City of God (28 page)

“Calm yourself, Dr. Turner. I thought the sacrifice of patients was exactly what we were seeking to avoid. The aldermen are to witness a surgery conducted in the most peaceful way possible, with the patient sound asleep and feeling nothing. What can be wrong with that?”

“What’s wrong is that you’re making medical care a traveling circus. I won’t—”

Ben Klein cleared his throat. Then did so a second time. Nick and Tobias Grant stopped shouting at each other and turned to him.

“It’s only a suggestion, sir,” Ben said, “but perhaps Dr. Grant could bring the members of the Common Council to us. They could witness an operation performed under ether right here in Bellevue Hospital.”

“I’ve asked Dr. Turner if I may bring you, Addie, and he says I may. Since members of the public are in any case being admitted to watch.”

“The aldermen, you said.”

“That’s right, Addie.” Manon went on with her darning while she spoke. “Along with you. Because Dr. Turner said you may.”

“But why would I want to? I don’t want to go back to the almshouse.”

“Don’t be ridiculous, Addie. You’re not going back to stay. Only to observe an operation performed painlessly. It’s truly remarkable.”

“Even if it is, I don’t want to.”

“Why not?”

“I mentioned about that little girl. At church.”

“Oh yes?”

“About her sleeping right through having her leg sawed off. I told Reverend Finney and some of the others.”

Manon bit through a length of thread and rolled it into a knot with her thumb and forefinger. Addie Bellingham frequently drove her mad, but the woman had nowhere else to go, and having taken her on, Manon could see no way to get out of being responsible for her. Addie must be incorporated into her plans for the dispensary which, Manon realized, Addie already knew about because she listened at keyholes. Nonetheless, it would be best if she was convinced it was in her best interest. Manon saw herself giving up these rooms and living in the dispensary once it got started, so Addie must live there as well. “And what did they say at your church, Addie?”

“That man is meant to suffer. That it’s God’s law. That the little girl had to have been paying for her sins, and that we shouldn’t be trying to change everything to suit us rather than God.”

“Well, leaving aside the matter of a six-year-old paying for her sins, suppose you do as I ask and come along and watch. Just this once. Then you can decide for yourself what you think to be the law of God.”

According to Tobias Grant seven aldermen had consented to attend, so the director’s room off the lobby wouldn’t be large enough. “Leave that to me, Dr. Turner. I will arrange a proper location for your demonstration. You just select the patient.”

Nick already had. He was Patrick Shaughnessey, a porter thrown out of work by the fire. He had a growth on his shoulder so big it reached almost to his ear and forced him to hold his head to one side all the time. By the time the town’s recovery had made work for porters plentiful, the tumor had become so unsightly no one would hire him.

“Observe, gentlemen,” Nick had told the other doctors and the medical students the first time he examined Shaughnessey, “this tumor, if such it is, is movable.” He could shift it slightly with his fingers. “That means it is not an osteosarcoma. What would it be if it were? Can one of you students tell me?”

“A cancer,” one of them said.

“Exactly. Cancer from the Greek for crab,
karkinos
, because of the swollen veins resembling the legs of that creature. ‘Osteo’ is also from the Greek, from
osteon
for bone. But here on Patrick Shaughnessey’s shoulder we have, as you can see, no swollen veins, simply a rough-textured and blackened series of bumps that have formed themselves into one ugly whole. And since the thing moves enough for me to all but get my finger underneath it, it cannot be connected to the bone. It is not properly speaking a tumor, gentlemen, it is a cyst. A sac attached to muscle and skin that is filled with sebaceous matter, fatty stuff produced by the body itself.”

Nick leaned over his patient. “What do you say, Patrick? Will you give me permission to take off this thing?” He didn’t need to ask permission. Nick could administer any treatment he thought necessary for a resident in the almshouse. Still, on this occasion he’d rather not have Shaughnessey dragged kicking and screaming to the operating table. “I can promise you won’t feel a thing.”

“Sure and it’s hard to think how much worse things could be, Dr. Turner. If you can get this thing off me neck, I’d think meself blessed by all the saints, however much I suffered in the doing of it. If it’s to be painless, well…”

Nick had already taken a brief whiff of the canister of sulfuric ether supplied by Ben Klein’s friend the chemist. It was Mr. Grave’s Somnus, no question. “Absolutely painless, Patrick. You’ll sleep through the entire thing and wake up with the lump gone and only a bandage on your neck. I guarantee it.”

He needed only one assistant for this sort of surgery. Nick chose Ben Klein. Monty Chance wouldn’t be pleased, he was after all the more senior of the two residents, but if it were not for Ben the whole thing wouldn’t be happening. The younger man deserved a share in the glory. “Someone has to be in charge of the hospital while we’re operating, Dr. Chance. Your greater experience makes you the man for that job.”

“I hear you’re to do the surgery in the director’s cottage.”

Nick grimaced. “So they tell me. I wanted it to be here in the hospital. But it’s all of us in the director’s cottage,” he said, “and you, Dr. Chance, in complete charge of the hospital while I’m away.”

“Who would think there would be any place looked like this at the almshouse?” Addie spoke in hushed tones of wonder. The front parlor of the director’s cottage had been cleared of much of its furniture, but the windows were curtained in dark blue velvet trimmed with gold tassels, a flowered Turkey carpet still covered the floor, and a dozen gilt and damask chairs had been set in front of a long table spread with a floor-length satin cloth. Addie pointed to the table. “Is that where he’s going to do it?”

“It appears so,” Manon said. “Though I cannot imagine a less appropriate arrangement. Come, Addie. We’re to watch from this little cloakroom. That was the agreement.”

“Not in here?” Having gotten a look at the grand front parlor, Addie did not wish to be immediately banished from it.

“Definitely not. That’s why we had to come early. The aldermen would be shocked to see women present at a surgery. We must be discreet.”

Two chairs had already been placed in the cloakroom, which was apparently also a staging area for the operation to come. There was a table below the small room’s single window spread with surgical equipment. Addie stared at the array of knives and other things to which she could give no name and went quite pale. “To think of human flesh being butchered in such a—”

“It’s nothing to do with butchery, Addie. It is life-saving medicine. That is the Somnus,” Manon pointed to the metal canister. “It allows the patient to be put to sleep before the surgery begins. It’s quite wonderful, Addie. A miracle. I so wish you would understand. Here, you look quite pale. I’ll open the window and let in some fresh air.”

It was considerably milder now that it was almost April and spring had officially arrived. The cloakroom was in fact close and stuffy. “Sit down, Addie.” Addie did so, averting her eyes from the array of scalpels
positioned exactly at her elbow. “There, that’s better.” Manon spied a pile of blankets and a pillow. “And that’s what’s meant to cover the operating table, not that ridiculous silk cloth.” She went to the door; there was still no one in the front parlor. “I’ll just nip out and arrange things.”

Manon picked up the blankets and a pillow and left the cloakroom.

Addie considered for a moment, possibly two. Then, with no further hesitation, she pulled the cork from the metal canister and emptied the contents out the open window, after which she replaced the cork and put the canister back where it had been.

T
EN MINUTES INTO
the surgery. Nick had used a four-inch scalpel to cut around the diameter of the sebaceous cyst in the place where it was connected to the shoulder and the neck. He’d heard gasps from his audience as soon as he’d begun, and someone retching when there was a spurt of blood before he managed to clamp off an artery. Other than that he was able to ignore the roomful of onlookers and concentrate on his work.

Just oozing blood now, and Ben Klein deftly sopping that. Nick took the bulk of the lump off in slices, dropping each into the basin Ben held close to the table. Interesting to get a look at those under a microscope later.

He’d spotted the reporter, Henry Morrison, with his notebook and his pencil in the back row. Grant’s idea no doubt. Still trying to get the tale into the papers.

Movement behind him. Someone had taken a step closer to the operating table. One of the less squeamish of the aldermen probably. “Here,” a voice said, “how do we know it isn’t a corpse he’s cutting?”

“You’d not think so if you had arrived when we began, sir.” Tobias Grant, from his vantage point in the back row next to the reporter. “The patient was ambulatory before the operation began. He walked into the room and climbed up on the table on his own.”

“True,” someone else said.

Shaughnessey was peaceful, breathing quietly. Christ with this sort of procedure who could tell if a man went into shock? “The stethoscope, Dr. Klein. If you please.”

Ben took his stethoscope from his pocket and pressed it to Shaughnessey’s chest. “Slow and steady, Dr. Turner,” he said after he’d listened for a bit.

“Excellent. Thank you.”

A miracle indeed. Let the tight-fisted members of the bloody Common Council get a gander at this. Envy of the medical world this would be. And while they were about it, the aldermen could note as well the luxury of this house compared to the squalor everywhere else. Maybe after the operation was done he’d invite them to tour Bellevue. Grant wouldn’t like it, but what could he say? Particularly if the invitation was made while Nick and Ben were basking in the congratulations sure to come. But finish the job first.

Nick reached for his smallest scalpel, a triangular blade only an inch long, and began delicately to cut the thin skin of the neck just below the ear. Absolutely marvelous to be able to take his time, to cut as slowly as care demanded, not swiftly so the patient could withstand the agony. Not just a miracle, a blessing for all concerned. When he completed this last process the visible part of Patrick Shaughnessey’s lump would be gone. After that, time to excise the root of the sac lodged in the intermuscular membrane of the shoulder itself. Give it five, maybe six, minutes of careful cutting; with the time needed to tie off the veins and arteries and sew up the wound, say another fifteen minutes. Then—

His patient moaned softly. And a second time. “Dr. Klein, more ether.”

“Yes, sir.” Ben put down the basin holding the pieces of the cyst and
reached for the canister. He pulled the cork and grabbed the wad of bandages he had used previously. Nick stopped cutting, waiting for Ben to put the patient back to sleep.

Ben was acutely conscious of being watched. He tried not to look concerned. He’d thought the canister lighter than it should be when the operation began, but it was too late then to say anything, and it was anyway remarkably light to begin with. Very volatile, his friend the chemist had explained, lighter than water and highly flammable. Important not to allow anyone to smoke when there was ether around. Smoking,
Hashem
help him, was not the immediate problem.

Ben turned the canister upside down over the folded cloth and shook it. Nothing seemed to be coming out. Dr. Turner looked at him. Ben avoided his glance and stared over his chief’s shoulder at the aldermen and Dr. Grant and the man he now knew to be a reporter for the
Sun. Hashem
help him and Dr. Turner and poor Shaughnessey the patient, who was moaning more loudly now.

Everyone was watching him. Ben was careful to keep his face expressionless.

Patrick Shaughnessey moaned a third time. And opened his eyes.

Ben gave the canister one last shake, then held the cloth over the lower half of the Irishman’s face, pressing it firmly into place over the nose and the mouth. “Take deep breaths,” he murmured. “Deep as you can.” The Irishman complied, or at least he seemed to, but he didn’t immediately go back to sleep, just moaned again. Forcefully enough this time so that the sound could be called a groan. Ben grabbed the canister itself and held it right under Shaughnessey’s nose. “Inhale,” he said in an urgent whisper. “As strongly as you can.”

Shaughnessey did as he was told. His eyes closed.

Nick breathed a sigh of relief and went back to work with his scalpel.

Patrick Shaughnessey emitted a scream loud enough to wake the dead at home in faraway Galway.

“I told you to stop, but you did not.”

“I had a man lying on a table with his neck and shoulder sliced open. How in holy heaven could I stop? He could have died if I hadn’t finished. Aren’t you doctor enough to know that?” With each word Nick was conscious of how much he was making things worse. Grant’s eyes became more opaque and his face more frozen in an expression that had passed mere disapproval and become rage.

“You embarrassed me in front of seven aldermen and a reporter. I invited distinguished guests to witness a painless surgery, and they finished up listening to a man howling in agony. If they wanted to hear such things, they would have become doctors themselves. Damn you, Turner, you could have stopped and finished later.”

“I got Shaughnessey’s permission to continue. You heard me do so. If I had waited he might—”

“His
permission?
What do I care for the permission of a convicted felon who then disgusted all present by vomiting on my carpet?”

“Vomiting after the inhalation of ether appears to be the norm, Dr. Grant. We shall make proper provision for it in future. And I believe Mrs. Turner prevented there being too much damage to your carpet.”

“Mrs. Turner! Indeed, as if everything wasn’t already bad enough, to have a woman come running out of the cloakroom. A woman thought to be a lady, no less.”

“As you know, she’s an experienced nurse. She wished to be of what help she could while Dr. Klein and I were occupied with the surgery.”

“Ah, yes, Dr. Klein. And what do you have to say about all this?”

“I’ve already explained, sir. There wasn’t enough ether in the canister when we began operating, only I didn’t realize that. It’s liquid but it’s very volatile, sir. That means it acts like a gas. I can only think that the cork wasn’t tightly enough in the canister after I collected it from the chemist yesterday and the stuff evaporated.”

“This chemist is a friend of yours, isn’t he Dr. Klein?”

“An acquaintance, Dr. Grant.”

“Another Jew is he?”

Ben had been looking Tobias Grant straight in the eye. The way Papa always told him an honest man should behave when talking to anyone, whether higher or lower in status. Now he forced himself to look at the wall over Grant’s shoulder so he could control the urge to punch the old fool in the face. “No, as it happens, Dr. Grant, he is not.”

“I don’t believe you. I think he must be a Jew. And everyone knows your kind will do ill to Christians any opportunity you get. You will leave the employ of this hospital immediately, Dr. Klein. And you, Dr. Turner, should consider yourself on probation until I—”

“If you discharge Dr. Klein,” Nick said, “I resign from my post. You keep us both or lose us both. Your choice, Dr. Grant.”

Ben was horrified. “Dr. Turner! You don’t have to do that, sir. It was my fault. I should have told you the canister felt light before you started.”

“Be quiet, Ben. We must give Dr. Grant an opportunity to consider his options. How important is it to have the latest of a long line of Doctors Turner running his miserable excuse for a hospital? How much is that kind of cover worth to you, Grant? Surely as much as the employment of one young resident. Both of us or neither of us. It’s up to you.”

“Get out. Both of you. Pack your things and leave Bellevue.”

“I gambled,” Nick said, “and I lost. It’s as simple as that.”

“But it’s not simple at all.” Manon had sent Addie to Vandam Street on her own and waited for Nick in the hospital. “What will happen to this place if you leave?”

“It will go on, Manon. It can’t be much worse than it is.”

“Oh yes it can,” she said grimly. “You don’t know what it was like before you came. You’ve made a great difference here, however much Tobias Grant tried to tie your hands. Where is Dr. Klein?”

“He left straight after the meeting. I said I’d send his belongings to his home. Poor fellow’s distraught. Blames himself.”

“That’s not fair.”

Nick shrugged. “No, but it’s natural, given his youth and inexperience. It’s Tobias Grant who is the idiot. He’s the one who didn’t understand that working with something so new is bound to involve some setbacks. He was a fool for insisting we do what was only our second painless surgery with an audience. And I was doubly a fool for agreeing to it.”

“You did what you thought best. And I know it was wrong for Dr. Grant to discharge Dr. Klein, Cousin Nicholas, but you’re so much needed at Bellevue. Can’t you reconsider?”

“No, dear Manon, I cannot. Not under the conditions that exist at the moment. What this place needs is a complete top to bottom turn-out. And if it makes you feel any better, Cousin Manon, I have lost the battle, but not the war. I do not intend to give up.”

Here it was then, the reason for coming to number three East Fourteenth Street that he’d been unable to find in the sixteen months since the fire. Though not the one he would have wanted. Nick rang the bell.

Apparently the forbidden to pass order placed on him previously had been lifted. Dorothy showed him into the front parlor and left to get her mistress. Minutes later Carolina arrived.

“Your visit is a surprise, Cousin Nicholas.”

What had happened to the less formal Cousin Nick? Burned up in that bloody fire like so much else. “I’m sure it is, and frankly, I didn’t send a note because I feared you’d tell me not to come.”

Carolina had turned to close the double doors to the hall and she hesitated briefly before swinging round to face him. “Now why ever would I do that? Shall I send for tea?”

“No, dear Carolina. Don’t trouble yourself. I shan’t stay long. I’ll get to my business straightaway, but first tell me how you are, how you’ve been.” She wore dark gray today, with her fair hair drawn back in a strict bun. It was the first time he’d not seen her in the lovely rich colors that so suited her. Beautiful still, but different.

“I am well, Cousin Nicholas. And I’m sorry not to have seen you
in such a long time. I was confined last year. Perhaps my husband told you.” She did not look at him when she spoke.

“I haven’t seen Cousin Samuel either.” He started to say that he’d not seen Devrey since he last saw her, then thought better of it. “But I did hear that you’ve a new daughter. Congratulations.”

That, at least, was rewarded with a direct glance and a bright smile. “Thank you. We call her Ceci. She’s princess of the house, I’m afraid. Even little Zac adores her.”

“Yes, I’m sure.” She had crossed the room and come to stand close enough for him to smell her scent, a flower or flowers he could not name but would recognize anywhere now and always associate with her. “Can we sit down? Only for a few minutes, I promise.”

“Yes, of course. I’m sorry to be so rude. Here by the fire, Cousin Nicholas. Perhaps a glass of sherry wine?”

“Nothing, thank you.”

Carolina could not think of another thing to say. She sat across from him and folded her hands in her lap the way Aunt Lucy had always told her a lady must. Though it was hard to imagine that Nick Turner could still think her a lady. If her own husband valued her so little, as Nick above all people knew to be the case, she must surely be to blame. “It’s a bit milder now, isn’t it? Such a welcome change after the long winter.”

“A bit milder, yes. Still quite a nip in the air, however.”

Carolina caught herself making pleats in the fabric of her gray wool gown and made an effort to stop. Dear God, he has not come here to discuss the weather. A lady never lets a gentleman feel socially awkward. What topic could Carolina now introduce?
That time soon after the fire when Samuel violated me night after night. When slapping me wasn’t enough and he brought a riding crop to my bedroom, shall we discuss that? Samuel was careful to leave no marks where they would show, and he knew I would be too mortified ever to let anyone see them. Would he find that a proper subject.
“I’m sorry to have no interesting conversation, Cousin Nicholas. I don’t go out in society much these days. I’m afraid it’s made me quite dull.”

“You could never be dull, my dear Carolina.”

She turned away. “Don’t be kind,” she whispered. “I cannot bear it.”

“Carolina…” He stretched out a hand, then snatched it back.

“Please, Nick. Whatever you’ve come for…please just tell me and go.”