Chapter 63 — Everyone Has to Start Somewhere

_November 19, 1989, Circleville, Ohio_

{psc} On Sunday, after the Divine Liturgy, we skipped lunch with the congregation to head home so that Lyudmila and I could set up for a gathering to celebrate Kris' birthday. It was a day early because I had to work until 9:00pm on her actual birthday, so, similar to Holy Week services, we were celebrating the feast 'by anticipation'.

"What do I need to know about your sister's friends who are invited?" I asked, as we worked together in the kitchen.

"They are pretty, friendly, and intelligent, same as me!" said with a smile.

I laughed, "Good to know! What are they studying?"

"Marlene is pre-law and Beth is studying computers. They both have boyfriends, and both went to High School with my sister. The boyfriends' names are Karl and Ted."

"Thanks."

"Is anyone I don't know coming?"

"No. Ghost and Oksana, Joel, Milena, and Abigail, Clarissa and Tessa, Loretta and Bobby. And your parents, of course."

"I believe I've met them!" Lyudmila declared with a silly smile.

"No boyfriend?" I asked.

"I think my dad would be upset if my mom brought a boyfriend!"

I laughed, "I mean _you_!"

"Really?" she smirked. "No. My sister scooped up the handsome doctor! Of course, he might be a little old for me!"

"Just a bit," I chuckled. "Serious question, though."

"There are one or two guys at the cathedral who might be interesting."

"And if they're anything like I was, they're scared to death to ask you out. You might want to make the first move."

"You were scared?"

"To death! Tasha was the most beautiful girl I knew, she was interested, and I was more afraid than a mouse in a room full of cats!"

Lyudmila asked, "Boys can be pretty dumb!"

"Your brother-in-law included!"

"He appears to have outgrown that, or else my sister would never have married him!"

"I think you might want to ask her," I chuckled.

"No, it's Clarissa who thinks you haven't grown up!"

"She knows me too well!"

The party came off without a hitch, and once we'd had coffee, cake, and ice cream, our guests left. I read to Rachel, the three of us said evening prayers, and then we put Rachel to bed.

"I'm not suggesting anything, but when do you have a chance to change your schedule?"

"In January for February and March. Why?"

"When you couldn't join us in a toast at dinner, it felt uncomfortable."

"Not for me," I replied. "My rule is imposed on me, not on anyone else. Clarissa didn't drink, either, because we didn't eat until 6:00pm. Does it bother you that much?"

"It just feels uncomfortable."

"Because of something I've said or done?" I asked. "If so, I apologize."

"No need to apologize, Mike. I wasn't saying it to be critical. We need to be able to discuss things without becoming defensive and without you instantly taking blame for something where there is no blame to assign."

"I'd say I was sorry for apologizing, but that would go against what you just said!"

Kris laughed softly, "Cute. I don't think we have any major areas of disagreement, do we?"

"Minus card-carrying, flag-waving socialism?" I asked with a smile to show I was teasing.

"Well, yes, except for that! But you are coming around!"

"As if," I chuckled. "While I may agree with you on certain aspects of social democracy, I believe private ownership of property is the correct approach. Or do you think this house has living space for thirteen families?"

"You say that as if I should know what it infers."

"It's from _Doctor Zhivago_. In the film version, when Yuri returns home from World War I, he finds a Resident's Committee has been established and that other families now live in his house. The Chairwoman of the Resident's Committee says there was sufficient space for thirteen families, and Yuri pretends to agree by saying it's a 'better arrangement' and 'more just'."

"And you disagree, of course."

"I was more offended that they renamed Holy Cross Hospital to the Second Reformed Hospital. Then again, I could argue that Soviet Communism is what you get if you apply Reformed ideas to the Orthodox Church!"

"OK, I have to hear how THAT could possibly be true!"

"Well, let me ask you this first — what's the point of Lenin's mausoleum and tomb? Not the obvious one to most people, but the meaning that Orthodox Christians would understand?"

Kris thought for a moment, "Incorruptibility. Like the saints' bodies, which are reported to be incorrupt."

"Exactly. Now, consider the May Day parades and what they reflect."

"Paschal processions, replacing Jesus and the saints with Lenin and Stalin."

"Yes, so the Party seeks to replace the Church, but rather than offering grace and love to all, they only offer it to the elect."

"And we've agreed that the Soviet Union isn't socialist!"

"Except in _Zhivago_ that was before the complete corruption of the local soviets by Lenin and Stalin. They were converting private property to public property and distributing scant resources as best they could. Remember, Yuri came home between Russia's withdrawal from World War I and the beginning of the Russian Civil War. So, Yuri was actually commenting on socialism as _you_ define it, before it became a Stalinist personality cult."

Kris laughed softly, "Who knew Mike Loucks was so informed about Russian politics!"

"You can thank my grandfather, who rejected the Tsarists and Bolsheviks, and supported, as I've said, a liberal platform, as Europeans mean 'liberal' — right of center. But the point is, do you agree we shouldn't own a house, cars, or any other property?"

"No, but I do think the means of the production should be held in public trust, not privately."

"And we're going to go around in circles, because the major industries in this country _are_ owned by the public trust, usually via pension plans or retirement systems. Soon enough, we'll own shares via a mutual fund. And it's not as if our workers aren't compensated for their labor. Elias makes more than I do as a journeyman electrician! Tessa makes more than I do as Assistant Director of the Emergency Communications Center."

"And the robber barons?"

"Have all been dealt with! Standard Oil, AT&T, and others have been broken up. The technology moguls I read about all have become rich by having a good idea and convincing others to invest, and have made many others rich! The system works, and social democracy, that is, shared services and a safety net, are a far better answer than what amounts to nationalizing industry. That has worked SO well everywhere it's been tried!"

"Don't look now, but you're having a political discussion!"

"I'm having an _economics_ discussion! Pretty much everyone in the US is capitalist, except maybe a few people in Milwaukee or Madison and Bernie Sanders! Our political argument is how best to provide the safety net and which shared services are handled at which level — local, state, or federal. Even Ted Kennedy isn't arguing for remaking the economy after a socialist pattern."

"And yet, there are so many people exploited by capitalism!"

"And those numbers pale before the number of people subjugated by 'state socialism'!"

"Personality cults!"

"And yet, they're the only examples of socialism in the world. That system _always_ devolves into a cult of personality. We in the West reserve that for movie stars, musicians and athletes!"

"Sadly. We should probably go back to the original question."

"I like my current schedule as it allows me to work one day a week at the Free Clinic, I'm home every night, and I can attend services on Wednesdays, Saturdays, and Sundays. That said, if something would work better for you and Rachel, I'll obviously consider it."

"I know you'll have a similar number of hours for next year, but what about when you begin your surgical training?"

"I wouldn't be surprised if I didn't have a similar schedule so that I can cover the ED during the day, and the new trauma surgery Interns will cover nights and weekends. Doctor Cutter is already ensuring I have opportunities to be in surgery, though those are limited at the moment. During PGY3, I'll have more, but that means being there during the day to train. But all of that is speculation. I think, ultimately, my response is there is no need for you to feel uncomfortable. If you want the symbolism, white or purple grape juice will work."

"I probably should have approached it differently."

"No, you approached it exactly right because you conveyed what you were thinking and we've had a good discussion, even if we followed rabbit trails."

"There's another thing bunnies do we could follow!" Kris said invitingly.

She didn't have to ask twice. I scooped her up with a stifled squeal from her, and carried her up to bed.

_November 20, 1989, McKinley, Ohio_

"Hi, Nancy," I said when I walked into her room late on Monday morning.

"Hi, Mike!" she exclaimed. "I hear you saved my life! Thank you!"

"You're welcome! I wouldn't go quite that far, though I did get a good look at your insides!"

"Did you really stick a needle into my heart?"

"No! The needle went into the pericardium, which is a sac around your heart. There was an accumulation of fluid that was causing an irregular heartbeat, and I aspirated it. The chest tube, which went where you now have the drain, was to re-inflate your lung. And the surgery was to fix some bleeders and a liver laceration. How are you feeling?"

"Like I was hit by a truck! Matt told me the police cited the other driver."

"Good."

"How badly was he injured? Nobody here knew."

"A broken ankle and bumps and bruises. I was happy to see Matty!"

"He's a handful already, and he's only three months old!"

"Rachel was a handful then, but just wait until he's mobile! And worse, when he learns to say 'no'!"

Nancy laughed, then grimaced, "Please don't make me laugh! It hurts."

"I bet. Did they give you any guidance as to when they'll spring you?"

"Wednesday, so I can be home for Thanksgiving. They put casts on my leg and arm earlier today, but because I had what they called an 'open procedure', I need to stay until Wednesday, at least."

"Unfortunately, we can't use laparoscopy in emergency surgery at this point because speed is usually of the essence. Eventually, we probably will. How have you been otherwise?"

"Good. I enjoy managing the Quick Mart for Mr. Sokolov. You know he's mostly retired, right?"

"Yes. You know it'll probably be at least six weeks before you're allowed to go back to work, right?"

"Yes. Mr. Sokolov was here yesterday to see me. He's scrambling a bit, but he interviewed some Taft students this week to cover the shifts. He'll be in the store more, obviously. How are things with you?"

"Good. I love my work, I love my wife, and I love my daughter. Despite the things that have happened, I'm a very lucky man."

"It's good that you can have a positive outlook after what had to be a nightmare."

"I learned quite a bit about myself, and the world, and was able to bond with Rachel in ways that otherwise wouldn't have happened. That doesn't take away the pain or sadness of losing Elizaveta, but life has to go on, if only for Rachel's sake."

"What will you tell her?"

"The truth," I replied. "Probably first when she's around five, though I'm pretty sure Elizaveta's mom has already said something to Rachel."

"She's two, right?"

"Yes, so she probably doesn't understand. Anyway, I need to go back to the ED."

"ED?"

"Emergency Department. What you probably call the ER."

"Yes. Isn't that what it's called?"

"By the public, yes, and that's a remnant of the days when it was literally a room near the entrance to the hospital staffed by the surgical team. Think _Emergency_ or _Medical Center_."

"Ah, OK."

"I'll come see you again before you're discharged."

"Thanks, Mike. Matt, Matty, and I owe you, big time."

"You're welcome."

I said 'goodbye', left her room, and returned to the ED.

"How is she?" Clarissa asked when I walked in.

"In good spirits, but in pain, as is to be expected. No neuro deficits at all, but she has to have a whopper of a headache. They're thinking about discharging her on Wednesday so she can be home for Thanksgiving, but she'll need the cervical collar for another week, and they cast her left arm and left leg, so six weeks or so there."

"Doctor Mike, we're ready," Nicole announced.

I nodded and followed her into an exam room.

_November 23, 1989, Thanksgiving Day, McKinley, Ohio_

One significant downside of being a PGY1 working in the ED was no holidays off. And me being in the hospital allowed the entire remainder of the surgical staff to take the day off, though Nelson Burke was on call, and lived just four minutes from the hospital. My grandfather had arranged for a family gathering on Saturday evening, to which everyone was invited, and he'd obtained «ekonomia» from Vladyka JOHN to have our Thanksgiving celebration that day.

As was typically the case on Thanksgiving, the morning was extremely quiet, with only a handful of walk-in patients and only a single EMS run. That began to change just after noon, and at 2:00pm, things became crazy.

"EMS transporting five injured in some kind of cooking accident," Teri, the clerk, said. "First squad is five minutes out."

We were shorthanded for that, with just one Attending, three Residents, and seven medical students. I was positive we'd need help, but that was up to Isabella Mastriano.

"Cooking accident?" Doctor Mastriano asked. "Five people?"

"That's what they said," Teri replied. "Severe burns and lacerations."

"What the heck?" Clarissa asked.

"Got me," I replied. "No clue!"

"Teri, call for a surgeon and two Residents from Medicine, please," Doctor Mastriano instructed.

"I'll call Doctor Burke," I said. "He's at home, five minutes away. I'm the only surgeon on duty."

"We're screwed!" Clarissa teased.

"Love you too, Lissa!"

I went to the phone and dialed Doctor Burke's number. He answered on the second ring and I explained the situation. He swore, but said he'd be at the hospital in five minutes. I hung up, then hurried to the ambulance bay to join Isabella, Susan Townsend, Clarissa, six medical students, and four nurses.

"Nelson will be here in five minutes," I said. "How do you want to handle this if the Medicine Attendings don't arrive?"

"We'll assess as they come in. You run triage, Mike, and if there's a clear surgical case, you take it, and Sophia and Kent will handle the least injured patient. The other doctors should be here by then."

The plan went sideways as soon as the first squad pulled up and Roy jumped out.

"Two patients; both severe burns and shrapnel from an exploding turkey fryer."

"Say what?!" Isabella interrupted.

"They tried to deep fry a frozen turkey. Patient one, approximately forty-five-year-old male; oil burns over forty percent of his body, including his face; aluminum shards embedded in his chest and face; BP 140/90; tachy at 120; PO₂ 96% on canula; 10 megs morphine; GCS 6; IV saline."

"Trauma 1!" I ordered. "Clarissa, Marv, Emily, Kellie, with me!"

Emily was Clarissa's Third Year; her Fourth year, Kent was going to have a baptism by fire, together with Sophia.

"Clarissa, intubate; Marv, monitor, no EKG due to burns; Emily, Foley, then notify the burn unit; Kellie, stat ABG, Chem-20, CBC! Roy, any name?"

"No. Everyone present was injured, and we didn't look for ID."

Roy, a fireman, and my team rushed the patient to Trauma 1 and quickly moved him to the trauma table. I grabbed surgical scissors and carefully cut away the patient's shirt, though some material was stuck to his skin and would need to be debrided.

"There's a six-inch, jagged shard of aluminum in his left pectoral muscle," I announced.

"The one in his cheek penetrated into his oral cavity," Clarissa replied. "It's going to interfere with the tube."

"Marv, find Doctor Burke!" I ordered. "Lissa, keep him on the canula for now; his PO₂ is 95%."

"He'll lose his airway," she countered.

"I can't remove the shard," I replied. "I'm not cleared for that procedure."

About thirty seconds later, Doctor Burke came into the room.

"What do you have, Mike?"

"Aluminum shards in chest and cheek; I'm not cleared for those procedures. The one in the cheek penetrated the oral cavity and is interfering with intubation."

"I'll walk you through it," he said. "Bullet?"

"Approximately forty-five-year-old male; oil burns over forty percent of his body; BP 120/80; tachy at 120; PO₂ 94% on canula; 10 megs morphine in the field; IV saline."

"We'll need tin snips, a pair of hemostats, two-by GELFOAM, a needle driver, and 4-0 nylon."

Marv and Kellie retrieved the things we needed and set everything on a tray.

"Do you know the theory for this type of wound?" Doctor Burke asked.

I nodded, "Grasp the metal via the oral cavity with a hemostat, cut the metal as close to the skin as possible, trimming any part that might catch. Once that's done, pull it gently into the oral cavity, then out the mouth."

"Correct. Use the GELFOAM inside the cheek to control bleeding into the oral cavity, then dress the exterior cheek and intubate. Plastics can clean it up later."

"Doctor Mike," Sophia said from the door. "We need help."

"Clarissa, go!" I directed. "Marv, carefully grasp the aluminum protruding into the oral cavity with a hemostat and hold it steady; Emily, same with the external metal."

They did what I asked, and I used the tin snips to cut the aluminum as close to the skin as I dared, leaving as little metal as possible. I carefully pulled the metal through his cheek, extracted it, and dropped it in a basin. I placed the GELFOAM between his teeth and cheek, then quickly moved to perform the intubation and hook up the vent.

"Good bi-lateral breath sounds," Doctor Burke announced once I had the vent connected.

"What do you want to do about that metal in his chest?" I asked.

"We'll need a portable chest to assess. Keep him hemodynamically stable and continue fluids, checking electrolytes. I need to call in at least one team. Let me check with Isabella and I'll come back with a plan. Did you call the burn unit?"

"Isabella did as soon as we knew we had burn patients."

"Are you cleared for performing an escharotomy?"

"I've participated, but don't have a sign-off. I know the technique and the procedure."

"You're cleared to perform an emergency escharotomy on this specific patient if necessary."

"OK," I replied.

He left and I set about doing a thorough exam now that the patient had a secure airway. Whatever he and his family or friends had been doing had ruined not only his Thanksgiving, but that of the doctors and nurses who would be called in. Things would change in the near future, though, because to be a Level I trauma center, we'd need at least one full surgical team in the hospital at all times. While I was conducting the exam, the patient's PO₂ rose to 99%, indicating no lung damage.

"Marv, check his pocket for ID, please."

He did that and retrieved a wallet.

"William Brown, forty-six," he announced, and Kellie updated the chart.

"Do any of you know about 'deep frying' a turkey?" I asked Marv, Emily, and Kellie.

"I think it's just what it sounds like," Kellie said. "Instead of roasting it in the oven, you have some kind of large metal container with hot oil, you know, like for French fries, and cook the turkey in it."

"Roy said it was frozen," Emily observed. "If so, I suspect that's what caused the explosion. Think about how the oil bubbles when you put frozen fries in, then imagine something with the mass of a turkey."

"People keep finding new and interesting ways to injure themselves," I said, shaking my head.

"Think we'll need to fly this one to Columbus?" Kellie asked.

"No. The burns are bad, but not life-threatening. Emily, call the lab, please. I need electrolyte levels."

She went to the phone and Doctor Gibbs came into the room.

"Everything OK in here?" she asked.

"Yes. Isabella called you?"

"Yes. Burke is calling in two full surgical teams. Is your patient stable enough for transport?"

"I'm just waiting on the 'lytes."

"They're all in range," Emily announced.

"Exact numbers, please," I requested.

She gave them to me and they were, indeed, in range.

"He can go up anytime," I said.

"OK. Get him on a portable vent and I'll have Deb Atkins take him up. I can't let you leave the ED because we're overloaded."

"Understood. I'll get him on the portable vent and monitor."

Marv, Emily, Kellie, and I did that, and a minute later, Deb Atkins, a Medicine PGY1, came into the room. I informed her about the situation, updated the chart, then instructed Marv to get a gurney. He did that, and once we transferred the patient to it, he accompanied the patient to the OR with Doctor Atkins.

"Doctor Mike, do you have a name for that patient?" Deputy Turner asked.

"William Brown," I said.

"Thanks," he replied, making a note in his notebook.

"Does he have family in the waiting room?"

"No. I think the entire family was involved in the incident."

"OK."

I went to check on Clarissa and found Doctor Gibbs was with her, so I went see Isabella, who was just getting ready to send her patient up to the OR. I gave her an update, and she asked me to see if there was anyone in the waiting room who needed immediate attention. I went to the clerk's desk and checked the three charts, finding nothing that needed immediate attention and informed Isabella.

"Relieve Clarissa, and she can start seeing walk-ins."

"Loretta is with her," I replied.

"OK. Check with Sue and if she doesn't need help, you can see walk-ins."

"Will do."

I checked with Sue Townsend, but her patient was lucky, and only had burns similar to grease splatter across his arms, chest, and face. She didn't need help, so I grabbed the first chart in the rack, quickly skimmed it, then had Emily bring in the patient while I went to the locker room to relieve myself. Two minutes later I joined Emily and Kellie in Exam 2.

"Doctor Mike," Emily said, "this is Meghan Doyle, who is twenty-three. She presents with a hand laceration resulting from trying to catch a dropped knife."

"Not my smartest move," Ms. Doyle said.

"We'll get you fixed up! This is a teaching hospital, so I'd like my student to evaluate your injury, propose treatment, and then perform the treatment. I'll be here the entire time and watch. You're free to refuse, but I'd encourage not to."

"She's done this before?"

"She's a quarter of the way through her clinical training," I replied. "That's after two years of intensive classroom study, which also involved practical training such as suturing."

"OK," Ms. Doyle agreed.

"Emily, H&P, assess, and report, please," I instructed.

She performed a textbook H&P, then examined Ms. Doyle's hand.

"I believe the correct treatment is topical antibiotic, three Steri-Strips, and update tetanus."

I examine Ms. Doyle's hand, then nodded, "I concur. Ms. Doyle, you don't need sutures, so our nurse is going to put three Steri-Strips on your hand. They're surgical tape and are more effective because they won't pull the way sutures would if you flex your hand. Once that's done, she'll administer a tetanus shot, as you said, your last one was when you were sixteen, which is more than five years ago."

"I thought it was every ten years," Ms. Doyle countered.

"That's the norm," I replied. "But anytime you have an injury such as this one, we like to give a booster if it's been more than five years."

"OK," she agreed.

I asked Emily to get the next chart, then updated Ms. Doyle's chart, wrote out the discharge instructions, and then left the room, giving Kellie permission to release Ms. Doyle.

The rest of the afternoon was a slow trickle of kitchen injuries, a suspected heart attack, and several cases of severe indigestion which were mistaken by the individuals as heart attacks.

At 6:00pm, things were calm enough that all the doctors went to the cafeteria to have a turkey dinner. I got mine and sat down next to Clarissa and across from Isabella and Sue.

"Those clowns sure wrecked a bunch of Thanksgivings," Sue commented. "Two full surgical teams, two burn specialists, Doctor Gibbs, and probably others."

"One of the firemen said this kind of thing is happening all over the country," Clarissa said. "Supposedly, some newspaper in the South ran a recipe about five years ago, and it's taken off."

"Leave it to the rednecks!" Sue said, shaking her head.

"Where are you from, Sue?"

"Maine. Right near the Canadian border. You?"

"One county west."

{_ "Doctor Mastriano, ED stat! Doctor Isabella Mastriano, ED stat!" _}

"Ugh, she groaned. "Sue, can you put the rest of my meal in a 'to go' container for me and bring it when you come back to the ED?"

"Sure thing," Sue agreed.

Isabella got up and left the cafeteria, and the three of us remaining ate quickly, as there was a chance we'd be needed. Just over five minutes later, we were all back in the ED. I checked the board, and Isabella had a rule-out MI in Trauma 1, and there were two walk-ins waiting, which Sue and Clarissa took. I went to the lounge and sat down next to Sophia.

"You should get your meal," I said. "When you finish, Marv can take his."

"OK," she agreed. "Thanks."

The rest of the evening was relatively quiet, and I only saw four more patients before my shift ended at 9:00pm.

_November 25, 1989, Rutherford, Ohio_

On Saturday, Kris and Rachel were waiting for me at the hospital when I finished my shift so we could drive to Rutherford to join my grandparents, parents and their new spouses and children, my sister and her family, and my in-laws. My grandfather had arranged to use a banquet hall to meet, but the food was catered by Lou's Diner, which mainly focused on Italian food, but always served American holiday fare on major holidays.

The food was excellent, and the time with family was awesome, and because I had far more than twelve hours before my next shift, I had a glass of wine at dinner, and drank a vodka toast with my grandfather and father-in-law.

"How are things going at the hospital, Mike?" my grandfather asked.

"I'm very much enjoying being a doctor, but I can do without the hospital politics. Worse is having to deal with students who aren't really qualified to be doctors."

"How do they get that far?" Ignatiy asked.

"It happens when they transition from classroom and lab learning to clinical rotations. In nearly every case, it's someone who is extremely intelligent and very good at book learning, and to whom college and the first two years of medical school came easily."

"You graduated highest in your class, and your friends right behind you, and you're all doctors."

I nodded, "The classroom work didn't come easily for any of us. We studied, then studied more, then studied even more. I still study. I'm not denying I was a good student, but it wasn't easy."

"What is the difference, then?"

"I'd have to say it's a mix of things, really, and it's hard to know until the student struggles with clinical work. Some learn and graduate, others fail. It's one of the many things that can knock you out. The biggest challenge, the one that knocks out the largest percentage, is cadaver lab during First Year. It knocks out anywhere from ten to twenty percent of a class."

"That's happened to students you're training?" my grandfather asked.

I nodded, "Yes, but partly because they assign me the students who are seriously challenged by clinical rotations. I've had success with some, but others have left the program, voluntarily or not."

"Why you?" Ignatiy asked.

"The senior physicians believe I'm a good teacher, and I salvaged a student while I was in my last year of medical school. All junior doctors teach, it's part of the job, but some are better teachers than others."

"New doctors teach students, and senior doctors teach you?" my grandfather asked.

"Yes. And the teamwork is one of the things I enjoy most; well, after healing the sick."

"Is it OK to change the subject?" my grandfather asked.

"Of course, «Дедушка»," I replied.

"His Grace mentioned you're involved in prison ministry."

I nodded, "I am, but I was trying to keep it low key."

"Why is that?" Ignatiy inquired, "if it's OK to ask."

"I'm actually focused on one specific inmate at Southern Ohio Correctional Facility. It's the man who murdered my friend three years ago."

"I was unaware," Ignatiy said.

"It's not something I talk about. Kris is aware, obviously."

"I didn't mean to pry," Ignatiy said apologetically.

"It's OK," I replied

I provided a brief explanation of the circumstances, which my grandfather knew, and was happy when Ignatiy changed the subject once I'd finished. About an hour later, Kris, Rachel, and I headed home.

"Mike, did you drink tonight because I pushed you?" Kris asked.

"I didn't feel you were pushing," I replied. "It was just a rare opportunity when I could actually imbibe, and it fit my 'occasionally' and 'special occasions' rules. The conversation the other night simply reminded me of what I'd said. But abstaining most of the time is part and parcel of the choices I've made, just as I limit caffeine to avoid the negative effects. The same goes for refined sugar.

"In the end, it's all about ensuring I'm on an even keel, which means avoiding stimulants and depressants. It's the only way to ensure I'm able to do intricate work with a scalpel. In the long run, I'll likely stop doing surgical procedures except in the ED in my mid-fifties, because that's when the manual dexterity starts to decline. Maybe I'll be one of the fortunate ones who can operate into their sixties.

"Doctor Cutter is in his late fifties and is moving up to Medical Director because he knows that, relatively soon, his manual dexterity will diminish, and maybe it already has. His options at that point are all administrative or teaching, or straight up retirement. Doctors who aren't surgeons can practice much longer."

"Why didn't you say that the other night?"

"It didn't fit into the flow of the conversation, even though we did end up going down the rabbit trail."

"And doing the thing rabbits do!" Kris exclaimed. "Perhaps you'd like to do that when we arrive home?"

"Perhaps I would!"

_November 26, 1989, Southern Ohio Correctional Facility, Lucasville, Ohio_

On Sunday, Kris, Rachel, and I drove to Lucasville so I could visit Frank Bush and Kurt Bowman, and lead a Vespers service. They dropped me at the prison, where I put on my cassock and went inside. I went through the security check, then, as was my usual practice, played chess with Frank Bush.

"I signed up for a correspondence course," he said as we began our first game. "It starts in January. They'll send the tuition bill to you at the church."

"OK. I'll ensure it's paid. How do textbooks work?"

"They're included in the fee, and they'll send them here."

"What's the first course?"

"Ancient history," he replied. "It covers the period before Julius Caesar became emperor."

"Do you have access to a typewriter?"

"Yes. And there are actually a pair of computers with _WordPerfect_. I'm going to take a class and learn to use it next month."

"That's good. How are you otherwise?"

"You ask that as if things could actually change."

"Things can always change," I replied. "Yes, your physical freedom is limited, but not your intellectual, emotional, or spiritual freedom. I'm positive the routine here is mind-numbing, so you read to escape, and that's why you want to take the correspondence courses. I suspect that's also why you value my monthly visits — to break up the monotony. You also crave human contact, beyond the men with whom you're incarcerated and the guards."

"I'm still trying to figure you out," Frank said.

"What's to figure out? You know the Scriptures, therefore I'm certain you know the difference between the sheep and the goats."

"And you think this adds points to some ledger God keeps and if you score enough points, you're in?"

"One of the great mysteries, that is, things which are hidden, is that we can do nothing to save ourselves, but we can't be saved if we do nothing. Both Jesus and James are absolutely clear on that. But you've made it clear you don't want to discuss it or hear an alternative to what you were taught."

"Satan can quote Scripture."

I chuckled, "That line is from Shakespeare's _The Merchant of Venice_. The closest verses in the Bible would be the story about Jesus and Satan having a debate, where Satan tells Jesus to turn the stones to bread. Jesus replies '_Man shall not live on bread alone, but on every word that proceeds out of the mouth of God._'"

"Did you go to seminary?"

"No. I did study to be a catechist, but that was correspondence courses, plus instruction from my priest. Deacons, which I was, aren't required to go to seminary, though priests are. And contrary to what is often said, we use more Scripture in a typical Sunday service than your church ever did."

"But no expository teaching, right?"

"There are other ways to learn," I replied. "The West chose the academy; the East, worship and prayer. In the Orthodox Church, a theologian is one who prays, not one who practices academics, or worse, law!"

"Law?"

"Jean Calvin was a French lawyer. It stands to reason he took a legal approach to the Christian faith. Luther was an academic, so it stands to reason he took an academic approach to the Christian faith. Both systems miss very important points. Look, I know I'm not going to argue you into a different understanding of Christianity from the one you've been taught; all I want you to do is consider an alternative view. Importantly, one that says you, Frank Bush, are a child of God who can be saved."

"You really believe that?"

"I do. What would be the point of coming here if I didn't? What would be the point of ministering to you, even if it's simply playing chess and obtaining books? I could be spending this afternoon with my wife and daughter, but I choose to be here, with you. I hope you'll join us for Vespers once we finish our games."

"You don't stop, do you?"

"No, I don't. But I'll only ask once each time, and it's up to you to decide what to do."

"Pass."

"OK."

We finished our three games, Frank returned to the dayroom, and I was escorted to the chapel where Kurt Bowman, Nick Papadakis, John Williams, and Nate Washington were waiting with two other men. I greeted them, and Kurt introduced Sean Casey and Mark Stroll. I led a Vesper's service, with Nick providing the responses and afterwards I sat with each of the men to have a brief talk. Nick thanked me for the prayer book which I'd had sent, as well as for the visit from Protodeacon Ivan, who had brought him the Eucharist.

"What are you in for?" I asked Mark when we had a private conversation.

"Originally, armed robbery, but I killed another prisoner about four years ago at London Correctional Facility."

"What was the dispute?"

"He was the guy they called the 'Seven Hills Rapist' and one of his victims was my niece. I was already doing fifteen; that got me life."

"What are you looking for?"

"Hell if I know, Pastor!"

"It's Doctor Mike," I replied. "I'm a lay chaplain, and laymen often wear cassocks when leading services."

"Sorry, Doc. Anyway, nothing I've found answers the most important question I have."

"Which is?"

"If there's any hope at all."

"There is," I replied. "There is no unforgivable sin. May I suggest you read the books that have been donated to the library? Start with _The Orthodox Church_ by Bishop KALISTOS and we can discuss it next time I'm here, which will probably be late December."

"Thanks, Doc."

"You're welcome."

He moved away and Sean Casey came to speak to me.

"What are you in for?" I asked.

"Being too friendly with young girls," he replied.

"Statutory rape?" I asked.

"No, I was busted in '85 and charged with criminal sexual assault."

"How much time?"

"Twenty years."

"Mind if I ask how old she was?"

"Fourteen."

"And you were…"

"Twenty-eight. I was busted once before, in '80, but I pled to contributing to the delinquency of a minor and was giving probation."

"What are you looking for?"

"Honestly? Something to break of the monotony."

"You're welcome to join us when I'm here, and if there is anything you need that I can help with, so long as it's legal, let me know."

"You're the first preacher who didn't instantly get on my case about what I did."

"I find that listening works a whole lot better than condemnation. The State of Ohio incarcerated you and anything beyond that is between you and God."

"He and I don't see eye to eye on much."

"And yet, you attended the prayer service."

"As I said, it breaks of the routine."

"Everyone has to start somewhere," I said with a smile.