“We don’t know the future, Angie, only the present. I am proud of your stubbornness . . .”
“I know where it comes from.”
Ma laughed. Sir Charles had raised his head and sniffed suspiciously. Then he gave up and went back to sleep.
American medical education was a mess at that time. There were few rules and regulations about matriculation and graduation. Almost anyone could matriculate and there were few requirements for graduation. One could put in some time—a year at the beginning of Rush—observing surgeries and attending lectures, perhaps even working in hospitals. But medical licenses were easy to get and there were no quality standards for the practice of medicine. The Flexner report, which would revolutionize medical education and to some extent medical practice, was in preparation. There were rumors about it that frightened most faculties and licensed physicians. But it was generally assumed that pressure from the profession would be so strong that it would never be released. Rush was proud that it required a two-year course with entrance examinations at the beginning and license tests at the end. However, the requirements were not stringent and no one did roll calls at the lectures. Whether the students signed up for residencies was left entirely to them.
The board which interviewed Angela was hostile, though the influence of her foster father and of her foster brother and brother-in-law, already important physicians, practically guaranteed that she would be admitted.
Two of the examiners in the cavernous operating theater were elderly, one with a hearing horn, poor man. One was young and nasty.
“Why do you want to be a doctor, young woman?” demanded the deaf. “Don’t you know that women doctors never find a husband? Most men feel that they’re perverts anyway!”
She recited her reasons, standard answers about taking care of sick people. Then she added, “I’m not a pervert, Doctor, and I do hope to marry, please God, not to another doctor.”
The younger doctor leered.
“You realize that you will be subject to sexual aggression in this school. You will be very fortunate if you escape rape.”
“I will take my chances, Doctor, as those doctors who try to molest me must take their chances.”
“It won’t be that easy, my dear,” he said with another leer.
“I believe that in the State of Illinois there are laws against rape.”
The third examiner was a glum, unsmiling man.
“Your gumption is admirable, young woman. I’m afraid that won’t be enough. Let’s see how much you know about anatomy.”
He fired up a barrage of difficult questions to which she responded with a barrage of answers.
“You’ve done your homework, young woman, I hope it does you some good. Doctors are very difficult men, however.”
“So I’m told.”
Angela’s strategy was to match tough words with tough words. She would not show any signs of fear or weakness. She would respond in kind to any harsh words and indeed take the initiative in being tough. The students who were her own age, just two years younger than Tim and Seamus, were the most difficult of all because they were the most stupid. She responded to each attempted grope with a knee in the groin. When a group of them blocked a corridor and announced that they were going to teach her a lesson, she produced a scalpel from her skirt pocket, flipped it open, and said, “Which one of you wants to be cut first?”
They backed off.
She was horrified at the dissection of dead bodies which was supposed to teach her about anatomy. Most of the bodies were stolen, it was said, by grave robbers and delivered to the school late at night. Angela was assigned the corpse of a young but wasted prostitute who was pregnant when she died.
Angela ignored the nasty remarks from her colleagues and recited the rosary for the repose of the poor girl’s soul. She was sure that God loved her just as he loved everyone. Loved her more than he loved Angela, perhaps.
The most horrible experiences of her first year, however, were the surgeries conducted in the operating theater, surgeries which were designed to demonstrate the great skill of the surgeon for future imitation.
The first one featured the most famous surgeon on the faculty, Hezikiah Dalton. He was going to demonstrate how to remove a large growth from the abdominal cavity of a woman, a youngish person in her late twenties who had already produced “four useless children” to contribute to the decline of the world’s food supplies. She had believed that this growth was another child, which she had admitted to the doctor would bring her great joy. He commented that it would not bring joy to a country which already had too many useless immigrants. The woman was Italian and could not understand what the doctor was saying, but knew that he was being nasty.
The doctors and nurses in long gowns and caps looked like a group of priests huddling around an altar and the young woman like a sacrament they were going to create.
“Now, madam, would you be so good as to tell those who will watch this surgery why you seek it?”
“So I can go home and take care of my husband and my bambini!” she said in a loud, clear, and confident voice.
“You might well ask why we should operate on this woman?” he said as an assistant poured chloroform on a crude mask over her mouth. “The answer is that she is here and seeks surgery and it provides an opportunity to demonstrate how a skilled surgeon deals with a difficult problem. Will she survive? Her prognosis is poor whether we remove the growth or not. We may prolong her life briefly, but that is hardly our primary intent. We will not lament her departure. She will not in any case bear any more children, we will see to that.”
Angela used the skills at shorthand she had learned at St. Mary’s to take down Dr. Dalton’s comments. Her stomach, which had resisted all the horrors of Rush, revolted as she watched and listened as this poor woman was sliced up by a surgeon demonstrating his great skill. There were four children waiting at home for their mother. Doubtless they loved her and she loved them. Also a husband, probably a semiliterate immigrant. They surely loved one another, even if his demands on her may have been cruel.
“Now we see the cause of her distress, a large growth, probably cancerous, which we must remove with as much elegance as possible without damaging any of the nearby organs. Of course we will remove her womb before we proceed. In a few quick moves of the blade, we will eliminate the possibility of any more bambini. So it is done. We will insert sutures later. Now to the major work at hand.”
Deftly he removed the growth, disentangling it from her intestines. Angela had to admit to herself that he was good at what he did. Yet there was no concern over the life of the woman who had submitted herself to his skills so she could return to the care of her husband and children.
“That doesn’t look like cancer to me,” a gray-haired doctor next to Angela muttered. “He’s taking too many chances.”
Angela wrote that comment down in her notes.
Suddenly, a fountain of blood rose from the woman’s abdomen.
“Ah,” said the surgeon calmly, “we have an artery problem near the womb, or near where it was. We must suture it immediately.”
With hurried and still-elegant gestures he managed to close the bleeding artery. The audience was silent. Blood was everywhere on the stage. The nurse whispered in his ears.
“Alas, despite our heroic efforts, it seems that the patient has died. The strain was too great on her heart. We will now cover her lifeless body and consign her soul to the God who made her.”
“Bull shite,” Angela said.
The doctor next to her smiled and whispered, “Right you are.”
“We of course regret the death of any patient, even if there was no fault in the loss. But it is clear that this unfortunate woman had little time left to her life. A provident deity has spared further suffering.”
The body was carried off the stage. Negro attendants began to scrub up the bloody mess.
“I will be happy to answer any questions you might have or respond to any comment
s,” Dr. Dalton said as he washed the blood off his hands.
“Yes?”
There were a number of technical questions.
Then the man next to Angela raised his hand.
“Hez, you’ll autopsy that growth and let us know the findings. From this distance it didn’t look malignant.”
“I assure you, Dr. Fredericks, that from up here there was no doubt. But I will of course report the autopsy findings to you.
“The young person next to Dr. Fredericks.”
“I have a comment to make, Dr. Dalton,” Angela said.
“I am ready to learn from everyone.”
“You killed that woman. If you hadn’t been so eager to do your hysterectomy and get to the main event, you would have sutured the womb immediately and the artery might not have burst. Her husband has no wife, her children no mother, because you wanted to prevent any more Italian children and to exhibit your great skills as a surgeon. You may be a great surgeon, but you also are a murderer.”
“You are a hysterical woman,” Dr. Dalton screamed. “I will end this lecture now.”
He stalked off the stage.
“You’re Paddy Gaughan’s foster daughter, aren’t you?” Dr. Fredericks asked.
“Angela, sir.”
“You’re a remarkable young woman, Angela. Tell Paddy that Dr. Fredericks said so.”
“Thank you, Doctor.”
No one looked Angela in the eye as they left the operating theater.
One of the first-year students did whisper to her, “Well done.”
“I was at a surgery this afternoon at the operating theater.”
“The surgeon was?” Papa Paddy looked up from his copy of the Chicago Daily News.
“Hezikiah Dalton.”
Her foster father winced.
“Did he kill anyone?”
“Yes. An Italian woman with four children. He cut out her womb but did not suture because he was too busy showing his skills in removing a large, probably not cancerous tumor. She bled to death.”
“Who said it was not cancerous?”
“Dr. Fredericks, who was sitting next to me.”
“Lenny? A good man . . . Undoubtedly he is right. Did you chat with him? I suppose he knew who you were?”
“Everyone does . . . He said to tell you that I am a remarkable young woman.”
“That was very nice, not that it comes as a surprise to me. What led to that comment?”
“I accused Dr. Dalton of killing the woman. I recorded the whole event in shorthand. This is what I said:
“ ‘You killed that woman. If you hadn’t been so eager to do your hysterectomy and get to the main event, you would have sutured the womb immediately and the artery might not have burst. Her husband has no wife, her children no mother, because you wanted to prevent any more Italian children being born and to exhibit your great skills as a surgeon. You may be a great surgeon, but you also are a murderer.’ ”
Papa Paddy did not even try to restrain his smile.
“And my good friend Hez?”
“He accused me of being a hysterical woman and stormed out of the theater.”
“You won’t have any more trouble at Rush, small one.”
“Why not?”
“Because they will know they have a demon on their hands, an intelligent demon who speaks the truth. Dr. Fredericks is quite correct. When you see him again—and he has become your friend this afternoon—tell him I said that he didn’t know the half of it.”
“He noticed I was there when I said, ‘bull shite!’ I’m a terrible woman altogether.”
“Indeed you are. May I have those notes? I’ll have them transcribed.”
Then Seamus and Timothy tumbled into the room.
“Dad, you’d never guess what happened at Rush this afternoon. We just heard it from two friends that were there . . . But you’ve heard about it already . . .”
“Little sister, will you translate the relevant passage of your notes for these uncouth young men?”
Angela read it again.
“Dear God in Heaven!” Seamus exclaimed.
“They all must be terrified over there,” Timothy agreed.
“And Len Fredericks sent her home with a message to me which confirmed our impression that little sister is a remarkable young woman.”
“No one will bother you any more over there, Angela. You’ll own Rush from now on.”
“I don’t understand why. I just lost my temper and said what I thought.”
“I wish I had been there,” Shay said.
“Me too.”
Mama Mae came in.
“What’s all the excitement about?”
So they retold the story again.
Exhausted now and drained, Angela sank into an easy chair.
“I’m so proud of you, Angela, so proud. He’s such a terrible man.”
“He won’t give any of those shows of his again.”
“If only we could have saved that poor young woman’s life.”
“We are still struggling to take advantage of all our knowledge,” Dr. Paddy murmured. “The Flexner report can’t appear soon enough.”
“There was a time”—Angela was now experiencing some pangs of guilt—“when Dr. Dalton was a young man with good intentions.”
“Very brave man during the war. Now believes in his own excellence. Can happen to any of us.”
The next day some of her classmates at Rush congratulated her for her courage. As one of them said to her ruefully, “None of us are going to make trouble for you, Angela. Now we just hope you’re on our side.”
She didn’t understand that either.
13
AT THE end of her first year at Rush, Angela applied for residency at Mercy Hospital, which was administered by the Sisters of Mercy but was also the municipal hospital for the city. Sister Mary John of the Cross considered her suspiciously.
“How old are you, young woman?”
“Nineteen, S’ter. Going on twenty.”
“And you’re from Galway?”
“Carraroe in Connemara, Sister.”
“Rather wild country over there.”
“Yes, S’ter.”
“And you live with Dr. Gaughan’s family, but your name is Tierney.”
“Yes, S’ter.”
“I know where I heard about you. You’re the one who took on Hezikiah Dalton. Either you were very dumb or very brave.”
“I’m not at all brave, S’ter.”
“My friend Dr. Fredricks thinks so . . . Well, I don’t think you’re dumb. You want to work in the obstetrics ward. You think you’ll like delivering babies?”
“I helped in the delivery of two of my brothers back in Ireland.”
“They both lived?”
“For a time. Later they died with the rest of my family.”
“You’re a good young woman, Angela Tierney. We will be delighted to have you at Mercy. I hope you will be pleased with us. We try hard. Hospitals are better than they used to be, God knows. But we have a long way to go.”
Angela had read articles which suggested that those who deliver babies should wash their hands in chlorinated water every day to prevent the spread of puerperal fever among new members. Since she was, for all practical purpose, the head of the obstetrics department at Mercy, she posted orders for this practice and provided the chlorinated water. The nurses and midwives were skeptical until the cases of puerperal fever disappeared from the ward. She began to prepare a handbook of hygiene for mothers with new babies. It insisted on cleanliness for both mother and midwife.
She also had to do Cesareans, since there was no one else in the hospital who had done it. She had dashed over to Rush and seen her patron, Lenny Fredericks, who gave her some quick instructions. The first time, Angela was more frightened than the young woman. When the firstborn son appeared, happy and healthy, they both wept. Mother and child were promptly cleansed in chlorinated water, which some of the nuns claimed was Dr. Tierney’s Holy W
ater. She began free workshops for midwives, called “Keeping Mother and Child Alive: Childbirth and Sanitation.” Her fundamental assumption was that everything had to be clean.
When Angela graduated from Rush—her two years there had passed like two weeks—her family had a party for her. Bishop Muldoon came, as did Dr. Fredericks and nuns from both St. Mary’s and Mercy. She had the impression that the orders were competing for her. She had swept through her medical education in record time and was appointed to the Chicago Board of Health, an institution which had some real power. It was all very heady, she told herself, for an orphan from Connemara.
The day after the party, a week of torrential rain hit Chicago, the river flooded into the lake and cholera came to Chicago again. Contaminated drinking water, Angela told everyone on the Board of Health. They were inclined to agree. Sister John of the Cross asked Angela if she would take charge of a ward of nine Mercy nuns who would almost certainly die. Of course she would. She asked her father to send a shipment of a hundred five-gallon bottles of the spring water they had drunk at the lake—pure Wisconsin water. Then she insisted that each of the young women drink a half pint of the water after every bowel movement.
“It’s foul water that made you sick,” she told them confidently. “It will be this sweet water from the north woods that will keep you alive.”
An article in a French journal had argued, with a little evidence, that cholera victims died of dehydration. If le médicin could keep the patient hydrated with uncontaminiated water, they would survive until the résistance naturel in their bodies rid them of the infection.
Angela was about the same age as the young nuns. There was no reason why they should trust her, save that she was Dr. Tierney. On the third day of the “water torture,” as they called it, they came close to outright revolt. Angela led them in the recitation of the rosary and the singing of hymns, and they fell asleep. She remained awake, watching them closely.
“Dear God, grant life to these young brides of yours. They are brave, vital young women, and Irish at that, if I may remind you. Bring them back to health so that they may serve you in this strange new land which I share with them. Please, please please, I beg you.”
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