Chapter 48 — Internecine Warfare

_September 12, 1989, McKinley and Circleville, Ohio_

{psc} Shelly Lindsay and I met for lunch later on Tuesday morning, though we ate in the surgical Resident's office rather than in the cafeteria.

"I spoke to Owen Roth, and we went to see Doctor Cutter together. Doctor Cutter is very unhappy that Doctor Northrup reprimanded and disciplined you, and not just that he did it, but that he did it in front of outsiders. He has a meeting scheduled with Northrup this afternoon. Just hang tight until after that meeting, OK?"

"Other than my wife and Doctor Saunders, I haven't discussed this with anyone except Krista, and that was only a brief conversation this morning where I suggested that during her Medicine Sub-I she go to Doctor Saunders for any questions or if she needed help."

"Good. Let's keep it that way."

"I do have a good idea who the source of the rumors and innuendo is."

"Oh?"

"Doctor Rosenbaum from Pedes. According to Krista, he hit on her and she turned him down. Given how he treated me during my pediatrics Clerkship, I'd say blackballing Krista fits the pattern of his behavior. I can't prove it, mind you, but the evidence lines up that way."

Doctor Lindsay frowned, "That guy is a menace. He's…well, let's just say this wouldn't be the first time. I complained to Doctor Roth about Rosenbaum when I was a Fourth Year and Rosenbaum was my Resident."

And that sealed the deal for me as to my suspicions — I was positive that someone was covering for Rosenbaum. Of course, it could be deeper than that, but I was now reasonably sure of at least one situation that was being swept under the rug.

"You did a pediatric Sub-I?" I asked, somewhat surprised.

"General surgeons were encouraged to do a pediatric Sub-I when I was in med school here. The usual Sub-Is were trauma, pediatrics, cardiology, internal medicine, and surgery times two. The next year it was a double in trauma, dropping pediatrics. And after your experience, pathology is an option instead of the double in trauma, but those slots are severely limited."

"Thanks for explaining. Did you know Rosenbaum was having an affair with Isabella Mastriano?"

"No, but it doesn't surprise me. Was? As in, it's over?"

"Yes. I believe Rosenbaum was the cause of how she treated me — he basically trashed me with her."

"Is that something you can share?"

"I don't have incontrovertible proof, mind you, so please don't repeat this."

"I won't."

"Someone, and I cannot reveal who, told me they had overheard him calling my church to check on service times, and then designing my schedule expressly to prevent me from attending church."

"You're joking! Why?"

"Ostensibly his objection to me wearing a cassock at the hospital on some rotations. He made a remark that supports my theory — that I was smart to have ditched the clerical robes. He also stated that religion and medicine do not mix, and that Moore Memorial was a public hospital, and required to be completely secular, which isn't actually how the law works."

"What an ass!" Shelly declared. "What did you do?"

"Nothing. In my mind, I would win by happily performing my tasks, and he'd be the one who was upset because his strategy of upsetting me had failed."

"A bit of psychological judo?"

"Yes. But in the end, it didn't matter because Kylie Baxter asked me to swap shift schedules with her due to family concerns, and Doctor Sumner approved. She and I have had a pact since then about swapping schedules or covering when we have a conflict."

"How did Rosenbaum react?"

"He wasn't happy, obviously, but there wasn't anything he could do about it. He had planned to give me only the worst scut, but with the new schedule, he wasn't my Resident. His attempt to retaliate was running me down with Isabella Mastriano."

"Today, on _General Hospital_," Shelly said, shaking her head.

"Pretty much. On that theme, I did suggest to Krista it would be wise to avoid relationships with doctors for the remainder of her time here."

"That would be for the best. I don't see anything wrong with what you said to her, so just let things be now."

"As I've said, I achieved my main goal of rectifying an injustice. I can pick my spots for the ethical issues when the time is ripe. And I have a backdoor way of fixing most of the problems."

"Care to share?"

"If the medical school makes having sex while on shift an ethics violation with dismissal as the standard, that will put an end to that problem fairly quickly. And while the medical school probably can't ban relationships outside the hospital or school, they _could_ require private disclosure, with failing to disclose a relationship being grounds for dismissal. That alone would end most of it because doctors wouldn't want to be on record, especially if they're married."

"And there is literally nothing the hospital can do about that because the rules apply to the students, not the hospital or doctors."

"Exactly."

"Do you think that can happen?"

"Doctor Mertens agreed to consider it and discuss it with the Board of Trustees of the Medical School. I think given what happened with Gerald Kirby, there's a good chance the on premises ban will happen. The other one, I'm not so sure about. I'm having lunch with her tomorrow."

"I'd wait a bit before you push for changes."

"Doctor Mertens said she'd think about it and discuss it, so I'm going to wait for her to bring it up.'

"Good. How are things with Loretta?"

"Frosty, because I declined to have any conversation that wasn't about clinical matters because of the insistence that she snitch if I said anything Doctor Northrup thought was out of line."

"Hopefully Doctor Cutter will resolve things. You know there's been low-intensity warfare between them about your Residency, right?"

"Yes. I thought it had more or less died down."

"What you might not know is that Northrup wants to be Medical Director."

"No chance. It'll go to Doctor Cutter when Doctor Rhodes leaves at the end of the year. That position has always been filled by a surgeon since the hospital was opened. And it fits with the 'only a surgeon may supervise a surgeon' rule."

"Given you'll be a surgeon, that's no impediment," Shelly said with a smile.

"As if I'd want _that_ job! No chance! And I'd only take a department head job if I could do it as a practicing physician, similar to Cutter or Baker."

"You think Northrup is simply a bureaucrat?" Doctor Lindsay asked.

"You said it, not me!" I replied with a smile.

"You seem to be in a better mood."

"Doctor Gibbs would likely disagree. It's all about demeanor. And the thing is, I was never not calm. That doesn't mean I wasn't upset, but there are Orthodox Christian strategies for maintaining inner peace. I haven't always practiced them, but I know how to use them. I did so yesterday and today."

"Some kind of meditation?"

"Using a very specific prayer, yes. Done properly, it's continual prayer during waking and sleeping hours. It's mostly a monastic practice, but then again, I have monastic and ascetic tendencies; well, minus the whole chastity bit!"

"Obviously, given you have a beautiful daughter!"

"And why I chose to resign my clerical office. To keep it would have required a vow of chastity as we ordain married men, but ordained men may not marry."

"Brutal."

"It has solid practical reasoning behind it, but I won't bore you with the details."

"Thank you!" she said with a smile.

We finished our lunches, and I returned to the ED, wondering exactly what might come of the meeting between Doctor Cutter and Doctor Northrup.

"Is everything OK?" Kellie asked when I walked into the ED.

"No, but it's not something I can discuss. Don't worry, because it's being handled and I'm fine."

"If there's anything I can do to help, just ask."

"Thanks. I appreciate it."

"Under different circumstances, I'd offer to take your mind off your troubles," she said with a twinkle in her eye.

"Remove the 'K' at the start of your name and it's 'Ellie'!" I chuckled.

"Now that's low!" Kellie declared. "I did say 'under different circumstances', as in, if you weren't married!"

"Oh," I replied flatly.

"You're a goofball, Doctor Mike!"

"You are another in a long line of women to point that out!"

"Doctor Saunders?"

"Chiefly, yes. Let me…"

"Mike?" Nurse Mary interrupted, coming up to us. "Paramedics are three minutes out with a gunshot wound. Doctor Nielson wants your help."

"Kellie, would you let my students know, please?" I requested.

"Right away!" she confirmed.

I walked over to the cart, put on a disposable gown and a pair of gloves, then headed for the ambulance bay where Perry Nielson was waiting with his Fourth Year, Sam Braddock.

"Hi, Perry. Any details?"

"A McKinley cop," he said. "Report was two in the chest."

"No vest?"

"It doesn't seem so."

"Wonderful."

Jake, Heather, and Mary joined us just as the EMS squad turned into the driveway. It pulled up in front of us, rolled to a stop, and Roy jumped out of the cab.

"Detective William Townshend, forty-nine, two gunshot wounds to the right chest; no exit wounds; collapsed lung and significant blood loss; BP 70/30; pulse 106; PO₂ 90%; unit of plasma and a saline IV."

"Trauma 1!" Perry ordered. "Mike, chest tube; Sam, intubate; Mary, type and cross match for two units, then trauma panel; Jake, EKG and monitor!"

"Heather, call surgery!" I declared. "He'll go up as soon as we stabilize him!"

"Calling surgery!" she confirmed.

We rushed Detective Townshend into Trauma 1 and, with help from the paramedics, transferred him to the trauma table. Everyone spring into action, but because everyone had an assignment, I got my own chest tube tray and tube from the cabinet.

"At least 500ccs on the floor!" I declared after making the incision. "Mary, put a unit on the rapid infuser; I'm going to insert a subclavian! Heather, get me a kit!"

"BP 60 over 20, pulse 120; PO₂ 89%!" Jake announced. "Sinus tach!"

"OR ready in five minutes!" Heather announced. "Full team standing by!"

I quickly completed the chest tube, then inserted the subclavian line, to which Mary hooked up the rapid infuser. As the blood was going in, I stabilized the chest tube, hooked up the Thora-Seal.

Because he'd been shot twice in the chest, he had a classic 'sucking chest wound', which meant the lung wouldn't re-inflate. We couldn't do anything to actually close the wounds in the trauma room, but there was a technique I'd read in a journal article that would help - defibrillator pads, which were designed to stick to diaphoretic skin.

"There's blood in the Thora-Seal," I observed. "Heather, get me two defib pads!"

"No negative neuro signs," Perry declared; good breath sounds on the left. "No trauma other than the gunshot wounds."

Heather handed me the pads, and I used them to temporarily seal the chest wounds. Perry listened and nodded.

"Breath sounds on the right," he announced.

"PO₂ coming up!" Jake announced. "93%."

"Better. His BP isn't going to come up until they find the bleeders in the OR. Sam, get a Foley into him while the blood runs in, then we'll get him upstairs and let the sawbones have him! Heather, get a gurney."

Sam inserted the Foley and then we moved Detective Townshend to the gurney Heather had retrieved from the corridor.

"Take him up, Mike!" Doctor Nielson ordered.

"Let's go!" I said to Jake and Heather.

We rushed him from the trauma room into the corridor and towards the elevators. I called out for them to hold the elevator, which caused two nurses and two others to move out of the way and allow us to push the gurney into the elevator. Jake hit the button for the surgical floor, then held the button to close the elevator door. Thirty seconds later, we turned Detective Townshend over to the surgical team, with me providing his vitals. I had hoped I'd be asked to scrub in, but Doctor Roth was waiting with two other Residents, so I headed back down to the ED with my students.

Unsurprisingly, there were half-a-dozen cops in the ED waiting room, and Perry was speaking to them. I felt Detective Townshend had a good chance, but gunshot wounds often created significant damage, and he had lost a lot of blood. They'd do a rapid thoracotomy to find the bleeders, then set about repairing any other damage. I envisioned a day, likely ten years down the road, when someone like me would do that in the ED and we'd have the patient fully stabilized before rushing them to surgery.

The rest of the afternoon was routine, and just after 6:00pm, Shelly Lindsay asked me to take my meal break. I checked with Doctor Mastriano and she cleared me to leave the ED, so Shelly and I went to the cafeteria, got our food, and sat down at a table by ourselves.

"First," she said, "I'm your new surgical mentor, as Doctor Roth believes we click, and I'm positive he's correct."

"I agree, with no disrespect to Doctor Taylor."

"He's OK with the change, as he doesn't want to become enmeshed in the internecine warfare."

"Totally understandable. You?"

"I'm as fearless as all those Russian women before whom you quiver like a bowl of Jell-O!"

"There might be some truth to that statement," I chuckled. "And that includes girls, too, especially daughters."

"Having a kid would make ME quiver!" Doctor Lindsay declared. "But I also hear my biological clock ticking loudly."

"We give up a lot in the pursuit of serving our fellow human beings."

"True. Back to the topic at hand — Cutter and Northrup achieved something of a truce, though it's likely only a short-term ceasefire. Doctor Cutter can't tell Doctor Northrup how to manage his staff, but you're a surgical Resident, so while corrective actions on clinical matters may come from either service, any reprimands or discipline have to come from the Chief Surgeon, not the Chief of Emergency Medicine.

"Bottom line — while Doctor Cutter can't force Doctor Northrup to take you off double-secret probation, or whatever it is, because you're on the surgical staff, any concerns have to be addressed first with me, Doctor Roth, or Doctor Cutter. And while he's not willing to state a public opinion on the matter, Doctor Cutter believes you have the right to voice your opinions, so long as it's done professionally. Doctor Northrup disagrees."

"I'm going to guess Doctor Cutter is protecting his flank?"

"I'd say so. Without support from the other Chiefs, he'll have a hard time being appointed as Medical Director, let alone being able to manage all the egos involved."

"No thanks," I said, shaking my head. "I have enough trouble managing my own ego!"

"You're a surgical Resident, Doctor Loucks. It's a pre-req!"

"TELL me about it," I chuckled. "I'm going to guess Doctor Northrup is displeased."

"He threatened to go to the Board to have the program canceled, but that's not going to happen. Well, he might try, but everyone thinks it's working well; it's more your personality that's at issue. And, honestly, you're in red scrubs for a reason — you think like a surgeon and act like a surgeon. Doctor Roth saw that during your Clerkship, and it's why he pushed you towards surgery rather than emergency medicine."

"But my heart lies with trauma," I replied.

"Obviously, but you found a way to satisfy both. As far as Doctor Cutter can tell, the only person in the entire hospital who has any problems with the program is Northrup. He lost the battle over which service would hire you, and I suspect you can guess his motivation and why he's so bothered by it."

"Because so long as only a surgeon can oversee a surgeon, the position of Medical Director will always be filled by a surgeon, similar to US Navy aircraft carriers only being commanded by former pilots."

"I didn't know that, but it makes total sense. I mean, if your job is to command a mobile airfield, you should know a heck of a lot about flying. The same is true of overseeing a surgical service; or really, any specialty service. The difference is, surgery truly is special because it's invasive. That brings considerations never encountered in other services and requires a different way of looking at medicine. I'm sure you see and feel it, having one foot in both worlds."

I nodded, "I do. Both services require split-second decision making and complete accuracy. There is almost never a chance for a Mulligan. We can't 'try and see what happens' the way, say, Medicine or Endocrinology or even Oncology can. If you cut into someone, you have to be completely sure you're doing the right thing, the right way, every single time. The same is true of emergency medicine — you likely have one shot to save the life, and if you make the wrong decision, the patient dies."

"And you eat stress for breakfast and live for the adrenaline high that comes with that. Your friend, Doctor Saunders, does not."

"Clarissa thinks I'm nuts."

"Most internal medicine specialists think that about trauma specialists. It's the same job, in effect, but one calls for considered, thoughtful, reasoned, and mutually agreed actions taken in measured steps; the other is usually fifteen minutes of sheer pandemonium, with a veneer of organization."

"It's not THAT bad," I chuckled. "But with one foot in each world, I can see why you would say so. Surgery is well-planned, and well-orchestrated, much like an opera. It's only when something goes wrong that the 'pandemonium with a veneer of organization' kicks in. You find that troubling, whereas I find it exhilarating."

"Because the best trauma specialists are bat-shit crazy!"

"I resemble that remark!"

"Back to our current situation — the bottom line is that Doctor Gibbs is to call me if there are concerns, and I'll discuss them with Doctor Roth and Doctor Cutter. That doesn't exactly solve the problem, but it does mean that Doctor Cutter has your back."

"I don't see this low-intensity warfare where I'm caught in the crossfire going away anytime soon. Could Northrup block Cutter's ascension to the throne?"

Doctor Lindsay laughed, "You have an interesting way with words! The short answer is that he could, but he'd have to have a reason other than sour grapes."

"Which is why Cutter is demurring on the policy about which I complained."

"Yes, and even if he agrees with you, he can't simply make that change unilaterally, even as Medical Director. He'll need a consensus, though if he can convince a majority, he could go to the Board and likely have some kind of change implemented. Politics, even in the hospital, are messy."

"More women in leadership positions would help," I suggested.

"You're preaching to the choir, to turn a phrase!"

"How much trouble could Northrup actually cause?"

"For Cutter? For you?"

"I was actually asking about Doctor Cutter, but I'm obviously interested in both answers."

"In theory," Shelly replied, "Northrup could try to ban you from the ED, but he'd have a hell of a time making that stick for several reasons. While we didn't discuss it, your worst-case scenario is you end up with a standard surgical Residency. I don't believe Northrup could control who provides consults in the ED, so you'd still be doing similar work, just not seeing ED patients regularly."

"That would suck," I sighed.

"I don't think it will come to that, but nobody can predict what Doctor Northrup will do. I'd say stay out of his line of fire, but I don't think that's possible when he's gunning for you."

"Wonderful."

"Just keep doing the excellent clinical work you've been doing. Northrup praised you for that, so he'll have a tough time retracting that statement."

"Until I make a mistake."

"And that's where the M & M is your friend, despite people dreading appearing there. I can't imagine you acting negligently or doing procedures for which you haven't been cleared, so a bad outcome will be seen as exactly that — a bad outcome. If Northrup tries to throw you under the bus, every Resident and Attending will stand up for you. Well, maybe not Rosenbaum, but the ones who really matter like Baker, Roth, Getty, Strong, and me.

"What I'm trying to say is don't be overly cautious, but don't be foolish, either. You aren't a cowboy, despite what Psych thinks. I've yet to find anyone outside of Psych who doesn't agree with your approach to Mr. Alien Encounter, as you dubbed him. And if I understand things right, the Medical Review Committee convened by the Medical Licensing Board against your friend's psychiatrist agreed."

I nodded, "They did; it was called unconventional, but acceptable. I'm surprised Northrup and Cutter aren't joining forces with regard to Lawson."

"You know part of Lawson's story, but not all of it."

"Do you?"

"Lawson is married to the youngest daughter of the former Medical Director, Paul Goddard, who is now on the Board of Directors. I think you can work out how Lawson was hired as an Attending and later became Chief."

"Oh, that's just perfect," I replied. "Nepotism at its finest."

"Your former father-in-law is on the hospital Board of Directors, right?"

"Yes, and he was, and is, extremely careful not to mix the business side with the medical side, if you get my meaning."

"I do."

"If it's OK to slightly change topics, and OK to ask, what's your take on Krista Sandberg?"

"I did my own snooping, as it were," Shelly said, "and I can trace every single rumor or innuendo about her back to Rosenbaum. I've let Doctor Roth and Doctor Cutter know, and I have to leave it to them, given he's an Attending, and he hasn't hit on me. If he does, he'll rue to day he was born."

"Good to know," I chuckled.

"You are NOT going to goad me into answering your question, Mister!" she said firmly.

But her goofy smile DID answer the question, which, all things being equal, was a mutual feeling — we liked each other, but neither of us would have ever considered acting on the attraction. I could see, as I had with a few other situations, how doctors easily fell into affairs, and only firm determination would prevent that from happening.

"Please let Doctor Cutter know I appreciate his intervention."

"It helps when interests align," Doctor Lindsay said. "And in this case, they do."

"Cutter, as Medical Director, makes Roth Chief Surgeon in January, and paves the way for you to hold the role of Chief Surgeon in six to eight years, when Roth becomes Medical Director."

"No comment."

"Thought so," I chuckled. "For me, nobody can ever accuse me of angling for the role of chief of anything. I can't be Chief Resident in the ED, as I'll be on a surgical team during PGY3, and I won't be a full-time surgeon, so I can't be Chief Surgical Resident. Ditto with Chief Attending in the ED or Chief Surgeon. And guess what? I think that's a _good_ thing!"

"You know the reasons why Roth and I think that way, I'm sure."

I nodded, "Manual dexterity declines with age. When my manual dexterity declines, I can continue as a regular trauma specialist. Obviously, at some point I'll retire from the hospital, but there's a good chance I'll work in a clinic or even hang out a shingle for a time."

"That fits your personality. Going back to the thing that caused this kerfuffle, I had a word with Pete Gabriel and he'll do his best to match Krista Sandberg's schedule to yours. Let's just say I hope you're right."

"Me, too."

We finished our meal, and I returned to the ED to complete my shift. It was uneventful, and after turning things over to Kylie for the overnight shift, I headed home.

"How did things go?" Kris asked after we'd said evening prayers and put Rachel to bed.

"Better. Doctor Cutter intervened as I expected he would."

"He's actually your boss, right?"

"Yes. He's the Chief Surgeon and I'm a surgical Resident."

"So, what does that mean?"

"According to Shelly Lindsay, and I agree with her, I'm a pawn in a power struggle between the Chief of Emergency Medicine, Doctor Northrup, and Doctor Cutter. Both of them want to succeed the current Medical Direct when he retires at the end of the year. Doctor Cutter has the inside track because he's a surgeon, and the position of Medical Director has always been held by a surgeon since the hospital opened right after World War II.

"Back when I proposed the Residency in trauma surgery, there was an internal battle over whether I'd be on the surgical team, and Doctor Cutter won, because historically, anyone who use a scalpel has to be supervised by a surgeon. Doctor Northrup had made the argument that I was a trauma specialist who was receiving additional training, but that didn't fly because I need board certification in surgery, not trauma, to practice. I'll obtain both, of course, but technically I don't need Board certification to work in trauma as a surgeon."

"I don't think we ever discussed it; when does the certification happen?"

"I can apply for my medical license sometime after I finish PGY2, and I'll do that, as well as take my Boards for trauma. I can't take the surgical Boards until at least PGY6, probably PGY7, given I'll spend three of the first seven years in the ED. I could, at that point, be an Attending trauma physician, but I'll stay a Resident because I'll need to complete my surgical training. I'll make about the same money either way, as surgical Residents are paid at a higher rate than regular Residents, and the salary is comparable to new Attendings in most department."

"What about the situation with Loretta Gibbs?" Kris asked.

"I think that will work itself out now that any criticism or concern has to be relayed to Doctor Lindsay, and though her to Doctor Roth and Doctor Cutter. And Doctor Cutter expressly said he feels I should be permitted to voice my opinions, so long as it's done professionally. That said, I have to be careful because Doctor Northrup is going to watch me like a hawk."

"I can't believe they condone what amounts to teachers sleeping with students! That happened quite a bit in France, and I objected to it there, just as I do here. I don't care about age differences the way some Americans do, but I do concern myself with the potential for abuse and for corrupting the system."

"Worse is the double standard," I replied. "The doctor goes scot-free while the medical student is looked upon with disdain, or is covertly punished for refusing the advances of a doctor, which appears to be what happened with Krista. I told you about Doctor Rosenbaum and my schedule; well, according to Shelly, all the rumors trace back to him."

"He should be fired!" Kris said resolutely.

"And therein lies the challenge. Doctor Cutter, because he needs the support of department heads, cannot come out against the practice until after he's Medical Director. And even then, he'd have to gain some kind of consensus amongst the department heads to change the policy."

"That's just wrong!"

"I agree," I replied, "but doctors are protecting what they see as their privilege of treating female medical students as part of their harem. I think the biggest problem is actually the small number of female Attendings and the lack of any female department heads. When that changes, the Old Boys Network is doomed, which should warm the cockles of your socialist heart!"

Kris laughed softly, "You agree with me on equality and egalitarian ideals."

"I do. And I look forward to the day when Loretta is Chief of Emergency Medicine and Shelly is Chief Surgeon."

"What will happen to the medical student?"

"According to Shelly, Krista will have her shifts scheduled to match mine. I'll be tough on her, and she's going to have to earn her grade. If she does, nobody will be able to legitimately question it."

"And if she doesn't?"

"Her grade will reflect that, and I'll get some grief. I believe that with proper instruction, she'll be successful. As I see it, it all derives from a doctor blackballing her for refusing to sleep with him, Well, and Krista not being properly instructed how to be successful. My study group had to figure that out for ourselves."

"How so?"

"By comparing experiences, we discovered early on in our clinical work that we had to take responsibility and initiative for our education, not rely on Residents to teach us. That meant, at times, insisting on being taught to do procedures or given the chance to do them.

"The perfect example is being able to read EKGs. Cardiology doesn't spend much time teaching that to students who aren't planning to become cardiologists. I asked Doctor Strong during Second Year when I had my Preceptorship to teach me. That meant that as a Third Year I was able to read EKGs as well as most of the ED doctors."

"Why wouldn't they teach that by default?" Kris inquired.

"They should," I replied, " but some Residents are poor teachers, some don't want to teach, and all of them are busy. I see that in the ED every day — some doctors simply don't have the patience, skill, or desire to teach. I make a point to teach my students as much as possible, within the rules, and allow them to do as many procedures as possible."

"It just seems strange that students would have to demand to be taught."

"I agree, and that wasn't my experience before medical school. Everything about medical education is strange and doesn't really track with how teaching is done in universities. Strangely, the closest parallel I find is in the trades — carpenters, electricians, plumbers, and so on. They start by observing, are taught to do basic tasks, and as they show they are skilled and can be trusted, they're given more responsibility. They also have similar progression — Apprentice, Journeyman, Master — with tests of knowledge and abilities required to progress."

"An interesting analogy."

"Perhaps we can continue this conversation in the future?"

"Did you have something more interesting in mind?" Kris asked with an inviting smile.

"Taking by beautiful, sexy wife to bed and seeing if we can make a baby!"

"A wonderful idea!"

I took my wife's hand and led her up to the bedroom.

_September 13, 1989, McKinley, Ohio_

Unfortunately, despite our best efforts, Kris wasn't pregnant, as her period had started overnight. Fortunately, she wasn't an emotional wreck about it the way Elizaveta had been. I hated making comparisons, but I couldn't help it because of the way my mind worked. That said, I would never voice them to Kris, not allow those comparisons to interfere with our relationship.

"We'll just have to redouble our efforts!" she said sexily as we got into the shower together on Wednesday morning.

"Oh, darn," I chuckled.

Kris laughed softly, "You are so silly at times!"

After we showered, we dressed, gathered Rachel from her bed, and said morning prayers. We had breakfast together as a family, something we could only do on Wednesday mornings, and then I headed to the Free Clinic. The morning was busy, and I saw seven patients — two for birth control pills, four for minor injuries, one for chest pain, who I sent to the hospital by ambulance.

I took my lunch break at noon so that I could meet Doctor Mertens at the diner.

"Doctor Warren and I do not agree with Doctor Northrup," she said once we'd placed our orders.

"Neither did Doctor Cutter," I replied. "He addressed the situation with Doctor Northrup after I spoke to Shelly Lindsay."

"You aren't in any trouble?"

"Not any serious trouble, anyway. As you know, I'm a surgical Resident, so any corrective action that isn't clinical in nature has to come from Doctor Cutter. A few changes came out of what I imagine was a tense meeting — Shelly Lindsay is my new mentor, and any concerns of a non-clinical nature are to be relayed by Doctor Gibbs to Doctor Lindsay, not to Doctor Northrup."

"Why the change in mentors?"

"Doctor Lindsay and I clicked, and she's taken me under her wing, so to speak. It started when we lost a patient on the table and she could tell it was eating me up. We had some good talks, and from there, developed a good rapport. It's also the case that Vince Taylor is completely uninterested in being in the line of fire, and wants to stay out of hospital politics as much as I do. A forlorn hope, sadly."

"It sounds as if this isn't over," Doctor Mertens observed.

"Not by a longshot," I replied. "Doctor Northrup is unhappy with how the trauma surgery program is being administered because he wants to run it. In the end, though, this is really about which of the two of them will replace Doctor Rhodes as Medical Director as of January 1st."

"So there was more to this than just Miss Sandberg."

"Much more."

"The Medical Director has always been a surgeon," Doctor Mertens stated.

"And therein lies the source of the problem. I expect things to flare up again, and probably soon, given it's September and the decision will be made in November. It appears Doctor Cutter has the inside track."

"Any scuttlebutt on the new Chief Surgeon?"

"No, but the smart money would be on Owen Roth."

"Back to the situation at hand, do you think the flareup will be about Krista Sandberg?"

"I'd say that's fairly likely."

"I agree, obviously," Doctor Mertens said. "I do want to ask why you've gone out on a limb that might well be sawed off behind you."

"Because there was an injustice being perpetrated," I replied. "And that is something I cannot tolerate."

"Nor would I expect you to, given you try to model your life on Civil Rights activists, such as Martin Luther King."

"I do," I acknowledged. "Back to Krista — I have a strong suspicion about who it was who blackballed her, though I have no proof, so I won't name names."

"I did some checking after the meeting, and I'm reasonably sure she did engage in what you would consider inappropriate behavior."

She'd admitted that to me, but I couldn't say that to Doctor Mertens, even off the record, as I didn't want Krista to think she couldn't confide in me. To reveal that would put me in exactly the same position I felt Doctor Gibbs was in, and there was no way I was going to do that.

"But not trading sex for a grade, right?" I inquired.

"As we discussed, she denied it to you, and the doctor allegedly involved denied it as well, but you and I both know they could be lying."

"She's been fairly candid with me," I countered, "so I don't think so. Is it possible? Sure. But her procedure book and her evaluations show her problems began in December, during here Pedes rotation. Before that, as I'm sure you know, she was in the top twenty in her class, and had slightly better-than-average evaluations of her clinical work.

"I attribute part of that to her being the classic example of someone who is excellent at classroom work but challenged in clinical work. Mostly, that can be solved by finding a good mentor. Sleeping with someone is not conducive to a mentoring relationship, so if the alleged behavior did occur, that would explain things. It's also the case that in Practice of Medicine medical students should be expressly told they're responsible for their clinical education."

"The point you made during your alumnus address."

"Yes, but it needs to be part of the formal curriculum, too."

"Want to teach?" she asked with a smile.

"I'm not an Attending, and Assistant Professorships go exclusively to Attendings."

"Not by policy, only by practice. But as a PGY1, there is no way that could happen. That said, a guest lecture or two would certainly be possible. Would you consider it?"

"I'd consider it, yes."

"Let me discuss that with Doctor Warren and Doctor Worth. Back to the hospital — what concerns do you have?"

"Given Doctor Northrup confirmed his trust in my clinical skills, it really is just a political battle, and if things go the way we all expect, Doctor Cutter will be the new Medical Director, and then he wins the battle perforce. At that point, I expect Doctor Northrup to leave for a position at another hospital."

"That wouldn't surprise me, given the obvious bad blood," Doctor Mertens observed.

"My only concern there is that Doctor Gibbs would be passed over because she's female."

"Sadly, that is a distinct possibility."

"The long-term solution is to continue to recruit extremely qualified female and minority students and change the landscape, not by giving preferences, but by providing equal opportunities."

"Is there anything you need from me?"

"Not at the moment. I'm no longer a student, so technically, you can't intervene. That said, Krista may need help, and I'd be happy if you'd pay close attention to how things go for her in Internal Medicine. I suggested she go to Clarissa Saunders for help or with questions, but I can't predict how the doctor who is trying to blackball her will react or what he'll do."

"I'll do that."

"Thank you."

The waitress brought our lunches, and we chatted amiably on every topic except medicine while we ate. When we finished, I headed back to the Free Clinic.