Chapter 25: Mama Bear

July 23, 1989, Circleville and McKinley, Ohio

On Sunday morning, we attended Matins and the Divine Liturgy at the Cathedral. We skipped lunch so we could take Rachel home for a nap before Ghost and Oksana's wedding, which was being celebrated at Saint Michael the Archangel. Once Rachel was in her bed, Kris and I decided to take a bubble bath together.

"How are you feeling, Mike?" Kris asked as we lounged together in the tub with her reclined back against me.

"Better," I replied. "I enjoy my work and I've adjusted to the hours, though obviously I wish I had more time for you and Rachel."

"You chose this course in fourth grade."

"I did," I agreed. "That doesn't make it easier."

"Is everything OK at the hospital?"

"You mean with Doctor Mastriano? Yes. She's on probation, and all the facts and records support me. Even if she's upset with me, there isn't really anything she can do."

"You're sure?"

"Yes. Anything she says or does will be heavily scrutinized, so there's no real risk. That said, the Chief of Psychiatry all but ordered me not to testify on Angie's behalf against Doctor Greenberg."

"Can he do that?"

"No. He stopped just short of a threat, saying I was 'throwing away my career' by testifying against a fellow doctor on what was, in the Chief's mind, a judgment call."

"Did you report him?"

"No. That wouldn't be smart, given it would back him into a corner. I'm only going to testify to things I personally observed and will refrain from making any diagnostic comments. Doctor Mercer will corroborate what I say, and that will be enough for Angie to prevail and at least have Doctor Greenberg reprimanded and possibly to have his license suspended."

"You're not worried?"

"No, but even if I was, I have an obligation to tell the truth, and Angie really has nobody except me to forcefully advocate for her."

"Her parents?"

"Without my support for Angie, they wouldn't have pressed the malpractice claims or the complaint to the Medical Licensing Board because they didn't have enough information. And that was because Doctor Greenberg and Doctor Mercer were telling them the same thing, and, to be honest, nobody without a personal stake would step into a case such as this."

"Why?"

"Sadly, doctors cover for each other, even in cases of negligence and malpractice. It's wrong, but it's similar to cops covering for each other or politicians covering up their own malfeasance."

"You're on good terms with the police, though, right?"

"Yes, of course, but that doesn't mean I wouldn't call out corruption if I saw it. Isn't that a socialist principle?"

"You know it is!"

"And government corruption was the objection both Jefferson and Trotsky made about bureaucracies!"

Kris laughed, "You do enjoy tweaking me!"

"Yes," I agreed, then gently pinched her nipple.

"Not like that!" Kris declared mirthfully.

"I enjoy both!"

"I think we have enough time..."

We did, and after very enjoyable lovemaking, we showered, then dressed for the wedding. I woke Rachel from her nap, changed her diaper, dressed her, and then the three of us left for Saint Michael the Archangel.

"Are you going to arrange a meeting with Father Nicholas as Father Roman suggested?"

"I think I have to," I replied. "Father Roman advised it, and I'm positive Vladyka would advise the same thing. I'll speak to Father Nicholas after the ceremony and make the arrangements for sometime next month."

"You're going to see the doctor in prison on Wednesday, right?"

"Yes. Clarissa and I will have lunch that day, so she's riding along. She'll take Rachel to a park while I'm visiting Frank Bush."

"I'm having lunch with a group of girls from the Cathedral tomorrow. Believe it or not, Danijela Dimitrijevic is joining us."

"I think that's a good thing. I still get evil looks from her grandmother."

"Me, too! She feels I cut in line, so to speak."

"Well, I gave Danijela every opportunity, and had she been a bit more patient, Oksana would not have had the opportunity to introduce you to me."

"And?" Kris asked impishly.

"And nothing. I have no regrets, and I do not wish anything different had happened after the day after Rachel was born. I'm very happy to be married to you, and I am looking forward to giving Rachel a brother or sister or two."

"NO BROTHERS!" Rachel said adamantly.

"You, young lady, have no say in the matter!" I said lightly.

"Viktor is loud! Ben is loud!"

Ben was a little boy at daycare who Marcie had said seemed sweet on Rachel but was as rambunctious as any other male toddler.

"Papa is a boy. Is he loud?"

"Rachel loves Papa!"

"I love you too! Will you dance with me?"

"Yes!" Rachel giggled. "Like dancing!"

"She's going to be dangerous as a teenager!" Kris said, sotto voce.

"And our job is to guide her to make good decisions," I replied. "But above everything, the most important thing we can do is love her and teach her how to think for herself."

"What about God?"

"All we can do is live our lives as Christians. Preaching doesn't work."

"Then why visit the doctor in prison?"

"Doing exactly what I just said — showing Christian love. How well do you think it would work if I went in there and beat him over the head with the Gospel? Or the Creed?"

"It wouldn't."

"And it won't work with our kids, either. At one point, when I was speaking to Doctor Mercer, I reminded her of what 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 —

"That sounds like you."

"I try."

"You do more than try, Mike."

"When I achieve inner peace, I'll let you know."

When we arrived at church, Serafima met us in the narthex.

"May I borrow my goddaughter?" she asked.

"OK to go to Serafima?" I asked Rachel.

"Yes!"

I handed Rachel to Serafima, then chatted briefly with Elias and Subdeacon Mark before the combined betrothal and crowning services. We all gathered for the services, which were identical to every other betrothal and crowning service, save the names of the couple and their sponsors. Just under an hour later, Ghost and Oksana were married, and we all gathered in the parish hall for the traditional reception. When that reception ended, I asked Father Nicholas if we could get together, and after a bit of back and forth, we agreed to have lunch on August 16th, the soonest our schedules aligned.

"We have about an hour before the reception at the banquet hall," I said to Kris. "Should we take Rachel to the park? I could use more time outside."

"That sounds good," Kris said. "What about her dress?"

"We'll change her at the park, then put it back on before the reception."

I briefly considered inviting others to join us but decided I wanted time with my family, as we had so few opportunities to be together. The three of us got into the car and drove to Milton Lake, where Rachel, Kris, and I found a shady spot under a tree. We played with a ball, and Rachel, being nearly two, was just becoming coördinated enough to learn to catch and throw, but she clearly enjoyed her time with me.

I did wonder how she'd respond to a baby brother or sister and suspected she'd get her nose out of joint either way, as she'd no longer be the sole center of attention. That was something to think about, and fortunately would be after I finished my Intern year. I was looking forward to having more kids, and that brought to mind Clarissa and how a baby we had together would integrate into the family.

But that was for later, and as it was time to leave the park, we changed Rachel, then headed to the reception hall. The food was decent, and I did, as promised, dance with Rachel. Kris had her dances as well, and with her permission, I danced with Clarissa, though Clarissa and I were careful not to dance too close.

Kris, Rachel, and I left as soon as Ghost and Oksana departed, as I had to be at the hospital before 6:00am and because Rachel was very tired. At home, we said evening prayers, and after putting Rachel in her bed, Kris and I went to bed.

July 24, 1989, McKinley, Ohio

"Morning, Kayla," I said to Doctor Billings when I arrived in the ED about five minutes before my shift began on Monday morning.

"Morning, Mike. Quiet overnight. One patient waiting for admission to Medicine for gallstones. Probably surgical, but they'll assess upstairs. They said they'd take her about 6:30am."

"OK."

"How was Ghost's wedding?" she asked.

"Literally, if you've seen one Russian Orthodox wedding, you've seen them all! There's no variation permitted."

"So you have to use traditional vows?"

"Orthodox don't use vows the way other Christians do. The prayers are always the same and have been for the best part of sixteen hundred years, with minor differences in translations depending on if they came from Greek, Russian, or Arabic. We basically follow the practices of the Hagia Sophia in Constantinople during the fourth century, and much of what they did was handed to them by even earlier traditions."

"Istanbul?"

"That's a recent name and literally derives from the Greek phrase 'to the city' or, colloquially, 'the big city'. Orthodox nearly always refer to it as Constantinople. But even that is a new name, as the city was originally Byzantium, from which we derive the terms 'Byzantine Empire' and 'Byzantine Rite', though 'Byzantine Empire' is a misnomer, as it was the Roman Empire and never ceased to be. The capital was moved from Rome long before Rome fell. To complete the short history lesson, it was known as 'New Rome' and later the 'Second Rome', with Moscow being the 'Third Rome', reflecting the seat of the most important bishops in Christianity."

"Not the Pope?"

"Not from our perspective, but that's an even LONGER history and theology lesson!"

"Pass!" Doctor Billings said. "I find it fascinating, but I need some sleep!"

She left, and I went to find Bob and Len, who were in the lounge with Doctor Nielson and a woman I didn't recognize.

"Mike, this is my wife, Shelly," he said. "Shelly, Doctor Mike Loucks."

"Nice to meet you," I said to the pretty strawberry blonde, who I estimated was about five months pregnant.

"Shelly's here for a pre-natal check with Alice Carmichael."

"Isn't it a bit early in the day for that?" I asked.

"Shelly teaches English at the High School, and she's teaching Summer school, so Alice did us a favor by setting up a 6:15am appointment here."

"Speaking of which," Shelly said to Perry, "I should go upstairs. I'll let you know before the ultrasound starts."

They exchanged a kiss, and she left.

"When did you guys meet?" I asked.

"About a month before I Matched at Cook County. We hit it off right away and were married that Summer. She finished her degree just as I finished my Residency and did her student teaching in Columbus. She was hired at the High School the following year."

That made her six or seven years younger than him, which seemed fairly common with doctors. Ghost was about eight years older than Oksana, and I was about eight years older than Kris.

"Cool. Excuse me, if you would."

"Sure."

I went over to Bob and Len and asked if they'd had breakfast. They hadn't, so I had them take turns, and both were back before 6:45am. We handed the gall bladder patient to Clarissa and then began taking walk-ins. The first one was a second-degree burn and was routine. When we returned, there was a hand lac, which, upon evaluation, I decided Bob could handle, so I had him and Len take the young man to Exam 6 for sutures.

"What else do you have?" I asked Jack, the Fourth Year at the desk.

"Fourteen-year-old with severe nausea."

"Sudden onset?" I asked.

"Last couple of days. Her mom was concerned, so she brought her in."

"Only in the mornings?" I inquired.

"I, uhm, didn't ask. You think it's morning sickness?"

"Fidgety fourteen-year-old presenting with nausea this early? It's a thought. How is the mom?"

"Mama bear," he replied.

"Wonderful," I replied. "Let me get a nurse, and we'll take her."

I went to the nurses' station and asked Ellie for a nurse and was assigned Kellie, which made me happy, as I was sure she and I could coöperate to find out if my suspicions were true without provoking 'mama bear'.

"Mary Josephson?" I called out.

"Here," a woman of about forty with a pretty girl with long blonde hair next to her said.

"If you'll come with us, please, we'll get Mary checked out."

Mrs. Josephson and Mary followed Kellie and me to Exam 4, where I had Mary get onto the table.

"What's bothering you, Mary?" I asked.

"She's been sick to her stomach the last few days," Mrs. Josephson said before Mary could answer.

I smiled and turned to Mrs. Josephson, "Thanks. I've found that this works better if the patient answers. Would that be OK with you?"

Mrs. Josephson eyed me suspiciously but nodded and said, "Yes."

"Mary?"

"I've been throwing up the last three days," she said.

"Before you eat, after you eat, or both?"

"Mostly before, but I feel kind of sick all day."

"Is it better or worse in the evening? You know, around bedtime?" I asked, trying to avoid using 'morning' or 'breakfast' as I didn't feel things would turn out well if Mary was pregnant.

"Better."

"Have you had a fever, cough, or runny nose in the past week?"

"No."

"What about hitting your head or being in an accident?"

"No."

"Any trouble hearing? Or do you have ringing in your ears?"

"No."

"Do you wear glasses or contacts?"

"No."

"Are you seeing double, or is anything blurry?"

"No."

The one-word staccato answers gave me the strong impression that Mary suspected the same thing I did, and the question was how I could ask the key questions without setting off 'mama bear', as I felt even asking the question would cause a severely negative response.

"Are you on any medication or taking any drugs, vitamins, or supplements?"

"Just a vitamin every morning," Mary replied.

"A multi-vitamin with iron," Mrs. Josephson interjected. "Her doctor recommended it."

"Is she anemic?"

"The doctor didn't say."

"OK," I replied, then turned back to Mary, "Let me examine you, please. If you could untuck your blouse and open the top two buttons, that'll be enough for me to listen to your heart and lungs."

While she did that, I washed my hands and put upon exam gloves.

I ran through the usual set of exams — auscultation, ears, eyes, nose, throat, glands, palpation, and checking distal pulses, then had Kellie take Mary's blood pressure and temperature.

"I don't see anything obviously wrong," I said. "Mrs. Josephson, I'd like to draw some blood, get a urine sample, and run some tests, please."

"What do you think is wrong?" she asked,

"At this point, I don't have any indications of the obvious things, such as a virus or appendicitis or food poisoning, so the next step is either 'wait and see' or blood tests. It's your choice, of course, though I'd recommended the tests."

"What would they show?"

"Any abnormalities in her blood chemistry, with the main thing I'd look for is an increased white cell count, which would indicate some kind of infection."

"Go ahead."

"Kellie, CBC, Chem-20, hCG, and urinalysis."

I hoped that using 'hCG' rather than saying 'pregnancy test' would work, and it appeared to, as Mrs. Josephson didn't react. Kellie wrote it on the chart and handed it to me to sign, which I did. While Kellie drew the blood and obtained a urine sample, I went to check on Bob and Len. There were no concerns, and I asked Len to come back to Exam 4 so he could take the blood and urine to the lab.

"How long will this take?" Mrs. Josephson asked.

"We should have the results in about an hour," I replied. "If you'd like to get coffee, the cafeteria is straight down the corridor. Kellie will stay with Mary while you go."

"You won't treat her without my permission, will you?" Mrs. Josephson asked.

"Only in the event of an immediate, critical illness which would put her life at risk. I don't see any indication of that necessity. Otherwise, as she's a minor, and you're here, we'd need your express permission, which is why I asked you about the blood and urine tests, not her."

"Maybe I will get some coffee," she said.

"Turn right out of the room, follow the corridor to the other end of the hospital, and it'll lead you straight into the cafeteria."

She left, and I looked to Kellie and said, "NVP."

That was 'nausea and vomiting of pregnancy' and was the medical term for 'morning sickness'. Kellie and I made eye contact, and she gave a slight nod.

"Mary, have you started having your periods?" Kellie asked.

Mary bit her lip and nodded, and I knew right then what the tests would show.

"When was your last period?"

"The end of May."

Which was exactly the right timing, as NVP typically began in the fourth week of pregnancy, and if I was right, Mary would have conceived mid-June, either on or just after her fourteenth birthday.

"Is there any chance you could be pregnant?" Kellie asked.

Mary didn't answer, but the tears streaming down her face told the story. Kellie and I exchanged a look, and I nodded, got up, and left the exam room. I went to check on Bob and signed off on the sutures, and he streeted the patient. I asked him and Len, who had returned from the lab, to wait in the lounge, and seeing Mrs. Josephson coming back, I went into the exam room where Mary had stopped crying. When Mrs. Josephson came in, Kellie and I excused ourselves, saying we'd check on Mary in about twenty minutes, and then went to the consultation room.