When the Dawn Breaks

by Emma Fraser

Isabel hadn’t come to act as anaesthetist, as Dr Howse would very well know. She glanced at Dr Hoffman, who was listening to the exchange with his arms folded and a slightly bemused smile.

  ‘Normally I would be happy to act as anaesthetist,’ Isabel replied firmly, ‘but I feel that this time, as Dr Hoffman invited me personally to help, I should pass that honour to you.’

  Dr Howse’s eyes flashed, but Isabel returned her gaze calmly. ‘I’m convinced,’ she continued, ‘that there will be other opportunities for you to act as Dr Hoffman’s assistant. And, besides, judging from the number of patients waiting in the corridor to see you, you have a full day’s work ahead.’

  Now, unless Dr Howse was prepared to argue and risk losing face, she had no alternative but to back down. Isabel felt a pang of sympathy for her, but Dr Howse would have done exactly the same had she been in Isabel’s shoes. Every woman had to fight for her career and Isabel would never realise her dream of becoming a surgeon unless she seized every opportunity to operate.

  ‘This is all most irregular,’ Sister Goody protested.

  ‘Irregular or not,’ Baron Hoffman responded, ‘it is what I wish.’

  ‘Very well,’ Dr Howse replied. ‘I shall, of course, be happy to act as anaesthetist. In the meantime, as Dr MacKenzie has pointed out, I have patients to attend to. I assume you wish to examine your patient first.’ She looked at Dr Hoffman, who nodded. ‘In that case, I shall meet you in theatre in an hour.’

  As Dr Howse marched out of the room, followed closely by Sister Goody, Isabel caught the baron’s eye.

  ‘You were not joking when you said last night that women doctors fight over patients,’ he observed.

  ‘If I wish to be a surgeon,’ Isabel replied, aware her cheeks were red, ‘I must have operating experience. I may never have another opportunity to watch someone of your skill.’

  ‘Somehow, Dr MacKenzie, I doubt you’re trying to flatter me. Now, shall we go and see our patient?’

  In the ward, around forty men were either playing cards at a table in the middle of the room or sitting on chairs while three women, in workhouse grey, fussed around them, trying to get them into bed. Isabel suppressed a smile. It didn’t seem to matter which hospital or ward one was in, the sister always liked to have the patients in bed and ready for the doctor. Sister Goody swept towards them. No doubt this was why she’d been in a hurry to leave them. She might not have bothered for the women doctors but Dr Hoffman was clearly another matter.

  Sister led them to the bed nearest the door. A man in his early sixties was lying on his side, clutching his stomach and groaning.

  ‘Please sit up, Kennedy,’ the nursing sister said sharply. ‘The doctor is here to see you.’

  Goody by name, but not by nature.

  As the man struggled onto his elbows, the baron reached across and pressed him gently back. ‘Lie there, Mr Kennedy. I’ll do the work.’ He looked over his shoulder. ‘Are there screens, Sister?’

  ‘I’m afraid not, but Kennedy won’t mind.’

  Dr Hoffman frowned. ‘We spoke about screens before, Sister. I prefer my patients to have privacy while I’m examining them.’

  ‘And, as I said, our little infirmary is short of funds. We do what we can with what we’re given. Now, if you’ll excuse me, I must get on.’ The rebuke, mild though it was, had brought two spots of colour to her cheeks.

  Isabel was relieved when she departed. She’d heard about poorhouse conditions: that there were only two trained nurses to look after almost four hundred patients; that most of the nursing was carried out by untrained paupers; the only doctor was expected to see to all the patients, assess those needing admission to the workhouse as well as carry out operations. Undoubtedly an impossible task.

  Dr Hoffman stood back from the bed. ‘Would you like to examine our patient and tell me what you think?’

  Isabel studied the man. Papa had always said it was important to do that before anything else. Mr Kennedy was gaunt and had a smear of encrusted blood at the corner of his mouth.

  ‘You’ve been bringing up blood, Mr Kennedy?’ Isabel asked, feeling for his pulse. Rapid and shallow. A possible sign of shock.

  ‘Aye, Miss. This last month or so.’

  ‘What colour is the blood?’

  Mr Kennedy looked to Dr Hoffman, as if asking for his help. ‘Red, Miss. What other colour of blood is there?’

  ‘Bright red? Or dark, like coffee.’

  ‘Come to think of it, it’s a bit like coffee. Not that I’ve ever drunk much of the stuff. I prefer my ale.’

  ‘And you have pain?’ She dropped his wrist. ‘Let me feel your stomach.’

  ‘Feel away, lass. Anything to make the pain go away. It hurts something terrible.’

  Isabel had been watching the way Kennedy moved and had noted the rigidity of his abdominal muscles even as he spoke. She palpated the lower right of his abdomen across then upwards, all the while watching his face. He winced as she pressed in the centre, just below the ribs. ‘Is that where it hurts?’

  ‘Aye, lass. Like buggery. Begging your pardon, Miss.’

  ‘I think he has a perforated ulcer,’ Isabel said to the baron.

  Dr Hoffman nodded, looking pleased. ‘And your treatment?’

  ‘I’m assuming you’re thinking of operating.’

  ‘And you’d assume correctly.’

  ‘I’m not having no operation!’ Mr Kennedy protested, clearly terrified. ‘You cut me open and the only way I’ll be leaving here is in a box.’

  ‘Mr Kennedy,’ Dr Hoffman said calmly, ‘as I explained yesterday, an operation is your best chance. If we don’t remove the ulcer it will continue to bleed. And if it continues to bleed…’ he glanced at Isabel, ‘…well, we don’t want that.’

  ‘I’ll be fine without any operation,’ Mr Kennedy protested again, his eyes wild and staring. ‘Just give me summat for the pain. That’s all I want. You doctors just want to practise on the likes o’ me, and I’m telling you, you can’t.’

  ‘Mr Kennedy, if you don’t let us stop the bleeding you will die,’ Dr Hoffman said baldly.

  Isabel took the man’s hand. ‘The treatment Dr Hoffman is suggesting is a new procedure but has been very successful in Germany.’ There are not many surgeons in this country with the skill and experience of Dr Hoffman, so you’re very lucky to have him as your surgeon.’

  Mr Kennedy looked up at Isabel. ‘What would you say, lass, if I were your da? Would you let the doctor operate?’

  ‘If you were my father I would have no hesitation in recommending the operation. It’s your only chance. You could live for many more years if you let us stop the bleeding. There’s nothing else we can do, I promise you.’

  Mr Kennedy stared into Isabel’s eyes and she returned his gaze steadily. She couldn’t promise him he’d survive the operation, but she did know he wouldn’t last much longer without it.

  Mr Kennedy sighed. He lifted his spittoon and spat a glob of bloody mucus. ‘Very well, then, Doctor. Do what you think best.’

  Dr Hoffman patted his shoulder. ‘I’m going to check that the theatre is ready for us. I shall see you down there shortly.’ He gestured to Sister Goody, who scurried over to them. ‘I’d like this man to be taken to theatre as soon as possible, Sister.’ He turned away and Isabel followed him out of the ward.

  The theatre was small but adequately, if not lavishly, supplied.

  Dr Howse was waiting for them, already wearing her long white theatre gown and hat. Isabel and Dr Hoffman scrubbed up and slipped into their white gowns and hats. After that they pulled on sterile rubber gloves.

  A wary but resigned Mr Kennedy was brought into theatre by Sister Goody and settled on the operating table. He struggled a little when Dr Howse administered the chloroform but after a minute or two he was unconscious.

  Dr Hoffman sliced into Kennedy’s belly. It was immediately obvious that there was a perforated ulcer, the stomach contents almost bursting out through the abdominal incision.


  ‘Why don’t you take over, Dr MacKenzie?’

  Pleased to be invited, Isabel lifted a scalpel and, running through the anatomy of the upper abdomen in her head, cut away the perforation. When she had finished, Dr Hoffman sutured the cut ends of the stomach together. He turned to Isabel.

  ‘Are you happy to close the abdomen, Doctor?’

  She nodded, took the needle-holder and dissecting forceps from him and closed the wound. She was thrilled with her first attempt at surgery.

  But if Dr Hoffman was impressed, he didn’t show it. All she got was a brief ‘Good’, as she placed the final suture and applied the dressings. As Kennedy began to come around, Dr Howse left them to see to her other patients.

  When the operation was over and a groggy Mr Kennedy had been returned to the ward, Dr Hoffman looked at his watch. ‘I have to go back to the Royal. I could drop you at home on the way.’

  ‘Yes, please,’ Isabel said, eyeing the pouring rain through the small window. ‘But first I must clean up here.’

  ‘And I must leave instructions for Dr Howse regarding Mr Kennedy’s care. I’ll meet you at the front door. I shall be but a few minutes.’

  Once they were in the carriage, Isabel studied Dr Hoffman from under her lashes. He was an excellent surgeon and teacher. ‘Thank you for allowing me to assist you,’ she said.

  ‘The pleasure was mine. You have the delicate touch of a surgeon.’

  Isabel felt a pulse of delight at the compliment.

  ‘If you wish to assist again, I shall be pleased,’ Dr Hoffman continued.

  ‘I should like that very much.’

  Dr Hoffman leaned forward until his knees were almost touching Isabel’s. ‘Good. Now, am I to see you this evening? At the Glendales’ party?’

  ‘I know you’ll think me dull, but I have a great deal of reading to catch up on.’ Despite her mother’s wishes, she couldn’t bear to spend an evening with Simon and his family. What if they spoke to her of Charles? How could she possibly smile and not let her revulsion show on hearing his name?

  A small smile played on Dr Hoffman’s lips. ‘My dear Dr MacKenzie, I doubt anyone could consider you dull.’

  Chapter 21

  The baron’s courting was slow and gentle but unrelenting.

  The spring weather was warm, and as summer approached, it became hot. Hotter than anyone could remember. With her studies behind her, Isabel was freer than she had been in years to attend tennis parties, lunches and dances. Until now she had avoided social occasions, pleading her studies or work, but with Maximilian her constant companion she found herself truly enjoying everything Edinburgh society had to offer. Occasionally she would go out walking with him, always accompanied by Ellie, who would discreetly lag behind, and on Sundays he would join Isabel and Mama for the morning service at St Giles Cathedral.

  Most afternoons he called at the house in Heriot Row and took tea with them. Sometimes he stayed for dinner, and she found herself listening out for the doorbell. When it rang she would put aside her book and go into the drawing room, where she’d find him listening attentively to her mother.

  Whenever she could she went with him to the poorhouse and assisted him with his scheduled surgeries. Increasingly she operated while he watched, guiding her hand with his own if ever she hesitated.

  He had made it clear he wanted more than her company at the operating table, and in the beginning it had frightened her: she had sworn never to marry. But, as he made no mention of this, she could hardly raise the subject. She told herself that he would return to Germany one day, and in the meantime she was gaining valuable practice as a surgeon. She had made no promises to him, or shown him anything but polite friendship, so her behaviour could not be faulted – but that did nothing to dispel her unease that she was playing false with him in some way.

  Christmas had come and gone, and because of the experience she’d gained from assisting Maximilian, she was increasingly allowed to do small operations on her own at the Bruntsfield Hospital. Whenever thoughts of Charles or Archie crept into her head she pushed them away. There was nothing, she’d decided, to be done.

  True to their word, Andrew and Simon had joined the Royal Flying Corps and become pilots. The corps kept them too busy for more than the briefest visits to Edinburgh and, as Simon’s family had returned to London, Isabel had avoided any further invitations to the Maxwells’ house in Charlotte Square.

  Maximilian was delighted when she practised her German on him, even if, at times, he couldn’t altogether hide his amusement when she mispronounced a word or chose the wrong one. Although they were never alone his hand would often brush hers or their eyes would meet as they smiled over some little incident they had both thought amusing.

  As summer wore on there was more talk of war, although they never spoke of it.

  One day in July she returned home to find him in his habitual position in the drawing room. However, instead of his usual smile, he looked pensive, and she saw a sadness in his eyes that made her heart wobble.

  ‘I wonder, Mrs MacKenzie, if I might have your permission to take your daughter for a walk tomorrow. I have never been up Arthur’s Seat and I would like to before I leave Edinburgh.’

  ‘Leave?’ Isabel’s breath caught in her throat. She had known, of course, that one day Maximilian would return to Germany for good. But not yet. Please, God, not yet.

  He grimaced. ‘My hospital is insisting that I return.’

  ‘Why?’

  He tossed his half-smoked cigar into the fire. ‘They are recalling all doctors. It seems that the threat of war is increasing.’

  Isabel sank down on a chair. ‘You think it will come to that?’

  ‘I hope not.’ The shadows in his eyes told her everything she needed to know. He was certain there would be war. ‘But what do you say?’ he continued. ‘Will you come with me tomorrow? It promises to be another fine day.’

  ‘Isabel likes to walk,’ her mother said, excited and delighted. ‘As long as her maid goes too, of course.’ She turned to Isabel. ‘You must wrap up warmly, my dear. The wind can be cold on top of the hills.’

  Isabel hid a smile. Her mother still didn’t think she was old enough to make decisions for herself. In this warm weather it was unlikely she would require a coat. She was far more likely to feel overheated in her layers.

  ‘I should like very much to walk up Arthur’s Seat with you,’ Isabel said. If her time with Maximilian was running out, she wanted to be with him as much as she could.

  ‘Now that that’s settled,’ her mother said, with a satisfied smile, ‘won’t you stay and have supper with us, Baron?’

  The next morning was, as Maximilian had predicted, another perfect early-summer’s day.

  Isabel hadn’t slept well. She’d been unable to stop thinking of the look in Maximilian’s eyes when he had suggested the walk. Would he propose? If he did, what would she say? They had many interests in common, apart from medicine, and she found him easy company. She liked the way his eyes creased at the corners when he smiled, his ferocious intelligence, his manner towards his patients, the way he listened to Mama, as if he were fascinated by what she had to tell him, but most of all she liked how he made her feel as if she were the most captivating woman in the world. In so many ways he reminded her of her Papa.

  But she’d sworn she wouldn’t get married. The thought of the physical act that came with marriage terrified her. Could she respond to him as she was supposed to? She knew that the act of love with the right man was supposed to be gentle and satisfying, and she kept telling herself that Maximilian would never touch her as Charles had, but still her mind shied away from the thought of any man’s hands on her naked skin.

  But Maximilian cared for her, perhaps even loved her. He was a rare man, someone who valued women as equals, and who could make her happy.

  Ellie came into the room to light the fire and help her dress. For once Isabel was undecided about what she should wear. But, as if she knew today was special, Elli
e had brought in Isabel’s new dress, a beautifully cut pastel blue silk. Even though she took little interest in the latest fashions, the beading on the bodice was exquisite and the touches of the finest Parisian lace on the sleeves and neck just right.

  With expert hands, Ellie arranged her hair so that it curled softly against her cheeks. The maid stood back and surveyed her handiwork. ‘Oh, Miss, you look beautiful.’

  Isabel smiled. ‘Thank you, Ellie.’ She did feel beautiful.

  By the time she had finished breakfast, she knew what she would do. If Maximilian proposed marriage, she would say yes. She would love and cherish him and be the best wife possible. Her spirits rose as she thought of them working together as they cared for their patients. They would end their day by the fire talking of medicine and then … Her thoughts shied away again. She wouldn’t think about that.

  Nevertheless, she was glad that Ellie was to accompany them. She would never again make the mistake of being alone with a man before she was married. In becoming a doctor she was already bordering on the cusp of what respectable women could do, and she couldn’t afford the merest whiff of scandal to be attached to her name. She had come close once to having her reputation ruined and her dream of becoming a doctor shattered, and she would never allow that to happen again.

  Ellie jumped up beside the driver while Maximilian settled Isabel into the open carriage, tucking the skirt of her dress out of the way of the door. His hands brushed against her thighs, and even through her clothes, her skin tingled.

  ‘How has your week been?’ he asked, somewhat stiffly for him, as they set off towards Arthur’s Seat.

  Isabel was almost halfway through her residency at Leith Hospital. She had been lucky to get the position: there was so much competition among the women for decent jobs and Leith was currently the only hospital in Edinburgh apart from Bruntsfield that accepted female doctors. But Dr Inglis had been so impressed with her – not least because of her growing surgical skills – that she had recommended her for a position. Most of Isabel’s fellow graduates had taken posts as missionary doctors or as residents in poorhouses and asylums. A lucky few, who had financial backing from their families, had set up in practice.