“Where was your practice before this?” Bertha asked, and Thomas felt that cursed blush rise up his neck and touch his cheeks. Surely Dr. Haines had mentioned Thomas’ circumstances to nurse Auerbach—fresh out of school, with no clinical or practical experience of his own.
“I assisted Professor Wilhelm in his work in Philadelphia,” Thomas said. “During my last two years in school there.”
“I see,” she said, and Thomas saw that figuring out just what Bertha Auerbach was thinking was going to be a challenge. “Well,” she said and turned away, “we shan’t be ready for anything, standing about yakkety-yakking. If you have instructions for me?”
Her retreat to the examining room required that Thomas follow along if he wanted to converse with her, and he glanced at Alvi, who smiled sweetly.
“I’ve work to do upstairs,” she said. “I’ll be in and out, if you have questions.”
“I shall have an unending list,” Thomas said.
“In most things, Berti will guide you,” Alvi said. “She’s most efficient. And Father will be here by ten o’clock, regardless of his promises.”
Thomas glanced at the clock and saw that it was seven-thirty. He felt as if he had already wasted half the day. Wheeling into the examining room, he arrived in time to see Bertha empty the contents of a steaming kettle into one of the washstand’s reservoir bottles.
“I did have one concern,” Thomas said. “I wanted to discuss the gas clave system with you. Yesterday, I noticed that it wasn’t operative.”
“Of course not, Doctor. Yesterday was the Sabbath. Normally, no one is here at that time. House calls, perhaps. But not here.”
“Well, you see the problem is,” and Thomas pushed himself more upright in the chair, leaning on his good right arm, “we don’t know when we’re going to need sterile instruments, Miss Auerbach.”
“I don’t understand what you’re asking of me,” Bertha said flatly, and her tone cut through Thomas’ efforts to be tactful.
“What I’m asking,” he said, “is that at any time, day, night, Sabbath or not, I may have sterile instruments in my hand for the, asking. Without delay. Without confusion.”
“How will I know what you require?”
“A commonsense selection,” Thomas said. “Nothing unusual. I shall draw up a list for you if that’s necessary. But it’s the notion of everything at the ready that’s important, Miss Auerbach. Ready and sterile.”
“Sometimes we make do with what we have,” she said, and she might have added and that’s that. Her tone softened a bit. “I heard about young Charlie,” she said. “Such a shame.”
“Yes, but more than a shame. A crime, in fact. And that’s my point. Before we leave the clinic for the day, I’ll have such a kit in the pan, already claved, simply left inside the machine where it will remain sterile,” Thomas said. “I’d like you to see to that each day. It’s easy to become busy, I imagine. But that needs to be done.”
“I see.”
He smiled at her. “Do we have such a selection at hand at the moment, Miss Auerbach? That’s sterile, I mean?”
“Indeed not. No.”
“Then perhaps that can be your first chore,” he said. “A scalpel or two, forceps large and small, sutures of varying sizes, probes, the hypodermics. Whoever arrives first in the morning will resterilize the kit as a double precaution.” He pivoted the chair so that he could survey the examination room again. “If there’s one thing that the War between the States taught us, it is that prompt medical attention, coupled with aseptic conditions, contributes to effective care.”
“The war was forty years ago,” the nurse replied.
“Indeed. Before either of us was born. I don’t mean to be pedantic, but it is also my observation that the lessons from that war are slow in taking root. Please don’t misunderstand me, Miss Auerbach. I mean in no way to be critical of what is done here. My particular interests have led me to believe that nearly any injury may be satisfactorily repaired by prompt treatment, including aseptic instruments, gentle surgery, and intelligent therapy afterward.” He realized that he had launched himself on a sermon, and cut himself off abruptly. “That’s all I’m saying,” he said. “Where did you complete your training, if I might ask?”
“At St. Vincent’s in Portland,” she replied. “I went there directly from Macy Normal.”
Thomas had heard of neither, but nodded as if he had. “May I ask what prompted you to move to Port McKinney?”
“An ill relative across the bay,” she said tersely. “Since passed on.”
“Ah, I see. I’m sorry. Other family here?”
“I have a brother who works for Mr. Schmidt.”
“Really,” Thomas said. “As does Mr. Tate, whom I’ve met already. He led the charge into the surf to rescue my carcass.”
“Jake Tate is a good man,” Bertha said. “You’ll find that many of Mr. Schmidt’s workers pass through here for one reason or another.”
“I would expect so. It surprises me that the ward is empty today. Is that the usual state of affairs?”
“We transfer any patient who will need extended care to St. Mary’s, Doctor.”
Although he had been told that by both John and Alvina Haines, Thomas still found the notion incredible. “We do? All?”
“Yes.”
And that’s a trip of some thirty miles?”
“Yes.”
“My God, Miss Auerbach, whatever for? Thirty miles there and thirty back?”
“Yes.”
“While we have a ward with eight beds? Good heavens. You have assistants? Am I understanding that correctly?”
The nurse looked sideways at Thomas. “I have no assistants, Doctor. There are six girls who work upstairs with Mr. Riggs and Miss Haines.” She glanced at the clock. “They will arrive shortly, although most often, they use the back stairway. I don’t want them clumping through the waiting room, you see. Down here, it is Dr. Haines and myself. And often, just myself.”
Thomas gazed at her thoughtfully, interested to hear her version of Zachary Riggs’ endeavors. “There are patients upstairs?”
“My heavens, no.”
“Then I’m confused. What do eight people do all day long on the second floor, while you and Dr. Haines struggle with the community’s medical needs here?”
“There is much correspondence,” the young woman said, and Thomas heard the discomfort in her voice.
“There must be,” he replied. “With whom are we corresponding at such a pace?”
“I was under the impression you would know about that aspect of the practice.”
“Apparently I hadn’t appreciated the magnitude of book sales,” he said.
Bertha Auerbach’s lips compressed a bit, and she raised an eyebrow as she stared at the floor. “I think it best that you discuss that affair with Mr. Riggs,” she said after a moment. “Or with Miss Haines. Or with the good doctor.” The mister, rather than a physician’s title, was not lost on Thomas.
“I shall. But tell me…when you transfer a patient to St. Mary’s, who drives the ambulance?”
“Normally, Mr. Winchell will do that.”
Thomas laughed. “Having the coroner and undertaker at the reins must inspire the patient’s confidence, I’m sure.”
“Mr. Winchell uses his white team for ambulance duties,” Miss Auerbach said. “The blacks are reserved for the hearse.”
Thomas caught himself when he saw that she was serious. “We have no ambulance routinely at hand. That’s what you’re telling me?”
“Mr. Winchell has one. Or hearse, depending on its need.”
And when Mr. Winchell is transferring a patient, we are left with no ambulance at our disposal for at least two days?”
“We are a small village.”
Thomas leaned back in the chair, resting his chin on his
right fist. “That puts us at a serious disadvantage.” he said. “Earlier you asked my preferences. Well, one of them is an ambulance at hand here at the clinic, fully prepared with a driver of our employ. If we must purchase an ambulance or two, we’ll do just that. I’ll speak with Dr. Haines about it today. This isn’t a matter for next year, Miss Auerbach.”
“That’s a considerable expense.”
“Indeed,” Thomas said. “I’m sure he is as eager as I am to make progress here. I hope you’ll join with me in this.”
“Of course,” she said. A ghost of a smile touched the nurse’s face, and Thomas saw that she was really quite pretty.
“This morning I’d like to examine the daily journals,” Thomas said. “Dr. Haines said that he keeps a narrative?”
“Of course. They’re shelved in his office. It is his habit to make notations after each patient he sees. There are times, certainly, when he is much pressed, and I’m sure some time passes before he makes an entry. But he’s really very organized in that regard.” She paused. “Would you like to see them now?”
“If you please.”
He wheeled after her to enter the quiet sanctum of Haines’ office. Bertha Auerbach opened the glass doors of one of the cabinets and slid out a heavy, leather-bound volume. Opening it, she turned to the last page of writing, and as Thomas wheeled behind the desk, she rested the book in front of him.
The doctor’s hand was fine and angular, the entries in black ink as easy to read as a printer’s copy. No scratch-outs marred the page.
“You’ll see that he makes an entry for each date,” she said. “A diary, more or less.”
“I see that,” Thomas said, reading down the page. “He assigns a case number for each visit, or for each patient?” He leafed back through two pages.
“That would depend,” Bertha replied.
“On what?”
“It is my understanding that each separate incident or illness receives a fresh case number,” she said.
“Ah, here I am.” Thomas said. He grinned. “I’m Case Number 43,731, entered September 12, 1891.” He turned the book slightly so that light fell more clearly on the page. “‘Thomas Brian Parks,’” he read aloud, “‘age 27, the victim of a riding accident, brought to this office via Schmidt’s freight wagon, found to be in a semiconscious state, suffering from multiple injuries.’” He looked up at Bertha.
“I have read that entry,” she said.
“Really?” He skimmed the lengthy list of injuries that the physician had enumerated. “He’s most complete.”
“I would imagine so.”
As the dates progressed down the pages, Thomas saw himself mentioned several times, interspersed with other patients. In the course of the past week. Dr. Haines had seen thirty-seven different cases, with complaints ranging from slivers to abscessed teeth to fractures, lacerations, and other interesting wounds, to cases of debility, dyspepsia, tuberculosis, and influenza. One patient had eaten raw fish and nearly died, while number 43,760 had tried to shoot himself in the head, changed his mind at the last moment, and managed to blow off only a portion of his left ear.
The treatment for each patient was recorded and in a final column, the fees charged. At those rates, Thomas reflected, a new clinic would be long in coming—as would his first paycheck.
“If you have nothing else for me?” Bertha Auerbach asked, and Thomas looked up with a start.
“I’m sorry. No. If you have time to tend to the instruments, I would be grateful.”
“I’ll let you know when patients arrive,” she said. “Since it’s Monday morning, we might expect Mrs. Cleary promptly.”
“Ah, Mrs. Cleary. Dr. Haines mentioned her.”
“Every Monday morning,” Bertha said. “She begins her week with a visit to the physician.”
“Whether needed or not?”
“As regular as the clock in the waiting room.”
“How interesting. She would be in here, then.” He patted the book.
“Number 21,210.” Her smile was tight, as if she feared that she might burst into laughter.
“My word,” Thomas said, and looked down at the book. He flipped back to the previous Monday, and sure enough, the first entry was
Number 21210, Mrs. Robina Cleary, a 71-year-old woman of impressive stature. Complains of a ringing in the ears. Advised to exercise (again) and to avoid rich foods (again). Accepted Universal Tonic. $2.00.
The week previous, the entry read
Number 21210, Mrs. Robina Cleary. Claims that the spate of hot weather has caused some discomfort. Suggested lighter clothing. Universal Tonic, $2.00.
Thomas paused and looked up. “Is this sort of thing common, Miss Auerbach?”
“Common?”
“We have a number of patients who take up space and time without any specific complaint?”
“I’m sure we do.”
He fanned some of the journal pages. “I had an elderly aunt,” he said. “A wonderful woman whom I loved dearly. As my father would say, Aunt Ethel enjoyed nothing as much as a good ailment. Something to discuss with neighbors. Mrs. Cleary reminds me of her.”
“Be kind, Doctor.”
The comment surprised Thomas. “Of course,” he said, and patted the book. “I’ll be prepared.”
Chapter Twenty-five
Doctor?” Thomas Parks looked up with a start. He put a finger on a name in the journal to mark his place. “The constable is here to see you, Doctor,” Bertha said.
Edgar Eastman’s towering, broad figure appeared in the office doorway. “There you are,” he said, as if Thomas might have been hiding.
“Come in, come in,” Thomas said, although Eastman already had. The constable closed the door a bit, nodded at Bertha as if accepting her permission, and then shut it the rest of the way. He turned and surveyed the room, in no hurry to engage the young physician in conversation.
“I thought to stop by.” He scanned the spines of books on the top shelf that were at his eye level. He pulled one book partially out, cocking his head to better read the inscription. “You read Latin?”
“Some,” Thomas replied, impressed that the constable recognized the language in the title.
“I don’t.”
“I wouldn’t think Latin of much value in your line of work.”
Eastman turned and looked at him. “You never know,” he said. “We can’t always tell what’s going to be of value, can we?”
“I suppose not.”
“I came by to see what you found out.” Eastman turned one of the heavy straight-backed chairs and sat down on it backward, then dug in his pocket, eventually pulling out a large pocket-knife. Sliding it across the polished surface of the desk toward Thomas, he waited while the physician pried out the blade and examined it.
“I have my notes,” Thomas said, and reached for his own medical bag that now rested on the floor beside the desk. He handed the open journal to Eastman.
“As you can see, it would be most difficult to say that this is the knife,” he said. “This blade is more blunt than I would expect, and there is only one.” He folded the knife and ran his finger along the front of the handle near the base of the blade. “This is not as wide as the bruising around the wound.”
“You’re sure?”
“Reasonably, yes.”
Eastman turned the page that included Thomas’ drawing of the bruise and squinted at it. “This?”
“Yes. The boy was stabbed so hard that the handle of the knife bruised the skin around the entry wound. And in my view, that bruise…that mark…is not consistent with this particular knife.”
“Interesting. And this?” He pointed at another sketch.
“That’s the shape of the wound in the posterior wall of the heart.”
“Huh.”
“That’s where the blade actu
ally came to rest.”
“So that shape would be fairly accurate?”
“I would say so.”
“And it matches this?” Eastman held up the pocket knife.
“Not at all. As you can see, that blade in your hand is quite rounded, almost blunt. The knife that caused that fatal wound was sharply pointed, an acute shape. As you can see by my notations, the angle of the tip was approximately twenty-five degrees. That’s a very pointed blade, sir.”
“Approximately twenty-five degrees.” Eastman grinned, looking ten years younger when he did so. “You’re a man of exact science.”
“It’s a relatively simple task to measure an incision in tough muscle,” Thomas said.
Eastman opened the knife blade and laid it on top of Thomas’ drawing for comparison.
“As you can see,” Thomas said.
“Huh.” The constable refolded the knife, slipped it in his pocket, and pulled out a second one. “And this?”
Much heavier, this knife featured two blades, and as Thomas opened the first, he felt a chill of apprehension. Fully four inches long, sharply pointed, and razor sharp. He knew before he overlaid it on the journal drawing that it would match.
“Now this one.” He looked up at Eastman. “It could match easily.” He laid the blade over the drawing of the heart wound. “If not a match, then an amazing coincidence. Both the wound itself and the bruise on the skin.”
“Well, well,” Eastman said, and accepted the knife back. He opened and closed the knife several times, brow furrowed in thought. Thomas heard voices out in the waiting room, and then sounds as if a herd of elephants were crossing the floor. The door to the examination room closed with a bang, and through the thin wall, he could hear the voices continuing. Eastman ignored the ruckus, and Thomas forced himself to relax, knowing that if he was needed. Bertha would feel free to interrupt.
“You know to whom the knife belongs?” Thomas prompted.
“Yes.”
“I should say both knives,” Thomas amended. “The first is not the murder weapon, I’m sure of that. The second may certainly be. It, or another knife exactly like it.”
Eastman rested his chin on his crossed arms, and for a moment it appeared as if he were going asleep. “All right,” he said after a moment, and it was little more than a murmur. “Irwin Pedersen. You’ve met him yet?”
Race for the Dying Page 16
