The Cole Trilogy: The Physician, Shaman And Matters Of Choice Part 133

"Jesus, she's in severe arrhythmia."

"Now you can call medical control. Tell them she's having a heart attack, that Dr. Cole is with you. Request permission for me to administer streptokinase." Even as she spoke, the hypodermic needle was entering flesh, her fingers depressing the plunger.

The cells of the heart muscle were perfused with oxygen, and by the time permission was given by medical control, the drug was beginning its work. When Mrs. Olchowski was off-loaded at the hospital by the emergency room staff, damage to her heart had been minimized.

For the first time, R.J. had learned that the strange message she sometimes received from patients could save their lives.

The Olchowskis told all their friends about their internist with the wonderful medical wisdom. "She just looked at me, and that woman knew what was going to happen. She is some doctor!" Stella said. The ambulance crew agreed, and added their own embellishments to the story. R.J. began to enjoy the smiles that were directed at her as she went on her house calls.

"This town likes having a doctor again," Peg told her. "And they're proud to think they have a d.a.m.n good one."

It embarra.s.sed R.J., but the message went out through the hills and valleys. Toby Smith came back from the state Democratic convention in Springfield and told her that a delegate from Charlemont had remarked that he had heard the lady doctor Toby worked for in Woodfield was a really warm, friendly sort of person. Always holding people's hands.

October brought an end to pesky insects and triggered incredible bursts of colors in the trees, a joyous streaking of the hills. The natives told her it was just a run-of-the-mill autumn, but she didn't believe it. On an Indian summer day she and David went fis.h.i.+ng on the Catamount, and he caught three decent trout and she caught two, gills brightly colored for mating. When they cleaned the trout they saw that two of them were females full of eggs. David reserved the trout eggs to fry with hen's eggs, but R.J. avoided them, disliking all roe.

Sitting with him on the riverbank, she found herself telling him details about the experiences she would never dare tell a medical colleague.

David didn't smile. He listened with great interest-even, she realized, with envy.

"It's written in the Mishnah.... Do you know what the Mishnah is?"

"Some kind of Hebrew holy book?"

"It's the basic book of Jewish law and thought, compiled eighteen hundred years ago. It records that there lived a rabbi named Hanina ben Dosa, who could work miracles. He prayed over the sick, and he used to say, 'This one will live' or 'This one will die,' and it always turned out as he said. And they asked him, 'How knowest thou?' And he said to them, 'If my prayer is fluent in my mouth, I know he is accepted. And if not, I know he is rejected.'"

She was annoyed. "I don't pray over them."

"I know. Your ancestors named it well. It's a gift."

"But ... what is it?"

He shrugged. "A religious savant would say of both you and Rabbi Hanina that it's a message you alone are privileged to hear."

"Why me? Why my family? ... And a message from whom? Certainly not from your angel of death."

"I think your father probably was right when he guessed that it's a genetic gift, a combination of mental and biological sensors that allows you additional information. A kind of sixth sense."

He held out both his hands to her.

"No. Go away," she said when she understood.

But he waited with an awful patience until she took his hands in hers.

She felt only the warmth and strength of his grip, and a weakness of relief, and anger at him.

"You're going to live forever."

"I will if you will," he said.

He talked as if they were soulmates. She considered the fact that he already had had a strong love, a wife he had cherished and now mourned. She had had Charlie Harris, an early lover who had died while their union was still perfect and untested, and then a bad marriage to a selfish and immature man. She continued to grip David's hands, unwilling to let go.

24.

NEW FRIENDS.

On a busy afternoon during office hours R.J. received a call from a woman named Penny Coleridge. "I told her you were with a patient and would return the call," Toby said. "She's a midwife. She said she would like to get to know you."

R.J. returned the call as soon as she was able. Penny Coleridge had a pleasant telephone voice, but it was impossible to guess her age over the phone. She said she had been practicing midwifery in the hills for four years. There were two other midwives-Susan Millet and June Todman-practicing with her. R.J. invited them to her house for supper on Thursday, her free afternoon, and after consulting with her colleagues, Penny Coleridge said all three would come.

She proved to be an affable, stocky brunette, perhaps in her late thirties. Susan Millet and June Todman were about ten years older. Susan was graying, but she and June were blondes who looked enough alike to be mistaken for sisters, although they had met only a few years earlier. June had received her training in the midwifery program at Yale-New Haven. Penny and Susan were nurse-midwives; Penny had trained at the University of Minnesota, and Susan had trained in Urbana, Illinois.

The three made it clear that they were happy to have a doctor in Woodfield. They told R.J. that some pregnant women in the hilltowns preferred an obstetrician or a family pract.i.tioner to deliver their babies and had to travel a good distance away to find one. Other patients preferred the less invasive techniques practiced by midwives. "In places where all the docs are men, some patients have come to us because they wanted a woman to deliver their baby," Susan said. She smiled at R.J. "Now that you're here, they have a wider choice."

Some years before, obstetricians in urban locations had worked to hobble midwives politically because they saw them as economic compet.i.tors. "But out here in the hill country, doctors don't give us trouble," Penny said. "There's more than enough work to go around, and they're happy we're here, sharing the burden. By law, we have to be salaried workers, employed by a clinic or a physician. And although midwives would be perfectly capable of doing things like vacuum extractions and forceps births, we have to have a boarded obstetrician on call to do those things, just as you do."

"Have you made connection with an ob-gyn to act as your backup?" June asked R.J.

"No. I would value your advice in that regard."

"We've been working under a good young obstetrician, Grant Hardy," Susan said. "He's smart, he has an open mind, and he's idealistic." She made a face. "He's too idealistic, I guess. He's taken a job with the surgeon general in Was.h.i.+ngton."

"Have you made a new arrangement with another ob-gyn, then?"

"Daniel Noyes has agreed to take us on. The trouble is, he's retiring in a year, and we'll have to start again with somebody new. Still," Penny said thoughtfully, "he might be just the ob-gyn to be your backup as well as ours. He's grouchy and crusty on the outside, but he's really an old dear. He's far and away the best obstetrician in the area, and an arrangement with him would let you take your time looking for another ob-gyn before he retires."

R.J. nodded. "That sounds sensible to me. I'll try to persuade him to work with me."

The midwives were discernably pleased when they learned that R.J. had had advanced training in obstetrics and gynecology and had worked in a clinic dealing with female hormonal problems. It was a relief to them that she was available in the event that a medical problem arose with one of their patients, and they had several women they wanted her to examine.

R.J. liked them as people and as professionals, and their presence made her feel more secure.

She dropped in often to see Eva Goodhue, sometimes bringing a package of ice cream or some fruit. Eva was quiet and introspective; for a few days R.J. suspected that was her way of grieving for her niece, but she had come to conclude that those qualities were aspects of Eva's personality.

The apartment had been thoroughly cleaned by the pastoral committee of the First Congregational Church, and Meals on Wheels, a nonprofit agency that served the elderly, delivered a hot dinner every day. R.J. met with the Franklin County social worker, Marjorie La.s.siter, and with John Richardson, minister of the church in Woodfield, to talk about Miss Goodhue's other needs. The social worker began with a blunt report of her financial status.

"She's broke."

Twenty-nine years before, Eva Goodhue's only living sibling, an unmarried brother named Norm, had died of pneumonia. His death had left Eva sole owner of the family farm on which she had always lived. She had promptly sold it for just under forty-one thousand dollars and rented the apartment on Main Street, in the village. A few years later her niece, Helen Goodhue Phillips, daughter of Harold Goodhue, Eva's other dead brother, had divorced her abusive husband and come to live with her aunt.

"They were supported by Eva's money in the bank and by a small monthly welfare check," Marjorie La.s.siter said. "They thought they were on easy street, even sometimes indulging in a weakness for mail-order purchases. They always spent more than the capital earned annually, and the dwindling bank account finally has run out." She sighed. "It's not uncommon, believe me, for someone to outlive her money."

"Thank G.o.d she still has the welfare check," John Richardson said.

"That won't support her," the social worker said. "Eva's monthly rent alone is four hundred and ten dollars. She has to buy groceries. She's on Medicare, but she has to buy drugs. She has no supplemental medical insurance."

"I'll look out for her medical care as long as she remains here in town," R.J. said quietly.

Ms. La.s.siter gave her a rueful smile. "But that still leaves fuel oil. The electric bill. The occasional purchase of a necessary article of clothing."

"The Sumner Fund," Richardson said. "The town of Woodfield has a sum of money left it in trust, the interest to be utilized to help needy citizens. The expenditures are made quietly at the discretion of the three selectpersons, and are kept private by them. I'll talk to Janet Cantwell," the minister said.

A few days later R.J. met Richardson in front of the library and he told her it was all set with the Board of Selectmen. Miss Goodhue would receive a monthly stipend from the Sumner Fund, enough to cover her deficit.

It was later that day, as R.J. finished updating the patient charts, that she realized a bright truth: as long as she lived in the kind of town that was willing to help an indigent old woman, she was content not to have s.h.i.+ny new plumbing in the Town Hall toilets.

"I want to stay in my own home," Eva Goodhue said.

"And you will," R.J. told her.

At Eva's suggestion, R.J. brewed a pot of black currant tea, Eva's favorite. They sat at the kitchen table and talked about the physical examination R.J. had just completed. "You're in remarkably good condition for somebody who is marching toward her ninety-third year. Obviously you have very good genes. Do you come from long-lived parents?"

"No, my parents died fairly young. My mother had a ruptured appendix when I was only five. My father might have lived to be old, but he was killed in a farm accident. A load of logs let go and he was crushed. That was when I was nine years old."

"So who raised you?"

"My brother Norm. I had two brothers. Norm was thirteen years older than I, and Harold was four years younger than Norm. They didn't get along at all. Not at all. Fought and fought, and Harold up and ran away from the farm-just left it for Norman to worry about. He joined the Coast Guard and never did get home again, never communicated with Norm, although now and again I would get a postcard, and sometimes there was a letter for me and a small amount of money at Christmas." She sipped her tea. "Harold died of tuberculosis in the Naval Hospital in Maryland about ten years before Norm pa.s.sed away."

"You know what boggles my mind?"

Eva smiled at the expression. "What?"

"When you were born, Victoria was England's queen. Wilhelm II was the last emperor of Germany. Teddy Roosevelt was about to become president of the United States. And Woodfield-what changes you must have seen as they took place in Woodfield."

"Not so many changes as you might expect," Eva said. "The automobile, certainly. Now all the main roads are tarred. And electricity is everywhere. I remember when street lamps came to Main Street. I was fourteen years old. I walked six miles from the farm and back, after ch.o.r.es, so I could see the lights turned on. It was another ten or twenty years before the electric wires reached all the houses of the town. We didn't even have milking machines until I was forty-seven. There was a blessed change!"

She said little about Helen's dying. R.J. raised the subject, thinking it would be healthy for her to talk about it, but Eva only stared out of tired eyes as deep and fathomless as lakes.

"She was a dear soul, my brother Harold's only child. Of course I shall miss her. I miss them all, or at least most.

"I've lived longer than everybody I once knew," she said.

25.

SETTLING IN.

On a mild day in mid-October, R.J. was leaving the hospital in Greenfield when she pa.s.sed Susan Millet standing in the parking lot talking with a ruddy-faced, balding man. He was large and tall but slightly crooked, as if his spine were made of bent tin, and his left shoulder was lower than his right. Chronic scoliosis, her mind registered.

"R.J., hi! Say, here's somebody I want you to meet. Dr. Daniel Noyes, this is Dr. Roberta Cole."

They shook hands. "So you're Dr. Cole. Seems to me, all I've heard lately from the three midwives is your name. You're some kind of expert on hormones, I'm told."

"Hardly an expert." She told him about having worked in the clinic at Lemuel Grace Hospital, and he nodded.

"Don't contradict. That makes you more of an expert on hormones than we've had around here up to now."

"I'm going to deliver babies, part of a full family practice. I need the cooperation of an ob-gyn who is on staff here."

"You do, eh?" he said coolly.

"Yes." They regarded one another.

"Well, are you asking me to work with you?"

He was crusty and cranky, she thought, just as the midwives had described him. "Yes, that's the idea. I realize you don't know much about me. Do you happen to be free for lunch?"

"No need to waste money buying me lunch. They've told me all about you. Did they tell you I was calling it a career in twelve and a half months?"

"Yes, they did."

"Well, if you still want me to consult with you for that brief a time, it's fine with me."

"That's great. I mean, I do."

Now he was smiling. "That's settled, then. So, how's about I take you to lunch at the world's best old-fas.h.i.+oned diner and tell you some war stories about practicing medicine in western Ma.s.sachusetts?"

He was an old dear, she could see that. "I'd like that very much."

"I suppose you want to come too," he said dourly to Susan, who was wearing a satisfied expression.

"No, I have an appointment, but you two go ahead," Susan said. She was laughing to herself as she walked to her car.

R.J. was busy, working long hours, and apt to be tired and unambitious when she had a little time off. The trail through the woods didn't progress far beyond the beaver ponds. When she wanted to go to the river, she still had to contend with a lot of rough hiking through heavy growth.

Late in the fall she and David had to stay out of the woods, which were full of hunters carrying loaded weapons, their trigger fingers itchy. She winced to see, again and again, white-tailed deer dead and broken, slung over the b.u.mpers of cars and trucks.

A lot of people in the hills hunted. Toby and Jan Smith invited R.J. and David to dinner and served an impressive royal crown roast of venison.

"Got a young buck, a four-pointer, right up on the ridge above the house," Jan said. "I always go out on opening day with my uncle Carter Smith, been hunting with him ever since I was a boy."

Whenever he and his uncle got a deer they followed a Smith family tradition, he told them. They cut out the deer's heart while they were still in the woods, sliced it, and ate it raw. He was pleased to share that detail with them and he told the story well, giving them a sense of the love and kins.h.i.+p between the old man and the young man.

R.J. suppressed her distaste. She couldn't help imagining that parasitic diseases might have been invited into their bodies with the deer's heart, but she cast all such thoughts from her mind. She had to admit the venison made a splendid roast, and she ate her fill and sang its praises.