The wind started up then, in the fat warm currents that mean rain; and the boy on the porch rested his chin on his arms, thinking nothing, watching the storm blowing down into the countryside, watching it moving the world around.
CHAPTER TWENTY-TWO
House Call
I SUPPOSE IT’S time I stopped using that little disclaimer, which for a while became automatic—“I’m not a native.” When I came here, it was true enough, although I didn’t come from so very far away. I came straight out of school to work with Dr. Greene, meaning to get some good solid clinical experience. It was to be just a stepping-stone, of course. I had great things in mind for the future—a big practice in the city, brilliant diagnoses, my name in the textbooks, maybe even a disease named for me.
Dr. Greene wasn’t even my first choice, if you want to know. I’d wanted to go right into an urban practice. And I don’t think I was his first choice, either. But I hadn’t the capital to set myself up right away or the academic standing to talk my way into a partnership in the city, and he hadn’t any other applicants; so we lucked into one another.
I showed up with a set of slick tools in a black leather bag stamped with my initials, and impatience all through my body. Two years at the outside, and then on to greater things, I promised myself, stepping down from the train. I quite expected to change the face of medicine in this part of the country during my short stay. After all, I knew all about the newest treatments, and I guessed that old Greene, with his pokey house visits, hadn’t kept in touch as he should have done. I planned to dazzle him, and dazzle Naples, and move on.
He came to get me at the station; to me, he looked like any old country dweller, and I couldn’t have picked him out from a crowd. But I suppose I was unmistakable, an Earnest Young Doc. He strode up to where I was standing on the platform, and put out his hand.
“I’m Greene,” he said.
“Maxwell,” I told him.
“Come on then,” he said. “We have a patient.”
I was surprised: apparently I wasn’t to have a chance to get my bearings before being rushed off to someone’s bedside. I followed the old man to his car, thinking hard.
I had heard that Greene was a soft old fellow, nice to underlings; clearly I’d been misled. From all evidence, he was turning out to be a “grinder,” a member of the gruff old school. One of those country docs who carried a chip on his shoulder and who enjoyed tormenting their ambitious juniors. There were dreadful stories passed around about these men: how they whisked you from the train to the hardest cases imaginable, the ones who hadn’t much time left, and made it look like you had killed them with your incompetence.
I looked sideways at Greene, taking in the beetling brows, the grim expression. They linked up nicely with my mental image of the tyrants of country practice. I quailed: many a new doctor had broken down and wept in the hands of a grinder. Then I rallied: it would not happen to me.
We drove a ways up into the hills. It was many years ago, but that first house call is vivid in my memory. I could lead you there now, if you wanted. We passed house after house without slowing, and then we hit an uninhabited stretch of road. More like a rutted cow path than a road, actually. Only cows wouldn’t be up so high.
“Have we come too far?” I ventured.
Greene raised his eyebrows, and shook his head.
I had heard how to handle grinders. Haggard survivors of their mistreatment had come back from the dead and instructed us all. The worst thing, they said, was to speak overmuch. “Whatever you do,” I had been told by one escapee, who broke into perspiration at the mere memory of his travails, “don’t volunteer.” So I kept quiet now, and we bumped along even further, until it was clear we had missed our destination. He must stop soon and admit his mistake, I thought with satisfaction. I confess my spirits rose at the prospect of so early a victory for me.
But then we came upon a house. A hut, to be precise. Twelve by twelve feet, and two windows set opposite one another, so that one looked right through the one large room and out at the mountainside. There were two men outside as we drew up, one fortyish and one twenty, and across their laps they held rifles.
Greene didn’t hesitate, but opened the gate which stood in front of the house. There was no fence, just the gate, and he could easily have walked around it, which was what I began to do. But he caught my sleeve and pulled me with him through the freestanding hip-high doorway. The men didn’t move as we went by. I nodded to them, but they didn’t so much as twitch. It was as if they hadn’t even seen us.
It was gathering dusk outside by now, but inside the house it was like midnight. A low fire burned in the grate, giving little light. At first I could see nothing at all. Greene must have known his way around, because he bustled right in while I stood in the doorway, and within a minute or two had lit a kerosene lamp and was adjusting the flame.
God! how to explain my first sight of that place, my first patient visit. In medical school, it had been hinted that some rural dwellings might be unsanitary; the subject had been dismissed again with blithe references to boiling water, and keeping a clean examining space. There was no clean space that I could see; and from the looks of things, no hot water to be had. I stood still, literally afraid to touch anything; the thought of defiling my lovely shiny medical instruments by bringing them out made me shudder.
Greene went right over to one of the beds below the far window, and bent over the figure lying there. I moved closer, and saw what I took to be an elderly man.
“Same thing again, Mrs. Price,” said Greene.
The patient made a muffled reply.
“We’ll take a look first,” said Greene, putting his bag down on the bedside chair. “We’ll have to roll her over,” he told me.
I couldn’t imagine touching those filthy blankets or that foul-smelling creature, but I nodded and began to roll my sleeves up.
“I’ll just wash,” I said.
“No use,” said Greene, with a smile. “You’d have to go out to the pump, and we don’t have time for that.”
Now I knew he was a grinder. He had brought me up here to humiliate me and watch me squirm. I could see that it was hardly an emergency case; yet he had insisted on dragging me up here straight from the station, as though someone were dying.
“This is Mrs. Price,” he told me. “Mrs. Price, this is my new assistant. Dr. Maxwell.”
“We’ll teach him a thing or two,” came out of the creature’s mouth, followed by a series of crackling noises which I belatedly understood to be laughter.
“That we will,” said Greene. “Maybe Maxwell would like to ask you a few questions before we take a look.”
“Nice to meet you, Mrs. Price,” I said, smoothly. I was at least comfortable with this part of medicine—taking histories. “What’s the trouble?”
“Same thing,” she said.
“Same thing,” I repeated. “And what’s that?”
“Can’t get up,” she said, and went off into that creaking laughter again.
“Mrs. Price had an accident—was it five years ago?”
“Five year, three month, two day,” said Mrs. Price promptly, surprising me. “It were Betsy,” she said to me. “Never trusted her, not from the moment we got ’er. Too wick for the price, what I told Clem. But he didn’t listen.” Bemused by her accent, which was British Isles swallowed in hill dialect, I let her go on. Too late, I realized my mistake. She digressed freely while I hung on, saying “Uh-huh, uh-huh,” waiting for her to draw breath. Finally she did, and I slipped in my next question.
“How did the accident happen?” I asked. “Betsy kicked you, is that right?”
She looked confused, and then impatient.
“Betsy never kicked,” she said.
“Then—how?” I fumbled.
“Ran off,” she said. “And I lost my feet.”
“Lost your feet,” I repeated.
“Betsy ran away,” explained Greene. “And Mrs. Price went after her, isn’
t that right, Mrs. Price?”
“Lost my feet like a ninny,” said the old woman. “Like I hadn’t lived here all my life.”
“You mean you fell?” I asked.
The woman nodded, emphatically.
“I’d never a believed it, it hadn’t happened,” she said. “I lost my feet in the dark.”
“She fell down the side of the mountain,” said Dr. Greene, into my ear. “Snapped the spine at L2.”
“Didn’t she go to the hospital?” I asked, turning away from the patient.
“Hospitals are for dying,” spat Mrs. Price, recalling my attention.
“But you went there for a little while, didn’t you?” asked Greene. “And then they let you out, and you came back home.”
She nodded.
“And have you had any other troubles since I saw you last?” asked Greene, smoothly taking up the questioning. My face burned; obviously, I’d failed at my very first task. I had done what all the textbooks cautioned against, and Let the Patient Take Control of the History. If Greene had left things to me, I’d have been there all day, saying “Uh-huh,” while the old woman talked.
“Just the same,” she said.
“Good, good,” he told her. “Well, let’s take a look.”
He lifted aside the bedclothes, and I saw an astonishing thing. Mrs. Price, whose wasted head lay on the pillow, and whose shrunken feet stuck out the other end, had an enormous swollen belly between, big enough for twins.
“Ascites,” murmured Dr. Greene.
He did a thorough but effortless-looking examination, squinting at Mrs. Price’s fingernails, feeling her calves gently.
“What am I looking for here?” he asked.
“Thromboses,” I said, disdainfully. It was an easy question.
He stood up. “Time for you know what,” he said cheerily.
“I hate this,” said Mrs. Price, and squinted up her face.
“We’ll need warm water and soap,” said Greene.
The patient opened her mouth and roared, “Harry!” The younger of the two sentinels came to the doorway. “I told you get the water going,” she said. Harry stepped across to the fireplace.
“It’s nearly hot,” he said.
“Nearly’s not good enough,” she said. The boy poked up the fire, scowling, and went out again. “What am I to do?” she said, turning to me. “Look what’s happened to my house with them two running wild in it.” Her chin quivered. “The doorstep used to be white as milk,” she said. “And you coulda eaten off anywhere on that floor.”
I was embarrassed at the woman’s tears, and didn’t know where to look or what to say. Dr. Greene reached over and took her hand. “Your boys are a handful,” he said.
“That they are,” she sniffed, brightening a little. “Bigger than their pa, and twice as wild.” She smiled. “He wasn’t any too tidy himself,” she said.
Finally, the water was hot enough.
“We’ll just clean the area today,” said Greene. “And then put on a new dressing. Mrs. Price is used to this, aren’t you?”
“Get it over with,” said she.
“Help me here,” said Greene, to me. “We have to roll her onto her side.”
We pushed and pulled very gently until Mrs. Price lay facing the window, with her back to us. Her gigantic belly rested on the bed, and she laid her arm across it, as though it were a pillow.
“You’re not using that nasty stuff this time?” she said, over her shoulder.
“Not this time,” said Greene.
“Hurry up,” she said.
“We’ll be as quick as we can,” he said, and pointed to the dressings, which had started out some time ago as sterile white bandages, but which were now quite black with dirt. “Those need to be peeled away,” he said. “That’s about the worst part for her, so go gently.”
I began to remove the dressings. What with the poor light and the general filth, it was hard to find the edges of the tape, except by feel, and there was quite a bit of resistance when I pulled them away from the skin, as though they’d become part of it. Mrs. Price gave a little cry as the last one came away. I gasped as the sores emerged: deep and wide, revealing a glimpse of bone.
“Now, a little wash,” said Greene, taking my place at the bedside. I stood and watched him laving the wounds, bizarrely jealous. “Looking better this week,” he said to Mrs. Price. “Are you doing what I said, and letting them shift you?”
“It’s so much better on my back,” she said, evasively.
“I know,” he said. “But you really must try.”
He rubbed on salve, and then moved aside, handing me the clean white bandages. I felt a rush of gratitude, taping them into place.
“The larger the better,” he said. “Keeps out the germs.”
“You done yet?” fussed Mrs. Price.
“All done,” said Greene. “But you should probably stay there like that for a while. Saves them having to shift you later.”
“All right,” she grumbled.
“We’ll see you next week,” said Dr. Greene, leaning over her so she could see his face.
“Bye,” she said to him. “Bye, Doctor Max,” she added, a little louder.
“How do you like that?” said Greene, smiling. “A name for you already.”
We left, again passing the silent men, going through the disembodied gate, shutting it carefully behind us. In the car, Greene smiled.
“Soon’s we’re gone,” he said, “she’ll have Harry in there, rolling her onto her back again.”
“Shouldn’t she be in the hospital?” I asked. “She needs regular care. Those sores.”
“She won’t have the hospital,” he said. “And the sores have gotten a little better. They’re just the things we treat, anyway.”
“I’ve never seen ascites like that,” I said, remembering.
He nodded. “She’s pretty orange, too,” he remarked. “Hard to tell in that light. Advanced hepatitis.”
“Infectious?” I asked with horror.
“Alcoholic,” he said, with a smile. “If you percussed out her liver it’d probably be smaller than a grapefruit. Did you look under the bed?”
“No,” I said.
“Dozens of mason jars,” he said. “Good homemade stuff. She’s got a lifetime supply right on hand. Her lifetime, anyway,” he said, his brow wrinkling.
“In the hospital—” I began.
“In the hospital,” he said, “we’d do a batch of procedures on her, and each one would leave her a little weaker than before. She’d last maybe two weeks of it. Up here, she’ll live much longer.”
“She can’t be comfortable,” I protested.
“She’s more comfortable with what she knows,” he said, firmly. “You heard her. Hospitals are for dying.” His mimicry was excellent, completely without condescension.
“That belly should be drained,” I argued.
“We do that when she lets us,” he said. “She hates it, so I’ve got it down to every other week. I know it’s hard for you,” he said. “You’ve just learned about all these miracles that doctors and hospitals can do. You’re eager to avail yourself of all that beautiful equipment.” He was reading my thoughts, exactly. “Maxwell, welcome to the rest of your education. Here, you’ll learn what we can’t do.” I was silent. “It’s not so bad,” he said. “In can’t, there’s always can.”
I didn’t understand what he meant; we didn’t speak any more, all the way back to the practice, which was open for evening hours. There was one woman in the waiting room; she’d been there twenty minutes, the nurse reported.
“Be with you in a minute,” he said, popping his head into the waiting room. He washed up, and I after him, and then the patient was shown into the consulting room.
She was as different to Mrs. Price as anyone could be while still belonging to the same sex. About twenty, very beautiful, clearly well-off.
Dr. Greene introduced me, and the woman nodded politely. “I wanted to talk to you alone
,” she said. “I don’t mean to be rude,” she said, to me.
“Dr. Maxwell is a fully qualified physician,” he said. “I will no doubt discuss this case with him. But if it will make you feel better …”
She nodded, not looking at me, and I tactfully withdrew.
Half an hour later, Greene came through to the dispensary, where I was chatting with the nurse.
“You’ll be wanting your supper,” he said to me.
I took the remark as implying weakness on my part.
“I’m fine,” I lied. “I can last out the rest of the patients.”
He raised his eyebrows.
“I’m starving, myself,” he said, gently, and I felt ashamed of my defensiveness.
“I’d like to stay and help,” I said.
“Thank you,” he said gravely. “But there shouldn’t be anyone else tonight. You can go on home, Miss Miles,” he said to the nurse. When she was gone, he spoke again. “That last patient,” he said. “Maybe I’m getting old?”
“The unmarried pregnancy?” I asked.
“Close,” he said, surprised. “But a little wide of the mark. She’s married.”
“But pregnant,” I said.
“Quite,” said he.
“What did she want?”
“These girls get married so quickly,” he said, irrelevantly. “Without even a moment’s thought.”
“She wanted to see you alone,” I said.
“Exactly,” said the old man, heavily. “I told her it was illegal. That I shouldn’t even be listening to her.” He sighed. “It’s not the first time I’ve had to say that.”
“It’s a terrible thing,” I said, wanting to comfort him.
“I used to think so,” he said. “But,” and he looked at me. “I’ve seen so many lives ruined. Bright young girls, with a chance of getting out from under the terrible burden of poverty. I see them when they’re babies, all pink and fat and promising; and not much more than a dozen years later they’re in the clinic, for their first. They’ve still got fire and hope then, but after the baby comes they’ve changed a little. And each one takes a little more out of them. By twenty-five, they’re old and used-up. They don’t even remember the things they used to dream of.”
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