The Art of Dying

by Ambrose Parry

  While Raven was abroad, he had told himself that what he felt was merely an infatuation: two people who had been thrown together in straitened circumstances, an unlikely dalliance from which they both would be wise to move on. But upon his return, when he was confronted with how Sarah had moved on, he realised how deep his feelings truly ran.

  He had been a fool.

  Raven had reasoned that if he wished to have a successful medical practice, it would be expected that he marry and have children, and that he take a respectable wife from a good family. If he were to marry a housemaid, it would be assumed that this was because he had got the poor girl pregnant and was doing the honourable thing by her. Even if no child was forthcoming, it would simply be assumed that she had lost the baby, and subsequently it would be expected of him to fade from prominence as a matter of decency. Marrying a housemaid would be the thing that defined him in the eyes of medical society, and he would not be permitted to rise far beyond it.

  If he were being honest, had Sarah not been a housemaid, he still could not imagine her as the kind of obsequious and compliant wife of which society approved. That, after all, was what had drawn him to her in the first place. In fact, since meeting Sarah, he had found such obsequious and compliant women to be insipid and dull. The very reason he had struck up a rapport with Gabriela in Berlin was that she was a woman who would not meekly accept her place.

  Raven had just begun to lay out the instruments he would require when Sarah walked in unannounced, as though his thoughts had summoned her.

  ‘What are you doing here?’ he asked, surprised. Surely she knew what he was about to do.

  ‘I’ve come to assist,’ she answered, as though it was the most natural thing in the world.

  ‘I am about to perform a post-mortem. You cannot be here.’

  ‘How am I to learn otherwise?’

  Raven indicated the shape on the table, shrouded beneath a sheet.

  ‘But this is Mrs Glassford,’ he told her.

  ‘This was Mrs Glassford,’ she replied. She was calm and dry-eyed, in contrast to the day before.

  Raven found this change in her demeanour disconcerting. He didn’t want her here. Her presence would be a distraction, and if he was honest, he feared a sudden dissolution of this new-found composure as soon as the sheet was removed.

  ‘Does Dr Simpson know you are here?’ he asked, thinking it unlikely that the professor would have sanctioned this.

  ‘Dr Simpson says I should grasp every opportunity to increase my knowledge.’

  Raven noted that she had not answered his question and was thinking he was going to have to manhandle her out of the room, when she walked over to the desk in the corner and picked up a piece of paper.

  ‘I will sit over here and make notes,’ she said. ‘Simply tell me what you find.’

  Raven stood with his hands on his hips in front of the examination table, trying to think of a way to dissuade her.

  ‘You knew this woman,’ he implored. ‘Only yesterday you wept for her.’

  ‘But this is not her, merely her remains. The body is no more than a vessel. We are both of us fascinated by its workings, but our bodies are not who we are or who we were. As a woman, I know better than you what a mistake it is to define a person by their physical form.’

  Raven hesitated for a moment, wondering how best to proceed without making a scene. Perhaps she will change her mind, he thought.

  He pulled the sheet from the body. Sarah remained where she was, her face betraying no response.

  The corpse lay completely exposed, leaving Raven to concede the wisdom of Sarah’s observation. As with all dead bodies, it bore only a passing resemblance to the person who had so recently given up residence within. There was something strangely unhuman about it, reminding him of an anatomical model rendered in wax. That thought quickly dissipated as he became aware of the smell. There was a distinct whiff of putrefaction and he decided that for the duration of the examination he would breathe through his mouth.

  The body was extremely bizarre in appearance: shrunken extremities and a swollen, globular abdomen rising up as if in triumph over its emaciated host. It looked as though the wrong pieces had been put together to make up the whole. It brought to mind a book Sarah had been telling him about, persisting as she did with her habit of reading in spare moments at the morning clinic. The tale concerned a scientist who created a man from constituent parts of different people. He did not recall the details, but it had not ended well.

  Raven lost little time in contemplating the task before him – prevarication would not serve. He looked at Sarah once more, hoping to see doubt written on her features, but she appeared resolute, sitting by the desk, pen in hand. It seemed he had no choice but to proceed.

  He made a visual inspection of the body, recounting the relevant details for Sarah to note down, and then proceeded to open the abdomen.

  As his blade sliced into the late Mrs Glassford’s skin, he thought back to his discussion with Simpson regarding how little they could do for her condition, and how John Lizars had successfully performed precisely the procedure that might have saved her – the removal of an ovary – but had been vilified for his actions, despite the recovery of his patient.

  If you performed a procedure against conventional wisdom, and the outcome was bad, then your reputation would never recover because calamity had resulted from your being reckless and arrogant. And if you performed a procedure against conventional wisdom and the outcome was good, you would be condemned equally for the same recklessness and arrogance. You could expect censure, investigation and condemnation. They would say that it was more by luck than judgment that you succeeded: that it was an anomaly, and therefore did not change anything. Perhaps they needed to reassure themselves that they would have been right to do nothing in the same circumstances, and tell themselves that their inaction was something other than cowardice.

  When a patient would surely die without intervention, how could it be wrong to try?

  Raven knew the answer: it was the same one that forbade hastening a patient’s end. It would be argued that the patient’s condition was ‘almost universally fatal’, and a great weight rested upon the first of those words.

  It was almost certain that the patient would die, but what if she didn’t? Intervene to save her or to end her suffering, and you were taking it upon yourself to decide her fate. It was not yours to make such a decision, they would say, because how could you be sure?

  The possibility that such a patient might rally and recover if you did nothing was the bedrock of the moral case against attempting anything outside of established practice. But how did something ever become established practice? Someone had to take the risk, not merely in terms of outcome but of reputation, and very few doctors were prepared to place that stake.

  Raven peered into the cavity he had opened up, curiosity suppressing all other emotion, and stated precisely what his examination revealed.

  ‘The abdomen contains a quantity of semi-purulent fluid, and on the right side a large cyst is attached to the ovary.’

  He cut into the cyst. A thick fluid began to ooze out.

  ‘The cyst contains a considerable amount of gelatinous matter.’

  He could hear the scratch of Sarah’s pen noting down what he said.

  As he continued to poke about at the bottom of the cyst, he momentarily became aware of her standing at his shoulder, craning her neck to see. He could feel her breath on his neck. Raven closed his eyes for a moment, his concentration interrupted. He took a deep breath – through his mouth – and forced himself to focus on what he was doing.

  ‘Look,’ he said, pointing out what was encased in the heart of the tumour.

  Sarah’s composure finally broke and she gasped, but it was in fascination rather than shock.

  ‘Hair, bone and teeth,’ she stated.

  ‘Indeed. One incisor, one bicuspid and one molar.’

  ‘How bizarre … and revolting.’ Her face
puckered in distaste.

  ‘Are you all right?’

  ‘I’m fine,’ she insisted, sounding annoyed by his solicitude. ‘Stop asking me things and start telling me things. What is that?’

  ‘Certain types of morbid growth may contain within them highly organised structures,’ Raven responded, enjoying a solicited opportunity to demonstrate his knowledge. He must not become verbose, he warned himself, though in the event, Sarah’s subsequent question would have prevented it anyway.

  ‘Why are teeth and bone present in some types of tumour?’

  ‘Pathological investigation has yet to provide an answer,’ he replied meekly.

  ‘You mean you don’t know,’ she said, staring closer.

  ‘No one does,’ he admitted. Raven felt a certain disappointment, as he always did whenever he was forced to confront how much of medicine remained shrouded in mystery. Each feat of progress or discovery was another candle in the dark, but sometimes all they let one see was the vastness of the void.

  FORTY-ONE

  he unmistakable odour of putrefaction still hung in the air, even though the corpse had been removed. Sarah observed Raven raising a hand to his nose, indicating that he suspected the smell might be coming from him. His subsequent expression confirmed that this was indeed the case. He moved to the sink and began running his hands together beneath the tap.

  ‘I’ve washed my hands three times already,’ he said. ‘It’s impossible to get rid of the smell.’

  ‘“Common ablutions are not enough”, remember?’ Sarah said, adding chloride of lime to the water in the bowl.

  The resultant chemical scent was a relief. Sarah had begun to feel queasy again. Curiosity and her keenness to be involved had made her determined to suppress any squeamishness she might feel, and for the most part the knowledge that it was Mrs Glassford’s remains had not been a problem. She was able to look at the body in abstract, particularly once Raven opened it up and revealed the organs within. However, the lingering smell was prompting an instinctive revulsion, and she did not wish to appear weak by being sick.

  It was not her only reason, either. Raven had seen her vomiting a few days ago. He had been sharp enough to deduce Archie’s condition, so perhaps it was folly to think that, as an obstetrician, he was not already suspecting hers too.

  She did not like to think about it, and yet it was always there, waiting, inexorable, like Archie’s illness. She knew this was one of the reasons she was so motivated to pursue her investigations. She needed some kind of distraction, a purpose to consume her in the here and now, because in the future there lay only the daunting certainty of Archie’s death and the daunting uncertainty of the new life growing inside her.

  Archie had said her future would be assured, and she did not doubt his sincerity, but it was the nature of that future that worried her. Assured also meant inescapable. Was a widow and a mother now all she would ever amount to? A life defined and dominated by raising a child was better than one defined and dominated by domestic service, but she had allowed herself to hope for so much more. For all Archie’s talk of wishing her to educate herself and to put that education to practical use, she did not envisage how that could be compatible with the demands of raising a child on her own.

  She thought of Mrs Glassford, of the strange and disturbing entity that had consumed her, and could not help but see it as a twisted, grotesque parody of her own condition. She carried inside her a creature that would swell her belly and then devour her, leaching from her the many lives she had dreamed for herself.

  The image shook something loose from her head that jolted her back into the present, a terrible possibility forming in her mind.

  ‘The leeches!’ she said.

  ‘What leeches?’ Raven asked, understandably confused by her random exclamation.

  ‘The ones Dr Fowler was bemoaning the loss of. You told me they had fallen off George Porteous and died.’

  ‘What about them?’

  ‘Isn’t it strange that they all died at the same time? Have you ever heard of such a thing?’

  Raven’s face took on a sudden glow of excitement.

  ‘Sarah, I believe you have made a crucial observation. It could be that this new malady is a disease of the blood. Perhaps that is in fact how it is carried. As you just said: common ablutions are not enough. If Mary Dempster has been less than scrupulous in washing her hands, tainted blood adhering to them might be the conduit by which the illness is being transferred from one patient to another.’

  The excitement in his expression wilted as he failed to see it mirrored in her own. He had leapt, with great energy and enthusiasm, to a predictable but entirely wrong conclusion.

  ‘Don’t you follow?’ he asked, sounding frustrated. ‘As Simpson found regarding puerperal fever—’

  ‘Will, permit me to ask you something,’ Sarah said, cutting him off. ‘How many diseases have you observed in gravely ill patients to whom leeches were applied?’

  His nose wrinkled in irritation. ‘Dozens. What of it?’

  ‘And what happened to those leeches?’

  ‘Nothing. They became engorged and fell off.’

  ‘After feasting on the blood of patients suffering every variety of disease, the leeches were unaffected. And yet the leeches attached to George Porteous all died. What does that tell you?’

  His enthusiasm was rekindling, as though she had merely needed to grasp a principle in order to properly understand.

  ‘That this is what makes it such a dangerous new manner of disease. If it can spread so quickly to the leeches, then perhaps by investigating that, I might ascertain how it spreads to other people.’

  Sarah could not believe she was having to spell it out. Raven was an otherwise rational and intelligent man. However, she understood what was impeding his thinking.

  ‘Do you recall what Martha Dempster said about what happens once an idea gets lodged in one’s head? You are so intent upon finding this new disease that you are missing what is obvious. There is a far simpler means by which Mary Dempster could be directly responsible for her patients becoming ever sicker and then dying. The leeches died because George Porteous had something in his blood that proved poisonous.’

  ‘Are you suggesting that the nurse administered something in error?’

  The possibility of such a simple but deadly mistake had crossed Sarah’s mind, and she would have welcomed this less disturbing explanation. However, the numbers were against it.

  ‘One fatal misadministration would be unfortunate. Three suggests something less accidental.’

  Raven took a moment to consider this, but that proved long enough to reject it.

  ‘I could say that your judgment is equally affected by a tenacious notion. Because of that horrible business last year, you are too easily inclined to see the possibility of poison.’

  Sarah had to concede that if it was true of Raven, it could equally be true of her. Nonetheless, her theory chimed with the unease that had been in her mind since they visited that cottage at Lochend.

  ‘It struck me there was something awkward and oddly wary about Martha Dempster’s manner when we spoke to her, and it has taken me until now to deduce what that was. The woman was afraid of her sister.’

  ‘I got no such sense, and even if I had, it would be quite the leap to extrapolate that she must be a poisoner.’

  ‘Isn’t it suspicious that she cannot be found?’

  ‘We have barely looked. But even were we to entertain your notion for a moment, what poison would have produced such symptoms, leaving no sign of its administration?’

  ‘There must be a few possibilities.’

  Raven fixed her with an unblinking look, like an impatient schoolmaster waiting for a pupil to admit she doesn’t have the answer.

  ‘Prussic acid?’ she suggested.

  ‘When it kills, it kills quickly and is not something easily procured,’ Raven responded dismissively.

  Sarah ignored his tone. She was not yet re
ady to abandon her thesis and attempted to work through the problem logically.

  ‘Well, if procurement is an issue, the most commonly available household poison is arsenic.’

  ‘But arsenic produces symptoms of abdominal pain and vomiting, which were not observed in these cases.’

  Sarah cursed inwardly. She ought to have remembered this. Nonetheless, there were still other possibilities.

  ‘Laudanum?’

  ‘The pupils would have been small. Pinpoint. They were normal in size.’

  ‘What about chloroform?’ she suggested, though she knew she was getting desperate. ‘Could it produce stupor or delirium that lasts for days?’

  ‘No. Its danger is that it kills quickly. There have been fatal accidents due to its abuse: a druggist’s assistant in Aberdeen developed a habit of sniffing it from a towel at his place of work and was found dead face-down on the counter; and at Duke Street Hospital in Glasgow a doctor was found dead after inhaling it. But in both cases, it was obvious what had occurred.’

  ‘What if the victims were given it to drink? I know that Mrs Lyndsay recovered from drinking Dr Simpson’s chloroform champagne, but what if she had taken more? It’s relatively easy to get hold of,’ she added, anticipating Raven’s previous objection.

  ‘Unless you’re Dr Simpson,’ he muttered cryptically.

  ‘What?’

  ‘Never mind. Anyway, you would be able to smell it. Furthermore, it would be highly irritant to the mouth and throat unless very diluted. I observed no such marks on George Porteous, and if there were any on Mrs Johnstone, you can be damned sure Professor Miller and James Matthews Duncan would have seized upon it.’

  Sarah frowned by way of admitting she was exhausted of suggestions, but Raven was not exhausted of arguments as to why she was wrong.

  ‘Even if the symptoms matched a known poison, what reason would a nurse have to murder her own patients? A private nurse, no less. She would be killing her employers and putting herself out of work. This is not like some scheming wife poisoning her rich husband so that she might live off the inheritance.’