Anna paused, wondering why she had expected anything else. Then she took her bag from Jack, crouched down to open it, and came out with a corked bottle that she pressed into the matron’s hand.

“Will you see to it that he is given enough of this to handle the worst of the pain? A teaspoon in a glass of water when it’s more than he can stand. He might need it every few hours or even every hour toward the end. Used carefully it should see him through.”

•   •   •

AS THEY WALKED back to the ferry Anna’s expression was almost cold, her thoughts clearly very far away. Thinking of Rosa, no doubt, and how to tell the little girl about her father’s situation. The gesture she had made—the bottle of laudanum she had pressed on the matron—was as much for Rosa as it was for Carmine Russo. Anna could say, now, that his death would be quiet and painless.

As they waited for the pilot she said, “He’s not an alcoholic, or if he was, that’s no longer his problem. He has an advanced cancer, at least a year gone. Could you arrange for me to bring the girls here, so they can see their father and say good-bye?”

The question took him by surprise. “Do you think that’s a good idea?”

Her expression was as sharp as a slap.

He said, “You think it necessary.”

She turned her head and for a long moment her gaze was fixed on the workhouse. Then she turned back, her expression set hard.

“We’re less than a mile from Randall’s Island here. Could we go to the Infant Hospital, or do you have to go back to the station house?”

•   •   •

THEY STEPPED ONTO the Randall’s Island dock as a church bell somewhere nearby struck six. Beneath his hand the muscles of Anna Savard’s arm were tense, but she tried to smile when she looked at him.

“I’m being superstitious and nonsensical,” she said. “But if the baby is here—”

She didn’t finish, and didn’t need to. In her mind the recovery of Rosa’s younger brother would outweigh the news of her father’s condition. Jack understood the impulse and said nothing discouraging; until she saw for herself that the boy wasn’t at the Infant Hospital, nothing he could say would help.

As many times as he had been on Blackwell on police business, Jack had never had occasion to visit Randall’s Island. There were no prisoners here, no jails or holding cells. It was an island of children. And graves, he reminded himself as they came to the front entrance. From here he could see the pauper’s graveyard in the distance, rows and rows of unmarked graves, stark earth tones with a backdrop of ocean and forest in deep blues and greens deepening toward night.

Anna’s whole posture changed when they entered the building, as if, Jack thought, she was preparing herself for disappointment, or battle.

It took no more than ten minutes to find the matron, and for the matron, barely concealing her irritation, to show them to the room where the infants from three to six months old were assigned, two to a cot barely large enough for one.

As he stood in the doorway, Jack’s heart began to hammer in his chest. He had seen many things in service: the worst multiple-murder scenes, cruelty beyond imagination, despair and senseless death. He had seen all that and more, but he couldn’t remember ever being more shocked, and before him was just a sea of young children. Row after row of them in the dim room that stank of soiled diapers and sour milk. Not the slightest breeze to bring relief, nothing to look at but walls painted the color of mud, water-stained and speckled with mold, and other children who couldn’t do anything for themselves.

But worse still was the silence. This room should have been too loud for normal conversation; as Jack knew from personal experience, healthy infants of this age made their needs known at the top of their lungs. It was true that many of the babies did seem to be asleep, but at least three dozen were awake, sitting like so many dolls and staring through the bars of their cots at nothing at all.

If Anna was shocked, she hid it well. She moved into the room and began to go up and down the aisles, pausing only rarely to look more closely and then once, for a full minute, reaching into the crib to touch, her expression lost in the dim light. The matron stood at one end of the room studying her own hands while Anna continued on from one row to the next, her posture never changing. Then she turned and shook her head to make it clear that the Russo boy wasn’t here.

Instead of crossing the room again, she gestured him closer.

She pointed to her bag, and Jack put it on the only flat surface, a long table against one wall interrupted by a single deep sink. Jack hesitated and then cleared a space by pushing dirty bowls encrusted with mush to one side so that roaches went skittering in a wave.

Anna was taking things out of her bag and looking around herself as if something was missing. Without looking toward the matron she called, “I need a basin. Two clean basins, one filled with hot water.”

Jack saw the woman hesitate only as long as it took for Anna to give her a look that could not be misinterpreted.

While the matron did as instructed, Anna was arranging instruments on a cloth she had spread out. Then she uncorked a bottle and the piercing smell of carbolic struck Jack hard enough to make him step away, and then back again, lest she think him so easily put off.

The liquid went into the empty basin, along with a pair of scissors and an instrument with handles like a scissors, but that ended in small paddles. She caught his glance.

“Forceps,” she said.

The sound of Anna’s voice had given the matron courage to speak. “And what is all this for?”

Anna ignored her, took a towel from her bag, and, turning, walked along the row of cots until she came to one where one child was sleeping and the other sat, neither awake or asleep.

She handed Jack the towel. “To protect your clothes. Please hold him in the crook of your arm while I get a few things ready. Talk to him, your voice will help.”

“Help what?” the matron asked, her tone much sharper. “What exactly do you think you’re doing, miss?”

Jack had introduced her to the matron as Dr. Savard, but the woman seemed to have forgotten that or gave it no credit. Now Anna paused and turned toward the matron, every fiber of her being thrumming with barely contained anger.

“That child—” Anna pointed toward the cot where Jack still stood. “That little boy is starving to death.”

The matron’s mouth fell open and snapped shut. “He is fed, I assure you. He receives a full ration, three times a day, the wet nurses see to him like the others—”

Anna interrupted her. “But he takes almost nothing.”

The matron drew up. “And how would you know that?”

“Because,” Anna said, biting off each word. “He is starving to death.”

“Do you see how many children we have in just this one room?” the matron said. She looked over the room. “We don’t have the time to force-feed picky children.”

All the color blanched from Anna’s face.

She turned away from the matron and looked at Jack directly. In an alarmingly calm tone she said, “Could you bring him here, please, and hold him firmly in the crook of your arm? I need to look in his mouth.”

“His mouth?” the matron sputtered.

Jack hoped never to experience a look like the one Anna turned on the matron.

“Whoever examined this child when he was admitted failed to notice that he has ankyloglossia. The frenulum that anchors his tongue is abnormally short and tight, which makes it impossible for him to suck properly. And that,” she said, enunciating every syllable, “would account for his pickiness.”

The matron started to protest, but Jack had had enough.

“Leave,” he told her. “Don’t come back before Dr. Savard has finished here.”

The matron looked at Anna and Jack and back to Anna again, and she fled the room.

“Thank you,” Anna said. “Now if you could bring him to me.”

The child weighed less than Anna’s doctor’s bag, a bundle of bones held together by tendons and skin. The belly was distended, and the eyes dull and sunken.

“Hold him gently, but don’t let him move.” She spoke to Jack, but all her attention was on the baby. With her left hand she pressed gently on the child’s cheeks until the mouth opened. She had poured more carbolic over her hands, and it made his eyes water.

Very quickly she used two fingers to explore the open mouth, her head turned away, Jack thought, to concentrate on what touch told her.

“This will take just a moment,” she murmured to Jack. To the boy she spoke more softly, a low crooning. “You haven’t been able to eat, have you? But that’s about to change. You’re a very strong boy to have survived this place as long as you have.”

The child blinked at her drowsily.

In a series of swift, tightly controlled movements, Anna used the forceps to grasp the boy’s tongue and hold it away so that she had a clear view of its underside. With her free hand she took up the scissors, reached in and snipped, as cleanly as a seamstress cutting a wayward thread.