Clarice knew she shouldn’t be doing this. The mirror wasn’t for her, for making sure that her hair was neatly tucked up in its bun. Or for smoothing her dress and seeing that her apron was as freshly white and laundered as it had been the day she bought it. The mirror was for the patients.
But she didn’t have any patients here — yet — and the mirror might as well get some use. Clarice had thought it a wonderful idea back when she requested it for her surgery. She had assumed that she would be dealing mostly with female patients, and most of the time, they would have to strip down to their shifts for her to examine them. Then they would have to get dressed again. What woman wouldn’t want a mirror to help her be absolutely certain that her gown and her hair would exit the office looking the same way they had when she came in? Thus the mirror safely tucked behind the changing screen, a little luxury that would keep her patients coming back to her.
Lately, though, Clarice was wondering if she was going about this entirely the wrong way. Not so much the medical part of her profession, healing injuries and treating the sick — she understood that as well as any doctor just out of Camford could be expected to. But running a business, making her little surgery profitable … she was beginning to think she didn’t know a thing about that at all.
And the conversation today at breakfast wasn’t helping matters.
Truth to tell, when Clarice had sat down that morning, she had not been imagining any difficult conversations. She’d been frankly relieved: the smell of the pancakes made her hungry, not nauseous. Maybe she would pay for it later, but for now, she would eat all her body asked her to. All of the best obstetrical authorities — that is to say, midwives and female doctors, not textbooks written by monks — said that women did well who listened to their bodies, and now that her body was telling her something she wanted to hear, Clarice planned to listen with all her heart.
Freddy saw her lift up her fork with relish and shot her grin. Then he turned back to his father to continue their conversation, which seemed to be about a cargo of rare woods that had been recently been unloaded from one of Richard’s ships.
“The damage can’t be that bad,” Bianca said, jumping right into the conversation as Clarice had not quite managed to do for herself yet. “Surely you can salvage some of it.”
“Of course we can salvage some of it,” Richard replied, “the question is, how much of a bath we’ve taken on this.” He turned to Freddy with a sigh. “I’ll need to talk to Mason about in what condition that wood was when he inspected it on the ship. Perhaps you can go down to the docks …”
But Freddy was shaking his head. “It’s Wednesday, Dad. Remember, I have to meet with Prince Thomas?”
“Oh, aye! Stupid me. I’ll find time for it today, then, or you can see to it tomor ….” He didn’t even finish the word, let alone the sentence. Instead, he turned to Clarice with a faintly puzzled brow. “Clarice, isn’t your surgery open on Wednesdays?”
“Yes — yes, sir,” Clarice replied. Richard winced, as he ever did when she called him “sir” — but she couldn’t help it; it felt wrong to be addressing a man whom she barely knew by his first name. Even if they were living in the same house. “Will that be a problem? I can …” Clarice bit her lip. She didn’t know what she could do — the whole point of having her surgery open on Wednesday and Saturday afternoon was to allow those who needed immediate care to come in without an appointment. But how could she get the word out this late? And who would she be getting the word out to?
“No, no, of course not! Unless …” Richard shot a glance at Freddy, Freddy replied with a why-are-you-looking-at-me look. Richard chuckled. “Never mind. I was just wondering, how are things going?”
“In general,” Richard clarified. “You barely say a thing about it — I have to get all of my information from poor Freddy, and I think he’s getting sick of it.”
“Dad!” Freddy yelped, then shook his head at Clarice before she could become aghast and embarrassed. Well, too aghast and embarrassed.
“Oh … things are going fine,” Clarice replied, wondering what else was she supposed to say. In fact — were things going fine? She was making inroads among the ladies of the land, that was true. Dannie was one of her patients now, even if Clarice wouldn’t dream of charging her anything. And she had given her mother, Lynn and the Queen full examinations, as well as examining the du Lac women and Bianca. She was also currently wondering how best to get into the good graces of Lady Eilwen and her daughters and daughter-in-law.
But the trouble with the ladies of Albion was this: no matter how inroads Clarice made with them, it might not help her practice, because they were, on the whole, a very healthy lot.
“Fine how?” asked Richard.
“Richard!” Bianca gasped, playfully smacking his arm. “She can’t tell us that!”
“I’m not asking her to tell us about — about — Lady Guinevere’s writer’s cramp and Lady Leona’s boxing injuries, I’m just asking for … for a general picture. That’s not against your medical ethics, is it, Clarice?” asked Richard.
“Leona doesn’t get boxing injuries,” Freddy muttered to the table, “she gives them.”
Clarice barely bit back a giggle; Freddy seemed to hear it anyway and sent her a wink. But giggles aside, there was Richard, looking mild and mildly expectant. So Clarice had to clear her throat and think of something to say.
“I — well,” she tried to joke, “the trouble is that all my patients are — are very healthy.”
“Bad for business,” Richard intoned solemnly.
“Oh, nonsense!” Bianca laughed. “Let me tell you, my dear, I’ve had my share of ladies who are so beautiful that I could dress them in a canvas sack and they would still turn everyone’s head. They could get their gowns from anybody! But you know how I keep them as my clients?”
Clarice cast a quick look at Freddy, who only shrugged. So Clarice shook her head.
“I made darn sure they knew their beauty was due to me and me alone!” Bianca laughed. “The sad thing is how well it worked.”
“Of course it worked well. It was true,” Richard replied.
Bianca chuckled. “Well, you just let your ladies know that the only reason why they’re so healthy is because of you — then you watch, they’ll come running to you for every sniffle and sneeze. Worked for me!”
“Ah, but Bianca,” Richard nudged his wife, “you of all people should know that the desire for a new gown often comes much more frequently than illness.”
“Well, there’s illness and there’s illness — eh?” Bianca winked at Clarice. And Clarice blushed. Of course Bianca knew that she was expecting — she had not yet worked up the courage to tell Richard, and truth to tell thought she ought to wait until she felt the child quicken — but after Clarice had told Freddy and after she had told her mother and her sister, it only seemed right to tell Bianca as well.
But the problem with Bianca’s sanguine assertion was … well, Lady Guinevere was past that time of life, and so was the Queen; Princess Jessie had breezily informed Clarice that she and her husband planned to wait until their twins were two before trying again; and Leona wasn’t married yet. True, she did have Lynn and Dannie to look after, but after they delivered — where would Clarice be? Waiting for someone to get sick — and checking up on the babies, of course. And having her own baby to worry about, not long after.
“But,” Richard pressed, “the noble ladies aren’t the only ones who come to you, eh? On your Wednesdays and Saturdays?”
“Oh, no, of course not!” Clarice stammered, stammered because … because she knew that she would make little or no profit on Wednesdays and Saturdays. People did come to see her, but there often wasn’t very much wrong with them — or else they were desperate and knew not where to turn, and could barely afford to pay Clarice anything at all. She couldn’t turn them away — even if she was that hard-hearted, it wasn’t as if she had any other patients to treat — but all the same, when a mother came to her in her rags and with her crying infant, maybe with an older child or two in tow, how could Clarice take anything from them? She couldn’t relieve a child or mother’s suffering and then take food out of their mouths as payment.
But on the other hand, she knew that Richard Ferreira had not built this fine castle and married his son to a lord’s daughter by dropping his prices whenever his customers looked poor.
“So how is that going?” Richard pressed.
Clarice gulped. “Well — well, I am getting a few patients every day. So — so hopefully the word is spreading.”
“Curing them?” Richard asked with a wink. “That will get the customers to line up at your door and around the street, I think.”
“I try,” Clarice replied. But sometimes … well, sometimes it was too late. She had already looked into one baby’s eyes, saw them fading, and had known that the best she could do is try to ease the poor little one’s suffering. The mother had known it, too, the moment Clarice looked up.
At least she hadn’t killed anyone through a wrong diagnosis or wrong treatment. Clarice would thank the Lord every day that she escaped that fate.
“So — so hopefully I will be getting more patients, soon,” Clarice hedged. “And then things will be …”
Better. More profitable.
Because, at the heart of it, that had to be what Richard wanted to know.
“You know,” Richard added, “if you need any help with the — the business side of things, you only have to ask. Bianca or I would be happy to help you go over the accounts.”
Oh, Lord, he wanted to see the accounts! Having Freddy look them over with her once a week wasn’t enough! Clarice only barely managed to avoid sending a panicked glance to Freddy as she turned to Richard. “Thank you, sir, but Freddy has already been so much help, I wasn’t going to bother you and my lady — but, but, if you really want to see them, of course you may have a look.”
“Not that there’s much worth looking at,” Freddy jumped in and to her rescue. “She’s still pretty well stocked, Dad. It’s just a matter of waiting for patients to come now.”
“Is it?” murmured Richard. He looked at Freddy — at Clarice — and then he sighed. “Look, you two –“
The cutlery jumped and the table shook slightly. And Bianca winced — not the wince of a chatelaine who saw her fine furniture and expensive silverware being misused, but, if Clarice was a doctor, the wince of a wife who had just aimed to kick her husband’s leg but had hit the table leg instead.
As for Richard, he looked at Bianca with one eyebrow raised, then glanced under the table. “Are you all right, dear?”
“Yes,” Bianca muttered.
“Good. You’re not stopping me that easily. Freddy, Clarice — we need to have a talk about this practice. A serious talk. Not a series of evasions and panicked looks.”
“Dad! I told you that if you needed to know anything, I would tell you!” Freddy protested.
“And I should have never let you get away with that — no, let me finish. Clarice, I have no interest in shutting down your practice,” Richard added, probably because he could see how Clarice’s breakfast was threatening to come up the wrong way for reasons that had nothing to do with the baby. “But we need to discuss, all of us, just what kind of practice you want to run. Do you want to be a fashionable doctor? Run a charity practice? It makes absolutely no difference to me which one you choose, Clarice, but they are very different things and need to be run very different ways. And even though Freddy,” Richard clapped his son’s shoulder, “is the most level-headed, sensible young man I’ve ever met — and I’m not just saying that because he’s my son! — he does not have Bianca and my business experience. We want to help you, but in order to help you, we need to know what it is you want to do with this.”
Clarice turned panicked eyes to Bianca, hoping she would still be her ally — but apparently, now that the words were spoken, Bianca would side with her husband. “He’s right, Clarice. We do want to help you. We won’t take you” She smiled and patted Clarice’s hand. “Richard, why don’t we talk about this this evening?” she added. “Give Clarice and Freddy some time to think about things.”
“Good idea,” Richard replied. “Is that all right with you two?”
Clarice could only look to Freddy. And Freddy could only smile, or try to smile, at her.
“It’ll be fine, Clarice. I promise.”
And with that she would have to be content. For now.
“M’lady?” asked the maid who was stationed in the waiting room on Wednesdays and Saturdays, to tell her when patients came in. “M’–m’lady?”
“Yes?” Clarice asked, hurrying out from behind the screen, patting her hair and straightening her dress, even though both were as straight and smooth as they had been thirty seconds beforehand.
The maid bobbed in a curtsey. “Mistress Wesleyan is here, axin’ if ye’ve got a moment. The elder one, that is.”
Clarice blinked. Mistress Wesleyan, Bianca’s friend, Dannie’s mother-in-law? What on earth … well, there could be any number of reasons why she was here, starting with simply wanting a female doctor and wanting to get acquainted. “Of course,” Clarice nodded. “Send her in, please.”
Clarice had not long to wait before in came the woman herself. “Mistress Wesleyan!” Clarice said, as heartily as she could. Cheerfulness was a good thing in a doctor; if the patients were in good spirits, they had a better chance of recovery. On the other hand, you didn’t want to look like you were reveling in their pain and discomfort. “Good afternoon!”
“Good afternoon,” replied Mistress Wesleyan, the corners of her lips barely lifting. So that was how it was. She closed the door behind her very carefully and glanced at the table. “Should I …?”
“Actually, if you don’t mind, I would like you to undress down to your shift, then you can get on the table,” Clarice replied. “It’s more helpful if I’m not trying to make an examination through three layers of cloth.”
Mistress Wesleyan seemed to consider that for a moment, then she nodded. “Of course, that makes sense.” Clarice gestured to the screen, and Mistress Wesleyan disappeared behind it.
She came out only a few moments later wearing only her shift. Clarice extended a hand to help her, but she got onto the table of her own power. Then there was nothing but for Clarice to put on a smile and ask, as cheerfully as seemed respectful, “Well! Is there something specific troubling you, or would you like me to make a full examination and see what comes up?”
Clarice hoped she would choose the latter. Patients often didn’t have the least idea what was wrong with them. If Clarice were able to examine them without the patients trying to guide her diagnosis, things tended to work much better —
“Actually,” Mistress Wesleyan replied, “I — I was hoping you could just — start where the trouble is, and then — well, and then we’ll see.”
Clarice knew that look. It was the look of a very, very worried woman. This was no mere ache or pain.
And whatever it turned out to be, it was best to examine that first, and hopefully put her fears to rest. Much as Clarice liked to start from the top and draw her own conclusions, to draw out an examination on a patient this nervous was tantamount to torture. “Of course,” Clarice replied. “Where would you like me to start?”
“My left breast,” replied Helena.
Clarice knit her brow. Usually it was younger women — nursing women, or women who had recently stopped nursing — that had breast problems, but if —
She pushed those thoughts to the side and nodded briskly. “Of course. If you’ll excuse me …”
Mistress Wesleyan’s shift was very loose, so it was easy enough to pull it down to see the breast. Clarice took a deep breath. She braced herself for some of the worst sights she had witnessed at Camford’s hospital — the lesions weeping black melancholy and the horrible smell, the yellow pus or pink organs plainly visible —
But all she saw was a perfectly normal, if obviously an older woman’s, breast.
Clarice’s brow furrowed, but she started to feel around, as gently as possible. Her left breast, Mistress Wesleyan had said. The heart was directly under the left breast — perhaps there was something with the heart —
“Oh — oh,” Clarice murmured.
“Oh?” Mistress Wesleyan asked, drawing back so swiftly as to make it seem an involuntary reaction.
“Please let me finish,” Clarice replied.
Slowly, Mistress Wesleyan leaned forward. And Clarice’s fingers picked up just where they had left off.
Yes — there was definitely a hard knot of tissue underneath the thin layer of skin. Mistress Wesleyan winced as Clarice prodded it. “Does that hurt?”
“It’s — it’s a little tender.”
“I see.” It was, quite possibly, the physician’s most annoying response (from the perspective of the patient), but there were times when there was nothing else to be said. “Is this why you came to see me?”
Mistress Wesleyan nodded.
“I see,” Clarice repeated. She took a deep breath. “Mistress Wesleyan … it seems you have a canker growing under your breast. However!” She put on the most cheerful face she could muster, which she very much feared was not all that cheerful at all. “Since you came in so very early, we do have some options. These cankers are caused by an excess of melancholy, you see, so if we can get your humors into balance again –“
“How many?” Mistress Wesleyan asked.
“I — I beg your pardon? How many … what?”
“How many women does …” Mistress Wesleyan took a deep breath. “How many women does that help?”
She wasn’t even asking if it saved them. “Mistress Wesleyan, has someone in your family had this disease?”
“My grandmother. My father’s mother.”
“I see.” And there it was again. Clarice took a deep breath. “Then, to answer your question — very few. But …”
Mistress Wesleyan’s bottom lip began to quiver.
Clarice stopped. “Do you need a moment?”
And that was all it took. One tear leaked from Mistress Wesleyan’s eye, then another. And another. A full-throated sob came next. Clarice grabbed a clean handkerchief — never in short supply in her surgery — and handed it to Mistress Wesleyan. “I’m so very sorry,” Clarice murmured.
Later, when Mistress Wesleyan had cried her full, Clarice would talk about possible treatments, things they could try. She would talk, also, about palliative care, for when the time came. She would entreat Mistress Wesleyan not to give up hope, either mentally or, well, physically. She could still have a few good months left in her. Maybe even a year.
But that would all come later. For now, all Clarice could do was stand there, and try to be there for her patient.
There were times when that was all a good doctor could do.