Chapter 19 — The Sleep of the Dead

_July 7, 1989, Circleville, Ohio_

{psc} "Dada!" Rachel exclaimed happily when I walked into the house.

I picked her up and kissed her forehead.

"I'm going to shower, eat, then fall into bed," I said to Kris.

"You don't look good at all, Mike," Kris observed.

"I need about two days of uninterrupted sleep."

"You have your shift tomorrow, plus band practice."

"I called Kim this afternoon and let her know I wasn't going to make it. I'll be back down in less than ten minutes."

I put down a protesting Rachel, then went upstairs, took a quick shower, put on shorts and a t-shirt, then went back down to the kitchen where Kris was putting dinner on the table.

"You're going to get sick if you aren't careful," she said.

"It's the after-effects of the adrenaline from the helicopter incident. Let's pray so I can eat, please."

I sat down and Kris put Rachel in her high chair. Once Kris had sat down, I gave the blessing and put food on my plate and began eating.

"I'm worried about you," Kris said. "It's only the first week and already you're so tired you can barely keep your eyes open when you come home."

"I know," I replied. "This is just something I'm going to have to find a way to get through. I'm not sure what the impact of the law that went into effect this week in New York will be here. It eliminates shifts longer than twenty-four hours and no more than eighty-hour work-weeks, averaged over four weeks. But there's no requirement that Ohio hospitals follow that, and the Accreditation Council for Graduate Medical Education hasn't adopted those new rules. That's going to create a conflict for Residents at New York Hospitals who seek Attending roles elsewhere."

"How so?"

"They won't have the number of hours or procedures that other Residents will without extending their Residencies. The other challenge is coverage on the services. If our hours are reduced, they'll need more Residents to do the same work. The problem, as always, is money. Hiring three additional Residents means money has to come from something else, and the County Board just approved hiring six nurses to help cover triage."

"You know my answer!"

"Yes, and that would require completely restructuring our tax system, our healthcare system, and basically the entire federal system. So until then, we're stuck with current funding methods and systems."

"America is such a mess!"

I smiled, "As President Bush has said, that's the 'price of freedom'. And I'm in no mental state to debate that right now. Can we save it for Sunday?"

"Yes."

I ate quickly, and with Kris' blessing, went right up to bed. I closed the blackout curtains, stripped off my clothes, put on my sleeping mask, and collapsed into bed.

_July 8, 1989, Circleville and McKinley, Ohio_

I slept the sleep of the dead, only waking when Kris shook my shoulder at 10:00am.

"Your shift starts in two hours," she said. "Rachel and I will do the shopping after you go to work."

"OK."

"How do you feel?"

"Better, but not fully human."

"With you being male, I can understand that!" Kris teased.

"Climb into bed and I'll show you the animal!" I teased.

"Rachel is in the living room."

"So put her in her playpen and come play with me! Unless you're not interested…"

"I suppose…" Kris said with a smirk.

She left and was back a minute later. She quickly stripped off her clothing and climbed into bed with me, and rather than our usual, slow, sensual lovemaking, we fucked for twelve headboard-banging minutes, then went to the shower.

"You certainly had plenty of energy!" Kris observed as we stepped into the spray.

"You're the one who accused me of being sub-human, so I decided to demonstrate!"

Kris laughed, "Very energetically! And that's fine on occasion, but I really do prefer our usual way."

"Me, too," I agreed. "Tomorrow evening after Rachel goes to bed?"

"It's a date!"

I managed to spend about thirty minutes playing with Rachel before lunch, and then I had to say 'goodbye' and head to the hospital. As I drove, I wondered how Doctor Mastriano would respond to my arrival. If I were in her position, and there was no way I'd ever be, I'd have done my best to make nice to try to gain enough camaraderie so as not to be thrown under the bus at the M & M.

With me, though, that wasn't going to work because I was simply going to relate the facts which included her writing her order on the chart. Doing anything else would call attention to me, and that was the last thing I wanted to happen in an M & M. My goal was to present, then find a foxhole to hide in to avoid the shrapnel from the fire she was going to take.

That said, I had to work with her, and that meant finding a way to get along, much of which would be on me as a PGY1. The problem was, there was open warfare between Doctor Cutter and Doctor Northrup, which was only exacerbated by the red scrubs. That said, those red scrubs and the 'S' on my badge meant I could do more procedures than any other PGY1 in the entire hospital.

"Morning, Luisa!" I said when I walked into the ED. "Is Doctor Mastriano in her office?"

"Yes. She said she wanted to see you as soon as you arrived."

"OK. I'm a bit early, so I'll see Doctor Billings before she leaves. If I end up stuck in Doctor Mastriano's office, have Doctor Billings come there so she can hand over any patients."

"Good luck."

"Thanks."

I walked to the door of the Attendings' office.

"You wanted to see me?" I asked.

"Come in and sit down. Close the door."

I did as she asked and waited for her to speak.

"I can't even begin to count the ways this is wrong, but you appear to be untouchable."

"I don't believe that's true," I said. "The same rules apply to me as apply to everyone. Residents perform procedures for which they are cleared by the Chief of their service. If you want to review my procedure book, I have it with me. If you have a problem with that, please take it up with Doctor Gibbs or Doctor Northrup, and they can take it up with Doctor Cutter. I'd prefer you didn't, and that we find a way to work together."

"Unfortunately, I don't have a choice. Your fairy godmother made that clear."

"There is literally no need to fight, Doctor Mastriano. How do you want me to handle things today?"

"What I want and what I think is correct both appear to be irrelevant. Do what you want, but it's your ass if things go wrong."

"That means I will check with you, even if it means waking you up, if I think it's necessary. That's the best way to help ensure things don't go wrong."

"You have walk-ins today," Doctor Mastriano said.

"Then let me speak with Kayla about the handover and get to it."

She nodded, and I left the Attendings' office. I found Kayla Billings at the nurses' station updating a chart and asked about her patient load.

"Cooking burn in Exam 6 waiting on discharge, which I'm filling out now and you'll handle one waiting on surgery for a badly broken ankle. Ortho said about 1:30pm. He's had Demerol IM with their approval, and is resting comfortably in Exam 2."

"OK. Where are the med students?"

"Lounge. Gabby just came back from dropping off pre-op labs for the ankle."

"Thanks. Have a good day."

"Ten hours of sleep! See you!"

I left the nurses' station and went to the lounge to see Callie and Gabby.

"Doctor Mike, can I have a moment in private?" Callie asked.

"Sure. Let's see if the consultation room is free."

We left the lounge, and I was happy to find the room free, as it doubled as an office, though most Residents had resorted to using the lounge for paperwork. We went in and I shut the door about halfway.

"What can I do for you?"

"I'm friends with Heather Pratt, well, Doctor Pratt, now, at Northwestern in Chicago. She had good things to say about you when I asked before you started. Anyway, I heard some scuttlebutt, and called Heather to ask about it because I wasn't sure what to do. She said I should just tell you one thing — Doctor Mastriano is having an affair with Doctor Rosenbaum."

Which would explain literally _everything_ about Doctor Mastriano's attitude, and would suggest the well was so poisoned that there would be no recovery. The consideration I'd given to finding a way to try to mitigate the results of the M & M went right out the window, though I'd been inclined against it.

"How sure are you?" I asked.

"Someone I trust implicitly has seen them together, including in the Pedes on-call room on multiple occasions. And another person I trust said you had a serious run-in with Doctor Mastriano and a patient died as a result of her orders."

"I can't really discuss this with you, but I very much appreciate the heads up. You should come to the M & M on Friday. If you're off, come in special; if you're on, ask permission. It's usually granted, though in the ED a lot depends on patient load, and both Doctor Mastriano and I have to be there. Let's go see our broken ankle, then see what we have waiting for us in triage."

We left the consultation room, collected Gabby from the lounge, and then went to see Mr. Miller, who had a shattered ankle.

"Hi, Mr. Miller," I said. "I'm Doctor Mike and I'll be taking care of you until you go up for surgery. How are you feeling?"

"My ankle is throbbing, but the shot they gave me took the edge off."

I checked the chart and said, "I can safely give you ibuprofen, which will help, in combination with the Demerol. I don't want to give you more Demerol because you'll be going up for surgery in just over an hour. The anesthesiologist will see you before then, and they'll give you the pre-op meds."

"Which ones?"

"An anti-anxiety drug, usually Versed or lorazepam. The actual anesthetic depends on the preferences of the surgeon and anesthesiologist, but is often a cocktail of propofol, fentanyl, and more of the anti-anxiety drug. The anesthesiologist will explain all of this to you when the time comes. Is there anything we can get you?"

"They said they called my wife, so she should be here."

"Callie," I said, "please check to see if Mrs. Miller is in the waiting room, and if so, escort her back."

"Right away, Doctor!"

She left and returned about a minute later with the patient's wife. Callie, Gabby, and I then left and went to the triage desk to get the next patient.

We handled a steady stream of mild injuries and illnesses, none of which technically needed an emergency room, but most GPs didn't work on Saturday, and despite the free clinic offering a complete range of services, most people associated it with gynecological services and therefore came to the hospital which had longer wait times and was more expensive.

I mostly avoided Doctor Mastriano, as the cases we handled were all so simple that I could have allowed Callie to run them unsupervised. On the plus side, it allowed me to give both Callie and Gabby opportunities to take the lead, which they very much appreciated. Things finally slowed just before 6:00pm, which let me take my dinner break with Clarissa.

"I think I might know what Mastriano's problem is," I said when we sat down at a table by ourselves. "She's having an affair with Rosenbaum in Pedes."

"Holy shit!" Clarissa exclaimed, though she kept her voice low. "No wonder she had such a bad attitude with you."

I nodded, "It started off OK, at least as I saw it, but quickly devolved. I wonder if they had a convo after my Saturday shift. That would explain the apparent change in attitude."

"Now what?"

"Nothing, though I had considered trying to find a way to mitigate the damage from the M & M, but she's made her bed…"

"Cute, Petrovich! Cute! He's married and has a couple of kids."

"His adultery is not my concern," I replied. "Nor who he's having sex with. What concerns me, obviously, is him poisoning the well."

"What are you going to do?"

"Nothing. As I said to Doctor Gibbs yesterday morning, I'll let the Attendings at the M & M deal with Doctor Mastriano. There's no need to bring her personal life into it."

"What do you think will happen?"

"I suspect it will end with a written note in her file, and the usual opprobrium of her colleagues. It'll put her on notice that she's being watched, and her contract is in danger of not being renewed. This is another case where a doctor is able to rely on 'standard of care' to avoid the repercussions of their actions, even though their actions are arguably negligent."

"You mean because she insisted on waiting until the patient had EtOH?"

"Yes. That _is_ the standard, but in my opinion, the CAT scanner has changed the standard of care. Before it, I would have to admit waiting was the right course of action, as without a CAT scan we'd have to rely on x-rays, which are iffy at best. If asked, my argument will be to change the standard of care to not require the patient to be sober and obtain a CAT scan."

"It sounds as if you're blaming the system."

"In a sense, I am, but remember, I wrote I recommended a neuro consult so I could get a CAT scan, and wrote that on the chart. Doctor Mastriano specifically ordered me not to get a neuro consult and put that order in writing as 'monitor until EtOH is below 0.05'."

"I know you well enough, and so do others, to ask why you didn't override her order."

"Because you know _exactly_ what the neuro Resident would have said given the patients EtOH was 0.19. They'd have refused, per policy. And I can't order a CAT scan without an Attending's signature. With no neurological signs that couldn't be attributed to being inebriated, Doctor Mastriano wasn't going to sign off, and she refused my request for a neuro consult, so I had nobody to side with me until it was too late."

"I think you're right about the note in her file because she did follow the approved standard of care, especially given the CAT scanner is new here."

"I know it's expensive to use," I said, "but I think any doctor in the ED should be able to order a CAT scan if there's an indicated risk of brain trauma."

"I think you're right, but the bean counters probably won't. Changing topics, how were you at the end of the shift yesterday?"

"Tired enough that I skipped band practice this morning. I slept about fifteen hours."

"I slept twelve, but I also wasn't on that helicopter!"

"Honestly, it was really no big deal. Two ex-Navy pilots resolved a minor mechanical problem by safely landing on a baseball field. Imagine similar trouble on a passenger aircraft which has to make it to an airfield. And from what I read, most people flying commercial never know about mechanical problems."

"Back to medicine, how has your day been?"

"Mastriano has me on walk-ins. That's positive for Callie and Gabby, because it allows them procedures they might not otherwise have a chance to do. We've been light on traumas today, anyway. How has your day been?"

"Routine, really, except for one mystery case. I've been doing research, but so far, nothing. I sent samples to Mayo yesterday, and I'll have a call with them on Monday."

"What do you suspect?"

"Mayo will test for Lyme disease antibodies, but the patient had no rash and claims not to have had a tick bite. That's what made us look for other things. If it's not that, we'll look at some of the rare autoimmune diseases. I honestly don't think it's Lyme, but I have to rule it out. Otherwise, we have a couple of pre-op patients, one waiting on a liver transplant, a pair recovering from surgery, one with COPD, and the TB patient."

We finished eating, and both headed back to our respective services. Callie, Gabby, and I continued to handle walk-ins, not fielding a trauma until just after 11:00pm, when there was a multiple-injury MVA. Doctor Casper took the first patient, and we took the second, and I had given advance orders to Callie, Gabby, and Billie.

"Joy Podesta, twenty-two; unbelted passenger; BP 110/80; pulse 110; PO₂ 98% on nasal canula; forehead laceration; right lower leg and right lower arm fractures; GCS 9; IV saline TKO."

"Trauma 3!" I commanded.

We quickly moved the patient to the trauma room, lifted her to the treatment table, and began our choreographed motions to implement my treatment plan.

"Normal sinus rhythm," Callie called out once the EKG was hooked up. "BP 110/70; tachy at 110; PO₂ 98%."

"Foley, please," I said. "Pupils are sluggish, but lungs are clear and heartbeat is strong. No rebound or guarding."

"Urine in the bag," Callie said, having inserted the Foley. "No evidence of blood."

The patient appeared to be in no immediate danger, but with the head injury, I was going to play it safe.

"Neuro and ortho consults," I said to Gabby. "And portable x-ray."

"Calling now!" she confirmed.

"Ultrasound?" Callie asked.

"No indication for that," I replied. "She has a moderate concussion and a pair of fractures, but I didn't appreciate any abdominal injuries. You can throw a pair of sutures in that forehead lac."

"Nurse, suture tray, please!" Callie requested. "Irrigation kit and lidocaine times two."

Just before midnight, we transferred the patient to neurology and did the handover with Kallie before heading to the surgical locker room for a shower.

_July 9, 1989, Circleville, Ohio_

After Church on Sunday, Kris, Rachel, and I headed home to spend some time together as a family.

"It dawned on me this morning that Sundays are the only day we have significant time together," Kris said as we relaxed on the couch. "You spend most of your time at home sleeping."

"There isn't really anything I can do about that," I replied. "We knew that going in."

"Yes, of course," Kris replied. "I was simply saying I hadn't thought of how it would work in practice."

"It's only going to be this bad for a year," I replied. "Once I complete my PGY1, I'll most likely have five fourteen-hour days, given one goal of the program is to free surgical Residents to do elective surgeries."

"Will the law in New York have any effect?"

"Directly? No. Indirectly, probably, though it will take some time for Ohio to consider adopting that rule, and I have no idea how that process works. Ultimately, though, it'll be up to the Accreditation Council, and I'd wager that will take a decade, possibly more, before it happens, if it does."

"Why?"

"A consensus has to be achieved, and that takes time. As we discussed, the biggest impediment is hiring new Residents."

"It always comes down to money, doesn't it?"

"One way or the other, in the end, we're constrained. If they don't hire more Residents, then waiting times will increase. There is always _some_ limit, even in France. I know more about the Canadian and British systems, and in both of those, which procedures and which medications are permitted are restricted, and waiting times are longer.

"In the end, there are tradeoffs in every system. Here we have access to more technology, a higher ratio of doctors to population, and other significant advantages, at the cost of care being expensive and not universal. I wish that weren't the case, and I wish our training systems weren't so brutal, and I hope those things change. In fact, I'll advocate for them! But that doesn't change the reality of the next year."

"No, I suppose it doesn't."

"I guess I have to ask how much it bothers you."

"I was more concerned about Rachel," Kris said. "I understand the logic and the tradeoffs, but Rachel obviously misses you."

"And I miss both of you."

"I miss you when you're working, Mike," Kris replied.

"I didn't mean to imply that you didn't. And I'm actually happy you said something rather than letting something that concerns you go unsaid, which can lead to serious problems."

"Dada sing?" Rachel requested.

"I'll get your guitar," Kris offered. "That way, you don't have to put her down."

"I can't play with her in my lap, so I will have to put her next to me."

"Just stay with Rachel."

Kris got up, went to the study, and returned with my guitar. I played six songs that I knew Rachel liked, and when I finished, we put her down for her afternoon nap. I'd considered skipping it, but I didn't want her to be cranky, which happened when she didn't get enough sleep. Fortunately, Rachel didn't protest when I put her down, and once she was settled, I went back downstairs to sit with Kris, who cuddled close.

"Are you unhappy?" I asked.

"No, and I didn't mean it to sound as if I was complaining. I think it's the difference between knowing something and experiencing it. Our wedding night was a perfect example of that!"

"What?" I asked with a smirk. "It's more fun to do it than talk about it?"

"Obviously! But you understand my point, right?"

"I do," I replied. "I knew how bad these shifts would be, but until I actually experienced two of them this past week, I didn't actually understand just how bad that was."

"So bad that you skipped evening prayers on Friday."

"I wasn't thinking clearly at all," I replied. "I'm sorry."

"I think God will understand. I'm curious how you'll see Father Roman."

"That is a challenge," I replied. "I think the only way that can work would be to drive up on a Wednesday morning and back that evening, and I'd have to go alone because you have class. But I'll call him in a few weeks and see what he thinks. It's possible we could handle it by telephone at least some of the time. One way would be for me to confess to him, and for him to call Father Luke to perform the absolution."

"There's another practical matter," Kris said.

"What's that?"

"Finding time to get pregnant. If I understand conception, it's a fairly narrow range of days in the middle of my periods."

"Roughly, though it's possible about two-thirds of the days of the cycle, but the chance of success diminishes significantly with time before or after ovulation. We'll just have to try our best and see what happens."

"I'll stop taking my pills when I have my period in August, which should be in about six weeks. Will we use condoms then?"

"Either that or you need to get a diaphragm, which requires a prescription, as dumb as that sounds."

"It seems as if the entire point of the system is to prevent women from easily obtaining contraception!"

"There's some truth to that," I replied. "The concerns about side effects of the Pill could be addressed by having pharmacists dispense it without a prescription, but after having checked blood pressure and asked a few basic questions about medical history. That said, doing that creates a possible break in continuity of care, which is the big problem we see with people using the emergency room instead of seeing their own physician. That said, one reason to always visit the same pharmacist is for him to be able to catch drug interactions."

"Wouldn't the doctors speak to each other?"

"Not necessarily. And that assumes the patient actually tells his or her doctors the truth. That is not a given."

"Crazy!"

"Human nature, which might well be the same thing! What did you want to do?"

"Is it dangerous to get pregnant the month following when you stop taking the Pill?"

"No. As I think I've mentioned, about three women in a thousand will get pregnant at some point while using the Pill, even with perfect use. And there's no evidence of an increase in birth defects related to the use of birth control pills."

"Then why wait?"

"An OB/GYN suggested it, mainly from a point of allowing the woman's hormone levels to return to normal, but it was only a suggestion, not a command."

"I don't prefer using condoms, and it seems silly to get a diaphragm when I would only use it for perhaps four weeks."

"What about time between children?"

"I think we discuss that when the time is appropriate. Out of curiosity, how long does one wait after having a baby?"

"That depends on the individual, and how the labor and delivery progressed, but two or three months is considered typical. But that's just for intercourse, of course."

"Of course!" Kris replied with a soft laugh. "Is there any truth to what they say about not becoming pregnant while nursing?"

"There is no medical evidence of which I'm aware, but nursing does affect hormone levels, so it _might_ affect it, but it certainly doesn't prevent it. Do you know the phrase 'Irish Twins'?"

"No."

"It means two children born less than a year apart, and is an implied criticism of Roman Catholic proscriptions on using birth control, whether chemical or physical barrier. Given that phrase, I'd say the experience, at least of English-speaking peoples, is that nursing does not inhibit conception.

"That said, I suspect that statistics DO show that nursing women don't get pregnant as often as those who aren't nursing, but mainly because they either don't try, or don't try as often, because of the challenge of caring for an infant. That causes 'confirmation bias' because we don't see too many women who are nursing and pregnant.

"In terms of relying on it, I wouldn't, any more than I'd rely on the oft-told misinformation that it's not possible to get pregnant your first time. That's absolutely false, to which I'm positive any number of teenage girls can attest. As Doctor Ruth Westheimer likes to say in response to her rhetorical question about how many sperm it takes to get pregnant — 'Vun qvick vun'."

"She's the Jewish doctor on the radio, right?"

"Yes. I think she's doing the country a great service, but as you can imagine, there is serious pushback against her open and frank talk about teenage and young adult sexuality."

"You Americans!" Kris declared, shaking her head.

"Last I checked, you applied to become an American!"

"I will have American citizenship and carry American identity papers, but I will NOT succumb to the foolish American prudishness nor become a capitalist!"

"I'd be shocked if you did!"

"So we agree then that I'll simply stop taking my pills and we'll allow nature to take its course?"

"That's fine."

"You know, I never asked, but when do you receive your pay?"

"The last day of each month," I replied. "The money will be deposited directly into our joint checking account."

"And it's a fixed amount?"

"Yes. There is no overtime pay for doctors who are full-time hospital employees."

"What about nurses?"

"They receive overtime pay. They also have work rules very different from those of physicians. You won't see a nurse on a thirty-six-hour shift! Generally, they work about forty-five hours per week, though it varies. Right now, most of them are earning overtime, as we're short-staffed. That's changing as of September 1st, but we'll still be short-staffed in terms of nurses and physicians. It'll be better when the new facility opens in just under two years, but that won't last long as demand growth outstrips the planned increases."

"Do you realize how dumb that is?"

"Barring setting up a printing press in the basement of the new trauma center, I'm not sure there is anything any of us can do. The County Board hasn't been stingy, but there are limits to the amount of taxes they are able to collect, and those taxes are limited to property and sales taxes, both of which I'm sure you consider regressive."

"Of course! But you only have objections; do you have a solution?"

"Not really," I replied. "Because as I've repeatedly maintained, every system has resource constraints. It's a question of how you use the resources, and who decides. And I hate to tell you, but it appears things are going to get worse, rather than better."

"What makes you say that?"

"Some medical schools are beginning to raise tuition, which is going to lead to higher medical bills because more people will borrow more money to go to medical school and have to repay the loans. All of that money, and I mean one hundred percent, comes from patients, either directly or indirectly, or from the taxpayers. A similar problem is occurring with college tuition, but fortunately, state schools are still affordable, and it's possible to work your way through."

"You know how to solve THAT!" Kris replied.

I nodded, "Taxpayer funded tertiary education. And I'm not opposed to that idea, but federal money always comes with restrictions and mandates, and that could interfere with academic freedom and with religious freedom. The social and political environment is fundamentally different from Sweden or France, and we'd be in an endless tug-of-war between the progressive left and religious right, with wild swings depending on elections. But did you want to spend our limited time while Rachel is napping discussing political theory?"

"You had another desire?" Kris asked with a smile.

"An appetizer for later, perhaps?"

"Shall we go to bed?"

"Yes!"

_July 10, 1989, McKinley, Ohio_

"I was reviewing charts from Saturday," Doctor Gibbs said when I stopped in her office before my shift began on Monday morning. "You were on walk-ins the entire shift?"

"Yes."

"You know, I liked Mike the medical student better, as he was never reluctant to speak his mind, which is odd, given most medical students fear for their grades and their ability to Match."

"What do you want me to say?" I asked.

"That you think Doctor Mastriano is punishing you."

"I think Doctor Mastriano found a way to achieve her goal of limiting the procedures I can do. It does allow me to teach more, because in most of those cases, I can allow my students to do procedures. Speaking of students, assigning me all four Second Years is not working. Two would work, but four is unwieldy. Fortunately, I didn't have any procedures that involved intimate regions, because that size audience would present a real problem. Assign two to Naveen."

Doctor Gibbs nodded, "Will do. But going back to your assignment — it doesn't upset you?"

"I asked Doctor Mastriano if we could find a way to work together. I'd say that's her solution, and, frankly, I'd rather not fight with her on the two shifts we share. I also daresay she's not going to be sleeping overnight after the M & M."

"No, she's not. You know we tolerate that for twenty-four-hour shifts, but sleeping is secondary to working."

"May I raise a concern privately?"

"You mean as in tell me, but I can't act on it?"

"Or reveal it to anyone. Well, you might know, but you might not know what flows from it."

"Just say it, Mike. You'll have to trust me to not misuse whatever you say."

"Doctor Mastriano is having an affair with Doctor Rosenbaum in Pedes. Normally, I don't give a fig about that, and any problems are between him and his wife. That said, I believe he's the source of Doctor Mastriano's attitude towards me. Remember how it was fine the first day? Well, I surmise she spoke to Doctor Rosenbaum after that, and he attempted to poison the well."

"Why would he do that? Your Pedes evaluation was as perfect and full of praise as every other evaluation."

"What you don't know, and most people don't know, is that he called my church to find out when services were held and purposefully and intentionally scheduled my shifts to prevent me from going to church."

"You're joking!"

"No, I'm not. I can't say how I found out, but I trust the person who told me. Not to mention my shifts didn't change from the first month to the second, while everyone else's did. I ended up doing an end-run courtesy of Kylie Baxter, when she asked to trade schedules because of an obligation to care for her mom post-chemo and post-radiation therapy. He made the comment that he felt I was smart to ditch my clerical garb, though that was after I'd chosen to resign."

"Why didn't you say anything?"

I laughed, "Come on, Loretta! You know me better than that!"

"You smiled and took the abuse because you knew it would annoy the fuck out of him."

"Yes. There's another incident you probably don't know about from Internal Medicine."

"What's that?"

"According to an Attending who shall remain nameless, I was assigned to work with Melissa Bush on my Medicine rotation in the hopes that it would lead to both of us failing that rotation."

"Oh, for the love of God!" Doctor Gibbs exclaimed. "Who told you that?"

"An Attending," I replied. "Honestly, I can't say more. That said, the view from the doctors who mattered was that if I could handle that, I could handle pretty much anything. They didn't know about the BS from Rosenbaum."

"I can see that, I suppose."

"The point I was trying to make is that there are Attendings who do not like me. There are Residents who don't like me. But the only one who actually did anything to me was Rosenbaum."

"There are NO nurses who don't like you," Doctor Gibbs smirked.

"That kind of 'like' I can do without!" I chuckled. "The same is true of certain McKinley PD detectives."

"Oh?"

"Detective Kleist's first question to me was whether I was married."

"She was just being thorough!" Doctor Gibbs said with a smirk. "She's the cute blonde, right?"

"As I said to Clarissa, I didn't notice. A combination of being tired and married, and at that point barely having the energy to stand, let alone think about anything other than medicine."

"What do you want me to do about Mastriano?"

"Let her suffer the withering fire at the M & M. I don't intend to offer anything that might mitigate her actions, and, frankly, nobody should. Once she's taken to task for her decision, then raise the issue of medicine being the priority over sleeping. If you're referring to her relationship with Rosenbaum, nothing. That doesn't violate my hospital ethics, though I find it morally objectionable for obvious reasons."

"I have half a mind to tell his wife."

"Do that, and you'll have to rat out half the married staff," I said. "It's none of our business. Even my strictest rules wouldn't bar a relationship between two Attendings on different services, and the last thing I want is for the Medical Director and the Hospital Board to become morality police. That cannot end well."

"No, it can't, and as reprehensible as I find cheating to be, it is, as you say, none of our business, so long as it doesn't affect patient care."

"I was reluctant to mention it, but I felt I needed to so that you know from where her attitude springs."

"I'm going to keep you off walk-ins today, at least as your primary responsibility."

"Does that include my medical students?"

"Unfortunately for them, no. Mary and Bob will still need to take their turns in triage. You heard about the new nurses, right?"

"I did. I'd say that's a good thing. May I suggest shorter shifts at the triage desk? Perhaps four hours at most?"

"That was my plan. I'm just waiting for agreement from the nursing supervisor and Doctor Northrup."

There was a knock at the door, and Doctor Gibbs called out for whomever was knocking to come in.

"Paramedics are about five minutes out with an OD," Ellie said.

"Mike, you take it. There's nothing on the board from Kylie as I just signed off on her last discharge. Grab your students. Call me if you need help."

"Will do!" I declared.

I got up and left her office and went to find Bob and Len.