Race for the Dying

by Steven F Havill

  “Ah, you’re too modest,” Riggs said. He had pulled a small ring of keys from the left pocket of his robe, and now turned to the locked door. “You’re curious enough to climb your way up a mammoth flight of stairs, so forgive me if I appear to boast a bit. What you see around you is a thriving concern that is bringing relief to literally thousands of souls,” he said. “I presume that you’ve perused some of the correspondence?”

  “Yes,” Thomas said, trying to sound impressed.

  “We have discovered—and it’s really nothing more than common sense—that many, many people live well away from any kind of formal medical care,” Riggs said. He opened the door, but made no move to pass through. “What we provide is the best medical care and support possible via the mails. As I’m sure you’re aware, recent advancements in the rails alone have made the post a vital resource for us. It no longer takes two or three months for a parcel to reach any spot in the country…merely a week, maybe two. Sometimes just days. We depend on that.”

  Thomas nodded toward the large wooden box—much like a firewood box—that held the as yet unopened mail. “You have an impressive response.”

  “Oh, yes,” Riggs said proudly. “And what we have learned is that in order for us to address the concerns that literally flood in daily via the post, we must divorce ourselves from the day-to-day workings of the medical clinic downstairs. It is impossible to do justice to both concerns.”

  “I would suppose.”

  “By facing the challenges downstairs, Thomas, you’re taking a considerable burden off John’s shoulders. Now, he is free to advise us in operations here. Even to dictate responses to troublesome cases.” Riggs lowered his voice and his hands folded over his belly. “John can do that, even though his sight is failing, Thomas. Being able to do that gives him purpose, allows him to pursue the work that keeps him vibrant.”

  “Of course.”

  “Good. Good.” Riggs nodded enthusiastically. “My God, man, what time is it?” He peered at the small pendulum clock on the far wall. “Ten minutes after one, and here we are, blathering away.” He smiled engagingly at Thomas. “Let me show you the rest, if you’ve a mind.”

  “I would appreciate that.”

  “Good. And then after that, I really must convince you to get some rest. Dawn brings another full day, you know. Now,” and he pushed open the door, “the pharmacy is located here, along with a considerable effort to keep up with the massive shipping that we do.” He grinned and held the door for Thomas. “I must say, I sometimes feel as if we are the sole support for the United States Post Office.”

  The back room actually included a full third of the second floor. Maneuvering through the doorway, Thomas saw that a large office was enclosed by a waist-high partition. The huge desk was an incredible clutter—newspapers, correspondence, clippings of various sorts, a large glue pot, another Remington typewriter, and several advance copies of the Advisor.

  “My cubbyhole,” Riggs said. “Alvi has given up with my housekeeping. Perhaps that’s the reason I’m banished back here. I don’t know.”

  Large shipping cases cluttered the floor beyond Riggs’ office. He bent down and pulled some of the excelsior to one side revealing the tops of small empty brown bottles. “All the way from San Francisco,” he said. “I am continually astonished at the number of bottles we send in a month.” He patted the excelsior back in place, straightened up, and swept his hand to include the various crates that were warehoused. “Each medication has a characteristic bottle design,” he said with pride. “Over here,” and he stepped through a passageway between crates, “is where I apply appropriate labels.” He pulled a large printed sheet from a flat packing case. Thomas saw hundreds of small labels for the Universal Tonic. “We keep our printer very busy.”

  “And he is located…”

  “In Bellingham,” Riggs replied. “He is slower than I would like, but his business is growing as well. So we must be a little patient with him.”

  “You have assistance with all this?”

  “No,” Riggs said quickly. “The day will come, I suppose. But this is where I spend my time, Thomas. Alvi and the six young ladies take care of most of the correspondence, with help from John if need be. That frees me to work back here. Come, let me show you.”

  Along one wall, a row of sixteen wooden casks rested on a sturdy bench. “This reminds me of a winery,” Thomas said and Riggs laughed, nothing evasive or furtive in his manner. He reached out and patted first one and then the other of the two largest casks. “The brandy can be an attractive nuisance,” he said. “Miss Haines is not driven by temperance, but she sees that her father is coming to depend more and more on spirits for relief of his ailments.” He grimaced. “One must embrace moderation, and as I’m sure you’ve observed, that isn’t always the case with John, God love him.” He sighed. “Anyway, this is the center of the pharmacy.” He walked along a series of shelves that included several hundred bottles of various shapes and sizes, along with an equal collection of small wooden boxes.

  “The raw materials,” Riggs announced. “We expend considerable energy finding the various ingredients. You know, I sometimes think that the alterative approach to medicine has been much ignored in some of our colleges and universities. Do you agree?”

  Thomas thought carefully. “I would think that in the most stubborn cases, the physician is advised to consider the entire arsenal,” he said.

  “The arsenal,” Riggs said enthusiastically. “That’s exactly right.” He waggled a finger. “The physician’s arsenal must be varied and creative, including the alternatives.”

  He stood with his hands on his hips, surveying the vast store of bottles, boxes, jugs, and crockery that lined the wall above the oaken casks. “There are people,” he said quietly, “who would pay large sums of money to know what is in this room, Thomas. The world is full of imitators. ‘If he can make it, then so can I, and for less, too.’ That’s what the imitators think. And so they use ingredients held to no quality standard. Or worse, they guess at what the ingredients might be.”

  “People are easily fooled,” Thomas said.

  “Indeed they are, sir. Indeed they are. The world is full of charlatans.”

  Chapter Thirty-three

  Thomas chose his words carefully. “I don’t understand attempting to treat patients without actually examining them. Think of the possibility of mistakes, or of missing a condition that’s obvious to the physician, but not to the patient.”

  Riggs nodded. “But, Thomas, please…Remember how many people cannot actually visit a clinic while ill. People with no physician within reasonable distance.”

  “A substantial number, I would suppose.”

  “Most certainly, a substantial number, Thomas. Now we provide an alternative. Not a perfect one, by any means, but an alternative. By applying reasonable standards and methods, backed by science, we can recognize the symptoms and signs of particular illnesses. You know that.” He paused, and Thomas waited for him to continue.

  “For instance, if a patient comes to you with tuberculosis, you are sure to recognize it, are you not?”

  “I would hope so,” Thomas replied.

  “Now, suppose you receive a carefully written questionnaire—you’ve seen our document?”

  “Yes.”

  “Well, then. The patient tells you that he is debilitated, losing weight no matter how much he eats, is coughing blood, suffering both sweats and chills…is in fact, in general decline.” Riggs held up both hands. “If such a patient sat before you, you would listen to the complaints, then listen to the lungs, would you not?”

  “Of course.”

  “And if sufficient tubercles existed in those lungs to alter the sound during auscultation, you might feel for tenderness in the hollow behind the clavicles. You might examine sputum under a microscope. You might perform a test with the spirometer. But you would
know, would you not, in your heart of hearts, that the patient sitting before you was suffering tubercular consumption? Simply by hearing his complaints.”

  “I suppose so.”

  “If we receive such a profile in the mail, from a patient in”—he threw his hands up—“it doesn’t matter where, but picture her sitting in front of a dwindling fire, her family wringing their hands hopelessly, her children petrified as they see their mother coughing blood into a kerchief. We receive her profile, and is there any doubt? Do we have to see her pathetic figure through our doors to know that the dread specter of consumption has yet another victim?”

  It wasn’t hard to see where the florid style of writing in the advertisements had its origin, Thomas thought.

  “And so we recommend treatment. It’s that simple.”

  “But no specific drug has shown promise in the treatment of tuberculosis,” Thomas persisted.

  “True enough,” Riggs agreed readily. “But what does show promise in treatment?”

  “Rest. Change of climate perhaps. Proper nutrition. Some symptomatic relief. Helping the patient maintain his strength.”

  “Exactly so,” Riggs said triumphantly. “That’s exactly right. Perhaps you recall my sermon about the marvelous peach? The human system is resilient, when given half a chance. If a few ounces of Universal Tonic each day help nature resume its course upward to perfect health, then we’ve done our job. If a few ounces of Dr. Tessier’s Metabolic Oils reduces the tendency to hack the lungs out, so be it. Cannot we do all of this without seeing the patient?”

  “I would suppose so.”

  “And if the patient is suffering not the ravages of consumption, but instead a cancer of the vitals—for which there is also no promising cure—then have we done harm in supporting his general health and well-being? No, we haven’t.”

  Thomas heard the words in a blur. “It seems to me,” he began, then started again, “It seems to me that such false hope is counterproductive. I—”

  “We raise hopes,” Riggs interrupted. “There is nothing false about that. Hope supports the patient’s will to fight, Thomas. Look to yourself as an example.”

  Thomas surveyed the pharmacy behind him. “Perhaps…” and he stopped. He had no desire to make an enemy of Zachary Riggs, but the examination of the tiny Beautard child remained etched in his mind. “I wondered about Sorrel’s Syrup, for instance,” he said. “I ran across that today.”

  “In what way?”

  “A mother giving her four-month-old son the syrup to ease his fretful moments.”

  “My God,” Riggs whispered. “Really so?”

  “She said you gave it to her. That you prescribed it for the infant.”

  “Then she misunderstood me, I’m sure. Sorrel’s relieves the discomfort of teething, no more.”

  “The child is a bit young for that.”

  “Of course.”

  “What are the ingredients of this concoction?”

  “Of Sorrel’s? We continue to evolve and change,” Riggs replied. “As with all our medications. Not one or two ingredients, but a careful balance of a dozen or more. And again, I assure you that there are people out there who would pay dearly to know the specific formulation.” He smiled. “I suppose I should be flattered by their attention.”

  “But the primary ingredient?”

  “Again, the formulation is evolving. For teething, a small percentage of anodyne is almost immediately effective, touching the gums and mucous membranes of the mouth. I use Carlisle’s preparation, for its purity.”

  “You have a veritable crowd of people working on your behalf, Zachary. Dr. Sorrel, Dr. Tessier, now Carlisle and his anodyne.” “Anodyne” referred to no particular pain reliever, but Thomas decided that the middle of the night wasn’t the time to pursue the issue.

  “Well…” Riggs said, and gazed around the room. “It’s a large operation, Thomas.”

  “The correspondence appeared to advertise Tessier’s compound frequently.”

  “Just so. We have found that if we can reduce the patient’s coughing, Thomas, reduce some of the damage from that, then rest and recuperation so often follow.”

  “So, by weight?”

  “Well,” Riggs said slowly, “I would suppose that by actual volume, the liquid substrate is the foundation on which the tonic is built. I have found nothing that works any better than a particularly fine brandy. It both soothes, especially when supported with various herbs and vegetative preparations, and is a restorative. Nothing provides more immediate nutrition. By including careful instructions for dosage, we can make the most of its qualities.”

  “Along with a cough suppressant?”

  “That’s correct. I have discovered that a simple infusion of red clover is a gentle means to that end, especially with the Carlisle’s. It is a fine balance, you see. Without the cough, we have nothing to purge the diseased lung tissue from the body. With an excess of violent coughing, as you know, much healthy tissue is torn and destroyed. But I don’t wish to simplify.”

  Thomas pointed at a considerable selection of small wooden boxes with one crutch. “And these?”

  “I have contracted with a mill up the coast to provide cedar shipping boxes,” Riggs said.

  “An amazing operation,” Thomas said. “I would suppose a fair income from this enterprise?”

  “In proportion,” Riggs said easily, and let it go at that. “By the way, Dr. Haines informed me of his arrangement with you. Would you prefer a bank draft, or cash?”

  Thomas found that he was hugging his arms around his ribs, and tried to straighten up. “At the moment, my world includes one-oh-one and this clinic. I have not even toured the village, and I’ve met only a handful of people. Visiting a bank or even Mr. Lindeman’s Mercantile would be a keen adventure, Zachary. So…I don’t know. I suppose it might be best to simply keep the money on account? Will that suffice?”

  “Well, of course. Should you need anything, however, you will not hesitate to let one of us know?”

  “Yes. And we do need something, without delay.” Riggs’ eyebrows raised in anticipation. “We must have additions to our nursing staff that allow patients to remain in the ward,” Thomas said. “I know that it has been the policy to remand patients to St. Mary’s, but we will no longer do that. Not when we can treat on the premises.”

  “I see. What have you in mind? Miss Auerbach isn’t adequate in some way?”

  “She is wonderful, Zachary. But we can’t expect Bertha to work all day long, and then during the night as well. We need nursing staff who are fresh and alert.”

  “You have two patients in the ward now, I understand.”

  “Yes. Our two left legs, as Bertha calls them. One will leave us in the morning, the other with a serious fracture of the leg that must remain in a fracture box for as much as two weeks.”

  “And he wouldn’t be better off at St. Mary’s?”

  “Indeed not. First of all, a trip of some thirty miles would likely kill him, or at least ruin what progress we’ve managed so far. All it would accomplish is removing the patient from under our roof. That’s neither necessary nor prudent.”

  “Well, then,” Riggs said. “Will you take care of this? Finding staff, I mean? Let me know and we’ll add them to our books. I trust your judgment in this. Someone discreet, ambitious, industrious.” He grinned. “In short, another Bertha or two would be nice. Is she paid adequately, do you think?”

  Thomas laughed. “I have no idea what she’s paid, Zachary.”

  “Ah, well, of course, there’s that,” Riggs said without providing a figure. “We want anyone who works for us to be content,” he said. “So whatever that takes.” He regarded Thomas. “Yourself included.”

  “Dr. Haines’ offer was most generous,” the young man said. “And on top of it all, we simply must have some way to prepare meals. It is
cumbersome to have to bring food down from one-oh-one.”

  “Ah,” Riggs said good-naturedly. “I can see a flood on the horizon. We’ll see about it all, to be sure. Make a comprehensive list so nothing is forgotten.” Riggs stood up and stretched, pulling his robe tightly across his barrel-like torso. “Now, if you please…You’ve exhausted me. And yourself, I’ll wager.”

  “Your quarters are on the third floor?”

  “Yes. A fine view of the harbor and the hills.” He stepped to the doorway and beckoned the younger man. “I can assist you down.”

  “That won’t be necessary.” As they made their way forward, Riggs turned off each gaslight until the second floor was pitched into darkness behind them. Thomas opened the door, and the steep decent that yawned ahead of him seemed a dozen times longer than when he’d made the climb.

  “How can I help?” Riggs said. He held out a hand, stopping just short of taking Thomas by the elbow.

  “Really, I can manage,” Thomas said. “I have this technique, you see.” He once more rested his right hip against the wall, and gingerly lowered first one crutch and then the other to the first stair tread. He eased his right foot down and held his position there, looking back at Riggs, who watched with bemused concern.

  “You see? It’s just a matter of patience,” Thomas said. He moved the crutches again, but this time the foot of the crutch caught ever so slightly on the tread, and he staggered. Riggs reacted instantly, catching the young man deftly by both shoulders.

  “Patience and balance,” Riggs said, laughing. “We can’t have you landing at the bottom in a heap. Allow me.” Together they made their way down the sixteen steps, and as he finally sank into the wicker wheelchair at the bottom, Thomas was faint, even slightly nauseous.

  “You’ll be all right now,” Riggs said. “And I see yet another reason why we need to finish the installation of the elevator. Or we could stuff you into the dumbwaiter, I suppose.” He held out his hand. “Good night, Doctor.”