Tuesday, March 29, 1955
Allan checked the address on the mailbox against the one scrawled on the paper in his hand. This was it? This cruddy little house on Ferry Street was where his last hope for med school lived? If he didn’t know that Dr. Farnsworth had no sense of humor, he’d think the old guy had been jerking him around. But he was the one who had set up this meeting between Allan and the founder of the new clinic. There must be more to Mrs. Jane Ketchem than met the eye. Allan looked at the peeling green paint on the door of the tiny barn and the front room’s sun-bleached curtains, whose barely discernible pattern was distorted through the ripples in the window glass. There certainly couldn’t be less.
He took the granite block steps in one stride and knocked on the door. It jerked open, startling him so he nearly tumbled backward off the top step. The woman standing there stared at him. “You must be Allan Rouse,” she said.
He recovered his balance. “Yes, ma’am.”
“I’m Mrs. Ketchem. You’re late.”
He saw she was buttoned into a navy coat, with a knit hat tied beneath her chin. Oh, Christ, had he blown it without ever getting a chance to present his case? “I’m sorry,” he began, “I was—”
“I’m due to volunteer at the clinic. You can walk with me.” She reached behind her and snatched a purse and gloves from a hall stand. He jumped out of her way as she swung out the door, shutting and locking it in one efficient movement. She tugged on her gloves and narrowed her eyes as she gave him the once-over. “Is that all you’re wearing?”
“Uh . . .” he gestured toward his mom’s Chevrolet. “My coat’s in the car. Can I drive you?”
“I’d rather walk. It keeps your joints young.” She nodded toward the car. “Well? Better get it if you’re coming along. It’s raw out today.”
Allan stumbled down the steps and loped across her bath mat–sized lawn. He retrieved his coat, a long, heavy thing that had been his brother Elliot’s, and slipped into it while following Mrs. Ketchem down the sidewalk. Evidently, she didn’t wait for stragglers. He fell into step beside her, and studied her in quick glimpses that could be passed off as checking out the ways home owners had tried to individualize this row of identical houses. If Mrs. Ketchem’s joints were young, they were the only part; she was gaunt and rawboned, with deep grooves running from her nose to her chin and tomahawk-slashed creases radiating out from her eyes.
“Dr. Farnsworth tells me that you want to become a doctor.”
“Yes, ma’am, I do.”
“Why?”
Because I’ve always been the smartest one in my class and I don’t want my brains to shrivel up behind a desk. Because I don’t ever want my fate to be decided by some faceless, cigar-puffing board in Cincinnati. Because I don’t want to work for thirty years with nothing to show for it but a paid-up mortgage on a house nobody wants to buy. Because I want respect, and money, and to travel on jet planes to places where no one has ever heard of Millers Kill.
None of which was what financial-aid boards and admissions officers wanted to hear. “Because I want to use my gifts—my facility with science, my curiosity, my empathy—to help people. Not in a lab, but hands on. One-on-one.”
“Have you thought about alternate careers? Medicine should be a calling, you know, not something you pursue because you can’t think of anything better.”
“I’ve always wanted to be a doctor, ma’am. Since I was a kid. I was the one who was always collecting hurt pets and trying to treat them.”
“But you don’t want to be a vet?”
He risked a grin. “People don’t bite you.”
“Don’t be so sure of that.” The reached the corner and crossed the street, to where the new cemetery lay behind a squared-off granite wall. That was another thing he wanted to put behind him, a place where something “new” had been built a hundred years ago.
“Tell me why it is you’re looking for funding,” Mrs. Ketchem said as they rounded the corner onto Burgoyne Street.
“My folks can’t afford to send me,” he said. It was embarrassing, but at this point, he had rehearsed the details on so many applications and forms that it was almost as if he were talking about some other Allan Rouse. “I’m going to Albany on a scholarship, and working for my room and board. I’ve applied for scholarships and loans for medical school, but I haven’t been able to pull together nearly enough money to cover all the expenses. Plus, they only go through school. I’d be left looking for money to live on all over again when it was time for my residency.”
“Couldn’t you work while going to school?”
“Not if I wanted to learn anything.” He looked at her, willing her to understand. “Medical schools only accept the best of the best. You have to be there, giving one hundred percent every day, if you hope to keep up. I don’t want to just keep up. I want to excel.”
She cocked a graying eyebrow. “Why not sign on with the military? They’ll pay for everything. One year of service for each year of schooling, isn’t it?”
His fingers closed around the edges of Elliot’s coat. “I had an older brother who was in the marines. He died in Korea three years ago. It would just kill my parents if another of us joined up.”
“I’m sorry,” she said. They reached the corner of Pine Street, and she paused, the toes of her shoes hanging off the edge of the curb, while a dump truck chuffed past. “It’s hard to lose a child. Real hard. I can understand your parents’ point of view.” She stepped across the street and he followed, dodging the mucky gutters still wet with melted snow and the earliest spring rains. “Your parents used to live here, didn’t they?”
“Yes, ma’am. I graduated from Millers Kill High.” He tilted his head back to look at the sky, heavy with scudding gray clouds. “My dad worked at the mill until it closed down. They moved to Johnstown a couple years ago.”
“This town’s been going through some hard times. I don’t mind telling you, that’s one of the reasons I told Dr. Farnsworth I’d be willing to speak to you. I gave them the building for the clinic—practically had to ram it down their throats—and I gave them my in-laws’ farm that had come to me, so there’d be money to support the thing. But I can’t make the aldermen pony up enough money so’s to keep a steady doctor around. If it weren’t for the hospital staff doing volunteer shifts, we’d have to close it down.”
She fell silent. Should he leap into the gap? Tell her he was dying to come back to town as Dr. Rouse and take care of her clinic? She looked as if she was thinking about something. Maybe he ought to just keep his mouth shut.
They reached Elm Street. “Down this way,” she said. She continued on, saying nothing, as they strode down Elm. He loved this street, loved the deep, wide lawns and the shiny new cars he could see peeping from inside old carriage houses or parked beneath porte cocheres. The enormous elms that had astonished him as a boy were all dead now, and the immature saplings that had taken their place looked imbalanced against the three- and four-story houses. Still, this place had the same certainty that he had seen in a few of the kids at SUNY Albany, the ones who never had to stop and think about whether they could afford a pizza pie or walk back from an evening out because a taxi was too expensive. The certainty he wanted for himself. He wondered if any of the homes here belonged to doctors.
“Did Dr. Farnsworth tell you what I was thinking of?” Mrs. Ketchem’s voice snapped him back to attention, and his gut jerked, as if she had seen the thoughts inside his head and could tell he was no lily-pure altruist. “All expenses paid, room, board, tuition, books, what have you. During the school year and for three years of residency, which is what he tells me it takes to make a man into a doctor fit to look after the needs of a town.”
“Yes, ma’am. He and I talked about it after I got in touch with him.”
“And a year serving as the clinic’s full-time physician for each year of support. Same as with the military, although I can promise you you won’t get shot at here.”
They turned down a short two-house street and emerged onto Barkley Avenue. “There it is,” she said, pointing with her chin. He followed her gaze two houses down and saw . . . a house. It resembled several other houses on Barkley and Elm Streets, tall, narrow, made of brick and fancy wood trim. He had known Mrs. Ketchem donated her in-laws’ house to get the clinic started, but somehow, he had drawn a mental picture of something more . . . modern. Something that looked more like a medical facility and less like a place where someone’s rich grandmother lived. “It looks great,” he said.
“It’s pretty plain inside. I sold all the furniture and whatnots that my brother-in-law and his family didn’t want to keep. Used that money to fit out the waiting room and the offices. Got some local doctors to help out with medical equipment and stuff for the examination rooms, and what I couldn’t wrangle, the town bought cheap off the hospital when they did their renovation two years back.”
She escorted him up the walk. “Up there’s the only change I made that didn’t go directly into treating the patients.” She pointed to the granite lintel above the etched-glass-and-oak door. THE JONATHON KETCHEM CLINIC.
He was still digesting the news about their flea-market approach to equipping the place. “That was your husband? Jonathon Ketchem?”
“Yes.” The hard edges of her face softened. “This is his monument. I never did put one up in the cemetery. Some folks talked about that, you know. Said it just went to prove how cheap I was. But this . . .” She nodded approvingly. “No one in town has as big a memorial stone as this.”
He wished he knew the dividing line between being an eccentric and being a fruitcake.
“Well, let’s not hang around. Come on in,” she said, all business again. He opened the door for her and they went inside into a narrow front hall. He lunged for the interior door and managed to jerk it open a second before her hand fell on the doorknob.
Straight ahead of him was a staircase, sweeping up to a second-floor landing. The stained-glass windows and the gleaming woodwork looked as if they ought to be in a church, but the noise would certainly have been out of place. He pulled his eyes away from the stairs’ perfection and saw what was making all the hubbub. To his right, in what would have been the drawing room, at least a dozen people were sitting in sturdy wooden chairs that he swore must have come from the high school. One woman with a baby perched on her hip was trying to chase down a bratty little kid without actually breaking into a run and grabbing him. “You come right here this minute, Russell!” she hissed. Two old men who had evidently turned off their hearing aids were having a loud discussion about the benefits of red wheat versus winter clover. A teenage girl sitting next to an older woman kept popping her gum until the woman shrieked, “Will you stop that!”
Thumbtacked onto the walls behind them were simpleminded posters extolling the benefits of vaccinations, dental hygiene, and eating the five food groups every day. The only thing missing was the magic-bullet ad: Use a condom, prevent the clap. A wide wooden desk blocked most of the squared-off archway that would once have divided the front room from the family parlor, separating the two areas into waiting room and office. An old lady of the sweet and little variety manned the desk, a blue-and-white-striped apron over her street clothes.
“This way,” Mrs. Ketchem said, and he followed her down the hall, past the parlor lined with metal filing cabinets, and into a small room just the right size to have been a butler’s pantry. “This is the doctor’s office,” she said. It had no personal touches, no family photographs or diplomas on the wall. The desk and chair were cheap metal castoffs that looked like Army-Navy surplus. The single window, behind the desk, was half covered with an old-fashioned green roller shade, complete with thick silk cord and pull.
The enormity of what it would mean, seven years of his life in this place, broke over him like a massive wave. He would be thirty-five years old before he was released from his self-imposed bondage. One-fifth of his life would be spent coming here every day, walking past those idiot posters, saying hello to a succession of little old ladies in striped aprons, seeing patients with ingrown toenails and conjunctivitis and the flu.
He closed his hand tightly over the edge of one of the shelves that ran along each side of the office. Pantry shelves, he realized, once used for the family china and pots and pans. Now they were filled with anatomy books, medical texts, journals in grosgrain boxes. The books. Filled with things he wanted to know. He breathed in again, forced himself to relax, to look around with apparent approval. There were medical students who earned out their educations serving in big-city ghettos, or in Appalachian hamlets where all their patients had bare feet and married their cousins. Compared to that, coming back to Millers Kill would be a cakewalk.
“It’s great,” he said. “I admire what you’ve done here.”
“Come on upstairs. If they aren’t all in use, you can see some of the examining rooms.”
He followed her up the grand staircase and down the second-floor hall. “Here’s where we’ve put in a ladies’ room,” she said, pointing to the first door on the left. “Ran the piping up from the kitchen belowstairs. Men’s room is the old second-floor toilet. I figured they didn’t need the space the women did. This one’s taken, this one.” She pointed to the closed doors as they walked past. “Here,” she said, entering through the last door in the corridor. It was an examining room. Plain, but with everything he’d expect to see. The wooden floor had been replaced with linoleum. She saw him looking at it. “The doctors said you can’t keep wood sterile. This stuff can be scrubbed down with hospital-strength disinfectant.”
For a moment he wondered if the clinic’s doctor would be responsible for that job, too.
Mrs. Ketchem crossed her arms and looked out one of the room’s two windows. “This house belonged to my husband’s grandparents before it came to my in-laws and then to me. Grandmother Ketchem was some house proud. Sometimes I can’t help but imagine those old folks rolling in their graves at some of the things I’ve done to this place.”
“Why?” Allan couldn’t restrain the question that had been swelling inside him since he had first seen her dumpy house on Ferry Street. “I mean, I know it’s great to give away money and all, but most folks who do it are rich. Didn’t you want to keep this house for yourself? Live, you know, in style?”
She didn’t answer him right away, and he wondered if he had just blown it, by showing that he was not the sort of person who would give away riches as soon as they fell into his hands. “I gave birth to my first child in this room,” she finally said. She let her gaze roam over the walls and windows, as if she were looking through time, to the way it used to be. “We had a farm out in the Sacandaga River valley, a good half day’s ride by horse and cart, which was all we had. So when my time came near, my husband brought me here, into town, to stay with his grandparents. It was in here I had my son Peter.” Her voice had gone all thin, as if it were coming from a long way away.
She looked straight at Allan. “I’m going to tell you something I don’t speak of, because I want you to understand what this clinic means. What it’s for.”
He nodded, desperately curious and afraid of what he might hear, both together.
“I had four children once, in that farm. It’s all gone now, children, farm, everything. But back then, it was my life. I never thought it wouldn’t all go on like it had, each day following the one before.”
He nodded again, feeling that he ought to make some acknowledgment.
“It was March, in ’24. It had been a cold March, like this one, after a cold winter. Jonathon had taken our two oldest to a party, one of our neighbors who lived upriver. I figured they must have gotten it there. Some of the older kids came down with it, but they recovered after a bad croup. It works that way, you know. Once they’re eight, nine, ten, it mostly sickens them. But younger, it kills. My Lucy and Peter were the youngest there that day.”
Allan wanted to sit down, but his legs seemed nailed to that spot on the linoleum floor.
“About two days later, they both came down sick. It could have been most anything. They were feeling poorly, with a cough and a fever. Their coughs got worse and worse, and I could see how bad their throats looked, all white and red, and them pulling for breath and spitting out nasty mucus. I stayed up all night for two nights running with both of them, steaming ’em, making potash gargle, giving them saltwater drops to keep their noses clear. Then the next day, they seemed to be on the mend. Both of them terrible weak, but their throats clearing up and their breath coming easier. I had kept the two younger ones away. . . .” She looked out the window again. “Three days after Peter and Lucy got over the worst of the coughing, Mary and Jack came down with it. But it was worse, so much worse. It went through them like wildfire. High fevers, and their little throats all swollen and choked. They couldn’t hardly breathe. It was when I saw their throats and tongues all dark that I couldn’t deny anymore that they had the black diphtheria. You know what they used to call the diphtheria, don’t you?”
Allan tried to nod. “The Strangler,” he said.
“That’s right. Jack died by the next morning, died hard, fighting it with everything in him. And then that evening, my little Lucy. Her heart stopped. That’s what it does, you know. If it doesn’t choke off the breath and blood, it paralyzes the heart.”
Allan felt as if his throat were closing up. At that moment, he would have promised Mrs. Ketchem another seven years’ service if she would only stop talking about it.
“That night, Jonathon went for the doctor. Mary . . .” She sighed. “I rocked her and rocked her all night. When Dr. Stillman came back with Jonathon in the small hours, he gave Peter the serum. He told us Mary was . . . She died just before the sun came up. I remember praying, praying harder than I ever did, that the angel of death would pass us by, and leave us our firstborn. But the poison had gotten too far, and Peter’s heart and kidneys were damaged too bad. He died three days later.”
Allan stood there. What could he say? His experience with sorrow was losing a grandparent. The death of a pet. He shifted from foot to foot, intensely uncomfortable and ashamed of himself for feeling that way.
“I had worried plenty, over the years, about the German measles, and mumps, and scarlet fever. But I never thought about the diphtheria. It had always seemed a faraway thing to me. Something you read about in the papers, happening in the cities. Places where folks lived all crowded together and didn’t know how to be clean. Whooping cough and influenza, that was something you had to worry about, living on a farm. Not the Strangler.” She moved then, stepping toward Allan, making him start backward as he had on her front steps. “That’s what this clinic is for. I want you to understand it, not like book understanding, but living-it understanding. You’re hardly more than a boy yet, but someday you’ll have children, and when you do, you’ll think of my children, and you’ll picture in your heart what it feels like to lay all four of your babies into the ground. You’ll know what it is to spend the rest of your life wishing you had done different things.”
Allan backed into a cabinet by the examination table, jarred it hard, and lurched forward as a glass container filled with cotton swabs tipped over. His hands closed on empty air and the container smashed against the floor, spraying glass shards and swabs across the linoleum, over his shoes, into the cuffs of his pants.
“Hold still,” Mrs. Ketchem said, in an entirely different voice than the one she had used when recounting her spooky history. “There’s a closet over this way.” He stood stock-still as she retrieved a broom and swept up the mess in short, efficient strokes. “Shake off your pants,” she directed, and he did as he was told. She bent over and squinted at his shoes. “You’re fine,” she said. “Go fetch me the dustpan.” He picked his way over to the closet and found it. He held it to the floor while she swept the glass and wood into a sparkling pile, and then he carried it, at her direction, to the waste bin.
“I sure hope you won’t be as careless as that when you’re working here.” She stepped out into the hall and beckoned him to follow. “We don’t have much of a budget and we have to stretch the supplies as far as we can.”
“Yes,” he said, trailing after her. “I mean, no, I’m usually not that clumsy. I was—” Scared.
“Jane?” On the stairs below the landing, he could see the old lady who had been working the reception desk. “Are you ready?” She was untying her striped apron. “I’d stay longer, but I promised my daughter I’d watch her girls this afternoon.”
“Sorry, Ruth,” Mrs. Ketchem said. The other woman passed her the apron, and Mrs. Ketchem tied it on over her dress. The starched sweetness of the blue and white stripes seemed to cast Mrs. Ketchem in a deeper darkness, like a witch wearing an angel’s robe. “I didn’t mean to keep you over,” she was saying as they all three descended the stairs.
Allan looked with longing at the door as the morning’s volunteer receptionist let herself out, but Mrs. Ketchem had cast a spell over his shoes—or perhaps they, more than his head, knew how much he wanted to become a doctor—and he found himself following her into the parlor turned office.
“It’ll be up to you to see you get accepted into medical school and that you keep your grades up. If you drop out or flunk out, I’ll be after you to repay the money I’ve spent. You or some other, I’m going to find someone to help me establish this clinic so that it can’t get knocked down.” Mrs. Ketchem enthroned herself on the desk chair and swiveled toward him. Across the desk, he could see the patients waiting for their turn with today’s doctor. These people would become his responsibility. This clinic would become his responsibility. For seven years. “I don’t mind telling you, I’m hoping that if you take the job on, you’ll want to stay even after your term is over.” A hint of the woman upstairs, the woman of the terrible story, rose in her eyes. “I need someone who believes in this place like I do. To keep it going in perpetuity after I’ve died. That’s the word my lawyer used when I gave over my in-laws’ dairy farm to the town. ‘To be used in perpetuity for the benefit of the clinic.’ I like that.”
The language reminded Allan of the way Roman Catholics paid to have masses sung for the souls of the dead. In perpetuity.
“Well?”
“What?” he asked, feeling that she had caught out his secret thoughts again. “Do we have a deal?”
He thought of the upstairs room, the glass shattering, the rising and falling of her voice. He thought of his dad’s face when he came home and told them the mill was closing down. For good. He thought of his own name, Allan G. Rouse. M.D. Then the bratty boy in the waiting room coughed, hard, whining his misery, and he thought suddenly of four small coffins.
“Yes,” he said. “We have a deal.”