I feel a familiar flutter of uncertainty as I stand on the porch of the old farmhouse. What awaits me on the other side of this door? Will it be a condition I haven’t seen before, for which I can’t even offer the comfort of a name? Or worse, a death sentence, for which all I can offer is my condolences? I grip my black bag, take a deep breath, and lift my hand to the door. My fist hovers for a second before my knuckles come down on the heavy wood door. One, two, three sharp raps. The noise is so loud against the background of crickets in the early morning quiet it makes me jump a little. I look around, embarrassed, but my horse only snorts and looks away. No one else is here to witness my apprehension.
I have not been here before, have only heard second- and third-hand of the well-to-do couple that moved here from the city. Moved for the fresh sea air, a tonic I’ve prescribed on more than one occasion, myself.
Her eyes are heavy in their sockets, pitch black against her papery, pale skin. She stares at me for a few seconds through a two-inch opening between the door and its frame, lids drooping over those dark eyes, before recognition startles her fully awake.
“Doctor.” She takes a step backwards, the door creaking open now of its own accord.
I run my index finger down the arm of my glasses, a nervous habit, then squint into the darkness ahead of me. “The patient?”
“Oh. Yes. Come with me.” She turns on her heel and strides quickly down the hall, as if time is of the essence.
There is so much furniture in the house and so little light that I am shocked when I make it to the back room unscathed. She perches herself on a small chair—a child’s chair—beside a figure in the bed. A candle flickers on the table beside her. The patient’s profile is outlined by the soft light, delicate curls framing the small forehead. I realize this is not an invalid parent, as I had secretly hoped. Not the woman’s husband, either.
I look down at the tiny frame for a moment while I acknowledge my emotions and then shove them down to that inaccessible place. I am not the victim here, although I can’t help but feel that way sometimes. Who else must face the bitter chill of death every day and then get up to do it again the next?
The woman doesn’t take her eyes off me, but I feel confident I have revealed nothing to her. I have perfected my presentation in the first few moments of the patient encounter. It is of no use to anyone for me to reveal uncertainty. Sadness. Horror. I stand with one hand on my chin and one gripping my bag. I put a look on my face that says, “I am calm and experienced. You did the right thing by calling me.” I give a subtle nod, then slide down to kneel beside the little girl’s bed.
“We received word of her illness eight days ago. It was a cold, nothing more. Fevers, cough, runny nose. But when other children developed the rash, the head mistress required any child with a fever be evacuated. We sent Charles to fetch her.”
“And that was…?”
“Six days ago. By the time she reached us, another day had passed and her little face was red, like a sunburn.” The woman’s voice quivers slightly, and she reaches out a hand to caress her daughter’s cheek. “By the next day it had spread down to her legs.”
The girl sleeps soundly, completely oblivious to the conversation going on around her. She takes small, almost imperceptible breaths, several in a row followed by a pause and a gasp. Then the pattern repeats.
“How long has she been sleeping like this?”
“She didn’t sleep all night last night. She was writhing and moaning…then the convulsions began. That’s when we sent for you.” She holds her daughter’s hand, stroking it with urgency, purpose. “I couldn’t watch it anymore. Peter went into town and the druggist sent a tonic, something to calm her.”
“And she’s been sleeping ever since?”
The woman’s head shoots up to look at me. “Is something wrong?” Her eyes search mine.
I look back at the child, studying her in silence, considering my next words carefully. “Please, don’t read too much into my questions, ma’am. I just need to get the whole story.”
She nods and looks down again at her daughter. A single tear splashes onto the girl’s hand.
“Tell me about the time between her arriving and the events of last night. Don’t leave anything out.” I open my black bag as she begins to talk.
The girl had not been herself upon arriving home. Weak, no appetite, complaining about various aches and pains. But something had changed two days ago. Just when her fever seemed to be breaking, she began to talk “out of her head.” Then she developed the pain, clutching her head in agony. She had required all the curtains be pulled and the room to be as dark as possible.
I have finished my exam. Suddenly exhausted, I place the tuning fork and the ophthalmoscope back in my bag, hold the stethoscope limp in my hand. The power of knowledge is no power at all.
“I kept thinking it would run its course.”
I nod, meeting her gaze as I do so. She needs to know she has done nothing wrong. This knowledge will steel her in the difficult months ahead. Hopefully prevent us losing a second life to hysteria or…worse.
“Many of her classmates have had this and recovered. They’re saying it’s measles.” Her eyes beg me for hope.
I take the woman’s hands in my own. “Yes. She almost certainly had the measles. For many, the disease consists of fevers and a rash and then they are done with it. For others—”
Her hands shake uncontrollably beneath mine. “For others?”
“Your daughter has developed a toxicity in the brain. Encephalitis.”
“And? What does that mean? What do we do?”
I try to swallow, but my mouth has gone dry, my throat like sandpaper. “You should call your husband.”
She looks at me through watery, sorrowful eyes. Then she collapses onto her daughter’s bed, sobbing, grabbing at the covers, at her daughter’s arms and legs. Grabbing her face between her hands.
“Eleanor, can you hear me? Eleanor, you’re going to be fine. Open your eyes, Eleanor.”
I place a hand on her back. There are no words, but I close my eyes and concentrate on sending peace, courage, and strength to her through my fingertips. God willing, she will not remember this day. But if she must, I hope she will recall a kind touch.
I reach into my bag and pull out a glass bottle. Place it on the bedside table. “Paraldehyde. It will calm the convulsions. Allow her to rest.”
The woman is silent now. Listening, but refusing to meet my gaze.
“A few drops on the tongue should be effective. If not, you can repeat the dose.”
The woman walks me to the door, slowly this time. She is melancholic, sinking already into a dangerous place from which she may never return. I pull another bottle out of my bag. “For you. For sleep.”
She takes the bottle from me and I step onto the porch. The door closes, and I am once more alone with the silence, feeling helpless. Useless.
A disease for which there is no cure, no prevention other than complete isolation from humanity. It is the human condition, to risk death from simply involving our lives in the lives of others, in the pursuit of something greater than ourselves.
I lean against the door and close my eyes tight, but not before a single tear escapes. It is my condition, the doctor’s condition, to care.