The Art of Dying Page 10

Dr Fowler looked momentarily confused. ‘No, Edinburgh,’ he replied, missing the veiled insult implied by this question. It had once been the case that, in their eagerness for funds, the University of St Andrews would issue a medical degree by post, without visit or examination, for the simple fee of ten pounds.

  ‘What do you think is the diagnosis here?’ Raven asked, hoping to redirect the man’s thoughts and curtail this nonsense; although given what had just been said, he did not anticipate giving his opinion much credence.

  ‘Some form of apoplexy?’ Fowler suggested.

  ‘Perhaps. His age would count against that and if there had been any kind of bleeding within the skull there would be other signs, would there not?’

  The nurse appeared at the landing, a slight woman in a navy-blue dress.

  ‘I’m just stepping out briefly, Dr Fowler,’ she said. Her accent was not local. Raven thought she might be from Glasgow.

  ‘I still think we ought to purge him,’ Fowler said, repeating his earlier suggestion, perhaps for the nurse’s benefit as she retreated downstairs.

  ‘Absolutely not,’ Raven insisted. ‘You asked me here for my advice and that is it. Perhaps if you desist from relentless depletion, he might recover sufficiently for me to make a better determination of what ails him.’

  The older man shrugged. ‘Very well,’ he conceded, though he didn’t sound convinced.

  Fowler went back into the patient’s room and returned presently with his jar of dead leeches.

  ‘A terrible loss,’ he said, shaking his head.

  Even in the dark of the hallway, Raven failed to conceal his disdain.

  ‘Your leeches?’

  ‘Why, yes. I’ve had them for some time, and they have served me well. I think of them as my little assistants.’

  ‘Perhaps their working life was excessively extended,’ Raven suggested, placing a hand on his colleague’s shoulder. ‘An earlier retirement from practice might well have saved them,’ he added, hoping to plant a suggestion in the old relic’s head.

  TWENTY-THREE

  arah poured tea into two china cups of expensive porcelain decorated with briar roses. The delicately painted pink petals made her think of the rosehip tea her grandmother had made them all drink during the winter months to ward off coughs and colds. She now spent considerably more time drinking tea than merely pouring it for others, but unlike the other married ladies of the New Town, could not imagine being satisfied by a future wherein tea drinking would occupy so much of her time. She preferred to work and to study, which was just as well as such solitary pursuits did not tend to garner many friends.

  Mrs Glassford sat opposite her in a high-backed chair, a mound of cushions supporting her back, her swollen feet elevated on an embroidered stool. Sarah handed a cup to her companion and noticed as she did so that Mrs Glassford’s tremulous grip caused a little spillage into the saucer. She was barely eating anything at all now, subsisting mainly on tea and thin soup. A pauper’s diet.

  ‘Have you thought any more about Dr Simpson’s offer?’ Sarah asked.

  ‘Of moving into a room at Queen Street? It is kind of him to suggest it, but I manage well enough here. I have a housemaid to assist me.’

  ‘Do you receive any visitors?’

  ‘None in addition to your good self. I know so few people here that I am left entirely unmolested. I am at liberty to spend my time as I choose, which I consider to be a great luxury.’

  ‘Your family are all in Glasgow?’

  ‘My parents reside there, but I doubt that they know where I am. Family ties have been severed for some time.’

  ‘I’m sorry to hear that.’

  ‘It was the price I paid for choosing my own path.’

  ‘Your own path?’

  Sarah felt the usual tension provoked by such snippets of information – polite rectitude straining against a ravenous curiosity. When your own life had been so limited, the exploits of others became a source of fascination.

  ‘I refused to marry the man my father had so carefully selected for me. A man of property who saw me in much the same way: an object to be owned, an acquisition. He was considerably older than I was, self-obsessed and controlling. I despised him.’

  ‘Did your father know this? The reasons why you did not want to marry?’

  ‘My opinion was irrelevant. Or so I was told. I was accused of being difficult, obstructive. But I had no wish to become an ornamental fixture with nothing to do but supervise servants and produce male heirs – “A toy of man who must jingle in his ear whenever he chooses to be amused.” Wollstonecraft said that.’

  Sarah was unfamiliar with the quote and the lack of recognition must have shown on her face.

  ‘Wollstonecraft,’ Mrs Glassford said again, as though repetition would invoke some kind of understanding. ‘Don’t tell me you have not read her Vindication of the Rights of Woman?’

  Sarah shook her head.

  ‘That is a deficiency we should rectify immediately. You must have my copy.’

  ‘Thank you,’ Sarah said. ‘What happened after that?’

  ‘I was sent to live with a maiden aunt as punishment. Father thought it would teach me about the lonely life of a spinster – a redundant woman, as he put it – but the experience had quite the opposite effect. My aunt opened my eyes to the world. She hardened my resolve. She was a committed bluestocking: enthusiastically devoted to academic pursuits and adamant that women were equal to men intellectually. She was an inspiration.’

  ‘Was?’

  ‘Yes. She died some years ago. I was inconsolable. My father suggested that she had overtaxed her brain, which left her vulnerable to bodily corruption or some such pernicious nonsense. I resolved at that point to have nothing further to do with him, to live my life on my own terms, free from male domination. But so few respectable occupations are available to a woman. It was a struggle; a lonely one at that.’

  ‘How did you manage?’

  ‘Private tutoring, piano lessons, that sort of thing. And my aunt left me some money, which was a help.’

  ‘And then?’

  ‘And then I met my husband. I had not thought to marry, but he surprised me. When we first encountered one another, I was terribly rude to him, and he later told me that was what drew him to me. He had not thought to marry either. He sought a life distant from convention, one full of excitement and challenge. “There is no room on this voyage for passengers, only crew.” That was what he used to say.’

  She smiled sadly at the memory.

  ‘Our merry crew of two. We thought we were bound for a life of discovery and adventure, but alas, it was not to be. A few weeks in India was all that it amounted to in the end.’

  Mrs Glassford sipped her tea, her eyes misting. Sarah felt a lump in her own throat. What was worse, she wondered: having the dreams of such adventures taken away or knowing already that your life together will be cut short?

  She felt the need to change the subject, and to break the growing silence.

  ‘What was it like, India?’

  ‘Hot. So stiflingly hot. And dusty. But also exotic and invigorating. I was not there long, but it was enough to convey what a tiny corner of the world this is.’

  ‘Did you see elephants?’

  Mrs Glassford seemed surprised by the question.

  ‘I did. Why do you ask?’

  ‘I saw an elephant once, at the Edinburgh Zoological Gardens in Broughton Park. As close as I will ever get to India, I should think.’

  ‘Nonsense. You are young yet. You do not know what your life will become.’

  ‘They also had a lion. And monkeys. And an eighty-four-foot whale skeleton. It was found floating off Dunbar and was dissected on the beach by Robert Knox. Dr Simpson says that Broughton Park is far superior to the zoological gardens he visited in Surrey, where the lion had cataracts and the monkeys all had consumption.’

  Mrs Glassford laughed. ‘Well, it seems, Sarah, that you have seen more of the world than I withou
t having had to leave Edinburgh. I shall have to go to this Broughton Park sometime.’

  They sat in silence for a while, both knowing that such a trip was unlikely to occur.

  ‘I do sometimes wonder if I am being punished,’ Mrs Glassford said quietly.

  ‘Punished?’

  She indicated her swollen abdomen.

  ‘That I have angered the gods in some way in failing to honour my father’s wishes.’

  Sarah thought of her own parents, and of the Simpsons’ lost children.

  ‘I have never found that death or disease discriminate in such a way,’ she said. ‘Good and bad, rich and poor, the sinner and the righteous man: all are vulnerable. No one is protected. And I don’t believe that you are being punished. As far as I am concerned, you have done nothing to deserve such a thing. You simply lived your life as you wanted to, and I can see no fault in that. The sin is that more of us do not do likewise.’

  TWENTY-FOUR

  here were times when Raven wondered about the wisdom of his choice of profession: when a baby died; when a mother died; and on occasions such as this, when he found himself on his knees at a bedside, his hand deep inside a recently vacated uterus, trying to retrieve a reluctant placenta. By rights the thing should have detached itself with no assistance from him, but it had shown no inclination to do so.

  ‘Just find the edge of it and peel it off the uterine wall,’ Dr Ziegler suggested, having placed himself well out of range of any blood spatter at the patient’s other end. ‘Are you going to be much longer?’ he added, lifting the chloroform bottle.

  ‘No, I have it,’ Raven said as he felt the placenta come away.

  He got to his feet, a bloody, pulpy mass of tissue and membrane clutched in his hand. He felt like a distorted reflection of the nurse alongside him, who was clutching an altogether more welcome bundle.

  ‘There must surely be an easier way of doing this,’ Raven muttered.

  ‘Some suggest injecting the umbilical vein with cold water, diluted vinegar or brandy but I have never found such interventions to be in any way effective,’ Ziegler said. ‘And never underestimate the skill required to do this procedure well. I read of a case recently where a surgeon removed part of the uterus and a small section of intestine in addition to the placenta.’

  ‘And yet Professor Syme maintains that certain procedures should only ever be carried out by surgeons.’

  Raven placed the now rather macerated organ into a bowl to examine it and ensure that it was complete. He noticed that Dr Ziegler was staring at him with a look of amusement, and realised that despite having rolled his sleeve up beyond the elbow, it was stained with blood all the way to the shoulder seam.

  ‘I don’t think you’re going to get another day out of that shirt,’ he said, laughing.

  Raven usually enjoyed working with Dr Ziegler at the Maternity Hospital, but today Ziegler’s good humour was wasted on him. He had received another letter from Henry, telling him that Gabriela had gone, and nobody knew where. Henry was subtly enquiring as to whether she might have followed Raven to Edinburgh as part of some secret assignation, though he could tell that his friend was clutching at straws. Raven replied to assure him that her disappearance so soon after his leaving was entirely coincidental, though he also expressed curiosity as to whether its coming so soon after the incident in the alley and the subsequent police inquiry could also be put down to mere happenstance.

  It troubled him to think of what could have occasioned her sudden flight, as it troubled him to consider what Henry might believe or suspect of him. Raven had obliquely confirmed Henry’s suspicions in a reply, stating how he concurred that ‘the unfortunate brigand must indeed have encountered someone with a perverse appetite for mayhem’.

  But even these were not the foremost among his troubling thoughts, being too far away and leaving no role for him by which to intercede. Primarily he was preoccupied with Sarah, an affliction he thought he had cured long ago. It had turned out to be merely in remission.

  He was still trying to come to terms with the fact of her being married. He should have been happy for her, should he not? Grateful that he had been vindicated, and they had both got what they wanted.

  That dinner at her home on Albany Street played out over and over in his mind, always climaxing with her expression of incredulous disgust. He had solid reasons for having refused Sarah’s request, but he remained stricken with doubt over whether it had been the right thing to do. Nor could he be certain whether his judgment was actually flawed or whether he was questioning it simply because he could not endure Sarah’s displeasure.

  He knew that such a consideration should not mean so much to him, especially now. She was at most a colleague, an acquaintance. She was a married woman with her own life, and her disappointment or disapproval should not be an impediment to his abiding by his own decisions. And yet.

  Perhaps it was Sarah’s judgment that was giving him pause. For sure she was over-enamoured of the professor and blind to his weaknesses, but she also had an infuriatingly consistent habit of being right. He wondered if that was what prompted him to hold forth in ostentatious demonstrations of his own knowledge when in her presence: the fear that no matter how much he learned, she would still be wiser than him.

  He returned to the task in hand, removing the soiled linen from beneath the unconscious patient before applying a bandage and compress.

  ‘May I ask you about something rather delicate, Dr Ziegler?’

  The older man’s brow rose in curiosity. Raven took it as assent.

  ‘What do you know about Dr Matthews Duncan and Professor Miller spreading rumours about Dr Simpson?’

  Ziegler looked grave. ‘A medical man relies on his reputation and there are those who seem intent upon destroying his.’

  ‘Why, would you say?’

  ‘Shifting allegiances. And I suspect jealousy plays a part.’

  ‘How so?’

  ‘Professional disagreements sometimes become acrimonious. Slights are deeply felt, grudges held.’

  ‘Specific instances might aid my understanding.’

  ‘I’m not privy to the nature of the dispute with Miller, but I know Matthews Duncan feels he has not been afforded the credit he is due for the discovery of chloroform.’

  ‘He was there that night, I suppose,’ Raven recalled, ‘and he participated in many experiments to find a replacement for ether, albeit unsuccessfully. But Simpson doesn’t deny he had a role, does he?’

  ‘Regardless, it is always referred to as Simpson’s chloroform, and I think Dr Matthews Duncan takes issue with that.’

  ‘That’s hardly Dr Simpson’s fault, and surely not sufficient reason to propagate malicious gossip.’

  Ziegler looked at him intently for a moment.

  ‘In this case, I think it might be more than enough.’

  Raven remembered previous encounters with James Matthews Duncan and thought perhaps Ziegler had a point. He was undoubtedly the possessor of a prodigious mind, but in order to accommodate his cleverness, the part of his intellect that negotiated relationships with other human beings seemed to have been diminished.

  ‘And what of Miller? There must be some perceived iniquity or quarrel to explain his involvement.’

  ‘As I said, I am unaware of recent unpleasantness between Miller and Dr Simpson. All I know is that Simpson did not support him when he applied for the chair of surgery.’

  ‘Why not?’

  ‘Syme was supporting Miller, which might have had something to do with it, but Dr Simpson said it was because Miller had been professionally dishonest.’

  ‘That is quite the accusation. How so?’

  ‘By publishing a report about the death of a patient he had operated on without mentioning the pertinent and incriminating details of the post-mortem findings.’

  ‘What was the case?’

  ‘An orbital aneurysm. Miller ligatured the carotid artery, as was the recognised practice at that time, but when the p
atient died the post-mortem demonstrated that the vagus nerve had been included in the arterial ligature.’

  ‘But that must have been such a long time ago. They are neighbours and always seemed to me to be on good terms. Surely that cannot be the cause.’

  ‘Much can be hidden behind courtesy and politeness, especially by those waiting for their moment to strike. A case of “nursing his wrath, to keep it warm” perhaps. They do say you can take the measure of a man by the calibre of his enemies, and I predict that in time Dr Simpson will cross swords with greater men than these.’

  Raven sighed.

  ‘Can anyone be trusted in this profession? Can you count anyone as a true friend?’

  ‘I would not have thought one so young could sound so weary,’ Ziegler said. ‘Instead of seeking an answer to that question, perhaps you ought to be the answer you would prefer.’

  Raven tucked in the end of the bandage and checked that it was sufficiently tight. He placed a hand on the patient’s abdomen, felt the now firmly contracted uterus and congratulated himself on a job well done. He thought about how many deliveries he had attended over the past few years, how much he enjoyed dealing with straightforward cases and how he was now able to manage the complex ones. He reflected upon how much he had been taught, most of it by Simpson.

  He still marvelled at the swelling of the pregnant abdomen, a new life contained inside, at his ability to feel the position of the child through the abdominal wall, to hear the foetal heartbeat with a stethoscope, an innovation Dr Simpson was keen on. Not everyone was as convinced of the stethoscope’s utility – some thought it had the appearance of quackery – but as usual Simpson was unconcerned with other people’s displeasure. He would endure disapproval and censure if he thought that he was right.

  When it came to the Johnstone case, though, it wasn’t about being right, it was a question of honesty. Was Simpson being professionally dishonest, as he had once accused Miller? Was he attempting to cover up a mistake? Was he so concerned with his reputation that he would do such a thing? Raven found that difficult to believe. Perhaps he should have agreed to help Sarah after all.