Beulah MacDonald eased her spare frame into the padded leather chair in Dr. James Nichols' crowded office with a carefully hidden sigh of relief. Beulah, old girl, you're not up to those long hospital shifts anymore. A woman your age has no business on her feet twelve hours a day, most days of the week, turning patients, running a hospital, and all that. Still, it wasn't as if there were many nurses around after the Ring of Fire. They could certainly use, oh, say a thousand fully trained registered nurses, a hundred nurse practitioners. And doctors. And pharmacists. Some physical and occupational therapists would be great, too. Enough trained people to handle everything that needed doing weren't just going to drop from the sky. Everyone had to help out where they could, including her. No more retirement checks and social security for you, m'dear.
"Here you go, Beulah. No cream and enough sugar to put any diabetic into a coma." James Nichols handed her a blue ceramic mug and shook his head in mock rebuke. His grin spoiled the effect a bit.
"I have to keep going somehow. I'm not diabetic you know, so a little sugar won't hurt me. At least we've got caffeine again, even if my arthritis is slowing me down some."
Beulah and James had developed a friendly sparring relationship when they were alone. When they were in public, acting in their roles as director of nursing and director of medicine, they were a little more formal but not too much. Beulah had never gone for that subservient nurse to the almighty doctor stuff in her entire forty-plus year career. She wasn't about to start at this late date even if James had been the type for that nonsense. Which he wasn't, thank God. She and James had worked together a great deal since the Ring of Fire, both in the field and here at the new Grantville hospital. Mutual respect for each other's expertise, a deep commitment to their patients, and a shared sense of humor had helped them develop a strong friendship over the last two years. Since Beulah had worked in just about every kind of nursing over the years, she had been the logical (and nearly the only) choice to be the director of nursing at the new hospital after the Ring of Fire. They needed the younger nurses for the more physical work, and the nurses older than she was were too old, too sick, or dead now.
Still, she couldn't keep up this pace forever. The willow-bark tea helped with the arthritis but it wasn't the same as her now unavailable prescriptions. Her hands wrapped stiffly around the hot mug of coffee. The heat helped the pain, as did the paraffin dips. Her definition of an old remedy was certainly changing, though. The paraffin dips had been something they did in the "old days." Without all the fancy medicines, surgeries, and other treatments from the twentieth century, a lot of people were using old folk remedies or adapting ones from the 1630s. Which caused its own set of problems. No, not problems. Directors of nursing don't have problems, they have challenges, she reminded herself.
They sipped coffee in comfortable silence for several minutes. Outside James' door, she could hear the sounds of the hospital quieting down for the night. She could practically feel her tired muscles unknot as she sank deeper into the chair. Getting up again would be interesting, but James had known how sore her hips and knees were at the end of the day and had given her the most comfortable chair in the room. The thoughtfulness was as appreciated as the coffee, and typical of the man.
She wasn't sure which of them spoke first, just general things at first, chatting about the staff, the hospital, difficult cases recently. So she was somewhat sandbagged by what he slipped in next.
"You want me to what!?"
No teasing grin lit James' face now. His tone was calm but determined. "Become the dean at the College of Medicine's new health sciences department."
"I hate administration. Endless meetings. There's too much paperwork in the job I've got now. Being the dean of a brand new health sciences department will mean even more paperwork. Have you ever developed a course curriculum? Handouts, lecture notes, syllabi. Paper everywhere."
"No, I haven't developed a course. But you have," he countered smoothly.
"I taught nursing for twenty years at a community college. Part-time. What we've all been talking about this past year is a multilevel training program for everything from nurses' aides to doctorally prepared researchers. I don't have the background for that. What about you or Balthazar? Balthazar knows everyone and the local educational system. He'd be perfect."
"Even if he weren't tied up with practice and helping train our spooks, Balthazar never fully recovered from his heart attack. You may be older chronologically, but he is older physically. The rest of the medically trained up-timers are needed for more direct patient care, although we'll all probably be doing some teaching and mentoring of students—especially the hands-on aspects of instruction. More importantly, most of us have never taught so much as a CPR course. We wouldn't know how to put together lectures, handouts, or a syllabus. We're all being stretched in ways we never planned. You'll be great as the new dean."
James was good, she'd have to give him that. "What about education? Shouldn't a dean have more than a bachelor's degree? I never finished my master's degree as a midwife. Many of the faculty at Jena will have more formal education than I do."
If his snort was anything to go by, James didn't even pretend to consider that one. "You have more education than any other nurse around, up-time or down-time. You also have a great deal of experience in just about every area we need taught." James held up one hand to forestall the comment he could see forming on her lips. "Even if some of that experience is a little old, you've gotten back up to speed very quickly. Don't think I haven't seen how many times you wind up taking care of patients rather than office work. And most of your out-of-date stuff is still state of the art and then some here. Besides, some of your old-time knowledge is more within our current technology base's capabilities."
"I like taking care of patients and we're short staffed."
James pounced on that one. "Which isn't going to change unless we set up programs and start running students through them just as fast as we can. Besides, you told me you like teaching."
A distinctly mulish frown bloomed on Beulah's face. "That doesn't make me the right person for this. I'm already running the hospital."
"We needed you to set the hospital up and get it running. Things are going pretty well here now. You've got the administration side set up and running smoothly. The staff is oriented and trained. Starr Hunsaker can take over while you move on to developing the educational program. You won't exactly be alone doing it, either. We'll all help as much as we can. Getting people trained is a priority. We're staring down more years of war, not to mention smallpox, the plague, and on and on. We have to have people ready or we're going to lose a hell of a lot of people, Beulah." James met Beulah's dark-blue gaze in shared grief and frustration over the ones that had already been lost.
"We thought Mary Pat would be a good assistant for you," he continued. "She's already living with you, is young, smart, and energetic, and has come up through the ranks in the army. She's been a medical corpsman and LPN and is now experienced as an RN. She had good trauma experience in the army plus her experiences here. She'd really help you out creating the trauma courses. I'm sure the military will release her for detached service given how desperately they need people trained as medics, nurses, and doctors. And almost all of Mary Pat's RN training was as an up-timer. That also works in her favor." James leaned forward in his chair, elbows on his knees, hands clasped loosely together. "We need you to get the ball rolling again, Beulah. You tend to make sure the practical details of setting things up don't get missed so everything runs as smoothly as possible. You know what you're doing, have lots of experience, know how to work as part of a team and get things done. And, frankly, you'd be training Mary Pat while you're at it. You've been acting as a mentor for her for nearly the entire time since the Ring of Fire. You curb some of her enthusiasm with experience. It's a good match, one we can't afford not to take as much advantage of as possible."
Ouch, another point to James, thought Beulah. Mary Pat Flanagan had come to the wedding of Rita Sterns Simpson the day of the Ring of Fire. Her entire large family was left behind, a wound that was still raw, although she hid it fairly well from the outside world. Beulah knew how much she missed them, though.
Beulah had taken Mary Pat into her home just to give her a place to stay at first. It wasn't like Beulah's brother needed his room anymore and space was at a premium in Grantville right after the Ring of Fire. Beulah had never married. There had been a few Mr. Almost Rights over the years, but never Mr. Right. She loved kids, though, and through her work had had "her" kids strung all across the state. But Mary Pat was more like the daughter she had always wanted. They had developed more than a mentoring or landlady-and-tenant relationship. Mary Pat had almost completed her training as an RN from West Virginia University up-time. Having Mary Pat as her assistant would make the job of dean a lot more doable, as James and the others had clearly realized. Mary Pat was smart, organized, and capable.
James and company are getting way too good at this sneaky political stuff. He's hung around Mike too long.
His next sentence changed her mind.
"You'd also have help from Hayes Daniels."
"Hayes! Are you nuts!" Beulah protested, waving her mug around and wincing when her swollen knuckles hit the chair arm. The throbbing in her hand convinced her to be still but didn't change her glare. "He and I worked together on the nurses' aide/LPN course that they're teaching over at the tech center, and the combat medics course. We don't exactly have a good working relationship. And Hayes wants everything done to his standards, his way. Like we have time for that. We needed good enough to get moving, make changes as we go, and we needed those aides pronto. Mary Pat's temper matches that red hair. Mary Pat would strangle him before we were done."
Hayes was the first Silicon Valley refugee she'd ever met. He'd worked in two high-flying start-ups, working too many thirty-six-hour days figuring out how to teach the world how the Internet would change their lives. He'd finally decided that he'd had enough, and gotten out and come, of all places, to West Virginia, close to his friend Mike Sterns.
James shook his head. "I don't know that I agree with you on that entirely. The two of you got the job done and we're getting well-trained aides, medics, and LPNs now. We need to be sure we set up the best system we can from the beginning. The need right now is urgent but we won't do ourselves any favors if we cut too many corners in the name of expediency. Hayes is the only person we have who can take highly technical material and translate it into the course material we need to teach new staff, in any reasonable amount of time. We need him to help evaluate and organize the Jena material in particular. You'll be too busy setting everything else up to handle all the course materials, our teachers are busy teaching the kids, and no one else has enough of a background to even start the job."
The mulish frown was back on Beulah's face. "The faculty at Jena could do some of it."
"The faculty at Jena will do some of it, but they're just getting up to speed on some of our basic science material themselves. They'll be one step ahead of the students the first few years. We need someone who can do some of the higher level knowledge synthesis now. And that someone is Hayes. I doubt that any of the Jena faculty even understand some of the biology and chemistry concepts from our era."
"Look, James," Beulah said, running a hand over short curly hair, "I like Hayes, I really do. He's smart and talented and a genuinely nice guy. Hell of a cook, too, for that matter. He's also going under for the third time with everyone's projects and has been since we got here. From the stories he told us while we were doing that last course, doing what he did is like being in a combat zone. And he did it for five years, with no breaks. He got six months off, and he's right back into it. You know what that's like—you've seen it."
James looked a little uncomfortable for the first time in their conversation. "It isn't just that. How old are you now, Beulah? Early seventies? You're in good shape except for the arthritis, but that's getting worse. The odds are, you won't be around for as long as we need you. We have to get the medical knowledge out of your head and the heads of the rest of us so we can pass it on to the next generation. Hayes is the only one who can take what you know and put it in a form others can use to learn. The knowledge is too important to be lost when we lose you." His voice was little more than a whisper.
"I know that James." Her voice was almost as quiet. "Hayes isn't even half my age, but at the rate he's going, he won't make it to forty-five. Adding more projects to the man won't help any of us. I'm really worried about him. The man needs a keeper. Otherwise, we may just use him up, and there won't be anything left."
"It isn't as if there are any other alternatives we've been able to find for Hayes. Let's leave him for a later discussion, okay? Right now, you are the best person for the dean's job. Period."
"There are other issues. What about Jena? We'll need to locate the new college there. The first few years of schooling will be there except for brief intensives here. We'll be depending pretty heavily on their faculty. They don't exactly have any women deans at the university. Or faculty, either. Not to mention some of my up-time notions on any number of topics. Have any of you talked to the professors at Jena? How much flack could I expect? It may be that however qualified I am, politically, I'm not the best person. I'm not exactly known for tact and diplomacy."
Beulah saw him note the shift in her tone. She was silently conceding that she was the best-prepared person for the job but looking at the position from another angle now. She was still looking for a way out as James continued his argument.
"There have been a lot of changes at Jena. They have had a considerable amount of exposure to us and to the way women function in all aspects of life here. Some of the faculty will undoubtedly be resistant to any change, just like anywhere else. Some will be especially uncomfortable with any changes initiated by a woman. The handwriting is on the wall, though. They know that women as faculty and as deans are going to happen, as surely as the snow comes in winter. From their standpoint, having an up-time woman take the first steps would make for an easier transition. The senior faculty and other deans support it, for the most part. You and, if she agrees, Mary Pat will have to work the rest out in Jena."
Beulah sighed. She couldn't think of any other arguments against her taking the position or other questions offhand but she wasn't about to rush into a decision this important. "I wasn't expecting this. I really thought you or Balthazar would become the new dean. Let me think about it. I'm not saying yes. I'm not saying no."
"That's fine. Think about it for a bit. How much time will you need?"
"Give me a couple of days, okay?"
As they walked out into the hall, James was quiet. Beulah was running things through in her head. He could practically hear the wheels spinning. When she got her teeth into a problem, she didn't let go. The early-summer evening air was still warm, although it would turn cool again in a few hours. Her "let me think about it" was as close to an answer as he'd get. There was just enough contrariness in her nature to make pushing Beulah an exercise in futility.
As they reached the street, she turned to him with a question. "Exactly when do you plan on starting the school anyway?"
"We'd like to enroll our first class at the start of the year. Good night, Beulah." A good Marine knew when to retreat. James hurried off into the night, the sound of Beulah's creative but anatomically impossible exclamation lingering in his ears. Since he was a man of good sense, he waited until he was around the corner and out of sight before he started smiling.
Mary Pat came down the stairs the next morning at a brisk clip, uniform neatly pressed. Where she found the energy after three straight twelve hour shifts plus her daily morning army PT, Beulah didn't know. The kitchen at home was softly lit by early morning light, quiet and still until Mary Pat brought it to vivid life.
"Morning, Beulah. What's up? You're not dressed yet. Are you sick?" Mary Pat's concern was evident in her voice. Beulah knew that this change in routine would worry her. She was always up when Mary Pat started PT. Her arthritis meant she took a little more time to get moving in the morning than Mary Pat. When Mary Pat came back home, Beulah was always ready to go and had breakfast waiting for them both before they headed to the hospital. The familiar routine felt like having family again. She'd never seen her still dressed in her robe and nightie at 6:30 before.
"Don't worry. I'm fine. I've just got some thinking to do and if I go into the hospital, I'll get sucked into work." Beulah chuckled. "The hospital is a madhouse on a good day. Not exactly a place for reflection. I've already called and let the hospital know. I'll tell you all about it tomorrow morning on your day off." Especially since my acceptance is contingent on you agreeing to go with me.
Politically, it might be better to have a faculty member of the College of Medicine at Jena as her assistant. Problem was, she didn't know any of them to pick one for that kind of relationship. Her close relationship with Mary Pat could make some people feel like she was bringing her own inner circle, especially if Hayes was along. That was another potential issue. If she had her choice, Mary Pat was it, politics or no politics. Besides, we make a good team.
The house settled in around itself again after Mary Pat left. Not without some concern and after she had made sure Beulah had the warm paraffin dip for her hands and an extra-large mug of that nasty willow-bark tea. Heavy on the honey. Why anyone would drink tea when they could have coffee, she had no idea. Beulah smiled affectionately. Mary Pat was a good kid and Beulah loved her dearly. She had brightened any number of dark areas caused by Grantville's trip back in time. If I hadn't had her to come home with, to talk to, and share with, I don't think I'd have made it this long. Dear Mary Pat, what is going to happen to you when I'm gone? James' remarks about her age had hit close to home for more reasons than he might suspect. She'd have to think about that, too. Soon. But right now she had a decision to make.
She had never much liked administration. Being in a rural area or Korea meant that she'd still had to do a certain amount of it, but she'd never liked it. Being the director of nursing had too much of it, even without reams of up-time insurance paperwork. Practice and teaching were what she loved. Carrying a public-health nurse's satchel and teaching at the local community college had suited her quite well, thank you very much. Watching a student "get it" was almost as good as actually caring for a patient herself. She had the background to teach in a lot of areas, no docs hanging over her shoulder with that handmaiden crap and lots to do. Best of all had been the babies. She had even gone back to get her masters degree as a midwife in the eighties, but she'd been too old and too busy to finish it. Or so she'd thought at the time. Now, she wished she had. Maybe as a family nurse practitioner she would have the broadest possible "womb to tomb" knowledge base. It would be nice if hindsight wasn't always so clear. Coulda, woulda, shoulda never changed anything. At least I still have all my textbooks. Those are priceless now.
She was happy with her life overall. She had done some interesting things, helped people out here and there and had a good time. After her stint in Korea and the army, she had stuck close to home. She'd moved back to Grantville to take care of her older brother after his stroke and then stayed on to retire from the local clinic after he died. She had done hospital work when she was younger in the little hospital over in Fairmont but she was too restless for that and had had too much of a taste for the kind of independence and responsibility a nurse could have in Korea. About the only good thing she could say about the war. No, that wasn't quite true. She had met and worked with some very special people in Korea and the experience meant she knew all too well how to handle the kinds of wounds they were seeing so much of in the midst of the Thirty Years War.
In a bizarre sort of way, here, now, she was in a place where everything she had learned and experienced came together. And she did have the skills to pass at least some of that on to the next generation, a wonderful legacy. At least I know which end of a gun to avoid and to duck when someone yells incoming, she thought with a flash of grim humor. Taken together with all she and James had discussed the night before, whether she liked it or not, James was right about her being the logical person for the deanship. Dammit.
"Okay, what's up?" Mary Pat sipped her coffee the next morning and sat back in the kitchen chair to get comfortable, trying to gauge Beulah's mood. She didn't look alarmed so much as determined and thoughtful. She had scared Mary Pat a little the day before. For a moment, Mary Pat had thought she was sick. The idea of anything happening to Beulah made her stomach tighten.
Something was going on, though. What that something might be had teased at the back of Mary Pat's mind all during her shift yesterday. Beulah taking a second day off was absolutely unheard of. Today, Mary Pat herself had a rare day off. It only happened about once a month. Between the hospital and her position in the army, she rarely had any time to herself. It was getting tiring, to say the least, even for someone as energetic as she was. She had intended to do some chores and maybe eat out at the Gardens tonight until Beulah went all mysterious on her.
"I talked to James Nichols two days ago. He and the others want me to become the new dean and get the health-care educator programs up and running here and at Jena."
"They've picked the right person for the job. Congratulations!"
"You haven't heard the rest of it yet." Beulah replied with a gotcha grin. "We want you to be my assistant."
Mary Pat didn't spew coffee all over the place but her green eyes did widen. "You could have waited until I didn't have a mouthful of coffee before you said that," she complained. "Exactly when in my spare time am I supposed to be doing this anyway? Not that I don't want to help you out, Beulah, but I just don't have any time."
"I'm sure that given the military's urgent need for doctors and nurses, they will be more than happy to have you temporarily assigned as my assistant. Your trauma skills will be invaluable. Finding a replacement for you at the hospital is going to be harder but the latest class of nurses' aides and LPNs has just graduated from the tech center at the high school. Not the same as an RN, I know, but they can take up a little of the slack so it won't be as hard. It isn't as though we'd be leaving for Jena tomorrow or anything."
"My patients—"
"I know," Beulah interrupted gently. "Neither of us wants to leave them. James and I already had a version of the same discussion. You should have seen me come up with reasons not to do this."
The tension in Mary Pat's voice didn't go unnoticed. Beulah would never say it to Mary Pat, but she was worried about the long hours and multiple commitments Mary Pat had taken on the last two years. She was an active-duty army nurse and had been deployed all over the area. That meant that although she knew a lot of people and a lot of the local area, she wasn't really close to anyone but her friends Elizabeth, Rodney, Sharon, and Beulah herself. When she was home, Mary Pat worked five or six twelve-hour shifts a week at the hospital. She was also one of the most senior officers of the tiny medical corps, which carried its own set of responsibilities and pressures. Having her with Beulah in Jena meant she would be freed up from working sixty-plus hours a week as a staff nurse and her regular military duties. Beulah knew she and Mary Pat weren't the only ones who were getting worn out. So were all the health-care types in Grantville. They were stretched way too thin and it wasn't getting any better. If anything, it was worse. Grantville's reputation as a center for healing was beginning to spread. Fortunately, right now the reputation was only local. That was going to change though, sooner rather than later. The demands on their tiny health-care system would get nothing but more intense as the war heated up and people found out that they could heal things no one else in this time could.
Beulah gave a dry, humorous recount of her conversation with James. They shared a chuckle, and a little of the tension eased from Mary Pat's shoulders. Mary Pat's sharp mind would fill in the blanks here and there. She was well aware of how strained the health-care resources were in Grantville and its military. Beulah ended her recounting with the role for Mary Pat and why she was needed for the position. Much the same way James did it to me.
"So you won't take the position without me as your assistant? You're perfect for it." Mary Pat was frowning a bit. "I can understand your points but I still think I could serve better here." Mary Pat reached for the coffeepot and refilled both their mugs before setting the pot back on the small kitchen table. She didn't like to see Beulah handling the heavy pot. Beulah let her think for a few minutes, enjoying the quiet and the aroma of the hot coffee.
"I don't stand a chance, do I?" she finally asked with a rueful grin. "I know that look on your face, Beulah. You've got all the bases covered and all the arguments ready. I guess we should both be getting used to being ambushed by projects like this. I could see this one coming for you but didn't see it for me." Mary Pat picked up her napkin and waved it like a flag. "Okay, I surrender. When do we get started and what do you think we need to do first?"
Beulah reached across the table and gave Mary Pat's hand a little squeeze. "That's the spirit. We need to get started now to be ready for the first class in six months. The way I see it, there are a few issues we need to start thinking about right away. Politics, personnel, and resources are the three big ones at the moment."
"One at a time then?" asked Mary Pat.
"Works for me. Have a preference for which one to tackle first?"
Mary Pat wrinkled her freckled nose and grimaced. "Let's leave the politics till last."
"Personnel and resources it is then. I don't know how much of the big picture you've been aware of and it will help me to think out loud, so I hope I don't go over too much you already know. On the personnel side, the first of the German students will be entering the nurses' aide and LPN program. We're lucky to have had the program already set up before the Ring of Fire at the high school. That has meant we haven't had to start totally from scratch, although Hayes and I had to change a few things with the curriculum given what we're facing now. Hayes will be working with us too. Garnet, Courtney, and Marcia are doing a great job in the nurses' aide and LPN program. They're all sharp and easy to work with and they have the program delivery down to a fine science. I know that ties up an RN and two LPNs but the work they are doing is too important to interrupt for direct patient care. I don't think we should change anything there. They're all ready to go with the mixed German-up-timer classes starting this summer."
"I agree about the aide and LPN program. That's been going really well. We have about sixty new aides and nearly twenty new LPNs now. We'll probably want to talk with Garnet, Courtney, and Marcia about which of their former students might be good for the new program. Some of them are so new, I don't think any of the hospital staff who have worked with them will have a very good sense of their capabilities yet. Two things, though. My German has gotten pretty good. Are we going to be teaching in German, English, or both? And what about Hayes?"
"German and English. It will depend on who is teaching what at the university and who the staff mentors are for students. Any applicants are going to have to be fairly fluent in both. Eventually, we'll probably switch entirely to German but that's a long way off. We have too many texts in English and too many people who aren't fluent in German as potential teachers and students. Some of the Germans in Jena and other areas won't be too happy about that, I imagine. English isn't known as a scholarly language in this time. Unless we're careful, it may look like we're excluding German natives from the new educational system at the same time we're using their facilities. We'll have to have some sort of English classes for some of the German students who will be coming to Jena. There's another problem with languages. Latin."
"I hadn't thought about that one." Mary Pat winced. "No one I know here speaks Latin except Father Larry. Lots of medical terms are based on it, especially anatomy and physiology terms. So we won't be starting entirely from the ground up."
"We're going to have to learn at least some Latin," Beulah replied. "Many of the textbooks used for medical information now are in Latin. Some of that information is still very relevant. How much and in which texts, I have no idea yet."
"Well, we'll be working with him over the next few months at least. We're going to have to put together the curricula and text materials soon. We'll be focusing on the RN- and MD-level training and that will mean higher-level synthesis. Plus, I'm hoping he can help evaluate the materials they have at Jena and help us figure out priorities for copying and translation."
"Okay. You know him better than I do. I know a few of the Jena faculty. They've downsized in recent years because of the war. There aren't going to be a lot of them to help out. The botanical gardens are great though. Werner Rolfinck is probably somebody we'll want to talk to early on. He's been at Jena for several years and heads the medical faculty. He's the one who had the OR theater set up there and is very up on the latest knowledge for this time. He borrowed a copy of a couple of my textbooks a few months ago. The next time I was in Jena, I was going to pick them back up and give him some new material. I had the books copied before I lent them to him. It was lucky I was in the emergency rotation at school. I had several anatomy and physiology texts and a drug book with me that he was interested in." It was Mary Pat's turn to sigh. "I just wish the drug book had more about herbs."
"We have some more information about herbs from the gardeners in town. I was pleasantly surprised about how much medical information they had. Not to mention the medicinal herbs in various gardens. Standardization of dosages and purity are still issues. Stoner and the others are making progress on that. I just wish we had more scientific basis for some of these new medicines. Some of the herbals claim to be able to cure everything that ails a body, including the common cold." She shook her head in disgust, sending shimmers of silver light flashing around her head.
"Sorting out what they have at Jena, what we have here, and how the herbs are named and grown will take time, but once we're rolling, I think it'll be fine. We may have to take at least one of our gardeners with us to Jena. Do you think Rolfinck will be supportive of us coming to Jena and making so many changes in the program? James and Balthazar have both been sending out feelers about it and kind of paving the way. Rolfinck seems very progressive and interested in having the information but it is actually his school, after all. We're outsiders coming in with ideas that challenge a lot of dearly held beliefs."
Mary Pat thought about it for a minute, then shrugged one slim shoulder. "There's really no way to know until we talk with him and the other faculty members. I'd suggest talking to him first. He seems like a very reasonable guy. There are a couple of the faculty who teach what they call iatrochemistry at Jena. It's more similar to our ideas about chemistry than alchemy and that humors stuff. I can't guess how receptive those two will be since I haven't met either of them yet."
"I haven't met any of them. Haven't been to Jena either. You, at least, will be a somewhat familiar face. That should help. I'm not sure how they are going to react to some of my ideas, however progressive they may be. We're going to have to negotiate carefully. I don't want to come across as know-it-all up-timers. First, because it isn't true. Second, because that kind of attitude will cause nothing but problems. We're having a hard enough time with what we can't do. They may have a hard time with what we can."
"I agree. Ideas such as?"
"I've always felt that the split between nursing and medicine was artificial and caused more problems than it helped but it's the time factor that really worries me. We need people trained now. That doesn't even get into content issues like up-time versus down-time knowledge or some of the ethical issues we'll have to deal with. Not to mention that I see men and women having an equal role in health care."
Mary Pat grinned. "You were saying the other day that things at the hospital were starting to get too routine. A new challenge will be good for you."
"Yeah, right. Like I need any more challenges. This project will be full of them."
Mary Pat got up to look for a pen and some paper to start taking notes. "Well, we don't have to solve everything right here and now. Let's think about who we have here and who we need to put together an educational team."
The four deans of the University of Jena met in Werner Rolfinck's office at the university. Werner was dean of the medical school. Next to him sat Johann Gerhard, the dean of theology. In his early fifties, Dean Gerhard was a conservative, thoughtful, and prudent man. Werner was particularly glad he was here, as Johann was known for his ability to smooth troubled waters and had studied medicine for several years in his younger days before turning to theology. He was also someone who listened to arguments, considered carefully, and then acted. Werner wasn't sure what Johann thought about the proposed merger with Grantville's medical people. He wasn't sure what he thought of it himself.
Across from Johann and Werner sat the deans of the schools of arts and law, Dietrich Wetzel and Karl Strom. Dietrich was about Werner's age and a good friend. He was a plump, cheerful sort of man who seemed to exist in a perpetual swirl of energetic chaos. Dietrich had incredible ideas. Making them happen was another story. He was usually off on the next idea before the first project was even halfway completed. Karl Strom was his exact opposite in some ways. A member of the minor aristocracy, Karl was meticulous and very cautious in his approach to life. He had a sunny smile but, most of the time, wore a sober face that he thought was more in keeping with his position. Werner wondered if he realized how young and earnest that sober face made him look. Or how like a young man dressing up in his father's clothes. Karl, only twenty-eight, was young for his position as law school dean and painfully aware of it. It could make him rather prickly on occasion.
Dietrich was all but bouncing in his chair with excitement. Werner stroked his dark, thick mustache to hide the grin trying to escape. "As I told you last time, the Americans want to start a joint . . . medical education program. If we are agreeable, they would like a formal arrangement with the school of medicine to start teaching nurses and doctors. The arrangement would be the first in a long-term partnership with us. The medical school would expand into a health sciences College with schools of medicine, nursing, pharmacy and allied health."
"From what you have told us so far, the other three schools we have now may need to be involved right away as well," Johann said thoughtfully.
Karl looked startled. "The other schools? But I thought that was further in the future?"
Werner waved a hand. "You know these Americans. They have laws for everything. They have laws for who can practice, in what area, and under what conditions. Fraulein Flanagan tells me they call it `scope of practice' or some such. I would imagine that as we are setting up the new school, there will be some need to reconcile their laws and ours."
Karl's ruddy complexion blanched a bit. "Yes, I can see the need. Still. They do have a great many laws. I don't know anything about medical law, though, theirs or ours. I have been mostly looking at constitutional and national law. None of us in the law school have experience in the areas of medical law. We did but with so many students and faculty leaving because of the war . . ."
"You could hardly do anything about the war, Karl. We have what we have. It may be that this partnership will attract new students and we will refill the ranks of our faculty as well." Johann's calm practicality eased the anxiety from Karl's face.
"What about the arts?" Dietrich leaned toward Johann and Karl. "We've been translating a few of the books Fraulein Flanagan lent Werner. Fascinating, just fascinating! And the quality of the illustrations are amazing! We may be able to help with that, too."
"Mathematics and philosophy are other areas where we may need help, but I'm just guessing. Right now, it's too early to make many plans." Werner knew Dietrich well enough to stop that line of thought before he went to far with it. The school of arts would be in absolute turmoil if they didn't slow Dietrich down a bit. As it was, that facile brain of his would have a dozen different projects ready to start before he left the room today anyway. "I've talked to the head of the delegation they want to send next month. Frau MacDonald will be—"
"Frau? The head of their medical delegation is a woman?" Johann looked and sounded shocked.
"Yes." Werner knew he sounded a bit defensive. "I don't know about the rest of the delegation but the leader is a woman."
"I hadn't realized they had women as physicians." Even Dietrich sounded a bit shocked. Women simply weren't university-educated physicians. Nor were they barber-surgeons or apothecaries, who were seen as lesser levels of healer. Women were usually midwives or herbwives, considered the very lowest of those caring for patients. They were necessary to care for women's mysteries but any of their other activities were not well regarded. There was simply no comparison between a physician and what amounted in their minds to an uneducated herb witch.
Werner gritted his teeth a bit. "She isn't a physician. She's a nurse." Which of course only made things worse.
The silence that followed was anything but comfortable for Werner. Intellectually, the deans had known that Americans didn't seem to care about a person's gender very much in terms of one's role in life. Most of the Americans they had each dealt with had been men, however. That they understood. Thanks to his meetings with Mary Pat Flanagan, Werner was a little better prepared than the other three but it would be his department that would have to make this work. He wasn't entirely certain how his faculty or students would respond.
"A nurse?" Dietrich seemed nonplussed. "Nurses to teach doctors, to be dean?"
Werner hastily explained. "The nurses from the future know a great deal. They have university degrees and some have graduate degrees, including doctorates. Nurses are faculty at medical schools in the future."
"How will your faculty respond to teaching with women?" asked Johann.
"We've discussed it but more in theory than in fact. Now that we are actually faced with it and soon . . . I just don't know."
"Why aren't they sending a man for such a position?" Karl's disapproval was all too apparent.
"I doubt it even occurred to them to be a problem. Dr. Nichols assured me that Fraulein MacDonald is the best person they have to do this. She taught for more than twenty years at one of their universities." Werner carefully didn't mention that she was a midwife or that she hadn't taught doctors. It would just make things worse. "We have talked about having women as faculty this last year, even as deans. Granted, there aren't many women with university educations in our experiences but we knew that our association with the Americans would change that."
Clearly, talking about it and actually doing it were two completely different things. Judging by the look on Johann's face, he had just thought of something unpleasant. "Will they expect us to enroll women with the men as students as well? The university's prestige may suffer if we do this. I had thought this might be a way of gaining students. Now I wonder if we will lose them."
"Women as students with the men?" asked Karl, looking rather stunned by the idea. "How do you teach women?"
"We are supposed to be one of the more forward-looking universities in all of Europe. We are part of the United States now. I have seen something of what they accomplished in the medical arena. Some of their leading scholars were women. We can build something like that here. Whatever reservations I have about merging with those of Grantville, I want to be able to treat patients as they do. And I want our students to have the very best education possible, as I am sure we all do. If that means women as deans and faculty, I am willing to at least try. I think my students and faculty will as well, but how we act, how we present this to them will be critical for shaping whether they see this as a difficult but exciting opportunity or as a lessening of the university and what we have to offer."
Werner looked each of them full in the face, his tone grim. "There are many other problems to be solved in the coming months. We must discuss at least some of those today. Ultimately, the question is whether or not we wish to join with Grantville and under what conditions."
It had rained the night before. As she crossed the grass in front of the hospital's front entrance, Beulah felt her shoes getting wet and soggy. At least she didn't have to wear hose anymore. She could put the socks over a chair in her office and they'd be dry before she had to be the director of nursing.
The hospital was a source of some pride in the community. The three-story building had been finished nearly a year ago despite shortages of materials and funds, and competing construction needs. The iron grillwork over the windows glistened from the rain. The hospital had been built with security in mind, given the time they were living in now, but they had still tried to make it look more comforting than fortresslike. They had tried to design a hospital that could handle casualties from battles and the epidemics every member of the health-care community feared were coming. Time would tell how successful they had been.
She had received a letter last week from Debbie Leek about building a hospital in Magdeburg using a similar design to the Leahy Medical Center, named after Dr. Leahy, a much-loved former town physician. The Leek family's story was one of the tragedies of the Ring of Fire. Jennifer Rush, Debbie's eleven-year-old cousin, had been doing very well on chemotherapy for her leukemia before the Ring of Fire. Afterward, unable to get the treatment she needed, she had lived only a matter of months. Before the family had moved to Magdeburg, Beulah had gotten to know them all well. Most of the family had been in some kind of management position pre-Ring of Fire and they saw Magdeburg as a place where their backgrounds could be put to good and profitable use. Debbie's letter indicated she was working with Mary Simpson on her educational projects with Veronica Dreeson. Long term, they wanted to found a university in Magdeburg.
That letter started Beulah thinking about something else now. Mary Simpson was working on fund-raising and other aspects of getting the girls' school up and running. The new department at Jena would need funding badly. Supplies, textbooks, tuition, living expenses, teacher salaries, the list went on and on. The cost of just one hand-painted, illustrated herbal had been stunning. They were going to need more funds. It was a certainty the current government didn't have any money to spare. In fact, most people didn't. All those deep pockets Mary Simpson was picking with such class could. . . .
"Guten morgen, Frau Professorin."
"Guten morgen, Fritz. Wait up a second." Beulah waved to the young man nearing the entrance. Friedrich Joseph Hersch, also known as Fritz, was a twenty-year-old who worked in the hospital bakery. His family were local German bakers who had relocated to Grantville shortly after the Ring of Fire. Several of them worked in the hospital bakery. Fritz was a little above average height, with sandy hair and hazel eyes. The heavy work he did as a baker had given him a strong build.
"If you have a few minutes in the next week or two, come up to my office. I'd like to talk with you about working here at the hospital taking care of patients."
Fritz seemed surprised but pleased. "I shall come to see you today at lunch. Will that be convenient, Frau Beulah?" Fritz's English was good but tended to be rather formal. He had spent a lot of time learning from English grammars as well as talking with people. Smart, kind, responsible, and motivated—excellent characteristics for what she wanted in a future graduate from Jena. As a bonus, Fritz was just plain nice.
"Perfect. I'll have some food brought in so you don't miss your lunch. Can't have a growing boy deprived of food." With a laugh and a wink, Beulah walked toward the conservatory at the center of the hospital while Fritz headed for the kitchen. The conservatory had practical as well as ornamental uses. Medicinal and ornamental plants were grown in the glass-roofed conservatory. There were cement paths and stone benches for patients, staff, and visitors to stroll or sit and rest. She had made it a habit to stop in and walk in the quiet garden for a few minutes before heading up to her office. Now, she sat on a bench sans wet shoes and deliberately set aside thoughts of all the tasks waiting for her upstairs to enjoy the fragrant stillness.
The plants had come along nicely. The aloe plant was sending out new leaves. Aloe had proven helpful in treating minor burns. It soothed the pain wonderfully and helped keep the tissue moist. The plant grew in the graveled area near the bench she was using. Nearby were Saint-John's-wort and valerian, herbs that were being used to treat depression and anxiety. There had certainly been some of both the last two years.
The garden had become something of a symbol for her. The plants meant hope for treating patients and for finding future cures for the diseases they now faced. When she lost another patient who might have been saved in the twentieth century, the hospital garden reminded her they weren't entirely helpless. They were adapting. The health-care situation was not quite so desperate as it had been when they first arrived, now that they had the hospital, its staff, and the herbal remedies. The sanitation committee was doing a great job. At the same time, the garden was not entirely benevolent. In a shady spot on the second floor was foxglove to make digitalis preparations. The plant grew four or five feet high and had lovely flowers. While good for treating congestive heart failure and some irregular heart problems, it could be deadly poison and thus was placed where curious children or adults couldn't get to it.
When she got too worried about the future, her personal faith and thinking about Mary Pat, Fritz, and the other youngsters eased her mind. Fritz would make a wonderful nurse or doctor. So would a number of others. They would have to choose the first students very carefully. Possible sources of students were likely graduates of the nurse's aide, emergency medical technician, combat medic, and licensed practical nurse programs, as well as personal recommendations from various people. Those programs all took a year or less to complete in Garnet's program at the tech center. They were running people through the programs as quickly as possible. Now that they'd opened them to German students, they'd have an even larger pool of possible applicants from which to draw.
Beulah would be recommending Fritz for the RN program. He'd need to get into the tech program at the high school as soon as possible to be ready to go to school for his degree as a registered nurse. There were several RNs she would like to see go on to the MD program at Jena. Which would leave them even shorter of RNs for a while. Some people, like Sharon Nichols, had essentially had enough on-the-job experience to be functioning as RNs. Some of the Jena students already in the medical program would undoubtedly want to be admitted. That was going to be trickier. How did you tell someone that while they were about to graduate with a medical degree, they weren't qualified to work as MDs in Grantville? A possible solution came to her. Hm. Have to check with Mike Sterns and a few others first. Might work. Who knows, maybe I can handle this diplomacy stuff after all. With a lighter heart, Beulah headed for her office.
The faces around the gleaming conference table at the medical center, or Leahy as it had come to be known, were all familiar to Beulah. She was not happy to see all of them. Mara Washaw was a thorn in her side. She was one of the small number of up-time RNs available, young but still experienced. That made her important and she knew it. Beulah had tried to be more rational about her. Mara had great experience, having worked in a large hospital as a nurse in Charleston before she married Lennon, Starr's brother. Mara and Starr were about the same age, early thirties, and both had kids. Other than that, they were very different. Mara hadn't taken it well that Starr was going to be taking Beulah's place. Frankly, Beulah was glad Mara hadn't gotten the position. Most others had stepped up to the plate after the Ring of Fire and done as much as they could for their families and community. But not everyone. Mara just sort of coasted. Since she was very bright and well educated she got away with it but she did the minimum amount necessary. She knew how bright and talented she was and didn't let others forget it. Beulah could forgive that if Mara had lived up to her potential. Or even tried to. Beulah hoped she didn't have trouble with Mara being on the committee. She didn't think Mara sitting at the opposite end of the head of the table was an accident. Beulah wished Starr was in her place but Starr wasn't at the table. She had assumed Beulah's duties this week. Which left Mara as one of the senior RNs available for the forming health care education committee.
"Morning everyone. Why don't we all get settled? We've got a lot to work on and not much time."
Garnet Szymanski, director of the high school nurses' aide, EMT, combat medic, and LPN programs, gave an exaggerated wince. "So what else is new?" A nice way to start the meeting. Grins all around. Except for Mara. Must have been the mention of lots of work, thought Beulah.
Beulah looked around the polished wooden table as the others got settled into their chairs. Balthazar Abrabanel sat on her left. His face was very welcome. Not to mention the fact that he's far more skilled in diplomacy than I'll ever be, Beulah thought with an inner grin. That wasn't the official reason he was here, of course. He was the first down-time physician to absorb enough up-time knowledge to become a full partner with Drs. Adams and Nichols. His knowledge of the current educational practices in Europe would be important as well. If not for his heart and the amount of time he spent training their spook squad, he was up to speed enough to be the new dean. In Beulah's opinion, he'd be a better choice for a lot of reasons, not the least of which that she and most of the others knew next to nothing about medical education in this time.
Garnet was seated next to Balthazar, wearing as usual, her beloved yellow. The woman had a bright yellow house and had driven a bright yellow car. She was fifty-three and solid in more ways than just her physical appearance. Garnet was someone you could count on. She loved teaching and it showed in the ways she interacted with her students. When Garnet was around, learning was going to be fascinating. Her enthusiasm was catching and her two LPN assistants, Courtney and Marcia, were just as dedicated and competent. Any future nurses and docs who got run through the program at the high school would be getting a first-rate start in their careers. Licensed practical nurses took only about nine months to train now, since many of the things they could have done up-time were no longer possible. They didn't know as much as registered nurses but they knew more than nurse's aides. The program was going to have to expand again but at least the groundwork was all done and most of the kinks worked out.
Across from Garnet was Ann Turski, a health educator who had worked with Garnet before the Ring of Fire. Her time was now split between Garnet's program and helping put staff in-services together here at Leahy. She and Beulah worked well together, although Ann tended to get upset if things weren't organized to her satisfaction. The woman was an organizing machine. Disorder and chaos were the enemy. She had had quite a lot of both to combat during the last two years. When Beulah had told her about the committee and asked her to serve on it, Ann had been visibly relieved. "Finally, we'll be getting properly organized. There's been too much flying by the seat of our pants the last two years." Ann had light-blue eyes and shoulder-length dark-brown hair. When she was nervous or facing disorder, she tended to pat her hair, as if making certain that at least her person was still neat and tidy. Right now, she was patting her hair and had just smoothed her knee-length skirt. Hmmm. Probably knows I'm about to drag her off to Jena and disrupt her routine again. At least her husband, Wells, is off on a diplomatic mission and they don't have kids to worry about.
Next to Ann sat Raymond Little, the hospital's chief pharmacist. He was a quiet man and deliberately rather nondescript. Ray blended into the woodwork whenever possible. He knew his stuff as a pharmacist but she'd never seen him really assert himself for anything. He and Stoner worked very closely together. Beulah suspected that he loved working with the plants and in the garden. Once, she had even seen him give a plant he was cutting a tender, apologetic pat and murmur soothingly to it in his pleasant baritone. Completing the group was Mary Pat, sitting at Beulah's right hand in more than a literal sense. Hayes had been tied up with other projects and couldn't make it to the first meeting. He would be keeping track of a lot of this by minutes when he couldn't attend anyway.
Before Beulah could even get started, Mara fired the first salvo. "This is such an exciting opportunity. I'm so glad you could be here to get us started. I'm sure that with everything going on, you're very busy."
"Yes, it is very exciting. There will be times I can't be here for meetings. Fortunately, when I can't be here, Mary Pat will sit in for me. If she isn't around, Balthazar will take over." Judging by the souring of Mara's smile, that wasn't what she had expected to hear. She'd undoubtedly thought that Balthazar would be too busy, Mary Pat deployed, and the other two easily managed, leaving her to take over and have all the glory with little of the work. Beulah had been on too many academic and public health committees to be taken in by that particular tactic, though. Normally she would have approached the leadership roles on the committee differently. Garnet was here more in a capacity as bridge between the programs to make sure they articulated well. She was already busy. Ann and Ray would be too likely to let Mara slide if they were in charge. Neither of them liked conflict and Mara in full attack mode was something to see.
"Did you all get the handouts for today's meeting? Anything in particular you'd like added to the agenda for today's meeting?" Mary Pat helped ease past the little conflict and get back to business.
"Yes, as a matter of fact there is a problem," Mara said firmly. "We have the hospital here and the most educated staff. It makes no sense to split our resources between here and Jena. It will leave us too short staffed and take too much travel time."
Beulah sternly refused to ask if Mara's concerns were really about the program or about having to work extra and not having students around to lord it over. Unfortunately, the point was a valid one, whatever the motives of the person making it. Beulah wasn't too surprised when Ann spoke up.
"I agree. We have what we need right here. The faculty and students from Jena could easily come here and we wouldn't have to leave Grantville."
"We thought about that. There are advantages to keeping it here but the advantages are outweighed by the disadvantages both in the short term and the long term. First, we need the resources and faculty at Jena. We don't have enough personnel here. We need to spend some time learning about their resources and skills, and time is short if we are going to start the first classes of new RNs and MDs in January."
Garnet nodded agreement. "At Jena," Beulah continued, "we'll have access to the botanical gardens, the faculty, and the textbooks as well as their other facilities. Space is at a premium here in Grantville for everything from classrooms to housing. We plan on building a student dorm, a medical library, and other facilities here but right now, we don't have the money or most of the other things we need to make that happen. Jena has everything but the hospital and our staff. We work with them and both of us win. The students can come here to the hospital for intensives early in their training. We'll have had time to get more resources in place for them here for later training when they are ready for more clinical time. I've already sent a letter to Debbie Leek about raising funds for the health education project.
"Finally, Jena is a strong university as well as being the closest one to us. We don't want to lose the university base for health care education. I know we've all had to do quite a bit of OJT the last few years. We need to be proactive now and set up an educational system capable of creating the knowledge and advances we had up-time. We need people who will be able to practice at that level as soon as possible."
Ann was nodding thoughtfully now, although she still didn't look too happy. Balthazar took over and added some more information about Jena and 1630s medicine. He also spoke a little about the faculty he had been corresponding with in Jena. One area smoothed over. Beulah sighed as Mara came up with another disagreement. Time to get things back on track.
It was going to be a very, very long meeting.
Dr. Werner Rolfinck strode through the botanical gardens early the morning of the first meeting with the representatives from Grantville and his faculty. He bent down and pulled a weed shoot from the row of Matricaria recutita. Chamomile was a useful herb for calming the nerves, as an aide to wound healing, decreasing inflammation, and an antispasmotic. The people from Grantville had expressed particular interest in the use of herbs and other botanical agents in healing. He didn't want the garden to look anything less than its best. Since it was July, the foliage was particularly lush.
Werner's feelings about the proposed "joint venture" with Grantville's medical personnel were mixed. So were those of the three Jena faculty members who would be sitting around the conference table with him in a few hours. Werner was thirty-four years old and had been the dean at the medical college for several years. He considered himself a forward-thinking man and made an effort to keep up with the latest information in the healing arts. He had been proud of his accomplishments and his career. He still was. Given what he had learned so far from the Grantville texts he had intently studied, he and the faculty here were on the right track in any number of areas. He was proud of the faculty, too. There may not be many of them left, but those who remained were excellent men, all dedicated healers who were devoted to their work.
None of which changed what he had read in those books and the implications of what he had read. Those things had left him frustrated, disheartened, and desperately wanting more. There was so much more to be learned, so much more that could be done for their patients. The possibilities were very exciting. He felt as though a new world was opening up and Jena was going to be a part of incredible things. So am I so unsettled because the changes are happening at all or because they aren't happening fast enough?
It would probably be rude to tell their guests, in the American phrase, about damn time. Rationally, he understood that the Americans had needed to secure their borders and that other pressing needs had kept them from addressing anything but immediate medical needs. Still, they could have shared more of their texts sooner and made medical care more of a priority. Werner began to pace through the feverfew section of the garden. Medical care could save lives just as surely as winning on a battlefield. Healing was its own kind of war. They could have been so much farther ahead of where they were now with more books and communication with Grantville's medical personnel.
Compounding his frustration was the sense of pressure he felt. So much would have to happen very quickly to be ready by January. The bits and pieces he had learned had been tantalizing but bitter. He had read the books and then seen patients in his practice that could have benefited from Grantville's level of care. But Grantville was too far away and even if they had its facilities here, he and the others didn't have the knowledge. That had been eating at all of them for at least a year when they began realizing what the Americans could do.
Instead, the Americans had decided to work with his school at their convenience, when they had time. He knew that wasn't really a fair way of putting it, and it certainly wasn't the frame of mind he needed for this upcoming meeting. Still, fair of not, it didn't change how he felt. He made a deliberate effort to unclench his muscles and slow his pacing. The Americans had chosen the medical college as their first real joint venture with the Jena university. It was both an honor and a burden. A lot of people would be watching how he and his faculty handled the merging. He was hardly naive enough to think the Americans didn't have their own priorities and needs but this could be a mutually beneficial partnership, a partnership among equals. He would see to it.
Werner tried to be subtle as he observed his new colleagues from Grantville. He had spoken with each of them at least once by radio and exchanged letters setting up the meeting today in Jena, but he also wanted to actually see them.
The leader of the delegation was an elderly woman who moved rather stiffly. He could see the arthritic changes in her hands, which the trip here and the cobblestones had probably aggravated. The sight didn't inspire much confidence. This old woman was supposed to lead the new college during a time of dramatic changes? Her evident age and ill health didn't bode well at all, even with the much younger Mary Pat Flanagan woman working as her aide. Werner was impressed with what he knew about Fraulein Flanagan and well disposed to her, given how she had gone out of her way to get texts and other materials copied and delivered to Jena. That they were in English made it rather difficult, but he had had them translated and copies made for the faculty.
Beulah MacDonald, as the elderly woman was named, eased stiffly into the hard wooden chair at the long table and smiled reassuringly up at Fraulein Flanagan. Werner could hardly miss the concern or the affection between them. Then Frau MacDonald turned to look at Werner and the others on the opposite side of the table. The smile changed but it was her eyes that Werner studied. Those navy blue eyes held humor, understanding, and shrewdness. There was an air of experience and competence about her. He wasn't quite sure how to describe it. He would watch and see how this played out.
Coming into the room behind MacDonald and Flanagan were a man and woman. Werner had gotten better about judging ages of Americans. They both looked around ten years older than Mary Pat Flanagan, give or take a few years. The man was of an intimidating size. What Werner suspected were permanent dark circles lay under his eyes. This would be Hayes Daniels, the only man in the group. The last woman to enter the room sat in her chair and carefully arranged pen and paper in front of her. Process of elimination meant this was Ann Turski. Werner still wasn't exactly clear what a health educator was and how that was different from a faculty member. Still, they each gave the impression of confidence and I-know-what-I'm-about he was coming to associate with some of the Americans he had met.
That attitude wasn't always justified, in his opinion. But . . . At least they all speak decent German. That will make things a little easier, Werner thought as the Americans introduced themselves. Now it was his turn to make introductions.
"At my far right is Conrad Herbers. He teaches iatrochemistry and theories of medicine." Conrad, whom they all called Kunz, gave a small seated bow, his expression polite but a bit cautious.
"Next to him is Wilhelm Hofacker, who teaches iatrochemistry and assists me in the botanical gardens."
"I am Willi, please. I shall be happy to give you a tour of the gardens later if you would like." Willi's English was accented but very understandable. He'd spent some time talking to other Americans before the meeting. The two iatrochemists were remarkably similar in more than appearance. Both were blond, forty-ish family men who were interested in what Grantville had to offer but wary of what it might mean for them both personally and professionally.
"On my left is Phillip Ackermann. Doktor Ackermann teaches anatomy and runs the operating theater." Ackermann had just turned fifty. His thinning blond hair was going gray. Werner noticed that although he was over twenty years her junior, Beulah had fewer lines on her face than Phillip. More than about any of the others, Werner was concerned about how Phillip would handle the coming changes. Werner was considered somewhat radical himself and he was younger than the more conservative Phillip. Phillip hadn't said much about his thoughts or feelings on the merger. He was facing the coming changes toward the end of his career, not the beginning. Phillip was terse at the best of times. Now he just gave a stiff inclination of his head in their guests' general direction.
"It is a pleasure to meet others from Grantville at last. We have had so little contact with other healers from Grantville in the last two years." A hint of hostility was present in the polite tenor voice, and it was that hostility Beulah responded to.
"It is a pleasure for us as well. If there had been any way we could have made things happen on our end more quickly so we could meet you sooner, we would have. As it is, we finally feel that we have enough to offer to entice your faculty into a long-term partnership."
That comment wasn't what any of them expected. Willi blinked several times and Kunz raised his eyebrows.
"What you have to offer us?" Kunz asked. "Surely, with all you know, the concern should be whether we have enough to offer you?"
No stranger to negotiations himself, a well-briefed Hayes stepped in. Hayes always did his homework. "On the contrary. You have a great deal to offer us. Books with useful knowledge, buildings to hold classes in, the operating theater, and, of course, your faculty."
"I've seen your facilities, especially the gardens," added Mary Pat. "They're impressive. We brought a few people from Grantville who are gardeners to help us figure out names of plants since we probably won't call them all the same things you do. You know far more about herbal remedies than we do. You know the local artisans who can make medical equipment and have your own practices here in town. Now, we can offer you our knowledge and the hospital in Grantville as a training site."
"We've been pretty disorganized while we were trying to get everything up and running. There wasn't time to plan anything properly before the Ring of Fire," Ann added with a wry grin.
No, Werner thought, definitely not the way I thought they'd approach us.
"You're already set up and fully functional here," Beulah said. "We've spent two years trying to get ourselves organized and dealing with various crises to get to the point where we could approach you. We do have things to offer. I think you'll agree that those things are important. But this merger won't be easy. This is important to us. We don't want to mess up this venture or any future ones."
Even though he had spoken with them over the radio, Werner wouldn't have predicted this. It was better than he had hoped for and the room's atmosphere was warmed by more than the summer sunlight.
Beulah smiled gently. "There is another bonus to working together. You have students who are much further along in their training than those we have in Grantville."
All four of the Jena representatives became very intent. They had been prepared to fight for their students and defend their students' caliber but it looked like that might not be necessary.
"We will be counting on them almost as heavily as on you. I know that the students will need to learn what we have to teach in addition to what you have already taught them," Beulah continued delicately, "but they are still much better trained in any number of areas than the students we would bring from Grantville. Few of our potential students have studied anatomy or performed surgery, for example. The most many of them have ever dissected is a frog in high school biology. One of the things we'd like to ask is whether or not you think your students would be willing to be teaching assistants for the incoming students. We're trying to put together funding for the positions now. We hope to be able to offer room and board, clinical at the hospital in Grantville, and access to our textbooks and equipment sooner. In exchange, in addition to acting as teachers' assistants, we'd want a commitment from anyone we offered the positions to stay in the area, one year for each year of study under the joint system. Naturally, we wouldn't restrict them just to Grantville. We don't think we can come up with enough funding for a stipend but we'll try."
"I think the students will be happy with that plan, if we can make it work," Werner said. "We had been concerned about our students and how they would fit in. None of us is under any illusions that we or the students could just go to Grantville and practice. That has not been an easy thing for any of us to admit. Do you see a similar role for the faculty?"
Again, it was Beulah who spoke. "Not exactly. We do think that there will be things you will need to learn and learn quickly. Part of the reason we wanted to come here is to get to know you and your backgrounds more personally. You are all experienced faculty. You don't need to learn how to teach any more than I do." She gave a little shrug. "There may be a few teaching strategies you'll need to adapt because of different material but you know how to deliver a lecture or teach students in a clinical setting already. There will also probably be some differences in styles that we will need to work on but I think that would be the case anyway. And, it wouldn't necessarily be you adapting to our style all the time, either. We're hoping that you will be the ones doing most if not all the teaching of material like chemistry and anatomy, at least at first."
"That's part of what I'm doing here," said Hayes. "I'd like to work with each of you on course materials, what you have here, what we have, and how they can be combined to get the material to the students in the best way."
"You'll probably not be too far ahead of the students sometimes in terms of learning some of the new material," Ann said. "It won't all be new to you, though, and it will get you ready to learn the practice stuff at the same time."
"What about our learning about your kind of practice? We are already physicians. If you expect us to teach more than the basic courses, we must know more about your kind of practice." Phillip's tone was very firm but without hostility.
"I had hoped to arrange time in Grantville for all of us before we began in January." Judging by the looks the Grantville team exchanged, Werner didn't think they had considered that. "We've studied all you have lent us but the material is complex and has not been given to us in any systematic way." Werner held up a hand. "This is not a complaint. It is just a fact. We would be able to learn more material more quickly if we spent some time with all your material, resources, and medical people in Grantville. We would also be able to see how you practice."
Mary Pat chuckled. "We'd been thinking the same thing but from the other direction. How much time would you want to spend in Grantville? Maybe we could split our time between the two places. Hayes will have to be going back to use his desktop computer for this anyway. We could spend some time here and then all go to Grantville together."
Werner thought a few moments. "Two months would be good. We would need time to see what was there and then decide what to focus on to bring copies of material back with us."
"We would need some time to make other arrangements as well." Kunz sounded a little hesitant. "Willi and I have wives and children."
"If you would like to bring them along, I would be happy to start making arrangements for housing," Ann volunteered. "It might work out even better if we can make arrangements with medical personnel for places for you to stay."
"What about bringing some of the students?" asked Phillip.
Beulah cleared her throat. "I think we should take a week or so and decide who should be approached about the teaching-assistant positions. That way, if we stay here a month, the students still have several weeks to prepare for the trip. And we'll all be back here by November to get ready for the students. Does that sound reasonable?"
Nods all around. "Now, how many children do you each have and how old are they?" asked Ann.
"Guten morgen, Doktor Rolfinck."
Werner looked up from his contemplation of the rather wilted looking mugwort. He'd have to speak with the gardeners about watering the plants more frequently. Mugwort was a versatile sort of herb in medicine. He used it regularly.
"Guten morgen, Frau Professorin MacDonald."
"I see you like to walk in a garden early in the morning as well. This is so lovely. Very nice layout, too. I try to stop for a bit at Leahy's garden each morning as I start my day. Some days, it is the only calm or quiet I get. Mugwort, isn't it? Stoner, our best herbal expert, has been talking about how useful it is, but I don't know much about it."
"I am pleased you like the garden. Feel free to walk here whenever you wish. I use mugwort primarily for pain, as a diuretic, an emetic, or laxative. I've also used it for headaches, insomnia, and as an appetite stimulant." Heartened by her admiration of the botanical garden he had created, Werner probed a bit. "From what you and the others said yesterday, I gather you are quite busy in Grantville."
"Fortunately, I've been too busy to tell myself I'm too old for all this very often." Her eyes were distant and grave. "We had casualties within the first hour and not even a clinic in town, much less a hospital. There were several pharmacies so we had a small supply of our usual medicines, but most of those were set aside for those who already needed them. They didn't last long. The pharmacies up-time also had some other supplies, bandages, and such. We nationalized those supplies right away but most of them didn't last long either. At first, we turned the high school into a makeshift hospital. There were only about ten doctors in town, some of them retired. All told, we had fewer than two hundred people with any medical training at all. Some, like me, were retired. Some have died. We did have the aide and LPN vocational technology program at the high school, thank God. We've been able to train some new people but not many and not at the higher levels. It's been a real scramble to get organized and get the hospital built. Everyone was just trying to get themselves and their families through each day at first. We had some things to work with but we didn't even know what materials, personnel, equipment, or problems we had initially. Fortunately, we had an architect and Mayor Dreeson put together a sanitation committee within the first week to oversee the public health needs. We've done the best we could but . . ." Beulah broke off with a grimace, eyes still distant.
Werner remained quiet and after a bit she continued. "Add to that the rapidly expanding population as refugees flooded in, most of whom didn't have a lot more than the clothes on their backs and maybe a few items of furniture or tools and a little food. The resources we had, in terms of supplies and building materials, were very limited when you think of the need. Then there were the deaths. There have been so many people we had the knowledge to treat but couldn't. Instead, we had to watch them suffer, sometimes die. Too often, there was little or nothing we could do about it, however hard we worked. I'll warn you now, that has left a mark on us all to some degree. Even with the most advanced materials, the best-trained staff, there were still plenty we couldn't have saved anyway. We know that. None of us are miracle workers. I hope you and the others aren't expecting us to be."
"It still hurts to lose a patient, whatever the circumstances. I knew things had been difficult, but I hadn't realized how difficult. I am sorry." Werner could certainly understand what it was to be spread so thin. The university had gotten much smaller with the war. Everyone was taking on a variety of roles. His feelings about the lack of materials from Grantville diminished. In its place was the realization that none of them had gone to Grantville's aide. When Grantville had first appeared, no one had known what was happening or what to think or do about them. Later, he had thought the Grantvillers could handle things themselves and that they were so advanced, he and his colleagues wouldn't have been of any use. Now, he wondered if that had been true. How can they be so cheerful then, so optimistic? The situation there may be worse than I thought. What does that mean for us?
"We don't expect you to be miracle workers. From our view though, the things you can accomplish do seem miraculous. Thank you for explaining. We did not understand why you didn't approach us sooner. Truthfully, we resented it. I understand a bit more now about why you are here and why now. To be frank, the meeting yesterday went far better than I had hoped."
"I'm also pleased by how the meeting went yesterday. We still have a great many details to take care of but I think we can do it. At least as we started getting down to some of the details in the afternoon, we weren't having major disagreements."
"It is, as you Americans say, early days yet. I hope we can work out any problems. Tell me, Frau MacDonald, do you think all your people in Grantville will be as open to working with us and our students?"
Beulah paused a moment before answering. "Most of them will, just as I hope is the case here." Hearing the questioning tone in her voice, he nodded but kept silent. She provided him with what she called "thumbnail sketches" of some of those he would be meeting soon. He would have to remember the phrase. He looked forward to meeting Ray and Stoner to talk about plants, and Balthazar, who was from his own time but was being treated as a valued member of the team by the Grantvillers. Werner had a great many questions for Balthazar Abrabanel. The respect in her voice when she spoke of him was obvious. Less obvious were her reservations about Mara. It wasn't anything she said, so much as what she didn't say that piqued his interest. The contrast with the way she spoke of Starr and Garnet was what made her reservations so evident. Werner could appreciate both the gesture of trust she showed by providing the information about her staff, and the discretion. When she spoke of Fritz and her hopes that he would be in the first class, Werner fit that in with the rest of what he had seen and heard the last few months. They really do want to make this a partnership.
"I have no doubt you'll want to share some of what we have talked about this morning with your faculty. That's fine. I would also like to arrange time to talk with you privately about some things as my counterpart. There are undoubtedly things that we wouldn't even consider because we aren't originally from this time or issues we should discuss between us before talking with the others. I hope you will share any concerns or problems you see."
"An excellent idea. Since we both enjoy the garden, perhaps we could meet here early each morning to talk."
"I'll look forward to it. And please, call me Beulah."
"Everyone ready to go?" Ann looked around the common room of the Black Bear Inn in northern Jena to make sure the others had everything they needed for the Jena tour. Werner and Phillip arrived to be their tour guides as she finished speaking. Willi and Kunz had classes this morning and couldn't come. Since there would be six of them and the streets were rather narrow, that was probably just as well.
"All set here." Mary Pat was carrying what Beulah would have called a visit bag in her public health days. Instead of the brown leather bag Beulah had carried, Mary Pat had turned her WVU book backpack into a mobile emergency kit. The kits had been standardized and accompanied all the teams that left Grantville with a medical type. Other kits had been made up for those without trained medical personnel along, given the skills needed to use some of the equipment.
As they stepped into the street, Ann couldn't help but appreciate the lack of odor. Jena's town fathers planned on developing indoor plumbing but right now, emptying chamber pots wherever was still the order of the day. Jena did have one crucial advantage however. At night, the city flushed the streets from a water reservoir so the city was actually much cleaner than most. What having raw sewage flushed downstream did to others was another issue. They were all concerned about what the level of sanitation meant for public health. Now wasn't the time to say anything about that, though, and the Grantville team followed Werner and Phillip through the streets with their colorful red-roofed buildings to the local clinic. They were only a short distance from the clinic when they were hailed.
"Herr Doktor! Ah, und Herr Doktor Ackermann." The rather breathless student looked relieved to see Werner and Phillip but barely glanced at the others. From what Beulah gathered between pants, a young printer had been working, suddenly became short of breath, and collapsed. His fellow workers had brought him to the clinic. Werner and Phillip headed for the clinic at a rapid walk. Mary Pat and Beulah exchanged a glance. Someone this short of breath and they weren't running?
The clinic was on the first floor of a building indistinguishable to Mary Pat from its neighbors. Inside, the clinic was an open area divided into several sections. One section looked like storage, another a procedure area, and the third had cots set up. About half the cots had patients in them, including one near the door with the breathless young man. Tall, thin, Caucasian, young male, severe shortness of breath, supraclavicular retractions, touch cyanotic. Don't see any jugular venous distention or tracheal deviation. Mary Pat could see Beulah making her own assessment as automatically while Werner and Phillip bent over to examine him.
"What happened to him before this started?" Mary Pat asked a nearby man in a printer's apron similar to the young man's.
"Veit just coughed and suddenly there was terrible pain in his chest and he couldn't breathe."
"He hadn't been injured or feeling ill before this?" she asked.
"No." The man turned away to watch the doctors, clearly thinking that Mary Pat was asking questions that were none of her business. It wasn't the first time she had seen that attitude and wouldn't be the last, no doubt. She had seen it during her deployments in Somalia and Yugoslavia but not to the degree she had seen it traveling around 1630s Germany. Right now, she didn't have time to pander to their delicate sensibilities about women and health care.
"Spontaneous pneumothorax?" Beulah's pronouncement caught the attention of Werner and Phillip. Mary Pat was already swinging her backpack around and unzipping it. She nodded and handed Beulah the stethoscope, then reached back into the bag. "I need to listen to see if air is still moving properly in his lungs. Sit him up, please."
No one moved despite the clear command in Beulah's voice. "We will treat him, Frau MacDonald." Phillip's voice held enough dismissive know-your-place to make Mary Pat flush angrily. She hadn't had too much exposure to that attitude in her previous life. Beulah glanced quickly at her, then back to Phillip.
"In just a minute, I can tell you if this is what I think it is. I need to use this to listen to his chest. If I'm right, we only have a few minutes to act before he is in very serious trouble."
"You do not consider this serious?" Werner's tone was disbelieving.
"Serious headed for critical and possibly life threatening. If there is nothing you're going to do for him in the next couple of minutes, what have you got to lose by letting us try to help him?" To someone who knew her as well as Mary Pat did, it was obvious it took everything Beulah had not to physically push them out of the way and to keep her voice level. The patient would soon be losing consciousness. There was no time for this. Beulah obviously thought so too.
"Hayes? About a thirty-degree angle. Please take care not to compress his chest."
Hayes didn't waste time with questions. He just moved behind the gasping young man and propped him up. Given his size and the element of surprise, the others moved out of his way quickly. Ann started clearing out the ward to give them more room, moving people out of the way. She knew what a spontaneous pneumothorax was, even if she wasn't a clinician and couldn't treat it. There were still people hovering in the doorway but now there was a good-sized circle of empty space around the cot. From the looks on Werner and Phillip's faces, however this turned out with the patient, it wouldn't be good. She took note of the confusion, anger, curiosity, and resentment there. She hoped things went well for the patient but the timing probably couldn't have been worse. Hi, we've been here less than twenty-four hours to set up a partnership with you and we shove you aside to treat the first of your patients we see. There didn't seem to be a good resolution from a political standpoint. If they couldn't save the patient after this, it would be even worse. If they did, it was rubbing salt in a very tender wound but at least the patient would be alive.
Beulah looked up at Mary Pat. "Pneumo, big one. Left lung is almost entirely down. Got a flutter valve in there? Lay him back down please, Hayes, and prop up his feet."
Mary Pat handed her an alcohol-based cleaning agent in a squirt bottle, and gauze. "Yeah, there are only a few left. I'll insert it." Mary Pat went after his shirt with a pair of industrial-sized scissors. They were great for cutting through clothes. The young man was losing consciousness now and they were out of time. She wished she had even a few liters of oxygen by cannula to make this a little better.
"Hurry, trachea beginning to shift." While Mary Pat cut the shirt away, Beulah was already wiping the skin under the shirt with the alcohol. Ideally they'd let it dry but this would have to do. Mary Pat had the small package containing the flutter valve and a few other pieces of equipment in hand.
"Wait, what are you doing?" demanded Werner.
"I'll explain later. For now, get out of the light," snapped Beulah.
Mary Pat hooked up the syringe to the end of the one-way valve and pulled the 16-gauge needle cap off the other end. She'd splashed alcohol over her hands. She didn't take time to put on gloves, just hoped she didn't hit a vessel. Second intercostal space, midclavicular line. She'd done this before and her movements were rapid and crisp. No fumbling. The needle slid right in and Mary Pat pushed a little further, feeling for it—ah, got it—and ignoring the gasps and chatter of the onlookers. The one-way flutter valve allowed air and fluid to escape but not to go back into the patient. As the air began to rush out of the pleural space through the valve, it made a honking sound, further startling the onlookers. Werner and Phillip were demanding to know what was going on. There was more to do so she and Beulah ignored them for the time being. Beulah had the suture ready to go and stitched the valve in place while Mary Pat reached for dressings, scissors, and tape. They needed to get this secure. The valves were almost gone, since they needed plastic materials to make them. Plastic Grantville couldn't produce anymore. The flutter valves were just a stopgap with a big pneumo anyway. There were a few minutes of onlooker chaos but Ann had them in hand.
"His breathing is easing. Hayes, put this pillow under his feet. His pressure is probably somewhere in the basement." Beulah reached for the stethoscope again, listened. "Breath sounds are improving, respiratory rate a little better, too. Nice work you, guys."
Werner was tight-lipped. "Does this mean you will finally explain what you have done to our patient?" Phillip looked too angry to even talk without yelling.
"Given the signs and symptoms we saw and the brief history Mary Pat got, we realized we were probably dealing with a medical emergency called a spontaneous pneumothorax. Young, thin white males are at particular risk for this. What happens is that a part of the lung is weak and bursts. Instead of air going in and out when he breathes, it gets trapped in the pleural lining between the lung and the chest wall. Each breath, more air goes in than comes out. The air builds up in the pleural space and begins pressing on the lung. The lung cannot properly expand anymore. If enough air gets into the space, the lung will start to press on the heart. A sign of that was the tracheal shift I mentioned. The air has to be removed right away so that the lung can reexpand and heal. We used a small piece of equipment called a flutter valve that will help with that." Beulah kept the explanation simple but Mary Pat could tell that some of it still went over their heads.
Beulah glanced back at their patient. His breathing was more regular and he was beginning to pink up nicely. Mary Pat took a turn explaining the procedure and how the valve worked. When she got into chest tubes and x-rays, Beulah stopped her. It wouldn't do any good to make the local doctors look more ignorant in front of their townfolk. Besides, she though uneasily, I don't think they're getting this. Is it that they are too angry to think or something else?
Mary Pat frowned and turned to Beulah. "He needs a chest tube. You can't just drop a lung like that and expect a flutter valve to fix it. An x-ray will tell us how bad it is."
"Agreed. We may not be able to hook him up to wall suction but at least in Grantville, they can put in a chest tube and hook him up to a waterseal system."
Phillip had had enough of them using words that he couldn't understand. Even if they were speaking German for most of it. There was nothing he or Werner could have done for the man but watch him die. They didn't even know what had happened to him. These women had known at a glance. Phillip didn't even understand what had happened in just a few minutes. The two women had done something in front of their students and townfolk that seemed incredible. The speed and skill with which they had acted was impressive. More confused than he had ever been in his entire life, he turned around and walked out, not waiting to see what those women, who weren't even doctors, would do next.
"I had thought you would be getting some sleep but Leutnant Flanagan said you had come here."
Werner's voice brought Beulah out of her thoughts. The stone bench she had been waiting on was not exactly comfortable but at least it had a nice view of the garden. She noted the change from Fraulein to Leutnant when he referred to Mary Pat with a sinking heart. "We had agreed to meet here in the mornings. Did our patient get off to Grantville all right?"
"Our patient? Interesting choice of words, but yes, Veit and Leutnant Flanagan just left. I would have thought you would be getting some sleep."
"It will take them most of the day to get to Grantville. They'll have to go slowly, even with the new suspension on the coach." She smiled softly. "As for sleep, talking with you is far more important. It's been a while since I've sat up all night with a patient. Not that I could have done much else for him if anything had gone wrong. The supplies and equipment are in Grantville. So are the people who can fix it if the lung doesn't reexpand. As for Veit being our joint patient, yes, he is." The testiness she heard in her own voice was enough to make Beulah wince. Every joint she had hurt and she had to face the fact that what had started so promisingly in Jena was rapidly falling apart. Add that to her fears about their patient's outcome and a sleepless night, and she wasn't at her most tactful. That was still no excuse for taking her feelings out of Werner.
"Look, I'm sorry. I shouldn't have snapped at you, now or yesterday. Not exactly professional behavior on my part. Let's be clear on a few things here. I'm not sorry that a man who would have died is still breathing. I am sorry for the way things happened. There were two choices, treat him or stay silent. I knew you didn't have the resources we did to treat him. If I had stayed silent, he could have very well died. How would you be feeling about this if I had and later, you found out we could have treated him but didn't for the sake of political expediency? What else could I have done?"
Werner was quiet a moment, weighing what she said. His innate fairness was warring with his anger and humiliation. How much of the humiliation he felt was because Veit had been saved by two women who weren't even physicians? What would he have done in her place? Given the stakes, would he have held one life as highly as she clearly did? What else could she have done, indeed? He spent a few minutes trying to get his thoughts together, to say what he had to say without making things worse.
"I can understand why you did what you did and I am very glad Veit did not die. That doesn't change the facts. You brushed us aside to treat one of our people. As though we were nothing, knew nothing. We are not used to being treated in such a fashion, especially by women. Don't you understand? That you were right, that we could do nothing while you could save him just makes it harder for us to bear. Phillip and I have spent our entire lives caring for our patients, studying, teaching, and trying to give the best care we could. You gave us a graphic demonstration of how little we know, how limited is our skill. And you did it in front of our students and townfolk. I know things happened quickly, but what happened couldn't have been more poorly timed or more painful to us. How can we have any confidence that we have anything to offer you? That we aren't nothing next to you?"
"Please, Werner, sit down with me."
While he sat stiffly at the opposite end of the bench, it was her turn to struggle to find words. "If any of us thought you were nothing or that you had nothing to offer, we wouldn't be here. What you have to offer hasn't changed since our first meeting. The last thing any of us wanted is to make you feel that way. I've thought about it all night but I don't know what to do to try to make this better."
"Show us what you did and why," Werner demanded promptly. "If we can understand it, then it won't seem so mysterious or out of reach."
Beulah smiled hugely. "That I can do. Can we have both students and faculty present?"
"Yes, I think we should. I'll set it up for tomorrow so you have a chance to sleep and I can take care of some other things today."
"Would Phillip be one of those things? Is he all right?"
"He is struggling with this. I hope he will be calmer by tomorrow. Get some rest now, Beulah. I will send a message to you tonight about the class." He didn't want her to ask about the other things he needed to address today. He was on his way to a meeting with the other deans. News spreads quickly in a small town. He had a feeling there would be more than just medical-school faculty and students at the lecture Beulah would give tomorrow. He thought about warning her but dismissed the idea. She and the others needed to understand just how serious what had happened was to his people. Part of him also wanted to know how she would handle such a surprise. It was not very Christian of him, Werner thought, as he watched her leave the garden.
Mary Pat flopped back onto the bed in their room at the inn with a loud moan. "The roads are awful. I should have just found a horse."
"I can sympathize, but you got Veit to Grantville safely and he's doing well. I'm sure your sacrifice of more road time was worth it." Beulah's cheer sounded a little forced to Mary Pat. She sat up and looked across the room to where Beulah sat.
"Okay, what's wrong? Start at the top and fill me in. I've only been gone a few days. How much worse could things have gotten?"
"Just about everything has gotten worse, actually. It's become pretty clear that we managed to offend the entire university in a matter of minutes. Werner and I talked the morning you left. Werner suggested a lecture to the faculty and students to explain what had happened and what we did and why." Beulah's tone was discouraged.
"Sounds like a good idea. What happened?"
"First, a lot more than just the med students and faculty showed up. The other three deans and some of the other faculty and students were there as well. I've given lectures for years. Never given one like this. They kept interrupting with questions. That usually isn't a problem for me. Tells me the students are still awake and paying attention. This time, though, the questions were a problem for a couple of reasons. It was pretty clear that they don't have a lot of basic concepts. I had Ann there to draw some of this out, you know how good at sketching she is, but I thought we were going to be dealing with a few dozen people, not nearly two hundred, so the drawings didn't help as much as I'd hoped. They had to be passed hand to hand and by that time, I'd gone onto other points. Points they also didn't understand sometimes. I'd have killed for an overhead projector or even a large blackboard and some colored chalk. The gist is that it is pretty clear that a lot of the basic principles we are counting on them to teach, they just don't have."
"From talking to Balthazar, I had thought things were further ahead than that."
"Well, they aren't. I wish I had talked to him in more depth about this. It was also pretty clear they shouldn't have sent me. Everyone from the students to the deans were ridiculing things I had to say. One of the law school faculty even got up and walked out, saying he saw no point in listening to anything a woman had to say about science. I think some of the others would have walked out too, but then they'd have missed their chance to laugh at Ann and me."
"What, they laughed at you?" Mary Pat was off the bed and pacing angrily now.
"Oh, yeah. I had to slap 'em down a bit, which didn't go over well either. Their ideas of science don't have anything to do with the experimental method, trust me. They are more about authoritative sources and since they don't believe a woman can be an authoritative source of anything scholarly . . ." Beulah paused. "To be fair, there weren't that many who were in need of a serious attitude adjustment. The ones from the law school were the worst. All that training in rhetoric certainly made things interesting. I was about to strangle them. Their dean didn't have any control over them at all. I'm not sure he even wanted to have any control; he seemed very much on his dignity, if you know what I mean. The arts dean, Wetzel, at least made an attempt to rein in his students. Werner's students and faculty just looked grim and angry and resentful. They had enough of a background to get at least some of what we were talking about, but that just seemed to have made it worse. It has made them more aware of what they don't know, not less. They don't understand `vacuum' and why negative pressure is necessary for the lungs to work properly. Nor do they have a very thorough knowledge of the circulatory system, much less what happens to the cardiovascular system during a shock state. Trying to explain why it was a medical emergency and why we had to act that quickly didn't quite get through. I had to keep going over things that a high school student would have known and backing up to explain basic science."
"I was afraid of this. I spent some time in the library the last few days. It doesn't have very much but I got enough to get a sense that they may know less than I thought they did. I can't blame them for being upset about it but they still shouldn't have treated you that way."
"That isn't all. Poor Hayes has had quite a time of it the last few days. I think he's about frustrated enough to give up and go home. Faculty are suddenly too busy to meet with him and Ann. Since we demonstrated that we know things they don't, the faculty and students don't want to give us their books. They want ours. I had read some things in teaching theory about the received view of knowledge, where the greatest authority had the knowledge and therefore `truth.' They may hate the fact that this knowledge came through women and that it doesn't agree with their worldview, but in a way that just makes them more determined to get their hands on our books. They all want to go to Grantville and raid the library. Immediately, if not sooner. Since Hayes is the only male, they think he has the authority to just hand them the books and can't understand why he is letting women stand in their way. They also don't understand why he wants to spend time looking at their material. Right now, I'm not sure either. Hayes is ready to pack it up and go back to all the other projects he has in Grantville. He's even muttering about walking the distance if there isn't a way to get back sooner."
Mary Pat gave a low whistle. "Wow. How's Ann doing?"
"The schedule we had has been effectively destroyed already. We've been lecturing and dealing with upset people instead of finding out what we need to know to move forward. Ann hates disrupted schedules. They aren't letting us anywhere near their patients at the moment. She and Hayes haven't been able to do anything to evaluate the material they came to look at, either. Ann is an experienced educator. She is none too happy with how the lectures are going and how we're being treated. Neither am I. The urge to snarl at them is getting pretty intense. That wouldn't exactly help."
"So where do you think we should go from here?"
"Good question. I hate to say it but maybe Mara was right. We should have just started our own med school from scratch."
A discreet consultation with the proprietor of the Black Bear a few days later had led to Beulah reserving the best private room at a local restaurant. The room looked nice and she had paid for a good dinner. Maybe I should have ordered more booze. Question is, for them or me? At least the white wine is really good. I have a feeling we'll be drinking quite a bit of it tonight.
The idea was to get away from the university environment and the other deans and faculty to talk about the future of the joint med school in a more relaxed environment. After the last week, Beulah wasn't too sure there was a future. She'd known it would be hard to pull this off but she hadn't realized it would be this bad. To make matters more interesting, Veit was due to come back from Grantville in a few more days, a week at the outside. Human nature being what it was, she was absolutely sure he would be talking about what he saw there, maybe even exaggerating a bit. At this juncture, she couldn't see that making things anything but worse. The Jenaites were convinced by now that Grantvillers were out to steal their herbal knowledge while depriving Jena of the up-time knowledge they craved. Rumors were flying all over town. Jena's mayor had hinted about the political consequences of Jena not being treated as an equal just this morning, for Pete's sake. She'd given Mike and James a heads-up the day Mary Pat had come back, but things had deteriorated since then.
James had told her yesterday that in the last few days the deans had already contacted him over the radio. And Mike. And Balthazar. When they found out a woman was running the hospital, they had just plain had a fit. James, Mike, and Balthazar had all told them the same thing: We're sorry to hear that but Beulah and her team have our full confidence. We're sure this can be worked out. So much for their end run around the women.
Wish I had a Tums right now, the way my stomach is churning. This mint tea just isn't getting it.
Predictably enough, Ann was the first to arrive. She was positively twitching. Beulah hadn't ever seen her do that much smoothing and hair checking before. Her eyes had darkened with her agitation until they were almost as dark a blue as Beulah's. As far as Ann was concerned, this trip was an unqualified disaster and she wished she had stayed in Grantville. She wanted to go home. So did Hayes. Neither of them had been shy about telling Beulah that.
Phillip seemed solidly in the you-are-withholding-information camp. He wanted the information and he wanted it now. Werner was still trying to work with them but he didn't seem to really trust them. Kunz and Willi weren't talking much, so Beulah wasn't sure where they stood. They had both somehow managed to be too busy to do much more than say hello in the halls in passing. Mary Pat had sarcastically begun calling them Tweedledee and Tweedledum. Beulah had put a quick end to that but she couldn't change what Mary Pat actually thought. Mary Pat deeply resented the treatment they were getting. While Hayes thought they had better things to do and Ann just wanted to go home, Mary Pat was ready to get in their faces and demand respect. Beulah had done that in her younger days. It usually didn't work but Mary Pat was too pissed off to listen to any words of wisdom on the subject. If it was only herself she perceived as being attacked, she would have restrained herself. Beulah knew that part of what had pushed her over the edge was the way she saw Beulah being treated.
Beulah firmly quashed the Tweedledee and Tweedledum thought that flickered through her head when Kunz and Willi walked into the room together, both garbed in sober dark-brown clothing. Mary Pat followed hard on their heels and gave Beulah a speaking look. Beulah gave her a tiny frown, None of that Tweedle stuff now. After the good-evenings were said all around, Hayes walked in and then Werner and Phillip. More good-evenings. Then silence.
"Please everyone, have a seat. Supper should be here soon. I hope everyone likes fish. Felix, could you start serving, please?"
Felix was a thin sixteen-year-old who would be their waiter tonight. He was apprenticed to the tavern keeper and had only recently started serving in the parlor. Beulah had arrived early while he was finishing setting up the steam table for supper. Supper looked good. There was salad to go with the fish, some wonderful smelling bread, cheese, and fresh fruit. She had taken a few minutes to chat with him and set him at ease. He seemed pretty nervous. He'd been surprised when she'd apologized for being so early and volunteered to leave if she was in his way. While Felix deftly slid plates in front of the diners and poured the wine, Beulah struggled to find small talk that would help ease the tension a bit, without any success that she could see. She was trying to pass the time until Felix left before they could get started talking about the school. When he took a position near the steam table, she realized he wouldn't be leaving. So much for privacy. Might as well get this over with.
"I need to ask you straight out. Is there any future for a joint med school with Jena and Grantville? Or have things gone too badly to repair before we could even really get started?"
Werner took a sip of wine to give himself a moment to think. "I don't know. I had wondered if you called this meeting to tell us you were leaving. There certainly seems some sentiment for that among your party."
"I realize things haven't gone as any of us thought it would. I want this to work and so do the rest of us. More than that, I think both Jena and Grantville need this to work. Perhaps what you are hearing is frustration and disappointment. I'd like to talk about what can get in the way of being successful at this and how we can remove barriers so that we can build something to benefit us all."
"Pretty words, Frau Professorin, but that is not the message your actions give," Phillip said. "You say you wish to be colleagues. You say we can contribute to a partnership. You say many fine things but you don't bring your books to share with us, you ask to see ours. You don't treat us with respect. You don't talk to us as equals."
"And you do?" That was too much for Mary Pat. "I've seen nothing but a lousy attitude since I got back. Okay, so we did something you couldn't do. So we did it in public. What else could we have done? You've been choosing to ignore everything we've said and done or put the worst possible spin on it. Respect, my ass. You are the ones who haven't treated us with respect. Respect is earned, buddy. You think that walking out on a teacher in the middle of a lecture, being rude, and laughing at her entitles you to respect? I've got a news flash for you. It doesn't. You've taken one incident and blown everything out of proportion. We didn't mean any disrespect to you and I think deep down you know it. This just gives you an excuse to quit so you won't have to face things you don't want to see. And take the easy way out by blaming it all on us."
"That is untrue," snapped Kunz. "We have acted in good faith. We welcomed you to our town and you repay us by shaming us, withholding your knowledge, and taking over. That is not a partnership."
"Let me address those points one by one. I think they're important," Beulah said. It should also keep our resident hotheads' mouths shut while they cool down a bit. At least Werner has a hothead on his side to deal with, too. "We do see you as colleagues. We wouldn't want to shame you any more than we like you treating us disrespectfully. Actions are important. I hope you will have seen from our actions that what you thought was shaming was actually simply an attempt to save a young man's life. We truly did not intend to shame you."
Ann spoke up next. "We didn't think to bring the books because we didn't know what you had or what you knew. It took quite a while before Dr. Abrabanel was ready to practice in Grantville and he hadn't been trained at your university or even in this country. That was part of the reason for the trip here. As for not sharing our knowledge, it isn't that simple. The things we have to show you can't just be learned by opening up a book and studying the text. If you do that, it will just be more confusing. There have been almost four hundred years of advances in medical care between now and our time. If all we did was give you the books, it would be like giving a beginning student the texts to study for their last set of exams. We need to figure out what you know and what you don't and then put the information together for you and help you integrate it into your practices."
"It doesn't help when you won't even let us look at your books so we can actually figure out what we have to work with here," growled Hayes.
"That is the attitude I am talking about," snapped Phillip. "You helping us, not us helping each other."
Hayes snorted. "You haven't given us a chance! We brought two gardeners along to learn about the botanical gardens and how you use them. You could be showing us something we need to know. Instead, I get nothing but the runaround from everybody I talk to. No one will let any of us anywhere near your precious books. We have to know what we are dealing with before we can make any plans."
"We didn't believe that our books had anything to offer you. We have seen the books Leutnant Flanagan shared with us. We have seen something of what you can do. Where do we and our students fit in to that? It will not be, as Beulah said that first day, a matter of us learning a certain amount and then being ready to teach it to our students. Ann is right. It is more complicated than that." Werner looked at each of his faculty in turn. "I don't know if we are ready to merge our schools. Yet we have no real choice. How can we live with ourselves if we don't learn what they have to offer? Are we so proud then? So angry? What is that next to those we might help, the lives we might save?"
Beulah said slowly, "It sounds as though you've been concerned about this since before we even got here. And we haven't been concerned enough about it."
Willi looked up from shredding a piece of bread. Beulah didn't think he'd taken a bite of food yet. "It is not easy to see what is in those books. How do I take care of my patients now? There is so much more to know."
"The books . . . I thought I was helping by giving you the copies of the books. Instead I just made it worse. I'm sorry. I only meant to help."
"You did help, Mary Pat." Werner used her first name deliberately. "Without that, we might not have realized there was such a problem until much later. Perhaps we were ready to make certain assumptions given any excuse."
"Which brings us to the start of this conversation," said Willi. "Does the joint venture have a future? For myself, I too wish to learn what you have to teach."
"This won't work at all unless we are all for it. Does everyone agree that we want the merger to work?" Beulah asked. There were nods around the table. "Okay. We have some issues here already to address. How about starting tonight by identifying what we think the problem areas are and then we all take a few days to come up with possible ways to solve them before we meet again?"
"An excellent suggestion. We could all use some time to think and for tempers to cool." Werner glanced around the table. "Let us each take turns bringing up one issue until we have covered all our concerns."
Ann reached into her suitcase-sized purse for the paper and pen she carried everywhere with her. "I'll take notes so we don't miss anything at our next meeting."
They had all had to send for or buy warmer clothes before they got back from Jena as the weather had changed considerably over the last two months. The trip back had been cool, rainy, and generally uncomfortable. Beulah wanted nothing more than her bed and some willow-bark tea. They had been able to distill the active ingredient for the equivalent of aspirin from the birch bark into a pill form, since it worked better in pill form than the willow bark, but she usually drank the tea. The heat from the mug was a double benefit for her hands.
She had sent James, Balthazar, and Starr a long letter a few days ago catching them up so she didn't have to meet with anyone tonight. Tomorrow was slated as a settle-in day, so she was planning to take things easy. The group from Jena wanted to get started right away. Beulah thought they needed at least a day or two to get accustomed to Grantville. She hoped the trip had taken some of the starch out of them. It certainly had taken the starch out of her. It had also given her more time than she needed to think on the last few months and what lay ahead. The changing leaves on the trip back had just seemed to emphasize the running-out-of-time message playing in her head.
Veit's arrival in Jena a week after the supper meeting had had several consequences. As she had feared, he'd spread his view of Grantville's medical capabilities far and wide. Beulah and the others had been approached by Jena natives for all sorts of medical needs. Most of them, they couldn't meet. Some of those could be fixed in Grantville. When they had explained that they didn't have the equipment they needed, a considerable number had shown up at the Grantville hospital. It hadn't been a flood exactly, but it had strained resources and personnel, who were already stretched thin. The doctors in Jena saw their patients look to Grantville, not them, for help. It was a double-edged sword. Some of those who went to Grantville were helped. They had brought back stories of relieved pain or even cures over the last two months. Others weren't helped and no one in Jena had enough of a background to understand exactly why one particular patient could be helped but not another.
She and Mary Pat had had to do a lot of explaining. The Jenaites just wanted answers while she and Mary Pat wanted to put things in a larger context. So the answers the Jenaites got didn't really make sense to them, because they didn't always want to listen to the underlying reasons and what nurses called critical thinking that went into the processes of assessment, diagnosis, treatment, and evaluation.
They hadn't been too eager to share their medicines when Beulah and Mary Pat ran out, either. The doctors had seen that Mary Pat and Beulah could help with some things in Jena without sending the patients to Grantville. It had kept the wounds from the episode with Veit fresh in everyone's mind.
Beulah and Mary Pat had hoped to establish a better relationship between themselves and the doctors and students at Jena. There had been a little progress but the things that helped them make progress sometimes hurt rather than helped.
That was true for more than the med school and the town. The rest of the university was watching all that happened very closely. So closely, in fact, that they had sent along several university delegates. The dean of theology was one, as were representatives from the law and arts schools. She was grateful the other two deans hadn't come. The arts school dean made her dizzy, hopping from topic to topic and the law school dean had a permanent scowl etched on his face. Beulah thought their goals were to find out as much as they could about the knowledge in their areas that might be affected by Grantville know-how before they were confronted with it more directly. She had to admire their being proactive and wanting to learn. She just wished they were coming after the med school delegation left. The Grantville library wasn't too well organized yet and there wasn't a lot of space for people to go looking around. The other schools would also be watching how the med school faculty and students were treated. That put the med school faculty and staff under a microscope instead of letting them just deal with the Grantville people. Beulah felt for them. It wasn't an easy position to be in.
Werner and his entire faculty had come, which was what they had planned at the beginning, more or less. The entire student body had also come. Since there were only about thirty students, and as Werner pointed out, the students couldn't do much with the faculty gone, that had made sense. Given the extra time, they had even found space for everyone. But more people trekking to Grantville meant more time was needed to get everything organized. Which had put them further behind schedule. Ann had been a godsend, although the frequent changes in plans as one more person (and usually his family) just had to be added had kind of gotten to her. At least it had given all the Jenaites time to work on their English. One of the few nice surprises on the trip to Jena was that all the med school faculty and some of the students had been practicing English for some months before they got there, so they actually spoke it pretty well.
Beulah stared at all the horses, carts, and wagons disgorging people and baggage into the cold night air. We looked like an old-time wagon train headed west, she thought tiredly. It was a toss-up whether she was going to brave the crowd of people or just wait till everything settled down. Mary Pat had met up with Rodney and his girlfriend, Pris, then headed to the hospital to drop off her emergency bag for restocking and to check in with the army officer on duty. Beulah hoped to already be asleep in her own bed by the time Mary Pat got home. Rodney had told Beulah someone was coming to help with her bags, but he hadn't been sure who was coming.
The Grantvillers who were taking in some of the Jenaites were moving among them, trying to figure out whom they were supposed to meet and take home. The smarter ones were holding signs, but in the gaslight and the confusion, it wasn't easy to make out what was written on the signs. The ones going to the town's only hotel were in a group and those people had ridden up together so they and their bags could be rounded up all at once. It still took time and was noisy. Fritz was standing right beside her before she heard him call her name.
"Frau MacDonald, are you all right?" he asked in concern.
"I'm just tired, Fritz. It was a long trip."
"I asked to come carry your bags home for you tonight. I thought you would have many and it is some distance to your home. I shall find your bags and help you get home with them if you would like."
"That would be wonderful. I wasn't sure how I was going to get my things out of this mob."
Fritz dove into the crowd and found the bags with Beulah's name on them. "I also wanted to thank you for recommending me to the nurses' aide courses. I am enjoying my new work very much." He set off with Beulah toward her home. They walked quietly for a while, Beulah letting her thoughts settle and Fritz apparently gathering his nerve.
"I have heard that the classes in Jena will start in a few months, that you and the others will be picking the first students soon."
"The reason I wanted you to get started in the nurse's aide courses so quickly is because I wanted to see how you did and if you liked the work. I hope to be able to recommend you for the first class. I don't know what the outcome will be and I can't promise anything. But I think you'd make a fine nurse or doctor, Fritz."
"Thank you, Frau MacDonald. I would like that. I had heard that things did not go smoothly in Jena. I was afraid that there would be no school or that there would be no chance for me there."
"We're working it out but it hasn't been easy. We have some of what we need pulled together. All of us want this merger to work out." She wished she could give him the reassurance he was looking for but this was the best she could do. They were farther behind than she liked. "Thanks for carrying the bags for me. You saved me a major hassle. I'll see you again soon."
"Come in, James." Beulah stepped back to let him in the kitchen door the next morning. He had his hands full with breakfast. "Thanks for bringing breakfast. We didn't have time to shop last night and the cupboards are pretty bare."
"I see Mary Pat has your favorite beverage at the ready." James nodded a good-morning to Mary Pat, who was starting to pour mugs of coffee. She'd been ready to go off to work but Beulah had insisted she take the day to catch up on what was happening in Grantville. At least it got her to rest a bit. She was wound too tightly, and had been for too long, especially the last few months. This wasn't exactly time off but it was the best Beulah could do.
Mary Pat glanced up and gave a casual wave. "Morning, James. Thanks for breakfast."
"Fritz came by and walked me home last night. He mentioned some talk in town about the med school merger. What have you heard?" Beulah asked.
"Jeez, Beulah, let a man put down breakfast and get a cup of coffee first. See if I bring you breakfast again." To Beulah, his smile had a bit of an edge to it. Stalling.
"All right, all right. I'll quit pushing."
"For now, anyway," Mary Pat laughed, while she helped him off-load breakfast. "Let's get some food before she gets going again. Once she's had a cup of coffee, we're in trouble."
"How was the trip home, Buelah?"
"Cold, wet, bumpy, and long. Okay. Get it over with." In response to his questioning look, Beulah explained. "You're giving me your clinician look. Assessing my movement, general appearance, yada, yada. I'm a seventy-three-year-old woman who is tired, sore, and aggravated. Otherwise, I'm fine."
He turned to Mary Pat. "She always this grouchy in the mornings?"
"Just lately. It's been a pretty rough few months." Mary Pat seemed to take his comment more seriously than he had intended. Now it was her turn to get the clinician look. Beulah didn't think he liked what he saw.
"I gathered that from the letters you both sent back. You sketched out the broad picture. How about you fill me in some more? We have a few days before all of us are officially supposed to get together, but in a town this small, we may run into each other sooner. I'll pass whatever you think is important on to Starr and Balthazar later today. Then you two can get some well-deserved rest."
"I'll leave you two to it. I think I'll go get some groceries. Rodney can fill me in on how things are going in town and points beyond." Mary Pat grabbed a slice of heavy dark bread and headed for the door, carefully avoiding his stare. "Thanks for breakfast. See you in a bit."
James turned slowly back to Beulah. "You want to tell me what just happened?"
"I think she thought it was confession time. Irish Catholic, you know. Very good at the guilt thing."
"Ah. Not exactly enlightening. I take it she felt she had something to confess? From that look, you feeling the need for confession, too?"
"I'm a Methodist, remember? No confession, but I do have a few things to catch you up on. Mary Pat first, because it's all of a piece really." Beulah took a fortifying sip of coffee. She'd been good and had the medicinal tea first but it didn't seem to work quite as well of late except to help turn her stomach into a vat of acid. And the tea didn't even taste like coffee. "I'm old enough to remember how women were treated in nursing and medicine even comparatively recently where we're from."
He nodded in understanding. "So am I. Mary Pat isn't. I take it she took issue with their attitudes."
"Yeah. She thought showing them the error of their ways would be enough, that once they saw the evidence that she was every bit as good, if not better, than they were in the healing arts, they'd get it and that would be that. Sometimes that strategy actually works, but it isn't without its drawbacks and it usually takes more than two months. The thing is, Mary Pat knew that. She knew better but it was like she couldn't stop doing it. She was going to make them see. Whatever was going through her mind, I don't think it was just about Jena or the merger."
She sighed. "Part of the problem is that I agree with her about most of it. For all I've tried to be politically correct and culturally tolerant, we've come from a time that has been through history that has disproven or otherwise challenged some of this time period's views that were driving us nuts. Especially their views about women. I'm not a feminazi but I won't be less than I am just because it threatens notions I find ridiculous anyway."
"We are all products of our time and culture, just as they are of theirs. Being aware of that is fine. So is trying not to come across as arrogant know-it-alls. That doesn't mean we're all going to agree with their views. We can't even agree about plenty of things among ourselves."
"She saw me as not being very supportive when I tried to talk to her about modifying her approach or about being sensitive to their side of things. She was frustrated with them for not listening to reason and not seeing what, in her opinion, was right in front of their faces. She got madder. They got their backs up even more. Vicious cycle. I didn't exactly help matters. I know you sent me along as the mature member of our little party, but I certainly had my own moments."
"I'm almost afraid to ask. What moments?"
She slumped a little in her chair. "They quoted Galen to me one too many times and they did it at the same time that they were pulling a nicely subtle `you're a woman, we don't expect you to be able to comprehend this' crap. Galen was just plain wrong about a lot of things and I, ah, took exception. I brought up the fact that in ancient Greece, most of the healing deities were women. I brought up Hygeia and Panacea and pointed out that their precious Galen spoke highly of women physicians like Margereta, who was an army surgeon, or Origenia, a physician, and even extolled the virtues of some of her treatments."
James started snickering.
"I'm glad you find it so amusing," she said quellingly. "They didn't. These are very devout men, James. I respect that. I may not park my butt in a pew each and every week, but I take my beliefs pretty seriously. I'd talked to Balthazar a bit but evidently not enough. With a daughter like Rebecca, his viewpoint isn't exactly typical, although he does know what those attitudes are.
"If I'd asked the right questions and paid more attention to what is going on right here in Grantville, I might have been better prepared for this. I haven't spent a lot of time with our new German citizens, certainly not enough to realize how deeply their attitude toward women in general and women as healers in particular goes. They truly don't believe women can learn this sort of material, much less teach it. Their beliefs aren't just about academics or medical practice. They're founded in beliefs about the basis of their society and the roles of men and women in their daily lives.
"I'm afraid that by sending women as the medical delegates, we made a serious error. We've been here two years; I should have been more aware of the culture here but I've been somewhat isolated by working in the hospital so much and mainly with other Grantville professionals. Most of the Germans I've met have been as patients, family of patients, or casually in town and on `my' turf."
"I kind of expected something like this," James told her. "I had the advantage of talking with some of the people here, including Balthazar, who were born in this time. It's been enlightening. Whether or not it was a mistake to send a mostly female delegation or not remains to be seen. It's certainly got the issue out in the open. What did Machiavelli say about a leader figuring out all the cruelties necessary and getting them out of the way all at once?"
"Medicine by Machiavelli now, is it? You're really hanging out with the wrong crowd, James." She shook her head in mock rebuke, clearly grateful for his support and for him lightening the mood a bit. "I don't know what the long term consequences will be. We have to face them but right now, we need to get through the short term without making things worse."
"I agree. After we realized what some of the problems were, we had a group of up-timer and down-timer health care people get together to brainstorm solutions and try to identify any other tripwires we might face. We've been giving in-services based on their recommendations to all the staff. The members of our ad-hoc committee have also been trying to prep the rest of the town."
"And how are they taking it?
"It varies. Some are unsurprised by the attitudes and just plan to work around it or think that it doesn't really affect us here in Grantville. That's rather shortsighted, given that the USE is lots bigger than just Grantville. Others have a milder version of Mary Pat's reaction. There are a few people who have been problems."
"Let me guess. Mara and her little band of twits," Beulah said acidly.
"Um hum. She's been quietly stirring up some of the staff, exaggerating the cultural and academic differences in our positions and goals. Most people know enough to ignore her but she's smart enough and good enough that she is making headway. Everyone here is a bit tense. On the upside, some of the tension is that most of us want this to work and want to get off on a good foot with our guests. Most of our people will be on their best behavior."
"Thanks, that is good news. So, Machiavelli-in-training, is that why we don't have an official meeting for another few days?"
"We're going to show them around a little first. We thought that might make a number of points without having to rub anybody's nose in it. Then, when we get to the official meet and greet and the hospital tour, two days from now, things might have loosened up a bit. Each of the host families or some other designated tour guide will be showing them around town tomorrow. Today is a rest, unpack, and get-to-know-your-hosts day."
"Sounds good. Fill me in on any of your other plans and then tell me the story with Rebecca and her group. Have you heard anything from Julie and Andrew yet? Are Melissa and the others okay? From what little we've heard in Jena, it sounds like things are heating up."
Mary Pat slid the groceries onto the kitchen counter early that afternoon. Diving for the nearest exit this morning meant that she hadn't taken either the cloth bags she used or Beulah's little two-wheeled pulley cart to the store. No "paper or plastic" at the grocery in 1633. She'd stopped by Rodney's place to borrow his bags rather than come back and face Beulah and James. Cowardly retreat wasn't her style, but this morning she'd just had it.
Things hadn't gotten any better when she went to Rodney and Pris' place. Last night in the dark, she hadn't noticed the engagement ring that Pris was wearing. Rodney was like her little brother. She certainly didn't think of him in any romantic way but she had felt a stab of something like hurt or grief when she'd seen the ring. She knew they were getting serious and had sort of seen this coming. She also knew from experience with two of her brothers that things would change now. Rodney would, quite naturally, be changing his priorities to his wife and eventual children. That had to come first. She understood and even applauded that.
She had admired the ring and congratulated both of them. She'd even managed to smile and joke. Inside, though, it was different. Normally, she'd have talked to Sharon or Elizabeth but Sharon was deployed with one of the mobile units who were trying to help out Gustavus Adolphus, and Elizabeth was doing railroad stuff somewhere. And Beulah. . . .
Things were pretty strained between the two of them at the moment. Mary Pat knew Beulah didn't approve of the attitude of the Jenaites toward women or nurses. She also knew that Beulah had to play diplomat, a role she wasn't too comfortable with. Beulah had talked to her about trust building and potential and need and different cultures. Beulah was a public health nurse. Beulah knew how to do that kind of stuff. Mary Pat however, was more on the trauma end of things. "Grab 'em and go" was closer to her reality. And my own impulsiveness and temper didn't exactly help out either.
Mary Pat reached into the bag for the cheese and eggs. She still needed to stop by the bakery but the bread James had left would do for today. One of the nice things about being in the seventeenth century was that the bread wasn't that store-bought yuck she'd grown up with. This bread had some real taste to it.
Rationally, she knew Beulah had been trying to teach and comfort her under circumstances that were a strain for Beulah as well. Emotionally, she felt betrayed. She trusted Beulah, counted on her. The incremental approach Beulah had taken didn't suit Mary Pat's nature at all. Beulah had tried to laugh it off as one of the benefits of age. Well, Mary Pat was thirty-one, not exactly a kid. Rodney was nearly ten years younger than she was and he was getting married. Before she knew it, he'd have kids and . . .
The hanky was lace-trimmed. Beulah had tatted before arthritis had ended her hobby and now she was handing Mary Pat one of the few remaining hankies she'd made. Mary Pat had been so deep in thought she hadn't heard her come in, much less realized she herself was crying. "Thanks, Beulah," she said stiffly. "I don't know what's wrong with me. I'm not the crying sort."
The floodgates suddenly opened and she was babbling, a jumbled collection of two years of grief and stress and confusion. Rodney and Pris. Sharon and Hans. Jena. Marriage and kids. No connections. Work and how tired she was. Missing her family. Aunt Heather and her brothers and Mom and Dad and the rest of the Flanagan clan. On and on and on. Beulah just listened and handed her another hanky.
"I'm glad you're crying. About time. You've been carrying a lot of things around with you for a long time and not letting any of us in. When we came through the Ring of Fire, no one handed you a cape and tights or put a `Super Mary Pat' on your chest, my dear." She'd been trying to sort out what Mary Pat was really saying while she listened.
"Things are changing, but you aren't alone. Rodney and Pris, Sharon and Hans just expanded your family. When the kids come along, you'll be Auntie Mary Pat. Yes, your relationships will change but that's life. Right now, you're looking at what you've lost instead of what you've gained."
The next area was more sensitive and Beulah wished for some of Rebecca Stearns' subtlety. "As for marriage and a family of your own, you're going to have to stop hiding in work and being deployed all over the place. I've seen you turn down several offers for dates during the last two years using that as an excuse. What are you really afraid of, loving someone that deeply and then losing them the way you did your up-time family?"
Mary Pat bolted. Beulah had anticipated her maneuver and reached over to grab her wrist. Mary Pat was younger and stronger and could have broken the grip and left, but the pain on Beulah's face wasn't just from arthritis. There was such understanding, such shared grief there that all Mary Pat could do was lean against the cabinet and cry. Beulah reached out and took her in her arms, hugging her fiercely, knowing Mary Pat wouldn't have accepted that comfort earlier. I should have brought a hanky for myself, too. Is this what mothers feel when their children are hurting so badly? This need to do anything to take the pain away, the intense empathy with their pain?
"I'm sorry," Mary Pat said dully, looking spent and hollow. "I gave you nothing but trouble in Jena and now I'm whining like a baby because my life's a mess and it's my own fault."
Beulah loosened her grip and leaned back, pretending shock. "You mean you were the one responsible for the Ring of Fire? You were the one who shaped the attitudes of the early modern era? I'd have never guessed. Shame on you."
To her own surprise, Mary Pat gave a watery laugh, a little shaky but still a laugh. "Cut that out."
"You were more help than you know in Jena. I had quite a bit of time to think the last couple of days. They needed to see that we wouldn't take their attitudes lying down. I was so worried about being culturally sensitive and not putting my foot in my mouth that I didn't put forward much about our culture and beliefs. You did and in a way they couldn't miss. That may not be the disaster you're making it out to be. These are not stupid people and we're all motivated to make the project work. It'll take time and effort but we'll get it done. You aren't the only one trying to make it happen. I'm sorry that I was so selfish in asking you to be part of this. I thought it would help you get a break."
She let go of Mary Pat and motioned toward the kitchen table. That was where the two of them always sat and talked. She wished she could promise her that she would always be there for her. Reality was different. Beulah was not getting any younger in a time with a lousy life expectancy.
"I never had kids myself but I've still had a great life. I wouldn't change any of it—including the Ring of Fire, oddly enough. Without that, I'd never have met you. I'd have just been another retiree with too much time on her hands. I'd never have met so many interesting people or grown as much. I didn't think an old dog could still learn so many new tricks. I know things have been a little tense with us lately but I wanted you to know that I love you as though you were my own daughter. I'm not your mother but you still have someone who loves you that way. You have more connections than you know here. It's time to start reaching out a bit, letting your heart heal. You do have a future here. You can shape that future. It's up to you but you won't be alone while you're doing it."
Gary Lambert literally tripped over his own feet. The man coming toward him early that morning was Johann Gerhard. Gary had known he would be coming with the Jena delegation, but he hadn't thought to run into him the very first morning. Yet there he was. The peaked eyebrows, the balding head with its ring of shoulder-length wavy hair, just like it was in the copies of Grandpa's books. Johann Gerhard was one of the most respected Lutheran theologians of his day. Gary had a copy of an 1871 edition of one of his books and had picked up a CD of some others just before the Ring of Fire. The books were still highly regarded and had been pretty much in continuous print after he wrote them.
Since Gary was the business manager at the hospital, he'd been hoping for a chance to talk with Pastor Gerhard. Gary preferred things low-key and was not comfortable being the center of attention for any reason. When he'd thought about it, the falling-flat-on-his-face part had not been included in meeting the pastor. Or should he call him Dean Gerhard?
"Here, young man. Are you all right?" Johann caught the young man under the elbow to steady him.
"You're the Pastor Gerhard," Gary blurted and then blushed as he juggled an armload of papers. "I'm sorry, sir. Of course you know who you are. I didn't mean . . . it's just that I've just read your work since I was a kid. Your picture is in several of my books. That's how I recognized you. I've been rereading some of it when I have any spare time since the Ring of Fire. I wanted to thank you. It's been a great comfort to me," he finished with a little more dignity.
"Thank you. I have only been wandering through your fair town for an hour. With what I have already seen, I am not sure of much at the moment. It comforts me to know that some of what I believe now still holds true. May I introduce my companions? Jakob Arnold is one of the faculty in the College of Law, and Christoph Burkholtz is one of my students."
"An honor to meet all of you. I'm Gary Lambert. I work at the hospital as a business manager. I was hoping to meet the pastor and ask him to autograph a copy of one of his books for me." Gary just managed to not point out that today was to be a day of rest and that they weren't supposed to be out wandering around alone yet. Evidently, these three had set out on their own first thing in the morning. It wasn't like they were being kept prisoners or anything, but he wasn't sure what he should do about this, if anything.
When he paused, apparently speechless, Johann spoke. "Perhaps we could talk a moment more unless you have to be off somewhere else? I'm sure Jakob and Christoph can look about some more on their own." Jakob and Christoph shook hands with Gary and said their good-byes.
"You work at the hospital then? That is fortuitous. I have been looking forward to touring both Grantville and the hospital, but I understand the hospital tour is not planned until tomorrow."
"Yes, sir. I usually have breakfast in the cafeteria but I had to stop by the printer this morning first. These are some drafts I'm working on for the new hospital in Magdeburg. I could show you around a little if you'd like, buy you breakfast," Gary volunteered hesitantly. After reading so much that he had written, he realized the pastor just didn't seem like a stranger. Still, he didn't want to derail the plan. "I'm not anybody special there and I don't know the medical stuff, but I could still show you around some of the other areas. Later, you'd see more."
"That would be most kind of you. I would like that."
A large, bright-yellow vehicle rumbled by, filled with children. Gary waved casually to them and headed up the street toward the hospital. Johann's gaze lingered on the children, some in American garb, some in the garb he was familiar with, all chattering or waving or bent over their studies for some last-minute cramming. To be as accepting as a child. I could use some of that right now. He turned and set off with Gary, a little uneasy about what he might see, but curious. He needed more information, wanted to get more of a sense of the people here in their own environment. Gary seemed like a nice tour guide. He pointed out some places he thought Johann might find interesting. The town was clearly busy and thriving, if a bit chaotic.
Fortunately, the rain held off until they got inside the hospital. He hadn't been tempted to linger, knowing that he would be seeing more tomorrow. As it was, he simply admired the fact that, according to Gary, the hospital had gone up a year or so after their arrival. He noted the pride with which Gary spoke of the hospital and what had been accomplished.
"Of course, you'll be hearing more about the other plans tomorrow. There is a plan to build a hospital in Magdeburg soon. This building and the record system I set up will be prototypes. Do you think Jena will build one, too?"
"I don't think our thoughts had gotten that far." Johann sat in a large open room that Gary took him to. There were tables and chairs grouped around an area with food already prepared by the kitchen staff.
"Sure you wouldn't like something to eat as well?" Gary asked.
"Thank you, but the ale will be sufficient. I've already eaten with Christoph and Jakob before we left this morning." Johann took the opportunity to look around and observe the people in this "cafeteria" while Gary went to get food and drink. A German family had pushed two tables together to accommodate their numbers and were talking softly a short distance away. Men and women in various groupings were scattered through the cafeteria. They wore loose-fitting blue shirts and pants and soft-soled shoes. Whitish jackets covered them to just above the knee, and an array of books and implements he couldn't identify protruded from ample pockets. There seemed to be some sort of name placard on their left breast but he couldn't read them from where he sat without staring. Some were speaking English and some German. Their mien wasn't any different in their way than that of plowmen eating a meal on the edge of a field.
"Here's your ale." Gary slid his breakfast tray into place across from Johann and set the beer in front of him. "I can take you around as soon as we finish."
Johann Gerhard wouldn't have thought he'd be at the hospital this morning discussing Lutheran dogma and answering Gary's questions about the various schisms in Lutheranism when he got up this morning. Gary had put up the tray, waved to some of the people in the cafeteria, and begun the tour. They had started with the second floor, which seemed to hold office and meeting rooms as well as storage and some medical rooms. There were some areas that Gary called exam and clinic rooms. Johann was surprised to see the chapel that was located on the second floor. It was small but he could tell it was carefully tended. The third floor held more office space, a largely empty but sizable medical reference library, and a few rooms for staff to stay in if they had to sleep over during bad weather or times of short staffing. Most of the rooms for patients were on the first floor. The operating theater that was on the first floor was two stories tall so that students could observe the surgery from the second floor.
He had been impressed with the spaciousness and craftsmanship of the hospital. All those they had met on the tour had greeted them cordially as they went about their tasks. If someone they met had a moment, Johann was introduced. Otherwise, they just walked around and observed, with Gary pointing out a few features as they strolled.
The first floor of the hospital, where most of the patients were cared for, proved a different experience for Johann. What struck him most were the things Gary didn't point out. In this corner of the surgical ward a doctor and nurse spoke in hushed tones about a patient. He noticed that there was mutual respect but no subservience in the way they spoke. On the medical ward, he saw a nurse showing the doctor a chemical analysis of some kind. From what he could catch at a distance, the nurse was clearly knowledgeable and even discussing courses of treatment. Those images were repeated throughout the hospital. Gary pointed out the technology to a degree, or architectural details. He showed Johann the glassed-in conservatory and introduced him to people. But he didn't even seem to notice the way the staff all worked together.
As he said good-bye to Gary at the hospital entrance, Johann had a lot to think about. He needed to speak to the others in the Jena delegation about what he had seen as well. First, he was going for another stroll through Grantville.
Ten days after returning to Grantville from Jena, Beulah ran her hand through her hair for the second time in the last half hour and looked around the conference table on the third floor of Leahy. She suspected the tangled curls were sticking up and gave her the appearance of an aggrieved rooster. This is what I hated most about academia. Curriculum meetings. Wrangling about nothing much as though the fate of the world depended on it. The things that actually are important get lost in all the noise.
"It sounds like there are some areas we agree on and some that will need further work. I'd like to summarize the areas of agreement before we adjourn this afternoon and then set some priorities for discussion tomorrow. Is everyone agreed?"
Nods around the table. She had been careful to instruct those from the Grantville curriculum group to scatter themselves in with those from Jena. She didn't want these meetings looking like opposing forces gathering to negotiate a peace treaty. The group from Jena had spent more time looking around Grantville than they'd planned, but Beulah thought it time well spent. Nothing like an up-close-and-personal look to make them a little more willing to consider other points of view, and she'd been agreeably surprised by the things they did have in common.
"At the baccalaureate level, points in agreement are length of time to degree completion, a rigorous examination for licensure to practice after graduation, a defined scope of practice for the new nurses, and some of the course content. Given the amount of science education that will be needed, it is more likely to take four years rather than three to complete the baccalaureate curricula, although with year-round courses and intensive clinicals, we may be able to cut it to three years."
Mary Pat looked around at the group. "I've been asked as a representative of the military side to stress the need for medical personnel to be trained as quickly as possible. Next year, we will probably be facing more conflicts and more injuries. We're also concerned about the possible spread of diseases."
"Ann, please make a note of Mary Pat's concern in the minutes." Beulah glanced at the representatives from Jena. "I realize that it is a somewhat less pressing concern from your end, but the military is going to be using some of our students and graduates as soon as they can get them. I don't know if any of the current students are particularly interested in military medicine. But, later, I'd like to talk about a few interested students doing a residency in trauma and military medicine with some of our military staff, Mary Pat for one."
Phillip spoke up. "There are several students that I think might be interested. Werner and I can talk to them if you would like. The ones I am thinking of are particularly interested in surgery techniques such as the one you demonstrated at Jena on Viet." His smile was small but genuine. Beulah was glad to see it. Phillip looked to have relaxed somewhat in the last few weeks. He wasn't quite as confrontational. She'd been dreading that attitude in these meetings but it hadn't materialized.
"That would be very helpful. Thank you. If everyone is agreeable, I think that after the curricula are agreed on, we can put together an examination with a smaller subgroup of this committee and the staff at Leahy. For now, I think it is enough to just acknowledge the licensure issue and then move on to more pressing matters. May I see a show of hands?" Every hand rose. Beulah nodded to Ann, who was taking meeting minutes. She jotted the vote down. "Where we seem to be having problems is in three areas. First, grandfathering in students and professionals from Grantville and Jena. Second, content, and third, faculty."
"There is an additional concern, Beulah," Werner corrected. "There is a difference between a trade school or guild education and a university education. What you have been proposing sounds too close to a trade school for our comfort."
"Perhaps we can discuss that when we speak about content and faculty responsibilities," suggested Johann. "After the last few days of meetings, I have a feeling Beulah has an idea about how to deal with the grandfathering issue."
"I do in general. It's some of the specifics that concern me. I think that both Grantville and Jena people who want to practice at the baccalaureate level should take the exam, even those who are already nurses here."
"Wait a minute! That's illegal!" Mara was outraged. "You can't take away our licenses! We're already nurses and should just be grandfathered in. Those from Jena can take the exam and the new students from here can take it after they graduate."
Thanks, Mara. That went over like the proverbial lead balloon with the crowd from Jena. At least the rest of our group is waiting to hear me explain before passing judgment.
"Normally, I'd agree with that and I am concerned about the precedent that could be set. The legal types will undoubtedly get involved but I think we should at least consider it for several reasons. First, we are making entry into practice at the baccalaureate level. Not all the up-time nurses have that level of training, particularly the public health content we need so badly. There are also new content and new ways of doing things that we have developed in the last two years. I believe it is important to start out clean. I don't want there to be any doubt about our nurses' qualifications by future graduates or anyone else."
Mara's mouth shut with a faint but audible click. Beulah had known that would hit home and had prepared her arguments carefully. The Jenaites might not understand it, but she had no doubt that the up-timers would. The highly contentious debate within nursing about entry into practice education and licensure had raged for nearly a century in the U.S., flaring up every decade or two in ways that were not always very helpful. A classic example, Beulah had often thought, of circling the wagons and shooting inward.
Registered nurses or RNs could come from any one of three educational backgrounds but all took the same licensing exam. Hospital-based diploma schools were three years with minimal coursework and an emphasis on on-the-job training at a particular hospital. Those schools were largely closed in the U.S. up-time. The second group was taught in junior colleges. Although in theory it took only two years of courses to complete the degree and be eligible to sit the RN exam, Beulah had rarely seen anyone get through the program in only two years. The third group was those who attended four-year universities and obtained baccalaureate degrees. Those students had public health, teaching, and administrative content as well as greater depth in other areas.
Mara was as aware of all that as any other up-timer would be. Since a license wasn't something that could legally be taken away by changing the law, nurses with different preparations would have to be grandfathered in to RN status. Grandfathering the current crop of nurses in would always leave that kernel of doubt about their knowledge and competence. Since the legal authority that had granted those licenses, namely the state of West Virginia, didn't really exist anymore, the legal types could probably make a case for not needing the grandfathering fairly easily, but she really didn't want to get into that at all. Beulah hadn't mentioned the fact that it would go down well with the Jenaites to have everyone sit the same exam for licensure. She would if she had to, but Mara made no further comments beyond a quietly murmured, "I hadn't thought of that." The group from Jena clearly noted her response but made no comments. Beulah appreciated their tact.
"I think we should all think about that for a few days and then revisit it after we talk more about content and faculty roles. The content difficulty seems to be between what we up-timers would call liberal arts and professional education. As I understand from what's been said, grammar, literature, rhetoric, and logic are the basis for the trivium and start in what we'd call grade school. Literature includes Latin and Greek classics, and basic mathematics is part of logic. At the baccalaureate level are more of what up-timers would call liberal arts. Courses like physics, which we are all agreed should be in the curricula, are taught as part of astronomy. We up-timers find the placement of physics in astronomy a little odd. I don't know how helpful it will be to have a nurse or physician study astronomy and physics related to astronomy rather than physiology, but at least we agree that we need physics. Engineering, which we are conflicted about including, is taught under mathematics and so on as part of the quadrivium. Masters' level education is for teaching at Latin secondary schools in the arts, and doctoral education is what we'd call a professional doctorate, such as a doctor of medicine or a doctorate of jurisprudence. The current doctoral level doesn't really have any liberal arts content at all. Professionals without a doctorate can get a license to practice in a particular area after they earn a baccalaureate. Professional schools such as law or medicine need a doctorate to teach. There is not a research doctorate like the doctorate of philosophy we're used to. Have I got it right so far?" Nods again from the Jena group.
"Your contention is that without the liberal-arts courses such as astronomy, the students will be getting essentially a trade-school education, not a university degree. Without those courses, you can't say they are graduates from Jena. Our contention is that some of those courses need to be shaped more toward practical need for the medical or nursing profession and be heavier on the sciences at the expense of some of the courses you regard as essential. We don't believe, at least initially, that there is time for courses like drama right now. We need nurses and doctors who can practice. To you, they aren't able to be fully functional without the liberal arts courses."
"You have captured it succinctly," Johann agreed. "We cannot call what we are creating here a university education without those courses. Any graduates of the program would be unable to be employed or to continue their education anywhere else. It would also bring us into conflict with the guilds and make our students appear more like barber surgeons than university graduates. The courses must be included in the curricula."
Whatever else Johann would have said was interrupted when a very pale Starr came into the conference room. "Can I talk with you a minute, Beulah?" Starr was wearing what Beulah thought of as "nurse face." It was the kind of neutral, calm look that nurses used to avoid alarming patients or their families when things were going seriously wrong. Beulah felt her own face automatically assuming the same mask as she excused herself and stepped into the hallway with Starr. Once in the hallway, Starr's mask cracked and her soft brown eyes began to fill with tears.
"Oh, Beulah. There's been a battle at Wismar. Hans, Larry, and Eddie have been killed in action!"
The shock of it made everything sway sickeningly in front of her for a few moments. Isolated, fragmented images and incomplete thoughts went spinning through her mind. Sharon and Hans at dinner. Larry coming into the high school infirmary banged up from something after the Ring of Fire. So many people were going to mourn the loss of those boys. They'd achieved legendary status in the Battle of the Crapper and with all they had done since. Aside from his notorious driving, Hans was well loved here, too.
"Where are Sharon and James? Veronica Richter and the others? Do they know?"
"They're being told. Sharon was there in Wismar. James is here and I'm not sure about Frau Richter. I wanted to tell you before I made a general announcement over the PA."
"That was the right thing to do." Beulah heard her own voice from a distance, making suggestions and giving instructions, slow tears falling down her cheeks. Oh, God. How will I tell Mary Pat?
"May I join you, Beulah? If it won't disturb you," Werner asked quietly. At her nod, Werner sat on a bench next to her in Leahy's conservatory. "This is a lovely spot. I can see why you start your mornings here. Especially lately."
"It's been especially comforting this last week. The memorial service yesterday was pretty intense. We're going to miss them. At least Mary Pat got to go to Magdeburg to be with Sharon for a while. Given the unrest there, having a trauma nurse on the spot might not be a bad thing. She'll be back in another week or two if things settle down there. I hear she and Phillip had organized a trauma rotation for a couple of the students."
Werner gracefully accepted the change in topic. She clearly didn't want to talk too much about what had happened. He understood taking refuge in work. While he hated to push at a time like this, the needs and responsibilities that had brought him to Grantville still existed. "So I am given to understand. Phillip and the students are very excited about it. We have spent a considerable amount of time in the library reading basic texts and sharing the texts we brought with us with Hayes and Stoner. I have had some very interesting conversations with Stoner. When he can be spared from his work here, and before he leaves for Italy, I should very much like to have him visit me in Jena and look over our gardens there."
"I'm sure he'd be happy to see them. You've done a great job with them."
"Thank you. As we have been reading in the library, the complexity of public health measures that are taken to prevent the spread of illness are of particular interest, especially as it will be spring soon. I was wondering if it would be possible to have a lecture given to the students and faculty on public health and the prevention of communicable diseases? I understand you have some expertise in this area."
If she was at all unhappy or angry about being in essence asked to give a lecture to the group from Jena after what happened last time, Werner saw no sign of it. Then again, she was an experienced faculty member. The circumstances were different and one incident out of a long career wasn't going to stop her. He doubted much of anything would stop this woman once she set her mind to something, and he both needed and wanted to have a better relationship with her and the other medical personnel in Grantville. But particularly with her. She was very highly regarded and involved in some way in every aspect of medical care here. It was Beulah who was the liaison with the program at the high school, who had been the director of nursing, who consulted with the sanitation committee, and on and on. While they had been here less than a month, her central role in the small medical community was clear. He and the other faculty would make sure the students stayed in line this time.
Not that he thought it would be really necessary. Kunz had had a severe talking-to for some of the more rigid students. Being left behind with Grantville's treasures before them had weighed more heavily than some of the views currently being shaken. He rather thought Kunz had been surprised to find himself as an advocate for Beulah and the Grantvillers, however reluctant he had been. Werner thought that the students had responded very well to the lead the faculty had taken. They had all had their eyes opened to another way of practicing, a highly effective way at that. He didn't know what they would take from the Grantville way of doing things in the long run. But, in the short run, all of them were very curious and being very observant. And polite about it, too.
"Makes sense. I'd be happy to give the lecture myself if you'd like. I'd want to pull some materials so they have a few of the basic science concepts down before I gave the lecture. We could set it for say, two weeks from today?"
"I was hoping you would agree to do it. Two weeks from today then."
Beulah paused in the ER exam room door that evening to watch Ernst, one of the Jena students, with Fritz as his assistant, stitch up a small shin laceration. The patient was an up-time youngster of about eight, whose mother was watching carefully. Beulah didn't see any extra anxiety because a down-timer was working on her son. Fritz was translating Ernst's comments when he needed help with English. Nice bedside manner, reassuring and calm. A little gentle teasing to set the little one and his mom at ease and distract him. She noticed with a tiny smile that he was being very, very careful of his sterile technique.
Beulah slipped away unseen by the group in the small room. She didn't want them to feel she wasn't confident in them. The scene heartened her. This was what they were working toward. The child would have had to wait until James or one of the RNs was free to do the suturing otherwise. He'd have been in pain and the normal inflammatory response to injury would have made the wound more difficult to close. Since James was in surgery and the only RN available to cover the ER was with another patient, that wait might have been an hour or more.
They would make this work. It had taken no time at all for Phillip and two of his students to start spending every spare moment in the ER. Phillip the adrenaline junkie. Who'd have thought it?
"What happened?" Phillip asked as he hurried into Leahy's emergency room. Two of his students, Ernst and Heinrich, trailed closely after him as he more or less trotted beside Mary Pat. She'd grabbed them out of the grand rounds they'd been having on the surgery ward. Phillip, Ernst, and Heinrich were doing a trauma and surgery minirotation. They spent every spare minute they could in the ER.
Beulah had instituted grand rounds as a teaching tool. The rounds gave them a chance to review cases with Beulah, who did hands-on teaching and explanations of actual patient conditions and their treatments for small groups of students. Much as Phillip and the other two students appreciated the floor time, they'd fallen in love with trauma, and any opportunity to get in on something that got Mary Pat moving that quickly was to be pounced on with speed. Beulah had waved them on with a "Catch up in a few minutes. Go on."
"Just got a call from the ambulance. We've got a couple of casualties coming in; they're about ten minutes out now. I left Mara prepping before I came to get you and grabbed some supplies from the OR on the way. The report the EMTs called in is that there was an accident at one of the farms. The loft in a barn gave way and the two men getting hay for the cows went down with it. One of the men is in pretty good shape. Bumps, bruises, stable vital signs. He's got a possible concussion but also has a scalp laceration that's bleeding even through the pressure dressing."
As they arrived in the ER, she directed them to the side-by-side exam rooms where Mara was prepping IV fluids and setting out linen bandages. Mara worked quite a bit in the ER because she got calmer and calmer the more desperate the situation. She was sharp as the proverbial tack to boot. Mary Pat appreciated her abilities, but the fact that Mara's thick drawl also got slower during a crisis drove her nuts sometimes. Mara looked up at them and waved Ernst over to a cabinet. "Great. Our master of the suture is here. Going to put all the suture practice you've had to use today, Ernst. Can you get your stuff ready?"
As Ernst headed over to the supply cabinet, Phillip and Heinrich looked at Mary Pat, who continued her report. "The one we're most concerned about, Harmon Manning, wasn't so lucky. Evidently, he fell directly onto the concrete floor rather than the hay, and some equipment stored in the loft fell on his chest. Looks like he's got crushing chest injuries as well as a broken arm and collarbone. May have some spinal-cord injuries. They're bringing them all in on backboards just in case. Mara, any new info?"
"Vitals are going downhill on Manning. Carotid pulse is palpable, rhythm sinus tach with a rate of one-sixty, up from one-forties." Seeming to remember who else was in the room, she glanced up and then went on. "They don't have much time with someone that far out and that seriously injured. So they don't spend a lot of time on blood-pressure taking. Instead, as a general rule of thumb if you have a carotid pulse, you have a systolic—ah, that's the top number on the blood pressure—of at least sixty. Sixty is the minimum amount necessary for the brain to be perfused, although it isn't optimal. Sinus tachycardia means that the heart rhythm is regular but too fast."
"Can you two start setting up the splints and chest-tube trays?" Mary Pat headed for the oxygen cylinder set up near the wall. They didn't have oxygen piped through the walls the way an up-time hospital would have, but at least they could make it and refill the cylinders from the nursing home. With the curtains open between the ER "rooms," they could all talk freely. The rooms were large so they could handle lots of people and equipment if needed. Phillip, Heinrich, and Ernst had spent a fair amount of time here and they'd been shown where things were located and some of the basics during the last few weeks. "A pulse at the femoral artery should indicate a pressure of at least seventy, radial at the wrist at least eighty. That they're looking at a carotid pulse and that his heart rate is that rapid is a probable indication of being in shock. The shock could be from hypovolemia, that is, too much blood los,s or from cardiogenic shock from injury to the heart. That is, that the heart has been hurt too badly to function well."
Mara laid out toweling and said, "Okay, everybody, get scrubbed up. They should be here any minute. The last report indicated that his respiratory status was bad. Supraclavicular retractions, respiratory rate is almost forty, and he's cyanotic. They've been able to cut away his clothes in the ambulance to get a better look at him. They've got a flail segment. Sounds like a big one."
Phillip looked from one to the other. "And the significance of that is . . . ?"
Mary Pat looked back at them and scrubbed her hands harder. "With a flail segment, a contiguous group of ribs are broken. The person can't breathe normally because the rib cage doesn't move in a unified fashion. When the person breathes in, the flail segment sinks instead of expanding and vice versa. There isn't enough negative pressure to fill the lungs with air sufficiently if the segment is big enough. That means we're probably dealing with a pneumothorax, maybe a hemopneumothorax, which is blood as well as air building up in the chest cavity."
"Ah, like Viet."
"Worse than Viet this time, I think. Heinrich, I'd like you to handle the ambu bagging please. You'll be monitoring his respiratory status. You've done it before. You may be at it a while this time."
James came in through the double swinging doors from the OR. He pulled off the surgical gown he was wearing, dumped it in a linen bag, and began scrubbing his hands. While Mara briefed him quickly, Mary Pat looked around to make sure that everything was ready and got a final report from the ambulance crew. Their patient sounded unstable as all hell. Mary Pat felt the adrenaline pumping through her system, sharpening her mind and slowing everything down with an odd crystalline clarity. They were lucky to have this much prep time but every minute that their critical patient was in the field was a minute too long. Beulah came in and caught the report while she joined James at the sink to scrub.
"Beulah," James began, "I'd like you and Heinrich to take the possible concussion. Evaluate him and get him patched up as much as you can. Give a shout if you think he's got an intracranical bleed cooking in there or anything else you think I ought to look at. The rest of us will work on the patient with the flail segment."
Two things happened as James finished speaking. The outer doors opened with the ambulance crew bringing in the stretcher with their critical patient while the LPN and nurse's aide stationed outside to wait for the ambulance helped get the second patient out. Another aide came rushing in carrying two glass bottles of blood from the blood bank. Mara had ordered them as Mary Pat had gone out earlier.
From the looks of Harmon Manning, they were going to need both of them, and then some.
Phillip didn't like the way the man looked as the EMTs wheeled him in. There wasn't a great deal of bleeding apparent, but the man's skin was a grayish blue color he'd recently learned to call cyanotic. Each rapid breath was a labored, pain-filled gasp. Phillip knew what death looked like and this was death before him. He exchanged glances with Ernst and Heinrich, who both looked grave but still optimistic. Phillip, who had seen far more death than they, wasn't so confident. They had seen amazing things in Grantville these last weeks, true.
Ernst and Beulah headed for the second patient while Mary Pat, Mara, and one of the EMTs helped move him over onto the ER gurney, since it was wider. Phillip managed the IV and oxygen tubing as James leaned over to expose his chest, stethoscope in hand. Phillip had been reading about "breath sounds" and he'd been able to actually hear an asthmatic child's wheeze just that morning on rounds. He didn't think James would be happy with whatever breath sounds he heard out of this patient.
He could hear Beulah talking with the second patient, hear his slurred speech and concern about his friend. Beulah was talking quietly with him behind the drawn curtain and reassuring him that his friend was being treated. Phillip had moved a tray of instruments and gotten out of the way as the others settled Harmon and began the examination. Mara's face was the only one he had a good view of, and something in her face made him edge closer to the gurney, trying to see what had occasioned that sad, compassionate look.
As he got closer, he could see the look on James' face as well. James was very carefully touching—ah, palpating, the word was palpating—their patient's chest. Phillip frowned. He thought that normally, one listened to the chest first in an assessment. That was what the book had said. He remembered the passage clearly. As James lightly touched his chest on the right front side, Phillip could hear a crackling kind of sound.
"What is that noise? His ribs?"
"Crepitus," answered Mary Pat. "That means that the ribs have probably punctured the lung, and air is being forced into the skin by the building pressure. See how the area is swollen, too? James is trying to get a sense of how big the flail is. An x-ray would tell us more but the patient doesn't have that kind of time."
"About twelve by sixteen centimeters," James reported grimly. He turned to Chester, the EMT. "Is the family on the way?"
"Won't be here for at least an hour."
Phillip felt it again, just as he had with Viet all those months ago. It was clear that Mara, Mary Pat, and Chester knew what to make of James' question. He didn't, and neither did Heinrich, who was carefully using the ambu bag to help the patient breathe. Beulah stepped softly to Phillip's side. He could hear the LPN working with Ernst as they stitched up the bleeding laceration on the patient in the next bay.
"Want me to get some morphine?" she asked quietly.
James looked up at her and nodded. "Yeah. Let's make him as comfortable as we can."
Phillip walked with Beulah to the medicine cabinet at the nurse's station in the center of the room. "He is not going to live, is he?"
"No. The flail is too large and the bones are pulverized under his skin. I watched as Mary Pat took his blood pressure. I could tell she didn't get a very good pulse and when I saw the mercury pulse the first time in the glass, it was only around fifty. His heart rate is becoming not just rapid, but erratic. We'd rush him into surgery at this point if we could, giving him more blood and IV fluids to keep his pressure up as much as possible. We'd also put in at least one chest tube and so on. But we don't have any ventilators. Ventilators are machines that can breathe for the patient when the patient can't manage. With a flail chest, we'd need to do that so the bones could knit together while the machine breathed for him. We can't splint the ribs when they're broken that badly because we could drive a piece of bone into his lung. Plus, unlike limbs, which can be immobilized by casts or splints to heal, the ribs will move multiple times each minute with every breath. It would take too much strength for him to do that himself for a few weeks. With a small flail, we'd give it a try but this is just too large. The other injuries he has might kill him as well but if we can't keep him breathing, it's a moot point."
She finished drawing the morphine into a syringe and headed back to the patient. "All we can do is make him comfortable. We don't have a vent to breathe for him for weeks after the surgery. We also don't have any of the substance that could help glue the bones together. Even though we know he won't make it, we could try to keep him alive until his family gets here so they could say good-bye." She handed the syringe to Mara. "There's ten milligrams in the syringe. I thought you could space it out as needed."
She turned back to Phillip and motioned him back from the bed. "We can't use the supplies to buy him an extra hour and give them a chance to say goodbye. We only have so many chest tubes. That blood was scheduled to be used this afternoon in surgery. We don't have all the resources we once did. Even then, we never had endless resources anywhere I worked. Which means making tough choices sometimes."
Everyone who remained was oddly hushed, their movements and aspect subdued, Phillip thought. They continued to do small tasks for their patient and to clear away material, used or not. There was an air of sadness and frustration in his Grantville colleagues. He was familiar with the feeling of losing a patient. How much more difficult must it be to lose one that you might have saved, that you had the knowledge to save.
"For God's sake, Mary Pat, did you have to come armed?" Beulah hissed the aside as she looked out into the lecture room on the third floor of Leahy. They were using the future medical library for a lecture on the history of public health and infection control for the Jena students. A lecture Beulah was giving. Damned if she was going to let anyone else face them after her experience last time in Jena.
Mary Pat tenderly patted the Berretta 9mm pistol her oldest brother had given her and tried very hard to look innocent. Beulah didn't think she looked at all repentant and the sparkle in those green eyes was far from innocent. "I'm on duty. So of course I'm in my basic dress uniform and carrying a sidearm. Do you really think I'd shoot one of these med students for getting out of line?"
"I don't think you'd do it but they might. This is serious overkill here. Not that I don't appreciate the sentiment but even I'm more subtle than that." She looked at Mary Pat out of the corner of her eye. "That smile would reassure me and our audience a little more if it had fewer teeth in it."
"I'm on duty. I wouldn't go around shooting unarmed civilians for no good reason." She pursed her lips thoughtfully. "Like say, oh, disorderly conduct."
"We have cops to handle that. I don't buy the `just happened to turn up here of all places while on duty' line, Lieutenant."
"Didn't think you would but it got your mind off the lecture, didn't it? I'll be on my way, Officer Flanagan, always at your service."
Beulah laughed and shook her head at her. She was so relieved to see Mary Pat teasing again, she'd forgive her just about anything. "Brat. Okay, okay, it worked. Besides, I think they've already got your point. The lecture's about to start—now scoot. You're scaring my students."
Besides, she thought, I've got to be in the right mood to pull this off. These were not stupid people. In fact, some of those in that room, like Werner, had first-rate minds. They also wouldn't be strangers to some of the political maneuvering she was about to try. Ah, well. Misdirection and cooptation were tried and true strategies. She just had to make sure she approached it properly so that she gave them an "invisible war" that they would be fascinated enough by not to look too closely to see what other invisible war they might be fighting. And to think I've given James such a hard time of late. Maybe I should start hanging around Mike and Balthazar more often myself.
"Good morning. For those of you I haven't already met, I'm Beulah MacDonald. Today, I'll be giving a lecture introducing some of the developments in public health as we use it in Grantville. The readings I assigned should have provided you a basis for understanding terms and concepts I'll be using. I know you've all had to learn a lot of information about statistics quickly."
In fact, that had nearly led to an interdisciplinary wrangle. There was only one basic statistics book at the high school. She knew that the students would need that content to understand simple concepts in public health, particularly in epidemiology. The medical students and faculty from Jena had set up a roster to share the book and essentially taken over the high school library for the duration. Those not studying the statistics book had been studying other material until it was their turn. Copies were being made as quickly as possible when the book wasn't actively in use. Basic statistics had lots of applications.
One of the Jena delegates was a high-ranking math faculty member. Seeing clear evidence that the math part of the university quadrivium would be needed by future nurses and doctors, he wanted the book for the math faculty and students. He was genuinely interested in the concepts and quite ready to stake a claim to the text. The school librarian had found him some other texts on probability theory to hold him off for a time, but just who had the priority need for the text had been a bit sticky for a moment. The librarian was both amused and appalled. She was thrilled to have people wanting to get to a textbook but the arguing over it was a different matter. Beulah gathered that the argument had gotten quite heated. That was perhaps the most blatant conflict over up-timer books among the Jenaites but not the only one. It made Beulah a little uneasy. There were more faculty and students coming from Jena. This was getting out of control. Each group had some reason attached (not always peripherally) to why they needed access to information or books or specialists to help get the new health-sciences program up and running. They seemed to have started an avalanche. Or a train wreck.
She had had the Grantville high school math teachers tutoring the students in the evenings, whenever one had a break between classes and at lunch so the group from Jena had at least a little information about statistics. Math students had joined the med school group. Fortunately, there were only a few math students here. So far at least. She'd also given them quite a bit to read in terms of foundations of public health. According to James, the med students and faculty had spent a late night at the Gardens with their notes cramming before this morning's lecture. She hoped they weren't too hungover.
"The public health situation has been frightening and in some ways shocking to us. Public health measures for us have been so interwoven into our lives that we no longer noticed many of them. We took for granted that our water would be safe to drink, our air clean to breathe, and that our food wouldn't make us sick. Children are taught the basics of hand washing when they are toilet trained. No one has to specify that the reason for washing your hands after going to the bathroom is to avoid spreading certain diseases. It's part of the knowledge we absorb as small children, unquestioned and just there. It's considered rude to sneeze or cough without covering one's mouth and nose. The reason isn't openly stated, that the person who sneezes or coughs without covering their mouth and nose could spread airborne diseases to other people. It's automatic, part of everyday life. Then, suddenly, we've found ourselves fighting an invisible war, a war we thought largely won, against communicable diseases. That is, diseases like measles and smallpox that can be spread among a population. Many of those diseases were controlled or eradicated in our time. Vaccination had been around for several centuries. School children were required to be vaccinated before entering school. Before the measles vaccine was developed in 1963, there were millions of cases every year in the U.S. By the time children were six, more than half had had the measles and ninety percent had the measles by the time they were fifteen. After the vaccination programs began, the number of cases dropped by ninety-eight percent. What was once a common disease became rare. While many of the public health supports that we took for granted are gone now, much of the knowledge remains and we are putting those supports back into place just as quickly as we can. I'd like to talk with you today about how public health developed, how we got to where we were, and where we are moving toward in the future. As you learn about these measures, you could become soldiers in an invisible war against diseases that have been the scourge of humankind from time immemorial.
"Public health efforts focus on measures that prevent illness or injury, track disease outbreaks, and promote life and maximum functionality in groups of people. I'd like to talk with you today about historic developments in public health history and how those have led to changes in public health practice. I'll be focusing on three areas primarily: epidemiology, public health measures, and vaccination. Obviously, this will be a brief introduction to what can be a very complex subject.
"Epidemiology is a cornerstone of public health. Epidemiology gives us a way to study how factors that affect health and illness are distributed in a given community or population. Epidemiology is really a form of research and uses many of the same methods as research. The epidemiologist collects a variety of data from many sources in order to identify at-risk populations and to prevent or ameliorate the spread of disease and illness and promote health."
So far no one looked lost. She turned on the computer she'd borrowed from Hayes and pulled up the first slide. "Hippocrates was the first known epidemiologist. In fact, Hippocrates was far more accurate in his perceptions about public health and the spread of communicable diseases than about his medical treatments. He developed a number of principles of epidemiology that are still important. Hippocrates gave very accurate descriptions of diseases in his practice. He also wrote about natural factors such as water supplies that are important to consider in public health. He stressed that clinicians should be observant and should consider lifestyle factors such as activity in treating illnesses. He noticed that certain diseases occurred at certain places or times of year. We'll talk more about some of these things as class progresses today."
Beulah paused for a sip of water and let the students catch up a bit on their notes. She hoped that hearing a familiar name and that he had contributed relevant, accurate information to public health would reassure her audience that all they knew didn't have to be relearned. Some but not all of it had later been proven inaccurate. Hayes had found copies of Hippocrates' Epidemics I and Epidemics II that were being translated. She planned to use some of it in the developing curriculum. Not only was some of it still relevant, but use of some "classics" added legitimacy to the things they were teaching. She was acutely aware that in the long term, there was more involved here than just the university at Jena. She also wanted to make the point that they all stood as it were, "on the shoulders of giants." Knowledge had been created, lost, accepted, ignored, and tested in various ways, moving forward in fits and starts. Such was the nature of scientific advances.
"Did you all have a chance to attend the sanitation committee meetings?"
Most of those present nodded. James had commented that there hadn't been so many people at the committee meeting last week for over a year. We take the risk of infection too lightly. We're too used to antibiotics and clean streets and an immunized population. So we don't pay attention to them. Despite all the preparation we've been trying to do, most of our people still have, at most, an intellectual understanding of an epidemic. Even the oldest of us, who ought to remember our younger years, aren't immune to that attitude. She shared the fears of James and the others. It was only a matter of time until they were hit here in Grantville. How bad it would be depended in part on how prepared their neighbors were. There's never enough time to get everything done. There are too few of us, spread too thin. We should be having programs like this all over the USE. At least this is being videotaped. I've got to talk with James and the others on the sanitation committee about spreading this information out. We need to put together a basic primer and recommendations for prompt action.
She'd given lectures like this so many times that part of her had gone on autopilot while she talked about how to identify potential problems or disease outbreaks. The classic example she'd given was John Snow's work identifying the cholera epidemic in 1850s London. The initial outbreak in the early 1830s had caused at least sixty thousand deaths in Great Britain. Snow's investigations of the 1849 and 1854 epidemics had occurred years after the first outbreak. She saw the way the students' attention sharpened when she pointed out that the epidemiological approach he'd taken to identify geographic clusters of outbreaks had helped identify the water source as a culprit before the cholera germ was identified. She emphasized his use of epidemiological data such as mortality rates, too. He'd spotted the crucial fact that, among other things, the source of drinking water had changed but the population had stayed the same. Those with the better water source were twenty times less likely to die from cholera. He'd done door-to-door validation of water source to get an accurate rate, a typical public health approach to collecting data. The result was that they were able to take appropriate public health measures and control the contaminated drinking water sources. She thought that the students leaning forward a bit in their chairs got the point that you needed knowledge, not just technology, to address these problems. Public health and spreading knowledge were two types of invisible war. They weren't fought in the open but the effects could be profound and even more lasting. Kunz and Willi were both nodding thoughtfully in separate parts of the room. Kunz had a particularly intense look on his face. And if they thought that example was pointed, wait till I bring up Florence Nightingale.
With an effort she pulled herself back to the matter at hand and went on to talk about the work of Koch and Pasteur in discovering microorganisms and how to set criteria to determine the role of the microorganism in a given outbreak. "In order to transmit an infectious disease, you need three things: a vulnerable host, an agent, and an environment that can result in an infection. I'd like to take each one at a time. Host factors may be things that can be changed or things that indicate the public health professional should pay particular attention to that group in certain situations."
Beulah moved onto a discussion of passive and active immunity and immunization. Active immunity to a particular disease was acquired through immunization or a previous infection with the microorganism that caused the disease. Passive immunity was a bit more difficult to explain. Maternal antibodies and gamma-globulin prophylaxis weren't as easy to understand but she thought they were getting it. She noted another student perk up when she talked about the idea of herd immunity. If at least eighty percent of a community was vaccinated, it was more difficult for communicable diseases to find a vulnerable host. The example she used was of the development of smallpox vaccine using cowpox by Jenner. She was careful to point out how long some form of vaccination had actually been around and what Jenner had done that was different and why what he did was so effective. The drops in death rate were impressive statistics.
From there, it was a fairly easy step to talk about personal hygiene and cleanliness before she moved onto the agent of disease part of the lecture. "Are you all familiar with childbed fever? During the 1840s, many women died of childbed fever. Often, the child became ill and died as well. A doctor named Semmelweis conducted a classic epidemiological study of what caused the fevers. He noticed that in the two clinics he was director of, one had higher rates of death than the other. The mothers were ill during the birth or up to thirty-six hours later and then quickly died in the clinic with the high mortality rates. He observed that the problem seemed to start during the examination of the mother during dilation." She went on to discuss the data he'd collected and analyzed and the controlled experiments he'd conducted to try to determine the cause of the deaths.
"He realized that the deaths were caused when the medical students came to the hospital from the death house after performing autopsies and conducted pelvic examinations on the laboring mothers. The doctors' hands carried germs from the dead bodies to the mothers because they didn't wash their hands. The traditional Hippocratic view of disease was still held and, initially, his findings weren't accepted. He was successful, however, in instituting hand washing by every nurse or doctor entering the ward. At first, he thought it would be enough just when entering the ward. Later he realized that it was necessary to wash between each examination. Something as simple as consistent hand washing dropped the mortality rate by ninety percent in just six years. I know you've seen how often we wash our hands in the hospital and clinics here. It is a very simple but very effective way to stop the spread of infection. It's quick, cheap, and anyone can learn to do it.
"The presence of infectious agents is another concern I'd like to touch on. One of your handouts gave common infectious agents, which we also call pathogens, that are found on or in the body and that are found in the USE."
One of the students waved his hand.
"Yes?"
"Excuse me, Frau Professorin, but if these pathogens are in and on the body and all around us, why aren't we all sick all the time?"
Beulah beamed at him. "An excellent question, Mr . . . ?"
"Georg Holtz." His voice sounded a little more confident.
"Well, Mr. Holtz, you've raised a very important issue about pathogens. That has to do with part of the agent, namely the vector, as well as how strong the pathogen is. The vector is the way the pathogen gets to the person in a way to do harm. The vector may be biological, such as a person or animal that has the disease, or it can be mechanical. A mechanical vector can be something like a contaminated surgical instrument or piece of clothing." She very carefully didn't notice them stiffening. She remembered how she and all the students she'd met had reacted when they came face to face with some of this. As she recalled, she hadn't been the only one who'd suddenly wanted a shower with lots of hot water and soap. A truly evil thought encroached. Well, it's all for the greater good. It certainly made an impression on other students and it's fairly easy to do. The lab is going to love this one.
"As a matter of fact, if you're interested, I'll talk to the lab folks for you. They can show you how to culture some of those organisms we live with all the time on our hair, skin, clothing, and so on. Most of the time, we call those organisms benign. Even benign microorganisms can be nasty under the right circumstances. Let me give you an example you've probably seen in practice. A person with a wound has an open area that the germs that normally are on your skin, such as the staphylococcal class, can get into. If the person had an intact skin, the microorganism couldn't get into them to cause an infection. The host was vulnerable, the microbe was there, and it had a way to get in."
She finished what she had to say about agents of disease and went on to control measures such as quarantines. The students seemed surprised that the practice of quarantines had begun in the fourteenth century and that she still considered it a relevant measure of infection control.
When she talked about the role of disasters such as floods or war in creating conditions that promoted the spread of disease, she saw that they were fitting what she was saying into their own experiences. War as a topic led her to Florence Nightingale and the Crimean war. She talked about how Florence had used epidemiology and statistics as well as astute political and other lobbying to improve conditions and reduce mortality and morbidity of the soldiers and later, of people in England. Making the point that when she'd arrived in 1854 in the Crimea, she'd immediately worked to improve the conditions for the ill soldiers by organizing measures such as kitchens, laundries, and a central supply department. The end result was that in ten days, the death rate dropped from thirty-eight percent to two percent. Mentioning that she was a nurse near the end didn't hurt either. Beulah fully intended to discuss Clara Barton, the U.S. Civil War, and the founding of the Red Cross later in her lecture.
"The methods Nightingale and others have used rely on incidence, prevalence, and relative risk ratios." She went to the board and put the formulas up with discussions of each, how it was calculated, and what it meant. That naturally led her to a brief mention of statistics such as infant mortality that gave important clues to a population's health.
"But that is really beyond the scope of our talk today. I'd like to talk some more about modes of transmission of disease and then we'll talk about ways to break that chain of environment, agent, and host determinates leading to infection. Biological modes of transmission are physical contact such as spitting or touching, sexual contact such as intercourse, and airborne contact such as dust or droplet nuclei. Those modes of transmission are direct or airborne. Indirect transmission results from mechanical transmission. Books, coins, toilets, soiled dressings, food, and many other things can be a reservoir for an infectious agent. For the last hour today, I'd like to talk about ways to interrupt the transmission vector, to strengthen potential hosts, and to reduce risks from the environment."
During the next hour, she covered everything from adequate sewage disposal to hand washing. The work of Joseph Lister and the use of antiseptic techniques and carbolic acid solution fit in here. She also brought up Thomas Syndenham, who was only nine years old at the present time. She made an effort not to stress too much that he used observation and other techniques to diagnose different diseases and avoided Galen's approaches. Syndenham's work classifying fevers in London during the 1660s and 1670s and how he treated the different classifications went against the Hippocratic and Galenic approaches. For which he took considerable flak. His treatments were effective, however, even if he hadn't understood what was causing the fevers. She did make a point of talking about the criticism and threats he endured. He persevered despite that and influenced an up-and-coming generation of physicians with his use of empirical techniques.
She gave them additional resources to read on all the areas she'd introduced and hoped it would be enough to get them started. Hopefully, they'd take the ideas back to Jena. "If any of you have specific areas of interest in public health, please see me. I'll try to set up an experience for you so that you can learn more in a clinical setting, and I can probably point you to more references. Thank you for your attention today. Do you have any other questions before we adjourn?"
"May we join you, Frau Professorin?" Georg sounded a little hesitant but eager.
"The Leahy garden is always better for company. Please, Georg, Kunz, have a seat."
"We wanted to thank you for showing us around the lab and setting up the culturing experience after the lecture yesterday." Kunz sat next to her on a bench and grinned at her. "We really enjoyed it. Georg and I are very interested in aspects of public health and would like to talk with you more about books to study and a clinical experience in public health."
"With you, if we can," Georg blurted and then blushed right up to his straw-olored hair. "I'm particularly interested in microbiology."
"While I am interested in the methods of disease surveillance you spoke of," said Kunz. "We were on our way to check on the microbial growth but when we saw you here, we thought we'd take the opportunity to ask."
The smile she gave them both was slightly blinding. "I'd love to. I'll make up a list of materials for you. I can even lend you my personal texts, if you'd like, in some cases. Most of them have been copied already. I'll check and see what's at the printers right now."
"You're all certainly keeping the printers in Jena busy." Kunz grinned back at her. She couldn't help but contrast that with the attitude a few months ago, and took heart.
"Please excuse me, Frau Professorin, but in the lab, they said that there would be growth within a day. I'd like to go check the petri dishes before things get too busy there."
"Have fun. Kunz and I will set up a time to meet and talk some more."
She and Kunz grinned after the tall young man as he dove for the door.
"What are you doing here?"
Georg nodded politely. "I am one of the medical students from Jena. My name is Geo—"
"I know you're one of the Jena students. I asked what you're doing here in the lab?"
Georg straightened to his full height. "I have permission to be here. I was checking the growth of the cultures we took yesterday."
Mara stared at the young man standing a few feet away. She couldn't believe he was arguing with her this way. Little know-nothing. "There won't really be anything to see if you just took the cultures yesterday. I don't know why anyone is letting you do cultures in here, anyway. It's a waste of our resources to be using materials that way."
"Frau Professorin MacDonald didn't think so. She called it a good learning experience. I and the other students found it most interesting."
"We only have so many supplies. They should be used for patients or for our students." Mara heard the belligerence in her tone but didn't care. She was sick of everyone trying to make them happy. She'd already figured out she wasn't going to be one of those asked to be in the MD program at Jena. She should be. God knew she'd earned it and she was certainly smart enough. She'd even volunteered for the education committee. It was all going to be people's pets who got in, especially Beulah's pets. She'd heard someone talking with Mary Pat in the hall yesterday, asking if she was going to apply to the MD program. The other nurse thought Mary Pat would be great. Mary Pat had laughed and said she wasn't interested, she liked nursing too much. Hearing one of Beulah's pets dismiss what she herself wanted had just frosted the cake. She should be in that program. She should be getting special attention. But no. Beulah was sponsoring Fritz and now it looked like she was going to have one of the Jena students, too.
"I am one of the students," Georg replied in evident confusion.
That was more than she needed to hear. All thoughts of running a pregnancy test before her shift started and anyone else was around went flying out of her head. The injustice of it, the slights were more than her temper could stand. "Well, you are sort of a student. Not that any of you'll be worth much for a long time. We'll have to spend a lot of time and effort just getting you up to speed on things any junior-high student would know. Some people may think you'll be useful teaching assistants but I'm not one of them. We'd be much better off starting from scratch with our own people."
Georg's attempt to interrupt went unheeded. "You're nothing but a bunch of parasites. You'll take and take but you sure won't give much back. You don't know enough. Your ideas about everything are from the dark ages. There's no way you'll be able to catch up on hundreds of years of knowledge in a few years, much less a matter of weeks."
"How dare you say such a thing!" Georg's voice was rising toward a yell and echoed oddly in the lab. "We are not parasites. The others would not be spending so much time with us if they didn't think we could learn. More than that, we are not some sort of ignorant fools who . . ."
Even Mara knew she'd gone too far. With an effort that left tears in her eyes, she stopped herself from saying any more. She spun away from him and slammed out of the lab.
"Hi, Kunz, Georg. Are you all right, Georg?" Beulah asked in concern. Georg and Kunz had just come into the conservatory as she was about to leave, and looked upset.
"Fraulein Beulah. No, I do not think I am but I will be fine."
Beulah tried again. She thought she had an idea of what was wrong. Young people had tender egos about such things, sometimes, so she proceeded rather obliquely. "Did you just come from the lab?"
"Yes. I had permission to be there." His tone was both defensive and angry. He looked pale. "I was just checking the samples."
"An excellent idea. Did somebody say you couldn't be in the lab or look at the samples?"
"Not exactly."
"What did happen? Exactly." Beulah noticed that Kunz was getting red blotches in his face and clenching his fists. Something was really off here.
"I can handle it."
"I have no doubt of that but since I was the one who suggested the lab experiment, I feel a little responsible. Humor me, okay? What happened?"
"One of the nurses felt that I should not be in the lab."
Kunz jumped in. "She did far more than just tell him that he shouldn't be in the lab. She also felt that our presence was a waste of time and told him that in the rudest way. There is no excuse for such behavior."
Beulah was adding one and one and coming up with . . . Mara. She had a pretty good idea what Mara had been doing in the lab since she was the one who'd told Mara to have a pregnancy test. Beulah had seen lots and lots of pregnant women in her career and Mara definitely had the look. She'd like to be able to blame Mara's behavior on hormones, but the hormones had probably just made her less subtle in her attack methods. "Let me guess. About this tall?" She help up her hand to around five feet and a bit. "Strawberry blonde, big blue eyes, tanned, looks harmless?"
At Georg's nod she gritted her teeth and said one word. "Mara." This certainly put her in an interesting position. Starr and Mara were sisters-in-law. She needed to go to Starr about the behavior of one of her staff. It was going be awkward for Starr but she would handle it. In the meantime, Beulah got damage control duty. Lovely. "Help me up, please, Georg. We'll all get something from the cafeteria and then go to my office to talk. I'm upset at Mara, not at you. I just want a little privacy."
Georg and Kunz were largely silent after that except for an offer by Georg to carry her coffee mug. She hated being glad of that offer. The cold weather wasn't doing her joints any good and she'd had to cut back on the willow bark tea. The tea and stress was turning her stomach sour and she was starting to get bruises at the slightest touch. She'd been able to hide them with long-sleeved sweaters or shirts and since she almost never wore dresses, no one had noticed the bruises. Delayed blood-clotting times was one of the side effects of the tea. So, less tea. Which didn't leave her much for the pain unless she wanted her mental state interfered with by some of Stoner's crops of marijuana or poppy. She couldn't afford that right now. A break in the tea would give her body a chance to recover. It would be weeks, though, before her clotting times were close to normal again. She was also trying more stress management techniques. So far, so good. Except for the pain.
Beulah nodded toward the small table in her office. She used it for meetings sometimes or when she needed to spread her work out. She didn't want to be sitting behind the desk with Georg in front of it like an errant schoolboy. The walk had helped her calm down a little and given her some space to think. "Can you tell me what happened, please?"
By the time Georg had finished the description of what had just happened downstairs, Beulah was ready to do Mara a mischief in a dark alley. Kunz would probably help by holding Mara still for it. The description rang too true to some of the things she'd seen Mara do, but she'd never gone this far over the line before. She'd been tripping over little bits of poison strewn by Mara and a few others over the last month. This was the last straw. I don't care if it is her hormones, we do not need this kind of crap. Specifically, she didn't need to be doing more damage control right now. Now, how did she avoid undermining one of the few senior nurses they had but support Georg while one of the Jena faculty was watching and not looking at all friendly? She had no doubt that this would spread among the Jenaites at the speed only good gossip can obtain. Einstein should have made gossip an exception to the travel at the speed of light stuff.
"What do you intend to do about this woman?" demanded Kunz.
"I'll speak with Starr first. Mara is one of her staff. Second, I'll speak with Mara personally. I know I'm not the DON anymore but Georg is one of our students and that should give me a say in how this is handled. It won't happen again if I have anything to say about it. I'm really sorry, Georg. If Mara had pulled anything like this in an up-time hospital, she'd have been out the door so fast she'd have left skid marks on the linoleum." Beulah sighed. "As it is, because we don't have enough staff, we can't do what I'd like, which is fire her. Between Starr and me, we'll come up with something . . . suitable. One thing for sure. This won't happen again to you or any of the other students. If you or any of the other students get so much as one whiff of attitude from anyone, come right to me."
Just wait till I get my hands on little Miss Twit. Maybe I'd better watch some WWF reruns first.
Beulah peeked into Garnet's hospital room. Garnet was sitting up in bed, awake. Beulah didn't like the way she looked or was breathing at all. This is what happened when people pushed themselves this hard for so long. She'd just got the call after Kunz and Georg left her office. Garnet had just been admitted to the medical ward. She hadn't been able to get to see Garnet for another few hours, which was probably just as well. She had other things to take care of, including meeting with Starr, finding the treat she'd brought, and that didn't even touch what she had to get through before today had started going downhill. The meeting with Mara at the end of the shift today was just going to finish up a lousy day with a lousy mess. Garnet, however, didn't need to know or see any of that. She needed to get well.
"Come on in. I'm not contagious. It's just pneumonia."
"There isn't any `just' to pneumonia anymore and you know it." Beulah came in and set the small package she was carrying on Garnet's nightstand. Bringing flowers to someone with pneumonia was out, so she had brought some of the lemon candy Garnet loved. It would help soothe her throat, too.
"I shouldn't even be in here. I can lie around in bed at home."
Beulah settled herself in a chair by Garnet's bed and said pleasantly, "You even try to get out of that bed and I'll personally put you in four-point leathers and abscond with the key."
"We don't have leather restraints here."
"There are plenty of people around here who could make up a set real quick. Besides, it'd do wonders for my reputation."
Garnet gave a choking laugh that started a coughing fit. Beulah helped her sit up and handed her a handkerchief. She poured Garnet a glass of water when the fit was over.
"Don't make me laugh, okay?"
"Sorry. I'll be sober as a judge. Promise. I'm just glad Stoner's got some more antibiotics on hand. I've seen your micro report. What we've got will cover you, so you should be able to go home within a few days and be back at a limited work schedule in a few weeks."
"We've got classes going. I have to teach—"
"Class material that you aren't teaching will either be taught by someone else if we can find them, or not get taught till you're better. The students won't mind a break, especially before the holidays. We'll think of something, maybe more clinical time. They can always use more of that. You just concentrate on getting better, okay?"
"Okay. But I could probably . . ." She broke off at Beulah's frown and firm head shake. "I thought it was just the flu."
"That's been going around. I've been working with our outbreak tracking team all week. Looks like the flu is all it is and we've got it pretty well contained so far. I don't think we're looking at a major outbreak. Flu isn't anything to mess with, though. I'm going to be showing Kunz and some of the others how the tracking team works later and how we're responding to this. It should be a good small-scale object lesson." She switched the conversation briefly to the interest Georg and Kunz had shown in public health and then left after making sure Garnet had plenty of handkerchiefs and cold water. She didn't want to tire her out.
As she left, she was mentally trying to rearrange the teaching schedule. She needed to talk with Courtney or Marcia as soon as she could get in touch with them. There was going to have to be some shuffling but they'd work it out. The sooner Garnet had a definite solution, the sooner she'd be able to relax a little and focus on getting well again. Beulah would stop by again as soon as she had things worked out with the other teachers at the vo-tech program. The EMT and LPN courses would be most affected. She'd have to contact Starr again today and talk about what that would do to staffing projections, especially with some of the staff being pulled as students at Jena in two months. Starr is going to start running when she sees me coming after today.
"Please come in and sit down, Mara." Beulah kept her voice even and pleasant with an effort. This was a professional conversation. She wasn't going to stoop to name calling, ranting, or even incivility. Well, probably not.
"I wasn't exactly surprised to get a summons to your office at the end of the day. Don't you think using your authority to protect one of your pets is stretching it a bit? Especially since you aren't the DON anymore. Starr is."
Mara had evidently decided she didn't have much to lose and that there wasn't much Beulah could do about what had happened. Wrong move, Mara. The best defense isn't always a good offense. "I'm not talking to you as the DON. I'm talking to you as the dean of the health sciences school and the chair of the health education committee. Of which, at the moment, you are a member." A brief pause to let that sink in; then, "I'm here to talk about your unprofessional behavior and the fallout from it. Mr. Holtz told me what you said to him in the lab this morning."
Mara crossed her arms over her chest and glared at Beulah. "And is what I said so wrong? Okay, calling them parasites went a little far but the truth is that they are parasites. They don't have what we need to do this and by the time they get it, we could have trained our own people to the level we need. We give; they take. That's parasitism."
"And how many of our own people could we train, Mara? How many of us are there available for health care? How many of us have any significant time to teach the math and science that we need taught or the—"
"But they don't have what we need taught, so why do we want them teaching any of it? They don't understand the scientific method. They don't understand being skeptical and observing and testing what they see. For them, knowledge flows from the authority. They've just figured out that we're now the authority. You want that attitude passed on to students? And that doesn't even get into content. They don't know the basics of virtually anything."
"You're exaggerating. Just the experience of having to look at what has changed historically, how and why, is already leading them to question their knowledge and how it was generated. They've made a lot of progress and we've got a plan in place to move them forward. The seeds of the scientific method are already present. Autopsies and other ways of observational learning are already going on and have been for a while. See one, do one, teach one has worked for a long time. We still use it in our time. They do have content we need and some of their knowledge is valid. They do have skills we need. Yes, some of what they know will have to be unlearned. Yes, they'll have to make changes in their worldview. But they're smart and motivated and I think they can do it."
"In two more months?" sneered Mara. "Yeah, right. Meanwhile, we'll be splitting our resources and wasting our time on them. Just splitting the campus so that some of us are here and some in Jena is a waste of time and resources we don't have. You aren't the only one who knows what we're facing. I tried to tell you this months ago, but you wouldn't listen. If I said it, it had to be wrong, didn't it?"
Beulah took a firm grip on her slipping temper. "Have you ever heard the old saying about putting all your eggs in one basket? Right now, all our eggs are in Grantville's basket. What happens if we have one nasty epidemic wipe out most of our medical staff? You and I both know that in epidemics and plagues, the healer death rate is sky high. If we have some of our people and knowledge in Jena, they may be far enough away to have some of it survive. Not to mention that the time issue is really a wash. Yes, splitting the campus takes more time but it also means that we can have students, the students you don't think know anything, teaching basic anatomy lab and skills like how to dissect, how to suture. We don't have the people or the time to do everything that needs doing."
"Most of our people may lack those skills but they've still got more basic science knowledge and they've got the mentality, the worldview that the Jenaites don't." Mara leaned forward, fists clenched on Beulah's desk. "Why won't you see that?"
"I do see it," Beulah returned angrily. "I just don't see it as an insurmountable barrier. These are smart people and they've very motivated. They can get it and they will."
"As fast as we need it? Have you thought about the fact that your little jaunt to Jena has already meant the word about our medical care is spreading even faster? Most people will think it's a fairy story and dismiss it, but not everyone, and not for long. We can't take care of our own people and now you're spreading this around. We've got more people coming in. What if one of us gets sick? They can't take care of us but we can take care of them. You can damn well bet that if my kids or husband are ill, I'm not going to want the medicine or care my family needs going to someone else. And I'm not the only one who feels this way."
"The only way to change that is to train more people and make more resources. Does that mean there will be a bottleneck, for a while? Yes. Does that mean that we're vulnerable right now and will be for a while? I know that better than you ever will. That means we have to look beyond ourselves for both teachers and students. There. Are. Not. Enough. Up-timers. Why won't you see that? Or is it just that you don't want to hear anything I have to say? You talk about content but do you know how to judge the potency of herbs from a particular place? And how to grow and collect and administer them safely and effectively? They do. They may not know all the whys and wherefores but together we can figure that part out. That's just one example. We can help each other and that's symbiosis not parasitism." Forget professionalism. She'd had enough of Mara and her attitude.
"So what are we supposed to do? All turn into little Jenaites? You've been in those meetings. They're still trying to hang onto the quadrivium and the trivium even when it doesn't make sense. We need people who can think and practice nursing and medicine. We don't need nurses and doctors who can debate how many angels dance on the head of a pin because they've had years of theology as part of their basic education. That's bull and you know it. But you won't call them on it. They're fighting for things that aren't what we need, things that don't matter. That doesn't sound to me like they're getting it at all. They have their definition of knowledge and what makes a university and it isn't anything like ours and never will be."
The truth of some of what she was saying stung Beulah. But she's skewing things, twisting them. How much of it does she really believe and how much is to fight me? Beulah suddenly felt exhausted. Rage had given her a temporary burst of energy but she couldn't sustain it. "They're trying to hang onto what they, and others here, believe a university education to be. It's difficult but we're working it out." Even to Beulah's ears, that sounded pretty lame. She was getting so mad that she couldn't think too clearly. This meeting had gone way far afield. Maybe Mara's strategy hadn't been so off target after all. "Debating what is going on with Jena isn't the reason you're here. I'm relieving you of your position on the education committee. Unless I see changes in your behavior, you won't act as preceptor for any students, whether from here or from Jena. Starr will talk with you about your behavior as a staff nurse tomorrow. Dismissed."
After Mara left, Beulah stood shaking in her office. She hadn't been this mad in a long time. Or this scared. Mara's comments went round and round in her head. They argued for a very different course of action. But there were other voices, too. The voices of the dead and of those who would die if they didn't succeed. She had worked in poor areas of West Virginia. She had a pretty realistic idea of what could happen if they didn't get modern public health and other methods in place. The specter of epidemic was real but not as visible as the other threat, war. She'd seen so many die in Korea. Now, war was taking children from her town, people she knew. And it was going to get worse, not better. At least for a time.
No. They'd chosen the best path. None of the choices were without risk. Certainly none were ideal. Mara was just being spiteful. Even as she tried to rationalize it, Beulah knew she couldn't just dismiss all that Mara had said.
The pain hit suddenly. Something with lots of dull teeth was trying to gnaw through her stomach from front to back. A cold sweat broke out on her skin as she lurched for the bathroom just down the hall. A few very unpleasant minutes later, she looked down into the toilet bowl. Blood.
There wasn't that much really. Probably only a few ounces. And it didn't look that bright a red. If the bleed was arterial, she'd be in a world of trouble already. She got shakily to her feet after flushing the toilet, thankful that most people were gone from the second floor for the day. The blood wasn't a big surprise, given her symptoms. After washing her face and rinsing her mouth, she wobbled down the hall to her office, sank down into a chair, and reviewed the 1633-available options for a bleeding ulcer.
She'd already changed her diet, although she'd have to add more greens and liver to up her iron intake and correct for the blood loss. She could start a baking soda slurry to help reduce the acid. Not too much; she didn't need metabolic alkalosis on top of everything else. Instead of cutting the willow bark dosage, she'd have to stop it entirely. She didn't have anything else for the pain. She wasn't going to try to deal with these problems stoned. She'd just have to tough it out.
They didn't have the equipment to do a scope and see what was down there and then cauterize any bleeders. Surgery for something that might not be so bad, just to see what was there, was too risky in this time. If it came to that, the surgery would be both exploratory and repair work. There wasn't time for surgery. Things were at a crucial juncture with the Jena project. They were already behind where they needed to be, and events like this morning didn't help.
She'd have to hide this from Mary Pat, which wouldn't be that hard as busy as they both were. She could tell her that she had had her tea before Mary Pat left on her run each morning. There would even be a hot teakettle there. Getting the variety of calendula and licorice she needed wouldn't be hard. Ray wouldn't ask what she needed it for. He'd just assume she was helping out with a patient or working with the Jena students. The calendula would help with the bleeding as well as the healing. She could possibly use some sucralfate but that was expensive and time-consuming to make. They didn't have much in stock and she couldn't get that without rousing some suspicions. If she had to, she'd get some but that would mean going to James. She'd set a little more time aside for the stress reduction exercises. Just a few minutes here and there could make a difference. The exercises would also help with the pain.
There were options. She'd take them. There wasn't any point in adding to anyone else's worry, especially Mary Pat so soon after the death of Hans and Larry. There really wasn't anything else anyone could do, either. She'd make the changes, take the meds and monitor her condition. If things got much worse, she'd talk to James.
The stress didn't abate over the next two weeks. If anything, it was getting worse. The meetings with the Jenaites weren't going as well as Beulah had hoped. Mara's words came back to nibble at her more often than she'd have liked. Garnet was back on light duty starting today. If Garnet had gotten ill just a week earlier, there wouldn't have been any antibiotics to treat her pneumonia. They'd sent them all to the siege areas. She might have survived the pneumonia but the odds were much worse without antibiotics. Garnet wasn't just a colleague. She was a friend. She knew her so well. Garnet the gun nut who loved to debate for hours on caliber and range and anything else gun or hunting related. Garnet who was positively phobic when it came to spiders and who loved the color yellow. They'd already lost so many people they couldn't treat. Beulah firmly believed in the moral stand they were taking and the pragmatic logic that also went with it. But there were consequences. Always consequences.
They were still arguing with the Jena faculty about things like astronomy, for Pete's sake. Great, you've got an observatory. We're happy for you. What does being able to find Venus have to do with diagnosing and treating a patient? Beulah's patience wasn't endless and they were running out of time. It wasn't just the January start date she was thinking about. It was almost Thanksgiving. The Jenaites would be leaving the first part of December and they still hadn't been able to iron out some basics in the curriculum. Every time she thought they'd gotten ahead there was another stumbling block. She also wanted to get some more knowledge squeezed out of them. Just yesterday, Werner came up with a botanical treatment none of them had heard of for a patient that they'd been trying to treat without success for weeks.
She was able to hide the bleeding for those two weeks, even from Mary Pat although she was beginning to watch Beulah pretty closely. At first, the measures Beulah tried seemed to be helping enough. The bleeding stopped for a while but the pain was worsening over the last few days. She was debating whether or not to see James in the morning when the decision was taken out of her hands that night.
"Beulah?" Mary Pat shrugged out of her coat and shook the raindrops off as she stood by the front door. She put the coat onto the coatrack and headed for the kitchen. Dinner preparations were partway made and the light was on, but no Beulah. Mary Pat had stepped out of the kitchen and headed down the short hall to the stairs when she heard the sound of vomiting. The flu was going around but it was more respiratory this year than GI.
She quickly headed up the stairs and opened the door, calling Beulah's name. What she saw wasn't what she expected. She had caught a whiff of the blood as she approached the door but it hadn't had time to register. Beulah had almost made it to the toilet before she was sick. Despite all Mary Pat's experience, the sight of Beulah half-lying amid reddish black blood, deathly pale and shaking, hit her hard. For a heartbeat, then another, she couldn't move, couldn't think. Then training kicked in and her nursing skills came flooding back. She touched Beulah gently on the shoulder, then the neck, doing an at-a-glance assessment. The feebleness of Beulah's pulse, her pallor, and the moisture on her skin worried Mary Pat. Beulah was going into shock.
"I'm here. I'm going to call an ambulance and be right back." She didn't remember later whether her feet even touched the steps on the way down the stairs. The phone was in her hand and she cursed under her breath. Why couldn't Beulah have a touch-tone phone instead of the slow black rotary phone? The second it took after dialing 9 in 911 would have been all the time she needed to punch in 911.
"EMS, Walter Allen. What is the nature of your emergency?"
"Walt, it's Mary Pat. I just got home and Beulah's throwing up a lot of blood." She gave him a concise assessment, not that there'd been time to gather more information. She didn't hear anything from upstairs. Had Beulah passed out?
"Chester and I are on our way. Be there in a few minutes. I'll notify the ER staff on the way. They'll gear up for her."
Mary Pat was relieved that Walt and Chester were on duty. Both were experienced EMTs in their fifties. "I'll have the door open for you." She hung up and rushed back up the stairs, praying all the way. Please, please God, help her. And, more selfishly, Don't take her from me yet.
James sat on the edge of her hospital bed and glared at her. "Don't think we aren't going to have a long talk about you hiding this the last few weeks just as soon as you're up to it."
"Mary Pat . . ."
"I'll see she's taken care of. Right now she looks like hell. I'm going to send her home with something to help her sleep."
"She won't take it."
"Then I'll come up with another plan. You're going to rest if I have to hog-tie you to that bed. I heard about you threatening Garnet with leathers. I'll have a pair made up for you."
"Haven't worn leather in years. Don't have the body for it anymore." As comebacks went, it was a little weak, but James' lips twitched just a little. She couldn't be that bad if she could still come up with a joke.
"We'll see about that. You can bet that everyone who walks into this room is going to be on your case if you overdo. And we all know you well enough to watch you like a hawk. In the meantime, I'm giving you four milligrams of morphine. It'll help with the pain and let you get some sleep."
He stayed with her for a few minutes waiting for the medicine to take effect and then got up. He had an idea of how to handle this before he faced the crowd outside. And he had no doubt there would be a crowd, even this late.
Mary Pat was at the desk talking with the nurse who'd be caring for Beulah tonight. James' gaze lit on Fritz and he relaxed a little. "Fritz, come over here a minute."
A very concerned Fritz walked out of the group of others hovering near the door. Hospital staff and EMTs, off duty or not, a couple of Jenaites even. Word had spread fast even though it was after ten at night. Garnet was there, too. He'd have to see she got back to bed as well. Dammit, didn't anybody know how to get some rest around here?
"I'd like you to special Beulah tonight. It'll let Mary Pat get some rest and her bearings. Then she can help me deal with Beulah tomorrow. Can you do it?"
"Of course. I was planning to study for another few hours anyway. Now that Fraulein Garnet is back, we are catching up on our studies for the LPN courses. I was off tomorrow anyway. Just let me get my books." As Mary Pat approached, the crowd moved in a little closer. Fritz patted her on the shoulder a little awkwardly before moving off. "She's going to be well soon. She is very strong and we'll take good care of her."
"How is she?" asked Mary Pat anxiously.
"Sleeping. I gave her some MS for the pain. I've got a couple of patients I'm keeping a close eye on, so I'll stay here tonight. Fritz was going to be up studying anyway, so I've asked him to sit with her." Anticipating her protest, James continued firmly, "I'd like you to go home and get some sleep tonight, Mary Pat. You get some rest so you can help me sit on her tomorrow."
"I'd rather stay. Not that I don't appreciate Fritz being willing to stay."
"I just gave her four of morphine. She's out like a light. She needs the rest and so do you. When she wakes up tomorrow morning, we're going to have a stubborn patient on our hands." James looked past her to see Hayes coming down the hall with Gary and a stack of papers. Hayes lived not that far from Beulah and Mary Pat. "Hi, Gary, Hayes. Hayes, could I ask a favor? If you're leaving, could you walk Mary Pat home? We just admitted Beulah and Mary Pat's a little shaky."
"Wait a minute. I haven't even said I'm leaving. Besides, Hayes, I don't want to bother you."
"No bother. Beulah going to be okay?"
"Bleeding ulcer." Mary Pat steadied her voice with an obvious effort. "If she gets some rest and with treatment she should be okay. James is hoping not to have to operate. She's getting blood and pain meds and she's stable right now. I found her when I got home."
"We'll call you if anything changes with her. I promise. Please get some rest. You know she's going to want to get out of that bed tomorrow and take on the world again."
"I'll be glad to walk you home," said Hayes. "Sorry to hear about Beulah. I'll come in for a visit tomorrow if she's up to it." He nodded to James. "Please tell her I told her to get some rest and hope she gets better soon. Let's go, Mary Pat. I'll see you tomorrow, Gary. 'Night, everybody."
His tone may have been a little abrupt but he looked at Mary Pat with concern and crooked an elbow in an old-fashioned gesture that brought a brief, wan smile to her face. "How about I make you something to eat? I'm a great cook and I need to eat anyway."
An hour later, Mary Pat was sitting on the couch in the 1633 equivalent of comfy sweats. The scent of old blood still lingered and it was too cold out to open up the house to air it out. She shivered anyway. Beulah's blood. She'd cleaned up the mess in the bathroom and was now staring at the phone. It was stupid to be staring at an inanimate object this way. She'd kept finding excuses to come stare at it while she was cleaning. And changing her clothes, too. Which was also stupid. It wasn't like she could will Beulah to get better and the phone not to ring. Hayes' knock on the door came as a relief.
"Hi. Look, I really appreciate you going to so much trouble."
"No trouble. Always nicer to eat with company, especially yours. Where do you want me to set it down? Hope you like pasta. I've got a standing arrangement with Senior Nasi to have some of the special flour I need and good olive oil brought up with the coffee. Took some doing but it's worth it to have the right ingredients. And pasta dough doesn't take long to whip up. I put up some really great sauce before we went to Jena this summer. I can't wait till we get some tomatoes going but a white sauce will do for now. I've made up the tortellinis so if we can get some water boiling, we'll be ready in a few minutes. There's salad, dressing, and bread, and some wine to go with it."
"This way to the kitchen, master chef. That sounds perfect and very impressive. Especially the wine. A glass of that would be very welcome right now."
Dinner and the cleanup afterward were surprisingly pleasant. The phone didn't ring and Hayes kindly didn't say anything about how many times she stared at it. He just kept up a light conversation to help distract her. Partway through the second glass of wine, sometime before 1 a.m., she fell asleep curled up in a corner of the couch. She didn't stir when Hayes covered her with the brightly colored crocheted afghan from the back of the couch, then opened the work he'd brought with him. He'd be there for her. Just in case the phone did ring.
It was a conspiracy and they were all in on it. Two days after she'd been admitted, Beulah was convinced of it. The old saying about even paranoids having enemies had a corollary. Your friends can make you paranoid in the first place. It wasn't that she didn't appreciate the attention. She was touched. Really.
"But if I don't get out of this room soon, Mary Pat, I'm going to scream."
"You've been out of this room. Hanna caught you trying to sneak up to your office last night. At this rate, we're going to have to post guards outside your door to keep you in this room. I know a couple of Marines who'd love to volunteer."
"I just wanted to look at a little paperwork."
Mary Pat grinned. "Now I know it's bad. You're eager to do paperwork. And you're still not getting out of this room. I know all the arguments about what you have to do and how much you have to get done. That still won't get you out of here any faster. The only thing that is going to get you out of here is no more signs of bleeding and no more pain. That won't be for a few days. Deal with it."
She reached into her satchel and pulled out a stack of letters. "These are from home over the last few days. I'm not letting you at anything official that comes into the hospital. I'll be back later tonight. Hayes is bringing over something special for you for supper. He's been consulting medical books and me about what you can have to eat."
"Anything is better than just sitting here. And I'll be sure and tell Hayes thanks when he brings supper. One of the great mysteries of the universe is how otherwise normal food becomes the dreaded hospital food the moment it clears the hospital doors. The phenomena wouldn't dare affect anything Hayes fixes."
Much as she hated to admit they were right, having some time to rest and think was precious. She really needed it. She'd had a couple of days to do nothing but think about the current situation with Jena and the need for more modern medical education. The ideas simmering in her brain would mean changing their approach pretty radically.
If Mary Pat had known what was in those letters, she'd have kept them away from Beulah at all costs. She probably thought they were ordinary correspondence since they came to the house. There were two letters that concerned Beulah. The first letter was from a man named Johannes Schultes, or Scultetus in the Latinate version of his name. She'd known about him uptime because of his work in obstetrics. The Scultetus bandage was still in use. His publications were famous and sometimes infamous, as was the case for his book illustrating a Caesarean section surgery, then rarely performed. He was writing to her from Ulm.
She'd had some letters from physicians, mainly over the last year or so. Usually they were asking for specific advice and often wanted to correspond with James or one of the other doctors rather than with her. A few had been willing and able to come to Grantville but they hadn't been willing to do what Balthazar or the Jena faculty had done, learn or relearn what they thought they already knew. This letter was different. Schultes was brilliant, comparatively local, and his letter reeked of desperately want to learn, ego checked at city limits. She'd hoped that they'd have the courses at least sketched out before outside physicians started coming to them. By now, she shouldn't be surprised that as usual, they were a step behind the need. It had been that way ever since the Ring of Fire.
Looking at the second letter, she thought, Make that a step behind in multiple directions. The letter from Debbie Leek contained a not so simple request. Magdeburg was growing at an incredible rate. There was a great need for a more modern medical system. Debbie wanted to be sure that the hospital that they wanted to add had the ability to use or add on up-timer medical technology. That made perfect sense to Beulah. Part of the letter was asking questions about which technology could be incorporated into the new hospital now and which would have to wait another five to ten years for their tech base to get to that point. Beulah could ask some of the people here and have them pull the information together for Debbie.
The second part of the letter was about the need for trained personnel to work in the hospital. Which would be built in the next eighteen months or so. The first part was easy enough to answer. The second, far more problematic. Quite understandably, the Jenaites were already making polite noises about upgrading their facilities in Jena. It would benefit them and the students. Which was true. So they'd need even more staff. There had to be a better way of doing this project.
Beulah swung her feet over the side of the bed and used the rail to help pull herself up. She was still pretty woozy even with all the blood and IV fluids she'd been given. She still had an IV line but was otherwise unencumbered. Poking around in the bedside stand yielded not a scrap of paper or even the stub of a pencil. Mary Pat had been thorough but Beulah wasn't ready to give up yet. It was an hour before the aides would be bringing lunch trays. Most of the staff would be busy in patient rooms right about now. If she could just sneak out to the nurses' station, she could find pen and paper and get started on the list for Debbie. She had another idea, too. The fight with Mara may have had something good come out of it. They weren't just putting all their personnel eggs in one basket, they had all their tech eggs in one basket as well at Leahy. Maybe it was time to change that, although that could lead to one heck of a wrangle. She'd have to think a lot about that and sound out a few people before she brought it up.
She stuffed her feet into her slippers and slid quietly out of bed. There was no dignity in these hospital gowns, or in a woman her age skulking about. But if they caught her, she'd be back in bed with nothing to do but count ceiling tiles. At least the IV pole rolled well. The hospital's floors didn't have carpeting.
She'd made it a few feet past her door when she heard the sound of a fretting child coming from a few doors down. Kid sounded congested. From crying or something else? She changed direction and headed down the hall toward the sound. She almost made it.
"Ahem."
Beulah wasn't sure if the polite throat clearing was from Dean Johann Gerhardt or from Dean Werner Rolfinck. Judging by the folded arms and the frown on Werner's face, it had probably been Johann. Either way, she was busted. Again.
"I'm going to have to sign up for some special-ops training in order to learn proper sneaking technique. I was just going for a little walk when I heard the crying."
"I'll check on the child. Johann, if you'd escort the Professorin back to her room, please?"
"Thanks, both of you. By way of the nurses' station, if you don't mind. I was just thinking about you two and needed some pen and paper to jot a few things down."
"I'll get the pen and paper after I see you to your room." Johann gestured courteously but firmly toward her room.
"Beulah, you have got to be nuts!" Mary Pat snapped, hands gripping the arms of the kitchen chair she'd brought into Beulah's living room for this informal meeting.
Beulah looked from Mary Pat to James. He and Johann were in the room's two armchairs. Werner shared the worn, floral-pattern couch with her. Mary Pat wasn't through holding forth on Beulah's temporary insanity by a long shot.
"You just got out of hospital a few days ago. Now you want to move to Jena?" Her attention was caught as James stood up and retrieved a leather wallet from his back pocket. He pulled a Yankee dollar from it and handed it across to Beulah. "What's going on?"
"I do so admire a man who pays his gambling debts promptly," Beulah graciously acknowledged James before turning back to a confused Mary Pat. "James bet you would wait to hear what I had to say before you freaked about me going to Jena."
Werner chuckled. "And what would he have won if she hadn't, ah, freaked?"
"My top secret family christmas ham recipe."
"You must have been sure I'd freak if you were willing to bet that. Okay, you two have gotten my attention. Unveil the great plan." Mary Pat sat back in her chair.
"I've spent the last week with nothing to do, really, but think. I've thought about what we're trying to do and the things that have happened in the last six months. It was pretty clear that we were going to have to make some changes in our plans. I'm not proposing going to Jena for another few weeks. I really can use the rest and it will give me time to figure out what I want to take with me."
Johann nodded. "It would also give me time to catch up with my students in Jena, and for Werner and the others to catch up with their patients."
"Yes and no," Beulah replied. "I'd like Phillip and half the students to remain here in Grantville. Or maybe go back to Jena for a few weeks and then be here the first of the year. I don't know what other plans they have. Phillip, Ernst, and Heinrich are working on trauma and surgery. Mary Pat, you're our trauma and military medical expert. You're the one who can best prepare them for that. They can even accompany you on deployments to see battlefield conditions and our MASH system if you can get clearance for it. They can also keep learning more surgical techniques from James. Phillip and all the students here can have intensive clinicals and class time for, say, three months."
"And the rest of us?" Werner asked.
"You, Willi, Kunz, and I will start work on the curriculum in Jena. I can also do more teaching of public health content to those like Kunz and Georg who are interested. We can still have grand rounds in the clinic in Jena. We can also coordinate with the other deans and faculty about some of the courses we'll need from them."
"I still don't like the idea of you being the one to go. If you had any problems, you'd be pretty far from Leahy." Mary Pat looked uneasy but Beulah could tell she was thinking now, not just reacting protectively.
"That's part of the reason I'm not proposing leaving right away. I'll be here for several weeks and I'll rest up." Seeing the varying degrees of open skepticism on the faces off the other four, she decided to change the topic. "I know it isn't what we'd planned but if we delay opening the revised programs, I think the downside is offset by a couple of things. For one, we all get some of the pressure taken off. We also get more time to prepare and we'll be more ready if we have the curriculum set up and the faculty and med students have a chance to get more up to speed."
"If we switch the students and faculty between here and Jena say, the end of March, that would give us the summer to polish up the curriculum," Werner said thoughtfully.
"We should be able to take in more students than we'd originally planned." Beulah said. "That should help offset the delay. I'm also concerned that right now, all of our medical personnel are pretty much here in Grantville. Granted, we have a few elsewhere but not many."
James followed her train of thought immediately. "We aren't at risk of too many battles in the near future here in Grantville but if there is an epidemic, we could be in trouble."
There was silence except for the crackling of the fire for a few moments while everyone thought about the implications of the changes she was proposing. Beulah looked contentedly at the fire. She loved a nice fire on a cold, snowy day like today.
"There's another thing I've been thinking about. We have a very diverse student body, to use the up-time phrase." Beulah took a sip of her coffee, savoring the taste. Although it was very weak, this was the first cup they'd let her have. All her protestations that coffee could be considered a clear liquid too had gotten her precisely nowhere in the hospital. "Let me give you a couple of examples. Fritz is literate and by the time the classes start, he'll have completed the LPN training and have a little experience at that level. His formal education before coming to Grantville was fairly minimal, though, because his family needed him in the bakery."
"Ah. The reverse will be an issue as well for the up-timers," Johann chimed in. "While they have stronger math and science backgrounds than any of us, they will need preparation for our type of university education."
Mary Pat nodded. "We've also got a wide array of experience and education for those who'll be going into the MD and RN programs, not just the fact that some will be up-timers and some down-timers."
Werner nodded as well. "For the medical students and faculty, most of us will need fairly standardized content. We all need to know similar basics. For the incoming students it will be different. If we can get them better prepared now, on—what is the phrase—a more even playing field, then things should go more smoothly and the students will be better able to learn."
"I think this is the best idea I've had in a long time. This will solve a lot of problems. Granted, it isn't what we'd originally planned but this way, we'll be able to enroll a lot more students in the fall and be able to teach them better, too."
"Here, let me get that." Mary Pat took the sweater from Beulah's hands and folded it herself. "Are you sure this is a good idea? You've only been out of the hospital for a month now. Why don't you sit down a minute?"
Beulah obediently sat on the edge of her bed. Mary Pat was still not too sure about Beulah moving to Jena for months on end away from Leahy and James' eagle eye. And hers, of course. If sitting on the bed for a few minutes and letting her help pack eased her mind a bit, Beulah was willing to let her do it.
Mary Pat made one final, rather weak attempt at a protest. "I still don't think you should be the one to go. I could go instead. Or maybe Balthazar could go. It's slow season for spies, isn't it?"
"Actually, I think it's heavy duty plotting season for spies. I'll be counting on you, Balthazar, Starr, and James to get the ones staying here ready, including your three trauma junkies."
Mary Pat reached into Beulah's closet for another sweater to fold and pack. The bright yellow thing was a going-away gift from Garnet. Beulah had no idea where she'd found thread dyed that vivid a shade to knit the sweater and matching mittens. Much less the time.
"I have to admit, I was pretty surprise by Dean Gerhardt's idea about the high school classes. I wouldn't have thought they'd have gone for something like that," Mary Pat said.
It had been Johann's suggestion that selected faculty and students from the other schools plus half the med school students and Phillip take the basic science and math classes at the high school with the high school students. Beulah hadn't been too sure about shifting their problem onto the already busy high school teachers but they'd kept it down enough that there were only three or four more students in each class. Some of them were taking junior high classes too. They were still hitting the books at night in some adult education-style classes. Between that and the clinical time, there was barely time for the Jenaites to sleep but it didn't seem to faze them a bit.
They'd figured out who would be enrolled for MD or RN school in the fall and were designing specific plans for each of them to help them prepare. All the texts were going to be translated into English or German. Skipping the Latin had been a compromise for the Jenaites. In exchange, the students would be getting enough astronomy to squeak through any discussion with outsiders but most of the physics would be health related.
"Johann's a very practical sort. I'm looking forward to staying with him and his family in Jena."
"I'd rather you were staying with Werner, Willi, or Kunz."
"So they can keep a better eye on me? Don't worry. I'd imagine there isn't anyone in Jena by now who doesn't have watch Beulah duty. I probably won't even be able to lift a textbook off a shelf by myself." Beulah carefully didn't share her suspicion that Johann might have an ulterior motive for having her stay with them. After all, it had also been Johann who had suggested that Gary Lambert come show them all how to set up a medical records system for the clinic and model public health department. Johann had taken a strong liking to Gary. The fact that he had an unattached daughter about Gary's age had nothing to do with it. Yeah, right.
"I'll be seeing Werner, Kunz, and Willi almost every day while we work on the curricula and the public health project. I have no doubt that between the three of them and the students, they'll hover just as much as even you could want."
The public health project had come out of her discussions with Werner, Kunz, Georg, and Balthazar. They were going to have people from Magdeburg and other towns come as well to see them set up a more modern public health system in Jena. Jena would be the model for other places in the USE, which pleased the Jenaites enormously. In addition to helping disseminate infection control and sanitation methods, it would be teaching the students. She'd spoken to the mayor of Jena last week. He was thrilled with the idea. It was going a long way to repair some of the damage done by the last visit. He was also happy to be getting most of the town's medical community back at last. The town should be seeing an influx of more university students soon, which didn't hurt a bit either. Jena's economic picture was continuing to improve, and the mayor and town fathers were happy campers again.
"I'd like you to do a couple of other things while I'm gone." At Mary Pat's curious look and nod, she went on. "Keep an eye on Fritz for me. He loves what he's doing and is too apt to study and work without sleeping or eating. With all the pressure he's feeling as the first member of his family to go to university and being one of the down-timers admitted to the RN program, he may go a little overboard."
"Ah. In other words, make sure he doesn't follow in his role model's footsteps and wind up collapsed and rushed to the hospital."
"You're never going to let me live that down, are you? But, yes, that's basically it. Also, I want you to keep an eye on Hayes. I've asked him to drop by with the occasional meal using the excuse that I don't want you to be lonely with me gone."
"You're worried about him, too."
"He isn't looking too good. I hate to go behind his back like this but if he thinks he's helping you out, he may actually slow down a bit and take better care of himself."
"Gotcha. It certainly won't be hard to put up with the man's cooking. He's got a real gift there. I'll be happy to look out for both of them for you."
The sad part, Beulah thought, was that she didn't feel one bit guilty for playing matchmaker. Mary Pat needed a nice, reliable, smart guy. Hayes fit the bill beautifully. Besides, Mary Pat was, at best, a mediocre cook. At least they wouldn't starve if they got together.
"There's still a lot to do to get ready for fall, but I think we're going to be able, not just to pull something together, but to do it really well. I think that's everything I need. Let's get these bags downstairs. I can't wait to get started." A recharged Beulah reached for the smallest bag, already wondering what she'd find in Jena this time.