At that point I expected the doctor to invite Starr to New Jerusalem so he could see with his own eyes how phantasmagorical the nature of his life’s work was. But he held his tongue, and he, too, glanced toward the doorway. Both men seemed to be waiting for something.

“It is a hard and lonely life,” whispered the old man, his tone softening somewhat. “We are, both of us, Warthrop, voices crying in the wilderness. For fifty years I’ve provided an invaluable service to my fellow man. I have sacrificed, barely subsisting on meager donations and philanthropic grants. I could have taken a steady and certainly more lucrative position at a university, but I chose instead to dedicate my life to helping the poor unfortunates whom fate and circumstance have washed up upon my shore. Mistake me not, I do not complain, but it is hard. Hard!”

Remarkably, the Cheshire grin had fled, and in its place were a quivering lip and a solitary tear trailing down his weathered cheek.

“And this is how I end my days!” he cried softly. “A destitute wretch with hardly enough in his purse to cover the expenses of his burial. You asked for the diagnosis of my affliction, and I spoke truthfully there is none, for I cannot afford the services of a physician. I, a doctor myself, who has sacrificed his well-being upon the altar of altruism, am forced to suffer a humiliating end because I refused to worship the golden calf! Ah, Warthrop, ’tis a pity-but I beg for none! ’Tis pride my undoing-but I would not undo it! I have no regrets. No lungs, either, but I’d rather die honorably poor than dishonorably live.”

He dissolved into another raucous coughing spell, pressing his skeletal hands to his collapsing chest. The sleeves of his coat fell to his elbows, exposing his boney arms. He seemed to shrivel before our eyes, to wilt into a quivering mass of withered flesh and oversize yellowy teeth.

The doctor made no move. He did not speak. He watched the old fellow repeat the ritual with the handkerchief, saying naught, but his eyes burned with that same disconcerting backlit quality, and his fists remained clenched at his side.

He waited until Starr was still, then quietly stepped forward and dropped a gold coin beside his teacup. The teary old eyes darted to the coin, darted away again.

“I do not require your charity, Dr. Warthrop,” the curmudgeon croaked. “You add insult to injury.”

“That is certainly not my intention, Dr. Starr,” replied the doctor. “This is a loan. You must repay me. The only other stipulation is that you use this to see a doctor.”

Dart, dart went the eyes. “My only hope is in finding a specialist.”

A second coin joined the first.

“In Boston.”

A third. When Starr failed to speak, but sighed loudly in answer to the gentle clink of metal striking metal, Warthrop added a fourth. Starr coughed, and the attendant rattle in his chest sounded like beans smacking about in a hollow gourd. Warthrop dropped a fifth coin onto the pile; Starr sat bolt upright, hands falling to his sides, and cried out in a loud, clear voice, “Mrs. Bratton! Mrs. Braaaatton!”

She appeared in the doorway instantly, the irascible crone who had greeted us at the front door, as if she had been awaiting the summons just out of sight. Her entrance was accompanied by the unmistakable odor of bleach.

“Escort Dr. Warthrop to Captain Varner’s room,” instructed Starr. He did not attempt to join us. He remained in his chair, sipping the dregs of his tea, holding the cup with a hand markedly steadier than it had been a few moments before. The gold that the doctor had dropped beside the saucer had steeled him.

“Yes, Doctor,” answered the old woman. “Follow me,” she said to Warthrop.

As we started from the room, Starr called to the doctor, “Perhaps the boy should remain here with me.”

“The boy is my assistant,” my master reminded him curtly. “His services are indispensable to me.” He followed the old woman from the room and did not bid me come, or look behind to see if I would; he knew I would.

Led by the black-clad, chlorine-infused Mrs. Bratton, we mounted the poorly lit narrow staircase leading to the second floor. Halfway up, the doctor murmured into my ear, “Remember what I told you, Will Henry.” As we climbed, the eerie moans and cries, which seemed to originate from a twilight region neither wholly fantastical nor altogether human, steadily grew in volume. A guttural voice rose above the din, jabbering a furious monologue peppered with profanities. A woman called desperately, again and again, for someone named Hanna. A man sobbed uncontrollably. And running like a swift undercurrent beneath this unsettled sea of disembodied clamor, the frantic laughter I had heard since entering the sanatorium. Strengthening too as we climbed was the same cloying odor I had noted in the parlor beneath us, its malodorous composition unmistakable as it intensified: a throat-tightening potpourri of unwashed flesh, old urine, and human feces.

Lining both sides of the long second-floor hall were heavy wooden doors, each fitted with iron dead bolts and padlocks the size of my fist, each with a six-inch-wide slot cut into it at eye level, the opening covered by a hinged piece of metal. The old floorboards creaked beneath our feet, alerting the occupants of these barricaded rooms to our presence, and their cries rose to a fever pitch, tripling in volume and intensity. A door shook upon its ancient hinges as the denizen within hurled himself against it. We passed the profane monologist’s room, whereat he pressed his lips against the jam and unleashed a string of execrations worthy of the saltiest marine. The shrill, despairing cries for Hanna vibrated in our ears. I glanced up at the doctor’s face, seeking some sign of reassurance in this foul Babel of human suffering and misery, but he gave no sign. His countenance was as calm as a man strolling in the park on a warm summer’s day.

For me the jittery trek down that dismal hall seemed longer than a mile, and a million more from any pleasant park. When we stopped at the last door, I was out of breath, forced by the stench to breathe shallow gulps through my half-open mouth. Our guide produced a large ring from her apron pocket and commenced to flipping through the dozens of keys hanging from it, an operation apparently more complex than one might imagine, for she bent low over her work, running a crooked finger over the teeth of each key, as if she could identify the proper one by touch. I nearly jumped clear of my clothing when the door directly behind me gave a violent shudder and a rasping voice whispered, “Hello, now, who is this? Who is this?” I heard the sound of someone snuffling as he pressed his nose against the door. “I know you’re there. I can smell you.”

“The patient wasn’t awake when last I checked on him,” Mrs. Bratton informed the doctor as she caressed her keys.

“Then we shall wake him,” said the doctor.

“You won’t get much out of him,” she said. “He hasn’t made a peep in weeks.”

Warthrop made no reply. Mrs. Bratton at last found the key and popped open the old padlock, threw back the three bolts above its clasp, and with her shoulder pushed open the ponderous door.

The room was tiny, hardly larger than my little alcove on Harrington Lane, with no furniture but the rickety bed placed two paces from the door. A kerosene lamp sat on the floor beside it, its smoky flame providing the only source of light. It flung our shadows upon the ceiling and the peeling plaster of the wall opposite the filthy window, beneath which, on the dusty sill, clustered the bodies of desiccated flies. Above them, a congregation of their extant cousins buzzed about and crawled upon glass. My eyes began to water, for the smell of bleach was overwhelming, and I deduced the reason for delaying the doctor downstairs: Mrs. Bratton had needed time to scour and disinfect before our introduction to Captain Varner.

He lay upon the bed beneath several layers of blankets and sheets, the uppermost as white and wrinkleless as a burial shroud, leaving only his head and neck exposed. The bed was not large, but it appeared even smaller due to his enormous bulk. I had imagined him as a frail and shriveled old man, wasted away to a mere husk of humanity after twenty years of confinement and deprivation. Instead, lying before me was a man of monstrous proportions, weighing more than four hundred pounds, I would venture, cradled as it were in a kind of trough created in the mattress by his staggering corpulence. His head was equally huge; in relation to it the pillow upon which it rested appeared to be the size a pincushion. The eyes were lost in folds of grayish flesh; the nose was scarlet and bulbous, rising from the sunken cheeks like a red potato resting upon a parched landscape; and the mouth was a dark, toothless tunnel in which his swollen tongue slithered restlessly over bare gums.

The doctor stepped to his bedside. In her emaciated claws the old woman nervously turned the key ring. The jingling of the keys, the labored breath of the afflicted, and the buzzing of the flies against the window were the only sounds in the tiny, claustrophobic space.

“I wouldn’t touch him,” she cautioned. “Captain Varner hates to be touched. Don’t you, Captain Varner?”

He answered not. Though his eyes were barely visible in their fleshy furrows, I saw they were open. The tip of his tongue, a mottled gray like his skin, wet his lips. His chin, but a knuckle-size knot lodged between his neck and lower lip, shone with spittle.

For a long moment Warthrop regarded this wretched object of his quest, saying nothing, allowing no expression to disclose his feelings. At last he seemed to shake himself from the spell and turned abruptly to the old woman.

“Leave us,” he said.

“I cannot,” replied she curtly. “It’s against the rules.”

He repeated the command without raising his voice but measuring the words as if she had failed somehow to understand them.

“Leave… us.”

She saw something in his eyes, and whatever she saw cowed her, for she at once looked away, furiously shaking her keys, the symbols of her total authority, and said, “The doctor shall hear about this.”

Warthrop had already turned back to the beached behemoth upon the bed. The sound of the jangling keys faded down the hall; she had left the door ajar. He directed me to close it. Then, as I pressed my back against its comforting sturdiness, Warthrop leaned over the bed, bringing his face close to the bloated one beneath him, and said in a loud, clear voice, “Hezekiah Varner! Captain!”

Varner did not respond. His eyes remained focused on the ceiling; his mouth hung open; his tongue restlessly swiped the lower lip, then retreated into the shadowy recesses of the toothless maw. From deep within his chest rose a sound somewhere between a hum and a moan. But for the uneasy tongue, he moved not a muscle, if any muscle remained efficacious buried beneath the rolls of fat.

“Varner, do you hear me?” asked the doctor. He waited for an answer, shoulders tensed, jaw tightly set, as behind him the flies fussed against the glass. The room was stifling and reeked of bleach. I breathed as shallowly as I could, and wondered if the doctor would mind if I cracked open the window for a bit of fresh air.

Warthrop raised his voice and fairly shouted into the man’s face, “Do you know who I am, Varner? Were you told who has come to see you this night?”

The obese invalid moaned. The doctor sighed and looked at me.