Law of Similars

by Chris Bohjalian

There were no medical schools in Europe that even admitted women.

  Melanie’s sentence? She was asked to pay a fine of one hundred francs. About what she was paying for her annual newspaper subscription. Or what she charged a patient at a first consultation.

  And she was asked to stop practicing medicine.

  Apparently she paid the fine in full.

  And then continued her practice.

  She was simply more discreet than before the trial.

  But, much to her patients’ relief, she continued to heal them, treating them without poisonous doses of mercury, or strychnine, or opium. Without subjecting them to venesection.

  She merely stopped passing out business cards.

  Jennifer Emmons smiled when she saw me in the windowless waiting room outside the ICU, and for a second I was surprised. I hadn’t expected a smile. But there it was, that small but sincere, close-lipped little grin I had gotten before from the partners and children of the not-quite-dead: the smile of thanks. Thank you for coming. Thank you for remembering us. Him. Me. Thank you for not making me do this alone.

  I surprised myself by giving her what I’d come to call my friend-of-the-family hug—arms around the shoulders instead of the lower back, a scapula pat to signal separation—and she surprised me by staying there a second longer than most people, her arms against my chest in a variation of what my friend the M.E. described as the pugilist’s pose: her fingers balled into fists, her elbows bent and pressed flat against her ribs. It was one of the basic postures of death.

  “How nice of you to come,” she said when we finally parted, her voice soft and hoarse.

  The television on the wall behind her was tuned to the Weather Channel, although the sound was all the way off. A pair of elderly women in slacks and scarves had been playing gin rummy on a couch when I’d arrived, occasionally looking up at the screen. I’d offered to turn up the volume for them—I was standing, after all, and they were sitting—but they’d passed. Then a nurse had come in and told one of the women that her brother was cleaned up and they could resume their visit.

  “I wanted to come sooner,” I said. “But I let the…the awkwardness get in the way.”

  “You shouldn’t have felt awkward. Vermont’s a small state.”

  “Still…”

  “We all know people. You know Carissa Lake, so what? I must have three or four friends who know Carissa Lake.”

  “They’re not prosecutors.”

  “No. But you won’t be prosecuting her, either now, will you?”

  “Nope.”

  I noticed most of the doctors and nurses who passed between the ICU and the waiting room were wearing surgical scrubs.

  “Probably nobody will be,” she continued, just the tiniest hint of frustration in her voice. “Phil Hood told me it isn’t likely you’ll ever file a criminal charge.”

  “The case is still open. It’s only been three or four days. An information—an indictment—often takes months.”

  “I don’t expect anything. There isn’t even much chance of a civil suit, I’m told. My Richard just…he just did this to himself. Made a mistake. I wanted to blame that woman because I wanted to blame somebody—God, wouldn’t you?—but it doesn’t seem like she did anything wrong.”

  On the radar map on the TV screen, a swirl of clouds was stretching in a wide band through Minnesota, the Dakotas, and most of Iowa. It looked like we’d be getting more snow in Vermont in another day or two.

  “It must all seem pretty complicated,” I murmured.

  “It did. It doesn’t anymore. At first, we all thought for sure she was responsible. I did. Richard’s allergist did. The state psych board did,” she said, and then gave me that thin little smile once again.

  “What do you do, Jennifer?”

  “I’m a veterinarian. But I went part-time after our second child was born. Timmy. So now I only work Thursdays and Saturdays.”

  “In Bartlett?”

  “Uh-huh,” she said, adding, “I guess I’ll be going back full-time as soon as I can.”

  “How is he?”

  She puffed out her cheeks for a brief second. “He flexed his arm this morning when they knuckled his chest.”

  “That sounds like progress.”

  “It is. It means he’s dying.”

  I nodded, and tried hard not to blink or look away. “I’m sorry,” I said.

  “Me, too.”

  “And they know this…for sure?”

  “They do.”

  “Because he moved…”

  “He’s posturing. Isn’t that a great word?” she said sarcastically. “It sounds like he’s putting on airs.”

  “It’s a terrible word,” I agreed.

  “Yup. The decorticate posture. Poke him or prick him or knuckle his chest, and his arm flexes.” She flexed her own arm. “Like a spring. It means the brain is malfunctioning. It means he’s probably lost his cerebral cortex.”

  “I am so sorry,” I said again. “I’m so very sorry.”

  “I talk to the doctors and nurses, and I know they’re doing all they can. But it doesn’t do any good.”

  I thought of all the things the doctors had done for Elizabeth in the four hours she’d lived, unconscious, after the accident, and what I gathered had been the Herculean efforts of two volunteer EMTs just to keep her alive long enough to die in an operating room. Doctors had sewn her spleen and re-inflated the lung that had collapsed. They’d set her broken arm. They’d given her blood, at least seven pints I believed, and then a powerful cardiac potion to help her heart pump blood to her brain.

  I realized I didn’t know which lung had collapsed.

  “Do you want to see him?” Jennifer was asking.

  “May I?”

  She nodded, and motioned toward the shut double doors with an imposing list of visitor regulations.

  Although my father had died in a nursing home, my wife and my mother had died in this hospital. Neither, however, had ever spent a day or a night in either of the two adult ICUs. Elizabeth had never even made it to post-op.

  But my mother’s death, at least, had lasted so long that I’d been able to behold all kinds of long-term interventions: Heart monitors and bladder catheters. Bags of blood and nutrition dripped into her veins through the sorts of tubes I saw every spring linking maple trees in the woods. A big hole with a plug in her chest to pump in the food when it became impossible for her to swallow because the esophageal radiation had so badly burned her throat.

  The difference that struck me most between the ICU and the regular hospital rooms in which my mother had wasted away—a feature even more evident than the rustling from the respirators, a sound like the wind—was that the walls facing the massive nursing station were made largely of glass. There wasn’t a lot of privacy in those high-tech little chambers, but if you were sick enough to be there, it probably didn’t matter.

  “Now, I know you two never met,” Jennifer said when we finally stopped, and I realized that if she were to move her body a bit to the left or the right, I would glimpse Richard in his room. I noticed a lump under the sheets that I assumed was the fellow’s feet, and I could see the bed rails were up. “But…well, he looks different than he used to.”

  “I understand.”

  “He looks older.”

  “Thank you.”

  When she entered the room, I saw Richard for the first time. Only his feet and his shins were under the sheet; the rest of his body was covered solely by a short hospital gown and a filigree of fat and thin tubing. And he did indeed look old, as if his body were collapsing in upon itself: He could have been the father of the Richard Emmons I had glimpsed in church a couple of times, a wrinkled and shrunken and pale version of the fellow I’d seen in the sanctuary.

  On his forehead was a flat silver circle.

  “Richard, I’ve brought a visitor,” she said, and she leaned over the thick respirator tubes covering his mouth to get close to his ear. “Leland Fowler. He lives up in East Bartle
tt.”

  “Hi, Richard,” I said, hoping my voice sounded friendly and warm. I glanced around the room: Although I’d expected a fair amount of hardware, I was still unprepared for the mass of hoses and wiring and monitors. I could only guess what most of the screens were tracking and what most of the tubes were draining. All I could tell for sure was that one large box—a ventilator, I assumed—was breathing for Richard, and that the screen on the wall mount over the bed was shadowing his heart rate and rhythm.

  “Leland’s a lawyer,” Jennifer said. “He’s Bob Fowler’s son.”

  “He knew my father?”

  “Not well. But Richard’s ad agency did a little work for Green Mountain Grizzlies a few years ago.”

  “I see,” I said, nodding.

  “Some brochures, a catalog. The annual poster.”

  “I’m sure my dad was a very difficult client. He really loved his bears.”

  “Oh, Richard’s had worse.”

  “Thank you.”

  “How’s your little one? Abigail?”

  “She’s fine.”

  “Bonnie will be bringing my kids by a little later,” she said, and then lowered her voice: “Bonnie’s my sister. I don’t know how I could have gotten through this without her.”

  “Do you and Richard have big families?”

  “No, small. Tiny. I have Bonnie, that’s all. And Richard’s an only child.”

  “What about your parents?”

  “My mother’s alive, but my father passed away.”

  “Richard’s?”

  “Both of his parents are gone.”

  “Who’s taking care of the kids right now?”

  “Kate’s thirteen, so she doesn’t need much supervision. And it’s been mostly my mother or Bonnie looking after Timmy. He’s eight. It’ll get a little easier for the kids next week when school starts again.”

  “I’m sure,” I said. I wondered how much time Richard had left. I wondered if next week those kids would be at their father’s funeral.

  “Your room got a lot of sun today,” Jennifer said to her husband, including him once more in the conversation. “It was nice and bright around noon.”

  I half-expected the body in the bed to respond. I wondered if Jennifer still fantasized about such things.

  “Don’t you think you can already feel the days getting longer?” she asked, and it took me a second to realize she was now speaking to me.

  “I do.”

  “God, winter. It can be endless.” She shook her head and then leaned into her husband and murmured, “Richard, I’m going to walk Leland back outside. I’ll be right back.”

  I went up to the bed for the first time and ran my fingers along Richard’s pale, thin arm. “I’ll see you again, Richard,” I heard myself saying. “In the meantime, I’ll be praying for you.”

  We stood together for a moment in the hallway beside the ICU waiting room, separated by double doors from the glass chambers the hospital had built for the likely to die.

  “Do you know your way back to the elevator?” she asked me.

  “I do. It’s a labyrinth, but I figured it out.”

  “Thank you for coming.”

  “It’s nothing. You know that. It’s just…it’s nothing.”

  “No, it was really sweet of you to visit. Will you do something else for us?”

  “Of course.”

  “Pray. You said you would. But really do it. Okay?”

  “Okay.”

  “But don’t pray for any miracles.”

  “No?”

  “No,” she said, bowing her head and shaking it, and then falling forward into my chest. “There won’t be any miracles, so don’t pray for one. You’ll only be disappointed.”

  I rubbed her back with both hands. “I’ll pray for whatever you want.”

  “Then pray he isn’t in pain,” she said, a slight tremor in her voice. “They tell me he isn’t, but please: Pray he isn’t in pain.”

  Number 225

  There are of course a few psychic diseases that have not merely degenerated from physical ones; instead, with only slight physical illness, they arise and proceed from the psyche, from persistent grief.

  Dr. Samuel Hahnemann,

  Organon of Medicine, 1842

  Abby and I were having dinner at Paul and Nora Woodson’s Friday night, so before leaving Burlington I bought some gourmet coffee and chocolate truffles in a store in a strip mall near the hospital. Then when I realized how close I was to the mammoth two-story bookstore that had just gone in beside the little mall, I decided I’d take a quick peek at the books in the health section. I wasn’t sure if I’d find anything about arsenic poisoning, but the fact that my feet were continuing to tingle and I’d had to rush to the men’s room before leaving the hospital—the Pepto-Bismol wasn’t doing a damn thing—had me worried.

  Intellectually, I knew I couldn’t possibly be poisoning myself with homeopathic arsenic, but I figured I’d check the symptoms of an arsenic overdose just in case, so I could rule it out and find another life-threatening, ICU-triggering ailment to worry about instead.

  “I think I’ll bring some underpants for Merlin and Addison,” Abby was saying, referring to the Woodsons’ two cats. Earlier in the fall, Nora Woodson had informed Abby that when she’d been a girl just a bit older than Abby, she had put underpants and a small T-shirt on her cat. For months now, Abby had been contemplating the idea of dressing up the pastor’s wife’s cats, and she figured tonight was her big chance.

  “Bring the ones with the trolls on the front,” I said, clicking the word Search on my computer screen in the den.

  “But they don’t fit me anymore!”

  “Exactly.” Within seconds, a list of more than forty-seven thousand sites appeared, all of which had either the word arsenic or the word poisoning somewhere in them. The bookstore may not have had a treatise devoted to arsenic or arsenic poisoning, but the Internet was a virtual library on the subject.

  “Can I bring a shirt, too?”

  “Sure.”

  Next I typed in the word arsenic alone, hoping the Internet search engine would offer a less impressive but more manageable number of entries.

  “I better bring two shirts and two pairs of underpants.”

  Eleven thousand–plus possibilities came up. Smaller. But still astonishing.

  “Okay.”

  “Can I bring a suitcase?”

  I turned to her. “We’re only going to be there a couple hours, sweetheart. We’re just going for dinner.”

  “I know. But I have to bring the clothes for the cats. And then I have to bring some Barbies and some books and some stuff for me.”

  I nodded. The Woodsons’ children were grown, and there weren’t a whole lot of toys left in the parsonage. “Sure. You go pack. But we need to leave in about fifteen minutes. Okay?”

  “Gotcha!” she shouted, and raced up the stairs to her bedroom.

  For a moment I glanced at the entries on the screen before me, but there were still way too many, and so I decided to winnow the search one more time. I linked the words arsenic and poisoning with the word AND in capital letters, signaling the search engine that I wanted only those sites that had both items somewhere within them. The result was a mere 978 entries—mere, of course, only when I thought back on the numbers I’d seen a moment before. It still wasn’t a bad total. In fact, it seemed pretty damn impressive: everything I could ever want to know about arsenic, right there at my fingertips.

  The source of the sites, as always on the Web, was a mélange spanning the sublime and the ridiculous. An occupational safety organization in Australia followed a group of high-school kids in Kansas who’d just performed Arsenic and Old Lace. A university professor presented his theories about Napoleon’s death, and then a country inn used its home page to advertise an upcoming Murder Mystery Weekend for Lovers. There were entries from journals devoted to timber treating, hepatology, the preservation of animal skins, and nineteenth-century embalming.
I learned about the 1991 investigation into President Zachary Taylor’s death—they’d actually exhumed whatever remained of the fellow from the ground, and quantified the amount of arsenic in his nails and his hair—and the problems of groundwater contamination in neighborhoods near century-old cemeteries.

  It was a full and rich exploration. And if Abby and I weren’t due at the Woodsons’ in a little while, I thought, I might be happy hanging out with these links for hours. But since we had to leave soon, I started scrolling through the computer sites in search of a basic primer on arsenic poisoning: its symptoms and, I hoped, its antidotes. Quickly I found what I thought I was looking for, the Treatment of Arsine Toxicosis, at a site run by the Iowa Agricultural Information Retrieval System.

  It took no more than ten or fifteen seconds for the entire site to download into my computer—no filthy, time-consuming graphics here, I thought—and I started to read. And then I tried to be calm, but it wasn’t easy. I could hear the sound of my breathing through my nose, whistles of air that went up and down, and every time I exhaled I could feel the warm wind on the backs of my fingers and hands, still poised atop my keyboard.

  The good news was that I didn’t have any lesions on my skin. At least any that I’d noticed. And I didn’t think the reflexes in my extremities were impaired, but in all honesty I wasn’t sure I knew how to test such a thing. Still, I seemed perfectly able to slam on the brakes in the truck, and that had to count for something.

  I had virtually no opportunity to savor the good news, however, because underneath skin lesions and impaired reflexes was a litany of symptoms that I did have. Anxiety. Diarrhea. Tingling along the soles of my feet, numbness across the palms of my hands. Vomiting.

  No, I haven’t vomited, I reminded myself, I’ve simply felt nauseous! And there’s a big difference!

  The last paragraph of the page offered the mesmerizingly unhelpful—and inappropriately unscientific, I decided—information that arsenic had been used for centuries to poison people (including popes and politicians) because the symptoms resembled those of so many other illnesses, and the toxin was almost impossible to detect in a corpse. It wasn’t until the late 1800s that forensic medicine had figured out how to grind up livers and test them for heavy metals.