The Cider House Rules (7 page)

He would milk a drop of pus from his penis onto an {61} ordinary stained slide. Magnified more than a thousand times, the villains he spotted every morning under the microscope were still smaller thsm common red ants.

Years later Larch would write that the gonococci looked stooped, like too-tall visitors in ain igloo. ('They bend,' he wrote, 'as if they have waists and are bowing to each other.')

Young Larch would stare at his pus until
Dr.
Ernst would arrive and greet his little living experiments all over the lab (as if they were his old baseball teammates).

'Honestly, Larch,' the famous bacteriologist said one morning, 'the way you look into that microscope, you appear to be plotting revenge.'

But it was not the smirk of vengeance that Dr. Ernst recognized on Wilbur Larch's face. It was simply the intensity with which Larch was emerging; from his etherdaze. The young medical student had discovered that the light, tasty vapor was a safe, effective killer of his pain. In his days spent fighting the dancing gonococci, Larch had become quite a knowledgeable imbiber of ether. By the time the fierce bacteria had burned themselves out, Larch was an ether addict. He was an open-dropmethod man. With one hand he held a cone over his mouth and nose; he made this mask himself (by wrapping many layers of gauze around a cone of stiff paper); with his other hand, he wet the cone. He used a quarterpound ether can punctured with a safety pin; the drops that fell from the elbow of the safety pin fell in exactly the correct size and at exactly the correct rate:.

It was the way he would give ether to his patients, too, except that he gave himself much less; when the hand that held the ether can felt unsteady, he put the can down; when the hand that held the cone over his mouth and nose dropped to his side, the cone fell off his face—it wouldn't stay in place if no one held it, He felt nothing of the panic that a patient being anesthetized with ether experiences—he never approached the moment when there wasn't enough air to breathe. Before {62} that happened, he always dropped the mask.

When young Dr. Larch first set out from the South Branch of the Boston Lying-in to deliver babies in the poor districts of the city, he had a place in his mind where the peace of ether resided. Although he carried the ether can and the gauze cone with him, he didn't always have time to anesthetize the patient. The woman's labor was often too far advanced for the ether to help her. Of course he used it when he had the time; he would never share the opinion of some of his elder colleagues that ether was a deviation from the given—that children
should
be brought forth in pain.

Larch delivered his first child to a Lithuanian family in a coldwater, top-floor apartment—the surrounding streets littered with squashed fruit and tattered vegetables and horse droppings. There was no ice to put on the abdomen, over the uterus, in case of postpartum hemorrhage. There was a pot of water already boiling on the stove, but Larch wished he could sterilize the entire apartment. He sent the husband out for ice. He measured the woman's pelvis. He mapped out the fetus. He listened to its heartbeat while he watched a cat toying with a dead mouse on the kitchen floor.

There was a would-be grandmother present; she spoke Lithuanian to the woman in labor. To Dr. Larch shespoke a strange language of gestures, which suggested to him that the would-be grandmother was feebleminded. She indicated that a large mole on her face was either a source of hysterical pleasure or hysterical pain—Larch couldn't tell which; perhaps she simply wanted him to remove it, either before or after he delivered the baby. She found several ways to exhibit the mole—once by holding a spoon under it, as if it were about to fall; once capping it with a teacup and revealing it suddenly, as if it were a surprise or a kind of magician's trick. But the zeal she brought to each revelation of the mole suggested to Wilbur Larch that the old woman simply forgot that she had already shown him her mole. {63}

When the husband returned with the ice, he trod on the cat, which voiced its disapproval in tones that made Wilbur Larch think the child was being born. Larch was grateful not to have to use the forceps; it was a short, safe, loud delivery, following which the husband refused to wash the baby. The grandmother offered, but Larch feared that her combination of excitement and feeblemindedness would cause an accident. Indicating (as well as he could, without the benefit of Lithuanian) that the child should be washed in warm water and soap—but
not
boiled in the pot on the stove, and
not
held head down under the coldwater tap—Larch turned his attention to the afterbirth, which refused to come away. The way the patient kept bleeding, Larch knew he would soon be faced with serious hemorrhage.

He begged the husband to hack him some ice—the strong fellow had brought a whole block, borrowing the ice company's tongs for this purpose and standing in the kitchen with the tongs on his shoulder in a menacing fashion. The block of ice could cool the uteri of several bleeding patients; to apply it whole, to a single patient, would likely crush the uterus, if not the patient. At this moment the grandmother lost her grip on the soapy child and dropped it among the dishes soaking in the coldwater sink; this happened the instant that the husband again trod upon the cat.

Seizing the moment, when he saw that the grandmother and the husband were distracted, Larch grasped the top of his patient's uterus through her abdominal wall and squeezed hard. The woman screamed and grabbed his hands; the grandmother, abandoning the baby among the dishes, tackled Larch at the waist and bit him between the shoulder blades. The husband retrieved the child from the sink with one hand, but he raised the ice tongs over Larch with the other. Whereupon, lucky Wilbur Larch felt the placenta separate. When he calmly pointed to its appearance, the grandmother and the husband seemed more in awe of it 64 than of the child. After washing the baby himself and giving the mother some ergot, he bowed a wordless goodbye. Leaving the apartment, he was surprised to hear a commotion almost the instant he closed the door: the grandmother, the iced patient, the husband—all shouting in Lithuanian—and the baby giving forceful voice to its first family quarrel. It was as if the delivery, and Dr. Larch's entire appearance, had been only a brief interruption to a life of unintelligible turmoil.

Larch navigated the dark stairs and groped his way outside; he stepped on a rotting head of lettuce, which gave under his foot with the disquieting softness of a newborn baby's skull. This time he did not confuse the cat's terrible yowl with the sounds a child can make. He looked up in time to see the object flying through the window of the Lithuanian apartment. He was in time to dodge it. It had clearly been hurled at him, and Larch wondered what particular, perhaps Lithuanian, offense he had caused these poor people. Larch was shocked to see that the object thrown from the window—and now dead on the ground at his feet—was the cat. But he was not
that
shocked; for a passing second, he feared it might have been the child. He had been told by his professor of obstetrics at Harvard that 'the tensile strength of the newborn' was 'a marvel,' but Larch knew that the tensile strength of a cat was also considerable and he noted that the beast had failed to survive its fall.

'Here in St. Cloud's,' Dr. Larch would write, 'I am constantly grateful for the South End of Boston.' He meant he was grateful for its children and for the feeling they gave him: that the act of bringing them into this world was perhaps the safest phase of their journey. Larch also appreciated the blunt reminder given him by the prostitutes in the South End. They recalled for him the painful gift of Mrs. Eames. He could not see the prostitutes without imagining their bacteria under the microscope. And he could not imagine those bacteria without feeling the need for the giddy warmth of 65 ether—just a sniff; just a light dose (and a light doze). He was not a drinking man, Dr. Larch, and he had no taste for tobacco. But now and then he provided his sagging spirits with an ether frolic.

One night, when Wilbur was dozing in the South End Branch of the Boston Lying-in, he was informed by one of the doctors that there was an emergency arrival, and that it was his turn. Although she had lost a lot of weight and all of her youthfulness since Larch had last seen her, he had no trouble recognizing Mrs. Eames. She was so frightened, and in such intense pain, that she had difficulty catching her breath, and more trouble telling the nurse-receptionist her name.

'Rhymes with screams,' said Dr. Larch helpfully.

If Mrs. Eames recognized him right away, she didn't let on. She was cold to the touch, her pulse was very fast, and her abdomen was as hard and white as the knuckles of a tight fist; Larch could detect no signs of labor, and he couldn't hear the heartbeats of the fetus, which Larch couldn't help imagining as having features similar to Mrs. Eames's sullen teen-age daughter. How old would she be now? he wondered. Still about his own age —that much he had time to remember before attending to his diagnosis of Mrs. Eames: hemorrhage within the abdomen. He operated as soon as the house officer could locate the necessary donors for the transfusion.

'Missus Eames?' he asked her softly, still seeking some recognition from her.

'How's your father, Wilbur?' she asked him, just before he operated.

Her abdomen was full of blood; he sponged away, looking for the source, and
saw
that the hemorrhage issued from a six-inch rupture in the back of the uterus. Larch performed a Caesarean section and delivered a stillborn child—the pinched, scornful face of which forcibly reminded him of the cigar-smoking daughter. He wondered why Mrs. Eames had come here alone. {66}

To this point in the operation, young Larch felt in charge. Despite his memories of the woman opened up before him—and his memories of her transmitted disease, which he was only recently rid of—he felt he was handling a fairly manageable emergency. But when he tried to sew up Mrs. Eames's uterus, his stitches simply pulled through the tissue, which he noticed was the texture of a soft cheese—imagine trying to put stitches in Muenster! He had no choice then; he had to remove the uterus. After all the transfusions, Larch was surprised that Mrs. Eames's condition seemed pretty good.

He conferred with a senior surgeon in the morning. At the Boston Lying-in it was standard that an obstetrician's background was surgical—Larch had interned in surgery at Mass General—and the senior surgeon shared young Larch's bafflement with the disintegrating consistency of Mrs. Eames's uterus. Even the rupture was a puzzle. There was no scar of a previous Caesarean section that could have given way; the placenta could not have weakened the wall of the uterus because the afterbirth had been on the other side of the uterus from the tear. There had been no tumor.

For forty-eight hours Mrs. Eames did very well. She consoled young Wilbur on the death of his parents. 'I never knew your mother, of course,' she confided. She again expressed her concern that Wilbur consider her reputation, which Wilbur assured her he would (and
had
—by refraining from expressing his fears to the senior surgeon that the condition of Mrs. Eames might somehow be the result of gonorrhea). He briefly wondered which story Mrs Eames was using at the moment, regarding her reputation: whether she was claiming to live a proper life in Portland or in Boston; whether a third city was now involved and necessarily a third fictitious life.

On the third day after the removal of her strange uterus, Mrs. Eames filled up with blood again, and Wilbur Larch reopened her wound; this time he was {67} quite afraid of what he'd find. At: first, he was relieved; there was not as much blood in her abdomen as before. But when he sponged the blood away, he perforated the intestine, which he had hardly touched, and when he lifted up the injured loop to close the hole, his fingers passed as easily through the intestine as through gelatin. If all her organs were this same fragile jelly, Larch knew Mrs. Eames wouldn't live very long.

She lived three more days. The night she died. Larch had a nightmare—his penis fell oft sf in his hands; he tried to sew it back on but it kept disintegrating; then his fingers gave way in a similar fashion. How like a surgeon! he thought. Fingers are valued above penises. How like Wilbur Larch!

This helped to strengthen Larch's conviction regarding sexual abstinence. He waited for whatever had destroyed Mrs. Eames to claim him, but the autopsy, which was performed by a distinguished pathologist, seemed off the track.

'Scurvy,' the pathologist said.

So much for pathologists, thought Wilbur Larch. Scurvy indeed!

'Missus Eames was a prostitute,' Larch told the pathologist respectfully. 'She wasn't a sailor.'

But the pathologist was sure about it. It had nothing to do with the gonorrhea, nothing to do with the pregnancy. Mrs. Eames had died of the sailor's curse; she had not a trace of Vitamin C, and, the pathologist said, 'She had destruction of connective tissue and the tendency to bleed that goes with it.' Scurvy.

Though this was a puzzle, it convinced Larch that it wasn't a venereal puzzle and he had one good night's sleep before Mrs. Eames's daughter came to see him.

'It's not my turn, is it?' he sleepily asked the colleague who roused him.

'She says you're her doctor,' the colleague told him.

He did not recognize Mrs. Eames's daughter, who had {68} once cost less than Mrs. Eames; now, she would have charged more than her mother could get. If, on the train, she had seemed only a few years younger than Wilbur, now she seemed several years older. Her sullen teen-age quality had matured in a brash and caustic fashion. Her makeup, her jewelry, and her perfume were excessive; her dress was slatternly. Her hair—in a sinrle, thick braid with a sea-gull feather stuck in it—was so severely pulled back from her face that the veins in her temples seemed strained, and her neck muscles were tensed—as if a violent lover had thrown her to her back and held her there by her strong, dark pigtail.