PLUMBING
LIKE PLUMBING, MEDICINE is a profession where you learn early on not to put your fingers in your mouth. I smelled my next patient coming and was reaching for the jar of soft soap and the bottle of raw alcohol before she came through the door. And the instant I saw her, I knew what the problem was.
There were two women, in fact: one was a tall, rather commanding-looking woman, well dressed and wearing a hat rather than the usual bonnet. The other was a small, slight girl who might have been any age between twelve and twenty. She was what they called a mulatto, half black and half white, with café au lait skin and snub features. I set her lower age limit at twelve only because she had apparent breasts bubbling over the top of her stays. She was dressed neatly but plainly in blue gingham, and she stank like an open sewer.
The tall woman paused, looking me over consideringly.
“You are a female physician?” she asked, in a tone just short of accusation.
“I am Dr. Fraser, yes,” I replied equably. “And you are . . . ?”
She flushed at that and looked disconcerted. Also very dubious. But after an awkward pause, she made up her mind and gave a sharp nod. “I am Sarah Bradshaw. Mrs. Phillip Bradshaw.”
“I’m pleased to meet you. And your . . . companion?” I nodded at the young woman, who stood with her shoulders hunched and her head bent, staring at the ground. I could hear a soft dripping noise, and she shifted as though trying to press her legs together, wincing as she did so.
“This is Sophronia. One of my husband’s slaves.” Mrs. Bradshaw’s lips compressed and drew in tight; from the lines surrounding her mouth, she did it routinely. “She—that is—I thought perhaps—” Her rather plain face flamed crimson; she couldn’t bring herself to describe the trouble.
“I know what it is,” I said, saving her the difficulty. I came round the table and took Sophronia by the hand; hers was small and very callused, but her fingernails were clean. A house slave, then. “What happened to the baby?” I asked her gently.
A small, frightened intake of breath, and she glanced sideways at Mrs. Bradshaw, who gave her another sharp nod, lips still pursed.
“It died in me,” the girl said, so softly I could scarcely hear her, even though she was no more than an arm’s length from me. “Dey cut it out in pieces.” That had likely saved the girl’s life, but it surely hadn’t helped her condition.
Despite the smell, I took a deep breath, trying to keep my emotions under control.
“I’ll need to examine Sophronia, Mrs. Bradshaw. If you have any errands, perhaps you’d like to go and take care of them . . . ?”
She unzipped her lips sufficiently as to make a small, frustrated noise. Quite obviously, she would like nothing better than to leave the girl and never come back. But just as obviously, she was afraid of what the slave might tell me if left alone with me.
“Was the child your husband’s?” I asked baldly. I didn’t have time to beat around the bush; the poor girl was dripping urine and fecal matter on the floor and appeared ready to die of shame.
I doubted that Mrs. Bradshaw meant to die of that condition, but she plainly felt it almost as acutely as did Sophronia. She went white with shock, then her face flamed anew. She turned on her heel and stamped out, slamming the door behind her.
“I’ll take that as a ‘yes,’ then,” I said to the door, and turned to the girl, smiling in reassurance. “Here, sweetheart. Let’s have a look at the trouble, shall we?”
Vesicovaginal fistula and rectovaginal fistula. I’d known that from the first moment; I just didn’t know how bad they might be or how far up the vaginal canal they’d occurred. A fistula is a passage between two things that ought never to be joined and is, generally speaking, a bad thing.
It wasn’t a common condition in civilized countries in the twentieth century but more common than one might think. I’d seen it several times in Boston, at a clinic where I gave time once a week to provide medical care to the city’s poor. Young girls, much too young to be considering the opposite sex in any serious way, becoming pregnant before their bodies had ripened enough. Prostitutes, some of them. Others just girls who had been in the wrong place at the wrong time. Like this one.
A full-term baby that couldn’t be forced out through the birth canal, and days of nonproductive labor, the child’s head a battering ram against the tissues of the pelvis, the bladder, the vagina, and the bowel. Until at last the tissues thinned and split, leaving a ragged hole between bladder and vagina, or between vagina and rectum, allowing the body’s waste to drip out unhindered through the vagina.
Not a matter of life or death, but revolting, uncontrollable, and bloody uncomfortable, too. Sophronia’s inner thighs were swollen, a bright, patchy red, the skin macerated by the constant wetness, the irritating fecal slime. Like a permanent diaper rash, I thought, suppressing a deeply visceral urge to find Mr. Bradshaw and make a few fistulas in him with a blunt probe.
I talked to her while I made my examinations, soothingly, and after a little she began to answer me, though still in whispers. She was thirteen. Yes, Mr. Bradshaw had took her to his bed. She hadn’t minded. He said his wife was mean to him, and she was—all the slaves knew it. Mr. Bradshaw had been nice to her, gentle-like, and when she fell pregnant, he’d taken her from the laundry and put her to kitchen work, where she’d have good food and wouldn’t have to break her back with the heavy linens.
“He was sad,” she said softly, looking up at the ceiling while I wiped away the filthy trickle between her legs. “When the baby died. He cried.”
“Did he,” I said, in what I hoped was a neutral voice. I folded a clean towel and pressed it between her legs, throwing the wet one she’d been wearing into my bucket of vinegar and water. “When did the baby die—how long ago, I mean?”
She frowned, the expression barely rippling the pure young skin of her forehead. Could she count? I wondered.
“Be some time before the sausage-makin’,” she said uncertainly.
“In the fall, then?”
“Yessum.”
And it was mid-December now. I poured water over my dirty hand and dribbled a bit of soap into my palm. I really must try to get a nailbrush, I thought.
Mrs. Bradshaw had come back but hadn’t come in; I’d pulled the curtains over the front window, but her shadowed outline was plain on the cloth, the jaunty feathers in her hat stuck up like a silhouette cowlick.
I tapped my foot thoughtfully, then shook myself into order and went to open the door.
“I might be able to help,” I said without preamble, startling the woman.
“How?” She blinked at me, and, taken unawares, her face was open, troubled but without the pinched look she’d worn earlier.
“Come inside,” I said. “It’s cold out here in the wind,” and guided her in, a hand on her back. She was very thin; I could feel the knobs of her spine, even through her coat and stays.
Sophronia was sitting on the table, hands folded in her lap; when her mistress came in, she bent her head, looking at the floor again.
I explained the nature of the difficulty, so well as I could—neither of them had any grasp of internal anatomy at all; it was simply a matter of holes to them. Still, I managed to get the general point across.
“You know that a wound can be stitched, to hold the skin together while it heals?” I said patiently. “Well, this is much the same kind of thing, but made much harder by the wounds being inside and the tissues being very thin and slippery. It would be very difficult to mend—I’m not sure I can do it—but it is at least possible to try.”
It was—just. In the late nineteenth century, a physician named J. Marion Sims had more or less invented the entire practice of gynecological surgery, in order to address exactly this condition. It had taken him years to develop the techniques, and I knew them—had done the procedure more than once. The catch was that you really needed good, solid anesthesia in order to have a chance of success. Laudanum or whisky might answer for cruder, swifter operations, but for painstakingly delicate surgery like this, the patient had to be completely unconscious and immobile. I would have to have ether.
I had no idea how I was going to make ether, living in a small rented house with a number of people whom I really didn’t want to risk blowing to bits. And the thought of what flammable ether could do—had done—made me break out in a cold sweat. But seeing the faint hope rise in both their faces, I made up my mind to do it.
I gave Sophronia a small jar of beeswax ointment for the skin of her thighs and told them to come back in a week; I would know then whether it was possible. I saw them out, and as they went away down the street, Mrs. Bradshaw reached out unconsciously and touched Sophronia’s shoulder in a brief caress of reassurance.
I took a deep breath and resolved that I would find a way. Turning to go inside, I glanced the other way down the street and saw a tall young man whose lean ranginess struck me with a sense of instant recognition. I blinked once, and imagination promptly clothed him in scarlet.
“William!” I called, and, picking up my skirts, ran after him.
HE DIDN’T HEAR me at first, and I had time for doubt—but not much; the set of head and shoulders, that long, decisive stride . . . He was thinner than Jamie, and his hair was a dark chestnut, not red, but he had his father’s bones. And his eyes: hearing me at last, he turned, and those dark-blue cat eyes widened in surprise.
“Mother Cl—” He cut the word off, his face hardening, but I reached out and took his big hand between my own (rather hoping that I had got all of the slime off).
“William,” I said, panting just a bit, but smiling up at him. “You can call me what you like, but I’m no less—and no more—to you than I ever was.”
His severe look softened a little at that, and he ducked his head awkwardly.
“I think I must call you Mrs. Fraser, mustn’t I?” He detached his hand, though gently. “How do you come to be here?”
“I might ask the same of you—and perhaps with more reason. Where’s your uniform?”
“I’ve resigned my commission,” he said, a little stiffly. “Under the circumstances, there seemed little point to my remaining in the army. And I have business that requires somewhat more independence of movement than I should have as one of Sir Henry’s aides.”
“Will you come and have something hot to drink with me? You can tell me about your business.” I’d rushed out without my cloak, and a chilly breeze was fingering me with more intimacy than I liked.
“I—” He caught himself, frowning, then looked at me thoughtfully and rubbed a finger down the long, straight bridge of his nose, just as Jamie did when making up his mind. And just as Jamie did, he dropped his hand and nodded briefly as though to himself.
“All right,” he said, rather gruffly. “In fact, my business may be of some . . . importance to you.”
Another five minutes saw us in an ordinary off Ellis Square, drinking hot cider, rich with cinnamon and nutmeg. Savannah wasn’t—thank God—Philadelphia, in terms of nasty winter weather, but the day was cold and windy, and the pewter cup was delightfully warm in my hands.
“What does bring you here, then, Willie? Or should I call you William now?”
“William, please,” he said dryly. “It’s the only name I feel is rightfully mine, for the moment. I should like to preserve what small dignity I have.”
“Mmm,” I said noncommittally. “William it is, then.”
“As for my business . . .” He sighed briefly and rubbed a knuckle between his brows. He then explained about his cousin Ben, Ben’s wife and child, then Denys Randall, and finally—Captain Ezekiel Richardson. That name made me sit up straight.
He noticed my reaction and nodded, grimacing.
“That’s what I meant when I said my business might have some relevance to you. Pa—Lord John said that it was Richardson’s threatening to arrest you as a spy that caused him to, er, marry you.” He flushed a little.
“It was,” I said, trying not to recall the occasion. In fact, I recalled only snatches of those empty, glaring days when I’d believed Jamie to be dead. One of those snatches, though, was a vivid recollection of standing in the parlor of Number 17, holding a bouquet of white roses, with John beside me and a military chaplain with a book before us—and, standing on John’s other side, grave and handsome, William in his captain’s uniform and shining gorget, looking so like Jamie that I felt for a dizzying instant that Jamie’s ghost had come to watch. Unable to decide whether to faint or to run out of the room shrieking, I’d simply stood frozen, until John had nudged me gently, whispering in my ear, and I’d blurted out, “I do,” and collapsed on the ottoman, flowers spilling from my hands.
Caught up in the memory, I’d missed what William was saying and shook my head, trying to focus.
“I’ve been searching for him for the last three months,” he said, putting down his cup and wiping his mouth with the back of his hand. “He’s an elusive scoundrel. And I don’t know that he’s in Savannah at all, for that matter. But the last hint I had of him was in Charleston, and he left there three weeks ago, heading south.
“Now, for all I know, the fellow’s bound for Florida or has already taken ship for England. On the other hand . . . Amaranthus is here, or at least I believe so. Richardson seems to take an inordinate interest in the Grey family and its connections, so perhaps . . . Do you know Denys Randall yourself, by the way?”
He was looking at me intently over his cup, and I realized, with a faint sense of amusement mingled with outrage, that he had thrown the name at me suddenly in hopes of surprising any guilty knowledge I might have.
Why, you little scallywag, I thought, amusement getting the upper hand. You need a bit more practice before you can pull off that sort of thing, my lad.
I did in fact know something about Denys Randall that William almost certainly didn’t know—and that Denys Randall himself might not know—but it wasn’t information that would shed any light on the whereabouts and motives of Ezekiel Richardson.
“I’ve never met him,” I said, quite truthfully, and held up my cup toward the serving maid for more cider. “I used to know his mother, Mary Hawkins; we met in Paris. A lovely, sweet girl, but I’ve had no contact with her for the last . . . thirty . . . no, thirty-four years. I assume from what you tell me that she married a Mr. Isaacs—you said he was a Jewish merchant?”
“Yes. So Randall said—and I can’t see why he’d lie about it.”
“Nor can I. But what you do know—you think,” I corrected, “is that while Denys Randall and Ezekiel Richardson have heretofore appeared to be working together, now they aren’t?”
William shrugged, impatient.
“So far as I know. I haven’t seen Randall since he warned me about Richardson, but I haven’t seen Richardson, either.”
I could sense his rising desire to be up and off; he was drumming his fingers softly on the tabletop, and the table itself shuddered slightly when his leg bumped it.
“Where are you staying, William?” I asked impulsively, before he could go. “In—in case I do see Richardson. Or hear anything of Amaranthus, for that matter. I am a doctor; a lot of people come to see me, and everyone talks to a doctor.”
He hesitated, but then gave another shrug, this one infinitesimal. “I’ve taken a room at Hendry’s, on River Street.”
He stood, tossed some money on the table, and extended a hand to help me up.
“We’re staying at Landrum’s, one square over from the City Market,” I said on impulse, rising. “If you should—want to call. Or need help. Just in case, I mean.”
His face had gone carefully blank, though his eyes were burning like match flames. I felt a chill, knowing from experience the sort of thing that was likely going on behind such a fa?ade.
“I doubt it, Mrs. Fraser,” he said politely. And, kissing my hand in brief farewell, he left.