The Cider House Rules

They were seated at a long table, next to each other. Across from them, and about their age, was one of the young men in tennis whites, either the Chadwick or the Cabot. He looked cross, or else he'd just had a fight with Miss Channing-Peabody, or else he would rather have been seated next to her himself. Or maybe he's just her brother and wishes he were seated farther away from her, thought Wilbur Larch.

The girl looked unwell. In a family of tans, she was pale; she picked at her food. It was one of those dinners where the arrival of each course caused a complete change of dishes, and as the conversation lapsed and failed, or at least grew fainter, the sound of china and silverware grew louder, and a tension mounted at the dinner table. It was not a tension caused by any subject of conversation--it was a tension caused by no subject of conversation.

The rather senile retired surgeon who was seated on Wilbur's other side--he was either a Channing or a Peabody--seemed disappointed to learn that Larch was an obstetrician. Still, the old codger insisted on knowing Dr. Larch's preferred method of expelling the placenta into the lower genital tract. Wilbur Larch tried, quietly, to describe the expression of placenta to Dr. Peabody or Dr. Channing, or whoever he was, but the old man was hard of hearing and insisted that young Larch speak up! Their conversation, which was the dinner table's only conversation, thus progressed to injuries to the perineum--including the method of holding back the baby's head to prevent a perineal tear--and the proper mediolateral incision for the performance of an episiotomy when a tear of the perineum seems imminent.

Wilbur Larch was aware that Missy Channing-Peabody's skin was changing color beside him. She went from milk to mustard to spring-grass green, and almost back to milk before she fainted. Her skin was quite cool and clammy, and when Wilbur Larch looked at her, he saw that her eyes were almost completely rolled up into her head. Her mother and the cross young man in tennis whites, the Cabot or the Chadwick, whisked her away from the table--"She needs air," Mrs. Channing-Peabody announced, but air was not in short supply in Maine.

Wilbur Larch already knew what Missy needed. She needed an abortion. It came to him through the visible anger of young Chadwick or Cabot, it came to him over the babbling senility of the old surgeon inquiring about "modern" obstetrical procedure, it came to him through the absence of other conversation and through the noise of the knives and the forks and the plates. That was why he'd been invited: Missy Channing-Peabody, suffering from morning sickness, needed an abortion. Rich people needed them, too. Even rich people, who, in Wilbur Larch's opinion, were the last to learn about anything, even rich people knew about him. He wanted to leave, but now it was his fate that held him. Sometimes, when we are labeled, when we are branded, our brand becomes our calling; Wilbur Larch felt himself called. The letter from the prostitute from St. Cloud's was on its way to him and he would go there, but first he was being called to perform--here.

He rose from the table. The men were being sent to some special room--for cigars. The women had gathered around someone's baby--a nurse or a governess (a servant, thought Wilbur Larch) had brought a baby into the dining room, and the women were having a look. Wilbur Larch had a look, too. The women made room for him. The baby was rosy-looking and cheerful, about three months old, but Dr. Larch noticed the forceps mark on its cheek: a definite indentation, it would leave a scar. I can do better work than this, he thought.

"Isn't that a darling baby, Doctor Larch?" one of the women asked him.

"It's too bad about that forceps mark," Larch said, and that shut them all up.

Mrs. Channing-Peabody took him out into the hall. He let her lead him to the room that had been prepared for him. On the way she said, "We have this little problem."

"How many months along is she?" he asked Mrs. Channing-Peabody. "Is she quick?"

Quick or not, Missy Channing-Peabody had certainly been prepared. The family had converted a small reading room into an operating theater. There were old pictures of men in uniform, and books (looking long untouched) stood at attention. In the grim room's foreground was a solid table appropriately set with cotton batting and rubber sheeting, and Missy herself was lying in the correct examining position. She was already shaved, already swabbed with the bichloride solution. Someone had done the necessary homework; perhaps they'd pumped the senile family surgeon for details. Dr. Larch saw the alcohol, the green soap, the nail brush (which he proceeded, immediately, to use). There was a set of six metal dilators, and a set of three curettes in a leather-covered, satin-lined case. There was chloroform and a chloroform inhaler, and this one mistake--that they didn't know Wilbur Larch's preference for ether--made Larch almost forgive them.

What Wilbur Larch could not forgive was the obvious loathing they felt for him. There was an old woman in attendance, perhaps some faithful household servant who had played midwife to countless little Channing-Peabodys, maybe even midwife to Missy. The old woman was particularly chisel-faced and sharp-eyed when she looked at Larch, as if she expected him to congratulate her--at which moment she would not acknowledge that he'd spoken to her--for her precision in readying the patient. Mrs. Channing-Peabody herself seemed unable to touch him; she did offer to hold his coat, which he let her take before he asked her to leave.

"Send that young man," Larch told her. "He should be here, I think." He meant the particularly hostile young man in tennis whites, whether he was the outraged brother or the guilty lover or both. These people need me but they hate me, Larch was thinking, as he scrubbed under his nails. While he let his arms soak in the alcohol bath, he wondered how many doctors the Channing-Peabodys must know (how many must be in the family!), but they would never have asked one of their kind for help with this "little problem." They were too pure for it.

"You want my help?" the sullen young man asked Larch.

"Not really," Larch replied. "Don't touch anything and stand to my left. Just look over my shoulder, and be sure you can see everything."

That class-conscious look of scorn had all but left young Chadwick's (or young Cabot's) face when Wilbur Larch went to work with the curette; with the first appearance of the products of conception, the young man's expression opened--that certain, judgmental air was not discernible in any aspect of his face, which seemed softened and resembled his tennis whites in its color.

"I have made this observation about the wall of the uterus," Dr. Larch told the ghostly young man. "It is a good

, hard, muscular wall, and when you've scraped it clean, it responds with a gritty sound. That's how you know when you've got all of it--all the products of conception. You just listen for that gritty sound." He scraped some more. "Can you hear it?" he asked.

"No," the young man whispered.

"Well, perhaps 'sound' isn't the right word," Wilbur Larch said. "Perhaps it's more like a gritty feeling, but it's a sound to me. Gritty," he said, as young Cabot or young Chadwick attempted to catch his own vomit in his cupped hands.

"Take her temperature every hour," Larch told the rigid servant who held the sterile towels. "If there's more than a little bleeding, or if she has a fever, I should be called. And treat her like a princess," Wilbur Larch told the old woman and the ashen, empty young man. "No one should be allowed to make her feel ashamed."

He would have departed like a gentleman after he looked under Missy's eyelids at her chloroform gaze; but when he put his coat on, he felt the envelope bulge in the breast pocket. He didn't count the money, but he saw there were several hundred dollars. It was the mayor's mansion all over again, the servant's quarters treatment; it meant the Channing-Peabodys wouldn't ask him back for tennis or croquet or a sail.

He promptly handed about fifty dollars to the old woman who had bathed Missy's genitals with the bichloride solution and had covered her with a sterile vulval pad. He gave about twenty dollars to the young tennis player, who had opened the door to the patio to breathe a little of the garden air. Larch was going to leave. Then, when he shoved his hands in his coat pockets and found the panties again, on an impulse he grabbed the placenta forceps and took the instrument with him. He went off looking for the old surgeon, but there were only servants in the dining room--still clearing the table. He gave each of them about twenty or thirty dollars.

He found the senile doctor asleep in a reading chair in another room. He opened the mouth of the forceps, clamped the pair of panties from "Off Harrison" in it, and then clamped the whole business to the old snorer's lapel.

He found the kitchen, and several servants busy in it, and gave away about two hundred dollars there.

He went out on the grounds and gave the last of the money, another two hundred dollars, to a gardener who was on his knees in a flower bed by the main door. He would have liked to have handed the empty envelope back to Mrs. Channing-Peabody; the grand lady was hiding from him. He tried to fold the envelope and pin it to the main door under the big brass door knocker; the envelope kept blowing free in the wind. Then he got angry and waded it up in a ball and threw it into a manicured circle of green lawn, which served as a rotary for the main driveway. Two croquet players on a far lawn held up their game and stared first at the crumpled envelope and then at the blue summer sky, as if a lightning bolt, at the very least, were momentarily expected to strike Larch dead.

On his way back to Portland, Wilbur Larch reflected on the last century of medical history--when abortion was legal, when many more complex procedures than a simple abortion were routinely taught medical students: such things as utero decapitation and fetal pulverization (these in lieu of the more dangerous Caesarean section). He mumbled those words to himself: utero decapitation, fetal pulverization. By the time he got back to Portland, he had worked the matter out. He was an obstetrician; he delivered babies into the world. His colleagues called this "the Lord's work." And he was an abortionist; he delivered mothers, too. His colleagues called this "the Devil's work," but it was all the Lord's work to Wilbur Larch. As Mrs. Maxwell had observed: "The true physician's soul cannot be too broad and gentle."

Later, when he would have occasion to doubt himself, he would force himself to remember: he had slept with someone's mother and dressed himself in the light of her daughter's cigar. He could quite comfortably abstain from having sex for the rest of his life, but how could he ever condemn another person for having sex? He would remember, too, what he hadn't done for Mrs. Eames's daughter, and what that had cost.

He would deliver babies. He would deliver mothers, too.

In Portland, a letter from St. Cloud's awaited him. When the Maine State board of medical examiners sent him to St. Cloud's, they could not have known Wilbur Larch's feeling for orphans--nor could they have known his readiness to leave Portland, that safe harbor from which the Great Eastern had sailed with no plans for return. And they would never know that in the first week Wilbur Larch spent in St. Cloud's, he founded an orphanage (because it was needed), delivered three babies (one wanted, two inevitable--one would be another orphan), and performed one abortion (his third). It would take Larch some years to educate the population regarding birth control--the ratio would endure for some time: one abortion for every three births. Over the years, it would go to one in four, then to one in five.