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

by Noah Gordon

  “But I depend on my rents to live, you understand, so I cannot come down on the price.” Nor could she afford to do the renovations R.J. would need, she said; but she would give permission for them, as well as whatever painting the doctor might like to have done at her own expense.

  “It’ll cost you to renovate and paint,” Markus told R.J. “If you go for it, you ought to protect yourself with a lease.”

  In the end, that’s what she did. The painting was done by Bob and Tillie Matthewson, a husband-and-wife team who doubled as dairy farmers. The place was full of antique woodwork that they brought back to a soft luster, and worn and scarred random-width pine floors that she had them paint teal blue. They covered the dead or dying wallpaper in every room with two coats of washable off-white. A local carpenter put up lots of shelves and cut a large square hole—behind which the receptionist would sit—through the interior wall of what used to be the parlor. A plumber put in two additional toilets, placed sinks in both the former bedrooms that would now be examining rooms, and added a tankless boiler to the furnace in the basement so R.J. would have hot water on demand.

  Buying furniture and equipment should have been fun but was a source of anxiety because she had to keep one eye on her bank balance. Her problem was that she had been accustomed to ordering the best of everything when it was needed at the hospital. Now she settled for secondhand desks and chairs, a gem of a Salvation Army rug for the waiting room, a good used microscope, a rebuilt autoclave. But she bought new instruments. She had been advised she needed two computers, the first for patient records, the second for billing, but grimly decided to make use of one.

  “You met Mary Stern yet?” Sally Howland asked her.

  “I don’t believe I have.”

  “Well, she’s postmistress. She owns the heavy old upright scale that used to be in Dr. Thorndike’s office. Bought it at the auction after the doctor died twenty-two years ago. She’s willing to sell the scale to you for thirty dollars.”

  R.J. bought the scale, scrubbed it, had it checked and rebalanced. It became part of the office, a link between the town’s old doctor and the new one.

  She had intended to advertise for help, but there was no need. Woodfield had an underground communications system that worked efficiently and with the speed of light. Very quickly she had four applications from women who wanted to be her receptionist, and three applications from registered nurses. She was careful and took her time choosing, but Toby Smith, the personable blond woman who had driven the ambulance the night Freda Krantz had been shot, was one of the applicants for the receptionist job. She had impressed R.J. from the moment they had met, and she had the added attraction of heavy bookkeeping and accounting experience, so she could keep the financial records. For her nurse R.J. hired solid, gray-haired, fifty-six-year-old Margaret Weiler, who was called Peggy.

  She felt guilty when it came to discussing money with each of them. “What I can pay you at the start is less than you would be paid in Boston,” she told Toby.

  “Listen, don’t you sweat about that,” the new receptionist said forthrightly. “Both Peg and I are tickled to be able to work right here in town. This isn’t Boston. Jobs are hard to find in the country.”

  David Markus came around to the emerging office now and then. He cast an experienced eye on the renovation work and sometimes offered her a quiet word of advice. A couple of times they had lunch at the River Bank, a pizza joint on the outskirts of the village—twice he paid, once she did. She found herself liking him, telling him her friends called her R.J.

  “Everybody calls me Dave,” he said. Then he smiled. “My friends call me David.” His blue jeans were faded but always looked freshly washed. His ponytailed hair was always very clean. When they shook hands she could feel that his palm was muscular and work-hardened, but his nails were cut short and looked cared-for.

  She couldn’t make up her mind whether he was sexy or just interesting.

  The Saturday before she moved from Boston, he took her on a real date, to dinner in Northampton. As they were leaving the restaurant, he took a handful of candy from the bowl by the front door, bits of coated chocolate. “Mmmm, upscale M&Ms,” he said, offering her some.

  “No, thank you.”

  In the car she watched him chewing and lost a struggle to keep quiet. “You shouldn’t eat those.”

  “Hey, I love ’em. I don’t gain weight.”

  “I love them too. I’ll buy you some in a nice clean package.”

  “You a cleanliness freak? I got these at a nice clean restaurant.”

  “I just read about tests that were done on candy from restaurant candy bowls. They found that in most cases the candy contained traces of urine.”

  He looked at her in silence. He had stopped chewing.

  “Male diners go to the men’s room. They don’t wash their hands. On their way out of the restaurant, they reach into the candy bowl …”

  She knew he was trying to decide whether to spit or to swallow. There goes this relationship, she thought as he swallowed, lowered the car window, dumped the rest of the candies.

  “That’s a terrible thing to tell somebody. I’ve been enjoying restaurant candy for years. You’ve absolutely ruined that pleasure for me for all time.”

  “I know. But if I had been eating them and you knew, wouldn’t you have told me?”

  “Maybe not,” he said, and when he started to laugh, so did she. They chuckled halfway up Route 91.

  On the drive back up into the hills, and then sitting in his parked pickup truck in front of her house, they told each other about their lives. He was a jock as a youth, “just good enough to get a lot of injuries in a lot of sports.” By the time he reached college, he had been hurt enough that he didn’t play varsity anything. He majored in English at Hamilton College, did graduate work about which he was vague. Before coming to the hills of Massachusetts he had been a corporate real estate executive at Lever Brothers in New York, the final two years a vice president. “The full catastrophe—the 7:05 train to Manhattan, the big house, the pool, the tennis court.” His wife, Natalie, had developed amyotrophic lateral sclerosis, Lou Gehrig’s disease. They both knew what was involved; they had watched a friend die of ALS. A month after her diagnosis was confirmed, David came home to find that Sarah, then nine years old, had been left with a neighbor, and Natalie had placed wet towels around the garage doors, started her car, and died listening to her favorite classical music station.

  He had hired a cook and a housekeeper so Sarah would be cared for, and he had gotten drunk regularly for eight months. On a sober day he had realized that his bright, coltish daughter was failing in school and developing psychological problems and a chronic, nervous little cough, and he had gone to his first meeting of Alcoholics Anonymous. Two months later David and Sarah had come to Woodfield.

  He nodded when he heard R.J.’s story a little later, over three cups of strong coffee in her kitchen.

  “These hills are full of survivors,” he said.

  16

  OFFICE HOURS

  She moved from Cambridge on a hot morning in late June, under high, dark rain clouds that promised thunder and lightning. She had thought she would be happy to leave the house on Brattle Street; but in the last days, as some of the furnishings were sold and some went to storage and some went to Tom—as piece by piece was carried out until her high heels made echoes in the empty rooms—she looked at the house with the forgiving eyes of a former owner and saw that Tom had been right about its dignity and splendor. She was reluctant to leave it; despite her failed marriage, it had been her nest. Then she remembered that it was like a large hole in the ground into which they had poured their money, and she was content to lock the door and drive out of the driveway, past the brick wall with sections that still needed work, her responsibility no longer.

  She was aware that she was driving into the unknown. All the way to Woodfield, her mind grappled with medical economics, fearful lest she was making a disastrous
mistake.

  For several days she had toyed with a fantasy. Suppose she were to operate a practice on a cash basis only—able completely to ignore the insurance companies, whence came most of the bad stuff that on occasion made doctoring unpleasant? If she were to drop her fee for an office visit steeply—say, down to twenty dollars—would enough patients come to keep her afloat financially? Some would come, she knew, sick people who weren’t covered by medical insurance. But would anybody covered by Blue Cross/Blue Shield forget about the fact that he or she owned a paid-up insurance policy and volunteer to pay cash at Dr. Cole’s office?

  She realized regretfully that most people wouldn’t.

  She decided to try to establish an unofficial fee of twenty dollars for those who were uninsured. Insurance companies would pay their usual forty dollars to sixty-five dollars for an office visit by one of their clients, depending on the complexity of the problem, with an additional charge for house calls. Full physical examinations would be billed at ninety-five dollars, and all lab work would be done at the medical center in Greenfield.

  She put Toby to work two weeks before the office officially opened, programming all the insurance company documents into the computer. She would do most of her business with the five largest insurance companies, but there were fifteen other companies from which many patients bought insurance, and about thirty-five smaller, marginal companies. All of them had to be in the computer, multiple forms from each firm. The exhausting programming was a one-time job, but R.J. knew from experience that it would have to be updated constantly as companies discontinued some forms, revised others, and added new ones.

  It was a major expense, one with which her great-grandfather had not had to contend.

  A Monday morning.

  She arrived at the office early, her hurried breakfast of toast and tea turned into a cold ball of nervousness in her stomach. The place smelled of paint and varnish. Toby already was at work, and Peg arrived two minutes later. The three of them grinned at one another foolishly.

  The waiting room was small, but suddenly it looked enormous to R.J., deserted and empty.

  Only thirteen people had made appointments. People who had been twenty-two years without a local doctor must have grown accustomed to the fact that they had to go out of town, she told herself. And once people had forged a relationship with a physician, why should they go to somebody new?

  Suppose no one showed up? she asked herself in what she recognized as unreasonable panic.

  Her first patient was there fifteen minutes before his appointment, George Palmer, seventy-two years old, a retired lumber miller with a painful hip and three stubs where fingers should have been.

  “Morning, Mr. Palmer,” Toby Smith said calmly, as though she had been greeting patients for years as they came through the door.

  “Mornin’, Toby.”

  “Morning, George.”

  “Mornin’, Peg.”

  Peg Weiler knew just what to do, ushered him into an examining room, filled in the top of his chart, took a set of vitals and recorded his data.

  R.J. enjoyed taking a very relaxed history of George Palmer. In the beginning, each of the office visits would require a lot of time because every patient was new to her and would require a full workup.

  In Boston she would have sent Mr. Palmer and his bursitis to an orthopod for a shot of cortisone. Here she gave the injection herself and asked him to make another appointment to see her.

  When she stuck her head into the waiting room, Toby showed her a bouquet of summer flowers, sent by her father, and a huge ficus plant sent by David Markus. There were six people in the waiting room, and three of them didn’t have appointments. She told Toby to practice triage; anyone in pain or severely ill should be worked in quickly. Others should be given the first available appointment. She realized suddenly, with a strange mixture of relief and regret, that she didn’t have time to spare, after all. She asked Toby to bring her a cheese sandwich on a kaiser roll from the general store, and a large decaf. “I’ll work through my lunch hour.”

  Sally Howland was coming through the front door. “I have an appointment,” she said, as if she expected to be challenged, and R.J. had to restrain herself from kissing her crabby landlady.

  Both Peg and Toby said they would work through the lunch hour too, and that they had better order sandwiches of their own. “I’ll pay,” R.J. told Toby happily.

  17

  DAVID MARKUS

  He invited her to supper at his house.

  “Will Sarah be there too?”

  “Sarah is having a big, formal dinner with the cooking club at the regional high school,” he said. He regarded her contemplatively. “You can’t come to my house unless a third person is around?”

  “No, of course I’ll come. I was just hoping Sarah would be there.”

  She liked their house, the warmth and friendliness of the thick log walls and comfortable old furniture. There were lots of paintings on the walls, the work of local artists whose names didn’t mean anything to her. He gave her the tour. Eat-in kitchen. His office, full of real estate paraphernalia, a computer, a big gray cat sleeping on his desk chair.

  “Is the cat Jewish too, like the horse?”

  “Matter of fact, she is.” He grinned. “We got her with a beat-up, horny old tomcat Sarah said was her husband. But the male hung around only two days and then ran off, so I named this one Agunah. That’s Yiddish for deserted wife.”

  His monastic bedroom. There was just a bit of sexual tension as she took in the king-size mattress and box spring on legs. There was another computer on the desk, a bookcase full of volumes about history and agriculture, and a pile of manuscript. Under probing, he admitted he was writing a novel about the death of small farms in America and about the early farmers who settled the Berkshire hills.

  “I always wanted to tell stories. After Natalie was gone, I decided to give it a try. I had Sarah to clothe and feed, so I stayed with real estate when we moved, but real estate is not exactly a pressured business out here. I have plenty of time to write.”

  “How’s it going?”

  “Oh …” He smiled, shrugged.

  Sarah’s room. Terrible multicolored drapes on the windows; he said Sarah had tie-dyed them herself. Two Barbra Streisand posters. All over the room, trays of rocks. Big rocks, little pebbles, medium-size stones, each of them roughly in the shape of a heart. Geological valentines.

  “What are they?”

  “She calls them heartrocks. She’s been collecting them since she was a little girl. It’s something Natalie started her on.”

  R. J. had taken a year of geology at Tufts. As she looked at the trays she thought she could identify quartz, shale, marble, sandstone, basalt, schist, feldspar, gneiss, slate, a red garnet, all heartshaped. There were crystals she couldn’t even guess at. “This one I moved in the bucket of the tractor,” David said, pointing to a heart-shaped granite boulder more than two feet tall, propped in the corner of the room. “Six miles, from Frank Parsons’s woods. It took three of us to carry it into the house.”

  “She just finds them on the ground?”

  “She finds them everywhere. She has a knack. I almost never find one. Sarah is tough, she rejects a lot of stones. She doesn’t call it a heartrock unless it has a true heart shape.”

  “Perhaps you should look more carefully. There are billions and billions of rocks out there. I’ll bet I can find Sarah some heartrocks.”

  “You think so, eh? You have twenty-five minutes before I serve the food. What will you bet?”

  “A pizza with everything. Twenty-five minutes should be enough time.”

  “You win, you get a pizza. I win, I get a kiss.”

  “Hey.”

  “What’s the matter, you afraid? Put your money where my mouth is.” He grinned, daring her.

  “You’re on.”

  She didn’t waste much time in their barnyard or drive, figuring they would keep the area around the house well patrolled.
Their road was unpaved, full of stones. She walked down it slowly, head bent, studying the ground. She had never been aware how varied stones were, how many shapes they came in, long, round, angular, thin, flat.

  Now and then she would stoop and pick up a stone, but it was never right.

  After ten minutes had gone by, she was a quarter of a mile from the log house and had found only one stone that looked even remotely like a heart, but it was misshapen, too low on one side.

  A bad bet, she decided. She wanted to find a heartrock. She didn’t want him to think she had failed on purpose.

  At the end of the allotted time, she was back at his house. “I found one,” she said, holding it out.

  He looked at it and grinned. “This heart is missing … what’s the name of the upper chamber?”

  “Atrium.”

  “Yeah. This heart is missing the atrium on the right side.” He carried it to the door, flipped it outside.

  What happened next would be important, she told herself. If he used the bet to demonstrate his machismo, either with a clinch or an exchange of saliva, she would have no interest in him at all.

  But he bent and barely touched her mouth with his lips, a kiss that was tender and incredibly sweet.

  Ooh.

  He gave her a simple but wonderful supper: a large, crisp salad made entirely from his own garden stuff, except for the tomatoes, which were store-bought because his weren’t ripe yet. It was served with the house specialty, a honey-miso dressing, and garnished with asparagus they picked and steamed just before they sat down to eat. He had made his own sprouts from a combination of seeds and legumes he assured her was a secret, and he had baked crispy rolls filled with tiny pieces of garlic that exploded flavor as she chewed.