Matters of Choice

by Noah Gordon

  Toby hesitated, and then she nodded. “If it’s not too great an imposition?”

  “Nonsense. It’s not an imposition at all,” Gwen said.

  Next morning, the three of them met in the inner office after the examination. “You have random abdominal pain?” Gwen said.

  Toby nodded. “Sometimes.”

  “I wasn’t able to find any overt problems,” Gwen told her slowly. “But I think you should have a laparoscope, an exploratory procedure that would tell us exactly what is going on internally.”

  Toby made a face. “That’s what R.J. has been trying to get me to do.”

  Gwen nodded. “That’s because R.J. is a good doctor.”

  “Do you do laparoscopies?”

  “I do pelviscopies all the time.”

  “Would you do mine?”

  “I wish I could, Toby. I’m still licensed in Massachusetts, but I’m not on a hospital staff. If it could be arranged before I have to go back to Idaho, I’d be happy to scrub up and participate as an observer, and consult with the surgeon of record.”

  And that’s how the arrangements were made. Dan Noyes’s secretary was able to book the operating room for three days before Gwen was scheduled to go home. When R.J. talked with Dr. Noyes, he was amiably willing to have Gwen stand at his elbow as an observer.

  “Why don’t you come, too?” he said to R.J. “I have two elbows.”

  Gwen spent the next five days visiting HMOs and physicians in a number of communities located within commuting distance of Amherst. On the evening of the fifth day, she and R.J. sat and watched a televised debate about national health care in America.

  It was a frustrating experience. Everyone acknowledged that the health care system in the United States was inefficient, exclusive, and too expensive. The simplest and most cost-effective plan was the “single-payer” system used by other leading nations, in which the government collected taxes and paid for the health care of all its citizens. But while American capitalism provides the best aspects of democracy, it also provides the worst, as represented by paid lobbyists applying enormous pressures on Congress to protect the rich profits of the health care industry. The enormous army of lobbyists represented private insurance companies, nursing homes, hospitals, the pharmaceutical industry, doctors’ groups, labor unions, business associations, pro-choice groups who wanted abortion paid for, anti-abortion groups who wanted abortion excluded, welfare groups, the aged …

  The fight for dollars was mean and dirty, not pretty to watch. Some Republicans admitted they wanted the health care bill killed because if it were passed it would help the president’s chances for re-election. Other Republicans declared themselves for universal health care but said they would fight to the death against either a raise in taxes or funding of health insurance by employers. Some Democrats who faced re-election campaigns and were dependent on the lobbyists for funds talked exactly like the Republicans.

  The business suits on the television screens were agreeing that any plan must be phased in gently, over many years, and that they should be satisfied to cover 90 percent of the United States population eventually. Gwen got up suddenly and switched off the television in anger.

  “Idiots. They talk as if ninety percent coverage would be a wonderful achievement. Don’t they realize that would leave more than twenty-five million people without care? They’ll end up creating a new caste of untouchables in America, millions of people who are poor enough to be allowed to sicken and die.”

  “What’s going to happen, Gwen?”

  “Oh, they’ll blunder through to a workable system, after years and years of wasted time, wasted health, wasted lives. But just the fact that Bill Clinton had the courage to make them face the problem is making a difference. Superfluous hospitals are closing, others are merging. Doctors aren’t ordering unnecessary procedures….”

  She looked at R.J. moodily. “Doctors may have to change things without much help from the politicians, try to treat some people without charge.”

  “I already do.”

  Gwen nodded. “Hell, you and I are good physicians, R.J. Suppose we started our own medical group? We could begin by practicing together.”

  The thought swept R.J. into momentary excitement, but very quickly reason took over. “You’re my best friend and I love you, Gwen. But my office is too small for two doctors, and I don’t want to move. This has become my town, the people are my people. What I’ve made for myself here … it suits me. How do I explain? I can’t risk ruining it.”

  Gwen nodded and placed her fingers on R.J.’s lips. “I wouldn’t want to do anything to spoil things for you.”

  “Suppose you set up an office of your own nearby? We could still incorporate, and maybe form a cooperative network of good independent physicians. We could buy our supplies together, cover for one another, contract together for lab work, refer patients to one another, share someone to do our billing, and try to figure out how to provide treatment for uninsured people. What do you think?”

  “I think I like it!”

  The following afternoon they began searching for office space for Gwen in nearby towns. Three days later they found the space she wanted, in a two-story red-brick building in Shelburne Falls that already housed two lawyers, a psychotherapist, and a studio that taught ballroom dancing.

  On a Tuesday morning they got up in the dark, had time only for coffee, and drove to the hospital through the predawn chill. They went through the scrubbing process with Dr. Noyes, achieving antisepsis in the prescribed routine that was at the same time necessary practice and a rite of their profession. At 6:45 they were in an operating theater when Toby was wheeled in.

  “Hey there, kiddo,” R.J. said behind the mask, and winked.

  Toby smiled blearily. She already had been started on an intravenous solution of lactated Ringer’s solution to which a relaxant had been added—Midazolam, R.J. knew from her conversation with Dom Perrone, the anesthesiologist who was overseeing the attachment of EKG, BP, and pulse oximeter. R.J. and Gwen stood with folded arms safely outside the sterile field, watching while Dr. Perrone gave Toby 120 mgs of Propofol.

  Ta-ta, my friend. Sleep well, Tobe, R.J. thought tenderly.

  The anesthesiologist administered a muscle relaxant, inserted the endotrachial tube and began the flow of oxygen, adding nitrous oxide and Isoflurane. Finally he grunted in satisfaction. “She’s all set for you, Dr. Noyes.”

  In a few minutes, Dan Noyes had accomplished the three tiny incisions and inserted the fiber optics eye, and presently they were watching a screen that revealed the interior of Toby’s pelvis.

  “Endometrial growth on the pelvic wall,” Dr. Noyes observed. “That would explain the occasional random pain noted on her chart.” In a moment they were zeroed in on something else, and he and his visitors exchanged nods; the screen showed five small cysts between the ovaries and the fallopian tubes, two on one side, three on the other.

  “That might explain why there’s been no pregnancy,” Gwen murmured.

  “Probably it does,” Dan Noyes said cheerfully, and went to work.

  In an hour both the endometrial growths and the cysts had been removed, Toby was resting comfortably, and Gwen and R.J. were driving back down the Mohawk Trail so R.J. could keep office hours.

  “Dr. Noyes did a neat job,” Gwen said.

  “He’s very good. Retiring this year. He has a lot of women from the hills in his practice.”

  Gwen nodded. “Hmmm. Then remind me to drop him a letter and admire him a whole lot,” she said, and shot R.J. her warm grin.

  She was leaving on Friday, so they wanted to make Thursday count. “Let’s see,” Gwen said, “I’ve contributed mightily and generously to the welfare of your sugar pod peas, I’ve altered my entire life in order to become your associate and neighbor, and I’ve collaborated to try and help Toby. Is there anything else I can do before I leave?”

  “As a matter of fact. Come with me,” R.J. said.

  In the barn she fo
und the three-pound maul and the enormous old crowbar, long and thick, that had been left there, perhaps by Harry Crawford. She gave Gwen work gloves and the maul, and she carried the crowbar as she led Gwen down the trail and around by the river, all the way to the final bridge. The three flat rocks were still just where she had abandoned them.

  They got down into the brook. She positioned the crowbar and let Gwen hold it while she drove it firmly beneath the framework log on the far bank.

  “Now,” she said. “We try and lift it together. On the count of three. One … Two …” R.J. had been in junior high school when she learned about Archimedes’ claim that, given a long enough lever, he could move the planet. Now she had faith. “Three.”

  Sure enough, as she and Gwen grunted together and lifted their arms, the end of the timber rose.

  “Little more,” R.J. said judiciously. “Now,” she said, “you’re going to have to hold it alone.”

  Gwen’s face went blank.

  “Okay?”

  Gwen nodded. R.J. let go and dove for the flat rocks.

  “R.J.” The lever wobbled as R.J. lifted one of the rocks and slid it into place. She bent for another rock, as Gwen gasped.

  “R.J.! For …”

  The second rock was in place.

  “… crying … out … LOUD!”

  “Hold it. Hold it, Gwen.”

  The last rock thumped into place just as Gwen let go and sank to her haunches in the bed of the brook.

  It took all of R.J.’s remaining strength to pull the crowbar from beneath the log. It grated on the top rock, but the three rocks stayed in position. R.J. climbed out of the brook and walked onto the bridge.

  It was reasonably level. When she stamped on it, it appeared to be strong, a bridge for generations.

  She did her tarantella. The bridge quivered a bit because it was flexible, but it didn’t move. It felt firm and permanent. She threw back her head and stared into the leafy greenness of the trees, stamping her feet as she danced.

  “I christen thee the Gwendolyn T. for Terrific Gabler Bridge.” Below her, Gwen was trying to whoop but was achieving only strangled laughter.

  “I can do anything. Anything,” R.J. told the spirits of the forest, “with a little help from my friends.”

  40

  WHAT AGUNAH FEARED

  May was soft and good. The warmed earth could now be gardened, and graves could be dug in it again. On the fifth day of the month, two days before the annual Town Meeting, the body of Eva Goodhue was taken from the keeping vault at the Woodfield Cemetery and buried. John Richardson conducted a simple, moving graveside service. Only a handful of townfolk were there, mostly old people who remembered that Eva had come from a family that went far back in the town’s history.

  When R.J. came back from the funeral, she planted one of her two raised beds. She set the seeds in broad rows a foot wide, so there would be little room for weeds. She planted two kinds of carrots, three varieties of lettuce, red and white radishes, shallots, beets, basil, parsley, dill, and fava beans. It was somehow meaningful to her that Eva was now part of the earth that could bestow such beneficence.

  It was late afternoon by the time she finished and put the gardening tools away. She was washing up in the kitchen when the telephone rang.

  “Hello. This is Dr. Cole.”

  “Dr. Cole, my name is Barbara Eustis. I’m director of the Family Planning Clinic in Springfield.”

  “Oh?”

  Speaking slowly and quietly, Barbara Eustis conveyed her desperation. Her doctors had been intimidated by the violence of the anti-abortion zealots, the threats, the murder of Dr. Gunn in Florida.

  “Well, they gave that murderer a life sentence. Surely that will be a deterrent.”

  “Oh, I hope so. But the thing is … a lot of doctors aren’t willing to place themselves and their families at risk. I don’t blame them, but I’m afraid that unless I get some physicians to help, the clinic will have to close. And that would be tragic, because women really need us. I was talking with Gwen Gabler, and she suggested I give you a call.”

  She didn’t! Damn you, Gwen, how could you? R.J. tasted brass.

  Barbara Eustis was saying she had a couple of gutsy people who were willing to work. Gwen had promised she would work one day a week after she moved east. The voice on the phone begged R.J. to give the clinic one day a week also, to do first-trimester abortions.

  “I’m sorry. I can’t. My malpractice insurance premiums come to thirty-five hundred dollars a year. If I work for you, they’ll go up to more than ten thousand dollars.”

  “We’ll pay your insurance.”

  “I’m as lacking in courage as anyone. I’m just plain scared.”

  “Of course you are, and with reason. Let me tell you that we spend real money on security. We have armed guards. We have volunteer bodyguards and escorts who meet our doctors and accompany them to and from the clinic.”

  R.J. didn’t want to have to contend with that. Or with the controversy and the crowds and the hatred. She wanted to spend her day off working in the woods, taking walks, practicing the viola da gamba.

  She never wanted to see an abortion clinic again. She knew she would be forever haunted by what had happened to Sarah. But neither could she escape awareness of what had happened to the young Eva Goodhue and all those other women. She sighed.

  “Suppose I give you Thursdays,” she said.

  There was a fairly short stretch of woods between the Gwendolyn T. for Terrific Gabler Bridge and the backyard of her house, but it was mostly tough brush and close-set trees. She had only one Thursday left before starting work at the Springfield clinic, and she determined that she would attempt to finish the trail that day.

  She arose early and got breakfast out of the way, eager to get outside and go to work. As she was putting away the breakfast things, there was a scratching at the door, and she let Agunah in.

  As usual, Agunah ignored R.J., made her inspection of the house, and waited by the front door to be let out again. R.J. had abandoned offering pleasantries to the aloof visitor. She opened the door and waited for the cat to leave, but Agunah hung back, her spine becoming round, her tail rising. She looked like a cartoon caricature of a frightened cat, and she turned and ran into R.J.’s room.

  “What is it, Agunah? What are you afraid of?”

  She closed the door, compulsively turning the key in the lock, and began to peer out the windows.

  There was a very large black shape moving at an unhurried pace across the meadow and toward her house.

  The bear waded through the tall grass. R.J. never had imagined that a bear in the Massachusetts hills could become so large. The great male was doubtless the one whose sign she had been seeing in the woods for weeks. She stood transfixed, unable to leave the window long enough to run and search for her camera.

  When he neared the house, he stopped at the crabapple tree and stood on his hind legs to sniff at a couple of wrinkled apples left over from last year. Then he dropped back onto all fours and shambled out of her vision to the side of the house.

  R.J. raced up the stairs to the bedroom window and looked directly down at him. He was staring at his reflection in the glass of the first-floor window; she was certain he thought he was looking at another bear, and she hoped he wouldn’t attack and break the glass. The shaggy black hair on his neck and shoulders appeared to bristle. His great, wide head was slightly bent, and his eyes, too small for the large head, glittered with hostility.

  After a moment he turned from the mirrored image. From where she watched, the power of the massive shoulders and the surprisingly thick, long legs was overwhelming. For the first time in her life R.J. actually felt the hair on the back of her neck lifting. Agunah and I, she thought.

  She watched until the bear entered the woods, then she returned to the kitchen and sat in a chair without moving.

  The cat went to the front door again, somewhat furtively. When R.J. opened it, Agunah hesitated only a moment a
nd then slipped out and ran in the opposite direction from the one in which the bear had disappeared.

  R.J. continued to sit. She told herself that she couldn’t go into the woods now.

  Yet she knew if she didn’t finish the trail that day she might not have a free day for a long time.

  When half an hour had passed, she went into the barn and filled the chain saw with fuel and oil, then she carried it onto the wooden path. Jan Smith had told her that bears lived in fear of human beings and avoided them, but the moment she entered the dark, shaded trail she was terrified, aware she had left her own territory and entered the bear’s. Jon had assured her that when bears were warned of human presence they would depart, and she picked up a stick and tapped it against the handle of the saw. He had also told her that it didn’t warn a bear if you whistled, because they were accustomed to the sound of the birds. So she began to sing at the top of her voice, songs she had sung as a teenager in Harvard Square, “This Land Is Your Land,” and then “Where Have All the Flowers Gone?” She was well into “When the Saints Go Marching In” when she came to the last bridge and clumped across.

  It wasn’t until the motor of the chain saw had roared to life that she felt secure, and she moved quickly to overcome her fear with the hardest labor she could perform.

  41

  KINDRED SPIRITS

  The Family Planning Clinic in Springfield was in a handsome old brownstone house on State Street, now a bit shabby but in good repair. R.J. had told Barbara Eustis that, at least for the moment, she preferred to come and leave unaccompanied, not believing that an escort offered any real protection. But now, as she parked a block away and walked to the clinic, she wondered about the wisdom of that decision. A dozen protestors were already there with signs, and as soon as R.J. started to mount the steps, the hooting began and the signs were jabbed in her direction.

  One of the demonstrators held a sign saying “JESUS WEPT.” She was a woman who looked to be in her thirties, with long honeycolored hair, a narrow nose with sculptured nostrils, regretful brown eyes. She didn’t scream or wave her sign, she just stood there. Her gaze clicked onto R.J.’s, who knew they had never met but somehow felt that they knew one another, so that she nodded, and the other woman nodded back. And then she was up the stairs and inside the building, and the tumult was left behind.