The Cole Trilogy: The Physician, Shaman And Matters Of Choice Part 121

He leaned forward. "I'd like you to do this, R.J."

"I'll give it serious thought, Sidney."

This time she made it out of the chair. On the way out, she was annoyed with herself, realizing she was already trying to guess the other names on his list.

2.

THE HOUSE ON BRATTLE STREET.

Even before they were married, Tom had tried to convince R.J. that she should exploit the combination of law and medicine to produce optimum annual income. When, despite his advice, she had effectively turned her back on the law and concentrated on medicine, he had urged her to develop a private practice in one of the affluent suburbs. While they were buying their house he had grumbled about her hospital salary, almost 25 percent lower than the income would have been from a private practice.

They had gone to the Virgin Islands for their honeymoon, a week on a small island near St. Thomas. Two days after they returned they had started looking for property, and on the fifth day of their search a real estate woman had taken them to see the distinguished but run-down house on Brattle Street in Cambridge.

R.J. had viewed it with disinterest. It was too large, too expensive, too badly in need of repair, and there was too much traffic going by the front door. "It would be crazy."

"No, no, no," he had murmured. She remembered he had been so attractive that day, his straw-colored hair in a designer trim, and wearing a beautifully cut new suit. "It wouldn't be crazy at all." Tom Kendricks saw a handsome Georgian house on a graceful heirloom street with red-brick sidewalks that had been trod by poets and philosophers, men you read about in textbooks. Half a mile up the street was the stately house in which Henry Wadsworth Longfellow had lived. Just beyond that was the Divinity School. Tom already was more Boston than Boston, getting the accent just right, having his clothes tailored by Brooks Brothers. But in fact he was a midwestern farm boy who had gone to Bowling Green University and Ohio State, and the thought of being Harvard's neighbor-almost part of Harvard-fascinated him.

And he was seduced by the house-the exterior of red brick with Vermont marble ornamentation, the handsome thin columns alongside the doors, the small antique panes on each side and above the doorway, the matching brick wall around the property.

She thought he was joking. When it became apparent he was serious, she was dismayed and tried to talk him out of it. "It would be expensive. Both the house and the wall need repointing, the roof and the foundation need repair. The real estate company's description says right up front that it needs a new furnace. It doesn't make sense, Tom."

"Sense is what it does make. This is a house to be owned by a couple of successful doctors. A statement of confidence."

Neither of them had saved much. Because R.J. had received a law degree before entering medical school she had managed to earn some money, enough to finish her medical education and training with only a reasonable debt. But Tom owed a frightening amount. Nevertheless, he argued stubbornly and at length that they should buy the house. He reminded her that already he had begun to make very good money as a general surgeon and insisted that when her smaller income was added to his, they could easily afford the house. He said it again and again.

It was early enough in the marriage so that she was still besotted. He was a better lover than he was a person, but she didn't know that then, and she listened to him with gravity and respect. At last, bemused, she had given in.

They spent a good deal of money on furnishings, including antiques and near-antiques. At Tom's insistence, they bought a baby grand piano, more because it looked "just right" in the music room than because R.J. was a pianist. About once a month her father took a taxi to Brattle Street and tipped the cabbie to carry in his c.u.mbersome viola da gamba. Her father was happy to see her settled, and they played long and fulsome duets. The music covered a lot of scars that were there from the start and made the large house seem less empty.

She and Tom ate most of their meals out and didn't have live-in help. A taciturn black woman named Beatrix Johnson came every Monday and Thursday and kept the house clean, only now and again breaking something. The yardwork was done by a landscaping service. They rarely had guests. No hung shingle encouraged patients to enter the front gate of their home; the only clue as to the ident.i.ty of the inhabitants came from a pair of small copper plates Tom had fastened to the wood on the right-hand side of the front door frame.

THOMAS ALLEN KENDRICKS, M.D.

and ROBERTA J. COLE, M.D.

In those days, she called him Tommy.

When she left Dr. Ringgold she did morning rounds.

Unfortunately, she never had more than one or two patients in the wards. She was a general physician interested in family practice, working in a hospital that didn't have a department of family practice. That made her a kind of jack-of-all-trades, a utility player without cla.s.sification. Her work for the hospital and the medical school fell between departmental boundaries; she saw pregnant patients, but someone in Obstetrics delivered the babies; in the same way, almost always she referred her patients to a surgeon, a gastroenterologist, any one of more than a dozen specialists. Most of the time she never saw the patient again, because follow-up care was done by the specialist physician or the hometown family doctor; usually patients came to the hospital with only those problems that might require advanced technology.

At one time, political opposition and the sense that she was breaking new ground had lent spice to her activities at Lemuel Grace, but for a long time now she had lost her sense of joy in medical practice. She spent too much of her time reviewing and signing insurance papers-a special form if someone needed oxygen, a special long form for this, a special short form for that, in duplicate, in triplicate, every insurance company with different forms.

Her office visits were apt to be impersonal and brief. Faceless efficiency experts at insurance companies had determined how much time and how many visits she could allow for each patient, who was quickly sent off for lab work, for X rays, for ultrasound, for MRI-the procedures that did most of the real diagnostic work and protected her from malpractice suits.

Often she pondered, who were these patients who came to her for help? What elements in their lives, hidden from her almost cursory glance, contributed to their illness? What would become of them? There was neither time nor opportunity for her to relate to them as people, to really be a physician.

That evening she met Gwen Gabler at Alex's Gymnasium, an upscale health club in Kenmore Square. Gwen was R.J.'s medical school cla.s.smate and best friend, a gynecologist at Family Planning whose breeziness and salty tongue disguised the fact that she was hanging on by her fingernails. She had two children, a real estate broker husband who had run into hard times, an overcrowded schedule, bruised ideals, and depression. She and R.J. came to Alex's twice a week to punish themselves in a long aerobics cla.s.s, sweat out foolish desires in the sauna, soak away fruitless regrets in the hot tub, have a gla.s.s of wine in the lounge, and gossip and talk medicine throughout the evening.

Their favorite wickedness was to study the men in the club and judge their attraction solely by their appearance. R.J. found she required a hint of the cerebral in the face, a suggestion of introspection. Gwen liked more animal qualities. She was an admirer of the owner of the club, a golden Greek named Alexander Manakos. Easy for Gwen to dream of muscular but soulful romance and then go home to her Phil, myopic and stocky but deeply appreciated. R.J. went home and read herself to sleep with medical journals.

On the surface, she and Tom had the American dream-busy professional lives, the handsome house on Brattle Street, a farmhouse in the Berkshires that they used for extremely rare weekends and vacations. But the marriage was ashes. She told herself it might have been different if they had had a child. Ironically, the physician who frequently dealt with infertility in others had been infertile for years. Tom had had s.e.m.e.n a.n.a.lysis and she had had a battery of tests. But no cause of the infertility was uncovered, and she and Tom had been quickly caught up in the responsibilities of their medical personas. Those demands were so heavy for each of them that gradually they had drifted apart. If their marriage had been more substantial, doubtless in recent years she would have considered insemination or in vitro fertilization, or perhaps adoption. By now, neither she nor her husband was interested.

Long ago R.J. had become aware of two things: that she had married an insubstantial man and that he was seeing other women.

3.

BETTS.

R.J. knew Tom had been as surprised as anyone when Elizabeth Sullivan had come back into his life. He and Betts had lived together for two years in Columbus, Ohio, when they were young. At that time she was Elizabeth Bosshard. From what R.J. heard and saw when Tom talked about her, he must have cared for her a great deal, but she had left him after she met Brian Sullivan.

She had married Sullivan and moved to the Netherlands, to The Hague, where he was a marketing manager for IBM. Several years later he was transferred to Paris, and less than nine years after their marriage he had suffered a stroke and died. By that time Elizabeth Sullivan had published two mystery novels and had a large readership. Her protagonist was a computer programmer who traveled for his company, and each book took place in a different country. She traveled wherever the books led her, generally living a year or two in the country she was writing about.

Tom had seen Brian Sullivan's obituary in the New York Times and had written a letter of condolence to Betts and received a letter in return. Other than that, he'd not even had a postcard from her, nor had he thought much about her for years until the day she telephoned him and told him she had cancer.

"I've seen doctors in Spain and in Germany, and I know the disease is advanced. I decided to come home to be sick. The physician in Berlin suggested someone at Sloan-Kettering in New York, but I knew you were a doctor in Boston, so I came here."

Tom knew what she was telling him. Elizabeth's marriage, too, had been childless. She had lost her father in an accident when she was eight, and her mother had died four years later of the same kind of cancer that Betts now had. She had been raised well by her father's only sister, who now was an invalid in a nursing home in Cleveland. There was no one but Tom Kendricks for her to turn to.

"I feel so bad," he told R.J.

"Of course you do."

The problem was well beyond the skills of a general surgeon. Tom and R.J. talked it over, considering whatever they knew about Betts's case; it was the first time in a long while that they had shared such a meeting of the minds. Then he had arranged for Elizabeth to be seen at the Dana-Farber Cancer Inst.i.tute, and he had spoken to Howard Fisher about her after she was examined and tested.

"The carcinoma is widely traveled," Fisher had said. "I've seen patients go into remission who were worse off than your friend, but I'm sure you understand that I'm not hopeful."

"I do understand that," Tom had said, and the oncologist had blocked out a treatment regimen that combined radiation and chemotherapy.

R.J. had liked Elizabeth at sight. Her husband's ex-lover was a full-bodied, round-faced woman who dressed as wisely as a European but who had allowed middle age to make her comfortably heavier than was fashionable. She wasn't prepared to give up; she was a fighter. R.J. had helped Betts find a one-bedroom condominium on Ma.s.sachusetts Avenue, and she and Tom saw the ailing woman as often as possible, as friends and not as doctors.

R.J. took her to see the Boston Ballet do Sleeping Beauty and to the first autumn concert of Symphony, sitting high up in the balcony and giving Betts her own seventh-row-center seat in the orchestra.

"You have only the one season ticket?"

"Tom doesn't go. We have different interests. He likes to go to hockey games and I don't," R.J. said, and Elizabeth nodded thoughtfully and said she had enjoyed watching Seiji Ozawa conducting.

"You'll like the Boston Pops next summer. People sit at little tables and drink champagne and lemonade while they listen to lighter stuff. Very gemutlich."

"Oh, we must go!" Betts said.

The Boston Pops wasn't in the cards for her. Winter was very young when her disease took hold; she had needed the apartment only seven weeks. At Middles.e.x Memorial Hospital they gave her a private room on the VIP floor and her radiation treatments were stepped up. Very quickly her hair fell out and she began to lose weight.

She was so sensible, so calm. "It would make a really interesting book, you know?" she said to R.J. "Only, I don't have the energy to write it."

A genuine warmth had developed between the two women, but late one night when the three of them sat in her hospital room it was Tom she looked at. "I want you to make me a promise. I want you to swear you won't allow me to suffer or linger."

"I do," he said, almost a nuptial vow.

Elizabeth wanted to review her will and to draw up a living will stipulating that she didn't want her life artificially prolonged by drugs or technology. She asked R.J. to get her a lawyer, and R.J. called Suzanna Lorentz at WiG.o.der, Grant and Berlow, the firm where she had once worked briefly herself.

A couple of evenings later, Tom's car was already in the garage when R.J. got home from the hospital. She found him sitting at the kitchen table, having a beer while he watched television.

"Hi. That Lorentz woman call you?" He snapped off the TV.

"Hi. Suzanna? No, I haven't heard from her."

"She called me. She wants me to be Betts's legal health care agent. But I can't. I'm her a.s.sociate physician of record, and it would represent a conflict of interest, wouldn't it?"

"Yes, it would."

"So will you? Be her legal health care agent, I mean?"

He was gaining weight and looked as if he hadn't been sleeping enough. There were cracker crumbs on his shirtfront. She was saddened by the fact that an important part of his life was dying.

"Yes, that will be all right."

"Thank you."

"You're welcome," she said, and went up to her room and went to bed.

Max Roseman faced a long convalescence and had decided to retire. R.J. didn't get the news from Sidney Ringgold; indeed, Dr. Ringgold made no official announcement. But Tessa came in with the intelligence, beaming. She wouldn't reveal her source, but if R.J. had to bet, she'd have placed her money that Tessa had been told by Bess Harrison, Max Roseman's secretary.

"Word has it that you're among those being seriously considered as Dr. Roseman's replacement," Tessa said. "Whoo-eee! I think you have a real good chance. I think that for you the job of a.s.sociate chief would be the first rung of a tall, tall ladder. Would you rather aim at becoming dean of the medical school or director of the hospital? And whatever you end up doing, are you going to take me with you all the way?"

"Forget it, I'm not going to get that job. But I'm always going to take you with me. You hear so many rumors. And you get my coffee every morning, you d.a.m.n fool."

It was one of many rumors that floated all about the hospital. Now and again someone would say something sly and knowing, sending her a message that the world was aware of her name on a list. She wasn't holding her breath. She didn't know if she wanted the job enough to accept it if it were offered.

Soon Elizabeth had lost enough weight so that for a brief time R.J. was able to get a faint inkling of what she had looked like as the slim young girl Tom had loved. Her eyes seemed larger, her skin grew translucent. R.J. knew she teetered on the brink of gauntness.

There existed between them a curious intimacy, a world-weary knowledge that was closer than sisterhood. Partly, it was due to the fact that they shared memories of the same lover. R.J.'s mind wouldn't allow her to imagine Elizabeth and Tom having s.e.x. Had his lovemaking habits been the same? Had he cradled Elizabeth's b.u.t.tocks in his hands, had he kissed her navel after he was spent? Elizabeth must have some of the same thoughts when she looked at her, R.J. realized. Yet there was no jealousy in them; they were drawn close. Even burdensomely sick, Elizabeth was sensitive and astute. "Are you and Tom going to split?" she asked one night when R.J. had stopped to see her on the way home.

"Yes. Very soon, I think."

Elizabeth nodded. "Sorry," she whispered, finding the strength to console; but clearly, the confirmation came as no great surprise to her. R.J. wished they could have known each other for years.

They would have been wonderful friends.

4.

MOMENT OF DECISION.

Thursdays.

When R.J. was younger she had made a great many political statements. Now, it seemed to her that she had only Thursdays.

She placed special value on babies and disliked the notion of canceling them. Abortion was ugly and messy. Sometimes it got in the way of her other professional activities because a few of her colleagues disapproved, and for public relations reasons her husband had always feared and hated her involvement.

But there was an abortion war waging in America. A lot of doctors were driven from the clinics, intimidated by the ugly and unsubtle threats of the anti-abortion movement. R.J. believed it was a woman's right to make decisions about her own body, so every Thursday morning she drove to Jamaica Plain and sneaked into the Family Planning Clinic the back way, avoiding the demonstrators, the placards shaken at her head, the crucifixes jabbed at her, the thrown blood, the bottled fetuses stuck into her face, and the name-calling.

On the last Thursday in February she parked in the driveway of Ralph Aiello, a neighbor who was paid by the abortion clinic. The snow in the Aiello backyard was deep and new, but he had earned his money by shoveling a narrow path to the gate in the back fence. The backyard of the clinic property was on the other side of the gate, where another narrow shoveled path led to the rear door of the clinic building.

R.J. always made the walk from her car a quick one, afraid that demonstrators would burst around from the sidewalk in front of the clinic, and angry and illogically ashamed that she had to sneak to her work as a doctor.

On that Thursday there was no noise coming from the front of the building, no screams, no curses, but R.J. was particularly troubled, having stopped to see Elizabeth Sullivan on her way to work.

Elizabeth had traveled beyond the point of any hope and had entered the realm of intractable pain. The b.u.t.ton she was allowed to press for self-medication had been inadequate almost from the start. Whenever she regained consciousness she suffered terribly, and now Howard Fisher had begun to give her very heavy doses of morphine.

She slept in her bed without moving.

"Hi, Betts," R.J. had said loudly.

She had placed her fingers against Elizabeth's warm, faintly pulsing neck. In a moment, almost against her will, she had enclosed the other woman's hands in her own. From somewhere deep within Elizabeth Sullivan information had flowed into R.J. and found its way into her consciousness. She had sensed the smallness of the reservoir of life, depleting steadily in incremental amounts, with infinitesimal slowness. Oh, Elizabeth, I'm sorry, she told her silently. I'm so sorry, dear.

Elizabeth's mouth had moved. R.J. bent over her, straining to hear.

"... green one. Take the green one."

R.J. had mentioned the incident to one of the ward nurses, Beverly Martin.

"G.o.d love her," the nurse said. "Usually she never wakes up enough to say anything."

That week it was as if the screws suddenly were tightened on all the torture vises that brought stress to R.J. An abortion clinic in New York State had been set afire in the night, and the same sick pa.s.sion was alive in Boston. Large, turbulent protest demonstrations, manic at times, had hit two clinics in Brookline, one run by Planned Parenthood and the other by Preterm. They had led to disruption of services, a large police response, and ma.s.s arrests, and it was expected that the Family Planning Clinic in Jamaica Plain was next.