Comes a Time for Burning (11 page)

Hardy turned away, and then stopped. His tone was sharply commanding. “And nurse—every time, and I mean
every
time you handle her linens when they become soiled,
every
time you handle the patient in any way, you must cleanse your hands and arms as thoroughly as if you were about to assist Dr. Parks or myself in surgery. Do you understand that?
Every
time. With no hesitation, no delay. That is an absolute instruction that
will
not be debated. You will make whatever arrangements are necessary for fresh, clean clothing as well.” He nodded at her soiled apron. “Get rid of that immediately.”

He spun around before she could reply, and made for the stairway, with Thomas on his heels. Behind the clinic, Howard Deaton was cleaning the inside of the ambulance, and Thomas stared at the soiled blankets. “My God,” he whispered. “All to be burned, Howard. Not laundered.”

“You can’t burn all of them,” Deaton said automatically.

“Oh, yes, we can. And liberal coal oil to make the fire instant and hot. In fact, before the night is finished, we’ll be burning a good deal. If one incinerator is inadequate, fashion another. Lindeman must have something you can use. Wake him, if necessary.” He held up his hand, lifting a finger. “First, tend to the blankets you have there. Second, wash your hands all the way to your elbows with strong soap and hot water, disinfect after that with corrosive sublimate. You’ll find the bottle of that in the dispensary, marked as a solution. Ask Mrs. Crowell to assist you. Keep it away from your eyes. A witch hazel or brandy splash afterward may make it more agreeable. And
then
… and
then
… go fetch Nurse Stephens. Understood?”

Deaton looked at Thomas askance. “What hit her?”

“We’re about to find out, Howard.” Thomas returned to the clinic, and in the laboratory, Hardy straightened up. Gas light flinted off the polished brass barrel of the Heinnenberg.

“See for yourself, Thomas.” Hardy offered his place at the microscope. “While you’re looking, I’ll see if Mrs. Crowell knows what she is about. The evacuations are so frequent that if she is capable with the tube and bulb, so much the better. I’ll be back in a moment to speak with you about a strategy.” He dropped his hand on Thomas’ shoulder and then was gone before Thomas could frame a single question.

After some finagling, Thomas forced the image into startling clarity under the Heinnenberg’s big lens. At his elbow, a volume of Fellow’s
The Theory and Practice of Medicine
had been opened and marked. Although the poor rendition in the textbook paled in comparison with the brilliant image in the Heinnenberg microscope, Thomas could see the deadly similarities.

“
From one half to two-thirds the size of the tubercule bacillus
,” he read quickly.
“Thicker and somewhat curved, resembling a crescent or comma in shape, sometimes occurring in a double S. Length of the bacillus rarely exceeds a micron, with most half that. Frequently aggregated in small groups, perhaps even a spiral
.” He went back to the microscope, shifting the slide this way and that to observe the entire specimen. “My God,” he whispered, and sat back.

When Thomas had been at University, it had been fashionable among the medical students to discuss various careers paths. One popular notion had been to serve the wealthy and healthy, earning a sumptuous living. A second, favored by the most altruistic, was to journey to the far reaches of the globe, waging war against the dangerous diseases that decimated entire populations, diseases that preyed most commonly on the poverty-stricken and down-trodden. In between the two extremes were the majority, doctors-to-be who wanted a quiet life in modest private practice, whether in the congested cities or in the country.

In his class, Thomas had been alone in his fascination with the trauma that both war and peace could inflict on the human body.

But in deference to the second group, those who wished to confront the major scourges of the world, professors were fond of pontificating on what young physicians should do when serving in India, Burma, or China, fighting an epidemic.

“Exactly,” Thomas said aloud. This very bacillus had been the subject of discussion on more than one occasion, and Thomas could now freely admit—when he most needed for circumstances to be otherwise—that he hadn’t listened to the professors as well as he might now wish. He took a deep breath, and readjusted the instrument and the objectives, seeking more power. When his eye started to water with the concentration, he sat back again, referring again to the text.

“The bacillus thrives in foul water, especially briny water, and Koch considers the Delta of the Ganges to be its natural home
,” the book’s passage reported.
The good Dr. Koch
, Thomas thought, a man who knew more about the ‘wee beasties’ than anyone else on the planet—and still didn’t know very much. “Such tiny things,” Thomas murmured. He looked up at heavy bootsteps. Hardy reappeared, this time rubbing his hands, the smell of strong chemicals permeating the tiny room. “You’ve started a culture?” Thomas asked.

“Two, actually,” Hardy replied. “Peptone and beef broth. And by the way, Mrs. Crowell is
most
adept around the patient, although she had never performed this particular procedure. She appeared to feel somewhat more relieved when I admitted that I had never done it myself…but that you had instructed me carefully.” He grinned. “A small untruth, but a useful one. We’re a pair, aren’t we. Of course, by the time this night is finished, we’ll be seasoned veterans.”

“And the patient took how much?”

“The better part of a liter the first time.” Hardy grimaced. “And then promptly evacuated again. We repeat and repeat, whatever is necessary.” He reached over Thomas’ shoulder and turned several pages in the text. “I have followed this compound,” he said. “I don’t know what else to do.” Thomas read the mercifully brief list of preparations—boiled water with an infusion of chamomile, a few grains of tannin, a generous allowance of laudanum, and fifty grains of powdered gum arabic. On the counter across the room, he saw the pitifully inadequate supply of gum arabic.

“Do we have enough of
anything
for this? I mean to accomplish a continuing treatment?”

“I don’t know.” Hardy nodded at the clutter of chemical bottles on the counter. “I hope you’ll excuse my rummaging about.”

Thomas shook his head impatiently. “The clinic is yours, Lucius. Do as you see fit, always.”

“Well,” Hardy continued, “We have a great sufficiency of laudanum and morphine, somewhat less so of cocaine, should pain become unbearable.” He reached out and tapped the book. “This?” Thomas scanned the indicated paragraph. “We have chloride of sodium and sodium carbonate. If she continues to evacuate in such volumes, then we should not hesitate. You’ve done hypodermoclysis?”

“Never. Not even the bulb…”

“Before this night, anyway,” Hardy said. “We must hydrate, or we lose her. I believe it’s that simple.” When Thomas didn’t reply, he reached out again to tap the book. “So. Am I correct about this?”

“I fear so. I would never have believed it, but the symptoms leave no question. I don’t see
how
you could be wrong.” He sat back. “And if it’s some lesser thing, we can only be successful by treating for the worst possibility.” He took a deep breath. “And this is certainly the worst, Lucius. We must act on the supposition.” He patted the barrel of the expensive microscope. “Were the proof not in front of my own eyes, I would think a silly mistake has been made. This is hardly cholera country.” He patted the open pages of the text. “We are far, far from the Ganges River.”

“
Any
country may be cholera country, if the conditions are right,” Hardy replied. “You might recall the scourge in England and Wales half a century ago that killed fifty thousand. And as recently as ’73, when cholera rampaged through portions of New York City.” He heaved a sigh. “But the
immediate
question is simple, so simple. How are we to save Miss Levine’s life?” He lowered his voice. “And how to prevent the progression of what is now an isolated case? How many live in this village?”

“I’ve been told nearly eleven hundred if one includes the various small establishments on the periphery, along with the logging camps.”

Hardy’s expression was grim. “Fifty thousand in Egypt eight years ago, Thomas. This disease can be traced into every dark corner of the globe.” The muscles of his cheek clenched, and for the first time, Thomas saw some of Lucius Hardy’s confidence drain away.

“Not much frightens me, Thomas.” He nodded at the microscope. “This does.”

“Indeed,” Thomas said quietly. “This text instructs us. The cholera is no shrinking violet, Lucius. It will not be content in taking but one life.
Someone
brought the condition to Port McKinney, and Miss Levine is the first case brought to our attention. We can guarantee that she will not be the last. But how did this specter come under the Clarissa’sroof? According to this,” and Thomas nodded at the text, “there has been no generalized epidemic of cholera since that reported in 1873 in New York. Only isolated cases since. We can hope that’s true.”

“We must discover the origin. But we’re fortunate in one aspect, if only one. The thinking now is that cholera is not spread by the innocent exhalation,” Hardy said. “The bacillus thrives in the gut, and is then expelled, as we are now seeing all too clearly. Those who are in touch with unclean waters, infected food, the feces, the vomitus…”

“Both Mr. Deaton and Nurse Crowell must be the focus of our attentions,” Thomas said, standing up abruptly. “They are in jeopardy from this.”

“Mrs. Snyder as well, Thomas. In the process of admitting Miss Levine to our care, the good woman felt compelled to assist. She apparently knows Miss Levine.”

“She works at the Clarissa, Lucius,” Thomas said with alarm. “So of course she does. She…her husband…the child.”

“And you and I,” Hardy added gently. They stood in the small laboratory in silence for a dozen heartbeats. “Port McKinney has a newspaper?”

“We do. If you stand on the front boardwalk by the telegraph office on Lincoln, you can see the sign a block south on the little side street. The
McKinney Sentinel
. Frederick Garrison manages its publication.”

“If this is truly cholera, we shall have to court his cooperation, then. You know him well?”

“Well enough to call him by name. Nothing more. But before that…”

“Two things,” Hardy said, as if reading his mind. “First, we must protect ourselves and our families, and our patients. The environs of the clinic must be spotless—aseptic. In that, we are ahead. But the staff, each and every one, must be educated this very night…this very moment. And then, we must know with a certainty what still hides in the Clarissa. The patient’s room must be purged, the contents burned. We must know with whom she has had contact. We must trace the origins of this so we clearly understand the scope and magnitude of this threat.” He looked up at Thomas. “You agree?”

“Of course.”

Hardy turned the book toward the light. “What’s the incubation period on this fearsome beast?” He read quickly, his face scrunching in a frown of impatience. “This is useful. I now read: ‘
The incubation between first infection and the development of symptoms is not known with any certainty, perhaps as brief as a day, or as long as a fortnight.’”
He looked up at Thomas. “Helpful, yes? As brief as a day, Thomas. As brief as a day. We must find out who she has been with, who has shared her bed.”

The room fell silent, the ticking of the wall clock loud and insistent.

“Perhaps this is not a good time to remind you that you have a discussion with Mr. and Mrs. Schmidt this morning at nine?” Hardy asked.

“She must go to Portland,” Thomas said without hesitation. He looked at the clock again just as the minute hand jerked to thirteen minutes after three. “To remain here would be irresponsible. She must leave. There is no question about that.”

Hardy nodded slowly. “And your own wife and child?”

Thomas felt as if someone had stuffed a cotton swab down his throat. “I’ll speak with Alvina,” he replied. “But the quarantine must be complete.”

Chapter Fourteen

“I erred on the side of caution.” Thomas caught Lucius Hardy during an increasingly rare quiet moment. “I should have sent the Snyder child home yesterday. She was running a mild fever, and I wanted to be certain that her recovery would be uneventful.”

“What’s done is done,” Hardy replied. “But the mother, now…”

“She complains of enormous headache, cramps in the gut, and voids like a geyser. I have Mrs. Crowell with her in the third bed in the ward. But she couldn’t contract the disease and then run its course in just hours, Thomas. She must have been exposed at the Clarissa.”

“Her husband?”

“He shows no signs yet. Nor the child. But now I fear sending them home, Lucius. There are four other Snyder children at home as well. I have the child isolated in her room, and Mr. Snyder spends time with both. He is with his wife now, and I have given him the most thorough instructions.” He held out his hands. “Husband and wife refuse to remain apart, but at least this way, we can keep track of them.”

“Better that they be here,” Hardy said. “It appears that your wife’s father was a believer in Salol. I have made a preparation with it. I’m not optimistic, but it’s something else to try.” He pulled his watch out and regarded it with some disbelief, as if the hands were moving backward. “A Miss Eleanor Stephens has arrived. We met on the stairway, and I introduced myself.” He looked at Thomas skeptically. “Were I to hazard a guess, this is the last place she wants to be, Thomas.”

“A tender violet,” Thomas allowed. “But she has been of some use in the past. She suffers a squeamish stomach.”

“And yet wants to be a nurse?”

“Well, with time, maybe. She is the one I told you about who spent a few months across the sound at St. Mary’s. I hired her in the first place as a favor to Gert James, who thinks highly of the girl’s step-father, Pastor Roland Patterson. The good pastor is frustrated by his step-daughter’s…what’s the word Gert used? Her
inclinations
.”

“Toward what?”

Thomas grinned at Lucius Hardy’s blunt question. “I did not press the point. I have found it a good policy to accept Gert’s word at face value and let it go at that.”

“The girl is attractive, I must say,” Lucius said.

“She is that. I’ll go speak with her. It will be dawn in a bit. Will you be able to break away to visit the Clarissa with me? We must know, Lucius. If others are ill there, they must be brought here without delay.”

“Give me an hour. Howard Deaton and I are organizing the laundry and incinerator.” He nodded toward the door ajar behind him. “And the dispensary. I want the potions near at hand, the compounds already prepared, the cultures from each patient carefully recorded.” Hardy rested his hands on his hips. “This is really quite remarkable, Thomas. I had never supposed that I would cross paths with the cholera in this lifetime. The journals will be interested.”

“An hour, then,” Thomas said, and took the stairs back to the women’s ward. Lucius Hardy was right. Eleanor Stephens was attractive—tall and willowy with a face so pale that she looked carved from alabaster. Mrs. Crowell, so completely opposite in stature, was lecturing the girl about something, and Eleanor Stephens stood with her right hand’s index knuckle caught in her teeth, as if trying to stifle a cry.

“Ah, thank you for coming in,” Thomas said as he approached.

“I was reminding Miss Stephens of the need for absolute asepsis,” Mrs. Crowell said.

“You understand the nurse, Miss Stephens? In all matters?”

“I do, sir.”

“Good. Let me tell you that
symptoms
are of singular importance to us at this point, Miss Stephens. We will be admitting more patients this day, and that is a certainty. We must know the symptoms of each with absolute accuracy. On the clock. If you don’t know already, Mrs. Crowell will show you how I want each documented. Is that clear?”

“Yes, sir.”

“And that,” Thomas said, lowering his voice a bit but making no other effort to be tactful, “is a habit you would do well to break.” He reached out and pointed at the girl’s hand, whose knuckle still hovered near her mouth. “I would remind you,
again
, for I’m sure Mrs. Crowell has already spoken of it. The cholera bacillus is more vicious than anything we have ever treated. And it passes from soiled bedding, from soiled patients, from soiled
anything
, into the unlucky gut of the next victim. If you introduce the bacillus into your mouth from your hands,
you
will be taking up one of our beds.” He smiled briefly. “I’d hate to see that. So would you, my dear.”

Her voice quavered. “Yes, sir.” She dropped her hand away from her face.

“What we ask of you is complete vigilance, every moment you are in the ward. Do not hesitate to consult with Mrs. Crowell when you have questions. She will be your guide in all things. Understood? During the day, Miss Auerbach or Mrs. Whitman.”

“Yes, sir.”

He turned to the older woman. “It seems to me that Mr. Malone’s pulse is somewhat easier. Is that my imagination?”

Adelaide Crowell’s eyebrows flickered upward a bit at the unexpected consultation from a physician.

“The last time I applied the ice, I thought that one of his eye lids flickered ever so slightly, Doctor.”

“He must think he’s fallen head first from the tree into a frozen pond,” Thomas said. “In all of our rushing about, we must not forget him.”

“We can hope that he
is
thinking,” Mrs. Crowell said, and Thomas laughed in agreement.

“We’ll see what the new day brings for him. It’s quite amazing, really.” He turned again to Eleanor Stephens. “You have any questions?”

“No, sir.”

“That in itself is remarkable,” Thomas replied, not unkindly. “I have dozens and dozens.” He looked toward the back of the ward where Marcus Snyder stood in the doorway of his daughter’s small room, leaning against the jamb so he could keep a vigil on both his daughter and his wife, the two separated by half the length of the ward.

Thomas lowered his voice. “Keep a close watch on him,” he whispered. “The more removed he remains…“

“I’m keeping my eye on him,” Mrs. Crowell replied. “And we are using a frightful amount of the carbolic, the alcohol, and the witch hazel.”

“We shall find more. There are several bottles of brandy down stairs in the dispensary and more in my office, should the need arise.” He smiled. “For the hands, that is.”

A piteous groan arose from Mrs. Snyder, and Nurse Crowell turned without another word and made for the woman’s bedside. “Do what you can to be useful,” Thomas said to Miss Stephens. “Miss Auerbach will be here no later than six. I would ask that you plan on each night until this crisis has passed. Perhaps some hours during the day as well.”

The girl nodded. Thomas watched her move away, stopping first at Lucy Levine’s bedside, and then, at a summons with the snap of fingers, to Mrs. Crowell’s assistance. Thomas checked his watch again, and then knelt beside Lucy Levine. Whether or not the girl was conscious was hard to tell. With his thumb, Thomas ever so gently lifted the corner of one eye lid, and saw with astonishment how dry, how tearless, the girl’s eyes were.

“Eye drops of the mildest saline,” he said loud enough for Mrs. Crowell to hear. “The same for all patients.” He rose and found a small bulbed pipette in the dispensary cart in the corner of the ward, and pulled ten milliliters of saline solution. Five drops in each eye prompted a feeble blink, and the fluid ran down Lucy’s sunken cheeks.

“Mrs. Crowell, Dr. Hardy has prepared some powder of Salol in the dispensary. I think it may be warranted with each session of the enteroclysis. Perhaps five grains each time.”

“I am not familiar with its use,” Mrs. Crowell said.

“Nor I,” Thomas replied. “But at this stage, we’ll try anything. Salol is but phenyl salicylate, and in the gut releases some percentage of phenol—we may gain something from its antiseptic properties.”

“I see.”

“Perhaps five grains each time. Anything we can do to make the gut inhospitable for the bacilli, we’ll do.” Back at the cart, he found a single length of sterile tubing, together with its bulb. “The clave must be kept busy.” He held up the tube. “We have but the one?”

“We’ll see to it, Doctor Parks.”

“Because I’m going to use this one,” Thomas added. “I see it’s been nearly thirty minutes since Lucy’s last evacuation.”

“She was sleeping…I did not wish to disturb her,” Mrs. Crowell said.

“Well, the bacilli are not sleeping,” he replied.

“Eleanor,” Mrs. Crowell instructed when she saw the girl hesitate. The elder nurse nodded toward Thomas, and Eleanor approached Lucy Levine’s bedside. Even as Thomas looked up at her, he saw her index knuckle start its ascent toward her mouth.

“Don’t,” he snapped. “Go cleanse your hands and then give me some assistance here. Do not use a towel. Let your hands dry in the air.” Even as he said that, he heard the loud grumblings from Lucy Levine’s gut, and the girl writhed into a tight ball. In a couple minutes, Miss Stephens returned, hands dripping. Thomas drew away the towels that had diapered the patient. “Two clean towels, quickly now.” He had exactly enough time to reposition the bedding and towels before Miss Levine’s gut released. Even as the patient whimpered, Miss Stephens backed away.

“More towels,” he instructed. “She is finished, I think. And each time, we must fight the sepsis, Miss Stephens. The tube and bulb must be clean, the patient must be clean. It would certainly be counterproductive for us to reintroduce the contagion into her gut. Now,” he added, satisfied that the patient was as ready as she could be. “The tube I’ve prepared. And we must be generous with the petroleum gel.” For the next few moments, he concentrated on the simple procedure, all the while watching Lucy’s face. The girl lay as if pole-axed. Whether the infusion of two liters of fluid, salts and the Salol into the colon did any good at all was impossible to tell.

At one point he glanced up, and saw that Eleanor Stephens had backed away from the bed again, her already pale face now pasty white.

“Are you all right?”

The girl nodded and looked away.

“Do you know Miss Levine?” The question brought a slight nod. “You are personally acquainted?”

“She lives at the Clarissa.”

Thomas pointed at the blanket. “The corner of that, please.” She pulled the covering within his reach, and he draped the patient for some small semblance of modesty. “Do you know with whom she rooms there?”

“A girl name Missy. I think her last name is Buchanan.”

“She knows of Lucy’s illness?”

“I would not think so, Doctor. She has traveled to Seattle with a boyfriend.”

“How long ago?”

“Some days.”

“Some?”

“It has been a week.”

“Had you spoken with Miss Levine recently?”

“Not long ago. Earlier in the week.”

Thomas turned and looked at her quizzically. “But days ago, only? Was she ill then?”

“No, sir. Not that I could tell.”

“Do you know her well enough to know with whom she associates?”

Eleanor Stephens hesitated. “I suppose…I suppose that I do.”

Thomas emptied the last of the bulb, and as delicately as he could, removed the black rubber tube, wrapping the whole thing in a clean towel. “This must be rinsed and then claved immediately,” he said. “Has Mrs. Crowell showed you how?”

“I can do that now,” the older nurse said as she came up to the bed.

“Mrs. Snyder?”

“Resting easy for a moment. Let me do this now while I have the chance, and while you are in the ward, Doctor.”

Thomas stood up. “Miss Stephens, I would like a list of all of Miss Levine’s associates…all that you can remember.”

“Ben…” the single word came from the patient’s lips as a mere exhalation of breath, and had Thomas not been standing immediately beside her, he would not have heard it.

He knelt down and placed his hand on Lucy’s chilled forehead. “Who is Ben, Lucy?”

“His sister…his sister has died.” Lucy Levine eyes drifted almost closed, and the next sound from her was a faint, muted cry of pain.

“The turpentine stupes might help now.” Twisting at the waist, Thomas looked back at Eleanor Stephens. “Do you know who she means?”

“The man she would marry,” Eleanor murmured.

“And that would be…” he prompted.

“Ben Sitzberger,” the girl whispered, as if somehow a young lady’s beau was the world’s biggest and darkest secret.

Thomas stared at her, dumbfounded. “She associates with the logger, you mean?” He could remember Ben Sitzberger’s pale face, hand pressed to his gut as he bent over his horse’s saddle horn early that morning, when he had accompanied Buddy Huckla to the clinic. Spoiled salmon, indeed—only if the young man was most fortunate, Thomas thought.

“Yes. He spends a great deal…a great deal of time with her.”

“How do you come to know this?”

Eleanor Stephens looked down at the floor, and her voice was a whisper. “Lucy invited me to share her room at the Clarissa. After her friend moved to Seattle.”

For a long moment, Thomas regarded the young nurse, unsure of what to say. “That would make a gay party,” he said finally, and immediately knew that the attempt at levity was exactly the
wrong
thing to say. “We must find him, this young Mr. Sitzberger. I saw him this morning, and he was not well. His companion, a young chap named Buddy Huckla…you know him?”

Eleanor nodded slightly, the knuckle starting to stray toward her mouth.

Thomas snapped his fingers and pointed, and the young girl jerked her hand away as if stung.

“Fetch the stupes now,” he ordered. “I want to talk with Mr. Snyder for a few moments, and then Dr. Hardy and I shall be visiting the Clarissa…as soon as Nurse Auerbach and Nurse Whitman have arrived for the day.”

Adjusting a warm blanket over Lucy, and then doing the same at Mrs. Snyder’s bed, he made his way to the back of the ward after another session at the nurse’s cart to sterilize his hands. Marcus Snyder had slumped in a straight-backed chair by the doorway, and his face was pale, creased with worry.

“She sleeps.” Milly’s father pushed himself upright, at the same time tipping the door more widely open so Thomas could slip past. The little girl lay in peaceful rest, her face relaxed. Thomas touched the back of his hand to her forehead and was relieved to find her cool. As he moved his fingers to the side of her neck, one small hand curled up and grasped his wrist. He smiled as he counted the strong beats, an even sixty-five in a minute.