by Noah Gordon
MATTERS OF CHOICE
NOAH GORDON
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This is a work of fiction. Names, characters, places, and incidents either are the product of the author’s imagination or are used fictitiously. Any resemblance to actual persons, living or dead, businesses, companies, events, or locales is entirely coincidental.
Copyright © 1996 by Lise Gordon, Michael Seay Gordon and
The Jamie Gordon Trust
Cover design by Random House Mondadori
Image © Jamie Grill/Age Fotostock
ISBN: 978-1-4532-6376-1
This 2012 eBook published by:
Barcelona Digital Editions, S.L.
Av. Marques de l’Argentera, 17 pral.
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This 2012 edition distributed by Open Road Integrated Media
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This book is for Lorraine, my love.
And for our children—
Michael Gordon;
Lise Gordon and Roger Weiss;
and Jamie Beth Gordon, who had the warmth
and imagination to see the magic in heartrocks.
The difficulty in life is the choice.
—George Moore
The Bending of the Bough
I have never had a money practice; it would have been impossible for me. But the actual calling on people, at all times and under all conditions, the coming to grips with the intimate conditions of their lives, when they were being born, when they were dying, watching them die, watching them get well when they were ill, has always absorbed me.
—William Carlos Williams, M.D. Autobiography
The close-up, reassuring, warm touch of the physician, the comfort and concern, the long, leisurely discussions … are disappearing from the practice of medicine, and this may turn out to be too great a loss. … If I were a medical student or an intern, just getting ready to begin, I would be more worried about this aspect of my future than anything else. I would be apprehensive that my real job, caring for sick people, might soon be taken away, leaving me with the quite different occupation of looking after machines. I would be trying to figure out ways to keep this from happening.
—Lewis Thomas, M.D.
The Youngest Science: Notes of a Medicine Watcher
PART ONE
THE THROWBACK
1
AN APPOINTMENT
R.J. woke.
As long as she lived, from time to time in the middle of the night she would open her eyes and search the darkness in the tense certainty that she was still an overworked resident physician at the Lemuel Grace Hospital in Boston, grasping at a nap in an empty patient room in the middle of a thirty-six-hour shift.
She yawned while the present flooded into her consciousness and she knew with great relief that the residency was years behind her. But she closed her mind to reality because the luminous hands of the clock told her she had two hours left and she had learned in that long-ago residency to milk every moment of sleep.
She emerged again two hours later to graying light and no panic and reached over and killed the alarm. Invariably she awoke just before it rang, but she always set it the night before anyway, just in case. The special shower head thrummed the water into her scalp not quite bruisingly, as reviving as an extra hour of sleep. The soap slid over a body ampler than she thought desirable, and she wished there were time for a run, but there wasn’t.
As she used the dryer on her short black hair, still thick and good, she appraised her face. Her skin was fair and clear, her nose narrow and somewhat long, her mouth wide and full. Sensual? Wide, full, and unkissed for a long time. There were bags under her eyes.
“So, what do you want, R.J.?” she demanded rudely to the woman in the mirror.
Not Tom Kendricks any longer, she told herself. Of that she was certain.
She had selected her clothing before she went to bed, and it waited at one side of the closet, a blouse and tailored slacks, attractive but comfortable shoes. In the hallway she saw through the open door to Tom’s bedroom that the suit he had worn yesterday was still on the floor where he had dropped it the night before. He had been up earlier than she and was long gone from the house, needing to be scrubbed and in the operating room by 6:45.
Downstairs, she poured a glass of orange juice and forced herself to drink it slowly. Then she put on her coat, picked up her briefcase, and went through the unused kitchen and out to the garage. The little red BMW was her indulgence, as the grand antique house was Tom’s. She enjoyed the purr of the engine, the responsiveness of the wheel.
It had snowed lightly during the night, but the Cambridge road crews did a good job removing snow, and she had no trouble once she was past Harvard Square and JFK Boulevard. She turned on the radio and listened to Mozart while drifting with the tide of traffic moving down Memorial Drive, then she took the Boston University Bridge across the Charles River to the Boston side.
Early as it was, at the hospital the staff parking lot was almost full. She slid the BMW into a space next to a wall, to minimize the chance of damage from a neighbor’s carelessly opened door, and then walked briskly into the building.
The security guard nodded. “Mornin’, Dockuh Cole.”
“Hi, Louie.”
At the elevator she said hello to several people. She got out at the third floor and walked quickly into Room 308. She always got to work very hungry in the morning. She and Tom rarely had lunch or dinner at home, and never breakfast; the refrigerator was empty except for juice, beer and soft drinks. For four years R.J. had stopped at the crowded cafeteria every morning, but then Tessa Martula had become her secretary and insisted on doing for her what she doubtless wouldn’t have agreed to do for a man.
“I go there to get my own coffee, so it doesn’t make sense not to get yours,” Tessa had insisted. So now R.J. put on a fresh white coat and began to review the case histories that had been left on her desk, and seven minutes later she was rewarded by the sight of Tessa bearing a tray containing a toasted bagel and cream cheese, and coffee black and strong.
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 front 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 p
roblems 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.