The Anatomy of Deception (7 page)

“Turk took him out to some dive near the waterfront, just after he arrived here. It had some odd biblical name….”

“The Fatted Calf?” When Simpson confirmed my conjecture, I excused myself and sidled over to Farnshaw.

The young Bostonian had a compulsion to reveal everything that he knew to anyone who would listen, so it was not necessary to ask a direct question. I merely noted that Turk’s illness might have been due to other than a microbe.

“I couldn’t agree more, Carroll,” my young colleague replied eagerly. “From the evidence I’ve seen, it’s remarkable he can stand upright. I don’t think you know this, but he asked me to join him out one evening just after I came on the staff.”

“Really?”

“Yes,” Farnshaw said. “He told me that it must be difficult coming to a new city and working with strangers. I thought it was quite decent of him. We went first to dinner at a very lively restaurant….”

“Barker’s?”

“Yes. How did you know?”

“I’ve been there myself.”

“Ah. In any event, Turk could not have been more affable. He even insisted on paying, though by rights, the check should have been mine.”

“Why is that?”

Farnshaw grew uncomfortable. “It’s obvious … Turk … as we all know … must scrape by on a staff physician’s remuneration, whereas I am … uh …”

“Rich?”

“It is not my fault that I come from means,” he replied haughtily. “In any event,” he continued, “after we had finished dinner, Turk invited me to see some of the city and suggested a drinking establishment he knew. It was down in the waterfront district, but he assured me that I was quite safe with him and that we should have great fun.”

“And you went.”

“I’m sorry to say that I did. Don’t get me wrong, Carroll, it
was
great fun … for a time at least. But I’m afraid that I’m not as accustomed to revelry as I believed, and certainly not as much as is Turk. We drank prodigiously and I became somewhat intoxicated, although Turk, as I remember, was largely unaffected.”

“Was it just the two of you, or were you joined by Turk’s friends?”

“Just us. He did introduce me to a number of people, denizens of the place it seemed, including some most appealing ladies. He was quite familiar … he made sure everyone knew my name. ‘Here’s George,’ he said or, ‘Everyone, meet George.’ I believe that by the time we left, half of the men and women in the establishment knew who I was.”

“That was very generous of him,” I said. “Did he ever take you there again?”

“No,” said Farnshaw, demonstrating genuine puzzlement. “It was quite odd. When I told him on the way home how much I had enjoyed myself, he refused to even acknowledge me. Perhaps I embarrassed him by becoming intoxicated. I was quite ill, I’m afraid. It took three days to recover. But ever since, he has either ignored or made sport of me. Harvard fees, indeed.”

“Turk makes sport of everyone,” I reassured him.

“I know that,” replied Farnshaw, “but I thought he liked me.”

I felt more than a bit foolish to have been taken in by the same ploy used on my naïve colleague. I wondered why
someone as calculating as Turk would waste his time on Farnshaw—or me, for that matter. Before I could inquire further, however, the Professor had moved to the entrance of the children’s ward and swung open the door.

We entered a large and airy room with tall windows that admitted bountiful light. At his insistence, beds had been moved to be at least three feet apart and screens made readily available so that a young patient might enjoy a modicum of privacy during treatment.

In the first bed lay a boy of nine with dark eyes and a mop of black hair, who had been admitted the previous day suffering from dizziness and extreme fatigue. Blood had been taken and examined under the microscope.

“Hello, Giuseppe,” the Professor said with a smile. “How are you feeling today?” Another of the improvements in the care of children was an identification card at the foot of each bed, so that a physician or nurse might address the patient by name. The Professor never needed to look at a card more than once.

“Johnny,” the boy replied weakly. “Not too swell.”

The Professor pulled up a chair. “Okay, then, Johnny, I was wondering if you could help me with something.”

The boy looked suspicious.

“These are my students,” the Professor went on, “and, well, some of them aren’t very good.” Two or three of my colleagues around the bed pretended to look aghast, which elicited a faint smile from Johnny. “I was wondering if you could help me teach them to be better doctors.”

“What do I have to do?”

“I’m trying to teach them to remember four words—just four—but they can’t seem to get it.”

“I could do it,” said the boy.

“They’re kind of tricky.”

“Ah, four words won’t be no trouble.”

The Professor stroked his mustache, then nodded. “All
right. Let’s try. Each of these words stands for something that every doctor should do each time he sees a patient. Ready?”

“Yeah.”

“The first word is ‘inspect.’ Do you know what that means?”

Johnny’s smile broadened. Most of us attending stood blank-faced. Farnshaw had succeeded in appearing positively stupid. “To check something out,” said the boy.

“Perfect!” said the Professor. He turned to us. “A natural, this lad is. That’s right, the first thing a doctor should do is check out the patient, see how the patient looks and feels. So, Johnny, how do you feel today? What bothers you?”

“I’m real tired,” the lad answered. “Every time I stand up, I feel like I’m gonna fall.”

“Do your ears ring?”

“Nah.”

“Are you eating all right? Do you get sick after you eat?”

“Nah.”

“Does it hurt when you breathe?”

“Nah.”

“Fine,” said the Professor. “Now, on to the second word. This one is harder. Do you know what ‘percussion’ means?”

Johnny shook his head.

“It means to knock two things together and see what kind of sound it makes.” The Professor stood. “Watch.” Without warning, he rapped his knuckles against my head. Rounds had distracted me from my postalcoholic malaise but, although it was a physiologic impossibility, I felt as if my brain had shifted inside my skull.

“I just percussed Dr. Carroll here,” he informed the boy with a grin, and I wondered if he had chosen me on purpose. “From the sound, I can tell you what’s inside his head. Sounded kind of hollow, eh?”

Johnny was not the only one who agreed.

“Now, I’m going to percuss your stomach and chest.” The Professor pulled back the sheet and the boy watched with
curiosity as the Professor examined his abdomen and thorax. “Perfect,” the Professor declared when he had finished. “Nothing bad going on there. On to number three, another tricky one. It’s ‘palpate.’ “

“Don’t know that one,” Johnny said.

“It means to press on something, to see how it feels, if it’s too hard or too soft. I’m going to palpate your stomach and your liver.”

When he was finished, the Professor said, “The last word is the hardest, Johnny. It’s ‘auscultate.’ It means to listen. For this one, we have something special.” Dr. Osler removed the familiar device from the pocket of his coat. “This is called a Cammann binaural stethoscope. A lot of big words, but it just makes sound louder. Want to hear your heart?”

“Sure,” said the boy.

The Professor put the earpieces in Johnny’s ears and placed the diaphragm against his chest wall. The boy’s eyes went wide. The Professor then listened himself. When he had completed the examination and tucked the stethoscope back into his coat, he asked, “Well, Johnny, my friend, can you repeat the four words for my doctors here?”

Other than leaving the first “t” out of auscultate, the lad got all four.

“Congratulations,” Dr. Osler exulted. “You now know the four points of the medical student’s compass.” “The four compass points”—inspect, percuss, palpate, auscultate—was to become one of the Professor’s trademark teaching tools. “Johnny,” he went on, “I want you to promise that when you decide to go to medical school, you’ll come here and work for me.”

Johnny, now feeling very good about himself, pursed his lips, looked up at the group clustered around his narrow bed, then nodded. “Sure,” he said. “Why not?”

“And I’m going to make you a promise. You’ll be out of here by early next week and you’re going to be feeling a lot better.”

This was, in fact, a routine diagnosis. Examination of a blood sample had confirmed a red cell deficiency—anemia—which, given the boy’s slum address, was almost certainly due to iron deficiency in his diet. Simple anemia could be treated with an elixir rich in that element, although the boy’s diet once he returned home was unlikely to prevent a relapse.

“Johnny, the nurses will be coming around with medicine. It isn’t going to taste very good, but it’s going to help you get better very quickly. The nurses are very nice women and I don’t want you to give them any trouble about taking it. Then, they are going to give you a nice meal and I expect you to eat it without a fuss. All right?”

The boy agreed quite willingly and we moved on to the next bed, which was occupied by a scrawny girl with sunken eyes and stringy blond hair, no more than twelve. She had been here for over a week with a nontubercular pulmonary illness. “Well, Annie.” The Professor smiled, pulling up a chair next to the bed while the rest of us gathered around. He took her hand and patted it softly. “How are you feeling today?”

“A little better today, Doctor.” The rasp from her lungs was audible with each breath.

“Doctor?” he scolded gently. “Didn’t I tell you to call me Willie?”

A strained smile played across the girl’s pallid face. Her teeth, even at such a young age, were stained and rotting. “Willie,” she whispered.

The Professor nodded. “That’s better.” Again he removed his stethoscope. “Now I’m going to auscultate … you remember … it means I’m going to listen to your breathing.” The Professor listened to her lungs.

“Well, that certainly sounds better,” he said to her after he was done. “In fact, I’d like some of these other doctors to listen also. Would that be all right?”

Annie smiled and nodded. The Professor had made her feel proud, part of the process instead of the subject of it. We took turns listening, the grate in her lungs roaring like surf in
our ears. She was not in the least improved. As Simpson placed the stethoscope’s diaphragm against the girl’s protruding ribs, I saw moistness in her eyes and realized that my colleague was fighting for control. I then remembered that she was always stiffer and quieter in the children’s ward. I surmised that despite her protestations, not having children of her own had not left her inured to maternal instincts.

When the examination was complete, the Professor reached down and smoothed the girl’s hair. “Well, Annie,” he said, “we have to move along and examine some other children who are
really
sick. I’ll be back tomorrow. Will you wait for me?”

“Oh, yes, Willie.” Her eyes had brightened and she seemed genuinely happy. But her tomorrows were not to be many.

As we moved away, one of the students, a boy of about twenty named Naughton, began to ask a question while we were still in earshot of the girl’s bed. The Professor spun and faced him with a glare that closed Naughton’s mouth like a bear trap. Particulars of a case were never discussed when a patient could overhear. In this case, particularly, there was little that needed to be said.

After rounds, the Professor asked me to join him for a moment. As we walked down the corridor, unexpectedly he asked, “Do you have any notion of where Turk is this morning?”

I said I did not, although I did not look him in the eye.

“Excuse me for embarrassing you,” he said, “but when a physician who has not made a misstep in two years arrives at work appearing as you do, it is not difficult to diagnose the cause … or the means of transmission.”

I admitted that I had been out with Turk, but added that he had dropped me at my rooms and I knew nothing of his whereabouts since then.

“What sort of fellow is Turk?” he asked.

“He is of extremely high ability,” I replied, assuming that the Professor was reassessing Turk’s fitness to be on staff.

“But?”

It was difficult to know where disloyalty to Turk ended and disloyalty to the Professor began. “His upbringing has left him angry and embittered,” I answered. “I hope it does not cause him to squander his talent.”

“Yes, I agree,” the Professor replied. “Do you like him … personally, I mean?”

“Whenever I begin to like him, he does something to bring me up short. But he is difficult to dislike as well.”

“Yes,” mused the Professor. “Quite so.” Then he brightened and placed his hand on my shoulder. “There’s something else, Ephraim. If you are free tomorrow evening, I would like you to accompany me to a dinner. It is at the Benedicts’ on Rittenhouse Square. Formal, I’m afraid. Starched collar, tight vest, and all. Are you up for it?”

“I would be glad to,” I said.

“It is not strictly a social affair,” the Professor noted. “Carroll, how abreast are you with the doings in Baltimore?”

He was speaking, of course, of the new hospital and plans for a medical school funded by an extraordinary endowment by the Quaker Johns Hopkins. Hopkins had amassed a fortune in dry goods and railroads and died childless in 1873, leaving seven million dollars to create the most modern medical facility in the world.

“I know,” I replied, “that the hospital will finally open after years of delays but the medical school is still not as yet complete. There are those who doubt it ever will be.”

“Oh, it will be, it will be. And when it is, it will be the envy of the nation. During that weekend I was absent last month, I traveled to Baltimore. Briefly put, I was solicited by the Hopkins board to accept the position of Physician in Chief at the hospital. It would, I was not displeased to learn, pay five times what I earn here. I was also offered the Professorship of Theory and Practice of Medicine when the medical school opens.”

“That’s wonderful,” I exulted. For a moment, an echo of Turk’s cynical prediction that the Professor would leave
Philadelphia for money alone rang in my ears. I quickly dismissed it. Advancement in any profession was remunerated, and the acceptance of higher pay was not necessarily evidence of greed. “Congratulations,” I said. “There is no one who deserves it more.”