There are overt and subtle elements of racism in “Change,” which takes place in the rural South. Though offensive, the narrator’s racism is an integral part of the story he tells.

“Change,” Stewart Massad’s first published fiction, is based on his experiences as a medical student and gynecology resident at Duke University. During that eight-year period, he provided care to rural women in eastern North Carolina and worked with community organizers and lawyers for political, economic, and social reforms. “Change,” writes Massad, is part of a series in progress “describing the consequences medicine brings to those with hubris enough to practice it.”

— Ed.


Change comes, even to eastern North Carolina. Old patterns, old structures that I came to know, growing up in Tartan, are lost now. It seems everyone I know is divorced, and the children leave town as soon as they can afford the down payment on a secondhand car. Soybeans drove cotton from our fields years ago, and the marijuana that grows back in the pocosin woods brings in more money than tobacco ever could. The Southern Line pulled up tracks the year I finished residency. The mills have all closed; the mortar in the brickwork crumbles away under a pitiless sun. Convenience stores have replaced general stores. Racial tension has died down: blacks here keep to themselves, and we do the same; no more demonstrations, no more lynchings.

Tartan Hospital hasn’t changed much. The words “colored” and “white” are still legible under the paint on bathroom doors, and the wards are still segregated, if only by the cost of a private room. There’s been a federally subsidized clinic at the crossroads by the Davis County line for the past fifteen years. It needs a gynecologist badly these days, but I turned forty-eight last spring. I’m too old for that kind of practice. The clinic limps along with two family practitioners and a resident who drives there from the university medical center in Greenville once a week. In the overflowing waiting room, rows of pregnant women sit on folding chairs under a single ceiling fan. In the little exam rooms, the specula are rusted, the lamps broken, the vinyl pads on the examining tables stained and torn. The nurses are inept, or maybe just exhausted. The air is full of the wails of bored, hungry children and the smell of hair straightener and unwashed clothes. No, I’m too old to dream that I could make a difference there.

But not long ago, the clinic did have a doctor who held that dream. Not that she even wanted to be there — at least not at first. The National Health Service sent her to Tartan, to work the four years she owed for her medical school tuition. She’d wanted to work up north, she told me, but her application was misplaced in Washington. Between the strains of medical school and the deterioration of her marriage, she was unable to pursue the matter; by the time her assignment to Tartan came, it was too late.

She arrived in early July in a new green Volvo wagon, straight from a Boston residency. She moved into Mrs. Tripp’s converted carriage house, the closest thing to an apartment in the only part of Tartan where a white woman could live alone.

Her name was Rachel Polonowicz, which no one around here could pronounce or spell. From the first, she was always just “the lady doctor,” a simple name that was clear enough, since she was the only one in three counties.

I heard about her first day at work from the clinic’s head nurse, Rita McComb, who’d been two years behind me at Tartan High. Rachel came to work in a long white coat, her hair down over her shoulders. By noon, the August heat had stripped her to sundress and sandals, with a long stain of sweat down her spine. She had her hair up in borrowed bobby pins. She worked till after 6, struggling with the dialect, learning from the black nurse’s aides in their blue pinafores the meaning of words and expressions she’d never heard.

The diseases she saw were familiar enough, though, from her work in the Boston ghetto: premature labor, drug abuse, gonorrhea, obesity, toxemia, obscure pains, the marks of beatings, neglected tumors, neglected lives. She met Leitha Mae Jeffers, a fat mother of eight in her thirty-fourth week of pregnancy. The woman sat on the end of an exam table with her torn panties in her hands, while Rachel leafed through her chart.

“You haven’t been here since May,” Rachel said.

“No, ma’am,” Leitha Mae admitted, her eyes downcast.

“Why not? Don’t you know you should be coming in every week when you’re this pregnant and forty-one years old?”

“Yes, ma’am. I knows,” said Leitha Mae.

“Well then? Don’t you care about your baby?”

“Yes, ma’am. It’s just I been doing for my other babies. I ain’t had no ride till today.”

“Isn’t there anybody to help?”

“No, ma’am.”

“Nobody? What about your husband?”

“He in Raleigh.”

“Raleigh? Why isn’t he here? Doesn’t he know you need help?”

“Yes, ma’am. He know.”

“Then why doesn’t he help you?”

Leitha Mae just stared at her puffed ankles till the nurse’s aide spoke up.

“Ma’am,” she said gently. “He’s in prison, ma’am.”

I met Rachel during that first week. I was in the little delivery suite at Tartan Hospital, where I spend most of my time when I’m not in the office across the street or in surgery downstairs. I’d been called in to check on Jody Corbett, who was, as it turned out, starting the last night of her first pregnancy. I wandered back to the delivery room, looking for a nurse. There was Rachel, with blood on her gown, and a newborn baby in the crook of her arm. She clamped and cut the umbilical cord, then turned and saw me watching from the doorway.

Her dark hair was tucked up inside her surgical cap but stray curls twined out around her face. Her eyes were dark, with long lashes; above her mask, they smiled at me.

She turned back to the child, sucked the fluid from its mouth with a blue rubber bulb while it squirmed and cried. She held it up to its mother, but the woman — exhausted, wet, and shivering, her legs up in stirrups and her privates exposed — kept her arms over her eyes, cursing softly. I turned away.

Later, when Rachel was out, I introduced myself. She was mostly cleaned up, with clots of blood still on the cuffs of her scrub pants.

“I’ve heard about you,” I said. “You don’t know how glad I am to see you.”

“I’ll bet,” she said. She knew that I’d been backing up the clinic’s family physicians since her predecessor left.

I showed her the doctors’ lounge, which was also the men’s locker room; Rachel had to change with the nurses. I turned on the television, while Rachel filled out her patient’s chart. When she started asking me questions about the hospital, I warned her about our radiologist and one of our two general surgeons, about the weak points of our emergency room and lab, and about the things her family practitioners had never learned about obstetrics. I didn’t realize how frank I was being until she put her chart down, drew her knees up under her chin, and asked me why I stayed.

I could have told her about my grandfather’s farm — my farm now, even though it’s all rented out to men with gumption and fertilizer, all except my piece of yard with twin live oaks and a white house surrounded with a veranda and a peaceful quiet. Or I might have tried to explain the comfort I take from the cadences of language and the tough fabric of our interwoven families. As a doctor, maybe she would have understood the sense of belonging that comes from delivering the babies of women born into my father’s hands and from solacing the many women who have trusted me down the years with their sins and secret sorrows. But pride of place, however strong, a Southern man learns early on to keep to himself.

“I guess,” was all I could say, “that Tartan’s the kind of town only a son could ever love. Besides, I’m too old to move.”

“You’re not so old,” she said.

“Sister,” I warned her, stretching a little, and turning back to the television, “you’ll learn here that old is a state of mind.”

“We’ll see about that,” she murmured, smiling to herself. She had her mouth open to say more, but then a nurse put her head in the door, asking Rachel for her patient’s orders. Rachel went out. I went back to check on Jody Corbett again. By the time I’d finished talking to the father-to-be and the mother-in-law, Rachel had gone. I stayed on, napping in front of the television, until Jody was delivered of a pink little girl. I was home by 3, wide awake, the blood and bright lights of the delivery room still in my eyes. A short glass of neat bourbon put me right: I caught four hours of sleep in the empty, overcooled house before the new day broke in on my dreams.

My place is on the state road between Tartan and the clinic, the road the dust blows across after the plowing in the spring, the road trucks scatter with white feathers as they travel from the chicken houses to the Perdue packing plant. Rachel took to stopping by, evenings after work when the labor suite was quiet. I’d cook steak or ribs on the back-yard brick barbecue, while she sat with her feet up and her hair down. After the meal, we would sip drinks and talk till past dark. I tried to teach her to fry the catfish a patient’s husband once brought by, but the sight of the fat, dark fish lying dead by the sink, its eyes still bright and its whiskers still wet, drove her onto the porch.

She asked a lot of questions and didn’t talk much herself. I expect she did enough talking at the clinic, interviewing patients and cajoling nurses. She asked me about the history of our town, built at the first shoal water upriver from the Albemarle, and I told her the little there was to tell; nobody famous ever dared be born in Tartan. She asked how Tartan figured into the War between the States, and I had to admit that it really didn’t, except that too many Tartan boys went off to die fighting it, same as they did in every war since. She had all the Yankee preconceptions about race relations; she didn’t believe me when I told her it wasn’t conspiracy that kept all the aldermen and county commissioners in Tartan white. Around Tartan, even when blacks aren’t too busy or too tired or too hopeless to vote, they don’t seem to hang together any better than we do. And besides, there are more of us — that’s why they’re called a minority.

In October, I invited her to a pig-picking that the First Baptists put on every year to benefit their choir. The day was fine, warm but no longer as oppressive as summer and fall had been. The church people set up long tables on the lawn and spread them with pots and paper plates. There were slabs of pork and piles of hush puppies, turnip greens, cabbage, fried okra, butter beans, and slaw, and deep dishes of sweet potato pie. Rachel was fascinated by the sight of the carcass butchered out beside the roasting pit, as though she’d never seen a dead hog before.

We wandered. I introduced her to cousins and their kids, old friends, my patients and their husbands. Rachel flattered all the cooks with compliments for foods she’d never tasted before.

“How many calories in all this?” she asked me, her mouth full of pecan pie.

“Enough for a full day’s fieldwork,” I told her.

“And how many of these nice people work in the fields?”

“Not many,” I admitted. “Not anymore. Used to be most of them did, women and young ones, too.”

She shook her head. “I wish it didn’t taste so good,” she said. “I can feel my arteries hardening already.”

We walked onto the bare sand under a sweet gum tree. I introduced Rachel to some of the church matrons talking in the shade. They all gushed over her, the lady doctor.

“How do you say your name?” asked Mrs. Peabody. Rachel sighed, used to the question, and repeated it slowly.

“How’ve you been getting along in Tartan so far, Doctor?” Mrs. Jenks asked her.

“Pretty well, thanks,” Rachel said. “It’s quite a change, though.”

“Dr. Polonowicz is from Boston,” I told them.

“Oh, my,” said Mrs. Jenks. She glanced at her friends with big eyes. “You must find us just terribly dull.”

“No,” said Rachel. “The work keeps me busy, actually. We saw more than sixty women in clinic on Friday.”

“Goodness,” said Mrs. Hairston.

“I had no idea,” said Mrs. Jenks, “although I must say that whenever I drive by on my way to visit my brother in Winton, that parking lot is always full. Still, you can’t be seeing as much real sickness out here in the country as you did in a big city like Boston.”

“Oh, but Mrs. Jenks, you’re so wrong,” Rachel told her. “In Boston, people go to a doctor when they first get sick. Here I’ve already seen women with huge tumors, with bleeding that’s gone on till they’re just too weak to cope. The infant mortality rate here is worse than Costa Rica’s, and the teenage pregnancy rate is a scandal. Syphilis is out of control, and all this week it’s seemed like every woman I’ve examined has had a roaring dose of the clap to go along with whatever else brought her in to see me.”

I could see Mrs. Jenks start to cloud over and Mrs. Hairston turn away to hide her blushes. I put a hand on Rachel’s arm as she launched into a story about a gorgeous young man celebrating his release from the Marine Corps by spreading herpes across half the county.

“I know things aren’t what they should be in Tartan county,” I interrupted, “but I’m sure now that we’ve got helping hands like yours with us, things will start to change. Mrs. Jenks, Mrs. Hairston, Mrs. Peabody: it’s been fine talking with you all, but the doctor hasn’t tasted the ice cream I hear is being cranked in the vestibule. Won’t you excuse us?”

They did, graciously and with smiles, but as we walked toward the church, over the brown bermuda grass, the murmuring started.

“Rachel,” I cautioned her, “you have to be careful how you talk to folks around here.”

“But it’s that damned complacency that lets poor people around here get so sick,” she said. “And besides, what did I say that wasn’t true?”

“Sometimes you have to go along to get along. Just because something’s true doesn’t mean a lady has to say it.”

“Shit,” Rachel said, “I haven’t been a lady for a long time.”

“Well, if you want to be accepted in this town, you may have to go back to it. People expect it. It can’t be so hard.”

She turned on me.

“It’s about as easy as becoming a virgin again,” she snapped. She turned back toward the church and started walking away. “And about as much fun,” she grumbled. “But then, I suppose these people expect that of me, too.”

In November, elections came and went. Rachel talked to me about the campaign, surprised that I felt too busy to be involved, even in the local races. I learned from a patient that Rachel had started sitting in on meetings of the county commission.

All through that winter, Rachel and I scrubbed on surgery together. She put together a collection of terribly difficult cases, the kind I usually referred to Greenville or Chapel Hill — they took so long that there was no money in them. But Rachel was still young and proud, and she asked me to help. She re-acquainted me with the chill fear of failure I’d long forgotten — since I stopped taking risks a prudent man should forego. She made me remember skills I hadn’t used in years, and I taught them to her. She taught me about new techniques, new sutures, new procedures for old diseases. She had good hands, too, surprisingly good for a woman so young, but she was impatient, always so impatient.

I suppose she was right to have spoken up at the medical staff meetings of Tartan Hospital, though decorum and deference were expected of her. She started off by suggesting we ban smoking in the rooms of pregnant women, a droll idea that no one took seriously. Then she started criticizing the timidity of our monthly morbidity review. Of course it was true that Dan Rainey, one of our older general practitioners, should never have sent home that pregnant girl with headaches and high blood pressure who came back in a permanent coma. But to suggest that we revoke his obstetric privileges because of that incident and a few others, after poor Dan, with his sick wife to care for, had lost his savings in Texas real estate investments — well, that made Rachel enemies she didn’t need. In retrospect, Ram Swamareshi should have done a pregnancy test on little Keisha Buttler when she came to the emergency room with cramps, but Keisha’s always been a whiner; fortunately, Rachel had her in the operating room with her ruptured tubal pregnancy out hours before the internal bleeding would have killed her. Those things happen, even in Boston, and if Rachel had been more smart than smartass, she’d have known that there are names a Southern man never forgets being called by a woman and a Yankee.

That was a wet winter. The floors at the clinic where Rachel worked were always slick with mud, the air full of dampness and the sound of children’s coughing. Every night she left after dark, always the last to go, too tired to see me as often as I might have liked.

Yet she never seemed discouraged. When I stopped by the clinic, she always could manage a smile. She listened patiently to the rambling stories that ragged, illiterate women told her. She held classes for the clinic nurses, gave tutorials for her family practitioners, bought books with her own salary. She praised the posters Rita picked up from a public-health nurse in Raleigh and pasted up in all the rooms. She admired aides’ pictures of children in uniform and grandchildren in toddler’s clothes. She rewrote the chart forms for gynecologic visits. Her enthusiasm even infected that slothful bureaucrat who was the clinic’s director: he spent a week in Washington learning new guidelines for federal funding and grantsmanship, then reworked the clinic’s fee structure so that the place almost paid its way that year.

Most of all, though, Rachel spent her time talking about teenage pregnancy. She traveled about the county preaching to ministers and giving lectures to high-school sophomores. She was quoted in the Tartan Tattler and sat through an interminable interview on public service radio one Saturday evening. She even lobbied the county commissioners, nagging them until they gave her a hearing.

A group of people came together around her. They met once a month in the convention room of the A.M.E. church. They were mostly black, since white girls in Tartan by and large could afford marriage or abortion. They worked all through the winter and spring, their campaign opening out as the dogwood blossomed. In May, the county voted a few thousand dollars for a pilot program. This paid for a Tartan county public-health nurse to dispense nonprescription contraceptives and the fear of God at the high school. Rachel was very proud that night. I don’t think she realized that the commissioners’ vote wasn’t all altruism: in Tartan, there’s always money to keep more blacks from being born onto the welfare rolls.

I was at the commission meeting for that vote. I spoke up for her, an easy enough favor, since she was right. It had been easy enough, too — though Rachel never knew — to spend Sundays that spring calling on the commissioners, sharing their whiskey, inquiring after their children, admiring their azaleas, persuading them to promise their votes for Rachel’s cause. And when Rachel, all aglow, asked me to cover for her till morning so that she could celebrate the funding of her program with her friends, I was happy to do it. I had to be in the hospital anyway, having been paged because one of my patients broke her water.

Rachel and her friends went to Elijah Watson’s place, flushed with the congratulations of the town. I should have seen what would follow, I suppose, but I thought that Elijah had sense as well as brains, even if sometimes Rachel didn’t. I’d known Elijah for years: he was from Tartan, too, and we were of an age, though he was black. Like me, he left Tartan in the Sixties, but instead of going to college, he enlisted. When I left medical school for internship in Chapel Hill, he went off to Vietnam. He came back after two years, drifted awhile, then joined up with radicals. He moved around the South, organizing, agitating. I heard stories about him. He got a law degree from Howard, moved to Philadelphia, spent a year in Senegal, another in L.A., married and divorced. Eventually, like me, he came home. He found a job in Ahoskie, and every weekday he drove his sun-blistered Cutlass there, to serve the clients of the Legal Services of the Coastal Plain.

Rachel may have believed that no one would notice a Volvo in Elijah’s driveway at sunup, in front of the old shotgun house with its peeling white paint and weedy yard. She may never have considered the consequences, though I’m sure Elijah did. She may have thought that no one would care; if she did, she was wrong. I expect they just neither one gave a damn what we all thought.

Gossips here hold that there’s only one reason a white woman sleeps with a black man, but I know that she loved him. She talked about him all the time, about where he’d been and what he dreamed. Her love showed in her work, in the way that she spoke to her patients, as victims, comrades, sisters. She dressed more brightly. Sometimes she even let one of his nieces cornrow her hair.

Her speech softened and slowed. She learned to say “ain’t,” to let a handshake trail off. She learned to ask about family before business, to work up to her questions, not throw them in a body’s face. She learned to call blacks “mister” and “miz,” because white folks never did.

She learned about other things, too. Mrs. Tripp, her landlady, stopped sitting down with her for a chat. In surgery, the nurses assigned to her were always the least trained, usually black women with no interest in waiting on a white woman. The special instruments she wanted were always unavailable. My mechanic wouldn’t look at her car the day it died; he made her get it towed to the dealer in Rocky Mount, who found the air filter clogged with the dust of the back roads she’d taken to driving with Elijah, nothing more.

Still, they were happy together. He took her fishing on the Sound; she burned a deep brown, and the sun bleached her hair. He introduced her to people: a poet, a woman trying to unionize poultry workers, the couple who founded the only day-care cooperative in Tartan after their daughter, lost on New York drugs, sent them their grandchild by Greyhound. He took her to the prison to meet old clients and hear their stories. He took her to visit the toxic dump, the Haliwa reservation, and the museums in Halifax, Bath, and Edenton, where his people were ghosts in the panoramas, unacknowledged, omnipresent. He took her into the country, the real country, into the dark woods and swamps and scrub lands, where old folk told her of segregation and stoop labor in a dialect she could scarcely understand. He took her to meetings where he tried with patient questions to shift focus from children’s pregnancies to children’s hopes and opportunities, forcing the admission that Tartan held none, trying to elicit ideas for change. Coming up empty, they persevered.

Her visits to see me tapered off; I wasn’t part of their solution. Still, one night in September, like old times, her car pulled into my drive. I was on the porch, drinking bourbon on ice with no lights on. I got her a drink. She sat with me, listening to the crickets shrilling in darkness, thinking her own thoughts. I had my feet up and was rocking the night away in my grandmother’s chair.

“Why did your wife leave?” she asked me.

I thought about that awhile. God knows, I’d thought about it enough by then.

“You’d have to ask her.” I said, but I knew that wasn’t true. “She was bored here,” I ventured, but that was wrong, too. “She was stifling here. She was born in Asheville, you know.”

“I didn’t know,” Rachel said gently, leaning forward to listen.

“She was used to that kind of society. She liked music and art, and there isn’t much of that here. She liked formal parties, and galas, and debuts, and nobody here does that. Then, too, she was from the mountains — she couldn’t stand the summers.”

“I can understand that,” Rachel said with a wry smile.

“Sure. Well, she was fine in Chapel Hill, where I met her, and she was happy in Germany, when the Army sent us there. She was marvelous in New Haven when I was at Yale, but she was stifling here in Tartan.”

“I never knew you were at Yale.”

I shrugged.

“They asked me to stay on, actually,” I said.

“And you didn’t?”

“I didn’t belong there.”

“You belonged here, instead.”

“My father died. We came back for the funeral. My brother and sisters had married by then and moved on — to Charlotte, Houston, and Mobile. Nobody else wanted the house. I couldn’t let it go. Besides, there was no one to pick up his practice.”

“He was a gynecologist, too?”

I nodded.

“We weren’t here long before my wife wanted us to leave. I couldn’t. She couldn’t stay.”

We talked on into the night. The moon rose. Its light shimmered on the deep green leaves of the camellias around the porch and frosted the dusty chinaberries along the drive. I lit a citronella candle for Rachel. We listened to the moths thud against the screens. After a long time and a second bourbon, she opened up. We talked about the delusions of love. I had to lie a lot to cheer her up. It grew very late. I stood up and stretched. She stood, too, stepped close, and took my hand. Her upturned face studied mine. Ever a gentleman and a fool, I could only kiss her forehead and send her home.

As the fall cooled to winter, the preachers turned on Rachel. They never called her name from the pulpit, but in a town the size of Tartan, they never had to. At first it was only one man, one of our white fundamentalists, who condemned the promotion of contraception over abstinence — though down the years his crying parishioners have confessed to me from cold exam tables that abstinence has never been his way. Then Rachel drove the high-school valedictorian to Greenville for an abortion. When word of that got around, the denunciations crossed lines of race and denomination. There was nothing Elijah or I could do to help her, though we tried; here in Tartan, the wages of sin are babies, and that will never change. People stopped listening to her. Members of her little group drifted away. After the leaves fell, her pilot project came up before the commissioners for review and renewal. It never made their agenda.

Hurt, Rachel moved out to Elijah’s place, scandalizing black and white alike. He cooked for her, kept house for her, hung her laundry on the back-yard line, under the leafless pecan tree. Her skirts flapped in the north wind that blew wood smoke over the rusty roof.

In February, a pregnant speedball addict came to the hospital. She had grown too big for prostitution, and since she was broke, she was in withdrawal; it had sent her into labor. When the nurses undressed her, the baby’s feet were already out, and by the time Rachel arrived, the child was dead, its head still trapped. The nurses called me in. Together, Rachel and I wrestled with forceps while the woman screamed and called out to Jesus. We delivered the baby, but the afterbirth refused to follow, and she began to hemorrhage. Rachel tried all the right manipulations and every proper drug, but the bleeding kept on. The anesthesiologist was delayed. The woman lost consciousness. In the end, her hysterectomy took three hours: the viscera were matted together by the scars of old infection and three previous Caesarean sections.

Afterward, exhausted, but confident that the woman would not die that night, we sat around the nursing station. I was drinking another cup of coffee. Rachel sat on a stool, her scrubs dark with sweat, her hair loose in its pins, staring at nothing. I took the chart from her.

“I’ll take care of the paperwork,” I said. “You go on home.”

She blinked, as if just waking.

“What?” she said.

“Go home. I’ll take care of the chart. You look beat.”

“God,” she said. “God, I was scared.”

“You did good,” I said. She just kept shaking her head, lost in the maze of her fatigue.

“Is there any family to talk to?” I asked the nurse.

“You don’t want to see him,” she said. “He’s drunk.”

I helped Rachel to her feet. She went down the hall to talk to the patient’s companion: husband, lover, pimp — no one knew. I was finishing the paperwork beside the unconscious woman in the recovery room, when I heard a man shouting outside the nursing station. He was a skinny black man with gray in his uncombed Afro and cigarette burns in his jeans. He stank of alcohol, and his voice was taut with cocaine. He was shouting at Rachel, slapping her shoulder with the flat of one hand as he cursed her.

He was too angry to see me coming. I grabbed him by the upper arm and shoved him against the wall.

“Hey now, boy,” I whispered in his ear. “None of that here. We don’t want none of that here, do we, boy?”

I expect no white man had called him “boy” in years. It caught his attention. He looked at me up close, cold angry.

“You,” he said, as if we knew each other. “You ain’t got no right to do a man this way.” He pointed to Rachel. “That bitch,” he said, “she kilt my baby. She went and kilt him, just like that. You damn white folks think a nigger ain’t nothing. You think you can kill my baby and just walk away. Well, I ain’t bowing down to you, white man, not to you or nobody else. I know my rights, and you going to be sorry you ever messed with me.”

“Boy,” I said, bumping him again against the pale green wall tiles, “you got the right to leave this hospital now, and you got the right to set your sorry ass in jail for one long time. You got no other rights at all. You understand that?”

“Motherfucker,” he said to me, getting spittle on my face.

“Janine,” I said to the ward secretary, “call up the sheriff’s dispatcher for me.”

“Glad to, honey,” said Janine. She picked up the phone. The man against the wall went limp.

“No,” he said. “It’s all right. I’m cool. I’m walking.”

I let him go. He backed toward the door, his hands up, palms out.

“You’re welcome to come back here when you’re straight and when you can be decent,” I told him.

He paused.

“I want to see Leora,” he said.

“You can’t see her now,” I said. “She’s not awake yet. She had a bad time. She like to have died, except for the lady doctor here. You’re lucky you didn’t lose her and the baby both. Now you go on home. You come back in the morning. You can see her then.”

“Shit,” he said, but he went out. I turned back to Rachel.

“He’ll leave you be from now on,” I said. Then I saw the hatred in her eyes, angry and deep.

“I can’t believe you did that to him,” she said.

“He’s a junkie and a drunk,” I said. “He could have hurt you.”

“He’s a human being, you racist Southern bastard.”

I hesitated, looked at her, glanced at the nurse, who rolled her eyes.

“Whatever,” I said. I turned away.

“What is wrong with you people?” Rachel screamed. I didn’t answer, didn’t turn around. I just went on to the little call room, lay down on the bed, and killed the light.

After that night, none of the obstetrics nurses would speak to Rachel, except on business. They made her life unendurable, calling her in the small hours of every night, again and again, about little things that they once had taken care of themselves.

Leora’s case was selected for medical staff review; if my name hadn’t been on the chart with Rachel’s, the other doctors would have pilloried her. As it was, Rachel’s patients came up month after month. Every decision she made was questioned. Her competence to practice was impugned. She grew hostile, bitter, withdrawn. She began to make mistakes.

By spring, Rachel was burnt out. Only Elijah and her contract kept her from leaving. One evening, at twilight, she and Elijah were out walking, holding hands. In his easy baritone, he tried to smooth over her latest wounds. She took the soft shoulder of the road, while he walked on the edge of the asphalt. In the woods, the redbuds were in bloom. The air was charged with the day’s afterglow. She heard the truck coming up behind, heard the engine’s noise and the tires’ growl growing louder. There was a glare of lights, the surprising sound of impact and Elijah’s grunt, and then only twilight and the red taillights shrinking into the distance. Elijah was thrown against her. They fell together, and by the time she got to her knees, the pickup was too far away for her to make out anything but the Confederate flag on its bumper.

There’s no ambulance in Tartan. Rachel had to run a quarter of a mile back to Elijah’s house to call a neighbor. On the way to the hospital, in the back of the station wagon, Rachel tried to keep Elijah alive with mouth-to-mouth and CPR, blood and sand clotting together on their clothes. Whenever she looked up, she saw the reproachful face of the old black man at the wheel staring at her in the rearview mirror. By the time they reached the hospital, Elijah was dead.

They never caught the driver. There are hundreds of pickups around Tartan, most of them with a Southern Cross. Rachel, city girl that she was, didn’t know if the truck that killed Elijah was a Ford, Dodge, or Chevy; didn’t know if it was blue, black, or dark green; couldn’t estimate the year. She alienated the sheriff’s detective who interviewed her by insisting that it was a racial killing, when it might only have been one more good old boy too drunk to keep the road. And then, too, Rachel never could understand that to too much of Tartan, a dead nigger was still just a dead nigger, no matter where he’d been to school or how much of this wide world he’d seen.

Rachel went to the funeral. Except for me, she was the only white person in the chapel. She stood out in that congregation like a lone blossom among magnolia leaves. It was his mother’s church, a real holiness temple, a steepleless church of whitewashed cinderblocks under second-growth pines, where fans with King’s portrait were the only cooling system the congregation had when the preacher warmed to his work. The eulogy was given to the backbeat of an electric bass guitar, and the pianist’s syncopations drove her listeners to an ecstasy of tears.

As we filed out, the mourners were cordial to us, but no more: just as whites in Tartan had ostracized Rachel for loving a black man, so the blacks shunned her because her loving had killed him.

After the others had gone, I waited by the car while Rachel stood at the grave, along with the stone, her memories, her anger, and her grief, a beautiful woman amid trampled sand, tufts of grass, and faded plastic flowers scattered by the wind.

Rachel is in Arizona now, finishing her service obligation on a reservation. She sent me a postcard that came today. She says she’s happy now.

Life goes on in Tartan, the way it always has, the way it always will. Cycles of birthing and dying are imperturbable; a doctor but attends their revolution.

Tonight, with the Indian on Rachel’s card grinning up at me from the cold brick floor, I sit in the still heat on my back porch, too old to be drinking alone in the dusk like this, too old to change. In the shadows under the trees, mourning doves cry.