by Sara Donati
It was as if she had put down her profession at some point since leaving home, and now picked it up as easily as a scarf once believed to be lost but then found, when all hope was lost, in the very drawer where it was meant to be.
The stethoscope told her what she anticipated: both of these young people were in poor condition, but the girl was far worse off. In addition to her headache, her heart was racing, her respiration was very fast and shallow, and she was drifting in and out of consciousness. She moaned and tried to turn, as if that would be enough to escape the pain.
Sophie palpated the lymph nodes under the jaw and folded the blanket away to examine her abdomen. It was then she realized that the girl—she could be no more than eighteen—was far gone with child.
Gently Sophie traced the taut line of her belly, cupped the curve of a skull, the bulge of a knee that suddenly flexed and withdrew, like a fish darting away to safer, deeper waters. The baby was alive, and no more than a month from term. She saw no evidence of contractions, but that might change at any moment; the terrible shock and stress of the shipwreck would be more than enough to send anyone into premature labor.
To Charles Belmain she said, “Has she been sick to her stomach?”
The question confused him, and Sophie repeated it in French.
“Yes,” he said. “Most of us were, the last three days. But we had so little to eat. At sunrise we got a handful of rice and a single swallow of water and nothing more.”
“Has she been disoriented, speaking of odd things?”
His expression cleared. “Yes. She’s been calling me by her husband’s name.” Something odd in his expression, but this was not the time to pursue family politics.
“Complaints of pain?”
“Since earlier today, that too. A terrible headache, she says she can hardly stand it. She had some protection from the sun—a tray I held over her head—but still, the heat was too much.”
All the symptoms of heatstroke, a disastrous diagnosis in the current situation. Sophie stood up and looked over the room until she found the captain, who was talking to the ship’s physician.
To Charles Belmain she said, “Keep giving her sips of water, and take sips yourself. But just sips. I’ll be right back.”
On her way across the dining hall Sophie scanned the survivors where they lay, attended by crew members and a few intrepid passengers. They were all male and none seemed to be suffering from heatstroke. She was glad of it, because the one thing she must have would be in short supply.
The captain turned toward her as she approached, a deep crease furrowing his brow.
“Mrs. Verhoeven,” he said, his tone quite short. “You needn’t concern yourself—”
He was trying to dismiss her, but Sophie had a lot of experience with people who thought she could be shooed away.
“You have no reason to know this,” she interrupted him. “But I am a fully trained and qualified physician, registered at the New York City Board of Health. Professionally I use my maiden name, Dr. Savard.” Briefly she asked herself when she had made this decision, and decided it didn’t matter; it felt right.
“Captain, you have one female survivor”—she glanced over her shoulder toward the corner where Charles Belmain and his sister sat propped against the wall—“and she is in the last weeks of her pregnancy. She also has heatstroke, which may be fatal. How much ice do you have on board?”
* * *
• • •
FIFTEEN MINUTES LATER she was back in her cabin cutting the disoriented young woman out of her ragged clothes and then moving her into the hip bath lined with a sheet she took from her own bed. She spread a second sheet over the girl’s swollen form and as she was tucking a rolled towel beneath her neck, there was a knock at the door.
She called to Mr. Belmain, who sat in the next room of the cabin suite drinking a bowl of broth. “That will be the ice. It needs to be chopped into pieces. Would you, please?”
It was a lot to ask of him, but she knew that some kind of activity would help him maintain his calm through what was to come.
Sophie was in constant motion for the next hour. Using a syringe without a needle she dribbled cool water into Catherine Bellegarde’s mouth and massaged her throat when she was slow to swallow, pausing only to scoop more ice into the bath, to wipe the girl’s face, to take her pulse and check her pupils. As if she understood that Sophie needed some encouragement, Catherine Bellegarde finally raised a hand to touch Sophie’s damp wrist.
“Madame Bellegarde,” she said in a calm, even voice. “Catherine. I am Sophie Savard, a physician. The survivors of the Cairo have been rescued, and now you’re on board the Cassandra. You are safe. Your brother is safe.” She repeated herself in French, and got in reply only a grimace. The girl touched her own head.
“You have a headache, I know. I have medicine for you. But you are very dehydrated and you must keep taking water while I get the medicine ready. Here’s a clean cloth for you to suck on, can you do that?”
“My baby?”
“You feel it kicking, yes?”
Catherine Bellegarde smiled with lips that were puffy and cracked. Sophie smiled too.
Pip, who was clearly worried, settled himself on the bed where he could watch the patient, as vigilant as the best of nurses.
* * *
• • •
BY NOON THE next day Sophie was beginning to believe that Catherine Bellegarde might revive and recover. Her temperature was close to normal, and her heartbeat had steadied. She had taken a pint of water and a pint of beef broth, and she was perspiring freely.
But her headache, never quite conquered, reasserted itself and then came roaring back. Sophie was helping her take a weak dose of laudanum when she realized the girl’s eyelids had begun to swell. As had her hands. With a sense of dread she turned to get the small basin she had been using as a bedpan—a urine sample would tell her some things, even without a laboratory in which to test it—when Catherine Bellegarde began to seize.
Pip came to his feet and gave a fretful yip as she thrashed, looking to Sophie with something like accusation.
Now you really are imagining things, Sophie told herself, but she understood well enough: the accusation came from her own mind, where this new set of symptoms was adding up to something terrible.
Over the next hours as she tended her patient she took note of what was happening, and knew the truth even before a second and then a third seizure.
In the morning she sought out the ship’s doctor for a consultation. Dr. Conway listened to the case history and her poor prognosis, stroking his beard and shaking his head.
“Have you told the brother?”
“No,” Sophie said. “But I will have to speak of it if there’s no improvement by this evening.”
“If you would like me to examine her, just send word with one of the cabin boys.” He paused. “I’m very glad for her sake that you happened to be on board. I’ve had my hands full with the rest of the survivors.”
“Deaths?”
He nodded. “One. Exposure and a weak heart. Three amputations, as well. But it’s amazing that they survived, any of them.”
Sophie wanted to get back to her patient, but her curiosity about the wreck made her pause. “What exactly happened?”
He puffed out his cheeks and let his breath go with a pop. “According to the quartermaster, they got caught up in a nor’easter. Treacherous. A swell like a mountain—so he said, and he’s twenty years a sailor—struck her starboard and took the whole ship over. She might have righted herself, but the hold was full of cattle and every one of them was thrown to the port side when the swell hit. So that’s how they stayed, the cattle thrashing and bawling. The captain put half the crew on the pumps and set the other half to dragging the cattle out of the hold, one by one, up a deck slanted like a roof, you have to imagine it, a
nd then forcing them overboard. One of the sailors got hooked on a horn that tore his arm up. I had to amputate at the elbow.
“Took a day and a night to empty the hold, and the whole time she was sinking, inch by inch. Then they waited another two days to be rescued, in blinding sun. You saw how much was left. The miracle is that we came across them when we did.”
Sophie went back to her cabin thinking of Catherine Bellegarde, who had such a short time left to live. In these few hours of their acquaintance, the young woman had reminded Sophie that she had a profession and—though she disliked the word—what amounted to a calling. She could no more pretend not to be a doctor than she could convince herself that she wasn’t female. This thought was in her mind still when she opened the door and saw Charles Belmain bent over his sister, trying to hold her down while she convulsed. Pip put back his head and howled.
Sophie sent the cabin boy running. Dr. Conroy, no longer young and made in the shape of a barrel, was breathing hard when he reached the cabin.
Sophie said, “Sudden-onset cortical blindness and there’s pitting edema on her face and chest. No avoiding the diagnosis anymore.”
He bowed his head. “Eclampsia.”
“Yes. But the baby is still alive, and I might be able to save it.”
He was a physician and understood what she hadn’t said out loud: Catherine Bellegarde was as good as gone. Eclampsia was always fatal, even in the most controlled situation and best-equipped hospital surrounded by specialists; there was nothing to be done for her. It was unlikely that the child would live, but there was at least a small chance.
Charles Belmain was standing near the door, his color very bad. Sophie walked to him, took him by the arm, and forced him to sit down before he fainted.
“Mr. Belmain. Your sister has eclampsia, I’m very sorry to say. There’s nothing we can do for her, but I will try my best to save her child.”
When he glanced up Sophie had the sense that he hadn’t really heard her.
“Let me do what I can to save her child,” Sophie repeated.
Belmain blinked and looked down at his feet. When he looked up again, there were tears in his eyes. “You said she had coup de chaleur. Heatstroke.”
“She did have heatstroke, but it was masking another problem. Eclampsia.”
“What is it?”
“Éclampsie. Probablement à la suite de l’hypertension artérielle. Arterial blood pressure has something to do with it, but I can’t tell you any more than that. As far as medical science has come, the reasons some women develop these symptoms are not understood.”
“And you have seen this before?”
“I’ve seen at least fifteen cases.”
“How many of them recovered?”
“None. I’m sorry to say, there’s nothing to be done for her. The baby is another matter. It might be possible to save the child. Monsieur Belmain, if you want me to try to save her child, you must say so in front of Dr. Conroy, as a witness. I will have to operate, and I can only do that once she has passed.”
For a span of three heartbeats he stared at his fisted hands where they rested on his knees. “All right,” he said finally, his tone almost angry. “If you must, save the child.”
Sophie started at such wording, but there was no time to inquire what he might mean.
Dr. Conroy said, “Tell me what to do, and I’ll help where I can.”
“I’ll need your surgical instruments,” Sophie said. “I have only very basic supplies in my bag.”
She had surprised him. He tried to say something, stopped, and then cleared his throat. “A Caesarean?”
“It’s the only way to save the child. Post-mortem, in such a case. And that may not come to pass for hours. Do you object?”
“Object? No, but—have you done a Caesarean before?”
“I’m not a surgeon, but I have assisted any number of times. In these circumstances a Caesarean is tragic but it’s not a very complicated affair.”
“I see.” He went to the bed and studied Mrs. Bellegarde for a long moment, put his ear to her chest, lifted her eyelids, looked in her mouth, tested her muscle tone. Then he put a hand on her abdomen, gently, and after a moment, he nodded.
“We are very close to port,” he said. “She may last that long.”
“I hope she does,” Sophie said. “I would much rather a surgeon did this operation, if that can be arranged in time.”
* * *
• • •
“SHE HAS ALWAYS been the most stubborn person,” Charles Belmain said later when the Cassandra had just dropped anchor in New York harbor. He stood calmly with Sophie and Dr. Conroy at his sister’s bedside. Her respiration was uneven, thready, almost imperceptible, but the child was alive and active.
“We can take her to a hospital as she is,” Sophie said. “They will look after her until she dies and then they’ll deliver the child.”
“Or we could let them both go.” Belmain’s tone was flat, without the vaguest touch of emotion. And in fact it was an impossible decision. Many people were horrified at the thought of delivering a living child from a dead mother, while others were desperate to have the child at any cost. Whatever his doubts, the decision was his to make. Sophie must keep her opinion to herself.
“I have no money for a hospital,” he said finally. He spoke English, looking at Dr. Conroy.
“They will accept her at the New Amsterdam Charity Hospital,” Sophie said in the same language. “I am—I was on staff there and I know many of the surgeons.”
“A charity hospital?” His complexion, so damaged by sun and water, could not flush, but his tone made it clear that the suggestion was an affront.
Dr. Conroy said, “This is not the time for pride. Your sister’s child may still be saved if you are willing to take the help being offered to you.”
Belmain was studying the floor, every muscle in his body tensed and unhappy. His sister was very near death, and he himself was still suffering after-effects of the shipwreck. Sophie took these things into consideration and softened her tone.
“What is it that frightens you?”
He glanced up at her from under the shelf of his brow. “I can almost hear my mother shouting from the heavens. She sent me here to rescue my sister from an unsuitable marriage and bring her home, and I did that. I lied and cheated, but she came away with me and here is my reward: it was all for nothing because she’ll die in a charity ward. I promised my mother on her deathbed and I’ve failed. And tell me, what am I going to do with a baby? How will I get it home to France, and if I somehow manage, who will want it there? I can tell you: no one.”
There was no time for polite suggestions. She said, “Your brother-in-law’s people, are they here in the city?”
The corner of his mouth pulled down. “I’d rather see it dead.”
Sophie drew back. “This is an innocent child we’re talking about.”
He shook her admonition off. “If it’s born alive it will have to go to an orphan asylum. Unless you want to keep it.”
Sophie had just spent two days caring for a woman who could not survive, who carried a child who might live but would be rejected by anyone who had the right to claim it as family. The idea of taking this child to raise as her own was an impossibility, regardless of her own feelings: no court would give her custody of a white child.
“One thing at a time,” she said. “Do you want to save this infant?”
The look he shot her was equal parts anger and resignation.
“If my sister survives a trip to a hospital, yes. Save the child, if you can. But I want nothing to do with it.”
PART III
Stuyvesant Square
2
AS THE CASSANDRA docked in New York Harbor, Elise Mercier was dashing across Livingston Place into Stuyvesant Square Park. She angled for the far corner, d
odging around trees, her book bag thumping wildly against her back while spring mud squelched and spat with every step. Where Second Avenue bisected the park she stopped; it was that, or be run down by four draft horses and an omnibus.
While she waited she thought of the day she got the letter telling her she had been accepted as a student at the Woman’s Medical School. Since that day, it seemed, she had been running flat out.
They had warned her. Everyone had warned her. When she went to the nursing office at the New Amsterdam to give notice, Matron Gilfoyle listened, her expression carefully neutral. Whether she was feeling disbelief or disappointment or even satisfaction, Elise never knew because she kept it all to herself. She didn’t even say what they were both thinking: Elise was not the first nurse who aspired to medical school. Over the last five years there had been eight nurses, all experienced, who had been admitted to medical school. Two of them had come back to their positions as nurses here, four had failed outright and left medicine, and two were still studying medicine at other institutions.
Instead the matron said, “You are an excellent nurse, and you are always welcome here. If you . . . decide to return to nursing.”
All through her first year of medical school that short conversation came back to Elise. “I could return to nursing,” she reminded herself as she yawned over Bartholow’s Practical Treatise on Materia Medica and Therapeutics or ran to class or sat down to take another exam. “Imagine how much I’d learn as a surgical nurse, watching. Always just watching.”
