The Cider House Rules (89 page)

Candy and Wally Worthington would throw themselves full tilt into apple farming. Wally would serve two terms as president of the Maine Horticultural Society; Candy would serve a term as director of the New York- New England Apple Institute. And Angel Wells, whom Rose Rose had introduced to love and to imagination, would one day be a noveliSt.

'The kid's got fiction in his blood,' Wally would tell Homer Wells.

To Candy, a novelist was also what Homer Wells had become—for a novelist, in Candy's opinion, was also a kind of impostor doctor, but a good doctor nonetheless.

Homer never minded giving up his name—it wasn't his actual name, to begin with—and it was as easy to be a Fuzzy as it was to be a Homer—as easy (or as hard) to be a Stone as it was to be anything else.{715}

When he was tired or plagued with insomnia (or both), he would miss Angel, or he would think of Candy. Sometimes he longed to carry Wally into the surf, or to fly with him. Some nights Homer imagined he would be caught, or he worried about what he would do when Nurse Angela and Nurse Edna were too old for the Lord's work, and for all the other work in St. Cloud's. And how would he ever replace Mrs. Grogan? Sometimes, when he was especially tired, he dreamed that abortions were legal—that they were safe and available, and therefore he could stop performing them (because someone else would do them)—but he was rarely that tired.

And, after a while, he would write to Candy and say that he had become a socialist; or, at least, that he'd become sympathetic to socialist views. Candy understood by this confession that Homer was sleeping with Nurse Caroline, which she also understood would be good for them—that is, this new development was good for Homer and for Nurse Caroline, and it was good for Candy, too.

Homer Wells saw no end to the insights he perceived nightly, in his continuous reading from
Jane Eyre,
and from
David Copperfield
and
Great Expectations.
He would smile to remember how he had once thought Dickens was 'better than' Bronte. When they both gave such huge entertainment and instruction, what did it matter? he thought—and from where comes this childish business of 'better'? If not entertainment, he took continued instruction from
Gray's Anatomy.

For a while, he lacked one thing—and he was about to order it when one came unordered to him. 'As if from God,' Mrs. Grogan would say.

The stationmaster sent him the message: there was a body at the railroad station, addressed to Dr. Stone. It was from the hospital in Bath—which had been Dr. Larch's long-standing source for bodies, in the days when he'd ordered them. It was some mistake, Homer Wells was sure, but he went to the railroad to view the body {716} anyway—and to spare the stationmaster any unnecessary agitation.

Homer stood staring at the cadaver (which had been correctly prepared) for such a long time that the stationmaster grew even more anxious. 'I'd just as soon you either take it up the hill, or send it back,' the stationmaster said, but Homer Wells waved the fool off; he wanted peace to look at Melony.

She had requested this use of her body, Lorna had told the pathologist at the Bath hospital. Melony had seen a photograph in the Bath paper, together with an article revealing Dr. Stone's appointment in St. Cloud's. In the event of her death (which was caused by an electrical accident), Melony had instructed Lorna to send her body to Dr. Stone in St. Cloud's. 'I might be of some use to him, finally,' she had told her friend. Of course Homer remembered how Melony had been jealous of Clara.

He would write to Lorna; they would correspond for a while. Lorna would inform him that Melony was 'a relatively happy woman at the time of her accident'; in Lorna's opinion, something to do with how relaxed Melony had become was responsible for her electrocuting herself. 'She was a daydreamer,' Lorna would write. Homer knew that all orphans were daydreamers. 'You was her hero, finally,' Lorna would tell him.

When he viewed her body, he knew he could never use it for a refresher course; he would send to Bath for another cadaver. Melony had been used enough.

'Should I send it back, Doctor?' the stationmaster whispered.

'No, she belongs here,' Homer Wells told him, and so he had Melony brought uphill. It would be essential to keep the sight of her in her present form a secret from Mrs. Grogan. What Homer told them all was that Melony had requested she be buried in St. Cloud's, and so she was—on the hill, under the apple trees, where it was torturously hard to dig a correct hole (the root systems of the trees were everywhere). Finally, a large and {717} deep enough hole was managed, although it was backbreaking labor, and Nurse Caroline said, 'I don't know who she is, but she sure is
difficult.'

'She was always that,' said Homer Wells.

('Here in St. Cloud's,' Wilbur Larch had written, 'we learn to love the difficult.')

Mrs. Grogan said her Cardinal Newman over Melony's grave, and Homer said his own prayer (to himself) about her. He had always expected much from Melony. but she had provided him with more than he'd ever expected— she had truly educated him, she had shown him the light. She was more Sunshine than he ever was, he thought. ('Let us be happy for Melony,' he said to himself. 'Melony has found a family.')

But chiefly, for his education, he would peruse (and linger over every word of)
A Brief History of St. Cloud's.
In this pursuit, he would have Nurse Angela's and Nurse Edna's and Mrs. Grogan's and Nurse Caroline's tireless company, for by this pursuit they would keep Wilbur Larch alive.

Not that everything was clear to Homer: the later entries in
A Brief History of St. Cloud's
were marred by shorthand inspirations and the whimsy conveyed to Larch through ether. For example, what did Larch mean by 'rhymes with screams!'? And it seemed uncharacteristically harsh of Larch to have written: '
I
put the pony's penis in her mouth!
I
contributed to that!' How could he have thought that? Homer wondered, because Homer never knew how well Dr. Larch had known Mrs. Eames's daughter.

And as he grew older, Homer Wells (alias Fuzzy Stone) would take special comfort in an unexplained revelation he found in the writings of Wilbur Larch.

'Tell Dr. Stone,' Dr. Larch wrote—and this was his very last entry; these were Wilbur's last words: 'There is absolutely nothing wrong with Homer's heart.' Except for the ether, Homer Wells knew there had been very little that was wrong with the heart of Wilbur Larch.{718}

To Nurse Edna, who was in love, and to Nurse Angela, who wasn't (but who had in her wisdom named both Homer Wells and Fuzzy Stone), there was no fault to be found in the hearts of either Dr. Stone or Dr. Larch, who were—if there ever were—Princes of Maine, Kings of New England.

THE END

Author's Notes

(pp 56-7) Anthony Trollope, who visited Portland, Maine, in 1861, and wrote about it in his
North America,
was mistaken—in the manner of Wilbur Larch's father —about the intended future of the
Great Eastern.

(pp 61-2) I am indebted to my grandfather Dr. Frederick C. Irving for this information regarding Dr. Ernst, the curve-ball pitcher—and for the particularly medical language in this chapter. My grandfather's books include The Expectant Mother's Handbook, A Textbook of Obstetrics, and Safe Deliverance. Dr. Ernst's studies of bacterial infections drew the attention of a Dr. Richardson of the Boston Lying-in Hospital, the maternity hospital where Wilbur Larch served an internship and later joined the staff. Dr. Richardson's article The Use of Antiseptics in Obstetric Practice' would surely have caught the attention of that eager student of bacteriology, clap-sufferer Wilbur Larch.

The interest in antiseptics among obstetricians was due to their effect in preventing the most deadly puerperal infection of that day, childbed fever. In 188-, in some maternity hospitals, the death rate among the mothers was about one in eight. In 189-, when Wilbur Larch was still at the Boston Lying-in, a mother's odds were better; the doctors and their patients were washed with a solution of bichloride of mercury. Before Larch would leave the Boston Lying-in, he would see the antiseptic technique advance to the aseptic—the latter meaning 'free from bacteria' which meant that everything was {721} sterilized (the sheets, the towels, the gowns, the gauze sponges); the instruments were boiled.

(pp 62-3) On the use of ether: most historians of anesthesia agree with Dr. Sherwin B. Nuland that surgical anesthesia began at Massachusetts General Hospital on October 16, 1846, when William Morton demonstrated the effectiveness of ether. Dr. Nuland writes: 'Everything that led up to it was prologue, everything that was tangential to it was byplay, and everything that followed it was amplification.'

According to Dr. Nuland, ether in proper hands remains one of the safest inhalation agents known. At a concentration of only 1 to 2 percent it is a light, tasty vapor; in light concentration, even thirty years ago, hundreds of cases of cardiac surgery were clone with light ether and partially awake (even talking) patients.

Some of Dr. Larch's colleagues, at the time, would have preferred nitrous oxide or chloroform, but Larch developed his preference for ether through self-administer. Someone would be crazy to self-administration chloroform. It is twenty-five times more toxic to heart muscle than is ether and has an extremely narrow margin of safety; a minimal overdose can result in cardiac irregularity and death.

Nitrous oxide requires a very high (at least 80 percent) concentration to do the job and is always accompanied by a degree of what is called hypoxia—insufficient oxygen. It requires careful monitoring and cumbersome apparatus, and the patient runs the risk of bizarre fantasies or giggling fits. Induction is very faSt.

Ether is a perfect drug addiction for a conservative.

(p 64) The source of this story is, again, my grandfather, who graduated from Harvard Medical SJchool in 1910. He became chief of staff of the Boston Lying-in Hospital and was William Lambert Richardson Professor of Obstetrics at Harvard for a number of years. I remember him as a good storyteller and an occasional bully—of the other members of his family. As a young {722} doctor, he had many experiences delivering babies to Boston's poorer immigrant families, and to read him is to understand that he had as many opinions and prejudices as he had experiences and talents.

(pp 65-6) Ether was first synthesized in 1540 by a twenty-five-year-old Prussian botanist. People have been having ether frolics—and later laughing-gas parties—ever since. In 1819, John Dalton published his study of the compound's physical and chemical properties. Coleridge was a laughing-gas man—a party sniffer, and a frequenter of the experiments with nitrous oxide conducted by Humphrey Davy. The poet was certainly familiar with ether; it was a pity—for him—that he apparently preferred opium.

(pp 66-7) A Caesarean section is, today, a relatively calm operation: the abdominal incision is small because the uterus is opened inside the abdominal cavity. But in Dr. Larch's days at the Boston Lying-in, in 188- and 189-, the incision made in the abdominal wall was nearly a foot long; the uterus was lifted through the incision and placed upon the patient's abdomen. 'The slashing of this great, plum-colored organ produced a dramatic gush of liquid and blood,' my grandfather wrote. The uterus was then sutured with silk and returned to the abdominal cavity; the abdomen was closed in the same way. Considerably more discomfort followed such an operation than follows a Caesarean section now. The operation, in Larch's time—and without complications —would require nearly an hour.

(p 70) This death by scurvy is based on an actual case: 'The Strange Case of Ellen Bean,' as told by my grandfather. 'A spinster of thirty-five years and of New England stock,' Grandfather wrote of Ms. Bean, whose condition (and cause of death) was the same fate I awarded to the unfortunate Mrs. Earnes. As my grandfather wrote: The pregnant state does not engender in all women the rapturous joy traditionally associated with this condition; indeed, there are some who view their 723 future with a sour visage and
a
jaundiced eye. This much may be assumed from the case of Ellen Bean.'

(p 70) In Wilbur Larch's own state, in dear old Maine, performing an abortion was punishable by a year in jail or a one-thousand-dollar fine, or both—and, if you were a doctor, you might lose your license to practice. The Eastman-Everett Act of 1840 described the attempted abortion of any woman with child as an offense, 'whether such child be quick or not'—and regardless of the method.

(p 72) Instead of red merthiolate Dr. Larch might have used Dakin's solution, although it's likely he would have learned more about its uses during his short visit to France in World War I. That is where my grandfather learned of the many uses of Dakin's solution and where he learned how to
débride
—that is, to cut away all the devitalized tissue surrounding a wound; the French were good teachers of this, he said.

(pp 75-83) In order for Dr. Larch to find the music in the 189-, abortion palace 'remindful of Mahler's
Kindertotenlieder,'
he would have to be gifted with a little precognition; Mahler's song cycle was written in 1902. That is implied in the line, 'Of course they could not have been singing Mahler's Songs
on the Death of Children,
but those were the songs Wilbur Larch had heard.'

(p 83) This is my grandfather's description of the condition of an actual patient, an extreme!)' small woman named Edith Fletcher—upon whom a Caesarean section was performed (Boston Lying-in Hospital; July 13, 1894). A pelvis this small is rare.

(pp 84-5) Mrs. W. H. Maxwell's
A Female Physician to the Ladies of the United States: Being a Familiar and Practical Treatise of Matters of Utmost Importance Peculiar to Women
('Adapted to Every Woman's Own Private Use') was published in New York in 1860. Mrs. Maxwell treated 'all diseases peculiar to women, or which they may have unfortunately incurred through the dissipations or wanton unfaithfulness of husbands, or otherwise.' {724}(In short, she treated venereal diseases.) Mrs. Maxwell also wrote that she gave her attention, as well, 'to women… who are forced by the malfunction of their genital organs, or other cause, to resort to premature delivery.' (In short, she performed abortions.)

(p 128) The New England Home for Little Wanderers was originally The Baldwin Place Home for Little Wanderers; the charter was granted by the Commonwealth of Massachusetts in 1865. The name was changed to The New England Home for Little Wanderers, its present name, in 1889—more than a decade before Wilbur Larch founded the orphanage in St. Cloud's.

(p 141) In a 1928 gynecology textbook (Howard Kelly—the standard at that time), the term D and C is used. I think it's safe to assume that the term was in common use in 192-.

(p 141) My grandfather said that he needed to use his
Gray's Anatomy
in France in World War I as a 'navigational chart.'

(pp 151) This is the exact description of a D and C as viewed by Dr. Richard Selzer (Yale School of Medicine), a general surgeon and author
(Mortal Lessons: Notes on the Art of Surgery
and
Rituals of Surgery
are among his books). I'm grateful for his reading of the manuscript of this novel and his generous advice—especially his introducing me to Dr. Nuland, who was the overseer of all the medical aspects of this novel.

(p 167) The source of my information concerning the physical and mental manifestations of Alzheimer's disease is
The Journal of the History of Medicine and Allied Sciences,
Volume XXXIV, Number 3, July 1979: the article by Dr. Sherwin B. Nuland, 'The Enigma of Semmelweis—An Interpretation.' Dr. Nuland first presented his material in a lecture at the Yale School of Medicine (the annual History of Surgery Series). His thesis is that Ignac Semmelweis, the tortured discoverer of the sources of puerperal fever, suffered from Alzheimer's disease and not from neurosyphilis; furthermore, Dr. Nuland {725} believes that Semmelweis died of injuries received in a mental institution—i.e., he was beaten to death by his keepers. The records of Bedlam and of other institutions for the insane show that this was common as late as the early part of this century, and occasional reports still appear.

(pp 166-7) The source of the description of Homer Wells's first eclampsia patient is my grandfather's book
Safe Deliverance
—the chapter on puerperal convulsions. Grandfather examines the case of a Lucy Nickerson, who died in 1880 of an eclamptic condition that .was further aggravated by a forced delivery—the only method known to physicians of the unfortunate Mrs. Nickerson's day.

(pp 168) The source of this treatment is again my grandfather, Dr. Frederick C. Irving (he was called Fritz). Grandfather describes this as the correct and lifesaving treatment given to one Mrs. Mary O'Toole in 1937.

(p 174) As of 1942, these are my grandfather's findings. Syphilis—although a great source of agitation to the public-health officials of the day—afflicted only 2 percent of the pregnant women of Boston. The incidence of eclamptic convulsions was much higher. The disease developed in 8 percent of the country's childbearing women.

(p 197) Spring would be considered too early to bother waxing the press boards; the first press wouldn't be until September, when you'd be pressing the early Mclntoshes and the Gravensteins. The press boards, or racks, are wooden slats, over which the cider cloths (or press cloths) are folded. The press boards—they are stacked seven-high —take quite a beating, and the wax protects them. The mash, which is also called the pomace, is squeezed between these boards under a pressure of two thousand pounds. It takes eight hours to squeeze a thousand gallons of cider out of the press—about three gallons per bushel of apples.