FIVE

 

DAY 2. THURSDAY, 9/21—9 A.M.

The pediatric ward was the pride of the sprawling Brooklyn Hospital. Endowed by the dowagers of the Ladies’ League, the vast, high-ceilinged room was on the third floor, facing south, so the children could enjoy a light and airy environment. Twenty-four beds lined the walls, twelve on each side, with ample space between. The floors were polished tile, the windows large, and the walls painted a bright off-white. The room smelled of disinfectant and talc. Four nurses were on duty, either sitting at bedside or scurrying between patients.

Each of the beds was occupied. Although the room held both boys and girls, curtains had been set between the beds and could be pulled shut for privacy. The patients ranged in age from two or three to early teens. Some were talking to one another, a few others were attended by visitors sitting in chairs pulled next to the beds, but most of them lay quietly alone. The dowagers could not provide caring relatives, so many children of the poor would receive no visitors for their entire stay. Some would be abandoned permanently by families who could not bear the burden of a convalescing child, then sent to orphanages when they were well enough to be discharged. There, most would languish and molder. Many would die.

Noah stepped inside through the swinging double doors to the sound of dry coughing. Respiratory ailments abounded. More children died from non-tubercular pulmonary infection than from any other cause. He could see just from tone, color, and posture that at least six of the children were gravely ill. Others seemed to be convalescing well. A boy, one of the older patients, was sitting up in bed reading a battered copy of Huckleberry Finn.

Alan De Kuyper stood at a bed at the far end of the ward with four younger doctors, three men and a woman. Morning rounds. He was attending a scrawny, pallid, twitchy boy of six or seven. De Kuyper was in his early thirties, a gangly man with robin’s-egg-blue eyes, an unlined face, and hair gone prematurely gray. He grinned when he saw Noah walking his way.

“Couldn’t wait until tonight to see me?” he asked, then turned his attention back to his patient. “All right, Anson. We’re going to play a game. You’re going to tell these doctors what’s bothering you, and they’re going to try to guess what’s making you sick.”

“I don’ wanna play no game,” the boy replied.

“No game? Do you want breakfast instead?”

“Not hungry.”

“Would you like to get up and play, then?”

“Too tired.”

De Kuyper continued to question the boy, eliciting that he suffered from headaches, bad teeth, and that he had difficulty holding things or walking because of weakness in his hands and feet. “Well, Anson,” he said, finally. “I’m sorry you won’t play with us. We’ll leave you alone now.”

“Yeah,” grunted the boy.

De Kuyper led the doctors to the aisle, out of earshot of the patient. “Well?” he asked.

None of the four responded.

“Review the symptoms. Irritability, hyperactivity, fatigue, loss of appetite, weakness in the extremities, excessive tooth decay . . .”

Still nothing.

De Kuyper sighed deeply. “I’ll give you a hint.” He bunched his fingers and poked them back and forth toward his open mouth. The four glanced about at one another, but none spoke.

He rolled his eyes heavenward. “Children are known to put anything and everything into their mouths, are they not?”

“I’ve got it,” the woman said, raising her hand as if she were still in class. She was reedy and dark, in her early twenties. “Lead toxicity.”

“Very good, Dr. Bertelli. And the treatment?”

“Remove the source of the problem.”

“Correct,” De Kuyper replied. “Easier said than done though. But we’ll have a talk with the boy’s parents and tell them to repaint their apartment and keep a cleaner house. I’m certain they will run right off and do so.”

He excused himself and gestured to Noah to walk to the end of the ward.

“Dolts,” he muttered. “Anyone can get into medical school these days.”

“They can’t be that bad,” Noah replied.

“Not like you, old man.” De Kuyper clapped Noah on the shoulder. “Actually, they just started. Bertelli’s the best. One of the others will be all right, another fair. As for the fourth . . . let’s just hope he decides to give up medicine and become a banker.”

“Your brother Jamie is a banker.”

“Precisely. So, what brings you to my atelier?”

Noah described Willard Anschutz’s symptoms, both during his initial visit with the boy and then immediately before he died.

“I’m sorry, old man. Sounds ghastly. My God, I hate to lose patients. It’s as if every child is entitled to a life and when one dies, I’ve denied it to them. Can’t dwell on it though. If I did, I’d have to leave the profession.”

Noah nodded in mock agreement. This from a man Noah had once found weeping in a closet when one of his patients died of a seizure. “The mother thinks I’m responsible,” he said.

“From two drops of laudanum. Ridiculous.”

“I thought so, too. But what else could have done it?”

“Was the boy taking patent medicines?”

“I asked and was told categorically by his mother he wasn’t. It’s a good family. Anschutz. Wurster’s niece. The father’s an army officer, off slaughtering Filipinos. But I’m convinced the mother was telling the truth.”

“Very well. Let’s look elsewhere then. You say both pupils were dilated when you first observed the boy?”

“Yes.”

“That would eliminate a brain tumor. Could be a strain of encephalitis, I suppose, although the set of symptoms on your first visit work against it. Might be something new. We live near the waterfront, after all. Perhaps an unknown bacillus has been brought ashore from Africa or Asia. One which mimics morphia and only affects the young. You should ask Jacobi.”

Jacobi, the oracle. Alan’s mentor. In 1861, he had become the first man in America to establish pediatrics as a separate discipline.

“I thought Jacobi doesn’t see anybody.”

“An exaggeration. Most stories about Jacobi are. He’s sarcastic, domineering, a socialist, and a Jew. A man to emulate, except for the Jew part. He’s still a revolutionary under the surface, I expect. Although he never talks about it, you know of course that he came to America as a stowaway on a freighter after he escaped from prison in Germany? He was under a death sentence for radical activities.”

“Yes. I believe you have mentioned that.”

Alan chuckled. “Yes, I suppose I have. In any event, he has no patience for fools or anyone who would waste his time, another of his traits I admire. But he’ll be happy to see you if I make an introduction.”

“I’d be grateful. He’s still at Columbia?”

“Absolutely. Still teaching. At seventy. Amazing fellow. If there is an obscure ailment from which the Anschutz boy died, Jacobi will know it.”

Noah reached into his vest and removed the envelope. He held it open to show Alan the small, blue tablet. “Have you ever seen one of these before?”

De Kuyper shook his head. “That doesn’t mean much, of course. There are thousands of different medications floating about. The boy was taking these?”

“His mother claimed he had stopped two weeks ago.”

“Are they a morphiate?”

“The mother assures me they are not.”

“But you suspect otherwise. Quite right. Who prescribed them?”

“Frias.”

“Ah! Dr. Dollars.” He gestured toward the pill. “Let me have this tested for you.”

“I’d like to do it myself.”

“Of course. The laboratory will be empty this time of day. Have you used Herold’s Manual of Legal Medicine?”

“No.”

“There’s a copy on the front shelf. It’s outstanding. If you’re going to run a test, follow Herold’s methodology.” Alan put a finger to his chin. “And why don’t I fetch you tonight? You shouldn’t be forced to enter the lion’s den alone. I’ll be by at 6:30.”

“I hope eventually I won’t need an honor guard to go to your parents’ house.”

“Give it twenty years.” Alan paused. “However the test comes out, you didn’t have anything to do with the boy’s death.”

“How can you be so sure?”

“I wouldn’t introduce my sister to an imbecile.”

“I’m greatly relieved.” When Noah turned to leave, a man who had been sitting at the bedside of a young boy rose to leave as well. Noah held the door as the man passed through. He was sharp-featured and light-haired, in his mid-twenties, clean-shaven, and wearing wire-frame spectacles that framed a prominent, aquiline nose. Behind the lenses lay a pair of quick, attentive eyes. He nodded in thanks but eyed Noah strangely, as if Noah were an acquaintance that he could not quite place.

The light-haired man paused after he walked by, holding the door open and gazing back into the ward. He allowed Noah to pass him and make his way down the hall. As Noah reached the staircase, he looked back, but the man was gone.