He clamped the colon on either side of the abscess and then, still using the scalpel with which he had cut through the outer skin, he excised the section. After reaching into his case for a length of silk suture and a needle, he stitched up the anastomosis. From there, Burleigh closed the incision in layers, sealing the giant opening with stitches far too large, in each case using the same needle and suture.
When he was near the end, Burleigh asked for the time. The entire operation had taken under forty minutes. He seemed disappointed and glared at Corrigan and the other assistants. When he had tied off the last external suture and the ether cone was removed, Burleigh nodded at the assistant keeping time and stepped back. Blood was everywhere, on the table, the floor, and soaking everyone’s clothing.
Burleigh turned and faced the gallery. “As you can see,” he exclaimed proudly, “the operation was a success.”
Even before the last syllable was out, the Professor was on his feet. “We can go now,” he said to me softly. As we left, I could feel Burleigh’s eyes on my back.
Once we were out in the hall, the Professor asked, “So, Doctor, what did you think?”
“Ghastly. The entire process was highly septic, he used the wrong instruments, tissue trauma was severe, he did not examine the affected area for additional damage, and the stitching was worse than could have been achieved by an inebriated seamstress.” I might have added that my indignation at watching Burleigh at work had shocked the last aftereffects of drink right out of my system.
“And the result?” The Professor was attempting to speak evenly, but he was so angry that his face had gone pale and his mustache quivered.
“The patient will be disfigured for life.”
“No. The patient will die. I would say, Ephraim, that it was the most appalling piece of surgery I have ever seen, but unfortunately I have been forced to witness all too many other examples.” He pounded a fist into his hand. “Damn!”
“How can Burleigh be allowed to continue here?” I asked.
“Because he’s been here for four decades, that’s why,” the Professor fumed. “There is a ridiculous reluctance among some in authority to toss out someone with whom they regularly share dinner and a sherry, even if he kills or mutilates his patients. Agnew tried to have him dismissed in ‘85, but Burleigh’s friends on the board shrieked blasphemy.”
“They should be forced to sample his methods,” I said.
“Doctor, there is nothing more important than to obtain the best men in our profession, not just to treat patients but also to train the next generation. Do you understand? Nothing! That human beings are forced to endure the horrors of inept surgery is criminal. I would move mountains not to have to see the results of such butchery in the wards. And we would not in any surgical department with Halsted in charge.” He cocked his head toward the operating theater we had just left. “This answers your questions about Halsted’s fitness, I presume?”
It did. There would be no Wilberforce Burleighs at Johns Hopkins—but there would be an Ephraim Carroll. As the Professor walked down the corridor and disappeared around the corner, the words assistant head of clinical medicine played in my ears.
CHAPTER 5
AN ASSISTANT HEAD OF CLINICAL medicine cannot allow his energies to flag. I decided to busy myself with patients through the afternoon, head for the doctors’ dining room at about six—where my choice, as always, would be overcooked pork chops or dried roasted chicken—and then spend the evening at the library or the forensic laboratory. I had also resolved to satisfy my curiosity on another matter, but needed to wait until well into the night to do it.
Planning cannot stand up to circumstance, however. My odd and tumultuous day took an additional twist when, just after Dr. Osler’s departure, Simpson appeared at the other end of the hall. She beckoned me to join her.
“I’ve been hoping to speak to you,” she began. Simpson, even in her uniform, now appeared to me as she had the previous day at tea—amber-flecked eyes and sorrel hair. “I thought I might reciprocate your offer. Are you free this evening? Or do you intend to repeat last night’s bacchanalia?”
“I do not expect to repeat that for some considerable time,” I observed, “but I was planning on reading case histories and studying tissue samples.”
“Reluctant though I am to draw you away from scholarly pursuits,” she replied, “I believe that I can offer you an alternative equally illuminating.”
I pressed to find out what she meant, but Simpson demurred, so I assured her that I would be pleased to accept her invitation and asked when and where I should come with a carriage.
“That won’t be necessary,” she replied. “I’ll come for you. Be out front at five forty-five.” She dismissed my protests with a wave of her hand. “Consider it a step into a new world,” she said.
Although there was much to do, I confess that curiosity as to what Simpson had in store kept intruding into my concentration and I found myself awaiting our rendezvous with mounting anticipation. At five-thirty, just before I went to change my clothes, I checked in on Burleigh’s patient. The nurse on duty told me that Mr. Whitbread was running a fever of 101 and that his blood pressure was low. I considered sending a messenger to Burleigh’s home, but what good would it do? Burleigh wouldn’t come and the poor wretch had already gone septic. Dr. Osler had been correct. Nothing could save Mr. Whitbread now. I ordered Antifebrin to control the fever, and then silently said a prayer over him before leaving the ward.
Promptly at the appointed hour, Simpson pulled up in front of the hospital in what seemed to be a private carriage driven by an aging man with gray whiskers and a disinterested air. Carriage, driver, and horse, while not exuding prosperity, seemed well-kept and functional—much, I realized, like Simpson herself. I stepped in and the carriage took off, the driver heading south for a destination that Simpson refused to divulge.
When I asked Simpson who owned the carriage, she replied tersely, “Friends of mine.”
We crossed the Schuylkill at the South Street bridge and continued south and west along Mifflin Street until just before South Twenty-second Street, where the carriage made a turn and pulled up in front of a three-story, brown clapboard building. Two women and three small children stood on the sidewalk outside. The women waved hello when they saw my companion.
“Where are we?” I asked her.
“You seemed confused as to the parameters of domestic fulfillment,” Simpson replied. “I thought a visit here might help clarify the question.”
Simpson alighted first and, before she went up the steps to the door, the children ran to her. She said hello to each of them by name. I followed her and my suspicion that this was no rooming house was confirmed the instant we entered.
The front hall led down the center of the building, with a staircase to the right. I saw at least six more children on the stairs or popping into or out of one of the rooms to either side of the hall. Two women moved between the rooms, occupied with some chore or other. The décor, I noticed, while not costly, was cheery and feminine—light colors, with a good deal of frill. The wallpaper in the halls was pale yellow festooned with cherubs.
“This is an orphanage,” I offered, as Simpson led me into a parlor on the left of the hall.
She did not reply. Instead, she bade me sit in a chair near the fireplace and asked if I cared for a cup of tea. I thanked her, hung my coat and hat on a tree near the door, and took a seat.
“I’ll be right back,” she said, and ducked back into the hall. I was left waiting for a minute or two, during which time a boy and girl, each about seven or eight, peered in the doorway at me, then withdrew.
When Simpson returned, she was holding two cups of tea. “This is the Croskey Street Settlement House,” she informed me as she placed the cups on the table and sat across from me. “It is not an orphanage. The children you see here live with their mothers. This building is part residence, part clinic, and part school.”
“And the fathers?”
“The fathers are not present.”
“This is reminiscent of a similar establishment for fallen women that I knew on the West Side of Chicago.”
“‘Fallen women,’” Simpson repeated with a shake of the head. “Ephraim, could you please define a ‘fallen woman’ for me?”
“It is merely a phrase,” I answered, trying to sound casual but knowing I had misspoken again. “To describe a woman who has a child out of wedlock. I presume that is who lives here.”
“A phrase indeed,” Simpson replied coldly. “A particularly insulting phrase.” She shook her head slightly, as if trying to comprehend my stupidity. I realized suddenly that, in these matters, I knew nothing at all. “Do you consider the men who cause these women to have children out of wedlock to be fallen as well?” she asked.
Did I? What if fortune had played against me in Chicago? What if Wanda had been telling the truth about her pregnancy? Would I have married her then? “Not fallen, no,” I replied, “but certainly beneath contempt and utterly without honor.”
“But less culpable than the women …”
“No,” I said, the vitriol in my response containing a measure of self-reproach. “More.”
“A noble sentiment, Ephraim, but you are nonetheless misguided,” Simpson said patiently, but with frustration, sounding like Dr. Osler lecturing the callow Farnshaw. “The correct answer is neither more nor less. Women are neither inherently the precipitants of sin nor too weak and fragile to resist it. That is the purpose of this settlement—to show women who have been forced to endure the scorn of society that they are worthy and may take a place with honor. That they have not ‘fallen,’ regardless of who might say or think otherwise.” She placed her tea on the table and rose from her chair. “Would you like to see the evidence?”
Simpson guided me up the stairs and, for the next thirty minutes, I received a tour of the remarkable institution. The top floor contained sleeping quarters for eight women and their children. The bedrooms were small, but allowed for privacy and self-respect. The second floor contained two rooms set aside for learning and a large common room where the children could play together. The rear of the first floor contained a kitchen and dining area and, set in the corner, a surprisingly modern medical facility. Simpson was greeted by everyone we encountered with a mixture of warmth and deference.
When I expressed my admiration for whoever had begun such a progressive establishment, Simpson surprised me by reacting with venom.
“But eight women, Ephraim. Only eight. There are thousands who should be able to avail themselves of our services. Do you have any idea of what it is like for a woman who finds herself in such a predicament? A woman without means? What choices has she? She may remain at her home and live with disgrace, never marrying because she is considered tainted by other men. In many cases, her baby will be torn from her by her own family, given to an orphanage in an effort to expunge the shame. She can attempt to hide her disgrace by leaving home to have her baby and giving it to an orphanage herself, then return to live a lie and wonder for the rest of her life what has happened to her child. She can move to a new town, have her baby, and try to pass herself off as a widow. For the rich or the truly disreputable, there is abortion, the most loathsome option of all. Each option is ghastly. Each option is a lie. We try and provide an alternative that is not … for just eight.”
“But surely your eight can be a start,” I said. “A model on which other like institutions may be established.”
“That is our hope. Otherwise …”
“You are the physician here?”
“Yes,” she replied. “I provide medical services.”
“Does Dr. Osler know?”
“Oh, yes. In fact he has contributed to our cause, most generously, I might add. In addition, he has come here often to help with medical problems that are beyond my capability.”
“How did you come to be involved?”
“A patient,” she said tersely.
I opened my mouth to inquire further, but she asked instead, “But please tell me. Do our residents remind you of the fallen women in Chicago?”
“I swear before the Almighty that I will never use that term again.”
“The Almighty will be grateful,” she replied. “I would like to hear about your time there, though. Did you enjoy private practice?”
Now that Simpson had revealed something of herself, she was asking me to do likewise. I wanted to, wanted to more strongly than I would have thought, but, as always, feared the consequences of revelation. Nonetheless, I resolved to try.
“There was little to enjoy, I’m afraid. I practiced on the West Side for three years, apprenticed to a doctor named Jorgensen. Jorgie, everyone called him. He was about sixty, drank quite a bit, and was in need of someone to help out and eventually take over his practice. Our patients consisted entirely of working people and immigrants. Sometimes we were paid, sometimes not. Often, we accepted whatever could be offered. I was able to barter rent in return for tending to my landlady’s rheumatism, and was always sure of a supply of Italian sausage as payment for treating the scabies infection of the local butcher’s wife.
“I came to understand that Jorgie’s cynical demeanor, and even his drinking, helped him to cope with the tragedies that we seemed to encounter almost every day—a Lithuanian whose hand had been mangled in a grinding machine, a woman whose three sons had either died or been killed in three successive years, a series of children born with horrible deformities, untreated wounds that festered into infection, and endless victims of crime, violence, or neglect. There were rewards, certainly, in trying to provide some basic medical care to a segment of the population who could get it no other way, but mostly we simply flailed about.”
“How did you ward off despair?” she asked, as would one who has been forced to fight despair herself.
“I’m not sure,” I admitted. “Perhaps I didn’t. I was constantly frustrated by the extreme limitations of medical knowledge. Finally, I realized that, despite whatever comfort I might be giving to these poor wretches, this was not the medicine I wished to practice. Perhaps that was despair and I didn’t recognize it.”
“Is that when you left Chicago to come here?”
How to respond? “Soon after. I decided that what I wanted was to help develop improvements in the science of medicine so that my work might help not just a few patients, but thousands.”
“Do you ever regret the decision?”
“There is guilt sometimes … for abandoning Jorgie’s practice and leaving his patients with even less hope than before.”
We spoke easily for another hour, talking mostly of science and the even greater advances in medical care and technique that would be manifest in the coming years. The enthusiasm and energy she exhibited were in contrast to the extreme discipline that always dominated her behavior at the hospital. Unlike Turk, who thought medicine merely a means to wealth, here was someone who shared my vision and my hopes. Mary Simpson, I decided, was even more formidable—and more interesting—than I had previously been aware.
Soon afterward, I thanked her for an evening as illuminating as she had promised, and offered to see her home. She declined, saying she lived only a few streets away, and offered me use of the carriage. Instead of giving the driver directions to Mrs. Mooney’s, I told him to return to the hospital. I had two unfinished chores to complete.
I arrived just after nine P.M. I waited for the carriage to pull away and then, rather than walking to the front door, headed down the street to the side of the building. Soon I was at a gate in the Blockley wall and, minutes later, I stood at the entrance to the Dead House. Low clouds were draped across the sky and a March chill had settled over the city. My breath formed plumes in the night air. I waited for a moment, my ears attuned to the sound of anyone else who might be wandering the grounds.
Charlie kept a spare key in one of the flowerpots that had been incongruously placed on either side of the door in a miserable
attempt to provide a dose of cheer. When I was completely sure that no one else was about, I quickly retrieved the key and slipped inside.
When the door was shut, I was alone in the dark, in the silence, alone with the dead. Science deserted me and I felt as if I had ventured without leave into forbidden terrain, perhaps even to purgatory itself. At any moment, I feared cold fingers on my cheek or a grasp at my ankle. I tried to be furious with myself for fearing the dark like a child, but my palms remained moist and my breath shallow and labored. Forcing myself inside, I felt my way to the drawers where the matches were kept. With some difficulty, I located the box and, although even through the thick curtain the illumination might be visible to a passerby, lit one quickly all the same.
As soon as the match was struck, I felt an enormous wave of relief. In the light, even from one match, the Dead House was again simply a set of rooms in which I sometimes worked. I removed the smallest candle from the shelf and placed the match to the wick. When the flame had taken, I shielded the light with my hand and moved quickly to the morgue. I intended to discover why Turk and the Professor had reacted so strangely yesterday to the corpse of the young woman.
The morgue was windowless so, as soon as I shut the door, I could move about with impunity. I walked to the receptacle that held the young girl and swung open the lid.
It was empty. I checked the other four chests that held yesterday’s subjects. Two were empty as well. Two held cadavers that had obviously been brought in since.
I was puzzled. Generally, three or four days at least were required to make arrangements with the city authorities for public burial, and Charlie had assured the Professor that each of the cadavers had arrived just the day before. Why had these cadavers been removed so rapidly? Charlie could have been mistaken, of course. Still, he had never made such an error in the past.
The Anatomy of Deception Page 7