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Things take a turn for the worse. Also I think I've been misspelling Cochran's name.
Extract from the diary of Ezra Jennings
October 17th, 1840.
Sky a chill bright blue, neither the deep blue sky of my childhood nor the grey sky of my father's homeland, but a sharp blue, well-suited to this rough young country.
Dr. Burree seemed to be recovering last night, and I decreased his dose to forty drops, but today he is in agonies again. Must learn to neither under- nor over-estimate an elderly man's powers of recovery. Meanwhile, Dr. Ashton, in taking charge of the Watts case, has managed the feat of taking credit for Cochran's report while rejecting it entirely - declares the cataplexy, etc, to be merely (merely!) symptoms of the girl's worsening consumption and has had her removed to the ward; a turn of events which has a least given me the opportunity to confirm the student's notes on the case. Severe narcolepsy, with night-hags, hypnagogic hallucinations, and cataplexy, the latter triggered by my first appearance by her bed. Though once recovered, she seemed to regard me with friendly curiosity, I thought it best to depart for the day, and to henceforward send Cochran to monitor her condition, at least during the afternoon and evening hours when she is most often conscious. Our study of this case is, of course, extra-curricular - over and above my teaching duties and his studies - but then long hours are the lot of a physician. I can state without vanity that I am blessed with somewhat more physical strength than the average man of my build; though of late I find myself suffering internal pangs in the early morning - age takes its toll on us all, I suppose. As for Cochran, though he looks as though a stiff breeze could knock him over, I have seen him to be an active youth, and perhaps more importantly, possessed of a stubborn determination to do right by the patients.
October 22nd, 1840.
It seems to me that one can over-dose on fresh air as much as on any other substance - at least one can when it is served as cold as it is in the consumptives' quarters. Lizzie seems, to my eye, to be wilting day by day. I have argued with Ashton, have pointed out the severity of the night sweats (both C. and myself have, during our vigils, had to change the girl's sheets); have made the case that even if the narcolepsy were a symptom of the consumption, the treatment is doing nothing for either. The man, it seems, cannot admit to being wrong, even if the cost is a frail child's life. Burree, who is a stolid man, but not bound up by bride, and who might as Ashton's equal be able to move him, is still unable to leave his bed. I feel like a watcher by some shore, who sees a small boat in peril and having no craft of his own, cannot make the larger vessels move to her rescue.
Evening. Quarter to eleven.
Patient's attacks seem triggered by strong emotions or by light and pattern. Her sensitivity to light, in particular, increases as the days shorten. Have instructed attendants to keep reflective objects away from her bed or covered up. As to the strong emotions, the ward is unlikely to arouse any save fear and loneliness. Cochran, when I spoke to him on the topic, believes keeping the patient placid is a poor solution:
"Sooner or later, she will leave this place and live her life - surely it's in her interests to build up her mind's resources, so that she may deal with the tides of human experience without suffering nervous collapse every time she hears a piece of news. Besides, I never knew a child to be made well by boredom."
"You are basing your forecast on the optimistic assumption that she will live to leave this place at all."
At this, he cursed Dr. Ashton, consumption, cataplexy, god, the devil and myself, in roughly that order. "What's the use," he cried, "of diagnosing what we can't fix?!" All at once he seemed to me to be pathetically young, and I felt a keen dread as I wondered what the years may do to him. For now, I thought it best to give him hope, frail or not.
"You are correct, that Lizzie is not encouraged by the hospital environment. I do believe, though, that she is encouraged by you."
At this, Cochran's eyes widened, and he fell into the local vernacular:
"You saying she's sweet on me?"
"Surely you recall being her age - the passionate friendships, the craving for a half-understood romance? You've sat day after day by her bedside, talking to her, very likely giving her more attention than she has ever received from a grown person, barring only, perhaps, her mother - and you are not unpleasing to the eye, you know." This time, I could not forbear smiling at my young colleague's quizzical, angular face, and at his expressions regarding the last part of the argument. "It requires fine steering, of course: to lead on an innocent, particularly one in such a position, would be criminal; to break her heart the act of a brute; yet she needs some stake in this world if she is to keep fighting for her life. I have trusted to your honesty and discretion before - surely giving the child a kind word or two, without overstepping the boundaries of propriety, is no great task."
"I lack the gift of a bedside manner."
"Continue as you have been doing - it seems to have made a favourable impression. Only be sensible to the child's feelings."
"I think I find it easier to be sensible to the workings of her brain."
October 26th. Half-past two in the morning.
Lizzie asleep, though she trembles from time to time, and bites her lower lip. Cochran is asleep in the chair by her bedside - I found him thus. He must have nodded off while making observations, for his notebook is still in his hands and his spectacles on his face. He has been working himself hard of late, even for a student. for myself, I cannot sleep - so I am keeping watch on them both as I write this. Neither one has the type of face that relaxes in a state of unconsciousness, and indeed Cochran's face appears all the more pinched and bloodless without those querying blue eyes open and expressive. No doubt if I had seen Lizzie as a healthy child her silent face would give me the same pangs. Enough of these thoughts - this is not a sane time of night to be wakeful and alone. Against my better nature, I shall rouse him.
November 2nd
All our arguments, all our conjectures as to Lizzie's course of treatment meaningless now. She fell insensible half-past eleven; by three o-clock no heartbeat detected. I write no more for the moment.
* * * * * *
Extract from the diary of Ezra Jennings
October 17th, 1840.
Sky a chill bright blue, neither the deep blue sky of my childhood nor the grey sky of my father's homeland, but a sharp blue, well-suited to this rough young country.
Dr. Burree seemed to be recovering last night, and I decreased his dose to forty drops, but today he is in agonies again. Must learn to neither under- nor over-estimate an elderly man's powers of recovery. Meanwhile, Dr. Ashton, in taking charge of the Watts case, has managed the feat of taking credit for Cochran's report while rejecting it entirely - declares the cataplexy, etc, to be merely (merely!) symptoms of the girl's worsening consumption and has had her removed to the ward; a turn of events which has a least given me the opportunity to confirm the student's notes on the case. Severe narcolepsy, with night-hags, hypnagogic hallucinations, and cataplexy, the latter triggered by my first appearance by her bed. Though once recovered, she seemed to regard me with friendly curiosity, I thought it best to depart for the day, and to henceforward send Cochran to monitor her condition, at least during the afternoon and evening hours when she is most often conscious. Our study of this case is, of course, extra-curricular - over and above my teaching duties and his studies - but then long hours are the lot of a physician. I can state without vanity that I am blessed with somewhat more physical strength than the average man of my build; though of late I find myself suffering internal pangs in the early morning - age takes its toll on us all, I suppose. As for Cochran, though he looks as though a stiff breeze could knock him over, I have seen him to be an active youth, and perhaps more importantly, possessed of a stubborn determination to do right by the patients.
October 22nd, 1840.
It seems to me that one can over-dose on fresh air as much as on any other substance - at least one can when it is served as cold as it is in the consumptives' quarters. Lizzie seems, to my eye, to be wilting day by day. I have argued with Ashton, have pointed out the severity of the night sweats (both C. and myself have, during our vigils, had to change the girl's sheets); have made the case that even if the narcolepsy were a symptom of the consumption, the treatment is doing nothing for either. The man, it seems, cannot admit to being wrong, even if the cost is a frail child's life. Burree, who is a stolid man, but not bound up by bride, and who might as Ashton's equal be able to move him, is still unable to leave his bed. I feel like a watcher by some shore, who sees a small boat in peril and having no craft of his own, cannot make the larger vessels move to her rescue.
Evening. Quarter to eleven.
Patient's attacks seem triggered by strong emotions or by light and pattern. Her sensitivity to light, in particular, increases as the days shorten. Have instructed attendants to keep reflective objects away from her bed or covered up. As to the strong emotions, the ward is unlikely to arouse any save fear and loneliness. Cochran, when I spoke to him on the topic, believes keeping the patient placid is a poor solution:
"Sooner or later, she will leave this place and live her life - surely it's in her interests to build up her mind's resources, so that she may deal with the tides of human experience without suffering nervous collapse every time she hears a piece of news. Besides, I never knew a child to be made well by boredom."
"You are basing your forecast on the optimistic assumption that she will live to leave this place at all."
At this, he cursed Dr. Ashton, consumption, cataplexy, god, the devil and myself, in roughly that order. "What's the use," he cried, "of diagnosing what we can't fix?!" All at once he seemed to me to be pathetically young, and I felt a keen dread as I wondered what the years may do to him. For now, I thought it best to give him hope, frail or not.
"You are correct, that Lizzie is not encouraged by the hospital environment. I do believe, though, that she is encouraged by you."
At this, Cochran's eyes widened, and he fell into the local vernacular:
"You saying she's sweet on me?"
"Surely you recall being her age - the passionate friendships, the craving for a half-understood romance? You've sat day after day by her bedside, talking to her, very likely giving her more attention than she has ever received from a grown person, barring only, perhaps, her mother - and you are not unpleasing to the eye, you know." This time, I could not forbear smiling at my young colleague's quizzical, angular face, and at his expressions regarding the last part of the argument. "It requires fine steering, of course: to lead on an innocent, particularly one in such a position, would be criminal; to break her heart the act of a brute; yet she needs some stake in this world if she is to keep fighting for her life. I have trusted to your honesty and discretion before - surely giving the child a kind word or two, without overstepping the boundaries of propriety, is no great task."
"I lack the gift of a bedside manner."
"Continue as you have been doing - it seems to have made a favourable impression. Only be sensible to the child's feelings."
"I think I find it easier to be sensible to the workings of her brain."
October 26th. Half-past two in the morning.
Lizzie asleep, though she trembles from time to time, and bites her lower lip. Cochran is asleep in the chair by her bedside - I found him thus. He must have nodded off while making observations, for his notebook is still in his hands and his spectacles on his face. He has been working himself hard of late, even for a student. for myself, I cannot sleep - so I am keeping watch on them both as I write this. Neither one has the type of face that relaxes in a state of unconsciousness, and indeed Cochran's face appears all the more pinched and bloodless without those querying blue eyes open and expressive. No doubt if I had seen Lizzie as a healthy child her silent face would give me the same pangs. Enough of these thoughts - this is not a sane time of night to be wakeful and alone. Against my better nature, I shall rouse him.
November 2nd
All our arguments, all our conjectures as to Lizzie's course of treatment meaningless now. She fell insensible half-past eleven; by three o-clock no heartbeat detected. I write no more for the moment.
* * * * * *
