The Way of All Flesh

by Ambrose Parry

  Simpson stepped from the carriage followed by the dog. He searched the doorways and shopfronts momentarily, then set off up a narrow and dimly lit close, the dog scampering after him.

  Confusion reigned in Raven’s aching head. What was a man of Dr Simpson’s stature and reputation doing in the Canongate? Where were the rich ladies of the New Town that he had been led to expect? What of the grand houses wherein lay the sweet-smelling wives and daughters of the quality?

  Raven followed his new chief into the passageway and was confronted by a familiar ammoniacal aroma, like cabbage boiled in urine. Clearly Mrs Cherry had been sharing recipes around the neighbourhood. They climbed three storeys up a dark staircase, Simpson’s pace remaining steady throughout the ascent even as Raven felt the strain grow in his thighs and an ache pound in his battered chest.

  ‘It’s always the top,’ the professor observed, with gratingly good cheer.

  The door was opened by a typical male inhabitant of these parts, unshaven and missing his front teeth. It always amazed Raven that he could live so close to people and yet never have seen them before, or at least not noticed them any more than the cursory assessment of whether they might be a threat. The sight of this one would ordinarily be enough for Raven to check his pockets were secure, but there was no need, they having already been emptied by the Weasel and Gargantua.

  Despite his unkempt appearance, the man did not smell too bad, which came as a small relief. The same could not be said for the chamber they were shown into. The stench hit him full in the face, an ungodly combination of blood, sweat and faecal matter. He observed the merest wave of discomfort on Simpson’s visage, before the doctor masked his response behind a calm veil of politeness.

  The man of the house hovered at the threshold a mere moment before absenting himself with visible relief.

  Mrs Fraser was lying within a tangle of visibly soiled sheets, her face contorted with pain. Raven banished an image of Evie in the throes she endured alone and confined himself to the here and now, though this was scarcely more pleasant. The patient was evidently in labour and making heavy weather of it, drenched in sweat with her face an unnaturally purple colour. She was scrawny and malnourished, similar to many of his erstwhile neighbours and almost all of the patients he had encountered both in his dispensary work and in walking the wards of the Royal Infirmary.

  Simpson seemed unfazed by his surroundings, which did not bode well as far as Raven was concerned. He really did not wish to spend his time ministering to the poor when there was money to be made among the wealthy, particularly with his eye under threat should he not soon make good on what he owed.

  Simpson whipped off his great black coat and rolled up his sleeves.

  ‘Let’s see what’s what, then,’ he said, as he made his initial examination.

  A few moments later he reported that the cervix had not yet fully dilated and declared himself content to await events. He installed himself on a chair beside the only window, where he began to read his book. The dog curled itself up beside him on the floor, indicating that the beast was sufficiently versed in its master’s habits to know they were in for a long haul.

  ‘I like to make use of bits and pieces of time,’ Simpson said, indicating the volume on his lap. ‘Some of my best papers have been written at the bedside of my patients.’

  Raven took in the only other seat in the room, a three-legged stool, liable to put skelfs in his arse. He lowered himself reluctantly onto it, thinking he would have ideally preferred to wait out the time in a nearby hostelry, which prompted him to remember that he had no money on him, and precious little back at Mrs Cherry’s either. He would have little option but to develop more abstemious habits. Would that he had done so one day sooner.

  Lacking any reading material by way of diversion, time seemed to slow. Raven reached instinctively for his watch and remembered that it was gone. Gargantua had been through his pockets and found the one thing of value that Raven possessed. In truth, the old timepiece was of modest monetary worth and would do little to reduce the sum that he owed even if it was passed on to Flint, which he doubted. But its absence was felt keenly, because his father had given him that watch. It was thus a valuable keepsake inasmuch as it was a constant reminder that the old wretch had given him nothing else worth having.

  With some difficulty he got up and moved the stool into a corner of the room, hoping that by doing so he might rest his head on the wall and perhaps sleep for a while. He changed his mind when he saw the damp and peeling plaster, seemingly held together by clumps of black mould. He had to make do with sitting upright and letting his head fall forward onto his chest.

  He must have drifted off at some point because he was suddenly hauled from oblivion’s gentle respite by a scream from the patient. The laudanum which had been liberally applied to Mrs Fraser by a local midwife prior to their arrival had evidently worn off. There was a young, worried-looking girl – when did she arrive? he wondered – filling a bowl with water from a jug.

  Simpson looked over at his new apprentice as he washed his hands.

  ‘Ah, Mr Raven. You are awake. It is time to re-examine the patient and decide upon the best course of action.’

  Raven rinsed his own hands in the bowl and watched as Simpson performed the examination, but there was little he could see. A blanket had been draped across the woman’s knees, obscuring the view. The doctor then turned to face him.

  ‘Would you care to make an examination yourself?’

  Raven could think of little he would like less right then, but it was not an invitation. He steeled himself and took a moment to remember how hard he had worked to put himself in this position.

  He reached beneath the blanket, closing his eyes as he attempted to work out the position of the infant’s head relative to the maternal pelvis. With only touch to guide him, his inexperienced hands were not so gentle as the doctor’s, and the woman grunted in her discomfort, occasionally eyeing him with a resentment bordering on violence. He was increasingly tempted to toss the blanket aside. If he was to learn anything from these encounters, it would be better, would it not, if he could at least see a little of what he was doing.

  ‘What are your findings?’ Simpson asked, his voice calm and quiet. Raven was uncertain whether this tone was intended to reassure him or the patient, but it served to remind him that he was not the one who ought to be feeling the greater stress.

  ‘The infant’s head is sitting at the pelvic brim,’ he stated, surprised at his own conviction. ‘It has not descended as it should have done.’

  Simpson nodded, eyeing him thoughtfully. ‘How should we proceed?’

  ‘Forceps?’ Raven ventured, a question rather than a statement of fact.

  The mere mention of the dreaded instrument drew a loud moan from Mrs Fraser, while the young girl diligently mopping her brow stopped what she was doing and began to weep.

  ‘Fear not,’ the doctor told her, his tone still as measured. ‘Bear with us just a bit longer and we shall have the little one delivered safe.’

  Simpson then turned to Raven, his voice deliberately quieter, inaudible to the others above the cries and moans.

  ‘The head has not yet entered the brim of the pelvis, so it is too high even for the long forceps. In this case I think turning would be the better option.’

  The doctor picked up his bag and rooted around in it, eventually removing a piece of paper and a stubby pencil. Leaning on the wax-spattered table, he drew a cone shape and pointed at it as though it explained everything. Raven’s incomprehension proved legible enough upon his expression for Simpson to add some arrows as he attempted to clarify what his diagram represented.

  ‘The whole child can be considered cone-shaped, the apex or narrowest part being the feet. The skull can also be thought of as a cone, the narrowest part of which is the base. By turning the child in the womb, the feet can be pulled through the pelvis first, distending the maternal passages for the transit of the larger part. The feet a
re first brought down then used to pull through the body and the partially compressible head.’

  Raven grasped the notion only vaguely but nodded vigorously to forestall any further explanation. The screams were rattling his aching head and he wanted the whole thing to be over almost as much as Mrs Fraser.

  Simpson then removed an amber-coloured bottle from his bag.

  ‘This is an ideal case for ether,’ he said, holding up the vessel as evidence of his intentions.

  Raven had seen ether used before in the operating theatre. The patient had complained vigorously about its lack of effect while oblivious to the fact that his gangrenous foot was being removed even as he spoke. Raven was amazed, but there were those who argued it had only been partially successful, inasmuch as they thought the very purpose of the anaesthetic was to render the patient insensible and therefore altogether less troublesome.

  He had inhaled it himself at a meeting of the Edinburgh Medico-Chirurgical Society, shortly after its anaesthetic effects had been discovered. It produced an unpleasant dizziness resulting in much staggering about. This caused some short-lived hilarity but he had not fallen asleep as others had done. He had wondered if perhaps he was resistant to its effects in some way.

  Raven watched as Simpson poured some of the fluid onto a piece of sponge. The air was immediately filled with a pungent aroma, which was welcome in that it partially masked the other odours still permeating the place. The sponge was then held over the patient’s nose and mouth. She recoiled initially at the fumes, before the young girl said gently: ‘It’s the ether, Ellie, like Moira had.’

  The agent’s reputation evidently preceding it, she breathed in the vapour eagerly now, before passing quickly and easily into sleep.

  ‘It is important to administer a narcotising dose,’ the doctor said, ‘thereby avoiding the potentially troublesome primary stage of exhilaration.’

  He spoke of ether with knowledge and enthusiasm, just as Henry had implied. There were those who were already dismissing it as a passing novelty, but clearly Simpson was not among them.

  He indicated that Raven should take command of the soporific sponge while he busied himself at the other end.

  ‘Ether is most helpful when turning or using instruments,’ he said as he reached his hand into the patient’s uterus. The lack of response from Mrs Fraser, in contrast to her previous tortured writhing, convincingly bore this out.

  ‘I’ve found a knee,’ the professor reported, smiling.

  With Simpson’s activities largely obscured by the blanket, Raven looked down at the sleeping woman; except she wasn’t sleeping. She lay completely still, almost as though she was suspended in some realm between life and death. She had become an effigy of herself, a figure cast in wax. Raven found it hard to believe that she would ever wake up, and with alarm recalled Henry’s mention of a recent death from the stuff.

  A few minutes later Simpson announced that the feet and legs had been delivered. The body and head soon followed in a gush of blood and amniotic fluid which formed a puddle at the doctor’s feet.

  Simpson produced the infant from beneath the blanket, rather like a stage magician revealing a dove from an upturned hat. It was a boy. The child began to cry, lustily. The ether evidently had little effect on him.

  The baby was swaddled and handed to the young girl, who had been standing statuesque and wide-eyed while the delivery was in progress. She stirred herself now and began singing softly to the child, seeking to soothe its angry bawling.

  The mother slept on while the placenta was removed and the baby cleaned and dried. Then she woke as if from a natural sleep and seemed surprised to the point of confusion to find that her ordeal was over.

  As the child was placed in the delighted mother’s arms, the young girl went to summon the new father. Mr Fraser stepped tentatively into the room at first, almost in a state of disbelief. He looked to Simpson as though for permission, before approaching closer and placing a hand gently onto the head of his newborn son.

  Raven was surprised to see tears welling in Mr Fraser’s eyes. He hadn’t thought him the sort. That said, there had to be a great well of relief gushing through him, as the outcome in cases of obstructed labour was always far from certain. Raven was more surprised to feel tears well up in his own eyes. Maybe it was an effect of all that had happened last night, but he felt this dank and squalid place transformed briefly into one of hope and happiness.

  Mr Fraser wiped his eyes on his grubby sleeve then turned to shake the doctor’s hand while fumbling in his pocket for the fee that was due. Raven caught a glimpse of the modest specie in the man’s dirt-smeared palm. It seemed a paltry sum to offer a man of Dr Simpson’s reputation, particularly as he had performed the delivery himself.

  Simpson also appeared to be examining the proffered coins. Clearly it wasn’t enough, and Raven was bracing himself for an awkward exchange. Instead the doctor reached out and gently closed Mr Fraser’s fingers around the money.

  ‘Naw, naw. Away with ye,’ he said, smiling.

  He picked up his bag, waving to Mrs Fraser who was now nursing her infant son, and led Raven from the room.

  They stepped out into the Canongate, Raven enjoying the feel of a cool breeze upon his face. He imagined it blowing away all that had adhered to him in the preceding hours, feeling as though he had been confined inside Mrs Fraser’s womb itself.

  Simpson was looking about for his carriage, which was not where they left it, the coachman having perhaps decided to take a turn to relieve the monotony during the many hours they were inside. Raven cast an eye about the street also, which was when he noticed a small gathering outside a close across the road. Evie’s close.

  He drifted nearer, as though conveyed there by an involuntary compulsion. There were two men carrying out a body swathed in a shroud, a cart waiting by the roadside. The shroud was grey and tattered at the edges, one that had been used many times before. Nothing fine, nothing new to clothe poor Evie, even in death.

  There were several familiar faces standing on the pavement, other prostitutes. Some he had known through Evie, and some he had merely known. Evie’s landlady was there too, Effie Peake. Raven kept his head down. He did not wish to be recognised, and even less to be hailed.

  There was an officer of the police standing at the mouth of the close, watching the corpse being loaded onto the cart. Raven overheard someone ask him what had happened. ‘Just another deid hoor,’ the officer replied neutrally, not even a note of regret in his voice. ‘Killed herself with the drink, looks like.’

  The words echoed and echoed around Raven’s head. He felt a hollow open up inside him, something deeper than shame.

  Just another deid hoor.

  That was not the woman he knew. Evie deserved to be more than that.

  Six

  Sarah surveyed the waiting room and observed with a frown that there were a good many patients still to be seen. Dr Simpson’s sudden departure had resulted in an inevitable delay as Dr George Keith, his assistant, was left to deal alone with all those who remained. Sarah liked George, but he was slow and had a tendency to lecture the patients, which she didn’t care for. She wondered if she should request that Dr Duncan come and help but decided it was unlikely he would. He was always too busy with his experiments, though this was perhaps no bad thing. He had the coldest of manner and seemed better suited to dealing with chemicals than with people.

  She much preferred watching Dr Simpson work, but that was a relatively rare occurrence. He mostly saw the well-to-do patients upstairs, where Jarvis had the equivalent to Sarah’s role. To be fair, Jarvis was better equipped to deal with the clientele up above, being seldom cowed by their complaints. He exhibited a healthy disregard for their position in society and as a result was seldom intimidated, browbeaten or lost for words.

  Jarvis was a tall man, which made it difficult for others to physically look down on him. He was also very particular about his appearance, carrying himself with great elegance and dign
ity, and was confidently articulate. Sarah often thought that with a different set of clothes Jarvis could easily pass for a member of the upper orders himself. On one occasion she had seen a gentleman approach the butler, waving a rolled-up newspaper in a rather threatening manner. ‘I have been waiting to see Dr Simpson for more than an hour,’ he had said, ‘which I find to be quite unacceptable. I have come all the way from Jedburgh.’

  ‘Is that so?’ Jarvis had replied witheringly. ‘The last patient was from Japan.’

  Sarah looked again at the sorry assembly littering the downstairs waiting room that was her domain. They were poor-looking souls suffering a variety of maladies that Sarah could often diagnose merely by looking at them. Scrofula, consumption, ringworm and scabies were all frequently in evidence. The sound of coughing and expectoration was so commonplace that she was no longer aware of it, although it was always there.

  She sighed as she noticed the time on the clock above the fireplace. There was always so much work to be done and so little time for the pleasures that others took for granted. She patted the books still weighing down her pocket and wondered if she would have the opportunity to open them today.

  She was shaken from her musings by the sound of someone coming down the stairs. She looked up, expecting to see Jarvis, but it was Mina.

  ‘Sarah, I have been ringing the bell in the drawing room repeatedly and no one has answered.’

  ‘Mrs Lyndsay doesn’t always hear the bell when she’s in the scullery, ma’am.’

  That was certainly what Mrs Lyndsay claimed to be the case. The cook insisted that she was deaf in one ear, which was why the bell sometimes went unanswered, but Sarah suspected otherwise. Mrs Lyndsay resented being interrupted when she was cooking.

  ‘I am in need of tea. I have been struggling with the same piece of embroidery for the past hour. Such a difficult pattern.’

  ‘Wouldn’t it calm your spirits to be reading a book instead?’ Sarah suggested.