Beyond the Ashes

by Karen Barnett

  Ruby bit her lip. “Antitoxin?”

  Gerald’s throat ached, as if in sympathy for the toddler. He rubbed a hand over the child’s sandy hair, smoothing it back from the damp forehead. He lowered his voice. “Let’s examine the others first.”

  He turned to the children. Their fear radiated across the floorboards, but he didn’t have time for tenderness. “Sore throats, over here. The others need to wait outside.”

  The siblings scrambled to their feet, the younger two hiding behind the skirts of the oldest. She spoke out. “Doctor, my little sister and I are the ones. But Jess and Michael—they don’t have it yet.” She shoved the two boys toward the door.

  Gerald gestured for her to come closer. “What’s your name? How old are you?”

  She swallowed, obviously with some effort. “My name’s Myrtle, I’m thirteen. This is Birdie. She’s eight.” The little girl wrapped her arms around Myrtle’s waist, peeping out around her side.

  After a quick check, Gerald’s heart sunk lower. Both girls had grayish-yellow patches of pseudomembrane on their tonsils, though neither as severe as the youngest. He turned to the mother. “Put these two to bed. Nurse Marshall and I will examine the rest of the patients, and then we’ll return.”

  The woman nodded, wringing her soiled apron in her fists. “My boys?”

  “I’ll assess them on my way out. If they exhibit any symptoms, I’ll send them in here. Otherwise, they’ll need to stay elsewhere.”

  “My sister lives next door.”

  Ruby reached for the bag. “Any sickness there?”

  “No. She has no children, and she hasn’t said anything about feeling poorly.”

  Patrick rubbed a hand across his chin. “I’ll go over and explain, Mrs. Ives.”

  Gerald took the case from Ruby and gestured for her to exit first. Following in her wake, the fresh air cooled his raw nerves, the day’s worries sitting like a lead weight on his chest. After checking the other two children and sending them off with Patrick, he turned to Ruby. “I’m glad you’re here. Today’s shaping up to be a long day. You’re the only bright spot I’ve seen.”

  She offered a weak smile and laid a hand on his arm. “I’m sorry the circumstances aren’t better.”

  He leaned close, dying for a whiff of her rose-scented hair. “We’ll make up for it this evening. What say you to a moonlit walk?”

  Ruby squeezed his wrist. “Sounds delightful. But will our families approve?”

  “Little point in hiding now.” He claimed her hand and drew her a step closer. “I plan on kissing you in front of the dining room window every evening. I don’t care who watches.”

  She blushed, but the bright smile was his reward. “Now, who will require a chaperone?”

  Patrick reappeared a few minutes later, his shoulders hunched. “I suppose this confirms your fears, Dr. Larkspur. How bad is the situation?”

  “I’ll need to evaluate the rest of the patients. We’ll move some of them to the County Hospital and treat them there.”

  Ruby’s head jerked upward. “Why not our hospital?”

  Gerald raked fingers through his hair before replacing his derby. “County handles most infectious disease cases. We may receive some at Lane if things get desperate. The patients will need to be isolated during treatment. Any affected cottages need to be under quarantine. We can’t allow this to spread.” He glanced around at the rows upon rows of tiny green cabins, barely three feet between each—like lines of dominoes. “An epidemic would be disastrous.”

  “What is the treatment?” Patrick’s brow wrinkled.

  “An injection of antitoxin. I’ve one dose in my case, another in my home office, and I’ll put a call in to see how much more we can get our hands on.”

  Ruby’s lips pursed. “Two doses won’t even treat this family.”

  Gerald shook his head, the enormity of the situation pressing against his shoulders. “I pray we find enough for everyone.” He glanced back toward the cottage. “I’ll give my dose to the Ives baby. It may be too late, however. His heart’s already weakening—myocarditis. He’s not likely to survive the night, but it’ll give him a chance.”

  Patrick pressed a hand to his brow. “I had no idea.”

  “I should’ve come earlier, when you first mentioned illness in the camp. This is what I’ve been dreading.”

  “Can we prevent the spread?”

  Gerald searched for encouraging words, but came up empty. “It’ll be tough. I’ll inform the health department. We’ll post quarantine notices on the affected cabins. I’m not certain what else we can do.”

  * * *

  Ruby stared out across the dark camp as she waited, dim lights flickering in a few of the postage stamp windows. She ran a hand over the back of her neck, muscles protesting the long day. She and Gerald had checked every last patient in the camp, diagnosing fourteen sick children and two adults. Her heart ached nearly as badly as her feet.

  Gerald had administered his single dose of antitoxin and raced back to the house for the second. Robert arrived with two more from the hospital. Only four children treated in the whole camp.

  She watched the late evening sun paint the sky with broad strokes of violet and pink. Ruby pressed an embroidered handkerchief against her eyes, determined not to submit to tears. Hopefully they’d be able to procure additional vials tomorrow. God willing, as Gerald said. She turned from the sunset in time to see Robert and Gerald closing the door to the cottage behind her.

  Her brother’s face grim, he shook his head. “This is the last thing the city needs.”

  Gerald nodded, his mouth twisted into a scowl. “We need more doses. We should check with the General Hospital at the Presidio. They might keep some stocked. If they don’t, they’ll know where to locate it.”

  Robert shrugged into his jacket. “I’ll go over there and see what I can find.”

  Tucking the medical bag under his arm, Gerald blew a slow breath between his lips. “If the Ives baby isn’t responding to the antitoxin, Ruby and I will take him over to County. We could try intubating him. I need some bit of good news, today.”

  A chill laced the evening air, and Ruby shivered. “I’ve never seen anyone intubate a child before.”

  “And I’ve never done one.” Gerald grimaced. “But I’m willing to give it a go. It would be preferable to a tracheotomy.”

  She nodded. The idea of cutting into a child’s throat set Ruby’s stomach aflutter.

  “It won’t be necessary.” Patrick’s voice echoed out of the darkness a moment before he appeared at Ruby’s elbow. “I’m afraid it’s too late.”

  Ruby covered her mouth with her fingers. “So soon? Why didn’t you come find us?”

  Gerald took her hand. “The baby’s heart was already damaged, Ruby.”

  She sank against his shoulder, thinking of all the sweet children they’d seen today. How many more?

  “I’ll take you home. There’s nothing else we can do tonight.”

  “What about the additional doses?” Ruby lifted her head.

  “If Robert locates some, he’ll administer them. Otherwise, we’ll search for more first thing in the morning.”

  Ruby chewed the inside of her cheek. She battled between the idea of returning to the house and hiding from this disaster or pounding on each hospital’s door and demanding every unit of antitoxin in the city.

  Gerald wove his arm around her waist, drawing her close. “We’ll return at dawn, but the doctors from County are on their way. They can watch over things tonight.” His brow furrowed. “Ever been exposed to diphtheria?”

  “Robert and I both had mild cases as children. My mother always said Papa brought home every illness he encountered.”

  He squeezed her arm. “Good. One less worry.”

  “And you?”

  “I believe so. But I never catch anything—healthy as a horse.” He thumped a fist against his chest and uttered a mock-cough. “Diphtheria mostly affects children, anyhow.”

&
nbsp; “You gave away your only dose.”

  “Good thing we have no youngsters at home. I’m glad Davy returned to San Jose with Clara and Herman.”

  They walked toward the automobile parked at the edge of the camp. Her heart gave its normal kick as she gazed at the metal frame, gleaming under the glow of the electric streetlight. She shook her head, brushing away the misgivings. Why fear such a contraption, when a simple bacterium could steal life every bit as easily?

  * * *

  When they arrived at the house, Gerald opened the auto door for Ruby, casting a quick glance at the light spilling out the windows—a welcome sight after the military-style barracks at Golden Gate Park.

  He took her hand, wincing at the cold skin. He tucked it between his palms. “Chilled? Or nervous about my driving?”

  She ducked her head, but didn’t pull away. “A little of both, I’m afraid.”

  “I hope you’re still up for our moonlight walk.” He tried to keep the excitement from lining his voice, but failed.

  Her smile lit the night. “I’d love to. After supper.”

  “I’m not hungry, are you? Let’s sneak away now, before anyone realizes we’re home.”

  “We shouldn’t be selfish. I’m certain your mother and Abby held the meal for us. Besides, I’d like to find a warmer wrap.”

  He pulled her into his arms, tucking her between his body and the automobile. “I can keep you warm.”

  Ruby laughed. “I’m sure you can, Dr. Larkspur. But let’s take things slow, shall we?”

  He let her wriggle from his grasp, suddenly understanding Robert’s ongoing dilemma of having Abby under the same roof. Lord, I asked for this—but I may require Your strength to survive it.

  He followed Ruby up the front walk, hurrying ahead to open the door. As his fingers closed over the icy knob, a sharp pain lanced up his forearm, like the sting of an angry scorpion. Gerald hopped backward, clamping his jaw shut before a yelp could escape. He shook his hand, willing feeling back into his quivering fingertips.

  Ruby paused, head cocked. “What’s wrong?” She reached for his arm.

  “Nothing.” He tucked his palm behind him, grasping the knob with the opposite hand. “Just a sore spot. Nicked myself with the scalpel.”

  She frowned, her eyes narrowing. “You were at a board meeting this morning and at the camp all afternoon. When were you handling a scalpel?”

  He swung the door wide and gestured for her to enter. Ruby’s dog spilled out the open door and circled around their legs, its tail beating out a steady rhythm.

  Ruby planted her feet. “Robert mentioned your hand to me earlier. He said you refused to let him examine it.”

  “He looked at it—I only prevented him from turning me into a ridiculous laboratory experiment. Allow me a scrap of dignity?” Gerald squeezed his fist, pressing it to his chest. “And your brother talks too much.”

  Ruby blew a noisy exhale through her lips and crossed the threshold with her shoulders pressed back. “I’ve seen the condition of the camps. You might have picked up a nasty fungal infection. If you intend to allow something to fester through your system, you can forget about coming anywhere near me—with either hand.” She glanced back over her shoulder at him, chin raised.

  Gerald pushed the door closed behind him and leaned upon the oak panel. “You, my dear, are not playing fair. Robert put you up to this, didn’t he?”

  Her brows lifted. “I’m not playing at all. I’ve never been more serious.”

  32

  The walls of the tiny cottage pressed inward as Ruby tapped the glass syringe with her fingernail, double-checking the measurement.

  A pair of massive brown eyes stared up at her from the bed. Not yet six years old, Myrna Walker likely had never seen a hypodermic needle.

  Ruby crouched beside her and forced a big smile. “This will only hurt for a moment and probably much less than your throat does right now.”

  Myrna’s older brother sat at the girl’s head, stroking her hair. “It’s nothing, Sis. I took mine like a man, didn’t I, Nurse?”

  The robust thirteen-year-old reminded Ruby of Robert at a similar age—man and child, all at the same time. “Yes, you did, but your sister might appreciate a little privacy for hers, I think.”

  The boy nodded and turned his back.

  The girl shifted onto one side and yanked at her nightdress, a shiver coursing through her body as she exposed her backside to the air.

  Ruby bit her lip, plunging the needle into the girl’s pale skin before the child had time to reconsider her cooperative attitude.

  Myrna gasped, but only a meager whimper escaped her mouth.

  The hairs on the back of Ruby’s neck prickled as she withdrew the syringe and pressed a piece of gauze to the wound. How many would they have lost, if not for the army’s supply of antitoxin? Without treatment, the death rate from diphtheria could rise as high as fifty percent of those infected. As it stood, she, Gerald, Robert, and Dr. Jones from the health department had treated twenty-two patients over the past week and the only fatality had been the Ives baby. Most saw remarkable improvement within twenty-four hours. She tucked the covers around her shivering patient. “All done, sweetheart. You’ll need to stay in bed for a few weeks, but I think you’ll start feeling better by tomorrow.”

  “Thank you, Nurse.” The boy returned to his spot at his sister’s head. “Ma will be relieved. She had to stay with the baby. He’s never got it, not yet, anyhow. We’ve been staying away so he won’t.”

  Patrick loomed in the doorway. His voice echoed off the thin walls. “You’re a good lad, Jonathan. Your mother is lucky to have you. And with Nurse Marshall’s help, she’ll have both of you around for years to come.”

  Ruby tucked the needle back into the silver case and snapped the lid closed. She followed Patrick out into the fresh air.

  The man took the medical bag from her hand, hoisting it up under his elbow. “I think that’s the last of them for today. Will you be going home now?”

  “After a quick stop at the sewing center. I told Mrs. Williams I’d repair her machine.”

  “I’ll walk you there.” His ran a finger under his collar as if the slender bow tie squeezed his throat. “I’m mighty beholden to you and Dr. Larkspur for all you’ve done.”

  She smoothed the wrinkles from her apron, Patrick’s pensive expression causing her to tense. “You are well, aren’t you?”

  He glanced up. “Aye . . . well, no, but I’m not here as a patient. I’m just feeling a little down in the mouth.” A smile glittered his eyes, though it didn’t change the fine lines gathering on his forehead. “Not down in the throat.”

  Ruby cocked her head to the side. “Why? What’s bothering you?”

  He ran a hand down the front of his pin-striped vest. “Are you counseling now, in addition to your nursing duties?”

  “I’m speaking as a friend.”

  He ducked his head. “Ah. Of course.” Patrick glanced each direction down the mud-splattered board path. “I’ve been pondering my future. The camps are emptying, little by little. It’s time I faced facts.” He shrugged. “I’m a shepherd without a flock. I’ve got no church to return to.”

  Ruby dug her hands into her pockets. “Couldn’t you find a new congregation?”

  “I’m not sure I have the heart for it. Or the calling. I know the Lord has something in mind for me, but I don’t think it’s working in the hallowed halls of some dusty building.” He lifted a hand, gesturing to their surroundings. “I’ve never felt so alive as I do walking the camps. It’s like I’m journeying with the Lord through the streets of Jerusalem—walking a few miles in his sandals.”

  Ruby stepped over a slick-looking spot on the pathway. “You’ve found purpose.”

  His eyes lit up. “Yes.”

  “I came to San Francisco in search of significance. I was wasting away in my grief back home. I needed to find a reason to continue.”

  “Did you discover one?”

&n
bsp; Ruby thought through the past months—sitting at Dee’s side, rocking the feverish baby, and nursing the sick in the camp. And then there was the time spent with Robert, and getting to know the young woman who’d captured her brother’s heart. And Gerald . . . Her pulse skipped along faster, like the needle flying on the sewing machine. “I believe so.” She couldn’t hide the smile rushing to her face. “More reasons than I could have imagined.” She paused before the door to the sewing cottage.

  “I’m glad. If the Father could show you how to go on, I’ve got to trust He will point me in the right direction as well.” Patrick cocked his head to the side, his green eyes gleaming. “Will you pray for me, Mrs. Marshall?”

  A stitch caught in her throat. Pray for Patrick? Had she even prayed about her own situation? She swallowed. “Of course.”

  * * *

  The chill in the office matched Gerald’s mood. He pushed back the load of papers cluttering the blotter and placed his hand palm up on the hard surface. A bitter taste settled in his mouth, as if he’d consumed a headache powder with no water. “Let’s get this over with, shall we?” He’d postponed the procedure twice already. Ruby was unlikely to tolerate another delay.

  Robert hovered over his shoulder. “Won’t it be better to know the truth—one way or the other?”

  It’s not your life we’re deciding. Gerald shot a silent glare at his partner, not trusting his tongue to remain civil.

  “I think you’ll be relieved when this is complete.” Robert placed the tray on the table. “We should have done this in one of the examination rooms.”

  “I didn’t want to take the chance of Emil walking in on us. He’s already turned both you and Ruby into anxious mother hens.” Gerald moistened his lips, the walls of the small office suddenly feeling closer than usual. He picked up the vial of Novocaine and ran it between his fingers.

  “Give it to me.” Robert grasped the syringe and reached for the anesthetic. “There’s no way I’m letting you do this yourself.” He pressed the needle into the bottle and measured the dosage. “You relax.”

  Unlikely. Gerald leaned back in the office chair, his knees bouncing an unsteady rhythm. “I’m taking your sister to lunch when we’ve finished here. She’s put in too many hours at the camp. She deserves some time away.”