Copyright © 2015-2022 Michael P. Loucks

Сам Себя Издат

First publication date: TBD

First revision publication date: TBD

You may contact the author at: author@michaelloucks.com

https://a-well-lived-life.com/

Scripture taken from the New King James Version®. Copyright © 1982 by Thomas Nelson.

Used by permission. All rights reserved.

For Jennifer

Other Books in This Series

Freshman Year

Sophomore Year

Junior Year

Senior Year

Medical School I

Madical Shool II

Medical School III

Medical Schoo IV

Residency I (\)*

Work in Progress

Other Books by Michael Loucks

A Well-Lived Life, Series I

Book 1 - Birgit

Book 2 - Jennifer

Book 3 - Pia

Book 4 - Bethany

Book 5 - Stephanie

Book 6 - Kara I

Book 7 - Kara II

Book 8 - Stephie

Book 9 - Anala

Book 10 - The Wife

A Well-Lived Life, Series 2

Book 1 - Bethany

Book 2 - Stephie

Book 3 - Jessica

Book 4 - Elyse

Book 5 - Michelle

Book 6 - Samantha

Book 7 - Sakurako

Book 8 - NIKA

Book 9 - Kami

Book 10 - Bridget

A Well-Lived Life Series 3

Book 1 - Suzanne

Book 2 - The Inner Circle

Book 3 - A New World

Book 4 - Coming of Age

Book 5 - The Pumpkin Patch (\)*

Cliimbing the Ladder

Book 01 - The First Rung

Book 02 - The Second Rung

Book 03 - Climbing Higher (\)*

From the Files of Doctor Fran Mercer (\+)*

A Sailor's Diary

Book 1 - The War Years (\+)*

Work in Progress

+ Available exclusively on Patreon or BuyMeACoffee

I. The Doctor is IN (or is he?)

May 25, 1989, Graduation Day, McKinley, Ohio

I accepted the leather-bound diploma from Doctor Warren with my right hand, instead of the usual left, as Rachel was in my left arm and was snuggled against my chest. I tucked it under my arm and shook his hand.

"Congratulations, Mike," Doctor Warren said. "An excellent valedictory oration."

"Thanks."

"She's beautiful. And it was a nice touch to walk her across the stage."

I smiled and nodded, but had to move on, as Tom Meyer's name had been called and he was right behind me. I shook hands with the other deans, then the President of the Medical School Board, and then returned to my seat. Just under fifteen minutes later, Medical School Board President Thomas Abbott gave us our commission to serve our fellow men, and closed the ceremony.

"Dada? Eat?" Rachel asked.

"As soon as we get to Mama," I said. "She has some cookies and juice for you."

I found my extended family and friends, and went to give Rachel to Kris, but Grandma Borodin intercepted. I let her know Rachel was hungry, and Kris gave Rachel's bag to my grandmother. Kris gave me a quick hug, but protocol dictated what I did next. I turned and took two steps to where my bishop was standing.

"Congratulations, Mischa," Bishop JOHN said.

"Thank you, Vladyka."

"A very good speech, one worthy of publication in the church bulletin of every parish in our diocese. It's a message that applies to all Orthodox Christians."

"I'm honored," I said.

"Then with your agreement, I'll have it published."

"I agree."

"Your grandfather looks as if he's about to burst!" Vladyka said with a smile. "I think I've monopolized you long enough!"

"Master, bless," I said.

I turned my hands up, and he gave his blessing, then I turned and took a step over to my grandfather.

"Congratulations, Mike!" my grandfather said.

"This one will result in wearing white, not black," I replied with a smile.

"Speaking of that," he said with a smile.

He handed me a package and nodded that I should open it. I did and found a long white medical coat, signifying a physician, rather than the short one signifying a student. Embroidered in black above the pocket was 'Doctor Michael P. Loucks'.

"Thank you, «Дедушка»," I said.

"You're welcome, Mike! Stefan and I reserved the overflow room at the steak house in McKinley and everyone is invited, including Viktor. I spoke to His Grace and he'll join us, and per your mother, I cleared it with Kris. Your friends are welcome, of course, though I expect Svetlana Yakovovna will want to be with her parents."

I laughed, "I haven't called her that in ages! And yes, she's going to be with her parents and grandparents tonight. Maryam, Fran, Peter, and Nadine all have their parents and others here as well. We're having a get-together at the house on Sunday."

"Congratulations, Mike!" Stefan said, coming over to us.

That started a string of congratulations from everyone else who was there - my mom and dad, my two grandmothers, Paul and Liz, Holly, Jocelyn and Gene, José, Lara, the Korolyovs, Doctor Smith, Doctor Forsberg, Doctor Casper, Doctor Strong, Doctor Roth, and Doctor Gibbs, who looked about ready to pop.

"You should not be here!" I said, looking at her positively huge abdomen.

"My feet and my hemorrhoids agree with you!"

"TMI, Doc!" I chuckled. "You aren't a patient!"

"I'm losing patience with Bobby Junior right now! And with his dad!"

"I bet! Go home, Doc! Doctor's orders!"

"That didn't take long!" she said, laughing. "Did you get your schedule for next week?"

"Yes. I'm on Bobby's three twenty-four-hour shifts starting at 0700 on Monday, Thursday, and Sunday."

"When do you leave for your vacation?"

"The Monday following my last ride-along shift, so Kris will do most of the driving. It's only about six hours, so I'll get a two hour nap before we leave."

"Sorry about that."

"Don't apologize! I want to do this. It'll be instructive and interesting to see what happens before the guys roll the patients out of the squad. It's just too bad they're Squad 2!"

"There are only twelve in the county, so no 'Squad 51' for you!"

"The real bummer is that fire stations no longer have poles to slide down!" I declared.

Doctor Gibbs laughed, "True, but they do have the mandatory Dalmatian!"

"What's his or her name?"

"Brigid, because she's the Irish goddess of the hearth and sacred flame, as well as of water."

"That makes perfect sense."

"Bobby named her."

"I have one for you," I said with a smirk. "Cerberus, the hell-hound and guard dog of the Underworld, comes from the root Indo-European word '∗k̑érberos', which evolved into the Greek word kerberos, which changed to Cerberus when it went from Greek to Latin. That Indo-European root word '∗k̑érberos' means 'spotted'. That means that Hades, Lord of the Dead, literally named his pet dog Spot!"

Doctor Gibbs laughed, hard.

"Don't do that! You'll make me go into labor!"

"I think there might be a doctor or two here to assist," I chuckled.

"More like two hundred! But there is no way YOU are delivering my baby!"

"I'd say 'The Doctor is IN' and ask for 5¢, but the LAST thing I want to do is deliver your baby! Now go home!"

"Yes, Doctor," Doctor Gibbs smirked.

We exchanged a light hug, she left, and I spent a few minutes speaking with Anicka and Milena, then our entourage began filing out of the auditorium. As we were walking to the parking lot, Maryam called my name so she could introduce me to her parents, and more importantly to Matta, who I was sure would be her husband in less than a year. We shook hands, but really didn't have time to talk. He was heading back to Chicago with Maryam's parents, so wouldn't be at the house on Sunday.

"I should go home and change," I said to my grandfather. "We'll meet you there about fifteen minutes after you arrive."

"OK."

Kris took Rachel from my grandmother, and we got her settled in her car seat in the back of my Mustang, then got in so we could head home.

"How do you feel, Mike?" Kris asked as I pulled out of the parking lot.

"As I said to Doctor Casper and Doctor Gabriel, the most important thing was the Match. To me, the Match letter was a bigger deal than the diploma. Graduating without Matching would have been depressing, and graduation has been a done deal since I passed all my core rotations."

"You're not excited?"

"I am, just not as excited as I think you expect me to be!"

"How about later?" she asked in her sultry French accent.

"You always excite me!" I declared.

"Dada Mama kiss!" Rachel giggled.

"Dada is driving," I replied, laughing, then said, "OK, who taught her THAT?" I asked.

"My sister, I bet!" Kris replied. "Like most fifteen-year-olds, she's very curious about that part of life! And I could just see her teaching Rachel to say that to tease you."

"Me?"

"You! She knows better than to tease me!"

I laughed, "Hell hath no fury like the elder sister scorned?"

"You know we really don't torment each other the way you and your sister did, or even the way you and Jocelyn did."

"Or Clarissa?"

"That's more like, well, a married couple, than anything. I'm positive if she were straight, you two would have married long ago."

"You aren't wrong," I replied. "But I've known her orientation since Freshman year. Angie was around then, and you know how I felt...feel about her. Sorry."

"Don't apologize," Kris said. "There is literally nothing you can do to change the past, and I don't feel slighted because you care for Angie and want to help her. I want you to help her."

"Thanks. What did I do to deserve you?"

"You listened to my cousin!" Kris declared mirthfully. "We each now have the doctor best suited for us!"

"I'm curious..."

"Doctor Casper needs a devoted wife who will spend quiet, relaxing time at home with him; you need a partner in crime!"

I laughed, "Clarissa, Jocelyn, or both?"

"Both! And your mom."

"Of course," I chuckled. "The three women who basically ruled my life until Elizaveta and Rachel came along!"

"Clarissa still does, at least outside our house."

"But never in a way that would interfere with my relationship with you," I countered. "She helped shape me into the man I am today. You would not have liked me eight years ago!"

"Eight years ago I was ten!" Kris declared mirthfully.

"You know what I meant!" I countered.

"I do, of course."

"And inside our house?" I asked.

"We both know who's really in charge."

"Rach!" my daughter giggled.

"Uh oh," I said quietly. "We're so dead!"

"Dada?"

"Yes, Rachel?" I inquired.

"«Zha'tim»!"

"I'm not sure what you just said, Rachel," I replied.

Kris laughed softly, "I think she tried to say «Je t'aime»! My sister strikes again!"

"Rachel, «Je t'aime»!" I said.

"Mama! «Zha'tim»!" Rachel declared.

"«Je t'aime, mon petit lapin!»" ("I love you, little bunny rabbit.")

"So it would appear she's going to learn French after all," I said as I pulled into the driveway of our house.

"Is that a problem?" Kris asked.

"Not really," I replied. "We had decided not to teach her Russian, at least as a toddler, but I'm sure she'll pick up the odd phrase here and there from my grandparents or Clarissa, who will, no doubt, revel in teaching my daughter how to tease me in Russian!"

"Clarsa!" Rachel exclaimed. "Love Clarsa!"

"Ok, now I'm positive I'm doomed!" I declared.

"Poor baby," Kris teased.

"Yeah, yeah," I chuckled. "I will admit that I signed up for this willingly."

"Perhaps you just need some personal attention later, after Rachel goes to bed?"

"Perhaps I do!"

I parked, we got out of the car and went into the house. While I took off my graduation regalia, Kris changed Rachel's diaper and packed food in her bag, as there was no way Rachel could eat anything at the steakhouse except perhaps the warm breadsticks they served with the salads and some baked potato.

We had an enjoyable time at dinner with Bishop JOHN, my extended family, including the Korolyovs, José, Lara, and Jocelyn and Gene. After dinner, Kris, Rachel, and I headed home, and once Rachel was in bed, Kris supplied the personal attention she'd promised.

May 26, 1989, McKinley, Ohio

"What do you plan to do today?" Kris asked when we got out of bed on Friday morning and went to the bathroom to take a shower together.

"If they'd let me, I'd work in the Emergency Department, but I can't actually do that before June 1st, when the Residency position is officially available. They couldn't pay me until then, and I wouldn't be covered by malpractice insurance."

"That's such a foolish concept! The state should simply pay compensation to those who are truly harmed and dispense with the silly lawsuits."

"The problem there is that it turns it into a political fight as much as one about medicine. That said, going to court is a losing proposition because juries almost always find for the plaintiff."

"And you told me the insurance companies settle for that reason, so why even bother with insurance companies? You could even simply take the premiums and put them in a pool administered by the state. No more insurance companies and no more court battles."

I laughed, "Oh you poor, naïve French girl!"

"What?"

"Instead of suing the hospital and the insurance company, they'd sue the government or the board that made the decisions, or sue the doctors and hospitals, anyway. It's almost impossible to avoid a lawsuit, no matter what you do."

"But the government could make it so you couldn't go to court, right?"

"Yes, and then there would be lawsuits over that. But you'd never get a law like that passed. Every attempt to reform malpractice is fought tooth and nail by what are politely called 'plaintiff's attorneys' but which most people at the hospital call 'ambulance chasers'. They have serious political clout because they have serious money to donate."

"The entire system is corrupted by money!"

"Perhaps so, but the First Amendment guarantees a right to free speech and free press, and the courts generally include an individual spending their own money to advance a political cause as covered by the First Amendment. I read about a case going to the Supreme Court this year about corporations being able to spend money on politics, and the consensus appears to be that the Supreme Court will allow those restrictions because corporations aren't people."

"Well, obviously!"

"Actually, not so obviously under American law," I replied. "I learned in High School that there are two important points. First, a corporation is owned by individuals who cannot be forced to give up their Constitutional rights to gain some service or benefit from the government. Second, in some things, corporations are treated as individual persons. That's necessary fiction because if that fiction weren't maintained, a lawsuit against IBM or GE would, under our system, necessitate suing every individual stockholder as an owner, rather than suing the corporate entity."

"That's just silly!"

"Maybe so, but that's how things work in our Common Law system. Remember, the basis of our system is different from the French system. Well, except Louisiana, which is based on French Civil Law. All the other states are based on English Common Law."

"How can one state be different?"

"ALL states are different! The laws in Ohio are different from the laws in Indiana, Michigan, Pennsylvania, West Virginia, and Kentucky, even though the states are contiguous with Ohio."

"The system is far too complex, and it should be simple for the national government to pass any necessary laws!"

"The system is actually designed to prevent that," I chuckled. "You don't have to like it, but you do have to accept that's the way things are. Well, at least until the glorious people's revolution hoists the red and black flag over the White House!"

"Are you mocking me?" Kris asked, hands on her hips.

"Me? Would I do that?"

"YES!"

"Perhaps," I chuckled.

We finished our shower, dried off, and dressed.

"You never did answer as to what you planned to do today," Kris said when we went down the hall to get Rachel.

"I think the Tsarina and I will just have some daddy-daughter time. I'll see if I can deprogram her from the French cult your sister is trying to indoctrinate her into!"

"You like this French girl!"

"I also like French kissing her!"

"Of course you do!"

"But neither of those things make it any less vital to teach Rachel the truth about France!"

"And what is that, Michael? Hmm?"

"What's the first thing you teach a French soldier?"

"Uhm, how to march?"

"No. This!"

I raised my hands to the 'surrender' position.

"Oh, please!" Kris exclaimed, rolling her eyes.

"Did you hear about the new French battle tank?" I asked as I began changing Rachel's diaper.

"No."

"Five speeds -- four in reverse; one forward, in case the enemy gets behind them."

"Are you going to keep going?" she asked, tapping her foot.

"New French military rifles for sale! Never fired; dropped once!"

"Perhaps you would like to sleep on the couch?" Kris threatened.

"Why are French main roads lined with trees?" I asked.

"Don't even go there, Michael Loucks!"

"Because the German Army likes to march in the shade!"

"Are you quite through?"

"I'm all out of French military jokes," I said with a grin. "I mean, besides the French military itself!"

"Gilbert du Motier, Marquis de Lafayette, is rolling in his grave!"

"I actually never knew his name," I replied. "He was always referred to by his aristocratic title."

"So, this French girl taught you something!"

"More than one thing, and I've returned the favor."

"To your own advantage!" she said mirthfully.

"And to yours!"

"True!"

I finished changing Rachel's diaper and the three of us went downstairs for breakfast.

"I still don't understand why Americans make fun of the French! We were your allies and helped you defeat the British king and his German mercenaries!"

"I honestly don't know, but I strongly suspect it has to do with World War II and Vichy."

"An outrage, though worse was the «collaboration horizontale»."

"Survival often necessitates setting aside ones' principles in favor of food and shelter. I find it hard to judge someone at risk of starving to death for whatever they might do to obtain food, short of physically assaulting someone or killing them. I assume you've read Les Misérables? Do you think Jean Valjean should have been sentenced to hard labor for taking a loaf of bread when he was hungry?"

"Isn't theft always wrong?"

"Isn't refusing to feed the hungry also wrong? One begets the other, don't you think?"

"Yes, of course, but you're a capitalist!"

"And an Orthodox Christian. The two are not as incompatible as you think they are. I would never refuse to share what I had with someone in need, to the extent of my ability to do so. Remember, 'sell all you have and give to the poor' was about love of riches, NOT a command for everyone to live in abject poverty. And, as we've discussed, in Acts, where Marx cribbed 'from each according to his means; to each according to his needs', it was voluntary, as shown by the incident with Ananias and Sapphira.

"You and I will have two above-average incomes, and we'll happily pay our taxes, tithe, and give generously to charity. But that does not mean we shouldn't enjoy some of the fruits of our labor. After all, as Jesus said in Luke's Gospel -- 'the worker is worth his wages'. Paul repeats it in his letter to Timothy with reference to supporting individuals engaged in Christian ministry. I daresay if ministers are to be appropriately compensated, then so are doctors.

"In the Old Testament, in Fourth Kings, it makes the point that religious leaders were to be compensated by the people so they could dedicate their lives to service to the community. I think there's a clear parallel for physicians. And it's not as if I'm doing this for the money. You heard my 'call to arms' yesterday, and that's the important thing. The compensation comes second, and while I won't turn it down or be embarrassed by it, I will follow the same course with money as I do my medical skills."

Kris smiled, "For somebody who hates politics, you have very strong political convictions."

"I'm an American and I believe in capitalism, so sue me!"

Kris laughed, "Only Americans would use 'so sue me' to make a point! The phrase works because you run to court at the drop of a hat!"

"And, sadly, our justice system provides little justice and plenty of retribution."

"Do you still plan to visit the man who murdered Lee after we come back from our vacation?"

"I'm going to try. I have no idea if he'll see me. I do have to find out the rules for visiting him, because his sentence was life without parole. I know visiting death row inmates is very difficult, and he's in the same prison where they house them."

"The death penalty is barbaric!"

"I agree, and so are the conditions in most prisons in the US. Had I remained a deacon, eventually I would have become involved in prison ministry."

"There's no reason you can't do that as a lay person, is there?"

"With the caveat that I'd be able to bring the Eucharist if I was a deacon, yes. And it's something to consider in three or four years when things calm down with regard to my schedule at the hospital."

"When will you know your schedule?"

"Not long after we return from Tennessee, though the first week is technically orientation week, but I'll start my regular shifts immediately because I don't need orientation on the hospital."

"What do they do for that?"

"The first week is a series of ten, four-hour shifts in each department where the new Resident shadows a PGY2 to become familiar with the other services."

"All Residents?"

"From the Emergency Department, yes. But because I had time on all those services at Moore, I don't need to do it."

"What do the other services do?"

"Nothing at the moment. In the future, Residents from all the major services will spend three months of their first year in the Emergency Department. That way, when we have major incidents, everyone will have recent experience in trauma. The typical Resident outside of trauma almost never does intubation, for example. Neither do the paramedics, for that matter, which is going to change and is why they'll spend time training in the ED in the future."

We finished making our breakfast, ate, and then Kris left for her final day of High School. She had two exams, though she was at absolutely no risk of not having straight A's, and we'd attend her graduation ceremony on Saturday.

"What would you like to do?" I asked Rachel.

"Dada sing!"

"You really are learning a bunch of words!" I said. "I'll get my guitar and play for you."

Rachel was twenty-one-months old, and her vocabulary was growing by leaps and bounds, and she was able to express herself in simple ways, but that was far more than even three months previous. To satisfy her, I got my guitar and sheet music, then sat on the couch in the great room to play for her.

As she often did, Rachel sat on the couch and leaned against me while I played and surprised me by trying to hum along with the guitar. Many of the songs I knew she preferred I knew by heart, but I also took the opportunity to practice some of the newer songs. When I finished playing, I put the guitar and sheet music away, then decided Rachel and I should take a walk.

Instead of putting her in her stroller right away, I held her hand until we reached the end of the driveway. I picked her up and met immediate resistance.

"NO! RACH WALK!"

"We'll try it your way," I replied.

She was determined, and I saw so much of Elizaveta in her personality. It could only be genetic, as except for a few brief seconds, Elizaveta hadn't even held her. Of course, she could have inherited that through me from my mom and grandmother because she had a double dose of Russian X chromosomes! Her Borodin stubbornness lasted about a hundred yards and she plopped down, her little legs clearly tired. I picked her up, and this time she didn't resist going into her stroller.

After our forty-minute walk, I read to Rachel, played with her, and then we had lunch. After lunch, I called Viktor and as he and Yulia were home, I took Rachel to see them, as she hadn't been to see them for several weeks.

When we arrived, I left Rachel with Yulia and Viktor and I went into his study.

"Thank you," I said. "I wouldn't be where I am without your help."

"You're welcome. And thank you for bringing Rachel to see us. What are you doing before you begin your Residency?"

"Next week, I'm going on ride-alongs with EMS as part of the new program. Then Kris, Rachel, and I are going to Gatlinburg, Tennessee, for ten days."

"When you return, we'd like you to join us for dinner at the country club."

"We'd love to," I replied.

"How are things going other the medical school?"

"I'd say they're good. You saw Rachel, and she's healthy and happy, and developing at a slightly advanced pace."

"Elizaveta was like that as well. She was helping Yulia in the kitchen by age three."

"That doesn't surprise me in the least!"

"The anniversary is on a Saturday this year, and I planned to ask Father Nicholas to conduct a graveside memorial service in the morning."

"If you do that, we'll be there."

"May I ask about you leaving the parish?"

"You may, but Father Nicholas didn't tell you why?"

"No."

"We left because I spoke the truth and was taken to task for doing so."

"About?"

"Oksana and Greg Casper," I replied. "Ghost, as Doctor Casper prefers to be called, felt he was being pressured into converting, which, of course, he was. I pointed out that there is nothing in the canons which required him to be chrismated before the wedding. Oksana didn't have a problem with that, but Father Nicholas did, and confronted me about it. When I pushed back, he said he was tired of my attitude, so, in keeping with him being tired of me telling the truth and acting like a Christian, I announced we were transferring our membership to the cathedral."

Viktor sighed, "I do not understand why Father Nicholas feels it necessary to get into confrontations with you at every turn! Father Roman is your spiritual father and confessor, and if Father Nicholas had a problem with you, he should have taken it up with Father Roman, who, I daresay, would not reprimand you for telling the truth. What did His Grace say?"

"That he was happy to have us at the Cathedral. The incident wasn't even mentioned. The same was true for Father Luke. Of course, Kris is happy, because her parents and sister attend services at the Cathedral."

"Does anyone else know the reason for you transferring your membership?"

"I only spoke to Clarissa about it, and I believe Kris only informed her parents, but she didn't give a reason. I didn't want to put Subdeacon Mark in the middle of things, so I simply let him know Kris and I had talked it through and made the decision. I have no idea what Father Nicholas might have said to him, and I don't want to open a can of worms."

"Wise. Shall we spend some time with my granddaughter?"

"If you can wrest her away from her grandmother!"

Viktor did get a chance to hold Rachel and read a book to her before we left. We arrived home just before Kris, who had brought Lyudmila with her to watch Rachel while Kris and I were at the graduation banquet. About two hours later, with me in a suit and Kris in a formal dress, we left the house and headed to the Holiday Inn where the banquet was being held, a reprise of the banquet at the beginning of medical school.

For this one, we were at the head table because I was class valedictorian, though the downside was that meant sitting with the deans rather than with my classmates. On the positive side of the ledger, Matta had stayed, and I had a chance to speak with him for about ten minutes. After that talk, I was even more convinced that he and Maryam would marry, and very soon. Fran had Jason with her, of course, and Clarissa had Tessa, but both Peter and Nadine had come alone.

The banquet has, as most banquets did, had decent food, but nothing special, and the speeches were, for the most part, simply platitudes and congratulations. The one highlight was when Clarissa was given a special award for achieving the highest test score in the history of McKinley Medical School. Later, I received a certificate and plaque for being valedictorian, and Clarissa received a certificate for being salutatorian. Those awards ended the evening, and Kris and I headed home.

May 27, 1989, McKinley, Ohio

"Your turn today!" I declared when Kris and I got out of bed on Saturday morning.

"Yes, but I start school again in July."

"And when you receive your Master's degree in seven years, I'll still be a Resident!"

"Poor baby," Kris teased.

"Careful, young lady!" I said, trying to sound menacing.

"Or what? You'll throw me in bed and ravish me? Oh, darn!"

"Well, that would be punishment...for me!"

"We could stop doing it, if it's so terrible for you!"

"On second thought..."

"I thought as much!" Kris said mirthfully. "Let's take our shower."

We had our usual busy Saturday morning with band practice, grocery shopping, a trip to the bakery, and then lunch at home. After lunch, we put Rachel down for an early nap, and at 3:00pm, we were at the High School football stadium for Kris' graduation. Rachel and I sat with her parents and Lyudmila, and I thought back to my own High School graduation, when I'd finally had the courage to tell Jocelyn how I felt about her.

That had set off a sequence of events that nobody could have predicted, and our lives had been completely upended by a terrible accident that had nearly cost Jocelyn her life. So many things had happened since then, culminating with sitting in the stands watching my second wife graduate from High School.

After the graduation ceremony, we had a celebratory dinner at the Korolyovs, then went to the Cathedral for Vespers. After Vespers, Kris, Rachel, and I headed home. After we put Rachel to bed, Kris poured us each a glass of wine, and we sat together in the great room.

"To both our graduations!" she said.

"«Ваше здоровье»!" I declared. ("Cheers!")

"«Ваше здоровье»!" Kris replied.

We touched the crystal glasses, and each sipped the red wine.

"What class did you decide to take in July?"

"An English elective -- composition. Mom turned in the paperwork yesterday. They just need my final transcript."

"Did they waive the language requirement?"

"Yes, because I'm trilingual."

"I certainly appreciate your oral skills!"

Kris laughed softly, "I don't think you want me to demonstrate those at Ohio State!"

"Most decidedly not! On the other hand, there's tonight!"

"I will if you will!" Kris said mirthfully.

"You don't have to ask twice!" I replied.

May 28, 1989, Circleville, Ohio

On Sunday, Kris, Rachel, and I went to church, but left immediately following the services, taking Lyudmila with us, so we could get home to meet José, Lara, Subdeacon Mark, Alyssa, Elias, and Serafima to set up for a joint graduation party for Kris, Jocelyn, Clarissa, me, and the rest of our study group, as well as Mark and Alyssa, who were both graduating from Taft.

"It's been quite the month!" Subdeacon Mark observed as he and I set up the grill. "You, Clarissa, and Fran graduating from medical school, Robby finishing his Master's, Kris graduating from High School, and Alyssa and I both finishing our undergrad degrees."

"It has," I agreed. "And for me, the culmination of eight tumultuous years."

"I know there's more to your story from before Alyssa and I met you four years ago, but I've really only heard bits and pieces here and there."

"And depending on where you get your information, it may or may not be accurate."

"You're referring to Father Nicholas, aren't you?"

"I'd rather just leave the statement generic."

"You can tell me if I'm out of line for asking, but what happened?"

I considered my options, and the first and most important thing was that I wasn't clergy, and so was free to speak my mind, even if it contradicted something the bishop said, with the exception of specific points of dogmatic belief. I would, of course, be seen by Father Nicholas as a troublemaker, but evidence suggested he was going to see me that way no matter what I did. And I saw no point in hiding something which would be blatantly obvious when Ghost and Oksana married.

"Greg Casper, Oksana's fiancé, made a comment about being strong-armed into being chrismated, with the implication that it was absolutely necessary to be married. I explained to him that wasn't the case, and that so long as he agreed to allow any kids they have to be baptized, and wouldn't interfere with Oksana taking them to church, the priest could not object to the wedding on canonical grounds.

"I made it clear that the two people who had a say in the matter were Oksana and him -- his decision to be chrismated or not, and her decision to marry someone who wasn't chrismated. Because of that, I was called a 'troublemaker' and when I pointed out that I was following the teachings of the church and wasn't about to back down, Father Nicholas told me he was tired of my attitude. That was, as they say, the last straw.

"You most likely know, at least in a general way, all the other times he got on my case for something I did or said which was not actually problematic. Worse was when he got on my case for things I didn't say or didn't do that I was accused of saying or doing. I don't need to give you the details, but there were numerous instances, including the Nativity before last, that led me to not worship anywhere for a time, and then worship elsewhere for several months."

"Father Nicholas has not confided in me at all the way I believe he confided in you."

"And I suspect that's at least partly because we're friends, though much of the confiding was done after I became a deacon, so it's not directly comparable. How is your relationship with Bishop JOHN?"

"Fine, I guess. I mean, I don't see him nor talk to him as often as you did, but again, that was after you were made a deacon. I basically only see him when he visits or at the twice-a-year clergy meetings, of if I'm needed at the Cathedral for some reason."

"That's true for most deacons, too," I replied. "The only reason I had such close dealings with Vladyka JOHN was because of everything that had happened with Bishop ARKADY."

"Let's just say I'm glad I had nothing to do with any of that."

"I wish that had been the case for me," I said.

I lit the kindling under the coals, which I used so I didn't have to use lighter fluid, and then we went back into the house to join the others, with the number of guests eventually swelling to around fifty.

We had a nice afternoon and evening together, along with plenty of food and fellowship. Maryam and I had a chance to speak, and with a blessing from Kris, we walked to the furthest corner of the backyard to speak privately, but not out of sight of others, to maintain proper decorum.

"He's a great guy," I said. "When he asks, say 'yes'."

Maryam laughed softly, "As if I'd say 'no' to the guy I basically chose! I'm not fickle!"

"That is the last word I'd use for you," I replied. "Do you have a timeframe? I'd like to come to your wedding, if I can swing it."

"I'd guess September or October. Obviously, it has to be before Little Lent, and can't be during the Apostles' Fast or Dormition Fast. Would you drive up?"

"I think I'd fly simply because it would be a whirlwind trip where I'd arrive on Saturday and leave Sunday evening, if possible. And that would all depend on my schedule and if Kylie can take part or all of a shift. You know how tough it is during a PGY1 year."

"That's part of the problem for me, too. But I don't want to wait a whole year before..."

She left the word hanging in the air, and her eyes twinkled, make it absolutely clear to me what she was referring to.

"It is addictive!"

Maryam laughed softly, "Not when I was sixteen, but last year? Yes!"

"I wanted to be addicted at sixteen, but I couldn't find a supplier!"

Maryam laughed hard, "Cute! How are things going with Kris?"

"Very well. We have very different political views, but that has led to some very good conversations, rather than conflict."

"You appear to be very happy."

"I am," I replied. "I still miss Elizaveta, but as we discussed, I had to find a way forward, for Rachel's sake."

"And yours, Mike," Maryam said, touching my arm lightly. "It would have been too easy for you to withdraw and hide behind your cassock. As you've said, 'Monk Michael' was not outside the realm of possibilities, but that wouldn't have been good for you."

"No, it wouldn't."

"Especially for the reason given in Stripes!" she teased.

I laughed hard at the reference to a monk not being wildly fucked by teenage girls that I would never have expected from Maryam, though on second thought, in private, I should have expected it.

"Your private self is VERY different from your public self," I observed.

"As we discussed, for a very good reason," Maryam observed.

"True."

"And I haven't been a teenager for a long time!"

"And yet..." I chuckled. "But setting that aside, I'm going to miss you."

"And I'm going to miss you as well. We'll keep in touch. I let Matta know."

"And I let Kris know as well."

"I'll hug you when I leave, but I wanted to say 'goodbye' privately so I could express just how much I care for you."

"It's mutual."

"Then let's rejoin the others," Maryam suggested.

"Let's."

II. Farewells

May 28, 1989, Circleville, Ohio

"You have NO idea how badly I wanted to stick my tongue out at you at the banquet when I received my award," Clarissa declared when we stood next to each other at the snack table

"I saw the look on your face," I replied. "I can read you like a book!"

"And I can play her like a piano!" Tessa declared.

"Sassy as always!" I replied.

"High praise coming from a nut like you!" Tessa exclaimed.

"He may be a nut, but he's my nut!" Clarissa declared.

"You're lucky I share!" Kris said, coming over to the table.

"She's not interested in THAT!" Tessa teased.

"That I do NOT share!" Kris declared.

"Which works well for all involved, doesn't it?" I suggested.

"It does!" Kris declared. "At some point, the four of us need to talk."

"We do," Clarissa replied, turning serious. "But we have a few years before any decisions have to be made."

"When we come back from Tennessee and you two come back from California, we'll have you over for dinner," Kris said.

"That sounds good," Clarissa replied. "Ten days in Napa Valley is exactly what I need before I start my Residency. We'll bring you a couple of bottles of California wine."

"It's OK for cooking, but not drinking," Kris said with a silly smile.

"Funny," I chuckled, "you were drinking California white the other night."

"You're supposed to be on my side!" Kris protested.

"Good luck with THAT," Clarissa smirked. "Petrovich is going to give you more grief than he gives me, and that's saying something!"

"Who? Me?" I asked innocently.

"Yes, you!" Kris and Clarissa both said simultaneously.

"I think I'm going to go hang out with the guys," I said. "It's safer!"

All three girls laughed, and I made a point of joining Bobby, Ghost, Jason, Elias, Subdeacon Mark, Robby, Peter, Gene, Chris, and Pete.

"Be about twenty minutes early tomorrow morning," Bobby said. "I'll meet you there then and get you set up with a locker and rack, and check you out on your bunker gear and the squad."

"Mike Loucks as a fireman," Robby said, shaking his head.

"Mike Loucks is expressly prohibited from running into burning buildings!" I declared. "I have a provisional paramedic certificate based on my MD and passing the paramedic test, but I am NOT a firefighter!"

"Heck, I don't run into burning buildings," Bobby said. "That hero shit is not my gig!"

"But you would, right?" Ghost asked.

"To save someone if that was necessary?" Bobby responded. "Absolutely. That's why I had full firefighter training. But that's not my job any more than doing routine physicals is your job. That said, the rules expressly prohibit Mike from doing that. But to ride in the squad or on either truck, he has to be checked out in bunker gear. Just being near a fire can be dangerous, especially in farm country, where every fire is a potential explosion or chemical release."

"Bunker gear?" Peter asked.

"It's all the protective equipment we use," Bobby said, "including gloves, helmets, boots, trousers, and coats. Respirators aren't technically part of that, because they weren't traditionally kept in a fireman's bunk, but we generally refer to everything we wear on our person as 'bunker gear'. It's all designed to fit over our uniforms, and the uniforms are designed to be comfortable at the station, and eliminate the need for soft linings for the trousers and coats."

"Do you put them on for every response?" Peter asked.

"Paramedics usually don't. We keep our gear in the squad and put it on if we need it on site. The guys on the truck, except the engineers, all put on their turnout gear before they get on the truck. The engineers' gear is in the cab of their vehicle, and they put it on once we get to the site. We discovered it's safer for them to drive in their station uniforms than wearing all the heavy gear, especially their boots."

"How do you get water when you're out in the boonies?" Peter asked.

"Some we bring with. We have a pair of engines which carry the firefighting crew and all the equipment they need, including hoses, ladders, saws, hooks, the 'Jaws of Life', and all the respiration gear. Each engine carries a thousand gallons of water on board. After that, they draw from any available water source - a hydrant, pond, river, swimming pool, or other water source up to two hundred yards away. The county can also dispatch up to five water tenders that carry three thousand gallons of water.

"In addition to those two, we have our rescue squad, which is a combination ambulance and what you might have seen on Emergency. For a fire, MVA, or HazMat, we respond with all three vehicles; for rescue or medical emergency, we respond with two. In addition to the water, we have extinguishers on all three apparatuses."

"What if the water source is too far away?" Peter inquired.

"A water tender will drive to the water source, fill up, and return. It will deliver the water into what's called a drop tank from which the engines will draw. It's not ideal, but we do what we have to do. We can also draw from cisterns. Some of the big houses northeast of town that aren't on city water and either don't have a well or don't have a reliable well, have cisterns they fill with rainwater or have water delivered, and we can draw from those, too."

"What will you do, Mike?" Jason asked.

"Mostly observe," I replied, "but I'm allowed to do anything I could do as a medical student. That gives me one advantage over Bobby, which is that I'm able to intubate a patient. The paramedics will be trained to do that over the next two years. Me going on a ride-along is the first step in a complete rethinking of providing advanced life support, starting with EMS response. The name change - Emergency Medical Services -- finally acknowledged what paramedics do.

"We've come a long way in twenty years from 'scoop and run' ambulance service to paramedics being trained to do significant medical procedures. Eventually, we'll have trauma physicians available to respond to 'mass casualty' events. I'll be one of the first qualified to do that. They're still working out the malpractice and liability insurance problems."

"Problems?" Robby asked.

"Lawsuits," I replied. "Firefighters are indemnified against basically anything they do by state law, so long as they follow procedures or specific orders from county officials, or in the case of EMTs, from doctors. Doctors, on the other hand, are not, even if they respond to the scene of an accident. We can still be sued, and as such, the hospital has to negotiate with their insurance company for covering me when I'm outside the hospital grounds. I have some coverage if I happen upon an accident or illness, but specifically responding as part of a rescue isn't covered."

Ghost nodded and added, "If there is any topic where you'll find physicians in complete agreement, it's malpractice reform. You can't sue a firefighter for failing to rescue you, or for injuries sustained while rescuing you, but even the slightest adverse outcome can lead to a multi-million dollar settlement from a doctor or hospital, even if they weren't really at fault."

"There is," Doctor Gabriel interjected, "always a chance of adverse outcomes, no matter what we do. A perfect example is the drugs used for intubation. They are standard doses and have no significant contraindications. One person in a 100,000 will have an adverse reaction to them, and one percent of those who have a reaction will die. There is no way to know in advance, and no test we can run because intubation has to occur within ninety seconds for an airway obstruction. So we do it. And get sued if something goes wrong, even if it's beyond anyone's control."

"Has that happened?" Subdeacon Mark asked.

"Not since I've been at Moore," Doctor Gabriel replied. "We had one incident at Cook County, but it was never proved it was the intubation drugs. That said, we do have people who never come out of anesthesia, even with reversing drugs. And there's no way to know in advance. Ditto for pulmonary or cardiac arrest during anesthesia. Even testing can't tell you in advance when that will happen. Again, nobody is at fault, but we pay the price."

"So, what's the solution?" Subdeacon Mark asked.

I smiled, "My wife would say fully socialized medicine with the government paying all claims for actual injury."

"What about negligent doctors?" Elias asked.

"A different problem of a completely different character," Doctor Gabriel replied. "All of us, and I mean physicians and non-physicians, should work together to weed out negligent doctors. You don't need malpractice suits to do that, you need good oversight with a mix of physicians and regular citizens."

"And no lawyers!" Ghost added. "Shakespeare had it right!"

I shook my head, "When Shakespeare had Dick Butcher say 'The first thing we do is kill all the lawyers' he was speaking about how a tyrant establishes an autocracy. But I agree, no lawyers on any review board. And adherence to accepted best practices should be a complete and total defense to any claims of negligence or malpractice."

"What he said!" Doctor Gabriel replied. "Though Mike's idea that we currently have socialized medicine is non-conventional."

"Says the man who works for a government hospital which receives significant funding from taxes!" I countered. "Not to mention the very point of insurance of any kind is to pool funds to socialize the risk. I have State Farm for my auto and home, and it's a mutual insurance company, which means at the end of a year, any excess premiums collected over losses and operating costs are returned to the policy holders, minus any money retained for reserves."

"That's not socialism!" Subdeacon Mark protested.

"No, but it's what people here mean when they say 'socialized medicine'. Most proposals do not call for every doctor to be a government employee or for all hospitals to be publicly owned. The proposals are almost always about 'single payer' in the way Medicare and Medicaid operate -- insurance funded by premiums collected as taxes. True socialism is common ownership of the means of production. That's a VERY different thing. Volvo and Ericsson, despite being Swedish companies, are publicly traded on stock exchanges."

"When did YOU start discussing politics in a serious way?" Ghost asked, sounding surprised.

"When he married Kris!" Robby exclaimed. "She's the 'Red' in his bed!"

"She'd reject that nod to the Soviets," I said. "She and my grandfather have the exact same opinion of the USSR and the Communist Party, despite coming from basically opposite sides. He's a liberal, and she's a socialist, to put it in European terms."

Some of the guests began to leave, including Nadine, who was driving home before heading to California. I walked her to her car, where we exchanged a chaste hug.

"Thank you for everything," she said. "If you're ever in California, look me up at UCLA."

"Absolutely. I suspect you won't be coming back to Ohio anytime soon."

"If I'm going to fly for four hours, I'm going to Hawaii, which is only five hours away!"

"I hear you on that! I'll make it to Hawaii at some point, but that's probably ten years from now. As for California, after speaking with Clarissa and Tessa, Kris is interested in visiting Napa Valley, but that's what? Three hundred miles from LA?"

"Closer to four hundred, I think," Nadine replied.

"Let's keep in touch," I said. "You have my address and phone, so just call or write once you have yours. Fran, Clarissa, and I will all be in the area. I already have Peter's home address and phone number, as he plans to live with his parents for the first year. I have Maryam's apartment address and she'll get me her phone number as soon as she's in Chicago. I'll make sure you get all the information for everyone and be the one to keep up with all the addresses and phone numbers."

"Awesome. Thanks again, Mike. I hope to see you in my OR someday, but vertical, not horizontal!"

"The same for my trauma room!"

We hugged again, and she got into her car and drove away. The scenario repeated itself with Peter about ten minutes later, as he was flying home first thing in the morning.

"Thanks for being there for me for four years," I said.

"I was just about to say the same thing!" Peter replied.

"It was fortuitous that we met at the banquet and then were paired for CPR. I'm glad that happened, and I'm glad you were part of our study group."

"Again, I could say exactly the same thing. Come to Atlanta and I'll show you some real Southern hospitality!"

"It'll be at least a year, for obvious reasons. I'm going to miss you."

"I'm going to miss you as well," Peter replied.

We hugged and slapped each other's backs.

"Take care and stay in touch," I said.

"You, too."

He got into his car, which he'd agreed to sell to a Second Year, and as he drove away, Maryam came out of the house. We'd already said what we needed to say, so we hugged carefully, Maryam smiled, and kissed my cheek.

"I'll see you at your wedding, by hook or by crook," I said. "Have a safe trip."

"Enjoy your belated honeymoon!"

"We will."

Maryam got into her car, backed out of the driveway, and, with a wave, drove off. Once her car was out of sight, I went back into the house. The party wound down around 8:30pm, and several couples stayed to help us clean up. When we finished, they left, then Kris and I put Rachel to bed, and went to bed ourselves.

May 29, 1989, McKinley, Ohio

On Monday morning, even though she didn't have school, Kris had been up early with me for our usual joint shower, to say morning prayers with Rachel, and to have breakfast. I'd kissed them both, then headed to Fire Station #2, which was about two miles from Moore Memorial Hospital.

"Morning, Doc!" Bobby said with a grin when he met me in the small parking lot behind Fire Station. "Welcome to Station #2!"

"Also known as the Second People's Hospital for the Insane!" I said with a grin. "After all, only someone who was truly nuts would make a living by running into burning buildings!"

"You do realize we don't ACTUALLY do that very often, right?" a fireman said, coming over to us.

"Doctor Mike Loucks, Lieutenant Jim Greer."

"Lieutenant," I said, extending my hand.

"Doctor," he replied, shaking my extended hand. "Just call me Jim, please. Usually, only our captain is addressed with his rank."

"How many firefighters are on duty at any given time?" I asked.

"A captain, a lieutenant, two engineers, two firefighter-paramedics, and eight firefighters. There is a battalion commander, but he's responsible for three stations and only responds when multiple fire companies respond. He's based in Station #1."

"Let's get inside and get you settled," Bobby said. "A rack, a locker, and bunker gear. Did you get your steel-toed shoes?"

"UPS delivered them on Friday."

"Safety regs require you to wear those at all times, except in the shower or sleeping."

"Got it."

"Your uniforms are here, and ready for you."

We went into the station and Bobby was greeted by other firefighters, some coming on duty, some going off.

"What happens if a call comes in now? Or if the crews were on a call?"

"Until 7:00am sharp, the crew on duty would respond, and if they were out, they'd stay out until they finished the run or were relieved by another unit."

We went to the back of the station where the dormitory and showers were located, and Bobby showed me the rack and locker I'd been assigned.

"Let's get you into your turnout gear. Once I'm satisfied you know how to wear it, we'll store it in the squad with ours. Put your uniform on first."

I changed out of my 'street clothes' and put on the brand new uniform that was hanging in the locker. Once I had it on, I began to put on the bunker gear. I had reviewed my notes from the training class I had and mostly got things right. Bobby provided pointers as I put on the gear, especially about the flaps which covered the zippers on the turnout coat. Once he was satisfied I'd be able to put the gear on properly, I put on the new shoes I'd ordered. Once they were on, we took the gear to the squad and stored it behind the bench seat in the cab, along with my medical bag. Once we'd done that, he showed me where all the gear was stored in various compartments accessible from the outside, along with what was stored in the ambulance portion of the squad.

"One thing I wondered," I said, "is why you don't have the radio hookup they showed in Emergency where Doctor Bracket or Doctor Early would say 'send us a strip' to get an EKG."

"We didn't have the money LA County did when we started."

"What are your standards for defibrillating?"

"No pulse or no heartbeat. Basically, 'shock and see'. Our new ALS ambulance units will have EKG equipment, and the ability to transmit, but that's next year before they begin delivery, and Moore needs to install the new radio and telemetry equipment."

"And for compromised airways, all you can do is bag at the moment, right?"

"Yes. You brought your bag of tricks with you, right?"

"Yes. I have everything I need for intubation in my medical bag. Has your training been scheduled?"

"No. That starts in September, but they don't have individual schedules out. It's going to take some time to get eighty hours of training in."

"Not to mention the 'luck of the draw' with regard to patients needing intubation. You'll need to do six or eight before an Attending will sign off. Do you know how to read an EKG?"

"I think the correct answer is 'no', because other than what I learned in paramedic school, I have no experience."

"That'll take another chunk of time, probably ten hours to become proficient enough to know when administering a shock will work. That said, you pretty much can't hurt someone by shocking them. And CPR is always indicated, except for a suspected flail chest."

"Let's go meet the guys," he said.

"Any female firefighters? I know there is a female paramedic because I've met Julie."

"Only one female firefighter in the county so far, and she's at Station #1. Julie is at Station #3. Did you know that the first paid fire company was in Cincinnati, and was started in 1853, and while it was all men, there were women volunteers?"

"No, I didn't know that! Did you know the first Residency program in emergency medicine was at UC in 1972?"

Bobby introduced me to the other firefighters, some who I knew by sight from the hospital. I already knew Sam Collins, his partner who I saw regularly at the hospital, and who was one of the few African American members of the Fire Department.

"You know, I never asked, but what do you guys do when you aren't on a run?"

"Depends on the time and the person. Some guys play chess, some play bridge, some read, and some watch TV or tapes. We also have a ping-pong table, free weights, and a treadmill."

"How do you handle meals?"

"Each shift is responsible for their own food. In the galley you'll see cabinets labeled by shift, and we make a grocery run when we need to restock."

"How does that work?"

"Usually an engine crew goes to Kroger. The engineer stays in the truck and the four firefighters and the officer go into the store and do the shopping. If there's a call, the guys in the store are called by walkie-talkie and basically drop everything and respond from there."

"Come to think of it, I've seen that on occasion at Kroger. What now?"

"Relax and wait for the call, exactly as you do in the ER! The only difference is you're coming with us, instead of us coming to you."

"OK. I brought medical journals, so at least for this morning, I'll read. What's the scoop on sleeping?"

"Quiet hours are from 10:00pm to 6:00am, so it's up to you. Did you bring an eye mask?"

"I did. I'm used to sleeping when other people are moving around. I bet it's actually quieter here than in the on-call room at the hospital."

"The guys are pretty good about keeping quiet. Use any of the recliners, couches, or chairs. There aren't any assigned spots except for wherever Brigid decides she wants to sit. You move if she wants the recliner or spot on the couch."

"Does she go on runs?"

"Usually with Lieutenant Greer on the second engine."

"I meant to ask before, but why respond with an engine and the squad for purely medical calls?"

"We learned when we first started that having two extra guys is necessary in moving some patients out of second or third floors, and sometimes we have to remove doors. Having an engine crew along allows us to focus on the victim while the other guys deal with any obstacles, or assist in getting someone out of difficult spots. Think about some of the narrow staircases and how well a stretcher would work. In those cases, we'll use a ladder and take someone out a window in a Stokes basket."

"So Emergency wasn't fiction?"

"It was pretty accurate in most cases. Did you know that engineer Mike Stoker was actually an active LA County Firefighter at Station #69 in Topanga Canyon?"

"No, I didn't."

"Basically, they needed someone who could drive and operate an engine and other apparatus and he held a Screen Actors Guild card. The dispatcher for the series, who you mostly heard over the radio, was LA County Dispatcher Samuel Lanier, and the captain in the first season was LA County Fire Captain Richard 'Dick' Hammer."

"You seem to have had more luck with doctors than Johnny did with nurses!" I chuckled. "How was she this morning?"

"Cranky! But I think that's as much not being able to work as it is Bobby Junior being stubborn."

"I was hoping he'd be born before Kris, Rachel, and I leave on vacation."

"I think Lor is as well!"

A klaxon sounded, followed by a loudspeaker call.

"Station 2; structure fire; County Route 25-A at Ferry Market Road."

Some other details were given in jargon I didn't comprehend, and it certainly wasn't time to ask.

"That's us!" he declared, and I followed him towards the squad while Lieutenant Greer acknowledged the dispatcher.

I chuckled to myself that the only thing missing from his radio acknowledgment was 'KMG-365'. We were first out of the station, as we didn't need to put on bunker gear. I had a general idea of where we were headed, and if memory served, it was a farm, which meant it could be a house, barn, or, more dangerously, a silo. It would, at the speed we were moving, take about eight to ten minutes to get there.

"What's the drill when we arrive?" I asked Sam, who was sitting to my right on the bench seat.

"Assess and treat any victims and wait for the engines for anything else. If there's a need for immediate rescue, we'll gear up and go in; you stay by the squad until we come out or you're directed to do something by the Captain or Lieutenant."

"Got it."

"The only exception," Bobby said as he slowed for an unguarded railroad crossing, "is a simple kitchen fire, where we can use extinguishers. But it's usually too late for that by the time we arrive when we respond to the boonies."

"You have to figure," Sam continued, "that by the time someone calls it in, we're dispatched, and arrive for one of these remote runs, it's twenty minutes. At that point, either the fire is out or fully involved. Old barns and farmhouses go like kindling. Remember, keep your helmet on at all times, even if you aren't wearing the rest of your gear."

"Got it."

As we turned west, I could clearly see smoke rising, and when we reached the crossroads, I saw, true to Sam's prediction, a barn that was fully involved. We stopped about fifty yards away, I grabbed my helmet and medical bag and followed SAm out the right-hand side of the squad.

"Where's the fire engine?" a man of about sixty asked.

"About a minute behind us," Bobby replied. "Anyone in the barn?"

"No, and we got the cows and horses out."

"Anyone hurt?"

"Don't think so. None of my hands were in the barn, and my wife and I got the animals out into the pasture."

The two engines pulled up behind us and the crews set to work. Fortunately, there was a large pond next to the barn that appeared to be fed by a well to draw extra water from. Hoses were deployed and water was directed onto the barn, which I was positive was a total loss. Twenty minutes later, there was no longer any black smoke and fifteen minutes after that, Captain Brinker declared the fire out. He sent one engine back to the station while the other crew checked for any hot spots using axes and hooks.

"Squad 2, County Dispatch! Squad 2, County Dispatch!" the radio chirped.

"Squad 2!" Sam answered.

"MVA; County Road 25-A and Thompson Road; Engine 22 responding with you, ETA eight minutes."

Engine 22 was the second engine, which the captain had ordered back to the station, keeping Engine 21 at the scene of the fire.

Sam acknowledge the radio call and, then said "Let's go! That's about two miles from here."

We clambered back into the squad and five minutes later climbed out at the scene of a single-car accident with the car upside down in a drainage ditch. A Sheriff's cruiser was blocking the road, and we pulled up behind it.

"Two victims; no fire!" the Deputy called out.

"Mike, stay by the squad!" Bobby ordered as he and Sam jumped out and ran over to the vehicle.

I put on my helmet and stood next to the squad while they went over to the car.

"Gear up!" Bobby called back. "We're going to need cervical collars and IVs right away."

I got into my gear, grabbed my medical bag, and then followed Bobby and Sam back to the overturned late 60s Ford LTD. I watched as they quickly assessed the patients, inserted IVs, and cervical collars. The engine pulled up just then and the four firefighters and Lieutenant Greer hopped out and came over to us, while the engineer, Carl Voline, stood by the engine.

"Mike, move back," Lieutenant Greer ordered. "We'll get 'em out for you."

I moved about ten feet away, and Bobby and Sam joined me while the firemen assessed the vehicle. I saw Bobby and Sam removing their gear, so I followed suit. The firefighters pried open the driver's door with a crowbar, but couldn't get the passenger door open, so they extracted both victims via the driver's door.

Bobby, Sam, and I went to check on the victims and neither of them had compromised airways, so I simply observed while the paramedics assessed them. The firefighters brought the two transport gurneys from the squad and carefully transferred the victims, one conscious and one unconscious, to them, then rushed them into the back of the squad.

"With me, Mike!" Sam called out.

I followed him into the back with the patients while Bobby got into the cab. One of the firemen shut the door behind us and pounded on it three times to signal to Bobby to go.

"Assess the patient by you, Mike."

I connected the PulseOx sensor to the teenage male and turned on the monitor, then auscultated the patient's chest and abdomen. He clearly needed oxygen, so I hooked up a mask and set the flow to five liters per minute, then checked his BP. The patient had an obvious broken arm, as well as a serious contusion to his temple, likely responsible for his lack of consciousness, but his belly wasn't rigid and his ribs did not appear to be broken. I got my penlight from my bag and checked his pupils and the right one was blown and the left one sluggish.

"How are your patient's pupils?" I asked.

"Sluggish, major contusion to the chest from the steering wheel. No other apparent injuries. Yours?"

"GCS 6; one pupil blown, the other sluggish. Bobby?" I called out.

"Yeah?"

"Call in and ask for neuro to be standing by."

"Got it!"

He made the radio call and about three minutes later, we pulled into the hospital driveway.

"How do we report vitals?" I asked Sam.

"You and I will do it, otherwise I'd give Bobby the most critical patient bullet."

"Mine goes first," I said.

"You got it, Doc!"

A few seconds later, the squad stopped, Bobby jumped out and hurried to the back of the squad to open the door. I disconnected the PulseOx monitor and Bobby and I got my patient out first.

"Late teen male," I called out. "MVA restrained by lap belt; severe contusion and laceration to the right temple; GCS 6; right pupil blown, left sluggish; BP 80 palp; tachy at 110; PO₂ 93% on five liters; IV saline TKO."

"Trauma 1!" Doctor Gabriel replied. "Neuro consult is waiting for us."

He, Felicity, Jamie, and I rushed the patient into the trauma room and I was about to begin hooking up monitors.

"Mike," Bobby said, "You're a paramedic today. Get the oxygen bottle and we're out of here."

I nodded, and as soon as Jamie had the hospital oxygen hooked up, I grabbed the portable bottle and we left the trauma room.

"Sorry," I said.

"Don't be," Bobby replied. "Those trauma rooms are your natural element, and I expect you to go on autopilot."

"If you need the john, use it now in case we get a call on our way back to the station," Bobby advised.

I took his advice and started to go to the locker room, but realized I wasn't acting as doctor or medical student, so I used the public restroom. When I came out the door, I nearly ran into Ellie.

"I see you decided to join the Fire Department instead of being a doctor?" she teased. "Good!"

"That sounds like sour grapes!" I chuckled. "Can't have it, so I don't want it, and I want it out of my sight?"

"Oh, I want it alright!" she said sexily. "But I know better."

I smiled and nodded, then found Bobby and we headed back to the squad where we met Sam. The three of us got into the cab and headed back to the fire station.

"How long do you usually stay on site for a fire?" I asked.

"Until we're released by the officer in command of the site," Bobby replied. "At that point, we're released for dispatch."

"Out of curiosity, what were you expressly told about what I can and can't do?"

"You're officially an observer unless Sam or I expressly assign you a task, and we're only supposed to do that if we're shorthanded, or like today when we have two patients in the squad."

Which was what I had expected to be the case. That meant barring a mass-casualty event or a need for intubation, I was going to be doing a lot of standing around watching, which was not all that different from my Preceptorships. What I was doing really was just observation, and the real involvement would come in training the paramedics to do additional procedures.

"I figured that was the case," I replied. "The main rationale is for me to get used to Fire Department procedures so I can train you guys to do intubations, hook up EKGs, and perform other procedures when that program starts in the fall."

"That's basically what Captain Brinker said to us," Bobby confirmed.

"I'm curious why you guys didn't try to pry open the doors of the car."

"We do have pry bars and other light equipment in the squad, but by the time he had the cervical collars on and the IVs in, the engine was only about two minutes away. If the car had been on fire, we'd have done the extraction. Otherwise, unless we need to perform immediate CPR, we wait for the firefighters."

"That delay could be sufficient for a victim to die," I countered.

"It's a balancing act," Sam interjected. "We do risk our lives, but it's always a calculated risk. In this case, with that ancient LTD, prying open the door gave complete access. But with a compact car we'd likely have had to cut away parts of the frame to extract the victims, and we simply don't have those tools."

"That makes sense," I replied. "I'm just thinking about the Golden Hour and how much of it elapsed while we were on the scene before we transported the victims."

"I hear you," Sam replied. "But even in the city, it's probably about thirty minutes from the call to the dispatch center until the responding unit arrives at the door of the ambulance bay. You figure six minutes transit time, roughly, each way, so twelve minutes is gone right there. Then assessment, initial treatment, and loading into the squad are at least five minutes, often closer to ten. That's a third of the Golden Hour right there, in perfect conditions. I'm not sure there's much we can reasonably do to speed things up."

"Being able to do more procedures on arrival is the key," I replied. "But some things, like clot-busting drugs, are risky, even in the ED."

"Incremental progress," Bobby said. "You made the point that just over a decade ago, it was still 'scoop and run' ambulance service. Soon we'll add intubation to our repertoire, but the biggest problem, and one for which there isn't a solution beyond saline IV, is blood loss."

"That's a tough problem to solve given the requirements for storing blood and blood products like plasma. I haven't seen any articles on pre-hospital transfusions, but I know the military used them successfully in Korea and Vietnam in aid stations. What do you carry in your drug box?"

"Atropine, albuterol, epinephrine, insulin, morphine, naloxone, and nitroglycerin. We also carry Tylenol, aspirin, and of course saline and lactated Ringer's. We'll add a few drugs when we convert to ALS units, but I'm not sure what those will be."

"I'd speculate at least lidocaine as an anti-arrhythmic plus succinylcholine and etomidate for intubation. Those are the obvious ones. Maybe something like Haldol or midazolam. I'll look into it, actually, because we'll need to know to properly train you guys."

We arrived back at the station and had five more runs before quiet time began, none of which were exciting -- two MIs, two MVAs, and a broken limb. I observed on all of them, as without a proper EKG or drugs, there really wasn't anything I could contribute, and Bobby and Sam knew their job. I quietly said abbreviated evening prayers, put on my mask, and turned in for the night just after 11:00pm.

May 30, 1989, McKinley, Ohio

We had one overnight run, just after 2:00am, for an elderly man who had fallen down the stairs at home and had broken his hip. I managed about six hours' sleep, which was more than I'd get in the hospital. At 7:00am, I left the station and headed home.

"Morning!" Kris exclaimed when I walked in, coming to greet me with a kiss.

"Dada!" Rachel exclaimed, toddling over for her own hug and kiss.

"Breakfast in about fifteen minutes," Kris said.

"OK. I'm going to take a quick shower and put on shorts and a t-shirt."

I did that and was back downstairs in ten minutes.

"How was it?" Kris asked.

"Interesting, as far as it goes. I'm an observer, with the main point being to understand how the guys work and what they encounter, so I'm equipped to train them in the Fall."

"Did you get any sleep?"

"About six hours total. We had a run just after 2:00am and were back at the station about 3:15am. I don't plan to nap or anything today."

"OK. I planned to take Rachel to the park. We'll meet Abigail and her nanny there."

"That sounds like a great plan! Mind if I tag along?"

"Of course not!"

Breakfast was ready a few minutes later, and after we ate, we cleaned up, then said morning prayers. At 9:45am we left for the park, where Rachel and Abigail had a great time playing together for an hour, then we returned home for lunch, and after that, we had a lazy day at home.

III. Field Work

May 31, 1989, Columbus, Ohio

On Tuesday, I joined Bishop JOHN for lunch at the Cathedral at his request.

"Thank you for joining me for lunch," he said after I received his blessing.

"It's my pleasure, Vladyka."

We sat down in the comfortable wingback chairs in his office, he said the prayer of blessing, and we began to eat.

"Was there a specific agenda you had in mind?" I asked.

"No, though I would, if you're willing, like to discuss Father Nicholas."

"I'm not sure I'm the best person to give an opinion."

"I've heard from several people, and without naming names, I'm sure you can deduce who, that they are unhappy that he, in effect, ran you out of the parish."

Viktor was almost a certainty, and it wouldn't surprise me if Subdeacon Mark had spoken with Bishop JOHN. Serafima was also a possibility, as she could no longer see her goddaughter regularly at church. It also wouldn't surprise me if Oksana had not said something given Kris was her cousin and given Doctor Casper -- Ghost -- and I were friends and colleagues.

"I think," I said carefully, "that the last four years have been so stressful for the entire diocese, and Saint Michael specifically, that it's difficult to lay blame at the feet of anyone, except perhaps the deposed Robert Langley. Everything stemmed from his behavior. I am not excusing the response of retired Bishop ARKADY, nor of anyone else, simply pointing to the origins of the problem."

There were also the unproven allegations of sexual impropriety against Bishop ARKADY, which privately I believed, but as they had not been investigated nor had they been proven, I kept that opinion completely to myself.

"You have," Kris said, "on a number of occasions, made the point that while we can't control what others do, we're responsible for our own actions."

"Me and my big mouth!" I chuckled.

"You also have a history of being reluctant to assign blame to others, even when they are clearly at fault."

"Because of my own failings," I replied. "For the most part, I'm too busy trying to remove the log from my own eye. I figure when I achieve complete theosis, and thus synergistic perfection, that's the time to worry about other's faults."

"A Christian attitude with which I cannot find fault, and yet, as episkopos, I have a duty to oversee my diocese and to care for the wellbeing of individuals, parishes, and the diocese as a whole. I appreciate your desire to, in effect, shake the dust from your shoes and move on, but I have no such luxury."

"Permission to speak freely?"

Bishop JOHN laughed softly, then said, "As if I could prevent that! I might as well tell the mountain to go cast itself into the sea!"

"My Residents and Attendings at the hospital would agree with you!"

"You are always free to speak your mind and your heart to me, Misha."

"I'm sure you're well aware of the false allegations and that I don't need to rehash them."

"I'm curious as to why you think Father Nicholas would have considered those allegations valid; if you're willing to share."

"I think the best answer to that is, that at times when I was neither betrothed, married, nor a deacon, celibacy was not my strong suit, something of which Father Nicholas, Father Herman, Father Stephen, and Father Roman are all aware."

"I surmise, then, that you confessed and received absolution for your failing in that regard, and that no transgressions of your marital or diaconal vows occurred."

"That's accurate. And it's that history, along with the whisper campaign about Rachel's caregivers, which led Father Nicholas to not give me the benefit of the doubt, so to speak. The most recent incident had to do with Doctor Greg Casper and his upcoming marriage to Oksana Ivashko.

"Had I remained a deacon and that same situation had been brought to my attention, I'd have spoken to Father Nicholas directly, or to you. But as a layman, I felt it was my place to correct a misunderstanding he had, one which, in my opinion, was created intentionally by Father Nicholas. In my mind, something I heard back in High School when studying the Spanish Inquisition..."

"Which nobody expects, right?" Bishop JOHN interrupted with a twinkle in his eye.

I couldn't help but laugh.

"Well," I replied, "I am sitting in a comfy chair!"

"Sorry to interrupt. Please continue."

"No apology necessary! That's exactly the kind of thing I would do myself! In any event, what was said was 'A man converted against his will is of the same opinion still', and I think that's exactly right. Doctor Casper is attending services regularly, and has no objections of any kind to having his children with Oksana baptized, and has many views which align with the Church.

"The problem, at its root, is he felt compelled to convert. It's my firm belief that had Father Nicholas not adamantly insisted he be chrismated, he might well have chosen to do so voluntarily before the wedding. The pressure bothered him, and, to be honest, was completely inappropriate. It would be one thing if Oksana had made that a requirement, as I did for any girl with whom I was serious; it's a different thing when the priest makes it a condition, when the canons require no such thing."

"You did have a habit of what my protestant friends would call 'missionary dating'."

"So sue me," I chuckled. "But to be honest, it worked with Angie, and if not for her illness, my life would have turned out significantly different. The same is true with regard to Kimiko, where the deciding factor for her was not a rejection of Orthodox, but of American culture, such as it is."

"I can see how, from the perspective of a young Japanese woman, our culture would be too chaotic and foreign. Some of our brethren in Russia would certainly agree."

"The elections in Poland this weekend may well be a major turning point in history," I replied. "If the Communist Party loses power, I would say that the Kremlin wall might bear the prophetic phrase 'mene mene tekel upharsin'. My grandfather certainly thinks this will be the crack in the dam, and that nothing will stop the water from bursting through. The fear, of course, is that the CPSU decides to go out with a bang, not a whimper, and the world is destroyed with fire."

"Lord have mercy that is not the case," Bishop JOHN said. "But returning to your thoughts, are you making an accusation against Father Nicholas?"

"Not formally," I replied. "But it is the case that, from what I can tell from my conversations with Doctor Casper, that Father Nicholas misrepresented the canons and teachings of the Church, if not directly, then by omission. But in the end, the problem was not a disagreement about the approach, or even about the canons, but when he said, and I quote, 'this attitude of yours is very tiring'."

"Said in response to what statement?"

"He asked, after I answered his question about Doctor Casper deciding not to be chrismated before his crowning, why it appeared I was bent on causing trouble."

"I responded in my usual fashion, and concluded with a statement that if my behavior was such a problem, Kris, Rachel, and I would worship at the Cathedral in the future. He said I was being overly dramatic, and I replied that he was being overly critical, as he had been for years. That's when he made the 'very tiring attitude' comment. At that point, I said we were going to transfer our membership."

"By 'usual fashion', I'm going to guess a reference to the canons and the Scriptures?'

"I'd covered the canons before, when I'd raised Doctor Casper's concerns. As for the Scriptures, I pointed out that the established clergy of the day called Jesus a troublemaker and that the secular governments called Saint John Chrysostom a troublemaker. I also mentioned Socrates for good measure. I made it clear I wouldn't apologize for speaking the truth, and that's when I said we'd worship at the Cathedral and the conversation proceeded as described."

"You are not afraid to speak truth to power, which is a positive trait, so long as it's done in love. Was their animosity in your heart when you spoke to Father Nicholas?"

"Probably some," I replied. "I planned to discuss that in detail with Father Roman when I see him on the 24th."

"Good. Then I'll leave that in his capable hands. Do you think Father Nicholas is a good pastor?"

"Generally speaking, yes," I replied. "My one objection was him not quashing the rumors, backbiting, and whisper campaign, which required you to step in."

"Yes, and confidentially, I addressed that privately with Father Nicholas. Do you think he should remain as pastor of Saint Michael?"

"I have two responses, first, that's a decision that is WAY above my pay grade! Second, our tradition is that priests serve the same parish for their entire career, if possible."

"A careful answer, as usual. In your mind, what would be sufficient cause to break with that tradition?"

"If the needs of the diocese were such that the priest's unique skills could be put to better use, or, more rarely, if conditions in a parish necessitated a reassignment. What happened at Holy Transfiguration rose to that level."

"But not Saint Michael?"

"Honestly, I believe more harm than good would be done by transferring Father Nicholas, if that's what you're considering. I am a unique, difficult case, perhaps impossible for a parish priest to manage. Possibly for a bishop as well."

Bishop JOHN laughed heartily, "You are not even close to the most difficult! And that is NOT an invitation to try!"

"Darn," I said flatly.

"In all seriousness, Misha, a parish full of outspoken individuals who promoted love, joy, peace, patience, kindness, goodness, gentleness, and self-control would be far preferable to a quiet parish which did not exemplify Christian morals and ethics. Nobody, even those who might object to your methods, could level an accusation against you for not living your life as a Christian should."

"And yet, I'm a sinner."

"What's the saying?" Bishop JOHN asked with a smile. "Join the club? Not to excuse your sin, but you know as well as I do that the Christian life is not an easy one, and we all miss the mark. The joy of our faith is that God loves us and is there to give us a hand up when we stumble every single time, no matter how often we make a misstep."

I nodded, "Something for which I am eternally grateful. Are you considering moving Father Nicholas?"

"On that, I have to keep my own counsel, though you're a wise man, Misha."

"If I may offer advice..."

"Of course."

"See how things are over the next year with the thorn removed from Father Nicholas' side."

"And instead in Father Luke's?" Bishop JOHN asked mirthfully.

"Because I'm not involved in teaching, almsgiving, serving at the altar, or on the council, I doubt there will be any concerns. I say that as the Dimitrijevics have greeted me cordially, and if anyone has a right to complain, it would be them."

"If I understand correctly, it was Danijela's decision not to move forward."

"It's complicated," I replied. "We had agreed on a decision after the one-year memorial of Elizaveta's repose, and Danijela pushed me to decide before then, mainly because I was still seeing Danika Kurian. It's my belief that either Danijela's grandmother, or mine, pushed her to 'close the deal', as it were, and when I demurred, she broke things off. I did speak to Danijela before I had my second date with Kris, and Danijela rejected my overtures, which I felt left me free to continue with Kris."

"Quite a few words to say 'yes'," Bishop JOHN replied with a smile.

"I know," I replied. "But you also know I'm reluctant to place blame solely on anyone else when I've been involved in the matter."

"Something I wish more people would do."

"I typically have a forest in my eye compared to other's splinters."

"A proper attitude, but one which can be taken too far. Should I, never, as a sinful man, correct a member of my flock who strays?"

"Far be it from me to teach theology to a bishop..."

"So, you're changing then?" Bishop JOHN asked with a sly smile, interrupting me.

I laughed, "OK, so I do have a history of doing that! It's not about being sinless, but about being cognizant of one's own sins, and not holding others to a higher standard than the one to which we hold ourselves."

"Quite so. I know your availability is extremely limited over the next year, but would you have time to be involved in the Orthodox Prison Ministry project?"

That made me suspect Subdeacon Mark had been one of the individuals to speak to Vladyka JOHN, though he and I had discussed the topic back in April.

"I believe back in April you said I should take two years before I became involved in anything like that."

"The topic arose recently," he replied, confirming my thought.

"I intend to visit Frank Bush, if he'll see me, sometime after I return from Tennessee."

"If you're willing, I could commission you as a lay chaplain, which would give you more access. No pressure, and if you say 'no', I'll completely understand. I wouldn't make the commission public, though I would need to inform the Metropolitan. It would also let you, if you chose, serve as a chaplain at the hospital."

"That I cannot do," I replied. "The roles are completely separate for a reason, and need to stay that way. I can minister, when appropriate, but being a chaplain at the hospital would interfere with my role as a trauma physician. The division of labor is a critical component of how the hospital functions."

"Ah, OK. It was only a thought."

"Let me confer with Kris," I replied, "but I'm inclined to accept a commission expressly for prison ministry."

"Good. I take it all is well between Kris and you and Kris and Rachel?"

"Other than my wife being a card-carrying socialist, yes!"

Bishop JOHN laughed, "So, divergent politics aside, there are no concerns?"

"None. Our plan is to have a brother or sister for Rachel in June or July of next year."

"God willing, I look forward to that! Children are a blessing for their parents and for the Church."

"I question that when my little tsarina gets her back up about something!"

"What would you have said in the past? That she's a Russian woman?"

"Oh, that she is! She takes after her mother; both, actually. Though my Franco-Russian wife has a different way of applying her Russianness."

"She's a wonderful young woman."

"She is, and I'm fortunate to be her partner. Or, as she put it, when discussing the difference between Doctor Casper and me, he needed a devoted, loving wife to greet him when he arrives home and I need a partner in crime!"

"She's not wrong!" Bishop JOHN said mirthfully.

"This kind of abuse I can get from Clarissa!" I chuckled. "And soon enough from my daughter!"

"And if them, why not your bishop?"

"I'm not even going to try to answer that!"

"What? Michael Loucks lost for words? Now I can die happy, having seen everything!"

I laughed hard, "This is a side of you I haven't seen before."

"You know the reason why, of course."

I sighed, "Because certain people would get their noses out of joint, similar to how they did with me with regard to Rachel's caregivers and my close female friends."

"It's our cross to bear, Misha. But with you I can, as they used to say, let my hair down."

"It's longer than mine! As is your beard!"

"In all seriousness, you need to trim yours for your masks, right?"

"It helps, but I could let it grow out further. It's only in surgery that I wear a special mask with a beard pocket. In the Emergency Department that's not necessary, and we don't generally mask because it's not a sterile environment in the first place, the way an Operating Room is."

"What about your surgical cap?"

"I wear one designed for women with long hair, but they're all the same color and basic design, so it's not something that makes me stand out. Once I finish my first year of surgical Residency, I can choose my own design. That said, we mostly don't wear surgical caps in trauma."

"What color do you wear?"

"Light blue in the Emergency Department. After my second year, when I start my surgical rotation, I'll wear red to distinguish me from the other doctors in the Emergency Department. Attending surgeons usually wear Dark Blue, but Doctor Cutter wants to distinguish trauma surgeons."

"Doctor Cutter? A surgeon?"

"Not just a surgeon, but the Chief of Surgery! A perfect name! It would be like the Navy having a Doctor McCoy as a ship's physician or a ship's captain named Kirk!"

"Unfortunately, our time is almost up," Vladyka said. "I have a 1:00pm meeting that I simply cannot delay. Please let me know if you'll accept the commission, and I'll send you a proclamation as well as inform the Ohio Bureau of Prisons and the Hayes County Sheriff."

"I'll let you know before I leave for Tennessee."

"Excellent."

We finished our lunch, I received his blessing, then headed home.

May 31, 1989, Circleville, Ohio

"This isn't a backhanded attempt to lure you into accepting ordination, is it?" Kris asked after I explained the bishop's offer.

"No. It's actually neutral in that regard, but after today's meeting, I would wager that Vladyka will elect not to offer to ordain me in three years."

"Why is that?"

"I saw a very different side of him today, one he cannot show anyone who is clergy, and possibly not even his brother bishops."

"How so?"

"What I'm about to say is not something that can be shared with anyone."

"OK," Kris agreed.

"Vladyka treated me like a friend," I replied. "Joking, teasing, and generally being irreverent without being ungodly."

"And that makes you certain he won't ask?"

"Certain? No. Reasonably confident? Yes. Even as close as he and I were when I was a deacon, he was never this way with me. There is a protocol for such conversations, and this is the first one that didn't even come close to following the protocol. If you think about it, who can the bishop have as a true friend? With his brother bishops, he has to follow protocol; the same is true of his behavior when he's with his clergy. And most of the laity would never be willing, or possibly even able, to see His Grace as a man."

"But you, the most spiritual person I know, can?" Kris inquired.

"Actually, that's part of why I can," I replied. "Along with knowing the canons and traditions, I also understand the theology. It also helps that I have an understanding of my own sinful nature, and that is my primary focus."

"I'm sure Rachel will appreciate that when she's a teenager!" Kris teased.

"I may revise my views at that point!" I chuckled.

"I doubt you would do that."

"Of course not," I replied. "We'll teach her the ideal, and do our best to help her make wise choices, but in the end, she has to make her own decisions, just as you and I did, and we'll love her unreservedly. And the same is true for the kids we have in the future. In any event, back to the original question -- do you have any objection to me accepting a commission as a lay chaplain?"

"No. I think it's something you'll be very good at, and I know it's important to you to find a way to serve the Church."

"Then I'll inform him tomorrow. That will help when I try to see Frank Bush after our vacation."

"How do you think that will go?"

"Badly, but I have to try."

June 1, 1989, McKinley, Ohio

On Thursday, the first two hours at the fire station were quiet, but just after 9:00am the station was called to a house fire which required a rescue, with three victims brought out suffering from smoke inhalation.

"Mike, I think this one might have a compromised airway," Rob, one of the firefighters, said carefully setting down an unconscious young girl in front of me. "Soot around her mouth and nose."

I put an oxygen mask on her and turned the flow to maximum, which was ten liters, then quickly auscultated to her lungs. She was moving very little air, so I opened my medical bag and took out my equipment to intubate. I moved so I was in the correct spot, then tilted her head. I saw a lot of mucous.

"Bobby," I called out, "do you have suction?"

"No. It's not something we carry on the rig."

I replaced the mask and quickly considered my options. I had an idea and went to the supply box, got an irrigation syringe as well as an IV tube. Connecting the tube to the hypo was a challenged, but I solved that with a hemostat from my bag. My makeshift suction device worked well enough to clear some of the mucous, which allowed me to visualize the vocal cords and pass the endotracheal tube properly. I connected an Ambu-bag to the tube and held it with one hand while I held the diaphragm of my stethoscope to the young girl's chest. I squeezed the bag a few times and had good breath sounds. Given she had only minor burns and no other obvious injuries, I simply bagged her until Sam was finished assessing his patient, a young boy.

"Bag her while I finish my assessment, please," I requested.

I did that and quickly confirmed that her only immediate problem was smoke inhalation, which bagging would help improve. I connected a PulseOx monitor to her finger and saw that her PO₂ was 88%. A minute later it was 92%, which meant she was in relatively good shape, though she might have lung damage.

"She goes first," I said. "And right away."

"OK," Sam said. "Let's load her and go. The other two are conscious and breathing OK with only minor burns. We'll have the Sheriff bring them in."

We got the girl, who I guess was about thirteen or fourteen, onto the gurney, and loaded her into the squad. Bobby hopped into the front seat, I got into the back, Sam closed the doors, then pounded on them, signaling Bobby to go. As we pulled away, I continued bagging.

"Neat trick with the suction," Bobby called back. "I'll have to remember that."

"Hopefully, your new ALS units will have suction in the kit. Actually, do you have an equipment list?"

"We don't, but somebody in the department has to because the orders were placed at the end of last year."

"Could you get me a copy? It would help with planning your training for later this year if I knew what equipment you'll have."

"I'll speak to Captain Brinker and see what I can do."

I began giving him the vitals, and four minutes later we were at the hospital.

"Approximately fourteen-year-old girl," Bobby called out. "Unconscious at the scene of a structure fire; smoke inhalation with soot in her nose and mouth; intubated; PO₂ 94% with bagging; pulse tachy at 110; BP 130/80; first-degree burns on both arms. Two more with first-degree burns but conscious coming in by Sheriff's cruiser."

We unloaded the girl from the squad and I continued bagging as we moved to Trauma 2.

"Trauma 2!" Doctor Casper said. "You did this, Mike?"

"Yes. I had to rig up suction with an irrigation syringe, an IV tube, and a hemostat to clear mucus to visualize the cords, but then the tube went right in, and I had good bilateral breath sounds. Her PO₂ came up from 88% to 92% bagging and improved from there during transport."

"Excellent work, Doctor!"

"Thanks."

As was the case with every transport, once we were in the trauma room, the doctors, nurses, and medical students took over, and Bobby and I left, meeting Sam who had come in with the Sheriff and the two other victims in the corridor. Once they were both in the capable hands of the medical staff, we paramedics headed back to the station.

"How'd you come up with that idea?" Sam asked.

"In autopsy, when Doctor McKnight wanted to draw fluid from a body cavity, he used a device that is basically like what I put together. The difference is the tube is fitted to the syringe with a proper collar with a screw. The hemostat did the trick, and while I couldn't get a lot of suction, I got enough to allow me to visualize the girl's vocal cords so I could pass the endotracheal tube."

"Would she have made it to the hospital if you hadn't done what you did?"

"I'd say she probably would've, if you'd put her on hi-flow O₂ and transported her right away. Her PO₂ was low, but not dangerously low. In Denver, normal PO₂ would be around 92%, so she wasn't that much lower. There was no cyanosis, which is the key. If her lips or under her fingernails had been blue, that would be a different story. Another four or five points would make it dangerous, or if she was cyanotic from carbon monoxide, toxic fumes, or lung damage. The fact that her PO₂ came up with bagging indicates no serious lung damage. She'll cough up a lot of mucous over the next few days, but after that, she should be OK."

"Losing kids is the toughest," Bobby said.

"I agree," I replied.

"Squad 2, County Dispatch!" the radio squawked.

Sam answered, "Squad 2."

"Respond with Station #3, MVA, Route 50, mile marker 111."

"Squad 2, responding; ETA seven minutes."

"Lord have mercy," I said quietly.

"What?" Bobby asked.

"Jocelyn nearly died eight years ago on that stretch of Route 50."

"Who's that?" Sam asked.

"A close friend from the time I was in kindergarten. An elderly man had a stroke, crossed the center line, and hit her head-on. She was choppered direct to OSU."

"I remember you telling me about that," Bobby said.

"How is she?" Sam asked.

"Married, and she graduated from law school last Friday. She starts her job on Monday, and she and her husband will adopt a baby as soon as one is available."

"She's a really smart woman," Bobby said. "I spoke to her last Sunday. Her husband seems like a good guy."

"He is," I confirmed.

We arrived at the scene after Station #3 and three Sheriff's cruisers. The paramedics from Squad 3 were working on two victims and the firefighters were working to extract at least one other victim from a crushed Ford Escort that had collided with a minivan, which I couldn't identify.

"Is that the Doc?" Ralph, one of the paramedics, called out when I jumped out of our squad.

"Yes," Bobby replied loudly.

"You guys take the ones still in the Ford. Doc, come here!"

I hurried over and knelt down next to the patient.

"Male, mid-30s; unconscious restrained passenger; extracted about a minute ago; cervical collar and backboard; obvious tib/fib and forearm fractures; trouble breathing and difficult to bag; pulse thready, BP 80 palp."

I quickly auscultated the patient and was positive he had a tension pneumothorax and possibly a cardiac tamponade from broken ribs. The problem was, I couldn't put in a chest tube in the field and I couldn't do a pericardiocentesis as I'd only seen them done, never performed one.

"Get him into the squad and let's go. I can't do a chest tube or pericardiocentesis in the field. I'll ride with you and do a complete evaluation so the docs can do an immediate pericardiocentesis. We need someone with us to bag."

"John?!" Ralph called. "Let's load 'em and go!"

With assistance from two firefighters, we got the victims onto gurneys and into the squad. I hopped in and sat on the bench on the side with the patient, along with one of the firefighters from Station #3.

"Just bag as best you can," I instructed as I began my exam.

About two minutes after we pulled away, the patient's PO₂ had dropped to 85% and I detected cyanosis, which greatly concerned me.

"Ralph? ETA?"

"About four minutes, Doc!"

"I don't know that this guy has four minutes."

I felt the squad accelerate, but that wasn't going to cut more than a few seconds off the transit time. I could buy him some time with a needle decompression, but I didn't have the appropriate kit with me. I could improvise, though, as I'd read about how it had been done before specific needle-catheter systems had been developed.

"John, I'm going to try a needle decompression," I said.

"You're the doc, Doc!"

"I need a 12-gauge needle," I said.

"In the compartment to your left."

I opened the compartment and found the needle with the pale blue Luer taper, screwed it onto a syringe, removed the plunger, located the second intercostal space, and carefully pressed the needle into the patient's chest.

"Easier to bag," the firefighter announced

The victim's PO₂ reading came up to 89%. I listened and heard breath sounds on both sides of the patient's chest, and his pulse grew stronger. My solution was temporary at best, but it would ensure the patient at least made it to the hospital. By the time we reached Moore Memorial, the PO₂ reading was 91%.

When we stopped, Ralph hopped out of the cab and called out, "The Doc has the bullet!"

He opened the door, and I jumped out, giving the vitals as we moved the gurney out of the squad.

"Male, mid-30s; unconscious restrained passenger; cervical collar and backboard; tib/fib and forearm fractures; tension pneumo due to fractured ribs; emergency needle decompression performed after cyanosis was observed; pulse tachy at 110; BP 100/60."

"Trauma 3!" Doctor Nielson ordered. "Is that a syringe in his chest?"

"I didn't have a proper chest needle and catheter," I replied as we moved the patient into the hospital with the firefighter continuing to bag. "That was a technique described in JEM."

Doctor Nielson gave orders and, as was protocol, I left the trauma room with the firefighter and John.

"Great save, Doc," John said.

"That's on the list of procedures we'll teach you during your ALS certification. How do I get back?"

"2 is on their way here with the final victim," Ralph said, coming out of Trauma 2.

They left, and I went to the nurses' station to wait for Bobby and Sam. They arrived about four minutes later with the victim who'd been extracted from the Ford Escort by the firefighters, and who was obviously in bad shape as Sam was on the gurney doing chest compressions, and Rick, a firefighter, was bagging.

"That was probably futile," Bobby said when he, Sam, and Rick came out of the trauma room a minute later. "Arrested two minutes out. Major head trauma, plus both legs broken, one compound. The impact was on both driver's sides, obviously high speed, and the minivan driver had an airbag. How was your guy?"

"Tension pneumothorax, I resolved with a needle decompression."

"Good thing you were along. Let's head back to the station."

"Bobby!" Ellie called out. "Your wife just came into OB!"

"Sam, put us out of service for fifteen minutes while I check on Lor."

"Will do!"

"Mind if I tag along?" I asked Bobby.

"Not at all."

Sam made the radio call while I followed Bobby to the elevator that took us up to OB. We stopped at the nurses' station to find out which room Doctor Gibbs was in, then quickly walked there.

"I'm here to deliver your baby!" I announced when we walked in.

"Oh, HELL NO!" Doctor Gibbs replied.

"OK, maybe not," I chuckled as Bobby went over to kiss her.

"How are you, Lor?" he asked.

"Eight minutes apart, but my water broke, so I came in."

"Hi, Loretta," Doctor Alice Carmichael said, coming into the room. "Candace is aware and she'll be over in about an hour, and asked me to manage your delivery. OK with you?"

"So long as you keep the PGY1 in the paramedic getup there the hell away from me!"

"Hi, Mike," Doctor Carmichael said. "What's with the uniform?"

"Paramedic ride-alongs," I replied.

"I need to do an exam," Doctor Carmichael said.

"I'll step out," I announced, and went out into the corridor.

Five minutes later, Bobby came out into the corridor.

"Let's go. I'll come back when relief comes in. Shouldn't be a problem, as Doctor Carmichael thinks four to six hours most likely. Why'd you step out?"

"Because your wife is my mentor," I replied. "And I believe she'd prefer I wasn't in the room."

"You're a doctor!" Bobby protested.

"And yet, we only treat family in extremis and are very careful about treating friends. If you ask your wife, she'll agree with me. Anyway, how does this work for you?"

"Normally, I'd have to trade shifts, but cases like this, I can call the Chief's office and they'll find someone to cover the remainder of this shift."

"You know what I just realized?" I asked. "That you guys have it even worse than I do with regard to knowing what happened with a patient. I usually know if they're going to make it or not by the time we're done in the ED, but you guys drop them off and levae."

"Every once in a while someone stops by the station to thank us for a rescue, but otherwise, you're right -- we mostly don't know. Like you, we're just cogs in the healthcare machine!"

I chuckled, "It does seem like that at times!"

We met Sam in the ED, then headed back to the station where Bobby informed Captain Brinker that Doctor Gibbs was in labor, then called for a relief paramedic. About thirty minutes later, Gabe arrived and Bobby headed to the hospital.

June 2, 1989, Circleville, Ohio

The rest of the shift had been what Sam called routine -- minor injuries and possible heart attacks, and just after 6:00am on Friday morning, Bobby called to say that Bobby Junior had been born at 2:04am and both Doctor Gibbs and the baby were fine. At 7:00am, with the shift turnover, I had weighed visiting Doctor Gibbs, but was positive she'd be tired and cranky, so I'd headed home, where Kris and Rachel greeted me with kisses.

"Did you get any sleep?" Kris asked.

"About five hours total," I replied. "I'll be fine without a nap, though I could take one while Rachel takes hers."

"Go get your shower; breakfast will be ready in fifteen minutes."

I went upstairs, took a quick shower, then put on shorts and a t-shirt and went back down to the kitchen.

"Bobby and Loretta had their baby last night," I said. "Mom and Bobby Junior are both healthy."

"How typical! The man does two minutes of pleasurable work, then the woman carries the baby for nine months and labors and delivers, and the man gets equal credit!"

"Two minutes?! Excuse me?!" I protested.

"And another typical male reaction! Question their virility in even the slightest way and they lose their minds! What little they have of them, anyway!"

I rolled my eyes theatrically, then declared, "I have half a mind to prove you wrong!"

"Half a mind is right!" Kris teased. "But that's still more than most men!"

"Ah, then my decision is made," I said firmly. "Rather than demonstrate my prowess, I shall not bother, as, clearly, my efforts are not appreciated!"

"I didn't say that!" Kris countered. "It's just I want to needle you!"

"And what I have for you is bigger than a needle!"

Kris laughed, "You are a very virile and well-endowed man!"

"Thank you! Perhaps I'll relent and demonstrate after all!"

"In all seriousness, though, that doesn't seem like something you've ever had trouble with."

"No. My problem was one of a libido in overdrive."

"I don't mind," Kris replied with a smile.

"You don't mind?!" I asked with faux outrage.

"You are so easy to wind up, Mike!"

"Or," I said slyly, "I know you want to wind me up, so I play along to make you happy!"

"Wait!" Kris protested. "That's what you do with Clarissa, isn't it?"

"It is! And if you ever tell her, I'm going to be very unhappy!"