Beyond the Ashes

by Karen Barnett

  She gritted her teeth and scooted up along the seat cushion for a better angle on the pedals. The wind tugged at her curls, more popping loose by the second. By the time she arrived at Lane Hospital, she’d look like a wooly mammoth. She didn’t dare lift a finger, her hands busy wringing the life out of the steering wheel.

  After a few more blocks, the tension tapered from her arms, her elbows lowering a few inches. It wasn’t so different from driving on a deserted country road. As long as she ignored the other vehicles and the—she jammed her foot down on the brake pedal as a newspaper boy dashed across the street, his short pant legs flapping.

  Ten minutes later, Ruby slowed to a stop in front of the hospital, parking the automobile behind a white delivery truck. She shook out her arms and climbed down to the sidewalk, knees quivering. Ruby dashed up the stairs and pulled open the double doors.

  The hospital lobby yawned in front of her, the expanse of black and white tile flooring exaggerating the lengthy path to the front desk. The duty nurse glanced up, her lips pulling into a tight frown. “Nurse Marshall—we just heard the news. How is Dr. Larkspur faring?”

  Ruby gripped the edge of the counter with Gerald’s gloves. “Not well, I’m afraid. My brother—Dr. King sent me. He said to ask for Dr. Lawrence.”

  The nurse glanced down at the roster sheet open on the desk. “Drs. Dawson and Lawrence are in surgery in the amphitheater. He should be done in an hour or so.” She leaned closer to Ruby. “I hear the patient isn’t expected to survive. More of a spectacle for the medical students, if you ask me.”

  Ruby didn’t have time for chitchat. She spun on her heel and raced down the hall, dodging patients and equipment until she stood at the surgery door. Glancing past the No Admittance sign, Ruby yanked at the door handle.

  The cavernous amphitheater extended upward, the gallery seats filled with murmuring medical students. Ruby stepped through the dark entrance hall into the bright light spilling from the glass atrium above.

  Dr. Dawson’s head jerked up, his long silver whiskers bristling as his lips pulled back from his teeth. “What are you doing in here?”

  After maneuvering through San Francisco traffic, Ruby wasn’t about to be intimidated by a barking physician. “I need to speak to Dr. Lawrence. It’s urgent.”

  Dr. Lawrence glanced up from his work. His red-stained hands hovered over an open cavity in the patient’s chest. “Nurse Marshall? I’ll be with you in a moment.” He pushed back a strand of hair with the back of his wrist. He turned to the pink-cheeked woman beside him. “Could you get me towel?”

  The older doctor sputtered. “Lawrence, what is the meaning of this?” A snicker traveled through the crowd of spectators, a few rising to their feet.

  “I apologize, sir. But I believe this may be a life-and-death situation.” He glanced toward Ruby.

  She nodded, taking a step back toward the exit.

  “And this is not?” Dr. Dawson gestured to the motionless form on the table.

  “Of course, sir. I won’t be but a minute.” Dr. Lawrence wiped his fingers on the white towel and shoved it back at the nurse, hurrying to join Ruby in the doorway.

  She followed him into the hall, practically tripping on the man’s heels.

  “I hope this is serious, because I probably just cost myself a month of surgeries.” Dr. Lawrence lowered his voice as they stepped out into the busy corridor.

  “My brother—Dr. King, sent me. He said you might know where we could get some additional doses of antitoxin.”

  Dr. Lawrence rubbed his eyebrow, his shoulders rounding. “For Dr. Larkspur? We just heard this morning. Is he worse?”

  “I’m afraid so.” Ruby lifted her chin and kept her eyes focused on the young doctor. “Did you receive the vials from County?”

  He managed a curt nod, shadows drawing close around his eyes. “But we administered them immediately. We have several cases—it’s why we requested the serum in the first place. It’s in short supply.”

  Ruby’s composure collapsed, her knees threatening to join it.

  The doctor took two steps closer and grasped her elbow, as if aware of her crumbling spirits. “If I’d known Gerald was ill, I’d have held one for him—somehow. He and Dr. King only brought me in on the carcinoma a few days ago. I’m still reeling from the news. I can’t imagine how you are feeling. It’s little wonder he succumbed to the infection so quickly.”

  Ruby shook her head, the conversations of dozens of people in the hall filling her ears. “Carcinoma? You mean their new patient?”

  “I had no idea when they requested my help with the procedure we’d be operating on one of our own. I knew Gerald had suffered a nasty X-ray burn, but I had no idea it had progressed to cancer.”

  Ruby stumbled backward, her lungs clamping down. Cancer? She pressed fingernails into her palm to steady herself. “I’m concerned about the diphtheria right now. We can deal with the . . . the other, later.”

  “Right, right.” The doctor glanced back toward the surgery door. “I need to get back. You might try the General Hospital at the Presidio. The military doctors often keep stockpiles beyond what they tell us about. I believe Dr. King procured some from there before. I don’t know if they’ll release it to you, though.”

  “I’ll try. Thank you.” She pressed a hand against her lace cravat, hoping to slow the bouncing of her heart.

  Dr. Lawrence gripped the brass door handle. “Wish me luck.”

  Ruby stared at the wooden door as it swung shut. Someone bumped her elbow in passing, but she didn’t bother to lift her gaze. She gulped stale hospital air, ribs aching. Breaking from her trance, Ruby ducked through the busy hallway, weaving past patients and doctors until she slid across the black and white tiles and slammed though the front door.

  Gerald has cancer.

  39

  Gerald paddled through the waves, pushing his head through the sea foam. Darkness reigned both above and below the surface, but breathing seemed easier up here. The swells lifted and dropped him at their whim, like a carousel ride at the carnival. Gerald didn’t know how he’d gotten into the water, but he’d think of it later. Right now, he needed to focus on staying alive.

  Spray caught him in the face, tumbling him backward and filling his lungs. He pushed upward, coughing and gagging, but firm hands grasped his forearms and thrust him back under. He sagged down, drawn into the depths.

  “Gerald, wake up.” A voice sounded out of the gloom.

  Gerald’s eyes flew open, even as the pressure of the deep water crushed against his chest.

  Robert’s face loomed before his eyes. “You’re going to throw yourself off the bed.”

  “Can’t . . . breathe.” Gerald coughed out the words.

  Robert reversed the pressure and yanked Gerald forward, pulling him to a sitting position.

  A deep gulp of air rushed into Gerald’s lungs, an agonizing burn as it burrowed through his chest. He gasped and choked, the jolting pain demanding a second and third inhalation. After a few excruciating minutes, the spell passed. The pressure eased, air pushing in and out of his chest with less effort. Gerald’s racing pulse slowed, the ravening waves fading into his memory. He leaned on his friend’s arm, focusing on little more than staying conscious. Sweat trickled down his back.

  “Better?” Robert tipped his head.

  Gerald managed a weak nod.

  Robert released his grip. He gestured to the dachshund pacing the floorboards near the bed. “Otto was downstairs raising a ruckus. When I got up here and found you, you were hardly breathing.” He balled up a pillow and forced it behind Gerald’s back, adding two more for good measure. “Let’s keep you upright. Chest pain, yes?” He retrieved the water glass from the bedside table and pressed it into his friend’s hand. Not waiting for an answer, he pulled a stethoscope from the bag.

  “Myo—myocarditis.” Gerald leaned against the feathery pile, fighting the sensation of falling back into the sea.

  “Yes, Dr. Larkspur. I’m
not your student anymore.”

  “Sorry. Habit.”

  Robert settled the stethoscope bell against Gerald’s chest, the metal like a sliver of ice against his skin.

  “At least Ruby stopped to warm it.”

  Robert glanced up from under his dark brows. “Was she in here? Very long ago?”

  Gerald shrugged, the action jolting his ribs. He pressed an arm against his side—the action becoming habit. “Asleep. Remember?” A wave of exhaustion swept over him, traveling upward from his legs. He closed his eyes.

  His friend sighed and folded the instrument in his palm. “Your heartbeat is irregular.”

  Gerald grunted. “Could’ve told you.”

  “Gerald . . .”

  At the touch of Robert’s hand, Gerald opened his eyes.

  “We’re out of antitoxin.” Lines gathered around his friend’s mouth, visible through the day’s growth of beard. Robert raked a hand through his dark hair, spiking it like a boar bristle brush. “I could use your advice.”

  Gerald moistened his chapped lips. “Talk through it.” His partner might not be a student anymore, but sometimes he still needed a cold dose of reality.

  Otto scrambled up into Robert’s lap and leaped across to the foot of the bed. He sniffed Gerald several times before curling up beside his leg.

  Robert sat back in the chair. “Male patient, age thirty-one. Mid-stage carcinoma on left palm, nodes potentially involved.”

  “They’re involved.”

  Robert’s lips thinned. “You don’t know for certain. They could be enlarged due to the infection.” He cleared his throat. “Presenting with diphtheria—pseudomembrane partially obstructing throat and tonsils, progressing to myocarditis after single dose of antitoxin.”

  “Why?” How easily he slipped back into instructor mode. Perhaps he should seek a teaching post at the medical college. Assuming I live.

  Robert cleared his throat, leaning forward and bracing his elbow on his knees. “The toxin spreads through the blood and causes inflammation of the heart muscle and valves.”

  “Prognosis?”

  Robert hesitated. “If it’s slight, patient might see a complete recovery.” Silence fell over the room, broken only by the sound of rain dripping from the roof. “If it’s severe . . .” Robert lowered his gaze, “the patient could endure years of chronic heart disease.”

  Assuming he had years. Gerald turned his head away from the light. “Or?”

  Robert jumped from the chair, sending it skittering back across the floor. “Why are you doing this? You know the prognosis. Paralysis. Congestive heart failure. Do you need me to say it?”

  The dog lifted his head, his gaze darting between the two men.

  Gerald took a deep breath, ignoring the rattle in his chest. “I want you to face facts. If I survive this—what do I have to look forward to? Carcinoma. Amputation. Prolonged illness. Death.”

  Robert spun around to meet his gaze, fire in his eyes. “You can’t predict the future. You don’t know how far the cancer’s progressed. Give yourself a chance to survive. Please. For your family’s sake. For my sake.”

  A weak laugh gurgled in Gerald’s stomach. “You’ve always been the dreamer. I’m the pragmatist.”

  Robert sank back into the chair. “It’s why we make a good team.” He leaned forward, bracing an elbow on each knee, his energy feeding into Gerald. “Let my dreams carry you, for once. You’re the one who led me to faith—what if God wants you to live?”

  Gerald studied his young partner, his shoulders hunched forward. “Then He’s not making it easy.”

  * * *

  Ruby pulled onto the bluff overlooking the water, the rocks crunching under the automobile’s tires. The misty rain stung at her cheeks, her throat squeezing until she allowed a frustrated cry to thrust its way up from her stomach. She slammed both palms against the wooden wheel. “How dare they not tell me?” She dug the heel of her hand against her eyes to wipe away the stinging tears.

  The wind tugged at Ruby’s curls. The hat was lost under the seat after her hair-raising drive through the city. She didn’t bother to retrieve it as she stepped out of the car.

  Ruby stomped over to the bench where she and Gerald had sat together just a few weeks ago. His gentle kiss lingered in her memory. Had he known then? She stood and glared at the bench as if Gerald sat waiting. “You let me fall in love with you. You spoke of God and trust and life.” Her stomach curdled. “You never mentioned cancer or—or death.” She crouched and swept up a handful of pebbles and flung them at the imagined apparition.

  His hoarse voice from earlier today echoed in her thoughts. “I don’t love you . . . I won’t die with it on my conscience.”

  It was a lie—at least in part. He didn’t want to die with her on his conscience.

  Ruby stumbled forward, gazing out over the fog-strewn waterway. I was content alone. I didn’t need him, God. Another sob tugged at her chest. She pressed both hands against her lace blouse, pushing away the ache growing there.

  The chilly breeze pulled at Ruby’s sleeves, so she wrapped her arms around her middle, tucking her hands under her elbows. Wisps of fog crept up over the bluff. Except for the temperature, it reminded Ruby of steam from an overheated kettle. An unwanted tear spilled down her cheek, tickling the edge of her lip. I didn’t need him, did I, God? I needed You. The new idea curled its way through her heart. Warmth flooded through her frame, beginning in the center of her back and working its way to her fingertips. She swallowed a sob inching its way up her throat. I needed You.

  The wind lifted her hair, blowing it back from her face. Ruby closed her eyes, letting the damp air wash over her. I need You.

  * * *

  Gerald lay in the quiet room, glancing across at his mother dozing in the chair. He pulled his eyes away. She’d endured too much already. What would she do if he died? Gerald grimaced. When I die.

  Robert’s words continued to echo through his thoughts. “What if God wants you to live?”

  Gerald lifted himself a few inches to get more air past the membrane obstructing his throat. Do You, Lord? Was this just another challenge to face—a trial to build his faith? Gerald pulled his hand out from under the quilt and stared down at the bandages. He flexed it, wiggling his fingers. Fingers he might never see again.

  He closed his eyes, Ruby’s face never more than a whisper away from his thoughts. For the first time all day, he allowed her image to flood his mind. Lord, even if I decide to fight this, I can’t ask her to do the same. A dull ache settled in his stomach. Life without her would be gray and empty, but at least he wouldn’t be risking her heart as well.

  Gerald pushed up to a sitting position, the quilt falling to his waist. He reached for the water glass, his arm trembling with the simple exertion. A sip of the tepid liquid cooled his throat, and he returned the glass to the table. Red light streaked the sky outside the window, the rain-soaked afternoon giving way to a quiet evening. Gerald shivered in the silence, but he didn’t reach for the blanket. He gazed out through the pane at the setting sun. Your will, Lord. Not mine. If You want me to live, I’ll do my best. Just You and me.

  * * *

  Ruby pushed through the doors of the Presidio hospital, glancing down the long hall.

  A nurse approached from the left. “Can I help you, ma’am? Visiting hours are long over.” As her gaze traveled over Ruby’s unkempt appearance, her upper lip twitched.

  Ruby ran a quick hand through her curls. They likely resembled the frizzy-topped marigolds in her mother’s flower box by now. “I’m Nurse Marshall from Lane Hospital. We have a desperate need for diphtheria antitoxin.”

  The nurse frowned. “Most of the doctors have gone home. Major O’Connor is on call. Would you like me to contact him?”

  Ruby pushed down the scream building in her chest. “How long will it take? I have a patient in severe distress. He can’t wait.”

  The woman pursed her lips. “Come with me. The pharmacist owes me a favor.
” She flashed a crooked smile. “A few, in fact.”

  Ruby scurried after the woman as she marched down the long corridor. “I don’t want to get you in trouble.” She choked off the words. What am I saying? Ruby cleared her throat and began anew. “I appreciate your help. I wouldn’t ask if it wasn’t urgent.”

  The nurse touched her white cap. “I know, honey. Nurses must join forces, right?”

  Ruby’s heart lifted. “Yes, we do. Oh, thank you!”

  “Don’t thank me yet. Pharmacists are a different ilk.” The woman turned the corner and approached a long desk where a white-coated man worked, head down. “Henry?” Her voice carried a teasing lilt.

  The man lifted his head, his brows pulled together. “Margie—don’t call me—I mean, Nurse Jones . . .” He sputtered the words, face flushing.

  She placed both hands on the desk and fixed him with a stare. “There’s no one here but me—and my friend, Nurse Marshall from Lane.

  He jerked to attention and nodded at Ruby. “Ma’am.”

  Nurse Jones explained the situation, laying it out better than Ruby, in her exhaustion, had managed.

  The pharmacist scowled, clamping both hands on his hips. “We can’t release medication without a doctor’s order.”

  Ruby lifted her chin, matching Nurse Jones’s strong countenance. “Do you have a telephone? Contact Dr. Lawrence at Lane Hospital. He sent me. The patient is another doctor.”

  The man paled. “Dr. Lawrence? He works with Dr. Emil Dawson, doesn’t he?”

  Ruby nodded, folding her arms across her sodden shirtwaist. “And I don’t believe either like to be kept waiting.”

  The pharmacist swallowed, his Adam’s apple prominent in his narrow neck. “No, ma’am.” He glanced at the telephone on the desk. “I’d heard rumor a doctor had taken ill. Didn’t know it was him.”

  Ruby opened her mouth, but the words died in her throat as he spun toward the long line of shelves.

  “I’ve got twelve vials. How many do you need?”