The Art of Dying

by Ambrose Parry

  It didn’t take Mrs Lyndsay laid out on the floor and Jarvis worried he had killed her for Raven to side with Snow in believing that powerful agents should not be treated lightly. Raven had seen what alcohol did to his father. It was the magic potion that effected an unfailing transformation from merely a selfish philanderer into an angry brute, and the man would surely have killed his mother but for Raven’s intervention.

  He had been only twelve years of age at the time. Raven had saved her life, but what that night had witnessed was a burden no child should have to carry.

  The experience had in its own way transformed him. In a world where it seemed easy to serve injury and lay waste, he had made it his vocation to heal. In Dr Simpson he believed he had found the perfect teacher: a man driven by the stated desire to alleviate pain and suffering. But was his mentor falling to a different form of intoxication, deriving from the power of that which he had discovered? He had never struck Raven as a seeker of fame, but the goddess of reputation ruled over the field of medicine with a capricious hand, and there were few who did not relish the gilding of renown when it was bestowed upon them. If chloroform took Dr Simpson’s name with it across the world, would that affect his judgment when it came to its safety?

  He turned from the window and looked around the room. Dr Simpson’s desk was piled high with papers and books, lecture notes were strewn about, and amid all of this sat an unfinished letter. The last sentence was abandoned halfway through, ink dripping onto the paper from the nib of a discarded pen. The appointing of Mr Quinton as secretary had made little impact here.

  The letter was addressed to Robert Christison, Professor of Materia Medica and Therapeutics at the university. Raven read the line ‘… the discovery of a large effusion of blood upon the bed of our lamented patient …’, and fully intended to read further, but heard someone approaching and so he stood back, turning towards the window again.

  The door to the study opened and the professor entered carrying more papers and a large leather-bound volume which he dumped heedlessly into the middle of his overcrowded desk.

  ‘Come away now, we must get on,’ he said. He looked at Raven, his brow furrowed. ‘Are you ready?’

  ‘Of course,’ Raven replied with conviction. ‘I am familiar with the procedure. I imagine it will have to be repeated several times.’

  ‘That is highly likely,’ nodded the professor. ‘There was once a case, a Lady Paget if I recall correctly, who required sixty-seven tappings in five years, yielding two hundred and forty gallons of fluid! That of course was an exceptional case. Hopes of ultimate and complete cure for ovarian dropsy by paracentesis are faint and slight indeed. Usually all that can be achieved is temporary palliation.’

  There was a small rap at the door and Sarah entered, followed by Mrs Glassford. Raven met Sarah’s eye, and he felt a growing frustration about seeing her once more without having the chance to talk to her.

  In the midst of the previous evening’s chaos there had been no opportunity for him to ask more about her, but perhaps that had been for the best. What he most wanted to know – when and how she came to be married – would have necessitated inappropriate and intrusive questioning. And yet he was tormented by this lack of information. He had only been gone a year. How could such a thing have happened in such a short space of time? Who was this Dr Banks and why would a gentleman from a good family take a housemaid as his bride? It made no sense to him and he found, to his chagrin, that such questions had continued to torment him into the small hours of the night, keeping him from sleep.

  Raven had to admit that Sarah had a glow about her, though he did not care to dwell upon why. This was in stark contrast to the woman beside her, who if anything looked worse than she had done the day before; sallow, drawn and feeble. Raven took the patient’s hand and helped her up onto the examination couch, which had been placed against one wall, close to the window to capture the best of the available light.

  Sarah moved about the room with purpose deriving from an evident familiarity with all that went on there. She removed a box from the cupboard beneath the bookcase and took from it a small glass bottle and a cloth. Approaching the patient, she removed the stopper from the bottle just as Raven turned to check the instruments he had laid out. He made clumsy contact with her forearm and knocked the bottle from her hand. It landed on the floor, the contents pouring out and rapidly seeping into the carpet. The sweet smell of chloroform began to pervade the room.

  Sarah looked at the floor for a moment, then at Raven, then finally at Dr Simpson.

  ‘I’m sorry, sir.’

  ‘Accidents happen, Sarah,’ he told her. ‘Just fetch another bottle.’

  Sarah blanched. ‘That was the last one,’ she said.

  ‘Then perhaps you would be so kind as to go to Duncan and Flockhart’s and replenish our supply.’

  ‘At once, Dr Simpson,’ she said, then hurried off.

  Dr Simpson stood poised, knife in hand, and Raven feared for a moment that he was about to start the procedure without the anaesthetic. Instead he bent to the floor and cut out a square of the chloroform-impregnated carpet. He handed Raven the knife and then held the remnant above the patient’s nose and mouth.

  ‘Take a couple of deep breaths if you please, Mrs Glassford.’

  Mrs Glassford, to her credit, did as she was told, unperturbed by this improvised method of administration. Raven stood motionless, trying to comprehend what the doctor had just done. He was unsure whether this was impressive or not. He could not readily imagine any other practitioner of his acquaintance doing such a thing and wondered distantly what Mrs Simpson would say when she saw the hole in her Brussels carpet.

  After a few minutes, Dr Simpson was satisfied that the patient was suitably anaesthetised and indicated that Raven should start. Raven wiped the knife on the sleeve of his jacket to remove any adherent carpet fibres and then made a small incision in the taut skin of Mrs Glassford’s abdomen, between the umbilicus and the pubic bone. Then he picked up a metal trocar and, unwilling to seem in any way hesitant, thrust the instrument into the patient’s abdomen.

  A large bowl had been placed across the patient’s knees ready to collect whatever effusion was about to pour forth. Raven removed the spiked trocar from the metal cannula, bracing himself for the ensuing deluge, but nothing came. Not a drop. He felt a growing anxiety. It was the first task he had been allotted by the professor since his return and he was signally failing in it.

  Determined that this should not prove to be the case, he rotated the cannula a little and lowered his head to examine its end. He chose to do this just as Dr Simpson sought to encourage the flow of fluid by applying gentle pressure to the sides of the swollen abdomen. The result was a voluminous gush which hit Raven full in the face, splashing over his clothes, his hair and the patterned wallpaper. It even reached up as far as the framed diploma which hung on the wall above the examination couch.

  He stood, dripping, while Dr Simpson regained control of the situation by occluding the end of the spouting cannula with his thumb. Raven removed himself from the line of fire and with sopping hands positioned the bowl more suitably to catch the torrent.

  Six pints of fluid were eventually obtained (minus the volume that had soaked into Raven’s clothes), decompressing the patient’s abdomen. This would, more than likely, alleviate her breathlessness and markedly reduce her discomfort. Raven’s discomfort was not so swiftly relieved. He had to fight a strong impulse to run from the room, but dutifully remained, fluid seeping into his trousers, while the professor monitored the flow. He stood his ground until Simpson had applied an adhesive plaster to the patient’s wound, then excused himself with as much dignity as he could muster, determined to leave before the patient woke up.

  As he climbed the stairs to his room, feet squelching in his shoes, he heard footsteps behind him. He sighed as he realised that his embarrassment was about to be compounded. Of course it had to be Sarah, returning from the druggists’ with a baske
t containing several large stock bottles of chloroform.

  ‘What happened?’ she asked, concern morphing into amusement. As he turned around, a glob of something left the ends of his hair and hit the wall.

  ‘We managed to decompress Mrs Glassford’s abdomen.’

  ‘So I see,’ Sarah said, unable to contain a snort of laughter. ‘I am certainly no expert in complex medical procedures, but I suspect you may be in need of a change of clothes.’

  Raven said nothing, turning away to resume his ascent. He realised with some confusion that she was following him. She continued to do so until he entered his room, where he was further disturbed to see her put down her basket and move towards him as though meaning to help him off with his saturated clothing. This intended resumption of a familiarity they had once enjoyed only served to remind Raven of what intimacies she now shared with someone else.

  ‘I can manage,’ he said, brushing her hand away from his shirt button.

  Sarah stopped smiling.

  ‘I’ll bring some warm water and towels,’ she said, and left him to remove the rest of his clothing alone.

  TWELVE

  hen Sarah returned, she found Raven already dressed, a pile of sopping garments at his feet. He accepted the ewer of warm water she had brought up from the kitchen wordlessly and unsmiling.

  Raven bent over the basin on his washstand and, without ceremony, tipped the ewer’s contents over his head before vigorously scrubbing at his face. He then dried his face and hair, and handed the wet towel to her, his expression inscrutable.

  She had thought the levity deriving from his misfortune might help set a tone for them to speak again, but she reckoned without him feeling humiliated. She had forgotten how proud he could be, how sensitive about how he might be perceived. In his absence she had recalled only the things she liked about him. Small wonder she had suppressed the very thing that had driven them apart.

  She stared at him for a moment, unsure of what to say. He looked well. His lean frame had filled out a little and he had lost his Edinburgh pallor. His face was burnished by the sun and the scar on his cheek had faded to a thin white line. She experienced an urge to reach out and touch him, but she suppressed it. She felt suddenly uncomfortable. He too looked as though he wanted to be elsewhere.

  Sarah felt the need to say something, to acknowledge the awkwardness between them.

  ‘You didn’t write to me,’ she said.

  It was both a statement and a question.

  ‘I did not think it appropriate to do so.’

  ‘Correspondence is a private affair and seldom a scandal.’

  He had no answer to this. He shifted his weight from one foot to the other and looked at his shoes.

  ‘Well, you didn’t write to me either,’ he replied, his discomfort making him churlish.

  ‘An address is usually necessary when engaging in correspondence, and I had none.’

  ‘We moved frequently. We were seldom in one place for any length of time.’

  ‘Did you not think that I might want to know what it was like? Visiting the great hospitals of Europe? An opportunity that I will never have,’ she added, an edge creeping into her voice. Now she was the one becoming churlish.

  He said nothing for a while, then looked up at her, his brow furrowed.

  ‘I am sorry,’ he said. ‘More than you will ever know. But it is too late now, isn’t it? You are married.’

  ‘Marriage does not preclude friendship.’

  ‘I think your husband might disagree,’ he said and moved past her towards the stairs.

  THIRTEEN

  aven returned to the doctor’s study. He could see no point in skulking about in his room and he needed to get away from Sarah. Talking to her had only compounded his misery, though if he sought a return to the familiar, he could look to the fact that badly handling a discussion with Sarah had been a leitmotif of his time here. Another was that work always offered a useful distraction, and he wished to discuss the likely pathology underlying Mrs Glassford’s condition.

  Mrs Glassford had been taken from the consulting room to one of the guest bedrooms to recover from her ordeal, although Raven was apt to think he had suffered more from the procedure than she had. At least she had been anaesthetised for the duration of her part in it.

  ‘If the seat of the disease is the ovary, why then is no attempt made to remove it?’ he asked as he entered the room, intent on putting his embarrassment behind him.

  ‘Attempts have been made,’ Simpson replied. Raven was grateful he made no mention of what had just occurred. ‘A small number have even been successful. However, it is a procedure much frowned upon by our surgical colleagues. Any trespass into the abdominal cavity is deemed by them to be a death sentence, the risks too great to countenance. Here in Edinburgh some years ago, John Lizars attempted four ovariotomies; he was unanimously denounced by his colleagues for his endeavours. Liston called him a “belly ripper”. Surgical opinion has changed little in the intervening time.’

  ‘Anaesthesia has not quite been the boon that I thought it would be,’ Raven confessed. ‘I had expected great strides in surgery as a result.’

  ‘I think you will find a vast number of grateful patients who would disagree with you most vigorously on that point,’ Simpson replied. ‘But with or without anaesthesia, few survive the opening of the abdomen. Hence Caesarean section being an obstetricians’ operation of last resort. It is done only that we might save the infant when we know the mother is about to die.’

  Raven sighed as he thought about the tumour in Mrs Glassford’s belly, a malignant lump that was most likely already in the process of replacing the fluid they had just removed. Their therapeutic efforts would only produce a temporary relief. Suddenly everything felt hopeless. Perhaps, he thought, he should not have come back at all. Nothing was as he had imagined it would be and he now knew there was a wide world out there beyond Edinburgh.

  Dr Simpson placed a hand upon his shoulder. ‘All may yet be well, Dr Raven. We must not lose hope; without it how could we continue?’

  How indeed.

  FOURTEEN

  llow me to open the curtains upon another play, not quite a year after the last. Three figures stand outside the Belmont Institute, a charitable establishment dedicated, according to its articles, to ‘laying hold of and educating neglected and destitute children who, having no parents, or worse, whose parents are themselves living in vice and profligacy, leave their offspring to grow up in ignorance to become vagrants or criminals’.

  Murdo MacDonald had nominated himself as a parent qualifying in the latter category. He stood upon feet rendered unsteady by beer and whisky, a sorry sight with matted hair, ragged clothes and his arm in a sling. He told his daughters it was broken in an accident involving one of the looms. He railed against the carelessness of his colleagues and the negligence of their employer, but his broken nose, swollen purple eye and a dozen older scars bore testament to a more likely explanation for his injuries.

  One thing he said was undoubtedly true: with his arm broken, he could not work, and consequently he had declared that he could no longer afford to feed his family. He wished to entrust his daughters to the care of the Belmont Institute instead.

  He told us we would be here for ‘a time’, my younger sister firmly of the belief that he would return at the end of the day.

  I knew otherwise.

  I was nine years old. Ellie and I had grown taller in the months since our mother died, but no broader. We mostly lived on bread when Murdo had the money and the inclination to bring some home, and upon thin porridge when there was fuel enough for the stove.

  From up in the grand circle, the spectators might notice a redness upon the backs of my hands, but not the rough patchwork of raised lines and welts that had not yet healed.

  A few weeks before, my father had come home from the mill directly, not having any money left for the tavern. His consequent sobriety was seldom an ameliorative. I was scratching upon my sl
ate at the table when he became suddenly enraged and seized me by the wrist.

  ‘Look at these hands, so pale and fair and soft. Is it any wonder I’m penniless? These are hands that have known no toil, hands that do naught but take from me, who works all the hours God sends.’

  He went to the sink, from where he lifted the scrubbing brush.

  ‘Who is it you think you are, to have hands so smooth and unblemished? Some rich lady of the quality? Fancy yourself the wife of a merchant or the mill owner? You were made to work, girl. I’ll show you how your hands ought to look.’

  He held each of my hands down upon the table in turn and scrubbed until my knuckles were bloody and ragged. He struck me about the head each time I cried out with the pain, telling me: ‘I will not cease until you show the strength to endure this lesson in silence.’

  The only mercy that night, with my fingers still bleeding and sticky and raw, was that he spared my hands the other task to which he often set them while Ellie slept.

  Thus, despite my trepidation and my concern for my sister, I regarded our entry into the Belmont Institute as a form of deliverance. I could not imagine a life worse than with our father.

  FIFTEEN

  aven was about to cross Leith Street when he heard the clatter of hooves behind him and the rumble of wheels on the cobbles, loud and sudden. It caused him to halt at the edge of the road, an instinctive reaction to the sound of a carriage taking the corner at an injudicious speed.

  The coach whipped past him, then was pulled to an impromptu halt, causing the horses to strain against their own momentum and that of the weight they pulled. Raven looked up to see what kind of fool was so recklessly driving the carriage with so little concern for his own safety and the welfare of the horses.

  He was jarred by the sight of who held the reins, a wretched creature who looked more fit for a hearse than a carriage, and for riding horizontal in the back rather than driving the thing. More disturbing still, Raven recognised him, and with it the implications. The man’s skeletal visage and grim pallor hauled Raven’s mind back to a black night he would never forget, and two terrifying rides in a stolen brougham. He wondered whether the owner of this contraption was currently questioning its whereabouts.