The Cole Trilogy: The Physician, Shaman And Matters Of Choice Part 125

The Medical Incidents Committee met on the following week. It was not a lengthy session. In the face of clear evidence and testimony that Elizabeth Sullivan was dying and in terrible pain, they decided unanimously that Dr. Thomas A. Kendricks had not acted unprofessionally in heavily sedating Mrs. Sullivan.

A few days after the meeting Phil Roswell, one of the committee members, told R.J. there had been no debate. "d.a.m.n it, let's be honest. We all do that to hasten a merciful end when death is close and inevitable," Roswell said. "Tom wasn't trying to hide a crime, he wrote the order honestly, right there in her chart. If we punished him, we'd have to punish ourselves and most of the doctors we know."

Nat Rourke had a discreet chat with the district attorney and came away with the knowledge that Wilhoit did not intend to bring Elizabeth Sullivan's death to the grand jury.

Tom was exultant. He wanted to turn a page in his life, anxious to get on with the divorce and begin his new marriage.

R.J.'s mood was exacerbated by the beggars who were everywhere. She had been born and raised in Boston and she loved it, but now she couldn't bear to look at the street people. She saw them throughout the city, sifting through the trash cans and Dumpsters, trundling their few possessions in shopping carts stolen from the supermarkets, sleeping in shipping crates on cold loading docks, lined up for free meals at the soup kitchen on Tremont Street, taking over the benches in Boston Common and other public places.

To her, homeless people were a medical problem. In the 1970s, psychiatrists had lobbied to phase out the ma.s.sive stone public asylums where the insane had been stockpiled under shameful conditions. The idea was that patients would be returned to freedom to live in harmony alongside the sane, as was being done successfully in several European countries. But in America the community mental health centers set up to serve the freed patients were underfunded, and they failed. Patients scattered. It was impossible for psychiatric social workers to keep track of someone who slept in a cardboard carton one night and miles away over a steam grate the next night. All over the United States, alcoholics, drug addicts, schizophrenics, and every variety of the mentally ill made up an army of the homeless. Many of them turned to begging, some soliciting on subways and buses with loud speeches and pitiful stories, others sitting against a building with a cup or overturned cap next to crude signs making their pleas: "Will work for food. Four children at home." R.J. had read a study estimating that 95 percent of America's beggars were addicted to drugs or alcohol, and that some begged up to three hundred dollars a day, money they promptly spent on substance abuse. R.J. thought with great guilt of the 5 percent who weren't addicted, merely homeless and jobless. Still, she steeled herself against giving and was furious when she saw someone dropping a dime or a quarter into a cup instead of pressuring politically to get homeless people off the streets and into adequate care.

It wasn't only the homeless; all the ingredients of her existence in the city got on her nerves-the ending of her marriage, the depersonalization of her profession, the daily paperwork grind, the traffic, the fact that she hated to go to work now in a place where Allen Greenstein had beaten her out of a job.

Everything merged into a bitter c.o.c.ktail. Realization slowly dawned that it was time for her to change her life drastically, to leave Boston.

The two medical communities where there were programs into which someone with her hybrid interests might fit were Baltimore and Philadelphia. She sat down and wrote letters to Roger Carleton at Johns Hopkins and Irving Simpson at Penn, asking if they were interested in her services.

Long ago she had arranged for her spring calendar to be clear for a week, dreaming about St. Thomas. Instead, on a warm Friday afternoon she got away from the hospital early and went home to pack a few things she could wear in the country. She had to dispose of the Berkshires property.

She had left the house and was getting into the car when she remembered Elizabeth's ashes, and she went back inside and took the cardboard box from the top of the bureau in the guest room, where she had put it when she brought it home.

She couldn't bring herself to put the ashes into the trunk with her suitcase. Instead, she placed the small box on the seat next to her and put her folded raincoat in front of it so it wouldn't roll off if she had to stop short.

Then she drove to the Ma.s.s Pike and pointed the red BMW west.

9.

WOODFIELD.

Even before the Georgian house on Brattle Street had been restored and furnished to their satisfaction, her marriage to Tom had begun to unravel. When they had found a charming property on a Berkshires mountainside in the township of Woodfield, in western Ma.s.sachusetts near the Vermont line, they bought it and used the project of a vacation home to try to reinvent their "togetherness." The small yellow frame house was about eighty-five years old, surviving st.u.r.dily next to an old tobacco barn that had begun to sag badly, like their relationship. There were seven acres of fields and thirty-nine acres of tangled old New England woods, and the Catamount, one of Woodfield's three small mountain rivers, ran through both the forest and the meadow.

Tom had hired a contractor to dig a swim pond out of a wet place in the pasture, and the bulldozer unearthed the small, stubborn remains of an infant child. The connective tissue had long since disappeared. What was left could have been mistaken for chicken bones save for the unmistakably human skull, like a delicate hardened mushroom, in three sections. There was no grave marker and the land was too marshy to be a cemetery. The find had caused a local stir; n.o.body in the town knew how the fetus had gotten there.

Maybe the buried child had been Indian. The medical examiner said the little bones were old. Not eons, but certainly they had been buried long ago.

Found in the earth above the bones had been a small earthenware plate. When it was washed, a series of rust-colored letters came into view, now terribly faded. What had been written on the plate couldn't be read. Most of the letters were gone, but a few remained: ah, and od. And o, and again, od. Despite the sifting, a few of the small bones never were recovered. The county medical examiner had pieced together enough of the tiny skeleton to determine that it had been almost but not quite full-term, but the s.e.x was unknown. The coroner took the bones away, but when R.J. asked if she could have the plate, he shrugged and gave it to her. She had kept it ever since in the breakfront in the parlor.

The Ma.s.sachusetts Turnpike is unexciting over most of its length. It was only when she had left the turnpike near Springfield and driven north on 1-91 that she first saw the low, worn-down mountains and began to feel happy. I will lift up mine eyes unto the hills, from whence cometh mine help. In another half hour she was in the hills, climbing roads that twisted and undulated, pa.s.sing farms and forest, until she turned onto Laurel Hill Road and then drove down the long and winding driveway to the wood-frame farmhouse, the color of b.u.t.ter, that hugged the fringe of woods at the far end of the meadow.

She and Tom hadn't used the country house since the previous fall. When she opened the door the air was heavy and slightly bitter. There were droppings on a windowsill in the parlor, like mouse feces only larger, and with a quick return of the bad feeling that had plagued her for days, she told herself there was a rat in the house. But in a corner of the kitchen she found the desiccated remains of a bat. The first job she gave herself was to fetch the dustpan and broom and dispose of bat and droppings. She turned on the refrigerator, threw open the windows to let in fresh air, and carried in her supplies, two cartons of groceries and a cooler with perishables. Hungry but unambitious, she made a supper of a hard and tasteless supermarket tomato, a kaiser roll, two cups of tea and a package of chocolate cookies.

Brushing the crumbs off the table, she realized with a pang that she had forgotten about Elizabeth.

She went outside and brought in the box of ashes from the car, setting it on the fireplace mantel. She would have to discover the beautiful place Elizabeth had trusted her to find, and bury the ashes. She was drawn outside again and took a few steps into the woods, but they were dark and tangled. There was no way to explore them except by climbing over or under downed trees and bulling through brush and brambles, and something in her wasn't ready for them, so she beat a hasty retreat and walked down the gravel driveway to Laurel Hill Road. It was an oiled gravel road, almost three miles long, rising and falling in several hills. She was glad to walk. A mile and a quarter down the road, she approached the small white farmhouse and enormous red barn of Hank and Freda Krantz, the farmers who had sold Tom and her their place. She turned around before she reached their door, for the moment not wanting to answer questions about Tom and explain the end of her marriage.

The sun was down when she got back to the house, and the clear air was sharply cold. She closed all the windows but one. There was dry wood in the shed, and she built a small blaze in the fireplace and took away the chill. As dusk fell, the shrill of peepers in the pond spillway came through the open window, and she sat on the couch and drank hot, black coffee that was sweet enough to guarantee weight gain, and watched the fire.

The next morning she slept late, had eggs for brunch, and then indulged in a frenzy of housecleaning. Because she so seldom was required to do housework she enjoyed it, and now she gained satisfaction out of vacuuming, sweeping, dusting. She washed all the pots and pans, but only a few dishes and utensils, just the things she would need.

She knew the Krantzes ate midday farm dinners promptly at noon, so she waited until 1:15 and then walked up the road and knocked on their door.

"Well, look who's here," Hank Krantz boomed. "Come in, come in."

They welcomed her into their kitchen, and Freda Krantz poured her a cup of coffee without asking and cut a wedge from half a white cake that was on the counter.

R.J. didn't know them that well, really, seeing them only on her infrequent visits, but she saw honest regret in their eyes as she told them about the divorce and asked their advice about the best way to sell the house and land.

Hank Krantz scratched his face. "You could go to a real estate agent in Greenfield or Amherst, of course, but nowadays most folks sell through a fella named Dave Markus, right here in town. He advertises and gets good prices. And he's a straight shooter. Not a bad sort at all for a fella from New York."

They told her how to get to Markus's house. She drove first to the state highway and then off it and down a series of very b.u.mpy gravel roads that didn't do her car any good. In a clover field a lovely Morgan horse, brown with a white face blaze, ran alongside her car on the inside of the fence and then pa.s.sed her, tail and mane streaming. There was a real estate sign outside a handsome log house looking out on a splendid view. A second sign made her smile: I'M-IN-LOVE-WITH-YOU

HONEY.

Jars of amber honey were stacked in two old bookcases on the porch. Inside, radio rock music blared: The Who. A teenaged girl with long black hair came to the door. Freckled, heavy-breasted, angel-faced behind thick gla.s.ses, she was dabbing a cotton ball against a b.l.o.o.d.y pimple on her pointed chin.

"Hi, I'm Sarah, my father's away. He'll be back tonight." She scribbled R.J.'s name and telephone number and promised her father would call. While R.J. bought a jar of honey, the horse whinnied behind the fence.

"He's such a d.a.m.ned busybody," the girl said. "Want to give him his sugar?"

"Sure."

Sarah Markus got two cubes of sugar and gave them to her, and they walked to the fence together. R.J. presented the cubes timidly, but the big square horse teeth missed the flesh of her palm, and the lapping rough tongue made her smile. "What's his name?"

"Chaim. He's Jewish. My father named him for a writer."

R.J. was beginning to relax as she waved good-bye to the girl and the horse and drove back down the road lined with tall trees and old stone walls.

Main Street in Woodfield contained the post office and four businesses-Hazel's, an establishment that couldn't make up its mind if it was a hardware store or a gift shop; Buell's Expert Auto Repair; Sotheby's General Market (Est. 1842); and Terry's, a modern convenience store with a couple of gas pumps out front. R.J. was partial to the funky general store. Frank Sotheby always had a wheel of sharp aged cheddar that made her mouth water. He sold maple syrup, cut his own meat, and made his own sausage, sweet and hot.

There was no lunch counter. "Would you make me a sandwich, cheddar on a roll?"

"Why not?" the storekeeper said. He charged her a dollar, and fifty cents for an Orange Crush. She had her lunch sitting on the bench on the store porch, watching the village go by. Then she went back into the store and recklessly cast aside her usual low-cholesterol approach to food, buying a sirloin steak, sweet sausage, and a wedge of the good cheese.

That afternoon she put on her oldest clothes and some boots and braved the woods. Just a few feet in, it was another world, cooler, dark, quiet with only the wind through billions of leaves, a gentle acc.u.mulated rustle that sometimes became as loud as surf and made her feel holy, and also a little scared. She was counting on the supposition that large animals and monsters would be frightened off by the disturbance she was making without trying, stepping on branches that snapped and generally moving clumsily through the close-grown forest. Now and again she came to a tiny clearing that gave respite, but there was no inviting place to rest.

She followed a brook to the Catamount River. She estimated she was close to the midpoint of her property, and she traced the river downstream. The bank was as overgrown as the woods and the going was hard; despite the spring coolness she found that she was sweating and exhausted, and when she came to a large granite rock that projected from the bank into the water, she sat on it. She studied the pool and could see small trout hovering at mid-depth in the shelter of the rock, sometimes moving in unison like a squadron of fighter planes. The water at the tail of the pool was rushing and high with snowmelt, and she lay full-length on the warm rock in the hot sun and watched the fish. Once in a while she felt a spray like a whisper of ice on her cheek.

She stayed out late until she was exhausted, then she struggled back through the woods, flopped on the couch and napped for two hours. When she woke up she fried potatoes and onions and peppers, and pan-fried the steak medium rare, and gobbled everything in sight, finishing with honey-sweetened tea. Just as the last light was squeezed out of the sky outside she was settling down for coffee before the fire and listening to another peepers concert, when the telephone rang.

"Dr. Cole, G.o.d, it's Hank. Freda's shot, my rifle went off-"

"Where was she hit?"

"The upper leg, under the hip. She's bleeding something fierce, it's just pumping out."

"Get a clean towel and press it against the wound, hard. I'm coming."

10.

NEIGHBORS.

She was on vacation, she had no medical bag. Her car wheels scattered gravel, the high beams battling crazy shadows as the BMW sped up the road and turned into the drive, the left tires wounding the lawn Hank Krantz maintained so neatly. She drove up to the front door and went into the house without knocking. The errant rifle was on the newspaper-covered kitchen table, along with rag patches, a ramrod, and a small can of gun oil.

Freda, white-faced, lay on her left side in blood. Her eyes were closed, but she opened them and looked at R.J. Hank had half removed her jeans. He was kneeling, holding a saturated towel against her lower thigh. His hands and sleeves were smeared. "My G.o.d. G.o.d in heaven, look what I did to her."

He was in misery, but he was keeping a tight rein on himself. "I called the town ambulance," he said.

"Good. Take a fresh towel. Just put it on top of the soaked one and continue to bear down." She knelt and with her fingers palpated the flesh where the thigh met the torso, next to the black pubic hair that showed through Freda's cotton underpants. When she felt the pulsations of the femoral artery she placed the heel of her palm over the spot and pressed. Freda was a large and heavy woman, and years of farm work had made her muscular. R.J. had to bear down hard to try to compress the artery, and Freda opened her mouth to scream, but only a low moan came out.

"Sorry ..." While the fingers of R.J.'s left hand maintained pressure, her right hand searched lightly and carefully under Freda's thigh. When she found the exit wound, Freda shuddered.

R.J. was taking the pulse in Freda's throat when the first animal wail of the siren reached them. Very soon, two vehicles stopped outside and doors slammed. Three people came in-a burly, middle-aged police officer and a man and a woman wearing red polyester jackets. The woman carried a portable oxygen tank.

"I'm a doctor," R.J. said. "She's been shot, she has a broken femur and there's trauma to the artery, maybe it's severed. There's an entry wound and an exit wound. Her pulse is 119 and thready."

The male EMT nodded. "Shocky, all right. Lost a s.h.i.tload of blood, hasn't she," he said, taking in the mess on the floor. "Can you keep holding the pressure point, Doc?"

"Yes, I can,"

"Good, you do that." He knelt on the other side of Freda. Without wasting time, he began doing a swift physical a.s.sessment. He was broad and overweight and young, scarcely more than a boy but with quick, capable hands.

"Was it just the one shot fired, Hank?" he called.

"Yes," Hank Krantz called back angrily, upset by the implications of the question.

"Yeah, one entry wound, one exit," the EMT said when he finished his a.s.sessment.

The small, blond woman already had taken a blood pressure. "Eighty-one over fifty-seven," she said, and the other technician nodded. She set up the portable oxygen unit and fixed a nonrebreathing mask over Freda's mouth and nose. Then she cut away Freda's jeans and underpants, covering her groin with a towel, and removed the sock and tennis shoe from her foot. Grasping the bare foot in both hands, the woman EMT began a steady, concentrated pulling.

The male technician wrapped an ankle hitch around his patient's foot. "This is going to be clumsy, Doc," he said. "We've got to get in there, past your hand, with the splint. You'll have to let up on the pressure for a few seconds."

When she did, Freda's blood began to pump out again. Working quickly, the technicians proceeded to immobilize the leg in a Hare traction splint, a metal frame that fit snugly into the groin area at one end and extended all the way beyond the foot. As soon as she could, R.J. resumed the pressure on the femoral artery, and the bleeding eased. The splint was strapped to the thigh and, on the other end, was secured to the ankle hitch. A little windla.s.s allowed the technicians to tighten it so manual traction no longer was needed.

Freda sighed, and the male EMT nodded. "Yes, I imagine that feels some better, doesn't it." She nodded back, but she cried out when they lifted her and was weeping as they set her down on the gurney. They moved out in a small mob, Hank and the policeman at the front corners of the gurney, the male EMT behind Freda's head, the blond tech carrying the portable oxygen tank, and R.J. trying to maintain her weight on the pressure point as she walked along.

They lifted the gurney into the ambulance and locked it into place. The blonde switched Freda's mask from the portable tank to the on-board oxygen supply, and they elevated her legs and covered her with warm blankets against the shock. "We're a crew member short. You want to come along?" the senior technician asked R.J.

"Sure," she said, and he nodded.

The blond woman drove, Hank beside her in the front seat. As they pulled away from the farmhouse, the driver spoke into her radio, telling the dispatcher they had picked up their patient and were on their way to the hospital. The police car led the way, its roof light turning and its siren laying a ribbon of sound. The ambulance's external flashers had been on while parked, and now the blond woman turned on a two-toned wail, alternately whup-whup-whup and ee-awe, ee-awe, ee-awe.

It was difficult for R.J. to bear down on the pressure point while standing in an ambulance that jounced over b.u.mps and lurched and swayed alarmingly around curves.

"She's bleeding again," she said.

"I know." The EMT was already laying out what looked like the bottom half of a s.p.a.ce suit, a bulky garment that sprouted cables and tubes. He took a quick blood pressure reading and pulse and respiration rates, and then lifted a radio-telephone speaker off the wall and called the hospital, requesting permission to use MAST trousers. After a brief discussion, permission was given, and R.J. helped him to move the trousers into place over the splint. There was a hiss as air was pumped into the garment over the injured leg and it ballooned and became rigid.

"I love this thing. Have you ever used one, Doc?"

"I haven't done much emergency medicine."

"Well, it does everything for you, all at once," the man said. "Stops the bleeding, reinforces the Hare splint to stabilize the leg, and pushes blood up to the heart and brain. But they make us get permission from medical control before we use it, because if there was internal bleeding it would cause a blowout, push all the blood into the abdominal cavity." He checked Freda to make sure she was okay, then he grinned and stuck out his hand. "Steve Ripley."

"I'm Roberta Cole."

"Our demon driver is Toby Smith."

"Hey, Doc!" The driver didn't take her eyes off the road, but in the mirror R.J. saw a winsome grin.

"Hey, Toby," she said.

Nurses were waiting at the ambulance entrance and Freda was taken away. The two EMTs stripped the b.l.o.o.d.y sheets from the gurney and exchanged them for fresh sheets from the hospital supply room; they disinfected the gurney and made it up again before returning it to the ambulance. Then they sat in the waiting room with R.J. and Hank and the policeman. He said he was Maurice A. McCourtney, the Woodfield police chief. "They call me Mack," he told R.J. gravely.

The four of them drooped visibly; their job was done and reaction had set in.

Hank Krantz was making all of them party to his remorse. It was coyotes, he said, they had been around his farm for the better part of a week. He had decided to clean his deer gun and shoot a couple of them, to drive the pack away.

"Winchester, ain't it?" Mack McCourtney asked.

"Yeah, old lever-action Winchester Ninety-four, takes a .30-.30. I've owned it, must be eighteen years now, never had an accident with it. I set it down on the table a little hard, and it just banged off."

"Safety wasn't on?" Steve Ripley said.