The Cole Trilogy: The Physician, Shaman And Matters Of Choice Part 154

54.

THE SOWING.

It was chill in the darkness before sunrise when the wind blew down from the mountain slopes and swept across her meadow to buffet the house. In half sleep, R.J. liked the wind sounds as long as she was snug; she was awakened by burgeoning daylight and huddled under her warm double quilt and thought long thoughts until she forced herself up and out, to turn up the thermostat and jump into the shower.

Her period was several weeks late, she realized as she toweled, and she frowned at a possibility that pushed its way into her consciousness: premenopausal amenorrhea. It forced her to confront the fact that now, or soon, her body would be slowing and changing as obsolescent organs began to shut down, presaging the permanent disappearance of menses; and then she pushed the thought from her mind.

It was Thursday, her free day. As soon as the sun rose fully, it warmed the house, and she turned down the thermostat and built a fire in the stove. It was nice to build wood fires again, but they dried the air and caused an efflorescence of thin gray ash to settle on every surface, and the heartrocks that were everywhere made dusting her house an Augean task.

She found herself standing and staring at a rounded gray river stone. Eventually she set down her dustcloth and went to the closet where she stored her knapsack. She put the gray stone into the knapsack and began to walk about the house, collecting the heartrocks.

When the knapsack was almost full, she lugged it out the back door to the big construction wheelbarrow and let the contents clatter and thump into it. Then she went back into the house and collected more. She kept only the three heartrocks Sarah had given her, and the two stones she had given Sarah, the crystal and the tiny black basalt.

It took her five trips with the knapsack to clear the house of the stones. She dressed for winter-down jacket, stocking cap, work gloves-and went out and grabbed the wheelbarrow handles. The big barrow was more than a third full, and the aggregate of the stones weighed a lot more than she could move in comfort. It took effort to bull it across twenty-five feet of lawn, but once she entered the wood trail, the ground began to dip toward the river, and the barrow seemed to move of its own accord.

The little sunlight that came through the canopy of branches beautifully dappled the rich, deep shade. It was cold in the woods, but the trees broke up the occasional wind gusts, and the wheelbarrow's balloon tire hissed over the damp packed pine needles and then thumped over the s.p.a.ced boards of the Gwendolyn Gabler Bridge.

She stopped pushing as soon as she reached the river, which was brisk and burbling from the autumn rains. She hadn't emptied the last knapsack load into the barrow, and now she took the knapsack and began walking along the trail. The riverbank was lined with trees and brush, but there was access between the tree trunks, and every now and then she would pause and take a heartrock from the knapsack and throw it into the water.

She was a woman of practical method, and she quickly realized a pattern of dispersal: the small rocks were carefully thrown into the shallows at the edge, while the larger specimens went into the depths, mostly in the occasional pools. When she had emptied the knapsack she went back to the barrow and pushed it along the trail, upstream. Then she filled the knapsack and continued to throw away heartrocks.

The heaviest rock in the barrow was the large one she had rescued from the construction ditch in Northampton. Back straining, shoulders hunched, she carried it to the deepest pool, just downstream of a tall and wide beaver dam. It was too heavy to throw; she had to try to carry it out along the brushy dam, to the middle of the pool. At the outset her foot slipped, and she got a boot full of icy water, but slowly and gradually she made her way to a place that satisfied her and dropped the stone heart like a bomb, watching it sink to the bottom and settle in the sand.

R.J. liked to see the rock there, where soon it would be covered with ice and snow at the winter's coldest. In the spring mayflies might lay their eggs on it, and trout could suck up the larvae and then shelter from the current behind the heart. She imagined that in the secret silence of summer nights, beavers might hang suspended over the rock and join in the clear moonlit waters like birds coupling in midair.

She made her way off the beaver dam, and in similar fashion she emptied the remaining contents of the barrow into the river that flowed through her land, like the funerary scattering of ashes. She had turned half a mile of beautiful mountain river into her memorial to Sarah Markus.

It had become a river where you could find a heartrock when you needed one.

She pushed the empty wheelbarrow home and put it away.

She took off her outer garments in the mudroom, and her shoes and sodden socks. Barefoot, she walked to get dry woolen socks and put them on. Then in her stockinged feet she started in the kitchen and dusted every room in her house.

When she was through, she went into the living room. The house was empty and polished, silent but for the sound of her own breathing. There was no man, there was no cat, there was no ghost. It was solely her own house again, and she sat in the living room in the silence and the gathering darkness, waiting for what was going to happen to her next.

55.

COMING OF SNOW.

November became December under a sky of greasy clouds. In the woods the deciduous trees were bare of leaves, their branches like upraised arms, the twigs like reaching fingers. R.J. had walked the trail unafraid all summer long, yet now that most of the bears had gone into hibernation, she was perversely afflicted with fear that she would meet the big bear face-to-face on the narrow path. Next time she went to Greenfield, she stopped at a sporting goods store and bought a boat horn, a small can with a b.u.t.ton that gave a great blast of sound when pressed. She wore the noisemaker in a belly pack when she went into the woods, but the only animal she saw was a large buck that moved through the woods not far from where she stood without scenting her; if she had been a hunter, it would have died.

For the first time, she was fully aware of her aloneness.

All the trees along the trail had dead lower branches, and one day she carried an extension pruning saw into the woods in mittened hands and sawed, freeing tree after tree of dried, barkless limbs. She liked the appearance of the pruned trunks, rising cleanly like natural pillars, and she determined to prune the trees all along the trail, a long-term project.

Snow came on the third day of December, a heavy, dumping storm with no early flurries or warning. It snowed for a day and most of a night, and she wanted to ski the trail but had to contend with the nameless, irrational fear that had plagued her for days. She went to the phone and called Freda Krantz. "It's R.J., Freda. I'm going skiing on my wood path. If I don't call you again in about an hour and a half, will you ask Hank to come in and get me? I don't expect any difficulty, but ..."

"Smart girl," Freda said firmly. "Sure. You enjoy yourself out there, R.J."

The sun was high, in a blue sky. The new snow dazzled her, but once she was in the woods it wasn't so bright. Her skis hissed along; it was too soon after the storm to see many tracks, but she saw a rabbit's, a fox's, and some mouse prints.

There was only one bad, precipitous drop in the whole loop of trail, and on the way down her balance vanished and she fell heavily, but into snow that was new and deep. She lay in the soft cold with her eyes closed, vulnerable to whatever might spring onto her from the nearby wooded cover-a bear, a thug, a bearded David Markus.

But nothing came, and in a little while she got up and skied home and telephoned Freda.

There seemed to be no lasting effects of the fall, no breaks or sprains or even bruises, except that her b.r.e.a.s.t.s ached and were sensitive.

That night when she went to bed, for the first time in a long time she turned on the security alarm.

She decided to get a dog. She began by taking books from the library and reading about the different breeds. Everyone she talked with had a different preference, but she spent several weekends visiting pet shops and kennels, and she kept narrowing the list until finally she decided she wanted a giant schnauzer, a breed developed several centuries ago to provide huge, tough dogs that could herd cattle and protect cows from predators. The breeders had matched the handsome, intelligent standard schnauzer with sheepdogs and Great Danes; one of the books said the result was "a wonderful watchdog, large, loyal, and strong."

She found a kennel in Springfield that specialized in giant schnauzers. "It's best to get a puppy that will imprint on you while it's young," the owner cautioned. "I've got just the little fella."

R.J. was seduced by the puppy at once. He was small and clumsy, with enormous paws, a wiry black-and-gray coat, a blunt square jaw, and stubby whiskers. "He's gonna stand over two feet tall and weigh eighty pounds," the kennel man said. "Be warned that he'll eat a whole lot."

The dog had a hoa.r.s.e, excited bark that reminded R.J. of Andy Devine, the wheezy-voiced actor in the old movies she sometimes saw on television late at night. She called him Andy for the first time on the way home, when she reprimanded him for wetting the car seat.

Toby was having terrible backaches. She managed to go to church on Christmas morning, but R.J. roasted a turkey and made Christmas dinner at the Smiths' cabin. She purposely had bought a turkey that was too large, so leftovers would provide the Smiths with meals for the next few days. Several of Toby's friends had been cooking and delivering meals; it was something that was done in Woodfield when it was needed, a small-town custom R.J. particularly admired.

After dinner, R.J. played carols on their old piano, and the three of them sang, and afterward she sat sleepily in front of the fire, surprised by her own exhaustion. Sometimes there were long, comfortable silences, and Toby commented on them. "We don't have to talk. We can just sit here and wait for my kid to be born."

"I can wait at home," R.J. said crankily, and kissed them and wished them a Merry Christmas and a good night.

After she got home, she received her best present, a phone call from Florida. Her father sounded good to her, strong and happy. "Susan is kicking me back to work next week," he said. "Wait a moment. We have something to tell you."

Susan came on the phone extension, and they told her they had decided to get married in the spring. "The last week of May, we think."

"Oh. Dad ... Susan. I'm so happy for you."

Her father cleared his throat. "R.J., we were wondering. Could we be married up there, at your house?"

"Dad, that would be perfect."

"If the weather is nice, we'd like to be married outside, in the meadow, with those hills of yours looking down. We'd like to invite a few people from Miami. Some of my friends from Boston, and a couple of Susan's closest relatives. About thirty guests in all, I think. We'll pay for the reception, of course, but R.J., could you make the arrangements? You know, find a good caterer, a minister, that sort of thing?"

She promised she would. When they said good-bye and hung up, she sat before her own fire and tried to play the viola, but her mind wasn't on the music. She got pen and paper and began to make lists of what would be needed. Music, perhaps four pieces; fortunately, there were wonderful musicians in the town. The food would take careful thought and consultation. Flowers ... lilacs would be everywhere in late May, and perhaps early roses. The first haying of the meadow would have to be done early. She would rent a tent, a small one with open sides ...

Planning Dad's wedding!

It had taken several weeks of grim determination for R.J. to housebreak Andy, and even after that was accomplished, the puppy sometimes lost control of his bladder when excited. She decided he would be a cellar dog, and fixed him a soft bed next to the furnace. She gave in only on New Year's Eve. Dateless and home alone, she spent the evening trying not to indulge in self-pity. Finally, she went down to the cellar and fetched Andy, who was pleased to lie next to her chair in front of the fire. R.J. toasted him with cocoa. "Here's to us, Andy. The old lady and her dog," she told him, but he had fallen asleep.

The annual epidemic of colds and flu was well under way, and that week the waiting room at her office was crowded with hackers and sneezers. R.J. had avoided catching cold, but she felt rundown and irritable; her b.r.e.a.s.t.s still hurt, and her muscles ached.

During her lunch hour on Tuesday, stopping at the small stone library to return a book, she found herself staring hard at Shirley Benson, the library clerk.

"How long have you had that black mark on the side of your nose?"

Shirley grimaced. "Couple of months. Isn't it ugly? I've soaked it and tried to squeeze it, but nothing seems to work."

"Let me have Mary Wilson make an immediate appointment for you to see a dermatologist."

"No, I don't want to, Dr. Cole." She hesitated, coloring. "I can't afford to spend money on something like that. I'm only part-time here, so I don't have medical insurance from the town. My kid is a senior in high school this year, and we're really worried about paying for college."

"I suspect that mark may be a melanoma, Shirley. Maybe I'm wrong, and you'll waste some money. But if I'm right, it could metastasize fast. I'm certain you want to be around to see your son go to college."

"All right." Moisture glinted in Shirley's eyes. R.J. didn't know whether the tears were caused by fear or by anger at her despotism.

Wednesday morning the office was busy. She did several annual physical exams and changed Betty Patterson's medication regimen to deal with her tendency toward insulin infection. She sat and discussed with Sally Howland what the echocardiogram had indicated about her tachycardia. Polly Strickland came in because she had had such a heavy monthly flow that it had frightened her. She was forty-five years old.

"It could be the start of menopause," R.J. said.

"I thought that's when periods stopped."

"Sometimes at the very beginning they get heavy, then irregular. There are many patterns. With a smaller percentage of women, menstruation just turns off, like a faucet."

"Lucky."

"Yes ..."

Before leaving to buy her lunch, R.J. read through several pathology reports. Included was one informing her that the neoplasm removed from Shirley Benson's nose had been a melanoma.

After the office closed R.J. felt that she needed nourishment, and she drove to the restaurant in Shelburne Falls and ordered a spinach salad, changing her mind in the same breath and telling the waitress to bring her a large sirloin, medium rare.

She ate the steak with mashed potatoes, squash, a Greek salad and rolls, and apple pie and coffee.

Driving back to Woodfield, it occurred to her to consider what she would do if a patient came to her with the symptoms she had been displaying for several weeks: irritability and mood swings, muscular pains, a ferocious appet.i.te, aching and sensitive b.r.e.a.s.t.s, and a missed menstrual period.

It was an absurd thought. She had spent years trying to conceive a child without the slightest success.

Still.

She knew what she would do if someone else were the patient, and instead of going home, she drove to her office and parked near the door.

The office was locked and dark, but she used her key and switched on the lights. She took off her coat and went around pulling down the window shades, as nervous as if she were an addict about to shoot up.

She found a sterile b.u.t.terfly needle she knew was easy to use and attached a tube to it and then tied a tourniquet around her left arm. She scrubbed the inside of her elbow with an alcohol patch and made a fist. It was clumsy taking her own blood, but she found the medial cubital vein with the needle and drew the dark, brown-red fluid.

She had to use her teeth to remove the tourniquet. And then she detached and capped the tube and placed it in a manila envelope, put her coat back on, turned off the lights and locked the door, and carried the blood to the car.

She drove straight back down the Mohawk Trail, this time all the way to Greenfield.

The blood lab in the hospital bas.e.m.e.nt was open twenty-four hours a day. There was a single phlebotomist on duty, holding down the evening shift alone.

"I'm Dr. Cole, I'd like to leave a sample with you."

"Sure, doctor. Is the case urgent? This time of night, the only stat work we do is for emergencies."

"It's not an emergency. It's for a pregnancy test."

"Well, I can accept it, and they'll do the testing tomorrow. Have you filled out the form?"

"No."

The tech nodded and got one from a drawer. For a long moment R.J. intended to write a false name after "Patient" and to sign it legitimately as the attending doctor; and then she felt great fury at herself and scribbled her own name twice, both as the patient and as the physician.

She gave it to the phlebotomist and saw careful blankness on the young woman's face as she took in the two signatures.

"I'd like you to telephone the results to my home phone instead of to my office."

"We'll be glad to, Dr. Cole."

"Thank you." She went to her car and drove home slowly, as if she had just run a long way.

"Gwen?" she said into the phone.

"Yeah. R.J.?"

"Yes. I know it's a little late to call ..."

"No, we're still up."

"Are you free for dinner tomorrow? I need to talk."

"Well, no, I'm in the midst of packing a bag. I still need fourteen CME points for my license renewal, and I'm taking your solution. I'm leaving in the morning, going to a conference on cesarean delivery in Albany."

"Oh ... Good idea."

"Yeah. I don't have a patient due for the next couple of weeks, and Stanley Zinck is covering for me. Look, do you have a problem? Do you want to talk now? Or I can cancel. I don't have to go to this conference."

"No, of course not. It's nothing, really."

"I get home Sunday night. How about we talk about it over early dinner on Monday, after work?"

"You're on, that sounds good.... You drive carefully, now."

"Okay, luv. Good night, R.J."