FOUR

 

DAY 2. THURSDAY, 9/21—7:30 A.M.

Father, a patient died in my care last night. A child. His mother believes I am responsible for his death.”

Abel Whitestone ran his forefinger around the diaphragm of his stethoscope, then placed the end in his vest pocket. He was a large man with small, delicate hands. Lines had given way to pouches along his jaw and under his eyes. He reached up and patted Noah softly on the cheek. “Come into the office.”

It was just after seven. Even at fifty-five, Abel arrived early every morning to tidy up, complete leftover paperwork, read medical journals, and prepare the office for the daily onslaught. Noah had tried to persuade his father to sleep an extra hour, but Abel would have none of it. Noah had encountered him in one of the examining rooms, setting bandages, sheets, and instruments in their proper places.

Father and son made their way to the rear. The practice had been here on Adams Street for two decades. Abel had leased office space on the first floor until nine years ago, when Noah announced his intention to enter medical school at New York University in Manhattan. Abel then scraped together the money to purchase the two-story building. Abel, Elspeth, and Noah’s sister, Agnes, had moved into the top floor and bottom floor rear, leaving the offices on the street level front. By the time Noah finished school, Agnes had married and moved to Milwaukee. Abel then expanded the offices to the entire first floor. When he extended an invitation to join the practice, Noah had accepted instantly.

Where Noah’s private office was bright and modern, Abel’s was wood-paneled and dark. It was filled with photographs, letters of appreciation, and plaques from religious and civic organizations, expressing gratitude for some service that Dr. Whitestone had performed in the community. Nothing was more revealing of a doctor’s character than his reputation among his patients. Any greed, incompetence, lack of commitment, or professional vanity will soon surface in one who treats his fellows when they are afraid and vulnerable. Abel Whitestone was adored; invited to innumerable weddings and christenings, he had been made godfather to more neighborhood children than Noah could count.

Noah sat in a leather chair opposite the desk, a location from which countless patients over the years had heard that they were pregnant, or tubercular, or in fine health, or dying. Here they had confided, asked favors, or requested an extension on their arrears. This chair had held millionaires, community leaders, the indigent, and thieves. Many had sat and merely sought advice. As now Noah did.

Abel walked in a moment later, letting his hand linger on his son’s shoulder as he passed. He settled heavily into the wing chair behind the desk and polished his spectacles with a small handkerchief he removed from a vest pocket. With his glasses off, Abel’s eyes appeared sleepy, slightly lacking in focus. Old.

“All right, son. Tell me about your patient.”

Noah recited the case history in full, from the first summons by Mildred Anschutz to Willard’s death. He restricted himself to a recitation of the symptoms and did not propose a diagnosis. As he spoke, his father sat leaned against one arm of the chair, tugging at his lower lip, looking off to the side. When Noah had finished, Abel sat back in his chair. He never spoke in haste, appearing to give due consideration to even the most obvious question.

“A tragedy,” Abel said with a deep sigh. “There is nothing worse than the death of a child.” He paused to once again polish his spectacles. “What will you enter on the death certificate?”

“Respiratory failure.”

“Seems vague.” Abel leaned even farther back, but eyed Noah in a way that had made him uncomfortable since he was eight.

“Should I enter something specific, even if I’m not totally certain?”

“You’re not totally certain?”

“How could I be?”

Abel nodded slowly, as if reviewing the diagnosis, but instead he said, “The boy’s mother blames you for his death . . .”

“She was distraught. It’s natural.”

“Perhaps. But do you share her assessment?”

“No. I don’t think so.” Noah rubbed his forefinger across his thumb. “I’m not sure.”

“Not sure if he died from the laudanum or not sure if you are responsible?”

“I can’t see how he could have died from the laudanum.”

“Then you don’t. It was something out of your control. What more do you believe you could have done?”

“Saved him.”

“Ah, yes. And how could you have done that?”

“I’m not sure of that either.”

“Most men, Noah, if they’re worth anything, are responsible for something in their lives. We doctors happen to be responsible for something precious. We are responsible for people’s lives. And their health. But the nature of the responsibility doesn’t mean we cease being human. We all have our failures. It’s painful. And inevitable. Only God is omnipotent. But you know all this. You’ve lost patients before.”

“This seems different.”

“Why? Because the Anschutz boy was five?”

Noah didn’t reply. From anyone else, he would have been furious.

“Willard Anschutz was not your son, Noah.”

His son. For five years, the most bleak of phrases.

Abel heaved out a breath. “Noah, you were not to blame for Isobel’s death. Or the baby’s. Isobel hemorrhaged. Thousands of women each year die in childbirth. Dear Isobel was one of them. And you were only assisting. Not even the primary physician. A tragedy. A horrible tragedy. But tragedy does not mean culpability.”

“I was too slow.” The words came out in a whisper.

“You could have been Mercury himself and still not have stopped the bleeding.”

“I was too slow,” Noah repeated. “Isobel’s parents were correct.”

“How? How could they have been correct? They aren’t doctors. They weren’t even in the room. Nor, I might add, was Mildred Anschutz.”

“It doesn’t matter. They believe my negligence contributed to the death of their daughter. That I shouldn’t have even been in the room. And they were correct.”

Abel shook his head. They had been over this hundreds of times. There were no words left.

“How is Clement Van Meter?” he asked instead.

“He continues to hang on. The man has astounding will. If only he had come to us sooner.”

“He’s been stubborn for thirty years. Whenever I knew he was in port, I tried to get him to let me take a look at him. Went to his house any number of times. He laughed at me. Thought planning for old age was a joke. ‘Aw, doc,’ he’d say, ‘I’m gonna die at sea. Eaten by sharks, most likely. Or washed overboard in a storm. Ain’t no cure for that.’ Then he’d throw his arm around my shoulders . . . strong as a plow horse . . . and lead me out the door. ‘Now you go and tend to all the shore folk who’re gonna die in their beds.’ The last thing he figured was that he would be one of them, rotting away, dying by inches.”

“I never knew him like that.”

“A person just couldn’t help liking Clement.” Abel paused. “So, Noah? Should I feel guilt? For not convincing Clement to take better care of himself.”

“Of course not. Clement Van Meter was a grown man. There was nothing more you could have done.”

“I don’t see the difference.”

“Maybe there isn’t any. I don’t know,” Noah exclaimed. “Don’t you feel guilt anyway, father? See their faces? The patients who have died in your care?”

Abel looked off over Noah’s shoulder. “Do you remember Rosemary Mangino?”

“From Henry Street? The funny old woman who talked to herself? Of course.”

“She had a daughter. Born almost a year to the day after you.”

“I didn’t even know she ever had a husband.”

“Oh yes. A drunk. Ran off after the little girl was born. In any event, the doctor who delivered Rosemary’s daughter botched the job. Forceps delivery. He was young and made a mistake. The little girl’s skull was compressed. Viola they called her. Grew up to be an idiot, poor thing. Could barely feed or dress herself. But a sweeter or more gentle child never graced God’s earth. Viola was always laughing and making other people laugh. Not in a bad way, mind you. It was simply that she was so happy, so easy to please, that people could not help but be happy around her.

“But she was always sickly, of course. Seemed not a month went by when either her breathing or her digestion or something else wasn’t out of whack. One day, her respiration went bad. Non-tubercular but clearly degenerative. Everyone knew she was going to die, even her mother. Everyone except me, that is. I decided I was going to save her. I tried everything. Medication, inhalers . . . I read that a tribe in the Amazon ate some mixture of ground-up plants to cure respiratory ailments, so I even tried that. She steadily worsened, of course. I became more determined. At the end, I was spending more time at Viola’s house than here. None of it mattered. The little girl died. Six years old.”

“I’m so sorry, father. Why did you never tell me this before?”

“Why would I?” Abel heaved a sigh. “I was disconsolate. I even considered giving up medicine. Thought I could never treat patients in the same way again.”

“But you did.”

“Yes. It took three months, but I did. As will you. And, yes, I still see Viola Mangino’s face. Every day.”

Abel placed his elbows on the arms of his chair, letting his fingertips fall together just under his chin. “So what will you do now?”

“I thought I might speak with Alan.”

“If that will make you feel better. You’re seeing him at dinner tonight, are you not?”

“I thought perhaps I would see him this morning. At the hospital.”

Abel sat straighter in his chair. “You suspect Arnold had some role in the boy’s death?”

“The boy almost certainly died of morphia toxicity. You know that as well as I, father. If it wasn’t the laudanum, it must have been something else. Perhaps something Dr. Frias prescribed.”

“That is a leap, not a conclusion. I advise you to leave the matter as it is. No one will blame you for the boy’s death. Even his mother will come to see that you acted appropriately.”

“I can’t leave it, father. I have to at least try to find the truth.”

“Why? The boy cannot come back. It will make no difference.”

“I’m not sure. Maybe I need to prove to myself that it wasn’t my fault. Maybe I have to find a way not to feel Mildred Anschutz looking at me the way Isobel’s parents did. I just know that I need to. Can you spare me this morning?”

Abel shook his head in resignation. “You never could be dissuaded when you were determined to do something. I suppose that’s why you’re such a good doctor.” He thought for a moment. “I suppose I can ask Pierre Gaspard to help out. He lives only three blocks away, and he loathes retirement. Did you plan on making a condolence call?”

“I thought I should wait until tomorrow. Seeing how Mrs. Anschutz feels.”

“Probably wise. Let me go with you.”

“No, father. I should do it alone.” Noah stood to leave. “Have you forgiven yourself, father? For Viola Mangino? Have you come to accept that it was not your fault?”

“Her dying? Yes, I have.”

“No. I meant the forceps delivery.”

“Oh, you thought . . . no, Noah. I didn’t perform the delivery.”

“But . . .”

“Oh no, son. That wasn’t me. Arnold Frias delivered Viola Mangino.”