by Jim Piecuch
When Eustace went into practice in London his earnings were good, but nowhere near enough to support the lifestyle he wished to lead, which ultimately inspired his innovations in medical practice. Physicians of his day called on patients in their homes, making their rounds on foot or by carriage. Some of the more prominent doctors had reduced the time spent traveling about by receiving patients in their offices on Harley Street, the home of London’s medical elite. Eustace figured that if he stopped making home visits altogether, he could see three or four times as many patients in a day, thereby tripling or quadrupling his income. There would be an additional benefit in that those patients who were able to come and see him would likely be in better health than those he saw at their homes, and thus would not tax his rather limited skills. And so Eustace had purchased the house on Harley Street, converted it into medical offices, and soon developed a thriving practice treating wealthy victims of gout and dyspepsia.
When Tim had joined Eustace’s practice, he had known his colleague only by reputation, and had expected to be working with a talented medical man. Tim soon learned that Eustace’s skills did not match his renown—he was competent to treat simple cases, but was neither brilliant nor dedicated to his profession. Upon becoming partners with Eustace and Dr. Humphrey Jones, Tim had taken over Jones’s ground-floor offices while Jones moved to the upper floor. Later, Tim learned that Jones could not abide Eustace and had taken the upstairs rooms to increase the distance from his partner. Less than a year after Tim had joined their practice, Jones left and returned to practicing on his own.
Eustace had made changes in the grounds to keep the practices separate. Two gates in the wrought-iron fence along the street opened into two walkways, one leading to Eustace’s rooms and the stairs to the upper floor, and the other to Tim’s office.
Tim stood and held the door open as Eustace entered his office, where they studied the week’s appointment book, diagnoses, treatments, and fees charged. Their contract required Tim every Saturday to pay his partner rent and twenty percent of fees collected, but Eustace often left early on Saturday or did not come in at all, so that Tim usually saw him only once or twice a month. Though not unfriendly, Eustace disliked trivial conversation, preferring to simply calculate and collect his fees and then leave. That done, he declined Tim’s invitation to his Christmas party, but did wish his young partner the joy of the season. “I shan’t be in on Christmas Eve, Dr. Cratchit,” he announced as he departed. “I’ll instruct my clerk to refer any emergency cases to you.” Tim grimaced; Eustace simply assumed that Tim would work all day on the twenty-fourth, never bothering to ask him if he had other intentions.
It was always the same, Tim thought. Christmas, the summer holiday, whenever Eustace decided he wanted a day or a fortnight off, he simply instructed Tim to take over his practice and expected him to do it. I’m not a partner in this practice, Tim mused. I’m just an employee.
Eustace angled across the lawn to his own walkway. His coach waited outside the gate. Eager to leave, the doctor flung the gate open with such force that it almost struck Ginny Whitson, who was trotting up the sidewalk as fast as she could, her child in her arms. She halted to let him pass, and he glared at her.
“Away with you,” he shouted, waving his arm in a dismissive gesture. “We want no trollops or beggars in this neighborhood. Go ply your trade among your own kind.” He climbed into his carriage, knocked twice on the roof, and his driver cracked the whip. The four perfectly matched black horses sped off.
Undeterred, Ginny waited for the carriage to drive out of sight and then continued to Tim’s door. He apologized for his partner’s behavior, but Ginny shrugged it off.
“It’s like that all the time for me, sir,” she remarked, “no need to get upset. But if I’m making trouble for you, Doctor, I won’t come ’round anymore.”
“You’re not the one who’s making the trouble,” Tim said, his tone carrying the bitterness he felt toward Eustace. The greedy physician hated Tim’s penchant for treating the occasional poor caller, since such patients could not pay and deprived Eustace of a commission. He had said as much to Tim on several occasions.
“That’s no way for a gentleman to behave,” Tim continued. As he spoke, Tim looked at Ginny, and his shock at her appearance immediately chased away his displeasure with his partner. A dark red slash crossed her forehead above her right eye, and her left cheek was bruised and swollen. Her lower lip was split, a bloody scab covering most of it. The blanket she had worn as a cloak was missing, and the shoulder of her frock was torn.
“What happened?” Tim asked. “Were you attacked?”
“Yes, sir, but it’s nothing for you to worry about,” she answered, his concern making her uncomfortable. Tim, however, pressed for an explanation, and, feeling obliged to him for his willingness to treat her son, Ginny reluctantly told the story.
“It was early this morning, Doctor. Jonathan and I had just started on our way here, and we passed a hot soup cart. I bought a cup of broth for the baby’s breakfast. There were two men standing across the street, and when they saw my bag of coins, they tried to steal them. I fought, but they were too strong. They hit me, stole the money and my cloak. But I’m all right, sir. The soup man was kind enough to give me another cup of broth, seeing as how the first one got spilled in the fight. At least Jonathan wasn’t hurt—I held on to him the whole time.”
“Were the constables able to find the men?” Tim inquired.
“I never called them, sir. I didn’t know the men who robbed me, and the peelers wouldn’t have done much for the likes of me, anyway. That’s just how it is.”
Once Tim had Ginny and her son in the consulting room, he cleaned her cuts and bandaged her forehead. Then he turned his attention to Jonathan. He carefully pressed and prodded the swelling, measured its size and its exact location on the boy’s back, and examined the surrounding area. Each time Tim touched the swollen point, Jonathan groaned. Ginny watched the procedure with intense interest. When Tim was done, he turned to her and excused himself.
“I need to check something in one of my books,” he explained. “I’ll be back in a moment.”
Tim stepped into the waiting room, closing the door behind him. He took a deep breath. He did not need to check anything. The diagnosis was clear. The boy had a fibrous tumor, and the fibers were beginning to impair function in the nerves leading to Jonathan’s diaphragm. That was the reason the boy had trouble breathing, and the problem would continue to worsen until he eventually died of asphyxiation. Without treatment, Jonathan had no more than one or two months to live, if Ginny had accurately described the tumor’s rate of growth. How could he tell a mother that her child was going to die? Tim barely knew Jonathan, yet he was overcome with sadness at the impending loss of a life that had barely begun. Ginny would be devastated. Tim decided to withhold the worst part of the diagnosis. He would do what he could in the following weeks to ease Jonathan’s pain, and slowly prepare her for what was to come.
After several calming breaths, Tim reentered the consulting room. Despite his effort to compose himself, his expression sent a wave of fear coursing through Ginny’s body.
“It’s bad, isn’t it, Doctor?”
“Yes, it is,” Tim conceded, wishing that he had been able to conceal that fact. “Jonathan has a fibrous tumor. It’s growing quickly, and some of the fibers are spreading from the main tumor into nearby parts of his body. The tumor and these tentacles are choking off the nerves and blood vessels, so that he can’t walk.”
“But you can do something to help Jonny, can’t you, Doctor?” Ginny pleaded.
“I’m not sure,” Tim said honestly. “This is a rare condition, very difficult to treat. I’m going to need time to do more research before I can promise anything. If I rush ahead, it’s likely to do more harm than good.”
Ginny began to cry. Tim wanted to console her, but the words would not come. How co
uld he raise false hopes, only to see them dashed within a short time? Aware that something was wrong, Jonathan also began to cry. Tim lifted the child from the examining table and held him to his chest, fighting back tears of his own.
One thing he could do, Tim knew, was keep Ginny and Jonathan off the streets, away from the danger and cold and hunger. Perhaps that would distract her from her child’s illness for a while, giving him time to try and find a remedy for Jonathan. Food and shelter would also help the little boy build up his strength, improving his odds of surviving if Tim decided to perform the surgery necessary to remove the tumor.
Ginny stood, took Jonathan from Tim, dressed her child, and wrapped him in the blanket fragment. Her tears had stopped, though she still sniffled as she addressed Tim.
“We’ll be going, then, Doctor,” she said in a surprisingly firm voice. “I’m sorry to have troubled you, but thank you for what you’ve done.” Despite her disappointment and tattered condition, her bearing reflected an inner dignity. All of the harshness of life on London’s streets had hardened her, but it had not yet destroyed her pride. She had the same mixture of defiance and resignation as the captain of a sinking ship who put on his dress uniform and stood at attention by the wheel, watching the churning waters inexorably rise about him yet refusing to wail and thrash against a fate he could not alter. Tim sensed that if Ginny could somehow find a way to overcome her circumstances, she would prove to be a remarkable person.
“Wait a moment,” Tim said as Ginny grabbed the knob of the consulting room door. “I didn’t say I couldn’t help Jonathan, only that I need more time to see how I can proceed without making him worse. There are books, and other doctors, I want to consult. Until I do, you must stay close by. The tumor is growing rapidly, and if it turns out I can operate, I have to do so as soon as possible.”
Ginny uttered a short, bitter laugh. “Sure, we’ll just set ourselves up right near your office and be very welcome. Hah! You heard what that gentleman told me when he saw us here.”
“He doesn’t speak for me,” Tim declared. “My coachman must be waiting outside, and he’ll take you and Jonathan home with me. Bridget, my maid, will have a meal for us, and then she and you can go shopping and get some warm clothes for you and the child. I’ll check with an old friend of mine, a vicar who runs St. Luke’s Mission, and see if he can give you a place there for the time being.”
Although Ginny found Tim’s proposal appealing, she hesitated to accept it. “That’s too much charity for us, Doctor, but thank you,” she replied.
“It’s not charity. The vicar will expect you to help at the mission to pay for your room and board. And it’s only common decency to make certain that you have warm clothes to wear and a safe place to stay after what happened to you this morning.”
Tim spoke so fervently that his kindness was difficult to refuse, but above all it was Ginny’s concern for her son that overcame her pride. Tim could see the inner struggle played out in her expressive face, and her slight smile told him that he had won the argument. “All right, Doctor,” she finally replied. “I accept, but you must let me pay you back for the clothes when I have the money.”
“If you insist, Miss Whitson,” he agreed. “Now come along, Jonathan, and you can ride in my coach. Would you like to see the horses? There are two of them, very big and strong.” Jonathan’s eyes flashed interest, although he said nothing. Tim realized that he had never heard the child speak a single word.
Tim escorted Ginny and Jonathan to the coach, where Henry waited patiently. The coats of the two geldings, newly brushed, shone in the thin afternoon sun. Ginny held Jonathan close to the head of the nearest horse, and the child extended a tentative hand. At his touch, the animal snorted, and Jonathan’s eyes widened in fear and he quickly pulled his arm back under the blanket. Tim, Ginny, and Henry laughed, which seemed to reassure the child. He reached out again, brushing his fingers against the horse’s neck. This time the horse remained still. Jonathan petted it, eyes shining, face still solemn. After a minute Ginny told him it was time to go, and stepped away from the animal.
“Nice hoss,” Jonathan whispered, and Ginny hugged him close to her.
At noon that Saturday, Bridget and William had shared dinner in the serving room of the Cratchit house. Henry had eaten earlier and left to post the Christmas party invitations before picking up the doctor. Pushing away his empty plate, William leaned back from the table, lit his pipe, and looked squarely at Bridget.
“So,” he said, “I take it you still haven’t told the doctor about you and Henry?”
Bridget shook her head. “Not yet, but I’ll do it soon.”
“That’s what you said last week,” William remarked.
“I was ready to tell him this morning if he had been in good spirits,” Bridget explained. “But the doctor was up and gone before I had the chance. If I was going to stay, it would be easier to tell him. I want to catch him in good spirits, so it won’t upset him.”
“If you wait for that,” William said, stroking his mustache, “you might die an old maid. You and Henry can’t even set a date for the wedding until you tell the doctor that you’re leaving his service to set up housekeeping for yourself. I’m surprised he hasn’t already noticed there’s something going on. When you and Henry are together, you’re so sweet I don’t need to add sugar to my tea!”
Bridget laughed. “Don’t you have a hedge to trim or something?”
“Nothing at all to do, my dear, except help you manage your affairs of the heart.”
William left to take a nap, and Bridget went upstairs to tidy Tim’s study. She was surprised to find a child’s rough wooden crutch leaning against the fireplace. Assuming it belonged to one of the doctor’s patients, she left it there and was dusting the mantel when she heard the front door open.
As she reached the top of the stairs, Bridget noticed that Tim was accompanied by a poor woman with a battered face and her child. Tim explained the situation to her, and Bridget said that she would be happy to take the pair shopping after they had eaten. She set out beef and bread before sitting at the dining room table with their guests. Henry joined them after giving the horses a drink. Tim, who had not eaten all day, devoured two thick sandwiches.
“I have to do some work upstairs,” he announced when he had finished. He gave Bridget several gold sovereigns along with a look indicating that she should not stint in purchasing clothes and other necessities for Ginny and Jonathan. Henry also received a sovereign to compensate him for undertaking the extra journey, although he seemed quite happy to go. Tim then bade them good-bye and went upstairs, intending to scour the Lancet and his other journals for information on Jonathan’s condition.
Busy formulating his research plans, Tim had seated himself at his desk before he realized that the office had been subtly altered. The furniture had been dusted, books neatly stacked, and he involuntarily leaped to his feet when suddenly startled. Three days before, he had imagined seeing his crutch in the office, but this was not a hallucination. The crutch was real.
Tim walked over and picked up the crude device, noting that parts had been worn smooth where a child’s hand had gripped it and an arm had rested heavily upon it. There was no mistaking that it was his childhood crutch. What is it doing here? he wondered. Surely Bridget would not have put it there. She never touched anything of his except in the course of her duties, and even then, she always asked before handling his personal things. He thought back to Wednesday night, and his dream, or flight of imagination, whatever the vision had been. Had he gotten the crutch while sleepwalking, and left it there? That would explain the sense of reality that still marked the experience three days later. Yet, he did not recall seeing the crutch when he roused himself from his reverie that night, and he had been in the office several times since and never noticed it. And then what of last night when he saw, or imagined he saw, his father and old Scrooge in their former of
fice? Tim resolved to cancel all his appointments on the day after Christmas and rest. Exhaustion, he decided, had to be the cause of these hallucinations. Either that or, he feared, he was beginning to lose his mind.
His medical training enabled Tim to put aside distractions and focus on the problems at hand, and this he did. He began by pulling several British, Continental, and American medical directories from a bookshelf. Next he took a stack of telegraph forms from his desk drawer. He filled out four, briefly describing Jonathan’s condition on each of them and asking for advice on its treatment. The first went to a prominent surgeon in Edinburgh who had once been Tim’s instructor, the second to a specialist in New York, and the third to a renowned medical researcher in Berlin. The fourth seemed to promise the best chance of success. Several years earlier, Tim had met Monsieur Jean-Pierre de Valmont at a medical conference in Paris. A pioneer in the study of the nervous system, Valmont had written a book on the topic that had become the standard guide for surgical procedures on or near the spine. Tim offered to pay the specialist’s fees and expenses if he was willing to come from Paris to operate on Jonathan. When the forms were completed, Tim went in search of William, finding the gardener in the servants’ pantry enjoying the leftover sandwiches. William finished his snack and left to send the telegrams, while Tim returned to his office.
Casting a sidelong glance at the crutch, Tim returned to the desk and paged through his British medical directory. He pored over each name, eventually compiling a list of a half dozen London physicians and surgeons who might have useful advice to offer. He briefly considered calling on them in person, but realized that neither he nor they had the time. He retrieved the telegraph forms from the drawer, completed six more, and had just reached the foyer when William entered the house.
