Alone, Sarah wanders out the front door and into the September afternoon. Her skirts brush down the porch steps and over the grass, crushing one fallen leaf, then two. A sudden breeze trembles the maple sapling in the yard, and she sets both hands on her belly. A quiver answers her, under the skin stretching tighter every day. She has to soak in as much light as possible, before the winter comes and the sun is gone here in Iowa. When her baby thinks of home, it will think of this little town on what is still, technically, the frontier. Not the plantation, back in Alabama. She’s made sure of that.

Despite herself, her mother’s voice natters in her head, approving her: a lady, walking on her lawn. Her lawn. That’s what it would be called back home. Here it’s really just the clear square of ground in front of the house, where the old doctor broke up the prairie sod before he died. There are no flower borders, no herringbone brick walks, no walls. Under her feet, the soil is deep and black, netted with tangled roots tamped down by buffalo, or by whatever large creatures walked this corner of Iowa with their milch-cow snufflings, once upon a time, as the glaciers melted and the grass grew tall. She imagines them lumbering into this tiny town, like Mr. Dickens’s Megalosaurus waddling up Holborn Hill. London must be so crowded, teeming with dirt and noise and life, in its matter-of-fact foreignness. A great city. Not like this small town at the edge of the world. This place with its optimistic signpost: Eldorado.

“You’d better take the Dickens,” Mama had urged. “God knows what else you’ll have to read out there.” So the red leather novels had gone into the trunks with the big blue volume of Shakespeare and the Spenser and Mrs. Wollstonecraft’s Original Stories. With the quilts and the butter churn and the thick woolen capes and the knitting needles and the gold-rimmed teacups and the medicine chest and the anatomy texts and the forceps and the knives. With old Nero the cat in a big basket. With the blank diary at the bottom of Sarah’s red morocco sewing box, latched tight, its pages swarming with silences she can’t break.

But not the piano. No.

Sarah wanders to the dirt track running past the house – Eldorado, Iowa’s main street – and looks to the north, then the south. High limestone cliffs, forested with maple and oak and black walnut, rear above the roofs. At the foot of those cliffs, the river unspools a thin silver thread. She turns her head to look up the street. She knows each building by now: Mrs. Thorson’s inn, the Linsvolds’ general store, the McElvains’ house, Mr. Gabrielson’s forge and undertaking parlor, Mrs. Thorson’s house, the Johnsons’ house, the church, Reverend Preus’s house, the schoolhouse, the Olsons’ house, the Sawyers’ house, the Gundersons’ house, the tiny bank with its iron-barred windows, and the square red-brick house where the four Norwegian seminary students live (the Norwegian Lutheran Church paid good money for that brick.) Farther down toward the end of the valley stands the cabin the Thorson twins have built for themselves, on their own land. Almost all of them are covered with neat board siding, whitewashed or painted the pale brown Mrs. Linsvold can buy in bulk from St. Paul. The forge and the church are made of stone. How fast these Norwegians and Germans and Swedes, fresh off the boat, had worked. How quickly time seemed to accelerate as Sarah herself moved further into it. When these buildings were built, the war was just getting started back in Alabama. Indians made their camps on these prairies and the wide flat plains beside the river. Now the Indians were gone, pushed further west by the same blue-coated soldiers who had marched down the road past Sarah’s own home. And Sarah’s home was gone too.

At the end of the street stands old Dr. Foster’s house. Now it belongs to Sarah and her husband, Galen – the new doctor has taken the old one’s place, just as if he’d never left. This town seems a good place for them to be, a going concern, as the land agent had exclaimed. Eldorado. A place where the Lutheran Church of Norway is training young men to minister, in English, to Norwegian settlers. A little town that only needs a doctor. A place to set the pieces of a life on top of one another until they make a wall, a roof, a door.

In its round dark cask under her heart, the baby clenches and pitches: grabbing for its toes, elbowing her bladder, quickening. Four months yet to go until it’s born, just over the border into the new year 1876. This child is strong. She speaks to it: I feel you in there, honey. I’m going to see you soon. A whim strikes her to unbutton her blouse and stretch the growing mound of her belly toward the sun, to feel her child rotate and swim face-first toward the warm world beyond her skin. Galen’s anatomy books have shown her its curled shape, fed by its purple-black cord. Her blood is carrying the news of this sunlight even now, from the surface of her skin straight to the child in its dark. I know you feel this. In a year, she’ll walk on this lawn with the baby wrapped in a shawl. She’ll point out the leaves tickling down through the air to the grass, the bluejays hopping and screeching in the big maple tree. She’ll turn its face toward the cluster of buildings down the street and the bluffs reared high above the river, spangled with yellow, orange, red, and green. She will show this world to her child.

She reaches for the buttons of her blouse and stops. Silly, she smiles at herself. I can’t walk around with my shirt hanging open. She should be warm enough, anyway, with all the light there is. This morning, she and Rosa Lee raised all the windows in the house, including the window of Galen’s study. Rosa Lee is inside the house now. Through the window, Sarah can hear the slip and slither of bread dough on the kitchen table. She should go inside to help; she’s being selfish. The true lady, the mistress of the house, assists her servants in all their tasks, the conduct books all exhort, never ceasing from her own calm labors; her untroubled appearance belies her weight of care. Instead, Sarah turns away, wanders one step further, then another.  Wind nudges a blonde curl out of its knot. Her footsteps rustle in the dead grass, and her skirt crackles through the red and gold maple leaves scattered there. More leaves are pasted to the dirt track that is the end of Main Street, ending at their door. Old Dr. Foster’s door, Sarah corrects herself. When the baby comes, the house will be really theirs.

Every week, now, the days are shorter. The sun’s leaving them, slipping over the edge of the world like Galen’s tired face slips out of sight below the edge of their blankets. He curls up like a child at night, now, nestles in, breathes deeply. But then he starts to shout through the bars of his dreams, pedaling his feet against her swollen legs. If she leaves him alone in their bed, it gets worse. So she throws herself over him like a woman smothering a burning child with a blanket, stretching her arms and legs over his, as close to him as the baby-stomach will allow. This is the only thing that calls him back to her. In his sleep, he huddles downward to nest his cheek against her belly or her breast, and she shifts to accommodate him as best she can. In the mornings, she wakes without ever knowing that she fell asleep.

She could sleep out in the yard, right now. Lean against a tree in this warm sun, out of the wind, and just close her eyes—

“Sarah?” Galen is calling her. So she turns and walks back across the lawn to the house, crackling through the grass and leaves, thump, thumpingup the steps and across the porch. Chairs stand against the wall in the foyer, where the grandfather clock reads just after two. She comes through the door and turns to the left, to the small front parlor that’s now Galen’s office and dispensary in one. An old man’s voice wobbles through the door: “And he always told me that the bowels are—”

“Ah, Sarah,” interrupts Galen, “this is Mr. McElvain, the founding father of Eldorado. He was the first settler here and because of that the first mayor.” A tall thin old man with a stained white beard sits blinking on Galen’s examining table, his worn plaid vest buttoned tight. A long-tailed black frock coat like Mr. Lincoln’s trails over the table, and a watch chain drapes across his stomach. One link, close to the middle button, has been replaced with a loop of string. His watery gray eyes fasten on Sarah, then slide away. “So this is your wife,” he says to Galen, and smiles. “She is a lovely one for such a remote place as this, sir.” He pauses. “I named it, you know. Eldorado. Such a hopeful name.”

Sarah smiles, as if she’s never met this man before. But she has. He appeared in Galen’s office the first week they were settled in this house, asking to see the good doctor, and comes back every week since. He never remembers her. But he remembers her husband. Galen’s fulsome introduction makes him sit straighter, wobbling his mouth as if about to make a speech. She presses down a flash of irritation. Someday she too will be old and need a patient girl to help her. Won’t there always be a patient girl, sighing and setting down her knitting or her pen to rise to someone else’s task, as long as there are men whose feelings must not be hurt? As long as there are mothers to flatter and satisfy, to please?

“Sarah,” Galen says, “Mr. McElvain has asked that we note his symptoms, but to relate them he needs my undivided attention. So I ask that you act as our recording angel this morning. He’s got entries in Dr. Foster’s ledger. Do you mind?” He’s trying not to laugh: the reddish-brown hair over his forehead is trembling, and his wide mouth is quirked down, his long chin twitching. She could look at him and break that laughter loose, if she wanted. But the old man is so anxious, the one string-looped link so frail.

“Of course,” she says. “Good morning, Mr. McElvain.” She crosses to the tall cabinet behind Galen and removes Dr. Foster’s maroon-bound ledger. The pages crackle. McElvain, Philip, mutters Dr. Foster’s handwriting, 4 April 73, Dementia of which I know not the precise Cause. As ever, record the symptoms he relates: a thickening of the Stool, a “madness in the Bowels.” Then, crammed into the margin: Poor creature.

She and Galen have read this whole ledger together. “What would they think if they knew we knew so much about them?” she laughed. The wart removed from Mrs. Thorson’s upper lip (“he must have been really good,” marveled Galen, “I never would have known, to look at her”), kidney stones, oxen kicks and broken legs and sprained wrists and kettle-scalds and babies: the Thorson twins twenty-five years ago, the little Johnson girls ten and eight, the Olsons’ boys. One living, two in the tiny cemetery behind the church. Don’t think of it, Sarah commands herself. She grips the ledger, firming up her smile.

But, thankfully, the men aren’t looking at her. Galen’s face is expectant, and Mr. McElvain leans close. “The thing is,” he confides, “the bowels are such a delicate machine, when they go off it unhinges the rest of the body, and the mind…” He peers at Sarah from under his thick eyebrows. “Doctor” – he leans closer – “is it fit for her to hear this conversation?”

“Oh, Sarah often assists me,” Galen says. “Please continue.”

Mr. McElvain leans even closer. A sour whiff rises from his clothes. Since Sarah, poised over the ledger with her pen, can smell it, it must be even worse for Galen, but he doesn’t move away. “The bowels, sir,” says the old man. “They run down with age, like any machine. But one can do one’s part to keep them up. Oats, sir, for breakfast! Horses have no such complaints, and thus we learn from the beasts!” He snorts with laughter. “When I perform my morning ablutions I am careful to monitor the stool. It is a valuable indicator, sir, of the state of one’s inward body. As opposed to the outer one. When I was a Harvard man, I read all about this distinction. In the original Greek.” Sarah scribbles, sighing, Harvard man. Original Greek. Bowels, bowels, bowels.

“Well, Mr. McElvain,” intones Galen, “yours is a serious case.” The old man straightens. “So I am going to give you a rare tincture, to be taken for a week. I’ve never known it to fail. Sarah, will you reach me a bottle?”

Sarah swivels behind her and selects a tiny empty glass bottle from the cabinet. She hands it to Galen with a flourish. “Thank you, dear,” he says. Looking deliberately away from her, he opens the lid of his medicine chest, releasing a musty chemical wind. The box is heavy mahogany, two feet square, with a gold inlay in the lid and levered trays that rear up on smooth hinges when the lid is opened. In the worn purple velvet interior, vials are slotted, labeled in Galen’s hand: Fels.nap. Merc. Laud. His hand moves to the back left corner: Plac. Carefully, he draws from its slot a slim vial full of white grains, then shakes it just enough to rustle them. Mr. McElvain watches every move. “Ah,” Galen says, “how well it survived its journey West. I have to be careful; it’s like to spoil.”

“Indeed,” Sarah adds. She grins to herself, thinking of the bin in the kitchen which she and Rosa Lee dip into for cakes, pies, or a spoonful in a cup of tea, and Galen dips into to fill this vial. “It’s most valuable.”

“And necessary,” Galen says. Into the empty bottle he tips a pinch of the white grains, then funnels water down its neck, corks it, and shakes until the grains melt. “Guard it, sir,” he warns. “Take a half a spoonful once daily until it’s gone. I’ll re-examine you when the dosage has run its course.”

Mr. McElvain slips the bottle into his vest pocket and staggers to his feet. Through the long white beard, his lips tremble. Sudden tears spring to his eyes. “Sir,” he blurts, clasping Galen’s hand, “you are a very great healer. The mantle of Dr. Foster rests upon the shoulders of a suitable heir, sir. In this wilderness, healing is a rare thing.”

“And necessary,” Sarah adds.

Galen smiles at the old man and shakes his hand. “I’m privileged to practice it,” he says. “With my lovely assistant.”

Mr. McElvain turns to Sarah and bows. “Guard her, sir,” he warns. “And the child she bears. It is a wilderness but, with care, not inhospitable.”

“I’ll remember that,” says Galen gravely.

Footsteps thump up the front steps, and a tall woman – her thick hair scraped into a knot, her apron water-spotted – appears in Galen’s office door. “Oh, Papa,” she sighs. “Dr. Archer, I’m so sorry.” Her angular face burns. “I thought he was all settled in his bedroom with his books, and here I find him, again.”

“Please don’t worry,” Galen says. “He’s no bother.”

Mr. McElvain leans to Galen, frowning. “This woman,” he says, in what he thinks is a low voice, “dogs my steps like the Furies. I suspect, but cannot prove” – he leans closer still – “that she steals. My Tacitus is never in its same place, let alone my Shakespeare. And my chamber pot, sir, migrates. I find myself in her house, a house of thieves and –”

On the woman’s weary face, tears and anger chase each other back and forth. Sarah steps close and pats her on the shoulder.

“Lear, sir,” continues Mr. McElvain, oblivious. “Only Lear knew such troubles as I. Such daughters as this.”

“Bessy is doing well by you,” Sarah blurts. Why is she arguing with this poor old man? But she can’t ignore the pain on his daughter’s face. She sees Bessy every day behind her whitewashed house up the street, hanging Mr. McElvain’s clothes on the line, sees her in church, helping her father into his pew. How could you ever get used to this? To anger in your father’s eyes, to impatience, to judgment, to unknowingness, to fear? Once, Bessy was the schoolteacher in Eldorado. She’d come here with her father years ago, never married, her mother long dead. Now she takes care of him, and one of the young Norwegian pastors-in-training from the red-brick seminary up the street has charge of the children’s school. Mr. McElvain is healthy; his body will continue its burbling, cheerful life as his mind crumbles. And Bessy will keep on, just as she is.

Sarah reaches for Bessy’s hand and squeezes it; it’s long and slender, roughened with laundry and work. She leans close and murmurs a line for Bessy to recognize: “How sharper than a serpent’s tooth it is to have a thankless… father.”

Bessy smiles, blinks, and squeezes Sarah’s hand back. “Never afflict yourself to know more of it,” she returns another line, “but let his disposition have that scope that dotage gives it.”

Mr. McElvain turns to the door. “I must leave you, for the moment, but will see you anon,” he says. “My translations call.” Again, he bows to Sarah and shakes Galen’s hand, ignoring his daughter. Settling himself inside his coat, he shuffles across the foyer and down the steps out into the bright fall sun. But then he stops, peering side to side. The wind catches his long beard, lifting white wisps light as milkweed.

“I’ll be by to see you soon,” Bessy sighs, “some afternoon when he’s napping.” Sarah hugs her, and Bessy trudges out the door toward her father, taking him by the elbow. He leans against her as they walk away.

Sarah will make him smile, dispel the chill that settles over both of them as they watch the McElvains disappear. “Now, Galen,” she pretends to scold, “what happens when we run out of sugar?”

“Nonsense,” Galen says. He’s smiling, but then his eyes shade over. “Dr. Pickett taught me this. You get that old and you just want somebody to look at you.”

Sarah considers. It doesn’t seem that she, or Galen, could ever be that old. But they will have their child, and their child’s descendants, to take care of them. Will they still be here? She pictures Eldorado grown to fifty houses, a hundred, with another church, with a milliner’s and a bookshop and maybe a tea room, with the little Norwegian seminary blooming into a college, with a bigger schoolhouse full of even more children. Including theirs. But what if Galen says, again, I can’t stay here?Where will their real home, eventually, be?