The Lord's Work 1 page

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A child of Maine, Wilbur Larch was born in Portland in 186 the son of a sullen, tidy woman who was; among the staff of cooks and housekeepers for a man named Neal Dow, the mayor of Portland and the so-called father of the Maine law that introduced Prohibition to that state. Neal Dow once ran for the presidency as the candidate of the Prohibition Party, but he won barely ten thousand votes—proving that the general voter was wiser than Wilbur Larch's mother, who worshiped her employer and saw herself more as his co-worker for temperance reform than as his servant (which she was).

Interestingly, Wilbur Larch's father was a drunk— no small feat in the Portland of Mayor Dow's day. It was permitted to advertise beer in the shop windows—Scotch ale and bitter beer, which Wilbur Larch's father consumed copiously; it was necessary, he claimed, to drink these weak brews by the bucketful in order to get a buzz on. To young Wilbur, his father never looked drunk—he never staggered or fell or lay in a stupor, he never shouted or slurred his speech. Rather, he had about him the appearance of one perpetually surprised, of one given to frequent and sudden revelations that would stop him in his tracks or in midsentence, as if something had just come to him (or had just escaped him) that had preoccupied him for days.

He shook his head a lot, and all his life dispensed this misinformation: that the nineteen-thousarid-ton ship the Great Eastern, which was built in Portland, was destined \'7b56\'7d to sail the North Atlantic between Europe and Maine. It was the opinion of Wilbur Larch's father that the two best wharves in Portland Harbor had been built specifically for the Great Eastern, that the new and huge hotel in Portland had been built expressly to house the Great Eastern's passengers, and that someone evil or at least corrupt or just plain foolish was responsible for keeping the Great Eastern from returning to her home port in Maine.

Wilbur Larch's father had worked as a lathe operator during the building of the Great Eastern, and perhaps the complaining noise of that machinery and the constant buzz he felt from all the beer he consumed had deceived him. The Great Eastern had not been built for voyages to and from Portland; she was originally intended for the route to Australia, but the many delays in getting her to sea drove her owners to bankruptcy and she was purchased for use on the North Atlantic route for which she proved unsuitable. She was, in fact, a failure.

So Wilbur Larch's father had an addled memory of his days as a lathe operator, and he had considerable loathing for temperance reform, his wife's beliefs and his wife's employer, Mayor Neal Dow himself. In the opinion of Wilbur Larch's father, the Great Eastern didn't return to Portland because of Prohibition—that curse which had limited him to a bilious dependency on Scotch ale and bitter beer. Since Wilbur knew his father only in the man's later years, when the Great Eastern was gone and his father was a porter in the Portland station of the Grand Trunk Railway, he could only imagine why working a wood-turning machine had been the high point of his father's life.

As a boy, it never occurred to Wilbur Larch that his father's missing fingers were the result of too many Scotch ales and bitter beers while operating the lathe—'just accidents,' his father said—or that his mother's zeal for temperance reform might be the result of a lathe operator's demotion to porter. Of course, \'7b57\'7d Wilbur realized later, his parents were servants; their disappointment made Wilbur become what his teachers called a whale of a student.

Although he grew up in the mayor's mansion, Wilbur Larch always used the kitchen entrance and ate his meals with the great prohibitionist's hired help; his father drank his meals, down at the docks. Wilbur Larch was a good student because he preferred the company of books to overhearing his mother's talk of temperance with Mayor Dow's servants.

He went to Bowdoin College, and to Harvard Medical School—where a fascination with bacteria almost deterred him from practicing medicine, almost turned him into a laboratory animal, or at least a bacteriologist. He had a gift for the field, his professor told him, and he enjoyed the careful atmosphere of the laboratory; also, he had a burning desire to learn about bacteria. For nearly a year of medical school young Wilbur carried a bacterium that so offended and pained him that: he was driven by more than scientific curiosity to discover its cure. He had gonorrhea: a gift, indirectly, from his father. The old man, in his beer buzz, had been so proud of Wilbur that he sent him to medicine school in 188-with a present. He bought the boy a Portland whore, setting up his son with a night of supposed pleasure in one of the wharf side boardinghouses. It was a present the boy had been too embarrassed to refuse. His father's selfish nostalgia allowed him so few gestures toward his son; his mother's bitter righteousness was selfish in her own way; young Wilbur was touched that his father had offered to give him anything.

In the boardinghouse—the wood dry with salt and a sea-damp clinging to the curtains and to the bedspread —the whore reminded Wilbur of one of his mother's more attractive servant-colleagues; he shut his eyes and tried to imagine that he was embarking on a forbidden romance in a back room of the mayor's mansion. When he opened his eyes, he saw the candlelight deepening the \'7b58\'7d stretch marks across the whore's abdomen; he didn't know they were stretch marks, then. The whore seemed unconcerned whether Wilbur noticed the stretch marks or not; in fact, as they fell asleep with his head on her stomach, he was vaguely wondering if the woman's wrinkles would transfer to his face—marking him. A sharp, unpleasant smell awakened him and he moved quickly off the woman, without disturbing her. In a chair in the room, the one where she'd put her clothes, someone was smoking a cigar—Wilbur saw the end glow brighter with each inhalation. He assumed that a man— the whore's next customer—was politely waiting for him to leave, but when he asked if there was a fresh candle to light (he needed to locate his clothes), it was a young girl's voice that answered him.

'You could have had me for less,' was all she said. He could not see her distinctly but—since there was no fresh candle—she lit his way to his clothes by puffing earnestly on her cigar, casting both a red glow and a haze of smoke over his search. He thanked her for her help, and left.

On the morning train to Boston, he was embarrassed to meet the whore again. A chatty woman in the daylight, she was carrying a bandbox with the authority of a chronic shopper; he fell: obliged to give her his seat on the overcrowded train. A young girl was traveling with the whore—'my daughter,' the whore said, indicating the girl with a jab of her thumb. The daughter reminded Wilbur that they'd already met by breathing her astonishingly foul cigar breath into his face. She was a girl not quite Wilbur's age.

The whore's name was Mrs. Eames—'She rhymes with screams!' Wilbur's father had told him. Mrs. Eames told Wilbur she was a widow who lived a proper life in Boston, but that in order to afford such a life she found it necessary to sell herself in some out-of-the-way town. She begged Wilbur to allow her to keep her appearances and her reputation intact—in Boston. Wilbur not only assured her that her reputation was safe with him; he \'7b59\'7d also, unasked, paid her more money of his own, on the spot, than his father had originally paid the woman. The amount of the original payment, he learned later— when his father told Wilbur that Mrs. Eames was a proper Portlander of good reputation who occasionally was obliged to sell herself in Boston so that she might afford to keep up her appearances in Portland. As an old favor to Wilbur's father, she had allowed—'Just this once!'—the exception of lowering herself in her hometown.

Wilbur's father didn't know that Mrs. Eames had a daughter, who—by her own confession—cost less than her mother and made no pretense of keeping up appearances in either Boston or Portland. The sullen girl never spoke on the train ride into Boston's North Station; her cigar breath and her scornful gaze spoke for her. Wilbur never told his father that there was some contradiction regarding which town Mrs. Eames had a good reputation in, and he never told his father that he caught the clap from Mrs. Eames, who might not have known she had it.

At medical school, Wilbur learned that gonorrhea could live in the Fallopian tubes of females for years. Only the appearance of an abscess in the pelvis might allow the woman to know that she carried the disease. The symptomatology, the discharge and so forth, could go unnoticed for a long time. It did not go unnoticed in Wilbur Larch; the bacterial infection, in these prepenicillin days, lived on for months in young Wilbur, giving him his passionate interest in bacteriology before burning itself out. It left his urethra scarred and his prostate rocky. It left him fond of ether, too—because the ether sleeps he occasionally administered to himself relieved him of the burning sensation he experienced, both when he urinated and when he dreamed. This singular and painful encounter with sexual pleasure—in combination with Wilbur's memory of his parents' loveless marriage—convinced the would-be doctor that a life of \'7b60\'7d sexual abstinence was both medically and philosophically sound.

In the same year, 188-, that Wilbur Larch became a doctor, Neal Dow died. In grief, Wilbur Larch's mother shortly followed her temperance hero to the grave. A few days later, Wilbur's father auctioned every item from their servants' rooms in the former mayor's mansion and rode the Grand Trunk Railway to Montreal, a town less temperance-minded than Portland, and where Wilbur Larch's father pushed his liver beyond limits. His body was returned to Portland on the same Grand Trunk Railway that had carried the former lathe operator away. Wilbur Larch met the train; he played the porter to his father's remains. From the near-cadavers of the cirrhotic that he had seen during his first internship, young Dr. Larch knew exactly what must have been his father's condition at the end. Cirrhosis turns the liver to a mass of scars and lumps, the skin reflects the bile of jaundice, the stools lighten, the urine darkens, the blood doesn't clot. Dr. Larch doubted that his father would have even noticed the accompanying impotence.

How moving to conclude that young Larch chose to be an obstetrician because the loss of his parents inspired him to bring more children into the world, but the road that led Larch to obstetrics was strewn with bacteria. The demonstrator of bacteriology at Harvard Medical School, a Dr. Harold Ernst, is best remembered as one of the first college baseball pitchers to throw a curve ball; he was also the first college baseball player to become a bacteriologist. In the early morning laboratory, before Dr. Ernst—the former curve-ball pitcher—would arrive to set up his demonstrations, young Wilbur Larch would be all alone. He didn't feel alone in the presence of so many bacteria growing in the little Petri dishes, in the presence of the bacteria inhabiting his urethra and his prostate gland.

He would milk a drop of pus from his penis onto an \'7b61\'7d ordinary stained slide. Magnified more than a thousand times, the villains he spotted every morning under the microscope were still smaller thsm common red ants.

Years later Larch would write that the gonococci looked stooped, like too-tall visitors in ain igloo. ('They bend,' he wrote, 'as if they have waists and are bowing to each other.')

Young Larch would stare at his pus until Dr. Ernst would arrive and greet his little living experiments all over the lab (as if they were his old baseball teammates).

'Honestly, Larch,' the famous bacteriologist said one morning, 'the way you look into that microscope, you appear to be plotting revenge.'

But it was not the smirk of vengeance that Dr. Ernst recognized on Wilbur Larch's face. It was simply the intensity with which Larch was emerging; from his etherdaze. The young medical student had discovered that the light, tasty vapor was a safe, effective killer of his pain. In his days spent fighting the dancing gonococci, Larch had become quite a knowledgeable imbiber of ether. By the time the fierce bacteria had burned themselves out, Larch was an ether addict. He was an open-dropmethod man. With one hand he held a cone over his mouth and nose; he made this mask himself (by wrapping many layers of gauze around a cone of stiff paper); with his other hand, he wet the cone. He used a quarterpound ether can punctured with a safety pin; the drops that fell from the elbow of the safety pin fell in exactly the correct size and at exactly the correct rate:.

It was the way he would give ether to his patients, too, except that he gave himself much less; when the hand that held the ether can felt unsteady, he put the can down; when the hand that held the cone over his mouth and nose dropped to his side, the cone fell off his face—it wouldn't stay in place if no one held it, He felt nothing of the panic that a patient being anesthetized with ether experiences—he never approached the moment when there wasn't enough air to breathe. Before \'7b62\'7d that happened, he always dropped the mask.

When young Dr. Larch first set out from the South Branch of the Boston Lying-in to deliver babies in the poor districts of the city, he had a place in his mind where the peace of ether resided. Although he carried the ether can and the gauze cone with him, he didn't always have time to anesthetize the patient. The woman's labor was often too far advanced for the ether to help her. Of course he used it when he had the time; he would never share the opinion of some of his elder colleagues that ether was a deviation from the given—that children should be brought forth in pain.

Larch delivered his first child to a Lithuanian family in a coldwater, top-floor apartment—the surrounding streets littered with squashed fruit and tattered vegetables and horse droppings. There was no ice to put on the abdomen, over the uterus, in case of postpartum hemorrhage. There was a pot of water already boiling on the stove, but Larch wished he could sterilize the entire apartment. He sent the husband out for ice. He measured the woman's pelvis. He mapped out the fetus. He listened to its heartbeat while he watched a cat toying with a dead mouse on the kitchen floor.

There was a would-be grandmother present; she spoke Lithuanian to the woman in labor. To Dr. Larch shespoke a strange language of gestures, which suggested to him that the would-be grandmother was feebleminded. She indicated that a large mole on her face was either a source of hysterical pleasure or hysterical pain—Larch couldn't tell which; perhaps she simply wanted him to remove it, either before or after he delivered the baby. She found several ways to exhibit the mole—once by holding a spoon under it, as if it were about to fall; once capping it with a teacup and revealing it suddenly, as if it were a surprise or a kind of magician's trick. But the zeal she brought to each revelation of the mole suggested to Wilbur Larch that the old woman simply forgot that she had already shown him her mole. \'7b63\'7d

When the husband returned with the ice, he trod on the cat, which voiced its disapproval in tones that made Wilbur Larch think the child was being born. Larch was grateful not to have to use the forceps; it was a short, safe, loud delivery, following which the husband refused to wash the baby. The grandmother offered, but Larch feared that her combination of excitement and feeblemindedness would cause an accident. Indicating (as well as he could, without the benefit of Lithuanian) that the child should be washed in warm water and soap—but not boiled in the pot on the stove, and not held head down under the coldwater tap—Larch turned his attention to the afterbirth, which refused to come away. The way the patient kept bleeding, Larch knew he would soon be faced with serious hemorrhage.

He begged the husband to hack him some ice—the strong fellow had brought a whole block, borrowing the ice company's tongs for this purpose and standing in the kitchen with the tongs on his shoulder in a menacing fashion. The block of ice could cool the uteri of several bleeding patients; to apply it whole, to a single patient, would likely crush the uterus, if not the patient. At this moment the grandmother lost her grip on the soapy child and dropped it among the dishes soaking in the coldwater sink; this happened the instant that the husband again trod upon the cat.

Seizing the moment, when he saw that the grandmother and the husband were distracted, Larch grasped the top of his patient's uterus through her abdominal wall and squeezed hard. The woman screamed and grabbed his hands; the grandmother, abandoning the baby among the dishes, tackled Larch at the waist and bit him between the shoulder blades. The husband retrieved the child from the sink with one hand, but he raised the ice tongs over Larch with the other. Whereupon, lucky Wilbur Larch felt the placenta separate. When he calmly pointed to its appearance, the grandmother and the husband seemed more in awe of it 64 than of the child. After washing the baby himself and giving the mother some ergot, he bowed a wordless goodbye. Leaving the apartment, he was surprised to hear a commotion almost the instant he closed the door: the grandmother, the iced patient, the husband—all shouting in Lithuanian—and the baby giving forceful voice to its first family quarrel. It was as if the delivery, and Dr. Larch's entire appearance, had been only a brief interruption to a life of unintelligible turmoil.

Larch navigated the dark stairs and groped his way outside; he stepped on a rotting head of lettuce, which gave under his foot with the disquieting softness of a newborn baby's skull. This time he did not confuse the cat's terrible yowl with the sounds a child can make. He looked up in time to see the object flying through the window of the Lithuanian apartment. He was in time to dodge it. It had clearly been hurled at him, and Larch wondered what particular, perhaps Lithuanian, offense he had caused these poor people. Larch was shocked to see that the object thrown from the window—and now dead on the ground at his feet—was the cat. But he was not that shocked; for a passing second, he feared it might have been the child. He had been told by his professor of obstetrics at Harvard that 'the tensile strength of the newborn' was 'a marvel,' but Larch knew that the tensile strength of a cat was also considerable and he noted that the beast had failed to survive its fall.

'Here in St. Cloud's,' Dr. Larch would write, 'I am constantly grateful for the South End of Boston.' He meant he was grateful for its children and for the feeling they gave him: that the act of bringing them into this world was perhaps the safest phase of their journey. Larch also appreciated the blunt reminder given him by the prostitutes in the South End. They recalled for him the painful gift of Mrs. Eames. He could not see the prostitutes without imagining their bacteria under the microscope. And he could not imagine those bacteria without feeling the need for the giddy warmth of 65 ether—just a sniff; just a light dose (and a light doze). He was not a drinking man, Dr. Larch, and he had no taste for tobacco. But now and then he provided his sagging spirits with an ether frolic.

One night, when Wilbur was dozing in the South End Branch of the Boston Lying-in, he was informed by one of the doctors that there was an emergency arrival, and that it was his turn. Although she had lost a lot of weight and all of her youthfulness since Larch had last seen her, he had no trouble recognizing Mrs. Eames. She was so frightened, and in such intense pain, that she had difficulty catching her breath, and more trouble telling the nurse-receptionist her name.

'Rhymes with screams,' said Dr. Larch helpfully.

If Mrs. Eames recognized him right away, she didn't let on. She was cold to the touch, her pulse was very fast, and her abdomen was as hard and white as the knuckles of a tight fist; Larch could detect no signs of labor, and he couldn't hear the heartbeats of the fetus, which Larch couldn't help imagining as having features similar to Mrs. Eames's sullen teen-age daughter. How old would she be now? he wondered. Still about his own age —that much he had time to remember before attending to his diagnosis of Mrs. Eames: hemorrhage within the abdomen. He operated as soon as the house officer could locate the necessary donors for the transfusion.

'Missus Eames?' he asked her softly, still seeking some recognition from her.

'How's your father, Wilbur?' she asked him, just before he operated.

Her abdomen was full of blood; he sponged away, looking for the source, and saw that the hemorrhage issued from a six-inch rupture in the back of the uterus. Larch performed a Caesarean section and delivered a stillborn child—the pinched, scornful face of which forcibly reminded him of the cigar-smoking daughter. He wondered why Mrs. Eames had come here alone. \'7b66\'7d

To this point in the operation, young Larch felt in charge. Despite his memories of the woman opened up before him—and his memories of her transmitted disease, which he was only recently rid of—he felt he was handling a fairly manageable emergency. But when he tried to sew up Mrs. Eames's uterus, his stitches simply pulled through the tissue, which he noticed was the texture of a soft cheese—imagine trying to put stitches in Muenster! He had no choice then; he had to remove the uterus. After all the transfusions, Larch was surprised that Mrs. Eames's condition seemed pretty good.

He conferred with a senior surgeon in the morning. At the Boston Lying-in it was standard that an obstetrician's background was surgical—Larch had interned in surgery at Mass General—and the senior surgeon shared young Larch's bafflement with the disintegrating consistency of Mrs. Eames's uterus. Even the rupture was a puzzle. There was no scar of a previous Caesarean section that could have given way; the placenta could not have weakened the wall of the uterus because the afterbirth had been on the other side of the uterus from the tear. There had been no tumor.

For forty-eight hours Mrs. Eames did very well. She consoled young Wilbur on the death of his parents. 'I never knew your mother, of course,' she confided. She again expressed her concern that Wilbur consider her reputation, which Wilbur assured her he would (and had—by refraining from expressing his fears to the senior surgeon that the condition of Mrs. Eames might somehow be the result of gonorrhea). He briefly wondered which story Mrs Eames was using at the moment, regarding her reputation: whether she was claiming to live a proper life in Portland or in Boston; whether a third city was now involved and necessarily a third fictitious life.

On the third day after the removal of her strange uterus, Mrs. Eames filled up with blood again, and Wilbur Larch reopened her wound; this time he was \'7b67\'7d quite afraid of what he'd find. At: first, he was relieved; there was not as much blood in her abdomen as before. But when he sponged the blood away, he perforated the intestine, which he had hardly touched, and when he lifted up the injured loop to close the hole, his fingers passed as easily through the intestine as through gelatin. If all her organs were this same fragile jelly, Larch knew Mrs. Eames wouldn't live very long.

She lived three more days. The night she died. Larch had a nightmare—his penis fell oft sf in his hands; he tried to sew it back on but it kept disintegrating; then his fingers gave way in a similar fashion. How like a surgeon! he thought. Fingers are valued above penises. How like Wilbur Larch!

This helped to strengthen Larch's conviction regarding sexual abstinence. He waited for whatever had destroyed Mrs. Eames to claim him, but the autopsy, which was performed by a distinguished pathologist, seemed off the track.

'Scurvy,' the pathologist said.

So much for pathologists, thought Wilbur Larch. Scurvy indeed!

'Missus Eames was a prostitute,' Larch told the pathologist respectfully. 'She wasn't a sailor.'

But the pathologist was sure about it. It had nothing to do with the gonorrhea, nothing to do with the pregnancy. Mrs. Eames had died of the sailor's curse; she had not a trace of Vitamin C, and, the pathologist said, 'She had destruction of connective tissue and the tendency to bleed that goes with it.' Scurvy.

Though this was a puzzle, it convinced Larch that it wasn't a venereal puzzle and he had one good night's sleep before Mrs. Eames's daughter came to see him.

'It's not my turn, is it?' he sleepily asked the colleague who roused him.

'She says you're her doctor,' the colleague told him.

He did not recognize Mrs. Eames's daughter, who had \'7b68\'7d once cost less than Mrs. Eames; now, she would have charged more than her mother could get. If, on the train, she had seemed only a few years younger than Wilbur, now she seemed several years older. Her sullen teen-age quality had matured in a brash and caustic fashion. Her makeup, her jewelry, and her perfume were excessive; her dress was slatternly. Her hair—in a sinrle, thick braid with a sea-gull feather stuck in it—was so severely pulled back from her face that the veins in her temples seemed strained, and her neck muscles were tensed—as if a violent lover had thrown her to her back and held her there by her strong, dark pigtail.

She greeted Wilbur Larch by roughly handing him a bottle of brown liquid—its pungent odor escaping through a leaky cork stopper. The bottle's label was illegibly stained.

That's what did her in,' the girl said with a growl. 'I ain't having any. There's other ways.'

Is it Miss Eames?' Wilbur Larch asked, searching for her memorable cigar breath.

I said there's other ways!' Miss Eames said. 'I ain't so far along as she was, I ain't quick.'

Wilbur Larch sniffed the bottle in his hand; he knew what 'quick' meant. If a fetus was quick it meant the mother had felt it move, it meant the mother was about half through her gestation period, usually in her fourth or fifth month; to some doctors, with religion, when a fetus was quick it meant it had a soul. Wilbur Larch didn't think anyone haid a soul, but until the middle of the nineteenth century, the common law's attitude toward abortion was simple and (to Wilbur Larch) sensible: before 'quickeninG'—before the first, felt movement of the fetus—abortion was legal. More important, to the doctor in Wilbur Larch, it was not dangerous to the mother to perform an abortion before the fetus was quick. After the third month, whether the fetus was quick or not, Wilbur Larch knew it had a grip on the uterus that required more force to break. \'7b69\'7d

For example, the liquid in the bottle Wilbur Larch was holding had not provided sufficient force to break the grip that Mrs. Eames's fetus had on her—although, apparently, it had exerted enough force to kill the fetus and turn Mrs. Eames's insides to mush.

'It's gotta be pure poison,' Mrs. Eames's tough daughter remarked to Wilbur Larch, who dabbed a little of his beloved ether on the bottle's stained label, cleaning it up enough to read.

FRENCH LUNAR SOLUTION

Restores Female Monthly Regularity!

Stops Suppression!

(Suppression, young Larch knew, was a euphemism for pregnancy.)

Caution: Dangerous to Married Women!

Almost Certainly Causes Miscarriages!

the label concluded; which, of course, was why Mrs. Eames had taken it and taken it.

Larch had studied the abuse of aborticides in medical school. Some—like the ergot Larch used to make the uterus contract after delivery, and pituitary extract— directly affected the uterus. Others ruined the intestines —they were simply drastic purgatives. Two of the cadavers Larch had worked with in medical school had been victims of a rather common household aborticide of the time: turpentine. People who didn't Avant babies in the 1880s and 1890s were also killing themselves with strychnine and oil of rue. The French Lunar Solution Mrs. Eames had tried was oil of tansy; she had taken it for such a long time, and in such amounts, that her intestines had lost their ability to absorb Vitamin C. Thus did she turn herself into Muenster. She died, as the pathologist had correctly observed, of scurvy.

Date: 2015-02-03; view: 855