Fighting for Life

by S. Josephine Baker

  But even more important than such fertile association with potentially first-class doctors was the general training in sound, shrewdly acquired knowledge. That was implicit in everything that happened—sometimes gradually and solemnly, sometimes ironically. For instance, in my student days I was one of those people who liked to suspect that most inhabitants of insane asylums are as sane as those outside and that, in many cases, scheming relatives or people unwilling to be bothered by the more eccentric kind of human being used the asylum as an unjustified answer to selfish impulses. On one occasion, when we students were going through an insane asylum, I went out of my way to mention to one of the resident physicians that the inmates looked and sounded quite as sane as I was.

  “You do get that impression,” he said. “If you want to try it out—well, choose anybody you like and talk to him and give me your opinion on him. But mind you, you must talk to him at least ten minutes before you make up your mind.”

  I chose my man—a quiet, easy-mannered individual to whom I found myself talking as sanely and conventionally as if I had just met him at a social party. He spoke of this and that and then asked me to get in touch with a certain person “outside” who would make a real effort to get him out, if only his plight could be properly represented. I wrote down the address of the “outside” person very carefully and listened while the inmate explained just how he had been railroaded into the asylum.

  “But,” I asked, “why did they want to treat you that way?”

  “Ah,” he said, “that’s the story. They wanted to get my invention out of my hands.”

  “Your invention?” I asked.

  “Yes,” he said, “it’ll make their fortunes. It’s the greatest thing since the steam-engine. I have invented and perfected the wonder of the age—a paper lining for lamp-chimneys, to make them easier to clean.”

  Perhaps that is a little too farcical to be real irony. But irony is certainly present in the fact that the one subject I failed in medical school was to be the foundation of my life-work. This was related to a course, during my sophomore year, on “The Normal Child,” given by Dr. Annie Sturges Daniel, a pioneer woman physician who is loved and honored by every student who came under her influence. Dr. Daniel’s course was an uncharted sea and I had no interest in it; neither had anyone else so far as I could discover except Dr. Daniel herself. No other college had such a course and anything normal seemed far removed from the subjects that medical colleges had to teach in those days. There was, naturally, no textbook on the subject, with one minor exception which did not seem either interesting or informative. There were Dr. Daniel’s lectures, to be sure, but they seemed to have little bearing upon the future career of a would-be doctor. It was a subject far in advance of the time and Dr. Daniel had practically invented it herself, believing as she did that no doctor could be reasonably intelligent about abnormal children until he, or she, knew what the normal child might be like. The intellectual soundness of that position left my callous young mind cold and disinterested and, as a result, I “flunked” that course because I had done no work in it at all.

  That was my first, and only, failure. It not only gave a severe jolt to my pride but roused in me a fierce anger at having to take the course over again the following year. I made up my mind that, stupid as it might seem, I intended to learn all there was to know about the normal child. I took voluminous notes on the lectures; I read everything I could find that had the slightest relation to the subject, combing all the available libraries for scraps of information about that unusual phenomenon. The lectures, I discovered, once I started listening to them, were very fine; the bits of sought-out information most intriguing. As a result, that little pest, the normal child, made such a dent on my consciousness that it was he, rather than my lame knee, who is undoubtedly responsible for the survival of those 90,000 babies the reporter mentioned. The whole procedure of preventive hygiene which I was later to install in modern child care certainly had its inspiration in that half-year of pique and hard work. Everything that Dr. Daniel taught me in 1895 is still truer than ever in 1939. Neither she nor I had any idea that she was preparing me for thirty years of child welfare crusading. But, when the opportunity came, I was ready and eager for it and I, as well as the babies, owe a debt of gratitude to Dr. Daniel which I can never repay.

  Some day, someone will write the epic story of the medical student. It will come from a doctor, of course, but it will be written, I think, by someone whose student days are far in the background. I am not the one, for it all seems very hazy and unreal to me now. I know there were four long years of grinding study, four years of irresponsible happiness, and four years so remote from the real work of the world that one might as well have been in a convent.

  Many among those who taught me stand out in my memory: Dr. Gertrude B. Kelly, the friend of all lost causes, whose personal charm and beauty made her seem like a shy young girl and who yet contrived to be such a valiant fighter for the underdog that, when I spoke at her funeral a few years ago, I found my fellow speakers were representatives of the fighting Irish, determined Jews, radicals of all degrees, ex-prisoners for political so-called “crimes,” and even atheists—all loving her and all proud to be called her friends. I remember one day when she had a friend call me over the telephone to tell me she was in jail, arrested for blocking Fifth Avenue traffic as she carried a huge banner calling attention to some social wrong, and asking me to go to Jefferson Market Court to act as a character witness for her. I found her as gay and amused as always. The charge was dismissed, but not until Dr. Kelly had whispered in my ear: “I loved being in jail. I was only there for three hours and I sold four thousand dollars’ worth of Irish bonds to the other prisoners.” She was a lovely soul. Among the others who made a definite imprint on my young mind, a few still stand out: Dr. Henry Mann Silver, Dr. George Roe Lockwood, Miss Chevalier—who could make even chemistry interesting, Dr. Martha Wollstein, Dr. Alice Wakefield, Dr. Emily Lewi, Dr. Eleanor B. Kilham, and Dr. Elizabeth Cushier. There were hosts of others, to be sure, but these are the ones to whom I am most indebted.

  At last, in the spring of 1898, my coveted diploma was given me. I was a real doctor at last—or so I thought then.

  * Pioneer Work, by Dr. Elizabeth Blackwell. E. P. Dutton & Co. New York.

  CHAPTER III

  THE PRIVILEGE AND HONOR OF WRITING M.D. after his name is always a great spiritual comfort to the newly graduated medical student. It was a particular joy to me because so many inhabitants of Poughkeepsie had prophesied that I would never go through with it; and were now greeting the news that I had done so with rather scant appreciation. In spite of all the impressive Latin on the sheepskin, however, “M.D.” in itself does not mean much. A student fresh out of medical school is no more a doctor than a man who has taught himself to go through swimming motions across a chair is a swimmer. That, of course, is why experience either as interne in a hospital or other graduate experience is almost an essential before beginning actual practice. The average year of routine interning may not teach you a great deal but it does clarify all that you have learned and give you the time and opportunity to turn theory into practice.

  So I became an interne, addressed as Dr. Baker for the first time, wearing a white uniform and doing actual work in a hospital. Since I had graduated second in a class of eighteen (the rest of the thirty-five had fallen by the wayside), I was offered a fine interneship in the New York Infirmary for Women and Children, the hospital in connection with the college where I had taken my degree. But I felt that I needed to cut away from this familiar environment, to which I had devoted four whole years, that I needed new associates and a new point of view. That idea took me to Boston where I applied for, and obtained, a position as interne in the New England Hospital for Women and Children. There was no question of getting into a large general hospital. At that time no such institution admitted women in any capacity. Strange as it may sound in this year of 1939, few enough of them have yet seen the l
ight sufficiently to admit women.

  Still, the New England Hospital fitted my needs admirably. It was staffed entirely by women of first-rate calibre. The superintendent of nurses was Miss Clara Noyes who, when she died last year, was superintendent of nurses of the American Red Cross. It provided a wide range of medical, surgical and obstetrical work, which is always the best possible training for an interne. I grew very keen about surgery now that I had an opportunity of meeting its problems; it is clean, definite work with visible results and a consciousness of direct accomplishment. When you remove an appendix or amputate a leg you have done the indicated thing for good and all, whereas, in handling medical cases, at best, it is a matter of being a watchman always and the help one can give, with the best intentions in the world, must vary. If I had been exposed to the modern cult for specialization, I should probably have become a woman-surgeon, several of whom have made great names for themselves. I have great sympathy with and understanding of the fact that the majority of medical students make surgery their goal. But as it was, I thought of nothing beyond preparing myself for general practice and of making up sleep on that half-day a week when an interne was not on call. There was little question of amusement during one’s time off; both energy and money were lacking.

  Part of our service was three months of duty in the out-practice department. We spent this time in a completely equipped clinic in Fayette Street, Boston, which served a huge poverty-stricken clientele drawn from among the inhabitants of Boston’s worst slums, which were quite as bad as any in the country at that time. This was hard work and, when your financial resources were as slim as mine were, you got little enough nourishment for fuel to do it on. Each interne was given four dollars a week to feed herself. Things were cheaper then than now, but even so we were in no danger of over-eating. Dr. Florence Laighton, a fellow interne, and I went in on a system to make it last as long as possible. Six days a week we ate at the Y. W. C. A., which cost three dollars, largely for indeterminate stews, baked beans, bread and stewed prunes. I really have not cared for beans since. Then, on Sunday, when we were both certain that we could not stand this kind of fare any longer, we would spend our remaining dollar apiece and have one good meal at the old Thorndike Hotel which would help us to survive until the following Sunday.

  That was only one of the ways in which I had now to adjust myself to a kind of reality of which I had never dreamed at home, or at medical school either. For the first time in my life I was really up against facts. No student, whether in law or medicine, is living a real life. An academic atmosphere is necessarily artificial. Here, in Boston, submerged in the hectic life of a big clinic, I was abruptly forced to translate what I had studied into actuality, to realize that the luridly colored pictures in ponderous medical texts meant actual fever and pain and delirium and mutilation, and that those crisp summaries of what to do about this or that physical ailment, which had sounded so reassuring on the printed page, were of distressingly little help to an inexperienced beginner. It was all the more discouraging because the raw material we worked with on Fayette Street was anything but pretty. We were dealing with the dregs of Boston, ignorant, shiftless, settled irrevocably into surly degradation. Just to make sure they would be hopeless, many of them drank savagely. Having borne children and lived and fought and made love regardless, they took that method of dodging the consequences. Nothing admirable about it, but one could not honestly blame them for making use of alcohol as an anaesthetic.

  In time I got used to it, if not hardened to it. But, for the first few weeks at the clinic, my inexperienced and still reasonably girlish soul was aghast at the discovery that, with these people, any and every calamity was such a matter of course. There was the Irishwoman who came to the Hospital to be delivered of a baby. She looked much too old for motherhood, but then you get wrinkled and bent quickly under the conditions she had always known. On admission she proved to have both feet badly burned in addition to her other difficulties. I asked her how the burns happened. “Well, deary,” she said, “I come in a night or two ago with me feet wet and I stuck thim in the oven to dry thim and forgot thim.” Drunk, no doubt, drifting peacefully off into an alcoholic fog with a new life in her waiting to be born, and much too numb to know that her feet were blistering in the oven. Numb—that seems to be the right word for all of them.

  Presently I signalized my new acquaintance with reality by committing murder—to all intents and purposes. That came about with appalling naturalness. It was another obstetrical case, a routine hurry call to come to a woman who was about to have a baby. A man with a long beard brought the message. He silently guided me through snow-choked alleyways to an old frame house hidden in a court. As soon as he saw me started up to the top floor, he went away; I had the idea that he was afraid to accompany me for some reason. But I went on up the stairs, feeling with my feet for loose boards and holes in the enveloping darkness, and found my patient at last.

  I thought I already knew something about how filthy a tenement room could be. But this was something special, particularly in the amount of insect life. One dingy oil lamp, by the light of which I could barely make out the woman in labor, lying on a heap of straw in one corner. Four stunted children, too frightened to make any noise, huddled together in a far corner. The floor was littered with scraps of food, too old to be easily identifiable, but all contributing to the odor of the place. Cockroaches and bed-bugs crawled about everywhere. The only thing to wash up in was, as usual, an old tin basin, rusted and ragged at the edge. All of it was the nth power of abject, discouraged squalor. But the ugliest detail was a man, also lying on the floor because he was apparently too drunk to get up. But he was all too capable of speech.

  The moment I approached my patient I discovered that her back was one raw, festering sore. She said that her husband had thrown a kettle of scalding water over her a few days before. That accusation brought him to his feet crazy with rage, threatening me and her, toppling and lurching all over the place.

  I knew that could not go on. I had to get him out of the way. As he wavered toward me, waving his clenched fist and uttering verbal filth, I ran out into the hall. He followed as I had intended. I had thought of running in quickly again and seeing if the door would lock. But then, as he lurched after me, he crossed the stair-head and, with instinctive reaction, I doubled my fist and hit him. It was beautifully timed. I weighed hardly half as much as he, but he was practically incapable of standing up, and this frantic tap of mine was strategically placed. He toppled backward, struck about a third of the way down the rather long stair and slid to the bottom with a hideous crash. Then there was absolute silence. I had taken my opportunity and the result was evident. I went back into the room, pushed a piece of furniture against the closed door and delivered the baby undisturbed.

  Under stress of this emergency work, I did not have much time to speculate on what had happened to my victim. Only when the delivery was finished, the room partly cleaned up, the children cared for and the patient made relatively comfortable, did I collect my wits enough to start meditating on the fact that I had probably killed a man. I suppose it should have sickened me with anxiety but I was too tired to make emotional sense of the situation. It had been sheer reflex instinct; he was in the way and not fit to live anyhow and I had taken the first handy means of getting rid of him. I was not sorry; I was not glad either—it had just been part of the exigencies of this particular job. Well, I thought, as calmly as I could, there is the end of your medical career and probably jail to follow.

  By the time I reached the head of the stairs on my way out, however, I did comprehend that the body was down in the hall and that something probably ought to be done about it. So I went and knocked at a door across the hall. A man appeared, half dressed, apparently too sleepy to be startled by my telling him that I had killed his next door neighbor. He just said “humph” and went downstairs with me to find out what it was all about. There was the body lying motionless as I expected, crumpled against
the wall where it had struck head-foremost. My escort scowled and gave it a kick in the ribs. It still did not move. But it did emit a gust of bass profanity which was the sweetest sound I ever heard in my life. Only then, when I realized that he was not dead, did I fully realize what it would have meant to have killed him. I think that in those relatively few moments I did more growing up than I had done in my previous twenty-odd years.

  At the end of our year as internes, Dr. Laighton and I went back to New York to seek what advice we could get about the chance of our starting to practice in that city. Our old professors at the medical college, our acquaintances among established practitioners, all said the same thing: “If you have enough money to support yourselves for five years entirely and for another five years in part, you stand a fighting chance in New York. If you haven’t, New York is hopeless. Go to some small town and do the best you can.” In my case only a few hundreds remained of the $5,000 I had taken from my father’s estate. Dr. Laighton was little better off. The obvious thing was to return to Poughkeepsie where being well known would give me a favorable start. But I liked New York; I have always liked it in spite of its noise, its confusion and its seeming indifference. We had the usual resiliency of youth and we discarded this wise advice. We thanked all of our advisers and rented an apartment on West Ninety-first Street, near Central Park, took a few weeks off to pass our State Regents’ examinations, hung out our shingles and, with inexplicable equanimity, had no fear at all for the future. Dr. Laighton’s family gave us enough money to furnish the place and equip our office and we had every intention of staying. It was just imbecile optimism. The advice we had received was all too sound. I would give it myself in about the same words to any young doctors who asked me what to do nowadays. And they would probably refuse to act upon it just as we did.