Comes a Time for Burning (4 page)

Chapter Five

Dr. Thomas Parks stood in the clinic’s dispensary, elbows leaning on the counter, head cradled in both hands. He stared at the printed pages in front of him, pages that he’d read a dozen times, searching. He could recite them by heart. The letters fused into fascinating patterns now, as elusive as a simple answer. The truth was simple—twenty-six year-old Sonny Malone lay comatose in the ward, unresponsive and dying. There was nothing to be done for him.

Thomas closed his eyes. Sonny Malone deserved to live, but he would not. It was really that simple. Fifty sticks of dynamite had detonated within a few feet of a human skull that protected a brain the consistency of gelatin. The shock had been as if Sonny Malone had been smashed with a giant sledge hammer. That ten sticks immediately over his head had
not
detonated might have saved his life for a few hours.

Careful examination had found no skull fracture, even with Sonny Malone’s black Irish locks shorn and his skull shaven as smooth as a billiard ball. Little scars from past adventures here and there, but nothing else. Yet the damage to the fragile brain inside had to be immense. An ampoule of ammonia held under his nostrils or the prick of a pin on the bottom of his foot produced not the slightest twitch. With no obvious depression of the skull, no lesion, no laceration, there was no single, isolated spot that Thomas could point to and say,
“Aha! Here
lies the source of hemorrhage.
This
is where to begin.
This
is where we should open the doorway into the skull.”

Thomas opened his eyes and regarded the textbook again, a current edition that professed the very latest in medical advances. But the author—and one of Thomas’ favorite professors at the University of Pennsylvania—had been skeptical of treatment.

“The measures appropriate for the first few hours’ treatment of contusion of the brain are diametrically opposed to the line of treatment required after reaction has been induced,”
Dr. John Roberts had written, then added—and Thomas could imagine that wry smile that he remembered so well from lectures—
“It is a nice question to know when the change should be made.”

A nice question indeed, since no discussion of initial treatment for blast injury had been mentioned. A contusion of the brain generally resulted from a blow, and a blow left marks that said, “
Open here.”
Thomas had no such sign.

After reaction has been induced
. But there had been no reaction induced. Sonny Malone lay comatose as his life’s blood leaked from a thousand tears in his concussed brain—a thousand lacerations, the text called them.

Thomas snapped the book closed and pushed back from the counter. He glanced at his watch and saw that lunch had passed him by an hour before. He walked through the main ward to the three small rooms that had been partitioned off in the back. Sonny Malone lay in the first, curtains drawn over the single window and the gas light turned down to a tiny, quiet flame.

For a long time, the physician stood at the foot of Malone’s bed. The “ice pillow” was in place, cushioning the patient’s skull from the nape of his neck to his eyebrows, the chill of the ice helping to constrict blood vessels, slowing the deadly seep of blood that would suffocate the brain.

A nice question
. At what point, then, should healing be encouraged by gentle heat or stimulation?

Should the patient be bled as a means of releasing pressure on the brain? The textbook had mentioned such a measure, but to be used with great caution. That meant that Dr. John Roberts, despite his years of experience, was just not sure
what
would work. Yet Thomas could not bring himself to believe that draining the body’s very life source would be anything but counterproductive.

Sonny Malone’s bashed hands lay bandaged and splinted. The three great knuckles for the first, second and third fingers of each hand had been smashed by the spruce, but that was of little concern now. Thomas had rearranged the bones into a reasonably straight line and splinted them, but at this point, he would have considered it a triumph if Sonny Malone had howled out in conscious agony.

“Will you talk with Mrs. Schmidt now?” Bertha Auerbach’s voice was a mere whisper, and he turned.

“Yes, I suppose so. When was the ice changed last?” He found it difficult to tear his mind from this case, to wash the slate clean, to direct his attentions elsewhere.

“Every twenty minutes, as you instructed. Twenty on, then rest for twenty.”

“You’ve seen no reaction?”

“None. But the body has great resources.”

Thomas sighed. “A daring rescue, and here he is, under our roof. And there’s nothing we can do to save him. Nothing.” Thomas ran a hand through his hair, pausing with his palm on the crown of his head. “What could we have done within the first few minutes? What if the rescue hadn’t taken so interminably
long
? Should I have climbed up to him myself and tried to administer some relief? Sometimes I think that I should have insisted on that.”

“What if,” Bertha said, and Thomas glanced at her. “You can torture yourself all you like, Doctor. That won’t change this young man’s condition one iota. And if
you
suffered an accident doing something so foolish as climbing, who would patch you back together this time?”

“Yes, I suppose. I just can’t help thinking…”

“Thinking is good. And of course there I go again, talking out of turn. You’ve spoken with Mr. Deaton?”

“I haven’t yet had a chance.”

Bertha managed to curb her impatience. “He’s in the stables now. Carlotta Schmidt is also waiting for you. I asked her to wait in your office where she might be more comfortable, since I didn’t know how long you would be.”

“Ah.” He brightened and held out a hand as if to escort his nurse. “If you please, then.”

Carlotta Schmidt stood in front of one of the bookcases in the comfortable, over-stuffed office, her head cocked to one side as she read the titles. Her long auburn hair, now lightly streaked with gray, was captured up in a fashionable sweep, a small but stylish hat pinned to the bun. At the sound of their footsteps, she turned and offered a radiant smile. No wonder she was legend among the rough men who worked for her husband, Thomas thought.

“Mrs. Schmidt, please.” He held a chair for her. It was a large, padded leather monstrosity, and Carlotta Schmidt appeared amused. She sat, perched well forward, one hand folded over the other.

“I’m loathe to take your time with such trivial matters.” Her voice was a soft alto and she held a white linen kerchief to her nose. Thomas caught the delicate aroma of perfume water.

“At this point in my day, I welcome something trivial,” Thomas said. It appeared that Bertha was about to leave the office, but Thomas beckoned her to stay. “You’ve met Nurse Auerbach, of course.”

“Of course. We’ve had a moment or two to chat.”

Thomas settled behind the desk. “Now, first let me apologize for not meeting with you earlier today.”

“That’s hardly necessary, Doctor.” Carlotta held the white linen to her mouth, suppressing a small, shallow cough. The faintest flush touched her flawless cheeks, and her hazel eyes were bright but reddened, the conjunctiva swollen. Only a trace of darkness marked the hollows under her eyes, as if she had not been enjoying as much rest as she should.

“So,” Thomas said. “Your complaint. From the beginning.”

“I would not have bothered you…”

“It is no bother.”

She smiled at the abruptness of his interruption. “A nuisance is all. I cough a little. And sometimes I think it bothers my husband more than it does me, especially when a fit strikes in the night.” She smiled again, as if embarrassed at how silly and perhaps even indelicate the next suggestion might sound. “He is concerned…that I might have tuberculosis.” At Thomas’ frown, she added, “His mother and sister died of that affliction, so he fears…”

“I can understand his concern, and yours.” That the disease sometimes favored families, even through generations, was well known. But Carlotta’s blood relatives were not her husband’s, and the woman who sat before him hardly was the definition of a tubercular patient. “In your family as well?”

“No one.”

“That’s good. Is the cough productive?” Her eyebrow lifted at that. “Does the cough itself relieve a congestion, a collection of mucous, or is it dry and
un
productive? We could call it a cough for no good reason.”

“I feel as if the contents of my head are trying to run down my throat,” she said, drawing two fingers down a velvety neck. “The cough offers some relief.”

“And this is a recent condition?”

“Several weeks. Perhaps as much as two months. Perhaps longer.”

“You’ve tried remedies?”

“This and that.” She dropped her eyes. “I traveled to Portland some weeks ago to visit a cousin. I felt so much better while there. Upon my return…”

“Matters became worse.”

“Exactly.”

“So.” Thomas leaned back. “Is there any pain? Especially around the ribs?”

“Only a little ache when the coughing is persistent.”

“Well, to be sure. The rib muscles are assaulted. The discharge from the nose is clear, or of a color?”

“From time to time, colored. It is the itching that is most troubling.”

“Your throat, you mean?”

She nodded. “The itching extends back into my ears.” She made a claw of one hand. “Most irritating.”

“And visiting Portland helped immediately. Is that what you feel?”

“Assuredly so.”

“Have you been able to identify any
particular
thing that is irritating to you? That makes the nasal discharge more significant?”

She hesitated. “I’m not altogether sure.”

Thomas looked thoughtfully at the journal in his lap. “I would like to listen to your lungs, to be sure. Shall we adjourn to the examination room?” He nodded at Bertha Auerbach, who turned to the door.

“Alvi…she is well?” Carlotta asked.

“She is wonderful, thank you.”

“I thought I would stop by and call on her, if you think that would be appropriate.”

“She would love to see you.” He pointed toward the back of the examination room, where Bertha waited with a soft wrap. “If you’d step behind the screen, Nurse Auerbach will assist you.”

In a moment, as Mrs. Schmidt returned and sat on the end of the examining table, Thomas noted how graceful and elegant she was, each movement so measured and careful. The nurse slipped a glass thermometer under Carlotta’s tongue, and stood nearby to manage the decorous draping of the wrap as Thomas worked the bell of the stethoscope through its course. He listened, he thumped, he searched, but heard only one thing—the sound of healthy lungs moving air about—no rasping, no rales, no sounds of lung damaged or infected.

The delicate tissues lining the patient’s throat were inflamed, her nasal passages swollen and painful, and the thermometer registered a scant 99.1 degrees.

After a time, Thomas relaxed back and regarded Carlotta Schmidt for a moment. “I think that we can reassure both you and your husband,” he said. “Now…” but he interrupted himself at a subtle gesture by Bertha. Thomas assumed that she was reminding him that other patients were gathering. He could hear quiet voices out in the waiting room, one of them sounding very like his wife. But other visitors were not on the nurse’s mind.

“Doctor, I’m sorry, but if I might be so bold?” Bertha didn’t wait for permission from Thomas, but added, “If you would raise your left arm?” When Carlotta did so, the nurse re-arranged the wrap ever so slightly, at the same time stroking two fingers together down the curve of the left breast. She looked up at Thomas, waiting.

From a pace away, he could see the small irregularity, the ever-so-slight dimpling.

“If you please,” he said gently, and Bertha stepped aside to give him room. He nodded at her thankfully, wanting her to be absolutely certain that he had forgiven her forward intrusion. Thomas had known professors who would have exploded in rage at such behavior by a nurse. To them, nurses should be cooperative, deferential pieces of furniture.

The tips of his fingers traced the soft, spongy outline of the tumor, an elastic mass the size of a walnut. He continued the examination with his eyes closed, trying to picture the perimeter of the mass, trying to assess the infiltration into surrounding tissues. He could feel nothing beyond the breast, nothing up in the arm pit. “Your age, Mrs. Schmidt?”

She didn’t hesitate a heartbeat. “I am forty-one in July.”

Thomas nodded. “Children?”

This time, Carlotta did hesitate, and for a moment Thomas thought that she might be considering the question a silly one. Thomas had met the Schmidts on more than one occasion, and had never heard rumors of a family. After a moment, she replied, “One who died in infancy. It was with my first husband. I was twenty.”

“I’m sorry to hear that,” Thomas said. “Mrs. Schmidt, you appear to have a small…perhaps we could call it a
knot
, here. You are aware of it?” A soft rap on the door interrupted them, and Bertha handed the corner of the wrap she was holding to Carlotta and then stepped quickly to block the door should the visitor enter. She held the knob and opened the door just enough to look through the slot. Thomas recognized his wife’s voice again.

“It will be but a moment,” Bertha said, and then added, “Oh? For heaven’s sakes. Well, a moment.”

“You are aware of it?” Thomas repeated, ignoring the interruption.

“Yes.”

“It pains you?”

“No.”

“When did you first notice its presence?”

“Some weeks ago.”

“Weeks.” He frowned at her in mock vexation. “Lie back, if you please.”

When Bertha had assisted her and tended to the drapes, Thomas again traced the lump’s outline and beyond, until he was satisfied with his exploration. “The right side, now,” he said quietly, and continued, once again closing his eyes and forcing himself to concentrate only on what his fingertips could trace.

When he opened his eyes, he discovered that Mrs. Schmidt was watching his face attentively.