Good Medicine - Medical School II - Cover

Good Medicine - Medical School II

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Chapter 15: Psychiatric Care

April 10, 1986, McKinley, Ohio

“I saw Lara and Tasha today!” Elizaveta exclaimed when I arrived home on Thursday.

I shrugged, “Seen one baby, you’ve seen them all!”

“How rude!” Elizaveta exclaimed.

I chuckled, “Gotcha!”

“You!” Elizaveta groused. “Go change!”

I did as she’d requested, then went back to the kitchen where she was preparing our evening meal.

“How did your meeting with the attorneys go?” she asked.

“Pretty much as I expected it to. Basically, if Jill told the truth, I didn’t give Melissa’s attorney anything he didn’t already have.”

“Then why?”

“To build his case based on one very specific thing — that Doctor Gibbs allowed me to ask a question and patiently explained the situation after having cut Melissa off when she tried to ask a question. Now, I know exactly what was going on, but I gave a neutral answer because I think Melissa deserves a second chance. I’m sure she’ll fail, but maybe she’ll surprise me.”

“You’re more forgiving than I would be!”

“See, that’s just it, I haven’t forgiven her because she hasn’t shown any repentance nor asked Robby for forgiveness. I just think she should have a second chance. I know I’d want one if I screwed up that badly. Anyway, how are Tasha and Larisa?”

“Doing fine. They’ll be at church for Liturgy on Sunday.”

“No surprise. I take it Nik wasn’t there?”

“No. He went back to work today. Tasha’s mom and mother-in-law are helping out, alternating days.”

“And how is Tasha handling that?” I asked with a smirk.

“Right?” Elizaveta said with a soft laugh. “Seriously, though, she’s fine with it because she’s still recovering from labor and delivery. I’m positive that by next week, she won’t want them there. I take it your mom won’t try to interfere?”

“No, she won’t. Your mom and grandmothers, on the other hand...”

“Can keep their noses out of our business!” Elizaveta said firmly. “But that’s more than a year from now.”

“Are you still thinking you want to have a baby in about fifteen months?”

“I think so, yes. But we can discuss it in October. Unless you think we need to talk about it now.”

“No, it was just a question. My part is simple! You have to do all the hard work!”

“Girls can handle it!” Elizaveta declared. “If boys were the ones who got pregnant, the species would die out in a generation!”

“There might be some truth to that statement,” I chuckled.

“And you remember that!” she said firmly. “Back to your meeting — what happens next?”

“That’s up to the lawyers, but I’ll bet you anything Melissa is reinstated and restarts her fourth year in June. Also, I did find out there’s a hearing for Nadine Bush on Monday afternoon at 1:00pm. It’s about the psych evals she had.”

“Insanity defense?”

“I have no idea. Even though all court records are usually public, these are sealed because they’re medical records.”

“Then how do they have a public hearing?”

“The testimony will be public, but the record could be sealed if the judge orders that. Well, that’s what the person in the Clerk’s office who provided the information when I called today said.”

“Does that affect her husband’s case?”

“I don’t think so, but I’m not sure. You’d have to ask Katy’s mom, though she’s not a criminal defense lawyer, so she might not know for sure.”

“You’re missing an awful lot of classes.”

“But I’m keeping up with the work, and I had a chat with Doctor Worth after the deposition. The school totally understands the situation and I’m still earning honors in my courses. If this were my third or fourth year, it would be difficult. Even this year, I’ve been fortunate that nothing has occurred on a Tuesday, because I won’t skip my Preceptorship. Even though it’s only observation, it’s the most important part of my education right now. Anatomy lab was the most important, but Preceptorships are way more important than any other class. Fundamentally, the only way to learn to be a doctor is to watch other doctors and ask questions.”

“But what about all the biology and anatomy?”

“Knowing all that doesn’t make you a doctor. That’s why we have the Practice of Medicine class and Preceptorships, and eventually, clinical rotations where we watch, learn, and eventually do. And after that, Internship and Residency are also a lot of watching, with more and more doing as you demonstrate your skills, until eventually you are hired as an Attending Physician, which is when you can work without supervision by an Attending.”

Elizaveta brought dinner to the table, and after I said the blessing, we ate. I helped her with the dishes, one of the few things I was permitted to do. We had just finished when my study group arrived. Three hours later, they left, and Elizaveta and I got ready for bed.

“Wanna fool around?” I asked as we climbed into bed.

“I thought you’d never ask!” Elizaveta giggled. “Of course!”

April 13, 1986, McKinley, Ohio

“Good morning, Tasha!” Father Nicholas exclaimed.

“Good morning, Father!”

“I’m happy to see you this morning! And Larisa Nicole!”

I could see in Nik’s eyes that he was VERY unhappy, but Tasha, being Tasha, I was not surprised they were in church. I really felt that if Nik didn’t mellow, he and Tasha were going to have serious problems at some point in the not-too-distant future. And those problems might be insurmountable.

“Good morning, Tasha,” I said.

“Father Deacon, I heard you said all babies look alike!”

“I was kidding!” I said reflexively and defensively.

Tasha laughed, “I know that! But you look like you’ve seen a ghost!”

I chuckled, “I came face-to-face with mortality! Congratulations!”

“Thank you!”

“Deacon, we need to begin Matins,” Father Nicholas said.

“Yes, Father,” I agreed.

We left the nave, went through the right-hand deacon’s door, and took our places at the altar. After a brief prayer, I retrieved the censer, put incense into it, then had Father bless it. Once that was completed, I walked around the altar, exited through the other deacon’s door, and began censing the nave.

Just over four hours later, the congregation gathered in the parish hall for lunch, and as I expected, Tasha was swarmed by every female in the parish, from toddlers to great-grandmothers. Father Nicholas did manage to speak to Tasha long enough to schedule Larisa’s baptism for May 16th.

Given it was the second Sunday of the month, we had our Parish Council meeting, which was uneventful, as the only slightly controversial matter was who would represent the parish at the meeting to elect a new bishop. Unsurprisingly, both Viktor and Tasha were quickly nominated and agreed to, and the third nomination was for Mrs. Sokolova, who was agreed to after some discussion. The mix felt right — one person from each generation in the laity, and two women and one man, given all the clergy who could vote were male.

Later that afternoon, our Dinner Club met, though minus Tasha and Nik, as Elizaveta and I discussed.

“Will Tasha bring Lara when they start coming again?” Alyssa asked.

“They’ll be here next week,” Elizaveta said. “And they bought a portable crib, which we’ll put in the small bedroom. Tasha wanted to come today, but I talked her out of it.”

“Why?” Mark asked.

“Because she was doing it to make a point with Nik, like coming to church today.”

“No gossip, please, Matushka,” I counseled.

“Sorry, Deacon,” Mark quickly said. “I shouldn’t have asked that question.”

“Just remember for the future, please. And you, too, Kitten.”

She glared briefly at me, then replied, “Sorry. You’re right. Alyssa, is there anything you need Serafima and me to do for your crowning or reception? I mean, besides preparing the usual candles?”

“No. Our moms have it totally under control. Well, Mark’s mom is staying out of any discussions about what happens at Saint Michael, but is helping with the reception. My mom, your mom, and Mrs. Sokolova have everything else under control.”

“Mark, your parents decided to come to the crowning, right?” Elias asked.

“Yes. Deacon Mike’s friend Jocelyn actually helped, because she’s at the same church, and the pastor also pointed out that Mike came to Jocelyn’s wedding.”

“And your parents are being chrismated on Holy Saturday, right, Alyssa?” Serafima asked.

“Yes.”

“Deacon, is it OK to mention something about Melissa Bush?” Elias asked.

“I suppose it depends on if it’s ‘gossip’ or ‘news’. Determining the difference can be tricky.”

“She stopped attending Faith Bible and is attending an Evangelical Free Church.”

“I suppose when your entire family was arrested at one time or another, that makes sense!” Serafima exclaimed.

“Supposedly, and this is where I’m not sure what to say, she wrote them a letter repudiating their ‘hateful attitude and behavior’ towards homosexuals.”

I wondered if that was part of her attorney’s plan to have her reinstated at McKinley Medical School. It wouldn’t surprise me, though it was possible that it was motivated by «metanoia» — a genuine change of heart. That would have to remain to be seen, or as the saying went — actions spoke louder than words.

“If she’s left that church, I can’t see how it’s anything but good,” I replied. “But let’s be careful about assigning motives when we don’t know for sure. We should always assume someone has the best motives until it’s shown otherwise.”

“She’s suing to get back into the medical school, right?” Elias asked.

I nodded, “Yes. I gave a deposition on Thursday about something that happened at the hospital. There’s a hearing on Tuesday afternoon, which I can’t attend because I have to be at the hospital.”

“Will she win?” he asked.

“I think they’ll settle with her and let her back in, assuming she completes her anger-management counseling. That said, graduating does not mean she’ll Match at a hospital, nor that she’ll ever be able to get a medical license due to her guilty plea. Granted, it was misdemeanor disturbing the peace, but the licensing board will know that felony charges were filed, and that alone can prevent you from getting a license based on the subjective ‘moral turpitude’ rules.”

“Do you think that’s fair?” Serafima asked.

“I think being granted a medical license is a privilege, not a right, and given the State of Ohio is giving their approval, they, representing the people, ought to be able to consider everything about a person that is true and accurate, to determine if they qualify. Obviously, discriminating because of race or sex or religion isn’t acceptable, but based on what amounts to bad behavior? Absolutely!”

“I’m pretty sure that applies to all professional licenses,” Mark said. “One of my friends is a licensed civil engineer and his license can be pulled for any criminal conviction.”

“That’s true,” I confirmed. “My dad is a civil engineer and is under the same rules. Basically, the State of Ohio is vouching for you, and if you have a criminal conviction, the burden is on you to prove they should vouch for you. Jocelyn will be under similar rules as an attorney.”

“Did the Parish Council decide who would represent us in Columbus?” Elias asked.

“Yes. Mrs. Sokolova, my father-in-law, and Tasha.”

“What about Holy Transfiguration?”

“Their meeting is Tuesday.”

And there had been some debate as to whether the former members of the Parish Council could represent the parish, but I knew the rules, and they permitted anyone who was eighteen and in ‘good standing’ to vote. To be in ‘good standing’ a parishioner had to regularly attend services, have confessed recently, and have recently received the Eucharist.

The question of needing approval from the priest was an open one, with some believing it necessary and others, like myself, believing it was up to the Parish Council so long as there wasn’t a valid objection raised by their priest based on a legitimate spiritual impediment. That last part was tricky, as the priest couldn’t reveal the impediment to the Parish Council, which allowed him an effective veto without giving a reason.

“Shall we play Uno?” Elizaveta suggested.

Everyone agreed, so that was what we did until dinner.

April 14, 1986, McKinley, Ohio

The timing had worked out such that Clarissa and I could be at the courthouse for Nadine Bush’s hearing and likely make it back to campus for the start of our Practice of Medicine class. It had meant eating quickly and cutting my time in the steam room in half, but those were minor things compared to being able to get to class on time.

“The State of Ohio versus Nadine Bush,” the Clerk announced. “Ms. Bush is in custody.”

“The bailiff will bring her before the bench, please,” the Judge requested.

Two minutes later, she was brought to the table where her attorney was sitting.

“Counsel?” the judge asked.

“Jonathan Taft for the State.”

“Cathy Owens for Ms. Bush, who is before Your Honor.”

“Ms. Owens, I have both psychiatric reports as well as your motion. I also have the prosecution’s response in opposition. You have ten minutes if you wish to make oral arguments.”

“Thank you, Your Honor. I can be brief. The Ohio statutes permit, as an affirmative defense, that a person charged with a crime of passion may prove mental and physical abuse, threats, or coercion as mitigating factors, and, if successful, may have indictments quashed, charges dropped or reduced, and potential sentences limited.

“It is our contention that Nadine Bush acted out of fear for her physical, emotional, and financial security. As the charges and discovery show, Ms. Bush’s involvement is limited to renting a car and driving her family to a friend’s house. She was not in the car driven by Frank Bush, nor was she aware of the hit-and-run until after the fact.

“As the psychiatric report shows, Ms. Bush was raised in what is best called a ‘lapsed Episcopalian’ family. They attended church irregularly, mostly at Easter, and were otherwise lax in their religious activities. Ms. Bush has a degree in secondary education and held a Virginia teaching license. She was a teacher until the day when she married Frank Bush, who required that she stop working immediately following their marriage.

“From that day, she was completely financially dependent on Frank Bush, and has been for twenty-three years. At the time of their marriage, Ms. Bush was twenty-five and Frank Bush was twenty-seven, and in the first year of his Pediatric Residency. Ms. Bush became pregnant shortly after the marriage and ultimately had three children. In addition, she joined his fundamentalist Bible church in Virginia. Upon completion of his Residency, Frank Bush moved his family to McKinley to practice with a friend from medical school, and they joined Faith Bible Church.

“I am handing up a copy of the ‘Faith Statement’ and ‘Christian Behavior’ documents, which indicate that a wife is completely subservient to her husband, and he is, in effect, her lord and master. I’ve provided copies of these documents to the prosecution. The relevant sections have been highlighted, including the section that discourages women from working and implies, quite strongly, that not being a full-time homemaker is sinful.”

Holy shit!” Clarissa whispered.

“Yeah, that’s a no brainer,” I whispered back. “But I’m not sure it’s enough.”

She handed the documents to the judge, who accepted them and had them entered as evidence.

“I am also handing up two police reports from Alexandria, Virginia,” Ms. Owens said. “In both instances, neighbors called the police to report domestic disturbances in the Bush’s apartment. No charges were filed, but the police reports indicate that Frank Bush was verbally abusive. The prosecution has copies of these reports.”

He was a First Year Resident at that point,” I whispered.

Clarissa nodded.

“Turning to the psychiatric report,” Ms. Owens said, “our doctor indicates, strongly, that Ms. Bush feared for her health, safety, and financial security, and rented a car on behalf of her husband out of that fear. Your Honor will take note that the psychiatrist reported that Frank Bush completely controlled the finances and accounts, because that was, per the Church’s teaching, the sole domain of a husband. Ms. Bush had a small bank account which was used to buy groceries and other necessities, but had no access to the substantial wealth her husband had access to.”

What the fuck?!” Clarissa gasped, but not quietly enough.

“Order, please!” the judge demanded, banging his gavel. “No more outbursts, please. The use of further profanity will result in a contempt citation.”

Way to go, Lissa,” I said under my breath, suppressing a chuckle.

“I won’t take much more of the Court’s time,” Ms. Owens said. “But the psychiatrist’s determination is that Ms. Bush was not acting freely when she rented the car, had no criminal intent, had no knowledge of the crime until several hours after it had happened, and, once in the presence of her husband, no way to report it without risk to her health or safety. I believe and request, as my motion states, that a complete competency hearing be scheduled, and at that hearing, complete evidence, including testimony from the psychiatrist will show that Ms. Bush had no criminal intent, and took the alleged actions purely out of fear. Thank you.”

“Thank you, Ms. Owens. Mr. Taft, I’m going to save us all a few minutes. Ms. Owens’ authorities are controlling and her motion for a competency hearing is granted. That does no harm to the State.”

“Your Honor,” Mr. Taft said, standing up. “The State insists that Ms. Bush remains in custody with no bail given her admitted mental incapacity.”

Ouch,” I chuckled.

“I’m inclined to agree. Ms. Owens?”

“We continue to request bail be set. In lieu, we would request that Ms. Bush be admitted to a psychiatric care facility for observation, based on the prosecutor’s statement.”

“State?” the judge asked.

“The State has no objection to a transfer. The County has an appropriate secure facility at University Hospital and we would not object to Ms. Bush being transferred there.”

“Ms. Owens, do you have an objection to Ms. Bush being sent to the secure psychiatric ward at University Hospital?”

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