The Psychologist's Patient
(1) Imbecile: correct medical term of time period to describe the mentally impaired.
(2) Three divisions of legitimate medical groups: Royal College of Physicians, Royal College of Surgeons, and Society of Apothecaries.
When I look back on Holmes's prolific case histories, there are just a few peculiar instances where there Holmes dealt justice in his own peculiar way that was fairer than any English court with his unbreakable silence. This particular case came our way from the most shocking medical surgery I had ever seen. Yet, it was one of those heart-rending stories that reaffirmed my beliefs in humanity after such despicable crimes as Black Peter and the Sign of Four.
I was enjoying one of my last evenings as a free bachelor gazing out into the bustling quiet of the street below. I was to be married within a fortnight and no man could be happier. My heart was carried away forever with my Mary and I could only hope when we finally began our lives together I would be able to make her as happy as she has made me.
The bell rang rather rudely and the image of my smiling Mary disappeared from my mind like soft petals caught in a swift wind. So much for my dreaming. Few of my acquaintances would call at such an hour, so I supposed our visitor might be yet another lost soul seeking repose in his haunted existence.
For once the client did not come alone. Mrs. Hudson let in a thin elderly gentleman and a bent over adolescent boy with a stock of fair hair who walked with flat feet turned inward. They were a little weather stained from that peculiar London weather. There was nothing astonishing about the gentleman. He wore a plain starched shirt with ink-stained cuffs beneath a tan linen jacket. He had the bearing of an efficient society figure but the kindly look in his eyes betrayed a compassionate and worrying nature.
The boy he kept close at his side was clearly an imbecile (1). His wide eyes rolled in his head looking at everything but remembering nothing. His fixed childish smile seemed strange on an older face, but one couldn't help but feel pity for one so helpless. It was through no fault of his that he was made to carry such a burden. I could not quite place his age, but he was probably more than twenty years old although this immature manner initially led me to believe he was much younger. He had a remarkably handsome face. It was well-formed with an aristocratically curved nose and just rounded enough around the edges to demonstrate his innocence. Large blue eyes penetrated mine and seemed to sympathize with my disappointment at being away from Mary. This boy seemed to be so much more aware of the world than the psychologist he stood next to, but his retardation would dispel all initial impressions of this.
"Why hello, I'm Sherlock Holmes and this is my good friend Dr. Watson. How may I help you?"
"Good day, my name is Dr. Warner and this is my patient Harold Cole. We are here to seek the advice of you and Dr. Watson, if you don't mind. Mrs. Cecil Forrester told me of your immense powers of solving curiosities as well as Dr. Watson's extensive medical knowledge."
This was recited impatiently by a man accustomed more to listening to the misfortunes of others than expressing his own. It was clear he was agitated by some terrible occurrence concerning his patient when he draped a protective arm over his companion's shoulders. In response, Harold looked at his caretaker with sad yet confused eyes cocking his head to one side, incomprehensible of the situation.
Pray take a seat, you must surely be tried from your long journey from Guildford, doctor," said Holmes cordially with his eyes glinting anxiously as he offered the doctor a stuffed armchair and the boy the lounge chaise facing the window.
"Why I don't believe I've ever met you before. Mr. Holmes, yet you can already tell I am a doctor and that we had spent the entire morning traveling. Please don't tell me, the news I bring you has already reached your ears? This will be a disgrace to the institution!"
"Come, come. I've heard of no such thing. I observed that you used a fountain pen to copy from a public map the streets leading to my doorstep. The first direction is Serway Street which you followed to Jewett and so on. This means you took a long distance mode of transportation up to Serway. Serway is only two short blocks from the popular Signet Dock for steam launch ferries going between main towns along the Thames River and London. The two of you have also bought in the distinctive scents of the Thames into my stuffy adobe. In that direction, I known there is an asylum for the mentally disabled in Guildford. You are obviously a learned man and a doctor that specializes in psychoanalysis. I can tell because you have not studied my person for physical illness, but have focused your energies on analyzing my speech and behavior, besides your hands lack the dexterity and calluses homogenous to surgeons."
Dr. Warner was taken aback by Holmes' simple deductions, but quickly recovered this composure.
"Now that you explain it, it was all simple enough. You are just the man I need, Mr. Holmes. In my profession, I value patient discretion quite highly. Am I able to trust you and Dr. Watson to keep secret what I am about to say?"
"You have our confidence, not a word will be repeated unless required to do so."
"Very well."
"Please begin your story from the very beginning with all details."
"I am one of the three psychologists at the Guildford Institution. It is a privileged institution for the mentally disabled. Our patients are usually from wealthy families who desire the best care for their unfortunate relatives as well as the assurance their reputations are protected from public embarrassment.
"I graduated from Cambridge with my doctorate and was soon taken up by Guildford three years ago. I usually see my patients privately once a week to assess their progress and make sure they are doing well. Harold Cole has only been my patient for this past year. His previous doctor passed away from old age. From his records, he entered the institution at the age of eight and has lived there exclusively since then. His family felt they could no longer care for him without taking away his freedom and causing embarrassment to themselves. He is now seventeen years old. He was not born as you see him. At three years of age, he suffered from scarlet fever and never recovered. It took his mind and what little speech he had learned. As you can see he has the mental acuity of a small child. Not only that, he has a growing tumor in his neck near the carotid arteries. We are not sure if it is cancerous, but I fear for the worst. From my experience, children with disabilities and childhood illnesses rarely survive into adulthood despite all efforts.
"Harold cannot recall events clearly nor express himself with words, although he can understand simple words and meanings. He can remember people he sees regularly, such as me and the nurses at the institution. Unlike the other children however I've noticed, he does not become frustrated or throw temper tantrums. Psychologically, I believe Harold understands more than he lets on. Despite his retardation, He understands his restraints. Instead of rebelling against themselves as all children do, Harold always tries to do whatever he can to progress even though he knows the letters he learned today will be forgotten the next day. When he knows there is something he can do, he does it. He tries his best to help others in his own selfless way.
"It is because of this, I believe we are here today. Our mystery has already been dismissed by the local police and doctors as a trivial matter. Something to me simply doesn't feel quite right.
"More than a month ago, on the twenty-third of August, Harold disappeared and reappeared thirty-five days later. Of course there was a full investigation from the start. On the twenty-third of August, Harold was last seen in the yard at 2 P.M. His usual routine is breakfast at seven, classes with a lunch break from eight to two, then recreation such as outdoor games, with the other patients in the pediatric department until dinner at seven. He is to be in bed by nine in the evening. For the protection of the children, they are collectively overseen by two experienced nurses at a time. His absence was immediately noticed and staff went about the grounds looking for him. No trace of him could be found. The police were called and a blockade of the main road was set up, each passing traveler was questioned, and a search of the immediate vicinity done. The searched extended into the city but was still unsuccessful. At the time, I was attending the Annual Psychology Conference away in Dover.
"Then just as suddenly as he had disappeared, he reappeared at the gates on the very early morning of September 27th about 6 A.M. according to the nurse who saw him. No one could account for how this. The only road leading to the institution gates are covered with gravel and it hadn't rained in quite some time. He wore the same attire he disappeared in. He was well-fed and clean. His face was ruddy from the morning chill and seemed excited to be back at the institution with the people was familiar with. I could ascertain no change in his behavior. He was the same affectionate child. However, it was only at the end of the day when a nurse went to bathe him that a previously nonexistent scar on his left side was finally noticed. Allow me to show you. It's not very obvious, I'm afraid."
Dr. Warner went over to his patient and made him pull up his shirt to expose the fleshy torso and made him lie on this right side on the couch. True enough, there was a scar on the boy's left side that followed the edge of the lowest rib slanting towards the midline. It was perhaps six inches in length and as thin as a shoelace. The cut had healed long ago and all that was left was a pink colored scar. By looking at the remaining scar, the initial cut was probably a superficial cut that had been well taken care of. It did not look out of the ordinary for an adolescent child to get scrapes or bruises.
"May I examine him, Dr. Warner?" asked Holmes.
"Yes, of course, that is why I bought him. And if you wouldn't mind Dr. Watson, I would prefer another medical opinion."
We crowded over the boy who seemed neither frightened nor amused. He had no doubt undergone several examinations of this kind already. Holmes took out his magnifying glass and began his meticulous scrutiny of the entire body, especially the boy's hands and mouth. He was like a violin luthier examining every curved piece trying to pick up every imperfection. The boy took to my friend uneasily at first until Holmes offered him a piece of chocolate. Holmes was so absorbed in his work, taking tissue samples or something with forceps, that he did not notice the boy pick up his gold snuffbox with the large jewel in the center and gaze mesmerized at its workmanship and beauty.
"I am no medical doctor," continued the doctor, "but the medical examinations completely by the police and institution doctors were unanimous: the scar came from a minor cut. Harold himself has already been interrogated many times and he cannot remember anything nor give any indication of anything. The police concluded and ultimately reported that Harold left and returned to the institution of his own accord with a minor cut.
"From beginning to end, the small Guilford police could make nothing of it. They have evidently dismissed the case as normality among mental institutions. Despite our efforts, one or two patients of the adult ward annually escape. Since Guildford is easily accessible to London, about two or three days walk, those patients are rarely seen again, but children have always been a different matter. No child has ever escaped; they prefer our quiet institution to the city's chaos.
"Several points simply do not fit. As Harold's doctor, I know he wouldn't leave the institution; he is far too attached to it. He usually abhors strangers. No psychological change, as far as I can tell, has come over him. And yet, there is that scar. I don't care what those doctors say, that scar simply isn't typical. What am I supposed to do? I can't just ignore –."
"Ah-choo!" Harold sneezed.
He had finally spilled the snuffbox sending up a small plume of particles. But sneezing obviously pained him greatly. He clutched at his scar and started gasping for air. Tears came to his eyes as he looked imploringly towards his doctor for help. The doctor opened windows and called for a glass of water. When none of our efforts worked, Holmes went quickly into his laboratory and came back with a syringe.
"With your permission Doctor, may I give him an analgesic pain killer? This is weak opium-derivative codeine," asked Holmes.
The psychologist looked at me questionably.
"Why does he need a pain killer when he's showing asthmatic symptoms?" I asked, alarmed that Holmes would use his own evil medications on an innocent boy.
"Because he isn't showing asthmatic symptoms. I'll answer your questions after I take care of this," Holmes replied as he expertly injected the boy in the arm.
After the medication had calmed the boy down, Holmes said, "Now, I have some questions for you, doctor. Do you suspect foul play from one of your coworkers?"
"No. That has already been established by the police. The institution only caters to fifty-one patients, so our staff of twenty-three had firm alibis. I understand you would suspect wrongdoing or negligence by the caretakers of the mentally disabled, but Dr. Massenet, the president of the institution, has a son as a patient there and so takes considerable care in monitoring the staff and everything."
"Does Harold have any visitors?"
"I have never met his parents, Mr. and Mrs. Jonathan Cole, but apparently they visited him when he was young but the father died in an accident and his wife followed soon after of some terminal illness several years ago. Since then Harold only has a married sister who visits him from London on occasion with her husband, perhaps twenty or more times a year. She is the only one. And she takes care of his costs. She visited him three weeks before his disappearance and immediately after he returned. The news of the investigation made her quite ill and she took to bed soon after giving her statement to the police. Mrs. Angela Norwood is an angel of a woman. Her visits always seem to brighten the sobriety of the school. She is very attached to her brother. I believe she returned from American not long ago. Perhaps two or three years ago. Her present address is 32 Parsol Street."
"And in the time before Harold disappeared, what was his overall health?"
"As I said before he has a tumor that may someday constrict his breathing, but bodily he is fine. He is able to exercise and recover from colds and such like any other child his age. Currently he is doing well."
"That's all, thank you doctor," said Holmes with his brows knitted, "You may not be ready to hear this, but this is not just a kidnapping; no simple manipulation of Harold's good nature, as you suspected. It is a far more serious crime: Harold is missing his left kidney."
The impact of Holmes's conclusion was momentous. How could such a thing happen? Why would anyone remove a kidney? I looked at the same patient and saw no signs of major invasive surgery.
"Preposterous! Inconceivable! W—why it's just impossible! For one thing, it's not even possible!" cried Dr. Warner.
"Wrong. When you have eliminated all which is impossible, then whatever remains, however improbable, must be the truth. Do you see here with the magnifying glass doctor, the remains of some white filament in the scar? I have studied fabric thread intensively. It is one of the best indications of past locations. Threads cling to everything and are not easily gotten rid of. What you see is the remains of white silk."
Holmes showed the doctor a piece he had removed earlier. It looked no bigger than a dandelion seed, perfectly straight and white.
"The only thread that can withstand regular bathing and still remain relatively straight, unchanged, and strong is silk. Cotton or linen threads crumple or fray under such conditions which is why silk is ideal for medical sutures. We are lucky the stitches were removed by cutting one end of the stitch then removed all at once or we wouldn't have such evidence. Once again the scarlet thread in the colorless skein of life has appeared but white this time."
"But that's still impossible! Suturing is always done with an interrupted stitch, you would be able to see the scars of the needle marks," I said.
"That," said Holmes "is the beauty of this case, doctors. Watson, when Sir Leslie Oakshott patched me up from that run-in with Baron Gruner's thugs in the Illustrious Client case. I noticed him using the same technique. He told me it was a common maxillofacial suturing technique that could also be used on other parts of the body such as the abdomen. But only skilled surgeons are able to execute this particularly efficient stitch. There are needle marks, but there are only two. Watson, what do you think?"
"Well, I usually use the interrupted stitch, where the curved needle enters the skin perpendicularly and makes a semicircle under the skin through the incision and over the incision to the other side again, you would see two lines of dotted needle marks parallel to the incision."
"Precisely, Watson. Yet there are only two needle marks, nearly invisible. This is the classic maxillofacial surgeon's subcuticular suture technique. Instead of using a curved needle, a straight needle is inserted at the apex of the incision and run through the dermis of the skin. The suture was completed under the skin, but the needle ends went through the epidermis so the suturing thread could be removed when the incision healed. So you only see two small needle marks. A cosmetic effect, really. I've never seen a better suture."
There were indeed two very small needle marks at either end of the scar now that Holmes pointed them out, but barely visible than to be mistaken for normal skin pigmentations. The skin was perfectly flush on both sides. Usually on large surgical sutures you see kinks in the skin, yet there was none here. It had been an absolutely perfect stitch. How strange that an educated surgeon would remove a kidney from a mentally retarded child and take great pains to hide it. What purpose could have motivated this blatant violation of medicine's noble purposes?
"But how did you know the kidney was taken?" I asked.
"That was obvious; the only organ located beneath Harold's incision is the kidney. One can still live on a single kidney and Harold is still clearly alive. My suspicions were confirmed when he sneezed from the snuff. When the kidney was removed renal arteries and nerves had to have been severed. These nerves are proximal to the diaphragm. So while is he still healing, heavy breathing of any sort is rather painful. That is why he needed the codeine."
There was no hint of triumph or accomplishment on Holmes's face after such an explanation. I interpreted only the same feeling we all felt: shock and disgust that such a thing could happen. The psychologist had slumped into a chair and looked terribly agitated that the situation was more sinister than he had ever expected.
"Who—who would commit such an atrocity?" he asked.
After some time, Holmes replied, "someone who was desperate. As Horatio Nelson once said, 'Desperate affairs require desperate measure.' You had better leave this matter in my hands for now. I promise you I will find who did this to your patient. At the moment I think you had better take Harold back to the institution and make sure he is well rested. Tell absolutely no one about this. Do you understand, no one must know."
When the good doctor and his patient left, my friend gathered several encyclopedia volumes and began to study from them intently. Unfortunately I had pressing matter I had to attend to and did not speak to him again until late at night.
"Before a detective begins work on highly intellectual crime, must first have some understanding of the science involved. I studied physiology and medicine in college, but in my profession what the deuce is it to me that a man trips and breaks his arm unless there was deeper, malignant reason to harm him. In a medical emergency, I fancy I would know what to do, but the rest, I'd rather leave to the professionals, such as yourself, Watson. As you know, the tainted threads of life have always interested me more."
It seemed outrageous to me that Holmes would belittle the honorable medical profession. But the frightening thought of Holmes as a physician or surgeon held my tongue. Knowing him as long as I have, he would have no qualms in giving a trusting patient a bit of vegetable alkaloid to just find its effects. Perhaps people like him are probably better off retaining an unreasonable disdain for medicine. For the sake of humanity I shouldn't persuade him otherwise. I shook my head. With his talent, he could have contributed much to humanity through medicine.
I caught Holmes' eyes looking at me with quiet amusement from behind the top of the K volume.
"Since you left, I've been reading up on medicine. I prefer to analyze the clues with an unbiased perspective, so I haven't analyzed the clues yet. But I have some questions for a medical man, Watson."
"Then I am at your service."
"Good, but remember I haven't formed any theories yet. First, is it possible to transplant organs between two people?"
"Theoretically anything is possible. Indeed, organ failure is a large concern of medicine, and replacing or supplementing the damaged organ with a healthy one has been proposed. It has been tried many times with animals and people alike, but the organ was never accepted by the recipient's body. It was attacked by the body's own immune system after an hour or two of being transplanted. This isn't clear why, but the term is called 'biochemical barriers.' Recent studies have found that every cell presents specific surface proteins that are genetically unique to each person. Your body only recognizes its own proteins and the immune system destroys cells with foreign ones. So theoretically, transplant success pivots on whether you can manipulate the body to recognize these identifier proteins as its own."
"Very good, Watson."
"Say, you are suggesting the kidney was used for a transplant? Removing a kidney is extremely risky. In fact, I'm surprised Harold has not died from an infection or internal bleeding."
"On the contrary. The removal was completed by a top surgeon who took the utmost care. I don't believe Harold was ever in harm's way. This is a peculiar case isn't it? A possible scandal in high society and the latest medical crime."
"I don't find it very fascinating. This surgeon took advantage of a mentally disabled child and used his talents for wrong."
"Perhaps he felt he was justified. One cannot judge a man without all the facts."
"Will you go to Guildford then?"
"No, my first movement will be in London. We have a curious incident occurring before an even more curious incident. The simple-minded Guildford police made the mistake of focusing attention on the second incident, the disappearance, and dismissing it because he returned. But how could Harold alone elude the police for an entire month? He was obviously led away and bought back by the kidnapper, who decided beforehand he had to take a kidney belonging to Harold and no one else. The answer lies with his contact to the world: his London relatives, the Norwood household. Watson, could you look up the father, 'Jonathan Cole,' in the index? There must be something."
I went over to the bookshelf where he kept portfolio books carefully stocked with clippings on men and things. I found five miscellaneous clippings on Jonathan Cole.
"Let me see!" said Holmes. "These articles are three years old. Mr. Jonathan Cole, born 1823, old well-known aristocratic family in London. Fortune from investments in oriental trade and transport. Married Juliet Harrington, also a descent from Old Money, two children – quite so! Hosted one or two Charing Cross Hospital fundraiser event. Hum! Automobile accident during country vacation. Apparently unavoidable circumstances. Mud slide on a steep road. Just shows you the deplorable condition of roads in Sussex. There's nothing promising here on the late Mr. Cole. Mrs. Juliet Harrington Cole, beloved lady, recently widowed three months ago…from an undisclosed illness. The Cole fortune passes to her daughter, Angela Cole who currently resides in Boston, America.
"You'd think with how well sensational news sells, the paper would have at least found out what illness she died of."
Suddenly I saw my friend spring out of the chair with the most energy all day. He rushed into this bedroom and returned several minutes in the character of a young handsome stable groom with side-whiskers. His imitation was so complete, even I would not have been able to recognize him. The short jacket with the sash at the waist, high black collar, worn driving cap, and the affable manner, curious gaze, and broguish country speech were every bit the part of the role he had taken on. "I'll be back late tonight, Watson," he said.
I was too interested in this case not see it through, so I stayed up to await his return. He didn't return until eleven o'clock. He vanished again into his bedroom and emerged in his usual manner and dressing gown. Lying down on the couch with furrowed brows, he light his pipe with tobacco from the Persian slipper.
"This is one of the most peculiar cases I've ever taken on. And on one hand I would let the fellow go because he has not committed a crime, but eventually his moral justifications will lead to disaster. He is either the greatest surgeon of our time or just the luckiest."
"So it was a surgeon."
"No, a philosopher first, a doctor second. I did my rounds at the annual fair as a congenial bachelor and met several pretty, loquacious chambermaids to the Norwoods who told me quite a lot. The Norwoods moved back to the former Cole residence in London three years ago and are a very private couple who is adored by their employees and friends.
"'When I entered into their service three years ago, my mistress's health was never very strong and deteriorated very much so last month, but she usually keeps a busy social schedule nonetheless, charities, fundraisers, and such. Right now she has been confined to bed after a severe cold these past weeks. But she has never looked quite so healthy before, even says her physician, Dr. Clarkson, who was a friend of the master's in college. Her mother, Mrs. Cole, the sweet woman, died from an affliction of the kidneys, but since Mrs. Norwood has been looking so well lately, I don't believe the disease passed to her, thank goodness. Her husband really ought to let her move about by now. He is such a dear man.'
"The husband has been a physiology professor at Cambridge for two years. His ideas are most liberal, but is a quietly studious and kind man who dabbles in medicine for his wife's sake. Originally from London, he studied at Harvard and met his wife while pursuing his doctorate in physiology. No one could elaborate on what else he did while in America besides what he had told them."
"Do you believe it was Harold's sister who received his kidney?"
"No, I am absolutely sure of it."
"But their efforts are in vain! It cannot work!"
"But it did, which makes this case particularly singular. The only medical man mentioned was Dr. Clarkson. But he was only a physician and not a trained surgeon. Before I came home, I looked him up in the registry. He is a physician from Harvard, not a surgeon, least of all a surgeon capable of a transplantation.
"My investigations would have ended there, had not a jealous and heavily inebriated suitor of one of the chambermaids come up so suddenly from behind me in a crowd with a knife. To protect the unsuspecting woman behind me, I took a superficial slash to the forearm. The man was taken away by the authorities, but at nine o'clock the chambermaids decided there was no surgeon available to stitch my wound."
My dedicated friend unbuttoned his right cuff to show me a well-bandaged arm. I began to undo the high-quality linen bandages carefully.
"But a groom from the Norwood stable in the same bar recounted how the master, the professor, had stitched a serious facial cut a stable boy had received from a stubborn horse and one could hardly believe it had been there at all. At this hour they decided the master was still awake studying from his books and would be happy to assist me. Upon hearing this, I knew I had my man. I exaggerated my pain and the flow of blood from my arm helped this facade. The good stablehand helped me to the Norwood mansion.
"Dr. Norwood was a dark, handsome, and dashing man. He emanated a humble and benevolent nature with the thoughtful manner of a learned man. I knew immediately from his hands he was not just a professor of physiology, he was also our skilled surgeon. He introduced himself cordially enough and proceeded to examine my arm. He kept making the excuse that it was for the sake of his weak wife that he started learning the basics of medicine which began to interest him.
My friend's wound and stopped bleeding. It was a gash several inches long along the right ulnar bone. Indeed it was superficial, but at that particularly vascular spot it must have bled substantially. At times, I did believe Sherlock Holmes to be a medical anomaly. The stitch closed the wound from underneath the skin, characteristic of cosmetic surgery, not over, across, and under. Two well-tied knots at either end were the only evidence of a suture. I could tell by the shiny texture of the suturing thread that the thread was white silk. This was the same stitch performed on Harold Cole.
"Watson, I've never seen a surgeon work so expertly, not even Sir Leslie Oakshott. Dr. Norwood took extreme care in cleaning the wound and actually used the same stitching technique as we saw on Harold. Even though he used the same stitch, this doesn't automatically convict him and I gave him my word I would not tell the authorities that a man without a license to practice surgery had operated on me. I simply couldn't let the opportunity pass, so I questioned him knowing him to be a philosopher the justification of this deceit under the disguise of lazy conversation. My purpose was to find out how he felt compelled to illegally take the law into his own trained hands.
"'Some things would just never get completed with the restrictions of the law. Take this for example. If I decided to do things legally, you would have had to wait until tomorrow morning to receive these stitches. By then you might have already bled to death, and I did a proficient enough job of stitching. Therefore this was the best course of action. Besides you agreed to this little surgery and what is a little secret between friends anyways? Eh? Keep this clean. If the redness spreads past the wound and you're able to see foul-smelling green discharge, the wound has become infected. See a physician immediately. If not, in two weeks see a doctor to get these removed.'
"It was obviously his love for his wife that forced him to become a desperate man. Being so late, all the curtains had already been completely drawn, so I could not catch a glimpse of the wife. I thanked him and left knowing there was more to this man who justifies breaking the law for a greater good. What's more, in America he must have been a surgeon, and yet he has no license. The answer lies in America, which we will hopefully hear from tomorrow.
"No, there were still too many mysteries still unexplained, I could not take him then. There is nothing criminal about his man, only his flawed ethics. And yet, if I don't impress upon him the consequences of experimenting with new procedures, he may accidentally kill a man and even my silence cannot protect him from the law then."
I spent a sleepless night wondering how the moral judgments of such a skilled medical man could have been corrupted. His actions spoke for him: he acts only out of the interests of his patients. I doubt he cares what happens to himself. If he had succeeded with the transplantation by some innovative manipulation, he should be lauded as a medical genius. Yet he ought to go to prison for bad judgment in practicing medicine without a license and putting his patients in danger. But he has the skill. In fact, that makes him safer than most surgeons who practice with licenses. I supposed I had better wait until to tomorrow to understand more of his past.
On schedule, the fateful telegram from Boston arrived the next morning. When Holmes finished with it he tossed it with this wounded arm across the breakfast table to me. It read:
LAuRENCE BAXTER NORWOOD. English born. Parents dead. GRADUATED HARVARD MEDICAL SCHOOL 1870. Former Profession: General Surgeon at Massachusetts general hospital. ACCUSED OF murdering Gregory lewis via PHYSICIAN-ASSITED SUICIDE. ACQUITTED on lack of evidence. license to practice medicine revoked. Left America for England 24 June 1886.
BOSTON POLICE HEADQUARTERS
"Well this is the last piece of evidence, Watson," said Holmes. "Norwood was a surgeon and did lose his license. Physician-assisted suicide, the term falls outside my forte. Could you enlighten me?"
"Yes. I've heard of several instances in America these past years. There are several definitions of it, but a patient, usually terminally ill and in perpetual pain, decides to end his life. He has not the means, no access to medication nor the physical ability, so he turns to his caregiver. And the physician knowing the intent of the patient decides whether or not to fulfill that request."
"So Mr. Norwood had been presented with a question of medical ethics before and still gave in. But before we judge too harshly we shall hear the whole story from him. Will you be so good as to accompany me and see if the transplantation really was a success?"
The cab ride was not long and I soon found myself with my friend on the doorsteps of a small town mansion on Parsol Street not far from the University. It was beautifully furnished with a touch of American design. The morning sun streamed in through the windows unto a quiet and peaceful sitting room. It was a setting for self-reflection and inspiration, not the inquisitive investigation of a good man's selfless actions and weak morality.
We were shown into the surgeon's study. It was large and exactly like the sitting room but with taller windows, large tables in the center, and shelves overflowing with books. Open books, high power microscopes, surgical tools, and used leafs of foolscap were spread neatly throughout the room. I even spied a cello beside a chair in a sunny corner.
At the far end, the surgeon peered questionably at us. As we entered his refuge of science and disrupted his intellectual thoughts, he eagerly came around his desk to greet us. My first impression of him was that he reminded of Sherlock Holmes. His eyes were constantly alert watching and interpreting everything. This with the jutting chin, firm mouth, and furrowing eyebrows delineated a determined man who does not accept what life hands to him but takes destiny into his own hands and molds it answering to no one. Speaking of hands, they were most curious of all. They were the quickest and nimble ten digits I had ever seen. No wonder his vocation had been a surgeon. His hair was graying a little at the temples but he was as Holmes described, dark, handsome, and dashing. He could not have been more than in his mid-thirties.
"Hello, I am Dr. Norwood. How are you? Please, take a seat. I expected a visit from the two of you before long."
He had obviously been in America for a number of years. Even though his speech was that of an Englishman, Bostonian brashness and vocalizations had permeated it. He spoke with confidence, but it was marred by a hint of sadness.
"Yes, Dr. Norwood. My friend and I are here because of your involvement in the kidnapping Mr. Harold Cole and removal of his left kidney. What have you to say?"
"And if I say I know nothing of this?"
"Let me refresh your memory. You lost your medical license in America after assisting one of patients in suicide even though you were not convicted. As if that did not teach you a lesson, now you're here in England lifting a kidney from a defenseless mentally disabled child whom you kidnapped from an institution. You are performing risky medical experiments on your own wife and therefore practicing medicine without a license. The consequence for these abominable crimes committed in London is at least a decade of hard labor."
"You've forgotten, I was given their consent."
"Maybe so, but that's only because they've survived thus far from your interventions."
"Well, I'm surprised Mr. Holmes. You truly are a detective not to be trifled with." Norwood bowed deeply to my friend. "Yes, I did it. I don't deny it. But please let me explain."
"From the beginning, if you don't mind."
"Very well. I was born and raised in London. I chose to attend Cambridge University and later on Harvard Medical School in the States. To study medicine in America was to see medical innovations unrestrained by silly superstitions and social propriety.
"I met my wife, Angela Cole, early on in my education. Being young and so far from home, we engaged immediately and eventually married a few years later. I had planned to lead a life in research, but she showed me the plight of the lower-class: the medical neglect and perpetual misunderstanding of the mentally disabled. So I trained as a surgeon instead.
"Perhaps in my case, I should have never touched medicine for it has become my downfall. I had hoped to help people achieve a better quality of life. But now our technology has exceeded our humanity. One of my patients in the Massachusetts General Hospital was an old man Gregory Lewis who was terminally ill with cancer of the intestine, living day to day was torture to him. He told me he had no reason to stay in the mortal world with all his family and loved ones already waiting for him in Heaven.
"Late one night, he asked me to help him end his suffering. I tried to reason with him. I tried to tell him how wonderful life can still be for him. But he said, 'Son, I've lived my life, and I'm ready to end it. This body of mine won't take much more anyways. For the past five years I haven't felt anything but pain. All I ask of you as a doctor is to let my final moment be painless and in peace. Don't you see, even right now I'm not living I'm suffering. Just let me go, Doctor.'
"He asked me repeatedly, each argument more pathetic and cogent than the last. I began to watch him. He never smiled, just stared out the window and into the skies as his body slowly destroyed itself.
"Finally one day, his laboratory tests came back significantly unnerving. He did not have long to live. By how fast the cancer was spreading and my experience, I would have given him two weeks, but his unwillingness to live, only a few days.
"I finally made up my mind. When I entered his room, I suppose from my distraught face he knew what I had done and smiled for the first time.
"'Bless you, child,' he said and kissed my hand.
"I told him seriously, 'Mr. Lewis, as you already know you don't have much longer to live. I will not help you to end your life, but I will at least give you the choice.'
"'Son, that has made all the difference.'
"I set three highly concentrated morphine pills on the table. I had planned to leave as he made his choice, but he held me back, 'Could you stay with me as I do this. It's a terrible thing to die alone.'
"I stayed that with him that night as he swallowed the pills and all through the morning. He died holding my hand. I can still remember the chill I felt as the warmth of life left that diseased body.
"Several days later, there was an inquiry made by the police and I came forward on my own accord to tell the whole story.
"I was acquitted on lack of evidence, but my license was revoked. After this incident and the terrible questioning of the district prosecutor, I had lost all faith in myself as a man capable of being a physician with unshakeable ethics. I decided to give up medicine forever.
"But as soon as my wife and I arrived in London to escape the humiliation, she fell ill suddenly with diabetic nephropathy, failure of the kidney to function. It's a disease that has a very quick onset and is more common in women. Death usually occurs two to three years after. Nothing could be done.
"Nonetheless my faithful wife insisted on visiting her disabled brother especially after the death of their parents had occurred so suddenly. While seeing this brother for the first time, I noticed something very peculiar. They were not only brother and sister, but twins!"
"Really?," cried Holmes. "I never would have guessed that."
"Yes, it was an incredible coincidence. I questioned my wife and she finally confessed that they were indeed fraternal twins. Perhaps it is better if Mrs. Norwood explained. I would have called her in earlier, but she does need her rest," explained the doctor as he rang the bell and asked the butler to bring her in.
"How were you able to recognize the resemblance between the twins so quickly?" asked Holmes.
"Well, it just happened that at the time I received my doctorate in surgery, the Civil War in America had only ended five years prior. The war left many of them facially disfigured. So at night, after my shifts were over, I trained under a reconstructive surgeon. As you can see, my favorite stitch is the subcuticular. Eventually I was able to fix the faces of several Civil War veterans in town. Once, you train for maxillofacial surgeries, you develop a certain way of noticing key aspects of a person's facial features. No two people are alike, but twins are very close to the exception. By the way, Mr. Holmes or should I say Mr. Basil, how is your arm feeling today?"
It was Holmes's turn to be surprised.
"Come, come Mr. Holmes did you really think false side-whiskers would be enough to hide your angular jaw line? The broadness of the frontal bone and unique shape of your supraorbital process gave the game away."
Mrs. Angela Norwood arrived promptly. As she came into the room, her husband quickly explained the situation to her. She was a beautiful young woman indeed. In fact she looked very much like her brother, but more mature and older. I easily saw the same curved nose, large blue eyes, and yellow hair. However, even I would not have thought them to have been twins. Not only that, she looked to be at the height of health. Her cheeks were a rosy tinge, her breathing regular, and her movements graceful and fluid.
"Yes, Harold and I are twins, although fraternal. Guildford agreed to change his age at my late mother's request so that I am older. Inheritance issues. So the family estate does not pass to a disabled son. When we arrived in London, I was immediately diagnosed with chronic renal failure. Its onset would have occurred eventually; my mother had the same illness," Mrs. Norwood said, calmly.
Dr. Norwood interjected, "The only treatment was to transplant a functional kidney, a risky procedure. Even though I had given up medicine, I took up the position of physiology profess at Cambridge to access their research materials and find a way to save my wife.
"You see, rejection of an organ can be controlled when the donor organ shares nearly the same genes as the recipient, so the possibility of using her twin's kidney became a plausible idea. Of course I did all kinds of tests including blood between them. I assure you, I proceeded with every precaution to determine the probability of rejection.
"At last my wife finally took seriously ill once more and this time, it did not look like she would fully recover as she usually does. And it had already been two years and eight months since the first organ failure, so I knew I had to act fast.
"There is nothing wrong with removing a kidney from a willing donor. And Harold loves his sister more than the world. You can still live with one kidney, but you need at least one. Harold was willing to give a part of himself so another might live. To him, I am forever grateful.
"But in English society, the removal of an organ no matter how noble a purpose is seen as monstrous and unnatural. Least of all how could I justify the removal, when I had just lost my license to such a scandal in America? Besides I could not ask a licensed surgeon to remove his kidney. I didn't trust anyone except myself. There was no safer alternative than to do it all myself. So I had to do it in secret, I had to kidnap Harold from Guildford.
"A month before the kidnapping, I tested my surgical skills on three pairs of sows from a country farmer. Rejection resulted in the all unrelated pairs except between the one pair of identical twins. When I felt confident in my skills, I snuck Harold out to London by bribing a farmer to hide us within the hay stack he was transporting to Clemmer so we could take a train that entered London from the South End.
"I had set up a makeshift but sterile operating room in my basement and transplanted one of Harold kidney very carefully into my wife. After the operation I monitored both of them as much as I could. Four weeks after the operation I returned Harold to the institution before daylight. No one saw us.
In previous testing, the longest period a transplanted organ would function before rejection set in was a week. It has been nearly five weeks now and my wife has never looked better. Also her present tests are finally within range of the normal output levels of a healthy person with functional kidneys. My only conclusion is that the transplantation has not been rejected up to this point."
"Are you sure both Mrs. Norwood and her twin brother will survive this?" ask Holmes.
"Harold has a severe form of a malignant tumor metastasizing from his neck. In my honest opinion, he does not have more than a few years left to live. As far as I know, there is no hope for him. I have read all old and recent oncology reports. My wife, on the other hand, if this transplantation is successful will live for many more long years, I hope."
I could no longer contain my excitement any longer, "but you must publish this!"
"No! It is too soon to tell. I must wait. Yes, I agree with you Dr. Watson that the techniques of successful organ transplantation will save many lives. But I am still not sure of everything. I am still hypothesizing the combination of immunosuppressant drugs needed to prevent the immune system from rejecting an organ of similar genetic origins.
"Try to understand, I did this because the only alternative was death. I never wanted to pick up a scalpel ever again, but I was desperate and I risked everything for it. My wife, her brother, and our reputation. I cannot put the lives of others at danger if my untested ideas result in disaster. And, according to Mr. Holmes I should already be behind bars. Please, I am begging you, let me stay out of jail until I finish researching the post operative treatments. I only need more time to figure everything out! "
"And you shall have it, Norwood. You are truly unfit to be a physician. The reason there are laws governing the practice of medicine is so that unfit people cannot recklessly take the lives of others into their own unfit hands. The law is meant to protect people like your wife and brother-in-law from dying at your hands. You have the skill, doctor, but not the iron will to enforce the distinction between right and wrong. If you never practice medicine again until you are determined to uphold morality, I at least, will be assured of your innocence in this incident and you will never have to see the inside of a cell," declared Holmes.
"Thank you Mr. Holmes! Thank you! I am forever in your debt!"
"Not to me, but to your new patients and humanity. We have given you a second chance to redeem yourself. Take care not to disappoint us."
As we drove away from the Norwood mansion, Holmes confessed to me, "Sometimes I feel as though I do more harm by discovering the criminal than his crime. But I've also learned prudence. I would rather deceive the English law by not saying anything at all than deceive my own conscience when I know more good will come from him being free than in jail.
"Norwood was another doctor that went wrong and became the first of criminals acting with nerve and knowledge, but I think we were successful in impressing upon him the need to rethink his morals. He truly will be an honorable man from now on."
Holmes's predictions came true nearly three years later when the results of Dr. Norwood's transplantation were finally published. Every understanding authority was willing to overlook the laws Norwood had broken to accomplish the transplantation because the impact of his ideas were so momentous. The Royal College of Surgeons (2) even decided to reinstate his medical license, whose offer he deferred for several months in order to familiarize himself with the art of surgery once more.