Cider House Rules Read online

  “You want an abortion,” Wilbur Larch said softly. It was the first time he had spoken the word.

  Mrs. Eames’s daughter took the sea-gull feather out of her pigtail and jabbed Larch in the chest with the quill end. “Shit or get off the pot,” she said. It was with the words “shit” and “pot” that the sour stench of cigar reached him.

  Wilbur Larch could hear the nurse-anesthesiologist sleeping—she had a sinus condition. For an abortion, he wouldn’t need as much ether as he liked to use for a delivery; he would need only a little more than he routinely gave himself. He also doubted it was necessary to shave the patient; patients were routinely shaved for a delivery and Larch would have preferred it for an abortion, but to save time, he could skip it; he would not skip ether. He would put red merthiolate on the vaginal area. If he’d had a childhood like Mrs. Eames’s daughter, he wouldn’t have wanted to bring a child into the world, either. He would use the set of dilators with the Douglass points—rounded, snub-nosed points, they had the advantage of an easy introduction into the uterus and eliminated the danger of pinching tissue in withdrawal. With the cervix dilated to the desired size, he doubted that—unless Mrs. Eames’s daughter was well along in her third or fourth month—he would need to use forceps, and then only for the removal of placenta and the larger pieces. A medical school textbook had referred, euphemistically, to the products of conception: these could be scraped from the wall of the uterus with a curette—perhaps with two different-sized curettes, the small one to reach into the corners.

  But he was too young, Wilbur Larch; he hesitated. He was thinking about the time for recovery from ether that he would need to allow Mrs. Eames’s daughter, and what he would say to his colleagues, or to the nurse if she woke up—or even to the house officer if it turned out to be necessary to keep the girl until the morning (if there was any excessive bleeding, for example). He was surprised by the sudden pain in his chest; Mrs. Eames’s savage daughter was stabbing him with the sea-gull feather again.

  “I ain’t quick! I ain’t quick, I said!” the Eames girl screamed at him, stabbing him again and again, until the feather bent in her hand; she left it stuck in his shirt. In turning away from him, her heavy braid brushed his face—the braid’s odor overwhelmingly conveying smoke. When she was gone and Larch plucked the sea-gull feather from his breast, he noticed that the oil of tansy—the French Lunar Solution—had spilled on his hands. Its smell was not unpleasant, but it momentarily overpowered the smell Larch liked and was used to—it overpowered the ether; it put an end to his peace of mind.

  They did not use ether “Off Harrison.” They didn’t concern themselves with pain there. For pain “Off Harrison,” they used music. An outfit called The German Choir practiced Lieder in the front rooms “Off Harrison.” They sang passionately. Perhaps Mrs. Eames’s daughter appreciated it, but she made no mention of the music when she was brought back to the South Branch a week later. No one was sure how she got there; she appeared to have been flung against the door. She also appeared to have been beaten about the face and neck, perhaps for failing to pay the usual abortion fee. She had a very high fever—her swollen face was as hot and dry to the touch as bread fresh from the oven. From the fever and the tenseness of her abdomen, rigid as glass, the house officer and the night nurse suspected peritonitis. The reason they woke Wilbur was that Mrs. Eames’s daughter had a piece of paper pinned to the shoulder of her dress.

  DOCTOR LARCH—

  SHIT OR GET OFF THE POT!

  Pinned to her other shoulder—like a mismatched epaulette, pulling her dress askew—was a pair of ladies’ underwear. They were her only pair. It was discovered she wasn’t wearing any. Apparently, her panties had been pinned there in a hurry; that way they wouldn’t be lost. Wilbur Larch didn’t need to examine Mrs. Eames’s daughter very thoroughly in order to discover that the abortion attempt had failed. A fetus with no heartbeat was imprisoned in her uterus, which had suffered some haywire contraction and was in a state of spasm. The hemorrhage and infection could have come from any of the several methods employed “Off Harrison.”

  There was the water-cure school, which advocated the use of an intrauterine tube and syringe, but neither the tube nor the water was sterile—and the syringe had many other uses. There was a primitive suction system, simply an airtight cup from which all the air could be sucked by a foot-operated pump; it had the power to abort, but it also had the power to draw blood through the pores of the skin. It could do a lot of damage to soft tissue. And—as the little sign said on the door “Off Harrison,” WE TREAT MENSTRUAL SUPPRESSION ELECTRICALLY!—there was the McIntosh galvanic battery. The long leads were hooked up to the battery; the leads had intravaginal and intrauterine attachments on insulated, rubber-covered handles; that way the abortionist wouldn’t feel the shock in his hands.

  When Mrs. Eames’s daughter died—before Dr. Larch could operate on her and without her having further words with him (beyond the “Shit or get off the pot!” note that was pinned to her shoulder), her temperature was nearly 107. The house officer felt compelled to ask Larch if he knew the woman. The note certainly implied an intimate message.

  “She was angry with me for not giving her an abortion,” Wilbur Larch replied.

  “Good for you!” said the house officer.

  But Wilbur Larch failed to see how this was good for anyone. There was a widespread inflammation of the membranes and viscera of the abdominal cavity, the uterus had been perforated twice, and the fetus, which was dead, was true to Mrs. Eames’s daughter’s prediction: it had not been quick.

  In the morning, Dr. Larch visited “Off Harrison.” He needed to see for himself what happened there; he wanted to know where women went when doctors turned them down. On his mind was Mrs. Eames’s daughter’s last puff of cigar breath in his face as he bent over her before she died—reminding him, of course, of the night he needed her puffing cigar to find his clothes. If pride was a sin, thought Dr. Larch, the greatest sin was moral pride. 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?

  The German Choir blasted him at the door with the little sign that promised the return of menstruation electrically. There was a harsh and out-of-tune piano—no oboe, no English horn, no mezzo-soprano—yet Larch thought the music was remindful of Mahler’s Kindertotenlieder. Years later, when he first heard the scream-concealing sound of the water rushing through Three Mile Falls, he would remember the abortionist’s songs that pumped like jism “Off Harrison.” He beat on the door—he could have screamed—but no one heard him. When he opened the door and stepped inside, no one bothered to look at him; The German Choir kept singing. The only instrument was a piano, and there were not nearly enough chairs for the women, and there were only a few music stands; the men stood huddled in two groups, far from the women; there weren’t enough copies of the sheet music to go around. The choir conductor stood by the piano. A lean, bald man without a shirt, he wore a dirty-white shirt collar (perhaps to catch the sweat) and kept his eyes half closed, as if in prayer, while his arms wildly pummeled the air—as if the air, which was full of cigar smoke and the urine-like stink of cheap draft beer, were hard to move. The choir pursued the man’s wild arms.

  A fussy or critical God, thought Wilbur Larch, would strike us all dead. Larch walked behind the piano and through the only open door. He entered into a room with nothing in it—not a piece of furniture, not a window. There was only a closed door. Larch opened it and found himself in what was obviously the waiting room—at least people appeared to be waiting there. There were even newspapers and fresh flowers and an open window; four people sat in pairs. No one read the papers or sniffed the flowers or looked out the window; everyone looked down and continued to look down when Wilbur Larch walked in. At a desk, with only a pad of paper and a cashbox on it, sat an alert man eating something that loo
ked like navy beans out of a bowl. The man appeared young and strong and indifferent; he wore a pair of work overalls and a sleeveless undershirt; around his neck, like a gym instructor’s whistle, hung a key—obviously to the cashbox. He was as bald as the choir conductor; Larch considered that their heads were shaved.

  Without looking at Wilbur Larch, the man, who might have been one of the choir sitting out a song or two, said: “Hey, you don’t come here. You just have the lady come by herself, or with a lady friend.”

  In the front room, Wilbur Larch heard them singing something about someone’s “dear mother”—wasn’t that what “mütterlein” meant?

  “I’m a doctor,” Dr. Larch said.

  The cashbox man kept eating, but he looked up at Larch. The singers took a deep breath, and in the split-second silence Larch heard the man’s swift, skillful spoon scrape against the bowl—and, from another room, the sound of someone retching, quickly followed by the splash of vomit in a metal basin. One of the women in the waiting room began to cry, but before Larch could identify which of the women it was, the singers caught their breath and bore down again. Something about Christ’s blood, Larch thought.

  “What do you want?” the man asked Larch.

  “I’m a doctor, I want to see the doctor here,” Larch said.

  “No doctor here,” the man said. “Just you.”

  “Then I want to give advice,” Larch said. “Medical advice. Free medical advice.”

  The man studied Larch’s face; he appeared to think that a response to Larch’s offer could be found there. “You’re not the first one here,” the man said, after a while. “You wait your turn.”

  That seemed to satisfy both men for the moment, and Larch looked for a seat—taking a chair precisely between the twosomes of women already in the room. He was too shocked by everything to be surprised when he recognized one of the couples: the Lithuanian woman whose child he’d delivered (his first delivery) sat mutely with her mole-faced mother. They wouldn’t look up at him; Larch smiled at them and nodded. The woman was very pregnant—too pregnant for an easy abortion, under the safest of circumstances. Larch realized, with panic, that he couldn’t convey this to her; she spoke only Lithuanian. She would associate him with delivering only live babies! Also, he knew nothing of what might have become of her first baby—nothing of what her life with that baby had been, or was now. He tapped his foot nervously and looked at the other couple—also, clearly, a mother and her daughter, but both of them were younger than the Lithuanians and it was hard to tell which of them was pregnant. This abortion, at least, looked easier to perform. The daughter looked too young to be pregnant, but then why, Larch wondered, had the mother brought the girl here? Did she need the company so badly, or was this meant as a lesson? Watch out—this could happen to you! In the front room, the singers grew hysterical on the subject of God’s love and something that sounded like “blinding destiny”—verblendenen Geschike.

  Wilbur Larch stared at the shut door, behind which he had heard unmistakable vomiting. A bee, crazily out of place, buzzed in the open window and seemed to find the flowers fakes; it buzzed straight out again. When Larch looked at the Lithuanian couple, he saw that the grandmother had recognized him—and she had discovered a new way to exhibit her mole, which had grown additional and longer hairs and had slightly changed color. Pinching her fingers to either side of the mole, the grandmother inflamed the surrounding skin and made the mole appear to explode from her face—like a boil come to a head, about to burst. The pregnant woman seemed not to notice her mother’s charmless demonstration, and when she stared at Larch she appeared not to recognize him; for Larch, there was only Lithuanian written on her face. Perhaps, Larch thought, her husband threw her baby out the window and drove her mad. For a moment Larch thought that the choir might be Lithuanian, but he recognized something about a battle between Gott und Schicksal—clearly German, clearly God and Fate.

  The scream that cut through the shut door had no difficulty rising above the voices declaring that God had won. The young girl jumped from her seat, sat down, hugged herself, cried out; she put her face in her mother’s lap to muffle her cries. Larch realized she’d been the one to cry before. He also realized that she must be the one needing the abortion—not her mother. The girl didn’t look older than ten or twelve.

  “Excuse me,” Larch said to the mother. “I’m a doctor.”

  He felt like an actor with good potential who’d been crippled with a single stupid line—it was all he had to say. “I’m a doctor.” What followed from that?

  “So you’re a doctor,” the mother said, bitterly, but Larch was happy to hear she didn’t speak Lithuanian. “So what help are you?” the mother asked him.

  “How many months is she?” Larch asked the mother.

  “Maybe three,” the mother said suspiciously. “But I already paid them here.”

  “How old is she?” Larch asked.

  The girl looked up from her mother’s lap; a strand of her dirty-blond hair caught in her mouth. “I’m fourteen,” she said defensively.

  “She’ll be fourteen, next year,” the mother said.

  Larch stood up and said to the man with the cashbox key, “Pay them back. I’ll help the girl.”

  “I thought you came for advice,” the man said.

  “To give it,” Dr. Larch said.

  “Why not take some while you’re here?” the man said. “When you pay, there’s a deposit. You don’t get a deposit back.”

  “How much is the deposit?” Larch asked. The man shrugged; he drummed his fingers on the cashbox.

  “Maybe half,” he said.

  “Eure ganze Macht!” the choir sang. “Your whole power,” translated Wilbur Larch. Many medical students were good in German.

  When the evil door opened, an old couple, like someone’s bewildered grandparents, peered anxiously into the waiting room—both confusion and curiosity on their faces, which, like the faces of many old couples, had grown to resemble each other. They were small and stooped, and behind them, on a cot—as still as a painting—a woman lay resting under a sheet, her eyes open but unfocused. The vomit basin had been placed on a towel on the floor, within her reach.

  “He says he’s a doctor,” the cashbox man said, without looking at the old couple. “He says he came to give you free medical advice. He says to pay these ladies back. He says he’ll take care of the young lady himself.”

  By the way that the old white-haired woman had become a presence—or, stronger, a force—in the doorway between the waiting room and the operating theater, Larch realized that she was in charge; the old white-haired man was her assistant. The old woman would have looked at home in a pleasant kitchen, baking cookies, inviting the neighborhood children to come and go as they pleased.

  “Doctor Larch,” Dr. Larch said, bowing a little too formally.

  “Oh, yes, Doctor Larch,” the old woman said, neutrally. “Come to shit or to get off the pot?”

  The abortionist was known in the neighborhood “Off Harrison” as Mrs. Santa Claus. She was not the original author of that remark—or of that note. Mrs. Eames’s daughter had written that herself, before she went to see Mrs. Santa Claus; she knew enough about the dangers “Off Harrison” to know that she might be in no shape to write anything at all after Mrs. Santa Claus finished with her.

  Larch was unprepared for Mrs. Santa Claus—specifically, for her attitude. He had imagined that in any meeting with an abortionist he (Dr. Larch) would take charge. He still tried to. He walked into the operating theater and picked up something, just to demonstrate his authority. What he picked up was the suction cup with a short hose running to the foot pump. The cup fitted nearly into the palm of his hand; he had no trouble imagining what else it fitted. To his surprise, when he had attached the cup to his palm, Mrs. Santa Claus began stepping on the foot pump. When he felt the blood rushing to his pores, he popped the cup out of his palm before the thing could raise more than a blood blister on the heel of his han
d.

  “Well?” Mrs. Claus asked, aggressively. “What’s your advice, Doctor?” As if in reply, the patient under the sheet drew Larch to her; the woman’s forehead was clammy with sweat.

  “You don’t know what you’re doing,” Dr. Larch said to Mrs. Santa Claus.

  “At least I’m doing something,” the old woman said with hostile calm. “If you know how to do it, why don’t you do it?” Mrs. Santa Clause asked. “If you know how, why don’t you teach me?”

  The woman under the sheet looked groggy, but she was trying to pull herself together. She sat up and tried to examine herself; she discovered that, under the sheet, she still wore her own dress. This knowledge appeared to relax her.

  “Please listen to me,” Dr. Larch said to her. “If you have a fever—if you have more than just a little bleeding—you must come to the hospital. Don’t wait.”

  “I thought the advice was for me,” Mrs. Santa Claus said. “Where’s my advice?”

  Larch tried to ignore her. He went out to the waiting room and told the mother with her young daughter that they should leave, but the mother was concerned about the money.

  “Pay them back!” Mrs. Santa Claus told the cashbox man.

  “They don’t get the deposit back,” the man said again.

  “Pay them back the deposit, too!” the old woman said angrily. She came into the waiting room to oversee the disgruntled transaction. She put her hand on Dr. Larch’s arm. “Ask her who the father is,” Mrs. Santa Claus said.

  “That’s none of my business,” Larch said.

  “You’re right,” the old woman said. “That much you got right. But ask her, anyway—it’s an interesting story.”

  Larch tried to ignore her; Mrs. Santa Claus grabbed hold of both the mother and her daughter. She spoke to the mother. “Tell him who the father is,” she said. The daughter began to snivel and whine; Mrs. Santa Claus ignored her; she looked only at the mother. “Tell him,” she repeated.