Chapter 6 — Match and Scrambles!

_March 12, 1990, McKinley, Ohio_

{psc} "Got a moment, Mike?" Doctor Ross said when he saw me late on Monday morning.

"Sure. What's up?"

"Privately, please."

I nodded, followed him to his office, and shut the door behind us.

"I received our Match list," he said. "You obviously cannot share what I'm about to say with anyone."

"Understood."

"It won't surprise you, but Mary Anderson matched here, as did Ryan Harrison; it might surprise you that Erin Jackson matched here as well."

"Interesting. For that to have happened, she had to have taken a fairly extreme risk. I'm happy about that, obviously. Before I ask you about the other three, do you know if Leticia Jefferson matched with the ED?"

"She did. Brent Williams called to let me know, as he was positive you would ask."

"Excellent. Who else did we get?"

"The married couple and Felicity Howard. We didn't get our third-ranked choice or our sixth. Obviously, Mary had already Matched for the trauma surgery slot. Thoughts?"

"I'm glad we got the Kennedys, and I'm positive Felicity will bust her butt. I'd have ranked her higher, but I understand why you were reluctant to do so."

"Huge red flags, even with her improvement. To be honest, without your strong support, I wouldn't have listed her."

"I believe in redemption," I replied. "Everyone screws up at one time or another. Fortunately, my major screwups have occurred in areas other than medicine."

"And I know you'll do your best to ensure it stays that way."

"I will. Did Brent share any other names?"

"No. Just that one; he said she's the cousin of a friend?"

"My roommate at Taft for the first two years. I was his first white friend, and he was my first black friend. You could have used our interactions as material for one of those goofy sitcoms."

"First black friend? In college?"

"Yes. I mostly hung out with two friends from second grade onward, and there were no black guys on the chess team and none at my dōjō. He grew up in Over-the-Rhine in Cincinnati, and the only white people he interacted with regularly were cops, and you can imagine how that went."

"Badly. Racism is a scourge."

"I agree. That is one of my concerns about Leticia Jefferson, but I know the ED docs and nurses well enough she won't get grief from them. There are others…"

"We all know who they are, and if it were up to me, they'd be out. And I don't just mean out of the hospital; I mean no medical license. Bigotry has no place in medicine, and even if not expressed, it affects how patients are treated. Study after study shows that minorities receive substandard care, even when presenting at the exact same hospital."

"That is unconscionable," I replied. "But if you look at the details, you'll see it's actually a question of insured versus uninsured versus Medicaid. Guess which have the worst outcomes, irrespective of race?"

"Medicaid."

"Exactly. You're better off being uninsured than having Medicaid because there is no gatekeeper of any kind. Yes, the hospital has to eat the cost, but we make those decisions purely on medical need. _Our_ judgment of medical need, not the government's."

"Sad but true," Doctor Roth agreed.

"Anything else?"

"Not at the moment. Go have your lunch. And I'm sure you'll stop in to see Brent."

"I will!"

I left his office, let my students know I was going to lunch, then left the floor. I walked to the ED, but Brent Williams was in a trauma, so I headed down the long corridor to the cafeteria. I got my food, saw Sophia and her friends, and went to sit with them.

"The anticipation is killing me!" Sophia declared once I'd quietly prayed.

"You'll Match, I'm sure."

"But I don't find out where until Friday!"

"Been there," I said. "But for me, it was Tuesday morning that ended all the stress. I mean, sure, I was convinced I'd Match here, but knowing I'd Matched meant I was going to be a doctor. And that was the key."

"You couldn't have seriously been worried," Kelly Atkins said. "You were first in your class, and I heard you were the best!"

The way she said 'best' was clearly meant as innuendo, but I ignored it.

"While the odds of not Matching were slim, they weren't zero."

"Only because Mike has a hate-hate relationship with computers and was sure it could find some edge case to screw him!" Sophia declared mirthfully.

"There might be some truth to that," I chuckled. "Though I have switched to tolerance of the infernal devices!"

"Not just edge cases!" Kelly smirked.

"Kelly, stop it!" Sophia ordered. "I mean it. Stop it. Now."

"Who died and made YOU queen bitch?" Kelly asked.

"Nobody. Mike is happily married and faithful. Deal with it and drop it."

Kelly muttered something under her breath, and I decided I was glad I didn't hear it. She was quiet for the rest of the lunch while Sophia, Jenny, Nancy, and I talked about their clinical rotations. Jenny had tried to Match with Moore for Internal Medicine, but I had no idea if she had, and I doubted Tim Baker would share the list with Clarissa in advance. When I finished my lunch, I excused myself and walked back to the ED to see if Brent Williams was available.

"Hi, Brent," I said when I saw him. "Got a sec?"

"Sure. My office?"

"Yes."

I followed him to the office and shut the door behind us.

"Owen let me know Leticia had matched here. I'm extremely happy. OK to ask who else?"

"You know the secrecy rules, right?"

"Yes. Owen reminded me."

"He has to, as I do. Karl Schmidt, Julie Plemons, Mai Liu, and Mike Jorgensen. The last spot didn't fill. Are you available to interview Scramblers by phone?"

"Yes. How often does that occur here?"

"The last two years were fine, but before that, we nearly always had one that didn't fill. Remember, we were a smaller regional medical center at that point."

"When we hit Level I, I suspect that problem will go away."

"Me, too. I'll start receiving inquiries after 10:00am tomorrow. I'll coördinate with Owen for your time."

"Thanks. Any word on the new Emergency Medicine Chief?"

"An announcement is due tomorrow. I'm fairly certain it's Dutch Wernher from Rush-Pres in Chicago."

"Is that his given name or a nickname?"

"Nickname; his given name is Rupert."

"I think I'd go by 'Dutch'," I observed.

"Yeah, me, too."

"CV?"

"Mid-fifties. He switched from Internal Medicine to Emergency Medicine around 1972 and has a good reputation in the field. Graduated from UC Berkeley, attended Emory Medical School, Residency at Bethesda Naval Hospital, and two years at Cam Ranh Bay before leaving the service and being hired at Rush-Pres. Married with three daughters."

"Sounds like a good guy, but Loretta should have that role."

"We still don't know if she'll be able to come back," Brent said, "and that role has to be a practicing physician. That was one of Cutter's criteria — no more pure administrators."

"That I can't argue with, though I'm convinced Loretta will come back."

"Me, too, but you and I both know it's a potentially long road."

"Unfortunately. Anyway, I'll keep all of that under my hat. Let me know about the Scramblers."

"Will do, and thanks."

I left his office and returned to the surgical ward, and given things were quiet, let my students take their lunch before prepping the afternoon patient. The rest of the day was routine, with three ED consults, two of which were surgical cases, though neither were emergencies. We didn't admit them, but we scheduled surgery for them later in the week.

_March 13, 1990, McKinley, Ohio_

Tuesday was Match Day, and as had been the case for my friends and me, all the Fourth Years were on pins and needles until the first batch of Match letters were handed out. All of the students who had had their clinical rotations with me had Matched, though other than the names I'd been given by Owen Roth and Brent Williams, I had no idea where they might have Matched.

I took the opportunity at lunch to call Doctor Mertens and inquire how many were Scrambling.

"Six. It's a good year. I see one of the emergency medicine slots didn't fill."

"I'm expecting names from Brent Williams at some point today to begin phone interviews. Are any of the six worth talking to?"

"That's a heck of a question for the Dean of Clinical Instruction!"

"No reflection on you, Doc! There are some people who simply should not be physicians."

"Nicole Caton; middle of the pack, with average reviews. I think she might have overshot for her first choices and was unlucky with her backups."

"What programs?"

"Internal Medicine."

"Have her call Brent Williams," I said. "Well, assuming she's interested in Emergency Medicine as an alternative."

"She'll actually be in my office in about ten minutes to review the Scramble list."

"Are there any other open slots here?"

"One in psych and one in OB/GYN. That's not uncommon; surprisingly, the dermatology slot filled."

"I take it that's a tough sell here?"

"They only have one opening once every three years, and it's been in the Scramble for as long as I've been at the medical school."

"Sorry about not being able to make the guest lectures."

"I understand. How is Doctor Gibbs doing?"

"Not enjoying her physical therapy, but improving every week. She has some numbness in her lower extremities, but she's walking between parallel bars with the aid of braces. I'm positive she'll recover enough to return to the ED, though she might need leg braces permanently."

"I heard Doctor Lindsay will be back on April 1st."

"She's really champing at the bit at the enforced vacation."

"How is your wife? She's in her sixth month, or thereabouts."

"She's doing fine, and Rachel is impatiently awaiting a sister; I believe she'll try to trade in a brother! Too bad for her it doesn't work that way!"

"I was ready to sell my little brother to our neighbors for a dollar when I was five. My dad objected."

I chuckled. "Just one buck? Really?"

"That was more money back then," Doctor Mertens said mirthfully, "but he was, as the saying goes with car dealers, 'priced to move'!"

I laughed hard, "Nice, Doc. Very Nice!"

"You should call me Nora. Do you think you'll be able to lecture before the Fall?"

"Probably not, given things are still crazy around here. I will talk to Owen Roth about the Fall."

"Thanks, Mike."

I thanked her, said 'goodbye', then went to the Cafeteria to have lunch with Clarissa.

"I'm going to guess you know who Matched for the ED and surgery."

I nodded, "Yes, though I'm sworn to absolute secrecy. The last thing we want to happen is to get in trouble with the NRMP. I take it Baker didn't talk to you?"

"He barely knows I exist because I'm in the ED until the end of May."

"And yet you'll receive glowing reviews for the good work you're doing, so no big deal! You'll have two years before it's time for an Attending slot, and you'll have the extra ED experience, including your paramedic ride-alongs! Now you just need flight surgeon status!"

Clarissa laughed, "And you got it just in time for it to mostly be phased out because we're on our way to being a Level I trauma center!"

"Fortunately, there are no continuing training requirements for that which aren't satisfied by my day job!"

"I take it you heard about the new Chief of Emergency Medicine?"

"Yes. UC Berkeley, Emory, US Navy, Rush-Presbyterian in Chicago. Switched to emergency medicine from internal medicine at Rush. Married, with three daughters."

"But you're unhappy because of Doctor Gibbs."

"Yes, but as Brent Williams pointed out, she has a long way to go, and Cutter added a 'no paper pushers' requirement to the job description. You know my problem with Northrup, though I do make a small allowance for the amount of time he had to spend on the new ED."

"Just over a year," Clarissa observed. "From what I hear, the big challenge is all the new telemetry equipment."

"That's what I hear as well. Buildings are pretty easy, from everything I witnessed with my dad growing up, but the computer stuff is complicated."

"Listen to you! 'Computer stuff'! You're too funny, Petrovich!"

"Tell me that the telemetry isn't a computer."

"Technically."

"In my book, being technically correct is the best kind of correct!"

"Of course it is! You can be a real dope at times, Petrovich!"

"Which, of course, is why you love me!"

"You just go right on with that fantasy!"

"You know MY fantasy, Lissa!" I smirked.

"There is just no way it was THAT good!"

"It's not the 'what' it's the 'who," I countered.

"And you could never consummate your relationship with the girl who would have been sublime."

"It didn't hurt she had red hair, green eyes, and a sexy body!"

"My only possible response to THAT is — «ты некультурная свинья» (_ty nekulturnaya svinya_)!" {green}("You uncultured swine!"){/green}

I laughed, "One of Tasha's favorite epithets. And I need to get back before my toddlers kill a patient with a safety razor!"

"Oh, give me a break! Erin is an excellent medical student."

"Of course she is, but my membership card in the Residents' Union would be revoked if I didn't disparage them in jest to other Residents!"

"You might have a point…at the top of your head!"

"Love you, too, Lissa."

We hugged, Clarissa headed back to the ED, and I took the stairs up to the surgical wing. When my shift ended, I showered, dressed, and headed to the parking lot where Kris and Rachel were waiting. I got into Kris' Tempo, and we headed to the fire station for dinner with Bobby's company.

"Do you always eat this well?" Kris asked after a fantastic meal of barbecued chicken sandwiches, home fries, and homemade coleslaw.

"Firemen tend to be great cooks," Bobby said. "Though you get a lot of chili, barbecue, and spaghetti. Fortunately, we weren't rudely interrupted by the…"

"DO NOT SAY THAT!" Lieutenant Greer declared. "You know what will…"

And it happened before he could even complete his sentence. The tones sounded then a disembodied voice came over the PA…

{_ "Station 2; motor vehicle accident with trapped victims; US 23 at Ohio 159." _}

Half the company scrambled away from the table, but Bobby and Jim Greer were not on shift, so they remained.

"You're a dead man, Murphy!" Chet, one of the firefighters, growled as he hurried away.

"Smooth," I chuckled. "is the County ever going to fix that intersection?"

"There's money in next year's county budget to change it from a two-way stop to an overpass with ramps. Hopefully, they'll actually do it, but it depends on money from the Feds."

"It's so silly," Kris observed, "that the US government can't simply maintain the roads."

"They can," Lieutenant Greer countered. "It's the state highway that's the problem. The county and state have to put in an overpass and build the ramps, but the federal government will chip in money. The county can't afford to do it without state and federal help."

"It just seems overly complicated. But I'll drop it because I see my husband's eyes rolling!"

"Come by the house on May 1st and see the red banner flown by my unreconstructed socialist wife!"

"Before this gets out of hand," Bobby said, "Captain Brinker has a medal and a plaque for you."

I wanted to protest that it wasn't necessary, but I knew that would fall on deaf ears.

"I'll keep it short," Captain Brinker said, "because I know the men hear me talk more than they want to!"

"Fuckin' eh, Cappy!" Bobby's partner Sam exclaimed.

"You're on report, Bolton!" Captain Brinker said with a grin. "Doctor Mike, please stand."

I stood up.

"For extraordinary service to an injured firefighter and his unwavering support of the paramedic program, I hereby award the Hayes Country Fire Department Citizen Valor award to Doctor Michael Loucks."

He handed me a plaque, then pinned the medal on my shirt.

"Thank you," I said. "No speech."

"Thank God!" Sam grinned.

Everyone laughed.

"I also want to thank you for providing support and encouragement to Loretta," Lieutenant Greer said. "That's actually more important, but we can't give you an award for that."

"Thanks, LT," Bobby said.

"Where's the ice cream?" Sam asked. "They told me there would be ice cream!"

Everyone laughed.

"Is he always like this?" Kris asked.

"Only when he's not on shift," Bobby said. "Then he's all business. But off the clock? He's a bigger clown than your husband!"

"I find that very hard to believe," Kris said with a silly smile.

_March 15, 1990, McKinley, Ohio_

"How did we do in the Match?" Shelly Lindsay asked when we sat down to have lunch on Thursday.

"Very well," I replied. "I'm sworn to complete secrecy, but you won't be disappointed. The ED didn't fill one slot, and I have a phone interview today with a Scrambler from Michigan State and a face-to-face with Nicole Caton from McKinley Medical School, who failed to Match."

"Scraping the bottom of the barrel?"

"According to Nora Mertens, Nicole is an average medical student with average evaluations who shot a bit too high with her Match list and had bad luck with her backups. She was trying for Internal Medicine."

"And the other candidate?"

"Similarly situated student from UC, but who tried for Emergency Medicine only at major hospitals. Again, a bit of bad luck because if you construct your list properly, you should Match somewhere. A single interview at a second or third-tier hospital is a fairly safe bet."

"OK, but if they built bad lists, doesn't that show something, too?" Shelly asked.

"All it takes is being fifth or sixth choice for hospitals who don't have overlapping lists. As Nora said, a bit of bad luck. And honestly, I could see that if you felt your interviews went better than they did. We all have a difficult time seeing ourselves as others see us. Paul Lincoln told me he thought he completely blew his interview here, and yet he Matched, so he obviously didn't."

"Mary Wilson actually did blow her interview, but she had great grades and excellent recommendations, so we took a chance. It was nerves, and I'm sure you've seen she's OK with patients."

"Actually, I haven't seen much of her given I'm not on a surgical team, and they have me hopping covering for your lazy butt as well as handling ED consults!"

"Lazy butt?!" Shelly growled in outrage. "They won't LET me come back for two more weeks! I'm ready. It's the damned rules that are the problem, and they don't have any leeway. Six weeks post-op for major surgery before you can come back. And the clock only starts ticking when you're stable."

"And you know why that is! Surgeons are, in general, an arrogant bunch who would lie, cheat, or steal to get into an OR! Present company excepted, of course."

"Of course," Shelly agreed with a soft laugh. "Which is, of course, why Psych objected to you going to your outside psychologist. They figured it was a scam because that is what surgeons stereotypically do."

"And if you had your way, you'd have been in an OR two minutes after you were released. And please have the decency and respect not to deny that to me!"

"Loretta is right! You're a royal pain in the ass, Loucks!"

"Thank you," I replied with a grin. "My psychologist suggested I wear such comments as a badge of honor, and she's not wrong."

"No kidding," Shelly said dryly.

We finished our lunch, exchanged a quick hug, and she left the hospital while I went back upstairs. About an hour later, I called Casey Van Houten from Michigan State to conduct a Scramble interview. He was, as I had expected he would be, an average candidate who would not have made our top ten, but by the end of the interview, I felt he was a qualified candidate. He asked when he would hear, and I couldn't make any promises. I thanked him and said that Doctor Williams would be in touch.

About twenty minutes later, I met Nicole Caton in a small conference room to conduct her interview. My concern with her was she'd listed Internal Medicine at Moore and hadn't been selected. Per my instructions from Brent, I wasn't allowed to ask for their evaluation, which didn't make sense to me. But, because Nora Mertens had said Nicole was deserving, I set aside her failed Match.

"Hi, Doctor Mike," Nicole said. "Thanks for seeing me."

"You're welcome. Have a seat, and we'll do this as a standard Match interview, though with only one physician, instead of a team."

After the usual preliminary questions and her biographical spiel, I asked my first unscripted question.

"Why did you not choose an emergency medicine Sub-I?"

"I had the required Clerkship, and because I wanted to match for Internal Medicine, I didn't think it was important. I had a Pedes Sub-I instead."

Which made sense, though not having an emergency medicine Sub-I had absolutely hurt her in the Match and would potentially work against her in the Scramble for an emergency medicine spot, at least at any urban hospital. She, like Melissa Bush, might need to look further afield.

"I'm not suggesting you'll receive a negative answer from us, but you should ask Doctor Mertens for a list of open Residencies in rural Kentucky, Tennessee, West Virginia, Georgia, and Alabama. They'll be less concerned with a missing emergency medicine Sub-I, and they almost always have open positions."

"I really do not want to work in an area like that."

"And if that's your only choice?" I asked.

"Then I suppose I would. Why didn't anyone tell me I made a suboptimal choice?"

"I have no idea," I replied. "The only thing I can say is something I was told during my time in medical school and something I stated clearly in the alumnus speech I gave at last year's White Coat Ceremony — every morning when you get up and look in the mirror, you see the person primarily responsible for your medical education. It's not the deans, it's not the professors, it's not the doctors on your clinical rotations. It's you. Period. No exceptions and no excuses."

"I never heard that," Nicole replied. "From anyone."

"Now you have. It's not too late. We might hire you, but if not, you need options. And you're the only one who can arrange those. So, as soon as we finish, go see Doctor Mertens and ask for the list of rural programs which have trouble attracting candidates. I know someone who Scrambled to a spot in Kentucky after failing to Match in _two_ Matches. Your other options are research or an insurance company."

"Ugh."

"So, how badly do you want to be a doctor?"

Nicole nodded, "I see your point."

"Good. Now, convince me why we should select you for the open emergency medicine spot."

For the next twenty minutes, she made her case, and when she finished, I thanked her, then went to the ED to report to Brent Williams.

"One name, please," he said. "You, Ghost, and Perry each had two candidates. I'll call or speak to three of them."

I considered which I'd choose and made a tentative decision.

"May I ask why I wasn't allowed to check with Internal Medicine on Nicole Caton?"

"Because we can't check outside candidates. I can't even ask if she was on their list, let alone her position."

"That makes no sense, but OK. Of the two, I'd recommend you speak to Nicole Caton."

"OK. I'll call her and have her come speak to me. I'll call the other two candidates once I finish with Nicole, then decide."

"Just you?"

"We don't have an ED Chief until May 1st, so yep, just me."

"OK. I'm heading back to the surgical ward."

"Thanks, Mike. I appreciate it."

_March 15, 1990, Circleville, Ohio_

Later that same day, Antonne and the rest of the mentoring group came to the house to have dinner with Kris, Rachel, and me.

"Rachel is such a big girl!" Conchita exclaimed as Rachel climbed into her lap.

"You had your chance," Jordan teased. "Mike was single when you met him!"

"Nothing personal against Doctor Mike, but there was no way I was ready to be a mom as a Freshman! Talk to me in about ten years!"

"You realize his wife is actually younger than you are, right?" Danika observed.

"That's HER problem, not mine!" Conchita declared. "I love Rachel, but I'm very happy to return her after an hour!"

"There are times I'd like to do that after five minutes," I chuckled. "Especially when she has 'no' on repeat!"

"What happened?" Julius asked.

"Rachel accompanied me to band practice but refused to wear her ear protection. Toddlers are not known for their susceptibility to reason, so we had an impasse. She had to sit in the hall and was cross with me for the rest of the day."

"Just wait until she's a teenager!" Jordan exclaimed.

"YOU are still a teenager!" Conchita teased.

"OK, technically, yes, but we don't usually include kids who are eighteen or nineteen in the 'teenager' group!"

"I know a former dean who thought they were not just teenagers but children," I said, shaking my head.

"I've heard about that Dean," Antonne said. "She sounds like a real piece of work."

"That's an understatement. You six are very lucky to have Dean Anderson. She's awesome."

"Not awesome enough," Paul smirked. "I haven't been able to convince her to allow co-ed dorm rooms!"

Everyone laughed.

"Good luck with THAT," Kris said. "You Americans are so prudish!"

"And, once again, «ma chérie»," I said with a grin, "I am forced to remind you that YOU are an American, and I have the paperwork to prove it!"

"Is he always like this?" Jordan asked.

"He's actually behaving!" Kris teased.

"Antonne," I said with a grin, "how are classes going?"

"We're all doing very well," he replied. "I had a call from Doctor Nora Mertens encouraging all six of us to apply to McKinley Medical School when the time comes."

"They're all considering it," Danika said. "But you know I'm going to Stanford."

Which was, in the end, why we hadn't continued down the path towards marriage. Danika, like Katy, felt her best interests were served by going to Stanford, and I not only couldn't argue with that, but I'd insisted she be true to herself and not make that sacrifice on my account.

"Which, as we discussed, is the right choice for you. How is your dad?"

"He's doing well. He did ask that you call him some time to check in. I think he has designs on stealing you for Cleveland Clinic!"

"And Doctor Al Barton in Chicago sent me a Christmas card reminding me he'd like to talk to me when I complete my Residency."

"That's a far different culture from Ohio, and you could live in a rural area and easily drive to Cleveland Clinic. Good luck doing that in Chicago!"

"May I remind you — and even though they aren't here, your dad and Al Barton — that I haven't even finished my PGY1 year, and my Residency is at least seven years!"

"Right," Danika said with a smile, "because my dad didn't start working on me to stay in the family business when I was a toddler!"

"Point taken," I chuckled. "He is pretty intense."

"That's one way to put it," Danika said.

"Any trouble with anything for which any of you need my help?"

They all shook their heads, which I was happy to see. We had a wonderful rest of the evening and made our plans for our April meeting before they left.

"So, just how close of a thing was it for you and Danika?" Kris asked.

"In one sense, very; in another, not close at all. She'd have had to give up on going to Stanford and on a Residency anywhere except Moore Memorial or in Columbus. Nothing else would have worked. There was no way I was going to try to move to California with Rachel. If moving had been an option, Danika would never have even been a thought because I'd have moved to Tennessee with Annette Turner-Cooper."

"She was at the wedding, right? With her parents?"

"Yes. Doctor Cooper was my Attending for my OB/GYN rotation. I was living at their house when Rachel was born."

"And Annette offered to comfort you afterwards?"

"An offer I declined," I replied. "Whatever else was true, I was still a deacon at that point, so accepting any offers of that kind of comfort was out of the question. We did date a bit, much later, and if she hadn't had a scholarship to Vanderbilt, things might have been different. But again, as with Danika, our paths didn't align the way yours and mine did."

"Which is what led you to Danijela, and then to me, when Danijela refused to wait until your agreed time to ask her."

"Yes."

"Well, I am not complaining in any way, shape, or form!" Kris declared. "Their loss was my gain!"

"And mine," I replied. "When it comes right down to it, you were the far better choice."

"Not to hear my sister tell it!"

I laughed, "True, but since she started seeing Brett, she hasn't been teasing me nearly as much. I figure she's chosen to torture him instead!"

"I think you may be right! Shall we read to Rachel, say our family prayers, and put her to bed?"

"Sounds like a plan."

"You know, I don't think Charlotte Michelle will mind Papa making love to Mama, so long as he's gentle."

"That sounds like an even better plan!"

_March 16, 1990, McKinley, Ohio_

I saw Mary Anderson hurrying down the corridor with a huge smile on her face. She nearly bowled me over, giving me a tight hug.

"Thank you!" she gushed.

"You're welcome! Congratulations."

"Do you know the worst part?" she asked.

"There's a 'worst part' of Matching here?"

"That I can't start training until June 1st! I have ten weeks of scut before then!"

"And a year of scut after," I teased.

"I know you better than that, Doctor Mike!"

"Once again, congratulations."

"Thanks."

She left, and about a minute later, Erin Jackson came up to me.

"I Matched here!"

"Congrats. You had to have taken a fairly severe risk to make that happen."

"Actually, I just called UC and told them they were my second choice, not my first. I was positive they'd move me down the list, and they obviously did. Is there any chance we'll be on the same surgical team?"

"At least some of the time, yes, because they rotate a few times a year. And you'll absolutely be on shift when I'm here because you'll basically never be off shift!"

Erin laughed, "They cut it from ninety-six to eighty hours, so it's not as bad as it used to be! I take it Mary Anderson Matched for trauma surgery."

"The bear hug gave that away, did it?" I chuckled.

"Medical students are supposed to observe everything around them! I'd give you a hug, but I'm very careful with married guys. Wives tend to have a limited tolerance for that."

"True, and it's wise to be cautious. Hugs won't bother my wife so long as they're platonic."

Erin gave me a quick hug.

"Who else Matched for surgery?"

"Bob & Sue Kennedy, a married couple; Felicity Howard; and Ryan Harrison."

"How will that work? The married couple, I mean?"

"They'll be on separate teams, and very little consideration is given for synchronizing their shifts during their PGY1 because it's just not possible. When they get to PGY3, they'll have a better chance of having similar shifts, but the rules prohibit them from being in the same surgery except _in extremis_."

"OK. Well, back to the salt mines!"

I chuckled, "It's not quite _that_ bad!"

She left, and a few seconds later, I was paged to the ED. I walked to the lounge to get Todd, and we went downstairs to rule out an appy, which, for once, I did. But that didn't mean the patient didn't need surgery, as he had a bowel obstruction that needed immediate attention. I had Todd arrange to take him upstairs while I went to see Brent Williams.

"What was your decision?" I asked.

"I offered the position to Nicole, and she accepted," he said. "Mainly because she's here and can start June 1st. The other two were from out of state. Neither of them was better enough to not pick the local student."

"Clarissa Saunders will be grateful. What's the word on an Attending?"

"Cutter has it narrowed down to two. He's flying them both in for interviews next week. One from Texas, one from Arizona."

"Did somebody tell them it gets cold here?" I asked.

Brent laughed, "It snows in both Arizona and Texas. One of them went to OSU for undergrad, so that one knows for sure."

"What happens when Loretta is ready to come back?"

"That's up to Cutter, and he hasn't shared that with me. That said, you know we'll have more Residents and Attendings next year because of the new ED. I'm sure there's a spot for her if she can get around reasonably well."

"Thanks. I'm off to assist with a bowel obstruction."

"I know PGY3s who would kill for the opportunities you're getting!"

"Me, too. I wear a Kevlar jacket under my scrubs!"

Brent laughed, "Nice. Get out of here!"

"You're in Lor's chair, so you get Lor's treatment."

"Wonderful,” he deadpanned.

I left his office and went back to Trauma 1, where an orderly was helping move the patient to a transport gurney. Todd, the orderly, and Joe, a Third Year, escorted the patient up to the OR where Erin, Todd, and I had an opportunity to scrub in, though I only observed, rather than assisted, as I had not resected a bowel, nor seen that procedure more than a few times.

At lunch, I met Sophia in the cafeteria.

"Well?" I asked.

"I got it!"

"University of California, San Francisco, right?"

"Yes! Obviously, that was just step one, but it was the toughest step. You know nobody is going to beat out a Greek girl for something she wants!"

"Except for a Russian girl," I chuckled.

"Not even close!" Sophia declared. "I heard Mary Anderson Matched for trauma surgery."

"That was as much of a lock as me Matching here. What's your schedule?"

"I start July 1st, and Robby's job starts August 1st. He's going to fly out in May and look for a place for us. He'll narrow it down, and I'll fly out right after graduation to see the two he likes best."

"He's at Stanford, and you're in San Francisco. How close are they?"

"Not close enough, so we'll find a spot somewhere in between."

"I'll miss you guys, but I'm very happy you Matched your first choice."

"Me, too!"

When we finished lunch, I headed back to the surgical ward to supervise Erin and Todd, prepping a patient for a lumpectomy.

"Mrs. Carson," I asked once the prep was complete, "On which breast will be performing the procedure?"

"If you don't know, I'm in real trouble!" she exclaimed.

"I do, but I need to verify that you and the chart agree. I'll actually write my initials on the correct shoulder, at the collarbone. So will your surgeon and anesthesiologist. We certainly don't want to make any mistakes."

"Left," she said. "My left."

Which confirmed what was on the chart and the X-rays. Erin handed me a new Sharpie, which I used to write 'MPL' on Mrs. Carson's left shoulder, then handed it back to Erin.

"That goes in the medical waste bin once Doctor Edmonds and Doctor Clausen sign."

"You throw away a new pen?" Mrs. Carson asked.

I nodded, "Yes. We'll use the pen for the same patient, then dispose of it. The concern is spreading germs from one patient to the next. Nobody has completed a proper study, so we act out of an abundance of caution. I know it seems wasteful, but unless we can quantify the risk, it's necessary. Erin, would you walk Mrs. Carson through the procedure and the consent forms, please?"

"Yes, Doctor," Erin replied.

{_ [Author's Note: A formal study in 2008 showed there was little risk of disease transmission from re-use of Sharpie markers] _}