Matters of Choice

by Noah Gordon

  “Dr. Cole, God, it’s Hank. Freda’s shot, my rifle went off—”

  “Where was she hit?”

  “The upper leg, under the hip. She’s bleeding something fierce, it’s just pumping out.”

  “Get a clean towel and press it against the wound, hard. I’m coming.”

  10

  NEIGHBORS

  She was on vacation, she had no medical bag. Her car wheels scattered gravel, the high beams battling crazy shadows as the BMW sped up the road and turned into the drive, the left tires wounding the lawn Hank Krantz maintained so neatly. She drove up to the front door and went into the house without knocking. The errant rifle was on the newspaper-covered kitchen table, along with rag patches, a ramrod, and a small can of gun oil.

  Freda, white-faced, lay on her left side in blood. Her eyes were closed, but she opened them and looked at R.J. Hank had half removed her jeans. He was kneeling, holding a saturated towel against her lower thigh. His hands and sleeves were smeared. “My God. God in heaven, look what I did to her.”

  He was in misery, but he was keeping a tight rein on himself. “I called the town ambulance,” he said.

  “Good. Take a fresh towel. Just put it on top of the soaked one and continue to bear down.” She knelt and with her fingers palpated the flesh where the thigh met the torso, next to the black pubic hair that showed through Freda’s cotton underpants. When she felt the pulsations of the femoral artery she placed the heel of her palm over the spot and pressed. Freda was a large and heavy woman, and years of farm work had made her muscular. R.J. had to bear down hard to try to compress the artery, and Freda opened her mouth to scream, but only a low moan came out.

  “Sorry …” While the fingers of R.J.’s left hand maintained pressure, her right hand searched lightly and carefully under Freda’s thigh. When she found the exit wound, Freda shuddered.

  R.J. was taking the pulse in Freda’s throat when the first animal wail of the siren reached them. Very soon, two vehicles stopped outside and doors slammed. Three people came in—a burly, middle-aged police officer and a man and a woman wearing red polyester jackets. The woman carried a portable oxygen tank.

  “I’m a doctor,” R.J. said. “She’s been shot, she has a broken femur and there’s trauma to the artery, maybe it’s severed. There’s an entry wound and an exit wound. Her pulse is 119 and thready.”

  The male EMT nodded. “Shocky, all right. Lost a shitload of blood, hasn’t she,” he said, taking in the mess on the floor. “Can you keep holding the pressure point, Doc?”

  “Yes, I can,”

  “Good, you do that.” He knelt on the other side of Freda. Without wasting time, he began doing a swift physical assessment. He was broad and overweight and young, scarcely more than a boy but with quick, capable hands.

  “Was it just the one shot fired, Hank?” he called.

  “Yes,” Hank Krantz called back angrily, upset by the implications of the question.

  “Yeah, one entry wound, one exit,” the EMT said when he finished his assessment.

  The small, blond woman already had taken a blood pressure. “Eighty-one over fifty-seven,” she said, and the other technician nodded. She set up the portable oxygen unit and fixed a nonrebreathing mask over Freda’s mouth and nose. Then she cut away Freda’s jeans and underpants, covering her groin with a towel, and removed the sock and tennis shoe from her foot. Grasping the bare foot in both hands, the woman EMT began a steady, concentrated pulling.

  The male technician wrapped an ankle hitch around his patient’s foot. “This is going to be clumsy, Doc,” he said. “We’ve got to get in there, past your hand, with the splint. You’ll have to let up on the pressure for a few seconds.”

  When she did, Freda’s blood began to pump out again. Working quickly, the technicians proceeded to immobilize the leg in a Hare traction splint, a metal frame that fit snugly into the groin area at one end and extended all the way beyond the foot. As soon as she could, R.J. resumed the pressure on the femoral artery, and the bleeding eased. The splint was strapped to the thigh and, on the other end, was secured to the ankle hitch. A little windlass allowed the technicians to tighten it so manual traction no longer was needed.

  Freda sighed, and the male EMT nodded. “Yes, I imagine that feels some better, doesn’t it.” She nodded back, but she cried out when they lifted her and was weeping as they set her down on the gurney. They moved out in a small mob, Hank and the policeman at the front corners of the gurney, the male EMT behind Freda’s head, the blond tech carrying the portable oxygen tank, and R.J. trying to maintain her weight on the pressure point as she walked along.

  They lifted the gurney into the ambulance and locked it into place. The blonde switched Freda’s mask from the portable tank to the on-board oxygen supply, and they elevated her legs and covered her with warm blankets against the shock. “We’re a crew member short. You want to come along?” the senior technician asked R.J.

  “Sure,” she said, and he nodded.

  The blond woman drove, Hank beside her in the front seat. As they pulled away from the farmhouse, the driver spoke into her radio, telling the dispatcher they had picked up their patient and were on their way to the hospital. The police car led the way, its roof light turning and its siren laying a ribbon of sound. The ambulance’s external flashers had been on while parked, and now the blond woman turned on a two-toned wail, alternately whup-whup-whup and ee-awe, ee-awe, ee-awe.

  It was difficult for R.J. to bear down on the pressure point while standing in an ambulance that jounced over bumps and lurched and swayed alarmingly around curves.

  “She’s bleeding again,” she said.

  “I know.” The EMT was already laying out what looked like the bottom half of a space suit, a bulky garment that sprouted cables and tubes. He took a quick blood pressure reading and pulse and respiration rates, and then lifted a radio-telephone speaker off the wall and called the hospital, requesting permission to use MAST trousers. After a brief discussion, permission was given, and R.J. helped him to move the trousers into place over the splint. There was a hiss as air was pumped into the garment over the injured leg and it ballooned and became rigid.

  “I love this thing. Have you ever used one, Doc?”

  “I haven’t done much emergency medicine.”

  “Well, it does everything for you, all at once,” the man said. “Stops the bleeding, reinforces the Hare splint to stabilize the leg, and pushes blood up to the heart and brain. But they make us get permission from medical control before we use it, because if there was internal bleeding it would cause a blowout, push all the blood into the abdominal cavity.” He checked Freda to make sure she was okay, then he grinned and stuck out his hand. “Steve Ripley.”

  “I’m Roberta Cole.”

  “Our demon driver is Toby Smith.”

  “Hey, Doc!” The driver didn’t take her eyes off the road, but in the mirror R.J. saw a winsome grin.

  “Hey, Toby,” she said.

  Nurses were waiting at the ambulance entrance and Freda was taken away. The two EMTs stripped the bloody sheets from the gurney and exchanged them for fresh sheets from the hospital supply room; they disinfected the gurney and made it up again before returning it to the ambulance. Then they sat in the waiting room with R.J. and Hank and the policeman. He said he was Maurice A. McCourtney, the Woodfield police chief. “They call me Mack,” he told R.J. gravely.

  The four of them drooped visibly; their job was done and reaction had set in.

  Hank Krantz was making all of them party to his remorse. It was coyotes, he said, they had been around his farm for the better part of a week. He had decided to clean his deer gun and shoot a couple of them, to drive the pack away.

  “Winchester, ain’t it?” Mack McCourtney asked.

  “Yeah, old lever-action Winchester Ninety-four, takes a .30-.30. I’ve owned it, must be eighteen years now, never had an accident with it. I set it down on the table a little hard, and it just banged off.”

&nb
sp; “Safety wasn’t on?” Steve Ripley said.

  “Well, Jesus, I never keep a round in the chamber. I always empty the damn thing when I finish with it. I must of just forgot this time, the way I forget everything nowadays.” He glared. “And you got some nerve, Ripley, asking me did she have more than one bullet in her. You think I shot my wife?”

  “Listen. There she was on the floor, bleeding hard. I just had to know in a hurry if there was more than one wound to worry about.”

  Hank’s eyes softened. “Yeah, and I shouldn’t be giving you a bad time. You saved her life, I hope.”

  Ripley shook his head. “The real one saved her life is the doctor here. If she hadn’t found the pressure point when she did, we’d be real sad right about now.”

  Krantz looked at R.J. “I’m never going to forget it.” He shook his head. “Look what I did to my Freda!”

  Toby Smith leaned over and patted his hand, leaving her hand on his. “Listen, Hank, we all screw up. We all make every kind of stupid mistake. All that guilt you’re piling on yourself isn’t going to help Freda one bit.”

  The police chief frowned. “You haven’t got a milk herd anymore. You’ve just got some beef steers, right? I wouldn’t think coyotes would go after anything large as a beefer.”

  “No, they won’t go for a steer. But I bought four calves last week from Bernstein, that cattle dealer from out Pittsfield way.”

  Mack McCourtney nodded. “That explains it, then. They’ll do a hell of a job on a calf, but not on a heifer.”

  “Yeah, mostly they’ll leave a heifer alone,” Hank agreed.

  McCourtney left, needing to have the police car on patrol in Woodfield. “You’ll need to get back too,” Hank said to Ripley.

  “Well, the neighboring towns can cover for us for a little while. We’ll wait. You’ll want to speak to the doctor.”

  It was another hour and a half before the surgeon came out of the operating theater. He told Hank he had repaired the artery and placed a metal pin to rejoin the sections of Freda’s broken femur. “She’s going to be just fine. She’ll be here about five days. Five days to a week.”

  “Can I see her?”

  “She’s in recovery. She’ll be sedated all night. Best for you to go home, get some sleep. You can see her in the morning. You want me to send a report to your family doctor?”

  Hank made a face. “Well, at the moment, we don’t have one. Our doctor’s just retired.”

  “Who was that, Hugh Marchant, over on High Street?”

  “Yes, Dr. Marchant.”

  “Well, you get a new doctor, let me know who it is and I’ll send him a report.”

  “How come you travel all the way to Greenfield to see a doctor?” R.J. asked Hank on the way home.

  “Well, because there isn’t one who is closer. We haven’t had a doctor in Woodfield for twenty years, since the old doctor died.”

  “What was his name?”

  “Thorndike.”

  “Yes. Several people mentioned him when I first started coming here.”

  “Craig Thorndike. People loved that man. But after he died, no other doctor came to Woodfield.”

  It was close to midnight when the ambulance dropped Hank and R.J. at the Krantzes’ driveway.

  “You all right?” R.J. asked Hank.

  “Yeah. I won’t be able to sleep, I know that. I guess I’ll just clean up that mess in the kitchen.”

  “Let me help you.”

  “No, I wouldn’t hear of it,” he said firmly, and suddenly she was glad of that, because she was very tired.

  He hesitated. “I thank you. Lord only knows what would have happened if you hadn’t been here.”

  “I’m glad I was here. You get some rest, now.”

  There were large, white stars. The night held the memory of ice, a spring chill, but she was warmed as she drove back down the road.

  11

  THE CALLING

  The next morning she awoke early and lay in bed reviewing the events of the previous evening. She guessed that the coyote pack Hank had wanted to drive away had moved off on its own to hunt elsewhere, because through the bedroom window she could see three white-tailed deer feeding in the meadow, their tails waggling as they cropped the clover. A car came down the road and the tails went up, showing their white flags of alarm. When the car passed, the tails dropped and waggled again, and the deer went back to feeding.

  Ten minutes later a boy roared by on a motorcycle, and the deer broke for the woods with long, fearful bounds that were at the same time powerful and delicate.

  When she got out of bed and called the hospital, she learned that Freda’s condition was stable.

  It was Sunday. After breakfast R.J. drove slowly to Sotheby’s, where she bought the New York Times and the Boston Globe. As she was leaving the general store she met Toby Smith and exchanged good-mornings.

  “Well, you’re looking rested after working late last night,” Toby said.

  “I’m afraid I’m accustomed to late nights. Do you have a minute or two to talk, Toby?”

  “I surely do.”

  The other woman led the way to the bench on the store porch, and they sat. “Tell me about the ambulance service.”

  “Well … history. It was started just after World War II. A couple of people who had served in the armed forces as medics came home, and they bought a surplus army ambulance and began to serve the town. After a while the state began to test and certify Emergency Medical Technicians, and a whole system of continuing education evolved. EMTs have to keep up with developments in emergency medicine and recertify every year. Here in town, we have fourteen registered emergency technicians, all volunteers. It’s a free service to everyone who lives in Woodfield. We wear pagers and cover the town for medical emergencies around the clock. Ideally we like to have three people in the crew on every run, one behind the wheel, two riding in back with the patient. But much of the time we have only two, like last night.”

  “Why is it a free service?” R.J. said. “Why don’t you bill insurance companies for transporting their clients to the hospital?”

  Toby stared at her quizzically. “We don’t have big employers here in the hilltowns. Lots of our people are self-employed and just scraping by—loggers, carpenters, farmers, folks who do crafts. A big hunk of our population hasn’t got health insurance. I wouldn’t have it myself if my husband didn’t have a federal job as a fish and game officer. I do bookkeeping on a freelance basis, and I simply couldn’t afford to pay the premiums.”

  R.J. nodded and sighed. “I guess things aren’t very different here than they are in the city, as far as medical coverage is concerned.”

  “A whole lot of people gamble they won’t get sick or be hurt. It scares the dickens out of a person to do that, but a lot of them have to do it anyway.” The ambulance service played an important role in the town, Toby said. “Folks really appreciate that we’re around. Closest doctor to the east is all the way into Greenfield. To the west, there’s a general practitioner named Newly thirty-two miles away, just outside of Dalton on Route Nine.” Toby looked at her and smiled. “Why don’t you come here to live year-round and be our doc?”

  R.J. smiled back. “Not likely,” she said.

  Still, when she got back home she took out a map of the region and studied it. There were eleven small towns and villages in the area that Toby Smith said didn’t have a resident doctor.

  That afternoon she bought a houseplant—an African violet in plump blue blossom—and brought it to Freda in the hospital. Freda was still post-op and not talking much, but Hank Krantz was warmed by R.J.’s presence.

  “I’ve been wanting to ask you. What do I owe you for last night?”

  R.J. shook her head. “I was there as a neighbor more than as a physician,” she said, and Freda looked at her and smiled.

  R.J. drove back to Woodfield slowly, relishing the sights of farms and wooded hills.

  Just as the sun was setting, her telephone rang.


  “Dr. Cole? This is David Markus. My daughter tells me you came to our place yesterday. Sorry I wasn’t home.”

  “Yes, Mr. Markus … I wanted to talk with you about selling my house and land….”

  “We can surely talk. When would be a good time for me to come by?”

  “Well, the thing is … I still might want to sell, but suddenly I’m not all that certain. I have to do some deciding.”

  “Well, you take your time. Think it all out.”

  He had a nice, warm voice, she thought. “But I’d like to talk to you about something else.”

  “I see,” he said, although clearly he didn’t.

  “By the way, you make wonderful honey.”

  She could feel his smile over the phone. “Thank you, I’ll tell the bees. They love to hear things like that, although it drives them crazy when I get all the credit.”

  Monday morning was overcast, but she had a responsibility that was very much on her mind. She bulled her way back into the woods, getting a thorn scratch on the neck and several small gouges on the backs of her hands. When she reached the river, she traced it downstream as close as she could get to the banks, which sometimes were blocked to her by wild roses and raspberries and other brambles. She followed the river the length of her land and considered several sites carefully, finally choosing a sunny, grassy place where a thick white birch arched over a small waterfall that made a lively plashing. She made another torturous trip through the woods and came back carrying the spade that had hung from a nail in the barn, and the box containing Elizabeth Sullivan’s ashes.

  She dug a deep hole between two thick roots of the tree and poured the ashes from the box. They were just fragments of bone, really. In the hungry blast of the crematorium, Betts Sullivan’s fleshy self had vaporized and disappeared, flying off somewhere just as R.J. had always imagined the departing soul flew free of the world, when she had been a child.

  She covered the ashes with earth, trod it down tenderly. Then, worried lest some animal dig them up, she found a round, current-washed rock in the river, almost but not quite too large for her to move, and in a series of lifts and drops, moved it onto the dug earth. Now Betts was part of this land. The strange thing was, increasingly R.J. had the feeling that in many ways she was part of it too.