The Cole Trilogy: The Physician, Shaman And Matters Of Choice Part 120

ACKNOWLEDGMENTS AND NOTES.

Sauks and Mesquakies still live in Tama, Iowa, on land they own. Their original eighty-acre purchase has been added to considerably. Some 575 Native Americans now live on 3,500 acres along the Iowa River. In the summer of 1987 I visited the settlement at Tama with my wife, Lorraine. Don Wanatee, then the executive director of the Tribal Council, and Leonard Young Bear, a noted Native American artist, answered my questions patiently. In subsequent conversations, so did Muriel Racehill, current executive director, and Charlie Old Bear.

I have tried to present the events of Black Hawk's War as close to history as possible. The warrior leader known as Black Hawk-the literal translation of his Sauk name, Makataime-shekiakiak, is Black Sparrow Hawk-is a historic figure. The shaman Wabokieshiek, White Cloud, also was a living man. In this book he evolves into a fictional character after he meets the girl who is to become Makwa-ikwa, the Bear Woman.

For much of the Sauk and Mesquakie vocabulary utilized in this novel, I relied heavily on a number of early publications of the Smithsonian Inst.i.tution's Bureau of American Ethnology.

The early days of the charitable organization known as the Boston Dispensary were much as I have depicted them. I have exercised an author's license in the matter of the salaries of the visiting physicians. Although the pay scale is authentic, compensation didn't begin until 1842, several years after Rob J. is shown as salaried to attend the poor. Until 1842, being a physician at the Boston Dispensary was a kind of unpaid internship. Conditions among the impoverished were so difficult, however, that the young doctors rebelled. First they demanded payment, and then they refused to continue visiting patients in the slums. Instead, the Boston Dispensary moved into quarters and became a clinic, the patients coming to the doctors. By the time I covered the Boston Dispensary in the late 1950's and early 1960's as science editor of the old Boston Herald, it had grown into an established hospital-clinic and was in a loose administrative a.s.sociation with the Pratt Diagnostic Clinic, the Floating Hospital for Infants and Children, and Tufts Medical School, as the Tufts-New England Medical Center. In 1965 the component hospitals were united and absorbed into the present distinguished inst.i.tution known as the New England Medical Center Hospitals. David W. Nathan, former archivist at the medical center, and Kevin Richardson of the medical center's Department of External Affairs furnished me with information and historical material.

While writing Shaman, I found an unexpected lode of information and insights right at home, and I am grateful to close friends, neighbors, and fellow townspeople.

Edward Gulick talked with me about pacifism and told me about Elmira, New York. Elizabeth Gulick shared thoughts about the Society of Friends and allowed me to read some of her own writings about Quaker worship. Don Buckloh, a resource conservationist with the U.S. Department of Agriculture, answered questions about early Midwestern farms. His wife, Denise Jane Buckloh, the former Sister Miriam of the Eucharist, OCD, gave me details about Catholicism and the daily life of a convent nun.

Donald Fitzgerald lent me reference books and presented me with a copy of the Civil War diary of his great-grandfather John Fitzgerald, who at sixteen had walked from Rowe, Ma.s.sachusetts, to Greenfield, twenty-five miles down the Mohawk Trail, to enlist in the Union Army. John Fitzgerald fought with the Twenty-seventh Ma.s.sachusetts Volunteers until captured by Confederates, and he survived several prison camps, including Andersonville.

Theodore Bobetsky, a lifelong farmer whose land abuts ours, gave me information about butchering. Attorney Stewart Eisenberg discussed with me the system of bail utilized by nineteenth-century courts, and Nina Heiser allowed me to borrow her collection of books on Native Americans.

Walter A. Whitney Jr. gave me a copy of a letter written April 22, 1862, by Addison Graves, to his father, Ebenezer Graves Jr., of Ashfield, Ma.s.sachusetts. The letter is an account of Addison Graves's experience as a volunteer nurse on the hospital ship War Eagle, which carried Union wounded from Pittsburg, Tennessee, to Cincinnati. It was the basis for Chapter 48, in which Rob J. Cole serves as a volunteer surgeon on the hospital ship War Hawk.

Beverly Presley, map and geography librarian at Clark University, calculated the distance traveled during the voyages of the historic and fictional hospital ships.

The faculty of the Cla.s.sics Department at the College of the Holy Cross a.s.sisted me with several Latin translations.

Richard M. Jakowski, VMD, a.s.sociate professor in the Department of Pathology at the Tufts-New England Veterinary Medical Center, in North Grafton, Ma.s.sachusetts, answered my questions about the anatomy of dogs.

I am grateful to the University of Ma.s.sachusetts at Amherst for continuing to grant me faculty privileges to all of its libraries, and to Edla Holm of the Interlibrary Loans Office at that university. I thank the American Antiquarian Society, in Worcester, Ma.s.sachusetts, for giving me access to its collections.

I received help and materials from Richard J. Wolfe, curator of rare books and ma.n.u.scripts and Joseph Garland Librarian at the Countway Medical Library of Harvard Medical School, and I enjoyed long-term loans from the Lamar Soutter Library of the University of Ma.s.sachusetts Medical School, in Worcester. I also thank the reference staffs of the Boston Public Library and the Boston Athenaeum for their help.

Bernard Wax, of the American Jewish Historical Society at Brandeis University, supplied me with information and research regarding Company C of the eighty-second Illinois, "the Jewish company."

In the summer of 1989 my wife and I visited several Civil War battlefields. In Charlottesville, Professor Ervin L. Jordan Jr., archivist at the Alderman Library of the University of Virginia, showed me the hospitality of that library and provided me with information about the hospitals of the Confederate Army. Civil War medical conditions, battles, and events in Shaman are based on history. The regiments with which Rob J. Cole served are fict.i.tious.

My resource concerning the Yiddish language was my mother-in-law, Dorothy Seay.

During much of the writing of this book, Ann N. Lilly was a staff member at both the Forbes Library in Northampton and the Western Ma.s.sachusetts Regional Library System in Hadley, Ma.s.sachusetts. She often conducted t.i.tle searches for me, and hand-carried books from both inst.i.tutions to her Ashfield home. I also thank Barbara Zalenski of the Belding Memorial Library of Ashfield, and the staff of the Field Memorial Library of Conway, Ma.s.sachusetts, for their help with research.

The Planned Parenthood Federation of America sent me material about the manufacture and use of condoms during the 1800's. At the Center for Disease Control, in Atlanta, Georgia, Robert Cannon, M.D., gave me information about the treatment of syphilis during the period of my story, and the American Parkinson Disease a.s.sociation, Inc., furnished me with information about that disease.

William McDonald, a graduate student in the Department of Metallurgy at the Ma.s.sachusetts Inst.i.tute of Technology, told me about metals used to make instruments during the Civil War era.

Jason Geiger's a.n.a.lysis of what would have happened if Lincoln had allowed the Confederacy to break away from the Union without war, as expressed in Chapter 72, is based on the opinion of the late psychographer Gamaliel Bradford in his biography of Robert E. Lee (Lee the American, Houghton Mifflin, Boston, 1912).

I thank Dennis B. Gjerdingen, president of the Clarke School for the Deaf, in Northampton, Ma.s.sachusetts, for granting me access to the staff and library of that school. Ana D. Grist, former librarian at the Clarke School, allowed me to borrow books for long periods of time. I am especially grateful to Marjorie E. Magner, who has spent forty-three years teaching deaf children. She provided me with a number of insights and also read the book ma.n.u.script to ensure its accuracy about deafness.

Several Ma.s.sachusetts physicians have been generous in helping me with this book. Albert B. Giknis, M.D., the medical examiner of Franklin County, Ma.s.sachusetts, discussed rape and murder with me at length, and allowed me to borrow his pathology texts. Joel F. Moorhead, M.D., outpatient medical director at the Spaulding Hospital and clinical instructor in rehabilitation medicine at Tufts Medical School, answered questions about injury and disease. Wolfgang G. Gilliar, D.O., program director for rehabilitation medicine at the Greenery Rehabilitation Center and instructor in rehabilitation medicine at Tufts Medical School, talked with me about physical medicine. My family internist, Barry E. Poret, M.D., gave me information and made available his own medical books. Stuart R. Jaffee, M.D., senior urologist at St. Vincent Hospital in Worcester, Ma.s.sachusetts, and a.s.sistant professor of urology at the University of Ma.s.sachusetts Medical School, answered my questions about lithocenosis and read the book ma.n.u.script for medical accuracy.

I am grateful to my agent, Eugene H. Winick of McIntosh & Otis, Inc., for his friendship and enthusiasm, and to Dr. Karl Blessing, Geschaftsfuhrer at the Droemer Knaur Publishing Company in Munich. Shaman is the second book in a projected trilogy about the Cole medical dynasty. Dr. Blessing's early faith in the first book of the trilogy, The Physician, helped it to become a best-seller in Germany and other countries and energized me during the writing of Shaman.

For their efforts on behalf of this book I thank Peter Mayer, Elaine Koster, and Robert Dreesen of Penguin Books USA. Raymond Phillips did a wonderful job of copy editing.

In many ways, Shaman was a family project. My daughter Lise Gordon edited Shaman before it reached my publishers. She is meticulous, tough even with her own father, and wonderfully encouraging. My wife, Lorraine, helped me prepare the ma.n.u.script and, as usual, gave me her love and total support. My daughter Jamie Beth Gordon, a photographer, eased my fear of the camera during a special and hilarious shoot, when she took my pictures for use on the book's jackets and in publishers' catalogs. She buoyed me with her notes and cards. And the frequent long-distance calls from my son, Michael Seay Gordon, invariably came when I needed the lift he always brings.

These four people are the most important part of my life, and they have increased, at least tenfold, my joy in finishing this novel.

Ashfield, Ma.s.sachusetts.

November 20, 1991.

MATTERS OF CHOICE.

NOAH GORDON.

This book is for Lorraine, my love.

And for our children-.

Michael Gordon.

Lise Gordon and Roger Weiss;

and Jamie Beth Gordon, who had the warmth

and imagination to see the magic in heartrocks.

The difficulty in life is the choice.

-George Moore.

The Bending of the Bough.

I have never had a money practice; it would have been impossible for me. But the actual calling on people, at all times and under all conditions, the coming to grips with the intimate conditions of their lives, when they were being born, when they were dying, watching them die, watching them get well when they were ill, has always absorbed me.

-William Carlos Williams, M.D. Autobiography The close-up, rea.s.suring, warm touch of the physician, the comfort and concern, the long, leisurely discussions ... are disappearing from the practice of medicine, and this may turn out to be too great a loss. ... If I were a medical student or an intern, just getting ready to begin, I would be more worried about this aspect of my future than anything else. I would be apprehensive that my real job, caring for sick people, might soon be taken away, leaving me with the quite different occupation of looking after machines. I would be trying to figure out ways to keep this from happening.

-Lewis Thomas, M.D.

The Youngest Science: Notes of a Medicine Watcher.

PART ONE.

THE THROWBACK.

1.

AN APPOINTMENT.

R.J. woke.

As long as she lived, from time to time in the middle of the night she would open her eyes and search the darkness in the tense certainty that she was still an overworked resident physician at the Lemuel Grace Hospital in Boston, grasping at a nap in an empty patient room in the middle of a thirty-six-hour shift.

She yawned while the present flooded into her consciousness and she knew with great relief that the residency was years behind her. But she closed her mind to reality because the luminous hands of the clock told her she had two hours left and she had learned in that long-ago residency to milk every moment of sleep.

She emerged again two hours later to graying light and no panic and reached over and killed the alarm. Invariably she awoke just before it rang, but she always set it the night before anyway, just in case. The special shower head thrummed the water into her scalp not quite bruisingly, as reviving as an extra hour of sleep. The soap slid over a body ampler than she thought desirable, and she wished there were time for a run, but there wasn't.

As she used the dryer on her short black hair, still thick and good, she appraised her face. Her skin was fair and clear, her nose narrow and somewhat long, her mouth wide and full. Sensual? Wide, full, and unkissed for a long time. There were bags under her eyes.

"So, what do you want, R.J.?" she demanded rudely to the woman in the mirror.

Not Tom Kendricks any longer, she told herself. Of that she was certain.

She had selected her clothing before she went to bed, and it waited at one side of the closet, a blouse and tailored slacks, attractive but comfortable shoes. In the hallway she saw through the open door to Tom's bedroom that the suit he had worn yesterday was still on the floor where he had dropped it the night before. He had been up earlier than she and was long gone from the house, needing to be scrubbed and in the operating room by 6:45.

Downstairs, she poured a gla.s.s of orange juice and forced herself to drink it slowly. Then she put on her coat, picked up her briefcase, and went through the unused kitchen and out to the garage. The little red BMW was her indulgence, as the grand antique house was Tom's. She enjoyed the purr of the engine, the responsiveness of the wheel.

It had snowed lightly during the night, but the Cambridge road crews did a good job removing snow, and she had no trouble once she was past Harvard Square and JFK Boulevard. She turned on the radio and listened to Mozart while drifting with the tide of traffic moving down Memorial Drive, then she took the Boston University Bridge across the Charles River to the Boston side.

Early as it was, at the hospital the staff parking lot was almost full. She slid the BMW into a s.p.a.ce next to a wall, to minimize the chance of damage from a neighbor's carelessly opened door, and then walked briskly into the building.

The security guard nodded. "Mornin', Dockuh Cole."

"Hi, Louie."

At the elevator she said h.e.l.lo to several people. She got out at the third floor and walked quickly into Room 308. She always got to work very hungry in the morning. She and Tom rarely had lunch or dinner at home, and never breakfast; the refrigerator was empty except for juice, beer and soft drinks. For four years R.J. had stopped at the crowded cafeteria every morning, but then Tessa Martula had become her secretary and insisted on doing for her what she doubtless wouldn't have agreed to do for a man.

"I go there to get my own coffee, so it doesn't make sense not to get yours," Tessa had insisted. So now R.J. put on a fresh white coat and began to review the case histories that had been left on her desk, and seven minutes later she was rewarded by the sight of Tessa bearing a tray containing a toasted bagel and cream cheese, and coffee black and strong.

While she made short work of the food, Tessa came in again with the appointment schedule, and they reviewed it.

"Dr. Ringgold called. Wants to see you before you start your day."

The chief of medicine had a corner office on the fourth floor. "Go right in, Dr. Cole. He's expecting you," his secretary said.

In the inner office, Dr. Ringgold nodded, pointed at a chair, and closed the door firmly.

"Max Roseman had a stroke yesterday while he was attending the communicable diseases meeting at Columbia. He's a patient at New York Hospital."

"Oh, Sidney! Poor Max. How is he?"

He shrugged. "Surviving, but he could be better. Profound paralysis and sensory impairment of the contralateral face, arm and leg, for starters. We'll see what the next few hours bring. I just got a courtesy call from Jim Jeffers in New York. He said he'll keep me informed, but it's going to be a long time before Max returns to work. Matter of fact, given his age, I doubt he'll ever be back."

R.J. nodded, suddenly watchful. Max Roseman was a.s.sociate chief of medicine.

"Someone like you, a good female physician and with your background in law, would bring new dimensions to the department as Max's successor."

She had no desire to be a.s.sociate chief, a job of many responsibilities and limited power.

It was as if Sidney Ringgold could read her mind. "In three years I reach sixty-five, the age of compulsory retirement. The a.s.sociate chief of medicine will have a tremendous advantage over other candidates to succeed me."

"Sidney, are you offering me the job?"

"No, I'm not, R.J. Matter of fact, I'm going to talk with several other people about the appointment. But you would be a strong candidate."

R.J. nodded. "Fair enough. Thanks for filling me in."

But his glance held her in her chair. "One other thing," he said. "I've been thinking for a long time that we should have a publications committee to encourage staff physicians to write and publish more. I'd like you to set it up and chair it."

She shook her head. "I simply can't," she said flatly. "I'm already stretching to handle my schedule." It was true; he should know that, she thought with resentment. Mondays, Tuesdays, Wednesdays, and Fridays, she dealt with patients at her hospital office. Tuesday mornings she went across the street to give a two-hour cla.s.s at the Ma.s.sachusetts College of Physicians and Surgeons on the prevention of iatrogenic illness, sickness or injury caused by a doctor or a hospital. Wednesday afternoons she lectured at the medical school on the avoidance and survival of malpractice suits. Thursdays she performed first-trimester abortions at the Family Planning Clinic of Jamaica Plain. Friday afternoons she worked at a PMS clinic which, like the iatrogenic illness course, had been established because of her persistence and over the objections of some of the hospital's more conservative doctors.

Both she and Sidney Ringgold were conscious of her debt to him. The chief of medicine had sponsored her projects and promotions despite political opposition. At first he had looked upon her warily-a lawyer turned physician, an expert on illnesses caused by the mistakes of physicians and hospitals, someone who did peer review work and judged her fellow physicians, often costing them money. In the beginning, some of her colleagues had referred to her as "Dr. Snitch," an appellation she wore proudly. The chief of medicine had watched Dr. Snitch survive and prosper and become Dr. Cole, accepted because she was honest and tough. Now both her lectures and her clinics had become politically correct, a.s.sets so prized that Sidney Ringgold often took credit for them.

"Perhaps you can trim some other activity?" Both of them knew he was talking about Thursdays at the Family Planning clinic.