Orphan #8

by Kim van Alkemade

  “Not even a little milk? She’s sure to cry.”

  “No, only water, nothing else. It’s very important for the quality of the radiograph.”

  “Yes, ma’am,” the nurse said, then corrected herself. “Yes, Doctor.”

  Mildred Solomon made no effort to hide her irritation at the subtle insubordination. The nurses never questioned Dr. Hess’s orders the way they did hers. Simply because they were all women was no reason for the nurses to assume they were on the same level. Perhaps once they saw her taking charge of a study, they would begin to show her the deference a doctor deserved.

  The next day, Dr. Solomon alerted the technician to ready the X-ray room while she prepared the barium drink, mixing the powder thoroughly in cold water. Entering the Scurvy Ward, she approached Rachel’s crib, a large metal cup in her hand. “You must be very hungry,” she said.

  Rachel looked up at the pretty doctor. All of the nurses had been so mean to her, leaving her in the crib while the other children ate, ignoring her crying as her stomach cramped and growled. “I’m so hungry. Did I do something bad? Is that why they won’t give me any food?”

  “No, you haven’t been bad. In fact, you’re doing something very important for science.” The girl looked at her quizzically. “Very important for me,” she said, and saw Rachel’s face soften. Dr. Solomon hoped the nurses could hear how kindly she talked to the child. She demanded their respect, yes, but she wouldn’t mind if they liked her—she had endured enough hostility in medical school. “I brought you this milk shake. I want you to drink the whole cup, and then we’ll go to the X-ray room again, like we did a few days ago. That didn’t hurt a bit, did it?”

  The X-ray room, with its maze of pipes and pulleys, the hum and sizzle of its generator, had unsettled Rachel, but she didn’t remember anything bad happening to her there. Thinking back, she found she could remember only entering the strange room, not leaving it; her next memory was of waking up from a nap in her crib. “No, it didn’t hurt.”

  “Good then, now drink up.”

  Rachel, starving, grabbed for the cup, but after a few swallows she pushed it away. “I don’t like it. It tastes like chalk.”

  “It is very important for you to drink it all, and quickly. You are a good girl, aren’t you? That’s what the nurses told me. That’s why I chose you, of all the children, to help me in my work.”

  Rachel wasn’t used to being told she was good, and it had been a long time since she had been helpful. She thought of how pleased Papa had been when she matched buttons for him, how Mama had depended on her to sort their coins. The wall of grief that separated her from the warmth of those memories turned her away from the past, forcing her attention on the woman in front of her. Rachel wanted desperately to please the lady doctor. She started to drink but gagged at the chalky taste. Dr. Solomon tipped up the bottom of the cup, filling Rachel’s mouth, leaving her no choice but to swallow. Soon the cup was empty and Rachel was left with a scratchy feeling in her throat.

  “I’m very proud of you, Rachel. Now, let me take you to the X-ray room.” Lifting the girl out of her crib, Dr. Solomon strained at the weight. Grudgingly, she wondered how the nurses managed it day in and day out. She’d have to get one of them to bring the girl to her next time.

  She took Rachel’s hand and led her out of the Scurvy Ward and down the hallway. As they walked, Rachel felt the milk shake sloshing in her belly. “Was I very good?”

  Mildred Solomon looked down at the child. Again, excitement at the prospect of conducting her own research lit her face with a smile that spilled over onto Rachel. “You are a very good girl.” They turned a corner and went into the X-ray room.

  The technician assured Dr. Solomon that the generator was working perfectly and that the Coolidge tube was in place and ready for its electric charge. She hadn’t expected to have such expert support—most radiologists had to manage all the equipment themselves, risking shocks and burns. This technician had gotten his training in X-rays during the Great War, hauling the equipment around France in a van and setting it up outside field hospitals spitting distance from the trenches.

  “Thank you, Glen. I can manage from here if you want to take your lunch break, but I’ll need you back in an hour. I’m screening the new infants for rickets this afternoon.”

  “Yes, Doctor,” he said, nearly saluting her. Something about Mildred Solomon brought out his military manners.

  Dr. Solomon turned her attention to Rachel. “Let’s arrange you on the table.” Stepping on a small stool, Rachel climbed up. “Careful!” Dr. Solomon pushed down on the crown of Rachel’s head, which had nearly collided with the Coolidge tube. Rachel ducked, then stretched out on the table. As Dr. Solomon leaned over her, Rachel reached for the necktie and gave it a tug, pulling it loose.

  “No playing now,” Dr. Solomon said, catching the girl’s hand. “You have to lie very, very still when I make the X-ray.” She placed Rachel’s arms down along her sides and secured them with straps that buckled over her wrists and elbows. Her legs, too, were strapped down, and finally a strap was wrapped around her forehead.

  “Now, I want you to breathe in slowly and deeply.” Dr. Solomon placed a stiff mask over Rachel’s mouth and nose that made it hard for her to breathe at all. The chalky taste was rising into the back of her throat as Dr. Solomon dripped chloroform onto the mask. Though she was lying quite still, Rachel began to feel dizzy. “Breathe in, that’s right. That’s a good girl.” As the room started to spin, the doctor’s voice sounded farther and farther away.

  Once the child was unconscious, Mildred Solomon turned the crank on the table, tilting it to forty-five degrees. She loosened the strap around the girl’s forehead to turn the head to the side, then rebuckled it. She clipped the plate in place under the table, positioned the Coolidge tube, set the generator, and stepped behind the lead screen. Wanting the exposure to be perfect, she counted out thirty seconds on the watch she wore pinned to her jacket before switching off the flow of electricity to the tube. Allowing five minutes for the barium liquid to further its journey down the child’s esophagus and into her stomach, she repositioned the Coolidge tube and replaced the plate, then made another exposure. Five minutes later, another exposure, the X-ray focused on the duodenum, then a fourth, aimed at the ileum. Dr. Solomon wasn’t sure if the intervals were optimal—she’d discover that when she reviewed the radiographs. Based on her findings, she would adjust the timing of the next series of X-rays accordingly.

  Strapped to the table, Rachel began to stir and whimper. Enough for today, Dr. Solomon decided. She unstrapped the child and sat her on the table. “Can you stand up?” she asked, but Rachel’s woozy stare suggested not. As if she were a bridegroom, Dr. Solomon carried the girl out of the X-ray room and back to her crib in the Scurvy Ward.

  “Nurse, come here, please. When she is alert again, begin with some milk, then soft foods for the rest of the day. Tomorrow she can eat normally. There’s a potential for constipation, so if she hasn’t had a stool by tomorrow evening, you can use a suppository. I’ll wait until her digestion has normalized before ordering another fast.” Dr. Solomon gazed down at Rachel, conscious of the nurse peering over her shoulder. “You were a brave little girl today,” she said, offering Rachel a smile. Then she turned to the nurse. “Next time, I’ll have you administer the barium drink and deliver the child to the X-ray room.”

  “Yes, Doctor.”

  “I DON’T WANT to drink it!” Once again, Rachel had spent an entire day without food, her stomach growling with hunger, but now she refused to take the cup the nurse offered her.

  “Please, Rachel, it’s the same as last time. Like a milk shake, remember? Be a good girl and drink it all up.” The nurse pushed the cup at the child who had previously been so cooperative, but Rachel clenched her teeth tight, pressing her lips into a hard line.

  “Oh, for heaven’s sake, I give up.” Walking away with the cup, the nurse left the ward and returned with Dr. Solomon. “I’m
sorry to involve you, but she won’t take the drink, and I wasn’t sure what you wanted me to do. Perhaps this one has participated enough? I could begin one of the other children on a fast.”

  “No, I need to complete this series today; the next one will be the last, and that’s the enema for the lower tract. Rachel, listen to me.” Dr. Solomon fixed the girl with a stern look. “This is the last time you have to drink the milk shake, I promise. Now be a good girl and drink it down.” The barium would only taste worse, she knew, the longer it sat in the cup, settling in the warming water.

  Rachel’s throat had closed up. Shame and anger trembled her lip. “I can’t do it,” she yelled, swatting at the cup in Dr. Solomon’s hand.

  “You leave me no choice,” Dr. Solomon said. “Nurse, go get a gastric tube and a funnel.” When the nurse returned and handed the items to Dr. Solomon, Rachel began to realize she’d made a terrible mistake. She had seen Dr. Hess threading that tube into the open mouths of other children, watched them choke and cry as he instructed them to swallow it down. She tried to say she’d drink the milk shake, but it was too late. The nurse held Rachel’s head back while Dr. Solomon poked the rubber tube down her throat. Panicking, she retched.

  “Don’t make this harder than it needs to be,” Dr. Solomon said. Tears leaked from Rachel’s eyes and pooled in her ears as she gagged on the tube. When it was finally down, Dr. Solomon held the funnel up above Rachel’s head while the nurse poured in the barium drink. Rachel, helpless, felt her stomach swell. Dr. Solomon pulled the tube out slowly so the girl wouldn’t throw up and ruin everything.

  Rachel’s throat burned as if she had gulped a scalding cup of tea. The nurse carried her down the hallway, following Dr. Solomon to the X-ray room.

  “Thank you for your help,” Dr. Solomon said as the nurse placed Rachel on the table. “I can manage from here.” As she secured Rachel’s limbs Dr. Solomon leaned over and frowned. “I’m very disappointed in you,” she said, cinching the straps. Rachel was desolate at having angered the one person who was kind to her. For once, she welcomed the chloroform.

  Early the next morning, Rachel’s belly cramped as the barium clotted in her intestines. The ward nurse inserted a laxative suppository, then sat her on a toilet. Rachel stared past her swinging feet at the tiles on the floor, black and white hexagons swimming in and out of focus. Afterward, relieved of her discomfort and now ravenous, Rachel looked around for the nurse to ask for her breakfast. She wasn’t in the room, or behind the desk at her station. The door to the Scurvy Ward stood slightly open; she must have gone into the hallway. Rachel peeked out, hoping the nurse would be nearby.

  No one was in sight. Rachel wobbled down the empty hallway, passing the Pertussis Ward, the Measles Ward, the Diphtheria Ward. She had just passed the X-ray room when she heard a door slam somewhere. Startled, she ducked into the nearest opening.

  Rachel found herself in a small room with no windows. Light from the hallway illuminated a chair and a table. The top of the table slanted up and seemed to be made of glass. Rachel, curious to know if she could see through it, crawled underneath, but from below all she saw was a flat wooden surface. Footsteps approached and Rachel crouched down, waiting for the person to pass. But they didn’t pass. Whoever it was came in, shutting the door and snuffing the room into darkness. A thin line of light outlined the door, then Rachel heard the sound of a curtain being pulled and even that little bit of light was extinguished. It was so dark Rachel couldn’t tell the difference between her eyes being open or shut.

  In the radiograph room, Dr. Solomon welcomed the darkness, settling into her chair with a sigh. She felt along the tabletop until her hand encountered the timer. By feel, she turned the dial to fifteen minutes, the quick ticking loud in the quiet room. She held her eyes open, seeing nothing, imagining her retinal cones relaxing as the darkness coaxed her eyes into maximum sensitivity. There was nothing to do now but wait and think.

  The digestion study was nearly complete. Dr. Hess assured her the barium X-rays had given him great insight into the normal rates at which food moves through a child’s digestive tract. It would aid him immeasurably as he continued his nutrition studies. Her name might be added as a coauthor on his next article—at the very least, her assistance would be acknowledged in his credits. He had begun to hint that she might take over next year as attending physician to the Infant Home, while he focused on his research. But Mildred Solomon’s ambitions would not be satisfied doctoring orphans. She needed to write an article under her own name, make her own reputation, if she was ever to get out from under Dr. Hess and away from all of these children, but she had yet to initiate her own experiment.

  A rustle on the floor caused her to pull her legs up with a gasp. How silly, she thought, to be scared of a mouse after all of the rodents she’d handled in the laboratory. Yet it was a perfectly natural reaction when startled in the dark. Holding her knees to her chest, she listened for the mouse’s rustle. Instead, she heard a shallow panting. She pictured a lost dog, though that was impossible.

  “What’s there?”

  A small voice under the table said, “It’s me, Dr. Solomon. It’s Rachel.”

  She waved her hand under the desk, brushing against Rachel’s sleeve. Her fingers curled around the little elbow and guided the girl out from under the desk. Dr. Solomon’s voice sounded close to Rachel’s ear. “What are you doing in here?”

  “I got lost, I’m sorry.” Rachel tensed, waiting for Dr. Solomon to switch on the light, but nothing happened. “Why is it so dark?”

  “I’m letting my eyes adjust before I read the radiographs.” Dr. Solomon didn’t have time for this; if she turned on the light now, if she so much as cracked open the door, she’d have to start all over again. “You’ll have to stay with me. Come up here, so I know where you are.” She pulled the child onto her lap and wrapped her arms around the small body. “You’re not afraid of the dark, are you?”

  “I’m a little afraid. It’s so, so dark.”

  “You just sit here with me and you won’t have anything to be afraid of.”

  “Am I in trouble?”

  “Not if you stay quiet and still. Can you do that for me?”

  “I’ll try.”

  “Good girl. Hush, now.”

  The ticking of the timer infiltrated every crevice of the room. Mildred Solomon aligned her breathing to the timer, five seconds in and five seconds out. Unnoticed, her heartbeat, too, began to slow. The heaviness of the lady doctor’s arm around her waist, the softness of her breathing, made Rachel feel safe and calm. She began rocking slightly as she relaxed against the doctor’s chest, cheek on collarbone.

  A bell went off, startling them both. “Time’s up,” Dr. Solomon said. Rachel expected they would get up now and leave the little room, but instead she felt Dr. Solomon reach out, heard a switch flipped. A faint green light came on, but in the darkness, their eyes fully dilated, it was enough to illuminate the room. “Stay here,” Dr. Solomon said, getting up and walking carefully around the table. She lifted some brittle radiographs from a drawer and mounted them on the light board. Resuming her seat, she settled the girl on her lap and wrapped a rubber cape around them both. Rachel’s head peeked out, just below Dr. Solomon’s chin. “Keep your hands under the cape. I have to put gloves on now.” She did, the thick rubber exaggerating her fingers. “Ready?”

  “For what?” Rachel asked, and then she saw.

  Mildred Solomon flipped another switch, and the light table buzzed and flickered. The white light was intense, and over it were the radiographs, dark and mysterious images through which emerged white streaks and swirls and clouds.

  “What are they?”

  “These are the pictures we make with the X-ray machine.” The chair moved—Rachel realized it was on wheels—and together they rolled closer to the images. “The X-rays pass right through you, through your skin and your muscles, to reach the bones and organs. The X-ray makes the radiograph. Then, when the light shines through th
e radiograph, it shows all of the shapes and shadows. Because I know how to read them and I understand the anatomy, the radiograph lets me see what’s inside you.”

  The doctor’s words sparked a memory in Rachel’s brain. She was in the tub in Mrs. Giovanni’s kitchen, warm water up to her chin, being scrubbed with a rough, red cloth. “It’s all my fault,” Rachel whimpered, thinking of the broken teapot, of Papa’s left-behind lunch, of the operator from the factory, of her mother’s black eyes. “You listen to me now,” Mrs. Giovanni said, taking the little face in her soapy hands so she could look into the girl’s eyes. “Nothing is your fault. Never think that again. God can see inside you, right into your soul, and He knows you did nothing wrong. Remember that, Rachel, if you ever feel alone or afraid.” Looking at the X-ray images, Rachel imagined this was what God saw when he looked at her. Where on the radiograph, she wondered, did it show right from wrong?

  “See this bright squiggle?” Dr. Solomon’s gloved hand pointed. “That’s why you drink the milk shake, so I can see what’s inside your intestines. And look here, these are your ribs.” Dr. Solomon slipped off one rubber glove and reached under the cape. As she pointed to the white shapes on the radiograph with her gloved hand, the other touched Rachel’s ribs. “And there is your spine.” Rachel felt a finger slide up the middle of her back. “See your shoulders there, and your hip bones, here? These big clouds are your lungs. And on this one, with your head turned to the side, see your jaws, and all your baby teeth, with the grown-up teeth behind them, ready to take their place? And see that little swirl, there? That’s your tonsils.”

  Mildred Solomon leaned forward, lost in thought as she contemplated the radiographs. She remembered learning about Béclère’s experimental X-ray treatment of a tumor on a young woman’s pituitary gland. The tumor had shrunk after exposure to the rays, but how had Béclère solved the problem of burning the skin? Oh yes, he varied the angle of the rays, focusing on the tumor from different points of entry. If he could use X-rays to shrink a tumor, Mildred Solomon wondered if the tonsils, too, could be eliminated through X-rays. It was the most common procedure in pediatric medicine, performed on thousands and thousands of children a year. Those surgeons, so superior, regarded radiology as little more than a mapping service to guide them in the real work of cutting people open. With X-rays, though, surgical tonsillectomy might become a thing of the past. At the Infant Home, it was standard practice to excise the tonsils and adenoids of every five-year-old. If she could develop a technique using X-rays, it might replace the tonsillectomy, sparing countless children the risks of surgery.