The Cider House Rules

The Lord's Work

A child of Maine, Wilbur Larch was born in Portland in 186_--the son of a sullen, tidy woman who was among the staff of cooks and housekeepers for a man named Neal Dow, the mayor of Portland and the so-called father of the Maine law that introduced Prohibition to that state. Neal Dow once ran for the presidency as the candidate of the Prohibition Party, but he won barely ten thousand votes--proving that the general voter was wiser than Wilbur Larch's mother, who worshiped her employer and saw herself more as his co-worker for temperance reform than as his servant (which she was).

Interestingly, Wilbur Larch's father was a drunk--no small feat in the Portland of Mayor Dow's day. It was permitted to advertise beer in the shop windows--Scotch ale and bitter beer, which Wilbur Larch's father consumed copiously; it was necessary, he claimed, to drink these weak brews by the bucketful in order to get a buzz on. To young Wilbur, his father never looked drunk--he never staggered or fell or lay in a stupor, he never shouted or slurred his speech. Rather, he had about him the appearance of one perpetually surprised, of one given to frequent and sudden revelations that would stop him in his tracks, or in midsentence, as if something had just come to him (or had just escaped him) that had preoccupied him for days.

He shook his head a lot, and all his life dispensed this misinformation: that the nineteen-thousand-ton ship the Great Eastern, which was built in Portland, was destined to sail the North Atlantic between Europe and Maine. It was the opinion of Wilbur Larch's father that the two best wharves in Portland Harbor had been built specifically for the Great Eastern, that the new and huge hotel in Portland had been built expressly to house the Great Eastern's passengers, and that someone evil or at least corrupt or just plain foolish was responsible for keeping the Great Eastern from returning to her home port in Maine.

Wilbur Larch's father had worked as a lathe operator during the building of the Great Eastern, and perhaps the complaining noise of that machinery and the constant buzz he felt from all the beer he consumed had deceived him. The Great Eastern had not been built for voyages to and from Portland; she was originally intended for the route to Australia, but the many delays in getting her to sea drove her owners to bankruptcy and she was purchased for use on the North Atlantic route for which she proved unsuitable. She was, in fact, a failure.

So Wilbur Larch's father had an addled memory of his days as a lathe operator, and he had considerable loathing for temperance reform, his wife's beliefs and his wife's employer, Mayor Neal Dow himself. In the opinion of Wilbur Larch's father, the Great Eastern didn't return to Portland because of Prohibition--that curse which had limited him to a bilious dependency on Scotch ale and bitter beer. Since Wilbur knew his father only in the man's later years, when the Great Eastern was gone and his father was a porter in the Portland station of the Grand Trunk Railway, he could only imagine why working a wood-turning machine had been the high point of his father's life.

As a boy, it never occurred to Wilbur Larch that his father's missing fingers were the result of too many Scotch ales and bitter beers while operating the lathe--"just accidents," his father said--or that his mother's zeal for temperance reform might be the result of a lathe operator's demotion to porter. Of course, Wilbur realized later, his parents were servants; their disappointment made Wilbur become what his teachers called a whale of a student.

Although he grew up in the mayor's mansion, Wilbur Larch always used the kitchen entrance and ate

his meals with the great prohibitionist's hired help; his father drank his meals, down at the docks. Wilbur Larch was a good student because he preferred the company of books to overhearing his mother's talk of temperance with Mayor Dow's servants.

He went to Bowdoin College, and to Harvard Medical School--where a fascination with bacteria almost deterred him from practicing medicine, almost turned him into a laboratory animal, or at least a bacteriologist. He had a gift for the field, his professor told him, and he enjoyed the careful atmosphere of the laboratory; also, he had a burning desire to learn about bacteria. For nearly a year of medical school young Wilbur carried a bacterium that so offended and pained him that he was driven by more than scientific curiosity to discover its cure. He had gonorrhea: a gift, indirectly, from his father. The old man, in his beer buzz, had been so proud of Wilbur that he sent him to medicine school in 188_ with a present. He bought the boy a Portland whore, setting up his son with a night of supposed pleasure in one of the wharfside boardinghouses. It was a present the boy had been too embarrassed to refuse. His father's selfish nostalgia allowed him so few gestures toward his son; his mother's bitter righteousness was selfish in her own way; young Wilbur was touched that his father had offered to give him anything.

In the boardinghouse--the wood dry with salt and a sea-damp clinging to the curtains and to the bedspread--the whore reminded Wilbur of one of his mother's more attractive servant-colleagues; he shut his eyes and tried to imagine that he was embarking on a forbidden romance in a back room of the mayor's mansion. When he opened his eyes, he saw the candlelight deepening the stretch marks across the whore's abdomen; he didn't know they were stretch marks, then. The whore seemed unconcerned whether Wilbur noticed the stretch marks or not; in fact, as they fell asleep with his head on her stomach, he was vaguely wondering if the woman's wrinkles would transfer to his face--marking him. A sharp, unpleasant smell awakened him and he moved quickly off the woman, without disturbing her. In a chair in the room, the one where she'd put her clothes, someone was smoking a cigar--Wilbur saw the end glow brighter with each inhalation. He assumed that a man--the whore's next customer--was politely waiting for him to leave, but when he asked if there was a fresh candle to light (he needed to locate his clothes), it was a young girl's voice that answered him.

"You could have had me for less," was all she said. He could not see her distinctly but--since there was no fresh candle--she lit his way to his clothes by puffing earnestly on her cigar, casting both a red glow and a haze of smoke over his search. He thanked her for her help, and left.

On the morning train to Boston, he was embarrassed to meet the whore again. A chatty woman in the daylight, she was carrying a bandbox with the authority of a chronic shopper; he felt obliged to give her his seat on the overcrowded train. A young girl was traveling with the whore--"my daughter," the whore said, indicating the girl with a jab of her thumb. The daughter reminded Wilbur that they'd already met by breathing her astonishingly foul cigar breath into his face. She was a girl not quite Wilbur's age.

The whore's name was Mrs. Eames--"She rhymes with screams!" Wilbur's father had told him. Mrs. Eames told Wilbur she was a widow who lived a proper life in Boston, but that in order to afford such a life she found it necessary to sell herself in some out-of-the-way town. She begged Wilbur to allow her to keep her appearances and her reputation intact--in Boston. Wilbur not only assured her that her reputation was safe with him; he also, unasked, paid her more money of his own, on the spot, than his father had originally paid the woman. The amount of the original payment, he learned later--when his father told Wilbur that Mrs. Eames was a proper Portlander of good reputation who occasionally was obliged to sell herself in Boston so that she might afford to keep up her appearances in Portland. As an old favor to Wilbur's father, she had allowed--"Just this once!"--the exception of lowering herself in her hometown.

Wilbur's father didn't know that Mrs. Eames had a daughter, who--by her own confession--cost less than her mother and made no pretense of keeping up appearances in either Boston or Portland. The sullen girl never spoke on the train ride into Boston's North Station; her cigar breath and her scornful gaze spoke for her. Wilbur never told his father that there was some contradiction regarding which town Mrs. Eames had a good reputation in, and he never told his father that he caught the clap from Mrs. Eames, who might not have known she had it.

At medical school, Wilbur learned that gonorrhea could live in the Fallopian tubes of females for years. Only the appearance of an abscess in the pelvis might allow the woman to know that she carried the disease. The symptomatology, the discharge and so forth, could go unnoticed for a long time. It did not go unnoticed in Wilbur Larch; the bacterial infection, in these prepenicillin days, lived on for months in young Wilbur, giving him his passionate interest in bacteriology before burning itself out. It left his urethra scarred and his prostate rocky. It left him fond of ether, too--because the ether sleeps he occasionally administered to himself relieved him of the burning sensation he experienced, both when he urinated and when he dreamed. This singular and painful encounter with sexual pleasure--in combination with Wilbur's memory of his parents' loveless marriage--convinced the would-be doctor that a life of sexual abstinence was both medically and philosophically sound.

In the same year, 188_, that Wilbur Larch became a doctor, Neal Dow died. In grief, Wilbur Larch's mother shortly followed her temperance hero to the grave. A few days later, Wilbur's father auctioned every item from their servants' rooms in the former mayor's mansion and rode the Grand Trunk Railway to Montreal, a town less temperance-minded than Portland, and where Wilbur Larch's father pushed his liver beyond limits. His body was returned to Portland on the same Grand Trunk Railway that had carried the former lathe operator away. Wilbur Larch met the train; he played the porter to his father's remains. From the near-cadavers of the cirrhotic that he had seen during his first internship, young Dr. Larch knew exactly what must have been his father's condition at the end. Cirrhosis turns the liver to a mass of scars and lumps, the skin reflects the bile of jaundice, the stools lighten, the urine darkens, the blood doesn't clot. Dr. Larch doubted that his father would have even noticed the accompanying impotence.

How moving to conclude that young Larch chose to be an obstetrician because the loss of his parents inspired him to bring more children into the world, but the road that led Larch to obstetrics was strewn with bacteria. The demonstrator of bacteriology at Harvard Medical School, a Dr. Harold Ernst, is best remembered as one of the first college baseball pitchers to throw a curve ball; he was also the first college baseball player to become a bacteriologist. In the early morning laboratory, before Dr. Ernst--the former curve-ball pitcher--would arrive to set up his demonstrations, young Wilbur Larch would be all alone. He didn't feel alone in the presence of so many bacteria growing in the little Petri dishes, in the presence of the bacteria inhabiting his urethra and his prostate gland.

He would milk a drop of pus from his penis onto an ordinary stained slide. Magnified more than a thousand times, the villains he spotted every morning under the microscope were still smaller than common red ants.

Years later Larch would write that the gonococci looked stooped, like too-tall visitors in an igloo. ("They bend," he wrote, "as if they have waists and are bowing to each other.")

Young Larch would stare at his pus until Dr. Ernst would arrive and greet his little living experiments all over the lab (as if they were his old baseball teammates).

"Honestly, Larch," the famous bacteriologist said one morning, "the way you look into that microscope, you appear to be plotting revenge!"

But it was not the smirk of vengeance that Dr. Ernst recognized on Wilbur Larch's face. It was simply the intensity with which Larch was emerging from his ether-daze. The young medical student had discovered that the light, tasty vapor was a safe, effective killer of his pain. In his days spent fighting the dancing gonococci, Larch had become quite a knowledgeable imbiber of ether. By the time the

fierce bacteria had burned themselves out, Larch was an ether addict. He was an open-drop-method man. With one hand he held a cone over his mouth and nose; he made this mask himself (by wrapping many layers of gauze around a cone of stiff paper); with his other hand, he wet the cone. He used a quarter-pound ether can punctured with a safety pin; the drops that fell from the elbow of the safety pin fell in exactly the correct size and at exactly the correct rate.

It was the way he would give ether to his patients, too, except that he gave himself much less; when the hand that held the ether can felt unsteady, he put the can down; when the hand that held the cone over his mouth and nose dropped to his side, the cone fell off his face--it wouldn't stay in place if no one held it. He felt nothing of the panic that a patient being anesthetized with ether experiences--he never approached the moment when there wasn't enough air to breathe. Before that happened, he always dropped the mask.

When young Dr. Larch first set out from the South Branch of the Boston Lying-In to deliver babies in the poor districts of the city, he had a place in his mind where the peace of ether resided. Although he carried the ether can and the gauze cone with him, he didn't always have time to anesthetize the patient. The woman's labor was often too far advanced for the ether to help her. Of course he used it when he had the time; he would never share the opinion of some of his elder colleagues that ether was a deviation from the given--that children should be brought forth in pain.

Larch delivered his first child to a Lithuanian family in a coldwater, top-floor apartment--the surrounding streets littered with squashed fruit and tattered vegetables and horse droppings. There was no ice to put on the abdomen, over the uterus, in case of postpartum hemorrhage. There was a pot of water already boiling on the stove, but Larch wished he could sterilize the entire apartment. He sent the husband out for ice. He measured the woman's pelvis. He mapped out the fetus. He listened to its heartbeat while he watched a cat toying with a dead mouse on the kitchen floor.

There was a would-be grandmother present; she spoke Lithuanian to the woman in labor. To Dr. Larch she spoke a strange language of gestures, which suggested to him that the would-be grandmother was feebleminded. She indicated that a large mole on her face was either a source of hysterical pleasure or hysterical pain--Larch couldn't tell which; perhaps she simply wanted him to remove it, either before or after he delivered the baby. She found several ways to exhibit the mole--once by holding a spoon under it, as if it were about to fall; once capping it with a teacup and revealing it suddenly, as if it were a surprise or a kind of magician's trick. But the zeal she brought to each revelation of the mole suggested to Wilbur Larch that the old woman simply forgot that she had already shown him her mole.

When the husband returned with the ice, he trod on the cat, which voiced its disapproval in tones that made Wilbur Larch think the child was being born. Larch was grateful not to have to use the forceps; it was a short, safe, loud delivery, following which the husband refused to wash the baby. The grandmother offered, but Larch feared that her combination of excitement and feeblemindedness would cause an accident. Indicating (as well as he could, without the benefit of Lithuanian) that the child should be washed in warm water and soap--but not boiled in the pot on the stove, and not held head down under the coldwater tap--Larch turned his attention to the afterbirth, which refused to come away. The way the patient kept bleeding, Larch knew he would soon be faced with serious hemorrhage.

He begged the husband to hack him some ice--the strong fellow had brought a whole block, borrowing the ice company's tongs for this purpose and standing in the kitchen with the tongs on his shoulder in a menacing fashion. The block of ice could cool the uteri of several bleeding patients; to apply it whole, to a single patient, would likely crush the uterus, if not the patient. At this moment the grandmother lost her grip on the soapy child and dropped it among the dishes soaking in the coldwater sink; this happened the instant that the husband again trod upon the cat.