Yes, she said, only two men have found the exact spot. And she pointed to a place in her right iliac quadrant. One was a young doctor at the Post Graduate Hospital who has become famous since then, and another was the surgeon who operated on me the first time. The rest just feel around the abdomen as you have done.
But do not forget, I said in my own defense, that there is a place in the abdomen in major hysteria which if it is pressed upon will definitely bring on a convulsive attack.
She looked at me with interest.
Yes, the Greeks connected it with those organs. That is its name. Perhaps I should have everything cut out.
Not on your life, I told her.
No, I believe that too. I don’t want any more operations. So you do not think I have a cancer.
Not from the evidence I have found so far. If I could see the X-rays I might have a different opinion, but I do not think so. From what you say and the length of time that the symptoms have been going on, the fact that you have not lost weight, that you are ruddy and well—I believe that you are suffering merely—but that is quite enough—from what Llwelyn C. Barker calls—I have forgotten the term—what we used to call mucous colitis. It is a spasm of the large intestine which simulates all sorts of illnesses for which people are frequently operated on.
I left the room while she dressed. While I was away she told my wife: I want to live because I have found my place in life. I am a housekeeper. I have my husband and my work to do and that is my world. I have found, she added, that we must live for others, that we are not alone in the world and we cannot live alone.
To me she said when I had taken her to the bus and we were waiting: Well, you haven’t told me what is the matter with me. What is it? Don’t tell me I am nervous.
There has never been an anatomic basis discovered for an opinion in cases like yours, I said, until recently. Apparently the cause was laid down in the germ plasm when you were created.
Yes, my family history is bad, she agreed. They were an old family, run down. Yes, I come from an old family. I should have married a robust type. But my inferiority complex would not let me. I did not take up when I had the chance. I didn’t have the nerve. Instead I looked for someone that I could mother, someone to take care of. That is how I took to Yates, he needed me so much. I wonder what was the matter with him. He didn’t walk till he was twelve with his big head and little legs.
The anatomic basis for your condition, I continued, seems to have been detected in a new study called capillaroscopy, a study of the microscopic terminal blood vessels. In people of your type these terminal loops between the arteries and the veins are long and gracile. They are frail, expand and contract easily, it is the cause of all the unstable nervous phenomena which you see.
Yes, I can feel it often, she agreed. The blood goes into my face or into my brain. I often want to run or scream out, it is so hard for me to stand it.
Others have short more or less inert loops. Those are the lethargic types, the stable, even dispositions.
Here’s the bus, she cried out. Good-bye. And she grasped the tips of my fingers in her hurry to be gone.
Good-bye, I called after her. Bring Yates with you next time. Remember me to him. Good-bye, good-bye.
Old Doc Rivers
HORSES. These definitely should be taken into consideration in estimating Rivers position, along with the bad roads, the difficult means of communication of those times.
For a physician everything depended on horses. They were a factor determining his life.
Rivers prided himself on his teams. It was something to look at when he came down the street in the rubber-tired sulky with the red wheels. He’d sit there peering out under the brim of his hat with that smile of his always on his face, confident, a little disdainful, but not unfriendly.
He knew them all. …
Hello, Frank, how’s the wife?
Not so good, Doc.
The old trouble, eh? Tell you what I’ll do. I’ll drive around and take ner up to the hospital this afternoon.
Can’t get her to do it, Doc.
Scared?
Guess you hit it.
All right, you old rascal; have a cigar. And he’d turn away, with the horses pawing and shaking their heads right and left, ready to go.
A young man and a bachelor, this was the happiest period of his life, when he was exhilarated by an occupation, the sun, the cold, the motion of the horses, their haunches working muscularly before him as he sat and smoked. Maybe it was that and a mad rush to get from place to place; it came and went in a moment. He saw it, realized it, there was nothing else and—he had the rest of his life to live.
This is how he practiced. …
Come in, Jerry—making a pass at him with his open hand—How’s the old soak?
Fer Christ’s sake, Doc, lay off me. I’m sick.
Who’s sick? Have a drap of the auld Crater. He nearly always had a jug of it just behind his desk. Did a dog bite you?
Look a’ this damned neck of mine. Jesus, what the hell’s the matter with you? Easy, I says.
Shut up! You white-livered Hibernian.
Aw, Doc, fer Christ’s sake, gimme a break.
What’s the matter, did I do anything to you?
Listen, Doc, ain’t ya gonna put something on it?
On what? Keep those pants buttoned. Sit down. Grab onto these arms. And don’t let go until I’m through or I’m likely to slit you in half.
Yeow! Jesus, Mary and Joseph! Whadje do to me, Doc?
I think your throat’s cut, Jerry. Here, drink this. Go lie down over there a minute. I didn’t think you were so yellow.
What! Lie down? What for? Whadda you think I am, a woman? Wow! Have you got any more of that liquor? Say, you’re some man, Doc. You’re some man. What do you get?
That’s all right, Jerry, bring it around next week.
That’s some relief.
The phone rang. It was one of the first in the region. Wanted at the hospital.
Hey, Maggie!—to the dour old Irish woman who sullenly cared for his world: Tell John to drive around to the side door.
Wait a minute now, wait a minute. There’s a woman out there has been wantin’ to see you for three days. She looks real sick. She’s been here all morning waitin’ for you.
Get her in.
Doctor …
Yes, I know—he could see that her color was bad. Where is it? In your belly?
Yes, Doctor.
He made a quick examination, slipping on a rubber glove without removing his coat, washing his hands after at the basin in the corner of the room. The whole thing hadn’t taken six minutes.
Leaning over his desk he scribbled two notes.
Take thirty drops of it tonight, in a little water. And here, here’s a note to Sister Rose. Get up to the hospital in the morning. Don’t eat any breakfast.
But, Doctor, what’s the matter with me?
Now, now. Tomorrow morning. Don’t worry, Mother. It’ll be all right. Good-bye, and he pushed her out of the door.
John’s waiting for you, said big Margaret as he was struggling with his coat, his hat, a cigar, stopping in the corner of the porch to light it. A few moments later he was into the carriage and off.
He leaned back, seeing nothing. The horses trotted up the Plank Road. Past the railroad cut. It was a dark spring night. The cherry blossoms were out on the McGee property. Past the nurseries. Down the steep hill by the swamp. The turn. By the Cadmus farm. The County Bridge; clattering over the boards. Over the creek. The creek was flowing swiftly, an outgoing tide, a few lights streaking it, a few sounds rising, a faint ripple and a cool air.
Naturally, he must have given value for value, good services for money received. He had a record of thirty years behind him, finally, for getting there (provided you could find him) anywhere, anytime, for anybody—no distinctions; and for doing something, mostly the right thing, without delay and of his own initiative, once he was there.
He was
ready, energetic and courageous. The people were convinced that he knew his stuff—if anyone knew it. And they would pay him well for his services—if they paid him at all.
But what could he do? What did he do? What kind of a doctor was he, really?
Thinking it over, it occurred to me to drop in at the hospital in the small nearby city where he took many of his operative cases to see for myself exactly what he had been about all these years. To satisfy myself, then, as to the man’s scope I went to the St. Michael’s Hospital of which I am speaking and induced the librarian to get out the older record books for me to look at.
As usual in such cases, something other than the thing desired first catches the eye.
These were heavy ledgers, serious and interesting in appearance with their worn leather covers and gold lettering across the front: Registry of Cases treated at St. Michael’s Hospital, etc., etc. There were a dozen of them in all from the year 1898 on. I felt a catch at the throat before the summary of so much human misery.
Opening at random, there it lay, the whole story of the hospital, what had been done and the result, along with the doctors’ names and other like information, listed in tall columns. These were carefully written in through the months and years in longhand of many characters, minute and tall, precise and free, in blue, in green, black, purple and even red; with stub pens, sharp pens and even pencil, across two full pages with two narrower fly leaves between.
I chose the years 1905 and 1908 and began to thumb over the leaves looking for Rivers’ name. But my eye fell instead upon the list of patients’ occupations. Such a short time ago and yet some of these entries struck me as odd: Liveryman, coachman, bartender! Nothing in years has so impressed me with the swiftness of time’s flight.
In the doctors’ column, there was Rivers, dead surely of the effects of his addiction, but here another who had shot himself in despair at the outcome, it is said, of an affair with the wife of another physician on the same page, his friend. While this one had divorced his wife and married once again—a younger woman. Another at sixty had quietly laid himself down upon his office couch and said good-bye and died. This one had left town hurriedly taking himself to the coast, possibly to escape jail—leaving a wife and child behind him. Some had grown old in the profession and been forgotten though they were still alive. One of these, ninety and more, totally deaf, still morosely wandered the streets and scarcely anyone remembered that he had been a doctor. Queer, all that since 1908.
What had Rivers really accomplished?
Surgically, there were, to be sure, more than enough of the usual scrapings, and appendicitis was common. But here is a list of some of his undertakings; I copy from the records: endometritis, salpingitis, contracture of the hand, ruptured spleen, hernia, lacerations (some accident, no doubt). There were malignancies of the bowel, excisions of the thyroid, breast amputations; here an ununited fracture of the humerus involving the insertion of a plate and marked “Cured” in the final column. There were normal maternity cases, Caesarean sections, ruptured ectopic pregnancies. He treated fistulas, empyema, hydrocele. He performed hysterectomies, gastro-enterostomies, gall bladder resections. He even tackled a deviated nasal septum. There were fractures of all the bones of the body, nearly, and many of those of the head, simple and compound.
And at the far edge of the right-hand page, you would see the brief legend “Cured” as often following his name as that of any other doctor.
On the medical side, the old familiar “neurasthenia” which meant that they never did discover what was the matter with the patient; but also nephritis, pneumonia, endocarditis, rheumatism, malaria and typhoid fever. Most left the hospital cured.
And who were they? Plumber, nurseryman, farmer, saloonkeeper (with hob-nail liver), painter, printer, housewife, that’s the way it would go. It was a long and interesting list of the occupations of the region from tea merchant to no occupation at all.
Acute alcoholism and D.T. were frequent entries.
It was not money. It came of his sensitivity, his civility; it was that that made him do it, I’m sure; the antithesis rather of that hog-like complacency that comes to so many men following the successful scamper for cash. Nervous, he accepted his life at its own terms and never let it beat him—to no matter what extremity he was driven.
But sometimes I know he had to quit an operation half way through and have another finish it for him. Or perhaps he would retire for a moment (we all knew why), return, change his gloves, and continue. The transformation in him would be striking. From a haggard old man he would be changed “like that” into a resourceful and alert operator.
Going further, I asked several men who had been in the habit of standing opposite him across the operating table their opinion of him as a surgeon—what had been the secret of his success.
Again, I began to pick up odd pieces of news. Dr. Jamison, who had been an intern in the hospital during several of Rivers’ most active years, recalled how he would awaken sometimes in his room on the first floor at night to find Rivers asleep outside the covers on his bed beside him snoring like a good fellow. And once on a trip to the state hospital for mental diseases at Nashawan, one of the attendants of the place had come up to the group to ask them if the person he had found in a semi-conscious condition leaning against the wall down the corridor was one of their party. It was Rivers; something had gone wrong with his usual arrangements and he was coked to the eyes.
In sum, his ability lay first in an uncanny sense for diagnosis. Then, he didn’t flounder. He made up his mind and went to it. Furthermore, he was not, as might be supposed, radical and eccentric in his surgical technique but conservative and thoroughgoing throughout. He was not nervous but cool and painstaking—so long as he had the drug in him. His principles were sound, nor was he exhibitionistic in any sense of the word.
And what a psychologist he was. There was a boy down in Kingsland who had had diarrhoea for about a week. Several doctors had seen him and prescribed medicine but the child had been eating almost anything he wanted. Finally they called in Rivers. He pulled down the kid’s pants, took one look and said, Hell, what he needs is a circumcision. And he did it, there and then, kept food away from him a day or two (because of the operation) and of course the kid got well. That’s how smart he was.
Only twice did I personally assist him at operations.
The first case was that of a man called Milliken, an enormous, hulking fellow in his late thirties, swarthy, hairy-chested and with arms and legs on him fit for the strong man in the circus. He ran a milk route at one end of the town. It was acute appendicitis.
When we got to the little house where he lived, a double house I recall, the only room big enough to handle him in was the parlor. We rigged up a table in the usual way. Rivers said we were ready and told the big boy to climb on up. Which he did.
I forgot to mention that Milliken was a great drinker. He also forgot to mention it to me at the time.
Go ahead with the ether, said Rivers.
Well, it didn’t take me long—not more than twenty minutes—to find out that ether wouldn’t touch this fellow anyway you gave it—unless it might be by a tube. There are individuals like that, powerfully muscled men and alcoholics.
By this time Rivers and his assistant were ready
Wait a minute, Doc, managed to mumble the patient. For, strange to say, the man had been docile up to that point so that we thought he was under. But it was not so.
I could see that Rivers was losing patience but I was already pouring a stream of ether upon the mask. They were ready for the incision, scrubbed up, the sheet in place, just waiting.
Rivers was fidgeting and I wasn’t in a particularly pleasant mood myself. Finally he spoke sharply to me asking if I didn’t know how to give an anesthetic. I could feel my face flush but I didn’t say anything. Instead I took out the chloroform and began to give that, carefully. Rivers looked approval but said nothing. We all waited a moment or two for this to take effec
t. By this time, we were all sweating and mad—at the patient, each other, and ourselves.
The outcome was that, after three attempts at an incision—at which time an earthquake occurred under our grips, Rivers gave it up and turned to me.
Here, he said, Gimme that mask. Come up here and assist Willie. I’ll show you how to get this man under.
I wanted to scrub. He said, No, put on the gloves. I obeyed. There was nothing else to do. Asepsis had gone to the winds long since in our efforts to keep the man from walking out of the room.
Rivers just took the chloroform bottle and poured the stuff into that Bohunk. I expected to see him turn black and pass out.
But he didn’t.
After a few minutes, we were told by Rivers to go ahead.
His assistant just touched the skin with his knife and up flew the man’s knees. I was tickled to death.
Go ahead, go ahead, cried Rivers excitedly, hold him down and go to it.
That’s what we did. One man held the head and arms. I finally quit entirely as an assistant, lay on my stomach across the man’s thighs and grasped the legs of the table on the other side. One man, alone, did the actual work. It is to his credit that he did it well.
It must have been a month after that I saw the patient, one day, standing in front of the fire house. Curious, I went up to him to find out if he had felt anything while the operation had been going on.
At first he didn’t know me, but when I told him who I was, expecting to get a crack in the eye maybe for my trouble, he came up with a start:
Did I feel anything? said he. My God, every bit of it, every bit of it. But he was a well man by that time.
It was the case though of an old German harness maker of East Hazleton, Frankel by name, which first raised doubts in my mind as to Rivers’ actual condition. I received the call one day and went to the address given, where I knew the old man and his wife lived above the store.
The Doctor Stories Page 3