The Winter Rose (8 page)

The contributions of Lister, Pasteur, Jenner, and Koch to the
under-standing of germ theory--combined with advances in anesthesia--had
enabled amazing gains to be made in surgery. Wounded or fractured
limbs, once certain to become gangrenous, could now be disinfected and
repaired instead of amputated. Cancers could be excised. Why, entire
organs could be removed without hemorrhage or infection--she'd seen it
done. The eminent American gynecologists Simpson and Kelly had made
successful hysterectomies and ovariotomies, and there had even been
recent reports of a successful Cesarean surgery, in which both mother
and baby had actually lived.

In Germany a man named Roentgen had discovered light rays that could
pass through human tissue, and already battlefield doctors were using
them to locate bullets in soldiers. In France, Becquerel's work with
ura-nium and the Curies' with radium promised that doctors would soon be
able to peer all the way inside the body without cutting, blood loss,
shock, or infection.

There were new drug discoveries, too--painkillers such as aspirin,
heroin, and chloroform, and antitoxins for smallpox and diphtheria. Some
felt it was only a short matter of time--a year, maybe two--before one
was found for tuberculosis.

There were times when India felt breathless just thinking about these
advances and how she would use them to better the lives of the
Whitechapel poor. And yet all she had to do was pick up a city newspaper
to be reminded of all that medicine had still to accomplish. Scores of
pub-lic health acts, designed to safeguard citizens from contaminated
water, filthy sewers, and overcrowded housing, had finally caused a
sharp decline in deaths from cholera, typhus, and smallpox, but scarlet
fever, influenza, and typhoid still raged through the slums. Gin and
opium destroyed minds, while malnutrition and poverty destroyed bodies.
India knew that for every social reformer, every doctor or missionary
trying to pull the poor out of the pub, the gin palace, and the opium
den, there was a Sid Malone pulling them back in.

The challenges to medicine were still many and daunting, and as
excited as she was to be starting her professional life, she was also
nervous. Could she meet the demands of a busy surgery? Cope with the
case load? Cor-rectly diagnose the staggering array of symptoms she
would encounter? There would be no Professor Fenwick to back her up now;
she was on her own.

She dodged a group of chattering factory girls and climbed a short
flight of steps to 33 Varden Street. It was a sandy-colored Georgian
house, two stories high. Dr. Edwin Gifford's surgery was on the first
floor; the second was rented out to a family. India paused at the front
step for a few seconds to calm herself. It wouldn't do to arrive
breathless on her first day.

She had just raised her hand to knock when the door was wrenched open
and a woman about India's age, wearing a nurse's uniform, hurtled smack
into her.

"Oy vey!" she exclaimed, taking India by the arm. "There you are! Got
sei dank! Was just on me way to look for you. Dr. Selwyn Jones, innit?
Where on earth have you been? I was worried you weren't coming at all."

India checked her watch. "It's only a quarter to eight," she said.

The woman snorted. "Are you a doctor or a banker? We start at seven sharp here."

"Seven? Dr. Gifford said eight."

"He always tells the new hires that. This is Whitechapel, Doctor. A
lot of people here work in factories or down the docks and need to see
us before the whistle blows. Come on, let's get you settled."

She tugged on India's sleeve, leading her past a waiting room full of
pa-tients, through a narrow hallway to the back of the building and Dr.
Gif-ford's office. She managed to get her hat and duster off along the
way and hustle her into a white jacket. The jacket's hem hung down past
India's knees and the sleeves covered her hands.

The woman frowned. She rolled up the sleeves. "Too big, this. Fit Dr.
Seymour perfectly, but you're not a man, are you? I'll have to order
some small ones." She pointed to an open door leading off the office,
and said, "Exam room's through there--" Before she could finish, there
was a loud metallic crash. She ran into the room and came out again
dragging a young boy by his ear. He wore a black skullcap and long side
curls. "Ach, du Pisher! Du fangst shoyn on?" the young woman scolded.
"Go in the waiting room and stay put!"

India was about to ask the woman who she was, but she'd disappeared
into the exam room again. India followed and found her on her hands and
knees, picking up the tray of instruments the little boy had dumped.

"Where's the autoclave?" she asked, kneeling down to help.

"The what?"

"The water bath. These will have to be sterilized."

"We don't have one."

"But how can you not? The need for an aseptic environment during
di-agnosis, as well as surgery, has been proven repeatedly. Dr. Lister
is very clear on the germicidal properties of--"

"Well, Dr. Lister ain't here today, is he? I am."

India sat back on her heels. "But how do you clean the instruments?"

"I take them home and give them a wash in the kitchen sink. When I
can remember," she replied, tossing a scalpel and two clamps back on the
tray. "You all set, then?" she asked, getting to her feet. "I'll send
the first patient in."

"Wait! I didn't get your name."

"Oh, sorry. Ella Moskowitz," the woman said, extending her hand.

India took it. "Dr. Jones," she said. "You're the receptionist?"

"And the nurse, secretary, clerk, and bookkeeper. Zookeeper, too. I
can't stay to chat. We're way behind. Going to have to go at it hammer
and tongs to get you through that lot by lunchtime."

"What? All of them? By noon?" There were more people in the waiting
room than she could see in an entire day, never mind a morning.

"Yes, all of them."

"Is Dr. Gifford here?"

"No. It's just yourself today."

"My word. Is there some kind of epidemic?"

Ella Moskowitz burst into laughter. "Epidemic! That's a good one. Oh,
it's an epidemic, all right, it's Whitechapelitis. This is just a
normal day. You want to see true pandemonium, wait till there really is
an epidemic. Got zol ophiten!"

"I beg your pardon?"

"Sorry. God forbid. You're not Jewish, are you?" she asked. "Can't
imag-ine you are. Don't recall a lot of Selwyn Joneses at temple. Many
of your patients are, though. Any trouble with the Jews, call me. Any
trouble with the Irish, you're on your own."

Ella hurried off, leaving India to stare after her. She barely had
time to orient herself before Ella was back with a patient--a small,
thin woman whom India guessed to be in her mid-forties. "This is Mrs.
Adams, and this is her file," Ella said, slapping a folder on the desk.

"Wait one bleedin' minute!" Mrs. Adams cried.

Ella stopped in the doorway. "Yes, Mrs. Adams?"

"I'm payin' good money to see a doctor and I want to see a doctor, not a flippin' nurse."

"Dr. Jones is a doctor, Mrs. Adams."

Mrs. Adams looked at India. "Pull the other one, it's got bells on," she said.

India looked down at herself, at the too-long jacket, the rolled
sleeves, and realized that she looked like a child playing dress-up.

"Now, Mrs. Adams--" Ella began.

"It's all right, Ella," India said, closing her office door. "Good
morning, Mrs. Adams. I assure you I am a doctor. I have a diploma. Would
you like to see it?" She reached into her bag and took the document
out.

She had other things in her bag, too. Colorful illustrations of
smiling fruits and vegetables. Booklets on economical and nutritious
cookery. Pamphlets on the principles of proper hygiene. She planned to
share them with her patients during examinations.

Mrs. Adams gave the diploma a look but remained unconvinced. "You
have one of them things Dr. Gifford wears? Round his neck?" she asked.

India pulled her stethoscope out of her bag and held it up.

"All right, then. I reckon you'd have to be a doctor to have one of them."

India smiled. "Can you tell me what's troubling you?"

"Baby's paining me something terrible. Dr. Gifford gave me laudanum and it helped for a while, but not no more."

"Do you have the bottle with you? May I see it?"

Mrs. Adams reached into her dress pocket for the bottle and handed it to India.

She read the label. It was laudanum, all right, which was not usually
prescribed for pregnant women. "How long have you been taking this,
Mrs. Adams?" she asked.

"About three months."

"And how far along are you?"

"Five months. Maybe six."

India nodded. She scanned Mrs. Adams's file, but saw no mention of
pregnancy. She did see Dr. Gifford's notations for pain and fatigue, and
that he'd started her on a weak laudanum solution and had been
increasing the strength of the dosage. She led Mrs. Adams into the exam
room and persuaded her to remove her dress and lie down on the table.
Mrs. Adams wondered aloud why it was necessary and said Dr. Gifford
never made her, but did as she was asked. When India saw her bare arms,
she had to work to keep her expression neutral. Mrs. Adams's bones were
practically pro-truding through her skin.

"Are you eating well?" she asked.

"I haven't much of an appetite. Been feeling a bit green, but that's to be expected with babies."

"Nausea is very common," India agreed.

"You don't have to tell me. Nine pregnancies I've had, and five
living chil-dren. None was easy, but this one's the hardest. I'm that
tired, there's days I fall asleep standing up. Once by the stove. Nearly
set me pinny on fire."

"How are you sleeping at night?"

"Poorly. Pains me to sleep on me side, and I can't get comfortable on me back."

"How old are you, Mrs. Adams?"

"Forty-six. Never thought I'd quicken again at this age. Thought it
was the change because me periods stopped. But then there was quite a
bit of bleeding right before, y'see, and there's no bleeding with the
change, is there?"

"May I look at your belly?"

Mrs. Adams nodded. India undid the buttons of her camisole and the
tie at the waistband of her petticoat to expose her abdomen. She saw
im-mediately that instead of the pleasing, symmetrical swell of
pregnancy, there was an uneven, lumpy look to her belly. Starting just
under the ribcage, she pressed down into the muscle, feeling for the
fundus, the top of an expanding uterus, but could not find it. Her hands
moved lower, probing for a bony nub--a skull, heel, or elbow. Nothing.
She fished in her bag for her fetal stethoscope, a wooden device that
resembled a bicycle horn. She pressed the bulb end to Mrs. Adams's belly
and put her ear to the trumpet-shaped cup. Again, nothing. There was
something growing inside Mrs. Adams, of this India was certain. But it
was not--and had never been--a baby.

"Is everything all right? There's nothing wrong, is there?"

India dodged the question. "Do you know what a speculum is?"

The woman shook her head.

"It's a device that enables doctors to view the reproductive organs. I would like to take a look if I may."

Mrs. Adams opened her mouth and stuck out her tongue.

"Um ...no, Mrs. Adams. It's the other end I need to examine."

"You what?"

"I need to do a vaginal exam. I can't tell what's going on inside you un-less I look inside you."

Mrs. Adams sat up. "Why, you filthy little monkey! I've never heard
of such a thing in all my born days. Is that what they teach you in
medical school? To use dirty words and look up people's privates?" India
heard anger in the woman's voice, but in her eyes there was only fear.
"Why can't you just give me my prescription like Dr. Gifford does?" she
asked, her voice rising.

"Now, now, now. What's all this noise, Mrs. Adams?"

India started and turned around. A compact man with gray hair and a
neat goatee stood by the desk. It was Dr. Gifford. He hadn't bothered to
knock; he'd simply walked into the exam room, not knowing who was
inside it or what was occurring. India found it highly discourteous to
both herself and her patient.

"Oh, Dr. Gifford, I am glad to see you! This lass of yours has me
stripped to me drawers when all I want is me prescription filled."

"Dr. Gifford, there is no gravidity," India said, choosing language
she hoped her patient could not follow. "There's a uterine mass. A large
one..."

"That will be all, Dr. Jones."

"But, sir, Mrs. Adams should be examined internally. She should--"

"That will be all."

"What's she on about, Dr. Gifford? Is me baby all right?" Mrs. Adams asked anxiously.

"Everything's fine, Mrs. Adams." He scribbled on a piece of paper and handed it to her.

"Here's a new prescription. Three drops every two hours in your tea."

Mrs. Adams's drawn face shone with relief. She thanked Dr. Gifford, dressed hurriedly, and left.

"Dr. Gifford..." India began.

"You are far too slow, Dr. Jones," Gifford said briskly, noting the
prescription in Mrs. Adams's file. "Ninety percent of the time you
should simply perform a quick exam and prescribe laudanum."

"That woman probably has uterine cancer. She needs surgery, not laudanum."

"I'm afraid surgery is not possible in Mrs. Adams's case."

"You... you knew she wasn't pregnant?"

Dr. Gifford looked up. "Yes, I knew. Do you take me for an idiot?"

"Of course not. I didn't mean to imply anything of the sort. But ...why didn't you tell her?"

"To what end? She's going to die, whether I tell her or I don't. Why
make her last months harder than they have to be? Let her think she's
pregnant. What harm is there in it? And keep her out of pain. More I
cannot do."

India could not believe what she was hearing. Gifford was making an
outrageous set of assumptions. He was playing God. Elizabeth Adams was a
grown woman, not a child. She deserved to be told the truth and allowed
to make her own decisions.