They talked of many things, he and these scarecrow men with carefully sewn patches on their pants, their hair grown long not because long hair was in style but because no one in the family had as yet gotten around to cutting it. They talked of the weather, which bore heavily on their minds and was worthy of lengthy conversation; of someone having seen a panther, although wildlife biologists were agreed there had been no panthers in these hills for almost forty years; of times long gone and tales told by forebears now only dimly remembered.
In the course of these conversations Benton always got around to mentioning the exhaustion syndrome—although he did not use that term—explaining how patients for no apparent reason were gaining weight, were feeling all tired out in the middle of the morning, and had a seemingly never-satisfied longing for sweets. He didn’t know what caused it, he told them; and he was somewhat upset about it and was wondering if there might be any such condition in the neighborhood.
They looked at him with ill-concealed laughter in their eyes and said, no, unless that was what might be wrong with Grandpa Wilson or Gabby Whiteside or any one of another dozen people. They regaled him with stories of fabulously lazy men who, all their lives, had worked much harder to avoid work than the work would have been itself. But their tales all had the ring of folklore to them, so Benton accepted them as such. Most of the shiftless men who peopled the stories, he realized, did not exist and never had existed.
He came home convinced that no signs of Abbott’s epidemic existed in the hills.
It could be body chemistry, he told himself—something in the hills, the way of life, the things they ate, the conveniences they could not afford—that made all the difference. Although maybe, he admitted, he had that turned around; not something that kept the syndrome from the hills, but something that afflicted the townspeople with the syndrome.
Nonetheless, Benton thought, this business of body chemistry might be the best bet yet. Figure what the townspeople had or did not have, did or did not do, and the answer might be there. But, he warned himself, the elusive factor that he sought must be unique to town life.
That evening he went to the office, pleading paperwork, and wrestled with himself. Sitting at the desk, doing nothing except sitting at the desk, with a single gooseneck lamp making a splash of light upon the desk top, he tried to think it through.
He had tried to forget all the silly business, but he could not forget it. Perhaps he was unable to forget it because it was not a silly business, because he knew all the time, deep down within that hidden core of medical awareness, that it was a greater threat than he had allowed himself to believe—and knew as well that if he were to keep faith with his community he must not go on ignoring it, or attempting to ignore it. Although, he asked himself, how, for my own peace of mind, can I do other than ignore it? I do not have the training … He was not a research man. For too long he had been a plodding country doctor, exerting all his energy and knowledge to fight disease and death in this tiny corner of the land. He had no tools for research; he did not have the brain for research; he did not have the time—and, he thought, he might as well admit it, he did not have the devoted objectivity and the narrowness of purpose to do a research job.
But, ill-equipped as he might be, he owed it to the town to have a go at it at least. That was the hell of it—he owed it to the town! All his life he had owed everything he was and ever hoped to be to the people of this little town in payment for the trust that they had in him. He had placed them in his debt, but they had placed him in even greater debt. Just walking in and talking with him cured half of what was wrong with them, and how did a man respond to a faith like that? They thought he had all the answers, so he could not tell them how few answers he did have. Their faith in his infallibility often was the one last resort they had going for them. They put their faith and trust in him, and in doing that they made him feel guilty when he was forced, through inadequacy, to betray that faith and trust. How, he wondered, was a man trapped? How had he allowed himself to be trapped into such a situation?
He dug into the desk drawer and brought out his notes and those of Dr. Smith. Carefully, he went through them, hoping that further study might give him a clue. But there seemed none.
Hormones? he wondered. Some sort of hormonal imbalance? If that were true, however, there would have to be something to have brought about such an imbalance. This was not the first time he had thought of hormones, for an imbalance of insulin would explain the diabetic symptoms; but the hell of it, he reminded himself, was that it had not been diabetes. Glucogen, perhaps? But the trouble there was that no one knew for certain what glucogen really did, although it was suspected that by elevating the glucose blood level it might kill appetite. The hypothalamus? he asked himself. Or the steroid hormones? No, it could be none of these.
Personality disturbances? Fine as far as obesity and irritability might be concerned, but certainly not for any of the other symptoms. And, anyhow, personality disturbances were slimy things to work with and psychiatric training was required to cope with them.
Enzymes? Vitamins? Trace elements?
He was going at it wrong, Benton told himself. He was going at it backward. The way to work out the syndrome was to find a common factor that might be the cause and then try to cipher out what effect the factor had. Although, still thinking of it backward, the enzymes might hold more promise than any of the others. Enzymes basically were catalysts that sped up biochemical reactions. Not that biochemical reactions could not occur without the enzymatic catalytic action, but the reactions would be so slow that the body could not function.
He sat quietly and ran through his mind what he could recall about enzymes. He was surprised to find that after all the years he had scarcely thought of enzymes, he could remember so much about them. The reason that he could recall so much was that instead of thinking directly about enzymes he found himself recalling Professor Walter Cox—old Stony Cox, eccentric and beloved in a rather ragged way—who had paced up and down when he lectured, bobbing like a ball, his head hunched forward between skinny lifted shoulders, punching the air with one clenched fist to emphasize his words. He wondered where Stony Cox might be this night. More than likely dead, he thought, for that had been more than thirty years ago and he had been an old man then.
Thirty years and all, the words came clearly to mind. “The enzymes,” Cox had said, jabbing wildly at the air, “are made up of apoenzymes and coenzymes, the two forming a loose bond to make up an enzyme. The coenzyme normally is a vitamin plus another organic molecule, bonded together. And now, gentlemen, today I ask that you focus your attention on a single coenzyme, the coenzyme A, which is directly involved in two biochemical cycles, the fatty-acid cycle and the citric-acid cycle …”
Benton sat limp in his chair, shaken by what his mind had conjured up, dredging out of a past that measured more than thirty years an instant of almost complete recall—not of the man alone but of the words he had spoken, the slanted shine of sunlight through the slatted blinds, the smell of chalk dust in the air—hearing the words perhaps more distinctly than he had heard them at the time.