The Americans

by John Jakes

  The girl was only eighteen or so. She had a pretty, high-cheekboned face, bright with sweat. Her hair was damp and stringy. Her abdomen pushed up beneath a soiled sheet. She tried to respond to Drew’s smile with a shy and hopeful one of her own, but the fright in her hazel eyes was unmistakable.

  How much greater that fear must be because she couldn’t understand what was said by those around her, Will thought. Her expression had a sudden and unexpected effect on him. It made Vlandingham’s greed seem contemptible.

  They transferred the girl from the cart to the table. She said something to Drew in a foreign language. Even though her words made no sense to him, he responded with a nod and solicitous sounds.

  “Don’t worry,” he said, his round head bobbing. He placed his left hand just above the mountainous belly. “We’ll take care of your baby. He’ll be perfectly fine. “We’ll see to it, Dr. Kent and I.”

  Somehow, she comprehended one word. “Doctor? Doctor?”

  “Yes, I’m Dr. Hastings.” He touched his chest, then pointed. “That’s Dr. Kent. We’re both doctors. You’re safe.”

  He was stretching the truth by using the term doctor to refer to a couple of students; but it was what she wanted to hear. She nodded, her eyes fixing on Drew with unquestioning trust. She was in a foreign land, in pain, but the two young men were relievers of pain—deliverers of children. That much was clear, and it eased her anxiety.

  Suddenly she clenched her teeth and her fists. Another contraction racked her body. Drew’s eyes flicked to Will, a signal.

  Will opened his pocket watch, laid it on a stool. His hand shook slightly as he picked up the Allis inhaler, a metal tube more oval than round. After a quick look at the gas flame hissing overhead, he began to sprinkle ether on the long gauze bandage threaded through the maze of wires within the inhaler. He hoped to God he didn’t make a mistake.

  No one spoke. Will pressed the inhaler’s turned metal edge against the girl’s mouth. He continued to sprinkle ether into the other end, glancing frequently at his watch. Its tick seemed thunderous.

  Ten minutes passed.

  Twelve.

  The girl’s face turned deep red, a sign of the first stage of ether narcosis. Will warned Clarence to be ready for the possible onset of violent struggling.

  The young woman started to mutter. Soon she was babbling loudly, and tossing in a restive way, not quite sleeping yet.

  Her hands spasmed toward her belly; she still felt the contractions. The pain should be lessening moment by moment—

  The babbling stopped. The girl passed safely into the deep, completely relaxed second stage of anesthesia. Will said, “You’re free to go ahead.”

  iii

  Drew turned the gas jets up full. Then he lifted the sheet and bared the girl’s lower body. The orderly started to snigger. Drew’s murderous look silenced him.

  Drew positioned the girl’s feet and told Clarence to tie them. The loutish young man moved with surprising alacrity, tying both feet neatly. Drew complimented him. The orderly lost his sullen look.

  The gaslight hissed; the pocketwatch ticked. Will’s clothing was soaked with sweat. He stood behind the girl’s head, lightly holding the inhaler in place, his heart slamming fast and hard within his chest. He leaned down to check the girl’s pulse. Drew looked at him.

  “All right?”

  “Yes, fine.”

  With great care, Drew inserted his hand to examine the fetus trapped in the birth canal. The problem he faced was stark and simple. In the posterior position, the back of the fetus was toward the mother’s back. This put the head in an attitude in which its largest dimension pushed against the walls of a uterine canal made too narrow by a pelvic bone structure Drew had characterized as inadequate. Had the girl been fortunate enough to be born with a normal pelvis—the luck of the draw, some doctors termed it—the fetus might have passed through the canal with no difficulty.

  But that wasn’t the case, and so a rotation was necessary. With the fetus in the correct position—its back toward the mother’s belly—the head would be in a slightly different attitude, presenting a slightly narrower dimension to the canal opening. The difference was only a matter of one or two centimeters, but it was critical if the fetus was to be driven downward and outward to the air, and to life, by the mother’s labor.

  When Drew was sure the dilation of the OS was complete, he took a deep breath. Then he moved his right hand forward again, slipping it up into the uterus, well out of sight. The hand was positioned between the side of the fetus’s head and the uterine wall on the mother’s left side. It would stay there as a guide and buffer for the potentially damaging blade of the forceps.

  Drew’s face shone under the gaslight. Will whispered an order. Clarence took a rag and mopped Drew’s forehead and cheeks.

  “Thank you, Clarence.”

  Upper teeth biting down on his lower lip, Drew took the left forceps blade in his left hand. He slowly inserted the blade next to his right hand. The procedure seemed to take hours.

  He pulled his right hand out. Jammed his sleeve against his forehead to swab sweat away. He glanced at Will again, his tension unmistakable. Once more Will checked the girl’s pulse.

  “Everything satisfactory.”

  Drew reached for the right forceps blade. His palm must have been excessively slick. The metal handle slipped away from him.

  Clarence caught the handle just before it hit the floor. He didn’t touch the blade. Drew nodded his appreciation. Slowly and carefully, he inserted the blade into the opposite side of the uterus.

  Deeper—

  Deeper—

  Drew swallowed hard, took another long breath. Then Will heard the faint click as the crossed blades locked.

  With barely a pause, Drew began to rotate the forceps clockwise, like a man turning a key in a lock. Suddenly his face wrenched.

  “Damn.”

  “Hard?” Will whispered.

  “Won’t budge.”

  With the fetus in a perfect posterior position, the practitioner had a choice of rotations—to the right or to the left. Either way, a turn of a hundred eighty degrees was required. Sometimes a fetus was canted slightly in one direction or another, requiring a turn of only a hundred thirty-five degrees or even less. Drew hadn’t been that fortunate. And the direction he’d picked had been the wrong one.

  Face twisted into a mask of concentration, he applied pressure in the other direction. It seemed to Will that his friend was barely breathing. He was undoubtedly conscious of the blades clasping the fetus’s head, and of the potential for damage. One mistake and an entire lifetime could be blighted, even before the fetus was transformed into an infant by its first struggling intake of outside air.

  “Turning,” Drew said abruptly. Under the flaring gas, he looked like a hunched cherub there at the end of the table. His whisper sounded remarkably like a prayer. “Come on. Come on—a little more. Come on—”

  Will’s spine prickled. There was hope on Drew’s face now; the fetus was rotating properly. Drew maintained the gentle but firm pressure. And as Will continued to monitor the young woman’s pulse and respiration, he knew he was witnessing a miracle. The kind of miracle of love and concern that made one human being minister to another not because there was money to be made, but because there was pain, and danger, and desperate need.

  “Done!” Drew exclaimed, looking ready to faint. “Done, by God!”

  “And no advice needed from Dr. Leishman,” Will said by way of a compliment.

  “Not so far, anyway. I swear, Will—this one’s big as a lumberjack.”

  Will grinned. “Let’s see.”

  “Any minute now.”

  With the fetus reversed in the birth canal, Drew removed the forceps and turned them over in preparation for delivering the baby. When the instrument was once again inserted, he formed a tight ring around the crossed shanks with his left thumb and index finger. Clarence reached over Drew’s arm to place a sponge between the handles
, both of which Drew held in his right hand. The sponge protected against accidental pressure on the head of the fetus as Drew grasped it with the blades and began the extraction.

  He did it perfectly, simulating the contractions of the uterus in labor. He’d give a little tug, then let up. Another tug; another pause. Downward and then upward in the classic arc, he brought “a small head through the canal and into the open. Amid the fuzz of black hair Will could clearly see the soft indentation of the posterior fontanel.

  He watched tiny red ears and the back of a neck come into sight above the mother’s pubis. Then small shoulders, a backbone, and buttocks appeared.

  Drew brought the newborn the rest of the way into the world, as proud and delighted as if he were the father.

  “Damn if he won’t make a lumberjack. Look at him! Ten pounds if he’s an ounce.”

  After one whack of his wrinkled red bottom, the baby howled. Will felt tears of joy in his eyes.

  iv

  Drew’s hands moved confidently as he cut and tied the cord. The newborn kicked and screamed while Drew lowered him to clean towels Clarence was holding. The orderly, too, had a soft, wondering look on his coarse face. Drew smiled in a weary but satisfied way. The baby boy was strong of lung, and apparently perfect.

  Within a couple of hours, the mother had her first bleary look at her child. She was resting on a cot Drew had set up in his own office. While Will handed the young woman the warm, squirming bundle, Drew cooled her forehead with a cloth dipped in alcohol.

  Although the mother understood none of what Drew and Will said as they murmured appreciations of her fine son, something in Drew’s expression continued to communicate calmness, reassurance—a promise that the young woman had survived her ordeal in steerage, and her more recent one at Castle Gardens, to a good purpose. The purpose was wiggling and squalling in her arms.

  “Very fine,” Drew said, lifting the blanket so the mother could clearly see the infant’s sex. “A very fine, strong boy.” He kept smiling and nodding as he said it. The exhausted girl understood. She burst into tears. The sight sent another shiver up Will’s spine.

  Then the young woman uttered a short sentence Will didn’t understand. Her tone of pride was unmistakable, though. Drew seemed to grasp what she meant. As he tucked the starched sheet beneath her chin, he bobbed his head again.

  “Yes, that’s a very good thing. A good omen for his life.”

  Softly, Will asked, “What did she say?”

  “She said born in America. She’s glad her son came into the world on this side of the Atlantic.” He unfolded fresh swaddling clothes; the gurgling infant had wet the other ones. As he began to wrap the baby, he added, “I’m glad I was here to help her.”

  Will gazed down at the tired, pretty face of the young woman, so peaceful and happy now that her ordeal was over. He was deeply moved—as moved as he’d been that first night he watched Lon Adam work.

  “So am I,” he said. Medicine wasn’t a chateau on Fifth Avenue, an investment portfolio, an invitation to the Astor ball. This was what medicine was all about.

  This.

  CHAPTER XIII

  “THE WRETCHED REFUSE OF YOUR TEEMING SHORE”

  i

  THE REST OF WILL’S week in New York passed swiftly. He moved in with Drew at a run-down rooming house near Battery Park. Cost of an extra bed—thirty cents a night. He didn’t mind staying in such a sleazy place; he and Drew were seldom there. They spent most of their time at Castle Garden.

  Large as Castle Garden was, the facility was still taxed to capacity. Two or three shiploads of new Americans arrived almost every day. An atmosphere of confusion prevailed.

  Nor was Castle Garden free of official corruption, Will discovered. Drew said he’d seen cheating and price-gouging at the currency exchange and general store inside the gates. One official who was supposed to give newcomers advice about honest boardinghouses had recently been discharged for sending people to a filthy tenement owned by his wife.

  Two middle-aged doctors supervised the Castle Garden inspection station. A few minor cases were treated on the premises, rather than at Ward’s Island. Drew got most of these—not an easy assignment, because many of the patients were hard to handle. They feared the American doctors and were suspicious, even hostile because they didn’t know the language and customs of their new country.

  Drew worked twelve to fourteen hours a day. Will accompanied him everywhere, and quickly discovered that his friend had a remarkable knack for putting the immigrants at ease and winning their trust. His air of competence and his innate kindness were instantly communicated to patients, no matter what language they spoke.

  Will saw that when Drew bathed the feverish forehead of a young Bohemian boy, or palpated the flux-bloated belly of a surly old Russian, he soon calmed them, won them, had them smiling and swallowing whatever medicine he wanted them to take. He talked blithely about the medicine in English, as if he was confident they’d understand. Somehow, Will almost believed they did.

  It struck him that in at least one respect, Drew was very much like Lon Adam. He did more than merely treat symptoms. He was a healer of the spirit. Will decided that the man whose style he wanted to emulate in his own practice was not Vlandingham, but Drew. It was a tall order. Although Drew wouldn’t get his diploma for another year, he was already a skilled practitioner. Perhaps a better one than Will could ever hope to be.

  The week soon came to an end. Castle Garden received no immigrants on Sunday, so the two friends decided to treat themselves to a good meal at August Luchow’s restaurant up on Fourteenth Street. But first they’d visit the city’s newest tourist attraction. They took a steam launch out to Bedloe’s Island for a close look at the Bartholdi statue.

  A midweek thunderstorm had cleared the air and brought a spell of cool, almost autumnal weather. Sunlight sparkled on the harbor and the rooftops of lower Manhattan. From Bedloe’s Island the view of the city was impressive. And from the base of the granite and concrete pedestal designed by Richard Morris Hunt, the view straight up was breathtaking.

  The colossal statue with its covering of more than three hundred copper sheets towered into the cloudless sky. The great torch upraised in Liberty’s right hand was so far above them, Will could almost imagine that it was visible on the other side of the ocean.

  They walked all the way around the pedestal, then entered a hallway which led to the stairs. On a plaque in the hall they found “The New Colossus,” the sonnet by Emma Lazarus which the statue had inspired.

  The friends stopped and silently read the poem. It had a special, personal significance for Will; his family had been founded by a young European boy yearning to breathe free, as the poetess had put it.

  Still saying nothing, the friends walked outside again. The sea wind was raising white water on the Atlantic. Will took off his straw hat and let the wind cool his forehead. He squinted against the sun’s glare and softly repeated the line he’d found most memorable.

  “ ‘The wretched refuse of your teeming shore—’ I understand that now that I’ve seen Castle Garden. America takes them all.”

  “We do, and we should be proud of it,” Drew said. “It’s hardly a pleasure to examine some of them after they’ve been cooped up between decks a week or so. But once you look into their faces, you forget the shabbiness and the stench. You understand what this country means to them. We take it for granted, but to them it’s a haven like no other in the world.”

  They strolled toward the jetty where the excursion launches docked. “I’m glad I got a summer job here,” Drew went on, hands in his pockets and his eyes fixed on the ocean. “It’s clarified my thinking about what I want to do after I get my diploma.”

  He pointed a plump finger at Castle Garden and the panorama of buildings beyond the Battery. “That makes Harvard seem like the proverbial ivory tower. That’s the real world, Will. There’s so much squalor and pain in that one city, no single life’s long enough to do all that needs to
be done to relieve it.”

  Will thought he knew the direction Drew wanted the conversation to take. The realization made him defensive, even a bit testy. “If you’re trying to say that only greenhorns and the poor get sick, you know you’re distorting the truth. And I still believe every doctor ought to practice where he wants to practice.”

  “I disagree. Doctors should practice where they’re needed.”

  “Meaning—?”

  “Meaning that a doctor is seldom needed very urgently in the parlors along Fifth Avenue. There, the typical illness is some society girl’s headache, which is usually imaginary.”

  Will stepped in front of his friend, his dark eyes fierce and bright in the sunlight. “Drew, why the hell are you constantly sitting in judgment of me?”

  “Because we’re friends.”

  “Does that confer some special right to criticize?”

  “I think so.”

  “Well, whether it does or not, we won’t be friends for long if you keep it up.”

  Drew’s cocksure smile turned a bit uneasy then. “I’ve got to, Will. You have the makings of a fine doctor. But someone’s got to set you straight before you waste your talent.”

  Will couldn’t help laughing. “My God, I’ve never heard such gall. Is it a Yankee characteristic?”

  “Can’t say. I know it’s a Hastings characteristic.”

  Will’s smile faded. “Whatever it is, I damned well resent your constant hints that I’ll turn out to be nothing but a medical hack.”

  “Hints?” Drew’s round head bobbed from side to side. “No hints. I’m saying it straight out. Except for rare moments—helping me deliver that baby was one—you don’t seem to care about anything but the financial and social rewards of being a doctor. I admit you can probably set up a very lucrative practice thanks to your liaison with Laura Pen—”

  “Leave my personal life out of this!”

  Drew sighed. “Wish I could, but I can’t.”

  “Who the hell appointed you as my conscience?”