The Cole Trilogy: The Physician, Shaman, and Matters of Choice (184 page)

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ROBERTA J. COLE, M.D.

In those days, she called him Tommy.

When she left Dr. Ringgold she did morning rounds.

Unfortunately, she never had more than one or two patients in the wards. She was a general physician interested in family practice, working in a hospital that didn’t have a department of family practice. That made her a kind of jack-of-all-trades, a utility player without classification. Her work for the hospital and the medical school fell between departmental boundaries; she saw pregnant patients, but someone in Obstetrics delivered the babies; in the same way, almost always she referred her patients to a surgeon, a gastroenterologist, any one of more than a dozen specialists. Most of the time she never saw the patient again, because follow-up care was done by the specialist physician or the hometown family doctor; usually patients came to the hospital with only those problems that might require advanced technology.

At one time, political opposition and the sense that she was breaking new ground had lent spice to her activities at Lemuel Grace, but for a long time now she had lost her sense of joy in
medical practice. She spent too much of her time reviewing and signing insurance papers—a special form if someone needed oxygen, a special long form for this, a special short form for that, in duplicate, in triplicate, every insurance company with different forms.

Her office visits were apt to be impersonal and brief. Faceless efficiency experts at insurance companies had determined how much time and how many visits she could allow for each patient, who was quickly sent off for lab work, for X rays, for ultrasound, for MRI—the procedures that did most of the real diagnostic work and protected her from malpractice suits.

Often she pondered, who were these patients who came to her for help? What elements in their lives, hidden from her almost cursory glance, contributed to their illness? What would become of them? There was neither time nor opportunity for her to relate to them as people, to really be a physician.

That evening she met Gwen Gabler at Alex’s Gymnasium, an upscale health club in Kenmore Square. Gwen was R.J.’s medical school classmate and best friend, a gynecologist at Family Planning whose breeziness and salty tongue disguised the fact that she was hanging on by her fingernails. She had two children, a real estate broker husband who had run into hard times, an overcrowded schedule, bruised ideals, and depression. She and R.J. came to Alex’s twice a week to punish themselves in a long aerobics class, sweat out foolish desires in the sauna, soak away fruitless regrets in the hot tub, have a glass of wine in the lounge, and gossip and talk medicine throughout the evening.

Their favorite wickedness was to study the men in the club and judge their attraction solely by their appearance. R.J. found she required a hint of the cerebral in the face, a suggestion of introspection. Gwen liked more animal qualities. She was an admirer of the owner of the club, a golden Greek named Alexander Manakos. Easy for Gwen to dream of muscular but soulful romance and then go home to her Phil, myopic and stocky but deeply appreciated. R.J. went home and read herself to sleep with medical journals.

On the surface, she and Tom had the American dream—busy professional lives, the handsome house on Brattle Street, a farmhouse in the Berkshires that they used for extremely rare weekends and vacations. But the marriage was ashes. She told herself it might have been different if they had had a child. Ironically, the physician who frequently dealt with infertility in others had been infertile for years. Tom had had semen analysis and she had had a battery of tests. But no cause of the infertility was uncovered, and she and Tom had been quickly caught up in the responsibilities of their medical personas. Those demands were so heavy for each of them that gradually they had drifted apart. If their marriage had been more substantial, doubtless in recent years she would have considered insemination or in vitro fertilization, or perhaps adoption. By now, neither she nor her husband was interested.

Long ago R.J. had become aware of two things: that she had married an insubstantial man and that he was seeing other women.

3

B
ETTS

R.J. knew Tom had been as surprised as anyone when Elizabeth Sullivan had come back into his life. He and Betts had lived together for two years in Columbus, Ohio, when they were young. At that time she was Elizabeth Bosshard. From what R.J. heard and saw when Tom talked about her, he must have cared for her a great deal, but she had left him after she met Brian Sullivan.

She had married Sullivan and moved to the Netherlands, to The Hague, where he was a marketing manager for IBM. Several years later he was transferred to Paris, and less than nine years after their marriage he had suffered a stroke and died. By that time Elizabeth Sullivan had published two mystery novels and had a large readership. Her protagonist was a computer programmer who traveled for his company, and each book took place in a different country. She traveled wherever the books led her, generally living a year or two in the country she was writing about.

Tom had seen Brian Sullivan’s obituary in the
New York Times
and had written a letter of condolence to Betts and received a letter in return. Other than that, he’d not even had a postcard from her, nor had he thought much about her for years until the day she telephoned him and told him she had cancer.

“I’ve seen doctors in Spain and in Germany, and I know the disease is advanced. I decided to come home to be sick. The physician in Berlin suggested someone at Sloan-Kettering in New York, but I knew you were a doctor in Boston, so I came here.”

Tom knew what she was telling him. Elizabeth’s marriage, too,
had been childless. She had lost her father in an accident when she was eight, and her mother had died four years later of the same kind of cancer that Betts now had. She had been raised well by her father’s only sister, who now was an invalid in a nursing home in Cleveland. There was no one but Tom Kendricks for her to turn to.

“I feel so bad,” he told R.J.

“Of course you do.”

The problem was well beyond the skills of a general surgeon. Tom and R.J. talked it over, considering whatever they knew about Betts’s case; it was the first time in a long while that they had shared such a meeting of the minds. Then he had arranged for Elizabeth to be seen at the Dana-Farber Cancer Institute, and he had spoken to Howard Fisher about her after she was examined and tested.

“The carcinoma is widely traveled,” Fisher had said. “I’ve seen patients go into remission who were worse off than your friend, but I’m sure you understand that I’m not hopeful.”

“I do understand that,” Tom had said, and the oncologist had blocked out a treatment regimen that combined radiation and chemotherapy.

R.J. had liked Elizabeth at sight. Her husband’s ex-lover was a full-bodied, round-faced woman who dressed as wisely as a European but who had allowed middle age to make her comfortably heavier than was fashionable. She wasn’t prepared to give up; she was a fighter. R.J. had helped Betts find a one-bedroom condominium on Massachusetts Avenue, and she and Tom saw the ailing woman as often as possible, as friends and not as doctors.

R.J. took her to see the Boston Ballet do
Sleeping Beauty
and to the first autumn concert of Symphony, sitting high up in the balcony and giving Betts her own seventh-row-center seat in the orchestra.

“You have only the one season ticket?”

“Tom doesn’t go. We have different interests. He likes to go to hockey games and I don’t,” R.J. said, and Elizabeth nodded
thoughtfully and said she had enjoyed watching Seiji Ozawa conducting.

“You’ll like the Boston Pops next summer. People sit at little tables and drink champagne and lemonade while they listen to lighter stuff. Very
gemütlich.”

“Oh, we must go!” Betts said.

The Boston Pops wasn’t in the cards for her. Winter was very young when her disease took hold; she had needed the apartment only seven weeks. At Middlesex Memorial Hospital they gave her a private room on the VIP floor and her radiation treatments were stepped up. Very quickly her hair fell out and she began to lose weight.

She was so sensible, so calm. “It would make a really interesting book, you know?” she said to R.J. “Only, I don’t have the energy to write it.”

A genuine warmth had developed between the two women, but late one night when the three of them sat in her hospital room it was Tom she looked at. “I want you to make me a promise. I want you to swear you won’t allow me to suffer or linger.”

“I do,” he said, almost a nuptial vow.

Elizabeth wanted to review her will and to draw up a living will stipulating that she didn’t want her life artificially prolonged by drugs or technology. She asked R.J. to get her a lawyer, and R.J. called Suzanna Lorentz at Wigoder, Grant and Berlow, the firm where she had once worked briefly herself.

A couple of evenings later, Tom’s car was already in the garage when R.J. got home from the hospital. She found him sitting at the kitchen table, having a beer while he watched television.

“Hi. That Lorentz woman call you?” He snapped off the TV.

“Hi. Suzanna? No, I haven’t heard from her.”

“She called me. She wants me to be Betts’s legal health care agent. But I can’t. I’m her associate physician of record, and it would represent a conflict of interest, wouldn’t it?”

“Yes, it would.”

“So will you? Be her legal health care agent, I mean?”

He was gaining weight and looked as if he hadn’t been sleeping
enough. There were cracker crumbs on his shirtfront. She was saddened by the fact that an important part of his life was dying.

“Yes, that will be all right.”

“Thank you.”

“You’re welcome,” she said, and went up to her room and went to bed.

Max Roseman faced a long convalescence and had decided to retire. R.J. didn’t get the news from Sidney Ringgold; indeed, Dr. Ringgold made no official announcement. But Tessa came in with the intelligence, beaming. She wouldn’t reveal her source, but if R.J. had to bet, she’d have placed her money that Tessa had been told by Bess Harrison, Max Roseman’s secretary.

“Word has it that you’re among those being seriously considered as Dr. Roseman’s replacement,” Tessa said. “Whoo-eee! I think you have a real good chance. I think that for you the job of associate chief would be the first rung of a tall, tall ladder. Would you rather aim at becoming dean of the medical school or director of the hospital? And whatever you end up doing, are you going to take me with you all the way?”

“Forget it, I’m not going to get that job. But I’m always going to take you with me. You hear so many rumors. And you get my coffee every morning, you damn fool.”

It was one of many rumors that floated all about the hospital. Now and again someone would say something sly and knowing, sending her a message that the world was aware of her name on a list. She wasn’t holding her breath. She didn’t know if she wanted the job enough to accept it if it were offered.

Soon Elizabeth had lost enough weight so that for a brief time R.J. was able to get a faint inkling of what she had looked like as the slim young girl Tom had loved. Her eyes seemed larger, her skin grew translucent. R.J. knew she teetered on the brink of gauntness.

There existed between them a curious intimacy, a world-weary knowledge that was closer than sisterhood. Partly, it was due to the fact that they shared memories of the same lover. R.J.’s mind
wouldn’t allow her to imagine Elizabeth and Tom having sex. Had his lovemaking habits been the same? Had he cradled Elizabeth’s buttocks in his hands, had he kissed her navel after he was spent? Elizabeth must have some of the same thoughts when she looked at her, R.J. realized. Yet there was no jealousy in them; they were drawn close. Even burdensomely sick, Elizabeth was sensitive and astute. “Are you and Tom going to split?” she asked one night when R.J. had stopped to see her on the way home.

“Yes. Very soon, I think.”

Elizabeth nodded. “Sorry,” she whispered, finding the strength to console; but clearly, the confirmation came as no great surprise to her. R.J. wished they could have known each other for years.

They would have been wonderful friends.

4

M
OMENT OF
D
ECISION