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

by Noah Gordon

  All through April she pushed the trail home, attaining now a few difficult feet, now an easier advance. Eventually she came to the last major challenge, a brook to be bridged. Over a very long time the brook had eaten deeply into the forest floor, draining the wet pasture into the river. David had made three wooden bridges where they had been needed in other places; she didn’t know if she could make the fourth—perhaps it would take more strength and construction experience than she possessed.

  One day after she came home from work she studied the high banks and then visited the bridges David had made, analyzing what she would need to do. She could see that the job would require at least a full day, so it would have to wait for her day off, and she turned away and declared a holiday with whatever light remained of the afternoon. The river was swollen and fast, still too high for fishing, but she went home and got her spinning rod and dug half a dozen worms next to the compost pile. She cast out into the largest of the beaver ponds and alternately watched the little bobber and admired the work of the beavers, which had built up the dam and thinned an impressive number of trees. Before the bobber moved at all, a kingfisher came and mocked her with its cry, and it dove into the pond and flew away bearing a fish. R.J. felt inferior to the bird, but eventually she caught two beautiful small brook trout, which she had for supper with a mess of steamed fiddleheads, tasting the season in the wild greens.

  After supper, bringing out her garbage, she came upon a small black heartrock where she had dug the worms, and she pounced on it as if it could scuttle away. She brought it inside and washed it and rubbed it to bring out its sheen, and placed it on top of the television set.

  Once the earth was bared of snow, it was as if R.J. somehow had been singled out to inherit Sarah Markus’s serendipitous ability to discover heart-shaped stones. Everywhere she went, her eyes fell upon them as if directed by Sarah’s spirit. They came in all shapes—stones with the heart’s upper cheeks curvy as a pear and deeply indented as a perfect fundament, stones with angular but balanced cheeks, stones with lower points that were sharp as fate or shaped like the shallow arc of a kindergarten swing.

  She discovered a stone that was as tiny as a smooth, brown birthmark, in a plastic bag of purchased plant soil. She found one the size of a fist at the base of the crumbling stone wall on the western boundary of her property. She came upon them while working in the woods, while walking on Laurel Hill Road, while doing errands on Main Street.

  Very quickly, people in Woodfield observed the doctor’s preoccupation with cardioid stones and began finding them for her, dropping them off with pleased smiles at her home and her office, helping her with her hobby. She became accustomed, on coming home, to emptying her pockets of stones, or taking stones from her purse or from paper bags. She washed and dried them and spent anxious moments wondering where to put them. The collection quickly outgrew the guest room. Soon the heartrocks were displayed all over the living room as well, on the wall mantels and above the fireplace. And on end tables and the coffee table. And on the kitchen counter, and in the bathroom upstairs, and on her bedroom bureaus, and on the toilet tank in the lavatory on the ground floor.

  The stones spoke to her, a sad, wordless message reminding her of Sarah and David. She didn’t want to hear it, but still she collected them compulsively. She bought a geology manual and began to identify the stones, taking pleasure in the knowledge that this one was basalt from the lower Jurassic era, when monster creatures had roamed the valley; that that one was solidified magma that had poured, liquid and boiling, up from the molten core a million years ago when the earth had hiccupped fiery vomit; that this stone of fused sand and gravel came from a time when ocean depths covered these now-inland hills; that that piece of glittering gneiss most likely had been a drab rock before colliding continents had transformed it in the pressure cooker of metamorphism.

  One afternoon in Northampton, R.J. walked past the site of a sewer line replacement on King Street. The excavation was a trench perhaps five feet deep, cordoned off from the public by wooden sawhorses, metal barriers, and yellow plastic rope. In the corner of the hole was something that made her eyes widen—a reddish, well-shaped stone about fifteen inches long and eighteen inches wide.

  The petrified heart of a vanished giant.

  The work site was abandoned. The laborers had finished work for the day and were gone, or she would have asked someone to get it for her. Too bad, R.J. thought and passed it by. But she hadn’t taken five steps before she turned and went back. She sat in the dirt on the lip of the trench with her feet dangling, never mind her new slacks, and ducked her head inside the rope; then she pushed off with her hands and dropped into the hole.

  The rock was fully as good as it had looked from above. But it was heavy, very difficult for her to lift, and she had to raise it the height of her neck in order to push it out of the trench. She accomplished the feat on the second try, as an act of desperation.

  “Lady, what the hell?”

  He was a police officer, glaring down at her in disbelief from the side of the trench that faced the road.

  “Do you mind giving me a pull up?” she asked, holding up her hands. He was not a large officer. But in a moment he had hauled her out, exhibiting as much strain as she had shown when she lifted the stone.

  Breathing hard, he stared at her, seeing the dirt smudge on her right cheek, the black slacks streaked with gray clay, and the mud on her shoes. “What were you doing down there?”

  All she could do was give him a beatific smile and thank him for his help. “I’m a collector,” she said.

  Three Thursdays came and went before she had an opportunity to spend the day building her bridge. She knew what she had to do. She had walked the trail to the brook half a dozen times to study the site, and again and again she had gone over in her mind how it might be done.

  She had to cut two matching trees whose trunks would provide the main bridge supports. The trimmed logs had to be heavy enough to hold weight and endure, yet light enough for her to be able to move them into position.

  She had already chosen the trees and went right to them, the growl and whine of the saw a comfort, and she felt expert now as she cut the boles and trimmed them. The logs were deceptively slender. They were very heavy, but she discovered she was able to move each one a few feet at a time by lifting and heaving first one end and then the other. The thud each time a log dropped seemed to shake the earth and made her feel she was an Amazon, except that she was tiring very quickly.

  With a pick and a shovel she dug four shallow sockets, two on each bank, into which the log ends needed to nest to give them stability.

  Slowly but surely, she moved the logs into place, ultimately getting into the brook and lifting the logs on her shoulder to maneuver each end into its prepared slot. When she was finally done, it was lunchtime, and the black flies and mosquitoes had begun feeding on her, so she beat a retreat.

  She was too excited to spend time preparing much of a meal, eating peanut butter smeared hastily on sliced bread, and a cup of tea. She longed to soak in a hot bath, but she knew she wouldn’t finish the bridge if she did, and she could smell victory. So, freshly sprayed with repellent, she went back outside.

  She had bought a truckload of black locust slabs from Hank Krantz—they were piled in the backyard—and she measured and cut four-foot lengths of slab, trying to select pieces that were more or less uniformly thick. Then she carried them, three or four at a time, to the bridge site. By this time she was really tired, and she stopped for more tea. But she knew that what remained to be done was clearly within her range of capabilities, and the knowledge drove her as she placed the slabs one by one and drove in the long nails, the sound of her hammer blows daring any wild critter to challenge her in her territory.

  Finally, as the late afternoon shadows darkened the woods, she finished. The bridge was strong. It lacked only elegant white birch rails that she would install another day. It was springier than it would have been if she had
been able to handle thicker logs, she admitted to herself. But it was a good job, and it would serve her well.

  She stood in the middle of it and danced a triumphant little tarantella.

  And on the east side of the brook, the right-hand corner of the bridge moved slightly.

  When she went closer and jumped up and down, the corner sank. She jumped several times, cursing, and the corner went down quite a bit more. Her tape measure told her the bridge ended up fourteen inches lower on that side than on the other.

  R.J. had set the stage for the problem by neglecting to firm the soil under the log on that side, and the weight of the bridge had done the rest. She saw that it would have been wise to have placed a flat rock under each log end, as well.

  She went back into the brook and tried to lift the bridge on the low end but it was impossible for her to move it, and she surveyed the slanting structure bitterly. It would be possible to cross it gingerly, if it didn’t drop any more. But it would be folly to try to get across it while carrying a heavy load, or while pushing a laden wheelbarrow.

  She collected her tools and made her slow way home, bone weary and terribly disappointed. It would no longer be easy or pleasurable to boast to herself that she could do anything, if she had to add a qualifier:

  “… almost.”

  38

  THE REUNION

  George Palmer came to R.J.’s office one day when every seat was taken in the waiting room and Nordahl Peterson was sitting outside on the front steps. Still, when she had finished talking with George Palmer about his bursitis, explaining why she wasn’t going to give him any more cortisone, he nodded and thanked her but showed no sign of leaving.

  “My youngest child is Harold. My baby,” he said sardonically. “Now forty-two years old. Harold Wellington Palmer.”

  R.J. smiled and nodded.

  “Accountant. Lives in Boston. That is, he has been living there, past twelve years. Now he’s going to be living with me again. He’s coming back to Woodfield.”

  “Oh? That should be nice for you, George,” she said cautiously, having no way to know whether or not it would be nice until he came to the point.

  It turned out that it might not be at all nice for George.

  “Harold is what they call HIV positive. He’s coming here with his friend Eugene. They’ve been living together for nine years….” He seemed to lose his train of thought and then found it again with a start. “Well, he’s going to need a doctor’s care.”

  R.J. put her hand on George’s hand. “I’ll look forward to meeting him and being his doctor,” she said, and squeezed his hand. George Palmer smiled at her and thanked her and left her office.

  * * *

  There wasn’t a great deal of forest between the end of the trail and her house, but the sadly sagged bridge had dampened her enthusiasm for trail building, and she turned to her vegetable garden with relief. It was too early for tender vegetables. The gardening books said she should have planted peas several weeks earlier instead of working in the woods, but the cool mountain climate gave her leeway, and she spread peat moss, compost, and two bags of purchased greensand on the raised beds that she and David had made, and dug everything in. She planted edible pod peas, of which she was especially fond, and spinach, knowing that neither would be bothered by the heavy frosts that still fell at night with regularity.

  She watered carefully—not too much, to avoid damping off; not too little, to avoid aridness—and was rewarded by a row of seedlings that lasted scarcely a week. At the end of that time they had vanished, and the clue to where they had gone was a single perfect print in the velvet earth.

  A small deer.

  That night she went for coffee and dessert to the Smiths’ house and told them what had happened. “What do I do now? Replant?”

  “You can,” Toby said. “You might still have time to get a crop.”

  “But there are a whole lot of deer out in the woods,” Jan said. “You’d better take steps to keep the wild animals away from your garden.”

  “You’re the fish and game expert,” R.J. said. “So how do I do that?”

  “Well, some folks collect human hair from barbershops and spread it around. I’ve tried that myself. Sometimes it works, sometimes it doesn’t.”

  “How do you protect your own garden?”

  “We pee all around it,” Toby said calmly. “Well, I don’t.” She jerked her thumb at her husband. “He does.”

  Jan nodded. “Best thing. One whiff of human piss, the critters find an excuse to make a business trip elsewhere. That’s what you should use.”

  “Easy for you to say. There is a certain physiological dissimilarity that makes my situation more difficult than your own when it comes to spraying. Would you consider coming over to my place, and …?”

  “Nope,” Toby said firmly. “His supply is limited, and spoken for.”

  Jan grinned and offered a final word of advice. “Use a paper cup.”

  That was what she did, after replanting her peas. The problem was, she had a very limited supply too, even when she forced herself to drink more fluids than her thirst demanded. But she anointed the area next to the portion of the raised bed where she had replanted her peas, and this time when the seedlings came up, they weren’t eaten.

  One day R.J. heard a sound like multiple motors in her backyard, and when she left the house she saw that a buzzing host was lifting from one of the hives. Thousands of bees rose in twisting, dancing ropes that coalesced and merged at roof height into a thick column that looked almost solid at times, so closely packed and multitudinous were the small black bodies. The column became a cloud that contracted and expanded, shifted and grew, and eventually it lifted and moved darkly over the trees and into the woods.

  Two days later, another hive swarmed. David had worked hard on his bees, and R.J. had ignored them, but their loss gave her no feelings of guilt. She was busy with her own work and interests, and she had decided that she had her own life to live.

  The afternoon of the second swarm she received a telephone call at the office. Gwen Gabler was coming from Idaho to visit her. “I need to be in western Massachusetts for a couple of weeks. I’ll explain when I see you,” Gwen said.

  Marital problems? But no, it didn’t sound like that at all: “Phil and the boys send their love,” Gwen said.

  “Give my love to them. And hurry from there to here. Hurry,” R.J. told her.

  * * *

  R.J. wanted to pick her up, but Gwen knew what a doctor’s schedule was like, and she arrived by cab from the Hartford airport, the same wiseass, warm, wonderful Gwen!

  She came in the afternoon accompanied by a spring rainstorm, and they hugged damply and kissed and stared at one another and hooted and laughed. R.J. showed her the guest room.

  “Never mind that. Where’s the toilet? I’ve held it in since Springfield.”

  “First door on the left,” R.J. said. “Ooh, wait.” She ran into her own room, grabbed four paper cups from the bureau top, and hurried after Gwen. “Here. Would you use these, please? I’d appreciate it greatly.”

  Gwen stared. “You want a specimen?”

  “As much as you can give. It’s for the garden.”

  “Oh, for the garden.” Gwen turned away, but her shoulders were already shaking, and in a moment she was roaring, leaning against the wall helplessly. “You haven’t changed, not one marvelous cell. God, how I have missed you, R.J. Cole,” she said, wiping her eyes. “For the garden?”

  “Well, let me explain.”

  “Don’t you dare. I don’t ever want to hear it. Don’t spoil a thing,” Gwen said, and clutching the four cups, ran into the bathroom.

  That night they were more serious. They stayed up and talked late, late, while outside the rain drummed against the windowpanes. Gwen listened as R.J. spoke about David and told her about Sarah. She asked a question or two and held R.J.’s hand.

  “And what of you? How is life in the HMO?”

  “Well, Idaho�
�s beautiful and the people are really nice. But the Highland Family Health Center is a Health Maintenance Organization from hell.”

  “Ah, Gwen, damn. Your hopes were so high.”

  Gwen shrugged. She said that in the beginning it had appeared ideal. She believed in the HMO system, and she had received a bonus for signing her contract. She was guaranteed four weeks of paid vacation time and three weeks to attend professional meetings. There were a couple of doctors who seemed to her to be less than geniuses, but she saw at once that four of the staff physicians were first-rate, three men and a woman.

  But almost immediately one of the good male doctors, an internist, had left the Highland Center and gone to work at a nearby Veterans Administration hospital. Then another man—the HMO’s only other ob-gyn—had moved to Chicago. By the time the woman doc, a pediatrician, had bailed out, Gwen had a good idea what the exodus was about.

  The management was very bad. The company owned nine HMOs throughout the western states and advertised that its driving goal was quality care, but the bottom line clearly was profit. Its regional manager, a former internist named Ralph Buchanan, now did time-and-motion studies instead of practicing medicine. Buchanan reviewed all the case reports to determine where money was “wasted” by the employee-physicians. It didn’t matter whether a doctor sensed something in a patient that made him or her want to investigate further. Unless there were citable “book reasons” for ordering a test, the physician was brought to account. The company had something it called the Algorithmic Decision Tree. “If A occurs, go to B. If B happens, go to C,” Gwen said. “It’s truly medical practice by the numbers. The science is standardized and spelled out for you, with no allowance for individual variations and needs. Management insists that the nonclinical details of a patient’s life—the background that sometimes points us to the real causes of trouble—must be ignored as a waste of time. There’s absolutely no room for a doctor to practice the art of medicine.”