Driving on the Rim

7

IN THE EARLY DAYS OF MY PRACTICE, I sustained an affair with an incredibly self-absorbed folksinger named Kay who left me for another man and a career in music that went nowhere. I remember an awful evening at her riverside condo, snow blowing against the double-paned picture window, when she auditioned for a New York impresario who held his head and moaned while she intoned, “I loves you, Porgy,” over the big twelve-string. Tessa was still around town and I often heard that she was furious with me for dating Kay. If she thought I went out of my way to stay out of hers, she was right — not from a simple wish for avoidance so much as a recognition of the power acquired in my youth which she still held over me, and which, considering my standing, I now thought to be unseemly. I had grown to be an independent sort, a bachelor who thrived on connubial hopelessness and the outdoors. I kept bird dogs and horses, and I went on some sort of adventure at least once a year. I felt I was much too fancy even for acquaintance with Tessa. This was a form of whistling in the dark, because whenever I saw her she wielded exactly the same authority over me as she had when I was very young.

Over the years that followed, I’d occasionally see her going about the affairs of Hoxey. As he was now old, sick, and demented and Tessa was seen as exploiting him, she had acquired a questionable reputation around town. When Hoxey died, whatever worries I might have had for her were briefly allayed, as it seemed that she must have inherited the business. Then she made an appointment to see me at the clinic. I had forgotten her physical abundance and burning vitality. Her hair piled atop her head and held there by a bright-red plastic comb seemed to represent fulminating energy. She had a white streak in her hair, which she attributed to “trauma.” She stared at me significantly.

“Henchmen of Hoxey have turned me out into the street,” she told me, “with little more than the clothes on my back.”

“Tessa, I find this very hard to picture.”

“Perhaps a few prints, a negligible watercolor or two.”

“Who exactly are these ‘henchmen’?”

“Grown daughters. I never factored them in. They arrived on the scene like Valkyries hovering over the battlefield in search of corpses to eat.”

“I’m terribly sorry.”

“At a difficult time, Doctor, I offered you companionship and sexual healing.”

“Is there anything I can do? Medication is my line, but I don’t think that is what you have in mind.”

“I’ll have to start looking for work. I hope you’ll recommend me.”

I reached for a pen, poised to join the millions who’ve made their way out of a difficult situation by providing letters of recommendation. But Tessa said, “Not now. I’ll let you know.” That, more or less, was the end of our appointment. She seemed happy with my response, taking my hand in both of hers. I suppose she was just checking to see whether I was still on her side.

Tessa went downhill fast. Within two years, she endured spells of homelessness, punctuated by temporary jobs, none of which became permanent, because of her imperious nature, her contempt for owners and bosses. She never merely left a job, she stormed off. She took over the homes where she was briefly a guest. But even as her fortunes fell, Tessa didn’t lose her rakish airs, though they began to seem almost detached from her, and just a bit automatic as she strode around town in worn-out clothes.

I was one of several who helped in small ways, but I rarely saw Tessa. I had established myself in a small-town practice that would not make me rich, though it might make me happy. Hoxey had since returned to California in powder form, leaving nothing behind him. In those years I seemed to have awakened from my own background and, without boasting, I can say that I had become somewhat less of a fool, though I was aware that my foolishness could recur at any time, like a dormant virus. I can’t say that I saw Tessa as my responsibility, nor can I claim to have quite got her out of my system.

Bob Kavanagh took me to lunch on a Thursday. Bob was a hearty, shifty fellow who would do anything for a laugh. He owned a motel in Gardiner and the movie theater here in town. During that morning’s digital prostate exam, he had deliberately farted into my examining glove, and taking me to lunch was by way of making up for his bad manners, which I had not thought funny. “How’s your sandwich?” he asked. His incongruous smile suggested that the sandwich, too, was amusing. He must have been proud of his Panama hat because he wore it all through the meal.

“It’s very good.”

He smiled; he’d made it up to me. He said, “You know how people would find things in their food, cockroaches, fingers, stuff like that?”

I answered him warily. “Yes?”

“Last week guy come in here orders a chicken potpie and there was a cell phone in it. Just imagine if someone called that number and it rang in the pie.”

“I can’t.”

The conversation rambled on until Kavanagh brought up the subject of Tessa, whom he described as a community eyesore. He wanted to get up a collection to ship her back to California. I said, “What if we ship you back to California?”

“I’m not from California. I’m from here.”

“I’m sorry to hear that. I thought I was onto something.”

I wanted to leave the restaurant, but I was spotted by Adrienne Wilmot and her husband, Raymond, dining alone by the bricked-up fireplace at the north end of the room. She was an attractive, actually wonderful woman, though it was mildly to her discredit that she seemed, in the absence of any other sufficient explanation, to have married for money or social standing. She’d had a couple of affairs in our town and left her lovers grateful. I say that from experience. There was really nothing wrong with Raymond, exactly; he sold high-end recreational properties to members of his far-flung society. He was known in the business as “Tightly Held” Wilmot because no matter what obscure neighborhood he was promoting, he always described it as “tightly held.” She once admitted her moderate infidelity to me but added, “I never do it to get anywhere.” Perhaps Raymond was the exception. In any event, Raymond Wilmot was making money hand over fist.

Wilmot’s face and head, his small moustache, projected a sort of gloom. I thought he looked like Edgar Allan Poe. He told me that the lovely small towns of New England where he had once lived were now “stiff with fairies fixing up houses.” He had a habit of throwing his head back, looking into space, and laughing; the effect was one of extreme condescension.

Adrienne said, “They don’t call them that anymore. You’re not keeping up, Raymond.” And Wilmot said, “Oh, very well.” To this he attached an elegant and contemptuous ennui. Wilmot knew of my family and often teased me about my breeding or sardonically complimented me on triumphing over my origins. I would always be displeased with myself for laughing at this, as I was actually quite offended.

Raymond got to his feet, pressed his napkin to his chest, and gave me a hearty welcome. He was the sort of person who smiled with blatant insincerity from one side of his mouth while addressing you as “Mr. So-and-So,” sometimes preceding that with “Well, if it isn’t old—” I think he was trying to be funny but I’m not sure. I hugged Adrienne as she stood, running the end of my forefinger up the small of her back to feel her shiver. Very responsive, that Adrienne, and she rewarded me with a twinkle. The three of us sat down together. They both beamed at me with the intense curiosity which we save for people we suspect might not be stable. I do think I was viewed as not quite under control, but some women liked that. Adrienne had once said of her husband, “I wanted him so badly, I can’t believe I’m sick of him now.” I thought she was either being provocative or just covering her tracks.

Quite inadvertently as my hand rested in my lap our fingers touched, and as she didn’t withdraw hers, I let them intertwine. Raymond did notice this. “A little wine?” he asked sarcastically. “Some candles, perhaps?”

“Raymond, be a sport and let me at him.” Expressed like this, we had to laugh. “Really, all of my antics are just for Raymond’s entertainment.” Good one, that, and it took Raymond in, as his returning complacency attested.

“In English class,” Raymond said, “we once had to write an essay on one of Dante’s circles of hell, and we could pick whichever circle we wanted. I picked ‘the Sea of Excrement’ and it really has stayed with me.”

When Adrienne and Raymond came with me one afternoon for a visit to my father, Raymond kept saying about his meager house, “It’s all you need!” He seemed antic and uncomfortable. Afterward, my father remarked, “I wouldn’t piss on him if he was on fire.”

I knew Raymond didn’t like me. My cherished friend Jinx said he hated me, but I thought that was a bit much. As a single woman, Jinx gets around more than I do, invited here and there: she had a very sharp ear and a sharper memory.

I had by now acknowledged my solipsism, my slow winding inward. I also noticed that Kavanagh left without a word. I supposed I had impolitely abandoned him, but after all, he had farted in my glove. Still, I’d been discomfited by the cold stare I had caught from Raymond Wilmot before he realized I’d seen him.

“You can make Adrienne very happy if you’ll come for dinner.”

“I’d love to,” I intoned.

“And in the interest of appearances, I’ll join you.”

I told Raymond that that was entirely up to him. I knew how unsatisfactory that was, since he undoubtedly knew there had been more to Adrienne’s and my flirtation than met the eye. I just didn’t think he cared. I was wrong about that: he cared. It would later seem that it was all he cared about.

The December night that I was celebrating my fortieth birthday with a small cake in the emergency room, they brought Tessa in: into her abdomen she had plunged a serrated bread knife, an item she continued to clutch while on the gurney. I took it from her hand, and feeling the heat of her gaze, I quickly moved to dealing with her wound. I knew that if she were admitted to the clinic itself she would be subjected to what I viewed as diagnostic imprudence — laparotomy and various explorations, which experience had caused me to associate with increased morbidity. Though I would later have a chance to review these judgments, I honestly felt that they didn’t alter the way things turned out. In effect, I was keeping Tessa to myself. I had hoped that this was a cry-for-help injury — the timing, during my shift, aroused my suspicions — but the knife, it turned out, had pierced the skin, the subcutaneous layer, the linea alba, and the peritoneum, and I could only hope that it had gone no farther, that is, into the viscera. Over the next four days, attending Tessa round the clock while she stared at me without speaking, I failed to contain the major leakage, the uncontrolled granulosis of the peritoneum, the necrosis, and an infection that laughed off antibiotics in a general cascade. She was looking right through me when she slipped away.

Aren’t there things that your parents should tell you? After my mother’s death, I had found her reading glasses. I’d sat down on our old sofa in front of the window, with its view of a stunted row of odorless rugosa roses, still knowing, after all those years, which part I could sit on without feeling the springs. I put my mother’s glasses on. The earpieces were too short for me, and I had to press them down on my nose uncomfortably. It didn’t matter: I could barely see through them.

I only felt that something quite terrible had happened to me. My first instinct was flight: I would just leave town, leave the area, try to leave myself; but that soon struck me as irrational and no more than a conversion of this terrible feeling into weakness that would open up into something worse. And something happened that was quite meaningless, however unsettling: driving home from the hospital, I saw children standing alongside the road holding tombstones; at closer range the tombstones turned out to be skateboards, but the first impression endured.

The death of Tessa gave rise to some misunderstandings in town, and at first the doctors stood by me. But we began having trouble with our board of directors, and the clinic went half speed as a kind of protest or strike. Raymond Wilmot was now chairman of the board.

But I wanted to work. I had to work. It was the only balm I had for the several kinds of mental pain that had beset me. I may have taken the whole thing too seriously. I had a classmate at medical school who was now marketing a homeopathic cure for jet lag; when I saw him at our reunion and asked if it actually worked, he said blandly, “There’s no fucking way.” He pointed out another classmate who had invented a universal stool softener. “He’s making a fortune.” It seemed that believing we were surrounded by people who enjoyed being fooled is what united all Americans. I had begun in the emergency room. Trauma was different: we knew exactly what to blame, and the literal qualities of the obvious thing that caused the injury was but a poor object to resent. The beauty of trauma lay in its peculiarly genuine qualities.

We kept having meetings, most among ourselves, and sometimes with the board, an altogether tiresome exercise, since the board really didn’t understand what we did and seemed to regard doctors as a necessary evil. Wilmot preached fiscal responsibility and local control. He saluted himself for “giving back to the community” which had been so good to him by taking it in the shorts on every Wilmot transaction. He never failed to thwart us on equipment and facility enhancements and would blow up if challenged. Any doctor raising questions about the finances of the clinic was urged to stick to his knitting. We also had an obsequious clinic manager, Darryl Coutts, a native of Tennessee whose genial Southern ways masked his spineless inability to grasp the essentials of the job. We ignored him too.

It seemed that we had barely recovered from one of Wilmot’s board meeting pep talks when it was time for another, with fresh rants about “emerging challenges” and “opportunities for greatness.” It didn’t help that Alan Hirsch made a cylinder with his right hand and raised and lowered it over his crotch while rolling his eyes. If the roof leaked, Wilmot assured us that a “capital infusion” was on the horizon and that our only obligation was to close ranks and provide better care for our patients. Hirsch whispered to me, “An absolute dribbling fuckwit.” As Wilmot was looking my way, I nodded gravely, hoping to give the appearance of having just absorbed some insight supportive of his bottomless inanities. “He loves you,” whispered Hirsch.

“So that you each may do the work you do best,” said Wilmot, “we have chosen our trustees strictly from among the abundant reserve of community leaders. This will come as nothing new to you. But in this we differ from those boards substantially comprised of physicians.” This was a sore subject, and we had no idea why he saw fit to revisit it now. “We are as empowered toward decision making as you each should be empowered toward healing.” All of us could feel the generalizations rise toward a disorienting crescendo, and we were on our guard, sensing there was a fucking afoot. “I am in contact, thanks to the good efforts of Darryl Coutts, with Heritage Asset Strategies of Eldorado, Oklahoma, specialists in the management of acute care hospitals in small places like ours. They are owned by various affiliates of private equity firms and know from top to bottom what institutions like ours require. Heritage Asset Strategies boasts a combined experience of almost a thousand years and hence has a perspective few of their competitors can match. Because of the confidence of fellow trustees Bob Comstock of Big Sky Florists; Olan Berg, a car salesman; Joseph Pancrack, a rodeo clown; Genevieve Shanstrom, housewife; Oliver Perkins of Hair Today Gone Tomorrow; and Dr. Dave Manovich, dentist, I have been entrusted with their proxies to open negotiations with Heritage Asset Strategies as of start of business Monday.”

Except for the emergency room and absolutely skeletal services in desperate cases, we shut the whole place down the next morning. Jinx made the somewhat sibylline remark, “I’m afraid we are always ruled by the collective disappointments of the community.” I had several patients in the hospital wing — not gravely ill, I admit — but I went on seeing them. That’s how I became a scab, persona non grata. Thus I visited Earline Campbell, recovering from an appendectomy, and arranged to have her television fixed; something in our food service was aggravating Roland Crowley’s gout, so I brought him colchicine tablets and meals from his preferred restaurants; I continued to monitor ninety-five-year-old Donald Fairhurst, who thought he was dying and may well have been and who therefore, despite his great age, was frightened.

Three days into this I found Gary Haack, our orthopedic surgeon, and Laird McAllister, a family practice doctor, waiting for me at my car. They looked sad, reluctant to tell me what they had to tell me, that as I had not stood by them at this crisis they hoped that I would see what was best for one and all. Laird began, “We are very reluctant to say what we have to say but cannot do otherwise.”

“Because I failed to stand by you during this crisis it would be better if I just left the clinic.”

“I told Laird you’d be a sport,” said Gary brightly. “You’ve made this easy.” These weren’t bad fellows, just committed to their situation, something that eluded me. However, I couldn’t go along with them.

“My thought is,” I said, “if you’re a doctor you’re a doctor. Who cares who they sell the business to? I had patients who needed me.”

“Very naive,” said Dr. Haack. “Bordering on infantile.”

I was sensing the prospect of relief from something whose burden I had barely let myself recognize. As soon as the picture was clear, I said, “Just let me get through my inpatients and I’m sure we can work this out. I’ll try to find a way to practice elsewhere.”

That night as I lay in bed swaddled in unclean sheets and smelling the rail yards on the light north wind, I felt abashed that I had made such bitter innuendos to my colleagues. I admitted to myself — at last! — that there was something more to my distaste for hospital bureaucracy than just ordinary irritation with management. I had long felt that those who bent to their work, whatever it was, sooner or later landed in the hands of swindlers like Raymond Wilmot. We had an informal slogan in our town: “You can get used to anything.”

I strolled over to the hospital in my new role to visit my handful of patients. Nurses were there seeing to the others and collaborating with the physicians by cell phone. There was little difference in the care the patients were receiving, and experience told me that my responsible colleagues were watching them closely while maintaining the front of negligent solidarity. On reflection, I felt they were on the right track and I, perhaps, was on the wrong one. If they kept the place from being sold to a consortium with its empty claims of local control, all except me would benefit. I was a scab. Even the nurses were distant, though I had to intervene when old Mrs. Kefler declined to “eat anything with a central nervous system” and had been put on cold cereal for several days. She complained of weakness, though she was overweight. I once read in an Icelandic book, “The world has never taken the tears of a plump woman seriously, and a fat martyr has always been considered contrary to the laws of reason.”

When I went in to see ancient Donald Fairhurst, who ranched up the Shields River for seventy years, I found him in good spirits and glad to be under the covers on a morning that was in his opinion “cold enough to freeze the nuts off a riding plow.” He asked me who the president was this time. I told him and he wanted to know about the legislature; he said Americans had to get out of the habit of sending the village idiot to Congress. His ninety-five years did not seem to have blunted his wit. Donald once told me that he had been a hellhound in his youth before he started going to church. “Now I’m sanctified.” He said he had no intention of dying until the time was ripe. He had attended the last public hanging in Montana as a boy and told me that in those days the young were encouraged to attend as a moral lesson. I asked him about the spectacle. “Wasn’t nothing to it,” he said. “It was like watching a turd fall from a tall cow.”

I saw the nurses rush toward the room of a patient who was singing “Jambalaya” in a loud and despairing voice. An older nurse headed his way with a syringe on a tray.

Jinx Mayhall came into my office. We were very good friends with shared interests in cooking and the outdoors. An unpleasant stillness came upon us. Jinx stared at my face, her eyes a pair of gloomy orbs. “Whatever possessed you to do away with that poor girl?” she asked. My blood ran cold, I don’t know why; though later I would wonder whether something like this had been in the air and I had registered it subconsciously.

“Do away with what poor girl?”

“Your old squeeze. The one who stabbed herself.”

“Jinx, I tried everything I knew to—”

“—saying such terrible things about you—”

“—keep her alive. I didn’t know that. I’d hardly seen in her in years.”

“Never out of her mind. She made that clear to one and all. It’s not that no one understands, a doomed soul surely.”

“Jinx, stop. Now just stop this. I tried my best to save her.”

“Did you.”

We sat without a word for a long time. I had my hands in front of me on the desk, and I was staring between them while my mind whirled. Finally, I told Jinx that I thought it best she go. She stopped in the doorway in her big loden coat and without turning to me, said, “I thought you knew.”

* * *

I looked at Bob Carmichael’s chart and felt sad and unsurprised. Bob wouldn’t be here much longer because of his age and diabetes, but he was so stouthearted he would doubtless have numerous amputations before the merciful failure of his heart. Retired from the railroad long ago, Bob was a ham radio operator and had a far-flung society of fellow “hams” he communicated with every day. He once picked up the distress messages of a crab boat sinking in the Gulf of Alaska, connected the crew to a Russian trawler, and from the comfort of his small house on H Street saved seven men from drowning in cold black water. Entering my office, he quickly sat to keep me from evaluating his mobility, which was greatly reduced. He wore a frayed flannel shirt, high-heeled logger boots, and suspenders. His white hair had the pinkish tinge of the redhead he formerly was. Bob and I were tired of sending him for blood tests and suggesting changes in his lifestyle. The unspoken thing between us was that it was in God’s hands, sooner or later, though one of us might have called it luck. Bob did not feel he had been cheated by life, and after fifty years of marriage he and his wife still had each other’s companionship. By checking in with me a few times a year, he felt he had done enough for his health. I agreed.

“Feeling okay?”

“Feeling okay.”

That was it for medicine. Bob said, “About five this morning, there was a wolf on the baseball diamond.”

“What was he doing there?”

“I don’t know.”

“Out by the fence?” I asked this because just past that is woods.

“Oh, hell no. He was in the infield licking the baselines. Might be there’s salt or something he needed in them baselines.”

“Did you see this?”

“The kids seen it.”

“You sure you don’t have anything to report healthwise?”

“Not really. I suppose something will jump out and bite me on the ass but not yet.”

“Well, okay. See me this winter, unless something comes up.”

Bob was my last patient for the day. I no longer knew what the rules were. I guessed I wasn’t supposed to be here at all. I was quite disturbed by what Jinx had said, and it had the effect of widening my outlook on my life. Lately, I’d been dreaming about my mother. Sometimes she was in the dream; sometimes she was not but I got letters from her. In neither case did she do anything significant except that it must have been significant that she was in my dreams at all. She just walked around, did a few chores; or I went to the box and got the letters but I didn’t open them. I was sometimes awakened by the longing for something to happen in these dreams, but they remained maddeningly innocuous. I suspected that this was the way we dreamt of our late parents; what we wished to have fulfilled was simply their presence. Psychologists focus on symbolism of events in dreams, which is part of their own wish fulfillment. The ones that meant the most were remarkably bland, like mine of my mother. Usually, she was in a room. That’s it: she was in a room. It was unclear whether I was in the room as well. For some reason, it was heartbreaking. How it would have cleared the air if she could have shouted, “You destroyed me with your indifference!” or something along those lines. The dreams somehow told me that the significance lay in the disparity between someone who was there and someone who was not there. I wasn’t alone in finding simplicity and plainness unbearable. I wished she’d speak up. Instead, she dusted the piano that no one ever played.

I awakened feeling confused. I remembered how I had met boyhood confusion with fishing, and I thought to try it one more time. The only other doctor still coming to work on a regular basis (“Hiding behind her gender,” said Laird McAllister) was Jinx, and she said she’d fill in for me. I could tell she wished she hadn’t said what she had and was trying to make it up to me. I knew just by the way people were looking at me that trouble was headed my way, and it was getting to me: this was my town!