by Sara Donati
While Dr. Lambert gave them what information he had about the subject, she managed to extract a notebook and pencil from her bag, toss aside her cape, and roll up her sleeves. Most of the others were wearing smocks, but she would have to do without today or draw more attention to herself.
Dr. Lambert was saying, “. . . a Methodist minister. Age fifty-three. This morning when his wife tried to wake him she found him deceased. Recently complaining of abdominal pain and indigestion. Towlson, what do you see?”
“Jaundice. Ascites. Looks like cirrhosis.”
Elise wrote: Ink stains on right hand and fingers. Scrupulous personal hygiene. Nostril hair trimmed. Nails (hands, feet) clipped short.
For the next hour Elise focused on taking notes as each organ was removed, described, weighed, and put aside for further examination. The liver, enlarged and off-color, was dropped into a basin and carried to a side table, with every pair of eyes following it. They would all scramble to be first at that station when the time came for close dissection. They had decided that this fifty-three-year-old Methodist minister had died of cirrhosis following from alcoholism. Elise had another idea. Possibly far-fetched, but worth at least considering.
When the time came Dr. Lambert looked around the table and raised both brows high. “What next? Grimes, you look like you need to relieve yourself. Stop prancing and speak up.”
“It’s obviously the liver,” Grimes said. “Jaundice, ascites, and just look at the size of the thing. I’d like to examine the hepatic and portal veins and take a look at some slides.”
All of the Bellevue students agreed that the liver was the place to start.
“Any other ideas? Mercier, you don’t look convinced about the liver.”
Elise was aware that the Bellevue students were looking at her. Some smirking, others dismissive.
She said, “I’d like to start with the heart.”
“The heart!” Grimes shook his head at such a ridiculous idea. “Didn’t you see the liver?”
“I did,” Elise said. “And now I’d like to have a closer look at the heart.”
“She’s uneasy about slides,” somebody else muttered. “Probably never seen a microscope.”
“Enough,” Dr. Lambert said. “Mercier, go on then and have a look at the heart. You’ve all got an hour and then we’ll sit down for discussion in my office.”
Working by herself at a station in one corner, Elise thought at first that she would be distracted by the very noisy discussion on the other side of the room. Then she picked up a scalpel and realized she was about to cut into a human heart. Perspiration trickled down her neck, and she shivered.
* * *
• • •
“CAUSE OF DEATH is a fatty liver,” Grimes announced as soon as everyone had taken a place at the long table in Dr. Lambert’s office. “No question. Unless Mercier knows better.”
Elise didn’t react to his tone. She said, “I do have an alternate proposal, but first I have to ask. You found diffuse venous congestion in the liver?”
Grimes relaxed, quite visibly. “We did.”
He had a half smile on his face, the kind of smile a brother might give a younger, very silly sister who insisted the moon was made of cheese or fairies lived in the garden. Elise refused to clear her throat or make any sound they might interpret as uncertainty.
Dr. Lambert said, “Go on, Mercier.”
She nodded. “I believe that right ventricular heart failure caused the venous congestion in the liver—”
“That’s ridiculous,” Grimes interrupted her.
O’Connor said, “If there is any ventricular heart failure on the right, it’s because the left side failed first, you should be aware.” O’Connor preened at his own generosity, taking the time to instruct her.
Elise looked him calmly in the eye. “You didn’t let me finish. Right ventricular failure can follow from constrictive pericarditis.”
Every head swiveled in Dr. Lambert’s direction.
He nodded. “This is true.”
“And so I examined the parietal pericardium,” Elise went on, her voice wobbling ever so slightly. “It should be about one millimeter in thickness, but in this case it is slightly more than four millimeters, as I measured it.”
There was a brief silence around the table.
“Why did you decide to pursue the heart?” Dr. Lambert asked her.
“His history,” Elise said. “This isn’t a man who has been living on stale beer for twenty years. He’s a Methodist minister.”
“Sayeth the Catholic nun.” A low mutter, but meant to be heard.
Grimes gave her a wide smile. “Mercier, you are very naïve if you think Methodists never tipple.”
“I didn’t say that,” Elise shot back. “You concluded he’s an alcoholic. I doubt that. And if he is not an alcoholic—”
“Ascites,” said O’Connor. “Ischemic necrosis—”
Elise leaned toward him across the table and interrupted. “If he is not an alcoholic, coronary disease is the most common cause of sudden death for men of his age.” She straightened in her chair and took pains to modulate her tone. “Which is why I asked to examine the heart.”
“Let’s look at his pericardium,” said Lambert. “That will be proof enough. Mercier, show us what you found.”
* * *
• • •
EXHILARATED, EXHAUSTED, ELISE got a horse car that would take her, eventually, to the Cooper Union. It would give her time to think through the session and collect her composure. She had to fold her hands together until they stopped trembling, but she could not keep her smile at bay.
Well done, Mercier. Those three words from Dr. Lambert echoed in her head, far more powerful than the begrudging acknowledgment of the Bellevue students. Well done.
Tonight she would sleep very well, and tomorrow she would present herself at the New Amsterdam to start a new rotation, this time with Dr. Kingsolver, who was generally liked and considered fair. That idea was still in her head when she left the horse car and crossed Fourth Avenue while an elevated train screeched overhead. She continued past the Mercantile Library, and turned south on Broadway where a pretzel vendor was packing up his handcart for the day.
There would be a good dinner on the table, she told herself. And every penny was precious.
The storms that had passed through earlier in the day had left the city feeling almost fresh. The sun threw a long shadow behind her as she passed the New York Hotel and nodded to the doorman, who touched his hat in greeting. Then Roses came into view and she stopped in surprise.
Oscar Maroney was about to open a cab door to help Mrs. Lee and Sophie in when he raised his head and saw her.
He called out, “Just the person I was hoping for. We need your help.”
“And I need to go back to my kitchen,” Mrs. Lee said. “Elise, I surely am glad to see you, though I am sorry that you are getting caught up in this sad business. Sophie, I’ll want to hear everything tomorrow when I stop by to look in on Tonino and the girls.”
And she marched back up the steps to Roses and disappeared inside.
Elise, alarmed and confused, turned to Oscar. He gave her a courtly half bow and gestured to the cab, where Sophie had already taken a seat.
* * *
• • •
SOPHIE WAS VERY glad to see Elise, and happier still to leave Oscar to explain the situation to her. On second telling the encounter with Nora Smithson was just as unsettling.
Elise sat back and put a hand to her mouth.
“Wait,” she said. “I’m not sure I understand. Neill Graham is Dr. dePaul?”
He shook his head. “Unclear. He might be dePaul, or what seems more likely, dePaul was a pen name Dr. Cameron was using. The important point is that we have a solid connection between Neill Graham, Dr. Cameron, and Nora Smit
hson.”
“But I thought that you were looking for some connection between Mrs. Louden and the apothecary,” Elise said. “Isn’t that what Amelie’s day-book made you think? Did you see any trace of Mrs. Louden there?”
“No,” he said. “But—”
Elise barely seemed to hear him. “Because if that’s the case, then there’s no evidence of a crime, as I understand it. What grounds do you have to arrest Mrs. Smithson?”
Sophie was delighted to hear Elise make this point, which she had argued with Oscar. Now he sent her a frown, as if she had put the words in Elise’s head against his express instructions.
“Graham has been missing for weeks,” he said. “That means that Nora Smithson’s brother and husband are both unaccounted for, and she refuses to tell us where they are.”
“Does she know?”
Oscar scowled at her. “About her husband, I would say yes. My sense is that she knows about her brother too. Now I hope you master detectives are finished questioning me about my methods. You’ll have to be satisfied with practicing medicine.”
Elise turned to Sophie. “What is it he wants us to do?”
“Mrs. Smithson complained of feeling unwell,” Sophie said. “Which gives us a reason to examine her. But I think we’ll have to reverse our roles.”
Elise tried to make sense of this, but Oscar was too anxious or impatient or both to wait.
“You will take the lead,” he said to Elise. “Because Nora Smithson will almost surely object to letting Sophie examine her. All in all it’s a good thing that you weren’t able to see her earlier today, as it turns out.”
“I’m not qualified to examine a pregnant woman,” Elise said.
Sophie gave her a wan smile. “I’ll be walking you through every step, in French. If she isn’t pregnant we’ll know that shortly.”
“What about Anna?” Elise’s voice came rough. “Wouldn’t it be better to have her there with you?”
Oscar said, “I went to the New Amsterdam first, but she was in the middle of an emergency surgery.”
Now Elise looked a little desperate. She said, “The examination can’t wait until tomorrow?”
“Taking her into custody is difficult given her condition,” Sophie said. “Pregnant or not, I can’t see her in the House of Detention.”
“I can,” Oscar said.
“House of Detention?” Elise looked between them.
“Sometimes a witness needs to be detained for questioning,” Oscar said, refusing to meet Sophie’s gaze.
“Oh, yes,” Sophie said. “For example—”
“You can tell the horror stories later,” Oscar interrupted her. “We don’t have much time right now. To keep track of Nora Smithson—to make sure she doesn’t disappear—we will have to post a guard here at her home rather than taking her into custody, given her condition. If there is a condition.”
Sophie shrugged her acknowledgment of this point.
Oscar sat back and considered Sophie critically. It was not a comfortable examination, but neither was she worried. Despite the odd and vaguely threatening situation, she was feeling very calm.
“Explain something to me,” he said. “Why are you so put out about this investigation? We are talking about someone who played a part in hurting a lot of innocents.”
It was a question Sophie had been asking herself for days. She wondered if she could make Oscar Maroney—who saw things in black and white, right and wrong—understand.
“You are assuming the worst,” she began. “So let’s start there. We have a woman who participated in—wait, let me be clear. Someone who is responsible, at least in part, for some terrible cruelty at the very least, and a number of deaths at the worst. But Oscar, this is not about good and evil. These crimes are the product of insanity. The responsible person is someone who is sick in heart and soul and mind.”
She paused and saw that he was listening.
“You have read what was done to her, and know what she suffered at her grandfather’s hands. A man who was supposed to protect her, to care for her. She was otherwise alone in the world, and this grandfather dosed her with a tea that nearly took her life and—at least, we believe—robbed her of her fertility. This far we can agree, am I right?”
He considered her, his chin bedded on his chest and his gaze cool. When he nodded, she went on.
“Anger is corrosive. It can wear away at the mind and cause as much damage as a cancer. For ten years Nora Smithson has been wallowing in her anger, and it has done things to her ability to reason. I am, first and always, a physician. I swore an oath. First do no harm is an idea for you, but for me, for Anna, for Elise, it’s how we live our lives.”
She watched people walking along Washington Square for a moment, trying to organize her thoughts and calm her tone.
“If she is guilty she has to be stopped. Of course. But Oscar, once her guilt is established, you will see her as someone who should forfeit her life for her crimes. I see her as someone who is sick unto death and needs help. I have no wish to do her harm. Or better said, I refuse to do her harm, or to let anyone else do her harm, if it is within my power.”
His mouth contorted. “Do you think it’s within your power—within anyone’s power—to fix what’s wrong with a person who would torture women to death?”
“Maybe not,” Sophie said. “Probably not. But first that question has to be asked, and answered.”
* * *
• • •
THE APOTHECARY HAD been closed to business for a good half hour by the time they arrived.
Oscar led them to the side entrance, in a recessed wall between Smithson’s and Hobart’s Bookshop. The wooden door set in the bricks opened without a key, and they climbed the stairs to the second-story landing, where a door stood ajar.
It opened into a hallway with rooms on both sides. A family apartment like any other, except Jack sat on a chair in the hall under a wall sconce, holding a book.
Elise recognized the book by its blue binding. Faith in the Great Physician. She wondered if Jack had found anything in it that might shed light on this strange situation.
Jack said, “We’ll be right in here in the hall. Call out if you need us.”
“She’s not a wild animal,” Sophie said, almost wearily.
“She’s desperate,” Jack said, meeting Sophie’s gaze.
“Many women are,” Sophie said. “Just let us tend to her.”
* * *
• • •
NORA SMITHSON, FULLY dressed, her hands folded in her lap, sat at the window and looked out over Shin-bone Alley. The room was small but neatly kept, very clean. A narrow bed with a simple blanket and without a pillow, a small table with a washstand, the single chair and a dresser. There was no closet or wardrobe in the room; instead, clothes hung from wall hooks in the old-fashioned way: a few skirts, some bodices and blouses, aprons. She saw nothing of a man’s clothing at all and wondered what to make of that.
The walls were painted a dull brown and without any trace of decoration beyond two embroidery samplers hung where a mirror would be expected over the dresser. From where she stood Elise could make out the wording, so exact was the stitching. The first read Honor Thy Father and Mother, and the second, black thread on white linen, spelled out one word without ornament or curlicue: Obedience.
All Sophie’s attention was on the patient, but it took some effort for Elise to draw her gaze away from the samplers.
In a low voice Sophie gave her directions, and Elise began.
“Mrs. Smithson,” she said, striving for a tone that was polite but firm. “I am Elise Mercier, a doctor in training. You are unwell?”
Her patient gave no sign that she heard. One fingertip traced its way back and forth on the arm of her chair, a small movement like the tick of a carpenter beetle in the woodwork.
“Mrs. Smithson?”
She was beautiful, with a long neck and perfectly symmetrical features. Her skin was so clear and smooth that for the first time Elise understood what people meant when they talked of a porcelain complexion.
Sophie touched her shoulder and finally she seemed to wake.
“Yes?”
Elise had to clear her throat. “We are here from the New Amsterdam to take care of you. Please lie down so that I can examine you. I’d like to make sure your baby is not in distress.”
That idea got through to her. Without objection she moved to the bed and lay down without further complaint. This quiet complacence could be a ruse; even in her short hospital career Elise had seen many patients who were masters of assuming an expression as artificial as a face drawn hastily on canvas.
In the few minutes it took them to unpack what they needed from Sophie’s Gladstone bag and wash their hands in the basin, their patient never moved or spoke. She didn’t respond when she was asked to unbutton her bodice, but neither did she object when Elise did that service for her.
“Now, Mrs. Smithson, when is your baby due, do you know?”
“When the time is right,” she said. “And not a moment before.”
Sophie hummed under her breath but let Elise carry on.
“Are you in any discomfort?”
“Discomfort?” The question puzzled her.
“Are you in pain at all?”
Mrs. Smithson said, “In pain? Of course I am in pain. ‘Unto the woman he said, I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth children; and thy desire shall be to thy husband, and he shall rule over thee.’ Genesis 3:16.”
Sophie hummed again, her mouth held in a grim line.