The symptoms show up anywhere from two to seven days after exposure.” Astrid looked right at each of the gathered group in the hospital. “If you get a sore throat or start to cough, you have to tell me. Promise?” Coughing would be obvious but not the other symptoms. They all nodded. “We are counting on you to not try to play the hero.”
She nodded to her head nurse. “Deborah, you have a schedule for us.”
Looking as tired as all the others, Deborah held up a piece of paper. “We all have to get rest to stay strong, so I’ve moved everyone into shifts.” She read off the schedule, then said, “I will post this on the bulletin board in Astrid’s office. That is the only room now without at least a pallet in it. We will use the beds at the far end in the new ward. Just to remind everyone, none of us may leave the hospital, other than to work on the train. But with Thomas Devlin and Mr. Sidorov working out there . . .” She nodded to Sandra and Abigail, the two student nurses who had been inoculated. “You will be sharing the shifts. Thank you all for your dedication. We are saving lives.”
“Thank you.” Astrid drew in a deep breath. “Now back to work. Make sure you eat too. You have to keep your strength up to be able to help others.” O Lord, how I wish Mor were here.
Sandy paused in the doorway. “By the way, we are out of cough syrup again.”
“I’ll telephone Mor and Freda.” We are about out of laudanum to mix with it too. Was there possibly any whiskey in town? That would help cut the mucus too. Thoughts, horrible thoughts, bombarded her, clamoring to take over, fear and anger and beyond it all, a weariness not only of body but of mind and soul. Oh, Mor, I need you. Lord, my mind says you are here in the midst of all of this, but the rest of me is screaming. No, I’ve not even the energy to scream but despair. Help us, Lord God. You said you would.
Mrs. Geddick stepped in the door. “I got ten chickens. But we will need more.”
“I’ll call Mary Martha and have her find more. It’ll take two days at least if we order them from a supplier.”
“Dr. Astrid, we need you—stat.” The call came from the examining room.
Please, Lord, not another trach. Get those intubation supplies here. And I thought we were well prepared for any emergency. She pushed the door open, hearing the coughing before she stepped through. A boy lay on the table, his swollen neck clamping down his ability to breathe. She used a tongue depressor and turned his head to the light. Sure enough, the telltale gray membrane covered part of his tonsils but had not grown over his esophagus. He was not in extremis sufficiently to warrant a trach.
She looked up at Miriam’s sister Mercy, standing by his head. The dear girl had volunteered to come in and help since she had already had a mild case of diphtheria when she was younger. “I thought we were not bringing any more in from the train but treating them out there.”
“I know, but they didn’t think there was sufficient light out there to do a trach if we needed to.”
“Let’s clean him up and pack his neck in ice. Do we have a name for him?”
“No, Mr. Sidorov carried him in and rushed right out again. His English was so broken I couldn’t understand him.”
Astrid shook the boy’s shoulder. “Can you hear me?”
He nodded, his eyes fluttering at least partway open.
“I have something here for you to drink. We’ll hold you up enough to swallow. You have to swallow it, no matter how much it hurts. Do you understand?” Astrid held her hand out for the cup of warm honey, vinegar, and willow bark water. “Is the steam room ready?”
“We have three patients in there now.”
“Room for another?” Astrid slid her arm under the boy’s shoulders and held the cup to his swollen lips. “Drink.” He slowly and slightly moved his head from side to side, the liquid draining out the side of his mouth. “Spoon it in.” She shook the boy again. “You have to swallow. Now!”
While she held the patient, Mercy spooned in the concoction.
“Good for you. More.” She looked to her assistant. “You might have to follow in your sister’s footsteps; you’re getting plenty of training already. We need to get some nourishment into him too—no telling when he last ate.”
“Mrs. Geddick has the chickens cooking for broth. It will be a while.”
“We are all out?”
“Sorry.”
“Forgive me for being short. Clean him up and move him into the steam room.” They had moved a small stove into one room and had kettles of water boiling with eucalyptus oil and menthol in them. Breathing steam was an old remedy to aid breathing, but it was helping. If her mor ran out of herbs, they would have another mountain to climb. Were there others in Blessing who gathered herbs too? Perhaps Amelia.
Deborah stuck her head in the door. “Astrid, we need you.”
Once in the hall, Astrid asked, “What now?”
“That baby girl is not going to last much longer, I’m afraid.”
Astrid followed Deborah to the crib where two little ones shared the space. Gretchen was there speaking calming words to the babies. Astrid didn’t need her stethoscope to tell her how bad it was. The blue lips and fingers told the story. Lord, what can I do? Help us, help us. She smoothed the dark hair back from the little forehead, then reached down and picked up the baby. Rocking her in her arms, she whispered more prayers. The mother was too sick to care for her little one, but surely someone could hold her. No baby should die alone in a crib.
“Let me hold her; you are needed in room one.” Gretchen held out her arms.
“Thank you.” If only Mor were there to help. Astrid knew her mother was praying, as were many others, but somehow her presence always brought peace into a room. And gave strength and comfort to the suffering. Right now she needed a hug from her mother as much as any of the patients did. A hug and a shoulder to cry on. She stepped into the room that was normally for one patient. A gray-haired man lay in the bed, and three other pallets took up most of the floor. Was every child on the train affected?
Abigail stood beside him. “I think his trach is plugged.”
“Get me a syringe. We’ll suction it out.” With Abigail holding the tube in place, Astrid inserted the syringe with no needle in the tube and drew out a small glob of cloudy mucus. Squirting that into a pan, she repeated the action three times. If only I had more supplies. When the antitoxin and intubation supplies arrived tomorrow, they’d go around and insert as many as needed. Anything to keep the airway open until the body could fight off the infection.
“He’s better.”
“I see that. Get these sterilized right away.” They were keeping a kettle boiling with carbolic acid in it. Had someone said they were low on that too? Astrid brushed her hair back with the back of her hand.
“When did you sleep last?” Deborah asked.
Astrid shrugged.
“Go lie down—now.”
Astrid bit her lip to keep from snapping back. “What about Elizabeth? She’s been out on that train for hours.”
“No, she slept for three hours. She should have slept longer, but she’s eating in the kitchen right now.”
“I’ll stop and check with her.” She looked her head nurse in the eye. “What is the body count?”
Deborah looked back at her steadily. “They had three bodies on the train when they arrived and two today, and we have lost three children, one of the mothers, and an older man they sent over this morning. Someone said he was the elephant trainer.”
Together they walked toward the kitchen. “How many more are near death?”
“I wish we could tell. A child who looked like he was recovering just stopped breathing and died. A young man who had no vital signs—no pulse or breath you could detect—suddenly opened his eyes. I think he might live. It’s madness, Astrid.”
“Has anyone learned when the first person showed symptoms?”
“No, but it had to be at least two weeks or more.”
“And Stetler, the circus owner, didn’t seek any medical help
?”
“He says he didn’t know about it.”
Astrid snorted, her fists clenched. “Would serve him right if he got it.”
“Mr. Devlin mentioned hot fires of hell . . .”
“When did they give their last performance?”
“No idea.” Deborah continued down the hall.
Astrid turned aside into the kitchen and stopped by Elizabeth. “Did the rest help?” If she looked as bad as Elizabeth, no wonder Deborah insisted she sleep.
“I think so. There is no way we can keep up the wash. I called on the women to bring us any that they have. We have three iron kettles on fires outside. The washing machines cannot keep up. Tonio is keeping the fires going and changing water. He’s tireless, that worker.”
“We should have asked Chicago to send us more help.”
“Maybe they will. Dr. Deming and Vera are helping out on the train too.” Elizabeth stared at the wall, shaking her head. “You realize, most places don’t get a disease-laden train in the middle of the night.”
Astrid gripped Elizabeth’s shoulder and began rubbing, digging deep into the muscles, like her mother had taught her.
“Oh, that feels so good. How I wish Ingeborg could be here, if for no other reason than to encourage us.”
“I know, makes me want to run out and hide in her lap.”
Astrid was afraid she might not be able to sleep with all the chaos going on in her mind, but she was out like dropping a rock in a well. She woke to someone shaking her shoulder. “What?”
“We’re going to lose another one unless you do a trach.” Miriam shrugged. “I’m sorry for waking you, but Elizabeth said her hands are shaking too much to attempt any surgery.”
“She is shaking? Did you ask if she had a sore throat?” Astrid swung her feet to the floor and reached for her shoes.
“She said she thinks it is from being so exhausted.”
Astrid thought while she tied her shoes. “I had that happen once, scared me silly. When I was training in Chicago.” She sucked in a deep breath and got to her feet. “I’ll go scrub. Bring me some coffee please. Who will be assisting?”
“Me and Gretchen. I sent Deborah to bed, along with nurse Sandra. Abigail went out on the train with Devlin.”
“How long have I been sleeping?”
“Nearly five hours. We could handle all but this.”
“Watch carefully and I’ll talk and show you through it.” Astrid leaned over the sink and started to scrub, flinching at the same time. Like everyone else, her hands were raw from all the scrubbing, in spite of repeated applications of her mother’s salve. “I’m going to train you to intubate tomorrow. When did you sleep last?”
“While you were.”
Astrid nodded. “Get him in surgery please and scrub his neck with carbolic acid. We’ll be ready in about five minutes.”
“He’s there already and prepped.”
“How’s that baby girl?”
“Gone. About an hour ago.” Miriam turned away but not before the tears started.
Astrid closed her eyes. This should not be happening to such innocents. Not to anyone, but especially not to small children. Could it be that someday everyone would receive the antitoxin and eradicate this horrible disease?
Astrid threw the brush in the sink. “Let’s go.” Blinking hard, she entered the operating room. “Let’s pray. Heavenly Father, guide us here, right now, that we can help save this life. Give us steady hands and bring breath back to our patient. Give us strength to get through the hours and days ahead. Please protect the people of Blessing as we strive to help these who are so ill. Breathe on them, breath of God. Amen.”
She looked at Miriam as they both put on masks. “You ready? Good. Watch carefully. We need to enter the trachea between any two of the cartilaginous rings, preferably low. I choose this point just above the sternum. Make a small incision. You will sometimes hear a whistle to let you know you are in the right spot.” She did exactly as she said, and Miriam sponged the site. “Now you insert this tube. Hear the breath entering and exiting?”
“Yes.” Miriam heaved a sigh behind her mask. “You make it look easy.”
“Actually when you have the necessary supplies, it is. The hard part is when you have to improvise.”
Miriam smirked. “I see. Your tube keeping the airway open is the barrel of a hypodermic syringe. Nice improvisation, Doctor.”
“Thank you. Let’s move him back to the other room. Have someone sit with him until he is out of the anesthetic, and we can tell him what we had to do.”
She called two others, one of them a recovering patient, to help move him to the gurney and then to the bed. While they’d been in surgery, Sandy had been scrubbing the room, supplying the bed with clean linens. At least they weren’t needing blankets. While night had brought cooler temperatures, thanks to the lights, the operating room was always hot.
It was an endless process of sponging, feeding, using ice packs, dispensing what medicines they had left. The laudanum was long gone, and while two quart bottles of cough syrup had been delivered, they were running low again. The laundry kettles continued to bubble through the night. Someone brought a load of firewood. Getting the sheets dry was proving a problem at night, but the predawn breeze took care of that.
“Ingeborg is running out of honey,” Reverend Solberg announced when he brought the last of the jars of cough syrup in. “Whoever it was who delivered it had left the jars outside the hospital with a note.” He poured himself a mug of strong coffee.
Astrid held her mug out and he refilled hers as well. “What can we do for more help? I’m down to pressing patients into service.”
“Keep praying for strength. The inoculations will make others immune, so that should solve part of the problem.” Reverend Solberg leaned against a wall to drink his coffee.
Elizabeth entered the kitchen and plopped into a chair. “How are our people handling all this?”
“Afraid, angry, stoic—all the emotions we should expect. Hard to believe the world goes on as we fight the battle. That train . . . I don’t know how we’ll ever get the disease out of it. I hope you ordered gallons of carbolic acid. Does it come in barrels?”
“That train should be burned. What’s happening with all the circus animals?”
“Manny has taken over seeing that the menagerie gets fed,” Solberg told her. “Farmers are bringing in some leftover hay. Do you realize how much one grown elephant eats in a day? The circus has three. The owner ordered meat for the big cats, so a new family in the area, the Ericksons, butchered that runt calf they had. It wasn’t gaining anyway. Stetler’s anxious to leave because he’s had to cancel three locations. He says this might break him. He’s probably right. This is not a first-class outfit. I have a feeling he was in financial distress before the diphtheria hit them.”
“Thorliff said he and the others are working to bring us what supplies they can and to keep everyone calm.” Astrid shook her head. “I was on the phone with Chicago. The doctors said this is one of the worst outbreaks because people were confined in a relatively small space.”
“I am praying our good North Dakota wind can blow our land clean again.”
Elizabeth stared at the tabletop. “I don’t even know what to pray for anymore, other than for strength to keep going, for all of us, and to protect the people of Blessing. And that we are able to contain it.”
Solberg nodded. “And so we keep thanking Him for His continued presence. For His grace and mercy. That’s all I know to do. He says to love the unlovely, and that we are doing. Makes me think on leprosy, but this happens so much faster. Unclean.” He shook his head.
Astrid eyed him. “When did you sleep last?”
“On my way now.”
“Get something to eat first.”
“Yes, Doctor.” Even his usually ready smile was missing. He set his mug in the sink and left.
Astrid scribbled some notes about the tracheotomy. Record keeping was important, yes,
but people’s lives were more so. She left her office to go stand at an eastern-facing window. The sun had yet to crest the line of trees but the sky said any moment now. Streamers of whitening clouds, the sky turning blue, birds singing, all heralded the new day. How could everything look so normal outside when death and disease inhabited the hospital and stalked her people like the worst black cloud ever seen? Had it only been two days since the train arrived? It felt like they’d been fighting this monster forever.
CHAPTER 20
Did the hours drag? Was the clock broken? Was the train late?
They moved patients in and out of the steam room, forced fluids, put ice packs on some, placed fever-reducing wet cloths on others. As much as they were able, they held the babies, small children too, in the steam room and on the wards. To contain the disease, mothers who showed no symptoms were not allowed in the hospital.
Elizabeth returned from her rounds on the train and collapsed in a chair in Astrid’s office. “Only three new cases. Perhaps intubation will save them.”
“Are any improving?”
“It’s hard to tell, but I think so. Looks to me like people either die or start to get well within a week.” She shook her head. “I guess it’s that way with all sicknesses. Forget I said what I did.” Tipping her head back to rest against the wall, she gave a deep sigh. “We’ll inoculate the hospital staff first, then all those possibly exposed. You agree?”
“Ja, that makes good sense. But what about the circus people?”
“Before our people here in Blessing?”
Astrid rubbed her forehead. “You know people are already demanding to know how we are going to do this.” She had talked with Thorliff on the telephone, their only means of communication. She didn’t tell Elizabeth that Sophie was insisting the families from Blessing should come before outsiders. No matter how they did this, there would be angry people. “It all depends on how much antitoxin we receive. Hospital staff and helpers who are not immune first, all those exposed that first night, and then God help us. I wonder how long the antitoxin needs to be in the body before it can fight off the disease.”
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