Chapter 27 — All I Can Do Is Try

_July 25, 1989, Centerville, Ohio_

{psc} "I need to apologize for dinner last night," I said to Kris after I greeted her and Rachel when I arrived home on Tuesday evening.

"You were upset and stressed," Kris replied. "But please don't walk away from Rachel and me that way again."

"I have an appointment tomorrow morning with Maryann Manning, a counselor in Columbus who specializes in doctors," I said. "Shelly Lindsay recommended her. Clarissa called Vince Taylor, and he asked Shelly to talk to me. Clarissa will watch Rachel."

"You're still going to the prison, right?"

"Yes. My appointment is at 9:00am, and I can be at the prison at any point between 10:00am and 5:00pm. Technically, as a chaplain, I can visit other times, but I don't want to use up any possible goodwill I might need at some point in the future."

"Go change," Kris said. "Dinner is in five minutes."

I went up to our room, put on shorts and a t-shirt, then returned downstairs where I picked up Rachel.

"How's my little girl?" I asked.

"Rachel, miss Daddy!" she declared.

"I know, little one, but Daddy has to take care of people at the hospital."

"'Daddy' needs to care for himself, too," Kris interjected.

Kris put the finishing touches on dinner and we sat down to eat, with Rachel sitting on my lap. It made eating a bit of a challenge, but I knew she needed my attention.

"Are you going right to bed?" Kris asked.

"I managed two forty-minute naps overnight, so I'm actually doing OK. I can spend some time with you and Rachel before bed. I think I'll go to bed when she does around 8:00pm so we can say evening prayers together."

"Daddy sing?" Rachel asked.

"If it's OK with Mama."

"Of course it's OK," Kris agreed. "And I can come to bed with you, if you have enough energy."

"I think I can find the energy for that."

After our meal, Kris and I cleaned up while Rachel played, then I retrieved my guitar and sang for Rachel for about thirty minutes before we said evening prayers. After prayers, I read _The Bears Picnic_ to Rachel as part of her bedtime routine, and after we put her down, Kris and I went to bed and made love before falling asleep spooned together.

_July 26, 1989, Columbus, Ohio_

"Tell me why you're here," Maryann Manning, who was in her late thirties, said after I sat down in her office on Wednesday morning.

"The snarky answer is that I was ordered to," I replied.

"Let's accept that as true," she said with a smile. "Why were you ordered to?"

"I wasn't really ordered," I replied. "I was counseled because, actually, I can't give a specific reason, except to describe a fairly lengthy series of events."

"I blocked out a full hour, so tell me what you think I need to know that led to you sitting in my office today."

I decided to start with the first time I'd seen Angie and ended with the treatment of the patient who averred alien contact. That used nearly thirty minutes, and Maryann was mostly quiet, asking only four questions of a clarifying nature.

"Why, then, did Shelly send you to me?"

"Because I'm at a risk for burnout or depression, and those are the primary causes of alcohol abuse, drug abuse, domestic violence, and infidelity amongst physicians."

"And knowing that, you allowed your understandable anger about your friends' treatment to lead you to a place where burnout or depression are not only possible, but likely, at least in the eyes of your mentors. What does that tell you, _Doctor_?"

"Well," I said with a wry smile, "the phrase 'physician, heal thyself' advises a course of action that can lead to dismissal from the hospital staff. That tells me I need to speak to someone who can help me, because self-help by physicians almost always leads to one of the abuses I mentioned before."

"Who are you accountable to with regard to alcohol or drug use?"

"In addition to the Chief Attending in the Emergency Department, my mentors, one in the ED and one on the surgical staff."

"I'm going to assume you're accountable to your wife for fidelity?"

"Yes, of course, but also to my «staretz» at a monastery in Michigan, as well as my bishop at the Russian Orthodox Cathedral here in Columbus."

"What's a «staretz»?"

"A spiritual guide, who has the gift of insight into a person's interior life. Call it the religious equivalent of a combined trauma surgeon, GP, and life counselor."

"So why come to me rather than go to him?"

"Oh, I'll go to him, but his guidance tends to focus on spiritual topics and my interior life, not on externals, which, for Orthodox, are a product of interior life. Or, to put it in secular terms, the psyche is responsible for our actions. It's also the case that he's not well-versed in the trials and tribulations of physicians, and his guidance in that area would have to be somewhat generic and open to interpretation. And like most Orthodox, I'm a fairly expert rules lawyer."

"What do you mean?"

"With regard to just about everything, save a few clear dogmatic statements, most Orthodox rules are open to interpretation and can be applied with strictness or lenity. Thus, it's both easy to read them in either way, as well as to find opinions amongst the Church Fathers and teachers that interpret them either way. I'm a catechist, which authorizes me to teach at church, as well as a prison chaplain."

"Prison chaplain?"

"Starting this year, with exactly one person. And that's another story that involves tragedy."

"Besides your first wife and Angie?"

"There are several others, including the suicide of one of our medical school classmates who I'd been involved with; a close friend who was badly injured in an accident and later attempted suicide; and a friend who was murdered, which is what led to my appointment as a chaplain."

"There's a lot to unpack here, even compared to most doctors."

"Life has thrown me a ridiculous number of curveballs."

"If I may make an observation — your reaction to your friend's treatment for her illness is stronger and more visceral than how you described your reaction to your wife's death in childbirth."

"I suppose that's at least partly because Elizaveta isn't suffering now, while Angie will suffer for decades. And while there's a hole in my heart that will never completely heal, that's different from spending every moment for the rest of my life aware of Angie's predicament, and knowing it didn't have to be this way."

"There's no need to get into a debate about the specifics, but you do understand the logical fallacy of 'hypothesis contrary to fact', right?"

I nodded, "The idea that changing something in the past would have guaranteed a different outcome when there is no way of knowing what else might have changed because of that change, or what other events might have occurred."

"But knowing that, you still believe an alternative outcome was guaranteed?"

"If I implied that, I'm sorry, because no, I don't know what the outcome would have been, only that it could not have been worse than the one that actually occurred."

"But you don't _know_ that. Perhaps that chain of events would have led to her being permanently institutionalized?"

"And perhaps I'll sprout wings and fly to Europe," I countered. "If I've learned one thing, it's that there are no guarantees in life. That said, if Angie had gained even one more day without psychoactive drugs, that would have been a better outcome, which has been my point all along. I never once had the idea that she was cured, or that complete remission was in any way likely. That said, I won't dispute that I've obsessed about the situation and allowed my visceral reaction to that to color my responses in just about any instance where psychiatry is involved."

"I notice you make the point to say 'psychiatry' versus 'mental health' or even 'psychology'."

"Can you prescribe medication?"

"No."

"That's why. I have an aversion to pharmaceutical intervention unless strictly necessary."

"You have the typical surgeon's mentality that all other doctors are 'pill pushers'."

"Because they are," I chuckled. "But I had that even before I chose the dual path of trauma surgery. My goal since fourth grade was emergency medicine. The trauma surgery thing came along after I learned about a program started by a doctor at Indiana University Hospital."

"We only have about fifteen minutes left today, so I'd like to discuss the negative interactions you've had with doctors at Moore Memorial."

I nodded and described my experiences with Doctor Rosenbaum, Doctor Mastriano, Doctor Lawson, and, to a lesser extent, Doctor Rafiq.

"We're basically out of time," Maryann said. "I know you have a crazy schedule, so shall we say two weeks from today?"

"Yes."

"I'll leave you with this question, which I don't need you to answer today — do you believe you can solve every single thing that ails medicine?"

_July 26, 1989, McKinley, Ohio_

"I'd say she asked exactly the right question," Clarissa said after she, Rachel, and I sat down in a booth at Frisch's.

"What can I get you?" the waitress asked.

"FRIES!" Rachel exclaimed happily.

"You need something other than fries," I said.

"More fries!" she giggled.

"Your mom, aunt, and I are going to have words!" I chuckled.

I ordered a chopped salad given it was Wednesday, Clarissa ordered a Big Boy platter, and we ordered a chicken strips and fries from the kids' menu for Rachel.

"She made a good point, you know," Clarissa said once the waitress had left.

"I don't want to cure every ailment, just the ones that affect me."

"So, as she said, every ailment. Come on, Petrovich! You know darn well it all affects you one way or the other because you care so deeply about both the practice of medicine and your patients. And you need to focus on your patients."

"You do realize that was what I was doing with Mr. Alien Encounter, right? Looking out for my patient."

"I know this is going to sound wrong, but you care too much."

"How is that even possible?"

"What is your job, Mike? I know you've been asked that question before, and I know you know the answer. I want to remind you that every single day you pray to the Savior of the World, and that is not you. Honestly, if you can't do your job the way it's meant to be done, you'll prove Lawson correct."

"What if the way it's meant to be done is _wrong_?"

"When it's YOUR department, you change it. Until then, and that will happen, you have to work by the policies that are set by the Chiefs. And guess what? Even when you're Chief of Emergency Medicine, you can't tell the _other_ chiefs what to do. And unless you become medical director, a job you don't want, that's going to be the way it is."

"That's defeatist!"

"No, it's not, Petrovich! It's reality. And I'm not saying you have to be complacent, but you have to accept reality. I know it's not an Orthodox prayer, but it's one I know you could pray - '_God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference._'"

"Martin Luther King was influenced by Reinhold Niebuhr."

"Which is high praise in your book."

"He was also an avowed socialist in the 1930s."

"So high praise from your wife, too! You understand the key phrase, right?"

"The wisdom to know the difference."

"So do that. You won't do anyone any good if you burn out, or worse, have someone decide you aren't really qualified to be a doctor. We _know_ that's not true, but you're giving idiots like Rosenbaum and Mastriano ammunition they don't deserve, and you KNOW they'll try to use it against you."

"I'm just trying to be the best doctor I know how to be," I protested.

"Remember the prayer, Petrovich! If you're lacking anything, it's what I think you call discernment, but which Niebuhr called 'wisdom'. Mike, you're regarded as the best young doctor in the hospital. Be that doctor. Don't throw it away in some Quixotic crusade to single-handedly save the world."

"The entire system is fu…messed up."

Clarissa laughed, "Don't want a certain little tape recorder to repeat what you say?"

"That would be bad," I chuckled. "She'll learn those words eventually, but why give her a head start?"

The waitress brought our food and after I prayed, we began eating, with Rachel greedily and happily eating her fries, which she finished before she ate her two small chicken tenders which she slathered in catsup.

"Are we OK, Petrovich?" Clarissa asked.

"If anyone can call me on the carpet, you can."

"But how many times before you actually listen? It's been three years, Petrovich. And it's the same story over and over again. Something offends your notions of right and wrong, and your response every time is 'damn the torpedoes; full speed ahead!' Well, this isn't the Navy, and it's not a suicide mission."

"Daddy! Poo!"

"You got that exactly right, Rachel!" Clarissa said through barely contained laughter.

I cleaned Rachel's face and hands with a pre-moistened towelette that came with her meal, then took her to the restroom where I changed her diaper. After washing my hands, we returned to the table so I could finish eating.

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

"Doctor Michael Loucks, chaplain, here to see prisoner Frank Bush," I said to the officer behind the plexiglass.

We went through the same basic motions as during my previous visit, and ten minutes after I'd arrived, Frank Bush, dressed in orange prison overalls, was escorted to the visitors' room and sat down across from me.

"How are you?" I asked.

"How do you think I am?"

"We had this conversation last time, so rather than repeat it, I'll simply assume your answer would be 'as well as can be expected, given the circumstances'. The book you asked me to order will be shipped directly here next month."

"Thank you."

"What else can I do for you?"

"Nobody can do anything for me."

"That's demonstrably false, because I arranged for you to get your book."

"Meaningless in the larger scheme of things, but if it makes you feel good…" he shrugged.

"I expect you'll obtain some amount of enjoyment from the book, even if the locale leaves something to be desired. If that weren't true, you wouldn't have asked me to get it for you."

"How do you find being a doctor?"

"Not all it's cracked up to be," I replied.

"You're an Intern, and that's tough in general, but toughest in trauma. What has you disillusioned?"

"Mostly things which are outside my control."

"That's the exact reason I went into private practice, instead of working in a hospital. I made my own rules, set my own hours, chose my patients, and practice medicine exactly the way I wanted. But I get the feeling that's not you. You're driven in a way I never was."

"I'm interested in how you became a doctor."

"The same way everyone does — medical school and Residency."

"Obviously, but was it a family thing?"

"My dad was a physician, though a GP, not a pediatrician."

And that had been Melissa's goal as well, and in theory she could be a pediatrician or a GP, despite matching for internal medicine. The track to being a pediatrician was a bit complicated, but could be done by taking shifts in pediatrics during her Residency. I suspected that in her rural medical center, that would be easier than it would in a big city hospital, or even at Moore Memorial.

"I'm the only physician in my family. My dad's side were all businessmen or government employees; on my mom's side it was all trades of some kind in Russia and here. Would you like to play chess?"

"If you want."

I signaled the guard and asked for a chess set, which was brought from an adjoining room. Frank took the white pieces, and I took the black, and we began to play while we talked.

"I spoke to Melissa," I said.

"I'm going to guess she has no interest in speaking with me."

"Correct, but I'll keep in touch with her. At a minimum, I can let you know how she's doing."

"What is it you want?" Frank asked, moving his queen-side knight.

"Why do I have to want something?" I asked. "I'm sure you recall Matthew 25, starting at verse 31:"

{_ When the Son of Man comes in His glory, and all the holy angels with Him, then He will sit on the throne of His glory. All the nations will be gathered before Him, and He will separate them one from another, as a shepherd divides his sheep from the goats. And He will set the sheep on His right hand, but the goats on the left. Then the King will say to those on His right hand, 'Come, you blessed of My Father, inherit the kingdom prepared for you from the foundation of the world: for I was hungry and you gave Me food; I was thirsty, and you gave Me drink; I was a stranger, and you took Me in; I was naked, and you clothed Me; I was sick, and you visited Me; I was in prison and you came to Me.'

"Then the righteous will answer Him, saying, 'Lord, when did we see You hungry and feed You, or thirsty and give You drink? When did we see You as a stranger and take You in, or naked and clothe You? Or when did we see You sick, or in prison, and come to You?' And the King will answer and say to them, 'Assuredly, I say to you, inasmuch as you did it to one of the least of these My brethren, you did it to Me.'

"Then He will also say to those on the left hand, 'Depart from Me, you cursed, into the everlasting fire prepared for the devil and his angels: for I was hungry and you gave Me no food; I was thirsty, and you gave Me no drink; I was a stranger, and you did not take Me in, naked and you did not clothe Me, sick and in prison and you did not visit Me.'

"Then they also will answer Him, saying, 'Lord, when did we see You hungry or thirsty or a stranger or naked or sick or in prison, and did not minister to You?' Then He will answer them, saying, 'Assuredly, I say to you, inasmuch as you did not do it to one of the least of these, you did not do it to Me.' And these will go away into everlasting punishment, but the righteous into eternal life." _}

"Memorized that for today, did you?"

"No. We use so much Scripture at church that I have about half the Psalms and a third of the New Testament memorized," I said as I castled king side. "Our monks generally have the entire Psalter memorized."

"Then I'm sure you know that the Scriptures say a pastor is to have a wife and kids."

"Which is, of course, why the vast majority of our pastors are married men," I replied. "But back to the verse, how could I, as a believing Christian, not obey that text?"

"The same way you don't obey the instruction to call no man 'father'."

I smiled as I moved my king's knight, "And yet, you and I both have fathers, and use that term. That verse is not intended to be taken any more literally than Paul's command to pluck out your eye or cut off your hand is to be taken literally. As my former bishop said, 'let the Protestants and their scholars fight over the literal truth of each word, while we worship the undivided Trinity who has saved us'."

"And you're here to save me, is that it?" Frank asked, moving his queen.

I shook my head, "Only God can save. All I can do is live my life as a Christian. As Saint Seraphim of Sarov said — 'Acquire the Spirit of Peace and a thousand souls around you will be saved'. His advice for how to achieve that was succinct:"

{_ "You cannot be too gentle, too kind. Shun even to appear harsh in your treatment of each other. Joy, radiant joy, streams from the face of him, who gives and kindles joy in the heart of him who receives.

All condemnation is from the devil. Never condemn each other, instead of condemning others, strive to reach inner peace.

Keep silent, refrain from judgment. This will raise you above the deadly arrows of slander, insult, and outrage and will shield your glowing hearts against all evil.'" _}

"So this is about you, then?"

"No, it's about God's love and mercy. But I'm actually interested in where you went to college and medical school, and when you decided to be a doctor."

"My dad and grandfather expected me to be a doctor, so I never really gave consideration to anything else. I attended University of Virginia, then Drexel for medical school, which is the same as both my father and grandfather. I did my Residency at the University of Virginia Hospital."

"You met your wife sometime around then, right?"

"When I was a Third Year. We married after I started my Residency."

"Your dad and grandfather practice in Virginia?"

"Yes. I moved here because Fred Newsome and I were friends in medical school and wanted to practice together, similar to what I've heard about you and the lesbian."

"The lesbian has a name," I said. "It's Clarissa Saunders. Where did Doctor Newsome serve his Residency?"

"The University of Cincinnati," Frank replied. "He's from Hamilton, Ohio, and we met at Drexel."

"Did you attend the same church as your dad?"

"My dad and grandfather were High Church Episcopal, but I read my bible, and joined Faith Bible Fellowship."

"Where did your wife attend before that?"

"She was basically unchurched. Her parents were Lutheran. What about your family?"

I delayed answering to consider my next move, shifting my knight.

"Check," I said. "My mom's side has been Orthodox since the tenth century; on my dad's side, Dutch Reformed, and they attended a Bible church in the Chicago suburbs. My parents met at the University of Illinois and dad converted. He's basically unchurched since the divorce."

Frank countered by moving his king, providing me with a slightly stronger line of attack, but as rusty as I was, I wasn't sure I'd be able to sufficiently press the advantage.

"Do you attend services here at all?" I asked.

"No. I know exactly what the Scriptures say."

"I'll happily debate that with you, though I'd rather simply talk."

"I expected you to start preaching at some point."

"James also says he'll show his faith by his works, and I'll take him at his word. Did you two found the practice?"

"We bought a practice from a doctor who was about to retire. His dad and my dad financed the purchase for us."

"What happened when you were arrested?"

"I actually retained an ownership interest in the partnership, so I receive a portion of the profits. A good chunk of that goes to Nadine, and she received everything else we had in the divorce. I didn't contest it because what was I going to do? But the money I get keeps me in commissary."

I shifted my rook, preparing for my next attack.

"How does that work?"

"Basically we can spend our own money to purchase additional items to what the state provides — toiletries, food, stationery, stamps, and other sundries."

"I take it most of that money comes from families?"

"Yes. They can make deposits into the commissary account, though there are rules if you owe fines or restitution about how much can be in that account."

"What do you do all day?" I asked, advancing a pawn.

"So long as I behave, I can spend most of my free time in the day room, which is where the TV is, or the library. There are free weights and when the weather is nice, I can spend an hour a day in the yard. Lights out is 10:00pm, and lights come on at 7:00am, and I work for three hours in the laundry after breakfast."

"What about education?"

"Correspondence courses, mostly."

"Check," I said, capturing a pawn with my bishop and revealing a check.

Frank toppled his king, and we reset the board with me taking white and him black.

We played a second game, and I made a fairly large blunder mid-game, allowing Frank to win, and then my two hours were up. Most visits were an hour, but chaplains had up to two hours per person they visited. Given it was permitted, I shook hands with Frank before calling the guard over to collect the chess set. Once he'd counted the pieces, he put it away, then called for a guard to escort Frank to the day room and me to the entrance.

"How did it go?" Clarissa asked when I got into the car.

"We talked and played chess. He's doing about as well as anyone could expect, given his predicament."

"And he's ready to join the Orthodox Church?"

"That's not my goal, Lissa. My only goal with him is to give him some hope. At some point in the next year, I'll see if I can hold a weekly Vespers for anyone who might be interested. How was the park?"

"We met some moms and kids and Rachel had fun playing with the little girls while I chatted with the moms."

"That's you for real someday."

"I think I can wait a few years on having one of my own! You're going to work on siblings soon, right?"

"We're getting in occasional practice now, so we'll be ready."

Clarissa laughed, "You're the last person to need to practice! And you know the equipment works not just for pleasure but for procreation. Changing subjects, are you going to take the beatings to heart, or are you going to do what you usually do and require additional beatings?"

"All I can do is try, Lissa."

_July 27, 1989, McKinley, Ohio_

"Lawson called Northrup," Doctor Gibbs said when I checked in with her before my shift started on Thursday morning.

"Unhappy that I humored the patient."

"You could say that."

"And?"

"I understand Shelly Lindsay spoke with you."

"She did."

"Then that's the end of it. You're a surgical intern and were counseled by a senior Resident from your service."

"Did he say anything about you having signed the chart?"

"Between you and me, and off the record, he and I had a good laugh. Then he said you need to stop antagonizing Bill Lawson."

"I am going to testify on Angie's behalf, no matter what Doctor Lawson thinks."

"He did encourage Northrup to try to dissuade you, but Northrup declined, because you're not giving medical testimony and it's not about someone at this hospital."

"And if it was?"

"You'd have to ask Northrup for the answer to that question, because I don't know."

"Besides Shelly, Clarissa spoke to me, and I went to see a counselor Shelly recommended in Columbus."

"Maryann Manning?" Doctor Gibbs asked.

"Yes. You know her?"

"I had three sessions with her when I was a PGY1."

"Stress?"

"Caused by the intersection of idealism and reality, combined with lack of sleep. Sound familiar?"

"It does," I confirmed.

"It's a common ailment," Doctor Gibbs said. "Shelly was the one who sent me to see Maryann. She was my mentor because there were no female Residents in trauma when I arrived, and Doctor Simons was the only female Attending. Shelly was the first female on the surgical staff, and we still don't have any female Attendings."

"She's a PGY5, so three more years and she'll be the first female surgical Attending. That's a good thing, but delayed far too long."

"When she started college thirteen years ago, nobody in Surgery would have even considered selecting a woman in the Match. Cutter had to fight to get her five years ago."

"She's one of the best up there," I said.

"She is," Doctor Gibbs confirmed. "Play things at least in the neighborhood of the book today? Please?"

"I'll do my best."

"That's what I'm afraid of!" Doctor Gibbs said with a wry smile. "Go heal the sick."

I left the office and went to the lounge to get the handover from Kayla Billings. There were two patients waiting to go up to Medicine and one to discharge. Bob, Len, and I handled those three cases, catching an EMS run just after the last patient.

"Cody Nelson, twelve; go-kart accident; flipped and his head struck the pavement; no LOC; pulse 76; BP 110/70; PO₂ 98% on air; multiple scrapes and contusions; cervical collar and backboard."

"Trauma 2," I said. "Do you have the helmet?"

"Deputy Miller has it," the paramedic said, just as the Sheriff's Department cruiser pulled up.

"Len, monitor, but no EKG; Bob, primary assessment. I want to talk to the deputy."

"No IV or blood?" Bob asked.

"No. And be very careful moving him."

The two paramedics and my students went into the ED while I walked over to the cruiser.

"Hi, Doc," Deputy Miller said.

"Greg says you have the helmet."

"Yep," he said, retrieving it from the passenger seat.

I looked at it and saw a scrape, but it was intact otherwise.

"Thanks," I said. "Parents?"

"Deputy McCallum is on his way to inform the dad; he works construction and there's no phone on the site."

"OK. Have him find me when he arrives."

"I'll radio it in."

"Thanks."

I walked into the building and went to Trauma 2.

"Continue your primary exam," I said to Bob. "Cody, I'm Doctor Mike. How are you feeling?"

"Dizzy, and my head hurts."

"Can you tell me what happened?"

"I had my go-kart out and was on our street. The kid who lives next door rode his bike out in the street in front of me and I swerved, hit the curb, and flipped."

"Did you lose consciousness?"

"No, just dizzy and my head and leg hurts."

"No apparent internal injuries," Bob said. "No CSF. Pupils reactive. Leg is bruised, but no breaks or lacerations."

"Babinski," I said.

He performed the check, and the response was proper.

"Clear the neck," I said.

"I haven't done that before," Bob said.

"OK. Carefully feel under the cervical collar for any swelling or distension, or bulging vertebrae."

Bob did that, then said, "I think it feels normal."

"Cody, I'm going to double check your neck," I said.

I checked and confirmed Bob's findings.

"Now, I'll hold his head, and you remove the cervical collar," I said. "Then repeat the check."

Bob followed my directions and found nothing.

"Cody," I said. "I'm going to slowly rotate your head right and left. You tell me if your neck hurts, or if anything feels strange."

I did that and Cody reported no pain.

"You can unstrap him from the back board, remove it, then raise the bed so he can sit comfortably."

As Bob and Len were doing that, Deputy McCallum came into the room with Cody's father.

"Mr. Nelson, I'm Doctor Mike," I said. "Cody has no serious injuries, though I believe he has a concussion. Because there is a scrape on the helmet, I'm required to call for a neurology consultation."

"What happened, Cody?" Mr. Nelson asked.

"Joey purposefully drove his bike in front of me," Cody said.

"Deputy, I want that kid arrested!" Mr. Nelson said. "This has happened four times now. Every time my kid tries to drive his go-kart, the neighbor kid rides in front of him, or throws things at him."

"Deputy, the consultation room is free if you want to take a report. Len, call neurology, please."

Deputy McCallum escorted Mr. Nelson from the trauma room, and about five minutes later, Doctor Larry Flynn came in.

"Flynn, Neuro."

"Mike Loucks," I said. "Bob, present please."

He did, and Doctor Flynn walked over to Cody.

"Hi, Cody, I'm Doctor Flynn and I'm a neurologist, which is a brain doctor. Mike, the helmet?"

I reached over to the counter and handed it to Doctor Flynn. He looked it over, then handed it back.

"Did you lose consciousness?" Doctor Flynn asked.

"No, but I was dizzy and my head and leg hurt. Mrs. Jameson told me not to move and called the Fire Department."

Doctor Flynn repeated the neuro checks and cleared Cody. We conferred and agreed Cody could be discharged. I updated the chart, we both signed it, and I took it to Doctor Gibbs for her signature. Once that was complete, I returned to the room and explained to Cody and his dad that Cody needed three days of rest and should take Tylenol or Advil for pain. I went over the reasons they should return, gave Cody his choice of candy, then directed them to Patient Services.

We handled three walk-ins before Detective Kleist came into the ED with a young woman in handcuffs.

"Mike, can you take this one?" Ellie asked. "Exam 4."

"Sure. I'll need a nurse."

"Kellie will come in with you."

"Exam 4, Detective."

"Bob, Len, take your break, please."

Kellie joined me and we went into Exam 4 with Detective Kleist and her arrestee.

"What's your name, Miss?" I asked.

"Fuck you!"

"OK. Miss You, why are you here?"

She simply glared at me.

"Department policy is anyone under eighteen is brought here for a health check before we take them to holding."

"Name and age?" I asked Detective Kleist.

"Debbie Jones, sixteen."

"What are the charges?" I asked.

"Possession with intent to distribute."

Which was non-violent, and the girl didn't look dangerous, though she had a bad attitude.

"Can we remove the cuffs, please? I'll need to do an exam."

"Compromise on one cuff on the rail of the bed?" Detective Kleist asked.

"That will work," I agreed. "Debbie, do you consent to an exam?"

"What if I say 'no'?" Debbie asked defiantly.

"Then Detective Kleist will go see a judge in Juvenile Court who will order an exam. If you were over eighteen, they'd take you to the city jail where they'd examine you and you wouldn't have a choice. But I can't examine you without your permission or a court order. You'll only piss off Detective Kleist by requiring her to do extra work, and you'll still have to have the exam. I can get a female doctor if you prefer, too."

"Fine."

"OK to examine you?"

"I said 'fine'!"

"Detective?"

Detective Kleist removed the cuff from Debbie's left wrist and hooked it to the railing of the exam bed.

"First question," I said. "Are you on anything?"

"I'm not saying anything with the cop here."

I understood her lack of cooperation, but it was important to know if she was on anything.

"Then well do it the hard way," I said. "Kellie, CBC, Chem-20, tox screen, EtOH level, and hCG."

Kellie drew the blood and called a student nurse take it to the lab. I put a monitor on Debbie's finger, then checked her blood pressure and temperature.

"PO₂ 99% on room air," I announced so Kellie could record Debbie's vitals on the chart. "Pulse 72; BP 120/70; temp 36.9°C. Debbie, I need to check your heart and lungs."

Debbie didn't object so I auscultated her heart and lungs through her thin t-shirt.

"Lie back, please."

I palpated her abdomen, listened for bowel sounds, checked her peripheral pulses, then had her sit up so I could check her ears, eyes, nose, and throat, then checked the glands in her neck.

"Barring something in the blood work, she gets a clean bill of health," I said.

"How long on the blood work?" Detective Kleist asked.

"Anywhere from sixty to ninety minutes, because it's not stat."

"I have a form for you to sign once the blood work comes back," Detective Kleist said.

"You'll need Doctor Gibbs signature," I said. "But I'll take care of that."

"Buy you a drink at the end of your shift?"

"That's not until tomorrow at 6:00pm, and then I'm going home to my wife."

"Tough luck," Debbie said with a smirk.

"Keep your mouth shut!" Detective Kleist ordered.

"We'll come back when we have the blood test results."

"Thanks, Doc," Detective Kleist said.

Kellie and I left the exam room and went to inform Doctor Gibbs. Once that was done, we went to the lounge.

"She's cute," Kellie said.

"The detective? She is, and persistent. But she's barking up the wrong tree."

"I realized that from the first second I met you. Your wife is a lucky woman."

"Yes, she is. But I'm luckier."