Die Once Live Twice

by Lawrence Dorr

  “Swedenborgianism,” Park interjected.

  “Yes. Which believes injections contaminate the soul. I just want all these Catholics and Jews in this ward to accept the inoculations.”

  “Jonathan, medicine has never had any cultural authority in this country. It is the same in the homelands of these immigrants. I don’t think we will reach the status of European countries like Germany, France, and England until we have a disciplined educational system that produces scientifically trained doctors.”

  “There are two solutions to this lack of authority, Doctor Park,” Marion said. “Your solution is the foundation for permanent respect. But mine is the solution for now. We need to be trusted by all the people we serve. I think Jonathan’s teacher, William Osler, calls it the art of medicine.”

  “If we don’t have it now, after the lives we have saved, how do we get it?” Park asked.

  Jonathan leaped in. “By being here every day for them. By showing we care, that we are concerned for their health. Once a week is never going to earn their trust.”

  “Jonathan, I have a Department of Health that I have to run for Biggs. You have laboratory work at Rockefeller Institute. We don’t have time to do that.”

  “I can do it,” Marion said.

  Park raised an eyebrow at her, but asked gently, “What do you know about running a medical clinic, Marion? This isn’t a musical where you have a score and the script. This is something new every day, with more boos than cheers.”

  “Face it, Doctor Park, your scientific treatments haven’t earned you much trust from these people, and there aren’t that many treatments I have to learn! The caring and concern, the individual attention that create the art of medicine is simply a woman’s touch,” Marion answered. “I’m unemployed now, so I’m going to come and show them someone from scientific medicine cares enough to be here every day.”

  Park blushed. “Well, I’ll be damned.”

  Jonathan said, “Just wait until the reviews get published. Marion will be a star!”

  “I can’t imagine the reviews. But if I succeed it will be my quint-essential achievement.”

  “Wow. I didn’t know a girl from Des Moines knew such a big word!” Jonathan smiled.

  “I’m a librarian, remember?” Marion answered.

  “When does this begin?” Park asked.

  “Today,” Marion said as she stood. “And I have people to talk to, so I’ll bid you good day, Doctor Park.”

  Chapter Twenty-one

  EVOLUTION

  Marion had come to New York expecting to perform on a stage in an ornate theatre, looking at boxes and balconies filled with adoring fans standing and cheering for an encore. Her day would end with a sweeping bow and glamorous company. But now her stage was a small, dark, three-room house converted into a clinic, and her audience was pale, feverish, and rarely cheerful. The front room held the registration desk, waiting chairs and the triage area. The small bedroom had three cots separated by sheets hung from wire strung on the ceiling. Marion’s new office was a small desk in the kitchen, where water boiled on the stove to sterilize scissors and forceps. Jonathan had added a room with a flush toilet and a shower, but the outhouse still stood in the back.

  Marion carried a pistol in her purse, but each day as she walked through the tenements Gino would leave his porch with a “G’morn’, Mrs. Dottore” and serve as her bodyguard. She brought her Midwest work ethic to the tenements and within a month she had forged some order. She hired two nurses, one Italian and one Jewish, who taught her basic nursing, showed her how to give inoculations, and translated for her. Marion purchased lights for every room. “At least we should see who we are treating, even if I don’t know why or how we are to treat them!” She hired Rabbi Radulovic to provide transportation to a hospital for the really sick. All day long he had a horse and a buckboard with a driver available at the temple a block away.

  Angelo hung around the clinic for hours on end and finally Marion gave him jobs to do so that he was not always underfoot. Marion had him scrub the clinic walls with alcohol. “I don’t know what a patient came here with, but no one is leaving with something new.” She quickly fell in love with his enthusiasm, intelligence, and charm. After the hectic pace of the first month slowed, she wondered why he wasn’t in school. “Angelo, what grade are you in?”

  “Grade? No school, Dottore. Help mama.”

  “School, Angelo!” Marion commanded, pointing her index finger straight at his face. “You are to start Father Padraig’s school tomorrow. I will help Lucia.” Marion hired Lucia as a nurse’s aide to insure that there was money for Lucia’s family. Angelo could continue to work at the clinic after school.

  The clinic forced Marion to evolve. In Des Moines, her father was a lawyer and she never lacked for food or clothes, though neither was ever fancy. But the whole state had fewer citizens than New York City. Her world was her neighborhood, where she and her friends played after school, and she walked everywhere, though never very far. Her girlfriends married local men who worked in the family business, usually linked to farming. But her soprano voice thrilled people, and it took her to Drake for college and then bought her a ticket to New York City. The city opened her eyes to wealth. The clothes were pretty, the hats flamboyant. The people she met in the theater taught her the ways of the city so that by the time she married Jonathan her conversion to socialite was complete.

  She had expected Ward 19 to resemble a poor section of Iowa. “Slum” was a word from her literature courses at Drake. These people had no jobs, no certainty of food each day, committed petty crimes for money, and lived with thirty families in a single dwelling. For them, suffering was an everyday experience.

  But after a month in this tenement clinic, Marion understood why Jonathan would not give it up. In the theater she had given people pleasure for an evening, and perhaps they would remember her music for a week, but then she faded from their minds. Her music did not change their lives. But in the clinic, a baby’s life was saved with an inoculation or a child’s with a vaccine. She could save a whole family from typhus by teaching them hygiene. It was a performance that made a difference for a lifetime, not a week.

  Though she knew little medicine, she realized that no one knew enough. In the summer of 1908, children were sick with unfamiliar symptoms. Lucia’s friend Maria brought her boy Vincent on a hot August morning that happened to be Jonathan’s weekly clinic day. He was suturing a cut on a teenage boy’s arm in the kitchen when Marion had five-year-old Vincent laid on one of the three cots in their treatment room. “She says he has a bad headache and backache, Marion,” Lucia translated. “He won’t eat and he has an upset stomach. He cried all night.”

  Marion said sympathetically, “We have two or three children a day with these symptoms, muscle aches and bad stomach. Have you seen anything like this before?”

  “No, Dottore Marion. This is new this summer. Seems like it is mostly boys.”

  “Are the boys playing somewhere different than the girls? Could they be exposed to some germ the girls aren’t?”

  “No. They play in streets. Same streets.”

  Vincent said he needed to go the toilet and when his mother Maria stood him up he crumpled to the floor. He tried to push himself up but his legs were jelly. Maria covered her mouth and wailed as Marion and Lucia lifted Vincent back to bed. Marion went to Jonathan while Lucia helped Vincent pee in a bottle.

  Jonathan listened to Vincent’s history and examined his legs. “It is infantile paralysis. Is this the first boy you had with paralysis?” he asked Marion.

  “The first one for me.”

  “There were a lot of cases in New York last summer,” Jonathan said. “Maybe as many as two thousand cases. Before that, there were only scattered reports of it. It seems to occur only in the summer, and usually with boys five years old and younger. Simon Flexner has made it a priority, so there’s a special project at the Rockefeller Institute for it.”

  “What causes it?” Mario
n asked.

  “A viral infection. I think. The germ can’t be seen with the microscope so that’s why I think it’s a virus.”

  Flexner was interested in the disease because it caused paralysis, which struck fear into the heart of New Yorkers. Although tuberculosis and smallpox caused many more deaths in children, caring for a crippled child was a particular hardship for these families. The social need compelled the Institute to study the disease, and everyone hoped Flexner could repeat the success he’d had in curing meningitis. Flexner was confident that the virus causing infantile paralysis entered the body through the nose and infected the olfactory nerves leading to the brain.

  Marion’s need, however, was immediate. “But what do I do with Vincent?” she demanded. “What do I tell Maria?”

  Jonathan shook his head. “I don’t know, Marion. I just don’t know. There is nothing we can do. Either it reverses spontaneously or the boy is permanently paralyzed. We need to send him to Willard Hospital. They have a special ward for these kids. We’ll have to quarantine Maria’s building.”

  “We had a Jewish boy last week who couldn’t swallow. We sent him to Willard Hospital. Audrey says Rabbi told her the boy died. Is it the same disease?”

  “Yes. Less common, but more lethal. That’s called bulbar paralysis. The chest muscles get paralyzed, so the child can’t breathe.”

  “This disease is dreadful. If I get paralyzed, shoot me. Right now, I’m glad that you and I don’t have children or they might get it. Do all children have these same symptoms?”

  “I’m not sure of the range of symptoms, honey. We will have to learn by keeping track of the patients and their symptoms. Hire someone to keep records of all the patients. We’ll sort it out when we have numbers.”

  “Angelo could do that. It will make him feel important and he can use the skills he’s learning in school. But oh, I sure would like to talk to that Doctor Flexner. I could light a fire under him.”

  Jonathan laughed. “He’s not the most approachable of individuals. He likes to give orders, not take them. And whatever he says, goes.”

  Marion raised her finger. “We’ll see about that.”

  “I was born on Christmas,” Marion told William Welch, the guest of honor at the Sullivans’ Christmas party.

  “I’ve never known anyone born on that day. How did your parents synthesize your birthday party and Christmas celebration?”

  “Oh, they just always made me feel special. I always got to be Mary in the church nativity play. That’s where I first knew I liked acting. Christmas has always been a special week.”

  Across the table, Jonathan stood, banging on a water glass with his spoon. “Happy birthday to my wife, Nurse Marion, the twin sister of Jesus. Both were born on Christmas day.”

  “Oh, Jonathan, you are blasphemous!” Marion shouted. “You know I never graduated from nursing school.” She sat and winked at Jonathan while laughter filled the room and the guests sang a boisterous chorus of the birthday song.

  Welch leaned over to her. “Is it true you have entirely given up your Broadway career to work in the tenements?”

  “Yes.”

  “Do you miss the adulation and applause? You obviously still have the knack for timing!”

  Marion paused before answering. “It’s a different reward. I’m a local hero. Not in the newspapers, not with any national acclaim. But Doctor Welch, it is a thrill to do work that makes someone’s life better every day. Sometimes we even save their life.”

  By Christmas Marion had taken charge of Ward 19. Mothers believed her when she told them to use clean water and to boil milk. More babies were surviving, so Marion became a beacon to the families.

  “I am glad that you have medicines to save children. That is because Jonathan’s mother supported laboratory medicine and we were able to build a flagship medical school at Johns Hopkins.”

  “And your outstanding Rockefeller Institute.”

  Welch looked a little confused. “Well, of course, the funding for that came from Mr. Rockefeller.”

  “Oh yes, of course you’re right, but what’s important,” she said, raising her voice, “is that they’re studying infantile paralysis. Don’t you think infantile paralysis is the most important problem of our age? We’re seeing it at the clinic all the time now.”

  The guest sitting on Welch’s other side turned to look at Marion. Simon Flexner, the chief of the Rockefeller Institute, never saw patients and didn’t believe any disease could be understood by any method except in the laboratory. Marion looked expectantly at him, and then at Doctor Welch.

  “Oh, excuse me,” Welch stammered. “Simon Flexner, have you been introduced to our hostess, Marion Sullivan? Marion, Doctor Flexner is the head of our research into infantile paralysis.”

  “Yes, I do know that,” Marion said brightly, and smiled at Flexner, whose expression changed not at all. “Doctor Flexner, we need to talk.”

  Flexner frowned. He sat in haughty silence waiting for the next sentence.

  “We’ve been keeping records on our infantile paralysis patients at my clinic and I think your theory about the germ entering directly through the nose to the nervous system is wrong.” The table conversation quieted and Jonathan shook his head no to his wife. Flexner was a small man, shorter than Marion, and slightly built. “He’s got a short man syndrome,” Jonathan had told her.

  “My dear Mrs. Sullivan, I’m afraid that simply cannot be.” The effort to be polite was obvious. “I am studying it in monkeys in the laboratory every day. I can only make these germs grow in nervous tissue culture.”

  “That’s not how it grows in the kids in Ward 19. When this disease is in season there are lots of kids with flu-like sickness. They don’t get paralyzed. Just sick. We’ve kept records.”

  “With all due respect, Mrs. Sullivan, your records are not as accurate as my laboratory work. I have tried to infect monkeys by feeding them infected infantile paralysis tissue and they never get paralyzed.”

  “It must be the species of the monkey you used,” Marion continued, raising her index finger. “Lucia, one of my Italian mothers who works as an aide, thinks it has to do with cleaning up the water. She thinks the old water had soldati in it.” Flexner’s frown deepened, making Marion think she should explain. “That is her name for antibodies in the blood.”

  The muscles in Flexner’s jaw clenched. “It’s nonsense that an Italian mother in the tenements could know anything about polio. It doesn’t come in through the stomach. I’ve proved that.” His conversation with Marion was finished. He turned his back to her and spoke to the doctor on his left.

  Marion was quiet. “You won’t change his mind, Marion,” Welch whispered to her. “He is brilliant, but pugnacious. Always sure he is right.”

  “Well, he’s wrong,” and the index finger stood straight up in front of Welch’s nose. “The secret is in the water. That’s why it affects rich people more than my tenement kids. The kids still live in filth and the new immigrants do not get infantile paralysis.”

  “This virus is so hard to culture, Marion. It will take a while for us to know if you or Simon is correct.”

  “Don’t bet against me, Doctor Welch. Patients are the ultimate lab. It is not a disease of filth and it starts with clean water.”

  That night, Marion worried to Jonathan, “I think I care too much. How do I keep from being a mother to every child?”

  “You can’t, but you don’t need to. You are the essence of medicine, you are Hope. It is all we can offer most patients. We pray to God to let their suffering pass. We prescribe compassion. It is so frustrating. We need more scientific answers.”

  “Well, that Flexner is not going to provide them. Self-important booby.”

  Jonathan took Marion in his arms. “I think we can be quite sure that he’s not going to provide them to you.”

  Chapter Twenty-two

  EUREKA!

  —1911—

  Jonathan was hunched over a microscope, his laborat
ory lights dimmed so he could better see what was on the slide. He dialed the eyepieces so the focus was clear and watched a white blood cell engulf a bacteria. “Having your favorite lunch, boy?” He smiled.

  Research was Jonathan’s passion, both because of his obsession to rise to Katherine’s challenge and because he knew that revolutionary changes in medicine originated in the laboratory. Despite the success of vaccines against infections and the improvements in public health medicine, the magic bullet was still out there. The Holy Grail that would save lives was still to be discovered and he meant to be the one to find it.

  While Jonathan watched the dynamics of phagocytosis under his microscope, he thought how clearly it confirmed the Science of Self theory, which proposed that body cells recognized and accepted each other, but attacked foreigners. When a foreign cell invaded the body, host cells circulating in the blood identified it as not of the self and engulfed it, as well as signaling the immune system to form antibodies to fight it. Antibodies were the “circulating factor” in blood that biologists had posited for at least three hundred years, but had been identified by Pasteur only fifty years prior. That idea had led doctors to believe that bleeding patients when they were sick would drain out the disease, which they called bad humors.

  Jonathan and his colleagues had reconciled the two views of cells and circulating factor, showing that circulating antibodies and white blood cells worked in concert to defend the body. When this system was strong, patients had a better chance of overcoming an infection. All that medicine could do to support the body was serotherapy—vaccines to stimulate more antibody formation. Or antitoxins, which injected antibodies that had been created in another body.

  Jonathan was convinced that the Science of Self was true for all cellular organisms and that he could use it to find a chemical produced by one organism that would kill another. Pasteur already had shown that a bacterium would not flourish if it were in competition with another microorganism, even a less virulent one. Jonathan believed that the microorganism was releasing a chemical, a toxin, that inhibited the rival bacterium. He slaved daily in his laboratory to find a universal toxin that could be safely injected into patients to augment their host defense. This discovery would revolutionize treatment of infections, a step far beyond serotherapy. The Holy Grail—survival against infection.