Comes a Time for Burning (6 page)

Chapter Seven

“I find your wife to be a remarkable woman,” Hardy said, and the unexpected comment jerked Thomas out of his reading. “My God, how studious you are,” Hardy laughed at the reaction. “I understand now why both your wife and Miss Auerbach were so reticent about disturbing you during an examination. You startle so!” He made a slashing upward motion with an imaginary scalpel. “Whoops, pardon me! Sutures, please!”

“Alvi
is
remarkable,” Thomas replied in self-defense. “I heartily agree. I wish you could have met her father.”

“Passed rather suddenly, did he?”

“Yes. A stroke this past autumn. She misses him terribly. We both do.”

“Well, of course you do.”

Thomas beckoned to a chair. “Here, please. How about some brandy to wash down the dust? We haven’t allowed you a moment’s rest from your journey.”

“I haven’t seen dust since I left the Dakotas, Thomas. Wash away the
muck
, perhaps. And yes to the brandy.” He watched with keen interest as Thomas poured two glasses, both with a conservative jigger or two. Accepting the glass, Lucius Hardy closed his eyes, sipped delicately, twitched his mustache, and uttered a heart-felt groan of pleasure. He smacked his lips then, and carefully placed the glass on a small table near his chair without taking a second sip.

“So,” he said, eyes roaming about the office. “Look at you.” He reached for the glass again, took another minute sip with closed eyes, and replaced it. “Alvina is charming. You’re a lucky man, Thomas. Getting on a bit, isn’t she.”

“Seven months.”

Hardy’s thick eyebrows shot up. “Really now? My soul, she’s a mountain for seven, I’ll say that. What is she carrying, triplets?”

“I wouldn’t care to bet.”

“Surely by now you can hear the separate heart beats, Thomas.” Just a trace of reproof there, Thomas thought, the same gentle tone he’d heard from Lucius Hardy in the laboratory at the university where Hardy had first been an anatomy assistant, and then an instructor in microscopy.

“I can, Lucius. Two good strong hearts—mother and child.”

“Well, then. There you are. That’s my specialty, you know. I left the university and indulged in Philadelphia’s high life for a couple years. Lots of very wealthy young women having lots of stunningly beautiful babies.”

“Dr. Roberts so informed me, Lucius. And in part that’s why I wrote to you, at his urging. I hardly dared believe that you might accept my offer.”

“Well, you know,” Hardy said with a casual, dismissive wave of the hand. “You’ve seen one stuffy parlor of the wealthy, you’ve seen them all, so to speak. I’ve always loved the notion of the sea…not the sea itself, mind you,” he laughed. “I’ve discovered that I become dreadfully seasick. But the
notion
of it. The sea at a distance. I had been considering a post in New Haven, but then your persuasive letter arrived. Having never been west of Philadelphia, the lure of adventure was strong. And I have to admit, Thomas, I half suspected you of aggrandizing the situation you have here, but my word.” He looked around the room. “This is most pleasant.”

“I’ve tried to make it sound so, and now here we are. Dr. Roberts says that you were the best in your class. I had to work hard to lure you.”

“The best in
any
class, my friend. Simply the best. And still am. Perhaps hampered by an overwhelming modesty, but I work to overcome that.” He grinned and sipped the brandy again. “So, tell me what…” He stopped in mid-sentence, and Thomas turned to see Berti at the office doorway.

The nurse could set her narrow, pretty face into an expression of perfect neutrality, exactly what she did at that moment.

“Mr. Deaton is ready for you in the examining room, Doctor. And Mr. Malone remains unchanged. Alvina is upstairs with the Snyders.”

“Thank you, Berti.”

When the door closed softly behind the nurse, Hardy nodded his approval. “She’d be a beautiful young lady if she would smile more often.”

“She has to feel the need,” Thomas said. “The most important thing is that she has made herself indispensable, as you have no doubt noticed. Come with me? You’ll have an introduction to the Clinic before you take a few hours to relax. After dinner, we can settle in for a serious chat. Alvi has made the pronouncement, and our housekeeper Gert James will have outdone herself with the preparations.”

Hardy slapped his belly. “As you can see, food is of little interest to me. But lead on, Doctor.”

Howard Deaton leaned on the end of the examination table, arms crossed over his chest, his thatch of eyebrows and lined face giving him an expression of vexed impatience—and at this moment, a little more than usual. He straightened as the two physicians entered the examining room.

“Howard Deaton, my man. Let me introduce you to Dr. Lucius Hardy.” Howard extended a hand uncertainly, as if undecided about how deferential to be. “Dr. Hardy, Howard is the best man with horses and an ambulance on the planet, in addition to a long list of other skills.”

“My pleasure,” Hardy said, and then nodded another greeting at Bertha Auerbach.

“The leg troubles you some?” Thomas’ question appeared to take Deaton off guard. Perhaps he’d been expecting a discussion of proposed new ambulance features, or the general health of one of the horses.

“Some days more’n others,” he said. “But I’m gettin’ on.” His convalescence had been both exquisitely painful and complicated, and no doubt seemed interminable. That he was loath to even broach the subject of his injury was understandable.

“May I have a look?”

“Ain’t no different from what it was,” Deaton replied, and for a moment it looked as if he wasn’t going to oblige. Then he stepped across the room and sat in one of the straight wooden chairs. “You need the boot off?” Thomas nodded. “I was afraid of that.” He took his time unlacing his boot, pulling the laces wide all the way to the bottom of the tongue.

“A multiple compound fracture of the tibia and fibula a few inches above the ankle,” Thomas explained to Hardy. “The result of an accident with a steel-shod freight wagon. A Stimson’s fracture box was tried first, but the results were unsatisfactory. Eventually we resorted to open surgery, and I pinned the large bone fragments with silver.”

Hardy’s left eyebrow raised a fraction.

“Closure and healing of the wound were uneventful, except that Mr. Deaton went through hell for several weeks.”

“Months,” Deaton muttered morosely. “I wouldn’t be the one to call it uneventful.” His jaw set in determination, he eased the boot off, and let out a sigh of relief when it slipped free. The woolen stocking came next, not yet showing signs of life of its own, but certainly due for a walk in the nearest creek. Thomas patted the table, and Deaton limped across and positioned himself near the head so the he could swing his leg up. He hiked up his trouser leg, and Thomas regarded the enormous scar that marked the front of Deaton’s shin for eight inches above the ankle. With the lightest of touches, he ran the index and middle fingers of each hand down the sides of the man’s leg. At one point four inches above the ankle he felt Deaton’s involuntary jerk.

“Tender there?”

“A mite.”

Thomas repositioned himself, remembering exactly where he had pinned the shattered bones. He could feel a prominent knot on the anterior blade of the tibia where the bone was repairing itself, but as he moved his fingers laterally where he could feel the rise of the fibula, Deaton sucked air sharply through clenched teeth.

“Dr. Hardy?” Thomas nodded toward the leg.

“I’m no surgeon,” Hardy allowed. He glanced up at Deaton, eyes twinkling. “In point of fact, young man, if you were several months pregnant, I’d be of considerably more use.”

“I ain’t that.”

“Well, thank God,” Hardy chuckled. “But I feel some inflammation here, some swelling, more than there should be at this stage. Surgery in September, you say?” Thomas nodded. “Then we most certainly have a little something going on here.” He shut his eyes as Thomas had done, and let his fingers roam for a moment. “The silver was used here as well?”

“Yes.”

“Huh. Silver. I hadn’t heard of that.” He straightened and held out a hand toward Bertha, who instantly passed him a clean towel. He wiped his hands thoughtfully and handed the towel back without so much as a glance her way. “What turned you away from grafting, if I might ask? Shierson has had considerable luck at our own
alma mater
.”

“The gravity of the situation, for one thing,” Thomas replied. “Time was of the essence.”

“Ah.” Hardy looked up at the patient. “How do you describe the pain, Mr. Deaton?”

“Well, it hurts like hell sometimes.”

“Sharp stabbing pain? Blunt, aching pain? A deep, burning itch? Be specific, man.”

Deaton looked first at Thomas as if he wanted permission to speak, then back at Hardy. “Feels like somebody’s holdin’ a white hot iron poker to my leg. But deep inside.”

“Ah. How does it bear weight?”

“Fair to middlin’.”

“And what does that mean?”

“Well, I can walk on it all right. I mean, normally, it don’t hurt none.”

“But there is some discomfort, obviously. What makes it hurt at its worst?”

Deaton thought for a moment. “Seems like when I twist some, maybe carryin’ a load. Like I pick up a saddle and turn…why, hurts all to hell.”

“May I humbly suggest that you don’t do that, then?” Hardy said.

“Amen,” Thomas added, motioning to Bertha. “This is what we’re going to try. I want ice for the inflammation, four times a day, fifteen minutes each session. Without fail. Follow the ice with soothing heat—not so much as to redden the skin, but enough to sooth out the chill from the ice.”

“I ain’t got the time…”

Thomas held up a hand to interrupt Deaton. “You
do
have the time, Howard. You do. Or to put a finer point on it, you will
make
time. Consider it part of your job. I’ll
pay
you to do it.”

“But I got things to tend to.”

“Indeed you do. Your leg, for one. I can’t afford to lose you, sir. Perhaps you recall the discomfort from your previous convalescence?” Deaton’s jaw clamped. “You don’t want to go through that again, I’m sure. And I can’t have you lolling about in bed all day for weeks at a time. Things to do, as you say. So let’s try the easy route first. Ice and heat upon first rising, then noon, at supper, and just before you retire. Without fail. You might even try a mild liniment, such as you use on the horses for sore muscles.”

“And the rest of the time, favor it,” Hardy added. “It wouldn’t hurt to go back to the cane that you no doubt used earlier.”

“Don’t need no cane.”

“Welllll…” and Hardy drew the word out for full effect, “yes, my good man, you do. Think how elegant you’ll look. The ladies will swoon.” Thomas noted with satisfaction how thoroughly at ease the physician appeared, hands thrust in the pockets of his tweed woolen trousers, completely at home though he been under the clinic’s roof for less than an hour.

Chapter Eight

They left Howard Deaton to his first round of therapy with Bertha Auerbach, and Thomas escorted Hardy through the rest of the first floor of the clinic.

“You favor a sort of temperature therapy, I see,” Hardy said at one point as he studied the small operating room on the north side of the building that Thomas had reserved for dissection and post-mortems. “I find that interesting.”

“It seems natural to me. Cold tends to relieve inflammation as well as numbing discomfort. Heat encourages the chemical reactions of healing, as well as feeling heavenly.” He leaned against the operating table. “I tell you, Lucius, during my own convalescence, I think I should have gone insane without it.” He touched his right eyebrow, over which a scar arched, disappearing up into his hairline. “Fracture of the orbit.” He held up his left thumb. “Fracture of the thumb.” He stretched and touched ribs on his left side. “Multiple fractures.” Finally, he indicated his left hip. “Dislocated. And bruises from head to toe.”

“My word, man.”

“Yes. Alvi was a saint during my recovery. And the ice and heat…well, I have no doubts about its use.”

“You think it can actually make a difference in a difficult case such as your blown-up logger?”

“Probably not. I know nothing else to do. I
do
know it can do no harm.”

“Well, there’s that. You know, your surgical skills were legendary at school. I never realized
how
good you must be until I discovered how
abominable
I was.” He grinned. “Although I do a damn good post—as long as the patient doesn’t need to get up and walk away afterward.” He surveyed the room. “I’ll probably be of considerable use here for just that sort of thing. I have a question, however.”

“Please ask. Anything.”

“You have nothing to lose with…Mr. Malone, is it? Why not a simple exploratory surgery with him?”

“For one thing, there is no ‘simple’ surgery involving the brain, Lucius. I’m sure you know that as well as I. That, and I have no suggestion about where to begin. If there’s an obvious wound, then I would know. But there is not. I can’t very well evacuate his entire brain case, chasing shadows.”

“The explosion was above him?”

Thomas nodded, and formed an umbrella of his hands over his own head. “Like so.“

“And yet he didn’t fall.”

“They wear a climbing belt. Steel core. And most extraordinary. He cut the rope when he saw that the split would crush him.”

“After the explosion?”

“Exactly. He had but a fraction of a second to make his decision and act.”

“My word. And no exploratory, at least at the top of the cranium where the brunt of the explosion was taken? And here I thought you surgeons could find any excuse to use the knife.”

Thomas laughed ruefully. “What this surgeon has learned is that every time the knife touches the flesh, there is an equal chance of correction or fatality. I would be less than truthful if I were to say my record in the past few months was anything but dismal.”

Hardy reached out and shook him lightly by the shoulder. “Come, now. Look at the sorts of cases demanding your attention, Thomas. I suspect a goodly number of your patients are the walking dead anyway—finished before they are ever carried across your doorstep. I haven’t seen much of this country in the last hour, but I’ve heard tales and read a good deal. Absolutely fascinating.”

“My God, Lucius, the life that some of these people lead is simply amazing. We must visit the timber on the very first opportunity. You’ll be astonished. And in addition, they laugh and joke about the dangers, completely heedless. I wish you could have seen Malone’s rescue from the tree tops this morning. Just remarkable. And the first patient on my doorstep this morning? Hand absolutely ruined by a ridiculous
game
. And yet he laughed about it, at first refusing treatment. Finger twisted with painful fractures, dislocated thumb…my God.” He took a deep breath as he saw the grin spread across the other physician’s face.

“I carry on, don’t I,” Thomas said. “What I need right now, as I told you in our correspondence, is not just another surgeon. You see, I had the rare occasion to work with Alvi’s father for just a few weeks before his untimely death this past autumn. Dr. John Haines? He had lost the sight in one eye, drank too much brandy, but still could diagnose circles around me. I am painfully aware of my inexperience, and I miss his presence terribly.”

“You are somewhat removed from the rest of the world in this little island of activity you have here,” Hardy said.

“But the opportunity is boundless, Lucius. To
build
. I want to show you the renovations we’ve accomplished upstairs for both women and children.” He turned toward the hallway behind them, then stopped. “Let me tell you what I’m
not
, Lucius. I am no obstetrician. And…” He looked behind him as if someone might be eavesdropping. “I don’t
want
to be. If that sounds unnatural, so be it. In my nine months here, I have delivered exactly two infants. Both successfully, I may add. But throughout the entire procedure, it was Nurse Auerbach and a competent mid-wife who orchestrated events. It would be fair to say that they
tolerated
my presence, should some kind of surgical intervention be necessary.”

“Surely you exaggerate a bit,” Hardy said. “But an interesting woman, your Miss Auerbach. You have other nursing staff, I understand?”

“Three others. You just missed Helen Whitman, who has gone for the day. She is a competent woman with no particular formal training, but vast experience. The other two provide coverage for us during the nighttime hours. Mrs. Crowell and Miss Stephens, both competent.” He hesitated. “Well, Mrs. Crowell is competent. She has recently lost her husband and finds that working at night is somehow soothing. Miss Stephens is very young, but tried a few months at St. Mary’s across the sound before returning home. She has much to learn, and I have reservations, I admit. She is somehow easily embarrassed by the human body and its functions.”

“I have to say that I am impressed with Miss Auerbach,” Hardy mused.

“A gem,” Thomas said fervently. “She and Alvi are the only two who will tell me what I need to hear…
exactly
what I need to hear, whether I like it or not.”

“How fortunate you are—I think.” Hardy chuckled again. “You might disagree with Cushing’s comments, then. That in all things, the physician is captain of his ship.”

“If he meant that no one should be allowed to speak up and remind the physician when he’s being a stubborn mule-headed pedant who is clearly
wrong
and headed toward disaster, then yes. I couldn’t disagree with him more. What little experience I have has taught me that.”

Hardy’s eyes twinkled. “You’ve found yourself in that situation, have you?”

“Too many times.”

“You’re a remarkable man to admit it, sir.”

“My convalescence had a lot to do with it. During the six months when I was a patient…” He hunched his shoulders. “Primarily I learned how very little the physician actually
knows
, without fear of debate. The moment I think I’m in control of all factors in a case, nature proves to me otherwise.”

“Ah. I suppose so. You must tell me more about your own mishap when you have a moment.”

Thomas stopped and gestured around the men’s ward they had just entered. “Originally, this was the
only
ward. Eight beds, no provisions for women or children. No provision for extended care. No way to separate the chronically ill, or the infectiously ill, from otherwise healthy surgical patients. Now this floor is reserved for male patients, with three separate rooms toward the rear for the most challenging cases, or those that require the additional privacy. That’s where we’ve placed Mr. Malone. so he would have complete quiet.” He patted the foot rail of the first bed.

“The young man with the broken finger was here this morning. He recovered from the oxide quickly, and we saw no reason to keep him further. He left with absolute instructions about how he should take care of himself. I don’t believe that he will,” and the physician grinned ruefully. “But later today, I plan to ride out to the tract and check on him myself. We also have the possibility of food poisoning at the camp, and that can be fearsome. I would be remiss if I didn’t investigate the situation.”

Thomas gestured toward the rear of the ward, and Dr. Hardy followed him. At one point half-way down the short ward, he once again thrust his hands in his trouser pockets as if not quite trusting them to venture out unsupervised.

“I heard mention of a women’s ward? You have them separate?”

“Upstairs.”

“Up?” Hardy looked puzzled.

“We have an Otis,” Thomas said proudly. “A pregnant woman need navigate not a single step. An absolutely remarkable machine. Hydraulic, you know.”

“My word. An elevator. How cosmopolitan.”

Thomas opened the doorway to one of the tiny private rooms. Sonny Malone lay insensible. His mouth hung slack, eye lids parted, breath coming in hesitant, irregular little gasps.

“So it is a general concussion, then,” Hardy mused. “Very much as if a cannon shell had exploded near his skull.”

“Absent the fragmentation, yes. Both eardrums are ruptured, massive internal hemorrhage showing itself in the vitreous, little or no reflex at the extremities.”

“Nothing for it then, is there.”

“I’m afraid not. I’ve instructed continued cold wraps to the shaved skull, in a vain hope that the bleeding might yet stop and be reabsorbed.”

“Might I listen?” Hardy held out his hand and Thomas drew the coiled stethoscope from his jacket pocket. For a long time, the physician roamed the instrument across Sonny Malone’s pale chest. “I don’t think that the blast injuries are limited to the brain.”

“Almost certainly not.”

“It sounds as if his heart is trying to pump lard.”

“It amazes me that within an hour of the event he was heard to utter a coherent sentence. And then nothing but groans and cries.” Even as Thomas spoke, Hardy bent over and, placing a hand on each side of Malone’s rib cage, applied compressive pressure in a number of places.

The physician straightened up and hunched his shoulders. “Will he swallow? A trickle of brandy, perhaps?”

“No. And the risk of gagging is too great. A single cough might kill him.”

“As surely as he is already on the way,” Hardy said softly. “We can do nothing for him that you haven’t already done, Thomas.”

He waited outside the room while Thomas closed the door.

“So…you have your man with a game leg, another poor man blasted to pieces…and you began your day with surgery of the digits. Now there is a delightful woman suffering a dangerous carcinoma. And it’s not yet dinner time. Somehow we have avoided the constant flow of hypochondriacs who vie for a physician’s time. What else has filled your day, then?” He smiled and clapped Thomas lightly on the shoulder again.

“We have our full share of the continually ill, as Alvi’s father used to refer to them,” Thomas said. “Bertha is most effective as captain of the guard. In real need, she schedules them for the first three days of the week. She has her techniques.”

“And your lovely wife is most skillful herself, I have gathered. As she progresses along, you must miss her steadying hand. She is in her seventh month, you say?”

“I believe so.”

Hardy stopped short. “You
believe
so? Dr. Parks, you surprise me.” He crossed his arms over his barrel chest and rested his chin in one with his index along the side of his nose. He frowned at Thomas. “You’ve spoken to the local mid-wife?”

“Mrs. McLaughlin. Yes, of course.”

“I mean, surely, sometime in the past nine months of your residency here, a child has been born? Didn’t you mention two?”

“And many more that I never saw.”

“But you attended two?”

A flush crept up Thomas’ neck. “To be honest, I would have to say that I
assisted
twice.”

“Assisted the mid-wife? I thought that you were just being modest when you said that earlier.”

“Yes. I assisted.”

Hardy regarded him with a mixture of skepticism and amusement. “How very interesting. May I ask a somewhat presumptuous question? May I presume on our past friendship at the University?”

“Certainly.”

“You said that your wife is in her
seventh
month.”

“Yes.”

“How has that been ascertained?”

“She has been in continual conversation with Nurse Auerbach, and with Mrs. McLaughlin. That is what she wished.”

“You’ve examined her yourself, I assume?”

“Of course. But she becomes impatient with me. It’s really quite remarkable, Lucius. To feel the outline of the infant…”

Hardy nodded slowly. “How very interesting. Let us pray that all is progressing perfectly with her pregnancy, then.”

“It is. In matters of this sort, Alvina has far more experience than I. As does Nurse Auerbach.”

Hardy laughed. “Thomas, Thomas.” He shook his head, and Thomas wasn’t quite sure what was amusing the physician, who added, “The woman with the carcinoma of the breast…if she chooses to remain in Port McKinney for the surgery?”

“I shall operate Saturday morning at nine o’clock. You’ll join me and administer the ether?”

“Of course. Of course. And you have a good microscope? Mine is being shipped and won’t arrive for some weeks.”

“I do. A new Heinnenberg with immersion.”

“Good. Then we can rapidly ascertain whether the beast be benign or malignant, and have the deed be done before she awakes.” He cleared his throat. “We need take no one’s word for it. You know, despite the gloom of the gambler’s choice we were discussing earlier, I’ve read of success rates as high as ninety percent for a mastectomy with axial complications.”

“I will be satisfied with one hundred percent in this particular case,” Thomas replied.

“Ah. We love all our patients, don’t we. She is near and dear, then?”

“I would suppose that in a village the size of Port McKinney,” Thomas said, “that they all are. But you force me to admit that this is my first such case.”