Medicine and Manners #2 (5 page)

It was neither Artie's fear nor her patients' cranky moods that kept Alexandra awake that night. It was Charlotte Malcolm going into labor.

Charlotte was practically a child herself—no more than fifteen years old—and her husband, Samuel, was only two or three years older than Charlotte. When he arrived at the surgery door, he was pale and could hardly speak.

“You must come with me, Nancy,” Alexandra called out, though Nancy had already donned her cloak and bonnet by the time the words were out of her mouth. Within a few minutes they were on their way to the small cottage where the young couple lived as they worked the farmland belonging to Nicholas Forsythe, the sixth Earl of Dunsford. Nancy rode behind young Samuel on his horse while Alexandra rode Lucy.

They could hear Charlotte's screams long before they reached the door. As soon as Alexandra and Nancy entered, they both saw Charlotte writhing on the bed.

“You never should have left her alone!” Nancy scolded Samuel. “You should have stopped at a neighbor's place on your way to the surgery and asked someone to stay with her.”

White-faced and trembling, Samuel had retreated to a corner and made no indication that he'd heard Nancy's reprimand.

“There's water in the kettle,” Alexandra said, directing her comments to Nancy. “I'll wash up first, then you.”

Alexandra did her best to calm the screaming girl so she could examine her, but Charlotte, almost as big and robust as her young husband, was proving difficult to handle.

“Samuel, I'll need your help,” Alexandra called over her shoulder. “Nancy, we're going to need—” Nancy, with her hands still dripping from the quick wash, clamped a mask soaked in chloroform on Charlotte's face, calming her enough for Alexandra to force her on her back in order to examine her pelvic area. Samuel had not moved from his corner, but they had managed without his help. It took only a few more seconds for Alexandra's prodding to confirm what she had feared. “Breech!” she said in a clipped tone to Nancy.

“God help us!” Nancy said.

“What?” Samuel asked. “What's that mean?”

“Coming out feet first,” Nancy said. “Now stay quiet while we try to save her.” She had opened both of the emergency medical bags they brought and was pulling out instruments to be doused with an antiseptic solution of carbolic acid. Next she set up a Lister machine, which Alexandra had recently purchased at great expense. The machine, invented by Dr. Joseph Lister, was small and could be mounted on a table as it sprayed a carbolic acid solution over the patient during the surgical procedure. Nancy would have to interrupt her other duties periodically in order to turn the crank to allow the solution to be sprayed over Charlotte's body.

“Is she passed out?” Samuel asked. “Did ye poison 'er?”

“Sleeping,” Alexandra said. She didn't have time to explain to him how anesthesia worked and that Queen Victoria's personal decision to use chloroform during childbirth had helped spread its use to many women in the realm. “Help me move her to the table.”

Samuel seemed grateful to have something to do. Nancy had already wiped the table with the carbolic acid, and Alexandra took a swath of gauze, doused it in the liquid, and began to bathe Charlotte's stomach while Nancy returned to the chloroform mask to try to maintain the delicate balance of giving enough to keep Charlotte unconscious but not enough to kill her.

Alexandra made her first cut, incising Charlotte's midsection and into the uterus, extending the lengthwise incision with blunt pressure. Behind her, she heard a thump. It was loud enough and startling enough to make her turn around. Samuel was lying prone on the floor. She and Nancy exchanged a glance, but neither stopped what she was doing to attend to him.

When the incision through the uterus was complete, Alexandra grasped the blood-covered male infant and removed him first, then the placenta. After she snipped the umbilical cord, she forced her finger down the baby's throat to remove any debris and to make him cry. Charlotte was breathing shallow breaths and moaning, but a brief nod of Nancy's head told Alexandra that, so far, the girl was in at least satisfactory condition. Nancy left her position at Charlotte's head long enough to take the infant boy and clean him.

Samuel groaned and rubbed his head as he pulled himself up to a sitting position. “What?” he said again.

“You have a son,” Alexandra said, not adding that there was still danger of Charlotte bleeding to death.

Samuel staggered toward Alexandra and his wife. “I have a…” He took one look at the gaping wound and saw Alexandra insert the catgut-threaded needle in his wife's flesh and slumped to the floor again.

“Never should have let him stay in the first place,” Nancy said, stepping over him with the baby, wrapped in a cloth and tucked into the crook of her arm, as she made her way back to attend to the ether mask.

“There wasn't much time to dispatch him,” Alexandra said.

Nancy nodded at the new mother. “How is she?”

“I don't know,” Alexandra said. “We can only hope, but there's always so much blood loss with a Cesarean birth. So much risk of infection, even when we use the carbolic acid.”

Alexandra finished closing the womb, and Nancy gave Samuel a quick whiff of smelling salts before ordering him outside until he was called.

“Is they all right? The two of 'em?” he asked in a weak voice.

“Pray that they are, Sam,” Nancy said. “ 'Twill give you something to do while you wait.” She gave him a shove outside and closed the door, then set about cleaning the room of the blood and debris the procedure had created. Alexandra remained by Charlotte's side where she still lay on the table. It was too early to move her, and she wanted to make sure the girl was able to awaken. Nancy alternately bathed the girl's face and tried to soothe the crying infant, who, by now, had been placed in a homemade cradle. Alexandra found that Charlotte's pulse was erratic, and she was having a difficult time awakening from the anesthesia. Meanwhile, the baby continued to cry.

“What's wrong with it?” Samuel shouted through the closed door. “What are you doing to it?”

“He's hungry,” Nancy snapped at him. “And he's not an
it.
He's a boy. Your son. Now be quiet! We're busy.”

“Let him in,” Alexandra said. “This is going to be a long night. He should be by her side if she passes.”

Nancy hesitated slightly before she nodded and opened the door. “Come in,” she said.

Samuel took a reluctant step inside the door and glanced at his wife. “She's dead, ain't she?”

“She's not dead,” Nancy said, “but she's doing poorly. You've got to be strong. She needs you now.”

Still pale and trembling, Samuel nodded and moved to the table. He seemed not to know what to do with himself at first, but he picked up one of Charlotte's limp hands. Nancy picked up the baby and held him, swaying back and forth to quiet him. Alexandra took over the job of bathing Charlotte's face until she was awake enough to attempt to nurse the baby.

When the pale light of dawn crept across the seaside village, Alexandra had Samuel help her move Charlotte to the bed, then sent him to fetch Wilma Beaty to stay with Charlotte and the baby so she and Nancy could return home to their other duties. Wilma knew well what needed to be done, and without a word, she set about trying to spoon some of the broth she'd brought into Charlotte's mouth. When Nancy and Alexandra left at last, Charlotte, weak from loss of blood, still had not fully awakened, and Samuel was sound asleep on the floor next to her bed.

Alexandra would have to forgo her morning rounds, and she was thankful none of the patients who were homebound were in critical need of her. She and Nancy had hoped for a short nap before patients began to show up at the surgery door. That was not to be, however, and it was past noon before Alexandra could get away to visit Judith Payne again.

The young woman was working in her garden and looked up when she heard Alexandra approaching Lucy. Leaning on her garden hoe, she gave Alexandra a brief nod. There was no smile, however, and her expression was blank

“Good afternoon, Judith,” Alexandra said.

Judith made no response.

Alexandra dismounted and took a step toward the young woman. “I meant to stop by earlier, but I was called away.”

There was still no response from Judith.

“I didn't have time to tell you yesterday that I was unable to speak to the Constable Snow. It seems he's left the village for some reason.”

“I know,” Judith said, and nothing more.

“According to the note he left on his door, there is to be a deputy in charge. Perhaps I could bring him here so you can tell him your story.”

“No,” Judith said, breaking her silence at last. “I've changed my mind about that.”

“Judith…”

“It's because I'm afraid. I should never have mentioned it. Not even to you. Please don't betray me.” Her voice trembled even more.

“Of course I won't betray you, Judith, but if your father is a murderer as you say, it's difficult for me to understand why you wouldn't want him arrested.”

“I'm protecting myself. You see what he's capable of.”

“If you truly believe he may harm you, that's all the more the reason that you should inform the authorities,” Alexandra said. “If what you believe about your father is true, he should be arrested.”

“And if he learns I'm the one who set them on him, he'd come for me.”

“Your father need not know you spoke to the deputy. I believe I can assure you of that.”

Judith was silent for a moment. “Are you certain no one will know?”

“Yes,” Alexandra said. “I can arrange it so no one will know. You will come to my house on the pretext of visiting the surgery. I will arrange for you to talk to the deputy, or the constable, if he has returned.”

“If any of your patients see me there when the constable or his deputy is present, word is certain to get back to my father.”

“Please trust me,” Alexandra said.

Judith was silent for another long moment. “All right,” she said finally. “I will do it if I have your word.”

Alexandra took her hand in both of hers in a gesture of warmth and reassurance. “Of course,” she said.

Now she must set things in action. She would need cooperation from the constable's office. She was certain it would be more effective to deal with Snow himself than with a deputy. She would enlist the aid of the sixth Earl of Dunsford to locate him.

Nicholas Forsythe, sixth Earl of Dunsford, was not at home at his country estate, Montmarsh, outside of Newton-upon-Sea. He did not reside there permanently, as might be expected of him. Instead, he spent a great deal of his time in London, where he still maintained his practice as a barrister, a source of considerable chagrin and embarrassment to his mother, Lady Anne Forsythe. To her, his law practice was unbearably middle-class, and she'd greatly prefer that her son concentrate on his estate and his position in the House of Lords. She wanted him to marry a suitable woman and live the life that was expected of him at Montmarsh as Lord Dunsford. In her mind, the only reason to be thankful that he spent as little time at Montmarsh as he did was that it meant he saw less of Alexandra Gladstone. He seemed not to care at all that she was entirely unacceptable.

As for Alexandra, while unable to deny to herself that she found Lord Dunsford attractive in more ways than one, she was determined that nothing of a romantic nature would ever develop between them. Her reasons were similar to those of Lady Forsythe. The difference in their class overcomplicated any relationship.

She also knew that Lord Dunsford was not at Montmarsh. In spite of his attempts to slip in and out unseen, everyone in the parish knew when he was or was not residing in his country house. For that reason, Alexandra didn't bother to ride Lucy out to the estate, but stopped at the telegraph office at the train station. She sent him a brief wire telling him she believed Constable Snow to be in London, since it was his habit to make frequent visits to the city, and she asked his help in locating him. Lord Dunsford, by virtue of his law practice as well as his seat in the House of Lords, had remarkable means and connections to accomplish any number of seemingly impossible tasks.

As soon as the wire was sent, she told Michael Gray, the telegraph man, that she expected a reply that could be delivered to her home, where she would be busy in the surgery. Mr. Gray was a man in his late thirties with light-colored hair and features so unremarkable they would be difficult to describe. He reminded Alexandra of a nondescript drawing of a human figure in one of her medical texts. He was impeccably professional in his work in that he never commented on any message he translated from the electronic
click-clack
of his machine. The end result was that it made his personality appear as bland as his looks.

Alexandra went back to her surgery to see patients, expecting to be interrupted at any time by one of the boys Mr. Gray hired as runners to deliver telegrams. When the day ended and she still had received no word from Lord Dunsford, she could only assume he was traveling and had never received her message.

Zack, who had a way of sensing when something was wrong, emitted a soft, whining growl as he stood in front of her while she sat in a chair with a book and tried to relax in the parlor.

“Something troubling you, Miss Alex?” Nancy asked.

“What makes you think there's something—”

“No need to deny it, miss,” Nancy interrupted.

Alexandra sighed audibly. “No, I suppose not,” she said, and told Nancy about her conversation with Judith. “I thought if I could contact Nicholas—I should say, Lord Dunsford—he could help me find Constable Snow so I could arrange a secret meeting between the constable and Judith. It's important that the entire matter be handled with great discretion.”

“Find Constable Snow!” Nancy sounded indignant. “He's always running off to London, and I suspect he doesn't want to be found. He has a secret life there, and you can be sure it involves a woman. But there's more to it this time. He doesn't usually leave in the middle of trouble in the village.”

“I'm not concerned with his secret life, if indeed there is one. I'm seeking his help.”

“Left at a bad time, I'd say.”

“I agree, he's never left so suddenly,” Alexandra mused. “And he always gives the town notice that he'll be away for a day.”

“Suspicious, if you ask me.”

“You're still trying to implicate him in the murders.”

“Of course not. Got no proof, now, do I? All I can say is I just have a caution…” Nancy let her voice trail off.

Alexandra gave her a concerned look. However, she'd learned long ago not to dismiss Nancy's “cautions.” All too often she'd had a prescience about something amiss that turned out to be valid. She didn't want to think that Constable Snow was in any way connected to the murders, as Nancy had hinted earlier.

“I suppose he left Daniel Poole in charge as the deputy, just as he always does,” Nancy said.

“That's likely,” Alexandra agreed. “I suppose I could ask Deputy Poole to come here to meet Judith, if all else fails.”

“Excuse me, miss, but I have to say, Miss Payne is right when she says every patient who came to the clinic will know both of them were here. Newton's the kind of town where everyone knows everyone else's affairs and all their comings and goings, and gossip spreads fast. I wouldn't rely on it not getting back to her father, even if he is in Foulness.”

“If only Nicholas were here…” Alexandra regretted her words as soon as she spoke.

“Don't see how His Lordship could help.” Nancy sounded more than a little disdainful.

Alexandra was silent for a moment. “He owns a carriage—a truly fine one he uses when he travels up from London,” she said, thinking aloud.

Nancy gave her a confused and questioning look. “True, he has a fine carriage, but 'tis not relevant to the problem, if you ask me.”

“He almost always comes here to my house when he travels up to Montmarsh from London.” By this time Zack had relaxed and was resting his head on Alexandra's knee.

“ 'Tis true,” Nancy agreed. “Everyone knows that's because he's sweet on you. Even you know that, I dare say.”

“The reason he comes here is irrelevant. The point is, no one will consider it out of the ordinary,” Alexandra said. Much to her chagrin, she knew she was blushing, but she carried on. “So if Judith is here, he can spirit her away, hiding under a blanket, perhaps, in his carriage, and—”

“And you think no one will see her leave?” Nancy asked, her voice full of doubt.

“We can arrange that somehow, I expect.”

“We? You're going to involve me? Forgive me, miss, but I don't think I—”

“Oh, stop it, Nancy. You're always up for something tricky and devious.”

Nancy hesitated for a moment. “Well…Perhaps you're right, but it's not like
you
to be tricky and devious.”

“You've corrupted me, Nancy,” Alexandra said and grinned.

Nancy frowned. “Are you sure you've thought this through completely? Where's Lord Dunsford going to take her once he has her hidden in a blanket? To the constable's office? Someone will see her there.”

“I think he should take her to Montmarsh,” Alexandra said. “It shouldn't be too hard to spirit her into the house. It has so many doors, you know, including one that's more or less hidden from view that leads down to the kitchen and servants' quarters.”

“Which you've used to your advantage on another occasion,” Nancy said, her eyes flashing mischief.

Alexandra blushed. “That's neither here nor there, Nancy.”

“More to the point,” Nancy said, enjoying herself, “is why take her to Montmarsh?”

“Constable Snow, if he's back, can come later, or the deputy if need be, and Judith can tell him her story,” Alexandra said. “It's certainly not unusual for the constable to meet with Lord Dunsford when he's here. There's always business relating to the assizes or the county elections, or issues to present to Parliament. Any number of things.”

“Oh, my! I see I've taught you well,” Nancy said. “You've become quite devious. Still, I think your plan is a bit far-fetched, and I'd be careful about telling the constable too much.”

Alexandra did her best to ignore Nancy and to concentrate on her reading, but it was a futile attempt. She put her book aside and, telling Nancy she was going to retire, started up the stairs to her bedroom. That's when Zack set up a frenzied angry bark, alternating with a menacing growl.

Alexandra stopped on her way up the stairs and looked down at Nancy, who was trying to quiet Zack. “There's someone out there,” Alexandra said, hurrying down. “Something must have happened to Charlotte. Tell the boys to saddle Lucy and—”

“No need for that,” Nancy said, peeking out a front window. “Speak of the devil.”

“The devil?” Alexandra picked up her medical bag and was searching for her cloak.

“Lord Dunsford.”

“He's here?” Alexandra was unable to keep the excitement out of her voice. “I was afraid he was traveling and wouldn't get the wire.”

Nancy had already started to the door. “I'll wager he hasn't eaten, and we'll have to have a try at filling his belly.”

When an urgent knock sounded at the door, Zack's barking stopped. But his low growl sounded even more menacing. “Hush now, Zack,” Nancy said. “He's not here to take her away from you.” Nancy's theory was that Zack, who treated all others, friends and strangers alike, with the happy eagerness of a puppy, was jealous of Lord Dunsford and disliked him because of his attraction to Alexandra.

“Nicholas!” Alexandra's heartbeat quickened. “I really didn't expect you to come. I only meant to ask you to help me find—”

“I took the late train,” Nicholas said, shucking off his coat. “Was almost the only person to board, but I couldn't get away any sooner.” He was eyeing the enormous dog with caution as Alexandra forced Zack away from her guest and made him sit.

“You said you needed to consult with me. Is something wrong?” Nicholas asked, absently handing his coat to Nancy.

“I thought you'd telegraph a reply,” Alexandra said, still a bit stunned. “I didn't expect you to come so quickly.”

“You know I'm always looking for an excuse to come back to Montmarsh. More and more lately, I'm thinking of making it my permanent home, you know.”

Alexandra was even more surprised. “You'd give up your practice as a barrister?”

“I could always be available, couldn't I? If a good case should arise, I mean.” Nicholas took a seat as far away from Zack as possible.

“I'm sure I don't know about such things,” Alexandra said, “but my guess is it would make Lady Forsythe happy if you gave up practicing law.”

“I can assure you my motive isn't to please MaMa. Oh, what have we here?” Nicholas asked as Nancy reappeared, bearing a tray.

“I knew you'd be hungry,” Nancy said, setting the tray on a table next to Nicholas's chair. “We had a bit of boiled beef and a hasty pudding with treacle.”

“Aw, Nancy, your cooking is one of the many reasons I'm contemplating making Montmarsh and Newton-upon-Sea my permanent home.”

Nancy rolled her eyes and moved toward the hallway that led out to the kitchen. She'd never been known as a good cook, and she was certain the earl was only trying to flatter her. Or tease her. She didn't leave the room entirely, however. Alexandra and Nicholas both knew she would be far too interested in what they had to say to venture far. Zack, in the meantime, had not taken his eyes off Nicholas.

“Now, what's this about Constable Snow? Disappeared, has he?” Nicholas touched a napkin to his mouth and pulled his foot in a bit closer, imagining Zack had his eye on it.

Alexandra took notice. “Nancy, would you remove Zack from the room, please? I fear his presence could interfere with Lord Dunsford's digestion. You've heard the story, so you won't be missing anything.”

“Of course, miss,” Nancy said, moving toward Zack to urge him out of the room. “And as for my missing anything, you know I'm not in the habit of eavesdropping.” She managed a hurt look on her face.

“Thank you, Nancy,” Nicholas said to her back as she led Zack away. “The beast does have a way of making me uncomfortable.” Turning to Alexandra, he said, “Now, about your request…”

Before Alexandra had finished telling Nicholas about Judith's suspicion about her father and her fear of him, she saw Nancy had moved with Zack within hearing range of their conversation. Alexandra continued nonetheless, explaining her strategy.

“My dear Alexandra, that is a rather convoluted scheme you've come up with,” Nicholas said when she'd told him her plan to ferry Judith away in his carriage and take her to Montmarsh for a meeting with the constable or deputy.

“I'm afraid Nancy agrees with you that it's somewhat contrived,” Alexandra said with a glance toward her maid, who was back in the hallway, trying to appear not to be listening. “I am, of course, open to a better idea,” she added, a tinge of hope in her voice.

“Well, I certainly agree with you that Miss Payne must share her suspicion with the authorities,” Nicholas said, “and I shall give it some thought as to how we can accommodate her. Shall I contact you first thing in the morning? I'm sure I'll have it all worked out by then.”

“You're very kind, Nicholas. I knew I could count on you,” Alexandra said, “and yes, please do let me know as early as possible. Poor Judith is simply tormented by all of this. If you could come by here before eight in the morning when I start my rounds, I would be able to stop by her house. It will give her a great deal of reassurance, I'm quite certain.”

“Before eight, you say?”

Alexandra noted the look on Nicholas's face. It was nothing less than consternation. “Is that too early, my lord?”

“Too early? Of course not,” Nicholas said, sounding flustered in spite of himself. “I'm quite used to rising early.”

“Of course, my lord. Forgive me if I offended you.”

Nicholas laughed. “When you start addressing me as
my lord,
there is almost always trouble ahead.”