Chapter 11 — All We Can Do Is Hope for the Best

_April 2, 1990, McKinley and Circleville, Ohio_

{psc} "Mike, do you have a minute?" Kellie Martin asked late on Monday afternoon.

"I give two minutes for you and your gallant nursing crew."

"If you're quoting Kahn from _Star Trek_, I think we're in bigger trouble than just the ED!"

"That was actually Kruge, played by Christopher Lloyd in _The Search for Spock_," I replied with a grin. "The same actor who was Doc Brown in _Back to the Future_."

"Oops!"

In order to have some privacy, we went to a consultation room rather than the lounge, though, as always, when I was with a female staff member, I made sure the door was open. I'd trust Kellie with my life, but the last thing either of us needed was rumors.

"What's up?"

"What exactly did _Rupert_ Wernher say to you?"

"Between you and me, right?"

Kellie smirked, "I'd sleep with you before I'd violate your confidence."

"Good to know," I chuckled. "So, zero chance, then, because I'm married."

"Exactly."

"He kicked me out of the ED and said if I wanted ED shifts, I'd have to shave, cut my hair, and wear blue scrubs. He had the temerity to suggest I leave the surgical staff and become an ED Resident."

"You're joking!"

"Nope."

"When that Charlie Foxtrot of a former officer was in the Navy, they were allowed beards! That changed in '84 when the idiot CNO, Admiral Watkins, decided sailors had to be clean-shaven. The propaganda circulated was that it was about breathing apparatus seals, but he was clear in his statements to Congress it was about 'sharpening' appearances."

"The Cincinnati Reds," I said. "Charlie Foxtrot?"

Kellie smirked, "Military jargon for 'cluster fuck'! Only officers can swear in front of officers, so enlisted use things like 'Charlie Foxtrot' and 'Whisky Tango Foxtrot'. I bet you can work that one out for yourself."

"What The Fuck?" I suggested with a grin. "And SNAFU conforms to the pattern."

"Yes! Anyway, your beard and ponytail are religious, right?"

"Yes. Why are you asking about Wernher?"

"Gathering information for a grievance. I just wanted to know what was actually said, but the grievance will be about kicking qualified doctors out of the ED over a turf war, leaving us shorthanded. And don't worry, this is coming from the nurses' union, not any doctors or other staff."

"Does he use military terms when he's giving orders?" I asked. "He told me to 'shut the hatch' when I followed him into his office."

"He talks like a Navy lifer on a combat ship, but it's an affectation, given he was a doctor who served on land. And I'm sure you saw his fighter pilot 'I love me' wall instead of the usual medical certifications and patient pictures."

"Come to think of it, I did see the pictures of him in his naval uniform and shaking hands with people I have to assume are politicians, but I didn't look closely because that wall was behind me when I was in his office."

"One is with Richard Nixon, two are of the two Mayor Daleys of Chicago, and another is Senator Everett Dirksen from Illinois. I'm not sure of the others because I only had a brief glimpse."

"Who _is_ this guy?" I asked.

"I did some checking with my contacts, and he was a run-of-the-mill Navy doctor, then an average internist before switching to emergency medicine. Nobody in Chicago liked him. Scuttlebutt is that they gave him glowing reviews to get rid of him. Perry knows him from medical school, but Wernher wasn't chief then and Perry was never assigned to him. Wernher apparently tried for the Chief's role at University of Chicago Hospital but was turned down."

"I know the doctor who is Chief there, so I'd say Doctor Wernher had zero chance. And I'm guessing he has a chip on his shoulder."

"Yep. Rumor has it that three members of the Board pushed for him to be hired because he promised to be a hard ass and crack down on the ED staff."

"How's that playing in Peoria?" I asked.

"About as well as _Our American Cousin_ on April 14, 1865 at Ford's Theatre in DC."

"Other than that, Mrs. Lincoln, how was the play?" I smirked.

"You're a goofball, Mike!"

"Takes one to know one. When is the grievance going to be filed?"

"Probably Wednesday. Just keep your head down because he's going to try to take it off if you stick it up."

"I didn't _do_ anything," I protested.

"It's mostly not you, it's him pissing on everything to mark his territory. Well, much to his chagrin, none of us are into water sports!"

"Also good to know," I chuckled.

"I know this will never happen, but get a hall pass from your wife, and I'll wipe that smirk off your face!"

"Says the woman who has the same opinion of cheaters I have."

"Obviously, but I like being irreverent, and you're a good sidekick for that, and so is Doctor Saunders."

"We do come as a matched set!"

"I need to get back. Do your best to stay out of the blast radius."

"Count on it!"

We left the consultation room, and Kellie returned to the ED. I checked my watch and went straight to the scrub room as it was time for Kenton's surgery. I scrubbed in and went into the OR just as he was being brought in by Nick and Penny.

"Hi, Kenton," I said. "It's Doctor Mike. How are you feeling?"

"Like I want to go to sleep."

"Good. I'll see you when you wake up, OK?"

"Yes."

"Light's out, Bob," Doctor Anniston said to the anesthesiologist.

"Good to go," Bob Allen said about three minutes later.

"All yours, Pete," Doctor Anniston said. "Your Resident is busy, so Mike will assist, and I'll supervise him."

Kenton's surgery was routine, and when we finished, I had Nick carry the resected small bowel to the pathology lab for immediate analysis, then went with Penny to take Kenton to recovery. I wasn't too worried about the pathology report, as the tumor had been completely contained in the intestine, though if it was malignant, Kenton would very likely have to undergo chemotherapy, though protocols were changing with regard to completely excised tumors, and not being an oncology specialist, I didn't keep up with the latest developments.

Just before 5:00pm, we had the results, and they were benign, which Pete Barton reported to Kenton's parents. I left the hospital and headed home, happy to be away from the unfolding confrontation. I realized that for the first time, I was happy to be away from the hospital, not because I was tired, but because I didn't want to be there. That bothered me tremendously, and it was something I'd discuss with Father Roman when I saw him.

When I arrived home, Kris and Rachel greeted me with hugs, and I confirmed it was OK to call Doctor Turner's attorney. Kris was accepting of the request, so I went to my study, with Rachel tagging along.

"Papa has to make a phone call," I said. "You can stay if you're very quiet."

My daughter made a perfect impression of her biological mom, giving me a look and putting her hands on her hips.

"I want to cuddle!" she said.

"And we can, so long as you're quiet. Otherwise, it will have to wait."

I sat down, and she scurried over and climbed into my lap. I picked up the phone and dialed the number for Walter Burch. He answered on the second ring.

"This is Doctor Mike Loucks calling," I said. "I understand you're representing Gale Turner?"

"That's correct, Doctor. Thank you for returning my call."

"How is Gale doing?"

"OK, given the circumstances. He's home with his wife and children."

"That's a good thing, for sure. How can I help?"

"First, how long have you known Doctor Turner?"

"A little over three years. I first met him in February of 1987 during a clinical rotation as a medical student."

"When did you become a doctor?"

"About ten months ago — May 25, 1989."

"Have you worked with Doctor Turner as a physician?"

"Yes. I was assigned to one shift a week at the Free Clinic until the shootings at the hospital required my schedule to change."

"As an aside – were you there?"

"Yes. I was in the trauma room where Deputy Sommers was shot. I worked on her, but it was hopeless."

"At the clinic, did you ever see the treatment protocols violated or circumvented? I mean, any?"

"Never. Gale and Trina Carlslyle were both sticklers for always following protocol. That included a minor case where either Trina or I could have done the procedure, but because it called for a scalpel, she called Gale to do it. I treated several hundred patients over the years as a student and Intern, and never once was I alone with a female patient, and very rarely with a male patient."

"Were you aware of any complaints of any kind made at the clinic? Not just against Doctor Turner?"

"I had a few cases where the patient complained about reporting an active sexually transmitted disease to the County Health Department, but that was it. I did hear, long after the fact, that complaints had been lodged against Nurse Abby Norman, but she left the Free Clinic before I started."

"When did you hear about those?"

"From Detectives Tremaine and Kleist when they interviewed me. My friend, Doctor Clarissa Saunders, dated Abby for a time, and they were on a trip to Europe with my first wife and me and another couple. On that trip, I saw nothing that would indicate Abby was in any way inappropriate."

"Are you divorced, Doctor?"

"No. My wife died immediately after giving birth to our daughter just under three years ago."

"My condolences. I was asking because anything you might have said to her at the time it happened could corroborate your statements."

"I remarried, but one thing was as true with Elizaveta as is true with Kris, I keep my professional life separate from my private life as best I can. I suspect you do the same."

"I do. What do you know about the protestors outside the clinic?"

"Not much. That began after my assignment changed in February. Do you know anything about them? Gale suggested it's a setup."

"We can't find any specific ties to any church or organization, but the private investigator we hired has found individuals from the local Catholic church and at least two Protestant churches."

"Faith Bible is one of them, right?"

"I thought you didn't know anything about the protestors?"

"I don't. It was a logical conclusion based on my past interactions with them."

"Do you know either Father Walter Clifton or Pastor James McDougal?"

"I know Father Clifton, and I know Pastor McDougal by name. I can't imagine Father Clifton condoning perjury. I can't speak to the virtue of James McDougal given the interactions I've had with his congregation over the years."

"Are there any other doctors you can refer me to besides Doctor Saunders?"

"Paul Lincoln, Kylie Baxter, and Naveen Varma all had shifts in the past year. They're all assigned to the Emergency Department at Taft and had shifts at the Free Clinic the same as I did."

"OK. I'll reach out to them. I assume you'll testify on behalf of Gale Turner?"

"Absolutely. As will Doctor Saunders. And we'll both appear before the Medical Review Board, if necessary."

"Excellent. I'll be in touch. Thank you."

"You're welcome."

We said 'goodbye', and I ended the call.

"You were a very good girl, Rachel," I said.

"«Je t'aime papa!»" she giggled.

"On second thought," I chuckled.

I got up and carried Rachel with me to the kitchen.

"How did the call go?" Kris asked.

"Fine, I guess. The attorney was just gathering preliminary information."

{_ Beep! Beep! Beep! _}

I looked at my pager.

"Eight 1s," I said. "That's a Level I Disaster Protocol. I have to go to the hospital."

"NO!" Rachel protested. "Papa cuddle and play guitar!"

"Sorry, young lady, but sick people need me."

I put my unhappy toddler on a chair, kissed her forehead, then kissed Kris.

"I'll call when I know something," I said. "Don't wait for me for dinner."

"OK," Kris agreed.

I grabbed my medical coat and bag, hurried from the house, got into my Mustang, and headed to the hospital, arriving about twelve minutes later. The first thing I noticed was that there were no cruisers in the parking lot and no EMS squads in the ambulance bay. I found that very odd, given the first patients from a mass casualty incident should have arrived.

I parked, put on my medical coat, locked my car, and hurried into the ED via the waiting room. There were roughly a dozen people waiting, but no law enforcement and no medical students performing triage. Patty buzzed me through to the ED, and I saw several other Residents from the ED and Internal Medicine, along with Vince Taylor, a fellow surgeon, though he was PGY3.

Scanning, I saw Dutch Wernher with a stopwatch and a clipboard and suppressed a groan because I was positive this was a drill. I walked over to where Clarissa was standing with Antonio Gómez and Kylie Baxter.

"Drill?" I asked quietly.

"Yes," Kylie replied.

"Are patients being seen?"

"Slowly. We were short two physicians today, which I'm sure you know."

"Yep. Any idea how long this will take?"

"No clue."

About twenty-five minutes after I'd been paged and ten minutes after I'd walked into the ED, Doctor Wernher asked for everyone's attention.

"This was an assembly drill designed to test the notification system and gauge response times. I recorded when each of you arrived, as well as whether you followed protocol in wearing your medical coats and IDs. We'll conduct regular drills at random times, and future drills may include simulated patients. That is all. You're dismissed."

There was general grumbling and complaining, but I kept my mouth shut and went to the consultation room to let Kris know I was on my way home. She said she'd have dinner waiting. I thanked her, ended the call, and left the building.

"He sure has a way of endearing himself to the team," Becky, who had followed me out, observed.

"I know these are necessary for a Level I Trauma Center," I said, "but you would think he'd get the lay of the land and not call a drill on his first day. But it fits the other changes."

"He's trying to be a hard ass, and he's succeeding, but he's also about to have a nurses' strike."

"What's the process?"

"A grievance which will be presented tomorrow, hopefully first thing. The hospital has forty-eight hours to respond. If the response is not sufficient, a notice of intent to strike will be filed. Then a vote of the members authorizes the strike, and the strike can commence fourteen days after the official notice was filed."

"What are you asking for?"

"Flexible breaks, which we always had; access to the lounge, which we always had; and a full complement of doctors, nurses, and medical students at all times. Our contract expires on June 30, so this will feed right into that."

"Will it come to a strike?"

"It all depends on how much backing Wernher has on the Hospital Board."

"Would it be all nurses or just the ED?"

"All. There's a master contract, though each service is covered by slightly different conditions to accommodate differences between, say, surgery and the ED. The ICU nurses will be given a waiver to work, and there will be one team of nurses available for critical emergency surgery. Otherwise, we all walk."

"That will basically close the hospital."

"The negotiations for our new contract haven't been going well, and this gives us a chance to force their hand because Roth, Baker, and Getty have already complained to Cutter about Wernher. I think Cutter was purposefully misled."

"To what end?"

"The Hospital Board is under extreme pressure from new County Board members to bring costs down significantly. They'll replace the Hospital Board members with members of their liking when terms expire. The new County Board members freaked out at the revised operating cost numbers for the new ED and new surgical wing. The capital costs are funded with bonds and charitable donations, so those are set, but taxes have to be raised to fund operations, or costs have to be cut. And you know where they're going to cut, right?"

"Nursing," I said with a sigh.

"Exactly. One of the things they're trying to take away in the contract is subsidized meals in the cafeteria for nurses. They're already taking it away from medical students as of June 1st."

"Oh, that's freaking brilliant! Most med students are already paupers! And nurses are underpaid!"

"Amen! Preach it, Brother Mike!"

I laughed, "If anyone ever said that in my church, I think the building would collapse!"

"I was raised Baptist, but I got better!"

I laughed again, "I can't disagree with that statement! I need to get back home."

"Me, too!"

We each got into our cars and headed to our respective homes. Rachel greeted me at the door, and I scooped her up.

"Sorry, Rachel," I said. "Papa is home now."

"Did you fix everyone?"

I debated explaining things to Rachel and thought better of it.

"Everyone that needed my help!"

"Papa is the best doctor!"

"Your chief fan!" Kris said, coming over to me for a kiss. "Dinner is on the table."

After we ate and cleaned up, the three of us went to the great room, and I played my guitar for Rachel, playing mostly her favorite songs. When we finished, we said family prayers together, and I put Rachel to bed. Once my daughter was safely tucked in, I went back downstairs to be with Kris.

"Have you had a practice drill before?" Kris asked.

"This was the first," I replied. "I was just surprised Doctor Wernher called one on his first day, but he does things very differently. I spoke to Becky afterwards, and she says the nurses are filing a grievance against him over the changes, and they're considering a strike because the County is not offering proper terms for a new contract to take effect July 1st. The County Board is insisting on cost savings, and it's falling on the nurses, of course."

"Outrageous!" Kris declared. "I read about that in the paper with hospitals in New York City and other places. Nurses are terribly underpaid compared to doctors!"

"For Attendings, I'll agree with you, but Residents are not exactly paid princely salaries. We're fortunate here that our salaries are appropriate for the cost of living. That's not true in big cities like New York, Chicago, and Los Angeles. Sophia and Robby are going to have trouble in the Bay Area until he's working."

"We need a national healthcare plan funded by income taxes, with standardized pay based on cost of living!"

"Good luck selling that to the American public!" I declared. "Medicare and Medicaid are bureaucratic nightmares that often interfere with patient care."

"The error — and it is not just in the US — is funding _insurance_ when what should be funded is healthcare. Eliminate all the bureaucracy!"

"Trotsky and Jefferson would be proud," I said, "but that still won't solve the problem because someone will have to ration care to ensure costs are kept in line with tax collection. How do you control, for example, elective surgery? Can everyone have any procedure at any time? I'll give you a hint — the answer is we couldn't collect enough taxes to do that. There would have to be _some_ limits."

"But our taxes here are so low, and Reagan cut them dramatically."

"I read a statistic that the percentage of GDP collected by the government is relatively stable no matter what the highest marginal tax rate might be, because most taxes are collected from the middle class, as we've discussed.

"But the point is, Americans are not going to agree to massive tax increases on the middle class. That's why even our left isn't trying for nationalized healthcare. The typical proposal is 'single-payer', which is an insurance program similar to Medicare, and even that won't fly with the public.

"And, back to your comment about bureaucracy, you're just replacing one unaccountable bureaucracy with another."

"So, what then?" Kris asked. "Do nothing?"

"A system where major medical insurance is subsidized by the government with premiums based on income, including complete subsidies for the poor. For everything else, healthcare accounts to which the government and employers contribute. I'm sure there are flaws in that system, but I haven't spent a lot of time thinking about it. I have other concerns."

"The situation at the hospital?"

"Yes, and my wife and daughter; soon to be two daughters."

"Will you be OK with all girls if that happens? With no boy to carry on the family name?"

"If I were going to try to carry on a family name, it would be Borodin, not Loucks. You know I identify with that side of my family far more than my dad's side. And you know from our discussion of Rachel's name that it wasn't important. Nor was it important to me for you to change your name."

"What's going to happen with you and the Emergency Department?"

"In the long term, Dutch Wernher _has_ to lose because Level I Trauma Centers have to have a qualified trauma surgeon in the ED at all times. And there is literally no way that Cutter or Roth are going to agree to have surgeons report to the ED Chief because surgeons always supervise surgeons. That's why the Medical Director is always a former surgeon. Could that change? Maybe, but it would create problems with training and with liability insurance. Imagine a new Resident surgeon being supervised by someone without any surgical training and having something go wrong."

"So what is all of this then?"

"Posturing. I strongly suspect he thinks he can win in the long run, and has designs on being Medical Director. It's improbable, but maybe his strategy is to endear himself to the Hospital Board and County Board by 'cracking down' and cutting costs through efficiency. The problem still lies with the tradition that surgeons supervise surgeons, and the Medical Director supervises everyone."

"Is that a law?"

"No, simply tradition, so far as I can tell. I'm absolutely positive there are medical directors out there who are not surgeons, I just don't know of any specific examples. All I'm doing now is keeping my head down and making sure I follow protocols in the ED to the letter. That actually interferes with training my students, but I was expressly told not to get into it with Doctor Wernher. Fundamentally, I can't win on my own, so I have to let the Chiefs fight. It's like bishops fighting — it's best to stay out of the blast radius until they settle it amongst themselves."

Kris laughed, "You're too funny! Think I could get a back rub?"

"You could."

"And gentle lovemaking after?"

"Whatever you need."

"I love you, Mike."

"I love you, Kris. Shall we go up to bed?"

"Yes."

_April 3, 1990, McKinley, Ohio_

"I take it you heard?" Clarissa said when we met for coffee on Tuesday morning.

"Heard?"

"The Free Clinic is closing on Friday. The Kelsey Foundation pulled the funding."

"Fuck," I growled. "In addition to people losing access to healthcare, Trina, four nurses, and the receptionist all lose their jobs."

"That was the only clinic in the entire county that offered family planning services," Clarissa said. "It's Columbus, Rutherford, or Washington Courthouse now."

"I think I read that the one in Washington Courthouse closed last year because they lost their funding."

"I bet those picketers are happy."

"And I strongly suspect the charges against Gale Turner will be dropped," I said.

"Which will make it obvious it's a setup."

"Yes, and we'll know for sure when they offer Gale a sweetheart plea bargain. Mark my words, sometime in the next week, the Prosecutor will offer a single charge of misdemeanor battery or something like that with no jail time and six months probation.

"That is SO transparent!"

"Sure, the other option is to somehow coöpt the grand jury to return 'no bill', and then the County Prosecutor cries to the Press about how Gale Turner got away with it because the Grand Jury blew it. That would be best for Gale because 'no bill' means he can argue with the Medical Review Board that he didn't do it. A plea bargain could be a real problem."

"What if they offered expungement as part of the deal?"

"He'd still be admitting to inappropriately touching a patient, and you can be sure someone will file a complaint, or the Board could act on their own based on the conviction. That said, misdemeanors are not automatic suspensions or revocations the way felonies can be. If I'm Walter Burch, I'd tell the prosecutor to pound sand."

"You don't think the girls will perjure themselves?"

"Getting on the stand and lying is not the same as making an accusation to the cops, and if even one of them recants, it's all over. And with four, you _know_ there was a conspiracy, and those almost always break down because somebody rats or folds. Remember, they won because they forced the clinic to close. You know what comes next?"

"Protesting the hospital because we offer medically necessary abortions, and the standard is fairly vague."

"Because it has to be. I mean, an ectopic is a slam-dunk. An abortion before chemo or radiation therapy? You know the argument there."

"A stupid one, but a lot of people buy it," Clarissa said.

"Which is why the Orthodox Church leaves it to the mother to choose when one or the other, or both, would die without an abortion. Motherhood may be compared to martyrdom, but not literally!"

"You mean figuratively giving up your life to care for your children properly?"

"Yes. It's an expression of «agápē» love, similar to the idea of a husband loving his wife as Christ loved the church and giving himself up for her."

"I should know better, but I'm constantly amazed at your practical responses to very difficult questions, including abortion."

"As I've said, two thousand years of wisdom is valuable. Have you heard anything about last night?"

"Just general grumbling. I know it's required to be certified Level I, but we're still over a year away."

"That time is going to go fast. I wouldn't do it the way Wernher did, but it will have to happen."

"Did you hear anything?"

"For your ears only, the nurses' grievance will be filed today, and in forty-eight hours, a notice of intention to strike. It's bound up in their contract negotiations, which haven't been going well."

"Somebody needs to clue in the morons who run this county and this hospital that without nurses, the hospital can't function. And not just some nurses, a full complement."

"You're preaching to the choir!"

"I need to get back to work. Lunch?"

"Unless I have a consult."

I left the cafeteria and headed back to the surgical ward.

"Doctor Lindsay would like to see you, Mike," Carol said when I checked in at the nurses' station. "She's in the Residents' office."

"Thanks, Carol."

I went to the Residents' office, and Shelly waved me in, indicating I should shut the door.

"What's up?" I asked as I sat down across from her.

"Please tell me there is no truth to the rumor."

"What rumor?" I asked.

"Please don't play coy with me."

"Seriously. What rumor?"

"That you and Clarissa are negotiating with University of Chicago Hospital to transfer in June."

"Neither admitting nor denying the rumor, would you blame me given the attempt to destroy my Residency program?"

"Mike, please, please, please, do not act impulsively or do anything rash. Let Owen, Getty, and Baker fix this, please."

"And if they can't?" I asked. "Then what?"

Shelly sighed, "So it's true, then?"

"True or not, it wouldn't be rash or impulsive. If Wernher wins, my options are an emergency medicine Residency working for a doctor who is completely at odds with how I want to practice medicine or a pure surgical Residency, something I expressly chose not to do and am sure is not for me. Owen agrees."

"Is this posturing, or is this real?"

"In my shoes, wouldn't you consider all your options?

"I would," Shelly admitted. "Please do not act precipitously."

"You know me better than that."

"Which is what has me concerned. _Russians don't take a dump, Son, without a plan_."

I laughed at the _Red October_ quote.

"That was a good line, and Admiral Painter wasn't wrong."

"Give us some time, Mike. Please. This is Shelly asking."

"I will take it under advisement."

Shelly sighed and nodded at the door. I got up, walked out, and headed to the lounge to wait to be called for a consult in the ED. Kylie had clearly 'leaked' the information to someone who had spread it, and I strongly suspected that would cause further grief for Dutch Wernher. If it didn't, then I might actually need to make the phone call.

A move like that would totally disrupt my life, along with that of my family, but I didn't see any alternatives if my Residency program was effectively dismantled. I wasn't sure how Kris would respond to that proposition, but I had no need to raise it with her at the moment. The best possible outcome would be that the revolt against Dutch Wernher led to a more rational approach to running the ED.

It wasn't that I would object to efficiency improvements if they improved patient care or at least didn't harm it. To me, the lounge restrictions were silly, and I didn't see how that improved efficiency or improved patient care, and it certainly didn't help morale, either of doctors or nurses. I could also argue that denying medical students access to the lounge did interfere with medical training, as I often used the lounges as impromptu classrooms.

The nursing staff changes simply couldn't work. While pretty much any other service except surgery could use scheduled breaks, that was impossible in a busy emergency department unless you overstaffed, and nurses switched in the middle of traumas for their breaks. Neither of those made sense, either for finances or for patient care.

For my own situation, I considered if I was being selfish, and while that accusation might be laid at my feet, I had a contract which specified a specific training program. There were ways for those contracts to be canceled, but none of them applied, at least so far as I understood, because poor performance was a component of most of them. A program _could_ be terminated, but that required approval from NRMP or a court order, neither of which were likely given the hospital wasn't in severe financial distress or under review for subpar patient care.

As I sat thinking, I recalled that I was scheduled to attend a trauma conference in Indianapolis the weekend of May 18–20, and I wondered if that was still on. I got up and used the phone to call the ED and see if Ghost was available. He was and could take a break, so he came up to surgery, and we went to the consultation room for privacy.

"Do you realize how stupid it is that you have to come up here?" I asked when we were in the consultation room with the door shut.

"Oh, I know, and I fear it's going to be even more stupid before it gets better. I have to ask you, and I will not repeat your answer to anyone — are the rumors true?"

"That I called Doctor Barton to arrange to transfer my Residency? No. That I will use that as a last-resort option? Yes. I'm OK with the rumor spreading, though."

"Did you start it?"

"I didn't object to it starting. Have you heard anything about the trauma conference we're supposed to attend in May?"

"No, because I don't think Wernher has got that far yet. It's paid for, and we're past the point where they'll refund the money. There's no problem with Roth, right?"

"He signed off and hasn't said anything," I replied. "If he and the other Chiefs are successful, we'll be back to _status quo ante_. I don't plan to say anything, but I wondered if Wernher had."

"As I said, not yet, but I suspect only because so far he hasn't stumbled across it. I'll let you know. I assume you know the nurses filed a formal grievance this morning."

"I expected that. I heard the contract negotiations aren't going well, and Wernher took away benefits they've always had. Not a good move on his part."

"It'll all depend on what's in their contract. You can bet that will be in the new contract because otherwise, it might spread."

"What's your take on the lounge and the scheduled breaks?"

"The scheduled breaks _could_ work for any other service. Not for the ED. I mean, is a nurse going to walk out of a trauma because it's her break?"

"Surgery, too. It's not predictable like nursing in a ward. Has someone pointed that out to Wernher?"

"Ellie did yesterday morning. He told her it's _her_ problem to solve."

"Bull!" I protested.

"Yeah, I'm with you on that one. It _can't_ work. As for the lounge, that was just petty. Do the nurses sometimes sit in there? Yes. Same with med students. Are they slacking? Never! But being able to relax between traumas is important."

"It's also used as an impromptu classroom — we all talk to med students in there."

"That's a really good point. His hospital didn't do Preceptorships, and I get the impression that he's of the Old School where even Fourth Years mostly do scut."

"Wonderful. He's setting back ten years of progress."

"I need to get back; just keep your head down. If anyone asks about you and Chicago, I'll give my usual response about not listening to hospital gossip."

"Thanks."

Ghost left, and I returned to the lounge. It was a quiet morning, and I had lunch with Clarissa, Shelly, and Sophia. The afternoon was a little busier, but I only had two consults, neither of which required emergency surgery. At 5:00pm, I headed home for a quiet evening with Kris and Rachel.

_April 5, 1990, Circleville, Ohio_

On Thursday, Jocelyn, Gene, and Timothy joined us for dinner, as did Clarissa and Tessa.

"How are things at the law firm, Jos?" I asked when we sat down to eat.

"Lawyer scut is research, motions, and briefs. In July, I'll be allowed to have a few of my own clients, though I'll be supervised by a partner, similar to your situation. How is the hospital?"

"Don't ask," I sighed. "This has been the week from Hell. The new Chief of Emergency Medicine is a hard ass who is upsetting the apple cart, and he appears to have some backing on the Board."

"How does that affect you?" Gene asked.

"He basically kicked me out of the ED. I sit in the surgical lounge and wait for consult calls, and it's been a relatively slow week."

"Can he do that?" Jocelyn asked.

"He thinks he can, and he took me off the rotation. The other main service Chiefs — Surgery, Cardiology, and Internal Medicine all agree he's doing it wrong, but so far, he's being allowed to do it. The nurses are in open revolt, and at 5:00pm today, they served notice of a strike due to a material change in working conditions. Their contract expires at the end of June, and negotiations haven't been going well, so they're itching for a fight."

"What changed, if you can share?"

"He banned them from the lounge, along with med students, and also implemented scheduled breaks with are impossible in the ED. When the Charge Nurse objected on those grounds, he told her it was her problem to solve."

"Who is this moron?" Jocelyn asked.

"Ex-Navy, via Rush-Presbyterian in Chicago. Perry knows him from when he was a med student, but that was seven years ago, and Wernher wasn't Chief then. Word is that he tried for the Chief's role at University of Chicago Hospital and didn't get it."

"He was up against Doctor Barton?" Clarissa asked.

"Yes. No contest."

"So what's going to happen?" Gene asked.

"All we can do is wait and see and hope for the best."