DOCTOR HILLHOUSE was in his office one morning when a gentleman named Carlton, in whose family he had practiced for two or three years, came in. This was a few weeks before the party at Mr. Birtwell's.
"Doctor"—there was a troubled look on his visitor's face—"I wish you would call in to-day and examine a lump on Mrs. Carlton's neck. It's been coming for two or three months. We thought it only the swelling of a gland at first, and expected it to go away in a little while. But in the last few weeks it has grown perceptibly."
"How large is it?" inquired the doctor.
"About the size of a pigeon's egg."
"Indeed! So large?"
"Yes; and I am beginning to feel very much concerned about it."
"Is there any discoloration?"
"No."
"Any soreness or tenderness to the touch?"
"No; but Mrs. Carlton is beginning to feel a sense of tightness and oppression, as though the lump, whatever it may be, were beginning to press upon some of the blood-vessels."
"Nothing serious, I imagine," replied Dr. Hillhouse, speaking with a lightness of manner he did not feel. "I will call about twelve o'clock. Tell Mrs. Carlton to expect me at that time."
Mr. Carlton made a movement to go, but came back from the door, and betraying more anxiety of manner than at first, said:
"This may seem a light thing in your eyes, doctor, but I cannot help feeling troubled. I am afraid of a tumor."
"What is the exact location?" asked Dr. Hillhouse.
"On the side of the neck, a little back from the lower edge of the right ear."
The doctor did not reply. After a brief silence Mr. Carlton said:
"Do you think it a regular tumor, doctor?"
"It is difficult to say. I can speak with more certainty after I have made an examination," replied Doctor Hillhouse, his manner showing some reserve.
"If it should prove to be a tumor, cannot its growth be stopped? Is there no relief except through an operation—no curative agents that will restore a healthy action to the parts and cause the tumor to be absorbed?"
"There is a class of tumors," replied the doctor, "that may be absorbed, but the treatment is prejudicial to the general health, and no wise physician will, I think, resort to it instead of a surgical operation, which is usually simple and safe."
"Much depends on the location of a tumor," said Mr. Carlton. "The extirpation may be safe and easy if the operation be in one place, and difficult and dangerous if in another."
"It is the surgeon's business to do his work so well that danger shall not exist in any case," replied Doctor Hillhouse.
"I shall trust her in your hands," said Mr. Carlton, trying to assume a cheerful air. "But I cannot help feeling nervous and extremely anxious."
"You are, of course, over-sensitive about everything that touches one so dear as your wife," replied the doctor. "But do not give yourself needless anxiety. Tumors in the neck are generally of the kind known as 'benignant,' and are easily removed."
Dr. Angier came into the office while they were talking, and heard a part of the conversation. As soon as Mr. Carlton had retired he asked if the tumor were deep-seated or only a wen-like protuberance.
"Deep-seated, I infer, from what Mr. Carlton said," replied Dr. Hillhouse.
"What is her constitution?"
"Not as free from a scrofulous tendency as I should like."
"Then this tumor, if it should really prove to be one, may be of a malignant character."
"That is possible. But I trust to find only a simple cyst, or, at the worst, an adipose or fibrous tumor easy of removal, though I am sorry it is in the neck. I never like to cut in among the large blood-vessels and tendons of that region."
At twelve o'clock Doctor Hillhouse made the promised visit. He found Mrs. Carlton to all appearance quiet and cheerful.
"My husband is apt to worry himself when anything ails me," she said, with a faint smile.
The doctor took her hand and felt a low tremor of the nerves that betrayed the nervous anxiety she was trying hard to conceal. His first diagnosis was not satisfactory, and he was not able wholly to conceal his doubts from the keen observation of Mr. Carlton, whose eyes never turned for a moment from the doctor's face. The swelling was clearly outlined, but neither sharp nor protuberant. From the manner of its presentation, and also from the fact that Mrs. Carlton complained of a feeling of pressure on the vessels of the neck, the doctor feared the tumor was larger and more deeply seated than the lady's friends had suspected. But he was most concerned as to its true character. Being hard and nodulated, he feared that it might prove to be of a malignant type, and his apprehensions were increased by the fact that his patient had in her constitution a taint of scrofula. There was no apparent congestion of the veins nor discoloration of the skin around the hard protuberance, no pulsation, elasticity, fluctuation or soreness, only a solid lump which the doctor's sensitive touch recognized as the small section or lobule of a deeply-seated tumor already beginning to press upon and obstruct the blood vessels in its immediate vicinity. Whether it were fibrous or albuminous, "benignant" or "malignant," he was not able in his first diagnosis to determine.
Dr. Hillhouse could not so veil his face as to hide from Mr. Carlton the doubt and concern that were in his mind.
"Deal with me plainly," said the latter as he stood alone with the doctor after the examination was over. "I want the exact truth. Don't conceal anything."
Mr. Carlton's lips trembled.
"Is it a—a tumor?" He got the words out in a low, shaky voice.
"I think so," replied Doctor Hillhouse. He saw the face of Mr. Carlton blanch instantly.
"It presents," added the doctor, "all the indications of what we call a fibrous tumor."
"Is it of a malignant type?" asked Mr. Carlton, with suspended breath.
"No; these tumors are harmless in themselves, but their mechanical pressure on surrounding blood-vessels and tissues renders their removal necessary."
Mr. Carlton caught his breath with a sigh of relief.
"Is their removal attended with danger?" he asked.
"None," replied Dr. Hillhouse.
"Have you ever taken a tumor from the neck?"
"Yes. I have operated in cases of this kind often."
"Were you always successful?"
"Yes; in every instance."
Mr. Carlton breathed more freely. After a pause, he said, his lips growing white as he spoke:
"There will have to be an operation in this case?"
"It cannot, I fear, be avoided," replied the doctor.
"There is one comfort," said Mr. Carlton, rallying and speaking in a more cheerful voice. "The tumor is small and superficial in character. The knife will not have to go very deep among the veins and arteries."
Doctor Hillhouse did not correct his error.
"How long will it take?" queried the anxious husband, to whom the thought of cutting down into the tender flesh of his wife was so painful that it completely unmanned him.
"Not very long," answered the doctor.
"Ten minutes?"
"Yes, or maybe a little longer."
"She will feel no pain?"
"None."
"Nor be conscious of what you are doing?"
"She will be as much in oblivion as a sleeping infant," replied the doctor.
Mr. Carlton turned from Dr. Hillhouse and walked the whole length of the parlor twice, then stood still, and said, with painful impressiveness:
"Doctor, I place her in your hands. She is ready for anything we may decide upon as best."
He stopped and turned partly away to hide his feelings. But recovering himself, and forcing a smile to his lips, he said:
"To your professional eyes I show unmanly weakness. But you must bear in mind how very dear she is to me. It makes me shiver in every nerve to think of the knife going down into her tender flesh. You might cut me to pieces, doctor, if that would save her."
"Your fears exaggerate everything," returned Doctor Hillhouse, in an assuring voice. "She will go into a tranquil sleep, and while dreaming pleasant dreams we will quickly dissect out the tumor, and leave the freed organs to continue their healthy action under the old laws of unobstructed life."
"When ought it to be done?" asked Mr. Carlton the tremor coming back into his voice.
"The sooner, the better, after an operation is decided upon," answered the doctor. "I will make another examination in about two weeks. The changes that take place in that time will help me to a clearer decision than it is possible to arrive at now."
After a lapse of two weeks Doctor Hillhouse, in company with another surgeon, made a second examination. What his conclusions were will appear in the following conversation held with Dr. Angier.
"The tumor is not of a malignant character," Doctor Hillhouse replied, in answer to his assistant's inquiry. "But it is larger than I at first suspected and is growing very rapidly. From a slight suffusion of Mrs. Carlton's face which I did not observe at any previous visit, it is evident that the tumor is beginning to press upon the carotids. Serious displacements of blood-vessels, nerves, glands and muscles must soon occur if this growth goes on."
"Then her life is in danger?" said Dr. Angier.
"It is assuredly, and nothing but a successful operation can save her."
"What does Doctor Kline think of the case?"
"He agrees with me as to the character of the tumor, but thinks it larger than an orange, deeply cast among the great blood-vessels, and probably so attached to their sheaths as to make its extirpation not only difficult, but dangerous."
"Will he assist you in the operation?"
"Yes."
Dr. Hillhouse became thoughtful and silent. His countenance wore a serious, almost troubled aspect.
"Never before," he said, after a long pause, "have I looked forward to an operation with such a feeling of concern as I look forward to this. Three or four months ago, when there was only a little sack there, it could have been removed without risk. But I greatly fear that in its rapid growth it has become largely attached to the blood-vessels and the sheaths of nerves, and you know how difficult this will make the operation, and that the risk will be largely increased. The fact is, doctor, I am free to say that it would be more agreeable to me if some other surgeon had the responsibility of this case."
"Dr. Kline would, no doubt, be very ready to take it off of your hands."
"If the family were satisfied, I would cheerfully delegate the work to him," said Doctor Hillhouse.
"He's a younger man, and his recent brilliant operations have brought him quite prominently before, the public."
As he spoke Doctor Hillhouse, who was past sixty-five and beginning to feel the effects of over forty years of earnest professional labor, lifted his small hand, the texture of which, was as fine as that of a woman's, and holding it up, looked at it steadily for some moments. It trembled just a little.
"Not quite so firm as it was twenty years ago," he remarked, with a slight depression in his voice.
"But the sight is clearer and the skill greater," said Doctor Angier.
"I don't know about the sight." returned Doctor Hillhouse. "I'm afraid that is no truer than the hand."
"The inner sight, I mean, the perception that comes from long-applied skill," said Doctor Angier. "That is something in which you have the advantage of younger men."
Doctor Hillhouse made no reply to this, but sat like one in deep and, perplexed thought for a considerable time.
"I must see Doctor Kline and go over the case with him more carefully," he remarked at length. "I shall then be able to see with more clearness what is best. The fact that I feel so averse to operating myself comes almost as a warning; and if no change should occur in my feelings, I shall, with the consent of the family, transfer the knife to Doctor Kline."
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