Doctors, on the other hand, tend to view death as akin to the force of gravity: to be resisted or delayed wherever possible, but sooner or later, everyone fails.
… the mad race run
Up to the end, the golden goal
Attained and found to be a hole!—Ambrose Bierce
AS RESIDENT PHYSICIAN, my private rooms were situated on the top floor of the right tower, its pointed roof directly over my head like a dunce’s cap. It made for a tiresome stair-climb but afforded a majestic view of the landmarks of the city—General Washington, Nelsonlike on his sixty-foot column; the towers of the great Catholic church; the masts of clippers in the harbor.
Perhaps I relit my pipe, or stoked my blazing fire against what would surely be a cold, dank evening—unseasonably so for October, unhealthily wet, the barometer falling and a squall on the way.
Having painted this cozy domestic picture of myself, it seems odd to disclose that for some time I had been thinking about taking my own life. By mentioning this I do not wish to cast myself in a tragic light. I was not in a state of romantic mourning, nor did I despair for the human race. I swear that the incentive arose from pure laziness, the urge to be done with the tiresome work of breathing.
When it came to the act of suicide, however, my deep laziness proved also a blessing, for if I lacked the motive to live, neither was I prepared to take the initiative and bring about my death.
As a consequence, I adopted a pattern of behavior in which I took a detached, scientific interest in life, almost to the exclusion of any other sensation. This disposition made for a conscientious physician, which is to say that I killed fewer patients than did my colleagues. As well, I had compiled a thick portfolio of scientific articles that will surely be of interest one day, or perhaps not.
For probably the fifth time that day, I descended the spiral staircase like an insect going down a drain, entering the great hall just in time to watch the patient carried to the south end of the building—a wing reserved for the Agitated Insane—and ensconced in a private room. Who is paying? I wondered. A close relative, probably—though not so close as to nurse the patient himself. Not an unusual occurrence when it came to the Agitated Insane—defined as patients whose words and behavior had become an embarrassment to the family.
Unlike other sections of the hospital, the wing distinguished itself not by sight or smell, but by sound—an aggregate of confused desperation; a chattering fugue in which occasionally recognizable words could be discerned: “Jesus!… Mother!… Snakes!”
In the room next door to the patient, like a soloist at the opera, a gentleman intoned a litany that might have been said by an especially repentant priest: “O wretch that I am behold my degradation and ruin what I have suffered and lost and the sorrow and misery I have brought upon others I could sink through this bed into the lowermost abyss forsaken by God, O God…”
According to Nurse Slatin, the new arrival had been lying in the gutter on Light Street outside Gunner’s Hall with his head on his valise since early dawn. A compositor with the Baltimore Sun happened to notice a crowd collecting and recognized the fellow as somebody famous. After calling for an ambulance, the compositor even went so far as to place a note in the man’s coat pocket:
Dear Sir or Madam—
This gentleman was found rather the worse for wear near 4th ward polls. He goes under the cognomen Edgar Allan Poe & appears in great distress & says he is acquainted with you & is in need of immediate assistance. I was told to inform Mr. Neilson Poe and will do so.
Yours in haste,
Jos. W. Walker
A Christian gentleman, I thought, and a charitable one. A rare combination in Baltimore on Election Day.
The patient was indeed in a bad way. It required the strength of two additional nurses to put him to bed. Delirious, drenched in sweat, with a violent tremor of the limbs, staring wildly at the ceiling, he kept repeating a name I heard clearly as Riley—but which could have been the Queen of Sheba for all it meant.
After ordering Nurse Slatin and her assistant to prepare plasters, I began the examination … and abruptly stopped cold.
Well, bless me, if it isn’t Eddie Poe.
His medical condition did not at all surprise me, yet his appearance certainly did, as it would anyone who had ever known him.
Even when addled and penniless, Poe’s deportment remained smart and orderly, with a well-trimmed mustache, artfully coifed hair, and impeccable linen. By contrast, the gentleman on the bed lay vestless and tieless, in ill-fitting, filthy trousers and a crumpled, yellowed shirt. A stained, faded old bombazine coat had been spread across the foot of the cot. A cheap, greasy palm-leaf hat lay beside his pillow.
The nurses undressed and bathed the patient, then applied the plasters to his feet, thighs, and abdomen, whereupon he began to writhe violently. Color rose to his face and the vessels became swollen at the temples. I ordered ice to be applied to his head and heat to his extremities. The nurses carried this out, to a mournful accompaniment from the gentleman next door:
He who arches the heavens and upholds the universe has His decrees written upon the frontlet of every human being and upon demons incarnate!
Despite my efforts, the muscular twitching and jerking did not subside but grew more violent. At last, however, he began to grow tired, and after a general tremor, fell into a stupor.
For an emergency physician, the first step in treating a new patient is to determine what happened to him. This would lead, one hoped, to either a cure or an explanation. In the absence of a cure, the victory lay in diagnoses: though the patient died, at least you knew why.
Had he fallen in with Election Day rowdies who plied him with drink and robbed him? Had he suffered a contusion to the head and succumbed to swelling of the brain?
I surveyed his personal effects, stacked in the corner of the room, and was satisfied that he had not been robbed. No assailant would leave his victim with a walking stick and a leather valise—both of which I recognized from our time together at West Point.
As I observed the prone figure before me, his eyes opened slightly. Though I detected no sign of recognition, he seemed to calm somewhat on seeing me, and fell into a jittery doze.
By now the assistant nurse had left for other duties and the admitting nurse was impatient for her cup of tea. I gave the dismissal, Nurse Slatin trundled resentfully out of sight, and the door closed, and now I stood alone with the wretched figure of my oldest acquaintance in the world. I would not go so far as to call him a friend.
As noted, to anyone with even a vague familiarity with his reputation it could hardly come as a shock that Eddie Poe had fallen into such a state. Nor did his presence in Baltimore seem odd; although identified with Richmond and Philadelphia, generations of Poes had hailed from Baltimore, and the family plot was situated there.
At some point during his admission, Nurse Slatin informed me that a Baltimore cousin by the name of Neilson had paid for his private room. This fitted with what I knew of Eddie: no doubt he had visited his relations in Baltimore to borrow money, with which to drink and medicate himself to oblivion.
Down the hall, the wretched babble continued as the gentleman in the next room segued to a nautical theme:
Where is the gulf beyond the stream where is the buoy lifeboat ship of fire sea of brass, test, test, shore no more!
I examined the patient’s pulse: One hundred and twenty beats to the minute, feeble, sharp, and irregular. As a treatment I considered a febrifuge mixture and a nerve stimulant. (I did not probe nor palpitate so as not to disturb him.) Oddly, I detected no smell of alcohol, only a sour, metallic odor common to inhalers of arsenic, cocaine, and codeine—sometimes used as additives in snuff mixtures. Obviously, the absence of alcohol did not mean that no other medicament or poison had been consumed, and in quantity.
In my preliminary judgment, Poe’s condition represented a latter stage of a well-documented general deterioration, a brain poisoned by morbidity, excitabil
ity, medicaments, and drink. The only mystifying circumstance was that, by fate or by fluke, he should find himself with me as his attending physician—at my mercy, so to speak. I could have smothered him with a pillow and none would be the wiser …
“O God, is there no ransom for the deathless spirit?” cried the patient next door.
As my mind turned to unhealthy speculation I became immersed in the wallpaper—an ornate floral pattern once arrayed in patriotic colors, now a blotched greenish-gray and emitting a musty sweetness.
Is there no ransom for the deathless spirit?
BOTH THEORETICAL STUDY (Brewster, ‘35) and my own observations {Scientific American declined to publish, citing a lack of “procedural clarity”) suggest that, due to trauma, substance, or pathology, the imagination can break free of the constraints of the conscious will. When such a disconnection occurs, the imagination becomes a sort of free-floating demon, independent of, and even opposed to, the will of its host.
The pathological result of an untamed imagination could find no more fitting embodiment than the figure on the cot before me.
Poe and I spent our boyhood together in Richmond, Virginia, during which time he was my best… No. It would be a cruel travesty to call him my best friend, or any friend at all.
He took an indecent pleasure in telling tales that proved to be untrue, and was given to the most intemperate bluffing—recruiting a companion to take part in some risky activity, pretending to know what would happen when in truth he just wanted to see what would happen.
Still, at school and church it was agreed that he was a future leader of men (mis-leader of men I should say now), with an almost mesmeric ability to persuade.
When I first encountered Eddie Poe, he was the undisputed leader of a gang of local toughs known as the Butcher Cats.
Thanks to Eddie’s influence my presence was tolerated. While the gang sat around doing nothing in a menacing kind of a way, Eddie and I played marbles and mumblety-peg, and he dreamed up trouble.
“Old Man Foster, over by Bleaker’s Dam?” Eddie asked me on one occasion.
“What of him?” Old Man Foster had two long yellow teeth and threatened with a hatchet anyone who strayed onto his property.
“They say he has a passel of money from grave-robbing. Bam Johnson watched him through the window one night, saw the kitchen table piled with gold coins.”
“So why does he live like that if he has that much money?”
“Because he’s crazy, is why. But crafty too. Keeps his doors locked day and night. Never does nothing’ cept counts his money. Never goes out’ cept feeds the chickens.”
I had nothing to add to this, because I didn’t really believe it, so Eddie continued.
“While he’s feeding the chickens, you can sneak in through the window.”
“The mischief I will!” The thought of it made me sick with fear.
“You’re the only one small enough. We’ll watch out and warn you, Willie. Honor bright.”
Of course eventually I gave in rather than risk being left out, and of course Old Man Foster collared me halfway through the window and threatened to have me jailed and kicked me in the pants, and Eddie and the Butcher Cats were nowhere to be seen.
Later, Eddie presented the incident as a test of my loyalty, and I was made into a full-fledged gang member because I could be trusted not to snitch.
And of course I felt honored, as though the Butcher Cats were the Round Table, the James River was our fiefdom, and Eddie Poe was the Black Knight.
From then on, Eddie took me on as a sort of page or apprentice. My delight in the role reached its summit one hot June afternoon, when he swam from Ludlow’s Wharf to Warwick, a distance of six miles, against one of the strongest tides ever known in the river— and walked home afterward! A shaver of twelve! Byron’s crossing of the Hellespont amounted to a paddle across a pond by comparison.
As you might expect, my feeling for Eddie at that time was one of abject hero worship. However, this common boyhood attachment was soon to make way for darker sentiments that would contaminate our association forever.
Can you imagine what it is like to have a friend two years older, and to discover that he wants your mother?
FAILING TO FIND enlightenment in the institutional wallpaper, I returned my attention to my old acquaintance—the broad forehead, the classical, oversensitive features—and resolved that as far as I was concerned, this was no longer Eddie Poe. Whatever had passed between us long ago, he was now my patient, and would receive the best treatment I could provide.
I shut the window against the night air’s harmful vapors. There being no bed table and only one chair, I placed my satchel upon the edge of the bed. I unbuttoned the patient’s shirt—the sallow skin, stretched over visible ribs, rose and fell in short gasps, like a fox at the end of the chase. From my open bag I extracted my bone cup and placed its flattened bell against the patient’s left breast. I put my ear to the cup at the other end of the wooden tube, and detected a weak heartbeat, more sluggish than the breathing would suggest. Perhaps it called for a tincture of adrenaline and cocaine as a heart stimulant …
Are we alone?”
My expensive French instrument so amplified his voice as to attain an almost biblical resonance.
Startled by this sudden blast I reared back, and in so doing my elbow caught the handle of my bag, whose entire contents clattered onto the black hardwood floor—tins, tubes, bottles of pills, containers of powders, a tourniquet, cotton wool bandages, boric lint, powder papers, my copy of Mental Hygiene Acts Schedule 15, my poisons’ book …
“Startled you, did I, Willie?”
I dropped to one knee and put my alligator bag upright (a graduation gift from Father), and began hastily returning its contents to their proper places. “Somewhat,” I replied, not to provide more fodder for his amusement.
“What were you trying to do—kiss me?”
Eddie always had an uncanny way of throwing a fellow off-kilter. In that instant, twenty-five years of adulthood peeled from my skin and I was again on the defensive, feeling foolish and vaguely soiled— literally so in the case of my surgical instruments, strewn upon a floor that had scarcely been scrubbed since the War of 1812.
“I was examining your heart. Your circulation is in poor condition. You have a nervous disorder. Your skin tone is that of a cadaver.”
“Willie, can you tell me how long I am going to live? I should love to know, suh. I would make plans.”
“Do you experience chest pain? Moments of dizziness?”
“All of it,” he replied, and his features turned from superciliousness to despair—apparently even Romantics worry about their health. “It would be appropriate if I were to die here and now. A relief, really,” he said as though to himself.
“Are you in pain?” I asked.
“Yes.”
“And for how long?”
“As long as I can remember.”
Casting his eyes upward (with suspect theatricality it seemed to me), he shuddered and sighed, then his features returned to their normal impression of calm superiority. “I hate to repeat myself, Willie, but are we alone, suh?” he asked, in the soft, Virginia drawl he had practiced to good effect as a boy, though he spent his early childhood in England.
“We are alone, sir. But I can call for assistance in an emergency.”
“Good. That is excellent,” Poe said, rising to a seated position and cushioning his back with his pillow, seemingly in reasonable health.
For my part, I had already run out of patience, for at Washington College Hospital we take a dim view of malingering. At the same time, I reminded myself that his clinical symptoms were measurable and genuine; though a patient may be feigning illness, it does not necessarily follow that he is not sick.
“Am I to understand that this has all been a performance for my benefit? Cutting shines again, are we, Eddie?”
“What do you mean—cutting shines?”
“Oh you know
, gumming a person—like pulling the chair from underneath without warning at the Masonic supper.”
Poe’s gaze became speculative. “That was thirty years ago. A boyhood prank. I am surprised you remember it.”
“Fine, then perhaps you’ll remember nearly deafening me a moment ago.”
His expression became serious. “My presence is no joke, suh, I can assure you of that.”
“Then what is your purpose in carrying out this charade? Do you suppose that I lack patients?”
In truth, I had somewhat less than a full caseload, and my patients tended to be the lower sort. My superiors had judged my bedside manner unsuitable for a teaching position, and my cure rate a matter of fool’s luck. And the more prosperous patients agreed with him. Perhaps they resented my candor—or rather, the expression it took—my tendency as a war veteran to make quips about death that were offensive to the wealthy.
Or they may have simply disliked my looks: having gone prematurely bald, I determined early on that I would not only flaunt my baldness, I would make a virtue of it. One of my favorite sayings at social gatherings was that I was probably the only human being in the room who did not have head lice. I regarded as my private joke the furtive scratching that followed.
Especially controversial among my colleagues at Washington College Hospital was my eccentric habit of washing my hands between patients and after handling a cadaver. This was regarded as an affectation, a kind of snobbery. Next thing you know, it was said, surgeons will be wearing masks, lest we breathe upon a fellow!
Not Quite Dead Page 2