The door slammed, followed almost immediately by the sounds of severe diarrhea.
Noah pondered forcing the door open. How could he tell her that he must check for blood or mucus? He reached for the handle, but before he could turn it, heard a rush of water. Mrs. Anschutz had apparently been stocked with modern conveniences. A modern jet-flush toilet had been installed to replace the old wash-outs that dominated in most of the neighborhood. When Noah heard the sound, he knew any further attempt at investigation would be pointless.
Moments later, the door opened. Mother and son emerged. After his bout, Willard was wan, his jaw slack, agitation replaced by exhaustion. Noah dropped into a squat and once more put his arm around the boy. Mrs. Anschutz stood by, shaking and grasping herself about the chest.
“Mrs. Anschutz,” Noah told her. “I need some water. Could you fetch a glass?”
She began to protest but then nodded and moved toward the stairs. Activity would help her control her nerves and her absence would be helpful in restoring calm.
“Well, Willard,” Noah said with a smile, “I understand you want to be a fireman when you are old enough. Or do you wish to join the army like your father?”
“Fireman,” Willard replied weakly, looking up at the stranger. His dilated pupils forced him to squint.
“A wonderful occupation. Very exciting. We’ll soon have you well enough to be back to your training. I watch you, you know. Very professional. Your uncle was fire commissioner before he was mayor, was he not? Do you want to man the hose or climb the ladder?”
Willard succeeded in forcing out a tiny grin. “Ladder.”
“Why don’t you let me play fireman now and carry you to the bedroom?” Without waiting for a reply, Noah lifted the boy in his arms. Willard shivered uncontrollably. Noah placed him on the bed and again stroked his hair.
“I would like to conduct an examination. It won’t hurt, and it will help me determine what is making you sick. Once I do that, I will know how to make you feel better. Will that be all right?”
Noah withdrew a stethoscope from his bag. The instrument had been a gift from his father when Noah joined his practice. Willard’s lungs seemed clear, although his respiration rate was high. The boy’s liver palpated normally. He seemed to have a slight fever. His pulse was quickened and shallow. His abdomen was neither hard nor tender, but Noah detected hyperactive bowel sounds. Both pupils were dilated, and Willard said his vision was blurred. His ears were clear. Willard’s lips were dry, as were his oral mucous membranes. His skin exhibited tenting—a lack of elastic response after a soft pinch on the back of the hand. Everything confirmed the initial, if incredible, diagnosis.
When he was done, Noah stroked Willard’s hair. The worst, Noah hoped, was past, at least for the moment. His symptoms, however, would undoubtedly return, at least through the night.
Mrs. Anschutz had returned, holding a tall tumbler filled with water. Noah motioned for her to bring it to the bed.
“Do you think you could drink some water for me, Willard?”
The boy shook his head.
“Very well, Willard, but you have to promise to drink when you are able. It is important for firemen to drink lots of water.”
The boy motioned for the glass. He took a few sips.
“Bravo,” Noah said. “I’d like you to keep drinking whenever you can. Now I need to speak with your mother for a moment. Will you wait for me here?” Noah motioned for Mrs. Anschutz to join him at the far side of the room.
“What is it, doctor?” Mrs. Anschutz asked. Her voice contained the quaver that betrayed the fear of the unknown with which every physician is familiar. “Do you know what is responsible for his illness?” She seemed genuinely ignorant of the cause.
Noah proceeded with caution. “Willard’s symptoms seem to point to a toxic reaction. With children, something they have eaten is generally the culprit. Did he partake of oysters, by some chance?”
She shook her head.
“Any meat that was not shared by your family?”
Once again, as expected, the answer was no.
“Has he vomited or just experienced diarrhea?”
“Only the second.”
“How long has Willard exhibited these symptoms?”
“He was perfectly fine yesterday afternoon, then began feeling a bit ill last night. He said he had trouble sleeping, but that is not unusual for Willard.” She forced a tiny smile. “He has so much energy. This morning he began to feel a bit of stomach pain, although not terribly severe.”
“Did you give him any medicine?”
“Bismosal. I always give it to the children for stomach upset.”
Bismosal was a patent medicine, bright pink in color, a suspension of bismuth subsalicylate, relatively insoluble and, unlike many patent medicines, had low toxicity. It was generally used for treating infant cholera, but also seemed to provide some relief from gastritis.
“Does Dr. Frias know you treat your children with Bismosal?”
“Certainly. Dr. Frias recommended it. Not all patent medicines are harmful, doctor.”
“Of course not. Did it work?”
“It seemed to make him feel better, yes. The pain returned in the afternoon, however, but much more severely. I gave him another spoonful of Bismosal, but Willard continued to deteriorate until . . . until I came for you.”
“Has he been given any other medication than Bismosal?”
Mrs. Anschutz shook her head.
“Why did you not call Dr. Frias?”
Mrs. Anschutz dropped her arms and clasped her hands in front of her, in the manner of a schoolgirl giving a recitation. “As I said, his condition did not become radically worse until late afternoon.” Her voice had chilled. “When I called Dr. Frias, I was told he had an important personal engagement and could not be reached. Even a physician is allowed a private life, Dr. Whitestone.”
“Of course.”
“When I saw that Willard needed immediate attention, I presumed to ask you. I chose to fetch you myself because I feared if I sent Aldridge, you might not come.”
“Of course I would have come,” Noah replied. He had wondered why she had left Willard’s side. “I am flattered that you summoned me. One last question. Has Willard had any recent illnesses?”
“He had a cough and low fever some weeks ago.”
“Was he given medication then?”
Mrs. Anschutz nodded. “Dr. Frias prescribed some tablets.”
“What sort of tablets?”
“Dr. Frias did not say. He told me they would cure Willard’s illness and they did. He was markedly improved after three days and has been in superb health since. In even better spirits than usual.”
“Until today?”
She nodded.
“And he stopped taking medication . . .”
“Two weeks ago.”
“And you are certain that, other than Bismosal, he has not taken anything more recently?”
“My powers of recollection are uninhibited, doctor.”
“Very well, Mrs. Anschutz. I feel certain I can alleviate your son’s symptoms, at least temporarily, although I would ask you to bring him to my offices tomorrow. I would like my father to have a look at him.”
“Very well, doctor,” she replied evenly. Noah suspected, when tomorrow arrived, she would take the boy to Frias instead.
“Ordinarily, I would suggest having Willard admitted to the hospital,” Noah said. A look of alarm returned to Mildred Anschutz’s face. “As a precaution only,” he added hastily. “I suspect a short-term illness that will abate significantly in the next forty-eight hours. With the night staff, however, Willard would not receive any better attention than he could get here at home. And, if he needs attention at any time during the night, come to my door.
“For the present, I am going to give him two drops of laudanum. Laudanum is tincture of opium, as I am certain you are aware. I would generally not administer an opiate to a child of Willard’s age, but deh
ydration presents the biggest immediate risk and laudanum will control his diarrhea. It will also ease the cramping and allow him to sleep. You may rest assured that the dose is far too small to do him any harm.”
Noah removed the small, dark bottle from his bag. He used a medicine dropper to place the two drops of laudanum into a spoon. He put his free hand to Willard’s back to help him sit up and take the medicine. Within minutes, the boy’s symptoms began to subside. Soon afterward, he appeared to be resting comfortably.
Noah paused, studying Mildred Anschutz. He should not ask, he knew. Most physicians would leave matters as they were. Let the doctor who caused the problem solve the problem. What was more, this woman had no trust in him, despite her momentary gratitude. But Noah refused to be that sort of physician. There was one diagnosis that fit the symptoms precisely, and he would pursue it.
“Mrs. Anschutz,” he inquired, trying to sound matter-of-fact, “might there by some chance be morphia anywhere in the house?”
Her reaction was predictable. She drew herself up to her considerable height and stuck out her chin as if it were weapon. “Certainly not! We are not Chinamen or dope fiends in my home. What would possess you to ask such a question?”
“I am not suggesting that the morphia is here for any nefarious purpose,” he assured her. “Perhaps in a patent medicine . . .”
“I told you, no,” she insisted.
“I can assure you, Mrs. Anschutz, my motive is simply to eliminate all potential sources of Willard’s condition so that we may discover what is actually causing his distress. The tablets that Dr. Frias prescribed. Might you have any left?”
“I don’t see why you are interested in medicine Willard has not taken for two weeks.”
Why indeed? “The more I know about Willard’s history, the more likely I am to find an effective treatment,” he offered.
Mrs. Anschutz glowered but, after another glance at her son, left the room. Returning soon after, she held a small, pewter-clasped box with an “A” set in red stones on the top. Inside were about ten small, blue tablets. Noah was certain he had never encountered them before, but as each drug company fabricated its own wares, this was not unusual.
“Might I have one?”
Grudgingly, she extended the case. Noah asked for an envelope, which Mrs. Anschutz fetched, small and cream colored with the omnipresent “A” emblazoned on the back flap. Noah removed a tablet, dropped it into the envelope, and tucked the envelope in his vest pocket.
He was relieved to see that Willard was nearly asleep. Every moment his wracked body could rest would help. “I must make two other calls,” he said. “Willard will probably rouse in about two hours, and I will be back no later than shortly after that.”
Mrs. Anschutz shook her head fiercely. “You cannot leave. You must stay with Willard. I insist, doctor. If he awakens sooner and his symptoms have returned, I will be at wit’s end.”
“I can’t, Mrs. Anschutz, as much as I would like to. My other two patients are equally acute. One is terminally ill. Both are expecting me. I administered the laudanum to calm Willard in my absence.”
Mrs. Anschutz began to protest further, when a young, lank, red-haired woman appeared in the doorway. “I’m back, ma’am.”
“And high time, too,” snapped Mrs. Anschutz. She then ordered the girl, whom she called Molly, to change clothes immediately.
“Perhaps Molly can sit with Willard until I return,” Noah offered, after the girl had hurried off.
“Molly is a maid, not a physician, doctor. You must stay. Get word to your other patients that you are responding to an emergency.”
“I told you, Mrs. Anschutz, I will be here before Willard’s symptoms return.” Noah moved to the bedroom door. “When he awakens, try to persuade him to drink. Small sips, but as much as he can.” He took a glance back at Willard. The boy was sleeping peacefully. Then, before Mildred Anschutz could renew her protests, he took his leave.
TWO
DAY 1. WEDNESDAY, 9/20—7:30 P.M.
Clement Van Meter was a seventy-year-old former mate on a schooner. He had contracted cancer of the colon but, after a lifetime of incompetent care by alcoholic ships’ doctors, had not sought treatment until a bowel resection had ceased to be feasible. He had gone comatose two days before. He might linger for days or be dead in hours.
The Van Meters lived in a two-room flat on Pineapple Street, about a ten-minute walk. Noah stepped into a home filled with old furniture, worn carpets, and the slightly musty smell that seemed to settle around the aging like a shroud. A model of a four-masted schooner sat on the mantle. Some of the rigging on the mainmast had come undone and lay hanging over the deck.
Hermione Van Meter, a tiny, desiccated creature, latched on to Noah. “Thank you, doctor. Thank you so much for coming.” She dragged him toward the bedroom. Her bony fingers felt like twigs on Noah’s wrist. “You got here just in time. I saw his eyelids flutter. Twice. I think he might be waking up.”
Noah thought the prospect unlikely. Loved ones of the terminally ill often cling to the hope that the mere presence of a doctor might prompt a miraculous abatement of symptoms.
“Let’s go and see, Hermione.” One look at the husk of a once-vibrant seaman, the rhythm of the short rise and fall of Clement Van Meter’s emaciated chest, told Noah that there would be no miracle here. “I’ll sit with him for a bit,” Noah told her, pulling a rickety slat-backed chair to the bedside. “Perhaps it will happen again.”
Hermione Van Meter sat on the other side of the bed. She reached out and took her husband’s hand. “Is there something you can give him, doctor? So that he might wake up sooner, I mean?” She had endured a half century of extended absences of long sea voyages, sometimes two years at a time, but the prospect of the absence being permanent was unendurable.
“Nothing right now, Hermione. Let’s just see how he does.”
“All right, doctor,” she replied, trying to force a smile to show she was grateful for the visit.
They sat in silence for some moments, Hermione Van Meter stroking her husband’s hand. “Clement was going to buy a boat after he stopped sailing. For us to live on, I mean. He was so used to the water, he couldn’t get to sleep here. But I was used to the land and said no. Perhaps I shouldn’t have been so selfish.”
“Nonsense, Hermione. Clement only wanted for your happiness. I’m certain he loved the home you made for him.”
She nodded, unconvinced, and they lapsed once more into silence. Hermione Van Meter did not move her gaze from her husband. Noah was certain that, even now, she still saw him as the strapping young merchantman that she had married five decades before.
After about thirty minutes, Noah told her he must leave. “Perhaps I can fetch a pastor.” The Van Meters were Lutheran. “I would like you to have company.”
She shook her head.
“Any friends I might ask?”
“No, thank you, doctor,” she replied with resignation and hopelessness. “I’d like to just be with Clement. Fifty years, but we had such little time, really.”
Noah nodded and stood to leave. Mrs. Van Meter reached for her purse on the table at the side of the bed. “I suppose I should pay you now,” she said softly.
“I never accept payment in the evenings, Mrs. Van Meter. I’ll prepare a proper invoice and have it sent over.” He would not, of course. Funeral expenses would come close to breaking her as it was.
She paused for a moment, her fingers on the snap of the purse. Then she replaced it on the table. “Thank you, Dr. Whitestone.”
“You’re very welcome, Hermione.” He took her hand and wished her well as she showed him out, frail and very old, alone with her dying husband.
Medicine taught to avoid personal involvement. Treat with the head and not the heart. Slip into the reverse, and patients suffered. But how could he not feel for Hermione Van Meter? Doomed to pass her remaining years in a two-room flat, abandoned by her husband, her neighbors, even by life itself. What
was worse: death or loneliness? Noah had no shortage of opportunity to observe the former, but the latter he had known all too well. Isobel. Oliver. There had been many days when he was convinced death could not be worse. What about now? Would his loneliness finally ameliorate with Maribeth?
Noah arrived at a tenement on Montague Street, the home of his second patient, Thea Harpin, an aging widow with Bright’s disease. While she was in no immediate danger, her kidneys were certain to eventually fail, leaving her with the same prognosis as Clement Van Meter. Her rooms, on the second floor, were as crowded as Van Meter’s had been empty. Five other widows had crammed their way in to keep vigil, partly in triumph that they would live while their acquaintance would die, partly in despair that one of them would be the next to be chosen in this devilish tontine.
The widow Harpin herself was little changed. But with six women in one room, he was forced not only see to his patient but also to reply to a plethora of inquiries about the various ailments of the others. Then there were the cakes he had to sample and the inquiries as to his marital situation to which he was forced to respond. When the assembled widows learned that he was now betrothed, disappointment filled the room. Various nieces and granddaughters—all beautiful, bright, and vivacious—would now be forced to locate another good catch. With it all, there was scant a moment to reflect on Hermione Van Meter. Or himself. In truth, Noah loved the busiest days. Hard on the body, but easy on the spirit.
By the time he could extricate himself, it was nearly nine. He did not return to the Anschutz home until about a quarter after. Three hours. The laudanum he had given Willard would have largely worn off. Noah hoped that the symptoms would not yet have returned in full force. He wasn’t sure what he would do—he was reluctant to administer laudanum twice to a child so young—but controlling the symptoms was most urgent until, if necessary, he could insist that Willard be admitted to the hospital in the morning.
He knocked lightly on the door. The maid answered almost immediately. Molly was a thin, fragile girl, her face spattered with freckles. She seemed to wear a look of perpetual anxiety, no doubt a result of having Mildred Anschutz as her employer. Her lips began to quiver, as if she was trying to force herself to say something, when Mrs. Anschutz stepped through a doorway to the left.
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