I went to the door and opened it, to find Liam sitting on the top step with his head in his heads. Hearing me, he looked around and stood up. “Laudanum,” I said. “Ask if they have some. If not, send to the apothecary.” He nodded without a word and turned down the stairs as I returned to my patient. On my way back into the room, I noticed the chamber pot under her bed and gingerly pulled it out for a look, finding a small amount of urine, cloudy and faintly pink.
I sat down in the chair again. “Do you mind if I—” But I had pulled back the sheet without permission. I am palpating Jane Austen’s abdomen. I was so dizzied by the strangeness of it that at first I could not concentrate. Then I decided her liver was swollen. I kept my hands there, as if the answer lay beneath her skin. Which it did, but not in a way that could help me. “That is the location of the dull pain, approximately?”
“Yes.”
“And the sharp one?” I touched where her hand was. “Somewhere there?”
“Somewhere there.” She winced again, and closed her eyes.
“Do you perspire heavily, at night? I mean, usually. I can see you are feverish now.”
“No.”
I took my hands off her liver and felt her neck again, and all around the throat. “Do you have any pain elsewhere?”
“In my knees. At my hips. In my fingers. Sometimes it is hard to hold the pen. To walk.”
“How long?”
“I cannot recall exactly. Some time now.”
“Do you—” I realized I had no vocabulary for this, a puzzling oversight of Preparation. I did not know the terms polite people used; I did not know the vulgar terms. And since I was spared it myself, the issue had never come up with my servants. For a paranoid moment, I thought how suspicious they must find this: no indisposition, no bloody rags. “Your bleeding—you know. Is it normal?” She stared. “Does it—come every month as usual?”
“Oh!” She looked toward the ceiling. “That has stopped.”
“How long ago?”
“This twelvemonth at least, I should think.” She looked at me. “May I ask to what these questions tend? Do you know what is wrong?”
I hesitated, but she was continuing: “You and your brother are so very clever. No one has forgotten the evening you saved Fanny from choking. I am confident that you—or your brother, for who is the guiding intelligence of this concern, Cassandra and I continue in some doubt—can effect a cure.” She paused, and moved restlessly, seeming distracted, less present. “For despite my sedate time of life, I sometimes feel I have only started to live.” She closed her eyes, grimacing, then gagged and retched as I dived for the chamber pot.
The material that came up offered no indication of internal bleeding; good news. It looked bilious, however, and there wasn’t much of it, despite the effort the vomiting had cost her. I wiped her face and neck off with a damp cloth Cassandra had left; Jane leaned back and closed her eyes.
“Strange how one feels better, just after,” she murmured.
“Not strange at all. It’s a simple physiological—” I stopped myself.
She opened her eyes. Studied me. Closed them again. We sat in silence for a while like that, as I stared at my patient, thinking.
A KNOCK AT THE DOOR; LIAM, HOLDING OUT A SMALL BOTTLE AND a spoon. “Excellent, thank you.” I took them and paused. “Can you possibly find the housemaid?” I asked in a lower tone. “The, uh—”
Following my gaze, he came into the room, reached under the bed, and picked up the chamber pot with a nonchalant air, as if this were nothing unusual for a gentleman. “Back soon.”
As the door closed softly behind him, I turned back to the bed to see Jane’s eyes open again, and wide with surprise. She said nothing, however, as I sat down and opened the bottle of opium solution.
It worked fast; within minutes I saw the tense lines of pain in her face smooth out and her eyes, growing glassier, droop a little. “Did Dr. Ravenswood really just carry my chamber pot away?” she asked, her words slow and dreamy. “Or did I imagine that?”
“Try to sleep a little.” I patted her hand. “He will return it before you need it again.”
“The world is an even stranger place than I have imagined, Mary dear.”
“I know. I know.”
MY EXISTENCE CONTRACTED TO HER BEDSIDE. I STAYED BY IT THE rest of that day, the hours sliding like shadows as I held her hand, wiped her forehead, gave her as much opium as I dared, and encouraged her to drink the barley water Martha supplied at regular intervals with trembling hands and a worried look. Cassandra disappeared for a while to sleep. Liam looked in from time to time, but mostly sat on the stairs just outside in case I asked for something, sometimes going down to talk to Mrs. Austen, who had spent the day gardening, as if a gravely ill daughter were nothing out of the ordinary. I had been appalled by her coldness, but when she came into the room at last, sat down, and looked at her daughter, something in her expression made me forgive her.
Jane was able to keep down the barley water, or most of it; her fever was not better but seemed no worse. Slightly loopy from the laudanum, she remained oriented. As darkness was stealing into the room, Cassandra, who had come by several times already offering to take over, finally insisted strenuously enough that I stood up, kissed my patient on the forehead as I had wanted to do all day, and promised to return in the morning.
“WHAT DO YOU SUPPOSE IS WRONG WITH HER?” LIAM ASKED WHEN we were outside.
I hesitated, as every feeling I’d resisted all day seemed to catch up with me: uncertainty, sadness, dread. “It seems possible that there are two things going on. Whatever has sent her to bed with pain and fever. And whatever she’s had all this time, that’s been turning her odd colors and causing the joint pain and fatigue. Of course this might be an acute presentation of the same underlying ailment, but—I don’t know.” Liam said nothing, just looked at me sideways, worried. “I’m actually praying it’s a kidney stone. She’ll feel like hell for a couple of days, and then she’ll be better. If it’s, say, appendicitis—” I stopped.
She’ll die. I could not say it.
“But she doesn’t die yet. It’s only 1816,” Liam said.
The thought of the probability field, and what we might have done to it, hung in the cool evening air, present but unmentioned. After a long silence that brought us nearly back to our own house, he said:
“And the chronic thing? Do you think it’s what they thought she had? Addison’s?”
“Possible.”
Primary adrenal insufficiency, named after Thomas Addison, who would first describe it in the middle of the nineteenth century, is caused by the destruction of the adrenal cortex by the body’s own immune system. It is rare; a physician could spend a career without seeing a case. Her malaise and nausea could have been caused by the resulting lack of stress hormones—but by many other things too.
The hyperpigmentation, though, was interesting. A comment in a letter to Fanny Knight in March 1817— . . . am considerably better now, & recovering my Looks a little, which have been bad enough, black & white, & every wrong colour—had prompted Dr. Zachary Cope, writing in 1964, to propose the diagnosis of Addison’s.
Lab tests could have determined the levels of stress hormones in her blood. An MRI might have revealed bilateral enlargement and calcification of the adrenal glands. None of which did me any good here.