The Heart Specialist

by Claire Holden Rothman

  These were my mysteries, specimens that had so far eluded identification. I had managed to catalogue the bulk of Howlett’s specimens but these eighty-six stymied me. From the table Howlett picked up a fat tome with a binding so old it left a rusty residue on his hands. It was one of his autopsy journals. I had thought he might want to see it.

  He sighed, flipping through it. “It’s like meeting an old friend.” He reached for my hand. “The work this woman has accomplished,” he said, gesturing at the shelves, “simply takes my breath away.”

  I couldn’t move. His touch was a shock, stunning me momentarily as the praise surged through me.

  Howlett took a pen from his breast pocket and uncapped it. “These, I trust,” he said, pointing with the nib at the blank cards laid out so carefully by Jakob and me the night before, “are for me to scribble on?”

  “If it’s not too much trouble,” I said with excitement. Dugald beamed a smile while Mastro moved in closer to see what the great man would write. We circled him like moons; each of us caught up in his magnetism, except for Jakob Hertzlich.

  There was no time to think about anyone but Howlett. Although it had been twenty years since he’d laid eyes on these specimens he set to work. I had hoped he might identify the half of what I had laid out but in the end he managed seventy-three. He was a walking mine of information. Each jar he picked up and turned in silence. After a moment’s pause there was an anecdote. The stories were fascinating medically, but also for the light they shed on Howlett’s mind and personality. His powers of observation, his recall and his concentration were amazing. He displayed an endearing modesty as well.

  “That fellow I remember well,” he said, scribbling on the card propped against an aortic aneurysm. “There was no trace of clot, but strangely the aorta had ruptured into the right pleura. It took some time to diagnose. He kept complaining of fatigue. One day he came to the hospital with a pulsation in the second and third right interspaces, so I put him to bed and gave him potassium iodide. The dose: 120 grains a day. His pulsation vanished and I was about to discharge him in triumph when he died.”

  Jakob, who had been designated secretary, looked up from his notepad. I could see he was intrigued. This was vintage Howlett, admitting his own limits and the limits of the profession while at the same time suggesting that no one could have done more than he to save the patient. We all laughed. Jakob transcribed Howlett’s comments and anecdotes.

  Howlett turned to him. “Do you understand me when I speak of pulsations and interspaces?” he asked. “You see, of course, the aneurysm of the aorta?” Then he addressed me in my capacity of museum supervisor. “How much can I assume the scrivener knows?”

  The tips of Jakob’s ears turned red again, but this time not with cold. I cut in before he could say anything rude. “He has been trained in medicine. Here at McGill,” I said a little defensively. “He knows exactly what is what.”

  The skin of Jakob’s cheek had mottled. With his pink ears he appeared to be sunburned. He refused to look up from his notebook. For the duration of the session he sat this way, staring at his lap and smouldering. Howlett paid him no attention and seized instead a small, unlabelled specimen that had long bedevilled me. It looked like a healthy bit of thoracic aorta, but in its wall was a hole leading into a sac the size of a tangerine nestled up against the esophagus. “This,” Howlett explained, “is an extraordinary case of mycotic aneurysm of the aorta, rupturing into the esophagus. She died without any warning at all.” Howlett asked if I’d come across similar cases.

  “Dr. Rivers supplied this just last week,” I said, jumping up and retrieving a jar from a nearby shelf.

  Howlett turned to him. “You’ll report it, won’t you? Resurrect mine at the same time and make a pair of them. I never wrote mine up. They’d make a first-rate article, don’t you think?” He tossed the jar to Dugald, who caught it and grinned, so pleased he could do little more than nod his flustered head.

  We proceeded item by item until just short of noon. One of the last items on the table was the Howlett Heart. Unlike the other specimens it had a typed card in front of it for Howlett had given me its full history six years ago.

  He picked it up, smiling with recognition. “And this one, Agnes? Your signature piece? What is it doing here among the mystery items? I’ve already supplied you with its story.”

  I smiled back at him. “And I thank you for that, Sir, for it started me on what has turned out to be a life’s career. But there remains one issue concerning it that troubles me. It has to do with your autopsy journals, which I’ve been combing through to correlate with the collection.”

  I brought out the journal and opened it to the passage that had puzzled me. I had come across it a month previously and had been worrying about it ever since. Ordinarily I would have written to Howlett about it and cleared the matter up, but I had decided it could wait until we met in person. There was likely some perfectly good explanation that for some reason I couldn’t figure out by myself.

  I pointed at an entry from the autumn of 1872, a season that seemed to involve almost daily work at the Montreal Dead House for Howlett, who would have recently graduated from McGill. “This entry,” I explained, “concerns the Howlett Heart. You say here that you did the work, Dr. Howlett, and that you worked alone. But I thought Dr. Bourret was responsible. You told me it yourself. I put it in my article.”

  Dr. Howlett pulled the journal closer. “That can’t be right. There’s a confusion of some kind.” He scanned the entry.

  “The description of the lesion fits,” I said. “And the date. I’m certain it’s the same heart.”

  “It is indeed,” said Howlett, rereading the entry and frowning. “Of that there’s no dispute.” His face had gone quite serious, but then suddenly he laughed and looked at us. “I remember now. Something came up and there was doubt as to whether Dr. Bourret would be able to make it that day. He delegated the job to me as we were frequent collaborators. I thought I would be working alone but at the last minute he was able to attend.”

  “So it’s a mistake,” said Jakob, challenging him baldly. I cringed.

  “That’s right, old boy,” Howlett said, smiling coldly. “It was a mistake. Being human I make them occasionally.”

  Jakob had a look in his eye I knew all too well. He stared straight at Howlett, his interest fully engaged. “But surely you wrote a report after the autopsy? By then you would have been aware who had presided.”

  I attempted to kick him under the table but my legs were too short. He had no sense of propriety. Not a grain. Jakob had degenerated our discussion to a court-room interrogation with our guest in the witness box. I turned away, wishing I had not introduced the issue.

  Oxford’s new regius professor of medicine was not, however, looking for a scrap. “Yes, well,” he said, shrugging. “Mistakes happen, as I said, Mr. Hertzlich. It was an oversight.”

  “So you’re saying that this fellow Bourret did the work?” persisted Jakob.

  “Look here, Hertzlich,” said Dr. Mastro. “I think he’s made himself clear.”

  “Yes,” I said, although I wasn’t as certain as my intervention sounded. I too wanted an answer to Jakob’s question despite its impertinence. “Mistakes happen. We all make them, Dr. Howlett. But your records are so meticulous. This is the first error of yours I believe I have come across.”

  I had meant this as a compliment to smooth the ruffled feathers but William Howlett did not take it this way. “Mea culpa, Dr. White,” he said, refusing to look at me. “Now if you don’t mind my proposing it we should move on.”

  The morning was not entirely ruined, but its tone had changed. I wasn’t sure what to do. There were several more items to discuss, but the group’s desire to look at them had evaporated.

  William Howlett was the first to recover. He moved back from the table, loosening his tie, and began to talk about his days at McGill, nudging Dean Clarke for names or other details when his memory failed him. He had
grown up in the province of Ontario and when he first arrived in Quebec he’d been shocked at how lawless the place was. “There were laws,” he clarified, “but no one seemed to obey them.” There was a law, for instance, decreeing that bodies unclaimed at death be sent to the medical faculties of Quebec universities. The Catholic Church wouldn’t hear of the practice so there was a chronic shortage of cadavers for dissection. Some of the students became adept at body snatching, paying their way through medical school with the proceeds they collected for this service. Howlett told about tobogganing down Côte des Neiges Road from the Catholic cemetery one time in the dead of a winter’s night, clutching a freshly exhumed corpse. On another occasion he agreed to present himself at Windsor Station to claim a stinking Saratoga trunk that had been shipped across the US border by rail. He also remembered the memorable night the medical faculty was searched by the Montreal police after bodies were reported missing from a nunnery. The corpses of the dead sisters were never found. Howlett and several other students had stuck them outside the medical building, which at the time had been on St. Urbain and Viger Streets, in a snowbank behind the nearby Theatre Royal.

  Howlett was a gifted raconteur with a flair for adding just the right detail and soon I was laughing hard. But the stories gave me pause. This man I admired dearly had lifted corpses out of nunneries. He had been young, of course, probably encouraged by his peers, but my picture of him shifted that day, if only slightly. The mix-up over the Howlett Heart could not be put down to youthful exuberance. Something did not add up.

  The magic of the morning was spent and I had only myself — and Jakob Hertzlich, my sorcerer’s apprentice — to blame. Over in his corner Jakob waved his writing hand and winced. “Nearly fifty pages,” he said to no one in particular. “I think I need a doctor.”

  We laughed uneasily. “We have to take care of this young man,” I said with feeling. “Just look at what his hands can do.”

  Howlett was clearly finished with work for the time being, but I didn’t want him checking his watch so I pointed at the drawings adorning the museum’s walls.

  “These are yours, Hertzlich?” asked Dr. Howlett.

  Jakob’s head was still lowered.

  “I happen to be looking for someone like you,” Howlett said. He turned to the rest of us. “I’ve received word from England. Our heart book is going into a second printing, Dr. White. Perhaps we could make use of Mr. Hertzlich’s drawings as illustrations? Excellent exposure for him. We’ve just won a prize over in London, which they tell me is quite prestigious. That’s something I wished to announce today.”

  I stopped breathing. The heart book, which bore my name right under Howlett’s, was a prizewinner. He took me by the arms and looked me full in the face. “You are a laureate, my dear. I only wish I’d brought the laurel leaves with which to crown you!”

  His hands remained on me for several seconds.

  The prize was to be awarded by the London Pathological Society. “You must come to London in November for the ceremony,” said Howlett. “We will accept the purse together.” He told me I could stay with him and Lady Howlett up at Oxford, perhaps visit the London Museum of Pathology on a day trip and travel up to Edinburgh and meet curators there. Introductions would easily be arranged.

  I nodded, agreeing to it all. The news swept away the morning’s problems and confusions. Howlett’s announcement and invitation so bowled me over that I could barely attend to anything, least of all my colleagues from McGill, who approached me with smiles small and forced. Dean Clarke looked genuinely pleased, but Rivers and Mastro both tried to conceal their envy. Mastro’s face froze and Dugald coughed into his hand. I had neither the time nor the energy to look at Jakob and so failed to see him slip away. It was only when we’d moved collectively to the door to exchange goodbyes that I noticed he was gone. But by then there was even less time to think about it. Howlett was sticking his arm into his coat sleeve. Clarke was holding his walking stick, about to hand it over.

  I couldn’t let him leave. Seven years of waiting was too long to be offset by such a short visit. There was so much else I wanted to ask and hear. The promise of London beckoned for the autumn, but that was months away. I chattered aimlessly. At one point I even caught myself clutching his sleeve.

  He took the walking stick from Dr. Clarke and adjusted his hat. “It’s been enormous fun,” he said, appraising each one of our eager faces. “And you,” he said, taking my hand, not to examine this time but to kiss, “you’ve done a remarkable job here.”

  His eyes were on me. His lips were too, and at that moment I would have done just about anything to keep them there. Inspiration hit me.

  “You’ll come tomorrow,” I said, surprising myself with my own forwardness. “I insist. You haven’t heard about my teas, Dr. Howlett. They are not to be missed.”

  Dugald laughed. “She’s famous for them. It’s not an invitation to pass up lightly: high tea at the museum. You can pretend you’re in England.”

  “We’ll make a party,” I said, excitement rising in me like a fever. “Everyone is welcome. How does four o’clock sound?” Dugald nodded immediately. Dean Clarke and Dr. Mastro were willing too.

  Sir William Howlett reached out a gloved hand. “I’ll see what I can do.”

  “I insist, Sir William,” I said, my voice rising to something resembling a squeal.

  He glanced at me. “My appointment book is full but I’ll see what I can do.”

  “Four o’clock then?”

  He bowed slightly, touched his cane to his hat, and was gone.

  18

  APRIL 1905

  The next day I rose at dawn. Most of the night I had sat wrapped in a comforter drawing up lists of purchases, figuring out tasks and listening to the clock tick through the interminable passing of each hour.

  At the moment, walking along the still damp street, a tote bag beneath one arm, I looked like a housewife, although perhaps more carefully dressed than some of the women I was passing. I’d taken pains with my hair, pinning it so tightly that even Laure would have been proud. Because the weather was good I didn’t need to hide it with a hat. I’d put on fresh stockings as well — not silk like the ones I’d ruined the day before — but of good enough quality that they hugged my legs like a shiny new skin. My dress was green, punctuated with tiny wine-coloured buds. Laure and Miss Skerry had given it to me the previous Christmas, taking the pattern from a well-known Montreal couturier. It was the most fashionable item of clothing in my wardrobe. So fashionable in fact that I’d dared wear it only once before, on Christmas day in St. Andrews East, so the gift givers could see me model it. Miss Skerry must have done the lion’s share of the handiwork. Laure’s shifts of temper were such that these days it was hard to imagine her concentrating for long on a single project, but the dress was beautiful regardless of whose hand had made it. It made me feel almost beautiful.

  St. Lawrence Boulevard was the first stop on my itinerary. Plenty of people were out already, crowding the muddy boardwalk. Just in front of me a boy sang out in a striking soprano, “Herald. Get your Montreal Herald!” A few steps on a man in a red sandwich board was competing with him, yelling about smoked fish.

  I was part of this swirling, boisterous scene, swept up in the crowd energy. The sun was already high and I squinted up at it, feeling the warm rays touch my face. What a change from the day before. The ice had just about disappeared, exposing soggy squares of grass. In the gutters beside the wooden ramps the water ran freely.

  At last I arrived at the fruit emporium. This was one of my favourite places to shop although I rarely made it down here. The size made me feel like a child. The first floor resembled that of a normal store, with barrels of apples and root vegetables harvested the previous autumn, but the real wonders lay below. I descended into the basement, a cavernous room with treasures imported from places so distant I knew them only as dots on maps. There were oranges, plums, and pineapples with spiky tops, picked green and carried north o
n ships in whose holds they slowly ripened.

  What a sight for eyes dulled by six months of winter. What would it be like to live in a place where such extravagance existed year-round? The people living there probably didn’t react at all to the sight of an orange in April. Maybe a certain degree of deprivation was necessary to the experience of pleasure, just as suffering was an integral part of joy.

  The pineapples were right in front of me. I remembered the first time I’d eaten this fruit at the party Mrs. Drummond had thrown in my honour fifteen years ago. It had been like eating sunshine, taking that brightness right inside of me. I picked one up and sniffed. The smell was faint but it was there: sunshine just under the skin.

  I was not here for pineapples, however; the fruit I wanted wasn’t available so early in the year. On a big table in the corner I found what I was looking for — jars of bright strawberries boiled in sugar and pectin to last through the winter. It was a poor substitute for the fresh fruit but it was the best I could do. On my way to the cash register I spotted cucumbers and slipped a couple into my bag.

  After this I visited the cheese shop and bought a round of brie. Quebec was one of the few places in North America where you could buy good soft cheeses. Settlers from Breton and Normandy started making them here in the seventeenth and eighteenth centuries, educating palettes like mine in the English and Scottish communities. The cheese I bought that day cost me half a week’s wages, but the man assured me it was ripe and of a fine quality. It came in a wooden case, which was a blessing as I still had several errands to run and didn’t want to squash it. Next I visited the patisserie and finally the wine shop, empty at this hour of the day. I was ashamed to be seen there — a woman alone — but the clerk was respectful enough. He owed me that at the very least because I was buying a magnum of his very best champagne, thereby completely draining my coffers.