The Cole Trilogy: The Physician, Shaman And Matters Of Choice Part 155

"Good night."

56.

DISCOVERIES.

A restless night. She was out of bed early on Thursday, sleep-starved and cranky. Her breakfast cereal tasted like bits of cardboard. She wouldn't hear from the lab for hours. It might have been easier if it hadn't been her day off; perhaps work would have occupied her mind. She determined to subst.i.tute household ch.o.r.es and began by washing the floor in the mudroom. It took energetic scrubbing to remove the acc.u.mulated grit and stain, but eventually the old linoleum shone.

When she looked at the clock, only three quarters of an hour had pa.s.sed.

The two woodboxes were almost empty, and she lugged in logs from the woodshed, three or four at a time, and dropped them into the big pine box near the fireplace and the cherry woodbox next to the stove. Then she swept up the wood chips and sawdust.

Shortly after 10:30 she got the silver polish and set the silver service on the kitchen table. She put a Mozart CD, Adagio for Violin and Orchestra, on to play. Ordinarily Itzhak Perlman's violin could carry her through anything, but this morning the concerto sounded intrusive and jangling, and she got up after a while and washed the polish from her hands and went to the CD player.

As soon as the music stopped, the telephone rang, and she took a deep breath and said h.e.l.lo.

But it was Jan. "R.J., Toby's in real pain. Her backache is worse than ever, and now she has cramps."

"Let me talk to her, Jan."

"She's too upset to talk; she's crying."

Toby wasn't due to deliver for another three and a half weeks.

"I guess I'd better drop over there."

"Thanks, R.J."

She found Toby agitated, wearing a flannel nightgown with tiny roses printed on it, and pacing shoeless, in argyle socks that R.J. knew Peggy Weiler had given her for Christmas.

"R.J., I'm so scared."

"Listen, sit down. Let's see what's going on here."

"Sitting down makes my back worse."

"Well, lie down. I want to take your vital signs," R.J. said easily but briskly, inviting no argument.

Toby was breathing a little fast. Her blood pressure was 140 over 86, and her heart rate was 92, not bad at all, considering that she was excited. R.J. didn't bother to take her temperature. When she put her palm on the convex abdomen, the contraction was unmistakable, and she took Toby's hand and placed it so she would understand.

R.J. turned to Jan. "Will you call the ambulance and tell them your wife is in labor, please? Then call the hospital. Tell them we're coming in, and ask them to notify Dr. Stanley Zinck."

Toby started to cry. "Is he any good?"

"Of course he's good. Gwen wouldn't allow just anybody to cover for her." R.J. pushed into sterile gloves. Toby's eyes were large. R.J. had to ask her several times to raise her knees, the last time sharply. The digital exam was unremarkable; she had scarcely dilated, perhaps three centimeters.

"I'm so afraid, R.J."

R.J. hugged her. "You're going to be just fine. I promise." She sent her into the bathroom to empty her bladder before the ambulance got there.

Jan came back. "She'll need to take a few things," R.J. told him.

"She's had a bag packed for five weeks."

Steve Ripley and Dennis Stanley came with the ambulance, especially eager because Toby was one of theirs. When they arrived, R.J. had just taken a second set of vitals and recorded them, and she handed the paper to Steve.

Jan and Dennis went out to get the gurney.

"I'm coming with her," R.J. said. "She's frightened. It would be good if her husband rode in back with us, too," she added, and Steve nodded.

The ambulance was crowded. Steve stood beyond Toby's head, closest to the driver and the radiotelephone; Jan stood by his wife's feet, and R.J. was in the middle, the three of them swaying together and fighting for balance, especially after the ambulance left the secondary roads and was on the curving highway. It was warm inside the ambulance because the heaters were powerful. They had removed the blankets from Toby at the beginning of the run, and R.J. had raised her nightgown well above her swollen belly. At first R.J. had covered Toby with a light sheet for modesty's sake, but Toby's thrashing legs had kicked it down.

Toby had started the trip white-faced and silent, but soon her face was reddened by the exertion of fighting the pains, and she was making a succession of grunts and moans, with an occasional sharp cry.

"Shall I give her some oxygen?" Steve asked.

"It can't hurt," R.J. said.

But after a few breaths, Toby was having none of it and ripped the mask from her face. "R.J.," she called frantically, and moved back from the great gush that came from inside her and leaped out onto R.J.'s hands and jeans.

"It's all right, Tobe, it's just your waters breaking," R.J. said, and reached for a towel. Toby opened her mouth wide and stuck out her tongue as if trying to give a great scream, but no sound came out. R.J. had been watching closely and had seen a little additional dilation, perhaps to four centimeters, but now she looked down and saw that Toby's v.u.l.v.a was a full circle crowning the top of a small, hairy skull.

"Dennis," she called, "pull over and park."

He turned the ambulance smartly to the side of the road and set the brake. R.J. thought they might be there a long while, but something about the sound of Toby's grunt made her realize otherwise. She brought her hands down between Toby's legs, and a small, rose-colored baby slid out and filled them.

The first thing R.J. noticed was that, premature or not, the baby had a matted head of hair, as light and fine as its mother's.

"You've got a boy, Toby. Jan, you have a son."

"Will you look at that," Jan said. He never stopped rubbing his wife's feet.

The baby was wailing, a sharp, indignant little sound. They wrapped him in a towel and lay him down close to his mother. "Take us in, Dennis," Steve called. The ambulance was just past the Greenfield town line when Toby began to pant again. "Oh, G.o.d. Jan, I'm having another one."

She thrashed, and R.J. lifted the infant out of her way and gave it to Steve for safekeeping. "Better stop again," she called.

This time Dennis turned the ambulance into a supermarket parking lot. All around them, people were getting in and out of cars.

Toby's eyes bulged. She held her breath, grunted, and bore down. And held her breath, grunted, and bore down, again and again, lying partially on her left side and staring hopelessly at the ambulance wall.

"She needs some help. Lift her right leg high, Jan," R.J. said, and Jan held her knee in his right hand and leaned on her thigh with his left hand to keep her leg flexed.

Now Toby screamed.

"No, hold her!" R.J. said, and delivered the placenta. In the process, Toby had a small bowel movement; R.J. saw, and covered it with a towel, marveling that this was how the world was made, all those millions of people for millions of years, each produced in just this kind of slime, blood, and agony.

As Dennis drove again, through the center of town, she found a plastic bag and put the placenta into it.

They lay the baby next to Toby again, and the placenta next to the baby. "Shall we cut the cord?" Steve asked.

"With what?"

He opened the ambulance's useless little obstetrics kit and held up a single-edged razor blade. R.J. thought of using it in the moving vehicle and suppressed a shudder. "We'll wait and let somebody use a sterile scissors," she said, but she took the two laces from the kit and tied off the cord, first an inch above the baby's abdomen and again near the opening of the plastic bag. Toby was inert, her eyes closed. R.J. ma.s.saged her abdomen, and just as the ambulance turned in to the hospital, through the thin, smooth skin of the slack belly she felt the uterus respond and contract, starting to become firm and ready in case someday there might be another birth.

In the staff toilet, R.J. stood at the sink and scrubbed her hands and arms, washing away the amniotic fluid and diluted blood. Her clothes were saturated and gave off an earthy, pungent smell, and she stripped off her jeans and sweater and rolled them into a tight ball. There was a pile of freshly laundered gray scrub suits on a shelf, and R.J. helped herself to a bottom and a top and put them on. When she left the toilet she carried her clothes in a paper bag.

Toby lay in a hospital bed. "Where is he? I want him." Her voice was hoa.r.s.e.

"They're cleaning him up. His daddy is watching him. He weighs five pounds, ten ounces."

"That's not much, is it?"

"He's healthy. Just small because he was born a little early. That's why you had such an easy time."

"I had an easy time?"

"Well ... fast." That reminded her, just as one of the nurses came into the room. "She has some small tears in the perineum. If you give me some sutures, I can sew her."

"Oh ... Dr. Zinck is on his way. He's officially the obstetrician. Don't you want to wait and let him do it?" the nurse suggested delicately, and R.J. got the message and nodded.

"You plan to name him after the good old doctor, the one who answered your call?" R.J. said.

"Nix." Toby shook her head. "Jan Paul Smith, same as his father. But you'll have a piece of him. You can talk to him about hygiene, and how to treat all those girls. Stuff like that."

Her eyes closed, and R.J. brushed back her damp hair.

It was 2:10 when the ambulance dropped R.J. at her car. She drove home slowly, down the town's familiar roads. The sky had turned gray over the snow-covered fields. Between meadows, stretches of forest offered shelter, but in the open the wind leapt across the long s.p.a.ces like a weather wolf, chasing frozen snow pellets to rattle against her car.

When she reached the house, she went directly to the telephone answering machine, but no one had called.

She brought food and fresh water to Andy in the cellar, gave him a good scratching behind the ears, and then climbed the stairs and got into a long, hot shower, a blessing. When she left it, she toweled luxuriously and then dressed in her most comfortable clothes, sweatpants and a ragged sweatshirt.

She had put one shoe on when the telephone sounded, and she dropped the other shoe and hobbled to pick up the receiver.

"h.e.l.lo? ...

"Yes, this is she. ...

"Yes, what did it show?...

"I see. What are the numbers?...

"Well, will you please send a copy of the report to my home? ...

"Thank you very much."

She wasn't conscious of putting on the other shoe. She wandered about the house. Eventually, she made herself a peanut b.u.t.ter and jelly sandwich and drank a gla.s.s of milk.

A long-term dream come true, winning the globe's best lottery.

But ... the responsibility!

The world seemed to be growing bleaker and meaner as technology shrank it. Everywhere, people were killing people.

Maybe, this year, a child will be born who ...

So unfair, even to think of placing on unborn shoulders the burden of being a secret saint, or even of becoming a Rob J., next in the line of the Cole physicians. It will be enough, she thought incredulously, to produce a human being, a good human being.

It was such an easy choice.

This child would come home to a warm house and would be familiar with good smells of cooking and baking. R.J. thought of what she would have to try to teach her/him-gentleness, how to love, how to be strong and deal with fear, how to exist with the live things in the woods, how to read a river for trout. How to make a trail, choose a path. About the legacy of heartrocks.

She felt as though her mind would burst. She wanted to walk for hours, but the wind was still outside, and it had begun to snow heavily.

She turned on the CD player and sat in a kitchen chair. Now the Mozart concerto made sense and spoke to her sweetly of joy and antic.i.p.ation. R.J. calmed as she sat and listened, her palms on her stomach. The music swelled. She could feel it being carried from her ears down nerve pathways through tissue and bone. It was powerful enough to travel to her soul and to the very core of her being, down to the little pool where the tiny fish swam.

ACKNOWLEDGMENTS.

During the writing of this novel a number of physicians shared with me their very limited time, answered my questions, and loaned me books and materials. Among them were private pract.i.tioners-Richard Warner, M.D., of Buckland, MA; Barry Poret, M.D., and Nancy Bershof, M.D., both of Greenfield, MA; Christopher French, M.D., of Shelburne Falls, MA; and Wolfgang G. Gilliar, D.O., of San Francisco.

I received help also from academic and hospital physicians, including Louis R. Caplan, M.D., chairman of the Department of Neurology at Tufts University and Neurologist-in-Chief at New England Medical Center, Boston; Charles A. Vacanti, M.D., professor of anesthesiology and chairman of the Department of Anesthesiology at the University of Ma.s.sachusetts Medical Center, Worcester, MA; and William F. Doyle, M.D., chairman of the Department of Pathology, Franklin Medical Center, Greenfield, MA.

I received information from Esther W. Purinton, R.N., Director of Quality Management at Franklin Medical Center, and from midwife Liza Ramlow, CMW. Susan Newsome of the Planned Parenthood League of Ma.s.sachusetts talked with me about abortion; so did Virginia A. Talbot, R.N., of Hampden Gynecological a.s.sociates and the Bay State Medical Center, Springfield, MA., and Kathleen A. Mellen, R.N. Polly Weiss of West Palm Beach, FL, provided reasoned insights about the anti-abortion movement.

As usual, I found help in my hometown. Margaret Keith furnished anthropological information about bones; Suzanne Corbett talked with me about horses; EMTs Philip Lucier and Roberta Evans refreshed my memories of a hilltown ambulance service; and Denise Jane Buckloh, the former Sister Miriam of the Eucharist, OCD, provided insights into Catholicism and sociology. Farmer Ted Bobetsky and Don Buckloh of the U.S. Department of Agriculture told me about husbandry. Don Buckloh also made available to me the books on bee-keeping that had belonged to his father, the late Harold W. Buckloh of Coldwater, OH. Attorney Stewart Eisenberg and former Ashfield Police Chief Gary Sibilia advised me about prison sentencing, and Russell Fessenden provided information about his late grandfather, Dr. George Russell Fessenden, an early country doctor.

Roger L. West, DVM, of Conway, MA, talked with me about bovine obstetrics, and dairy farmer David Thibault of that town allowed me to witness his delivery of a calf.

Julie Reilly, objects conservator at the Winterthur Museum, Winterthur, DE, provided details about dating old ceramics, and I received help from Susan McGowan of the Poc.u.mtuck Valley Memorial a.s.sociation, Old Deerfield, MA. I am grateful also to the Memorial Libraries at Historic Deerfield, and to the staffs at the Belding Memorial Library in Ashfield and at the libraries of the University of Ma.s.sachusetts in Amherst.

For their advice and support I thank my literary agent, Eugene H. Winick of McIntosh & Otis, Inc., Dr. Karl H. Blessing of the Droemer Knaur Publishing Company in Munich, and Peter Mayer and Robert Dreesen of Penguin Books USA.