A NAMING
“So? What will you do when you get here?” R.J. asked.
Gwen shrugged. “I still believe managed care is America’s only chance to get health coverage for everybody. I’ll look for another HMO to hire me, I guess. And make certain it’s a good one this time.”
In the morning she went to the village with R.J. They walked the length of Main Street, and she watched wistfully as people called out a greeting to the doctor or gave R.J. a smile. In the office she went from room to room, observing everything, stopping now and again to ask a question.
While R.J. saw patients, Gwen sat in the waiting room and read gynecology journals. They ordered sandwiches at the general store for lunch.
“How many ob-gyns are there in the hilltowns?”
“None. The women have to travel to Greenfield or Amherst or Northampton. There are a couple of midwives based in Greenfield who come up into the hills. All the hilltowns are growing, Gwen, and there are enough women here now to provide a gynecologist with patients.” It would be too much for her to hope that Gwen would practice in the hills, and she wasn’t surprised when Gwen merely nodded and went on to talk of something else.
That evening Toby and Jan had them to dinner. During the meal the phone rang and someone reported to the fish and game officer that a hunter had wounded a bald eagle in Colrain, so as soon as he had eaten, Jan asked their forgiveness and went to see what that was all about. It was just as well. Left to their own devices, the three women settled down in the living room and talked comfortably.
R.J. had sometimes found it dangerous to meet the close friend of a close friend. The experience could go either way—jealousy and rivalry could sour the meeting, or the two newly introduced people could see in each other what their mutual friend saw in each of them. Happily, Toby and Gwen responded to one another warmly. Toby learned all about Gwen’s family, and she was frank in describing her yearning for a child and the weariness she and Jan had come to feel as a result of their unsuccessful efforts.
“This woman is the best ob-gyn I have ever met,” R.J. told Toby. “I’d feel so much better if she were to examine you at the office in the morning.”
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 found 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.”