The Cole Trilogy: The Physician, Shaman And Matters Of Choice Part 151

"d.a.m.n disease." He motioned to another metal folding chair deeper in the barn. "Set a while?"

"I will." She went to get the chair. She had never been in his barn; it stretched before her into the animal-warmed gloom like an airplane hangar, cows in the stalls on both sides. Far above her under the vast roof something fluttered and dove and fluttered again, and Greg Hinton saw the direction of her glance.

"Just a bat. They stay high."

"Some barn," she said.

He nodded. "Made from two old barns, really. This part was original. The rear half was another barn, moved here by oxen about a hundred years ago. Always figured I'd put in one of those fancy milking parlors, but I never did. Stacia and I milk 'em old-fashioned, with their necks in stanchions so they can't move on us."

He closed his eyes, and she reached over and put her hand over his.

"You think they'll ever find a cure for this rotten thing, R.J.?"

"I think they will, Greg. They're working on genetic cures for lots of diseases, including different kinds of cancer. The next few years are going to make an enormous difference. It's going to be a new world."

His eyes opened and found hers. "How many years?"

The big black-and-white cow in the stall in front of them lowed suddenly, a loud, complaining bawling that startled her. How many years, indeed. She steeled herself. "Oh, Greg. I don't know. Maybe five? Just a guess."

He gave her a bitter trace of a smile. "Well, however many years. I won't be around to see that new world, will I?"

"I don't know. Lots of people with your disease live a number of years. I think it's important that you believe-really believe-that you'll be one of them. I know you're religious, and it won't hurt if you pray a lot right now."

"Will you do me a favor?"

"What's that?"

"Will you pray for me too, R.J.?"

Oh, glory, wrong number. But she smiled at him. "Well, that can't do any harm either, can it?" she said, and promised him she would. The creature in front of them suddenly let out a great call that was answered first by a cow at the other end of the barn and then by others.

"What are you doing sitting out here by yourself, anyway?"

"Well, this one is trying to drop a calf, and she's in trouble," he said, motioning with his chin at the cow in the stall. "She's a heifer cow. You know, never had a calf before?"

R.J. nodded. A primigravida.

"Well, she's tight, and the calf is hung up on her insides. I've called the only two veterinarians around who handle big animals anymore. Hal Dominic is down bad with the flu, and Lincoln Foster is all the way over to the south county with two or three jobs still to do. He said he'd try to be here by eleven o'clock."

The cow sounded again and clambered to her feet. "Easy, there, Zsa Zsa."

"How many cows do you have?"

"Seventy-seven, at the moment. Forty-one of them milkers."

"And you know their names?"

"Just the cows that are registered. See, you have to put names on the registration papers. The ones that aren't registered have numbers painted on their sides instead of names, but this cow is named Zsa Zsa."

The Holstein sank down again as they watched, dropping onto her right side with her legs sticking straight out.

"s.h.i.t. s.h.i.t! Beg your pardon," Hinton said. "They only go to their side like that when they're almost gone. She'll never last until eleven o'clock. She's been trying to give birth for five hours.

"I've got money sunk into her," he said bitterly. "A registered cow like this, I can expect eighty to a hundred pounds of milk per day. And the calf would have been worthwhile. I paid a hundred dollars just for the s.e.m.e.n from a specially good bull."

The cow moaned and shuddered.

"Isn't there something we can do for her?" R.J. asked.

"No, I'm too sick to handle this, and Stacia's absolutely worn out from doing most of the milking. Stacia's no longer young either. She tried to deal with this for a couple of hours and just couldn't, had to go into the house and lie down."

The cow bellowed in pain, climbed to her feet, sank back onto her belly.

"Let me have a look," R.J. said. She took off her Italian leather jacket and placed it on a bale of hay. "Will she kick me?"

"Not likely, lying down like that," Hinton said dryly, and R.J. approached the cow and squatted in the sawdust behind her. It was a strange sight, a manurial a.n.u.s like a great, round eye above the enormous bovine v.u.l.v.a in which she could see one pathetic hoof and a flaccid red object dangling to the side.

"What's that?"

"Calf's tongue. The head's just below there, out of sight. For some reason, calves often are born sticking their tongues out at you."

"What's holding it back?"

"Normal birth, the calf would be born with the two front hooves first, then the head-the way a diver goes into the water holding his hands out in front of him. This one has the left hoof in the proper position, but the right leg is doubled back somewhere in there. What the veterinarian has to do is push the head back into the v.a.g.i.n.a and reach his hand in to see what's wrong."

"Why don't I give it a try?"

He shook his head. "Takes some little bit of strength."

She watched the cow shudder. "Well, it can't hurt to try. I've never lost a cow yet," she said, but it was wasted, he didn't even smile. "Do you use a lubricant?"

He eyed her doubtfully, then shook his head. "No, you wash your whole arm and just leave plenty of soap on it," he said, leading her to the sink.

She rolled up both sleeves of her shirt until they were all the way to the shoulders, and then she scrubbed in the cold water, using the thick, stained block of laundry soap that was there.

Then she went back behind the cow. "Now, Zsa Zsa," she said, and then felt silly to be speaking to a rear end. As R.J.'s fingers and then her hand entered the warm moistness of inner s.p.a.ce, the cow extended her tail, straight and rigid as a poker.

The calf's head indeed was just below the surface, but it felt immovable. When she looked at Greg, she saw that despite his concern his eyes held a clear I-told-you-so, and R.J. took a breath and leaned into it, as if trying to push a swimmer's head down into almost-solid water. Slowly, the head began to recede. When there was room, she pushed her hand into the cow's v.a.g.i.n.a, wrist deep, then halfway to her elbow, and her fingers found something else.

"I can feel ... I think it's the calf's knee."

"Yeah, probably is. See if you can reach below it, pull the hoof up," Hinton said, and R.J. tried.

She worked her hand and arm deeper but suddenly felt a kind of cosmic ripple as undeniable as a small earthquake, then a rolling force that pushed a tsunami of muscle and tissue against her hand and forearm and simply moved them up and out like a seed spat out so forcefully that her entire body fell back.

"What the h.e.l.l," she whispered, but she didn't need Greg to tell her it was a variety of v.a.g.i.n.al contraction she never had met before.

She took the time to resoap her arm. Back at the cow, she spent several minutes of experimentation before she realized what she was up against. The contractions came once a minute and lasted about forty-five seconds, leaving her only a fifteen-second window in which to work. She pushed her arm deep into the straining b.u.t.t in front of her as soon as she felt a contraction slacken-past the knee, along the foreleg.

"I can feel a bone, the pelvic bone," she told Greg. And then, "I've got the hoof, but it's caught under the pelvic bone."

The rigid tail switched, perhaps in pain, and smacked R.J. in the mouth. Sputtering, she grabbed the tail with her left hand and held it. She was warned by new ripples and had just enough time to grasp the hoof and hold on while a v.a.g.i.n.al vise clamped her arm from fingertips to shoulder. After a moment there was no danger her arm would be expelled, because the pressure around it had become too tight. The pressure pushed the front of her wrist against the cow's pelvic bone. The pain made her gasp, but her arm quickly became numb, and R.J. closed her eyes and dug her forehead into Zsa Zsa. Her arm was captive all the way to the shoulder; she had become a prisoner, joined to this cow. She felt faint and experienced a sudden fantasy, a terrible certainty that Zsa Zsa was going to die, and they would have to cut up the cow's carca.s.s in order to free her.

She didn't hear Stacia Hinton come into the barn, but she caught the woman's cranky challenge-"What's that girl think she's doing in there?"-and an inaudible mumble as Greg Hinton replied. R.J. smelled manure, and the internal odor of the cow, and the animal stink of her own sweat and terror. Then the contraction was over.

She had delivered enough human babies to know now what had to be done, and she withdrew her numbed hand as far as the calf's knee and pushed it back. Then she was able to reach past it, in and down. When her hand found the hoof again, she had to fight against a panic that made her want to rush things, because she didn't want to be in the v.a.g.i.n.a when the next contraction came.

But she worked carefully, grasping the hoof, working it up the v.a.g.i.n.a, and finally out and next to the other hoof, where it belonged.

"Heyyyy!" Greg Hinton breathed in delight.

"Good girl!" Stacia called.

At the next contraction, the calf's head appeared.

h.e.l.lo, there, R.J. told it silently, enchanted. But they were unable to pull more than the forelegs and head from the cow. The calf was stuck like a cork in a bottle.

"If only we had a calf puller," Stacia Hinton said.

"What's that?"

"It's kind of a winch," Greg said.

"Tie the hooves together," R.J. said. She went to the Explorer and released the hook of the come-along, then pulled the cable into the barn.

The calf was drawn out easily-such an argument for technology, R.J. thought.

"Bull calf," Greg said.

R.J. sat on the floor and watched Stacia wipe mucus, the remains of the water bag, from the little bull's nostrils. They brought the calf around to the front of the cow, but Zsa Zsa was exhausted and barely moved. Greg began rubbing the newborn's chest with clumps of dry hay. "This gets the lungs working, that's why the cow always gives the calf a rough licking with her tongue. But this little fella's momma is too tired to lick a stamp."

"Will she be all right?" R.J. asked.

"Sure she will," Stacia said. "I'll get her a nice bucket of warm water in a while. That'll help her pa.s.s the placenta."

R.J. raised herself from the floor and went to the sink. She washed her hands and arm, but it would be impossible to get herself clean there, she saw at once.

"Got some ... ah, manure in your hair," Greg said delicately.

"Don't touch it, it'll just smear, dear," Stacia said.

R.J. stowed the come-along cable and, carrying the leather jacket well in front of her, placed it in the backseat of the car, as far from her as possible.

"Good night."

She scarcely heard their expressions of grat.i.tude. She drove home trying to make as little contact as possible with the car upholstery.

When she was in her kitchen she took off her shirt. The sleeves had rolled down and the front was smeared as well; she identified blood, mucus, soap, manure, and a variety of birth fluids, and she shuddered and rolled it up and dropped it into the trash bin.

She stayed under the hot shower a long time, ma.s.saging her arm and using a great deal of soap and shampoo.

When she got out, she brushed her teeth and then put on her pajamas in the dark.

"What?" David called.

"Nothing," she said, and he went back to sleep.

She had intended to go to sleep too, but instead she went back down to the kitchen and put water on the stove for coffee. Her arm was bruised and aching, but she flexed her fingers and her wrist and her elbow and saw that nothing was broken. She took paper and a pen from her desk and sat at the table to make certain she could write.

She decided to send a letter to Samantha Potter.

Dear Sam, You told me to write if I thought of something a doctor can do in the country that she can't do in a medical center.

Tonight, I thought of something: You can put your arm into a cow.

Yours truly, R.J.

52.

THE CALLING CARD.

One morning R.J. realized to her discomfort that the date was approaching when she would be required to renew her license to practice medicine in the Commonwealth of Ma.s.sachusetts, and she wasn't prepared to apply. The state license had to be renewed every two years, and to safeguard the public, the law required that every physician who applied for relicensing must submit evidence that he or she had taken one hundred hours of continuing medical education (CME).

The system was designed to update medical knowledge and continually sharpen skills, and to prevent doctors from falling below the standards of their profession. R.J. thoroughly approved of the concept of continuing education, but she realized that over a period of almost two years she had accrued only eighty-one CME points. Busy establishing her new practice and working at the Springfield clinic, she had neglected her educational program.

The local hospitals frequently offered lectures or seminars worth a few points, but she didn't have enough time left to fulfill her obligation that way.

"You need to attend a large professional meeting," Gwen said. "I'm in the same position myself."

So R.J. began to study the meeting announcements as she read her medical journals, and she noted that a three-day cancer symposium for primary care physicians would be held in New York City, at the Plaza Hotel. Sponsored jointly by the American Cancer Society and the American Board of Internal Medicine, it offered twenty-eight continuing medical education points.

Peter Gerome agreed that he and Estie would come and stay at her house while she was gone, so Peter could cover for her. He had applied for hospital privileges but they hadn't come through yet, and R.J. arranged for a Greenfield internist to admit any patients who might have to be hospitalized.

David was laboring on his next-to-last chapter, and they agreed he couldn't interrupt his work. So she drove to New York alone, through the pale-lemony sunshine of early November.

She found that although she had been happy to flee the city pressures when she had left Boston, now she was ready to embrace them. After the solitude and quiet of the country, New York seemed like a colossal human anthill, and the interaction of all those people was a powerful stimulant. Driving through Manhattan was no pleasure, and she was content to surrender her car to the doorman at the hotel, but she was glad she had come.

Her room was on the ninth floor, small but comfortable. She took a short nap and then had just enough time to shower and dress. Registration was combined with a c.o.c.ktail party, and she had a beer and helped herself hungrily to the lavish buffet.

She saw no one she knew. There were many couples. At the buffet a doctor whose name tag said he was Robert Starbuck from Detroit, Michigan, struck up a conversation.