The Doctor's Discretion

by EE Ottoman

  He watched William move the brush across his cheeks and chin in quick circular movements and then down to soap the underside of his jaw and a little of his neck. Augustus’ gaze drifted down the open neckline of William’s dressing gown. Purple silk against red-brown skin and dark chest hair. Augustus wanted to put his mouth there, open that robe so he could go to his knees and follow that warm skin all the way down.

  Swallowing hard, he turned away from William and busied himself with dressing before he disrupted their morning again.

  They left William’s rooms as soon as they were both washed and dressed.

  The sky was a very dark gray above them with just the barest hint of light beginning to peek above the city buildings.

  The air was cold enough to make their breaths hang before them in clouds of white, and pink Augustus’ cheeks. It was not oppressively cold, though, more brisk and invigorating, especially dressed as he was in his Navy-issue wool greatcoat.

  “Come on.” William made a small movement as though he wanted to take Augustus’ hand but, of course, didn’t. “We can walk a little ways; the place I have in mind isn’t far.”

  “No?” Augustus looked up at him, and William smiled.

  “You took me to the eating-house you always go to. I thought I’d take you to mine.”

  They started down the sidewalk together.

  Even this early, there was a good amount of traffic. Cabs, and people hurrying to work filled the streets, as well as some carts taking goods to markets and shops. In William’s neighborhood, young, single men in fashionable coats and top hats were coming out of their apartments, hail cabs or, like them, deciding to walk.

  William lived in the St. John’s Park neighborhood. It was home to a small community of men and women of color, businessmen, shop owners, and skilled craftsmen, with a few artists and intellectuals thrown into the mix. Although the brick houses lacked the stately grandeur of the neighborhoods around Washington Square, they were perfectly respectable. A growing number of young white professionals were moving into the area, making it an affluent and fashionable place to live. They were also trying to force its original occupants out. Augustus hoped they didn’t succeed.

  They walked a few blocks together. The brick houses gave way to shops and slightly less expensive wooden boardinghouses that were cleanly painted and tidy.

  The scent of coffee and baking bread was coming from some of the shops and not a few of the boardinghouses. Augustus’ stomach growled, reminding him he’d only had a sweet potato for supper the night before. William stopped at a brick building with a swinging sign over the door that read ADRIEUX.

  William pulled the door open for Augustus and followed him inside the eating-house.

  It was filled with the scents of coffee and frying meat and looked much like every other low-end eating-house Augustus had ever been in. Wooden booths lined the walls with a smattering of tables filling the rest of the space.

  This early in the morning, the place was mostly empty, but there were a few clusters of men sitting and drinking coffee before going off to work. All of them were black or otherwise dark-skinned, Augustus realized; his was the only white face in the room. People turned to watch as William ushered him over to an empty table, and Augustus did his best not to feel self-conscious.

  “There is only one option in the mornings,” William said as they sat. “It’s usually eggs, some sort of meat, and then some sort of bread, with coffee of course.”

  Augustus nodded, and William waved over the young waiter. “A plate for each of us and plenty of coffee.”

  Within a matter of minutes, two waiters approached their table carrying food and a pot of coffee, which was set down between them. The plates that were set before each of them were laden with fried eggs, biscuits straight out of the oven, what looked to be beef kidneys fried with onions, and something yellow he couldn’t quite identify.

  “Fried plantains,” William said when Augustus raised his eyebrows at him. “Try them. They’re good.”

  The waiter who had brought the coffeepot set down their cups along with apple preserves for the biscuits.

  Augustus tucked into his plate of food with a will as William poured them each a cup of coffee.

  When William picked up his knife and fork and skewered a slice of kidney with care, Augustus realized he’d been shoving meat and eggs into his mouth with only his knife, ignoring his fork completely. It was an old habit he’d been trying over the last few years to break. He swallowed his mouthful and reached for his cup of coffee, hoping William had missed his lack of table manners.

  Although, truthfully, he wasn’t sure who he was trying to fool. William had spent almost every waking moment over the last few days in Augustus’ company, had been drinking with him in a dockside whorehouse just last night. There was no way for Augustus to pass himself off as high society at this point.

  “I have a question I’ve been wondering about for the last few days.”

  William looked up from cutting his eggs and meat into bite-sized pieces. “What?”

  “When you’re not working on Doctor Russell’s collection, what are you working on?”

  William had mentioned briefly and in passing that he still did medical research and wrote, even though he no longer practiced. That, and he’d obviously been writing something when Augustus came to speak with him the evening they’d gotten Moss out of New York Hospital.

  “Right now, I’m interested in the science of blood transfusion.” William reached for his coffee. “The history of the medical debate around the subject, but also the advances that have been made over the last few years, and, of course, its possible future applications.”

  Augustus sat back, calling to mind what he knew of blood transfusion research. It was still such a risky procedure, with so few practical applications, that he hadn’t ever thought much about it. He had read an article a few years back, though. “Doctor Blundell’s research?”

  William smiled, seeming pleased that Augustus wasn’t altogether ignorant on the subject. “In part. Doctor Blundell has had the most success with human-to-human blood transfusion as a method of treatment for postpartum hemorrhage. He’s conducted almost ten to date, half of which have been successful. But doctors have been studying and conducting experiments around the concept of blood transfusion for close to two centuries now. Even today, we are not sure what causes some patients to respond well to the treatment and not others. Imagine the applications, though, if it could be perfected.”

  Augustus could well imagine; he’d seen enough people die of blood loss. Next to infection, blood loss was the terror of all physicians and surgeons. They could do everything right and still have a patient die from lack of blood.

  “I’m most interested in it as a possible treatment for bleeding disease,” William went on. “Or for amputation patients, soldiers who have been shot or stabbed on the battlefield, work-related injuries such as impalement, or people who have fallen from horses.”

  “Certainly, it would completely change hospital medicine if it could be safely done.” Augustus reached for a biscuit, split it, and spread it with apple preserves. “You said half of Doctor Blundell’s attempts failed?”

  “Fifty percent success rate is higher than has ever been achieved before. But it troubles me that when it does fail, we have very little understanding as to why.”

  “What was the method Blundell used for transferring the blood?” Augustus took a bite of biscuit and washed it down with a sip of coffee.

  “For his first few attempts, he used a sort of funnel leading to a syringe, but found it difficult to inject enough blood into a patient before it began coagulating. In his most recent publication, dating from earlier this year, he describes using a funnel attached to a tube held above the patient, which would allow the use of gravity to hasten the delivery of blood. Still it is my understanding that coagulation is a major issue with any method, based on the sheer quantity of blood that must be moved from donor to patient. Yet, at
the same time, injecting the blood too quickly has also proven dangerous.”

  A well-dressed young man who had been heading towards their table blanched at William’s description of the blood transfusion process and changed course to find himself somewhere else to sit.

  Augustus watched him go, feeling slightly amused, before turning back to William. “Obviously, there must be some method found to thin the blood before this can become a widely used process.”

  “Yes, but it’s difficult. Experiments with injecting water and milk into patients have not been overly successful. Blood which has somehow been changed, such as heated, has also proven to kill patients outright.”

  “Well, even with the issues and risks, it seems like a promising method for extreme cases.”

  “I think so. It’s ironic really. So many doctors believe bloodletting is the cure for these sorts of aliments, but here I am studying the exact opposition method, putting blood back into the patient. And although blood transfusions came from the study of bloodletting, I think in the long run, it will be much more useful and beneficial a practice.”

  “Are you not a supporter of bloodletting?”

  William frowned as he reached for his coffee cup. “Not at all. Look over the research. When has a patient been cured or even successfully treated using bloodletting when the physician or surgeon did not already expect it to work?”

  “Exactly, and this is why more and more doctors of our generation are moving away from the practice, and rightly so I think. Not that you’ll ever get the older generation to admit it.”

  William’s smile had grown wider and a lot more knowing. “No indeed.”

  “What about handwashing?” Augustus was practically leaning across the table now, forearms braced on top, having thrown good manners completely to the wind in his excitement.

  William’s eyebrows went up. “What about it?”

  “It’s my research interest at the moment, especially in the running of hospitals.” He did not say Doctor Cooke disagreed or how strongly, wanting to hear William’s opinion first before he brought up his own ongoing feud at New York Hospital.

  “Well, I think there is a certain amount of common sense to that,” William said, his expression going serious. “It’s been proven repeatedly that physicians and surgeons who value cleanliness lose fewer patients. Certainly, when it comes to surgery or amputation, doctors who use equipment boiled beforehand and who make sure to wash both themselves and the space thoroughly between each patient have fewer deaths. I’ve yet to see any large-scale study of the role of cleanliness or handwashing among hospital doctors and employees, though. I don’t think such a study has taken place. Although we can certainly extrapolate that what works in the case of individual doctors would also work in a hospital setting.”

  Augustus nodded and sat back, satisfied by William’s answer. “That’s what I think as well. In my own career practicing medicine, I have found a marked difference in survival rates based on cleanliness, especially when it comes to fighting infection. Of course, such ideas have been hard to implement effectively at New York Hospital, where I have very little control over what goes on and none whatsoever when it comes to shaping policy. One day maybe.”

  “I’m sure you’d run an excellent hospital.”

  William probably just meant it to pacify him, but Augustus felt happiness collect inside his chest, and he smiled helplessly across the table. William smiled back, lowering his lashes a little shyly.

  Augustus reminded himself again that they needed to meet Moss. They could not go back to William’s rooms to spend the rest of the day in bed, fucking and talking medical theory and practice.

  Between the two of them, they’d managed to clean their plates and drink most of the coffee. William waved the waiter back over and paid him while Augustus stood and put on his greatcoat and hat. Together, they left the eating-house and went to see if they could convince a cab driver to take them to Chatham Street.

  Chatham cut through the poorest parts of the city, dividing the east docks from the Five Points slums. While cabs were often unwilling to risk traveling to Five Points, Chatham was a major street that ran through the heart of the city. The driver they found was willing to take them there at least, if not further.

  The cab rattled down a road that became increasingly unevenly paved and then gave way to deeply pockmarked dirt, lined with a mix of older wooden buildings and newer brick. At least Chatham was a wide road, only half choked with carts piled high with goods headed towards Chatham Square, which boasted the largest market in lower Manhattan. People on foot, street vendors and pedestrians alike, filled the remaining space along Chatham Street. Augustus watched the stream of women carrying baskets back and forth from the market, the men on their way to work, and children running wild. Their cab jerked to a halt, with the driver swearing indistinctly from above them.

  Augustus opened the door and stuck his head out. Several carts piled with produce were stopped in front of them, their drivers swearing with vigor at a bedraggled and obstinate-looking man driving a flock of sheep down the street towards Chatham Square.

  He shut the door and turned back to William. “We may have to get out and walk. Traffic from the market could keep us trapped here for hours otherwise.”

  William’s gaze went to the buildings on either side of them, which were in various stages of disrepair with small, dark, garbage-choked alleys between them. This neighborhood wasn’t much different from the one they’d been in the night before. In fact, they weren’t far from that particular whorehouse. William had been nervous then too, nervous and off-balance enough Augustus had thought at one point William would have clung to him if he could.

  In truth, the streets of Five Points didn’t hold that much fear for him. He’d grown up, not exactly in this neighborhood but not far from it. But William had been much more gently raised. Also, the combination of his fine clothes and race meant he ran a greater risk of being made a target of thieves.

  “It’ll be all right. I did learn some things about fighting in the navy. I can protect us if it comes to that.”

  William met his gaze with unflattering doubt, which Augustus couldn’t blame him for.

  The cab lurched forward, the street evidently having been cleared of sheep. They rolled a few more feet before stopping again. This time, there seemed to be a small knot of people, a mixture of men and women, in the road yelling at each other. One man shoved another into a large hole of muddy water. With an oath, the man surged up and grappled his assailant back onto the street. A circle of jeering onlookers began to form around the two. The woman who’d been involved in the original altercation was still screaming and swearing at both of them.

  “There’s a fight,” Augustus reported. “Who knows how long it will take to break up. We should get out and walk.”

  “As long as we’re going in a different direction.” William swung his own door open and climbed out of the cab.

  Augustus got out of the other side and went to speak with the driver. The driver was more than happy to take Augustus’ money and turn the cab around without having to fight his way through the traffic for the market.

  William was waiting by the side of the road for him. Augustus wove between the people and carts to join him and then led the way down one of the side streets leading off Chatham.

  The streets were older here, a lot narrower and more winding than the streets uptown. The neighborhoods north of Canal Street or even the neighborhoods around St. John’s, where he lived and where New York Hospital was, were laid out like a grid. Down here, there were no neat rows of streets. Instead, it was a maze of tightly packed tenement houses and small alleyways between them.

  Luckily, it only took them a block, moving down a street so small it didn’t even have a name, before it branched onto Augustus Street.

  August continued to lead the way, stride purposeful, in a diagonal across the street and between two brick buildings. The alley was, like all alleys, strewn with ref
use, but there had been some attempts to clear the way. At the end of the alleyway was a heavily rusted metal gate. There had been a lock on it at one point, but that had long broken off. The weeds that choked the gateway would make it difficult, if not impossible, to close completely the gate anyway.

  Beyond was a green space, somewhere between a field and courtyard. The ground was choked with long grass, weeds, and bushes, with small gnarled trees trying their best to reach towards the sky.

  There weren’t gravestones among the trees and scrub, there never had been, but every so often someone had laid down a roughly hewn stone flat to the ground. There was no path, but a series of markers that would in summer stand out against the red of the owl’s clover, the purple of the asters and bull thistle, and the yellow of the goldenrod, wound between the trees.

  It was not to Augustus’ eye a bad place to sleep for the rest of eternity. Especially since the people who were laid here hadn’t been allowed much beauty or peace during life.

  Now the grass and weeds lay reduced to dried husks in browns and grays still laced white with frost and ice from the previous night’s cold. The stones stood out stark against the dead grass, more obviously graves without the gentle touch of wild flowers and bending green trees.

  Beside him, William shivered.

  They waited. Augustus kept an eye on the trees. They weren’t really close enough together to hide someone, and most people in this neighborhood tended to leave places like this to the dead, but still it paid to be vigilant.

  William picked his way between the weeds and trees, inspecting the stones. A cold wind started up, blowing between the leaning wood tenement houses at the far end of the burial ground and causing the branches of the trees to shake and clack together.

  William came back to stand beside Augustus. “When do you suppose Moss will be here?”

  Augustus shrugged, hunching deeper into his greatcoat. “I don’t know. I’m surprised he isn’t already here, actually; he had less of a distance to travel than we did.”