Race for the Dying (22 page)

Chapter Thirty-seven

Dinner presented a succulent pork roast with small potatoes, late garden greens, biscuits that sopped up butter like small sponges, and copious wine so dark that it appeared black in the crystal glasses in the gaslight. Thomas did the meal justice, all the while a bit uneasy.

As if sensing his discomfort, Zachary Riggs was at his most charming and solicitous. He poured wine for Gert and Horace James as if they were visiting royalty, was unfailingly deferential and courteous to the rest of them—and playfully flirtatious with Alvi.

His mood was in sharp contrast to Dr. John Haines, whose fatigue was tempered with intoxication.

“My apologies for never making an appearance at the clinic,” he said at one point to Thomas, and Alvi reached over and rested her hand lightly on the elderly physician's forearm.

“I was distressed to hear about Mrs. Cleary, John,” Thomas said. “A formidable woman.”

“Oh, my,” Gert James said. “Such a sadness.”

“Well, one in, one out,” Haines muttered. “She was a remarkable woman in many ways. We'll all miss her. On the other side of the balance beam, little Heather Thompson has come into the world, all six pounds seven ounces of her.”

“Oh, my,” Gert said again, and clasped both hands together over her bosom. “And little Janey?”

Alvi leaned toward Thomas and said softly, “Jane Thompson is the mother.”

“Janey is fine,” Dr. Haines said. “A long, long, and difficult birth. I really do think that little Heather didn't want to have anything to do with this world. But we forced the issue. Now Bruce, on the other hand…he's not fine.”

“Oh, dear,” Gert breathed. “He's such a sensitive boy.”

“Bruce is the father,” Alvi whispered, her breath wine-sweet on Thomas' ear.

“Yes, well, Bruce managed all right, with the help of a bottle of spirits,” Haines said. “If Janey had let out one more scream, I think he would have walked into the sea and not returned.”

“Oh, but he'll dote on his new daughter,” Gert said.

“I hope so. That's child number three, and I told him that if he wants to lose his wife, having another child is apt to accommodate the matter.”

“Did he hear you?” Alvi asked. “Sometimes men don't, you know.”

“I doubt it,” Haines said glumly. “Anyway, Thomas, that's been the sum and substance of the last twenty-four hours for me…one into the world, one out of it.” He sighed and sipped his wine. “I understand from Zachary that you had adventures of your own last night.”

“I admit so.” Thomas hesitated, unsure of how to proceed. “I confess, my curiosity got the better of me. At first, sixteen steps didn't seem insurmountable.”

“Your hip is showing marked improvement, at least,” Haines said. “We've been a bit concerned about that.”

“Much improved,” Thomas said. “And then Zachary was good enough to give me a tour, so to speak. Quite an undertaking, I must say.” He tried to sound offhanded. “I'm of mixed minds about attempting to treat patients without meeting them face to face.”

“The questionnaire is thorough,” Riggs said.

“That it is. But the issue is simple, it seems to me. Can a patient be trusted to describe his own illness? Will the questionnaire be a fair and true reflection of what is actually wrong? We know how one pain may initiate another, referring to some other part of the body.”

“Of course,” Haines said. “That's an issue even when the patient is sitting in front of you, true?”

“I suppose so. But my observations might reveal what the patient fails to tell me. That's not so with the questionnaire.”

“Well,” Riggs said with some resignation, “what it allows is treatment where none is possible otherwise. Or all else fails, and the patient has nowhere to turn. And I think we may assume further that in such cases, the patient has heard enough about his condition, has discussed it sufficiently with various physicians, that he has a fair notion of what his ailments might be. We may assume that what is reflected in the questionnaire is fair and true. And then we act upon it.”

“But there is nothing…There is no drug or medication that is known to treat cancer, for instance. Much less cure it,” Thomas interjected. “To promote some patent medicine as a cure is to raise false hopes.”

“We have countless testimonials that support the treatment,” Riggs said.

“That's human nature,” Thomas replied. “When someone has lost all hope, is truly grasping at straws, there is a surge of desperate optimism when something new is offered. For a time the patient is convinced that this new thing has worked miracles for them.”

“You've seen that happen often enough, then?” Riggs commented. His tone was not derisive, but Thomas, who was acutely aware of his own lack of experience, understood him clearly.

“No, sir, I haven't. But I've studied. I've read. I've listened to the most eminent professors in the field. Nostrums build false hopes. A bit of alcohol, a pinch of opiates to dull the pain…”

Horace shifted uncomfortably, and Thomas bit off what he was about to say. “I apologize,” he said instead. “I'm tired. I should make my way back to the clinic.”

“I'll drive you when you're ready,” Horace muttered.

“Thank you.” He smiled at John. “Now that I've survived my first ride, I anticipate being able to explore the environs. If the people I've met are any indication, the country has much to offer.” He watched his wine catch the gaslight. “And I'm intrigued with some I haven't met as of yet.”

“Really?” John prompted. “For instance?”

“You mentioned Bruce…Thompson was it?”

“Indeed.”

“I had an infant patient today suffering a broken arm, compliments of his father. The arm of a four-month-old. Can you imagine that?”

“Unfortunately, I can,” John said sadly. “You refer to the Beautards?”

“Yes. The same. The mother is absolutely charming. And pregnant for the second time. She's fearful of what her husband will say—or do—when he finds out.”

“I know Lawrence,” John said slowly. “He works at Schmidt's mill. The mother is fearful, you say?”

“Decidedly so.” Thomas cleared his throat. “So much so, in fact, that she won't nurse the baby.”

“May I take your plate, dear?” Gert said, rising suddenly and reaching out for Alvi's plate. “Honestly,” she added, but let it go at that.

“That's not unusual.” Haines ignored his housekeeper's discomfort at such risqué conversation. “People harbor these odd ideas.”

“The child cries, and the father loses his temper at the disturbance. Now with a second child coming, Mrs. Beautard is distraught. She was feeding the child teething syrup to quiet his fussing. I told her no more opiates. Can you imagine? Opiates with an infant?”

“There are no opiates in the tonic,” Riggs said pleasantly. “Perhaps she should try that, in judicious amounts.”

“Brandy with an infant? Hardly.”

“What did you suggest?” Haines asked.

“That she feed the child in the natural way. That she attend to the child's general health, and that she reason with her bone-headed husband. Perhaps teach the man how to hold the infant. I said that I'd be pleased to speak with him myself.”

“Most—,” but Riggs was interrupted by the bell on the front door as someone twisted the thumb crank.

Haines reached out and set his wineglass down, practically in slow motion. “Almost,” he sighed, and flashed a grin at Alvi and then Thomas.

“Let me,” Riggs said, already on his feet. “Enjoy your dinner.” He strode out of the dining room, and Thomas could then hear an agitated voice on the front porch. In a moment, Riggs reappeared.

“Nathan Unger, John.”

“Nathan? I instructed him to drive his daughter to St. Mary's.”

“It appears that he didn't,” Riggs said. “What would you like me to tell him?”

“Good God,” Haines muttered, and pushed himself to his feet. “Thomas, I may need you.”

Chapter Thirty-eight

With the scalpel tip, Thomas scratched a faint line on the pearl-white skin of the child's lower abdomen, a scratch perhaps three inches long just outside of the right semilunar line, ending an inch above Poupart's ligament. He hesitated, heart pounding. That was the location the textbook had outlined, but…

“Let the appendix itself be your guide,” Dr. Roberts had lectured at the university, exhorting his students to avoid a standard “one incision fits all” mentality. Thomas' mind raced. He had actually felt an inflamed appendix only twice in his student career, and neither time had he been sure of himself. This time, the patient's small body was so slender, so entirely lacking in adipose padding, that the swollen organ presented itself as the slightest imperfection, so painful that even the gentlest touch caused distress.

He glanced over at John Haines, who raised an eyebrow as he moved around the small patient's head. The little girl lay under the ether now, quiet and relaxed.

Thomas swallowed hard and looked up again at John Haines, who appeared serene and confident. “I have assisted once and observed another time,” Thomas said.

Haines nodded enthusiastically. “Well, that's plenty, then. You're an old hand at it. I did my first on a kitchen table with everyone watching, including the damn dog. I think he was waiting for scraps. Haines stroked the girl's forehead. “Just take it one layer at a time, just as the books say. That's all there is to it. You know that. The young lady and I are both ready when you are.”

Thomas glanced across at Bertha Auerbach, who tended the generous selection of accoutrements arranged in neat order on the small, linen-covered table. She was either confident or an accomplished actress. Out in the waiting room, Mary and Nathan Unger sat with hands entwined and frightened black-hollowed eyes. Alvina Haines kept them company.

They needed encouraging, Thomas had reflected. They might not have known that John Haines was half blind and more than half inebriated, but they could hardly fail to notice the bandaging that encircled the young surgeon's left hand and skull. Facing the knife was a fright in the best of circumstances, he knew, let alone in the middle of the night with two cripples wielding sharp instruments.

“Simply know what you're going to do before you do it,” Haines said easily. “That's the trick.”

“Indeed,” Thomas said. Adjusting his stance once more to take his weight entirely on his right leg, with his hip braced against the side of the table, he bent slightly at the waist, took a long, slow breath, bit his lip, and drew the first incision. The skin split like that of a peach, blood welling up as Bertha's deft fingers worked the gauze sponges.

The moment the bistoury parted the skin, Thomas' pulse slowed, and the rest of the room ceased to be. He deepened the incision to the first mass of abdominal muscle below the skin and fat. He worked with restraint, since the bands of muscle weren't the tough, clearly defined layers of a lumberjack or sailor. This child patient, not yet eleven years old, was not simply an adult in miniature. The muscle masses were still developing, without the definition that marked a fit adult.

Bertha sensed when Thomas might struggle. They worked together, even their breath in synch, she with forceps and Thomas with the scalpel turned so that he could employ its polished handle to compress the thin layer of the peritoneum away, freeing the thin, elastic layer from the tissues of the intestines that lay underneath. The extra set of hands worked as if they were linked directly to his own mind.

Fortune was with little Louella. The appendix itself, swollen and inflamed, had not ruptured, and was easily separated from mesentery. When he was satisfied with the clamp around its base, he tended to the fine ligatures. By the time he was prepared to tackle the appendix itself, he could feel the sweat running down into his eyes, and he straightened for a moment so Bertha could mop his face.

“Splendid,” Haines said, and Thomas wasn't sure what the older man was referring to, since Haines was staring off into space as if communing with spirits. Little Louella slept on, her respiration strong and even.

With another ligature around the base of the appendix, he deftly tied the purse-string sutures.

“A moment,” Bertha said, and nestled another layer of sterile sponges around the area.

Confident of his ligatures and sutures, Thomas excised the diseased appendix, then spent several minutes disinfecting the area. In another moment, the stump of the appendix was invaginated back into the wall of the cecum.

Retracing his steps for closure, he took extra time with each layer of sutures, making them as elegantly small and neat as he could.

When he finally straightened up as Bertha swabbed the area around the tiny line of fine stitchery that now marked the lower right quadrant of the little girl's abdomen, he felt as if Horace's wagon had rolled back and forth over his lower back and hip.

“A wonder,” John Haines said. He had capped the ether bottle a few moments before. He stifled a belch and looked at Thomas with affection. “Why don't you talk with her parents?” he suggested. “You'll want her in the ward for the remainder of the night?” He pulled out his watch. “It's just after eleven.”

“Yes. We'll see her through the wake-up. That can be terrifying for children.” He blushed when he realized what he had said, since he had never actually seen a child awaken from anesthesia. But the books said so.

“Not just children,” Haines said. “Well, if she's staying, we'll figure out something. You're staying the night?” he asked Bertha.

“I think I should,” she replied.

“Thomas is staying. One or both of her parents may decide to be with her as well.”

“If you don't think it's necessary…”

Haines shrugged. “It's just that tomorrow is another day, Bertha. Someone in this outfit has to be clearheaded come morning.” He grinned lopsidedly. “I won't be, that's certain.”

“Then after the little angel is situated, I'll be off,” Bertha said. “And return promptly at six.”

Thomas settled into his wheelchair and pushed open the door. The parents looked up as if for a moment they didn't know where they were.

“Oh,” Mrs. Unger managed. “How is she?”

“She'll be just fine, ma'am,” Thomas said. “There were no complications. The appendix had not burst, so there's little danger of peritonitis. Still, coming out of the ether is always something of a trial. It would be a benefit if one of you were to remain with her for the night?”

“She can't go home?” Nathan Unger asked. He was a tiny, angular man.

“No. That is to say, she could, I suppose, but subjecting her to a wagon ride in the middle of the night would be a pointless risk. She's going to be very sore for a day or so, and then for several days, excessive movement will be a trial. Tonight, the nurse will administer an injection that will help her rest, and tomorrow we'll see what can be done. I'd prefer if you can give us two or three days, to make sure.”

“Can we see her?”

“Of course you can.”

The couple rose, leaving Alvi sitting on the bench, and made their way with obvious trepidation to the surgery. Thomas heard John Haines greet them.

“You look exhausted,” Alvi said.

“I confess I am.”

“It went well, though?”

“Perfectly. I couldn't remember where the appendix was, so I just started at the neck until I found what I thought was it.”

Alvi nodded soberly. “Sometimes that's the best way.” She turned as the front door opened. Zachary Riggs stepped inside. He closed the door quickly to shut off the rush of sodden, cold air.

“Ah,” Riggs said. “Here we are.”

“We just finished the surgery,” Thomas said.

“Good. Everything is well?”

“Perfectly.”

“And good again. You look a wreck, my friend.”

“It's temporary.”

“Of course. Of course.” Riggs drew his watch out of his vest and regarded it thoughtfully. “Well, tomorrow is another day. I think if there's nothing more I can do, I'll retire for the night.” He pointed upward. “You'll visit later? You never did have the chance to enjoy your brandy this evening.”

“Ah, no,” Thomas said with a smile. “I'm not ready for the stairs again, thanks just the same.”

“Well, imagine that,” Riggs said, and laughed. He winked at Alvi. “Good night then, all. Good work, young man.”

“Thank you.” He watched Riggs stride off down the hall and listened to the rhythmic thudding of his boots on the stairs.

“Something bothers you,” Alvi said softly.

“I'm just tired.”

“When Zachary arrived, I could see the veil come down,” Alvi said.

He found it impossible to dissemble with her. “I think that I will send a sample of each of the potions that he bottles for an analysis.”

Alvi nodded but said nothing. Thomas found himself wishing that she was transparent.

“What would you do for the patient then?” she asked quietly.

“I can do nothing from a thousand miles away, other than advising them to visit a competent surgeon. If a cancer has progressed sufficiently, then there's nothing the surgeon can do, either.”

“And if he is unable to visit this surgeon? What then?”

Thomas shrugged in defeat. “Then he makes his peace,” he said. “He does what he can to bolster his body's systems.”

“Just so.” Alvi said. “The Universal Tonic does exactly that.”

“But it is promoted as a cure,” Thomas persisted. “It is not a cure. A palliative, perhaps. That's all.”

“What are you suggesting?” Alvi asked. “That we advertise by saying, ‘Buy our tonic and feel a little better while you wait to die'?”

“It would certainly be more honest,” he replied. “How can he address the myriad questionnaires presenting all manner of afflictions?”

“He doesn't work alone.”

“Obviously not. But Doctors Tessier and Sorrels are inventions. You're suggesting that your father has the energy to do so?”

“We had hoped that with your arrival…”

Thomas scoffed. “You expect I should spend my days reading the mail and writing palliative responses to be packaged with worthless snake oil?” His tone was sharper than he would have liked, but Alvi didn't flinch or respond in kind.

“And the surgery you just performed,” she said gently. “Do you think that the thirty-five dollars we will receive from the Ungers will pay for expansions to the clinic? For the new equipment which you will want to buy? For nursing staff? Even your thousand dollars a month stipend? Or Bertha's fifty dollars a week? Or the support of the household at one-oh-one?”

“Of course not,” Thomas said. “But—”

“On the other hand, can you imagine how many people we have reached? How many we have helped? How much pain and suffering we have assuaged?”

“I think I can. Upstairs, I see six desks where the ladies work for you. Each is piled high with various correspondence. I looked at only the first.”

“And mine.”

“True.”

She regarded him in silence for a moment, and Thomas could hear the hushed voices from the surgery. Bertha appeared, and nodded at the two of them.

“We'll move her now,” she said, and vanished into the ward.

Thomas started to turn his chair, but Alvi reached out and rested her hand on his right arm.

“Three thousand, four hundred and sixty-five dollars, Dr. Thomas. And some odd cents,” she whispered, and first clenched his arm for emphasis, then released him. “Think on that.”

“The number means nothing to me,” Thomas said.

“It means that you would have to put the knife to a hundred Louella Ungers to equal it,” Alvi countered.

“This clinic has operated on three patients in the past twenty-four hours,” Thomas said. “And seen a dozen more.”

A faint smile touched her lips. “You are splendid,” she said. “Imagine what you might do when you are on your feet.”

“Just so.”

She nodded and stretched, bracing her hands on her hips and arching her spine. “You need rest,” Alvi said. “Let's get little Louella settled, and then do the same for you.”

As he wheeled after her toward the surgery, she turned and bent down, blocking his path. Her lips brushing his left ear, her whisper husky.

“By the way. Dr. Thomas, that three thousand five hundred dollars represents one week. The income from only a single, average week. You think on that.” She patted him affectionately on the shoulder.