Matters of Choice

by Noah Gordon

  24

  NEW FRIENDS

  On a busy afternoon during office hours R.J. received a call from a woman named Penny Coleridge. “I told her you were with a patient and would return the call,” Toby said. “She’s a midwife. She said she would like to get to know you.”

  R.J. returned the call as soon as she was able. Penny Coleridge had a pleasant telephone voice, but it was impossible to guess her age over the phone. She said she had been practicing midwifery in the hills for four years. There were two other midwives—Susan Millet and June Todman—practicing with her. R.J. invited them to her house for supper on Thursday, her free afternoon, and after consulting with her colleagues, Penny Coleridge said all three would come.

  She proved to be an affable, stocky brunette, perhaps in her late thirties. Susan Millet and June Todman were about ten years older. Susan was graying, but she and June were blondes who looked enough alike to be mistaken for sisters, although they had met only a few years earlier. June had received her training in the midwifery program at Yale-New Haven. Penny and Susan were nurse-midwives; Penny had trained at the University of Minnesota, and Susan had trained in Urbana, Illinois.

  The three made it clear that they were happy to have a doctor in Woodfield. They told R.J. that some pregnant women in the hilltowns preferred an obstetrician or a family practitioner to deliver their babies and had to travel a good distance away to find one. Other patients preferred the less invasive techniques practiced by midwives. “In places where all the docs are men, some patients have come to us because they wanted a woman to deliver their baby,” Susan said. She smiled at R.J. “Now that you’re here, they have a wider choice.”

  Some years before, obstetricians in urban locations had worked to hobble midwives politically because they saw them as economic competitors. “But out here in the hill country, doctors don’t give us trouble,” Penny said. “There’s more than enough work to go around, and they’re happy we’re here, sharing the burden. By law, we have to be salaried workers, employed by a clinic or a physician. And although midwives would be perfectly capable of doing things like vacuum extractions and forceps births, we have to have a boarded obstetrician on call to do those things, just as you do.”

  “Have you made connection with an ob-gyn to act as your backup?” June asked R.J.

  “No. I would value your advice in that regard.”

  “We’ve been working under a good young obstetrician, Grant Hardy,” Susan said. “He’s smart, he has an open mind, and he’s idealistic.” She made a face. “He’s too idealistic, I guess. He’s taken a job with the surgeon general in Washington.”

  “Have you made a new arrangement with another ob-gyn, then?”

  “Daniel Noyes has agreed to take us on. The trouble is, he’s retiring in a year, and we’ll have to start again with somebody new. Still,” Penny said thoughtfully, “he might be just the ob-gyn to be your backup as well as ours. He’s grouchy and crusty on the outside, but he’s really an old dear. He’s far and away the best obstetrician in the area, and an arrangement with him would let you take your time looking for another ob-gyn before he retires.”

  R.J. nodded. “That sounds sensible to me. I’ll try to persuade him to work with me.”

  The midwives were discernably pleased when they learned that R.J. had had advanced training in obstetrics and gynecology and had worked in a clinic dealing with female hormonal problems. It was a relief to them that she was available in the event that a medical problem arose with one of their patients, and they had several women they wanted her to examine.

  R.J. liked them as people and as professionals, and their presence made her feel more secure.

  She dropped in often to see Eva Goodhue, sometimes bringing a package of ice cream or some fruit. Eva was quiet and introspective; for a few days R.J. suspected that was her way of grieving for her niece, but she had come to conclude that those qualities were aspects of Eva’s personality.

  The apartment had been thoroughly cleaned by the pastoral committee of the First Congregational Church, and Meals on Wheels, a nonprofit agency that served the elderly, delivered a hot dinner every day. R.J. met with the Franklin County social worker, Marjorie Lassiter, and with John Richardson, minister of the church in Woodfield, to talk about Miss Goodhue’s other needs. The social worker began with a blunt report of her financial status.

  “She’s broke.”

  Twenty-nine years before, Eva Goodhue’s only living sibling, an unmarried brother named Norm, had died of pneumonia. His death had left Eva sole owner of the family farm on which she had always lived. She had promptly sold it for just under forty-one thousand dollars and rented the apartment on Main Street, in the village. A few years later her niece, Helen Goodhue Phillips, daughter of Harold Goodhue, Eva’s other dead brother, had divorced her abusive husband and come to live with her aunt.

  “They were supported by Eva’s money in the bank and by a small monthly welfare check,” Marjorie Lassiter said. “They thought they were on easy street, even sometimes indulging in a weakness for mail-order purchases. They always spent more than the capital earned annually, and the dwindling bank account finally has run out.” She sighed. “It’s not uncommon, believe me, for someone to outlive her money.”

  “Thank God she still has the welfare check,” John Richardson said.

  “That won’t support her,” the social worker said. “Eva’s monthly rent alone is four hundred and ten dollars. She has to buy groceries. She’s on Medicare, but she has to buy drugs. She has no supplemental medical insurance.”

  “I’ll look out for her medical care as long as she remains here in town,” R.J. said quietly.

  Ms. Lassiter gave her a rueful smile. “But that still leaves fuel oil. The electric bill. The occasional purchase of a necessary article of clothing.”

  “The Sumner Fund,” Richardson said. “The town of Woodfield has a sum of money left it in trust, the interest to be utilized to help needy citizens. The expenditures are made quietly at the discretion of the three selectpersons, and are kept private by them. I’ll talk to Janet Cantwell,” the minister said.

  A few days later R.J. met Richardson in front of the library and he told her it was all set with the Board of Selectmen. Miss Goodhue would receive a monthly stipend from the Sumner Fund, enough to cover her deficit.

  It was later that day, as R.J. finished updating the patient charts, that she realized a bright truth: as long as she lived in the kind of town that was willing to help an indigent old woman, she was content not to have shiny new plumbing in the Town Hall toilets.

  “I want to stay in my own home,” Eva Goodhue said.

  “And you will,” R.J. told her.

  At Eva’s suggestion, R.J. brewed a pot of black currant tea, Eva’s favorite. They sat at the kitchen table and talked about the physical examination R.J. had just completed. “You’re in remarkably good condition for somebody who is marching toward her ninety-third year. Obviously you have very good genes. Do you come from long-lived parents?”

  “No, my parents died fairly young. My mother had a ruptured appendix when I was only five. My father might have lived to be old, but he was killed in a farm accident. A load of logs let go and he was crushed. That was when I was nine years old.”

  “So who raised you?”

  “My brother Norm. I had two brothers. Norm was thirteen years older than I, and Harold was four years younger than Norm. They didn’t get along at all. Not at all. Fought and fought, and Harold up and ran away from the farm—just left it for Norman to worry about. He joined the Coast Guard and never did get home again, never communicated with Norm, although now and again I would get a postcard, and sometimes there was a letter for me and a small amount of money at Christmas.” She sipped her tea. “Harold died of tuberculosis in the Naval Hospital in Maryland about ten years before Norm passed away.”

  “You know what boggles my mind?”

  Eva smiled at the expression. “What?”

  “When you w
ere born, Victoria was England’s queen. Wilhelm II was the last emperor of Germany. Teddy Roosevelt was about to become president of the United States. And Woodfield—what changes you must have seen as they took place in Woodfield.”

  “Not so many changes as you might expect,” Eva said. “The automobile, certainly. Now all the main roads are tarred. And electricity is everywhere. I remember when street lamps came to Main Street. I was fourteen years old. I walked six miles from the farm and back, after chores, so I could see the lights turned on. It was another ten or twenty years before the electric wires reached all the houses of the town. We didn’t even have milking machines until I was forty-seven. There was a blessed change!”

  She said little about Helen’s dying. R.J. raised the subject, thinking it would be healthy for her to talk about it, but Eva only stared out of tired eyes as deep and fathomless as lakes.

  “She was a dear soul, my brother Harold’s only child. Of course I shall miss her. I miss them all, or at least most.

  “I’ve lived longer than everybody I once knew,” she said.

  25

  SETTLING IN

  On a mild day in mid-October, R.J. was leaving the hospital in Greenfield when she passed Susan Millet standing in the parking lot talking with a ruddy-faced, balding man. He was large and tall but slightly crooked, as if his spine were made of bent tin, and his left shoulder was lower than his right. Chronic scoliosis, her mind registered.

  “R.J., hi! Say, here’s somebody I want you to meet. Dr. Daniel Noyes, this is Dr. Roberta Cole.”

  They shook hands. “So you’re Dr. Cole. Seems to me, all I’ve heard lately from the three midwives is your name. You’re some kind of expert on hormones, I’m told.”

  “Hardly an expert.” She told him about having worked in the clinic at Lemuel Grace Hospital, and he nodded.

  “Don’t contradict. That makes you more of an expert on hormones than we’ve had around here up to now.”

  “I’m going to deliver babies, part of a full family practice. I need the cooperation of an ob-gyn who is on staff here.”

  “You do, eh?” he said coolly.

  “Yes.” They regarded one another.

  “Well, are you asking me to work with you?”

  He was crusty and cranky, she thought, just as the midwives had described him. “Yes, that’s the idea. I realize you don’t know much about me. Do you happen to be free for lunch?”

  “No need to waste money buying me lunch. They’ve told me all about you. Did they tell you I was calling it a career in twelve and a half months?”

  “Yes, they did.”

  “Well, if you still want me to consult with you for that brief a time, it’s fine with me.”

  “That’s great. I mean, I do.”

  Now he was smiling. “That’s settled, then. So, how’s about I take you to lunch at the world’s best old-fashioned diner and tell you some war stories about practicing medicine in western Massachusetts?”

  He was an old dear, she could see that. “I’d like that very much.”

  “I suppose you want to come too,” he said dourly to Susan, who was wearing a satisfied expression.

  “No, I have an appointment, but you two go ahead,” Susan said. She was laughing to herself as she walked to her car.

  R.J. was busy, working long hours, and apt to be tired and unambitious when she had a little time off. The trail through the woods didn’t progress far beyond the beaver ponds. When she wanted to go to the river, she still had to contend with a lot of rough hiking through heavy growth.

  Late in the fall she and David had to stay out of the woods, which were full of hunters carrying loaded weapons, their trigger fingers itchy. She winced to see, again and again, white-tailed deer dead and broken, slung over the bumpers of cars and trucks.

  A lot of people in the hills hunted. Toby and Jan Smith invited R.J. and David to dinner and served an impressive royal crown roast of venison.

  “Got a young buck, a four-pointer, right up on the ridge above the house,” Jan said. “I always go out on opening day with my uncle Carter Smith, been hunting with him ever since I was a boy.”

  Whenever he and his uncle got a deer they followed a Smith family tradition, he told them. They cut out the deer’s heart while they were still in the woods, sliced it, and ate it raw. He was pleased to share that detail with them and he told the story well, giving them a sense of the love and kinship between the old man and the young man.

  R.J. suppressed her distaste. She couldn’t help imagining that parasitic diseases might have been invited into their bodies with the deer’s heart, but she cast all such thoughts from her mind. She had to admit the venison made a splendid roast, and she ate her fill and sang its praises.

  She had inserted herself into a culture that was remarkably unfamiliar to her. At times she had to swallow hard as she adjusted to traditions that were foreign to her experience.

  A number of families had been in the town for many generations—Jan Smith’s ancestors had walked all the way to Woodfield from Cape Cod in the final months of the seventeenth century, driving their cows in front of them—and they had intermarried, so everyone seemed to be everyone else’s cousin. Some of those who came from old families in Woodfield were welcoming to newcomers, while others were not. R.J. observed that individuals who were more or less happy with themselves, secure in their own souls, usually opened themselves to new friendships. It was those whose ancestry and native status were their only hopes for distinction who tended to be critical and cold toward “new people.”

  Most of the town’s residents were happy about the presence of the doctor. Still, the environment was largely unfamiliar to R.J., and often she got the feeling that she was a pioneer on a new frontier. A country practice was like doing high acrobatic work without a net. At the Lemuel Grace Hospital in Boston, labs and diagnostic technology had been at her fingertips. Here, she was alone. High-tech science was available, but she and her patients had to make an effort to reach it.

  She didn’t send patients away from Woodfield unless she had to, preferring to depend on her own skills and capability. But there were times when she contemplated a patient and a silent warning bell rang starkly in her head, and she realized that she needed help; then she referred the patient to Greenfield or Northampton or Pittsfield, or even to the greater specialization and technology in Boston or New Haven or Hanover, New Hampshire.

  She was still feeling her way but she had come to know many of her patients intimately, to see into the corners of their lives that affected their health, in a way that was possible to a small-town doctor.

  One night at two a.m. she was awakened by a call from Stacia Hinton, Greg Hinton’s wife.

  “Dr. Cole, our daughter Mary and our two grandchildren are visiting us from New York. The littlest one, Kathy, she’s two years old. She’s an asthmatic, and now she’s come down with a bad, bad cold. She’s having a terrible time trying to breathe. She’s all red in the face, and we’re frightened. We don’t know what to do.”

  “Hold her over a steaming kettle and make a little tent around her with a towel. Just keep her there, and I’ll come right over, Mrs. Hinton.”

  R.J. made certain a tracheotomy kit was in her bag, but when she got to the Hinton farm she saw it wouldn’t be necessary for her to do a trache. The steam already had done some good. The child had a barking cough, but she was getting air into her lungs, and the redness was gone from her face. R.J. would have liked an X ray to tell her whether it was epiglottitis, but a careful examination indicated to her that the epiglottis wasn’t involved. There was a mucosal inflammation of the lower larynx and trachea. Kathy cried all through the examination, and when it was over R.J. remembered something she had seen her father do with pediatric patients.

  “Would you like me to give you a tricycle?”

  Kathy nodded, sniffling. R.J. wiped the tears from her cheeks, then she took a clean wooden tongue depressor and drew a tricycle on it with her ballpoint pen. The li
ttle girl took it and looked at her with interest.

  “Want one with a clown on it?”

  Kathy nodded again, and soon she had a clown. “Big Bird.”

  “Oh-oh,” R.J. said. Her television memory was weak, but she managed to draw an ostrich with a hat, and the child smiled.

  “Will she have to go to the hospital?” Stacia Hinton asked.

  “I don’t think so,” R.J. said. She left some pharmaceutical samples and two prescriptions to be filled in the morning, when the drugstore opened in Shelburne Falls.

  “You keep her breathing that steam. If she has any more trouble, call me right away,” she said. Then she walked woodenly to her car, drove sleepily home, and fell into her bed.

  The next afternoon Greg Hinton came to the office and told Toby he had to speak to the doctor personally. He sat and read a magazine until R.J. was able to see him.

  “What do I owe you for last night?”

  When she told him, he nodded and wrote out a check. She saw that it covered everything he owed her for his past visits.

  “I didn’t see you last night,” she said.

  He nodded again. “I thought I’d better stay out of the way. I’ve been a stubborn fool. I guess I didn’t feel comfortable, getting you to my house in the middle of the night after the way I’ve talked to you.”

  She smiled. “Don’t worry about that, Mr. Hinton. How’s Kathy doing today?”

  “Much better. And we thank you for that. No hard feelings?”

  “No hard feelings,” she said, and shook the hand he held out to her.

  With his 175-cow herd, Greg Hinton could more than afford to pay for a doctor’s services, but R.J. also took care of Bonnie and Paul Roche, a young couple with two small children, who were struggling to survive with an eighteen-cow dairy farm.