The Doctor Stories

by William Carlos Williams

  I made the examination and found the head high but the cervix fully dilated. Oh yeah. It often happens in women who have had many children; pendulous abdomen, lack of muscular power resulting in a slight misdirection of the forces of labor and the thing may go on for days.

  When I finished, Angelina got up and sat on the edge of the bed. I went back to the kitchen, the candle following me, leaving the room dark again.

  Do you need it any more? the sister-in-law said, I’ll put it out.

  Then the husband spoke up, Ain’t you got but that one candle?

  No, said the sister.

  Why didn’t you get some at the store when you woke him up; use your head.

  The woman had the candle in a holder on the cold coal range. She leaned over to blow it out but misdirecting her aim, she had to blow three times to do it. Three or four times.

  What’s the matter? said her brother, getting weak? Old age counts, eh Doc? he said and got up finally to go out.

  We could hear an engineer signaling outside in the still night—with short quick blasts of his whistle—very staccato—not, I suppose, to make any greater disturbance than necessary with people sleeping all about.

  Later on the freights began to roar past shaking the whole house.

  She doesn’t seem to be having many strong pains, I said to my companion in the kitchen, for there wasn’t a sound from the labor room and hadn’t been for the past half hour.

  She don’t want to make no noise and wake the kids.

  How old is the oldest now? I asked.

  He’s sixteen. The girl would have been eighteen this year. You know the first one you took from her.

  Where are they all?

  In there, with a nod of the head toward the other room of the apartment, such as it was, the first floor of an old two-story house, the whole thing perhaps twenty-five feet each way.

  I sat in a straight chair by the kitchen table, my right arm, bare to the shoulder, resting on the worn oil cloth.

  She says she wants an enema, said the woman. O.K. But I don’t know how to give it to her. She ain’t got a bed-pan or nothing. I don’t want to get the bed all wet.

  Has she had a movement today?

  Yeah, but she thinks an enema will help her.

  Well, have you got a bag?

  Yeah, she says there’s one here somewhere.

  Get it. She’s got a chamber pot here, hasn’t she?

  Sure.

  So the woman got the equipment, a blue rubber douche bag, the rubber of it feeling rather stiff to the touch. She laid it on the stove in its open box and looked at it holding her hands out helplessly. I’m afraid, she said.

  All right, you hold the candle. Mix up a little warm soapy water. We’ll need some vaseline.

  The woman called out to us where to find it, having overheard our conversation.

  Lift up, till I put these newspapers under you, said my assistant. I don’t want to wet the bed.

  That’s nothing, Angelina answered smiling. But she raised her buttocks high so we could fix her.

  Returning ten minutes later to my chair, I saw the woman taking the pot out through the kitchen and upstairs to empty it. I crossed my legs, crossed my bare arms in my lap also and let my head fall forward. I must have slept, for when I opened my eyes again, both my legs and my arms were somewhat numb. I felt deliciously relaxed though somewhat bewildered. I must have snored, waking myself with a start. Everything was quiet as before. The peace of the room was unchanged. Delicious.

  I heard the woman and her attendant making some slight sounds in the next room and went in to her.

  Examining her, I found things unchanged. It was about half past four. What to do? Do you mind if I give you the needle? I asked her gently. We’d been through this many times before. She shrugged her shoulders as much as to say, It’s up to you. So I gave her a few minims of pituitrin to intensify the strength of the pains. I was cautious since the practice is not without danger. It is possible to get a ruptured uterus where the muscle has been stretched by many pregnancies if one does not know what one is doing. Then I returned to the kitchen to wait once more.

  This time I took out the obstetric gown I had brought with me, it was in a roll as it had come from the satchel, and covering it with my shirt to make a better surface and a little more bulk, I placed it at the edge of the table and leaning forward, laid my face sidewise upon it, my arms resting on the table before me, my nose and mouth at the table edge between my arms. I could breathe freely. It was a pleasant position and as I lay there content, I thought as I often do of what painting it was in which I had seen men sleeping that way.

  Then I fell asleep and, in my half sleep began to argue with myself—or some imaginary power—of science and humanity. Our exaggerated ways will have to pull in their horns, I said. We’ve learned from one teacher and neglected another. Now that I’m older, I’m finding the older school.

  The pituitary extract and other simple devices represent science. Science, I dreamed, has crowded the stage more than is necessary. The process of selection will simplify the application. It touches us too crudely now, all newness is over-complex. I couldn’t tell whether I was asleep or awake.

  But without science, without pituitrin, I’d be here till noon or maybe—what? Some others wouldn’t wait so long but rush her now. A carefully guarded shot of pituitrin—ought to save her at least much exhaustion—if not more. But I don’t want to have anything happen to her.

  Now when I lifted my head, there was beginning to be a little light outside. The woman was quiet. No progress. This time I increased the dose of pituitrin. She had stronger pains but without effect.

  Maybe I’d better give you a still larger dose, I said. She made no demur. Well, let me see if I can help you first. I sat on the edge of the bed while the sister-in-law held the candle again glancing at the window where the daylight was growing. With my left hand steering the child’s head, I used my ungloved right hand outside on her bare abdomen to press upon the fundus. The woman and I then got to work. Her two hands grabbed me at first a little timidly about the right wrist and forearm. Go ahead, I said. Pull hard. I welcomed the feel of her hands and the strong pull. It quieted me in the way the whole house had quieted me all night.

  This woman in her present condition would have seemed repulsive to me ten years ago—now, poor soul, I see her to be as clean as a cow that calves. The flesh of my arm lay against the flesh of her knee gratefully. It was I who was being comforted and soothed.

  Finally the head began to move. I wasn’t sorry, thinking perhaps I’d have to do something radical before long. We kept at it till the head was born and I could leave her for a moment to put on my other glove. It was almost light now. What time is it? I asked the other woman. Six o’clock, she said.

  Just after I had tied the cord, cut it and lifted the baby, a girl, to hand it to the woman, I saw the mother clutch herself suddenly between her thighs and give a cry. I was startled.

  The other woman turned with a flash and shouted, Get out of here, you damned kids! I’ll slap your damned face for you. And the door through which a head had peered was pulled closed. The three-year-old on the bed beside the mother stirred when the baby cried at first shrilly but had not wakened.

  Oh yes, the drops in the baby’s eyes. No need. She’s as clean as a beast. How do I know? Medical discipline says every case must have drops in the eyes. No chance of gonorrhoea though here—but—Do it.

  I heard her husband come into the kitchen now so we gave him the afterbirth in a newspaper to bury. Keep them damned kids out of here, his sister told him. Lock that door. Of course, there was no lock on it.

  How do you feel now? I asked the mother after everything had been cleaned up. All right, she said with the peculiar turn of her head and smile by which I knew her.

  How many is that? I asked the other woman. Five boys and three girls, she said. I’ve forgotten how to fix a baby, she went on. What shall I do? Put a little boric acid powder on the b
elly button to help dry it up?

  Jean Beicke

  DURING A TIME like this, they kid a lot among the doctors and nurses on the obstetrical floor because of the rushing business in new babies that’s pretty nearly always going on up there. It’s the Depression, they say, nobody has any money so they stay home nights. But one bad result of this is that in the children’s ward, another floor up, you see a lot of unwanted children.

  The parents get them into the place under all sorts of pretexts. For instance, we have two premature brats, Navarro and Cryschka, one a boy and one a girl; the mother died when Cryschka was born, I think. We got them within a few days of each other, one weighing four pounds and one a few ounces more. They dropped down below four pounds before we got them going but there they are; we had a lot of fun betting on their daily gains in weight but we still have them. They’re in pretty good shape though now. Most of the kids that are left that way get along swell. The nurses grow attached to them and get a real thrill when they begin to pick up. It’s great to see. And the parents sometimes don’t even come to visit them, afraid we’ll grab them and make them take the kids out, I suppose.

  A funny one is a little Hungarian Gypsy girl that’s been up there for the past month. She was about eight weeks old maybe when they brought her in with something on her lower lip that looked like a chancre. Everyone was interested but the Wassermann was negative. It turned out finally to be nothing but a peculiarly situated birthmark. But that kid is still there too. Nobody can find the parents. Maybe they’ll turn up some day.

  Even when we do get rid of them, they often come back in a week or so—sometimes in terrible condition, full of impetigo, down in weight—everything we’d done for them to do over again. I think it’s deliberate neglect in most cases. That’s what happened to this little Gypsy. The nurse was funny after the mother had left the second time. I couldn’t speak to her, she said. I just couldn’t say a word I was so mad. I wanted to slap her.

  We had a couple of Irish girls a while back named Cowley. One was a red head with beautiful wavy hair and the other a straight haired blonde. They really were good looking and not infants at all. I should say they must have been two and three years old approximately. I can’t imagine how the parents could have abandoned them. But they did. I think they were habitual drunkards and may have had to beat it besides on short notice. No fault of theirs maybe.

  But all these are, after all, not the kind of kids I have in mind. The ones I mean are those they bring in stinking dirty, and I mean stinking. The poor brats are almost dead sometimes, just living skeletons, almost, wrapped in rags, their heads caked with dirt, their eyes stuck together with pus and their legs all excoriated from the dirty diapers no one has had the interest to take off them regularly. One poor little pot we have now with a thin purplish skin and big veins standing out all over its head had a big sore place in the fold of its neck under the chin. The nurse told me that when she started to undress it it had on a shirt with a neckband that rubbed right into that place. Just dirt. The mother gave a story of having had it in some sort of home in Paterson. We couldn’t get it straight. We never try. What the hell? We take ’em and try to make something out of them.

  Sometimes, you’d be surprised, some doctor has given the parents a ride before they bring the child to the clinic. You wouldn’t believe it. They clean ’em out, maybe for twenty-five dollars—they maybe had to borrow—and then tell ’em to move on. It happens. Men we all know too. Pretty bad. But what can you do?

  And sometimes the kids are not only dirty and neglected but sick, ready to die. You ought to see those nurses work. You’d think it was the brat of their best friend. They handle those kids as if they were worth a million dollars. Not that some nurses aren’t better than others but in general they break their hearts over those kids, many times, when I, for one, wish they’d never get well.

  I often kid the girls. Why not? I look at some miserable specimens they’ve dolled up for me when I make the rounds in the morning and I tell them: Give it an enema, maybe it will get well and grow up into a cheap prostitute or something. The country needs you, brat. I once proposed that we have a mock wedding between a born garbage hustler we’d saved and a little female with a fresh mug on her that would make anybody smile.

  Poor kids! You really wonder sometimes if medicine isn’t all wrong to try to do anything for them at all. You actually want to see them pass out, especially when they’re deformed or—they’re awful sometimes. Every one has rickets in an advanced form, scurvy too, flat chests, spindly arms and legs. They come in with pneumonia, a temperature of a hundred and six, maybe, and before you can do a thing, they’re dead.

  This little Jean Beicke was like that. She was about the worst you’d expect to find anywhere. Eleven months old. Lying on the examining table with a blanket half way up her body, stripped, lying there, you’d think it a five months baby, just about that long. But when the nurse took the blanket away, her legs kept on going for a good eight inches longer. I couldn’t get used to it. I covered her up and asked two of the men to guess how long she was. Both guessed at least half a foot too short. One thing that helped the illusion besides her small face was her arms. They came about to her hips. I don’t know what made that. They should come down to her thighs, you know.

  She was just skin and bones but her eyes were good and she looked straight at you. Only if you touched her anywhere, she started to whine and then cry with a shrieking, distressing sort of cry that no one wanted to hear. We handled her as gently as we knew how but she had to cry just the same.

  She was one of the damnedest looking kids I’ve ever seen. Her head was all up in front and flat behind, I suppose from lying on the back of her head so long the weight of it and the softness of the bones from the rickets had just flattened it out and pushed it up forward. And her legs and arms seemed loose on her like the arms and legs of some cheap dolls. You could bend her feet up on her shins absolutely flat—but there was no real deformity, just all loosened up. Nobody was with her when I saw her though her mother had brought her in.

  It was about ten in the evening, the interne had asked me to see her because she had a stiff neck, and how! and there was some thought of meningitis—perhaps infantile paralysis. Anyhow, they didn’t want her to go through the night without at least a lumbar puncture if she needed it. She had a fierce cough and a fairly high fever. I made it out to be a case of broncho-pneumonia with meningismus but no true involvement of the central nervous system. Besides she had inflamed ear drums.

  I wanted to incise the drums, especially the left, and would have done it only the night superintendent came along just then and made me call the ear man on service. You know. She also looked to see if we had an operative release from the parents. There was. So I went home, the ear man came in a while later and opened the ears—a little bloody serum from both sides and that was that.

  Next day we did a lumbar puncture, tapped the spine that is, and found clear fluid with a few lymphocytes in it, nothing diagnostic. The X-ray of the chest clinched the diagnosis of broncho-pneumonia, there was an extensive involvement. She was pretty sick. We all expected her to die from exhaustion before she’d gone very far.

  I had to laugh every time I looked at the brat after that, she was such a funny looking one but one thing that kept her from being a total loss was that she did eat. Boy! how that kid could eat! As sick as she was she took her grub right on time every three hours, a big eight ounce bottle of whole milk and digested it perfectly. In this depression you got to be such a hungry baby, I heard the nurse say to her once. It’s a sign of intelligence, I told her. But anyway, we all got to be crazy about Jean. She’d just lie there and eat and sleep. Or she’d lie and look straight in front of her by the hour. Her eyes were blue, a pale sort of blue. But if you went to touch her, she’d begin to scream. We just didn’t, that’s all, unless we absolutely had to. And she began to gain in weight. Can you imagine that? I suppose she had been so terribly run down that food, real f
ood, was an entirely new experience to her. Anyway she took her food and gained on it though her temperature continued to run steadily around between a hundred and three and a hundred and four for the first eight or ten days. We were surprised.

  When we were expecting her to begin to show improvement, however, she didn’t. We did another lumbar puncture and found fewer cells. That was fine and the second X-ray of the chest showed it somewhat improved also. That wasn’t so good though, because the temperature still kept up and we had no way to account for it. I looked at the ears again and thought they ought to be opened once more. The ear man disagreed but I kept after him and next day he did it to please me. He didn’t get anything but a drop of serum on either side.

  Well, Jean didn’t get well. We did everything we knew how to do except the right thing. She carried on for another two—no I think it was three—weeks longer. A couple of times her temperature shot up to a hundred and eight. Of course we knew then it was the end. We went over her six or eight times, three or four of us, one after the other, and nobody thought to take an X-ray of the mastoid regions. It was dumb, if you want to say it, but there wasn’t a sign of anything but the history of the case to point to it. The ears had been opened early, they had been watched carefully, there was no discharge to speak of at any time and from the external examination, the mastoid processes showed no change from the normal. But that’s what she died of, acute purulent mastoiditis of the left side, going on to involvement of the left lateral sinus and finally the meninges. We might, however, have taken a culture of the pus when the ear was first opened and I shall always, after this, in suspicious cases. I have been told since that if you get a virulent bug like the streptococcus mucosus capsulatus it’s wise at least to go in behind the ear for drainage if the temperature keeps up. Anyhow she died.

  I went in when she was just lying there gasping. Somehow or other, I hated to see that kid go. Everybody felt rotten. She was such a scrawny, misshapen, worthless piece of humanity that I had said many times that somebody ought to chuck her in the garbage chute—but after a month watching her suck up her milk and thrive on it—and to see those alert blue eyes in that face—well, it wasn’t pleasant. Her mother was sitting by the bed crying quietly when I came in, the morning of the last day. She was a young woman, didn’t look more than a girl, she just sat there looking at the child and crying without a sound.