The Cole Trilogy: The Physician, Shaman, and Matters of Choice

by Noah Gordon

  While she made short work of the food, Tessa came in again with the appointment schedule, and they reviewed it.

  “Dr. Ringgold called. Wants to see you before you start your day.”

  The chief of medicine had a corner office on the fourth floor. “Go right in, Dr. Cole. He’s expecting you,” his secretary said.

  In the inner office, Dr. Ringgold nodded, pointed at a chair, and closed the door firmly.

  “Max Roseman had a stroke yesterday while he was attending the communicable diseases meeting at Columbia. He’s a patient at New York Hospital.”

  “Oh, Sidney! Poor Max. How is he?”

  He shrugged. “Surviving, but he could be better. Profound paralysis and sensory impairment of the contralateral face, arm and leg, for starters. We’ll see what the next few hours bring. I just got a courtesy call from Jim Jeffers in New York. He said he’ll keep me informed, but it’s going to be a long time before Max returns to work. Matter of fact, given his age, I doubt he’ll ever be back.”

  R.J. nodded, suddenly watchful. Max Roseman was associate chief of medicine.

  “Someone like you, a good female physician and with your background in law, would bring new dimensions to the department as Max’s successor.”

  She had no desire to be associate chief, a job of many responsibilities and limited power.

  It was as if Sidney Ringgold could read her mind. “In three years I reach sixty-five, the age of compulsory retirement. The associate chief of medicine will have a tremendous advantage over other candidates to succeed me.”

  “Sidney, are you offering me the job?”

  “No, I’m not, R.J. Matter of fact, I’m going to talk with several other people about the appointment. But you would be a strong candidate.”

  R.J. nodded. “Fair enough. Thanks for filling me in.”

  But his glance held her in her chair. “One other thing,” he said. “I’ve been thinking for a long time that we should have a publications committee to encourage staff physicians to write and publish more. I’d like you to set it up and chair it.”

  She shook her head. “I simply can’t,” she said flatly. “I’m already stretching to handle my schedule.” It was true; he should know that, she thought with resentment. Mondays, Tuesdays, Wednesdays, and Fridays, she dealt with patients at her hospital office. Tuesday mornings she went across the street to give a two-hour class at the Massachusetts College of Physicians and Surgeons on the prevention of iatrogenic illness, sickness or injury caused by a doctor or a hospital. Wednesday afternoons she lectured at the medical school on the avoidance and survival of malpractice suits. Thursdays she performed first-trimester abortions at the Family Planning Clinic of Jamaica Plain. Friday afternoons she worked at a PMS clinic which, like the iatrogenic illness course, had been established because of her persistence and over the objections of some of the hospital’s more conservative doctors.

  Both she and Sidney Ringgold were conscious of her debt to him. The chief of medicine had sponsored her projects and promotions despite political opposition. At first he had looked upon her warily—a lawyer turned physician, an expert on illnesses caused by the mistakes of physicians and hospitals, someone who did peer review work and judged her fellow physicians, often costing them money. In the beginning, some of her colleagues had referred to her as “Dr. Snitch,” an appellation she wore proudly. The chief of medicine had watched Dr. Snitch survive and prosper and become Dr. Cole, accepted because she was honest and tough. Now both her lectures and her clinics had become politically correct, assets so prized that Sidney Ringgold often took credit for them.

  “Perhaps you can trim some other activity?” Both of them knew he was talking about Thursdays at the Family Planning clinic.

  He leaned forward. “I’d like you to do this, R.J.”

  “I’ll give it serious thought, Sidney.”

  This time she made it out of the chair. On the way out, she was annoyed with herself, realizing she was already trying to guess the other names on his list.

  2

  THE HOUSE ON BRATTLE STREET

  Even before they were married, Tom had tried to convince R.J. that she should exploit the combination of law and medicine to produce optimum annual income. When, despite his advice, she had effectively turned her back on the law and concentrated on medicine, he had urged her to develop a private practice in one of the affluent suburbs. While they were buying their house he had grumbled about her hospital salary, almost 25 percent lower than the income would have been from a private practice.

  They had gone to the Virgin Islands for their honeymoon, a week on a small island near St. Thomas. Two days after they returned they had started looking for property, and on the fifth day of their search a real estate woman had taken them to see the distinguished but run-down house on Brattle Street in Cambridge.

  R.J. had viewed it with disinterest. It was too large, too expensive, too badly in need of repair, and there was too much traffic going by the front door. “It would be crazy.”

  “No, no, no,” he had murmured. She remembered he had been so attractive that day, his straw-colored hair in a designer trim, and wearing a beautifully cut new suit. “It wouldn’t be crazy at all.” Tom Kendricks saw a handsome Georgian house on a graceful heirloom street with red-brick sidewalks that had been trod by poets and philosophers, men you read about in textbooks. Half a mile up the street was the stately house in which Henry Wadsworth Longfellow had lived. Just beyond that was the Divinity School. Tom already was more Boston than Boston, getting the accent just right, having his clothes tailored by Brooks Brothers. But in fact he was a midwestern farm boy who had gone to Bowling Green University and Ohio State, and the thought of being Harvard’s neighbor—almost part of Harvard—fascinated him.

  And he was seduced by the house—the exterior of red brick with Vermont marble ornamentation, the handsome thin columns alongside the doors, the small antique panes on each side and above the doorway, the matching brick wall around the property.

  She thought he was joking. When it became apparent he was serious, she was dismayed and tried to talk him out of it. “It would be expensive. Both the house and the wall need repointing, the roof and the foundation need repair. The real estate company’s description says right up front that it needs a new furnace. It doesn’t make sense, Tom.”

  “Sense is what it does make. This is a house to be owned by a couple of successful doctors. A statement of confidence.”

  Neither of them had saved much. Because R.J. had received a law degree before entering medical school she had managed to earn some money, enough to finish her medical education and training with only a reasonable debt. But Tom owed a frightening amount. Nevertheless, he argued stubbornly and at length that they should buy the house. He reminded her that already he had begun to make very good money as a general surgeon and insisted that when her smaller income was added to his, they could easily afford the house. He said it again and again.

  It was early enough in the marriage so that she was still besotted. He was a better lover than he was a person, but she didn’t know that then, and she listened to him with gravity and respect. At last, bemused, she had given in.

  They spent a good deal of money on furnishings, including antiques and near-antiques. At Tom’s insistence, they bought a baby grand piano, more because it looked “just right” in the music room than because R.J. was a pianist. About once a month her father took a taxi to Brattle Street and tipped the cabbie to carry in his cumbersome viola da gamba. Her father was happy to see her settled, and they played long and fulsome duets. The music covered a lot of scars that were there from the start and made the large house seem less empty.

  She and Tom ate most of their meals out and didn’t have live-in help. A taciturn black woman named Beatrix Johnson came every Monday and Thursday and kept the house clean, only now and again breaking something. The yardwork was done by a landscaping service. They rarely had guests. No hung shingle encouraged patients to enter the f
ront gate of their home; the only clue as to the identity of the inhabitants came from a pair of small copper plates Tom had fastened to the wood on the right-hand side of the front door frame.

  THOMAS ALLEN KENDRICKS, M.D.

  and

  ROBERTA J. COLE, M.D.

  In those days, she called him Tommy.

  When she left Dr. Ringgold she did morning rounds.

  Unfortunately, she never had more than one or two patients in the wards. She was a general physician interested in family practice, working in a hospital that didn’t have a department of family practice. That made her a kind of jack-of-all-trades, a utility player without classification. Her work for the hospital and the medical school fell between departmental boundaries; she saw pregnant patients, but someone in Obstetrics delivered the babies; in the same way, almost always she referred her patients to a surgeon, a gastroenterologist, any one of more than a dozen specialists. Most of the time she never saw the patient again, because follow-up care was done by the specialist physician or the hometown family doctor; usually patients came to the hospital with only those problems that might require advanced technology.

  At one time, political opposition and the sense that she was breaking new ground had lent spice to her activities at Lemuel Grace, but for a long time now she had lost her sense of joy in medical practice. She spent too much of her time reviewing and signing insurance papers—a special form if someone needed oxygen, a special long form for this, a special short form for that, in duplicate, in triplicate, every insurance company with different forms.

  Her office visits were apt to be impersonal and brief. Faceless efficiency experts at insurance companies had determined how much time and how many visits she could allow for each patient, who was quickly sent off for lab work, for X rays, for ultrasound, for MRI—the procedures that did most of the real diagnostic work and protected her from malpractice suits.

  Often she pondered, who were these patients who came to her for help? What elements in their lives, hidden from her almost cursory glance, contributed to their illness? What would become of them? There was neither time nor opportunity for her to relate to them as people, to really be a physician.

  That evening she met Gwen Gabler at Alex’s Gymnasium, an upscale health club in Kenmore Square. Gwen was R.J.’s medical school classmate and best friend, a gynecologist at Family Planning whose breeziness and salty tongue disguised the fact that she was hanging on by her fingernails. She had two children, a real estate broker husband who had run into hard times, an overcrowded schedule, bruised ideals, and depression. She and R.J. came to Alex’s twice a week to punish themselves in a long aerobics class, sweat out foolish desires in the sauna, soak away fruitless regrets in the hot tub, have a glass of wine in the lounge, and gossip and talk medicine throughout the evening.

  Their favorite wickedness was to study the men in the club and judge their attraction solely by their appearance. R.J. found she required a hint of the cerebral in the face, a suggestion of introspection. Gwen liked more animal qualities. She was an admirer of the owner of the club, a golden Greek named Alexander Manakos. Easy for Gwen to dream of muscular but soulful romance and then go home to her Phil, myopic and stocky but deeply appreciated. R.J. went home and read herself to sleep with medical journals.

  On the surface, she and Tom had the American dream—busy professional lives, the handsome house on Brattle Street, a farmhouse in the Berkshires that they used for extremely rare weekends and vacations. But the marriage was ashes. She told herself it might have been different if they had had a child. Ironically, the physician who frequently dealt with infertility in others had been infertile for years. Tom had had semen analysis and she had had a battery of tests. But no cause of the infertility was uncovered, and she and Tom had been quickly caught up in the responsibilities of their medical personas. Those demands were so heavy for each of them that gradually they had drifted apart. If their marriage had been more substantial, doubtless in recent years she would have considered insemination or in vitro fertilization, or perhaps adoption. By now, neither she nor her husband was interested.

  Long ago R.J. had become aware of two things: that she had married an insubstantial man and that he was seeing other women.

  3

  BETTS

  R.J. knew Tom had been as surprised as anyone when Elizabeth Sullivan had come back into his life. He and Betts had lived together for two years in Columbus, Ohio, when they were young. At that time she was Elizabeth Bosshard. From what R.J. heard and saw when Tom talked about her, he must have cared for her a great deal, but she had left him after she met Brian Sullivan.

  She had married Sullivan and moved to the Netherlands, to The Hague, where he was a marketing manager for IBM. Several years later he was transferred to Paris, and less than nine years after their marriage he had suffered a stroke and died. By that time Elizabeth Sullivan had published two mystery novels and had a large readership. Her protagonist was a computer programmer who traveled for his company, and each book took place in a different country. She traveled wherever the books led her, generally living a year or two in the country she was writing about.

  Tom had seen Brian Sullivan’s obituary in the New York Times and had written a letter of condolence to Betts and received a letter in return. Other than that, he’d not even had a postcard from her, nor had he thought much about her for years until the day she telephoned him and told him she had cancer.

  “I’ve seen doctors in Spain and in Germany, and I know the disease is advanced. I decided to come home to be sick. The physician in Berlin suggested someone at Sloan-Kettering in New York, but I knew you were a doctor in Boston, so I came here.”

  Tom knew what she was telling him. Elizabeth’s marriage, too, had been childless. She had lost her father in an accident when she was eight, and her mother had died four years later of the same kind of cancer that Betts now had. She had been raised well by her father’s only sister, who now was an invalid in a nursing home in Cleveland. There was no one but Tom Kendricks for her to turn to.

  “I feel so bad,” he told R.J.

  “Of course you do.”

  The problem was well beyond the skills of a general surgeon. Tom and R.J. talked it over, considering whatever they knew about Betts’s case; it was the first time in a long while that they had shared such a meeting of the minds. Then he had arranged for Elizabeth to be seen at the Dana-Farber Cancer Institute, and he had spoken to Howard Fisher about her after she was examined and tested.

  “The carcinoma is widely traveled,” Fisher had said. “I’ve seen patients go into remission who were worse off than your friend, but I’m sure you understand that I’m not hopeful.”

  “I do understand that,” Tom had said, and the oncologist had blocked out a treatment regimen that combined radiation and chemotherapy.

  R.J. had liked Elizabeth at sight. Her husband’s ex-lover was a full-bodied, round-faced woman who dressed as wisely as a European but who had allowed middle age to make her comfortably heavier than was fashionable. She wasn’t prepared to give up; she was a fighter. R.J. had helped Betts find a one-bedroom condominium on Massachusetts Avenue, and she and Tom saw the ailing woman as often as possible, as friends and not as doctors.

  R.J. took her to see the Boston Ballet do Sleeping Beauty and to the first autumn concert of Symphony, sitting high up in the balcony and giving Betts her own seventh-row-center seat in the orchestra.

  “You have only the one season ticket?”

  “Tom doesn’t go. We have different interests. He likes to go to hockey games and I don’t,” R.J. said, and Elizabeth nodded thoughtfully and said she had enjoyed watching Seiji Ozawa conducting.

  “You’ll like the Boston Pops next summer. People sit at little tables and drink champagne and lemonade while they listen to lighter stuff. Very gemütlich.”

  “Oh, we must go!” Betts said.

  The Boston Pops wasn’t in the cards for her. Winter was very young when her disease took hold; she
had needed the apartment only seven weeks. At Middlesex Memorial Hospital they gave her a private room on the VIP floor and her radiation treatments were stepped up. Very quickly her hair fell out and she began to lose weight.

  She was so sensible, so calm. “It would make a really interesting book, you know?” she said to R.J. “Only, I don’t have the energy to write it.”

  A genuine warmth had developed between the two women, but late one night when the three of them sat in her hospital room it was Tom she looked at. “I want you to make me a promise. I want you to swear you won’t allow me to suffer or linger.”

  “I do,” he said, almost a nuptial vow.

  Elizabeth wanted to review her will and to draw up a living will stipulating that she didn’t want her life artificially prolonged by drugs or technology. She asked R.J. to get her a lawyer, and R.J. called Suzanna Lorentz at Wigoder, Grant and Berlow, the firm where she had once worked briefly herself.

  A couple of evenings later, Tom’s car was already in the garage when R.J. got home from the hospital. She found him sitting at the kitchen table, having a beer while he watched television.

  “Hi. That Lorentz woman call you?” He snapped off the TV.

  “Hi. Suzanna? No, I haven’t heard from her.”

  “She called me. She wants me to be Betts’s legal health care agent. But I can’t. I’m her associate physician of record, and it would represent a conflict of interest, wouldn’t it?”

  “Yes, it would.”

  “So will you? Be her legal health care agent, I mean?”

  He was gaining weight and looked as if he hadn’t been sleeping enough. There were cracker crumbs on his shirtfront. She was saddened by the fact that an important part of his life was dying.

  “Yes, that will be all right.”

  “Thank you.”

  “You’re welcome,” she said, and went up to her room and went to bed.