3
He tried to forget it, but over the weeks it nagged at him. Time and time again, he went back to the notes and graphs to convince himself that he was not imagining the evidence found in his records. Could it be, he wondered, a circumstance that prevailed only in this place? He wondered what the other physicians Abbott had talked with were doing about it—if they were doing anything; if, in fact, they had even looked at their records; and if they had, what they might have found …
He spent hours going back through old issues of The Journal of the American Medical Association and other journals, digging into the dusty stacks down in the basement, where they were stored. He could easily have missed something bearing on the matter in the medical magazines, for up till now he had not been too conscientious in his reading of them. A man, he told himself—making excuses for himself—had so little time to read; and there was so damn much to read, so many medical eager beavers intent on making points that there was a continuous flood of papers and reports.
But he found nothing. Could it be possible, he wondered, that despite Abbott’s work he, Benton, might be the only man who knew about the condition that he had come to characterize as the exhaustion syndrome?
A disease? he wondered. But he shied away from that. It was too selective to be a disease, its parameters too narrow. A metabolic disorder, more than likely. But for a metabolic disorder to come about, there must be an underlying cause.
Burt Curtis, it turned out, was no more diabetic than Ted Brown had been. His blood sugar was haywire, but he was not diabetic. After Helen had nagged at him for a time, Herb Anderson came in and his case was almost identical with Burt’s and Ted’s. An insurance salesman, a merchant, and a down-at-the-heels house painter—what in the name of God, he asked himself, could those three have in common? And then there was the Barr family! The Barr family bothered him a lot.
There were others now as well, not such classic examples as Burt and Ted and Herb; but each of them showed some of the symptoms of the exhaustion syndrome.
“You have to put it out of your mind,” Harriet said one day at the breakfast table. “It’s the ‘good old Doc’ complex again. You have allowed it to drive you all your life and here it’s driving you again. You can’t go on like this. You have other things to do, you have a full-time job. If this Abbott person had not shown up, you would not have noticed it.”
He agreed with her. “No, I don’t suppose I would have. Even if I had, I would not have paid too much attention to it. But when he talked to me, he made an uncommon lot of sense. As you’ve heard me say, I suppose far too often, medicine is not an exact science. There’s an awful lot of it a man can’t understand. A lot of problems he can’t begin to understand.”
“You’ve encountered those kind of problems before,” Harriet pointed out, just a shade too sharply. “And you have always said—I have heard you say it often—that someday a researcher will come up with an answer. You didn’t spend days fretting over those problems. Why can’t you stop this fretting now?”
“Because, damn it,” he told her, “here it is, right underneath my nose! There’s Ted and Herb and Burt, and a lot of others—more of them every day. There is nothing I can do about it. It’s nothing that I recognize; I’m completely in the dark. I’m tied hand and foot and I don’t like the feeling.”
“The trouble is, you are feeling guilty. You’ve got to cut that out.”
“All right,” he said. “I will cut it out.”
But he didn’t.
He did what, at the time, seemed rather silly things. He stopped at the Fanny Farmer candy shop and learned that in the last three years sales had increased by almost twenty-five percent. He phoned the two small factories at the edge of town and was told that sick leave and absenteeism had risen by almost ten percent in the last few months. At the drug store, he talked with his old friend the pharmacist, who told him that over-the-counter sales of analgesics were higher than at any time within memory.
That afternoon he phoned Dr. Herman Smith at Spring Valley. “You have a minute to talk with a competitor?” he asked.
Smith snorted. “You’re no competition,” he said. “We got that worked out years ago, remember? You work your side of the street and I work mine. We have our territories all laid out and fenced, and we have a gentleman’s agreement to do no trespassing. But I won’t let you in on any of my trade secrets, if that’s what you’re calling about.”
“Nothing like that,” said Benton. “I’ve been noticing some strange things. I’ve been wondering if you are noticing them as well.”
Smith’s voice became serious. “You sound worried, Art.”
“Not worried. Puzzled, that’s all.” He went ahead and told Smith what he had been noticing, making no mention of Abbott.
“You think it’s important?”
“I don’t know about its importance, but it’s a funny business. There seems to be no reason for it, no underlying cause. I’ve been wondering if it’s only happening here or if—”
“If you want me to, I could have a look at my records.”
“If you would,” Benton said.
“No sweat. I’ll let you know in a week or so. I’ll even draw you up some graphs to match with yours. If I find anything, that is.”
Dr. Smith didn’t take his week. In four days’ time there was a fat envelope. Opening it, Benton found not only the graphs, but statistical tables and a sheet of Xeroxed notes.
Benton had no need to take his own graphs out of the desk; he knew them now by heart. Staring at Smith’s graphs laid out on the desk top, he knew immediately they were almost identical with his own.
He sat down weakly in his chair, grasping the arms so tightly that his fingers ached.
“I was right,” he told himself. “God help us, I was right!”
4
When bird season opened, Benton drove out to the Ezra Pike farm for an afternoon of pheasant shooting, jotting down a mental note that before the day was over he would ask about the Barrs, who were Pike’s next-door neighbors. But he never got around to it.
Pike had a lot to show him: the pen of shoats that were becoming sleek and plump for the late-fall market; the high-quality wheat from the little patch he had grown as a hobby and which he was intending to take in to Millville to an old-time water mill to be ground into flour by a genial, half-mad hermit who was unconvinced that he lived in the twentieth century; the ritual sampling of some cider Pike had run off, using the fruit from an ancient, withered tree, the only one remaining in the country that bore the famed snow apples of another day. There was politics to talk about and the rising prices of food; the gasoline-wasting propensities of the anti-pollution equipment which had been installed on cars; the latest, rather mild scandal of the neighborhood, involving a boy barely out of his teens and a widow who was old enough to be the lad’s grandmother. They shot some pheasants, ate fresh apple pie—washing it down with milk—and talked of many things, the time passing pleasantly.
It was not until he was halfway home that Benton remembered he had not asked about the Barrs.
The following Saturday he skipped his morning office hours, loaded his gun into the car trunk, and took off for the hills, ostensibly to shoot quail. He made the quail trip several times each autumn, but when he thought about it he realized that it was not the quail he was looking for now, but the time that he could spend with the hill people.
If one had asked them what they were, they would have said that they were farmers; but precious few of them did any actual farming. Their acreages mostly stood on end, with only here and there a creek bottom or a hillside bench that was level enough for a plow to turn the soil. They planted some corn to fatten up the scrawny hogs that mostly ranged the woods for acorns, a field of potatoes at times larger than the corn patch, and a slightly smaller garden. They might at times plant other crops as well, but mostly it was corn, potat
oes, and the plants in the garden. The women canned a lot of vegetables, for there was no electricity to freeze them, and even if there had been, few of the hill people could have scraped together the money for a freezer. There were strawberry beds for eating and for canning as well as wild fruits such as blackberries and raspberries. By the end of autumn, the cellars of the hill farm homes were well stocked with canned vegetables and fruits, with potatoes and “winter keeper” apples from the scraggly trees of their haphazard orchards.
As he drove, Benton fell to wondering, as he had many times before, just how the hill folk managed to live from year to year. Each family ordinarily had a cow or two, as well as a few hogs and a bedraggled flock of chickens. Most of the hogs were butchered for meat rather than sold on market, and many of the farms had smokehouses out in back in which hams and bacon were cured. Game such as rabbits, squirrels, coons, and an occasional deer—usually taken in a fine disregard of game laws—helped round out their diet. Fish from the many streams, as well as ruffed grouse and quail, were often on the table. Somehow or other they managed to eat rather well all the year round.
But they had little money. They were largely self-sufficient and they had to be, raising and gathering most of their food. They bought little at the grocery store: flour, sugar, coffee, salt … Living that way, Benton told himself, they didn’t need much money. What little they had they earned at odd jobs here and there. A few of them worked at small industrial plants in the valley, but not very many of them. He suspected that few had any taste for such work. Occasionally some of them peddled firewood to the townspeople.
But, despite all the hardships which they probably did not regard as such, they were a relatively happy, reliable, proud, and independent people, filled with dignity and inborn courtesy.
Benton had a good day, dropping in at the homes of several families that he knew. He did a little hunting, but not a great deal, getting, in all, three quail. But he did a lot of talking, sitting on the steps of the sagging verandahs of houses so old that moss grew upon the clapboard and the brick—houses there so long that they were accepted even by the environment in which they sat as a part of that environment—or as he roosted on a split-rail fence that might have been erected a hundred years before or stood in the coolness of a springhouse after he had drunk a dipper full of ice-cold buttermilk.
They talked of many things, he and these scarecrow men with carefully sewn patches on their pants, their hair grown long not because long hair was in style but because no one in the family had as yet gotten around to cutting it. They talked of the weather, which bore heavily on their minds and was worthy of lengthy conversation; of someone having seen a panther, although wildlife biologists were agreed there had been no panthers in these hills for almost forty years; of times long gone and tales told by forebears now only dimly remembered.
In the course of these conversations Benton always got around to mentioning the exhaustion syndrome—although he did not use that term—explaining how patients for no apparent reason were gaining weight, were feeling all tired out in the middle of the morning, and had a seemingly never-satisfied longing for sweets. He didn’t know what caused it, he told them; and he was somewhat upset about it and was wondering if there might be any such condition in the neighborhood.
They looked at him with ill-concealed laughter in their eyes and said, no, unless that was what might be wrong with Grandpa Wilson or Gabby Whiteside or any one of another dozen people. They regaled him with stories of fabulously lazy men who, all their lives, had worked much harder to avoid work than the work would have been itself. But their tales all had the ring of folklore to them, so Benton accepted them as such. Most of the shiftless men who peopled the stories, he realized, did not exist and never had existed.
He came home convinced that no signs of Abbott’s epidemic existed in the hills.
It could be body chemistry, he told himself—something in the hills, the way of life, the things they ate, the conveniences they could not afford—that made all the difference. Although maybe, he admitted, he had that turned around; not something that kept the syndrome from the hills, but something that afflicted the townspeople with the syndrome.
Nonetheless, Benton thought, this business of body chemistry might be the best bet yet. Figure what the townspeople had or did not have, did or did not do, and the answer might be there. But, he warned himself, the elusive factor that he sought must be unique to town life.
That evening he went to the office, pleading paperwork, and wrestled with himself. Sitting at the desk, doing nothing except sitting at the desk, with a single gooseneck lamp making a splash of light upon the desk top, he tried to think it through.
He had tried to forget all the silly business, but he could not forget it. Perhaps he was unable to forget it because it was not a silly business, because he knew all the time, deep down within that hidden core of medical awareness, that it was a greater threat than he had allowed himself to believe—and knew as well that if he were to keep faith with his community he must not go on ignoring it, or attempting to ignore it. Although, he asked himself, how, for my own peace of mind, can I do other than ignore it? I do not have the training … He was not a research man. For too long he had been a plodding country doctor, exerting all his energy and knowledge to fight disease and death in this tiny corner of the land. He had no tools for research; he did not have the brain for research; he did not have the time—and, he thought, he might as well admit it, he did not have the devoted objectivity and the narrowness of purpose to do a research job.
But, ill-equipped as he might be, he owed it to the town to have a go at it at least. That was the hell of it—he owed it to the town! All his life he had owed everything he was and ever hoped to be to the people of this little town in payment for the trust that they had in him. He had placed them in his debt, but they had placed him in even greater debt. Just walking in and talking with him cured half of what was wrong with them, and how did a man respond to a faith like that? They thought he had all the answers, so he could not tell them how few answers he did have. Their faith in his infallibility often was the one last resort they had going for them. They put their faith and trust in him, and in doing that they made him feel guilty when he was forced, through inadequacy, to betray that faith and trust. How, he wondered, was a man trapped? How had he allowed himself to be trapped into such a situation?
He dug into the desk drawer and brought out his notes and those of Dr. Smith. Carefully, he went through them, hoping that further study might give him a clue. But there seemed none.
Hormones? he wondered. Some sort of hormonal imbalance? If that were true, however, there would have to be something to have brought about such an imbalance. This was not the first time he had thought of hormones, for an imbalance of insulin would explain the diabetic symptoms; but the hell of it, he reminded himself, was that it had not been diabetes. Glucogen, perhaps? But the trouble there was that no one knew for certain what glucogen really did, although it was suspected that by elevating the glucose blood level it might kill appetite. The hypothalamus? he asked himself. Or the steroid hormones? No, it could be none of these.
Personality disturbances? Fine as far as obesity and irritability might be concerned, but certainly not for any of the other symptoms. And, anyhow, personality disturbances were slimy things to work with and psychiatric training was required to cope with them.
Enzymes? Vitamins? Trace elements?
He was going at it wrong, Benton told himself. He was going at it backward. The way to work out the syndrome was to find a common factor that might be the cause and then try to cipher out what effect the factor had. Although, still thinking of it backward, the enzymes might hold more promise than any of the others. Enzymes basically were catalysts that sped up biochemical reactions. Not that biochemical reactions could not occur without the enzymatic catalytic action, but the reactions would be so slow that the body could not function.
/> He sat quietly and ran through his mind what he could recall about enzymes. He was surprised to find that after all the years he had scarcely thought of enzymes, he could remember so much about them. The reason that he could recall so much was that instead of thinking directly about enzymes he found himself recalling Professor Walter Cox—old Stony Cox, eccentric and beloved in a rather ragged way—who had paced up and down when he lectured, bobbing like a ball, his head hunched forward between skinny lifted shoulders, punching the air with one clenched fist to emphasize his words. He wondered where Stony Cox might be this night. More than likely dead, he thought, for that had been more than thirty years ago and he had been an old man then.
Thirty years and all, the words came clearly to mind. “The enzymes,” Cox had said, jabbing wildly at the air, “are made up of apoenzymes and coenzymes, the two forming a loose bond to make up an enzyme. The coenzyme normally is a vitamin plus another organic molecule, bonded together. And now, gentlemen, today I ask that you focus your attention on a single coenzyme, the coenzyme A, which is directly involved in two biochemical cycles, the fatty-acid cycle and the citric-acid cycle …”
Benton sat limp in his chair, shaken by what his mind had conjured up, dredging out of a past that measured more than thirty years an instant of almost complete recall—not of the man alone but of the words he had spoken, the slanted shine of sunlight through the slatted blinds, the smell of chalk dust in the air—hearing the words perhaps more distinctly than he had heard them at the time.
Was it a sign? he wondered. Had his subconscious mind reached back and laid a bony finger on this isolated incident to tell him what his conscious reasoning could not tell him?