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

by Noah Gordon

  She mentioned it to Hank Krantz, who came roaring and clattering up her driveway one morning on his big John Deere tractor, pulling his manure spreader. “Get in,” he said, “and we’ll get you a log for your signpost.” So she clambered into the big metal spreader, providentially empty but redolent of cow shit, and held on in disbelief while he jarred and bumped her—a country woman at last—all the way to the river.

  Hank chose a healthy, mature black locust tree in a stand on the riverbank and felled it with his chain saw, trimming the log and putting it in the manure spreader to keep her company on the way back.

  David fashioned a stout, square-cut signpost from the log, approving Hank’s choice. “Black locust is just about rot-proof,” he said, and set it three feet into the earth. An arm extended from it, with two eyebolts on the bottom surface from which the sign would be suspended. “You want something besides your name? You want to call the place anything special?”

  “No,” she said. Then she made up her mind, and she smiled. “Yes, I do.”

  She thought it was beautiful when it was done, painted the same yellow as the house, with the lettering in black.

  THE HOUSE

  ON THE VERGE

  R.J. COLE, M.D.

  The sign puzzled people. On the verge of what? they asked her.

  Depending on her mood she pleased herself by telling them the house was on the verge of solvency, on the verge of despair, on the verge of collapse, on the verge of answering the cosmic riddle of life. Pretty soon either they grew bored by her oddness or accustomed to the sign, and they stopped asking.

  20

  SNAPSHOTS

  “Who’s next?” R.J. asked Toby Smith late one afternoon.

  “I am,” Toby said nervously.

  “You? Oh … of course, Toby. Do you need a physical exam, or do you have a problem?”

  “Problem.”

  Toby sat by the desk and outlined the facts sparingly and clearly.

  She and her husband, Jan, had been married for two and a half years. For the past two years they had been trying to conceive a child.

  “No luck at all. We make love all the time, desperately and much too often, really. It’s ruined our sex life.”

  R.J. nodded in sympathy. “Well, give it a rest. It ain’t what you do, it’s the way you do it. And when. Does Jan know you’re talking with me about this? Is he willing to see me, too?”

  “Oh, yes.”

  “Well, we’ll do a semen analysis and run some tests on you, for starters. After we gather some information, we’ll be able to set up a regular drill for you.”

  Toby regarded her seriously. “I would appreciate it if you would use another word, Dr. Cole.”

  “Of course. Schedule? We’ll set up a regular schedule?”

  “Schedule is fine,” Toby said, and they smiled at one another.

  * * *

  She and David had reached the stage where they asked each other a lot of questions, wanting to know one another in every way. He was curious about how she regarded her work, and it was interesting to him that she had been educated both as an attorney and as a physician.

  “Maimonides was a lawyer as well as a doctor.”

  “A rabbi too, no?”

  “A rabbi too, and a diamond merchant, to bring bread into the house.”

  She smiled. “Maybe I should become a diamond merchant.”

  She found it possible to talk about anything with him, an unbelievable luxury. He felt the same way about abortion that he felt about God: he was undecided. “I think a woman should have the right to save her own life, to safeguard her health or her future, but … to me, a baby is a very serious thing.”

  “Well, of course. To me, too. Conserving life, making it better—that’s my job.”

  She told him how it felt when she was able to help someone, really score points to drive away pain, to extend life. “Like a cosmic orgasm. Like the world’s biggest hug.”

  He listened when she remembered agony too, times when she had made a mistake, when she realized that someone who had come to her for help had been harmed by her efforts.

  “Have you ever ended somebody’s life?”

  “Hurried death in through the door? Yes.”

  She liked the fact that he didn’t say the obvious things. He only looked into her eyes as he nodded, and took her hand.

  He could be moody. Real estate sales seldom influenced his spirits, but she was able to guess whether or not his writing was going well. When it was going badly he took refuge in physical work. Sometimes on weekends he allowed her to share his garden chores, and she pulled weeds and dug her hands into the soil, loving the gritty contact of earth with skin. Despite her supply of fresh vegetables from the gardens of others, she wanted her own. He convinced her of the wisdom of a couple of raised beds, and he knew where she could buy some used barn beams with which to make the frames.

  They removed the grassy topsoil from two rectangles on a gradual, south-facing slope in the meadow, block by block like Inuits building an igloo, and piled the sod upside down in the composter. They set flat stones in the ground in the shape of the beds, four feet by eight feet, using a bubble level to make certain the stones were even. On the stone base David built the bed frames, using two layers of the oak beams on each. The beams were difficult to handle and work. “Hard as death and heavy as sin,” David grunted, but soon he had shiplapped the corners and had driven long galvanized spikes to form the frames.

  He set down his sledge and took her hand. “You know what I love?”

  “What?” she asked, her heart pounding.

  “Horse shit and cow shit.”

  The manure available to them was from the Krantzes’ cow barn. They mixed it with peat moss and soil and overfilled the beds, and then piled a foot of loose hay on top.

  “It will settle some. Next spring, all you’ll have to do is pull the hay aside and plant your seeds, and then add more mulch as things grow,” David said, and she looked forward to all of that with the anticipation of a child.

  By the end of July she was able to see some financial trends in her practice. It became troublingly clear to her that certain patients ran up doctor’s bills without any serious commitment to paying. Payment for treating insured patients, although slow, was guaranteed. Of the uninsured, some were destitute, and without hesitation or regret she wrote off their treatment—pro bono. But a few patients were reluctant to pay even though it was obvious they were able to do so. She had treated Gregory Hinton, a prosperous dairy farmer, for a series of ulcerated boils on his back. He had been to her office three times, each time telling Toby he would “send a check,” but no check had arrived.

  While driving past his farm, she saw him enter the barn, and she turned the Explorer into his driveway. He greeted her pleasantly, if with curiosity. “Don’t need your services, glad to say. Boils are all gone.”

  “That’s good, Mr. Hinton. Glad to hear it. I was wondering … well, if you could pay your bill for the three visits?”

  “You were what?” He glared. “Good lord. Is it necessary to dun patients? What kind of a doctor are you, woman?”

  “A doctor who has just begun a new practice.”

  “You should be advised that Doc Thorndike always gave a person plenty of space about paying.”

  “Dr. Thorndike has been gone a long, long time, and I don’t have that luxury. I’d appreciate it if you could pay what you owe,” she said, and bade him good-day as pleasantly as she was able.

  That evening David nodded slowly when she told him about the encounter.

  “Hinton is a stubborn old skinflint. He keeps everyone waiting to be paid, so he can milk the last bit of bank interest out of every dollar. What you have to realize—what your patients must realize, too—is that you’re running a business at the same time that you’re doctoring them.”

  She needed to work out a system for collections, David said. Any dunning should be done by someone other than the doctor, so R.J. could keep her
“image as a saint.” Collecting debts was pretty much the same no matter what the business, he told her, and together they mapped out a program that she explained the next morning to Toby, the delegated collector, who would send out bills once a month.

  Toby knew the local population well and would make the difficult decision about whether a patient truly was indigent. Anyone who couldn’t pay but who wished to barter work or goods would be allowed to do so. Anyone who couldn’t give money or barter wouldn’t be billed.

  For those whom Toby believed capable of paying, separate computer categories were programmed for accounts that were up to thirty days overdue, sixty to ninety days overdue, and more than ninety days overdue. Forty-five days after the first bill was mailed, Letter No. I was sent, asking the patient to contact the doctor with any questions about the account. After sixty days, Toby would make a telephone call reminding the patient of the outstanding balance and recording his or her response. After ninety days, Letter No. 2 was sent, a firmer request for payment by a specific date.

  David suggested that after four months the account should be turned over to a collection agency. R.J. wrinkled her nose in distaste; that didn’t fit her vision of the relationships she wanted to build in a small town. She realized she had to teach herself to be a businesswoman as well as a healer; still, for the time being she and Toby agreed to hold off on dealing with a collection agency.

  Toby came to work one morning with a piece of paper that she handed to R.J. with a smile. It was yellowed and crumbling and had been placed for protection in a clear plastic holder.

  “Mary Stern found it in the files of the Historic Society,” Toby said. “Since it was addressed to an ancestor of my husband’s—the brother of his great-great-grandmother—she brought it over to our house to show it to us.”

  It was a physician’s bill, made out to Alonzo S. Sheffield, for “Office visit, grippe—50 cents.” The name printed at the top was Doctor Peter Elias Hathaway, and the date on the bill was May 16, 1889. “There have been several dozen physicians in Woodfield between Dr. Hathaway and you,” Toby told R.J. “Turn the bill over,” she said.

  A verse was printed on the back:

  Just on the brink of danger, not before,

  God and the Doctor we alike adore;

  The danger passed, both are alike requited;

  God forgot and the Doctor slighted.

  Toby returned the bill to the historical society, but not before copying the verse and placing it into the computer with Accounts Receivable.

  David talked all the time about Sarah, and R.J. encouraged him to do it. One evening he brought out pictures, four fat albums that recorded the life of one child. Here was Sarah as a newborn, held in the arms of her maternal grandmother, the late Trudi Kaufman, a plump woman with a wide smile. Here was serious little Sarah in her Teeterbabe, gravely watching her young father while he shaved. Many of the pictures engendered an anecdote. “See this snowsuit? Navy blue, her first snowsuit. She was just a year old, and Natalie and I were making a big deal over the fact that we had been able to switch her from diapers to training pants. One Saturday we took her to A&S—Abraham and Strauss, the nice department store in downtown Brooklyn. It was January, right after the holidays, and cold. You know what it is to dress a little kid for the cold? All the layers you have to put on them?”

  R.J. nodded, smiling.

  “She had so many layers of clothing she was shaped like a little ball, a little Vienna roll. Well, we’re in the elevator at A&S, the elevator man is announcing the merchandise, floor by floor. I had been carrying her, but now she’s standing between us, Natalie and I each have a hand. And I notice the elevator man’s face as he’s reciting the merchandise, and I follow his eyes. And I see that all around those two little white baby shoes there is a big wet circle in the carpet on the elevator floor. And Sarah’s legs are a darker, wetter blue than the rest of her snowsuit.

  “We had changes for her in the car and I ran to the garage and got them. So we had to take all those wet layers off and put all those dry layers on. But the snowsuit was soaked, so we had to go to Infants’ Wear and buy another snowsuit.”

  Sarah on her first day of school. Sarah as a skinny eight-year-old, digging in the sand on vacation at Old Lyme Beach in Connecticut. Sarah with braces on her teeth and a big, exaggerated grin to show them off.

  David appeared in some of the pictures with her, but R.J. assumed that mostly he had been behind the camera, because Natalie was in many of the snapshots. R.J. studied her covertly, a pretty, self-assured young woman with long black hair, shockingly familiar because her sixteen-year-old daughter looked so much like her.

  There was something wrong—sick—about envying a dead woman, but R.J. envied the woman who had been alive when all the pictures had been taken, the woman who had conceived and borne a daughter, taught and guided Sarah, given the girl her love. She recognized uncomfortably that some of her interest in David Markus stemmed from the fact that she yearned for a daughter herself, coveting the girl he and Natalie Kaufman Markus had brought into the world.

  From time to time as she traveled the town she remembered Sarah and her collection, and she tried to keep her eyes out for heartrocks but never had any success. Mostly she was too busy to remember, and too short on time to spend pleasant minutes studying stones on the ground.

  It happened by accident, a moment of serendipity. On a hot midsummer day she stole into the woods and took off her shoes and socks at the riverbank. She rolled up the legs of her slacks above the knee and waded blissfully in the cold water of the Catamount. In a moment she came to a pool and saw that it was full of fingerlings. She couldn’t tell if they were brook trout or brown trout as they hovered in the clear water. Then, just beyond and below the trout, she saw a small whitish stone. Although she was conditioned by previous disappointments not to have expectations, she waded a few feet into deeper water, scattering fish in every direction, and reached down until her fingers closed on the stone.

  A heartrock.

  A crystal, probably quartz, about two inches in diameter, with a smooth surface made opaque by untold years of running water and grinding sands until the stone was just the proper shape.

  She carried it home in triumph. In her bureau drawer was a small jeweler’s box, and she emptied it of the pearl earrings it had contained and nestled the crystal into the velvet lining. Then she took the box and drove across town.

  Fortunately, the log house looked deserted. Leaving the Explorer’s motor running, she left the car and placed the little box in the middle of the top step, in front of Sarah Markus’s door. Then she jumped into her car and made her getaway as gratefully as if she had just robbed a bank.

  21

  FINDING HER WAY

  R.J. had said nothing to Sarah about the heartrock that had been left for her, and nothing was said by Sarah to indicate that she had found the crystal in the jewelry box.

  But the following Wednesday afternoon when R.J. came home from the office, she found a small cardboard box by her front door. It contained a dark green, shiny stone with a ragged crack that started from the dip at the top and ran halfway through to the point at the base.

  The next morning, on her precious day off, R.J. drove to a gravel pit in the hills that was used by the town highway department. Millions of years ago, a great torrent of ice had moved over the land, picking up and carrying soil, stones, and rocks, and great frozen chunks had broken off and fallen here to melt and become a river of water, washing up alluvial material into a moraine that now furnished material for the gravel roads of Woodfield.

  R.J. spent all morning moving over the piles of stones, burrowing into them with her hands. There were stones of infinite hue and combination—brown, beige, white, blue, green, black, and gray. There were stones of diverse shape, and R.J. inspected and discarded thousands, one by one, without finding what she sought. Toward noon, sunburned and grumpy, she drove home. Passing the Krantz place, she saw Freda in the garden, waving the car
to a halt with her cane.

  “Picking beets,” Freda called when R.J. rolled down the window. “Want some?”

  “Sure. I’ll come out and help.”

  In the large garden on the south side of the big red Krantz barn, they had pulled the eighth big round beet when R.J. saw in the upturned dirt a piece of black basalt the size of the nail on her little finger and perfectly shaped. She began to laugh even as she pounced on it.

  “May I have this?”

  “Well, is it a diamond?” Freda said in astonishment.

  “No, it’s just a pebble,” R.J. said, and bore away the beets and the heartrock in triumph.

  In the house she washed the stone and wrapped it in tissue paper. Then she placed it in a plastic box that had housed a VCR tape. She found a cardboard box, fourteen inches square, and made popcorn, eating some for her lunch, and placed the VCR box in the small carton and filled it with popcorn. Then she got a larger carton, three feet by two feet, and placed the smaller carton inside, surrounded by balls of crumpled newspaper, and taped it closed securely.

  She had to set the alarm in order to get up early enough the next morning so that David and Sarah would still be asleep when she went to their house. The sun was still low enough to glitter on the wet grass as she pulled up on their road, not daring to drive to the door. She carried the box down their driveway and set it on the front steps, just as Chaim nickered in the field.

  “Aha! So it was you,” Sarah said from her open window.

  In a moment she had come downstairs. “Wow. This must be a big one,” she said, and R.J. laughed at her expression as she lifted the box, with its lack of weight.

  “Come in. I’ll give you coffee,” Sarah said.

  Seated at the kitchen table, they grinned at one another. “I love the two heartrocks you gave me. I’ll keep them always,” R.J. said.

  “The crystal one is my favorite, at least at the moment. I change favorites a lot,” Sarah said, careful to be honest. “They say crystal has the power to cure illness. Do you think it does?”