“Hey, Horace,” I said. I gestured at the cut on his face. “That looks bad.”
He shrugged. “There’s worse off than me.”
“I know,” I said, lowering my rifle, “but we’ll start with you. Then you tell me who’s worst off.”
He looked back at the others. “There’s a lot that are bad off, Kate,” he said. “How long do you have today?”
I leaned the rifle in a spot where I could reach it in a hurry if I needed to. “You’re my only stop.”
He nodded, though he knew as well as I did that even in a full day I only had time to see the very worst off. Their affliction aside, my patients’ age and the conditions they lived in meant that each of them had a host of issues for me to deal with. I counted on Horace to keep an eye on who was seriously injured, who had developed anything infectious, and who was showing signs of going end-stage. Everything else—minor illnesses and injuries, the frequent combination of scurvy and obesity caused by their diet of packaged food—I couldn’t even hope to treat.
I glanced up at the sky, saw just a few white clouds. “Let’s set up outside today,” I said. “Sunshine and fresh air ought to do everyone some good.”
“Sure. At least we’ve got plenty of those.” Horace gestured to two of the waiting patients and they came up to the tent, giving me a wide berth, and hauled out the exam bed. He turned to the others. “You might as well get on with your day. I’ll come get you when she’s ready for you.”
A few of the waiting patients wandered off when he said this, but most stayed where they were. The line was mostly silent, with little chatter: the camp residents were used to isolation, many of them only coming out of their tents when I visited or to take care of bodily necessities.
I patted the exam table and Horace sat down on it stiffly. I unzipped one of the pockets on my backpack, drawing out my checkup kit, then held his wrist in my hand to take his pulse and slipped the cuff around his arm and inflated it. “Any cough?” I asked.
He shrugged. “Little bit now and then,” he said. “I used to smoke. Guess I’m better off now, huh?”
I nodded. A lot of my patients were former smokers: when they were kids everyone had been, and they had grown up watching cigarette ads on TV. I got the TB kit and a pair of gloves out of my pack, pulled on the gloves, and tapped a syringe of PPD into his forearm. “Let’s hope it’s just that,” I said.
He scowled. “Does it matter?” he asked.
I shook my head. “TB’s a bad way to go. You remember how this works?”
He nodded.
“Tell me anyway.”
“Watch where you pricked me for three days. If there’s a spot, stay out of camp until you get back.”
“Good. Hey, do you remember what we were talking about last time I was here? You never finished that story.”
“You wanted to know how Adele and I met. Right?” I nodded. “Well, she used to work in the corner store. I would go in every day to buy something, just to see her. Of course all I could afford was a Coke, so she started to wonder—”
I reached out to tap him on the lips, right under his nose, and nodded with relief when he didn’t react. “Horace, that thing you pull to open a parachute—what’s that called?”
“It’s a—damn it, that’s, I know it . . . ” He closed his eyes, frowning. “I don’t remember.”
“Never mind,” I said. “How’d you get the cut?”
He was silent for a moment. “You know how it is.”
I opened a steri-wipe and washed his wound; he flinched as I ran my fingers along the edges of the cut. “Does it hurt?”
He shrugged, gritting his teeth and hissing as I pressed a chitosan sponge into the wound and then covered it with plaskin, running my fingers along the edge to make the seal. He jerked his head suddenly and I pulled my hand back. “What is it?” I asked. “Did I hurt you?”
“Rip cord!” He broke into a broad grin. “Rip cord. Right?”
“That’s good, Horace,” I said. “No progression since last time. Anybody else I should know about?”
“What do you mean?”
“Your cut,” I said. “Those are bite marks. Who was it?”
“Jerry,” he said after a moment. “He didn’t—I didn’t know he’d gone end-stage.”
“I’m sorry,” I said. One of the things that makes the affliction so terrifying is how rapidly and unpredictably it can progress, smoldering like an ember in some and burning like a brush fire in others. That’s why it has to be dealt with when the first symptoms surface, when they’re still the parents and grandparents we had known in spirit as well as in body. “I don’t suppose he’s in the dog cage?”
Horace shook his head. “Ran off. Guess he’s out in the woods somewhere.” He was quiet for a moment. “Am I going to . . . will I . . . ?”
For a moment I said nothing, trying not to look him in the eyes. The fact is that nobody knows for sure what causes the affliction, or even how it spreads: it could be that it’s lurking in all of us, waiting for us to grow old. It seemed to me that the ones who had friends or spouses in the camps stayed well longer—but when one went, the others almost always followed soon.
“I can tell that’s paining you,” I said. “Say no to a little morphine?”
“I guess not.”
“Arms up, then,” I said, and fished out a syringe. He held his arms up in front of him so that the sleeves of his bathrobe fell to reveal his bare forearms. I drew a finger over his papery skin, tapped the syringe on a good vein. “How does that feel? Better?”
“One of those and I don’t feel much of anything,” he said. He took a breath, then smiled weakly. “What do you suppose two would do for me? Or three?”
“I don’t aim to find out,” I said.
“Damn it, Kate—if I’d gone end-stage, you wouldn’t hold a moment’s thought before you dropped me.”
I shook my head. “I’ll put down an animal in pain, but you’re still a man.”
“You won’t feel that way when you’re my age.”
Even just the worst cases took most of the day, and after that I still had the public health work—checking that the rain barrels storing the water supply weren’t contaminated, and that the honey buckets were being emptied far enough from the camp—so it was already dark when I finished up, and too late to head to my cabin. I crashed in the Red Cross tent, sleeping on the exam table.
The next morning I rose a bit after dawn and started back to the tracks. My joints were stiff from being on my feet the day before, my skin itched sympathetically from all the scabies cases I had seen, and my stomach was still leaden with the camp ice cream—sugar, wild berries, and Crisco whipped together—one patient had insisted on giving me. (Crisco is a big part of camp cooking, which goes a long way toward explaining the chronic obesity in the camps; the other factor is that, for the most part, the residents have absolutely nothing to do, no motivation even to get out of their tents. The end-stagers, of course, don’t have access to the camp food and usually become malnourished soon after they turn.)
Once I had finished my self-check I headed off again, along the train tracks. When I was about halfway to the station I saw that someone else had broken a trail out from the tracks, into the woods: there were a lot of confused footprints in the mud there, and what looked like blood on some thorns. I followed the trail for a little while, keeping a careful pace, then sped up when I heard the shrieks.
The trail led me into a small clearing in the shade of a tall willow. A man and two women, all clearly end-stage, were standing at the foot of the tree. There was a tension among the three of them, like cats facing off over a fallen baby bird, and when I got a bit nearer I could see the cause: a young girl, maybe ten years old, was up in the tree.