Matters of Choice

  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

  BETTS

  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 seeme
d 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

  MOMENT OF DECISION

  Thursdays.

  When R.J. was younger she had made a great many political statements. Now, it seemed to her that she had only Thursdays.

  She placed special value on babies and disliked the notion of canceling them. Abortion was ugly and messy. Sometimes it got in the way of her other professional activities because a few of her colleagues disapproved, and for public relations reasons her husband had always feared and hated her involvement.

  But there was an abortion war waging in America. A lot of doctors were driven from the clinics, intimidated by the ugly and unsubtle threats of the anti-abortion movement. R.J. believed it was a woman’s right to make decisions about her own body, so every Thursday morning she drove to Jamaica Plain and sneaked into the Family Planning Clinic the back way, avoiding the demonstrators, the placards shaken at her head, the crucifixes jabbed at her, the thrown blood, the bottled fetuses stuck into her face, and the name-calling.

  On the last Thursday in February she parked in the driveway of Ralph Aiello, a neighbor who was paid by the abortion clinic. The snow in the Aiello backyard was deep and new, but he had earned his money by shoveling a narrow path to the gate in the back fence. The backyard of the clinic property was on the other side of the gate, where another narrow shoveled path led to the rear door of the clinic building.

  R.J. always made the walk from her car a quick one, afraid that demonstrators would burst around from the sidewalk in front of the clinic, and angry and illogically ashamed that she had to sneak to her work as a doctor.

  On that Thursday there was no noise coming from the front of the building, no screams, no curses, but R.J. was particularly troubled, having stopped to see Elizabeth Sullivan on her way to work.

  Elizabeth had traveled beyond the point of any hope and had entered the realm of intractable pain. The button she was allowed to press for self-medication had been inadequate almost from the start. Whenever she regained consciousness she suffered terribly, and now Howard Fisher had begun to give her very heavy doses of morphine.

  She slept in her bed without moving.

  “Hi, Betts,” R.J. had said loudly.

  She had placed her fingers against Elizabeth’s warm, faintly pulsing neck. In a moment, almost against her will, she had enclosed the other woman’s hands in her own. From somewhere deep within Elizabeth Sullivan information had flowed into R.J. and found its way into her consciousness. She had sensed the smallness of the reservoir of life, depleting steadily in incremental amounts, with infinitesimal slowness. Oh, Elizabeth, I’m sorry, she told her silently. I’m so sorry, dear.

  Elizabeth’s mouth had moved. R.J. bent over her, straining to hear.

  “… green one. Take the green one.”

  R.J. had mentioned the incident to one of the ward nurses, Beverly Martin.

  “God love her,” the nurse said. “Usually she never wakes up enough to say anything.”

  That week it was as if the screws suddenly were tightened on all the torture vises that brought stress to R.J. An abortion clinic in New York State had been set afire in the night, and the same sick passion was alive in Boston. Large, turbulent protest demonstrations, manic at times, had hit two clinics in Brookline, one run by Planned Parenthood and the other by Preterm. They had led to disruption of services, a large police response, and mass arrests, and it was expected that the Family Planning Clinic in Jamaica Plain was next.

  In the staff room, Gwen Gabler was drinking coffee, uncharacteristically quiet.

  “Something wrong?”

  Gwen set down her cup and reached for her purse. The sheet of paper was folded twice. When R.J. opened it, she saw a wanted poster, the sort displayed in post offices. It bore Gwen’s name, address, and photograph, her weekly schedule, the fact that she had left a lucrative ob-gyn practice in Framingham “to get rich performing abortions,” and the crime for which she was wanted: murder of babies.

  “It doesn’t say dead or alive,” Gwen said bitterly.

  “Did they make up a poster of Les, too?” Leszek Ustinovich had practiced for twenty-six years as a gynecologist in Newton before joining the clinic. He and Gwen were the only full-time physicians at Family Planning.

  “No, I’m the chosen goat here, apparently, although I understand Walter Hearst at the Deaconess Hospital has been similarly honored.”

  “What are you going to do about it?”

  Gwen tore the poster in half, and then in half again, and dropped the pieces into the trash basket. Then she kissed her fingertips and gently slapped R.J.’s cheek. “They can’t drive us away if we won’t let them.”

  R.J. finished her coffee thoughtfully. She had been doing first-trimester abortions at the clinic for two years. She had had postresidency training in gynecology, and Les Ustinovich, a superb teacher with a lifetime of experience, had trained her in the first-trimester procedure. First-trimester procedures were absolutely safe when done carefully and correctly, and she was careful to be correct. Still, every Thursday morning she was as tense as though she had to spend the day doing brain surgery.

  She sighed, threw her paper cup away, got up and went to work.

  * * *

  The next morning at the hospital Tessa gave her a very solemn stare along with her coffee and bagel. “It’s getting down to the crunch. Serious stuff. The word we have is that Dr. Ringgold is discussing four names, and you’re one of them.”

  R.J. swallowed a bite of bagel. “Who are the other three?” she said, unable to resist.

  “Don’t know yet. I heard only that every one is a heavy hitter.” Tessa gave her a sidelong glance. “Do you know there has never been a woman in that position?”

  R.J. smiled less than joyfully. Pressure was no more welcome because it came from her secretary. “That isn’t a surprise, is it?”

  “No, it isn’t,” Tessa said.

  That afternoon R.J. was walking back from the PMS clinic when she met Sidney in front of the medical office building.

  “Hiyuh,” he said.

  “Hi there to you.”

  “Have you decided anything concerning that request I made of you?”

  She hesitated. The truth was, she had pushed it from her mind, not wanting to deal with it. But that was unfair to Sidney. “No, I haven’t. But I will in a very short time.”

  He nodded. “You know what every teaching hospital in this city does? When they need somebody to fill a leadership job, they look for a candidate who’s already created interest in himself because he’s a hotshot bench scientist. They want someone who’s published a number of papers.”

  “Like the young Sidney Ringgold, with his papers on weight reduction and blood pressure and onset of disease.”

  “Yes, like that long-ago young hotshot Sidney Ringgold. Research is what got me this job,” he agreed. “It’s no more logical than the fact that search committees looking for a college president always choose someone who has been a distinguished teacher. But there you
are.

  “You, on the other hand. You’ve published a few papers, and you’ve created a couple of stirs, but you’re a doctor, not a bench science investigator. Personally, I think this is a good moment in time to have a physician of people as the assistant chief of medicine, but I need to make an appointment that will win a consensus of approval from the hospital staff and the medical community. So if a nonresearch type is going to be appointed associate chief of medicine, she has to have as much professional leadership in her résumé as is humanly possible.”

  She smiled at him, aware he was her friend. “I do understand, Sidney. And I’ll get back to you very soon with my decision about chairing the publications committee.”

  “Thank you, Dr. Cole. Enjoy your weekend, R.J.”

  “You too, Dr. Ringgold.”

  A weirdly warm storm blew in from the sea, pelting Boston and Cambridge with heavy rains and defrosting the late winter’s snow. Outside, all was puddles and dripping, and the gutters were awash.

  She lay in bed Saturday morning, listening to the downpour and thinking. She didn’t like her mood; she was increasingly morose, and she knew that kind of thing could affect her decisions, if she allowed it.

  She wasn’t enthusiastic about being Max Roseman’s successor. But she wasn’t enthusiastic about her medical life as it existed at the moment, and she found herself responding to Sidney Ringgold’s faith in her—and to the fact that again and again he had given her opportunities that other men would have denied her.

  And she kept seeing the look on Tessa’s face when she said that no woman had ever been associate chief of medicine.

  Mid-morning she got out of bed and put on her oldest sweat suit, a windbreaker, her most disreputable running shoes, and a Red Sox cap that she pulled down hard over her ears. Outside, her feet squished through the water, soaked before she was twenty yards from the house. Despite the thaw it was winter in Massachusetts, and she was wet and shivering, but as she jogged her blood began to sing and she warmed quickly. She had intended to go only to Memorial Drive and back, but the running was too good to cut short and she loped alongside the frozen Charles River, watching the rain on the ice, until she began to tire. On the way back cars splashed her twice, but it hardly mattered; she was wet as a swimmer. She let herself into the house through the back door and left her drenched garments on the tile floor of the kitchen, wiping herself with a dish towel so she wouldn’t drip on the rug on her way to the shower. She stayed under a very hot spray for a long time, until the mirror was so fogged she had no reflection when she got out and rubbed herself dry.