The Heart Specialist

by Claire Holden Rothman

  I picked up the nearest jar. Inside was the largest heart of the collection, grey as a pigeon’s breast, with feathers of disintegrating flesh blurring the contours. This one was labelled “Ulcerative Endocarditis.” The handwriting was my father’s.

  There was a knock on the door and Dr. Clarke’s head appeared. I checked my watch. It was eleven o’clock, the hour I’d said I would expect him. I had forgotten. My lab coat needed a wash, I thought suddenly. I smelled as if I’d been pickled in preservatives myself. I blushed, trying to disentangle myself from the coat as Dr. Clarke walked toward me across the room.

  “How’s the system?” he asked, taking my hand.

  The “system” was something I had dreamed up when I realized the extent of the pathology collection with which I had been entrusted. The oldest items dated back to 1823, the year the McGill medical school had been founded. In the intervening years hundreds of specimens had been collected. With some regularity specimens arrived by the pail-full from the Montreal General or the Royal Victoria Hospital, compounding the chaos. There was enough room for everything, but the challenge was to organize the collection so that items could be retrieved with speed and efficiency.

  In Zurich a physician had adapted the Dewey Decimal Classification system — devised in 1876 and used primarily to sort books in libraries — to anatomical specimens. My innovation, which had impressed Dr. Mastro and several other faculty men, was to add a pathological number after the decimal point. It had taken four months to devise this system and apply it. As of this week each of the identified specimens in the museum, save the hearts, had been tagged.

  Incoming specimens were less problematic. They arrived with autopsy reports, and if these reports were unclear all I had to do was check with Mastro or the doctor who had supplied them. It was the older specimens that caused me anguish. Much of the time I felt like Sisyphus, pushing that boulder up the hill only to have it roll down and squash me. The anatomy was the easy part of my task. More challenging was to identify the pathological anomaly. I had to date these specimens, which led me to search through ancient hospital records to see what had been written about them. It was slow, painstaking work.

  “Done!” I said dramatically.

  Dr. Clarke laughed and shook my hand. “You’re quite a girl.”

  The skin on my hand was rough from daily handling of specimens; I pulled it back quickly.

  Dr. Clarke pretended not to notice. “So what have you unearthed, Agnes?”

  The previous night I had left a note on his desk. As a rule I tried to avoid placing demands on him. He had too much work. On top of his administrative functions he published scholarly papers and ran a private medical office. He was also a mentor to students and younger colleagues.

  I pointed to the jar with the large heart at which I’d been peering all morning. It was an adult organ, but such a strange, misshapen thing, it was a mystery how its owner could have survived infancy.

  Clarke pulled the jar toward him and squinted at the heart in the uneven light. “Ulcerative Endocarditis?”

  “The label’s wrong.”

  “I’ll say,” Clarke agreed. “It’s some sort of anomaly, but not one I’ve ever seen. Look at how dilated the auricles are.”

  My spirits began to sink. Working here was like trying to piece together an enormous jigsaw puzzle with parts missing and others that refused to fit. “You’re not familiar with it?”

  He rotated the jar slowly. “It has only one ventricle,” he said, shaking his head in wonder. “Like a reptile!”

  I nodded. When I first came across it I had thought it could not be human. The museum held a number of veterinary specimens and I’d suspected it might be one of those. I suggested this to Dr. Clarke.

  “Too big,” he said, scratching his chin. “All but the ventricle is clearly human.”

  “Not quite,” I said, pointing to the heart’s right corner, just off the pulmonary artery. “There’s a cavity. Can you see it? I suppose it’s to make up for the missing chamber.”

  Clarke rotated the jar a final time, lips pursed, deep in thought. “Do you know who could help you with this?”

  My breath slowed. I didn’t dare turn my head. The heart was old, perhaps even predating my father, although he had been the resident expert in morbidity when it had been acquired. He had, perhaps, autopsied it. I did not look at the dean, did not know what I would do if the name I both dreaded and hoped for rolled off his tongue.

  “William Howlett,” the dean said, bringing the tips of his fingers together.

  I was surprised and turned to face him.

  “He knew this collection better than anyone,” Clarke explained. “When he was teaching here he used these specimens in the classroom. They were demonstrations for his students.”

  I tried to nod and smile. William Howlett. His name hadn’t even crossed my mind.

  “Yes,” said Dr. Clarke. “Howlett’s the man you want. You’ve heard of him, of course?” He put the mysterious specimen down on the table. “He’s made quite a reputation for himself since he left Montreal.”

  I nodded weakly, which Dr. Clarke would interpret as he wished.

  “You would do well to arrange a meeting with him, Dr. White, for many reasons, the least of which may be this heart.”

  11

  What I first noticed about the city of Baltimore was the colour. Green leaves unfurling on the branches of elms and oaks lining the sedate streets, green buds on all the hedges, green grass on the large, well-maintained lawns. When I’d boarded the train two days before at Windsor Station, Montreal had been clothed in grey. Spring had only just begun in my northern city. On my journey south colour seeped incrementally into the landscape. By the time I reached Baltimore it was as if a hand had reached down from the sky and painted the land in lush colours of spring.

  I was here because of Dr. Clarke. It was he who had instigated the trip and secured the funding in the face of opposition from Dr. Mastro and others on faculty. My primary destination was the Army Medical Museum in Washington, which housed, according to Clarke, the largest collection of pathological specimens in North America. It would do much, he said, to inspire me. On the way there he suggested I stop in Baltimore to visit the Johns Hopkins medical school and hospital. Dr. Mastro had put up quite a fuss when he had heard. He did not see why university funds — insufficient at the best of times — should be spent on someone who wasn’t even a faculty member.

  Clarke had arranged it, however, and here I was, on a tram winding through the Baltimore streets, heading toward the most renowned medical school in the United States. On my lap was a leather satchel stuffed with tissues and week-old newspapers. Nestled inside this wrapping was a jar containing the enigmatic, three-chambered heart that had obsessed me since I’d first laid eyes on it. I hoped I was about to solve the mystery of its origin. In addition to the heart my satchel held a letter of introduction to the physicianin-chief at the hospital, Dr. William Howlett.

  I was excited to be meeting him again. He was sure to remember me as I had practically fallen at his feet in the dean’s office at McGill and then sobbed out the confession of my true identity. I wanted to show him that I had succeeded.

  The heart weighed heavily on my legs. It was proving to be a literal burden. I had carried it all the way from Montreal and hadn’t left it unattended in all that time. Although the glass of the jar was thick it was still breakable. I was hoping I could stash it in Howlett’s office for the length of my sojourn.

  Below me stretched the harbour and a labyrinth of streets. Baltimore is an industrial city. There are wealthy residential neighbourhoods, including the one in which my hotel was situated, full of huge old houses of brick and stone, but the city also contained many more with crowded row houses and tenements. There seemed to be a large working class, made up, I understood, mainly of German immigrants. The servants, however, were uniformly coloured. This morning as I’d waited for the tram I had been passed by no fewer than five Negro ladies
, each pushing a perambulator with a white child inside.

  Johns Hopkins Hospital sits on a hill in the middle of Baltimore with a view of Chesapeake Bay. It was built in the 1870s, before Pasteur dispelled the notion that contagion was airborne. Back then the hill, which caught fresh sea breezes, had been considered conducive to health. Overnight theories had changed and the place had become an anachronism. I had read somewhere that not only was the sea-breeze theory wrong, the architect hadn’t planned adequate sewage or ventilation. In spite of this the hospital and its medical school were reputed to be the best in North America. The buildings may have been constructed on a faulty premise but the people inside made up for it.

  The tram wheezed as it travelled uphill. It was electric. There was nothing but a thin wire to keep us from plunging backwards into Chesapeake Bay. The two other passengers didn’t seem to mind. One had her nose in a textbook. I was just near enough for me to discern pink organs embedded in a sea of print.

  The other passenger was a man closer to my own age with cropped hair and a military bearing. He carried no books and paid no attention to me or to the girl, passing his time staring out the window. His colour was too good to be that of a patient, but he couldn’t be a medical student as they lived up the hill. Why would he be in this tram at eight thirty in the morning? “Living in” was one of the requisites for enrolling at Johns Hopkins. One had to be single and willing to sleep in the hospital itself. These rules had been set down by Dr. Howlett, who believed apprenticeship was far more useful than book learning in training student physicians. The few women enrolled in the program were exempted from the rule; they took rooms in the city or slept in the nurses’ residence, also located up the hill.

  By the time the tram reached the hill’s crest it was close to nine o’clock. The man was the first out. He didn’t wait or offer to help me with my bulky carrying case, but proceeded quickly toward the hospital. The girl hurried after him, checking her watch and stumbling beneath a load of books.

  I too hurried off the tram. When I had written William Howlett’s office to request a meeting his secretary had warned me not to be late. “Dr. Howlett is a punctual man,” she had written. “He will expect as much from you.”

  I wondered what he made of my request to visit and exactly how he would greet me. Nine years had elapsed since our unfortunate encounter in Montreal. I cringed slightly, recalling the committee’s hostility. How humiliating the entire affair had been. Miss Skerry said that the most painful situations were the richest because you learned so much from them. This one had not taught me much. It had been an irredeemable fiasco.

  Dr. Howlett had not contacted me in the months following that first meeting. Perhaps he had been put off, or perhaps the mention of my father had shaken him. Whatever it was within a year he had left Montreal, crossing the border to work first in Philadelphia and then a few years later in Baltimore. Now he and I would meet again. My grip tightened on the handle of my case. I would not have sought him out without Dr. Clarke’s prompting; he was perhaps the only person in the world capable of solving the riddle of my heart.

  The hospital loomed majestically above me. Most of its buildings were constructed of brick and there was a tower with a cupola making it seem more like a fairy-tale castle than a sick house. A couple of patients and what I presumed to be their families were standing near the entrance conversing. A guard sat at a desk, whittling with a penknife. Before I opened my mouth he gave several short, practised waves of his hand to indicate the route.

  When I pushed open the door on the landing to the second floor I found a huge crowd milling about. I was hot from my climb and from lugging the satchel. I remained at the periphery, trying to decipher who all these people were and what exactly was happening. Everyone was talking excitedly. A hush fell over the crowd and everyone turned in the same direction toward an office door that had opened. Dr. Howlett stepped out. I could see him through the lines of people, smiling and reaching to shake hands.

  Nine years had barely altered him. He was still carefully dressed, this time in a morning coat and top hat, which he declined to remove even though there were women present. In his left hand was a walking stick and in a buttonhole was a sprig of purple lilac, which he sniffed as he spoke. His face was thinner than it had once been, but the eyes were every bit as lively.

  The people in this crowd had probably each written him, just as I had, requesting a private interview. It was likely that he hadn’t read my letter. He might not know I was here. I watched him work his way through the crowd with smiles and light conversation. I recognized the girl from the tram, now carrying a notepad instead of books. She smiled shyly as Howlett whispered something in her ear. They could have been lovers the gesture was so intimate. The young man who carried himself like a soldier was also here. He now had a stethoscope hanging around his neck and was following Howlett’s movements with a look of what I can only describe as yearning. This crowd was here only to see him, which explained why the guard had known without my asking where to direct me. When Dr. Howlett’s secretary had arranged the appointment I had imagined it a privilege. I had tossed and turned on my hotel bed the night before, trying to picture myself in Dr. Howlett’s office and composing speeches in my mind. As it was, I thought, surveying the group with whom I was to share the occasion, I needn’t have lost sleep.

  It was doubtful I would have the opportunity to discuss the specimen I’d lugged from Montreal. Dr. Howlett was about to start his morning rounds. Evidently it was his custom to invite many students and colleagues. I leaned against a wall, placing my satchel containing the heart on the floor beside my shoes, polished with care at five thirty that morning.

  “Good Lord, is it you?”

  I looked up and blinked.

  William Howlett was standing in front of me. “It is you, yes. I didn’t think I was mistaken. What a surprise, Agnes White.”

  His skin was still dark, as if a private sun had shone on him through the bleakest days of winter. He was more handsome than I remembered. The moustache had been coaxed upward and waxed at the tips. I stared stupidly then came to my senses and mumbled something about Dr. Clarke, McGill and Montreal.

  Howlett smiled and took my hand. I was the first to break eye contact, glancing nervously about. Every eye was now upon me.

  “Samuel Clarke?” Howlett cried. “Now there’s a name to stir the embers of memory.” He took the letter of introduction and opened it right on the spot as if it were a gift. “Well, well,” he said when he’d finished. “Dr. White, I welcome you.” He took my hand again, this time raising it to his lips.

  People were staring with open envy, trying to guess my identity, wondering why I deserved the great man’s attention. I felt Howlett’s lips on my skin. What on earth had Dr. Clarke written? I had anticipated that Howlett would remember me, but never had I dreamed he would be so lavish in his welcome.

  He released my hand and turned back to the crowd, allowing me to collect myself. With his walking stick he pointed toward the first of the wards and motioned the crowd forward. Then he clicked his heels, perhaps in salutation to me, or perhaps as a general sign that the rounds had begun, and strode down the corridor. When I next looked up no one was paying me the slightest attention. I straightened my dress, picked up my satchel, and followed. It soon became evident, however, that the treatment I had just received was far from unique.

  William Howlett was the essence of social grace. With each person he encountered he stopped, offering a moment of such pure attention that they were overcome. I saw the same rapt look on every face.

  Rounds were over in two hours. I had not dreamed a person could be so skilful, for Howlett had to satisfy patients and at the same time address the students and clerks and visiting doctors crowding about him. He did not exclude the patient, never once referred to anyone in the third person, at least not within earshot. His commentary was full of lively jokes and anecdotes.

  The tone of the morning was informal; one had to liste
n carefully to ascertain the quantity of information communicated. As he joked and talked, Howlett was observing. When he put his hand on a sick man’s foot, the gesture was more than kindness. From the foot Howlett discerned information about pulse and blockages of blood. When his gaze turned to the same man’s face he was checking for pallor, the yellow tinge of bile, the blue of cyanosis. What he saw rolled off his tongue faster than the interns or clerks could record. The young man from the tram was taking notes, barely looking at the patients in his effort to catch every word.

  The tour finally came to an end and the crowd began to disperse, students heading to their lectures and clerks to their hospital duties. A few of us lingered but Howlett evidently felt that he had paid us his dues. He tipped his hat and began to walk away.

  I felt suddenly sick at heart. Had it all been an act, then? Charm dispersed so evenly that my presence had not in the end registered? Did he not wish to speak with me, to hear about Dr. Clarke or McGill or why I had travelled all these miles to Baltimore? I clutched the satchel to my chest.

  I was standing in the doorway separating the first ward of patients from the professors’ offices when Howlett passed by. He was barely an arm’s length away but he didn’t raise his eyes. He was looking at the floor. I put my left hand on the lintel for support. The other hand dropped to my side, still holding the dead weight of the satchel. I wanted his notice. I wanted to feel his eyes on me once again.

  The young man from the tram pushed in front of me. He turned, gesticulating wildly, shouting something about the door. I stared into his eyes, the pupils of which were expanding so fast there was no division anymore between them and the irises. His voice was surprisingly high, as if it hadn’t broken yet, as if it belonged to a boy. But perhaps it was squeaking with distress. Was he having some kind of a fit? I didn’t think so because his skin was preternaturally white, lending him a delicate, calm beauty. Skin like that was the envy of any woman. For one strange and intimate moment before the door slammed shut, crushing my ring finger, I pictured myself reaching out and touching him.