by Noah Gordon
After she got home, she received her best present, a phone call from Florida. Her father sounded good to her, strong and happy. “Susan is kicking me back to work next week,” he said. “Wait a moment. We have something to tell you.”
Susan came on the phone extension, and they told her they had decided to get married in the spring. “The last week of May, we think.”
“Oh. Dad … Susan. I’m so happy for you.”
Her father cleared his throat. “R.J., we were wondering. Could we be married up there, at your house?”
“Dad, that would be perfect.”
“If the weather is nice, we’d like to be married outside, in the meadow, with those hills of yours looking down. We’d like to invite a few people from Miami. Some of my friends from Boston, and a couple of Susan’s closest relatives. About thirty guests in all, I think. We’ll pay for the reception, of course, but R.J., could you make the arrangements? You know, find a good caterer, a minister, that sort of thing?”
She promised she would. When they said good-bye and hung up, she sat before her own fire and tried to play the viola, but her mind wasn’t on the music. She got pen and paper and began to make lists of what would be needed. Music, perhaps four pieces; fortunately, there were wonderful musicians in the town. The food would take careful thought and consultation. Flowers … lilacs would be everywhere in late May, and perhaps early roses. The first haying of the meadow would have to be done early. She would rent a tent, a small one with open sides …
Planning Dad’s wedding!
It had taken several weeks of grim determination for R.J. to housebreak Andy, and even after that was accomplished, the puppy sometimes lost control of his bladder when excited. She decided he would be a cellar dog, and fixed him a soft bed next to the furnace. She gave in only on New Year’s Eve. Dateless and home alone, she spent the evening trying not to indulge in self-pity. Finally, she went down to the cellar and fetched Andy, who was pleased to lie next to her chair in front of the fire. R.J. toasted him with cocoa. “Here’s to us, Andy. The old lady and her dog,” she told him, but he had fallen asleep.
The annual epidemic of colds and flu was well under way, and that week the waiting room at her office was crowded with hackers and sneezers. R.J. had avoided catching cold, but she felt rundown and irritable; her breasts still hurt, and her muscles ached.
During her lunch hour on Tuesday, stopping at the small stone library to return a book, she found herself staring hard at Shirley Benson, the library clerk.
“How long have you had that black mark on the side of your nose?”
Shirley grimaced. “Couple of months. Isn’t it ugly? I’ve soaked it and tried to squeeze it, but nothing seems to work.”
“Let me have Mary Wilson make an immediate appointment for you to see a dermatologist.”
“No, I don’t want to, Dr. Cole.” She hesitated, coloring. “I can’t afford to spend money on something like that. I’m only part-time here, so I don’t have medical insurance from the town. My kid is a senior in high school this year, and we’re really worried about paying for college.”
“I suspect that mark may be a melanoma, Shirley. Maybe I’m wrong, and you’ll waste some money. But if I’m right, it could metastasize fast. I’m certain you want to be around to see your son go to college.”
“All right.” Moisture glinted in Shirley’s eyes. R.J. didn’t know whether the tears were caused by fear or by anger at her despotism.
Wednesday morning the office was busy. She did several annual physical exams and changed Betty Patterson’s medication regimen to deal with her tendency toward insulin infection. She sat and discussed with Sally Howland what the echocardiogram had indicated about her tachycardia. Polly Strickland came in because she had had such a heavy monthly flow that it had frightened her. She was forty-five years old.
“It could be the start of menopause,” R.J. said.
“I thought that’s when periods stopped.”
“Sometimes at the very beginning they get heavy, then irregular. There are many patterns. With a smaller percentage of women, menstruation just turns off, like a faucet.”
“Lucky.”
“Yes …”
Before leaving to buy her lunch, R.J. read through several pathology reports. Included was one informing her that the neoplasm removed from Shirley Benson’s nose had been a melanoma.
After the office closed R.J. felt that she needed nourishment, and she drove to the restaurant in Shelburne Falls and ordered a spinach salad, changing her mind in the same breath and telling the waitress to bring her a large sirloin, medium rare.
She ate the steak with mashed potatoes, squash, a Greek salad and rolls, and apple pie and coffee.
Driving back to Woodfield, it occurred to her to consider what she would do if a patient came to her with the symptoms she had been displaying for several weeks: irritability and mood swings, muscular pains, a ferocious appetite, aching and sensitive breasts, and a missed menstrual period.
It was an absurd thought. She had spent years trying to conceive a child without the slightest success.
Still.
She knew what she would do if someone else were the patient, and instead of going home, she drove to her office and parked near the door.
The office was locked and dark, but she used her key and switched on the lights. She took off her coat and went around pulling down the window shades, as nervous as if she were an addict about to shoot up.
She found a sterile butterfly needle she knew was easy to use and attached a tube to it and then tied a tourniquet around her left arm. She scrubbed the inside of her elbow with an alcohol patch and made a fist. It was clumsy taking her own blood, but she found the medial cubital vein with the needle and drew the dark, brown-red fluid.
She had to use her teeth to remove the tourniquet. And then she detached and capped the tube and placed it in a manila envelope, put her coat back on, turned off the lights and locked the door, and carried the blood to the car.
She drove straight back down the Mohawk Trail, this time all the way to Greenfield.
The blood lab in the hospital basement was open twenty-four hours a day. There was a single phlebotomist on duty, holding down the evening shift alone.
“I’m Dr. Cole, I’d like to leave a sample with you.”
“Sure, doctor. Is the case urgent? This time of night, the only stat work we do is for emergencies.”
“It’s not an emergency. It’s for a pregnancy test.”
“Well, I can accept it, and they’ll do the testing tomorrow. Have you filled out the form?”
“No.”
The tech nodded and got one from a drawer. For a long moment R.J. intended to write a false name after “Patient” and to sign it legitimately as the attending doctor; and then she felt great fury at herself and scribbled her own name twice, both as the patient and as the physician.
She gave it to the phlebotomist and saw careful blankness on the young woman’s face as she took in the two signatures.
“I’d like you to telephone the results to my home phone instead of to my office.”
“We’ll be glad to, Dr. Cole.”
“Thank you.” She went to her car and drove home slowly, as if she had just run a long way.
“Gwen?” she said into the phone.
“Yeah. R.J.?”
“Yes. I know it’s a little late to call …”
“No, we’re still up.”
“Are you free for dinner tomorrow? I need to talk.”
“Well, no, I’m in the midst of packing a bag. I still need fourteen CME points for my license renewal, and I’m taking your solution. I’m leaving in the morning, going to a conference on cesarean delivery in Albany.”
“Oh … Good idea.”
“Yeah. I don’t have a patient due for the next couple of weeks, and Stanley Zinck is covering for me. Look, do you have a problem? Do you want to talk now? Or I can cancel. I don’t have to go to this conference.”
“No, of course not. It’s nothing, really.”
“I get home Sunday night. How about we talk about it over early dinner on Monday, after work?”
“You’re on, that sounds good…. You drive carefully, now.”
“Okay, luv. Good night, R.J.”
“Good night.”
56
DISCOVERIES
A restless night. She was out of bed early on Thursday, sleep-starved and cranky. Her breakfast cereal tasted like bits of cardboard. She wouldn’t hear from the lab for hours. It might have been easier if it hadn’t been her day off; perhaps work would have occupied her mind. She determined to substitute household chores and began by washing the floor in the mudroom. It took energetic scrubbing to remove the accumulated grit and stain, but eventually the old linoleum shone.
When she looked at the clock, only three quarters of an hour had passed.
The two woodboxes were almost empty, and she lugged in logs from the woodshed, three or four at a time, and dropped them into the big pine box near the fireplace and the cherry woodbox next to the stove. Then she swept up the wood chips and sawdust.
Shortly after 10:30 she got the silver polish and set the silver service on the kitchen table. She put a Mozart CD, Adagio for Violin and Orchestra, on to play. Ordinarily Itzhak Perlman’s violin could carry her through anything, but this morning the concerto sounded intrusive and jangling, and she got up after a while and washed the polish from her hands and went to the CD player.
As soon as the music stopped, the telephone rang, and she took a deep breath and said hello.
But it was Jan. “R.J., Toby’s in real pain. Her backache is worse than ever, and now she has cramps.”
“Let me talk to her, Jan.”
“She’s too upset to talk; she’s crying.”
Toby wasn’t due to deliver for another three and a half weeks.
“I guess I’d better drop over there.”
“Thanks, R.J.”
She found Toby agitated, wearing a flannel nightgown with tiny roses printed on it, and pacing shoeless, in argyle socks that R.J. knew Peggy Weiler had given her for Christmas.
“R.J., I’m so scared.”
“Listen, sit down. Let’s see what’s going on here.”
“Sitting down makes my back worse.”
“Well, lie down. I want to take your vital signs,” R.J. said easily but briskly, inviting no argument.
Toby was breathing a little fast. Her blood pressure was 140 over 86, and her heart rate was 92, not bad at all, considering that she was excited. R.J. didn’t bother to take her temperature. When she put her palm on the convex abdomen, the contraction was unmistakable, and she took Toby’s hand and placed it so she would understand.
R.J. turned to Jan. “Will you call the ambulance and tell them your wife is in labor, please? Then call the hospital. Tell them we’re coming in, and ask them to notify Dr. Stanley Zinck.”
Toby started to cry. “Is he any good?”
“Of course he’s good. Gwen wouldn’t allow just anybody to cover for her.” R.J. pushed into sterile gloves. Toby’s eyes were large. R.J. had to ask her several times to raise her knees, the last time sharply. The digital exam was unremarkable; she had scarcely dilated, perhaps three centimeters.
“I’m so afraid, R.J.”
R.J. hugged her. “You’re going to be just fine. I promise.” She sent her into the bathroom to empty her bladder before the ambulance got there.
Jan came back. “She’ll need to take a few things,” R.J. told him.
“She’s had a bag packed for five weeks.”
* * *
Steve Ripley and Dennis Stanley came with the ambulance, especially eager because Toby was one of theirs. When they arrived, R.J. had just taken a second set of vitals and recorded them, and she handed the paper to Steve.
Jan and Dennis went out to get the gurney.
“I’m coming with her,” R.J. said. “She’s frightened. It would be good if her husband rode in back with us, too,” she added, and Steve nodded.
The ambulance was crowded. Steve stood beyond Toby’s head, closest to the driver and the radiotelephone; Jan stood by his wife’s feet, and R.J. was in the middle, the three of them swaying together and fighting for balance, especially after the ambulance left the secondary roads and was on the curving highway. It was warm inside the ambulance because the heaters were powerful. They had removed the blankets from Toby at the beginning of the run, and R.J. had raised her nightgown well above her swollen belly. At first R.J. had covered Toby with a light sheet for modesty’s sake, but Toby’s thrashing legs had kicked it down.
Toby had started the trip white-faced and silent, but soon her face was reddened by the exertion of fighting the pains, and she was making a succession of grunts and moans, with an occasional sharp cry.
“Shall I give her some oxygen?” Steve asked.
“It can’t hurt,” R.J. said.
But after a few breaths, Toby was having none of it and ripped the mask from her face. “R.J.,” she called frantically, and moved back from the great gush that came from inside her and leaped out onto R.J.’s hands and jeans.
“It’s all right, Tobe, it’s just your waters breaking,” R.J. said, and reached for a towel. Toby opened her mouth wide and stuck out her tongue as if trying to give a great scream, but no sound came out. R.J. had been watching closely and had seen a little additional dilation, perhaps to four centimeters, but now she looked down and saw that Toby’s vulva was a full circle crowning the top of a small, hairy skull.
“Dennis,” she called, “pull over and park.”
He turned the ambulance smartly to the side of the road and set the brake. R.J. thought they might be there a long while, but something about the sound of Toby’s grunt made her realize otherwise. She brought her hands down between Toby’s legs, and a small, rose-colored baby slid out and filled them.
The first thing R.J. noticed was that, premature or not, the baby had a matted head of hair, as light and fine as its mother’s.
“You’ve got a boy, Toby. Jan, you have a son.”
“Will you look at that,” Jan said. He never stopped rubbing his wife’s feet.
The baby was wailing, a sharp, indignant little sound. They wrapped him in a towel and lay him down close to his mother. “Take us in, Dennis,” Steve called. The ambulance was just past the Greenfield town line when Toby began to pant again. “Oh, God. Jan, I’m having another one.”
She thrashed, and R.J. lifted the infant out of her way and gave it to Steve for safekeeping. “Better stop again,” she called.
This time Dennis turned the ambulance into a supermarket parking lot. All around them, people were getting in and out of cars.
Toby’s eyes bulged. She held her breath, grunted, and bore down. And held her breath, grunted, and bore down, again and again, lying partially on her left side and staring hopelessly at the ambulance wall.
“She needs some help. Lift her right leg high, Jan,” R.J. said, and Jan held her knee in his right hand and leaned on her thigh with his left hand to keep her leg flexed.
Now Toby screamed.
“No, hold her!” R.J. said, and delivered the placenta. In the process, Toby had a small bowel movement; R.J. saw, and covered it with a towel, marveling that this was how the world was made, all those millions of people for millions of years, each produced in just this kind of slime, blood, and agony.
As Dennis drove again, through the center of town, she found a plastic bag and put the placenta into it.
They lay the baby next to Toby again, and the placenta next to the baby. “Shall we cut the cord?” Steve asked.
“With what?”
He opened the ambulance’s useless little obstetrics kit and held up a single-edged razor blade. R.J. thought of using it in the moving vehicle and suppressed a shudder. “We’ll wait and let somebody use a sterile scissors,” she said, but she took the two laces from the kit and tied off the cord, first an inch above the bab
y’s abdomen and again near the opening of the plastic bag. Toby was inert, her eyes closed. R.J. massaged her abdomen, and just as the ambulance turned in to the hospital, through the thin, smooth skin of the slack belly she felt the uterus respond and contract, starting to become firm and ready in case someday there might be another birth.
In the staff toilet, R.J. stood at the sink and scrubbed her hands and arms, washing away the amniotic fluid and diluted blood. Her clothes were saturated and gave off an earthy, pungent smell, and she stripped off her jeans and sweater and rolled them into a tight ball. There was a pile of freshly laundered gray scrub suits on a shelf, and R.J. helped herself to a bottom and a top and put them on. When she left the toilet she carried her clothes in a paper bag.
Toby lay in a hospital bed. “Where is he? I want him.” Her voice was hoarse.
“They’re cleaning him up. His daddy is watching him. He weighs five pounds, ten ounces.”
“That’s not much, is it?”
“He’s healthy. Just small because he was born a little early. That’s why you had such an easy time.”
“I had an easy time?”
“Well … fast.” That reminded her, just as one of the nurses came into the room. “She has some small tears in the perineum. If you give me some sutures, I can sew her.”
“Oh … Dr. Zinck is on his way. He’s officially the obstetrician. Don’t you want to wait and let him do it?” the nurse suggested delicately, and R.J. got the message and nodded.
“You plan to name him after the good old doctor, the one who answered your call?” R.J. said.
“Nix.” Toby shook her head. “Jan Paul Smith, same as his father. But you’ll have a piece of him. You can talk to him about hygiene, and how to treat all those girls. Stuff like that.”
Her eyes closed, and R.J. brushed back her damp hair.
It was 2:10 when the ambulance dropped R.J. at her car. She drove home slowly, down the town’s familiar roads. The sky had turned gray over the snow-covered fields. Between meadows, stretches of forest offered shelter, but in the open the wind leapt across the long spaces like a weather wolf, chasing frozen snow pellets to rattle against her car.
