Had his father told him about Mr. Truscott’s threatening letter? Dr. Brown had mentioned that there had been some disagreement between father and son over Phoebe Truscott’s treatment. Ella wondered if this was because Harrison thought his father should have referred this case to him, not Dr. Brown. The son, who was on the staff of the City and County Hospital, could easily have done both the expressions and the ovariotomy there, and he did have more experience than Dr. Brown in handling this sort of operation.
Yet, after spending time supervising Phoebe Truscott’s aftercare this fall, Ella was convinced Dr. Granger had made the right decision. She had trouble imagining the delicate young woman being at ease with a young man like Harrison Granger examining her. The effect that the cysts had on her body were embarrassing enough, but all the other symptoms that accompanied her disease would be equally hard to tell a young male doctor about. Additionally, Ella absolutely believed that the general nursing care at the dispensary was superior to that of any of the other city hospitals. She’d done her clinical practice in City and County, and she knew it was understaffed, many of the nurses not more than glorified servants, and the food was terrible.
That’s why she believed so strongly in the mission of the Pacific Dispensary, to give women a place where they could be treated by competent female physicians and trained female nurses. A place where they felt safe and respected. And she had always assumed that Dr. Harrison Granger, like his father, supported that mission since he had signed on as one of the consulting physicians. Yet had he done this willingly? Or had his father forced him to? Maybe he saw women like Dr. Brown and herself as rivals? If so, would he be active in supporting the dispensary if it really was under attack by Mr. Truscott? She certainly hoped so.
As Ella left Hilda’s room and went with Mrs. McClellan down to check in with the patients on the first floor, she continued to worry about Mrs. Truscott. The woman had been so timid and dispirited the day she arrived at the dispensary for the operation. During her intake session, with her husband present, she’d given the barest answers, her husband often showing exasperation, telling her to speak up, or contradicting her when he felt one of her answers wasn’t accurate.
Yet, by the time she was ready to leave the dispensary, she’d seemed an entirely different woman. Confident, hopeful, looking forward to resuming her life as a healthy, vital, young married woman.
Such a tragedy if it turned out that she was ill again. And Ella shared Dr. Granger’s concern that Dr. Skerry, as a homeopathic doctor, wouldn’t handle her illness correctly, particularly if she were suffering from some infection. Maybe the reason Dr. Granger was turned away yesterday from seeing her was because he was a male, not because he represented the dispensary. In that case, Mrs. Truscott might be willing to see Ella, if she showed up at her door.
With a sudden sense of resolve, she decided she would go to see Mrs. Truscott first thing tomorrow, see if she could find out exactly what was going on, maybe even straighten out whatever had caused Mr. Truscott to send his threatening letter.
Chapter 13
Saturday evening, February 25, 1882
O’Farrell Street Boardinghouse
* * *
When Laura asked Annie if Caro Sutton could make up one of the party this evening, Annie decided to have the late supper in the boardinghouse dining room, after the boarders had their dinner.
Laura had met Miss Sutton last spring when she showed up at the Berkeley university campus, supposedly to brush up on German before entering medical school. Her real reason was her determination to discover the reason behind a cousin’s death, something Laura had helped her do.
Caro had spent the subsequent summer and fall traveling throughout Europe, attending lectures in various medical schools. However, much to Laura’s delight, she had decided to come back to San Francisco to study at the University of California’s medical school. The regular term didn’t start until June, but Caro came back in time for the preliminary session, which started in February. This gave her time to get settled in before the full range of classes started.
Laura had confided to Annie that Caro, who was originally from Chicago, recently had come into a substantial inheritance, which was how she was able to afford to buy and staff an entire house up in San Francisco, on the corner of Greenwich and Powell. This put her just a few blocks from Toland Hall, which housed the university medical school.
From what Laura had shared about her friend, Annie had the impression that Caro was a very practical kind of person who decided on a goal and pursued it single-mindedly. This made an interesting contrast to Laura, whose rampant curiosity about life tended to blow her hither and yon. Not necessarily a bad characteristic for someone who was flirting with the idea of being a journalist, which was Laura’s current enthusiasm.
Nate worried about this tendency in his sister, afraid that she wasn’t ever going to settle down.
Annie thought that the very fact that she had chosen Caro as a friend showed that her sister-in-law appreciated someone with a steadier attitude towards life…as a sort of anchor.
And then, of course, there was Seth Timmons, Laura’s fiancé.
Seth, who was ten years older than Laura, might have been a bit of a rolling stone in the past, but he was now studying to be a lawyer, working in Nate’s law office as a clerk, and still working part time running a printing press. That printing job was why he wouldn’t be at the dinner tonight—he would be starting the night shift putting out the Sunday edition for several of the smaller newspapers in town. In Annie’s opinion, there wasn’t a more down-to-earth person you could find than Seth Timmons.
So, no, Annie didn’t worry about Laura.
“Caro said she would be here by seven-thirty,” Laura said, coming into the dining room from the front hall. “I trust that my brother and Mitchell won’t be late.”
“I made Nate promise he would be on time. Mitchell was going to stop by the law office, and they can share a cab here instead of taking a horse car.”
Nate had met Mitchell a couple of years ago, when he moved into Nate’s boardinghouse up on Vallejo. Annie remembered the first time she met him, and the young man had said, “Just call me Mitchell.” Later, she had asked Nate if Mitchell was his first or his last name. He had laughed and said his fellow boarder’s given name was Martin Mitchell, but after being called Marty Mitchell as a boy, he swore never to use his first name.
However, Annie wondered if he would start telling people to call him Doctor Mitchell since he’d received his medical degree this fall.
Laura turned and said, “That’s the front door bell. Must be Caro.”
Annie followed her into the hallway to greet the young woman, and they were quickly joined by Kathleen, who would have heard the bell down in the kitchen.
After Kathleen helped Caro off with her coat, Annie said, “We’ll go on into my office until Nate and the others arrive. Kathleen, when you hear the front door bell, you can assume it is time to start bringing up the first course. Is Abigail still asleep?”
“Yes, ma’am. All nestled down in the basket in the corner of the kitchen. Sleeping like the angel she is.”
Annie had debated about what to do with Abigail this evening. She didn’t want to impose again on Mrs. Stein, feeling that this would somehow reinforce the good woman’s disapproval that Annie was letting work come before her daughter.
Sometimes her daughter wanted to play for a bit after being nursed at seven. Other times, like tonight, she fell fast asleep and wouldn’t wake until Annie changed and nursed her again right before she and Nate went to bed for the night.
Tilly had been the one to suggest seeing if the baby could sleep in the kitchen, where it was nice and warm and where, if she woke, there would be someone to comfort her and get her back to sleep. Tilly said that, in her experience, babies could sleep through anything and often found the background noise of voices they knew as comforting. Both Tilly and Kathleen, who’d helped raise her brothers until her fathe
r’s death, had more experience with babies than Annie, so she had agreed. However, she made Kathleen promise that if her daughter became a problem she would bring her up to the dining room.
She was hoping that there wouldn’t be a problem because she really needed to be able to concentrate on extracting as much information from Mitchell as possible to help her understand exactly what was going on with the Pacific Dispensary and the Truscotts.
Chapter 14
“Thank you, Miss Tilly, and please convey our gratitude to Mrs. O’Rourke for another fine meal,” Annie’s husband said as he put his napkin on the table.
Annie stood up and ushered the young maid into the hallway. “Yes, and thank you, Tilly. You did an excellent job of helping serve. Do tell Kathleen to let me know if I need to come down to attend to Abigail. Otherwise, I think we will just stay in the dining room to have our tea and coffee.”
Dinner had been a roaring success, with Mitchell and Nate each topping each other with stories about the awful meals Mrs. Randall, the Vallejo boardinghouse cook, produced. The running joke was that Nate’s Uncle Frank, who lived there as well, seemed oblivious to the inferior cooking.
Annie had noticed that Caro was very quiet throughout the meal, although she had chuckled when Laura had added a story about the terrible meal she had once had at the boardinghouse in Berkeley where Caro had stayed last spring.
Laura jumped up at Annie’s return to the table and went to the sideboard where Tilly had laid out the cups and saucers and a pot of coffee and hot tea. As she poured out coffee for Caro and the men, she said, “I know you didn’t just invite Mitchell here to save him from bad cooking, Annie. So, tell us, why do you need expert advice from a doctor?”
Annie smiled at her forthright sister-in-law and said, “First, I need to give you all some background about my latest auditing job.”
She proceeded to tell them about the difficulty that the Pacific Dispensary for Women and Children had fallen into when their treasurer suddenly resigned, leaving the financial records in complete disarray.
Annie said, “Fortunately, after going through all the records over the past two days, I think I have found most of the information I need to get a clear view of where they stand financially. However, there is one major problem that goes beyond a simple financial one, and this is where Nate and I need some medical guidance from you, Mitchell, and perhaps Miss Sutton.”
She went on to tell them about the unpaid bills from Phoebe Truscott’s operation and after care, and the letter from Richard Truscott accusing the dispensary staff of malpractice and threatening legal action. She could tell by both Mitchell’s and Caro’s reactions that they recognized the seriousness of this situation.
Getting the copies of the medical notes that Dr. Blair had given her from the sideboard, she said, “I would like you two to look over these notes about Mrs. Truscott’s operation and her after care. I also have a copy of the form that Mr. Truscott and his wife signed before the operation. Nate assures me this document does protect the dispensary and the staff from legal liability, but what I need is some reassurance that there wasn’t anything the staff did that either of you would see as questionable.”
Mitchell chuckled and said, “Well, Mrs. Dawson, I didn’t think I was going to have to pass a medical exam all over again when I agreed to come to dinner…although I must say Mrs. O’Rourke’s cooking was certainly worth it.”
He took the notes from Annie and scooted his chair nearer to Caro’s, saying, with exaggerated politeness, “Miss Sutton, would you care to take a look at these with me? I understand from Laura, here, that you spent the last six months touring all the great medical schools of Europe.”
Caro pushed her spectacles up her nose and said quietly, “I mostly sat in on lectures on neurology and diseases of the heart when I was abroad, Dr. Mitchell. And I fear I have no particular interest in gynecology or diseases that are specific to women. However, I am taking Taylor’s class on Operative Surgery and Anesthetics, so I will be interested in looking over these notes to see how closely they correspond to what Professor Taylor has been laying down as the fundamental principles of any surgical operation.”
Annie repressed a smile as she watched Mitchell and Miss Sutton lean over the papers she had presented them. What a contrast they made. Mitchell was tall, gangly, and effusive, with a ginger mustache that proclaimed his Irish heritage. Caro Sutton was short and stout, and even her expensive black silk couldn’t hide the fact that she was descended from plain, no-nonsense, Kansas farmers.
Mitchell began to make a running commentary as his finger ran down the notes. “Ah, see here? They did try the more conservative method of dealing with cysts. Look at the volume of fluid they expressed the last time! Remarkable. Poor woman must’ve been in agony. The decision to recommend surgery only came when the progression of the disease accelerated. Brown did the surgery. However, both of the Grangers, senior and junior, were there as consulting physicians. All very above board.”
Caro intruded and said, “Mrs. Dawson, you said that Dr. Brown is one of the founders of the Pacific Dispensary?”
Annie, noticing the emphasis by Caro on Charlotte Brown’s medical title, said, “Yes. I believe that she is also the first female who was accepted for membership by both the California and San Francisco medical societies.”
Mitchell nodded and went on, saying, “I see they first injected morphia before they administered the ether for the operation. Oh, Dr. Blake was their anesthesiologist. He has the reputation of being the best in the city, so no one could complain about this. I believe he’s also Dr. Brown’s brother. Makes sense they would have brought him in for the operation.”
Annie interrupted at this point and said, “So you agree with Dr. Blair’s assessment that the operation was warranted and handled correctly?”
“Dr. Blair, Ella Blair?” Mitchell sounded surprised. He looked at the notes again. “Oh, she was listed as present.”
“Yes, she’s the current resident physician for the dispensary. I understand she is a recent graduate of the Medical College of the Pacific. Isn’t that the other medical school in town? Do you know her?”
“Mostly by reputation, although I did take one term of clinical classes at City and County Hospital with her last spring. Her fellow classmates say she is a bit of a cipher. I just know she didn’t think much of my jokes. Didn’t like it the time I tried to say good morning with the skeleton’s hand I happened to have in my pocket!”
Annie felt Laura stiffen beside her, and she put a restraining hand on her sister-in-law’s arm and said, “Dr. Brown speaks very highly of Dr. Blair. So these various procedures, I believe they are called ‘expressions,’ are standard practice.”
Mitchell said, “Yes, but that doesn’t mean they aren’t controversial. For some doctors, even the expression of the fluid from cysts isn’t a safe practice, and there are many physicians who would never recommend an operation in these circumstances. One school of medical opinion argues that the newest crop of doctors in America are too quick to operate. They believe any operation that has to cut through the abdomen wall should be avoided, unless this is the only way to save a person’s life.”
“Why is that?” Annie leaned forward. This was just the kind of information she hoped Mitchell would provide.
“Because of the chances of infecting the wound. Peritonitis, or an infection of the abdominal cavity, is one of the most difficult infections to treat. From these notes, Mrs. Dawson, there seems to be signs that the patient did develop an infection after the operation.”
Caro looked at where Mitchell was pointing in the notes and said, “Yes, I see. There was a slight elevation of her temperature in the six days after the operation, and I do know that fever is one of the most prevalent signs of an internal infection. However, the notes say this elevation of temperature disappeared as soon as they removed the last stitches. Then, suddenly, six days later, there is a more dramatic rise in the patient’s temperature, reaching a peak of 100
.3.”
Mitchell added, “Dr. Brown notes that they discovered some swelling near the site where they removed the largest cyst, and that certainly suggests some internal infection. However, they acted quickly to apply iodine, and that seems to have done the trick. A day later the patient’s temperature and pulse had returned to normal and appears to have remained so for another week, until she was released.”
Annie said, “So you are saying she did probably suffer from some sort of infection, and the danger of this sort of infection resulting in a patient’s death is why some doctors would advise against doing this sort of operation.”
Mitchell nodded. “Even though ovariotomies are more common now than even a decade ago, the mortality rate is still high, particularly from sepsis. A real conundrum. The removal of a cancerous tumor is the only known way to prevent a woman from dying. Yet the only way a doctor can be sure that a tumor is cancerous is through microscopic analysis after the operation has been performed.”
Laura stirred beside her and said, “So, are you telling us that doctors can only say after they have risked a woman’s life…that the operation was necessary?”
“Yes, and I don’t suspect doctors who have performed these surgeries are eager to admit that they may have been unnecessary,” he said.
Annie was surprised by Mitchell’s comment about cancer, and she said, “Neither Dr. Brown nor Dr. Blair said anything about Phoebe Truscott having cancer.”
“I didn’t mean to say she did,” Mitchell responded. “In fact, the fluid and the discovery of multiple cysts when they operated suggest that this patient was simply suffering from benign cysts, although there is still a lot of controversy over what causes these growths. However, this would make the question of whether or not to do surgery even more controversial. If the cysts were not cancerous, then the chances of the patient dying from them goes down, making the possibility of her dying from the surgery more of a risk.”
Lethal Remedies Page 9