the doctor raised his eyebrows, “how is Tom doing?”
“In his last letter, he told me how much he enjoys his butcher shop. He did say his cough is back, but other than that, he’s enjoying Canada.”
The doctor sighed. “I think about him often.” He frowned and put his finger to his chin. “Now for Elsie. I have the results from her last test.”
At the mention of her name, Elsie came to her mother’s side. With a puzzled expression, she looked up at the doctor.
Ethel took Elsie to a corner of the doctor’s office, gave her some blocks to play with, and then returned to her seat. “Yes, go on.” Ethel leaned forward.
“I have no doubt in my mind that the bacteria that causes scarlet fever can also initiate other conditions. Unfortunately, Elsie has developed a weak heart, and it’s something we have to watch.” The doctor raised a hand to prevent interruption. “This is not unusual. We knew there was a problem from Elsie’s initial medical examinations, but I didn’t see it as a crisis until now.”
“I thought she was coming along just fine.” Ethel pressed a hand to her chest, her own heart pounding fast.
“There’s always caution following scarlet fever or any childhood disease, as you well know. I don’t want to alarm you unduly, but now…now since my last examination, I’m certain she has a greater problem.” The doctor paused. “I’m sorry, but I feel she is at risk.”
“At risk? What does at risk mean?” Scenes of her family’s sorrow fled through Ethel’s mind when she remembered her older brother’s death 11 years ago. The doctor had told Pa that Will had fainted and then died due to a weakened heart, probably caused from an earlier bout of influenza. He was only 16 years old, with his whole life ahead of him. Ethel caught a sob in her throat. Could that happen to Elsie? Oh, God forbid it!
“Scarlet fever can stress the kidneys and the heart.” The doctor broke into her thoughts. “And we don’t know a lot about why these two organs are affected more than others. But we do know that a patient who’s had scarlet fever should have special care following the disease—especially a child. We have to admit, Elsie did have quite a serious bout. And we want to be sure she can lead a healthy and active life as she grows up.” Shuffling his papers, the doctor continued, “You’ll know all this, of course, from your nursing experience.”
“Yes, I understand. But do you think that in Elsie’s case it’s so serious?” Ethel asked.
“I’m afraid so. I’m relieved to have had the time to determine this.”
Ethel cleared her throat and rubbed her hands together as if warming them. “What are you saying? I mean, you’re aware that I’ve arranged passage to Canada in a short time. Is there something that can be done before then?”
“No, there isn’t. Well, not immediately anyway.” The doctor came out from behind his desk and sat on the corner. He looked over at Elsie, then to Ethel. “What I’m going to suggest will be difficult to hear.”
“Yes?” Ethel straightened her back. “Go on.”
“Your family situation is very common. Individual members of a family are often sick with various conditions that need different care. Tom, for instance, needed to leave England to look after his lungs. He was still a young man with a chance to work and save for his family. But staying here with his condition, as well as continually being exposed to disease, would have limited any chance of recovery for him.”
“I understand that. But what does that mean for Elsie?”
“Let me continue. You should go to Canada and get yourself settled. Elsie, on the other hand, because of her health should not go, just yet.”
“No!” Ethel stood. The chair legs screeched on the linoleum floor. “I won’t hear of it.”
“Now, just think this through.”
“No, Doctor Austin. I will not leave Elsie behind, if this is what you’re suggesting. And that’s final. My goodness, how could I even consider it? How could I survive being separated from her?” Ethel lowered her head. “And what would people say?”
She quickly turned away, as if to free herself from this distressing situation. Her heart raced. She wanted this conversation to stop.
Doctor Austin continued. “Perhaps you’re not aware of it, but people do this all the time. I have several patients who are leaving their children in England and travelling to Canada—for various reasons. Education is, of course, a big factor, and health is as well. Perhaps if you could talk to some of these people, they’d help you understand that it isn’t so terrible to want the best for your children, regardless of whether you’re the one who provides it or you arrange for someone else to do so. You just do what you have to do.”
Ethel looked at the doctor and swallowed. He was right, of course. A family of the neighbourhood came to mind. But not her family. There’d been enough separation. She wouldn’t have it. That was final.
“This might be all right for somebody else, but my goodness, Elsie’s only four years old. She needs me,” Ethel pleaded.
“Yes, she does. And I’m the first to admit that being together is the ideal situation. However, we’re dealing with reality. The tests show that her condition requires special monitoring. You won’t have the same access to medical care as you’ve had here, and I feel it’s crucial to examine and watch her regularly over the next few months. Also, it’ll be extremely stressful for her to endure a long crossing, plus the ongoing tension of adjusting to a new environment.”
“This your final word, Doctor?” Ethel asked.
“Yes. I’m afraid it is.”
“Then, perhaps I should consider not going? I could—”
“I’m recommending that you go on—without Elsie for the time being. Go to Tom. You can both prepare for Elsie to join you as soon as I feel she can travel. I’ll write to you and keep you informed.”
As though caught in a press, Ethel struggled to breathe. Tom and Elsie were the two most important people in her life. How could she tolerate separation from either one of them? Tom in Canada and Elsie here. Wherever she was, Ethel would have to be without one of the persons she loved. She sat still and closed her eyes, as if to shut out reality. Then, she gathered her skirts, walked over to Elsie and hugged her before turning towards the door.
“Thank you, Doctor. We mustn’t keep you any longer.” Ethel’s voice broke and she continued softly, “Should you have reason to change your mind about this, please be so kind as to inform me by post at Mum’s address in Enfield.”
“Very well. I’m sorry I couldn’t have better news for you. But I assure you, this solution is for the best.”
Ethel nodded goodbye to the doctor and then quietly directed Elsie down the dark corridor and out into the sunlight of a summer afternoon.
The day had grown humid, and the warm damp London air hung around them like a wet cover. They trudged along the crowded street.
Ethel tucked Elsie’s hand into hers, feeling small fingers lace through her own. “Don’t you worry none,” she said to Elsie, juggling her bag and purse in her other
