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 little 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.
“Every month,” Bonnie Roche told her, “I have a veterinarian come in to give our cows their tests and shots, but we can’t afford medical insurance for ourselves. Until you came, my cows got better medical care than my kids.”
The Roches weren’t an isolated case in America. In November, R.J. went to the old wooden Town Hall and cast a ballot for Bill Clinton as president of the United States. Clinton had promised her patients that he would provide medical insurance to everyone who didn’t have it. Dr. Roberta Cole intended to hold him to that promise, and she cast her vote as if it were a lance she was leveling at the health care system.