Chapter 7 — Red Scrubs

_June 29, 1989, Greater Cincinnati, Ohio_

"Hi, Ang," I said when she greeted Kris, Rachel, and me at the door.

"Hi, Mike! May I hold Rachel?"

"That's up to her," I replied. "She's discovering her independence!"

"She's almost two, right?" Mrs. Stephens asked from behind Angie.

"At the end of August," I replied as I handed a willing Rachel to Angie.

Kris and I followed Angie as she carried Rachel into the living room, and once Angie was settled, I left the three girls and joined Mrs. Stephens in the kitchen. Mr. Stephens joined us a moment later.

"First," she said, "you should call us Marjorie and Ken."

"And you should continue to call me Mike," I replied. "Are you willing to proceed with the formal complaint to the medical board?"

"Yes," Ken replied firmly. "My only question is who'll be paying the attorney."

"A close friend who has the resources and wishes to remain anonymous," I replied. "I already spoke to my stepdad, and he recommended an attorney from his firm who specializes in malpractice. My friend will pay the bill directly."

"What do we need to do?" Marjorie asked.

"The attorney, Tom Kirkland, will call you in the next few days. He'll want to gather any records you have, and he'll likely subpoena files from Doctor Mercer and Doctor Greenberg. Stefan will provide him copies of the depositions and the settlement agreement."

"And that doesn't prevent us from doing this?" Ken asked.

"No. It says you won't take any legal action, and you aren't. The Ohio Medical Licensing Board is an administrative body, not a judicial one. Doctor Greenberg may try to make that argument, but according to Stefan it's a settled principle in Ohio courts that actions by licensing boards are administrative."

"Do you think he'll have his license revoked?" Marjorie asked.

"It's unlikely, according to everyone with whom I've spoken, but the complaint will go into his records, and that means any additional complaint would be given much greater weight, even if, in the end, he's not disciplined. That said, I think the argument I'm going to make is inescapable, and the board will have no choice but to, at a minimum, issue a reprimand. We'll go for more than that, of course, but sadly, that's the most probable outcome."

"Why?" Ken asked.

"Because he followed the standard treatment protocols, and that is almost invariably sufficient to defeat claims of malpractice. That said, I believe I can show he actually didn't do that, which will, I hope, force the Board to act."

"How do you plan to show that?"

"As I'm positive you know, one of the key symptoms of schizophrenia is not being able to process things long term — literally everything is 'now'."

"Right," Marjorie said. "Angie wasn't able to think long term."

"And that right there is what Doctor Greenberg got so very wrong. When Angie decided she was going to do whatever was necessary to get to a point where she and I could marry, she was thinking about the future, outside the moment, had made a plan, and was successfully executing it. That is not a sign of someone who is suffering from full-blown schizophrenia and is a strong sign that something has changed. In my opinion, that's why the insurance company settled. They knew they would lose, not just on emotion, but on facts."

"And you saying that, as a doctor, carries weight?"

"They'll argue that I have insufficient experience, but I have the textbooks and peer-reviewed journal articles on my side, not to mention I believe, in the end, Doctor Mercer will confirm. I think she'll testify on _our_ behalf, not Doctor Greenberg's."

"Angie really liked her."

"Me, too, until she listened to Doctor Greenberg instead of all of us. That said, I understand why she did, even if I don't agree. Anyway, I should spend some time with Angie before dinner."

"Thanks, Mike," Marjorie said.

"Yes, thanks, Mike," Ken added.

"You're welcome."

We went back to the living room where Angie had Rachel on her lap and I briefly flashed to an alternate universe where Rachel was mine and Angie's, though I suspected strongly she'd have had red, rather than black, hair. The source of Rachel's black hair could be either side of the family, as all of Elizaveta's family had black hair, as did my mom and grandfather, while I had my dad's sandy brown hair. The odd one out was my maternal grandmother, who had been blonde before her hair had turned white.

"How does it feel to be a doctor, Mike?" Angie asked.

"Not all that different, really. My final rotation in the Emergency Department was basically exactly what it will be like for the next few months, only I don't need close supervision and can work more independently. How are you doing?"

"OK, I guess. I'm working and going to Aikido."

Which was probably about the limit for her, given she was still taking psychoactive drugs, albeit at very low doses. I doubted she'd ever be able to go back to school, or get a better job than her data entry job, but it was _something_, when the alternative was nothing. I hated the situation and wished there was something I could do other than exacting a pound of flesh from the psychiatrist, but sadly, any last hope had been destroyed by his actions.

"That's good."

"Are you going to have more kids?"

"Angie…" her mom said firmly.

"It's OK," I said to Marjorie, then turned to look at Angie again, "Yes, Kris and I plan to have two more."

"What do you do, Kris?" Ken asked.

"I'm enrolled at Ohio State University in political science with a goal of an advanced degree in Public Administration."

"And you've been in the US how long?"

"Almost eighteen months," Kris replied.

"Her citizenship papers will be filed next week," I added.

"That's fast!" Ken declared.

"They were issued Green Cards based on her dad's job, and a Green Card holder can apply after eighteen months if they're married. Once Kris is approved, then her parents can apply early as well."

A timer rang, and Marjorie asked us all to go to the table while she brought the food to the table. She'd made oven fried chicken, home-style fries, bread, and coleslaw. I was asked to give the blessing, which I did, and then we dug in. The food was excellent, and I ate more than I probably should have, but it was so good that I simply couldn't resist. Dessert was apple pie and ice cream, along with coffee.

When we finished, I offered to help Marjorie with the dishes, which gave Angie more time with Rachel. After we finished the dishes, I spent a bit of time with Angie, and then Kris, Rachel, and I said 'good night' and headed home.

_June 30, 1989, Circleville, Ohio_

"What are we doing today?" Kris asked at breakfast on Friday morning. "You start your Residency tomorrow, and I start classes on Wednesday."

"I think we should do the grocery shopping today. We really won't have time tomorrow after band practice, and I can't skip that, given we have our concert on Tuesday."

"No, of course not! Grocery shopping today is fine. And a stop at the record store?"

"Yes. I also want to stop at Barnes & Noble and place a pre-order for the book I promised to buy for Frank Bush."

"We should obviously stop at the record store and bookstore before the grocery store, given how warm it is outside."

"Obviously," I agreed.

"What about tonight?"

"No plans, as most of the gang is gone and several others aren't available. You're OK with what Serafima and Alyssa suggested after Vespers on Wednesday evening — that we restart in the fall with what we used to call Dinner Club, which would be them, us, and Ghost and Oksana, right?"

"Yes, of course! And, as you and I discussed, we'll find time to get together with José and Sierra, Gene and Jocelyn, and Clarissa and Tessa."

"Then let's just stay in, have a quiet family dinner, and once Rachel goes to bed, you and I can take a nice bubble bath."

"«C'est magnifique!»" Kris exclaimed happily. "And after the bubble bath?"

"Anything you want, of course!"

"As it should be!" Kris declared.

"Some day, Rachel will say that to YOU and I'll laugh!"

"She's much more likely to say it to you!"

"Dada? Want Abby!"

"She's in Spain, which is far, far away. She'll be home in about a week."

Rachel crossed her arms and stared at me, but there was really nothing I could do. She'd be back in hospital daycare on Wednesday, which I hoped would improve her mood. We needed more friends with daughters, but so far, except for Abigail, there were only boys, including my nephews. My half-sister and my adoptive niece lived too far away for Rachel to see her regularly.

"I think we need to find a few more girls for Rachel to play with," I said. "But the majority of the babies at Saint Michael, Holy Transfiguration, and the cathedral, and in my family, are boys. Anna has remarked a few times that we need more girls because Viktor Gennadyevich will need a wife!"

"It's a bit soon to worry about that, don't you think?" Kris asked.

"Specifically, yes, but the general problem is that when our young men marry outside the church, they usually leave and attend their wife's church. When our young women marry outside the church, their husbands usually attend our church. So if we have too many boys in the parishes, we have a long-term problem, unless the trend of which church mixed-faith couples attend is reversed."

"I never really paid close attention to that in Paris, but I've heard others here say that."

"In any event, Rachel will have her choice of boys in about thirteen years. But for now, she much prefers the company of girls."

"If I had to spend time with Viktor Gennadyevich, I would, too!"

I chuckled, "He is one hundred percent 'boy' and reminds me of his uncle, more than his dad."

"You mean Joe, not you, right?"

"I was more like Rachel when I was little, and you know I hung out with Jocelyn more than anyone else. And that was true even after Dale and I became friends in second grade, after I had some disagreement with Jocelyn. Whatever the source of our disagreement was, it's lost in the mists of time, but me hanging out with Dale caused Jocelyn to seek me out and that created a trio of fast friends."

"You do have some qualities which are more feminine."

"That's been said before, and I attribute it to a combination of my mom and Jocelyn."

"DADA! WANT ABBY!" Rachel demanded.

"I wish you could understand what it means to say she's in Spain," I said. "You'll see your friends in daycare on Wednesday."

"Why don't you take her on Monday?" Kris asked. "She really hasn't seen her friends in a month. I'll pick her up, and if you're able, we could have dinner together at the hospital."

"Let's give that a shot," I said. "I really do not want an unhappy toddler!"

"Think about _my_ situation," Kris teased. "I have to raise _two_ toddlers!"

"Oh, give me a break!" I chuckled. "I was already housebroken when you met me! You owe thanks to my mom, Jocelyn, Clarissa, and Elizaveta for that!"

"You are useful around the house," Kris observed. "Especially in the bedroom!"

"Gee, thanks," I replied with a grin.

"Would you prefer I said _not_ in the bedroom?" Kris asked lightly.

"No."

We finished our breakfast, cleaned up the kitchen, then got ready to run our errands. Our first stop was Barnes & Noble, where I pre-ordered _The Sum of All Fears_ for Frank Bush and arranged for it to be mailed to him at Southern Ohio Correctional Facility. Per the clerk, it would be shipped directly from their warehouse, rather than to the store first, as the warehouse was fully up to speed on the rules for sending things into prisons.

Our next stop was the record store, though it now carried more CDs and video games than vinyl albums.

"What's new I should listen to?" I asked Johnny.

"_Bleach_, by Nirvana. They're a grunge band from Seattle. I think they're going to be big."

"You've never steered me wrong. What else?"

"_The End of the Innocence_ by Don Henley or _Disintegration_ by The Cure, which returns to their early 80s style. And _The Miracle_ by Queen."

"Decisions, decisions! How about the new group and Queen?"

"You got it! CDs, correct?"

"Yes."

He retrieved both CDs for me, put them in a bag, and rang up my purchase.

"I read in the paper that you graduated and are officially a doctor now."

"I am. I actually start my first official shift tomorrow."

"Cool. Your daughter is growing like a weed!" he said as I handed him three $10 bills.

"She is! You know, I've never asked, do you have kids?"

"A ten-year-old son."

"Business still good?"

"Being the only dedicated store in town helps, though I get undercut by K-Mart. But my selection is wider, and I do special orders, not to mention my regular customers. Adding video games helped, and I'm going to start carrying video game hardware, too. And I've expanded my used album business. I know you won't sell, but if you know anyone looking to unload vinyl or CDs, let them know."

"Will do."

Jonny handed me my change, I thanked him, and then Kris, Rachel, and I headed for Kroger. We completed our grocery shopping, stopped at the bakery, then headed home. After we put away the groceries, I put on the Nirvana album.

"You like this?" Kris asked.

"I have eclectic tastes," I replied. "Grunge isn't my preferred style, but I do appreciate the talent and artistry. I'd say Johnny is correct and Nirvana will be very popular."

After we listened to the album, we ate lunch, then put Rachel down for her nap. The rest of the day was quiet, and Kris and that evening, I had an enjoyable time in the bathtub and bed.

_July 1, 1989, McKinley, Ohio_

"How was Disney?" I asked José when he walked into the music room at Taft.

"You think the man even SAW the parks?" Sticks asked.

"I bet he did," I said.

"You'd win that bet," José replied. "Not that we didn't do what Sticks is implying! And yes, we had a great time."

"Shall we practice?" Kim asked. "We need to run through the two sets we're doing on Tuesday."

We did that, and Kim was happy with our practice. When we finished, we hurried to pick up Rachel at her grandparents' and then home for a shower. I dressed, put on the new long medical coat that my grandfather had given me, kissed my wife and daughter, then headed to Dorothea Rhodes Lummis Moore Memorial Hospital for my first shift of my PGY1.

Because I was assigned to the surgical staff, I reported to Doctor Vince Taylor in the Surgical Department at 11:30am.

"We'll dispense with the usual first-day Resident BS," he said. "I've been assigned as your mentor, but I don't think you'll need much mentoring from me for your first two years. Your mentor in the ED is Ghost, and you should go to him for anything related to trauma, and to me for anything else. Doctor Cutter wants you to wear red scrubs."

"Marking his territory, so to speak?" I asked with a grin.

Doctor Taylor laughed, "That's one way to put it, but yes, he wants to ensure that everyone knows you're officially a surgical intern. He feels it's better to differentiate the surgeons from the other doctors in the ED."

"OK. I'll take several sets down to the ED locker room with me, so I don't have to come up here if I need to change."

"Actually, your locker is here," Doctor Taylor said.

"Turf war, right?"

"Good guess. It started as soon as you Matched. I assumed you knew."

"I didn't. I thought there was a requirement for surgical Residents to be supervised by surgeons."

"There is, but you're in a gray area, at least for the next two years. In any event, Doctor Cutter prevailed, but that hasn't stopped Doctor Northrup."

"Wonderful," I sighed. "Day one, and it's already political."

"Just be a doctor and ignore the BS. You can do that as a PGY1. Let the senior Attendings fight it out with the Medical Director. In the end, you're going to be a Board certified surgeon, and that's the master trump."

"Trust me," I said with a smile, "I'll ignore it for as long as I possibly can!"

"See Penny at the nurses' station. She has your ID, your keys, and your pager."

"Keys?"

"We began locking all supply rooms as of last week. Too many consumables were disappearing. Everything has to be logged, not just drugs."

"More paperwork," I said, shaking my head.

"Unfortunately, I think we have to get used to it. Our patient load is up and our funding levels are stagnant."

"Same old story. I did see the construction equipment in what used to be the grassy field outside the ED, so that's something."

"It is, but they should have built the new surgical wing first."

"Well, being on the surgical service, I'm not going to disagree with you, but I disagree with you!"

Doctor Taylor laughed, "I hear you. You're not a surgeon at heart, even if you'll make a very good one."

"Thanks, Doctor Taylor."

"It's Vince, please. All surgical Residents address each other by their first name."

"Thanks, Vince."

"Go see Penny and let me know if you need anything. I can't imagine what it might be, given you've been here for four years, which is longer than I have!"

I shook his hand and went to the nurses' station to see Penny, who was new.

"Hi, Penny," I said. "You have my ID, pager, and keys."

"Doctor Loucks?"

"Mike, please," I said.

"Protocol is to call all doctors by their title," she said.

"Then Doctor Mike, please."

"OK. I understand you were a medical student here, so I'm sure you know about the pager."

"I do."

She handed me the ID, pager, and keys, I thanked her, then headed to the locker room to change. Using the surgical locker room was a minor inconvenience for working in the ED, but, in the end, I was a member of the surgical service, so it made sense. I found the locker with the tag 'M. Loucks' on it, and opened it, finding it empty as was to be expected.

I walked over to the cabinet which held the red scrubs, selected the correct size, changed into them, slung my stethoscope around my neck, clipped on my new photo ID which identified me as 'Doctor Michael P. Loucks' and had the red 'S' symbolizing the surgical service superimposed on the lower left of my photo, while the lower right had the standard Staff of Asclepius.

Normally, surgical Residents wore surgical caps while on duty, and I had several I'd ordered, as they were personalized, but they were not usually worn in the ED, so I simply left them in my locker. Last, I put on my medical coat, which surgeons wore when not in surgery, but which was generally dispensed with by doctors in the ED except when meeting with families.

Properly attired, I shut the locker, attached my combination lock, closed it, spun the dial, and then left the locker room to head to the ED. I took the stairs, something I had resolved to do to get that bit of extra exercise with my schedule, making regular exercise difficult, if not impossible.

"Good morning, Luisa," I said to the nurse at the nurses' station. "Doctor Mike Loucks."

She was new, having just graduated from nursing school in May.

"Good morning, Doctor!" she said brightly. "It's nice to meet you. Doctor Casper is in the lounge."

"Thank you."

I went to the lounge and saw Doctor Casper stretched out on the couch.

"Morning!" I said.

"Hi, Mike," he said, sitting up. "What's with the red scrubs?"

"Doctor Cutter's orders," I said.

"Proving, in his mind, that he has the bigger dick."

"Of all the things I could possibly care less about, I'm not sure there are many I care less about than the relative size of two Attendings' dicks."

"You and me both!"

"Who's the Attending?"

"A new-hire you haven't met - Doctor Isabella Mastriano."

"Italian?"

"Yes. She graduated from OSU and served her Residency in Texas. Loretta spoke to her, so she's been warned about you."

I chuckled, "Of course. Who are the med students?"

"You have Callie Newsom and Gabriella Martin today; Newsom is the Fourth Year. Also, Doctor Gibbs wants you to take the Preceptorship students on Tuesday afternoons."

"I know Callie. Preceptorships should be fun at the end of a thirty-six-hour shift."

"Welcome to PGY1! Anyway, you'll get mostly walk-ins today. See me if you have questions, and Doctor Mastriano will sign your charts."

"Sounds good."

"Hi, Mike!" Nurse Alice said, coming into the lounge.

"Hi, Alice."

"Doctor Casper, EMS four minutes out with a fall from a ladder."

"Thanks, Alice. Which room?"

"Trauma 3 is open."

He got up, and I went to the triage desk to check in with the medical student and nurse who were manning the desk.

"Hi, Doctor Loucks!" Nurse Billie said.

"Hi, Billie."

"Hi, Mik…Doctor," Fred Lawson said.

"Hi, Fred. I'm assigned to walk-ins. I just need to do the handover with Doctor Billings."

"OK. There are two waiting, so they're all yours."

"What do we have?"

"Two days of nausea and diarrhea and a minor arm lac."

"OK. I'll be right back."

"What's with the red scrubs?" he asked.

"As a trauma surgeon, I'm on the surgical service, but assigned to the ED. Surgeons wear red."

"Interesting."

I left the triage desk, checked the board, and went to see Doctor Billings.

"Hi, Doctor Billings," I said as I stepped into Exam 2.

"Hi, Mike. Call me Kayla, please. I'll be finished in two minutes. Meet in the lounge?"

"You got it."

I returned to the lounge and a few minutes later, Doctor Billings came in.

"Nothing to turn over," she said. "I just streeted that sprained ankle and my last admission went up fifteen minutes ago. Ready for your first shift?"

"It doesn't feel that way, actually."

"The golden-haired boy who did more procedures as a Fourth Year than I did as a PGY1! And why do you rate red scrubs?"

"Jackpot," I chuckled. "You and every other person I've spoken to has asked or commented! I'm officially on the surgical team though I'm assigned to the ED. Doctor Cutter wants me to wear red."

"Dick measuring contest between him and Northrup."

"So it would appear. I have two patients waiting on me, so unless there's something else…"

"Nope. I'm outta here!"

We both left the lounge with Kayla heading to the locker room while I went to find Callie and Gabriella, both of whom were standing in the ambulance bay, with Callie smoking.

"Don't you know those will kill you?" I asked Callie.

"It helps with the stress," she replied. "How are you, Doctor?"

"I'm fine. Who's your cohort in crime?"

"Doctor Mike Loucks, Gabriella Martin, Third Year. Gabby, meet Doctor Loucks, PGY1."

"Doctor Mike, please," I said. "Nice to meet you, Gabby. We're catching walk-ins. Come with me."

Callie stubbed out her cigarette and the two of them followed me inside.

"Callie, I'll have you do the H & P."

"Seriously?" she asked. "On your first shift?"

"Yes. My job, in addition to healing, is teaching. I know how to do an H & P. Now we'll see if you do. And Gabby, pay attention, because you'll do one as soon as I'm sure enough about Callie to turn her loose on her own."

"On her own?" Gabby asked. "Don't we have to be supervised?"

"Yes. My definition of supervision is allowing Callie to do an H & P on a walk-in on her own, then verifying her findings. That's how she'll learn."

"Rumor has it that you know everything," Gabby said.

I chuckled, "Let's assume for a moment that's true. It's what you learn _after_ you know everything that counts!"

"Hang on! If you know everything, you can't…wait, Zen, right?"

"Of that same basic idea, but I heard it from a Russian Orthodox monk."

We arrived at the triage desk, so I switched out of friendly teacher mode into doctor mode.

"Who's first?" I asked Fred.

"I'd say nausea," he replied.

"Me, too," I agreed.

"Kaylee Jennings, nineteen; last vitals: pulse 92; BP 120/70; temp 38.6°; no cough or sore throat; ears clear."

"OK. Chart please."

He handed me the chart, and I went to the door to the waiting room and opened it.

"Kaylee Jennings?" I called out.

A pretty girl stood up, as did a woman who I suspected was her mom, and came to the door.

"Hi; I'm Doctor Mike. Ms. Jennings, if you'd follow me," I said to the young woman, then turned to the older woman, "Ma'am, you'll need to wait here, please."

"It's OK, Mom," Kaylee said.

I checked the board, saw that Exam 1 was open, and brought Ms. Jennings there, with Callie and Gabby following me.

"Go ahead, Callie," I said.

"Hi, Kaylee," she said. "What brings you here today?"

That was literally the by-the-book first question to ask and was intentionally open-ended to elicit as much as possible from the patient.

"I've been sick to my stomach and have the runs."

"When did those symptoms start?" Callie asked.

"Thursday night."

"What did you do on Wednesday and Thursday?" Callie asked.

"Not much. A picnic at the lake."

I made a mental bet with myself that she had salmonellosis, or, as it was more commonly known, food poisoning. I almost laughed, thinking back to carrying Lara from the dorm to the infirmary at Taft, but that would have been inappropriate. Callie obviously had the same thought as she asked what Kaylee had eaten, then went through a complete H & P, reporting her findings.

"Preliminary diagnosis is food poisoning," Callie announced.

"I concur," I said. "Kaylee, I need to do a quick exam to check Callie's findings."

"She's not a doctor?"

"No. She's a medical student. This is normal for training."

I did a quick exam, hearing no anomalies in her heart or with her breathing.

"Kaylee and I need to present your case to our Attending," I said. "That's a senior doctor. Gabby, you stay with her."

"OK," Gabby agreed.

Callie and I stepped into the corridor.

"You'll present," I said. "What's your proposed treatment?"

"The choices are oral or IV rehydration, and given she's nauseated, I recommend IV Ringer's."

"Good. Anything else?"

"Ceftriaxone."

I shook my head, "Studies show that has no positive effect on otherwise healthy patients who are not very young or very old. Overuse of antibiotics is a serious problem, so we don't use them unless we have to."

"Patients want them."

"And I want shorter shifts!" I chuckled. "I don't see anyone granting that wish simply because I want it!"

Callie laughed, "Good point!"

"Anything else?"

"Not that I can think of."

"Antiemetic?" I asked.

"Is her emesis sufficient to need that?"

"I asked you first!" I chuckled.

"She hasn't vomited since we brought her into the exam room, so I'd say she doesn't need it."

"Think about that for a second," I suggested.

"She said she couldn't keep anything down. So, in addition to the IV, we give her some juice and see what happens."

"Excellent. How do we confirm our diagnosis?"

"Stool sample or blood test. If I suggest a stool sample, are you going to make me collect it?"

"What do you think?" I asked with a goofy smile.

"I think she needs a blood test!" Callie declared.

I laughed, nodded, and we went to the Attendings' office and I knocked on the open door.

"Doctor Mastriano?"

"You must be Mike Loucks.

"I am."

"What's with the red scrubs?"

"Doctor Northrup's orders," I replied. "We have a patient to present."

"Go."

"Callie?"

"Kaylee Jennings, nineteen-year-old female; pulse 94; BP 124/72; temp 38.6°; nausea and diarrhea onset on Thursday after a picnic at the lake; no cough or sore throat; ears clear. My preliminary diagnosis is food poisoning, likely caused by salmonella. Recommend treatment with IV Ringer's for dehydration and blood test to confirm."

"Antibiotics?"

"Not indicated for healthy adults. She doesn't appear to need antiemetics at this point. Observe for two hours."

"Approved. Let me have the chart to sign."

Callie handed over the chart, Doctor Mastriano signed it, and then handed it back.

"Mike," Doctor Mastriano said, "come see me when you have a break, please."

"Will do."

Callie and I left the office and stopped outside the exam room.

"Thanks for the tip on antibiotics," Callie said.

"All part of the service!" I replied. "Do you know if Gabby has done IVs?"

"I haven't seen her do one, no."

"OK. Then you do it. I'll ask her about it, but not in front of the patient. Blood draw?"

"Same answer."

"OK. You do that, too, and have her take the blood sample to the lab."

"OK."

We went into the exam room and I nodded to Callie.

"Kaylee, we're going to give you IV fluids, and run a blood test to confirm our suspicion that you have salmonella-based food poisoning."

"No antibiotics?" Kaylee asked.

"No," Callie replied. "They're usually not necessary for otherwise healthy adults. We will keep you for a few hours to see how you're feeling, as well as get the results of the blood test. If you'll lie back down, I'll get the IV going and draw the blood."

Callie did a good job on the IV and the blood draw, and as we agreed, asked Gabby to take the blood to the lab. Once that was done, I sent Callie to bring in Kaylee's mom.

"She'll be fine," I said. "We're giving her IV fluids to counteract the dehydration caused by her vomiting and diarrhea while we wait for the blood tests to confirm food poisoning. You can wait here with her. If the tests do confirm it's food poisoning, you can take her home and have her eat broth until her stomach settles. We'll come back to check on her every twenty minutes or so."

"Thank you, Doctor!"

"You're welcome."

Callie and I left the exam room and went to the triage desk.

"Arm lac or migraine next?" Fred asked.

"How long as the arm lac been here?"

"About thirty minutes," he replied.

"How many sutures do you estimate?"

"Five or six at most."

"Callie, may I see your procedure book?" I asked.

She handed it to me and I counted five signed-off sutures during her current rotation.

"OK. I'll do a quick exam, you can suture, and I'll check your work. While you're doing that, I'll see the migraine. I'll ask a nurse to help you; I'll have Gabby help me."

"Great!" Callie declared. "I'm going to enjoy working _under_ you!"

The stress on the word might have been my imagination, but I didn't think so. I elected to simply let it go.

"Fred, we'll take the arm lac chart, please."

"Jack King; forty-eight; vitals normal; five centimeter lac on right forearm."

He handed me the chart, and we went to the door, I called Mr. King, and Callie led him to the new suture room that used to be the Residents' office. I went to the nurses' station and ensure there was an experienced nurse to help Callie. I was assigned Nurse Julie, and she followed me to the suture room.

I did a quick exam saw no contraindications and asked Callie to proceed.

"Call me when you're finished, and I'll sign the discharge papers."

"Will do, Doctor," Callie said.

I left the room and saw Gabby returning from the lab, waved for her to follow me to the triage desk.

"Migraine," I said.

"Take two aspirin and call you in the morning?" Josh, the clerk asked.

"Sadly, that may be about as effective as most treatments we have for migraines. Vitals, Fred?"

"Stephanie Smith, twenty-six; pulse 88; BP 124/74; temp 37°; onset shortly after waking this morning; previous visits in January, March, and May."

"Frequent flyer," I said. "Did you pull her records?"

"No. I can't leave the triage desk."

"OK. Gabby, go to the records room and find me the file for Stephanie Smith. Birthdate…"

"March 22, 1963," Fred said.

"Be right back," Gabby said.

Five minutes later she returned.

"What does it say?" I asked.

"I didn't know I was allowed to look."

"Required, is more like it. Tell me what you see."

She opened the file and flipped through it."

"Each visit is about eight weeks apart, she was treated the first time with a 'migraine cocktail'. What's that?"

"Basically Excedrin, but with higher dosage — 500mg acetaminophen, 300mg acetylsalicylic acid, and 100mg caffeine."

"The second time, with IV metoclopramide; the third time they added dexamethasone.

"Any red dot on the inside folder?"

"No. Why?"

"That would indicate a drug-seeker," I said. "Claiming migraines or back pain are the most common excuses for asking for opiates. This young woman hasn't done that, so we believe she actually has migraines. Let's bring her in."

Fred handed me the chart and Gabby and I went to the door and called Ms. Smith.

"Hi, I'm Doctor Mike and this is Gabby, a medical student. Let's get you into an exam room."

I checked the board and Exam 3 was open, so we led Ms. Smith there and she climbed onto the exam table.

"What brought you here today?" I asked.

"I have terrible migraines."

"When did they start?"

"The first one was probably about a year ago, and Excedrin knocked them down for the first six months. When that stopped working, I came here, and they gave me a higher dose of the same stuff. The next times I had an IV, but can't tell you what it was."

"Are you sensitive to light or noise?"

"Both," she replied.

"Your migraines seem cyclical," I said. "Do you have any idea what triggers them?"

"No."

"When was your last menstrual period?"

"It should start tomorrow or Monday."

"Is there any chance you're pregnant?"

"No. It's been a couple of months since the last time, and I've had my period."

I went over her medical history, then said, "I'd like to do a physical exam, please."

"Sure."

I started with heart and lungs, then eyes, ears, nose, and mouth, and finally palpation of her abdomen.

"Gabby, let's get a CBC, Chem-20, and a glucose panel," I said, writing those orders on the chart, along with a medication order. "Let's also start her with 500mg acetaminophen, 300mg acetylsalicylic acid, and 100mg caffeine. Ms. Smith, I'm going to check on two other patients and I'll come back after Gabby draws the blood."

"Do you need Doctor Mastriano to sign off?" Gabby asked.

"No," I replied. "Only for scheduled drugs."

"Why would you need approval?" Ms. Smith asked.

"That's normal for Interns," I replied. "That's someone in their first year of Residency."

"You're a brand new doctor?"

"First day, officially, though I've technically been a doctor for over a month."

"First day? Seriously?"

"Yes."

"You're in good hands, Ms. Smith!" Gabby said. "Mike graduated at the top of his class and aced his exams!"

"I wasn't concerned," Ms. Smith said. "I was impressed!"

"I'll be back shortly," I said.

I went to check on Kaylee who was feeling OK and resting comfortably, updated the board, which I'd failed to do earlier, then went to check on Callie, who was almost finished.

"Those stitches look good," I said. "When you finish, fill out the discharge form, bring it to me to sign, then take it to Doctor Mastriano. Discharge if she signs off."

"Will do!" Callie said.

I left and went to check if there were any other walk-ins, but there weren't, so I returned to Exam 3 where Gabby was completing the blood draw. Given it was just the two of us, I went to the drug locker, retrieved the oral tablets, then went to the nurses' station knowing I'd need someone in the exam room when Gabby ran the blood to the lab. Nurse Jessica walked to the exam room with me, and Gabby took the blood to the lab. I administered the medication.

"I'm going to speak to my Attending," I said to Ms. Smith. "Nurse Jessica will stay with you."

I left and went to see Doctor Mastriano. I described Ms. Smith's complaint and what I'd done so far.

"What do you want to do next?" Doctor Mastriano asked.

"IV metoclopramide and dexamethasone. Once the blood test results come back, I'll return with any additional treatment plan."

"OK. Do you have a moment now?"

"Yes."

"Shut the door and have a seat."

I did as she asked.

"First day, first patient, and you have a Fourth Year do the exam?"

"It was impressed on me that teaching is an important part of a Resident's job, and from experience, I found that many Residents don't give their Third Years and Fourth Years enough opportunities. It was the right decision."

"I wasn't challenging, you," Doctor Mastriano said. "I was surprised a PGY1 would do that their first day. You'll have every student clamoring to be assigned to you."

"I don't see that as MY problem!" I chuckled. "I was under the impression Doctor Gibbs had told you about me."

"She did, but that doesn't mean I'm not surprised."

"I believe she should have _warned_ you, not told you about me," I chuckled.

"I believe you're right!"