by Sara Donati
Elise watched with dismay as Sally—who was looking over her shoulder to make a face at her—ran straight into Dr. McClure. Sally’s bag flew off, spitting books and papers and pencils as it hit the marble floor.
“Dr. Micky,” Sally began, straightening to her full height. “I mean, Dr. McClure. Good—”
“Stop.”
Sally ducked her head, not out of respect but because she was in danger of smiling. Elise could see this, and so could Dr. McClure, who was studying them, her gaze shifting from Elise to Sally and back again.
She said, “They are shorthanded in the clinic today. Both of you are to report there. And do you know why, Miss Fontaine?”
“To get us out of your sight?” Sally suggested helpfully.
“Exactly. Do that, now.”
* * *
• • •
“YOU WILL PUSH too hard someday,” Elise said.
“I’ll make more of an effort to act my age. Now tell me quick, are the rumors about the clinic true?”
Clinic duty was usually reserved for third-year students, who had more experience and at the same time needed more experience as they neared the end of their medical school training.
“I’m afraid most of them are,” Elise said.
There were other free clinics in the city, but most of them were smaller, poorly staffed, and lacking even basic supplies. Free clinics attached to the religious hospitals were well staffed and supplied, but they were also choosy about who they would admit. So the sickest and most desperate found their way to one of three places: Bellevue, the charity clinic at the Woman’s Medical School, or the New Amsterdam. And the New Amsterdam was closest to the poorest neighborhoods.
“I heard that a man who came in last week stabbed one of the orderlies.” Sally seemed less frightened by this idea than oddly intrigued.
“That rumor isn’t true,” Elise said.
“How do you know?”
“Because,” Elise said, with an impatience she didn’t try to hide. “This hospital serves women and children. There was a boy with a straight razor, but he didn’t stab anybody. Just the opposite, it was lodged in his metacarpophalangeal joint.”
“I would have liked to see that. Did he lose the thumb?” Sally might be irreverent, but she had something close to a photographic memory and an all-consuming interest in the things that could go wrong with the human body.
“Not yet,” Elise said. “Tell me, Sally, do you stick close to me because of Dr. Savard? Are you hoping for a social introduction?” She had been waiting for a time and a subtle way to ask this question. This was neither, but the words were in the air before she could stop them, and Elise realized she was angry at Sally for getting this day off to a less than good start.
To her credit, Sally didn’t flinch. “That would be nice, one day. For right now I stick close to you because you’re the person in our class with the most actual experience with patients. And because you are good for me, and I think I may be good for you, sooner or later, in one way or another. Now shouldn’t we get to work?”
At the clinic doors Elise paused, put down her bag to open it. She drew a small vial out of one pocket and a piece of muslin out of another.
“Oil of wintergreen,” she said. “Give me your handkerchief.”
Sally handed it over. “Will it be that bad?”
“Most of the poor have no chance to wash over the winter,” Elise said. “And the free public baths have been closed for weeks. So, yes. It will be that bad.”
* * *
• • •
THERE WERE ORDERLIES and nurses on duty and not a single doctor, because, Margery Inwood told them, a three-year-old had bitten Dr. Constantine’s arm to the bone, and the third-year medical student who was on duty had been sent home with a fever.
“Dr. Constantine’s gone off to have her wrist cleaned and sutured and I doubt she’ll be back anytime soon,” Margery said with great good cheer. “So it’s up to you until they find a doctor to take your place.”
She was already congratulating herself on the stories she would have to tell: how she, Margery Inwood, witnessed Elise Mercier trip over her pride to land on her face.
Sally Fontaine watched this exchange with narrowed eyes and interpreted it perfectly.
She said, “Nurse Wood, is it?”
“Inwood. Margery Inwood.”
“In training?”
“No,” Margery said, drawing herself up. “I am two years in service.”
“Then why are you standing here making faces, when there are patients in need of attention? Or do you leave all the work to the other nurses—who else is on the floor?”
Elise scanned the room. “Gale and Ellery.”
“Nurses Gale and Ellery are busy with patients. Why aren’t you?”
Margery’s mouth opened and closed; she cleared her throat and tried again to respond—Elise was truly curious about what she could possibly say—but Sally had already turned away and was studying the waiting patients.
“Nurse Inwood,” Elise said, her tone even and professional. “Bring the two most urgent cases to the exam rooms, please. Unless the little girl in a biting mood is still here, in which case I’ll start with her.”
* * *
• • •
ELISE’S SIXTH PATIENT was a seventy-year-old woman in heart failure. She sent her upstairs to be admitted to the hospital and was wondering about something to drink and five minutes of solitude when the nurse who had been assisting her came to the door. Marion Ellery was impossible to rattle and utterly competent, and she had made the morning far less difficult than it might have been.
“There’s someone here asking for you especially. She says you told her to ask for you by name. A French woman, or two of them, actually. With an infant in distress.”
“Name?”
“Bellegarde, from that French bakery on Greene Street. You know them?”
“I do,” Elise said. “Please bring them in.”
* * *
• • •
DOCTORS WHO TREATED the poor in free clinics and crowded tenements had to develop the ability to block out every distraction: angry shouts, wailing, arguments, street noise, the stench of unwashed linen and bodies, the sight of children on the verge of starvation. If you could not narrow your focus, the chances that you’d get to the source of the problem were slim. Elise knew that she was beginning to be able to do this, because when the small party from the boulangerie came into the exam room, her gaze went first not to the infant, but to the younger of the two women, the wet nurse Alphee. She had been quiet and polite when Elise met her, but now she never even looked up; she went to a stool in the corner, sat down, and bent forward to rest her forehead on her knees. Her arms came up and wrapped around her middle, and she rocked herself.
The baby in Lucie Bellegarde’s arms was howling in the particular wah-wah-wah of a very young infant who is truly hungry or agitated or both.
“Dr. Sophie,” she was saying. “He is in such a state, vomiting and loose bowels, nothing works to calm him, and his eyes—”
Elise raised a hand to stop the river of words and took the baby. With his mouth wide open and his eyes squeezed shut it was hard to get a sense of things, and so she blew a short, sharp breath over his face. The effect was immediate, as she had hoped: his expression relaxed and his eyes opened.
His pupils were dilated.
She handed the young Denis Bellegarde back to his grandmother, a dozen images tumbling through her mind, passages from textbooks and illustrations of the human eye. Pupils dilated and contracted in response to light and darkness. Pupils that remained dilated did so because of traumatic injury to the brain, or in response to some kind of drug or stimulant. She cast a quick glance at Alphee, who was still bent over her knees and rocking in what was clearly pain.
“Alp
hee,” she said in her calmest tone. “Was he dropped?”
Alphee’s voice came muffled. “Pas de tout!”
“No,” Lucie Bellegarde echoed, “I’m sure he wasn’t.”
“Before I examine him, tell me what’s wrong with Alphee.”
The older woman’s mouth dropped open in surprise. “Alphee?”
“She’s not well,” Elise said. “Surely you see that.”
Marion Ellery was standing beside the wet nurse now. “Come a little closer,” she said to Elise. “And you’ll be able to tell for yourself what’s wrong with her.”
And it was true; even from a few feet away, Alphee smelled like a brewery. Alcohol came off her in waves, but alcohol was not the source of the problem.
In sharpest French she said, “Alphee. Raise your head and look at me.”
Tears washed over the girl’s cheeks, but she did as Elise demanded. One side of her face was lumpy and swollen, as though her cheek were stuffed full with nuts.
Lucie Bellegarde made a tutting noise to show her sympathy. “A un mal de dents terrible. Toot-ache.”
“When did this start?” Elise asked.
The girl dropped her face back to her knees, her back curved like a mollusk’s shell, and Lucie Bellegarde told the story, which wasn’t long or complicated: Alphee had broken a tooth the previous morning and had been in agony ever since. Dentists were demons, never to be trusted. Better to dose her for the pain and wait for the barber Cottinet, who was away from his shop but would be back tomorrow.
Elise had never heard of this barber but learned now that he was the only person the French in the city would trust to pull a tooth.
The light began to dawn. Elise said, “And what have you given her for the pain, in the meantime?”
This question pleased the older woman. She had a net bag slung over one shoulder, and now she let it slip down her arm and offered it to Elise.
“Vin,” said Lucie Bellegarde, and repeated herself in English, turning toward the nurse. “Wine.”
Elise peeled the net bag away from the bottle inside it. “This is what they gave you at the apothecary?”
“Oh, no.” Her tone was shocked and disgruntled both. Lucie Bellegarde had gone, quite logically as she saw it, to her brother-in-law Henri, who owned the Taverne Alsacienne, just down the street. Henri had given her the wine.
“Is very good for toot-ache,” she said in her careful English. “No more pain. I should give her more now?”
The label featured a likeness of the pope, an elaborate seal, and, in large letters: Vin Tonique Mariani ala Coca du Perou.
“No,” Elise said. “No more of this for her.”
“What is it?” Nurse Ellery wanted to know.
“Coca wine,” Elise said. “Wine infused with cocaine. No doubt it does wonders for a toothache. But then she passes it right along to the baby in her milk. How much of the wine did she have? Was the bottle full when you got it?”
The answers she got to her questions were not comforting, and neither was the baby’s condition as he thrashed in his grandmother’s arms. She needed to flush as much of the cocaine out of his system as she could, as quickly as possible. The ways to do this were limited.
Sophie would have been the right person to call in. She would know how to treat such a case, but Sophie was at Greenwood and wouldn’t be back until late afternoon or evening.
She turned to the nurse. “First, we need another wet nurse to try to feed him. What doctor on staff has the most experience with newborns in distress?”
Asking the nursing staff was always the best way to find out about the physicians, their strengths and weaknesses, and that observation bore itself out now, as it had many times in the past.
“Dr. Martindale,” said Marion Ellery.
Gus Martindale, who had, Elise remembered very clearly, been flirting with her in the staircase when she first met him, and later flirted again after he examined the street urchin called Mariah.
“Then go, get him, please. And a wet nurse.”
Lucie Bellegarde was shaking with fear. “What?” she asked, her voice wavering and breaking. “What is it?”
“Madame Bellegarde,” Elise said. “This wine of yours is full of cocaine.” And at the blank look on the woman’s face: “Burny. There is burny in the wine. Alphee drinks the wine, the burny makes her toothache better so she can nurse, but the burny passes on to the baby with her milk.”
There was a moment of silence in the room. Elise was glad that Alphee was in too much pain to pay close attention, because she had seemed a kind, goodhearted girl, and this news would be devastating to her.
Lucie Bellegarde had understood, and now she stared at her grandson’s face. “Jésus, Marie, Joseph,” she breathed. “If he dies, my son will never forgive me.” Then she thrust him toward Elise. “Fix him, please. Do what you must, but fix him.”
Elise turned all her attention to the wailing child and set out to do exactly that. What her chances of success were she didn’t know, and it didn’t matter.
By the time she had stripped him out of his wrappings the wet nurse was there to take him. Like many of the wet nurses, she had come to the New Amsterdam to give birth because she had nowhere else to go, and agreed to stay on to nurse an orphaned infant alongside her own for a period of three months. Elise had seen hundreds of women in this situation throughout her career as a nurse, and most of them were well intentioned and careful with their charges. This one was very young but she radiated calm.
She sat down on the low chair in the corner designed specifically for nursing and bared her breast, took the writhing, naked boy, and set about trying to get him to latch on.
She was gentle but insistent, holding his head still with one cupped hand and brushing the nipple over his mouth. His full-throated wailing brought on her milk in a rush, but even that could not focus his attention.
“Come now,” she murmured, her head canted forward so that her breath would touch his cheek. “Come now, little man.”
Elise was watching so closely she didn’t realize that Dr. Martindale had come in. There was a splatter of blood on the surgical tunic he wore, but his hands were freshly scrubbed and still damp with disinfectant.
“Well, this will never do,” he said in a genial tone.
The boy’s wailing was softening; exhaustion was setting in, and he was in danger of slipping into lethargy.
Elise took the baby from the wet nurse and passed him to Dr. Martindale as she gave him the history. While she talked she watched his examination and saw him run a finger over the skull and take note of the sinking of the fontanel.
“Coca wine.” He made a sound in his throat, a little huff not of surprise but acknowledgment.
“He won’t take the breast and he can’t keep even a few drops of water down,” Elise said. “Hydration is the issue.”
Eyes of a dark blue came up to meet her gaze. “And you would suggest?”
There was no time to play to his ego, if that was going to be an issue. Elise said, “Dr. Trall’s water treatments are not popular, I know. But we could try rehydrating him rectally. By enema. Maybe with Ringer’s solution? The water at least would probably be absorbed.”
“Ellery,” Dr. Martindale said without looking away from Elise. “You heard Candidate Mercier. Snag an orderly to help you and get what we’ll need, and be quick. Oh and, please show the family out to the waiting room, would you?”
Then in a simple movement he flipped the boy over so that he was cradled, belly down, along his forearm with the skull resting in his cupped hand. Decisive but gentle, and with a determined air that said this boy would not die if he could help it.
* * *
• • •
HOURS LATER SALLY Fontaine had to hear every detail, from the preparation of the Ringer’s solution to the diameter of the tubing.
Elise spread out both hands, palms up. “He’s improving. He’s swallowing again and taking the wet nurse’s breast.”
“And aren’t you the clever one.” Sally pushed her gently. “You know all the nurses and most of the doctors are in love with Martindale? Though he is married, they can’t stop sighing over him.”
“How many male physicians are on staff here?” Elise asked. “Three? The odds are in his favor.”
“Oh, as if the other two were any competition. No, Martindale is the favorite, and not just because he’s good looking.”
Elise wondered if she could get away with changing the subject and saw by Sally’s expression that she could not. “Compared to McClure, he is a saint,” she admitted. “He was professional and collegial.”
“Collegial?” Sally raised a brow.
“He talked to me like an equal.”
Sally expression shifted from amusement to appreciation. “That would be refreshing. Come on, you have to admit that he’s the perfect combination of masculine and feminine.”
That made her laugh. “I wonder what his wife would say to that.”
Sally fluttered her fingers, as if a wife were irrelevant to the topic at hand. Elise recognized the signs: one of Sally’s theories on the medical mind was about to be launched. So she got up and said one thing she knew would send Sally scampering in the other direction.
“I have to go pull a tooth. Care to lend a hand?”
The look of horror on Sally’s face was almost enough to make Elise sorry to have conjured up a difficult image. Sooner or later she would come across some procedure that horrified her. In the study of medicine some things were unavoidable.
36
ON SUNDAY MORNING, to take her mind off of Tonino and the fact that she would be examining him shortly, Sophie let the girls give her a tour of the Mezzanotte farm, with Pip dancing along behind them. They took her through every barn and outbuilding, around the apiary and pastures and fields to admire a river, where, they told her, Anna had gone swimming on her first visit to Greenwood. In her clothes, and unexpectedly.