The Cole Trilogy: The Physician, Shaman, and Matters of Choice (149 page)

“But I’ll never be able to hear rales in the chest.”

“No, you will not.”

“For me, rales will not be warnings of trouble. When I see the early stages of croupy breathing, I will know that if I could hear them, the rales in his chest doubtless would be crackling. If my patient becomes markedly croupy, I will know that there are bubbling rales in the chest. If there is asthma or an infection of the bronchia, I’ll know there are sibilant rales. But I won’t be able to confirm that knowledge.” He paused and looked directly at Dr. Meigs. “I can’t do anything about my deafness. Nature has robbed me of a valuable diagnostic tool, but I have other tools. And in an emergency, I would care for my patient, using my eyes and my nose and my mouth and my fingers and my brain.”

It wasn’t the deferent answer Dr. Meigs would have appreciated from a first-year student, and his face showed annoyance. Dr. McGowan came to him and leaned over his chair, speaking into his ear.

Soon Dr. Meigs looked back at Shaman. “It is suggested that we take you at your word, and give you a patient to diagnose without using the stethoscope. I am ready to do so, if you agree.”

Shaman nodded, although his stomach lurched.

The medical professor led them into the nearest ward, where he paused before a patient whose card at the foot of his bed revealed he was Arthur Herrenshaw. “You may examine this patient, Mr. Cole.”

Shaman saw at once from Arthur Herrenshaw’s eyes that the man was in terrible trouble.

He pulled back the sheet and blanket and raised the gown. The patient’s body looked extremely fat, but when Shaman placed his hand on Mr. Herrenshaw’s flesh, it was like touching raised dough. From his neck, where the veins were distended and pulsating, to his shapeless ankles, the swollen tissues were laden with fluid. He heaved with the effort of breathing.

“How are you today, Mr. Herrenshaw?”

He had to ask again, in a loud voice, before the patient responded with a slight shake of his head.

“How old are you, sir?”

“… I … fift … two.” He gasped profusely between syllables, like a man who has run a long way.

“Do you have pain, Mr. Herrenshaw? … Sir? Do you have pain?”

“Oh …” he said, his hand on his sternum. Shaman noted he seemed to be straining upward.

“You wish to sit up?” He helped him to do so, supported his back with pillows. Mr. Herrenshaw was sweating profusely, but he also shivered. The only heat in the ward came from a thick black stovepipe that bisected the ceiling as it ran from the wood-burning stove, and Shaman pulled the blanket up over Mr. Herrenshaw’s shoulders. He took out his watch. When he checked Mr. Herrenshaw’s pulse, it was as if the second hand suddenly slowed. The pulse was light and thready and incredibly fast, like the desperate skittering footsteps of a small animal fleeing a predator. Shaman had trouble counting fast enough. The animal slowed, stopped, took a couple of slow hops. Began to scurry again.

He was aware that now was the time Dr. Meigs would have used the stethoscope. He could imagine the interesting, tragic sounds he could have reported, the noises of a man drowning in his own juices.

He held both of Mr. Herrenshaw’s hands in his own and was chilled
and saddened by their message. Without knowing he did it, he touched the bowed shoulder before he turned away.

They went back to the clinic room for Shaman’s report. “I don’t know what caused the fluids to collect in his tissues. I don’t have the experience to understand that. But the patient’s pulse was light and thready. Irregular. His heart is in failure, beating one hundred and thirty-two times a minute when racing.” He looked at Meigs. “In the last several years I helped my father to autopsy two males and a female whose hearts failed. In each, a small portion of the heart wall was dead. The tissue appeared burnt, as if it had been touched by a live coal.”

“What would you do for him?”

“I would keep him warm. I would give him soporifics. He’ll die in a few hours, so we should ease his pain.” At once, he knew he had said too much, but the words couldn’t be recalled.

Meigs pounced. “How do you know he will die?”

“I sensed it,” Shaman said in a low voice.

“What? Speak up, Mr. Cole, so the class may hear.”

“I sensed it, sir.”

“You do not have enough experience to know about body fluids, but you are able to sense impending death,” the professor said cuttingly. He looked at his class. “The lesson here is clear, gentlemen. While there is life in a patient, we never—you shall
never!
—consign them to death. We struggle to give them renewed life until they are gone. Do you understand that, Mr. Cole?”

“Yes, sir,” Shaman said miserably.

“Then you may sit down.”

He took Jim Halleck to supper at a riverside saloon with sawdust on the floor, where they ate boiled beef and cabbage and each had three schooners of bitter dark beer. It wasn’t a victory meal. Neither of them felt good about what had occurred. Besides agreeing that Meigs was a real misery, they had little to say to one another, and when they had eaten, Shaman thanked Halleck and paid him for his help, allowing him to go home to his wife and four children several dollars less poor than he had left them that morning.

Shaman stayed there and drank more beer. He didn’t allow himself to worry about the effect of the alcohol on the Gift. He didn’t imagine that he
would be in a position very much longer in which the Gift could be important to his life.

He walked back to the dormitory carefully, not allowing himself to think of very much except the necessity of placing each foot just so as he progressed, and climbed up into his bunk fully dressed as soon as he had arrived.

In the morning he knew another good reason to avoid strong drink, because his head and his facial bones ached, fitting punishment. He took a long time to wash and to change his clothing, and he was slowly heading to a late breakfast when another first-year student named Rogers hurried into the hospital dining room. “Dr. McGowan says you are to come at once to his hospital lab.”

When he reached the low-ceilinged dissection room in the basement, Dr. Berwyn was there with Dr. McGowan. The body of Arthur Herrenshaw lay on the table.

“We’ve been waiting for you,” Dr. McGowan said irritably, as though Shaman were late for a preordained appointment.

“Yes, sir,” he managed, not knowing what else he could say.

“Would you care to open?” Dr. McGowan said.

Shaman had never. But he had seen his father do it often enough, and Dr. McGowan handed him a scalpel when he nodded. He was aware of the two physicians watching closely as he incised the chest. Dr. McGowan used the rib cutters himself, and when he had removed the sternum the pathologist bent over the heart and then reached in and lifted it slightly so Dr. Berwyn and Shaman could see the roundish burned-looking damage that had been done to the wall of Mr. Herrenshaw’s heart muscle.

“Something you should know,” Dr. Berwyn told Shaman. “Sometimes the failure occurs inside the heart, so that it can’t be seen in the heart wall.”

Shaman nodded, to show he understood.

McGowan turned to Dr. Berwyn and said something, and Dr. Berwyn laughed. Dr. McGowan looked at Shaman. His face was like seamed leather, and this was the first time Shaman had seen it lit by a smile.

“I told him, ‘Go out and get me more of them that are deaf,’ ” Dr. McGowan said.

47

CINCINNATI DAYS

Every day during that slate-gray spring of national torment, anxious crowds gathered outside the offices of the Cincinnati
Commercial
to read news bulletins of the war, written in chalk on a blackboard. President Lincoln had ordered a blockade of all Confederate ports by the federal Department of the Navy, and asked men in all the Northern states to answer the call to the colors. Everywhere there was talk of the war, speculation aplenty. General Winfield Scott, general in chief of the Union Army, was a Southerner who supported the United States, but he was a tired old man; a patient on the medical ward shared with Shaman the rumor that Lincoln had approached Colonel Robert E. Lee and asked him to take command of the Union Army. But a few days later there were newspaper reports that Lee had resigned his federal commission, preferring to fight on the side of the South.

Before that semester was over at the Polyclinic Medical School, more than a dozen students, most of them in academic trouble, had quit to join one army or the other. Among them was Ruel Torrington, who left two empty bureau drawers that retained the smell of unwashed clothing. Other students spoke of finishing the semester and then joining up. In May Dr. Berwyn called a meeting of the student body and explained that the faculty had considered closing the medical school during the military emergency, but after much soul-searching they had decided to continue to teach. He urged each student to stay in school. “Very soon doctors will be needed as never before, both in the army and to care for civilians.”

But Dr. Berwyn had bad news. Because the faculty was paid from tuition receipts, and because enrollment had decreased, tuition fees had to be raised sharply. For Shaman, this meant he would have to come up with funds he hadn’t planned for. But if he wouldn’t allow deafness to stand in his way, he was determined that a little thing like money wouldn’t stop him from becoming a doctor.

He and Paul Cooke became friends. In matters of school and medicine, Shaman was the adviser and the guide, while in other matters Cooke did the leading. Paul introduced him to restaurant dining and the theater. In awe, they went to Pike’s Opera House to see Edwin Thomas Booth as Richard
III. The opera house had three tiers of balconies, three thousand seats, and standing room for another thousand. Even the eighth-row seats Cooke had wangled from the box office wouldn’t have allowed Shaman full comprehension of the play, but he had read all of Shakespeare at college, and he reread this play before the performance. Being familiar with the story and the speeches made all the difference, and he enjoyed the experience tremendously.

On another Saturday evening Cooke took him to a whorehouse, where Shaman followed a taciturn woman to her room and received a fast servicing. The woman never lost her fixed smile and said almost nothing. Shaman didn’t ever feel impelled to go there again, but at times, because he was normal and healthy, sexual desire presented a problem. On a day when it was his duty to drive a hospital ambulance, he went to the P. L. Trent Candle Company, which employed women and children, and treated a thirteen-year-old boy for leg burns suffered from a splash of boiling wax. They took the boy back to the ward, accompanied by a peach-skinned young woman with black hair who gave up her own hourly wages to go to the hospital with the patient, her cousin. Shaman saw her again that Thursday evening during the weekly visiting hour in the charity wards. Other relatives waited to see the burned boy, so her visit was short, and he had a chance to talk with her. Her name was Hazel Melville. Although he couldn’t afford it, he asked her to have supper with him on the following Sunday; she tried to appear shocked, but instead she smiled in satisfaction and nodded.

She lived within walking distance of the hospital, on the third floor of a tenement building very similar to the medical-school dormitory. Her mother was dead. Shaman was very conscious of his guttural speech as her red-faced father, a bailiff at the Cincinnati Municipal Courthouse, regarded him with cool suspicion, not certain what was different about Hazel’s caller.

If the day had been warmer, he might have taken her boating on the river. There was a wind from the water, but they wore coats and it was comfortable to walk. They looked in the windows of shops by the waning light. She was very pretty, he decided, except for her lips, which were thin and severe, etching tiny lines of habitual discontent into the corners of her mouth. She was shocked to learn of his deafness. While he explained about lip-reading, she wore an uncertain smile.

Still, it was pleasant to talk to a female who wasn’t ill or hurt. She said she’d been dipping candles for a year; she hated it, but there were few jobs for females. She told him resentfully that she had two older male cousins
who had gone to work for good money at Wells & Company. “Wells & Company has received an order from the Indiana State Militia to cast ten thousand barrels of minié musket balls. I do so wish they would employ women!”

They had supper in a small restaurant Cooke had helped him choose, selected because it was both inexpensive and well-lighted, so he could see what she was saying. She appeared to enjoy it, though she sent the rolls back because they weren’t hot, speaking sharply to the waiter. When they returned to her flat her father wasn’t at home. She made it easy for Shaman to kiss her, responding so completely that it was a natural progression for him to touch her through her clothing and eventually to make love to her on the discomfort of the fringed settee. Lest her father return, she kept the lamp on and wouldn’t remove her clothing, pulling her skirts and shift back above her waist. Her womanly odor was overlaid with the smell of bayberry from the paraffin into which she dipped her wicks six days a week. Shaman took her hard and fast and without any semblance of enjoyment, conscious of possible enraged interruption by the bailiff, sharing no more human contact with her than he had experienced with the woman in the bordello.