Lake in the Clouds (44 page)

A
PRIL
26. E
VENING.

The air in the city is heavy with soot; I have heard birds but seen no living creatures beyond men, dogs, pigs, sparrows, rats, and horses this day. I feel a thunderstorm coming.

Examined seven patients vaccinated before I arrived here. None have yet reached day eight. Four new vaccinations, two observed and two performed with Dr. Simon’s guidance. He seems well pleased with the preservation technique suggested by the Hakim in his last letter and will adopt it in the clinic.

My own vaccination day two. Sites on both arms dry, no symptoms.

Examined five orphans and dosed them all for worms; assisted in two normal deliveries, mothers and infants all in good health, and a stillbirth. The mother, a girl of fourteen years, turned away and would not look at her child. Removed dead tissue from Mrs. Hallahan’s suppurating breast. She is in great pain and opium provides little relief.

One thing I had not expected to need here was a knowledge of foreign languages. The little bit of French I learned from lessons with Elizabeth was all but used up by the arrival of a number of Acadians, and I floundered until Dr. Savard came to my rescue. Every day we see patients who are newly arrived from the docks and have no English. Twice I have been called upon to speak Scots and find that I am grown clumsy with it from long disuse. My grandmother Cora would be disappointed and my cousin Jennet outraged.

When Irish is needed, I must call on Mr. Chamberlain from the porter’s desk. Mr. Holbein from the carpentry shop does for German, Mrs. Gronewold for Dutch, Mr. Luedtke for Danish and Swedish, Dr. O’Connell for Spanish and Italian as he learned these languages when he was a ship’s surgeon. Dr. Savard speaks the French language fluently. According to Mr. Magee, who has stopped asking me questions and instead plies me with gossip whenever I am near, no matter how little interest I show, Dr. Savard lived much of his early life in France and then in French Canada. Mr. Magee also informs me that the doctor wears his hair shorn very short because he detests lice. A very strange preoccupation for a doctor who works with the poor of this city.

There are on occasion African servants and slaves who come to us for care but thus far all of them have had some English. I have seen no Indians at all, which does not surprise me in this overcrowded city.

Of all the white immigrants the German are the most openly disliked and are often treated very badly. It is a revelation to me to see that O’seronni hatred can also be turned toward their own in this way.

I have begun a list of the most crucial terms in all these languages, which I keep in my apron pocket. Thus far I have recorded “please” and “thank you,” “where is the pain?,” “hold still,” and “I can help you.”

A
PRIL
28. E
VENING.

Today I found the room they call the nursery, where the orphaned infants are kept. What misery.

A
PRIL
29. L
ATE
A
FTERNOON.

Overcast for most of the day; some showers. Two buntings on my windowsill this evening, chased away by a robin, the robin then dislodged by a crow who stares at me with a sharp black eye and reminds
me of Dr. Savard. Another curiosity about the doctor: he seems to have memorized much of Dr. Morgagni’s writings, which he quotes at great length in Latin or English as his mood dictates. I am glad now of the hours Elizabeth made me spend with Latin grammar, as I am mostly able to follow his mutterings. When Dr. Savard examines a patient he asks the question out loud:
Ubi est morbus?
Where is the disease? as he begins his questioning.

Examined sixteen patients vaccinated in the last month; three of whom had reached day eight. Two of these showed the expected white vesicle raised at the edges and depressed at the center, with a turgid margin. Dr. Scofield, who continues to speak to me in a loud voice as if I were deaf, supervised while I used the lancet to extract the virus from these two patients. The third patient, a twenty-seven-year-old farm worker called Marie LeTourneau, was revaccinated with the fresh material. It may be that she has already had the pox or been exposed to it, thus the lack of reaction to the first vaccination attempt.

My own vaccination, day five. Sites on both arms lightly inflamed and tumid to the touch. Slight headache in the morning hours. No fever or swollen glands nor any other symptoms. No sign of eruption or vesicles.

This morning at eleven a man called Matthew Johns was brought into the ward. The patient was about forty years of age, resident in the Almshouse four weeks, with no prior history of serious illness beyond the broken arm that had cost him his job as a dockworker (a simple fracture of the ulna set by Dr. Simon and largely healed). A short man, thickly built and strong. Symptoms of shortness of breath, erratic pulse, profuse sweating, and ashen complexion. While he was answering questions put to him by Dr. Savard, he suddenly threw up both arms over his head with such force that his fists hit the wall and made it shudder. At the same time he let out a great bellowing cry like an ox struck by a dull axe. His face flushed a deep and angry red and his eyes bulged as if pushed from inside his head. Mr. Johns was instantly dead, with no pulse at the throat or wrists.

Dr. Scofield made a record of death due to violent apoplexy. As the patient had no family or next of kin and was a ward of the city, Dr. Simon has released his remains to the hospital for autopsy, which has been scheduled for eight this evening. He has invited me to observe.

In the late afternoon Mr. Eddy, who keeps the record books, came into the Kine-Pox office and argued with Dr. Savard for a quarter
hour about the cost of the ivory vaccinators we must have for our work. Dr. Savard refused to answer his questions with any seriousness of tone, which put Mr. Eddy in a very poor mood. The louder Mr. Eddy spoke in his irritation the softer spoke Dr. Savard. Just before he left Mr. Eddy took note of me and announced that he objected most strenuously to my presence. According to Mr. Eddy, an unmarried young lady—and this word came to him with great difficulty—has no place in the Almshouse wards.

Dr. Savard then offered to marry me on the spot, which caused Mr. Eddy to leave in a state of great agitation. When I remarked to Dr. Savard that he seems to enjoy baiting Mr. Eddy he said he was in all seriousness; he would rather marry than have to vaccinate another Irish orphan, a task which falls now entirely to me.

A
PRIL
30.

A letter from Curiosity with no news of my father and stepmother but the curious report that Jemima Southern and Isaiah Kuick are man and wife. She says that the widow is as displeased as Jemima is satisfied with her new prize. The village will speak of nothing else. For the first time I am glad not to be home. Included in her letter was one from my brother Daniel asking questions but giving no answers, and a drawing done by my sister of Blue sleeping with his head on his paws. It is a little awkward in execution, but still I am amazed and a little unsettled at how well she has rendered his likeness. She has sprained her ankle, but seems otherwise in good health and remarkable spirits. I still do not understand the message the dream-walker brought to me.

Manny came to visit while I was in the kitchen with Mrs. Douglas just before dinner. He brought more news of a neighbor’s plan to remove herself and her slaves to the South. This is causing great concern and uneasiness among the servants.

He refuses to say when he will leave this city. I believe he is waiting for news of the voyager, and is reluctant to leave for fear of missing a letter.

Today Mrs. Douglas spoke to me of Kitty’s bleeding, which has increased rather than decreased since our arrival as evidenced by the state of her linen. I asked if Dr. Ehrlich had been informed of this, to which Mrs. Douglas only pressed her lips together and refused to say anything at all.

We agreed that Kitty is to be fed a broth of beef and leeks twice daily to fortify her blood. Ethan will sit by her side and make sure she takes it all.

The boy’s spirits are so much improved since we are here that I cannot regret this journey.

The first week at the Almshouse went by so quickly that Hannah might have lost track of the days if it were not for Kitty, who spent the dinner hour reminding her that she was sacrificing a great many pleasures in the pursuit of her medical training.

“You have turned down three invitations in three days and oh, yesterday’s musical evening at the theater, did I mention that we sat behind Mr. Astor and his lady? It is said that he is a fine musician.”

“Not the story of his forty flutes again, Kitty, please.” Will held up a hand in mock horror.

“I think it is a very revealing story. To come from Germany with nothing but flutes to sell and look at him now.”

“Mr. Astor’s fortune has far more to do with furs than flutes,” Hannah said firmly, and stopped herself there. She would not be drawn into another argument about Astor’s fur trade practices, something Kitty knew little about but was willing to defend nonetheless.

“Mr. Astor aside,” Kitty said. “You are avoiding my point.”

Hannah considered her own fatigue, the fact that she had three pages of notes to record in her daybook, and finally Kitty’s expression, which was as stubborn as it had ever been. It was obvious that further resistance would be unproductive.

“I’m listening.”

“It is simple. You spend all day with Dr. Simon, and now
he is asking for your assistance in the evenings as well. It is too much.”

“Yesterday was an unusual circumstance.”

“Was it. Well, I hope he is not going to ask again. I’m sure you would have liked the musicale much better than whatever task he set you.”

For a moment Hannah had the very dangerous urge to tell Kitty exactly what she had been doing, and how much more instructive it had been than any musicale. But Elizabeth had trained her well, and Hannah could not insult Will and Amanda Spencer with a description of an autopsy at their supper table. And beyond simple good manners, she had promised Dr. Simon. Dissections were very unpopular with the public, primarily because some doctors had got into the habit of robbing graves for their students to study. She must keep her silence, no matter what she had seen and learned; no matter the dreams that woke her in the night.

She said, “I have no plans to go back to the dispensary this evening.”

“That is good news.” Kitty studied Hannah with pursed lips. “And you must promise me that you will be home by noon tomorrow or you won’t be ready for the guests at four.”

Hannah looked up from her plate and caught two smiles—Will’s amused one and Amanda’s, far more concerned and sympathetic.

Will said, “It is just a small party, Kitty. An old friend on his way back to England and some friends, nothing more.”

Kitty made a strangled noise that meant she was not going to let Will Spencer understate the excellence of his guest list.

The idea of a recitation of the life history and family connections of each person who would come through the door tomorrow evening made Hannah a little desperate. The only hope was to distract Kitty by changing the topic.

She said, “Ethan mentioned to me that you fainted this afternoon.”

The thin, pale face went quite still for a moment. Then Kitty turned to Amanda, as one sister might turn to another looking for an ally when a mother began to ask difficult questions.

Amanda cleared her throat gently. “Perhaps the second outing was a little too much after all.”

Kitty pressed her lips together. “It was nothing, just a little dizziness.”

But of course it was more. Dr. Ehrlich’s treatments seemed to be doing very little good at all, and Hannah had the uneasy feeling that if she were to examine Kitty she would find her much worse off than she had been even a week ago. She suspected that some of Kitty’s irritable mood had to do with the fact that she was in pain, but she would not be questioned by Hannah; she had put all her hope in the doctor, who bled her when she requested and otherwise left her to her whims. Because, Hannah knew quite well, he had no other treatment to offer.

A vision of Mr. Johns came to her, his chest laid neatly open, ribs cut and spread, muscles folded back to reveal the heart. She had spent enough time studying anatomy books to know that what she was seeing was not normal; for some reason, this particular heart was twice the size it should have been, and embedded in a nest of blood vessels that were as brittle as dry bark. A ragged tear in the muscle wall was plain to see, the tissue worn as thin as intestine.

Inside of Kitty there was something wrong too, something that would remain a mystery even if—even when—it killed her. This thought made Hannah regret her impatience, but Will had already decided to intercede in the disagreement.

Will said, “May I propose a compromise? If Kitty spends somewhat less time satisfying social obligations”—he held up a single finger to keep her from interrupting—“and Hannah spends somewhat more, you may both be better satisfied. Hannah?”