The Cole Trilogy: The Physician, Shaman, and Matters of Choice (223 page)

When R.J. had written to hospital medical chiefs, informing them of the opportunity for a new practice in the Berkshire hills, she had emphasized the beautiful countryside and the opportunities for fishing and hunting. She hadn’t anticipated a deluge of replies, but neither had she expected that her letter would go unanswered.

So she was pleased when finally she received a telephone call from Peter Gerome, who said he had completed a residency in medicine at the New England Medical Center and had followed it with a postresidency fellowship in family medicine at the University of Massachusetts Medical Center. “Right now, I’m working in an emergency room while I look around for a country practice. I wonder if my wife and I could visit you?”

“Come as soon as you can,” R.J. told him.

Together they worked out a date for the visit, and that afternoon she sent Dr. Gerome directions to her office, transmitting them on her latest concession to technology, a fax machine that would allow her to receive messages and records from the hospitals and other doctors.

She was bemused by the upcoming visit. “It’s too much to expect that the one respondent we’ve had will be any good at all,” she told Gwen, anxious to make the visit an attractive one. “At least the scenery will be at its very best for him. The leaves already have begun to turn.”

But as sometimes happens in the autumn, a drenching rain began to fall on New England the day before Peter Gerome and his
wife were to arrive. The downpour drummed on the roof of the house all through the night, and in the drizzly morning R.J. wasn’t surprised to see that most of the colorful foliage had been stripped from the trees.

The Geromes were a likable couple. Peter Gerome was a large teddy bear of a young man, with a round face, gentle brown eyes behind thick glasses, and almost ashen hair that he kept brushing away as it fell over his right eye. His wife, Estelle, whom he introduced as Estie, was an attractive brunette, slightly overweight, who was a registered nurse-anesthetist. She was very much like her husband in temperament, with a calm, pleasant demeanor that R.J. warmed to at once.

The Geromes came on a Thursday. She took them to meet Gwen, and then she drove them throughout the western county and into Greenfield and Northampton to visit the hospitals.

“How did it go?” Gwen asked her that night on the phone.

“I couldn’t tell. They weren’t exactly bubbling over with enthusiasm.”

“I don’t think they’re the kind to bubble over. They’re thinkers,” Gwen said.

They had liked what they saw well enough to come back, this time for a four-day visit. R.J. would have wanted them to stay with her, but the guest room had been turned into David’s office. Portions of his manuscript were all over the room, and he was working feverishly to finish his book. Gwen wasn’t sufficiently established yet to have houseguests, but the Geromes found a room at a bed and breakfast on Main Street, two blocks from R.J.’s office, and she and Gwen settled for having them to dinner every evening.

R.J. found herself hoping they would move to the area. Each of them had had exemplary training and experience, and they asked sensible, practical questions when she discussed with them the loose, HMO-like medical group she and Gwen wanted to establish in the hills.

The Geromes spent the four days driving around the county, stopping to talk with people in town halls and general stores and firehouses. The afternoon of the fourth day was chill and overcast,
but R.J. took them walking on the wood trail, and Peter was appreciative of the Catamount. “It looks like a good little trout river.”

R.J. smiled. “It is, very good.”

“Well, may we fish it when we come out here to live?”

R.J. was very pleased. “Of course you will.”

“I suppose that settles it, then,” Estie Gerome said.

Change—more than the change of seasons—was in the chill, leaden air. Toby was less than two-thirds through her pregnancy but she was leaving R.J.’s office. She planned to spend a month preparing for the baby and helping Peter Gerome to find and set up an office. After that, she would serve as business manager of the Hilltowns Medical Cooperative, splitting her time among R.J.’s office and Peter’s and Gwen’s, doing all the billing and purchasing and keeping the three sets of books.

Toby recommended her own successor as R.J.’s receptionist, and R.J. hired her, knowing that Toby’s instincts about people were very good. Mary Wilson had been a member of the town planning board when R.J. had appeared before that group to get permits for her office renovations. Mary would probably be a fine receptionist, but R.J. knew she would miss seeing Toby every day. To celebrate Toby’s new job, R.J. and Gwen took her to dinner at the inn in Deerfield.

They met at the restaurant after work. Toby couldn’t drink because of her pregnancy, but the three of them were quickly in good humor without wine, and they toasted the new baby and the new job with cranberry juice. R.J. felt deep affection for both of her friends, and she had a very good time.

It began to rain during the drive home, when she and Toby were halfway up Woodfield Mountain. By the time she dropped Toby off it was pelting, and R.J. drove slowly, peering through the windshield wipers.

Intent on her driving, she was almost past Gregory Hinton’s farmhouse when she became aware that the light was on in the barn, and she glimpsed, through the open barn door, a figure seated inside.

The road was slick, and she didn’t try to brake, but she slowed the car, and when she came to the rough lane leading into the Hintons’ pasture, she turned the car around and went back. Gregory was in the midst of a combined course of radiation and chemotherapy, and he had lost his hair and was suffering from the side effects of the treatment. It wouldn’t hurt to say hello to him, she thought.

She drove right up to the barn door, and he turned as she slammed the car door and ran in through the rain. He was seated in a folding chair by one of the stalls, wearing overalls and a barn coat, his new baldness covered by a cap that advertised a fertilizer company.

“Whew, what a night. Hi, Greg, how are you doing?”

“R.J.… Well, you know.” He shook his head. “Nausea, diarrhea. Weakness like a baby.”

“This is the worst part of the treatment. You’ll feel much better when it’s done. The thing is, we’ve got no choice. We have to stop that brain tumor from growing. Shrink it if we can.”

“Damn disease.” He motioned to another metal folding chair deeper in the barn. “Set a while?”

“I will.” She went to get the chair. She had never been in his barn; it stretched before her into the animal-warmed gloom like an airplane hangar, cows in the stalls on both sides. Far above her under the vast roof something fluttered and dove and fluttered again, and Greg Hinton saw the direction of her glance.

“Just a bat. They stay high.”

“Some barn,” she said.

He nodded. “Made from two old barns, really. This part was original. The rear half was another barn, moved here by oxen about a hundred years ago. Always figured I’d put in one of those fancy milking parlors, but I never did. Stacia and I milk ’em old-fashioned, with their necks in stanchions so they can’t move on us.”

He closed his eyes, and she reached over and put her hand over his.

“You think they’ll ever find a cure for this rotten thing, R.J.?”

“I think they will, Greg. They’re working on genetic cures for
lots of diseases, including different kinds of cancer. The next few years are going to make an enormous difference. It’s going to be a new world.”

His eyes opened and found hers. “How many years?”

The big black-and-white cow in the stall in front of them lowed suddenly, a loud, complaining bawling that startled her. How many years, indeed. She steeled herself. “Oh, Greg. I don’t know. Maybe five? Just a guess.”

He gave her a bitter trace of a smile. “Well, however many years. I won’t be around to see that new world, will I?”

“I don’t know. Lots of people with your disease live a number of years. I think it’s important that you believe—
really believe
—that you’ll be one of them. I know you’re religious, and it won’t hurt if you pray a lot right now.”

“Will you do me a favor?”

“What’s that?”

“Will you pray for me too, R.J.?”

Oh, glory, wrong number. But she smiled at him. “Well, that can’t do any harm either, can it?” she said, and promised him she would. The creature in front of them suddenly let out a great call that was answered first by a cow at the other end of the barn and then by others.

“What are you doing sitting out here by yourself, anyway?”

“Well, this one is trying to drop a calf, and she’s in trouble,” he said, motioning with his chin at the cow in the stall. “She’s a heifer cow. You know, never had a calf before?”

R.J. nodded. A primigravida.

“Well, she’s tight, and the calf is hung up on her insides. I’ve called the only two veterinarians around who handle big animals anymore. Hal Dominic is down bad with the flu, and Lincoln Foster is all the way over to the south county with two or three jobs still to do. He said he’d try to be here by eleven o’clock.”

The cow sounded again and clambered to her feet. “Easy, there, Zsa Zsa.”

“How many cows do you have?”

“Seventy-seven, at the moment. Forty-one of them milkers.”

“And you know their names?”

“Just the cows that are registered. See, you have to put names on the registration papers. The ones that aren’t registered have numbers painted on their sides instead of names, but this cow is named Zsa Zsa.”

The Holstein sank down again as they watched, dropping onto her right side with her legs sticking straight out.

“Shit.
Shit!
Beg your pardon,” Hinton said. “They only go to their side like that when they’re almost gone. She’ll never last until eleven o’clock. She’s been trying to give birth for five hours.

“I’ve got money sunk into her,” he said bitterly. “A registered cow like this, I can expect eighty to a hundred pounds of milk per day. And the calf would have been worthwhile. I paid a hundred dollars just for the semen from a specially good bull.”

The cow moaned and shuddered.

“Isn’t there something we can do for her?” R.J. asked.

“No, I’m too sick to handle this, and Stacia’s absolutely worn out from doing most of the milking. Stacia’s no longer young either. She tried to deal with this for a couple of hours and just couldn’t, had to go into the house and lie down.”

The cow bellowed in pain, climbed to her feet, sank back onto her belly.

“Let me have a look,” R.J. said. She took off her Italian leather jacket and placed it on a bale of hay. “Will she kick me?”

“Not likely, lying down like that,” Hinton said dryly, and R.J. approached the cow and squatted in the sawdust behind her. It was a strange sight, a manurial anus like a great, round eye above the enormous bovine vulva in which she could see one pathetic hoof and a flaccid red object dangling to the side.

“What’s that?”

“Calf’s tongue. The head’s just below there, out of sight. For some reason, calves often are born sticking their tongues out at you.”

“What’s holding it back?”

“Normal birth, the calf would be born with the two front hooves first, then the head—the way a diver goes into the water holding his hands out in front of him. This one has the left hoof in the proper position, but the right leg is doubled back somewhere
in there. What the veterinarian has to do is push the head back into the vagina and reach his hand in to see what’s wrong.”

“Why don’t I give it a try?”

He shook his head. “Takes some little bit of strength.”

She watched the cow shudder. “Well, it can’t hurt to try. I’ve never lost a cow yet,” she said, but it was wasted, he didn’t even smile. “Do you use a lubricant?”

He eyed her doubtfully, then shook his head. “No, you wash your whole arm and just leave plenty of soap on it,” he said, leading her to the sink.

She rolled up both sleeves of her shirt until they were all the way to the shoulders, and then she scrubbed in the cold water, using the thick, stained block of laundry soap that was there.

Then she went back behind the cow. “Now, Zsa Zsa,” she said, and then felt silly to be speaking to a rear end. As R.J.’s fingers and then her hand entered the warm moistness of inner space, the cow extended her tail, straight and rigid as a poker.

The calf’s head indeed was just below the surface, but it felt immovable. When she looked at Greg, she saw that despite his concern his eyes held a clear I-told-you-so, and R.J. took a breath and leaned into it, as if trying to push a swimmer’s head down into almost-solid water. Slowly, the head began to recede. When there was room, she pushed her hand into the cow’s vagina, wrist deep, then halfway to her elbow, and her fingers found something else.

“I can feel … I think it’s the calf’s knee.”

“Yeah, probably is. See if you can reach below it, pull the hoof up,” Hinton said, and R.J. tried.

She worked her hand and arm deeper but suddenly felt a kind of cosmic ripple as undeniable as a small earthquake, then a rolling force that pushed a tsunami of muscle and tissue against her hand and forearm and simply moved them up and out like a seed spat out so forcefully that her entire body fell back.