The Art of Dying Read online

  ‘I cannot imagine there is anything that we need to talk about. Please bring me the next patient.’

  ‘It’s about Dr Simpson,’ she said.

  ‘What about him?’

  ‘There has been a recent difficulty. A patient died under his care. He has been accused of negligence.’

  ‘By whom? The family? Grieving relatives often wish to apportion blame when in fact the practitioner bears no responsibility for an adverse outcome. I doubt they have grounds for their complaint.’

  ‘It’s not the family.’

  ‘Then who?’

  ‘Dr Matthews Duncan and Professor Miller.’

  Raven got up from his chair. ‘I don’t understand. A former assistant and the Professor of Surgery are accusing him of killing a patient. Why?’

  ‘There is not the time to explain right now. Come to dinner this evening. We can discuss it then.’

  Without waiting for a reply, she left the room.

  Dinner. With Sarah. And presumably her husband. He would rather be back in Berlin facing the police.

  EIGHTEEN

  he dishes on the table looked and smelled inviting but Raven had little appetite. How could he eat? He was sitting opposite Sarah’s husband.

  Dr Archie Banks was not what he had expected. Or, if he was being honest, not what he had hoped for. He had thought – one of the many explanations he had entertained – that perhaps Dr Banks suffered from some form of physical deformity, a dowager’s hump or a facial disfigurement, to account for his taking a wife from so far outside his own social class. However, this had proven not to be the case.

  Archie Banks was, incontrovertibly, an attractive man. He was tall, with a full head of sandy-coloured hair, neatly trimmed moustache, clear complexion and strikingly blue eyes. He was perhaps a little thin, but this could hardly be construed as a defect. He did not gorge his food or consume too much wine – in fact he ate and drank with considerable moderation. He expressed himself well though he said little. He seemed content to let Sarah do most of the talking. For all that Raven had been prepared to detest him, he found Archie to be disappointingly deficient in objectionable traits.

  Raven tried to engage in polite conversation while he pushed the food around on his plate, but all he could think about was the fact that Sarah had married this man – and all that this entailed. By the end of the meal he felt thoroughly dyspeptic and would have excused himself and gone home but for the fact that they had not discussed the issue which had necessitated his coming here in the first place.

  ‘So,’ Raven said as the housekeeper cleared away the last of the dishes, ‘regarding Dr Simpson. Tell me what has happened.’

  Sarah waited for the door to close.

  ‘It all started with a rumour.’

  ‘These things usually do.’

  ‘Originating with Professor Henderson,’ she went on.

  ‘Henderson. The homeopathy enthusiast. Everyone knows he has an axe to grind. Simpson has always been vocally opposed to that nonsense.’

  Sarah frowned at him and he realised that he should probably let her continue without further interruption.

  ‘Dr Simpson performed a procedure on a woman who subsequently died. Henderson claims that her bloodstained mattress is proof that she died as a result of haemorrhage. According to him, she bled to death and the fault lies with Dr Simpson.’

  Raven opened his mouth to speak but thought better of it.

  ‘This rumour was then given credence when Dr Matthews Duncan and Professor Miller went to interview the upholsterer about the mattress.’

  ‘The upholsterer?’

  ‘The mattress had been sent to him to be cleaned.’

  ‘That is very irregular,’ Raven said, now finding it impossible to hold his tongue. ‘It is most unprofessional to instigate an arbitrary investigation into another doctor’s practice.’

  ‘They denied that they did,’ Archie said. ‘They claim that they merely sought refuge in his shop during a downpour while waiting for the omnibus and happened onto the subject by chance.’

  Raven snorted. There were multiple implausibilities to this explanation, chief of which was the notion of the two Edinburgh doctors in question clambering to the top of a crowded omnibus. In the rain.

  ‘Tell me about the case itself.’

  ‘I’ll tell you what I know,’ Sarah said. ‘Mrs Johnstone, wife of Dr Johnstone at 34 Queen Street, was to undergo a straightforward procedure. Something to do with the cervix, I think. Professor Syme had performed a similar procedure two years before. Dr Simpson maintains that there was little bleeding, that the patient did not die as a result of haemorrhage.’

  ‘What was the cause of death?’

  ‘Inflammation.’

  Raven refrained from asking how she came to know these things. He knew she had a habit of listening behind doors.

  ‘Syme must be enjoying this,’ he ventured. ‘Has he entered the fray?’

  ‘Not that I’m aware of.’

  ‘What did the post-mortem reveal?’

  ‘There wasn’t one. Dr Simpson wanted to spare the husband further distress. Although I think he regrets that now.’

  ‘What does Dr Johnstone say about this? He must have formed an opinion.’

  ‘I don’t know, but I think we should ask him.’

  ‘We?’

  ‘Yes. We ought to find out what really happened, don’t you think? Dr Simpson seems content to write a few letters and hope the whole thing dies down. But I am not prepared to stand by and let his good name be sullied.’

  Raven was surprised that Sarah should seek to involve him and was about to ask why her husband couldn’t perform this role when Archie stood and excused himself.

  ‘I’m afraid I’m going to have to withdraw. Please do accept my apologies but I am suddenly terribly tired.’

  He reached out his hand and Raven shook it.

  ‘I’m really very pleased to have finally met you,’ Archie said. ‘From what I have been told, if anyone could get to the bottom of this queer business, it would be you.’

  Sarah also got up from the table and went to the sideboard. She took a glass bottle from it and followed Archie out of the room.

  Raven thought this rather strange. He would have taken the opportunity to leave himself, but his curiosity was piqued by Archie’s sudden withdrawal. Despite Archie’s politeness, Raven wondered if he had unwittingly caused offence in some way. He had a tendency to do that, though it usually ended in a threat of violence rather than the injured party taking to his bed.

  Sarah returned after a short time and put the bottle back into the cupboard.

  ‘What is that?’ Raven asked.

  ‘Chloroform. It helps him sleep.’

  Raven’s opinion of this must have shown on his face.

  ‘Dr Simpson suggested it,’ she said, as though the mention of the great man’s name would dispel all doubt as to the propriety of using an anaesthetic as a cure for insomnia. ‘Mrs Simpson uses it on occasion too,’ she added, sensing further justification was required.

  ‘The professor seems to prescribe it for everything, showing little concern for the dangers associated with such indiscriminate use.’

  ‘That is not true.’

  ‘What about the patients who have died as a result of inhaling it?’

  ‘Sometimes the chloroform is not pure. It is not always correctly manufactured. And there are frequently errors in how it is administered.’

  ‘You sound just like him.’

  ‘If you are referring to Dr Simpson, I have no issue with that.’

  Raven sighed. He couldn’t help but think about the incident with the carpet.

  ‘Don’t you ever fear he can be a little rash? A little impetuous?’ he asked, moderating his tone. He did not want to get into an argument. This was her household, after all.

  ‘I would say fearless. Robust in his opinions.’

  ‘I suspect his enthusiasm for chloroform may on occasion cloud his judgmen
t.’

  If he hadn’t given offence before, the look on her face left him in no doubt that he had given it now.

  ‘Will Raven, you’re not the first to have toured the great hospitals and institutions of Europe and come back convinced you know everything. You might have been listening to great minds discussing hypotheticals, but I have been working with Dr Simpson on the practical realities every day. I think I’m in a better position to assess how “cloudy” his judgment is.’

  Raven answered quietly, choosing his words with concision and care.

  ‘No one is infallible, Sarah.’

  He could see the outrage building in her eyes.

  ‘Do you doubt him? Are you saying you believe he might be guilty of what he is accused?’

  He answered swiftly to head off her ire.

  ‘Of course not. I am simply warning you that even Dr Simpson has feet of clay. As for this business, I suspect it is merely an unseemly squabble among rivals that is less about the facts of the case and far more about personal agendas.’

  ‘Then you’ll help me?’

  He looked at her for a moment. There was a time when she could have easily talked him into doing just that, but those days had passed.

  He thought about the forces ranged against Simpson, and not merely the ones who had shown their hands here. Raven was trying to build a career, and needed to forge profitable allegiances, not make powerful enemies. He thought about his fragile reputation and how it could quickly be tarnished by association. If he were discovered taking sides in this dispute, he would be mere cannon fodder in a battle between generals.

  ‘As I already mentioned, it is unprofessional to secretly investigate another doctor’s conduct,’ he said. ‘It would be no more appropriate for me to go snooping about behind Dr Simpson’s back than it is for Miller or Matthews Duncan. I am quite sure that if the professor required my assistance in this matter, he would ask me himself.’

  NINETEEN

  espite the trouble it was to bring me, I think the killing of Mrs Johnstone remains the one of which I am most proud. It continues to amuse me that her death should have become the centre of so much controversy, the great men of Edinburgh medicine playing out their games of blame and innuendo, speculation and accusation across the journals and the newspapers. What sport they had, what duels they fought, and yet none came close to the truth. Supposedly the greatest medical minds in the city failed to deduce why she should have suddenly deteriorated and would not respond even under the care of the esteemed Dr Simpson, a man whose name is known around the world.

  If I had anticipated what this death would precipitate, perhaps I would have savoured it more. But is that not often the way of things: how the most significant moments pass us by, only revealing their value to us after the fact?

  And in any case, I did relish Mrs Johnstone’s death at the time, in and of itself. It could be said that we made each other famous, so it was appropriate that we should have had our intimacy, our exquisite coupling.

  I recall the warmth of her body against me. How her breath hastened as our limbs entangled beneath the sheets. A perversity, you would no doubt say: a forbidden kind of love. But my God, the things I felt as she died in my arms, knowing it was by my hand.

  TWENTY

  aven took a deep breath of the cold, clear sea air through the open window of the carriage and imagined the soot and the smog of the city being swept from him. They were on their way to Portobello to visit a patient there: a child who had a recurrent problem with her ears, attributed to bathing in the sea too late in the season. Raven was enjoying the journey as a welcome respite from everything else that was going on, and a distraction from the pain of a sore tooth that had begun to trouble him.

  He rarely accompanied the professor on home visits, his time being taken up with his other duties. Most days he saw patients at Queen Street in the morning and attended the Maternity Hospital in the afternoon. He mainly saw Dr Simpson at mealtimes, though he had declined an invitation to participate in the doctor’s ongoing post-prandial inhalational experiments. He decided that he had no stomach (or head) for such things and marvelled at the professor’s enthusiasm for persisting with such a risky undertaking. Raven agreed with Jarvis that the professor was unlikely to find anything better than ‘chlory’.

  When on occasion he was invited along, Raven enjoyed the novelty of a change of scene, be it a Princes Street hotel or a jaunt further afield. He had ceased trying to impress the professor with the knowledge he had accumulated on his travels and was rediscovering the value of listening to his mentor hold forth on any number of topics.

  He felt a little guilty that he had refused Sarah’s request, and found himself seeking reassurance that he was right not to get involved.

  ‘Pay no heed to idle chatter,’ Simpson said. ‘I have more important things to occupy my time. I remain busy in the defence of chloroform. Pockets of opposition still persist, and I am determined to root them out.’

  Raven wondered if his own reservations about its indiscriminate administration were being referred to. And although Simpson’s reply regarding the Johnstone case ought to have comforted him, paradoxically it had the opposite effect. It was often the things that Simpson did not want to talk about that were preying hardest upon his mind. Everything else was a pleasing diversion.

  As they passed Piershill Barracks, Dr Simpson began extolling the virtues of sea air for all manner of complaints, indicating that their previous conversation was at an end. The cold wind which had initially seemed refreshing now felt distinctly icy, but there seemed little likelihood of the carriage windows being closed. Raven sat back as the brougham rumbled on, concerned that the end of his nose might succumb to frostbite by the time they reached their destination. The chill was proving no friend to his sore tooth either.

  They drew up at a house situated on a wide avenue with an uninterrupted view of the sea. The sound of waves could be heard through the open windows of the carriage and Raven could taste salt on his tongue. Simpson sat for a moment before disembarking. Raven assumed he was enjoying the vista before them, but the professor sighed and said quietly to himself: ‘How I yearn for an outing without the usual invalid at the end of it. I really must get a week or two free from the bell and sick folk.’

  Raven wondered if the professor’s workload was beginning to take a toll on the man, but any self-pity, if such it was, he quickly brushed aside. He turned to Raven and smiled.

  ‘Come away now,’ he said, stepping down from the carriage.

  The front door opened as they ascended the steps and a worried-looking woman directed them to the room where their patient lay sleeping.

  ‘She has been awake all night, poor lamb,’ said the child’s mother. ‘She has only just fallen asleep.’

  ‘Then we must endeavour not to wake her,’ Simpson replied.

  They entered a room, shutters closed against the brightness of the day, an oil lamp providing a dim glow in one corner. The child was lying propped up on several pillows, turned slightly towards them, her left ear uppermost. Her face was flushed, the ear a brilliant red, like glowing coals, and seemed to be giving out almost as much heat.

  Dr Simpson removed his coat and quietly knelt down beside the bed. He placed his hand lightly on the child’s head and then felt for the pulse at the wrist. Then he stood again, opened his bag and removed a glass jar containing several leeches.

  Raven observed the mother’s revulsion upon seeing the damp, black creatures. He masked his own surprise better, but hers was exacerbated by fear for her child. Raven had seen that look before when unpleasant treatments were prescribed: squeamishness at the prospect of what must be done, mixed with a greater dread that the diagnosis must be terrible to have necessitated such a course.

  Simpson was about to unclip the lid when he paused and squinted at the ear.

  ‘Will, bring the lamp over here if you please. Hold it up so that I may see.’ Raven retrieved the lamp from a table in the corner of the r
oom and held it above Simpson’s head. The doctor pulled gently on the pinna of the child’s ear and moved his own head from side to side as if trying to get a better view of something.

  ‘Ha!’ he said at last.

  He rummaged in his bag for a small metal probe. (Raven always marvelled at the selection of instruments that could be mined from the doctor’s bag.) He then prodded carefully within the ear canal, and after a few minutes extracted a round object which had been lodged within it.

  Simpson placed the object upon Raven’s outstretched hand to allow him to examine his find. Raven rolled it back and forth over his palm. It was a spherical concretion which could have been, in its original form, animal, mineral or vegetable.

  ‘Is it a bead?’ Raven asked, making what he thought to be an intelligent guess.

  Simpson punctured the surface of the object with his probe and held it closer to the light.

  ‘I think it is, or was, a pea,’ the doctor said. ‘Children have a great propensity for placing small items within the cavities of the nose and the ear. This curious behaviour defies any rational explanation, but the presence of such a foreign body does provide us with the reason for the child’s recurrent ear problems. Mystery solved.’

  Chuckling to himself, Dr Simpson then unclipped the lid of the leech jar and applied several of the creatures to the most inflamed parts of the ear.

  Evidently, he had noted Raven’s previous response.

  ‘I am entirely sceptical about the efficacy of relentless purging, blistering and bloodletting,’ he said. ‘However, leeches do serve a useful function, if one altogether more limited and specific than our predecessors – and sadly still some of our peers – believe. They are most efficient at reducing engorgement, and they seem to purify the blood in some way, as if removing the poisons responsible for fever.’