“Well, I’ve decided what career I am going to pursue,” Jeffrey said. Katherine and Jonathan looked at him in surprise. He continued, “I am going to be a medical educator. I am going to build this new educational system with Welch.”
“But I thought you hated medicine because it’s so impotent,” Jonathan protested.
“That’s the point, dear brother. Doctor Welch convinced me I can help change that. I will finish the academic year at Yale, then I will come back to work in the labs here at Hopkins until the medical school opens. If becoming a doctor gives me the knowledge to improve programs, that’s what I’ll do. I think I’ll start with Harvard!” Jeffrey poked Jonathan on the arm.
“We’ll see. After we clobber Yale in football this fall I’ll make you bow three times toward Boston,” Jonathan answered.
The next morning Katherine arrived to see Welch at ten a.m. and was immediately ushered into his private office. “It’s very unusual for me to see you under these circumstances, Katherine. What is our topic today?” Welch asked with evident curiosity.
“I have a lump on my breast. I know about breast cancer. I nursed my mother through her final months as she died from it.”
Welch paled, shaken by this news. “I’m deeply sorry, Katherine.”
“Is there any new treatment?”
Welch spread his hands. “There is no cure, as you know. But Halsted has worked in the laboratory for the last year on a new technique for removing a cancerous breast.”
“Removing...?”
“He can explain better than I. Wait here. I will get him.”
Welch returned with Halsted, who had a powerfully built chest and shoulders and an athletic face. He had been the captain of the first football team fielded by Yale in 1873. His long white coat made him an intimidating figure, but he shook hands with Katherine deferentially. Welch excused himself and Halsted took Katherine into an adjoining room and removed her blouse, covering her with a medical gown—made with Donovan & Sullivan textiles, Katherine noted wryly. Halsted examined her breast and palpated the lump next to her nipple. It was three centimeters in diameter, with the overlying skin firm and dimpled like the skin of an orange. He felt under her armpit and there was a swollen lymph node. “I can only agree with your diagnosis,” he said gravely.
“William said you were working on a treatment.”
“It is still being refined. To speak openly, I need patients who will take the risk. Cutting out the tumor is the only way to try and stop it from killing you,” he said bluntly.
Katherine sat quietly, listening to Halsted describe this mutilating operation he called radical mastectomy. While doctors had attempted the removal of the breast as soon as anesthesia was developed enough to permit a long operation, Halsted had realized that it was equally important to remove the underlying muscle and the lymph nodes under the armpits. Just the thought of it caused her to feel pain. What if it didn’t work? Would all that pain be worth it? “Thank you, Doctor Halsted. I must discuss this with my sons. I will give you my answer by tomorrow.”
As Katherine told the boys of her disease and options, the blood drained from Jeffrey’s face. “Mother, please don’t let Halsted do this to you. He will kill you.”
She understood his fear. “Jeffrey, the cancer will kill me. I am under a death sentence, and Doctor Halsted is the only one who can offer me a reprieve.”
“He will kill you,” Jeffrey repeated, agonized at the thought of losing his mother.
“He is the greatest surgeon of our time,” Jonathan spoke up. “He performed a gallbladder operation on his own mother at home in their kitchen. She is still alive.”
“Let him experiment on his own family.”
“Jeffrey, you know that Mother has fought against the odds all her life. She pioneered roads women never would have traveled and she never considered quitting, even when things got tough. How can you ask her to quit now? She has to try this. It’s her one chance.”
Katherine turned to Jeffrey. “My son, I understand your fear. I couldn’t stand losing my own mother. But I want to do this. I know that my mother would have leaped at the chance to live—to see me grow and to live life longer. I have come to the conclusion that I have the courage and will to do this operation. I view it as the seminal event in the future of our family and my heirs. We have amassed all the wealth we could imagine. Now we need to use our money, our talents, and our lives to better humanity by finding cures. Infection and cancer are foremost to me. By having this operation I am leading the way for you. Whether I live or die, I want you to follow my example of forging new treatments for medicine. This is to be your calling, Jeffrey and Jonathan.”
Both of them sat quietly, surprised at this destiny their mother envisioned for them. She took their hands. “You know that I have always loved the story of Richard the Lionheart and his mother, Eleanor.”
“The most powerful woman in Europe,” Jeffrey said, remembering Katherine’s retelling of the story.
“And the richest,” Jonathan added.
“The conquest of disease is the great crusade of our time,” Katherine continued, “and I want you to lead it, as Richard did the Third Crusade. My challenge to you is to find the Holy Grail—the ability to face certain death and conquer it, to live twice.”
Jeffrey and Jonathan looked at each other. Jeffrey looked down for a moment, then said to his mother, “I accept.”
Jonathan rose and paced across the room, then back again. “So...” he paused. “Which one of us gets to be Richard?”
Chapter Fifteen
PROMISE KEPT
Professor William Halsted strode confidently into the amphitheater, his bearing as regal in his white cotton gown as in his finest evening suit. His fastidiousness about personal appearance was well known to his students and merely added to the allure of the man about whom they knew little but nonetheless aspired to emulate. The anticipation of watching him perform an historic operation added to the air of exhilaration and tension. The surgical amphitheater at Hopkins, with its circular rows of wooden benches, allowed students a rare opportunity to witness Halsted’s talent and techniques as he operated in the pit.
Miss Caroline Sharpe, the chief operating room nurse and Halsted’s long-time scrub nurse, was standing next to the doctor administering anesthesia. She spoke softly to Katherine, whose eyes showed fear. The chloroform quickly induced unconsciousness and many of the students bowed their heads in a silent prayer for her safe return to consciousness.
The surgical team sterilized their hands and arms with Lister’s antiseptic solution, carbolic acid, and put on rubber gloves. Miss Sharpe was allergic to the antiseptic solution so Halsted had designed rubber gloves so she could continue to scrub with him. The team gently but thoroughly washed Katherine’s right chest, breast, upper arm, and armpit with carbolic acid. They covered her exposed breast with permanganate solution, which left her skin purple-brown.
Halsted’s operation, a radical mastectomy, had never been attempted by him before. Taking a deep breath to quiet his nerves, Halsted said to his assistant, Doctor Howard Kelly, “I truly believe in my heart that I can remove the entire tumor.” Kelly, one of the original four surgeons of Johns Hopkins, seconded the belief. “Today is the start of a living experiment,” Halsted said as he prepared for the first cut. He placed his hands upon Katherine’s chest and closed his eyes for a brief moment. I know there must be a Supreme Being, and it is not me. I pray for His blessing as I embark into this new frontier.
“Miss Sharpe, may I have the syringe of cocaine?” he asked. As she handed it to him, he wished briefly that he had injected himself, to calm his nerves. “The cocaine will enhance the chloroform,” Halsted told the students in a loud voice. “It will act to block the nerves from transmitting pain signals. Miss Sharpe, please keep an extra syringe of cocaine at the ready as I advance through the operation. Doctor Kelly, are you ready to start?” he asked. Kelly nodded and Halsted heard a chorus of squeaking wood as the audience watc
hing above moved forward in their seats.
Halsted began by making a circumferential incision away from the breast tissue. When he cut the skin and fat, many small vessels began to pump blood into the wound. He clamped them. “Miss Sharpe, be sure that we have plenty of serrefines. Blood control will be tedious.” Halsted had designed a “mosquito forceps,” which had a small tip specifically designed to allow the clamping of bleeders. This device, a result of his vascular studies with animals and cadavers, saved the tissues surrounding the vessel. He firmly grasped the breast and pulled on it to create tension so that tissues he was dissecting would separate more easily. He wondered just how many times the patient’s husband had caressed this breast during nights of passion and marveled that in just hours her life would be forever changed. The violation of his patient’s body, though necessary, was never lost on him.
Halsted’s assistant retracted and exposed tissue for him, anticipating his every move. He tied off bleeders as Halsted clamped them and at times even found himself impatient with Halsted’s methodical pace. Good God, man, Kelly thought, the patient’s tissues will be healed by the time you finish. Had Kelly uttered his words out loud it was doubtful that Halsted would have heard them, so focused was he on his work. Following the master plan in his head, he began cutting the pectoralis muscle and freeing it from the smaller pectoralis minor muscle.
Kelly carefully retracted the mass of breast, fat, and muscle tissue so that Halsted could then cut away the pectoralis minor muscle. The entire tissue mass had to be removed en block or all his work might be for naught. If he cut through the tumor it would seed the wound with cancer cells, which would spread rampantly. If Kelly relaxed his traction on the breast, the wound would flood with blood. Halsted had at least ten veins to separate and ligate to free the entire tissue mass for total exposure of the axilla.
In the armpit were the largest blood vessels and nerves and to err here would be disaster. Miss Sharpe, aware of Halsted’s dilemma, mutely began passing him mosquito forceps, followed by a ligature, followed by a forceps, and finally another ligature in a steady rhythm. He could feel beads of perspiration dotting his forehead. His need to be perfect had started to make him anxious as he painstakingly tied one vein, then another, then another until all ten had been tied off.
His hands now worked automatically. The operation was in its third hour, but he was near its finish. He recalled the numerous cadavers he had used to perfect his skill at dissecting the nodes and fat, and the memory made his heart beat faster. He exposed the subclavian vein, which he needed to identify to avoid damaging it. Should he do so, her arm would be left useless from pain and swelling. The arm would swell enough as it was from the removal of the lymph glands.
Preparing for the end of the surgery, he tied each small axillary vessel without any extraneous tissue so as to leave no tumor behind. As he eased the knife along the tissue, blood suddenly filled the wound. He had lacerated the subclavian vein. His stomach tightened and his breathing increased. Miss Sharp immediately began soaking up the blood in the wound with gauzes, but everyone knew that death would follow unless he and Kelly found a way to stop the deluge. There was no way to give his patient new blood. If he clamped the entire vein, he would permanently injure it.
Kelly came to the rescue by clamping a mosquito forceps on one cut edge of the vein, allowing Halsted to control the bleeding by covering the hole with his finger. With the other cut edge visible, he now placed a mosquito clamp precisely and closed the laceration with a suture. He prayed the blood flow would be strong and uninterrupted once the silks were firmly knotted. The air in the room grew thick. He knew his audience was wondering if he had made a fatal mistake. To his relief the blood flowed freely in the vein without any leakage. He huffed to himself that the only fluid flowing outside the vein was the sweat on his forehead, which had fully soaked his cap.
He trusted no one but himself to complete the operation. Infection would destroy any hope for a cure. Using silver wire he closed the tissue just under the skin and watched patiently as the wound oozed blood, filling the dead space in the wound. His research had shown that clotted blood in such dead spaces promoted healing, and he believed this technique should be incorporated into every closure. As he handed Miss Sharpe his suture needle he took a brief moment to thank Kelly, who had clearly eased his burden this day.
The crowd stood and erupted into applause. Halsted felt a deep rush of pride. He nodded at Miss Sharpe. She handed him a syringe of cocaine as he turned and retreated into the privacy of the adjoining room. Once he was alone, he injected the needle into his own arm. With the cocaine’s full sensation racing through his bloodstream, Halsted discarded his soiled operating gown and the syringe. Leaning against the counter he closed his eyes with the somber knowledge that even in his finest hour his demons still owned him.
At the 1893 opening ceremony for the Johns Hopkins Medical School, Mary Garrett was honored for her vision in enabling the school to become reality. Katherine Sullivan, who was a pillar in its funding, beamed at the first class of eighteen students, fifteen men and three women, seated in the front rows. The best-looking student, she was sure, was Jeffrey Sullivan. Katherine said a silent prayer to her doctor, thanking his research and surgical skills, which had rescued her from her time to die and given her a second life. She felt satisfaction that she had kept her promise to her mother that she would do something about making medicine better. She was confident her sons would carry on her crusade.
PART II
THE AWAKENING
1895–1922
Chapter Sixteen
LEGACY
Jonathan shivered, and not only with the cold and damp of the tenement. A dozen angry women stood in a circle around them, but were keeping their distance, as if the doctor himself was the source of the contagion that was killing their children. Coughing and wheezing children, victims of the diphtheria epidemic sweeping the city, provided an ominous chorus to their drama. Doctor William Park stood poised, a syringe in his right hand, pinching a small boy’s arm with his left thumb and forefinger. The boy’s mother sat in front of him, holding her child in her lap. Jonathan knelt beside them, keeping a hand under the boy’s arm in case the frightened and nervous child tried to pull his arm away when the needle pricked his skin. Though few others would have been able to tell, Jonathan knew the doctor was both exhilarated and deeply worried.
It was January 1895, and Park was attempting to inject the first dose of diphtheria vaccine ever administered in the United States. He and Jonathan were in a tenement on East 44th Street and First Avenue in New York City, where forty Italian families lived in an overcrowded five-story building. Over time Jonathan had become accustomed to the stench, but the filth made his skin itch, as if diphtheria bacteria were crawling all over it. The tenement was a house of death, filled with youngsters who were febrile and wheezing. In many cases a toxic membrane formed over the trachea, literally strangling the victim to death from the inside. That it occurred in children in waves of winter epidemics added to the urgency as the cold weather settled in. If nothing was done, most of them would die.
Yet the very people who were most concerned for their health – their families – had for two days prevented the doctors from administering this new cure. When Park had asked that he be allowed to inoculate their children, the mothers had ignored him or backed away as if he were the Devil, muttering, “This punishment was sent by God and only God can call it off.” “We have prayed to St. Jude. It is all we can do.” “Father Padraig assures us God will have mercy.”
Others attacked the doctor directly. “What has the government done for us but step on us? Who shut down the shops so that we cannot earn a living and buy bread?” Never mind that the “shops” were little more than dank holes where children and adults worked together for two nickels a day. In this ghetto, Italian or Russian depending on which street you walked, the Italians had been immovable. As the diphtheria epidemic gained momentum, Park had begged the mothers
who surrounded him in the tenement to allow him to inject their children with the new antitoxin against diphtheria. They steadfastly refused, out of fear and distrust.
“What is your name, child?” Doctor Park asked in a whisper. As the boy looked up at his mother for help, the doctor asked again, “Come se dice?”
The mother nodded and the boy, pale and weak, whispered, “Angelo.”
Doctor Park smiled. “Bene, you will be a guardian angel for your people.” The boy did his best to return the smile, but he was obviously worried. As the doctor cleared the syringe and brought it toward the boy’s arm, a woman in the room shrieked and fainted. For all they knew, the doctor was about to turn the child into a zombie. When their sick children were taken to Willard Park Hospital, so far from their families and home, they rarely came home again. Surely the needles this doctor showed them must contain some new poison, some drug that would allow doctors to control their children and enslave them.
Finally, after Jonathan and Doctor Park had exhausted all the arguments of their limited Italian vocabulary, one woman had stepped forward from among the crowd staring distrustfully at them. Her six-year-old Angelo was limp in her arms, struggling for air. “Lucia, non!” one of her neighbors shouted, but the woman had continued forward, staring at the doctor as if that would tell her everything she needed to know. Jonathan felt that if Doctor Park smiled, if he tried to seem at all ingratiating, too eager, the woman would bolt. The doctor stood still, looking back at the woman with concern and something else Jonathan couldn’t quite place. Understanding, perhaps. At last she had nodded, grimly satisfied. She took a chair that was sitting behind Park, her son in her arms. She would let the doctor inject him, but not hold him. Doctor Park knelt down to prepare his syringe.
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