The Cole Trilogy: The Physician, Shaman, and Matters of Choice

by Noah Gordon

  Nick Holden had been returned to the state legislature three terms in a row. At times some of the citizens of the town became annoyed at his air of proprietorship, reminding one another that he might own most of the bank, and part of the mill and the general store and that saloon, and Lord alone knew how many acres, but by God he didn’t own them and he didn’t own their land! But generally they watched with pride and astonishment as he operated like a real politician down there in Springfield, drinking bourbon whiskey with the Tennessee-born governor and serving on legislative committees and pulling strings so fast and so skillfully that all they could do was spit and grin and shake their heads.

  Nick had two ambitions, held openly. “I want to bring the railroad to Holden’s Crossing, so mebbe someday this town will become a city,” he told Rob J. one morning, enjoying a kingly cigar on the porch bench at Haskins’ store. “And I sorely want to be elected to the United States Congress. I’m not gonna get us a railroad staying down there in Springfield.”

  They hadn’t pretended real warmth since Nick had tried to talk him out of marrying Sarah, but they both were friendly whenever they met. Now Rob regarded him doubtfully. “Getting into the U.S. House of Representatives will be hard, Nick. You’ll need votes from the much larger congressional district, not just from around here. And there’s old Singleton.” The incumbent congressman, Samuel Turner Singleton, known throughout Rock Island County as “our own Sammil,” was firmly entrenched.

  “Sammil Singleton is old. And soon he’s gonna die or retire. When that time comes, I’ll make everyone in the district see that a vote for me is a vote for prosperity.” Nick grinned at him. “I’ve done all right by you, haven’t I, Doctor?”

  He had to admit it was so. He was a stockholder in both the grain mill and the bank. Nick also had controlled the financing of the general store and the saloon but hadn’t invited Rob J. to participate in those businesses. Rob understood: his roots were sunk deeply in Holden’s Crossing now, and Nick never wasted blandishments when they weren’t necessary.

  The presence of Jay Geiger’s pharmacy and the steady flow of settlers into the region soon attracted another physician to Holden’s Crossing. Dr. Thomas Beckermann was a sallow middle-aged man with bad breath and red eyes. Lately of Albany, New York, he settled in a small frame house in the Village, hard by the apothecary shop. He wasn’t a medical-school graduate, and he was vague when discussing the details of his apprenticeship, which he said had been taken with a Dr. Cantwell in Concord, New Hampshire. At first Rob J. viewed his coming with appreciation. There were enough patients for two doctors who weren’t greedy, and the presence of another medical man should have meant a sharing of the long, difficult house calls that often took him far into the prairie. But Beckermann was a poor doctor and a steady, heavy drinker, and the community quickly observed both facts. So Rob J. continued to ride too far and treat too many.

  This became unmanageable only in the springtime, when the annual epidemics struck, with fevers along the rivers, the Illinois mange on the prairie farms, and communicable illnesses everywhere. Sarah had nurtured the picture of herself at her husband’s side, administering to the afflicted, and the spring after her younger son’s birth she waged a strong campaign to be allowed to ride out with Rob J. and help him. Her timing was bad. That year, the troubling diseases were milk fever and measles, and by the time she began to pester him, he already had very sick people, a few of them dying, and he couldn’t pay her sufficient attention. So Sarah watched Makwa-ikwa ride out with him all through another spring, and her inner torment returned.

  By midsummer the epidemics had quieted and Rob resumed the more routine pattern of his days. One evening, after he and Jay Geiger had restored themselves with Mozart’s Duet in G for violin and viola, Jay raised the sensitive question of Sarah’s unhappiness. By now they were comfortable best friends, yet Rob was taken aback that Geiger should presume to enter a world he had considered so inviolably private.

  “How do you come to know of Sarah’s feelings?”

  “She talks to Lillian. Lillian talks to me,” Jay said, and struggled with a moment of abashed silence. “I hope you understand. I speak out of … genuine affection … for you both.”

  “I do. And along with your affectionate concern, do you have … advice?”

  “For your wife’s sake, you have to get rid of the Indian woman.”

  “There’s nothing but friendship between us,” he said, failing to control his resentment.

  “It doesn’t matter. Her presence is the source of Sarah’s unhappiness.”

  “There’s no place for her to go! There’s no place for any of them to go. The whites say they’re savages and won’t let them live the way they used to. Comes Singing and Moon are the best damn farm workers you could hope for, but no one else around here is willing to hire a Sauk. Makwa and Moon and Comes Singing keep the rest of the pack going, with what little money they earn from me. She works hard and she’s loyal, and I can’t send her away to starvation or worse.”

  Jay sighed and nodded, and didn’t speak of it again.

  Delivery of a letter was a rarity. Almost an occasion. One came for Rob J., sent on by the postmaster at Rock Island, who had held it for five days until Harold Ames, the insurance agent, made a business trip to Holden’s Crossing.

  Rob opened the envelope eagerly. It was a long letter from Dr. Harry Loomis, his friend in Boston. When he finished reading, he went back and read it again, more slowly. And then again.

  It had been written on November 20, 1846, and had taken all winter to reach its destination. Harry obviously was on the road to a fine career, a Boston career. He reported that he’d recently been appointed an assistant professor of anatomy at Harvard, and he hinted at impending marriage to a lady named Julia Salmon. But the letter was more medical intelligence than personal report. A discovery now made pain-free surgery a reality, Harry wrote with discernible excitement. It was the gas known as ether, which had been used for years as a solvent in the manufacture of waxes and perfumes. Harry reminded Rob J. of past experiments held in Boston hospitals to assess the painkilling effectiveness of nitrous oxide, known as “laughing gas.” He added roguishly that Rob might remember recreations with nitrous oxide that were conducted outside of hospitals. Rob did remember, with combined guilt and pleasure, sharing with Meg Holland a flask of laughing gas Harry had given to him for a little party. Perhaps time and distance made the memory better and funnier than it had been.

  “On October 5 just past,” Loomis wrote, “another experiment, this time with ether, was scheduled to take place in the operating dome of the Massachusetts General Hospital. Past attempts to kill pain with nitrous oxide had been complete failures, with galleries of students and doctors jeering and calling out ‘Humbug! Humbug!’ The attempts had taken on a tone of hilarity, and the scheduled operation at the Massachusetts General promised to be more of the same. The surgeon was Dr. John Collins Warren. I’m certain you’ll remember that Dr. Warren is a crusty, hardened cutter, more known for his swiftness with the scalpel than for his patience with fools. So a number of us flocked to the surgical dome that day as if attending an entertainment.

  “Picture it, Rob: the man delivering the ether, a dentist named Morton, is late. Warren, vastly annoyed, uses the delay to lecture on how he will proceed to cut a large tumor from the cancerous tongue of a young man named Abbott, who already sits in the red operating chair, half-dead with terror. In fifteen minutes Warren runs out of words and grimly takes out his watch. The gallery already has started to titter, when here arrives the errant dentist. Dr. Morton administers the gas and presently announces the patient is ready. Dr. Warren nods, still in fury, rolls up his sleeves, and selects his scalpel. Aides pull open Abbott’s jaw and grasp his tongue. Other hands pin him to the operating chair so he won’t thrash. Warren bends over him and makes the first swift, deep slash, a lightning motion that brings blood trickling from a corner of young Abbott’s mouth.

  “He doesn’t
stir.

  “There is utter silence in the gallery. The slightest sigh or groan will be heard. Warren bends back to his task. He makes a second incision, and then a third. Carefully, quickly, he excises the tumor, scrapes it, applies stitches, presses a sponge to control bleeding.

  “The patient sleeps. The patient sleeps. Warren straightens up. If you can credit it, Rob, the eyes of that caustic autocrat are wet!

  “ ‘Gentlemen,’ he says, ‘this is no humbug.’ ”

  The discovery of ether as a surgical painkiller has been announced in the medical press of Boston, Harry reported. “Our Holmes, ever quick off the mark, already has suggested that it be called anaesthesia, from the Greek word for insensibility.”

  Geiger’s Pharmacy didn’t stock ether.

  “But I’m a fair chemist,” Jay said thoughtfully. “I can make it, probably. I’d have to distill grain alcohol with sulfuric acid. I couldn’t use my metal still, because the acid would burn right through it. But I own a glass coil and a big bottle.”

  When they searched his shelves, they found lots of alcohol but no sulfuric acid.

  “Can you make sulfuric acid?” Rob asked him.

  Geiger scratched his chin, clearly enjoying himself. “For that, I’ll need to mix sulfur with oxygen. I’ve plenty of sulfur, but the chemistry is a mite complicated. Oxidize sulfur once and you get sulfur dioxide. I’ll need to oxidize the sulfur dioxide again, to make sulfuric acid. But … sure, why not?”

  In a few days, Rob J. had a supply of ether. Harry Loomis had explained how to assemble an ether cone out of wire and rags. First Rob tried the gas on a cat who remained insensible for twenty-two minutes. Then he deprived a dog of consciousness for more than an hour, such a long time that it became obvious ether was dangerous and must be treated with respect. He administered the gas to a male lamb before castration, and the gonads came off without a bleat.

  Finally he instructed Geiger and Sarah in ether’s use, and they gave it to him. He was unconscious for only a few minutes, because nervousness made them miserly with the dose, but it was a singular experience.

  Several days later, Gus Schroeder, already down to eight and one-half fingers, got the index finger of his good hand, the right hand, caught under his stone boat and ground to a pulp. Rob gave him the ether, and Gus woke up with seven and one-half fingers and asked when the operating would begin.

  Rob was stunned by possibilities. He felt as though he had been given a glimpse of the limitless stretches beyond the stars, aware at once that ether was more powerful than the Gift. The Gift was shared by only a few members of his family, but every doctor in the world now would be able to operate without causing torturous pain. In the middle of the night Sarah came down to the kitchen and found her husband sitting alone.

  “Do you feel all right?”

  He was studying the colorless liquid in a glass bottle, as if memorizing it.

  “If I’d had this, Sarah, I wouldn’t have hurt you, those times I operated.”

  “You did very well without it. Saved my life, I know.”

  “This stuff.” He held up the bottle. To her it looked no different from water. “It will save lots of lives. It’s a sword against the Black Knight.”

  Sarah hated when he spoke of death as a person who might open the door and walk into their house at any moment. She hugged her heavy breasts with her white arms and shivered with the night chill. “Come to bed, Rob J.,” she said.

  Next day Rob began to contact doctors in the region, inviting them to a meeting. It was held a few weeks later in a room above the feed store in Rock Island. By that time Rob J. had used ether on three other occasions. Seven doctors and Jason Geiger assembled and listened to what Loomis had written, and Rob’s report of his own cases.

  Reactions ranged from great interest to open skepticism. Two of those present ordered ether and ether cones from Jay. “It’s a passing fad,” Thomas Beckermann said, “like all that nonsense about hand-washing.” Several of the doctors smiled, because everyone was aware of Rob Cole’s eccentric use of soap and water. “Maybe metropolitan hospitals can spend time on such things. But no bunch of doctors in Boston should try to tell us how to practice medicine on the western frontier.”

  The other doctors were more discreet than Beckermann. Tobias Barr said he liked the experience of meeting with other physicians to share ideas, and he suggested that they form the Rock Island County Medical Society, which they proceeded to do. Dr. Barr was elected president. Rob J. was elected corresponding secretary, an honor he couldn’t refuse, because everyone present was given an office or the chairmanship of a committee that Tobias Barr described as being of genuine importance.

  That was a bad year. On a hot, sticky afternoon toward the end of summer, when the crops were reaching ripeness, very quickly the sky became heavy and black. Thunder rumbled and lightning cleaved the roiling clouds. Weeding her garden, Sarah saw that far out on the prairie a slim funnel extended earthward from the cloud mass. It twisted like a giant snake and emitted a serpentine hissing that became a loud roar as its mouth reached the prairie and began to suck up dirt and debris.

  It was moving away from her, but still Sarah ran to find her children and bring them down into the cellar.

  Eight miles away, Rob J. had watched the tornado from afar too. It was gone in a few minutes, but when he rode up to Hans Buckman’s farm he saw that forty acres of prime corn had been leveled. “As if Satan wielded a great big scythe,” Buckman observed bitterly. Some farmers lost both corn and wheat. The Muellers’ old white mare was sucked up into the vortex and spat out lifeless in an adjoining pasture a hundred feet away. But no human lives had been lost, and everyone knew that Holden’s Crossing had been lucky.

  People were still congratulating themselves when epidemic broke out in the autumn. It was the season when the cool crispness of the air was supposed to guarantee vigor and good health. The first week of October eight families came down with a malady Rob J. couldn’t put a name to. It was a fever accompanied by some of the bilious symptoms of typhoid, yet he suspected it wasn’t typhoid. When he began to hear of at least one new case every day, he knew they were in for it.

  He had started toward the longhouse to tell Makwa-ikwa to prepare to ride out with him, but he changed directions and walked to the kitchen of his own house.

  “People are beginning to get a nasty fever, and it’ll spread, for certain. I may be out there for weeks.”

  Sarah was nodding gravely, to show she understood. When he asked if she wanted to come with him, her face came alive in a way that dispelled his doubts.

  “You’ll be away from the boys,” he cautioned.

  “Makwa will care for them while we’re gone. Makwa’s really good with them,” she said.

  They left that afternoon. This early in an epidemic, it was Rob’s way to ride to any house where he heard the disease was present, trying to put out the fire before it became a conflagration. He saw that each case started the same way, with sudden high temperature or with inflamed throat followed by the fever. Usually there was diarrhea early, with lots of yellow-green bile. In every patient the mouth became covered with small papillae, regardless of whether the tongue was dry or moist, blackish or whitish.

  Within a week Rob J. knew that if the patient had no additional symptoms, death was coming. If the early symptoms were followed by chills and pain in the extremities, often severe, the patient probably would recover. Boils and other abscesses, erupting at the end of the fever, were favorable signs. He had no idea how to treat the disease. Since the early diarrhea often broke the high fever, he sometimes tried to encourage its onset by administering physic. When the patients shook with chills, he gave them Makwa-ikwa’s green tonic doctored with a little alcohol, to induce sweating, and blistered them with mustard plasters. Soon after the epidemic began, he and Sarah met Tom Beckermann riding out to fever victims.

  “Typhoid, for sure,” Beckermann said. Rob didn’t think so. There were no red spots on the abdomen, and
no one was hemorrhaging from the anus. But he didn’t argue. Whatever was striking people down, calling it by one name or another wouldn’t make it any less scary. Beckermann told them two of his patients had died the previous day, following copious bleeding and cupping. Rob did his best to argue against bleeding a patient to fight fever, but Beckermann was the kind of physician unlikely to follow any treatment recommended by the only other doctor in town. They didn’t spend more than a few minutes with Dr. Beckermann before saying good-bye. Nothing bothered Rob J. more than a bad physician.