The Art of Dying

by Ambrose Parry

  ‘Better than the view from here now, I would wager. How on earth did a man like you end up crossing paths with Flint?’

  ‘Am I to assume you are familiar with the fellow?’

  ‘More than I would care to be.’

  ‘I did not seek him. It happened the other way about.’

  Raven’s expression betrayed his confusion.

  ‘Flint purchased my debt. It is one of the ways he operates. He approaches creditors and offers them a figure that is less than the sum owed, but more than they think they may ever get.’

  ‘And he has a greater success than such creditors when it comes to motivating his debtors to pay,’ Raven said. ‘I know this from experience.’

  ‘His men took our furniture. I feared what they might take next, but happily an opportunity arose.’

  ‘For you to render services in lieu of payment.’

  ‘My debt to him will be redeemed once I have helped him sell on some stock certificates. In fact, I am due to receive a share of the takings. I will make good on everything after that, I give my word.’

  ‘That is not how it works with a man like Flint. That is why I came here. Once he has his hooks in you, there can be no escape. He tells me you are keeping his books too.’

  ‘Only while I remain in his debt. Once the stocks are sold, I will have no need to deal with him.’

  ‘You will always be in his debt: that is my point. He now has leverage over you. You are involved in fraud, forgery and theft.’

  ‘I haven’t stolen anything.’

  Raven raised an eyebrow.

  ‘To Flint’s knowledge,’ he clarified.

  ‘You are complicit, though: forging the signature of the registrar of the exchange, on documents stolen in a robbery which saw guards assaulted and a man shot dead.’

  This last detail seemed to drive home the depths he was sinking into. Quinton was a man used to dealing with gentlemen in fine tailoring trading numbers on paper.

  ‘What would you have me do?’

  ‘Not make the mistake I did when I first came to Queen Street, similarly in debt to Flint. I concealed my situation out of pride, and fear of making a poor impression. You must come clean and ask for help.’

  ‘I have little faith we would get it. My wife pressed Mrs Simpson for more money for looking after Rochester, but she refused.’

  ‘She did not know your circumstances. Dr Simpson and his wife are reasonable and compassionate people. If you are honest and contrite, I am sure this can be resolved. I would not see you trapped in Flint’s clutches. But I will not permit you to persist in your deception, or in sowing suspicion about Dr Simpson’s household, leading people to believe their colleagues might be dishonest.’

  ‘I just need more time,’ he pleaded.

  ‘What you need is to tell the truth and confess to Dr Simpson that you are the one who has been taking money. It would be better coming from you, but if it does not, I will have no choice but to inform him myself. He is with a patient in Dunblane and will be back in two days. I will give you until then.’

  The door was closed behind Raven with more force than he considered seemly. Perhaps once he had time to calm down, Quinton would appreciate that Raven had his best interests at heart, but for now he did not blame the man for feeling raw.

  The rain had become heavier and the wind blustery. He bowed his head and pulled his coat about him as he strode down Castle Street. A carriage clattered past on his right, giving him a moment’s concern. Every time one drew near, he was apt to recoil in case the Skeleton should turn out to be at the reins. This one continued on its way, leaving him unmolested, but once the noise of hooves began to fade, he became aware of being hailed with some urgency.

  ‘Dr Raven? Dr Raven!’

  He glanced up to see the plump figure of Martha Dempster hastening along Queen Street to intercept him at the junction. A gust of wind whipped up from the east, causing her instinctively to grab at her hat, strands of her fair hair escaping from beneath.

  She produced his calling card as she approached, gripping it in her fingers and holding it up as though to establish her credentials.

  ‘I was coming to the address on here in the hope of speaking to you. It is regarding my sister.’

  ‘You have found her?’ he asked eagerly.

  ‘No. Quite the opposite. I am growing concerned that I have heard nothing from her.’

  Raven eyed the calling card. These were not matters he wished anyone at No. 52 to overhear. He led her instead down the slope in the direction of Albany Street.

  ‘We must get in out of the rain. Mrs Banks’s home is nearer.’

  It was his intended destination anyway as he had decided to keep a close eye on Sarah after witnessing her episode of pain. Something about it troubled him despite Sarah’s insistence that all was well.

  ‘I thought long after your last visit,’ Martha said. ‘About you saying I ought to be afraid of Mary. Though right now I am increasingly afraid for her.’

  Raven knew she would not be bringing up his warning if it had not struck home. She had come to talk, but she would still need to be delicately coaxed.

  ‘I cannot help Mary unless I am in possession of all knowledge that might be relevant, and that particularly includes matters you might consider unsavoury. In all truth, Martha, is there anything about your sister that has ever given you pause?’

  Martha frowned, her head bowed against the rain.

  ‘She could be coarse. That always set her at odds with my parents. Mother said she was wanton. I don’t know about that, but she was certainly defiant. She seemed to court my mother’s ire, which troubled me because I always endeavoured to avoid precisely that.’

  As she said this, it struck Raven that Martha was the opposite of all he admired in Sarah. Though it was an uncharitable thought, he wondered if her late fiancé would have run a mile had he been presented instead with a woman who challenged everything.

  ‘And over your whole lives together, is that the sum of it?’ he asked, trying to keep the frustration from his voice.

  Martha hugged herself and briefly bit her lip.

  ‘Well, there is something. I’ve never said this to anyone, though. It seems disloyal. Shameful, in fact, even to have thought it.’

  She shook her head and Raven feared she was about to clam up again.

  ‘There is nothing disloyal about it if it helps us find her. Tell me, Martha.’

  ‘All our animals kept dying. The dogs and the cats. Our pets. And God forgive me for thinking it, but I sometimes wondered if Mary had something to do with it.’

  ‘Why?’

  ‘Whenever Mary was punished by my mother – and by punished, I mean beaten – sometime later, one of the animals would die. Not immediately, but it would happen. I might be wrong, though, or misremembering. Pets die all the time, don’t they?’

  There was a look of uncertainty on her face. She had been wary of him but now she needed someone to trust, and perhaps the knowledge that someone trusted her. This would be the time to tell her what they had discovered, and what they suspected about Martha’s own family. He had to get her in out of the rain, though: put her at ease in Sarah’s parlour with a warm fire and a cup of tea. He could see her front door up ahead.

  As they closed in on it, something wasn’t right. He felt some instinct seize him as he noticed that the door was not closed. Hurrying towards it, he could see a pair of feet within the hall, the toes pointing upwards.

  Sarah was laid out on the floor, unconscious.

  SIXTY-THREE

  arah was pale, drifting in and out of consciousness. Raven lifted her up and carried her through to the bedroom, where he placed her on the bed. Martha followed, looking blank-eyed at what had confronted them.

  Raven loosened Sarah’s clothing. Her face was blanched, her pulse rapid, her abdomen swollen. His worst fears had been realised. He had not a second to waste.

  ‘Can you wait with her?’ he asked Martha.

  S
he nodded. ‘Where are you going?’

  Raven did not answer, already tearing off into the rain, bound for Queen Street as fast as he had ever run.

  His recent reading about ovariotomy had reacquainted him with the current thinking regarding all ovarian and fallopian-tube pathologies. In response to Sarah’s episode of pain he had scoured the books and journals searching for a possible explanation, hoping to exclude the one he had immediately thought of, seeking reassurance but finding only cause for concern. Since then his bag had been packed with everything that he might need should the worst happen.

  Raven bolted inside No. 52 and fetched the bag from his consulting room. He was almost to the front door again when he recalled his recent moment of apprehension visiting one of the outdoor patients. He checked to ensure he had chloroform. There was indeed a bottle, but it was close to empty.

  Raven ran to Dr Simpson’s office and seized a replacement from the store cupboard. As he emerged with it gripped in his hand, he encountered Quinton coming up the stairs. Raven’s look was enough to warn him not to even open his mouth.

  ‘What is wrong with her?’ Martha asked when he returned to Albany Street, her features expressing a combination of horror and fascination.

  ‘I think she has an extra-uterine pregnancy,’ he said. ‘The foetus is growing in the fallopian tube instead of the uterus. Now the tube has ruptured, and she is bleeding.’

  ‘What can be done?’

  Raven wondered how to explain the complexities of the situation that they had found themselves in: that Sarah was bleeding into her abdomen, that what was happening was almost uniformly fatal, that although the pathology was relatively well understood, suggestions as to how such a catastrophe might be managed were few. One such was in a passage he had read just a few days before: ‘Here is an accident which can happen to any wife in the most useful period of her life which good authorities have said can never be cured, but the bleeding vessel through which the stream of life is rushing away can be ligatured.’

  The only problem was, to his knowledge, no one had ever done it.

  From his discussions with Dr Simpson he knew that the concept of ovariotomy was contentious enough – some even suggesting that the opening of the abdomen to remove an ovarian cyst was tantamount to homicide – but this was more contentious still.

  He had thought about summoning help. Another practitioner more experienced than he was. A surgeon. Another obstetrician. But he hesitated. They might not agree with his plan of action, might attempt to prevent him doing what he wanted to do, what he felt he must do in the circumstances.

  He wondered what Dr Simpson would do in his place, but couldn’t convince himself that he would agree with Raven’s somewhat reckless plan of action. The opinions of other obstetricians were not encouraging either. Some of his reading on the subject was, in retrospect, more hindrance than help. Charles Meigs, the eminent American obstetrician, had discussed the management of tubal pregnancy as a hopeless endeavour: ‘We could make an incision in the abdomen and clear away the coagula and serum. But who is bold enough to do so? Who is astute enough to discriminate betwixt all possible causes of such phenomena to warrant him in the performance of gastrotomy for fallopian pregnancy? There is no such wise and bold surgeon. Nothing remains but for us to extend all relief and calmly await and submit to the inevitable end.’

  No such wise and bold surgeon? Not wise perhaps. But bold certainly. Especially if the alternative was to stand by and watch Sarah die. Calmly submit to the inevitable end? Such a thing was not possible.

  ‘Martha, she is bleeding,’ Raven said as calmly as he could, despite a sense of rising panic. ‘The only way to save her is to open the abdomen and arrest the haemorrhage.’

  Martha looked appalled by this suggestion. ‘Are you sure?’

  The question caused him to ask himself how certain he was about the diagnosis. He went through the symptoms and signs again. No menstruation for eight weeks, recurrent pain and then collapse. She was pale and cold, with a weak pulse. There was a considerable amount of effusion in the abdomen. However, there was no way of knowing for sure, no way to confirm it without actually going in. The only alternative would be to wait until she was dead and confirm his diagnosis at post-mortem, as had been the case in Paris, and that he was not prepared to do. Not again. It was always better to do something than nothing.

  He had to act, and he must do so immediately if she was to have any chance of survival. The fallopian tube and its vessels would be secured and divided in much the same way as during an ovariotomy, as he had done when he removed the ovarian cyst from Mrs Glassford’s abdomen post mortem. The operation itself should be relatively straightforward. The result, however, would be quite another matter.

  ‘Yes. I’m sure,’ he said, trying to speak with confidence and authority.

  ‘Is there no other way to help her?’

  ‘No. But I can’t do this alone. I’m going to need your help.’

  Martha hesitated for a few moments then nodded.

  ‘Tell me what to do.’

  ‘Go to the kitchen and fetch me hot water, a basin and some towels. I think I have everything else now.’

  Martha left the room and Raven began to lay out the instruments that he would need: scalpel, clamp, ligatures, piles of lint, sponges and the chloroform. In Sarah’s depleted state she would not require much of the latter. Her pulse, still rapid, felt a little stronger now that she was in bed, her feet elevated on pillows. She was groaning a little, not fully awake.

  Martha returned with a large bowl of water and an empty basin. Raven added chloride of lime to the water, dropped his scalpel in and then washed his hands, almost scalding himself.

  ‘Christ, Martha, I said hot, not boiling.’

  Martha bit her lip but said nothing. She stood silently by the bed awaiting further instructions. Raven proceeded to give the chloroform. As he had expected, only a small amount was required. He rolled up Sarah’s chemise and paused, quickly running through in his mind what he had to do. Most basically, get in there and stop the bleeding. But how different the theory was to the practice.

  He took a few deep breaths, forcing himself to think of everything in an abstract way. It was a procedure, a process, a series of steps to be followed: incision from umbilicus to pubis, enter peritoneal cavity, pass ligature around broad ligament and divide it.

  Even if he succeeded, he knew he would be criticised for this. It was unjustifiable in the eyes of the profession to perform hazardous experiments, for surely this is what he was about to do. Those who challenged established rules were always harshly dealt with. Only those whose professional stature had been recognised and rewarded could expect a fair hearing. Someone at his stage would be condemned out of hand. He thought of Dr Simpson, the scandal of the bloodstained mattress, the criticism he had endured over nothing but unsubstantiated gossip. This mattress was going to be a thousand times worse. But there was no time to think about such things. His reputation be damned. If he had to choose, then he chose Sarah.

  Without further thought, he began. His mind cleared, his focus became preternaturally acute. He opened the abdomen, scooped out a huge amount of clot, filling the basin that Martha had brought him. The source of mischief was easily identified: an ovoid swelling in the left tube, ruptured and full of clot. He clamped and tied the broad ligament, arresting the haemorrhage just as the textbooks suggested it would, and removed the ruptured tube. He worked quickly, knowing that Sarah would be weakened by blood loss.

  He washed out the remaining clots, bloody serum and debris and closed the abdomen using interrupted sutures. Martha helped him apply a bandage. It was done.

  As soon as he was finished his hands began to shake uncontrollably. He sank to his knees, grasped Sarah’s arm and felt for the pulse at her wrist. It was there: just palpable to his tremulous fingers. He kissed the back of her hand and then let his forehead rest upon it.

  ‘Don’t die, Sarah,’ he whispered. ‘Please don’t die.�
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  SIXTY-FOUR

  artha helped him change the sheets on the bed, Sarah groaning a little as they moved her. She had been busy around him as he worked, dealing with the worst of the mess. He thanked his good fortune that there had been a nurse in his company when this happened, though in one respect it would have been better if he had been alone.

  ‘I would ask you not to discuss this with anyone,’ he said. He wondered how he would explain himself if she asked why, but she did not.

  ‘I may be less experienced than Mary,’ she said, ‘but I have worked as a nurse long enough to understand the need for discretion.’

  Having thus reassured him, Martha asked if she could be spared. She was anxious to continue her search for her sister, though she vowed to come back later in the day.

  Mrs Sullivan arrived shortly after Martha’s departure. She had been out on errands when Sarah collapsed, an absence which Raven had initially been grateful for, given the necessarily clandestine nature of his intervention. Her return required Raven to provide some explanation for the alarming quantity of blood on the soiled sheets. Martha had performed a near miracle cleaning up, but there was only so much that she could do. He informed the housekeeper that Sarah had suffered a miscarriage.

  ‘Some things are just not meant to be, are they?’ Mrs Sullivan said, revealing a philosophical bent that Raven had not suspected she possessed. Then she added, less than charitably, ‘It seems that I have traded one invalid for another.’

  Raven stayed by Sarah’s bed – ignoring Mrs Sullivan’s suggestion that he go home – giving her small amounts of brandy and water when she could manage it. The fact that she roused sufficiently to take anything at all was reassuring but he knew there was likely worse to come. After what he had done, inflammation was inevitable and he knew that her survival was still very much in the balance.

  Some hours later Raven felt a chill, and was suddenly aware of how cold the bedroom had become now that his sweat-soaked shirt was sticking to his skin. The fire had gone out at some point, he knew not when. It could have been hours ago.