Doc's Dilemma

Chapter 3

Being the only physician within a hundred miles or more, Galen Adams rarely had the opportunity to sit and discus the latest surgical techniques, medical papers or even the weather with others of his profession. His position made him privy to many secrets that haunted some of Ford County's notable inhabitants, but they were for him alone to know. He would never divulge things he learned during the course of his professional services, even though sometimes it was difficult to decide what was best for the common good. Some things, like bullet wounds and certain infectious diseases, he was legally bound to report to the Marshal, that line was very clearly drawn but there were always cases that blurred the line a little and then it became a tough decision for him to make. Somehow the knowledge that came along with his profession set him apart from others and isolated him in his own world, burdened with his own thoughts.

The oil lamp sitting on the top of his desk gave a yellowish glow to the journal he was reading. So many of the papers he read interested him, but had nothing at all to do with most of what his work consisted of. Take the man in the next room for instance. He had been there for 3 days now. There was nothing in this journal about removing bullets embedded so tightly to the lung, nor anything in the two previous editions he had read either. According to the only paper he could find on the subject, the man in the next room should have stopped breathing several hours ago. There wasn't even anything new regarding medication for controlling fever. He needed something because everything he had tried so far had failed. He had written several letters to surgeons and physicians he knew in some of the more prestigious medical centers back east, just in case there was some new technique or medicine that he was not aware of. He didn't hold out much hope for positive replies, but would leave no stone unturned.

The onus was squarely on his shoulders now and there was no one he could turn to for help. He was at the top of the pyramid trying to give support and comfort to everyone else, but keeping the hard truth to himself. If this patient died it was solely his responsibility, he would be the one to accept the blame. The fact was that this man meant more to him than a patient who just needed his skills, this was his one true friend. They always said physicians should not treat family, ostensibly for the good of the patient, but that worked both ways. It was always bad to lose a patient, but to lose a friend – that was far worse.

He heard noises from the other room. They were getting louder,

"Doc!" He was being called. "Doc, I think I need some help here."

The big man had been very restless; his fever was rising despite the cool cloths and, when available, the ice packs they had been using.

Adams got up wearily from his desk. He had hardly closed his eyes during the previous seventy-two hours and sleep had certainly not come his way. As a result he knew he was not as alert as he should be.

Kitty was still where she had been ever since they brought him in. Day and night she had stayed by the bed where Matt Dillon was lying, refusing to leave despite the physicians orders and cajoling. He knew she hadn't slept much either.

He opened the door quietly. She was sitting on the bed, one elegantly manicured hand was encompassing the big calloused palm of the Marshal. In the other hand she held a cloth stained with red.

"Doc?" she looked up at him holding the blood stain so he could see it. "This isn't right is it?"

"What happened?" Doc asked already knowing the answer.

"He had a coughing spell and then this." She raised the blood stained cloth once more to show him, but he had seen it already and his stomach suddenly felt as if it would rise into his throat.

Her blue eyes were looking straight at him, begging for assurance that all would be well. He could see the shadows under her eyes and the redness where she had been crying.

"It's to be expected, Kitty," he managed to say, "we just don't know what kind of damage that bullet did."

He reached for his stethoscope that had been left lying on the small table by the window. It wasn't going to tell him anything new, but doing something was better than standing uselessly by.

He sat gently on the far side of the bed from her and felt for the marshal's other wrist. Opening his pocket watch he counted the rhythm of the man's pulse. Even after everything the man had been through, its beat was reasonably strong and regular. He replaced the watch in its usual resting place and using his fingers gently percussed the man's chest. Amazingly both sides were still resonant except for an area at the base of the left lung. He thought there was a small amount of fluid there but tried to ignore it and keep the hope alive that the lung had only been bruised and not punctured by the bullet he had painstakingly extracted.

He placed the stethoscope in his ears and listened. There were good breath sounds on the right, but as expected, at the left base he heard very little air entry. Fortunately the man could breath well enough. There was sufficient functioning lung for that as long as pneumonia didn't set in.

"Well Doc?" Kitty's question brought him back from his thoughts, "how is he?" Her voice was demanding an answer.

He folded his stethoscope and returned it to the table before pulling on his ear and trying to think of the best way to deliver news that was neither good nor bad.

"Kitty I really don't know what to tell you. Most of his lung is working fine, he still has some fever, but right now he is as good as we can hope for. He lost a lot of blood and that was a bad place to take a bullet. The lung is bruised and he may cough up a little blood from time to time. All we can do is to keep him as quiet as possible and let him heal."

"Is he going to be all right Doc?" She dared to ask the question that haunted her mind night and day.

"I don't know the answer to that yet Kitty. You know I'll do everything I can."

"I know Doc." Her shoulders slumped and she turned her face to hide the salty wetness in her eyes. He reached over and put his arm around her shoulders. It was as if the strength suddenly drained out of her, tears began rolling down her cheeks and he held her closer trying to give a little comfort. It was the only thing left that he could do. After a minute or two he spoke quietly to her.

"You need to go home and eat something then get some sleep. I'll stay with him tonight."

She tried to object but knew he was right. Exhaustion was setting in and explained why she was so emotional.

He led her, still with one arm around her shoulders, away from the bedside and into the outer office. Opening the glass door of the medicine cabinet he removed a small envelope containing a measured dose of powder and handed it to her.

"I want you to take this when you get home, Kitty, it will help you sleep. I don't want any argument from you either. Matt is going to need you when he wakes up and you need to be ready for that with all your strength." He eased her towards the outer door and opened it, ready to help her down the stairs. He saw Mr. Jonas going by and called to him.

"Hey Jonas," the man looked up. "Would you walk Kitty back to the Long Branch please?"

Jonas knew what was going on and hurried up the stairs, looking from Doc to Kitty trying to see any news in their eyes. Finally he asked.

"How is he Doc?"

"He's stable right now, we still have to wait and see."
Jonas nodded knowingly as he took Kitty's arm. At first she was unwilling to leave.

"Go on now Kitty, I want you to get some rest. I promise I'll call you if anything changes."
Reluctantly she allowed herself to be escorted down the stairs and along Front Street.

Jonas was not much good with words but he tried.

"Doc's a good man Miss Kitty and if anyone can pull him through, Doc can do it."

She dabbed at her eyes with the corner of a lace handkerchief, trying to hide her tears before entering the saloon. It would not be good for the whole town to see her distress.

"Thank you Mr. Jonas, I'll be all right now."

As she entered the Long Branch, all heads turned towards her. Calls of "How is he Miss Kitty?" and "Is the Marshal going to be all right?" greeted her. She smiled, appreciating all their concern.
"Doc says he doesn't know much right now, " she told them as she steadied herself before climbing the stairs. Her room would be a very cold, lonely place.

"Can I get you anything Miss Kitty," Sam called after her as she slowly mounted the stairs.

Really all she wanted was to feel Matt's strong steady arms around her. She wanted Doc to tell her that he was going to be fine and good as new in a few days. She wanted the lawman to be safe so that she didn't have to worry about him day after day, but Sam had no influence over any of these things.

"No thanks Sam. I'm going to try and get some sleep. If you lock up for me before you leave, that would be good."

xxx

Doc counted his patient's pulse one more time before lighting the single oil lamp on the small table in front of the window. He replaced the glass chimney and adjusted the wick to where its flickering light would be just enough to allow him to check on his friend from time to time. He pulled the old rocking chair up to the bed and lowered himself into it. The window had been left open on purpose to let the cooler night air in. He had hoped it would help reduce the men's fever but the result was that now the room was cold and he needed a way to keep himself warm. He reached for an old patchwork quilt that some grateful patient had made for him a long time ago, so long ago that the patterns and colors had all faded into an unrecognizable grey, but it would serve to keep the cold from his tired body. He carefully tucked it in around himself as he tried to settle in for the night, knowing from experience that there was no way to sleep comfortably in this old chair, but maybe he could doze a little. His patient's condition would not allow much more than that anyway.

xxx

Adams could tell that several hours had passed and they were now well into the night. A few lamps out on Front Street were still burning but the saloons had closed down and except for the occasional straggler stumbling along the boardwalk, there were hardly any sounds coming from outside. These hours were hardest on any physician with a sick patient, if things were going to go bad this was so often the time when it would happen. In these small hours of the night, fevers could rise without warning and carefully sutured wounds could suddenly burst open. It was at such times that he really felt alone. There was no one else around, all the responsibility was his and if his knowledge was not sufficient, his friend would die. Those were the cold hard facts of medicine.

Over the years he had sat many nights, sometimes with a sick child, or a woman in labor, even an old farmer or two who was ready to give up the perpetual struggle of trying to eke a living from the cruel prairie. Some of those patients had lived and some died, but every one of them left a mark on his soul. Maybe if he had just had a little more knowledge or a little more skill in his hands, more would have lived. He pulled the old quilt a little closer against the cold and thought back on the many times he had sat with this particular man, a man who for some reason had dedicated his life to bringing law and order to the new frontier. They had a lot in common, the physician and the lawman. Both were isolated from other men by the profession they chose to serve.

Doc didn't know much about Matt Dillon's past or understand what it was that drove him on with such purpose. He only knew that there was something in the man that would not let him rest until he had righted every wrong in the world - or at least in Kansas. Doc had sat in this very chair watching over the tall, young Marshal as he recovered from gunshot wounds, beatings, fevers or just plain exhaustion, on many previous occasions, but tonight was different. From everything he had read the man would not recover from this particular wound, it had been too deep into the chest, too close to the lung, and too much blood had been lost. Even so, he would not give up trying. He knew Matt would not give up either, and certainly Kitty would be right there beside him no matter how bleak the outlook. But what about Dodge City? So many people here looked on Marshal Dillon as their source of security and protection. He was the one who chased down bank robbers and prevented gunslingers taking over the town. He was the one who always had an answer and always stood on the side of the law. All those people expected him, Dr. Galen Adams, to work a miracle yet again and put this man with a badge back together so that he could watch over Front Street once more.

In these dark hours before dawn the physician felt helpless and even afraid. There was no one for him to turn to for support, no one to say "let me take over for a while", or "maybe we could try this or do that," something he didn't know or hadn't thought of. If the Angel of Death was to come in these hours he was the only one here to fight the battle, and he knew that his weapons were so very limited. One day he was sure they would have the means to treat all the infections that plagued his patients, a medicine that would lower fever and allow wounds to heal. There would be surgical techniques of which he knew nothing so that damage to vital organs could be repaired, but those times had not come yet. All he could do was sit and wait and hope the Angel didn't come tonight.

A guttural groan dispelled his half dream and pulled him sharply back to the cold, poorly lit room.

"Matt?" he questioned as he leaned over the bed. "Matt it's Doc, can you hear me?"

The answer wasn't clear. The man on the bed made an effort to lift an arm and turn his head, but the movements were very slight and seemingly random.

The physician in him took over, falling back on the familiar routine of checking temperature by placing a hand on the forehead and the pulse by feeling for a wrist. There wasn't much change, the patient was still warm to the touch, maybe a little cooler than before but the temperature in the room was quite cold now so it was difficult to judge. Amazingly the heart rate was still going strong, a little fast maybe but almost regular. He picked up the stethoscope once more and plugged it in his ears. The right lung was remained clear, the left still not working fully.

"Matt?" He tried again. Maybe a little more focused look came into the blue eyes. He watched as the head tuned haltingly towards him, the searching eyes desperately trying to locate something familiar to lock on to. "Matt it's Doc," he tried again, his voice more gentle, the friend in him speaking now.

The lips were too parched and the tongue dry, he couldn't expect much of an answer. Reaching for a cloth he dampened it in a bowl of clean water and gently moistened the dry mouth. Friend or physician? Both were playing their part. He tried once more to separate those sides of himself. He hated to admit it, but the physician had little to offer and the friend could only offer comfort and reassurance. He could tell that his patient was trying to be coherent, but there was little he could do to help him.

"It's Doc," he said once more, softly, trying to give the man an anchor, something for his mind to focus on.

Slowly the face that had become so gaunt and pallid during the last few days, turned towards him. The lips and tongue struggled to co ordinate their movements until finally a sound was produced, barely audible, but certainly there.
"Doc." almost a whisper but a triumph never the less.

"Yes Matt, it's Doc." The man was trying to say something else, but the words wouldn't form. The friend in him took a guess. "Kitty's fine, I just sent her home to get some rest, she'll be back soon." The man relaxed a little. The hot whips of fever where still thrashing around in his mind, but he seemed to understand those words - or maybe just that one word; 'Kitty'. There was a bond between his two friends, a bond of love, acceptance and understanding. The friend in Adams had hoped that the Marshal would give up that tin badge and marry the woman who loved him so deeply. He knew the love was reciprocated but the drive of the badge got in the way. Maybe after this, assuming his friend survived, he would think twice before putting that piece of metal back on his shirt.

Dillon was trying to sit up now, his movements still not coordinated but the intention was obvious. Doc, the physician, leaned over and pushed the shoulders gently back down to the pillows.

"You need to be very still Matt, don't try to move."
The pressure from the physician's hands didn't stop the weak struggle.

"Gotta get.. gotta get.." Still something was driving the man to raise his head.

"There's nothing you gotta do Matt, I just took a bullet out of your chest and you need to lie very still and not mess up my handiwork."

The exertion brought on a coughing spell followed by a small trickle of blood at the corner of the dry mouth. The doctor in him watched, hoping it would not be more, the friend tried to convince himself that was to be expected, just some bruising, it would stop soon. With the ease of practice he wiped the blood away and reached for a small glass of water sitting on the bedside table.

"Here Matt, let's see if you can drink a little." He slid one hand under the damp fevered head and with the other touched the glass to the pale lips. A couple of sips, that was all he managed, but it was a start.

Doc sank back in his chair and pulled the quilt around himself once more. The room was quite cold now and he almost shivered. It wasn't only the temperature that caused the sense of unease he felt. The man lying there was the closest friend he had. If he should lose him he would become even more isolated. Kitty was a good friend too, more than a friend in fact- almost a daughter, but that was a very different relationship. Matt was a friend he could play a game of checkers or pool with, drink a beer with. Most of all he was a friend he could confide in or discuss a problem with and know the conversation would go no further.

The Marshal's friendship went further than that and Doc knew it. Matt would protect the physician with his life if necessary, and not as he joked, just because the doctor was a valued commodity to the town. He did it out of caring for his fellow man. In that respect the two men had a lot in common.

The Marshal thought nothing of riding out with he Doctor if he had to go visit a patient in a situation that could be dangerous. There was that time when old man Pitcher sent his boy out to get him. Doc didn't even have to ask, his friend the Marshal was right there. He remembered like it was yesterday, being there in old man Pitcher's barn. He was so angry because the man had brought him all the way from town to attend his sick cow. The man didn't even keep his barn clean, he could still smell the stale cow dung and urine. How could anyone expect the animal to flourish in such conditions? Matt was there telling him to calm down, to get back in the buggy and leave, but the boy had returned and said how everyone in Dodge was looking for him. A woman had cut herself badly and bled to death because he wasn't there. He had been out at Pitcher's place tending a sick cow! The anger rose in him just thinking about it. He couldn't help it, he wanted to hurt Pitcher, the woman had died and that would be on his conscience forever. If he had been in town he could have stopped the bleeding and she would have lived. Pitcher was coming at him with a knife. He felt it slide beneath his ribs. Blood started to flow. Matt was there for him. The Marshal didn't want to do the surgery, he had been scared at first and reluctant to try. His large toughened hands were not cut out for such delicate work, but somehow he managed to complete the grisly task and Doc had survived. Doc relived those moments in Pitcher's cabin. He remembered the pain and the fear. He would have bled to death if Matt hadn't had the courage to try. (1)

He shook his head. Matt was a man who asked very little in return for his unquestioning friendship, not that Doc had anything much to give - only the benefit of his medical skills and goodness knows Dillon had needed those often enough. He hoped to goodness they would be enough this time.

His patient had grown quiet again and Doc rested his head back on the pillow behind him. Maybe he could close his eyes for a few minutes. His mind wouldn't rest, he went over and over everything he had done to try to save this man's life. Maybe he had overlooked something but if he had he didn't know what it was.

He was back in the cabin just outside of town with Jed Butler. His partner was wounded and he had taken Doc out there to tend him, threatening to kill the physician if the man died. Doc knew the man would not live and resigned himself to dying at the hands of the man called Butler. Then at the last minute there was a knock on the door. Matt had entered the cabin unarmed, hands in the air, willing to give his own life to save Doc. (2) "Greater love hath no man," the physician had quoted at the time, that was what made Dillon so unique, that soft quiet love, a concern for fellow man. This was a man with unusual strength and determination who devoted his life to upholding the law and caring about his friends. Now that same life was in Doc Adam's hands, hanging in a balance he alone controlled. He hated the burden but knew he owed this man much and he would see it through.

1 Cow Doctor season 2

2 Greater Love season 2

TBC