Race for the Dying (20 page)

Chapter Thirty-three

Thomas chose his words carefully. “I don't understand attempting to treat patients without actually examining them. Think of the possibility of mistakes, or of missing a condition that's obvious to the physician, but not to the patient.”

Riggs nodded. “But, Thomas, please…Remember how many people cannot actually visit a clinic while ill. People with no physician within reasonable distance.”

“A substantial number, I would suppose.”

“Most certainly, a substantial number, Thomas. Now we provide an alternative. Not a perfect one, by any means, but an alternative. By applying reasonable standards and methods, backed by science, we can recognize the symptoms and signs of particular illnesses. You know that.” He paused, and Thomas waited for him to continue.

“For instance, if a patient comes to you with tuberculosis, you are sure to recognize it, are you not?”

“I would hope so,” Thomas replied.

“Now, suppose you receive a carefully written questionnaire—you've seen our document?”

“Yes.”

“Well, then. The patient tells you that he is debilitated, losing weight no matter how much he eats, is coughing blood, suffering both sweats and chills…is in fact, in general decline.” Riggs held up both hands. “If such a patient sat before you, you would listen to the complaints, then listen to the lungs, would you not?”

“Of course.”

“And if sufficient tubercles existed in those lungs to alter the sound during auscultation, you might feel for tenderness in the hollow behind the clavicles. You might examine sputum under a microscope. You might perform a test with the spirometer. But you would know, would you not, in your heart of hearts, that the patient sitting before you was suffering tubercular consumption? Simply by hearing his complaints.”

“I suppose so.”

“If we receive such a profile in the mail, from a patient in”—he threw his hands up—“it doesn't matter where, but picture her sitting in front of a dwindling fire, her family wringing their hands hopelessly, her children petrified as they see their mother coughing blood into a kerchief. We receive her profile, and is there any doubt? Do we have to see her pathetic figure through our doors to know that the dread specter of consumption has yet another victim?”

It wasn't hard to see where the florid style of writing in the advertisements had its origin, Thomas thought.

“And so we recommend treatment. It's that simple.”

“But no specific drug has shown promise in the treatment of tuberculosis,” Thomas persisted.

“True enough,” Riggs agreed readily. “But what does show promise in treatment?”

“Rest. Change of climate perhaps. Proper nutrition. Some symptomatic relief. Helping the patient maintain his strength.”

“Exactly so,” Riggs said triumphantly. “That's exactly right. Perhaps you recall my sermon about the marvelous peach? The human system is resilient, when given half a chance. If a few ounces of Universal Tonic each day help nature resume its course upward to perfect health, then we've done our job. If a few ounces of Dr. Tessier's Metabolic Oils reduces the tendency to hack the lungs out, so be it. Cannot we do all of this without seeing the patient?”

“I would suppose so.”

“And if the patient is suffering not the ravages of consumption, but instead a cancer of the vitals—for which there is also no promising cure—then have we done harm in supporting his general health and well-being? No, we haven't.”

Thomas heard the words in a blur. “It seems to me,” he began, then started again, “It seems to me that such false hope is counterproductive. I—”

“We raise hopes,” Riggs interrupted. “There is nothing false about that. Hope supports the patient's will to fight, Thomas. Look to yourself as an example.”

Thomas surveyed the pharmacy behind him. “Perhaps…” and he stopped. He had no desire to make an enemy of Zachary Riggs, but the examination of the tiny Beautard child remained etched in his mind. “I wondered about Sorrel's Syrup, for instance,” he said. “I ran across that today.”

“In what way?”

“A mother giving her four-month-old son the syrup to ease his fretful moments.”

“My God,” Riggs whispered. “Really so?”

“She said you gave it to her. That you prescribed it for the infant.”

“Then she misunderstood me, I'm sure. Sorrel's relieves the discomfort of teething, no more.”

“The child is a bit young for that.”

“Of course.”

“What are the ingredients of this concoction?”

“Of Sorrel's? We continue to evolve and change,” Riggs replied. “As with all our medications. Not one or two ingredients, but a careful balance of a dozen or more. And again, I assure you that there are people out there who would pay dearly to know the specific formulation.” He smiled. “I suppose I should be flattered by their attention.”

“But the primary ingredient?”

“Again, the formulation is evolving. For teething, a small percentage of anodyne is almost immediately effective, touching the gums and mucous membranes of the mouth. I use Carlisle's preparation, for its purity.”

“You have a veritable crowd of people working on your behalf, Zachary. Dr. Sorrel, Dr. Tessier, now Carlisle and his anodyne.” “Anodyne” referred to no particular pain reliever, but Thomas decided that the middle of the night wasn't the time to pursue the issue.

“Well…” Riggs said, and gazed around the room. “It's a large operation, Thomas.”

“The correspondence appeared to advertise Tessier's compound frequently.”

“Just so. We have found that if we can reduce the patient's coughing, Thomas, reduce some of the damage from that, then rest and recuperation so often follow.”

“So, by weight?”

“Well,” Riggs said slowly, “I would suppose that by actual volume, the liquid substrate is the foundation on which the tonic is built. I have found nothing that works any better than a particularly fine brandy. It both soothes, especially when supported with various herbs and vegetative preparations, and is a restorative. Nothing provides more immediate nutrition. By including careful instructions for dosage, we can make the most of its qualities.”

“Along with a cough suppressant?”

“That's correct. I have discovered that a simple infusion of red clover is a gentle means to that end, especially with the Carlisle's. It is a fine balance, you see. Without the cough, we have nothing to purge the diseased lung tissue from the body. With an excess of violent coughing, as you know, much healthy tissue is torn and destroyed. But I don't wish to simplify.”

Thomas pointed at a considerable selection of small wooden boxes with one crutch. “And these?”

“I have contracted with a mill up the coast to provide cedar shipping boxes,” Riggs said.

“An amazing operation,” Thomas said. “I would suppose a fair income from this enterprise?”

“In proportion,” Riggs said easily, and let it go at that. “By the way, Dr. Haines informed me of his arrangement with you. Would you prefer a bank draft, or cash?”

Thomas found that he was hugging his arms around his ribs, and tried to straighten up. “At the moment, my world includes one-oh-one and this clinic. I have not even toured the village, and I've met only a handful of people. Visiting a bank or even Mr. Lindeman's Mercantile would be a keen adventure, Zachary. So…I don't know. I suppose it might be best to simply keep the money on account? Will that suffice?”

“Well, of course. Should you need anything, however, you will not hesitate to let one of us know?”

“Yes. And we do need something, without delay.” Riggs' eyebrows raised in anticipation. “We must have additions to our nursing staff that allow patients to remain in the ward,” Thomas said. “I know that it has been the policy to remand patients to St. Mary's, but we will no longer do that. Not when we can treat on the premises.”

“I see. What have you in mind? Miss Auerbach isn't adequate in some way?”

“She is wonderful, Zachary. But we can't expect Bertha to work all day long, and then during the night as well. We need nursing staff who are fresh and alert.”

“You have two patients in the ward now, I understand.”

“Yes. Our two left legs, as Bertha calls them. One will leave us in the morning, the other with a serious fracture of the leg that must remain in a fracture box for as much as two weeks.”

“And he wouldn't be better off at St. Mary's?”

“Indeed not. First of all, a trip of some thirty miles would likely kill him, or at least ruin what progress we've managed so far. All it would accomplish is removing the patient from under our roof. That's neither necessary nor prudent.”

“Well, then,” Riggs said. “Will you take care of this? Finding staff, I mean? Let me know and we'll add them to our books. I trust your judgment in this. Someone discreet, ambitious, industrious.” He grinned. “In short, another Bertha or two would be nice. Is she paid adequately, do you think?”

Thomas laughed. “I have no idea what she's paid, Zachary.”

“Ah, well, of course, there's that,” Riggs said without providing a figure. “We want anyone who works for us to be content,” he said. “So whatever that takes.” He regarded Thomas. “Yourself included.”

“Dr. Haines' offer was most generous,” the young man said. “And on top of it all, we simply must have some way to prepare meals. It is cumbersome to have to bring food down from one-oh-one.”

“Ah,” Riggs said good-naturedly. “I can see a flood on the horizon. We'll see about it all, to be sure. Make a comprehensive list so nothing is forgotten.” Riggs stood up and stretched, pulling his robe tightly across his barrel-like torso. “Now, if you please…You've exhausted me. And yourself, I'll wager.”

“Your quarters are on the third floor?”

“Yes. A fine view of the harbor and the hills.” He stepped to the doorway and beckoned the younger man. “I can assist you down.”

“That won't be necessary.” As they made their way forward, Riggs turned off each gaslight until the second floor was pitched into darkness behind them. Thomas opened the door, and the steep decent that yawned ahead of him seemed a dozen times longer than when he'd made the climb.

“How can I help?” Riggs said. He held out a hand, stopping just short of taking Thomas by the elbow.

“Really, I can manage,” Thomas said. “I have this technique, you see.” He once more rested his right hip against the wall, and gingerly lowered first one crutch and then the other to the first stair tread. He eased his right foot down and held his position there, looking back at Riggs, who watched with bemused concern.

“You see? It's just a matter of patience,” Thomas said. He moved the crutches again, but this time the foot of the crutch caught ever so slightly on the tread, and he staggered. Riggs reacted instantly, catching the young man deftly by both shoulders.

“Patience and balance,” Riggs said, laughing. “We can't have you landing at the bottom in a heap. Allow me.” Together they made their way down the sixteen steps, and as he finally sank into the wicker wheelchair at the bottom, Thomas was faint, even slightly nauseous.

“You'll be all right now,” Riggs said. “And I see yet another reason why we need to finish the installation of the elevator. Or we could stuff you into the dumbwaiter, I suppose.” He held out his hand. “Good night, Doctor.”

Chapter Thirty-four

His conversation with Zachary Riggs had left a myriad of questions, and Thomas was irritated with himself for not pursuing answers more forcefully. Still, he found himself drawn close to these people who had welcomed him into their home with such hospitality. Dr. Haines, so close to the Parks family for so many years—now a dignified man facing his own demons. Alvina, a delightful young woman whose presence in the room Thomas had already begun to anticipate. And Zachary Riggs himself—assured, charming, bright, inventive—Thomas had liked him immediately.

Still, although Riggs' arguments were compelling on the surface, it appeared that the business they were building was based in large part on deception. Little Henry Beautard shared his listless behavior with some of the opium addicts whom Thomas had seen in the slums of Philadelphia. Riggs had sounded knowledgeable enough; could he actually be ignorant of the drug's effects?

Out in the waiting room, the clock chimed four o'clock, and Thomas heard it against the steady drumming of rain outside. The window near his bed was open only an inch, but he could feel the cool elixir as the storm moved through. At the other end of the small ward, his two patients lay like dead men. As long as they weren't, Thomas was thankful. He had not the slightest inclination to move an inch.

A small, cool hand rested on his forehead, and Thomas started, sucking in a quick breath that he regretted.

“I didn't mean to wake you, but you were restless,” the voice said, and for a moment Thomas was so disoriented that he knew neither where he was nor whose shadow bent over his cot. The hand stroked across his forehead and stopped with the back of her fingers resting against his cheek.

“Alvi?”

“It's Miss Auerbach,” the voice said.

“My word,” he murmured. “It's that late?”

“Just after six. I gave both Mr. Deaton and Mr. Doyle injections.”

“Thank you. Otherwise, they're resting easy?”

“As can be expected. I brought some breakfast. You should eat while it's still hot.” The gas lamp above his cot flamed bright.

“You're never going to heal without a proper night's sleep,” Bertha said stiffly. “My word, you didn't even take off your shoes.”

“I can't take them off,” Thomas whispered.

She bent down and peered more closely at him. “You're drenched with perspiration,” she said. “You shouldn't have this window open. You'll catch your death of cold.”

Slowly, moving like an old man, Thomas sat up, swinging his feet to the floor. His left hip now allowed him to sit reasonably straight, and he leaned cautiously forward until he could rest his elbows on his knees. “This is progress,” he said.

“The night was quiet after I left? With the other two, I mean?”

“Yes. I heard not a word from them. What I really need is a hot bath.”

“Well, you won't get it here, Doctor.”

“That's something else that we need. If we must bathe a patient, how are we to do it?”

“With a sponge and pan, as always,” Bertha replied. Besides, Dr. Haines is adamant about sending patients to St. Mary's.”

“I know he is…or was. We're going to have a proper ward here, Bertha. And staff to go with it. I mentioned that to Dr. Riggs last night.”

“Oh. Mr. Riggs paid a visit, did he?”

“I went upstairs.”

Nurse Auerbach stood up straight, tiny hands on her hips, riveting Thomas with the kind of stare that a schoolmistress might use on recalcitrant youths. “However did you manage that?”

“Well, one step at a time is how,” Thomas said. “I was curious.”

“I see. And your curiosity was satisfied?”

“I'm not sure what to think.” He eased forward, and reached out to pull his wheelchair closer. She turned it for him, and braced it as he struggled from the bed. “I have a question or two to ask you, if you don't mind.”

“I just do my work,” Bertha said, “and that's that.”

He wheeled after her. Jimmy Doyle was obviously sound asleep. Howard Deaton lay staring at the ceiling, his eyes half-lidded, mouth forming a silent conversation. For a moment, Thomas watched the pulse in Deaton's temple.

“A slight fever,” Bertha said.

“To be expected. As long as it remains slight.” He lifted the light towel that lay across the fracture box and examined Deaton's bruised and swollen leg. “I wish I felt more confident about this,” he said. Bertha made no comment, and they left the ward. Both the examination room and the office blazed with light.

The delightful aroma emanated from the office, and Thomas found a towel-covered plate with biscuits, ham, and a mound of scrambled eggs. Bertha appeared with an old steel coffeepot that looked as if it had spent a lifetime in a prospector's camp. “The sterilizer serves admirably,” she said, and poured a cup for Thomas. “You could have fallen, you know.”

“I suppose. In point of fact, I almost did. As I was leaving, and on the very top step.” He savored one of the buttered biscuits. “Zachary caught me.”

“You just keep it up,” Bertha admonished, and nodded toward the ward. “You'll be number three in there.”

“I can't lie about useless anymore,” Thomas said. “Yesterday was exhilarating, Bertha. I finally felt as if I was earning my keep.”

“Patience is not your strongest virtue.”

“True enough. But last night I decided to see for myself what it is that keeps Miss Haines and Dr. Riggs so busy.”

“And what did you see?”

“You're aware of their enterprise?”

“Only in the most general way. I keep my nose out of other people's business.”

“Do you know Dr. Tessier?”

“Only by name.”

“You've never met the gentleman?”

“Hardly.”

He slipped the small brown bottle from his pocket and held it out to her. “And Dr. Sorrel?”

She slipped her hands into her apron pockets as if she might be tainted by touching the bottle. “That is a common treatment,” she said. “And you saw the infant yesterday. So you know.”

“Am I correct to suspect opium poisoning?”

“Of course you are, Doctor.” She took a deep breath and her black eyebrows nearly touched in the middle. “I have to say that I was most adamant with Dr. Haines some months ago about Dr. Sorrel's.” She emphasized the name with contempt. “I was surprised yesterday to see that Mrs. Beautard had obtained a bottle.”

“She said that she obtained it from Dr. Riggs, if you recall.”

“Indeed she did.”

“Well, he says not.” Thomas watched her face and saw the tension there. “You don't care for him, do you?”

“What Mr. Riggs does is none of my business,” she said.

“Mister Riggs.”

“Yes. Mister Riggs. I have worked for Doctor Haines for eight years. In that time, I have never seen Mr. Riggs treat a patient…other than handing them the odd bottle of the nostrums that he peddles through the mails.”

“Ah. So you know what the business upstairs is all about.”

“How could one not?” Bertha said. “This is a small town, but the fame of the Haines Clinic has spread far and wide.”

“I want to send a bottle of this to the university, along with a sample of Universal Tonic. For analysis.”

“And then?”

“Well, and then…” He stopped as he heard footsteps on the stairway. In a moment Zachary Riggs strode into the office looking fresh and energetic, stylish in a brown tweed suit and bowler hat.

“Morning, all. You're up and about. No ill effects from your journey last night?”

“Just aches and pains,” Thomas said. He slipped the empty bottle of Sorrel's into his pocket. “It probably wasn't the smartest thing I've done lately.”

“Well, we all make mistakes,” Riggs said. He nodded at Bertha. “I was on my way down to the hotel for breakfast,” he said. “When you're on your feet, you'll have to join me in that ritual. Although”—he peered at the plate—“it appears that you've done well for yourself.” He consulted his gold watch. “Well, cheers. I must be about,” he said. “A busy day ahead.” He held up a finger. “Ah, I remember our discussion from last night. Be sure to discuss with Alvi about the nursing staff you anticipate hiring. We'll want to act on that sooner, rather than later. Miss Auerbach, how's that brother of yours?”

“Well, thank you.”

“Good, good.” He adjusted his bowler carefully as he regarded Thomas. “We expect great things from you, Thomas. May I make a suggestion?”

“Certainly.”

“I hope you'll join us at one-oh-one this evening. I see that we have a number of things to discuss. And doing so over a nice brandy is so much the better, you agree?”

“We'll see what develops today,” Thomas said. “At the moment, we have no one to stay with the patients.”

“Alvi will find you someone,” Riggs said. “Be assured of that.” He pulled out his watch. “She'll be here momentarily. And I must be off.”

He tipped his hat at Bertha and nodded at Thomas, then was gone, leaving behind a vapor of cologne.

“An accomplished liar,” Bertha Auerbach said, and Thomas was surprised at the venom in her voice.