The Cole Trilogy: The Physician, Shaman And Matters Of Choice Part 137

30.

A SMALL TRIP.

"After all, what is a lie? 'Tis but the truth in masquerade," Byron wrote. R.J. hated the masquerade.

"I'm taking your daughter to Boston for a couple of days, my treat, if it's okay with you, David. Girls only."

"Wow. What's in Boston?"

"There's a revival road company production of Les Miserables, for one. We'll pig out and do some very serious window-shopping. I want us to get to know one another better." She felt demeaned by the deception, yet she knew no other way.

He was delighted, kissed her, and sent them off with his blessings, in high good humor.

R.J. telephoned Mona Wilson at the Jamaica Plain clinic and told her she would be bringing in Sarah Markus, a seventeen-year-old patient who had entered the second trimester of pregnancy.

"This kid means a lot to me, Mona. A whole lot."

"Well, R.J., we'll offer her every amenity," Mona said, a little less warm than she had been.

R.J. got the message that to Mona every patient was special, but she persisted doggedly. "Is Les Ustinovich still working there?"

"Yes, he is."

"Could she have Les, please?"

"Dr. Ustinovich for Sarah Markus. She's got him."

When R.J. picked her up at the log house, Sarah was too bright, too cheerful. She was wearing a loose two-piece outfit on the advice of R.J., who had explained that she would only have to disrobe the lower part of her body.

It was a mild summer day, the air clear as gla.s.s, and R.J. drove slowly and carefully down the Mohawk Trail and Route 2, making Boston in less than three hours.

Outside the clinic in Jamaica Plain there were two boredlooking policemen R.J. didn't recognize, and no demonstrators. Inside, the receptionist, Charlotte Mannion, took one look at her and let out a whoop. "Well, h.e.l.lo, stranger!" she said, and hurried from behind her desk to kiss R.J.'s cheek.

The turnover had been high; half the staff people R.J. saw that morning were unknown to her. The other half made a fuss over seeing her again, which she found especially gratifying because it visibly gave Sarah confidence. Even Mona had gotten over her snit and hugged her long and hard. Les Ustinovich, rumpled and grumpy as always, gave her the briefest of smiles, but it was warm. "How's life on the frontier?"

"Very good, Les." She introduced Sarah to him and then took him aside and told him quietly how important his patient was to her. "I'm glad you were free to take care of her."

"Yeah?" He was studying Sarah's forms, noting that Daniel Noyes had done the pre-clinic physical instead of R.J. He looked at her curiously. "She something to you? Your niece? Or a cousin?"

"Her father is something to me."

"Oh-ho! Lucky father." He started to turn away but came back. "You want to a.s.sist?"

"No, thank you." She knew Les was being gracious, a stretch for him.

She stayed with Sarah through several hours of first-day preliminaries, taking her through admitting and medical screening. She waited outside, reading a two-month-old Time during the counseling session, most of which would be a repeat for Sarah because R.J. had gone over every detail with her as carefully as possible.

The last stop of the day was in a procedure room for laminaria insertion.

R.J. stared sightlessly at Vanity Fair, knowing that in the room next door Sarah would be on the examining table, her feet in the stirrups, while BethAnn DeMarco, a nurse, inserted a two-inch twist of seaweed, like a tiny stick, into her cervix. In first-trimester abortions, R.J. had dilated the cervix with stainless steel rods, each one larger than the last. A second-trimester procedure required a larger opening to enable the use of a larger cannula. The seaweed expanded as it absorbed moisture overnight, and by the next day the patient didn't need further dilation.

BethAnn DeMarco accompanied them to the front door, telling R.J. the whereabouts of several people with whom they had worked. "You might just feel a little pressure," the nurse told Sarah casually, "or the laminaria might give you some cramps tonight."

From the clinic they went to a suite hotel overlooking the Charles River. After they registered and went up to the room, R.J. whisked Sarah off to Chef Chang's for dinner, thinking to razzle-dazzle her with sizzling soup and Peking duck. But razzle-dazzle was difficult because of discomfort; halfway through dessert they abandoned the ginger ice cream because the "little pressure" DeMarco had mentioned was rapidly becoming cramps.

By the time they got back to the hotel, Sarah was pale and racked. She took the crystal heartrock from her purse and placed it on the night table where she could see it, and then she curled up like a ball on one of the beds, trying not to weep.

R.J. gave her codeine, and finally she kicked off her shoes and lay down next to the girl. She was painfully certain she would be rebuffed, but Sarah snuffled into her shoulder when R.J. put her arms around her.

R.J. stroked her cheek, smoothed her hair. "You know, honey, in a way I wish you hadn't been so healthy up to now. I wish you'd needed a few fillings at the dentist's, maybe even had your tonsils and your appendix out, so you'd understand that Dr. Ustinovich is going to take care of you and that this will pa.s.s.

"Just tomorrow, and then it will be over," R.J. said, patting Sarah's back gently and even rocking her a bit. It felt right, and they lay like that for a long time.

Next morning they arrived at the clinic early. Les Ustinovich hadn't had his morning coffee yet and gave them a nod and a grunt. By the time he'd had his caffeine fix, DeMarco had ushered them into the treatment room, and Sarah was positioned on the table.

She was pale, rigid with tension. R.J. held her hand as DeMarco administered the paracervical block, an injection of 20 cc of Lidocaine, and then started the IV. As luck would have it, DeMarco made a couple of false tries with the IV needle before she found the vein, and Sarah was gripping R.J.'s hand so tight it hurt. "This will make you feel better," R.J. said as DeMarco started conscious IV sedation, 10 mcg of Fentanyl.

Les Ustinovich came in and looked at their welded hands. "I think you'd better go to the waiting room now, Dr. Cole."

R.J. knew he was right. She reclaimed her hand and kissed Sarah on the cheek. "I'll see you in just a little while."

In the waiting room she settled onto a hard chair between a skinny young man who was concentrating on biting off a cuticle and a middle-aged woman who was pretending to read a tattered issue of Redbook. R.J. had brought the New England Journal of Medicine but she had a hard time concentrating. She was thoroughly familiar with the timetable and knew exactly what probably was happening to Sarah. The curettage was done in two stages of suctioning. The first was called "the long session" and took about a minute and a half. Then, after a pause, the second, touch-up suctioning was briefer. She hadn't had time to make her way through an entire article before Les Ustinovich came to the door and beckoned to her.

He had only one clinical manner, bluntness.

"She's aborted, but I perforated her."

"Jesus Christ, Les!"

He froze her with a glance that brought her to her senses. He undoubtedly felt bad enough without salt in the wound.

"She jerked her body at just the wrong moment. G.o.d knows she wasn't feeling any pain, but she was a nervous wreck. The perforation of the uterus took place where she has a fibroid tumor, so there's some ripping and tearing. She's bleeding a lot, but she'll be all right. We've got her packed, and the ambulance is on its way."

From then on, everything went into very slow motion for R.J., as if suddenly she existed under deep water.

She never had perforated a uterus during her time at the clinic, but she always had worked on women in the first trimester. Perforations happened very rarely, and they required surgical repair. Luckily, Lemuel Grace Hospital was only minutes away, and the ambulance was there almost before she had finished rea.s.suring Sarah.

She made the short ride with Sarah, who was taken to the operating room on arrival.

She didn't have to request a surgeon. Sarah was a.s.signed a gynecologist whom R.J. knew by reputation. Sumner Harrison. He was supposed to be very good, the luck of the draw.

The place that once had been so familiar to her was slightly out of focus. A lot of strange faces. Two familiar people smiled and said h.e.l.lo as they pa.s.sed her in the corridor, hurrying from someplace to someplace.

But she remembered where the telephones were located. She picked up a phone, ran her credit card through the slot, and dialed the number.

He picked it up after two rings.

"h.e.l.lo, David? This is R.J."

31.

A RIDE DOWN THE MOUNTAIN.

By the time David got to Boston, Sarah was out of surgery and doing nicely. He sat by her bed and held her hand as she emerged from anesthesia. At first Sarah wept to see him and watched him warily, but R.J. thought he handled her in exactly the right way; he was tender and supportive and gave no indication he wasn't completely in control of his thirst.

R.J. thought it best to give them some time alone. She wanted to know details of what had happened, and she telephoned BethAnn DeMarco and asked her if they might meet for dinner. BethAnn was free, and they met in a small Mexican restaurant in Brookline, near where BethAnn lived.

"This morning was something, wasn't it?" DeMarco said.

"Some morning."

"I can recommend the arroz con polio, very good," BethAnn said. "Les feels bad. He doesn't talk about it, but I know him. I've worked at the clinic four years, R.J., and this is only the second perforation I've seen."

"Who did the other one?"

BethAnn looked uncomfortable. "It happened to be Les. But it was so innocuous it didn't require surgery. All we had to do was pack her and send her home for bed rest. That wasn't Les's fault this morning. The girl just gave an involuntary lurch, like a big twist, and the curette penetrated. That doctor who examined her out where you live ..."

"Daniel Noyes."

"Well, Dr. Noyes can't be faulted either. For missing the fibroid, I mean. It wasn't large, and it was in a little fold of tissue, impossible to see. If it had been just the perforation, or just dealing with the fibroid, it would have been easier to handle. How's she doing?"

"She seems to be fine."

"Well, all's well that ends well. Me for the arroz con pollo. How about you?"

R.J. didn't care; she had the arroz con pollo too.

It wasn't until later that evening, when she and David were alone, that he began to formulate the hard questions that she found difficult to answer.

"What in h.e.l.l were you thinking of, R.J.? Don't you know you should have consulted me?"

"I wanted to, but Sarah wouldn't hear of it. It was her decision, David."

"She's a child!"

"Sometimes pregnancy makes women out of children. She's a seventeen-year-old woman, and she insisted on dealing with her own pregnancy. She went before a judge, who decided she was mature enough to end the pregnancy without bringing you into it."

"I suppose you arranged for her to see the judge?"

"At her request. Yes."

"G.o.d d.a.m.n you, R.J. You acted as if her father were a stranger to you."

"That isn't fair."

When he didn't answer, she asked if he intended to stay in Boston until Sarah was released from the hospital.

"Of course."

"I have patients waiting to see me. So I'll go back."

"Yes, you do that," he said.

It rained hard for three days in the hills, but the day Sarah came home the sun was warm, and the spicy smell of the summer woods was in the soft breeze. "What a day for riding Chaim!" Sarah said. It was good for R.J. to see her smile, but she was pale and tired-looking.

"Don't you dare. You stay in and rest for a few days. That's important. Do you understand?"

Sarah smiled. "Yes."

"This is a chance for you to listen to some ba-ad music." She had bought the newest Pearl Jam CD, and Sarah's eyes filled when R.J. gave it to her.

"R.J., I'll never forget ..."

"Never mind that. Now, you take care of yourself, sweetheart, and get on with your life. Is he still angry?"

"He'll get over it. He will. We'll honey-hug and sweet-talk him."

"You're a great girl." R.J. kissed her on the cheek. She decided she had to talk to David without delay. She walked out to the barnyard, where he was unloading bales of hay from his pickup truck. "Will you please come to dinner tomorrow night? Alone?"

He looked at her and then nodded his head. "All right."

The next morning shortly after eleven she was preparing to drive down into Greenfield to visit two hospitalized patients when her telephone rang.

"R.J., it's Sarah. I'm bleeding."

"A lot or a little?"

"A lot. A whole lot."

"I'll be right there." She called the ambulance first.