The Cider House Rules

There are things that the societies of towns know about you, and things that they miss. Senior Worthington was baffled by his own deterioration, which he also believed to be the result of the evils of drink. When he drank less--and still couldn't remember in the morning what he'd said or done the evening before; still saw no relenting of his remarkably speeded-up process of aging; still hopped from one activity to the next, leaving a jacket in one place, a hat in another, his car keys in the lost jacket--when he drank less and still behaved like a fool, this bewildered him to such an extreme that he began to drink more. In the end, he would be a victim of both Alzheimer's disease and alcoholism; a happy drunk, with unexplained plunges of mood. In a better, and better-informed world, he would have been cared for like the nearly faultless patient that he was.

In this one respect Heart's Haven and Heart's Rock resembled St. Cloud's: there was no saving Senior Worthington from what was wrong with him, as surely as there had been no saving Fuzzy Stone.

In 193_, Homer Wells began Gray's Anatomy--at the beginning. He began with osteology, the skeleton. He began with bones. In 194_, he was making his third journey through Gray's Anatomy, some of which he shared with Melony. Melony showed a wayward concentration, though she confessed interest in the complexity of the nervous system, specifically the description of the twelfth or hypoglossal nerve, which is the motor nerve of the tongue.

"What's a motor nerve?" Melony aske

d, sticking out her tongue. Homer tried to explain, but he felt tired. He was making his sixth journey through David Copperfield, his seventh through Great Expectations, his fourth through Jane Eyre. Only last night he had come to a part that always made Melony cringe--which made Homer anxious.

It's near the beginning of Chapter Twelve, when Jane shrewdly observes, "It is vain to say human beings ought to be satisfied with tranquillity: they must have action; and they will make it if they cannot find it."

"Just remember, Sunshine," Melony interrupted him. "As long as I stay, you stay. A promise is a promise."

But Homer Wells was tired of Melony making him anxious. He repeated the line, this time reading it as if he were personally delivering a threat.

"It is vain to say human beings ought to be satisfied with tranquillity: they must have action; and they will make it if they cannot find it." Mrs. Grogan looked taken aback at the ominousness in his voice.

He copied the line in a handwriting nearly as orderly and cramped as Dr. Larch's; Homer typed it on Nurse Angela's typewriter, making only a few mistakes. And when Wilbur Larch was "just resting" in the dispensary, Homer crept up on the tired saint and placed the piece of paper with the quotation from Jane Eyre on Dr. Larch's rising and falling chest. Dr. Larch felt less threatened by the actual text of the quotation than he felt a general unease: that Homer knew Dr. Larch's ether habit so exactly that the boy could approach his bed undetected. Or am I using a little more of this stuff than I used to? Larch wondered.

Was it meant as a message that Homer had used the ether cone to hold the Jane Eyre quotation to Larch's chest?

"History," wrote Dr. Larch, "is composed of the smallest, often undetected mistakes."

He may have been referring to something as small as the apostrophe that someone added to the original St. Clouds. His point is also illuminated by the case of the heart in both Heart's Haven and in Heart's Rock, a case similar in error to how Melody became forever a Melony. The explorer credited with the discovery of the fine, pretty harbor at Heart's Haven--a seafaring man named Reginald Hart--was also the first settler of Heart's Rock to clear land and try to be a farmer. The general illiteracy of the times, and of the times following Reginald Hart's death, prevailed; no one knew of any written difference between one heart and another. The first settlers of Heart's Haven and Heart's Rock, probably never knowing that Reginald Hart had been given the name of a deer, quite comfortably named their towns after an organ.

"A hollow muscular organ of conical form," as Homer Wells could recite, by rote, from Gray's Anatomy, ". . . enclosed in the cavity of the PERICARDIUM." By 194_ Homer had looked at each of the hearts in the three cadavers Dr. Larch had acquired for him (each cadaver outliving its usefulness for exploratory purposes in about two years' time).

The cadavers were female; it hardly served Dr. Larch's purpose--in the process of educating Homer Wells in obstetrical procedure and procedures of a related kind--to have his student examining male cadavers. There was always a problem getting a body (once one was delivered in water that was supposed to be ice; another had to be disposed of because the embalming fluid had clearly been old or too weak). Homer remembered the three cadavers distinctly. It was not until the third body that he developed enough of a sense of humor to give the body a name; he called her Clara after David Copperfield's wimpish mother--that poor, weak woman who'd allowed herself and young David to be so bullied by the terrible Mr. Murdstone.

"You should call her Jane," Melony advised Homer; Melony was alternately sick of Jane Eyre and completely identified with her.

"I could have called her Melony," Homer responded, but humor was not reliably to be found in Melony, who preferred to play her own jokes.

Body number two provided Homer with the essential practice that prepared him for his first Caesarean section; for that one, he had felt Dr. Larch's eyes so riveted to his hands that his hands seemed not his own--they moved with such smooth purpose that Homer was sure that Dr. Larch had discovered a way to make that perfect, no-bigger-than-necessary incision in the uterus with his mind (no need for using hands, at all).

The harangue that developed at the railroad station over the arrival of the body Homer would call Clara gave Homer his first experience with eclamptic convulsions--or puerperal convulsions, as they were called in Wilbur Larch's days at the Boston Lying-In. At the exact moment that Dr. Larch was at the railroad station arguing with the stationmaster about the release form for the unfortunate Clara, Homer Wells was at St. Cloud's trying to locate, exactly, the inferior thyroid vein on body number two. Although he didn't know it, he had a good excuse for having, momentarily, lost his way; body number two was wholly shopworn, and many things were hard to locate within it. He would have consulted his Gray's in another minute or two, but just then Nurse Edna burst upon him--shrieking (as she always did when she saw Homer with body number two; it was as if she'd caught him up to something with Melony).

"Oh, Homer!" she cried, but she couldn't speak; she flapped her arms in an agitated, chickenlike fashion before she managed to point Homer in the direction of the dispensary. He ran there as quickly as he could, finding a woman lying on the dispensary floor--her eyes staring so wildly and so steadily unseeing that at first he mistook her for the body he knew Dr. Larch was trying to liberate from the stationmaster. Then the woman began to move, and Homer Wells knew she was quite close to becoming a cadaver; the convulsions began with a twitching in her face, but they spread rapidly through all the muscles of her frame. Her face, which had been flushed, turned a shiny blue-black; her heels struck the floor with such force that both her shoes flew off--Homer saw instantly that her ankles were hugely swollen. Her jaws were set; her mouth and chin were wet with a frothy spittle, laced with blood because she'd bitten her tongue--which was at least preferable to her swallowing it. Her respiration was hardworking; she expelled air with a hiss, and the spray splashed Homer's face with a violence he'd not felt since he stood back from the bank and watched the Winkles being swept away.

"Eclampsia," Homer Wells said to Nurse Edna. It derives from the Greek; Dr. Larch had told him that the word refers to the flashes of light a patient sees at the onset of the puerperal convulsions. With any sensible prenatal care, Homer knew, eclampsia was usually avoidable. There was an easily detected rise in blood pressure, the presence of albumin in the urine, swelling of the feet and hands, headaches, vomiting, and of course those spots and flashes in the eyes. Bed rest, diet, reduction of fluid intake, and free catharsis usually worked; but if they didn't, the bringing on of premature labor almost always prevented the convulsions and often produced a living baby.

But the patients Dr. Larch saw were not women who sought or even understood prenatal care. This patient was very last-minute--even by the standards of Dr. Larch's practice.

"Doctor Larch is at the railroad station," Homer told Nurse Edna calmly. "Someone has to get him. You and Nurse Angela should stay to help me."

In lifting the woman and carrying her to the delivery room, Homer felt the woman's moist, cold skin and was reminded of body number one and body number two (the latter, he recalled, had been left on the examining table in the room now used for his anatomical studies, near the boys' division kitchen). In the last century, Homer Wells knew, a doctor would have given this patient an ether anesthesia and would have dilated the mouth of the womb to effect a forcible delivery--a method that usually caused the patient's death.

At the Boston Lying-In Wilbur Larch had learned to fortify the heart muscle with doses of digitalis, which helped prevent the development of fluid in the lungs. Homer listened to the woman's watery breathing and realized he might be too late, even if he correctly remembered the procedure. He knew that one had to be conservative with eclampsia; if he was forced to deliver the woman prematurely, he must allow the labor to develop as naturally as possible. The woman just then moaned; her head and heels whacked the operating table in unison, her pregnant belly seemed to levitate--and one of her arms, without will, without purposeful direction, flew up and hit Homer in the face.

He knew that sometimes a woman had only one puerperal convulsion; it was recorded that a few patients had survived as many as a hundred. What Homer didn't know, of course, was whether he was observing this woman's second convulsion or her ninetieth.

When Nurse Edna returned to the delivery room with Nurse Angela, Homer instructed the nurses to administer morphine to the patient; Homer himself injected some magnesium sulphate into a vein, to lower her blood pressure at least temporarily. In the interval between her last and what Homer knew would be her next convulsion, he asked Nurse Edna to take a urine sample from the woman and he asked Nurse Angela to examine the specimen for traces of albumin. He asked the woman to tell him how many convulsions she had already suffered; but although the woman was coherent and could even answer questions intelligently, she couldn't pinpoint the number of convulsions. Typically, she remembered nothing of the convulsions themselves--only their onset and their draining aftereffects. She estimated she was at least a month away from expecting her baby.

At the onset of her next convulsion, Homer gave the woman a light ether sedation, hoping he might reduce the violence of the fit. This fit was different in character from the last, though Homer doubted it was any less violent; the woman's motion was slower, but--if anything--more powerful. Homer lay across her chest, but her body abruptly jackknifed--lifting him off the operating table. In the next interval, while the woman was still relaxed under the ether sedation, Homer's investigations showed him that the neck of the patient's womb was not shortened, its mouth was not dilated; labor hadn't begun. He contemplated beginning it, prayed that he wouldn't have to make this decision, wondered why it was taking so long to find Dr. Larch.

An orphan with a bad cold had been assigned to locate Larch at the railroad station; he returned with a thick rivulet of snot in each nostril and strung across one cheek, like a welt from a whiplash. His name (Nurse Angela's, of course) was Curly Day, and he wetly announced that Dr. Larch had boarded the train to Three Mile Falls--in order to chase down and capture the body that the stationmaster (in a pique of perversity prompted by religious outrage) had forwarded to the next stop. The stationmaster had simply refused to accept the cadaver. Larch, in a rage now surpassing the stationmaster's, had taken the next train after it.

"Oh-oh," Nurse Edna said.