half to death!"

"Angie."

"Again, special circumstances, but she was already after you when you spoke to her. The guys pointed out she was interested."

"By the way, speaking of Angie, Doctor Mercer called last night."

"Uh-oh."

"She said she wanted to apologize. We're supposed to speak tomorrow."

"Interesting. I assume you'll accept her apology?"

"Assuming it's sincere, of course I will. But I also have to be careful because of the complaint that was filed against Doctor Greenberg."

"What are your plans for tomorrow?"

"A day with Rachel," I replied. "It's basically the only time I have with her when it's just the two of us. I'm not sure what we'll do, well, once I speak to Doctor Mercer in the morning."

"Is Rachel here?"

"No, she's with Anna today so she can play with her girl cousin and hide from her boy cousin. I'll stop by and get her on my way home."

We finished our breakfast and Clarissa returned to Medicine while I headed back to the ED.

"You two should grab your breakfast before the morning rush," I said to Mary and Tom.

They left, and I sat down in the lounge with Doctor Varma.

"Mind if I ask where you're from?"

"Sunnyvale, California," Naveen replied. "My dad works for Apple Computer. You're from around here, right?"

"One county over. I went to Taft and McKinley Medical school. You?"

"UC Berkeley, then OHSU School of Medicine in Portland."

"How'd you end up here?"

"My fiancée is working on her PhD in biochemistry at OSU. I interviewed at six hospitals and Moore Memorial was my second choice, but I have no complaints."

"Doctor Varma?" Nurse Alice called from the door to the lounge. "EMS four minutes out car versus pedestrian. Doctor Nielson needs your assistance."

"Coming," he replied. "Sorry, Mike."

"Duty calls," I replied.

He left and about two minutes later, Tami McCarty came into the lounge.

"I came down to take a woman in labor up to Labor and Delivery and wanted to say 'hi'."

"Hi. How have you been?"

"Good. I started in OB full time on June 1st. How is Rachel?"

"Growing like the proverbial weed! Walking, talking, and generally acting like a toddler."

"I heard you married in January."

I nodded, "I did. A girl from the Russian Cathedral in Columbus. She's majoring in Political Science at OSU."

"Mike?" Nurse Jenny said, coming into the lounge. "Walk-in with near-syncope and nausea."

"My students are at breakfast, so I'll need a nurse, please."

"I'm all yours!" Jenny declared. "We brought the patient into Exam 2."

I excused myself, then got up and followed Jenny to the exam room, taking the chart from the rack and scanning it. The name was uncommon enough that I made an assumption which was proved correct when I walked into the exam room.

"Good morning, Detective Tremaine," I said. "Doctor Mike Loucks."

"I remember you from a case about six years ago. A missing student."

I nodded, "You interviewed me in the disappearance of Angie Stephens. What brings you here this morning?"

He smiled wryly, "I was at the coffee shop having doughnuts with my partner, felt light headed, and felt as if I was going to throw up. The nauseous feeling passed but not the light-headedness, and my partner insisted on bringing me in."

Correctly speaking, it was 'nauseated' but I didn't feel it was the time or place to correct him.

"I'll dispense with the cop and doughnut jokes," I said with a smile. "Are you armed?"

"Yes."

"Would you please remove your firearm so we can do the exam? I don't need to take it, but I don't want to take any risks, even with the safety on. Well, a safety assuming it's semi-auto, not a revolver."

"I carry a Glock 9mm," he said, removing the shoulder holster. "Where should I put it?"

"The nurse can put it on the counter for you."

He handed it to Jenny, and she set it on the counter.

"No vest, right?"

"No."

"Then if you'd take off your jacket, loosen your tie and unbutton your shirt, I'll examine you."

I did the basic exam and found nothing remarkable, so my first impression was likely some kind of viral infection or inner ear disorder, but I had nothing on which to hang my hat.

"Have you had any medical procedures? Even minor ones?"

"A colonoscopy about three years ago, but that's it other than my annual physicals."

"Have you recently had a head injury of any kind or been in a fender bender?"

"No."

"Do you smoke?"

"I quit about five years ago using the _Kojak_ method. My dentist hates it, but it worked."

"I'd trade cavities from lollipops against lung cancer or emphysema any day. Do you drink?"

"A beer after work most days, but just one. An occasional glass of whisky."

"Exercise?"

"The gym three times a week, mostly for cardio, recommended by my doctor. Something about sitting on my ass six or more hours a day."

"Any headaches?" I asked.

"Off and on for years, and aspirin always worked. My doctor advised cutting back on caffeine, so I drink decaf half the time and that's helped."

"How much coffee do you drink?"

"All of it!" he chuckled. "I always have a cup."

"How's your diet, besides the police breakfast?"

He laughed, "Believe it or not, we only get doughnuts once a week. Usually it's a sit-down breakfast. Eggs, bacon, and either toast or waffles."

"And otherwise?"

"Too many burgers and fries," he said. "My doc got on my case about that, but the exercise has taken off some of the weight I put on."

"How much?"

"Gained ten, took off five."

"Over what period did you lose that weight?"

"About two months."

"Any changes in frequency of urination or significant changes in bowel movements?"

"No. Thank God I'm not getting up every two hours to take a leak like my dad."

"Any trouble performing in the bedroom?"

"According to me? No."

Jenny laughed, and I chuckled.

"Have you ever had dizzy spells before?"

"No. First time."

"Any vision changes?"

"A new prescription in May."

"And before that?"

"At least five years."

"Presbyopia?" I asked.

"Sorry, I don't know that word."

"Literally it means 'elder eyes'. Did your prescription change in general, or is it for reading?"

"These are progressive bifocals and I needed them for reading."

"Fairly common for men over fifty," I observed. "Any problems with your hearing?"

"According to whom? My wife? My captain?"

I chuckled, "I was thinking more about doctors."

"No."

"Tinnitus or 'ringing' in your ears?"

"Twice, when I've had to fire a gun without ear protection."

"When was that?"

"Once as a patrol officer about thirty years ago, once eight years ago."

"How long did the tinnitus last?"

"Less than a day both times."

"Any changes in how you feel during your workouts? Changes in your breathing? Or trouble walking or standing?"

"No. None of those."

"OK. The next thing we'll do is draw blood. Are you still feeling light-headed?"

"It's not as bad when I'm lying down, but yes."

"Jenny, nasal canula, please, then draw blood for a CBC, Chem-20, ABG, cardiac enzymes, and metabolic and glucose panels."

"Right away, Mike."

"Detective, I'm also going to get an EKG."

"OK. Mind telling me what all those other tests are?"

"A CBC is Complete Blood Chemistry and looks at the number and types of cells in your blood; Chem-20 measures twenty different components of blood, including calcium, sodium, and electrolytes; ABG is arterial blood gas and tells us about oxygen and other gasses in your blood; cardiac enzymes are markers for heart attacks, though I don't think you're having one; the metabolic and glucose panels tell us how your body is processing glucose and eliminating waste, as well as your cholesterol. The nasal canula is oxygen, and that's simply out of an abundance of caution."

"What do you think is wrong?"

"This is the shotgun approach to non-specific syncope — fainting or lightheadedness — and nausea. The most common diagnosis with those symptoms is a virus or a mild inner ear disorder. The challenge is that neither of those can be directly diagnosed in most cases, so we run all the tests to rule out the other things."

"So, like eliminating suspects?"

"Something like that, yes."

"You understand why we liked you for that disappearance, right?"

"For the same reason," I replied. "With the basic information, you look for reasons why it's not the boyfriend with whom the young woman had a fight before you'll stop thinking it's the boyfriend. And the reason is, that more often than not, it actually is the boyfriend. So, in that sense, it's the same way we deal with differential diagnosis. Let me get the EKG pads on you and Jenny will draw the blood."

Ten minutes later, the blood was drawn, and I had five minutes of EKG strip which showed no specific anomalies, his pulse was 75, his BP was 120/70, and his PO₂ was 99%.

"Everything looks good so far," I said. "Would you sit up and tell me how you feel?"

He did, and I could tell he was still suffering from lightheadedness.

"My head spun a bit, and I felt queasy," he reported.

"OK. At this point, just relax and we'll wait for the blood work to come back. Jenny, I, or one of my students, will check on you while we're waiting, and if you need anything, just press the purple button on the wall there."

"Thanks, Doc."

Nurse Jenny and I left the room, and she touched my arm.

"Care to explain?" she asked.

"A young woman with whom I was close disappeared after we went jogging. It turned out, when all was said and done, she was diagnosed with schizophrenia, but nobody knew it at that point. It was no fun at the time, but Detective Tremaine was doing his job."

"How is she?"

"Medicated, but able to work a data entry job, go to church, and practice Aikido."

"That's better than many."

And it should have been even better, but I didn't want to get into a lengthy discussion about Angie with anyone not directly involved.

"It is."

"What do you think? I mean, about the detective?"

"Exactly what I said — the probable cause is a virus or inner-ear disorder."

"And if it's not that?"

"Any other diagnosis is pure speculation," I replied. "Let's wait and see if we find any clues in his blood work. Get that blood to the lab and we'll see what they say. Actually, here come Mary and Tom, so you can have Tom take the tubes to the lab."

She handed Tom the tray, and I filled Mary in on the case and asked her to check on Detective Tremaine every fifteen minutes until the blood came back.

"If there are no clues in the blood," I asked as we went to the lounge, "what would you do next?"

"Well, from what I've been taught, there's no reliable way to prove it's a virus or inner ear disorder, so with normal blood chemistry, you have to be thinking about the possibility that it's a tumor or some kind of neurological problem, including an aneurism, stroke, or some other problem."

"Yes. And?"

"EEG, CAT scan, or lumbar puncture would be the next diagnostic steps, so a Neuro consult."

"What about monitoring and if it resolves, streeting him with a referral to his family physician?"

"You're worried about the cost of the tests if it's simply viral?"

"I don't give a fig about the _cost_ of the tests, but a CAT scan induces significant ionizing radiation and a lumbar puncture is very uncomfortable at best."

"We were warned in practice of medicine about the cost to the hospital of advanced tests."

"Well, I know the cops have good insurance, so it's not the hospital that would be on the hook, but even then, I don't care. That's for the bean counters. If I think a test is warranted, and it's not against standard hospital practice, I'm going to run it. If it is against standard hospital practice, then I'm going to be…"

I paused to see how they would respond.

"A forceful advocate for your patient," Mary said, completing the thought.

"Yes," I confirmed. "What do we do if the blood tests are all negative diagnostically?"

"Did you do reflex and muscle tone tests?" Mary asked.

"No. That would be the next step before a consult."

"He had good distal pulses, right?" she asked.

"Yes, and he's about twenty pounds over his ideal weight, but he's in good shape for fifty-three. And if the reflex and muscle tone tests are diagnostically negative?"

"EEG, because it's non-invasive and doesn't use ionizing radiation."

"And if that shows nothing?"

"Then one of the invasive tests."

"Or street him," I said.

"That seems counter to your usual thinking," Mary protested.

"Now, why might I do that?" I asked.

Mary laughed softly, "Devil's Advocate, right?"

"The question is whether or not you can defend your decision. You haven't seen me have a strong disagreement with an Attending over a diagnosis, but they do happen, and you have to be able to defend your position and support your conclusions. Think about the M & M."

"Have you had those disagreements?"

"Not specifically adversarial, but differences of approach and opinion. In the end, the Attendings make the decision on how to proceed, and you have to consider how hard you want to push and how certain you are that you're correct. And that was why it was legitimate for Mastriano to question me and override me."

"But she was wrong."

"Yes, but at the time, I couldn't prove I was right. That said, I was concerned enough about her decision that I had her write the order on the chart."

"So she couldn't deny it later, right?"

"If you are ever told by anyone, including me, to do something you believe is wrong, make sure it's in writing."

"You would listen."

"That's true, but that doesn't mean I'd agree with you, nor does it mean I'm going to be right every time. Don't put me on too high a pedestal, because I won't survive the inevitable fall."

"So, what will you do?"

"Neuro consult," I replied. "It's the ED equivalent of dropping back ten yards and punting. I don't have the experience to diagnose the kind of thing we're discussing, and neither does Doctor Gibbs. We'll punt it to Neuro and let the experts decide the next steps. And don't be surprised if Doctor Gibbs suggests streeting him with orders to take it easy for a few days and follow up with his physician."

"She seems more like you than like Mastriano."

"Yes, but the difference is Attendings _do_ have to care about allocation of resources, and also have a lot more experience than we do. Yes, Doctor Gibbs has only been out of medical school for six years, but those six years are huge. Think about what you've learned in the last six weeks, then multiply that out."

"Got it. Let me go check on the detective."

I nodded, and she left, returning about five minutes later, along with Tom.

"No change," she said. "EKG still shows sinus rhythm, vitals are good…sorry, pulse 72, BP 120/70; PO₂ 99% on nasal canula."

"Then we wait for the blood work."

"Mike?" Ellie said from the door to the lounge. "Doctor Gibbs needs you. EMS three minutes out with car versus pedestrian."

"Another one?" I asked.

"Bad day to walk the streets of McKinley, I guess."

"Thanks. Mary, Tom, let's go."

The pedestrian's injuries were serious, but not life-threatening, and he was admitted to Ortho with a badly broken leg. I'd sent Mary to check on Detective Tremaine twice, and the lab results had come back just before we transferred the accident patient.

"Nada," Tom said. "Everything is completely in range across the board."

"Anything close to the limits?" I asked.

"No. All mid-range. Basically textbook readings."

"Mary?"

"Neuro consult for sure."

"I agree. Let's present to Doctor Gibbs and see what she says."

We went to the Attendings' office where Doctor Gibbs and Doctor Mastriano were speaking, and I waited until Doctor Mastriano was finished. She gave me a hard look as she left, but I simply ignored it.

"What do you have, Mike?" she asked.

I presented the case and gave my recommendation.

"Why?" Doctor Gibbs asked.

"Otherwise generally healthy male with no obvious indications of the source of the problem. If this were May, I'd attribute it to the new glasses. If this were immediately after he quit smoking, I'd attribute it to nicotine withdrawal and changes in hemoglobin and pulmonary function associated with inhaled carbon monoxide, tar, and nicotine. If he'd eaten something out of the ordinary, I'd attribute it to that. That leaves us with 'probably a virus' or a generic Ménière disease diagnosis."

"Neuro is going to push back."

"Entirely possible," I replied. "But I don't feel comfortable streeting a patient who has sudden-onset symptoms with no discernable cause."

"Why not wait and see?"

"Krissy Sumner," I said.

"You've lost me," Doctor Gibbs said.

I smiled, "Burnt toast."

She cocked her head, then nodded, "Your very first day here when you were a First Year."

"How many times was she sent away?" I asked.

"Enough. I'm sure you remember the exact numbers."

"We diagnosed her brain tumor on visit _nineteen_ and she'd seen eleven different doctors over three years."

"Call for your consult," Doctor Gibbs said.

I handed her the chart, she made a notation and signed it.

"So, did I?" I asked when she handed me the chart.

"Did you what?" Doctor Gibbs asked.

"Make a decent doctor?"

"Get the hell out of my office!" Doctor Gibbs said, laughing. "Shoo!"

Tom, Mary, and I left, and as soon as we walked into the corridor, Mary put her hand on my arm.

"What did I miss?"

"I'll explain after we speak to Detective Tremaine and call for the consult."

We went to Exam 2 and after a quick check of the monitoring equipment, I explained the situation.

"So, with nothing we can point to, I'm going to call in a neurologist," I said.

"To look for what?"

"The cause of your symptoms. If you had any hearing trouble, I'd start with an ENT, but without that, a neurologist is the best choice."

"What will they do?"

"Decide what additional tests to run. I could order them, but I'd need them to sign off, so it's easier just to call for a consultation."

"Fess up, Doc. What are you looking for? Give it to me straight."

"I could be a smart ass and say 'the cause of your symptoms', but I know that's not what you mean. There are any number of things that could cause this, besides the ones I mentioned. Anything from having hit your head on one end to a tumor on the other. But please don't jump to any conclusions."

"I said I hadn't hit my head."

"Believe it or not, even a minor bump, something you don't even think about, could cause a hematoma, that is, bleeding in your brain. Small ones generally resolve on their own. The same is true with a very mild concussion, which could happen even if you don't fall, if your head snaps quickly one way or the other, again, perhaps without you even realizing."

"Huh. I was rough-housing with my grandson yesterday. He's three, and he hit me with a Nerf bat."

"That may well be it," I said.

"You're joking!"

"Not at all. Any kind of blow to the head, including from a three-year-old terrorist with a Nerf bat, could do it."

He laughed, "Terrorist?"

"You do know the difference between terrorists and toddlers, right?"

"Yeah, I've heard that one! And he is fearless."

"Let me call for the neuro consult, but I think we have an idea as to what caused your symptoms."

"I am going to get SO much shit at work, if that's the case."

"Consider the alternative," I said with a smile.

"Yeah, I suppose being beaned by a toddler with a Nerf bat beats a tumor or stroke or whatever!"

I had Tom place the call, and Rebekah Cohen came for the consult, concurring that it was most likely the blow from the Nerf bat, and prescribed forty-eight-hours of rest and follow-up with his physician. I went over the discharge notes with him, reminding him to come back to the hospital immediately if the symptoms worsened. Once he was discharged, Mary, Tom, and I reported to Doctor Gibbs.

"What Lesson did you learn, Mary?" Doctor Gibbs asked.

"That patients don't always volunteer relevant information. Doctor Mike asked about injuries, including head injuries, but the patient denied them."

"What _should_ I have asked," I prompted.

"If he'd suffered any blow to the head of any kind."

"Very good," Doctor Gibbs said. "Tom, what should you do if you think Doctor Mike has missed something?"

"Ask him, privately, about it."

"Correct. Dismissed."

The three of us left the office and went to the lounge.

"What was I just saying?" I asked.

"But the patient didn't answer correctly!" Tom protested.

"Mary?"

"He answered the question Doctor Mike _asked_, not what Doctor Mike actually wanted to know."

"Bingo," I said. "How you ask the question is important, and I should have asked about even a slight blow to the head. The patient should have told us; why didn't he?"

"Because it was a Nerf bat and nobody thinks those can harm you."

"Especially wielded by a toddler," I replied.

"So what was the 'burnt toast' thing?" Mary asked.

"On my very first day of my first Preceptorship, when Doctor Gibbs was a PGY2, we had a Frequent Flier who had previously come to the hospital eighteen times over the course of three years, always with varying complaints. Each time she was given an analgesic or released without treatment.

"Eleven different doctors saw her over that period of time, and none of them sat down with all her charts and put all the pieces together. I asked Doctor Gibbs to ask the patient a single question, based on something I'd read when I was researching my friend's illness. The answer 'burnt toast' was the diagnostic symptom that pointed to a brain tumor."

"WHOA!" Tom gasped. "It was missed?"

"Mary?"

"No continuity of care. They stressed that in Practice of Medicine. She wasn't seeing her own doctor, was she?"

"No. And with all records on paper except billing, there was no easy way to find and compare all those charts. I sat down with all of them after the fact and found the pattern, but it took significant time. The new computerized system will help, but that's coming with the new ED so it's still a couple of years away before it's populated with enough data."

"But why did nobody else figure it out?" Tom asked.

"Confirmation bias," I replied. "With nothing provable, and repeat visits, they classified her as a 'Gomer' and treated her as such."

"'Gomer'?" he asked.

"'Get out of my ER'. I use 'frequent flier' because it's not as derogatory, but it's the same idea. You will see patients who present simply because they want attention or have some imagined illness or are mentally ill. They thought that patient, Krissy Sumner, was mentally ill, but she refused psych consults and they had no plausible reason to put her on a psych hold."

"You remember her name?"

"She was my very first diagnosis! I know a few other names, but they were special cases. You heard what triggered Doctor Gibbs' memory — the smell of burnt toast. That phantom smell, together with that of burning rubber, are signs of a brain tumor. And to complete the story, it was after that diagnosis that Doctor Gibbs said that if I continued along those lines, I might make decent doctor."

"And she ran you out of her office because your ego doesn't need a boost!" Mary said mirthfully.

"Your evaluation is still pending, Missy!" I said with a grin.

"Says the doctor in surgeon's colors!"

I chuckled, "As you've noted, I'm not a big enough prick to be a surgeon, but I do have the ego necessary to do it."

"Why do you say that?" Tom asked.

"It takes a strong, confident person, with a very positive self-image, to cut into bodies to fix them. But that doesn't make me into some kind of god as some surgeons think of themselves. I put my pants on one leg at a time like everyone else, and I nearly soiled my underwear when the helicopter had the mechanical malfunction."

"I can't believe Kellie's response was to calmly say 'we have two engines'!" he said.

"The Navy will do that to you," I replied. "Do you know the most dangerous workplace in the world?"

"Coal mine?"

"Deck of an aircraft carrier. It's only because they are so highly trained and skilled that there aren't more injuries or fatalities. I mean, would you go stand on a runway at Port Columbus while a plane was taking off or landing?"

"Hell no!"

"Those sailors do that every day, with multiple launches per day. Personally, I'll stick to medicine."

"What about the helicopter?"

"I'll get on the next one without even thinking about it. And as much as I know Mary won't like to hear this, if we have another run in the next ten days, you'll go with me."

"I'm not sure I can do that," he said."

"Your call, but I think you should."

"Mike," Nate said from the door to the lounge, "several walk-ins in the waiting room. Doctor Gibbs said to ask you to see them."

"Thanks, Nate."

I used the facilities, washed my hands, then Mary, Tom, and I went to see the patients. A steady stream kept both Naveen and me busy until lunch, which I ate with Ghost and Doctor Gibbs, then returned to the ED to find my two Second Years waiting. They shadowed us for the afternoon, with a mix of EMS transports and walk-ins, but nothing life threatening or all that interesting. At 6:00pm, I signed out and left the hospital.

"How are you, Mike? Viktor asked when I arrived at the house to pick up Rachel.

"Tired," I replied. "But I'm getting used to it, so it's not as bad as the first week. How are things with you?"

"I'm enjoying my three grandchildren and Geno is handling most of the day-to-day at the family businesses. I know this is probably a foolish question, but any chance you could play a round of golf?"

I shook my head, "I have so little time, so no. Between my shifts and sleeping, I only really get to see Rachel on Wednesdays, Saturday mornings, and Sundays. I see Kris less, because she's at school on Wednesdays."

"I heard you were on the helicopter that had engine failure last week."

"I was, but we all came out unscathed, and it was on the return flight, so no risk to a patient."

"I'll let you get Rachel, but we'd like you to come to dinner in the next few weeks."

"Let me speak with Kris and I'll get back to you."

We went to the living room and Rachel squealed and hurried over to me to be picked up.

"How's my little girl?"

"Playing!" She exclaimed. "Viktor loud!"

I laughed, "Little boys are like that.'

"Big boys, too!" Anna said with a smile.

"Shall we go home to Mama?" I asked.

"Yes! And «tante» L'dmila!"

"She's probably not there," I said, causing my daughter to pout.

We left the house and headed home.

_July 18, 1989, Circleville, Ohio_

"Hello!" I called out when I carried Rachel into the house.

"Hi!" Kris said, coming out of the kitchen.

I put Rachel down so Kris and I could hug and exchange a quick kiss. I went upstairs and changed into shorts and a t-shirt and then went back downstairs. Rachel demanded to be picked up, so I scooped her into my arms and carried her to the kitchen.

"Did Doctor Mercer get in touch with you?" Kris asked as she put the finishing touches on dinner.

"Yes. I couldn't speak too long because I was on shift, so I'm going to call her tomorrow morning."

"Do you know what she wanted?"

"She said she wanted to apologize, so we'll see."

"Did she tell you what Lyudmila said?"

"No. She didn't mention anything."

"I was putting Rachel in her crib and Lyudmila answered the phone. Doctor Mercer asked if Lyudmila was your wife and my little sister said you only wished you'd married the better sister!"

I chuckled, "She was only fourteen back in January, so that wasn't even an option!"

"And the 'better sister' comment?"

"What is it with you and Lyudmila suddenly in competition?" I asked.

"Love «tante» L'dmila!" Rachel declared.

"So?" Kris asked with her hands on her hips. "Better sister?"

"You, of course!"

"Well said!" Kris declared and turned back to the counter.

"In all seriousness, it feels as if something has changed."

"Not really," Kris said. "It's just that Lyudmila feels comfortable around you. She's always liked to tease, but at first she wasn't sure how you'd react so she was careful about it. She said things privately to me. And you know that's how Chloé and I were with each other. Does it bother you?"

"Not if it doesn't bother you. Rachel certainly loves her."

"How were things at the Kozlovs'?"

"Fine. Viktor invited us to dinner, but I put him off saying I needed to discuss it with you. I think no sooner than a few weeks from now."

"I think that's wise. How tired are you today?"

"It's not as bad as the past two weeks, and I did catch a few very short naps overnight."

"Oh, before I forget, Jocelyn and Gene will be here a week from Sunday, along with Tasha and Chris, and Sophia and Robby. We'll be at the wedding this Sunday, so I rescheduled."

"Great! I miss the Sunday dinners that we used to have before…everything changed."

"That was with different couples, though, right?"

"Subdeacon Mark and Alyssa and Elias and Serafima. And we do need to have them over at some point."

"Why not alternate Sundays?" Kris suggested.

"If that works for you, it works for me, though we'll need to take into account seeing our parents, too."

"Maybe one dinner a month with each group?"

"That sounds reasonable."

"Dinner is ready. Please get Rachel in her high chair."

We had a nice meal, and as I wasn't feeling completely dead on my feet, I helped Kris clean up, played my guitar for about twenty minutes, we said evening prayers, and I turned in as soon as we put Rachel to bed.

_July 19, 1989, Circleville, Ohio_

On Wednesday morning, I was awake before Kris needed to leave for OSU, so we said morning prayers and had breakfast together. Once she had left, I played my guitar for Rachel until just before 9:00am.

"Daddy needs to make a phone call, so I hope you'll play quietly."

I put Rachel on the floor with some toys, then picked up the receiver on the new cordless phone Kris had purchased and dialed Doctor Mercer's office number. I had to wait a minute before she came on the line and used that time to say the Jesus Prayer to keep myself in the right frame of mind.

"Hi, Mike."

"Good morning, Doctor Mercer," I replied evenly.

"How are you?"

"Other than being generally exhausted from my shifts, fine. Rachel is doing well, and Kris and I are happy, minus the fact we can't spend as much time together as a family as we would like."

"How does it feel to be a doctor?"

"Satisfying, I suppose, is the best answer. I was provided with so many opportunities during my clinical rotations that the change wasn't night and day as it is for some."

"That makes sense. As I said on Monday evening, I want to apologize."

"Is this apology about Angie?" I interrupted.

"Yes…"

"And is it unequivocal, unqualified, and with no caveats?"

"Will you at least let me say what I want to say?"

"You're the one who said, quite clearly, that we had nothing to speak about if I insisted on those conditions. My position has not changed. The ball is in your court."

"Still as inflexible as always."

"On this topic? Yes. And you know why."

"I do," Doctor Mercer confirmed. "Mike, you were absolutely right with regard to Angie. She showed clear signs of improvement and the correct course of treatment was the one you were following. I was wrong to try to defend Doctor Greenberg with statistics and the literature. What he did was indefensible, and I'll say that in a letter to the Medical Licensing Board."

"I accept your apology," I replied. "Let me supply you with Tom Kirkland's number. He's the attorney handling the complaint to the Board."

"I have it. I was sent a copy of the complaint because I was named in it, though no formal accusation was leveled against me."

"I never thought you should be brought before the Board," I said. "My beef with you was your defense of Doctor Greenberg despite all evidence pointing to clear malpractice on his part, and the way you defended him."

"I really am sorry, Mike, and I hope you can see that I had no real choice but to report Angie's statement to Doctor Greenberg."

"I understand that, as I understand that Father Stephen had to tell you, because Angie said something outside of confession. My only question to you is how hard you pushed Doctor Greenberg to not tell Angie that what she wanted was impossible?"

"Not hard enough, obviously."

"What will your letter say?"

"In effect, what you said — that allowing Angie to continue with her efforts, while potentially fruitless, could not have led to a worse situation than the one created by Doctor Greenberg when he told her it could never happen, thus depriving her of some amount of time where she didn't need drugs, though knowing how long that might have been is impossible."

"Will you call it for what it is?"

"You mean use the term 'malpractice'?"

"Yes."

"No, but I will say that he discounted clinically significant behavior."

Which, in the end, was the same thing, but couched in words that he'd made a bad judgment call. I felt it was more than that, but having Angie's counselor, a licensed clinical psychologist, say it was bad judgment was a huge win, and would put Doctor Greenberg in an untenable position.

"That's sufficient for my purposes," I replied.

"I'll call Mr. Kirkland this afternoon. I'd like to have lunch with you, if you're open to the idea."

She'd extended the olive branch, and I couldn't, in good conscience, slap it away.

"I am, though it would have to be a Wednesday, but not next week, as I already have plans."

"That's fine. What about two weeks from today? We could meet in Rutherford, if that works for you."

"That would be more convenient than coming to Milford."

"Shall we say Lou's in Rutherford at noon on August 2nd?" Doctor Mercer asked.

"That sounds good. I'll see you then."